UN Blocked From Delivering Aid to Besieged Areas in Syria
Voice of America – Lisa Schlein
March 17, 2016 1:41 PM
GENEVA—
The United Nations is appealing to the Syrian government to provide the permits needed to send humanitarian aid convoys into besieged and hard-to-reach areas and to allow a life-saving vaccination campaign for children to go ahead.

United Nations convoys have delivered desperately needed humanitarian assistance to nearly 260,000 people living in those areas of Syria since the beginning of the year. Aid agencies aim to reach more than 1 million people before the end of April.

The U.N., however, says it has not received permission to enter six areas – most government-controlled – where hundreds of thousands of people have received no relief supplies for more than one year. It is calling for the blockade of these places to be lifted.

Jan Egeland is the special adviser to the U.N. special envoy for Syria. Egeland says he is particularly concerned by the government’s refusal to allow medical relief supplies, including surgical and trauma care equipment, to be delivered.

“We are not able to get through medical personnel. We are not able to get medical assessment personnel. We are not able to do medical evacuations from besieged areas and even some hard-to-reach areas. So people are dying,” said Egeland.

Egeland says the inability to get medical supplies and personnel into these areas could jeopardize an important national vaccination campaign planned for between April 18 and 24. He says the campaign aims to inoculate the millions of children who are not vaccinated against killer diseases in Syria.

“That would be part of a three-phase vaccination campaign …against a number of diseases that are now threatening to spread in Syria because the vaccination rate is now in many areas down to 50 or 60 percent, which is a prescription for epidemic disease,” he said.

Egeland says children will be vaccinated against polio, measles and other communicable diseases. A cluster of 22 cases of polio was detected in Syria in October 2013. The country had been free of the crippling disease since 1999.

Egeland says the disease was eventually brought under control, but he warns polio could spread again in the country and across borders if the planned vaccination campaign does not go ahead…

European Vaccine Initiative [to 19 March 2016]
http://www.euvaccine.eu/news-events

.
IPROVE: Roadmap launched 16 March
:: Roadmap to bolster vaccine innovation launched in European Parliament
:: IPROVE roadmap informs strategic decisions on the priorities for future vaccine investment
Brussels, 16 March 2016
The “Innovation Partnership for a Roadmap on Vaccines in Europe” (IPROVE) – financed under the EU 7th Framework Programme (FP7) – today launched a strategy setting out a vision for vaccine research and innovation in Europe over the next 20 years.

The roadmap, which is the first of its kind, was launched during a special European Parliament event that took place on the 16th of March and was hosted by MEPs Francoise Grossetête, Cristian-Silviu Busoi and Markus Ferber. Key opinion leaders in the field of vaccine research and development attended the event including representatives from the European Commission, the European Parliament, European Union Member States and a broad representation of the vaccines community including academia, industry, civil society and regulatory bodies.

The IPROVE roadmap will inform strategic decisions on the priorities for future vaccine investment in innovation and technological development at European Union and individual Member State level. Through a bottom-up approach involving all key stakeholders in the European vaccine field, the strategy aims to overcome fragmentation and remove bottlenecks to translation of breakthrough research into innovative vaccines.

Following a two year consultation period, the plan covers the critical areas of intervention relevant to the entire innovation value chain, defines priorities and makes recommendations to support and accelerate research in vaccines, to help steer European competitiveness in this field for the delivery and benefit of innovative prophylactic and therapeutic vaccines.

The IPROVE roadmap focuses on seven main thematic topics of consultation;
:: Vaccine R&D
:: Therapeutic Vaccines
:: Production and Manufacturing
:: Infrastructures
:: Vaccine SME needs
:: Training
:: Communications and Acceptance of Vaccination

Ruxandra Draghia-Akli, Director of the Health Directorate DG Research & Innovation at the European Commission comments; “The FP7-funded IPROVE project is an important contributor to build a strategic vision for future European activities in the entire innovation chain for vaccines, and to maintain Europe’s leading position in this important area of research, which is close to the hearts of European citizens.”

Speaking on the launch of the first vaccine R&D roadmap for Europe, Michael Watson, IPROVE Chair and former Head Global Policy at SANOFI adds; “We urge all of the key vaccination stakeholders to embrace IPROVE as a shared starting point that will drive and pull Europe and the world to new heights in vaccination development”.

The IPROVE consortium comprises four renowned organisations in the vaccine field in Europe: Vaccines Europe (VE), a specialised group within the European Federation of Pharmaceutical Industries and Associations (EFPIA) representing all major research-based vaccine global companies as well SMEs operating in Europe; the European Vaccine Initiative (EVI), a leading European Product Development Partnership supporting the development of effective, accessible, and affordable vaccines against diseases of poverty; the Sclavo Vaccines Association (SVA), a non-profit association whose main objective is to promote vaccine research targeted towards the discovery and study of advanced immunisation technologies; and EATRIS, a European consortium of academic institutions of excellence in translational research, working together to advance candidates into clinical development.

You can read or download the roadmap document at: www.iprove-roadmap.eu

EDCTP [to 19 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.

.
17 March 2016
Joep Lange Institute for global healthcare improvement officially launched
The Joep Lange Institute (JLI) was officially inaugurated in Amsterdam, The Netherlands on 15 March 2016. High-level speakers and participants from civil society, industry, politics and global health research backgrounds attended. JLI is “an activist institute, inspired by the life and work of Joep Lange” and its goal is to make health markets work for the poor in countries where the (health care) system fails the people. The institute is closely linked to the Amsterdam Institute for Global Health and Development (AIGHD).

Gavi [to 19 March 2016]
http://www.gavialliance.org/library/news/press-releases/

.
17 March 2016
Gavi welcomes new record low price for pneumococcal vaccine
GSK commitment is latest step towards improving access to PCV but challenges remain

17 March 2016 – A new commitment from GlaxoSmithKline (GSK) to provide pneumococcal vaccine at the lowest ever price was today welcomed by Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. The new price will be set at US$ 3.05 for doses being provided from 2017, a reduction of 10% from the current price of $3.40.

The commitment was announced by GSK’s Chief Executive, Sir Andrew Witty, at an event in Washington DC. The price will be available through the pilot Advance Market Commitment (AMC) to all Gavi countries and, for countries using the vaccine when they transition from Gavi support, it will continue to be available at this price for 10 years after transition.

“This price reduction is good news for everyone who wants to see children protected against the leading cause of pneumonia,” said Dr Berkley. “Sustainable pricing is one important objective of Gavi’s supply and procurement strategy, along with secure supply and product innovation. Healthy long term vaccine markets are critical to ensuring that the immunisation systems being built in developing countries today will benefit children for generations to come.”

Pneumococcal vaccines protect against pneumococcal disease, which is the leading cause of pneumonia. In 2015, pneumonia claimed the lives of 922,000 children under the age of five, accounting for around 15% of deaths worldwide of children in this age group, making it the largest vaccine-preventable killer of children.

Gavi began supporting developing countries to introduce pneumococcal vaccines in 2010. Since then, more than 50 countries have introduced the vaccine into their routine immunisation schedule with close to 50 million children now fully immunised against the disease…

NIH [to 19 March 2016]
http://www.nih.gov/news/releases.htm

.
Experimental dengue vaccine protects all recipients in virus challenge study
March 16, 2016 — Vaccine developed by NIH and FDA scientists.

A clinical trial in which volunteers were infected with dengue virus six months after receiving either an experimental dengue vaccine developed by scientists from the National Institutes of Health (NIH) or a placebo injection yielded starkly contrasting results. All 21 volunteers who received the vaccine, TV003, were protected from infection, while all 20 placebo recipients developed infection. The study, published in Science Translational Medicine, underscores the importance of human challenge studies, in which volunteers are exposed to disease-causing pathogens under carefully controlled conditions.

“The findings from this trial are very encouraging to those of us who have spent many years working on vaccine candidates to protect against dengue, a disease that is a significant burden in much of the world and is now endemic in Puerto Rico,” said Stephen Whitehead, Ph.D., of NIH’s National Institute of Allergy and Infectious Diseases (NIAID). “In fact, these results informed the recent decision by officials at Brazil’s Butantan Institute to advance the TV003 vaccine into a large phase 3 efficacy trial.”…
[See Journal Watch below for Editor’s Summary and Abstract]

Fondation Merieux [to 19 March 2016]
Mission: Contribute to global health by strengthening local capacities of developing countries to reduce the impact of infectious diseases on vulnerable populations.
http://www.fondation-merieux.org/news

.
17 March 2016, Lyon (France)
Fondation Mérieux and 3 Foundations Publish the 1st Edition of Humanitarian Alternatives
Humanitarian Alternatives launched its inaugural issue. Fondation Mérieux, the French Red-Cross Fund, the Action Against Hunger Foundation and the Handicap International Foundation collaborated to initiate and support this bilingual humanitarian journal with an international scope. The journal will be published three times a year with each issue devoted to a specific topic. This first edition focuses on the Ebola virus and what it reveals about the humanitarian sector.

The ambition of Humanitarian Alternatives is to bring together researchers and humanitarian stakeholders to reflect upon and create a more dynamic exchange on current practices and development within the humanitarian sector. Universities, including the UQAM of Montreal and the University of Lyon, are also contributing to the project.

Sabin Vaccine Institute [to 19 March 2016]
http://www.sabin.org/updates/ressreleases

.
03.17.16
Sabin Publishes on Challenges and Way Forward for Effective Dengue Vaccine Communication and Advocacy
International efforts to improve dengue communication and advocacy have increased over the last years, as dengue becomes one of the fastest spreading vector-borne diseases. However, few concerted efforts have been agreed upon at the international level to effectively communicate about dengue vaccines. The recent approvals in Mexico, the Philippines, Brazil and El Salvador of the first dengue vaccine, Dengvaxia®, coupled with the progress of seven other vaccine candidates, call for urgent focus on this topic. Dengue-endemic countries need scientific evidence to inform their decisions on vaccine introduction. Waiting to plan until vaccine licensure, as routinely occurs, may unnecessarily delay access to dengue vaccines in developing countries by years.

Where do we stand today in understanding dengue vaccines? What has been done to generate knowledge in this area and how has it been communicated? The Sabin Vaccine Institute seeks to answer these questions in a new publication titled “International Dengue Vaccine Communication and Advocacy: Challenges and Way Forward,” published today in a Dengue Special Edition of Expert Review of Vaccines. This special edition also includes important updates on dengue vaccine development…

PATH [to 19 March 2016]
http://www.path.org/news/index.php

.
Announcement | March 16, 2016
PATH welcomes two new members to its board of directors
PATH’s board of directors has voted to appoint two new members: Dr. Laurie Michaels and Dr. Peter G. Smith. Drs. Michaels and Smith will deepen the expertise of the board, particularly in the areas of vaccine research and safety, create greater flexibility between donors and grantees, and strengthen relationships among nonprofit, academic, multilateral, and philanthropic groups…

National Foundation for Infectious Diseases (NFID) [to 19 March 2016]
http://www.nfid.org/newsroom/press-releases

.
March 8, 2016
Honoring Infectious Disease Heroes
Bethesda, MD (March 8, 2016)
– The National Foundation for Infectious Diseases (NFID) will honor Robert E. Black, MD, MPH; Diane E. Griffin, MD, PhD; and Larry K. Pickering, MD for their significant and lasting contributions to global public health a t the 2016 NFID Awards Dinner on Thursday, May 5, 2016 in Bethesda, MD.

IVI [to 19 March 2016]
http://www.ivi.org/web/www/home

.
16 March 2916
The International Vaccine Institute (IVI) is pleased to announce the publication of the “Typhoid Fever Surveillance in Africa Program (TSAP)” supplement of Clinical Infectious Diseases.
The seminal publication contains 15 original articles that report significant research findings from the TSAP Program. TSAP was established by IVI in 2009 to fill the data void concerning invasive Salmonella disease in sub-Saharan Africa, and to estimate the burden of bloodstream infections caused by the key pathogen, Salmonella enterica serovar Typhi. IVI, in collaboration with various partners, conducted standardized disease surveillance and other studies in a network of 13 sentinel sites in 10 sub-Saharan African countries. The supplement is the culmination of four years of a landmark study that aimed to definitively determine the burden of invasive Salmonella disease in Africa.

The supplement is open-access and can be viewed at: http://cid.oxfordjournals.org/content/62/suppl_1.toc

.Major findings:
:: High incidences of disease by Salmonella Typhi and invasive non-typhoidal Salmonella (iNTS) in children :: High incidences of typhoid fever in both rural and urban populations
:: Positive correlation between iNTS disease and malaria endemicity
:: Prevalence of resistance to first-line antimicrobial agents seen in both S. Typhi and iNTS isolates in some locations
:: Evidence of NTS excretion in stool may indicate possible disease transmission
:: Patients with fever who sought health care were assessed across all 13 sites; pivotal for disease burden surveillance and incidence analysis

Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks
WHO – A Prüss-Ustün, J Wolf, C Corvalán, R Bos and M Neira
March 2016 :: 176 pages
ISBN 978 92 4 156519 6

Executive Summary (excerpt)
In 2012, this present study estimates, 12.6 million deaths globally, representing 23% (95% CI: 13–34%) of all deaths, were attributable to the environment. When accounting for both death and disability, the fraction of the global burden of disease due to the environment is 22% (95% CI: 13–32%). In children under five years, up to 26% (95% CI: 16–38%) of all deaths could be prevented, if environmental risks were removed. Of the 12.6 million deaths attributable to the environment, 8.1 million (15%) were estimated using comparative risk assessment (CRA) methods, and the remaining 4.5 million using a combination of methods including expert opinion.

