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

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

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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

Milestones :: Perspectives

The Vaccine Confidence Project [to 26 November 2106]
http://www.vaccineconfidence.org/
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Confidence Commentary
Dangerous liaisons
Heidi Larson | 19 Nov, 2016
Donald Trump could be the biggest single threat to vaccine confidence ever faced.

Trump’s links to the likes of Andrew Wakefield – with his network of celebrity supporters as well as multiple parent associations – is particularly worrying. Furthermore, although clearly not loved by all, both Trump and Wakefield have their champions well beyond the US and UK. An alliance between the world’s most widely known – and self-promoting – vaccine critic and the elected figure to one of most powerful political positions in the world is, to say the least, a dangerous liaison.

Anti-vaccination lobbyists are already seeing Trump as an ally. Shortly after the election results were known, the ‘The Age of Autism’ posted: ‘Now that Trump won, we can all feel safe in sharing that Mr Trump met with autism advocates in August. He gave us 45 minutes and was extremely educated on our issues.… Dr Gary ended the meeting by saying “Donald, you are the only one who can fix this”. He said ” I will”. We left hopeful. Lots of work left to do.’

Rightly or wrongly Trump is seen as ‘a man who can make things happen’, a challenger of orthodox thinking, and a beacon of hope to those who believe that any alternative is worth trying to break the status quo.

Trump’s widely followed tweets and public statements about children becoming autistic after vaccination, and calling for the end of combination vaccines because ‘tiny children are not horses,’ are a small indicator of Trump’s views on vaccines which are being propagated, unchecked by political or policy processes.

Trump’s views on science, climate change, abortion rights and the future of healthcare in general are all cause for concern, but a viral spread of negative sentiment around vaccines can tip confidence like swings in the stock market and, for the more infectious diseases, have immediate debilitating consequences…

Emergencies

Haiti’s Ministry of Health successfully vaccinates 729,000 persons against cholera
Port-au-Prince, Haiti, 23 Nov. 2016—Haiti’s Ministry of Health (MSPP) is nearing completion of its vaccination campaign against cholera, having reached more than 729,000 people with vaccines in Sud and Grand Anse departments, areas ravaged by Hurricane Matthew.

With support from the Pan American Health Organization / World Health Organization (PAHO / WHO) and other partners, vaccination teams fanned out across the two departments starting Nov. 8, aiming to reduce the burden of cholera cases by immunizing people in 16 different communes where cholera cases had been reported and where water and sanitation systems were damaged.

Ministry of Health early reports show that vaccination coverage reached 94 percent in Grande Anse and 90 percent in Sud Department, but the communes of Moron (Grande Anse), Port-a-Piment, and Chardonnieres (Sud) had lower than average coverage. In some areas teams were hampered by difficult access as roads were cut by the hurricane, and populations were displaced, said PAHO-WHO Representative Dr. Jean-Luc Poncelet. Ministry of Health officials are now collecting data and consolidating results, while looking for pockets of unvaccinated people in the communes.

Epidemiologists and immunization experts were mobilized to support the campaign, which was carried out with 1 million doses of oral cholera vaccine provided by GAVI through the Global Task Force for Cholera Control. The International Medical Corps (IMC), CDC, UNICEF, WFP, PIH, Gheskio, and other vaccination partners supported the Ministry in the campaign, with social mobilization and logistics, including cold chain to keep vaccines potent, and transport and support for vaccination brigades…

Since Hurricane Matthew struck Haiti October 4, more than 5,800 suspected cholera cases have been reported by the Ministry of Health, while the population in need of humanitarian assistance remains at 1.4 million, and more than 175,000 people are still in shelters, according to PAHO’s latest situation report. Increases in suspected malaria cases have been observed in Grand Ánse and Sud both Departments, and Haiti’s National program for Malaria Control began fumigation and destruction of mosquito breeding sites.

Haiti still needs humanitarian assistance for rural areas, rehabilitation of health facilities, household access to chlorinated water and community health workers especially for areas with non-functional facilities, Poncelet said.

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WHO Grade 3 Emergencies [to 26 November 2106]
Iraq –
:: WHO scales up trauma care services for injured people from Mosul, Iraq
23 November 2016 – As military operations into Mosul continue, WHO is working with national health authorities to ensure that people with war-related trauma injuries have access to live-saving medical care. WHO anticipates that approximately 40 000 civilians will require care for trauma injuries as a result of Mosul military operations.

The Syrian Arab Republic
:: WHO supplies prosthetic devices for Syrians injured by conflict 25 November 2016
:: Statements – Eastern Aleppo without any hospitals for more than 250,000 residents
20 November 2016 – More than 250,000 men, women, and children living in Eastern Aleppo are now without access to hospital care following attacks on the remaining hospitals over the last week. According to reports to WHO from the Organization’s partners in Syria, there are currently no hospitals functioning in the besieged area of the city.

Nigeria – No new announcements identified.
South Sudan – No new announcements identified.
Yemen – No new announcements identified.

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WHO Grade 2 Emergencies [to 26 November 2106]
Cameroon – No new announcements identified.
Central African Republic – No new announcements identified.
Democratic Republic of the Congo – No new announcements identified.
Ethiopia – No new announcements identified.
Libya – No new announcements identified.
Myanmar – No new announcements identified.
Niger – No new announcements identified.
Ukraine – No new announcements identified.

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises.
Iraq –
:: Iraq: Mosul Humanitarian Response Situation Report #8 (14-20 November 2016)
:: Press Releases – Iraq Humanitarian Crisis, 25 November 2016
IN NUMBERS
10m – PEOPLE IN NEED OF SOME FORM OF HUMANITARIAN ASSISTANCE
4m – PEOPLE HAVE BEEN INTERNALLY DISPLACED SINCE JANUARY 2014
1.7m – PEOPLE ARE ESTIMATED TO LIVE IN AREAS OUTSIDE GOVERNMENT CONTROL IN NORTHERN AND WESTERN IRAQ; MANY ARE LIKELY TO BE VULNERABLE
8m – PEOPLE NEED PROTECTION ASSISTANCE
480,000 – PEOPLE HAVE BEEN NEWLY DISPLACED IN 2016
920,000 – DISPLACED PEOPLE ARE HOSTED IN THE KURDISTAN REGION OF IRAQ
$861m – REQUESTED TO SUPPORT 7.3 MILLION VULNERABLE IRAQIS
70% – OF THE REQUESTED FUNDING HAS BEEN RECEIVED
$284m – REQUESTED TO SCALE-UP PREPAREDNESS EFFORTS AHEAD OF THE EXPECTED MILITARY CAMPAIGN TO RETAKE MOSUL
73% – OF THE REQUIRED AMOUNT FOR THE MOSUL FLASH APPEAL HAS BEEN RECEIVED

Syria
:: Rajm Slebi evacuations completed – but further arrivals possible as Mosul offensive continues 26 Nov 2016
:: Statement on the resumption of life-saving assistance at the Jordan-Syria border 22 Nov 2016

Yemen
:: Yemen: Cholera Outbreak Weekly AWD/Cholera Situation Report 10 – 17 November 2016 21 Nov 2016

Zika virus [to 26 November 2106]
http://www.who.int/emergencies/zika-virus/en/

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Zika situation report – 24 November 2016
Full report: http://apps.who.int/iris/bitstream/10665/251648/1/zikasitrep24Nov16-eng.pdf?ua=1

Key Updates
:: Countries and territories reporting mosquito-borne Zika virus infections for the first time in the past week:
… None
:: Countries and territories reporting microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection for the first time in the past week:
… None
:: Countries and territories reporting Guillain-Barré syndrome (GBS) cases associated with Zika virus infection for the first time in the past week:
… None
:: The fifth meeting of the Emergency Committee (EC) on Zika virus, microcephaly and other neurological disorders was held on 18 November 2016. The Director-General accepted the recommendations of the EC and declared the end of the Public Health Emergency of International Concern (PHEIC). However, Zika virus and associated consequences remains a significant enduring public health challenge. Research has demonstrated the link between Zika virus infection and microcephaly, furthering the need for a robust technical mechanism to manage the global response and research agenda. The coordination and response to Zika virus is being escalated into a sustained programme of work with dedicated resources to address the long-term nature of the disease and its consequences. Recommendations from previous EC meetings will remain in place for three months while WHO implements the transition plan to shift activities into a longer-term programme. Building on established mechanisms and guided by the Zika Strategic Response Plan, WHO continues to coordinate and support more than 60 partners in the areas of detection, prevention, care and support, and research to strengthen preparedness and response in countries and territories where the Aedes mosquitoes are established.

Analysis
:: Overall, the global risk assessment has not changed. Zika virus continues to spread geographically to areas where competent vectors are present. Although a decline in cases of Zika infection has been reported in some countries, or in some parts of countries, vigilance needs to remain high.

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Zika Open [to 26 November 2106]
[Bulletin of the World Health Organization]
:: All papers available here
No new papers identified.

POLIO [to 26 November 2106]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 23 November 2016
:: Rotary Foundation named “world’s outstanding foundation for 2016”, by the Association of Fundraising Professionals. The judges cited Rotary’s PolioPlus efforts as a major driver for its selection. More.

:: The GPEI report to the January Executive Board (EB) meeting has now been finalized and is available here. The report summarizes the status against the Polio Endgame Plan and Resolution WHA68.3, adopted by the WHA in May 2015, including the impact of national emergency action plans in the remaining infected countries and of the IHR Temporary Recommendations; the achievements of the globally coordinated switch from trivalent OPV to bivalent OPV and associated IPV global supply issues and risk mitigation strategies (including fractional-dose IPV); the status of global containment activities; transition planning; and, the global budget. This report will be the main tool to inform the discussions by Member States at the January EB.

:: Also published this week: WHO’s Human Resources Update to the EB. The report includes an update on WHO’s component of the human resources infrastructure funded by the GPEI and the associated financial liabilities.

: The 11th meeting of the Emergency Committee under the International Health Regulations (IHR) met on 11 November and concluded that current epidemiology continues to constitute a Public Health Emergency of International Concern (PHEIC). Read about the IHR findings and recommendations here. [see below]

Country Updates [Selected Excerpts]
Pakistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week, from Sujawal district in central Sindh, with onset of paralysis on 3 November. It is the most recent case in the country and brings the total number of WPV1 cases for 2016 to 17.
:: One new WPV1 positive environmental sample was reported in the past week, from Lahore, Punjab (collected on 18 October).

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Statement of the 11th IHR Emergency Committee regarding the international spread of poliovirus
WHO statement – 11 November 2016
[Selected excerpts; text bolding by Editor]

The eleventh meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened via teleconference by the Director General on 11 November 2016.

