Bulletin of the World Health Organization – Volume 94, Number 3, March 2016, 157-232

Bulletin of the World Health Organization
Volume 94, Number 3, March 2016, 157-232
http://www.who.int/bulletin/volumes/94/3/en/

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EDITORIALS
Data sharing in public health emergencies: a call to researchers
Christopher Dye, Kidist Bartolomeos, Vasee Moorthy & Marie Paule Kieny
http://dx.doi.org/10.2471/BLT.16.170860

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Measuring quality-of-care in the context of sustainable development goal 3: a call for papers
Yoko Akachi, Finn Tarp, Edward Kelley, Tony Addison & Margaret E Kruk
http://dx.doi.org/10.2471/BLT.16.170605

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Research
POLICY & PRACTICE
Psychosocial effects of an Ebola outbreak at individual, community and international levels
Tine Van Bortel, Anoma Basnayake, Fatou Wurie, Musu Jambai, Alimamy Sultan Koroma, Andrew T Muana, Katrina Hann, Julian Eaton, Steven Martin & Laura B Nellums
http://dx.doi.org/10.2471/BLT.15.158543

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PERSPECTIVES
A new global agenda for nutrition and health: the importance of agriculture and food systems
Andrew D Jones & Gebisa Ejeta
http://dx.doi.org/10.2471/BLT.15.164509

 

Toward Earlier Inclusion of Pregnant and Postpartum Women in Tuberculosis Drug Trials: Consensus Statements From an International Expert Panel

Clinical Infectious Diseases (CID)
Volume 62 Issue 6 March 15, 2016
http://cid.oxfordjournals.org/content/current

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VIEWPOINTS
Toward Earlier Inclusion of Pregnant and Postpartum Women in Tuberculosis Drug Trials: Consensus Statements From an International Expert Panel
Amita Gupta, Jyoti S. Mathad, Susan M. Abdel-Rahman, Jessica D. Albano, Radu Botgros,
Vikki Brown, Renee S. Browning, Liza Dawson, Kelly E. Dooley, Devasena Gnanashanmugam,
Beatriz Grinsztejn, Sonia Hernandez-Diaz, Patrick Jean-Philippe, Peter Kim, Anne D. Lyerly,
Mark Mirochnick, Lynne M. Mofenson, Grace Montepiedra, Jeanna Piper, Leyla Sahin, Radojka Savic, Betsy Smith, Hans Spiegel, Soumya Swaminathan, D. Heather Watts, and Amina White
Clin Infect Dis. (2016) 62 (6): 761-769 doi:10.1093/cid/civ991

Consensus statements from an expert panel to include pregnant and postpartum women in tuberculosis drug trials note high-priority research areas: preventing latent tuberculosis infection progression; evaluating new drugs for multidrug-resistant tuberculosis; and safety and pharmacokinetic data for current tuberculosis drugs.

Pneumococcal vaccination

Current Opinion in Infectious Diseases
April 2016 – Volume 29 – Issue 2 pp: v-v,99-228
http://journals.lww.com/co-infectiousdiseases/pages/currenttoc.aspx

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RESPIRATORY INFECTIONS
Pneumococcal vaccination
Cillóniz, Catia; Amaro, Rosanel; Torres, Antoni
Abstract
Purpose of review: Pneumococcal diseases (invasive diseases, pneumonia, otitis media, and sinusitis) are among the most frequent preventable infectious diseases carrying a very high morbidity and case fatality rate worldwide. Pneumococcal vaccination is a key element to reduce the global burden of the disease in children and adult population. Our aim is to discuss current knowledge of the epidemiology of pneumococcal disease and pneumococcal vaccines.
Recent findings:
After the introduction of conjugate vaccines (PCV7 and PCV13), rates of pneumococcal diseases because of vaccine serotypes have decreased considerably among children in the vaccine target and among nonvaccinated children and adults. Results of the Community-Acquired Pneumonia Immunization Trial in Adults demonstrated 45.6% efficacy of PCV13 against the first episode of pneumonia, 45% against first-episode nonbacteremic pneumococcal pneumonia, and 75% against the first episode of invasive pneumococcal diseases in adults older than 65 years. Recommendations for pneumococcal vaccination have changed recently in both the United States and Europe.
Summary:
The changing epidemiology of pneumococcal diseases should be closely investigated to assess the effectiveness and the usefulness of the current vaccination policies, and to identify future directions for preventing pneumococcal infections.

Developing World Bioethics – April 2016

Developing World Bioethics
April 2016 Volume 16, Issue 1 Pages 1–60
http://onlinelibrary.wiley.com/doi/10.1111/dewb.2016.16.issue-1/issuetoc

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EDITORIAL
Future Infectious Disease Outbreaks: Ethics of Emergency Access to Unregistered Medical Interventions and Clinical Trial Designs (pages 2–3)
Udo Schuklenk
Article first published online: 19 JAN 2016 | DOI: 10.1111/dewb.12102
[No abstract]

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Against Permitted Exploitation in Developing World Research Agreements (pages 36–44)
Danielle M. Wenner
Article first published online: 17 FEB 2015 | DOI: 10.1111/dewb.12081
Abstract
This paper examines the moral force of exploitation in developing world research agreements. Taking for granted that some clinical research which is conducted in the developing world but funded by developed world sponsors is exploitative, it asks whether a third party would be morally justified in enforcing limits on research agreements in order to ensure more fair and less exploitative outcomes. This question is particularly relevant when such exploitative transactions are entered into voluntarily by all relevant parties, and both research sponsors and host communities benefit from the resulting agreements. I show that defenders of the claim that exploitation ought to be permitted rely on a mischaracterization of certain forms of interference as unjustly paternalistic and two dubious empirical assumptions about the results of regulation. The view I put forward is that by evaluating a system of constraints on international research agreements, rather than individual transaction-level interference, we can better assess the alternatives to permitting exploitative research agreements.

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Maintaining Research Integrity While Balancing Cultural Sensitivity: A Case Study and Lessons From the Field (pages 55–60)
Rebekah Sibbald, Bethina Loiseau, Benedict Darren, Salem A. Raman, Helen Dimaras and Lawrence C. Loh
Article first published online: 11 SEP 2015 | DOI: 10.1111/dewb.12089
Abstract
Contemporary emphasis on creating culturally relevant and context specific knowledge increasingly drives researchers to conduct their work in settings outside their home country. This often requires researchers to build relationships with various stakeholders who may have a vested interest in the research. This case study examines the tension between relationship development with stakeholders and maintaining study integrity, in the context of potential harms, data credibility and cultural sensitivity. We describe an ethical breach in the conduct of global health research by a arising from the ad-hoc participation of a community stakeholder external to the visiting research group. A framework for reflection is developed from a careful examination of underlying factors and presented with a discussion of consequences and mitigation measures. This framework aims to present lessons learned for researchers working abroad who might face similar situations in their work.

Eurosurveillance – Volume 21, Issue 9, 03 March 2016

Eurosurveillance
Volume 21, Issue 9, 03 March 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Rapid communications
Zika virus detection in urine from patients with Guillain-Barré syndrome on Martinique, January 2016
by B Rozé, F Najioullah, J Fergé, K Apetse, Y Brouste, R Cesaire, C Fagour, L Fagour, P Hochedez, S Jeannin, J Joux, H Mehdaoui, R Valentino, A Signate, A Cabié, on behalf of the GBS Zika Working Group

Surveillance report
The measles outbreak in Bulgaria, 2009–2011: An epidemiological assessment and lessons learnt
by M Muscat, L Marinova, A Mankertz, N Gatcheva, Z Mihneva, S Santibanez, A Kunchev, R Filipova, M Kojouharova

Spillover effect of HIV-specific foreign aid on immunization services in Nigeria

International Health
Volume 8 Issue 2 February 2016
http://inthealth.oxfordjournals.org/content/current

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Spillover effect of HIV-specific foreign aid on immunization services in Nigeria
Charles C. Chima and Luisa Franzini
Abstract
Background Health aid to Nigeria increased tremendously in the last decade and a significant portion of the funds were earmarked for HIV-associated programs. Studies on the impact of HIV-specific aid on the delivery of non-HIV health services in sub-Saharan Africa have yielded mixed results. This study assessed if there is a spillover effect of HIV-specific aid on childhood vaccinations in Nigeria.
Methods Multivariate logistic regression models were used to estimate the effect of aid disbursements in a previous year on the receipt of vaccines at the individual level in a given year. Estimations were done for approximately 11 700 children using data from demographic and health surveys conducted in Nigeria in 2003 and 2008.
Results US$1 increase in HIV aid per capita was associated with a decrease in the probability of receipt of vaccines by 8–31%: polio first dose decreased by 8%; polio final dose by 9%; diphtheria-pertussis-tetanus (DPT) first dose by 11%; DPT final dose by 19%; measles by 31%; final doses of polio and DPT plus measles vaccine by 8%.
Conclusions HIV-specific aid had a negative spillover effect on immunization services in Nigeria over the study period. Donors may need to rethink their funding strategies in favour of more horizontal approaches.

The Emerging Zika Pandemic: Enhancing Preparedness

JAMA
March 1, 2016, Vol 315, No. 9
http://jama.jamanetwork.com/issue.aspx

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Viewpoint
The Emerging Zika Pandemic: Enhancing Preparedness
Daniel R. Lucey, MD, MPH; Lawrence O. Gostin, JD
Extract
This Viewpoint discusses Zika virus infection and health system preparedness and urges the World Health Organization to proactively respond to the growing global threat of infection.
The Zika virus (ZIKV), a flavivirus related to yellow fever, dengue, West Nile, and Japanese encephalitis, originated in the Zika forest in Uganda and was discovered in a rhesus monkey in 1947. The disease now has “explosive” pandemic potential, with outbreaks in Africa, Southeast Asia, the Pacific Islands, and the Americas.1 Since Brazil reported Zika virus in May 2015, infections have occurred in at least 20 countries in the Americas.2 Puerto Rico reported the first locally transmitted infection in December 2015, but Zika is likely to spread to the United States. The Aedes species mosquito (an aggressive daytime biter) that transmits Zika virus (as well as dengue, chikungunya, and yellow fever) occurs worldwide, posing a high risk for global transmission. Modeling anticipates significant international spread by travelers from Brazil to the rest of the Americas, Europe, and Asia.3 What steps are required now to shore up preparedness in the Americas and worldwide?…

Journal of Community Health – Volume 41, Issue 2, April 2016

Journal of Community Health
Volume 41, Issue 2, April 2016
http://link.springer.com/journal/10900/41/2/page/1

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Commentary
Taxi Drivers: A Target Population for the Prevention of Transmissible Disease?
Heather M. Limper, Jennifer L. Burns, Kenneth A. Alexander
Abstract
We set out to assess the feasibility and uptake of an on-site influenza vaccination campaign targeting taxi drivers in airport taxicab lots in Chicago, Illinois. Influenza vaccine was provided by the Chicago Department of Public Health as this event aligned with ongoing efforts to provide influenza vaccinations throughout the city. Clinicians and clinic support staff were volunteers recruited from the University of Chicago Medicine and incorporated nursing staff, physicians, physician residents, and administrative support. Together, this allowed for a cost-effective approach to provide free influenza vaccines to the primarily uninsured taxi driver population. During these events, 545 taxi drivers received influenza vaccine in 2012 while 354 drivers were immunized in 2013. Nearly all drivers reported uninsured or under-insured status. The ability to use volunteers and healthcare organization’s desires to meet the needs of the community, in collaboration with often under-staffed but highly dedicated local health departments have the potential to offer valuable public health services to underserved members of the community. Educational initiatives targeting vaccine hesitancy and misinformation may be necessary to improve immunization coverage among this population.

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Original Paper
Effects of Community Health Nurse-Led Intervention on Childhood Routine Immunization Completion in Primary Health Care Centers in Ibadan, Nigeria
V. B. Brown, O. A. Oluwatosin, J. O. Akinyemi, A. A. Adeyemo
Abstract
Immunization coverage of vulnerable children is often sub-optimal in many low- and middle-income countries. The use of a reminder/recall (R/R) system has been one of the strategies shown to be effective in improving immunization rates. In the resent study, we evaluated the effect of R/R and Primary Health Care Immunization Providers’ Training (PHCIPT) intervention on routine immunization completion among 595 infants in Ibadan, Nigeria. The design was a group randomized controlled trial with Local Government Area (LGA) being the unit of randomization. Four randomly selected LGAs were randomized to receive a cellphone R/R only (A), a PHCIPT only (B); combined R/R and PHCIPT (C) intervention or serve as a control group (D). Children aged 0–12 weeks were consecutively recruited into each group and followed up for 12 months. The primary outcome measure was routine immunization completion at 12 months of age. At the study endpoint, immunization completion rates were: group A, 98.6 %; group B, 70 %; group C, 97.3 %; and group D, 57.3 %. Compared to the control group, the cellphone R/R group was 72 % (RR 1.72, 95 % CI 1.50–1.98) and the combined RR/PHCIPT group 70 % (RR 1.70, 95 % CI 1.47–1.95) more likely to complete immunization. In contrast, immunization completion in the PHCIPT group was marginally different from the control group (RR 1.22, 95 % CI 1.03–1.45). These findings remained robust to adjustment for potential predictors of immunization completion as covariates. In conclusion, cellphone reminder/recall was effective in improving immunization completion in this Nigerian setting. Its use is recommended for large scale implementation.

