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_20 February 2016

– blog edition: comprised of the approx. 35+ entries posted below on 21- February 2016.

– Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
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– Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.

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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

Zika virus [to 20 February 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

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ZIKA – STRATEGIC RESPONSE FRAMEWORK & JOINT OPERATIONS PLAN – JANUARY-JUNE 2016
WHO – February 2016 :: 32 pages
Pdf: http://apps.who.int/iris/bitstream/10665/204420/1/ZikaResponseFramework_JanJun16_eng.pdf?ua=1
STRATEGIC OBJECTIVES
The over-arching goal of this strategy is to investigate and respond to the cluster of microcephaly and other neurological complications that could be linked to Zika virus infection, while increasing preventive measures, communicating risks and providing care to those affected.
.1. Surveillance
:: Provide up to date and accurate epidemiological information on Zika virus disease, neurological syndromes and congenital malformations.

.2. Response
:: Engage communities to communicate the risks associated with Zika virus disease and promote protective behaviors, reduce anxiety, address stigma, dispel rumors and cultural misperceptions.
:: Increase efforts to Control the spread of the Aedes and potentially other mosquito species as well as provide access to personal protection measures equipment and supplies.
:: Provide guidance and mitigate the potential impact on women of childbearing age and those who are pregnant, as well as families with children affected by Zika virus.

.3. Research
:: Investigate the reported increase in incidence of microcephaly and neurological syndromes including their possible association with Zika virus infection.
:: Fast-track the research and development (R&D) of new products (e.g. diagnostics, vaccines, therapeutics).

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Zika Strategic Response Framework Announcement
Zika Outbreak: WHO’s Global Emergency Response Plan
Global prevention and control strategy
16 February 2016
WHO has launched a global Strategic Response Framework and Joint Operations Plan to guide the international response to the spread of Zika virus infection and the neonatal malformations and neurological conditions associated with it.

The strategy focuses on mobilizing and coordinating partners, experts and resources to help countries enhance surveillance of the Zika virus and disorders that could be linked to it, improve vector control, effectively communicate risks, guidance and protection measures, provide medical care to those affected and fast-track research and development of vaccines, diagnostics and therapeutics.

WHO says $56 million is required to implement the Strategic Response Framework and Joint Operations Plan, of which $25 million would fund the WHO/AMRO/PAHO response and $31 million would fund the work of key partners. In the interim, WHO has tapped a recently established emergency contingency fund to finance its initial operations.

As part of WHO’s new emergency programme, the agency’s headquarters activated an Incident Management System to oversee the global response and leverage expertise from across the organization to address the crisis.

WHO’s Regional Office for the Americas (AMRO/PAHO) has been working closely with affected countries since May 2015, when the first reports of Zika virus disease emerged from northeastern Brazil. AMRO/PAHO and partner specialists were deployed to help health ministries detect and track the virus, contain its spread, advise on clinical management of Zika and investigate the spikes in microcephaly and Guillain-Barré syndrome in areas where Zika outbreaks have occurred.

AMRO/PAHO will continue to work with partners to manage the response in the Americas.
WHO is issuing regular information and guidance on the congenital and neurological conditions associated with Zika virus disease, as well as related health, safety and travel issues.

Working with partners, WHO is also mapping efforts to develop vaccines, therapies, diagnostic tests and new vector control tactics and putting in place mechanisms to expedite data sharing, product development and clinical trials…

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WHO – Press Conference: update on global response to Microcephaly (Geneva, 19 February 2016)
WHO update on global response to microcephaly, neurological disorders and Zika virus.
[Video: 1:09:31]
WHO has launched a global prevention and control strategy to guide its international response to the spread of Zika virus infection and the neonatal malformations and neurological conditions associated with it.

The strategy includes working with partners to investigate and respond to increases in microcephaly and other neurological disorders in areas where there are also Zika outbreaks, to contain the spread of Zika virus, and fast track R & D, and boost preparedness in at risk countries.

Zika has catalysed immediate action to put into place some of the practical processes that will underpin WHO’s new programme on outbreaks and emergencies.

WHO will also give an overview of the vector control measures that work to prevent Zika.
Speakers:
:: Dr Bruce Aylward, Executive Director, Outbreaks and Health Emergencies (ai), WHO
:: Dr Pedro Alonso, Director Global Malaria Programme, WHO

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WHO activities on Zika R&D
Dr Marie-Paule Kieny, Assistant Director-General, Health Systems and Innovation
16 February 2016
Commentary [Excerpt; Editor’s text bolding]
The Ebola outbreak of 2014-15 highlighted the need for a master plan for research and development (R&D) to both prepare for health emergencies and to be able to mount a fast response in case of need. The World Health Organization’s “R&D Blueprint” aims to accelerate the availability of medical countermeasures during epidemics and limit damage as much as possible. We have now established critical paths for coordinated action and industry interest in providing platform technologies for the development of medical products.

Our relatively poor knowledge of the Zika virus presents a series of challenges for research and development. However, building on experience from the Ebola epidemic, WHO has been able to set in motion a rapid R&D response for Zika.

We have already identified a large number of manufacturers and research institutions either involved in the development of medical tools for Zika, or interested in embarking on such research.
Embarking on vaccine and diagnostic research

Numerous groups are looking at the feasibility of initiating animal or human testing, particularly for vaccines and diagnostics.

For vaccines, the landscape is evolving swiftly, and numbers change daily. About 15 companies and research groups have been identified so far, though most have only just started work.

Two vaccine candidates seem to be at a more advanced stage: a DNA vaccine from the US and an inactivated product from India.

Still, the current absence of standardized animal models and reagents is a hindrance. And although the landscape is encouraging, it will be at least 18 months before vaccines could be tested in large-scale trials.

For diagnostics, 10 biotech companies have been identified so far that can provide nucleic acid or serological tests. Nucleic acid tests are based on a molecular technique used to detect a virus in the blood; serological tests measure the levels of antibodies as a result of exposure to a particular virus…

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WHO: Zika, Microcephaly, and Guillain–Barré syndrome situation report
19 February 2016
Read the full situation report
Summary
:: Between January 2007 and 17 February 2016, a total of 41 countries and territories reported local (autochthonous) transmission of Zika virus, including those where the outbreak is now over. One country (United States of America) reported a locally acquired case without vector-borne transmission, likely to have been contracted by sexual contact, and indirect evidence of local transmission has been documented in six additional countries. Two new countries/ territories have reported local transmission in the week running up to 17 February 2016 (Aruba and Bonaire).

:: Geographical distribution of Zika virus has steadily broadened since the virus was first detected in the Americas in 2015. Zika transmission has been reported in 28 countries /territories. The discovery of Zika virus in additional countries within the geographical range of competent mosquito vectors — especially Aedes aegypti— is considered likely.

:: Six countries/territories (Brazil, French Polynesia, El Salvador, Venezuela, Colombia and Suriname) have reported an increase in the incidence of cases of microcephaly and/or Guillain-Barré syndrome (GBS) following a Zika virus outbreak. Microcephaly has so far been reported only from Brazil and French Polynesia. Puerto Rico and Martinique have also reported cases of GBS associated with Zika virus infection, but without evidence of an overall increase in the incidence of GBS.

:: Evidence that neurological disorders, including microcephaly and GBS, are linked to Zika virus infection remains circumstantial, but a growing body of clinical and epidemiological data possibly leans towards a causal role for Zika virus.

:: The global prevention and control strategy launched by WHO as a Strategic Response Framework (SRF) encompasses surveillance, response activities, and research. Following consultation with partners and taking changes in caseload into account, the SRF will be updated at the end of March 2016 to reflect epidemiological evidence coming to light and the evolving division of roles and responsibilities for tackling this emergency.

:: From 2007 to 11 February 2016, Zika virus transmission was documented in a total of 48 countries/territories (Fig. 1 and Fig. 2). This includes 36 countries which reported local transmission between 2015 and 2016, six countries with indirect evidence of viral circulation, five countries with reported terminated outbreaks and one country with a locally acquired case but without vector-borne transmission (Table 1). Two new countries/territories – Aruba and Bonaire – reported autochthonous transmission in the week running up to 17 February 2016.

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WHO: Maintaining a safe and adequate blood supply during Zika virus outbreaks, interim guidance
Publication date: February 2016 :: 4 pages
ISBN: WHO/ZIKV/HS/16.1
Pdf: Safe-blood_supply18Feb2016.pdf pdf, 290kb
Overview
These guidelines have been developed in recognition that infection with Zika virus may present a risk to blood safety, and in consideration of the declaration on 1 February 2016 by the WHO Director-General of a Public Health Emergency of International Concern with regard to clusters of microcephaly and other neurological disorders, potentially associated with Zika virus. Currently there is limited knowledge of Zika virus biology and lack of definitive evidence of a link between infection and potential complications. These guidelines will be regularly reviewed and updated as new information becomes available.

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FDA [to 20 February 2016]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
February 16, 2016
FDA issues recommendations to reduce the risk for Zika virus blood transmission in the United States
As a safety measure against the emerging Zika virus outbreak, today the U.S. Food and Drug Administration issued a new guidance recommending the deferral of individuals from donating blood if they have been to areas with active Zika virus transmission, potentially have been exposed to the virus, or have had a confirmed Zika virus infection.

“The FDA has critical responsibilities in outbreak situations and has been working rapidly to take important steps to respond to the emerging Zika virus outbreak,” said Luciana Borio, M.D., the FDA’s acting chief scientist. “We are issuing this guidance for immediate implementation in order to better protect the U.S. blood supply.”

While there have been no reports to date of Zika virus entering the U.S. blood supply, the risk of blood transmission is considered likely based on the most current scientific evidence of how Zika virus and similar viruses (flaviviruses) are spread and recent reports of transfusion-associated infection outside of the U.S. Furthermore, about 4 out of 5 of those infected with Zika virus do not become symptomatic. For these reasons, the FDA is recommending that blood establishments defer blood donations from individuals in accordance with the new guidance.

In areas without active Zika virus transmission, the FDA recommends that donors at risk for Zika virus infection be deferred for four weeks. Individuals considered to be at risk include: those who have had symptoms suggestive of Zika virus infection during the past four weeks, those who have had sexual contact with a person who has traveled to, or resided in, an area with active Zika virus transmission during the prior three months, and those who have traveled to areas with active transmission of Zika virus during the past four weeks.

In areas with active Zika virus transmission, the FDA recommends that Whole Blood and blood components for transfusion be obtained from areas of the U.S. without active transmission. Blood establishments may continue collecting and preparing platelets and plasma if an FDA-approved, pathogen-reduction device is used. The guidance also recommends blood establishments update donor education materials with information about Zika virus signs and symptoms and ask potentially affected donors to refrain from giving blood…

PDF: Recommendations for Donor Screening, Deferral, and Product Management to Reduce the Risk of Transfusion-Transmission of Zika Virus; Guidance for Industry (PDF – 111KB)
Posted: 2/16/2016

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Zika Open
[Bulletin of the World Health Organization]
:: New Papers available here

Update on Zika virus transmission in the Pacific islands, 2007 to February 2016 and failure of acute flaccid paralysis surveillance to signal Zika emergence in this setting
– Adam T Craig, Michelle T Butler, Roberta Pastmore, Beverley J Paterson, David N Durrheim
Posted: 19 February 2016

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CDC [to 20 February 2016]
http://www.cdc.gov/media/index.html
FRIDAY, FEBRUARY 19, 2016
Updated Guidelines for Healthcare Providers Caring for Infants or Children with Possible Zika Virus Infection
CDC has updated its interim guidelines for healthcare providers who care for infants and children with possible Zika virus infection.

THURSDAY, FEBRUARY 18, 2016
CDC adds 2 destinations to interim travel guidance related to Zika virus
CDC is working with other public health officials to monitor for ongoing Zika virus? transmission. Today, CDC added the following destinations to the Zika virus travel notices: Aruba and Bonaire…

MMWR February 19, 2016 / Vol. 65 / No. 6
:: Local Transmission of Zika Virus — Puerto Rico, November 23, 2015–January 28, 2016
:: Notes from the Field: Evidence of Zika Virus Infection in Brain and Placental Tissues from Two Congenitally Infected Newborns and Two Fetal Losses — Brazil, 2015

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Global Virus Network
http://gvn.org/
February 11, 2016
GVN Launches Zika Task Force
Global Virus Network (GVN) Launches Zika Task Force Comprised of Leading Virus Researchers from Around the Globe
GVN catalyzes international collaborations in an effort to address the urgent need to share information and research to better combat the global Zika outbreak

Baltimore, MD: The Global Virus Network (GVN), representing 35 Centers of Excellence and 5 Affiliates in 26 countries, and comprising foremost experts in every class of virus causing disease in humans, today announced the formation of the GVN Zika Task Force chaired by Scott Weaver, PhD, who is also co-chairman for the GVN Chikungunya Task Force and is director of the University of Texas Medical Branch’s Institute for Human Infections and Immunity and scientific director of the Galveston National Laboratory, a GVN Center of Excellence. The GVN Zika Task force, which is expected to grow, fills a gap identified by leading scientists to catalyze urgent international collaborative research. The announcement was made today by Robert Gallo, MD, co-founder of the GVN and chair of GVN’s Scientific Leadership Board and José Esparza, MD, PhD, president of the GVN.

“I am pleased to chair GVN’s Zika Task Force which will serve as a catalyst for driving communication and information flow between fellow GVN colleagues researching and responding to the Zika epidemic gripping much of Central and South America and the Caribbean,” said Dr. Weaver. “Our research team has been studying Zika virus for several years now, including working with countries such as Senegal to study enzootic ecology as well as Brazil and Mexico in developing sensitive diagnostics to identify those infected and follow the epidemiology of these outbreaks.” Dr. Weaver continued, “We look forward to beginning nonhuman primate model development next month and continuing vaccine research, and to coordinating efforts with others in the GVN Zika Task Force in these efforts.”…

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World Bank [to 20 February 2016]
http://www.worldbank.org/en/news/all
February 18, 2016
World Bank Provides $150 Million to Combat Zika Virus In Latin America and the Caribbean
Initial regional economic impact projected to be moderate but requires urgent action to halt virus spread
WASHINGTON,— In order to support countries in Latin America and the Caribbean affected by the Zika virus outbreak, the World Bank Group announced today that it has made US$150 million immediately available.

