Milestones :: Perspectives

 
Measles no longer endemic in 79% of the WHO European Region
Copenhagen, 26  September 2017
In the WHO European Region, 42 of 53 countries have interrupted endemic transmission of measles, and 37 countries have interrupted endemic transmission of rubella as of the end of 2016. This was determined by the European Regional Verification Commission for Measles and Rubella Elimination (RVC) at its 6th meeting in June 2017.
“I congratulate each country for fulfilling the commitment to protect its people from measles and rubella and collectively moving the European Region closer to its elimination goal,” said Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “However, we cannot become complacent now. Outbreaks continue to cause unnecessary suffering and loss of life, and routine immunization coverage is decreasing. It is unacceptable that 1 in every 15 children still does not receive the first vaccination dose against measles and rubella on time. We will eliminate these diseases from our Region, but need to be ready to walk the hardest last mile.”…
 
::::::
::::::
 
Serum Institute’s vaccine demonstrates significant efficacy against severe rotavirus gastroenteritis
Indian Government orders the vaccine for use in Universal Immunization Programme
Pune, India (26 September 2017)—Results from a Phase 3 efficacy study in India of the Serum Institute of India Pvt. Ltd.’s rotavirus vaccine BRV-PV (known as ROTASIIL®) were published in the journal Vaccine. The study showed the vaccine to be safe, well tolerated, and to provide significant efficacy against severe rotavirus gastroenteritis. In 2013, an estimated 47,100 rotavirus deaths occurred in India, 22 percent of all rotavirus deaths that occurred globally.

ROTASIIL reduced severe rotavirus diarrhea by more than a third – 39.5 percent over two years. Significantly, the vaccine efficacy was nearly 55 percent against the most severe and potentially life-threatening cases of rotavirus diarrhea, which represent the highest risk of dehydration, hospitalizations, and deaths. The results demonstrated by ROTASIIL in India appear generally comparable to the performance of RotaTeq® and Rotarix® in Bangladesh and in some African countries.

Dr. Rajeev Dhere, executive director of the Serum Institute, under whose leadership this vaccine has been developed, commented, “We are delighted with these results, which indicate that ROTASIIL could save the lives of tens of thousands of children each year in India and, potentially, around the world.”

The international nonprofit PATH partnered with Serum Institute on evaluating this vaccine in the Phase 3 efficacy study. Six study sites across India enrolled 7,500 infants in the trial. ROTASIIL is an oral vaccine administered to infants in a three-dose course at 6, 10, and 14 weeks of age, at the same time as routine vaccinations under India’s Universal Immunization Programme.

The office of the Drugs Controller General of India, through its subject expert committee, reviewed the Phase 3 safety and efficacy results and subsequently inspected Serum Institute’s manufacturing facilities leading to licensure of ROTASIIL in January 2017.

The Government of India has placed an order for 3.8 million doses of ROTASIIL to use in the Universal Immunization Programme, which serves 26 million children. Serum Institute has manufactured the vaccine doses and is awaiting instructions from the Ministry of Health and Family Welfare for their distribution. ROTASIIL will also be available for sale in India’s private market later this year.

Serum Institute is pursuing World Health Organization (WHO) prequalification to make this vaccine available for global procurement. PATH and Serum Institute partnered to conduct a separate Phase 3 study in India to gather additional data required for WHO prequalification; results from that study will be submitted for publication this year.

“This is great news for India,” noted Dr. David Kaslow, PATH’s vice president for Essential Medicines and global head of the Center for Vaccine Innovation and Access. “The results and successful licensure of this rotavirus vaccine is an exciting and encouraging milestone toward the public health goal of improving the supply of affordable rotavirus vaccines, both in India and worldwide.”

Médecins Sans Frontières and Epicentre are also evaluating the efficacy and safety of ROTASIIL in a separate Phase 3 study in Niger. That study is still ongoing, but results from the primary analysis (one year of data) also showed the vaccine to be highly efficacious for the prevention of severe rotavirus diarrhea and to have an excellent safety profile. The efficacy of the vaccine against severe and very severe rotavirus diarrhea in the Niger study was 66.7 percent and 78.8 percent, respectively. These results were published in the New England Journal of Medicine in March 2017.

The ROTASIIL used in the Niger study was stored at less than 25°C and transported for vaccination at ambient temperature, thus bypassing the typically challenging and costly cold-chain requirements that apply to most other vaccines. The ROTASIIL used in the India study was from the same lots of vaccine used in the Niger study.

::::::
::::::
 
Towards a Rabies-Free World as Unparalleled Global Initiative Gets Underway
Global partners announce plan to end human deaths from dog-transmitted rabies by 2030
NEW YORK, Sept. 28, 2017 /PRNewswire/
…World Rabies Day marks the announcement of the biggest global anti-rabies initiative, as the World Health Organization (WHO), the World Organisation for Animal Health (OIE), the Food and Agriculture Organization of the UN (FAO) and the Global Alliance for Rabies Control (GARC) reveal an ambitious plan to end human deaths from dog-transmitted rabies by 2030.

The plan — ‘Zero by 30: The Strategic Plan’ — centres on a One Health approach and addresses the disease in a holistic and cross-sectoral manner while highlighting the important role veterinary, health and educational services play in rabies prevention and control.

“The plan ensures support to countries in developing national plans, and provides innovative training and education tools across regional rabies networks,” said Dr. Bernadette Abela-Ridder on behalf of the four partners. “Vaccines are a key component of the global plan and a trigger for national programmes. The United Against Rabies collaboration provides leadership and advocates for resources critical to reaching zero human rabies deaths by 2030.”

‘United against Rabies’ builds on more than ten years of global partnership, research and evidence- building to demonstrate the feasibility of eliminating dog-transmitted rabies. The plan places a magnifying glass on the problem of continued human deaths from rabies and helps to make this a priority disease for key international organizations and governments…
 
::::::
::::::
 
New global initiative will connect the world for better health through digital technology
Digital Square, led by PATH, will align multi-sector investments into scalable solutions that strengthen national digital health systems
Washington, DC, September 28, 2017—Global Innovation Week, an annual gathering of the international development community, kicked off today with a series of institutional commitments to support innovation. This evening at USAID, Dr. David Fleming, PATH’s vice president for Public Health, delivered PATH’s pledge to advance a new type of funding model that maximizes the impact of every dollar spent on digital technology in the global health sector.

“For over a decade, PATH’s Digital Health program has been a leader in the application and use of scalable digital products and services globally and at the country level. We build on that legacy by pledging to encourage co-investment among partners and donors to support countries in seamlessly connecting their digital health systems, sharing better data, and reaching better health outcomes,” said Dr. Fleming.

As a part of this commitment, PATH is pleased to announce Digital Square. The new initiative, comprised of 40+ partner organizations, encourages more efficient investment in digital health technology solutions in low- and middle-income countries through an innovative co-investment model. “Co-investment is a simple but powerful concept. Development dollars are scarce; by coordinating them, we can maximize the impact of our financial investments,” said Dykki Settle, Director of Digital Health at PATH.

The initiative offers a platform for individuals and organizations to confidently coordinate their funding and technical expertise into a suite of proven, adaptable digital health technologies. These solutions can be scaled across an entire country, and even between countries. “This alignment of donors and partners to fund proven technology solutions – that we know can scale – is what sets us apart,” said Digital Square Director Lesley-Anne Long.

Digital Square also helps to support countries to develop the skills they need at all levels—from national government leaders to local healthcare workers—to bring these technologies to scale. Digital Square is a USAID program designed and funded in partnership with the Bill & Melinda Gates Foundation.

::::::
::::::
 
Cholera
 
Yemen  eDEWS Cholera Response Daily Epidemiological Update [EN/AR] 29 Sep 2017
Suspected Cases:       753,098
Associated Deaths:      2,122
Case Fatality Rate        0.28%
Governates affected:      96%
Districts affected:           91%
 
::::::
 
900,000 vaccines ‘en route’ to Cox’s Bazar to prevent cholera
Oral cholera vaccine will protect Rohingya refugees seeking shelter in Bangladesh as well as the resident population
Cox’s Bazar, Bangladesh, 29 September 2017 – The International Coordinating Group (ICG) on Vaccine Provision will release 900,000 doses of the Oral Cholera Vaccine (OCV) from the global stockpile to prevent the spread of cholera among recently arrived vulnerable populations and host communities in areas around Cox’s Bazar.
The Government of Bangladesh made the request to the ICG on 27 September, and the approval was granted in 24 hours by the coordinating mechanism that brings together WHO, UNICEF, Médecins Sans Frontières (MSF), and the International Federation of the Red Cross (IFRC).
ICG partners – with support from Gavi, the Vaccine Alliance – will deliver 900,000 doses of Oral Cholera Vaccine to Bangladesh within two weeks for an immunisation campaign due to start in October.
“This is a precautionary step to avoid a preventable cholera outbreak,” said Dr. Abul Kalam Azad, Director General of Health Services at the Bangladesh Ministry of Health and Family Welfare. “We appreciate the support and speed of partners in delivering on this urgent request, and we look forward to receiving and using the vaccines.”
More than half a million people have crossed from Myanmar to Bangladesh since 25 August following violence in Rakhine State.
Many are crowded into camps or temporary settlements with challenging access to clean water     and sanitation amid heavy rains; this increases the risk of vector and waterborne diseases such as cholera.
“We are doing everything we can to prevent an outbreak, including pre-positioning supplies, implementing disease surveillance and monitoring water quality,” said Dr. Navaratnasamy Paranietharan, WHO Representative in Bangladesh. “A vaccination campaign will help to keep this vulnerable population safe from cholera.”

Featured Journal Content

Lancet Infectious Diseases
Oct 2017 Volume 17 Number 10 p1003-1098  e306-e333
http://www.thelancet.com/journals/laninf/issue/current
Comment 

Oral cholera vaccines: exploring the farrago of evidence
Suman Kanungo, Pranab Chatterjee
1012
Open Access
Summary
The development of a cheap and effective oral cholera vaccine (OCV) is a remarkable achievement in the field of cholera prevention. A meta-analysis on the efficacy and effectiveness of OCVs by Qifang Bi and colleagues1 updates the estimates of the 2011 Cochrane review.2 Their analysis includes additional studies published since 2011, yet provides estimates that are almost the same.

