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_26 March 2016

– blog edition: comprised of the approx. 35+ entries posted below on 27-28 March 2016.

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

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

Zika virus [to 26 March 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

.
WHO Situation Report
Zika virus, Microcephaly and Guillain-Barré syndrome 24 March 2016
Read the full situation report
Summary
:: From 1 January 2007 to 23 March 2016, Zika virus transmission was documented in a total of 61 countries and territories. Four of these countries and territories reported a Zika virus outbreak that is now over. Argentina and New Zealand are the latest countries to report sexual transmission of Zika virus. Thus, five countries have now reported locally acquired infection in the absence of any known mosquito vectors, probably through sexual transmission (Argentina, France, Italy, New Zealand and the United States of America).

:: The geographical distribution of Zika virus has steadily widened since the virus was first detected in the Americas in 2014. Autochthonous Zika virus transmission has been reported in 34 countries and territories of this region.

:: So far an increase in microcephaly and other fetal malformations has been reported in Brazil and French Polynesia. Two additional cases, linked to a stay in Brazil, were detected in the United States of America and Slovenia. Panama recently reported a newborn with microcephaly and occipital encephalocoele (neural tube defect) who died a few hours after birth and tested positive for Zika virus by RT-PCR.

:: In the context of Zika virus circulation, 12 countries or territories have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases.

:: The mounting evidence from observational, cohort and case-control studies indicates that Zika virus is highly likely to be a cause of microcephaly, GBS and other neurological disorders. Among the tasks ahead are to further quantify the risk of neurological disorders following Zika virus infection, and to investigate the biological mechanisms that lead to neurological disorders.

:: The global prevention and control strategy launched by the World Health Organization (WHO) as a Strategic Response Framework encompasses surveillance, response activities and research, and this situation report is organized under those headings.

.

Public consultation of Zika diagnostics
In order to address the limitations and gaps of current diagnostic tests for Zika, WHO and several key stakeholders have developed target product profiles (TPPs) to test for the disease. TPPs define the desired characteristics of Zika diagnostic tests, and are aspirational in nature.
WHO invites experts to comment and give input on these TPPS by 3 April 2016. The contact information is at the end of the TPPs.
The TPPs include a brief summary of additional important considerations that highlight technical challenges to test development and the limits to scientific understanding of the virus at this stage of the Zika response.
:: Target product profiles (TPPs)pdf, 263kb
:: WHO global consultation on research related to Zika virus infection 7-9 March 2016

.

Latest updates
:: WHO Director-General briefs the media on the Zika situation
22 March 2016

Guidance for health workers
:: Knowledge, Attitudes and Practice surveys
24 March 2016
:: Lab testing for Zika virus infection
23 March 2016

Zika Open
[Bulletin of the World Health Organization]
:: All papers available here
[No new papers posted]

.

CDC/ACIP [to 26 March 2016]
http://www.cdc.gov/media/index.html
FRIDAY, MARCH 25, 2016
CDC Issues Updated Zika Recommendations: Timing of Pregnancy after Zika Exposure, Prevention of Sexual Transmission, Considerations for Reducing Unintended Pregnancy in Areas with Zika Transmission
CDC today issued new guidance and information to prevent Zika virus transmission and health effects.
:: Updated interim guidance for healthcare professionals for counseling patients about pregnancy planning and the timing of pregnancy after possible exposure to Zika virus;
:: Updated interim guidance for preventing sexual transmission with information about how long men and women should consider using condoms or not having sex; and
:: Considerations and challenges, based on Puerto Rico’s experience, for reducing unintended pregnancy in areas with active Zika transmission…

FRIDAY, MARCH 25, 2016
Transcript for CDC Telebriefing: Updates on CDC recommendations related to Zika virus

TUESDAY, MARCH 22, 2016
CDC adds Dominica to interim travel guidance related to Zika virus – Media Statement

MMWR – March 25, 2016 / Vol. 65 / No. 11
:: Travel-Associated Zika Virus Disease Cases Among U.S. Residents — United States, January 2015–February 2016
:: Preventing Transmission of Zika Virus in Labor and Delivery Settings Through Implementation of Standard Precautions — United States, 2016

EBOLA/EVD [to 26 March 2016]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

Ebola Situation Reports
[While no announcement of a change in reporting cycle is evident, we deduce that Ebola Situation Reports have been reduced to a bi-weekly cycle given the spacing of the last few reports – previous update: Ebola Situation Report – 16 March 2016]

.

WHO: Hundreds of contacts identified and monitored in new Ebola flare-up in Guinea
22 March 2016 Update from the field
Nzérékoré, Guinea — More than 800 contacts of recently confirmed Ebola cases in Guinea’s southern prefecture of Nzérékoré have been identified and placed under medical monitoring in a bid to contain a new flare-up of Ebola virus disease.

POLIO [to 26 March 2016]
Public Health Emergency of International Concern (PHEIC)

.

Polio this week as of 16 March 2016
:: An innovative new product has been developed by a collaboration of Australian researchers. The Nanopatch may one day enable unprecedented levels of antigen sparing. Read more here.
:: There are three weeks to go until the globally synchronized switch from the trivalent to bivalent oral polio vaccine. Learn more about the switch through this series of videos.
Selected Country Levels Updates [excerpted]
[No new case activity reported globally]

WHO & Regional Offices [to 26 March 2016]

.
WHO: Angola grapples with worst yellow fever outbreak in 30 years
March 2016
Angola is grappling with a yellow fever outbreak, which has infected more than 450 people and killed 178 – the first epidemic of the disease to hit the country in 30 years.
The outbreak, which was first reported in the capital city Luanda in December 2015, has since spread to 6 of the country’s 18 provinces…

Vaccination a powerful weapon but in short supply
WHO has taken urgent action to contain this outbreak, working with the Angolan Ministry of Health and partners to vaccinate people in the affected provinces. As of 24 March 2016, WHO and partners have vaccinated 5.7 million people in Luanda against yellow fever using vaccines from the International Coordination Group emergency stockpile.

WHO has established an incident management system and deployed around 65 experts in epidemiology, vector control, community engagement and other areas to support the vaccination campaign.

WHO’s recently established Contingency Fund for Emergencies released US$500,000 to enable a rapid response to this outbreak in Angola and WHO’s African Public Health Emergency Fund has provided US$289,383. WHO has also supported the development of an emergency response plan to provide an additional US$ 3 million funds from the UN Office for the Coordination of Humanitarian Affairs to cover 50% of the costs of the vaccines for the province of Luanda.

Vaccine storage
“The vaccination campaign has so far been effective. We are seeing case numbers dropping considerably, especially in Luanda. However, we have to keep going and vaccinate all the people in Luanda and the affected provinces to end this outbreak. This is an enormous job which is exhausting supplies of vaccines,” says Dr Yactayo.

Whilst concerted efforts are being made to stop the outbreak, there is a global vaccine shortage, with the emergency stockpile completely depleted. An additional 1.5 million doses are needed to vaccinate the population at risk in Luanda province alone.

With the spread of the outbreak to other provinces in Angola and increasing numbers of imported cases reported by countries in Africa, WHO requests prioritizing vaccination of people at highest risk. WHO is in discussion with manufacturers and partners to divert shipments of vaccines for national routine immunization programmes until the emergency stockpile is replenished.

Partners working with WHO and the Ministry of Health include UNICEF, CDC/Atlanta, CORE Group, Médicins Sans Frontières, Medicos del Mundo, the National Red Cross of Angola and local community based organizations…

.

Iraq’s 2015 response to cholera outbreak minimizes future risk
23 March 2016, Baghdad, Iraq – After the declaration of a cholera epidemic in Iraq in September 2015, and in anticipation of a potential new outbreak, WHO, UNICEF and the Ministry of Health of Iraq, jointly with water and sanitation and health cluster partners held a consultation today to review lessons learnt and best practices from the successful 2015 response to the outbreak. Consultations such as these will help guide cholera contingency plans for 2016 and beyond….

…The meeting focused on a number of key issues, including the need to:
:: build local capacities to scale up surveillance, case investigation and management, as well as cholera prevention and control measures
:: strengthen laboratory capacities at central, governorate, and peripheral levels to ensure early detection and confirmation of a cholera outbreak
:: enhance collaborative activities between relevant ministries and agencies, with clear roles and accountability
:: maintain strong and regular communication with the health sector and apply an intersectoral approach for the management of cholera/acute watery diarrhoea.
…Cholera is endemic in Iraq, and the outbreak, officially declared in September 2015, resulted in 4945 cases confirmed in 17 of the 18 governorates across Iraq. WHO and UNICEF supported the Ministry of Health and other partners to put in place immediate preventive and control measures that included targeting approximately 249 319 people with oral cholera vaccine in a 2-round immunization campaign for vulnerable populations in 62 refugee and internally displaced persons camps and collective centres throughout the country.

.

WHO Launches a New Vaccine Pipeline Tracker
21 March 2016
A new resource for vaccine research – the global vaccine development tracker – has been launched by WHO. This brings together the global clinical development pipeline for the following seven diseases in one single location: HIV, tuberculosis, malaria, RSV (Respiratory Syncytial Virus), ETEC (Enterotoxigenic E.Coli), Shigella, and Norovirus. [These diseases were chosen somewhat empirically and it is anticipated that the list will be expanded in future. An update will occur every 6 months or more often.]
The tracker will be updated every six months, and may be expanded to other disease areas. This initiative was recommended as a priority by the WHO Product Development for Vaccines Advisory Committee (PDVAC).
WHO Vaccine Pipeline Tracker
WHO gratefully acknowledges the following groups as sources for the data provided:
HIV
:: HIV Vaccine Trials Network
:: The US Military’s HIV Research Program (MHRP)
:: The International AIDS Vaccine Initiative (IAVI)
Malaria
:: DMID/NIAID/NIH
:: European & Developing Countries Clinical Trials Partnership
:: European Vaccine Initiative
:: PATH Malaria Vaccine Initiative
Tuberculosis
:: Aeras
RSV – PATH
:: RSV Vaccine Program
ETEC, Shigella & Norovirus
:: PATH Enteric Vaccine Initiative

.

WHO SAGE Meeting
Geneva: 12 – 14 April 2016.
:: Draft agenda pdf, 145kb As of 11 March 2016

.

Pandemic Influenza Preparedness Framework Review
30 March 2016 – Geneva, Switzerland
Background
As recommended by the Advisory Group in the Special Session of 13-14 October 2015, a review group on the implementation of the (Pandemic Influenza Preparedness) PIP Framework has been established. The first 2 meetings were held via teleconference on 7 January and 19 February 2016, where the group agreed on the terms of reference, method of work and next steps forward.
Purpose
The purpose of the meeting is for the Review Group to receive views from stakeholders on the implementation of the PIP Framework…

.

Weekly Epidemiological Record (WER) 25 March 2016, vol. 91, 11 (pp. 145–168)
Contents
145 Polio vaccines: WHO position paper – March, 2016

.

Disease Outbreak News (DONs)
:: 23 March 2016 Human infection with avian influenza A(H7N9) virus – China
:: 23 March 2016 Human infection with avian influenza A(H5N6) virus – China
:: 23 March 2016 Lassa Fever – Germany
:: 23 March 2016 Lassa Fever – Togo
:: 23 March 2016 Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
:: 22 March 2016 Yellow Fever – Angola
:: 21 March 2016 Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia

.

WHO Fact sheets
:: Measles 24 March 2016
:: Rubella 24 March 2016
:: Immunization coverage 24 March 2016
:: Dengue and severe dengue 22 March 2016
:: Tuberculosis 21 March 2016
:: Leishmaniasis 21 March 2016

:: WHO Regional Offices
WHO African Region AFRO
No new digest content identified.

WHO Region of the Americas PAHO
:: PAHO/WHO calls on countries to work together to end tuberculosis in the next 20 years (03/24/2016)
:: Sesame Street Muppets Join PAHO to Educate Families About Preventing Zika Mosquito Bites (03/23/2016)

WHO South-East Asia Region SEARO
:: Media statement – Invest in safe water to enhance public health
22 March 2016

WHO European Region EURO
:: Public Health Panorama: TB in central Asia
23-03-2016
:: Regional workshop on the global oral polio vaccine “switch” 30–31 March 2016, Vienna, Austria

WHO Eastern Mediterranean Region EMRO
:: Iraq’s 2015 response to cholera outbreak minimizes future risk
23 March 2016

WHO Western Pacific Region
:: Stronger action and commitment needed to end tuberculosis
MANILA, 23 March 2016 – As the world observes World TB Day (24 March), the World Health Organization (WHO) in the Western Pacific Region urges governments and partners to strongly support calls to action to end the burden of tuberculosis (TB) in the Region. “Sadly, tuberculosis continues to be an agonizing chapter in the public health history of the Region,” said Dr Shin Young-soo, WHO Regional Director for the Western Pacific. “We must strengthen efforts to close the book on TB for the Region’s 1.8 billion people.”

CDC/ACIP [to 26 March 2016]
http://www.cdc.gov/media/index.html
[see Zika coverage above which includes CDC briefing content]

.

MMWR – March 25, 2016 / Vol. 65 / No. 11
:: World TB Day — March 24, 2016
:: Leveling of Tuberculosis Incidence — United States, 2013–2015
:: Tuberculosis Among Temporary Visa Holders Working in the Tourism Industry — United States, 2012–2014
:: Travel-Associated Zika Virus Disease Cases Among U.S. Residents — United States, January 2015–February 2016
:: Preventing Transmission of Zika Virus in Labor and Delivery Settings Through Implementation of Standard Precautions — United States, 2016

New EU-Turkey agreement on refugee and migrants could leave children at risk: UNICEF
GENEVA, 22 March 2016 – UNICEF today expressed concern that the new agreement between the EU and Turkey, which comes into effect this week, does not address the pressing humanitarian needs of 19,000 refugee and migrant children stranded in Greece. Children make up 40 percent of the refugee and migrant population in Greece. It is estimated that unaccompanied children make up 10 percent of the child population.

UNICEF warned the new agreement could push children and families to take other more dangerous routes including the central Mediterranean Sea. UNICEF welcomes EU leaders’ commitment to determining the individual status of refugees and migrants rather than collective expulsions, push-back practices or other measures that may be harmful to children.

The children’s agency, however, urges that a number of priorities are addressed:
:: Unaccompanied and separated children are properly identified and taken into protective care rather than detention. They are entitled to a full hearing and assessment of their best interests prior to any decision related to them, including on return. The capacity of state institutions in Greece needs to be scaled up significantly to deal with this new caseload.

:: Child and family support services such as child friendly spaces, and safe mother and baby areas are rapidly expanded in ‘Blue Dots’ services.

:: Children stranded for longer periods in Greece will require an expanded set of basic services such as emergency education. Many children have been out of school for several months and would benefit even from short term learning.

:: To prevent disease outbreaks among children, urgent consideration has to be given to vaccinating refugee and migrant children, especially as many have been living in unsanitary conditions for weeks. An initial response would include vaccinating against measles, polio and pneumococcal infections.

Pfizer Joins The Human Vaccines Project To Help Decode The Immune System
March 22, 2016
NEW YORK–(BUSINESS WIRE)–Pfizer Inc. today announced it will join the Human Vaccines Project (the Project), a public-private consortium focused on cross-sector collaboration to identify human immune responses associated with optimal vaccine protection. Insights gained will guide the development of potentially improved vaccines against diseases such as influenza, dengue, HIV and other infectious illnesses as well as cancer.

