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_25 June 2016

– blog edition: comprised of the approx. 35+ entries posted below.

– 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

Zika virus [to 25 June 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

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Zika situation report – 23 June 2016
Full report: http://apps.who.int/iris/bitstream/10665/246112/1/zikasitrep-23Jun2016-eng.pdf?ua=1
Summary [Initial text]
As of 22 June 2016, 61 countries and territories report continuing mosquito-borne transmission (Fig. 1) of which:
:: 47 countries are experiencing a first outbreak of Zika virus since 2015, with no previous evidence of circulation, and with ongoing transmission by mosquitoes.
:: 14 countries reported evidence of Zika virus transmission between 2007 and 2014, with ongoing transmission…

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Zika Open [to 25 June 2016]
[Bulletin of the World Health Organization]
:: All papers available here
No new papers identified.

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CDC/ACIP [to 25 June 2016]
http://www.cdc.gov/media/index.html
MMWR, June 24, 2016 / Vol. 65 / No. 24
:: Screening of Blood Donations for Zika Virus Infection — Puerto Rico, April 3–June 11, 2016
:: Zika Virus Surveillance and Preparedness — New York City, 2015–2016

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WHO European Region EURO
24-06-2016
European countries agree to build on existing systems for rapid response to Zika virus
Countries in Europe need to build on existing systems for vector control, disease surveillance, laboratory testing and emergency risk communications in order to strengthen their preparedness and response to Zika virus, and prevent or contain quickly any outbreak in Europe.

This is the main conclusion reached at a meeting of 18 European countries at high or moderate likelihood of Zika virus transmission. Experts from these countries gathered in Lisbon, Portugal, during 22–24 June 2016 to participate in the WHO regional technical consultation on Zika virus for Europe.

The 80 participants with expertise in epidemiology, entomology, laboratory diagnosis and risk communications found the meeting timely and useful in preparing for a possible Zika virus outbreak. They discussed the experience in responding to Zika virus in Brazil and the Americas as well as in addressing previous vector-borne disease outbreaks in Europe.

They recommended that all four pillars of Zika virus response — vector control, disease surveillance, laboratory testing and emergency risk communications — are better integrated. Interventions should focus on:
:: preparing now and acting early;
:: selecting the most effective interventions in different scenarios of Zika virus transmission and related complications;
:: addressing vector-borne diseases as a whole; and
:: coordinating centrally and acting locally.

Countries called on WHO to support them with guidance, standards, templates and trainings in all pillars of Zika virus preparedness and response. They recommended that the Organization should facilitate sharing of information, expertise and best practice and provide support in case of a Zika virus outbreak.

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NIH [to 25 June 2016]
http://www.nih.gov/news-events/news-releases
June 21, 2016
NIH launches large study of pregnant women in areas affected by Zika virus
International effort to enroll approximately 10,000 women
The National Institutes of Health and Fundacao Oswaldo Cruz-Fiocruz (Fiocruz), a national scientific research organization linked to the Brazilian Ministry of Health, have begun a multi-country study to evaluate the magnitude of health risks that Zika virus infection poses to pregnant women and their developing fetuses and infants. The study is opening in Puerto Rico and will expand to several locations in Brazil, Colombia and other areas that are experiencing active local transmission of the virus.

Zika virus is spread primarily through bites from infected Aedes aegypti mosquitoes, although other forms of transmission — notably, mother-to-child and sexual transmission — also occur. Active virus transmission currently is ongoing in 60 countries and territories. The virus has been linked to a spike in cases of microcephaly, a condition in which babies are born with abnormally small heads and possible neurological damage, sparking international concern. In addition to microcephaly, other problems have been detected in pregnancies and among fetuses and infants infected with Zika virus before birth, including miscarriage, stillbirth, absent or poorly developed brain structures, eye defects, hearing deficits, and impaired growth.

The Zika in Infants and Pregnancy (ZIP) study aims to enroll as many as 10,000 pregnant women ages 15 years and older at up to 15 sites. The participants will be in their first trimester of pregnancy and will be followed throughout their pregnancies to determine if they become infected with Zika virus and if so, what outcomes result for both mother and child. The participants’ infants will be carefully followed for at least one year after birth.

The National Institute of Allergy and Infectious Diseases (NIAID), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the National Institute of Environmental Health Sciences (NIEHS), all part of the NIH, are funding and conducting the study, along with Fiocruz.

“The full scope of the effect of Zika virus in pregnancy has not yet been fully determined,” said NIAID Director Anthony S. Fauci, M.D. “This large prospective study promises to provide important new data that will help guide the medical and public health responses to the Zika virus epidemic.”…

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Wellcome Trust [to 25 June 2016]
http://www.wellcome.ac.uk/News/2016/index.htm
News 23 June 2016
Dengue exposure may ‘amplify’ Zika infection
People who have previously been infected with the dengue virus may be more at risk from Zika.
Early-stage laboratory research, part-funded by Wellcome, suggests that the recent outbreak of Zika in South America may have been driven in part by the high prevalence of dengue in the region.

“We now need further studies to confirm these findings, and to progress towards a vaccine,” said senior author Professor Gavin Screaton from Imperial College London.

Researchers from the UK, France and Thailand found that antibodies the body makes against dengue can also react to the Zika virus.
But instead of clearing the Zika virus, the antibodies instead allow it to enter cells where it can quickly replicate. Higher levels of Zika in the blood may in turn lead to increased transmission of the virus.

This phenomenon, known as antibody-dependent enhancement, is seen also seen in dengue and is thought to explain why a second dengue infection is often more serious than the first.

Dengue and Zika are very similar viruses. They are members of the same virus ‘family’ – called flaviviridae – and both are transmitted by the Aedes mosquito.

The research results appear in two new studies published today in Nature and Nature Immunology.  For more information, please read the Imperial College press release.

EBOLA/EVD [to 25 June 2016]
“Threat to international peace and security” (UN Security Council)

[Editor’s Note:
We deduce that WHO has suspended issuance of new Situation Reports after resuming them for several weekly cycles. Most recent report summary below]

EBOLA VIRUS DISEASE – Situation Report – 10 JUNE 2016
[Excerpt]
Risk assessment:
Guinea and Liberia declared the end of the most recent outbreak of EVD on 1 and 9 June, respectively. The performance indicators suggest that Guinea, Liberia and Sierra Leone still have variable capacity to prevent, detect 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 25 June 2016]
Public Health Emergency of International Concern (PHEIC)

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Polio this week as of 21 June 2016
:: On 24 June, stakeholders of the Global Polio Eradication Initiative including member states and donors are gathering in Geneva at the meeting of the Polio Partners Group to review progress and discuss the trivalent to bivalent oral polio vaccine switch, transition planning and the financial resources urgently needed to see eradication through to the end.

:: The knowledge, skills and infrastructure built to end polio are helping to make dramatic progress on improving children’s health more broadly. In this factsheet discover how the eradication infrastructure is expanding the reach of health services, improving disease surveillance and building health worker capacity. By planning now, we can keep the world polio-free and ensure that the investments made in ending polio have a broad and lasting impact on children’s health and development, long after polio is gone.

Selected Country Levels Updates [excerpted]
No new case reports in affected countries

Yellow Fever [to 25 June 2016]
http://www.who.int/emergencies/yellow-fever/en/

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Launch of emergency vaccination campaigns on the DR Congo and Angola border – WHO
Brazzaville, 22 June 2016 – As the yellow fever outbreak in Angola and Democratic Republic of the Congo continues, the World Health Organization will launch emergency pre-emptive vaccination campaigns on the DR Congo, Angola border and the city of Kinshasa in the DR Congo to halt the epidemic and prevent the risk of further international spread.

The initial phase of the campaign which begins in July will focus on districts where there is high movement of people and intense trade activities, particularly the northern border districts of Angola and targeted border districts in neighbouring countries. Specifically, within a 75-100km belt spanning the border between Angola and DR Congo and targeted health zones/communes at risk in Kinshasa city in the DR Congo. This will create an immune buffer to prevent further international spread.

Important gains in preventive vaccination campaigns have been achieved. So far more than 15 million doses of vaccine have been delivered to Angola and DR Congo. However, the urgent need to accelerate vaccination campaigns and the lack of sufficient funds for field operational activities, remain a challenge in Angola and DR Congo.

“While WHO is working with partners and vaccine manufacturers to increase vaccine production and replenish the emergency stockpile currently being used for this outbreak, it is vital to interrupt transmission, especially in cross-border areas to rapidly bring this outbreak under control and halt further international spread,” said Dr Matshidiso Moeti, the World Health Organization Regional Director for Africa.

Angola and DR Congo are being supported by WHO and partners to strengthen yellow fever screening for evidence at all major points of entry including – Luanda, Kinshasa, Lubumbashi and Matadi. Yellow fever vaccination is being offered at these points of entry for eligible travelers.

“WHO will continue to work with partners to scale up the required human resources, financial and other logistics so that response teams are present in every province of Angola where cases have been reported or where there is high risk. WHO will also continue its resource mobilization efforts as more resources are needed to address the operational challenges in Angola. In addition, to this a multidisciplinary team of experts will next week begin an evaluation of the response efforts in Angola and DR Congo and address any gaps.” the Regional Director added.

As of 13 June 2016, three countries – China, Kenya, and the Democratic Republic of the Congo – had reported cases linked to the Angola outbreak. An alert issued by the Republic of Congo is under investigation by a joint Ministry of Health, WHO and UNICEF team. Two suspected cases of yellow fever earlier reported in Sao Tome and Principe were investigated and have been ruled out. Another outbreak of yellow fever reported in Uganda and not linked to the Angola outbreak has been controlled.

As of 19 June 2016, 1106 suspected cases, including 75 deaths, had been reported in the country in five provinces (Bas-Uélé, Kwango, Tshuapa, Kongo Central and Kinshasa). At least 7 cases are confirmed as locally transmitted. WHO has dispatched multidisciplinary teams to Kongo Central, Kwango and Kinshasa provinces and is supporting the country with active case investigations, reactive vaccination and social mobilization activities.

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Yellow Fever – Situation Report – 16 June 2016
Full Report:
http://www.who.int/emergencies/yellow-fever/situation-reports/23-june-2016/en/

MERS-CoV [to 25 June 2016]

Disease Outbreak News (DONs)
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 22 June 2016
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – United Arab Emirates 21 June 2016
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 21 June 2016
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 19 June 2016

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WHO update and clarification on recent MERS cases reported by the Kingdom of Saudi Arabia
23 June 2016
Between 19-22 June 2016, WHO published 3 reports on the Disease Outbreak News (DON) describing 25 cases of Middle East Respiratory Syndrome (MERS). Twenty-four of the cases were identified as having contact with a probable, single index case who was diagnosed with MERS in a hospital in Riyadh City, Riyadh Region. The 22 June 2016 DON reported that the index case had died.

Based on available information, the probable index case is a woman who presented on 10 June 2016 to the hospital with a critical health condition, not consistent with MERS symptoms. She was triaged in the emergency room of the hospital and admitted to the vascular surgery ward. Following admission the patient showed signs of respiratory illness, and MERS was suspected. The hospital diagnosed and confirmed MERS on 12 June 2016, within 48 hours of her original admission. The patient’s MERS clinical symptoms were initially masked by other predominant symptoms.

Immediately following diagnosis the Ministry of Health of Saudi Arabia dispatched a rapid response team to the hospital. The team conducted active screening and contact tracing to identify health care workers, visitors, patients and household contacts who may have been exposed to MERS by the probable index patient. In addition, other public health control measures were immediately implemented in the hospital to limit further transmission.

As of 22 June 2016 twenty-four (24) contacts have tested positive for MERS including twenty (20) healthcare contacts and three (3) household contacts. In addition, one case has been diagnosed in a household contact of a hospital patient who was diagnosed with the disease after exposure to the probable index case. Twenty (20) of the twenty-four (24) have not exhibited any MERS symptoms.

According to WHO General-Director Margaret Chan “the Kingdom of Saudi Arabia has worked to improve its response to this challenging disease, especially through infection prevention and control in health care facilitates. Diagnosis is often complicated in patients affected by multiple co-morbidities.”