The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine-derived polioviruses (cVDPV). The Secretariat presented a report of progress for affected IHR States Parties subject to Temporary Recommendations. The following IHR States Parties presented an update on the implementation of the WHO Temporary Recommendations since the Committee last met on 11 August 2016: Afghanistan, Pakistan, Nigeria, Cameroon, Chad and Niger…

…Conclusion
The Committee unanimously agreed that the international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC), and recommended the extension of the Temporary Recommendations for a further three months. The Committee considered the following factors in reaching this conclusion:
:: The new outbreak of WPV1 in Nigeria highlighting that there are high-risk areas where surveillance is compromised by inaccessibility, resulting in ongoing circulation of WPV for several years without detection. The risk of transmission in the Lake Chad sub-region appears very high.
:: The continued international spread of wild poliovirus during 2016 from Pakistan to Afghanistan, resulting in intense transmission in vulnerable populations.
:: The persistent, wide geographical distribution of positive WPV1 in environmental samples in Pakistan.
:: The current special and extraordinary context of being closer to polio eradication than ever before in history.
:: The risk and consequent costs of failure to eradicate globally one of the world’s most serious vaccine preventable diseases. Even though global transmission has fallen dramatically and with it the likelihood of international spread, the consequences and impact of international spread should it occur would be grave.
:: The possibility of global complacency developing as the numbers of polio cases continues to fall and eradication becomes a possibility.
:: The serious consequences of further international spread for the increasing number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies. Populations in these fragile states are vulnerable to outbreaks of polio. Outbreaks in fragile states are exceedingly difficult to control and threaten the completion of global polio eradication during its end stage.
:: The continued necessity for a coordinated international response to improve immunization and surveillance for wild poliovirus, to stop international spread and reduce the risk of new spread.
:: The importance of a regional approach and strong cross¬border cooperation, as much international spread of polio occurs over land borders, while also recognizing that the risk of distant international spread remains from zones with active poliovirus transmission.

Additionally with respect to cVDPV:
:: cVDPVs also pose a risk for international spread, which without an urgent response with appropriate measures threatens vulnerable populations as noted above;
:: The ongoing circulation of cVDPV2 in Nigeria and possibly in Guinea, and in Lao PDR, demonstrates significant gaps in population immunity at a critical time in the polio endgame;
:: The ongoing urgency to prevent type 2 cVDPVs following the globally synchronized withdrawal of the type 2 component of the oral poliovirus vaccine in April 2016;
:: The ongoing challenges of improving routine immunization in areas affected by insecurity and other emergencies, including Ebola;
:: The global shortage of IPV which poses an additional threat from cVDPVs…

…Additional considerations for all infected and high risk countries
The Committee strongly urged global partners in polio eradication to provide optimal support to all infected and vulnerable countries at this critical time in the polio eradication programme for implementation of the Temporary Recommendations under the IHR, as well as providing ongoing support to countries, such as Somalia that were recently subject to Temporary Recommendations. The Committee requested that future secretariat reports should include a cumulative table of countries which have been removed from the ‘vulnerable country’ list, with comments on the current situation in those countries.

Learning from recent events in Nigeria, the committee requested the secretariat provide a global report on all inaccessible areas where polio surveillance may be compromised. Recognizing that cVDPV illustrates serious gaps in routine immunization programmes in otherwise polio free countries, the Committee recommended that the international partners in routine immunization, for example Gavi, should assist affected countries to improve the national immunization programme.

The Committee noted the threat posed to eradication efforts caused by the global IPV shortage and requested that SAGE continue to monitor and make recommendations to address this situation.

The Committee noted the Secretariat’s report on the identification of Sabin 2 virus detected in environmental samples in India probably due to the ongoing use of tOPV in the private sector. As Sabin 2 virus has also been detected in Russia, Nigeria and Afghanistan, the Committee requested a full report on this at the next meeting.

The Committee noted a more detailed analysis of the public health benefits and costs of implementing temporary recommendations was under way and requested a report be made available to the committee in February 2017.

The Committee urged all countries to avoid complacency which could easily lead to a polio resurgence. Surveillance particularly needs careful attention to quickly detect any resurgent transmission.

Based on the advice concerning wild poliovirus and cVDPV, and the reports made by Afghanistan, Pakistan, Nigeria, Cameroon, Chad and Niger, the Director General accepted the Committee’s assessment and on 18 November 2016 determined that the events relating to poliovirus continue to constitute a PHEIC, with respect to wild poliovirus and cVDPV. The Director General endorsed the Committee’s recommendations for countries falling into the definition of ‘States currently exporting wild polioviruses or cVDPV’, for ‘States infected with wild poliovirus or cVDPV but not currently exporting’ and for ‘States no longer infected by wild poliovirus, but which remain vulnerable to international spread, and states that are vulnerable to the emergence and circulation of VDPV’ and extended the Temporary Recommendations as revised by the Committee under the IHR to reduce the international spread of poliovirus, effective 18 November 2016.

WHO & Regional Offices [to 26 November 2106]

International day for the elimination of violence against women
25 November 2016 – Worldwide, 1 in 3 women will experience physical and/or sexual violence by an intimate partner, or sexual violence by a non-partner at some point in their life. Women who have experienced violence use health services more than non-abused women. Health professionals are in a unique position to address the health, psychosocial, and legal needs of women who have experienced violence.

Eliminating malaria in the Greater Mekong Subregion
25 November 2016 – Since 2012, countries across the Greater Mekong Subregion have reported a sharp decline in malaria cases and deaths. But the spread of antimalarial drug resistance threatens to undermine these gains. A new report from WHO offers a set of tried-and-tested approaches that can help countries countries end transmission of this deadly disease.
Report

Highlights
WHO scales up trauma care services for injured people from Mosul, Iraq
November 2016 – As military operations into Mosul continue, WHO is working with national health authorities to ensure that people with war-related trauma injuries have access to live-saving medical care. WHO anticipates that approximately 40 000 civilians will require care for trauma injuries as a result of Mosul military operations.

WHO and partners immunized over 155,000 migrant children in South Sudan
November 2016 – In response to the poliomyelitis outbreak associated with type 2 circulating vaccine-derived poliovirus and ambiguous vaccine derived polio virus identified in Unity state, WHO, in collaboration with Ministry of Health and partners immunized over 155 000 migrant children under the age of 15 through special vaccination posts.

Handbook: Strategizing national health in the 21st century
November 2016 – A new WHO handbook on national health planning and strategizing has been launched, providing up-to-date and practical guidance. The handbook establishes a set of best practices to support strategic plans for health and represents the wealth of experience accumulated by WHO on national health policies, strategies and plans (NHPSPs).

UN urges protection for breastfeeding, end of inappropriate marketing of substitutes
November 2016 – Today, UN human rights experts told countries that they need to do more to support and protect breastfeeding as a human right, including ending the inappropriate marketing of breast-milk substitutes and other foods intended for infants and young children.

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Stories from countries
Winning the war against yellow fever
25 November 2016

Finding the gaps in meeting adolescent health needs in Nepal
22 November 2016

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Weekly Epidemiological Record, 25 November 2016, vol. 91, 47 (pp. 549–560)
:: Progress towards poliomyelitis eradication: Pakistan, January 2015–September 2016
:: Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2016

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:: WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Regional consultation in Chad to discuss accelerating progress towards the prevention and control of HIV infection in children and adolescents – 22 November 2016
:: Global leaders agree to promote health to achieve Sustainable Development Goals – 21 November 2016

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

WHO South-East Asia Region SEARO
:: Countries of the South-East Asia Region Launch Path-breaking Initiative to Guarantee High-Quality Medical Products
25 November 2016

WHO European Region EURO
:: Influenza A(H5N8) virus detected in birds in several countries in the WHO European Region 24-11-2016
:: WHO and European Committee of the Regions join forces to improve European dialogue on health policy 22-11-2016

WHO Eastern Mediterranean Region EMRO
:: WHO scales up trauma care services for injured people from Mosul, Iraq 24 November 2016
:: WHO denounces false reporting regarding Iraq 20 November 2016

WHO Western Pacific Region
:: Partnership, protection, response and empowerment: rolling out essential services to end gender-based violence against women and girls in Asia and the Pacific
BANGKOK, 24 November 2016 – Governments, civil society and the United Nations family in Asia and the Pacific are strengthening efforts to respond to the persistent scourge of gender-based violence against women and girls in the region, with the roll-out of an essential services package that incorporates prevention and response underpinned by strategic partnerships, impactful laws and policies, and justice and healing for survivors.

CDC/ACIP [to 26 November 2106]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/

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Media Statement
TUESDAY, NOVEMBER 22, 2016
CDC updates guidance for Miami Beach (FL) area with active Zika transmission
The Centers for Disease Control and Prevention (CDC) has updated guidance for people who travel to or live in the previously identified 4.5-square-mile area in Miami Beach, FL. The North…

Media Statement
TUESDAY, NOVEMBER 22, 2016
CDC, US and Brazilian researchers find evidence of onset of Zika-associated microcephaly and other neurologic complications after birth
CDC researchers in collaboration with researchers from the United States and Brazil investigated the first series of infants with laboratory evidence of congenital Zika virus infection documented to have onset…

Media Statement
MONDAY, NOVEMBER 21, 2016
CDC adds Montserrat to interim travel guidance related to Zika virus
CDC is working with other public health officials to monitor for ongoing spread of Zika virus?. Today, CDC posted a Zika virus travel notice for Montserrat. CDC has issued travel…

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MMWR Weekly November 25, 2016 / No. 46
:: World AIDS Day — December 1, 2016
:: Early Diagnosis of HIV Infection in Infants — One Caribbean and Six Sub-Saharan African Countries, 2011–2015
:: Progress Toward Poliomyelitis Eradication — Pakistan, January 2015–September 2016
:: Announcement: Guidance for U.S. Laboratory Testing for Zika Virus Infection: Implications for Health Care Providers
:: Notice to Readers: Final 2015 Reports of Nationally Notifiable Infectious Diseases and Conditions

UNAIDS [to 26 November 2106]
http://www.unaids.org/en/resources/presscentre/

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Press statement
World AIDS Day message 2016
1 December 2016
Michel Sidibé, Executive Director of UNAIDS, Under-Secretary-General of the United Nations
Today, we commemorate World AIDS Day—we stand in solidarity with the 78 million people who have become infected with HIV and remember the 35 million who have died from AIDS-related illnesses since the first cases of HIV were reported.

The world has committed to end the AIDS epidemic by 2030 as part of the Sustainable Development Goals. We are seeing that countries are getting on the Fast-Track—more than 18 million people are on life-saving HIV treatment and country after country is on track to virtually eliminate HIV transmission from mother to child.

We are winning against the AIDS epidemic, but we are not seeing progress everywhere. The number of new HIV infections is not declining among adults, with young women particularly at risk of becoming infected with HIV.

We know that for girls in sub-Saharan Africa, the transition to adulthood is a particularly dangerous time. Young women are facing a triple threat: a high risk of HIV infection, low rates of HIV testing and poor adherence to HIV treatment.

Coinfections of people living with HIV, such as tuberculosis (TB), cervical cancer and hepatitis C, are at risk of putting the 2020 target of fewer than 500,000 AIDS-related deaths out of reach. TB caused about a third of AIDS-related deaths in 2015, while women living with HIV are at four to five times greater risk of developing cervical cancer. Taking AIDS out of isolation remains an imperative if the world is to reach the 2020 target.

With access to treatment, people living with HIV are living longer. Investing in treatment is paying off, but people older than 50 who are living with HIV, including people who are on treatment, are at increased risk of developing age-associated noncommunicable diseases, affecting HIV disease progression.

AIDS is not over, but it can be if we tailor the response to individual needs at particular times in life. Whatever our individual situation may be, we all need access to the tools to protect us from HIV and to access antiretroviral medicines should we need them. A life-cycle approach to HIV that finds solutions for everyone at every stage of life can address the complexities of HIV. Risks and challenges change as people go through life, highlighting the need to adapt HIV prevention and treatment strategies from birth to old age.

