PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
[Accessed 5 November 2016]

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The Ebola Crisis and the Corresponding Public Behavior: A System Dynamics Approach
November 3, 2016 · Research Article
Background: The interaction of several sociocultural and environmental factors during an epidemic crisis leads to behavioral responses that consequently make the crisis control a complex problem.
Methods: The system dynamics approach has been adopted to study the relationships between spread of disease, public attention, situational awareness, and community’s response to the Ebola epidemic.
Results: In developing different simulation models to capture the trend of death and incidence data from the World Health Organization for the Ebola outbreak, the final model has the best fit to the historical trends. Results demonstrate that the increase of quarantining rate over time due to increase in situational awareness and performing safe burials had a significant impact on the control of epidemic. However, public attention did not play a significant role.
Conclusion: The best fit to historical data are achieved when behavioral factors specific to West Africa like studying the Situational Awareness and Public Attention are included in the model. However, by ignoring the sociocultural factors, the model is not able to represent the reality; therefore, in the case of any epidemics, it is necessary that all the parties and community members find the most significant behavioral factors that can curb the epidemic.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 5 November 2016)

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Perspective
Improving the Pipeline for Developing and Testing Pharmacological Treatments in Pregnancy
Lucy C. Chappell, Anna L. David
Perspective | published 01 Nov 2016 PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002161

Research Article
Pregnancy-Associated Changes in Pharmacokinetics: A Systematic Review
Gali Pariente, Tom Leibson, Alexandra Carls, Thomasin Adams-Webber, Shinya Ito, Gideon Koren
published 01 Nov 2016 PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002160

PLoS Neglected Tropical Diseases
http://www.plosntds.org/

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Research Article
Containing Ebola at the Source with Ring Vaccination
Stefano Merler, Marco Ajelli, Laura Fumanelli, Stefano Parlamento, Ana Pastore y Piontti, Natalie E. Dean, Giovanni Putoto, Dante Carraro, Ira M. Longini Jr., M. Elizabeth Halloran, Alessandro Vespignani
| published 02 Nov 2016 PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0005093
Abstract
Interim results from the Guinea Ebola ring vaccination trial suggest high efficacy of the rVSV-ZEBOV vaccine. These findings open the door to the use of ring vaccination strategies in which the contacts and contacts of contacts of each index case are promptly vaccinated to contain future Ebola virus disease outbreaks. To provide a numerical estimate of the effectiveness of ring vaccination strategies we introduce a spatially explicit agent-based model to simulate Ebola outbreaks in the Pujehun district, Sierra Leone, structurally similar to previous modelling approaches. We find that ring vaccination can successfully contain an outbreak for values of the effective reproduction number up to 1.6. Through an extensive sensitivity analysis of parameters characterising the readiness and capacity of the health care system, we identify interventions that, alongside ring vaccination, could increase the likelihood of containment. In particular, shortening the time from symptoms onset to hospitalisation to 2–3 days on average through improved contact tracing procedures, adding a 2km spatial component to the vaccination ring, and decreasing human mobility by quarantining affected areas might contribute increase our ability to contain outbreaks with effective reproduction number up to 2.6. These results have implications for future control of Ebola and other emerging infectious disease threats.
Author Summary
When the 2014–15 Ebola outbreak in West Africa began, no licensed vaccines for the disease were available. The rVSV-ZEBOV vaccine was developed during the course of the epidemic and underwent a clinical trial demonstrating 100% efficacy when vaccinating contacts and contacts of contacts of confirmed Ebola cases (an approach called ring vaccination). However, the trial did not provide any understanding on whether this vaccination strategy can be effective in containing future Ebola virus disease outbreaks. Through a modelling study on a region of Sierra Leone, we provide numerical estimates for the effectiveness of ring vaccination: we show that outbreaks with moderate transmission potential, with no more than 1.6 secondary cases generated by an index case on average, can be successfully contained; more extensive vaccination(e.g., including spatial rings around index cases) and reinforcement of the healthcare system would increase the likelihood of containment even if the virus were more transmissible than in the past. Our results provide implications for control plans of possible future Ebola outbreaks.

PLoS One
http://www.plosone.org/
[Accessed 5 November 2016]