The debate about the low efficacy of OCVs in children aged younger than 5 years has continued to dominate the policy discourse in endemic countries such as India, where children are the main target of immunisation programmes. Older estimates identified children younger than 5 years to be at a disproportionately higher risk of cholera than other age groups;3 however, updated estimates have shown that making robust assertions in the absence of accurate age-specific morbidity and mortality data is difficult.4 This uncertainty has further contributed to a policy-level hesitancy in adopting OCVs for widespread use in endemic countries. Crucially, more accurate estimates of cholera burden should be established to enable programmatic implementation of OCVs, and the reasons for poor immune responses to OCVs in children need to be understood. Furthermore, we propose that the extent of herd protection offered by OCVs should be established, especially in children, if a targeted vaccination policy covering all age groups is endorsed for highly endemic hotspots.5

Water, sanitation, and hygiene (WaSH) interventions are considered to be the best method of cholera control, but gaps have been shown in the knowledge about which interventions work best.6 In our experience, in-house contamination of water remains a major problem, which sometimes persists despite efficient programmatic implementation of WaSH strategies.7 Trials in India have shown similar problems, and a rural sanitation programme failed to show evidence of prevention of diarrhoea and soil-transmitted helminth infections or reduction in faecal contamination of water sources.8, 9, 10

Modelling studies have suggested that in areas with poor sanitation, isolated efforts for water quality improvement are likely to be met with low success.11 Further, considering the high endemicity of cholera in low-income and middle-income countries (LMICs), single-pathway interventions are likely to be inadequate in the control of diarrhoeal diseases, and cholera in particular because of environmental persistence of vibrios, which might not be eradicated even with stringent implementation of such interventions.11 Besides, deploying adequate WaSH interventions takes time because it involves significant investment in infrastructural improvements and behavioural changes. Keeping these issues in mind, cheap and effective OCVs emerge as a viable option to keep cholera at bay, reducing morbidity and mortality, while the definitive WaSH interventions are identified and rolled out. The successful expansion of the Swachh Bharat (Clean India) mission in India provides a governance-driven model of sanitation and hygiene promotion that can be replicated in other LMICs; however, its effectiveness in reducing numbers of cases and deaths from cholera or diarrhoeal diseases needs to be systematically studied.

Although cholera outbreaks in areas of political and civil unrest are a major concern, strategies to mitigate the risks have been poorly studied. Mortality and morbidity from cholera in complex emergencies remains high. A systematic review showed that the evidence on the effectiveness of WaSH interventions in times of humanitarian crises is scarce and of poor quality.12 Only point-of-use interventions and safe water storage were effective measures in reducing diarrhoea incidence.12 By contrast, a single-dose regimen was an effective strategy to combat a cholera outbreak in South Sudan and an endemic focus in Bangladesh.13, 14

The creation of an OCV stockpile, and the commitment of Gavi, the Vaccine Alliance, to support vaccination of emergency and endemic areas of cholera activity, provides a cost-effective method by which countries can access vaccines as they work towards universal deployment of adequate WaSH facilities. In our opinion, a balanced public health policy needs to be in place, in which OCVs are used as a synergistic tool for cholera control, while the most efficient, cost-effective, and locally feasible, acceptable, and relevant WaSH interventions are identified and deployed. Given that even in endemic countries, cholera is a public health menace only in specific regions, with multiple local factors contributing to disease epidemiology, health policies need to be customised to fit the local contexts, eschewing one-size-fits all approaches.
[References at article title link]

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 27 September 2017 [GPEI]
:: Summary of newly-reported viruses this week:
…Pakistan:  one new wild poliovirus type 1 (WPV1) case reported, in Lakki Marwat district, Khyber Pakhtoon province; four new WPV1-positive environmental samples, reported in Sindh and Balochistan provinces.
…Afghanistan: two new WPV1-positive environmental samples reported in Kandahar province.

::::::
::::::

WHO Grade 3 Emergencies  [to 30 September 2017]
South Sudan
:: South Sudan completes the self-assessment for the implementation of the Joint External Evaluation of the International Health Regulations (2005)  25 September 2017
:: Read the latest health situation report pdf, 1.59Mb  22 September 2017
…General cholera trends
Cholera transmission has continued to decline countrywide. In the last four weeks [weeks
35-38], cholera cases dropped from at least 132 cases in week 35 of 2017 to at least 5 cases
In week 38 of 2017…
 
The Syrian Arab Republic
:: WHO online trainings help medical staff in Syria’s besieged areas save lives  28-09-2017

Yemen
:: [Cholera] Daily epidemiology bulletin, 27 September 2017
[See Cholera above for more detail]

::::::
 
WHO Grade 2 Emergencies [to 30 September 2017]
Democratic Republic of the Congo
:: WHO is providing essential medicines for basic health care in response to the growing humanitarian needs of internally displaced people in Tanganyika and Greater Kasai
[French] 26 September 2017 — In this emergency project, WHO is providing medicines to about 100 health facilities in targeted health zones to reduce the impact of epidemics affecting IDPs and host communities.

Ethiopia
:: Integrated Measles and EOS campaign protects 2.6 million children in Ethiopia’s Somali Region
11 September 2017 –Measles is a highly infectious vaccine-preventable disease. While children that are not immunized are at risk, those that are also malnourished or are already affected by other diseases are especially susceptible to it. Children in countries and districts where there is an ongoing emergency such as the current drought which has led to water scarcity and food insecurity in the Horn of Africa are therefore more at risk of contracting the virus and developing complications that often lead to disability and even death…

::::::
::::::
 
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
:: OCHA Iraq | Hawiga Flash Update #2: Hawiga Humanitarian Response, 29 September 2017
 
Syrian Arab Republic
:: 29 Sep 2017  Children in Homs vaccinated against measles thanks to UNICEF
With World Health Organization and the Ministry of Health, UNICEF launched a two-week vaccination campaign against measles. The campaign aims to reach over 260,000 children, aged 5-12 years old, in Homs with the necessary vaccines, focusing on children in hard to reach areas and shelters for internally displaced families…

Yemen  
:: eDEWS Cholera Response Daily Epidemiological Update [EN/AR]
[See Cholera above for more detail]

::::::
UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
DRC
:: DRC: More than 1 million people uprooted from their homes by lingering violence in Kasai
Published on 25 Sep 2017

Nigeria 
:: Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator Mark Lowcock : Opening remarks on Lake Chad Basin for the noon briefing – 28.09.17

Somalia 
:: Humanitarian Bulletin Somalia, September 2017 | Issued on 26 September 2017
HIGHLIGHTS
…Displaced persons among worst affected by drought.
…Over 100,000 displaced people evicted from settlements in 2017, according to the Norwegian Refuge Council.
…AWD/Cholera cases have declined from a peak of over 5,300 cases in June to 93 cases in August.
…Strengthening localization of humanitarian response
 
::::::
::::::
 
Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.

MERS-CoV [to 30 September 2017]
http://www.who.int/emergencies/mers-cov/en/
27 September 2017
Countries agree next steps to combat global health threat by MERS-CoV
Critical next steps to accelerate the response to the global public health threat posed by Middle-East respiratory syndrome coronavirus (MERS-CoV) have been agreed by representatives from the Ministries of Health and Ministries of Agriculture of affected and at-risk countries, and experts. The virus, which circulates in dromedary camels without causing visible disease, can be fatal for humans.

At a meeting hosted by the World Health Organization (WHO), the Food and Agriculture Organization (FAO), and the World Organisation for Animal Health (OIE) in Geneva this week, more than 130 experts from 33 countries, organizations and research institutions met to share what is known about the virus, identify priority research needs, improve cross-collaboration between animal and human health sectors and agree on a plan to address crucial gaps.

“MERS is not only a regional threat. While the majority of human cases have been reported from the Middle-East, the outbreak in the Republic of Korea in 2015 showed MERS’ global reach and capacity to have significant public health and economic consequences,” said Dr Maria Van Kerkhove, MERS-CoV Technical Lead in WHO’s Health Emergencies programme. “We are at the stage where we have to confront the challenges in our ability to detect and respond to MERS outbreaks and improve our knowledge about this virus through collaborative research,” she said.

Since 2012, when the virus was first identified in Saudi Arabia, there have been 2081 laboratory-confirmed cases of MERS-CoV infection reported to WHO from 27 countries, with at least 722 deaths – a fatality rate of 35%. While progress has been made in research and surveillance, significant gaps remain in understanding the virus, including how it circulates in dromedary camels, the natural reservoir host, or how it spills over into the human population.

“MERS-CoV is a disease with a significant impact on public health, which requires further investigations in animal sources to better understand its epidemiology and improve its control in humans. OIE Member Countries are requested to notify any occurrences of MERS-CoV in animals. This crucial information will contribute to escalating a coordinated response from the animal and human health sectors”, said Dr Gounalan Pavade, Chargé de mission, OIE…
 
 
CDC Is Deactivating the Emergency Operations Center for the Zika Response
Press Release  September 29, 2017
CDC is deactivating its emergency response for Zika virus (Zika) to transition efforts to normal program operations on September 29, 2017. On January 22, 2016, CDC activated its Emergency Operations Center (EOC) in response to the devastating effects of Zika virus infection during pregnancy. A team of experts from across the agency, called the Zika Coordination and Operations Transition Team (ZCOTT), will lead the transition from EOC activation to routine, long-term activities and will ensure timely coordination and collaboration on scientific, communication, and policy activities..

WHO & Regional Offices [to 30 September 2017]

Health services must stop leaving older people behind
29 September 2017 – Ahead of the International Day of the Older Person – 1 October – WHO calls for a new approach to providing health services for older people. WHO highlights the role of primary care and the contribution community health workers can make to keeping older people healthier for longer. Older adults are more likely to experience chronic conditions and often multiple conditions at the same time. Yet today’s health systems generally focus on the detection and treatment of individual acute diseases.

Highlights
Antimalarial drug resistance in the Greater Mekong Subregion: How concerned should we be?
September 2017 – A recent letter published in The Lancet Infectious Diseases reported on the presence of a drug-resistant lineage (strain) of malaria parasites in south Viet Nam that is responsible for “alarming rates of failure” of dihydroartemisinin-piperaquine, a first-line antimalarial medicine.

::::::

Weekly Epidemiological Record, 29 September 2017, vol. 92, 39 (pp. 573–588)
:: Armenia, Maldives, Sri Lanka and Kyrgyzstan certified malaria-free
:: Malaria elimination: report from the inaugural global forum of countries with potential to eliminate malaria by 2020
:: Monthly report on dracunculiasis cases, January-August 2017
 
::::::
 
Request for proposals: Website administrator/developer for the TechNet-21 website
pdf, 254kb 29 September 2017 Application deadline: 3 November 2017
 
::::::
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Uganda commits to scaling up collaboration between veterinary health and the public health sector  29 September 2017
:: WHO and partners meet to reflect on progress made in expanding access to medicines through the EC/ACP/WHO Renewed Partnership Project  28 September 2017
:: WHO’s emergency mobile medical teams provide lifesaving health services in famine-affected and hard-to-reach areas of South Sudan  27 September 2017
:: Sixth Meeting of African Ministers of Health of Small Island Developing States opens in Seychelles  27 September 2017
:: South Sudan completes the self-assessment for the implementation of the Joint External Evaluation of the International Health Regulations (2005)  27 September 2017
:: President Danny Faure calls on small island developing nations to continue to ‘Work together as One’  27 September 2017
: Uganda hosts Inter-agency meeting on Neonatal health for Eastern and Southern Africa
25 September 2017
:: Tackling the common health challenges of African Small Island Developing States 25 September 2017

WHO Region of the Americas PAHO
:: PAHO aims to reduce shortage of health workers in the Americas, improve distribution, and enhance skills to achieve SDGs (09/28/2017)
::  Agreements reached on new sustainable health agenda, tobacco control and maintenance of measles and rubella elimination (09/28/2017)
::  Region of the Americas aims to be smoke-free by 2022 (09/28/2017)
::  Dr. Carissa F. Etienne re-elected for second term as PAHO Director (09/27/2017)
:: The Americas adopt ambitious agenda to build sustainable and universal health by 2030 (09/27/2017)
::  Countries of the Americas pledge to improve the health of ethnic groups (09/26/2017)
::  Life expectancy in the Americas increases to 75 years (09/26/2017)
::  PAHO Director highlights regional health achievements and challenges during 2013-2017 (09/25/2017)
::  Health ministers’ meeting at PAHO opens with somber tone after recent disasters (09/25/2017)

WHO South-East Asia Region SEARO
:: 900,000 vaccines “en route” to Cox’s Bazar to prevent cholera  29 Sep 2017
[See Cholera above for more detail]

WHO European Region EURO
:: Living longer, healthier lives – working towards integrated, people-centred care for older persons 29-09-2017
::  Over 100 cases of Chikungunya confirmed in Italy 29-09-2017
::  WHO and Italy sign first country cooperation strategy 26-09-2017
::  Endemic measles interrupted in 42 out of 53 countries in the Region 26-09-2017
[See Milestones above for more detail]

CDC/ACIP [to 30 September 2017]
http://www.cdc.gov/media/index.html

Press Release  September 29, 2017
CDC Is Deactivating the Emergency Operations Center for the Zika Response
CDC is deactivating its emergency response for Zika virus (Zika) to transition efforts to normal program operations on September 29, 2017. On January 22, 2016, CDC activated its Emergency Operations Center (EOC) in response to the devastating effects of Zika virus infection during pregnancy. A team of experts from across the agency, called the Zika Coordination and Operations Transition Team (ZCOTT), will lead the transition from EOC activation to routine, long-term activities and will ensure timely coordination and collaboration on scientific, communication, and policy activities..
 
