The European Journal of Public Health
Volume 26, Issue 1, 1 February 2016
http://eurpub.oxfordjournals.org/content/26/1

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Viewpoints
Europe’s migration challenges: mounting an effective health system response
Govin Permanand, Allan Krasnik, Hans Kluge, Martin McKee
DOI: http://dx.doi.org/10.1093/eurpub/ckv249 3-4 First published online: 1 February 2016
Extract
Health systems are at the forefront of the response to the ongoing humanitarian crisis facing refugees and other migrants fleeing to Europe, both as a first point of contact for arrivals and later during their resettlement and beyond. (The term ‘migrant’ is used here with the understanding that there are numerous groups that fall within this categorization, but which are distinct in terms of their status, e.g. asylum-seeker, refugee, undocumented migrant, economic migrant, family-reunited migrant, etc., where a specific group is mentioned by name, it is in a context where this specificity is required.) Yet even if the scale of migration is new, at least in the post-war period, some European countries have considerable experience of sudden large-scale immigration, whether from Algeria to France in the 1960s, East African Asians coming to the United Kingdom in the 1970s, refugees from former Yugoslavia in the 1990s and, more recently, across the Mediterranean to Italy, Malta and Spain.

However, few lessons seem to have been learnt, and European health systems vary greatly in their ability to respond to this new challenge.1The situation is complicated further by differences in formal entitlement to health care,2 even though it is now clear that restricting access costs more money in the long run.3 The challenges facing undocumented migrants are particularly alarming, as many of those now moving either fall into this category already or will soon do so if their applications for asylum are rejected.

Even where migrants are entitled to care they may face many barriers. These include language barriers and inadequate information about their rights and how to claim them…

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Europe’s response to the refugee crisis: why relocation quotas will fail to achieve ‘fairness’ from a health perspective
Kayvan Bozorgmehr, Joachim Szecsenyi, Christian Stock, Oliver Razum
DOI: http://dx.doi.org/10.1093/eurpub/ckv246 5-6 First published online: 1 February 2016
Extract
EU refugee law is deficient—this has become obvious as thousands of refugees cross the Mediterranean and EU borders to reach a safe destination. Germany’s Chancellor Angela Merkel calls for a scheme of compulsory relocation of refugees to EU member states to achieve a ‘fair’ distribution1 based on ‘objective, quantifiable and verifiable criteria’ such as GDP, population size and unemployment rates.2 While we strongly believe that providing international protection to refugees is a collective duty of EU member states, we argue that the concept of their ‘fair’ (but factually enforced) relocation across the EU is flawed and may ultimately be detrimental from a public health perspective.

First, if fairness is defined as the product of a quota based on a contract between EU member states, the interests of non-contractors (here refugees) remain neglected—a dilemma inherent in contractarian concepts of fairness.3…

Eurosurveillance
Volume 21, Issue 6, 11 February 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Rapid communications
Zika virus infections in three travellers returning from South America and the Caribbean respectively, to Montpellier, France, December 2015 to January 2016
by A Maria, M Maquart, A Makinson, O Flusin, M Segondy, I Leparc-Goffart, V Le Moing, V Foulongne

News
European Commission Horizon 2020 programme call for vaccine development research into malaria and neglected infectious diseases, including Zika virus
by Eurosurveillance editorial team

Health Affairs
February 2016; Volume 35, Issue 2
http://content.healthaffairs.org/content/current
Issue Focus: Vaccines
Vaccine Discovery, Production, And Delivery
Alan R. Weil
Extract
Vaccines are a bit like a wonder drug. A shot or two is all it takes to prevent premature death or a lifetime of disability. What more do we need to know? Quite a lot, it turns out. The gap between the potential vaccines offer and what we actually achieve is determined by myriad social, economic, political, and health system factors.

As Seth Berkley, CEO of Gavi, the Vaccine Alliance, notes in an interview in these pages: “Vaccines do not deliver themselves.” They also don’t finance their own development or distribution, educate the public about their benefits, or eliminate income disparities in access to health services.
The complex environment in which vaccines are discovered, produced, and delivered is the theme of this month’s Health Affairs.

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DataGraphic
Why The Decade Of Vaccines?
Health Aff February 2016 35:188-189; doi:10.1377/hlthaff.2015.1518

Interview
Eliminating Vaccine-Preventable Diseases Around The World
Alan R. Weil

Entry Point
The United States’ Piecemeal Approach To Vaccine Policy
Jessica Bylander
Health Aff February 2016 35:195-198; doi:10.1377/hlthaff.2015.1599

Value Of Vaccines
Return On Investment From Childhood Immunization In Low- And Middle-Income Countries, 2011–20
Sachiko Ozawa, Samantha Clark, Allison Portnoy, Simrun Grewal, Logan Brenzel, and Damian G. Walker

PERSPECTIVE: When Not All That Counts Can Be Counted: Economic Evaluations And The Value Of Vaccination
Jason L. Schwartz and Adel Mahmoud
Health Aff February 2016 35:208-211; doi:10.1377/hlthaff.2015.1438

VIEWPOINT: The Social Value Of Vaccination Programs: Beyond Cost-Effectiveness
Jeroen Luyten and Philippe Beutels
Health Aff February 2016 35:212-218; doi:10.1377/hlthaff.2015.1088

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Economics Of Vaccines
Vaccine Pipeline Has Grown During The Past Two Decades With More Early-Stage Trials From Small And Medium-Size Companies
Thomas J. Hwang and Aaron S. Kesselheim
Health Aff February 2016 35:219-226; doi:10.1377/hlthaff.2015.1073

Current Global Pricing For Human Papillomavirus Vaccines Brings The Greatest Economic Benefits To Rich Countries
Niamh Herlihy, Raymond Hutubessy, and Mark Jit
Health Aff February 2016 35:227-234; doi:10.1377/hlthaff.2015.1411

No Shot: US Vaccine Prices And Shortages
David B. Ridley, Xiaoshu Bei, and Eli B. Liebman

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Sustainable Financing For Vaccines
Vaccine Assistance To Low- And Middle-Income Countries Increased To $3.6 Billion In 2014
Annie Haakenstad, Maxwell Birger, Lavanya Singh, Patrick Liu, Stephen Lim, Marie Ng, and Joseph L. Dieleman

Gavi’s Transition Policy: Moving From Development Assistance To Domestic Financing Of Immunization Programs
Judith Kallenberg, Wilson Mok, Robert Newman, Aurélia Nguyen, Theresa Ryckman, Helen Saxenian, and Paul Wilson
Health Aff February 2016 35:250-258; doi:10.1377/hlthaff.2015.1079

EPIC Studies: Governments Finance, On Average, More Than 50 Percent Of Immunization Expenses, 2010–11
Logan Brenzel, Carl Schütte, Keti Goguadze, Werner Valdez, Jean-Bernard Le Gargasson, and Teresa Guthrie

ANALYSIS & COMMENTARY: Routes Countries Can Take To Achieve Full Ownership Of Immunization Programs
Michael McQuestion, Andrew Carlson, Khongorzul Dari, Devendra Gnawali, Clifford Kamara, Helene Mambu-Ma-Disu, Jonas Mbwanque, Diana Kizza, Dana Silver, and Eka Paatashvili
Health Aff February 2016 35:266-271; doi:10.1377/hlthaff.2015.1067

PERSPECTIVE: Country Ownership And Gavi Transition: Comprehensive Approaches To Supporting New Vaccine Introduction
Angela K. Shen, Jonathan M. Weiss, Jon Kim Andrus, Clint Pecenka, Deborah Atherly, Katherine Taylor, and Michael McQuestion

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Strengthening Immunization Programs
ANALYSIS & COMMENTARY: The Global Polio Eradication Initiative: Progress, Lessons Learned, And Polio Legacy Transition Planning
Stephen L. Cochi, Lea Hegg, Anjali Kaur, Carol Pandak, and Hamid Jafari
Health Aff February 2016 35:277-283; doi:10.1377/hlthaff.2015.1104

Assessing Interventions To Improve Influenza Vaccine Uptake Among Health Care Workers
Harunor Rashid, Jiehui Kevin Yin, Kirsten Ward, Catherine King, Holly Seale, and Robert Booy
Health Aff February 2016 35:284-292; doi:10.1377/hlthaff.2015.1087

Reorganizing Nigeria’s Vaccine Supply Chain Reduces Need For Additional Storage Facilities, But More Storage Is Required
Ekundayo Shittu, Melissa Harnly, Shanta Whitaker, and Roger Miller

INNOVATION PROFILE: Argentina’s Successful Implementation Of A National Human Papillomavirus Vaccination Program
Hannah Patel, Ellen Wilson, Carla Vizzotti, Greg Parston, Jessica Prestt, and Ara Darzi

Strategies To Boost Maternal Immunization To Achieve Further Gains In Improved Maternal And Newborn Health
Mark R. Steedman, Beate Kampmann, Egbert Schillings, Hanan Al Kuwari, and Ara Darzi

As Oral Vaccines Fall Short In Low-Income Countries, Researchers Look For Solutions
Carina Storrs

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Eliminating Measles & Rubella
DATAWATCH: Slow Progress In Finalizing Measles And Rubella Elimination In The European Region
Robin Biellik, Iria Davidkin, Susanna Esposito, Andrey Lobanov, Mira Kojouharova, Günter Pfaff,
José Ignacio Santos, John Simpson, Myriam Ben Mamou, Robb Butler, Sergei Deshevoi, Shahin Huseynov, Dragan Jankovic, and Abigail Shefer

ANALYSIS & COMMENTARY: Combining Global Elimination Of Measles And Rubella With Strengthening Of Health Systems In Developing Countries
Jon Kim Andrus, Stephen L. Cochi, Louis Z. Cooper, and Jonathan D. Klein

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Attitudes Toward Vaccination
Exploring The Impact Of The US Measles Outbreak On Parental Awareness Of And Support For Vaccination
Michael A. Cacciatore, Glen Nowak, and Nathaniel J. Evans

Publicly Available Online Tool Facilitates Real-Time Monitoring Of Vaccine Conversations And Sentiments
Chi Y. Bahk, Melissa Cumming, Louisa Paushter, Lawrence C. Madoff, Angus Thomson, and John S. Brownstein

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Children’s Vaccination In The United States
ANALYSIS & COMMENTARY: A Tale Of Two States: Mississippi, West Virginia, And Exemptions To Compulsory School Vaccination Laws
James Colgrove and Abigail Lowin

Since The Start Of The Vaccines For Children Program, Uptake Has Increased, And Most Disparities Have Decreased
Brendan Walsh, Edel Doherty, and Ciaran O’Neill

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Web First
DATAWATCH: Variation In Rural Health Information Technology Adoption And Use
Dawn M. Heisey-Grove

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 13 February 2016]

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Research
A multiple case study of intersectoral public health networks: experiences and benefits of using research
Anita Kothari, Charmaine McPherson, Dana Gore, Benita Cohen, Marjorie MacDonald and Shannon L. Sibbald
Published on: 11 February 2016

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Research
Setting priorities in health research using the model proposed by the World Health Organization: development of a quantitative methodology using tuberculosis in South Africa as a worked example
Damian Hacking and Susan Cleary
Published on: 9 February 2016

Journal of Global Infectious Diseases (JGID)
January-March 2016 Volume 8 | Issue 1 Page Nos. 1-56
http://www.jgid.org/currentissue.asp?sabs=n

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SPECIAL ARTICLE
The emergence of zika virus as a global health security threat: A review and a consensus statement of the INDUSEM Joint working Group (JWG)
DOI: 10.4103/0974-777X.176140
Veronica Sikka1, Vijay Kumar Chattu2, Raaj K Popli3, Sagar C Galwankar4, Dhanashree Kelkar4, Stanley G Sawicki5, Stanislaw P Stawicki6, Thomas J Papadimos7
1 Department of Emergency Medicine, Veterans Affairs Medical Center, Orlando, USA
2 Institute for International Relations, The University of West Indies, St. Augustine, Trinidad and Tobago, USA
3 Digestive Disease Consultants of Central Florida, Altamonte Springs, Florida, USA
4 Department of Emergency Medicine, University of Florida, Jacksonville, Florida, USA
5 Department of Medical Microbiology and Immunology, College of Medicine and the Life Sciences, University of Toledo, Toledo, USA
6 Department of Research and Innovation, St. Luke’s University Health Network, Bethlehem, Pennsylvania, USA
7 Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
Abstract
The Zika virus (ZIKV), first discovered in 1947, has emerged as a global public health threat over the last decade, with the accelerated geographic spread of the virus noted during the last 5 years. The World Health Organization (WHO) predicts that millions of cases of ZIKV are likely to occur in the Americas during the next 12 months. These projections, in conjunction with suspected Zika-associated increase in newborn microcephaly cases, prompted WHO to declare public health emergency of international concern. ZIKV-associated illness is characterized by an incubation period of 3-12 days. Most patients remain asymptomatic (i.e., ~80%) after contracting the virus. When symptomatic, clinical presentation is usually mild and consists of a self-limiting febrile illness that lasts approximately 2-7 days. Among common clinical manifestations are fever, arthralgia, conjunctivitis, myalgia, headache, and maculopapular rash. Hospitalization and complication rates are low, with fatalities being extremely rare. Newborn microcephaly, the most devastating and insidious complication associated with the ZIKV, has been described in the offspring of women who became infected while pregnant. Much remains to be elucidated about the timing of ZIKV infection in the context of the temporal progression of pregnancy, the corresponding in utero fetal development stage(s), and the risk of microcephaly. Without further knowledge of the pathophysiology involved, the true risk of ZIKV to the unborn remains difficult to quantify and remediate. Accurate, portable, and inexpensive point-of-care testing is required to better identify cases and manage the current and future outbreaks of ZIKV, including optimization of preventive approaches and the identification of more effective risk reduction strategies. In addition, much more work needs to be done to produce an effective vaccine. Given the rapid geographic spread of ZIKV in recent years, a coordinated local, regional, and global effort is needed to generate sufficient resources and political traction to effectively halt and contain further expansion of the current outbreak.

The Lancet
Feb 13, 2016 Volume 387 Number 10019 p619-716 e20
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
Australia’s immigration centres are no place for children
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(16)00317-2
Summary
Last week, the High Court in Australia ruled that the country was within its constitutional rights to detain asylum seekers offshore. This ruling is scandalously objectionable not only for the health and wellbeing of individuals seeking asylum or refuge in Australia, but also for the more than 260 people, including children, on the mainland who are now at risk of deportation.

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Comment
A crucial time for public health preparedness: Zika virus and the 2016 Olympics, Umrah, and Hajj
Published Online: 06 February 2016
Habida Elachola, Ernesto Gozzer, Jiatong Zhuo, Ziad A Memish
DOI: http://dx.doi.org/10.1016/S0140-6736(16)00274-9

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Series
Ending preventable stillbirths
Stillbirths: recall to action in high-income countries
Vicki Flenady, Aleena M Wojcieszek, Philippa Middleton, David Ellwood, Jan Jaap Erwich, Michael Coory, T Yee Khong, Robert M Silver, Gordon C S Smith, Frances M Boyle, Joy E Lawn, Hannah Blencowe, Susannah Hopkins Leisher, Mechthild M Gross, Dell Horey, Lynn Farrales, Frank Bloomfield, Lesley McCowan, Stephanie J Brown, K S Joseph, Jennifer Zeitlin, Hanna E Reinebrant, Claudia Ravaldi, Alfredo Vannacci, Jillian Cassidy, Paul Cassidy, Cindy Farquhar, Euan Wallace, Dimitrios Siassakos, Alexander E P Heazell, Claire Storey, Lynn Sadler, Scott Petersen, J Frederik Frøen, Robert L Goldenberg, The Lancet Ending Preventable Stillbirths study group, The Lancet Stillbirths In High-Income Countries Investigator Group

Ending preventable stillbirths
Stillbirths: ending preventable deaths by 2030
Luc de Bernis, Mary V Kinney, William Stones, Petra ten Hoope-Bender, Donna Vivio, Susannah Hopkins Leisher, Zulfiqar A Bhutta, Metin Gülmezoglu, Matthews Mathai, Jose M Belizán, Lynne Franco, Lori McDougall, Jennifer Zeitlin, Address Malata, Kim E Dickson, Joy E Lawn, The Lancet Ending Preventable Stillbirths Series study group, The Lancet Ending Preventable Stillbirths Series Advisory Group

Lancet Global Health
Feb 2016 Volume 4 Number 2 e69-e136
http://www.thelancet.com/journals/langlo/issue/current

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Editorial
Stillbirths: still neglected?
Zoë Mullan
Summary
5 years ago, The Lancet published a groundbreaking (and taboo-breaking) Series on stillbirths. Its powerful mix of advocacy and hard data attracted more media attention than perhaps any other Series, and made waves on numerous levels, from the individual to the intergovernmental. Working closely with countries and WHO, the Series authors fought to bring “out of the shadows” the unacceptable toll of intrapartum stillbirths in low-income countries, the addressable differences in stillbirth rates between countries with advanced health systems, and the deplorable absence of such devastating events from global tracking efforts such as those of the UN, the Millennium Development Goals, and the Global Burden of Disease.