The success we have achieved so far gives us hope for the future, but as we look ahead we must remember not to be complacent. We cannot stop now. This is the time to move forward together to ensure that all children start their lives free from HIV, that young people and adults grow up and stay free from HIV and that treatment becomes more accessible so that everyone stays AIDS-free.

NIH [to 26 November 2106]
http://www.nih.gov/news-events/news-releases

November 23, 2016
A new strategic direction for behavioral and social sciences research at NIH
Strategic plan focuses on scientific priorities which reflect key research challenges that OBSSR is uniquely positioned to address.
The Office of Behavioral and Social Sciences Research (OBSSR) at the National Institutes of Health has released a new strategic plan for 2017 through 2021. The plan focuses on scientific priorities, which reflect key research challenges that OBSSR is uniquely positioned to address. Developed with considerable input from internal and external NIH stakeholders, the plan ensures OBSSR continues to fulfill its mission.

While it is widely accepted that behavioral and social factors account for approximately half of the premature deaths in the United States, understanding how these behavioral and social factors interact with biology and can be modified to improve health requires a robust and rigorous behavioral and social sciences research agenda. Recent scientific and technological advances in the biomedical, behavioral, and social sciences are generating massive amounts of information from the molecular and genetic levels to clinical and community outcomes. NIH Director Francis S. Collins, M.D., Ph.D., and OBSSR Director William T. Riley, Ph.D., wrote an editorial published today in Science Translational Medicine (link is external) that highlights some of the scientific and technological advances that are transforming the behavioral and social sciences.

OBSSR’s strategic priorities are to: improve the synergy of basic and applied behavioral and social sciences research; enhance and promote the research infrastructure, methods, and measures needed to support a more cumulative and integrated approach to behavioral and social sciences research; and facilitate the adoption of behavioral and social sciences research findings in health research and in practice.

To address these priorities and broader NIH efforts in the behavioral and social sciences, OBSSR will rely on four foundational processes:
:: Communicating behavioral and social sciences research findings
:: Coordinating behavioral and social sciences research programs across the NIH and integrating behavioral and social sciences research within the larger NIH research enterprise
:: Training the next generation of behavioral and social science researchers
:: Evaluating the impact of behavioral and social sciences research and addressing scientific policies that support this research

Coalition for Epidemic Preparedness Innovations (CEPI) [to 26 November 2106]
http://cepi.net/
CEPI Newsletter 21 November 2016
[Excerpt]
CEPI policies – invitation to feedback
Over the last two months, the CEPI Secretariat has been working with colleagues from the
founding partners to draft CEPI’s core policies to reflect CEPI’s operating principles and
provide guidance for potential awardees during the call for proposal process. The team
has also consulted with individuals working with Product Development Partnerships
and researchers in this field.

We now invite your comments and feedback on these draft policies on equitable access,
shared risks/benefits and management of IP http://cepi.net/resources#CEPI-Policies-Draft
. The open public consultation period is from today through to COB CET 2 December,
2016. Please send feedback to cepi@fhi.no.

Following receipt of feedback during the open public consultation period, the Secretariat
will amend the policies as required and submit them to the CEPI Board for approval prior
to their release with the call for proposals.

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EDCTP [to 26 November 2106]
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.

23 November 2016
Stakeholder meeting reports published: diarrhoeal diseases and lower respiratory tract infections
EDCTP published two reports of the stakeholder meetings on diarrhoeal diseases and lower respiratory tract infections, respectively. The meetings for these fields added to our scope under the second programme took place in Amsterdam, The Netherlands on 5 and 6 July 2016. Their aim was to consult experts in these fields in order to inform EDCTP’s funding strategy and future work plans related to these disease areas.. Representatives from academic and research institutions, funding agencies, product development partnerships among others were invited to participate.

On 5 July 2016, Prof. Philippe Sansonetti (Institut Pasteur and Collège de France, France) and Dr Jeffrey Mphahlele (South African Medical Research Council, South Africa) chaired the meeting on diarrhoeal diseases which featured three speakers and sessions with focus groups. Download report (PDF)

On 6 July 2016, Prof. Jeremy Brown (University College London, United Kingdom) steered the discussions on lower respiratory tract infections in response to six speakers. Download report (PDF)
The objectives of both meetings were to review the research landscape, available interventions and products in development, and to identify short and medium term priorities for EDCTP in terms of disease, research and intervention.

EDCTP regularly organises thematic stakeholder meetings as part of its ongoing consultation process. The purpose of thematic stakeholder meetings is to contribute to shaping the programme’s strategic research agenda, funding approach and strategic alignment with work of other partners involved in clinical development of interventions against poverty-related diseases.

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Industry Watch [to 26 November 2106]
:: GSK receives FDA approval for expanded indication for FluLaval® Quadrivalent (Influenza Vaccine) for infants 6 months and older
PHILADELPHIA, Nov. 21, 2016 /PRNewswire/ — GSK [LSE/NYSE: GSK] announced today it has received approval from the US Food and Drug Administration’s (FDA) Center for Biologics Evaluation and Research expanding the indication for FluLaval® Quadrivalent (Influenza Vaccine) to include use in children 6 months and older. Prior to this, the vaccine was only approved for active immunization against influenza A subtype viruses and type B viruses, in persons 3 years of age and older…

IFPMA [to 26 November 2106]
http://www.ifpma.org/resources/news-releases/
23 November 2016
International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) head announces departure
Geneva, 23 November 2016 – After seven years as Director General, Eduardo Pisani announced today his decision to leave the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA)…

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European Vaccine Initiative [to 26 November 2106]
http://www.euvaccine.eu/news-events
25 November 2016
Call for abstracts- 2017 SVS skin vaccination summit
The deadline for oral abstract submissions is Friday 2nd December 2016.

25 November 2016
New influenza reagents available from NIBSC
Two new influenza reagents are now available. Influenza anti-A/Michigan/45/2015-like HA serum and Influenza Antigen A/…

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

American Journal of Public Health
Volume 106, Issue 11 (November 2016)
http://ajph.aphapublications.org/toc/ajph/current
AJPH SPECIAL SECTION: WORLD HEALTH ORGANIZATION
[Reviewed earlier]

e-View ahead of Print
Parental Refusal of Childhood Vaccines and Medical Neglect Laws
Efthimios Parasidis, JD, MBioethics, and Douglas J. Opel, MD, MPH
Abstract
Objectives. To examine the relation of vaccine refusal and medical neglect under child welfare laws.
Methods. We used the Westlaw legal database to search court opinions from 1905 to 2016 and identified cases in which vaccine refusal was the sole or a primary reason in a neglect proceeding. We also delineated if religious or philosophical exemptions from required school immunizations were available at the time of adjudication.
Results. Our search yielded 9 cases from 5 states. Most courts (7 of 9) considered vaccine refusal to constitute neglect. In the 4 cases decided in jurisdictions that permitted religious exemptions, courts either found that vaccine refusal did not constitute neglect or considered it neglect only in the absence of a sincere religious objection to vaccination.
Conclusions. Some states have a legal precedent for considering parental vaccine refusal as medical neglect, but this is based on a small number of cases. Each state should clarify whether, under its laws, vaccine refusal constitutes medical neglect. (Am J Public Health. Published online ahead of print November 17, 2016: e1–e4. doi:10.2105/AJPH.2016.303500

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 26 November 2106)

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Research article
Effectiveness, immunogenicity and safety of 23-valent pneumococcal polysaccharide vaccine revaccinations in the elderly: a systematic review
In many industrialized countries routine vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPSV-23) is recommended to prevent pneumococcal disease in the elderly. However, vaccine-induced imm…
Cornelius Remschmidt, Thomas Harder, Ole Wichmann, Christian Bogdan and Gerhard Falkenhorst
BMC Infectious Diseases 2016 16:711
Published on: 25 November 2016

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Study protocol
A prospective cohort study to assess seroprevalence, incidence, knowledge, attitudes and practices, willingness to pay for vaccine and related risk factors in dengue in a high incidence setting
Dengue is one of the most important vector-borne diseases in the world, causing significant morbidity and economic impact. In Colombia, dengue is a major public health problem. Departments of La Guajira, Cesar…
Ruth Aralí Martínez-Vega, Alfonso J. Rodriguez-Morales, Yalil Tomás Bracho-Churio, Mirley Enith Castro-Salas, Fredy Galvis-Ovallos, Ronald Giovanny Díaz-Quijano, María Lucrecia Luna-González, Jaime E. Castellanos, José Ramos-Castañeda and Fredi Alexander Diaz-Quijano
BMC Infectious Diseases 2016 16:705
Published on: 25 November 2016

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Debate
The Ebola Outbreak: Catalyzing a “Shift” in Global Health Governance?
As the 2014 Ebola virus disease outbreak (EVD) transitions to its post-endemic phase, its impact on the future of global public health, particularly the World Health Organization (WHO), is the subject of conti…
Tim K. Mackey
BMC Infectious Diseases 2016 16:699
Published on: 24 November 2016

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 26 November 2106)

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Commentary
A framework: make it useful to guide and improve practice of clinical trial design in smaller populations
The increased attention to design and analysis of randomised clinical trials in small populations has triggered thinking regarding the most appropriate design methods for a particular clinical research question…
Kit C. B. Roes
BMC Medicine 2016 14:195
Published on: 25 November 2016

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CORRESPONDENCE
How do you design randomised trials for smaller populations? A framework
How should we approach trial design when we can get some, but not all, of the way to the numbers required for a randomised phase III trial?
Mahesh K. B. Parmar, Matthew R. Sydes and Tim P. Morris
BMC Medicine 2016 14:183
Published on: 25 November 2016

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 26 November 2106)
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Research article
Epidemiology of pertussis in two Ibero-American countries with different vaccination policies: lessons derived from different surveillance systems
Pertussis is a re-emerging disease worldwide despite its high vaccination coverage. European and Latin-American countries have used different surveillance and vaccination policies against pertussis. We compare…
Rubén Solano, Josefa Masa-Calles, Zacarías Garib, Patricia Grullón, Sandy L. Santiago, Altagracia Brache, Ángela Domínguez and Joan A. Caylà
BMC Public Health 2016 16:1178
Published on: 22 November 2016

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Research article
Determinants of seasonal influenza vaccination in pregnant women in Valencia, Spain
In most countries the coverage of seasonal influenza vaccination in pregnant women is low. We investigated the acceptance, reasons for rejection and professional involvement related to vaccine information in p…
R. Vila-Candel, P. Navarro-Illana, E. Navarro-Illana, E. Castro-Sánchez, Kiri Duke, F. J. Soriano-Vidal, J. Tuells and J. Díez-Domingo
BMC Public Health 2016 16:1173
Published on: 21 November 2016

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 26 November 2106]

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Review
What are the best methodologies for rapid reviews of the research evidence for evidence-informed decision making in health policy and practice: a rapid review
Michelle M. Haby, Evelina Chapman, Rachel Clark, Jorge Barreto, Ludovic Reveiz and John N. Lavis
Published on: 25 November 2016
Abstract
Background
Rapid reviews have the potential to overcome a key barrier to the use of research evidence in decision making, namely that of the lack of timely and relevant research. This rapid review of systematic reviews and primary studies sought to answer the question: What are the best methodologies to enable a rapid review of research evidence for evidence-informed decision making in health policy and practice?
Methods
This rapid review utilised systematic review methods and was conducted according to a pre-defined protocol including clear inclusion criteria (PROSPERO registration: CRD42015015998). A comprehensive search strategy was used, including published and grey literature, written in English, French, Portuguese or Spanish, from 2004 onwards. Eleven databases and two websites were searched. Two review authors independently applied the eligibility criteria. Data extraction was done by one reviewer and checked by a second. The methodological quality of included studies was assessed independently by two reviewers. A narrative summary of the results is presented.
Results
Five systematic reviews and one randomised controlled trial (RCT) that investigated methodologies for rapid reviews met the inclusion criteria. None of the systematic reviews were of sufficient quality to allow firm conclusions to be made. Thus, the findings need to be treated with caution. There is no agreed definition of rapid reviews in the literature and no agreed methodology for conducting rapid reviews. While a wide range of ‘shortcuts’ are used to make rapid reviews faster than a full systematic review, the included studies found little empirical evidence of their impact on the conclusions of either rapid or systematic reviews. There is some evidence from the included RCT (that had a low risk of bias) that rapid reviews may improve clarity and accessibility of research evidence for decision makers.
Conclusions
Greater care needs to be taken in improving the transparency of the methods used in rapid review products. There is no evidence available to suggest that rapid reviews should not be done or that they are misleading in any way. We offer an improved definition of rapid reviews to guide future research as well as clearer guidance for policy and practice.

