BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 16 April 2016)

Research article
Estimating the cost-effectiveness profile of a universal vaccination programme with a nine-valent HPV vaccine in Austria
HPV is a major cancer-causing factor in both sexes in the cervix, vulva, vagina, anus, penis, oropharynx as well as the causal factor in other diseases such as genital warts and recurrent respiratory papilloma…
L. Boiron, E. Joura, N. Largeron, B. Prager and M. Uhart
BMC Infectious Diseases 2016 16:153
Published on: 16 April 2016
Abstract
Background
HPV is a major cancer-causing factor in both sexes in the cervix, vulva, vagina, anus, penis, oropharynx as well as the causal factor in other diseases such as genital warts and recurrent respiratory papillomatis. In the context of the arrival of a nonavalent HPV vaccine (6/11/16/18/31/33/45/52/58), this analysis aims to estimate the public health impact and the incremental cost-effectiveness of a universal (girls and boys) vaccination program with a nonavalent HPV vaccine as compared to the current universal vaccination program with a quadrivalent HPV vaccine (6/11/16/18), in Austria.
Method
A dynamic transmission model including a wide range of health and cost outcomes related to cervical, anal, vulvar, vaginal diseases and genital warts was calibrated to Austrian epidemiological data. The clinical impact due to the 5 new types was included for cervical and anal diseases outcomes only. In the base case, a two-dose schedule, lifelong vaccine type-specific protection and a vaccination coverage rate of 60 % and 40 % for girls and boys respectively for the 9-year old cohorts were assumed. A cost-effectiveness threshold of €30,000/QALY-gained was considered.
Results
Universal vaccination with the nonavalent vaccine was shown to reduce the incidence of HPV16/18/31/33/45/52/58 -related cervical cancer by 92 %, the related CIN2/3 cases by 96 % and anal cancer by 83 % and 76 % respectively in females and males after 100 years, relative to 75 %, 76 %, 80 % and 74 % with the quadrivalent vaccine, respectively. Furthermore, the nonavalent vaccine was projected to prevent an additional 14,893 cases of CIN2/3 and 2544 cases of cervical cancer, over 100 years. Depending on the vaccine price, the strategy was shown to be from cost-saving to cost-effective.
Conclusion
The present evaluation showed that vaccinating 60 % of girls and 40 % of boys aged 9 in Austria with a 9-valent vaccine will substantially reduce the incidence of cervical cancer, CIN and anal cancer compared to the existing strategy. The vaccination strategies performed with the 9-valent vaccine in the current study were all found to be cost-effective compared to the current quadrivalent vaccination strategy by considering a cost-effectiveness threshold of 30,000€/QALY gained.

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 16 April 2016)

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Research article
Effect of pay for performance to improve quality of maternal and child care in low- and middle-income countries: a systematic review
Pay for Performance (P4P) mechanisms to health facilities and providers are currently being tested in several low- and middle-income countries (LMIC) to improve maternal and child health (MCH).
Ashis Das, Saji S. Gopalan and Daniel Chandramohan
BMC Public Health 2016 16:321
Published on: 14 April 2016

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Research article
Projected economic evaluation of the national implementation of a hypothetical HIV vaccination program among adolescents in South Africa, 2012
Nishila Moodley, Glenda Gray and Melanie Bertram
BMC Public Health 2016 16:330
Published on: 14 April 2016
Abstract
Background
Adolescents in South Africa are at high risk of acquiring HIV. The HIV vaccination of adolescents could reduce HIV incidence and mortality. The potential impact and cost-effectiveness of a national school-based HIV vaccination program among adolescents was determined.
Method
The national HIV disease and cost burden was compared with (intervention) and without HIV vaccination (comparator) given to school-going adolescents using a semi-Markov model. Life table analysis was conducted to determine the impact of the intervention on life expectancy. Model inputs included measures of disease and cost burden and hypothetical assumptions of vaccine characteristics. The base-case HIV vaccine modelled cost at US$ 12 per dose; vaccine efficacy of 50 %; duration of protection of 10 years achieved at a coverage rate of 60 % and required annual boosters. Incremental cost-effectiveness ratios (ICER) were calculated using life years gained (LYG) serving as the outcome measure. Sensitivity analyses were conducted on the vaccine characteristics to assess parameter uncertainty.
Results
The HIV vaccination model yielded an ICER of US$ 5 per LYG (95 % CI ZAR 2.77–11.61) compared with the comparator, which is considerably less than the national willingness-to-pay threshold of cost-effectiveness. This translated to an 11 % increase in per capita costs from US$ 80 to US$ 89. National implementation of this intervention could potentially result in an estimated cumulative gain of 23.6 million years of life (95 % CI 8.48–34.3 million years) among adolescents age 10–19 years that were vaccinated. The 10 year absolute risk reduction projected by vaccine implementation was 0.42 % for HIV incidence and 0.41 % for HIV mortality, with an increase in life expectancy noted across all age groups. The ICER was sensitive to the vaccine efficacy, coverage and vaccine pricing in the sensitivity analysis.
Conclusions
A national HIV vaccination program would be cost-effective and would avert new HIV infections and decrease the mortality and morbidity associated with HIV disease. Decision makers would have to discern how these findings, derived from local data and reflective of the South African epidemic, can be integrated into the national long term health planning should a HIV vaccine become available.

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Research article
Measles susceptibility in young Thai men suggests need for young adult measles vaccination: a cross sectional study
Siriphan Gonwong, Thippawan Chuenchitra, Patchariya Khantapura, Dilara Islam and Carl J. Mason
BMC Public Health 2016 16:309
Published on: 11 April 2016
Abstract
Background
Measles remains a major public health concern in Thailand despite the introduction of vaccination since 1984. Similar to other countries, Thailand has experienced numerous measles outbreaks including adult communities such as university student dormitories, prisons, refugee camps, and military recruit camps. These outbreaks raise questions on the seroprotective antibody level in Thai adults.
Methods
To better understand measles susceptibility in young Thai adults, a retrospective measles seroprevalence study on repository serum specimens obtained with informed consent from young Thai men entering the Royal Thai Army (RTA) during 2007–2008 was conducted. A total of 7760 stratified randomized samples were chosen by residence province. Measles IgG titer was measured using a commercial IgG quantitative ELISA kit following the manufacturer’s instructions. An antibody level ≥ 250 International Units per Liter (IU/L) was interpreted as seropositive.
Results
The overall measles seroprevalence was 78.5 % (95 % Confidence Interval: 77.6–79.4 %) with geometric mean titer of 738 IU/L (95 % Confidence Interval: 716–760 IU/L). The measles seroprevalence by province ranged from 59.6 % to 93.1 %. A trend of decreasing seroprevalence in the younger cohorts despite increasing immunization coverage was found. Lower seroprevalence than vaccination coverage was observed in the youngest age group.
Conclusions
To achieve long term measles control and elimination, an integrated two doses vaccination strategy has been implemented in children in Thailand. This nationwide measles seroprevalence study in young adult RTA recruits found a measles seroprevalence lower than WHO’s recommendation for measles outbreak prevention and elimination. These results raise concerns for measles control in Thailand. Supplementary immunization in young adults is essential especially in high-risk and densely populated communities to establish herd immunity for outbreak prevention and elimination.

BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content
(Accessed 16 April 2016)

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Research article
Tracing the scientific outputs in the field of Ebola research based on publications in the Web of Science
Fengyun Yi, Pin Yang and Huifeng Sheng
BMC Research Notes 2016 9:221
Published on: 15 April 2016
Abstract
Background
Ebola virus disease (hereafter EVD or Ebola) has a high fatality rate. The devastating effects of the current epidemic of Ebola in West Africa have put the global health response in acute focus. In response, the World Health Organization (WHO) has declared the Ebola outbreak in West Africa as a “Public Health Emergency of International Concern”. A small proportion of scientific literature is dedicated to Ebola research.
Methods
To identify global research trends in Ebola research, the Institute for Scientific Information (ISI) Web of Science™ database was used to search for data, which encompassed original articles published from 1900 to 2013. The keyword “Ebola” was used to identify articles for the purposes of this review. In order to include all published items, the database was searched using the Basic Search method.
Results
The earliest record of literature about Ebola indexed in the Web of Science is from 1977. A total of 2477 publications on Ebola, published between 1977 and 2014 (with the number of publications increasing annually), were retrieved from the database. Original research articles (n = 1623, 65.5 %) were the most common type of publication. Almost all (96.5 %) of the literature in this field was in English. The USA had the highest scientific output and greatest number of funding agencies. Journal of Virology published 239 papers on Ebola, followed by Journal of Infectious Diseases and Virology, which published 113 and 99 papers, respectively. A total of 1911 papers on Ebola were cited 61,477 times.
Conclusion
This analysis identified the current state of research and trends in studies about Ebola between 1977 and 2014. Our bibliometric analysis provides a historical perspective on the progress in Ebola research.

British Medical Journal
16 April 2016 (vol 352, issue 8053)
http://www.bmj.com/content/353/8053

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Research Update
Clinical features and neuroimaging (CT and MRI) findings in presumed Zika virus related congenital infection and microcephaly: retrospective case series study
BMJ 2016; 353 :i1901 (Published 13 April 2016)
Maria de Fatima Vasco Aragao, neuroradiologist and professor of radiology1, Vanessa van der Linden, paediatric neurologist2, Alessandra Mertens Brainer-Lima, neuroradiologist and professor of radiology3, Regina Ramos Coeli, paediatric infectologist and professor4, Maria Angela Rocha, infectologist4, Paula Sobral da Silva, paediatric neurologist4, Maria Durce Costa Gomes de Carvalho, paediatric neurologist4, Ana van der Linden, paediatric neurologist5, Arthur Cesario de Holanda, medical student6, Marcelo Moraes Valenca, neurosurgeon and full professor of neurology and neurosurgery7
Abstract
Objective
To report radiological findings observed in computed tomography (CT) and magnetic resonance imaging (MRI) scans of the first cases of congenital infection and microcephaly presumably associated with the Zika virus in the current Brazilian epidemic.
Design
Retrospective study with a case series.
Setting
Association for Assistance of Disabled Children (AACD), Pernambuco state, Brazil.
Participants
23 children with a diagnosis of congenital infection presumably associated with the Zika virus during the Brazilian microcephaly epidemic.
Main outcome measures
Types of abnormalities and the radiological pattern of lesions identified on CT and MRI brain scans.
Results
Six of the 23 children tested positive for IgM antibodies to Zika virus in cerebrospinal fluid. The other 17 children met the protocol criteria for congenital infection presumably associated with the Zika virus, even without being tested for IgM antibodies to the virus—the test was not yet available on a routine basis. Of the 23 children, 15 underwent CT, seven underwent both CT and MRI, and one underwent MRI. Of the 22 children who underwent CT, all had calcifications in the junction between cortical and subcortical white matter, 21 (95%) had malformations of cortical development, 20 (91%) had a decreased brain volume, 19 (86%) had ventriculomegaly, and 11 (50%) had hypoplasia of the cerebellum or brainstem. Of the eight children who underwent MRI, all had calcifications in the junction between cortical and subcortical white matter, malformations of cortical development occurring predominantly in the frontal lobes, and ventriculomegaly. Seven of the eight (88%) children had enlarged cisterna magna, seven (88%) delayed myelination, and six each (75%) a moderate to severe decrease in brain volume, simplified gyral pattern, and abnormalities of the corpus callosum (38% hypogenesis and 38% hypoplasia). Malformations were symmetrical in 75% of the cases.
Conclusion
Severe cerebral damage was found on imaging in most of the children in this case series with congenital infection presumably associated with the Zika virus. The features most commonly found were brain calcifications in the junction between cortical and subcortical white matter associated with malformations of cortical development, often with a simplified gyral pattern and predominance of pachygyria or polymicrogyria in the frontal lobes. Additional findings were enlarged cisterna magna, abnormalities of corpus callosum (hypoplasia or hypogenesis), ventriculomegaly, delayed myelination, and hypoplasia of the cerebellum and the brainstem.