“We look forward to Pfizer’s contribution to the Human Vaccines Project as we launch an unprecedented public-private partnership in human immunology discovery, to decipher the human immunome and principles of protective immunity, to usher in a new era in global disease prevention”

“Over the last decade, we’ve seen unprecedented technological advances in our understanding of the biology of diseases, and new tools in designing vaccines including therapeutic vaccines. Yet, the translation from preclinical to clinical vaccine research has often been hampered by a lack of understanding of the desired human immune responses required to obtain optimal vaccine protection,” said Kathrin U. Jansen, Ph.D., senior vice president and head of Vaccines Research & Development at Pfizer. “With our strong heritage of translating scientific findings into the development of medicines and vaccines, Pfizer is proud to contribute to the consortium’s research efforts.”

One of the key challenges in vaccine development is the lack of understanding of the rules of effective immunity, and how to generate such responses through vaccines and immunotherapies in key global populations. Applying the latest in biomedical technologies, the consortium will have the potential to identify the fundamentals of immunological protection which could lead to the development of new and improved vaccines, immunotherapies, and diagnostics. Led by the Human Vaccines Project, the partners will help shape the Project’s research agenda which will be carried out by a global network of leading universities, with strong linkages to biopharmaceutical companies such as Pfizer capable of rapidly translating research breakthroughs into potential new products.

“We look forward to Pfizer’s contribution to the Human Vaccines Project as we launch an unprecedented public-private partnership in human immunology discovery, to decipher the human immunome and principles of protective immunity, to usher in a new era in global disease prevention,” said Wayne C. Koff, Ph.D., founder of the Human Vaccines Project. “The human immune system holds the key to preventing and controlling a broad spectrum of infectious diseases, cancers, autoimmune diseases and allergies. By bringing together leading vaccine researchers, institutions and biopharmaceutical companies, and harnessing recent technological advances in molecular and cellular biology and bioinformatics, the Project may potentially enable accelerated development of vaccines and immunotherapies for some of the most devastating diseases of our time.”

About the Human Vaccines Project
The Human Vaccines Project is a non-profit public-private partnership with the mission to accelerate the development of vaccines and immunotherapies against major infectious diseases and cancers by decoding the human immune system. The Project, incubated initially at the International AIDS Vaccine Initiative (IAVI) has a growing list of partners and financial supporters including: the Robert Wood Johnson Foundation, Pfizer, Regeneron, GSK, Aeras, MedImmune, Sanofi Pasteur, Crucell/Janssen, Vanderbilt University Medical Center, and the John D. and Catherine T. MacArthur Foundation. The Project brings together leading academic research centers, industrial partners, nonprofits and governments to address the primary scientific barriers to developing new vaccines and immunotherapies, and has been endorsed by 35 of the world’s leading vaccine scientists.

Sabin Vaccine Institute [to 26 March 2016]
http://www.sabin.org/updates/ressreleases

.
Thursday, March 24, 2016
Amy Finan Appointed Chief Executive Officer of the Sabin Vaccine Institute
WASHINGTON, D.C. —The Sabin Vaccine Institute (Sabin) today announced the appointment of Amy Finan as its next chief executive officer, following a global search by its Board of Trustees.

Finan, currently the senior vice president responsible for business development with the Biotechnology Innovation Organization (BIO), the world’s largest membership organization representing biotechnology companies, academic institutions, and state biotechnology centers, will assume her new role with Sabin on April 18, 2016.

“Amy is an exceptional leader who blends decades of experience in life sciences with the business acumen, advocacy skills, and effective business development and relationship-building abilities required to lead this dynamic and multidimensional non-profit organization,” said Dr. Axel Hoos, chair of the Board of Trustees at Sabin. “Sabin is at the forefront of many of the world’s most pressing health issues and Amy’s record of growth, innovation and partnership development will help to propel the organization into new, exciting territory.”…

IAVI International AIDS Vaccine Initiative [to 26 March 2016]
http://www.iavi.org/press-releases/2016

.
March 24, 2016
New Findings in Humans Provide Encouraging Foundation for Upcoming AIDS Vaccine Clinical Trial
Engineered vaccine protein binds key immune cells that exist in nearly everyone
LA JOLLA, CA, 24 March, 2016 — Some people infected with HIV naturally produce antibodies that effectively neutralize many strains of the rapidly mutating virus, and scientists are working to develop a vaccine capable of inducing such “broadly neutralizing” antibodies that can prevent HIV infection.

An emerging vaccine strategy involves immunizing people with a series of different engineered HIV proteins as immunogens to teach the immune system to produce broadly neutralizing antibodies against HIV. This strategy depends on the ability of the first immunogen to bind and activate special cells, known as broadly neutralizing antibody precursor B cells, which have the potential to develop into broadly neutralizing antibody-producing B cells.

A research team has now found that the right precursor (“germline”) cells for one kind of HIV broadly neutralizing antibody are present in most people, and has described the design of an HIV vaccine germline-targeting immunogen capable of binding those B cells. The findings by scientists from The Scripps Research Institute (TSRI), the International AIDS Vaccine Initiative (IAVI) and the La Jolla Institute for Allergy and Immunology were published in Science on 25 March.

“We found that almost everybody has these broadly neutralizing antibody precursors, and that a precisely engineered protein can bind to these cells that have potential to develop into HIV broadly neutralizing antibody-producing cells, even in the presence of competition from other immune cells,” said the study’s lead author, William Schief, TSRI Professor and Director, Vaccine Design of the IAVI Neutralizing Antibody Center at TSRI, in whose lab the engineered HIV vaccine protein was developed…

World TB Day – 24 March 2016
[see also announcements from WHO Regions above]

.
WHO: On the road to ending tuberculosis
24 March 2016 — For World TB Day, today, WHO is calling on countries and partners to “Unite to End TB”. This is an ambitious aim. While there has been significant progress in the fight against TB, with 43 million lives saved since 2000, the battle is only half-won. 2016 marks the beginning of the Sustainable Development Goals (SDG) era. Ethiopia is one country making progress in tackling TB and is committed to reaching the SDG target of ending TB by 2030…

.
AERAS [to 26 March 2016]
http://www.aeras.org/pressreleases
.
March 21, 2016
Aeras Launches Animated Video Short to Honor World TB Day
Aeras, a non-profit biotechnology organization developing new tuberculosis (TB) vaccines for the world, is launching a new 90-second animated video in honor of World TB Day to help raise awareness about TB’s devastating toll and the need for new tools, including vaccines, to fight this epidemic…

.
NIH [to 26 March 2016]
http://www.nih.gov/news/releases.htm
.
March 24, 2016
NIH statement on World Tuberculosis Day 2016
— The 2016 World TB Day theme is Unite to End TB.

.
Global Fund [to 26 March 2016]
http://www.theglobalfund.org/
.
in Voices on 23 March 2016
“To Succeed, We Need to Change the Way We Fight TB”
By Lucica Ditiu, Executive Director for the Stop TB Partnership, spoke to News Flash on the occasion of World TB Day.

.
UNAIDS [to 26 March 2016]
http://www.unaids.org/en/resources/presscentre/
.
23 March 2016
UNAIDS calls for stronger partnerships to end the epidemics of tuberculosis and HIV
On World Tuberculosis (TB) Day, UNAIDS is calling for stronger partnerships and a united approach to end the twin epidemics of TB and HIV and save millions of lives. It has never been more urgent for governments, the medical and scientific communities, the private sector and people affected by the diseases to come together to ensure access to existing treatment regimens and to push for new diagnostic tools and treatments to reach all people in need.

“We achieve the most when we work together and use all our strengths to reach ambitious goals,” said UNAIDS Executive Director, Michel Sidibé. “Harnessing the potential of everyone involved in the response to HIV and TB is needed now more than ever to end these epidemics and create a healthier world as part of the Sustainable Development Goals.”

…The international community is committed to ending the epidemics of TB and HIV within the framework of the Sustainable Development Goals. This will be possible only by strengthening and accelerating current responses and by maximizing the contribution of all those involved through a united approach at the international, regional, national and community levels. For example, the development of new diagnostic tools, treatments and potential vaccines against HIV and TB must be speeded up, especially in response to the emergence of multi-drug resistant tuberculosis. Most importantly, these new regimens and tools must be within reach of everyone affected by TB and HIV…

EDCTP [to 26 March 2016]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials.

.
24 March 2016
World TB Day 2016: Uniting to end the childhood TB epidemic
In 2015 tuberculosis (TB) became the world’s deadliest infectious disease, currently causing the death of 1.5 million people per year…

.

Tuberculosis Study Launched, Powered By Citizen Scientists on IBM’s World Community Grid
ARMONK, N.Y. and NOTTINGHAM, England, March 24, 2016 /PRNewswire/ — IBM’s World Community Grid and scientists at the University of Nottingham are launching a study to address tuberculosis, one of the world’s most deadly diseases. It is expected that hundreds of thousands of volunteers will donate vast computing resources to aid this effort facilitated by IBM.

Launched today, the new “Help Stop TB” project on IBM World Community Grid will model aspects of the behavior of tuberculosis bacteria to better understand its potential vulnerabilities that new medicines may one day exploit. Volunteers will make the processing power on their devices available, when otherwise not being used, to perform the millions of calculations necessary for these simulations. Crowdsourcing a virtual supercomputer in this manner to study the disease will provide results significantly faster and achieve greater results than relying on conventional computational resources typically available to researchers…

FDA [to 26 March 2016]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm

.
Posted: 3/22/2016
FDA Scientists Contribute to Development of Investigational Dengue Vaccine
On March 16, 2016, the National Institutes of Health announced that an investigational dengue vaccine developed at the National Institute for Allergy and Infectious Disease (NIAID) has advanced into a phase 3 efficacy trial in Brazil. Lew Markoff, MD, and Barry Falgout, PhD, with the Laboratory of Vector-borne Virus Diseases in FDA’s Center for Biologics Evaluation and Research, made an early contribution to the development of this vaccine. The phase 3 trial is a direct result of success in a human challenge study where the vaccine protected healthy U.S volunteers from signs and symptoms of dengue. The study involved a total of 41 individuals, 21 of whom received the vaccine and 20 of whom received a placebo on the same day. After six months, all volunteers were infected with a strain of dengue virus chosen because it causes only mild manifestations of disease. All of the vaccine recipients were protected, while all 20 volunteers who received placebo experienced a rash and/or other mild manifestations of dengue fever, caused by the challenge dengue virus…

European Medicines Agency [to 26 March 2016]
http://www.ema.europa.eu/

.
21/03/2016
EMA Management Board: highlights of March 2016 meeting
Christa Wirthumer-Hoche elected as new chair of the Management Board
At its 17 March meeting in London, the European Medicines Agency’s (EMA) Management Board elected Christa Wirthumer-Hoche as chair of the Board for a three-year period. Dr Wirthumer-Hoche is Head of the Austrian Medicines and Medical Devices Agency, a post she has held since October 2013. She has served as vice-chair of EMA’s Management Board since March 2015. For further information, please see separate announcement.

Medicines for children: achievements and challenges
Dr Dirk Mentzer, chair of EMA’s Paediatric Committee (PDCO) and Head of Pharmacovigilance at the German national agency for vaccine and biomedicinal products (Paul-Ehrlich-Institut), presented the achievements, challenges and priorities of the PDCO regarding medicines for children.

The chair recalled that the EU Paediatric Regulation came into force 10 years ago to improve the health of children in Europe by stimulating high quality research and promoting the development and authorisation of paediatric medicines in the EU.

Dr Mentzer highlighted areas where the therapeutic landscape for children has significantly improved over the past few years. These include rheumatologic diseases, conditions that affect the joints, muscles, bones and immune system, for which children had extremely limited therapeutic options a few years ago. “Thanks to the EU Paediatric Regulation which has enforced the study of new innovative treatments in paediatric rheumatology, a number of biological medicines for rheumatologic conditions are now authorised for use in children,” explained Dr Mentzer. “Children also have access to new and innovative treatments for hypertension and hypercholesterolaemia as well as for infectious diseases, such as HIV and hepatitis C. All these medicines were authorised on the basis of studies conducted as part of paediatric investigation plans (PIP) agreed with the PDCO.”

Dirk Mentzer mentioned ongoing challenges in areas such as neonatology, neurology, congenital defects and paediatric rare cancers in which it is difficult to study medicines, in particular due to the rarity of these children-only indications or the high toxicity of the medicines, e.g. in cancer.

In future, the PDCO will focus on the integration of innovative clinical trial methodology, such as modelling, simulation and extrapolation of data, in its decisions. “These tools are very helpful to avoid unnecessary studies in children, one of the objectives of the Paediatric Regulation,” explained Dirk Mentzer. Strengthening collaboration between EMA committees and increasing the involvement of patients in PIP decisions, for example to collect their views on the feasibility of clinical trials, are also among the PDCO’s key priorities for the years ahead…

Harnessing the collective strengths of the UN system to reach every woman, child, and adolescent
Joint Press Statement
18 March 2016
As part of the global effort to achieve the Millennium Development Goals (MDGs), countries around the world reported major gains in the health and wellbeing of women and children between 1990 and 2015. The global rate of maternal mortality fell by 47 per cent and child mortality declined by 49 per cent. However, any celebration of progress is tempered by the reality that millions of women, children, newborns, and adolescents continue to die every year; mostly from preventable causes. As the world transitions from the MDGs to the Sustainable Development Goals (SDGs), we must uphold our commitment to keep reproductive, maternal, newborn, child, and adolescent health (RMNCAH) at the heart of the global agenda. Fulfilling this promise is both a practical imperative and a moral obligation.

The UN Secretary-General’s Global Strategy for Women’s, Children’s, and Adolescents’ Health sets out a plan to give every woman, child, and adolescent the opportunity to not only survive, but to thrive and transform his or her community. Implementing the Global Strategy and achieving the SDG targets requires an unprecedented level of alignment and coordination amongst each and every one of us working in the field of RMNCAH.

On behalf of the six organizations responsible for promoting and implementing the global health agenda across the UN system, UNAIDS, UNFPA, UNICEF, UN Women, WHO, and the World Bank Group, we, the undersigned, stand united in our commitment to operationalize the Global Strategy.

Building on our tradition of working together to support countries in achieving the MDGs, we, as members of the H6 (previously known as the H4+), will provide coordinated technical support to country-led efforts to implement the Global Strategy and achieve the ambitious targets of the health-related SDGs. At the same time, we will continue to advocate for evidence-based RMNCAH programmes and policies at the global, regional, and national levels.

As the current H6 chair (2016-2018), UNAIDS will lead the partnership in fulfilling its mandate to leverage the strengths and capacities of each of the six member organizations in order to support high-burden countries in their efforts to improve the survival, health, and well-being of every woman, newborn, child, and adolescent.

As representatives of the H6, we renew our commitment to implement this mandate in support of the Global Strategy. We call on RMNCAH activists and advocates worldwide to join us in fulfilling this shared pledge to women, children, and adolescents everywhere.