Globally since September 2012 WHO has been notified of over 1,700 laboratory-confirmed cases of infection with MERS, in 27 countries, including more than 600 related deaths…

WHO & Regional Offices [to 25 June 2016]

Health advice for the Rio 2016 Olympic and Paralympic Games
21 June 2016 – WHO, today, releases health advice for the Rio 2016 Olympic and Paralympic Games geared towards national health authorities and health workers. The health advice gives measures travellers can take to be as safe as possible from any public health risk. WHO provides advice and support to host governments preparing for mass gathering events, including major sporting, religious, and cultural events.
:: Read the health advice

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Highlights
Research and development blueprint to prevent epidemics
June 2016 — WHO’s research and development blueprint is a global strategy that accelerates lifesaving R&D during epidemics. The strategy aims to fast-track the availability of effective tests, vaccines and medicines when they are most needed in emergency situations.

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Antiretroviral therapy reduces risk of life-threatening infections from HIV
June 2016 — Two new WHO studies confirm that HIV-related deaths can be dramatically reduced in both adults and children if access to antiretroviral therapy is provided as soon as possible, regardless of the stage of HIV infection. Opportunistic infections are the major cause of death for people with HIV.

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Weekly Epidemiological Record (WER) 24 June 2016, vol. 91, 25 (pp. 317–328)
Contents
317 Maternal and neonatal tetanus validation assessment in Region 4, Indonesia, May 2016

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Disease Outbreak News (DONs)
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 22 June 2016
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – United Arab Emirates 21 June 2016
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 21 June 2016
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 19 June 2016

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:: WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: From refusal to promotion: Religious leaders in Lunda Norte, Angola agree to advocate for yellow fever vaccination
The district health authorities, WHO and the Red Cross on 19 June 2016, met with leaders of one religious group based in Estufa neighbourhood, Chitato district, Lunda North province to explain the importance of yellow fever vaccination in protecting members of their communities from the disease.

The religious group is known for refusing any kind of medical assistance including vaccination. In the first encounter, the religious leaders resisted vaccination on the basis of biblical teachings. However following discussions between WHO and the pastors during which WHO’s mission was explained as Ensuring that all people stay healthy, a common ground was reached. WHO also helped the pastors define the meaning of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The group’s religious leader, Abel Moisés concluded that both the partners and they shared the same mission.
“In accordance with our faith, believers may be vaccinated,” said Moisés.

Moisés proceeded to orient the church members on the benefits of yellow fever vaccination, which they accepted to take. Among those who later went to seek vaccination was a pastor from the group. Since then 711 people have been vaccinated in this community.

The social mobilization team then visited three other churches and requested its religious leaders to share information on the benefits of yellow fever vaccination with the congregation. This helped to mobilize church members for vaccination at the nearby booth.

“Collaborating with religious leaders is a priority for WHO because of their influence in the community.” said Dr Hernando Agudelo, WHO Representative Angola. “By bringing religion and health together, we are able to properly inform communities and mobilize them to protect themselves in order to stop yellow fever in its tracks.”

Vaccine refusal puts members of the community at risk of the country’s yellow fever outbreak. To date 861 cases of yellow fever cases have been confirmed in Angola since December 2015…

:: Launch of emergency vaccination campaigns on the DR Congo and Angola border – 22 June 2016

WHO Region of the Americas PAHO
No new digest content identified.

WHO South-East Asia Region SEARO
No new digest content identified.

WHO European Region EURO
:: European countries agree to build on existing systems for rapid response to Zika virus 24-06-2016
:: WHO/Europe stands with refugees on World Refugee Day 20-06-2016

WHO Eastern Mediterranean Region EMRO
:: Syria reaches 2 million children in first ever deworming campaign 24 June 2016
:: Clarification on a MERS-CoV case in Saudi Arabia 23 June 2016
:: Health advice for the Rio 2016 Olympic and Paralympic Games 21 June 2016

WHO Western Pacific Region
:: 7 Million Deaths Averted through Hepatitis B Vaccination
Hong Kong, 22 June 2016 – New data shows that hepatitis B vaccination across the Western Pacific has averted 7 million deaths that would have occurred among children born between 1990 and 2014. This signifies a tremendous public health achievement for the Region. This significant achievement represents an important step towards the elimination of viral hepatitis as a public health threat in the Western Pacific Region by 2030.

CDC/ACIP [to 25 June 2016]
http://www.cdc.gov/media/index.html

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WEDNESDAY, JUNE 22, 2016
ACIP votes down use of LAIV for 2016-2017 flu season
CDC’s Advisory Committee on Immunization Practices (ACIP) today voted that live attenuated influenza vaccine (LAIV), also known as the “nasal spray” flu vaccine, should not be used during the 2016-2017 flu season. ACIP continues to recommend annual flu vaccination, with either the inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV), for everyone 6 months and older.
ACIP is a panel of immunization experts that advises the Centers for Disease Control and Prevention (CDC). This ACIP vote is based on data showing poor or relatively lower effectiveness of LAIV from 2013 through 2016…

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MMWR, June 24, 2016 / Vol. 65 / No. 24
:: National HIV Testing Day — June 27, 2016
:: Evaluation of the Impact of National HIV Testing Day — United States, 2011–2014
:: Health Care Use and HIV Testing of Males Aged 15–39 Years in Physicians’ Offices — United States, 2009–2012
:: Screening of Blood Donations for Zika Virus Infection — Puerto Rico, April 3–June 11, 2016
:: Zika Virus Surveillance and Preparedness — New York City, 2015–2016

Gavi [to 25 June 2016]
http://www.gavialliance.org/library/news/press-releases/

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23 June 2016
Gavi Board makes decisions on malaria vaccine pilots, health systems, and supply and procurement strategy
At her first Board meeting, Dr. Ngozi Okonjo-Iweala calls on funders to match Gavi’s proposed malaria vaccine pilot commitment

Geneva – Gavi, the Vaccine Alliance is ready to play a role in supporting WHO’s malaria vaccine pilots. The decision, taken today by the Gavi Board, would see up to US$ 27.5 million of support for the first phase of the pilots, provided other organisations come forward to match the Vaccine Alliance’s commitment.

The pilots will provide real-world insight into how the RTS,S malaria vaccine, developed by GSK, could be implemented in Africa, given that three of the four doses of the vaccine will be given outside the normal schedule for childhood vaccinations. They also will generate further evidence on the vaccine’s potential to reduce the death toll from malaria, which claims almost 440,000 lives every year.

WHO is currently finalising the design of the pilots and will select three African locations to begin implementation, as recommended jointly by the Strategic Advisory Group of Experts on Immunisation (SAGE) and the Malaria Policy Advisory Committee (MPAC).

“Gavi is ready to play its part in helping the world to understand the opportunities and challenges of implementing the world’s first malaria vaccine in real life settings,” said Dr Ngozi Okonjo-Iweala, Chair of the Gavi Board. “Malaria’s heavy burden on Africa means it is vital that we understand the impact of this vaccine in communities, as was so powerfully articulated by the African Ministers of Health represented at the Board. We call on others to come forward with sufficient funding to enable the pilots to proceed.”…

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PATH [to 25 June 2016]
http://www.path.org/news/index.php
Press release | June 23, 2016
GSK and PATH welcome commitment by Gavi, the Vaccine Alliance, to co-fund pilot implementation programme for RTS,S malaria vaccine candidate in Africa
UNITAID funding decision expected later this summer

GSK and PATH welcome the commitment by the Board of Gavi, the Vaccine Alliance, to provide up to US$ 27.5 million in co-funding to the World Health Organization (WHO) for a pilot implementation programme for the RTS,S malaria vaccine candidate in sub-Saharan Africa.

This commitment comes as UNITAID’s Executive Board today indicated that providing funding towards the pilot implementation programme aligns with UNITAID’s mandate, but that any funding should be limited and proportionate. This statement paves the way for a funding decision later this summer.

Together, the Gavi and UNITAID announcements represent another critical step towards helping the world’s first malaria vaccine reach young children in Africa. PATH and GSK remain committed to working in partnership with the WHO, Gavi, UNITAID, and other stakeholders to ensure successful implementation of the pilot programme.

In support of the programme, GSK and PATH will collaborate to donate doses of RTS,S for use in the WHO pilots.

Luc Debruyne, President, Vaccines at GSK said: “Gavi’s commitment is a critical milestone in preparation for the pilot programme and in the 30-year effort to bring a malaria vaccine to the children who need it most. We believe that the potential of this vaccine to reduce the burden of disease in sub-Saharan Africa is significant and we welcome the support for the pilot programme to enable us to gain additional information about how best to deliver RTS,S in a real-world setting.”

David C. Kaslow, MD, head of PATH’s Center for Vaccine Innovation and Access and vice president for product development at PATH, said, “The results of Phase 3 studies demonstrated the potential public health impact of RTS,S, when used alongside bed nets and other malaria control interventions, in the setting of clinical trials. Our goal is to work urgently with WHO, GSK, and other partners to further evaluate the full public health impact of RTS,S—as well as aspects of both implementation feasibility and safety—when provided in a routine use setting. Although Gavi’s support comes with contingencies—including that other organizations match its commitment—we are closer to our goal of understanding the full public health value of RTS,S to young children in Africa.”

WHO will provide an estimated US$ 17 million in in-kind contributions and PATH, a grantee of the Bill & Melinda Gates Foundation, will receive a grant of approximately US$ 8 million towards the project. The funds committed by Gavi are for the first phase of the pilot programme and contingent upon WHO securing funding from other sources to fill the remaining gap. The pilot programme will be complementary to the follow-up Phase IV clinical studies; GSK is investing more than US$ 200 million in those studies and other remaining development costs..

Sabin Vaccine Institute [to 25 June 2016]
http://www.sabin.org/updates/ressreleases

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June 22, 2016
Sabin Vaccine Institute Partners with King Saud University to Build Vaccine Research and Development Capacity in Saudi Arabia
WASHINGTON, D.C. —— The Sabin Vaccine Institute is partnering with King Saud University (KSU) in Riyadh, Saudi Arabia, to advance vaccine research and development capacity in the Middle East and North Africa. As part of the new $6.6 million agreement, Saudi scientists will receive technical training in vaccine development at the Sabin Vaccine Institute Product Development Partnership (Sabin PDP) laboratories in Houston, Texas

Global Fund [to 25 June 2016]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=

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24 June 2016
South Africa Seeks to End Epidemics among Women and Girls
PIETERMARITZBURG , South Africa – South Africa’s deputy president Cyril Ramaphosa today launched a national campaign to transform the health of young women and girls in the country.

The new program led by the government and supported by global health partners will go beyond biomedical approaches that seek to prevent young women and girls from HIV and treat those infected with the virus. It will encompass long-term measures that address structural barriers, which predispose young women and girls to diseases.

Despite the great progress made against HIV, tuberculosis and malaria in the last decade, gender inequalities continue to increase women’s and girls’ vulnerability to the diseases. In South Africa in particular, HIV is a significant threat for young women and girls. About 2,500 girls and young women of 15-24 are infected with the virus every week. Young women and girls in that age group are four times likely to become infected with HIV than males of the same group.

“This is a pivotal moment in reaching our National Development Plan goal of a generation free of HIV by 2030, which illustrates South Africa’s commitment to achieving the global target of ending AIDS by 2030,” South Africa’s Health Minister Aaron Motsoaledi said. “We wish to thank the Global Fund, PEPFAR and the German Government for their financial contribution to our national campaign which will assist us to accelerate the implementation of specific programs that target young people in selected districts over the next three years.”…

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21 June 2016
Global Fund Honored with Geneva’s “Vigne des Nations 2016”
GENEVA – The Global Fund to Fight AIDS, Tuberculosis and Malaria has been honored by the Canton of Geneva and awarded the “Vigne des Nations”, a symbolic recognition given every year to an international organization that contributes to reinforce Geneva’s international commitment…

During this event, the Republic and Canton of Geneva recognized the Global Fund for its engagement in the fight against AIDS, tuberculosis, malaria and in building resilient and sustainable systems for health and for the organization’s contribution to the larger family that is known as “Geneva International”.