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Research Article
Cost-Effectiveness Analysis of Hepatitis B Vaccination Strategies to Prevent Perinatal Transmission in North Korea: Selective Vaccination vs. Universal Vaccination
Donghoon Lee, Sang Min Park
Research Article | published 01 Nov 2016 PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0165879
Abstract
Background
To tackle the high prevalence of Hepatitis B virus (HBV) infection in North Korea, it is essential that birth doses of HBV vaccines should be administered within 24 hours of birth. As the country fails to provide a Timely Birth Dose (TBD) of HBV vaccine, the efforts of reducing the high prevalence of HBV have been significantly hampered.
Methods
To examine the cost-effectiveness of vaccination strategies to prevent perinatal transmission of HBV in North Korea, we established a decision tree with a Markov model consisting of selective, universal, and the country’s current vaccination program against HBV. The cost-effectiveness analysis was performed from societal and payer’s perspectives and evaluated by Disability Adjusted Life Year (DALY).
Results
The results suggest that introducing the universal vaccination would prevent 1,866 cases of perinatal infections per 100,000 of the birth cohort of 2013. Furthermore, 900 cases of perinatal infections per 100,000 could be additionally averted if switching to the selective vaccination. The current vaccination is a dominated strategy both from the societal and payer’s perspective. The Incremental Cost-Effectiveness Ratio (ICER) between universal and selective vaccination is $267 from the societal perspective and is reported as $273 from the payer’s perspective.
Conclusion
Based on the assumption that the 2012 Gross Domestic Product (GDP) per capita in North Korea, $582.6 was set for cost-effectiveness criteria, the result of this study indicates that selective vaccination may be a highly cost-effective strategy compared to universal vaccination.

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 – Population Biology:
Vaccination strategies against respiratory syncytial virus
Dan Yamin, Forrest K. Jones, John P. DeVincenzo, Shai Gertler, Oren Kobiler, Jeffrey P. ownsend, and Alison P. Galvani
PNAS 2016 ; published ahead of print October 31, 2016, doi:10.1073/pnas.1522597113
Significance
The WHO estimates that respiratory syncytial virus (RSV) vaccination will be available in the next 5–10 y. To evaluate the population effectiveness of an RSV vaccination program in the United States, we developed a transmission model that integrates data on daily infectious viral load and behavior changes while symptomatic. Our model simulations demonstrate that vaccinating children younger than 5 y of age will be the most efficient and effective way to prevent RSV infection in both children and older adults, a result that is robust across the US states considered. Accordingly, the population burden of RSV would be most effectively reduced if current vaccine candidates were to focus on children.
Abstract
Respiratory syncytial virus (RSV) is the most common cause of US infant hospitalization. Additionally, RSV is responsible for 10,000 deaths annually among the elderly across the United States, and accounts for nearly as many hospitalizations as influenza. Currently, several RSV vaccine candidates are under development to target different age groups. To evaluate the potential effectiveness of age-specific vaccination strategies in averting RSV incidence, we developed a transmission model that integrates data on daily infectious viral load and changes of behavior associated with RSV symptoms. Calibrating to RSV weekly incidence rates in Texas, California, Colorado, and Pennsylvania, we show that in all states considered, an infected child under 5 y of age is more than twice as likely as a person over 50 y of age to transmit the virus. Geographic variability in the effectiveness of a vaccination program across states arises from interplay between seasonality patterns, population demography, vaccination uptake, and vaccine mechanism of action. Regardless of these variabilities, our analysis showed that allocating vaccine to children under 5 y of age would be the most efficient strategy per dose to avert RSV in both children and adults. Furthermore, due to substantial indirect protection, the targeting of children is even predicted to reduce RSV in the elderly more than directly vaccinating the elderly themselves. Our results can help inform ongoing clinical trials and future recommendations on RSV vaccination.

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

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Commentary:
Timing and periodicity of influenza epidemics
Ottar N. Bjørnstad and Cecile Viboud
PNAS 2016 ; published ahead of print November 3, 2016, doi:10.1073/pnas.1616052113
[Extract]
Although the annual cycle of summers and winters is a long-resolved mystery of astronomy, the annual antipodal waxing and waning of influenza epidemics is still an unresolved question in epidemiology. In 1981, R. E. Hope-Simpson, an astute British physician who maintained and analyzed detailed records of his patients and their diseases for more than three decades, observed that “Influenza outbreaks are globally ubiquitous and epidemics move smoothly to and fro across the surface of the earth almost every year in a sinuous curve that runs parallel with the ‘midsummer’ curve of vertical solar radiation…” (1). In PNAS Deyle et al. (2) combine convergent cross-mapping with empirical dynamic modeling to elucidate the nonlinear roles of absolute humidity and temperature in explaining influenza’s “sinuous curve that runs parallel with the ‘midsummer’” across the globe (1).