Press Release  September 28, 2017
New study shows Tdap vaccination during pregnancy can prevent whooping cough in babies
Less than half of pregnant women in the United States take advantage of vaccination
A new CDC study published today in Clinical Infectious Diseases reported that vaccination with whooping cough vaccine, Tdap, during the third trimester of pregnancy prevented more than three out of four (78 percent) cases of whooping cough (also known as pertussis) in babies younger than two months. However, only 49 percent of pregnant women who delivered between fall 2015 and spring 2016 received the vaccine. CDC recommends women get Tdap during each pregnancy to provide critical short-term protection to babies when they are most at risk for this life-threatening illness…

MMWR News Synopsis for September 28, 2017
:: Influenza Vaccination Coverage Among Health Care Personnel – United States, 2016-17 Influenza Season
CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommend that all U.S. health care workers get vaccinated annually against influenza. CDC recommends that all health care personnel (HCP) receive an annual flu vaccination to reduce flu-related morbidity and mortality among HCP and their patients. We analyzed data from an internet panel survey to measure what proportion of HCP received the flu vaccine during the 2016-17 flu season. Based on the data:
:: 79 percent of survey respondents reported receiving vaccination, which is similar coverage during the past three flu seasons.
:: Vaccination coverage continued to be higher among HCP working in hospitals (92 percent) and lower among HCP working in ambulatory (76 percent) and long-term care settings (68 percent).
:: As in previous seasons, coverage was highest among HCP who were required by their employer to be vaccinated (97 percent) and lowest among HCP working in settings where vaccination was not required, promoted, or offered onsite (46 percent).
 
:: Influenza Vaccination Coverage Among Pregnant Women – United States, 2016-17 Influenza Season
CDC recommends that pregnant women get a flu shot during any trimester of their pregnancy to protect themselves and their newborn babies from flu. Pregnant women are at risk for severe flu-associated illness and, since 2004, CDC has recommended flu vaccination for all women who are or will be pregnant during the flu season. We analyzed data from an internet panel survey to measure what proportion of pregnant women received the flu vaccine during the 2016-17 flu season. Based on the data:
:: 54 percent of pregnant women reported being vaccinated before (16 percent) or during (37 percent) pregnancy, which is similar to coverage during the past four flu seasons.
:: 67 percent of women reported receiving a provider offer for influenza vaccination, 12 percent received a recommendation but no offer, and 21 percent received no recommendation; among these women, influenza vaccination coverage was 71 percent, 44 percent, and 15 percent, respectively.
 
:: Evaluation of the Impact of Mandating Health Care Providers to Offer Hepatitis C Virus Screening to All Persons Born During 1945-1965 – New York, 2014

::::::
::::::

Announcements
 
FDA [to 30 September 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
September 28, 2017 –
FDA improves access to reports of adverse drug reactions
The U.S. Food and Drug Administration today launched a new user-friendly search tool that improves access to data on adverse events associated with drug and biologic products through the FDA’s Adverse Event Reporting System (FAERS). The tool is designed to make it easier for consumers, providers, and researchers to access this information.

What’s New for Biologics
:: Important Information for Human Cell, Tissue, and Cellular and Tissue-Based Product (HCT/P) Establishments Regarding Zika Virus Transmission Risk in the World (PDF – 162KB)
Posted: 9/28/2017
:: Important Information for Blood Establishments Regarding Zika Virus Transmission Risk in the World (PDF – 143KB)
Posted: 9/28/2017
:: Influenza Virus Vaccine for the 2017-2018 Season
Updated: 9/28/2017
 
Gavi [to 30 September 2017]
http://www.gavi.org/library/news/press-releases/
29 September 2017
900,000 vaccines ‘en route’ to Cox’s Bazar to prevent cholera
Oral cholera vaccine will protect Rohingya refugees seeking shelter in Bangladesh as well as resident population.
 [See Cholera above for more detail]
 
Korea commits US$4 million to immunise children in world’s poorest countries
South Korea renews pledge to Gavi, the Vaccine Alliance for 2018
Geneva, 25 September 2017 – The Republic of Korea has committed US$4 million to Gavi, the Vaccine Alliance to fund its work over 2018, helping to reach hundreds of thousands of children across the developing world with lifesaving vaccines.
South Korea became the first East Asian donor to Gavi in 2010, and has since provided $15 million to the Vaccine Alliance. Today’s $4 million commitment, made at a signing ceremony at the Ministry of Foreign Affairs (MOFA) in Seoul, will be delivered in 2018 and will be funded through Korea’s Global Disease Eradication Fund…
 
Hilleman Laboratories   [to 30 September 2017]
http://www.hillemanlabs.org/
28/09/2017
Hilleman Laboratories receives Indo-Swedish grant for developing – Oral Cholera Vaccine (OCV)
New Delhi: Hilleman Laboratories, a joint-venture partnership between MSD and Wellcome Trust, received a 6 million krona Indo – Swedish grant for the project ‘Improved, affordable single strain whole cell-B subunit oral cholera vaccine’.
The proposed project carried out by Hilleman Laboratories, is being jointly funded by the Department of Biotechnology (DBT), Government of India and Vinnova, the Swedish Governmental Agency for Innovation Systems.
The project will fuel further Research & Development of the Oral Cholera Vaccine (OCV) with knowledge exchange and transfer of scientists across India and Sweden.
Speaking on the partnership, Dr. Davinder Gill, CEO Hilleman Laboratories said, “Cholera remains a threat to global public health and is a barometer of health inequity and lack of social development. Considering the urgent need for effective and affordable Cholera vaccines, both for use in Cholera outbreaks and in mass vaccination campaigns, we would like to accelerate development of our simplified Oral Cholera Vaccine, HILLCHOLTM.” …
 
Human Vaccines Project   [to 30 September 2017]
http://www.humanvaccinesproject.org/media/press-releases/
Sep 26, 2017, 09:04 ET
Dr. Marie-Paule Kieny Appointed To The Human Vaccines Project Board Of Directors
PRNewswire-USNewswire/ — The Human Vaccines Project, a nonprofit public-private partnership focused on decoding the immune system to improve human health, welcomes Dr. Marie-Paule Kieny to its Board of Directors. Dr. Kieny is currently Director of Research at Institut National de la Santé et de la Recherché Médicale (INSERM) where she connects INSERM with the international health research community, and has held several positions at the World Health Organization (WHO)….
 
IAVI  [to 30 September 2017]
https://www.iavi.org/
September 29, 2017
New IAVI Collaboration Seeks to Expand Evolutionary Data on Cancer and HIV
What do HIV and cancer have in common?
The scientific question gets a fresh start this month as IAVI’s Jonathan Hare and Charles Swanton of the Francis Crick Institute and Cancer Research UK (CRUK) initiate their CRUK Pioneer Award. The £200,000 grant over two years funds their search for immunological parallels between HIV/AIDS and Non-Small Cell Lung Cancer (NSCLC).
Jonathan Hare is senior manager of IAVI’s Human Immunology Lab in London and winner of a CRUK Pioneer Award to expand evolutionary data on HIV and cancer.“ Scientists have ruminated on the crossover between cancer and HIV for years,” said Hare, who is senior manager of IAVI’s Human Immunology Lab at Imperial College London. “Though some data exists to suggest a connection, we can now get started on a more systematic approach to identifying common ground.”…
 
MSF/Médecins Sans Frontières  [to 30 September 2017]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
Intensified Bombings Decimate Health Facilities Across Northwestern Syria
Brussels/New York, September 28, 2017—An escalation in the bombing of medical facilities since September 19 has forced the closure and evacuation of hospitals throughout northwestern Syria, leaving people trapped in a war zone without access to health care, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) in a statement today.

Press release
Yemen: Government Health Staff are Saving Lives Without Salaries in War-Torn Country
September 28, 2017
Yemen’s public health staff have not received their regular salaries in a year, bringing medical services to the edge of collapse, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) in a report released today.
 
NIH  [to 30 September 2017]
http://www.nih.gov/news-events/news-releases
September 28, 2017
Disease resistance successfully spread from modified to wild mosquitoes
— NIAID-funded group assesses mating of genetically modified species
 
PATH  [to 30 September 2017]
http://www.path.org/news/index.php
Press release | September 28, 2017
New global initiative will connect the world for better health through digital technology
Digital Square, led by PATH, will align multi-sector investments into scalable solutions that strengthen national digital health systems

Announcement | September 26, 2017
PATH welcomes $10.5 million grant to expand contraceptive choice and access
Subcutaneous DMPA Access Collaborative will provide coordination and technical assistance for product introduction and scale-up in family planning programs

Press release | September 26, 2017
Serum Institute’s vaccine demonstrates significant efficacy against severe rotavirus gastroenteritis
Indian Government orders the vaccine for use in Universal Immunization Programme

UNAIDS [to 30 September 2017]
http://www.unaids.org/en
Update
Governments of Belarus and the Netherlands exchange best practices
29 September 2017
During a two-day visit on 25 and 26 September to Belarus, UNAIDS Deputy Executive Director Luiz Loures and the Ambassador for Sexual and Reproductive Health and Rights & HIV/AIDS of the Netherlands, Lambert Grijns, met with civil society organizations and communities of people who inject drugs, women living with HIV, men who have sex with men and sex workers to hear their perspectives on the current needs and challenges of the AIDS response in the country.
 
Wellcome Trust  [to 30 September 2017]
https://wellcome.ac.uk/news
News / Published: 29 September 2017
New typhoid vaccine could halve infection rate
Researchers have shown that a new typhoid vaccine called Vi-TT is safe, well-tolerated and could be effective in tackling typhoid rates in affected areas.
 