Michel Sidibé, Executive Director, UNAIDS
Babatunde Osotimehin, Executive Director, UNFPA
Anthony Lake, Executive Director, UNICEF
Phumzile Mlambo-Ngcuka, Executive Director, UN Women
Margaret Chan, Director General, WHO
Tim Evans, Senior Director, Health, Nutrition and Population Global Practice, The World Bank Group

Pdf of Global Strategy for Women’s, Children’s, and Adolescents’ Health: http://www.who.int/life-course/partners/global-strategy/globalstrategyreport2016-2030-lowres.pdf?ua=1

Global Reports on Ebola’s Lessons Overlook Politics and Misplace Scrutiny
International Rescue Committee
22 Mar 2016 – Global public health experts are overlooking the most critical lessons of the Ebola outbreak that could help prevent the next epidemic, according to the International Rescue Committee. In a report titled, “The Ebola Lessons Reader: What’s being said, what’s missing and why it matters,” the IRC has synthesized actionable insight and analyzed critical gaps that were missed in the plethora of reports generated in the aftermath of the Ebola epidemic.

The unprecedented and deadly scale of Ebola, which began two years ago today, inspired actors across the global health community to examine the weaknesses of the global response and what must change. In an effort to consolidate their actionable insight, the IRC reviewed 74 recommendations from donors, United Nations agencies, think-tanks, academics and governmental public health agencies. This review identified two key gaps: an imbalanced scrutiny of actors who will play major roles in averting the next epidemic and limited attention to the political dimensions of epidemics.

“Ebola evolved into a regional catastrophe precisely because the most important and sensitive issues — particularly those related to the politics of poor, post-conflict countries and the politics on the United Nations, NGOs, and the international aid world — have been wished away in the past by those of us who work on public health,” said Emmanuel d’Harcourt, Senior Health Director of the International Rescue Committee. “If we want ‘never again’ to be a reality rather than just another good intention, we need to call out the most sensitive and important issues.”

The analysis found that the World Health Organization received the most focus collectively, in terms of critiques and recommendations. Other major actors, like other UN agencies, militaries and donors, received significantly less attention and scrutiny. The vulnerabilities of affected governments received ample attention, but were largely focused on resources and weak health systems versus the overall political context.

Report Analysis
We have selected reflections from key actors involved in the Ebola response. Our selection includes representa¬tives from academia, think-tanks, NGOs, donors and the United Nations. We identified specific top-line recom¬mendations assigned to actors and consolidated similar observations. Pages 4-9 include our review.
:: Bill Gates. The Next Epidemic – Lessons from Ebola. New England Journal of Medicine 2015. April 9, 2015.
:: World Health Organization. Ebola Interim Assessment Panel “Stocking Report.” July 2015.
Tony Blair Africa Governance Initiative. State of Emergency: How Government Fought Ebola. July 10, 2015.
:: Overseas Development Institute. Humanitarian Policy Group Working Paper. The Ebola Response in West Africa: Exposing the politics and culture of international aid. July 10, 2015.
:: The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola. Will Ebola change the game? Ten essential reforms before the next pandemic. The Lancet. November 22, 2015.
:: Council on Foreign Relations. Lessons Learned After the Ebola Crisis – Darryl G. Behrman Lecture on Africa Policy with Thomas Frieden. November 24, 2015.
:: Médecins Sans Frontières. Epidemics as Neglected Emergencies. November 25, 2015.

The IRC’s analysis focused on three key gaps:
:: The reports focus on the World Health Organization’s role and performance but fail to address basic questions about the WHO’s mandate.
Most of the reports assume, in both their diagnosis and their prescriptions, that WHO is and should be an operational agency, rather than a norm-setting, coordinating agency. In reality, there are legitimate questions about whether, even with significant reforms, WHO can be operational at a large scale.

:: The reports give little attention or scrutiny to other actors who provided the bulk of the response.
While the reports collectively give sufficient attention to the WHO, it gives little attention and scrutiny to other actors, including other UN agencies, a variety of NGOs, militaries, donors and governmental public health agencies. These organizations collectively played a large role in the response on the ground and their contributions and failures will play key roles in the next epidemic.

:: Overall, the reports pay inadequate attention to the political economy of the countries affected and of the international response.
Epidemics are political, and Ebola was no exception. Yet the political context of this epidemic is glossed over in most of the reports, with the exception of the one. Similarly, several of the reports recommend health system strengthening, treating the issue as a technical one, and ignoring the political economy for health system weakness: the failures to pay health workers and the failure of external actors to tackle the political aspects of health systems reform.

“Many of the recommendations from the Ebola reports make sense. But the most critical issues seem to have been swept under the carpet, minimized or ignored altogether,” d’Harcourt said. “Ebola has laid bare the tragic rift that exists between theory and reality when it comes to epidemic response in the poorest places on earth. If we don’t acknowledge and deal with these realities, they will continue to compromise recovery efforts in West Africa, as well as our ability to stop the next epidemic.”

Report: The Ebola Lessons Reader – What’s being said, what’s missing and why it matters
International Rescue Committee
March 2016 :: 16 pages

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 26 March 2016)
.

Research article
Characterization of outbreak response strategies and potential vaccine stockpile needs for the polio endgame
Radboud J. Duintjer Tebbens, Mark A. Pallansch, Steven G. F. Wassilak, Stephen L. Cochi and Kimberly M. Thompson
BMC Infectious Diseases 2016 16:137
Published on: 24 March 2016
Abstract
Background
Following successful eradication of wild polioviruses and planned globally-coordinated cessation of oral poliovirus vaccine (OPV), national and global health leaders may need to respond to outbreaks from reintroduced live polioviruses, particularly vaccine-derived polioviruses (VDPVs). Preparing outbreak response plans and assessing potential vaccine needs from an emergency stockpile require consideration of the different national risks and conditions as they change with time after OPV cessation.
Methods
We used an integrated global model to consider several key issues related to managing poliovirus risks and outbreak response, including the time interval during which monovalent OPV (mOPV) can be safely used following homotypic OPV cessation; the timing, quality, and quantity of rounds required to stop transmission; vaccine stockpile needs; and the impacts of vaccine choices and surveillance quality. We compare the base case scenario that assumes aggressive outbreak response and sufficient mOPV available from the stockpile for all outbreaks that occur in the model, with various scenarios that change the outbreak response strategies.
Results
Outbreak response after OPV cessation will require careful management, with some circumstances expected to require more and/or higher quality rounds to stop transmission than others. For outbreaks involving serotype 2, using trivalent OPV instead of mOPV2 following cessation of OPV serotype 2 but before cessation of OPV serotypes 1 and 3 would represent a good option if logistically feasible. Using mOPV for outbreak response can start new outbreaks if exported outside the outbreak population into populations with decreasing population immunity to transmission after OPV cessation, but failure to contain outbreaks resulting in exportation of the outbreak poliovirus may represent a greater risk. The possibility of mOPV use generating new long-term poliovirus excretors represents a real concern. Using the base case outbreak response assumptions, we expect over 25 % probability of a shortage of stockpiled filled mOPV vaccine, which could jeopardize the achievement of global polio eradication. For the long term, responding to any poliovirus reintroductions may require a global IPV stockpile. Despite the risks, our model suggests that good risk management and response strategies can successfully control most potential outbreaks after OPV cessation.
Conclusions
Health leaders should carefully consider the numerous outbreak response choices that affect the probability of successfully managing poliovirus risks after OPV cessation.

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 26 March 2016)
.

Debate
End TB strategy: the need to reduce risk inequalities
M. Gabriela M. Gomes, Maurício L. Barreto, Philippe Glaziou, Graham F. Medley, Laura C. Rodrigues, Jacco Wallinga and S. Bertel Squire
BMC Infectious Diseases 2016 16:132
Published on: 22 March 2016
Abstract
Background
Diseases occur in populations whose individuals differ in essential characteristics, such as exposure to the causative agent, susceptibility given exposure, and infectiousness upon infection in the case of infectious diseases.
Discussion
Concepts developed in demography more than 30 years ago assert that variability between individuals affects substantially the estimation of overall population risk from disease incidence data. Methods that ignore individual heterogeneity tend to underestimate overall risk and lead to overoptimistic expectations for control. Concerned that this phenomenon is frequently overlooked in epidemiology, here we feature its significance for interpreting global data on human tuberculosis and predicting the impact of control measures.
Summary
We show that population-wide interventions have the greatest impact in populations where all individuals face an equal risk. Lowering variability in risk has great potential to increase the impact of interventions. Reducing inequality, therefore, empowers health interventions, which in turn improves health, further reducing inequality, in a virtuous circle.

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 26 March 2016)

.
Research article
Ethical analysis in HTA of complex health interventions
Kristin Bakke Lysdahl, Wija Oortwijn, Gert Jan van der Wilt, Pietro Refolo, Dario Sacchini, Kati Mozygemba, Ansgar Gerhardus, Louise Brereton and Bjørn Hofmann
Published on: 22 March 2016
Abstract
Background
In the field of health technology assessment (HTA), there are several approaches that can be used for ethical analysis. However, there is a scarcity of literature that critically evaluates and compares the strength and weaknesses of these approaches when they are applied in practice. In this paper, we analyse the applicability of some selected approaches for addressing ethical issues in HTA in the field of complex health interventions. Complex health interventions have been the focus of methodological attention in HTA. However, the potential methodological challenges for ethical analysis are as yet unknown.
Methods
Six of the most frequently described and applied ethical approaches in HTA were critically assessed against a set of five characteristics of complex health interventions: multiple and changing perspectives, indeterminate phenomena, uncertain causality, unpredictable outcomes, and ethical complexity. The assessments are based on literature and the authors’ experiences of developing, applying and assessing the approaches.
Results
The Interactive, participatory HTA approach is by its nature and flexibility, applicable across most complexity characteristics. Wide Reflective Equilibrium is also flexible and its openness to different perspectives makes it better suited for complex health interventions than more rigid conventional approaches, such as Principlism and Casuistry. Approaches developed for HTA purposes are fairly applicable for complex health interventions, which one could expect because they include various ethical perspectives, such as the HTA Core Model® and the Socratic approach.
Conclusion
This study shows how the applicability for addressing ethical issues in HTA of complex health interventions differs between the selected ethical approaches. Knowledge about these differences may be helpful when choosing and applying an approach for ethical analyses in HTA. We believe that the study contributes to increasing awareness and interest of the ethical aspects of complex health interventions in general.

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 26 March 2016)

.
World TB Day 2016 – Article Collection
In recognition of World TB Day 2016, BMC Medicine and BMC Infectious Diseases have launched an article collection. In collaboration with the UCL-TB Centre and the LSHTM TB Centre, guest edited by Ibrahim Abubakar, Helen Fletcher, Marc Lipman and Tim McHugh. The collection includes articles addressing the most up-to-date evidence and innovation in the diagnosis, management and prevention of TB, as well as particular challenges affecting vulnerable populations.

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 26 March 2016)

.

Research article
The role of micro health insurance in providing financial risk protection in developing countries- a systematic review
Out of pocket payments are the predominant method of financing healthcare in many developing countries, which can result in impoverishment and financial catastrophe for those affected.
Shifa Salman Habib, Shagufta Perveen and Hussain Maqbool Ahmed Khuwaja
BMC Public Health 2016 16:281
Published on: 22 March 2016

The European Journal of Public Health
Volume 26, Issue 2, 1 April 2016
http://eurpub.oxfordjournals.org/content/26/2?current-issue=y

.

Viewpoint
A Global Charter for the Public’s Health—the public health system: role, functions, competencies and education requirements*
M. Lomazzi
DOI: http://dx.doi.org/10.1093/eurpub/ckw011 210-212 First published online: 8 March 2016
Introduction
Growth, development, equity and stability
Political leaders increasingly perceive health as being crucial to achieving growth, development, equity and stability throughout the world. Health is now understood as a product of complex and dynamic relations generated by numerous determinants at different levels of governance. Governments need to take into account the impact of social, environmental and behavioural health determinants, including economic constraints, living conditions, demographic changes and unhealthy lifestyles in many of the World Health Organization (WHO) Member States. This understanding and increasing globalization means it is very timely to review the role of (global) public health in this changing societal and political environment.

Globalization
The positive and negative impacts of globalization need to be better understood by public health professionals and more widely acknowledged by policy makers. Globalization is marked by increased interconnectedness and interdependence of peoples and countries, based on the opening of borders to increasingly fast flows of goods, services, finance, people and ideas across international borders and the changes in institutional and policy regimes at the international and national levels that facilitate or promote such flows. It is recognized that globalization has both positive and negative impacts on health development. Increasingly trade agreements provide frameworks for intergovernmental relationships; however, possible impacts on human health are not routinely assessed prior to signing.

The proposal for a Global Charter for the Public’s Health
In this context, the World Federation of Public Health Associations (WFPHA) has developed the A Global Charter for the Public’s Health (GCPH) as the main output of its collaboration plan with the WHO to adapt today’s public health to its global context in the light of and in conjunction with the Sustainable Development Goals (SDGs). GCPH brings together the best of all the existing models and provides a comprehensive, clear and flexible framework that can be applied globally and within individual countries, whether low, middle or high income.

Outcome of literature review and consultation
As part of the consultation process, several key points were raised:
:: The need for genuine political engagement was stressed, underlying that too often politicians only paid lip service to public health.
:: Commercial, social and environmental determinants of health, as well as social inequalities should be tackled and resources allocated in a sustainable and accountable way.
:: The impacts of underlying ideologies should be taken into consideration.
:: More comprehensive and reliable data are needed in many programmatic areas of the public’s health.
:: The multisectoral and holistic approach should be reached, engaging public health in big dialogues and in the concerted decision-making processes.
:: Participants of the consultation stressed that WHO should provide leadership in this process.
:: New leaders for public health are required.
:: A flexible common framework of instruments to influence governments has been suggested.
:: New creative solutions are needed.
:: Specific projects of selected countries where public health has a strong voice and is integrated in government policies and initiatives might be possible models for other settings.

While publications on global public health are exponentially increasing in the literature, the term ‘Global public health’ itself remains ill defined. The term is frequently used though, but more in the context of a ‘problem’ or a ‘challenge’. The framing of global public health is frequently medical and technical. This may be a result of the vertical technically oriented programs that are run throughout the world. Political and economic constraints found in the literature are important but there is not a large body of literature around this topic.

Despite the evidence that the different public health functions need to be much better integrated into health systems, a ‘know-do-gap’ is apparent. While multi-sectoral approaches in public health are increasingly chosen, they are by no means mainstream.

A Global Charter for the Public’s Health
Resilient public health systems are needed locally to globally and within each country. However, the current reality consists of fragmented, variable and incomplete public health services and functions, with little common understanding of what a good public health service looks like.

Currently, there is no global agreement on what public health functions or services consist of, and the lack of a common vocabulary in public health adversely affects the efforts of public health systems, including security and workforce development and quality standards across the world. Many public health policies, especially those that look at disease specific topics, remain vertical, even if they outline some inter-sectoral components. Many are not well coordinated with other related societal fields and, therefore, have a huge impact on population health. A GCPH has the potential to become an established framework to allow public health systems to communicate globally, compare capacity and improve performance through systematic action.

