The behind-the-scenes activity of parental decision-making discourse regarding childhood vaccination

American Journal of Infection Control
March 01, 2017 Volume 45, Issue 3, p215-340, e34-e44
http://www.ajicjournal.org/current

Major Articles
The behind-the-scenes activity of parental decision-making discourse regarding childhood vaccination
Anat Gesser-Edelsburg, Nathan Walter, Yaffa Shir-Raz, Oshrat Sassoni Bar-Lev, Shira Rosenblat
p267–271
Published online: November 14, 2016
Abstract
Background
Vaccine compliance has long been a cause for concern for health authorities throughout the world. However very little effort has been made to examine parental discourse during the decision-making process.
Methods
An online survey was conducted (N = 437) to examine predictors of parents’ attitudes regarding childhood vaccination.
Results
Hesitant parents were 4 times more likely to conduct intrafamily discussion regarding vaccination compared with provaccination parents (Exp[B] = 4.26). There were no significant differences between hesitant and antivaccination parents with respect to intrafamily discussion. Hesitant parents were also 4 times more likely than provaccination parents to report intrafamily disagreements regarding vaccination (Exp[B] = 4.27). They were also twice as likely as antivaccination parents to express disagreements regarding vaccination within their families (Exp[B] = 2.33). Likewise, Jewish parents were significantly more likely to define themselves as vaccination-hesitant, whereas Muslim parents were significantly more likely to be provaccination.
Conclusions
To improve the way health organizations communicate information about vaccines and increase parental trust in immunization programs, we should not only look at the level of understanding, perceptions, and biases of different groups, but also thoroughly examine parents’ decision-making processes and the discourse during this process. We must communicate risk to all groups, including the provaccination group, to improve parents’ decision making and the process of informed consent.

National and State-Specific Shingles Vaccination Among Adults Aged ≥60 Years

American Journal of Preventive Medicine
March 2017 Volume 52, Issue 3, p263-416, e67-e94
http://www.ajpmonline.org/current

Research Articles
National and State-Specific Shingles Vaccination Among Adults Aged ≥60 Years
Peng-jun Lu, Alissa O’Halloran, Walter W. Williams, Rafael Harpaz
p362–372
Published online: October 5, 2016
Abstract
Introduction
Shingles (herpes zoster) causes substantial morbidity, especially among older adults. The shingles vaccine has been recommended for people aged ≥60 years since 2006. This study assessed recent shingles vaccination at national and state levels among adults aged ≥60 years.
Methods
The 2014 Behavioral Risk Factor Surveillance System data were analyzed in 2015 to assess shingles vaccination coverage among adults aged ≥60 years at national and state levels. Multivariable logistic regression and predictive marginal models identified factors independently associated with vaccination.
Results
Shingles vaccination coverage among adults aged ≥60 years was 31.8% (95% CI=1.4%, 32.2%). Among states, shingles vaccination coverage ranged from 17.8% (95% CI=5.8%, 20.0%) in Mississippi to 46.6% (95% CI=4.3%, 48.8%) in Vermont, with a median of 33.3%. Coverage was <25% in four states and >40% in nine states. For all states, coverage was significantly higher among non-Hispanic whites compared with non-white races except for Oregon, with coverage differences ranging from –33.2% in the District of Columbia to 0.9% in Oregon and a median of –16.0%. Characteristics independently associated with vaccination were age, race/ethnicity, sex, education, employment status, household income, region, perceived health status, health insurance status, personal healthcare provider, routine checkup status, and whether reporting that cost was a barrier to seeing a doctor.
Conclusions
Coverage varied dramatically by state. State-level comparisons may aid in designing tailored intervention programs through sharing of best practices. Strategies are needed to mitigate financial barriers for both provider and patients, improve awareness, and increase provider recommendation of the vaccine.

Clinical trials from the patient perspective: survey in an online patient community

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 4 March 2017)

Research article
Clinical trials from the patient perspective: survey in an online patient community
Developing new medicines relies on the successful conduct of clinical trials. As trial protocols become more arduous, it becomes harder to recruit and retain patient volunteers, although recent efforts such as OMERACT and I-SPY2 show that partnering with patients can be beneficial. We sought to describe drivers and barriers to trial participation, as well as condition-specific trial preferences.
Pronabesh DasMahapatra, Priya Raja, Jeremy Gilbert and Paul Wicks
BMC Health Services Research 2017 17:166
Published on: 27 February 2017

Knowledge, attitudes, and behaviors of parents towards varicella and its vaccination

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 4 March 2017)

Research article
Knowledge, attitudes, and behaviors of parents towards varicella and its vaccination
The aims of this cross-sectional survey were to examine the knowledge, the attitudes, and the behavior regarding the varicella infection and its vaccination and to get insight into their determinants among par…
Luigi Vezzosi, Gabriella Santagati and Italo F. Angelillo
BMC Infectious Diseases 2017 17:172
Published on: 27 February 2017
Abstract
Background
The aims of this cross-sectional survey were to examine the knowledge, the attitudes, and the behavior regarding the varicella infection and its vaccination and to get insight into their determinants among parents of children in Italy.
Methods
From May to June 2015 in the geographic area of Naples (Italy) a random sample of 675 parents of children aged 4-7 years received a self-administered anonymous questionnaire about socio-demographic characteristics, knowledge, attitudes, and behaviors towards varicella and its vaccination.
Results
A total of 414 parents responded to the questionnaire, for a response rate of 61.3%. A history of varicella was reported in 163 children (39.6%). Only 26.6% parents knew that the vaccine was available and the number of doses and this knowledge was significantly higher in those who had a university degree, in those who had received information on the vaccination from a health care provider, and in those who had vaccinated their child. The perceived utility towards vaccination had a mean value of 5.7. The positive attitude towards the utility of the vaccination was higher in parents with a level of education not higher than middle school, in those who had vaccinated their child, in those who considered the varicella a dangerous disease, and in those who had received information from a health care provider. More than one-third had vaccinated their child. Immunization was more frequent in parents who had knowledge about the vaccination, who beliefs that the immunization was useful, who believed that the disease was not dangerous, and who had not a history of varicella among their children.
Conclusions
Educational programs are needed among parents as support to improve knowledge about vaccination and immunization coverage.

Policy perspectives on post pandemic influenza vaccination in Ghana and Malawi

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 4 March 2017)

Research article
Policy perspectives on post pandemic influenza vaccination in Ghana and Malawi
Evanson Z. Sambala and Lenore Manderson
BMC Public Health 2017 17:227
Published on: 28 February 2017
Abstract
Background
In the late 1990s, in the context of renewed concerns of an influenza pandemic, countries such as Ghana and Malawi established plans for the deployment of vaccines and vaccination strategies. A new pandemic was declared in mid-June 2009, and by April 2011, Ghana and Malawi vaccinated 10% of the population. We examine the public health policy perspectives on vaccination as a means to prevent the spread of infection under post pandemic conditions.
Methods
In-depth interviews were conducted with 46 policymakers (Ghana, n = 24; Malawi, n = 22), identified through snowballing sampling. Interviews were supplemented by field notes and the analysis of policy documents.
Results
The use of vaccination to interrupt the pandemic influenza was affected by delays in the procurement, delivery and administration of vaccines, suboptimal vaccination coverage, refusals to be vaccinated, and the politics behind vaccination strategies. More generally, rolling-out of vaccination after the transmission of the influenza virus had abated was influenced by policymakers’ own financial incentives, and government and foreign policy conditionality on vaccination. This led to confusion about targeting and coverage, with many policymakers justifying that the vaccination of 10% of the population would establish herd immunity and so reduce future risk. Ghana succeeded in vaccinating 2.3 million of the select groups (100% coverage), while Malawi, despite recourse to force, succeeded only in vaccinating 1.15 million (74% coverage of select groups). For most policymakers, vaccination coverage was perceived as successful, despite that vaccination delays and coverage would not have prevented infection when influenza was at its peak.
Conclusions
While the vaccination strategy was problematic and implemented too late to reduce the effects of the 2009 epidemic, policy makers supported the overall goal of pandemic influenza vaccination to interrupt infection. In this context, there was strong support for governments engaging in contracts with pharmaceutical companies to ensure the timely supply of vaccines, and developing well-defined guidelines to address vaccination delays, refusals and coverage.