::::::
 
DCVMN – Developing Country Vaccine Manufacturers Network  [to 30 September 2017]
http://www.dcvmn.org/
25 September 2017 to 28 September 2017
DCVMN Annual General Meeting
Seoul / Korea
Download the Agenda
 
::::::
 
Industry Watch
:: Moderna Announces Publication in Molecular Therapy Characterizing Potent Immune Response Generated by Its mRNA Prophylactic Vaccines
–Research led by Karolinska Institutet describes how Moderna’s vaccines target key antigen-presenting cells, leading to both B cell and T cell responses–
September 26, 2017 08:00 AM Eastern Daylight Time
CAMBRIDGE, Mass.–(BUSINESS WIRE)–Moderna Therapeutics, a clinical stage biotechnology company that is pioneering messenger RNA (mRNA) therapeutics and vaccines to create a new generation of transformative medicines for patients, announced a new publication in Molecular Therapy that provides mechanistic insights about its mRNA prophylactic vaccines. The research, led by Professor Karin Loré, Ph.D., and her group at the Karolinska Institutet in Stockholm, Sweden, characterizes how Moderna’s vaccines target key antigen-presenting cells, leading to both B cell and T cell activation, which yields a potent immune response.
The study utilized a research version of Moderna’s influenza H10N8 vaccine, which encodes for the viral antigenic protein hemagglutinin (HA) encapsulated in lipid nanoparticles (LNPs). In the study, the H10N8 vaccine induced protective titers of HA antibody, as well as CD4+ T cell responses, after intramuscular or intradermal injection into non-human primates (NHPs)…
 
“Given the software-like nature of our medicines, these findings should translate across our vaccine platform. We look forward to publishing additional mechanism of action insights as we continue to advance our ambitious pipeline of prophylactic vaccines.”

Journal Watch

   Vaccines and Global Health: The Week in Review continues its weekly scanning of key peer-reviewed journals to identify and cite articles, commentary and editorials, books reviews and other content supporting our focus on vaccine ethics and policy. Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher.

If you would like to suggest other journal titles to include in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

American Journal of Infection Control
October 01, 2017 Volume 45, Issue 10, p1057-1174, e103-e118
http://www.ajicjournal.org/current

Message from APIC
International Infection Prevention Week: A time to celebrate infection preventionists and raise awareness of the profession
Published in issue: October 01, 2017

Brief Report
Psychosocial determinants of influenza vaccination intention: A cross-sectional study on inpatient nurses in Singapore
Highlights
:: Of the respondents, 71% intended to receive the influenza vaccination.
:: Vaccination benefits and nonsusceptibility best predict vaccination intention.
:: Impending threat of infectious diseases affects nurses’ decision for vaccination.
:: Vaccination promotion should address concerns on influenza vaccine adverse effects.
Dwee Wee Lim, Lay Tin Lee, Win Mar Kyaw, Angela Chow
Published online: April 24, 2017

American Journal of Preventive Medicine
October 2017 Volume 53, Issue 4, p405-566, e123-e154
http://www.ajpmonline.org/current

Brief Reports
Potential Consequences of Not Using Live Attenuated Influenza Vaccine
Kenneth J. Smith, Mary Patricia Nowalk, Angela Wateska, Shawn T. Brown, Jay V. DePasse, Jonathan M. Raviotta, Eunha Shim, Richard K. Zimmerman
Published online: April 18, 2017

Population Health
Tdap Vaccination Among Healthcare Personnel, Internet Panel Survey, 2012–2014
Anup Srivastav, Carla L. Black, Peng-Jun Lu, Jun Zhang, Jennifer L. Liang, Stacie M. Greby
Published online: May 23, 2017

American Journal of Public Health
October 2017 107(10)
http://ajph.aphapublications.org/toc/ajph/current

Editorials
PREEXPOSURE PROPHYLAXIS
Preexposure Prophylaxis: Adapting HIV Prevention Models to Achieve Worldwide Access
Stewart Landers and Farzana Kapadia
107(10), pp. 1534–1535

PREVENTION OPTIMISM
Individual Versus Community-Level Risk Compensation Following Preexposure Prophylaxis of HIV
Martin Holt and Dean A. Murphy
107(10), pp. 1568–1571

HIV Preexposure Prophylaxis and Condomless Sex: Disentangling Personal Values From Public Health Priorities
Sarah K. Calabrese, Kristen Underhill and Kenneth H. Mayer
107(10), pp. 1572–1576

WORLD HEALTH ORGANIZATION
The World Health Organization, Public Health Ethics, and Surveillance: Essential Architecture for Social Well-Being
Amy L. Fairchild, Angus Dawson, Ronald Bayer and Michael J. Selgelid
107(10), pp. 1596–1598

American Journal of Tropical Medicine and Hygiene
Volume 97, Issue 3, 2017 Suppl, 2017
http://www.ajtmh.org/content/current

Editorial
Assessing the Health Impact of Malaria Control Interventions in the MDG/Sustainable Development Goal Era: A New Generation of Impact Evaluations
Author: Alexander K. Rowe
https://doi.org/10.4269/ajtmh.17-0509

Articles
Framework for Evaluating the Health Impact of the Scale-Up of Malaria Control Interventions on All-Cause Child Mortality in Sub-Saharan Africa
Authors: Yazoume Yé, Thomas P. Eisele, Erin Eckert, Eline Korenromp, Jui A. Shah, Christine L. Hershey, Elizabeth Ivanovich, Holly Newby, Liliana Carvajal-Velez, Michael Lynch, Ryuichi Komatsu, Richard E. Cibulskis, Zhuzhi Moore and Achuyt Bhattarai
https://doi.org/10.4269/ajtmh.15-0363

Implementing Impact Evaluations of Malaria Control Interventions: Process, Lessons Learned, and Recommendations
Authors: Christine L. Hershey, Achuyt Bhattarai, Lia S. Florey, Peter D. McElroy, Carrie F. Nielsen, Yazoume Yé, Erin Eckert, Ana Cláudia Franca-Koh, Estifanos Shargie, Ryuichi Komatsu, Paul Smithson, Julie Thwing, Jules Mihigo, Samantha Herrera, Cameron Taylor, Jui Shah, Eric Mouzin, Steven S. Yoon and S. René Salgado
https://doi.org/10.4269/ajtmh.17-0064

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 30 September 2017)

Research article
Knowledge translation tools for parents on child health topics: a scoping review
An emerging field of knowledge translation (KT) research has begun to focus on health consumers, particularly in child health. KT tools provide health consumers with research knowledge to inform health decisio…
Lauren Albrecht, Shannon D. Scott and Lisa Hartling
BMC Health Services Research 2017 17:686
Published on: 29 September 2017

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 30 September 2017)

Research article
Determinants of effective vaccine coverage in low and middle-income countries: a systematic review and interpretive synthesis
David E. Phillips, Joseph L. Dieleman, Stephen S. Lim and Jessica Shearer
BMC Health Services Research 2017 17:681
Published on: 26 September 2017
Abstract
Background
Many children in low and middle-income countries remain unvaccinated, and vaccines do not always produce immunity. Extensive research has sought to understand why, but most studies have been limited in breadth and depth. This study documents existing evidence on determinants of vaccination and immunization and presents a conceptual framework of determinants.
Methods
We used systematic review, content analysis, thematic analysis and interpretive synthesis to document and analyze the existing evidence on determinants of childhood vaccination and immunization.
Results
We documented 1609 articles, including content analysis of 78 articles. Three major thematic models were described in the context of one another. Interpretive synthesis identified similarities and differences between studies, resulting in a conceptual framework with three principal vaccine utilization determinants: 1) Intent to Vaccinate, 2) Community Access and 3) Health Facility Readiness.
Conclusion
This study presents the most comprehensive systematic review of vaccine determinants to date. The conceptual framework represents a synthesis of multiple existing frameworks, is applicable in low and middle-income countries, and is quantitatively testable. Future researchers can use these results to develop competing conceptual frameworks, or to analyze data in a theoretically-grounded way. This review enables better research in the future, further understanding of immunization determinants, and greater progress against vaccine preventable diseases around the world.
 
 

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 30 September 2017)

Research Article
Possible explanations for why some countries were harder hit by the pandemic influenza virus in 2009 – a global mortality impact modeling study
A global pandemic mortality study found prominent regional mortality variations in 2009 for Influenza A(H1N1)pdm09. Our study attempts to identify factors that explain why the pandemic mortality burden was hig…
Kathleen F. Morales, John Paget and Peter Spreeuwenberg
BMC Infectious Diseases 2017 17:642
Published on: 25 September 2017

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 30 September 2017)

Research article
Assessment of the HBV vaccine response in a group of HIV-infected children in Morocco
Since its development in the early 1980s, Hepatitis B virus (HBV) vaccine has been proven to be highly protective. However, its immunogenicity may be ineffective among HIV-infected children. In Morocco, HBV va…
Houda Haban, Soumia Benchekroun, Mina Sadeq, Abdelaziz Benjouad, Said Amzazi, Hicham Oumzil and Elmir Elharti
BMC Public Health 2017 17:752
Published on: 29 September 2017

Global Health: Science and Practice (GHSP)
September 2017 | Volume 5 | Number 3
http://www.ghspjournal.org/content/current

COMMENTARIES
Open Access
Seeking Synchrony Between Family Planning and Immunization: A Week-10 DMPA Start Option for Breastfeeding Mothers
John Stanback
Global Health: Science and Practice September 2017, 5(3):341-344; https://doi.org/10.9745/GHSP-D-17-00063
Many mothers initiate DMPA injectables at 6 weeks postpartum, at the time of their baby’s first immunization visit. Offering an optional delayed DMPA start at the next (10-week) immunization visit has potential advantages including a reduced follow-up schedule with DMPA visits synchronized with other immunization visits, and, possibly, improved contraceptive and immunization outcomes.