This amount is based on current country demands for financing and follows extensive engagement with governments across the region, including sending teams of technical experts to affected countries. If additional financing is needed, the World Bank Group stands ready to increase its support.

This announcement was accompanied by the release of initial projections that the short-term economic impact of the Zika virus on the region will be modest, totaling US$3.5 billion, or 0.06% of GDP in 2016. The World Bank Group noted, however, that these initial estimates are predicated on a swift, well-coordinated international response to the Zika virus. They also assume that the most significant health risks—and related behaviors to avoid transmission—are for pregnant women. This follows the World Health Organization’s February 1 declaration of the suspected link between Zika virus infection during pregnancy and microcephaly in newborns.

Even with these assumptions, however, a group of countries highly dependent on tourism—notably in the Caribbean—could suffer losses in excess of 1 percent of GDP and may require additional support from the international community to stem the economic impact of the virus. As new knowledge continues to emerge about Zika virus transmission and impact, or should public perceptions of risks from Zika rise sharply, the economic impacts will be reassessed…

EBOLA/EVD [to 20 February 2016]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

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Ebola Situation Reports
[While no announcement of a change in reporting cycle is evident, we deduce that Ebola Situation Reports have been reduced to a bi-weekly cycle given the spacing of the last few reports (previous update at 3 February 2016)]
Ebola Situation Report – 17 February 2016
SUMMARY [Excerpts]
:: Human-to-human transmission directly linked to the 2014 Ebola virus disease (EVD) outbreak in West Africa was declared to have ended in Sierra Leone on 7 November 2015. The country then entered a 90-day period of enhanced surveillance… On 14 January, 68 days into the 90-day surveillance period, a new confirmed case of EVD was reported after a post-mortem swab collected from a deceased 22-year-old woman tested positive for Ebola virus. On 20 January, the aunt of the index case developed symptoms and tested positive for Ebola virus… All contacts linked to the two cases had completed follow-up by 11 February 2016. Efforts to locate several untraced contacts in the district of Kambia will continue until at least 24 February. If no further cases are detected, transmission linked to this cluster of cases will be declared to have ended on 17 March.

:: Human-to-human transmission linked to the most recent cluster of cases in Liberia was declared to have ended on 14 January 2016. Guinea was declared free of Ebola transmission on 29 December 2015, and is approximately halfway through a 90-day period of enhanced surveillance that is due to end on 27 March 2016.

:: With guidance from WHO and other partners, ministries of health in Guinea, Liberia, and Sierra Leone have plans to deliver a package of essential services to safeguard the health of the estimated more than 10 000 survivors of EVD, and enable those individuals to take any necessary precautions to prevent infection of their close contacts. Over 300 male survivors in Liberia have accessed semen screening and counselling services. In addition, over 2600 survivors in Sierra Leone have accessed a general health assessment and eye exam…

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WHO Updates
Relief for families impacted by Ebola flare-up
February 2016
Sierra Leone is once again counting down the days until the latest flare-up of Ebola can be declared over. As part of the inter-agency response to the flare-up, dozens of people who were in contact with two individuals who had tested positive for Ebola were isolated and placed under medical observation. With the monitoring period now over, they are breathing a sigh of relief as their lives get back to normal.

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CDC [to 20 February 2016]
http://www.cdc.gov/media/index.html
THURSDAY, FEBRUARY 18, 2016
Enhanced Entry Airport Screening and Routing for Ebola to End for Travelers from Guinea to the United States
On Feb. 19, 2016, the Centers for Disease Control and Prevention (CDC) and the Department of Homeland Security (DHS) will remove Guinea from the list of nations affected by Ebola…

WHO & Regionals [to 20 February 2016]

Weekly Epidemiological Record (WER) 19 February 2016, vol. 91, 7 (pp. 73–88) –
:: Zika virus infection: global update on epidemiology and potentially associated clinical manifestations
:: Risk communication – A moving target in the fight against infectious hazards and epidemics
:: Monthly report on dracunculiasis cases, January– December 2015

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:: WHO Regional Offices
WHO African Region AFRO
:: Experts wrap up workshop on cancer registries
Brazzaville 12 February 2016 – Cancer control experts from nineteen French-speaking countries in Africa wrapped up a five-day workshop aimed at building their capacity to tackle the rising tide of cancer in the Region. The workshop which began on 8 February 2016, in Brazzaville, Congo brought together over forty high-level participants from ministries of health. It was organized by the World Health Organization Regional Office for Africa in collaboration with the International Atomic Energy Agency (IAEA), International Agency for Research on Cancer (IARC), African Cancer Registries Network (AFCRN) and the Registre des cancers de Brazzaville…

WHO Region of the Americas PAHO
:: PAHO defines excess levels of sugar, salt and fat in processed food and drink products (02/19/2016)
:: PAHO and EQUATOR Network provide tools in Portuguese to promote excellence in research reporting
(02/19/2016)
:: PAHO aims for faster diagnosis, more integration in combat against Zika, Dengue and Chikungunya viruses
(02/15/2016)

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

WHO European Region EURO
:: Newly updated training aims to improve quality of care for mothers and newborns 19-02-2016
:: Risk assessment of the 2015–2016 influenza season confirms that A(H1N1) is circulating as a seasonal virus but is included in the vaccine 18-02-2016

WHO Eastern Mediterranean Region EMRO
:: WHO reaches 5 besieged areas in Syria with life-saving medicines
19 February 2016
:: WHO condemns multiple attacks on health facilities in the Syrian Arab Republic
17 February 2016 – WHO is appalled at the recent attacks on health care facilities in the Syrian Arab Republic. These attacks have resulted in at least 14 people being killed, including 4 health care workers, and have left many others severely injured. Sadly, such attacks on health facilities and health workers are increasing in both frequency and scale. These attacks have severe immediate and long-term consequences, depriving Syria’s most vulnerable populations of life-saving health care.
:: Is Zika on our doorstep?
17 February 2016

WHO Western Pacific Region
No new digest content identified.

CDC/ACIP [to 20 February 2016]
http://www.cdc.gov/media/index.html
http://www.cdc.gov/vaccines/acip/
[see Zika and Ebola coverage above which includes CDC briefing content]

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ACIP Meeting – February 24, 2016 (Wednesday only)
Meeting Webcast Instructions
Registration is NOT required to watch the live meeting webcast or to listen via telephone.
DRAFT AGENDA[2 pages] (as of January 25)

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MMWR February 19, 2016 / Vol. 65 / No. 6
http://www.cdc.gov/mmwr/mmwr_wk.html
:: Update: Influenza Activity — United States, October 4, 2015–February 6, 2016
:: Local Transmission of Zika Virus — Puerto Rico, November 23, 2015–January 28, 2016
:: Notes from the Field: Evidence of Zika Virus Infection in Brain and Placental Tissues from Two Congenitally Infected Newborns and Two Fetal Losses — Brazil, 2015
:: Notes from the Field: Administration Error Involving a Meningococcal Conjugate Vaccine — United States, March 1, 2010–September 22, 2015
:: Notes from the Field: Nosocomial Outbreak of Middle East Respiratory Syndrome in a Large Tertiary Care Hospital — Riyadh, Saudi Arabia, 2015

EU launches new European Medical Corps to respond faster to emergencies
Date: 15/02/2016
The European Union today launches the European Medical Corps to help mobilise medical and public health teams and equipment for emergencies inside and outside the EU

Through the European Medical Corps, EU Member States and other European countries participating in the system can make medical teams and assets available for rapid deployment before an emergency strikes – thus ensuring a faster and more predictable response. The medical corps could include emergency medical teams, public health and medical coordination experts, mobile biosafety laboratories, medical evacuation planes and logistical support teams.

“The aim of the European Medical Corps is to create a much faster and more efficient EU response to health crises when they occur. We need to learn the lessons from the Ebola response; a key difficulty was mobilising medical teams. I thank all the Member States that have already contributed so far, and encourage others to join so the EU’s response will be able to meet increasing needs and will allow for better planning and preparation before any disaster.” said Commissioner Christos Stylianides who is hosting today’s high-level inauguration event in Brussels.

The framework for the European Medical Corps is part of the EU Civil Protection Mechanism’s new European Emergency Response Capacity (otherwise known as the ‘voluntary pool’). So far Belgium, Czech Republic, Finland, France, Luxembourg, Germany, Spain, Sweden and the Netherlands have already committed teams and equipment to the voluntary pool.

Background
A key difficulty during the Ebola virus outbreak response was the quick deployment of medical staff, as well as the logistical and management challenges which increased as a result. This led Germany and France in late 2014 to propose the “White Helmets” initiative, which laid the foundations. The European Medical Corps is now part of the European Emergency Response Capacity.

The EU Civil Protection Mechanism facilitates cooperation in disaster response among 33 European states (28 EU Member States, the former Yugoslav Republic of Macedonia, Iceland, Montenegro, Norway and Serbia). Turkey is also in the process of joining the Mechanism. These participating states pool the resources that can be made available to disaster-stricken countries all over the world. When activated, the Mechanism coordinates the provision of assistance inside and outside the European Union. The European Commission manages the Mechanism through the Emergency Response Coordination Centre.

In an effort to step up the EU’s preparedness and response to disasters, the European Emergency Response Capacity (‘voluntary pool’) was created in 2014, bringing together a range of pre-committed relief teams and equipment, for deployment in emergency response operations all over the world.

The European Medical Corps will also be Europe’s contribution to the Global Health Emergency Workforce being set up under the helm of the World Health Organisation.

:: Fact Sheet – EU launches new European Medical Corps to respond faster to emergencies –
Date: 15/02/2016
:: WHO Director-General launches the European Medical Corps
Brussels, Belgium 15 February 2016

IAVI International AIDS Vaccine Initiative [to 20 February 2016]
http://www.iavi.org/press-releases/2016

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February 17, 2016
IAVI Announces Continued Funding from Dutch Government
The International AIDS Vaccine Initiative (IAVI) is happy to announce continued funding from the Dutch Government, a longtime partner in the mission to ensure a safe, effective and accessible AIDS vaccine.

The Netherlands Ministry of Foreign Affairs will provide 16 million Euros (approximately US$18 million) to IAVI over five years to help accelerate the development of AIDS vaccine candidates effective for and accessible to the people most impacted by the epidemic, notably those in developing countries. This support under the Product Development Partnership III Fund extends through September 2020…

Sabin Vaccine Institute [to 20 February 2016]
http://www.sabin.org/updates/ressreleases

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02.16.16
Workshop Pays Off Through Increased Immunization Budgets
In June 2015, immunization officials from Senegal, Mali and Cameroon came together in Dakar, Senegal, to discuss expenditure tracking mechanisms used by countries to improve budget accountability for immunization.

IVI [to 20 February 2016]
http://www.ivi.org/web/www/home

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5 February, 2016
Dr. In-Kyu Yoon on Yonhap News about Zika
IVI’s Dr. In-Kyu Yoon, IVI Deputy Director General of Science and Director of the Dengue Vaccine Initiative, sat down with a reporter from Yonhap News to answer questions about Zika, which is causing concern in South Korea. Dr. Yoon, who has spent years studying flaviviruses like dengue and Zika, is among the few Zika experts in South Korea.

“The probability of Zika immediately spreading in Korea is very low. However, it remains uncertain what will happen over a period of time and if conditions are met.” Dr. Yoon In-Kyu, Director of the Dengue Vaccine Initiative (DVI) at the International Vaccine Institute (IVI), is a Zika virus expert in South Korea.

In an interview with Yonhap News at IVI on February 4, Dr. Yoon repeated “It is uncertain” several times. He said, “It is because adequate studies have not been conducted yet.” Zika virus generally causes mild febrile illness. Signs and symptoms also entail rash and conjunctivitis…

Global Fund [to 20 February 2016]
http://www.theglobalfund.org/en/news/

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17 February 2016
Organization of Islamic Cooperation and the Global Fund Strengthen Partnership
JEDDAH, Saudi Arabia – The Secretary General of the Organization of the Islamic Conference (OIC), Iyad Ameen Madani, praised the support that the Global Fund extends to the member states of the OIC.

At a meeting with senior representatives of the Global Fund on 16 February, the Secretary General stressed that the OIC will continue to support the Global Fund’s efforts…

…The Global Fund is a major supporter of health efforts in OIC member states. Today, 50 of the 57 OIC member states are implementing programs supported by the Global Fund to fight diseases and build resilient and sustainable systems for health.

With US$11.3 billion signed in grants, 2.7 million people are currently receiving treatment for HIV, 5.3 million cases of TB have been detected and treated, 320 million mosquito nets have been distributed to prevent malaria and 1.6 million orphans and vulnerable children are receiving basic care and support services.

Center for Global Development [to 20 February 2016]
http://www.cgdev.org/page/press-center
Selected Press Releases, Blog Posts, Publications

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Next Generation Financing for Global Health: What, Why, When, How?
2/16/16
Amanda Glassman and Rachel Silverman
Many researchers and policymakers have hypothesized that funding models tying grant payments to achieved and verified results — next generation financing models — offer an opportunity for global health funders to push forward their strategic interests and accelerate the impact of their investments. This brief, summarizing the conclusions of a CGD working group on the topic, outlines concrete steps global health funders can take to change the basis of payment of their grants from expenses (inputs) to outputs, outcomes, or impact.

PATH [to 20 February 2016]
http://www.path.org/news/index.php

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Announcement | February 17, 2016
PATH to host inaugural conference focused on new vaccines against diarrheal disease
Submit an abstract, register for the conference, or apply for a travel grant on the conference website
PATH is convening a new biennial scientific conference series focused on making vaccines for Shigella and enterotoxigenic Escherichia coli (ETEC), two leading causes of diarrheal disease, a reality for children in the developing world. The inaugural Vaccines Against Shigella and ETEC (VASE) Conference will be held June 28 to 30, 2016, in Washington, DC. In order to make this conference as accessible as possible, there is no cost to register to attend and a limited number of travel grants are available.