Utilization of outreach immunization services among children in Hoima District, Uganda: a cluster survey

BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content
(Accessed 4 March 2017)

Research article
Utilization of outreach immunization services among children in Hoima District, Uganda: a cluster survey
The global vaccine action plan 2011–2020 was endorsed by 194 states to equitably extend the benefits of immunization to all people. However, gaps in vaccination coverage remain in developing countries such as Uganda. One of the strategies used to tackle existing inequities is implementation of outreach immunization services to deliver services to those with poor geographical access. However, reports of inconsistent use of these services prevail; therefore understanding the factors associated with use of these services is critical for improving service delivery. This study examined the factors associated with utilization of outreach immunization services among children aged 10–23 months in Hoima District, Uganda.
Paul Oryema, Juliet N. Babirye, Charles Baguma, Peter Wasswa and David Guwatudde
BMC Research Notes 2017 10:111
Published on: 27 February 2017

Hepatitis B vaccination timing: results from demographic health surveys in 47 countries

Bulletin of the World Health Organization
Volume 95, Number 3, March 2017, 165-240
http://www.who.int/bulletin/volumes/95/3/en/

Research
Hepatitis B vaccination timing: results from demographic health surveys in 47 countries
Aparna Schweitzer, Manas K Akmatov & Gérard Krause
http://dx.doi.org/10.2471/BLT.16.178822
Objective
To examine the impact of hepatitis B vaccination schedules and types of vaccines on hepatitis B vaccination timing.
Methods
We used data for 211 643 children from demographic and health surveys in 47 low- and middle-income countries (median study year 2012). Data were from vaccination cards and maternal interviews. We grouped countries according to the vaccination schedule and type of vaccine used (monovalent or combination). For each country, we calculated hepatitis B vaccination coverage and timely receipt of vaccine doses. We used multivariable logistic regression models to study the effect of vaccination schedules and types on vaccination delay.
Findings
Substantial delays in vaccination were observed even in countries with fairly high coverage of all doses. Median delay was 1.0 week (interquartile range, IQR: 0.3 to 3.6) for the first dose (n = 108 626 children) and 3.7 weeks (IQR: 1.4 to 9.3) for the third dose (n = 101  542). We observed a tendency of lower odds of delays in vaccination schedules starting at 6 and at 9 weeks of age. For the first vaccine dose, we recorded lower odds of delays for combination vaccines than for monovalent vaccines (adjusted odds ratio, aOR: 0.76, 95% confidence interval, CI: 0.71 to 0.81).
Conclusion
Wide variations in hepatitis B vaccination coverage and adherence to vaccination schedules across countries underscore the continued need to strengthen national immunization systems. Timely initiation of the vaccination process might lead to timely receipt of successive doses and improved overall coverage. We suggest incorporating vaccination timing as a performance indicator of vaccination programmes to complement coverage metrics.

Pre-exposure rabies prophylaxis: a systematic review

Bulletin of the World Health Organization
Volume 95, Number 3, March 2017, 165-240
http://www.who.int/bulletin/volumes/95/3/en/

SYSTEMATIC REVIEWS
Pre-exposure rabies prophylaxis: a systematic review
Jocelyn A Kessels, Sergio Recuenco, Ana Maria Navarro-Vela, Raffy Deray, Marco Vigilato, Hildegund Ertl, David Durrheim, Helen Rees, Louis H Nel, Bernadette Abela-Ridder & Deborah Briggs
http://dx.doi.org/10.2471/BLT.16.173039
Objective
To review the safety and immunogenicity of pre-exposure rabies prophylaxis (including accelerated schedules, co-administration with other vaccines and booster doses), its cost–effectiveness and recommendations for use, particularly in high-risk settings.
Methods
We searched the PubMed, Centre for Agriculture and Biosciences International, Cochrane Library and Web of Science databases for papers on pre-exposure rabies prophylaxis published between 2007 and 29 January 2016. We reviewed field data from pre-exposure prophylaxis campaigns in Peru and the Philippines.
Findings
Pre-exposure rabies prophylaxis was safe and immunogenic in children and adults, also when co-administered with routine childhood vaccinations and the Japanese encephalitis vaccine. The evidence available indicates that shorter regimens and regimens involving fewer doses are safe and immunogenic and that booster intervals could be extended up to 10 years. The few studies on cost suggest that, at current vaccine and delivery costs, pre-exposure prophylaxis campaigns would not be cost-effective in most situations. Although pre-exposure prophylaxis has been advocated for high-risk populations, only Peru and the Philippines have implemented appropriate national programmes. In the future, accelerated regimens and novel vaccines could simplify delivery and increase affordability.
Conclusion
Pre-exposure rabies prophylaxis is safe and immunogenic and should be considered: (i) where access to postexposure prophylaxis is limited or delayed; (ii) where the risk of exposure is high and may go unrecognized; and (iii) where controlling rabies in the animal reservoir is difficult. Pre-exposure prophylaxis should not distract from canine vaccination efforts, provision of postexposure prophylaxis or education to increase rabies awareness in local communities.

Bulletin of the World Health Organization – Volume 95, Number 3, March 2017, 165-240

Bulletin of the World Health Organization
Volume 95, Number 3, March 2017, 165-240
http://www.who.int/bulletin/volumes/95/3/en/

LESSONS FROM THE FIELD
Adapting Nepal’s polio eradication programme
Krishna P Paudel, Lee M Hampton, Santosh Gurung, Rajendra Bohara, Indra K Rai, Sameer Anaokar, Rachel D Swift & Stephen Cochi
http://dx.doi.org/10.2471/BLT.16.173674

PERSPECTIVES
Therapeutic antibodies for infectious diseases
Erin Sparrow, Martin Friede, Mohamud Sheikh & Siranda Torvaldsen
http://dx.doi.org/10.2471/BLT.16.178061

Factors associated with influenza vaccine uptake in older adults living in the community in Singapore

Epidemiology and Infection
Volume 145 – Issue 4 – March 2017
http://www.cambridge.org/core/journals/epidemiology-and-infection/latest-issue

Original Papers
Factors associated with influenza vaccine uptake in older adults living in the community in Singapore
L. W. ANG, J. CUTTER, L. JAMES, K. T. GOH
DOI: https://doi.org/10.1017/S0950268816002491
Published online: 08 December 2016, pp. 775-786
Abstract
In Singapore, influenza vaccination is recommended for persons at higher risk of complications of seasonal influenza, including those with chronic medical conditions and the elderly (individuals aged ⩾65 years). We investigated the factors associated with influenza vaccine uptake based on a nationally representative sample of community-dwelling adults aged >50 years. The data for this study were obtained from the National Health Surveillance Survey (NHSS) 2013. The association between influenza vaccine uptake and socio-demographic and health-related variables was analysed using univariable and multivariable logistic regression models. Of 3700 respondents aged ⩾50 years in the NHSS, 15·2% had received seasonal influenza vaccination in the past year. Older age, single marital status and economic inactivity were the socio-demographic variables independently associated with vaccine uptake. Health-related factors which were predictive of influenza vaccine uptake were sufficient total physical activity, better self-rated health, having at least one medical condition at risk of influenza complications and a regular family doctor/general practitioner. Influenza vaccine uptake in community-dwelling older adults was low. Our findings are of relevance in the formulation of public health policies and targeted health promotion strategies to increase vaccine uptake in this population group.