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Original Paper
A Cluster-Randomized Trial to Evaluate a Mother–Daughter Dyadic Educational Intervention for Increasing HPV Vaccination Coverage in American Indian Girls
Rachel L. Winer, Angela A. Gonzales, Carolyn J. Noonan…
Abstract
We evaluated whether delivering educational presentations on human papillomavirus (HPV) to American Indian mothers affected HPV vaccination rates in their adolescent daughters. In March–April 2012, we recruited Hopi mothers or female guardians with daughters aged 9–12 years for a cluster-randomized intervention study on the Hopi Reservation. Participants attended mother-daughter dinners featuring educational presentations for mothers on either HPV (intervention) or juvenile diabetes (control) and completed baseline surveys. Eleven months later, we surveyed mothers on their daughters’ HPV vaccine uptake. We also reviewed aggregated immunization reports from the Indian Health Service to assess community-level HPV vaccination coverage from 2007 to 2013. Ninety-seven mother-daughter dyads participated; nine mothers reported that their daughters completed the three-dose HPV vaccination series before recruitment. Among the remaining mothers, 63 % completed the follow-up survey. Adjusting for household income, the proportion of daughters completing vaccination within 11 months post-intervention was similar in the intervention and control groups (32 vs. 28 %, adjusted RR = 1.2, 95 % confidence interval (CI) 0.6–2.3). Among unvaccinated daughters, those whose mothers received HPV education were more likely to initiate vaccination (50 vs. 27 %, adjusted RR = 2.6, 95 % CI 1.4–4.9) and complete three doses (adjusted RR = 4.0, 95 % CI 1.2–13.1) than girls whose mothers received diabetes education. Community-level data showed that 80 % of girls aged 13–17 years and 20 % of girls aged 11–12 completed the vaccination series by 2013. HPV vaccine uptake in Hopi girls aged 13–17 years is significantly higher than the U.S. national average. Brief educational presentations on HPV delivered to American Indian mothers might increase HPV vaccination rates in daughters aged 9–12 years.

The Lancet Infectious Diseases – Mar 2016

The Lancet Infectious Diseases
Mar 2016 Volume 16 Number 3 p265-384 e11-e33
http://www.thelancet.com/journals/laninf/issue/current

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Editorial
Zika virus in the dock
The Lancet Infectious Diseases
DOI: http://dx.doi.org/10.1016/S1473-3099(16)00085-2
Summary
In October, 2015, the Ministry of Health in Brazil reported an unexplained increase in cases of microcephaly, a congenital malformation normally associated with incomplete brain development, in newborn babies (4783 cases vs 150 in the previous year). The reported cases have caused widespread fear among pregnant women all over South and Central America, to the point that some nations such as Ecuador have recommended that their citizens postpone pregnancy to 2018, to give time to investigate the causes of the increase of microcephaly cases.

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Articles
H7N9 live attenuated influenza vaccine in healthy adults: a randomised, double-blind, placebo-controlled, phase 1 trial
Larisa Rudenko, Irina Isakova-Sivak, Anatoly Naykhin, Irina Kiseleva, Marina Stukova, Mariana Erofeeva, Daniil Korenkov, Victoria Matyushenko, Erin Sparrow, Marie-Paule Kieny
Summary
Background
H7N9 avian influenza viruses characterised by high virulence and presence of mammalian adaptation markers have pandemic potential. Specific influenza vaccines remain the main defence. We assessed the safety and immunogenicity of an H7N9 live attenuated influenza vaccine (LAIV) candidate in healthy adult volunteers.
Methods
We did a phase 1, double-blind, randomised, placebo-controlled trial in Saint Petersburg, Russia. Eligible participants were healthy adults aged 18–49 years. The participants were randomised 3:1 to receive live vaccine or placebo, according to a computer-generated randomisation scheme. Two doses of vaccine or placebo were administered intranasally 28 days apart, each followed by 7 day stays in hospital. Immune responses were assessed in nasal swabs, saliva, and serum specimens collected before and 28 days after each vaccine dose. The primary outcome was the safety profile. This trial is registered with ClinicalTrials.gov, number NCT02480101.
Findings
Between Oct 21, 2014, and Oct 31, 2014, 40 adults were randomised, of whom 39 (98%) were included in the per-protocol analysis (29 in the vaccine group and ten in the placebo group). The frequency of adverse events did not differ between the vaccine and placebo groups. Seroconversion of neutralising antibodies was seen in 14 participants after the first vaccine dose (48%, 95% CI 29·4–67·5) and 21 after the second vaccine dose (72%, 52·8–87·3). Immune responses were seen in 27 of 29 recipients (93%, 95% CI 77·2–99·2). Adverse effects were seen in 19 (63%) vaccine recipients and nine (90%) placebo recipients after the first dose and in nine (31%) and four (40%), respectively, after the second dose. These effects were mainly local and all were mild.
Interpretation
The H7N9 LAIV was well tolerated and safe and showed good immunogenicity.
Funding
WHO.

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Safety and immunogenicity of a chimpanzee adenovirus-vectored Ebola vaccine in healthy adults: a randomised, double-blind, placebo-controlled, dose-finding, phase 1/2a study
Olga De Santis, Régine Audran, Emilie Pothin, Loane Warpelin-Decrausaz, Laure Vallotton, Grégoire Wuerzner, Camille Cochet, Daniel Estoppey, Viviane Steiner-Monard, Sophie Lonchampt, Anne-Christine Thierry, Carole Mayor, Robert T Bailer, Olivier Tshiani Mbaya, Yan Zhou, Aurélie Ploquin, Nancy J Sullivan, Barney S Graham, François Roman, Iris De Ryck, W Ripley Ballou, Marie Paule Kieny, Vasee Moorthy, François Spertini, Blaise Genton
Summary
Background
The ongoing Ebola outbreak led to accelerated efforts to test vaccine candidates. On the basis of a request by WHO, we aimed to assess the safety and immunogenicity of the monovalent, recombinant, chimpanzee adenovirus type-3 vector-based Ebola Zaire vaccine (ChAd3-EBO-Z).
Methods
We did this randomised, double-blind, placebo-controlled, dose-finding, phase 1/2a trial at the Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Participants (aged 18–65 years) were randomly assigned (2:2:1), via two computer-generated randomisation lists for individuals potentially deployed in endemic areas and those not deployed, to receive a single intramuscular dose of high-dose vaccine (5 × 1010 viral particles), low-dose vaccine (2·5 × 1010 viral particles), or placebo. Deployed participants were allocated to only the vaccine groups. Group allocation was concealed from non-deployed participants, investigators, and outcome assessors. The safety evaluation was not masked for potentially deployed participants, who were therefore not included in the safety analysis for comparison between the vaccine doses and placebo, but were pooled with the non-deployed group to compare immunogenicity. The main objectives were safety and immunogenicity of ChAd3-EBO-Z. We did analysis by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02289027.
Findings
Between Oct 24, 2014, and June 22, 2015, we randomly assigned 120 participants, of whom 18 (15%) were potentially deployed and 102 (85%) were non-deployed, to receive high-dose vaccine (n=49), low-dose vaccine (n=51), or placebo (n=20). Participants were followed up for 6 months. No vaccine-related serious adverse events were reported. We recorded local adverse events in 30 (75%) of 40 participants in the high-dose group, 33 (79%) of 42 participants in the low-dose group, and five (25%) of 20 participants in the placebo group. Fatigue or malaise was the most common systemic adverse event, reported in 25 (62%) participants in the high-dose group, 25 (60%) participants in the low-dose group, and five (25%) participants in the placebo group, followed by headache, reported in 23 (57%), 25 (60%), and three (15%) participants, respectively. Fever occurred 24 h after injection in 12 (30%) participants in the high-dose group and 11 (26%) participants in the low-dose group versus one (5%) participant in the placebo group. Geometric mean concentrations of IgG antibodies against Ebola glycoprotein peaked on day 28 at 51 μg/mL (95% CI 41·1–63·3) in the high-dose group, 44·9 μg/mL (25·8–56·3) in the low-dose group, and 5·2 μg/mL (3·5–7·6) in the placebo group, with respective response rates of 96% (95% CI 85·7–99·5), 96% (86·5–99·5), and 5% (0·1–24·9). Geometric mean concentrations decreased by day 180 to 25·5 μg/mL (95% CI 20·6–31·5) in the high-dose group, 22·1 μg/mL (19·3–28·6) in the low-dose group, and 3·2 μg/mL (2·4–4·9) in the placebo group. 28 (57%) participants given high-dose vaccine and 31 (61%) participants given low-dose vaccine developed glycoprotein-specific CD4 cell responses, and 33 (67%) and 35 (69%), respectively, developed CD8 responses.
Interpretation
ChAd3-EBO-Z was safe and well tolerated, although mild to moderate systemic adverse events were common. A single dose was immunogenic in almost all vaccine recipients. Antibody responses were still significantly present at 6 months. There was no significant difference between doses for safety and immunogenicity outcomes. This acceptable safety profile provides a reliable basis to proceed with phase 2 and phase 3 efficacy trials in Africa.
Funding
Swiss State Secretariat for Education, Research and Innovation (SERI), through the EU Horizon 2020 Research and Innovation Programme.

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Immunogenicity and safety of a novel monovalent high-dose inactivated poliovirus type 2 vaccine in infants: a comparative, observer-blind, randomised, controlled trial
Xavier Sáez-Llorens, Ralf Clemens, Geert Leroux-Roels, José Jimeno, Sue Ann Costa Clemens, William C Weldon, M Steven Oberste, Natanael Molina, Ananda S Bandyopadhyay
Summary
Background
Following the proposed worldwide switch from trivalent oral poliovirus vaccine (tOPV) to bivalent types 1 and 3 OPV (bOPV) in 2016, inactivated poliovirus vaccine (IPV) will be the only source of protection against poliovirus type 2. With most countries opting for one dose of IPV in routine immunisation schedules during this transition because of cost and manufacturing constraints, optimisation of protection against all poliovirus types will be a priority of the global eradication programme. We assessed the immunogenicity and safety of a novel monovalent high-dose inactivated poliovirus type 2 vaccine (mIPV2HD) in infants.
Methods
This observer-blind, comparative, randomised controlled trial was done in a single centre in Panama. We enrolled healthy infants who had not received any previous vaccination against poliovirus. Infants were randomly assigned (1:1) by computer-generated randomisation sequence to receive a single dose of either mIPV2HD or standard trivalent IPV given concurrently with a third dose of bOPV at 14 weeks of age. At 18 weeks, all infants were challenged with one dose of monovalent type 2 OPV (mOPV2). Primary endpoints were seroconversion and median antibody titres to type 2 poliovirus 4 weeks after vaccination with mIPV2HD or IPV; and safety (as determined by the proportion and nature of serious adverse events and important medical events for 8 weeks after vaccination). The primary immunogenicity analyses included all participants for whom a post-vaccination blood sample was available. All randomised participants were included in the safety analyses. This trial is registered with ClinicalTrials.gov, number NCT02111135.
Findings
Between April 14 and May 9, 2014, 233 children were enrolled and randomly assigned to receive mIPV2HD (117 infants) or IPV (116 infants). 4 weeks after vaccination with mIPV2HD or IPV, seroconversion to poliovirus type 2 was recorded in 107 (93·0%, 95% CI 86·8–96·9) of 115 infants in the mIPV2HD group compared with 86 (74·8%, 65·8–82·4) of 115 infants in the IPV group (difference between groups 18·3%, 95% CI 5·0–31·1; p<0·0001), and median antibody titres against poliovirus type 2 were 181 (95% CI 72·0–362·0) in the mIPV2HD group and 36 (18·0–113·8) in the IPV group (difference between groups 98·8, 95% CI 60·7–136·9; p<0·0001). Serious adverse events were reported for six (5%) of 117 infants in the mIPV2HD group and seven (6%) of 116 infants in the IPV group during the 8-week period after vaccination; none were related to vaccination. No important medical events were reported.
Interpretation
Our findings lend support to the use of mIPV2HD as an option for stockpiling for outbreak response or primary protection in selected areas at risk for emergence of poliovirus type 2 during the next phase of the polio eradication plan.
Funding
Bill & Melinda Gates Foundation.

The Lancet – Mar 05, 2016

The Lancet
Mar 05, 2016 Volume 387 Number 10022 p917-1026 e22
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
Health—an explicit human right
The Lancet
Summary
“The past year severely tested the international system’s capacity to respond to crises and mass forced displacements of people, and found it woefully inadequate.” So begins Amnesty International’s annual report for 2015, The state of the world’s human rights, published last week. Set against the backdrop of unprecedented and worldwide migration, recurring themes include access to health services, the effects of conflict on health, women and children’s health, sexual rights, and the denial of health care in prisons.

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Comment
Zika virus and microcephaly in Brazil: a scientific agenda
Mauricio L Barreto, Manoel Barral-Netto, Rodrigo Stabeli, Naomar Almeida-Filho, Pedro F C Vasconcelos, Mauro Teixeira, Paulo Buss, Paulo E Gadelha
Summary
Since 1981, the Brazilian population has had dengue fever epidemics and all control efforts have been unsuccessful.1 In 2014, chikungunya fever was reported for the first time in the country.2 In 2015, the occurrence of Zika virus was also reported,3 along with an increase of microcephaly and brain damage in newborn babies.4,5 The mosquito Aedes aegypti is the most conventional vector of these three viral infections and is widely disseminated in a great part of urban Brazil. Brazilian public health authorities declared a National Public Health Emergency on Nov 11, 2015, and intensified the vector control campaign to tackle the epidemic.

