Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO pages for updates and key developments.

MERS-CoV [to 21 January 2017]
http://www.who.int/emergencies/mers-cov/en/
Disease Outbreak News [DONs]
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 17 January 2017

Zika virus [to 21 January 2017]
http://www.who.int/emergencies/zika-virus/en/

Zika situation report – 20 January 2017
Full report: http://apps.who.int/iris/bitstream/10665/253604/1/zikasitrep20Jan17-eng.pdf?ua=1
…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.

POLIO [to 21 January 2017]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 17 January 2017
:: Independent Monitoring Board (IMB) – changes to its membership: The IMB, established in 2010 to independently monitor progress towards a polio-free world, is undertaking changes to its membership. Under the guidance of the IMB and its chair, Sir Liam Donaldson, polio has been restricted to areas of just three countries: Pakistan, Afghanistan and Nigeria. To help achieve a polio-free world, the structure and composition of the IMB is now being revisited, in particular to strengthen its remit to focus solely on Objective 1 of the Polio Endgame Plan – detection and interruption of poliovirus transmission. At the request of the Polio Oversight Board (POB), Sir Liam will continue to chair the IMB and will form a selection committee to identify a new set of members. A call for nomination will be issued over the coming weeks. The GPEI owe a great debt of gratitude for the invaluable contribution that the current members of the IMB have made to this historic endeavour, and we look forward to working with the new, re-structured IMB to lead us over the finish line.

Country Updates [Selected Excerpts]

Afghanistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week from Bermal district, Paktika province, with onset of paralysis on 16 December 2016.  This brings the total number of WPV1 cases for 2016 to 13.  More than half of the country’s cases in 2016 are from Bermal district.
:: One new environmental WPV1 positive sample was reported in the past week from Jalalabad, Nangarhar, collected on 26 December 2016.

Pakistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week, from Killa Abdullah, Balochistan, with onset of paralysis on 22 December 2016. This brings the total number of WPV1 cases for 2016 to 20.
:: One new circulating vaccine-derived poliovirus type 2 (cVDPV2) positive environmental sample was reported in the past week, from Quetta, Balochistan, collected on 28 December 2016. This isolate is linked to an ongoing, confirmed cVDPV2 outbreak currently affecting Quetta.

Nigeria
:: A circulating vaccine-derived poliovirus type 2 (cVDPV2) has been detected from Bodinga Local Government Area (LGA), Sokoto state. Two genetically-related viruses were isolated from an acute flaccid paralysis (AFP) case with onset of paralysis on 28 October 2016, and from a healthy community contact, collected on 24 November.

Lake Chad Basin
:: The detection of wild poliovirus type 1 (WPV1) and vaccine-derived poliovirus type 2 (VDPV2) in Nigeria poses a risk to the neighbouring countries of the Lake Chad basin and hence an outbreak response plan is being implemented as part of the response to the Nigeria outbreak.

WHO & Regional Offices [to 21 January 2017]

140th session of the Executive Board
23 January–1 February 2017, Geneva
[see selected main documents summary and live webcast information above]

Finding priorities for health research and development
20 January 2017 – Today’s investments in health R&D are poorly aligned with global public health needs. As little as 1% of all funding for health R&D is allocated to diseases such as malaria and tuberculosis, although they account for more than 12% of the global disease burden. The WHO Global Observatory on Health R&D builds on existing data to enable decisions on R&D priorities.

Disease Outbreak News [DONs]
:: Human infection with avian influenza A(H7N9) virus – China 18 January 2017
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 17 January 2017
:: Human infection with avian influenza A(H7N9) virus – China 17 January 2017

Weekly Epidemiological Record, 20 January 2017, vol. 92, 3 (pp. 21–36)
:: Maternal and neonatal tetanus elimination: validation in Punjab Province, Pakistan, November 2016
:: Monthly report on dracunculiasis cases, January– November 2016

WHO Region of the Americas PAHO
:: Overweight affects almost half the population of all countries in Latin America and the Caribbean except for Haiti (01/18/2017)

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

WHO European Region EURO
:: Global Health Case Challenge: fighting antibiotic resistance 19-01-2017
:: Cold weather increases health risks for refugees and migrants in Serbia and other countries in the Region 18-01-2017

WHO Eastern Mediterranean Region EMRO
:: Joint Statement on Syria 16 January 2017
[See full text above]

CDC/ACIP [to 21 January 2017]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/
THURSDAY, JANUARY 19, 2017
South African Study Provides Compelling New Evidence on Role of Person-to Person Transmission in Drug-Resistant TB Epidemics
A study published today in The New England Journal of Medicine provides compelling evidence that extensively drug-resistant tuberculosis (XDR TB) is spread from person-to-person in the KwaZulu-Natal province, South Africa…

MMWR Weekly January 20, 2017/No. 1
[Excerpts]
:: West Nile Virus and Other Nationally Notifiable Arboviral Diseases — United States, 2015
:: Coverage with Tetanus, Diphtheria, and Acellular Pertussis Vaccine and Influenza Vaccine Among Pregnant Women — Minnesota, March 2013–December 2014

Register for upcoming February ACIP meeting
February 22-23, 2017
Deadline for registration:
:: Non-US Citizens: February 1, 2017; US Citizens: February 13, 2017
Registration is NOT required to watch the live meeting webcast or to listen via telephone.

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Gavi [to 21 January 2017]
http://www.gavi.org/library/news/press-releases/

18 January 2017
Google & Gavi partner to scale up high-tech innovations for vaccine delivery
New funding through Gavi will help start-up Nexleaf Analytics provide real-time data solutions for cold chain equipment performance and maintenance in developing countries.
Davos, 18 January 2017 – Google.org and Gavi announced a new partnership today to help tech start-up Nexleaf Analytics strengthen vaccine cold chain equipment for developing countries. Google.org’s contribution of US$ 2 million, which will be matched by the Bill & Melinda Gates Foundation’s funding to the Gavi Matching Fund, will be used to help countries to make evidence-based decisions on the purchase and maintenance of vaccine refrigerators.
Over the next years the volume of vaccines in Gavi-supported countries is expected to rise significantly. Vaccines are highly sensitive to high and low temperatures, and high-performing and well-maintained cold chain technologies are essential for ensuring vaccine potency…

18 January 2017
Deutsche Post DHL Group and Gavi forge global partnership to improve delivery of life-saving vaccines
Organisations to collaborate on addressing supply chain challenges to improve developing country access to life-saving vaccines.
Test programme announced with Kenyan Health Ministry: DHL and Gavi to provide efficient transport management solution for vaccine distribution.
Davos, Switzerland, 18 January 2017 – Deutsche Post DHL Group, the leading global mail and logistics company, and Gavi, the Vaccine Alliance, today announced a global partnership to help improve vaccine supply chains in developing countries.
As immunisation programmes expand to deliver new, life-saving vaccines to more people, often in remote areas, they are increasingly constrained by outdated supply chains. With vaccine volumes continuing to increase and the persistence of often weak or broken health systems, there is a critical need for improvements in immunisation supply chain infrastructure.
Over the next three years, the new partnership will be vital in helping to provide countries with efficient supply chain solutions to improve healthcare delivery. Deutsche Post DHL Group’s industry-leading logistics expertise in life sciences and healthcare, combined with the global DHL transportation network, will help countries overcome challenges, and make the vaccine supply chain more efficient…

18 January 2017
Gavi and Unilever’s Lifebuoy join forces to tackle preventable diseases and save children’s lives
Ground-breaking partnership will raise awareness of the power of immunisation and of handwashing with soap to accelerate child survival efforts
Davos, Switzerland, 18 January 2017 – Gavi, the Vaccine Alliance and Lifebuoy, Unilever’s leading health soap brand, have launched an innovative partnership to protect children under five from illnesses and premature death. By promoting handwashing with soap and immunisation together – two of the most cost-effective child survival interventions – the partnership aims to improve and save many young lives in India.

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Fondation Merieux [to 21 January 2017]
http://www.fondation-merieux.org/news
Mission: Contribute to global health by strengthening local capacities of developing countries to reduce the impact of infectious diseases on vulnerable populations.

18 January 2017, Dakar (Senegal)
Senegal Welcomes Major West African Experts in Clinical Biology: 4th International Steering Committee of West African Laboratory Network of Biomedical Analysis Laboratories
Some 70 participants, including the leading figures in clinical biology of Benin, Burkina Faso, Guinea, Mali, Niger, Senegal and Togo, are gathering in Dakar in Senegal, January 18-20 for the 4th International Steering Committee of the West African laboratory network of biomedical analysis laboratories (RESAOLAB). They are sharing their results in fighting against epidemics and improving laboratory services.

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EDCTP [to 21 January 2017]
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.

17 January 2017
Switzerland fully associated to Horizon 2020 per 1 January 2017
Switzerland became an Associated Country for the full Horizon 2020 programme
as of 1 January 2017. Consequently, Switzerland has regained the possibility to fully participate in the European & Developing Countries Clinical Trials Partnership. Swiss legal entities may participate and receive funding in EDCTP2 actions*. Switzerland may also become a full member of the EDCTP Association, the legal implementation structure for the second EDCTP programme….