Pathways to research impact in primary healthcare: What do Australian primary healthcare researchers believe works best to facilitate the use of their research findings?

Health Research Policy and Systems

[Accessed 4 March 2017]

Research
Pathways to research impact in primary healthcare: What do Australian primary healthcare researchers believe works best to facilitate the use of their research findings?
Primary healthcare researchers are under increasing pressure to demonstrate measurable and lasting improvement in clinical practice and healthcare policy as a result of their work. It is therefore important to…
Richard L. Reed, Ellen McIntyre, Eleanor Jackson-Bowers and Libby Kalucy
Health Research Policy and Systems 2017 15:17
Published on: 2 March 2017

Is mothers’ knowledge and practice regarding childhood immunization compliant with immunization completeness?

International Journal of Community Medicine and Public Health
Vol 4, No 3 (2017) March 2017
http://www.ijcmph.com/index.php/ijcmph/issue/view/21

Original Research Articles
Is mothers’ knowledge and practice regarding childhood immunization compliant with immunization completeness?
Nafeha Sameen Siddiqui, Arvind K. Gaikwad, Bina M. Kuril, Rajendra T. Ankushe, Mohan K. Doibale, Sandeep B. Pund, Purushottam Kumar
Abstract
Background: Immunization is one of the most effective, safest and efficient public health interventions. Despite the concrete efforts of government and other health agencies, a large proportion of vulnerable infants and children in India remain unimmunized. In order to improve immunization coverage, factors such as knowledge, attitude and practices of parents/caretakers are known to contribute to success or failure of immunization program. The aim of present study is to assess the knowledge and practice of mothers with respect to immunization completeness of their child.
Methods: This is a descriptive cross sectional study involving 364 mothers attending immunization OPD in Government Medical College, Aurangabad, Maharashtra, India during month of September till December 2015.
Results: 78.5% children were completely immunized as per date. 57.97% of the study population was found to have adequate knowledge-practice scores. A significant association of immunization completeness with KP scores of mothers (p<0.05) was found.
Conclusions: Future efforts are required to improve immunization rate and parents’ knowledge and practice.

Assessment of under-five immunization coverage among the population of slum areas in Mangalore taluk, India

International Journal of Community Medicine and Public Health
Vol 4, No 3 (2017) March 2017
http://www.ijcmph.com/index.php/ijcmph/issue/view/21

Original Research Articles
Assessment of under-five immunization coverage among the population of slum areas in Mangalore taluk, India
Saurabh Kumar, Sudhir Prabhu, Arun P. Jose, Sowmya Bhat, Oliver D. Souza, Narayana V.
Abstract
Background: Immunization coverage is better in urban than rural areas. However, we anticipate and argue that within the urban areas disparities and inequities persist in immunization coverage and that the socioeconomically disadvantaged, particularly those who reside in slum areas are more vulnerable and may contribute to the lower uptake of immunization. The objectives of the study were to assess the under-five immunization coverage amongst the households in slums of Mangalore taluk and to identify determinants of full immunization uptake among under 5 in the slums population and to know the reasons for non-immunization or partial immunization of children.
Methods: Community Based Cross sectional study was conducted in the notified slum areas of Mangalore during August-November 2015. Information was collected from the parents regarding vaccination of their children and sociodemographic variables using a semi-structured interview schedule.
Results: 88 (57.7%) of under 5 children were fully immunized, 62 (41.3%) were partially immunized in the slum areas of Mangalore, Karnataka, India. Mean age of the children in our study was found to be 35.15 months. Immunization coverage was found to be associated with the presence of immunization card, occupation of mother, knowledge about universal immunization programme (UIP), knowledge about protection offered by vaccines.
Conclusions: Unfortunately, the immunization coverage was found to be very bad in the slum areas of Mangalore city, Karnataka, India. There is an urgent need to ensure that regular health education sessions are conducted. Secondly, slum areas should be the target of RCH programme with special focus on immunization related activities e.g. ensuring that all households with children should have immunization cards, as the slum areas remain the neglected section of the society due to various reasons.

Linking Immunization Status and Eligibility for Welfare and Benefits Payments The Australian “No Jab, No Pay” Legislation

JAMA
February 28, 2017, Vol 317, No. 8, Pages 783-880
http://jama.jamanetwork.com/issue.aspx

Viewpoint
Linking Immunization Status and Eligibility for Welfare and Benefits Payments The Australian “No Jab, No Pay” Legislation
Y. Tony Yang, ScD, LLM, MPH; David M. Studdert, LLB, ScD, MPH
The recent outbreaks of vaccine-preventable diseases have refocused attention on the threat posed by unvaccinated and undervaccinated individuals.1 Governments around the world have responded by strengthening laws and policies directed at increasing vaccination rates. The standard menu of options includes education and information initiatives, incentives, and mandates; these may be directed at the general public, health care organizations, or practitioners.

Journal of Medical Ethics – March 2017 – Volume 43 – 3

Journal of Medical Ethics
March 2017 – Volume 43 – 3
http://jme.bmj.com/content/current

Editorials
Introduction: Special Issue on the Ethics of Incentives in Healthcare
Anca Gheaus, Verina Wild
This special issue is the result of a conference organised by Verina Wild and Anca Gheaus, at the Ludwig-Maximilians University of Munich in December 2014. The conference addressed normative issues raised by the use of incentive mechanisms to promote better health, and included papers by most contributors to this special issue. So far, the normative discussion on health incentives focussed on questions of autonomy, paternalism, motivation and responsibility. This resulting special issue responds to a need to expand the normative analysis of such measures to other issues of justice, which have so far been largely ignored.
Recent policies and programmes in health prevention tend to appeal to, and encourage, individual responsibility with respect to lifestyle choices. One way of advancing this goal is via schemes that provide individuals with incentives to live healthy lives. For example, individuals may be offered discounted health insurance rates if they adopt healthy lifestyles or be given vouchers to purchase healthy food or to use fitness centres. Such programmes often use so-called ‘nudging’ mechanisms, meant to motivate people without coercively interfering with their private choices and to improve health outcomes without overregulating the market for products that are detrimental to health. They also raise many normative questions…

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Public health ethics
Paper: Paying for antiretroviral adherence: is it unethical when the patient is an adolescent?
Justin Healy, Rebecca Hope, Jacqueline Bhabha, Nir Eyal

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Which strings attached: ethical considerations for selecting appropriate conditionalities in conditional cash transfer programmes
Carleigh B Krubiner, Maria W Merritt

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Paper: Solidarity, justice and unconditional access to healthcare
Anca Gheaus

Syndemics: health in context

The Lancet
Mar 04, 2017 Volume 389 Number 10072 p881-982 e3
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Syndemics: health in context
The Lancet
Syndemics, as a new Series published in today’s Lancet details, is a conceptual framework for understanding diseases or health conditions that arise in populations and that are exacerbated by the social, economic, environmental, and political milieu in which a population is immersed. A syndemic, or synergistic epidemic, is more than a convenient portmanteau or a synonym for comorbidity. The hallmark of a syndemic is the presence of two or more disease states that adversely interact with each other, negatively affecting the mutual course of each disease trajectory, enhancing vulnerability, and which are made more deleterious by experienced inequities.