Comment
Success of rotavirus vaccination in Africa: good news and remaining questions
Timo Vesikari

Borders and migration: an issue of global health importance
James Smith, Leigh Daynes

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Articles
National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis
Hannah Blencowe, Simon Cousens, Fiorella Bianchi Jassir, Lale Say, Doris Chou, Colin Mathers, Dan Hogan, Suhail Shiekh, Zeshan U Qureshi, Danzhen You, Joy E Lawn, The Lancet Stillbirth Epidemiology Investigator Group
Summary
Background
Previous estimates have highlighted a large global burden of stillbirths, with an absence of reliable data from regions where most stillbirths occur. The Every Newborn Action Plan (ENAP) targets national stillbirth rates (SBRs) of 12 or fewer stillbirths per 1000 births by 2030. We estimate SBRs and numbers for 195 countries, including trends from 2000 to 2015.
Methods
We collated SBR data meeting prespecified inclusion criteria from national routine or registration systems, nationally representative surveys, and other data sources identified through a systematic review, web-based searches, and consultation with stillbirth experts. We modelled SBR (≥28 weeks’ gestation) for 195 countries with restricted maximum likelihood estimation with country-level random effects. Uncertainty ranges were obtained through a bootstrap approach.
Findings
Data from 157 countries (2207 datapoints) met the inclusion criteria, a 90% increase from 2009 estimates. The estimated average global SBR in 2015 was 18·4 per 1000 births, down from 24·7 in 2000 (25·5% reduction). In 2015, an estimated 2·6 million (uncertainty range 2·4–3·0 million) babies were stillborn, giving a 19% decline in numbers since 2000 with the slowest progress in sub-Saharan Africa. 98% of all stillbirths occur in low-income and middle-income countries; 77% in south Asia and sub-Saharan Africa.
Interpretation
Progress in reducing the large worldwide stillbirth burden remains slow and insufficient to meet national targets such as for ENAP. Stillbirths are increasingly being counted at a local level, but countries and the global community must further improve the quality and comparability of data, and ensure that this is more clearly linked to accountability processes including the Sustainable Development Goals.
Funding
Save the Children’s Saving Newborn Lives programme to The London School of Hygiene & Tropical Medicine.

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Effect of pentavalent rotavirus vaccine introduction on hospital admissions for diarrhoea and rotavirus in children in Rwanda: a time-series analysis
Fidele Ngabo, Jacqueline E Tate, Maurice Gatera, Celse Rugambwa, Philippe Donnen, Philippe Lepage, Jason M Mwenda, Agnes Binagwaho, Umesh D Parashar
Summary
Background
In May, 2012, Rwanda became the first low-income African country to introduce pentavalent rotavirus vaccine into its routine national immunisation programme. Although the potential health benefits of rotavirus vaccination are huge in low-income African countries that account for more than half the global deaths from rotavirus, concerns remain about the performance of oral rotavirus vaccines in these challenging settings.
Methods
We conducted a time-series analysis to examine trends in admissions to hospital for non-bloody diarrhoea in children younger than 5 years in Rwanda between Jan 1, 2009, and Dec 31, 2014, using monthly discharge data from the Health Management Information System. Additionally, we reviewed the registries in the paediatric wards at six hospitals from 2009 to 2014 and abstracted the number of total admissions and admissions for diarrhoea in children younger than 5 years by admission month and age group. We studied trends in admissions specific to rotavirus at one hospital that had undertaken active rotavirus surveillance from 2011 to 2014. We assessed changes in rotavirus epidemiology by use of data from eight active surveillance hospitals.
Findings
Compared with the 2009–11 prevaccine baseline, hospital admissions for non-bloody diarrhoea captured by the Health Management Information System fell by 17–29% from a pre-vaccine median of 4051 to 2881 in 2013 and 3371 in 2014, admissions for acute gastroenteritis captured in paediatric ward registries decreased by 48–49%, and admissions specific to rotavirus captured by active surveillance fell by 61–70%. The greatest effect was recorded in children age-eligible to be vaccinated, but we noted a decrease in the proportion of children with diarrhoea testing positive for rotavirus in almost every age group.
Interpretation
The number of admissions to hospital for diarrhoea and rotavirus in Rwanda fell substantially after rotavirus vaccine implementation, including among older children age-ineligible for vaccination, suggesting indirect protection through reduced transmission of rotavirus. These data highlight the benefits of routine vaccination against rotavirus in low-income settings.
Funding
Gavi, the Vaccine Alliance and the Government of Rwanda.

New England Journal of Medicine
February 11, 2016 Vol. 374 No. 6
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
A World Free of Polio — The Final Steps
Manish Patel, M.D., and Walter Orenstein, M.D.
N Engl J Med 2016; 374:501-503
February 11, 2016
DOI: 10.1056/NEJMp1514467
Audio Interview
Interview with Dr. Walter Orenstein on the final steps in the global effort to eradicate polio. (8:37) Listen Download

Global polio-eradication efforts have led to a dramatic decrease in polio cases, from an estimated 350,000 cases in 125 countries in 1988 to 72 cases in 2015. As of January 2016, endemic transmission of polio caused by wild polioviruses (WPVs) had been interrupted in all countries except Pakistan and Afghanistan. Indeed, the Global Commission for Certification of the Eradication of Poliomyelitis recently certified that type 2 wild poliovirus, one of three strains responsible for centuries of human paralysis and disfigurement, has been eradicated. Type 2 poliovirus now exists only in laboratories and in trivalent oral polio vaccine (tOPV) in an attenuated form, though in rare circumstances it surfaces in the community, through persistent transmission, in the form of outbreaks of vaccine-derived viruses. Getting to this point has not been easy. Sustaining our wins and traversing the last mile of the eradication journey calls for escalation of global immunization activities on an unprecedented scale.

Oral polio vaccine (OPV) has been the lynchpin of successful control of paralytic polio. However, in very rare instances, it has been associated with cases of paralysis caused by vaccine-associated paralytic polio (VAPP) or circulating vaccine-derived polioviruses (cVDPVs) — the latter when the viruses included in the vaccine have mutated over time, acquiring the neurovirulence and transmissibility of WPV. For this reason, it is of paramount importance to discontinue the use of OPV after polio eradication has been certified. Since the last case of naturally occurring type 2 WPV in 1999, continued use of OPV2 (the type 2 component of tOPV) has paralyzed an estimated 1600 to 3200 people with VAPP and more than 600 people with type 2 cVDPV.1 Because routine use of type 2–containing vaccine is no longer needed, the global community has a moral imperative to discontinue it as soon as programmatically feasible. Because WPV types 1 and 3 have not yet been eradicated, however, the phased withdrawal of OPV antigens will begin with a shift from tOPV (containing types 1, 2, and 3) to bivalent OPV (bOPV, containing types 1 and 3).

Global cessation of OPV2 use poses a low but real risk of outbreaks of cVDPV2 or WPV infections associated with declining immunity to type 2 poliovirus.2 The overarching strategy for reducing this risk is to maximize immunity against type 2 before and after withdrawal of the vaccine and to prepare for an appropriate outbreak response. Doing so requires a comprehensive, multipronged approach (see table Risks and Risk-Mitigation Strategies for Switching from Trivalent Oral Polio Vaccine (tOPV) to Bivalent OPV (bOPV).).

First, it is important to stop current cVDPV2 outbreaks in advance of the switch, through aggressive tOPV vaccination in any place where cVDPV2 is detected. Programs with lower routine coverage will have to boost type 2 immunity through additional tOPV campaigns just before OPV2 withdrawal.2 A high level of immunity, especially OPV2-induced intestinal immunity, will prevent sustained transmission of vaccine viruses, which could lead to generation of new cVDPV2s.

Second, all countries should have access to enough inactivated polio vaccine (IPV) to administer at least one dose to all children through the routine immunization program. IPV provides immunity against all three polioviruses without generating any infectious vaccine-associated polioviruses. Introduction of IPV is intended to provide some immunity against type 2 viruses in new birth cohorts to mitigate future outbreaks of type 2 WPV and type 2 cVDPVs, should the viruses be reintroduced.3 IPV, however, may not prevent cVDPV2 emergence, which will be greatest during the first 6 to 12 months after OPV2 withdrawal.

Third, there had to be certified eradication of type 2 WPV, which has been accomplished.

Fourth, all countries must have destroyed type 2 WPV or securely contain it in essential laboratory and vaccine-production facilities by the end of 2015 and must do the same with OPV2 within 3 months after it is withdrawn.

Fifth, a global stockpile of monovalent type 2 OPV should be available to control outbreaks of type 2 polio, should type 2 viruses be reintroduced.

Finally, leaders of the Global Polio Eradication Initiative (GPEI) should finalize a protocol for surveillance of and response to such outbreaks.

Recently, the Strategic Advisory Group of Experts on Immunization (SAGE) reviewed progress on these readiness indicators.1,4 All high-risk countries are on track for introducing IPV. Supply shortages will delay introduction by a few months in some low-risk countries but are unlikely to increase the short-term risk of cVDPV2. SAGE also recommended accelerating implementation of the containment plan. Overall, it determined that the benefits of withdrawing OPV2 outweighed the risks, reaffirming the decision to proceed with the global switch from tOPV to bOPV between April 17 and May 1, 2016. Furthermore, it reiterated that OPV2 withdrawal must be synchronized worldwide. A prolonged, staggered withdrawal would pose a risk of continuous generation of cVDPV2s and potential exportation of these viruses to regions or countries with susceptible children born after the switch. Withdrawal of OPV2 during the seasonally low-transmission month of April further reduces the risk of type 2 polio outbreaks.

Switching from tOPV to bOPV may sound simple, but synchronization requires global coordination on an unprecedented scale. To use bOPV in routine immunization, all countries must either license a bivalent vaccine or accept one that is prequalified by the World Health Organization. Recent trial data and use of bOPV in campaigns since 2009 indicate that it is safe and more immunogenic to types 1 and 3 than is tOPV.5 Multilevel efforts to manage the global supply of OPV have begun, including discontinuation of tOPV production, scale-up of bOPV production, initiation of interactions between procurement agencies or manufacturers and countries, management of countrywide tOPV inventories to ensure that stocks are adequate until the switch and to track collection and destruction afterward, and allocation of funds for procuring bOPV. Fundamentally, countries will strive to avoid having either excess or insufficient quantities of tOPV leading up to the switch and to ensure the availability of bOPV after the switch.

Coordinated communication among global health organizations, countries, manufacturers, and funders is imperative to ensure synchronized OPV2 withdrawal with minimal disruption in vaccination services to children worldwide. Successful synchronization also requires GPEI leaders and countries to monitor the timely completion of preparatory steps both globally and within each country (e.g., managing of tOPV inventories; bOPV licensure, procurement, and shipment; securing of financial resources; establishment of communication; and training of logisticians, health workers, and monitors). Equally, if not more, important, however, will be the monitoring of outcomes of withdrawal of the vaccine in April 2016. Although it is nearly impossible to monitor every vaccination service point — India alone has more than 26,000 — a targeted monitoring strategy for high-risk areas, such as facilities storing large stocks of tOPV, could provide further reassurance of low risk of cVDPV2 reemergence. Countries will need to dispose of residual tOPV stocks using their existing pharmaceutical-waste-disposal procedures to avoid continued use of the discontinued vaccine.

More preparation for the switch is required in the coming months, and for completing polio eradication in the coming years. But collaboration in eradication efforts has reached a high point never before achieved by the immunization community. Getting here has required tireless effort and practical innovation in science, policy, and implementation. Capitalizing on the gains made to date should push overall polio eradication over the finish line and may pave the way for measles eradication and future global health initiatives.

Pediatrics
February 2016, VOLUME 137 / ISSUE 2
http://pediatrics.aappublications.org/content/137/2?current-issue=y

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Articles
Primary Care Physicians’ Perspectives About HPV Vaccine
Mandy A. Allison, Laura P. Hurley, Lauri Markowitz, Lori A. Crane, Michaela Brtnikova, Brenda L. Beaty, Megan Snow, Janine Cory, Shannon Stokley, Jill Roark, Allison Kempe
Pediatrics Feb 2016, 137 (2) 1-9; DOI: 10.1542/peds.2015-2488
Abstract
BACKGROUND AND OBJECTIVES: Because physicians’ practices could be modified to reduce missed opportunities for human papillomavirus (HPV) vaccination, our goal was to: (1) describe self-reported practices regarding recommending the HPV vaccine; (2) estimate the frequency of parental deferral of HPV vaccination; and (3)identify characteristics associated with not discussing it.
METHODS: A national survey among pediatricians and family physicians (FP) was conducted between October 2013 and January 2014. Using multivariable analysis, characteristics associated with not discussing HPV vaccination were examined.
RESULTS: Response rates were 82% for pediatricians (364 of 442) and 56% for FP (218 of 387). For 11-12 year-old girls, 60% of pediatricians and 59% of FP strongly recommend HPV vaccine; for boys,52% and 41% ostrongly recommen. More than one-half reported ≥25% of parents deferred HPV vaccination. At the 11-12 year well visit, 84% of pediatricians and 75% of FP frequently/always discuss HPV vaccination. Compared with physicians who frequently/always discuss , those who occasionally/rarely discuss(18%) were more likely to be FP (adjusted odds ratio [aOR]: 2.0 [95% confidence interval (CI): 1.1–3.5), be male (aOR: 1.8 [95% CI: 1.1–3.1]), disagree that parents will accept HPV vaccine if discussed with other vaccines (aOR: 2.3 [95% CI: 1.3–4.2]), report that 25% to 49% (aOR: 2.8 [95% CI: 1.1–6.8]) or ≥50% (aOR: 7.8 [95% CI: 3.4–17.6]) of parents defer, and express concern about waning immunity (aOR: 3.4 [95% CI: 1.8–6.4]).
CONCLUSIONS: Addressing physicians’ perceptions about parental acceptance of HPV vaccine, the possible advantages of discussing HPV vaccination with other recommended vaccines, and concerns about waning immunity could lead to increased vaccination rates

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Seasonal Effectiveness of Live Attenuated and Inactivated Influenza Vaccine
Jessie R. Chung, Brendan Flannery, Mark G. Thompson, Manjusha Gaglani, Michael L. Jackson, Arnold S. Monto, Mary Patricia Nowalk, H. Keipp Talbot, John J. Treanor, Edward A. Belongia, Kempapura Murthy, Lisa A. Jackson, Joshua G. Petrie, Richard K. Zimmerman, Marie R. Griffin, Huong Q. McLean, Alicia M. Fry
Pediatrics Feb 2016, 137 (2) 1-10; DOI: 10.1542/peds.2015-3279

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Safety and Immunogenicity of Sequential Rotavirus Vaccine Schedules
Romina Libster, Monica McNeal, Emmanuel B. Walter, Andi L. Shane, Patricia Winokur, Gretchen Cress, Andrea A. Berry, Karen L. Kotloff, Kwabena Sarpong, Christine B. Turley, Christopher J. Harrison, Barbara A. Pahud, Jyothi Marbin, John Dunn, Jill El-Khorazaty, Jill Barrett, Kathryn M. Edwards, for the VTEU Rotavirus Vaccine Study Work Group
Pediatrics Feb 2016, 137 (2) 1-10; DOI: 10.1542/peds.2015-2603

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From the American Academy of Pediatrics
Medical Countermeasures for Children in Public Health Emergencies, Disasters, or Terrorism
DISASTER PREPAREDNESS ADVISORY COUNCIL
Pediatrics Feb 2016, 137 (2) 1-9; DOI: 10.1542/peds.2015-4273
Abstract
Significant strides have been made over the past 10 to 15 years to develop medical countermeasures (MCMs) to address potential disaster hazards, including chemical, biological, radiologic, and nuclear threats. Significant and effective collaboration between the pediatric health community, including the American Academy of Pediatrics, and federal partners, such as the Office of the Assistant Secretary for Preparedness and Response, Centers for Disease Control and Prevention, Federal Emergency Management Agency, National Institutes of Health, Food and Drug Administration, and other federal agencies, over the past 5 years has resulted in substantial gains in addressing the needs of children related to disaster preparedness in general and MCMs in particular. Yet, major gaps still remain related to MCMs for children, a population highly vulnerable to the effects of exposure to such threats, because many vaccines and pharmaceuticals approved for use by adults as MCMs do not yet have pediatric formulations, dosing information, or safety information. As a result, the nation’s stockpiles and other caches (designated supply of MCMs) where pharmacotherapeutic and other MCMs are stored are less prepared to address the needs of children compared with those of adults in the event of a disaster. This policy statement provides recommendations to close the remaining gaps for the development and use of MCMs in children during public health emergencies or disasters. The progress made by federal agencies to date to address the needs of children and the shared commitment of collaboration that characterizes the current relationship between the pediatric health community and the federal agencies responsible for MCMs should encourage all child advocates to invest the necessary energy and resources now to complete the process of remedying the remaining significant gaps in preparedness.