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FDA [to 21 January 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm

January 19, 2017
Statement from FDA Commissioner Robert Califf, M.D. announcing FDA Oncology Center of Excellence launch

January 18, 2017
Statement from FDA Commissioner Robert Califf, M.D. announcing new draft guidances on medical product communications

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Industry Watch [to 21 January 2017]
:: MSD for Mothers Commits $10 Million and Business Expertise to the Global Financing Facility to Help End Preventable Deaths of Mothers
Represents a Critical Step toward Meeting the Sustainable Development Goals for Women, Children and Adolescent Health

January 19, 2017 01:30 AM Eastern Standard Time
DAVOS, Switzerland–(BUSINESS WIRE)–MSD, known as Merck & Co., Inc., Kenilworth, N.J., U.S.A., inside the United States and Canada, announced today its $10 million commitment to the Global Financing Facility (GFF) in support of Every Woman Every Child to improve maternal and child health in low- and lower-middle-income countries worldwide through its MSD for Mothers initiative. Through the GFF – a multi-stakeholder partnership hosted by the World Bank Group – countries are aiming to make a much greater impact on the lives of their most vulnerable citizens, with the goal of preventing an estimated 3.8 million maternal deaths, 101 million child deaths and 21 million stillbirths by 2030…

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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 Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 21 January 2017)

Study protocol
Effects of community health volunteers on infectious diseases of children under five in Volta Region, Ghana: study protocol for a cluster randomized controlled trial
In many low- and middle-income countries, community health volunteers (CHVs) are employed as a key element of the public health system in rural areas with poor accessibility. However, few studies have assessed…
Yeonji Ma, Heunghee Kim, Yinseo Cho, Jaeeun Lee, Joseph Kwami Degley, Abdul-Ghaffa Adam, Gyuhong Lee, Hoonsang Lee and Seungman Cha
BMC Public Health 2017 17:95
Published on: 19 January 2017’

Research article
Community-based health care is an essential component of a resilient health system: evidence from Ebola outbreak in Liberia
Trained community health workers (CHW) enhance access to essential primary health care services in contexts where the health system lacks capacity to adequately deliver them. In Liberia, the Ebola outbreak fur…
Kendra Siekmans, Salim Sohani, Tamba Boima, Florence Koffa, Luay Basil and Saïd Laaziz
BMC Public Health 2017 17:84
Published on: 17 January 2017

Issue Focus: Coverage Expansion, Accountable Care & More

Global Health
Large Reductions In Amenable Mortality Associated With Brazil’s Primary Care Expansion And Strong Health Governance
Thomas Hone, Davide Rasella, Mauricio Barreto, Rifat Atun, Azeem Majeed, and Christopher Millett

Abstract
Strong health governance is key to universal health coverage. However, the relationship between governance and health system performance is underexplored. We investigated whether expansion of the Brazilian Estratégia de Saúde da Família (ESF; family health strategy), a community-based primary care program, reduced amenable mortality (mortality avoidable with timely and effective health care) and whether this association varied by municipal health governance. Fixed-effects longitudinal regression models were used to identify the relationship between ESF coverage and amenable mortality rates in 1,622 municipalities in Brazil over the period 2000–12. Municipal health governance was measured using indicators from a public administration survey, and the resulting scores were used in interactions. Overall, increasing ESF coverage from 0 percent to 100 percent was associated with a reduction of 6.8 percent in rates of amenable mortality, compared with no increase in ESF coverage. The reductions were 11.0 percent for municipalities with the highest governance scores and 4.3 percent for those with the lowest scores. These findings suggest that strengthening local health governance may be vital for improving health services effectiveness and health outcomes in decentralized health systems.

Issue Focus: Coverage Expansion, Accountable Care & More

ANALYSIS & COMMENTARY: Global Health: A Pivotal Moment Of Opportunity And Peril
Lawrence O. Gostin and Eric A. Friedman
Health Aff January 2017 36:159-165; doi:10.1377/hlthaff.2016.1492

Abstract
A growing tide of populism in Europe and the United States, combined with other factors, threatens the solidarity upon which the global health movement is based. The highest-profile example of the turn toward populism is US president-elect Donald Trump, whose proposals would redefine US engagement in global health, development, and environmental efforts. In this challenging landscape, three influential global institutions—the United Nations, the World Health Organization, and the World Bank—are undergoing leadership transitions. This new global health leadership should prioritize global health security, including antimicrobial resistance, health system strengthening, and action on mass migration and climate change. They will need to work as a team, leveraging the World Health Organization’s technical competence and mandate to set health norms and standards, the United Nations’ political clout, and the World Bank’s economic strength. Human rights, including principles of equality, participation, and accountability, should be their foremost guide, such as holding a United Nations special session on health inequities and advancing the Framework Convention on Global Health. The need for predictable and innovative financing and high ethical standards to prevent conflicts of interest can further guide global health leaders.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 21 January 2017]

Research
Development and validation of SEER (Seeking, Engaging with and Evaluating Research): a measure of policymakers’ capacity to engage with and use research
Capacity building strategies are widely used to increase the use of research in policy development. However, a lack of well-validated measures for policy contexts has hampered efforts to identify priorities for capacity building and to evaluate the impact of strategies. We aimed to address this gap by developing SEER (Seeking, Engaging with and Evaluating Research), a self-report measure of individual policymakers’ capacity to engage with and use research.
Sue E. Brennan, Joanne E. McKenzie, Tari Turner, Sally Redman, Steve Makkar, Anna Williamson, Abby Haynes and Sally E. Green
Published on: 17 January 2017

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 21 January 2017]

Scoping Review
Towards interruption of schistosomiasis transmission in sub-Saharan Africa: developing an appropriate environmental surveillance framework to guide and to support ‘end game’ interventions
J. Russell Stothard, Suzy J. Campbell, Mike Y. Osei-Atweneboana, Timothy Durant, Michelle C. Stanton, Nana-Kwadwo Biritwum, David Rollinson, Dieudonné R. Eloundou Ombede and Louis-Albert Tchuem-Tchuenté
Infectious Diseases of Poverty 2017 6:10
Published on: 14 January 2017

Abstract
Schistosomiasis is a waterborne parasitic disease in sub-Saharan Africa, particularly common in rural populations living in impoverished conditions. With the scale-up of preventive chemotherapy, national campaigns will transition from morbidity- to transmission-focused interventions thus formal investigation of actual or expected declines in environmental transmission is needed as ‘end game’ scenarios arise. Surprisingly, there are no international or national guidelines to do so in sub-Saharan Africa. Our article therefore provides an introduction to key practicalities and pitfalls in the development of an appropriate environmental surveillance framework. In this context, we discuss how strategies need to be adapted and tailored to the local level to better guide and support future interventions through this transition. As detection of egg-patent infection in people becomes rare, careful sampling of schistosome larvae in freshwater and in aquatic snails with robust species-specific DNA assays will be required. Appropriate metrics, derived from observed prevalence(s) as compared with predetermined thresholds, could each provide a clearer insight into contamination- and exposure-related dynamics. Application could be twofold, first to certify areas currently free from schistosomiasis transmission or second to red-flag recalcitrant locations where extra effort or alternative interventions are needed.

International Health
Volume 9, Issue 1 1 January 2017
http://inthealth.oxfordjournals.org/content/current

COMMENTARY
Sustainable development goals and the human resources crisis
Joseph Freer

Abstract
Achieving universal health coverage by 2030 requires that lessons from the Millennium Development Goals must be heeded. The most important lesson is that the workforce underpins every function of the health system, and is the rate-limiting step. The three dimensions that continue to limit the success of the development agenda are availability, distribution and performance of health workers – and the Sustainable Development Goals cannot be achieved without addressing all three. Hence, the traditional response of scaling up supply is inadequate: a paradigm shift is required in the design of systems that can properly identify, train, allocate and retain health workers.

International Health
Volume 9, Issue 1 1 January 2017
http://inthealth.oxfordjournals.org/content/current

Original Articles
Dedicated health systems strengthening of the Global Fund to Fight AIDS, Tuberculosis, and Malaria: an analysis of grants
Victoria Y. Fan; Feng-Jen J. Tsai; Zubin C. Shroff; Branden Nakahara; Nabil Vargha …

Abstract
Background
This study aims to understand the determinants of the Global Fund to Fight AIDS, Tuberculosis, and Malaria’s dedicated channel for health systems strengthening (HSS) funding across countries and to analyze their health system priorities expressed in budgets and performance indicators.

Methods
We obtained publicly available data for disease-specific and HSS grants from the Global Fund over 2004–2013 prior to the new funding model. Regression analysis was employed to assess the determinants of dedicated HSS funding across 111 countries. Documents for 27 dedicated HSS grants including budgets and performance indicators were collected, and activities were analyzed by health system functions.

Results
HSS funding per capita is significantly associated with TB and HIV funding per capita, but not per capita income and health worker density. Of 27 dedicated HSS grants, 11 had line-item budgets publicly available, in which health workforce and medical products form the majority (89% or US$132 million of US$148 million) of funds. Yet these areas accounted for 41.7% (215) of total 516 performance indicators.

Conclusions
Health worker densities were not correlated with HSS funding, despite the emphasis on health workforce in budgets and performance indicators. Priorities in health systems in line-item budgets differ from the numbers of indicators used.

International Journal of Infectious Diseases
December 2016
http://www.ijidonline.com/issue/S1201-9712(16)X0011-2
Volume 53, Supplement, p1-176

International Meeting on Emerging Diseases and Surveillance (IMED) 2016
Highlights from the 6th International Meeting on Emerging Diseases and Surveillance (IMED 2016) Vienna, Austria from Nov 3 to 7, 2016
Britta Lassmann, Lawrence C. Madoff

Journal of Community Health
Volume 42, Issue 1, February 2017
http://link.springer.com/journal/10900/42/1/page/1

Original Paper
Human Papillomavirus Vaccine Uptake in Texas Pediatric Care Settings: A Statewide Survey of Healthcare Professionals
Mehwish Javaid, Dana Ashrawi, Rachel Landgren, Lori Stevens, Rosalind Bello, Lewis Foxhall, , Melissa Mims, Lois Ramondetta

Abstract
The purpose of this study was to identify barriers to and facilitators of human papillomavirus (HPV) vaccination in children aged 9–17 years across Texas. A literature review informed the development of a web-based survey designed for people whose work involves HPV vaccination in settings serving pediatric patients. The survey was used to examine current HPV vaccine recommendation practices among healthcare providers, barriers to HPV vaccination, reasons for parent/caregiver vaccine refusal, staff and family education practices, utilization of reminder and recall systems and status of vaccine administration (payment, ordering and stocking). 1132 responses were received representing healthcare providers, administrative and managerial staff. Respondents identified perceived barriers to HPV vaccination as parental beliefs about lack of necessity of vaccination prior to sexual debut, parental concerns regarding safety and/or side effects, parental perceptions that their child is at low risk for HPV-related disease, and parental lack of knowledge that the vaccine is a series of three shots. Of responding healthcare providers, 94 % (n=582) reported they recommend the vaccine for 9–12 year olds; however, same-day acceptance of the vaccine is low with only 5 % (n=31) of providers reporting the HPV vaccine is “always” accepted the same day the recommendation is made. Healthcare providers and multidisciplinary care teams in pediatric care settings must work to identify gaps between recommendation and uptake to maximize clinical opportunities. Training in methods to communicate an effective HPV recommendation and patient education tailored to address identified barriers may be helpful to reduce missed opportunities and increase on-time HPV vaccinations.