Perhaps the most unique feature of the syndemic approach to understanding various disease states and the way in which they cluster is the emphasis on the situation and circumstances in which individuals live. In other words, syndemics fundamentally rely on context. When introduced in the 1990s by medical anthropologist Merrill Singer, the notion of a syndemic was used to describe the interactions among substance abuse, violence, and AIDS (SAVA), that had become a full-blown health crisis in Hartford, CT, USA. While investigating HIV prevention in drug users, researchers took notice of the constellation of elements that impinged on risk, structural factors such as lack of housing and poverty, and social aspects such as stigma and lack of support systems—all reinforcing the disease burden.

The observation that these factors did not merely exist in parallel, but were intertwined and cumulative, offered a branch point for clinical medicine and public health interventions. These fields have made appreciable strides in recognising that interventions for combating and treating disease must take a more multifactorial tack, nevertheless there exists a great need and opportunity to more widely apply the principles of the syndemic approach. In the years since SAVA was identified, there have been other syndemics described that include HIV/AIDS as a component, such as the HIV–malnutrition–food insecurity syndemic in sub-Saharan Africa. Alternatively, other existing and emerging syndemics centre on non-communicable diseases (NCDs) such as VIDDA (violence, immigration, depression, type 2 diabetes, and abuse) in women who have emigrated to the USA from Mexico.

Whether communicable diseases or NCDs, or set in high-income countries or low-income and middle-income countries (LMICs), there are similar forces at work that can perpetuate or accelerate existing syndemics. Specifically, rapid changes can precipitate conditions conducive to developing syndemics. For example, globalisation patterns have quickly and fundamentally changed dietary patterns in LMICs by increasing access to high-calorie foods and processed carbohydrates, radically increasing the proportion of individuals with type 2 diabetes. Changes in political and economic conditions, and relatedly the breakdown of protective health measures or infrastructure, can induce differentially and additive detrimental effects on specific populations.

The political and public health changes underway in the USA are especially worrisome in their potential for spurring a new wave of unforeseen health crises. The VIDDA syndemic may serve as a harbinger of sorts for other potential immigrant health-related syndemics because of the current uncertainty around immigration policy. After the executive order issued on Jan 25, 2017, immigration enforcement has pushed many people who were previously at low risk for deportation into an uneasy and unwelcome spotlight. Several major news outlets have reported recently that health-care centres have already noted a downturn in the number of immigrant patients keeping appointments for chronic conditions such as diabetes and hypertension. It is well documented that Hispanic patients are less likely to seek medical attention than are other ethnic groups, but in the wake of an already precarious climate for Mexican immigrants, the emerging accounts highlight an even greater vulnerability because of new political threats. From a clinical perspective, applying a syndemic approach is novel and valuable for expanding the focus from why a patient has a poor outcome (eg, dysregulated blood sugar) to what other factors are contributing.

Although there may be little that clinical practitioners and public health interventionists can do about the presence of social and political circumstances that might negatively affect health, the syndemic framework allows for the potential to mitigate those effects by appreciating the complex nature of certain diseases and conditions and for addressing the array of factors that give rise to them. In the pursuit of practising more socially conscious medicine, syndemics suggest that context is key.

Research matters: challenges of replication

The Lancet
Mar 04, 2017 Volume 389 Number 10072 p881-982 e3
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Research matters: challenges of replication
The Lancet
Summary
Scientific progress builds on an ever-accumulating body of evidence gathered over generations, and is deeply rooted in tenets of reliability and reproducibility. Last week, in Nature, Jeffery Mogil and Malcolm Macleod proposed a new framework that aims to instil greater confidence in research, calling for findings from basic research laboratories to be validated by a definitive preclinical trial before testing in human beings.
In their article, Mogil and Macleod highlight concerns of a so-called reproducibility crisis in scientific research. And they are by no means the first. In 2016, results of a brief online questionnaire of over 1500 basic science researchers published in Nature revealed that as many as 90% of those surveyed agreed that there was a reproducibility crisis in science. The Reproducibility Project: Cancer Biology aims to independently reproduce published results of high profile studies in cancer biology. In January this year, eLife published findings from the first five replication studies, some of which showed mixed results.
Such endeavours should be applauded for their intentions to ensure dissemination of robust findings in a culture often driven by fierce competition for publications and funding. But use of the term crisis over-generalises complex issues that are specific to highly intricate biological systems—such terminology could dangerously undermine public confidence in science and researchers. In an era when alternative facts are presented as truth, and lines between fact and fiction are increasingly blurred, trust in research integrity must be reaffirmed and defended.
Replicating studies is important, but to conclude that a failure to reproduce specific findings is failed science oversimplifies the problem. Novel research is, by nature, exploratory and diverse, and variations exist between experimental sites and individuals. Prescriptive regulation of scientific thought and processes that stifle creativity under a guise of enforcing reliability could ultimately impede discovery and advancement. Stakeholders, including funders, publishers, industry, and academics must enter a dialogue to establish nuanced solutions to improve transparency, accountability, and reporting of research.

Syndemics and the biosocial conception of health

The Lancet
Mar 04, 2017 Volume 389 Number 10072 p881-982 e3
http://www.thelancet.com/journals/lancet/issue/current

Series
Syndemics
Syndemics and the biosocial conception of health
Merrill Singer, Nicola Bulled, Bayla Ostrach, Emily Mendenhall
Summary
The syndemics model of health focuses on the biosocial complex, which consists of interacting, co-present, or sequential diseases and the social and environmental factors that promote and enhance the negative effects of disease interaction. This emergent approach to health conception and clinical practice reconfigures conventional historical understanding of diseases as distinct entities in nature, separate from other diseases and independent of the social contexts in which they are found. Rather, all of these factors tend to interact synergistically in various and consequential ways, having a substantial impact on the health of individuals and whole populations. Specifically, a syndemics approach examines why certain diseases cluster (ie, multiple diseases affecting individuals and groups); the pathways through which they interact biologically in individuals and within populations, and thereby multiply their overall disease burden, and the ways in which social environments, especially conditions of social inequality and injustice, contribute to disease clustering and interaction as well as to vulnerability. In this Series, the contributions of the syndemics approach for understanding both interacting chronic diseases in social context, and the implications of a syndemics orientation to the issue of health rights, are examined.

Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations

The Lancet
Mar 04, 2017 Volume 389 Number 10072 p881-982 e3
http://www.thelancet.com/journals/lancet/issue/current

Syndemics
Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations
Emily Mendenhall, Brandon A Kohrt, Shane A Norris, David Ndetei, Dorairaj Prabhakaran
Summary
The co-occurrence of health burdens in transitioning populations, particularly in specific socioeconomic and cultural contexts, calls for conceptual frameworks to improve understanding of risk factors, so as to better design and implement prevention and intervention programmes to address comorbidities. The concept of a syndemic, developed by medical anthropologists, provides such a framework for preventing and treating comorbidities. The term syndemic refers to synergistic health problems that affect the health of a population within the context of persistent social and economic inequalities. Until now, syndemic theory has been applied to comorbid health problems in poor immigrant communities in high-income countries with limited translation, and in low-income or middle-income countries. In this Series paper, we examine the application of syndemic theory to comorbidities and multimorbidities in low-income and middle-income countries. We employ diabetes as an exemplar and discuss its comorbidity with HIV in Kenya, tuberculosis in India, and depression in South Africa. Using a model of syndemics that addresses transactional pathophysiology, socioeconomic conditions, health system structures, and cultural context, we illustrate the different syndemics across these countries and the potential benefit of syndemic care to patients. We conclude with recommendations for research and systems of care to address syndemics in low-income and middle-income country settings.

Syndemic vulnerability and the right to health

The Lancet
Mar 04, 2017 Volume 389 Number 10072 p881-982 e3
http://www.thelancet.com/journals/lancet/issue/current

Syndemics
Syndemic vulnerability and the right to health
Sarah S Willen, Michael Knipper, César E Abadía-Barrero, Nadav Davidovitch
Summary
Investigators working both in syndemics, a field of applied health research with roots in medical anthropology, and in the field of health and human rights recognise that upstream social, political, and structural determinants contribute more to health inequities than do biological factors or personal choices. Syndemics investigates synergistic, often deleterious interactions among comorbid health conditions, especially under circumstances of structural and political adversity. Health and human rights research draws on international law to argue that all people deserve access not only to health care, but also to the underlying determinants of good health. Taking the urgent matter of migrant health as an empirical focus, we juxtapose the fields of syndemics and health and human rights, identify their complementarities, and advocate for a combined approach. By melding insights from these fields, the combined syndemics/health and human rights approach advanced here can provide clinicians and other key stakeholders with concrete insights, tools, and strategies to tackle the health inequities that affect migrants and other vulnerable groups by: (1) mapping the effect of social, political, and structural determinants on health; (2) identifying opportunities for upstream intervention; and (3) working collaboratively to tackle the structures, institutions, and processes that cause and exacerbate health inequities. Undergirding this approach is an egalitarian interpretation of the right to health that differs from narrow legalistic and individual interpretations by insisting that all people are equal in worth and, as a result, equally deserving of protection from syndemic vulnerability.

Co-occurring epidemics, syndemics, and population health

The Lancet
Mar 04, 2017 Volume 389 Number 10072 p881-982 e3
http://www.thelancet.com/journals/lancet/issue/current

Viewpoint
Co-occurring epidemics, syndemics, and population health
Alexander C Tsai, Emily Mendenhall, James A Trostle, Ichiro Kawachi
Summary
As originally theorised, three concepts underlie the notion of a syndemic: disease concentration, disease interaction, and the large-scale social forces that give rise to them.1,2 The concept of disease concentration holds that two or more epidemics co-occur in particular temporal or geographical contexts due to harmful social conditions. This aspect of the theory of syndemics is not necessarily what makes its contribution distinctive. For example, anthropologists have long called attention to the manner in which large-scale political, economic, and cultural forces have given rise to clustered epidemics of various infectious diseases, most prominently HIV and tuberculosis;3–5 and the theory of fundamental causes highlights the roles of these forces in driving concentrated health disadvantage.

Lancet Global Health – Mar 2017 Volume 5 Number 3 e229-e369

Lancet Global Health
Mar 2017 Volume 5 Number 3 e229-e369
http://www.thelancet.com/journals/langlo/issue/current

Articles
Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review
Luke Allen, Julianne Williams, Nick Townsend, Bente Mikkelsen, Nia Roberts, Charlie Foster, Kremlin Wickramasinghe

.

First estimates of the global and regional incidence of neonatal herpes infection
Katharine J Looker, Amalia S Magaret, Margaret T May, Katherine M E Turner, Peter Vickerman, Lori M Newman, Sami L Gottlieb

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Immunity duration of a recombinant adenovirus type-5 vector-based Ebola vaccine and a homologous prime-boost immunisation in healthy adults in China: final report of a randomised, double-blind, placebo-controlled, phase 1 trial
Jing-Xin Li, Li-Hua Hou, Fan-Yue Meng, Shi-Po Wu, Yue-Mei Hu, Qi Liang, Kai Chu, Zhe Zhang, Jun-Jie Xu, Rong Tang, Wen-Juan Wang, Pei Liu, Jia-Lei Hu, Li Luo, Rong Jiang, Feng-Cai Zhu, Wei Chen

.

Community resource centres to improve the health of women and children in informal settlements in Mumbai: a cluster-randomised, controlled trial
Neena Shah More, Sushmita Das, Ujwala Bapat, Glyn Alcock, Shreya Manjrekar, Vikas Kamble, Rijuta Sawant, Sushma Shende, Nayreen Daruwalla, Shanti Pantvaidya, David Osrin

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Levels and trends in contraceptive prevalence, unmet need, and demand for family planning for 29 states and union territories in India: a modelling study using the Family Planning Estimation Tool
Jin Rou New, Niamh Cahill, John Stover, Yogender Pal Gupta, Leontine Alkema

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Effectiveness of the 13-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in South African children: a case-control study
Cheryl Cohen, Claire von Mollendorf, Linda de Gouveia, Sarona Lengana, Susan Meiring, Vanessa Quan, Arthermon Nguweneza, David P Moore, Gary Reubenson, Mamokgethi Moshe, Shabir A Madhi, Brian Eley, Ute Hallbauer, Heather Finlayson, Sheeba Varughese, Katherine L O’Brien, Elizabeth R Zell, Keith P Klugman, Cynthia G Whitney, Anne von Gottberg for the South African IPD Case-Control Study Group

Mortality in children diagnosed with tuberculosis: a systematic review and meta-analysis

Lancet Infectious Diseases
Mar 2017 Volume 17 Number 3 p237-348 e70-e106
http://www.thelancet.com/journals/laninf/issue/current

Articles
Mortality in children diagnosed with tuberculosis: a systematic review and meta-analysis
Helen E Jenkins, Courtney M Yuen, Carly A Rodriguez, Ruvandhi R Nathavitharana, Megan M McLaughlin, Peter Donald, Ben J Marais, Mercedes C Becerra

Serotype-specific effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumococcal pneumonia in adults aged 65 years or older: a multicentre, prospective, test-negative design study

Lancet Infectious Diseases
Mar 2017 Volume 17 Number 3 p237-348 e70-e106
http://www.thelancet.com/journals/laninf/issue/current

Serotype-specific effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumococcal pneumonia in adults aged 65 years or older: a multicentre, prospective, test-negative design study
Motoi Suzuki, Bhim Gopal Dhoubhadel, Tomoko Ishifuji, Michio Yasunami, Makito Yaegashi, Norichika Asoh, Masayuki Ishida, Sugihiro Hamaguchi, Masahiro Aoshima, Koya Ariyoshi, Konosuke Morimoto on behalf of the Adult Pneumonia Study Group-Japan (APSG-J)

