European Vaccine Initiative [to 21 May 2016]
http://www.euvaccine.eu/news-events
News
Second Global Vaccine and Immunization Research Forum (GVIRF) from WHO – Presentations now available
17 May 2016
The presentations given at the captioned forum 15 – 17 March 2016 in Johannesburg are now available.

AERAS [to 21 May 2016]
http://www.aeras.org/pressreleases

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May 20, 2016
Aeras Applauds the Final Report and Recommendations by the United Kingdom Review on Antimicrobial Resistance
Rockville, MD,– Aeras applauds the Final Report and Recommendations released this week by the U.K. Review on Antimicrobial Resistance (Review) that highlights the extreme global health threat of antimicrobial resistance (AMR). The Review led by economist Jim O’Neill, specifically notes the threat of multidrug-resistant TB (MDR-TB) and the imperative of increased global investment in research and development to save the millions of lives lost each year due to AMR related to tuberculosis (TB) and other infectious diseases.

The final report warns that if new therapies, diagnostics and a new vaccine are not introduced, MDR-TB will be responsible for 2.5 million deaths per year by 2050, or roughly one quarter of the forecasted 10 million deaths related to AMR – equating to one death due to MDR-TB every 12 seconds. An interim paper entitled Vaccines and Alternative Approaches: Reducing our Dependence on Antimicobials published by the Review in February 2016 also emphasized the overwhelming need for new TB vaccines as an essential component of the global strategy to overcome TB and to address MDR-TB…

Fondation Merieux [to 21 May 2016]
Mission: Contribute to global health by strengthening local capacities of developing countries to reduce the impact of infectious diseases on vulnerable populations.
http://www.fondation-merieux.org/news
17 May 2016, Ouagadougou (Burkina Faso)
2nd Regional WARDS Workshop on Laboratory Strengthening and Networks in the 15 ECOWAS Countries and RESAOLAB Workshops in Collaboration with WAHO
Some 70 participants, including the leading figures in clinical biology from the 15 ECOWAS countries, are gathering in Ouagadougou in Burkina Faso, May 17-19 for the West African Regional Disease Surveillance (WARDS) project’s 2nd regional workshop on laboratory strengthening and networks and RESAOLAB** technical workshops.

GHIT Fund [to 21 May 2016]
https://www.ghitfund.org/
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that devastate the world’s poorest people. Other funders include six Japanese pharmaceutical companies, the Japanese Government and the Bill & Melinda Gates Foundation.

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2016.05.20 Press Room
Government of Japan Announces Decision to Contribute US$130 million to GHIT Fund/UNDP Replenishment
TOKYO, JAPAN (May 20, 2016)—Today, the Government of Japan (GOJ) announced its policy ahead of the G7 Ise-Shima Summit that it will make a US$130 million contribution to the Global Health Innovative Technology Fund (GHIT Fund) /United Nations Development Programme (UNDP) replenishment, signaling Japan’s unwavering support for research and development (R&D) for malaria, tuberculosis, HIV/AIDS and neglected tropical diseases (NTDs) worldwide.

Launched in 2013 as a public and private partnership, the GHIT Fund has built a robust portfolio of drugs, vaccines and diagnostics. The Fund is expanding: it has invested upwards of US$60 million in more than 60 global product development partnerships that leverage Japanese innovation and capacities in pharmaceuticals. In just three years, the GHIT Fund portfolio is expanding with six of its 23 novel screening programs advancing into next stage of development; two candidates successfully achieving first-in-human trials and an innovative antimalarial drug recently achieving Proof of Concept (Phase II). GHIT is on the ground, having already initiated seven clinical trials for novel candidates in high-burden countries.

The GOJ announcement today will not only allow this innovative work to continue, but will enable GHIT to expand its global development partnerships and its reach around the world. On the health agenda of this year’s G7 Summit in Japan are antimicrobial resistance (AMR) and R&D for infectious disease such as NTDs. Aligned with these goals, GHIT drives forward product development of new technologies to eliminate NTDs and, with over half of its investments targeting resistance in malaria and tuberculosis, is also committed to the fight against AMR.

“Since our initial commitment three years ago, GHIT has made incredible progress in leveraging Japan’s vast cutting-edge science and technology know-how for game-changing tools that have the potential to one day save millions of lives across the globe,” said Dr. Eiji Hinoshita, Director, Global Health Policy Division, International Cooperation Bureau, Ministry of Foreign Affairs. “With today’s announcement, we are incredibly proud to be able to support the continued advancement of these innovations, which, with their rapid advancement through the pipeline, are already poised to make real our vision of a healthier world.”…

Global Fund [to 21 May 2016]
http://www.theglobalfund.org/

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20 May 2016
Japan Increases Commitment to the Global Fund
TOKYO – The Government of Japan announced today a pledge of US$800 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria for the Fifth Replenishment that starts in 2017, representing a 46 percent increase when measured in Japanese yen, due to fluctuating exchange rates…

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19 May 2016
Global Fund Strongly Supports Inclusion and Full Participation at High-Level Meeting on Ending AIDS
GENEVA – The Global Fund strongly supports the UNAIDS call for inclusion and full participation of civil society organizations at the 2016 United Nations General Assembly High-Level Meeting on Ending AIDS.

From June 8-10, 2016, world leaders, government representatives, HIV program implementers and civil society organizations from around the world will gather at the United Nations Headquarters in New York to develop a way forward to reach the Sustainable Development Goal of ending AIDS as an epidemic by 2030.

The voices and perspectives of individuals and nongovernmental organizations working to ensure no one is left behind in the fight against HIV are a crucial part of this important forum, particularly people living with HIV and people most affected by the epidemic, including women and girls, sex workers, people who use drugs, men who have sex with men, and transgender people.

As a 21st-century partnership of governments, civil society, the private sector and people affected by AIDS, TB and malaria, the Global Fund recognizes that ending AIDS as an epidemic can only be achieved with the meaningful engagement and participation of people living with and affected by the disease. Reaching Millennium Development Goal 6 of halting and reversing the AIDS epidemic and the historic milestone of 15 million people on treatment by 2015 were due to a coordinated, committed effort of partners worldwide – including civil society groups.
The High-Level Meeting on Ending AIDS should be guided by the principles on which the successes of the AIDS response are built – inclusion, participation and dignity.

PATH [to 21 May 2016]
http://www.path.org/news/index.php
Press release | May 17, 2016
PATH and Laerdal Global Health to accelerate global access to an innovative feeding cup for preterm and high-risk newborns
The new feeding cup delivers lifesaving nutrients to newborns in low-resource settings who have difficulty breastfeeding

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Press release | May 17, 2016
PATH in collaboration with Novartis Foundation announce innovative program to tackle hypertension in Vietnam
Communities for Healthy Hearts will improve hypertension screening and management with a focus on empowering patients and health care workers

Journal Watch
Vaccines and Global Health: The Week in Review continues its weekly scanning of key peer-reviewed journals to identify and cite articles, commentary and editorials, books reviews and other content supporting our focus on vaccine ethics and policy. Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher.

  If you would like to suggest other journal titles to include in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

Annals of Internal Medicine
17 May 2016, Vol. 164. No. 10
http://annals.org/issue.aspx
Ideas and Opinions
Emergence of Congenital Zika Syndrome: Viewpoint From the Front Lines FREE
Federico Costa, PhD; Manoel Sarno, MD, PhD; Ricardo Khouri, PhD; Bruno de Paula Freitas, MD; Isadora Siqueira, MD, PhD; Guilherme S. Ribeiro, MD, PhD; Hugo C. Ribeiro, MD; Gubio S. Campos, PhD; Luiz C. Alcântara, PhD; Mitermayer G. Reis, MD, PhD; Scott C. Weaver, PhD; Nikos Vasilakis, PhD; Albert I. Ko, MD; and Antonio Raimundo Almeida, MD, PhD
[No abstract; Final text]
…Although recent advances in flavivirus vaccines may guide relatively rapid development of a Zika vaccine, availability is still probably years away. Treatment with a monoclonal antibody could also be developed quickly on the basis of promising past results with flaviviruses. However, systematic investigations of pregnant women and newborns will still be needed to determine the risk for transplacental infection and development of severe congenital sequelae that can, in turn, guide effective diagnostic and prevention efforts.

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 21 May 2016)

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Research article
Improving the uptake of pre-travel health advice amongst migrant Australians: exploring the attitudes of primary care providers and migrant community groups
Migrant travellers who return to their country of origin to visit family and friends (VFR) are less likely to seek travel-related medical care and are less likely to adhere to recommended medications …
Holly Seale, Rajneesh Kaur, Abela Mahimbo, C. Raina MacIntyre, Nicholas Zwar, Mitchell Smith, Heather Worth and Anita E Heywood
BMC Infectious Diseases 2016 16:213
Published on: 18 May 2016

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Research article
Initiation and completion rates for latent tuberculosis infection treatment: a systematic review
Control of latent tuberculosis infection (LTBI) is an important step towards tuberculosis elimination. Preventive treatment will prevent the development of disease in most cases diagnosed with LTBI.
Andreas Sandgren, Marije Vonk Noordegraaf-Schouten, Femke van Kessel, Anke Stuurman, Anouk Oordt-Speets and Marieke J. van der Werf
BMC Infectious Diseases 2016 16:204
Published on: 17 May 2016

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 21 May 2016)

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Research article
Human newborn bacille Calmette–Guérin vaccination and risk of tuberculosis disease: a case-control study
Helen A. Fletcher, Ali Filali-Mouhim, Elisa Nemes, Anthony Hawkridge, Alana Keyser, Samuel Njikan, Mark Hatherill, Thomas J. Scriba, Brian Abel, Benjamin M. Kagina, Ashley Veldsman, Nancy Marín Agudelo, Gilla Kaplan, Gregory D. Hussey, Rafick-Pierre Sekaly and Willem A. Hanekom
Published on: 16 May 201
Abstract
Background
An incomplete understanding of the immunological mechanisms underlying protection against tuberculosis (TB) hampers the development of new vaccines against TB. We aimed to define host correlates of prospective risk of TB disease following bacille Calmette–Guérin (BCG) vaccination.
Methods
In this study, 5,726 infants vaccinated with BCG at birth were enrolled. Host responses in blood collected at 10 weeks of age were compared between infants who developed pulmonary TB disease during 2 years of follow-up (cases) and those who remained healthy (controls).
Results
Comprehensive gene expression and cellular and soluble marker analysis failed to identify a correlate of risk. We showed that distinct host responses after BCG vaccination may be the reason: two major clusters of gene expression, with different myeloid and lymphoid activation and inflammatory patterns, were evident when all infants were examined together. Cases from each cluster demonstrated distinct patterns of gene expression, which were confirmed by cellular assays.
Conclusions
Distinct patterns of host responses to Mycobacterium bovis BCG suggest that novel TB vaccines may also elicit distinct patterns of host responses. This diversity should be considered in future TB vaccine development.

