PLoS Pathogens
http://journals.plos.org/plospathogens/
(Accessed 16 January 2016)

.
Research Article
Broadly Neutralizing Antibody Responses in a Large Longitudinal Sub-Saharan HIV Primary Infection Cohort
Elise Landais, Xiayu Huang, Colin Havenar-Daughton, Ben Murrell, Matt A. Price, Lalinda Wickramasinghe, Alejandra Ramos, Charoan B. Bian, Melissa Simek, Susan Allen, Etienne Karita,
William Kilembe, Shabir Lakhi, [ … ],ascal Poignard
Published: January 14, 2016
DOI: 10.1371/journal.ppat.1005369
Abstract
Broadly neutralizing antibodies (bnAbs) are thought to be a critical component of a protective HIV vaccine. However, designing vaccines immunogens able to elicit bnAbs has proven unsuccessful to date. Understanding the correlates and immunological mechanisms leading to the development of bnAb responses during natural HIV infection is thus critical to the design of a protective vaccine. The IAVI Protocol C program investigates a large longitudinal cohort of primary HIV-1 infection in Eastern and South Africa. Development of neutralization was evaluated in 439 donors using a 6 cross-clade pseudo-virus panel predictive of neutralization breadth on larger panels. About 15% of individuals developed bnAb responses, essentially between year 2 and year 4 of infection. Statistical analyses revealed no influence of gender, age or geographical origin on the development of neutralization breadth. However, cross-clade neutralization strongly correlated with high viral load as well as with low CD4 T cell counts, subtype-C infection and HLA-A*03(-) genotype. A correlation with high overall plasma IgG levels and anti-Env IgG binding titers was also found. The latter appeared not associated with higher affinity, suggesting a greater diversity of the anti-Env responses in broad neutralizers. Broadly neutralizing activity targeting glycan-dependent epitopes, largely the N332-glycan epitope region, was detected in nearly half of the broad neutralizers while CD4bs and gp41-MPER bnAb responses were only detected in very few individuals. Together the findings suggest that both viral and host factors are critical for the development of bnAbs and that the HIV Env N332-glycan supersite may be a favorable target for vaccine design.
Author Summary
Understanding how HIV-1-broadly neutralizing antibodies (bnAbs) develop during natural infection is essential to the design of an efficient HIV vaccine. We studied kinetics and correlates of neutralization breadth in a large sub-Saharan African longitudinal cohort of 439 participants with primary HIV-1 infection. Broadly nAb responses developed in 15% of individuals, on average three years after infection. Broad neutralization was associated with high viral load, low CD4+ T cell counts, virus subtype C infection and HLA*A3(-) genotype. A correlation with high overall plasma IgG levels and anti-Env binding titers was also found. Specificity mapping of the bnAb responses showed that glycan-dependent epitopes, in particular the N332 region, were most commonly targeted, in contrast to other bnAb epitopes, suggesting that the HIV Env N332-glycan epitope region may be a favorable target for vaccine design.

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 16 January 2016)

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Biological Sciences – Immunology and Inflammation
Systems biology of immunity to MF59-adjuvanted versus nonadjuvanted trivalent seasonal influenza vaccines in early childhood
Helder I. Nakaya, Elizabeth Clutterbuck, Dmitri Kazmin, Lili Wang, Mario Cortese, Steven E. Bosinger, Nirav B. Patel, Daniel E. Zak, Alan Aderem, Tao Dong, Giuseppe Del Giudice, Rino Rappuoli, Vincenzo Cerundolo, Andrew J. Pollard, Bali Pulendran, and Claire-Anne Siegrist
PNAS 2016 ; published ahead of print January 11, 2016, doi:10.1073/pnas.1519690113 Author Affiliations
Significance
Vaccines are one of the most cost-effective public health tools in history and offer a means to probe the human immune system. Recent advances have applied the tools of systems biology to study immune responses to vaccination in humans. Here we describe the application of this “systems vaccinology” approach to studying immunity to vaccination of 14- to 24-mo-old children with the inactivated influenza vaccine, administered with or without the MF59 adjuvant. These results reveal important new insights about the dynamics of the innate and adaptive responses to vaccination in this population, and identify potential correlates of immunity to vaccination in children.
Abstract
The dynamics and molecular mechanisms underlying vaccine immunity in early childhood remain poorly understood. Here we applied systems approaches to investigate the innate and adaptive responses to trivalent inactivated influenza vaccine (TIV) and MF59-adjuvanted TIV (ATIV) in 90 14- to 24-mo-old healthy children. MF59 enhanced the magnitude and kinetics of serum antibody titers following vaccination, and induced a greater frequency of vaccine specific, multicytokine-producing CD4+ T cells. Compared with transcriptional responses to TIV vaccination previously reported in adults, responses to TIV in infants were markedly attenuated, limited to genes regulating antiviral and antigen presentation pathways, and observed only in a subset of vaccinees. In contrast, transcriptional responses to ATIV boost were more homogenous and robust. Interestingly, a day 1 gene signature characteristic of the innate response (antiviral IFN genes, dendritic cell, and monocyte responses) correlated with hemagglutination at day 28. These findings demonstrate that MF59 enhances the magnitude, kinetics, and consistency of the innate and adaptive response to vaccination with the seasonal influenza vaccine during early childhood, and identify potential molecular correlates of antibody responses.

Vaccine
Volume 34, Issue 5, Pages 597-702 (27 January 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/5

.

Original Research Article
Cost-utility analysis of dengue vaccination in a country with heterogeneous risk of dengue transmission
Pages 616-621
Pablo Wenceslao Orellano, Julieta Itati Reynoso, Hans-Christian Stahl, Oscar Daniel Salomon
Abstract
Background
Dengue is one of the most important vector-borne diseases worldwide, and annually, nearly 390 million people are infected and 500,000 patients are hospitalized for severe dengue. Argentina has great variability in the risk of dengue transmission due to eco-climatic reasons. Currently no vaccines are available for dengue even though several vaccines are under development.
Objective
The aim of this study was to estimate the cost-effectiveness of a dengue vaccine in a country with heterogeneous risk of dengue transmission like Argentina.
Methods
The analysis was carried out from a societal perspective using a Markov model that included both vaccine and disease parameters. Utility was measured as disability adjusted life years (DALYs) averted, and the incremental cost-effectiveness ratio (ICER) of the vaccination was expressed in 2014 American dollars (US$) per DALY averted. One-way and probabilistic sensitivity analyses were performed to evaluate uncertainty in model outcomes, and a threshold analysis was conducted to estimate the highest possible price of the vaccine.
Results
The ICER of the vaccination program was found to be US$ 5714 per DALY averted. This value is lower than 3 times the per capita GDP of Argentina (US$ 38,619 in 2014); 54.9% of the simulations were below this value. If a vaccination program would be implemented the maximum vaccine price per dose has to be US$1.49 for a vaccination at national level or US$28.72 for a targeted vaccination in high transmission areas.
Conclusions
These results demonstrate that vaccination against dengue would be cost-effective in Argentina, especially if carried out in predetermined regions at high risk of dengue transmission. However, these results should be interpreted with caution because the probabilistic sensitivity analysis showed that there was considerable uncertainty around the ICER value. The influence of variations in vaccine efficacy, cost and other important parameters are discussed in the text.

Vaccine
Volume 34, Issue 5, Pages 597-702 (27 January 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/5

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Adolescent, parent and societal preferences and willingness to pay for meningococcal B vaccine: A Discrete Choice Experiment
Original Research Article
Pages 671-677
H.S. Marshall, G. Chen, M. Clarke, J. Ratcliffe
Abstract
Objective
Meningococcal B (MenB) vaccines have been licensed in many countries with private purchase the only option until recently, when a funded programme was introduced in the UK. The aim of this study was to explore adolescent/parental values for a variety of salient vaccine attributes (cost, effectiveness, side effect profile) to assess preferences and willingness-to-pay (WTP) for a MenB vaccine.
Methodology
A national cross-sectional population study was conducted in Australia using Discrete Choice Experiment methodology to assess adolescent/parent/adult preferences for attributes related to MenB vaccine.
Results
2003 adults and 502 adolescents completed the survey in 2013. The majority of participants were willing to be vaccinated with MenB vaccine with vaccination opt-out chosen by 11.9% of adolescents and parents, and 18.2% of non-parent adults. A mixed logit regression model examining adolescent/adult preferences indicated consistent findings; the higher the effectiveness, the longer the duration of protection, the less chance of adverse events and the lower the cost, the more likely respondents were to agree to vaccination. For an ideal MenB vaccine, including the most favoured level of each attribute summed together (90% effectiveness, 10 year duration, 1 injection, no adverse events) adolescents would pay AU$251.60 and parents AU$295.10. Adolescents and parents would pay AU$90.70 or AU$127.20 for 90% vaccine effectiveness vs AU$18.50 or AU$16.70 for 70% effectiveness and would want to be financially compensated for 50% effectiveness; pay AU$63.30 or AU$76.40 for 10 years protection; and pay AU$48.50 or AU$49.20 for no vaccine related adverse events. A slight fever post vaccination was a preferred choice with parents and adolescents willing to pay AU$9.60 or AU$12.30 for this attribute.
Conclusions
Vaccine effectiveness, adverse events and duration of immunity are important drivers for parental and adolescent decisions about WTP for MenB vaccine and should be included in discussions on the benefits, risks and cost.

Vaccine
Volume 34, Issue 5, Pages 597-702 (27 January 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/5

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Knowledge, attitudes, beliefs, and behaviors of parents and healthcare providers before and after implementation of a universal rotavirus vaccination program
Original Research Article
Pages 687-695
Donna M. MacDougall, Beth A. Halperin, Joanne M. Langley, Donna MacKinnon-Cameron, Li Li, Scott A. Halperin, for the Maritime Universal Rotavirus Vaccination Program (MURVP)
Abstract
Objective
In Canada, rotavirus vaccine is recommended for all infants, but not all provinces/territories have publicly funded programs. We compared public and healthcare provider (HCP) knowledge, attitudes, beliefs, and behaviors in a province with a public health nurse-delivered, publicly funded rotavirus vaccination program to a province with a publicly funded, physician-delivered program. A third province with no vaccination program acted as a control.
Design
Information about knowledge, attitudes, beliefs, and behaviors of parents whose children were eligible for the universal program and healthcare providers responsible for administering the vaccine were collected through the use of two validated surveys distributed in public health clinics, physicians’ offices, and via e-mail. Early and postvaccine-program survey results were compared.
Results
A total of 722 early implementation and 709 postimplementation parent surveys and 180 early and 141 postimplementation HCP surveys were analyzed. HCP and public attitudes toward rotavirus vaccination were generally positive and didn’t change over time. More parents postprogram were aware of the NACI recommendation and the vaccination program and reported that their healthcare provider discussed rotavirus infection and vaccine with them. Prior to the program across all sites, more physicians than nurses were aware of the national recommendation regarding rotavirus vaccine. In the postprogram survey, however, more nurses were aware of the national recommendation and their provincial universal rotavirus vaccination program. Nurses had higher knowledge scores than physicians in the postprogram survey (p < 0.001). Parents of young infants were also more knowledgeable about rotavirus and rotavirus vaccine in the two areas where universal programs were in place (p < 0.001).
Conclusions
Implementation of a universal rotavirus vaccination program was associated with an increase in knowledge and more positive attitudes toward rotavirus vaccine amongst parents of eligible infants. Nurses involved in a public health-delivered vaccination program were more knowledgeable and had more positive attitudes toward the vaccine than physicians in a jurisdiction where vaccine was physician-delivered.

Vaccine
Volume 34, Issue 4, Pages 401-596 (20 January 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/4

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Validity of the estimates of oral cholera vaccine effectiveness derived from the test-negative design
Original Research Article
Pages 479-485
Mohammad Ali, Young Ae You, Dipika Sur, Suman Kanungo, Deok Ryun Kim, Jacqueline Deen, Anna Lena Lopez, Thomas F. Wierzba, Sujit K. Bhattacharya, John D. Clemens
Abstract
Background
The test-negative design (TND) has emerged as a simple method for evaluating vaccine effectiveness (VE). Its utility for evaluating oral cholera vaccine (OCV) effectiveness is unknown. We examined this method’s validity in assessing OCV effectiveness by comparing the results of TND analyses with those of conventional cohort analyses.
Methods
Randomized controlled trials of OCV were conducted in Matlab (Bangladesh) and Kolkata (India), and an observational cohort design was used in Zanzibar (Tanzania). For all three studies, VE using the TND was estimated from the odds ratio (OR) relating vaccination status to fecal test status (Vibrio cholerae O1 positive or negative) among diarrheal patients enrolled during surveillance (VE = (1 − OR)×100%). In cohort analyses of these studies, we employed the Cox proportional hazard model for estimating VE (=1 − hazard ratio)×100%).
Results
OCV effectiveness estimates obtained using the TND (Matlab: 51%, 95% CI:37–62%; Kolkata: 67%, 95% CI:57–75%) were similar to the cohort analyses of these RCTs (Matlab: 52%, 95% CI:43–60% and Kolkata: 66%, 95% CI:55–74%). The TND VE estimate for the Zanzibar data was 94% (95% CI:84–98%) compared with 82% (95% CI:58–93%) in the cohort analysis. After adjusting for residual confounding in the cohort analysis of the Zanzibar study, using a bias indicator condition, we observed almost no difference in the two estimates.
Conclusion
Our findings suggest that the TND is a valid approach for evaluating OCV effectiveness in routine vaccination programs.

Vaccine
Volume 34, Issue 4, Pages 401-596 (20 January 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/4

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Commentary
Commentary on: “Seasonal influenza vaccine dose distribution in 195 countries (2004–2013): Little progress in estimated global vaccination coverage”
Pages 401-402
David M. Salisbury
[No abstract]

.

Brief report
The potential acceptability of infant vaccination against malaria: A mapping of parental positions in Togo
Pages 408-412
Lonzozou Kpanake, Paul Clay Sorum, Etienne Mullet
Abstract
Objective
To map the acceptability to parents in Togo of infant vaccination against malaria.
Methods
From July to October 2014, a study of 209 parents of infants in Togo was conducted to assess their willingness to have their infants vaccinated against malaria. Participants were exposed to 48 vignettes, designed using the main constructs of health-protective theories.
Results
Five qualitatively different positions were found, which were labeled Neighbors’ Attitude (5%), Cost Only (21%), Neighbors’ Attitude and Cost (22%), Risk and Cost (33%), and Always Vaccine (20%).
Conclusion
The diversity of parental positions regarding vaccinating their infants against malaria implies that malaria vaccination campaigns in Togo, and possibly in other sub-Saharan African countries, must not be “one size fits all,” but must be tailored in design and implementation to match the diversity of parents’ needs and views.