 

Effect of Haemophilus influenzae type b vaccination without a booster dose on invasive H influenzae type b disease, nasopharyngeal carriage, and population immunity in Kilifi, Kenya: a 15-year regional surveillance study

Lancet Global Health
Mar 2016 Volume 4 Number 3 e137-e214
http://www.thelancet.com/journals/langlo/issue/current

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Articles
Effect of Haemophilus influenzae type b vaccination without a booster dose on invasive H influenzae type b disease, nasopharyngeal carriage, and population immunity in Kilifi, Kenya: a 15-year regional surveillance study
Laura L Hammitt, Rosie J Crane, Angela Karani, Alex Mutuku, Susan C Morpeth, Polly Burbidge, David Goldblatt, Tatu Kamau, Shahnaaz Sharif, Neema Mturi, J Anthony G Scott
Summary
Background
Haemophilus influenzae type b (Hib) conjugate vaccine, delivered as a three-dose series without a booster, was introduced into the childhood vaccination programme in Kenya in 2001. The duration of protection and need for a booster dose are unknown. We aimed to assess vaccine effectiveness, the impact of the vaccine on nasopharyngeal carriage, and population immunity after introduction of conjugate Hib vaccine in infancy without a booster dose in Kenya.
Methods
This study took place in the Kilifi Health and Demographic Surveillance System (KHDSS), an area of Kenya that has been monitored for vital events and migration every 4 months since 2000. We analysed sterile site cultures for H influenzae type b from children (aged ≤12 years) admitted to the Kilifi County Hospital (KCH) from Jan 1, 2000, through to Dec 31, 2014. We determined the prevalence of nasopharyngeal carriage by undertaking cross-sectional surveys in random samples of KHDSS residents (of all ages) once every year from 2009 to 2012, and measured Hib antibody concentrations in five cross-sectional samples of children (aged ≤12 years) within the KHDSS (in 1998, 2000, 2004–05, 2007, and 2009). We calculated incidence rate ratios between the prevaccine era (2000–01) and the routine-use era (2004–14) and defined vaccine effectiveness as 1 minus the incidence rate ratio, expressed as a percentage.
Findings
40 482 children younger than 13 years resident in KHDSS were admitted to KCH between 2000 and 2014, 38 206 (94%) of whom had their blood cultured. The incidence of invasive H influenzae type b disease in children younger than 5 years declined from 62·6 (95% CI 46·0–83·3) per 100 000 in 2000–01 to 4·5 (2·5–7·5) per 100 000 in 2004–14, giving a vaccine effectiveness of 93% (95% CI 87–96). In the final 5 years of observation (2010–14), only one case of invasive H influenzae type b disease was detected in a child younger than 5 years. Nasopharyngeal H influenzae type b carriage was detected in one (0·2%) of 623 children younger than 5 years between 2009 and 2012. In the 2009 serosurvey, 92 (79%; 95% CI 70–86) of 117 children aged 4–35 months had long-term protective antibody concentrations.
Interpretation
In this region of Kenya, use of a three-dose primary series of Hib vaccine without a booster dose has resulted in a significant and sustained reduction in invasive H influenzae type b disease. The prevalence of nasopharyngeal carriage is low and the profile of Hib antibodies suggests that protection wanes only after the age at greatest risk of disease. Although continued surveillance is important to determine whether effective control persists, these findings suggest that a booster dose is not currently required in Kenya.
Funding
Gavi, the Vaccine Alliance, Wellcome Trust, European Society for Paediatric Infectious Diseases, and National Institute for Health Research.

Knowledge, Attitude and Perception of Ebola Virus Disease among Secondary School Students in Ondo State, Nigeria, October, 2014

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 5 March 2016)

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Research Article
Knowledge, Attitude and Perception of Ebola Virus Disease among Secondary School Students in Ondo State, Nigeria, October, 2014
March 4, 2016 ·
Introduction: The first case of Ebola Virus Disease (EVD) in Nigeria was imported on 20th July 2014, by an air traveller. On 8th August, 2014, WHO declared the Ebola outbreak in West Africa a Public Health Emergency of International Concern (PHEIC). This study aimed at assessing the knowledge, perception and attitude of secondary school students towards EVD and adopting disease preventive behaviour.
Methods: A descriptive cross sectional study of 440 students from a mixed secondary school in Owo, Ondo State was done. Data was collected in October 2014 when Nigeria was yet to be declared EVD free. Simple random sampling was used to select the school while Systematic random sampling was used in the selection of participants. A semi-structured, interviewer administered questionnaire was used to collect data. Data was analyzed with SPSS version 21. Descriptive statistics and Chi-square test were done, level of statistical significant was 5%.
Results: Mean age of respondents was 13.7±1.9 years. Females were 48.2%. Most of the respondents had heard of Ebola Virus Disease (95.4%). Female respondents (51.3%), those who were 15 years and above (51.1%) and in the senior class (54.1%), and had good general knowledge of EVD and across all domains. Being in the senior secondary class and seeking for health care in the hospital were positively associated with good general knowledge (p-value: 0.029, and <0.001 respectively). Three commonest modes of spread of EVD mentioned were contact between infected animals and men (74.8%), touching body fluids of a person who is sick of EVD (57.0%), and contact (55.2%). The top three signs of EVD mentioned were abnormal bleeding from any part of the body (56.10%), vomiting (47.0%) and fever (42.3%).
Conclusion: Our results revealed suboptimal EVD-related knowledge, attitude and practice among the students. Promotion of health messages and training of students on prevention of EVD to effectively control past and future outbreaks of EVD in Nigeria was immediately initiated in schools in Ondo State.

Transformative Innovations in Reproductive, Maternal, Newborn, and Child Health over the Next 20 Years

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 5 March 2016)
Transformative Innovations in Reproductive, Maternal, Newborn, and Child Health over the Next 20 Years
Cyril M. Engmann, Sadaf Khan, Cheryl A. Moyer, Patricia S. Coffey, Zulfiqar A. Bhutta
Collection Review | published 02 Mar 2016 | PLOS Medicine
10.1371/journal.pmed.1001969
Summary Points
:: Accelerating progress in reproductive, maternal, newborn, and child health (RMNCH) over the past 30 years has resulted in significant decreases in mortality, as well as shifts in causes of death. For example, deaths from diarrhea among children under age 5 have significantly declined. This increased survival means an increasing fraction of under-5 deaths occur in the first 4 weeks of life, the neonatal period.
:: Transformative changes, including advances such as the development of immunizations, wide uptake of contraception, and the availability of medications such as oxytocin, have contributed to an improved morbidity and mortality curve. Such advances are set against a broader backdrop of increasing national wealth, stronger health systems, aligned political agendas, and advocacy systems.
:: Global mechanisms and strategies such as the Global Strategy for Women’s, Children’s, and Adolescents’ Health, Global Alliance for the Vaccine Initiative (GAVI), the United Nations Commission on Life-Saving Commodities for Women and Children, Family Planning 2020, and the Every Newborn Action Plan, among others, are serving to drive the global agenda forward, although stubborn gaps remain.
:: In this paper, we discuss promising innovations that in our opinion have significant promise in moving the RMNCH agenda forward. While some of these are technologies, others are efforts aimed at improving commodities, increasing demand for services, and promoting equity in access.

PLoS Neglected Tropical Diseases (Accessed 5 March 2016)

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 5 March 2016)

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Zika Virus: Medical Countermeasure Development Challenges
Robert W. Malone, Jane Homan, Michael V. Callahan, Jill Glasspool-Malone, Lambodhar Damodaran, Adriano De Bernardi Schneider, Rebecca Zimler, James Talton, Ronald R. Cobb, Ivan Ruzic, Julie Smith-Gagen, Daniel Janies, James Wilson, Zika Response Working Group
Review | published 02 Mar 2016 | PLOS Neglected Tropical Diseases
10.1371/journal.pntd.0004530
Abstract
Introduction
Reports of high rates of primary microcephaly and Guillain–Barré syndrome associated with Zika virus infection in French Polynesia and Brazil have raised concerns that the virus circulating in these regions is a rapidly developing neuropathic, teratogenic, emerging infectious public health threat. There are no licensed medical countermeasures (vaccines, therapies or preventive drugs) available for Zika virus infection and disease. The Pan American Health Organization (PAHO) predicts that Zika virus will continue to spread and eventually reach all countries and territories in the Americas with endemic Aedes mosquitoes. This paper reviews the status of the Zika virus outbreak, including medical countermeasure options, with a focus on how the epidemiology, insect vectors, neuropathology, virology and immunology inform options and strategies available for medical countermeasure development and deployment.
Methods
Multiple information sources were employed to support the review. These included publically available literature, patents, official communications, English and Lusophone lay press. Online surveys were distributed to physicians in the US, Mexico and Argentina and responses analyzed. Computational epitope analysis as well as infectious disease outbreak modeling and forecasting were implemented. Field observations in Brazil were compiled and interviews conducted with public health officials.

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Eliminating the Neglected Tropical Diseases: Translational Science and New Technologies
Peter J. Hotez, Bernard Pecoul, Suman Rijal, Catharina Boehme, Serap Aksoy, Mwelecele Malecela, Roberto Tapia-Conyer, John C. Reeder
Review | published 02 Mar 2016 | PLOS Neglected Tropical Diseases
10.1371/journal.pntd.0003895
Abstract
Today, the World Health Organization recognizes 17 major parasitic and related infections as the neglected tropical diseases (NTDs). Despite recent gains in the understanding of the nature and prevalence of NTDs, as well as successes in recent scaled-up preventive chemotherapy strategies and other health interventions, the NTDs continue to rank among the world’s greatest global health problems. For virtually all of the NTDs (including those slated for elimination under the auspices of a 2012 London Declaration for NTDs and a 2013 World Health Assembly resolution [WHA 66.12]), additional control mechanisms and tools are needed, including new NTD drugs, vaccines, diagnostics, and vector control agents and strategies. Elimination will not be possible without these new tools. Here we summarize some of the key challenges in translational science to develop and introduce these new technologies in order to ensure success in global NTD elimination efforts.

PLoS One [Accessed 5 March 2016]

PLoS One
http://www.plosone.org/
[Accessed 5 March 2016]

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The Success of a Universal Hepatitis B Immunization Program as Part of Thailand’s EPI after 22 Years’ Implementation
Nawarat Posuwan, Nasamon Wanlapakorn, Pattaratida Sa-nguanmoo, Rujipat Wasitthankasem, Preeyaporn Vichaiwattana, Sirapa Klinfueng, Viboonsak Vuthitanachot, Siriporn Sae-lao, Monthana Foonoi, Apinya Fakthongyoo, Jamorn Makaroon, Klaita Srisingh, Duangporn Asawarachun, Somchai Owatanapanich, Norra Wutthiratkowit, Kraisorn Tohtubtiang, Pornsak Yoocharoen, Sompong Vongpunsawad, Yong Poovorawan
Research Article | published 03 Mar 2016 | PLOS ONE
10.1371/journal.pone.0150499

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Immunization Coverage Surveys and Linked Biomarker Serosurveys in Three Regions in Ethiopia
Mark A. Travassos, Berhane Beyene, Zenaw Adam, James D. Campbell, Nigisti Mulholland, Seydou S. Diarra, Tassew Kassa, Lisa Oot, Jenny Sequeira, Mardi Reymann, William C. Blackwelder, Yukun Wu, Inna Ruslanova, Jaya Goswami, Samba O. Sow, Marcela F. Pasetti, Robert Steinglass, Amha Kebede, Myron M. Levine
Research Article | published 02 Mar 2016 | PLOS ONE
10.1371/journal.pone.0149970
Abstract
Objective
Demographic and health surveys, immunization coverage surveys and administrative data often divergently estimate vaccination coverage, which hinders pinpointing districts where immunization services require strengthening. We assayed vaccination coverage in three regions in Ethiopia by coverage surveys and linked serosurveys.
Methods
Households with children aged 12–23 (N = 300) or 6–8 months (N = 100) in each of three districts (woredas) were randomly selected for immunization coverage surveys (inspection of vaccination cards and immunization clinic records and maternal recall) and linked serosurveys. IgG-ELISA serologic biomarkers included tetanus antitoxin ≥ 0.15 IU/ml in toddlers (receipt of tetanus toxoid) and Haemophilus influenzae type b (Hib) anti-capsular titers ≥ 1.0 mcg/ml in infants (timely receipt of Hib vaccine).
Findings
Coverage surveys enrolled 1,181 children across three woredas; 1,023 (87%) also enrolled in linked serosurveys. Administrative data over-estimated coverage compared to surveys, while maternal recall was unreliable. Serologic biomarkers documented a hierarchy among the districts. Biomarker measurement in infants provided insight on timeliness of vaccination not deducible from toddler results.
Conclusion
Neither administrative projections, vaccination card or EPI register inspections, nor parental recall, substitute for objective serological biomarker measurement. Including infants in serosurveys informs on vaccination timeliness.

Predictors of influenza vaccine uptake during the 2009/10 influenza A H1N1v (‘swine flu’) pandemic: Results from five national surveys in the United Kingdom

Preventive Medicine
Volume 83, Pages 1-76 (February 2016)
http://www.sciencedirect.com/science/journal/00917435/84

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Regular Articles
Predictors of influenza vaccine uptake during the 2009/10 influenza A H1N1v (‘swine flu’) pandemic: Results from five national surveys in the United Kingdom
Original Research Article
Pages 57-61
You Kyung Julia Han, Susan Michie, Henry W.W. Potts, G. James Rubin

Public Health Ethics – Volume 9 Issue 1 April 2016

Public Health Ethics
Volume 9 Issue 1 April 2016
http://phe.oxfordjournals.org/content/current

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Original Articles
An Ethical Justification for Expanding the Notion of Effectiveness in Vaccine Post-Market Monitoring: Insights from the HPV Vaccine in Canada
Ana Komparic, Maxwell J. Smith, and Alison Thompson
Public Health Ethics (2016) 9 (1): 78-91 doi:10.1093/phe/phu049
Abstract
Health regulators must carefully monitor the real-world safety and effectiveness of marketed vaccines through post-market monitoring in order to protect the public’s health and promote those vaccines that best achieve public health goals. Yet, despite the fact that vaccines used in collective immunization programmes should be assessed in the context of a public health response, post-market effectiveness monitoring is often limited to assessing immunogenicity or limited programmatic features, rather than assessing effectiveness across populations. We argue that post-market monitoring ought to be expanded in two ways to reflect a ‘public health notion of post-market effectiveness’, which incorporates normative public health considerations: (i) effectiveness monitoring should yield higher quality data and grant special attention to underrepresented and vulnerable populations; and (ii) the scope of effectiveness should be expanded to include a consideration of the various social factors that maximize (and minimize) a vaccine’s effectiveness at the population level, paying particular attention to how immunization programmes impact related health gradients. We use the case of the human papillomavirus vaccine in Canada to elucidate how expanding post-market effectiveness monitoring is necessary to close the gap between clinical practice and public health, and to ensure that vaccines are effective in a morally relevant sense.