Journal of Community Health
Volume 42, Issue 1, February 2017
http://link.springer.com/journal/10900/42/1/page/1

Original Paper
Improving Human Papillomavirus (HPV) Vaccination in the Postpartum Setting
Reni Soon, Stephen Sung, May Rose Dela Cruz, John J. Chen, Mark Hiraoka

Abstract
Although the HPV vaccine has been shown to be highly effective in preventing cervical dysplasia, vaccination rates remain low. The objective of this study was to assess the effectiveness of an electronic medical record (EMR) prompt on HPV vaccination rates in the postpartum setting. We conducted a pre-post intervention study among postpartum women ages 18–26 seen at an outpatient clinic from 09/01/2012–08/31/2013 (pre-intervention) and from 10/01/2013–03/31/2014 (post-intervention). The intervention was a drop-down menu that was inserted into the EMR postpartum note template inquiring about the patient’s HPV vaccination status and whether or not the vaccine was administered at that visit. HPV vaccination uptake was compared pre and post-intervention. Of the 278 postpartum visits during the study period, 241 were eligible for analysis. There was a significant increase of the HPV vaccine uptake, from 1.2 % (2/173) among pre-intervention visits to 26.5 % (18/68) among post-intervention visits (p < 0.001). After adjusting for age, ethnicity, insurance, and religion, HPV vaccination was significantly higher at postpartum visits during the intervention period, with an adjusted OR=93.49 [95 % CI 15.29–571.52]. Among visits in which the vaccine was not given, HPV vaccination was not discussed in 46 % and patients refused the vaccine in 40% of visits. An EMR prompt in the postpartum note could be an effective way to promote HPV vaccination in the postpartum setting. It will likely take a combination of strategies to optimize vaccination uptake.

Journal of Infectious Diseases
Volume 215 Issue 1 January 1, 2017
http://jid.oxfordjournals.org/content/current

EDITORIAL COMMENTARIES
Vaccines Against Respiratory Syncytial Virus: The Time Has Come
J Infect Dis. (2017) 215 (1): 4-7 doi:10.1093/infdis/jiw455
Janet A. Englund and Helen Y. Chu
Extract
Respiratory syncytial virus (RSV) remains the single most important cause of respiratory tract disease in infants, both in the United States [1] and worldwide [2]. This virus is responsible for bronchiolitis in infants and for clinical disease often indistinguishable from influenza in elderly or immunocompromised hosts. RSV disease was first characterized by astute clinicians such as John Adams in the 1940s, as the cause of primary viral pneumonitis in infants in winter months [3]. RSV was subsequently propagated in Robert Chanock’s laboratory in the late 1950s [4], confirming the laboratory and clinical findings of disease caused by “chimpanzee coryza” virus described earlier by Morris et al in 1956 [5]. Over the next 50 years, innovative clinical studies by Caroline Breese Hall, Paul Glezen, Ann Falsey, and many others demonstrated the ubiquity, importance, and potential severity of RSV infection in preterm infants, young children, immunocompromised patients, and elderly individuals [6–8]. The article by Langley et al [9] in this issue of The Journal of Infectious Diseases adds considerably to our knowledge regarding vaccines against RSV, a saga that has been ongoing for decades with remarkably little success [10].
There is still no approved vaccine against RSV. The tragic outcome of a formalin-inactivated, alum-precipitated RSV vaccine candidate in the 1960s has resulted in a near moratorium on RSV vaccine research since that time [11, 12]. The early formalin-inactivated vaccine candidate not only failed to protect young seronegative infants against RSV disease but resulted in severe enhanced respiratory disease in vaccine recipients after…

Journal of Infectious Diseases
Volume 215 Issue 1 January 1, 2017
http://jid.oxfordjournals.org/content/current

MAJOR ARTICLES AND BRIEF REPORTS
A Randomized, Controlled, Observer-Blinded Phase 1 Study of the Safety and Immunogenicity of a Respiratory Syncytial Virus Vaccine With or Without Alum Adjuvant
J Infect Dis. (2017) 215 (1): 24-33 doi:10.1093/infdis/jiw453
Joanne M. Langley, Naresh Aggarwal, Azhar Toma, Scott A. Halperin, Shelly A. McNeil, Laurence Fissette, Walthere Dewé, Maarten Leyssen, Jean-François Toussaint, and Ilse Dieussaert

Abstract
Background.
Respiratory syncytial virus (RSV) is a leading cause of childhood bronchiolitis and pneumonia, particularly in early infancy. Immunization of pregnant women could boost preexisting immune responses, providing passive protection to newborns through placental transfer of anti-RSV antibody.

Methods.
In this first-in-humans clinical trial of a purified recombinant RSV protein F vaccine engineered to preferentially maintain prefusion conformation (RSV-PreF), 128 healthy men 18–44 years old were randomized to one dose of a RSV-PreF vaccine containing 10, 30, or 60 µg of RSV-PreF antigen, with or without alum adjuvant, or control, and followed for one year for safety and immunogenicity outcomes.

Results.
Injection site pain was the most common adverse event, reported by up to 81.3% of participants. The highest RSV neutralizing antibody responses were in the 30 µg RSV-PreF/alum, 60 µg RSV-PreF/alum, and 60 µg RSV-PreF/nonadjuvant groups. Responses were evident on day 7, and 30 days after vaccination these participants had RSV-A neutralizing antibody titers of ≥1:512, and >70% had titers of 1:1024, with titers increasing by 3.2–4.9 fold. Responses remained high on day 60 but waned on days 180 and 360.

Conclusions.
The RSV-PreF vaccine elicited rapid RSV neutralizing antibody responses in healthy young men, with an acceptable adverse event profile.

Journal of Infectious Diseases
Volume 215 Issue 1 January 1, 2017
http://jid.oxfordjournals.org/content/current

MAJOR ARTICLES AND BRIEF REPORTS
Significant Correlation Between the Infant Gut Microbiome and Rotavirus Vaccine Response in Rural Ghana
J Infect Dis. (2017) 215 (1): 34-41 doi:10.1093/infdis/jiw518
Vanessa C. Harris, George Armah, Susana Fuentes, Katri E. Korpela, Umesh Parashar, John C. Victor, Jacqueline Tate, Carolina de Weerth, Carlo Giaquinto, Willem Joost Wiersinga, Kristen D. C. Lewis, and Willem M. de Vos
Abstract

Background.
Rotavirus (RV) is the leading cause of diarrhea-related death in children worldwide and 95% of RV-associated deaths occur in Africa and Asia where RV vaccines (RVVs) have lower efficacy. We hypothesize that differences in intestinal microbiome composition correlate with the decreased RVV efficacy observed in poor settings.

Methods.
We conducted a nested, case-control study comparing prevaccination, fecal microbiome compositions between 6-week old, matched RVV responders and nonresponders in rural Ghana. These infants’ microbiomes were then compared with 154 age-matched, healthy Dutch infants’ microbiomes, assumed to be RVV responders. Fecal microbiome analysis was performed in all groups using the Human Intestinal Tract Chip.

Results.
We analyzed findings in 78 Ghanaian infants, including 39 RVV responder and nonresponder pairs. The overall microbiome composition was significantly different between RVV responders and nonresponders (FDR, 0.12), and Ghanaian responders were more similar to Dutch infants than nonresponders (P=.002). RVV response correlated with an increased abundance of Streptococcus bovis and a decreased abundance of the Bacteroidetes phylum in comparisons between both Ghanaian RVV responders and nonresponders (FDR, 0.008 vs 0.003) and Dutch infants and Ghanaian nonresponders (FDR, 0.002 vs 0.009).

Conclusions.
The intestinal microbiome composition correlates significantly with RVV immunogenicity and may contribute to the diminished RVV immunogenicity observed in developing countries.

The Lancet
Jan 21, 2017 Volume 389 Number 10066 p225-330
http://www.thelancet.com/journals/lancet/issue/current

Comment
CEPI—a new global R&D organisation for epidemic preparedness and response
Børge Brende, Jeremy Farrar, Diane Gashumba, Carlos Moedas, Trevor Mundel, Yasuhisa Shiozaki, Harsh Vardhan, Johanna Wanka, John-Arne Røttingen
Summary
The outbreak of Ebola virus disease in west Africa in 2013–16 showed that the world is not sufficiently prepared to detect and respond to epidemic threats. It exposed a systemic need for stronger operational and strategic capabilities in infectious disease response, and for the development of more effective tools and technologies to manage, treat, and prevent disease. Evaluations of the Ebola response highlight that the global community must rethink how vaccines, diagnostics, and drugs for emerging infections are developed given their lack of commercial profitability, especially since outbreaks are most likely to occur in resource-constrained environments.

The Lancet
Jan 21, 2017 Volume 389 Number 10066 p225-330
http://www.thelancet.com/journals/lancet/issue/current

Comment
Access to Medicine Index—what about sustainability?
Summary
A pharmaceutical company representative described the Access to Medicine Index 2016 as “a force for good, and not yet another stick with which to beat industry”.1 The Access to Medicine Index 2016,1 which will be presented at a public meeting later this month at the time of the WHO Executive Board meeting in Geneva, ranks the top 20 research-based pharmaceutical companies on their efforts to improve access to medicine in low-income and middle-income countries (LMICs). And those companies with high ranking tout their success to their stockholders and the media.

The Lancet
Jan 21, 2017 Volume 389 Number 10066 p225-330
http://www.thelancet.com/journals/lancet/issue/current

Review
Neglected tropical diseases: progress towards addressing the chronic pandemic
David H Molyneux, Lorenzo Savioli, Dirk Engels
Summary
The concept of neglected tropical diseases (NTDs) emerged more than a decade ago and has been recognised as a valid way to categorise diseases that affect the poorest individuals. Substantial progress in control and elimination has been achieved and policy momentum has been generated through continued bilateral, philanthropic, and non-governmental development organisation (NGDO) support, and donations of drugs from pharmaceutical companies. WHO has defined a Roadmap to reach 2020 targets, which was endorsed by member states in a World Health Assembly Resolution in 2013. NTDs have been included within the Sustainable Development Goal targets and are a crucial component of universal health coverage, conceptualised as “leaving no one behind”. WHO reported that more than 1 billion people in 88 countries have benefited from preventive chemotherapy in 2014. The research agenda has defined the need for affordable products (diagnostics, drugs and insecticides). However challenges such as insecurity and weak health systems continue to prevail in the poorest countries, inhibiting progress in scaling up and also in achieving Roadmap goals.