Obstetrics & Gynecology
Post Author Corrections: January 07, 2016
Maternal Immunization With an Investigational Trivalent Group B Streptococcal Vaccine: A Randomized Controlled Trial.
Donders, Gilbert G.G. MD, PhD; Halperin, Scott A. MD; Devlieger, Roland MD, PhD; Baker, Sherryl PhD; Forte, Pietro BA; Wittke, Frederick MD; Slobod, Karen S. MD; Dull, Peter M. MD
doi: 10.1097/AOG.0000000000001190
Original Research: PDF Only
Published Ahead-of-Print
Abstract
OBJECTIVE: To evaluate the safety and immunogenicity of an investigational trivalent group B streptococcal vaccine in pregnant women and antibody transfer to their newborns.
METHODS: The primary outcome of this observer-blind, randomized study was to estimate placental antibody transfer rates at birth. Secondary outcomes included measurement of serotype-specific antibodies at screening, 30 days postvaccination, at delivery, and 91 days postpartum, infant antibody levels at 3 months of age, the potential effect on routine infant diphtheria vaccination at 1 month after the third infant series dose, and safety in mother and infant participants through at least 5 months postpartum. Sample size was based on 60 participants in the vaccine group giving a probability of observing at least one adverse event of 90% if the actual rate of the event was 3.8%.
RESULTS: From September 2011 to October 2013, 86 pregnant women were allocated in a 3:2 ratio to receive an investigational group B streptococcal vaccine containing glycoconjugates of serotypes Ia, Ib, and III or placebo. Demographics were similar across groups. Transfer ratios were 66-79% and maternal geometric mean concentrations increased 16-, 23-, and 20-fold by delivery against serotypes Ia, Ib, and III, respectively, Women with no detectable antibodies at inclusion had lower responses than those with detectable antibodies. Three months after birth, infant antibody concentrations were 22-25% of birth levels. Antidiphtheria geometric mean concentrations were similar across groups. In the vaccine and placebo groups, 32 of 51 women (63%) and 26 of 35 women (74%) reported adverse effects, respectively.
CONCLUSION: The investigational vaccine was well-tolerated without safety signals in recipients and their infants or interference with routine infant diphtheria vaccination, although further studies on safety and effectiveness are needed. The investigational vaccine was immunogenic for all serotypes, particularly among women with detectable antibody levels at baseline. Antibody transfer to neonates was at similar levels to other maternally administered polysaccharide vaccines.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, http://www.clinicaltrials.gov, NCT01446289.

Media/Policy Watch  [to 16 January 2016]
This section is intended to alert readers to substantive news, analysis and opinion from the general media on vaccines, immunization, global; public health and related themes. Media Watch is not intended to be exhaustive, but indicative of themes and issues CVEP is actively tracking. This section will grow from an initial base of newspapers, magazines and blog sources, and is segregated from Journal Watch above which scans the peer-reviewed journal ecology.

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

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Financial Times
http://www.ft.com/home/uk
Accessed 16 January 2016
January 13, 2016
Suicide bomber kills 14 at Pakistan polio vaccination clinic

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Forbes
http://www.forbes.com/
Accessed 16 January 2016
With First Texas Zika Case, Vaccine Desperately Needed, Expert Says
A recent U.S. case of Zika, a tropical disease linked to serious birth defects in the children of infected pregnant women, was diagnosed in the Houston area of Texas two days ago. This case was an imported case, so the individual arrived in the U.S. from Latin America with the illness…
Tara Haelle, Contributor
Jan 13, 2016

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The Guardian
http://www.guardiannews.com/
Accessed 16 January 2016
HPV vaccine rates higher in poor and Latino communities, study finds
:: Findings unusual as underserved typically have limited healthcare access
:: HPV is most common sexually transmitted infection in US
Thursday 14 January 2016 06.00 EST
Rates for the human papillomavirus (HPV) vaccine in the US are highest in communities that are predominantly Latino and poor, according to a report released Thursday that depicts a sharp turn in public health trends.

In high poverty communities, 61.1% of girls were given the first shot in the series, compared with 52.4% in low poverty communities, according to the American Association for Cancer Research’s report, the first to look at geography in relation to HPV vaccination rates.

“You’re finding everything is inverse essentially,” said Kevin Henry, lead author of the study, which is being published in Cancer Epidemiology, Biomarkers & Prevention. “You’re finding that the wealthier people have less vaccination yet they have more resources so in some respects they should be higher.”
The HPV vaccination rate was found to be higher among black people, American Indian/Alaska natives and Latinos compared with caucasian and Asian people. And girls whose families live below the poverty line also started taking the vaccination more frequently than women above the poverty line.

This is unusual because underserved communities typically have limited access to healthcare and take up public health initiatives like preventive screenings and immunizations at a lower rate…

.

New York Times
http://www.nytimes.com/
Accessed 16 January 2016
Brazil to Fund Development of Vaccine for Zika Virus
January 16, 2016 – By THE ASSOCIATED PRESS SAO PAULO — The Brazilian government announced it will direct funds to a biomedical research center to help develop a vaccine against a virus linked to brain damage in babies.
Health Minister Marcelo Castro said Friday that the goal is for the Sao Paulo-based Butantan Institute to develop “in record time” a vaccine for Zika, which is spread through mosquito bites.
Institute director Jorge Kalil said that is expected take 3 to 5 years.
Brazil is currently experiencing the largest known outbreak of Zika. The virus has been linked to a recent surge in birth defects including microcephaly, a rare condition in which newborns have smaller than normal heads and their brains do not develop properly.
The Health Ministry says 3,530 babies have been born with microcephaly in the country since October. Fewer than 150 such cases were seen in all of 2014.
Most have been concentrated in Brazil’s poor northeast, though cases in Rio de Janeiro and other big cities have also been on the rise, prompting people to stock up on mosquito repellent.
Some women of means have left the country to spend their pregnancies in the United States or Europe to avoid infection.
The Zika virus is spread by the Aedes aegypti mosquito, which can also carry dengue and chikungunya…

Suicide Bomb Near Polio Center in Pakistan Kills at Least 16
By IHSANULLAH TIPU MEHSUDJAN. 13, 2016
ISLAMABAD, Pakistan — At least 16 people were killed on Wednesday in a suicide bombing outside a polio vaccination center in the southwestern Pakistani city of Quetta, officials and witnesses said.
Thirteen of the victims were police officers, said Syed Imtiaz Shah, a senior official with the Quetta police. He said the officers were there to guard polio workers, who are often targeted by Islamist militants in Pakistan.
The attack came on the third day of a vaccination campaign in the province of Baluchistan, of which Quetta is the capital. The bomber, who was also killed, walked up to police officers and detonated what Mr. Shah said amounted to more than 20 pounds of explosives.
A spokesman for the Pakistani Taliban, Muhammad Khurrasani, claimed responsibility for the attack on the militants’ behalf. Two civilians and a paramilitary police officer were also killed, and 10 police officers and nine civilians were wounded…

Zuckerberg Wades Into Vaccine Debate With Baby Shots Photo
Facebook founder and chief executive Mark Zuckerberg has dropped himself into the riotous social media debate over childhood vaccines after posting photos of himself taking his newborn daughter to get immunization shots at the doctor’s office.
January 11, 2016 – By REUTERS –

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_16 January 2016

– blog edition: comprised of the approx. 35+ entries posted below on 17 January 2016.

– Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
.
– 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.

.
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

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_9 January 2016

– blog edition: comprised of the approx. 35+ entries posted below on 10 January 2016.

– Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
.
– 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.

.
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 9 January 2016]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

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Ebola Situation Report – 6 January 2016
SUMMARY
:: No confirmed cases of Ebola virus disease (EVD) were reported in the week to 3 January. On 29 December, WHO declared that human-to-human transmission of Ebola virus has ended in Guinea, after the completion of 42 days with zero cases since the last person confirmed to have EVD received a second consecutive negative blood test for Ebola virus RNA. Guinea has now entered a 90-day period of heightened surveillance. Guinea, Liberia, and Sierra Leone have all now succeeded in interrupting human-to-human transmission linked to the original outbreak in West Africa.

:: Human-to-human transmission linked to the most recent cluster of cases in Liberia will be declared to have ended on 14 January 2016, 42 days after the 2 most-recent cases received a second consecutive negative test for Ebola virus, if no further cases are reported. In Sierra Leone, human-to-human transmission linked to the primary outbreak was declared to have ended on 7 November 2015. The country has now entered a 90-day period of enhanced surveillance scheduled to conclude on 5 February 2016.

:: The most recent cluster of cases in Liberia was the result of the re-emergence of Ebola virus that had persisted in a previously infected individual. Although the probability of such re-emergence events is low, the risk of further transmission following a re-emergence underscores the importance of implementing a comprehensive package of services for survivors that includes the testing of appropriate bodily fluids for the presence of Ebola virus RNA. The governments of Liberia and Sierra Leone, with support from partners including WHO and the US Centres for Disease Control and Prevention, have implemented voluntary semen screening and counselling programmes for male survivors in order to help affected individuals understand their risk and take necessary precautions to protect close contacts. 405 male survivors had accessed semen screening services up to 3 January 2016 in Liberia and Sierra Leone. A network of clinical services for survivors is also being expanded in Liberia and Sierra Leone, with plans for comprehensive national policies for the care of EVD survivors due to be completed in January 2016. To date approximately 3000 survivors have accessed basic care services…

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WHO – Ebola Vaccine Target Product Profile
5 January 2016 :: 16 pages
Overview
During the course of the high level WHO meetings on Ebola vaccine development, it was agreed that WHO would develop Ebola vaccine target product profiles (TPP) to provide guidance on WHO’s preferences for Ebola vaccines of two categories (for reactive use and prophylactic use).
The target audience for the WHO Ebola vaccine TPP are all those working to improve characteristics of currently tested Ebola vaccines. The TPP is also relevant to those developing Ebola vaccines that have not yet reached the clinical development phase.
.
WHO Ebola Vaccine TPP pdf, 403kb
Excerpt
This document considers two scenarios for use of an Ebola virus disease (EVD) vaccine, which have different preferred characteristics:
a) Reactive/emergency use in the face of an outbreak to prevent EVD in vaccinated individuals as well as interrupt chains of virus transmission to terminate outbreaks. Use will be in populations experiencing an outbreak, in populations geographically close to an outbreak and at high risk for importation of EVD cases from areas experiencing an outbreak:
:: Durability of protection: Less critical than rapidly achieving high rates of protection as the emphasis is interrupting transmission and terminating the outbreak.
:: Stability/storage: Amenable to stockpiling for future outbreaks of EVD.
:: Risk/benefit profile: Acceptability based on the assumption those vaccinated are at high risk of exposure to Ebola virus with relatively high EVD-associated mortality rate.

b) Prophylactic use to protect frontline workers (including healthcare workers, deploying international workers and others at particularly high risk of EVD due to their profession such as ancillary staff and those dealing with burials)
:: Durability of protection: A more prominent preferred characteristic than for reactive/emergency use
:: Risk/benefit profile: assumes that some of those vaccinated may not be as at high risk as the target group for reactive use.

.
Introduction
This document is intended to serve as guidance for scientists, regulators, and funding agencies, and for industry groups. It is relevant to those groups who wish to obtain WHO policy recommendations for use, and WHO prequalification of their products to maximise supply volumes for use of EVD vaccines, and meet the public health need related to future EVD outbreaks.
In order to reach the stage of use in countries most affected by Ebola outbreaks, vaccines will need to be prequalified by WHO, and be included within the remit of WHO policy recommendations for use. An essential requirement prior to WHO prequalification is licensure by an NRA considered functional by WHO.

All the requirements contained in WHO guidelines for WHO policy recommendation and prequalification will also apply. The criteria below lay out some of the considerations that will be relevant in WHO’s case-by-case assessments of EVD vaccines in the future.
None of the characteristics in the tables below dominates over any other. Therefore should a vaccine’s profile be sufficiently superior to the critical characteristics under one or more categories, this may outweigh failure to meet another specific critical characteristic. Vaccines which fail to meet multiple critical characteristics are unlikely to achieve favourable outcomes from WHO’s processes.

A generic description of WHO’s Vaccine Prequalification process can be found at the end of this document…

MERS-CoV [to 9 January 2016]
.
Disease Outbreak News (DONs)
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Oman
7 January 2016
On 3 January 2016, the National IHR Focal Point of Oman notified WHO of 1 additional case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection.

:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
4 January 2016
Between 29 November and 17 December 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 4 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 2 deaths.

WHO & Regionals [to 9 January 2016]
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Life-saving health supplies blocked in Yemen
7 January 2016 — WHO calls for immediate access to Taiz City for the delivery of life-saving health supplies. The health situation continues to deteriorate as more than 250 000 people have been living in a state of virtual siege since November 2015. All of the city’s 6 hospitals have been forced to partially close services and are overwhelmed with injured patients. Humanitarian organizations are struggling to deliver medical and surgical supplies due to the insecurity.

GIN December 2015 pdf, 3.02Mb 6 January 2016

Weekly Epidemiological Record (WER) 8 January 2016, vol. 91, 1 (pp. 1–12):
1 WHO informal consultation on surveillance of respiratory syncytial virus on the WHO Global Influenza Surveillance and Response System (GISRS) platform, 25–27 March 2015, Geneva, Switzerland
3 Detection of influenza virus subtype A by polymerase chain reaction: WHO external quality assessment programme summary analysis, 2015

Disease Outbreak News (DONs)
:: 8 January 2016 Microcephaly – Brazil
:: 8 January 2016 Zika virus infection – United States of America – Puerto Rico
:: 7 January 2016 Middle East respiratory syndrome coronavirus (MERS-CoV) – Oman
:: 4 January 2016 Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
:: 4 January 2016 Human infection with avian influenza A(H5N6) virus – China

Stories from Countries
:: Insecurity drives health workers out of Yemen 7 January 2016
:: WHO fosters local, global collaboration to fight NCDs 6 January 2016
:: Surviving the war to fight diabetes as a refugee 5 January 2016
:: Shouldering the care of refugees 5 January 2016
:: WHO Regional Offices
WHO African Region AFRO
No new digest content identified.

WHO Region of the Americas PAHO
No new digest content identified.

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

WHO European Region EURO
:: How can we best protect non-smokers from exposure to tobacco smoke?
05-01-2016

WHO Eastern Mediterranean Region EMRO
:: WHO calls for immediate access to Taiz City for delivery of life-saving health supplies
7 January 2015, Sana’a, Yemen – The World Health Organization is concerned about the deteriorating health situation in Taiz, where more than 250 000 people have been living in a state of virtual siege since November 2015. All of city’s 6 hospitals have been forced to partially close some services, and are overwhelmed with injured patients. Humanitarian organizations are struggling to deliver medical and surgical supplies due to the insecurity…

WHO Western Pacific Region
No new digest content identified.

Gavi [to 9 January 2016]
http://www.gavialliance.org/library/news/press-releases/

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06 January 2016
Historic partnership between Gavi and India to save millions of lives
Targeted new support will ensure new vaccines reach children across the country.
New Delhi, 6 January 2016 – The Government of India and Gavi, the Vaccine Alliance, have today announced a partnership that will help save the lives of millions of Indian children through increased access to vaccines.

India is due to begin transitioning away from Gavi support from 2017 and is expected to begin fully self-financing all its vaccine programmes by 2021. Under the partnership strategy, Gavi will provide up to US$ 500 million between 2016 and 2021 to support India’s immunisation programme, after which India will completely transition out of Gavi support. The new partnership will accelerate the introduction of modern, highly-efficacious vaccines in India, protecting children against the leading causes of disease, including pneumonia and severe diarrhoea, which combined claim the lives of more than 200,000 Indian children under the age of five every year.

Support will also be made available for the measles-rubella combined vaccine. This vaccine protects children against measles, a highly infectious disease that kills almost 30,000 children in India every year, as well as congenital rubella syndrome, which causes severe deformities and disabilities through the spread of the virus from pregnant women to their babies. Gavi will also provide future assistance for India to introduce the human papillomavirus vaccine, should the Government approve its introduction. This vaccine protects women against the leading cause of cervical cancer, a disease that kills 70,000 Indian women every year.