This study provides an approximate estimate of how much disease can be prevented by
reducing the environmental risks to health. It includes a meta-synthesis of key evidence
relating diseases and injuries to the environment. It brings together quantitative estimates of
the disease burden attributable to the environment using a combination of approaches that
includes CRA, epidemiological data, transmission pathways and expert opinion. The synthesis
of evidence linking 133 diseases and injuries, or their groupings, to the environment has been
reviewed to provide an overall picture of the disease burden that could be prevented through
healthier environments.

Environmental risks to health are defined, in this study, as “all the physical, chemical and
biological factors external to a person, and all related behaviours, but excluding those natural
environments that cannot reasonably be modified.” To increase the policy relevance of this
study, its focus is on that part of the environment which can reasonably be modified…

Download: Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks
pdf, 2.41Mb

American Journal of Infection Control
March 2016 Volume 44, Issue 3, p253-372, e15-e36
http://www.ajicjournal.org/current

.
Major Articles
Nosocomial transmission of Ebola virus disease on pediatric and maternity wards: Bombali and Tonkolili, Sierra Leone, 2014
Angela C. Dunn, Tiffany A. Walker, John Redd, David Sugerman, Jevon McFadden, Tushar Singh, Joseph Jasperse, Brima Osaio Kamara, Tom Sesay, James McAuley, Peter H. Kilmarx
p269–272
Published online: October 30 2015

.

Brief Reports
Barriers of influenza vaccination in health care personnel in France
Zoher Kadi, MD, Mohamed-Lamine Atif, MD, Annie Brenet, RN, Sylvain Izoard, PharmD,
Pascal Astagneau, MD, PhD
DOI: http://dx.doi.org/10.1016/j.ajic.2015.09.027
Highlights
:: A self-assessment questionnaire on influenza vaccination was proposed to every health care facility in the Picardie region (Northern France).
:: A total of 67 health care facilities participated, including 3,213 health care personnel.
:: Despite the annual influenza vaccination for health care personnel being supported by the health authority in France, vaccination coverage in health care personnel was reported as 22%.
:: Lack of knowledge was the most important barrier of influenza vaccination in health care personnel.

To identify barriers against influenza vaccination of health care personnel in Northern France, a cross-sectional study was conducted in health care facilities. A total of 3,213 questionnaires from 67 health care facilities were completed. In multivariate analysis using a logistic model, influenza vaccine coverage in health care personnel was significantly associated with level of knowledge about influenza disease and vaccine.

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 19 March 2016)

.
Research article
Negative attitude and low intention to vaccinate universally against varicella among public health professionals and parents in the Netherlands: two internet surveys
Prior to introduction of universal varicella vaccination, it is crucial to gain insight into the willingness to vaccinate among the population.
Alies van Lier, Alma Tostmann, Irene A. Harmsen, Hester E. de Melker, Jeannine L. A. Hautvast and Wilhelmina L. M. Ruijs
BMC Infectious Diseases 2016 16:127
Published on: 15 March 2016

.

Study protocol
Clinical evaluation of dengue and identification of risk factors for severe disease: protocol for a multicentre study in 8 countries
The burden of dengue continues to increase globally, with an estimated 100 million clinically apparent infections occurring each year.
Thomas Jaenisch, Dong Thi Hoai Tam, Nguyen Tan Thanh Kieu, Tran Van Ngoc, Nguyen Tran Nam, Nguyen Van Kinh, Sophie Yacoub, Ngoun Chanpheaktra, Varun Kumar, Lucy Lum Chai See, Jameela Sathar, Ernesto Pleités Sandoval, Gabriela Maria Marón Alfaro, Ida Safitri Laksono, Yodi Mahendradhata, Malabika Sarker…
BMC Infectious Diseases 2016 16:120
Published on: 11 March 2016

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 19 March 2016)

.
Commentary
Open Access
Reporting transparency: making the ethical mandate explicit
Stuart G. Nicholls, Sinéad M. Langan, Eric I. Benchimol and David Moher
BMC Medicine201614:44
DOI: 10.1186/s12916-016-0587-5
Published: 16 March 2016
Abstract
Improving the transparency and quality of reporting in biomedical research is considered ethically important; yet, this is often based on practical reasons such as the facilitation of peer review. Surprisingly, there has been little explicit discussion regarding the ethical obligations that underpin reporting guidelines. In this commentary, we suggest a number of ethical drivers for the improved reporting of research. These ethical drivers relate to researcher integrity as well as to the benefits derived from improved reporting such as the fair use of resources, minimizing risk of harms, and maximizing benefits. Despite their undoubted benefit to reporting completeness, questions remain regarding the extent to which reporting guidelines can influence processes beyond publication, including researcher integrity or the uptake of scientific research findings into policy or practice. Thus, we consider investigation on the effects of reporting guidelines an important step in providing evidence of their benefits.

Eurosurveillance
Volume 21, Issue 11, 17 March 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

.
Rapid Communications
Measles outbreak in a refugee settlement in Calais, France: January to February 2016
by G Jones, S Haeghebaert, B Merlin, D Antona, N Simon, M Elmouden, F Battist, M Janssens, K Wyndels, P Chaud
Abstract
We report a measles outbreak in a refugee settlement in Calais, France, between 5 January and 11 February 2016. In total, 13 confirmed measles cases were identified among migrants, healthcare workers in hospital and volunteers working on site. A large scale vaccination campaign was carried out in the settlement within two weeks of outbreak notification. In total, 60% of the estimated target population of 3,500 refugees was vaccinated during the week-long campaign.

.

Research Articles
Risk assessment, risk management and risk-based monitoring following a reported accidental release of poliovirus in Belgium, September to November 2014
by E Duizer, S Rutjes, A Husman, J Schijven
Abstract
On 6 September 2014, the accidental release of 1013 infectious wild poliovirus type 3 (WPV3) particles by a vaccine production plant in Belgium was reported. WPV3 was released into the sewage system and discharged directly to a wastewater treatment plant (WWTP) and subsequently into rivers that flowed to the Western Scheldt and the North Sea. No poliovirus was detected in samples from the WWTP, surface waters, mussels or sewage from the Netherlands. Quantitative microbial risk assessment (QMRA) showed that the infection risks resulting from swimming in Belgium waters were above 50% for several days and that the infection risk by consuming shellfish harvested in the eastern part of the Western Scheldt warranted a shellfish cooking advice. We conclude that the reported release of WPV3 has neither resulted in detectable levels of poliovirus in any of the samples nor in poliovirus circulation in the Netherlands. This QMRA showed that relevant data on water flows were not readily available and that prior assumptions on dilution factors were overestimated. A QMRA should have been performed by all vaccine production facilities before starting up large-scale culture of WPV to be able to implement effective interventions when an accident happens.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 19 March 2016]

.
Review
Evidence for Health I: Producing evidence for improving health and reducing inequities
In an ideal world, researchers and decision-makers would be involved from the outset in co-producing evidence, with local health needs assessments informing the research agenda and research evidence informing …
Anne Andermann, Tikki Pang, John N Newton, Adrian Davis and Ulysses Panisset
Health Research Policy and Systems 2016 14:18
Published on: 14 March 2016

Review
Evidence for Health II: Overcoming barriers to using evidence in policy and practice
Even the highest quality evidence will have little impact unless it is incorporated into decision-making for health. It is therefore critical to overcome the many barriers to using evidence in decision-making,…
Anne Andermann, Tikki Pang, John N. Newton, Adrian Davis and Ulysses Panisset
Health Research Policy and Systems 2016 14:17
Published on: 14 March 2016

Review
Evidence for Health III: Making evidence-informed decisions that integrate values and context
Making evidence-informed decisions with the aim of improving the health of individuals or populations can be facilitated by using a systematic approach. While a number of algorithms already exist,
Anne Andermann, Tikki Pang, John N Newton, Adrian Davis and Ulysses Panisset
Health Research Policy and Systems 2016 14:16
Published on: 14 March 2016

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 12, Issue 2, 2016
http://www.tandfonline.com/toc/khvi20/current

.
Reviews
The potential impact of pneumococcal conjugate vaccine in Africa: Considerations and early lessons learned from the South African experience
DOI:10.1080/21645515.2015.1084450
Shabir A Madhi & Marta C Nunes
pages 314-325
Abstract
The introduction of pneumococcal conjugate vaccine (PCV) into the South African public immunization program since 2009 adopted a novel vaccination schedule of 3 doses at 6, 14 and 40 weeks of age. Over the past 5 y it has been shown that infant PCV immunization in South Africa is effective in reducing the burden of invasive pneumococcal disease (IPD) among HIV-infected and HIV-uninfected children. Furthermore, indirect protection of unvaccinated age-groups (including high risk groups such as HIV-infected adults) against IPD was demonstrated despite the absence of any substantial catch-up campaign of older children. This indirect effect against IPD is corroborated by the temporal reduction in vaccine-serotype colonization among age-groups targeted for PCV immunization as well as unvaccinated HIV-infected and HIV-uninfected adults, which was evident within 2 y of PCV introduction into the immunization program. Vaccine effectiveness has also been demonstrated in children against presumed bacterial pneumonia. The evaluation of the impact of PCV in South Africa, however, remains incomplete. The knowledge gaps remaining include the evaluation of PCV on the incidence of all-cause pneumonia hospitalization among vaccinated and unvaccinated age-groups. Furthermore, ongoing surveillance is required to determine whether there is ongoing replacement disease by non-vaccine serotypes, which could offset the early gains associated with the immunization program in the country.

.

Review
Prevention of pneumococcal infections during mass gathering
DOI:10.1080/21645515.2015.1058456
Jaffar A Al-Tawfiq & Ziad A Memish
pages 326-330
Abstract
The interest in mass gathering and its implications has been increasing due to globalization and international travel. The potential occurrence of infectious disease outbreaks during mass gathering is most feared. In this context, respiratory tract infections are of great concern due to crowding in a limited space which facilitates and magnifies the potential of disease spread among attendees. Pneumococcal disease is best described among pilgrims to Makkah and vaccination is one of the methods for the prevention of this disease. Pneumonia was described in a mass gathering with a prevalence of 4.8/100,000 pilgrims and contributes to 15–39% of hospitalizations. Various studies showed that 7–37% of pilgrims are 65 y of age or older. The uptake of pneumococcal vaccine among pilgrims is low at 5%. There is no available data to make strong recommendations for S. pneumoniae vaccination of all pilgrims, it is important that a high risk population receive the indicated vaccination. We reviewed the available literature on the burden of pneumococcal infections during mass gathering and evaluate the available literature on pneumococcal vaccinations for attendees of mass gathering.

Review
Theory and strategy for Pneumococcal vaccines in the elderly
DOI:10.1080/21645515.2015.1075678
Ho Namkoong, Makoto Ishii, Yohei Funatsu, Yoshifumi Kimizuka, Kazuma Yagi, Takahiro Asami, Takanori Asakura, Shoji Suzuki, Testuro Kamo, Hiroshi Fujiwara, Sadatomo Tasaka, Tomoko Betsuyaku & Naoki Hasegawa
pages 336-343
Open access
Abstract
Pneumonia is the fourth-leading cause of death globally, and Streptococcus pneumoniae is the most important causative pathogen. Because the incidence of pneumococcal diseases is likely to increase with the aging society, we should determine an optimal strategy for pneumococcal vaccination. While consensus indicates that 23-valent pneumococcal polysaccharide vaccine prevents invasive pneumococcal diseases (IPD), its effects on community-acquired pneumonia (CAP) remain controversial. Recently, a 13-valent pneumococcal conjugate vaccine (PCV13) was released. The latest clinical study (CAPiTA study) showed that PCV13 reduced vaccine-type CAP and IPD. Based on these results, the Advisory Committee on Immunization Practices recommended initial vaccination with PCV13 for the elderly. Scientific evidence regarding immunosenescence is needed to determine a more ideal vaccination strategy for the elderly with impaired innate and adaptive immunity. Continuing research on the cost effectiveness of new vaccine strategies considering constantly changing epidemiology is also warranted.

.

Short Report
Low vaccine coverage among children born to HIV infected women in Niamey, Niger
DOI:10.1080/21645515.2015.1069451
Hyppolite Kuekou Tchidjou, Maria Fenicia Vescio, Martin Sanou Sobze, Animata Souleyman, Paola Stefanelli, Adalbert Mbabia, Ide Moussa, Bruno Gentile, Vittorio Colizzi & Giovanni Rezza
pages 540-544
Abstract
Background: The effect of mother’s HIV-status on child vaccination is an important public health issue in countries with high HIV prevalence. We conducted a study in a primary healthcare center located in Niamey, the capital of Niger, which offers free of charge services to HIV positive and/or underprivileged mothers, with the aim of assessing: 1) vaccination coverage for children 0–36 months old, born to HIV-infected mothers, and 2) the impact of maternal HIV status on child vaccination. Methods: Mothers of children less than 36 months old attending the center were interviewed, to collect information on vaccines administered to their child, and family’s socio-demographic characteristics. Results: Overall, 502 children were investigated. Children of HIV-seropositive mothers were less likely to receive follow up vaccinations for Diphtheria-Tetanus-Pertussis (DTP) than those of HIV-seronegative mothers, with a prevalence ratio (PR) of 2.03 (95%CI: 1.58–2.61). Children born to HIV-seropositive mothers were less likely to miss vaccination for MMR than those born to HIV negative mothers, with a RR of 0.46 (95%CI: 0.30–0.72). Conclusions: Vaccine coverage among children born to HIV infected mothers was rather low. It is important to favor access to vaccination programs in this population.