Maternal and Child Health Journal
Volume 21, Issue 1, January 2017
http://link.springer.com/journal/10995/20/12/page/1

Commentary
Enhancing HIV Treatment Access and Outcomes Amongst HIV Infected Children and Adolescents in Resource Limited Settings
Ameena Ebrahim Goga, Yagespari Singh, Michelle Singh, Nobuntu Noveve, Vuyolwethu  Magasana, Trisha Ramraj, Fareed Abdullah, Ashraf H. Coovadia, Sanjana Bhardwaj, Gayle G. Sherman

Abstract
Introduction
Increasing access to HIV-related care and treatment for children aged 0–18 years in resource-limited settings is an urgent global priority. In 2011–2012 the percentage increase in children accessing antiretroviral therapy was approximately half that of adults (11 vs. 21 %). We propose a model for increasing access to, and retention in, paediatric HIV care and treatment in resource-limited settings.

Methods
Following a rapid appraisal of recent literature seven main challenges in paediatric HIV-related care and treatment were identified: (1) lack of regular, integrated, ongoing HIV-related diagnosis; (2) weak facility-based systems for tracking and retention in care; (3) interrupted availability of dried blood spot cards (expiration/stock outs); (4) poor quality control of rapid HIV testing; (5) supply-related gaps at health facility-laboratory interface; (6) poor uptake of HIV testing, possibly relating to a fatalistic belief about HIV infection; (7) community-associated reasons e.g. non-disclosure and weak systems for social support, resulting in poor retention in care.

Results
To increase sustained access to paediatric HIV-related care and treatment, regular updating of Policies, review of inter-sectoral Plans (at facility and community levels) and evaluation of Programme implementation and impact (at national, subnational, facility and community levels) are non-negotiable critical elements. Additionally we recommend the intensified implementation of seven main interventions: (1) update or refresher messaging for health care staff and simple messaging for key staff at early childhood development centres and schools; (2) contact tracing, disclosure and retention monitoring; (3) paying particular attention to infant dried blood spot (DBS) stock control; (4) regular quality assurance of rapid HIV testing procedures; (5) workshops/meetings/dialogues between health facilities and laboratories to resolve transport-related gaps and to facilitate return of results to facilities; (6) community leader and health worker advocacy at creches, schools, religious centres to increase uptake of HIV testing and dispel fatalistic beliefs about HIV; (7) use of mobile communication technology (m-health) and peer/community supporters to maintain contact with patients.

Discussion and Conclusion
We propose that this package of facility, community and family-orientated interventions are needed to change the trajectory of the paediatric HIV epidemic and its associated patterns of morbidity and mortality, thus achieving the double dividend of improving HIV-free survival.

Original Paper
State-Level Immunization Information Systems: Potential for Childhood Immunization Data Linkages
Jill E. Fuller, Emmanuel B. Walter Jr., Nancy Dole, Richard O’Hara, Amy H. Herring, Maureen S. Durkin, Bonny Specker, Betty Wey

Nature
Volume 541 Number 7637 pp259-430 19 January 2017
http://www.nature.com/nature/current_issue.html

Editorials
Trump’s vaccine-commission idea is biased and dangerous
Scientists must fight back with the truth about the debunked link between vaccines and autism
Critics call Donald Trump unpredictable. “Who knows what he will do next?” has become a popular rhetorical question in US politics. And yet, quite often his actions are entirely predictable. The difficulty comes in comprehending them.

A prime example is last week’s revelation by environmental lawyer Robert F. Kennedy Jr that president-elect Trump may put together a commission to study “vaccine safety and scientific integrity”. (Trump’s team has countered that there are no definite plans to do so.) Kennedy says he would head the commission; he has in the past argued — unconvincingly — that a preservative in some childhood vaccines is linked to autism spectrum disorder, despite abundant evidence to the contrary.

Trump’s embrace of the tiresome and discredited anti-vaccination movement is no secret. He has tweeted and publicly discussed his concerns that childhood vaccines may be linked to autism. He has previously met with like-minded activists, including Andrew Wakefield, a father of the ‘anti-vaxxer’ crusade who has been barred from practising medicine in the United Kingdom for professional misconduct.

Given the people Trump has chosen to listen to, his suggestion of a Kennedy-headed vaccine commission should be no surprise. But it remains difficult to grasp how someone in his position, with unlimited access to the world’s best resources on vaccine safety, would selectively choose to overlook them all: the studies, the commissions, the scientists who have spent a lifetime studying vaccines. What good is another investigation of speculation already so thoroughly analysed and debunked — unless it is being set up to reach a different conclusion? It is a clear waste of money and effort. Much more frustratingly, it fuels an anti-vaccination movement that puts children and elderly people at risk.

Trump surely knows that there is already a federal commission to evaluate vaccine safety. The US Centers for Disease Control and Prevention (CDC) has an Advisory Committee on Immunization Practices that reports to the government on vaccine safety. Vaccines are also regulated by the US Food and Drug Administration — and often have particularly stringent safety requirements because they are used in healthy children.
There is already ample evidence that vaccines do not elevate the risk of autism. A 2015 study of more than 95,000 children found no association between the measles, mumps and rubella vaccine and an increased risk of autism — even among children with a family history of the disorder (A. Jain et al. J. Am. Med. Assoc. 313, 1534–1540; 2015). As for Kennedy’s argument about vaccine preservatives, the CDC has repeatedly tried — and failed — to find a link between that preservative, called thimerosal, and autism. In 2004, the US Institute of Medicine reported that a review of the literature had also found no such link (see go.nature.com/2jwe4ba). And in the United States, the argument is now moot: thimerosal was removed from most childhood vaccines administered in the country, as a precautionary measure, beginning in 2001. Autism diagnoses continued unabated.

All the evidence shows that it is actually misconceptions about vaccines — such as those promoted by Trump — that cause serious harm. The United States has already experienced a series of outbreaks of preventable diseases. In 2014, measles affected 667 people in the country, primarily those who were unvaccinated. The outbreaks are expensive, too: in 2011, it cost public-health institutions up to US$5.3 million to cope with 16 measles outbreaks that made 107 people ill.

If Trump moves ahead with his vaccine commission, he will give a sense of legitimacy to opponents of childhood vaccination. This could undercut efforts in some states, such as Texas and Michigan, to strengthen vaccination requirements for schoolchildren.

In the wake of the news about the commission, the American Medical Association moved to reassert the safety of vaccines. The American Academy of Pediatrics said that it would welcome the chance to discuss vaccine safety with Trump.

Scientists, medics and commentators who have fought vaccine disinformation in the past must take a deep breath and return to the fray. There is no need to wait for this commission to be announced officially. There is no need to wait until it issues its findings. There is no cause to be surprised if it shows little regard for science — or even if it targets scientists who speak out in favour of vaccination. Those who claim a link between vaccines and autism can do so only by discrediting the scientific evidence and, often, the scientists who gathered it. Kennedy’s reference to investigating vaccine safety “and scientific integrity” provides ample warning of what is to come. Scientists should get their retaliation in first. Lives are at stake.

Nature
Volume 541 Number 7637 pp259-430 19 January 2017
http://www.nature.com/nature/current_issue.html

Editorials
Replication studies offer much more than technical details
They demonstrate the practice of science at its best.
Purists will tell you that science is about what scientists don’t know, which is true but not much of a basis on which to develop new cancer drugs. Hence the importance of knowledge: how crucial this mutation or that cell-surface receptor really is to cancer growth. These are the findings that launch companies and clinical trials — provided, of course, that they have been published in research papers in peer-reviewed journals.

As we report in a News story this week, a systematic effort to check some of these findings by repeating an initial five published cancer studies has reported that none could be completely reproduced. The significance of this divergence — how the specific experiments were selected and what the results mean for the broader agenda of reproducibility in research — is already hotly contested.

Perhaps the most influential aspect of the exercise, called the Reproducibility Project: Cancer Biology, has nothing to do with those arguments. It lies beneath the surface, in the peer reviews of the project teams’ replication plans, which were published before the studies began. These reviews can be read as part of the editorial decision letters linked to each replication plan, or ‘registered report’ (see go.nature.com/2jte08a)…

PLOS Currents: Disasters
http://currents.plos.org/disasters/
[Accessed 21 January 2017]

Brief Report
The Solidarity and Health Neutrality of Physicians in War & Peace
January 20, 2017 ·
The wars in the Middle East have led to unprecedented threats and attacks on patients, healthcare workers, and purposeful targeting of hospitals and medical facilities. It is crucial that every healthcare provider, both civilian and military, on either side of the conflict become aware of the unique and inherent protections afforded to them under International Humanitarian Law. However, these protections come with obligations. Whereas Governments must guarantee these protections, when violated, medical providers have equal duty and obligations under the Law to ensure that they will neither commit nor assist in these violations nor take part in any act of hostility. Healthcare providers must not allow any inhuman or degrading treatment of which they are aware and must report such actions to the appropriate authorities. Failure to do so leads to risks of moral, ethical and legal consequences as well as penalties for their actions and inactions. There must be immediate recognition by all parties of the neutrality of health care workers and their rights and responsibilities to care for any sick and injured patient, regardless of their nationality, race, religion, or political point of view.

PLoS One
http://www.plosone.org/
[Accessed 21 January 2017]

Research Article
Childhood Vaccine Acceptance and Refusal among Warao Amerindian Caregivers in Venezuela; A Qualitative Approach
Jochem Burghouts, Berenice Del Nogal, Angimar Uriepero, Peter W. M. Hermans, Jacobus H. de Waard, Lilly M. Verhagen
Research Article | published 20 Jan 2017 PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0170227
Abstract

Objectives
Acceptance of childhood vaccination varies between societies, affecting worldwide vaccination coverage. Low coverage rates are common in indigenous populations where parents often choose not to vaccinate their children. We aimed to gain insight into reasons for vaccine acceptance or rejection among Warao Amerindians in Venezuela.

Methods
Based on records of vaccine acceptance or refusal, in-depth interviews with 20 vaccine-accepting and 11 vaccine-declining caregivers were performed. Parents’ attitudes were explored using a qualitative approach.

Results
Although Warao caregivers were generally in favor of vaccination, fear of side effects and the idea that young and sick children are too vulnerable to be vaccinated negatively affected vaccine acceptance. The importance assigned to side effects was related to the perception that these resembled symptoms/diseases of another origin and could thus harm the child. Religious beliefs or traditional healers did not influence the decision-making process.