Functions and services
The proposed GCPH consists of two groups of functions/services including:
:: Services: a group of core services—Protection, Prevention and Promotion
:: Functions: a group of enabler functions—Governance, Advocacy, Capacity and Information

Headings for the GCPH
There exists overlap between all these services and functions, especially between health promotion, primary prevention and environmental health, which benefit from a cross-sector approach. Specific public health topics require components drawn from across the range of services and functions. These include:
.1. Governance: public health legislation; health and cross-sector policy; strategy; financing; organisation; assurance: transparency, accountability and audit.
.2. Information: surveillance, monitoring and evaluation; monitoring of health determinants; research and evidence; risk and innovation; dissemination and uptake.
.3. Protection: international health regulation and co-ordination; health impact assessment; communicable disease control; emergency preparedness; occupational health; environmental health; climate change and sustainability.
.4. Prevention: primary prevention: vaccination; secondary prevention: screening; tertiary prevention: evidence-based, community-based, integrated, person-centred quality health-care and rehabilitation; healthcare management and planning.
.5. Promotion: inequalities; environmental determinants; social and economic determinants; resilience; behaviour and health literacy; life-course; healthy settings.
.6. Advocacy: leadership and ethics; health equity; social-mobilization and solidarity; education of the public; people-centred approach; voluntary community sector engagement; communications; sustainable development.
.7. Capacity: workforce development for public health, health workers and wider workforce; workforce planning: numbers, resources, infrastructure; standards, curriculum, accreditation; capabilities, teaching and training.

Recommendations
Recommendation 1–Consensus: A common conceptualization of global public health should be defined and adopted by the WFPHA and its members and used as a basis for public health education and training. It should be followed by a process of engagement with partners and Member States to adopt a WHO action plan on public health functions, based on the approved GCPH.

Recommendation 2–Co-ordination: WFPHA in association with partners supports and recognises WHO’s leadership role to facilitate global public health in global multi-sectoral dialogues, co-ordination and decision making.

Recommendation 3–Leadership: Public health leadership to be strengthened to integrate the public health charter into cross-sector policy, health systems policy and governance mechanisms, building on and enhancing existing frameworks.

Recommendation 4–Workforce: Applying the GCPH encompassing functions, services and healthy public policy to scale up the public health workforce to ensure global health security and the sustainability of health systems.

Recommendation 5–Tools and application: Case studies, tools and standards to be developed to illustrate the application of the GCPH at the global, national and local levels and for use in public health education and training. Adoption of a GCPH will require skilful communication and practical application.

Recommendation 6–Resources: In order to strengthen Global Public Health, political commitment is needed, with co-ordinated roles and resources with partners and donors.

Conclusion
In the broadest sense, public health in our globalized world is multi-faceted, serving as a basis for everyday life, crucial for growth and development, equity and stability and is a function of numerous social, environmental and behavioural determinants, not least of which are the impacts of globalization itself. To realize the potential of a healthy global citizenry to support economic growth and development, equity and stability, there is an urgent need for genuine political acknowledgement of, engagement with and leadership for the public’s health supported by a global public health system.

Action on two levels is required. First, consensus on a conceptualization of global public health and on a framework for sustainable and secure health infrastructures and services are essential first steps to underpin health in everyday life and to minimize the negative economic, social and environmental impacts of globalization on health development and community stability. Additionally, new models and skill sets are needed to address new and re-emerging public health challenges within the different socio-economic realities around the world, varying political capacities and new political entities.

Second, development of global public health requires political engagement, use of social networks, identification of political leverage points and steerage of public health agendas through the new societal and political environments. Importantly, global public health values should inform, be embedded within and be used to assess political and policy decisions.

The European Journal of Public Health
Volume 26, Issue 2, 1 April 2016
http://eurpub.oxfordjournals.org/content/26/2?current-issue=y

.

Health services research
Substantial between-country differences in organising community care for older people in Europe—a review
Liza Van Eenoo, Anja Declercq, Graziano Onder, Harriet Finne-Soveri, Vjenka Garms-Homolová, Pálmi V. Jónsson, Olivia H.M. Dix, Johannes H. Smit, Hein P.J. van Hout, Henriëtte G. van der Roest Eur J Public Health (2016) 26 (2): 213-219 DOI: http://dx.doi.org/10.1093/eurpub/ckv152 First published online: 2 September 2015 (7 pages)

.

Child and adolescent health
Relative deprivation in the Nordic countries—child mental health problems in relation to parental financial stress
Hrafnhildur Gunnarsdóttir, Gunnel Hensing, Lene Povlsen, Max Petzold Eur J Public Health (2016) 26 (2): 277-282 DOI: http://dx.doi.org/10.1093/eurpub/ckv191 First published online: 21 October 2015 (6 pages)

Eurosurveillance
Volume 21, Issue 12, 24 March 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

.
Editorials
Impact of migration on tuberculosis epidemiology and control in the EU/EEA
by MJ van der Werf, JP Zellweger

.

Research Articles
The effect of migration within the European Union/European Economic Area on the distribution of tuberculosis, 2007 to 2013
by V Hollo, SM Kotila, C Ködmön, P Zucs, MJ van der Werf
Abstract
Immigration from tuberculosis (TB) high-incidence countries is known to contribute notably to the TB burden in low-incidence countries. However, the effect of migration enabled by the free movement of persons within the European Union (EU)/European Economic Area (EEA) on TB notification has not been analysed. We analysed TB surveillance data from 29 EU/EEA countries submitted for the years 2007–2013 to The European Surveillance System. We used place of birth and nationality as proxy indicators for native, other EU/EEA and non-EU/EEA origin of the TB cases and analysed the characteristics of the subgroups by origin. From 2007–2013, a total of 527,467 TB cases were reported, of which 129,781 (24.6%) were of foreign origin including 12,566 (2.4%) originating from EU/EEA countries other than the reporting country. The countries reporting most TB cases originating from other EU/EEA countries were Germany and Italy, and the largest proportion of TB cases in individuals came from Poland (n=1,562) and Romania (n=6,285). At EU/EEA level only a small proportion of foreign TB cases originated from other EU/EEA countries, however, the uneven distribution of this presumed importation may pose a challenge to TB programmes in some countries.

.

Migration-related tuberculosis: epidemiology and characteristics of tuberculosis cases originating outside the European Union and European Economic Area, 2007 to 2013
by C Ködmön, P Zucs, MJ van der Werf
Abstract
Migrants arriving from high tuberculosis (TB)-incidence countries may pose a significant challenge to TB control programmes in the host country. TB surveillance data for 2007–2013 submitted to the European Surveillance System were analysed. Notified TB cases were stratified by origin and reporting country. The contribution of migrant TB cases to the TB epidemiology in EU/EEA countries was analysed. Migrant TB cases accounted for 17.4% (n = 92,039) of all TB cases reported in the EU/EEA in 2007–2013, continuously increasing from 13.6% in 2007 to 21.8% in 2013. Of 91,925 migrant cases with known country of origin, 29.3% were from the Eastern Mediterranean, 23.0% from south-east Asia, 21.4% from Africa, 13.4% from the World Health Organization European Region (excluding EU/EEA), and 12.9% from other regions. Of 46,499 migrant cases with known drug-susceptibility test results, 2.9% had multidrug-resistant TB, mainly (51.7%) originating from the European Region. The increasing contribution of TB in migrants from outside the EU/EEA to the TB burden in the EU/EEA is mainly due to a decrease in native TB cases. Especially in countries with a high proportion of TB cases in non-EU/EEA migrants, targeted prevention and control initiatives may be needed to progress towards TB elimination.

Global Health: Science and Practice (GHSP)
March 2016 | Volume 4 | Issue 1
http://www.ghspjournal.org/content/current

.
Original Articles
Routine Immunization Consultant Program in Nigeria: A Qualitative Review of a Country-Driven Management Approach for Health Systems Strengthening
Meghan O’Connell, Chizoba Wonodi
Glob Health Sci Pract 2016;4(1):29-42. http://dx.doi.org/10.9745/GHSP-D-15-00209
ABSTRACT
Background: Since 2002, the Nigerian government has deployed consultants to states to provide technical assistance for routine immunization (RI). RI consultants are expected to play a role in supportive supervision of health facility staff, capacity building, advocacy, and monitoring and evaluation.
Methods: We conducted a retrospective review of the RI consultant program’s strengths and weaknesses in 7 states and at the national level from June to September 2014 using semi-structured interviews and online surveys. Participants included RI consultants, RI program leaders, and implementers purposively drawn from national, state, and local government levels. Thematic analysis was used to analyze qualitative data from the interviews, which were triangulated with results from the quantitative surveys.
Findings: At the time of data collection, 23 of 36 states and the federal capital territory had an RI consultant. Of the 7 states visited during the study, only 3 states had present and visibly working consultants. We conducted 84 interviews with 101 participants across the 7 states and conducted data analysis on 70 interviews (with 82 individuals) that had complete data. Among the full sample of interview respondents (N = 101), most (66%) were men with an average age of 49 years (±5.6), and the majority were technical officers (63%) but a range of other roles were also represented, including consultants (22%), directors (13%), and health workers (2%). Fifteen consultants and 44 program leaders completed the online surveys. Interview data from the 3 states with active RI consultants indicated that the consultants’ main contribution was supportive supervision at the local level, particularly for collecting and using RI data for decision making. They also acted as effective advocates for RI funding. In states without an RI consultant, gaps were highlighted in data management capacity and in monitoring of RI funds. Program design strengths: the broad terms of reference and autonomy of the consultants allowed work to be tailored to the local context; consultants were often integrated into state RI teams but could also work independently when necessary; and recruitment of experienced consultants with strong professional networks, familiarity with the local context, and ability to speak the local language facilitated advocacy efforts. Key programmatic challenges were related to inadequate and inconsistent inputs (salaries, transportation means, and dedicated office space) and gaps in communication between consultants and national leadership and in management of consultants, including lack of performance feedback, lack of formal orientation at inception, and no clear job performance targets.
Conclusions: While weaknesses in managerial and material inputs affect current performance of RI consultants in Nigeria, the design of the RI consultant program employs a unique problem-focused, locally led model of development assistance that could prove valuable in strengthening the capacity of the government to implement such technical assistance on its own. Despite the lack of uniform deployment and implementation of RI consultants across the country, some consultants appear to have contributed to improved RI services through supportive supervision, capacity building, and advocacy.

.

Original Articles
Meeting Postpartum Women’s Family Planning Needs Through Integrated Family Planning and Immunization Services: Results of a Cluster-Randomized Controlled Trial in Rwanda
Lisa S Dulli, Marga Eichleay, Kate Rademacher, Steve Sortijas, Théophile NsengiyumvaGlob Health Sci Pract 2016;4(1):73-86. First published online February 22, 2016. http://dx.doi.org/10.9745/GHSP-D-15-00291
ABSTRACT
Objective The primary objective of this study was to test the effectiveness of integrating family planning service components into infant immunization services to increase modern contraceptive method use among postpartum women.
Methods The study was a separate sample, parallel, cluster-randomized controlled trial. Fourteen randomly selected primary health facilities were equally allocated to intervention (integrated family planning and immunization services at the same time and location) and control groups (standard immunization services only). At baseline (May–June 2010), we interviewed postpartum women attending immunization services for their infant aged 6 to 12 months using a structured questionnaire. A separate sample of postpartum women was interviewed 16 months later after implementation of the experimental health service intervention. We used linear mixed regression models to test the study hypothesis that postpartum women attending immunization services for their infants aged 6–12 months in the intervention facilities will be more likely to use a modern contraceptive method than postpartum women attending immunization services for their infants aged 6–12 months in control group facilities.
Results We interviewed and analyzed data for 825 women from the intervention group and 829 women from the control group. Results showed the intervention had a statistically significant, positive effect on modern contraceptive method use among intervention group participants compared with control group participants (regression coefficient, 0.15; 90% confidence interval [CI], 0.04 to 0.26). Although we conducted a 1-sided significance test, this effect was also significant at the 2-sided test with alpha = .05. Among those women who did not initiate a contraceptive method, awaiting the return of menses was the most common reason cited for non-use of a method. Women in both study groups overwhelmingly supported the concept of integrating family planning service components into infant immunization services (97.9% in each group), and service data collected during the intervention period did not indicate that the intervention had any negative effect on infant immunization service uptake.
Conclusion Integrating family planning service components into infant immunization services can be an acceptable and effective strategy to increase contraceptive use among postpartum women. Additional research is needed to examine the extent to which this integration strategy can be replicated in other health care settings. Future research should also explore persistent misconceptions regarding the relationship between return of menses and return to fertility during the postpartum period.

.

METHODOLOGIES
Simplified Asset Indices to Measure Wealth and Equity in Health Programs: A Reliability and Validity Analysis Using Survey Data From 16 Countries
Many program implementers have difficulty collecting and analyzing data on program beneficiaries’ wealth because a large number of survey questions are required to construct the standard wealth index. We created country-specific measures of household wealth with as few as 6 questions that are highly reliable and valid in both urban and rural contexts.
Nirali M Chakraborty, Kenzo Fry, Rasika Behl, Kim Longfield
Glob Health Sci Pract 2016;4(1):141-154. http://dx.doi.org/10.9745/GHSP-D-15-00384

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 26 March 2016]

.
Commentary
A critical analysis of the review on antimicrobial resistance report and the infectious disease financing facility
David M. Brogan and Elias Mossialos
Globalization and Health 2016 12:8
Published on: 22 March 2016
Abstract
Over the past year, two major policy initiatives have been introduced focusing on stimulating antibiotic development for human consumption. The European Investment Bank has announced the development of the Infectious Disease Financing Facility (IDFF) and the British government commissioned the Review on Antimicrobial Resistance, led by Jim O’Neill. Each constitutes a major effort by the European community to address the evolving crisis of antimicrobial resistance. Though both have similar goals, the approaches are unique and worthy of consideration.
This manuscript utilizes a previously published framework for evaluation of antibiotic incentive plans to clearly identify the strengths and weaknesses of each proposal. The merits of each proposal are evaluated in how they satisfy four key objectives: 1) Improve the overall net present value (NPV) for new antibiotic projects; 2) Enable greater participation of Small to Medium Sized Enterprises (SME); 3) Encourage participation by large pharmaceutical companies; 4) Facilitate cooperation and synergy across the antibiotic market. The IDFF seeks to make forgivable loans to corporations with promising compounds, while the O’Neill group proposes a more comprehensive framework of early stage funding, along with the creation of a stable global market.
Ultimately, the proposals may prove complementary and if implemented together may form a more comprehensive plan to address an impending global crisis. Substantial progress will only be made on these efforts if action is taken at an international level, therefore we recommend consideration of these efforts at the upcoming G20 summit.

Infectious Agents and Cancer

[Accessed 26 March 2016]

.
Research Article
Cervical cancer survival in a resource-limited setting-North Central Nigeria
Organized cervical cancer screening services are presently lacking in Nigeria contributing to late presentation and diagnosis of invasive cervical cancer cases (ICCs) at advanced stages in most gynecologic units in Nigeria. We evaluated outcomes of ICCs diagnosed at Jos University Teaching Hospital (JUTH) to better understand factors associated with cervical cancer survival in similar resource limited settings.
Jonah Musa, Joseph Nankat, Chad J. Achenbach, Iornum H. Shambe, Babafemi O. Taiwo, Barnabas Mandong, Patrick H. Daru, Robert L. Murphy and Atiene S. Sagay
Infectious Agents and Cancer 2016 11:15
Published on: 24 March 2016

JAMA
March 22/29, 2016, Vol 315, No. 12
http://jama.jamanetwork.com/issue.aspx

.
Viewpoint
Pregnancy in the Time of Zika: Addressing Barriers for Developing Vaccines and Other Measures for Pregnant Women FREE
Saad B. Omer, MBBS, MPH, PhD; Richard H. Beigi, MD, MSc

Three recent infectious disease outbreaks of global importance—H1N1 influenza, Ebola, and now Zika—have had specific implications for pregnant women. For the H1N1 pandemic, pregnant women and their infants were high-risk groups for severe complications and death. During the Ebola outbreak, there were concerns about worse outcomes among pregnant women and specific concerns regarding vertical transmission of infection to newborns. The current Zika outbreak, with its ostensible association with microcephaly, has direct and highly concerning implications for pregnant women and women of reproductive age.