International Journal of Epidemiology
Volume 45 Issue 1 February 2016
http://ije.oxfordjournals.org/content/current

.
Infectious Diseases
Risk factors for transmission of Ebola or Marburg virus disease: a systematic review and meta-analysis
Julii Brainard, Lee Hooper, Katherine Pond, Kelly Edmunds, and Paul R Hunter
Int. J. Epidemiol. (2016) 45 (1): 102-116 doi:10.1093/ije/dyv307
Abstract
Background: The Ebola virus disease outbreak that started in Western Africa in 2013 was unprecedented because it spread within densely populated urban environments and affected many thousands of people. As a result, previous advice and guidelines need to be critically reviewed, especially with regard to transmission risks in different contexts.
Methods: Scientific and grey literature were searched for articles about any African filovirus. Articles were screened for information about transmission (prevalence or odds ratios especially). Data were extracted from eligible articles and summarized narratively with partial meta-analysis. Study quality was also evaluated.
Results: A total of 31 reports were selected from 6552 found in the initial search. Eight papers gave numerical odds for contracting filovirus illness; 23 further articles provided supporting anecdotal observations about how transmission probably occurred for individuals. Many forms of contact (conversation, sharing a meal, sharing a bed, direct or indirect touching) were unlikely to result in disease transmission during incubation or early illness. Among household contacts who reported directly touching a case, the attack rate was 32% [95% confidence interval (CI) 26–38%]. Risk of disease transmission between household members without direct contact was low (1%; 95% CI 0–5%). Caring for a case in the community, especially until death, and participation in traditional funeral rites were strongly associated with acquiring disease, probably due to a high degree of direct physical contact with case or cadaver.
Conclusions: Transmission of filovirus is unlikely except through close contact, especially during the most severe stages of acute illness. More data are needed about the context, intimacy and timing of contact required to raise the odds of disease transmission. Risk factors specific to urban settings may need to be determined.

JAMA
March 15, 2016, Vol 315, No. 11
http://jama.jamanetwork.com/issue.aspx

.
Viewpoint
Innovations in Health Care Delivery
Does the Country of Origin Matter in Health Care Innovation Diffusion?
Matthew Harris, DPhil, MBBS, FFPH; Yasser Bhatti, DPhil, MSc, MoT, MSc, BEng; Ara Darzi, OM, KBE, PC, FRS, FMedSci
This Viewpoint discusses the need to examine how perceptions of the country of origin may of health care innovations proposed for US settings may influence diffusion of these innovations.

There is no shortage of US health care research centers advocating the adoption of innovations from other countries. The Institute for Healthcare Improvement (Boston, MA), the Commonwealth Fund (New York, NY), Innovations in Health at Duke University (Durham, NC), and the Network for Excellence in Healthcare Innovation (Cambridge, MA) are all promoting innovations from low-, middle-, and high-income countries for potential adoption into the United States. However, does it matter to patients if a proposed innovation is from India, rather than from, say, Sweden; or from Rwanda, rather than from, say, the United Kingdom? Very little is known about whether and how the country of origin of a proposed innovation matters in its diffusion…

.

Editorial | March 15, 2016
Toward High-Reliability Vaccination Efforts in the United States
Matthew M. Davis, MD, MAPP1,2,3,4,5
Author Affiliations
JAMA. 2016;315(11):1115-1117. doi:10.1001/jama.2016.1529.
Infectious disease eradication is a major public health achievement. Smallpox is the only human infectious disease that has been eliminated by deliberate intervention, and this was accomplished using strategic global immunization efforts. The public generally understands that effective vaccination is a key component of infectious disease prevention and eradication; for example, there has been substantial recent public interest in vaccination for emerging global health threats such as avian influenza, Ebola, and Zika virus…

.

Review
Association Between Vaccine Refusal and Vaccine-Preventable Diseases in the United States: A Review of Measles and Pertussis
FREE
Varun K. Phadke, MD; Robert A. Bednarczyk, MS, PhD; Daniel A. Salmon, MPH, PhD; Saad B. Omer, MBBS, MPH, PhD
Includes: CME, Supplemental Content, Author Video Interviews, JAMA Report Video, Author Interview
Abstract
Importance
Parents hesitant to vaccinate their children may delay routine immunizations or seek exemptions from state vaccine mandates. Recent outbreaks of vaccine-preventable diseases in the United States have drawn attention to this phenomenon. Improved understanding of the association between vaccine refusal and the epidemiology of these diseases is needed.
Objective
To review the published literature to evaluate the association between vaccine delay, refusal, or exemption and the epidemiology of measles and pertussis, 2 vaccine-preventable diseases with recent US outbreaks.
Evidence Review
Search of PubMed through November 30, 2015, for reports of US measles outbreaks that have occurred since measles was declared eliminated in the United States (after January 1, 2000), endemic and epidemic pertussis since the lowest point in US pertussis incidence (after January 1, 1977), and for studies that assessed disease risk in the context of vaccine delay or exemption.
Findings
We identified 18 published measles studies (9 annual summaries and 9 outbreak reports), which described 1416 measles cases (individual age range, 2 weeks-84 years; 178 cases younger than 12 months) and more than half (56.8%) had no history of measles vaccination. Of the 970 measles cases with detailed vaccination data, 574 cases were unvaccinated despite being vaccine eligible and 405 (70.6%) of these had nonmedical exemptions (eg, exemptions for religious or philosophical reasons, as opposed to medical contraindications; 41.8% of total). Among 32 reports of pertussis outbreaks, which included 10,609 individuals for whom vaccination status was reported (age range, 10 days-87 years), the 5 largest statewide epidemics had substantial proportions (range, 24%-45%) of unvaccinated or undervaccinated individuals. However, several pertussis outbreaks also occurred in highly vaccinated populations, indicating waning immunity. Nine reports (describing 12 outbreaks) provided detailed vaccination data on unimmunized cases; among 8 of these outbreaks from 59% through 93% of unvaccinated individuals were intentionally unvaccinated.
Conclusions and Relevance
A substantial proportion of the US measles cases in the era after elimination were intentionally unvaccinated. The phenomenon of vaccine refusal was associated with an increased risk for measles among people who refuse vaccines and among fully vaccinated individuals. Although pertussis resurgence has been attributed to waning immunity and other factors, vaccine refusal was still associated with an increased risk for pertussis in some populations.

Nature
Volume 531 Number 7594 pp275-408 17 March 2016
http://www.nature.com/nature/current_issue.html

.
Supplement
Outlook: Urban health and well-being
With more than half of the world’s population already living in cities and further growth expected, the health of urban dwellers is crucial to global well-being. This Nature Outlook explores some of the obstacles to a healthy, happy urban life – and the development of strategies to overcome them.
Free full access [Sponsored]
.
Urban health and well-being
Richard Hodson
.
The rise of the urbanite
Stephanie Pain
.
Mobility: The urban downshift
Sarah DeWeerdt
.
Flooding: Water potential
James M. Gaines
.
Green space: A natural high
Natasha Gilbert
.
Stress: The privilege of health
Amy Maxmen
.
Perspective: City farming needs monitoring
Andrew A. Meharg
.
Disease: Poverty and pathogens
Michael Eisenstein
.
Policy: Urban physics
Kevin Pollock

PLOS Currents: Disasters
http://currents.plos.org/disasters/
[Accessed 19 March 2016]

.
A Comparative Analysis of Disaster Risk, Vulnerability and Resilience Composite Indicators
March 14, 2016 · Research Article
Abstract
Introduction: In the past decade significant attention has been given to the development of tools that attempt to measure the vulnerability, risk or resilience of communities to disasters. Particular attention has been given to the development of composite indices to quantify these concepts mirroring their deployment in other fields such as sustainable development. Whilst some authors have published reviews of disaster vulnerability, risk and resilience composite indicator methodologies, these have been of a limited nature. This paper seeks to dramatically expand these efforts by analysing 106 composite indicator methodologies to understand the breadth and depth of practice.
Methods: An extensive search of the academic and grey literature was undertaken for composite indicator and scorecard methodologies that addressed multiple/all hazards; included social and economic aspects of risk, vulnerability or resilience; were sub-national in scope; explained the method and variables used; focussed on the present-day; and, had been tested or implemented. Information on the index construction, geographic areas of application, variables used and other relevant data was collected and analysed.
Results: Substantial variety in construction practices of composite indicators of risk, vulnerability and resilience were found. Five key approaches were identified in the literature, with the use of hierarchical or deductive indices being the most common. Typically variables were chosen by experts, came from existing statistical datasets and were combined by simple addition with equal weights. A minimum of 2 variables and a maximum of 235 were used, although approximately two thirds of methodologies used less than 40 variables. The 106 methodologies used 2298 unique variables, the most frequently used being common statistical variables such as population density and unemployment rate. Classification of variables found that on average 34% of the variables used in each methodology related to the social environment, 25% to the disaster environment, 20% to the economic environment, 13% to the built environment, 6% to the natural environment and 3% were other indices. However variables specifically measuring action to mitigate or prepare for disasters only comprised 12%, on average, of the total number of variables in each index. Only 19% of methodologies employed any sensitivity or uncertainty analysis and in only a single case was this comprehensive.
Discussion: A number of potential limitations of the present state of practice and how these might impact on decision makers are discussed. In particular the limited deployment of sensitivity and uncertainty analysis and the low use of direct measures of disaster risk, vulnerability and resilience could significantly limit the quality and reliability of existing methodologies. Recommendations for improvements to indicator development and use are made, as well as suggested future research directions to enhance the theoretical and empirical knowledge base for composite indicator development.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 19 March 2016)

.
On the Seasonal Occurrence and Abundance of the Zika Virus Vector Mosquito Aedes Aegypti in the Contiguous United States
March 16, 2016 · Research Article
Abstract
Introduction: An ongoing Zika virus pandemic in Latin America and the Caribbean has raised concerns that travel-related introduction of Zika virus could initiate local transmission in the United States (U.S.) by its primary vector, the mosquito Aedes aegypti.
Methods: We employed meteorologically driven models for 2006-2015 to simulate the potential seasonal abundance of adult Aedes aegypti for fifty cities within or near the margins of its known U.S. range. Mosquito abundance results were analyzed alongside travel and socioeconomic factors that are proxies of viral introduction and vulnerability to human-vector contact.
Results: Meteorological conditions are largely unsuitable for Aedes aegypti over the U.S. during winter months (December-March), except in southern Florida and south Texas where comparatively warm conditions can sustain low-to-moderate potential mosquito abundance. Meteorological conditions are suitable for Aedes aegypti across all fifty cities during peak summer months (July-September), though the mosquito has not been documented in all cities. Simulations indicate the highest mosquito abundance occurs in the Southeast and south Texas where locally acquired cases of Aedes-transmitted viruses have been reported previously. Cities in southern Florida and south Texas are at the nexus of high seasonal suitability for Aedes aegypti and strong potential for travel-related virus introduction. Higher poverty rates in cities along the U.S.-Mexico border may correlate with factors that increase human exposure to Aedes aegypti.
Discussion: Our results can inform baseline risk for local Zika virus transmission in the U.S. and the optimal timing of vector control activities, and underscore the need for enhanced surveillance for Aedes mosquitoes and Aedes-transmitted viruses.

.