Understanding interepidemic intervals and timing of outbreaks has been a focus of mathematical epidemiologists for more than 50 y (3, 4). Acute immunizing infections have internal cyclic clockworks determined by the overcompensatory predator/prey-like interaction that results from slow susceptible recruitment, through births and loss of immunity, and rapid susceptible depletion from transmission during epidemics. The internal clock depends on traits of both the pathogen and the host and determines the frequency of oscillations we expect to see in the presence of random perturbations to the disease dynamics (3). The “flu” is a recurrent menace—and sometime scourge—caused by cocirculating strains of influenza A and B viruses, which at the strain-aggregate level can be modeled using the “susceptible-infected-recovered-(re)suceptible” compartmental model (5). For influenza, the internal interepidemic period is usually in the 10- to 16-mo range depending on the infectious period and transmissibility (the basic reproductive ratio, R0) of each strain (Fig. 1A). The prediction is that, in the absence of extrinsic forcing, the flu peak would …

Science
04 November 2016 Vol 354, Issue 6312
http://www.sciencemag.org/current.dtl

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In Depth
Controversial HIV vaccine strategy gets a second chance
By Jon Cohen
Science04 Nov 2016 : 535 Restricted Access
Modest success in Thailand inspires South Africa trial
Summary
A two-pronged HIV vaccine strategy that delivered lackluster results in a trial in Thailand 7 years ago will get another chance in South Africa. Last week, researchers injected the first of what they hope will be 5400 participants in the $130 million study, which should show once and for all whether the combination actually works. But some researchers say the trial amounts to a waste of money. In the Thai study, the vaccine combination reduced the risk of HIV infection by only 31.2%, and the study failed to show a mechanism that explained this modest benefit, critics say. Backers of the new trial counter that there’s enough evidence to give it another try and argue that even a modestly efficacious vaccine would help South Africa, which has more than 6 million HIV-infected people.

Tropical Medicine & International Health
November 2016 Volume 21, Issue 11 Pages 1347–1488, E1–E1
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2016.21.issue-11/issuetoc

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Original Research Papers
Rotavirus vaccines contribute towards universal health coverage in a mixed public–private healthcare system (pages 1458–1467)
Tharani Loganathan, Mark Jit, Raymond Hutubessy, Chiu-Wan Ng, Way-Seah Lee and Stéphane Verguet
Version of Record online: 24 AUG 2016 | DOI: 10.1111/tmi.12766
Abstract
Objectives
To evaluate rotavirus vaccination in Malaysia from the household’s perspective. The extended cost-effectiveness analysis (ECEA) framework quantifies the broader value of universal vaccination starting with non-health benefits such as financial risk protection and equity. These dimensions better enable decision-makers to evaluate policy on the public finance of health programmes.
Methods
The incidence, health service utilisation and household expenditure related to rotavirus gastroenteritis according to national income quintiles were obtained from local data sources. Multiple birth cohorts were distributed into income quintiles and followed from birth over the first five years of life in a multicohort, static model.
Results
We found that the rich pay more out of pocket (OOP) than the poor, as the rich use more expensive private care. OOP payments among the poorest although small are high as a proportion of household income. Rotavirus vaccination results in substantial reduction in rotavirus episodes and expenditure and provides financial risk protection to all income groups. Poverty reduction benefits are concentrated amongst the poorest two income quintiles.
Conclusion
We propose that universal vaccination complements health financing reforms in strengthening Universal Health Coverage (UHC). ECEA provides an important tool to understand the implications of vaccination for UHC, beyond traditional considerations of economic efficiency.

Travel Medicine and Infectious Diseases
September-October, 2016 Volume 14, Issue 5
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Editorials
Hajj 2016: Required vaccinations, crowd control, novel wearable tech and the Zika threat
Qanta A. Ahmed, Ziad A. Memish
Vol. 14, Issue 5, p429–432
Published online: September 20, 2016
Article Outline [initial text]
Today 1,323,520 Muslims arrived in Saudi Arabia joining millions more Muslims from around the world to perform Hajj. As physician experts in Hajj medicine who have also performed the Hajj pilgrimage and attended pilgrim-patients both during Hajj at the Hajj sites we welcome the arrival of novel wearable technology introduced by Saudi Arabia to safeguard the Hajj pilgrim during what is one of the world’s largest mass gatherings [1].

Like all mass gatherings, physical hazards are a risk and among them one of the most dangerous is stampede that unfortunately impacted Hajj 2015 on a causeway on route to the Three Pillars in the Mina area of the Holy Sites [2]. Looking at the modern history of the Hajj, stampedes have indeed occurred sporadically though the 2015 events marked the end of years free of mass stampedes following significant reengineering of crowd management. Certainly this calamity is at the forefront of Hajj planners’ priorities with some interesting solutions already being piloted, but as every year basic precautions -cough etiquette, facemask use, hand hygiene and careful food hygiene remain paramount [[3], [4]].