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 21 May 2016)

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Research article
How equitable are community health worker programmes and which programme features influence equity of community health worker services? A systematic review
Community health workers (CHWs) are uniquely placed to link communities with the health system, playing a role in improving the reach of health systems and bringing health services closer to hard-to-reach and …
Rosalind McCollum, Woedem Gomez, Sally Theobald and Miriam Taegtmeyer
BMC Public Health 2016 16:419
Published on: 20 May 2016

Research article
Using short-message-service notification as a method to improve acute flaccid paralysis surveillance in Papua New Guinea
High quality acute flaccid paralysis (AFP) surveillance is required to maintain polio-free status of a country. Papua New Guinea (PNG) is considered as one of the highest risk countries for polio re-importation…
Siddhartha Sankar Datta, Berry Ropa, Gerard Pai Sui, Ramzi Khattar, Ravi Shankar Santhana Gopala Krishnan and Hiromasa Okayasu
BMC Public Health 2016 16:409
Published on: 17 May 2016

Debate
Critiquing the response to the Ebola epidemic through a Primary Health Care Approach
The 2014/2015 West Africa Ebola epidemic has caused the global public health community to engage in difficult self-reflection.
Vera Scott, Sarah Crawford-Browne and David Sanders
BMC Public Health 2016 16:410
Published on: 17 May 2016

Research article
Associations in the continuum of care for maternal, newborn and child health: a population-based study of 12 sub-Saharan Africa countries
Despite the progress in the Millennium Development Goals (MDGs) 4 and 5, inequity in the utilization of maternal, newborn and child health (MNCH) care services still remain high in sub-Saharan Africa (SSA).
Patrick Opiyo Owili, Miriam Adoyo Muga, Yiing-Jenq Chou, Yi-Hsin Elsa Hsu, Nicole Huang and Li-Yin Chien
BMC Public Health 2016 16:414
Published on: 17 May 2016

British Medical Journal
21 May 2016 (vol 352, issue 8058)
http://www.bmj.com/content/353/8058

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Research Update
Deaths, late deaths, and role of infecting dose in Ebola virus disease in Sierra Leone: retrospective cohort study
BMJ 2016; 353 :i2403 (Published 17 May 2016)
Abstract
Objectives To assess the frequency of fatal recrudescence from Ebola virus disease after discharge from treatment centres, and explore the influence of infecting dose on case fatality rates.
Design Retrospective cohort study.
Setting Western Area, Sierra Leone.
Participants 151 survivors treated for Ebola virus disease at the Kerry Town treatment centre and discharged. Survivors were followed up for a vital status check at four to nine months after discharge, and again at six to 13 months after discharge. Verbal autopsies were conducted for four survivors who had died since discharge (that is, late deaths). Survivors still living in Western Area were interviewed together with their household members. Exposure level to Ebola virus disease was ascertained as a proxy of infecting dose, including for those who died.
Main outcome measures Risks and causes of late death; case fatality rates; odds ratios of death from Ebola virus disease by age, sex, exposure level, date, occupation, and household risk factors.
Results Follow-up information was obtained on all 151 survivors of Ebola virus disease, a mean of 10 months after discharge. Four deaths occurred after discharge, all within six weeks: two probably due to late complications, one to prior tuberculosis, and only one after apparent full recovery, giving a maximum estimate of recrudescence leading to death of 0.7%. In these households, 395 people were reported to have had Ebola virus disease, of whom 227 died. A further 53 people fulfilled the case definition for probable disease, of whom 11 died. Therefore, the case fatality rate was 57.5% (227/395) for reported Ebola virus disease, or 53.1% (238/448) including probable disease. Case fatality rates were higher in children aged under 2 years and adults older than 30 years, in larger households, and in infections occurring earlier in the epidemic in Sierra Leone. There was no consistent trend of case fatality rate with exposure level, although increasing exposure increased the risk of Ebola virus disease.
Conclusions In this study of survivors in Western Area, Sierra Leone, late recrudescence of severe Ebola virus disease appears to be rare. There was no evidence for an effect of infecting dose (as measured by exposure level) on the severity of disease.

Clinical Therapeutics
May 2016 Volume 38, Issue 5, p991-1258
http://www.clinicaltherapeutics.com/current

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Original Research
Progress Report on Neglected Tropical Disease Drug Donation Programs
Joshua P. Cohen, Lisseth Silva, Alisa Cohen, Josephine Awatin, Robert Sturgeon
p1193–1204
Published online: March 31 2016
Abstract
Purpose
Neglected tropical diseases (NTDs) impose a significant burden on public health, particularly in developing nations. Many can be treated cost-effectively with drugs donated or offered at or below marginal cost. In 2012, the World Health Organization published an NTD roadmap that outlined a strategy for the prevention, control, and eradication of 17 NTDs by 2020. Inspired by this roadmap, executives from 13 pharmaceutical companies, government agencies, and other interested parties signed the London Declaration on Neglected Tropical Diseases in January 2012. In this paper, we will assess progress in meeting commitments on drug donations laid out in the London Declaration.
Methods
We conducted Medline and LexisNexis searches of peer-reviewed publications and trade journals, as well as product development partnership and government reports. Subsequently, we designed a survey instrument and surveyed 10 company signatories (companies with drug donation programs) to the London Declaration to determine current donations and pledges.
Findings
Nine of 10 companies with donation programs responded to the survey. The respondents reported substantial progress in meeting the goals laid out in the London Declaration. Survey respondents maintained 17 drug donation programs across 10 disease categories. In 2014, companies donated >1 billion treatments, with a dollar value of nearly $1.5 billion. However, not all donated products were distributed to patients in need. In addition, 4 of the 17 programs were slated to end before 2020, three of the 17 programs did not report explicit program objectives, and 7 of 17 did not measure the impact of programs in terms of numbers of patients treated. None of our survey respondents reported on whether the programs were leading to a reduction in disease prevalence.
Implications
Donations are a necessary but insufficient condition for patient access to neglected disease drugs. Additional resources must be allocated to ensure delivery of donated products to patients. In addition, drug donation programs should provide explicit descriptions of program objectives, measurements of the impacts of their programs, and extension of all donation commitments through 2020. To achieve this, multiple stakeholders with a vested interest in reducing the burden of neglected diseases must collaborate in a multipronged approach toward NTD elimination.

Development in Practice
Volume 26, Issue 4, 2016
http://www.tandfonline.com/toc/cdip20/current

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Articles
NGO–researcher partnerships in global health research: benefits, challenges, and approaches that promote success
DOI:10.1080/09614524.2016.1164122
Catherine Olivier, Matthew R. Hunt & Valéry Ridde
pages 444-455
Open access
Published online: 13 Apr 2016
ABSTRACT
Partnerships involving NGOs and academic researchers (NGO–R partnerships) are increasing in global health research. Such collaborations present opportunities for knowledge translation in global health, yet are also associated with challenges for establishing and sustaining effective and respectful partnerships. We conducted a narrative review of the literature to identify benefits and challenges associated with NGO–R partnerships, as well as approaches that promote successful partnerships. We illustrate this analysis with examples from our own experiences. The results suggest that collaborations characterised by trust, transparency, respect, solidarity, and mutuality contribute to the development of successful and sustainable NGO–R partnerships.

Eurosurveillance
Volume 21, Issue 20, 19 May 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Rapid communications
Outbreak of a new measles B3 variant in the Roma/Sinti population with transmission in the nosocomial setting, Italy, November 2015 to April 2016
by A Filia, A Amendola, M Faccini, M Del Manso, S Senatore, S Bianchi, BM Borrini, A Ciampelli, E Tanzi, MT Filipponi, G Piccirilli, T Lazzarotto, MG Pascucci, M Baggieri, F Magurano

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 21 May 2016]

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Research
Global health partnerships: building multi-national collaborations to achieve lasting improvements in maternal and neonatal health
In response to health care challenges worldwide, extensive funding has been channeled to the world’s most vulnerable health systems. Funding alone is not sufficient to address the complex issues and challenges…
Rohit Ramaswamy, Brianne Kallam, Dragica Kopic, Borislava Pujic and Medge D. Owen
Globalization and Health 2016 12:22
Published on: 20 May 2016

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Research
Discourse, ideas and power in global health policy networks: political attention for maternal and child health in the millennium development goal era
Maternal and child health issues have gained global political attention and resources in the past 10 years, due in part to their prominence on the Millennium Development Goal agenda and the use of evidence-based…
Lori McDougall
Globalization and Health 2016 12:21
Published on: 18 May 2016

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Research
From local to global: a qualitative review of the multi-leveled impact of a multi-country health research capacity development partnership on maternal health in Sudan
There is a substantial body of literature on the principles of good partnerships and the rationale for such partnerships in research capacity strengthening. This paper illustrates the long term effects…
Khalifa Elmusharaf, Hanan Tahir, Diarmuid O’ Donovan, Ruairi Brugha, Mamoun Homeida, Amal M. O. Abbas and Elaine Byrne
Globalization and Health 2016 12:20
Published on: 16 May 2016

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 21 May 2016]

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Research
Which health research gets used and why? An empirical analysis of 30 cases
Maarten Olivier Kok, John Owusu Gyapong, Ivan Wolffers, David Ofori-Adjei and Joost Ruitenberg
Published on: 17 May 2016
Abstract
Background
While health research is considered essential for improving health worldwide, it remains unclear how it is best organized to contribute to health. This study examined research that was part of a Ghanaian-Dutch research program that aimed to increase the likelihood that results would be used by funding research that focused on national research priorities and was led by local researchers. The aim of this study was to map the contribution of this research to action and examine which features of research and translation processes were associated with the use of the results.
Methods
Using Contribution Mapping, we systematically examined how 30 studies evolved and how results were used to contribute to action. We combined interviews with 113 purposively selected key informants, document analysis and triangulation to map how research and translation processes evolved and contributions to action were realized. After each case was analysed separately, a cross-case analysis was conducted to identify patterns in the association between features of research processes and the use of research.
Results
The results of 20 of the 30 studies were used to contribute to action within 12 months. The priority setting and proposal selection process led to the funding of studies which were from the outset closely aligned with health sector priorities. Research was most likely to be used when it was initiated and conducted by people who were in a position to use their results in their own work. The results of 17 out of 18 of these user-initiated studies were translated into action. Other features of research that appeared to contribute to its use were involving potential key users in formulating proposals and developing recommendations.
Conclusions
Our study underlines the importance of supporting research that meets locally-expressed needs and that is led by people embedded in the contexts in which results can be used. Supporting the involvement of health sector professionals in the design, conduct and interpretation of research appears to be an especially worthwhile investment.

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 21 May 2016]

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Research Article
Shrinking the malaria map in China: measuring the progress of the National Malaria Elimination Programme
Tao Hu, Yao-Bao Liu, Shao-Sen Zhang, Zhi-Gui Xia, Shui-Sen Zhou, Jun Yan, Jun Cao and Zhan-Chun Feng
Published on: 19 May 2016

Infectious Agents and Cancer
http://www.infectagentscancer.com/content
[Accessed 21 May 2016]

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Review
Open Access
Price and affordability of direct-acting antiviral regimens for hepatitis C virus in the United States
Elana S. Rosenthal and Camilla S. Graham
Infectious Agents and Cancer201611:24
DOI: 10.1186/s13027-016-0071-z
Abstract
Hepatitis C virus is a serious infection causing cirrhosis, liver cancer, and death. The recent development of direct-acting antivirals has dramatically improved tolerability of treatment and rates of cure. However, the high price of these medications has often limited access to care and resulted in rationing of medications in the United States to those with advanced liver disease, access to specialist care, and without active substance use. This review assesses the way pharmaceutical prices are established and how pricing of directly acting antiviral regimens in the United States has impacted access to treatment for hepatitis C virus.

