Eurosurveillance
Volume 21, Issue 17, 28 April 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Review articles
Best practices in ranking communicable disease threats: a literature review, 2015
by EC O’Brien, R Taft, K Geary, M Ciotti, JE Suk
The threat of serious, cross-border communicable disease outbreaks in Europe poses a significant challenge to public health and emergency preparedness because the relative likelihood of these threats and the pathogens involved are constantly shifting in response to a range of changing disease drivers. To inform strategic planning by enabling effective resource allocation to manage the consequences of communicable disease outbreaks, it is useful to be able to rank and prioritise pathogens. This paper reports on a literature review which identifies and evaluates the range of methods used for risk ranking. Searches were performed across biomedical and grey literature databases, supplemented by reference harvesting and citation tracking. Studies were selected using transparent inclusion criteria and underwent quality appraisal using a bespoke checklist based on the AGREE II criteria. Seventeen studies were included in the review, covering five methodologies. A narrative analysis of the selected studies suggests that no single methodology was superior. However, many of the methods shared common components, around which a ‘best-practice’ framework was formulated. This approach is intended to help inform decision makers’ choice of an appropriate risk-ranking study design.

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News
World Health Organization announces European Region malaria free
On 20 April 2016, the World Health Organization (WHO) announced that the WHO European Region, which comprises 53 countries, is the first of the WHO regions to have interrupted the indigenous transmission of malaria [1].

In 2005, the WHO European Regional Office for Europe adopted the Tashkent Declaration, ‘The Move from Malaria Control to Elimination’ [2] which paved the way for a new malaria elimination strategy, the ‘Regional Strategy: From Malaria Control to Elimination in the WHO European Region 2006-2015’ [3]. The Regional Strategy set out milestones for the countries of the WHO European Region to eliminate malaria. Between 1995 and 2015, the number of indigenous malaria cases went from around 90,000 to zero in the European Region.

In July 2016, the WHO will hold its first meeting on the prevention of the re-introduction of malaria into the WHO European Region. According to the WHO, the meeting will focus on prevention through (i) sustained political commitment, (ii) strong vigilance to test and treat all malaria cases promptly, (iii) understanding how malaria transmission could be reintroduced and the risk it poses; and (iv) immediate action if local malaria transmission resumes.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 30 April 2016]

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Research
Partnerships in global health and collaborative governance: lessons learnt from the Division of Tropical and Humanitarian Medicine at the Geneva University Hospitals
David Beran, Sigiriya Aebischer Perone, Gabriel Alcoba, Alexandre Bischoff, Claire-Lise Bussien, Gilles Eperon, Olivier Hagon, Olivia Heller, Frédérique Jacquerioz Bausch, Nicolas Perone, Thomas Vogel and François Chappuis
Published on: 29 April 2016
Abstract
Background
In 2007 the “Crisp Report” on international partnerships increased interest in Northern countries on the way their links with Southern partners operated. Since its establishment in 2007 the Division of Tropical and Humanitarian Medicine at the Geneva University Hospitals has developed a variety of partnerships. Frameworks to assess these partnerships are needed and recent attention in the field of public management on collaborative governance may provide a useful approach for analyzing international collaborations.
Methods
Projects of the Division of Tropical and Humanitarian Medicine were analyzed by collaborators within the Division using the model proposed by Emerson and colleagues for collaborative governance, which comprises different components that assess the collaborative process.
Results
International projects within the Division of Tropical and Humanitarian Medicine can be divided into four categories: Human resource development; Humanitarian response; Neglected Tropical Diseases and Noncommunicable diseases. For each of these projects there was a clear leader from the Division of Tropical and Humanitarian Medicine as well as a local counterpart. These individuals were seen as leaders both due to their role in establishing the collaboration as well as their technical expertise. Across these projects the actual partners vary greatly. This diversity means a wide range of contributions to the collaboration, but also complexity in managing different interests. A common definition of the collaborative aims in each of the projects is both a formal and informal process. Legal, financial and administrative aspects of the collaboration are the formal elements. These can be a challenge based on different administrative requirements. Friendship is part of the informal aspects and helps contribute to a relationship that is not exclusively professional.
Conclusion
Using collaborative governance allows the complexity of managing partnerships to be presented. The framework used highlights the process of establishing collaborations, which is an element often negated by other more traditional models used in international partnerships. Applying the framework to the projects of the Division of Tropical and Humanitarian Medicine highlights the importance of shared values and interests, credibility of partners, formal and informal methods of management as well as friendship.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 30 April 2016]

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Commentary
The Life Science Exchange: a case study of a sectoral and sub-sectoral knowledge exchange programme
Brian Lee Perkins, Rob Garlick, Jodie Wren, Jon Smart, Julie Kennedy, Phil Stephens, Gwyn Tudor, Jonathan Bisson and David V. Ford
Published on: 27 April 2016
Abstract
Background
Local and national governments have implemented sector-specific policies to support economic development through innovation, entrepreneurship and knowledge exchange. Supported by the Welsh Government through the European Regional Development Fund, The Life Science Exchange® project was created with the aim to increase interaction between stakeholders, to develop more effective knowledge exchange mechanisms, and to stimulate the formation and maintenance of long-term collaborative relationships within the Welsh life sciences ecosystem. The Life Science Exchange allowed participants to interact with other stakeholder communities (clinical, academic, business, governmental), exchange perspectives and discover new opportunities.
Methods
Six sub-sector focus groups comprising over 200 senior stakeholders from academia, industry, the Welsh Government and National Health Service were established. Over 18 months, each focus group provided input to inform healthcare innovation policy and knowledge mapping exercises of their respective sub-sectors. Collaborative projects identified during the focus groups and stakeholder engagement were further developed through sandpit events and bespoke support.
Results
Each sub-sector focus group produced a report outlining the significant strengths and opportunities in their respective areas of focus, made recommendations to overcome any ‘system failures’, and identified the stakeholder groups which needed to take action. A second outcome was a stakeholder-driven knowledge mapping exercise for each area of focus. Finally, the sandpit events and bespoke support resulted in participants generating more than £1.66 million in grant funding and inward investment. This article outlines four separate outcomes from the Life Science Exchange programme.
Conclusions
The Life Science Exchange process has resulted in a multitude of collaborations, projects, inward investment opportunities and special interest group formations, in addition to securing over ten times its own costs in funding for Wales. The Life Science Exchange model is a simple and straightforward mechanism for a regional or national government to adapt and implement in order to improve innovation, skills, networks and knowledge exchange.