Conclusions
Parental vaccine acceptance requires educational programs on the preventive nature of vaccines in relation to local beliefs about health and disease. Attention needs to be directed at population-specific concerns, including explanation on the nature of and therapeutic options for side effects.

Do Thai Physicians Recommend Seasonal Influenza Vaccines to Pregnant Women? A Cross-Sectional Survey of Physicians’ Perspectives and Practices in Thailand
Prabda Praphasiri, Darunee Ditsungneon, Adena Greenbaum, Fatimah S. Dawood, Pornsak Yoocharoen, Deborah M. Stone, Sonja J. Olsen, Kim A. Lindblade, Charung Muangchana
Research Article | published 18 Jan 2017 PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0169221

PLoS One
http://www.plosone.org/
[Accessed 21 January 2017]

A Systematic Review of Ebola Treatment Trials to Assess the Extent to Which They Adhere to Ethical Guidelines
Thomas Richardson, Andrew McDonald Johnston, Heather Draper
Research Article | published 17 Jan 2017 PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0168975
Abstract
Background
Objective: To determine to what extent each trial met criteria specified in three research frameworks for ethical trial conduct.
Design: Systematic review and narrative analysis

Methods and findings
Data sources: MEDBASE and EMBASE databases were searched using a specific search strategy. The Cochrane database for systematic reviews, the PROSPERO database and trial registries were examined. A grey literature search and citation search were also carried out.
Eligibility criteria for selecting studies: Studies were included where the intervention was being used to treat Ebola in human subjects regardless of study design, comparator or outcome measured. Studies were eligible if they had taken place after the 21st March 2014. Unpublished as well as published studies were included.
Included studies: Sixteen studies were included in the data synthesis. Data was extracted on study characteristics as well as any information relating to ten ethical areas of interest specified in the three research frameworks for ethical trial conduct and an additional criterion of whether the study received ethics approval from a research ethics committee.
Synthesis of results: Eight studies were judged to fully comply with all eleven criteria. The other eight studies all had at least one criteria where there was not enough information available to draw any conclusions. In two studies there were ethical concerns regarding the information provided in relation to at least one ethical criteria.
Description of the effect: One study did not receive ethical approval as the authors argued that treating approximately one hundred patients consecutively for compassionate reasons did not constitute a clinical trial. Furthermore, after the patients were treated, physicians in Sierra Leone did not release reports of treatment results and so study conclusions had to be made based on unpublished observations. In another study the risk-benefit ratio of the trial drug does not appear to be favourable and the pre-trial evidence base for its effectiveness against Ebola is speculative.

Conclusions
Some limited and appropriate deviation from standard research expectations in disaster situations is increasingly accepted. However, this is not an excuse for poor ethics oversight and international regulations are in place which should not be ignored. New guidelines are needed that better define the boundaries between using medicines for compassionate use and conducting a clinical trial. Greater support should be offered for local research ethics committees in affected areas so that they can provide robust ethical review. Further systematic reviews should be carried out in epidemics of any novel infectious diseases to assess if comparable findings arise.

Science
20 January 2017 Vol 355, Issue 6322
http://www.sciencemag.org/current.dtl

Feature
Taming rabies
By Erik Stokstad
Science20 Jan 2017 : 238-242 Full Access
The best way to stop people from dying of rabies is to protect dogs. Can that strategy work in the world’s poorest countries?

Summary
An estimated 59,000 people die from rabies around the world every year. Their horrible suffering—including convulsions, terror, and aggression—and the fact that many victims are children led the World Health Organization and others to announce a goal to eliminate rabies deaths worldwide by 2030. The plan calls for cheaper and faster treatment for people. But its long-term bet is on vaccinating domestic dogs, which cause more than 99% of infections. The challenges are enormous in sub-Saharan Africa, where poor countries can hardly pay for millions of dogs to be vaccinated, and their governments often have trouble organizing vaccination campaigns across vast rural areas. In pilot projects underway in Tanzania, Kenya, and a few other African countries, scientists are testing strategies for reaching and vaccinating dogs more efficiently and quantifying the economic benefits of potentially expensive national campaigns. For Africa as a whole, rabies elimination might cost between $800 million to $1.55 billion. The price could come down, however, from dog vaccine banks, for example, and other ways to make vaccines cheaper and more easily distributed.

Perspectives
Technology beats corruption
By Rema Hanna
Science20 Jan 2017 : 244-245 Full Access
Biometric smart cards help to reduce corruption in cash transfer programs in India

Summary
More than 1.9 billion individuals in the developing world benefit from social safety net programs: noncontributory transfer programs that distribute cash or basic in-kind products to the poor. But despite their importance, high levels of corruption often stifle the effectiveness of these programs. If cash transfer programs are particularly prone to graft, then in-kind programs should be preferred in practice. In a recent paper, Muralidharan et al. report evidence to the contrary by showing that use of a modern banking technology—biometric smart cards—can help to drastically reduce corruption in cash transfer programs (1).

Review
Human tissues in a dish: The research and ethical implications of organoid technology
By Annelien L. Bredenoord, Hans Clevers, Juergen A. Knoblich
Science20 Jan 2017
Abstract
Growing functional human tissues and organs would provide much needed material for regeneration and repair. New technologies are taking us in that direction. In addition to their use in regenerative medicine, stem cells that grow and morph into organ-like structures known as organoids can be used in drug development and toxicology testing. The potential developments and possibilities are numerous and affect not only biomedicine but also areas of ongoing ethical debate, such as animal experimentation, research on human embryos and fetuses, ethics review, and patient consent. Bredenoord et al. review how organoids affect existing ethical debates and how they raise novel ethical dilemmas and professional responsibilities.

Vaccine
Volume 35, Issue 4, Pages 503-712 (23 January 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/4

Brief report
Interest in an Ebola vaccine among a U.S. national sample during the height of the 2014–2016 Ebola outbreak in West Africa
Pages 508-512
Julia E. Painter, Ralph J. DiClemente, Michael E. von Fricken

Abstract
To better understand the association between Ebola-related attitudes and interest in receiving an Ebola virus vaccine, a survey was administered to a U.S. national sample using GfK’s KnowledgePanel®. Among participants (N = 1417), 34.1% expressed interest in an Ebola vaccine for themselves. In the subset of participants with children aged 0–17 (N = 410), 38.1% expressed interest in an Ebola vaccine for their child. In multivariable analyses, vaccine interest for oneself was associated with perceived susceptibility to Ebola (p = 0.009), beliefs that the U.S. government should spend money to control Ebola (p = 0.002), and beliefs Ebola posed a national threat (p = 0.007). Vaccine interest for one’s child was associated with perceived severity of Ebola (p = 0.018) and beliefs that the U.S. government should spend money to control Ebola (p = 0.003). Findings highlight the influence of personal and national threat beliefs on vaccine interest. Understanding the impact of threat beliefs may benefit vaccine campaign development during future pandemic threats

Vaccine
Volume 35, Issue 4, Pages 503-712 (23 January 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/4

Effectiveness of MF59-adjuvanted seasonal influenza vaccine in the elderly: A systematic review and meta-analysis
Review Article
Pages 513-520
Alexander Domnich, Lucia Arata, Daniela Amicizia, Joan Puig-Barberà, Roberto Gasparini, Donatella Panatto
Abstract

Background
In the elderly, traditional influenza inactivated vaccines are often only modestly immunogenic, owing to immunosenescence. Given that adjuvantation is a means of enhancing the immune response, the trivalent inactivated vaccine adjuvanted with MF59 (MF59-TIV) was specifically designed to overcome this problem. Considering that, for ethical reasons, the absolute effectiveness of an influenza vaccine in the elderly cannot be demonstrated in placebo-controlled studies, the present study aimed to assess the effectiveness of MF59-TIV in preventing influenza-related outcomes in the elderly.

Methods
We conducted a systematic review of observational studies aimed at evaluating the effectiveness of MF59-TIV against influenza-related outcomes. Results of single studies were pooled whenever possible.

Results
Of the 1993 papers screened, 11 (6 case-control, 3 cohort and 2 prospective case-control) studies were identified. Hospitalization due to pneumonia/influenza and laboratory-confirmed influenza were reported in more than one study, while other outcomes (influenza-like illness, cardio- and cerebrovascular accidents) were investigated only by one study each. Pooled analysis of four case-control studies showed an adjusted MF59-TIV effectiveness of 51% (95% CI: 39–61%) against hospitalizations for pneumonia/influenza among community-dwelling seniors. Pooled results of the adjusted vaccine effectiveness against laboratory-confirmed influenza were also high (60.1%), although the 95% CI passed through zero (−1.3 to 84.3%). Other single community-based studies showed very high effectiveness of MF59-TIV in preventing hospitalizations for acute coronary [87% (95% CI: 35–97%)] and cerebrovascular [93% (95% CI: 52–99%)] events. MF59-TIV proved highly effective [94% (95% CI: 47–100%] in reducing influenza-like illness among institutionalized elderly. Furthermore, MF59-TIV displayed greater efficacy than non-adjuvanted vaccines in preventing hospitalizations due to pneumonia/influenza [adjusted risk ratio 0.75 (95% CI: 0.57–0.98)] and laboratory-confirmed influenza [adjusted odds ratio 0.37 (0.14–0.96)].

Conclusions
Our results suggest that MF59-TIV is effective in reducing several influenza-related outcomes among the elderly, especially hospitalizations due to influenza-related complications.

Vaccine
Volume 35, Issue 4, Pages 503-712 (23 January 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/4

Pregnancy as a risk factor for severe outcomes from influenza virus infection: A systematic review and meta-analysis of observational studies
Review Article
Pages 521-528
Dominik Mertz, Johanna Geraci, Judi Winkup, Bradford D. Gessner, Justin R. Ortiz, Mark Loeb
Abstract

Background
Pregnancy is considered to be an important risk factor for severe complications following influenza virus infection. As a consequence, WHO recommendations prioritize pregnant women over other risk groups for influenza vaccination. However, the risk associated with pregnancy has not been systematically quantified.

Purpose
Systematic review and meta-analysis of observational studies that reported on pregnancy as a risk factor for severe outcomes from influenza virus infection.

Data source
MEDLINE, EMBASE, CINAHL, and CENTRAL up to April 2014.

Data selection
Studies reporting on outcomes in pregnant women with influenza in comparison to non-pregnant patients with influenza. Outcomes included community-acquired pneumonia, hospitalization, admission to intensive care units (ICU), ventilatory support, and death.