The recognition of the “Vigne des Nations 2016” also comes at a very significant time for the Global Fund, as it only a few days ago participated in the stone-setting ceremony for Geneva’s new Health Campus, a building in Grand-Saconnex that will house several health organizations, including the Global Fund. The new offices to be rented by the Global Fund will deliver substantial savings to the organization through lower rental costs…

European Medicines Agency [to 25 June 2016]
http://www.ema.europa.eu/

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24/06/2016
Meeting highlights from the Committee for Medicinal Products for Human Use (CHMP) 20-23 June 2016
Six new medicines, including one cell-based therapy, recommended for approval ..

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22/06/2016
EMA and FDA reinforce collaboration on patient engagement
New working group established to exchange best practices
The European Medicines Agency (EMA) and the United States Food and Drug Administration (FDA) have set up a new ‘cluster’ on patient engagement. The cluster will provide a forum to share experiences and best practices on the way the two agencies involve patients in development, evaluation and post-authorisation activities related to medicines.

Patients bring real-life experience, as well as specific knowledge and expertise, to scientific discussions on medicines and on the impact of regulatory decisions. Therefore, their involvement is a priority for both agencies.

“Our aim as regulators is to make sure that patients have access to safe and effective medicines that improve their lives. It is important to engage to be able to fully understand their needs and priorities and make their voice heard along a medicine’s lifecycle,” explains Guido Rasi, EMA Executive Director. “Many of the challenges and benefits of working with patients are similar for both regulators. We look forward to increasing our collaboration with FDA in this area in order to benefit from each other’s experiences, and to advance patient involvement.”

The first meeting of the cluster took place by teleconference on 22 June 2016…

EDCTP  [to 25 June 2016]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials.

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23 June 2016
Fit for Health 2.0 to organise a webinar on grant agreement preparation for EDCTP2 projects
Fit for Health 2.0 will host a webinar to address the challenges of negotiating the grant and consortium agreement for…

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22 June 2016
EDCTP 2016 stakeholder meetings on Diarrhoeal Diseases & Lower Respiratory Tract Infections
EDCTP will hold two stakeholder meetings on Diarrhoeal Diseases and Lower Respiratory Tract Infections on 5 and 6 July, respectively….

Industry Watch [to 25 June 2016]

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:: CDC Advisory Committee On Immunization Practices Votes To Recommend Vaxchora, PaxVax’s Single-Dose Oral Cholera Vaccine
Vaxchora™ is the only licensed vaccine in the U.S. for protection against cholera
June 23, 2016
REDWOOD CITY, Calif.–(BUSINESS WIRE)–PaxVax today announced that the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) voted yesterday on a recommendation for the use of Vaxchora™, a single-dose oral, live attenuated cholera vaccine indicated for use in adults 18 to 64 years of age. Vaxchora received marketing approval from the United States (U.S.) Food and Drug Administration (FDA) on June 10, 2016.

The ACIP voted unanimously at their June 22 meeting to recommend Vaxchora for the prevention of toxigenic Vibrio cholerae O1 for travelers to areas of active cholera transmission. The Category A recommendation made by the ACIP for Vaxchora will be forwarded to the director of the CDC and the U.S. Department of Health and Human Services for review and approval. Once approved, the recommendations will be published in the Morbidity and Mortality Weekly Report (MMWR). Category A recommendations are made for all persons in an age- or risk-factor-based group.

“Cholera is an underestimated disease that is found in many popular global travel destinations in the Caribbean, Africa and Asia. Until now, U.S. travelers have not had access to a vaccine to help protect against this potentially deadly pathogen,” said Lisa Danzig, M.D., Vice President, Clinical Development and Medical Affairs. “We are very proud to offer the only licensed vaccine against cholera and are encouraged by the ACIP’s recommendation which recognizes the value of Vaxchora as an important option for the protection of adults traveling to cholera-affected areas.”…

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:: Takeda Initiates World’s First Norovirus Vaccine Field Trial
Vaccine candidate will target the leading cause of acute gastroenteritis around the globe
June 20, 2016
OSAKA, Japan–(BUSINESS WIRE)–Takeda Pharmaceutical Company Limited (“Takeda”) today announced that it has dosed the first subject in a Phase 2b field efficacy trial of Takeda’s norovirus vaccine candidate (TAK-214), the only norovirus vaccine candidate in human clinical trials.

The Phase 2b, double-blind, randomized, placebo-controlled trial involves healthy male or female adults aged 18 – 49 years. It will evaluate the efficacy of intramuscular administration of Takeda’s norovirus vaccine candidate against moderate or severe acute gastroenteritis (AGE) due to norovirus, a common intestinal infection marked by watery diarrhea, vomiting, abdominal cramps, nausea and sometimes fever that may lead to clinically significant dehydration.1,2

Norovirus is recognized as the leading cause of acute gastroenteritis across the age spectrum.3 It is estimated that norovirus causes nearly 700 million cases of illness3 with significant morbidity and social burden worldwide. More than 200,000 deaths per year are estimated to result from norovirus illness, primarily in low-income countries.”…

Reports/Research/Analysis/Commentary/Conferences/Meetings/Book Watch/Tenders
Vaccines and Global Health: The Week in Review has expanded its coverage of new reports, books, research and analysis published independent of the journal channel covered in Journal Watch below. Our interests span immunization and vaccines, as well as global public health, health governance, and associated themes. If you would like to suggest content to be included in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

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1st International Vaccines Against Shigella and ETEC (VASE) Conference
June 28-30, Washington, DC
PATH
The inaugural Vaccines Against Shigella and ETEC (VASE) Conference will bring together scientists, public health professionals, immunization leaders, vaccine industry representatives, international donors, and other experts from across the globe to work toward the goal of developing and introducing new enteric vaccines.

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USAID Releases Plan to Save 8 Million Women and Children & Commits Funds To Strengthen Community Health
Tuesday, June 21, 2016
Washington, D.C. – Today, USAID released the third annual Acting on the Call report, which details how a renewed focus on the poorest 40% of the population can save the lives of 8 million women and children by 2020. The report also announces Burma as the twenty fifth priority country for USAID’s effort to end preventable child and maternal death. Alongside the report, USAID announced a new $9.2 million program – Integrating Community Health – which will leverage an additional $10 million investment from other sources and is designed to strengthen the role of community health in USAID’s efforts to end preventable child and maternal deaths.
This third annual Acting on the Call report provides country-by-country updates on progress made over the past year in priority countries, which together account for more than two-thirds of the child and maternal deaths worldwide. The report also examines how to accelerate progress through an equity based approach, describing what can be achieved if the bottom two wealth quintiles have the same opportunities and access to health interventions as the rest of the population…

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Fight Against Bite: ASEAN committed in battle against Dengue
BANGKOK, 22 June 2016 – …The two-day activity commenced with an ASEAN Dengue Conference, which discussed updates on the management of dengue, including information on the development and use of the dengue vaccine. There were deliberations on the progress of the regional dengue situation as well as the initiatives to promote community empowerment through sustaining the fight against dengue and other disease prevention and control in ASEAN. A “Bangkok Call for Action on the Prevention and Control of Dengue” was finalised to enhance the cause….

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Lack of action on Non-Communicable Diseases damaging Pacific economies: World Bank
June 20, 2016 -PRESS RELEASE
New World Bank report highlights the potential economic burden of NCDs in the Pacific
NUKU’ALOFA, June 20, 2016 – A new World Bank report has put the spotlight on the economic threat non-communicable diseases (NCDs) pose to the Pacific Islands, with heart disease, cancer, diabetes and chronic respiratory disease emerging as the top killers in the region.

The draft report, Pacific Possible: Health and Non-Communicable Diseases, was released for public comment today at the Pacific NCDs Summit in the Tongan capital Nuku’alofa. It shows that the economic burden of NCDs continues to rise in the Pacific. It projects that if no action is taken, the economic loss due to NCD mortality across 11 Pacific Island countries will reach between 8.5 and 14.3 percent of gross domestic product by 2040. The costs of NCD morbidity could increase, on average, from 13.2 percent of gross domestic product in 2015 to 18.8 percent by 2040.

“NCDs are a major public health issue in the Pacific region. Their economic burden is much greater in the Pacific Island countries than the global average,” said report lead author and World Bank senior health economist, Xiaohui Hou. “The number of Pacific Islanders affected by these conditions will continue to rise unless we work together to reduce unhealthy habits and ensure limited health resources are delivering the most value for the greatest number of people.”

The report also raises concerns over the long term financial sustainability of public health expenditures in the region, given that Pacific countries already spend a greater share of government funds on health care than the average across lower-middle incomes countries worldwide.

The report includes a number of key recommendations that Pacific Island governments could consider to help inform public health policies aimed at reducing NCDs, which directly cause up to 77 percent of deaths in the Pacific and are a major reason for premature deaths…

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

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 25 June 2016)

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Research article
The swine flu vaccine, public attitudes, and researcher interpretations: a systematic review of qualitative research
Benedicte Carlsen and Claire Glenton
Published on: 24 June 2016
Abstract
Background
During pandemics, health authorities may be uncertain about the spread and severity of the disease and the effectiveness and safety of available interventions. This was the case during the swine flu (H1N1) pandemic of 2009–2010, and governments were forced to make decisions despite these uncertainties. While many countries chose to implement wide scale vaccination programmes, few accomplished their vaccination goals. Many research studies aiming to explore barriers and facilitators to vaccine uptake have been conducted in the aftermath of the pandemic, including several qualitative studies.
Aims
1.To explore public attitudes to the swine flu vaccine in different countries through a review of qualitative primary studies.
2. To describe and discuss the implications drawn by the primary study authors.
Methods
Systematic review of qualitative research studies, using a broadly comparative cross case-study approach. Study quality was appraised using an adaptation of the Critical Appraisal Skills Programme (CASP) quality assessment tool.
Results
The review indicates that the public had varying opinions about disease risk and prevalence and had concerns about vaccine safety. Most primary study authors concluded that participants were uninformed, and that more information about the disease and the vaccine would have led to an increase in vaccine uptake. We find these conclusions problematic. We suggest instead that people’s questions and concerns were legitimate given the uncertainties of the situation at the time and the fact that the authorities did not have the necessary information to convince the public. Our quality assessment of the included studies points to a lack of reflexivity and a lack of information about study context. We suggest that these study weaknesses are tied to primary study authors’ lack of acknowledgement of the uncertainties surrounding the disease and the vaccine.
Conclusion
While primary study authors suggest that authorities could increase vaccine uptake through increased information, we suggest instead that health authorities should be more transparent in their information and decision-making processes in future pandemic situations.