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Pediatrics Perspectives
Planning for Research on Children During Public Health Emergencies
Laura J. Faherty, Sonja A. Rasmussen, Nicole Lurie
Pediatrics Feb 2016, 137 (2) 1-4; DOI: 10.1542/peds.2015-3611
Extract
The recent Ebola epidemic exposed critical knowledge gaps about the disease and its impact on different populations, particularly children, which hindered the public health and medical response. For instance, unanswered questions remain about the natural history of Ebola virus disease in young children and its transmissibility in breast milk. Other emerging infectious diseases, such as Middle East Respiratory Syndrome (MERS), remind us that there will always be another pathogen lurking around the corner. Public health emergencies (PHEs) resulting from natural disasters are increasing in ferocity and frequency.1 How can we ensure that we address our current knowledge gaps to better prepare for future disasters?
Awareness of the need to integrate scientific research into PHE response is growing,2 but the discussion of research involving children has been limited. Although several efforts have addressed the unique physical and socio-emotional needs of children in PHEs,3,4 pediatric research during PHEs has been lacking, resulting in significant knowledge gaps for children compared to adults. Conducting research, especially in children, without interfering with the PHE response is challenging. The present article discusses the importance of including children in PHE research and proposes components of a robust infrastructure that need to be in place to facilitate this research.
Barriers to Including Children in PHE Research
Including children in PHE research presents special challenges, including issues with recruitment, informed consent, and enrollment.3,5 Institutional review boards (IRBs) have more stringent requirements for inclusion of children in research than for adults.6 A life course …

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Stakeholder Views of Clinical Trials in Low- and Middle-Income Countries: A Systematic Review
Pathma D. Joseph, Patrina H.Y. Caldwell, Allison Tong, Camilla S. Hanson, Jonathan C. Craig
Pediatrics Feb 2016, 137 (2) 1-19; DOI: 10.1542/peds.2015-2800
Abstract
CONTEXT: Clinical trials are necessary to improve the health care of children, but only one-quarter are conducted in the low- to middle-income countries (LMICs) in which 98% of the global burden of disease resides.
OBJECTIVE: To describe stakeholder beliefs and experiences of conducting trials in children in LMICs.
DATA SOURCES: Electronic databases were searched to August 2014.
STUDY SELECTION: Qualitative studies of stakeholder perspectives on conducting clinical trials among children in LMICs.
DATA EXTRACTION: Findingswere analyzed by using thematic synthesis.
RESULTS: Thirty-nine studies involving 3110 participants (children [n = 290], parents or caregivers [n = 1609], community representatives [n = 621], clinical or research team members [n = 376], regulators [n = 18], or sponsors [n = 15]) across 22 countries were included. Five themes were identified: centrality of community engagement (mobilizing community, representatives’ pivotal role, managing expectations, and retaining involvement); cognizance of vulnerability and poverty (therapeutic opportunity and medical mistrust); contending with power differentials (exploitation, stigmatization, and disempowerment); translating research to local context (cultural beliefs, impoverishment constraints, and ethical pluralism); and advocating fair distribution of benefits (health care, sponsor obligation, and collateral community benefits).
LIMITATIONS: Studies not published in English were excluded.
CONCLUSIONS: Conducting trials in children in LMICs is complex due to social disadvantage, economic scarcity, idiosyncratic cultural beliefs, and historical disempowerment, all of which contribute to inequity, mistrust, and fears of exploitation. Effective community engagement in recruiting, building research capacities, and designing trials that are pragmatic, ethical, and relevant to the health care needs of children in LMICs may help to improve the equity and health outcomes of this vulnerable population.

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Commentaries
Rotavirus Vaccines—OK to Mix and Match
Carrie L. Byington, Yvonne Maldonado
Pediatrics Feb 2016, 137 (2) 1-2; DOI: 10.1542/peds.2015-3618

PLoS One
http://www.plosone.org/
[Accessed 13 February 2016]

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Long-Term Protection against Diphtheria in the Netherlands after 50 Years of Vaccination: Results from a Seroepidemiological Study
E. M. Swart, P. G. M. van Gageldonk, H. E. de Melker, F. R. van der Klis, G. A. M. Berbers, L. Mollema
Research Article | published 10 Feb 2016 | PLOS ONE
10.1371/journal.pone.0148605
Abstract
Background and Aims
To evaluate the National Immunisation Programme (NIP) a population-based cross-sectional seroepidemiological study was performed in the Netherlands. We assessed diphtheria antitoxin levels in the general Dutch population and in low vaccination coverage (LVC) areas where a relatively high proportion of orthodox Protestants live who decline vaccination based on religious grounds. Results were compared with a nationwide seroepidemiological study performed 11 years earlier.
Methods
In 2006/2007 a national serum bank was established. Blood samples were tested for diphtheria antitoxin IgG concentrations using a multiplex immunoassay for 6383 participants from the national sample (NS) and 1518 participants from LVC municipalities. A cut-off above 0.01 international units per ml (IU/ml) was used as minimum protective level.
Results
In the NS 91% of the population had antibody levels above 0.01 IU/ml compared to 88% in the 1995/1996 serosurvey (p<0.05). On average, 82% (vs. 78% in the 1995/1996 serosurvey, p<0.05) of individuals from the NS born before introduction of diphtheria vaccination in the NIP and 46% (vs. 37% in the 1995/1996 serosurvey, p = 0.11) of orthodox Protestants living in LVC areas had antibody levels above 0.01 IU/ml. Linear regression analysis among fully immunized individuals (six vaccinations) without evidence of revaccination indicated a continuous decline in antibodies in both serosurveys, but geometric mean antibodies remained well above 0.01 IU/ml in all age groups.
Conclusions
The NIP provides long-term protection against diphtheria, although antibody levels decline after vaccination. As a result of natural waning immunity, a substantial proportion of individuals born before introduction of diphtheria vaccination in the NIP lack adequate levels of diphtheria antibodies. Susceptibility due to lack of vaccination is highest among strictly orthodox Protestants. The potential risk of spread of diphtheria within the geographically clustered orthodox Protestant community after introduction in the Netherlands has not disappeared, despite national long-term high vaccination coverage

Vaccine
Volume 34, Issue 8, Pages 995-1138 (17 February 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/8
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Conference report
Workshop report: Schistosomiasis vaccine clinical development and product characteristics
Pages 995-1001
Annie X. Mo, Daniel G. Colley

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Reviews
The 5As: A practical taxonomy for the determinants of vaccine uptake
Review Article
Pages 1018-1024
Angus Thomson, Karis Robinson, Gaëlle Vallée-Tourangeau
Abstract
Suboptimal vaccine uptake in both childhood and adult immunisation programs limits their full potential impact on global health. A recent progress review of the Global Vaccine Action Plan stated that “countries should urgently identify barriers and bottlenecks and implement targeted approaches to increase and sustain coverage”. However, vaccination coverage may be determined by a complex mix of demographic, structural, social and behavioral factors. To develop a practical taxonomy to organise the myriad possible root causes of a gap in vaccination coverage rates, we performed a narrative review of the literature and tested whether all non-socio-demographic determinants of coverage could be organised into 4 dimensions: Access, Affordability, Awareness and Acceptance. Forty-three studies were reviewed, from which we identified 23 primary determinants of vaccination uptake. We identified a fifth domain, Activation, which captured interventions such as SMS reminders which effectively nudge people towards getting vaccinated. The 5As taxonomy captured all identified determinants of vaccine uptake. This intuitive taxonomy has already facilitated mutual understanding of the primary determinants of suboptimal coverage within inter-sectorial working groups, a first step towards them developing targeted and effective solutions.

Vaccine
Volume 34, Issue 8, Pages 995-1138 (17 February 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/8
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Regular Papers
Reciprocal interference of maternal and infant immunization in protection against pertussis
Original Research Article
Pages 1062-1069
Pascal Feunou Feunou, Nathalie Mielcarek, Camille Locht
Abstract
Background
Because of the current re-emergence of pertussis, vaccination during the 3rd trimester of pregnancy is recommended in several countries in order to protect neonates by placental transfer of maternal antibodies. Here, we examined the potential reciprocal interference of mother and infant vaccination in protection against pertussis in mice.
Methods
Female mice were vaccinated with acellular pertussis vaccines and protection against Bordetella pertussis challenge, as well as functional antibodies were measured in their offspring with or without re-vaccination.
Results
Maternal immunization protected the offspring against B. pertussis challenge, but protection waned quickly and was lost after vaccination of the infant mice with the same vaccine. Without affecting antibody titers, infant vaccination reduced the protective functions of maternally-derived antibodies, evidenced both in vitro and in vivo. Protection induced by infant vaccination was also affected by maternal antibodies. However, when mothers and infants were immunized with two different vaccines, no interference of infant vaccination on the protective effects of maternal antibodies was noted.
Conclusion
It may be important to determine the functionality of antibodies to evaluate potential interference of maternal and infant vaccination in protection against pertussis.

Vaccine
Volume 34, Issue 8, Pages 995-1138 (17 February 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/8
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Factors associated with a successful expansion of influenza vaccination among pregnant women in Nicaragua
Original Research Article
Pages 1086-1090
Carmen S. Arriola, Nancy Vasconez, Mark Thompson, Sara Mirza, Ann C. Moen, Joseph Bresee, Ivy Talavera, Alba María Ropero
Abstract
Background
Pregnant women are at risk of severe influenza disease and are a priority group for influenza vaccination programs. Nicaragua expanded recommendations to include influenza vaccination to all pregnant women in the municipality of Managua in 2013.
Methods
We carried out a survey among 1,807 pregnant women who delivered at public hospitals in the municipality of Managua to evaluate the uptake of influenza vaccination and factors associated with vaccination.
Results
We observed a high (71%) uptake of influenza vaccination among this population, with no differences observed by age, education or parity of the women. Having four antenatal visits and five or more visits were associated with receipt of influenza vaccination (AORs: 2.58; 95% CI: 1.15, 5.81, and 2.37; 95% CI: 1.12, 5.0, respectively). Also, receipt of influenza vaccination recommendation from a health care provider was positively associated with receipt of influenza vaccination (AOR: 14.22; 95% CI: 10.45, 19.33).
Conclusions
The successful expansion of influenza vaccination among pregnant women in the municipality of Managua may be due to ready access to free medical care and health care providers’ recommendation for vaccination at health care clinics that received influenza vaccine.

Vaccine
Volume 34, Issue 8, Pages 995-1138 (17 February 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/8
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The actual and potential costs of meningitis surveillance in the African meningitis belt: Results from Chad and Niger
Original Research Article
Pages 1133-1138
Maite Irurzun-Lopez, Ngozi A. Erondu, Ali Djibo, Ulla Griffiths, James M. Stuart, Katya Fernandez, Olivier Ronveaux, Jean-Bernard Le Gargasson, Bradford D. Gessner, Anaïs Colombini
Abstract
Background
The introduction of serogroup A meningococcal conjugate vaccine in the African meningitis belt required strengthened surveillance to assess long-term vaccine impact. The costs of implementing this strengthening had not been assessed.
Methodology
The ingredients approach was used to retrospectively determine bacterial meningitis surveillance costs in Chad and Niger in 2012. Resource use and unit cost data were collected through interviews with staff at health facilities, laboratories, government offices and international partners, and by reviewing financial reports. Sample costs were extrapolated to national level and costs of upgrading to desired standards were estimated.
Results
Case-based surveillance had been implemented in all 12 surveyed hospitals and 29 of 33 surveyed clinics in Niger, compared to six out of 21 clinics surveyed in Chad. Lumbar punctures were performed in 100% of hospitals and clinics in Niger, compared to 52% of the clinics in Chad. The total costs of meningitis surveillance were US$ 1,951,562 in Niger and US$ 338,056 in Chad, with costs per capita of US$ 0.12 and US$ 0.03, respectively. Laboratory investigation was the largest cost component per surveillance functions, comprising 51% of the total costs in Niger and 40% in Chad. Personnel resources comprised the biggest expense type: 37% of total costs in Niger and 26% in Chad. The estimated annual, incremental costs of upgrading current systems to desired standards were US$ 183,299 in Niger and US$ 605,912 in Chad, which are 9% and 143% of present costs, respectively.
Conclusions
Niger’s more robust meningitis surveillance system costs four times more per capita than the system in Chad. Since Chad spends less per capita, fewer activities are performed, which weakens detection and analysis of cases. Countries in the meningitis belt are diverse, and can use these results to assess local costs for adapting surveillance systems to monitor vaccine impact.

Therapeutic Advances in Vaccines
Published online before print February 4, 2016,
Intentions to receive a potentially available Lyme disease vaccine in an urban sample
doi: 10.1177/2051013616629881
Joshua Fogel
Department of Business Management, Brooklyn College of the City University of New York, 218A, 2900 Bedford Avenue, Brooklyn, NY 11210, USA
Martin Kusz
Department of Biology, Brooklyn College, Brooklyn, NY, USA
Abstract
Objectives: The only human Lyme disease vaccine of LYMErix was voluntarily removed from the market in the United States in 2002 for a number of reasons. A new human Lyme disease vaccine is currently being developed. We would like any future approved human Lyme disease vaccine to be of interest and marketable to consumers.
Methods: We surveyed 714 participants to determine variables associated with intentions to receive a Lyme disease vaccine. Predictor variables included demographics, protection motivational theory, Lyme disease knowledge, Lyme disease preventive behaviors, beliefs and perceived health.
Results: We found in multivariate linear regression analyses that Asian/Asian American race/ethnicity (p < 0.001), South Asian race/ethnicity (p = 0.01) and coping appraisal variables of response efficacy (p < 0.001) and self-efficacy (p < 0.001) were each significantly associated with increased intentions. The belief that vaccines are typically not safe was significantly associated with decreased intentions (p = 0.03).
Conclusions: Asian/Asian American and South Asian race/ethnicities have a strong interest in receiving a Lyme disease vaccine. Although pharmaceutical companies may benefit by advertising a Lyme disease vaccine to Asian/Asian Americans and South Asians, marketers need to address and use approaches to interest those from other race/ethnicities. Also, marketers need to address the erroneous belief that vaccines are typically not safe in order to interest those with such beliefs to use a Lyme disease vaccine.

Current Opinion in Applied Health Economics and Health Policy
First online: 30 January 2016
Methodological Challenges to Economic Evaluations of Vaccines: Is a Common Approach Still Possible?
Mark Jit, Raymond Hutubessy
10.1007/s40258-016-0224-7
Abstract
Economic evaluation of vaccination is a key tool to inform effective spending on vaccines. However, many evaluations have been criticised for failing to capture features of vaccines which are relevant to decision makers. These include broader societal benefits (such as improved educational achievement, economic growth and political stability), reduced health disparities, medical innovation, reduced hospital beds pressures, greater peace of mind and synergies in economic benefits with non-vaccine interventions. Also, the fiscal implications of vaccination programmes are not always made explicit.

Alternative methodological frameworks have been proposed to better capture these benefits. However, any broadening of the methodology for economic evaluation must also involve evaluations of non-vaccine interventions, and hence may not always benefit vaccines given a fixed health-care budget. The scope of an economic evaluation must consider the budget from which vaccines are funded, and the decision-maker’s stated aims for that spending to achieve.

Key Points for Decision Makers
:: Economic evaluations of vaccines usually fail to capture all the societal benefits of vaccination.
:: Broadening the benefits considered must also involve evaluations of non-vaccine interventions and hence may not always benefit vaccines given a fixed health-care budget.
::The scope of an evaluation must consider the budget from which vaccines are funded, and the decision-maker’s stated aims for that spending to achieve.

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

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

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The Atlantic
http://www.theatlantic.com/magazine/
Accessed 13 February 2016
The Zika Virus Family Tree: What Are Flaviviruses? – The Atlantic
Chelsey Coombs • Feb 10, 2016
What the disease spreading through the Americas has in common with yellow fever, dengue, and other flaviviruses.

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The Economist
http://www.economist.com/
Accessed 13 February 2016
Politics and vaccinations: What experts say, and what people hear
Feb 5th 2015, 15:47 by N.L. | CHICAGO The Economist
Both the media and politicians are complicit in the spread of anti-vaccine scare stories.