The VASE Conference will bring together scientists, public health professionals, immunization leaders, vaccine industry representatives, international donors, and other experts from across the globe to work toward the goal of developing and introducing new enteric vaccines. Conference participants will share and discuss various research topics and ideas about vaccines that address human enteric diseases. PATH intends for this meeting to provide a highly collaborative, interactive environment that will spark innovation in the field and boost the momentum for Shigella and ETEC vaccine research and development.

PATH is currently accepting abstracts of original work for presentation at the conference. The deadline for abstract submissions is March 1, 2016. While the primary focus of the conference is on Shigella and ETEC, there are also many other enteric diseases emerging as important causes of illness and death among infants and children in the developing world. For this reason, PATH aims to include broader work on other pathogens in the conference program, so that the field can learn from work across the spectrum of neglected enteric diseases.

Each year, nearly 600,000 children younger than five years of age die from severe, dehydrating diarrhea and dysentery worldwide, and millions more are hospitalized, mostly in low-resource countries. In addition, many more children suffer from diarrheal disease-associated malnutrition and its adverse effects on physical and cognitive development that perpetuate the cycle of poverty. Insufficient data exist, but conservative estimates suggest that Shigella and ETEC are responsible for almost one-third of child deaths from diarrhea, as well as many deaths in older age groups. Prevention through vaccination is a critical part of the strategy to reduce the impact of diarrheal disease, and currently there are no licensed vaccines against either pathogen.
For more information, please visit the VASE Conference website

American Journal of Preventive Medicine
March 2016 Volume 50, Issue 3, p295-426, e65-e90
http://www.ajpmonline.org/current

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Research Articles
Sex of Sexual Partners and Human Papillomavirus Vaccination Among U.S. Girls and Women
Madina Agénor, Heather L. McCauley, Sarah M. Peitzmeier, Sebastien Haneuse, Allegra R. Gordon, Jennifer Potter, S. Bryn Austin
p318–327
Published online: November 12 2015
Abstract
Introduction
Girls and women are at risk of human papillomavirus (HPV) infection and cervical cancer from male and female sexual partners throughout the life course. However, no study has assessed how sex of sexual partners, a dimension of sexual orientation, may relate to HPV vaccination among girls and women.
Methods
In 2014, data from the 2006–2010 National Survey of Family Growth were used to conduct logistic regression analyses estimating the relationship between sex of lifetime and past-year sexual partners and HPV vaccine awareness and initiation among U.S. girls and women aged 15–25 years (N=3,253).
Results
Among U.S. girls and women aged 15–25 years, the prevalence of HPV vaccine awareness and HPV vaccine initiation was 84.4% and 28.5%, respectively. Adjusting for sociodemographic factors, participants with only female past-year sexual partners had significantly lower odds of initiating HPV vaccination relative to those with only male past-year sexual partners (OR=0.16, 95% CI=0.05, 0.55). Similarly, respondents with no lifetime (OR=0.65, 95% CI=0.46, 0.92) or past-year (OR=0.69, 95% CI=0.50, 0.94) sexual partners had significantly lower adjusted odds of HPV vaccine initiation compared with those with only male sexual partners. No difference was apparent in the odds of initiating HPV vaccination between participants with male and female sexual partners and those with only male sexual partners.
Conclusions
Medical and public health professionals should ensure that girls and women with only female or no sexual partners are included in HPV vaccine education and promotion efforts.

American Journal of Public Health
Volume 106, Issue 3 (March 2016)
http://ajph.aphapublications.org/toc/ajph/current

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AJPH LAW & ETHICS
EBOLA VACCINE
Ethical Rationale for the Ebola “Ring Vaccination” Trial Design
Annette Rid, Franklin G. Miller
American Journal of Public Health: March 2016, Vol. 106, No. 3: 432–435.
Abstract |
The 2014 Ebola virus epidemic is the largest and most severe ever recorded. With no approved vaccines or specific treatments for Ebola, clinical trials were launched within months of the epidemic in an unprecedented show of global partnership. One of these trials used a highly innovative “ring vaccination” design. The design was chosen for operational, scientific, and ethical reasons—in particular, it was regarded as ethically superior to individually randomized placebo-controlled trials.

We scrutinize the ethical rationale for the ring vaccination design. We argue that the ring vaccination design is ethical but fundamentally equivalent to placebo-controlled designs with respect to withholding a potentially effective intervention from the control group.
We discuss the implications for the ongoing ring vaccination trial and future research.

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 20 February 2016)

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Research article
Factors influencing completion of multi-dose vaccine schedules in adolescents: a systematic review
K. E. Gallagher, E. Kadokura, L. O. Eckert, S. Miyake, S. Mounier-Jack, M. Aldea, D. A. Ross and D. Watson-Jones
BMC Public Health 2016 16:172
Published on: 19 February 2016
Abstract
Background
Completion of multiple dose vaccine schedules is crucial to ensure a protective immune response, and maximise vaccine cost-effectiveness. While barriers and facilitators to vaccine uptake have recently been reviewed, there is no comprehensive review of factors influencing subsequent adherence or completion, which is key to achieving vaccine effectiveness. This study identifies and summarises the literature on factors affecting completion of multi-dose vaccine schedules by adolescents.
Methods
Ten online databases and four websites were searched (February 2014). Studies with analysis of factors predicting completion of multi-dose vaccines were included. Study participants within 9–19 years of age were included in the review. The defined outcome was completion of the vaccine series within 1 year among those who received the first dose.
Results
Overall, 6159 abstracts were screened, and 502 full texts were reviewed. Sixty one studies were eligible for this review. All except two were set in high-income countries. Included studies evaluated human papillomavirus vaccine, hepatitis A, hepatitis B, and varicella vaccines. Reported vaccine completion rates, among those who initiated vaccination, ranged from 27 % to over 90 %. Minority racial or ethnic groups and inadequate health insurance coverage were risk factors for low completion, irrespective of initiation rates. Parental healthcare seeking behaviour was positively associated with completion. Vaccine delivery in schools was associated with higher completion than delivery in the community or health facilities. Gender, prior healthcare use and socio-economic status rarely remained significant risks or protective factors in multivariate analysis.
Conclusions
Almost all studies investigating factors affecting completion have been carried out in developed countries and investigate a limited range of variables. Increased understanding of barriers to completion in adolescents will be invaluable to future new vaccine introductions and the further development of an adolescent health platform.
PROSPERO reg# CRD42014006765.

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Research article
Reducing routine vaccination dropout rates: evaluating two interventions in three Kenyan districts, 2014
Adam Haji, S. Lowther, Z. Ngan’ga, Z. Gura, C. Tabu, H. Sandhu and Wences Arvelo
BMC Public Health 2016 16:152
Published on: 16 February 2016
Abstract
Background
Globally, vaccine preventable diseases are responsible for nearly 20 % of deaths annually among children <5 years old. Worldwide, many children dropout from the vaccination program, are vaccinated late, or incompletely vaccinated. We evaluated the impact of text messaging and sticker reminders to reduce dropouts from the vaccination program.
Methods
The evaluation was conducted in three selected districts in Kenya: Machakos, Langata and Njoro. Three health facilities were selected in each district, and randomly allocated to send text messages or provide stickers reminding parents to bring their children for second and third dose of pentavalent vaccine, or to the control group (routine reminder) with next appointment date indicated on the well-child booklet. Children aged <12 months presenting for their first dose of pentavalent vaccine were enrolled. A dropout was defined as not returning for vaccination ≥2 weeks after scheduled date for third dose of pentavalent vaccine. We calculated dropout rate as a percentage of the difference between first and third pentavalent dose.
Results
We enrolled 1,116 children; 372 in each intervention and 372 controls between February and October 2014. Median age was 45 days old (range: 31–99 days), and 574 (51 %) were male. There were 136 (12 %) dropouts. Thirteen (4 %) children dropped out among those who received text messages, 60 (16 %) among who received sticker reminders, and 63 (17 %) among the controls. Having a caregiver with below secondary education [Odds Ratio (OR) 1.8, 95 % Confidence Interval (CI) 1.1–3.2], and residing >5 km from health facility (OR 1.6, CI 1.0–2.7) were associated with higher odds of dropping out. Those who received text messages were less likely to drop out compared to controls (OR 0.2, CI 0.04–0.8). There was no statistical difference between those who received stickers and controls (OR 0.9, CI 0.5–1.6).
Conclusion
Text message reminders can reduce vaccination dropout rates in Kenya. We recommend the extended implementation of text message reminders in routine vaccination services.

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Research article
The first mile: community experience of outbreak control during an Ebola outbreak in Luwero District, Uganda
A major challenge to outbreak control lies in early detection of viral haemorrhagic fevers (VHFs) in local community contexts during the critical initial stages of an epidemic, when risk of spreading is its highest…
Daniel H. de Vries, Jude T. Rwemisisi, Laban K. Musinguzi, Turinawe E. Benoni, Denis Muhangi, Marije de Groot, David Kaawa-Mafigiri and Robert Pool
BMC Public Health 2016 16:161
Published on: 16 February 2016

BMC Cost Effectiveness and Resource Allocation
http://resource-allocation.biomedcentral.com/
(Accessed 20 February 2016)

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Research
The economic burden of childhood pneumococcal diseases in The Gambia
Effua Usuf, Grant Mackenzie, Sana Sambou, Deborah Atherly and Chutima Suraratdecha
Published on: 17 February 2016
Abstract
Background
Streptococcus pneumoniae is a common cause of child death. However, the economic burden of pneumococcal disease in low-income countries is poorly described. We aimed to estimate from a societal perspective, the costs incurred by health providers and families of children with pneumococcal diseases.
Methods
We recruited children less than 5 years of age with outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and bacterial meningitis at facilities in rural and urban Gambia. We collected provider costs, out of pocket costs and productivity loss for the families of children. For each disease diagnostic category, costs were collected before, during, and for 1 week after discharge from hospital or outpatient visit.
Results
A total of 340 children were enrolled; 100 outpatient pneumonia, 175 inpatient pneumonia 36 pneumococcal sepsis, and 29 bacterial meningitis cases. The mean provider costs per patient for treating outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and meningitis were US$8, US$64, US$87 and US$124 respectively and the mean out of pocket costs per patient were US$6, US$31, US$44 and US$34 respectively. The economic burden of outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and meningitis increased to US$15, US$109, US$144 and US$170 respectively when family members’ time loss from work was taken into account.
Conclusion
The economic burden of pneumococcal disease in The Gambia is substantial, costs to families was approximately one-third to a half of the provider costs, and accounted for up to 30 % of total societal costs. The introduction of pneumococcal conjugate vaccine has the potential to significantly reduce this economic burden in this society.

British Medical Journal
20 February 2016 (vol 352, issue 8045)
http://www.bmj.com/content/352/8045

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Research Update
Publication and reporting of clinical trial results: cross sectional analysis across academic medical centers
BMJ 2016; 352 :i637 (Published 17 February 2016)
Abstract
Objective
To determine rates of publication and reporting of results within two years for all completed clinical trials registered in ClinicalTrials.gov across leading academic medical centers in the United States.
Design
Cross sectional analysis.
Setting
Academic medical centers in the United States.
Participants
Academic medical centers with 40 or more completed interventional trials registered on ClinicalTrials.gov.
Methods
Using the Aggregate Analysis of ClinicalTrials.gov database and manual review, we identified all interventional clinical trials registered on ClinicalTrials.gov with a primary completion date between October 2007 and September 2010 and with a lead investigator affiliated with an academic medical center.
Main outcome measures
The proportion of trials that disseminated results, defined as publication or reporting of results on ClinicalTrials.gov, overall and within 24 months of study completion.
Results
We identified 4347 interventional clinical trials across 51 academic medical centers. Among the trials, 1005 (23%) enrolled more than 100 patients, 1216 (28%) were double blind, and 2169 (50%) were phase II through IV. Overall, academic medical centers disseminated results for 2892 (66%) trials, with 1560 (35.9%) achieving this within 24 months of study completion. The proportion of clinical trials with results disseminated within 24 months of study completion ranged from 16.2% (6/37) to 55.3% (57/103) across academic medical centers. The proportion of clinical trials published within 24 months of study completion ranged from 10.8% (4/37) to 40.3% (31/77) across academic medical centers, whereas results reporting on ClinicalTrials.gov ranged from 1.6% (2/122) to 40.7% (72/177).
Conclusions
Despite the ethical mandate and expressed values and mission of academic institutions, there is poor performance and noticeable variation in the dissemination of clinical trial results across leading academic medical centers.

Eurosurveillance
Volume 21, Issue 7, 18 February 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Surveillance report
Hepatitis B vaccination coverage and risk factors associated with incomplete vaccination of children born to hepatitis B surface antigen-positive mothers, Denmark, 2006 to 2010
by A Kunoee, J Nielsen, S Cowan

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Research Articles
Vaccine effectiveness in preventing laboratory-confirmed influenza in primary care patients in a season of co-circulation of influenza A(H1N1)pdm09, B and drifted A(H3N2), I-MOVE Multicentre Case–Control Study, Europe 2014/15
by M Valenciano, E Kissling, A Reuss, C Rizzo, A Gherasim, J Horváth, L Domegan, D Pitigoi, A Machado, I Paradowska-Stankiewicz, A Bella, A Larrauri, A Ferenczi, Joan O´Donell, M Lazar, P Pechirra, M Korczyńska, F Pozo, A Moren, on behalf of the I-MOVE multicentre case–control team

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 20 February 2016]

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Research
The 10 largest public and philanthropic funders of health research in the world: what they fund and how they distribute their funds
Roderik F. Viergever and Thom C. C. Hendriks
Published on: 18 February 2016
Abstract
Background
Little is known about who the main public and philanthropic funders of health research are globally, what they fund and how they decide what gets funded. This study aims to identify the 10 largest public and philanthropic health research funding organizations in the world, to report on what they fund, and on how they distribute their funds.
Methods
The world’s key health research funding organizations were identified through a search strategy aimed at identifying different types of funding organizations. Organizations were ranked by their reported total annual health research expenditures. For the 10 largest funding organizations, data were collected on (1) funding amounts allocated towards 20 health areas, and (2) schemes employed for distributing funding (intramural/extramural, project/‘people’/organizational and targeted/untargeted funding). Data collection consisted of a review of reports and websites and interviews with representatives of funding organizations. Data collection was challenging; data were often not reported or reported using different classification systems.
Results
Overall, 55 key health research funding organizations were identified. The 10 largest funding organizations together funded research for $37.1 billion, constituting 40% of all public and philanthropic health research spending globally. The largest funder was the United States National Institutes of Health ($26.1 billion), followed by the European Commission ($3.7 billion), and the United Kingdom Medical Research Council ($1.3 billion). The largest philanthropic funder was the Wellcome Trust ($909.1 million), the largest funder of health research through official development assistance was USAID ($186.4 million), and the largest multilateral funder was the World Health Organization ($135.0 million). Funding distribution mechanisms and funding patterns varied substantially between the 10 largest funders.
Conclusions
There is a need for increased transparency about who the main funders of health research are globally, what they fund and how they decide on what gets funded, and for improving the evidence base for various funding models. Data on organizations’ funding patterns and funding distribution mechanisms are often not available, and when they are, they are reported using different classification systems. To start increasing transparency in health research funding, we have established http://www.healthresearchfunders.org that lists health research funding organizations worldwide and their health research expenditures.