JAMA
April 26, 2016, Vol 315, No. 16
http://jama.jamanetwork.com/issue.aspx

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Special Communication | April 26, 2016
The Association Between Income and Life Expectancy in the United States, 2001-2014
Raj Chetty, PhD1; Michael Stepner, BA2; Sarah Abraham, BA2; Shelby Lin, MPhil3; Benjamin Scuderi, BA4; Nicholas Turner, PhD5; Augustin Bergeron, MA4; David Cutler, PhD4
Author Affiliations
JAMA. 2016;315(16):1750-1766. doi:10.1001/jama.2016.4226.
Abstract
Importance
The relationship between income and life expectancy is well established but remains poorly understood.
Objectives
To measure the level, time trend, and geographic variability in the association between income and life expectancy and to identify factors related to small area variation.
Design and Setting
Income data for the US population were obtained from 1.4 billion deidentified tax records between 1999 and 2014. Mortality data were obtained from Social Security Administration death records. These data were used to estimate race- and ethnicity-adjusted life expectancy at 40 years of age by household income percentile, sex, and geographic area, and to evaluate factors associated with differences in life expectancy.
Exposure
Pretax household earnings as a measure of income.
Main Outcomes and Measures
Relationship between income and life expectancy; trends in life expectancy by income group; geographic variation in life expectancy levels and trends by income group; and factors associated with differences in life expectancy across areas.
Results
The sample consisted of 1,408,287,218 person-year observations for individuals aged 40 to 76 years (mean age, 53.0 years; median household earnings among working individuals, $61 175 per year). There were 4 114 380 deaths among men (mortality rate, 596.3 per 100,000) and 2,694,808 deaths among women (mortality rate, 375.1 per 100,000). The analysis yielded 4 results. First, higher income was associated with greater longevity throughout the income distribution. The gap in life expectancy between the richest 1% and poorest 1% of individuals was 14.6 years (95% CI, 14.4 to 14.8 years) for men and 10.1 years (95% CI, 9.9 to 10.3 years) for women. Second, inequality in life expectancy increased over time. Between 2001 and 2014, life expectancy increased by 2.34 years for men and 2.91 years for women in the top 5% of the income distribution, but by only 0.32 years for men and 0.04 years for women in the bottom 5% (P < .001 for the differences for both sexes). Third, life expectancy for low-income individuals varied substantially across local areas. In the bottom income quartile, life expectancy differed by approximately 4.5 years between areas with the highest and lowest longevity. Changes in life expectancy between 2001 and 2014 ranged from gains of more than 4 years to losses of more than 2 years across areas. Fourth, geographic differences in life expectancy for individuals in the lowest income quartile were significantly correlated with health behaviors such as smoking (r=-0.69, P  < .001), but were not significantly correlated with access to medical care, physical environmental factors, income inequality, or labor market conditions. Life expectancy for low-income individuals was positively correlated with the local area fraction of immigrants (r = 0.72, P < .001), fraction of college graduates (r= 0.42, P < .001), and government expenditures (r=0.57, P < .001).
Conclusions and Relevance
In the United States between 2001 and 2014, higher income was associated with greater longevity, and differences in life expectancy across income groups increased over time. However, the association between life expectancy and income varied substantially across areas; differences in longevity across income groups decreased in some areas and increased in others. The differences in life expectancy were correlated with health behaviors and local area characteristics

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Editorials:
Associations Between Money and Death; Angus Deaton, PhD
Improving Opportunity, Population Health, and Well-being Collectively; Steven H. Woolf, MD, MPH; Jason Q. Purnell, PhD, MPH
Income, Longevity, and Community Health; J. Michael McGinnis, MD, MPP

Journal of Health Care for the Poor and Underserved (JHCPU)
Volume 27, Number 2, May 2016 Supplement
https://muse.jhu.edu/issue/33442

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Introduction to Public Health and Incarceration: Social Justice Matters
Overview Providing health care in jails, prisons, half-way houses, and community-supervised correctional programs, correctional facilities, and community systems has a direct effect on health outcomes of incarcerated populations. Moreover, effective linkages to a myriad of services upon release and assistance with community reintegration are key components for reducing recidivism. In an effort to highlight some of the disparity issues and challenges in corrections, we offer this issue, titled, Public Health and Incarceration: Social Justice Matters. In 2012, U.S. state prison systems, comprising 50 independent entities, incarcerated over 1.3 million people, of whom a disproportionate share were minorities, primarily African Americans and Hispanics. Despite recent reports that 2012 marked a decrease in the number of imprisonments of males and females, the U.S. continues to lead the world in incarceration of its residents. The reported decrease in incarceration may be attributed to alternative sentences, such as probation, which maintains individuals under correctional supervision.

Mass incarceration disrupts families and affects health status and the quality of life within families. Prisoners are more likely than the general population to have chronic health conditions and infectious diseases. In 2012, 43.9% of offenders reported a chronic condition, relative to 31.0% of the general population; 21.0% of offenders had had an infectious disease, relative to 4.8% of the general population. The disparities in mental health and substance abuse are equally troubling. These health risks are not proportionately distributed across populations. African American males have an imprisonment rate of 2,841 per 100,000; Hispanic males have a rate of 1,158 per 100,000; and White males have a rate of 463 per 100,000. There are similar disparities for African American and Hispanic females relative to Whites.

Although some of the health problems experienced by offenders are addressed during their incarceration, many are not addressed upon their release, which poses serious health risks for the former offenders and for the local communities to which they return. Health problems of former offenders become those of the local community, where there may be little knowledge and discussion related to the intersections of corrections, public health, and reentry for this subset of a vulnerable population.

This special issue of the JHCPU-with a focus on disparities related to racial and ethnic minorities, reentry, and public health-explores innovative research, services, and programs that deal with the health of the offender population. The social justice system is burdened with imperfections deleterious to health equity. The system disproportionately lessens the life opportunities of African Americans, Latinos, and other disadvantaged ethnic minority groups. Eliminating such imperfections is a formidable task, but nevertheless one that must be accomplished if the nation is to achieve true health equity.