Through this new partnership Gavi-supported vaccines administered between 2016 and 2021 are expected to prevent several hundred thousand deaths. By helping to establish these vaccines in India’s routine immunisation schedule and by strengthening existing immunisation and health systems to extend coverage and improve access, millions of children will benefit from the work being undertaken now for generations to come.

The Government of India already has a priority of reaching every child with vaccines, as is evidenced by its new Mission Indradhanush initiative, which aims to reduce the number of children who get sick or die from preventable diseases by ensuring that the number of infants receiving all vaccines included within the Universal Immunisation Programme (UIP) exceeds 90% within the next five years. Through the modernisation and strengthening of health systems under this new partnership, Gavi support will also help towards this goal and help engage with a broader community of stakeholders within India…

WHO – Cholera vaccine supply set to double, easing global shortage
8 January 2016
The global supply of oral cholera vaccines is set to double after WHO approved a third producer, helping to address global shortages and expand access in more countries.
Globally, OCV production is low, with demands currently exceeding supply. Sudan and Haiti last year made requests to WHO for supplies of vaccines to conduct pre-emptive vaccination campaigns that could not be filled because of the global shortage.

The vaccine producer, a South Korean company, is the latest oral cholera vaccine (OCV) manufacturer to be approved under the WHO’s pre-qualification programme, which ensures that drugs and vaccines bought by countries and international procurement agencies such as the United Nations Children’s Fund (UNICEF) meet acceptable standards of quality, safety and efficacy.

The addition of an additional pre-qualified vaccine producer is expected to double global supply to 6 million doses for 2016, with the potential for further increased production in the future. This additional capacity will contribute to reversing a vicious cycle of low demand, low production, high price and inequitable distribution, to a virtuous cycle of increased demand, increased production, reduced price and greater equity of access…

In 2013 the WHO created the world’s first OCV stockpile, undertaking to buy and use 2 million doses a year in order to stabilize and create demand for the vaccines…

Access to OCV has been further improved by a commitment of US$115 million over 5 years from Gavi, the Vaccine Alliance, to expand availability and the use of vaccine in countries with endemic cholera. Since the OCV stockpile was created more vaccines have been distributed and used than in the previous 15 years. A total of 21 OCV deployments of about 4 million doses to 11 countries have been used in various contexts: humanitarian crises in Cameroon, Haiti, Iraq, Nepal, South Sudan, and United Republic of Tanzania; outbreaks in Guinea and Malawi; and in endemic hotspots such as Bangladesh and Democratic Republic of the Congo…

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Geneva Press Briefing: WHO, IOM, UNHCR, OHCHR
8 Jan 2016
[Editor’s Note: Included in this press briefing is an extended report on the new OCV vaccine which received WHO pre-qualification in late December and its implication as above given by Stephen Martin of the WHO OCV stockpile program. His comments begin at about 05:24 in the video and runs for about 25 minutes.]

American Journal of Infection Control
January 2016 Volume 44, Issue 1, p1-124, e1-e7
http://www.ajicjournal.org/current

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APIC survey finds U.S. healthcare facilities are more prepared to confront Ebola compared to last year: Staffing and infection control resources remain issues
Published in issue: January 01 2016
Preview
Nine in 10 hospital-based APIC members believe their facilities are better prepared today than a year ago to receive a patient with a highly lethal infectious disease like Ebola, but more than half (55 percent) say their facilities have not provided additional resources to support their infection prevention and control (IPC) programs as a result of the Ebola crisis, according to a recent APIC survey.

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Immunity of nursing students to measles, mumps, rubella, and varicella in Yozgat, Turkey
Çiğdem Kader, Ayse Erbay, Nazan Kılıç Akça, Muhammet Fevzi Polat, Sevinç Polat
e5–e7
Published online: October 3 2015
Preview
Measles, mumps, rubella, and varicella (MMRV) are vaccine-preventable diseases. The aim of this study was to determine the vaccination status of first-year nursing students in Turkey. The sample used was 180 students and immunoglobulin G antibodies against MMRV viruses were determined quantitatively by enzyme-linked immunosorbent assay. Immunity rates to MMRV were 82.8%, 83.3%, 98.3%, and 100%, respectively. The results of this study showed that all of the students were immune to varicella and 32.8% of the students were not immune to at least 1 of the viruses covered by the measles, mumps, and rubella vaccine.

American Journal of Preventive Medicine
January 2016 Volume 50, Issue 1, p1-128, e1-e32
http://www.ajpmonline.org/current

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Brief Reports
Influenza Vaccination Coverage Among People With High-Risk Conditions in the U.S.
Alissa C. O’Halloran, Peng-jun Lu, Walter W. Williams, Carolyn B. Bridges, James A. Singleton
e15–e26
Published online: July 31 2015
Preview
During annual influenza epidemics, rates of serious illness and death are higher among those who have medical conditions, such as pulmonary disease, diabetes, or heart disease, which place them at increased risk of influenza complications. Annual influenza vaccination was recommended for people with high-risk conditions as early as 1960.

American Journal of Public Health
Volume 106, Issue 1 (January 2016)
http://ajph.aphapublications.org/toc/ajph/current

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Increasing the Incidence and Influence of Systematic Reviews on Health Policy and Practice
Iain Chalmers, DSc, and Daniel M. Fox, PhD
Iain Chalmers is a co-founder of the Cochrane Collaboration (www.cochrane.org) and the James Lind Initiative, Oxford, UK. Daniel Fox is president emeritus of the Milbank Memorial Fund, New York, NY.
Abstract
Why do people make practice and policy decisions in health care and public health without reference to relevant research, or only to biased samples of relevant research evidence? This illogical behavior doesn’t serve the interests of health service users or the public, yet it remains usual. One reason is that most reports of research do not help. Even very prestigious journals publish reports of new studies without acknowledging that readers need to know what the new evidence has added to the totality of trustworthy evidence relevant to the questions addressed.1
Waste in the conduct and reporting of research is a scientific, ethical, and economic scandal, especially because half of the potentially relevant research does not even get reported (see, for example, http://www.alltrials.net). Nevertheless, it is important that systematic use is made of those reports of research that are accessible. In this editorial we consider the increased availability of systematic reviews of research, some of their positive effects on policy and practice, and limitations in the current use of systematic reviews. We end by offering suggestions for enhancing the effectiveness of systematic reviews.

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The Health of the Newest Americans: How US Public Health Systems Can Support Syrian Refugees
Clea A. McNeely, DrPH, MALyn Morland, MSW, MA
Clea A. McNeely is with the Center for the Study of Youth and Political Conflict and the Department of Public Health, University of Tennessee, Knoxville. Lyn Morland is with the Division of Innovation, Policy, and Research, Bank Street College of Education, New York, NY.
ABSTRACT
The statistics are stunning: 1.9 million Syrian refugees in Turkey, 1.7 million in Lebanon, 630 000 in Jordan, 506 000 in the European Union, and 1883 in the United States.1–3 The United States will admit an additional 10 000 Syrian refugees during the next fiscal year, at which point Syrians will constitute approximately 18% of the total refugee population admitted in 2016.4 But this is not a public health emergency in the United States.
The media attention and national concern about Syrian refugees does provide an opportunity, however, to improve our public health system’s capacity to serve all refugees. With commitment and grit, several communities have increased refugees’ access to quality health services that span the full spectrum from preventive screening to management of complex chronic conditions. These promising practices demonstrate the feasibility of providing efficient, accessible and effective health services for even the most linguistically and economically marginalized members of our communities. As Beth Farmer, the director of International Counseling and Community Services in Washington State put it: “If we fix the healthcare system for refugees—make it understandable and easily accessible—we fix it for everyone” (telephone communication, October 2015).

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Sociodemographic Predictors of Vaccination Exemptions on the Basis of Personal Belief in California
American Journal of Public Health: January 2016, Vol. 106, No. 1: 172–177.
Michelle M. Mello, Y. Tony Yang, Paul L. Delamater, Timothy F. Leslie,
Abstract
Objectives. We examined the variability in the percentage of students with personal belief exemptions (PBEs) from mandatory vaccinations in California schools and communities according to income, education, race, and school characteristics.
Methods. We used spatial lag models to analyze 2007–2013 PBE data from the California Department of Public Health. The analyses included school- and regional-level models, and separately examined the percentage of students with exemptions in 2013 and the change in percentages over time.
Results. The percentage of students with PBEs doubled from 2007 to 2013, from 1.54% to 3.06%. Across all models, higher median household income and higher percentage of White race in the population, but not educational attainment, significantly predicted higher percentages of students with PBEs in 2013. Higher income, White population, and private school type significantly predicted greater increases in exemptions from 2007 to 2013, whereas higher educational attainment was associated with smaller increases.
Conclusions. Personal belief exemptions are more common in areas with a higher percentage of White race and higher income.

American Journal of Tropical Medicine and Hygiene
January 2016; 94 (1)
http://www.ajtmh.org/content/current
Successful Global Health Research Partnerships: What Makes Them Work?
Chandy C. John*, George Ayodo and Philippa Musoke
Author Affiliations
Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, Indiana; Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya; Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
Abstract
There are many successful global health research partnerships, but little information is available about what makes them successful. We asked 14 research colleagues from Uganda, Kenya, and the United States who have extensive global health research experience about what they considered the top three factors that led to or impeded successful international research collaborations. Four key factors were identified: 1) mutual respect and benefit, 2) trust, 3) good communication, and 4) clear partner roles and expectations. Initial and ongoing assessment of these factors in global health research partnerships may prevent misunderstandings and foster a collaborative environment that leads to successful research.

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Burden of Norovirus and Rotavirus in Children After Rotavirus Vaccine Introduction, Cochabamba, Bolivia
Casey L. McAtee*, Rachel Webman, Robert H. Gilman, Carolina Mejia, Caryn Bern, Sonia Apaza,
Susan Espetia, Mónica Pajuelo, Mayuko Saito, Roxanna Challappa, Richard Soria, Jose P. Ribera,
Daniel Lozano and Faustino Torrico
Author Affiliations
Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana; Department of Surgery, New York University, New York; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Asociación Benéfica PRISMA, Lima, Peru; CEADES Salud y Medio Ambiente, Cochabamba, Bolivia; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francico, California; Hospital Albina R. de Patiño, Cochabamba, Bolivia
Abstract
The effectiveness of rotavirus vaccine in the field may set the stage for a changing landscape of diarrheal illness affecting children worldwide. Norovirus and rotavirus are the two major viral enteropathogens of childhood. This study describes the prevalence of norovirus and rotavirus 2 years after widespread rotavirus vaccination in Cochabamba, Bolivia. Stool samples from hospitalized children with acute gastroenteritis (AGE) and outpatients aged 5–24 months without AGE were recruited from an urban hospital serving Bolivia’s third largest city. Both viruses were genotyped, and norovirus GII.4 was further sequenced. Norovirus was found much more frequently than rotavirus. Norovirus was detected in 69/201 (34.3%) of specimens from children with AGE and 13/71 (18.3%) of those without diarrhea. Rotavirus was detected in 38/201 (18.9%) of diarrheal specimens and 3/71 (4.2%) of non-diarrheal specimens. Norovirus GII was identified in 97.8% of norovirus-positive samples; GII.4 was the most common genotype (71.4% of typed specimens). Rotavirus G3P[8] was the most prevalent rotavirus genotype (44.0% of typed specimens) and G2P[4] was second most prevalent (16.0% of typed specimens). This community is likely part of a trend toward norovirus predominance over rotavirus in children after widespread vaccination against rotavirus

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 9 January 2016)

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Commentary
Infection prevention and control of the Ebola outbreak in Liberia, 2014–2015: key challenges and successes
Catherine Cooper, Dale Fisher, Neil Gupta, Rose MaCauley and Carmem L. Pessoa-Silva
Published on: 5 January 2016
Abstract
Prior to the 2014–2015 Ebola outbreak, infection prevention and control (IPC) activities in Liberian healthcare facilities were basic. There was no national IPC guidance, nor dedicated staff at any level of government or healthcare facility (HCF) to ensure the implementation of best practices. Efforts to improve IPC early in the outbreak were ad hoc and messaging was inconsistent. In September 2014, at the height of the outbreak, the national IPC Task Force was established with a Ministry of Health (MoH) mandate to coordinate IPC response activities. A steering group of the Task Force, including representatives of the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (CDC), supported MoH leadership in implementing standardized messaging and IPC training for the health workforce. This structure, and the activities implemented under this structure, played a crucial role in the implementation of IPC practices and successful containment of the outbreak. Moving forward, a nationwide culture of IPC needs to be maintained through this governance structure in Liberia’s health system to prevent and respond to future outbreaks.

BMJ Open
2016, Volume 6, Issue 1
http://bmjopen.bmj.com/content/current

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Global health
Systematic review of the literature on viral persistence and sexual transmission from recovered Ebola survivors: evidence and recommendations
Anna Thorson1,2, Pierre Formenty1, Clare Lofthouse1, Nathalie Broutet1
Author Affiliations
1World Health Organization (WHO), Geneva, Switzerland
2Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
Published 7 January 2016
Abstract
Objective The main aim of this article is to present a comprehensive, systematic review on evidence of sexual transmission from Ebola survivors and persistence of Ebola virus in body fluids of relevance to sexual transmission, and additionally to review condom effectiveness against sexual transmission of Ebola.
Design We performed a systematic review of viral persistence in body fluids of relevance to sexual transmission of Ebola survivors and evidence of sexual transmission of Ebola, and carried out a targeted review of condom effectiveness.
Results We identified nine published original articles presenting results on persistence of Ebola virus in relevant body fluids, or reporting suspect sexual transmission from Ebola survivors. We also included unpublished reports from the current 2014/2015 Ebola epidemic in West Africa. We found no articles reporting on condom effectiveness, but have included a targeted review on general condom efficacy and effectiveness.
Conclusions We conclude that the risk of sexual transmission from people who have recovered from Ebola cannot be ruled out. We found the longest duration of persistent Ebola RNA in a relevant body fluid from a survivor, to be reported from a man in Sierra Leone who had reverse transcriptase PCR (RT-PCR) positive semen 284 days after symptom onset. In line with current WHO recommendations. We recommend that men are offered the possibility to test their semen regularly for presence of Ebola RNA from3 months post-symptom onset. Safe sex practices including sexual abstinence, or else condom use, are recommended by WHO until semen has tested negative twice, or in absence of testing for at least 6 months post-symptom onset. Based on evidence reviewed, we conclude that male and female latex condoms offer some protection against EBOV compared to no condom use. Survivors should be offered access to care and prevention, in order to provide them with possibilities to mitigate any risks that may occur, and efforts should be linked to destigmatising activities.