International Journal of Epidemiology
Volume 45 Issue 2 April 2016
http://ije.oxfordjournals.org/content/current

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Editorials
African partnerships through the H3Africa Consortium bring a genomic dimension to longitudinal population studies on the continent
Michèle Ramsay1,*, Osman Sankoh2,3,
as members of the AWI-Gen study and the H3Africa Consortium
Author Affiliations
1Sydney Brenner Institute for Molecular Bioscience and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,
2INDEPTH Network, Kanda, Accra, Ghana and
3Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
*Corresponding author. E-mail: michele.ramsay@wits.ac.za
[Extract]
A health and epidemiological transition is enveloping the African continent from the southern and northern regions where the prevalence of obesity has rapidly increased over the past three decades.1 In the wake of the transition to increased urbanization follow increased rates of hypertension, stroke and type 2 diabetes (T2D). Despite the widespread HIV, TB and malaria epidemics, age-standardized mortality for non-communicable diseases (the probability of dying from one of the four main NCDs—CVD, cancer, chronic respiratory disease and diabetes) between the ages of 30 and 70 years (comparable estimates for 2012) is over 25% in South Africa compared with less than 15% in North America and Europe.2

Good health-related epidemiological data from most African populations are sparse. When accessing global data on non-communicable diseases, it becomes clear that many African countries have no data; in some there is sporadic reporting on specific variables and then there are pockets of excellent data, albeit usually on smaller cohorts, or only in specific regions. For this reason, African health data are often modelled and predictions are based on models that are supported with little and sub-optimal information. This highlights an urgent need to support more systematic approaches to collecting epidemiological data in Africa…

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Health Policies and Interventions
Loss of confidence in vaccines following media reports of infant deaths after hepatitis B vaccination in China
Int. J. Epidemiol. (2016) 45 (2): 441-449 doi:10.1093/ije/dyv349
Wenzhou Yu, Dawei Liu, Jingshan Zheng, Yanmin Liu, Zhijie An, Lance Rodewald, Guomin Zhang, Qiru Su, Keli Li, Disha Xu, Fuzhen Wang, Ping Yuan, Wei Xia, Guijun Ning, Hui Zheng,
Yaozhu Chu, Jian Cui, Mengjuan Duan, Lixin Hao, Yuqing Zhou, Zhenhua Wu, Xuan Zhang,
Fuqiang Cui, Li Li, and Huaqing Wang
Abstract
Background: China reduced hepatitis B virus (HBV) infection by 90% among children under 5 years old with safe and effective hepatitis B vaccines (HepB). In December 2013, this success was threatened by widespread media reports of infant deaths following HepB administration. Seventeen deaths and one case of anaphylactic shock following HBV vaccination had been reported.
Methods: We conducted a telephone survey to measure parental confidence in HepB in eleven provinces at four points in time; reviewed maternal HBV status and use of HepB for newborns in birth hospitals in eight provinces before and after the event; and monitored coverage with hepatitis B vaccine and other programme vaccines in ten provinces.
Results: HepB from the implicated company was suspended during the investigation, which showed that the deaths were not caused by HepB vaccination. Before the event, 85% respondents regarded domestic vaccines as safe, decreasing to 26.7% during the event. During the height of the crisis, 30% of parents reported being hesitant to vaccinate and 18.4% reported they would refuse HepB. Use of HepB in the monitored provinces decreased by 18.6%, from 53 653 doses the week before the event to 43 688 doses during the week that Biokangtai HepB was suspended. Use of HepB within the first day of life decreased by 10% among infants born to HBsAg-negative mothers, and by 6% among infants born to HBsAg-positive mothers. Vaccine refusal and HepB birth dose rates returned to baseline within 2 months; confidence increased, but remained below baseline.
Conclusions: The HBV vaccine event resulted in the suspension of a safe vaccine, which was associated with a decline of parental confidence, and refusal of vaccination. Suspension of a vaccine can lead to loss of confidence that is difficult to recover. Timely and credible investigation, accompanied by proactive outreach to stakeholders and the media, may help mitigate negative impact of future coincidental adverse events following immunization.

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Effectiveness of a pay-for-performance intervention to improve maternal and child health services in Afghanistan: a cluster-randomized trial
Cyrus Y Engineer, Elina Dale, Anubhav Agarwal, Arunika Agarwal, Olakunle Alonge, Anbrasi Edward, Shivam Gupta, Holly B Schuh, Gilbert Burnham, and David H Peters
Int. J. Epidemiol. (2016) 45 (2): 451-459 doi:10.1093/ije/dyv362
Abstract
Background: A cluster randomized trial of a pay-for-performance (P4P) scheme was implemented in Afghanistan to test whether P4P could improve maternal and child (MCH) services.
Methods: All 442 primary care facilities in 11 provinces were matched by type of facility and outpatient volume, and randomly assigned to the P4P or comparison arm. P4P facilities were given bonus payments based on the MCH services provided. An endline household sample survey was conducted in 72 randomly selected matched pair catchment areas (3421 P4P households; 3427 comparison).The quality of services was assessed in 81 randomly sampled matched pairs of facilities. Data collectors and households were blinded to the intervention assignment. MCH outcomes were assessed at the cluster level.
Results: There were no substantial differences in any of the five MCH coverage indicators (P4P vs comparison): modern contraception(10.7% vs 11.2% (P = 0.90); antenatal care: 56.2% vs 55.6% (P = 0.94); skilled birth attendance (33.9% vs 28.5%, P = 0.17); postnatal care (31.2% vs 30.3%, P = 0.98); and childhood pentavalent3 vaccination (49.6 vs 52.3%, P = 0.41), or in the equity measures. There were substantial increases in the quality of history and physical examinations index (P = 0.01); client counselling index (P = 0.01); and time spent with patients (P = 0.05). Health workers reported limited understanding about the bonuses.
Conclusions: The intervention had minimal effect, possibly due to difficulties communicating with health workers and inattention to demand-side factors. P4P interventions need to consider management and community demand issues.

JAMA
May 17, 2016, Vol 315, No. 19
http://jama.jamanetwork.com/issue.aspx

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Viewpoint
The New Era of Informed Consent: Getting to a Reasonable-Patient Standard Through Shared Decision Making FREE
Erica S. Spatz, MD, MHS; Harlan M. Krumholz, MD, SM; Benjamin W. Moulton, JD, MPH

Journal of Community Health
Volume 41, Issue 3, June 2016
http://link.springer.com/journal/10900/41/3/page/1

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Original Paper
Development of a Cost-Effective Educational Tool to Promote Acceptance of the HPV Vaccination by Hispanic Mothers
Doerthe Brueggmann, Neisha Opper, Juan Felix, David A. Groneberg, Daniel R. MishellJr., Jenny M. Jaque
Abstract
Although vaccination against the Human Papilloma Virus (HPV) reduces the risk of related morbidities, the vaccine uptake remains low in adolescents. This has been attributed to limited parental knowledge and misconceptions. In this cross sectional study, we assessed the (1) clarity of educational material informing Hispanic mothers about HPV, cervical cancer and the HPV vaccine, (2) determined vaccination acceptability and (3) identified predictors of vaccine acceptance in an underserved health setting. 418 Hispanic mothers received the educational material and completed an anonymous survey. 91 % of participants understood most or all of the information provided. 77 % of participants reported vaccine acceptance for their children; this increased to 84 % when only those with children eligible to receive vaccination were included. Significant positive predictors of maternal acceptance of the HPV vaccine for their children were understanding most or all of the provided information, older age and acceptance of the HPV vaccine for themselves. Concerns about safety and general dislike of vaccines were negatively associated with HPV vaccine acceptance. Prior knowledge, level of education, previous relevant gynecologic history, general willingness to vaccinate and other general beliefs about vaccines were not significantly associated with HPV vaccine acceptance. The majority of participants reported understanding of the provided educational material. Vaccine acceptability was fairly high, but was even higher among those who understood the information. This study documents a cost-effective way to provide Hispanic mothers with easy-to-understand HPV-related information that could increase parental vaccine acceptability and future vaccine uptake among their children.

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Original Paper
Help-Seeking Behavior and Health Care Navigation by Bhutanese Refugees
Katherine Yun , Papia Paul, Parangkush Subedi, Leela Kuikel, Giang T. Nguyen, Frances K. Barg
Abstract
The objective of this study was to document barriers to care, help-seeking behaviors, and the impact of a community-based patient navigation intervention on patient activation levels among Bhutanese refugees in the U.S. Data sources comprised 35 intake and 34 post-intervention interviews with program participants, 14 intake and 14 post-intervention interviews with patient navigators, and 164 case notes. Textual data were analyzed using the constant comparison method. Patient activation level was assessed at both time points. Participants had limited English proficiency (97 %), limited literacy (69 %), and the lowest level of patient activation (69 %). Participants routinely experienced complex insurance access, coverage, and payment problems and had limited healthcare-related life skills. Help-seeking began within social networks, with high reliance on bilingual, literate family members perceived to have experience with “the system.” Help-seeking was not stigmatized and was instead consistent with societal norms valuing mutual assistance. Participants preferred helpers to act as proxies and required repeated social modeling by peers to gain confidence applying healthcare-related life skills. Following the intervention, only one-third reported the lowest level of patient activation (35 %) and one-third were highly activated (32 %). Bhutanese refugees overcome healthcare access barriers by seeking help from a network of support that begins within the community. Community health workers serving as patient navigators are readily sought out, and this approach is concordant with cultural expectations for mutual assistance. Community health workers serving immigrant groups should model healthcare-related life skills in addition to providing direct assistance.