The articles in this issue of the JHCPU report on strategies for change. In the commentary by Ferguson, et al., a strong case is made that systems change is the “order of the day”; this case is eloquently presented as a “Call for Action.” While there have been many other such appeals, this call offers recommendations for clinical practice, criminal justice studies, health science institutions, and communities. Much like the compelling call for action in Michelle Alexander’s book, The New Jim Crow: Mass Incarceration in the Age of Colorblindness, a stage is set for sector stakeholders to move in a new direction, one involving sector accountability without compromise. We must change the mass incarceration practices and eliminate their catastrophic effects on racial and ethnic minorities, in the U.S. In the manuscript by Coughlin, Lewis, and Smith, developments in ethics in the context of the racial/ethnic disparities that exist in corrections, are discussed. Ethical considerations in clinical and public health research on HIV in prison and jail settings are considered. Factors in mental health research are summarized, along with issues pertaining to research involving female inmates. The ethics of research involving incarcerated people extends beyond traditional ethical concerns related to human subjects to include issues in the domains of bioethics and public health ethics. Tamburello and Ferguson present a commentary on marginalized individuals diagnosed with mental health conditions and the medication-prescribing practices in correctional facilities. Several articles in this issue concern incarcerated women specifically…

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Commentaries
Ethical and Social Issues in Health Research Involving Incarcerated People
pp. 18-28
Steven S. Coughlin, Sharon R. Lewis, Selina A. Smith
Abstract:
The use of inmates in research in the U.S. was restricted by the recommendations of the National Commission and by federal regulations and guidelines that followed. By the 1980s, many health care officials became concerned about the exclusion of inmates from experimental treatments for human immunodeficiency virus infection (HIV). These developments in ethics occurred in the context of racial/ethnic disparities in health. In this article, ethical considerations in clinical and public health research on HIV in prison and jail settings are considered. Ethical considerations in mental health research are summarized as well as issues pertaining to research involving female inmates. Issues related to oversight of research involving incarcerated people are considered along with the ethics of public health research. The ethics of research involving incarcerated people extends beyond traditional issues in human subjects ethics to include issues within the domains of bioethics and public health ethics.

Journal of Patient-Centered Research and Reviews
Volume 3, Issue 2 (2016)
http://digitalrepository.aurorahealthcare.org/jpcrr/

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Topic Synopsis
Is 13-Valent Pneumococcal Conjugate Vaccine (PCV13) Combined With 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23) Superior to PPSV23 Alone for Reducing Incidence or Severity of Pneumonia in Older Adults? A Clin-IQ
Starla Hayward, Lou Ann Thompson, and Andrea McEachern

Journal of Public Health Policy
Volume 37, Issue 2 (May 2016)
http://www.palgrave-journals.com/jphp/journal/v37/n2/index.html

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Editorial
How to understand the results of the climate change summit: Conference of Parties21 (COP21) Paris 2015 FREE
Our Co-Editor reports on developments from Paris, where he joined 40,000 people in November at the Summit at Le Bourget
Anthony Robbins
J Public Health Pol 37: 129-132; advance online publication, January 7, 2016; doi:10.1057/jphp.2015.47

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Viewpoints
Zika virus: An international emergency? FREE
A distinguished Mexican researcher anguishes about next steps to control this epidemic and its frightening consequences
Adolfo Martinez Palomo
J Public Health Pol 37: 133-135; advance online publication, February 25, 2016; doi:10.1057/jphp.2016.11
Abstract
This Viewpoint discusses the World Health Organization’s Declaration on 1 February 2016 that the epidemic infection caused by the Zika virus is a public health emergency of international concern – the basis of the decision and controversy surrounding it.

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Viewpoints
Unhealthy marketing of pharmaceutical products: An international public health concern
Shai Mulinari
J Public Health Pol 37: 149-159; advance online publication, February 25, 2016; doi:10.1057/jphp.2016.6
Abstract
I consider the current state of pharmaceutical marketing vis-à-vis ethical and legal standards and advocate measures to improve it. There is abundant evidence of unethical or illicit marketing. It fuels growing concerns about undue corporate influence over pharmaceutical research, education, and consumption. The most extensive evidence of industry transgressions comes from the United States (US), where whistle-blowers are encouraged by financial rewards to help uncover illicit marketing and fraud. Outside the US increasing evidence of transgressions exists. Recently I have observed a range of new measures to align pharmaceutical marketing practices with ethical and legal standards. In the interest of public health, I highlight the need for additional and more profound reforms to ensure that information about medicines supports quality and resource-efficient care

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Original Articles
Misconceptions about Ebola virus disease among lay people in Guinea: Lessons for community education
Lonzozou Kpanake, Komlantsè Gossou, Paul Clay Sorum, and Etienne Mullet
J Public Health Pol 37: 160-172; advance online publication, February 11, 2016; doi:10.1057/jphp.2016.1
Abstract
To characterize the perception of Ebola virus disease (EVD) in Guinea, we administered, from November 2014 to February 2015, a questionnaire to a convenience sample of 200 lay people in Conakry and a group of 8 physicians. We found widespread misconceptions among lay people, including that praying to God can protect against EVD, that traditional healers are more competent than physicians in treating EVD, that people get infected through physical proximity without contact, that the Ebola epidemic is the result of Western bioterrorism experiments, that Western medical staff disseminated the virus, and that the purpose of quarantine measures is to hasten the death of Ebola patients. Major educational interventions, sensitive to local cultural beliefs, are needed to overcome the misconceptions about Ebola in Guinea.

Journal of the Royal Society – Interface
01 April 2016; volume 13, issue 117
http://rsif.royalsocietypublishing.org/content/current

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Life Sciences–Mathematics interface
Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination
Amy Wesolowski, Keitly Mensah, Cara E. Brook, Miora Andrianjafimasy, Amy Winter, Caroline O. Buckee, Richter Razafindratsimandresy, Andrew J. Tatem, Jean-Michel Heraud, C. Jessica E. Metcalf
J. R. Soc. Interface 2016 13 20151101; DOI: 10.1098/rsif.2015.1101. Published 27 April 2016
Abstract
Few countries in Africa currently include rubella-containing vaccination (RCV) in their immunization schedule. The Global Alliance for Vaccines Initiative (GAVI) recently opened a funding window that has motivated more widespread roll-out of RCV. As countries plan RCV introductions, an understanding of the existing burden, spatial patterns of vaccine coverage, and the impact of patterns of local extinction and reintroduction for rubella will be critical to developing effective programmes. As one of the first countries proposing RCV introduction in part with GAVI funding, Madagascar provides a powerful and timely case study. We analyse serological data from measles surveillance systems to characterize the epidemiology of rubella in Madagascar. Combining these results with data on measles vaccination delivery, we develop an age-structured model to simulate rubella vaccination scenarios and evaluate the dynamics of rubella and the burden of congenital rubella syndrome (CRS) across Madagascar. We additionally evaluate the drivers of spatial heterogeneity in age of infection to identify focal locations where vaccine surveillance should be strengthened and where challenges to successful vaccination introduction are expected. Our analyses indicate that characteristics of rubella in Madagascar are in line with global observations, with an average age of infection near 7 years, and an impact of frequent local extinction with reintroductions causing localized epidemics. Modelling results indicate that introduction of RCV into the routine programme alone may initially decrease rubella incidence but then result in cumulative increases in the burden of CRS in some regions (and transient increases in this burden in many regions). Deployment of RCV with regular supplementary campaigns will mitigate these outcomes. Results suggest that introduction of RCV offers a potential for elimination of rubella in Madagascar, but also emphasize both that targeted vaccination is likely to be a lynchpin of this success, and the public health vigilance that this introduction will require.