International Health
Volume 8 Issue 2 March 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
Author Affiliations
Division of Management, Policy and Community Health, The University of Texas School of Public Health, 1200 Pressler Street, Houston, Texas 77030, USA
*Corresponding author: Present address: Healthcare Transformation Initiatives, The University of Texas Health Science Center at Houston, 1200 Binz Street Houston TX 77004, USA; Tel: +1 832-231-4955; E-mail: chimacharles@gmail.com
Received December 13, 2014.
Revision received April 20, 2015.
Accepted April 20, 2015.
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.

JAMA
April 12, 2016, Vol 315, No. 14
http://jama.jamanetwork.com/issue.aspx

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Viewpoint
Neglected Dimensions of Global Security: The Global Health Risk Framework Commission
Lawrence O. Gostin, JD; Carmen C. Mundaca-Shah, MD, DrPH; Patrick W. Kelley, MD, DrPH

This Viewpoint discusses the Global Health Risk Framework Commission’s strategy to safeguard human and economic security from pandemic threats.

The world has experienced global health crises ranging from novel influenzas (H5N1 and H1N1) and coronaviruses (SARS and MERS) to the Ebola and Zika viruses. In each case, governments and international organizations seemed unable to react quickly and decisively. Health crises have unmasked critical vulnerabilities—weak health systems, failures of leadership, and political overreaction and underreaction. The Global Health Risk Framework Commission, for which the National Academy of Medicine served as the secretariat, recently set out a comprehensive strategy to safeguard human and economic security from pandemic threats (eTable in the Supplement).1

Journal of Global Ethics
Volume 12, Issue 1, 2016
http://www.tandfonline.com/toc/rjge20/.U2V-Elf4L0l#.VAJEj2N4WF8

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Articles
Exploitative, irresistible, and coercive offers: why research participants should be paid well or not at all
Sara Belfrage
pages 69-86
DOI:10.1080/17449626.2016.1150318
ABSTRACT
This paper begins with the assumption that it is morally problematic when people in need are offered money in exchange for research participation if the amount offered is unfair. Such offers are called ‘coercive’, and the degree of coerciveness is determined by the offer’s potential to cause exploitation and its irresistibility. Depending on what view we take on the possibility to compensate for the sacrifices made by research participants, a wish to avoid ‘coercive offers’ leads to policy recommendations concerning payment for participation. For sacrifices considered compensable, we ought to offer either no payment or payment at a level deemed fair, while for sacrifices deemed incompensable, we always ought to offer no payment because as compensation appears and increases, so too does coercion. This article provides a model for thinking of the way in which degrees of exploitativeness, irresistibility, and coerciveness interact with the size of the reward for compensable and incompensable cases. The conclusions are of particular relevance in contexts where potential research participants are poor or in other ways lack reasonably good options, as is often the case when international pharmaceutical companies or researchers based in the Global North place clinical trials in the Global South.

The Lancet
Apr 16, 2016 Volume 387 Number 10028 p1591-1692
http://www.thelancet.com/journals/lancet/issue/current

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Comment
Yellow fever vaccine supply: a possible solution
Thomas P Monath, Jack P Woodall, Duane J Gubler, Thomas M Yuill, John S Mackenzie, Reinaldo M Martins, Paul Reiter, David L Heymann
Summary
The global threat of the emerging epidemic of yellow fever in Angola1 is underscored by the recent spread of similar Aedes aegypti mosquito-borne viruses including dengue, chikungunya, and now Zika. Since their emergence in the 1950s, dengue virus infection has been reported from more than 128 countries, the chikungunya virus has been reported from over 60 countries,2,3 while yellow fever, first identified as a viral infection in 1900, has been reported from more than 57 countries and is on the move once again.

The Milbank Quarterly
A Multidisciplinary Journal of Population Health and Health Policy
March 2016 Volume 94, Issue 1 Pages 1–223
http://onlinelibrary.wiley.com/doi/10.1111/1468-0009.2016.94.issue-1/issuetoc

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Op-Ed
Global Health Security After Ebola: Four Global Commissions (pages 34–38)
LAWRENCE O. GOSTIN
Article first published online: 14 MAR 2016 | DOI: 10.1111/1468-0009.12176

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 16 April 2016)

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Research Article
Clinical and Epidemiological Characterization of Laboratory-Confirmed Autochthonous Cases of Zika Virus Disease in Mexico
April 15, 2016 ·
Introduction: Since 2014, authoctonous circulation of Zika virus (ZIKV) in the Americas was detected (Easter Island, Chile). In May 2015, Brazil confirmed authoctonous ¬¬transmission and in October of that year Colombia reported their first cases. Now more than 52 countries have reported cases, including Mexico. To deal with this contingency in Mexico, several surveillance systems, in addition to systems for vector-borne diseases were strengthened with the participation of all health institutions. Also, the Ministry of Health defined an Action Plan against ZIKV for the whole country.
Methods: We analyzed 93 authoctonous cases of ZIKV disease identified by Epidemiological Surveillance System for Zika Virus in Mexico. All authoctonous cases confirmed by laboratory since November 25, 2015 to February 19, 2016 were included. A description of clinical and epidemiological characteristics of 93 cases of ZIKV disease are presenting and, we describe the Action Plan against this public health emergency.
Results: The distribution of cases by sex was 61 men and 32 women; mean age was 35 years old (S.D. 15, range 6-90). The main clinical features in the 93 cases were fever (96.6%), rash (93.3%), non-purulent conjunctivitis (88.8%), headache (85.4%), and myalgia (84.3%). No deaths were reported.
Conclusion: The ZIKV epidemic poses new challenges to public health systems. The information provided for basic, clinical, and epidemiological research, in addition to the data derived from epidemiological surveillance is essential. However, there are still many unanswered questions regarding mechanisms of transmission, complications, and impact of this virus.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 16 April 2016)

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Essay
The Future of the RTS,S/AS01 Malaria Vaccine: An Alternative Development Plan
Roly Gosling, Lorenz von Seidlein
| published 12 Apr 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1001994
Summary Points
:: RTS,S/AS01 is the falciparum malaria vaccine candidate that is most advanced in development, globally.
:: In a large clinical trial in sub-Saharan African children, the protection conferred by RTS,S/AS01 was found to rapidly decline, particularly in infants.
:: Although RTS,S/AS01 was approved by the European Medicines Agency for active immunization of children aged 6 weeks to 17 months against malaria, the WHO did not recommend the inclusion of RTS,S/AS01 in the Expanded Programme of Immunisations (EPI).
:: Instead of aiming for inclusion of the vaccine in EPI, we propose that the future development of RTS,S/AS01 could take advantage of its high transient protective efficacy.
:: Adding the vaccine to intensive malaria elimination strategies in low-endemicity areas could be the critical factor in interrupting transmission.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 16 April 2016)

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Research Article
Zika Virus Outbreak in Rio de Janeiro, Brazil: Clinical Characterization, Epidemiological and Virological Aspects
Patrícia Brasil, Guilherme Amaral Calvet, André Machado Siqueira, Mayumi Wakimoto, Patrícia Carvalho de Sequeira, Aline Nobre, Marcel de Souza Borges Quintana, Marco Cesar Lima de Mendonça, Otilia Lupi, Rogerio Valls de Souza, Carolina Romero, Heruza Zogbi, Clarisse da Silveira Bressan, Simone Sampaio Alves, Ricardo Lourenço-de-Oliveira, Rita Maria Ribeiro Nogueira, Marilia Sá Carvalho, Ana Maria Bispo de Filippis, Thomas Jaenisch
| published 12 Apr 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004636

Science
15 April 2016 Vol 352, Issue 6283
http://www.sciencemag.org/current.dtl

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Reports
Zika virus in the Americas: Early epidemiological and genetic findings
By Nuno Rodrigues Faria, Raimunda do Socorro da Silva Azevedo, Moritz U. G. Kraemer, Renato Souza, Mariana Sequetin Cunha, Sarah C. Hill, Julien Thézé, Michael B. Bonsall, Thomas A. Bowden, Ilona Rissanen, Iray Maria Rocco, Juliana Silva Nogueira, Adriana Yurika Maeda, Fernanda Giseli da Silva Vasami, Fernando Luiz de Lima Macedo, Akemi Suzuki, Sueli Guerreiro Rodrigues, Ana Cecilia Ribeiro Cruz, Bruno Tardeli Nunes, Daniele Barbosa de Almeida Medeiros, Daniela Sueli Guerreiro Rodrigues, Alice Louize Nunes Queiroz, Eliana Vieira Pinto da Silva, Daniele Freitas Henriques, Elisabeth Salbe Travassos da Rosa, Consuelo Silva de Oliveira, Livia Caricio Martins, Helena Baldez Vasconcelos, Livia Medeiros Neves Casseb, Darlene de Brito Simith, Jane P. Messina, Leandro Abade, José Lourenço, Luiz Carlos Junior Alcantara, Maricélia Maia de Lima, Marta Giovanetti, Simon I. Hay, Rodrigo Santos de Oliveira, Poliana da Silva Lemos, Layanna Freitas de Oliveira, Clayton Pereira Silva de Lima, Sandro Patroca da Silva, Janaina Mota de Vasconcelos, Luciano Franco, Jedson Ferreira Cardoso, João Lídio da Silva Gonçalves Vianez-Júnior, Daiana Mir, Gonzalo Bello, Edson Delatorre, Kamran Khan, Marisa Creatore, Giovanini Evelim Coelho, Wanderson Kleber de Oliveira, Robert Tesh, Oliver G. Pybus, Marcio R. T. Nunes, Pedro F. C. Vasconcelos
Science15 Apr 2016 : 345-349
Zika virus genomes from Brazil
The Zika virus outbreak is a major cause for concern in Brazil, where it has been linked with increased reports of otherwise rare birth defects and neuropathology. In a phylogenetic analysis, Faria et al. infer a single introduction of Zika to the Americas and estimated the introduction date to be about May to December 2013—some 12 months earlier than the virus was reported. This timing correlates with major events in the Brazilian cultural calendar associated with increased traveler numbers from areas where Zika virus has been circulating. A correlation was also observed between incidences of microcephaly and week 17 of pregnancy.
Abstract
Brazil has experienced an unprecedented epidemic of Zika virus (ZIKV), with ~30,000 cases reported to date. ZIKV was first detected in Brazil in May 2015, and cases of microcephaly potentially associated with ZIKV infection were identified in November 2015. We performed next-generation sequencing to generate seven Brazilian ZIKV genomes sampled from four self-limited cases, one blood donor, one fatal adult case, and one newborn with microcephaly and congenital malformations. Results of phylogenetic and molecular clock analyses show a single introduction of ZIKV into the Americas, which we estimated to have occurred between May and December 2013, more than 12 months before the detection of ZIKV in Brazil. The estimated date of origin coincides with an increase in air passengers to Brazil from ZIKV-endemic areas, as well as with reported outbreaks in the Pacific Islands. ZIKV genomes from Brazil are phylogenetically interspersed with those from other South American and Caribbean countries. Mapping mutations onto existing structural models revealed the context of viral amino acid changes present in the outbreak lineage; however, no shared amino acid changes were found among the three currently available virus genomes from microcephaly cases. Municipality-level incidence data indicate that reports of suspected microcephaly in Brazil best correlate with ZIKV incidence around week 17 of pregnancy, although this correlation does not demonstrate causation. Our genetic description and analysis of ZIKV isolates in Brazil provide a baseline for future studies of the evolution and molecular epidemiology of this emerging virus in the Americas.

