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.
.
– 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.

.
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/

.

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…

.

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

.

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

.

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.

.

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.”…

.

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)

.

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/

.

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.

.

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

.
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

.
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.

.
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.

.

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

.
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

.

:: 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.