The Lancet
Apr 30, 2016 Volume 387 Number 10030 p1789-1878 e25
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
The next Director-General of WHO
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(16)30358-0
Summary
WHO last week fired a starting pistol to launch the election for its next Director-General. The final vote does not take place until May, 2017. Procedures have been substantially revised since 2012, when Margaret Chan was elected to serve a second term. It is likely that this lengthy process will therefore be more transparent, accountable, and disputatious (and considerably less corrupt) than past elections.

[Excerpt]
…The deadline for member states to nominate candidates is Sept 22. Several prominent individuals have already disclosed their intentions to stand. Philippe Douste-Blazy served two terms as France’s Minister of Health and subsequently became Foreign Minister. He has been a leader on innovative financing for health and has chaired UNITAID since 2006. Tedros Adhanom Ghebreyesus is currently Ethiopia’s Minister of Foreign Affairs. He was Minister of Health from 2005–12. The African Union has endorsed him as the sole African candidate for Director-General. Sania Nishtar, Pakistan’s former Minister of Health (among several other government portfolios), has had a distinguished career as a civil society leader. She founded the influential non-governmental organisation Heartfile in 1999. All three candidates are highly accomplished global health leaders, which bodes well for the future of WHO…

New England Journal of Medicine
April 28, 2016 Vol. 374 No. 17
http://www.nejm.org/toc/nejm/medical-journal

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Original Article
Phase 1 Trials of rVSV Ebola Vaccine in Africa and Europe
Selidji T. Agnandji, M.D., Angela Huttner, M.D., Madeleine E. Zinser, M.D., Patricia Njuguna, M.Med., Christine Dahlke, Ph.D., José F. Fernandes, M.D., Sabine Yerly, M.Sc., Julie-Anne Dayer, M.D., Verena Kraehling, Ph.D., Rahel Kasonta, Ph.D., Akim A. Adegnika, M.D., Ph.D., Marcus Altfeld, M.D., Ph.D., Floriane Auderset, Ph.D., Emmanuel B. Bache, M.Sc., Nadine Biedenkopf, Ph.D., Saskia Borregaard, Ph.D., Jessica S. Brosnahan, M.H.Sc., Rebekah Burrow, B.Sc., Christophe Combescure, Ph.D., Jules Desmeules, M.D., Markus Eickmann, Ph.D., Sarah K. Fehling, Ph.D., Axel Finckh, M.D., Ana Rita Goncalves, Ph.D., Martin P. Grobusch, M.D., Ph.D., Jay Hooper, Ph.D., Alen Jambrecina, M.D., Anita L. Kabwende, M.D., Gürkan Kaya, M.D., Ph.D., Domtila Kimani, B.Sc., Bertrand Lell, M.D., Barbara Lemaître, M.Sc., Ansgar W. Lohse, M.D., Marguerite Massinga-Loembe, Ph.D., Alain Matthey, M.D., Benjamin Mordmüller, M.D., Anne Nolting, M.D., Caroline Ogwang, M.B., Ch.B., Michael Ramharter, M.D., Jonas Schmidt-Chanasit, M.D., Stefan Schmiedel, M.D., Peter Silvera, Ph.D., Felix R. Stahl, M.D., Ph.D., Henry M. Staines, D.Phil., Thomas Strecker, Ph.D., Hans C. Stubbe, M.D., Benjamin Tsofa, Ph.D., Sherif Zaki, M.D., Ph.D., Patricia Fast, M.D., Ph.D., Vasee Moorthy, Ph.D., Laurent Kaiser, M.D., Sanjeev Krishna, Sc.D., Stephan Becker, Ph.D., Marie-Paule Kieny, Ph.D., Philip Bejon, Ph.D., Peter G. Kremsner, M.D., Marylyn M. Addo, M.D., Ph.D., and Claire-Anne Siegrist, M.D.*
N Engl J Med 2016; 374:1647-1660 April 28, 2016 DOI: 10.1056/NEJMoa1502924

Abstract
Background
The replication-competent recombinant vesicular stomatitis virus (rVSV)–based vaccine expressing a Zaire ebolavirus (ZEBOV) glycoprotein was selected for rapid safety and immunogenicity testing before its use in West Africa.
Methods
We performed three open-label, dose-escalation phase 1 trials and one randomized, double-blind, controlled phase 1 trial to assess the safety, side-effect profile, and immunogenicity of rVSV-ZEBOV at various doses in 158 healthy adults in Europe and Africa. All participants were injected with doses of vaccine ranging from 300,000 to 50 million plaque-forming units (PFU) or placebo.
Results
No serious vaccine-related adverse events were reported. Mild-to-moderate early-onset reactogenicity was frequent but transient (median, 1 day). Fever was observed in up to 30% of vaccinees. Vaccine viremia was detected within 3 days in 123 of the 130 participants (95%) receiving 3 million PFU or more; rVSV was not detected in saliva or urine. In the second week after injection, arthritis affecting one to four joints developed in 11 of 51 participants (22%) in Geneva, with pain lasting a median of 8 days (interquartile range, 4 to 87); 2 self-limited cases occurred in 60 participants (3%) in Hamburg, Germany, and Kilifi, Kenya. The virus was identified in one synovial-fluid aspirate and in skin vesicles of 2 other vaccinees, showing peripheral viral replication in the second week after immunization. ZEBOV-glycoprotein–specific antibody responses were detected in all the participants, with similar glycoprotein-binding antibody titers but significantly higher neutralizing antibody titers at higher doses. Glycoprotein-binding antibody titers were sustained through 180 days in all participants.
Conclusions
In these studies, rVSV-ZEBOV was reactogenic but immunogenic after a single dose and warrants further evaluation for safety and efficacy. (Funded by the Wellcome Trust and others; ClinicalTrials.gov numbers, NCT02283099, NCT02287480, and NCT02296983; Pan African Clinical Trials Registry number, PACTR201411000919191.)