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Global health
Factors associated with declining under-five mortality rates from 2000 to 2013: an ecological analysis of 46 African countries
Aaron M Kipp1,2, Meridith Blevins1,3, Connie A Haley1,2, Kasonde Mwinga4, Phanuel Habimana4, Bryan E Shepherd1,3, Muktar H Aliyu1,5, Tigest Ketsela4, Sten H Vermund1,6
Author Affiliations
1Vanderbilt Institute for Global Health, Nashville, Tennessee, USA
2Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
3Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
4World Health Organization/Regional Office for Africa, Brazzaville, Congo
5Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
6Pediatrics Vanderbilt University School of Medicine, Nashville, Tennessee, USA
Published 8 January 2016
Abstract
Objective Inadequate overall progress has been made towards the 4th Millennium Development Goal of reducing under-five mortality rates by two-thirds between 1990 and 2015. Progress has been variable across African countries. We examined health, economic and social factors potentially associated with reductions in under-five mortality (U5M) from 2000 to 2013.
Setting Ecological analysis using publicly available data from the 46 nations within the WHO African Region.
Outcome measures We assessed the annual rate of change (ARC) of 70 different factors and their association with the annual rate of reduction (ARR) of U5M rates using robust linear regression models.
Results Most factors improved over the study period for most countries, with the largest increases seen for economic or technological development and external financing factors. The median (IQR) U5M ARR was 3.6% (2.8 to 5.1%). Only 4 of 70 factors demonstrated a strong and significant association with U5M ARRs, adjusting for potential confounders. Higher ARRs were associated with more rapidly increasing coverage of seeking treatment for acute respiratory infection (β=0.22 (ie, a 1% increase in the ARC was associated with a 0.22% increase in ARR); 90% CI 0.09 to 0.35; p=0.01), increasing health expenditure relative to gross domestic product (β=0.26; 95% CI 0.11 to 0.41; p=0.02), increasing fertility rate (β=0.54; 95% CI 0.07 to 1.02; p=0.07) and decreasing maternal mortality ratio (β=−0.47; 95% CI −0.69 to −0.24; p<0.01). The majority of factors showed no association or raised validity concerns due to missing data from a large number of countries.
Conclusions Improvements in sociodemographic, maternal health and governance and financing factors were more likely associated with U5M ARR. These underscore the essential role of contextual factors facilitating child health interventions and services. Surveillance of these factors could help monitor which countries need additional support in reducing U5M.

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Paediatrics
Infant outcomes after exposure to Tdap vaccine in pregnancy: an observational study
Tony Walls1, Patricia Graham1,2, Helen Petousis-Harris3, Linda Hill4, Nicola Austin1,2
Author Affiliations
1Department of Paediatrics, University of Otago, Christchurch, New Zealand
2Canterbury District Health Board, Christchurch, New Zealand
3Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
4Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
Published 6 January 2016
Abstract
Objective Pertussis vaccination during pregnancy has recently been recommended in both the USA and UK to prevent pertussis infection in infants. While there are no apparent safety concerns about the administration of Tdap vaccine during pregnancy, there is only limited safety data available. We aimed to closely monitor infants exposed to Tdap during pregnancy to look for any adverse outcomes that may be attributable to the vaccine.
Design This was a prospective observational study, collecting information to evaluate the safety of Tdap vaccine for infants exposed during pregnancy. Infants were followed for between 6 and 12 months after birth, with 84% completing 12 months of follow-up. Information was obtained from objective sources including routine health visits and vaccination records wherever possible, as well as frequent parental reports.
Setting The Canterbury region of New Zealand.
Patients A cohort of 403 infants whose mothers had received Tdap vaccine.
Main outcome measures Gestational age at birth, growth parameters, congenital anomalies, immunisation status and timeliness of immunisation, development of pertussis infection.
Results There were no significant differences in birth weight, gestational age at birth, congenital anomalies or infant growth as compared with baseline population data. Infants of mothers who had received the vaccine were more likely to receive their vaccinations on time during infancy. No cases of pertussis occurred in this cohort despite high rates of disease in the community. We have not found any adverse events attributable to vaccine exposure.
Conclusions These data add to the growing pool of evidence that the administration of Tdap vaccine during pregnancy is an appropriate strategy for reducing the burden of pertussis in infants.
Clinical trial registration Australia New Zealand Clinical Trials Registry ACTRN12613001045707.

Bulletin of the World Health Organization
Volume 94, Number 1, January 2016, 1-76
http://www.who.int/bulletin/volumes/94/1/en/

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Editorials
Health systems strengthening, universal health coverage, health security and resilience
Joseph Kutzin a & Susan P Sparkes a
a. World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland.
Bulletin of the World Health Organization 2016;94:2. doi: http://dx.doi.org/10.2471/BLT.15.165050
Initial text
Global and national initiatives focused on health systems strengthening, universal health coverage, health security, and resilience suffer when these terms are not well understood or believed to be different ways of saying the same thing. Here we aim to facilitate understanding and highlight key policy considerations by identifying critical attributes of each concept and emphasizing the distinction between ends and means in health policy…

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Research
Estimating mortality using data from civil registration: a cross-sectional study in India
Mamta Gupta, Chalapati Rao, PVM Lakshmi, Shankar Prinja & Rajesh Kumar
Abstract
Objective
To analyse the design and operational status of India’s civil registration and vital statistics system and facilitate the system’s development into an accurate and reliable source of mortality data.
Methods
We assessed the national civil registration and vital statistics system’s legal framework, administrative structure and design through document review. We did a cross-sectional study for the year 2013 at national level and in Punjab state to assess the quality of the system’s mortality data through analyses of life tables and investigation of the completeness of death registration and the proportion of deaths assigned ill-defined causes. We interviewed registrars, medical officers and coders in Punjab state to assess their knowledge and practice.
Findings
Although we found the legal framework and system design to be appropriate, data collection was based on complex intersectoral collaborations at state and local level and the collected data were found to be of poor quality. The registration data were inadequate for a robust estimate of mortality at national level. A medically certified cause of death was only recorded for 965 992 (16.8%) of the 5 735 082 deaths registered.
Conclusion
The data recorded by India’s civil registration and vital statistics system in 2011 were incomplete. If improved, the system could be used to reliably estimate mortality. We recommend improving political support and intersectoral coordination, capacity building, computerization and state-level initiatives to ensure that every death is registered and that reliable causes of death are recorded – at least within an adequate sample of registration units within each state.

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Policy & Practice
An integrated national mortality surveillance system for death registration and mortality surveillance, China
Shiwei Liu, Xiaoling Wu, Alan D Lopez, Lijun Wang, Yue Cai, Andrew Page, Peng Yin, Yunning Liu, Yichong Li, Jiangmei Liu, Jinling You & Maigeng Zhou
Abstract
In China, sample-based mortality surveillance systems, such as the Chinese Center for Disease Control and Prevention’s disease surveillance points system and the Ministry of Health’s vital registration system, have been used for decades to provide nationally representative data on health status for health-care decision-making and performance evaluation. However, neither system provided representative mortality and cause-of-death data at the provincial level to inform regional health service needs and policy priorities. Moreover, the systems overlapped to a considerable extent, thereby entailing a duplication of effort. In 2013, the Chinese Government combined these two systems into an integrated national mortality surveillance system to provide a provincially representative picture of total and cause-specific mortality and to accelerate the development of a comprehensive vital registration and mortality surveillance system for the whole country. This new system increased the surveillance population from 6 to 24% of the Chinese population. The number of surveillance points, each of which covered a district or county, increased from 161 to 605. To ensure representativeness at the provincial level, the 605 surveillance points were selected to cover China’s 31 provinces using an iterative method involving multistage stratification that took into account the sociodemographic characteristics of the population. This paper describes the development and operation of the new national mortality surveillance system, which is expected to yield representative provincial estimates of mortality in China for the first time.

Contemporary Clinical Trials
Volume 46, Pages 1-122 (January 2016)
http://www.sciencedirect.com/science/journal/15517144/46

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Original Research Article
Design of a multi-arm randomized clinical trial with no control arm
Pages 12-17
Amalia Magaret, Derek C. Angus, Neill K.J. Adhikari, Patrick Banura, Niranjan Kissoon, James V. Lawler, Shevin T. Jacob
Abstract
Background
Clinical trial designs that include multiple treatments are currently limited to those that perform pairwise comparisons of each investigational treatment to a single control. However, there are settings, such as the recent Ebola outbreak, in which no treatment has been demonstrated to be effective; and therefore, no standard of care exists which would serve as an appropriate control.
Methods/design
For illustrative purposes, we focused on the care of patients presenting in austere settings with critically ill ‘sepsis-like’ syndromes. Our approach involves a novel algorithm for comparing mortality among arms without requiring a single fixed control. The algorithm allows poorly-performing arms to be dropped during interim analyses. Consequently, the study may be completed earlier than planned. We used simulation to determine operating characteristics for the trial and to estimate the required sample size.
Results
We present a potential study design targeting a minimal effect size of a 23% relative reduction in mortality between any pair of arms. Using estimated power and spurious significance rates from the simulated scenarios, we show that such a trial would require 2550 participants. Over a range of scenarios, our study has 80 to 99% power to select the optimal treatment. Using a fixed control design, if the control arm is least efficacious, 640 subjects would be enrolled into the least efficacious arm, while our algorithm would enroll between 170 and 430. This simulation method can be easily extended to other settings or other binary outcomes.
Conclusion
Early dropping of arms is efficient and ethical when conducting clinical trials with multiple arms.

Development in Practice
Volume 26, Issue 1, 2016
http://www.tandfonline.com/toc/cdip20/current

Articles
Assessing the fit of RapidSMS for maternal and new-born health: perspectives of community health workers in rural Rwanda
DOI:10.1080/09614524.2016.1112769
Purity Mwendwa
ABSTRACT
This article examines field results that show the potential for mobile health (mHealth) technologies to support community health workers (CHWs) in delivering basic maternal and new-born services in Rwanda. The fit of RapidSMS, a UNICEF/Ministry of Health (MOH) mHealth technology is examined through focus groups with CHWs. The results highlight the need for more training in the use of RapidSMS, continued upgrading of mobile phones, devising innovative ways of charging mobile phones, and ensuring the availability of ambulances. We suggest that CHW supervision be a two-way process built into RapidSMS utilising real-time communication to enhance effectiveness.

Emerging Infectious Diseases
Volume 22, Number 1—January 2016
http://wwwnc.cdc.gov/eid/

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Human Papillomavirus Prevalence and Herd Immunity after Introduction of Vaccination Program, Scotland, 2009–2013 PDF Version [PDF – 527 KB – 9 pages]
R. L. Cameron et al.
Summary
Prevalence was reduced, and early evidence indicates herd immunity.

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Human Papillomavirus Vaccination at a Time of Changing Sexual Behavior PDF Version [PDF – 390 KB – 6 pages]
I. Baussano et al.
Summary
Early vaccination may prevent infections in populations undergoing age-specific changes in sexual activity.

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Effectiveness of Ring Vaccination as Control Strategy for Ebola Virus Disease PDF Version [PDF – 463 KB – 4 pages]
A. J. Kucharski et al.
Abstract
Using an Ebola virus disease transmission model, we found that addition of ring vaccination at the outset of the West Africa epidemic might not have led to containment of this disease. However, in later stages of the epidemic or in outbreaks with less intense transmission or more effective control, this strategy could help eliminate the disease.
…Conclusions
Ring vaccination enhances standard public health measures of contact tracing, isolation, and community engagement (14) and could be effective when such measures are in place. However, if standard measures are not working because many cases are not in known transmission chains, as in West Africa in early 2014, ring vaccination might be insufficient to contain the outbreak. If an EVD vaccine is shown to be efficacious, our results suggest that mass vaccination, or hybrid strategies involving mass and ring vaccinations, might need to be considered alongside ring vaccination when planning for future outbreaks.

The European Journal of Public Health
Volume 25, Issue 6, 1 December 2015
http://eurpub.oxfordjournals.org/content/25/6

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Editorials
Categorizations of migrants and ethnic minorities—are they useful for decisions on public health interventions?
Allan Krasnik
DOI: http://dx.doi.org/10.1093/eurpub/ckv177 907
Extract
Decisions regarding population-based preventive interventions require convincing measures of health and risks. Is it justified to initiate special community programs on diabetes prevention among migrants on the basis of a higher prevalence of diabetes than in the non-migrant population? Even as we know that diabetes is not a problem for the majority of the migrants? And that diabetes is also a problem for many non-migrants—however less prevalent? Relative risks and differences in prevalence of risks and diseases between groups are often used to justify such new programs for selected groups and communities based on certain characteristics such as ethnicity, migrant status, family situation or socio-economic position.
Mulinari et al.1 question the use of broad categorizations as instruments for predicting individual health problems using the area of ethnicity, migration and health as an example, and warn against the practice of only including measures of association in the consideration of public health interventions. Instead, these kinds of measures should always be reported together with measures of discriminatory accuracy…

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Editor’s Choice
Questioning the discriminatory accuracy of broad migrant categories in public health: self-rated health in Sweden
Shai Mulinari, Anna Bredström, Juan Merlo
DOI: http://dx.doi.org/10.1093/eurpub/ckv099 911-917
Abstract
Background: Differences between natives and migrants in average risk for poor self-rated health (SRH) are well documented, which has lent support to proposals for interventions targeting disadvantaged minority groups. However, such proposals are based on measures of association that neglect individual heterogeneity around group averages and thereby the discriminatory accuracy (DA) of the categories used (i.e. their ability to discriminate the individuals with poor and good SRH, respectively). Therefore, applying DA measures rather than only measures of association our study revisits the value of broad native and migrant categorizations for predicting SRH.
Design, setting and participants: We analyzed 27 723 individuals aged 18–80 who responded to a 2008 Swedish public health survey. We performed logistic regressions to estimate odds ratios (ORs), predicted risks and the area under the receiver operating characteristic curve (AU-ROC) as a measure of epidemiological DA.
Results: Being born abroad was associated with higher odds of poor SRH (OR = 1.75), but the AU-ROC of this variable only added 0.02 units to the AU-ROC for age alone (from 0.53 to 0.55). The AU-ROC increased, but remained unsatisfactorily low (0.62), when available social and demographic variables were included.
Conclusions: Our results question the use of broad native/migrant categorizations as instruments for forecasting individual SRH. Such simple categorizations have a very low DA and should be abandoned in public health practice. Measures of association and DA should be reported together whenever an intervention is being considered, especially in the area of ethnicity, migration and health.

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How do economic crises affect migrants’ risk of infectious disease? A systematic-narrative review
Alexander Kentikelenis, Marina Karanikolos, Gemma Williams, Philipa Mladovsky, Lawrence King, Anastasia Pharris, Jonathan E. Suk, Angelos Hatzakis, Martin McKee, Teymur Noori, David Stuckler
DOI: http://dx.doi.org/10.1093/eurpub/ckv151 937-944 First published online: 28 August 2015
Abstract
Background: It is not well understood how economic crises affect infectious disease incidence and prevalence, particularly among vulnerable groups. Using a susceptible-infected-recovered framework, we systematically reviewed literature on the impact of the economic crises on infectious disease risks in migrants in Europe, focusing principally on HIV, TB, hepatitis and other STIs.
Methods: We conducted two searches in PubMed/Medline, Web of Science, Cochrane Library, Google Scholar, websites of key organizations and grey literature to identify how economic changes affect migrant populations and infectious disease. We perform a narrative synthesis in order to map critical pathways and identify hypotheses for subsequent research.
Results: The systematic review on links between economic crises and migrant health identified 653 studies through database searching; only seven met the inclusion criteria. Fourteen items were identified through further searches. The systematic review on links between economic crises and infectious disease identified 480 studies through database searching; 19 met the inclusion criteria. Eight items were identified through further searches. The reviews show that migrant populations in Europe appear disproportionately at risk of specific infectious diseases, and that economic crises and subsequent responses have tended to exacerbate such risks. Recessions lead to unemployment, impoverishment and other risk factors that can be linked to the transmissibility of disease among migrants. Austerity measures that lead to cuts in prevention and treatment programmes further exacerbate infectious disease risks among migrants. Non-governmental health service providers occasionally stepped in to cater to specific populations that include migrants.
Conclusions: There is evidence that migrants are especially vulnerable to infectious disease during economic crises. Ring-fenced funding of prevention programs, including screening and treatment, is important for addressing this vulnerability.