Science Translational Medicine
13 April 2016 Vol 8, Issue 334
http://stm.sciencemag.org/

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Editorial
Global health partnerships: Are they working?
By Jonathan A. Muir, Jessica Farley, Allison Osterman, Stephen E. Hawes, Keith Martin, J. Stephen Morrison, King K. Holmes
Science Translational Medicine13 Apr 2016 : 334ed4
An assessment of global health collaborations highlights the advantages of synergies between global health research and training programs.

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Perspective
The Human Vaccines Project: A roadmap for cancer vaccine development
By Pedro Romero, Jacques Banchereau, Nina Bhardwaj, Mark Cockett, Mary L. Disis, Glenn Dranoff, Eli Gilboa, Scott A. Hammond, Robert Hershberg, Alan J. Korman, Pia Kvistborg, Cornelis Melief, Ira Mellman, A. Karolina Palucka, Irina Redchenko, Harlan Robins, Federica Sallusto, Theodore Schenkelberg, Stephen Schoenberger, Jeffrey Sosman, Özlem Türeci, Benoît Van den Eynde, Wayne Koff, George Coukos
Science Translational Medicine13 Apr 2016 : 334ps9
A concerted international effort is necessary to achieve clinically effective cancer vaccines.

Vaccine
Volume 34, Issue 19, Pages 2157-2290 (27 April 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/19

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Original Research Article
A therapeutic HIV-1 vaccine enhances anti-HIV-1 immune responses in patients under highly active antiretroviral therapy
Pages 2225-2232
Frank Y. Tung, Jack K. Tung, Suresh Pallikkuth, Savita Pahwa, Margaret A. Fischl
Abstract
Background
HIV-1 specific cellular immunity plays an important role in controlling viral replication. In this first-in-human therapeutic vaccination study, a replication-defective HIV-1 vaccine (HIVAX) was tested in HIV-1 infected participants undergoing highly active antiretroviral therapy (HAART) to enhance anti-HIV immunity (Clinicaltrials.gov, identifier NCT01428596).
Methods
A010 was a randomized, placebo-controlled trial to evaluate the safety and the immunogenicity of a replication defective HIV-1 vaccine (HIVAX) given as a subcutaneous injection to HIV-1 infected participants who were receiving HAART with HIV-1 viral load 500 cells/mm3. HIV-1 specific immune responses were monitored by INF-γ enzyme linked immunospot (Elispot) and intracellular cytokine staining (ICS) assay after vaccination. Following the randomized placebo-controlled vaccination phase, subjects who received HIVAX vaccine and who met eligibility underwent a 12-week analytical antiretroviral treatment interruption (ATI). Viral load was monitored throughout the study.
Results
HIVAX was well tolerated in trial participants. Transient grade 1 to 2 (mild to moderate) injection site reactions occurred in 8 of 10 vaccinated participants. HIVAX was immunogenic in all vaccinated participants. The functionality of T cells was significantly enhanced after vaccination. Median viral load (3.45 log10 copies/ml, range of 96–12,830 copies/ml) at the end of the 12-week treatment interruption in HIVAX vaccinated group was significantly lower than the pre-treatment levels. Three vaccinated participants extended ATI for up to 2 years with stable CD4 cells and low viral loads.
Conclusions
HIVAX vaccine is generally safe, elicits strong anti-HIV-1 immune responses, and may play an important role in controlling viral load during treatment interruption in HIV-1 infected participants.

Vaccine
Volume 34, Issue 19, Pages 2157-2290 (27 April 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/19

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Epidemiological impact and cost-effectiveness of introducing vaccination against serogroup B meningococcal disease in France
Original Research Article
Pages 2240-2250
Héloïse Lecocq, Isabelle Parent du Châtelet, Muhamed-Kheir Taha, Daniel Lévy-Bruhl, Benoit Dervaux
Abstract
Introduction
Despite its low incidence in France, invasive serogroup B meningococcal disease remains a public health concern. A new vaccine against the disease, Bexsero®, has been licensed in the EU. We studied the epidemiological impact and cost-effectiveness of routine vaccination using Bexsero® in order to inform the decision-making process regarding its potential inclusion in the vaccination schedule.
Methods
A multi-generational Markov model was used. Time horizon was set to 100 years. Five vaccination strategies were evaluated: infants at 3, 5, 6 and 13 months, toddlers at 13, 15 and 27 months and adolescents at 15 years provided 2 doses one month apart. A booster dose at 15 years old and a catch-up for 15 years old subjects during the first 15 years of the programme were added to the infant and toddler strategies. Costs per QALY gained were computed from a restricted societal perspective including direct costs only. Herd immunity was simulated in an alternative base-case scenario and sensitivity analyses.
Results
In the base-case analysis without herd immunity and with all cohorts vaccinated, at €40 per vaccine dose, routine infant vaccination would provide the lowest cost per QALY gained (€380,973) despite only preventing 18% of cases. Under the assumption of herd immunity, the adolescent vaccination would provide the lowest cost per QALY gained (€135,902) preventing 24% of cases. Infant vaccination with a late booster and catch-up would prevent 51% of cases with a cost of €188,511 per QALY gained.
Conclusions
Given current meningococcal epidemiology in France and the available data on the protection provided by Bexsero®, our modelling work showed that routine vaccination against serogroup B meningococcal disease is not cost-effective.

Vaccine
Volume 34, Issue 19, Pages 2157-2290 (27 April 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/19

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Acceptability of financial incentives or quasi-mandatory schemes to increase uptake of immunisations in preschool children in the United Kingdom: Qualitative study with parents and service delivery staff
Original Research Article
Pages 2259-2266
Rebekah Jayne McNaughton, Jean Adams, Janet Shucksmith
Abstract
Introduction
Since the 1990s strenuous attempts have been made to rebuild trust in childhood immunisations. This study aimed to understand if financial incentives (FI) or quasi-mandatory schemes (QMS), e.g. mandating immunisations for entry to universal services such as day care or school, might be acceptable interventions to increase immunisations uptake for preschool children.
Material and methods
Parents and carers of preschool children (n = 91); health and other professionals (n = 18); and those responsible for developing and commissioning immunisation services (n = 6) took part in the study. Qualitative methods were employed to explore the acceptability of FI/QMS with stakeholders. Framework analysis was used to develop a coding framework that was applied to the whole dataset. Interpretations of the emergent themes were verified between researchers and presented to the project’s Parent Reference Group to ensure coherence and relevance.
Results
(1) FI: parents and professionals felt introducing FI was inappropriate. It was acknowledged FI may encourage families living in disadvantage to prioritise immunisation, but unintended consequences could outweigh any advantage. FI essentially changes behaviour into a cash transaction which many equated to bribery that could inadvertently create inequalities.
(2) QMS: parents and professionals highlighted the positives of introducing QMS, stating it felt natural, fair and less likely to create inequality. Despite QMS’ potential to positively impact on uptake there were concerns about the implementation and workability of such schemes.
Discussion and conclusion
FI for preschool immunisation may not be acceptable, within a UK context. Introducing FI could have detrimental effects on uptake if it were associated with bribery and coercion. Quasi-mandatory schemes, mandating immunisation for universal service entry, was the most acceptable option and could contribute to the normalising of immunisation. Future work would be needed to assess how this could be successfully implemented and if it did indeed increase uptake.

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

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

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BBC
http://www.bbc.co.uk/
Accessed 16 April 2016
China to punish hundreds of officials over vaccine scandal
14 April 2016
The Chinese government has promised to punish 357 officials over a scandal involving the illegal sale of vaccines.
State media say 192 criminal cases have been filed. Improperly stored or transported vaccines were allegedly sent to 59 health institutions.
The government has said it will tighten procedures around vaccine-handling.
Anger over the scandal is widespread in China, where the alleged illegal vaccine ring had reportedly been in operation since 2011.
In April 2015 two women were arrested for selling some $88m (£61m) worth of vaccines.
Details were only made public last month, when the authorities issued a call demanding that suppliers come forward to help them trace potential victims.
China’s State Council said 357 officials faced demotion or losing their jobs and that 202 had been detained so far.
Health authorities have also urged people to continue coming forward for vaccinations.

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Forbes
http://www.forbes.com/
Accessed 16 April 2016
Apr 14, 2016
Zika Causes Birth Defects, But How Fast Can A Vaccine Be Developed?
…Public health workers have been struggling to address the threat of Zika since the first microcephaly cases following infection were reported in Brazil last year. Currently, primary preventive approaches are focused on controlling mosquito populations and protecting individuals, using repellent, screened windows and air conditioning. But the best approach, as Dr. Peter Hotez of Texas Children’s Hospital Center discussed in January, would be a vaccine.

Easier said than done. Despite hopes of having a vaccine “within months,” as the head of the National Institute of Allergy and Infectious Diseases claims is possible, vaccines typically take years to develop, explained Jay Nelson, PhD, a senior molecular virologist and founder and director of the Vaccine and Gene Therapy Institute at Oregon Health and Science University. He agreed that a vaccine is the most efficient and effective way to protect people, especially now that the virus appears to have mutated and poses a big threat to pregnant people and developing fetuses. But Zika is about 40% homologous to the dengue virus at the amino acid level, he explained, and a dengue vaccine has taken two decades to develop—and there still is not a highly effective, safe dengue vaccine.
Given the number of groups working on Zika vaccine development, however, it hopefully won’t take 20 years to develop one….

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New Yorker
Accessed 16 April 2016
April 14, 2016
With Summer Coming, Can the Zika Virus Be Contained?
By Joshua Lang
With no vaccine or antiviral treatment available so far, the only way to prevent an outbreak is to fight the virus’s main carrier: the mosquito.

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New York Times
http://www.nytimes.com/
Accessed 16 April 2016
The Looming Threat of Avian Flu
Last year’s outbreak showed just how difficult it is to protect America’s agricultural system from
devastating diseases. Next time it could be even worse.
April 17, 2016 – By MARYN MCKENNA –

The Opinion Pages | Editorial
On Zika, Congress Is Failing to Do Its Job
The Centers for Disease Control and Prevention has concluded that the Zika virus causes brain damage in babies born to infected women, which adds to the growing evidence that the virus is a major public health emergency. Yet Republicans in Congress are refusing to appropriate the money needed to respond to this crisis.

A Zika outbreak began last year in Brazil and has spread to other countries. In a paper published in The New England Journal of Medicine on Wednesday, C.D.C. researchers say there is enough evidence to determine that the mosquito-borne virus is causing microcephaly, a condition in which babies are born with small heads. Zika has also been linked to neurological disorders in adults.

President Obama asked Congress in February for more than $1.8 billion to fight Zika, but Republican lawmakers refused to act and said the government should use money that had been appropriated for other diseases, like Ebola. They have also made vague promises to provide more funds before the next fiscal year begins in October.

After weeks of fruitless talks with Congress, the administration said last week that it would shift nearly $600 million to anti-Zika efforts from Ebola and other programs. That is not sufficient and could increase the risk of another outbreak of Ebola, which remains a persistent threat. The World Health Organization says there have been new cases of that deadly disease in Liberia and Guinea recently.

The federal government has already been forced to hold back grants for state and local health departments because it needed the money for Zika programs. Congressional inaction is also depriving the fights against malaria and tuberculosis of money.

Lawmakers might be tempted to consider Zika a distant threat, but that is a dangerous misconception. There could be hundreds of thousands of Zika cases in Puerto Rico, with possibly hundreds of babies affected, according to Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases. As of Wednesday, 475 people were known to have the virus in American territories, 58 of them pregnant women, according to the C.D.C. A smaller number of cases have been reported in states involving people who contracted the virus while traveling.
Every weekday, get thought-provoking commentary from Op-Ed columnists, The Times editorial board and contributing writers from around the world.