Journal of Epidemiology & Community Health
March 2016, Volume 70, Issue 3
http://jech.bmj.com/content/current

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Editorial
Methods to estimate maternal mortality: a global perspective
Serena Donati, Alice Maraschini, Marta Buoncristiano, the Regional Maternal Mortality Working Group
Author Affiliations
National Centre for Epidemiology, Surveillance, and Health Promotion—Istituto Superiore di Sanità, Italian National Institute of Health, Rome Italy
Extract
The maternal mortality ratio (MMR) is globally a reproductive health core indicator, and the death of a woman, while pregnant or within 42 days of termination of pregnancy, is always, anywhere and anyway, a tragedy for the entire community. Reducing the MMR is one of the Millennium Development Goals and the UN Global strategy for women’s and children’s health mobilised multiple resources and commitments to accelerate this objective.1 However MMR estimates and accurate identification of the causes of maternal death are still a complex and difficult challenge. In most developing country settings, owing to the lack of complete and accurate civil registration systems, MMR estimates are based on data from a variety of alternative sources including censuses, household surveys, reproductive age mortality studies and verbal autopsies.2 The WHO classified 183 countries/territories according to the availability and quality of maternal mortality data: 67 countries (covering 17% of births) having complete civil registration data with good attribution of causes of death, 96 countries (covering 81% of births) having incomplete civil registration and/or other types of maternal mortality data and 20 countries (covering 2% of births) lacking national data on maternal mortality. For the last two categories, a regression model has been developed to estimate maternal mortality figures.3 The Demographic and Health Surveys Program4 uses the sisterhood method for Maternal Mortality estimations. This method remains the major source of empirical data on maternal mortality in developing countries, although it presents notable limitations.

Journal of Epidemiology & Community Health
March 2016, Volume 70, Issue 3
http://jech.bmj.com/content/current

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Ebola, jobs and economic activity in Liberia
Jeremy Bowles, Jonas Hjort, Timothy Melvin, Eric Werker
J Epidemiol Community Health 2016;70:271-277 Published Online First: 5 October 2015 doi:10.1136/jech-2015-205959
Abstract
Background
The 2014 Ebola virus disease (EVD) outbreak in the neighbouring West African countries of Guinea, Liberia and Sierra Leone represents the most significant setback to the region’s development in over a decade. This study provides evidence on the extent to which economic activity declined and jobs disappeared in Liberia during the outbreak.
Methods
To estimate how the level of activity and number of jobs in a given set of firms changed during the outbreak, we use a unique panel data set of registered firms surveyed by the business-development non-profit organisation, Building Markets. We also compare the change in economic activity during the outbreak, across regions of the country that had more versus fewer Ebola cases in a difference-in-differences approach.
Findings
We find a large decrease in economic activity and jobs in all of Liberia during the Ebola outbreak, and an especially large decline in Monrovia. Outside of Monrovia, the restaurants, and food and beverages sectors have suffered the most among the surveyed sectors, and in Monrovia, the construction and restaurant sectors have shed the most employees, while the food and beverages sectors experienced the largest drop in new contracts. We find little association between the incidence of Ebola cases and declines in economic activity outside of Monrovia.
Conclusions
If the large decline in economic activity that occurred during the Ebola outbreak persists, a focus on economic recovery may need to be added to the efforts to rebuild and support the healthcare system in order for Liberia to regain its footing.

Journal of Epidemiology & Community Health
March 2016, Volume 70, Issue 3
http://jech.bmj.com/content/current

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Immunisation coverage in rural–urban migrant children in low and middle-income countries (LMICs): a systematic review and meta-analysis
Abiyemi Benita Awoh, Emma Plugge
J Epidemiol Community Health 2016;70:305-311 Published Online First: 7 September 2015 doi:10.1136/jech-2015-205652
Abstract
Background
The majority of children who die from vaccine-preventable diseases (VPDs) live in low-income and-middle-income countries (LMICs). With the rapid urbanisation and rural–urban migration ongoing in LMICs, available research suggests that migration status might be a determinant of immunisation coverage in LMICs, with rural–urban migrant (RUM) children being less likely to be immunised.
Objectives
To examine and synthesise the data on immunisation coverage in RUM children in LMICs and to compare coverage in these children with non-migrant children.
Methods A multiple database search of published and unpublished literature on immunisation coverage for the routine Expanded Programme on Immunisation (EPI) vaccines in RUM children aged 5 years and below was conducted. Following a staged exclusion process, studies that met the inclusion criteria were assessed for quality and data extracted for meta-analysis.
Results
Eleven studies from three countries (China, India and Nigeria) were included in the review. There was substantial statistical heterogeneity between the studies, thus no summary estimate was reported for the meta-analysis. Data synthesis from the studies showed that the proportion of fully immunised RUM children was lower than the WHO bench-mark of 90% at the national level. RUMs were also less likely to be fully immunised than the urban-non-migrants and general population. For the individual EPI vaccines, all but two studies showed lower immunisation coverage in RUMs compared with the general population using national coverage estimates.
Conclusions
This review indicates that there is an association between rural–urban migration and immunisation coverage in LMICs with RUMs being less likely to be fully immunised than the urban non-migrants and the general population. Specific efforts to improve immunisation coverage in this subpopulation of urban residents will not only reduce morbidity and mortality from VPDs in migrants but will also reduce health inequity and the risk of infectious disease outbreaks in wider society.

The Lancet
Feb 20, 2016 Volume 387 Number 10020 p717-816
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
An ambitious agenda for humanity
The Lancet
As highlighted in today’s Lancet, protracted conflicts continue to harm human health and wellbeing. In Yemen, 21 million of 24 million people are now in need of humanitarian assistance and 15 million lack access to health care (see World Report). In Syria, despite a recent ceasefire agreement, fighting looks set to continue into its sixth year. A letter in this issue draws attention to the plight of the 1 million Syrian children who have been orphaned by the war.

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Comment
Zika virus and microcephaly: why is this situation a PHEIC?
David L Heymann, Abraham Hodgson, Amadou Alpha Sall, David O Freedman, J Erin Staples, Fernando Althabe, Kalpana Baruah, Ghazala Mahmud, Nyoman Kandun, Pedro F C Vasconcelos, Silvia Bino, K U MenonPublished Online: 10 February 2016
Summary
When the Director-General of WHO declared, on Feb 1, 2016, that recently reported clusters of microcephaly and other neurological disorders are a Public Health Emergency of International Concern (PHEIC),1 it was on the advice of an Emergency Committee of the International Health Regulations and of other experts whom she had previously consulted. We are the members of the Emergency Committee, and we were identified by the Director-General from rosters of experts that had been submitted by WHO Member States.

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Health Policy
Moving towards universal health coverage: lessons from 11 country studies
Michael R Reich, Joseph Harris, Naoki Ikegami, Akiko Maeda, Cheryl Cashin, Edson C Araujo, Keizo Takemi, Timothy G Evans
Summary
In recent years, many countries have adopted universal health coverage (UHC) as a national aspiration. In response to increasing demand for a systematic assessment of global experiences with UHC, the Government of Japan and the World Bank collaborated on a 2-year multicountry research programme to analyse the processes of moving towards UHC. The programme included 11 countries (Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam), representing diverse geographical, economic, and historical contexts. The study identified common challenges and opportunities and useful insights for how to move towards UHC. The study showed that UHC is a complex process, fraught with challenges, many possible pathways, and various pitfalls—but is also feasible and achievable. Movement towards UHC is a long-term policy engagement that needs both technical knowledge and political know-how. Technical solutions need to be accompanied by pragmatic and innovative strategies that address the national political economy context.

New England Journal of Medicine
February 18, 2016 Vol. 374 No. 7
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
Zika Virus in the Americas — Yet Another Arbovirus Threat
A.S. Fauci and D.M. Morens
[Extract; Free full text]
The explosive pandemic of Zika virus infection occurring throughout South America, Central America, and the Caribbean and potentially threatening the United States is the most recent of four unexpected arrivals of important arthropod-borne viral diseases in the Western Hemisphere over the past 20 years. It follows dengue, which entered this hemisphere stealthily over decades and then more aggressively in the 1990s; West Nile virus, which emerged in 1999; and chikungunya, which emerged in 2013. Are the successive migrations of these viruses unrelated, or do they reflect important new patterns of disease emergence? Furthermore, are there secondary health consequences of this arbovirus pandemic that set it apart from others?..

Original Articles
Clinical Management of Ebola Virus Disease in the United States and Europe
T.M. Uyeki and Others

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 20 February 2016)

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Essay
The Health Care Consequences Of Australian Immigration Policies
John-Paul Sanggaran, Bridget Haire, Deborah Zion
Essay | published 16 Feb 2016 | PLOS Medicine
10.1371/journal.pmed.1001960
Summary Points
:: In Australia, immigration policy is to incarcerate those seeking asylum in order to deter others from coming.
:: Within this environment, health care providers frequently experience “dual loyalty” conflict, whereby they cannot serve the interests of both their patients and their employers.
:: The ratification of the Optional Protocol to the Convention Against Torture (OPCAT) would allow for domestic and international monitoring of places of detention, which would serve to ameliorate some of the most problematic aspects of the detention system, including the undemocratic lack of transparency.
:: This would assist in resolving the “dual loyalty” conflict that health care workers must contend with in the current situation.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 20 February 2016)

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Research Article
Concerted Efforts to Control or Eliminate Neglected Tropical Diseases: How Much Health Will Be Gained?
Sake J. de Vlas, Wilma A. Stolk, Epke A. le Rutte, Jan A. C. Hontelez, Roel Bakker, David J. Blok, Rui Cai, Tanja A. J. Houweling, Margarete C. Kulik, Edeltraud J. Lenk, Marianne Luyendijk, Suzette M. Matthijsse, William K. Redekop, Inge Wagenaar, Julie Jacobson, Nico J. D. Nagelkerke, Jan H. Richardus
Research Article | published 18 Feb 2016 | PLOS Neglected Tropical Diseases
10.1371/journal.pntd.0004386
Abstract
Background
The London Declaration (2012) was formulated to support and focus the control and elimination of ten neglected tropical diseases (NTDs), with targets for 2020 as formulated by the WHO Roadmap. Five NTDs (lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths and trachoma) are to be controlled by preventive chemotherapy (PCT), and four (Chagas’ disease, human African trypanosomiasis, leprosy and visceral leishmaniasis) by innovative and intensified disease management (IDM). Guinea worm, virtually eradicated, is not considered here. We aim to estimate the global health impact of meeting these targets in terms of averted morbidity, mortality, and disability adjusted life years (DALYs).
Methods
The Global Burden of Disease (GBD) 2010 study provides prevalence and burden estimates for all nine NTDs in 1990 and 2010, by country, age and sex, which were taken as the basis for our calculations. Estimates for other years were obtained by interpolating between 1990 (or the start-year of large-scale control efforts) and 2010, and further extrapolating until 2030, such that the 2020 targets were met. The NTD disease manifestations considered in the GBD study were analyzed as either reversible or irreversible. Health impacts were assessed by comparing the results of achieving the targets with the counterfactual, construed as the health burden had the 1990 (or 2010 if higher) situation continued unabated.
Principle Findings/Conclusions
Our calculations show that meeting the targets will lead to about 600 million averted DALYs in the period 2011–2030, nearly equally distributed between PCT and IDM-NTDs, with the health gain amongst PCT-NTDs mostly (96%) due to averted disability and amongst IDM-NTDs largely (95%) from averted mortality. These health gains include about 150 million averted irreversible disease manifestations (e.g. blindness) and 5 million averted deaths. Control of soil-transmitted helminths accounts for one third of all averted DALYs. We conclude that the projected health impact of the London Declaration justifies the required efforts.
Author Summary
Neglected tropical diseases (NTDs) are a group of infectious diseases that occur mostly in poor, warm countries. NTDs are caused by various bacteria and parasites, such as worms. They can either be cured or prevented through drugs and other interventions, such as control of insects that spread the infection. The London Declaration is a statement by various organizations, including the World Health Organization (WHO) and pharmaceutical companies that donate the necessary drugs. The declaration endorses targets for disease reductions by 2020, as recently formulated in the WHO Roadmap, to be achieved by rigorous application of available interventions. We explore how much health can be gained if these targets are indeed achieved. We estimate that in such case 5 million deaths can be averted before 2030 and also that huge reductions in ill-health and disability can be realized. Over the period 2011–2030, a total health gain would be accomplished of about 600 million disability adjusted life years (DALYs) averted. DALYs are a measure of disease burden, consisting of life years lost and years lived with disability. This enormous health gain seems to justify similar investments as for e.g. HIV or malaria control.