New England Journal of Medicine
April 28, 2016 Vol. 374 No. 17
http://www.nejm.org/toc/nejm/medical-journal
Original Article
A Monovalent Chimpanzee Adenovirus Ebola Vaccine Boosted with MVA
Katie Ewer, Ph.D., Tommy Rampling, M.R.C.P., Navin Venkatraman, M.R.C.P., Georgina Bowyer, B.A., Danny Wright, M.Sc., Teresa Lambe, Ph.D., Egeruan B. Imoukhuede, M.D., Ruth Payne, M.R.C.P., Sarah Katharina Fehling, Ph.D., Thomas Strecker, Ph.D., Nadine Biedenkopf, Ph.D., Verena Krähling, Ph.D., Claire M. Tully, B.A., Nick J. Edwards, B.Sc., Emma M. Bentley, B.Sc., Dhanraj Samuel, Ph.D., Geneviève Labbé, Ph.D., Jing Jin, Ph.D., Malick Gibani, M.R.C.P., Alice Minhinnick, M.B., Ch.B., Morven Wilkie, M.R.C.P., Ian Poulton, Dip.H.E., Natalie Lella, B.A., Rachel Roberts, M.Sc., Felicity Hartnell, M.B., B.S., Carly Bliss, B.A., Kailan Sierra-Davidson, B.A., Jonathan Powlson, B.Sc., Eleanor Berrie, Ph.D., Richard Tedder, M.B., B.Chir., Francois Roman, M.D., Iris De Ryck, Ph.D., Alfredo Nicosia, Ph.D., Nancy J. Sullivan, Ph.D., Daphne A. Stanley, M.S., Olivier T. Mbaya, M.D., Julie E. Ledgerwood, D.O., Richard M. Schwartz, Ph.D., Loredana Siani, Ph.D., Stefano Colloca, Ph.D., Antonella Folgori, Ph.D., Stefania Di Marco, Ph.D., Riccardo Cortese, M.D., Edward Wright, Ph.D., Stephan Becker, Ph.D., Barney S. Graham, M.D., Richard A. Koup, M.D., Myron M. Levine, M.D., Ariane Volkmann, Ph.D., Paul Chaplin, Ph.D., Andrew J. Pollard, Ph.D., Simon J. Draper, D.Phil., W. Ripley Ballou, M.D., Alison Lawrie, Ph.D., Sarah C. Gilbert, Ph.D., and Adrian V.S. Hill, D.M.
N Engl J Med 2016; 374:1635-1646 April 28, 2016 DOI: 10.1056/NEJMoa1411627

Abstract
Background
The West African outbreak of Ebola virus disease that peaked in 2014 has caused more than 11,000 deaths. The development of an effective Ebola vaccine is a priority for control of a future outbreak.
Methods
In this phase 1 study, we administered a single dose of the chimpanzee adenovirus 3 (ChAd3) vaccine encoding the surface glycoprotein of Zaire ebolavirus (ZEBOV) to 60 healthy adult volunteers in Oxford, United Kingdom. The vaccine was administered in three dose levels — 1×1010 viral particles, 2.5×1010 viral particles, and 5×1010 viral particles — with 20 participants in each group. We then assessed the effect of adding a booster dose of a modified vaccinia Ankara (MVA) strain, encoding the same Ebola virus glycoprotein, in 30 of the 60 participants and evaluated a reduced prime–boost interval in another 16 participants. We also compared antibody responses to inactivated whole Ebola virus virions and neutralizing antibody activity with those observed in phase 1 studies of a recombinant vesicular stomatitis virus–based vaccine expressing a ZEBOV glycoprotein (rVSV-ZEBOV) to determine relative potency and assess durability.
Results
No safety concerns were identified at any of the dose levels studied. Four weeks after immunization with the ChAd3 vaccine, ZEBOV-specific antibody responses were similar to those induced by rVSV-ZEBOV vaccination, with a geometric mean titer of 752 and 921, respectively. ZEBOV neutralization activity was also similar with the two vaccines (geometric mean titer, 14.9 and 22.2, respectively). Boosting with the MVA vector increased virus-specific antibodies by a factor of 12 (geometric mean titer, 9007) and increased glycoprotein-specific CD8+ T cells by a factor of 5. Significant increases in neutralizing antibodies were seen after boosting in all 30 participants (geometric mean titer, 139; P<0.001). Virus-specific antibody responses in participants primed with ChAd3 remained positive 6 months after vaccination (geometric mean titer, 758) but were significantly higher in those who had received the MVA booster (geometric mean titer, 1750; P<0.001).
Conclusions
The ChAd3 vaccine boosted with MVA elicited B-cell and T-cell immune responses to ZEBOV that were superior to those induced by the ChAd3 vaccine alone. (Funded by the Wellcome Trust and others; ClinicalTrials.gov number, NCT02240875.)

Science Translational Medicine
27 April 2016 Vol 8, Issue 336
http://stm.sciencemag.org/

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Editorial
An incentive-based approach for improving data reproducibility
By Michael Rosenblatt
Science Translational Medicine27 Apr 2016 : 336ed5
A scientist who has worked in both academia and industry offers an incentive-based and nonprescriptive proposal to reduce data irreproducibility.

Vaccine
Volume 34, Issue 22, Pages 2467-2526 (11 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/22
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Regular papers
Cost-effectiveness of an influenza vaccination program offering intramuscular and intradermal vaccines versus intramuscular vaccine alone for elderly
Original Research Article
Pages 2469-2476
Man-Kit Leung, Joyce H.S. You
Abstract
Background
Intradermal (ID) injection is an alternative route for influenza vaccine administration in elderly with potential improvement of vaccine coverage. This study aimed to investigate the cost-effectiveness of an influenza vaccination program offering ID vaccine to elderly who had declined intramuscular (IM) vaccine from the perspective of Hong Kong public healthcare provider.
Methods
A decision analytic model was used to simulate outcomes of two programs: IM vaccine alone (IM program), and IM or ID vaccine (IM/ID program) in a hypothetic cohort of elderly aged 65 years. Outcome measures included influenza-related direct medical cost, infection rate, mortality rate, quality-adjusted life years (QALYs) loss, and incremental cost per QALY saved (ICER). Model inputs were derived from literature. Sensitivity analyses evaluated the impact of uncertainty of model variables.
Results
In base-case analysis, the IM/ID program was more costly (USD52.82 versus USD47.59 per individual to whom vaccine was offered) with lower influenza infection rate (8.71% versus 9.65%), mortality rate (0.021% versus 0.024%) and QALYs loss (0.00336 versus 0.00372) than the IM program. ICER of IM/ID program was USD14,528 per QALY saved. One-way sensitivity analysis found ICER of IM/ID program to exceed willingness-to-pay threshold (USD39,933) when probability of influenza infection in unvaccinated elderly decreased from 10.6% to 5.4%. In 10,000 Monte Carlo simulations of elderly populations of Hong Kong, the IM/ID program was the preferred option in 94.7% of time.
Conclusions
An influenza vaccination program offering ID vaccine to elderly who had declined IM vaccine appears to be a highly cost-effective option.