Routine vaccination is not only recommended but is required- Hajj visa applications being accepted contingent upon on full sets of immunizations as is standard. Like every year, the three key vaccine requirements for visa issuing include yellow fever vaccination for all travellers arriving from countries or areas at risk of yellow fever given at least 10 days prior to arrival, quadrivalent (ACYW135) meningococcal vaccine; both polysaccharide and conjugated vaccines are valid with attention to differing duration of protection [5] issued no more than 3 years and no less than 10 days before arrival in Saudi Arabia and proof of receipt of a dose of oral polio vaccine (OPV) or inactivated poliovirus vaccine (IPV), within the previous 12 months and at least 6 weeks prior to departure for travellers arriving from polio-endemic countries which have never interrupted indigenous virus transmission. In addition, the Ministry of Health of Saudi Arabia continues to recommend that international pilgrims be vaccinated against seasonal influenza with most recently available vaccines particularly those at increased risk of severe influenza diseases including pregnant women, children aged over 5 years, the elderly, and individuals with pre-existing health conditions such as asthma, chronic heart or lung diseases and HIV/AIDS infection [[5], [6], [7]]…

Vaccine
Volume 34, Issue 48, Pages 5819-5990 (21 November 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/48
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Original Research Article
Manufacturing costs of HPV vaccines for developing countries
Pages 5984-5989
Chaevia Clendinen, Yapei Zhang, Rebecca N. Warburton, Donald W. Light
Abstract
Background
Nearly all of the 500,000 new cases of cervical cancer and 270,000 deaths occur in middle or lower income countries. Yet the two most prevalent HPV vaccines are unaffordable to most. Even prices to Gavi, the Vaccine Alliance, are unaffordable to graduating countries, once they lose Gavi subsidies. Merck and Glaxosmithkline (GSK) claim their prices to Gavi equal their manufacturing costs; but these costs remain undisclosed. We undertook this investigation to estimate those costs.
Methods
Searches in published and commercial literature for information about the manufacturing of these vaccines. Interviews with experts in vaccine manufacturing.
Findings
This detailed sensitivity analysis, based on the best available evidence, finds that after a first set of batches for affluent markets, manufacturing costs of Gardasil for developing countries range between $0.48 and $0.59 a dose, a fraction of its alleged costs of $4.50. Because volume of Cervarix is low, its per unit costs are much higher, though at comparable volumes, its costs would be similar.
Interpretation
Given the recovery of fixed and annual costs from sales in affluent markets, Merck’s break-even price to Gavi could be $0.50–$0.60, not $4.50. These savings could support Gavi programs to strengthen delivery and increase coverage. Outside Gavi, prices to lower- and middle-income countries, with profit, could also be lowered and made available to millions more adolescents at risk. These estimates and their policy implications deserve further discussion.

Vaccine
Volume 34, Issue 48, Pages 5819-5990 (21 November 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/48
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Original Research Article
Rabies pre-exposure prophylaxis elicits long-lasting immunity in humans
Original Research Article
Pages 5959-5967
Karen L. Mansfield, Nick Andrews, Hooman Goharriz, Trudy Goddard, Lorraine M. McElhinney, Kevin E. Brown, Anthony R. Fooks
Abstract
Despite the availability of safe and effective human vaccines, rabies remains a global threat, with an estimated 60,000 human deaths annually attributed to rabies. Pre-exposure prophylaxis against rabies infection is recommended for travelers to countries where rabies is endemic, and also for those with a higher risk of exposure. In this study, the rabies-specific neutralising antibody responses in a cohort of rabies-vaccinated recipients over a period of twenty years have been assessed. In particular, the antibody response to primary vaccinations and boosters, and the waning of antibody post primary vaccination and post booster were investigated. The significance of gender, age at vaccination, vaccine manufacturer and vaccination intervals were also evaluated. These data confirm that rabies vaccination can elicit a neutralising antibody response that can remain at detectable levels for a number of years, without additional booster vaccinations. The antibody response following both primary vaccination and booster was significantly influenced by the gender of the subject (p = 0.002 and 0.03 respectively), with supportive data that suggests an effect by the make of vaccine administered following primary vaccination, with significantly higher VNA titres observed for one vaccine manufactured prior to 2006 (p < 0.001) in a small subset of recipients (n = 5). Additionally, the decay rate was demonstrated through the overall decline in antibody titre for all individuals, which was a 37% and 27% reduction per 2-fold change in time following primary and booster vaccination respectively. Individuals within older age groups demonstrated a significantly faster decline in antibody titre following the primary vaccination course (p = 0.012). Rate of decline in antibody titre was also significantly influenced by the vaccine make following primary course (p < 0.001). The assessment of neutralising antibody titre decline has also provided an insight into the most appropriate timing for booster administration, and enabled the prediction of long term titres from post-vaccination antibody titres.