Science
19 February 2016 Vol 351, Issue 6275
http://www.sciencemag.org/current.dtl

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Perspectives
Beyond Ebola
By Janet Currie, Bryan Grenfell, Jeremy Farrar
Science19 Feb 2016 : 815-816
[Free full text]
Summary
On 14 January 2016, Liberia was declared Ebola-free. A new case was identified shortly after the announcement, but it is nevertheless clear that the West African epidemic has moved on to a more hopeful phase. What lessons can be drawn from the Ebola crisis to help the international community to prepare for and respond to the next global epidemic? This question is particularly pertinent given the recent declaration of the Zika virus as a public health emergency.

Vaccine
Volume 34, Issue 9, Pages 1139-1232 (24 February 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/9
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Conference report
Beyond efficacy: The full public health impact of vaccines
Pages 1139-1147
Mitra Saadatian-Elahi, Olaf Horstick, Robert F. Breiman, Bradford D. Gessner, Duane J. Gubler, Jacques Louis, Umesh D. Parashar, Roberto Tapia, Valentina Picot, Jean-Antoine Zinsou, Christopher B. Nelson
Abstract
There is an active discussion in the public health community on how to assess and incorporate, in addition to safety and measures of protective efficacy, the full public health value of preventive vaccines into the evidence-based decision-making process of vaccine licensure and recommendations for public health use. The conference “Beyond efficacy: the full public health impact of vaccines in addition to efficacy measures in trials” held in Annecy, France (June 22–24, 2015) has addressed this issue and provided recommendations on how to better capture the whole public health impact of vaccines.
Using key examples, the expert group stressed that we are in the midst of a new paradigm in vaccine evaluation, where all aspects of public health value of vaccines beyond efficacy should be evaluated. To yield a wider scope of vaccine benefits, additional measures such as vaccine preventable disease incidence, overall efficacy and other outcomes such as under-five mortality or non-etiologically confirmed clinical syndromes should be assessed in addition to traditional efficacy or effectiveness measurements. Dynamic modelling and the use of probe studies should also be considered to provide additional insight to the full public health value of a vaccine. The use of burden reduction and conditional licensure of vaccines based on collection of outcome results should be considered by regulatory agencies.

Vaccine
Volume 34, Issue 9, Pages 1139-1232 (24 February 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/9
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Brief report
Trends in differences between births and surviving infants reported for immunization program planning and external data sources in Eastern and Southern Africa 2000–2013
Pages 1148-1151
Reinhard Kaiser, Jethro M. Chakauya, Messeret E. Shibeshi, Immunization, Vaccines, Emergencies Unit of the Inter-country Support Team for East, Southern Africa, World Health Organization Regional Office for Africa, Harare, Zimbabwe
Abstract
To inform our WHO team’s support for immunization programs in Member States in Eastern and Southern Africa, we compared annual trends from 2000 to 2013 in target populations reported by Member States through the WHO-UNICEF joint reporting form with United Nations (UN) population projections and modeled infant mortality estimates from the UN Inter-agency Group for Child Mortality Estimation. Our findings indicated a tendency of underestimating births and surviving infants used by Member States as denominators for administrative immunization coverage rates, resulting in or contributing to overestimation of coverage. The difference with UN estimates appeared to be more pronounced for surviving infants than births. Measures of central tendency for individual country differences indicated that those differences decreased over time. Comparing trends of births and surviving infants with external sources can help monitoring progress in efforts to provide accurate and reliable target population estimates and sampling frames.

Vaccine
Volume 34, Issue 9, Pages 1139-1232 (24 February 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/9
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Provider communication and HPV vaccination: The impact of recommendation quality
Original Research Article
Pages 1187-1192
Melissa B. Gilkey, William A. Calo, Jennifer L. Moss, Parth D. Shah, Macary W. Marciniak, Noel T. Brewer
Abstract
Background
Receiving a healthcare provider’s recommendation is a strong predictor of HPV vaccination, but little is known empirically about which types of recommendation are most influential. Thus, we sought to investigate the relationship between recommendation quality and HPV vaccination among U.S. adolescents.
Methods
In 2014, we conducted a national, online survey of 1495 parents of 11–17-year-old adolescents. Parents reported whether providers endorsed HPV vaccination strongly, encouraged same-day vaccination, and discussed cancer prevention. Using an index of these quality indicators, we categorized parents as having received no, low-quality, or high-quality recommendations for HPV vaccination. Separate multivariable logistic regression models assessed associations between recommendation quality and HPV vaccine initiation (≥1 dose), follow through (3 doses, among initiators), refusal, and delay.
Results
Almost half (48%) of parents reported no provider recommendation for HPV vaccination, while 16% received low-quality recommendations and 36% received high-quality recommendations. Compared to no recommendation, high-quality recommendations were associated with over nine times the odds of HPV vaccine initiation (23% vs. 74%, OR = 9.31, 95% CI, 7.10–12.22) and over three times the odds of follow through (17% vs. 44%, OR = 3.82, 95% CI, 2.39–6.11). Low-quality recommendations were more modestly associated with initiation (OR = 4.13, 95% CI, 2.99–5.70), but not follow through. Parents who received high- versus low-quality recommendations less often reported HPV vaccine refusal or delay.
Conclusions
High-quality recommendations were strongly associated with HPV vaccination behavior, but only about one-third of parents received them. Interventions are needed to improve not only whether, but how providers recommend HPV vaccination for adolescents.

Vaccine
Volume 34, Issue 9, Pages 1139-1232 (24 February 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/9
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Evaluation of measles–rubella vaccination for mothers in early puerperal phase
Original Research Article
Pages 1208-1214
Michi Hisano, Tatsuo Kato, Eisuke Inoue, Haruhiko Sago, Koushi Yamaguchi
Abstract
Background
The postpartum period is an ideal opportunity to vaccinate mothers with inadequate immunity to vaccine-preventable diseases including measles and rubella.
Methods
A prospective study of measles–rubella (MR) vaccination in the early puerperal phase was conducted in 171 mothers, who had insufficient antibody titers when screened for immunity to measles (≤1:4 on the neutralization test [NT]) or rubella (≤1:16 on the hemagglutination inhibition [HI] test) during pregnancy. To evaluate the efficacy of MR vaccination in the postpartum period, we determined their post-vaccination antibody titers and immune responses to vaccination, and investigated the association between these and their prolactin (PRL) levels and Th1/Th2 ratios at the time of vaccination. We also examined the passage of viral RNA and antigen into breast milk.
Results
Of the 169 participants who completed the study schedule, 117 and 101 had low antibody titers against measles and rubella, respectively. In the measles-seronegative group, the antibody-positive rate was 87% on the NT assay, and the NT geometric mean antibody titer was 11.4 (95% confidence interval [CI], 10.0–13.0). In the rubella-seronegative group, the antibody-positive rate was 88% on the HI test assay, and the HI geometric mean antibody titer was 64.0 (95% CI, 53.9–76.0). There was no association between the post-vaccination antibody titers and the PRL levels or Th1/Th2 ratios at the time of vaccination. In the rubella-seronegative group, subjects with higher Th1/Th2 ratios showed higher rates of responsiveness than those with lower ratios (P = 0.045). Although measles virus RNA was isolated from the breast milk of two vaccinated mothers, breastfeeding was not associated with clinical disease in any infants.
Conclusion
MR vaccination in the early puerperal phase is considered an effective way to prevent the diseases, regardless of the mother’s immunological status and hormonal milieu.

International Journal of Cancer
15 April 2016 Volume 138, Issue 8
http://onlinelibrary.wiley.com/doi/10.1002/ijc.v138.8/issuetoc
Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)

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Research Article
Quadrivalent HPV vaccine effectiveness against high-grade cervical lesions by age at vaccination: A population-based study
Eva Herweijer1,*, Karin Sundström2, Alexander Ploner1, Ingrid Uhnoo3, Pär Sparén1 and
Lisen Arnheim-Dahlström1
DOI: 10.1002/ijc.30035
Abstract
Human papillomavirus (HPV) types 16/18, included in HPV vaccines, contribute to the majority of cervical cancer, and a substantial proportion of cervical intraepithelial neoplasia (CIN) grades 2/3 or worse (CIN2+/CIN3+) including adenocarcinoma in situ or worse. The aim of this study was to quantify the effect of quadrivalent HPV (qHPV) vaccination on incidence of CIN2+ and CIN3+. A nationwide cohort of girls and young women resident in Sweden 2006-2013 and aged 13-29 (n=1,333,691) was followed for vaccination and histologically confirmed high-grade cervical lesions. Data were collected using the Swedish nationwide healthcare registers. Poisson regression was used to calculate incidence rate ratios (IRRs) and vaccine effectiveness [(1-IRR)x100%] comparing fully vaccinated with unvaccinated individuals. IRRs were adjusted for attained age and parental education, and stratified on vaccination initiation age. Effectiveness against CIN2+ was 75% (IRR=0.25, 95%CI=0.18-0.35) for those initiating vaccination before age 17, and 46% (IRR=0.54, 95%CI=0.46-0.64) and 22% (IRR=0.78, 95%CI=0.65-0.93) for those initiating vaccination at ages 17-19, and at ages 20-29, respectively. Vaccine effectiveness against CIN3+ was similar to vaccine effectiveness against CIN2+. Results were robust for both women participating to the organized screening program and for women at pre-screening ages. We show high effectiveness of qHPV vaccination on CIN2+ and CIN3+ lesions, with greater effectiveness observed in girls younger at vaccination initiation. Continued monitoring of impact of HPV vaccination in the population is needed in order to evaluate both long-term vaccine effectiveness and to evaluate whether the vaccination program achieves anticipated effects in prevention of invasive cervical cancer.

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_13 February 2016

– blog edition: comprised of the approx. 35+ entries posted below on 15 February 2016.

– Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
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– Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.

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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

Statement on Data Sharing in Public Health Emergencies
The arguments for sharing data, and the consequences of not doing so, have been thrown into stark relief by the Ebola and Zika outbreaks.

In the context of a public health emergency of international concern, there is an imperative on all parties to make any information available that might have value in combatting the crisis.

We are committed to working in partnership to ensure that the global response to public health emergencies is informed by the best available research evidence and data, as such:
:: Journal signatories will make all content concerning the Zika virus free to access. Any data or preprint deposited for unrestricted dissemination ahead of submission of any paper will not pre-empt its publication in these journals.
:: Funder signatories will require researchers undertaking work relevant to public health emergencies to set in place mechanisms to share quality-assured interim and final data as rapidly and widely as possible, including with public health and research communities and the World Health Organisation.

We urge other organisations to make the same commitments. This commitment is in line with the consensus statement agreed at a WHO expert consultation on data sharing last year whereby researchers are expected to share data at the earliest opportunity, once they are adequately controlled for release and subject to any safeguards required to protect research participants and patients.

Signatories to the Statement
Academy of Medical Sciences, UK
Bill and Melinda Gates Foundation
Biotechnology and Biological Sciences Research Council (BBSRC)
The British Medical Journal (BMJ)
Bulletin of the World Health Organization
Canadian Institutes of Health Research
The Centers for Disease Control and Prevention
Chinese Academy of Sciences
Chinese Centre for Disease Control and Prevention
The Department of Biotechnology, Government of India
The Department for International Development (DFID)
Deutsche Forschungsgemeinschaft (DFG)
eLife
The Economic and Social Research Council (ESRC)
F1000
Fondation Mérieux
Fundação Oswaldo Cruz (Fiocruz)
The Institut Pasteur
Japan Agency for Medical Research and Development (AMED)
The JAMA Network
The Lancet
Médecins Sans Frontières/Doctors Without Borders (MSF)
National Academy of Medicine
National Institutes of Health, USA
National Science Foundation, USA
The New England Journal of Medicine (NEJM)
PLOS
Science Journals
South African Medical Research Council
Springer Nature
UK Medical Research Council
Wellcome Trust
ZonMw – The Netherlands Organisation for Health Research and Development

Zika virus [to 13 February 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

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Situation report: Zika and potential complications – 12 February 2016
http://www.who.int/emergencies/zika-virus/situation-report/en/
Summary
:: WHO has called for a coordinated and multisectoral response through an inter-agency Strategic Response Framework focusing on response, surveillance and research.

:: 39 countries have reported locally acquired circulation of the virus since January 2007. Geographical distribution of the virus has steadily expanded.

:: Six countries (Brazil, French Polynesia, El Salvador, Venezuela, Colombia and Suriname) have reported an increase in the incidence of cases of microcephaly and/or Guillain-Barré syndrome (GBS) in conjunction with an outbreak of the Zika virus. Puerto Rico and Martinique have reported cases of GBS associated with Zika virus infection without an increase of incidence. No scientific evidence to date confirms a link between Zika virus and microcephaly or GBS.

:: Women’s reproductive health has been thrust into the limelight with the spread of the Zika virus. The latest evidence suggests that Zika virus infection during pregnancy may be linked to microcephaly in newborn babies.

:: WHO advice on travel to Zika-affected countries includes advice for pregnant women as well as women who are trying to become pregnant and their sexual partners.
Read the full situation report

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Zika Open
[Bulletin of the World Health Organization]
EDITORIAL
Data sharing in public health emergencies: a call to researchers
– Christopher Dye, Kidist Bartolomeos, Vasee Moorthy, Marie Paule Kieny
Posted: 4 February 2016 http://dx.doi.org/10.2471/BLT.16.170860
…The deficiencies with existing data-sharing mechanisms, which were highlighted during the 2013–16 Ebola epidemic in west Africa, have brought the question of data access to the forefront of the global health agenda.2 In September 2015, agreement was reached on the need for open sharing of data and results, especially in public health emergencies.3 Subsequently, following published expressions of support by its members, the International Committee of Medical Journal Editors (ICMJE) have explicitly confirmed that pre-publication dissemination of information critical to public health will not prejudice journal publication in the context of a public health emergency declared by WHO.4 While efforts so far have focused on results from clinical trials, and on making full accompanying data sets available at the time of publication, there are further opportunities to expand access to information from observational studies, operational research, routine surveillance and the monitoring of disease control programmes.