International Journal of Community Medicine and Public Health
2016, Volume: 3, Issue: 12
http://www.scopemed.org/?iid=2016-3-12.000&&jid=109&lng=

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Original Research
Closing the immunity gap through the strategy of intensification of routine immunization using the offline tool immunogram and supportive supervision – experiences from the rural health training centre of KVG medical college, Karnataka, India
Narayana V. Holla, Satya Kishore Chivukula, Sharanya Kaniambady
Int J Community Med Public Health. 2016; 3(12): 3450-3455

JAMA
November 22, 2016, Vol 316, No. 20, Pages 2059-2162
http://jama.jamanetwork.com/issue.aspx

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Viewpoint
Pharmaceuticals and Public Health
Rena M. Conti, PhD; Rebekah E. Gee, MD; Joshua M. Sharfstein, MD
JAMA. 2016;316(20):2083-2084. doi:10.1001/jama.2016.15397
This Viewpoint argues for a shift in pharmaceutical pricing from an individual- to a population-based perspective and proposes policy options to incentivize pricing that would make treating populations with disease sustainable.
Abstract
The national debate over increasing costs and spending for pharmaceuticals has reached a fever pitch. Special concern has focused on new “specialty” drugs, for which per-patient treatment costs often exceed $1000 per month or more than $10 000 for a course of a therapy. The most commonly discussed solutions include approaches to pricing these drugs based on their value to individual patients.1 However, for pharmaceuticals vital to public health, such as immunizations and drugs to treat communicable diseases, policy makers should broaden their perspective to consider the population as a whole.

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Research Letter
Infectious Disease Mortality Trends in the United States, 1980-2014
Victoria Hansen, MS; Eyal Oren, PhD; Leslie K. Dennis, PhD; et al.
JAMA. 2016;316(20):2149-2151. doi:10.1001/jama.2016.12423
This study uses data from the US National Office of Vital Statistics and the Centers for Disease Control and Prevention WONDER database to characterize trends in infectious disease mortality from 1980 through 2014.
Abstract
From 1900 through 1996, mortality from infectious diseases declined in the United States, except for a 1918 spike due to the Spanish flu pandemic.1 Since 1996, major changes in infectious diseases have occurred, such as the introduction of human immunodeficiency virus (HIV)/AIDS and West Nile virus into the United States, advances in HIV/AIDS treatment, changes in vaccine perceptions, and increased concern over drug-resistant pathogens. We investigated trends in infectious disease mortality from 1980 through 2014 to capture these changes.

Journal of Medical Ethics
December 2016, Volume 42, Issue 12
http://jme.bmj.com/content/current

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Extended essay
Victims, vectors and villains: are those who opt out of vaccination morally responsible for the deaths of others?
Euzebiusz Jamrozik, Toby Handfield, Michael J Selgelid
J Med Ethics 2016;42:762-768 Published Online First: 3 October 2016 doi:10.1136/medethics-2015-103327
Abstract
Mass vaccination has been a successful public health strategy for many contagious diseases. The immunity of the vaccinated also protects others who cannot be safely or effectively vaccinated—including infants and the immunosuppressed. When vaccination rates fall, diseases like measles can rapidly resurge in a population. Those who cannot be vaccinated for medical reasons are at the highest risk of severe disease and death. They thus may bear the burden of others’ freedom to opt out of vaccination. It is often asked whether it is legitimate for states to adopt and enforce mandatory universal vaccination. Yet this neglects a related question: are those who opt out, where it is permitted, morally responsible when others are harmed or die as a result of their decision? In this article, we argue that individuals who opt out of vaccination are morally responsible for resultant harms to others. Using measles as our main example, we demonstrate the ways in which opting out of vaccination can result in a significant risk of harm and death to others, especially infants and the immunosuppressed. We argue that imposing these risks without good justification is blameworthy and examine ways of reaching a coherent understanding of individual moral responsibility for harms in the context of the collective action required for disease transmission. Finally, we consider several objections to this view, provide counterarguments and suggest morally permissible alternatives to mandatory universal vaccination including controlled infection, self-imposed social isolation and financial penalties for refusal to vaccinate.

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Research ethics
Paper: Deciphering assumptions about stepped wedge designs: the case of Ebola vaccine research
Adélaïde Doussau, Christine Grady
J Med Ethics 2016;42:797-804 Published Online First: 17 October 2016 doi:10.1136/medethics-2015-103292
Abstract
Ethical concerns about randomising persons to a no-treatment arm in the context of Ebola epidemic led to consideration of alternative designs. The stepped wedge (SW) design, in which participants or clusters are randomised to receive an intervention at different time points, gained popularity. Common arguments in favour of using this design are (1) when an intervention is likely to do more good than harm, (2) all participants should receive the experimental intervention at some time point during the study and (3) the design might be preferable for practical reasons. We examine these assumptions when considering Ebola vaccine research. First, based on the claim that a stepped wedge design is indicated when it is likely that the intervention will do more good than harm, we reviewed published and ongoing SW trials to explore previous use of this design to test experimental drugs or vaccines, and found that SW design has never been used for trials of experimental drugs or vaccines. Given that Ebola vaccines were all experimental with no prior efficacy data, the use of a stepped wedge design would have been unprecedented. Second, we show that it is rarely true that all participants receive the intervention in SW studies, but rather, depending on certain design features, all clusters receive the intervention. Third, we explore whether the SW design is appealing for feasibility reasons and point out that there is significant complexity. In the setting of the Ebola epidemic, spatiotemporal variation may have posed problematic challenge

Nature
Volume 539 Number 7630 pp467-602 24 November 2016
http://www.nature.com/nature/current_issue.html

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Editorials
The power of big data must be harnessed for medical progress
But grave challenges remain before the promise of individually tailored medicine becomes reality.
There is art in ‘big data’ — in the poetic claims that it competes in volume with all the stars in the firmament. And in the seductive potential of its exponential, uncontrolled, ungraspable growth to improve our lives: by allowing medical treatments to be developed and approved more quickly — and, ultimately, truly personal medicine.
But at a workshop held in London by the European Medicines Agency earlier this month, just how much science has to happen to make this beautiful future a reality was apparent to all. Patient groups and research scientists attended, alongside computational heavyweights from IBM Watson Health and Google Cloud Platform. Together, they tackled chewy questions to which there are few answers.
How many data are ‘enough’ to reliably predict clinical effect? Which data sets can be useful? How can they be managed? What’s the best way to win the confidence of public and regulators? And, crucially, is academia training enough mathematicians and medical-data scientists, who will have to develop and harness all this new potential? The last of these questions at least has a clear answer: no…

New England Journal of Medicine
November 24, 2016 Vol. 375 No. 21
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
History of Medicine
Fifty Years of Expert Advice — Pharmaceutical Regulation and the Legacy of the Drug Efficacy Study
Jason L. Schwartz, Ph.D., M.B.E.
N Engl J Med 2016; 375:2015-2017 November 24, 2016 DOI: 10.1056/NEJMp1609763
The role of panels of experts from outside government in the FDA’s day-to-day work derives from the Drug Efficacy Study of the 1960s, which addressed many concerns that continue to shape discussions of pharmaceutical regulation.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 26 November 2106)

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Research Article
Effectiveness of Seasonal Malaria Chemoprevention in Children under Ten Years of Age in Senegal: A Stepped-Wedge Cluster-Randomised Trial
Badara Cissé, El Hadj Ba, Cheikh Sokhna, Jean Louis NDiaye, Jules F. Gomis, Yankhoba Dial, Catherine Pitt, Mouhamed NDiaye, Matthew Cairns, Ernest Faye, Magatte NDiaye, Aminata Lo, Roger Tine, Sylvain Faye, Babacar Faye, Ousmane Sy, Lansana Konate, Ekoue Kouevijdin, Clare Flach, Ousmane Faye, Jean-Francois Trape, Colin Sutherland, Fatou Ba Fall, Pape M. Thior, Oumar K. Faye, Brian Greenwood, Oumar Gaye, Paul Milligan
Research Article | published 22 Nov 2016 PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002175

PLoS One
http://www.plosone.org/
[Accessed 26 November 2106]

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Research Article
National Survey Indicates that Individual Vaccination Decisions Respond Positively to Community Vaccination Rates
John Romley, Prodyumna Goutam, Neeraj Sood
Research Article | published 21 Nov 2016 PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0166858
Abstract
Some models of vaccination behavior imply that an individual’s willingness to vaccinate could be negatively correlated with the vaccination rate in her community. The rationale is that a higher community vaccination rate reduces the risk of contracting the vaccine-preventable disease and thus reduces the individual’s incentive to vaccinate. At the same time, as for many health-related behaviors, individuals may want to conform to the vaccination behavior of peers, counteracting a reduced incentive to vaccinate due to herd immunity. Currently there is limited empirical evidence on how individual vaccination decisions respond to the vaccination decisions of peers. In the fall of 2014, we used a rapid survey technology to ask a large sample of U.S. adults about their willingness to use a vaccine for Ebola. Respondents expressed a greater inclination to use the vaccine in a hypothetical scenario with a high community vaccination rate. In particular, an increase in the community vaccination rate from 10% to 90% had the same impact on reported utilization as a nearly 50% reduction in out-of-pocket cost. These findings are consistent with a tendency to conform with vaccination among peers, and suggest that policies promoting vaccination could be more effective than has been recognized.