Health Policy and Planning
Volume 32, Issue 8   October 2017
http://heapol.oxfordjournals.org/content/current

The cost structure of routine infant immunization services: a systematic analysis of six countries
Fangli Geng; Christian Suharlim; Logan Brenzel; Stephen C Resch; Nicolas A Menzies
Health Policy and Planning, Volume 32, Issue 8, 1 October 2017, Pages 1174–1184, https://doi.org/10.1093/heapol/czx067

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 30 September 2017]

Research
The cost structure of routine infant immunization services: a systematic analysis of six countries
Fangli Geng; Christian Suharlim; Logan Brenzel; Stephen C Resch; Nicolas A Menzies
Health Policy and Planning, Volume 32, Issue 8, 1 October 2017, Pages 1174–1184, https://doi.org/10.1093/heapol/czx067
Abstract
Little information exists on the cost structure of routine infant immunization services in low- and middle-income settings. Using a unique dataset of routine infant immunization costs from six countries, we estimated how costs were distributed across budget categories and programmatic activities, and investigated how the cost structure of immunization sites varied by country and site characteristics. The EPIC study collected data on routine infant immunization costs from 319 sites in Benin, Ghana, Honduras, Moldova, Uganda, Zambia, using a standardized approach. For each country, we estimated the economic costs of infant immunization by administrative level, budget category, and programmatic activity from a programme perspective. We used regression models to describe how costs within each category were related to site operating characteristics and efficiency level. Site-level costs (incl. vaccines) represented 77–93% of national routine infant immunization costs. Labour and vaccine costs comprised 14–69% and 13–69% of site-level cost, respectively. The majority of site-level resources were devoted to service provision (facility-based or outreach), comprising 48–78% of site-level costs across the six countries. Based on the regression analyses, sites with the highest service volume had a greater proportion of costs devoted to vaccines, with vaccine costs per dose relatively unaffected by service volume but non-vaccine costs substantially lower with higher service volume. Across all countries, more efficient sites (compared with sites with similar characteristics) had a lower cost share devoted to labour. The cost structure of immunization services varied substantially between countries and across sites within each country, and was related to site characteristics. The substantial variation observed in this sample suggests differences in operating model for otherwise similar sites, and further understanding of these differences could reveal approaches to improve efficiency and performance of immunization sites.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 13, Issue 9 2017
http://www.tandfonline.com/toc/khvi20/current

Article
A forecast of typhoid conjugate vaccine introduction and demand in typhoid endemic low- and middle-income countries to support vaccine introduction policy and decisions
Vittal Mogasale, Enusa Ramani, Il Yeon Park & Jung Seok Lee
Pages: 2017-2024
Published online: 12 Jun 2017
ABSTRACT
A Typhoid Conjugate Vaccine (TCV) is expected to acquire WHO prequalification soon, which will pave the way for its use in many low- and middle-income countries where typhoid fever is endemic. Thus it is critical to forecast future vaccine demand to ensure supply meets demand, and to facilitate vaccine policy and introduction planning. We forecasted introduction dates for countries based on specific criteria and estimated vaccine demand by year for defined vaccination strategies in 2 scenarios: rapid vaccine introduction and slow vaccine introduction. In the rapid introduction scenario, we forecasted 17 countries and India introducing TCV in the first 5 y of the vaccine’s availability while in the slow introduction scenario we forecasted 4 countries and India introducing TCV in the same time period. If the vaccine is targeting infants in high-risk populations as a routine single dose, the vaccine demand peaks around 40 million doses per year under the rapid introduction scenario. Similarly, if the vaccine is targeting infants in the general population as a routine single dose, the vaccine demand increases to 160 million doses per year under the rapid introduction scenario. The demand forecast projected here is an upper bound estimate of vaccine demand, where actual demand depends on various factors such as country priorities, actual vaccine introduction, vaccination strategies, Gavi financing, costs, and overall product profile. Considering the potential role of TCV in typhoid control globally; manufacturers, policymakers, donors and financing bodies should work together to ensure vaccine access through sufficient production capacity, early WHO prequalification of the vaccine, continued Gavi financing and supportive policy.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 13, Issue 9 2017
http://www.tandfonline.com/toc/khvi20/current

Article
Age-appropriate versus up-to-date coverage of routine childhood vaccinations among young children in Israel
Chen Stein-Zamir & Avi Israeli
Pages: 2102-2110
Published online: 11 Jul 2017

Brief Report
Relationship between maternal experiences and adolescent HPV vaccination
Abbey B. Berenson, V. Gnaukita Brown, Erika L. Fuchs, Jacqueline M. Hirth & Mihyun Chang
Pages: 2150-2154
Published online: 12 Jun 2017

Review
Standard of care in immunotherapy trials: Challenges and considerations
Gareth Rivalland, Andrew M. Scott & Thomas John
Pages: 2164-2178
Published online: 01 Mar 2017
This review addresses the most important challenges in the selection of SOC in immunotherapeutic trials and the current and future challenges in trial design.

Article Commentary
Immunotherapy is different: Implications for vaccine clinical trial design
Richard Simon
Pages: 2179-2184
Published online: 12 May 2017

Article
Recall and decay of consent information among parents of infants participating in a randomized controlled clinical trial using an audio-visual tool in The Gambia
Robert B. Mboizi, Muhammed O. Afolabi, Michael Okoye, Beate Kampmann, Anna Roca & Olubukola T. Idoko
Pages: 2185-2191
Published online: 09 Jun 2017

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 13, Issue 9 2017
http://www.tandfonline.com/toc/khvi20/current

Review
Vaccine development and trials in low and lower-middle income countries: Key issues, advances and future opportunities
Amy Grenham & Tonya Villafana
Pages: 2192-2199
Published online: 31 Jul 2017
ABSTRACT
Over the past 10 years there has been an increase in the number of vaccine clinical studies conducted in resource limited countries. These include vaccine trials for diseases such as malaria and dengue fever which are endemic to many low and lower-middle income countries. Concurrent with the increase in the number of trials, has been the increase and improvement in local infrastructure to enable the appropriate conduct and oversight of trials in these settings, including strengthening of local scientific capabilities, ethical and regulatory oversight. While significant advances have been made, there remain gaps to be addressed including strengthening pharmacovigilance in these regions. There are also opportunities to establish novel collaborations to address diseases specific to these populations including strengthening local manufacturers, new ways to engage established large pharmaceutical companies and leveraging established global infrastructure and pathways to develop innovative products beyond vaccines.

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 30 September 2017]

Opinion
Neglected tropical diseases: exploring long term practical approaches to achieve sustainable disease elimination and beyond
Giuseppina Ortu and Oliver Williams
Published on: 27 September 2017
Abstract
Background
Remarkable progress has been made in the fight against neglected tropical diseases, but new challenges have emerged. Innovative diagnostics, better drugs and new insecticides are often identified as the priority; however, access to these new tools may not be sufficient to achieve and sustain disease elimination, if certain challenges and priorities are not considered.
Main body
The authors summarise key operational challenges, and based on these, identify two major priorities: strengthening the capacity of the primary health care health system in correctly diagnosing and managing neglected tropical diseases; and establishing an effective disease surveillance process.
Five steps are proposed as concrete actions to build an effective primary health care service for neglected tropical diseases, and a health management information system capable of accurately reporting these diseases. Community engagement and formalization of community health workers role are proposed as essential components of these steps.
Shift of financial support from disease oriented programmes to disease integrated interventions, improved access to international guidelines for primary health care staff, and availability of donated drugs in health care structures are also suggested as key elements of the proposed process.
Conclusion
The authors conclude that failure to address these priorities now may lead to further challenges on the long path towards neglected tropical disease elimination and beyond.

International Journal of Community Medicine and Public Health
Vol 4, No 10 (2017)  October 2017
http://www.ijcmph.com/index.php/ijcmph/issue/view/31

Original Research Articles
Assessment of immunization services at immunization sessions under Ghatnandur PHC area in Beed district
Shashikant Shivajirao Salunke, Poonam Vijay Sancheti
DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20174228

Awareness and attitudes of mothers towards new vaccines in the childhood vaccination programme in delhi state: a cross sectional study
Reema Mukherjee, Manisha Arora, Atul Kotwal, Poonam Hooda
DOI: 10.18203/2394-6040.ijcmph20174264

International Journal of Infectious Diseases
October 2017 Volume 63, p1-100
http://www.ijidonline.com/issue/S1201-9712(17)X0010-6

Reviews
Utility and potential of rapid epidemic intelligence from internet-based sources
S.J. Yan, A.A. Chughtai, C.R. Macintyre
p77–87
Published online: July 29, 2017

JAMA
September 26, 2017, Vol 318, No. 12, Pages 1083-1198
http://jama.jamanetwork.com/issue.aspx

Viewpoint
Addressing Antimicrobial Resistance and Stewardship: The Priority Antimicrobial Value and Entry (PAVE) Award
Gregory W. Daniel, PhD, MPH; Monika Schneider, PhD; Mark B. McClellan, MD, PhD
JAMA. 2017;318(12):1103-1104. doi:10.1001/jama.2017.10164
This Viewpoint describes the Priority Antimicrobial Value and Entry (PAVE) award, which has been proposed to address the problem of antimicrobial-resistant infections using limited public funds to shift to value-based payment for new, high-priority antimicrobial drugs.

Journal of Epidemiology & Community Health
October 2017 – Volume 71 – 10
http://jech.bmj.com/content/current

Cancer Risk
The impact of bivalent HPV vaccine on cervical intraepithelial neoplasia by deprivation in Scotland: reducing the gap
Ross L Cameron, Kimberley Kavanagh, D Cameron Watt, Chris Robertson, Kate Cuschieri, Syed Ahmed, Kevin G Pollock

Journal of Medical Ethics
October 2017 – Volume 43 – 10
http://jme.bmj.com/content/current

Editorials
Antimicrobial resistance and antimicrobial stewardship programmes: benefiting the patient or the population?
Alberto Giubilini

Why health services research needs bioethics
Lucy Frith
 
Commentaries
Vulnerability of pregnant women in clinical research Free
Indira S E van der Zande, Rieke van der Graaf, Martijn A Oudijk, Johannes J M van Delden

Pregnant women should not be categorised as a ‘vulnerable population’ in biomedical research studies: ending a vicious cycle of ‘vulnerability’
Carleigh B Krubiner, Ruth R Faden

Journal of Virology
October 2017, volume 91, issue 20
http://jvi.asm.org/content/current

Gem
Monoclonal Antibodies against Zika Virus: Therapeutics and Their Implications for Vaccine Design
Qihui Wang, Jinghua Yan, and George Fu Gao

The Lancet
Sep 30, 2017 Volume 390 Number 10102 p1563-1622  e23
http://www.thelancet.com/journals/lancet/issue/current

Articles
Effectiveness of a group B outer membrane vesicle meningococcal vaccine against gonorrhoea in New Zealand: a retrospective case-control study
Helen Petousis-Harris, Janine Paynter, Jane Morgan, Peter Saxton, Barbara McArdle, Felicity Goodyear-Smith, Steven Black
…Interpretation
Exposure to MeNZB was associated with reduced rates of gonorrhoea diagnosis, the first time a vaccine has shown any protection against gonorrhoea. These results provide a proof of principle that can inform prospective vaccine development not only for gonorrhoea but also for meningococcal vaccines.

Lancet Global Health
Oct 2017 Volume 5 Number 10 e948-e1046
http://www.thelancet.com/journals/langlo/issue/current

Articles
Effect of counselling on health-care-seeking behaviours and rabies vaccination adherence after dog bites in Haiti, 2014–15: a retrospective follow-up survey
Melissa Dominique Etheart, Maxwell Kligerman, Pierre Dilius Augustin, Jesse D Blanton, Benjamin Monroe, Ludder Fleurinord, Max Millien, Kelly Crowdis, Natael Fenelon, Ryan MacLaren Wallace

Lancet Infectious Diseases
Oct 2017 Volume 17 Number 10 p1003-1098  e306-e333
http://www.thelancet.com/journals/laninf/issue/current

Editorial
Vaccine against Zika virus must remain a priority
The Lancet Infectious Diseases

Lancet Infectious Diseases
Oct 2017 Volume 17 Number 10 p1003-1098  e306-e333
http://www.thelancet.com/journals/laninf/issue/current

Editorial
Comment 
Oral cholera vaccines: exploring the farrago of evidence
Suman Kanungo, Pranab Chatterjee
1012
Open Access
Summary
The development of a cheap and effective oral cholera vaccine (OCV) is a remarkable achievement in the field of cholera prevention. A meta-analysis on the efficacy and effectiveness of OCVs by Qifang Bi and colleagues1 updates the estimates of the 2011 Cochrane review.2 Their analysis includes additional studies published since 2011, yet provides estimates that are almost the same.