To improve timely access to data in the context of a public health emergency, the Bulletin of the World Health Organization will implement a new data sharing and reporting protocol. The protocol is established specifically to address the data gap that exists in responding to the current Zika virus epidemic and, in the first instance, will apply only to articles submitted in the context of this outbreak…
…Given the number and complexity of unanswered questions on the mechanisms and consequences of Zika infection and associated disease, our goal is to encourage all researchers to share their data as quickly and widely as possible. With this protocol for immediate online posting, we are providing another means to achieve immediate global access to relevant data. Researchers can thus share their data while meeting their need to retain authorship, achieve precedence, and put their research on public record. We are pleased to announce that the first paper to which this protocol applies is now available online.7
:: New Papers available here

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WHO involvement in Zika R&D
8 February 2016
WHO is currently mapping existing R&D for Zika in order to prioritize medical products and approaches that should be fast-tracked into development. These will be reviewed by expert advisory committees as soon as possible. As of today, most research that could be useful for Zika has been carried out on other flaviviruses – such as dengue or yellow fever.

Diagnostics are a top urgency in order to ascertain the presence of the Zika virus as opposed to other similar diseases caused by flaviviruses with mosquito vectors. Very few test are available. A call to interested companies and other groups was issued on 5 February to submit potential products to the WHO ‘Emergency Assessment and Listing’ procedure. This procedure, once a product has been accepted, guarantees acceptable levels of quality and performance and allows UN agencies, NGOs and countries to procure the product with confidence.

There are at least 12 groups working on Zika vaccines; all are in the early stages of development and availability of licensed products could take a few years.

Some studies are being carried out on prophylactic therapeutics that would work in the same way as prophylaxis for malaria. Fogging followed by the controlled release of genetically modified mosquitoes may be worth considering for halting the spread of Zika.

WHO is also working on:
:: Establishing regulatory support networks to fast-track approval of clinical trials in countries
:: Advocacy on timely samples and data sharing among groups undertaking R&D studies on Zika, to ensure the best science is brought to bear on research and development.

WHO’s R&D efforts on Zika are part of the overall work on a roadmap – the R&D Blueprint – for better R&D preparedness based on the experience of the R&D work carried out during the West-Africa Ebola outbreak. The roadmap will enable roll-out of an emergency R&D response as early and as efficiently as possible for emerging diseases for which there are no, or few, countermeasures. In December 2015, WHO held a consultation to identify a short-list of pathogens to be prioritized immediately for R&D preparedness. Zika was identified as a serious risk, needing further action as soon as possible.

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WHO: Disease Outbreak News (DONs) [Zika]
:: 12 February 2016 – Zika virus infection – United States of America
:: 12 February 2016 – Microcephaly – United States of America
:: 12 February 2016 – Guillain-Barré syndrome – Colombia and Venezuela
:: 8 February 2016 – Guillain-Barré syndrome – Brazil
:: 8 February 2016 – Guillain-Barré syndrome – France – Martinique
:: 8 February 2016 – Zika virus infection – Maldives
:: 8 February 2016 – Zika virus infection – Region of the Americas

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WHO: Women in the context of microcephaly and Zika virus disease
Online Q&A
10 February 2016
The risk of babies born with microcephaly has raised understandable concerns among women including those who are pregnant or planning to become pregnant. There are many unknowns regarding the possible causes of microcephaly. Until we have more answers, there are ways that women can protect themselves from Zika infection.

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CDC/ACIP [to 13 February 2016]
http://www.cdc.gov/media/index.html
http://www.cdc.gov/vaccines/acip/
MONDAY, FEBRUARY 8, 2016
CDC Emergency Operations Center moves to highest level of activation for Zika response
To further enhance its response to the Zika virus outbreak, CDC’s Emergency Operations Center is moving to a Level 1 activation—reflecting the agency’s assessment of the need for an accelerated preparedness to bring together experts to focus intently and work efficiently in anticipation of local Zika virus transmission by mosquitoes in the Continental U.S…

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IOM
Research Priorities to Inform Public Health and Medical Practice for Domestic Zika Virus: A Workshop
February 16, 2016 (8:30 AM EST/US)
Open Meeting
Activity Description
At the request of the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary of Preparedness and Response (ASPR), the National Academies of Sciences, Engineering, and Medicine will host a one-day public workshop on February 16, 2016 to explore potential research priorities arising as a result of the emergence of Zika virus in the United States…

…There is an urgent need for additional research to better characterize the Zika virus, especially those issues related to means of transmission and infection during pregnancy. Additional epidemiologic, entomologic, and virology research of the Zika virus under real-world conditions could provide a more robust evidence base to inform medical and public health efforts to protect those at-risk. Such research could also provide much needed answers to questions about health risks and appropriate public health and medical interventions.

This workshop will bring together key stakeholders and experts to discuss the research priorities needed to inform medical and public health practice that can be implemented under real world conditions to better understand the true risk that Zika virus poses to the public in the U.S. and adequate prevention efforts and interventions to mitigate that risk.

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The White House [U.S.] [to 13 February 2016]
https://www.whitehouse.gov/briefing-room/statements-and-releases
Selected Statements and Releases
FACT SHEET: Preparing for and Responding to the Zika Virus at Home and Abroad
February 08, 2016
Since late last year, the Administration has been aggressively working to combat Zika, a virus primarily spread by mosquitoes that has recently been linked to birth defects and other concerning health outcomes. The Federal Government has been monitoring the Zika virus and working with our domestic and international public health partners to alert healthcare providers and the public about Zika; provide public health laboratories with diagnostic tests; and detect and report cases both domestically and internationally.

The Administration is taking every appropriate measure to protect the American people, and today announced that it is asking Congress for more than $1.8 billion in emergency funding to enhance our ongoing efforts to prepare for and respond to the Zika virus, both domestically and internationally. The Administration will submit a formal request to Congress shortly…
…The requested resources will build on our ongoing preparedness efforts and will support essential strategies to combat this virus, such as rapidly expanding mosquito control programs; accelerating vaccine research and diagnostic development; enabling the testing and procurement of vaccines and diagnostics; educating health care providers, pregnant women and their partners; improving epidemiology and expanding laboratory and diagnostic testing capacity; improving health services and supports for low-income pregnant women, and enhancing the ability of Zika-affected countries to better combat mosquitoes and control transmission…

[Funding request excerpts; Editor’s text bolding]
Department of Health and Human Services – $1.48 billion
Centers for Disease Control and Prevention – $828 million. The request includes funding to support prevention and response strategies through the following activities:
:: Support Zika virus readiness and response capacity in States and territories with mosquito populations that are known to transmit Zika virus, with a priority focus on areas with ongoing Zika transmission;
:: Enhance mosquito control programs through enhanced laboratory, epidemiology and surveillance capacity in at-risk areas to reduce the opportunities for Zika transmission;
:: Establish rapid response teams to limit potential clusters of Zika virus in the United States;
:: Improve laboratory capacity and infrastructure to test for Zika virus and other infectious diseases;
:: Implement surveillance efforts to track Zika virus in communities and in mosquitoes;
:: Deploy targeted prevention and education strategies with key populations, including pregnant women, their partners, and health care professionals;
:: Expand the CDC Pregnancy Risk Assessment Monitoring System, improve Guillain Barré syndrome tracking, and ensure the ability of birth defect registries across the country to detect risks related to Zika;
:: Increase research into the link between Zika virus infections and the birth defect microcephaly and measure changes in incidence rates over time;
:: Enhance international capacity for virus surveillance, expand the Field Epidemiology Training program, laboratory testing, health care provider training, and vector surveillance and control in countries at highest risk of Zika virus outbreaks; and
:: Improve diagnostics for Zika virus, including advanced methods to refine tests, and support advanced developments for vector control.

Centers for Medicare and Medicaid Services – $250 million
The request seeks a temporary one-year increase in Puerto Rico’s Medicaid Federal Medical Assistance Percentage (FMAP) to provide an estimated $250 million in additional Federal assistance to support health services for pregnant women at risk of infection or diagnosed with Zika virus and for children with microcephaly, and other health care costs…

Vaccine Research and Diagnostic Development & Procurement – $200 million
The request includes $200 million for research, rapid advanced development and commercialization of new vaccines and diagnostic tests for Zika virus. It includes funding for the National Institutes of Health to build upon existing resources and work to develop a vaccine for Zika virus and the chikungunya virus, which is spread by the same type of mosquito. Funding will accelerate this work and improve scientific understanding of the disease to inform the development of additional tools to combat it. The request also includes resources for the Food and Drug Administration to support Zika virus medical product development including the next generation diagnostic devices.

Other HHS Response Activities – $210 million
The request includes funding to establish a new Urgent and Emerging Threat Fund to address Zika virus and other outbreaks. This funding would be available to support emerging needs related to Zika, including additional support to States for emerging public health response needs should mosquito populations known to be potential Zika carriers migrate to additional States…

U.S. Agency for International Development – $335 million
The request includes investments to support affected countries’ ability to control mosquitoes and the transmission of the virus; support maternal health; expand public education on prevention and response; and create new incentives for the development of vaccines and diagnostics. The request would also provide flexibility in the use of remaining USAID Ebola funds. Activities would focus particularly on South America, Central America, the Caribbean…

U.S. Department of State – $41 million
The funding request includes support for U.S. citizens in affected countries, medical support for State Department employees in affected countries, public diplomacy, communications, and other operations activities. State would also support the World Health Organization and its regional arm, the Pan American Health Organization (PAHO), to minimize the Zika threat in affected countries while reducing the risk of further spreading the virus. These resources will support critical public health actions underway, including preparedness, surveillance, data collection, and risk communication. Activities would also include support for UNICEF’s Zika response efforts in Brazil; activities to bolster diagnostic capabilities through deployment of equipment and specialized training.

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European Medicines Agency [to 13 February 2016]
http://www.ema.europa.eu/
08/02/2016
EMA sets up task force on Zika virus
European experts to provide support to global response on the emerging epidemic
The European Medicines Agency (EMA) has established a task force of European experts with specialised knowledge in vaccines, infectious diseases and other relevant expertise to contribute to the global response to the threat of the Zika virus infection. This group will be available to give advice on any scientific and regulatory matters for the research and development of medicines or vaccines against the virus…

…The Agency is encouraging medicines developers to contact EMA if they have any promising projects in this area. EMA will also proactively reach out to companies already planning to work on investigational vaccines and offer scientific and regulatory advice. EMA will review any new information as soon as it becomes available to support the response to this widening public health crisis.

During a health emergency such as the Zika virus outbreak, EMA works closely with European bodies, including the European Commission and the European Centre for Disease Prevention and Control (ECDC) and with international partners such as WHO and other international regulators from affected countries…

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Sabin Vaccine Institute [to 13 February 2016]
http://www.sabin.org/updates/ressreleases
Monday, February 8, 2016
Statement on the World Health Organization’s Declaration of a Public Health Emergency International Concern for Zika Virus
…The Sabin Vaccine Institute supports the WHO decision to declare the recent outbreak of Zika virus a global health emergency. We believe the highly infectious nature of Zika’s growing outbreak, coupled with its possible link to birth defects and other neurological conditions, warrants urgent collaboration among global health partners to accelerate the development of a sustainable measure against Zika — a vaccine.
To facilitate an efficient and effective response, the global health community must strengthen access to scientific evidence and close knowledge gaps in regions most affected by Zika, building information flows among stakeholders.
Global health advocates must also strengthen vector control initiatives and reinforce public awareness of techniques to prevent mosquito bites, currently the most protective measure available. Practices such as the use of insecticides, eliminating standing water and decreasing skin exposure in areas where the Aedes mosquito has been found should be prioritized and articulated extensively.
Lastly, disseminating previous lessons learned from fighting similar diseases, such as dengue fever, will be instrumental to quickly responding to Zika, assessing the potential for developing a vaccine, keeping communities and international agencies informed and building an integrated response against Zika.

EBOLA/EVD [to 13 February 2016]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

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Ebola Situation Reports
[While no announcement of a change in reporting cycle is evident, we deduce that Ebola Situation Reports have been reduced to a bi-weekly cycle given the spacing of the last few reports (last update at 3 February 2016)]

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Gavi [to 13 February 2016]
http://www.gavialliance.org/library/news/press-releases/
11 February 2016
Japan commits US$ 18.5 million to support immunisation in Ebola-affected region
Pledge from G7 President will help revitalise immunisation services and strengthen health systems.
TOKYO, 10 February 2016 – The Government of Japan has committed US$ 18.5 million to help Gavi restore immunisation services in Ebola-affected countries. The contribution, which is for 2016 and is Japan’s largest to Gavi to date, will also support the strengthening of health systems in 13 countries, including Guinea, Liberia and Sierra Leone, where thousands of children missed out on routine vaccinations during the Ebola outbreak.

State Minister for Foreign Affairs, Seiji Kihara, made the announcement ahead of a meeting in Tokyo last Thursday with new Gavi Board Chair Dr Ngozi Okonjo-Iweala. Japan’s commitment means that all members of the G7, which will be chaired this year by Japan, have now made pledges to Gavi to support childhood immunisation for the 2016 to 2020 period.

Japan’s contribution will help Gavi support work to trace children who missed out on immunisation in the Ebola-hit countries and ensure they are reached through catch-up programmes. The new funding will also help strengthen health systems in the Ebola-affected West Africa region, including purchasing new cold chain equipment to ensure vaccines are stored at the correct temperatures…

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EDCTP [to 13 February 2016]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials.
Ebola grantees have begun collaborations
12 February 2016
Grantees recently selected to conduct a range of research from basic science to implementation research, including capacity development and models of clinical care, have met for an Ebola Virus Disease (EVD) workshop on 10-11 February 2016 in Ghana to share their planned studies, identify collaborations and finalise project plans.

Six grantees are funded by the European & Developing Countries Clinical Trials Partnership (EDCTP), UK Medical Research Council (MRC), National Health Research Institute Carlos III, and the Special Programme for Research and Training in Tropical Diseases (TDR). Another 12 grantees are funded from a separate Canadian Institutes of Health Research (CIHR) grant competition. Coordination between the funders on these calls for proposals from which successful projects have been funded is in keeping with the objectives of the GLOPID-R (Global Research Collaboration for Infectious Diseases Preparedness), and culminated in the organisation of this workshop, bringing 32 collaborators from the 18 grantees together. Each project contains collaborations between African and northern institutions (Europe and Canada).