Vaccine
Volume 34, Issue 48, Pages 5819-5990 (21 November 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/48
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Original Research Article
Measuring polio immunity to plan immunization activities
Pages 5946-5952
Arend Voorman, Hil M. Lyons
Abstract
The Global Polio Eradication Initiative is closer than ever to achieving a polio-free world. Immunization activities must still be carried out in non-endemic countries to maintain population immunity at levels which will stop poliovirus from spreading if it is re-introduced from still-infected areas. In areas where there is no active transmission of poliovirus, programs must rely on surrogate indicators of population immunity to determine the appropriate immunization activities, typically caregiver-reported vaccination history obtained from non-polio acute flaccid paralysis patients identified through polio surveillance. We used regression models to examine the relationship between polio vaccination campaigns and caregiver-reported polio vaccination history. We find that in many countries, vaccination campaigns have a surprisingly weak impact on these commonly used indicators. We conclude that alternative criteria and data, such as routine immunization indicators from vaccination records or household surveys, should be considered for planning polio vaccination campaigns, and that validation of such surrogate indicators is necessary if they are to be used as the basis for program planning and risk assessment. We recommend that the GPEI and similar organizations consider or continue devoting additional resources to rigorously study population immunity and campaign effectiveness in at-risk countries.

Vaccine
Volume 34, Issue 48, Pages 5819-5990 (21 November 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/48
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Original Research Article
Rotavirus, vaccine failure or diagnostic error?
Pages 5912-5915
Monica Lopez-Lacort, Susana Collado, Ana Díez-Gandía, Javier Díez-Domingo
Abstract
Immunochromatography (ICG) is highly used in clinical settings for rotavirus (RV) diagnosis. The specificity of the tests differs by brand type and is not 100%, therefore its use when the prevalence of the disease is low (i.e. in vaccinated children) may result in a proportion of false positive diagnoses.
In some areas, vaccine effectiveness studies or surveillance is done using ICG. Our objective was to estimate the validity of ICG test in vaccinated children, and estimate the number of false positive results in the Valencian Region of Spain, where all RV infections are diagnosed using ICG and are not confirmed by PCR.
Population based registries were used to identify all results from the RV antigen tests performed between January 2008 and June 2012 in children under 37 months. Hospitalization and vaccination status of the patients were obtained by linking different databases through a unique identification number. The Positive Predictive Value of the ICG test depending on the vaccination status of the child, hospitalization and the rotavirus season was estimated by a Bayesian model of latent classes.
Of the 48,833 tests with valid results, 9429 were done in vaccinated children, and of those 3963 (42%) during the rotavirus season. The prevalence of positive results in vaccinated varied from 2.9 to 21.4% of the tests depending on the hospitalization and seasonality. The estimated PPV also varied from 27.1 to 84.6% when stratified by these two parameters. Globally it is calculated that approximately 267 out of the 520 (51.3%) positives in vaccinated children were false positive tests.
The large percentage of false positives, due to an excessive number of tests in vaccinated and out of the RV season, if interpreted as vaccine failures, can cause a loss of confidence in the vaccine and lower the estimates of vaccine effectiveness.

Vaccine
Volume 34, Issue 48, Pages 5819-5990 (21 November 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/48
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Original Research Article
Knowledge, attitudes, and practices of healthcare providers in the country of Georgia regarding influenza vaccinations for pregnant women
Pages 5907-5911
Mariam Dvalishvili, Darejan Mesxishvili, Maia Butsashvili, George Kamkamidze, Deborah McFarland, Robert A. Bednarczyk
Abstract
Objective
To document knowledge, attitudes, and practices of Georgian obstetrician-gynecologists concerning influenza infection and vaccination during pregnancy.
Methods
We conducted a cross-sectional study of obstetrician-gynecologists in 8 cities in the country of Georgian, from June to July, 2015, using an anonymous, self-administered, written survey. Collected data included demographics; knowledge, attitudes, and practices related to influenza vaccination during pregnancy; perceptions of influenza infection in pregnancy; perceived barriers to influenza vaccination during pregnancy; and willingness to receive education about influenza infection and vaccination during pregnancy.
Results
A total of 278 obstetrician-gynecologists completed surveys. Most physicians perceived influenza to be a serious infectious disease (88%) and that pregnant women are more susceptible to it than the general population. Only 43% of physicians reported recommending influenza vaccination during pregnancy; 18% reported vaccinating any pregnant patients during the last influenza season. Most (75%) physicians reported a perception that there is insufficient evidence supporting influenza vaccination during pregnancy. Most (93%) were receptive to receiving additional education on maternal vaccination.
Conclusions
Georgian physicians are hesitant to vaccinate pregnant women, but are receptive to education about maternal vaccination. Future educational outreach to Georgian physicians could reduce concerns about maternal vaccination, potentially increasing influenza vaccination among pregnant Georgian women.