Journal of Infectious Diseases
Volume 213 Issue 11 June 1, 2016
http://jid.oxfordjournals.org/content/current

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EDITORIAL COMMENTARY
Editor’s choice: Can Changes to Scheduling Enhance the Performance of Rotavirus Vaccines in Low-Income Countries?
J Infect Dis. (2016) 213 (11): 1673-1675 doi:10.1093/infdis/jiw026
Nigel A. Cunliffe and Gagandeep Kang

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VIRUSES
Editor’s choice: A Randomized, Controlled Trial of the Impact of Alternative Dosing Schedules on the Immune Response to Human Rotavirus Vaccine in Rural Ghanaian Infants
J Infect Dis. (2016) 213 (11): 1678-1685 doi:10.1093/infdis/jiw023
George Armah, Kristen D. C. Lewis, Margaret M. Cortese, Umesh D. Parashar, Akosua Ansah, Lauren Gazley, John C. Victor, Monica M. McNeal, Fred Binka, and A. Duncan Steele

Editor’s choice: Noninterference of Rotavirus Vaccine With Measles-Rubella Vaccine at 9 Months of Age and Improvements in Antirotavirus Immunity: A Randomized Trial
J Infect Dis. (2016) 213 (11): 1686-1693 doi:10.1093/infdis/jiw024
K. Zaman, Jessica A. Fleming, John C. Victor, Mohammad Yunus, Tajul Islam A. Bari, Tasnim Azim, Mustafizur Rahman, Syed Mohammad Niaz Mowla, William J. Bellini, Monica McNeal,
Joseph P. Icenogle, Ben Lopman, Umesh Parashar, Margaret M. Cortese, A. Duncan Steele,
and Kathleen M. Neuzil

Impact and Cost-effectiveness of 3 Doses of 9-Valent Human Papillomavirus (HPV) Vaccine Among US Females Previously Vaccinated With 4-Valent HPV Vaccine
J Infect Dis. (2016) 213 (11): 1694-1700 doi:10.1093/infdis/jiw046
Harrell W. Chesson, Jean-François Laprise, Marc Brisson, and Lauri E. Markowitz

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 5 Issue 2 June 2016
http://jpids.oxfordjournals.org/content/current

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ORIGINAL ARTICLES AND COMMENTARIES
Meningococcal Serogroup B Bivalent rLP2086 Vaccine Elicits Broad and Robust Serum Bactericidal Responses in Healthy Adolescents
J Ped Infect Dis (2016) 5 (2): 152-160 doi:10.1093/jpids/piv039
Timo Vesikari, Lars Østergaard, Javier Diez-Domingo, Jacek Wysocki, Carl-Erik Flodmark, Johannes Beeslaar, Joseph Eiden, Qin Jiang, Kathrin U. Jansen, Thomas R. Jones, Shannon L. Harris, Robert E. O’Neill, Laura J. York, Graham Crowther, and John L. Perez

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Immunogenicity, Safety, and Tolerability of Bivalent rLP2086 Meningococcal Group B Vaccine Administered Concomitantly With Diphtheria, Tetanus, and Acellular Pertussis and Inactivated Poliomyelitis Vaccines to Healthy Adolescents
J Ped Infect Dis (2016) 5 (2): 180-187 doi:10.1093/jpids/piv064
Timo Vesikari, Jacek Wysocki, Johannes Beeslaar, Joseph Eiden, Qin Jiang, Kathrin U. Jansen,
Thomas R. Jones, Shannon L. Harris, Robert E. O’Neill, Laura J. York, and John L. Perez

The Lancet
May 21, 2016 Volume 387 Number 10033 p2063-2162 e26-e27
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
No health workforce, no global health security
The Lancet
Summary
Since the recent epidemics of Ebola, MERS, and Zika viruses, the ever-present threat of pandemic influenza, and now the menace of a yellow fever crisis, the notion of global health security has risen to the top of concerns facing the 194 member states attending next week’s 69th World Health Assembly (WHA) in Geneva, Switzerland. Without global health security, the common goal of a more sustainable and resilient society for human health and wellbeing will be unattainable.

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Articles
Association between Zika virus and microcephaly in French Polynesia, 2013–15: a retrospective study
Simon Cauchemez, Marianne Besnard, Priscillia Bompard, Timothée Dub, Prisca Guillemette-Artur, Dominique Eyrolle-Guignot, Henrik Salje, Maria D Van Kerkhove, Véronique Abadie, Catherine Garel, Arnaud Fontanet, Henri-Pierre Mallet
Summary
Background
The emergence of Zika virus in the Americas has coincided with increased reports of babies born with microcephaly. On Feb 1, 2016, WHO declared the suspected link between Zika virus and microcephaly to be a Public Health Emergency of International Concern. This association, however, has not been precisely quantified.
Methods
We retrospectively analysed data from a Zika virus outbreak in French Polynesia, which was the largest documented outbreak before that in the Americas. We used serological and surveillance data to estimate the probability of infection with Zika virus for each week of the epidemic and searched medical records to identify all cases of microcephaly from September, 2013, to July, 2015. Simple models were used to assess periods of risk in pregnancy when Zika virus might increase the risk of microcephaly and estimate the associated risk.
Findings
The Zika virus outbreak began in October, 2013, and ended in April, 2014, and 66% (95% CI 62–70) of the general population were infected. Of the eight microcephaly cases identified during the 23-month study period, seven (88%) occurred in the 4-month period March 1 to July 10, 2014. The timing of these cases was best explained by a period of risk in the first trimester of pregnancy. In this model, the baseline prevalence of microcephaly was two cases (95% CI 0–8) per 10,000 neonates, and the risk of microcephaly associated with Zika virus infection was 95 cases (34–191) per 10,000 women infected in the first trimester. We could not rule out an increased risk of microcephaly from infection in other trimesters, but models that excluded the first trimester were not supported by the data.
Interpretation
Our findings provide a quantitative estimate of the risk of microcephaly in fetuses and neonates whose mothers are infected with Zika virus.
Funding
Labex-IBEID, NIH-MIDAS, AXA Research fund, EU-PREDEMICS.

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Review
Costs, affordability, and feasibility of an essential package of cancer control interventions in low-income and middle-income countries: key messages from Disease Control Priorities, 3rd edition
Hellen Gelband, Rengaswamy Sankaranarayanan, Cindy L Gauvreau, Susan Horton, Benjamin O Anderson, Freddie Bray, James Cleary, Anna J Dare, Lynette Denny, Mary K Gospodarowicz, Sumit Gupta, Scott C Howard, David A Jaffray, Felicia Knaul, Carol Levin, Linda Rabeneck, Preetha Rajaraman, Terrence Sullivan, Edward L Trimble, Prabhat Jha, Disease Control Priorities-3 Cancer Author Group
Summary
Investments in cancer control—prevention, detection, diagnosis, surgery, other treatment, and palliative care—are increasingly needed in low-income and particularly in middle-income countries, where most of the world’s cancer deaths occur without treatment or palliation. To help countries expand locally appropriate services, Cancer (the third volume of nine in Disease Control Priorities, 3rd edition) developed an essential package of potentially cost-effective measures for countries to consider and adapt. Interventions included in the package are: prevention of tobacco-related cancer and virus-related liver and cervical cancers; diagnosis and treatment of early breast cancer, cervical cancer, and selected childhood cancers; and widespread availability of palliative care, including opioids. These interventions would cost an additional US$20 billion per year worldwide, constituting 3% of total public spending on health in low-income and middle-income countries. With implementation of an appropriately tailored package, most countries could substantially reduce suffering and premature death from cancer before 2030, with even greater improvements in later decades.

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Health Policy
The World report on ageing and health: a policy framework for healthy ageing
John R Beard, Alana Officer, Islene Araujo de Carvalho, Ritu Sadana, Anne Margriet Pot, Jean-Pierre Michel, Peter Lloyd-Sherlock, JoAnne E Epping-Jordan, G M E E (Geeske) Peeters, Wahyu Retno Mahanani, Jotheeswaran Amuthavalli Thiyagarajan, Somnath Chatterji
Summary
Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report.

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Health Policy
Protecting human security: proposals for the G7 Ise-Shima Summit in Japan
Japan Global Health Working Group
2155
Summary
In today’s highly globalised world, protecting human security is a core challenge for political leaders who are simultaneously dealing with terrorism, refugee and migration crises, disease epidemics, and climate change. Promoting universal health coverage (UHC) will help prevent another disease outbreak similar to the recent Ebola outbreak in west Africa, and create robust health systems, capable of withstanding future shocks. Robust health systems, in turn, are the prerequisites for achieving UHC. We propose three areas for global health action by the G7 countries at their meeting in Japan in May, 2016, to protect human security around the world: restructuring of the global health architecture so that it enables preparedness and responses to health emergencies; development of platforms to share best practices and harness shared learning about the resilience and sustainability of health systems; and strengthening of coordination and financing for research and development and system innovations for global health security. Rather than creating new funding or organisations, global leaders should reorganise current financing structures and institutions so that they work more effectively and efficiently. By making smart investments, countries will improve their capacity to monitor, track, review, and assess health system performance and accountability, and thereby be better prepared for future global health shocks.

Medical Decision Making (MDM)
May 2016; 36 (4)
http://mdm.sagepub.com/content/current

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Reviews
The Impact of Patient Participation in Health Decisions Within Medical Encounters: A Systematic Review
Med Decis Making May 2016 36: 427-452, first published on November 19, 2015 doi:10.1177/0272989X15613530
Marla L. Clayman, Carma L. Bylund, Betty Chewning, and Gregory Makoul
Abstract
Background: Although there are compelling moral arguments for patient participation in medical decisions, the link to health outcomes has not been systematically explored. Objective: Assess the extent to which patient participation in decision making within medical encounters is associated with measured patient outcomes. Methods: We conducted a primary search in PubMed—excluding non-English and animal studies—for articles on decision making in the context of the physician–patient relationship published through the end of February 2015, using the MeSH headings (Physician-Patient Relations [MeSH] OR Patient Participation [MeSH]) and the terms (decision OR decisions OR option OR options OR choice OR choices OR alternative OR alternatives) in the title or abstract. We also conducted a secondary search of references in all articles that met the inclusion criteria. Results: A thorough search process yielded 116 articles for final analysis. There was wide variation in study design, as well as measurement of patient participation and outcomes, among the studies. Eleven of the 116 studies were randomized controlled trials (RCTs). Interventions increased patient involvement in 10 (91%) of the 11 RCTs. At least one positive outcome was detected in 5 (50%) of the 10 RCTs reporting increased participation; the ratio of positive results among all outcome variables measured in these studies was much smaller. Although proportions differed, similar patterns were found across the 105 nonrandomized studies. Conclusions: Very few RCTs in the field have measures of participation in decision making and at least one health outcome. Moreover, extant studies exhibit little consistency in measurement of these variables, and results are mixed. There is a great need for well-designed, reproducible research on clinically relevant outcomes of patient participation in medical decisions.

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Unknown Risks: Parental Hesitation about Vaccination
Med Decis Making May 2016 36: 479-489, first published on October 27, 2015 doi:10.1177/0272989X15607855
Laura L. Blaisdell, Caitlin Gutheil, Norbert A. M. Hootsmans, and Paul K. J. Han
Abstract
Objective. This qualitative study of a select sample of vaccine-hesitant parents (VHPs) explores perceived and constructed personal judgments about the risks and uncertainties associated with vaccines and vaccine-preventable diseases (VPDs) and how these subjective risk judgments influence parents’ decisions about childhood vaccination. Methods. The study employed semistructured focus group interviews with 42 VHPs to elicit parents’ perceptions and thought processes regarding the risks associated with vaccination and nonvaccination, the sources of these perceptions, and their approach to decision making about vaccination for their children. Results. VHPs engage in various reasoning processes and tend to perceive risks of vaccination as greater than the risks of VPDs. At the same time, VHPs engage in other reasoning processes that lead them to perceive ambiguity in information about the harms of vaccination—citing concerns about the missing, conflicting, changing, or otherwise unreliable nature of information. Conclusions. VHPs’ refusal of vaccination may reflect their aversion to both the risk and ambiguity they perceive to be associated with vaccination. Mitigating this vaccine hesitancy likely requires reconstructing the risks and ambiguities associated with vaccination—a challenging task that requires providing parents with meaningful evidence-based information on the known risks of vaccination versus VPDs and explicitly acknowledging the risks that remain truly unknown.