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 25 June 2016)
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Research article
Clinical features of suspected Ebola cases referred to the Moyamba ETC, Sierra Leone: challenges in the later stages of the 2014 outbreak
The last ebola virus disease (EVD) outbreak has been the most important since 1976. EVD cases decreased drastically in Sierra Leone at the beginning of 2015. We aim to determine the clinical findings and evolu…
Javier Arranz, Karen Marie Lundeby, Shoaib Hassan, Luis Matías Zabala Fuentes, Pedro San José Garcés, Yngvar Lunde Haaskjold, Hakon Angell Bolkan, Kurt Osthuus Krogh, James Jongopi, Sindre Mellesmo, Ola Josendal, Asmund Opstad, Erling Svensen, Alfred Sandy Kamara, David P. Roberts, Paul D. Stamper…
BMC Infectious Diseases 2016 16:308
Published on: 22 June 2016

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Debate
Towards cash transfer interventions for tuberculosis prevention, care and control: key operational challenges and research priorities
Cash transfer interventions are forms of social protection based on the provision of cash to vulnerable households with the aim of reduce risk, vulnerability, chronic poverty and improve human capital.
Delia Boccia, Debora Pedrazzoli, Tom Wingfield, Ernesto Jaramillo, Knut Lönnroth, James Lewis, James Hargreaves and Carlton A. Evans
BMC Infectious Diseases 2016 16:307
Published on: 21 June 2016

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BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 25 June 2016)

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Research article
Modeling the spread of polio in an IPV-vaccinated population: lessons learned from the 2013 silent outbreak in southern Israel
Rami Yaari, Ehud Kaliner, Itamar Grotto, Guy Katriel, Jacob Moran-Gilad, Danit Sofer, Ella Mendelson, Elizabeth Miller, Amit Huppert, E. Anis, E. Kopel, Y. Manor, O. Mor, L. Shulman, R. Singer and M. Weil
BMC Medicine 2016 14:95
Published on: 23 June 2016
Abstract
Background
Polio eradication is an extraordinary globally coordinated health program in terms of its magnitude and reach, leading to the elimination of wild poliovirus (WPV) in most parts of the world. In 2013, a silent outbreak of WPV was detected in Israel, a country using an inactivated polio vaccine (IPV) exclusively since 2005. The outbreak was detected using environmental surveillance (ES) of sewage reservoirs. Stool surveys indicated the outbreak to be restricted mainly to children under the age of 10 in the Bedouin population of southern Israel. In order to curtail the outbreak, a nationwide vaccination campaign using oral polio vaccine (OPV) was conducted, targeting all children under 10.
Methods
A transmission model, fitted to the results of the stool surveys, with additional conditions set by the ES measurements, was used to evaluate the prevalence of WPV in Bedouin children and the effectiveness of the vaccination campaign. Employing the parameter estimates of the model fitting, the model was used to investigate the effect of alternative timings, coverages and dosages of the OPV campaign on the outcome of the outbreak.
Results
The mean estimate for the mean reproductive number was 1.77 (95 % credible interval, 1.46–2.30). With seasonal variation, the reproductive number maximum range was between zero and six. The mean estimate for the mean infectious periods was 16.8 (8.6–24.9) days. The modeling indicates the OPV campaign was effective in curtailing the outbreak. The mean estimate for the attack rate in Bedouin children under 10 at the end of 2014 was 42 % (22–65 %), whereas without the campaign the mean projected attack rate was 57 % (35–74 %). The campaign also likely shortened the duration of the outbreak by a mean estimate of 309 (2–846) days. A faster initiation of the OPV campaign could have reduced the incidence of WPV even if a lower coverage was reached, at the risk of prolonging the outbreak.
Conclusions
OPV campaigns are essential for interrupting WPV transmission, even in a developed country setting with a high coverage of IPV. In this setting, establishing ES of WPV circulation is particularly crucial for early detection and containment of an outbreak.

BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content
(Accessed 25 June 2016)

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Research article
Involving hard-to-reach ethnic minorities in low-budget health research: lessons from a health survey among Moluccans in the Netherlands
Adee J. Bodewes and Anton E. Kunst
BMC Research Notes 2016 9:319
Published on: 21 June 2016
Abstract
Background
There is little evidence on which strategies are effective in recruiting minority groups in low-budget health surveys. We evaluated different recruitment strategies for their impact on response rates in a hard-to-reach minority population in the Netherlands.
Methods
We conducted a health survey in 19 Moluccan districts (MDs). Each MD had its own set of recruitment strategies, such as information meetings, involving social or local media, involving community organizations, and door-to-door collection. The association between recruitment strategies and MD-specific response rates was assessed with logistic regression analysis.
Results
The overall response rate was 24 %, and varied from 9 to 58 %. Higher rates were obtained when the strategy included door-to-door collection (OR 1.57) and ‘active’ key informants (OR 1.68). No positive associations with response rates were observed of the other strategies.
Conclusions
The overall low response rate in this study may be due to high levels of distrust, segmentation within the community and high respect for privacy among Moluccans. Our study shows that in such communities, response may be increased by a highly personal recruitment approach and a strong commitment and participation of community key-figures.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 25 June 2016]

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Research
Local and foreign authorship of maternal health interventional research in low- and middle-income countries: systematic mapping of publications 2000–2012
Matthew F. Chersich, Duane Blaauw, Mari Dumbaugh, Loveday Penn-Kekana, Ashar Dhana, Siphiwe Thwala, Leon Bijlmakers, Emily Vargas, Elinor Kern, Francisco Becerra-Posada, Josephine Kavanagh, Priya Mannava, Langelihle Mlotshwa, Victor Becerril-Montekio, Katharine Footman and Helen Rees
Published on: 23 June 2016
Abstract
Background
Researchers in low- and middle-income countries (LMICs) are under-represented in scientific literature. Mapping of authorship of articles can provide an assessment of data ownership and research capacity in LMICs over time and identify variations between different settings.
Methods
Systematic mapping of maternal health interventional research in LMICs from 2000 to 2012, comparing country of study and of affiliation of first authors. Studies on health systems or promotion; community-based activities; and haemorrhage, hypertension, HIV/STIs and malaria were included. Following review of 35,078 titles and abstracts, 2292 full-text publications were included. Data ownership was measured by the proportion of articles with an LMIC lead author (author affiliated with an LMIC institution).
Results
The total number of papers led by an LMIC author rose from 45.0/year in 2000–2003 to 98.0/year in 2004–2007, but increased only slightly thereafter to 113.1/year in 2008–2012. In the same periods, the proportion of papers led by a local author was 58.4 %, 60.8 % and 60.1 %, respectively. Data ownership varies markedly between countries. A quarter of countries led more than 75 % of their research; while in 10 countries, under 25 % of publications had a local first author. Researchers at LMIC institutions led 56.6 % (1297) of all papers, but only 26.8 % of systematic reviews (65/243), 29.9 % of modelling studies (44/147), and 33.2 % of articles in journals with an Impact Factor ≥5 (61/184). Sub-Saharan Africa authors led 54.2 % (538/993) of studies in the region, while 73.4 % did in Latin America and the Caribbean (223/304). Authors affiliated with United States (561) and United Kingdom (207) institutions together account for a third of publications. Around two thirds of USAID and European Union funded studies had high-income country leads, twice as many as that of Wellcome Trust and Rockefeller Foundation.
Conclusions
There are marked gaps in data ownership and these have not diminished over time. Increased locally-led publications, however, does suggest a growing capacity in LMIC institutions to analyse and articulate research findings. Differences in author attribution between funders might signal important variations in funders’ expectations of authorship and discrepancies in how funders understand collaboration. More stringent authorship oversight and reconsideration of authorship guidelines could facilitate growth in LMIC leadership. Left unaddressed, deficiencies in research ownership will continue to hinder alignment between the research undertaken and knowledge needs of LMICs.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 25 June 2016]

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Research
Training the next generation of global health experts: experiences and recommendations from Pacific Rim universities
Mellissa Withers, David Press, Heather Wipfli, Judith McCool, Chang-Chuan Chan, Masamine Jimba, Christopher Tremewan and Jonathan Samet
Published on: 23 June 2016
Abstract
Background
Finding solutions to global health problems will require a highly-trained, inter-disciplinary workforce. Global health education and research can potentially have long-range impact in addressing the global burden of disease and protecting and improving the health of the global population.
Methods
We conducted an online survey of twelve higher education institutions in the Pacific Rim that spanned the period 2005–2011. Program administrators provided data on program concentrations, student enrollment and student funding opportunities for 41 public health programs, including those specific to global health.
Results
The Master of Public Health (MPH) was the most common degree offered. A growing demand for global health education was evident. Enrollment in global health programs increased over three-fold between 2005–2011. Very few institutions had specific global health programs or offered training to undergraduates. Funding for student scholarships was also lacking.
Conclusions
The growing demand for global health education suggests that universities in the Pacific Rim should increase educational and training opportunities in this field. Schools of medicine may not be fully equipped to teach global health-related courses and to mentor students who are interested in global health. Increasing the number of dedicated global health research and training institutions in the Pacific Rim can contribute to building capacity in the region. Faculty from different departments and disciplines should be engaged to provide multi-disciplinary global health educational opportunities for undergraduate and graduate students. New, innovative ways to collaborate in education, such as distance education, can also help universities offer a wider range of global health-related courses. Additional funding of global health is also required.

Health and Human Rights
Volume 18, Issue 1, June 2016
http://www.hhrjournal.org/

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Special Section: Tuberculosis and the Right to Health
in collaboration with the International Human Rights Clinic, University of Chicago Law School
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Editorial: Developing a Human Rights-Based Approach to Tuberculosis
Brian Citro, Evan Lyon, Mihir Mankad, Kiran Raj Pandey, and Camila Gianella, Guest Editors

Falling Short of the Rights to Health and Scientific Progress: Inadequate TB Drug Research and Access
Mike Frick, Ian Henry, and Erica Lessem

TB in Vulnerable Populations: The Case of an Indigenous Community in the Peruvian Amazon
Camila Gianella, César Ugarte-Gil, Godofredo Caro, Rula Aylas, César Castro, and Claudia Lema

Double Standards in Global Health: Medicine, Human Rights Law, and Multidrug-Resistant TB Treatment Policy
Thomas Nicholson, Catherine Admay, Aaron Shakow, and Salmaan Keshavjee

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Perspective Essays on TB and the Right to Health
Petition 329: A Legal Challenge to the Involuntary Confinement of TB Patients in Kenyan Prisons
Allan Maleche and Nerima Were

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General Papers
An Independent Review and Accountability Mechanism for the Sustainable Development Goals: The Possibilities of a Framework Convention on Global Health
Eric A. Friedman

Essential Medicines in National Constitutions: Progress Since 2008
S. Katrina Perehudoff, Brigit Toebes, and Hans Hogerzeil

Human Trafficking Identification and Service Provision in the Medical and Social Service Sectors
Corinne Schwarz, Erik Unruh, Katie Cronin, Sarah Evans-Simpson, Hannah Britton, and Megha Ramaswamy

Indigenous Child Health in Brazil: The Evaluation of Impacts as a Human Rights Issue
Anna R. Coates, Sandra del Pino Marchito, and Bernardino Vitoy

Assessing and Improving Children’s Rights in Hospitals: Case Studies from Kyrgyzstan, Tajikistan, and Moldova
Ana Isabel Fernandes Guerreiro, Aigul Kuttumuratova, Kubanychbek Monolbaev, Larisa Boderscova, Zulfiya Pirova, and Martin W. Weber

Human Rights-Based Approaches to Mental Health: A Review of Programs
Sebastian Porsdam Mann, Valerie J. Bradley, and Barbara J. Sahakian

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Perspective Essays
Medical Hostages: Detention of Women and Babies in Hospitals
Delan Devakumar and Rob Yates

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 25 June 2016]

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Short Report
Good laboratory practices guarantee biosafety in the Sierra Leone-China friendship biosafety laboratory
Qin Wang, Wei-Min Zhou, Yong Zhang, Huan-Yu Wang, Hai-Jun Du, Kai Nie, Jing-Dong Song, Kang Xiao, Wen-Wen Lei, Jian-Qiang Guo, He-Jiang Wei, Kun Cai, Yan-Hai Wang, Jiang Wu, Gerard Kamara, Idrissa Kamara…
Published on: 23 June 2016
Abstract
Background
The outbreak of Ebola virus disease (EVD) in West Africa between 2014 and 2015 was the largest EDV epidemic since the identification of Ebola virus (EBOV) in 1976, and the countries most strongly affected were Sierra Leone, Guinea, and Liberia.
Findings
The Sierra Leone-China Friendship Biological Safety Laboratory (SLE-CHN Biosafety Lab), a fixed Biosafety Level 3 laboratory in the capital city of Sierra Leone, was established by the Chinese government and has been active in EBOV detection since 11 March 2015. Complete management and program documents were created for the SLE-CHN Biosafety Lab, and it was divided into four zones (the green, yellow, brown, and red zones) based on the risk assessment. Different types of safe and appropriate personnel protection equipment (PPE) are used in different zones of the laboratory, and it fully meets the Biosafety Level 3 laboratory standards of the World Health Organization.
Conclusion
Good preparedness, comprehensive risk assessment and operation documents, appropriate PPE, effective monitoring and intensive training, together with well-designed and reasonable laboratory sectioning are essential for guaranteeing biosafety.