Vaccine
Volume 34, Issue 48, Pages 5819-5990 (21 November 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/48
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Review Article
Meningococcal disease in the Asia-Pacific region: Findings and recommendations from the Global Meningococcal Initiative
Pages 5855-5862
Ray Borrow, Jin-Soo Lee, Julio A. Vázquez, Godwin Enwere, Muhamed-Kheir Taha, Hajime Kamiya, Hwang Min Kim, Dae Sun Jo, the Global Meningococcal Initiative
Abstract
The Global Meningococcal Initiative (GMI) is a global expert group that includes scientists, clinicians, and public health officials with a wide range of specialties. The purpose of the Initiative is to promote the global prevention of meningococcal disease (MD) through education, research, and cooperation. The first Asia-Pacific regional meeting was held in November 2014. The GMI reviewed the epidemiology of MD, surveillance, and prevention strategies, and outbreak control practices from participating countries in the Asia-Pacific region. Although, in general, MD is underreported in this region, serogroup A disease is most prominent in low-income countries such as India and the Philippines, while Taiwan, Japan, and Korea reported disease from serogroups C, W, and Y. China has a mixed epidemiology of serogroups A, B, C, and W.
Perspectives from countries outside of the region were also provided to provide insight into lessons learnt. Based on the available data and meeting discussions, a number of challenges and data gaps were identified and, as a consequence, several recommendations were formulated: strengthen surveillance; improve diagnosis, typing and case reporting; standardize case definitions; develop guidelines for outbreak management; and promote awareness of MD among healthcare professionals, public health officials, and the general public.

Vaccine
Volume 34, Issue 48, Pages 5819-5990 (21 November 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/48
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Brief report
Parental experiences with vaccine information statements: Implications for timing, delivery, and parent-provider immunization communication
Pages 5840-5844
Paula M. Frew, Yunmi Chung, Allison Kennedy Fisher, Jay Schamel, Michelle M. Basket
Abstract
Objective
We examined Vaccine Information Statements (VIS) dissemination practices and parental use and perceptions.
Methods
We conducted a national online panel survey of 2603 US parents of children aged Results
Most parents received a VIS (77.2%; [95% CI: 74.5–79.7%]), 59.7% [56.6–62.7%] before vaccination but 14.5% [12.5–16.8%] reported receiving it after their child’s immunization; 15.1% [13.0–17.6%] were unsure of receipt status or timing; another 10.7% [9.0–12.6%] reported non-receipt of a VIS. Less than half who received a VIS before vaccination completed it before vaccination (46.2% [42.4, 50.0%]), but most who read at least some found the information useful (95.7% [93.8–97.0%]). Parents who delayed or refused at least one recommended non-influenza vaccine reported fewer opportunities to ask providers VIS questions.
Conclusions
Most parents report receiving VIS before vaccination as per federal guidelines. Continued effort is needed to enhance VIS distribution practice and parent-provider VIS content communication.

Vaccine
Volume 34, Issue 48, Pages 5819-5990 (21 November 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/48
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WHO Report
Investing in life saving vaccines to guarantee life of future generations in Africa
Pages 5827-5832
R.M. Mihigo, J.C. Okeibunor, H. O’Malley, B. Masresha, P. Mkanda, F. Zawaira
Abstract
The World Health Organization’s Regional Offices for Africa and for the Eastern Mediterranean in conjunction with the African Union and the Government of Ethiopia hosted a ministerial conference on immunization in Africa from 24 to 25 February 2016 in Addis Ababa, Ethiopia under the theme “towards universal immunization coverage as a cornerstone for health and development in Africa”. The conference brought together African leaders – including health and finance ministers, and parliamentarians thus creating a powerful platform for governments to demonstrate their commitment to advancing universal access to immunization on the continent in line with the Global Vaccine Action Plan. The event also brought together advocates, technical experts, policymakers, partner agencies, donors and journalists to examine how best to drive forward immunization across Africa, ensuring every child has access to the vaccines they need. Key points highlighted throughout conference were: universal access to immunization is at the forefront of enabling Africa to reach its full potential – by improving health, driving economic growth and empowering future generations; it is one of the most cost-effective solutions in global health, with clear benefits for health and development; and immunization brings economic benefits too, reducing health care costs and increasing productivity. At the close of the conference, 46 African countries signed a historic ministerial declaration on “Universal Access to Immunization as a Cornerstone for Health and Development in Africa” signaling fierce determination among African leaders to secure the health and prosperity of their societies through immunization.

Vaccine
Volume 34, Issue 48, Pages 5819-5990 (21 November 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/48

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Conference report
Pertussis: Biology, epidemiology and prevention
Pages 5819-5826
Mitra Saadatian-Elahi, Stanley Plotkin, Kingston H.G. Mills, Scott A. Halperin, Peter B. McIntyre, Valentina Picot, Jacques Louis, David R. Johnson
Abstract
Despite long-standing vaccination programs, substantial increases in reported cases of pertussis have been described in several countries during the last 5 years. Cases among very young infants who are at greatest risk of pertussis-related hospitalizations and mortality are the most alarming. Multiple hypotheses including but not limited to the availability of more sensitive diagnostic tests, greater awareness, and waning vaccine-induced immunity over time have been posited for the current challenges with pertussis. The conference “Pertussis: biology, epidemiology and prevention” held in Annecy-France (November 11–13, 2015) brought together experts and interested individuals to examine these issues and to formulate recommendations for optimal use of current vaccines, with a particular focus on strategies to minimize severe morbidity and mortality among infants during the first months of life. The expert panel concluded that improving vaccination strategies with current vaccines and development of new highly immunogenic and efficacious pertussis vaccines that have acceptable adverse event profiles are currently the two main areas of investigation for the control of pertussis. Some possible pathways forward to address these main challenges are discussed in this report.