New England Journal of Medicine
May 19, 2016 Vol. 374 No. 20
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
Essential Medicines in the United States — Why Access Is Diminishing
Jonathan D. Alpern, M.D., John Song, M.D., M.P.H., and William M. Stauffer, M.D., M.S.P.H.
N Engl J Med 2016; 374:1904-1907 May 19, 2016 DOI: 10.1056/NEJMp1601559
Prices have been dramatically increasing for many older, off-patent drugs, some of which are considered “essential” by the World Health Organization. Some price hikes have made potentially life-saving therapies unavailable to disadvantaged patients in the United States

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Special Report
Zika Virus and Birth Defects — Reviewing the Evidence for Causality
S.A. Rasmussen, D.J. Jamieson, M.A. Honein, and L.R. Petersen
Free Full Text
Summary
The Zika virus has spread rapidly in the Americas since its first identification in Brazil in early 2015. Prenatal Zika virus infection has been linked to adverse pregnancy and birth outcomes, most notably microcephaly and other serious brain anomalies. To determine whether Zika virus infection during pregnancy causes these adverse outcomes, we evaluated available data using criteria that have been proposed for the assessment of potential teratogens. On the basis of this review, we conclude that a causal relationship exists between prenatal Zika virus infection and microcephaly and other serious brain anomalies. Evidence that was used to support this causal relationship included Zika virus infection at times during prenatal development that were consistent with the defects observed; a specific, rare phenotype involving microcephaly and associated brain anomalies in fetuses or infants with presumed or confirmed congenital Zika virus infection; and data that strongly support biologic plausibility, including the identification of Zika virus in the brain tissue of affected fetuses and infants. Given the recognition of this causal relationship, we need to intensify our efforts toward the prevention of adverse outcomes caused by congenital Zika virus infection. However, many questions that are critical to our prevention efforts remain, including the spectrum of defects caused by prenatal Zika virus infection, the degree of relative and absolute risks of adverse outcomes among fetuses whose mothers were infected at different times during pregnancy, and factors that might affect a woman’s risk of adverse pregnancy or birth outcomes. Addressing these questions will improve our ability to reduce the burden of the effects of Zika virus infection during pregnancy.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 21 May 2016)

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Research Article
Beyond Contact Tracing: Community-Based Early Detection for Ebola Response
May 19, 2016 ·
Introduction: The 2014 Ebola outbreak in West Africa raised many questions about the control of infectious disease in an increasingly connected global society. Limited availability of contact information made contact tracing diffcult or impractical in combating the outbreak.
Methods: We consider the development of multi-scale public health strategies that act on individual and community levels. We simulate policies for community-level response aimed at early screening all members of a community, as well as travel restrictions to prevent inter-community transmission.
Results: Our analysis shows the policies to be effective even at a relatively low level of compliance and for a variety of local and long range contact transmission networks. In our simulations, 40% of individuals conforming to these policies is enough to stop the outbreak. Simulations with a 50% compliance rate are consistent with the case counts in Liberia during the period of rapid decline after mid September, 2014. We also find the travel restriction to be effective at reducing the risks associated with compliance substantially below the 40% level, shortening the outbreak and enabling efforts to be focused on affected areas.
Discussion: Our results suggest that the multi-scale approach can be used to further evolve public health strategy for defeating emerging epidemics.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 21 May 2016)

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Policy Forum
Toward a Common Secure Future: Four Global Commissions in the Wake of Ebola
Lawrence O. Gostin, Oyewale Tomori, Suwit Wibulpolprasert, Ashish K. Jha, Julio Frenk, Suerie Moon, Joy Phumaphi, Peter Piot, Barbara Stocking, Victor J. Dzau, Gabriel M. Leung
| published 19 May 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002042
Summary Points
:: Four global commissions reviewing the recent Ebola virus disease epidemic response consistently recommended strengthening national health systems, consolidating and strengthening World Health Organization (WHO) emergency and outbreak response activities, and enhancing research and development.
:: System-wide accountability is vital to effectively prevent, detect, and respond to future global health emergencies.
:: Global leaders (e.g., United Nations, World Health Assembly, G7, and G20) should maintain continuous oversight of global health preparedness, and ensure effective implementation of the Ebola commissions’ key recommendations, including sustainable and scalable financing.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 21 May 2016)

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Research Article
A Cost-Effectiveness Tool for Informing Policies on Zika Virus Control
Jorge A. Alfaro-Murillo, Alyssa S. Parpia, Meagan C. Fitzpatrick, Jules A. Tamagnan, Jan Medlock, Martial L. Ndeffo-Mbah, Durland Fish, María L. Ávila-Agüero, Rodrigo Marín, Albert I. Ko, Alison P. Galvani
| published 20 May 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004743

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Research Article
Extent of Integration of Priority Interventions into General Health Systems: A Case Study of Neglected Tropical Diseases Programme in the Western Region of Ghana
Ernest O. Mensah, Moses K. Aikins, Margaret Gyapong, Francis Anto, Moses J. Bockarie, John O. Gyapong
| published 20 May 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004725

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Research Article
Cholera Incidence and Mortality in Sub-Saharan African Sites during Multi-country Surveillance
Delphine Sauvageot, Berthe-Marie Njanpop-Lafourcade, Laurent Akilimali, Jean-Claude Anne, Pawou Bidjada, Didier Bompangue, Godfrey Bwire, Daouda Coulibaly, Liliana Dengo-Baloi, Mireille Dosso, Christopher Garimoi Orach, Dorteia Inguane, Atek Kagirita, Adele Kacou-N’Douba, Sakoba Keita, Abiba Kere Banla, Yao Jean-Pierre Kouame, Dadja Essoya Landoh, Jose Paulo Langa, Issa Makumbi, Berthe Miwanda, Muggaga Malimbo, Guy Mutombo, Annie Mutombo, Emilienne Niamke NGuetta, Mamadou Saliou, Veronique Sarr, Raphael Kakongo Senga, Fode Sory, Cynthia Sema, Ouyi Valentin Tante, Bradford D. Gessner, Martin A. Mengel
| published 17 May 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004679

PLoS One
http://www.plosone.org/
[Accessed 21 May 2016]

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Research Article
Behavioral Perceptions of Oakland University Female College Students towards Human Papillomavirus Vaccination
Aishwarya Navalpakam, Mohammed Dany, Inaya Hajj Hussein
Research Article | published 20 May 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0155955
Abstract
Human Papillomavirus (HPV) vaccination decreases the risk for cervical cancer. However, the uptake of HPV vaccine remains low when compared with other recommended vaccines. This study evaluates the knowledge and attitudes towards HPV infection and vaccination, and the readiness for the uptake of HPV vaccine amongst female students attending Oakland University (OU) in Michigan, United States. This is a cross-sectional study targeting a randomized sample of a 1000 female OU students using an online questionnaire. The data were statistically analyzed using SPSS software. A total of 192 female students, with the mean age of 24 years completed the survey. The majority of participants had previous sexual experience with occasional use of contraceptives (78.1%), were non-smokers (92.7%), and non-alcohol drinkers (54.2%). The participants had a mean knowledge score of 53.0% with a standard error of 2.3% translating to a moderately informed population. The majority agreed that HPV is life threatening (79%), the vaccine prevents cervical cancer (62%), and that side effects would not deter them from vaccination (63%). Although two thirds (67%) believed that, based on sexual practices in the United States, female college students in Michigan have a higher chance of contracting HPV, about 50% did not believe they themselves were at risk. Higher knowledge correlated with increased recommendation for the vaccine (correlation-factor 0.20, p = 0.005). Results suggested that the best predictor for improvement of vaccination was the awareness level and health education. This indicates a need for an educational intervention to raise awareness, increase HPV vaccine uptake, and decrease the incidence of cervical cancer.

PLoS Pathogens
http://journals.plos.org/plospathogens/
(Accessed 21 May 2016)

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Pearls
Immunizing against Anogenital Cancer: HPV Vaccines
Cloe S. Pogoda, Richard B. S. Roden, Robert L. Garcea
| published 19 May 2016 | PLOS Pathogens
http://dx.doi.org/10.1371/journal.ppat.1005587
… Future Outlook
Vaccines have remarkable potential to prevent cancers that are related to infectious agents (e.g., HPV and Hepatitis B). While the latest HPV vaccine offers protection against up to 90% of cervical cancer, next generation vaccines will potentially offer broader protection and be more practical for universal implementation. Hopefully, they will address the issues of cost by using alternative production systems, fewer but more cross-protective antigens (L1 or L2), and suitability for manufacture in the regions where the vaccines will be delivered. By utilizing techniques such as lyophilization, these new vaccines may be shipped and stored without refrigeration. New delivery methods, such as nanoparticle platforms, have the potential to eliminate the need for multiple doses through timed-release technology [20]. More stable formulations also create the potential for aerosol or patch deliverable vaccines to eliminate the need for needles. Second generation vaccines may even have therapeutic properties that treat existing HPV infections. These factors may alter the current guidelines regarding when and to which populations vaccines should be administered. As current vaccines are administered, it will be important to monitor if an increase of non-targeted hrHPV genotypes occur. This potential viral replacement may dictate that second generation vaccines must immunize against different strains or be more broadly effective. As the current and second generation vaccines continue to evolve and are used by a greater fraction of the global population, we look forward to seeing the decreasing rates of anogenital (and likely oropharyngeal) cancers and deaths due to HPV infection.

Preventive Medicine
Volume 86, Pages 1-166 (May 2016)
http://www.sciencedirect.com/science/journal/00917435/86

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Original Research Article
Trends and predictors of HPV vaccination among U.S. College women and men
Pages 92-98
Erika L. Thompson, Cheryl A. Vamos, Coralia Vázquez-Otero, Rachel Logan, Stacey Griner, Ellen M. Daley
Abstract
Background
HPV vaccination was recommended by the Advisory Committee on Immunization Practices for young adult females in 2006 and males in 2011 to prevent HPV-related cancers and genital warts. As this prevention mechanism continues to disseminate, it is necessary to monitor the uptake of this vaccine. College students represent an important population for HPV vaccination efforts and surveillance due to increased risk for HPV infection and representing a priority population for catch-up HPV vaccination. The purpose of this study was to assess the trends in HPV vaccination among U.S. college females and males from 2009 to 2013, and to examine whether predictors for HPV vaccination differ between males and females.
Methods
The National College Health Assessment-II (Fall 2009–2013) was used to assess trends in HPV vaccination using hierarchical logistic regression across genders and demographics. Data from 2013 were used to assess demographic variables associated with HPV vaccination for males and females, respectively. The analysis was conducted in 2015.
Results
Females had nearly double the rates of HPV vaccination compared to males over time. All demographic sub-groups had significant increases in vaccine rates over time, with select male sub-groups having more accelerated increases (e.g., gay). Young age (18–21 vs. 22–26 years) was a significant predictor for HPV vaccination among males and females, while race/ethnicity was a predictor of vaccination among females only.
Conclusions
These findings identified specific demographic sub-groups that need continued support for HPV vaccination. Campus health centers may be rational settings to facilitate clinical opportunities for HPV vaccination among unvaccinated college students.