Unintended Pregnancies in Brazil – A Challenge for the Recommendation to Delay Pregnancy Due to Zika
March 16, 2016 · Discussion
Abstract
Because of the potential link between the ongoing Zika virus outbreak and a surge in the number of cases of congenital microcephaly, officials in Latin America have recommended that women postpone pregnancy until this association is firmly established or the outbreak subsides. However, in all these countries a large proportion of babies are still born out of unplanned pregnancies. Teenage girls are particularly at high risk, as they often lack access to preventive contraception methods, or the knowledge to use them appropriately. To gauge the magnitude of the barriers preventing the implementation of such a recommendation in Brazil, the country so far most affected by the Zika epidemic, we evaluated pregnancy rates in teenage girls, and their spatial heterogeneity in the country, in recent years (2012-2014). Nearly 20% of children born in Brazil today (~560,000 live births) are by teenage mothers. Birth incidence is far higher in the tropical and poorer northern states. However, in absolute terms most births occur in the populous southeastern states, matching to a large extent the geographic distribution of dengue (an indicator of suitable climatic and sociodemographic conditions for the circulation of Aedes mosquitoes). These findings indicate that recommendation to delay pregnancy will leave over half a million pregnant adolescents in Brazil vulnerable to infection every year if not accompanied by effective education and real access to prevention.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 19 March 2016)

.
Research Article |
Routine Pediatric Enterovirus 71 Vaccination in China: a Cost-Effectiveness Analysis
Joseph T. Wu, Mark Jit, Yaming Zheng, Kathy Leung, Weijia Xing, Juan Yang, Qiaohong Liao, Benjamin J. Cowling, Bingyi Yang, Eric H. Y. Lau, Saki Takahashi, Jeremy J. Farrar, Bryan T. Grenfell, Gabriel M. Leung, Hongjie Yu
published 15 Mar 2016 | PLOS Medicine
10.1371/journal.pmed.1001975
Abstract
Background
China accounted for 87% (9.8 million/11.3 million) of all hand, foot, and mouth disease (HFMD) cases reported to WHO during 2010–2014. Enterovirus 71 (EV71) is responsible for most of the severe HFMD cases. Three EV71 vaccines recently demonstrated good efficacy in children aged 6–71 mo. Here we assessed the cost-effectiveness of routine pediatric EV71 vaccination in China.
Methods and Findings
We characterized the economic and health burden of EV71-associated HFMD (EV71-HFMD) in China using (i) the national surveillance database, (ii) virological surveillance records from all provinces, and (iii) a caregiver survey on the household costs and health utility loss for 1,787 laboratory-confirmed pediatric cases. Using a static model parameterized with these data, we estimated the effective vaccine cost (EVC, defined as cost/efficacy or simply the cost of a 100% efficacious vaccine) below which routine pediatric vaccination would be considered cost-effective. We performed the base-case analysis from the societal perspective with a willingness-to-pay threshold of one times the gross domestic product per capita (GDPpc) and an annual discount rate of 3%. We performed uncertainty analysis by (i) accounting for the uncertainty in the risk of EV71-HFMD due to missing laboratory data in the national database, (ii) excluding productivity loss of parents and caregivers, (iii) increasing the willingness-to-pay threshold to three times GDPpc, (iv) increasing the discount rate to 6%, and (v) accounting for the proportion of EV71-HFMD cases not registered by national surveillance. In each of these scenarios, we performed probabilistic sensitivity analysis to account for parametric uncertainty in our estimates of the risk of EV71-HFMD and the expected costs and health utility loss due to EV71-HFMD. Routine pediatric EV71 vaccination would be cost-saving if the all-inclusive EVC is below US$10.6 (95% CI US$9.7–US$11.5) and would remain cost-effective if EVC is below US$17.9 (95% CI US$16.9–US$18.8) in the base case, but these ceilings could be up to 66% higher if all the test-negative cases with missing laboratory data are EV71-HFMD. The EVC ceiling is (i) 10%–14% lower if productivity loss of parents/caregivers is excluded, (ii) 58%–84% higher if the willingness-to-pay threshold is increased to three times GDPpc, (iii) 14%–19% lower if the discount rate is increased to 6%, and (iv) 36% (95% CI 23%–50%) higher if the proportion of EV71-HFMD registered by national surveillance is the same as that observed in the three EV71 vaccine phase III trials. The validity of our results relies on the following assumptions: (i) self-reported hospital charges are a good proxy for the opportunity cost of care, (ii) the cost and health utility loss estimates based on laboratory-confirmed EV71-HFMD cases are representative of all EV71-HFMD cases, and (iii) the long-term average risk of EV71-HFMD in the future is similar to that registered by national surveillance during 2010–2013.
Conclusions
Compared to no vaccination, routine pediatric EV71 vaccination would be very cost-effective in China if the cost of immunization (including all logistical, procurement, and administration costs needed to confer 5 y of vaccine protection) is below US$12.0–US$18.3, depending on the choice of vaccine among the three candidates. Given that the annual number of births in China has been around 16 million in recent years, the annual costs for routine pediatric EV71 vaccination at this cost range should not exceed US$192–US$293 million. Our results can be used to determine the optimal vaccine when the prices of the three vaccines are known.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 19 March 2016)

.
Editorial
The Zika Pandemic – A Perfect Storm?
Philip K. Russell
| published 18 Mar 2016 | PLOS Neglected Tropical Diseases
10.1371/journal.pntd.0004589

Research Article
Is Dengue Vector Control Deficient in Effectiveness or Evidence?: Systematic Review and Meta-analysis
Leigh R. Bowman, Sarah Donegan, Philip J. McCall
| published 17 Mar 2016 | PLOS Neglected Tropical Diseases
10.1371/journal.pntd.0004551

PLoS One
http://www.plosone.org/
[Accessed 19 March 2016]

.
Research Article
Highest Vaccine Uptake after School-Based Delivery – A County-Level Evaluation of the Implementation Strategies for HPV Catch-Up Vaccination in Sweden
Moa Rehn, Ingrid Uhnoo, Sharon Kühlmann-Berenzon, Anders Wallensten, Pär Sparén, Eva Netterlid
| published 14 Mar 2016 | PLOS ONE
10.1371/journal.pone.0149857

Prehospital & Disaster Medicine
Volume 31 – Issue 02 – April 2016
https://journals.cambridge.org/action/displayIssue?jid=PDM&tab=currentissue

.
Editorial
Zika Virus Association with Microcephaly: The Power for Population Statistics to Identify Public Health Emergencies
Samuel J. Stratton
DOI: http://dx.doi.org/10.1017/S1049023X16000170
Published online: 04 March 2016
[No abstract]

.

Original Research
An Assessment of Collaboration and Disasters: A Hospital Perspective
Sabrina A. Adelainea1 c1, Kimberly Shoafa2 and Caitlin Harveya1
a1 University of California, Los Angeles (UCLA), Fielding School of Public Health, Los Angeles, California USA
a2 University of Utah, Division of Public Health, Salt Lake City, Utah USA
Abstract
Introduction There is no standard guidance for strategies for hospitals to use to coordinate with other agencies during a disaster.
Hypothesis/Problem This study analyzes successful strategies and barriers encountered by hospitals across the nation in coordinating and collaborating with other response agencies.
Methods Quantitative and qualitative data were collected from a web-based study from 577 acute care hospitals sampled from the 2013 American Hospital Association (AHA) database. The results were analyzed using descriptive statistics.
Results The most common barriers to collaboration are related to finances, ability to communicate, and personnel.

.

Vaccination Against Seasonal or Pandemic Influenza in Emergency Medical Services
Alexandre Moser, Cédric Mabire, Olivier Hugli, Victor Dorribo, Giorgio Zanetti, Catherine Lazor-Blanchet and Pierre-Nicolas Carron
DOI: http://dx.doi.org/10.1017/S1049023X16000121
Published online: 09 February 2016
Abstract
Introduction Influenza is a major concern for Emergency Medical Services (EMS); EMS workers’ (EMS-Ws) vaccination rates remain low despite promotion. Determinants of vaccination for seasonal influenza (SI) or pandemic influenza (PI) are unknown in this setting.
Hypothesis The influence of the H1N1 pandemic on EMS-W vaccination rates, differences between SI and PI vaccination rates, and the vaccination determinants were investigated.
Methods A survey was conducted in 2011 involving 65 Swiss EMS-Ws. Socio-professional data, self-declared SI/PI vaccination status, and motives for vaccine refusal or acceptation were collected.
Results Response rate was 95%. The EMS-Ws were predominantly male (n=45; 73%), in good health (87%), with a mean age of 36 (SD=7.7) years. Seventy-four percent had more than six years of work experience. Self-declared vaccination rates were 40% for both SI and PI (PI+/SI+), 19% for PI only (PI+/SI-), 1.6% for SI only (PI-/SI+), and 39% were not vaccinated against either (PI-/SI-). Women’s vaccination rates specifically were lower in all categories but the difference was not statistically significant. During the previous three years, 92% of PI+/SI+ EMS-Ws received at least one SI vaccination; it was 8.3% in the case of PI-/SI- (P=.001) and 25% for PI+/SI- (P=.001). During the pandemic, SI vaccination rate increased from 26% during the preceding year to 42% (P=.001). Thirty percent of the PI+/SI+ EMS-Ws declared that they would not get vaccination next year, while this proportion was null for the PI-/SI- and PI+/SI- groups. Altruism and discomfort induced by the surgical mask required were the main motivations to get vaccinated against PI. Factors limiting PI or SI vaccination included the option to wear a mask, avoidance of medication, fear of adverse effects, and concerns about safety and effectiveness.
Conclusion Average vaccination rate in this study’s EMS-Ws was below recommended values, particularly for women. Previous vaccination status was a significant determinant of PI and future vaccinations. The new mask policy seemed to play a dual role, and its net impact is probably limited. This population could be divided in three groups: favorable to all vaccinations; against all, even in a pandemic context; and ambivalent with a “pandemic effect.” These results suggest a consistent vaccination pattern, only altered by exceptional circumstances.

.

International Consensus on Key Concepts and Data Definitions for Mass-gathering Health: Process and Progress
Sheila A. Turris, Malinda Steenkamp, Adam Lund, Alison Hutton, Jamie Ranse, Ron Bowles, Katherine Arbuthnott, Olga Anikeeva and Paul Arbon
DOI: http://dx.doi.org/10.1017/S1049023X1600011X
Published online: 04 February 2016
Abstract
Mass gatherings (MGs) occur worldwide on any given day, yet mass-gathering health (MGH) is a relatively new field of scientific inquiry. As the science underpinning the study of MGH continues to develop, there will be increasing opportunities to improve health and safety of those attending events. The emerging body of MG literature demonstrates considerable variation in the collection and reporting of data. This complicates comparison across settings and limits the value and utility of these reported data. Standardization of data points and/or reporting in relation to events would aid in creating a robust evidence base from which governments, researchers, clinicians, and event planners could benefit. Moving towards international consensus on any topic is a complex undertaking. This report describes a collaborative initiative to develop consensus on key concepts and data definitions for a MGH “Minimum Data Set.” This report makes transparent the process undertaken, demonstrates a pragmatic way of managing international collaboration, and proposes a number of steps for progressing international consensus. The process included correspondence through a journal, face-to-face meetings at a conference, then a four-day working meeting; virtual meetings over a two-year period supported by online project management tools; consultation with an international group of MGH researchers via an online Delphi process; and a workshop delivered at the 19thWorld Congress on Disaster and Emergency Medicine held in Cape Town, South Africa in April 2015. This resulted in an agreement by workshop participants that there is a need for international consensus on key concepts and data definitions.

.

Special Reports
Research and Evaluations of the Health Aspects of Disasters, Part VI: Interventional Research and the Disaster Logic Model
Marvin L. Birnbaum, Elaine K. Daily, Ann P. O’Rourke and Jennifer Kushner
DOI: http://dx.doi.org/10.1017/S1049023X16000017

Research and Evaluations of the Health Aspects of Disasters, Part VII: The Relief/Recovery Framework
Marvin L. Birnbaum, Elaine K. Daily and Ann P. O’Rourke
DOI: http://dx.doi.org/10.1017/S1049023X16000029

Preventive Medicine
Volume 84, Pages 1-98 (March 2016)
http://www.sciencedirect.com/science/journal/00917435/84

.
Original Research Article
Predictors of influenza vaccine uptake during the 2009/10 influenza A H1N1v (‘swine flu’) pandemic: Results from five national surveys in the United Kingdom
Pages 57-61
You Kyung Julia Han, Susan Michie, Henry W.W. Potts, G. James Rubin
Highlights
:: We analysed data from UK telephone surveys conducted during the 2009/10 pandemic.
:: We explored reasons for accepting or declining the swine flu vaccination.
:: Main reasons given for declining were safety concerns and being generally healthy.
:: Believing the vaccine to be ineffective was strongly associated with declining it.

Public Health Reports
Volume 131 , Issue Number 2 March/April 2016
http://www.publichealthreports.org/issuecontents.cfm?Volume=131&Issue=2

.
Articles
Physician Attitudes Toward Adult Vaccines and Other Preventive Practices, United States, 2012
Laura P. Hurley, MD, MPH / Carolyn Bridges, MD / Rafael Harpaz, MD, MPH / Mandy A. Allison, MD, MSPH / Sean T. O’Leary, MD / Lori Crane, PhD, MPH / Michaela Brtnikova, Phd, MPH / Shannon Stokley, MPH / Brenda L. Beaty, MSPH / Andrea Jimenez-Zambrano, MPH / Allison Kempe, MD, MPH
ABSTRACT
Objectives. We described the following among U.S. primary care physicians: (1) perceived importance of vaccines recommended by the Advisory Commit¬tee on Immunization Practices relative to U.S. Preventive Services Task Force (USPSTF) preventive services, (2) attitudes toward the U.S. adult immunization schedule, and (3) awareness and use of Medicare preventive service visits.
Methods. We conducted an Internet and mail survey from March to June 2012 among national networks of general internists and family physicians.
Results. We received responses from 352 of 445 (79%) general internists and 255 of 409 (62%) family physicians. For a 67-year-old hypothetical patient, 540/606 (89%, 95% confidence interval [CI] 87, 92) of physicians ranked sea¬sonal influenza vaccine and 487/607 (80%, 95% CI 77, 83) ranked pneumococ¬cal vaccine as very important, whereas 381/604 (63%, 95% CI 59, 67) ranked Tdap/Td vaccine and 288/607 (47%, 95% CI 43, 51) ranked herpes zoster vaccine as very important (p0.001). All Grade A USPSTF recommendations were considered more important than Tdap/Td and herpes zoster vaccines. For the hypothetical patient aged 30 years, the number and percentage of physi¬cians who reported that the Tdap/Td vaccine (377/604; 62%, 95% CI 59, 66) is very important was greater than the number and percentage who reported that the seasonal influenza vaccine (263/605; 43%, 95% CI 40, 47) is very important (p0.001), and all Grade A and Grade B USPSTF recommendations were more often reported as very important than was any vaccine. A total of 172 of 587 physicians (29%) found aspects of the adult immunization schedule confusing. Among physicians aware of “Welcome to Medicare” and annual wellness visits, 492/514 (96%, 95% CI 94, 97) and 329/496 (66%, 95% CI 62, 70), respectively, reported having conducted fewer than 10 such visits in the previous month.
Conclusions. Despite lack of prioritization of vaccines by ACIP, physicians are prioritizing some vaccines over others and ranking some vaccines below other preventive services. These attitudes and confusion about the immunization schedule may result in missed opportunities for vaccination. Medicare preven¬tive visits are not being used widely despite offering a venue for delivery of preventive services, including vaccinations.