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Ethical Criteria for Human Challenge Studies in Infectious Diseases
Ben Bambery, Michael Selgelid, Charles Weijer, Julian Savulescu, and Andrew J. Pollard
Public Health Ethics (2016) 9 (1): 92-103 doi:10.1093/phe/phv026
Abstract
Purposeful infection of healthy volunteers with a microbial pathogen seems at odds with acceptable ethical standards, but is an important contemporary research avenue used to study infectious diseases and their treatments. Generally termed ‘controlled human infection studies’, this research is particularly useful for fast tracking the development of candidate vaccines and may provide unique insight into disease pathogenesis otherwise unavailable. However, scarce bioethical literature is currently available to assist researchers and research ethics committees in negotiating the distinct issues raised by research involving purposefully infecting healthy volunteers. In this article, we present two separate challenge studies and highlight the ethical issues of human challenge studies as seen through a well-constructed framework. Beyond the same stringent ethical standards seen in other areas of medical research, we conclude that human challenge studies should also include: (i) independent expert reviews, including systematic reviews; (ii) a publicly available rationale for the research; (iii) implementation of measures to protect the public from spread of infection beyond the research setting; and (iv) a new system for compensation for harm. We hope these additions may encourage safer and more ethical research practice and help to safeguard public confidence in this vital research alternative in years to come.

Autoethnography in Health Research: Growing Pains?

Qualitative Health Research
March 2016; 26 (4)
http://qhr.sagepub.com/content/current
Special Issue: Autoethnography

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Commentary
Autoethnography in Health Research: Growing Pains?
Heewon Chang
1Eastern University, St. Davids, Pennsylvania, USA
Abstract
Autoethnography is gaining acceptance as a legitimate research method in health science research. The growing volume of published autoethnographies is indicative of this trend. After discussing the methodological tenents of this qualitative research method and its compatibility with health-related research, the author illustrates this trend with examples of published autoethnogrpahic books, theses, and journal articles. While celebrating the potential of autoethnography as a suitable health research method, the author critiques dominatly descriptive and evocative illness self-narratives that may evoke emontionally compelling responses from readers but offer insufficient sociocultural insights about the illness phenomenon. To identify a “desirable” autoethnography that provides not only a “thick description” of personal experiences but also a sociocultural interpretation of such experiences, the author recommends both creators and consumers of autoethnography to ask five evaluative questions: (1) Does the autoethnography use authentic and trustworthy data?; (2) Does the autoethnography follow a reliable research process and show the process clearly?; (3) Does the autoethnography follow ethical steps to protect the rights of self and others presented and implicated in the autoethnography?; (4) Does the autoethnography analyze and interpret the sociocultural meaning of the author’s personal experiences?; and (5) Does the autoethnography attempt to make a scholarly contribution with its conclusion and engagement of the existing literature?

Liberating field science samples and data

Science
04 March 2016 Vol 351, Issue 6277
http://www.sciencemag.org/current.dtl

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Policy Forum
Liberating field science samples and data
By Marcia McNutt, Kerstin Lehnert, Brooks Hanson, Brian A. Nosek, Aaron M. Ellison, John Leslie King
Science04 Mar 2016 : 1024-1026
Summary
Transparency and reproducibility enhance the integrity of research results for scientific and public uses and empower novel research applications. Access to data, samples, methods, and reagents used to conduct research and analysis, as well as to the code used to analyze and process data and samples, is a fundamental requirement for transparency and reproducibility. The field sciences (e.g., geology, ecology, and archaeology), where each study is temporally (and often spatially) unique, provide exemplars for the importance of preserving data and samples for further analysis. Yet field sciences, if they even address such access, commonly do so by simply noting “data and samples available upon request.” They lag behind some laboratory sciences in making data and samples available to the broader research community. It is time for this to change. We discuss cultural, financial, and technical barriers to change and ways in which funders, publishers, scientific societies, and others are responding.

Pertussis vaccines: WHO position paper, August 2015—Recommendations

Vaccine
Volume 34, Issue 12, Pages 1423-1488 (14 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/12

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WHO Report
Pertussis vaccines: WHO position paper, August 2015—Recommendations
Pages 1423-1425
WHO
Abstract
This article presents the World Health Organization’s (WHO) recommendations for the use of vaccines against Bordetella pertussis from the WHO position paper on Pertussis vaccines: WHO position paper—August 2015, recently published in the Weekly Epidemiological Record (Pertussis vaccines: WHO position paper. Wkly Epidemiol Rec 2015;90(August(35)):433–60). This position paper summarizes the most recent developments in the field of pertussis disease and its prevention by vaccination. It includes the WHO position on the choice of Pertussis vaccine as well as on the use of additional strategies, particularly vaccination during pregnancy, for prevention of early infant mortality. This document replaces the first WHO position paper on vaccines against disease caused by Pertussis published in 2010 (Pertussis vaccines: WHO position paper. Wkly Epidemiol Rec 2010;85(October(40)):385–400) and incorporates the revised guidance on the choice of pertussis vaccines published in July 2014 (Pertussis vaccines: WHO position paper. Wkly Epidemiol Rec 2014;89(July(30)):337–44).

Footnotes to this paper provide a number of core references. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO’s current position on the use of vaccines in the global context. This paper reflects the recommendations of WHO’s Strategic Advisory Group of Experts (SAGE) on immunization. These recommendations were discussed by SAGE at its April 2014 and April 2015 meetings. The evidence presented at the meetings can be accessed at http://www.who.int/immunization/sage/previous/en/index.html.

Hong Kong Chinese parental attitudes towards vaccination and associated socio-demographic disparities

Vaccine
Volume 34, Issue 12, Pages 1423-1488 (14 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/12

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Brief report
Hong Kong Chinese parental attitudes towards vaccination and associated socio-demographic disparities
Pages 1426-1429
Linda Dong-Ling Wang, Wendy Wing Tak Lam, Richard Fielding
Abstract
Background
Most previous studies on parental attitudes towards vaccination focused on a disease-specific vaccine. In this study we describe general attitudes towards vaccination in Chinese parents and associated socio-demographic disparities.
Methods
Data were collected from a random sample of 1996 Hong Kong Chinese parents by telephone interviews (response rate 60%). Multiple linear regression analysis was performed.
Results
Most parents believed vaccination to be effective (91.6%) and beneficial (78.7%), though many considered optional vaccines unimportant (39.5%) and unnecessary (62.1%). Demographic characteristics associated with parental negative attitudes to vaccination included being female, born in Hong Kong, married, having fewer children, and children ever experienced vaccination side effects. Lower personal income and religious affiliation were associated with more hesitant attitudes towards optional vaccines.
Conclusion
Segments of the population hold significantly negative attitudes towards vaccination and optional vaccines, suggesting a need for targeted efforts on vaccination communication in these groups.

Primary and booster vaccination with an inactivated poliovirus vaccine (IPV) is immunogenic and well-tolerated in infants and toddlers in China

Vaccine
Volume 34, Issue 12, Pages 1423-1488 (14 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/12

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Regular papers
Primary and booster vaccination with an inactivated poliovirus vaccine (IPV) is immunogenic and well-tolerated in infants and toddlers in China
Original Research Article
Pages 1436-1443
Rongcheng Li, Chang Gui Li, Yanping Li, Youping Liu, Hong Zhao, Xiaoling Chen, Sherine Kuriyakose, Olivier Van Der Meeren, Karin Hardt, Marjan Hezareh, Sumita Roy-Ghanta
Abstract
Introduction
Replacing live-attenuated oral poliovirus vaccines (OPV) with inactivated poliovirus vaccines (IPV) is part of the global strategy to eradicate poliomyelitis. China was declared polio-free in 2000 but continues to record cases of vaccine-associated-poliomyelitis and vaccine-derived-poliovirus outbreaks. Two pilot safety studies and two larger immunogenicity trials evaluated the non-inferiority of IPV (Poliorix™, GSK Vaccines, Belgium) versus OPV in infants and booster vaccination in toddlers primed with either IPV or OPV in China.
Methods
In pilot safety studies, 25 infants received 3-dose IPV primary vaccination (Study A, http://www.clinicaltrial.gov NCT00937404) and 25 received an IPV booster after priming with three OPV doses (Study B, NCT01021293). In the randomised, controlled immunogenicity and safety trial (Study C, NCT00920439), infants received 3-dose primary vaccination with IPV (N = 541) or OPV (N = 535) at 2,3,4 months of age, and a booster IPV dose at 18-24 months (N = 470, Study D, NCT01323647: extension of study C). Blood samples were collected before and one month post-dose-3 and booster. Reactogenicity was assessed using diary cards. Serious adverse events (SAEs) were captured throughout each study.
Results
Study A and B showed that IPV priming and IPV boosting (after OPV) was safe. Study C: One month post-dose-3, all IPV and ≥98.3% OPV recipients had seroprotective antibody titres towards each poliovirus type. The immune response elicited by IPV was non-inferior to Chinese OPV. Seroprotective antibody titres persisted in ≥94.7% IPV and ≥96.1% OPV recipients at 18–24 months (Study D). IPV had a clinically acceptable safety profile in all studies. Grade 3 local and systemic reactions were uncommon. No SAEs were related to IPV administration.
Conclusion
Trivalent IPV is non-inferior to OPV in terms of seroprotection (in the Chinese vaccination schedule) in infant and toddlers, with a clinically acceptable safety profile

Supplemental measles vaccine antibody response among HIV-infected and -uninfected children in Malawi after 1- and 2-dose primary measles vaccination schedules

Vaccine
Volume 34, Issue 12, Pages 1423-1488 (14 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/12

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Supplemental measles vaccine antibody response among HIV-infected and -uninfected children in Malawi after 1- and 2-dose primary measles vaccination schedules
Original Research Article
Pages 1459-1464
Ashley L. Fowlkes, Desiree Witte, Judy Beeler, Susette A. Audet, Robin Broadhead, William J. Bellini, Felicity Cutts, Rita F. Helfand
Abstract
Background
The long-term antibody response to measles vaccine (MV) administered at age 6 months with or without subsequent doses is not well documented.
Methods
Measles serum antibody responses were evaluated after a supplemental dose of measles vaccine (sMV) administered at a median age of 20 months among Malawian children who had previously received 2 doses of measles vaccine (MV) at ages 6 and 9 months (HIV-infected and random sample of HIV-uninfected) or 1 dose at age 9 months (random sample of HIV-uninfected). We compared measles antibody seropositivity between groups by enzyme linked immunoassay and seroprotection by plaque reduction neutralization geometric mean concentrations.
Results
Of 1756 children enrolled, 887 (50.5%) received a sMV dose following MV at 9 months of age and had specimens available after sMV receipt, including 401 HIV-uninfected children who received one MV dose at 9 months, 464 HIV-uninfected and 22 HIV-infected children who received two doses of MV at ages 6 and 9 months. Among HIV-uninfected children, protective levels of antibody were found post sMV in 90–99% through ages 24–36 months and were not affected by MV schedule. Geometric mean concentration levels of measles antibody were significantly increased post-sMV among those HIV-uninfected children previously non-responsive to vaccination. Among HIV-infected children, the proportion seroprotected increased initially but by 9 months post-sMV was no higher than pre-sMV.
Conclusions
Our findings support early 2-dose MV to provide measles immunity for young infants without risk of interference with antibody responses to subsequent MV doses administered as part of SIAs.

Long-term stability of influenza vaccine in a dissolving microneedle patch

Drug Delivery and Translational Research
First online: 29 February 2016
Research Article
Long-term stability of influenza vaccine in a dissolving microneedle patch
Matthew J. Mistilis, Jessica C. Joyce, E. Stein Esser, Ioanna Skountzou, Richard W. Compans, Andreas S. Bommarius, Mark R. Prausnitz
Abstract
This study tested the hypothesis that optimized microneedle patch formulations can stabilize trivalent subunit influenza vaccine during long-term storage outside the cold chain and when exposed to potential stresses found during manufacturing and storage. Formulations containing combinations of trehalose/sucrose, sucrose/arginine, and arginine/heptagluconate were successful at retaining most or all vaccine activity during storage at 25 °C for up to 24 months as determined by ELISA assay. The best formulation of microneedle patches contained arginine/heptagluconate, which showed no significant loss of vaccine activity during the study. To validate these in vitro findings, mice were immunized using trivalent influenza vaccine stored in microneedle patches for more than 1 year at 25 °C, which elicited antibody titers greater than or equal to fresh liquid vaccine delivered by intradermal injection, indicating the retention of immunogenicity during storage. Finally, influenza vaccine in microneedle patches lost no significant activity during exposure to 60 °C for 4 months, multiple freeze-thaw cycles, or electron beam irradiation. We conclude that optimally formulated microneedle patches can retain influenza vaccine activity during extended storage outside the cold chain and during other environmental stresses, which suggests the possibility of microneedle patch storage on pharmacy shelves without refrigeration.