Yet the global public health community again lacks the optimal tools for dealing with a disease that has specific and important implications for pregnant women. There are substantial knowledge gaps in current understanding of Zika, irrespective of the affected population. However, Zika’s association with adverse fetal outcomes requires that pregnant women be a priority group for developing and evaluating vaccines and other measures. There are several current scientific and structural barriers to developing vaccines for pregnant women. These barriers challenge the ability to prepare and respond to epidemics and are particularly highlighted during a public health emergency that has pregnant women and their unborn fetuses as the primary affected population.

One barrier is a lack of a broadly accepted ethical framework for guiding clinical research during pregnancy. For example, the term minimal risk1—a concept that informs ethical review of research—is not well defined for research in pregnancy. Therefore, institutional review boards (IRBs) often resort to categorizing most intervention research in pregnancy as high risk, often without a balanced consideration of the risks of not performing the research. Moreover, the risks and benefits to the fetus also need to be considered along with risks and benefits to the mother, adding to the challenge. This lack of a broadly accepted ethical framework has a chilling effect on both academic and industry-led clinical research in pregnancy.2,3 Therefore, there is a need for development and articulation of a pregnancy-specific ethical framework that can offer guidance to investigators and IRBs.

Pregnancy is a physiologically dynamic state. The immune profile of a pregnant woman is responsive to the changing levels of sex hormones and evolves through the course of pregnancy.4 However, most of the current knowledge base for vaccine response is derived from observational studies conducted in the latter part of pregnancy, with limited data available from the first and early second trimester or from randomized clinical trials. On the other hand, clinical, practical, and public health considerations require that vaccine use not be restricted to women with advanced gestational age. Given that a substantial portion of Zika’s teratogenic effects may occur in the earlier phase of pregnancy, administration of any forthcoming Zika vaccine will be most beneficial prior to or during the early parts of pregnancy. The knowledge gap for early pregnancy vaccine responses and safety will make the task of developing and recommending an effective Zika vaccine for use across pregnancy challenging.

Until recently, the pregnancy and lactation sections of US Food and Drug Administration (FDA)-approved labels for vaccines and pharmaceuticals contained ambiguous information with limited clinical utility. For example, the labels were required to contain determination of letter risk categories (A, B, C, D, or X) for pregnancy. These categories were an attempt to summarily convey risk of reproductive and developmental adverse effects. However, the categories were somewhat simplistic and challenging to translate into practice in a clinically meaningful manner.

After years of deliberations, revisions, and public comment, FDA recently issued the Pregnancy and Lactation Labeling Rule (PLLR).5 This rule will enable inclusion of clinically relevant and interpretable information in drug and vaccine labels and creates a consistent format for communicating information on risks as well as benefits relevant to pregnant and lactating women and for males and females of reproductive potential. Moreover, the new rule allows for incorporating information about risk and benefits from a variety of sources, including non–industry-sponsored epidemiological and interventional studies. Although the release of the PLLR is important and holds promise to provide more clinically useful information, its implementation faces many logistical challenges. For example, there is a need for a “mock label” (ie, a sample label providing examples of information to be included in the sections relevant to pregnancy and lactation) to provide guidance for inclusion and format of pregnancy-related information in sections relevant to pregnant women.

General understanding of the new categorization system is insufficient among clinicians who provide obstetrical care. Therefore, it will take concerted efforts to phase in this categorization. Having clarity regarding vaccine (and drug) labeling related to pregnancy will help ensure that clinicians have a higher level of confidence in pregnancy-related vaccines and could provide a road map for conducting research that can inform labeling and hence clinical decisions.
Robust safety evaluation is a cornerstone of any vaccine development and deployment program. There has been an increase in the number of studies evaluating the safety of currently recommended maternal vaccines, such as influenza and pertussis vaccines.6 Despite increased attention on the evaluation of safety of immunization in pregnancy, barriers remain. For example, a review commissioned by the World Health Organization highlighted the lack of standard definitions of outcomes, and standards for measurement of these outcomes, relevant to evaluation of vaccines in pregnancy.7 This lack of standardization poses a challenge for conduct of clinical trials, generalizability of safety data, and merging of large safety data sets. This last point is critical because large multilocation data sets could optimize the evaluation of rare but clinically important outcomes, such as microcephaly.

Moreover, safety assessment for pharmaceutical interventions against emerging public health threats requires real-time assessment of risk vs benefit. Baseline outcome rates are an essential input for such an assessment. The value of baseline rates was recognized during the H1N1 pandemic.8 Since then, there has been little progress in ascertaining baseline rates in different geographic locations of outcomes such as first trimester miscarriages. Ascertainment of baseline rates of outcomes is even more important when a disease emerges in the context of other infections (eg, malaria) that are associated with adverse birth outcomes.

Drug and vaccine development and evaluation in children may provide some context for the current outbreak response. Pediatricians and child health researchers recognized many parallel challenges in the amount and quality of data available for the care of children. The term therapeutic orphans was coined for children, stressing the concept of the lack of information available to prevent and treat disease in children. To address these challenges, efforts were mobilized around the conceptualization and passing of legislation (Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act). These efforts have contributed to improving the quantity and quality of research that has been conducted in children.9 A similar approach may also be relevant to fostering research in pregnancy.

Pregnant women have been a high-risk group requiring special consideration for several recent global public health emergencies. Currently, pregnant women and their unborn children are the focal point of the Zika outbreak. Although there are several barriers for developing vaccines and other measures for pregnant women, these barriers are surmountable with concerted efforts and leadership. Strategic planning and action have allowed for advances in pediatric drug development and provide a good model. However, the time to act is now, before the next epidemic takes its toll.
[References at link above]

Journal of Immigrant and Minority Health
Volume 18, Issue 2, April 2016
http://link.springer.com/journal/10903/18/2/page/1

.
Original Paper
Immunization Status of Young People Attending a Youth Clinic in Geneva, Switzerland
Anne Meynard, Lydia Markham Genequand
Abstract
Adolescent vaccination coverage is very variable in European countries and data are scarce. The aim of this study was to assess immunization status and analyze potential variations according to sociodemographic variables in a youth clinic in Geneva, Switzerland. Immunization status was assessed retrospectively: Tetanus (number of doses or in absence of data tetanus antibodies) and measles as indicators of childhood coverage as well as hepatitis B and human papillomavirus. All new patients (N = 390) of Geneva University Hospital’s youth clinic were included between January 2010 and June 2011. Vaccine coverage was low for all vaccines regardless of sex or origin. 89 % of young people tested (mostly recent immigrants with no available data) had tetanus antibodies indicating adequate childhood immunization but hepatitis B and HPV coverage was low especially in recent immigrants. Systematic assessment allows better adolescent vaccine coverage and can improve safety by avoiding unnecessary dosis.

New England Journal of Medicine
March 24, 2016 Vol. 374 No. 12
http://www.nejm.org/toc/nejm/medical-journal

.
Original Article
Symptomatic Dengue in Children in 10 Asian and Latin American Countries
Maïna L’Azou, M.Sc., Annick Moureau, M.Sc., Elsa Sarti, Ph.D., Joshua Nealon, M.Sc., Betzana Zambrano, M.D., T. Anh Wartel, M.D., Luis Villar, M.D., Maria R.Z. Capeding, M.D., and R. Leon Ochiai, Ph.D., for the CYD14 and CYD15 Primary Study Groups*
N Engl J Med 2016; 374:1155-1166 March 24, 2016
DOI: 10.1056/NEJMoa1503877
Abstract
Background
The control groups in two phase 3 trials of dengue vaccine efficacy included two large regional cohorts that were followed up for dengue infection. These cohorts provided a sample for epidemiologic analyses of symptomatic dengue in children across 10 countries in Southeast Asia and Latin America in which dengue is endemic.
Methods
We monitored acute febrile illness and virologically confirmed dengue (VCD) in 3424 healthy children, 2 to 16 years of age, in Asia (Indonesia, Malaysia, the Philippines, Thailand, and Vietnam) from June 2011 through December 2013 and in 6939 children, 9 to 18 years of age, in Latin America (Brazil, Colombia, Honduras, Mexico, and Puerto Rico) from June 2011 through April 2014. Acute febrile episodes were determined to be VCD by means of a nonstructural protein 1 antigen immunoassay and reverse-transcriptase–polymerase-chain-reaction assays. Dengue hemorrhagic fever was defined according to 1997 World Health Organization criteria.
Results
Approximately 10% of the febrile episodes in each cohort were confirmed to be VCD, with 319 VCD episodes (4.6 episodes per 100 person-years) occurring in the Asian cohort and 389 VCD episodes (2.9 episodes per 100 person-years) occurring in the Latin American cohort; no trend according to age group was observed. The incidence of dengue hemorrhagic fever was less than 0.3 episodes per 100 person-years in each cohort. The percentage of VCD episodes requiring hospitalization was 19.1% in the Asian cohort and 11.1% in the Latin American cohort. In comparable age groups (9 to 12 years and 13 to 16 years), the burden of dengue was higher in Asia than in Latin America.
Conclusions
The burdens of dengue were substantial in the two regions and in all age groups. Burdens varied widely according to country, but the rates were generally higher and the disease more frequently severe in Asian countries than in Latin American countries. (Funded by Sanofi Pasteur; CYD14 and CYD15 ClinicalTrials.gov numbers, NCT01373281 and NCT01374516.)

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 26 March 2016)

.
Research Article |
Global Role and Burden of Influenza in Pediatric Respiratory Hospitalizations, 1982–2012: A Systematic Analysis
Kathryn E. Lafond, Harish Nair, Mohammad Hafiz Rasooly, Fátima Valente, Robert Booy, Mahmudur Rahman, Paul Kitsutani, Hongjie Yu, Guiselle Guzman, Daouda Coulibaly, Julio Armero, Daddi Jima, Stephen R. C. Howie, William Ampofo, Ricardo Mena, Mandeep Chadha, Ondri Dwi Sampurno, Gideon O. Emukule, Zuridin Nurmatov, Andrew Corwin, Jean Michel Heraud, Daniel E. Noyola, Radu Cojocaru, Pagbajabyn Nymadawa, Amal Barakat, Adebayo Adedeji, Marta von Horoch, Remigio Olveda, Thierry Nyatanyi, Marietjie Venter, Vida Mmbaga, Malinee Chittaganpitch, Tran Hien Nguyen, Andros Theo, Melissa Whaley, Eduardo Azziz-Baumgartner, Joseph Bresee, Harry Campbell, Marc-Alain Widdowson, Global Respiratory Hospitalizations—Influenza Proportion Positive (GRIPP) Working Group
Research Article | published 24 Mar 2016 | PLOS Medicine
10.1371/journal.pmed.1001977
Abstract
Background
The global burden of pediatric severe respiratory illness is substantial, and influenza viruses contribute to this burden. Systematic surveillance and testing for influenza among hospitalized children has expanded globally over the past decade. However, only a fraction of the data has been used to estimate influenza burden. In this analysis, we use surveillance data to provide an estimate of influenza-associated hospitalizations among children worldwide.
Methods and Findings
We aggregated data from a systematic review (n = 108) and surveillance platforms (n = 37) to calculate a pooled estimate of the proportion of samples collected from children hospitalized with respiratory illnesses and positive for influenza by age group ( Influenza was associated with 10% (95% CI 8%–11%) of respiratory hospitalizations in children Conclusions
Influenza is an important contributor to respiratory hospitalizations among young children worldwide. Increasing influenza vaccination coverage among young children and pregnant women could reduce this burden and protect infants

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 26 March 2016)

.
Research Article
Willingness to Pay for Dog Rabies Vaccine and Registration in Ilocos Norte, Philippines (2012)
Meseret G. Birhane, Mary Elizabeth G. Miranda, Jessie L. Dyer, Jesse D. Blanton, Sergio Recuenco
Research Article | published 21 Mar 2016 | PLOS Neglected Tropical Diseases
10.1371/journal.pntd.0004486
Abstract
Background
The Philippines is one of the developing countries highly affected by rabies. Dog vaccination campaigns implemented through collaborative effort between the government and NGOs have played an important role in successfully reducing the burden of disease within the country. Nevertheless, rabies vaccination of the domestic animal population requires continuous commitment not only from governments and NGOs, but also from local communities that are directly affected by such efforts. To create such long-term sustained programs, the introduction of affordable dog vaccination and registration fees is essential and has been shown to be an important strategy in Bohol, Philippines. The aim of this study, therefore, was to estimate the average amount of money that individuals were willing to pay for dog vaccination and registration in Ilocos Norte, Philippines. This study also investigated some of the determinants of individuals’ willingness to pay (WTP).
Methods
A cross-sectional questionnaire was administered to 300 households in 17 municipalities (out of a total of 21) selected through a multi-stage cluster survey technique. At the time of the survey, Ilocos Norte had a population of approximately 568,017 and was predominantly rural. The Contingent Valuation Method was used to elicit WTP for dog rabies vaccination and registration. A ‘bidding game’ elicitation strategy that aims to find the maximum amount of money individuals were willing to pay was also employed. Data were collected using paper-based questionnaires. Linear regression was used to examine factors influencing participants’ WTP for dog rabies vaccination and registration.
Key Results
On average, Ilocos Norte residents were willing to pay 69.65 Philippine Pesos (PHP) (equivalent to 1.67 USD in 2012) for dog vaccination and 29.13PHP (0.70 USD) for dog registration. Eighty-six per cent of respondents were willing to pay the stated amount to vaccinate each of their dogs, annually. This study also found that WTP was influenced by demographic and knowledge factors. Among these, we found that age, income, participants’ willingness to commit to pay each year, municipality of residency, knowledge of the signs of rabies in dogs, and number of dogs owed significantly predicted WTP.