POLIO [to 13 February 2016]
Public Health Emergency of International Concern (PHEIC)
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Polio this week as of 10 February 2016
:: As we enter February 2016, GPEI bids farewell to Hamid Jafari, the former director of GPEI, whose tenure has seen the removal of Nigeria from the list of polio-endemic countries, certification of the eradication of wild poliovirus type 2, and the lowest number of cases reported in the fewest number of places in any one year. GPEI welcomes Michel Zaffran, former coordinator of the WHO Expanded Programme on Immunization (EPI), as its new director, as we enter a pivotal part of the Endgame Plan.
:: Iraq has introduced the inactivated poliovirus vaccine (IPV) into its routine immunization system. Read more here.
:: Environmental surveillance is playing an increasingly important role in ensuring that the poliovirus is found, wherever it continues to circulate. Find out more about environmental surveillance through this series of photographs.
:: There are nine weeks to go until the globally synchronized switch from the trivalent to bivalent oral polio vaccine, an important milestone in achieving a polio-free world. Read more here.
Selected content from Country updates
Afghanistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week, with onset of paralysis in Shahwalikot, Kandahar, on 20 December 2015. The total number of WPV1 cases for 2015 is now 20, compared to 28 reported in the country in 2014.
Pakistan
:: The first case of wild poliovirus type 1 (WPV1) in 2016 was reported in the past week, with onset of paralysis in Karachi Gadap, Sindh on 17 January 2016. The total number of WPV1 cases for 2016 is now 1, compared to 7 reported for 2015 at this point last year.
Lao People’s Democratic Republic
:: Two new cases of circulating vaccine-derived poliovirus type 1 (cVDPV1) were reported in the past week, in Phonhong and Fueng, Vientiane, with onset of paralysis on 8 January and 11 January 2016 respectively. The total number of cVDPV1 cases in 2016 is 2.

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Notes from the Field: Circulating Vaccine-Derived Poliovirus Outbreaks — Five Countries, 2014–2015
MMWR Weekly / February 12, 2016 / 65(05);128–129
Michelle Morales, MD1,2; Chimeremma D. Nnadi, MD, PhD2; Rudolf H. Tangermann, MD3; Steven G.F. Wassilak, MD2 (View author affiliations)
[Initial text]
In 2015, wild poliovirus (WPV) transmission was identified in only Afghanistan and Pakistan (1). The widespread use of live, attenuated oral poliovirus vaccine (OPV) has been key in polio eradication efforts. However, OPV use, particularly in areas with low vaccination coverage, is associated with the low risk for emergence of vaccine-derived polioviruses (VDPV), which can cause paralysis (2). VDPVs vary genetically from vaccine viruses and can cause outbreaks in areas with low vaccination coverage. Circulating VDPVs (cVDPVs) are VDPVs in confirmed outbreaks. Single VDPVs for which the origin cannot be determined are classified as ambiguous (aVDPVs), which can also cause paralysis. Among the three types of WPV, type 2 has been declared to be eradicated. More than 90% of cVDPV cases have been caused by type 2 cVDPVs (cVDPV2). Therefore, in April 2016, all OPV-using countries of the world are discontinuing use of type 2 Sabin vaccine by simultaneously switching from trivalent OPV (types 1, 2, and 3) to bivalent OPV (types 1 and 3) for routine and supplementary immunization.

The World Health Organization recently broadened the definition of cVDPVs to include any VDPV with genetic evidence of prolonged transmission (i.e., >1.5 years) and indicated that any single VDPV2 event (a case of paralysis caused by a VDPV or isolation of a VDPV from an environmental specimen) should elicit a detailed outbreak investigation and local immunization response. A confirmed cVDPV2 detection should elicit a full poliovirus outbreak response that includes multiple supplemental immunization activities (SIAs); an aVDPV designation should be made only after investigation and response (3). Since 2005, there have been 1–8 cVDPV outbreaks and 3–12 aVDPV events per year. There are currently five active cVDPV outbreaks in Guinea, Laos, Madagascar, Myanmar, and Ukraine, and four other active VDPV events…

WHO & Regionals [to 13 February 2016]

Weekly Epidemiological Record (WER) 12 February 2016, vol. 91, 6 (pp. 61–72)
Contents:
61 Meeting of the International Task Force for Disease Eradication, November 2015
71 Circulating vaccine-derived poliovirus outbreaks in 5 countries, 2014–2015

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Disease Outbreak News (DONs)
:: 12 February 2016 – Yellow Fever – Angola
:: 12 February 2016 – Zika virus infection – United States of America
:: 12 February 2016 – Microcephaly – United States of America
:: 12 February 2016 – Guillain-Barré syndrome – Colombia and Venezuela
:: 10 February 2016 – Human infection with avian influenza A(H7N9) virus – China
:: 8 February 2016 – Guillain-Barré syndrome – Brazil
:: 8 February 2016 – Guillain-Barré syndrome – France – Martinique
:: 8 February 2016 – Zika virus infection – Maldives
:: 8 February 2016 – Zika virus infection – Region of the Americas

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Highlights
Assistive technologies for the elderly and disabled
11 February 2016 — WHO has launched a global survey to gather views on the most necessary and useful assistive technologies, such as hearing aids and wheelchairs. The survey will feed into the first ever WHO mandated list of essential assistive technologies. Governments can use the list to plan and focus efforts to help populations acquire the 50 priority products, thereby improving the everyday lives of the elderly and people living with disabilities.

Deworming campaign targets 270 million children in one day
February 2016 −− An estimated 270 million children across India have received deworming medicine (albendazole) as part of a drive to eliminate intestinal parasitic infections – a widespread problem that affects children’s development.

First WHO Global Meeting of National NCD Programme Directors and Managers
February 2016 — WHO is organizing the First Global Meeting of National NCD Programme Directors and Managers from 15 to 17 February 2016 in Geneva, at the WHO Executive Board Room.

India launches plan to eliminate malaria
February 2016 — India’s Ministry of Health launched an ambitious national roadmap to eliminate malaria. The National Framework for Malaria Elimination in India 2016-2030, aims to reduce malaria case incidence and deaths to 0 over the next 15 years.

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:: WHO Regional Offices
WHO African Region AFRO
:: Official visit of WHO Regional Director for Africa, Dr Moeti to Gabon
Brazzaville/Libreville, 12 February 2016 – The WHO Regional Director for Africa, Dr Matshidiso Moeti is in Libreville, Gabon, for a 5 day official visit and to participate in the 7th Conference of Health Ministers of the Economic Community of Central African States (ECCAS), which begins today…

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

WHO South-East Asia Region SEARO
:: WHO lauds India’s de-worming initiative 10 February 2016

WHO European Region EURO
No new digest content identified.

WHO Eastern Mediterranean Region EMRO
:: WHO welcomes unprecedented international support for Syrians
10 February 2016
:: WHO and Ministry of Health endorse joint action to meet health needs and challenges in Iraq
10 February 2016

WHO Western Pacific Region
No new digest content identified.

CDC/ACIP [to 13 February 2016]
http://www.cdc.gov/media/index.html
http://www.cdc.gov/vaccines/acip/

[see Zika coverage above which includes CDC briefing content]

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ACIP Meeting – February 24, 2016 (Wednesday only)
Meeting Webcast Instructions
Registration is NOT required to watch the live meeting webcast or to listen via telephone.
DRAFT AGENDA[2 pages] (as of January 25)
Deadline for registration:
Non-US Citizens: February 3, 2016
US Citizens: February 10, 2016

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MMWR Weekly – February 12, 2016 / Vol. 65 / No. 5
http://www.cdc.gov/mmwr/mmwr_wk.html
:: Influenza-Related Hospitalizations and Poverty Levels — United States, 2010–2012
:: Interim Guidelines for Prevention of Sexual Transmission of Zika Virus — United States, 2016
:: Update: Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure — United States, 2016
:: Notes from the Field: Circulating Vaccine-Derived Poliovirus Outbreaks — Five Countries, 2014–2015

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Surveillance of Vaccination Coverage Among Adult Populations — United States, 2014
FEBRUARY 5, 2016
Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults is low. Data for 2014 for adult vaccination coverage in the United States indicate that aside from a few minor improvements, vaccination coverage among adults in 2014 was similar to estimates from 2013. This report represents the first comprehensive release of adult vaccination coverage data to include assessment of associations with expanded data on demographic characteristics of respondents including access to health care. These findings can be used by public health practitioners, adult vaccination providers, and the general public to better understand factors that contribute to low vaccination and modify strategies and interventions to improve vaccination coverage.

Global Fund [to 13 February 2016]
http://www.theglobalfund.org/en/news/

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11 February 2016
Global Fund Congratulates India on Launch of Malaria Elimination Framework
NEW DELHI – The Global Fund to Fight AIDS, Tuberculosis and Malaria praised India’s leadership and vision for launching an ambitious national framework to eliminate malaria by 2030, and called the country’s significant progress against the disease an example in global health.

With the support of many partners, India has seen a dramatic decline in malaria rates and malaria deaths. Through combined interventions that include rapid diagnostic tests, artemisinin-based combination therapy, long-lasting insecticidal nets and indoor residual spraying, India is projected to achieve a fall in case incidence of 50-75 percent between 2000 and 2015.

“India is showing others that with commitment, partnership and innovative strategies we can eliminate malaria,” Mark Dybul, Executive Director of the Global Fund, said during the presentation of the National Framework for Malaria Elimination in India 2016-2030 and the Operational Guidelines for Malaria Elimination in India. “This framework is a hugely important step that gets us closer towards that goal.”

J.P. Nadda, Minister of Health and Family Welfare of India, stressed his country’s engagement to eliminate the disease. “I can only assure you that the Government of India fully stands committed to the malaria elimination program, with the support of all stakeholders,” said Nadda.

During a two-day meeting that brought together the Government of India, WHO, academics and the Indian and global public health sector, partners discussed strategies and implementation of the framework, innovation and research, health system strengthening, and shared experiences for malaria elimination.

Under the framework, India aims to eliminate malaria (zero indigenous cases) throughout the entire country by 2030, and maintain malaria-free status in areas where malaria transmission has been interrupted and prevent re-introduction of malaria. Elimination will be undertaken in a phased manner, with states with low incidence rates first, followed by the high-incidence ones.
The framework is in line with the Asia Pacific Leaders’ Malaria Alliance Malaria Elimination Roadmap for 2030…

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09 February 2016
U.S. Demonstrates Strong Commitment to Global Health
GENEVA – The Global Fund to Fight AIDS, Tuberculosis and Malaria expressed deep appreciation for President Barack Obama’s request for US$1.35 billion for the Global Fund in his 2017 budget proposal, calling it a demonstration of great commitment to global health.

“We are privileged to call the United States our partner in efforts to end HIV, tuberculosis and malaria as epidemics,” said Mark Dybul, Executive Director of the Global Fund. “The U.S. has shown extremely strong leadership and continues to rally support from countries and partners worldwide to reach our common goals.”

The United States is the largest supporter of the Global Fund, contributing nearly one-third of overall funding, and connecting it to other U.S.-led efforts on global health. Ground-breaking work by the President’s Emergency Plan for AIDS Relief (PEPFAR) includes the launch of DREAMS, an ambitious partnership to reduce HIV infections among adolescent girls and young women in 10 African countries. The Global Fund also works closely with the President’s Malaria Initiative and with USAID on tuberculosis, to leverage and expand joint efforts…

THE NATIONAL ADULT IMMUNIZATION PLAN (NAIP)
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL VACCINE PROGRAM OFFICE
February 2016 :: 67n pages
Pdf: http://www.hhs.gov/nvpo/national-adult-immunization-plan/naip.pdf

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EXECUTIVE SUMMARY
Vaccination is considered one of the most important public health achievements of the 20th century and continues to offer great promise in the 21st century. Vaccines save lives and improve the quality of life by preventing serious infectious diseases and their consequences. However, the benefits of vaccination are not realized equally across the U.S. population. Adult vaccination rates remain low in the United States, and significant racial and ethnic disparities also exist.

The U.S. Department of Health and Human Services National Vaccine Plan (NVP), released in 2010, is a road map for vaccines and immunization programs for the decade 2010–2020. While the NVP provides a vision for improving protection from vaccine- preventable diseases across the lifespan, vaccination coverage levels among adults are not on track to meet Healthy People 2020 targets. The National Vaccine Advisory Committee and numerous stakeholder groups have emphasized the need for focused attention on adult vaccines and vaccination.1 The National Adult Immunization Plan (NAIP) outlined here results from the recognition that progress has been slow and that there is a need for a national adult immunization strategic plan.

As a national plan, the NAIP will require engagement from a wide range of stakeholders to achieve its full vision. The plan emphasizes collaboration and prioritization of efforts that will have the greatest impact. The NAIP also aims to leverage the unique opportunity presented by the implementation of the Affordable Care Act.

The NAIP is intended to facilitate coordinated action by federal and nonfederal partners to protect public health and achieve optimal prevention of infectious diseases and their consequences through vaccination of adults. The NAIP includes indicators to draw attention to and track progress against core goals. These indicators will measure progress against set standards and inform future implementation and quality improvement efforts.

The plan establishes four key goals, each of which is supported by objectives and strategies to guide implementation through 2020:
Goal 1: Strengthen the adult immunization infrastructure.
Goal 2: Improve access to adult vaccines.
Goal 3: Increase community demand for adult immunizations.
Goal 4: Foster innovation in adult vaccine development and vaccination-related technologies.

Ministerial Conference on Immunization in Africa
TOWARD UNIVERSAL IMMUNIZATION COVERAGE AS A CORNERSTONE FOR HEALTH AND DEVELOPMENT IN AFRICA
February 24-25 in Addis Ababa, Ethiopia.
African leaders—including health and finance ministers—will come together in Addis Ababa, making the conference a powerful platform for governments to demonstrate their commitment to expanding access to vaccines across the continent. The event will also bring together advocates, technical experts, policymakers, donors and journalists to examine how best to drive forward immunization across Africa, ensuring every child has access to the vaccines they need.