Group B Streptococcus: developing a correlate of protection for a vaccine against neonatal infections.

Current Opinion in Infectious Diseases
2016 Published Ahead-of-Print
Group B Streptococcus: developing a correlate of protection for a vaccine against neonatal infections.
Dangor, Ziyaad; Lala, Sanjay G.; Kwatra, Gaurav; Madhi, Shabir A.
Abstract
Purpose of review:
Maternal vaccination to prevent invasive Group B Streptococcus (GBS) disease in infants is an important alternative strategy to intrapartum antibiotic prophylaxis. Licensure of GBS vaccines could be expedited using immunological correlates of protection.
Recent findings:
Between 2014 and 2015, we identified two studies that demonstrated an inverse association between invasive GBS disease and maternal serotype III capsular antibody levels greater than 1 [mu]g/ml and greater than 3 [mu]g/ml, and higher maternal antibody levels were associated with protection against serotype Ia disease. Furthermore, serotype Ia and III antibody levels greater than 3 [mu]g/ml were associated with a reduced risk of GBS colonization in pregnant women.
Experimental studies have investigated the use of GBS surface proteins as vaccine candidates. Although the immunogenic potential of pilus island and other surface proteins has been shown in animal-model studies, no association between maternal pilus island antibody levels and invasive GBS disease was demonstrated in infants. Additionally, several novel innate immune mediators that prevent GBS infection have been described in human and experimental studies.
Summary:
Recent studies suggest that maternal capsular antibody thresholds may be used as immunological correlates of protection for vaccine licensure. Surface proteins, as candidate vaccines or conjugates to the polysaccharide-protein vaccine, may broaden protection against invasive GBS disease.

Reorienting health aid to meet post-2015 global health challenges: a case study of Sweden as a donor

Oxford Review of Economic Policy
Spring 2016
Reorienting health aid to meet post-2015 global health challenges: a case study of Sweden as a donor
Gavin Yamey, Jesper Sundewall, Helen Saxenian, Robert Hecht, Keely Jordan, Marco Schäferhoff, Christina Schrade, Cécile Deleye, Milan Thomas, Nathan Blanchet, Lawrence Summers, and Dean Jamison
Abstract
The international development community is transitioning from the era of the Millennium Development Goals (MDGs), ending in 2015, to the era of the Sustainable Development Goals (SDGs), which have a 2030 target. Global development assistance for health (DAH) increased substantially in the MDGs era, from US $10.8 billion in 2001 to $28.1 billion by 2012 (in 2010 US dollars), and it played a crucial role in tackling global challenges such as HIV/AIDS and malaria. In this paper, we describe the likely health challenges of the SDGs era and the types of international assistance that will be required to help tackle these challenges. We propose a new way of classifying DAH based on considering the functions that it will need to serve in order to address these post-2015 challenges. We apply this new classification to the current health aid spending of one donor, Sweden, as a case study. Based on our findings, we suggest ways in which Sweden’s DAH could be reoriented towards meeting the health challenges of the next two decades.

Honing the Priorities and Making the Investment Case for Global Health

PLoS Biology
Published: March 2, 2016
DOI: 10.1371/journal.pbio.1002376
Honing the Priorities and Making the Investment Case for Global Health
Trevor Mundel
Abstract
In the aftermath of the Ebola crisis, the global health community has a unique opportunity to reflect on the lessons learned and apply them to prepare the world for the next crisis. Part of that preparation will entail knowing, with greater precision, what the scale and scope of our specific global health challenges are and what resources are needed to address them. However, how can we know the magnitude of the challenge, and what resources are needed without knowing the current status of the world through accurate primary data? Once we know the current status, how can we decide on an intervention today with a predicted impact decades out if we cannot project into that future? Making a case for more investments will require not just better data generation and sharing but a whole new level of sophistication in our analytical capability—a fundamental shift in our thinking to set expectations to match the reality. In this current status of a distributed world, being transparent with our assumptions and specific with the case for investing in global health is a powerful approach to finding solutions to the problems that have plagued us for centuries.

Vaccines and Global Health: The Week in Review 27 February 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_27 February 2016

blog edition: comprised of the approx. 35+ entries posted below on 28-29 February 2016.

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

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

Zika virus [to 27 February 2016]

Zika virus [to 27 February 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

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Zika response accelerates as WHO Director-General visits Brazil
February 2016
As WHO continues its work to guide the international response to Zika, the Director-General, Dr Margaret Chan, has arrived in the northeast of the country to visit the area most affected by neurological disorders suspected of being linked to the virus, including microcephaly in babies.

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WHO: Zika Virus, Microcephaly and Guillain–Barré syndrome situation report
26 February 2016
Read the full situation report
Summary
:: Between 1 January 2007 and 25 February 2016, a total of 52 countries and territories have reported autochthonous (local) transmission of Zika virus, including those where the outbreak is now over and countries and territories that provided indirect evidence of local transmission. Among the 52 countries and territories, Marshall Islands, Saint Vincent and the Grenadines, and Trinidad and Tobago are the latest to report autochthonous transmission of Zika virus.

:: The geographical distribution of Zika virus has steadily widened since the virus was first detected in the Americas in 2015. Autochthonous Zika virus transmission has been reported in 31 countries and territories of this region. Zika virus is likely to be transmitted and detected in other countries within the geographical range of competent mosquito vectors, especially Aedes aegypti.

:: So far an increase in microcephaly cases and other neonatal malformations have only been reported in Brazil and French Polynesia, although two cases linked to a stay in Brazil were detected in two other countries.

:: During 2015 and 2016, eight countries and territories have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases.

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

:: The global prevention and control strategy launched by WHO as a Strategic Response Framework1 encompasses surveillance, response activities and research, and this situation report is organized under those headings. Following consultation with partners and taking changes in caseload into account, the framework will be updated at the end of March 2016 to reflect epidemiological evidence coming to light and the evolving division of roles and responsibilities for tackling this emergency.

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Disease Outbreak News (DONs)
:: Zika virus infection – Netherlands – Bonaire and Aruba 22 February 2016

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WHO Fact Sheet – Zika virus
22 February 2016

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WHO releases new guidance for Zika virus and potential complications
25 February 2016 — WHO, today, releases guidance for health workers to assess microcephaly and identify and manage Guillain-Barré syndrome and other issues in relation to Zika virus and the current health emergency. Watch the video to learn how to prevent Zika virus by protecting yourself against mosquitoes.
:: Psychosocial support for pregnant women and for families with microcephaly and other neurological complications in the context of Zika virus
26 February 2016
:: Assessment of infants with microcephaly in the context of Zika virus
25 February 2016
:: Identification and management of Guillain-Barré syndrome in the context of Zika virus
25 February 2016
:: Breastfeeding in the context of Zika virus
25 February 2016

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Zika Open
[Bulletin of the World Health Organization]
:: Papers available here
New
Birth prevalence of microcephaly in India
– Prajkta Bhide & Anita Kar
Posted: 23 February 2016 – http://dx.doi.org/10.2471/BLT.16.172080

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CDC/ACIP [to 27 February 2016]
http://www.cdc.gov/media/index.html
FRIDAY, FEBRUARY 26, 2016
New CDC Laboratory Test for Zika Virus Authorized for Emergency Use by FDA
Emergency action expected to bolster US laboratory capacity for Zika testing
In response to a request from the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration (FDA) today issued an Emergency Use Authorization (EUA) for a diagnostic tool for Zika virus that will be distributed to qualified laboratories and, in the United States, those that are certified to perform high-complexity tests.

The test, called the CDC Zika IgM Antibody Capture Enzyme-Linked Immunosorbent Assay (Zika MAC-ELISA), is intended for use in detecting antibodies that the body makes to fight a Zika virus infection. These antibodies (in this case, immunoglobulin M, or IgM) appear in the blood of a person infected with Zika virus beginning 4 to 5 days after the start of illness and last for about 12 weeks. The test is intended to be used on blood samples from people with a history of symptoms associated with Zika and/or people who have recently traveled to an area during a time of active Zika transmission…

FRIDAY, FEBRUARY 26, 2016
CDC issues advice for travel to the 2016 Summer Olympic Games
Today, CDC issued advice for people planning travel to the 2016 Summer Olympic Games in Rio de Janeiro, Brazil, from August 5 to August 21, 2016…

TUESDAY, FEBRUARY 23, 2016
CDC adds 2 destinations to interim travel guidance related to Zika virus – Media Statement
CDC is working with other public health officials to monitor for ongoing Zika virus‎ transmission. Today, CDC added the following destinations to the Zika virus travel notices: Trinidad and Tobago and the Marshall Islands. CDC has issued a travel notice (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing. For a full list of affected countries/regions: http://wwwnc.cdc.gov/travel/page/zika-travel-information. Specific areas where Zika virus transmission is ongoing are often difficult to determine and are likely to continue to change over time…

TUESDAY, FEBRUARY 23, 2016
CDC encourages following guidance to prevent sexual transmission of Zika virus – Media Statement

POLIO [to 27 February 2016]

POLIO [to 27 February 2016]
Public Health Emergency of International Concern (PHEIC)
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Polio this week as of 24 February 2016
:: GPEI have published six new videos on ‘Securing a Polio Free World’ covering topics including the polio vaccines, circulating vaccine-derived polioviruses and the upcoming ‘Switch’. The videos are available in both English and French.
:: There are eight weeks to go until the globally synchronized switch from the trivalent to bivalent oral polio vaccine, an important milestone in achieving a polio-free world. Read more about the reasons behind the switch here. Read more ongoing preparation for the switch here.

Selected Country Levels Updates [excerpted]
Pakistan
:: One new case of wild poliovirus type 1 (WPV1) was reported in the last week, in Nowshera, Khyber Pakhtunkhwa, with onset of paralysis on 22 January. The total number of WPV1 cases for 2016 is now 2, compared to 9 reported for 2015 at this point last year.
:: One new WPV1 environmental positive was reported in the past week in Karachi Gadap, Sindh province, with collection on 27 January.
:: National Immunization Days (NIDs) are planned in March using tOPV.
West Africa
:: Three new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported from Guinea in the past week, all in Kankan province. The first two cases were reported from Siguiri district and the third from Kankan district, with onset of paralysis on 10 October, 1 December and 14 December respectively. The total number of cVDPV2 cases for 2015 is now 7. The 2015 cases are genetically linked to the case with onset in August 2014.
:: National Immunization Days (NIDs) are planned in Benin, Burkina Faso, Cote d’Ivoire, Liberia, Mali, Niger and Sierra Leone from 26 to 29 February and in Guinea from 3 to 6 March. These will be repeated from 25 to 28 March. The March round of NIDs will also include Mauritania. All campaigns are using trivalent oral polio vaccine (tOPV).

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Circulating vaccine-derived poliovirus – Lao People’s Democratic Republic
Disease Outbreak News (DONs)
25 February 2016
Between 6 and 16 February 2016, the National IHR Focal Point (NFP) of Lao People’s Democratic Republic (PDR) notified WHO of 3 additional cases of vaccine-derived poliovirus type 1 (VDPV1).
Details of the new cases
:: The first case is a 15-month-old female from Phonhoung district, Vientiane Province. The patient developed paralysis on 8 January.
:: The second case is a 44-year-old female from Feuang district, Vientiane Province. The patient developed paralysis on 11 January.
Neither of the two cases received oral polio vaccine (OPV). On 3 February 2016, the National Institute of Infectious Diseases, Japan reported that stool samples for both cases tested positive for type 1 circulating vaccine-derived polio virus (cVDPV1). There is no epidemiological link between the two cases.
:: The third case is an 18-year-old male from Meun district, Vientiane Province. The case developed paralysis on 3 January 2016. Test results for his stool specimen are pending; however, the specimen was considered to be as ‘inadequate’ since it was collected more than 14 days after the onset of paralysis. A stool sample collected from a close contact tested positive for VDPV1, the case is classified as cVDPV1 based on the epidemiological link and the contact’s positive stool sample.
Of note is that these new cVDPV1 isolates are genetically linked but have considerable genetic differences with the previous Laos cVDPV1 isolates from the current outbreak. The new findings suggest that more than one strain of cVDPV1 may have emerged separately and co-circulated in Laos without being detected.
To date, the total number of confirmed cVDPV1 cases in this outbreak is 10. Furthermore, since the beginning of the outbreak, circulating cVDPV1 has been isolated from the stools of 23 healthy contacts in the provinces of Bolikhamxay, Xaisomboun and Vientiane…

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Organization of Islamic Cooperation (OIC) [to 27 February 2016]
http://www.oic-oci.org/oicv2/news/
23/02/2016
OIC Calls Upon Afghani Ulama to Play their Role in the Efforts to Eradicate Polio from Afghanistan
An International Ulama Conference on Eradication of Polio was opened in Kabul, Afghanistan on 22 February 2016. The Conference has attracted over 100 Ulama (Islamic Scholars) from all parts of Afghanistan and beyond. The Conference was organized by Islamic Advisory Group on Polio Eradication (IAG) in conjunction with the Government of Afghanistan.

IAG was launched at the OIC Headquarters in February 2014 after consultations among Al Azhar University, OIC General Secretariat, Islamic Development Bank (IDB) and International Islamic Fiqh Academy (IIFA). It comprises of Islamic Institutions, religious scholars, technical experts and academia from the Muslim World.