PLoS One
http://www.plosone.org/
[Accessed 26 March 2016]

.
Research Article
Twin Peaks: A/H1N1 Pandemic Influenza Virus Infection and Vaccination in Norway, 2009–2010
Thierry Van Effelterre, Gaël Dos Santos, Vivek Shinde
Research Article | published 24 Mar 2016 | PLOS ONE
10.1371/journal.pone.0151575

A Rapid and Improved Method to Generate Recombinant Dengue Virus Vaccine Candidates
Dhanasekaran Govindarajan, Liming Guan, Steven Meschino, Arthur Fridman, Ansu Bagchi, Irene Pak, Jan ter Meulen, Danilo R. Casimiro, Andrew J. Bett
Research Article | published 23 Mar 2016 | PLOS ONE
10.1371/journal.pone.0152209

A Comparison of the Adaptive Immune Response between Recovered Anthrax Patients and Individuals Receiving Three Different Anthrax Vaccines
Thomas R. Laws, Tinatin Kuchuloria, Nazibriola Chitadze, Stephen F. Little, Wendy M. Webster, Amanda K. Debes, Salome Saginadze, Nikoloz Tsertsvadze, Mariam Chubinidze, Robert G. Rivard, Shota Tsanava, Edward H. Dyson, Andrew J. H. Simpson, Matthew J. Hepburn, Nino Trapaidze
Research Article | published 23 Mar 2016 | PLOS ONE
10.1371/journal.pone.0148713

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 26 March 2016)

.
Biological Sciences – Medical Sciences – Social Sciences – Sustainability Science:
Analysis and valuation of the health and climate change cobenefits of dietary change
Marco Springmann, H. Charles J. Godfray, Mike Rayner, and Peter Scarborough
PNAS 2016 ; published ahead of print March 21, 2016, doi:10.1073/pnas.1523119113
Significance
The food system is responsible for more than a quarter of all greenhouse gas emissions while unhealthy diets and high body weight are among the greatest contributors to premature mortality. Our study provides a comparative analysis of the health and climate change benefits of global dietary changes for all major world regions. We project that health and climate change benefits will both be greater the lower the fraction of animal-sourced foods in our diets. Three quarters of all benefits occur in developing countries although the per capita impacts of dietary change would be greatest in developed countries. The monetized value of health improvements could be comparable with, and possibly larger than, the environmental benefits of the avoided damages from climate change.
Abstract
What we eat greatly influences our personal health and the environment we all share. Recent analyses have highlighted the likely dual health and environmental benefits of reducing the fraction of animal-sourced foods in our diets. Here, we couple for the first time, to our knowledge, a region-specific global health model based on dietary and weight-related risk factors with emissions accounting and economic valuation modules to quantify the linked health and environmental consequences of dietary changes. We find that the impacts of dietary changes toward less meat and more plant-based diets vary greatly among regions. The largest absolute environmental and health benefits result from diet shifts in developing countries whereas Western high-income and middle-income countries gain most in per capita terms. Transitioning toward more plant-based diets that are in line with standard dietary guidelines could reduce global mortality by 6–10% and food-related greenhouse gas emissions by 29–70% compared with a reference scenario in 2050. We find that the monetized value of the improvements in health would be comparable with, or exceed, the value of the environmental benefits although the exact valuation method used considerably affects the estimated amounts. Overall, we estimate the economic benefits of improving diets to be 1–31 trillion US dollars, which is equivalent to 0.4–13% of global gross domestic product (GDP) in 2050. However, significant changes in the global food system would be necessary for regional diets to match the dietary patterns studied here.

Science
25 March 2016 Vol 351, Issue 6280
http://www.sciencemag.org/current.dtl

.
Policy Forum
Ethics review for international data-intensive research
By Edward S. Dove, David Townend, Eric M. Meslin, Martin Bobrow, Katherine Littler, Dianne Nicol, Jantina de Vries, Anne Junker, Chiara Garattini, Jasper Bovenberg, Mahsa Shabani, Emmanuelle Lévesque, Bartha M. Knoppers
Science25 Mar 2016 : 1399-1400
Summary
Historically, research ethics committees (RECs) have been guided by ethical principles regarding human experimentation intended to protect participants from physical harms and to provide assurance as to their interests and welfare. But research that analyzes large aggregate data sets, possibly including detailed clinical and genomic information of individuals, may require different assessment. At the same time, growth in international data-sharing collaborations adds stress to a system already under fire for subjecting multisite research to replicate ethics reviews, which can inhibit research without improving the quality of human subjects’ protections (1, 2). “Top-down” national regulatory approaches exist for ethics review across multiple sites in domestic research projects [e.g., United States (3, 4), Canada (5), United Kingdom, (6), Australia (7)], but their applicability for data-intensive international research has not been considered. Stakeholders around the world have thus been developing “bottom-up” solutions. We scrutinize five such ef orts involving multiple countries around the world, including resource-poor settings (table S1), to identify models that could inform a framework for mutual recognition of international ethics review (i.e., the acceptance by RECs of the outcome of each other’s review).

Vaccine
Volume 34, Issue 16, Pages 1863-1986 (7 April 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/16
.

Brief report
Preparing for future efficacy trials of severe malaria vaccines
Pages 1865-1867
Bronner P. Gonçalves, D. Rebecca Prevots, Edward Kabyemela, Michal Fried, Patrick E. Duffy
Abstract
Severe malaria is a major cause of mortality in children, but comprises only a small proportion of Plasmodium falciparum infections in naturally exposed populations. The evaluation of vaccines that prevent severe falciparum disease will require clinical trials whose primary efficacy endpoint will be severe malaria risk during follow-up. Here, we show that such trials are feasible with fewer than 1000 participants in areas with intense malaria transmission during the age interval when severe malaria incidence peaks.

.

Regular papers
Severity of mumps disease is related to MMR vaccination status and viral shedding
Original Research Article
Pages 1868-1873
Sigrid Gouma, Susan J.M. Hahné, Daphne B. Gijselaar, Marion P.G. Koopmans, Rob S. van Binnendijk
Abstract
Background
During recent years, various mumps outbreaks have occurred among measles, mumps, and rubella (MMR) vaccinated persons in various countries worldwide, including the Netherlands. We studied mumps virus shedding in MMR vaccinated and unvaccinated mumps patients and related these findings to clinical data.
Methods
In this study, we included 1112 mumps patients of whom diagnostic samples were tested positive in our laboratory between 1 January 2007 and 31 December 2014. We compared mumps virus shedding and severity of disease between patients who had received 2 doses of MMR (n = 592) and unvaccinated mumps patients (n = 195). Mumps virus shedding in saliva and urine specimens was measured by qPCR. Severity of disease was studied in a subset of patients with clinical data available.
Results
Mumps patients who had received 2 MMR doses shed less often mumps virus in their urine than unvaccinated patients. Salivary viral loads were higher at day of onset of disease in twice MMR vaccinated patients with viruria than in twice MMR vaccinated patients without viruria. However, salivary viral loads did not significantly differ between patients who had received 2 MMR doses and unvaccinated patients. Bilateral parotitis and orchitis were less often reported in patients who had received 2 MMR doses than in unvaccinated patients. Furthermore, the prevalence of bilateral parotitis and orchitis was higher among twice MMR vaccinated patients with viruria than among twice MMR vaccinated patients without viruria.
Conclusions
MMR vaccination was associated with less severe disease among mumps patients. Systemic spread of virus was associated with more severe disease. The elevated salivary viral loads in patients with systemic mumps disease suggest that these patients pose a higher risk for mumps virus transmission. Our study contributes to the understanding of mumps virus pathogenesis and shows the protective effect of MMR vaccination on severity of disease.

.

Can high overall human papillomavirus vaccination coverage hide sociodemographic inequalities? An ecological analysis in Canada
Original Research Article
Pages 1874-1880
Melanie Drolet, Shelley L. Deeks, Erich Kliewer, Grace Musto, Pascal Lambert, Marc Brisson
Abstract
Background
Human papillomavirus (HPV) vaccination programs have been implemented in more than 50 countries. These programs offer tremendous promise of reducing HPV-related disease burden. However, failure to achieve high coverage among high-risk groups may mitigate program success and increase inequalities. We examined sociodemographic inequalities in HPV vaccination coverage in 4 Canadian provinces (Quebec (QC), Ontario (ON), Manitoba (MB), British Columbia (BC)).
Methods
We obtained annual HPV vaccination coverage of pre-adolescent girls at provincial and regional levels, from the start of programs to 2012/2013. Regions refer to administrative areas responsible for vaccine implementation and monitoring (there are 18/36/10/16 regions in QC/ON/MB/BC). We obtained regions’ sociodemographic characteristics from Statistics Canada Census. We used univariate weighted linear regression to examine the associations between regions’ sociodemographic characteristics and HPV vaccination coverage.
Results
Provincial HPV vaccination coverage is generally high (QC:78%; ON:80%; MB:64%, BC:69%, 2012/13). QC had the highest provincial vaccination coverage since the program start, but had the greatest inequalities. In QC, regional HPV vaccination coverage was lower in regions with higher proportions of socially deprived individuals, immigrants, and/or native English speakers (p < 0.0001). These inequalities remained stable over time. Regional-level analysis did not reveal inequalities in ON, MB and BC.
Conclusion
School-based HPV vaccination programs have resulted in high vaccination coverage in four Canadian provinces. Nonetheless, high overall coverage did not necessarily translate into equality in coverage. Future work is needed to understand underlying causes of inequalities and how this could impact existing inequalities in HPV-related diseases and overall program success.

.

LGBT health and vaccinations: Findings from a community health survey of Lexington-Fayette County, Kentucky, USA
Original Research Article
Pages 1909-1914
Jeff Jones, Asheley Poole, Vivian Lasley-Bibbs, Mark Johnson
Abstract
Data on adult immunization coverage at the state level and for LGBT Americans in particular are sparse. This study reports the results of a 2012 Lexington-Fayette County, Kentucky, community health assessment’s results asking about eight adult vaccinations among 218 lesbian, gay, bisexual, and transgendered (LGBT) respondents. Researchers collected data using an online survey distributed through LGBT social media, posters, and LGBT print media. The LGBT sample largely matches the demographics of the county as a whole except this group reports higher level of education and fewer uninsured individuals. Among LGBT respondents, immunization prevalence reaches 68.0% (annual Influenza), 65.7% (Hepatitis B), 58.8% (Chickenpox/Varicella), 55.9% (Hepatitis A), 41.2% (Smallpox), and 25.8% (Pneumonia). Among respondents who are currently within the recommended 19–26 years age range for the Human Papillomavirus (HPV) vaccine, the LGBT females are less likely to report receiving the vaccine (15.4%) compared to the national coverage percentage of 34.5%. Males, however, are more likely to have received the vaccine (10.3%) than the national percentage of 2.3%. The small number of LGBT seniors in the study report a much higher prevalence of the Shingles (Herpes Zoster) vaccines than for U.S. seniors 60 and older (71.4% compared to 20.1% nationally). LGBT respondents report higher percentages of adult vaccination.

.
Japanese Society for Vaccinology papers
Universal varicella vaccine immunization in Japan
Review Article
Pages 1965-1970
Tetsushi Yoshikawa, Yoshiki Kawamura, Masahiro Ohashi

Development and introduction of inactivated poliovirus vaccines derived from Sabin strains in Japan
Review Article
Pages 1975-1985

Vaccine
Volume 34, Issue 15, Pages 1739-1862 (4 April 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/15

.

Original Research Article
Knowledge and attitudes about Ebola vaccine among the general population in Sierra Leone
Pages 1767-1772
Xiang Huo, Guoqing Shi, Xinxu Li, Xuehui Lai, Liquan Deng, Feng Xu, Mingquan Chen, Qiang Wei, Thomas Samba, Xiaofeng Liang
Abstract
Background
Clinical trials of Ebola vaccine are ongoing. Before it becomes commercially available, understanding the Ebola vaccine-related knowledge and attitude of the general population is imperative to developing an effective vaccine coverage strategy.
Methods
We conducted a survey including 400 participants from general communities of the West Area Rural District, Sierra Leone. Knowledge and attitudes about Ebola vaccine were investigated, and the determinants of having knowledge and a positive attitude toward accepting vaccination were identified.
Results
Over half (55.8%) of the participants were aware of Ebola vaccine. About 60% of the participants were willing to be study subjects if the Ebola vaccine clinical trial were conducted in their communities. Most of the participants (72.5%) were willing to take Ebola vaccination if it was free of charge. Given that the vaccination was not free, the proportion willing to pay a fee to take the vaccination declined dramatically to 26.6%. Using a forward step-wise logistic model, monthly salary was identified as the single determinant (OR for every 100,000 Leones increase: 1.17, 95%CI: 1.04–1.31) for awareness of Ebola vaccine, which was identified as the determinant (OR: 1.88, 95%CI: 1.17–3.02) for free vaccination uptake willingness. The combination of monthly salary, monthly average income of family members and their interaction was found to be associated with charged vaccination uptake willingness.
Discussion
Measures are still needed to promote the Ebola vaccine awareness and knowledge updating. Free or low-priced vaccine could increase the vaccination acceptability of the general community population significantly.

Vaccine
Volume 34, Issue 15, Pages 1739-1862 (4 April 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/15

.

Does frequent residential mobility in early years affect the uptake and timeliness of routine immunisations? An anonymised cohort study
Original Research Article
Pages 1773-1777
Hayley A. Hutchings, Annette Evans, Peter Barnes, Melanie A. Healy, Michelle James-Ellison, Ronan A. Lyons, Alison Maddocks, Shantini Paranjothy, Sarah E. Rodgers, Frank Dunstan
Abstract
Background
There are conflicting findings regarding the impact of residential mobility on immunisation status. Our aim was to determine whether there was any association between residential mobility and take up of immunisations and whether they were delayed in administration.
Methods
We carried out a cohort analysis of children born in Wales, UK. Uptake and time of immunisation were collected electronically. We defined frequent movers as those who had moved: 2 or more times in the period prior to the final scheduled on-time date (4 months) for 5 in 1 vaccinations; and 3 or more times in the period prior to the final scheduled on-time date (12 months) for MMR, pneumococcal and meningitis C vaccinations. We defined immunisations due at 2–4 months delayed if they had not been given by age 1; and those due at 12–13 months as delayed if they had not been given by age 2.
Results
Uptake rates of routine immunisations and whether they were given within the specified timeframe were high for both groups. There was no increased risk (odds ratios (95% confidence intervals) between frequent movers compared to non-movers for the uptake of: primary MMR 1.08 (0.88–1.32); booster Meningitis C 1.65 (0.93–2.92); booster pneumococcal 1.60 (0.59–4.31); primary 5 in 1 1.28 (0.92–1.78); and timeliness: primary MMR 0.92 (0.79–1.07); booster Meningitis C 1.26 (0.77–2.07); booster pneumococcal 1.69 (0.23–12.14); and primary 5 in 1 1.04 (0.88–1.23).
Discussion
Findings suggest that children who move home frequently are not adversely affected in terms of the uptake of immunisations and whether they were given within a specified timeframe. Both were high and may reflect proactive behaviour in the primary healthcare setting to meet Government coverage rates for immunisation.

Vaccine
Volume 34, Issue 15, Pages 1739-1862 (4 April 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/15

.

Adverse events following HPV vaccination, Alberta 2006–2014
Original Research Article
Pages 1800-1805
Xianfang C. Liu, Christopher A. Bell, Kimberley A. Simmonds, Lawrence W. Svenson, Margaret L. Russell
Abstract
Background
In Canada, private purchase of human papilloma virus (HPV) vaccines has been possible since 2006. In Alberta, Canada, a publicly funded quadrivalent HPV vaccine program began in the 2008/2009 school year. There have been concerns about adverse events, including venous thromboembolism (VTE) associated with HPV vaccines. We describe the frequencies of adverse events following HPV vaccination among Alberta females aged 9 years or older and look at VTE following HPV vaccination.
Methods
We used the Alberta Immunization and Adverse Reaction to Immunization (Imm/ARI) repository (publicly funded vaccine), the population-based Pharmaceutical Information Network (PIN) information system (dispensing of a vaccine), and the Alberta Morbidity and Ambulatory Care Abstract reporting system (MACAR) for June 1, 2006–November 19, 2014. Deterministic data linkage used unique personal identifiers. We identified all reported adverse events following immunization (AEFI) and all emergency department (ED) utilization or hospitalizations within 42 days of immunization. We calculated the frequency of AEFI by type, rates per 100,000 doses of HPV vaccine administered and the frequencies of ICD-10-CA codes for hospitalizations and emergency department visits.
Results
Over the period 195,270 females received 528,913 doses of HPV vaccine. Of those receiving at least one dose, 192 reported one or more AEFI events (198 AEFI events), i.e., 37.4/100,000 doses administered (95% CI 32.5–43.0). None were consistent with VTE. Of the women who received HPV vaccine 958 were hospitalized and 19,351 had an ED visit within 42 days of immunization. Four women who had an ED visit and hospitalization event were diagnosed with VTE. Three of these had other diagnoses known to be associated with VTE; the fourth woman had VTE among ED diagnoses but not among those for the hospitalization.
Conclusions
Rates of AEFI after HPV immunization in Alberta are low and consistent with types of events seen elsewhere.