Spread of yellow fever virus outbreak in Angola and the Democratic Republic of the Congo 2015–16: a modelling study

Lancet Infectious Diseases
Mar 2017 Volume 17 Number 3 p237-348 e70-e106
http://www.thelancet.com/journals/laninf/issue/current

Spread of yellow fever virus outbreak in Angola and the Democratic Republic of the Congo 2015–16: a modelling study
Moritz U G Kraemer, Nuno R Faria, Robert C Reiner Jr, Nick Golding, Birgit Nikolay, Stephanie Stasse, Michael A Johansson, Henrik Salje, Ousmane Faye, G R William Wint, Matthias Niedrig, Freya M Shearer, Sarah C Hill, Robin N Thompson, Donal Bisanzio, Nuno Taveira, Heinrich H Nax, Bary S R Pradelski, Elaine O Nsoesie, Nicholas R Murphy, Isaac I Bogoch, Kamran Khan, John S Brownstein, Andrew J Tatem, Tulio de Oliveira, David L Smith, Amadou A Sall, Oliver G Pybus, Simon I Hay, Simon Cauchemez
Open Access

Lancet Infectious Diseases – Mar 2017 Volume 17 Number 3 p237-348 e70-e106

Lancet Infectious Diseases
Mar 2017 Volume 17 Number 3 p237-348 e70-e106
http://www.thelancet.com/journals/laninf/issue/current

Series
Dengue
Disease and economic burdens of dengue
Marcia C Castro, Mary E Wilson, David E Bloom

Dengue
Prevention and control of dengue—the light at the end of the tunnel
Tikki Pang, Tippi K Mak, Duane J Gubler

Dengue
Dengue: knowledge gaps, unmet needs, and research priorities
Leah C Katzelnick, Josefina Coloma, Eva Harris
e88

Personal View
Epidemic arboviral diseases: priorities for research and public health
Annelies Wilder-Smith, Duane J Gubler, Scott C Weaver, Thomas P Monath, David L Heymann, Thomas W Scott

The Changing Face of Clinical Trials: Informed Consent

New England Journal of Medicine
March 2, 2017  Vol. 376 No. 9
http://www.nejm.org/toc/nejm/medical-journal

Review Article
The Changing Face of Clinical Trials: Informed Consent
C. Grady and Others
This multipart review provides an overview of innovative approaches to improving and expanding the informed consent process for researchers and participants, along with short essays covering specific areas of innovation.

Conflicts of Interest for Patient-Advocacy Organizations

New England Journal of Medicine
March 2, 2017  Vol. 376 No. 9
http://www.nejm.org/toc/nejm/medical-journal

Special Report
Conflicts of Interest for Patient-Advocacy Organizations
M.S. McCoy and Others
Share:
In this examination of 104 large patient-advocacy organizations, 83% receive financial support from drug, device, and biotechnology companies, and industry executives often serve on governing boards. The authors recommend more transparency about industry involvement.

Poverty and Trends in Three Common Chronic Disorders

Pediatrics
March 2017, VOLUME 139 / ISSUE 3
http://pediatrics.aappublications.org/content/139/3?current-issue=y

Articles
Poverty and Trends in Three Common Chronic Disorders
For asthma, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD), the objectives were to (1) describe the percent increases in prevalence and comorbidity and how these vary by poverty status, and (2) examine the extent to which poverty status is a predictor of higher than average comorbid conditions.
Christian D. Pulcini, Bonnie T. Zima, Kelly J. Kelleher, Amy J. Houtrow
Pediatrics Mar 2017, 139 (3) e20162539; DOI: 10.1542/peds.2016-2539

Safety of Second-Dose Single-Antigen Varicella Vaccine

Pediatrics
March 2017, VOLUME 139 / ISSUE 3
http://pediatrics.aappublications.org/content/139/3?current-issue=y

Articles
Safety of Second-Dose Single-Antigen Varicella Vaccine
We identified no new or unexpected safety concerns for second-dose varicella vaccination. Robust safety monitoring remains an important component of the national varicella vaccination program.
John R. Su, Zanie Leroy, Paige W. Lewis, Penina Haber, Mona Marin, Jessica Leung, Emily Jane Woo, Tom T. Shimabukuro
Pediatrics Mar 2017, 139 (3) e20162536; DOI: 10.1542/peds.2016-2536

Vaccine Hesitancy: In Search of the Risk Communication Comfort Zone

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
[Accessed 4 March 2017]

Research Article
Vaccine Hesitancy: In Search of the Risk Communication Comfort Zone
March 3, 2017 ·
Introduction: This paper reports the findings of a national online survey to parents of children aged 5 and younger. The objectives of the study were to assess parental understanding of childhood immunizations, identify sources of information that they trust for vaccine-related content, assess where parents with young children stand on the key issues in the public debate about vaccination, and identify which risk communication messages are most effective for influencing the behaviours of vaccine hesitant parents.
Methods: A total of 1,000 surveys (closed and open-ended questions) were administered in November 2015 using the Angus Reid Forum Panel, a key consumer panel consisting of approximately 150,000 Canadian adults aged 18 and older, spread across all geographic regions of Canada.
Results: Approximately 92% of the Canadian parents surveyed consider vaccines safe and effective, and trust doctors and public health officials to provide timely and credible vaccine-related information. However, a concerning number of them either believe or are uncertain whether there is a link between vaccines and autism (28%), worry that vaccines might seriously harm their children (27%), or believe the pharmaceutical industry is behind the push for mandatory immunization (33%). Moreover, despite the common assumption that social media are becoming the go-to source of health news and information, most parents still rely on traditional media and official government websites for timely and credible information about vaccines and vaccine preventable diseases, particularly during community-based disease outbreaks. Finally, parents reported high levels of support for pro-vaccine messaging that has been demonstrated in previous research to have little to no positive impact on behaviour change, and may even be counterproductive.
Discussion: The study’s results are highly relevant in a context where public health officials are expending significant resources to increase rates of childhood immunization and combat vaccine hesitancy. The data offer insight into where parents stand on the political and public debate about mandatory vaccination, what aspects of vaccine science remain uncertain to them, which media and institutional sources they use and trust to navigate the health information environment, how they look for information and whom they trust during periods of health emergency or crisis, and which communication strategies are considered most effective in persuading vaccine hesitant parents to immunize their children.

Hope for HIV control in southern Africa: The continued quest for a vaccine

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 4 March 2017)

Perspective
Hope for HIV control in southern Africa: The continued quest for a vaccine
Linda-Gail Bekker, Glenda E. Gray
Perspective | published 28 Feb 2017 P
http://dx.doi.org/10.1371/journal.pmed.1002241
… The findings of the HVTN 702 trial have the potential to be a great leap in HIV prevention research, with vaccine efficacy results anticipated in early 2021. But, even if efficacious, a paramount challenge will be getting the vaccine out of the laboratory and to those people who need it most—particularly, difficult-to-reach populations in low- and middle-income countries. Notably, the cost of vaccine manufacturing will play a large role, as developing countries are already having to make tough decisions regarding optimal funding of HIV prevention and treatment programs. If a vaccine is at best only partially efficacious, the correct combination of preventative measures will need to be explored, likely on a population-specific basis, and choices made. From current predictions, however, a safe vaccine of even modest efficacy could be the game changer necessary to close the HIV prevention gap.