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Forbes
http://www.forbes.com/
Accessed 13 February 2016
With Zika, Is There Really A Case Against Postponing The 2016 Olympic Games in Rio?
Given the Zika virus outbreak, national and international athletic associations and officials face huge liability if they let teams travel to the 2016 Olympic Games in Rio and health problems ensue. Those worries are now starting to surface.
Lee Igel, Contributor Feb 12, 2016

Zika On Wall Street: Can These Companies Really Cash In On The Virus?
With the Dow down 9% and the Nasdaq having plunged 15% since New Year’s, it has been a lousy start to 2016 on Wall Street—but you wouldn’t know it from the bang-up performance of Intrexon, Cerus and Inovio Pharmaceuticals. What do these three biotech companies have in common? They’re all hoping to cash in on the rise of Zika virus, the mosquito-borne illness that originated in Brazil and has been linked to birth defects. All three companies are working on methods for preventing or treating the virus….
Arlene Weintraub, Contributor Feb 09, 2016

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Mail & Guardian
http://mg.co.za/
Accessed 13 February 2016
Good job so far, but African leaders need to still do a lot more on vaccines
Of the 10 countries with the most unvaccinated children, 5 are African: DR Congo, Ethiopia, Nigeria, South Africa and Uganda
08 Feb 2016 15:10 Ayo Ajayi
…In Ethiopia later this month, ministers of health and finance, as well as other national, traditional and religious leaders, will gather to discuss the unbeatable value of immunisation at the first-ever Ministerial Conference on Immunisation in Africa. This moment presents the perfect opportunity to acknowledge the benefits of vaccine programs, celebrate the successes on the continent, look seriously at what needs to be done to make sure all children get the vaccines they need, and then commit to making that happen…

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New York Times
http://www.nytimes.com/
Accessed 13 February 2016
Catholic Leaders Say Zika Doesn’t Change Ban on Contraception
February 14, 2016 – By LAURIE GOODSTEIN

More Than 5,000 Pregnant Women in Colombia Have Zika Virus: Government
February 13, 2016 – By REUTERS

W.H.O. Official on Zika Vaccine Plans
The World Health Organization said Friday that large-scale trials for a Zika virus vaccine were at least a year and a half away.
February 12, 2016 – By AGENCE FRANCE-PRESSE

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Time
http://time.com
Accessed 13 February 2016
Gates Foundation: Fear Must Not Dictate Zika Policy
5 February 2016
By Chris Elias and Trevor Mundel
Presidents of Global Development and Global Health respectively, Bill & Melinda Gates Foundation
Early reactions to the HIV/AIDS epidemic demonstrate the dangers of letting fear dictate policy
The spread of Zika virus across the Americas reminds us that a health crisis anywhere can rapidly become a health challenge everywhere. The current outbreak demands an urgent, coordinated and collaborative response by the international community to tackle the virus and its spread.
History teaches us that our response must also be rational and humane. The early years of the HIV/AIDS epidemic demonstrated the dangers of letting fear dictate policy. As families understandably struggle with the anxiety and uncertainty from this new threat, we must ensure we are guided by facts and science…

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Washington Post
http://www.washingtonpost.com/
Accessed 13 February 2016
NIH officials accelerate timeline for human trials of Zika vaccine, saying they will now begin in the summer –
By Ariana Eunjung Cha February 12
National Institutes of Health officials said this week that researchers may be closer to developing a Zika vaccine than previously thought and that tests on human subjects could begin in as soon as a few months.
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in an interview that government scientists have been able to leverage previous research done on two similar viruses — West Nile and dengue — to very quickly create a hybrid vaccine that targets Zika. The researchers are now working on fine-tuning the vaccine and in manufacturing enough of it to be able to test it on 20-30 healthy individuals this summer. Fauci said he is optimistic the experimental vaccine would pass those initial tests and would be ready for a larger-scale trial in early 2017.

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_6 February 2016

– blog edition: comprised of the approx. 35+ entries posted below on 7 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 6 February 2016]
Public Health Emergency of International Concern (PHEIC)

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WHO statement on the first meeting of the International Health Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations
WHO statement
1 February 2016
[Excerpt; Full statement distributed earlier and available here]
Based on the advice of the International Health Regulations (2005) Emergency Committee on Zika virus the Director-General declared a Public Health Emergency of International Concern (PHEIC) on 1 February 2016. The Director-General endorsed the Committee’s advice and issued them as Temporary Recommendations under IHR (2005).

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WHO: Zika situation report – 5 February 2016
Neurological syndrome and congenital anomalies
Read the full situation report :: 6 pages
Summary
:: An Emergency Committee was convened by the Director-General under the International Health Regulations (2005) on 1 February 2016. Following the advice of the Committee, the Director-General announced the recent cluster of microcephaly and other neurologic disorders reported in Brazil to be a Public Health Emergency of International Concern.
:: The Emergency Committee agreed that a causal relationship between Zika infection during pregnancy and microcephaly is strongly suspected, though not yet scientifically proven. All experts agreed on the urgent need to coordinate international efforts to investigate and understand this relationship better.
:: Between January 2014 and 5 February 2016, a total of 33 countries have reported autochthonous circulation of Zika virus. There is also indirect evidence of local transmission in 6 additional countries.
:: The geographical distribution of Zika virus has been steadily increasing since it was first detected in the Americas in 2015. Further spread to countries within the geographical range of competent disease vectors — Aedes mosquitoes — is considered likely.
:: Seven countries have reported an increase in the incidence of cases of microcephaly and/or Guillain-Barré syndrome concomitantly with a Zika virus outbreak.
:: The global prevention and control strategy launched by WHO is based on surveillance, response activities, and research.

WHO: Zika: Research in emergencies
February 2016 — To improve timely access to data in the context of a public health emergency, the WHO Bulletin is implementing a new data-sharing and reporting protocol. All research manuscripts relevant to the Zika epidemic will be posted online in the “Zika Open” collection within 24 hours.

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CDC issues Interim Guidelines for Preventing Sexual Transmission of Zika Virus and Updated Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure
Friday, February 5, 2016,
CDC has issued new interim guidance on preventing sexual transmission of Zika virus after confirming through laboratory testing, in collaboration with Dallas County Health and Human Services, the first case of Zika virus infection in a non-traveler in the continental United States during this outbreak.

Although sexual transmission of Zika virus infection is possible, mosquito bites remain the primary way that Zika virus is transmitted. Because there currently is no vaccine or treatment for Zika virus, the best way to avoid Zika virus infection is to prevent mosquito bites.

Based on what we know now, CDC is issuing interim recommendations to prevent sexual transmission of Zika virus. To date, there have been no reports of sexual transmission of Zika virus from infected women to their sex partners. CDC expects to update its interim guidance as new information becomes available….

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CDC adds 2 destinations to interim travel guidance related to Zika virus – Media Statement
WEDNESDAY, FEBRUARY 3, 2016
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 alerts: Jamaica and Tonga. CDC has issued a travel alert (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing. For a full list of affected countries/regions: http://www.cdc.gov/zika/geo/index.html. Specific areas where Zika virus transmission is ongoing are often difficult to determine and are likely to continue to change over time..

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Sanofi Pasteur to leverage its strong vaccine legacy in hunt for Zika vaccine
February 2, 2016
– Building on the company’s successful history in developing vaccines against similar viruses, most recently the introduction of Dengvaxia® against dengue, Sanofi Pasteur is launching a Zika vaccine project –

Lyon, France – February 2, 2016 -Sanofi Pasteur, the vaccines division of Sanofi, announced today that it has launched a vaccine research and development project targeting the prevention of Zika virus infection and disease.

Sanofi Pasteur leads the vaccine field for viruses in the same family as Zika virus (ZIKV), with licensed vaccines against Yellow Fever, Japanese Encephalitis and, most recently, Dengue. Importantly, Sanofi Pasteur’s expertise and established R&D and industrial infrastructure for the newly licensed vaccine for dengue, Dengvaxia®, can be rapidly leveraged to help understand the spread of ZIKV and potentially speed identification of a vaccine candidate for further clinical development.

“Our invaluable collaborations with scientific and public health experts, both globally and in the regions affected by the outbreaks of ZIKV, together with the mobilization of our best experts will expedite efforts to research and develop a vaccine for this disease,” said Dr. John Shiver, Global Head of R&D, Sanofi Pasteur.

The ZIKV is closely related to Dengue; it belongs to the same Flavivirus genus, is spread by the same species of mosquito and has a similar acute clinical presentation. Common symptoms caused by a Zika infection include fever, rash, joint swelling, conjunctivitis and headaches. However, there is a growing body of evidence linking Zika infection in pregnant women with an increased risk of a severe congenital complication at birth called microcephaly. Normally a rare condition, microcephaly results in an abnormally small head impairing brain development.

“Sanofi Pasteur is responding to the global call to action to develop a Zika vaccine given the disease’s rapid spread and possible medical complications,” says Dr. Nicholas Jackson, Global Head of Research for Sanofi Pasteur who will be driving the new ZIKV vaccine project. “In addition to the serious possibility of congenital complications associated with Zika, investigations are also underway to assess another reported connection between Zika and a dangerous neurological disorder”.

Until recently, ZIKV was considered a rare and seemingly benign virus. However in May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed ZIKV infection in Brazil, and since then it has spread across the Americas. In the United States, authorities have reported a locally transmitted case of Zika in Puerto Rico, with reports of cases in continental United States in returning travelers.

At a briefing session during the 138th Executive Board of the World Health Organization (WHO), the WHO Director General, Dr. Margaret Chan, stated that the WHO is deeply concerned about ZIKV for four main reasons:

:: the possible association of infection with birth malformations and neurological syndromes;
:: the potential for further international spread given the wide geographical distribution of the mosquito vector;
:: the lack of population immunity in newly affected areas;
:: absence of vaccines, specific treatments, and rapid diagnostic tests.

In addition, the Centers for Disease Control and Prevention (CDC) have issued travel recommendations for pregnant women to post-pone travel to countries in Latin America and the Caribbean where ZIKV transmission is ongoing.

Presently there is no vaccine or specific treatment for Zika. Vector control remains an important means of potentially controlling the mosquitoes responsible for spreading Zika.

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Pfizer, J&J, Merck evaluating technologies for Zika vaccine
Reuters Wed Feb 3, 2016

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Bharat Biotech says working on two possible Zika vaccines
Reuters Wed Feb 3, 2016

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Takeda Assembles Team to Evaluate Zika Vaccine Possibilities
Bloomberg Business February 2, 2016

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NIH [to 6 February 2016]
http://www.nih.gov/news/releases.htm
February 5, 2016
NIH seeks research applications to study Zika in pregnancy, developing fetus
New effort seeks to understand virus’ effect on reproduction, child development.

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IOM / International Organization for Migration [to 6 February 2016]
http://www.iom.int/press-room/press-releases
02/05/16
IOM: Migrants Must Be Included in Zika Virus Response Plans
Switzerland – IOM DG William Lacy Swing has called on governments to include migrants and mobile populations in Zika Virus preparedness and response plans.

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UN OHCHR Office of the United Nations High Commissioner for Human Rights [to 6 February 2016]
http://www.ohchr.org/EN/NewsEvents/Pages/media.aspx?IsMediaPage=true

5 February 2016
Upholding women’s human rights essential to Zika response – Zeid
GENEVA – Upholding women’s human rights is essential if the response to the Zika health emergency is to be effective, UN High Commissioner for Human Rights Zeid Ra’ad Al Hussein said Friday, adding that laws and policies that restrict access to sexual and reproductive health services in contravention of international standards, must be repealed and concrete steps must be taken so that women have the information, support and services they require to exercise their rights to determine whether and when they become pregnant.

“Clearly, managing the spread of Zika is a major challenge to the governments in Latin America,” Zeid said. “However, the advice of some governments to women to delay getting pregnant, ignores the reality that many women and girls simply cannot exercise control over whether or when or under what circumstances they become pregnant, especially in an environment where sexual violence is so common.”

“In Zika-affected countries that have restrictive laws governing women’s reproductive rights, the situation facing women and girls is particularly stark on a number of levels,” the UN Human Rights Chief said. “In situations where sexual violence is rampant, and sexual and reproductive health services are criminalized, or simply unavailable, efforts to halt this crisis will not be enhanced by placing the focus on advising women and girls not to become pregnant. Many of the key issues revolve around men’s failure to uphold the rights of women and girls, and a range of strong measures need to be taken to tackle these underlying problems.”

The World Health Organization has declared a Public Health Emergency of International Concern amid concerns of a possible association between upsurges in reported cases of Zika virus disease and of microcephaly in Latin America. A causative link between Zika and microcephaly (babies born with abnormally small heads), and Zika and Guillain-Barré Syndrome (a neurological condition), is still under investigation.

Amid the continuing spread of the Zika virus, authorities must ensure that their public health response is pursued in conformity with their human rights obligations, in particular relating to health and health-related rights.

“Upholding human rights is essential to an effective public health response and this requires that governments ensure women, men and adolescents have access to comprehensive and affordable quality sexual and reproductive health services and information, without discrimination,” Zeid said, noting that comprehensive sexual and reproductive health services include contraception — including emergency contraception — maternal healthcare and safe abortion services to the full extent of the law.

“Health services must be delivered in a way that ensures a woman’s fully informed consent, respects her dignity, guarantees her privacy, and is responsive to her needs and perspectives,” he added….

EBOLA/EVD [to 6 February 2016]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

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Ebola Situation Report – 3 February 2016
No new confirmed cases reported.
[Excerpt from Summary]
:: 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.

:: To achieve the second key objective of the phase 3 response framework of managing residual Ebola risks, WHO has supported the implementation of enhanced surveillance systems in Guinea, Liberia, and Sierra Leone to enable health workers and members of the public to report any case of febrile illness or death that they suspect may be related to EVD.

In the week to 31 January, 1063 alerts were reported in Guinea from all of the country’s 34 prefectures, with the vast majority of alerts (1060) reports of community deaths. Over the same period 9 operational laboratories in Guinea tested a total of 346 new and repeat samples (14 samples from live patients and 332 from community deaths) from 17 of the country’s 34 prefectures.

In Liberia, 1062 alerts were reported from all of the country’s 15 counties, most of which (925) were for live patients. The country’s 5 operational laboratories tested 1003 new and repeat samples (807 from live patients and 196 from community deaths) for Ebola virus over the same period.

In Sierra Leone 1287 alerts were reported from the country’s 14 districts. The vast majority of alerts (1071) were for community deaths. 1059 new and repeat samples (76 from live patients and 983 from community deaths) were tested for Ebola virus by the country’s 7 operational laboratories over the same period…

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IOM / International Organization for Migration [to 6 February 2016]
http://www.iom.int/press-room/press-releases
02/05/16
IOM Guinea Supports Psychosocial, Socio-economic Recovery of Ebola Survivors
Guinea – IOM has launched a programme to distribute cash grants to Ebola survivors as part of community-led projects in Boke in the northwestern part of the country.

POLIO [to 6 February 2016]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 3 February 2016
:: There are ten 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.
:: The WHO Executive Board met last week, recognising progress made in 2015 and renewing their commitment to polio eradication. Read more here.
:: For the first time in history, Africa has had 4-months without any wild or circulating vaccine-derived poliovirus cases, nor any environmental positive sample.

Selected content from country-level reports
Pakistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week, with onset of paralysis on 31 December in Peshawar, Khyber Pakhtunkhwa. The total number of WPV1 cases for 2015 is now 54, compared to 305 reported for 2014 by this time last year. A total of 306 cases reported onset in Pakistan in 2014.
:: Four new WPV1 environmental positive samples were detected in the past week. Two were in Sindh province, in Hyderabad and Karachi Gulshan-e-Iqbal with collection dates of 5 January and 18 January respectively. The other two were isolated from Peshawar, Khyber Pakhtunkhwa and in Kabdullah, Balochistan, with collection dates of 11 January and 15 January respectively.
:: Sub-National Immunization Days (SNIDs) are planned in February using tOPV. National Immunization Days (NIDs) are planned in March using tOPV.

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WHO: Inactivated polio vaccine introduced in Iraq
Baghdad, 3 February 2016 – Immunization is one of the most important preventive health actions in children’s lives as it provides protection against the most dangerous childhood diseases.

Iraqi children are set to receive protection from 6 major childhood diseases after the country’s introduction of the inactivated polio vaccine (IPV) as part of its national immunization programme. It is given to children at the age of 2 months, 4 months and 6 months. The IPV is introduced as a combination vaccine that contains antigens against polio, diphtheria, tetanus, whooping cough, hepatitis B and Haemophilus influenzae type B (the bacteria that causes meningitis, pneumonia and otitis). Introduction of IPV is one of the key pillars in the global polio eradication effort, which seeks to completely eliminate this terrible disease. To date, the polio virus has been eliminated from every country except for some small areas of Afghanistan and Pakistan…

…”WHO acknowledges the Government of Iraq’s commitment to childhood vaccination and supports the introduction of IPV-containing vaccine as part of the Endgame Strategic Plan for the Global Polio Eradication Initiative,” said acting WHO Representative Altaf Musani.

“Polio eradication activities have pioneered multiple innovations and demonstrated that health service can, and must reach every child. The introduction of IPV into the Iraq public health structure is one step forward to ensure that Iraqi children are protected from polio, and also that they have equitable access to all health services,” added Peter Hawkins, UNICEF Country Representative in Iraq.

In May 2015, Iraq was removed from the list of infected countries, a landmark achieved through the continued support of WHO, UNICEF and multiple partners in Global Polio Eradication Initiative.

MERS-CoV [to 6 February 2016]

Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
2 February 2016
Between 22 and 27 January 2016, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 5 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection…

…WHO remains vigilant and is monitoring the situation. Given the lack of evidence of sustained human-to-human transmission in the community, WHO does not recommend travel or trade restrictions with regard to this event. Raising awareness about MERS-CoV among travellers to and from affected countries is good public health practice.