Vaccine
Volume 34, Issue 15, Pages 1739-1862 (4 April 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/15

.

The economic cost of measles: Healthcare, public health and societal costs of the 2012–13 outbreak in Merseyside, UK
Original Research Article
Pages 1823-1831
Sam Ghebrehewet, Dominic Thorrington, Siobhan Farmer, James Kearney, Deidre Blissett, Hugh McLeod, Alex Keenan

Impact and cost-effectiveness of a second tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine dose to prevent pertussis in the United States
Original Research Article
Pages 1832-1838
Hajime Kamiya, Bo-Hyun Cho, Mark L. Messonnier, Thomas A. Clark, Jennifer L. Liang

A measles outbreak in a middle school with high vaccination coverage and evidence of prior immunity among cases, Beijing, P.R. China
Original Research Article
Pages 1853-1860
Rui Ma, Li Lu, Jiazi Zhangzhu, Meng Chen, Xiali Yu, Fengshuang Wang, Xiaoran Peng, Jiang

Value in Health
March 2016 Volume 19, Issue 2, p123-296
http://www.valueinhealthjournal.com/current

.
Systematic Reviews
Sources and Characteristics of Utility Weights for Economic Evaluation of Pediatric Vaccines: A Systematic Review
Michael Herdman, Amanda Cole, Christopher K. Hoyle, Victoria Coles, Stuart Carroll, Nancy Devlin
p255–266
Published online: December 29 2015
Abstract
Background
Cost-effectiveness analysis of pediatric vaccines for infectious diseases often requires quality-of-life (utility) weights.
Objective
To investigate how utility weights have been elicited and used in this context.
Methods
A systematic review was conducted of studies published between January 1990 and July 2013 that elicited or used utility weights in cost-effectiveness analyses of vaccines for pediatric populations. The review focused on vaccines for 17 infectious diseases and is presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology.
Results
A total of 6410 titles and abstracts and 225 full-text articles were reviewed. Of those selected for inclusion (n = 101), 15 articles described the elicitation of utility weights and 86 described economic modeling studies using utilities. Various methods were used to generate utilities, including time trade-off, contingent valuation, and willingness to pay, as well as a preference-based measure with associated value sets, such as the EuroQol five-dimensional questionnaire or the Health Utilities Index. In modeling studies, the source of utilities used was often unclear, poorly reported, or based on weak underlying evidence. We found no articles that reported on the elicitation or use of utilities in diphtheria, polio, or tetanus.
Conclusions
The scarcity of appropriate utility weights for vaccine-preventable infectious diseases in children and a lack of standardization in their use in economic assessments limit the ability to accurately assess the benefits associated with interventions to prevent infectious diseases. This is an issue that should be of concern to those making decisions regarding the prevention and treatment of infectious childhood illnesses.

Child Care, Health and Development
2016 Mar 15.
” I think they’re all basically the same”: parents’ perceptions of human papilloma virus (HPV) vaccine compared with other adolescent vaccines.
doi: 10.1111/cch.12331. [Epub ahead of print]
Ogunbajo A1, Hansen CE2, North AL1, Okoloko E1, Niccolai LM1,3,4.
Abstract
BACKGROUND:
Human papillomavirus (HPV) vaccination is recommended for routine administration at ages 11-12 years. However, uptake is lower than for other vaccines that are also routinely recommended for adolescents (MCV4 and Tdap). Understanding parental perceptions of HPV vaccine compared with other vaccines may help to inform strategies to increase uptake.
METHODS:
Parents and caregivers (n = 45) of adolescents ages 10-18 years from a low-income, ethnic minority population participated in a qualitative study. Interviews were transcribed verbatim and coded for emergent themes.
RESULTS:
Many participants perceived the HPV vaccine to be similar to other routine vaccines. Noted similarities included the vaccines’ ability to prevent disease, similar methods of administration and belief in health care providers’ recommendation. Some parents noted the greater benefit of HPV vaccine in preventing cancer, which was viewed as a serious disease. Parents also noted the different mode of transmission (sexual) for HPV, which evoked mixed opinions.
CONCLUSION:
Overall, most participants viewed the HPV vaccine in a positive light and similar to other adolescent vaccines with the added benefit of cancer prevention. Strategies that treat all three vaccines equally such as presenting them similarly as a ‘bundle’ to parents or considering policy initiatives such as school entry requirements might help increase raise coverage for HPV vaccine.

American Journal of Obstetrics and Gynecology
Available online 18 March 2016
Rates of Human Papillomavirus Vaccine Uptake amongst Girls Five Years after Introduction of Statewide Mandate in Virginia
In Press, Accepted Manuscript — Note to users
Ryan D. Cuff, MD1, Tommy Buchanan, MD2, Elizabeth Pelkofski, MD3, Jeffrey Korte, PhD4,
Susan P. Modesitt, MD5, Jennifer Young Pierce, MD2
Abstract
Background
The Commonwealth of Virginia enacted statewide school-entry Human Papillomavirus (HPV) vaccine mandate in 2008 requiring all girls to receive the vaccine prior to starting the 8th grade. The mandate, one of very few in the country, has been in effect for five years. This study assesses the impact that it has had on the rates of HPV uptake.
Objective
To evaluate uptake HPV vaccine amongst girls presenting for well-child care 5 years after introduction of statewide mandate in Virginia in October 2008.
Study Design
This prospective cohort study utilized the Clinical Data Repository (CDR) at the University of Virginia (UVA) to identify girls aged 11-12 who presented for well-child care from January – December 2014. Billing and diagnosis codes were used to establish HPV vaccine administration. Those identified through the CDR were then contacted by advance letter followed by a representative from the UVA Center for Survey Research (CSR) who invited the responsible parent or guardian to complete a 50-item telephone questionnaire. Questionnaire results were used to inform objective findings and to assess parental attitudes related to HPV vaccination.
Findings were compared against those of Pierce, et al (2013), which evaluated HPV vaccination levels in a similar cohort of patients in 2008, prior to mandate enactment in order to assess relative change attributable to vaccine mandate.
Results
Nine hundred eight girls were identified through the CDR, 50.9% received at least one dose of HPV vaccine. White race and private insurance coverage were found to be negatively associated with HPV vaccine uptake (RR 0.74 and 0.71, 95% CI 0.64-0.85 and 0.62-0.81, respectively). Black race and public insurance coverage were found to be positively associated with vaccine uptake (RR 1.35 and 1.39, 95% CI 1.17-1.55 and 1.22-1.58, respectively). When comparing to the previous study, there has been no change in HPV vaccine uptake or distribution of uptake after the introduction of the statewide mandate for HPV vaccination.
Conclusions
Statewide HPV vaccine mandate has had no impact on the overall rate of HPV vaccination, nor has it diminished the previously-described racial or payer disparities in vaccine uptake in school-aged girls presenting for well-child care in the state of Virginia.

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.

.

BBC
http://www.bbc.co.uk/
Accessed 26 March 2016
Uganda to jail parents over missed vaccinations
25 March 2016
Parents who fail to vaccinate their children in Uganda will face six months in jail, according to a new law signed by President Yoweri Museveni.
It also requires children to have an immunisation card to allow them to go to school.
The law will help the government reach its vaccination target, Health Minister Sarah Achieng Opendi told the BBC.
Some parents and members of a religious cult have refused to allow their children vaccinated, she says.
The government’s vaccination campaign targets several life-threatening diseases including polio and meningitis…

.

The Economist
http://www.economist.com/
Accessed 26 March 2016
Vaccination
A jab in time
Some Western countries have lower vaccination rates than poor parts of Africa. Anti-vaxxers are not the main culprits
Mar 26th 2016

HPV vaccines
The cost of embarrassment
A jab to ward off cervical cancer is standard for girls. Should boys have it, too?

.

Forbes
http://www.forbes.com/
Accessed 26 March 2016
Thank You, Robert DeNiro, For Doing the Right Thing For Autistic Individuals And Children
Robert DeNiro and the Tribeca Film Festival have removed the film Vaxxed, made by Andrew Wakefield from the festival.
Tara Haelle, Contributor Mar 26, 2016

.

New York Times
http://www.nytimes.com/
Accessed 26 March 2016
Health
Robert De Niro Defends Screening of Anti-Vaccine Film at Tribeca Festival
By PAM BELLUCK and MELENA RYZIK
MARCH 25, 2016
In a decision that has dredged up the widely debunked link between vaccines and autism, the Tribeca Film Festival plans to screen a film by a discredited former doctor whose research caused widespread alarm about the issue.

The film, “Vaxxed: From Cover-Up to Catastrophe,” is directed and co-written by Andrew Wakefield, an anti-vaccination activist and an author of a study — published in the British medical journal The Lancet, in 1998 — that was retracted in 2010. In addition to the retraction of the study, which involved 12 children, Britain’s General Medical Council, citing ethical violations and a failure to disclose financial conflicts of interest, revoked Mr. Wakefield’s medical license.

On the festival’s website, the biographical material about Mr. Wakefield does not mention that he was stripped of his license or that his Lancet study was retracted. Rather, it says that the Lancet study “would catapult Wakefield into becoming one of the most controversial figures in the history of medicine.”

On Friday, Robert De Niro, one of the festival’s founders, said in a statement issued through the festival’s publicists that he supported the plan to show the movie next month, although he said he was “not personally endorsing the film,” nor was he against vaccination….
[see Forbes story above in which the film is reported to have been pulled from the Festival]

China Vaccine Scandal Stokes Anger as Regulators Come Under Fire
March 23, 2016 – By REUTERS
SHANGHAI — A widening scandal over illegal vaccine sales in China has sparked anger and drawn criticism from the government over glaring loopholes in the regulation of the world’s second-largest medicine market. Police detained 37.

China Detains Dozens After Sales of Poorly Stored Vaccines
By THE ASSOCIATED PRESSMARCH 22, 2016, 10:48 P.M. E.D.T.
BEIJING — Police in eastern China have detained 37 people implicated in a scandal involving the selling of poorly refrigerated and probably ineffective vaccines, state media reported Wednesday.
The scandal came to light after police last month announced the detentions of a woman and daughter thought to have sold nearly $100 million worth of the suspect products nationwide since 2011.
The scandal re-enforces longstanding concerns among the public over the safety of food and medicine. Nine pharmaceutical wholesalers believed to have sold the vaccines are being investigated.
Chinese Premier Li Keqiang issued orders late Tuesday for government administrations to work together to conduct a thorough investigation. Along with prosecuting the criminals involved, government officials found guilty of negligence should be held to account, Li said, according to the official government website.
“This vaccine safety incident has created deep concern among the public and laid bare numerous regulatory loopholes,” Li was quoted as saying.
The Food and Drug Administration on Monday ordered a thorough check on where the vaccines were distributed and how they may have been used. The central government administration demanded local authorities investigate the nine wholesalers believed to have sold the vaccines.
The vaccines included those for hepatitis B, rabies, mumps and Japanese encephalitis.

.

Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 26 March 2016
De Niro’s Tribeca festival pulls anti-vaccination film
26 min ago
Robert De Niro is removing the anti-vaccination documentary “Vaxxed” from the lineup of his Tribeca Film Festival, after initially defending its inclusion.
Associated Press | National | Mar 26, 2016

China’s Vaccine Scandal Reveals System’s Flaws
March 25, 2016 7:44 am ET

India to Vaccinate Millions of Children Against Deadly Rotavirus
By Suryatapa Bhattacharya
March 25, 2016 1:47 am ET

.

Washington Post
http://www.washingtonpost.com/
Accessed 26 March 2016
China crackdown on problem vaccines nets 130 suspects
Chinese police say a crackdown on expired and improperly stored vaccines has netted 130 suspects and more than 20,000 doses of the suspect medications.
Associated Press | Foreign | Mar 24, 2016

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_19 March 2016

– blog edition: comprised of the approx. 35+ entries posted below on 20 March 2016.

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

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

Zika virus [to 19 March 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

.

Zika virus, Microcephaly and Guillain-Barré syndrome – 17 March 2016
WHO Situation Report: Read the full situation report
Summary
:: From 1 January 2007 to 16 March 2016, Zika virus transmission was documented in a total of 59 countries and territories. Cuba and Dominica are the latest to report autochthonous (local) transmission of Zika virus on 14 and 15 March, respectively. Five of these countries and territories reported a Zika virus outbreak that is now over. Three countries (France, Italy and United States of America) have reported locally acquired infection in the absence of any known mosquito vectors, probably through sexual transmission.

:: The geographical distribution of Zika virus has steadily widened since the virus was first detected in the Americas in 2014. Autochthonous Zika virus transmission has been reported in 33 countries and territories of this region.

:: So far an increase in microcephaly and other fetal malformations has been reported in Brazil and French Polynesia, although two additional cases linked to a stay in Brazil were detected in the United States of America and Slovenia.

:: In the context of Zika virus circulation 12 countries or territories have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases.

:: The mounting evidence from observational, cohort and case-control studies indicates that Zika virus is highly likely to be a cause of microcephaly, GBS and other neurologic disorders. Among the tasks ahead are to further quantify the risk of neurologic disorders following Zika virus infection, and to investigate the biological mechanisms that lead to neurologic disorders.

:: The global prevention and control strategy launched by WHO as a Strategic Response Framework encompasses surveillance, response activities and research, and this situation report is organized under those headings.

.

WHO supports Cabo Verde in managing Zika virus
18 March 2016 — Although the number of cases of Zika in Cabo Verde is declining, the Minister of Health announced on 15 March the first case of microcephaly. Investigations are underway to determine if this case of microcephaly is linked to Cabo Verde’s outbreak of Zika virus. Responding to a request from the Ministry of Health in Cabo Verde, WHO is sending a team to the country.
Read the note to the media

.

Latest updates
:: Mosquito control works if implemented well; new control tools in the pipeline
18 March 2016
:: Damn the mosquitoes! Full speed ahead!
15 March 2016

.

Guidance for health workers
:: Entomological surveillance for Aedes spp.
15 March 2016

.

Zika Open
[Bulletin of the World Health Organization]
:: All papers available here
Posted: 14 March 2016
Detection of immunoglobulin G responses in Haitian children exposed to chikungunya, dengue, and malaria using a multiplex bead assay
– Mathieu JP Poirier, Delynn M Moss, Karla R Feeser, Thomas G Streit, Gwong-Jen J Chang, Matthew Whitney, Brandy J Russell, Barbara W Johnson, Alison J Basile, Christin H Goodman, Amanda K Barry, & Patrick J Lammie
http://dx.doi.org/10.2471/BLT.16.173252

Posted: 16 March 2016
Evolution of cases of microcephaly and neurological abnormalities suggestive of congenital infection in Brazil: 2015-2016
– Antonio JLA Cunha, Maria Clara Magalhães-Barbosa, Fernanda Lima-Setta & Arnaldo Prata-Barbosa
http://dx.doi.org/10.2471/BLT.16.173583

.