Qualitative Health Research
April 2016; 26 (5)
http://qhr.sagepub.com/content/current
Special Issue: Qualitative Contributions to Quantitative Inquiry

.
Commentary
Adding Qualitative and Mixed Methods Research to Health Intervention Studies: Interacting With Differences
R. Burke Johnson and Judith Schoonenboom
Qual Health Res April 2016 26: 587-602, first published on December 9, 2015 doi:10.1177/1049732315617479
Abstract
The purpose of this article is to explain how to improve intervention designs, such as randomized controlled trials (RCTs), in health science research using a process philosophy and theory known as dialectical pluralism (DP). DP views reality as plural and uses dialectical, dialogical, and hermeneutical approaches to knowledge construction. Using DP and its “both/and” logic, and its attempt to produce new creative syntheses, researchers on heterogeneous teams can better dialogue with qualitative and mixed methods approaches, concepts, paradigms, methodologies, and methods to improve their intervention research studies. The concept of reflexivity is utilized but is expanded when it is a component of DP. Examples of strategies for identifying, inviting, and creating divergence and integrative strategies for producing strong mixed methods intervention studies are provided and illustrated using real-life examples.

Science Translational Medicine
16 March 2016 Vol 8, Issue 330
http://stm.sciencemag.org/

.
Editorial
Once and future epidemics: Zika virus emerging
By Gary J. Nabel, Elias A. Zerhouni
Science Translational Medicine16 Mar 2016 : 330ed2
Zika virus again reminds us that we need a globally coordinated system to protect against outbreaks caused by perilous pathogens.

.

Research Articles
The live attenuated dengue vaccine TV003 elicits complete protection against dengue in a human challenge model
By Beth D. Kirkpatrick, Stephen S. Whitehead, Kristen K. Pierce, Cecilia M. Tibery, Palmtama L. Grier, Noreen A. Hynes, Catherine J. Larsson, Beulah P. Sabundayo, Kawsar R. Talaat, Anna Janiak, Marya P. Carmolli, Catherine J. Luke, Sean A. Diehl, Anna P. Durbin
Science Translational Medicine16 Mar 2016 : 330ra36
Editor’s Summary
Dengue model rises to the challenge
Human efficacy testing remains a major hurdle in bringing new vaccine candidates to the clinic. In the absence of accepted correlates of protection, rounds of safety trials must be performed before efficacy can be tested in a large population in an endemic area. Kirkpatrick et al. have developed a controlled dengue human challenge model to assess the protective efficacy of the most clinically advanced dengue vaccine candidate. They found that TV003, a live attenuated dengue vaccine that induces antibodies to all four dengue virus serotypes, protected against infection of an attenuated virus in 21 recipients when compared with 20 nonvaccinated controls. This model may serve as an early check for dengue vaccine candidates, limiting the risk of conducting large unsuccessful trials.

Abstract
A dengue human challenge model can be an important tool to identify candidate dengue vaccines that should be further evaluated in large efficacy trials in endemic areas. Dengue is responsible for about 390 million infections annually. Protective efficacy results for the most advanced dengue vaccine candidate (CYD) were disappointing despite its ability to induce neutralizing antibodies against all four dengue virus (DENV) serotypes. TV003 is a live attenuated tetravalent DENV vaccine currently in phase 2 evaluation. To better assess the protective efficacy of TV003, a randomized double-blind, placebo-controlled trial in which recipients of TV003 or placebo were challenged 6 months later with a DENV-2 strain, rDEN2Δ30, was conducted. The primary endpoint of the trial was protection against dengue infection, defined as rDEN2Δ30 viremia. Secondary endpoints were protection against rash and neutropenia. All 21 recipients of TV003 who were challenged with rDEN2Δ30 were protected from infection with rDEN2Δ30. None developed viremia, rash, or neutropenia after challenge. In contrast, 100% of the 20 placebo recipients who were challenged with rDEN2Δ30 developed viremia, 80% developed rash, and 20% developed neutropenia. TV003 induced complete protection against challenge with rDEN2Δ30 administered 6 months after vaccination. TV003 will be further evaluated in dengue-endemic areas. The controlled dengue human challenge model can accelerate vaccine development by evaluating the protection afforded by the vaccine, thereby eliminating poor candidates from further consideration before the initiation of large efficacy trials.

Vaccine
Volume 34, Issue 14, Pages 1643-1738 (29 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/14
.
Protective and immunological behavior of chimeric yellow fever dengue vaccine
Review Article
Pages 1643-1647
Scott B. Halstead, Philip K. Russell
Abstract.
Clinical observations from the third year of the Sanofi Pasteur chimeric yellow fever dengue tetravalent vaccine (CYD) trials document both protection and vaccination-enhanced dengue disease among vaccine recipients. Children who were 5 years-old or younger when vaccinated experienced a DENV disease resulting in hospitalization at 5 times the rate of controls. On closer inspection, hospitalized cases among vaccinated seropositives, those at highest risk to hospitalized disease accompanying a dengue virus (DENV) infection, were greatly reduced by vaccination. But, seronegative individuals of all ages after being vaccinated were only modestly protected from mild to moderate disease throughout the entire observation period despite developing neutralizing antibodies at high rates. Applying a simple epidemiological model to the data, vaccinated seronegative individuals of all ages were at increased risk of developing hospitalized disease during a subsequent wild type DENV infection. The etiology of disease in placebo and vaccinated children resulting in hospitalization during a DENV infection, while clinically similar are of different origin. The implications of the observed mixture of DENV protection and enhanced disease in CYD vaccinees are discussed.

Vaccine
Volume 34, Issue 14, Pages 1643-1738 (29 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/14
.
Should professionals caring for children be vaccinated? Community perspectives on health care and child care worker immunisation
Original Research Article
Pages 1726-1732
Jane Tuckerman, Natalie Thomas, Helen S. Marshall
Abstract
Objective
Several immunisations including influenza and pertussis are specifically recommended for healthcare workers (HCW) and childcare workers (CCW). This study aimed to assess community attitudes to HCW and CCW immunisation recommendations for pertussis and seasonal influenza.
Methods
A cross-sectional study was conducted by Computer Assisted Telephone Interviewing (CATI) from April to May 2011. Statistical analyses used data weighted to the South Australian population by probability of selection, age, gender and geographical location using benchmarks derived from the 2009 Census population figures.
Results
Almost all respondents supported vaccination of HCWs and CCWs against pertussis and influenza. For pertussis, 95.3% agreed nurses, 94.9% agreed doctors and 94.7% agreed CCWs have an obligation to be vaccinated. For influenza, 91.4% agreed nurses, 90.7% agreed doctors and 89.9% agreed CCWs have an obligation to be vaccinated. We identified higher support for protection against pertussis compared to influenza for all three groups of workers (p < 0.001). There were higher concerns if CCWs compared to HCWs were not vaccinated against pertussis (OR = 2.78) and influenza (OR = 1.99). Young (18–30 years) and older age (60+ years) and lower educational attainment were predictors of support for HCWs and CCWs to be vaccinated against influenza. For pertussis, lower educational attainment was a predictor of support for HCWs immunisation.
Conclusions
Community support for CCW and HCW immunisation is strong with CCW immunisation was considered a priority. Pertussis immunisation was considered a higher priority than influenza immunisation for HCWs and CCWs. CCW immunisation should be considered for inclusion in public health immunisation programmes.

Vaccine
Volume 34, Issue 14, Pages 1643-1738 (29 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/14
.
Affluence as a predictor of vaccine refusal and underimmunization in California private kindergartens
Original Research Article
Pages 1733-1738
Louise-Anne McNutt, Cristina Desemone, Erica DeNicola, Hassan El Chebib, Jessica A. Nadeau, Robert A. Bednarczyk, Jana Shaw
Abstract
Background
Non-medical vaccine exemption rates in California private schools far exceed those of public schools, but little is known about specific factors which may be associated with high exemption rates in private schools.
Methods
The percent of personal-belief exemptions (PBEs) among California public and private kindergartens were computed for 2000–2001 to 2014–2015 academic years. For the 2014–2015 academic year, a random sample of private schools was selected to investigate associations between kindergarten characteristics (tuition amount, religious affiliation) and vaccine profile (non-medical vaccine exemptions, vaccine coverage).
Results
The proportion of private kindergartens reporting 5% or more children with PBEs increased from 9% (2000–2001) to 34% (2013–2014), followed by a small decrease in 2014–2015 (31%). Overall, 93.7% (565/605) of kindergartens sampled in 2014–2015 had data available. Very high PBE levels (>20%) were seen among secular and non-Catholic, Christian kindergartens but not Roman Catholic, Jewish or Islamic kindergartens. However, the majority of schools at all tuition levels had fewer than 5% of children with a PBE. Kindergartens with an annual tuition of $10,000 or more were over twice as likely to have 20% or more children with PBEs than kindergartens with a lower tuition (p < .01). Additionally, the conditional admission proportions for kindergartens with tuitions of $10,000 or more were 39% compared to 22% for less expensive kindergartens (p < .01). Only about half of all private kindergartens had 95% coverage of the MMR (49%) and pertussis-containing vaccines (51%).
Conclusions
School-entry vaccination requirements are critical to preventing outbreaks of vaccine preventable diseases in the US. Nonmedical exemptions increased between the 2000–2001 and 2014–2015 academic years and appear to be associated with affluence, raising social justice concerns.

Chemical Engineering Research and Design
Available online 21 February 2016,
In Press, Accepted Manuscript
A review of integrated supply chain network design models: key issues for vaccine supply chains
Stef Lemmens, Catherine Decouttere, Nico Vandaele, Mauro Bernuzzi
doi:10.1016/j.cherd.2016.02.015
Highlights
:: We describe the key issues for the design of vaccine supply chains.
:: A literature review on model-based supply chain network design is conducted.
:: We study the applicability of these models to the design of vaccine supply chains.
:: The reviewed literature is insufficient to design vaccine supply chains.
Abstract
In general, vaccines are recognized as an important means to protect populations against infectious diseases. We show that vaccines do not behave like commodity goods and elaborate on the key issues for vaccine supply chain design. This paper reviews the literature on model-based supply chain network design in order to identify the applicability of these models to the key issues of the design of a vaccine supply chain. We study whether the decisions at strategic, tactical and operational levels of the reviewed literature are able to address vaccine supply chain key issues as limited shelf life, cold chain distribution and accessing remote areas. Furthermore, we provide an overview of how uncertainty is incorporated in the reviewed literature and is able to incorporate disease epidemics, tender procurement, lead time variability and demand variability. Our future vaccine supply chain network needs to be sustainable, hereby taking the preferences of different stakeholders into account for obtaining a set of economical, technological and value key performance indicators that need to be satisfied by the design. Finally, we discuss the real-life applicability of the research up to now and discuss similarities and dissimilarities of vaccine supply chains with other pharmaceutical supply chains

The Lancet Respiratory Medicine
Online First – Published Online: 14 March 2016
Effectiveness of 13-valent pneumococcal conjugate vaccine for prevention of invasive pneumococcal disease in children in the USA: a matched case-control study
MR Moore, R Link-Gelles, W Schaffner, R Lynfield…
DOI: http://dx.doi.org/10.1016/S2213-2600(16)00052-7
Summary
Background
In 2010, 13-valent pneumococcal conjugate vaccine (PCV13) was licensed and recommended in the USA for prevention of invasive pneumococcal disease in children. Licensure was based on immunogenicity data comparing PCV13 with the earlier seven-valent formulation. Because clinical endpoints were not assessed for the new antigens, we did a postlicensure matched case-control study to assess vaccine effectiveness.
Methods
Cases in children aged 2–59 months were identified through active surveillance in 13 sites. Controls were identified via birth registries and matched to cases by age and postal (zip) code. The primary objective was the vaccine effectiveness of at least one dose against the 13 serotypes included in PCV13. Secondary objectives included vaccine effectiveness against all-cause invasive pneumococcal disease, against antibiotic non-susceptible invasive pneumococcal disease, and among children with and without underlying conditions. Vaccine effectiveness was calculated as (1 – matched odds ratio) × 100%.
Findings
We enrolled 722 children with invasive pneumococcal disease and 2991 controls; PCV13 serotype cases (217 [30%]) included most commonly serotypes 19A (128 [18%]), 7F (32 [4%]), and 3 (43 [6%]). Vaccine effectiveness against PCV13 serotypes was 86·0% (95% CI 75·5 to 92·3), driven by serotypes 19A and 7F, for which vaccine effectiveness was 85·6% (95% CI 70·6 to 93·5) and 96·5% (82·7 to 100), respectively. We also identified statistically significant effectiveness against serotype 3 (79·5%, 95% CI 30·3 to 94·8) and against antibiotic non-susceptible invasive pneumococcal disease (65·6%, 44·9 to 78·7). Vaccine effectiveness against all-cause invasive pneumococcal disease was 60·2% (95% CI 46·8 to 70·3). Vaccine effectiveness was similar among children with (81·4%, 95% CI 45·4 to 93·6) and without (85·8%, 74·9 to 91·9) underlying conditions.
Interpretation
PCV13 appears highly effective against invasive pneumococcal disease among children in the USA in the context of routine and catch-up schedules, although some new vaccine antigens could not be assessed. PCV13 immunisation provides a robust strategy for combating pneumococcal antimicrobial resistance.
Funding
Centers for Disease Control and Prevention.