WHO & Regionals [to 6 February 2016]

Zero tolerance for female genital mutilation
February 2016 — More than 125 million girls and women alive today have undergone some form of female genital mutilation. WHO opposes all forms of female genital mutilation, which can cause a wide range of both short- and long-term health risks, and which is a grave violation of the human rights of women and girls.

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Weekly Epidemiological Record (WER) 5 February 2016, vol. 91, 5 (pp. 53–60) – Contents
53 Schistosomiasis: number of people treated worldwide in 2014

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Disease Outbreak News (DONs)
No new reports posted.

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:: WHO Regional Offices
WHO African Region AFRO
:: Dr Moeti urges vigilance amid spread of Zika virus
Brazzaville, 4 February 2016 – Countries from the WHO African Region have been urged to be watchful and prepare to tackle any signs of the Zika virus disease. The call was made by Dr Matshidiso Moeti, the WHO Regional Director for Africa. “The most effective forms of prevention are reducing mosquito populations by eliminating their potential breeding sites, and using personal protection measures to prevent mosquito bites. I call upon countries in the Region to strengthen vector control, surveillance and laboratory detection of Zika virus disease and neurological complications, as well as public awareness”, said Dr Moeti..

:: Delegates adopted recommendations on Exchange of Best Practices to Reaching Every District/Community, equity and integration of child survival interventions in ESA –
Cape Town, 29 January 2016 – The first ever workshop on Exchange of Best Practices to Reaching Every District/Community (RED/REC), equity and integration of child survival interventions in East and Southern African (ESA) jointly organized by WHO, UNICEF and JSI, MCSP/USAID, ended with delegates agreeing on recommendations to address inequities in coverage of child survival interventions and make progress towards achieving Universal Health Coverage.
One hundred forty six (146) delegates drawn from the Ministries of Health child health and immunization programmes, partner organizations namely, WHO, UNICEF, JSI/MCSP, CDC, Bill and Melinda Gates Foundation, Sabin Vaccine Institute, the Gavi Alliance and PATH agreed for WHO and partners to develop a framework for integration of child survival interventions to address inequities and make progress towards achieving Universal Health Coverage. Additionally EPI managers were called upon to use findings and recommendations from the workshop to brief their respective ministers in preparation for the impending Ministerial Conference on Immunization in Africa scheduled to take place from February 24-25 in Addis Ababa, Ethiopia…
…The meeting agreed on the following recommendations:
…Countries to further review the best practices identified, adapt and plan for use in the national context, and develop an operation framework based on the integrated RED/REC strategic approach
…The African Region and partners to adapt the current RED strategic approach guidelines to include the expansion of RED components with equity and integration
…EPI managers to brief their respective ministers on the need to capitalize on the gains and expand RED approach to address inequities before the ministerial meeting
…WHO and partners should develop a regional framework for equitable and integrated delivery of child survival interventions in order to address inequities and make progress towards achieving Universal Health Coverage…

WHO Region of the Americas PAHO
:: PAHO Director calls for political commitment and more resources to fight Zika in the Americas (02/03/2016)
:: PAHO Director to brief ministers of health on microcephaly/Zika in the Americas (02/03/2016)
:: Films with smoking scenes should be rated “R” to protect children from tobacco addiction (02/01/2016)

WHO South-East Asia Region SEARO
:: WHO calls for preventive measures against Zika virus disease
New Delhi, 02 February 2016: WHO South-East Asia Regional Director Dr Poonam Khetrapal Singh is urging countries in the Region to strengthen surveillance and take preventive measures against the Zika Virus disease which is strongly suspected to have a causal relation with clusters of microcephaly and other neurological abnormalities.
WHO has declared the recent clusters of microcephaly and other neurological abnormalities reported in the Americas region as a Public Health Emergency of International Concern.
The Zika virus is of concern in the WHO South-East Asia Region as the Aedes aegyptii mosquito, responsible for its spread, is found in many areas and there is no evidence of immunity to the Zika virus in many populations of the Region.
In the past sporadic Zika virus cases were reported from Thailand and Maldives…

WHO European Region EURO
:: Preventing cancer – The European code against cancer 04-02-2016
:: Statement – WHO urges European countries to prevent Zika virus disease spread now 03-02-2016

WHO Eastern Mediterranean Region EMRO
:: WHO calls on countries of the Region to take steps to prevent Zika virus
Cairo, 31 January 2016 — As the Zika virus outbreak continues to spread reaching 24 countries in the Americas (as of 27 January), WHO’s Regional Director for the Eastern Mediterranean Dr Ala Alwan is calling on governments to work together to keep the Region protected.

WHO Western Pacific Region
No new digest content identified.

CDC/ACIP [to 6 February 2016]
http://www.cdc.gov/media/index.html
http://www.cdc.gov/vaccines/acip/

[see Zika coverage above which includes CDC briefing content]

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

More than 3 million US women at risk for alcohol-exposed pregnancy- Press Release
Tuesday, February 2, 2016

MMWR Weekly – February 5, 2016 / Vol. 65 / No. 4
http://www.cdc.gov/mmwr/index2015.html
:: National Black HIV/AIDS Awareness Day — February 7, 2016
:: Disparities in Consistent Retention in HIV Care — 11 States and the District of Columbia, 2011–2013
:: HIV Testing and Service Delivery Among Black Females — 61 Health Department Jurisdictions, United States, 2012–2014
:: Advisory Committee on Immunization Practices Recommended Immunization Schedules for Persons Aged 0 Through 18 Years — United States, 2016
:: Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2016

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.

UNICEF [to 6 February 2016]
http://www.unicef.org/media/media_89711.html

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Pneumonia kills half a million children under five in sub-Saharan Africa, UNICEF says as it launches campaign to curb the disease
NEW YORK/ADDIS ABABA, Ethiopia, 31 January 2016 – UNICEF and global partners launched a campaign today urging African leaders to increase funding for pneumonia interventions and adopt policy changes to strengthen its treatment at the community level. More than 490,000 children under-five died from the disease last year in sub-Saharan Africa…

… Pneumonia kills nearly 1 million children under the age of five around the world, causing more deaths than HIV/AIDS, diarrhea and malaria combined. Progress in the fight against the disease has been slow compared to progress in other leading diseases. Childhood pneumonia deaths have fallen by just 50 per cent compared to an 85 per cent decline in measles deaths, and 60 per cent in deaths from malaria, AIDS and tetanus in the last 15 years. Funding has also remained low: For every global health dollar spent in 2011, only 2 cents went to pneumonia.

The campaign, Every Breath Counts, seeks to raise awareness among leaders, donors and policy makers of the need for increased funding and more adequate policies for pneumonia interventions. Such measures would help:
:: Prevent pneumonia by immunizing children, reducing household air pollution and improving hygiene practices;
:: Protect new born babies from pneumonia though exclusive breastfeeding;
:: Facilitate community access to effective and timely diagnosis and treatment with amoxicillin as well as oxygen for severe cases.

Every Breath Counts was launched during the African Union Summit at the General Assembly of the Organisation of African First Ladies against HIV/AIDS (OAFLA)…

Gavi [to 6 February 2016]
http://www.gavialliance.org/library/news/press-releases/

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05 February 2016
Study shows near elimination of Hib disease in Kilifi region of Kenya after introduction of vaccine
Welcome Trust and Gavi funded research also shows Hib booster not needed for long-term protection.

Geneva – Research funded by the Wellcome Trust and Gavi, the Vaccine Alliance has provided compelling new evidence that three doses of Haemophilus influenzae type b (Hib) vaccine can give children in low-income countries long-lasting protection against life-threatening disease..

Published in the journal Lancet Global Health today, the study was carried out in the Kilifi region of Kenya over a period of 15 years…

Sabin Vaccine Institute [to 6 February 2016]
http://www.sabin.org/updates/ressreleases

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February 3, 2016
Nepal Enacts Bill to Strengthen National Immunization Program, Reduce Dependency on External Funding
KATHMANDU, NEPAL – The Sabin Vaccine Institute (Sabin) joins global health partners around the world in congratulating Nepal on new legislation that will bolster and help sustain its national immunization program. On Jan. 26, President Bidya Devi Bhandari of Nepal signed into law, “Immunization Bill 2072,” a landmark piece of legislation that will make the country’s national immunization program more financially-sustainable as new, costlier vaccines are introduced.

Among its provisions, the law provides for a dedicated national immunization fund to allocate money for the immunization program. This innovative fund will include both government and private contributions. The Nepali government has already allocated 60 million Nepalese rupees, or approximately US$550,000, to the fund, which will be managed by the private sector.

Proceeds will be used to purchase vaccines and support immunization delivery. The new national immunization fund will be supplemented by another fund created by Rotary District 3292. Both funds were established to push Nepal toward full domestic financing of its immunization program and reduce dependency on external financing.

“This legislation is an important milestone for Nepal in protecting children’s rights to getting quality immunization service; increasing country ownership; and sustaining the national immunization program by securing adequate funding,” said the Hon. Ranju Kumari Jha, chairperson of the Nepali Parliamentary Committee on Women, Children, Senior Citizen and Social Welfare. “I hope Nepalese children will be able to receive the full benefits of our immunization program. However, to achieve this goal, we need to work together to ensure the effective implementation of the law.”

This news is particularly important to Sabin’s Sustainable Immunization Financing (SIF) Program, which works in Nepal and 21 other countries to ensure increased and reliable immunization financing. The SIF Program collaborates with counterparts in government ministries and parliaments, subnational decision-makers and the private sector to develop innovative financing solutions, such as Nepal’s new immunization fund.

“Work on this bill began in 2012. Nepal now joins eight other SIF countries with immunization legislation on their books,” said Mike McQuestion, Ph.D., M.P.H., SIF program director. “Greater political commitment, expressed in part through laws, is building the momentum needed for countries to fully finance their immunization programs and achieve the goals set forth in the Global Vaccine Action Plan (GVAP).”…

IAVI International AIDS Vaccine Initiative [to 6 February 2016]
http://www.iavi.org/press-releases/2016

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February 5, 2016
IAVI Announces Partnership in European HIV Vaccine Alliance
The International AIDS Vaccine Initiative (IAVI) is pleased to announce its partnership in the European HIV Vaccine Alliance (EHVA), a new research consortium to develop innovative HIV vaccine concepts.

Funded by a European Union grant under the Horizon 2020 health program, the consortium convenes 39 industrial and academic partners from Europe, the United States and Africa to develop innovative concepts for both prophylactic and therapeutic HIV vaccines. The effort is led by Yves Lévy, CEO of the French Institute of Health and Medical Research (INSERM), and Giuseppe Pantaleo, Executive Director of the Swiss Vaccine Research Institute at Lausanne University Hospital (CHUV). The consortium grant is supplemented with additional funding from the Swiss Government for the Swiss project partners.

IAVI will provide product development support to help the consortium’s vaccine candidates to advance through clinical assessment. The IAVI Human Immunology Laboratory, a partnership with Imperial College London, will help assess immune responses induced in EHVA’s clinical trials. IAVI’s European regional office in Amsterdam will help coordinate the consortium’s communications activities…

IVI [to 6 February 2016]
http://www.ivi.org/web/www/home

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2016.02.05
Launch of New IVI: Strategic Renewal and Organizational Changes
Major exciting developments are in store for the organization. In 2015, IVI underwent a strategic renewal in which core capabilities were re-evaluated and organizational direction was redefined, with support from the Boston Consulting Group (BCG). As a result, IVI is in a much stronger position to deliver on our core mission due to the following changes:

[1] Revised mission statement to reflect our expanded focus on new and emerging diseases of global health importance such as MERS: Discover, develop, and deliver safe, effective and affordable vaccines for global public health.

[2] Articulation of a clear strategic direction that builds on our best-in-class product development and translational capabilities.

[3] Renewed focus on diseases where we have exceptional expertise and experience, including cholera, typhoid, dengue, hepatitis E, and MERS.

[4] A reorganized scientific lab structure designed to facilitate cross-departmental communication and to focus talent against highest priority activities.

[5] Streamlined core cost structure that ensures financial sustainability and operational efficiency.

[6] Strengthened relationships with funders, PDP partners and Developing Country Vaccine Manufacturers (DCVMs) that ensure that IVI will remain at the forefront of efforts to develop affordable vaccines with global, Asian and African public health importance

More information will be issued soon describing in more detail IVI’s new strategy, organization, and focus on cutting-edge vaccine development and delivery. The new team and new direction will help make IVI a stronger organization to deliver greater impact in global health.

Global Fund [to 6 February 2016]
http://www.theglobalfund.org/en/news/

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News
Grant to Fight TB in Southern Africa’s Mining Sector
PRETORIA, February 5, 2016 – The Global Fund to Fight AIDS, Tuberculosis and Malaria and a Regional Coordinating Mechanism (RCM) representing a group of 10 Southern African countries today signed a landmark grant to pioneer innovative models to reduce high rates of TB in the mining sector.

The Grant will support potentially-transformative interventions in Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Zambia and Zimbabwe. The World Bank Group serves as the Secretariat for the RCM while the Wits Health Consortium acts as the Principal Recipient of the Grant.

“Gold miners in southern Africa have some of the highest rates of TB infection in the world, we are committed to investing vigorously to reduce rates as much as possible,” said Mark Dybul, Executive Director of the Global Fund. “To end TB as an epidemic, we have to be effective here.”…

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Global Fund Supports Health Investment in Botswana
03 February 2016
GABORONE, Botswana – Two new grants signed today between the Global Fund and Botswana mark a new phase of partnership, with a focus on preventing, treating and caring for people affected by HIV and tuberculosis.

The financial resources provided through the Global Fund come from many sources and partners, represented today at a signing event by the United States, the United Kingdom, Japan, the European Union, Germany and France. The grants signed today total US$27 million.

“The overall goals of the grants are to achieve zero local malaria transmission or the elimination of malaria, to prevent new HIV infections, reduce morbidity and mortality as well as to enhance the psychosocial and economic impact associated with TB,” said Botswana’s Minister Of Health, Dorcas Makgato…

…Botswana faces high rates of HIV and TB. The HIV prevalence rate is 18.5 percent, one of the highest in the world. It also has one of the highest TB prevalence rates globally. The two diseases are highly interlinked – 60 percent of people with TB in Botswana also have HIV…

UNAIDS [to 6 February 2016]
http://www.unaids.org/en/resources/presscentre/

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04 February 2016
On World Cancer Day 2016, UNAIDS calls for greater integration of health services to save women’s lives
GENEVA, 4 February 2016—On World Cancer Day, UNAIDS calls for greater investment in the prevention and treatment of cervical cancer and underlines the additional benefits to be achieved for women and adolescent girls from a coordinated response to HIV and cervical cancer.

Every year, more than 500 000 women develop cervical cancer, which is caused by the human papillomavirus (HPV), and more than 250 000 women die of the disease, most of whom live in low- and middle-income countries. Yet cervical cancer is a preventable disease that can also be successfully treated if detected early. Furthermore, the relationship between HPV and HIV offers significant opportunities to reduce the impact of both viruses, since existing HIV programmes could play an important role in expanding cervical cancer prevention and treatment services. For example, every woman who tests positive for HIV should be offered cervical cancer screening and follow-up treatment if necessary; HIV testing should also be offered during cervical cancer screening…

HPV infection increases women’s vulnerability to HIV transmission, while women living with HIV are four to five times more likely to develop cervical cancer than their HIV-negative peers. HPV infections are common in the general population and most people with strong immune systems will be free of them over time. However, women with weakened immune systems are less likely to clear the HPV virus and become more susceptible to developing pre-invasive lesions that can, if left untreated, quickly progress to invasive, life-threatening cancer.

Reducing preventable deaths from cervical cancer requires a comprehensive approach that delivers effective and age-appropriate programmes that include the vaccination of young adolescent girls against HPV, the screening of women at risk of developing cervical cancer, treatment of pre-cancerous cervical lesions and treatment for invasive and advanced cervical cancer, including chemotherapy and/or radiotherapy.

The Neglected Dimension of Global Security: A Framework to Counter Infectious Disease Crises (2016)
Commission on a Global Health Risk Framework for the Future; National Academy of Medicine, Secretariat
National Research Council. Washington, DC: The National Academies Press, 2016. doi:10.17226/21891 :: 145 pages
Pdf: http://www.nap.edu/login.php?record_id=21891&page=http%3A%2F%2Fwww.nap.edu%2Fdownload.php%3Frecord_id%3D21891

Description
Since the 2014 Ebola outbreak many public- and private-sector leaders have seen a need for improved management of global public health emergencies. The effects of the Ebola epidemic go well beyond the three hardest-hit countries and beyond the health sector. Education, child protection, commerce, transportation, and human rights have all suffered. The consequences and lethality of Ebola have increased interest in coordinated global response to infectious threats, many of which could disrupt global health and commerce far more than the recent outbreak.

In order to explore the potential for improving international management and response to outbreaks the National Academy of Medicine agreed to manage an international, independent, evidence-based, authoritative, multistakeholder expert commission. As part of this effort, the Institute of Medicine convened four workshops in summer of 2015. This commission report considers the evidence supplied by these workshops and offers conclusions and actionable recommendations to guide policy makers, international funders, civil society organizations, and the private sector.