International Journal of Infectious Diseases
July 2016 Volume 48, p1-124 Open Access
http://www.ijidonline.com/current

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Editorial
Why is the yellow fever outbreak in Angola a ‘threat to the entire world’?
J.P. Woodall, T.M. Yuill
p96–97
Published online: May 6 2016
Preview
The short answer to the World Health Organization (WHO) declaration is because yellow fever has spread throughout the country, causing probably thousands of cases and hundreds of deaths, and the world has run out of vaccine. This is very bad because cases so far have been imported into the Democratic Republic of the Congo (DRC), Mauritania, Kenya, and even China, the first time in history that cases have been confirmed in Asia. In fact, more travelers infected with yellow fever have now been seen than in the last 50 years, each one with the potential to spread it on arrival, and still further to more countries worldwide via international airlines.

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Reviews
Traditional and syndromic surveillance of infectious diseases and pathogens
Cédric Abat, Hervé Chaudet, Jean-Marc Rolain, Philippe Colson, Didier Raoult
p22–28
Published online: April 30 2016
Preview
Classified as the second leading cause of death in humans by the World Health Organization, with approximately 15 million deaths worldwide every year,1 infectious diseases remain a serious public health problem in the 21st century. Among them, HIV/AIDS, tuberculosis, and malaria have been nicknamed the ‘big three’ because of their important impact on global human health. In 2011, tuberculosis infected two billion people and killed 1.3 million, malaria infected 207 million people and killed 62 700, and HIV infected 35.3 million people and killed 1.6 million.

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Original Papers
Yellow fever vaccination status and safety in hemodialysis patients
Tila Facincani, Maia Nogueira Crown Guimarães, Sigrid De Sousa dos Santos
p91–95
Published online: May 18 2016
Preview
The live attenuated yellow fever vaccine seems to be safe in patients on hemodialysis in a transition area.

The Lancet
Jun 25, 2016 Volume 387 Number 10038 p2575-2664 e30
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
What can public health do for mental health?
The Lancet
Summary
Public health practitioners should prioritise and advance the public’s mental health wherever possible, argues Better Mental Health For All, a report published last week by the UK’s Faculty of Public Health, in collaboration with the Mental Health Foundation. The report aims to be a resource for public health professionals to support the promotion of mental wellbeing and the primary prevention of mental ill health.

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Comment
Who should finance WHO’s work on emergencies?
Y-Ling Chi, Jaya Krishnakumar, Jürgen Maurer, Dejan Loncar, Antoine Flahault
Summary
In May, 2015, the 68th World Health Assembly approved the decision to reform the work of WHO on emergencies by creating a single programme for outbreaks and health emergencies, and an accompanying Contingency Fund for Emergencies (CFE).1 According to latest estimations, the core funding needs for the programme and the initial capital of the CFE will, respectively, range about US$300 million per year and $100 million.2 To respond effectively to emergencies, these resources should be flexible, predictable, and directly accessible.

New England Journal of Medicine
June 23, 2016 Vol. 374 No. 25
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
From Patient to Patient — Sharing the Data from Clinical Trials
Charlotte J. Haug, M.D., Ph.D.
N Engl J Med 2016; 374:2409-2411 June 23, 2016 DOI: 10.1056/NEJMp1605378
[Excerpt]
…Instead of spending time and resources on complicated techniques to try to deidentify and anonymize complex patient data — and risk failing and making populations or patient groups skeptical about the whole concept of data sharing — it may be better to define a core set of data that can be released (and freely accessed) from all trials and to allow sharing of the more complex data only through real and inclusive collaborations, the way successful data sharing related to specific diseases already happens in global health today. “It is not only about sharing of the raw data, but sharing of the questions, the problems, and the code that everybody is using,” Shasha Jumbe said. “It means collaborations throughout the whole process, definition of the goals, framing of the questions — and also thinking about inclusive attribution all the way from subjects that are part of these studies to the data science team.”

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Perspective
A Global, Neutral Platform for Sharing Trial Data
Barbara E. Bierer, M.D., Rebecca Li, Ph.D., Mark Barnes, J.D., LL.M., and Ida Sim, M.D., Ph.D.
N Engl J Med 2016; 374:2411-2413 June 23, 2016 DOI: 10.1056/NEJMp1605348

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 25 June 2016)

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Essay
Why Most Clinical Research Is Not Useful
John P. A. Ioannidis
Essay | published 21 Jun 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002049
Summary Points
:: Blue-sky research cannot be easily judged on the basis of practical impact, but clinical research is different and should be useful. It should make a difference for health and disease outcomes or should be undertaken with that as a realistic prospect.
:: Many of the features that make clinical research useful can be identified, including those relating to problem base, context placement, information gain, pragmatism, patient centeredness, value for money, feasibility, and transparency.
:: Many studies, even in the major general medical journals, do not satisfy these features, and very few studies satisfy most or all of them. Most clinical research therefore fails to be useful not because of its findings but because of its design.
:: The forces driving the production and dissemination of nonuseful clinical research are largely identifiable and modifiable.
:: Reform is needed. Altering our approach could easily produce more clinical research that is useful, at the same or even at a massively reduced cost.

PLoS One
http://www.plosone.org/
[Accessed 25 June 2016]
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Health and Ethical Consequences of Outsourcing Pivotal Clinical Trials to Latin America: A Cross-Sectional, Descriptive Study
Núria Homedes, Antonio Ugalde
Research Article | published 23 Jun 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0157756
Abstract
Introduction
The implications of conducting clinical trials in low and middle income countries on the financial accessibility and safety of the pharmaceutical products available in those markets have not been studied. Regulatory practices and ethical declarations lead to the commercialization of the new products, referred to as New Molecular Entities (NMEs), in the countries where tested as soon as they are approved in high surveillance countries. Patients and patients’ associations use the Latin American courts to access new and expensive treatments, regardless of their safety profile and therapeutic value.
Design and Objectives
Cross-sectional, descriptive study. To determine the therapeutic value and safety profile of the NMEs approved by the Food and Drug Administration (FDA) in 2011 and 2012 that had been tested in Latin America, and the implications of their market approval for the pharmaceutical budgets in the countries where tested.
Setting
Latin America.
Measures
To assess the therapeutic value and safety of the NMEs commercialized in the different countries we used f independent drug bulletins. The prices of the NMEs for the consumers were obtained from the pharmaceutical price observatories of the countries were the medicines had been tested. If the price was not available in the observatories, it was obtained from pharmaceutical distributors. We used the countries’ minimum wage and per capita income to calculate the financial accessibility of a course of treatment with the NMEs.
Results
We found that 33 NMEs approved by the FDA in 2011 and 2012 have been tested in Latin America. Of these, 26 had been evaluated by independent drug bulletins and only five were found to add some value to a subset of patients and had significant side-effects. The pharmaceutical prices were very high, varied widely across countries and were unrelated to the countries’ income per capita or minimum wage.
Conclusion
The implementation of clinical trials in Latin America results in the commercialization of medicines with questionable safety profiles and limited therapeutic value, putting patients at risk and causing budgetary strains in pharmaceutical budgets.

PLoS One
http://www.plosone.org/
[Accessed 25 June 2016]
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Hitting the Optimal Vaccination Percentage and the Risks of Error: Why to Miss Right
Michael J. Harvey, Lisa A. Prosser, Mark L. Messonnier, David W. Hutton
Research Article | published 22 Jun 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0156737
Abstract
Objective
To determine the optimal level of vaccination coverage defined as the level that minimizes total costs and explore how economic results change with marginal changes to this level of coverage.
Methods
A susceptible-infected-recovered-vaccinated model designed to represent theoretical infectious diseases was created to simulate disease spread. Parameter inputs were defined to include ranges that could represent a variety of possible vaccine-preventable conditions. Costs included vaccine costs and disease costs. Health benefits were quantified as monetized quality adjusted life years lost from disease. Primary outcomes were the number of infected people and the total costs of vaccination. Optimization methods were used to determine population vaccination coverage that achieved a minimum cost given disease and vaccine characteristics. Sensitivity analyses explored the effects of changes in reproductive rates, costs and vaccine efficacies on primary outcomes. Further analysis examined the additional cost incurred if the optimal coverage levels were not achieved.
Results
Results indicate that the relationship between vaccine and disease cost is the main driver of the optimal vaccination level. Under a wide range of assumptions, vaccination beyond the optimal level is less expensive compared to vaccination below the optimal level. This observation did not hold when the cost of the vaccine cost becomes approximately equal to the cost of disease.
Discussion and Conclusion
These results suggest that vaccination below the optimal level of coverage is more costly than vaccinating beyond the optimal level. This work helps provide information for assessing the impact of changes in vaccination coverage at a societal level.

PLoS One
http://www.plosone.org/
[Accessed 25 June 2016]
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Research Article
Use of Seasonal Influenza Vaccination and Its Associated Factors among Elderly People with Disabilities in Taiwan: A Population-Based Study
Yu-Chia Chang, Ho-Jui Tung, Shang-Wei Hsu, Lei-Shin Chen, Pei-Tseng Kung, Kuang-Hua Huang, Shang-Jyh Chiou, Wen-Chen Tsai
| published 23 Jun 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0158075
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Cost-Effectiveness of Increasing Influenza Vaccination Coverage in Adults with Type 2 Diabetes in Turkey
Levent Akın, Bérengère Macabéo, Zafer Caliskan, Serdar Altinel, Ilhan Satman
Research Article | published 20 Jun 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0157657

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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Original Articles
Lifestyle Vaccines and Public Health: Exploring Policy Options for a Vaccine to Stop Smoking
Anna Wolters, Guido de Wert, Onno C. P. van Schayck, and Klasien Horstman
Public Health Ethics (2016) 9 (2): 183-197 doi:10.1093/phe/phw004
Abstract
Experimental vaccines are being developed for the treatment of ‘unhealthy lifestyles’ and associated chronic illnesses. Policymakers and other stakeholders will have to deal with the ethical issues that this innovation path raises: are there morally justified reasons to integrate these innovative biotechnologies in future health policies? Should public money be invested in further research? Focusing on the case of an experimental nicotine vaccine, this article explores the ethical aspects of ‘lifestyle vaccines’ for public health. Based on findings from a qualitative study into a vaccine for smoking cessation, the article articulates possible value conflicts related to nicotine vaccination as an intervention in tobacco control. The ‘vaccinization’ of lifestyle disease piggybacks on the achievements of classic vaccines. Contrary to expectations of simplicity and success, quitting smoking with a vaccine requires a complex supportive network. Social justice and public trust may become important ethical challenges when deciding whether to use further public funds for research or whether to implement these innovative vaccines in the future.

Science
24 June 2016 Vol 352, Issue 6293
http://www.sciencemag.org/current.dtl

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Policy Forum
Capitalizing on convergence for health care
By Phillip Sharp, Tyler Jacks, Susan Hockfield
Science24 Jun 2016 : 1522-1523
Summary
For decades, scientists have called for more collaboration between the life and physical sciences, and in the past 5 years, we have been among those calling for a new national research strategy—one we call “convergence”—that would integrate engineering, physical, computational, and mathematical sciences with biomedical science (1). Thanks to the accelerating pace of biological discovery, the expanding power of computation, and a new focus in engineering on biocompatible materials and nanotechnology, the potential of such a strategy for advances in health care is greater than ever (see the photo). Technologies emerging from such efforts have potential implications far beyond health care: creating jobs; speeding products to market; and improving everything from agriculture and the environment to defense, the economy, and energy production. It all adds up to a moment of unprecedented opportunity, if we choose to invest in it meaningfully. But so far we have not. We detail below, and in greater depth in a new report with colleagues from across the country (2), the stakes in the convergence revolution and what we should do to capitalize on it.