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/

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Biological Sciences – Microbiology:
Armed conflict and population displacement as drivers of the evolution and dispersal of Mycobacterium tuberculosis
Vegard Eldholm, John H.-O. Pettersson, Ola B. Brynildsrud, Andrew Kitchen, Erik Michael Rasmussen, Troels Lillebaek, Janne O. Rønning, Valeriu Crudu, Anne Torunn Mengshoel, Nadia Debech, Kristian Alfsnes, Jon Bohlin, Caitlin S. Pepperell, and Francois Balloux
PNAS 2016 ; published ahead of print November 21, 2016, doi:10.1073/pnas.1611283113
Significance
We used population genomic analyses to reconstruct the recent history and dispersal of a major clade of Mycobacterium tuberculosis in central Asia and beyond. Our results indicate that the fall of the Soviet Union and the ensuing collapse of public health systems led to a rise in M. tuberculosis drug resistance. We also show that armed conflict and population displacement is likely to have aided the export of this clade from central Asia to war-torn Afghanistan and beyond.
Abstract
The “Beijing” Mycobacterium tuberculosis (Mtb) lineage 2 (L2) is spreading globally and has been associated with accelerated disease progression and increased antibiotic resistance. Here we performed a phylodynamic reconstruction of one of the L2 sublineages, the central Asian clade (CAC), which has recently spread to western Europe. We find that recent historical events have contributed to the evolution and dispersal of the CAC. Our timing estimates indicate that the clade was likely introduced to Afghanistan during the 1979–1989 Soviet–Afghan war and spread further after population displacement in the wake of the American invasion in 2001. We also find that drug resistance mutations accumulated on a massive scale in Mtb isolates from former Soviet republics after the fall of the Soviet Union, a pattern that was not observed in CAC isolates from Afghanistan. Our results underscore the detrimental effects of political instability and population displacement on tuberculosis control and demonstrate the power of phylodynamic methods in exploring bacterial evolution in space and time.

Prehospital & Disaster Medicine
Volume 31 – Issue 6 – December 2016
https://www.cambridge.org/core/journals/prehospital-and-disaster-medicine/latest-issue

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Editorial
Access to Essential Medications During Disaster Events
Samuel J. Stratton
DOI: https://doi.org/10.1017/S1049023X16001035
Published online: 26 September 2016, pp. 579-580

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH)
Recently Published Articles – November
http://www.paho.org/journal/index.php?option=com_content&view=featured&Itemid=101

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Special report | Published 22 November |
Determinantes sociales de la salud y convergencias en agendas de salud de organismos regionales de América del Sur [Social determinants of health and convergence in health agendas of regional agencies in South America]
Ximena Pamela Díaz-Bermúdez, Flavia Bueno, Luis Francisco Sánchez Otero, y Annela Jean Auer

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Special Report | Published 22 November |
Prioridades da pesquisa clínica com medicamentos no Brasil e as doenças da pobreza [Priorities of clinical drug trials in Brazil and neglected diseases of poverty]
Rafael Santos Santana e Silvana Nair Leite

Science
25 November 2016 Vol 354, Issue 6315
http://www.sciencemag.org/current.dtl
Research Articles
Social status alters immune regulation and response to infection in macaques
By Noah Snyder-Mackler, Joaquín Sanz, Jordan N. Kohn, Jessica F. Brinkworth, Shauna Morrow, Amanda O. Shaver, Jean-Christophe Grenier, Roger Pique-Regi, Zachary P. Johnson, Mark E. Wilson, Luis B. Barreiro, Jenny Tung
Science25 Nov 2016 : 1041-1045 Restricted Access
Manipulation of social status in macaques affects cell-specific immune gene regulation.
Editor’s Summary
Rhesus macaques experience variable levels of stress on the basis of their position in the social hierarchy. To examine how stress affects immune function, Snyder-Mackler et al. manipulated the social status of individual macaques (see the Perspective by Sapolsky). Social status influenced the immune system at multiple levels, from immune cell numbers to gene expression, and altered signaling pathways in a model of response to infection. Macaques possess a plastic and adaptive immune response wherein social subordination promotes antibacterial responses, whereas high social status promotes antiviral responses.

Patient Education and Counseling
Available online 20 November 2016 In Press, Accepted Manuscript — Note to users
Translating self-persuasion into an adolescent HPV vaccine promotion intervention for parents attending safety-net clinics
Austin S. Baldwina, Deanna C. Denmana, Margarita Salaa, Emily G. Marksb, L. Aubree Shayc,
Sobha Fullerd, Donna Persaudd, Simon Craddock Leeb, Celette Sugg Skinnerb, Deborah J. Wiebee, Jasmin A. Tirob
Abstract
Objective
Self-persuasion is an effective behavior change strategy, but has not been translated for low-income, less educated, uninsured populations attending safety-net clinics or to promote human papillomavirus (HPV) vaccination. We developed a tablet-based application (in English and Spanish) to elicit parental self-persuasion for adolescent HPV vaccination and evaluated its feasibility in a safety-net population.
Methods
Parents (N = 45) of age-eligible adolescents used the self-persuasion application. Then, during cognitive interviews, staff gathered quantitative and qualitative feedback on the self-persuasion tasks including parental decision stage.
Results
The self-persuasion tasks were rated as easy to complete and helpful. We identified six question prompts rated as uniformly helpful, not difficult to answer, and generated non-redundant responses from participants. Among the 33 parents with unvaccinated adolescents, 27 (81.8%) reported deciding to get their adolescent vaccinated after completing the self-persuasion tasks.
Conclusions
The self-persuasion application was feasible and resulted in a change in parents’ decision stage. Future studies can now test the efficacy of the tablet-based application on HPV vaccination.
Practice implications
The self-persuasion application facilitates verbalization of reasons for HPV vaccination in low literacy, safety-net settings. This self-administered application has the potential to be more easily incorporated into clinical practice than other patient education approaches.

Media/Policy Watch
This watch section is intended to alert readers to substantive news, analysis and opinion from the general media and selected think tanks and similar organizations 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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Forbes
http://www.forbes.com/
Accessed 26 November 2106
Fidel Castro-Supported Lung Cancer Vaccine To Be Tested In U.S. Clinical Trials
Nov 26, 2016
David Kroll, Contributor

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The Guardian
http://www.guardiannews.com/
Accessed 26 November 2106
AMA head criticises ‘demonisation’ of big pharma by anti-vaxxers
23 November 2016
The president of the Australian Medical Association, Dr Michael Gannon, says it has been disappointing to see a growing “demonisation of pharmaceutical companies” by the anti-vaccination movement in an attempt to promote distrust of proven medicines. Gannon made the comments in response to the NSW health department recommending reforms that, if implemented, would see parents of high-school students compelled to provide details of their child’s vaccination status, and give public health officers the power to exclude unvaccinated children from high schools during disease outbreaks…
“I’m reluctant to make the comparison between anti-vaxxers and climate change deniers, but it almost seems if you can shout louder than the careful, temperate advice from medical professionals and scientists you might get support for your non-scientific views,” he said….

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Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 26 November 2106
Stopping the Spread of Japan’s Antivaccine Panic
24 November 2016
Tokyo’s indecisiveness in the face of controversy has fueled unfounded doubts about the safety of the HPV vaccine.

What Global Disease Threat Worries Public-Health Officials Most?
22 November 2016
The CDC’s Thomas Frieden and Susan Desmond-Hellman of the Gates Foundation on preparing for a pandemic

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Washington Post
http://www.washingtonpost.com/
Accessed 26 November 2106
Major HIV vaccine trial in South Africa stokes hope
Ryan Lenora Brown and Lenny Bernstein
November 25, 2016
…Now all eyes are on South Africa, where researchers will begin inoculating thousands of volunteers Monday in the latest — and, some say, most promising — effort to develop a vaccine that prevents the disease. It is only the seventh full-scale human trial for a virus that infects more than 2 million people and kills more than 1 million every year.

“If this study shows efficacy . . . this would be a tectonic, historic event for HIV,” said Nelson L. Michael, director of the U.S. Military HIV Research Program, which led the Thailand study.
Should the vaccine prove to be 50 percent to 60 percent effective, experts say, that would be sufficient for drugmakers Sanofi Pasteur and GSK to begin licensing negotiations with the South African government. While such a rate is well below the acceptable margin for other vaccines, it would still make this one worth producing here — given that nearly 1 in 5 people are infected…

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Think Tanks et al

Council on Foreign Relations
http://www.cfr.org/
Accessed 26 November 2106
Interactive Map: Vaccine-Preventable Outbreaks
24 November 2016
This interactive map visually plots global outbreaks of measles, mumps, whooping cough, polio, rubella, and other diseases that are easily preventable by inexpensive and effective vaccines. Red triangles indicate attacks on vaccinators and healthcare workers, as well as announcements from both governments and non-state actors that have had an impact—either positive or negative—on the successful implementation of vaccination programs. The Global Health Program at the Council on Foreign Relations has been tracking reports by news media, governments, and the global health community on these outbreaks since the fall of 2008

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_19-november-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.

Support this knowledge-sharing service: Your financial support helps us cover our costs and to address a current shortfall in our annual operating budget. Click here to donate and thank you in advance for your contribution.

.
David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy

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_12-november-2016-docx

– 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.

Support this knowledge-sharing service: Your financial support helps us cover our costs and to address a current shortfall in our annual operating budget. Click here to donate and thank you in advance for your contribution.

.
David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy

Milestones :: Perspectives

Haiti begins vaccination campaign against cholera in areas most affected by Hurricane Matthew
Les Cayes, Haiti, 9 November 2016 (PAHO/WHO) – A large contingent of national supervisors, nurses, health workers and criesurs, or town criers, are being mobilized by the Ministry of Health and Population of Haiti to vaccinate some 800,000 people living in 16 communes in the departments of Sud and Grand’Anse, the areas most affected by Hurricane Mathew a month ago.

The campaign, which has the support of the Pan American Health Organization/World Health Organization (PAHO/WHO) and other partners, began yesterday and will run until November 14. The objective is to reduce the morbidity and mortality caused by cholera and to prevent the spread of the disease in other departments of the country. To ensure that there is collective protection a vaccine will be applied to each person over one year of age living in the 16 communes targeted for vaccination. According to experts, this single [does of] vaccine will avoid between 60% and 70% of severe cases of cholera.

As part of this vaccination campaign, PAHO / WHO mobilized a group of epidemiologists and immunization experts to provide technical support for the campaign. Vaccines provided by the GAVI alliance are already on the ground, and the International Medical Corps (IMC), UNICEF and other vaccination partners have readied components for the campaign. These include preservation of the cold chain to keep vaccines potent, social mobilization actions, and logistical support for vaccination brigades.

The Minister of Health of Haiti, Daphnée Benoit Delsoin, stressed that “Vaccination is a tool for the control of cholera; it is an additional measure to achieve the elimination of cholera in Haiti.” The minister launched the campaign in Les Cayes and applied the first dose of the oral vaccine against cholera. The launch took place in Les Cayes, with the presence of local authorities such as the mayor, parliamentary deputy of the area, representative of the president at local level, among others.

“Vaccination is complementary to other preventive measures,” said Jean Luc Poncelet, PAHO / WHO representative in Haiti, at the launch of the campaign. “Each person must be a leader of change: daily chlorination of water in the house, drinking potable water, rehydration if there is diarrhea, and seeking treatment. To avoid deaths, there are health services that are working and available. “…

Measles jab saves over 20 million young lives in 15 years, but hundreds of children still die of the disease every day
Joint news release CDC/GAVI/UNICEF/WHO
10 November 2016 | NEW YORK/ATLANTA/GENEVA – Despite a 79% worldwide decrease in measles deaths between 2000 and 2015, nearly 400 children still die from the disease every day, leading health organizations said in a report released today.

“Making measles history is not mission impossible,” said Robin Nandy, UNICEF Immunization Chief. “We have the tools and the knowledge to do it; what we lack is the political will to reach every single child, no matter how far. Without this commitment, children will continue to die from a disease that is easy and cheap to prevent.”