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Announcement
How to Stop Epidemics: Spend Billions to Save Trillions
Partners in Health
Posted on February 04, 2016
Global health has occupied the news this year. In January, the World Health Organization announced an end to Ebola in West Africa, only for a new case to emerge in Sierra Leone the next day. This week, the Zika virus was declared an international public health emergency as it runs rampant in Brazil and spreads to neighboring countries.

Global health experts are not surprised. Partners In Health Co-founder Dr. Paul Farmer is among them. He and 16 others—including university presidents, finance executives, and disease control specialists—forecast in a 130-page report that pandemics are inevitable as new infectious diseases emerge alongside ever-increasing international travel and trade.

The authors, who comprise the Commission on a Global Health Risk Framework for the Future, say the solution is proper investment in countries’ health systems.

This is at the core of PIH’s work. Early during the Ebola crisis, Farmer said the only “formula” to counter Ebola is a “comprehensive model of prevention,” meaning strong, functioning health systems that provide quality care.

The global community is learning this lesson again with the Zika virus. In Brazil, it is spreading where poverty is concentrated. Virus-carrying mosquitos breed in the stagnant water of dirty canals or the dumped garbage of shantytowns. Poor people without access to running water store their own, and are at greater risk of contracting Zika.

According to the commission, the public health community should view infectious diseases as important as other security threats. They recommend spending $4.5 billion per year on helping countries prepare for pandemics, growing funds for emergency responses, and accelerating research and development of drugs, vaccines, and diagnostics for infectious diseases. While a large figure, the commissioners say it’s a wise investment—pandemics could cost the global economy $60 billion a year. A fraction of that could prevent a $6 trillion problem over the next century.

PIH has been investing in the health systems of poor countries for nearly 30 years. And we’re beginning the long road to building robust health systems in West Africa, where we’ve been at the frontlines of the Ebola crisis since September 2014.

We believe this work—building clinics and hospitals, training nurses and doctors, conducting research, and partnering with local governments—will raise the standard of care available to poor communities. It is also the way to prevent debilitating epidemics such as Ebola and Zika in the future.

American Journal of Infection Control
February 2016 Volume 44, Issue 2, p125-252, e9-e14
http://www.ajicjournal.org/current

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Brief Reports
Influenza vaccination competence of nurses in France: A survey in nursing schools
Lucille Desbouys, Sabine Grison, Odile Launay, Pierre Loulergue
p236–238
Published online: November 13 2015
Abstract
Since 2008, French nurses have been allowed to vaccinate against influenza without medical prescription. Our survey aimed at assessing nursing students’ knowledge and perception of this prerogative. Among 213 responders, 61% were aware of this matter, and 47.5% were familiar with its requirements. Most (75.6%) were positive about it. Influenza vaccination without medical prescription is well-known and validated by nursing students. This new competence may improve vaccination coverage.

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Association between early influenza vaccination and the reduction of influenza-like syndromes in health care providers
Evelyn Saadeh-Navarro, Elvira Garza-González, Raúl Gabino Salazar-Montalvo, Juan Manuel Rodríguez-López, Lidia Mendoza-Flores, Adrián Camacho-Ortiz
p250–252
Published online: November 13 2015
Abstract
A comparison of 2 different influenza seasons (2013-2014 and 2014-2015) where early vaccination among health care providers (HCPs) in the latter was the difference. Differences in leave of absence because of influenza-like illness (ILI) (52 vs 15 [total number of leave of absence issued], P < .001) and total days of lost work (218 vs 68, P < .001) were found for the 2013-2014 and 2014-2015 seasons, respectively. An association between earlier influenza vaccination among HCPs and a reduction in ILI, leave of absence, and days of lost work was found.

American Journal of Public Health
Volume 106, Issue 2 (February 2016)
http://ajph.aphapublications.org/toc/ajph/current

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AJPH PERSPECTIVES
Protecting Personally Identifiable Information When Using Online Geographic Tools for Public Health Research
American Journal of Public Health: February 2016, Vol. 106, No. 2: 206–208.
Michael D. M. Bader, Stephen J. Mooney, Andrew G. Rundle
[No abstract]

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Integrating Systems Science and Community-Based Participatory Research to Achieve Health Equity
American Journal of Public Health: February 2016, Vol. 106, No. 2: 215–222.
Leah Frerichs, Kristen Hassmiller Lich, Gaurav Dave, Giselle Corbie-Smith
ABSTRACT
Unanswered questions about racial and socioeconomic health disparities may be addressed using community-based participatory research and systems science. Community-based participatory research is an orientation to research that prioritizes developing capacity, improving trust, and translating knowledge to action. Systems science provides research methods to study dynamic and interrelated forces that shape health disparities. Community-based participatory research and systems science are complementary, but their integration requires more research. We discuss paradigmatic, socioecological, capacity-building, colearning, and translational synergies that help advance progress toward health equity.

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AJPH POLICY
Use of Fees to Discourage Nonmedical Exemptions to School Immunization Laws in US States
American Journal of Public Health: February 2016, Vol. 106, No. 2: 269–270.
John K. Billington, Saad B. Omer
Abstract
Recent outbreaks of vaccine-preventable diseases in the United States have renewed public discourse about state vaccine mandates for children entering schools. With acknowledgment of the challenge of eliminating religious and philosophical exemptions in most states, some have proposed instead to impose additional administrative burdens for parents seeking such exemptions. We review the use of taxes, fines, and fees as financial disincentives in public health. We argue that adding processing fees to a comprehensive set of administrative requirements for obtaining exemptions will avoid the use of taxpayer funding for exemption processing and will help tilt the balance of convenience in favor of vaccination.

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AJPH LAW AND ETHICS
Ethics and Childhood Vaccination Policy in the United States
American Journal of Public Health: February 2016, Vol. 106, No. 2: 273–278.
Kristin S. Hendrix, Lynne A. Sturm, Gregory D. Zimet, Eric M. Meslin
Abstract
Childhood immunization involves a balance between parents’ autonomy in deciding whether to immunize their children and the benefits to public health from mandating vaccines. Ethical concerns about pediatric vaccination span several public health domains, including those of policymakers, clinicians, and other professionals.

In light of ongoing developments and debates, we discuss several key ethical issues concerning childhood immunization in the United States and describe how they affect policy development and clinical practice. We focus on ethical considerations pertaining to herd immunity as a community good, vaccine communication, dismissal of vaccine-refusing families from practice, and vaccine mandates.

Clinicians and policymakers need to consider the nature and timing of vaccine-related discussions and invoke deliberative approaches to policymaking.

American Journal of Tropical Medicine and Hygiene
February 2016; 94 (2)
http://www.ajtmh.org/content/current

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Perspective Piece
Clinical Research and the Training of Host Country Investigators: Essential Health Priorities for Disease-Endemic Regions
Ousmane A. Koita, Robert L. Murphy, Saharé Fongoro, Boubakar Diallo, Seydou O. Doumbia, Moussa Traoré, and Donald J. Krogstad
Am J Trop Med Hyg 2016 94:253-257; Published online November 23, 2015, doi:10.4269/ajtmh.15-0366
Abstract
The health-care needs and resources of disease-endemic regions such as west Africa have been a major focus during the recent Ebola outbreak. On the basis of that experience, we call attention to two priorities that have unfortunately been ignored thus far: 1) the development of clinical research facilities and 2) the training of host country investigators to ensure that the facilities and expertise necessary to evaluate candidate interventions are available on-site in endemic regions when and where they are needed. In their absence, as illustrated by the recent uncertainty about the use of antivirals and other interventions for Ebola virus disease, the only treatment available may be supportive care, case fatality rates may be unacceptably high and there may be long delays between the time potential interventions become available and it becomes clear whether those interventions are safe or effective. On the basis of our experience in Mali, we urge that the development of clinical research facilities and the training of host country investigators be prioritized in disease-endemic regions such as west Africa.

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 6 February 2016)

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Research article
Pattern of animal bites and post exposure prophylaxis in rabies: A five year study in a tertiary care unit in Sri Lanka
Rabies is a global problem which occurs in more than 150 countries and territories including Sri Lanka, where human deaths from rabies are in decline whilst resources incurred for prevention of rabies are in sharp incline over the years…
Senanayake Abeysinghe Mudiyanselage Kularatne, Dissanayake Mudiyanselage Priyantha Udaya Kumara Ralapanawa, Koasala Weerakoon, Usha Kumari Bokalamulla and Nanada Abagaspitiya
BMC Infectious Diseases 2016 16:62
Published on: 4 February 2016

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Research article
Trends in genital warts by socioeconomic status after the introduction of the national HPV vaccination program in Australia: analysis of national hospital data
Human papillomavirus (HPV) vaccination targeting females 12–13 years commenced in Australia in 2007, with catch-up of females 13–26 years until the end of 2009. No analyses of HPV vaccination program impact by either socioeconomic or geographic factors have been reported for Australia… The relative reduction in genital warts appears similar in young females across different levels of disadvantage, including within and outside major cities, both for females predominantly vaccinated at school and in the community.
Megan A. Smith, Bette Liu, Peter McIntyre, Robert Menzies, Aditi Dey and Karen Canfell
BMC Infectious Diseases 2016 16:52
Published on: 1 February 2016

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 6 February 2016)

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Research article
Exceptions to the rule of informed consent for research with an intervention
Susanne Rebers, Neil K. Aaronson, Flora E. van Leeuwen and Marjanka K. Schmidt
BMC Medical Ethics 2016 17:9
Published on: 6 F ebruary 2016
Abstract
Background
In specific situations it may be necessary to make an exception to the general rule of informed consent for scientific research with an intervention. Earlier reviews only described subsets of arguments for exceptions to waive consent.
Methods
Here, we provide a more extensive literature review of possible exceptions to the rule of informed consent and the accompanying arguments based on literature from 1997 onwards, using both Pubmed and PsycINFO in our search strategy.
Results
We identified three main categories of arguments for the acceptability of a consent waiver: data validity and quality, major practical problems, and distress or confusion of participants. Approval by a medical ethical review board always needs to be obtained. Further, we provide examples of specific conditions under which consent waiving might be allowed, such as additional privacy protection measures.
Conclusions
The reasons legitimized by the authors of the papers in this overview can be used by researchers to form their own opinion about requesting an exception to the rule of informed consent for their own study. Importantly, rules and guidelines applicable in their country, institute and research field should be followed. Moreover, researchers should also take the conditions under which they feel an exception is legitimized under consideration. After discussions with relevant stakeholders, a formal request should be sent to an IRB.

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 6 February 2016)

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Research article
Post-marketing withdrawal of 462 medicinal products because of adverse drug reactions: a systematic review of the world literature
Igho J. Onakpoya, Carl J. Heneghan and Jeffrey K. Aronson
BMC Medicine 2016 14:10
Published on: 4 February 2016
Abstract
Background
There have been no studies of the patterns of post-marketing withdrawals of medicinal products to which adverse reactions have been attributed. We identified medicinal products that were withdrawn because of adverse drug reactions, examined the evidence to support such withdrawals, and explored the pattern of withdrawals across countries.
Methods
We searched PubMed, Google Scholar, the WHO’s database of drugs, the websites of drug regulatory authorities, and textbooks. We included medicinal products withdrawn between 1950 and 2014 and assessed the levels of evidence used in making withdrawal decisions using the criteria of the Oxford Centre for Evidence Based Medicine.
Results
We identified 462 medicinal products that were withdrawn from the market between 1953 and 2013, the most common reason being hepatotoxicity. The supporting evidence in 72 % of cases consisted of anecdotal reports. Only 43 (9.34 %) drugs were withdrawn worldwide and 179 (39 %) were withdrawn in one country only. Withdrawal was significantly less likely in Africa than in other continents (Europe, the Americas, Asia, and Australasia and Oceania). The median interval between the first reported adverse reaction and the year of first withdrawal was 6 years (IQR, 1–15) and the interval did not consistently shorten over time.
Conclusion
There are discrepancies in the patterns of withdrawal of medicinal products from the market when adverse reactions are suspected, and withdrawals are inconsistent across countries. Greater co-ordination among drug regulatory authorities and increased transparency in reporting suspected adverse drug reactions would help improve current decision-making processes.

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Research article
A scoping review of competencies for scientific editors of biomedical journals
Biomedical journals are the main route for disseminating the results of health-related research. Despite this, their editors operate largely without formal training or certification. To our knowledge, no body of literature systematically identifying core competencies for scientific editors of biomedical journals exists. Therefore, we aimed to conduct a scoping review to determine what is known on the competency requirements for scientific editors of biomedical journals.
James Galipeau, Virginia Barbour, Patricia Baskin, Sally Bell-Syer, Kelly Cobey, Miranda Cumpston, Jon Deeks, Paul Garner, Harriet MacLehose, Larissa Shamseer, Sharon Straus, Peter Tugwell, Elizabeth Wager, Margaret Winker and David Moher
BMC Medicine 2016 14:16
Published on: 2 February 2016

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 6 February 2016)

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Research article
Determinants of tetanus, pneumococcal and influenza vaccination in the elderly: a representative cross-sectional study on knowledge, attitude and practice (KAP)
Severity and incidence of vaccine-preventable infections with influenza viruses, s. pneumoniae and c. tetani increase with age. Furthermore, vaccine coverage in the elderly is often insufficient. The aim of this …
Carolina J. Klett-Tammen, Gérard Krause, Linda Seefeld and Jördis J. Ott
BMC Public Health 2016 16:121
Published on: 4 February 2016
Abstract
Background
Severity and incidence of vaccine-preventable infections with influenza viruses, s. pneumoniae and c. tetani increase with age. Furthermore, vaccine coverage in the elderly is often insufficient. The aim of this study is to identify socio-economic and knowledge-, attitude- and practice- (KAP)-related determinants of vaccination against influenza, pneumococcal disease and tetanus in the older German population.
Methods
We analysed data from a German nationally representative questionnaire-based KAP-survey on infection prevention and hygiene behavior in the elderly (n  = 1223). We used logistic regressions to assess impacts of socio-demographic- and KAP-related variables on vaccine uptake in general and on tetanus-, influenza- and pneumococcal vaccination. To generate KAP-scores, we applied factor analyses and analysed scores as predictors of specific vaccinations.
Results
A low rated personal health status was associated with a higher uptake of influenza vaccine whereas place of residence within Germany strongly impacted on pneumococcal vaccination. For tetanus and influenza vaccination, the strongest single vaccination predictor was attitude-related, i.e., the perceived importance of the vaccine (OR = 18.1, 95 % CI = 4.5–71.8; OR = 23.0, 95 % CI = 14.9–35.3, respectively). Pneumococcal vaccination was mostly knowledge-associated, i.e., knowing the recommendation predicted uptake (OR = 17.1, 95 % CI = 9.5–30.7). Regarding the generated KAP-scores, the practice-score reflecting vaccine related behavior such as having a vaccination record, was predictive for all vaccines considered. The knowledge-score was associated with influenza (OR = 1.3, 95 % CI = 1.0–1.6) and pneumococcal vaccination (OR = 1.2, 95 % CI = 1.0–1.5). Uniquely for influenza vaccination, the attitude-score was linked to vaccine uptake (OR = 1.1, 95 % CI = 1.0–1.1).
Conclusions
Our results indicate that predictors of vaccination uptake in the elderly strongly depend on vaccine type and that scores of KAP are useful and valid to condense information from numerous individual KAP-variables. While awareness for vaccinations against influenza and tetanus is fairly high already it might have to be increased for vaccinations against pneumocoocal infection.

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Research article
Trends in childhood pneumococcal vaccine coverage in Shanghai, China, 2005–2011: a retrospective cohort study
In China, the pneumococcal conjugate vaccine (PCV7) and the pneumococcal polysaccharide vaccine (PPSV23) are not offered under the government’s Expanded Program on Immunization and are instead administered for…
Matthew L. Boulton, Nithin S. Ravi, Xiaodong Sun, Zhuoying Huang and Abram L. Wagner
BMC Public Health 2016 16:109
Published on: 2 February 2016
Abstract
Background
In China, the pneumococcal conjugate vaccine (PCV7) and the pneumococcal polysaccharide vaccine (PPSV23) are not offered under the government’s Expanded Program on Immunization and are instead administered for a fee. PCV7 is more effective and covers more serotypes associated with invasive disease in children, but is also more expensive, than PPSV23. Because of their expense, there is concern that these vaccines, especially PCV7, have low uptake particularly among non-locals, migrants from outside of Shanghai. This paper characterizes the differential coverage of PCV7 and PPSV23 between locals and non-locals in Shanghai, and illustrates coverage trends over time.
Methods
In this retrospective cohort study, children born between 2005 and 2011 were sampled from the Shanghai Immunization Program Information System. Bivariate and multivariable analyses examined the relationships between demographic characteristics, residency status (non-locals vs locals), and vaccination coverage.
Results
PPSV23 coverage (29.8 %) among children over 2 years of age was higher than PCV7 coverage (10.1 %) for locals and non-locals. Uptake of PCV7 increased substantially after children were 2 years of age. Overall, non-local populations had higher PPSV23 coverage (OR: 1.34; 98 % CI: 1.22, 1.46) but lower PCV7 coverage (OR: 0.617, 98 % CI: 0.547, 0.695) than locals.
Conclusions
There is a need for increasing overall pneumococcal coverage in Shanghai children, particularly with the more effective PCV7 vaccine. Morbidity and mortality due to invasive pneumococcal disease for children <1 year of age are unlikely to be mitigated if the current age-related vaccination patterns are not improved.