The debate about the low efficacy of OCVs in children aged younger than 5 years has continued to dominate the policy discourse in endemic countries such as India, where children are the main target of immunisation programmes. Older estimates identified children younger than 5 years to be at a disproportionately higher risk of cholera than other age groups;3 however, updated estimates have shown that making robust assertions in the absence of accurate age-specific morbidity and mortality data is difficult.4 This uncertainty has further contributed to a policy-level hesitancy in adopting OCVs for widespread use in endemic countries. Crucially, more accurate estimates of cholera burden should be established to enable programmatic implementation of OCVs, and the reasons for poor immune responses to OCVs in children need to be understood. Furthermore, we propose that the extent of herd protection offered by OCVs should be established, especially in children, if a targeted vaccination policy covering all age groups is endorsed for highly endemic hotspots.5

Water, sanitation, and hygiene (WaSH) interventions are considered to be the best method of cholera control, but gaps have been shown in the knowledge about which interventions work best.6 In our experience, in-house contamination of water remains a major problem, which sometimes persists despite efficient programmatic implementation of WaSH strategies.7 Trials in India have shown similar problems, and a rural sanitation programme failed to show evidence of prevention of diarrhoea and soil-transmitted helminth infections or reduction in faecal contamination of water sources.8, 9, 10

Modelling studies have suggested that in areas with poor sanitation, isolated efforts for water quality improvement are likely to be met with low success.11 Further, considering the high endemicity of cholera in low-income and middle-income countries (LMICs), single-pathway interventions are likely to be inadequate in the control of diarrhoeal diseases, and cholera in particular because of environmental persistence of vibrios, which might not be eradicated even with stringent implementation of such interventions.11 Besides, deploying adequate WaSH interventions takes time because it involves significant investment in infrastructural improvements and behavioural changes. Keeping these issues in mind, cheap and effective OCVs emerge as a viable option to keep cholera at bay, reducing morbidity and mortality, while the definitive WaSH interventions are identified and rolled out. The successful expansion of the Swachh Bharat (Clean India) mission in India provides a governance-driven model of sanitation and hygiene promotion that can be replicated in other LMICs; however, its effectiveness in reducing numbers of cases and deaths from cholera or diarrhoeal diseases needs to be systematically studied.

Although cholera outbreaks in areas of political and civil unrest are a major concern, strategies to mitigate the risks have been poorly studied. Mortality and morbidity from cholera in complex emergencies remains high. A systematic review showed that the evidence on the effectiveness of WaSH interventions in times of humanitarian crises is scarce and of poor quality.12 Only point-of-use interventions and safe water storage were effective measures in reducing diarrhoea incidence.12 By contrast, a single-dose regimen was an effective strategy to combat a cholera outbreak in South Sudan and an endemic focus in Bangladesh.13, 14

The creation of an OCV stockpile, and the commitment of Gavi, the Vaccine Alliance, to support vaccination of emergency and endemic areas of cholera activity, provides a cost-effective method by which countries can access vaccines as they work towards universal deployment of adequate WaSH facilities. In our opinion, a balanced public health policy needs to be in place, in which OCVs are used as a synergistic tool for cholera control, while the most efficient, cost-effective, and locally feasible, acceptable, and relevant WaSH interventions are identified and deployed. Given that even in endemic countries, cholera is a public health menace only in specific regions, with multiple local factors contributing to disease epidemiology, health policies need to be customised to fit the local contexts, eschewing one-size-fits all approaches.
[References at article title link]

Nature 
Volume 549 Number 7673 pp432-558  28 September 2017
http://www.nature.com/nature/current_issue.html

Editorials
Steps towards transparency in research publishing
As research and editorial processes become increasingly open, scientists and editors need to be proactive but also alert to risks.

New England Journal of Medicine
September 28, 2017  Vol. 377 No. 13
http://www.nejm.org/toc/nejm/medical-journal

Special Report
Investing in Global Health for Our Future
Victor Dzau, M.D., Valentin Fuster, M.D., Ph.D., Jendayi Frazer, Ph.D., and Megan Snair, M.P.H.
N Engl J Med 2017; 377:1292-1296 September 28, 2017 DOI: 10.1056/NEJMsr1707974
[Initial text]
With connectedness among countries increasing, the United States exists in a highly interdependent world. All countries are now vulnerable to the ever-present threats of infectious disease outbreaks and epidemics, as well as the continuous challenges of malaria, tuberculosis, and human immunodeficiency virus–acquired immunodeficiency syndrome (HIV–AIDS). Furthermore, the increasing prevalence of chronic noncommunicable diseases (NCDs) has negatively affected global health and economies, compromising societal gains in life expectancy, productivity, and overall quality of life.1 In addition to resulting in the loss of lives, these disease burdens can stall the progress of a country’s development and significantly affect its ability to become a strong trading partner or a business or travel destination. Human capital clearly contributes substantially to economic growth, and it follows that having a healthy population is critical for economic prosperity. For all these reasons, the health of other countries has a great influence on the health, security, economy, and well-being of the United States. At the same time, interdependency brings opportunities for shared innovation and universal purpose in response to similar disease burdens across countries…

Prehospital & Disaster Medicine
Volume 32 – Issue 5 – October 2017
https://www.cambridge.org/core/journals/prehospital-and-disaster-medicine/latest-issue

Editorial
The Revised International Guidelines for Ethical Health-Related Human Research
Samuel J. Stratton
https://doi.org/10.1017/S1049023X17006938
Published online: 28 September 2017, pp. 471-472

Original Research
Categorization and Analysis of Disaster Health Publications: An Inventory
Marvin L. Birnbaum, Sowmya Adibhatla, Olivia Dudek, Jessica Ramsel-Miller
https://doi.org/10.1017/S1049023X17006525
Published online: 31 May 2017, pp. 473-482

Disaster Metrics: A Comprehensive Framework for Disaster Evaluation Typologies
Diana F. Wong, Caroline Spencer, Lee Boyd, Frederick M. Burkle, Frank Archer
https://doi.org/10.1017/S1049023X17006471
Published online: 08 May 2017, pp. 501-514

Preventive Medicine
Volume 101, Pages 1-238 (August 2017)
http://www.sciencedirect.com/science/journal/00917435/101?sdc=1

Review Article
A systematic review of peer-supported interventions for health promotion and disease prevention
Pages 156-170
Rajeev Ramchand, Sangeeta C. Ahluwalia, Lea Xenakis, Eric Apaydin, Laura Raaen, Geoffrey Grimm

Regular Articles
Seasonal influenza vaccine uptake among people with disabilities: A nationwide population study of disparities by type of disability and socioeconomic status in France
Original Research Article
Pages 1-7
Aurélie Bocquier, Lisa Fressard, Alain Paraponaris, Bérengère Davin, Pierre Verger

Science         
29 September 2017  Vol 357, Issue 6358
http://www.sciencemag.org/current.dtl

Feature
The preprint dilemma
By Jocelyn Kaiser
Science29 Sep 2017 : 1344-1349 Full Access
Biologists are posting unreviewed papers in record numbers. Here’s a survival guide.

Policy Forum
Reducing antimicrobial use in food animals
By Thomas P. Van Boeckel, Emma E. Glennon, Dora Chen, Marius Gilbert, Timothy P. Robinson, Bryan T Grenfell, Simon A. Levin, Sebastian Bonhoeffer, Ramanan Laxminarayan
Science29 Sep 2017 : 1350-1352 Open Access CCBY
Consider user fees and regulatory caps on veterinary use

Vaccine
Volume 35, Issue 41, Pages 5435-5510 (4 October 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/41?sdc=1
New Technologies, New Vaccines

Edited by Stephen J. Streatfield, Jerzy Karczewski and Vidadi Yusibov
Original Research Article
Vaccine development for emerging virulent infectious diseases
Pages 5437-5443
Joel N. Maslow
Abstract
The recent outbreak of Zaire Ebola virus in West Africa altered the classical paradigm of vaccine development and that for emerging infectious diseases (EIDs) in general. In this paper, the precepts of vaccine discovery and advancement through pre-clinical and clinical assessment are discussed in the context of the recent Ebola virus, Middle East Respiratory Syndrome coronavirus (MERS-CoV), and Zika virus outbreaks. Clinical trial design for diseases with high mortality rates and/or high morbidity in the face of a global perception of immediate need and the factors that drive design in the face of a changing epidemiology are presented. Vaccines for EIDs thus present a unique paradigm to standard development precepts.

Original Research Article
Characterization of human monoclonal antibodies that neutralize multiple poliovirus
serotypes
Pages 5455-5462
Rama Devudu Puligedda, Diana Kouiavskaia, Fetweh H. Al-Saleem, Chandana Devi Kattala, Usman Nabi, Hamid Yaqoob, V. Sandeep Bhagavathula, Rashmi Sharma, Konstantin Chumakov, Scott K. Dessain

Value in Health                   
September 2017 Volume 20, Issue 8, p1003-1226
http://www.valueinhealthjournal.com/current

ISPOR/ISPE REPORTS
Good Practices for Real‐World Data Studies of Treatment and/or Comparative Effectiveness: Recommendations from the Joint ISPOR‐ISPE Special Task Force on Real‐World Evidence in Health Care Decision Making
Marc L. Berger, Harold Sox, Richard J. Willke, Diana L. Brixner, Hans‐Georg Eichler, Wim Goettsch, David Madigan, Amr Makady, Sebastian Schneeweiss, Rosanna Tarricone, Shirley V. Wang, John Watkins, C. Daniel Mullins
p1003–1008
Published online: September 14, 2017

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

Journal of the Pediatric Infectious Diseases Society
https://doi.org/10.1093/jpids/pix067
Published: 23 September 2017
Missed Opportunities for Human Papillomavirus Vaccine Initiation in an Insured Adolescent Female Population
CM Espinosa, GS Marshall, CR Woods, Q Ma, D Ems… –
Abstract
Background
This study assessed the initiation of HPV vaccination in insured adolescent females in relation to physician visits and receipt of other vaccines routinely given at the same age.
Methods
January 1, 2010, and September 31, 2015. Vaccination administration was determined by using Current Procedural Terminology codes. A missed opportunity was defined as the absence of an HPV vaccine at the following encounter types: visits with a 4-valent meningococcal conjugate vaccine (MenACWY) or tetanus, diphtheria, and acellular pertussis (Tdap) vaccine claim; well adolescent visits; or any encounter with a primary care provider (PCP). Missed opportunities were stratified by type of provider (pediatrician or nonpediatrician).
Results
Among 14588 adolescent girls, only 6098 (41.8%) initiated the HPV vaccine series. HPV vaccine was given at 37.1% of visits when a Tdap or MenACWY vaccine was administered, 26.0% of well adolescent visits and 41.8% of PCP visits. Pediatricians had fewer missed opportunities than nonpediatricians to administer HPV (50.7% vs 60.8%), as well as Tdap, although the difference was larger for Tdap (7.0% vs 29.6%).
Conclusions
These data indicate that pediatricians and nonpediatricians alike are missing opportunities to administer the HPV vaccine when other adolescent vaccines are given. Efforts should be focused on converting these missed vaccination opportunities into cancer-prevention visits.