Vaccine
Volume 34, Issue 22, Pages 2467-2526 (11 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/22
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Stability of live attenuated rotavirus vaccine with selected preservatives and primary containers
Original Research Article
Pages 2483-2489
Manjari Lal, Courtney Jarrahian, Changcheng Zhu, Nancy A. Hosken, Chris L. McClurkan, David M. Koelle, Eugene Saxon, Andrew Roehrig, Darin Zehrung, Dexiang Chen
Abstract
Rotavirus infection, which can be prevented by vaccination, is responsible for a high burden of acute gastroenteritis disease in children, especially in low-income countries. An appropriate formulation, packaging, and delivery device for oral rotavirus vaccine has the potential to reduce the manufacturing cost of the vaccine and the logistical impact associated with introduction of a new vaccine, simplify the vaccination procedure, and ensure that the vaccine is safely and accurately delivered to children. Single-dose prefilled presentations can be easy to use; however, they are typically more expensive, can be a bottleneck during production, and occupy a greater volume per dose vis-à-vis supply chain storage and medical waste disposal, which is a challenge in low-resource settings. Multi-dose presentations used thus far have other issues, including increased wastage of vaccine and the need for separate delivery devices. In this study, the goals were to evaluate both the technical feasibility of using preservatives to develop a liquid multi-dose formulation and the primary packaging alternatives for orally delivered, liquid rotavirus vaccines. The feasibility evaluation included evaluation of commonly used preservatives for compatibility with rotavirus vaccines and stability testing of rotavirus vaccine in various primary containers, including Lameplast’s plastic tubes, BD’s oral dispenser version of Uniject™ (Uniject DP), rommelag’s blow-fill-seal containers, and MEDInstill’s multi-dose vial and pouch. These presentations were compared to a standard glass vial. The results showed that none of the preservatives tested were compatible with a live attenuated rotavirus vaccine because they had a detrimental effect on the viability of the virus. In the presence of preservatives, vaccine virus titers declined to undetectable levels within 1 month. The vaccine formulation without preservatives maintained a stability profile over 12 months in all primary containers that was similar to its profile in standard glass vials. This study demonstrates that there are multiple options for the primary container for rotavirus vaccines intended for oral delivery. Selection of an optimal primary container should take into consideration additional factors, including stability as well as cold chain volume, usability, cost, and manufacturing feasibility.

Vaccine
Volume 34, Issue 22, Pages 2467-2526 (11 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/22
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HPV vaccine uptake among overweight and obese US adolescents: An analysis of the National Health and Nutrition Examination Survey (NHANES) 2009–2014
Original Research Article
Pages 2501-2506
Maria E. Sundaram, Susan M. Mason, Nicole E. Basta
Abstract
Background
Human papillomavirus (HPV) vaccine uptake in the US is suboptimal; identifying risk factors associated with low vaccine uptake is critical to increase vaccination coverage. Some evidence suggests body mass index (BMI) is associated with low HPV vaccine uptake and increased risk of HPV infection in adults. BMI may therefore be an important factor in targeting HPV vaccine to US adolescents.
Methods
We investigated the relationship between BMI categories (underweight, normal weight, overweight and obese) and HPV vaccine uptake in 4109 adolescents (9–18 years old) using data from the 2009 to 2014 National Health and Nutrition Examination Survey (NHANES). We used modified Poisson regression to assess the relationship between BMI and receipt of at least one HPV vaccine, and BMI and completion of the vaccine three-dose series. We assessed the relationship between BMI and age at first HPV vaccination using linear regression.
Results
Receipt of at least one dose of HPV vaccine was low in both females (35%) and males (10%). High BMI was not associated with initiation of the HPV vaccine series, age at first HPV vaccination, or completion of the HPV vaccine three-dose course.
Conclusions
We found no evidence that high BMI is associated with reduced initiation or completion of the HPV vaccination series, or age at initiation of the three-dose course among a general population sample of US adolescents. Our results suggest that efforts to increase HPV vaccine uptake need not consider targeting by weight status at this time.

Vaccine
Volume 34, Issue 22, Pages 2467-2526 (11 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/22
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The effect of diarrheal disease on bivalent oral polio vaccine (bOPV) immune response in infants in Nepal
Original Research Article
Pages 2519-2526
Cristina V. Cardemil, Concepcion Estivariz, Laxman Shrestha, Jeevan B. Sherchand, Arun Sharma, Howard E. Gary Jr., M. Steven Oberste, William C. Weldon III, Michael D. Bowen, Jan Vinjé, W. William Schluter, Abhijeet Anand, Ondrej Mach, Susan Y. Chu
Abstract
Background
A globally-coordinated phase out of all type 2 containing oral polio vaccine (OPV) is planned for April 2016 during which bivalent 1 + 3 OPV (bOPV) will replace trivalent OPV (tOPV) in routine immunization schedules and campaigns. Diarrhea impairs the immune response to tOPV, but the effect of diarrhea on bOPV is unknown.
Methods
Infants aged 6 weeks to 11 months, who had received 5 loose stools per day (OR = 0.36, 95% CI 0.21–0.62).
Conclusions
Diarrhea reduced the immune response to bOPV. Provision of additional doses of polio vaccine is necessary to maintain high population immunity in areas with high prevalence of diarrheal disease.
Clinical trial registry
This study is registered at clinicaltrials.gov as NCT01559636.