PLoS One

PLoS One
http://www.plosone.org/
[Accessed 4 March 2017]

Research Article
Determinants of geographic inequalities in HPV vaccination in the most populated region of France
Delphine Héquet, Roman Rouzier
Research Article | published 03 Mar 2017 P
http://dx.doi.org/10.1371/journal.pone.0172906

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Impact of ten-valent pneumococcal conjugate vaccine on pneumonia in Finnish children in a nation-wide population-based study
Arto A. Palmu, Hanna Rinta-Kokko, Hanna Nohynek, J. Pekka Nuorti, Terhi M. Kilpi, Jukka Jokinen
Research Article | published 01 Mar 2017 P
http://dx.doi.org/10.1371/journal.pone.0172690

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Impact of vaccine herd-protection effects in cost-effectiveness analyses of childhood vaccinations. A quantitative comparative analysis
Marisa Holubar, Maria Christina Stavroulakis, Yvonne Maldonado, John P. A. Ioannidis, Despina Contopoulos-Ioannidis
Research Article | published 01 Mar 2017
http://dx.doi.org/10.1371/journal.pone.0172414

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Assessments of global drivers of vaccine hesitancy in 2014—Looking beyond safety concerns
Melanie Marti, Monica de Cola, Noni E. MacDonald, Laure Dumolard, Philippe Duclos
Research Article | published 01 Mar 2017 P
http://dx.doi.org/10.1371/journal.pone.0172310

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HPV vaccine knowledge and acceptability among Peruvian men who have sex with men and transgender women: A pilot, qualitative study
Jerome T. Galea, Emmi Monsour, César R. Nureña, Magaly M. Blas, Brandon Brown
Research Article | published 28 Feb 2017 P
http://dx.doi.org/10.1371/journal.pone.0172964

Evolving policy with science

Science
03 March 2017 Vol 355, Issue 6328
http://www.sciencemag.org/current.dtl

Editorial
Evolving policy with science
By R. Alta Charo, Richard O. Hynes
Science03 Mar 2017 : 889
Summary
Albert Schweitzer, physician and Nobel laureate, wrote: “The first step in the evolution of ethics is a sense of solidarity with other human beings.” The evolution of U.S. policy governing heritable human germline modification reflects this observation, and a “Human Genome Editing” consensus study committee of the U.S. National Academy of Sciences and National Academy of Medicine (NAM) concluded last month that clinical trials for heritable editing, under strict regulations, may eventually be permissible for parents hoping to prevent serious diseases in their children.

The need for a translational science of democracy

Science
03 March 2017 Vol 355, Issue 6328
http://www.sciencemag.org/current.dtl

Policy Forum
The need for a translational science of democracy
By Michael A. Neblo, William Minozzi, Kevin M. Esterling, Jon Green, Jonathon Kingzette, David M. J. Lazer
Science03 Mar 2017 : 914-915 Restricted Access
The political science community should focus on how to foster the health of democracy
Summary
The bitterly factious 2016 U.S. presidential election campaign was the culmination of several trends that, taken together, constitute a syndrome of chronic ailments in the body politic. Ironically, these destructive trends have accelerated just as science has rapidly improved our understanding of them and their underlying causes. But mere understanding is not sufficient to repair our politics. The challenge is to build a translational science of democracy that maintains scientific rigor while actively promoting the health of the body politic.

Governance of global health research consortia: Sharing sovereignty and resources within Future Health Systems

Social Science & Medicine
Volume 174, Pages 1-228 (February 2017)
http://www.sciencedirect.com/science/journal/02779536/173

Original Research Article
Governance of global health research consortia: Sharing sovereignty and resources within Future Health Systems
Pages 113-121
Bridget Pratt, Adnan A. Hyder
Abstract
Global health research partnerships are increasingly taking the form of consortia that conduct programs of research in low and middle-income countries (LMICs). An ethical framework has been developed that describes how the governance of consortia comprised of institutions from high-income countries and LMICs should be structured to promote health equity. It encompasses initial guidance for sharing sovereignty in consortia decision-making and sharing consortia resources. This paper describes a first effort to examine whether and how consortia can uphold that guidance. Case study research was undertaken with the Future Health Systems consortium, performs research to improve health service delivery for the poor in Bangladesh, China, India, and Uganda. Data were thematically analysed and revealed that proposed ethical requirements for sharing sovereignty and sharing resources are largely upheld by Future Health Systems. Facilitating factors included having a decentralised governance model, LMIC partners with good research capacity, and firm budgets. Higher labour costs in the US and UK and the funder’s policy of allocating funds to consortia on a reimbursement basis prevented full alignment with guidance on sharing resources. The lessons described in this paper can assist other consortia to more systematically link their governance policy and practice to the promotion of health equity.

Dynamic axes of informed consent in Japan

Social Science & Medicine
Volume 174, Pages 1-228 (February 2017)
http://www.sciencedirect.com/science/journal/02779536/173

Original Research Article
Dynamic axes of informed consent in Japan
Pages 159-168
Laura Specker Sullivan
Abstract
Scholarship in cross-cultural bioethics routinely frames Japanese informed consent in contrast to informed consent in North America. This contrastive analysis foregrounds cancer diagnosis disclosure and physician paternalism as unique aspects of Japanese informed consent that deviate from American practices. Drawing on in-depth interviews with 15 Japanese medical professionals obtained during fieldwork in Japan from 2013 to 15, this article complicates the informed consent discourse beyond East-West comparisons premised on Anglo-American ethical frameworks. It expands professional perspectives to include nurses, medical social workers, clinical psychologists, and ethicists and it addresses informed consent for a broad range of conditions in addition to cancer. The results suggest that division of affective labor is an under-theorized dimension of informed consent that is perceived as at odds with principled demands for universal informed consent. These practical tensions are conceptualized as cultural differences, with Japan identified in terms of omakase as practical and supportive and the United States identified in terms of jiko kettei as principled and self-determining. These results have implications for the methodology of cross-cultural bioethics as well as for theories and practices of informed consent in both Japan and the United States. I conclude that responsible cross-cultural work in bioethics must begin from the ground up, incorporating all relevant stakeholder perspectives, attitudes, and experiences.

Profile and reintegration experience of Ebola survivors in Guinea: a cross-sectional study (pages 254–260)

Tropical Medicine & International Health
March 2017 Volume 22, Issue 3 Pages 253–369
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2017.22.issue-3/issuetoc

Original Articles
Profile and reintegration experience of Ebola survivors in Guinea: a cross-sectional study (pages 254–260)
Alexandre Delamou, Bienvenu Salim Camara, Jean Pe Kolie, Achille Diona Guemou, Nyankoye Yves Haba, Shannon Marquez, Abdoul Habib Beavogui, Therese Delvaux and Johan van Griensven
Version of Record online: 13 JAN 2017 | DOI: 10.1111/tmi.12825

Vaccines: Shaping global health

Vaccine
Available online 23 February 2017

In Press, Corrected Proof
Conference report
Vaccines: Shaping global health
Sonia Pagliusia, Ching-Chia Tinga, Fernando Lobosb, the DCVMN Executive Committee Group
Abstract
The Developing Countries Vaccine Manufacturers’ Network (DCVMN) gathered leaders in immunization programs, vaccine manufacturing, representatives of the Argentinean Health Authorities and Pan American Health Organization, among other global health stakeholders, for its 17th Annual General Meeting in Buenos Aires, to reflect on how vaccines are shaping global health. Polio eradication and elimination of measles and rubella from the Americas is a result of successful collaboration, made possible by timely supply of affordable vaccines. After decades of intense competition for high-value markets, collaboration with developing countries has become critical, and involvement of multiple manufacturers as well as public- and private-sector investments are essential, for developing new vaccines against emerging infectious diseases. The recent Zika virus outbreak and the accelerated Ebola vaccine development exemplify the need for international partnerships to combat infectious diseases. A new player, Coalition for Epidemic Preparedness Innovations (CEPI) has made its entrance in the global health community, aiming to stimulate research preparedness against emerging infections. Face-to-face panel discussions facilitated the dialogue around challenges, such as risks of viability to vaccine development and regulatory convergence, to improve access to sustainable vaccine supply. It was discussed that joint efforts to optimizing regulatory pathways in developing countries, reducing registration time by up to 50%, are required. Outbreaks of emerging infections and the global Polio eradication and containment challenges are reminders of the importance of vaccines’ access, and of the importance of new public-private partnerships.