Public Health Reports
Volume 131 , Issue Number 3 May/June 2016
http://www.publichealthreports.org/issuecontents.cfm?Volume=131&Issue=3

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Brief Report
Understanding Non-Completion of the Human Papillomavirus Vaccine Series: Parent-Reported Reasons for Why Adolescents Might Not Receive Additional Doses, United States, 2012
Sarah J. Clark, MPH / Anne E. Cowan, MPH / Stephanie L. Fillipp, MPH / Allison M. Fisher, MPH / Shannon Stokley, MPH

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Case Studies and Practice
Assessing Clinical Research Capacity in Vietnam: A Framework for Strengthening Capability for Clinical Trials in Developing Countries
Jonathan Kagan, PhD / Dao Duc Giang, MPH / Michael F. Iademarco, MD, MPH / Van TT Phung, MS / Chuen-Yen Lau, MD, MPH / Nguyen Ngo Quang, PhD

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Research
Human Papillomavirus Vaccination in Washington State: Estimated Coverage and Missed Opportunities, 2006–2013
Hanna N. Oltean, MPH / Kathryn H. Lofy, MD / Marcia Goldoft / Charla A. DeBolt, RN, MPH

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Law and the Public’s Health: Quarantine and Liability in the Context of Ebola
Polly J. Price, JD

Science
20 May 2016 Vol 352, Issue 6288
http://www.sciencemag.org/current.dtl

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Introduction to special issue
Cities are the Future
By Nicholas S. Wigginton, Julia Fahrenkamp-Uppenbrink, Brad Wible, David Malakoff
Science20 May 2016 : 904-905
Rapid urbanization is overtaxing the planet, but it may not have to

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Editorial
Leave no city behind
By Michele Acuto, Susan Parnell
Science20 May 2016 : 873
Summary
Close to 4 billion people live in cities. As the driver of environmental challenges, accounting for nearly 70% of the world’s carbon emissions, and as sites of critical social disparities, with 863 million dwellers now living in slums, urban settlements are at the heart of global change. This momentum is unlikely to disappear, as approximately 70 million more people will move to cities by the end of this year alone. The good news is that recent multilateral processes are now appreciating this key role of cities and are increasingly prioritizing urban concerns in policy-making. Yet, how can we ensure that these steps toward a global urban governance leave no city, town, or urban dweller behind?

Science Translational Medicine
11 May 2016 Vol 8, Issue 338
http://stm.sciencemag.org/

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Editorial
The need for global regulatory harmonization: A public health imperative
By Elias Zerhouni, Margaret Hamburg
Science Translational Medicine11 May 2016 : 338ed6
Because public health and innovation are no longer national issues, regulatory authorities must apply a global view to oversight.

Vaccine
Volume 34, Issue 25, Pages 2759-2862 (27 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/25
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Commentary
Introducing dengue vaccine: Implications for diagnosis in dengue vaccinated subjects
Pages 2759-2761
Kalichamy Alagarasu
Abstract
Diagnosis of dengue virus infections is complicated by preference for different diagnostic tests in different post onset days of illness and the presence of multiple serotypes leading to secondary and tertiary infections. The sensitivity of the most commonly employed diagnostic assays such as anti dengue IgM capture (MAC) ELISA and non structural protein (NS) 1 capture ELISA are lower in secondary and subsequent infections. Introduction of dengue vaccine in endemic regions will affect the way how dengue is diagnosed in vaccinated subjects. This viewpoint article discusses implications of introduction of dengue vaccine on the diagnosis of dengue infections in vaccinated subjects and the strategies that are needed to tackle the issue.

Vaccine
Volume 34, Issue 25, Pages 2759-2862 (27 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/25
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Review
Impact of the introduction of the pneumococcal conjugate vaccine in the Brazilian routine childhood national immunization program
Review Article
Pages 2766-2778
Marta Moreira, Otavio Cintra, Julie Harriague, William P. Hausdorff, Bernard Hoet
Abstract
Brazil introduced the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV, Synflorix™, GSK Vaccines) in the routine childhood immunization program in 2010 with a 3 + 1 schedule (with catch-up for children <2 years-old). This review represents the first analysis of the overall impact of a second-generation pneumococcal conjugate vaccine on nasopharyngeal carriage and all the major pneumococcal disease manifestations in a single, pneumococcal conjugate vaccine-naïve, developing country. A total of 15 published articles and 13 congress abstracts were included in the analysis. In children <5 years-old, studies showed a positive impact of PHiD-CV on the incidence of vaccine-type and any-type invasive pneumococcal disease (including decreases in pneumococcal meningitis morbidity and mortality), on pneumonia incidence and mortality, and on otitis media. Nasopharyngeal carriage of vaccine-type and any-type pneumococci decreased after the primary doses, with no early signs of replacement with other pathogens. Finally, herd protection against vaccine-type invasive pneumococcal disease and pneumonia in unvaccinated subjects was shown in some studies for some age groups. In conclusion, pneumococcal disease decreased after the introduction of PHiD-CV into the Brazilian national immunization program. Further follow-up is needed to evaluate the long-term overall impact of PHiD-CV in the Brazilian population.

Vaccine
Volume 34, Issue 25, Pages 2759-2862 (27 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/25
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Post-licensure safety surveillance of 23-valent pneumococcal polysaccharide vaccine in the Vaccine Adverse Event Reporting System (VAERS), 1990–2013
Original Research Article
Pages 2841-2846
Elaine R. Miller, Pedro L. Moro, Maria Cano, Paige Lewis, Marthe Bryant-Genevier, Tom T. Shimabukuro
Abstract
Background
23-Valent pneumococcal polysaccharide vaccine, trade name Pneumovax®23 (PPSV23), has been used for decades in the Unites States and has an extensive clinical record. However, limited post-licensure safety assessment has been conducted.
Objective
To analyze reports submitted to the Vaccine Adverse Event Reporting System (VAERS) following PPSV23 from 1990 to 2013 in order to characterize its safety profile.
Methods
We searched the VAERS database for US reports following PPSV23 for persons vaccinated from 1990 to 2013. We assessed safety through: automated analysis of VAERS data, crude adverse event (AE) reporting rates based on PPSV23 doses distributed in the US market, clinical review of death reports and reports involving vaccine administered to pregnant women, and empirical Bayesian data mining to assess for disproportional reporting.
Results
During the study period, VAERS received 25,168 PPSV23 reports; 92% were non-serious, 67% were in females and 86% were in adults aged ≥19 years. When PPSV23 was administered alone, fever (43%), injection site erythema (28%) and injection site pain (25%) were the most commonly reported non-serious AEs in children. Injection site erythema (32%), injection site pain (27%) and injection site swelling (23%) were the most commonly reported non-serious AEs in adults. Of serious reports (2129, 8% of total), fever was most commonly reported in both children (69%) and adults (39%). There were 66 reports of death, four in children and 62 in adults. Clinical review of death reports did not reveal any concerning patterns that would suggest a causal association with PPSV23. No disproportional reporting of unexpected AEs was observed in empirical Bayesian data mining.
Conclusions
We did not identify any new or unexpected safety concerns for PPSV23. The VAERS data are consistent with safety data from pre-licensure clinical trials and other post-licensure studies.

Vaccine
Volume 34, Issue 25, Pages 2759-2862 (27 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/25
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Progress towards hepatitis B prevention through vaccination in the Western Pacific, 1990–2014
Original Research Article
Pages 2855-2862
Eric Wiesen, Sergey Diorditsa, Xi Li
Abstract
Hepatitis B infections are responsible for more than 300 thousand deaths per year in the Western Pacific Region. Because of this high burden, the countries and areas of the Region established a goal of reducing hepatitis B chronic infection prevalence among children to less than 1% by 2017. This study was conducted to measure the progress in hepatitis B prevention and assess the status of achievement of the 2017 Regional hepatitis B control goal. A literature review was conducted to identify studies of hepatitis B prevalence in the countries and areas of the region, both before and after vaccine introduction. A mathematical model was applied to assess infections and deaths prevented by hepatitis B vaccination and hepatitis B prevalence in countries without recent empirical data. The majority of countries and areas (22 out of 36) were estimated to have over 8% prevalence of chronic hepatitis B infection among persons born before vaccine introduction. After introduction of hepatitis B vaccine, most countries and areas (24 out of 36) had chronic infection prevalence of less than 1% among children born after vaccine introduction. It was estimated that in the past 25 years immunization programmes in the Western Pacific Region have averted 7,167,128 deaths that would have occurred in the lifetime of children born between 1990 and 2014 if hepatitis B vaccination programmes had not been established. Regional prevalence among children born in 2012 was estimated to be 0.93%, meaning that the Regional hepatitis B control goal was achieved. While additional efforts are needed to further reduce hepatitis B transmission in the region, this study demonstrates the great success of the hepatitis B vaccination efforts in the Western Pacific Region

See content below…

Papillomavirus Research
Available online 17 May 2016
Monitoring the impact of HPV vaccine in males—considerations and challenges
JML Brotherton, AR Giuliano, LE Markowitz, EF Dunne… –
Abstract
In this article, we examine the issues involved if national or sub-national programs are considering extending post HPV vaccine introduction monitoring to include males. Vaccination programs are now being extended to include males in some countries, in order to improve population level HPV infection control and to directly prevent HPV-related disease in males such as anogenital warts and anal cancers. Coverage and adverse events surveillance are essential components of post-vaccination monitoring. Monitoring the impact of vaccination on HPV infection and disease in men raises some similar challenges to monitoring in females, such as the long time frame until cancer outcomes, and also different ones given that genital specimens suitable for monitoring HPV prevalence are not routinely collected for other diagnostic or screening purposes in males. Thus, dedicated surveillance strategies must be designed; the framework of these may be country-specific, dependent upon the male population that is offered vaccination, the health care infrastructure and existing models of disease surveillance such as STI networks. The primary objective of any male HPV surveillance program will be to document changes in the prevalence of HPV infection and disease due to vaccine targeted HPV types occurring post vaccination. The full spectrum of outcomes to be considered for inclusion in any surveillance plan includes HPV prevalence monitoring, anogenital warts, potentially pre-cancerous lesions such as anal squamous intraepithelial lesions (SIL), and cancers. Ideally, a combination of short term and long term outcome measures would be included. Surveillance over time in specific targeted populations of men who have sex with men and HIV-infected men (populations at high risk for HPV infection and associated disease) could be an efficient use of resources to demonstrate impact.

Obstetrics & Gynecology
May 2016
doi: 10.1097/01.AOG.0000483332.97659.57
Do Educational Seminars for the HPV Vaccine Improve Attitudes Toward and Likelihood of Vaccination?[12B].
Foster, Leah N. MD; Roussos-Ross, Kay MD; DeCesare, Julie Z. MD; McAlpin, Lindsey M. MD
Abstract
INTRODUCTION: In the United States, there are approximately 12,360 cases of invasive cervical cancer diagnosed annually resulting in 4,020 deaths each year. Human papillomavirus is the known cause for the majority of all cervical cancers. The FDA and CDC have approved vaccination for the prevention of HPV. Since the approval of HPV vaccines only 33 percent of eligible females and 10 percent of eligible males have been vaccinated. The goal of this study is to investigate the barriers to HPV vaccination for eligible recipients and to determine whether an educational intervention regarding HPV vaccination results in improved attitudes and likelihood of vaccination. The study is being performed in conjunction with the ACOG District XII Health Care for Underserved Women Committee.
METHODS: We conducted a community outreach educational seminar to evaluate participants’ baseline knowledge regarding HPV, the HPV vaccine, and opinions about vaccination. Each participant was asked to complete a survey on HPV upon arrival. We then executed a brief educational seminar about HPV. Following completion of the educational session, the study participants again completed the survey.
RESULTS: Data analyzed with Fisher Exact Test noted a statistically significant improvement in knowledge of HPV related facts and willingness to accept the HPV vaccine following the educational seminar, P<.01.
CONCLUSION: Educational seminars show a clear benefit increasing education and awareness regarding the purpose and benefits of the HPV vaccine. Providing addition educational opportunities of eligible recipients and their guardians may provide higher vaccination rates, and thereby lower cervical cancer rates in the future.