Medical experts say that Zika can spread quickly without warning, in part because most infected people have mild symptoms or none at all. The mosquitoes known to spread Zika are found in 30 states, and experts say places like Florida, Louisiana and Texas are particularly at risk. Public health officials say Zika can also be transmitted by unprotected sex.

Government researchers and pharmaceutical companies are working on a Zika vaccine. Scientists are also perfecting mosquitoes genetically modified to produce offspring that die young, but that approach requires more testing. In addition to research, programs are needed to prevent infections by encouraging people, especially pregnant women and their families, to protect themselves from mosquitoes and to practice safe sex.

Having learned from its slow response to Ebola, the Obama administration is trying to move faster against Zika. But if Congress doesn’t do its job, the public will be put at needless risk.

Center for Global Development
http://www.cgdev.org/
Accessed 16 April 2016

Testimony on the US Response to the Ebola Epidemic in West Africa
4/8/16
Amanda Glassman
On April 7, 2016, CGD’s vice president for programs and director of global health policy Amanda Glassman testified before the Senate Foreign Relations Subcommittee on Africa and Global Health Policy at a hearing examining progress made in addressing the West Africa Ebola epidemic and its secondary effects.

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_9 April 2016

– blog edition: comprised of the approx. 35+ entries posted below on 10 April 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 9 April 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

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Zika situation report
7 April 2016
Zika virus, Microcephaly and Guillain-Barré syndrome
Read the full situation report
Summary
:: From 1 January 2007 to 6 April 2016, Zika virus transmission was documented in a total of 62 countries and territories. Five of these (Cook Islands, French Polynesia, ISLA DE PASCUA – Chile, YAP (Federated States of Micronesia) and New Caledonia) reported a Zika virus outbreak that has terminated. Six countries have now reported locally acquired infection through sexual transmission (Argentina, Chile, France, Italy, New Zealand and the United States of America). Viet Nam is the country to most recently report mosquito-borne Zika virus transmission.

:: In the Region of the Americas, the geographical distribution of Zika virus has steadily widened since the presence of the virus was confirmed in 2015. Mosquito-borne Zika virus transmission has been reported in 33 countries and territories of this region.

:: From 2007, mosquito-borne Zika virus cases have been reported in 17 countries and areas of the Western Pacific Region.

:: Microcephaly and other fetal malformations potentially associated with Zika virus infection or suggestive of congenital infection have been reported in Brazil (1046 cases), Cabo Verde (two cases), Colombia (seven cases), French Polynesia (eight cases), Martinique (three cases) and Panama (one case). Two additional cases, each linked to a stay in Brazil, were detected in the United States of America and Slovenia.

:: In the context of Zika virus circulation, 13 countries or territories worldwide have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases.

:: Based on a growing body of preliminary research, there is scientific consensus that Zika virus is a cause of microcephaly and Guillain-Barré syndrome.

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

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Guidance for Health Workers
Surveillance for Zika virus infection, microcephaly and Guillain-Barré syndrome – Interim Guidance
6 April 2016
This document provides interim recommendations for the surveillance of Zika virus infection, microcephaly and Guillain-Barré syndrome, in four different contexts and describes reporting requirements to WHO. Transmission refers to vector-borne transmission, unless specified differently. Autochthonous infection is considered to be an infection acquired in-country, i.e. among patients with no history of travel during the incubation period or who have travelled exclusively to non-affected areas during the incubation period. This document does not provide guidance on laboratory investigation or vector surveillance.
Number of pages: 9
Publication date: Updated 7 April 2016
Languages: English
WHO reference number: WHO/ZIKV/SUR/16.2 Rev.1

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Zika Open [to 9 April 2016]
[Bulletin of the World Health Organization]
:: All papers available here
No new papers identified in last week

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White House to redirect unused Ebola money to prepare for Zika virus
By Debra Goldschmidt, CNN
Updated 11:44 PM ET, Thu April 7, 2016
(CNN)In an effort to take immediate action against the Zika virus, the White House said it will redirect $589 million of existing funds, including $510 million which had been designated to fight Ebola.

The funding is needed for detection, prevention and response efforts, Health and Human Services Secretary Sylvia Burwell said Wednesday.

There are about 40 million people traveling between the continental United States and areas where the virus is circulating, according to Burwell.

The primary goal, she said, is to protect pregnant women and those who may become pregnant, because the virus is linked to a neurological birth defect and other fetal abnormalities. Experts agree that there are many unknowns when it comes to the virus and more is being learned every day…

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CDC/ACIP [to 9 April 2016]
http://www.cdc.gov/media/index.html
TUESDAY, APRIL 5, 2016
Transcript for CDC Telebriefing: Zika Summit Press Conference
Transcript for CDC telebriefing of the Zika Summit Press Conference

MONDAY, APRIL 4, 2016
CDC Adds Fiji to Interim Travel Guidance Related to Zika Virus
CDC is working with other public health officials to monitor for ongoing Zika virus? transmission. Today, CDC posted a Zika virus travel notice for Fiji. CDC has issued travel notices…

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UN Women [to 9 April 2016]
http://www.unwomen.org/news/stories
Date: 07 April 2016
As World Health Day is commemorated globally, actions intensify in response to the Zika virus in Brazil
On World Health Day (7 April), UN Women and partners are beginning the second phase of targeted communication efforts around women’s rights in response to the Zika virus

EBOLA/EVD [to 9 April 2016]
“Threat to international peace and security” (UN Security Council)

Editor’s Note:
Following last week’s decision by WHO, we have removed the Public Health Emergency of International Concern (PHEIC) designation above. We have not identified any action by the UN Security Council to change the “Threat to international peace and security” designation.

The last “Ebola Situation Update” is dated 30 March 2016 and may be the final situation report. We include two updates identified from WHO below.
We also recommend and include the link below to an editorial by Peter Hotez in PLoS Neglected Tropical Diseases, and refer readers to the full-text of Dr. Hotez’ editorial in the New York Times – “Zika is coming” – in Media Watch section near the end of this edition.

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Liberia and Guinea step up coordination to stem new cases of Ebola
7 April 2016 — WHO and Ministry of Health teams in Guinea and Liberia have established epidemiological links between new Ebola cases in Liberia and a current flare-up of Ebola in neighbouring Guinea following intensified case investigations and contact tracing.

Emergency response to Ebola flare underway in Liberia. Case investigation widens to Guinea
4 April 2016
WHO and Ministry of Health teams in Liberia and Guinea are investigating the origins of transmission in Liberia’s latest flare-up after learning that a woman who died from Ebola in Liberia last week had recently travelled from Guinea with her three young children.

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PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 9 April 2016)
Editorial
Neglected Tropical Diseases in the Anthropocene: The Cases of Zika, Ebola, and Other Infections
Peter J. Hotez
Published 08 Apr 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004648

POLIO [to 9 April 2016]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 6 April 2016
:: The third Outbreak Response Assessment in Madagascar found that the surveillance system is not yet strong enough to conclude that polio transmission has been interrupted. Thirty-nine high-risk districts have been identified to receive focused attention.
:: There is one week to go until the globally synchronized switch from the trivalent to bivalent oral polio vaccine, the first stage of objective 2 of the Polio Eradication and Endgame Strategic Plan 2013-2018. Learn more about preparations for the switch here. Learn more about the rationale for the switch through this series of videos.

Selected Country Levels Updates [excerpted]
Pakistan
:: Five new WPV1 environmental positive samples were reported in the past week, with collection dates between 3 February and 12 March 2016. Two were collected from Sindh, one from Balochistan, one from Punjab and one from Khyber Pakhtunkhwa.
:: Sub-National Immunization Days (NIDs) are planned in April using bOPV.

WHO & Regional Offices [to 9 April 2016]
World Health Day 2016: Action needed to halt rise in diabetes
6 April 2016 — The number of people living with diabetes has nearly quadrupled since 1980 to 422 million adults, with most living in developing countries. WHO is marking World Health Day, 7 April, by calling for action on diabetes. In its first “Global report on diabetes”, WHO highlights the need to step up prevention and treatment of the disease.
Read the news release

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Highlights
WHO Director-General visits Angola; urgent action needed to contain yellow fever outbreak
April 2016 — The Director-General of WHO, Dr Margaret Chan, arrived today in Angola’s capital Luanda for a two-day visit to assess the situation of the current outbreak of yellow fever virus.

General Assembly proclaims the Decade of Action on Nutrition
April 2016 — The United Nations General Assembly today agreed a resolution proclaiming the UN Decade of Action on Nutrition from 2016 to 2025. The resolution aims to trigger intensified action to end hunger and eradicate malnutrition worldwide, and ensure universal access to healthier and more sustainable diets.

The Weekly Epidemiological Record (WER) celebrates 90 years
April 2016 — On 1 April 1926, epidemiologists in the Health Office of the League of Nations, Geneva created the first WER. The publication’s mission was to provide the world with information about disease hazards that, at that time, mostly travelled by sea: plague, cholera, yellow fever, typhus and smallpox.

Austria: Measles in the spotlight
April 2016
In Austria, where elimination of measles is tantalizingly close, a creative and innovative campaign seeks to encourage vaccination among unimmunized adults.

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WHO SAGE Meeting
Geneva: 12 – 14 April 2016.
:: Draft agenda pdf, 121kb as of 18 March 2016

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Weekly Epidemiological Record (WER) 08 April 2016, vol. 91, 14 (pp. 181–192)
Contents:
181 A review of the role of training in WHO Ebola emergency response
186 Yellow fever urban outbreak in Angola and the risk of extension
192 Monthly report on dracunculiasis cases, January– February 2016

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Disease Outbreak News (DONs)
:: 8 April 2016 Lassa Fever – Sweden
:: 6 April 2016 Yellow Fever – Kenya
:: 6 April 2016 Yellow Fever – China

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:: WHO Regional Offices
WHO African Region AFRO
:: WHO Director General and WHO Regional Director for Africa Conclude Official Visit to Angola
7 April 2016, Luanda – The World Health Organization Regional Director for Africa, Dr Matshidiso Moeti and the Director-General of WHO, Dr Margaret Chan have concluded a three-day official visit to Angola. The visit aimed at assessing the ongoing efforts to prevent and control the yellow fever epidemic which has gripped the country since December 2015, and to identify ways of further strengthening support to Angola.

WHO Region of the Americas PAHO
:: PAHO offers to provide technical support for pilot studies of new mosquito control technologies (04/08/2016)
:: PAHO Director lauds Mexico’s soda tax as a model measure to fight diabetes (04/07/2016)
:: The number of people with diabetes in the Americas has tripled since 1980 (04/06/2016)
:: ‘Don Francisco’ joins PAHO to promote diabetes prevention and control (04/05/2016)

WHO South-East Asia Region SEARO
:: Urgent, concerted efforts needed to stem diabetes epidemic: WHO
SEAR/PR/1620
New Delhi, 29 March 2016: Countries in the WHO South-East Asia Region must take vigorous and concerted action to ‘prevent, treat and beat’ diabetes, a potentially fatal disease that has reached epidemic proportions and is expected to further increase in coming years.

WHO European Region EURO
:: Poliomyelitis (polio) and the vaccines used to eradicate it – questions and answers 08-04-2016
:: European countries to participate in global polio vaccine switch 08-04-2016
:: WHO calls for global action on diabetes 07-04-2016
:: World Health Day 2016: Living with diabetes and educating others 07-04-2016
:: Consensus on causal link between Zika and neurological disorders 06-04-2016

WHO Eastern Mediterranean Region EMRO
:: WHO condemns attack on Ma’arib Hospital, Yemen 6 April 2016
:: Kuwait boosts treatments for chronic diseases in Syria 6 April 2016
:: New WHO policy aims to lower sugar intake to fight obesity and overweight in the Region
5 April 2016

WHO Western Pacific Region
:: World Health Day 2016: Together on the front lines against diabetes
MANILA, 7 April 2016 – On World Health Day, the World Health Organization (WHO) in the Western Pacific Region stands with all Member States and partners to renew its commitment to advance the understanding of diabetes and calls on all communities across the Region to work together to effectively manage and prevent the disease.