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Effect of Human Papillomavirus vaccination of daughters on the cervical screening uptake of their non-vaccinated mothers
Angela M. Spencer, Stephen A. Roberts, Arpana Verma, Julietta Patnick, Peter Elton, Loretta Brabin Eur J Public Health (2015) 25 (6): 1097-1100 DOI: http://dx.doi.org/10.1093/eurpub/ckv146 First published online: 8 August 2015 (4 pages)

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 9 January 2016]

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Editorial
Envisioning a Global Health Partnership Movement
Andrew Jones
Globalization and Health201612:1
DOI: 10.1186/s12992-015-0138-4
Published: 6 January 2016
Initial text
“A universal truth: No health without a workforce” was the rallying cry of the flagship report commissioned by the Global Health Workforce Alliance Secretariat and the World Health Organization [1] and one which must be embraced if the aspiration for universal health coverage is ever to be realised [2]. One in seven people will never see a qualified health worker in their lives. The world will be short of 12.9 million health-care workers by 2035. The figures speak for themselves. It has never been clearer that there has to be a major global effort to recruit, educate and train health workers.
As the international development community prepare for the delivery of the next set of development goals, focus must include a meaningful revitalisation of the concept of partnership and a shift from short-term global interests to strengthening systems in low and middle-income countries. The Sustainable Development Goals call on new forms of partnership that speak to co-development rather than traditional models of international development – mutuality, co-learning and a recognition that we gain as much as we give by working through partnerships. It is time for donors and governments to look beyond monetary contributions to also consider what resources, expertise and technology that, if shared, could result in mutual benefit. In this sense, health partnerships offer a vision of the way in which learning and knowledge-exchange will take place in the future…

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 9 January 2016]

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Research
Mapping the use of research to support strategies tackling maternal and child health inequities: evidence from six countries in Africa and Latin America
Emily Vargas, Victor Becerril-Montekio, Miguel Gonzalez-Block, Patricia Akweongo, Cynthia Hazel, Maria Cuembelo, Felix Limbani, Wanderley Bernardo, Fernando Muñoz
Published: 7 January 2016
Abstract
Background
Striving to foster collaboration among countries suffering from maternal and child health (MCH) inequities, the MASCOT project mapped and analyzed the use of research in strategies tackling them in 11 low- and middle-income countries. This article aims to present the way in which research influenced MCH policies and programs in six of these countries – three in Africa and three in Latin America.
Methods
Qualitative research using a thematic synthesis narrative process was used to identify and describe who is producing what kind of research, how research is funded, how inequities are approached by research and policies, the countries’ research capacities, and the type of evidence base that MCH policies and programs use. Four tools were designed for these purposes: an online survey for researchers, a semi-structured interview with decision makers, and two content analysis guides: one for policy and programs documents and one for scientific articles.
Results
Three modalities of research utilization were observed in the strategies tackling MCH inequities in the six included countries – instrumental, conceptual and symbolic. Instrumental utilization directly relates the formulation and contents of the strategies with research results, and is the least used within the analyzed policies and programs. Even though research is considered as an important input to support decision making and most of the analyzed countries count five or six relevant MCH research initiatives, in most cases, the actual impact of research is not clearly identifiable.
Conclusions
While MCH research is increasing in low- and middle-income countries, the impact of its outcomes on policy formulation is low. We did not identify a direct relationship between the nature of the financial support organizations and the kind of evidence utilization within the policy process. There is still a visible gap between researchers and policymakers regarding their different intentions to link evidence and decision making processes.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 11, Issue 12, 2015
http://www.tandfonline.com/toc/khvi20/current

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Research Papers
Missed opportunities for Hepatitis B vaccination among diabetic patients
pages 2806-2810
Lale Ozisik, Mine Durusu Tanriover, Nursel Calik Basaran, S Gul Oz & Serhat Unal

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Short Report
Acceptance of intradermal inactivated influenza vaccines among hospital staff following 2 seasonal vaccination campaigns
pages 2827-2830
Laura Goodliffe, Brenda L Coleman, Allison J McGeer & The Department of Occupational Health Wellness and Safety

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Commentary
Current status and uptake of influenza vaccination over time among senior adults in the United States
pages 2849-2851
Peng-jun Lu, Alissa O’Halloran, Helen Ding, Stacie M Greby & Walter W Williams
Abstract
Influenza is a major cause of morbidity and mortality among older adults in the United States, who may also have chronic medical conditions that place them at high risk for complications from influenza. The U.S. Public Health Service recommended influenza vaccination of adults ≥65 y and chronically ill persons since 1961 and beginning with the 2010–11 influenza season, the Advisory Committee on Immunization Practices (ACIP) has expanded its recommendation to vaccinate all persons 6 months of age and older. Medicare coverage for influenza vaccination began in 1993. However, despite the presence of a safe and effective vaccine, long-standing recommendations on vaccination, and federal financial support for vaccination, vaccination levels among adults ≥65 y are not optimal. Studies have shown that influenza vaccination coverage among U.S. adults ≥ 65 y steadily increased from 30.1% in 1989 to 64.2% in 1997, but plateaued near 65% from 1998 to 2013. Increasing influenza vaccination coverage among older adults in the United States will require more cooperation among health-care providers, professional organizations, vaccine manufacturers, and public health departments to raise public awareness about the benefits of influenza vaccination and to ensure continued administration of vaccinations throughout the influenza season.

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Commentaries
The Centers for Disease Control and Prevention’s public health response to monitoring Tdap safety in pregnant women in the United States
pages 2872-2879
Pedro L Moro, Michael M McNeil, Lakshmi Sukumaran & Karen R Broder
Abstract
In 2010, in response to a widespread pertussis outbreak and neonatal deaths, California became the first state to recommend routine administration of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during pregnancy. In 2011, the Advisory Committee on Immunization Practices (ACIP) followed with a similar recommendation for Tdap vaccination during pregnancy for previously unvaccinated women. In 2012, this recommendation was expanded to include Tdap vaccination of every pregnant woman during each pregnancy. These recommendations were based on urgent public health needs and available evidence on the safety of other inactivated vaccines during pregnancy. However, there were limited data on the safety of Tdap during pregnancy. In response to the new ACIP recommendations, the Centers for Disease Control and Prevention (CDC) implemented ongoing collaborative studies to evaluate whether vaccination with Tdap during pregnancy adversely affects the health of mothers and their offspring and provide the committee with regular updates. The current commentary describes the public health actions taken by CDC to respond to the ACIP recommendation to study and monitor the safety of Tdap vaccines in pregnant women and describes the current state of knowledge on the safety of Tdap vaccines in pregnant women. Data from the various monitoring activities support the safety of Tdap use during pregnancy.

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Research Papers
Overcoming barriers to HPV vaccination: A randomized clinical trial of a culturally-tailored, media intervention among African American girls
pages 2883-2894
Ralph J DiClemente, Colleen Crittenden Murray, Tracie Graham & Julia Still
Abstract
Although genital HPV is the most prevalent STI in the US, rates of vaccination uptake among high-risk subgroups remain low. Investigations of vaccine compliance have mainly targeted mother-daughter dyads, which in some settings may prove difficult. This study examines an innovative culturally tailored, computer-delivered media-based strategy to promote HPV vaccine uptake. Data, inclusive of sociodemographics, sexual behaviors, knowledge, attitudes, and beliefs about HPV and vaccination were collected via ACASI from 216 African American adolescent females (ages 14–18 years) seeking services in family planning and STI public health clinics in metropolitan Atlanta. Data were obtained prior to randomization and participation in an interactive media-based intervention designed to increase HPV vaccination uptake. Medical record abstraction was conducted 7 month post-randomization to assess initial vaccine uptake and compliance. Participants in the intervention were more compliant to vaccination relative to a placebo comparison condition (26 doses vs. Seventeen doses; p=0.12). However, vaccination series initiation and completion were lower than the national average. Thorough evaluation is needed to better understand factors facilitating HPV vaccine uptake and compliance, particularly perceived susceptibility and the influence of the patient-provider encounter in a clinical setting.

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Vaccination uptake by vaccine-hesitant parents attending a specialist immunization clinic in Australia
pages 2895-2903
Thomas A Forbes, Alissa McMinn, Nigel Crawford, Julie Leask & Margie Danchin
Abstract
Vaccine hesitancy (VH) is an issue of global concern. The quality of communication between healthcare providers and parents can influence parental immunization acceptance. We aimed to describe immunization uptake following specialist immunization clinic (SIC) consultation for Australian children of VH parents as a cohort, and according to pre-clinic parental position on immunization. At a single tertiary pediatric SIC (RCH, Melbourne) a retrospective descriptive study classified VH families according to 3 proposed parental positions on immunization at initial clinic attendance. Immunization status at follow up was ascertained via the Australian Children’s Immunization Register and National HPV Program Register and compared between groups. Of the VH cohort, 13/38 (34%) families were classified as hesitant, 21 (55%) as late/selective vaccinators and 4 (11%) as vaccine refusers. Mean follow up post-SIC attendance was 14.5 months. For the overall VH cohort, the majority chose selective immunization (42%) following SIC consultation. When analyzed by pre-clinic parental position on immunization, there was a trend for hesitant families to proceed with full immunization, selective families to continue selective immunization and refusing families to remain unimmunised (p < 0.0001). The most commonly omitted vaccines were hepatitis B (66%) and Haemophilus influenzae type B (55%), followed by the meningococcal C conjugate vaccine (53%) and measles, mumps and rubella vaccine (53%). Immunization outcome appears to correlate with pre-clinic parental position on immunization for the majority of families attending a SIC in Australia, with selective immunization the most common outcome. Tailored communication approaches based on parental position on immunization may optimise clinic resources and engagement of families, but require prospective research evaluation.

International Journal of Epidemiology
Volume 44 Issue 6 December 2015
http://ije.oxfordjournals.org/content/current

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Early Life
Institutional deliveries weakly associated with improved neonatal survival in developing countries: evidence from 192 Demographic and Health Surveys
Günther Fink*, Rebecca Ross and Kenneth Hill
Author Affiliations
Harvard T.H. Chan School of Public Health, Boston, MA, USA
Abstract
Background: Child and maternal mortality remain high in many developing countries. A principal strategy used in low- and middle-income countries is increasing the proportion of pregnancies delivered at facilities. Although this strategy is reasonable with high quality facilities, evidence for the protective effects of facility deliveries is mixed.
Methods: We pooled 1.47 million birth records collected by the Demographic and Health Surveys to estimate the association between institutional deliveries and early neonatal mortality. Subsample analysis and instrumental variable estimation were used to assess and correct the extent to which mortality differentials are biased by an increased likelihood of facility attendance for high-risk deliveries.
Results: No associations between institutional deliveries and early neonatal mortality were found in the pooled sample [adjusted odds ratio (aOR) 0.995, 95% confidence interval (CI) 0.966-1.025)]. When stratified by facility type, protective effects were found for private facilities (aOR 0.876, 95% CI 0.840-0.914), but not for public hospitals or health centres. Significant protective effects were found when past behaviour was used to eliminate selection bias generated by short-term responses to medical need (aOR 0.884, 95% CI 0.814-0.961). At the community and country levels, strong positive associations were found between early neonatal mortality among facility deliveries and the prevalence of institutional deliveries.
Conclusion: Facility deliveries have the potential to reduce early neonatal mortality in developing countries. The results presented suggest that the quality, utilization and protective effects of institutional deliveries vary widely across countries; major improvements in both utilization and quality of care will be needed to achieve further improvements in maternal and child health.

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Effect of fortified complementary food supplementation on child growth in rural Bangladesh: a cluster-randomized trial
Parul Christian, Saijuddin Shaikh, Abu Ahmed Shamim, Sucheta Mehra, Lee Wu, Maithilee Mitra, Hasmot Ali, Rebecca D Merrill, Nuzhat Choudhury, Monira Parveen, Rachel D Fuli, Md Iqbal Hossain, Md Munirul Islam, Rolf Klemm, Kerry Schulze, Alain Labrique, Saskia de Pee,
Tahmeed Ahmed, and Keith P West, Jr
Author Affiliations
1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,
2JiVitA Project, Gaibandha, Bangladesh,
3Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh,
4United Nations World Food Programme, IDB Bhaban, Dhaka, Bangladesh and
5Office of Nutrition Advisor, United Nations World Food Programme, Rome, Italy
Abstract
Background: Growth faltering in the first 2 years of life is high in South Asia where prevalence of stunting is estimated at 40–50%. Although nutrition counselling has shown modest benefits, few intervention trials of food supplementation exist showing improvements in growth and prevention of stunting.
Methods: A cluster-randomized controlled trial was conducted in rural Bangladesh to test the effect of two local, ready-to-use foods (chickpea and rice-lentil based) and a fortified blended food (wheat-soy-blend++, WSB++) compared with Plumpy’doz, all with nutrition counselling vs nutrition counselling alone (control) on outcomes of linear growth (length and length-for-age z-score, LAZ), stunting (LAZ < −2), weight-for-length z-score (WLZ) and wasting (WLZ < −2) in children 6–18 months of age. Children (n = 5536) were enrolled at 6 months of age and, in the food groups, provided with one of the allocated supplements daily for a year.
Results: Growth deceleration occurred from 6 to 18 months of age but deceleration in LAZ was lower (by 0.02–0.04/month) in the Plumpy’doz (P = 0.02), rice-lentil (< 0.01), and chickpea (< 0.01) groups relative to control, whereas WLZ decline was lower only in Plumpy’doz and chickpea groups. WSB++ did not impact on these outcomes. The prevalence of stunting was 44% at 18 months in the control group, but lower by 5–6% (P ≤ 0.01) in those receiving Plumpy’doz and chickpea. Mean length and LAZ at 18 months were higher by 0.27–0.30 cm and 0.07–0.10 (all P < 0.05), respectively, in all four food groups relative to the control.
Conclusions: In rural Bangladesh, small amounts of daily fortified complementary foods, provided for a year in addition to nutrition counselling, modestly increased linear growth and reduced stunting at 18 months of age.

JAMA Pediatrics
January 2016, Vol 170, No. 1
http://archpedi.jamanetwork.com/issue.aspx

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Viewpoint | January 2016
Harnessing Social Media for Child Health Research – Pediatric Research 2.0
Kurt R. Schumacher, MD, MS1; Joyce M. Lee, MD, MPH2,3
Author Affiliations
JAMA Pediatr. 2016;170(1):5-6. doi:10.1001/jamapediatrics.2015.2696.