Clinical Cancer Research
Published Online First
March 11, 2016; doi: 10.1158/1078-0432.CCR-16-021
Hope in the Long Road Toward the Development of a Therapeutic Human Papillomavirus Vaccine
Soumaya Karaki1, Helene PERE2, Cecile Badoual3, and Eric Tartour4,*
Author Affiliations
1Immunology, INSERM U970
2VIROLOGY, HEGP
3Immunology, INSERRM U970
4Immunology, Université Paris Descartes, Sorbonne Paris Cité; INSERM U970, Paris-Cardiovascular Research Center (PARCC); AP-HP, Hôpital Européen Georges Pompidou
Abstract
A pool of long synthetic peptides derived from HPV16 proteins induce objective partial or complete histological regression of lesions in more than 50% of patients with high-grade vulvar (VuVIN3) and vaginal intraepithelial neoplasia (VaIN3). The intensity of T cell response induced by the vaccine was correlated with clinical response.

Vaccine: Development and Therapy
Published 9 March 2016 Volume 2016:6 Pages 1—8 Review
Pertussis vaccine in pregnant women: safety and uptake
Flor M Munoz
Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
Abstract:
Pertussis continues to be an important cause of morbidity and mortality in children worldwide, particularly among infants too young to be vaccinated or who are unvaccinated and unprotected by naturally acquired passive antibodies from their mothers. Vaccination of women during pregnancy with an adult formulation of acellular pertussis vaccine in combination with tetanus and diphtheria toxoids (Tdap [tetanus, reduced diphtheria and acellular pertussis vaccine]) is recommended in several industrialized countries to boost the levels of maternal antibodies that are transferred transplacentally and protect infants during the period of life when they are more likely to succumb to pertussis. Data from clinical and epidemiologic studies are supportive of the safety and effectiveness of maternal immunization with pertussis vaccines. Tdap is safe and well tolerated in pregnant women. Local and systemic reactogenicity is similar to that observed in nonpregnant adults, and no serious adverse events have been attributed to Tdap vaccination during pregnancy. Maternal antibodies elicited by the vaccine are efficiently transferred to the fetus through the placenta, and studies have consistently found that infants born to vaccinated mothers have significantly higher concentrations of pertussis antibodies than infants of nonvaccinated mothers. Although a correlate of protection against pertussis is unknown, higher concentrations of antibodies are likely to result in protection of young infants. A reduction in infant pertussis has been shown to occur when high vaccine coverage rates are achieved by pregnant women, as reported in the UK vaccination program. Furthermore, as more vaccine programs incorporate Tdap vaccination during pregnancy, prospective and epidemiologic data will be available to continuously assess the safety and efficacy of this intervention. Improving the uptake of pertussis vaccine among pregnant women remains a challenge that will require the joint effort of multiple stakeholders to improve education, access, and acceptability of the vaccine among pregnant mothers and providers.

The Oncologist
First Published Online March 9, 2016
The Human Papillomavirus Vaccine: Current Perspective and Future Role in Prevention and Treatment of Anal Intraepithelial Neoplasia and Anal Cancer
doi: 10.1634/theoncologist.2015-0075
Felix A. Mensaha,b, Mudresh R. Mehtab, James S. Lewis Jr.c,d and A. Craig Lockharte
Abstract
The incidences of human papillomavirus (HPV)-related anal cancer and its precursor lesion, anal intraepithelial neoplasia, are rising in the U.S. and globally. Five-year survival rates with current modalities of treatment for anal cancer are generally favorable for localized and regional disease. For metastatic disease, the relative survival rate is poor. Major contributing factors for the increase in anal cancer incidence include increasing receptive anal intercourse (hetero- and homosexual), increasing HPV infections, and longer life expectancy of treated people who are seropositive for human immunodeficiency virus. Because treatment outcomes with systemic therapy in patients with advanced disease are so poor, prevention may be the best approach for reducing disease burden. The association of a major causative agent with anal cancer provides an excellent opportunity for prevention and treatment. The advent of the HPV vaccine for anal cancer prevention and treatment is a significant milestone and has the potential to greatly impact these cancers. The data regarding potential use of the HPV vaccine in anal cancer prevention and treatment are reviewed.

Implications for Practice:
The incidences of human papillomavirus (HPV)-related anal cancer and its precursor lesion, anal intraepithelial neoplasia, are on the rise in the U.S. and globally. Based on recent studies, the HPV vaccine is approved for prevention of the infection and development of HPV-related anal cancer. In addition, several small studies have shown that the vaccine may be useful as adjuvant therapy for anal cancer. There is a need for public health strategies aimed at education of both patients and practitioners to improve the use of the vaccine for prevention of HPV-related anal cancer. The development of a therapeutic vaccine is a work in progress

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 19 March 2016
Published Date
17 Mar 2016
Muslim mother overruled in ‘vaccine containing pork’ case
News London
A British Muslim who refused to immunise her children on religious grounds has been overruled by a judge.
The mother-of-four said her children should not be immunised with the vaccines as they contain pork gelatin.
Judge Carol Atkinson said it transpired there was no pork in the vaccines.
The children have been taken into care by the London Borough of Newham and have been directed to live in London with their father who is separated from his wife…

.

Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 19 March 2016
Business
GlaxoSmithKline Says Andrew Witty to Retire as CEO
By Denise Roland, Sarah Kent
March 17, 2016 4:30 pm ET

.

Washington Post
http://www.washingtonpost.com/
Accessed 19 March 2016
A toddler got meningitis. His anti-vac parents gave him an herbal remedy. The toddler died. Now his parents are on trial.
“There’s nothing in the world that will bring him back,” David Stephan said of his late son, Ezekiel. “What good could possibly come out of this?”
Michael E. Miller | National | Mar 18, 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_12 March 2016

– blog edition: comprised of the approx. 35+ entries posted below on 13 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 12 March 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

.
WHO and experts prioritize vaccines, diagnostics and innovative vector control tools for Zika R&D
67 groups working on experimental products
Note for the media [Editor’s text bolding]
9 March 2016
After a three-day consultation on Zika research and development, international experts, convened by WHO, have agreed on top priorities to advance R&D for Zika medical products.

The following tools were prioritized as the most viable options to help fight the spread of Zika virus in the immediate future:
:: Multiplex tests for ‘flaviviruses’ (viruses related to Zika, such as dengue, chikungunya), in addition to more traditional tests;
:: protective vaccines based on killed virus (or other non-live) preparations for women of childbearing age; and
:: innovative vector control tools that reduce the mosquito population.

“Zika virus induces a mild and mostly harmless infection in the majority of patients,” indicated Dr Marie-Paule Kieny, Assistant Director-General in charge of R&D at WHO. “For that reason medicines to treat it seem less of a priority at this stage. The most pressing need is the development of diagnostic and preventive tools to address the current R&D gap and protect pregnant women and their babies.”

As of 2 March, 67 companies and research institutions were already working on a number of products (31 on diagnostics, 18 on vaccines, 8 on therapeutics, 10 on vector control), which are at various stages of early development. No vaccine or therapeutic has yet been tested on humans.

Vaccines
Experts agreed that the development of a vaccine is a major priority to respond to epidemics in the future. Vaccination of pregnant women and women of childbearing age is the main target, and pragmatic strategies will be needed to fast-track the development of a safe and effective product.

Work is underway for the development of an emergency vaccine target product profile. The target product profile will serve as a guide to consult and build consensus on regulatory requirements for Zika vaccine evaluation and registration. A draft target profile will be submitted to a public consultation in the coming weeks, with a view to having a final profile in May.

Diagnostics
Over 30 companies are working on or have developed potential diagnostic tests. There is general support for the development of a target product profile for a multiplex test that can diagnose dengue, chikungunya and Zika viruses. A first draft is ready and this too will undergo public consultation before finalization in mid-April.
WHO continues to encourage manufacturers to apply to the WHO Emergency Use, Assessment and Listing procedure for a quality and performance evaluation of their products…
:: Emergency use assessment and listing procedure for Zika virus disease

,
WHO statement on the 2nd meeting of IHR Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations
WHO statement
8 March 2016
The second meeting of the Emergency Committee (EC) convened by the Director-General under the International Health Regulations (2005) (IHR 2005) regarding clusters of microcephaly cases and other neurological disorders in some areas affected by Zika virus was held by teleconference on 8 March 2016, from 13:00 to 16:45 Central European Time.

The WHO Secretariat briefed the Committee on action in implementing the Temporary Recommendations issued by the Director-General on 1 February 2016, and on clusters of microcephaly and Guillain-Barré Syndrome (GBS) that have had a temporal association with Zika virus transmission. The Committee was provided with additional data from observational, comparative and experimental studies on the possible causal association between Zika virus infection, microcephaly and GBS.

The following States Parties provided information on microcephaly, GBS and other neurological disorders occurring in the presence of Zika virus transmission: Brazil, Cabo Verde, Colombia, France, and the United States of America.

The Committee noted the new information from States Parties and academic institutions in terms of case reports, case series, 1 case control study (GBS) and 1 cohort study (microcephaly) on congenital abnormalities and neurologic disease in the presence of Zika virus infection. It reinforced the need for further work to generate additional evidence on this association and to understand any inconsistencies in data from countries. The Committee advised that the clusters of microcephaly cases and other neurological disorders continue to constitute a Public Health Emergency of International Concern (PHEIC), and that there is increasing evidence that there is a causal relationship with Zika virus.

The Committee provided the following advice to the Director-General for her consideration to address the PHEIC, in accordance with IHR (2005).

Microcephaly, other neurological disorders and Zika virus
:: Research into the relationship between new clusters of microcephaly, other neurological disorders, including GBS, and Zika virus, should be intensified.
:: Particular attention should be given to generating additional data on the genetic sequences and clinical effect of different Zika virus strains, studying the neuropathology of microcephaly, conducting additional case-control and cohort studies in other and more recently infected settings, and developing animal models for experimental studies.
:: Research on the natural history of Zika virus infection should be expedited, including on the rates of asymptomatic infection, the implications of asymptomatic infection, particularly with respect to pregnancy, and the persistence of virus excretion.
:: Retrospective and prospective studies of the rates of microcephaly and other neurological disorders should be conducted in other areas known to have had Zika virus transmission but where such clusters were not observed.
:: Research should continue to explore the possibility of other causative factors or co-factors for the observed clusters of microcephaly and other neurological disorders.
:: To facilitate this research and ensure the most rapid results:
:::: surveillance for microcephaly and GBS should be standardized and enhanced, particularly in areas of known Zika virus transmission and areas at risk,
:::: work should begin on the development of a potential case definition for ‘congenital Zika infection’,
:::: clinical, virologic and epidemiologic data related to the increased rates of microcephaly and/or GBS, and Zika virus transmission, should be rapidly shared with the World Health Organization to facilitate international understanding of the these events, to guide international support for control efforts, and to prioritize further research and product development.

Surveillance
:: Surveillance for and notification of Zika virus infection should be enhanced with the dissemination of standard case definitions and diagnostics to areas of transmission and at-risk areas; newly infected areas should undertake the vector control measures outlined below.

Vector control
:: Vector surveillance, including the determination of mosquito vector species and their sensitivity to insecticides, should be enhanced to strengthen risk assessments and vector control measures.
:: Vector control measures and appropriate personal protective measures should be aggressively promoted and implemented to reduce the risk of exposure to Zika virus.
:: Countries should strengthen vector control measures in the long term and the Director-General of WHO should explore the use of IHR mechanisms, and consider bringing this to a forthcoming World Health Assembly, as means to better engage countries on this issue.

Risk communication
:: Risk communication should be enhanced in countries with Zika virus transmission to address population concerns, enhance community engagement, improve reporting, and ensure application of vector control and personal protective measures.
:: These measures should be based on an appropriate assessment of public perception, knowledge and information; the impact of risk communication measures should be rigorously evaluated to guide their adaptation and improve their impact.
:: Attention should be given to ensuring women of childbearing age and particularly pregnant women have the necessary information and materials to reduce risk of exposure.
:: Information on the risk of sexual transmission, and measures to reduce that risk, should be available to people living in and returning from areas of reported Zika virus transmission.