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HPV Vaccination Does Not Provide Herd Immunity for Unvaccinated Women or Cross-Protection for Nonvaccine HPV Types [12].
Tarney, Christopher MD; Pagan, Megan MD; Klaric, John PhD; Beltran, Thomas; Han, Jasmine MD
Abstract
INTRODUCTION: To determine if the human papillomavirus (HPV) vaccination offers cross-protection against nonvaccine HPV types and whether introduction of the vaccination has offered herd immunity to unvaccinated women.
METHODS: We collected and analyzed HPV prevalence data for females aged 18-29 from the prevaccine era (2007-2008) and postvaccine era (2009-2012) using the National Health and Nutrition Examination Surveys (NHANES); 1628 female respondents aged 18-29, representing 21,135,134 females in the United States non-institutionalized civilian population, provided vaginal swabs across three consecutive NHANES survey cycles.
RESULTS: Among females aged 18-29, the prevalence of high risk HPV among women who received at least one dose of the HPV vaccine decreased from 67% (95% confidence interval [CI] 50.7-81.4) in 2007-2008 to 41.5% (95% CI, 30.5-53.1) in 2011-2012; among the women vaccinated for HPV in the postvaccine era, the prevalence of HPV-16 and -18 was 6.4% versus 93.6% for all other high risk HPV types. There was no difference in prevalence in high risk HPV for women who did not receive the vaccine; 49.5% (95% CI, 42.5-56.6) in 2007-2008 versus 50.8% (95% CI, 43.0-58.7) in 2011-2012.
CONCLUSION/IMPLICATIONS: The prevalence of high risk HPV significantly decreased among females aged 18-29 years who received the HPV vaccine, but there appeared to be no cross-protection against nonvaccine HPV types. These findings may offer support for usage of the investigational 9-valent HPV vaccine. There also was no evidence to suggest protection against HPV infection for unvaccinated women.

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 21 May 2016
The Plan to Avert Our Post-Antibiotic Apocalypse
19 May 2016
A new report estimates that by 2050, drug-resistant infections will kill one person every three seconds, unless the world’s governments take drastic steps now….Meanwhile, a “diagnostic market stimulus” would provide top-up payments to poorer countries that buy diagnostic tests, in the same way that organizations like Gavi fund vaccine use in the developing world.

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Forbes
http://www.forbes.com/
Accessed 21 May 2016
In Pursuit Of An HIV Vaccine And The AIDS-Free Generation
In the US, many people speak of “the AIDS crisis” as though it were something that happened and is now over. We do have effective treatments, and increasingly effective means of prevention. They include new, once-a-day pills that are very effective at preventing HIV infection as long as they are […]
Science Business, Contributor May 17, 2016

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New York Times
http://www.nytimes.com/
Accessed 21 May 2016
Stealing From Ebola to Fight Zika
19 May 2016
Nobody should be surprised when the present House of Representatives, dominated by penurious reactionaries, produces a stingy response to a danger that calls for compassionate largess. But for sheer fecklessness it’s hard to top the House’s response this week to the Zika virus. The salient feature is that in providing money to fight one health menace, it steals from other funds meant to fight an even more dangerous threat — the Ebola virus.

China Arrests 135 for Illegally Buying, Selling Vaccines
BEIJING — China has arrested 135 people in 22 provinces for illegally buying and selling vaccines, in the latest scandal shaking the Chinese public’s confidence in vaccine safety.
In an online statement Friday, the national prosecuting office said arrest warrants were issued for 125 people for running vaccine businesses without license.
It said 15 of them have been formally indicted, and two were found guilty. Ten health officials were arrested for on-duty negligence.
The accused health officials had worked at local public health centers and knowingly bought the illegal vaccines and used them on people, the prosecuting office said…
May 21, 2016 – By THE ASSOCIATED PRESS

C.D.C. Is Monitoring 279 Pregnant Women With Possible Zika Virus Infections
Doctors are monitoring 279 pregnant women with confirmed or suspected Zika virus infections in the United States and its territories, federal health officials said Friday.
Of those women, 157 are in the 50 states and the District of Columbia, and 122 are in territories, including Puerto Rico. Public health officials are gathering data on the health consequences of the infection, including the rate at which fetuses develop abnormally shrunken heads and brain damage, a birth defect called microcephaly.
May 21, 2016 – By DONALD G. McNEIL Jr –

The Opinion Pages | Op-Ed Contributor
Eliminate the TB Scourge
19 May 2016
By UVISTRA NAIDOOMAY 19, 2016

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Washington Post
http://www.washingtonpost.com/
Accessed 21 May 2016
Trying to get jump on Zika preparations with money in limbo
Beg, borrow and steal: Zika preparation involves a bit of all three as federal, state and local health officials try to get a jump on the mosquito-borne virus while Congress haggles over how much money they really need.
Lauran Neergaard | AP | Washington | May 21, 2016

Vaccines and Global Health: The Week in Review is a weekly digest  summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated with the current issue date

.– Request an Email Summary: Vaccines and Global Health : The Week in Review is published as a single email summary, scheduled for release each Saturday evening before midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.

– pdf version:  A pdf of the current issue is available here:  Vaccines and Global Health_The Week in Review_14 May 2016

– blog edition: comprised of the approx. 35+ entries posted below on 15 May 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 School of Medicine

World Health Assembly – WHA69
Geneva 23-28 May 2016.
Main Documents [Editor’s selection of documentation]
A69/15 – Health in the 2030 Agenda for Sustainable Development

A69/16 – Operational plan to take forward the Global Strategy for Women’s, Children’s and Adolescents’ Health

A69/21 – Implementation of the International Health Regulations (2005)
Report of the Review Committee on the Role of the International Health Regulations (2005) in the Ebola Outbreak and Response

A69/22 – Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits

A69/22 Add.1 – Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits
Report of the Special Session of the Pandemic Influenza Preparedness Framework Advisory Group

A69/23 – Smallpox eradication: destruction of variola virus stocks

A69/24 A69/24 Add.1 – Global action plan on antimicrobial resistance

A69/25 – Poliomyelitis

A69/26 – WHO response in severe, large-scale emergencies

A69/27 – Promoting the health of migrants

A69/29 – Options for strengthening information-sharing on diagnostic, preventive and therapeutic products and for enhancing WHO’s capacity to facilitate access to these products, including the establishment of a global database, starting with haemorrhagic fevers

A69/30 – Reform of WHO’s work in health emergency management
WHO Health Emergencies Programme

A69/31 – Draft global health sector strategies
HIV, 2016–2021

A69/32 – Draft global health sector strategies
Viral hepatitis, 2016–2021

A69/34 – Global vaccine action plan

A69/42 – Addressing the global shortages of medicines, and the safety and accessibility of children’s medication

Zika virus [to 14 May 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

Zika situation report – 12 May 2016
Zika virus, Microcephaly and Guillain-Barré syndrome
Read the full situation report
Summary
:: As of 11 May 2016, 58 countries and territories report continuing mosquito-borne transmission of which:
…45 countries are experiencing a first outbreak of Zika virus since 2015, with no previous evidence of circulation, and with ongoing transmission by mosquitoes.
…13 countries reported evidence of Zika virus transmission between 2007 and 2014, with ongoing transmission.
…In addition, four countries or territories have reported evidence of Zika virus transmission between 2007 and 2014, without ongoing transmission: Cook Islands, French Polynesia, ISLA DE PASCUA – Chile and YAP (Federated States of Micronesia).

Person-to-person transmission:
:: Nine countries have reported evidence of person-to-person transmission of Zika virus, probably via a sexual route.
:: In the week to 11 May 2016, Grenada is the latest country to report mosquito-borne Zika virus transmission.
:: Microcephaly, and other fetal malformations potentially associated with Zika virus infection or suggestive of congenital infection, have been reported in seven countries or territories. Two cases, each linked to a stay in Brazil, were detected in Slovenia and the United States of America. One additional case, linked to a brief stay in Mexico, Guatemala and Belize, was detected in a pregnant woman in the United States of America.
:: Three cases of microcephaly and other neurological abnormalities are under verification in Venezuela, Honduras and Spain (linked to a stay in Latin America).
:: In the context of Zika virus circulation, 13 countries and 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 research to date, there is scientific consensus that Zika virus is a cause of microcephaly and GBS.
:: The global prevention and control strategy launched by the World Health Organization (WHO) as a Strategic Response Framework encompasses surveillance, response activities and research. Key interventions are being undertaken jointly by WHO and international, regional and national partners in response to this public health emergency.
:: Incident managers from the six WHO Regional Offices and headquarters, as well as relevant technical and support staff, met in Washington D.C., USA on 4 and 5 May 2016 to review past and ongoing activities, to discuss key lessons and to develop a strategy for future action to ensure that the response collaboration continues to work effectively. A draft of the Strategic Response Framework for the second half of 2016 will be shared with partners mid-May and finalized by mid-June.
:: WHO has developed new advice and information on diverse topics in the context of Zika virus. WHO’s latest information materials, news and resources to support corporate and programmatic risk communication, and community engagement are available online.
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Zika virus and the Olympic and Paralympic Games Rio 2016
WHO statement
12 May 2016
WHO and the Pan American Health Organization (PAHO) recognize that athletes and visitors are seeking more information on the risks of Zika and ways to prevent infection while attending the Olympic and Paralympic Games Rio 2016 (5 August to 18 September 2016).

Brazil is one of the 58 countries and territories which to-date report continuing transmission of Zika virus by mosquitoes. While mosquitoes are the primary vectors, a person infected with Zika virus can also transmit the virus to another person through unprotected sex. Zika virus disease usually causes mild symptoms(1), and most people will not develop any symptoms. However, there is scientific consensus that Zika virus is a cause of microcephaly (children being born with unusually small heads) and other brain malformations and disorders in babies born to women who were infected with Zika virus during pregnancy, and Guillain-Barré syndrome (a rare but serious neurological disorder that could lead to paralysis and death).

Athletes and visitors to Rio de Janeiro, and other areas where Zika virus is circulating, are being encouraged to:
:: follow the travel advice(2) provided by WHO and their countries’ health authorities, and consult a health worker before travelling;
:: whenever possible, during the day, protect themselves from mosquito bites by using insect repellents and by wearing clothing – preferably light-coloured – that covers as much of the body as possible;
:: practice safer sex (e.g. use condoms correctly and consistently) or abstain from sex during their stay and for at least 4 weeks after their return, particularly if they have had or are experiencing symptoms of Zika virus;
:: choose air-conditioned accommodation (windows and doors are usually kept closed to prevent the cool air from escaping, and mosquitoes cannot enter the rooms);
:: avoid visiting impoverished and over-crowded areas in cities and towns with no piped water and poor sanitation (ideal breeding grounds of mosquitoes) where the risk of being bitten is higher.