Extract
This Viewpoint reviews both the opportunities and the challenges of using social media to obtain condition-specific, patient-reported data.
The term social media refers to the forms of electronic communication that enable users to create or share content with others, and these forms of electronic communication are nearly universal in the adolescent pediatric population, with more than 90% of teens 12 to 17 years of age reporting use of some form of social media.1 Facebook is still the dominant social network, but adolescents are using other channels, including Twitter, Instagram, and private messaging applications.1 With the widespread adoption of any new technology, including social media, there will likely be consequences for child health outcomes. The majority of pediatric research has focused on the potential harms (ie, a proliferation of research studies that have evaluated the adverse effects of social media on outcomes including sexting, cyberbullying, depression, and substance abuse).2,3 These represent important contributions to the literature but neglect the possible opportunities that social media bring to the research enterprise, including disease-specific investigations relevant to both pediatric generalists and subspecialists, because only a handful of pediatric studies have focused on specific medical conditions.2 The use of social media in child health research is in its infancy; we believe that social media hold great promise as a research tool to be leveraged across the entire child health research continuum, especially given that electronic resources are by far the most common media used by teens seeking health information.4 We review both the opportunities and the challenges of using social media to obtain condition-specific, patient-reported data…

The Lancet
Jan 09, 2016 Volume 387 Number 10014 p95-198 e1-e8
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
Zika virus: a new global threat for 2016
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(16)00014-3
Summary
Concerns about the threat posed to global health security by Zika virus are escalating, with new outbreaks reported in Central and South America. Locally transmitted (autochthonous) cases of Zika have now been detected in Colombia, El Salvador, Guatemala, Mexico, Paraguay, Puerto Rico, and Venezuela. The first five autochthonous cases detected in Suriname are reported in Correspondence online, with complete coding of the Zika virus sequence for one patient, and envelope protein coding sequences for three others.

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Comment
Civil–military cooperation in Ebola and beyond
Adam Kamradt-Scott, Sophie Harman, Clare Wenham, Frank Smith III
DOI: http://dx.doi.org/10.1016/S0140-6736(15)01128-9
Summary
The 2014 Ebola outbreak in west Africa blurred the lines between a public health emergency and humanitarian crisis. In so doing, it highlighted serious problems with coordinating disaster responses. Civilian agencies were overwhelmed; several non-government organisations closed down their operations and exited the affected countries; and, although the health sector in Liberia stepped up, Sierra Leone and Guinea remained in disarray. Since then WHO declared Sierra Leone to be Ebola free on Nov 7, 2015,1 and declared the end of human-to-human transmission of Ebola virus in Guinea on Dec 29, 2015.

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Series
Antimicrobials: access and sustainable effectiveness
Access to effective antimicrobials: a worldwide challenge
Ramanan Laxminarayan, Precious Matsoso, Suraj Pant, Charles Brower, John-Arne Røttingen, Keith Klugman, Sally Davies

Antimicrobials: access and sustainable effectiveness
Understanding the mechanisms and drivers of antimicrobial resistance
Alison H Holmes, Luke S P Moore, Arnfinn Sundsfjord, Martin Steinbakk, Sadie Regmi, Abhilasha Karkey, Philippe J Guerin, Laura J V Piddock

Antimicrobials: access and sustainable effectiveness
Maximising access to achieve appropriate human antimicrobial use in low-income and middle-income countries
Marc Mendelson, John-Arne Røttingen, Unni Gopinathan, Davidson H Hamer, Heiman Wertheim, Buddha Basnyat, Christopher Butler, Göran Tomson, Manica Balasegaram
Summary
Access to quality-assured antimicrobials is regarded as part of the human right to health, yet universal access is often undermined in low-income and middle-income countries. Lack of access to the instruments necessary to make the correct diagnosis and prescribe antimicrobials appropriately, in addition to weak health systems, heightens the challenge faced by prescribers. Evidence-based interventions in community and health-care settings can increase access to appropriately prescribed antimicrobials. The key global enablers of sustainable financing, governance, and leadership will be necessary to achieve access while preventing excess antimicrobial use.

The Lancet Infectious Diseases
Jan 2016 Volume 16 Number 1 p1-130 e1-e9
http://www.thelancet.com/journals/laninf/issue/current

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Editorial
Measles immunisation: time to close the gap
The Lancet Infectious Diseases
DOI: http://dx.doi.org/10.1016/S1473-3099(15)00504-6
Summary
Since the beginning of the century, the number of measles-related deaths has fallen substantially; between 2000 and 2014 mass immunisation efforts prevented an estimated 17·1 million deaths worldwide, and the number of cases decreased from 146 to 40 per million. Unfortunately, after this decrease the situation has stagnated and many countries are falling far behind the 2015 elimination targets according to a report by WHO and the US Centers for Disease Control and Prevention (CDC) released in November, 2015.

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Comment
Duration of immune responses after Ebola virus vaccination
Open Access
Steven B Bradfute
DOI: http://dx.doi.org/10.1016/S1473-3099(15)00408-9
Summary
In The Lancet Infectious Diseases, Milagritos Tapia and colleagues1 address two important facets of Ebola virus immunity: longevity of vaccine-induced immune responses and correlates of immunity. Early attempts at Ebola virus vaccines on the basis of traditional methods, such as inactivated preparations and subunit vaccines, were not effective in animal studies2 (although later publications on these platforms are more promising3). Subsequent studies used a wide diversity of vaccine platforms that had not been used in approved human vaccines, such as non-pathogenic viral vectors engineered to express Ebola virus surface glycoprotein.

Articles
Use of ChAd3-EBO-Z Ebola virus vaccine in Malian and US adults, and boosting of Malian adults with MVA-BN-Filo: a phase 1, single-blind, randomised trial, a phase 1b, open-label and double-blind, dose-escalation trial, and a nested, randomised, double-blind, placebo-controlled trial
Milagritos D Tapia, Samba O Sow, Kirsten E Lyke, Fadima Cheick Haidara, Fatoumata Diallo, Moussa Doumbia, Awa Traore, Flanon Coulibaly, Mamoudou Kodio, Uma Onwuchekwa, Marcelo B Sztein, Rezwanul Wahid, James D Campbell, Marie-Paule Kieny, Vasee Moorthy, Egeruan B Imoukhuede, Tommy Rampling, Francois Roman, Iris De Ryck, Abbie R Bellamy, Len Dally, Olivier Tshiani Mbaya, Aurélie Ploquin, Yan Zhou, Daphne A Stanley, Robert Bailer, Richard A Koup, Mario Roederer, Julie Ledgerwood, Adrian V S Hill, W Ripley Ballou, Nancy Sullivan, Barney Graham, Myron M Levine
Open Access
Summary
Background
The 2014 west African Zaire Ebola virus epidemic prompted worldwide partners to accelerate clinical development of replication-defective chimpanzee adenovirus 3 vector vaccine expressing Zaire Ebola virus glycoprotein (ChAd3-EBO-Z). We aimed to investigate the safety, tolerability, and immunogenicity of ChAd3-EBO-Z in Malian and US adults, and assess the effect of boosting of Malians with modified vaccinia Ankara expressing Zaire Ebola virus glycoprotein and other filovirus antigens (MVA-BN-Filo).
Methods
In the phase 1, single-blind, randomised trial of ChAd3-EBO-Z in the USA, we recruited adults aged 18–65 years from the University of Maryland medical community and the Baltimore community. In the phase 1b, open-label and double-blind, dose-escalation trial of ChAd3-EBO-Z in Mali, we recruited adults 18–50 years of age from six hospitals and health centres in Bamako (Mali), some of whom were also eligible for a nested, randomised, double-blind, placebo-controlled trial of MVA-BN-Filo. For randomised segments of the Malian trial and for the US trial, we randomly allocated participants (1:1; block size of six [Malian] or four [US]; ARB produced computer-generated randomisation lists; clinical staff did randomisation) to different single doses of intramuscular immunisation with ChAd3-EBO-Z: Malians received 1 × 1010 viral particle units (pu), 2·5 × 1010 pu, 5 × 1010 pu, or 1 × 1011 pu; US participants received 1 × 1010 pu or 1 × 1011 pu. We randomly allocated Malians in the nested trial (1:1) to receive a single dose of 2 × 108 plaque-forming units of MVA-BN-Filo or saline placebo. In the double-blind segments of the Malian trial, investigators, clinical staff, participants, and immunology laboratory staff were masked, but the study pharmacist (MK), vaccine administrator, and study statistician (ARB) were unmasked. In the US trial, investigators were not masked, but participants were. Analyses were per protocol. The primary outcome was safety, measured with occurrence of adverse events for 7 days after vaccination. Both trials are registered with ClinicalTrials.gov, numbers NCT02231866 (US) and NCT02267109 (Malian).
Findings
Between Oct 8, 2014, and Feb 16, 2015, we randomly allocated 91 participants in Mali (ten [11%] to 1 × 1010 pu, 35 [38%] to 2·5 × 1010 pu, 35 [38%] to 5 × 1010 pu, and 11 [12%] to 1 × 1011 pu) and 20 in the USA (ten [50%] to 1 × 1010 pu and ten [50%] to 1 × 1011 pu), and boosted 52 Malians with MVA-BN-Filo (27 [52%]) or saline (25 [48%]). We identified no safety concerns with either vaccine: seven (8%) of 91 participants in Mali (five [5%] received 5 × 1010 and two [2%] received 1 × 1011 pu) and four (20%) of 20 in the USA (all received 1 × 1011 pu) given ChAd3-EBO-Z had fever lasting for less than 24 h, and 15 (56%) of 27 Malians boosted with MVA-BN-Filo had injection-site pain or tenderness.
Interpretation
1 × 1011 pu single-dose ChAd3-EBO-Z could suffice for phase 3 efficacy trials of ring-vaccination containment needing short-term, high-level protection to interrupt transmission. MVA-BN-Filo boosting, although a complex regimen, could confer long-lived protection if needed (eg, for health-care workers).
Funding
Wellcome Trust, Medical Research Council UK, Department for International Development UK, National Cancer Institute, Frederick National Laboratory for Cancer Research, Federal Funds from National Institute of Allergy and Infectious Diseases.

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Personal View
The scenario approach for countries considering the addition of oral cholera vaccination in cholera preparedness and control plans
Jacqueline Deen, Lorenz von Seidlein, Francisco J Luquero, Christopher Troeger, Rita Reyburn, Anna Lena Lopez, Amanda Debes, David A Sack
Summary
Oral cholera vaccination could be deployed in a diverse range of situations from cholera-endemic areas and locations of humanitarian crises, but no clear consensus exists. The supply of licensed, WHO-prequalified cholera vaccines is not sufficient to meet endemic and epidemic needs worldwide and so prioritisation is needed. We have developed a scenario approach to systematically classify situations in which oral cholera vaccination might be useful. Our scenario approach distinguishes between five types of cholera epidemiology based on experiences from around the world and provides evidence that we hope will spur the development of detailed guidelines on how and where oral cholera vaccines could, and should, be most rationally deployed.

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The Ebola Vaccine Team B: a model for promoting the rapid development of medical countermeasures for emerging infectious disease threats
Michael Osterholm, Kristine Moore, Julie Ostrowsky, Kathleen Kimball-Baker, Jeremy Farrar, Wellcome Trust-CIDRAP Ebola Vaccine Team B
Summary
In support of accelerated development of Ebola vaccines from preclinical research to clinical trials, in November, 2014, the Wellcome Trust and the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota established the Wellcome Trust-CIDRAP Ebola Vaccine Team B initiative. This ongoing initiative includes experts with global experience in various phases of bringing new vaccines to market, such as funding, research and development, manufacturing, determination of safety and efficacy, regulatory approval, and vaccination delivery. It also includes experts in community engagement strategies and ethical issues germane to vaccination policies, including eight African scientists with direct experience in developing and implementing vaccination policies in Africa. Ebola Vaccine Team B members have worked on a range of vaccination programmes, such as polio eradication (Africa and globally), development of meningococcal A disease vaccination campaigns in Africa, and malaria and HIV/AIDS vaccine research. We also provide perspective on how this experience can inform future situations where urgent development of vaccines is needed, and we comment on the role that an independent, expert group such as Team B can have in support of national and international public health authorities toward addressing a public health crisis.

New England Journal of Medicine
January 7, 2016 Vol. 374 No. 1
http://www.nejm.org/toc/nejm/medical-journal

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Original Article
Effect of Artesunate–Amodiaquine on Mortality Related to Ebola Virus Disease
Etienne Gignoux, M.P.H., Andrew S. Azman, Ph.D., Martin de Smet, M.D., Philippe Azuma, M.D., Moses Massaquoi, M.D., Dorian Job, M.D., Amanda Tiffany, M.P.H., Roberta Petrucci, M.D., Esther Sterk, M.D., M.I.H., Julien Potet, M.D., Motoi Suzuki, M.D., Andreas Kurth, Ph.D., Angela Cannas, Ph.D., Anne Bocquin, M.Sc., Thomas Strecker, Ph.D., Christopher Logue, Ph.D., Thomas Pottage, B.Sc., Constanze Yue, Ph.D., Jean-Clement Cabrol, M.D., Micaela Serafini, M.D., M.P.H., and Iza Ciglenecki, M.D.
N Engl J Med 2016; 374:23-32 January 7, 2016 DOI: 10.1056/NEJMoa1504605
Abstract
Background
Malaria treatment is recommended for patients with suspected Ebola virus disease (EVD) in West Africa, whether systeomatically or based on confirmed malaria diagnosis. At the Ebola treatment center in Foya, Lofa County, Liberia, the supply of artemether–lumefantrine, a first-line antimalarial combination drug, ran out for a 12-day period in August 2014. During this time, patients received the combination drug artesunate–amodiaquine; amodiaquine is a compound with anti–Ebola virus activity in vitro. No other obvious change in the care of patients occurred during this period.
Full Text of Background…
Methods
We fit unadjusted and adjusted regression models to standardized patient-level data to estimate the risk ratio for death among patients with confirmed EVD who were prescribed artesunate–amodiaquine (artesunate–amodiaquine group), as compared with those who were prescribed artemether–lumefantrine (artemether–lumefantrine group) and those who were not prescribed any antimalarial drug (no-antimalarial group).
Full Text of Methods…
Results
Between June 5 and October 24, 2014, a total of 382 patients with confirmed EVD were admitted to the Ebola treatment center in Foya. At admission, 194 patients were prescribed artemether–lumefantrine and 71 were prescribed artesunate–amodiaquine. The characteristics of the patients in the artesunate–amodiaquine group were similar to those in the artemether–lumefantrine group and those in the no-antimalarial group. A total of 125 of the 194 patients in the artemether–lumefantrine group (64.4%) died, as compared with 36 of the 71 patients in the artesunate–amodiaquine group (50.7%). In adjusted analyses, the artesunate–amodiaquine group had a 31% lower risk of death than the artemether–lumefantrine group (risk ratio, 0.69; 95% confidence interval, 0.54 to 0.89), with a stronger effect observed among patients without malaria.
Full Text of Results…
Conclusions
Patients who were prescribed artesunate–amodiaquine had a lower risk of death from EVD than did patients who were prescribed artemether–lumefantrine. However, our analyses cannot exclude the possibility that artemether–lumefantrine is associated with an increased risk of death or that the use of artesunate–amodiaquine was associated with unmeasured patient characteristics that directly altered the risk of death.