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 Daily Beast
http://www.thedailybeast.com/
Accessed 30 September 2017
Paul Offit: The Pregnancy Vaccine Scare That Should Have Never Been
22 September 2017
Last week, researchers at the Centers for Disease Control and Prevention (CDC) warned that an influenza vaccine given in the first trimester of pregnancy might have caused miscarriages. News outlets all over America picked up the story.
The CDC’s claim wasn’t trivial. About 50 percent of all pregnant women in the U.S. receive an annual influenza vaccine. Now, some expectant mothers were wondering whether they had done the right thing by getting their flu shots‍.
These women had no need to worry. For several reasons, this CDC study should have never been published. Why?…
 
Forbes
http://www.forbes.com/
Accessed 30 September 2017
Flu Shots Aren’t 100% Effective, But They’re The Best Protection Available
Sep 28, 2017
Rita Rubin , Contributor
The good news is that 43.3% of U.S. adults 18 and older were vaccinated against the flu this past flu season, an increase of 1.6 percentage points over the previous flu season, according to data released Thursday by the Centers for Disease Control and Prevention.
The bad news is that only 43.3% of U.S. adults 18 and older were vaccinated against the flu this past flu season, which means that more than half of the people in that age group weren’t vaccinated…
 
The Guardian
http://www.guardiannews.com/
Accessed 30 September 2017
Protect babies from flu by getting older siblings vaccinated, parents advised
Babies and toddlers are significantly more at risk of being hospitalised with influenza complications if they have older brothers or sisters, research finds

Last modified on Wednesday 27 September 2017 19.05 EDT
Small children are significantly more at risk of serious illness from influenza if they have older brothers or sisters, new research has shown.
Babies and toddlers are more likely to be admitted to hospital with flu complications if they are not the first born in their family, the study found.
Children are “effective spreaders” of respiratory infections and can easily pass viruses onto their vulnerable younger siblings, said the researchers. Parents were told they can help protect their young children by getting older offspring vaccinated…
 
The Hill
http://thehill.com/
Accessed 30 September 2017
Bill Gates hopes talk with Trump on vaccine programs was ‘enlightening’
24 September 2017
By Mallory Shelbourne
Microsoft founder Bill Gates said in an interview broadcast Sunday that he hopes his conversation with President Trump about vaccines was “enlightening.”
“You know, we talked about vaccines and how they’re miraculous,” Gates told “Fox News Sunday” (see video) about his two meetings with Trump.
“We talked about these different programs and so I’m hopeful that was enlightening to him.”
“But it didn’t have the impact you hoped?” host Chris Wallace asked Gates. Gates said his hopes were not reflected in Trump’s first budget…

New York Times
http://www.nytimes.com/
Accessed 30 September 2017
Bavarian Nordic Eyes More U.S. Government Contracts After New Vaccine Order
Danish drug maker Bavarian Nordic expects to win further U.S. contracts for its smallpox vaccine after it secured a key government order, the company said on Thursday.
September 28, 2017 – By REUTERS

Can I Spread the Word About an Unvaccinated Child?
The magazine’s Ethicist columnist on whether to reveal another parent is an anti-vaxxer and more.
September 27, 2017 – By KWAME ANTHONY APPIAH

STAT
https://www.statnews.com/
Accessed 30 September 2017
Paul Offit: Correcting Robert F. Kennedy Jr.’s vaccine ‘facts’
| 22 September 2017
When people misrepresent facts on the record, journalists are in a tough spot — especially when that information can be harmful.
Which brings me to STAT’s recent interview with Robert F. Kennedy Jr., conducted by Helen Branswell. STAT wanted to interview Kennedy about his claim in January 2017 that Donald Trump would soon appoint him to head a commission on vaccine safety and scientific integrity. Seven months had passed since Kennedy had made the claim and no announcement had been made. STAT wanted to find out where things stood.
Branswell began her interview by asking Kennedy eight different times and in eight different ways where things stood on his commission. Each time, he failed to confirm or deny whether the White House was about to appoint him.
That clearly wasn’t what Kennedy wanted to talk about. Instead, he wanted to talk about his belief that mercury in vaccines is poisoning America’s children and that no one in the federal government seems to care. By insisting that the interview be conducted in the question-and-answer format, Kennedy effectively tied STAT’s hands, which had to print what he said without editorial comment or opposing views.
I feel compelled to oppose Kennedy’s claims…

Washington Post
http://www.washingtonpost.com/
Accessed 30 September 2017
Mother who refuses to follow court order to vaccinate son: ‘Most likely, I’ll be going to jail’
Kristine Phillips · National/health-science · Sep 30, 2017
A Michigan woman said she will “most likely” go to jail this week if she refuses a court order to vaccinate her 9-year-old son.
And Rebecca Bredow, it seems, is willing to take that risk.
“I can’t give in against my own religious belief,” she told The Washington Post on Saturday. “This is about choice. This is about having my choices as a mother to be able to make medical choices for my child.”
Bredow, who lives in a Detroit suburb, has been embroiled in a custody battle with her ex-husband, James Horne. Last November, an Oakland County court sided with Horne, ordering Bredow to get their son vaccinated. But she has so far not done so. Bredow said the county judge had given her until Wednesday to get her son the medically allowed amount of vaccination, which would be up to eight vaccines.
“I haven’t had the opportunity to have my side heard,” she said, adding later: “Most likely, I’ll be going to jail on Wednesday.”…

Zika was a mild bug. A new discovery shows how it turned monstrous.
By William Wan | 28 September 2017
When the Zika virus became a global terror two years ago — inflicting severe birth defects on the babies of pregnant women who were infected with the virus and alarming health officials worldwide — scientists were mystified.
How did such an obscure, relatively harmless pathogen that had been known for more than half a century suddenly blossom into a monster virus? Was it something about Zika’s new hunting grounds when it spread from Africa to South America and the Caribbean? Were its new victims in Brazil somehow more susceptible to its effects?
A group of scientists based in China may have finally solved the mystery. Their research — published Thursday in the journal Science — pinpoints a small mutation in Zika’s genetic makeup that made the virus much more dangerous…

Think Tanks et al

Center for Global Development  
http://www.cgdev.org/page/press-center
Accessed 30 September 2017
A Global Burden of Disease Data Plus Model to Inform Domestic Decision-Making: In Search of Super-local Data
Blog Post
9/27/17
Kalipso Chalkidou
Global Burden of Disease (GBD) country rankings can strengthen the case of advocates at global and national levels for prioritising investment towards the major drivers of mortality and morbidity. But as discussed in our earlier blog post, when it comes to informing specific investment cases within these broader priorities, GBD data alone are not enough to allow consideration of trade-offs and of opportunity costs of alternative investment choices addressing the same problem. The next step in using data to trigger action ought to be the generation, in conjunction with domestic stakeholders, of what we call below “super-local data.”

Measuring Progress towards Health SDGs: Great Effort, More Needed
Blog Post
9/26/17
Kalipso Chalkidou and Amanda Glassman
Earlier this month, the first analysis of countries’ progress towards attaining the health-related Sustainable Development Goals (SDGs) was published in the Lancet. The Institute for Health Metrics and Evaluation (IHME) used Global Burden of Disease Data (GBD 2016) to create an index for 37 (out of 50) health-related SDG indicators between 1990–2016, for a total of 188 countries. Based on the pace of change recorded over the past 25 years or so, the researchers then projected the indicators to 2030. The punchline: if past is prologue, the median number of SDG targets attained in 2030 will be five of the 24 defined targets currently measured. Not very inspiring.
 

Vaccines and Global Health: The Week in Review is a weekly digest  summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated with the current issue date

.– Request an Email Summary: Vaccines and Global Health : The Week in Review is published as a single email summary, scheduled for release each Saturday evening before midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.

– pdf version:  A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_23 September 2017

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

– Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
.
– Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.

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

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

Milestones :: Perspectives
 
Region of the Americas eliminates maternal and neonatal tetanus
Joint press release
WASHINGTON/NEW YORK, 21 September 2017 – The Region of the Americas has eliminated maternal and neonatal tetanus (MNT), a disease that used to be responsible for the deaths of more than 10,000 newborns every year in the Americas.

The elimination of the disease was declared this year in Haiti, which made it possible to reach the regional goal. MNT is the sixth vaccine-preventable disease to be eliminated from the Americas, following the regional eradication of smallpox in 1971, poliomyelitis in 1994, rubella and congenital rubella syndrome in 2015, and measles in 2016.

“The elimination of maternal and neonatal tetanus is proof again that vaccines work to save the lives of countless mothers and babies,” said Carissa F. Etienne, director of the Pan American Health Organization/World Health Organization (PAHO/WHO). “Let us continue to protect the people of our Region by investing in strong national immunization programs that are capable of vaccinating all individuals and quickly identifying vaccine-preventable diseases.”

Unlike other vaccine-preventable diseases, MNT is considered eliminated when there is an annual rate of less than one case of neonatal tetanus per 1,000 live births at the district level. Tetanus cannot be fully eradicated because the bacterium that causes the disease, Clostridium tetani, exists throughout the environment in soil and the feces of many different animals.

Before widespread modern vaccination against MNT began in the 1970s, neonatal tetanus was responsible for the deaths of more than 10,000 newborns every year in the Americas – a number considered low by experts due to severe underreporting of cases. According to data from WHO, neonatal tetanus killed about 34,000 newborn children in 2015, a 96% reduction from 1988, when an estimated 787,000 newborn babies died of tetanus within their first month of life…

Recent progress in global elimination has led to 43 countries, including Haiti, eliminating MNT between 2000 and June 2017. There are 16 countries worldwide that have yet to eliminate the disease…

Most countries of the Region were able to eliminate MNT by the early 2000s. Starting in 2003, special efforts were made in Haiti to achieve MNT elimination. The country vaccinated all women of reproductive age against tetanus, regardless of whether they were previously vaccinated. Pregnant women were also vaccinated against the disease as part of the routine schedule. Furthermore, neonatal tetanus surveillance was incorporated with surveillance for other vaccine-preventable diseases like measles, rubella, polio, diphtheria, and pertussis. Additionally, the country focused on increasing the number of clean births and deliveries and practicing proper umbilical care.

Following field visits in Haiti in June 2016, experts determined that MNT elimination could be possible in the country. To confirm, a survey was carried out in the South Department, which was considered to have the highest risk of MNT, to determine how many neonatal deaths were due to tetanus in a one-year period. As no neonatal death due to tetanus was found during the survey, MNT was considered eliminated…

PAHO is encouraging all countries in the Region to strengthen their efforts to maintain coverage of maternal immunization against tetanus at the recommended 95%, as several have fallen short of this goal during recent years.

“Because tetanus can never be eradicated, a single case of newborn tetanus in the Americas could still happen,” said Cuauhtemoc Ruiz, head of PAHO’s Comprehensive Family Immunization Program. “In this case, countries should carry out a thorough evaluation to determine how the case could have been averted in order to prevent new cases.”