Use of m-Health in polio eradication and other immunization activities in developing countries

Vaccine
Volume 35, Issue 10, Pages 1369-1474 (7 March 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/10

Reviews
Use of m-Health in polio eradication and other immunization activities in developing countries
Review Article
Pages 1373-1379
Sara S. Kim, Manish Patel, Alan Hinman
Abstract
Introduction
Reaching the children that are chronically missed by routine immunization services has been a key pillar of success in achieving progress toward polio eradication. The rapid advancement and accessibility of mobile technology (“mHealth”) in low and lower middle income countries provides an important opportunity to apply novel, innovative approaches to provide vaccine services. We sought to document the use and effectiveness of mHealth in immunization programs in low and lower middle income countries. We particularly focused on mHealth approaches used in polio eradication efforts by the Global Polio Eradication Initiative (GPEI) to leverage the knowledge and lessons learned that may be relevant for enhancing ongoing immunization services.
Methods
In June 2016, the electronic database PubMed was searched for peer reviewed studies that focused on efforts to improve immunization programs (both ongoing immunization services and supplemental immunization activities or campaigns) through mobile technology in low and lower middle income countries.
Results
The search yielded 317 papers of which 25 met the inclusion criteria. One additional article was included from the hand searching process. mHealth was used for reminder and recall, monitoring and surveillance, vaccine acceptance, and campaign strategic planning. Mobile phones were the most common mobile device used. Of the 26 studies, 21 of 26 studies (80.8%) reported that mHealth improved immunization efforts.
Conclusion
mHealth interventions can effectively enhance immunization services in low and lower middle income countries. With the growing capacity and access to mobile technology, mHealth can be a powerful and sustainable tool for enhancing the reach and impact of vaccine programs.

Policy making for vaccine use as a driver of vaccine innovation and development in the developed world

Vaccine
Volume 35, Issue 10, Pages 1369-1474 (7 March 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/10

Review Article
Policy making for vaccine use as a driver of vaccine innovation and development in the developed world
Pages 1380-1389
Katherine Seib, Andrew J. Pollard, Philippe de Wals, Ross M. Andrews, Fangjun Zhou, Richard J. Hatchett, Larry K. Pickering, Walter A. Orenstein
Abstract
In the past 200 years, vaccines have had unmistakable impacts on public health including declines in morbidity and mortality, most markedly in economically-developed countries. Highly engineered vaccines including vaccines for conditions other than infectious diseases are expected to dominate future vaccine development. We examine immunization vaccine policy as a driver of vaccine innovation and development. The pathways to recommendation for use of licensed vaccines in the US, UK, Canada and Australia have been similar, including: expert review of disease epidemiology, disease burden and severity; vaccine immunogenicity, efficacy and safety; programmatic feasibility; public demand; and increasingly cost-effectiveness. Other attributes particularly important in development of future vaccines are likely to include: duration of immunity for improved vaccines such as pertussis; a greater emphasis on optimizing community protection rather than direct protection only; programmatic implementation, feasibility, improvements (as in the case of development of a universal influenza vaccine); public concerns/confidence/fears related to outbreak pathogens like Ebola and Zika virus; and major societal burden for combating hard to treat diseases like HIV and antimicrobial resistant pathogens. Driving innovation and production of future vaccines faces enormous economic hurdles as available approaches, technologies and regulatory pathways become more complex. As such, cost-mitigating strategies and focused, aligned efforts (by governments, private organizations, and private-public partnerships) will likely be needed to continue to spur major advances in vaccine technologies and development.

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

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

Current Opinion in HIV and AIDS
Post Author Corrections: February 21, 2017
Lessons learned from human HIV vaccine trials
Pollara, Justin; Easterhoff, David; Fouda, Genevieve G.
doi: 10.1097/COH.0000000000000362
Abstract
Purpose of review: The ability to induce broadly neutralizing antibody (bNAb) responses is likely essential for development of a globally effective HIV vaccine. Unfortunately, human vaccine trials conducted to date have failed to elicit broad plasma neutralization of primary virus isolates. Despite this limitation, in-depth analysis of the vaccine-induced memory B-cell repertoire can provide valuable insights into the presence and function of subdominant B-cell responses, and identify initiation of antibody lineages that may be on a path towards development of neutralization breadth.
Recent findings: Characterization of the functional capabilities of monoclonal antibodies isolated from a HIV-1 vaccine trial with modest efficacy has revealed mechanisms by which non-neutralizing antibodies are presumed to have mediated protection. In addition, B-cell repertoire analysis has demonstrated that vaccine boosts shifted the HIV-specific B-cell repertoire, expanding pools of cells with long third heavy chain complementarity determining regions – a characteristic of some bNAb lineages.
Summary: Detailed analysis of memory B-cell repertoires and evaluating the effector functions of isolated monoclonal antibodies expands what we can learn from human vaccine trails, and may provide knowledge that can enable rational design of novel approaches to drive maturation of subdominant disfavored bNAb lineages.

Media/Policy Watch

Media/Policy Watch
This watch section is intended to alert readers to substantive news, analysis and opinion from the general media and selected think tanks and similar organizations on vaccines, immunization, global public health and related themes. Media Watch is not intended to be exhaustive, but indicative of themes and issues CVEP is actively tracking. This section will grow from an initial base of newspapers, magazines and blog sources, and is segregated from Journal Watch above which scans the peer-reviewed journal ecology.

We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.

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Financial Times
http://www.ft.com/home/uk
Accessed 4 March 2017
GSK ‘real world’ study offers new model for drug trials
26 February 2017
GlaxoSmithKline has conducted the world’s first drug trial under “real world” conditions — closely watched by an industry under greater pressure than ever to prove the value of its medicines to cost-constrained health systems. In a global first for drugmakers, GSK obtained permission to test Relvar, a drug to treat asthma and chronic obstructive pulmonary disease (COPD), before it had received full regulatory approval. It did this by setting in place an electronic patient data-monitoring system that ensured any adverse reactions were immediately communicated to physicians.

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Scientific American
https://www.scientificamerican.com/
Accessed 4 March 2017
Guest Blog
Will an American-Led Anti-Vaccine Movement Subvert Global Health?
We’ve made great gains in fighting infectious diseases in the last 50 years—but those gains are fragile
By Peter J. Hotez on March 3, 2017