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Original Article
Evaluation of Convalescent Plasma for Ebola Virus Disease in Guinea
Johan van Griensven, M.D., Ph.D., Tansy Edwards, M.Sc., Xavier de Lamballerie, M.D., Ph.D., Malcolm G. Semple, M.D., Ph.D., Pierre Gallian, Ph.D., Sylvain Baize, Ph.D., Peter W. Horby, M.D., Ph.D., Hervé Raoul, Ph.D., N’Faly Magassouba, Ph.D., Annick Antierens, M.D., Carolyn Lomas, M.D., Ousmane Faye, Ph.D., Amadou A. Sall, Ph.D., Katrien Fransen, M.Sc., Jozefien Buyze, Ph.D., Raffaella Ravinetto, Pharm.D., Pierre Tiberghien, M.D., Ph.D., Yves Claeys, M.Sc., Maaike De Crop, M.Sc., Lutgarde Lynen, M.D., Ph.D., Elhadj Ibrahima Bah, M.D., Peter G. Smith, D.Sc., Alexandre Delamou, M.D., Anja De Weggheleire, M.D., and Nyankoye Haba, M.Sc. for the Ebola-Tx Consortium
N Engl J Med 2016; 374:33-42 January 7, 2016 DOI: 10.1056/NEJMoa1511812
Abstract
Background
In the wake of the recent outbreak of Ebola virus disease (EVD) in several African countries, the World Health Organization prioritized the evaluation of treatment with convalescent plasma derived from patients who have recovered from the disease. We evaluated the safety and efficacy of convalescent plasma for the treatment of EVD in Guinea.
Full Text of Background…
Methods
In this nonrandomized, comparative study, 99 patients of various ages (including pregnant women) with confirmed EVD received two consecutive transfusions of 200 to 250 ml of ABO-compatible convalescent plasma, with each unit of plasma obtained from a separate convalescent donor. The transfusions were initiated on the day of diagnosis or up to 2 days later. The level of neutralizing antibodies against Ebola virus in the plasma was unknown at the time of administration. The control group was 418 patients who had been treated at the same center during the previous 5 months. The primary outcome was the risk of death during the period from 3 to 16 days after diagnosis with adjustments for age and the baseline cycle-threshold value on polymerase-chain-reaction assay; patients who had died before day 3 were excluded. The clinically important difference was defined as an absolute reduction in mortality of 20 percentage points in the convalescent-plasma group as compared with the control group.
Full Text of Methods…
Results
A total of 84 patients who were treated with plasma were included in the primary analysis. At baseline, the convalescent-plasma group had slightly higher cycle-threshold values and a shorter duration of symptoms than did the control group, along with a higher frequency of eye redness and difficulty in swallowing. From day 3 to day 16 after diagnosis, the risk of death was 31% in the convalescent-plasma group and 38% in the control group (risk difference, −7 percentage points; 95% confidence interval [CI], −18 to 4). The difference was reduced after adjustment for age and cycle-threshold value (adjusted risk difference, −3 percentage points; 95% CI, −13 to 8). No serious adverse reactions associated with the use of convalescent plasma were observed.
Full Text of Results…
Conclusions
The transfusion of up to 500 ml of convalescent plasma with unknown levels of neutralizing antibodies in 84 patients with confirmed EVD was not associated with a significant improvement in survival. (Funded by the European Union’s Horizon 2020 Research and Innovation Program and others; ClinicalTrials.gov number, NCT02342171.)

Pediatrics
January 2016, VOLUME 137 / ISSUE 1
http://pediatrics.aappublications.org/content/137/1?current-issue=y

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Ethics Rounds
Ethical Considerations for Including Women as Research Participants
Pediatrics Jan 2016, 137 (1) 1; DOI: 10.1542/peds.2015-3990
In November 2015, the American Academy of Pediatrics endorsed the following publication: American College of Obstetricians and Gynecologists. Committee Opinion No. 646. Ethical considerations for including women as research participants. Washington, DC: American College of Obstetricians and Gynecologists; November 2015. Available at: http://www.acog.org/-/media/Committee-Opinions/Committee-on-Ethics/co646.pdf?dmc=1&ts=20151028T1411564748
Abstract
Inclusion of women in research studies is necessary for valid inference about health and disease in women. The generalization of results from trials conducted in men may yield erroneous conclusions that fail to account for the biological differences between men and women. Although significant changes in research design and practice have led to an increase in the proportion of women in research trials, knowledge gaps remain because of a continued lack of inclusion of women, especially those who are pregnant, in in premarketing research trials. This document provides a historical overview of issues surrounding women as participants in research trials, followed by an ethical framework and discussion of the issues of informed consent, contraception requirements, intimate partner consent, and the appropriate inclusion of pregnant women in research studies.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 9 January 2016)

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Data Sharing as Part of the Normal Scientific Process: A View from the Pharmaceutical Industry
Patrick Vallance, Andrew Freeman, Murray Stewart
Perspective | published 05 Jan 2016 | PLOS Medicine
10.1371/journal.pmed.1001936

In this week’s PLOS Medicine, Modjarrad and colleagues report the outcome of a World Health Organisation (WHO) consultation on developing global norms for sharing data and results during public health emergencies, with a focus on clinical, epidemiologic, and genetic features of emerging infectious diseases as well as experimental diagnostics, therapeutics, and vaccines [1]. There can be little doubt that the need to find effective health care solutions as quickly as possible to prevent or stop the spread of infectious disease in an emergency makes rapid data sharing the right thing to do for patients and society. Many of the barriers to data sharing in public health emergencies identified in the paper by Modjarrad et al. have been highlighted as areas for change to enable data sharing more generally [2,3]. We are perpetually in the midst of several health care crises, including those of neglected tropical diseases and other chronic diseases, for which data sharing has the potential to lead to faster and better solutions. As a matter of principle, we should be willing to share data without regards to which disease is being studied. So, which data and when?…

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Developing Global Norms for Sharing Data and Results during Public Health Emergencies
Kayvon Modjarrad, Vasee S. Moorthy, Piers Millett, Pierre-Stéphane Gsell, Cathy Roth, Marie-Paule Kieny
Policy Forum | published 05 Jan 2016 | PLOS Medicine
10.1371/journal.pmed.1001935
Summary Points
:: Leading stakeholders from around the world convened at a WHO consultation in September 2015, where they affirmed that timely and transparent sharing of data and results during public health emergencies must become the global norm.
:: Representatives from major biomedical journals who attended the meeting agreed that public disclosure of information of relevance to public health emergencies should not be delayed by publication timelines and that early disclosure should not and will not prejudice later journal publication.
:: Researchers should be responsible for the accuracy of shared preliminary results, ensuring that they have been subjected to sufficient quality control before public dissemination.
:: Opting in to data sharing should be the default practice, and the onus should be placed on data generators and stewards at the local, national, and international level to explain any decision to opt out from sharing data and results during public health emergencies.
:: Incentives for sharing data should be created and tailored for each type of data generator and steward, while data management and analysis expertise is enhanced in under-resourced settings.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 9 January 2016)

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Relevance of Non-communicable Comorbidities for the Development of the Severe Forms of Dengue: A Systematic Literature Review
Joao Toledo, Leyanna George, Eric Martinez, Adhara Lazaro, Wai Wai Han, Giovanini E. Coelho, Silvia Runge Ranzinger, Olaf Horstick
Research Article | published 04 Jan 2016 | PLOS Neglected Tropical Diseases
10.1371/journal.pntd.0004284

PLoS One
http://www.plosone.org/
[Accessed 9 January 2016]

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Social Factors Influencing Child Health in Ghana
Emmanuel Quansah, Lilian Akorfa Ohene, Linda Norman, Michael Osei Mireku, Thomas K. Karikari
Research Article | published 08 Jan 2016 | PLOS ONE
10.1371/journal.pone.0145401
Abstract
Objectives
Social factors have profound effects on health. Children are especially vulnerable to social influences, particularly in their early years. Adverse social exposures in childhood can lead to chronic disorders later in life. Here, we sought to identify and evaluate the impact of social factors on child health in Ghana. As Ghana is unlikely to achieve the Millennium Development Goals’ target of reducing child mortality by two-thirds between 1990 and 2015, we deemed it necessary to identify social determinants that might have contributed to the non-realisation of this goal.
Methods
ScienceDirect, PubMed, MEDLINE via EBSCO and Google Scholar were searched for published articles reporting on the influence of social factors on child health in Ghana. After screening the 98 articles identified, 34 of them that met our inclusion criteria were selected for qualitative review.
Results
Major social factors influencing child health in the country include maternal education, rural-urban disparities (place of residence), family income (wealth/poverty) and high dependency (multiparousity). These factors are associated with child mortality, nutritional status of children, completion of immunisation programmes, health-seeking behaviour and hygiene practices.
Conclusions
Several social factors influence child health outcomes in Ghana. Developing more effective responses to these social determinants would require sustainable efforts from all stakeholders including the Government, healthcare providers and families. We recommend the development of interventions that would support families through direct social support initiatives aimed at alleviating poverty and inequality, and indirect approaches targeted at eliminating the dependence of poor health outcomes on social factors. Importantly, the expansion of quality free education interventions to improve would-be-mother’s health knowledge is emphasised.

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Exploring the Potential Health Impact and Cost-Effectiveness of AIDS Vaccine within a Comprehensive HIV/AIDS Response in Low- and Middle-Income Countries
Thomas M. Harmon, Kevin A. Fisher, Margaret G. McGlynn, John Stover, Mitchell J. Warren, Yu Teng, Arne Näveke
Research Article | published 05 Jan 2016 | PLOS ONE
10.1371/journal.pone.0146387
Abstract
Background
The Investment Framework Enhanced (IFE) proposed in 2013 by the Joint United Nations Programme on HIV/AIDS (UNAIDS) explored how maximizing existing interventions and adding emerging prevention options, including a vaccine, could further reduce new HIV infections and AIDS-related deaths in low- and middle-income countries (LMICs). This article describes additional modeling which looks more closely at the potential health impact and cost-effectiveness of AIDS vaccination in LMICs as part of UNAIDS IFE.
Methods
An epidemiological model was used to explore the potential impact of AIDS vaccination in LMICs in combination with other interventions through 2070. Assumptions were based on perspectives from research, vaccination and public health experts, as well as observations from other HIV/AIDS interventions and vaccination programs. Sensitivity analyses varied vaccine efficacy, duration of protection, coverage, and cost.
Results
If UNAIDS IFE goals were fully achieved, new annual HIV infections in LMICs would decline from 2.0 million in 2014 to 550,000 in 2070. A 70% efficacious vaccine introduced in 2027 with three doses, strong uptake and five years of protection would reduce annual new infections by 44% over the first decade, by 65% the first 25 years and by 78% to 122,000 in 2070. Vaccine impact would be much greater if the assumptions in UNAIDS IFE were not fully achieved. An AIDS vaccine would be cost-effective within a wide range of scenarios.
Interpretation
Even a modestly effective vaccine could contribute strongly to a sustainable response to HIV/AIDS and be cost-effective, even with optimistic assumptions about other interventions. Higher efficacy would provide even greater impact and cost-effectiveness, and would support broader access. Vaccine efficacy and cost per regimen are critical in achieving cost-effectiveness, with cost per regimen being particularly critical in low-income countries and at lower efficacy levels.

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Impact of Contextual Factors on the Effect of Interventions to Improve Health Worker Performance in Sub-Saharan Africa: Review of Randomised Clinical Trials
Claire Blacklock, Daniela C. Gonçalves Bradley, Sharon Mickan, Merlin Willcox, Nia Roberts, Anna Bergström, David Mant
Research Article | published 05 Jan 2016 | PLOS ONE
10.1371/journal.pone.0145206

Reproductive Health
http://www.reproductive-health-journal.com/content
[Accessed 9 January 2016]

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Research
Balancing workload, motivation and job satisfaction in Rwanda: assessing the effect of adding family planning service provision to community health worker duties
Dawn Chin-Quee, Cathy Mugeni, Denis Nkunda, Marie Uwizeye, Laurie Stockton, Jennifer Wesson Reproductive Health 2016, 13:2 (6 January 2016)

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Research
Mobile Technology for Improved Family Planning (MOTIF): the development of a mobile phone-based (mHealth) intervention to support post-abortion family planning (PAFP) in Cambodia
Chris Smith, Uk Vannak, Ly Sokhey, Thoai Ngo, Judy Gold, Caroline Free Reproductive Health 2016, 13:1 (5 January 2016)

Social Science & Medicine
Volume 148, Pages 1-172 (January 2016)
http://www.sciencedirect.com/science/journal/02779536/148

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Commentaries
Taking the bull by the horns: Ethical considerations in the design and implementation of an Ebola virus therapy trial
Pages 163-170
Francis Kombe, Morenike O. Folayan, Jennyfer Ambe, Adaora Igonoh, Akin Abayomi, GET members
Abstract
Ebola virus is categorized as one of the most dangerous pathogens in the world. Although there is no known cure for Ebola virus, there is some evidence that the severity of the disease can be curtailed using plasma from survivors. Although there is a general consensus on the importance of research, methodological and ethical challenges for conducting research in an emergency situation have been identified. Performing clinical trials is important, especially for health conditions that are of public health significance (including rare epidemics) to develop new therapies as well as to test the efficacy and effectiveness of new interventions. However, routine clinical trial procedures can be difficult to apply in emergency public health crises hence require a consideration of alternative approaches on how therapies in these situations are tested and brought to the market. This paper examines some of the ethical issues that arise when conducting clinical trials during a highly dangerous pathogen outbreak, with a special focus on the Ebola virus outbreak in West Africa. The issues presented here come from a review of a protocol that was submitted to the Global Emerging Pathogens Treatment Consortium (GET). In reviewing the proposal, which was about conducting a clinical trial to evaluate the safety and efficacy of using convalescent plasma in the management of Ebola virus disease, the authors deliberated on various issues, which were documented as minutes and later used as a basis for this paper. The experiences and reflections shared by the authors, who came from different regions and disciplines across Africa, present wide-ranging perspectives on the conduct of clinical trials during a dangerous disease outbreak in a resource-poor setting.

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“I was on the way to the hospital but delivered in the bush”: Maternal health in Ghana’s Upper West Region in the context of a traditional birth attendants’ ban
Original Research Article
Pages 8-17
Andrea Rishworth, Jenna Dixon, Isaac Luginaah, Paul Mkandawire, Caesar Tampah Prince
Abstract
This study examines perceptions and experiences of mothers, traditional birth attendants (TBA), and skilled birth attendants (SBA) regarding Ghana’s recent policy that forbids TBAs from undertaking deliveries and restricts their role to referrals. In the larger context of Ghana’s highly underdeveloped and geographically uneven health care system, this study draws on the political ecology of health framework to explore the ways global safe motherhood policy discourses intersect with local socio-cultural and political environments of Ghana’s Upper West Region (UWR). This study reveals that futile improvements in maternal health and the continued reliance on TBAs illustrate the government’s inability to understand local realities marked by poor access to SBAs or modern health care services. Using focus group discussions (FGDs) (n = 10) and in-depth interviews (IDIs) (n = 48) conducted in Ghana’s UWR, the findings suggest that mothers generally perceive TBAs as better placed to conduct deliveries in rural isolated communities, where in most cases no SBAs are present or easily accessible. The results indicate that by adhering to the World Health Organization’s guidelines, the local government may be imposing detrimental, unintended consequences on maternal and child health in remote rural locations. In addition, the findings suggest that the new policy has resulted in considerable confusion among TBAs, many of whom remain oblivious or have not been officially notified about the new policy. Furthermore, participant accounts suggest that the new policy is seen as contributing to worsening relations and tensions between TBAs and SBAs, a situation that undermines the delivery of maternal health services in the region. The study concludes by suggesting relevant policy recommendations.