Gavi [to 9 April 2016]
http://www.gavialliance.org/library/news/press-releases/

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04 April 2016
Norway strengthens commitment to immunisation in developing countries
Increased funding will help immunise 300 million more children in the world’s poorest countries by 2020
Oslo, 7 April 2016 – Børge Brende, Norwegian Minister of Foreign Affairs, and Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, today signed an agreement that will see Norway commit NOK 6.25 billion (US$ 850 million) to support the immunisation of children living in the world’s poorest countries between 2016 and 2020.

This renewed commitment – first announced by Prime Minister Erna Solberg in January 2015 at the Gavi replenishment conference in Berlin – represents a 50% increase in the country’s direct support for Gavi in the 2011-2015 period, underlining Norway’s strong commitment to childhood immunisation. The funds will help Gavi support developing countries to immunise more than 300 million children by 2020, helping save five to six million lives…

Global Fund [to 9 April 2016]
http://www.theglobalfund.org/

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04 April 2016
Global Fund Names Rahul Singhal as Chief Risk Officer
GENEVA – The Global Fund to Fight AIDS, Tuberculosis and Malaria has named Rahul Singhal, a senior global risk management and treasury executive, as its new Chief Risk Officer.

Mr. Singhal has 28 years of experience in risk management in the financial services industry, building and leading risk management teams, and executing complex global initiatives including acquisitions and strategic investments. Mr. Singhal joined the Global Fund in October 2015 as Deputy Chief Risk Officer, and has been Acting Chief Risk Officer since January 2016…

PATH [to 9 April 2016]
http://www.path.org/news/index.php

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Announcement | April 04, 2016
PATH announces leader for malaria and neglected tropical diseases
Dr. Laurence Slutsker to lead PATH’s malaria and neglected tropical diseases portfolios

…As PATH’s director of malaria and NTD programs, Dr. Slutsker will lead the design and implementation of PATH’s public health programs and investments in malaria, oversee the organization’s broad portfolio of malaria control and elimination work, and expand PATH’s portfolio in NTDs.

In this role, he will work across the organization—from diagnostics and drugs to one of the world’s largest pipelines of malaria vaccine projects—to advance PATH’s comprehensive malaria strategy, and increase collaboration across a network of projects and geographies…

European Medicines Agency [to 9 April 2016]
http://www.ema.europa.eu/

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04/04/2016
Extrapolation of data from adults to children can facilitate development of paediatric medicines
EMA releases draft reflection paper ahead of workshop in May
The European Medicines Agency (EMA) has published a preliminary version of its draft reflection paper which outlines a framework for the extrapolation of clinical trial data from adults to children to support the authorisation of new medicines for children.

Extrapolation of data aims to optimise the involvement of children in clinical studies, one of the objectives of the European Union Paediatric Regulation, by predicting how a medicine may work in children and adolescents on the basis of studies conducted in adults or other paediatric populations.

The draft reflection paper outlines a systematic approach to extrapolation of data from adults or other paediatric populations to children that is considered scientifically sound and reliable to support the authorisation of a medicine. The framework sets out when, to what extent, and how extrapolation can be applied and validated.

The principal steps of the extrapolation framework are:
:: Extrapolation concept: this consists of a systematic synthesis of all available data, including the use of modelling and simulation approaches, which aims to predict the differences with regard to pharmacokinetics/pharmacodynamics, disease progression, and clinical response to treatment between adults and children;
:: Extrapolation plan: this aims to propose optimal studies in the paediatric population in line with predictions identified by the extrapolation concept;
:: Confirmation and extrapolation: this phase aims to confirm the extrapolation concept on the basis of the data collected in children and adults. If the extrapolation concept cannot be fully confirmed, it should be updated and the extrapolation plan revised accordingly;
:: Mitigating uncertainty and risk: the limited data generated in the paediatric population may not be sufficient to resolve all uncertainties and assumptions of the extrapolation concept by the time of marketing authorisation. Additional follow-up data may be necessary to address uncertainties and to further evaluate assumptions. Measures to generate these data need to be proposed…

Industry Watch [to 9 April 2016]
:: Pfizer Receives European Approval for New Multi-Dose Vial Presentation of Prevenar 13
Four-Dose Vial Will Help Address Infrastructure Challenges in Developing Countries

April 06, 2016 NEW YORK–(BUSINESS WIRE)–Pfizer Inc. (NYSE:PFE) announced today that the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) approved a new four-dose, multi-dose vial (MDV) presentation of Prevenar 13®* (pneumococcal polysaccharide conjugate vaccine [13 – valent, adsorbed]). This new MDV presentation was developed to help maximize efficiency for health care workers by helping to significantly reduce storage requirements and shipping costs in communities with health systems that are still developing.

“With this new presentation, a box that once carried enough vaccine to help protect 50 infants and children will potentially vaccinate 200, helping to ensure Prevenar 13® is accessible in the most remote regions of the world where the greatest burden of invasive pneumococcal disease lies.”

The MDV presentation of Prevenar 13® offers significant benefits to developing countries, including a 75 percent reduction in:
:: Temperature-controlled supply chain requirements,
:: United Nations International Children’s Education Fund (UNICEF) shipping costs, and
:: Storage requirements at the national, regional, district, and community levels.

“Prevenar 13® is the first approved pneumococcal conjugate vaccine available in a preserved multi-dose vial presentation,” said Luis Jodar, Ph.D., global vice president, Vaccines, Pfizer Global Medicines Development Group and Medical/Scientific Affairs. “With this new presentation, a box that once carried enough vaccine to help protect 50 infants and children will potentially vaccinate 200, helping to ensure Prevenar 13® is accessible in the most remote regions of the world where the greatest burden of invasive pneumococcal disease lies.”…

FDA [to 9 April 2016]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm

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April 6, 2016 Approval Letter – (Menomune – A/C/Y/W -135 (PDF – 28KB)
Posted: 4/7/2016
April 6, 2016 Approval Letter – YF-VAX (PDF – 28KB)
Posted: 4/7/2016

American Journal of Tropical Medicine and Hygiene
April 2016; 94 (4)
http://www.ajtmh.org/content/current

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Perspective Piece
An Improved Ward Architecture for Treatment of Patients with Ebola Virus Disease in Liberia
Jianping You and Qing Mao
Am J Trop Med Hyg 2016 94:701-703; Published online January 11, 2016, doi:10.4269/ajtmh.15-0209
Abstract
During the recent outbreak of Ebola virus disease (EVD) in west Africa, we established an Ebola treatment center (ETC) with improved ward architecture. The ETC was built with movable prefabricated boards according to infectious disease unit standard requirements. The clinical staff ensured their own security while providing patients with effective treatment. Of the 180 admissions to the ETC, 10 cases were confirmed with EVD of which six patients survived. None of the clinical staff was infected. We hope that our experience will enable others to avoid unnecessary risks while delivering EVD care.

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Infectious Diseases in Sub-Saharan Immigrants to Spain
Núria Serre Delcor, Begoña Treviño Maruri, Antoni Soriano Arandes, Isabel Claveria Guiu, Hakima Ouaarab Essadik, Mateu Espasa Soley, Israel Molina Romero, and Carlos Ascaso
Am J Trop Med Hyg 2016 94:750-756; Published online February 15, 2016, doi:10.4269/ajtmh.15-0583
Abstract
Immigrants may be carriers of infectious diseases because of the prevalence of these diseases in their country of origin, exposure during migration, or conditions during resettlement, with this prevalence being particularly high in sub-Saharan Africans. We performed a retrospective review of 180 sub-Saharan immigrants screened for infectious diseases at an International Health Center from January 2009 to December 2012. At least one pathogenic infectious disease was diagnosed in 72.8% patients: 60.6% latent tuberculosis infection, 36.8% intestinal parasites (intestinal protozoa or helminths), 28.1% helminths, 14.8% hepatitis B surface antigen positive, 1.2% anti-hepatitis C virus positive, 1.2% human immunodeficiency virus–positive, and 1.2% malaria. Coinfections were present in 28.4%. There was significant association between eosinophilia (absolute count or percentage) or hyper-IgE and the presence of helminths (P < 0.001). Relative eosinophilia and hyper-IgE were better indicators of helminth infection than absolute eosinophilia, particularly for schistosomiasis and strongyloidiasis. We found a high prevalence of infectious diseases in sub-Saharan immigrants, which could lead to severe health problems (in the absence of prompt treatment), representing a high cost to the public health system and possible transmission in the host country. Accurate screening and tailored protocols for infectious diseases are recommended in sub-Saharan immigrants.

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Retrospective Analysis of the 2014–2015 Ebola Epidemic in Liberia
Katherine E. Atkins, Abhishek Pandey, Natasha S. Wenzel, Laura Skrip, Dan Yamin, Tolbert G. Nyenswah, Mosoka Fallah, Luke Bawo, Jan Medlock, Frederick L. Altice, Jeffrey Townsend,
Martial L. Ndeffo-Mbah, and Alison P. Galvani
Am J Trop Med Hyg 2016 94:833-839; Published online February 29, 2016, doi:10.4269/ajtmh.15-0328
Abstract
The 2014–2015 Ebola epidemic has been the most protracted and devastating in the history of the disease. To prevent future outbreaks on this scale, it is imperative to understand the reasons that led to eventual disease control. Here, we evaluated the shifts of Ebola dynamics at national and local scales during the epidemic in Liberia. We used a transmission model calibrated to epidemiological data between June 9 and December 31, 2014, to estimate the extent of community and hospital transmission. We found that despite varied local epidemic patterns, community transmission was reduced by 40–80% in all the counties analyzed. Our model suggests that the tapering of the epidemic was achieved through reductions in community transmission, rather than accumulation of immune individuals through asymptomatic infection and unreported cases. Although the times at which this transmission reduction occurred in the majority of the Liberian counties started before any large expansion in hospital capacity and the distribution of home protection kits, it remains difficult to associate the presence of interventions with reductions in Ebola incidence.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 9 April 2016)

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Research article
Drivers of improved health sector performance in Rwanda: a qualitative view from within
Rwanda has achieved great improvements in several key health indicators, including maternal mortality and other health outcomes. This raises the question: what has made this possible, and what makes Rwanda so …
Felix Sayinzoga and Leon Bijlmakers
BMC Health Services Research 2016 16:123
Published on: 8 April 2016

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Abstracts
Researching Complex Interventions in Health: The State of the Art
KEYNOTE PRESENTATIONS
Peter Craig, Ingalill Rahm-Hallberg, Nicky Britten, Gunilla Borglin, Gabriele Meyer, Sascha Köpke, Jane Noyes, Jackie Chandler, Sara Levati, Anne Sales, Lehana Thabane, Lora Giangregorio, Nancy Feeley, Sylvie Cossette, Rod Taylor, Jacqueline Hill…
BMC Health Services Research 2016 16(Suppl 1):101
Published on: 4 April 2016

Emerging Infectious Diseases
Volume 22, Number 4—April 2016
http://wwwnc.cdc.gov/eid/

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Perspective
Determinants and Drivers of Infectious Disease Threat Events in Europe PDF Version [PDF – 522 KB – 9 pages]
J. C. Semenza et al.
Summary
Globalization and environment, the most frequent underlying drivers, should be targeted for interventions to prevent such events.