Universal access to immunization is at the forefront of enabling Africa to reach its full potential – by improving health, driving economic growth and empowering future generations. Immunization is one of the most cost-effective solutions in global health, with clear benefits for health and development. Vaccines are a major reason child deaths in Africa fell by more than half between 1990 to 2012, saving millions of lives. Immunization brings economic benefits too, reducing health care costs and increasing productivity.

The conference will be hosted by the World Health Organization’s Regional Offices for Africa and for the Eastern Mediterranean in conjunction with the African Union, reflecting the breadth of desire across the continent to drive improvements in access to immunization…

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 13 February 2016)

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Research article
Inequalities in utilization of maternal and child health services in Ethiopia: the role of primary health care
Solomon Tessema Memirie, Stéphane Verguet, Ole F. Norheim, Carol Levin and Kjell Arne Johansson
BMC Health Services Research 2016 16:51
Published on: 12 February 2016
Abstract
Background
Health systems aim to narrow inequality in access to health care across socioeconomic groups and area of residency. However, in low-income countries, studies are lacking that systematically monitor and evaluate health programs with regard to their effect on specific inequalities. We aimed to measure changes in inequality in access to maternal and child health (MCH) interventions and the effect of Primary Health Care (PHC) facilities expansion on the inequality in access to care in Ethiopia.
Methods
The Demographic and Health Survey datasets from Ethiopia (2005 and 2011) were used. We calculated changes in utilization of MCH interventions and child morbidity. Concentration and horizontal inequity indices were estimated. Decomposition analysis was used to calculate the contribution of each determinant to the concentration index.
Results
Between 2005 and 2011, improvements in aggregate coverage have been observed for MCH interventions in Ethiopia. Wealth-related inequality has remained persistently high in all surveys. Socioeconomic factors were the main predictors of differences in maternal and child health services utilization and child health outcome. Utilization of primary care facilities for selected maternal and child health interventions have shown marked pro-poor improvement over the period 2005–2011.
Conclusions
Our findings suggest that expansion of PHC facilities in Ethiopia might have an important role in narrowing the urban-rural and rich-poor gaps in health service utilization for selected MCH intervention.

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 13 February 2016)

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Research article
Measuring the potential of individual airports for pandemic spread over the world airline network
Glenn Lawyer
BMC Infectious Diseases 2016 16:70
Published on: 9 February 2016
Abstract
Background
Massive growth in human mobility has dramatically increased the risk and rate of pandemic spread. Macro-level descriptors of the topology of the World Airline Network (WAN) explains middle and late stage dynamics of pandemic spread mediated by this network, but necessarily regard early stage variation as stochastic. We propose that much of this early stage variation can be explained by appropriately characterizing the local network topology surrounding an outbreak’s debut location.
Methods
Based on a model of the WAN derived from public data, we measure for each airport the expected force of infection (AEF) which a pandemic originating at that airport would generate, assuming an epidemic process which transmits from airport to airport via scheduled commercial flights. We observe, for a subset of world airports, the minimum transmission rate at which a disease becomes pandemically competent at each airport. We also observe, for a larger subset, the time until a pandemically competent outbreak achieves pandemic status given its debut location. Observations are generated using a highly sophisticated metapopulation reaction-diffusion simulator under a disease model known to well replicate the 2009 influenza pandemic. The robustness of the AEF measure to model misspecification is examined by degrading the underlying model WAN.
Results
AEF powerfully explains pandemic risk, showing correlation of 0.90 to the transmission level needed to give a disease pandemic competence, and correlation of 0.85 to the delay until an outbreak becomes a pandemic. The AEF is robust to model misspecification. For 97 % of airports, removing 15 % of airports from the model changes their AEF metric by less than 1 %.
Conclusions
Appropriately summarizing the size, shape, and diversity of an airport’s local neighborhood in the WAN accurately explains much of the macro-level stochasticity in pandemic outcomes.

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 13 February 2016)

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Debate
Ebola vaccine development plan: ethics, concerns and proposed measures
Morenike Oluwatoyin Folayan, Aminu Yakubu, Bridget Haire and Kristin Peterson
Published on: 8 February 2016
Abstract
Background
The global interest in developing therapies for Ebola infection management and its prevention is laudable. However the plan to conduct an emergency immunization program specifically for healthcare workers using experimental vaccines raises some ethical concerns. This paper shares perspectives on these concerns and suggests how some of them may best be addressed.
Discussion
The recruitment of healthcare workers for Ebola vaccine research has challenges. It could result in coercion of initially dissenting healthcare workers to assist in the management of EVD infected persons due to mistaken beliefs that the vaccine offers protection. It could also affect equity and justice. For example, where people who are not skilled health care professionals but who provide care to patients infected with Ebola (such as in home care settings) are not prioritized for vaccination. The possibility of study participants contracting Ebola infection despite the use of experimental vaccine, and the standard of care they would receive, needs to be addressed clearly, transparently and formalized as part of the ethics review process. Future access to study products in view of current status of the TRIPS agreement needs to be addressed. Finally, broad stakeholder engagement at local, regional and international levels needs to be promoted using available communication channels to engage local, regional and international support. These same concerns are applicable for current and future epidemics.
Summary
Successful Ebola vaccine development research requires concerted efforts at public dialogue to address misconceptions, equity and justice in participant selection, and honest discussions about risks, benefits and future access. Public dialogue about Ebola vaccine research plans is crucial and should be conducted by trusted locals and negotiated between communities, researchers and ethics committees in research study sites.

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 13 February 2016)

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Research article
Improved pregnancy outcomes with increasing antiretroviral coverage in South Africa
An improvement in birth outcomes is likely associated with the increased coverage of triple antiretroviral treatment for pregnant women. And untreated HIV infected women and women who do not seek antenatal care should be considered most at risk for poor birth outcomes.
Theron Moodley, Dhayendre Moodley, Motshedisi Sebitloane, Niren Maharaj and Benn Sartorius
Published on: 11 February 2016

Contemporary Clinical Trials
Volume 47, In Progress (March 2016)
http://www.sciencedirect.com/science/journal/15517144/47

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Original Research Article
Deconstructing the measure of vaccine efficacy against disease irrespective of HPV in HPV vaccine clinical trials
Pages 254-258
Oliver M. Bautista, Alain Luxembourg
Abstract
Background
Human papillomavirus (HPV) vaccines were licensed by demonstrating prevention of anogenital disease caused by specific HPV types in clinical studies. Measuring the impact of HPV vaccination on the overall burden of anogenital disease (irrespective of HPV) is an important public health question which is ideally addressed in post-licensure epidemiological studies. Attempts were made to use clinical trial data for that purpose. However, the interpretation of vaccine efficacy on the endpoint of disease irrespective of HPV is not widely understood.
Methods
We used the 9-valent HPV vaccine clinical program as a case study to determine the value of measuring vaccine efficacy in such endpoint. This assessment was rigorously performed by heuristic reasoning and through probability calculations.
Results
The measure of vaccine efficacy in the irrespective of HPV endpoint is driven simultaneously in opposite directions by the high estimate of prophylactic efficacy and a numerically negative estimate of risk reduction that is also a reflection of high prophylactic efficacy and no cross-protection.
Conclusions
The vaccine efficacy estimate in the irrespective of HPV endpoint is ambiguous and difficult to interpret. Comparing this estimate across different HPV vaccine studies requires an understanding of the contributions of vaccine HPV type efficacy and the incidence of disease not related to vaccine HPV types for each study. Without such understanding, comparing studies and drawing conclusions from such comparison are highly misleading. Approaches are proposed to divide this endpoint in components that are easier to interpret.

Development in Practice
Volume 26, Issue 2, 2016
http://www.tandfonline.com/toc/cdip20/current

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African solutions to African problems and the Ebola virus disease in Nigeria
Nathaniel Umukoro
pages 149-157
DOI:10.1080/09614524.2016.1133563
Published online: 10 Feb 2016
ABSTRACT
Africa grapples with the world’s most serious public health crisis, but this article shows that there are public health solutions that work in the African setting. When the Ebola virus disease outbreak was announced in Nigeria in July 2014, some public health specialists worried that an apocalyptic outbreak would sweep through the vast slums of Lagos. The words “Ebola” and “Lagos” in the same sentence were viewed as a dangerous combination, due to the large population of Lagos and the inefficient health care system in the city. Contrary to this view, the outbreak of Ebola virus disease was successfully contained in Nigeria. This article focuses on the factors that were responsible for this success. It examines strategies developed within Nigeria that help to ensure the successful containment of the disease. The paper identifies lessons that can be learnt by other countries from the Nigerian experience.

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Practical Note
Management and safety of a medical mission: occupational hazards of volunteering
Aidan Tan, Yuke Tien Fong, Sweet Far Ho, Boon Keng Tay & Yeow Leng Chua
pages 251-257
DOI:10.1080/09614524.2016.1131245
Published online: 10 Feb 2016
ABSTRACT
Medical aid missions involve travel to conflict or danger zones, posing safety risks in addition to the usual occupational risks arising from daily medical work. The note reports on a volunteer mission, using personal reports, anecdotal experiences, and the formal annual report to undertake an assessment similar to worksite assessments for hazards and control measures. Hazards were found to be prevalent, including physical noise and heat, infectious exposure from patients and local vectors, poor water sanitation, and psychosocial stress from unfamiliar environments and large patient numbers with limited means. Implementable preventative measures include increasing awareness with appropriate protective equipment usage and safety guidelines. Mission planning and management should also involve occupational health input.

Emerging Infectious Diseases
Volume 22, Number 2—February 2016
http://wwwnc.cdc.gov/eid/

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Expedited Ahead-of-Print Articles
Detection of Zika Virus in Semen
B. Atkinson et al.
May 2016

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Perspective
Ebola and Its Control in Liberia, 2014–2015 PDF Version [PDF – 525 KB – 9 pages]
T. G. Nyenswah et al.
Abstract
The severe epidemic of Ebola virus disease in Liberia started in March 2014. On May 9, 2015, the World Health Organization declared Liberia free of Ebola, 42 days after safe burial of the last known case-patient. However, another 6 cases occurred during June–July; on September 3, 2015, the country was again declared free of Ebola. Liberia had by then reported 10,672 cases of Ebola and 4,808 deaths, 37.0% and 42.6%, respectively, of the 28,103 cases and 11,290 deaths reported from the 3 countries that were heavily affected at that time. Essential components of the response included government leadership and sense of urgency, coordinated international assistance, sound technical work, flexibility guided by epidemiologic data, transparency and effective communication, and efforts by communities themselves. Priorities after the epidemic include surveillance in case of resurgence, restoration of health services, infection control in healthcare settings, and strengthening of basic public health systems.

Synopses
Epidemiology of Epidemic Ebola Virus Disease in Conakry and Surrounding Prefectures, Guinea, 2014–2015 PDF Version [PDF – 524 KB – 6 pages]
A. Rico et al.

Hospital Preparations for Viral Hemorrhagic Fever Patients and Experience Gained from Admission of an Ebola Patient PDF Version [PDF – 1.01 MB – 8 pages]
J. Haverkort et al.

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Research
Feasibility of Xpert Ebola Assay in Médecins Sans Frontières Ebola Program, Guinea PDF Version [PDF – 564 KB – 7 pages]
R. Van den Bergh et al.

Prognostic Indicators for Ebola Patient Survival PDF Version [PDF – 578 KB – 7 pages]
S. J. Crowe et al.

Epidemiology and Infection
Volume 144 – Issue 04 – March 2016
http://journals.cambridge.org/action/displayIssue?jid=HYG&tab=currentissue

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Original Papers
Other respiratory infections
Shelter crowding and increased incidence of acute respiratory infection in evacuees following the Great Eastern Japan Earthquake and tsunami
T. KAWANO, Y. TSUGAWA, K. NISHIYAMA, H. MORITA, O. YAMAMURA and K. HASEGAWA
SUMMARY
Although outbreaks of acute respiratory infection (ARI) at shelters are hypothesized to be associated with shelter crowding, no studies have examined this relationship. We conducted a retrospective study by reviewing medical records of evacuees presenting to one of the 37 clinics at the shelters in Ishinomaki city, Japan, during the 3-week period after the Great Eastern Japan Earthquake and tsunami in 2011. On the basis of a locally weighted scatter-plot smoothing technique, we categorized 37 shelters into crowded (mean space <5·5 m2/per person) and non-crowded (≥5·5 m2) shelters. Outcomes of interest were the cumulative and daily incidence rate of ARI/10 000 evacuees at each shelter. We found that the crowded shelters had a higher median cumulative incidence rate of ARI [5·4/10 000 person-days, interquartile range (IQR) 0–24·6, P = 0·04] compared to the non-crowded shelters (3·5/10 000 person-days, IQR 0–8·7) using Mann–Whitney U test. Similarly, the crowded shelters had an increased daily incidence rate of ARI of 19·1/10 000 person-days (95% confidence interval 5·9–32·4, P < 0·01) compared to the non-crowded shelters using quasi-least squares method. In sum, shelter crowding was associated with an increased incidence rate of ARI after the natural disaster.

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Original Papers
Measles
Reasons for measles cases not being vaccinated with MMR: investigation into parents’ and carers’ views following a large measles outbreak
P. McHALE, A. KEENAN and S. GHEBREHEWET
SUMMARY
Uptake rates for the combined measles, mumps and rubella (MMR) vaccine have been below the required 95% in the UK since a retracted and discredited article linking the MMR vaccine with autism and inflammatory bowel disease was released in 1998. This study undertook semi-structured telephone interviews among parents or carers of 47 unvaccinated measles cases who were aged between 13 months and 9 years, during a large measles outbreak in Merseyside. Results showed that concerns over the specific links with autism remain an important cause of refusal to vaccinate, with over half of respondents stating this as a reason. A quarter stated child illness during scheduled vaccination time, while other reasons included general safety concerns and access issues. Over half of respondents felt that more information or a discussion with a health professional would help the decision-making process, while a third stated improved access. There was clear support for vaccination among respondents when asked about current opinions regarding MMR vaccine. The findings support the hypothesis that safety concerns remain a major barrier to MMR vaccination, and also support previous evidence that experience of measles is an important determinant in the decision to vaccinate.