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Review
Childhood undernutrition, the gut microbiota, and microbiota-directed therapeutics
By Laura V. Blanton, Michael J. Barratt, Mark R. Charbonneau, Tahmeed Ahmed, Jeffrey I. Gordon
Science24 Jun 2016 : 1533
Editor’s Summary
Gut microbiota and undernutrition
Poor nutrition during the early years of life can have severe consequences for subsequent skeletal, immunological, and intellectual development. Blanton et al. review the evidence showing that undernutrition is not caused by food insecurity alone. Other factors range from the length of the breastfeeding period and the availability of milk oligosaccharides, enteropathogen exposure, and enteric dysfunction marked by villus atrophy and loss of gut barrier function. Unfortunately, nutritional restoration with or without antibiotic treatment may not be effective in the longer term. Differences in the succession of microbial establishment and maturity can explain much of family discordances in nutritional status. The evidence indicates that microbiota-directed therapeutics could be a promising route to nutritional restoration in these children

Vaccine
Volume 34, Issue 29, Pages 3331-3434 (17 June 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/29

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Barriers to timely administration of birth dose vaccines in The Gambia, West Africa
Original Research Article
Pages 3335-3341
Reiko Miyahara, Momodou Jasseh, Pierre Gomez, Yusuke Shimakawa, Brian Greenwood, Karamba Keita, Samba Ceesay, Umberto D’Alessandro, Anna Roca
Abstract
Objective
Although vaccine coverage in infants in sub-Saharan Africa is high, this is estimated at the age of 6–12 months. There is little information on the timely administration of birth dose vaccines. The objective of this study was to assess the timing of birth dose vaccines (hepatitis B, BCG and oral polio) and reasons for delayed administration in The Gambia.
Methods
We used vaccination data from the Farafenni Health and Demographic Surveillance System (FHDSS) between 2004 and 2014. Coverage was calculated at birth (0–1 day), day 7, day 28, 6 months and 1 year of age. Logistic regression models were used to identify demographic and socio-economic variables associated with vaccination by day 7 in children born between 2011 and 2014.
Results
Most of the 10,851 children had received the first dose of hepatitis B virus (HBV) vaccine by the age of 6 months (93.1%). Nevertheless, only 1.1% of them were vaccinated at birth, 5.4% by day 7, and 58.4% by day 28. Vaccination by day 7 was associated with living in urban areas (West rural: adjusted OR (AOR) = 6.13, 95%CI: 3.20–11.75, east rural: AOR = 6.72, 95%CI: 3.66–12.33) and maternal education (senior-educations: AOR = 2.43, 95%CI: 1.17–5.06); and inversely associated with distance to vaccination delivery points (≧2 km: AOR = 0.41, 95%CI: 0.24–0.70), and Fula ethnicity (AOR = 0.60, 95%CI: 0.40–0.91).
Conclusion
Vaccine coverage in The Gambia is high but infants are usually vaccinated after the neonatal period. Interventions to ensure the implementation of national vaccination policies are urgently needed.

Vaccine
Volume 34, Issue 29, Pages 3331-3434 (17 June 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/29

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Contributions and challenges for worldwide vaccine safety: The Global Advisory Committee on Vaccine Safety at 15 years
Original Research Article
Pages 3342-3349
Edwin J. Asturias, Melinda Wharton, Robert Pless, Noni E. MacDonald, Robert T. Chen, Nicholas Andrews, David Salisbury, Alexander N. Dodoo, Kenneth Hartigan-Go, Patrick L.F. Zuber
Abstract
In 1999, the Global Advisory Committee on Vaccine Safety (GACVS) was established by the World Health Organization (WHO) to provide independent scientific advice on issues relating to the safety of vaccines and immunization. Fifteen years onward, we conducted a multi-faceted review to evaluate the impact, reach and challenges facing GACVS, including the role GACVS plays in informing global, regional and WHO member state vaccine policy. The methods included measures of organizational structure, citation impact, themes approached, and a discussion by previous and current members to evaluate past, present and future challenges. Given the increasing range of data sources and the deployment of many new vaccines, the Committee is facing the complex task of identifying the best available evidence for recommendations on vaccine safety. To help meet the increased demand for public transparency in decision making, GACVS-structured methodology for evidence-based decisions is evolving. GACVS also promotes best practices and capacity building for timely and accurate risk assessment; risk communications; outreach to help countries maintain and, if needed, rebuild public trust in vaccines; and advocacy for bridging the major gaps in vaccine safety capacity globally.

Vaccine
Volume 34, Issue 29, Pages 3331-3434 (17 June 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/29

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Continuous active surveillance of adverse events following immunisation using SMS technology
Original Research Article
Pages 3350-3355
Darren W. Westphal, Stephanie A. Williams, Alan Leeb, Paul V. Effler
Abstract
Introduction
On-going post-licensure surveillance of adverse events following immunisation (AEFI) is critical to detecting and responding to potentially serious adverse events in a timely manner. SmartVax is a vaccine safety monitoring tool that uses automated data extraction from existing practice management software and short message service (SMS) technology to follow-up vaccinees in real-time. We report on childhood vaccine safety surveillance using SmartVax at a medical practice in Perth, Western Australia.
Methods
Parents of all children under age five years who were vaccinated according to the Australian National Immunisation Schedule between November 2011 and June 2015 were sent an SMS three days post administration to enquire whether the child had experienced a suspected vaccine reaction. Affirmative replies triggered a follow-up SMS requesting details of the reaction(s) via a link to a survey that could be completed using a smartphone or the web. Rates of reported AEFI including fever, headache, fatigue, rash, vomiting, diarrhoea, rigours, seizures, and local reactions were calculated by vaccination time point.
Results
Overall, 239 (8.2%; 95% CI 7.2–9.2%) possible vaccine reactions were reported for 2897 vaccination visits over the 44 month time period. The proportion of children experiencing a possible AEFI, mostly local reactions, was significantly greater following administration of diphtheria–tetanus–pertussis–poliomyelitis vaccine at 4 years of age (77/441; 17.5%; 95% CI 13.9–21.0%) compared to the vaccinations given at 2–18 months (p < 0.001). Across all time points, local reactions and fatigue were the most frequently reported AEFI.
Conclusion
Automated SMS-based reporting can facilitate sustainable, real-time, monitoring of adverse reactions and contribute to early identification of potential vaccine safety issues.

Vaccine
Volume 34, Issue 29, Pages 3331-3434 (17 June 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/29

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Epidemiological impact and cost-effectiveness of universal vaccination with Bexsero® to reduce meningococcal group B disease in Germany
Original Research Article
Pages 3412-3419
Hannah Christensen, Tom Irving, Judith Koch, Caroline L. Trotter, Bernhard Ultsch, Felix Weidemann, Ole Wichmann, Wiebke Hellenbrand
Abstract
Bexsero, a new vaccine against serogroup B meningococcal disease (MenB), was licensed in Europe in January 2013. In Germany, Bexsero is recommended for persons at increased risk of invasive meningococcal disease, but not for universal childhood vaccination. To support decision making we adapted the independently developed model for England to the German setting to predict the potential health impact and cost-effectiveness of universal vaccination with Bexsero® against MenB disease. We used both cohort and transmission dynamic mathematical models, the latter allowing for herd effects, to consider the impact of vaccination on individuals aged 0–99 years. Vaccination strategies included infant and adolescent vaccination, alone or in combination, and with one-off catch-up programmes. German specific data were used where possible from routine surveillance data and the literature. We assessed the impact of vaccination through cases averted and quality adjusted life years (QALY) gained and calculated costs per QALY gained. Assuming 65% vaccine uptake and 82% strain coverage, infant vaccination was estimated to prevent 15% (34) of MenB cases over the lifetime of one birth cohort. Including herd effects from vaccination increased the cases averted by infant vaccination to 22%, with an estimated 8461 infants requiring vaccination to prevent one case. In the short term the greatest health benefit is achieved through routine infant vaccination with large-scale catch-up, which could reduce cases by 24.9% after 5 years and 27.9% after 10 years. In the long term (20+ years) policies including routine adolescent vaccination are most favourable if herd effects are assumed. Under base case assumptions with a vaccine list price of €96.96 the incremental cost-effectiveness ratio (ICER) was >€500,000 per QALY for all considered strategies. Given the current very low incidence of MenB disease in Germany, universal vaccination with Bexsero® would prevent only a small absolute number of cases, at a high overall cost.

Vaccine
Volume 34, Issue 29, Pages 3331-3434 (17 June 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/29

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Successive introduction of four new vaccines in Rwanda: High coverage and rapid scale up of Rwanda’s expanded immunization program from 2009 to 2013
Original Research Article
Pages 3420-3426
Maurice Gatera, Sunil Bhatt, Fidele Ngabo, Mathilde Utamuliza, Hassan Sibomana, Corine Karema, Cathy Mugeni, Cameron T. Nutt, Sabin Nsanzimana, Claire M. Wagner, Agnes Binagwaho
Abstract
As the pace of vaccine uptake accelerates globally, there is a need to document low-income country experiences with vaccine introductions. Over the course of five years, the government of Rwanda rolled out vaccines against pneumococcus, human papillomavirus, rotavirus, and measles & rubella, achieving over 90% coverage for each. To carry out these rollouts, Rwanda’s Ministry of Health engaged in careful review of disease burden information and extensive, cross-sectoral planning at least one year before introducing each vaccine. Rwanda’s local leaders, development partners, civil society organizations and widespread community health worker network were mobilized to support communication efforts. Community health workers were also used to confirm target population size. Support from Gavi, UNICEF and WHO was used in combination with government funds to promote country ownership and collaboration. Vaccination was also combined with additional community-based health interventions. Other countries considering rapid consecutive or simultaneous rollouts of new vaccines may consider lessons from Rwanda’s experience while tailoring the strategies used to local context.

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 25 June 2016
A Surprising Link Between Zika and Dengue
23 June 2016
New research finds some dengue fever antibodies can help neutralize Zika—but they can also make Zika infections worse.

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New York Times
http://www.nytimes.com/
Accessed 25 June 2016
Dr. Jonas Salk and the Continuing Battle Against Polio
22 June 2016
Scientists racing to develop a vaccine against Zika virus disease this summer may be hoping for results like those of Dr. Jonas Salk, creator of the first successful vaccine against poliomyelitis. Dr. Salk died on this day in 1995 at the age of 80, decades after the polio vaccine he developed helped vanquish the deadly, paralyzing disease throughout much of the world. News that the polio vaccine worked in a field trial involving 440,000 American children, announced at a University of Michigan news conference on April 12, 1955, “caused a public sensation probably unequaled by any health development in modern times,” Harold M. Schmeck Jr. wrote in his New York Times obituary of Dr. Salk.

Abortion Pill Orders Rise in 7 Latin American Nations on Zika Alert
22 June 2016
Orders for abortion pills by women in seven Latin American countries with Zika outbreaks increased after health officials in those countries warned that the virus might cause severe birth defects, according to a women’s organization supplying such pills. Orders from women in Brazil, Ecuador and Venezuela roughly doubled, while those from Colombia, Costa Rica, El Salvador and Honduras went up by from 36 percent to 76 percent, researchers said in a study published Wednesday by The New England Journal of Medicine. The authors of the study included a leader of the group based in Amsterdam that is supplying the pills, Women on Web, a nonprofit staffed by doctors helping women from countries where abortion is illegal or restricted to terminate unwanted pregnancies.

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Washington Post
http://www.washingtonpost.com/
Accessed 25 June 2016
Editorial
The critical public-health benefits of the HPV vaccine
By Editorial Board June 22
A DECADE ago, the world of medical research celebrated the introduction of the first vaccine proven to protect people from an identified cancer-causing agent. Studies over subsequent years affirmed the effectiveness and safety of the HPV vaccine and its potential to spare tens of thousands of people from having to suffer horrible cancers. Yet, inexcusably, pediatricians and family doctors remain reluctant to recommend the vaccine. A new campaign targeting these doctors aims to boost use of this lifesaving vaccine.

Concern about the limited use of the HPV vaccine in the United States is not new; only 40 percent of teenage girls and 22 percent of teenage boys have been fully inoculated, according to the latest figures from the Centers for Disease Control and Prevention. From the start, there was controversy about the vaccine, much of it ill-informed. Not surprisingly, much of the misinformation had to do with sex. Because the vaccine prevents the most common sexually transmitted infections linked to the human papillomavirus, which in turn can cause cancer later in life, there was talk that use of the vaccine might encourage teenage promiscuity. There’s no evidence to support that illogical proposition.