Eurosurveillance
Volume 21, Issue 14, 07 April 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Rapid communications
Influenza vaccine effectiveness in adults 65 years and older, Denmark, 2015/16 – a rapid epidemiological and virological assessment
by HD Emborg, TG Krause, L Nielsen, MK Thomsen, CB Christiansen, MN Skov, XC Nielsen, LS Weinreich, TK Fischer, J Rønn, R Trebbien

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Research Articles
Adverse events following school-based vaccination of girls with quadrivalent human papillomavirus vaccine in Slovenia, 2009 to 2013
by M Šubelj, V Učakar, A Kraigher, I Klavs

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Direct, indirect and total effects of 13-valent pneumococcal conjugate vaccination on invasive pneumococcal disease in children in Navarra, Spain, 2001 to 2014: cohort and case–control study
by M Guevara, A Barricarte, L Torroba, M Herranz, A Gil-Setas, F Gil, E Bernaola, C Ezpeleta, J Castilla, Working Group for Surveillance of the Pneumococcal Invasive Disease in Navarra

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Perspectives
Risk communication as a core public health competence in infectious disease management: Development of the ECDC training curriculum and programme
by P Dickmann, T Abraham, S Sarkar, P Wysocki, S Cecconi, F Apfel, Ü Nurm

International Journal of Infectious Diseases
April 2016 Volume 45, In Progress
http://www.ijidonline.com/current

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Editorial
Zika virus outbreak and the case for building effective and sustainable rapid diagnostics laboratory capacity globally
Alimuddin Zumla, Ian Goodfellow, Francis Kasolo, Francine Ntoumi, Philippe Buchy, Matthew Bates, Esam I Azhar, Matthew Cotten, Eskild Petersen
p92–94
Published online: March 4 2016
Preview
New and re-emerging pathogens with epidemic potential have threatened global health security for the past century.1 As with the recent Ebola Virus Disease (EVD) epidemic, the Zika Virus (ZIKV) outbreak has yet again surprised and overwhelmed the international health community with an unexpected event for which it might have been better prepared.

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Editorial
Engaging high and low burden countries in the “TB end game”
B.J. Marais, A.C. Outhred, A. Zumla
p100–102
Published online: March 19 2016
Preview
Tuberculosis (TB) is now the single biggest infectious disease killer in the world, surpassing malaria and HIV/AIDS. In 2014, there were an estimated 9.6 million incident TB cases and 1.5 million deaths.1 It is not widely appreciated that TB is also a major cause of disease and death in young children.2,3 New estimates from the World Health Organization (WHO) are that 1 million children developed TB during 2014.1 This is disconcerting because children have poor access to TB services in most resource-limited settings and paediatric cases provide an accurate reflection of uncontrolled TB transmission within communities.

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Original Reports
Safety and immunogenicity of a single dose of a quadrivalent meningococcal conjugate vaccine (MenACYW–D): a multicenter, blind-observer, randomized, phase III clinical trial in the Republic of Korea
Dong Soo Kim, Min Ja Kim, Sung-Ho Cha, Hwang Min Kim, Jong-Hyun Kim, Kwang Nam Kim, Jin-Soo Lee, Jun Yong Choi, Valérie Bosch Castells, Hee Soo Kim, Joon Bang, Philipp Oster
p59–64
Published online: February 24 2016
Preview
Meningococcal disease is caused by the Gram-negative aerobic diplococcus Neisseria meningitidis. Meningococci are classified by serogroup based on the immunochemistry of the polysaccharide capsule.1 Invasive meningococcal disease (IMD), such as meningitis and meningococcemia, is most frequently caused by serogroups A, B, C, Y, and W-135, and more recently in Africa by serogroup X.2 IMD is rapidly progressive and associated with high mortality rates of 7% to 19%.3 Approximately 10% to 20% of patients suffer from permanent disabilities such as limb loss, deafness, seizures, or psychomotor retardation.

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Original Reports
The impact of supplementary immunization activities on the epidemiology of measles in Tianjin, China
Abram L. Wagner, Ying Zhang, Bhramar Mukherjee, Yaxing Ding, Eden V. Wells, Matthew L. Boulton
p103–108
Published online: March 10 2016
Preview
Measles was officially eliminated in the Americas in 2002,1 and the other five regions of the World Health Organization (WHO) are slated for measles elimination by 2020.2 This remarkable public health success in control of a highly infectious disease has been made possible through the universal recommendation of measles vaccination. Prior to the advent of the measles vaccine, 90% of people were infected by age 20 years, resulting in 100 million cases and six million deaths worldwide each year.3 As vaccination coverage has increased, the number of deaths from measles globally has decreased: there were 631 200 deaths in 1990 and 125 400 in 2010.

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Original Reports
Epidemiological trends and characteristics of Japanese encephalitis changed based on the vaccination program between 1960 and 2013 in Guangxi Zhuang Autonomous Region, southern China
Yan Yang, Nengxiu Liang, Yi Tan, Zhichun Xie
p135–138
Published online: March 10 2016
Preview
Japanese encephalitis (JE) is a serious threat to human lives and is caused by the Japanese encephalitis virus (JEV), which belongs to the Flaviviridae family. The first major epidemic of JE occurred in 1924 in Japan.1 Since then, JE has been found increasingly in most countries of Asia, especially in the south-east areas.2 Over three billion individuals have been found in JE epidemic/endemic countries.3 According to a report by the World Health Organization, the number of cases worldwide in 2007 was 9487, including 4330 cases in China, 4017 cases in India, and 435 cases in Nepal.

JAMA Pediatrics
April 2016, Vol 170, No. 4
http://archpedi.jamanetwork.com/issue.aspx

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Viewpoint
What Pediatricians and Other Clinicians Should Know About Zika Virus FREE
Mark W. Kline, MD; Gordon E. Schutze, MD

Journal of Pediatrics
April 2016 Volume 171, p1-326
http://www.jpeds.com/current

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Original Papers
Knowledge about Human Papillomavirus and Time to Complete Vaccination among Vulnerable Female Youth
Julie Nagpal, Lourdes Oriana Linares, Jocelyn Weiss, Nicolas F. Schlecht, Viswanathan Shankar, Debra Braun-Courville, Anne Nucci-Sack, Howard D. Strickler, Robert D. Burk, Angela Diaz
p122–127
Published online: February 2 2016
Abstract
Objective
To examine the association of knowledge about human papillomavirus (HPV) on the time to completion of the 3-dose quadrivalent vaccine series in an inner-city population of adolescent female subjects at high risk for infection.
Study design
We prospectively followed 139 female subjects aged 14-20 years enrolled in a vaccine surveillance study in New York City during a period of at least 24 months. Participants were given a 30-item true or false survey on HPV at enrollment and ranked according to the number of correct responses. Multivariate Cox regression was used to examine the association between level of knowledge about HPV and time to completion (in days) of vaccine dose 1-3, dose 1-2, and dose 2-3.
Results
Overall time to completion of the 3-dose vaccine ranged from 158 days to 1114 days. Participants in the high knowledge group (top quartile) were significantly more likely to complete the 3-dose series earlier (hazard ratio 1.69, 95% CI 1.03-2.77; P = .04), in particular doses 2-3 (hazard ratio 1.71, 95% CI 1.02-2.89; P = .04), than those with low-to-moderate knowledge (bottom 3 quartiles).
Conclusions
These findings suggest that knowledge of HPV is associated with shorter time to complete the 3-dose HPV vaccine series. Educational campaigns at time of vaccination may be important to improve vaccine adherence.

The Lancet
Apr 09, 2016 Volume 387 Number 10027 p1483-1590
http://www.thelancet.com/journals/lancet/issue/current

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Articles
Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants
NCD Risk Factor Collaboration (NCD-RisC)
Published Online: 06 April 2016
DOI: http://dx.doi.org/10.1016/S0140-6736(16)00618-8
Open access funded by Wellcome Trust
Summary
Background
One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes.
Methods
We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence—defined as fasting plasma glucose of 7·0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs—in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue.
Findings
We used data from 751 studies including 4 372 000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4·3% (95% credible interval 2·4–7·0) in 1980 to 9·0% (7·2–11·1) in 2014 in men, and from 5·0% (2·9–7·9) to 7·9% (6·4–9·7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28·5% due to the rise in prevalence, 39·7% due to population growth and ageing, and 31·8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target.
Interpretation
Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries.
Funding
Wellcome Trust.

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Articles
Guillain-Barré Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study
Van-Mai Cao-Lormeau, Alexandre Blake, Sandrine Mons, Stéphane Lastère, Claudine Roche, Jessica Vanhomwegen, Timothée Dub, Laure Baudouin, Anita Teissier, Philippe Larre, Anne-Laure Vial, Christophe Decam, Valérie Choumet, Susan K Halstead, Hugh J Willison, Lucile Musset, Jean-Claude Manuguerra, Philippe Despres, Emmanuel Fournier, Henri-Pierre Mallet, Didier Musso, Arnaud Fontanet, Jean Neil, Frédéric GhawchéPublished Online: 29 February 2016
DOI: http://dx.doi.org/10.1016/S0140-6736(16)00562-6
Summary
Background
Between October, 2013, and April, 2014, French Polynesia experienced the largest Zika virus outbreak ever described at that time. During the same period, an increase in Guillain-Barré syndrome was reported, suggesting a possible association between Zika virus and Guillain-Barré syndrome. We aimed to assess the role of Zika virus and dengue virus infection in developing Guillain-Barré syndrome.
Methods
In this case-control study, cases were patients with Guillain-Barré syndrome diagnosed at the Centre Hospitalier de Polynésie Française (Papeete, Tahiti, French Polynesia) during the outbreak period. Controls were age-matched, sex-matched, and residence-matched patients who presented at the hospital with a non-febrile illness (control group 1; n=98) and age-matched patients with acute Zika virus disease and no neurological symptoms (control group 2; n=70). Virological investigations included RT-PCR for Zika virus, and both microsphere immunofluorescent and seroneutralisation assays for Zika virus and dengue virus. Anti-glycolipid reactivity was studied in patients with Guillain-Barré syndrome using both ELISA and combinatorial microarrays.
Findings
42 patients were diagnosed with Guillain-Barré syndrome during the study period. 41 (98%) patients with Guillain-Barré syndrome had anti-Zika virus IgM or IgG, and all (100%) had neutralising antibodies against Zika virus compared with 54 (56%) of 98 in control group 1 (p<0·0001). 39 (93%) patients with Guillain-Barré syndrome had Zika virus IgM and 37 (88%) had experienced a transient illness in a median of 6 days (IQR 4–10) before the onset of neurological symptoms, suggesting recent Zika virus infection. Patients with Guillain-Barré syndrome had electrophysiological findings compatible with acute motor axonal neuropathy (AMAN) type, and had rapid evolution of disease (median duration of the installation and plateau phases was 6 [IQR 4–9] and 4 days [3–10], respectively). 12 (29%) patients required respiratory assistance. No patients died. Anti-glycolipid antibody activity was found in 13 (31%) patients, and notably against GA1 in eight (19%) patients, by ELISA and 19 (46%) of 41 by glycoarray at admission. The typical AMAN-associated anti-ganglioside antibodies were rarely present. Past dengue virus history did not differ significantly between patients with Guillain-Barré syndrome and those in the two control groups (95%, 89%, and 83%, respectively).
Interpretation
This is the first study providing evidence for Zika virus infection causing Guillain-Barré syndrome. Because Zika virus is spreading rapidly across the Americas, at risk countries need to prepare for adequate intensive care beds capacity to manage patients with Guillain-Barré syndrome.
Funding
Labex Integrative Biology of Emerging Infectious Diseases, EU 7th framework program PREDEMICS. and Wellcome Trust.