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Quality of qualitative research in the health sciences: Analysis of the common criteria present in 58 assessment guidelines by expert users
Original Research Article
Pages 142-151
M. Santiago-Delefosse, A. Gavin, C. Bruchez, P. Roux, S.L. Stephen
Abstract
The number of qualitative research methods has grown substantially over the last thirty years, both in social sciences and, more recently, in health sciences. This growth came with questions on the quality criteria needed to evaluate this work, and numerous guidelines were published. These guidelines, however, include many discrepancies, both in terms of vocabulary and structure. Many expert evaluators also decry the absence of consensual and reliable evaluation tools. To address this gap, we present the results of an evaluation of 58 existing guidelines in four major health science fields (medicine and epidemiology; nursing and health education; social sciences and public health; psychology/psychiatry, research methods and organization) by expert (n = 16) and peer (n = 40) users (e.g., article reviewers, experts allocating funds, editors). This research was conducted between 2011 and 2014 at the University of Lausanne in Switzerland. Experts met during three workshops spread over this period. A series of 12 consensual essential criteria, along with definitions, stemmed from a question in a semi-qualitative evaluation questionnaire that we developed. Although there is consensus on the name of the criteria, we highlight limitations on the ability to compare specific definitions of criteria across health science fields. We conclude that each criterion must be explained to come to broader consensus and identify definitions that are easily operational and consensual to all fields examined.

Tropical Medicine & International Health
January 2016 Volume 21, Issue 1 Pages 1–156
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2016.21.issue-1/issuetoc

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Original Research Papers
Quality of antenatal and childbirth care in rural health facilities in Burkina Faso, Ghana and Tanzania: an intervention study (pages 70–83)
Els Duysburgh, Marleen Temmerman, Maurice Yé, Afua Williams, Siriel Massawe, John Williams, Rose Mpembeni, Svetla Loukanova, Walter E. Haefeli and Antje Blank
Article first published online: 18 NOV 2015 | DOI: 10.1111/tmi.12627

Vaccine
Volume 34, Issue 3, Pages 299-400 (12 January 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/3
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Commentary
How many OPV rounds are required to stop wild polio virus circulation in a developed country? Lessons from the Israeli experience
Pages 299-301
Diana Tasher, Galia Rahav, Hagai Levine, Danit Sofer, Nehama Linder, Emilia Anis, Tamy Shohat, Yosi Manor, Eran Kopel, Lester M. Shulman, Ella Mendelson, Itamar Shalit, Eli Somekh
No abstract

WHO Reports
Japanese Encephalitis Vaccines: WHO position paper, February 2015 – Recommendations
Pages 302-303
WHO

Hepatitis E vaccine: WHO position paper, May 2015 – Recommendations
Pages 304-305
WHO

Vaccine
Volume 34, Issue 3, Pages 299-400 (12 January 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/3
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Original Research Article
Retrospective economic evaluation of childhood 7-valent pneumococcal conjugate vaccination in Australia: Uncertain herd impact on pneumonia critical
Pages 320-327
A.T. Newall, J.F. Reyes, P. McIntyre, R. Menzies, P. Beutels, J.G. Wood
Abstract
Background
Retrospective cost-effectiveness analyses of vaccination programs using routinely collected post-implementation data are sparse by comparison with pre-program analyses. We performed a retrospective economic evaluation of the childhood 7-valent pneumococcal conjugate vaccine (PCV7) program in Australia.
Methods
We developed a deterministic multi-compartment model that describes health states related to invasive and non-invasive pneumococcal disease. Costs (Australian dollars, A$) and health effects (quality-adjusted life years, QALYs) were attached to model states. The perspective for costs was that of the healthcare system and government. Where possible, we used observed changes in the disease rates from national surveillance and healthcare databases to estimate the impact of the PCV7 program (2005–2010). We stratified our cost-effectiveness results into alternative scenarios which differed by the outcome states included. Parameter uncertainty was explored using probabilistic sensitivity analysis.
Results
The PCV7 program was estimated to have prevented ∼5900 hospitalisations and ∼160 deaths from invasive pneumococcal disease (IPD). Approximately half of these were prevented in adults via herd protection. The incremental cost-effectiveness ratio was ∼A$161,000 per QALY gained when including only IPD-related outcomes. The cost-effectiveness of PCV7 remained in the range A$88,000–$122,000 when changes in various non-invasive disease states were included. The inclusion of observed changes in adult non-invasive pneumonia deaths substantially improved cost-effectiveness (∼A$9000 per QALY gained).
Conclusion
Using the initial vaccine price negotiated for Australia, the PCV7 program was unlikely to have been cost-effective (at conventional thresholds) unless observed reductions in non-invasive pneumonia deaths in the elderly are attributed to it. Further analyses are required to explore this finding, which has significant implications for the incremental benefit achievable by adult PCV programs.

Vaccine
Volume 34, Issue 3, Pages 299-400 (12 January 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/3
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National hospital data for intussusception: Data linkage and retrospective analysis to assess quality and use in vaccine safety surveillance
Original Research Article
Pages 373-379
Lamiya Samad, Mario Cortina-Borja, Alastair G. Sutcliffe, Sean Marven, J. Claire Cameron, Haitham El Bashir, Richard Lynn, Brent Taylor
Abstract
Objectives
To assess the quality of national Hospital Episode Statistics (HES) data for intussusception, and evaluate this routinely collected database for rotavirus vaccine safety surveillance by estimating pre-vaccination trends in intussusception hospitalisation.
Methods
Data linkage was performed between HES and prospective intussusception data from the British Paediatric Surveillance Unit (BPSU), followed by capture–recapture analysis to verify HES data quality. Inclusion criteria were infants aged less than 12 months and admitted for intussusception to National Health Service (NHS) hospitals in England from March 2008 to March 2009. To estimate pre-vaccination incidence rates of intussusception, we performed a retrospective analysis of HES data. Infants aged less than 12 months and admitted for intussusception to NHS hospitals in England between 1995 and 2009 were included.
Results
Data linkage between 254 cases of intussusception identified in HES data and 190 cases reported via the BPSU resulted in 163 cases common to both data sources. Of remaining 91 cases in HES, 37 had confirmed intussusception. HES data accuracy was 78.7% (200 confirmed/254 cases) and completeness for intussusception was 86% (163 matched/190 BPSU cases) compared to 81.5% (163 matched/200 HES cases) for BPSU. A total of 233 (95% CI: 227.4 to 238.8) intussusception cases were estimated for the infant population (2008 to 2009). For retrospective analysis, of 6462 intussusception admissions in HES data (1995 to 2009), 1594 (24.7%) were duplicate admissions. A declining trend in intussusception incidence was observed in the infant population, from 86/100,000 in 1997 to 34/100,000 in 2009 (60% reduction, P < 0.001). Cosinor modelling showed an excess of cases among infants in winter and spring (P < 0.001, n = 4957, 1995 to 2009).
Conclusion
National hospital data capture the majority of admissions for intussusception and should be considered for the post-implementation surveillance of rotavirus vaccine safety in England.

Vaccine
Volume 34, Issue 3, Pages 299-400 (12 January 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/3
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Completion and compliance of childhood vaccinations in the United States
Original Research Article
Pages 387-394
Samantha K. Kurosky, Keith L. Davis, Girishanthy Krishnarajah
Abstract
Background
The Advisory Committee on Immunization Practices recommends routine childhood vaccination by age 2 years, yet evidence suggests that only 2% to 26% of children receive vaccine doses at age-appropriate times (compliance). The objective of this study was to estimate vaccine completion and compliance rates between birth and age 2 years using recent, nationally representative data.
Methods
Using a sample of children aged 24 to 35 months from the 2012 National Immunization Survey (NIS), the present study examined completion and compliance of recommended childhood vaccines. A state-specific examination of vaccine completion and compliance was also conducted.
Results
An unweighted sample of 11,710 children (weighted to 4.1 million) was selected. Approximately 70% of children completed all doses of six recommended vaccines by 24 months of age. Completion rates varied by antigen, ranging from 68% completing two or three doses of rotavirus vaccine to 92% completing three doses of inactivated poliovirus vaccine. Vaccine completion rates also varied at different measurement periods, with the lowest rates observed at 18 months. Approximately 26% of children received all doses of six recommended vaccines on time. Among the 74% of children who received at least one late dose, 39% had >7 months of undervaccination. Patterns of completion and compliance also varied by geographic region.
Conclusions
Completion of individual antigens approached Healthy People 2020 targets. However, overall completion of the recommended vaccine series and compliance with the recommended vaccination dosing schedule were low, indicating few children received vaccines at age-appropriate times. Additional clinical, policy, and educational interventions are needed to increase receipt of vaccines at optimal ages.

Vaccine
Volume 34, Issue 2, Pages 187-298 (4 January 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/2
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Commentary
Worldwide rabies deaths prevention—A focus on the current inadequacies in postexposure prophylaxis of animal bite victims
Pages 187-189
Henry Wilde, Boonlert Lumlertdacha, François X. Meslin, Siriporn Ghai, Thiravat Hemachudha
Abstract
The World Health Organization reports that over 60,000 humans die of rabies annually, worldwide. Most occur in remote regions of developing countries. Almost all victims received no postexposure rabies prophylaxis (PEP). There are no facilities or health personnel able to provide it in many areas where the disease is prevalent. A first approach to correct this problem would be by extending provision of modern PEP to areas where human rabies is most prevalent.

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WHO Reports
WHO consultation on Respiratory Syncytial Virus Vaccine Development Report from a World Health Organization Meeting held on 23–24 March 2015
Pages 190-197
Kayvon Modjarrad, Birgitte Giersing, David C. Kaslow, Peter G. Smith, Vasee S. Moorthy, the WHO RSV Vaccine Consultation Expert Group

Varicella and herpes zoster vaccines: WHO position paper, June 2014 – Recommendations
Pages 198-199

Vaccine
Volume 34, Issue 2, Pages 187-298 (4 January 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/2
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Review Article
An approach to death as an adverse event following immunization
Pages 212-217
Michael S. Gold, Madhava Ram Balakrishnan, Ananda Amarasinghe, Noni E. MacDonald
Abstract
Co-incidental death occurring proximate to vaccination may be reported as an adverse event following immunization. Such events are particularly concerning because they may raise community and health provider concerns about the safety of the specific vaccine and often the immunization programme in general. Coincidental events need to be differentiated from vaccine reactions, such as anaphylaxis, which may very rarely result in death. In 2013, the World Health Organization (WHO) released an updated manual for the Causality Assessment of an AEFI. The purpose of this review is to apply the WHO causality methodology to death when this is reported as an AEFI. The causality assessment scheme recommends a four step process to enable classification of the AEFI and to differentiate events which are causally consistent from those that are inconsistent with immunization. However, for some events causality maybe indeterminate. Consistent causal reactions that may result in death are very rare and maybe related to the vaccine product (e.g. anaphylaxis, viscerotrophic disease), vaccine quality defect (e.g. an incompletely attenuated live vaccine agent) or an immunization error (e.g. vaccine vial contamination). Events that are inconsistent with immunizations are due to co-incidental conditions that may account for infant and childhood mortality. In countries with a high infant mortality rate the coincidental occurrence of death and immunization may occur not infrequently and a robust mechanism to obtain information from autopsy and perform an AEFI investigation and causality assessment is essential. Communication with the community and all stakeholders to maintain confidence in the immunization programme is critical.

Vaccine
Volume 34, Issue 2, Pages 187-298 (4 January 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/2
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Use of mobile phones for improving vaccination coverage among children living in rural hard-to-reach areas and urban streets of Bangladesh
Original Research Article
Pages 276-283
Md. Jasim Uddin, Md. Shamsuzzaman, Lily Horng, Alain Labrique, Lavanya Vasudevan, Kelsey Zeller, Mridul Chowdhury, Charles P. Larson, David Bishai, Nurul Alam
Abstract
In Bangladesh, full vaccination rates among children living in rural hard-to-reach areas and urban streets are low. We conducted a quasi-experimental pre-post study of a 12-month mobile phone intervention to improve vaccination among 0–11 months old children in rural hard-to-reach and urban street dweller areas. Software named “mTika” was employed within the existing public health system to electronically register each child’s birth and remind mothers about upcoming vaccination dates with text messages. Android smart phones with mTika were provided to all health assistants/vaccinators and supervisors in intervention areas, while mothers used plain cell phones already owned by themselves or their families. Pre and post-intervention vaccination coverage was surveyed in intervention and control areas. Among children over 298 days old, full vaccination coverage actually decreased in control areas – rural baseline 65.9% to endline 55.2% and urban baseline 44.5% to endline 33.9% – while increasing in intervention areas from rural baseline 58.9% to endline 76.8%, difference +18.8% (95% CI 5.7–31.9) and urban baseline 40.7% to endline 57.1%, difference +16.5% (95% CI 3.9–29.0). Difference-in-difference (DID) estimates were +29.5% for rural intervention versus control areas and +27.1% for urban areas for full vaccination in children over 298 days old, and logistic regression adjusting for maternal education, mobile phone ownership, and sex of child showed intervention effect odds ratio (OR) of 3.8 (95% CI 1.5–9.2) in rural areas and 3.0 (95% CI 1.4–6.4) in urban areas. Among all age groups, intervention effects on age-appropriate vaccination coverage were positive: DIDs +13.1–30.5% and ORs 2.5–4.6 (p < 0.001 in all comparisons). Qualitative data showed the intervention was well-accepted. Our study demonstrated that a mobile phone intervention can improve vaccination coverage in rural hard-to-reach and urban street dweller communities in Bangladesh. This small-scale successful demonstration should serve as an example to other low-income countries with high mobile phone usage.

Pediatrics International
Accepted Article

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The suitable timing of Haemophilus influenzae type b vaccination after cardiac surgery: Vaccination after cardiac surgery
Manabu Takanashi MD1, Shohei Ogata MD1,*, Takashi Honda MD1, Keiko Nomoto MS1, Eri Mineo MD1, Atsushi Kitagawa MD1, Hisashi Ando MD1, Sumito Kimura MD1, Yayoi Nakahata MD1, Norihiko Oka MD2, Kagami Miyaji MD3 andMasahiro Ishii MD1
DOI: 10.1111/ped.12899
Abstract
Background
The suitable timing of vaccination in infants with congenital heart disease (CHD) after cardiopulmonary bypass (CPB) surgery is unclear. However, it is important to prevent Haemophilus influenzae type b (Hib) infections in infants with CHD after CPB surgery. To reveal the suitable timing of Hib vaccination in infants with CHD after CPB surgery, we investigated the immunological status, and the efficacy and safety of Hib vaccination after CPB surgery.
Methods
Sixteen subjects who underwent surgical correction of a ventricular septal defect with CPB were investigated in this study. We evaluated the immunological status and cytokines were analyzed before surgery, 2 months after surgery, and before administering the Hib booster vaccination. The levels of Hib-specific IgG were also measured to evaluate the effectiveness of vaccination.
Results
All data regarding the immunological status before and 2 months after surgery, such as the population of whole blood cells and profile of lymphocyte subsets, were within the normal range and no subjects exhibited hypercytokinemia. Additionally, all subjects who received Hib vaccination at 2–3 months after CPB surgery had effective serum levels of Hib-specific IgG for protection against Hib infection without any side effects.
Conclusions
Our results show that CPB surgery does not influence acquired immunity and Hib vaccination may be immunologically safe to perform at 2 months after CPB surgery. The present study verified that Hib vaccination at 2–3 months after CPB surgery was effective in achieving immunization for infants with simple left to right shunt type CHD.