Mass measles vaccination campaigns and a global increase in routine measles vaccination coverage saved an estimated 20.3 million young lives between 2000 and 2015, according to UNICEF; WHO; Gavi, the Vaccine Alliance; and the Centers for Disease Control and Prevention (CDC).
But progress has been uneven. In 2015, about 20 million infants missed their measles shots and an estimated 134 000 children died from the disease. The Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria and Pakistan account for half of the unvaccinated infants and 75% of the measles deaths.

“It is not acceptable that millions of children miss their vaccines every year. We have a safe and highly effective vaccine to stop the spread of measles and save lives,” said Dr. Jean-Marie Okwo-Bele, Director of WHO’s Department of Immunization, Vaccines and Biologicals. “This year, the Region of the Americas was declared free of measles – proof that elimination is possible. Now, we must stop measles in the rest of the world. It starts with vaccination.”

“Measles is a key indicator of the strength of a country’s immunization systems and, all too often, it ends up being the canary in the coalmine with outbreaks acting as the first warning of deeper problems,” said Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance. “To address one of the world’s most deadly vaccine-preventable childhood killers we need strong commitments from countries and partners to boost routine immunization coverage and to strengthen surveillance systems.”…

Measles outbreaks in numerous countries – caused by gaps in routine immunization and in mass vaccination campaigns – continue to be a serious challenge. In 2015, large outbreaks were reported in Egypt, Ethiopia, Germany, Kyrgyzstan and Mongolia. The outbreaks in Germany and Mongolia affected older persons, highlighting the need to vaccinate adolescents and young adults who have no protection against measles.

Measles also tends to flare up in countries in conflict or humanitarian emergencies due to the challenges of vaccinating every child. Last year, outbreaks were reported in Nigeria, Somalia and South Sudan.

Measles elimination in 4 of 6 WHO regions is the global target at the midpoint of the Global Vaccine Action Plan implementation. “The world has missed this target, but we can achieve measles elimination as we have seen in the Region of the Americas,” said Dr. Rebecca Martin, director of CDC’s Center for Global Health. “As the African adage goes, ‘it takes a village to raise a child’ and it takes the same loca-l and global villages to protect children against measles. We can eliminate measles from countries and everyone needs to play a role. This year’s report shows that the 2015 WHO regional measles elimination goals were not met because not every child has been reached – gaps exist. We need to close these gaps, ensure that commitments for adequate human and financial resources are kept and used well to reach every child, detect and respond to every case of measles, and prevent further spread. These efforts will protect all children so that they can become the next generation of leaders. This will also ensure that every country has a strong safety net to stop disease threats where they occur and protect the world from global health threats.”

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Weekly Epidemiological Record, 11 November 2016, vol. 91, 45 (pp. 525–536)
:: Progress towards regional measles elimination – worldwide, 2000–2015
:: Monthly report on dracunculiasis cases, January– September 2016

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Gavi [to 12 November 2016]
http://www.gavi.org/library/news/press-releases/
Strong commitment needed to strengthen measles immunisation
Global routine immunisation coverage for the first dose of measles has stagnated in the last five years.
Geneva, 10 November 2016 – Measles remains one of the leading causes of death among children under five despite the availability of a safe and effective vaccine, according to new data released by UNICEF, the World Health Organization (WHO), Gavi, the Vaccine Alliance, and the Centers for Disease Control and Prevention (CDC). Last year, an estimated 134,000 people, mostly children, died from the disease compared to nearly 115,000 in 2014.

Moreover global routine immunisation coverage for the first dose of measles has stagnated in the last five years, plateauing at 84%-85% and in Gavi countries at 78%. The failure to vaccinate all children with two doses of the vaccine and maintain high levels of herd immunity (93%–95%) has resulted in an increased number of measles outbreaks.

“Globally more than 20 million children are still not vaccinated against measles,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “Countries need strong routine immunisation services, efficient measles surveillance activities and resources for strengthening health systems if they are to better control measles and meet elimination goals.”…

UNICEF Report: Ending Child Deaths from Pneumonia and Diarrhoea – One is Too Many
November 2016 :: 77 Pages :: ISBN: 978-92-806-4859-1
[Excerpt from Executive Summary]
Vaccines – coverage of key pneumonia-related vaccines is increasing and progress in sub-
Saharan Africa is improving faster than the global average. Yet despite recent progress, in
2015 just over 60 per cent of children globally received the recommended three doses of Hib
vaccine and just over 30 per cent received the PCV vaccine…

Press Release
Pneumonia and diarrhoea kill 1.4 million children each year, more than all other childhood illnesses combined – UNICEF
World leaders gathered at COP22 have opportunity to make commitments that will help save the lives of 12.7 million children by 2030
MARRAKECH, Morocco, 11 November 2016 – Pneumonia and diarrhoea together kill 1.4 million children each year, the overwhelming majority of whom live in lower and middle-income countries. These childhood deaths occur despite the fact that both illnesses are largely preventable through straightforward and cost effective solutions like exclusive breastfeeding, vaccination, quality primary healthcare and reducing household air pollution.
These findings are included in a new UNICEF report – ‘One is Too Many: Ending Child Deaths from Pneumonia and Diarrhoea’ – released today.
Pneumonia in particular remains the leading infectious killer of children under five, claiming the lives of nearly a million children in 2015 – approximately one child every 35 seconds, and more than malaria, TB, measles, and AIDS combined. Approximately half of all childhood pneumonia deaths are linked to air pollution, a fact UNICEF said world leaders should keep in mind during ongoing climate change talks at COP22…

Emergencies

WHO Grade 3 Emergencies [to 12 November 2016]
Iraq –
:: Iraq: Civilians caught in the cross-fire: WHO supports trauma care services for people in and around Mosul
9 November 2016 – The stories of civilians caught in the cross-fire in and around Mosul are heartbreaking and horrific. WHO is ensuring that life-saving health services are available to injured people, supporting the tireless work of the Erbil Directorate of Health to provide emergency medical care to all those who need it.
:: WHO condemns reported attacks using ambulances as weapons targeting civilians in Tikrit and Samarra, Iraq
6 November 2016

Nigeria -No new announcements identified.
South Sudan – No new announcements identified.
The Syrian Arab Republic – No new announcements identified.

Yemen – No new announcements identified.
:: Health system in Yemen
11 November 2016 – Health services play crucial role in preventing avoidable morbidity and mortality in emergencies. However, emergencies affect health facilities and services too. With many been damaged, left without medicines, equipment, basic amenities or health workers, cannot serve the population which may even have heightened healthcare needs due to the emergency. Health Resources Availability Monitoring System HeRAMS is developed to face these challenges. HeRAMS is a rapid online system for monitoring health facilities, services and resources availability in emergencies.

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WHO Grade 2 Emergencies [to 12 November 2016]
Cameroon – No new announcements identified.
Central African Republic – No new announcements identified.
Democratic Republic of the Congo – No new announcements identified.
Ethiopia – No new announcements identified.
Libya – No new announcements identified.
Myanmar – No new announcements identified.
Niger – No new announcements identified.
Ukraine – No new announcements identified.

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises.
Iraq
:: Mosul Humanitarian Crisis, 9 November 2016
:: Iraq: Mosul Humanitarian Response Situation Report #6 (1-6 November 2016) [EN/AR/KU]

Syria
:: Syrian Arab Republic: Whole of Syria sectors’ response to hard-to-reach and besieged locations* (January – September 2016) 11 Nov 2016

Yemen
:: Yemen Humanitarian Bulletin Issue 17 | As of 30 October 2016 8 Nov 2016

Corporate Emergencies
Haiti
:: Haiti: Hurricane Matthew – Situation Report No. 20 (8 November 2016)
Main Points:
…Of the 806,000 affected people who are at the “extreme level” of food insecurity, 426,000 people (or 53 per cent) have so far received food assistance.
…Continued security incidents targeting convoys of humanitarian supplies hinder the much needed delivery of assistance.
…During the reporting period, heavy rains in the departments of Grand’Anse, Nord-Est, and Nord led to the death of 10 people (Three women, four men, and three children). Three others are wounded and one is missing.
…With crop loss reaching a staggering 80 to 100 per cent in parts of the predominantly rural areas, people’s food insecurity risks worsening in the coming months if farming activities are not urgently restored by mid-November.

Zika virus [to 12 November 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

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NIH [to 12 November 2016]
http://www.nih.gov/news-events/news-releases

November 7, 2016 — First of five planned clinical trials to test ZPIV vaccine.
Testing of investigational inactivated Zika vaccine in humans begins
The first of five early stage clinical trials to test the safety and ability of an investigational Zika vaccine candidate called the Zika Purified Inactivated Virus (ZPIV) vaccine to generate an immune system response has begun at the Walter Reed Army Institute of Research (WRAIR) Clinical Trial Center in Silver Spring, Maryland. Scientists with WRAIR, part of the U.S. Department of Defense (DoD), developed the vaccine. The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), is co-funding the Phase 1 clinical trial with WRAIR, serving as the regulatory sponsor and providing other support.

“We urgently need a safe and effective vaccine to protect people from Zika virus infection…”
—Anthony S. Fauci, M.D., Director, National Institute of Allergy and Infectious Diseases (NIAID)
The experimental ZPIV vaccine is based on the same technology WRAIR used in 2009 to successfully develop a vaccine for another flavivirus called Japanese encephalitis. The ZPIV vaccine contains whole Zika virus particles that have been inactivated, meaning that the virus cannot replicate and cause disease in humans. However, the protein shell of the inactivated virus remains intact so it can be recognized by the immune system and evoke an immune response. NIAID partially supported the preclinical development of the ZPIV vaccine candidate, including safety testing and non-human primate studies that found that the vaccine induced antibodies that neutralized the virus and protected the animals from disease when they were challenged with Zika virus. WRAIR, NIAID and the Biomedical Advanced Research and Development Authority (BARDA) part of the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) have established a joint Research Collaboration Agreement to support the development of this vaccine.

“We urgently need a safe and effective vaccine to protect people from Zika virus infection as the virus continues to spread and cause serious public health consequences, particularly for pregnant women and their babies,” said NIAID Director Anthony S. Fauci, M.D. “We are pleased to be part of the collaborative effort to advance this promising candidate vaccine into clinical trials.”

Led by WRAIR principal investigator Maj. Leyi Lin, M.D., the new study aims to enroll 75 people ages 18 to 49 years with no prior flavivirus infection. Flaviviruses include Zika virus, yellow fever virus, dengue virus, Japanese encephalitis virus and West Nile virus. Participants will be randomly divided into three groups: the first group (25 participants) will receive two intramuscular injections of the ZPIV test vaccine or a placebo (saline) 28 days apart; the other two groups (25 participants each) will receive a two-dose regimen of a Japanese encephalitis virus vaccine or one dose of a yellow fever vaccine before beginning the two-dose ZPIV vaccine regimen. Investigators chose to administer additional flavivirus vaccines because U.S. service members are often vaccinated against these diseases before deploying to Zika-endemic areas.

Additionally, a subgroup of 30 of the participants who receive the two-dose ZPIV regimen will receive a third dose one year later. All participants in the trial will receive the same ZPIV dose at each injection (5 micrograms). A DoD Research Monitor, an independent physician not associated with the protocol, will monitor the conduct of the trial and report any safety issues to the WRAIR Institutional Review Board. Another independent group, the Safety Monitoring Committee, will also monitor participant safety, review data and report any issues to NIAID. As the regulatory sponsor, NIAID ensures the trial follows the study protocol and informs the FDA of any significant adverse events or risks. NIAID also maintains the Investigational New Drug (IND) application (link is external) for the candidate vaccine. The WRAIR study is expected to be completed by fall 2018.