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Review
Increasing value and reducing waste in biomedical research: who’s listening?
David Moher, Paul Glasziou, Iain Chalmers, Mona Nasser, Patrick M M Bossuyt, Daniël A Korevaar, Ian D Graham, Philippe Ravaud, Isabelle Boutron
Summary
The biomedical research complex has been estimated to consume almost a quarter of a trillion US dollars every year. Unfortunately, evidence suggests that a high proportion of this sum is avoidably wasted. In 2014, The Lancet published a series of five reviews showing how dividends from the investment in research might be increased from the relevance and priorities of the questions being asked, to how the research is designed, conducted, and reported. 17 recommendations were addressed to five main stakeholders—funders, regulators, journals, academic institutions, and researchers. This Review provides some initial observations on the possible effects of the Series, which seems to have provoked several important discussions and is on the agendas of several key players. Some examples of individual initiatives show ways to reduce waste and increase value in biomedical research. This momentum will probably move strongly across stakeholder groups, if collaborative relationships evolve between key players; further important work is needed to increase research value. A forthcoming meeting in Edinburgh, UK, will provide an initial forum within which to foster the collaboration needed.

Maternal and Child Health Journal
Volume 20, Issue 4, April 2016
http://link.springer.com/journal/10995/20/4/page/1

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Commentary
Catalyzing a Reproductive Health and Social Justice Movement
Sarah Verbiest, Christina Kiko Malin, Mario Drummonds…
Abstract
Objectives The maternal and child health (MCH) community, partnering with women and their families, has the potential to play a critical role in advancing a new multi-sector social movement focused on creating a women’s reproductive and economic justice agenda. Since the turn of the twenty-first century, the MCH field has been planting seeds for change. The time has come for this work to bear fruit as many states are facing stagnant or slow progress in reducing infant mortality, increasing maternal death rates, and growing health inequities. Methods This paper synthesizes three current, interrelated approaches to addressing MCH challenges—life course theory, preconception health, and social justice/reproductive equity. Conclusion Based on these core constructs, the authors offer four directions for advancing efforts to improve MCH outcomes. The first is to ensure access to quality health care for all. The second is to facilitate change through critical conversations about challenging issues such as poverty, racism, sexism, and immigration; the relevance of evidence-based practice in disenfranchised communities; and how we might be perpetuating inequities in our institutions. The third is to develop collaborative spaces in which leaders across diverse sectors can see their roles in creating equitable neighborhood conditions that ensure optimal reproductive choices and outcomes for women and their families. Last, the authors suggest that leaders engage the MCH workforce and its consumers in dialogue and action about local and national policies that address the social determinants of health and how these policies influence reproductive and early childhood outcomes.

Nature
Volume 532 Number 7597 pp5-142 7 April 2016
http://www.nature.com/nature/current_issue.html

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Editorials
Viral complacency
The first outbreak of yellow fever in Angola in almost 30 years illustrates the danger of a short attention span when confronting epidemic threats.

PharmacoEconomics
Volume 34, Issue 4, April 2016
http://link.springer.com/journal/40273/34/4/page/1

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Original Research Article
What Can We Expect from Value-Based Funding of Medicines? A Retrospective Study
Anthony Harris, Jing Jing Li, Karen Yong
Abstract
Objective
Deciding on public funding for pharmaceuticals on the basis of value for money is now widespread. We suggest that evidence-based assessment of value has restricted the availability of medicines in Australia in a way that reflects the relative bargaining power of government and the pharmaceutical industry. We propose a simple informal game-theoretic model of bargaining between the funding agency and industry and test its predictions using a logistic multiple regression model of past funding decisions made by the Pharmaceutical Benefits Advisory Committee in Australia.
Method
The model estimates the probability of a drug being recommended for subsidy as a function of incremental cost per quality-adjusted life-year (QALY), as well as other drug and market characteristics. Data are major submissions or resubmissions from 1993 to 2009 where there was a claim of superiority and evidence of a difference in quality of life. Independent variables measure the incremental cost per QALY, the cost to the public budget, the strength and quality of the clinical and economic evidence, need as measured by severity of illness and the availability of alternative treatments, whether or not a resubmission, and newspaper reports as a measure of public pressure. We report the odds ratio for each variable and calculate the ratio of the marginal effect of each variable to the marginal effect of the cost per QALY as a measure of the revealed willingness to pay for each of the variables that influence the decision.
Results
The results are consistent with a bargaining model where a 10,000 Australian dollar ($A) fall in value (increase in cost per QALY) reduces the average probability of public funding from 37 to 33 % (95 % CI 34–32). If the condition is life threatening or the drug has no active comparator, then the odds of a positive recommendation are 3.18 (95 % CI 1.00–10.11) and 2.14 (95 % CI 0.95–4.83) greater, equivalent to a $A33,000 and a $A21,000 increase in value (fall in cost per QALY). If both conditions are met, the odds are increased by 4.41 (95 % CI 1.28–15.24) times, equivalent to an increase in value of $A46,000. Funding is more likely as time elapses and price falls, but we did not find clear evidence that public or corporate pressure influences decisions.
Conclusion
Evidence from Australia suggests that the determinants of public funding and pricing decisions for medicines reflect the relative bargaining power of government and drug companies. Value for money depends on the quality of evidence, timing, patient need, perceived benefit and opportunity cost; these factors reflect the potential gains from striking a bargain and the risk of loss from not doing so

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 9 April 2016)

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Editorial
Neglected Tropical Diseases in the Anthropocene: The Cases of Zika, Ebola, and Other Infections
Peter J. Hotez
| published 08 Apr 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004648

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Effects of Mother’s Illness and Breastfeeding on Risk of Ebola Virus Disease in a Cohort of Very Young Children
Hilary Bower, Sembia Johnson, Mohamed S. Bangura, Alie Joshua Kamara, Osman Kamara, Saidu H. Mansaray, Daniel Sesay, Cecilia Turay, Francesco Checchi, Judith R. Glynn
Research Article | published 08 Apr 2016 | PLOS Neglected Tropical Diseases

PLoS One
http://www.plosone.org/
[Accessed 9 April 2016]

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Research Article
Effectiveness of the 10-Valent Pneumococcal Conjugate Vaccine (PCV-10) in Children in Chile: A Nested Case-Control Study Using Nationwide Pneumonia Morbidity and Mortality Surveillance Data
Janepsy Diaz, Solana Terrazas, Ana L. Bierrenbach, Cristiana M. Toscano, Gizelton P. Alencar, Andrés Alvarez, Maria T. Valenzuela, Jon Andrus, Roberto del Aguila, Juan C. Hormazábal, Pamela Araya, Paola Pidal, Cuauhtemoc R. Matus, Lucia H. de Oliveira
Research Article | published 08 Apr 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0153141

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Predicting and Evaluating the Epidemic Trend of Ebola Virus Disease in the 2014-2015 Outbreak and the Effects of Intervention Measures
Zuiyuan Guo, Dan Xiao, Dongli Li, Xiuhong Wang, Yayu Wang, Tiecheng Yan, Zhiqi Wang
Research Article | published 06 Apr 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0152438

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Optimizing Real-Time Vaccine Allocation in a Stochastic SIR Model
Chantal Nguyen, Jean M. Carlson
Research Article | published 04 Apr 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0152950
Abstract
Real-time vaccination following an outbreak can effectively mitigate the damage caused by an infectious disease. However, in many cases, available resources are insufficient to vaccinate the entire at-risk population, logistics result in delayed vaccine deployment, and the interaction between members of different cities facilitates a wide spatial spread of infection. Limited vaccine, time delays, and interaction (or coupling) of cities lead to tradeoffs that impact the overall magnitude of the epidemic. These tradeoffs mandate investigation of optimal strategies that minimize the severity of the epidemic by prioritizing allocation of vaccine to specific subpopulations. We use an SIR model to describe the disease dynamics of an epidemic which breaks out in one city and spreads to another. We solve a master equation to determine the resulting probability distribution of the final epidemic size. We then identify tradeoffs between vaccine, time delay, and coupling, and we determine the optimal vaccination protocols resulting from these tradeoffs.

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A Performance Analysis of Public Expenditure on Maternal Health in Mexico
Edson Servan-Mori, Leticia Avila-Burgos, Gustavo Nigenda, Rafael Lozano
Research Article | published 04 Apr 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0152635

Science
08 April 2016 Vol 352, Issue 6282
http://www.sciencemag.org/current.dtl
Special Issue: Metastasis

In Depth
Infectious Diseases
Yellow fever outbreak triggers vaccine alarm
Kai Kupferschmidt
Science 08 Apr 2016:
Vol. 352, Issue 6282, pp. 128-129
DOI: 10.1126/science.352.6282.128
Summary
A big yellow fever outbreak in Angola has depleted the world’s emergency vaccine stockpile and raised worries that future outbreaks of the mosquito-borne virus could be impossible to control. The Angolan outbreak has caused 490 confirmed cases and 198 deaths so far, but experts say the real toll may be 10 times as high. A vaccination campaign has already reached 6 million people in Luanda, where the outbreak began, but the disease has spread to other provinces as well and the vaccine is running out. Only four facilities in the world produce yellow fever vaccine, and their production methods are antiquated and difficult to scale up. Additional outbreaks in other African cities, or in Asia, where yellow fever has never gained a foothold, could be catastrophic, experts say.

Science Translational Medicine
06 April 2016 Vol 8, Issue 333
http://stm.sciencemag.org/

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Perspective
A “datathon” model to support cross-disciplinary collaboration
By Jerôme Aboab, Leo Anthony Celi, Peter Charlton, Mengling Feng, Mohammad Ghassemi, Dominic C. Marshall, Louis Mayaud, Tristan Naumann, Ned McCague, Kenneth E. Paik, Tom J. Pollard, Matthieu Resche-Rigon, Justin D. Salciccioli, David J. Stone
Science Translational Medicine06 Apr 2016 : 333ps8
A “datathon” model combines complementary knowledge and skills to formulate inquiries and drive research that addresses information gaps faced by clinicians.

Tropical Medicine & International Health
April 2016 Volume 21, Issue 4 Pages 455–567
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2016.21.issue-3/issuetoc
Series: who cares for women? Towards a greater understanding of reproductive and maternal healthcare markets

Family planning, antenatal and delivery care: cross-sectional survey evidence on levels of coverage and inequalities by public and private sector in 57 low- and middle-income countries (pages 486–503)
Oona M. R. Campbell, Lenka Benova, David MacLeod, Rebecca F. Baggaley, Laura C. Rodrigues, Kara Hanson, Timothy Powell-Jackson, Loveday Penn-Kekana, Reen Polonsky, Katharine Footman, Alice Vahanian, Shreya K. Pereira, Andreia Costa Santos, Veronique G. A. Filippi, Caroline A. Lynch and Catherine Goodman
Article first published online: 7 MAR 2016 | DOI: 10.1111/tmi.12681

Why women bypass front-line health facility services in pursuit of obstetric care provided elsewhere: a case study in three rural districts of Tanzania (pages 504–514)
A. M. Kanté, A. Exavery, J. F. Phillips and E. F. Jackson
Article first published online: 17 FEB 2016 | DOI: 10.1111/tmi.12672

Measuring the impact of non-monetary incentives on facility delivery in rural Zambia: a clustered randomised controlled trial (pages 515–524)
P. Wang, A. L. Connor, E. Guo, M. Nambao, P. Chanda-Kapata, N. Lambo and C. Phiri
Article first published online: 3 APR 2016 | DOI: 10.1111/tmi.12678

Criteria-based audit of caesarean section in a referral hospital in rural Tanzania (pages 525–534)
S. Heemelaar, E. Nelissen, P. Mdoe, H. Kidanto, J. van Roosmalen and J. Stekelenburg
Article first published online: 4 MAR 2016 | DOI: 10.1111/tmi.12683