Vaccines — Open Access Journal
http://www.mdpi.com/journal/vaccines
(Accessed 5 November 2016)

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Targeting Immune Regulatory Networks to Counteract Immune Suppression in Cancer
Vaccines 2016, 4(4), 38; doi:10.3390/vaccines4040038 (registering DOI) – 4 November 2016
by Chiara Camisaschi, Viviana Vallacchi, Elisabetta Vergani, Marcella Tazzari, Simona Ferro, Alessandra Tuccitto, Olga Kuchuk, Eriomina Shahaj, Roberta Sulsenti, Chiara Castelli, Monica Rodolfo, Licia Rivoltini and Veronica Huber
Abstract
The onset of cancer is unavoidably accompanied by suppression of antitumor immunity. This occurs through mechanisms ranging from the progressive accumulation of regulatory immune cells associated with chronic immune stimulation and inflammation, to the expression of immunosuppressive molecules. Some of them are being successfully exploited as therapeutic targets, with impressive clinical results achieved in patients, as in the case of immune checkpoint inhibitors. To limit immune attack, tumor cells exploit specific pathways to render the tumor microenvironment hostile for antitumor effector cells. Local acidification might, in fact, anergize activated T cells and facilitate the accumulation of immune suppressive cells. Moreover, the release of extracellular vesicles by tumor cells can condition distant immune sites contributing to the onset of systemic immune suppression. Understanding which mechanisms may be prevalent in specific cancers or disease stages, and identifying possible strategies to counterbalance would majorly contribute to improving clinical efficacy of cancer immunotherapy. Here, we intend to highlight these mechanisms, how they could be targeted and the tools that might be available in the near future to achieve this goal.

Journal of Preventive Medicine and Hygiene
Vol 57, No 3 (2016)
http://www.jpmh.org/index.php/jpmh/issue/view/2016573
Article
History and evolution of influenza control through vaccination: from the first monovalent vaccine to universal vaccines
Ilaria Barberis, Puja Myles, Steven Ault, Nicola Luigi Bragazzi, Mariano Martini
Abstract
Influenza is a highly infectious airborne disease with an important epidemiological and societal burden; annual epidemics and pandemics have occurred since ancient times, causing tens of millions of deaths. A hundred years after this virus was first isolated, influenza vaccines now ensure effective protection, and the preparations used display good safety and tolerability profiles.
Innovative tools, such as recombinant technologies and intra-dermal devices, are currently being investigated in order to elicit good immunity even in the event of unforeseen changes in the virus due to drift and antigenic shift or the co-circulation different viral strains.
The recurring mutations of influenza strains has prompted the recent introduction of a quadrivalent inactivated vaccine. In the near future, scientific research will strive to produce a long-lasting universal vaccine containing an antigen that is not subject to genetic modifications, and surveillance systems will be implemented in order to exactly predict circulating strains.

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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BBC
http://www.bbc.co.uk/
Accessed 5 November 2016
UK forms global infection response team
1 November 2016
The UK has created a specialist team of health experts who can be deployed anywhere around the world within 48 hours if a disease outbreak strikes.

The aim is to stamp out infections like Ebola before they spread far and wide.
The scientists, academics and clinicians will be funded by £20m from the government over five years.

When not responding to an immediate emergency, the rapid response team will assess future disease threats and train colleagues from home and abroad.

Public Health Minister Nicola Blackwood said the Ebola crisis highlighted the need for such a team.
“Ebola shook the world and brave experts from the UK led the global response in Sierra Leone. The ability to deploy emergency support to investigate and respond to disease outbreaks within 48 hours will save lives, prevent further outbreaks and cement the UK’s position as a leader in global health security.”

Public Health England will run the project with the London School of Hygiene and Tropical Medicine…

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Forbes
http://www.forbes.com/
Accessed 5 November 2016

Is It Fair To Reward Medicaid Patients For Receiving Flu Shots?
Peter Ubel, Contributor

Big Pharma Has Broken Its Social Contract: How To Restore Fairness In Drug Pricing
Kenneth L. Davis, Contributor
The pharmaceutical industry must restore the social contract governing its business practices and lower drug prices so Americans can better afford medication.

Why The Approach To Drug Pricing Has To Change Now
1 November 2016
By Joseph Jimenez, CEO of Novartis
As CEO of one of the world’s largest pharmaceutical companies, I believe that we need a new perspective on drug pricing: As an industry, we must shift to a model that focuses on value and outcomes delivered, both to patients and to health systems.