Some of the leading Members of the IAG are: Dr. Saleh Bin Abdullah Bin Humaid, President of the Council of IIFA; Dr. Abdulmohsin Al Qasim; Imam of Holy Mosque in Madinah; Dr. Ahmed Al Tayyeb, Grand Imam of Al Azhar Al Sharif; Mr. Iyad Ameen Madani, Secretary General of OIC; and Dr. Ahmed Mohamed Ali President of IDB.

The Conference in Kabul is intended to mobilize religious scholars and groups to support global efforts to end polio in Afghanistan. In his remarks during the opening of the Conference, the representative of the OIC General Secretariat Amb. Muhammad Naeem Khan, Assistant Secretary General underscored the important role of Ulama in sensitizing communities to protect their children from preventable diseases by embracing vaccination campaigns. He re-irritated OIC commitment to supporting Member States in their efforts to provide health care to their peoples.

The Conference was also addressed by H.E. Dr. Ferozuddin Feroz, Minister of Public Health of the Islamic Republic of Afghanistan and H.E. Dr. Fadhulullah Kakal, Special Advisor to the President of Afghanistan on health, among others. The Conference is expected to end on 23 February 2016 with a declaration and a clear commitment from Ulama to support polio eradication efforts.

Declaration: Universal Access to Immunization as a Cornerstone for Health and Development in Africa

WHO

Commentary
Africa: Now is the time to reach every child with life-saving vaccines
Dr Matshidiso Moeti, WHO Regional Director for Africa
Dr Ala Alwan, WHO Regional Director for the Eastern Mediterranean
22 February 2016
[Excerpts]
Africa has an incredible opportunity to provide a better life for each and every child – and we know exactly how to seize it: provide universal acces0s to immunization across the continent to protect them from vaccine preventable diseases. We have seen the transformative impact of efforts to reach more children with life-saving vaccines. Child deaths in Africa fell by half over the past generation, in large part due to the use of high impact interventions such as immunization…

Ministerial Conference on Immunization in Africa
To galvanize action, WHO’s offices for Africa and the Eastern Mediterranean, in conjunction with the African Union and other partners, are hosting the first-ever Ministerial Conference on Immunization in Africa, in Addis Ababa from 24–25 February 2016.

This conference will represent a remarkable moment. For the first time ministers of health, finance and other sectors from across the continent will come together to declare their commitment to strengthening immunization services, and put universal access to immunization at the forefront of efforts to improve health and drive sustainable development. These leaders are taking action now because they know that vaccines are a smart investment and that their countries can and must do more.

:: website – Ministerial Conference on Immunization in Africa

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Ministers pledge to improve access to vaccines at first-ever Ministerial Conference on Immunization in Africa
26 February 2016
Press Release and Declaration
With one in five African children lacking access to all needed and basic life-saving vaccines, ministers of health and other line ministers committed themselves to keep immunization at the forefront of efforts to reduce child mortality, morbidity and disability.

At a landmark Ministerial Conference on Immunization in Africa held from 24-25 February, in Addis Ababa, Ethiopia, the ministers signed a declaration to promote the use of vaccines to protect people of all ages against vaccine-preventable diseases and to close the immunization gap by 2020. The conference, which was hosted by the World Health Organization (WHO) Regional Offices for Africa (AFRO) and the Eastern Mediterranean (EMRO) in conjunction with the African Union Commission (AUC), was the first-ever ministerial-level gathering with a singular focus on ensuring that children across the continent can get access to life-saving vaccines. Below is the full declaration:

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Declaration of the Ministerial Conference on Immunization in Africa held from 24-25 February, in Addis Ababa, Ethiopia
Universal Access to Immunization as a Cornerstone for Health and Development in Africa
We, African Ministers of Health, Finance, Education, Social Affairs, Local Governments attending the Ministerial Conference on Immunization in Africa, which took place from 24 to 25 February 2016 in Addis Ababa, Ethiopia, and convened by the World Health Organization in collaboration with the African Union Commission, are committed to continued investment in immunization programs and a healthy future for all people of the African continent.

Recognizing the tremendous advances that are improving the health of Africa’s citizens, including:
:: A 50% decline in child death rates, and ever-growing numbers of children attending school;
:: Widespread access to vaccines that were not available to African children and adults just a decade ago;
:: Higher vaccine coverage rates across the continent in each five-year periods between 1999-2014;
:: The remarkable achievement of the Africa continent for interrupting wild poliovirus transmission for more than one year; achieving near elimination of Meningococcal meningitis A epidemics, and the significant reduction in disease burden and mortality due to measles.

Bearing in mind the recently ratified Sustainable Development Goal target of Universal Health Coverage which calls for access to immunisation for all (New York, September 2015); and that health is fundamental to social and economic development;

Acknowledging that, broad-based, inclusive growth in Africa is dependent on a healthy population; and that strong immunization programs are a cornerstone of robust systems that help achieving universal health coverage, which is critical to helping national leaders achieve their economic and development goals;

Reaffirming the economic imperative and benefits of reducing vaccine-preventable diseases and consequential deaths, which will improve overall health, empower our future generation and allow every person to achieve his or her full potential;

Recalling the Heads of State Declaration on Polio Eradication in Africa: “Our Historic Legacy to Future Generations” (Johannesburg, June 2015); the World Health Assembly resolution (WHA68.6) on the Global Vaccine Action Plan (Geneva, May 2015), the commitment made by African Ministers of Health on Universal Health Coverage in Africa (Luanda, April 2014); the Immunize Africa 2020 Declaration (Abuja, May 2014) endorsed by African Heads of State; the World Health Assembly resolution that commits all 194 Member States to apply the vision and strategies of the Global Vaccine Action Plan (GVAP) (Geneva, May 2012), and the African Heads of State endorsement of the Pharmaceutical Manufacturing Plan in 2012 as the framework for African people to have access to essential, quality, safe and effective medical products and technologies.

Recognizing that despite progress, universal access to immunisation by 2020, as endorsed under the GVAP, is largely off track in Africa as indicated by the 2014 GVAP report; but that with resolve we can still achieve the GVAP target of at least 90% coverage in our countries and at least 80% coverage in every district for all nationally available vaccines;

Admitting that to sustain the progress made in vaccine introduction and coverage – and achieve the full potential to save children’s and adult’s lives – current national budgetary allocations to vaccination programmes within the context of national health systems financing will need to be further increased;

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We hereby collectively and individually commit ourselves to:
:: Keeping universal access to immunisation at the forefront of our efforts to reduce child mortality, morbidity and disability, and in doing so help our countries achieve their long-term health, economic and development goals;

:: Increasing and sustaining our domestic investments and funding allocations, including innovative financing mechanisms, to meet the cost of traditional vaccines, fulfil our new vaccine financing requirements, and providing financial support for the operational implementation of immunization activities by EPI programs;

:: Addressing the persistent barriers in our vaccine and healthcare delivery systems, especially in the poorest, vulnerable and most marginalized communities, including the strengthening of data collection, reporting and use at all levels as well as building effective and efficient supply chains and integrated procurement systems;

:: Increasing the effectiveness and efficiency, as well as changing the approaches as needed, of our immunization delivery systems as an integrated part of strong and sustainable primary health care systems;

:: Attaining and maintaining high quality surveillance for targeted vaccine preventable diseases;

:: Monitoring progress towards achieving the goals of the global and regional immunization plans;

:: Ensuring polio legacy transition plans are in place by end-2016 that will allow future health programs to benefit from the knowledge and expertise the polio program has generated through the eradication initiative;

:: Developing a capacitated African research sector to enhance immunization implementation and uptake;

:: Building broad political will, working with communities, civil society organizations, traditional and religious leaders, health professional associations and parliamentarians, for the right of every child and every community to have universal access to life-saving vaccines, and by extension the best possible chance for a healthy future;

:: Promoting and investing in regional capacity for the development and production of vaccines in line with the African Union Pharmaceutical Manufacturing Plan including the strengthening of national regulatory authorities.

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We call upon:
:: Member states and partners, including African development banks and African regional economic communities, to support the implementation of this Declaration, and to increase their efforts to mobilize resources and secure new investments to strengthen national immunization programmes to achieve the GVAP goals and overall health care delivery systems in the Member States;

:: Member states and partners, to negotiate with vaccine manufacturers to facilitate access to available vaccines at affordable prices, and in increasing price transparency as well as developing price databases in line with resolution WHA68.6;

:: Gavi, the vaccine alliance to consider refugees and internally displaced populations as eligible recipients of Gavi support for vaccines and operational costs;

:: The World Health Organization and the African Union Commission to support member states to share experiences, strengthen capacity, and establish mechanisms for monitoring progress towards the fulfilment of these commitments.

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We thank his Excellency Hailemariam Desalegn, Prime Minister of the Federal Democratic Republic of Ethiopia, and host country for this Ministerial Conference on Immunization in Africa, for agreeing to champion this declaration and further request him to present it to the African Heads of States at the 26th Summit of the African Union, to be held in June 2016.
Done at Addis Ababa on 25 February 2016

WHO & Regionals [to 27 February 2016]

WHO & Regionals [to 27 February 2016]

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Weekly Epidemiological Record (WER) 26 February 2016, vol. 91, 8 (pp. 89–104)
Contents:
89 Plague around the world, 2010–2015
93 Preventive chemotherapy for helminth diseases: progress report, 2014

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Disease Outbreak News (DONs)
:: Human infection with avian influenza A(H7N9) virus – China 25 February 2016
:: Circulating vaccine-derived poliovirus – Lao People’s Democratic Republic 25 February 2016
:: Dengue Fever – Uruguay 25 February 2016
:: Zika virus infection – Netherlands – Bonaire and Aruba 22 February 2016

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Call for nominations for SAGE Working Group on the Decade of Vaccine’s Global Vaccine Action Plan
23 February 2016
Deadline for applications 18 March 2016

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WHO “Highlights”
Updated guidance on the care of critically ill children
February 2016 — Children admitted to hospital often die within 24 hours of admission. Many of these deaths can be prevented if treatment is started immediately after their arrival. Updated guidance covers the most common emergency conditions in children arriving at a health facility.

Health Infographics
February 2016 — WHO launches an infographics page to display what effects your health in a clear and concise format. View, download, and share infographics and key messages on diverse health topics.

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:: WHO Regional Offices
WHO African Region AFRO ::
:: Ministers pledge to improve access to vaccines at first-ever Ministerial Conference on Immunization in Africa
Addis Ababa, Ethiopia (25 February 2016)
:: Meningitis A nearly eliminated in Africa through vaccination, reaching more than 235 million people – 23 February 2016

WHO Region of the Americas PAHO
:: PAHO experts visit Colombia to support the response to Zika virus (02/23/2016)

WHO South-East Asia Region SEARO
:: Take concrete steps to fight antibiotic resistance, turn pledges into action: WHO
23 February 2016

WHO European Region EURO
No new digest content identified.

WHO Eastern Mediterranean Region EMRO
:: Health at your fingertips: Using mobiles to help diabetics in Egypt
24 February 2016
:: Africa: Now is the time to reach every child with life-saving vaccines
22 February 2016

WHO Western Pacific Region
:: WHO supports Fiji’s health needs caused by Tropical Cyclone Winston
SUVA, 26 February 2016 – In response to Fiji’s call for international assistance in the aftermath of Tropical Cyclone Winston, the World Health Organization (WHO) is providing emergency medical supplies and additional personnel to support Fiji as it organizes relief efforts for the survivors. Fiji has declared a State of Emergency.

 

CDC/ACIP [to 27 February 2016]

CDC/ACIP [to 27 February 2016]
http://www.cdc.gov/media/index.html
[see Zika coverage above which includes CDC briefing content]

WEDNESDAY, FEBRUARY 24, 2016
Flu Vaccine Nearly 60 Percent Effective – Press Release
The Centers for Disease Control and Prevention today reported preliminary overall influenza vaccine effectiveness (VE) of 59 percent this season. These data were presented at a meeting of the agency’s Advisory Committee for Immunization Practices (ACIP) in Atlanta. This finding is comparable to past estimates for seasons when most circulating flu viruses and vaccine viruses have been similar…

PATH [to 27 February 2016]

PATH [to 27 February 2016]
http://www.path.org/news/index.php

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Press release | February 22, 2016
Meningitis A nearly eliminated in Africa through vaccination, reaching more than 235 million people
Officials at Addis conference plan transition from mass campaigns to use in childhood immunization programs to prevent resurgence of deadly epidemics.
Addis Ababa, 23 February 2016—Global vaccine experts and officials from all 26 African “meningitis belt” countries have convened in Addis Ababa, Ethiopia to celebrate one of Africa’s biggest public health achievements—the introduction of a vaccine, MenAfriVac®, designed, developed, and produced for use in Africa, that in five years of use has nearly eliminated serogroup A meningococcal disease from meningitis belt countries and is now being integrated into routine national immunization programs.

Cases of the deadly infectious disease went from over 250,000 during an outbreak in 1996 to just 80 confirmed cases in 2015 among countries that had not yet conducted mass immunization campaigns and among those unvaccinated, scientists at the Meningitis Vaccine Project (MVP) Closure Conference reported.

At the same time, they announced that eight countries have applied for funding to start integrating this lifesaving vaccine into their national childhood immunization programs.

“Our great success against meningitis A is by no means permanent,” said Dr. Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. “To sustain the protection that has been afforded to date against meningitis A, all at-risk countries must finish conducting vaccination campaigns and begin incorporating the vaccine into routine childhood immunization programs.”