Data extraction
Two reviewers conducted independent screening and data extraction. A random effects model was used to obtain risk estimates. Ecological studies were summarized descriptively.

Data synthesis
A total of 142 non-ecological and 10 ecological studies were included. The majority of studies (n = 136, 95.8%) were conducted during the 2009 influenza A (pH1N1) pandemic. There was a higher risk for hospitalization in pregnant versus non-pregnant patients infected with influenza (odds ratio [OR] 2.44, 95% CI 1.22–4.87), but no significant difference in mortality (OR 1.04, 95% CI 0.81–1.33) or other outcomes. Ecologic studies confirmed the association between hospitalization risk and pregnancy and 4 of 7 studies reported higher mortality rates in pregnant women.

Limitations
No studies were identified in which follow-up began prior to contact with the healthcare system and lack of adjustment for confounding factors.

Conclusions
We found that influenza during pregnancy resulted in a higher risk of hospital admission than influenza infection in non-pregnant individuals, but that the risk of mortality following influenza was similar in both pregnant and non-pregnant individuals.

Vaccine
Volume 35, Issue 4, Pages 503-712 (23 January 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/4

Real-time dynamic modelling for the design of a cluster-randomized phase 3 Ebola vaccine trial in Sierra Leone
Original Research Article
Pages 544-551
A. Camacho, R.M. Eggo, N. Goeyvaerts, A. Vandebosch, R. Mogg, S. Funk, A.J. Kucharski, C.H. Watson, T. Vangeneugden, W.J. Edmunds
Abstract

Background
Declining incidence and spatial heterogeneity complicated the design of phase 3 Ebola vaccine trials during the tail of the 2013–16 Ebola virus disease (EVD) epidemic in West Africa. Mathematical models can provide forecasts of expected incidence through time and can account for both vaccine efficacy in participants and effectiveness in populations. Determining expected disease incidence was critical to calculating power and determining trial sample size.

Methods
In real-time, we fitted, forecasted, and simulated a proposed phase 3 cluster-randomized vaccine trial for a prime-boost EVD vaccine in three candidate regions in Sierra Leone. The aim was to forecast trial feasibility in these areas through time and guide study design planning.

Results
EVD incidence was highly variable during the epidemic, especially in the declining phase. Delays in trial start date were expected to greatly reduce the ability to discern an effect, particularly as a trial with an effective vaccine would cause the epidemic to go extinct more quickly in the vaccine arm. Real-time updates of the model allowed decision-makers to determine how trial feasibility changed with time.

Conclusions
This analysis was useful for vaccine trial planning because we simulated effectiveness as well as efficacy, which is possible with a dynamic transmission model. It contributed to decisions on choice of trial location and feasibility of the trial. Transmission models should be utilised as early as possible in the design process to provide mechanistic estimates of expected incidence, with which decisions about sample size, location, timing, and feasibility can be determined.

Vaccine
Volume 35, Issue 4, Pages 503-712 (23 January 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/4

Knowledge and recommendation regarding routine childhood vaccinations among pediatric healthcare providers in Israel
Original Research Article
Pages 633-638
Rana Shibli, Rivka Shemer, Liat Lerner-Geva, Shmuel Rishpon
Abstract

Background
A recommendation by pediatric healthcare providers (HCPs) is a major factor influencing parents’ decision to vaccinate their children. Consequently, it is important to understand the motives behind the HCPs’ recommendations to vaccinate children according to the routine immunization program.

Objectives
To study the association of pediatric HCPs’ knowledge about and attitudes towards childhood vaccinations and of their professional and demographic characteristics, with two variables: 1. Their recommendations to parents regarding adherence to the routine immunization program. 2. Their choices concerning routine immunization of their own children.

Study design and settings
We conducted a cross-sectional study of pediatric nurses and physicians working at Mother-Child Health Clinics (MCHCs) in Haifa and Tel-Aviv districts and at a hospital in Hadera City, Israel.

Methods
A structured, anonymous self-administered questionnaire was used.

Results
The overall response rate was 60%, totaling 218 participants. 92% of whom were nurses. Misconceptions related to vaccine safety were found among a high percentage of the participants. The HCPs knowledge level was associated with the HCPs vaccinating their own children according to the recommended immunization program (OR=1.32; CI95% 1.06–1.64), but not with their recommendation to parents to adhere to the program. No association was found between attitudes and these variables. Workplace (MCHCs versus hospital) correlated with the above mentioned two dependent variables (OR=1.89; CI95% 1.21–2.97 and OR=2.42; CI95% 1.73–3.4, respectively).

Conclusions
Amplifying the knowledge of HCPs and addressing their concern about vaccinations can improve their adherence to the routine immunization program regarding their own children. This may lead to better adherence of other parents who are frequently interested in the HCPs’ behavior and consider them as a role model. In general, there is a need to emphasize the HCP’s responsibility for the successful implementation of the immunization program in the community and at hospitals.

Vaccine
Volume 35, Issue 4, Pages 503-712 (23 January 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/4

Primary care physicians’ perspective on financial issues and adult immunization in the Era of the Affordable Care Act
Original Research Article
Pages 647-654
Laura P. Hurley, Megan C. Lindley, Mandy A. Allison, Lori A. Crane, Michaela Brtnikova, Brenda L. Beaty, Megan Snow, Carolyn B. Bridges, Allison Kempe

Abstract
Background
Financial barriers to adult vaccination are poorly understood. Our objectives were to assess among general internists (GIM) and family physicians (FP) shortly after Affordable Care Act (ACA) implementation: (1) proportion of adult patients deferring or refusing vaccines because of cost and frequency of physicians not recommending vaccines for financial reasons; (2) satisfaction with reimbursement for vaccine purchase and administration by payer type; (3) knowledge of Medicare coverage of vaccines; and (4) awareness of vaccine-specific provisions of the ACA.

Methods
We administered an Internet and mail survey from June to October 2013 to national networks of 438 GIMs and 401 FPs.

Results
Response rates were 72% (317/438) for GIM and 59% (236/401) for FP. Among physicians who routinely recommended vaccines, up to 24% of GIM and 30% of FP reported adult patients defer or refuse certain vaccines for financial reasons most of the time. Physicians reported not recommending vaccines because they thought the patient’s insurance would not cover it (35%) or the patient could be vaccinated more affordably elsewhere (38%). Among physicians who saw patients with this insurance, dissatisfaction (‘very dissatisfied’) was highest for payments received from Medicaid (16% vaccine purchase, 14% vaccine administration) and Medicare Part B (11% vaccine purchase, 11% vaccine administration). Depending on the vaccine, 36–71% reported not knowing how Medicare covered the vaccine. Thirty-seven percent were ‘not at all aware’ and 19% were ‘a little aware’ of vaccine-specific provisions of the ACA.

Conclusions
Patients are refusing and physicians are not recommending adult vaccinations for financial reasons. Increased knowledge of private and public insurance coverage for adult vaccinations might position physicians to be more likely to recommend vaccines and better enable them to refer patients to other vaccine providers when a particular vaccine or vaccines are not offered in the practice.

Vaccine
Volume 35, Issue 4, Pages 503-712 (23 January 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/4

Impact of the national rotavirus vaccination programme on acute gastroenteritis in England and associated costs averted
Original Research Article
Pages 680-686
Sara L. Thomas, Jemma L. Walker, Justin Fenty, Katherine E. Atkins, Alex J. Elliot, Helen E. Hughes, Julia Stowe, Shamez Ladhani, Nick J. Andrews
Abstract
Background
Introduction of infant oral rotavirus vaccination in the UK in July 2013 has resulted in decreased hospitalisations and Emergency Department (ED) visits for acute gastroenteritis (AGE), for both adults and children. We investigated reductions in AGE incidence seen in primary care in the two years after vaccine introduction, and estimated the healthcare costs averted across healthcare settings in the first year of the vaccination programme.
Methods
We used primary care data from the Clinical Practice Research Datalink and age-stratified time-series analyses to derive adjusted incidence rate ratios (IRRa) for AGE in the first two years of the post-vaccination era (July 2013-April 2015) compared to the pre-vaccination era (July 2008-June 2013). We estimated cases averted among children aged Results
In general practice, AGE rates in infants (the target group for vaccination) decreased by 15% overall after vaccine introduction (IRRa = 0.85; 95%CI=0.76–0.95), and by 41% in the months of historically high rotavirus circulation (IRRa=0.59; 95%CI=0.53–0.66). Rates also decreased in other young children and to a lesser degree in older individuals, indicating herd immunity. Across all three settings (general practice, EDs, and hospitalisations) an estimated 87,376 (95% prediction interval: 62,588–113,561) AGE visits by children aged Conclusions
The marked decreases in the general practice AGE burden after rotavirus vaccine introduction mirror decreases seen in other UK healthcare settings. Overall, these decreases are associated with substantial averted healthcare costs.

Vaccine
Volume 35, Issue 3, Pages 411-502 (11 January 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/3

Letter to the Editor
Ensuring access to oral cholera vaccine to those who need them most
Francisco J. Luquero, Anne Ballard, David A. Sack
[No abstract]

Pneumonia prevention: Cost-effectiveness analyses of two vaccines among refugee children aged under two years, Haemophilus influenzae type b-containing and pneumococcal conjugate vaccines, during a humanitarian emergency, Yida camp, South Sudan
Original Research Article
Pages 435-442
Lisa M. Gargano, Rana Hajjeh, Susan T. Cookson
Abstract
By September 2013, war between Sudan and South Sudan resulted in >70,000 Sudanese refugees and high pneumonia incidence among the 20,000 refugees in Yida camp, South Sudan. Using Médecins Sans Frontières (MSF)-provided data and modifying our decision-tree models, we estimated if administering Haemophilus influenzae type b (Hib)-containing (pentavalent vaccine, also with diphtheria pertussis and tetanus [DPT] and hepatitis B) and pneumococcal conjugate (PCV) vaccines were cost-effective against hospitalized pneumonia. Among children