Clinical care
:: Pregnant women who have been exposed to Zika virus should be counselled and followed for birth outcomes based on the best available information and national practice and policies,
:: In areas of known Zika virus transmission, health services should be prepared for potential increases in neurological syndromes and/or congenital malformations.

Travel measures
:: There should be no general restrictions on travel or trade with countries, areas and/or territories with Zika virus transmission.
:: Pregnant women should be advised not travel to areas of ongoing Zika virus outbreaks; pregnant women whose sexual partners live in or travel to areas with Zika virus outbreaks should ensure safe sexual practices or abstain from sex for the duration of their pregnancy.
:: Travellers to areas with Zika virus outbreaks should be provided with up to date advice on potential risks and appropriate measures to reduce the possibility of exposure to mosquito bites and, upon return, should take appropriate measures, including safe sex, to reduce the risk of onward transmission.
:: The World Health Organization should regularly update its guidance on travel with evolving information on the nature and duration of risks associated with Zika virus infection.
:: Standard WHO recommendations regarding vector control at airports should be implemented in keeping with the IHR (2005). Countries should consider the disinsection of aircraft.

Research & product development
:: The development of new diagnostics for Zika virus infection should be prioritized to facilitate surveillance and control measures, and especially the management of pregnancy.
:: Research, development and evaluation of novel vector control measures should be pursued with particular urgency.
:: Research and development efforts should also be intensified for Zika virus vaccines and therapeutics in the medium term.

Based on this advice the Director-General declared the continuation of the Public Health Emergency of International Concern (PHEIC). The Director-General endorsed the Committee’s advice and issued them as Temporary Recommendations under IHR (2005). The Director-General thanked the Committee Members and Advisors for their advice.

.
Zika virus, Microcephaly and Guillain-Barré syndrome – 10 March 2016
WHO Situation Report: Read the full situation report
Summary
:: The second meeting of the Emergency Committee was convened by the Director-General under the International Health Regulations (2005) on 8 March 2016. The Committee advised that the clusters of microcephaly cases and other neurological disorders in some areas affected by Zika virus continue to constitute a Public Health Emergency of International Concern, and that there is increasing evidence that there is a causal relationship with Zika virus.

:: Between 1 January 2007 and 9 March 2016, a total of 52 countries and territories have reported autochthonous (local) transmission or indication of transmission of Zika virus (41 since 1 January 2015). The Philippines is the latest to report autochthonous transmission of Zika virus. Five of these countries and territories reported a Zika virus outbreak that is now over. In addition, three countries 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 31 countries and territories of this region.

:: So far an increase in microcephaly and other neonatal malformations has only been reported in Brazil and French Polynesia, although two cases linked to a stay in Brazil were detected in the United States of America and Slovenia. Reported cases of microcephaly and/or congenital malformation in Colombia are under investigation.

:: In the context of Zika virus circulation, nine 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.

:: A recently published cohort study in Brazil shows an increased risk of microcephaly and other congenital abnormalities associated with a Zika virus infection during pregnancy and provides further information to support the possible causal relationship between Zika virus and microcephaly and other congenital abnormalities.

:: 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.

.
Disease Outbreak News (DONs)
:: 7 March 2016 – Guillain-Barré syndrome – France – French Polynesia
:: 7 March 2016 – Zika virus infection – Argentina and France

.
Guidance for health workers
:: Protecting the health and safety of workers in emergency vector control of Aedes mosquitoes
11 March 2016
:: Monitoring and managing insecticide resistance
8 March 2016

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

.
CDC/ACIP [to 12 March 2016]
http://www.cdc.gov/media/index.html
FRIDAY, MARCH 11, 2016
CDC’s revised travel notices estimate Zika risk using elevation information
Mosquitoes linked to Zika virus not likely in areas above 6,500 feet (2,000 meters)
CDC travel alerts for destinations where Zika is spreading will now include recommendations specific to travel at elevations above and below 6,500 feet (2,000 meters). As a result of these changes, CDC’s regional notices have been revised to destination-specific notices.

Starting in January 2016, CDC issued level 2 travel health notices for several countries where local vector-borne transmission of Zika virus infection has been reported. Local vector-borne transmission means that mosquitoes in an area are infected with Zika virus and are spreading it to people. Specific areas with Zika are often difficult to determine and are likely to change over time. As more information becomes available, travel notices are updated.

CDC today released 37 destination-specific Zika travel notices; for destinations with areas above 6,500 feet, the notices include elevation maps and additional information about the risk of Zika virus infection at these elevations. CDC recently examined historical reports of the mosquito species linked to Zika and dengue virus, which is spread by the same mosquito, and found that reports of both mosquitoes and dengue were rare for locations above 6,500 feet.

These new maps show, for each country, the areas above and below 6,500 feet. The maps are intended to help travelers determine if the location(s) they plan to visit are above the elevation at which the mosquitos are likely to be found. Travelers whose itineraries are limited to areas above 6,500 feet are at minimal risk of getting Zika from a mosquito…

FRIDAY, MARCH 11, 2016
Transcript for CDC Telebriefing: Updates on Zika response efforts
Audio recording[MP3, 3.10 MB]

THURSDAY, MARCH 10, 2016
Updates on Zika response efforts
CDC Director Tom Frieden traveled to Puerto Rico March 7-9 to assess firsthand CDC’s support for the Zika response.

WEDNESDAY, MARCH 9, 2016
CDC adds 1 destination to interim travel guidance related to Zika virus
CDC is working with other public health officials to monitor for ongoing Zika virus? transmission. Today, CDC added the following destination to the Zika virus travel notices: New Caledonia.

.
MMWR March 11, 2016 / Vol. 65 / No. 9
:: Increase in Reported Prevalence of Microcephaly in Infants Born to Women Living in Areas with Confirmed Zika Virus Transmission During the First Trimester of Pregnancy — Brazil, 2015

.
FDA [to 12 March 2016]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
Posted: 3/11/2016
Questions and Answers Regarding – Recommendations for Donor Screening, Deferral, and Product Management to Reduce the Risk of Transfusion-Transmission of Zika Virus: Guidance for Industry (PDF – 310KB)

EBOLA/EVD [to 12 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]

.
MMWR March 11, 2016 / Vol. 65 / No. 9
:: Evaluation of a National Call Center and a Local Alerts System for Detection of New Cases of Ebola Virus Disease — Guinea, 2014–2015

.
African Development Bank Group [to 12 March 2016]
http://www.afdb.org/en/news-and-events/press-releases/
07/03/2016
AfDB releases new report on the impact of Ebola on women
On the occasion of International Women’s Day, March 8, 2016, the Office of the African Development Bank’s Special Envoy on Gender, Geraldine Fraser-Moleketi, has launched a report on “Women’s Resilience: Integrating Gender in the Response to Ebola.”…

…The report investigates the futility of trying to build resilience to Ebola and future infectious disease shocks in households and communities without also addressing systemic gender inequality. Factors that entrench vulnerability for the entire population must be addressed in the immediate response, medium-term mitigation and long-term intervention. The gender effects of Ebola in the region are influenced by the skills and strategies used prior to the outbreak, and the mechanisms individuals used to cope and adapt differ.

The report also highlights that the lack of gender disaggregated data should not limit interventions, and that all efforts must be made to collect the relevant information to combat the inequalities underscored by disease outbreaks now. The insights contained in this report are not only invaluable for dealing with other epidemics, but may also assist in the prevention of further outbreaks.

One of the recommendations of the report was to establish a Social Investment Fund. The AfDB has since invested $33 million into the Post-Ebola Social Investment Fund, a project supported by the US State Department…

POLIO [to 12 March 2016]
Public Health Emergency of International Concern (PHEIC)

.
Polio this week as of 9 March 2016
:: 8 March marked International Women’s Day – a great opportunity to thank the many thousands of women who have been instrumental in the progress of polio eradication around the world. Read more here.
:: A new short film shown at the Ministerial Conference on Immunization in Africa demonstrates the value of the polio infrastructure in serving broader health goals. Watch the video here.
:: There are six weeks to go until the globally synchronized switch from the trivalent to bivalent oral polio vaccine.
Selected Country Levels Updates [excerpted]
Afghanistan
:: The first case of wild poliovirus type 1 (WPV1) in 2016 was reported in the past week, in the district Shigal Wa Sheltan in Kunar province, with onset of paralysis on 1 February.
Lao People’s Democratic Republic
:: Two new cases of circulating vaccine-derived poliovirus type 1 (cVDPV1) were reported in the past week, in the districts of Phonhong and Muen of Vientiane province, with onset of paralysis on 18 October 2015 and 3 January 2016 respectively. The total number of cVDPV1 cases in 2015 is now 8 and in 2016 is now 3.
:: An emergency outbreak response is continuing in the country, with particular focus on three high-risk provinces.
:: Efforts continue to further strengthen surveillance activities in all provinces of the country, to assure that no cVPDV1 transmission is missed anywhere.
:: Sub-National Immunization Days (SNIDs) are planned for March using tOPV. Both campaigns are targeting an expanded age group of children up to the age of 15 years.-

.
WHO: Women working for polio eradication in Pakistan
9 March 2016 – Women are at the centre of the polio eradication effort in Pakistan. Thousands of women: vaccinators, lady health workers, social mobilizers, union council polio workers, area coordinators, polio eradication officers work with communities every day to deliver vital immunizations against polio and other vaccine preventable diseases….

…In many parts of Pakistan, and indeed in parts of Noorjahan’s area, male vaccinators cannot enter the home to deliver vaccine to children during immunization days. Noorjahan says that being a woman she doesn’t face the same cultural barriers.

…Recruiting more female social mobilizers and vaccinators has proven to be one of the most innovative solutions to respond to the challenges in reaching every child in Pakistan. There are more than 177 000 vaccinators working in teams across Pakistan, 58% of whom are females. Thousands more women support vaccination as social mobilizers…

WHO & Regionals [to 12 March 2016]

WHO SAGE Meeting
Geneva: 12 – 14 April 2016.
Draft agenda pdf, 200kb – As of 15 February 2016

.
Weekly Epidemiological Record (WER) 11 March 2016, vol. 91, 10 (pp. 121–132)
Contents:
121 Recommended composition of influenza virus vaccines for use in the 2016–2017 northern hemisphere influenza season

.
Disease Outbreak News (DONs)
:: 10 March 2016 – Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
:: 10 March 2016 – Middle East respiratory syndrome coronavirus (MERS-CoV) – Qatar
:: 10 March 2016 – Dengue Fever – Uruguay
:: 7 March 2016 – Guillain-Barré syndrome – France – French Polynesia
:: 7 March 2016 – Zika virus infection – Argentina and France

.
More than numbers: how better data is changing health systems
March 2016
The Health Data Collaborative, launched by WHO and partner development agencies, countries, donors and academics, will strengthen countries’ capacity to collect, analyse and use reliable health data, thereby reducing administrative burden. A list of 100 core health indicators has been produced, and 60 low income and lower-middle income countries, and their supporting donors, will be using common investment plans to strengthen their health information systems by 2024.
:: Health Data Collaborative website
Editor’s Note:
The core health indicator referencing immunization is here:
Pdf: Immunization coverage rate by vaccine for each vaccine in the national schedule

.
WHO Highlights
Fukushima five years on
March 2016 — On 11 March 2011, a magnitude 9 earthquake occurred off the east coast of Japan, generating a tsunami that severely damaged coastal areas. These 10 questions and answers address WHO’s current response and next steps to mitigate the public health impact of the Fukushima accident.

Planet 50-50 by 2030: Step It Up for Gender Equality
March 2016 — This year’s International Women’s Day focuses on accelerating the 2030 Sustainable Development Agenda, especially goal number 5 – Achieve gender equality and empower all women and girls and goal 4 – Ensure inclusive and quality education for all and promote lifelong learning.

Consultation for adolescent health
March 2016 — In response to the health needs of adolescents, WHO and partners are developing a Global Framework for Accelerated Action for the Health of Adolescents (the Global AA-HA! Framework). Initial input is now requested from governments, civil society, the private sector, academia, youth groups and citizens.

.

:: WHO Regional Offices
WHO African Region AFRO
:: Angola immunizes 6.7 million people against yellow fever
WHO experts remain at the frontline Luanda, 9 March 2016 – Angolan health authorities and national and international partners continue making tireless efforts to immunize 6.7 million people in Luanda Province and to stop the yellow fever outbreak the country has been facing since December 2015.WHO is supporting the procurement of 7.4 million doses of vaccine that will allow the vaccination of the entire population of Luanda above the age of 6 months.