The MVP Closure Conference organized by WHO and the international global health nonprofit PATH, is taking place just before the Ministerial Conference on Immunization in Africa…

Gavi [to 27 February 2016]

Gavi [to 27 February 2016]
http://www.gavialliance.org/library/news/press-releases/

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26 February 2016
Positive impact of Advance Market Commitment highlighted in report
Innovative financing mechanism helping pneumococcal vaccines reach poorest children in record time.
Geneva,– Children in the world’s poorest countries are being protected against the leading cause of pneumonia more quickly than ever thanks in part to the influence of the pilot Advance Market Commitment (AMC) for pneumococcal vaccines, an independent evaluation report published today confirms.

The AMC Outcomes and Impact Evaluation examined the role of the AMC in the successful introduction of the pneumococcal vaccine into the routine immunisation programmes of more than 50 developing countries since 2010. Historically it has taken more than a decade for the first children in developing countries to access the same new, effective vaccines as children in richer countries. In this case, newly developed pneumococcal vaccines were provided to developing countries within a year.

The report concludes that “the introduction of pneumococcal conjugate vaccines through the AMC pilot has accelerated immunisation coverage against pneumococcal disease across 53 Gavi counties to date, with 49 million [children] fully immunised [against the disease]”. The report also confirms that manufacturers made decisions to expand capacity to serve Gavi countries’ requirements in response to the AMC and its supply agreements…

Vaginal ring provides partial protection from HIV in large multinational trial

NIH [to 27 February 2016]
http://www.nih.gov/news/releases.htm
February 22, 2016
Vaginal ring provides partial protection from HIV in large multinational trial
— NIH-funded study finds protective effect strongest in women over age 25.
A ring that continuously releases an experimental antiretroviral drug in the vagina safely provided a modest level of protection against HIV infection in women, a large clinical trial in four sub-Saharan African countries has found. The ring reduced the risk of HIV infection by 27 percent in the study population overall and by 61 percent among women ages 25 years and older, who used the ring most consistently.
These results were announced today at the Conference on Retroviruses and Opportunistic Infections (CROI) in Boston and simultaneously published online in the New England Journal of Medicine.

“Women need a discreet, long-acting form of HIV prevention that they control and want to use,” said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH) and the primary funder of the trial. “This study found that a vaginal ring containing a sustained-release antiretroviral drug confers partial protection against HIV among women in sub-Saharan Africa. Further research is needed to understand the age-related disparities in the observed level of protection.”…

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UNAIDS [to 27 February 2016]
http://www.unaids.org/en/resources/presscentre/
23 February 2016
More investment needed in developing female-controlled HIV prevention options
Results from two recent studies of a monthly vaginal ring show modest protection from HIV infection for women
GENEVA, 23 February 2016—Results from two large-scale studies of a vaginal ring that releases the antiretroviral medicine dapivirine to prevent HIV among women have shown protection of around 30% against HIV. The results are encouraging and show the urgent need to expand investment in research and development for female-controlled methods of HIV prevention.

Although less effective than hoped for, the results are the first to show that a sustained release mechanism for antiretroviral medicine is feasible, safe and partially effective in preventing HIV infection among women. Follow-up studies are needed to build on these results and there is a need to better understand how to optimize the HIV prevention effect and support adherence.

“Women urgently need better options for HIV prevention, especially options that allow them greater control,” said Luiz Loures, Deputy Executive Director, UNAIDS. “The path to an effective microbicide has been a long one. The important results from these two studies take us one step closer towards an HIV prevention product that could protect millions of women worldwide.”

The two studies, presented on 22 February 2016 at the annual Conference on Retroviruses and Opportunistic Infections, being held in Boston, United States of America, were carried out across four African countries and recruited more than 4500 women. Each participant was randomly assigned to use either an active ring that slowly released the antiretroviral medicine dapivirine over the course of one month or to receive an inactive placebo ring containing no medicine. The risk of HIV infection was compared between women using the active rings and women using the placebo rings after two to four years of follow-up.

The ASPIRE/MTN-020 trial was carried out by the Microbicide Trials Network and the Ring Study/IPM 027 trial was carried out by the International Partnership for Microbicides. As the two trials were independent, it is encouraging that they achieved similar results (27% protection in ASPIRE and 31% protection in the Ring Study). Despite the high levels of adherence to the ring (82% in ASPIRE and 73% in the Ring Study), the results are lower than hoped for.

Another important finding from both studies was that there was little protection against HIV for women aged 21 years and below, with better protection for women 22 years and above. At least part of this difference was explained by better adherence in the older age group.

Young women in sub-Saharan Africa remain most affected by HIV. Around 79% of all women living with HIV (aged 15 years and older) live in the region. The results from this, and previous studies into female-controlled HIV prevention methods, reinforce the urgent need to find better HIV prevention methods that offer more choices for women…

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IAVI International AIDS Vaccine Initiative [to 27 February 2016]
http://www.iavi.org/press-releases/2016
February 22, 2016
IAVI Welcomes New Data from Dapivirine Ring Studies
The International AIDS Vaccine Initiative (IAVI) welcomes new data from two late-stage clinical studies indicating that vaginal rings containing the antiretroviral drug dapivirine can safely help protect vulnerable women in Sub-Saharan Africa from HIV infection.

Results of the ASPIRE and The Ring studies, announced Monday at the Conference on Retroviruses and Opportunistic Infections (CROI) in Boston, indicate that, when used consistently, the ring reduced the risk of HIV infection by approximately 30 percent in study participants overall (the study enrolled HIV-negative women aged 18-45). The results also indicate higher efficacy in women 21 and older, who also appeared to use the ring more consistently. Lower to no protection was found among participants 18 to 21 years of age.
The studies confirmed the very high-incident HIV infection rates among women in Sub-Saharan Africa, and found rates even higher than anticipated among some groups of younger participants.

“These results represent a significant step in advancing biomedical research of effective approaches to preventing HIV infection in women, and provide important insights into both opportunities and challenges to developing innovations capable of protecting those at greatest risk of infection in Sub-Saharan Africa,” said Mark Feinberg, MD, PhD, IAVI President and CEO.

“The data also underscore yet again the critical need for choices in HIV prevention – and the power to exercise those choices – for women in low-income countries who bear the brunt of this epidemic. We must ensure that all those living with HIV get access to antiretroviral treatment, that all biomedical prevention strategies with demonstrated efficacy are available to those who need them, and that research efforts to develop new highly effective prevention modalities are redoubled and sustained,” said Feinberg. “The sponsors, investigators and participants in the studies announced today all deserve tremendous recognition for their dedication and efforts to ensure the successful conduct of these important studies.”

IAVI International AIDS Vaccine Initiative [to 27 February 2016]

IAVI International AIDS Vaccine Initiative [to 27 February 2016]
http://www.iavi.org/press-releases/2016

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Two Leading Experts Join IAVI’s Vaccine Design and Development Teams
February 22, 2015
The International AIDS Vaccine Initiative (IAVI) is pleased to welcome two new senior members to its vaccine design and development teams.

Effective 1 February, Philip R. Johnson has joined IAVI as a Senior Advisor to help with forward planning of vaccine discovery efforts and exploration of innovative approaches to evaluate platform technologies to accelerate progress in HIV vaccine R&D. Johnson’s extensive scientific and leadership experience includes 20 years with the National Institutes of Health and the Columbus (Ohio) Children’s Hospital and 10 years as Chief Scientific Officer & Executive Vice President of the Children’s Hospital of Philadelphia. He has overseen basic, clinical and translational research covering influenza, respiratory syncytial viruses and HIV, and pioneered the use of recombinant adeno-associated-virus (AAV) vectors to deliver genes encoding for neutralizing antibodies or antibody-like molecules that inhibit HIV entry. Johnson and IAVI have worked together for more than a decade on AAV-vector-based approaches; an ongoing Phase 1 trial also involves the National Institute of Allergy and Infectious Diseases and the University of Surrey. Johnson received his undergraduate and medical degrees from the University of North Carolina at Chapel Hill and completed a pediatric residency and an infectious diseases fellowship at Vanderbilt University.

And effective 15 February, Robert Lemon has become an Executive Director of the Vaccine Product Development Center at IAVI. In this position, he will lead teams that help Collaboration for AIDS Vaccine Discovery grantees, supported by the Bill & Melinda Gates Foundation, to move their promising vaccine candidates into clinical testing. During more than 20 years at Wyeth, Pfizer and Merck, Lemon led the development, manufacturing and tech transfer that enabled global launch of seven new pharmaceutical products; the successful scale-up for commercialization of two biological products, and the successful scale-up and globalization of development and manufacturing of Merck’s Hepatitis A and Rotavirus vaccines. Lemon received his Bachelor of Science in Biology & Environmental Science from SUNY Plattsburgh and his Master of Business Administration in Leadership & Global Management from the University of Phoenix.

“Phil and Bob will contribute a wealth of design and development experience to IAVI’s efforts to help bring the world an AIDS vaccine,” said Mark Feinberg, IAVI President and CEO. “We are proud to welcome them to the IAVI family.”

Global Fund [to 27 February 2016]

Global Fund [to 27 February 2016]
http://www.theglobalfund.org/en/news/

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25 February 2016
Global Fund Supports Health Investments in Mali
BAMAKO, Mali – Mali and the Global Fund strengthened their partnership by signing three new grant agreements totalling €108 million to achieve greater impact against AIDS, tuberculosis and malaria and to build sustainable systems of health.

The financial resources provided through the Global Fund come from many sources and partners, including France, which was represented at a signing ceremony this week…

…The HIV grant of €46 million aims to provide access to anti-retroviral treatment for people living with HIV and by ensuring that at least 65 percent of HIV-positive pregnant women receive treatment to prevent the transmission of the virus to her child.
The malaria grant of €55 million will permit the distribution of mosquito nets in three highly affected regions of the country and the provision of effective treatment for all adults and children diagnosed with malaria.

Mali will use the tuberculosis grant of €7.5 million to increase the treatment success rate for patients with tuberculosis and to ensure that, by 2017, 90 percent tuberculosis patients co-infected with HIV also receive anti-retroviral treatment…

FDA [to 27 February 2016]

FDA [to 27 February 2016]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm

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February 24, 2016 –
FDA Statement on Senate Confirmation of Dr. Robert M. Califf
“Today the U.S. Senate voted in support of the confirmation of Dr. Robert Califf, M.D. to be Commissioner of U.S. Food and Drug Administration. Dr. Califf has demonstrated a long and deep commitment to advancing the public health throughout his distinguished career as a physician, researcher, and leader in the fields of science and medicine. He understands well the critical role that the FDA plays in responding to the changes in our society while protecting and promoting the health of the public, across the many areas we regulate – and I am confident that our public health and scientific contributions will further grow under his exceptional leadership.” Dr. Stephen Ostroff

Center for Global Development [to 27 February 2016]

Center for Global Development [to 27 February 2016]
http://www.cgdev.org/page/press-center
Selected Press Releases, Blog Posts, Publications

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Global Health Donors Viewed as Regulators of Monopolistic Service Providers: Lessons from Regulatory Literature – Working Paper 424
2/26/16
Han Ye
Controlling healthcare costs while promoting maximum health impact in the recipient countries is one the biggest challenges for global health donors. This paper views global health donors as the regulators of monopolistic service providers, and explores potential optimal fund payment systems under asymmetric information. It provides a summary and assessment of optimal price regulation designs for monopolistic service providers.

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Designing Contracts for the Global Fund: Lessons from the Theory of Incentives – Working Paper 425
2/26/16
Liam Wren-Lewis
This paper uses contract theory to suggest simple contract designs that could be used by the Global Fund. Using a basic model of procurement, we lay out five alternative options and consider when each is likely to be most appropriate. We ultimately provide a synthesis to guide policy makers as to when and how ‘results-based’ incentive contracts can be used in practice.

Comparison of age-specific hospitalization during pandemic and seasonal influenza periods from 2009 to 2012 in Taiwan: a nationwide population-based study

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 27 February 2016)

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Research article
Comparison of age-specific hospitalization during pandemic and seasonal influenza periods from 2009 to 2012 in Taiwan: a nationwide population-based study
In both pandemic and seasonal periods, the highest hospitalization rate was observed for children younger than 7 years of age. Adults over 50 years of age had a higher hospitalization risk during the seasonal periods and a higher clinical severity during the pandemic periods. Those results emphasize that the importance of influenza-related prevention strategies in the younger and older age groups, either seasonal or pandemic periods.
Shew-Meei Sheu, Ching-Fang Tsai, Hsin-Yi Yang, Hui-Wen Pai and Solomon Chih-Cheng Chen
Published on: 24 February 2016

Quantifying the economic impact of government and charity funding of medical research on private research and development funding in the United Kingdom

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 27 February 2016)

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Research article
Quantifying the economic impact of government and charity funding of medical research on private research and development funding in the United Kingdom
Overall, this suggests that government and charity funded research in the UK crowds in additional private sector R&D in the UK. The implied historical returns from UK government and charity funded investment in medical research in the UK compare favourably with the rates of return achieved on investments in the rest of the UK economy and are greatly in excess of the 3.5 % real annual rate of return required by the UK government to public investments generally.
Jon Sussex, Yan Feng, Jorge Mestre-Ferrandiz, Michele Pistollato, Marco Hafner, Peter Burridge and Jonathan Grant
Published on: 24 February 2016

BMC Public Health (Accessed 27 February 2016)

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 27 February 2016)