Vaccine coverage and adherence to EPI schedules in eight resource poor settings in the MAL-ED cohort study
Original Research Article
Pages 443-451
Christel Hoest, Jessica C. Seidman, Gwenyth Lee, James A Platts-Mills, Asad Ali, Maribel Paredes Olortegui, Pascal Bessong, Ram Chandyo, Sudhir Babji, Venkata Raghava Mohan, Dinesh Mondal, Mustafa Mahfuz, Estomih R Mduma, Emanuel Nyathi, Claudia Abreu, Mark A. Miller, William Pan, Carl J. Mason, Stacey L. Knobler, the MAL-ED Network Investigators
Abstract
Background
Launched in 1974, the Expanded Program on Immunization (EPI) is estimated to prevent two-three million deaths annually from polio, diphtheria, tuberculosis, pertussis, measles, and tetanus. Additional lives could be saved through better understanding what influences adherence to the EPI schedule in specific settings.
Methods
The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study followed cohorts in eight sites in South Asia, Africa, and South America and monitored vaccine receipt over the first two years of life for the children enrolled in the study. Vaccination histories were obtained monthly from vaccination cards, local clinic records and/or caregiver reports. Vaccination histories were compared against the prescribed EPI schedules for each country, and coverage rates were examined in relation to the timing of vaccination. The influence of socioeconomic factors on vaccine timing and coverage was also considered.
Results
Coverage rates for EPI vaccines varied between sites and by type of vaccine; overall, coverage was highest in the Nepal and Bangladesh sites and lowest in the Tanzania and Brazil sites. Bacillus Calmette-Guérin coverage was high across all sites, 87–100%, whereas measles vaccination rates ranged widely, 73–100%. Significant delays between the scheduled administration age and actual vaccination date were present in all sites, especially for measles vaccine where less than 40% were administered on schedule. A range of socioeconomic factors were significantly associated with vaccination status in study children but these results were largely site-specific.
Conclusions
Our findings highlight the need to improve measles vaccination rates and reduce delayed vaccination to achieve EPI targets related to the establishment of herd immunity and reduction in disease transmission.
Special Section: Immunology and vaccinology of respiratory syncytial virus infections (Guest Editors: D. Altmann and C. Chiu)

Vaccines — Open Access Journal
http://www.mdpi.com/journal/vaccines
(Accessed 21 January 2017)

A Protective Vaccine against Chlamydia Genital Infection Using Vault Nanoparticles without an Added Adjuvant
Vaccines 2017, 5(1), 3; doi:10.3390/vaccines5010003 – 19 January 2017
by Janina Jiang, Guangchao Liu, Valerie A. Kickhoefer, Leonard H. Rome, Lin-Xi Li, Stephen J. McSorley and Kathleen A. Kelly
Abstract
Chlamydia trachomatis genital infection is the most common sexually transmitted bacterial disease, causing a significant burden to females due to reproductive dysfunction. Intensive screening and antibiotic treatment are unable to completely prevent female reproductive dysfunction, thus, efforts have become focused on developing a vaccine. A major impediment is identifying a safe and effective adjuvant which induces cluster of differentiation 4 (CD4) cells with attributes capable of halting genital infection and inflammation. Previously, we described a natural nanocapsule called the vault which was engineered to contain major outer membrane protein (MOMP) and was an effective vaccine which significantly reduced early infection and favored development of a cellular immune response in a mouse model. In the current study, we used another chlamydial antigen, a polymorphic membrane protein G-1 (PmpG) peptide, to track antigen-specific cells and evaluate, in depth, the vault vaccine for its protective capacity in the absence of an added adjuvant. We found PmpG-vault immunized mice significantly reduced the genital bacterial burden and histopathologic parameters of inflammation following a C. muridarum challenge. Immunization boosted antigen-specific CD4 cells with a multiple cytokine secretion pattern and reduced the number of inflammatory cells in the genital tract making the vault vaccine platform safe and effective for chlamydial genital infection. We conclude that vaccination with a Chlamydia-vault vaccine boosts antigen-specific immunities that are effective at eradicating infection and preventing reproductive tract inflammation.

From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary

Journal of Nursing Education and Practice
Online Published: January 15, 2017
Predictors of Human Papillomavirus Vaccine uptake or intent among parents of preadolescents and adolescents
Kimberlee Dayal, Sarah Robinson, Jessica Schoening, Mary Catherine Smith, Son Chae Kim
ABSTRACT
Aim: The aim of this study was to examine predictors of human papillomavirus (HPV) vaccine uptake or intent among parents of pre-adolescents and adolescents.
Methods: A cross-sectional descriptive study was conducted among parents of girls aged 9 to 18 years, visiting two primary care clinics in central Texas from September to November 2015. Pearson’s product-moment correlation procedures and path analyses based on Health Belief Model were performed.
Results: Path analysis showed that provider recommendation for HPV vaccination (Beta=-0.37; p < .001) and perceived HPV vaccine harm (Beta=-0.48; p < .001) had statistically significant direct effects on HPV vaccine uptake or intent. The perceived HPV vaccine effectiveness was directly influenced by HPV knowledge (Beta=-0.39; p < .001), empowerment in parent-provider
relationships (Beta=-0.30; p = .006) and parental college education (Beta=-0.23; p = .039).
Conclusions: Together with parental empowerment fostering an equal partnership with providers, targeted education to improve parental HPV knowledge may convince them of the HPV vaccine effectiveness. This, in turn, may help them put the perceived HPV vaccine harm in proper perspective and allow them to make informed decisions regarding the timely HPV vaccination of their children. Because provider recommendation is one of the most important contributing factors for HPV vaccine uptake or intent, parental education and recommendations from nurses will help reduce the knowledge gaps and empower parents to make the timely decisions to vaccinate their children.

Health Education Research
(2017) cyw055 DOI: https://doi.org/10.1093/her/cyw055
Hispanic mothers’ beliefs regarding HPV vaccine series completion in their adolescent daughters
AM Roncancio, KK Ward, CC Carmack, BT Muñoz… – 2017
Abstract
Rates of human papillomavirus (HPV) vaccine series completion among adolescent Hispanic females in Texas in 2014 (∼39%) lag behind the Healthy People 2020 goal (80%). This qualitative study identifies Hispanic mothers’ salient behavioral, normative and control beliefs regarding having their adolescent daughters complete the vaccine series. Thirty-two mothers of girls (aged 11–17) that had received at least one dose of the HPV vaccine, completed in-depth interviews. Six girls had received one dose of the HPV vaccine, 10 girls had received two doses, and 16 girls had received all three doses. The questions elicited salient: (i) experiential and instrumental attitudes (behavioral beliefs); (ii) supporters and non-supporters (normative beliefs) and (iii) facilitators and barriers (control beliefs). Directed content analysis was employed to select the most salient beliefs. Mothers: (i) expressed salient positive feelings (e.g. good, secure, happy and satisfied); (ii) believed that completing the series resulted in positive effects (e.g. protection, prevention); (iii) believed that the main supporters were themselves, their daughter’s father and doctor with some of their friends not supporting series completion and (iv) believed that vaccine affordability, information, transportation, ease of scheduling and keeping vaccination appointments and taking their daughter’s immunization card to appointments were facilitators. This study represents the first step in building theory-based framework of vaccine series completion for this population. The beliefs identified provide guidance for health care providers and intervention developers.

Papillomavirus Research
Available online 17 January 2017
In Press, Accepted Manuscript
Reasons for Acceptance or Refusal of Human Papillomavirus Vaccine in a California Pediatric Practice
B Brown, MI Gabra, H Pellman
Abstract
Despite the effectiveness and availability of the Human Papillomavirus (HPV) vaccine, HPV remains the most common sexually transmitted infection in the United States and has the lowest initiation rate of any routinely recommended teen vaccine. In January 2015, we surveyed parents at a Southern California pediatric private practice about reasons they accept or refuse HPV vaccine for their children. Of the 200 consecutive parents that had HPV vaccine initiation recommended for their child, 123 (61.5%) children were male and 38.5% were female. The overall age range of children was 10–17 years (median 12 years). Of the 164 (82.0%) who accepted the vaccine, a higher percentage were male (88.6% vs 71.4%, p=0.001). The most common reasons for accepting was strength of provider recommendation (84.2%) and available information (63.4%). The most common (55.6%) reason for refusing was wanting to learn more about the vaccine. These results further support the importance of both the strength of physician recommendation and improving public education about the vaccine.

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.

The Atlantic
http://www.theatlantic.com/magazine/
Accessed 21 January 2017
The Shadow Network of Anti-Vax Doctors
Both mainstream and alternative doctors help patients avoid or delay vaccines. Trump’s rhetoric might empower them further.
Jan 18, 2017
Olga Khazan
… Brandeis is one of a sizable number of doctors who allow their patients to avoid or delay vaccines if they are concerned about their health effects. It’s unknown how many of these physicians there are, but dozens of names—some even organized by state—come up on earthy mommy blogs and other web communities. “We are hoping to find a pediatrician/pediatric group in the … area who is an MD, but open-minded to alternative medicine, as well as less aggressive vaccination schedules,” wrote one California parent on the Berkeley Parents Network in December.
These doctors—and patients who seek them out—could be emboldened if President-elect Donald Trump goes through with the appointment of Robert F. Kennedy, an environmental activist and vocal vaccine skeptic, to lead a commission “on vaccine safety and scientific integrity,” as was reported last week. Trump met with Kennedy in Trump Tower on January 10, and Kennedy later told his environmental-group colleagues that he would be taking a leave to chair the vaccine commission. (Trump’s team said later that no decision had been made yet.)…

Forbes
http://www.forbes.com/
Accessed 21 January 2017
Letting Seriously Ill Patients Try Drugs Whose Safety, Efficacy Hasn’t Been Proven Could Be Deadly
Rita Rubin, Contributor
One potential candidate for Food and Drug Administration commissioner has supported the idea of allowing drugs on the market as long as they’re safe but before they’ve been proven to be effective. But a new FDA report lists 22 examples of therapies and vaccines whose early promise didn’t pan out.