New Measles Study Shows Why Anti-Vaccination Thinking Is Deadly
30 October 2016
New research on fatal measles complications shows how the failure to vaccinate not only endangers the patient, but also everyone else susceptible to the disease. Subacute sclerosing panencephalitis (SSPE) is a neurological disorder that can develop years after someone has measles, and it is fatal 100% of the time. Previously it was thought rare at about one in 100,000 post-measles cases. But recent research in Germany shows that it occurs in one in 1,700 children infected with measles before they turned five, and a new study finds the incidence can be as many as one in 600 for infants who contract measles before they’re vaccinated. The findings were presented at IDWeek 2016, the annual meeting of the Infectious Diseases Society of America…

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Fortune
http://fortune.com/
Accessed 5 November 2016
Here’s What We Could Be Doing to Stop Pandemics Like Zika and Ebola
1 November 2016
…A boiling pot of global conditions, like ubiquitous travel and the growing populations of developing cities, have led to an outbreak of pandemics like Ebola, Zika, SARs, and even the flu over the past decade.

But while the global health industry and national governments and regulators have made a lot of progress, there’s still much more that these groups can do together to better plan, fund, and organize the battle against emerging pandemics, said a group of experts at Fortune’s Brainstorm Health conference in San Diego, Calif. on Tuesday night.
Once an outbreak occurs, the response is all about speed, said Bruce Gellin, director of the U.S. National Vaccine Program Office.

GSK’s CEO Explains How Big Pharma Can Help the Poor and Still Make Money
2 November 2016
Capitalism and doing good don’t have to be mutually exclusive.
Big pharma has been a persistent villain in the public’s consciousness over the past year in the wake of exorbitant drug price hikes, including on ancient medications. But drug makers don’t necessarily have to conform to some Monopoly man caricature to be successful, according to the chief executive of pharma giant

Outgoing GSK chief Sir Andrew Witty laid out a straightforward manifesto to drug pricing, especially when it comes to vaccines, at Fortune’s Brainstorm Health conference on Wednesday. His message: Pharma can do good while still turning a profit.

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New York Times
http://www.nytimes.com/
Accessed 5 November 2016
Colombia is Hit Hard by Zika, but Not by Microcephaly
By DONALD G. McNEIL Jr. and JULIA SYMMES COBB OCT. 31, 2016
BARRANQUILLA, Colombia — This tropical city on the Caribbean coast may hold the answer to one of the deeper mysteries of the Zika epidemic: Why has the world’s second-largest outbreak, after Brazil’s, produced so few birth defects?

In Brazil, more than 2,000 babies have been born with microcephaly, abnormally small heads and brain damage caused by the Zika virus. In Colombia, officials had predicted there might be as many as 700 such babies by the end of this year. There have been merely 47.
The gap has been seen all over the Americas. According to the World Health Organization, the United States has 28 cases — almost all linked to women infected elsewhere. Guatemala has 15, and Martinique has 12.

Had the rest of the Americas been as affected as northeastern Brazil, a tidal wave of microcephaly would be washing over the region. Most experts say that will not happen, but they are at a loss as to why…

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Washington Post
http://www.washingtonpost.com/
Accessed 5 November 2016
Washington state polio-like cases linked to rare syndrome
Eight of nine children hospitalized in Washington state for a polio-like illness have a rare syndrome that causes varying degrees of limb weakness, state health officials confirmed on Friday.
Lisa Baumann | AP | National | Nov 4, 2016

Think Tanks et al

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Council on Foreign Relations
http://www.cfr.org/
Accessed 5 November 2016
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Health and U.S. Foreign Policy in the Age of Miracles
3 November 2016
Thomas J. Bollyky, Senior Fellow for Global Health, Economics, and Development, and Eric Goosby, UN Special Envoy on Tuberculosis and Former U.S. Global AIDS Coordinator

…Global deaths from malaria and tuberculosis (TB) declined 48 percent and 47 percent, respectively, over this period. Maternal mortality dropped 43 percent. Deaths for children under five have halved, which means nineteen thousand fewer of these children die each day. More than ten million people with HIV/AIDS in sub-Saharan Africa are on lifesaving antiretroviral treatment, up from just one hundred thousand in 2003.

U.S. leadership and investment helped spur this progress. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program, created in 2003, remains the largest financial commitment of any country to global health or the treatment of a specific disease. The United States is the biggest funder of GAVI, the global vaccine alliance, as well as the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which immunize and treat millions of people each year. The United States also provides the most aid to fight neglected tropical diseases and poor maternal and child health. These investments have been consistently bipartisan, and their returns are, quite literally, measured in reduced human suffering and longer lives around the globe.

Can this age of miracles endure? Yes, but only with continued U.S. leadership and investment amid some challenging headwinds. The next president should build on the recent efforts to harness the positive synergies between global health and U.S. foreign policy…