Vaccine
Volume 34, Issue 21, Pages 2403-2466 (5 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/21

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Review
Hepatitis B control among children in the Eastern Mediterranean Region of the World Health Organization
Review Article
Pages 2403-2409
Robert D. Allison, Nadia Teleb, Salah Al Awaidy, Hossam Ashmony, James P. Alexander, Minal K. Patel
Abstract
In the pre-vaccination era, the prevalence of chronic hepatitis B virus (HBV) infection in the World Health Organization (WHO) Eastern Mediterranean Region (EMR) ranged from two to seven percent in a total population of over 580 million people. Mortality estimates place cirrhosis among the top ten causes of years of life lost in the EMR. The region has made notable achievements, improving coverage from only 6% in 1992, when WHO recommended hepatitis B vaccination of all infants, to 83% in 2014. Member states adopted a hepatitis B control target in 2009 to reduce chronic hepatitis B virus infection prevalence to less than one percent among children aged

Vaccine
Volume 34, Issue 21, Pages 2403-2466 (5 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/21
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Can the vaccine adverse event reporting system be used to increase vaccine acceptance and trust?
Original Research Article
Pages 2424-2429
Laura D. Scherer, Victoria A. Shaffer, Niraj Patel, Brian J. Zikmund-Fisher
Abstract
Vaccine refusal has an impact on public health, and the human pappillomavirus (HPV) vaccine is particularly underutilized. Research suggests that it may be difficult to change vaccine-related attitudes, and there is currently no good evidence to recommend any particular intervention strategy. One reason for vaccine hesitancy is lack of trust that vaccine harms are adequately documented and reported, yet few communication strategies have explicitly attempted to improve this trust. This study tested the possibility that data from the vaccine adverse event reporting system (VAERS) can be used to increase trust that vaccine harms are adequately researched and that potential harms are disclosed to the public, and thereby improve perceptions of vaccines. In the study, participants were randomly assigned to one of three communication interventions. All participants read the Centers for Disease Control (CDC) vaccine information statement (VIS) for the HPV vaccine. Two other groups were exposed to additional information about VAERS, either summary data or full detailed reports of serious adverse events from 2013. Results showed that the CDC’s VIS alone significantly increased perceptions of vaccine benefits and decreased perceived risks. Participants who were also educated about VAERS and given summary data about the serious adverse events displayed more trust in the CDC and greater HPV vaccine acceptance relative to the VIS alone. However, exposure to the detailed VAERS reports significantly reduced trust in the CDC and vaccine acceptance. Hence, general information about the VAERS data slightly increased trust in the CDC and improved vaccine acceptance, but the specific VAERS reports negatively influenced both trust and acceptance. Implications for communicating about vaccines are discussed.

Vaccine
Volume 34, Issue 21, Pages 2403-2466 (5 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/21
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SMS text message reminders to improve infant vaccination coverage in Guatemala: A pilot randomized controlled trial
Original Research Article
Pages 2437-2443
Gretchen J. Domek, Ingrid L. Contreras-Roldan, Sean T. O’Leary, Sheana Bull, Anna Furniss, Allison Kempe, Edwin J. Asturias
Abstract
Background
Patient reminder systems are an evidence-based way to improve childhood vaccination rates but are difficult to implement in low- and middle-income countries (LMICs). Short Message Service (SMS) texts may offer a potential low-cost solution, especially in LMICs where mobile phones are becoming more ubiquitous.
Objective
To determine if an SMS-based vaccination reminder system aimed at improving completion of the infant primary immunization series is feasible and acceptable in Guatemala.
Methods
A pilot randomized controlled trial was conducted at two public health clinics in Guatemala City. Infants aged 8–14 weeks presenting for the first dose of the primary immunization series were enrolled in March–April 2013. Participants randomized into the intervention received three SMS reminders one week before the second and third dose. A follow-up acceptability survey was administered to both groups.
Results
The participation rate was 86.8% (321/370); 8 did not own a cell phone and 12 could not use SMS. 96.9% of intervention parents were sent at least one SMS reminder prior to visit 2 and 96.3% prior to visit 3. Both intervention and usual care participants had high rates of vaccine and visit completion, with a non-statistically significant higher percentage of children in the intervention completing both visit 2 (95.0% vs. 90.1%, p = .12) and visit 3 (84.4% vs. 80.7%, p = .69). More intervention vs. usual care parents agreed that SMS reminders would be helpful for remembering appointments (p < .0001), agreed to being interested in receiving future SMS reminders (p < .0001), and said that they would be willing to pay for future SMS reminders (p = .01).
Conclusion
This proof of concept evaluation showed that a new application of SMS technology is feasible to implement in a LMIC with high user satisfaction. Larger studies with modifications in the SMS system are needed to determine effectiveness (Clinical Trial Registry NCT01663636).

American Journal of Men’s Health
2016 Apr 22. pii: 1557988316645155. [Epub ahead of print]
Factors Associated With HPV Vaccine Initiation, Vaccine Completion, and Accuracy of Self-Reported Vaccination Status Among 13-to 26-Year-Old Men.
Thomas R1, Higgins L2, Ding L3, Widdice LE3, Chandler E3, Kahn JA4.
Abstract
Human papillomavirus (HPV) vaccination coverage in young men is suboptimal. The aims of this study were (a) to examine HPV vaccination and factors associated with HPV vaccination in men 13 to 26 years of age and (b) to examine and determine factors associated with accurate self-report of vaccination. Young men (n = 400) recruited from a teen health center and a sexually transmitted disease (STD) clinic completed a survey. Accuracy was defined as correct report of at least one dose and number of doses. Mean age was 21.5 years, 104 (26.0%) received at least one vaccine dose and 49 (12.3%) received all three doses. Factors significantly associated with receipt of at least one dose in multivariable models included recruitment site (teen health center vs. STD clinic, adjusted odds ratio [AOR] = 2.75), public versus other insurance (AOR = 2.12), and age (AOR = 0.68). Most young men accurately reported their vaccination status but accuracy of report differed by age: 50.6% of 14- to 18-year-olds, 75.9% of 19- to 21-year-olds, and 93.2% of 22- to 26-year-olds. Most (293, 73.3%) accurately reported number of doses received. Age was associated with accuracy of self-report of at least one vaccine dose (AOR = 1.42), while recruitment site (STD vs. teen health center, AOR = 2.56) and age (AOR = 1.44) were associated with accuracy of self-report of number of vaccine doses. In conclusion, HPV initiation and completion in this study sample were low. Teen health center attendance, public insurance, and younger age were associated with vaccine initiation; older age and STD clinic setting were associated with accurate vaccination self-report.