Huffington Post
http://www.huffingtonpost.com/
Accessed 21 January 2017
Americans Aren’t With Donald Trump On Vaccines
Public health experts and the general public think the president-elect is wrong that shots are unsafe.
19 January 2017
President-elect Donald Trump’s skepticism about the safety of childhood vaccines contrasts not only with the scientific consensus, but also with the opinions of Americans ― fewer than one-quarter of whom think immunization should be a matter of personal choice.
By a more than 2-1 margin, 54 percent to 26 percent, Americans say that the science supporting the safety of childhood vaccination is “indisputable,” rather than something that requires future debate, a new HuffPost/YouGov survey finds, although partisan divides on the issue are widening.
Two-thirds of Americans say that the issue of vaccinating children is a matter of public health, with just 24 percent considering it a matter of personal choice. A 56 percent majority of those polled say they have at least a fair amount of trust in the government to set vaccination policies.
Among public health experts, there’s little disagreement that immunization is safe and effective and one of the greatest public health achievements in modern times…

New York Times
http://www.nytimes.com/
Accessed 21 January 2017
How the Response to Zika Failed Millions
16 January 2017

Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 21 January 2017
Gates Foundation Joins Fight Against Epidemics
Jan. 18, 2017 5:59 pm ET

Washington Post
http://www.washingtonpost.com/
Accessed 21 January 2017
Researchers struggle to replicate 5 influential cancer experiments from top labs
Experiments should be reproducible, but most of these weren’t, a research team finds. The original scientists criticize the new results.
Joel Achenbach and Laurie McGinley | National/health-science | Jan 18, 2017

Milestones :: Perspectives

140th session of the Executive Board
23 January–1 February 2017, Geneva
Main Documents [Selected]
EB140/7
Health emergencies
WHO response in severe, large-scale emergencies

EB140/9
Research and development for potentially epidemic diseases
A blueprint for research and development preparedness and rapid research response

EB140/13
Poliomyelitis

EB140/14
Implementation of the International Health Regulations (2005)
Draft global implementation plan

EB140/15
Implementation of the International Health Regulations (2005)
Public health implications of the implementation of the Nagoya Protocol

EB140/16
Review of the Pandemic Influenza Preparedness Framework

EB140/25
Global vaccine action plan
[Excerpt]
ANNEX
A SUMMARY OF THE 2016 ASSESSMENT REPORT OF THE GLOBAL VACCINE ACTION PLAN BY THE STRATEGIC ADVISORY GROUP OF EXPERTS ON IMMUNIZATION [1]
1. At the midpoint of the Global Vaccine Action Plan, or GVAP (2012–2020), the Strategic Advisory Group of Experts on Immunization (SAGE) remains gravely concerned that progress toward the goals to eradicate polio, eliminate measles and rubella, eliminate maternal and neonatal tetanus, and increase equitable access to life saving vaccines is too slow.

2. Despite improvements in individual countries and a strong global rate of new vaccine introduction, global average immunization coverage has increased by only 1% since 2010.

3. In 2015, 68 countries fell short of the target to achieve at least 90% national coverage with the third dose of diphtheria-tetanus-pertussis vaccine. Not only that, 26 countries reported no change in coverage levels and 25 countries reported a net decrease in coverage since 2010.

4. The 16 countries that have made measurable progress since 2010 are to be commended for reaching more people, especially vulnerable and marginalized members of society with immunization. Some of the countries with the highest numbers of unvaccinated people have made the most progress, including the Democratic Republic of the Congo, Ethiopia and India, and even though coverage targets have not been achieved in these countries, they are moving forward in the right direction.

5. The 111 countries that entered the decade with high immunization coverage and sustained it through 2015 are already setting their sights on more aggressive goals, additional vaccines, and more equitable coverage. Immunization programmes in these countries can lead the way by increasing access to other public health interventions and providing a platform for the delivery of preventive health services throughout the life course. Vaccine research and development is progressing rapidly, and an expanding pipeline of new vaccines underscores the need to build health systems that can reliably reach new target age groups.

6. The members of the SAGE are steadfast and passionate believers in the power of immunization to give individuals and their families a better start in life and to protect people from a growing array of debilitating illnesses. Immunization is one of the world’s most effective and cost-effective tools against the threat of emerging diseases and has a powerful impact on social and economic development. Recognizing the role that immunization plays in ensuring good health and the role that good health plays in achieving sustainable development, the SAGE has supported the inclusion of immunization indicators to measure progress toward the Sustainable Development Goals.

7. The next four years present unprecedented opportunities for countries to leverage the attention and support that immunization receives and apply it for the benefit of people everywhere. Strident efforts on the part of all countries and immunization stakeholders are required to catch up and achieve GVAP goals by 2020…

[1]http://www.who.int/entity/immunization/global_vaccine_action_plan/SAGE_GVAP_Assessment_ Report_2016_EN.pdf (accessed 10 November 2016).

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Emergencies

Millions of children to receive measles vaccine in north-eastern Nigeria
12 January 2017 – A mass vaccination campaign to protect more than 4 million children against a measles outbreak in conflict-affected states in north-eastern Nigeria is planned to start this week. The two-week campaign, which starts on 13 January, will target all children aged from 6 months to 10 years in accessible areas in Borno, Yobe and Adamawa States.

“This measles vaccination campaign is an emergency intervention to protect more than 4 million children against a highly contagious and sometimes deadly disease,” says Dr Wondimagegnehu Alemu, WHO Representative in Nigeria. “Massive disruption to health services in conflict-affected areas for many years has deprived these children of essential childhood vaccinations. In addition, many of them have severe malnutrition, making them extremely vulnerable to serious complications and death from measles.”

Polio programme provides crucial support
WHO is supporting the 3 state Primary Healthcare Development Agencies to prepare for the campaign; working with partners including UNICEF, the United States Centers for Disease Control (CDC) and other health nongovernmental organizations. WHO is providing expertise in areas including logistics, data management, training, social mobilization, monitoring and evaluation, supportive supervision (human resource) and waste management.

“Nigeria’s well-established polio vaccination programme provides a strong underpinning for the campaign,” says Dr Alemu. “Population data from the polio programme has been essential to guide planning for the measles campaign. We are also able to make use of staff that have vast experience in providing health services in very difficult and risky areas.”

High insecurity, difficult terrain and lack of functioning health facilities add to the enormous logistical challenges of organizing a large mass vaccination campaign that requires assembling and training more than 4000 vaccination teams and ensuring the vaccine is kept within cold chain conditions (+2⁰ to 8⁰ C) in a climate where average daytime temperatures are above 30⁰ C.

The vaccination teams for this campaign are made up of 7 people including a supervisor, vaccinators (health workers), record keepers, community mobilizers and town criers. The teams will also give children deworming medication and vitamin A supplements at the same time as the measles vaccination.

To prevent double vaccinations especially in schools and camps for displaced people, vaccination cards will be issued to all vaccinated children as well as the use of pen markers to mark their thumbs…

:::::::

WHO Grade 3 Emergencies [to 14 January 2017]

The Syrian Arab Republic –
:: Survey raises concerns about hepatitis C infection in Syria
10 January 2017 – A survey of more than 20 000 people in Syria has found a concerning number of people infected with hepatitis C, especially among people who are at higher risk.

Iraq – No new announcements identified.
South Sudan – No new announcements identified.
Nigeria – See measles immunization campaign announcement above.
Yemen – No new announcements identified.

WHO Grade 2 Emergencies [to 14 January 2017]

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.

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 #15 (2 – 8 January 2017) [EN/AR/KU]

Syria
:: 14 Jan 2017 Syrian Arab Republic: Wadi Barada Situation Report No. 1 (14 January 2017)

Yemen
:: 9 Jan 2017 Yemen Humanitarian Bulletin Issue 19 (31 December 2016)

Corporate Emergencies
Haiti
:: Haiti: Hurricane Matthew – Situation Report No. 31 (09 January 2017)
… 807,395 Individuals living in high-risk areas, including the hurricane zone, received cholera vaccine Source: UNICEF

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Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO pages for updates and key developments. No new digest content identified for this edition.

Yellow Fever [to 14 January 2017]
http://www.who.int/emergencies/yellow-fever/en/

Disease Outbreal News [DONs}
Yellow fever – Brazil
13 January 2017
On 6 January 2017, the Brazil Ministry of Health (MoH) reported 12 suspected cases of yellow fever from six municipalities in the state of Minas Gerais…
On 12 January, the Brazil IHR NFP provided an update on the event informing that a total of 110 suspected cases, including 30 deaths, had been reported from 15 municipalities of Minas Gerais…

Public Health Response
Health authorities at the federal, state, and municipal levels are implementing several measures to respond to the outbreak:
:: The Ministry of Health has deployed technical teams to the state of Minas Gerais to assist the state and municipal secretary of health with surveillance and outbreak investigation, vector control, and coordination of health care services;
:: A house-to-house immunization campaign is being conducted in the rural areas of affected municipalities;
:: Preparedness activities are being conducted in states bordering Minas Gerais, for a potential introduction of yellow fever;
:: The local press is working together with the MoH to keep the public constantly informed on the situation.

WHO Risk Assessment
Yellow fever outbreak has previously been detected in Minas Gerais. The most recent outbreak occurred in 2002–2003, when 63 confirmed cases, including 23 deaths (CFR: 37%), were detected.
The current yellow fever outbreak is taking place in an area with relatively low vaccination coverage, which could favor the rapid spread of the disease…

Zika virus [to 14 January 2017]
http://www.who.int/emergencies/zika-virus/en/

Zika situation report – 05 January 2017
Full report: http://apps.who.int/iris/bitstream/10665/252762/1/zikasitrep5Jan17-eng.pdf?ua=1
Key Updates
:: This is the last weekly situation report. Going forward, the reports will be published every two weeks. The next report will be issued on 19 January.

WHO’s response to Zika virus and its associated complications – Report to donors: December 2016
WHO, 2016 :: 11 pages
[Excerpt]
On 1 February 2016 WHO Director-General Margaret Chan declared that the spread of Zika virus and its associated complications constituted a public health emergency of international concern (PHEIC). On 14 February, WHO launched a global Strategic Response Framework and Joint Operations Plan, subsequently updated on 15 July, in which WHO and partners set out their strategy for preventing, detecting, and responding to Zika virus and its complications. Support from donors has ensured that this strategy has been realised.
Between February and November 2016 WHO/PAHO received US$ 23.9 million in direct contributions from 13 donors (Annex 1). This document highlights some of WHO’s key activities during this period, and points to priority areas for funding through to December 2017, including investment in research and development to foster a better understanding of Zika virus epidemiology, and how we can prevent and treat the adverse health outcomes associated with Zika virus infection.
The figure below shows how funds were received over time to pay for the response outlined in the Zika Strategic Response Plan. Funds from the WHO Contingency Fund for Emergencies (CFE) were disbursed within 24 hours of the declaration of the PHEIC, and were crucial in the early stages of the response, enabling a full Incident Management Structure (IMS) to be implemented in WHO headquarters in Geneva and all WHO regional offices. Without this bridge funding the response would have been delayed until the first contributions from Japan and Australia were received, 6 weeks after the declaration of the PHEIC. Eleven months after the declaration of the PHEIC, and thanks to the generosity of donors, funding has been secured..

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