A group of the nation’s leading oncologists is hoping to reframe the debate, reports The Post’s Laurie McGinley. They want to put the focus on cancer prevention, and they are directing their efforts at pediatricians and family doctors, identified by researchers as the main obstacle to wider inoculation. The vaccine is recommended for preteens and is important for both girls and boys. Most cervical cancer in women is caused by HPV infections, and the infections can also result in anal, penile and throat cancers.
According to Lois Ramondetta of MD Anderson Cancer Center in Houston, doctors who are not recommending the vaccine are not doing their job. “It’s the equivalent,” she said, “of having patients in their 50s and not recommending a colonoscopy — and then having them come back with cancer.”

Doctors need to heed that sound advice, and further efforts must be made throughout society to tear down misconceptions about the HPV vaccine and to encourage its use. In particular, states that were scared off early on from including the vaccine in the portfolio of shots required (with parental opt-out) for school attendance should revisit this critical public-health issue.

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_18 June 2016

– blog edition: comprised of the approx. 35+ entries posted below.

– 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

Zika virus [to 18 June 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

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WHO statement on the third meeting of the International Health Regulations (2005) (IHR(2005)) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations
WHO statement
14 June 2016
The third meeting of the Emergency Committee (EC) convened by the Director-General under the International Health Regulations (2005) (IHR 2005) regarding microcephaly, other neurological disorders and Zika virus was held by teleconference on 14 June 2016, from 13:00 to 17:15 Central European Time. In addition to providing views to the Director-General on whether the event continued to constitute a Public Health Emergency of International Concern (PHEIC), the Committee was asked to consider the potential risks of Zika transmission for mass gatherings, including the Olympic and Paralympic Games scheduled for August and September 2016, respectively, in Rio de Janeiro, Brazil.

The Committee was briefed on the implementation of the Temporary Recommendations issued by the Director-General on 8 March 2016 and updated on the epidemiology and association of Zika virus infection, microcephaly and Guillain-Barré Syndrome (GBS) since that time. The following States Parties provided information on microcephaly, GBS and other neurological disorders occurring in the presence of Zika virus transmission: Brazil, Cabo Verde, Colombia, France, and the United States of America. Advisors to the Committee provided further information on the potential risks of Zika virus transmission associated with mass gatherings and the upcoming Olympic and Paralympic Games, and the Committee thoroughly reviewed the range of public perspectives, opinions and concerns that have recently been aired on this subject.

The Committee concurred with the international scientific consensus, reached since the Committee last met, that Zika virus is a cause of microcephaly and GBS, and, consequently, that Zika virus infection and its associated congenital and other neurological disorders is a Public Health Emergency of International Concern (PHEIC). The Committee restated the advice it provided to the Director-General in its 2nd meeting in the areas of public health research on microcephaly, other neurological disorders and Zika virus, surveillance, vector control, risk communications, clinical care, travel measures, and research and product development.

The Committee noted that mass gatherings, such as the Olympic and Paralympic Games, can bring together substantial numbers of susceptible individuals, and can pose a risk to the individuals themselves, can result in the amplification of transmission and can, potentially, contribute to the international spread of a communicable disease depending on its epidemiology, the risk factors present and the mitigation strategies that are in place. In the context of Zika virus, the Committee noted that the individual risks in areas of transmission are the same whether or not a mass gathering is conducted, and can be minimized by good public health measures. The Committee reaffirmed and updated its advice to the Director-General on the prevention of infection in international travellers as follows:

:: Pregnant women should be advised not to travel to areas of ongoing Zika virus outbreaks; pregnant women whose sexual partners live in or travel to areas with Zika virus outbreaks should ensure safe sexual practices or abstain from sex for the duration of their pregnancy,

:: Travellers to areas with Zika virus outbreaks should be provided with up to date advice on potential risks and appropriate measures to reduce the possibility of exposure through mosquito bites and sexual transmission and, upon return, should take appropriate measures, including practicing safer sex, to reduce the risk of onward transmission,

:: The World Health Organization should regularly update its guidance on travel with evolving information on the nature and duration of risks associated with Zika virus infection.

Based on the existing evidence from the current Zika virus outbreak, it is known that this virus can spread internationally and establish new transmission chains in areas where the vector is present. Focusing on the potential risks associated with the Olympic and Paralympic Games, the Committee reviewed information provided by Brazil and Advisors specializing in arboviruses, the international spread of infectious diseases, travel medicine, mass gatherings and bioethics. The Committee concluded that there is a very low risk of further international spread of Zika virus as a result of the Olympic and Paralympic Games as Brazil will be hosting the Games during the Brazilian winter when the intensity of autochthonous transmission of arboviruses, such as dengue and Zika viruses, will be minimal and is intensifying vector-control measures in and around the venues for the Games which should further reduce the risk of transmission.

The Committee reaffirmed its previous advice that there should be no general restrictions on travel and trade with countries, areas and/or territories with Zika virus transmission, including the cities in Brazil that will be hosting the Olympic and Paralympic Games. The Committee provided additional advice to the Director-General on mass gatherings and the Olympic and Paralympic Games as follows:
:: Countries, communities and organizations that are convening mass gatherings in areas affected by Zika virus outbreaks should undertake a risk assessment prior to the event and increase measures to reduce the risk of exposure to Zika virus,
:: Brazil should continue its work to intensify vector control measures in and around the cities and venues hosting Olympic and Paralympic Games events, make the nature and impact of those measures publicly available, enhance surveillance for Zika virus circulation and the mosquito vector in the cities hosting the events and publish that information in a timely manner, and ensure the availability of sufficient insect repellent and condoms for athletes and visitors,
:: Countries with travellers to and from the Olympic and Paralympic Games should ensure that those travellers are fully informed on the risks of Zika virus infection, the personal protective measures that should be taken to reduce those risks, and the action that they should take if they suspect they have been infected. Countries should also establish protocols for managing returning travellers with Zika virus infection based on WHO guidance,
:: Countries should act in accordance with guidance from the World Health Organization on mass gatherings in the context of Zika virus outbreaks, which will be updated as further information becomes available on the risks associated with Zika virus infection and factors affecting national and international spread.

Based on this advice the Director-General declared the continuation of the Public Health Emergency of International Concern (PHEIC). The Director-General reissued the Temporary Recommendations from the 2nd meeting of the Committee, endorsed the additional advice from the Committee’s 3rd meeting, and issued them as Temporary Recommendations under the IHR (2005). The Director-General thanked the Committee Members and Advisors for their advice.

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Zika virus outbreak global response – Updated 17 June 2016
WHO/PAHO and partners have set out their strategic response to Zika which will place a greater focus on preventing and managing medical complications caused by Zika virus infection. To date, US$121.9 million are necessary to effectively implement the Zika Strategic Response Plan, July 2016 to December 2017.

The revised Zika Strategic Response Plan includes a greater focus on preventing and managing medical complications caused by Zika virus infection and expanding health systems’ capacities for that purpose. Risk communication targeting pregnant women, their partners, households and communities will be central to prevention efforts to ensure they have the information they need to protect themselves.

Other elements include integrated vector management, sexual and reproductive health counselling as well as health education and care within the social and legal contexts of each country where Zika virus is being transmitted.

The plan highlights several specific characteristics of the Zika outbreak that require a collaborative, global response and support. These include:
:: the potential for further international spread of Zika virus given the wide distribution of Aedes mosquitoes that are capable of transmitting Zika virus,
:: the lack of population immunity in areas where Zika virus is circulating for the first time and which allows the disease to spread quickly,
:: the absence of vaccines, specific treatments and rapid diagnostic tests, and
:: inequalities in access to sanitation, information and health services in affected areas.
Read the “Strategic Response Plan”

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Zika situation report – 16 June 2016
Full report: http://apps.who.int/iris/bitstream/10665/242439/1/zikasitrep-16Jun2016-eng.pdf?ua=1

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Zika Open [to 18 June 2016]
[Bulletin of the World Health Organization]
:: All papers available here
No new papers identified.

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CDC/ACIP [to 18 June 2016]
http://www.cdc.gov/media/index.html
FRIDAY, JUNE 17, 2016
CDC Telebriefing: Zika Update
Transcripts for CDC Telebriefing Zika Screening Blood Donations for Zika Virus to Protect Blood Update

THURSDAY, JUNE 16, 2016•
CDC Begins Reporting Pregnancy and Birth Outcomes of Women Affected by Zika Virus During Pregnancy – Media Statement
The Centers for Disease Control and Prevention (CDC) will begin reporting poor outcomes of pregnancies with laboratory evidence of possible Zika virus infection. Starting today, CDC will report two types of outcomes:
:: Live-born infants with birth defects and
:: Pregnancy losses with birth defects
These numbers for US states and the District of Columbia come from the U.S. Zika Pregnancy Registry. In coming weeks, CDC will begin reporting Zika-linked poor pregnancy outcomes in the U.S. territories…

EBOLA/EVD [to 18 June 2016]
“Threat to international peace and security” (UN Security Council)

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[No new Situation Report…last report as below]
EBOLA VIRUS DISEASE – Situation Report – 10 JUNE 2016
[Excerpt]
Risk assessment:
Guinea and Liberia declared the end of the most recent outbreak of EVD on 1 and 9 June, respectively. The performance indicators suggest that Guinea, Liberia and Sierra Leone still have variable capacity to prevent, detect 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 18 June 2016]
Public Health Emergency of International Concern (PHEIC)

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Polio this week as of 15 June 2016
:: The knowledge, skills and infrastructure built to end polio are helping to make dramatic progress on improving children’s health more broadly. In this factsheet discover how the eradication infrastructure is expanding the reach of health services, improving disease surveillance and building health worker capacity. By planning now, we can keep the world polio-free and ensure that the investments made in ending polio have a broad and lasting impact on children’s health and development, long after polio is gone.

:: Next week, stakeholders of the Global Polio Eradication Initiative including member states and donors will gather in Geneva at the meeting of the Polio Partners Group to review progress and discuss the trivalent to bivalent oral polio vaccine switch, transition planning and the financial resources urgently needed to see eradication through to the end.

Selected Country Levels Updates [excerpted]
Afghanistan
:: One new case of wild poliovirus type 1 (WPV1) was reported in the past week in Shigal Wa Sheltan district of Kunar with onset of paralysis on 29 May. The total number of WPV1 cases for 2016 is now six compared to three at this time last year.

Yellow Fever [to 18 June 2016]
http://www.who.int/emergencies/yellow-fever/en/

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Yellow Fever – Situation Report – 16 June 2016
Full Report:
http://apps.who.int/iris/bitstream/10665/242438/1/yellowfeversitrep-16Jun2016-eng.pdf?ua=1

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Lower doses of yellow fever vaccine could be used in emergencies
WHO statement
17 June 2016
The yellow fever vaccine given as one fifth of the regular dose could be used to control an outbreak in case of vaccine shortages.

Experts agreed with this proposal at a meeting convened by WHO to consider potential shortages in yellow fever vaccine due to the outbreak in Angola and Democratic Republic of the
Congo.

WHO Strategic Advisory Group of Experts (SAGE) on Immunization reviewed existing evidence that demonstrates that using a fifth of a standard vaccine dose would still provide protection against the disease for at least 12 months and possibly much longer.

Fractional dosing; a short term measure
This approach, known as fractional dosing, is under consideration as a short-term measure, in the context of a potential vaccine shortage for use in emergencies. This approach is not proposed for routine immunization, as there is not yet enough data available to show that lower doses would confer the life-long protection provided by a vaccination with one full dose.

“Yellow fever outbreaks in Angola, Democratic Republic of the Congo and Uganda are placing unprecedented demands on vaccine supply for emergency vaccination campaigns to control the spread of the disease,” says Jon Abramson, chair of the WHO Strategic Advisory Group of Experts (SAGE) on Immunization.