BMJ Open
2016, Volume 6, Issue 2

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Protocol
Development of a Health Empowerment Programme to improve the health of working poor families: protocol for a prospective cohort study in Hong Kong
Colman Siu Cheung Fung, Esther Yee Tak Yu, Vivian Yawei Guo, Carlos King Ho Wong, Kenny Kung, Sin Yi Ho, Lai Ying Lam, Patrick Ip, Daniel Yee Tak Fong, David Chi Leung Lam, William Chi Wai Wong, Sandra Kit Man Tsang, Agnes Fung Yee Tiwari, Cindy Lo Kuen Lam
BMJ Open 2016;6:e010015 doi:10.1136/bmjopen-2015-010015
Abstract
Introduction
People from working poor families are at high risk of poor health partly due to limited healthcare access. Health empowerment, a process by which people can gain greater control over the decisions affecting their lives and health through education and motivation, can be an effective way to enhance health, health-related quality of life (HRQOL), health awareness and health-seeking behaviours of these people. A new cohort study will be launched to explore the potential for a Health Empowerment Programme to enable these families by enhancing their health status and modifying their attitudes towards health-related issues. If proven effective, similar empowerment programme models could be tested and further disseminated in collaborations with healthcare providers and policymakers.
Method and analysis
A prospective cohort study with 200 intervention families will be launched and followed up for 5 years. The following inclusion criteria will be used at the time of recruitment: (1) Having at least one working family member; (2) Having at least one child studying in grades 1–3; and (3) Having a monthly household income that is less than 75% of the median monthly household income of Hong Kong families. The Health Empowerment Programme that will be offered to intervention families will comprise four components: health assessment, health literacy, self-care enablement and health ambassador. Their health status, HRQOL, lifestyle and health service utilisation will be assessed and compared with 200 control families with matching characteristics but will not receive the health empowerment intervention.
Ethics and dissemination
This project was approved by the University of Hong Kong—the Hospital Authority Hong Kong West Cluster IRB, Reference number: UW 12-517. The study findings will be disseminated through a series of peer-reviewed publications and conference presentations, as well as a yearly report to the philanthropic funding body–Kerry Group Kuok Foundation (Hong Kong) Limited.

Bulletin of the World Health Organization
Volume 94, Number 2, February 2016, 77-156
http://www.who.int/bulletin/volumes/94/2/en/

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EDITORIALS
Building research and development on poverty-related diseases
John C Reeder & Winnie Mpanju-Shumbusho
doi: 10.2471/BLT.15.167072
[No abstract]

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RESEARCH
Community-based surveillance of maternal deaths in rural Ghana
Joseph Adomako, Gloria Q Asare, Anthony Ofosu, Bradley E Iott, Tiffany Anthony, Andrea S Momoh, Elisa V Warner, Judy P Idrovo, Rachel Ward & Frank WJ Anderson
doi: 10.2471/B
Objective
To examine the feasibility and effectiveness of community-based maternal mortality surveillance in rural Ghana, where most information on maternal deaths usually comes from retrospective surveys and hospital records.
Methods
In 2013, community-based surveillance volunteers used a modified reproductive age mortality survey (RAMOS 4+2) to interview family members of women of reproductive age (13–49 years) who died in Bosomtwe district in the previous five years. The survey comprised four yes–no questions and two supplementary questions. Verbal autopsies were done if there was a positive answer to at least one yes–no question. A mortality review committee established the cause of death.
Findings
Survey results were available for 357 women of reproductive age who died in the district. A positive response to at least one yes–no question was recorded for respondents reporting on the deaths of 132 women. These women had either a maternal death or died within one year of termination of pregnancy. Review of 108 available verbal autopsies found that 64 women had a maternal or late maternal death and 36 died of causes unrelated to childbearing. The most common causes of death were haemorrhage (15) and abortion (14). The resulting maternal mortality ratio was 357 per 100 000 live births, compared with 128 per 100 000 live births derived from hospital records.
Conclusion
The community-based mortality survey was effective for ascertaining maternal deaths and identified many deaths not included in hospital records. National surveys could provide the information needed to end preventable maternal mortality by 2030.

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Research
Drinking water and sanitation: progress in 73 countries in relation to socioeconomic indicators
Jeanne Luh & Jamie Bartram
doi: 10.2471/BLT.15.162974
Objective
To assess progress in the provision of drinking water and sanitation in relation to national socioeconomic indicators.
Methods
We used household survey data for 73 countries – collected between 2000 and 2012 – to calculate linear rates of change in population access to improved drinking water (n = 67) and/or sanitation (n = 61). To enable comparison of progress between countries with different initial levels of access, the calculated rates of change were normalized to fall between –1 and 1. In regression analyses, we investigated associations between the normalized rates of change in population access and national socioeconomic indicators: gross national income per capita, government effectiveness, official development assistance, freshwater resources, education, poverty, Gini coefficient, child mortality and the human development index.
Findings
The normalized rates of change indicated that most of the investigated countries were making progress towards achieving universal access to improved drinking water and sanitation. However, only about a third showed a level of progress that was at least half the maximum achievable level. The normalized rates of change did not appear to be correlated with any of the national indicators that we investigated.
Conclusion
In many countries, the progress being made towards universal access to improved drinking water and sanitation is falling well short of the maximum achievable level. Progress does not appear to be correlated with a country’s social and economic characteristics. The between-country variations observed in such progress may be linked to variations in government policies and in the institutional commitment and capacity needed to execute such policies effectively.

PERSPECTIVES
The use of mobile phones in polio eradication
Abdul Momin Kazi & Lubna Ashraf Jafri
doi: 10.2471/BLT.15.163683
[No abstract]

Eurosurveillance
Volume 21, Issue 5, 04 February 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Research Articles
Evaluation of a temporary vaccination recommendation in response to an outbreak of invasive meningococcal serogroup C disease in men who have sex with men in Berlin, 2013–2014
by J Koch, W Hellenbrand, S Schink, O Wichmann, A Carganico, J Drewes, M Kruspe, M Suckau, H Claus, U Marcus

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News
Resources and latest news about Zika virus disease available from ECDC
by Eurosurveillance editorial team

Health Policy and Planning
Volume 31 Issue 1 February 2016
http://heapol.oxfordjournals.org/content/current

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Original Articles
Editor’s Choice: The free health care initiative: how has it affected health workers in Sierra Leone?
Sophie Witter, Haja Wurie, and Maria Paola Bertone
Health Policy Plan. (2016) 31 (1): 1-9 doi:10.1093/heapol/czv006
Abstract
There is an acknowledged gap in the literature on the impact of fee exemption policies on health staff, and, conversely, the implications of staffing for fee exemption. This article draws from five research tools used to analyse changing health worker policies and incentives in post-war Sierra Leone to document the effects of the Free Health Care Initiative (FHCI) of 2010 on health workers.
Data were collected through document review (57 documents fully reviewed, published and grey); key informant interviews (23 with government, donors, NGO staff and consultants); analysis of human resource data held by the MoHS; in-depth interviews with health workers (23 doctors, nurses, mid-wives and community health officers); and a health worker survey (312 participants, including all main cadres). The article traces the HR reforms which were triggered by the FHCI and evidence of their effects, which include substantial increases in number and pay (particularly for higher cadres), as well as a reported reduction in absenteeism and attrition, and an increase (at least for some areas, where data is available) in outputs per health worker. The findings highlight how a flagship policy, combined with high profile support and financial and technical resources, can galvanize systemic changes. In this regard, the story of Sierra Leone differs from many countries introducing fee exemptions, where fee exemption has been a stand-alone programme, unconnected to wider health system reforms. The challenge will be sustaining the momentum and the attention to delivering results as the FHCI ceases to be an initiative and becomes just ‘business as normal’. The health system in Sierra Leone was fragile and conflict-affected prior to the FHCI and still faces significant challenges, both in human resources for health and more widely, as vividly evidenced by the current Ebola crisis

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Developing a holistic policy and intervention framework for global mental health
Akwatu Khenti, Stéfanie Fréel, Ruth Trainor, Sirad Mohamoud, Pablo Diaz, Erica Suh, Sireesha J Bobbili, and Jaime C Sapag
Health Policy Plan. (2016) 31 (1): 37-45 doi:10.1093/heapol/czv016
Abstract
Introduction: There are significant gaps in the accessibility and quality of mental health services around the globe. A wide range of institutions are addressing the challenges, but there is limited reflection and evaluation on the various approaches, how they compare with each other, and conclusions regarding the most effective approach for particular settings. This article presents a framework for global mental health capacity building that could potentially serve as a promising or best practice in the field. The framework is the outcome of a decade of collaborative global health work at the Centre for Addiction and Mental Health (CAMH) (Ontario, Canada). The framework is grounded in scientific evidence, relevant learning and behavioural theories and the underlying principles of health equity and human rights.
Methods: Grounded in CAMH’s research, programme evaluation and practical experience in developing and implementing mental health capacity building interventions, this article presents the iterative learning process and impetus that formed the basis of the framework. A developmental evaluation (Patton M.2010. Developmental Evaluation: Applying Complexity Concepts to Enhance Innovation and Use. New York: Guilford Press.) approach was used to build the framework, as global mental health collaboration occurs in complex or uncertain environments and evolving learning systems.
Results: A multilevel framework consists of five central components: (1) holistic health, (2) cultural and socioeconomic relevance, (3) partnerships, (4) collaborative action-based education and learning and (5) sustainability. The framework’s practical application is illustrated through the presentation of three international case studies and four policy implications. Lessons learned, limitations and future opportunities are also discussed.
Conclusion: The holistic policy and intervention framework for global mental health reflects an iterative learning process that can be applied and scaled up across different settings through appropriate modifications.

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Two decades of maternity care fee exemption policies in Ghana: have they benefited the poor?
Fiifi Amoako Johnson, Faustina Frempong-Ainguah, and Sabu S Padmadas
Health Policy Plan. (2016) 31 (1): 46-55 doi:10.1093/heapol/czv017

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 12, Issue 1, 2016
http://www.tandfonline.com/toc/khvi20/current

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Research Papers
How university students view human papillomavirus (HPV) vaccination: A cross-sectional study in Jinan, China
pages 39-46
DOI:10.1080/21645515.2015.1072667
Huachun Zou, Wei Wang, Yuanyuan Ma, Yongjie Wang, Fanghui Zhao, Shaoming Wang, Shaokai Zhang & Wei Ma
Abstract
The acceptability of HPV vaccination among university students in China is not well understood. Our study was of cross-sectional study design. We collected a questionnaire about socio-demographic characteristics, knowledge of, attitude toward and acceptability of HPV vaccination. A total of 351 students were included in data analyses, among whom 47.6% were males and 70.0% aged 19–21. Only 10.3% had previously heard of HPV and 5.4% HPV vaccine. Male and female students were equally likely to accept HPV vaccine (71.8 vs 69.4%, p = 0.634) and recommend it to sexual partners (73.1 vs 76.7%, p = 0.441). The great majority of students could only afford RMB 300 (USD 50) or less for HPV vaccination. HPV vaccination acceptance was associated with being in year-one (Adjusted odds ratio (AOR) = 3.78, 95% confidence interval (CI): 2.12–6.75), being from a key university (AOR = 1.88, 95%CI: 1.07–3.31), having heard of HPV-related morbidities (AOR = 1.88, 95% CI: 1.05–3.35), being concerned about HPV-related morbidities (AOR = 2.23, 95% CI: 1.16–4.27) and believing the vaccine should be given before first sexual contact (AOR = 2.44, 95% CI: 1.38–4.29). Female students were more likely to anticipate a late uptake of HPV vaccination (p = 0.002). The relatively lower levels of HPV knowledge but higher levels of vaccine acceptance among undergraduates highlighted the need for education on the roles of sexual behaviors in HPV transmission.

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Short Report
Parent HPV vaccine perspectives and the likelihood of HPV vaccination of adolescent males
pages 47-51
DOI:10.1080/21645515.2015.1073426
Sarah J Clark, Anne E Cowan, Stephanie L Filipp, Allison M Fisher & Shannon Stokley
Abstract
In 2013, approximately one-third of US adolescent males age 13–17 y had received ≥1 doses of HPV vaccines and only 14% had received ≥3 doses. This study used a nationally representative, online survey to explore experiences and attitudes related to HPV vaccination among parents with adolescent sons. Analyses compared the perspective of parents who do not intend to initiate HPV vaccine for ≥1 adolescent son to that of parents who are likely to initiate or continue HPV vaccination. Of 809 parents of sons age 11–17 years, half were classified as Unlikely to Initiate HPV vaccination and 39% as Likely to Vaccinate. A higher proportion of the Likely to Vaccinate group felt their son’s doctor was knowledgeable about HPV vaccine, did a good job explaining its purpose, and spent more time discussing HPV vaccine; in contrast, over half of the Unlikely to Initiate group had never discussed HPV vaccine with their child’s doctor. The majority of parents in both groups showed favorable attitudes to adolescent vaccination in general, with lower levels of support for HPV vaccine-specific statements. Physician-parent communication around HPV vaccine for adolescent males should build on positive attitude toward vaccines in general, while addressing parents’ HPV vaccine-specific concerns.

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Perspectives on benefit-risk decision-making in vaccinology: Conference report
pages 176-181
DOI:10.1080/21645515.2015.1075679
M Greenberg, F Simondon & M Saadatian-Elahi on behalf of the Benefit/risk conference steering committee
Abstract
Benefit/risk (B/R) assessment methods are increasingly being used by regulators and companies as an important decision-making tool and their outputs as the basis of communication. B/R appraisal of vaccines, as compared with drugs, is different due to their attributes and their use. For example, vaccines are typically given to healthy people, and, for some vaccines, benefits exist both at the population and individual level. For vaccines in particular, factors such as the benefit afforded through herd effects as a function of vaccine coverage and consequently impact the B/R ratio, should also be taken into consideration and parameterized in B/R assessment models. Currently, there is no single agreed methodology for vaccine B/R assessment that can fully capture all these aspects. The conference “Perspectives on Benefit-Risk Decision-making in Vaccinology,” held in Annecy (France), addressed these issues and provided recommendations on how to advance the science and practice of B/R assessment of vaccines and vaccination programs.

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Commentary
HIV vaccine: Can it be developed in the 21st century?
pages 222-224
DOI:10.1080/21645515.2015.1064571
Ramesh Verma, Pardeep Khanna, Suraj Chawla & Mukesh Dhankar
Abstract
HIV infection is a major public health problem especially in the developing countries. Once a person infects with HIV, it remained infected for lifelong. The advanced stage developed after 10–15 y of HIV infection that stage is called acquired immunodeficiency syndrome (AIDS). From 1990 to 2000 the number of people living with HIV rose from 8 million to 27 million; since the beginning of the HIV/AIDS epidemic, AIDS has claimed almost 39million lives so far. Till now, there is no cure for HIV infection; however, after the introduction of effective treatment with antiretroviral (ARV) drugs the HIV individual can enjoy healthy and productive lives. Vaccine is safe and cost-effective to prevent illness, impairment, disability and death. Like other vaccines, a preventive HIV vaccine could help save millions of lives. All vaccines work the same way i.e. the antigen stimulate the immune system and develop antibodies. The ultimate goal is to develop a safe and effective vaccine that protects people worldwide from getting infected with HIV. However, some school of thought that vaccine may protects only some HIV people, it could have a major impact on the rates of transmission of HIV and this will help in control of epidemic, especially in populations where high rate of HIV transmission. In the past, some scientist doubted on the development of an effective polio vaccine, but now we are near to eradicate the polio from the world this is possible because of successful vaccination programmes. HIV vaccine research is aided by the not-for-profit International AIDS/HIV vaccine Initiative (IAVI), which helps to support and coordinate vaccine research, development, policy and advocacy around the world. Although the challenges for scientist are intimidating but scientists remain hopeful that they can develop safe and effective HIV vaccines for patients in future.

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Obtaining consent for the immunization of adults
pages 231-234
DOI:10.1080/21645515.2015.1091132
Richard Griffith
Abstract
Effective immunization in adults is a desired health outcome, however it is not mandatory. Immunization of adults must be undertaken in accordance with a patient’s real and informed consent. This paper discusses requirements for the lawful administration of an immunization to both capable and incapable adults.

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Commentary
Ensuring excellence in immunization services
pages 252-254
DOI:10.1080/21645515.2015.1093262
Pauline MacDonald
Abstract
In order to increase uptake of measles, mumps and rubella (MMR) vaccine, a domiciliary immunization service was established in Dudley primary care trust in England in 2010. Parents of unimmunized children were offered vaccines at home. Uptake of MMR vaccine among 2 year olds rose from 89% in 2007/08 to 96.9% in 2015. Children were also given any other outstanding immunizations. The domiciliary immunization service reached vulnerable unimmunized children who may otherwise have remained unprotected against life threatening childhood illnesses. Domiciliary immunization service was set up in 2010 to reduce inequalities in uptake of MMR vaccine among children aged between 2 and 5 years.