Four additional Phase 1 studies to evaluate the ZPIV investigational vaccine are expected to launch in the coming months. These include

:: A trial enrolling 90 adults ages 18-49 years at the Center for Vaccine Development at the Saint Louis University School of Medicine. This site is an NIAID-funded Vaccine and Treatment Evaluation Unit, and Sarah George, M.D., will serve as principal investigator. All participants will receive either two injections of ZPIV or a placebo 28 days apart. Participants will be randomly assigned to receive either a high, moderate or low dose at both injections to evaluate the optimal dose for use in larger future studies.

:: A trial enrolling 90 adults ages 21-49 years at the clinical research center CAIMED, part of Ponce Health Sciences University in Puerto Rico. The site is supported by NIAID via a subcontract from the Saint Louis University School of Medicine. This trial will examine the vaccine’s safety and immunogenicity in participants who have already been naturally exposed to dengue virus. Participants will be randomly assigned to receive either a high dose, moderate dose or a placebo. Elizabeth A. Barranco, M.D., will lead the trial.

:: NIAID’s Vaccine Research Center (VRC) will test the ZPIV vaccine candidate as a boost vaccination to its DNA Zika vaccine candidate, which entered Phase 1 clinical trials in August. The next part of the study, which will enroll 60 additional participants ages 18-50 years, will take place at the NIH Clinical Center in Bethesda, Maryland, the Center for Vaccine Development at the University of Maryland School of Medicine’s Institute for Global Health in Baltimore, and Emory University in Atlanta. Half of the participants will receive the NIAID Zika virus investigational DNA vaccine followed by a ZPIV vaccine boost four or 12 weeks later. The remaining participants will receive only two doses of ZPIV vaccine four or 12 weeks apart. Julie Ledgerwood, D.O., chief of the VRC’s clinical trials program, will serve as principal investigator.

:: A WRAIR-funded trial enrolling 48 adults ages 18-50 years will be conducted at the Center for Virology and Vaccine Research, part of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston. One group of participants will receive a single dose of the ZPIV vaccine and all other participants will receive two doses of the ZPIV vaccine at varying intervals. Kathryn Stephenson, M.D., M.P.H., of Beth Israel Deaconess Medical Center, will lead the trial.

BARDA is funding the advanced development of the ZPIV vaccine candidate through a six-year contract with Sanofi Pasteur, which established a collaborative research and development agreement with WRAIR to accelerate further development of the vaccine.

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Zika situation report – 10 November 2016
Full report: http://apps.who.int/iris/bitstream/10665/251001/1/zikasitrep10Nov16-eng.pdf?ua=1
Key Updates
:: Countries and territories reporting mosquito-borne Zika virus infections for the first time in the past week:
… Montserrat, Palau

:: Countries and territories reporting microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection for the first time in the past week:
… None

:: Countries and territories reporting Guillain-Barré syndrome (GBS) cases associated with Zika virus infection for the first time in the past week:
… None

:: The fifth meeting of the Emergency Committee on Zika virus, microcephaly other neurological disorders will be convened on 18 November 2016.

Analysis
:: Overall, the global risk assessment has not changed. Zika virus continues to spread geographically to areas where competent vectors are present. Although a decline in cases of Zika infection has been reported in some countries, or in some parts of countries, vigilance needs to remain high.

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Zika Open [to 12 November 2016]
[Bulletin of the World Health Organization]
:: All papers available here
No new papers identified.

EBOLA/EVD [to 12 November 2016]
http://www.who.int/ebola/en/
“Threat to international peace and security” (UN Security Council)

Editor’s Note:
We note that the Ebola tab – which had been listed along with Zika, Yellow Fever, MERS CoV and other emergencies – has been removed from the WHO “home page”. We deduce that WHO has suspended issuance of new Situation Reports after resuming them for several weekly cycles. The most recent report posted is EBOLA VIRUS DISEASE – Situation Report – 10 JUNE 2016. We have not encountered any UN Security Council action changing its 2014 designation of Ebola as a “threat to international peace and security.” We will continue to highlight key articles and other developments around Ebola in this space.

POLIO [to 12 November 2016]
Public Health Emergency of International Concern (PHEIC)

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Polio this week as of 9 November 2016
:: In Nigeria last week, experts from the Government and international partners convened an urgent meeting to assess the impact of regional emergency outbreak response conducted thus far in Nigeria and the Lake Chad Basin. The group looked at progress achieved in boosting immunity levels and strengthening surveillance, the effectiveness of cross-border collaboration and coordination with the broader humanitarian emergency response.

:: A risk analysis is being conducted for non-affected areas of Nigeria and neighbouring countries, to assess vulnerability of populations to polio spread, risk mitigation measures being implemented and outbreak readiness plans in the event of spread of the virus from Borno.

:: News this week: continuing our focus on innovative strategies to facilitate eradication, a closer look at new ways of delivering inactivated polio vaccine (IPV) which could help address global supply constraint.

Country Updates [Selected Excerpts]
Afghanistan
:: Three new wild poliovirus type 1 (WPV1) cases were reported in the past week, all from Bermal district, Paktika province, with onsets of paralysis on 1 September, 7 October and 12 October, bringing the total number of WPV1 cases for 2016 to 12…
Pakistan
:: One new case of wild poliovirus type 1 (WPV1) was reported in the past week with onset of paralysis on 3 September, from Kohistan in Khyber Pakhtunkhwa (KP), in the north of the country. It brings the total number of WPV1 cases for 2016 to 16.
:: Three new WPV1 positive environmental samples were reported in the past week, from Balochistan (two from Quetta and one from Killa Abdullah, collected on 20 September, 14 October and 15 October). Continued detection of environmental positives throughout 2016 confirms that virus transmission remains geographically widespread across the country, despite strong improvements being achieved.
:: Efforts continue to further strengthen immunization and surveillance activities in all provinces, in close coordination with Afghanistan (see ‘Afghanistan’ section above, for more details).

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WHO: Over 5.6 million children to be vaccinated against polio across Afghanistan
Kabul 7 November 2016 – The Ministry of Public Health along with its partners WHO and UNICEF launched a polio vaccination campaign today in all provinces of the southern, eastern and south-eastern regions as well as selected high-risk districts across the country, including Kabul city. The campaign aims to reach over 5.6 million children and will run until 11 November.

“Wherever children are not immunized, children’s lives are at risk everywhere in Afghanistan. We urge all caregivers to vaccinate their children against polio because the polio vaccine is the only way to protect children from permanent paralysis and even death,” said H.E. Minister of Public Health Dr Ferozuddin Feroz. “Afghanistan is closer than ever to stopping the circulation of the wild poliovirus and our focus remains on reaching and immunizing every single child.”…

The campaign is carried out by around 25,000 trained vaccinators and it runs for four days with an additional day on Friday for vaccinators to revisit children who were missed when the vaccinators first visited. These vaccinators and other frontline health workers are trusted members of the community and they have been chosen because they care about children. Parents who miss having their children vaccinated over the next four days are urged to visit local health centres where their children can be vaccinated against polio.

So far 12 wild poliovirus cases have been reported in 2016 from Kunar, Paktika, Helmand and Kandahar provinces. Afghanistan remains one of the 3 polio-endemic countries together with Pakistan and Nigeria.

Yellow Fever [to 12 November 2016]
http://www.who.int/emergencies/yellow-fever/en/

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Yellow fever situation report
28 October 2016
[Link to the latest report above. No updated report posted and no indication as to status of situation reports overall]

MERS-CoV [to 12 November 2016]
http://www.who.int/emergencies/mers-cov/en/

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Disease Outbreak News (DONs)
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 11 November 2016
Between 15 and 29 October 2016 the National IHR Focal Point of Saudi Arabia reported thirteen (13) additional cases of Middle East Respiratory Syndrome (MERS) including four (4) fatal cases…

WHO & Regional Offices [to 12 November 2016]

Stories from countries
Information on health services essential for humanitarian response in Borno State, Nigeria
10 November 2016
WHO donates emergency medical supplies for the response in Borno State, Nigeria
9 November 2016
WHO and partners support measles vaccination in Borno State, Nigeria
9 November 2016

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Highlights
Monitoring Visualization Tool for the Global Action Plan for Pneumonia and Diarrhoea
This tool presents data on 24 key indicators related to the protection, prevention and treatment of diarrhoea and pneumonia in children under five years of age and two indicators on mortality due to the two diseases. The tool also enables access to country-specific profiles to see the progress made by 136 low- and middle-income countries in averting childhood diarrhoea and pneumonia deaths.

e-Learning Course on Health Financing Policy for universal health coverage (UHC)
November 2016 – This is a foundational course, targeting participants of various levels of experience and expertise. It is for free and available to anyone interested. Subjects covered include revenue raising, pooling revenues, purchasing, and benefit package design.

WHO condemns reported attacks using ambulances as weapons targeting civilians in Tikrit and Samarra, Iraq
November 2016 – WHO received reports of suicide bombers driving ambulances, killing more than 20 people and injuring dozens more at a checkpoint in Tikrit and a car park in Samarra. The reported use of medical vehicles as weapons threatens the ability to deliver health care and urgent medical services

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Weekly Epidemiological Record, 11 November 2016, vol. 91, 45 (pp. 525–536)
:: Progress towards regional measles elimination – worldwide, 2000–2015
:: Monthly report on dracunculiasis cases, January– September 2016

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:: WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: WHO-AfDB cooperation: Dr Moeti and Dr Adesina agree on a number of financing priorities for health in Africa
Abidjan (Côte d’Ivoire), 9 November 2016 – The WHO Regional Director for Africa, Dr Matshidiso Moeti and the President of the African Development Bank, Dr Akimwumi Adesina, have agreed on priority health programmes for potential future cooperation between the Bank and WHO.
:: WHO and partners support measles vaccination in Borno State, Nigeria – 09 November 2016
:: Ouagadougou subregional workshop to discuss noma, the face of poverty – 07 November 2016

WHO Region of the Americas PAHO
:: Caribbean Health Ministers agree on action plan for innovating national information systems for health (11/08/2016)
:: Experts at PAHO present imaging findings to detect Zika abnormalities (11/08/2016)

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

WHO European Region EURO
No new digest content identified.

WHO Eastern Mediterranean Region EMRO
:: Over 5.6 million children to be vaccinated against polio across Afghanistan
7 November
Pregnant women must be able to access the right care at the right time
7 November 2016
WHO establishes rapid response teams to safeguard the health of newly displaced people from Mosul, Iraq
6 November 2016

WHO Western Pacific Region
No new digest content identified.