“Right now we have enough vaccines in the global stockpile to cope with the ongoing outbreaks if there are no further extensions. However, given the wide spread of the disease in Angola and the potential for it to get out of control in the city of Kinshasa, in the Democratic Republic of the Congo, WHO and partners are seriously considering the use of this dose-sparing strategy to prevent transmission through large-scale vaccination campaigns.”

Vaccine shortages in urban outbreaks
At the request of the Emergency Committee regarding yellow fever convened by WHO’s Director-General on 19 May, the WHO secretariat has been exploring options, based on existing evidence, on ways to increase vaccine supply in case of urgent need.

SAGE was asked to review the evidence and options presented by WHO. A formal evaluation and recommendations by SAGE on the use of lower doses of yellow fever vaccine are planned for October 2016.

In the interim, SAGE found that the available evidence is sufficient to determine that fractional dosing of yellow fever vaccine to one fifth of the standard dose (0.1ml instead of 0.5ml) could be a safe and effective option for mass vaccination campaigns to control urban outbreaks in situations of acute vaccine shortage.

More research is needed to find out whether fractional doses would be effective in young children, who may have a weaker immune response to yellow fever vaccine.

Practical issues on administering the reduced doses need further investigation, including obtaining the necessary supply of suitable syringes.

International Health Regulations require full dose for travellers
Yellow fever is the only disease specified in the International Health Regulations (IHR) for which countries may require proof of vaccination from travellers as a condition of entry. The IHR were amended in 2014 to indicate that a single dose of the vaccine is sufficient for life-long immunity and therefore extends the validity of vaccination certificates to the life of the person vaccinated. All countries must abide by this new amendment when it enters into force on 11 July 2016.

A yellow fever vaccine given at a fractional dose would not qualify for a yellow fever certificate under the IHR requirements. Travellers will need to obtain the full dose of the vaccine to be eligible for the yellow fever certificate.

Global supply
WHO has prequalified yellow fever vaccines from 4 different vaccine manufacturers which together produce an annual volume of around 80-90 million doses. Prequalification means that vaccines and medicines meet WHO’s high standards of quality, safety and efficacy.

The global stockpile, funded by Gavi, the Vaccine Alliance, has 6 million doses for emergency use per year and this has already been depleted twice since February of this year. To date, WHO and partners have sent around 18 million vaccine doses to Angola, Democratic Republic of the Congo and Uganda for emergency use to control the current outbreaks.

In addition to fractional dosing, WHO’s SAGE group is looking at ways to prevent yellow fever outbreaks on a long-term basis by strengthening mass vaccination catch-up campaigns in conjunction with improving routine childhood immunization in countries with yellow fever.

WHO’s response strategy to the ongoing outbreaks requires coordinated work with partners in five areas: surveillance and risk assessment, vaccination, case management, social mobilization and risk communication and vector control.

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Yellow fever global vaccine stockpile in emergencies
16 June 2016
When a major outbreak of yellow fever hits, countries urgently need vaccine supplies to control the spread of the disease. By mid-June 2016, almost 18 million doses of yellow fever vaccine have been distributed in emergency vaccination campaigns in Angola, Democratic Republic of the Congo, and Uganda. If countries do not have sufficient yellow fever vaccine supplies, they can access the global stockpile of emergency vaccines….

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Disease Outbreak News (DONs)
:: Yellow fever – Angola 14 June 2016

WHO & Regional Offices [to 18 June 2016]

Highlights
Launch of the 2016 Global Nutrition Report
June 2016 –The Global Nutrition Report examines the world’s nutrition and the efforts to improve it. It assesses progress in meeting Global Nutrition Targets established by the World Health Assembly, and provides current information from global, regional and country perspectives. WHO is a Global Nutrition Report Partner.

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Disease Outbreak News (DONs)
:: Chikungunya – United States of America 14 June 2016
:: Yellow fever – Angola 14 June 2016
:: Lassa Fever – Benin 13 June 2016

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:: WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Yellow fever global vaccine stockpile in emergencies – 17 June 2016
:: WHO African Region Programme Subcommittee meeting begins in Brazzaville, Congo – 14 June 2016

WHO Region of the Americas PAHO
No new digest content identified.

WHO South-East Asia Region SEARO
:: WHO South-East Asia Region continues to be polio-free 18 June 2016

WHO European Region EURO
:: Celebrating 20 years of the Ljubljana Charter 16-06-2016
:: Slovenia’s substantial and sustained health gains revealed in new reports 16-06-2016
:: Conclusions of the third meeting of the Emergency Committee regarding microcephaly, other neurological disorders and Zika virus 15-06-2016
:: Blood connects us all – blood donation text message service in Sweden 14-06-2016

WHO Eastern Mediterranean Region EMRO
:: WHO expresses concern over disease outbreaks in its response to Fallujah crisis
Baghdad, 16 June 2016: WHO Regional Director for the Eastern Mediterranean Dr Ala Alwan arrived in Baghdad yesterday to review firsthand WHO’s response to the unfolding humanitarian crisis in Fallujah city, where more than 42,000 Iraqis have been displaced since the beginning of the military operations in the city in May 2016. Tens of thousands of besieged and displaced men, women, children and older people face major health risks as they lack adequate access to health services.
:: Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations 14 June 2016
::: WHO reaches more people in need with lifesaving treatments in Duma 13 June 2016

WHO Western Pacific Region
:: Tenofovir reduces mother-to-child transmission of hepatitis B: new study
GENEVA, 16 JUNE 2016 – New study findings published today confirm that antiviral therapy with tenofovir in late pregnancy can result in a 3-fold reduction in mother-to-child transmission (MTCT) of hepatitis B virus (HBV), when used in combination with immunoglobulin and HBV vaccine at birth…

CDC/ACIP [to 18 June 2016]
http://www.cdc.gov/media/index.html
FRIDAY, JUNE 17, 2016
CDC Telebriefing: Zika Update
Transcripts for CDC Telebriefing Zika Screening Blood Donations for Zika Virus to Protect Blood Update

THURSDAY, JUNE 16, 2016•
CDC Begins Reporting Pregnancy and Birth Outcomes of Women Affected by Zika Virus During Pregnancy – Media Statement
The Centers for Disease Control and Prevention (CDC) will begin reporting poor outcomes of pregnancies with laboratory evidence of possible Zika virus infection. Starting today, CDC will report two types of outcomes:
:: Live-born infants with birth defects and
:: Pregnancy losses with birth defects
These numbers for US states and the District of Columbia come from the U.S. Zika Pregnancy Registry. In coming weeks, CDC will begin reporting Zika-linked poor pregnancy outcomes in the U.S. territories…

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June ACIP meeting
June 22-23, 2016
Deadline for registration:
:: Non-US Citizens: May 20, 2016
:: US Citizens: June 6, 2016
Registration is NOT required to watch the live meeting webcast or to listen via telephone.
Draft June 22-23, 2016 Meeting Agenda[2 pages]

IRAQ
REGULAR PRESS BRIEFING BY THE INFORMATION SERVICE 17 June 2016
UNOG – UN Office at Geneva
[Excerpts; Text bolding by Editor]
Iraq
Tarik Jasarevic, for the World Health Organization (WHO), introduced Dr Ala Alwan, WHO Regional Director for the Eastern Mediterranean, speaking by phone from Iraq. Dr Alwan had been visiting displaced people from Fallujah over the past few days. He said that more than 40,000 people had been displaced in Amiriyat Fallujah, from the outskirts of Fallujah city. The WHO team had visited almost all the camps housing the thousands of families who had left Fallujah during the recent events. Some of the camps were housing people who had fled from Ramadi, following the military operations there. Most of the IDPs in the camps had left Fallujah in recent days. Fallujah had not been accessible to any humanitarian actors in more than a year, which was extremely worrisome. There were still an estimated 30,000 to 40,000 people inside the city. Some of them were beginning to leave today, and there was a flow of different people reaching parts of the region…

…Mothers had told the WHO team that their children had not been vaccinated for the past two years, which was of great concern, as those children were at risk of outbreaks of preventable diseases, such as polio. The team had seen one- to three-year-olds who had never been vaccinated. WHO had started immediately preparing for a massive vaccination campaign against polio and measles to all displaced children from zero to 15 years of age.

A major concern was the spread of diseases due to overcrowding and an inadequate hygiene situation, with a lack of sufficient sanitation. Water was now available in the camps and WHO was trying to monitor the quality of water. The lack of electricity in many places was another complicated issue being discussed with the Government. WHO was working closely with UNICEF on the water and sanitation issues in the camps…

…In response to questions, Dr Alwan said that in the camps WHO was providing routine immunization services, but had also decided that a regular, comprehensive campaign was needed covering the age group from zero to 15 years of age to reduce the possibility of disease outbreaks. WHO wanted to cover all the IDPs, all the children in the camps in existence today and those where the newcomers from Fallujah would go. The current camps in Amiriyat Fallujah were almost completely full now and newcomers were being directed to new camps in two different regions: Khalidiya and the Habbaniyah Tourist City. The immunization campaign would cover all those places.

Dr Alwan also said that the estimated total number of IDPs in the different camps was around 70,000, and it did not include those who would still come out of Fallujah. There was no precise estimation of the number of children as of yet, but it would be over 50 per cent of the population….

AERAS [to 18 June 2016]
http://www.aeras.org/pressreleases

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May 23, 2016
Aeras Provides Update on Phase 2 Trial (C-040-404/TUB09) of H4:IC31
Rockville, MD,– The Sanofi Pasteur-Aeras Joint Steering Committee for the Phase 2 trial (C-040-404/TUB09) convened on 14 June 2016 to review and discuss the recommendations of the study’s independent Data Monitoring Committee (DMC).

The DMC, which met on 02 June 2016, reviewed unblinded safety and efficacy data and concluded that the trial had been well conducted to date and that the data was of good quality. There were no safety concerns of note. The DMC recommends that follow-up be continued as per protocol with a further DMC review close to the end of follow-up…

Sabin Vaccine Institute [to 18 June 2016]
http://www.sabin.org/updates/ressreleases

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06.16.16
Peer Exchange Builds Momentum for Sustainable Immunization Financing in Africa
Immunization is one of the most cost-effective ways to save lives – preventing over 2 million child deaths each year. With the recent introduction of new vaccines, countries need to spend US$60 or more per infant to fully immunize, far more than what is traditionally spent on such programs in low-income countries. As vaccine science advances, nations must adapt their vaccine policies and mobilize more resources. The Sabin Vaccine Institute’s Sustainable Immunization Financing (SIF) program highlights the efforts of national institutions and lawmakers in this area. As they increase their domestic immunization budgets, the countries are reducing their dependence on external donors and taking financial ownership of their immunization programs.

SIF works with counterparts in 21 countries across Africa, Asia and Europe to facilitate their efforts to develop, implement and institutionalize solutions for sustainable immunization financing. An integral strategy for this advocacy work is peer-to-peer learning. The SIF Program arranges frequent peer exchanges, which bring together national counterparts to evaluate their current immunization programs and to foster momentum for necessary changes.

On 19-21 April 2016, delegates from five SIF countries convened in Abuja, Nigeria, for the second Anglophone Africa Peer Review Workshop on Sustainable Immunization Financing. The event was co-hosted by Sabin and the Nigeria Immunization Financing Task Team (NIFT) on behalf of the Nigerian Federal Ministry of Health. The workshop was a follow-up to a similar peer exchange workshop held in Nairobi, Kenya, in October 2015…

European Vaccine Initiative [to 18 June 2016]
http://www.euvaccine.eu/news-events

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News
VAC2VAC, a new project funded by the Innovative Medicines Initiative (IMI2)
14 June 2016
European public and private organisations are collaborating in VAC2VAC, a new project funded by the Innovative Medicines Initiative (IMI2) to develop and validate quality testing approaches for both human and veterinary vaccines using non-animal methods.

The initiative that started on 1 March 2016 will facilitate the move away from the traditional paradigm of vaccine batch release testing and to accelerate the introduction of a new paradigm based on innovative non-animal techniques, thereby taking into account both vaccine safety and animal welfare.
Full press-release