JAMA
February 2, 2016, Vol 315, No. 5
http://jama.jamanetwork.com/issue.aspx

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Editorial
Sharing Clinical Trial Data: A Proposal From the International Committee of Medical Journal Editors
FREE
Darren B. Taichman, MD, PhD; Joyce Backus, MSLS; Christopher Baethge, MD; Howard Bauchner, MD; Peter W. de Leeuw, MD; Jeffrey M. Drazen, MD; John Fletcher, MB, BChir, MPH; Frank A. Frizelle, MBChB, FRACS; Trish Groves, MBBS, MRCPsych; Abraham Haileamlak, MD; Astrid James, MBBS; Christine Laine, MD, MPH; Larry Peiperl, MD; Anja Pinborg, MD; Peush Sahni, MBBS, MS, PhD; Sinan Wu, MD

JAMA Pediatrics
February 2016, Vol 170, No. 2
http://archpedi.jamanetwork.com/issue.aspx

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Viewpoint
Sepsis and the Global Burden of Disease in Children
Niranjan Kissoon, MD, FRCPC; Timothy M. Uyeki, MD, MPH, MPP
Initial text
This Viewpoint discusses the impact of sepsis on childhood mortality worldwide.
In 2010, an estimated 25% of disability-adjusted life-years—a metric that incorporates premature death by years of life lost and years lived with disability—and 13% of all deaths worldwide were in children younger than 5 years.1,2 While reductions in mortality in children younger than 5 years have occurred in many countries since 1990, mortality increased in young children in some parts of sub-Saharan Africa, with severe infections leading to sepsis being a major contributor.1 For instance, in the neonatal period, diarrhea, lower respiratory tract infections, and meningitis were important contributors to mortality in 2010, while in the postneonatal period, nearly 1 million estimated deaths (half of all deaths) were due to lower respiratory tract infections (respiratory syncytial virus, Haemophilus influenzae type B, Streptococcus pneumoniae), diarrheal diseases (rotavirus, Cryptosporidium), and malaria.2 Other infectious causes of death in children younger than 5 years were measles, pertussis, and human immunodeficiency virus/AIDS. We suggest that sepsis-related pediatric deaths are substantially underestimated and that efforts are needed to better assess the impact of sepsis on childhood mortality worldwide…

Journal of Medical Ethics
February 2016, Volume 42, Issue 2
http://jme.bmj.com/content/current

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Research ethics
Paper: Obtaining informed consent for genomics research in Africa: analysis of H3Africa consent documents
Nchangwi Syntia Munung, Patricia Marshall, Megan Campbell, Katherine Littler, Francis Masiye,
Odile Ouwe-Missi-Oukem-Boyer, Janet Seeley, D J Stein, Paulina Tindana, Jantina de Vries
J Med Ethics 2016;42:132-137 Published Online First: 7 December 2015 doi:10.1136/medethics-2015-102796
Abstract
Background
The rise in genomic and biobanking research worldwide has led to the development of different informed consent models for use in such research. This study analyses consent documents used by investigators in the H3Africa (Human Heredity and Health in Africa) Consortium.
Methods
A qualitative method for text analysis was used to analyse consent documents used in the collection of samples and data in H3Africa projects. Thematic domains included type of consent model, explanations of genetics/genomics, data sharing and feedback of test results.
Results
Informed consent documents for 13 of the 19 H3Africa projects were analysed. Seven projects used broad consent, five projects used tiered consent and one used specific consent. Genetics was mostly explained in terms of inherited characteristics, heredity and health, genes and disease causation, or disease susceptibility. Only one project made provisions for the feedback of individual genetic results.
Conclusion
H3Africa research makes use of three consent models—specific, tiered and broad consent. We outlined different strategies used by H3Africa investigators to explain concepts in genomics to potential research participants. To further ensure that the decision to participate in genomic research is informed and meaningful, we recommend that innovative approaches to the informed consent process be developed, preferably in consultation with research participants, research ethics committees and researchers in Africa.

The Lancet
Feb 06, 2016 Volume 387 Number 10018 p505-618 e13-e19
http://www.thelancet.com/journals/lancet/issue/current

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Series
Ending preventable stillbirths
Stillbirths: progress and unfinished business
J Frederik Frøen, Ingrid K Friberg, Joy E Lawn, Zulfiqar A Bhutta, Robert C Pattinson, Emma R Allanson, Vicki Flenady, Elizabeth M McClure, Lynne Franco, Robert L Goldenberg, Mary V Kinney, Susannah Hopkins Leisher, Catherine Pitt, Monir Islam, Ajay Khera, Lakhbir Dhaliwal, Neelam Aggarwal, Neena Raina, Marleen Temmerman, The Lancet Ending Preventable Stillbirths Series study group
Summary
This first paper of the Lancet Series on ending preventable stillbirths reviews progress in essential areas, identified in the 2011 call to action for stillbirth prevention, to inform the integrated post-2015 agenda for maternal and newborn health. Worldwide attention to babies who die in stillbirth is rapidly increasing, from integration within the new Global Strategy for Women’s, Children’s and Adolescents’ Health, to country policies inspired by the Every Newborn Action Plan. Supportive new guidance and metrics including stillbirth as a core health indicator and measure of quality of care are emerging. Prenatal health is a crucial biological foundation to life-long health. A key priority is to integrate action for prenatal health within the continuum of care for maternal and newborn health. Still, specific actions for stillbirths are needed for advocacy, policy formulation, monitoring, and research, including improvement in the dearth of data for effective coverage of proven interventions for prenatal survival. Strong leadership is needed worldwide and in countries. Institutions with a mandate to lead global efforts for mothers and their babies must assert their leadership to reduce stillbirths by promoting healthy and safe pregnancies.

Ending preventable stillbirths
Stillbirths: rates, risk factors, and acceleration towards 2030
Joy E Lawn, Hannah Blencowe, Peter Waiswa, Agbessi Amouzou, Colin Mathers, Dan Hogan, Vicki Flenady, J Frederik Frøen, Zeshan U Qureshi, Claire Calderwood, Suhail Shiekh, Fiorella Bianchi Jassir, Danzhen You, Elizabeth M McClure, Matthews Mathai, Simon Cousens, Lancet Ending Preventable Stillbirths Series study group, The Lancet Stillbirth Epidemiology investigator group
Summary
An estimated 2·6 million third trimester stillbirths occurred in 2015 (uncertainty range 2·4–3·0 million). The number of stillbirths has reduced more slowly than has maternal mortality or mortality in children younger than 5 years, which were explicitly targeted in the Millennium Development Goals. The Every Newborn Action Plan has the target of 12 or fewer stillbirths per 1000 births in every country by 2030. 94 mainly high-income countries and upper middle-income countries have already met this target, although with noticeable disparities. At least 56 countries, particularly in Africa and in areas affected by conflict, will have to more than double present progress to reach this target. Most (98%) stillbirths are in low-income and middle-income countries. Improved care at birth is essential to prevent 1·3 million (uncertainty range 1·2–1·6 million) intrapartum stillbirths, end preventable maternal and neonatal deaths, and improve child development. Estimates for stillbirth causation are impeded by various classification systems, but for 18 countries with reliable data, congenital abnormalities account for a median of only 7·4% of stillbirths. Many disorders associated with stillbirths are potentially modifiable and often coexist, such as maternal infections (population attributable fraction: malaria 8·0% and syphilis 7·7%), non-communicable diseases, nutrition and lifestyle factors (each about 10%), and maternal age older than 35 years (6·7%). Prolonged pregnancies contribute to 14·0% of stillbirths. Causal pathways for stillbirth frequently involve impaired placental function, either with fetal growth restriction or preterm labour, or both. Two-thirds of newborns have their births registered. However, less than 5% of neonatal deaths and even fewer stillbirths have death registration. Records and registrations of all births, stillbirths, neonatal, and maternal deaths in a health facility would substantially increase data availability. Improved data alone will not save lives but provide a way to target interventions to reach more than 7000 women every day worldwide who experience the reality of stillbirth.

Ending preventable stillbirths
Stillbirths: economic and psychosocial consequences
Alexander E P Heazell, Dimitrios Siassakos, Hannah Blencowe, Christy Burden, Zulfiqar A Bhutta, Joanne Cacciatore, Nghia Dang, Jai Das, Vicki Flenady, Katherine J Gold, Olivia K Mensah, Joseph Millum, Daniel Nuzum, Keelin O’Donoghue, Maggie Redshaw, Arjumand Rizvi, Tracy Roberts, H E Toyin Saraki, Claire Storey, Aleena M Wojcieszek, Soo Downe, The Lancet Ending Preventable Stillbirths Series study group, The Lancet Ending Preventable Stillbirths investigator group
Summary
Despite the frequency of stillbirths, the subsequent implications are overlooked and underappreciated. We present findings from comprehensive, systematic literature reviews, and new analyses of published and unpublished data, to establish the effect of stillbirth on parents, families, health-care providers, and societies worldwide. Data for direct costs of this event are sparse but suggest that a stillbirth needs more resources than a livebirth, both in the perinatal period and in additional surveillance during subsequent pregnancies. Indirect and intangible costs of stillbirth are extensive and are usually met by families alone. This issue is particularly onerous for those with few resources. Negative effects, particularly on parental mental health, might be moderated by empathic attitudes of care providers and tailored interventions. The value of the baby, as well as the associated costs for parents, families, care providers, communities, and society, should be considered to prevent stillbirths and reduce associated morbidity.

The Lancet Infectious Diseases
Feb 2016 Volume 16 Number 2 p131-264 e10-e21
http://www.thelancet.com/journals/laninf/issue/current

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Editorial
Guinea worm disease nears eradication
The Lancet Infectious Diseases
DOI: http://dx.doi.org/10.1016/S1473-3099(16)00020-7
Summary
Only two infectious diseases have ever been eradicated: smallpox, of which the last naturally transmitted case occurred in 1977, and rinderpest, a disease of cattle and related ungulates, officially declared eradicated in 2011. This year might see a remarkable doubling in the list of eradicated diseases, with both polio (about which we wrote in the August, 2015, issue) and guinea worm no longer being naturally transmitted.

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Comment
Long-term protectiveness of BCG
Giovanni Sotgiu, Giovanni Battista Migliori
Published Online: 18 November 2015
DOI: http://dx.doi.org/10.1016/S1473-3099(15)00414-4
Summary
WHO has launched the End TB Strategy, which contains several elements supporting tuberculosis elimination.1–3 Pillar 1 consists of two tuberculosis prevention interventions: first, diagnosis and treatment of latent tuberculosis infection and, second, vaccination. A new, more effective vaccine is expected by 2025,2 but in the meantime, we still rely on BCG, which is more than a century old.4 Epidemiological studies of the BCG vaccine carried out in the past were not designed to provide high-quality evidence in the way that we define it today (ie, multicentre, randomised, double-blind, placebo-controlled clinical trials).

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Articles
Duration of BCG protection against tuberculosis and change in effectiveness with time since vaccination in Norway: a retrospective population-based cohort study
Patrick Nguipdop-Djomo, Einar Heldal, Laura Cunha Rodrigues, Ibrahim Abubakar, Punam Mangtani
Summary
Background
Little is known about how long the BCG vaccine protects against tuberculosis. We assessed the long-term vaccine effectiveness (VE) in Norwegian-born individuals.
Methods
In this retrospective population-based cohort study, we studied Norwegian-born individuals aged 12–50 years who were tuberculin skin test (TST) negative and eligible for BCG vaccination as part of the last round of Norway’s mandatory mass tuberculosis screening and BCG vaccination programme between 1962 and 1975. We excluded individuals who had tuberculosis before or in the year of screening and those with unknown TST and BCG status. We obtained TST and BCG information and linked it to the National Tuberculosis Register, population and housing censuses, and the population register for emigrations and deaths. We followed individuals up to their first tuberculosis episode, emigration, death, or Dec 31, 2011. We used Cox regressions to estimate VE against all tuberculosis and just pulmonary tuberculosis by time since vaccination, adjusted for age, time, county-level tuberculosis rates, and demographic and socioeconomic indicators.
Findings
Median follow-up was 41 years (IQR 32–49) for 83 421 BCG-unvaccinated and 44 years (41–46) for 297 905 vaccinated individuals, with 260 tuberculosis episodes. Tuberculosis rates were 3·3 per 100 000 person-years in unvaccinated and 1·3 per 100 000 person-years in vaccinated individuals. The adjusted average VE during 40 year follow-up was 49% (95% CI 26–65), although after 20 years, the VE was not significant (up to 9 years VE [excluding tuberculosis episodes in the first 2 years] 61% [95% CI 24–80]; 10–19 years 58% [27–76]; 20–29 years 38% [–32 to 71]; 30–40 years 42% [–24 to 73]). VE against pulmonary tuberculosis up to 9 years (excluding tuberculosis episodes in the first 2 years) was 67% (95% CI 27–85), 10–19 years was 63% (32–80), 20–29 years was 50% (−19 to 79), and 30–40 years was 40% (−46 to 76).
Interpretation
Findings are consistent with long-lasting BCG protection, but waning of VE with time. The vaccine could be more cost effective than has been previously estimated
Funding
Norwegian Institute of Public Health and London School of Hygiene & Tropical Medicine.

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Personal View
Interventions to reduce zoonotic and pandemic risks from avian influenza in Asia
J S Malik Peiris, Benjamin J Cowling, Joseph T Wu, Luzhao Feng, Yi Guan, Hongjie Yu, Gabriel M Leung

Ebola: lessons learned and future challenges for Europe
GianLuca Quaglio, Charles Goerens, Giovanni Putoto, Paul Rübig, Pierre Lafaye, Theodoros Karapiperis, Claudio Dario, Paul Delaunois, Rony Zachariah
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Maternal and Child Health Journal
Volume 20, Issue 2, February 2016
http://link.springer.com/journal/10995/20/2/page/1

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Original Paper
Assessing the Continuum of Care Pathway for Maternal Health in South Asia and Sub-Saharan Africa
Kavita Singh, William T. Story, Allisyn C. Moran
Abstract
Objective
We assess how countries in regions of the world where maternal mortality is highest—South Asia and Sub-Saharan Africa—are performing with regards to providing women with vital elements of the continuum of care.
Methods
Using recent Demographic and Health Survey data from nine countries including 18,036 women, descriptive and multilevel regression analyses were conducted on four key elements of the continuum of care—at least one antenatal care visit, four or more antenatal care visits, delivery with a skilled birth attendant and postnatal checks for the mother within the first 24 h since birth. Family planning counseling within a year of birth was also included in the descriptive analyses.
Results
Results indicated that a major drop-out (>50 %) occurs early on in the continuum of care between the first antenatal care visit and four or more antenatal care visits. Few women (<5 %) who do not receive any antenatal care go on to have a skilled delivery or receive postnatal care. Women who receive some or all the elements of the continuum of care have greater autonomy and are richer and more educated than women who receive none of the elements.
Conclusion
Understanding where drop-out occurs and who drops out can enable countries to better target interventions. Four or more ANC visits plays a pivotal role within the continuum of care and warrants more programmatic attention. Strategies to ensure that vital services are available to all women are essential in efforts to improve maternal health.

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Original Paper
Differences in Human Papillomavirus Vaccination Among Adolescent Girls in Metropolitan Versus Non-metropolitan Areas: Considering the Moderating Roles of Maternal Socioeconomic Status and Health Care Access
Shannon M. Monnat, Danielle C. Rhubart…
Abstract
Objectives This study is among the first to examine metropolitan status differences in human papillomavirus (HPV) vaccine initiation and completion among United States adolescent girls and is unique in its focus on how maternal socioeconomic status and health care access moderate metropolitan status differences in HPV vaccination. Methods Using cross-sectional data from 3573 girls aged 12–17 in the U.S. from the 2008–2010 Behavioral Risk Factor Surveillance System, we estimate main and interaction effects from binary logistic regression models to identify subgroups of girls for which there are metropolitan versus non-metropolitan differences in HPV vaccination. Results Overall 34 % of girls initiated vaccination, and 19 % completed all three shots. On average, there were no metropolitan status differences in vaccination odds. However, there were important subgroup differences. Among low-income girls and girls whose mothers did not complete high school, those in non-metropolitan areas had significantly higher probability of vaccine initiation than those in metropolitan areas. Among high-income girls and girls whose mothers completed college, those in metropolitan areas had significantly higher odds of vaccine initiation than those in non-metropolitan areas. Moreover, among girls whose mothers experienced a medical cost barrier, non-metropolitan girls were less likely to initiate vaccination compared to metropolitan girls. Conclusions Mothers remain essential targets for public health efforts to increase HPV vaccination and combat cervical cancer. Public health experts who study barriers to HPV vaccination and physicians who come into contact with mothers should be aware of group-specific barriers to vaccination and employ more tailored efforts to increase vaccination.