WHO Region of the Americas PAHO
:: PAHO and OAS partner with University of Miami to offer online courses on good research practices and standards (03/11/2016)
:: Scientists studying intensified vector control measures to combat Zika, dengue and chikungunya in the Americas (03/11/2016)
:: Misión de la OPS en El Salvador destaca oportunidad del país para aportar a la investigación internacional sobre el zika (03/11/2016)
:: International mission convened by PAHO visits El Salvador to exchange experiences and support the response to Zika (03/08/2016)

WHO South-East Asia Region SEARO
:: Media statement on International Women’s Day 8 March 2016

WHO European Region EURO
:: E-health in practice 10-03-2016
:: E-health – when, not if 10-03-2016
:: Outcome of the 2nd meeting of IHR Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations 09-03-2016
:: Towards a European strategy for women’s health 08-03-2016

WHO Eastern Mediterranean Region EMRO
:: Yemen’s national oncology centre struggles to continue functioning
10 March 2016 – In late 2015, the national oncology centre in Yemen appealed to the humanitarian community and international bodies to save cancer care services in Yemen from the brink of complete collapse. They warned of the looming health disaster brought about by lack of life-saving chemotherapy drugs, laboratory reagents, and even simple pain killers. The lack of availability of medicines and diagnostic supplies is a direct result of the defacto blockade on Yemen since March 2015, which shows few signs of lifting. Since its establishment in 2005, the national oncology centre has diagnosed and treated more than 60 000 patients.
:: Women working for polio eradication in Pakistan 9 March 2016

WHO Western Pacific Region
:: International Women’s Day 2016: Stand up against gender-based violence
8 March 2016 —Violence affects women and girls in epidemic proportions across the Western Pacific Region – with severe consequences for their health and well-being. Women and girls are at greatest risk of violence in their homes from someone they know. On International Women’s Day (8 March), the World Health Organization (WHO) enjoins everyone to protect and promote gender equality and women’s empowerment.

UNICEF [to 12 March 2016]
http://www.unicef.org/media/media_89711.html

.
News note
JUBA, South Sudan, 11 March 2016
Race for survival as South Sudan’s children struggle in forgotten crisis
Humanitarian funding for the world’s youngest country has collapsed, UNICEF said today, putting the lives of tens of thousands of children at risk.

Despite an urgent request by UNICEF in South Sudan for US$155 million in 2016 to support lifesaving interventions such as malnutrition treatment, health care and clean water to support the over 5 million children affected by the crisis, just $27 million – 18 per cent of the appeal – has been received to date.

The gap – some $128 million – will mean 3.3 million children will not be vaccinated against measles, 260,000 children affected by conflict will not be supported to return to school, and efforts to reunify 7,300 separated children with their families will be halted. Essential nutrition supplies will run out in August…

Gavi [to 12 March 2016]
http://www.gavialliance.org/library/news/press-releases/

.
09 March 2016
Pakistan progressing on immunisation efforts
High level mission praises country’s efforts and calls for increased commitment to reach every child
Islamabad, 9 March 2016 – Pakistan is making progress in improving its childhood immunisation programme, but sustained commitment at federal and provincial level is required to increase the coverage of services and reach children who today miss out on life-saving vaccines.

More than 1,000 Pakistani children under the age of five die every day, many of them from diseases that could have been prevented by vaccines. According to WHO and UNICEF estimates, Pakistan’s coverage rate with one of the most basic vaccines (DTP3) stood at 73% in 2014 with large variations between the provinces, districts and communities. The most recent Pakistan Demographic Health Survey, from 2013, showed Punjab had 76% coverage while in Baluchistan the figure was just 27%.

This week, a high level mission to Pakistan was led by Anuradha Gupta, Deputy CEO of Gavi, the Vaccine Alliance, together with the Bill & Melinda Gates Foundation, the UK’s Department for International Development, USAID, the Norwegian Agency for Development and Cooperation, UNICEF and WHO. The visit was a follow up to a similar mission conducted in February 2015. The delegation visited Islamabad, Lahore and Karachi to see the progress made in the last 12 months, understand the challenges that lie ahead, and encourage leaders to reinforce their commitment to end childhood vaccine preventable deaths.

“I have been deeply encouraged by much of what I have seen during this visit,” said Ms Gupta. “Coordination at federal and provincial level has clearly improved and I have seen for myself some of the innovative work at local level to reach children with vaccines. This week’s approval of the budget for the new provincial plans, which will kick-start the National Immunisation Support Project, is welcome news as it paves the way for intensified action on routine immunisation. Timely release of funding at all levels will be a critical next step.”

Among the initiatives witnessed by the mission was a recently-expanded approach using mobile phone technology and real-time data to monitor vaccinators, identify children missing out on vaccinations, and strengthen accountability. In Punjab this has significantly increased immunisation coverage. Similar approaches are now being initiated in KP and Sindh….

IVAC [International Vaccine Access Center] [to 12 March 2016]
http://www.jhsph.edu/research/centers-and-institutes/ivac/about-us/news.html

.
White paper
Rotavirus: Common, Severe, Devastating, Preventable
ROTA Council
Posted on March 7, 2016
Overview
The ROTA Council white paper Rotavirus: Common, Severe, Devastating, Preventable is the most comprehensive and up-to-date source of information on rotavirus disease and vaccines.

The 50-page synthesis includes the latest evidence and programmatic information about:
:: Rotavirus disease, and why every child is vulnerable
:: Vaccines in global use, nationally available vaccines, and new vaccines on the horizon
WHO recommendations and key guidance on vaccine administration
:: Public health impact in high-income countries, middle-income countries, and low-income countries
:: Cost-effectiveness of rotavirus vaccines
:: Emerging data and areas for further research
:: 21 recommendations for stakeholders to scale up coverage of rotavirus vaccines to all children
Download the Executive Summary.
Download the full report: Rotavirus: Common, Severe, Devastating, Preventable

.

[Undated]
Rwanda Study Demonstrates the Benefits of Routine Vaccination Against Rotavirus in Low-Income Settings
A new study published in February’s edition of the Lancet Global Health offers significant findings about the impact of pentavalent rotavirus vaccine on hospital admission for diarrhea and rotavirus in children in Rwanda, which in 2012 became the first low-income African country to introduce pentavalent rotavirus vaccine into its national immuniation program. Researchers from Rwanda’s Ministry of Health, CDC, WHO, and partner organizations examined trends in pediatric hospital admissions from 2009 to 2014 and looked at other epidemiological evidence from the country.

The study showed hospital admissions for acute gastroenteritis decreased by about half (48-49%) and admissions specific to rotavirus declined by 61-70% following introduction of rotavirus vaccine in the routine national immunization program. The greatest effect was recorded in children of vaccination age, but researchers noted a decrease in rotavirus diarrhea hospitalizations in almost every age group, suggesting herd immunity. Indirect protection of children too old to have been vaccinated has been previously reported in high-income and middle-income countries including the USA, Australia, and El Salvador, but this paper provides the first evidence of indirect protection from rotavirus vaccination in a high-burden, low-income setting.

This paper provides strong evidence of the public health impact of introducing rotavirus vaccine nationally in low-income settings, and the first data demonstrating the impact of routine pentavalent rotavirus vaccination in Africa. The reductions in hospital admissions for diarrhea noted in Rwanda is similar to decreases recorded after national rotavirus vaccine introductions in Brazil, Mexico, and Panama.

European Medicines Agency [to 12 March 2016]
http://www.ema.europa.eu/

.
07/03/2016
Launch of PRIME – Paving the way for promising medicines for patients
New scheme supports European Commission priorities
The European Medicines Agency (EMA) launches today its new PRIME (PRIority MEdicines) scheme to strengthen support to medicines that target an unmet medical need. The scheme focuses on medicines that may offer a major therapeutic advantage over existing treatments, or benefit patients with no treatment options. These medicines are considered priority medicines within the European Union (EU).

Through PRIME, EMA offers early, proactive and enhanced support to medicine developers to optimise the generation of robust data on a medicine’s benefits and risks and enable accelerated assessment of medicine applications. This will help patients to benefit as early as possible from therapies that may significantly improve their quality of life.

By engaging with medicine developers early, PRIME aims to strengthen clinical trial designs to facilitate the generation of high quality data for the evaluation of an application for marketing authorisation. Early dialogue and scientific advice also ensure that patients participate in trials that are likely to provide the necessary data for an application for marketing authorisation, and help to make best use of limited resources.

“The launch of PRIME is a major step forward for patients and their families that have long been hoping for earlier access to safe treatments for their unmet medical needs, such as rare cancers, Alzheimer’s disease and other dementias,” says Vytenis Andriukaitis, EU Commissioner for Health and Food Safety. “Through enhanced scientific support this scheme could also help, for example, to accelerate the development and authorisation of new classes of antibiotics or their alternatives in an era of increasing antimicrobial resistance.” The Commissioner also highlights that PRIME optimises the use of the current regulatory framework that can contribute to the European Commission’s priorities in terms of boosting innovation, jobs, growth and competitiveness.

“Our goal is to foster better planning of medicine development to help companies generate the high quality data we need to assess quality, safety and efficacy of medicines,” explains Professor Guido Rasi, EMA’s Executive Director. “Patients with no or insufficient treatments could then benefit from scientific progress and cutting edge medicines as soon as possible.”…

Global Fund [to 12 March 2016]
http://www.theglobalfund.org/en/news/

.
News
Removing Human Rights Barriers to End the HIV Epidemic
11 March 2016
GENEVA – The Global Fund made a strong appeal to address human rights issues as a key component of efforts to end epidemics such as AIDS, tuberculosis and malaria.

“To end HIV, we must overcome discrimination in laws and policies, in practice and in our hearts,” Mark Dybul, Executive Director of the Global Fund, said at a session of the United Nations Human Rights Council. “We must grasp the historic opportunity to become better people and societies built on the firm foundation of an inclusive human family.”

Despite extraordinary progress against HIV in the last decade, human rights barriers are preventing millions of people from being able to access prevention, treatment and care, Dr. Dybul said. In order to maximize health investments and achieve greater impact, the global community needs to do more to overcome these barriers, including by increasing investment in programs to fight stigma and discrimination, reduce violence against women, provide access to justice, and sensitize law-makers and law enforcement officials, Dr. Dybul said.

“We need to do better on removing human rights barriers, because it is the right thing to do, and because it is essential to our efforts to invest more strategically to end HIV,” he added.
Dr. Dybul spoke at a panel discussion on progress and challenges of addressing human rights issues in the context of efforts to end the HIV epidemic, as part of a current session of the Human Rights Council that is underway in Geneva this month.

Dr. Dybul pointed out that in many settings, the impact of investments in health is greatly reduced because of human rights-related barriers to services. In many countries, women and girls often do not access testing and treatment, or are not retained in treatment, because of stigma and discrimination and gender-based violence. Men who have sex with men, people who use drugs, sex workers, transgender people, migrants, and prisoners also often cannot access prevention and treatment because of the discrimination they experience in health-care settings, or the violence perpetrated by police.

The Global Fund partnership was founded with a strong commitment to advancing human rights. Dr. Dybul said the Global Fund had learned from the work done in recent years, and that it was intensifying efforts. The Global Fund’s new investment strategy, for 2017-2022, lists as one of its main objectives to “introduce and scale up programs that remove human rights barriers to accessing services”.

In this sense, Dr. Dybul said the Global Fund will concentrate efforts on 15 to 20 countries with particular needs and opportunities.

The target in these countries will be to implement comprehensive programs to address human rights-related barriers. This will result in increased uptake of and retention in services, thanks to decreased stigma and discrimination, particularly in health-care settings; increased access to justice; reduction of violence and discrimination against women and girls; greater support among law enforcement officials for prevention and treatment services; a more conducive policy environment; and strengthened participation of affected persons in programs linked to these interventions.
.
Better Education Will Mean Better Health for Young Women & Girls
By Julia Gillard
in Voices on 07 March 2016

Industry Watch [to 12 March 2016]
.
March 08, 2016 08:00 AM Eastern Standard Time
Sanofi Pasteur and Merck (Known as MSD Outside the United States and Canada) Announce Intent to End Joint Vaccines Operations in Europe, Sanofi Pasteur MSD, to Pursue Their Own Distinct Growth Strategies

KENILWORTH, N.J. & LYON, France–(BUSINESS WIRE)–Sanofi Pasteur and Merck, known as MSD outside the United States and Canada, today announced their intent to end their joint vaccines operations in Europe. Upon concluding their joint venture, both companies plan to integrate their respective European vaccine businesses into their operations, independently manage their product portfolios and pursue their own distinct growth strategies in Europe.

The joint venture Sanofi Pasteur MSD, owned on a 50/50 basis by Sanofi Pasteur and MSD, was created in 1994 to develop and commercialize vaccines originating from both companies’ pipelines to improve and promote public health in 19 European countries. Over the past twenty years, Sanofi Pasteur MSD has launched numerous innovative vaccines originating from Sanofi Pasteur and MSD’s development pipelines, addressing key unmet medical needs and helping to protect millions of lives.

Sanofi Pasteur and MSD jointly issued the following statement: “We are proud of Sanofi Pasteur MSD’s successful 20-year history. Our joint venture has achieved considerable success over the past two decades from a public health and commercial perspective. After carefully considering our individual strategic priorities, alongside the economic and regulatory environments for vaccine operations in the European Union, we have mutually agreed that it is in our best interests to manage our vaccine product portfolios independently. We believe that focusing our efforts on opportunities unique to our respective companies will better position us to drive growth, execute in a more efficient manner and optimize vaccine coverage. By bringing vaccines more rapidly to market, both companies would deliver greater value to all stakeholders.”

Sanofi Pasteur and MSD will ensure that any impact on employees as a result of the proposed changes to the business model will be managed responsibly. We are also focused on a smooth and orderly transition while achieving our public healthcare goals and upholding our commitments to our customers and business partners.

Sanofi Pasteur and MSD expect the project to be completed by the end of 2016, subject to local labor laws and regulations and regulatory approvals.