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Research article
Prevalence of influenza vaccination and its association with health conditions and risk factors among Kansas adults in 2013: a cross-sectional study
Jeanie Santaularia, Wei Hou, Ghazala Perveen, Ericka Welsh and Babalola Faseru
BMC Public Health 2016 16:185
Published on: 24 February 2016
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Research article
Factors influencing completion of multi-dose vaccine schedules in adolescents: a systematic review
Completion of multiple dose vaccine schedules is crucial to ensure a protective immune response, and maximise vaccine cost-effectiveness. While barriers and facilitators to vaccine uptake have recently been reviewed, there is no comprehensive review of factors influencing subsequent adherence or completion, which is key to achieving vaccine effectiveness. This study identifies and summarises the literature on factors affecting completion of multi-dose vaccine schedules by adolescents.
K. E. Gallagher, E. Kadokura, L. O. Eckert, S. Miyake, S. Mounier-Jack, M. Aldea, D. A. Ross and D. Watson-Jones
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Research article
Motivations to participate in a Phase I/II HIV vaccine trial: A descriptive study from Dar es Salaam, Tanzania
Participation in an HIV vaccine trial in a Tanzanian context is likely to be influenced by altruism and comprehensive education about the trial. Gender differences, marital status and education level need to be considered to enhance participation in future HIV vaccine trials.
E. A. M. Tarimo, M. Bakari, D. C. V. Kakoko, T. W. Kohi, F. Mhalu, E. Sandstrom and A. Kulane
BMC Public Health 2016 16:182
Published on: 24 February 2016

Protective Effect of Contemporary Pertussis Vaccines: A Systematic Review and Meta-analysis

Clinical Infectious Diseases (CID)
Volume 62 Issue 5 March 1, 2016
http://cid.oxfordjournals.org/content/current

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Advance Access
Protective Effect of Contemporary Pertussis Vaccines: A Systematic Review and Meta-analysis
T. Roice Fulton1,2, Varun K. Phadke3, Walter A. Orenstein4,6, Alan R. Hinman5, Wayne D. Johnson2, and Saad B. Omer1,2,4,6
Author Affiliations
1Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
2Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
3Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
4Emory Vaccine Center, Atlanta, Georgia, USA
5The Task Force for Global Health, Decatur, Georgia, USA
6Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
Abstract
Background.
Acellular (aP) and whole-cell (wP) pertussis vaccines are presumed to have similar short-term (<3 years after completion of the primary series) efficacy. However, vaccine effect varies between individual pertussis vaccine formulations, and many originally studied formulations are now unavailable. An updated analysis of the short-term protective effect of pertussis vaccines limited to formulations currently on the market in developed countries is needed.
Methods.
We conducted a systematic review and meta-analysis of published studies that evaluated pertussis vaccine efficacy or effectiveness within three years after completion (>3 doses) of a primary series of a currently available aP or wP formulation. The primary outcome was based on the World Health Organization (WHO) clinical case definitions for pertussis. Study quality was assessed using the approach developed by the Child Health Epidemiology Research Group (CHERG). We determined overall effect sizes using random effects meta-analyses, stratified by vaccine (aP or wP) and study (efficacy or effectiveness) type.
Results.
Meta-analysis of two aP vaccine efficacy studies (assessing the three-component GlaxoSmithKline and five-component Sanofi-Pasteur formulations) yielded an overall aP vaccine efficacy of 84% (95% confidence interval (CI), 81-87%). Meta-analysis of three wP vaccine effectiveness studies (assessing the Behringwerke, Pasteur/Merieux, and SmithKline Beecham formulations) yielded an overall wP vaccine effectiveness of 94% (95% CI, 88-97%) (both I2=0%).
Conclusions.
Although all contemporary aP and wP formulations protect against pertussis disease, in this meta-analysis the point estimate for short-term protective effect against WHO-defined pertussis in young children was lower for currently available aP vaccines than wP vaccines.

Global Public Health – Volume 11, Issue 4, 2016

Global Public Health
Volume 11, Issue 4, 2016
http://www.tandfonline.com/toc/rgph20/current

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Articles
Access and utilisation of healthcare services in rural Tanzania: A comparison of public and non-public facilities using quality, equity, and trust dimensions
pages 407-422
Elizabeth H. Shayo, Kesheni P. Senkoro, Romanus Momburi, Oystein E. Olsen, Jens Byskov, Emmanuel A. Makundi, Peter Kamuzora & Leonard E.G. Mboera
DOI:10.1080/17441692.2015.1132750
Published online: 17 Feb 2016
ABSTRACT
This study compared the access and utilisation of health services in public and non-public health facilities in terms of quality, equity and trust in the Mbarali district, Tanzania. Interviews, focus group discussions, and informal discussions were used to generate data. Of the 1836 respondents, 1157 and 679 respondents sought healthcare services on their last visit at public or non-public health facilities, respectively. While 45.5% rated the quality of services to be good in both types of facilities, reported medicine shortages were more pronounced among those who visited public rather than non-public health facilities (OR = 1.7, 95% CI 1.4, 2.1). Respondents who visited public facilities were 4.9 times less likely than those who visited non-public facilities to emphasise the influence of cost in accessing and utilising health care (OR = 4.9, CI 3.9–6.1). A significant difference was also found in the provider–client relationship satisfaction level between non-public (89.1%) and public facilities (74.7%) (OR = 2.8, CI: 1.5–5.0), indicating a level of lower trust in the later. Revised strategies are needed to ensure availability of medicines in public facilities, which are used by the majority of the population, while strengthening private–public partnerships to harmonise healthcare costs.

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The impact of global health initiatives on the health system in Angola
pages 475-495
Isabel Craveiro & Gilles Dussault
DOI:10.1080/17441692.2015.1128957
Published online: 13 Jan 2016
ABSTRACT
We assessed the impact of global health initiatives (GHIs) on the health care system of Angola, as a contribution to documenting how GHIs, such as the Global Fund, GAVI and PEPFAR, influence the planning and delivery of health services in low-income countries and how national systems respond. We collected the views of national and sub-national key informants through 42 semi-structured interviews between April 2009 and May 2011 (12 at the national level and 30 at the sub-national level). We used a snowball technique to identify respondents from government, donors and non-governmental organisations. GHIs stimulated the formulation of a health policy and of plans and strategies, but the country has yet to decide on its priorities for health. At the regional level, managers lack knowledge of how GHIs’ function, but they assess the effects of external funds as positive as they increased training opportunities, and augment the number of workers engaged in HIV or other specific disease programmes. However, GHIs did not address the challenge of attraction and retention of qualified personnel in provinces. Since Angola is not entirely dependent on external funding, national strategic programmes and the interventions of GHIs co-habit well, in contrast to countries such as Mozambique, which heavily depend on external aid.

Health policy and systems research and analysis in Nigeria: examining health policymakers’ and researchers’ capacity assets, needs and perspectives in south-east Nigeria

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 27 February 2016]

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Research
Health policy and systems research and analysis in Nigeria: examining health policymakers’ and researchers’ capacity assets, needs and perspectives in south-east Nigeria
Benjamin Uzochukwu, Chinyere Mbachu, Obinna Onwujekwe, Chinenye Okwuosa, Enyi Etiaba, Monica E. Nyström and Lucy Gilson
Published on: 24 February 2016

Moving interdisciplinary science forward: integrating participatory modelling with mathematical modelling of zoonotic disease in Africa

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 27 February 2016]

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Scoping Review
Moving interdisciplinary science forward: integrating participatory modelling with mathematical modelling of zoonotic disease in Africa
Catherine Grant, Giovanni Lo Iacono, Vupenyu Dzingirai, Bernard Bett, Thomas R. A. Winnebah and Peter M. Atkinson
Published on: 25 February 2016
Abstract
This review outlines the benefits of using multiple approaches to improve model design and facilitate multidisciplinary research into infectious diseases, as well as showing and proposing practical examples of effective integration. It looks particularly at the benefits of using participatory research in conjunction with traditional modelling methods to potentially improve disease research, control and management. Integrated approaches can lead to more realistic mathematical models which in turn can assist with making policy decisions that reduce disease and benefit local people. The emergence, risk, spread and control of diseases are affected by many complex bio-physical, environmental and socio-economic factors. These include climate and environmental change, land-use variation, changes in population and people’s behaviour.

The evidence base for this scoping review comes from the work of a consortium, with the aim of integrating modelling approaches traditionally used in epidemiological, ecological and development research. A total of five examples of the impacts of participatory research on the choice of model structure are presented. Example 1 focused on using participatory research as a tool to structure a model. Example 2 looks at identifying the most relevant parameters of the system. Example 3 concentrates on identifying the most relevant regime of the system (e.g., temporal stability or otherwise), Example 4 examines the feedbacks from mathematical models to guide participatory research and Example 5 goes beyond the so-far described two-way interplay between participatory and mathematical approaches to look at the integration of multiple methods and frameworks. This scoping review describes examples of best practice in the use of participatory methods, illustrating their potential to overcome disciplinary hurdles and promote multidisciplinary collaboration, with the aim of making models and their predictions more useful for decision-making and policy formulation.

Health literacy and infectious diseases: why does it matter?

International Journal of Infectious Diseases
February 2016 Volume 43, p1-110
Open Access
http://www.ijidonline.com/current

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Editorial
Health literacy: a concept with potential to greatly impact the infectious diseases field
Richard H. Osborne, Alison Beauchamp, Roy Batterham
p101–102
Published online: December 24 2015
Preview
This edition of the International Journal of Infectious Diseases presents a comprehensive narrative review of health literacy research by Castro-Sánchez et al. that has been undertaken across conditions and countries. Health literacy is a relatively new concept in medicine and, for many, has some immediate appeal. The term was coined by Simonds in the 1970s, who argued the case for school health education, with the intention that pupils would not only be educated in the customary curriculum subjects, but might become as ‘literate’ in health as they were, for example, in history and science.

Reviews
Health literacy and infectious diseases: why does it matter?
Enrique Castro-Sánchez, Peter W.S. Chang, Rafael Vila-Candel, Angel A. Escobedo, Alison H. Holmes
p103–110
Published online: January 2 2016
Preview
The planetary scale of the threat presented by infectious diseases to human health and society has been well described.1 An intricate arrangement of clinical, societal, and ecological determinants powers the emergence of new infectious pathogens such as Ebola virus, and the resurgence of others previously considered to be under control. These same factors drive the unsustainable use and consumption of antimicrobials,2 sketching the looming prospect of a ‘world without antibiotics’ reflected upon by many,3 and without new therapeutic agents likely to be developed at a sufficient rate and periodicity to provide a significant counterbalance.
Highlights
:: Health literacy is an emerging public health and research field.
:: There are limited studies focused on health literacy and infectious diseases.
:: Infections such as malaria with a high burden of morbidity were underrepresented.
:: Most investigations considered functional but not critical health literacy.
Summary
Objectives
Multifactorial interventions are crucial to arrest the threat posed by infectious diseases. Public involvement requires adequate information, but determinants such as health literacy can impact on the effective use of such knowledge. The influence of health literacy on infectious diseases is examined in this paper.
Methods
Databases were searched from January 1999 through July 2015 seeking studies reporting on health literacy and infections such tuberculosis, malaria, and influenza, and infection-related behaviours such as vaccination and hand hygiene. HIV was excluded, as comprehensive reviews have already been published.
Results
Studies were found on antibiotic knowledge and use, the adoption of influenza and MMR immunizations, and screening for sexually transmitted and viral hepatitis infections. There was a lack of investigations on areas such as tuberculosis, malaria, hand hygiene, and diarrhoeal diseases.
Conclusions
Limited or insufficient health literacy was associated with reduced adoption of protective behaviours such as immunization, and an inadequate understanding of antibiotics, although the relationship was not consistent. Large gaps remain in relation to infectious diseases with a high clinical and societal impact, such as tuberculosis and malaria.

Critical Care in Resource-Restricted Settings

JAMA
February 23, 2016, Vol 315, No. 8
http://jama.jamanetwork.com/issue.aspx

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Viewpoint | February 23, 2016
Critical Care in Resource-Restricted Settings
Arjen M. Dondorp, MD, PhD1,2; Shivakumar S. Iyer, MD3; Marcus J. Schultz, MD, PhD1,4
Author Affiliations
JAMA. 2016;315(8):753-754. doi:10.1001/jama.2016.0976.
Extract
This Viewpoint discusses the challenges of providing intensive care in settings and countries with limited resources.

In many low- and middle-income countries, with improved public health services like sanitation and immunization, the relative contribution of curative care for critically ill patients to overall health and life expectancy has increased considerably. The importance of intensive care facilities as a global good was emphasized by recent epidemics in which survival was highly dependent on adequate critical care. Examples include the SARS coronavirus (2002-2003), avian influenza H5N1 (2004 and onward), pandemic influenza A(H1N1) (2009), the MERS coronavirus (2012 and onward), and Ebola virus disease (2014-2015)…

Influenza B Burden in Latin America and Potential Benefits of the New Quadrivalent Vaccines

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 5 Issue 1 March 2016
http://jpids.oxfordjournals.org/content/current

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SLIPE HIGHLIGHTS: UPDATE FROM LATIN AMERICA
Influenza B Burden in Latin America and Potential Benefits of the New Quadrivalent Vaccines
Luiza Helena Falleiros Arlant, Lucia F. Bricks
Extract
Respiratory infections caused by the influenza virus have a huge impact on public health. Influenza vaccination offers many benefits to not only patients at high risk for complications of influenza but also to healthy individuals [1]. Because of pandemics, influenza A virus is perceived to carry greater risk than influenza B [2]. However, both types of influenza virus can affect people of any age group, and they cause clinically indistinguishable infections and pose equal risks [1, 2].
Globally, the influenza type B virus causes 20% to 25% of influenza infections. Influenza B viruses include 2 antigenically distinguished lineages, Victoria and Yamagata, which have been cocirculating globally since 2002 [3]. Circulation of the B lineages varies from year to year, so predicting which one to include in the next year’s trivalent influenza vaccine (IIV3) is difficult. In fact, data from the United States and Europe indicate that in half of the influenza seasons over the past decade, the B lineage included in …