CDC/ACIP [to 12 November 2016]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/

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MMWR Weekly November 11, 2016 / No. 44
:: Incidence of Zika Virus Disease by Age and Sex — Puerto Rico, November 1, 2015–October 20, 2016
:: Progress Toward Regional Measles Elimination — Worldwide, 2000–2015
:: Announcement: Get Smart About Antibiotics Week — November 14–20, 2016
:: Announcement: World Pneumonia Day — November 12, 2016
:: QuickStats: Percentage of Adults Aged ≥65 Years Who Reported Ever Receiving a Pneumococcal Vaccination, by Race/Ethnicity and Number of 10 Diagnosed Chronic Conditions — National Health Interview Survey, United States, 2014–2015

Industry Watch [to 12 November 2016]

Pfizer Announces Major Expansion of Humanitarian Assistance Program
Prevenar 13® Vaccine Will Be Available at Lowest Price for Humanitarian Emergencies
Pfizer to Donate Sales Proceeds to Organizations Supporting the Refugee Crisis
November 11, 2016
NEW YORK–(BUSINESS WIRE)–Pfizer Inc. (NYSE:PFE) announced today a major expansion of its humanitarian assistance program enabling broader access to its vaccine, Prevenar 13, in humanitarian emergency settings by offering its new multi-dose vial (MDV) at what will be the lowest prevailing global price, currently $3.10 per dose. In addition, given the acute need for aid on the ground, Pfizer will donate all sales proceeds for the first year of this program to humanitarian groups undertaking the difficult work of reaching vulnerable populations in emergency settings. Today’s announcement of a new and specific pricing tier for civil society organizations (CSOs) working in emergency settings builds on Pfizer’s longstanding support for humanitarian emergency relief around the world.

In the immediate term, Pfizer will meet humanitarian emergency needs through a short-term donation of the single-dose vial of Prevenar 13, which is available for expedited delivery.

Starting in 2017, refugees can receive the newest version of Prevenar 13, the MDV. This presentation is scheduled to be introduced early next year and contains four doses of Prevenar 13 in the same-sized vial that currently contains a single dose. This four-in-one vial is specially designed to address the unique conditions and challenges experienced in developing world settings and can help health workers in humanitarian emergencies. The MDV offers reduced cold storage and transportation requirements, helping to enable vaccination of children in humanitarian emergency situations more quickly. It has also been prequalified by the World Health Organization.

“Pfizer is proud of the significant impact that our Prevenar 13 vaccine and our partnerships with many humanitarian organizations have had on public health across the globe. Only by putting the needs of refugees at the center, can we all work collaboratively to help prevent disease in some of the world’s most vulnerable populations,” said Susan Silbermann, President and General Manager, Pfizer Vaccines. “Our new MDV presentation is an important vaccine technology, and in combination with our expanded humanitarian assistance program, will provide critical help in addressing the potential burden of pneumococcal disease in these populations that might otherwise go unreached. We are especially pleased to donate all proceeds from these sales to civil society organizations for the first year to support the significant additional needs these groups have on the ground.”

Pfizer Humanitarian Assistance Programs
Recognizing the critical need in settings requiring relief and emergency humanitarian assistance, Pfizer has a three-part approach which includes product donations, cash grants and other access solutions.
:: Pfizer donations are focused on specific diseases and designed to address the needs of people in a coordinated manner. The Company works with a range of local and global partners, including governments, health care experts, and CSOs to address the most pressing unmet medical needs and determine the most effective way for a donation to meet the needs of affected communities.

:: Pfizer supports a number of organizations working on providing relief and emergency humanitarian assistance to address refugee crises. The Pfizer Foundation provides cash grants to organizations working around the world to provide health care and other critical support to vulnerable populations.

:: Pfizer works closely with governments and CSOs to help provide access to its vaccines and regularly engages in discussions with partners on potential new access approaches to reach as many people as possible in emergency humanitarian situations.

For more information on Pfizer’s Humanitarian Assistance Programs please visit http://www.pfizer.com/responsibility/global-health/relief-and-emergency-humanitarian-assistance.

Announcements

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PATH [to 12 November 2016]
http://www.path.org/news/index.php
Press release | November 10, 2016
PATH’s ongoing impact in global health recognized by The Tech Awards’ 2016 Laureate Impact Award
PATH is honored to receive the prestigious 2016 Laureate Impact Award as a leader in solving global health problems for 40 years—from idea to impact.

Press release | November 10, 2016
PATH announces agreement with BD to advance new diagnostic technologies to support malaria elimination
Better tests for a common hereditary condition in humans are needed to facilitate treatment of Plasmodium vivax malaria

::::::

EDCTP [to 12 November 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.

9 November 2016
Professor Shabir Mahdi receives Scientific Leadership Award
On 7 November 2016, Professor Dr Shabir A. Mahdi (1966) received the EDCTP 2016 Award for Scientific Leadership. The award consists of a trophy and 10,000 euro. The award ceremony took place at the Eighth EDCTP Forum in Lusaka, Zambia. The award was presented by Dr Michael Makanga, EDCTP Executive Director.

9 November 2016
Zambian Research & Training Programme receives Outstanding Research Team award
The EDCTP Award for Outstanding Research Team 2016 was given to the University of Zambia – University College London Medical School (UNZA-UCLMS) Research & Training Program on 6 November 2016. The award consists of a trophy and 50,000 euro. At the opening session of the Eighth EDCTP Forum, Dr Peter Mwaba, on behalf of his team, received the award from His Excellency, the President of the Republic of Zambia, Mr Edgar Chagwa Lungu.

::::::

European Medicines Agency [to 12 November 2016]
http://www.ema.europa.eu/
08/11/2016
How big data can be used for the development and regulation of medicines
EMA workshop broadcast live on 14-15 November …

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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High-level dialogue on strengthening public health security in Africa calls for huge private sector investments in health
West African Ministerial Dialogue on Strengthening Public Health Security in Africa
07/11/2016
“Nothing could be more important,” African Development Bank President Akinwumi Adesina said Monday, as he addressed a high-level dialogue on strengthening public health security in Sub-Saharan Africa. “Health is wealth.”

“Our meeting today is crucial, for building resilient health systems to ensure that Africa can deal effectively with public health emergencies and support its economic transformation,” he told the West African Ministerial Dialogue on Strengthening Public Health Security in Africa, hosted by the AfDB. “A healthy population will translate into increased productivity, and drive sustainable economic growth.”

The meeting focused on lessons learned from the Ebola crisis and the preparedness of African governments in an effective healthcare system capable of responding to emergencies.

The Ebola virus disease (EVD) in West Africa exposed the vulnerability of countries to public health emergencies. In particular, it demonstrated that many countries do not have robust health systems, and are lacking the core capacities to respond effectively to health security threats. In light of the increasing number of new threats since 2015, including a major urban yellow fever outbreak and spread of the Zika virus disease in Africa, the need to strengthen countries’ capacities to respond to such threats has never been greater. The Ebola outbreak not only posed a serious threat to public health security; it also greatly impacted the economic security of the countries affected.

The Abidjan meeting, which featured presentations on how the Ebola Virus Disease spread through communities in Liberia, Guinea and Sierra Leone, brought together Finance and Health Ministers from Liberia, Guinea, Sierra Leone and Côte d’Ivoire; Ambassadors accredited to Côte d’Ivoire; representatives of bilateral, regional and multilateral organizations; healthcare experts; and members of AfDB’s Board of Directors.

President Adesina highlighted the significant progress made by Africa over the last two decades in terms of health outcomes, underscoring that child mortality has declined in Sub-Saharan Africa by more than 50% between 1990 and 2015. Similarly, maternal mortality rates declined by 45% in the sub-region and by 59% in North Africa over the same period. However, he underscored that key challenges related to the high disease burden in Africa remain…

“In addition, Sub-Saharan Africa faces a deficit of skilled health workers. While the region accounts for 25% of the global disease burden, it represents only 4% of the global health workforce. Lack of access to safe, quality and affordable medicines remains a major challenge, worsened by weak regulatory systems and a preponderance of fake drugs.”…

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 12 November 2016)

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Research article
Evaluating the implementation of a national disclosure policy for large-scale adverse events in an integrated health care system: identification of gaps and successes
Many healthcare organizations have developed disclosure policies for large-scale adverse events, including the Veterans Health Administration (VA). This study evaluated VA’s national large-scale disclosure pol…
Elizabeth M. Maguire, Barbara G. Bokhour, Todd H. Wagner, Steven M. Asch, Allen L. Gifford, Thomas H. Gallagher, Janet M. Durfee, Richard A. Martinello and A. Rani Elwy
BMC Health Services Research 2016 16:648
Published on: 11 November 2016

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Research article
Practical lessons for bringing policy-makers on board in sexual and reproductive health research
The need to translate research into policy, i.e. making research findings a driving force in agenda-setting and policy change, is increasingly acknowledged. However, little is known about translation mechanism...
Aurore Guieu, Wei-Hong Zhang, Yves Lafort, Peter Decat, Sara De Meyer, Shuchen Wang, Birgit Kerstens and Els Duysburgh
BMC Health Services Research 2016 16:649
Published on: 11 November 2016

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 12 November 2016)

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Case report
Three cases of Zika virus imported in Italy: need for a clinical awareness and evidence-based knowledge
Since early 2015, a large epidemic of Zika Virus (ZIKV) is spreading across South and Central America. An association between congenital neurological malformations (mainly microcephaly), other neurological man…
Emanuele Nicastri, Raffaella Pisapia, Angela Corpolongo, Francesco Maria Fusco, Stefania Cicalini, Paola Scognamiglio, Concetta Castilletti, Licia Bordi, Antonino Di Caro, Maria Rosaria Capobianchi, Vincenzo Puro and Giuseppe Ippolito
BMC Infectious Diseases 2016 16:669
Published on: 11 November 2016

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Research article
The burden of chickenpox disease in Sweden
Chickenpox vaccine is not included in the routine childhood vaccination programme in Sweden. The aim of this study was to estimate the baseline of national chickenpox disease burden, as comprehensive studies, …
Katarina Widgren, Johan Giesecke, Lars Lindquist and Anders Tegnell
BMC Infectious Diseases 2016 16:666
Published on: 10 November 2016

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 12 November 2016)

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Research article
Public responses to the sharing and linkage of health data for research purposes: a systematic review and thematic synthesis of qualitative studies
The past 10 years have witnessed a significant growth in sharing of health data for secondary uses. Alongside this there has been growing interest in the public acceptability of data sharing and data linkage p...
Mhairi Aitken, Jenna de St. Jorre, Claudia Pagliari, Ruth Jepson and Sarah Cunningham-Burley
BMC Medical Ethics 2016 17:73
Published on: 10 November 2016

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Research article
Knowledge, attitude and practice of healthcare ethics among resident doctors and ward nurses from a resource poor setting, Nepal
Healthcare ethics is neglected in clinical practice in LMICs (Low and Middle Income Countries) such as Nepal. The main objective of this study was to assess the current status of knowledge, attitude and practi…
Samaj Adhikari, Kumar Paudel, Arja R. Aro, Tara Ballav Adhikari, Bipin Adhikari and Shiva Raj Mishra
BMC Medical Ethics 2016 17:68
Published on: 8 November 2016

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Research article
The Norwegian national project for ethics support in community health and care services
Internationally, clinical ethics support has yet to be implemented systematically in community health and care services. A large-scale Norwegian project (2007–2015) attempted to increase ethical competence in …
Morten Magelssen, Elisabeth Gjerberg, Reidar Pedersen, Reidun Førde and Lillian Lillemoen
BMC Medical Ethics 2016 17:70
Published on: 8 November 2016

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 12 November 2016)

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Research article
The causes of maternal mortality in adolescents in low and middle income countries: a systematic review of the literature
While the main causes of maternal mortality in low and middle income countries are well understood, less is known about whether patterns for causes of maternal deaths among adolescents are the same as for olde…
Sarah Neal, Shanti Mahendra, Krishna Bose, Alma Virginia Camacho, Matthews Mathai, Andrea Nove, Felipe Santana and Zoë Matthews
BMC Pregnancy and Childbirth 2016 16:352
Published on: 11 November 2016