Neurology
April 21, 2016
Association Between Influenza Vaccination and Development of Guillain-Barré Syndrome in Adults: A Vaccine Safety Datalink (VSD) and Vaccine Adverse Event Reporting System (VAERS) Study (S53.007)
Francisco Gomez2, Mohammad El-Ghanem4, Abu Nasar1 and Nizar Souayah3
Abstract
Objective: To investigate whether there is correlation between Guillain-Barré Syndrome (GBS) and influenza vaccination in adults, utilizing Vaccine Adverse Event Reporting System (VAERS), and vaccine safety datalink (VSD) databases Background: There are reports of GBS after influenza vaccination, efforts have been undertaken to find a link between the two Methods: Data from VAERS and VSD were used during 1991-2000 time period. Two approaches utilized: self-controlled case series and case-centered. Six weeks after vaccination was defined as the risk period of possible cause effect between vaccination and GBS. Results: There were 69 VSD and 62 VAERS GBS cases after vaccination. VSD mean age was 65.9±12.07 and VAERS 55.83±15.4 years. Male distribution in VSD and VAERS was 64[percnt] and 53[percnt] respectively (p0.221) The incidence of GBS after vaccination in the VSD population was 2/100,000 Using case centered analysis, there was no significant difference between the risk and control periods in the VSD database ( 10[percnt] vs 8.5[percnt] p0.771). Similar results were observed with self-controlled case design. However in VAERS most cases were reported within the risk period. (96.5[percnt] vs 3.5[percnt] p< 0.001). Conclusions: There was no significant increase in incidence of GBS after influenza vaccination in the risk period compared to the control period or the general population in the VSD database. There is a significant difference in the distribution of GBS cases between VSD and VAERS. Several factors may explain this discrepancy: VSD is an active surveillance system whereas VAERS is a passive surveillance system, case ascertainment was different between databases and no case in VAERS fulfilled Brighton criteria, all VSD, but not VAERS patients belong to one health care system, and acute event close to the vaccination date are more reported than events occurring late after vaccination.

Clinical Microbiology and Infection
Available online 26 April 2016
Potential safety issues and other factors that may affect the introduction and uptake of rotavirus vaccines
N Aliabadi, JE Tate, UD Parashar
Summary
Rotavirus vaccines have demonstrated significant impact in reducing the burden of morbidity and mortality from childhood diarrhea in countries that have implemented routine vaccination to date. Despite this success, in many countries, rotavirus vaccine coverage remains lower than that of other routine childhood vaccines. Several issues may potentially affect vaccine uptake, namely safety concerns related to intussusception with consequent age restrictions on rotavirus vaccination, contamination with porcine circovirus, vaccine-derived reassortant strains, and hospitalization in newborn nurseries at time of administration of live, oral rotavirus vaccine. In addition to these safety concerns, other factors may also affect uptake, including lower vaccine efficacy in the developing world, potential emergence of strains escaping from vaccine protection resulting in lower overall impact of a vaccination program, and sustainable vaccine financing. Although further work is needed to address some of these concerns, global policy bodies have reaffirmed that the benefits of rotavirus vaccination outweigh the risks and vaccine use is recommended globally.

Health Education
Vol. 116, Issue 4, 2016
Intention of college students to receive the human papillomavirus vaccine
K Richards, K Weare –
Abstract:
Purpose
The current study set out to better understand what influences the intentions of college students to receive the human papillomavirus (HPV) vaccine. HPV is the most common sexually transmitted infection in the U.S. and cancers related to HPV are on the rise.
Design/methodology/approach
A 2×2 experimental design was used to predict the intentions. Messages were created that manipulated the level of severity and vulnerability to determine which would increase intentions to receive the HPV vaccine. Each of the 278 participants viewed a message that contained one severity message (high or low) and one vulnerability message (high or low).
Findings
Regression was used to determine that elements of the protection motivation theory (PMT) such as vulnerability and fear, along with norms, and information seeking explained a significant portion of the variance in intent to be vaccinated (R2=.40, F(4,268)=44.47, p<.001). Norms had the most influence on intention (β = .42, p<.001), next was vulnerability (β = .21, p<.001) then fear (β = .16, p=.002), and finally information seeking (β = .10, p=.01).
Originality/value
The current college age population did not have the opportunity to be vaccinated early and the recent (2011) recommendation that males get vaccinated makes this research valuable to those designing vaccination messages. The current study shows that norms were the most influential variable in regards to increasing intent to get vaccinated.

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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Huffington Post
http://www.huffingtonpost.com/impact/
Accessed 30 April 2016
Vaccines: A Global Health Success Story That Keeps Us On Our Toes
| 26 April 2016
by Flavia Bustreo, WHO ADG and Vice Chair of Gavi, and Marie-Paule Kieny, WHO ADG , Health Systems and Innovation
Suspense and high stakes
It’s no secret that vaccines are considered one of the greatest global health achievements. Every year they avert an estimated 2 to 3 million deaths.

During the last two centuries, vaccines have eradicated smallpox, reduced global child mortality rates, and prevented countless birth defects and lifelong disabilities, such as paralysis from polio.
But, the success story of vaccination is not yet finished.

There’s still a book waiting to be written that’s guaranteed to keep all of us, not just global health experts, up at night. Fortunately, many of the chapters full of suspense, high stakes and perseverance are being written right now…
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New York Times
http://www.nytimes.com/
Accessed 30 April 2016
6 Measles Cases Reported in Memphis Area, Exceeding Rest of U.S.
April 27, 2016 – By DANIEL VICTOR and CATHERINE SAINT LOUIS
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TIME
http://time.com/
Accessed 30 April 2016
Historic Global Vaccine Rollout Could End Polio Forever
27 April 2016
by Walter Orenstein, Associate Director of the Emory Vaccine Center
‘Never before in the history of vaccines have we collaborated on this scale, this quickly’
Let’s start simple: Imagine you need to vaccinate a child against a terrible disease. You acquire and administer the correct dosage to protect that child from a debilitating virus. Now, imagine doing that across a whole city. You train health workers, distribute the vaccine to every health facility, explain the process to parents and monitor closely to make sure all children in the city are being reached. Now, do it for a whole district. A whole country. 155 countries. Do all of that in just two weeks. It’s happening right now, all around the world. Between April 17 and May 1, health workers, governments and communities are working together to execute the largest, fastest effort in history to rollout a vaccine in routine immunization systems, as one of the final steps to end polio forever…
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Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 30 April 2016
Advocates hold NYC protest over price of pneumonia vaccine
April 27, 2016 1:26 pm ET
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Washington Post
http://www.washingtonpost.com/
Accessed 30 April 2016
Congress heads out with no resolution on Zika, Puerto Rico
Congress accomplished relatively little in a short work period, missing deadlines on the budget and on helping Puerto Rico with its financial crisis as lawmakers began a weeklong break.
Andrew Taylor | AP | Business | Apr 30, 2016