Characteristics of neonatal near miss in hospitals in Benin, Burkina Faso and Morocco in 2012–2013 (pages 535–545)
Carine Ronsmans, Jenny A. Cresswell, Sourou Goufodji, Schadrac Agbla, Rasmané Ganaba, Bouchra Assarag, Oscar Tonouhéoua, Cheick Diallo, Fatima-Zahra Meski and Véronique Filippi
Article first published online: 4 MAR 2016 | DOI: 10.1111/tmi.12682

Decreasing child mortality, spatial clustering and decreasing disparity in North-Western Burkina Faso (pages 546–555)
Heiko Becher, Olaf Müller, Peter Dambach, Sabine Gabrysch, Louis Niamba, Osman Sankoh, Seraphin Simboro, Anja Schoeps, Gabriele Stieglbauer, Yazoume Yé and Ali Sié
Article first published online: 19 FEB 2016 | DOI: 10.1111/tmi.12673

Clinical trials
2016 Feb 11. pii: 1740774515625976. [Epub ahead of print]

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A cluster randomized controlled trial comparing relative effectiveness of two licensed influenza vaccines in US nursing homes: Design and rationale.
S Gravenstein, R Dahal, PL Gozalo, HE Davidson…
Abstract
BACKGROUND:
Influenza, the most important viral infection affecting older adults, produces a substantial burden in health care costs, morbidity, and mortality. Influenza vaccination remains the mainstay in prevention and is associated with reduced rates of hospitalization, stroke, heart attack, and death in non-institutional older adult populations. Influenza vaccination produces considerably lower antibody response in the elderly compared to young adults. Four-fold higher vaccine antigen (high-dose) than in the standard adult vaccine (standard-dose) elicits higher serum antibody levels and antibody response in ambulatory elderly.
PURPOSE:
To describe the design considerations of a large clinical trial of high-dose compared to standard-dose influenza vaccine in nursing homes and baseline characteristics of participating nursing homes and long-stay (more than 90 days) residents over 65 years of age.
METHODS:
The high-dose influenza vaccine intervention trial is multifacility, cluster randomized controlled trial with a 2×2 factorial design that compares hospitalization rates, mortality, and functional decline among long-stay nursing home residents in facilities randomized to receive high-dose versus standard-dose influenza vaccine and also randomized with or without free staff vaccines provided by study organizers. Enrollment focused on nursing homes with a large long-stay resident population over 65 years of age. The primary outcome is the resident-level incidence of hospitalization with a primary diagnosis of pulmonary and influenza-like illness, based upon Medicare inpatient hospitalization claims. Secondary outcomes are all-cause mortality based upon the vital status indicator in the Medicare Vital Status file, all-cause hospitalization directly from the nursing home Minimum Data Set discharge records, and the probability of declining at least 4 points on the 28-point Activities of Daily Living Scale.
RESULTS:
Between February and September 2013, the high-dose influenza vaccine trial recruited and randomized 823 nursing homes. The analysis sample includes 53,035 long-stay nursing home residents over 65 years of age, representing 57.7% of the participating facilities’ population. Residents are mainly women (72.2%), white (75.5%), with a mean age of 83 years. Common conditions include hypertension (79.2%), depression (55.1%), and diabetes mellitus (34.4%). The prevalence of circulatory and pulmonary disorders includes heart failure (20.5%), stroke (20.1%), and asthma/chronic obstructive pulmonary disease (20.2%).
CONCLUSIONS:
This high-dose influenza vaccine trial uniquely offers a paradigm for future studies of clinical and programmatic interventions within the framework of efforts designed to test the impact of changes in usual treatment practices adopted by health care systems.
TRIAL REGISTRATION:
NCT01815268

Social Science & Medicine
Available online 4 April 2016
Of Natural Bodies and Antibodies: Parents’ Vaccine Refusal and the Dichotomies of Natural and Artificial
JA Reich
Abstract
Despite eliminating incidences of many diseases in the United States, parents are increasingly rejecting vaccines for their children. This article examines the reasons parents offer for doing so. It argues that parents construct a dichotomy between the natural and the artificial, in which vaccines come to be seen as unnecessary, ineffective, and potentially dangerous. Using qualitative data from interviews and observations, this article shows first, how parents view their children’s bodies, particularly from experiences of birth and with infants, as naturally perfect and in need of protection. Second, parents see vaccines as an artificial intervention that enters the body unnaturally, through injection. Third, parents perceive immunity occurring from illness to be natural and superior and immunity derived from vaccines as inferior and potentially dangerous. Finally, parents highlight the ways their own natural living serves to enhance their children’s immunity rendering vaccines unnecessary. Taken together, this dichotomy allows parents to justify rejection of vaccines as a form of protecting children’s health. These findings expose perceptions of science, technology, health, and the meanings of the body in ways that can inform public health efforts.

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

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

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The Atlantic
http://www.theatlantic.com/magazine/
Accessed 9 April 2016
What Zika Researchers Can Learn From the Rubella Outbreak of 1964
The viruses have key similarities that may help scientists respond to a possible epidemic.
Adrienne LaFrance
Apr 6, 2016
…“What we learned about rubella and pregnancy, and how we learned it—we are definitely looking to those lessons as we learn more every day about Zika virus,” said Peggy Honein, who is a leading researcher into birth defects on the Centers for Disease Control’s Zika Response Team…

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Foreign Policy
http://foreignpolicy.com/
Accessed 9 April 2016
White House Shifts Ebola Funds to Try to Stop Spread of Zika
HHS chief says Zika’s arrival in the U.S. is a matter of when, not if.
David Francis | April 6, 2016

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The Guardian
http://www.guardiannews.com/
Accessed 9 April 2016
Pakistan and Afghanistan join forces to wipe out polio
Islamic scholars have been countering the Taliban’s anti-vaccine campaign, accompanying health workers to urge parents to inoculate their children
Ashfaq Yusufzai for IPS, part of the Guardian’s development network
Tuesday 5 April 2016 07.27 EDT
Pakistan and Afghanistan, the two remaining countries where polio is endemic, have joined forces to eradicate polio by vaccinating their children in synchronised campaigns.
The countries – which share a 2,400km porous border – have been bracketed as the major stumbling block in the drive for the global eradication of polio. These countries have been tackling the Taliban’s opposition to the administration of oral polio vaccine (OPV) to children.

Peshawar, the capital of Khyber Pakhtunkhwa (KP), along with the adjacent Federally Administered Tribal Areas (Fata), as well as the adjoining Nangarhar province of Afghanistan, have been declared a polio-endemic geographical block by the World Health Organisation.
“We have started synchronised immunisation campaigns in KP, Fata and Afghanistan with a view to ensure vaccination of all children on both sides of the border,” said KP’s health minister, Shahram Tarakai.
“There are about 100,000 children [whose parents] refuse vaccination on both sides of the border. They pose a threat to the polio eradication campaign. Each child should get vaccinated,” he said.
The government has enlisted the support of Islamic scholars to combat refusals against OPV, said KP’s top polio officer, Dr Ayub Roz.

Taliban groups have been campaigning against OPV because they consider it a ploy by the US to render recipients impotent or infertile, and reduce the population of Muslims.
Ayub Roz said scholars have been involved in the vaccination campaigns to dispel the myth that OPV was against Islam and that it affected fertility.

Maulana Samiul Haq, chief of Pakistan’s Islamic seminary Darul Uloom Haqqani in Akora Khattak, has been given the task of countering the Taliban’s anti-vaccine campaign. He said the scholars have been engaged to accompany health workers and urge parents that OPV is important for their kids to safeguard them against disabilities.

“It is the responsibility of the parents to protect their children against diseases and provide them with safe and healthy environments. We have convinced 10,000 parents since January on vaccination of their children,” he said…

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New York Times
http://www.nytimes.com/
Accessed 9 April 2016
The Opinion Pages | Op-Ed Contributor
Zika Is Coming
By PETER J. HOTEZ

APRIL 8, 2016
Houston — IF I were a pregnant woman living on the Gulf Coast or in Florida, in an impoverished neighborhood in a city like Houston, New Orleans, Miami, Biloxi, Miss., or Mobile, Ala., I would be nervous right now. If mosquitoes carrying the Zika virus reach the United States later this spring or summer, these are the major urban areas where the sickness will spread. If we don’t intervene now, we could begin seeing newborns with microcephaly and stunted brain development on the obstetrics wards in one or more of these places.

There are many theories for Zika’s rapid rise, but the most plausible is that the virus mutated from an African to a pandemic strain a decade or more ago and then spread east across the Pacific from Micronesia and French Polynesia, until it struck Brazil. There, it infected more than a million people over the last one to two years. Today, the extremely poor cities of Brazil’s northeastern states make up the epicenter of the epidemic.

There are three reasons that Zika has slammed this particular part of Brazil: the presence of the main mosquito species that carries the virus and transmits it to humans, Aedes aegypti; overcrowding; and extreme poverty.

In crowded places, mosquitoes have lots of access to lots of people. Poor people often live in proximity to garbage, including old tires, plastic containers and drainage ditches filled with stagnant water, where this species of mosquito lives and breeds. And they often have homes with torn screens on their windows. The combination creates ideal conditions for the Zika virus to spread.

The same factors are present in the poorest urban areas of coastal Texas, Louisiana, Mississippi and Alabama, in addition to South Florida, and an area around Tucson. In the Fifth Ward of Houston (a historically African-American neighborhood that was populated by freed slaves after the Civil War), just a few miles from the medical center where I work, there is an astonishing level of extreme poverty. A brief tour reveals water-filled drainage ditches in place of gutters, as well as evidence of dumping — a common practice in which people toss old tires and other garbage into residential areas rather than designated landfill sites — right next to shabby and crumbling housing.

These are also the major areas in the continental United States where Aedes aegypti is found. This mosquito has transmitted viruses such as yellow fever and dengue throughout the Gulf Coast for centuries. Most recently, in 2003, it transmitted an outbreak of dengue here in Houston that was associated with at least two deaths.
It’s only April, but temperatures are hitting the 80s in the afternoons, and Aedes mosquitoes are already here. By May or June we will start seeing those mosquitoes in much larger numbers.

I develop vaccines for neglected tropical diseases. Several Zika vaccines are being created, but none will be ready in time for this year’s epidemic. In place of a vaccine we need a robust program of mosquito control and environmental cleanup in the poorest neighborhoods of our Gulf Coast cities and in Florida. This should include removing garbage and debris, and installing gutters to replace drainage ditches. We need to improve access to contraception, and provide pregnant women with proper window screens for their homes and information about the risk of Zika. Finally, we will need to train teams to visit homes in poor neighborhoods and instruct occupants on how to empty water containers and spray for mosquitoes, just as we are doing now in Puerto Rico.

At the federal level this effort would need to bring in the Environmental Protection Agency, the Centers for Disease Control and Prevention and the Department of Housing and Urban Development. But we’ll also need parallel approaches at the state, county and city levels.
This coordination is labor intensive and will not be easy, but if we don’t start working now, by the end of the year, I am afraid we will see microcephaly cases in Houston and elsewhere on the Gulf Coast. This could be a catastrophe to rival Hurricane Katrina or other recent miseries that disproportionately affect the poor. Zika is a potentially devastating health crisis headed for our region, and we might have only a few weeks to stop it before pregnant women become infected.

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Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 9 April 2016
Business
J&J Makes Renewed Push Into Africa
By Betsy McKay, Jonathan D. Rockoff
April 5, 2016 7:03 pm ET

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Washington Post
http://www.washingtonpost.com/
Accessed 9 April 2016
‘It’s everyone’s worst fear’: How a small college survived an outbreak
After students were diagnosed with meningitis, Santa Clara University launched the fastest-ever mobilization of a mass vaccination clinic in the country, according to the county health department
Susan Svrluga | Local | Apr 7, 2016

Here’s why the WHO responded so differently to Zika and Ebola
By Amy S. Patterson April 4