CDC/ACIP [to 19 March 2016]
http://www.cdc.gov/media/index.html
SATURDAY, MARCH 19, 2016
CDC adds Cuba to interim travel guidance related to Zika virus
CDC is working with other public health officials to monitor for ongoing Zika virus transmission. Today, CDC posted a Zika virus travel notice for Cuba…

FRIDAY, MARCH 18, 2016
New CDC Laboratory Test for Zika Virus Authorized for Emergency Use by FDA
In response to a request from the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration (FDA) yesterday issued an Emergency Use Authorization (EUA) for the Trioplex Real-time RT-PCR Assay, a diagnostic tool for Zika virus that will be distributed to qualified laboratories. The assay allows doctors to tell if an individual is currently infected with chikungunya, dengue, or Zika using one test, instead of having to perform three separate tests to determine which infection one might have…

MMWR – March 18, 2016 / Vol. 65 / No. 10
:: Revision to CDC’s Zika Travel Notices: Minimal Likelihood for Mosquito-Borne Zika Virus Transmission at Elevations Above 2,000 Meters

.

EU supports Zika research with €10 million
European Commission – Press release Brussels, 15 March 2016
The European Commission is today releasing €10 million for research on the Zika virus, currently affecting large parts of Latin America.

The most affected country is Brazil, where the World Health Organisation (WHO) has declared that the recent cluster of severe brain malformations in new-borns may be linked to the virus. While the risk of transmission of the Zika virus in the EU is low, there is currently no treatment or vaccine against the virus, and diagnostic tests for infections are not widely available.

The funding, which comes from the Horizon 2020 EU research and innovation funding programme, will go into projects that will first have to prove the link between the virus and severe brain malformations reported in newborn children. If proven, researchers could then move on to combatting the Zika virus, including developing diagnostics and testing potential treatments or vaccines…

EBOLA/EVD [to 19 March 2016]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

.
Ebola Situation Reports
[While no announcement of a change in reporting cycle is evident, we deduce that Ebola Situation Reports have been reduced to a bi-weekly cycle given the spacing of the last few reports – previous update: Ebola Situation Report – 2 March 2016]

Ebola Situation Report – 16 March 2016
SUMMARY
:: Human-to-human transmission linked to the most recent cluster of 2 cases of Ebola virus disease (EVD) first reported from Sierra Leone on 14 January will be declared to have ended on 17 March, 42 days after the second and last case in the cluster provided a second consecutive negative blood sample (RT-PCR) and was discharged. Human-to-human transmission linked to the most recent cluster of cases in Liberia was declared to have ended on 14 January 2016. Guinea was declared free of Ebola transmission linked directly to the original outbreak on 29 December 2015, and will complete its 90-day period of enhanced surveillance on 27 March 2016.

:: With guidance from WHO and other partners, ministries of health in Guinea, Liberia, and Sierra Leone have plans to deliver a package of essential services to safeguard the health of the estimated more than 10 000 survivors. So far over 350 male survivors in Liberia have accessed semen screening and counselling services. In addition, over 2600 survivors in Sierra Leone have accessed a general health assessment and eye exam.

:: To manage the residual risks of Ebola reintroduction or re-emergence, WHO has supported the implementation of enhanced surveillance systems in Guinea, Liberia, and Sierra Leone to alert authorities to cases of febrile illness or death that may be related to EVD. In the week to 13 March, 1611 alerts were reported in Guinea from all of the country’s 34 prefectures. All alerts were reports of community deaths. Over the same period, 9 operational laboratories in Guinea tested a total of 370 new and repeat samples (17 samples from live patients and 353 from community deaths) from 17 of the country’s 34 prefectures. In Liberia, 663 alerts were reported from all of the country’s 15 counties, most of which (544) were related to live patients. The country’s 5 operational laboratories tested 595 new and repeat samples (399 from live patients and 196 from community deaths) for Ebola virus over the same period, compared with 921 samples the previous week. In Sierra Leone 1494 alerts were reported from the country’s 14 districts. The majority of alerts (1142) were for community deaths. 952 new and repeat samples (19 from live patients and 933 from community deaths) were tested for Ebola virus by the country’s 7 operational laboratories over the same period.

.

WHO: New Ebola cases confirmed in Guinea as WHO warns of more possible flare ups
18 March 2016
Conakry — WHO has dispatched a team of specialists to the southern prefecture of Nzérékoré after 2 new cases of Ebola were detected and confirmed in a rural village.
Guinean health officials in the region alerted WHO and partners on 16 March to 3 unexplained deaths in recent weeks in the village of Koropara and said other members of the same family are currently showing symptoms characteristic of Ebola.
Guinea’s Ministry of Health, WHO, the US Centers for Disease Control and UNICEF sent in investigators on 17 March. Samples were taken from 4 individuals. A mother and her 5-year-old son, relatives of the deceased, confirmed positive for Ebola virus disease in lab tests. The 2 have been taken to a treatment facility.
In coordination with Guinea’s Ministry of Health, WHO has deployed an initial team of epidemiologists, surveillance experts, vaccinators, social mobilizers, contact tracers and an anthropologist today to support an inter-agency response. More specialists are expected to arrive in the coming days. Response teams will work to investigate the origin of the new infections and to identify, isolate, vaccinate and monitor all contacts of the new cases and those who died.
Guinea’s National Emergency Response Centre is convening a meeting 18 March to further coordinate a rapid response to contain the country’s first re-emergence of Ebola since its original outbreak was declared over on 29 December 2015…

.

WHO statement on end of Ebola flare-up in Sierra Leone
WHO statement
17 March 2016
WHO joins the government of Sierra Leone in marking the end of the recent flare-up of Ebola virus disease in the country. As of today, 17 March, 42 days have passed, two incubation cycles of the virus, since the last person confirmed to have Ebola virus disease in the country tested negative for a second time.

This latest flare-up of Ebola brings to 3,590 the number of lives lost in Sierra Leone to an epidemic that devastated families and communities across the country and disrupted every aspect of life.
Today marks another milestone in the country’s effort to defeat Ebola. WHO commends Sierra Leone’s government, partners and people on the effective and swift response to this latest outbreak. From nurses, vaccinators and social mobilizers to contact tracers, counsellors and community leaders, Sierra Leoneans in affected districts mobilized quickly and their involvement and dedication was instrumental and impactful.

The rapid containment of the flare-up was also a real-time demonstration of the increased capacity at the national, district and community level to respond to Ebola outbreaks and other health emergencies and mitigate their impact. Investments made in rapid response teams, surveillance, lab diagnostics, risk communication, infection prevention and control measures and other programmes were put to the test and clearly paid off.

However, WHO continues to stress that Sierra Leone, as well as Liberia and Guinea, are still at risk of Ebola flare-ups, largely due to virus persistence in some survivors, and must remain on high alert and ready to respond…

.

IOM / International Organization for Migration [to 19 March 2016]
http://www.iom.int/press-room/press-releases
Infectious Disease Holding Units Installed at Four Border Posts in Ghana
03/15/16
Ghana – IOM Ghana in partnership with the Government of Ghana installed four infectious disease holding units at Sampa and Elubo Points of Entry (border with Cote d’Ivoire), as well as the Hamile and Paga Points of Entry (border with Burkina Faso), to enhance the screening and surveillance capacities for Ebola Virus Disease (EVD) and other communicable diseases at these key border posts.
The holding units will facilitate the isolation of suspected cases of infectious diseases prior to their referral to the nearest health facilities for further management.

The holding units are equipped with examination couches, washrooms, hand washing sinks and a store room which is stocked with Personal Protective Equipment (including disposable gloves, disposable face masks, hand sanitizers, disposable aprons) as well as hygiene and cleaning equipment, and laser infra-red thermometers. The units also have their own individual sewer systems which are separate from the general public sewage system to avoid contamination…

…The IOM Chief of Mission in Ghana, Sylvia Lopez-Ekra said…“The Ebola epidemic in West Africa taught us two important things: First that the spread of Ebola was fueled among other things by the inability to control and screen population movements across borders, and second, that sick travelers should be swiftly identified and cared for with extra caution. With these new infectious disease holding units we are making an important contribution to addressing those two issues.”…

.

Trials of a New Vaccine for Ebola to Take Place at RUSAL’s Medical Centre in Guinea
MOSCOW, March 16, 2016 /PRNewswire/ —
UC RUSAL, a leading global aluminium producer, co-organized a roundtable discussion “Ebola vaccine from Russia: the first lessons and outlook into the future”. The Minister of Health, Veronika Skvortsova and the Head of the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (“Rospotrebnadzor”), Anna Popova joined RUSAL President Oleg Deripaska at the event. Via a teleconference facility, the Guinean President Alpha Conde addressed the President of Russia, Vladimir Putin and the entire world community to express his appreciation.

The Minister of Health, Veronika Skvortsova noted that the Ebola vaccine has been developed in Russia under the working directive of the President and has obtained Russian state registration. In addition, the Russian Federation has allocated financing for “field trials” of the new vaccine. Two thousand citizens of the Republic of Guinea will be vaccinated at the first stage with trials planned at the Research and Clinical Diagnostics Centre for Epidemiological and Microbiological Studies, founded by RUSAL in Guinea.

RUSAL has been operating in Guinea for over 10 years and is the largest foreign employer in the country. RUSAL opened a specialized Centre for the treatment of Ebola in Kindia, with total investment in the Centre amounting to around USD10 million…

POLIO [to 19 March 2016]
Public Health Emergency of International Concern (PHEIC)

.
Polio this week as of 16 March 2016
:: A new short film shown at the Ministerial Conference on Immunization in Africa, held in Addis Ababa, Ethiopia, demonstrates the value of the polio infrastructure in serving broader health goals. Watch the video here.
:: There is one month to go until the globally synchronized switch from the trivalent to bivalent oral polio vaccine. Learn more about the switch through this series of videos.

Selected Country Levels Updates [excerpted]
Pakistan
:: One new case of wild poliovirus type 1 (WPV1) was reported in the last week, in Jacobabad district, Sindh province, with onset of paralysis on 16 February. The total number of WPV1 cases for 2016 is now 6, compared to 19 reported for 2015 at this point last year.
:: One new WPV1 environmental positive sample was reported in the past week, in Quetta district of Balochistan, with collection date of 12 February.
:: National Immunization Days (NIDs) are currently ongoing in the country using tOPV

.

WHO: Sudan: monitoring for polio across sub-Saharan sands
WHO and the Ministry of Health actively search for cases of acute flaccid paralysis among the Rashaida tribal community, Gedarif State, Sudan. Gedarif borders with Ethiopia and is considered a high-risk area.

14 March 2016 – For years polio has been a thorn in the side of the Ministry of Health of Sudan and WHO who have worked together to stave off the debilitating disease. Although now officially polio free, Sudan is considered one of the most at-risk countries in WHO’s Eastern Mediterranean Region. Protracted conflict and insecurity has weakened the national health system and compromised people’s access to basic health services, including routine immunization. Mass internal displacement, nomadic population movement and inaccessible areas have made it challenging for health workers to reach every child under-5 years of age across the country with repeat doses of oral polio vaccine (OPV). And porous borders and refugee influxes from neighbouring countries have compounded logistical challenges and the country’s vulnerability to cross-border infection.

Amidst this complex and volatile sociopolitical environment, the Ministry of Health with the support of WHO and other partners has managed to keep Sudan polio free. However, in order to maintain this status, more than ever, vigilance is required…

WHO & Regionals [to 19 March 2016]

WHO SAGE Meeting
Geneva: 12 – 14 April 2016.
:: Draft agenda pdf, 145kb As of 11 March 2016

.
Weekly Epidemiological Record (WER) 18 March 2016, vol. 91, 11 (pp. 133–144)
Contents
133 Zoonotic influenza viruses: antigenic and genetic characteristics and development of candidate vaccine viruses for pandemic preparedness
143 Monthly report on dracunculiasis cases, January 2016

.
Disease Outbreak News (DONs)
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 16 March 2016
:: Chikungunya – Argentina 14 March 2016
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 14 March 2016

.
WHO: Syria 5 years on – delivering health against all odds
15 March 2016 – After five years of a brutal and senseless conflict over 250 000 Syrians have been killed and over half the population forced from their homes out of fear and want.
In the past few weeks however, we are seeing signs of momentum, fragile glimmers of hope. As humanitarians we welcome progress where it means real change..
:: View the photo story
:: Watch the video
:: Read the news release

.

:: WHO Regional Offices
WHO African Region AFRO
:: Official visit of Dr Matshidiso Moeti, WHO Regional Director for Africa to China
Brazzaville, 18 March 2016 – The WHO Regional Director for Africa, Dr Matshidiso Moeti will begin a 4 day official visit to China from 22 to 25 March 2016 at the invitation of the Chinese government. The visit is aimed at further exploring areas of mutual interest in health with a view to having a more structured collaboration between WHO and the Chinese government.
:: Guinea: Two (2) confirmed Ebola cases in Koropara village in Nzérékoré – 18 March 2016
:: WHO statement on the end of the Ebola flare-up in Sierra Leone – 17 March 2016

WHO Region of the Americas PAHO
:: Regional Parliamentary Front against Tuberculosis in the Americas launched in Brazil (03/16/2016)

WHO South-East Asia Region SEARO
:: Media Statement – Create Healthy Environments to Save Lives
15 March 2016

WHO European Region EURO
:: Zika virus vectors and risk of spread in the WHO European Region 18-03-2016
:: TB elimination at stake unless Europe cares urgently for vulnerable, poor and marginalized populations and migrants 17-03-2016
:: Antibiotic awareness drives digital conversation in European countries 16-03-2016
:: Informing policy for young people’s health 15-03-2016
:: New WHO study reveals that while smoking by school-aged children has declined significantly, young people’s health and well-being is being undermined by gender and social inequalities 15-03-2016

WHO Eastern Mediterranean Region EMRO
:: New shipment of health supplies arrives in Taiz City
18 March 2016
:: Sudan: monitoring for polio across sub-Saharan sands
14 March 2016
:: Mobile medical clinics connect patients to health care in camps in Iraq
13 March 2016

WHO Western Pacific Region
:: Zika Outbreak Response in Tonga: Providing Special Care for Pregnant Women
TONGA, 16 March 2016 – On 1 February 2016, the Ministry of Health declared a Zika outbreak in the Kingdom of Tonga. Coincidentally, it was on the same day that the World Health Organization (WHO) announced that the recent cluster of microcephaly cases and other neurological disorders reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes a Public Health Emergency of International Concern (PHEIC) as per the International Heath Regulations (IHR, 2005). Pregnant women living in or travelling to areas of Zika virus transmission are given special care in Tonga as the Zika virus may cause microcephaly in babies.

CDC/ACIP [to 19 March 2016]
http://www.cdc.gov/media/index.html
[see Zika coverage above which includes CDC briefing content]

MMWR – March 18, 2016 / Vol. 65 / No. 10
:: Human Rabies — Missouri, 2014
:: Use of Vaccinia Virus Smallpox Vaccine in Laboratory and Health Care Personnel at Risk for :: Occupational Exposure to Orthopoxviruses — Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2015
:: Revision to CDC’s Zika Travel Notices: Minimal Likelihood for Mosquito-Borne Zika Virus Transmission at Elevations Above 2,000 Meters