Pregnant women continue to be advised not to travel to areas with ongoing Zika virus transmission. This includes Rio de Janeiro. Pregnant women’s sex partners returning from areas with circulating virus continue to be counselled to practice safer sex or abstain throughout the pregnancy(3). The Games will take place during Brazil’s wintertime, when there are fewer active mosquitoes and the risk of being bitten is lower.

WHO/PAHO is providing public health advice to the Government of Brazil and, under a Memorandum of Understanding, the International Olympic Committee and, by extension, the Rio 2016 Local Organizing Committee, on ways to further mitigate the risk of athletes and visitors contracting Zika virus during the Games. An important focus of WHO advice revolves around measures to reduce populations of Aedes mosquitoes which transmit chikungunya, dengue and yellow fever in addition to Zika virus.

WHO/PAHO will continue to monitor the Zika virus transmission and risks in Brazil and in other affected areas to provide updates on how Zika virus outbreaks, risks and prevention interventions develop between now and August and beyond.
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WHO: Recovery toolkit: Supporting countries to achieve health service resilience
May 2016 :: 99 pages
WHO reference number: WHO/HIS/SDS/2016.2
Pdf: Recovery toolkit: Supporting countries to achieve health service resilience
pdf, 1.98 mb
Overview
The recovery toolkit is a library of guidance resources in a single place which can be quickly and easily accessed, to guide action. A key purpose of the Recovery Toolkit is to support countries in the reactivation of health services which may have suffered as a result of the emergency. These services include ongoing programmes such as immunization and vaccinations, maternal and child health services, and noncommunicable diseases. But in addition, and because the Toolkit contains core information needed to achieve functioning national health systems, it also supports countries to implement their national health plans during the recovery phase of a public health emergency.
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Zika Open [to 14 May 2016]
[Bulletin of the World Health Organization]
:: All papers available here
No new papers posted
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CDC/ACIP [to 14 May 2016]
http://www.cdc.gov/media/index.html
FRIDAY, MAY 13, 2016
CDC Announces Funds for States and Territories to Prepare for Zika
U.S. states and territories can now apply to CDC for funds to fight Zika locally. More than $85 million in redirected funds identified by the Department of Health and Human…

THURSDAY, MAY 12, 2016
CDC adds Grenada to interim travel guidance related to Zika virus
Today, CDC posted a Zika virus travel notice for Grenada. CDC has issued travel notices (level 2, “practice enhanced precautions”) for people traveling to destinations with Zika.

MONDAY, MAY 9, 2016
CDC adds Saint Barthelemy to interim travel guidance related to Zika virus
Today, CDC posted a Zika virus travel notice for Saint Barthelemy. CDC has issued travel notices (level 2, “practice enhanced precautions”) for people traveling to destinations with Zika.

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MMWR May 13, 2016 / Vol. 65 / No. 18
:: Interim Guidance for Zika Virus Testing of Urine — United States, 2016
:: Comparison of Test Results for Zika Virus RNA in Urine, Serum, and Saliva Specimens from Persons with Travel-Associated Zika Virus Disease — Florida, 2016
:: Reduced Incidence of Chikungunya Virus Infection in Communities with Ongoing Aedes Aegypti Mosquito Trap Intervention Studies — Salinas and Guayama, Puerto Rico, November 2015–February 2016

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United Nations Zika Response Multi-Partner Trust Fund Launched
6 May 2016
SG/2228
United Nations Secretary-General Ban Ki-moon has established the United Nations Zika Response Multi-Partner Trust Fund to finance critical unfunded priorities in the response to the Zika outbreak. The Trust Fund provides a rapid, flexible and accountable platform to support a coordinated response from the United Nations system and partners.

Urgent funds are required to support the implementation of national response plans and address the broader social and economic challenges that lie ahead. The United Nations Zika Response Multi-Partner Trust Fund will directly support the Zika Strategic Response Framework, developed by the World Health Organization (WHO) in consultation with United Nations agencies, partners, and international epidemiological experts.

Donors contribute to a central point and an Advisory Committee directs funds to the highest-priority activities in the affected countries…

EBOLA/EVD [to 14 May 2016]
“Threat to international peace and security” (UN Security Council)

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EBOLA VIRUS DISEASE – SITUATION REPORT 12 MAY 2016
:: The Public Health Emergency of International Concern (PHEIC) related to Ebola in West Africa was lifted on 29 March 2016. A total of 28,616 confirmed, probable and suspected cases have been reported in Guinea, Liberia and Sierra Leone, with 11 310 deaths.

:: In the latest cluster, seven confirmed and three probable cases of Ebola virus disease (EVD) were reported between 17 March and 6 April from the prefectures of N’Zerekore (nine cases) and Macenta (one case) in south-eastern Guinea. In addition, having travelled to Monrovia, Liberia, the wife and two children of the Macenta case were confirmed as Ebola cases between 1 and 5 April.

:: The index case of this cluster (a 37-year-old female from Koropara sub-prefecture in N’Zerekore) had symptom onset on or around 15 February and died on 27 February without a confirmed diagnosis. The source of her infection is likely to have been due to exposure to infected body fluid from an Ebola survivor.

:: In Guinea, the last case tested negative for Ebola virus for the second time on 19 April. In Liberia, the last case tested negative for the second time on 28 April.

:: The 42-day (two incubation periods) countdown must elapse before the outbreak can be declared over in Guinea and Liberia. In Guinea, this is due to end on 31 May and in Liberia, this is due to end on 9 June.

:: Having contained the last Ebola virus outbreak in March 2016, Sierra Leone has maintained heightened surveillance with mandatory swabbing, testing of all reported deaths and prompt investigation and testing of all suspected cases. The swabbing policy will be reviewed on the 30 June.

Risk assessment:
Active surveillance is ongoing in Guinea and Liberia and will continue 42 days after the last case tested negative for Ebola virus. The performance indicators suggest that Guinea, Liberia and Sierra Leone still have variable capacity to prevent (EVD survivor programme), detect (epidemiological and laboratory surveillance) and respond to new outbreaks (Table 1). The risk of additional outbreaks originating from exposure to infected survivor body fluids remains and requires sustained mitigation through counselling on safe sex practices and testing of body fluids.

POLIO [to 14 May 2016]
Public Health Emergency of International Concern (PHEIC)

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Polio this week as of 11 May 2016
:: From the 17 April to the 1 May, 155 countries and territories participated in the historic trivalent to bivalent oral polio vaccine switch, withdrawing the type two component of the vaccine to protect future generations against circulating vaccine derived polioviruses. Track the switch live.

:: Liechtenstein has contributed 15 000 Swiss francs to the Global Polio Eradication Initiative through Rotary International. With the Bill and Melinda Gates Foundation’s pledge to triple commitments made to polio eradication, this brings Liechtenstein’s contribution for 2016 to a per-capita contribution of more than 2 Swiss francs for every inhabitant of the country.

The Trivalent to Bivalent Oral Polio Vaccine Switch
:: Between 17 April and 1 May, the type 2 component of the oral polio vaccine (OPV) is being removed from use through a globally synchronized switch from the trivalent to bivalent oral polio vaccine. This is the first stage of objective 2 of the Polio Eradication and Endgame Strategic Plan 2013-2018 to withdraw OPV in a phased manner starting with the type 2 component following the eradication of wild poliovirus type 2 in September 2015.

:: Thanks to the efforts of a wide range of stakeholders from Ministries of Health, health workers, volunteers, switch monitors, WHO, UNCEF and partners of the World Health Organization, confirmation has been received that 152 countries have completed the switch.

:: Follow a live update of which countries have undergone the switch. Learn more about why the switch is such an important part of ensuring a polio-free world through this series of videos.

:: The following indicators are being carefully tracked to ensure the switch goes smoothly. As of 10 May:
…154 of 155 (99%) countries and territories have stopped using the trivalent oral polio vaccine.
…Independent monitoring to ensure the switch goes smoothly has begun in 149 of 153 countries (98%).
…The National Validation Committee has received switch monitoring data from 45 of 153 countries.
…The WHO Regional Office has received the National Validation Report from 43 countries.

Selected Country Levels Updates [excerpted]
Afghanistan
:: One new case of wild poliovirus type 1 (WPV1) was reported in the past week in Shahwalikot district of Kandahar, with onset of paralysis on 4 April. The total number of WPV1 cases for 2016 is now five, compared to one reported by this date in 2015.

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Weekly Epidemiological Record (WER) 13 May 2016, vol. 91, 19 (pp. 249–256)
Contents:
250 Progress towards polio eradication worldwide, 2015–2016

Yellow Fever [to 14 May 2016]
http://www.who.int/emergencies/yellow-fever/en/

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Yellow Fever – Situation Report – 12 May 2016
Full Report:
http://apps.who.int/iris/bitstream/10665/206312/1/yellowsitrep_12May2016_eng.pdf?ua=1
Summary:
Angola: 2267 suspected cases
As of 11 May 2016, Angola has reported 2267 suspected cases of yellow fever with 293 deaths. Among those cases, 696 have been laboratory confirmed. Despite vaccination campaigns in Luanda, Huambo and Benguela provinces circulation of the virus in some districts persists.
Three countries have reported confirmed yellow fever cases imported from Angola: Democratic Republic of The Congo (DRC) (39 cases), Kenya (two cases) and People’s Republic of China (11 cases). This highlights the risk of international spread through non-immunised travellers.

Democratic Republic of The Congo: 41 laboratory confirmed cases
On 22 March 2016, the Ministry of Health of DRC confirmed cases of yellow fever in connection with Angola. The government officially declared the yellow fever outbreak on 23 April. As of 11 May, DRC has reported three probable cases and 41 laboratory confirmed cases: 39 imported from Angola, reported in Kongo central province and Kinshasa and two autochthonous cases in Ndjili, Kinshasa and in Matadi, Kongo Central province. The possibility of locally acquired infections is under investigation for at least 10 non-classified cases in both Kinshasa and Kongo central provinces.

Uganda: 51 suspect cases
In Uganda, the Ministry of Health notified yellow fever cases in Masaka district on 9 April 2016. As of 11 May, 51 suspected cases and seven laboratory confirmed cases have been reported from three districts: Masaka, Rukungiri and Kalangala. According to sequencing results, those clusters are not epidemiologically linked to Angola.

The risk of spread
The virus in Angola and DRC is largely concentrated in main cities. The risk of spread and local transmission to other provinces in the three countries remains a serious concern. The risk is high also for potential spread to bordering countries especially those classified as low risks for yellow fever disease (i.e. Namibia, Zambia) where the population, travellers and foreign workers are not vaccinated against yellow fever.

:: 10 May 2016: Press briefing on yellow fever outbreak in Africa

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Yellow fever outbreak in Angola: EU deploys medical experts
11/05/2016
Amid the ongoing outbreak of yellow fever in the Republic of Angola, the European Union has deployed a team of medical experts under the European Medical Corps established earlier this year.

Experts from three EU Member States (Germany, Portugal and Belgium), the European Commission and the European Centre for Disease Prevention and Control will travel to the African country for what will be the first deployment of a public health team under the European Medical Corps…