Key partners involved in in the effort to eliminate MNT at the Regional level include the ministries of health of PAHO/WHO’s Member States, the CDC, and the Brazilian government. In Haiti, UNICEF collaborated with the Government of Canada, UNFPA, WHO, UNICEF National Committees, and the private sector for MNT elimination efforts.
 
::::::
::::::
 
The world is running out of antibiotics, WHO report confirms
WHO News release
Report: Antibacterial agents in clinical development – an analysis of the antibacterial clinical development pipeline, including tuberculosis
Report: Prioritization of pathogens to guide discovery, research and development of new antibiotics for drug-resistant bacterial infections, including tuberculosis
 
20 September 2017 | Geneva – A new report launched today by WHO shows a serious lack of new antibiotics under development to combat the growing threat of antimicrobial resistance.
Most of the drugs currently in the clinical pipeline are modifications of existing classes of antibiotics and are only short-term solutions. The report found very few potential treatment options for those antibiotic-resistant infections identified by WHO as posing the greatest threat to health, including drug-resistant tuberculosis which kills around 250 000 people each year.

“Antimicrobial resistance is a global health emergency that will seriously jeopardize progress in modern medicine,” says Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “There is an urgent need for more investment in research and development for antibiotic-resistant infections including TB, otherwise we will be forced back to a time when people feared common infections and risked their lives from minor surgery.”

In addition to multidrug-resistant tuberculosis, WHO has identified 12 classes of priority pathogens – some of them causing common infections such as pneumonia or urinary tract infections – that are increasingly resistant to existing antibiotics and urgently in need of new treatments.

The report identifies 51 new antibiotics and biologicals in clinical development to treat priority antibiotic-resistant pathogens, as well as tuberculosis and the sometimes deadly diarrhoeal infection Clostridium difficile.

Among all these candidate medicines, however, only 8 are classed by WHO as innovative treatments that will add value to the current antibiotic treatment arsenal.

There is a serious lack of treatment options for multidrug- and extensively drug-resistant M. tuberculosis and gram-negative pathogens, including Acinetobacter and Enterobacteriaceae (such as Klebsiella and E.coli) which can cause severe and often deadly infections that pose a particular threat in hospitals and nursing homes.

There are also very few oral antibiotics in the pipeline, yet these are essential formulations for treating infections outside hospitals or in resource-limited settings.

“Pharmaceutical companies and researchers must urgently focus on new antibiotics against certain types of extremely serious infections that can kill patients in a matter of days because we have no line of defence,” says Dr Suzanne Hill, Director of the Department of Essential Medicines at WHO.

To counter this threat, WHO and the Drugs for Neglected Diseases Initiative (DNDi) set up the Global Antibiotic Research and Development Partnership (known as GARDP). On 4 September 2017, Germany, Luxembourg, the Netherlands, South Africa, Switzerland and the United Kingdom of Great Britain and Northern Ireland and the Wellcome Trust pledged more than €56 million for this work.

“Research for tuberculosis is seriously underfunded, with only two new antibiotics for treatment of drug-resistant tuberculosis having reached the market in over 70 years,” says Dr Mario Raviglione, Director of the WHO Global Tuberculosis Programme. “If we are to end tuberculosis, more than US$ 800 million per year is urgently needed to fund research for new antituberculosis medicines”.

New treatments alone, however, will not be sufficient to combat the threat of antimicrobial resistance. WHO works with countries and partners to improve infection prevention and control and to foster appropriate use of existing and future antibiotics. WHO is also developing guidance for the responsible use of antibiotics in the human, animal and agricultural sectors.
 
::::::
::::::
 
Cholera
 
Editor’s Note:
   We continue to monitor chorea outbreaks, with a special focus on the widely varying role OCV in playing in responses. Indeed, the Yemen outbreak response and the variable narratives on OCV from WHO have, in our view, become suspect [see second item below].
   Equally puzzling are parallel announcements by Gavi and MSF [further below] regarding the outbreak response in Nigeria: Gavi speaks of almost nothing but the OCV campaign launch, while MSF’s announcement does not mention OCV at all.
 
::::::
 
Yemen Humanitarian Bulletin Issue 27 | 20 September 2017
HIGHLIGHTS
… Nearly 700,000 suspected cholera cases and over 2,000 associated deaths have been reported since 27 April…
 
::::::
 
WHO urges Yemen to accept vaccines as cholera crisis deepens
18 September 2017 – 17H40
GENEVA (AFP) – The World Health Organization on Monday urged Yemen to approve cholera vaccinations it has offered to help contain an epidemic that could affect nearly a million people by year’s end.

Yemen, where a multinational conflict has caused a humanitarian crisis, had asked the UN health agency earlier this year for doses of the vaccine, said Dominique Legros, the agency’s cholera specialist.

The WHO sent a million doses in June only to see the Yemeni government change its mind, leading the United Nations to reassign the vaccines to Somalia and Sudan, Legros told reporters in Geneva.

Asked about Yemen’s reversal, Legros said only that discussions with countries about vaccinations could be “complicated”, noting the lack of familiarity with them in affected communities, especially in the case of newer vaccines like the one for cholera.

“We are still in negotiation with the government in Yemen to make sure we can also use (vaccines) to help control” the outbreak, he said.

Last week, the International Committee of the Red Cross (ICRC) said the rampant cholera crisis in Yemen had reached “colossal proportions”, warning that it could affect 850,000 people by the end of the year.

More than 2,000 people have perished from the disease, according to the WHO.

The epidemic has put further strain on a ravaged health system in Yemen, where less than half of healthcare facilities are functioning as the conflict drags on.

Since March 2015, a Saudi-led coalition has been waging a war on behalf of the internationally recognised government against Iran-backed Huthi rebels.

More than 8,000 people have been killed, including at least 1,500 children, and millions displaced in the conflict which has pushed the impoverished country to the brink of famine.

::::::
 
MSF/Médecins Sans Frontières  [to 23 September 2017]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
Nigeria: MSF Scales Up Activities as Cholera Outbreak Continues to Spread Across Borno State
September 18, 2017
As new cases of cholera emerge in Monguno, Dikwa, and Maiduguri, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) continues to scale up its response in Borno state, including recently opening an additional cholera treatment unit (CTU) near Muna Garage camp.
…MSF is closely coordinating its efforts with the Borno Ministry of Health, the World Health Organisation (WHO) and other humanitarian organizations in the prevention and treatment of cholera, including providing training for their health workers….
 
::::::
 
Gavi [to 23 September 2017]
http://www.gavi.org/library/news/press-releases/
18 September 2017
Cholera vaccination campaign begins in north-eastern Nigeria
Mass vaccination effort will target over 915,000 people to contain cholera outbreak in Borno state.
Maiduguri, 18 September 2017 – A major vaccination campaign to halt the spread of cholera starts in Nigeria’s Borno state today.

Gavi, the Vaccine Alliance, WHO and partners delivered 915,005 doses of Oral Cholera Vaccine to the country last week.

The Government of Nigeria, supported by WHO and partners, plan to vaccinate everyone over the age of one – more than 915 000 people – over the next few days. The campaign will take place in Muna internally displaced persons (IDPs) camp in Maiduguri as well as Jere, Monguno and Dikwa local government areas (LGAs).

“The Federal Government of Nigeria through the Nigeria Centre for Disease Control (NCDC) and the National Primary Health Care Development Agency (NPHCDA) in collaboration with the WHO, UNICEF and other partners are all supporting the Borno State Ministry of Health in leaving no stone unturned to ensure that the current cholera outbreak in some parts of Borno state is contained shortly,” said NCDC Chief Executive Officer Dr. Chikwe Ihekweazu. “The Government at all levels is working closely with partners to improve the sanitation situation, conducting hygiene promotion and disinfection of the affected areas including Muna, Custom house, Monguno and Farm centre IDPs camp, Dikwa, Konduga, Jere LGAs and Maiduguri Municipal Council.”

Following heavy rainfall and lack of access to safe water, more than 2600 suspected cholera cases have been reported, as of 16 September, in Borno state with more than 40 deaths since the first case was confirmed in mid-August. The majority of cases have been detected in the Muna IDP camp on the outskirts of Borno state’s capital Maiduguri, which houses 20,000 people who have fled the Boko Haram conflict. The number of suspected cholera cases has also increased dramatically in Dikwa and Monguno areas in the past few weeks.

The decision to send cholera vaccines from the global stockpile was taken on 7 September by the International Coordinating Group (ICG) for Vaccine Provision.

“Thousands of people in these camps have already left their homes to flee violence and terror. They now find themselves at risk of cholera,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. ”These lifesaving vaccines will play a vital role in slowing the spread of the disease, buying valuable time to put the right water, sanitation and hygiene infrastructure in place to stop the root causes of this outbreak,” he added.

“WHO and partners are already making a difference by alerting people of the risks of cholera, supporting the early detection of cases, treating cases and taking other steps to end the outbreak,” said Dr Wondi Alemu, WHO Representative in Nigeria. “We are focusing on delivering a single dose to vaccinate as many people as quickly as possible. As we proceed with this vaccination campaign, we hope to contain this outbreak, and support the collective commitment by partners from the health sector and other sectors to help people in Borno state. Then we can move forward with addressing the myriad of other pressing health needs in Borno.”

Gavi, WHO and partners are working with the NCDC and Borno State Ministry of Health to make the vaccine available free-of-cost to affected populations, while supporting ongoing cholera prevention and preparedness.

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 20 September 2017 [GPEI]
:: Summary of newly-reported viruses this week:  Pakistan: one new wild poliovirus type 1 (WPV1) positive environmental sample; Syria: one new circulating vaccine-derived poliovirus type 2 (cVDPV2) case; and, Democratic Republic of Congo:  one new cVDPV2 case.

::::::

Situation reports on the polio outbreak in Syria [WHO]
Situation update 19 September 2017
:: One new case of cVDPV2 confirmed this week, from Mayadeen district, Deir Ez-Zor governorate. The case, a 9-month-old boy with no polio vaccination history, had onset of paralysis 19 June 2017.
:: The total number of cVDPV2 cases is 40. All confirmed cases to date have had onset of paralysis before 14 July 2017.
:: Preparations for the second Raqqa round continue.
:: Micro-plans are being updated for each of Raqqa’s districts. Pre-round C4D activities have started.
:: IPV vaccination for children missed in the second Deir Ez-Zor round continues through health facilities.
:: An IPV campaign targeting children aged between 2 and 23 months in Aleppo, Idlib and Hama is being planned to boost population immunity.

::::::
::::::

WHO Grade 3 Emergencies  [to 23 September 2017]
Nigeria
:: Cholera vaccination campaign begins in north-eastern Nigeria  18 September 2017
[See Cholera below for more detail]
 
The Syrian Arab Republic
:: Situation reports on the polio outbreak in Syria 19 September 2017
:: WHO responds to critical health needs of displaced populations in Al-Tabqa city, Ar-Raqqa Governorate   18 September 2017

Yemen
:: [Cholera] Daily epidemiology bulletin, 19 September 2017
 
South Sudan
:: WHO and partners respond to flood crises in the former Northern Bahr el Ghazal and Upper Nile States of South Sudan  18 September 201

::::::
 
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. 
Syrian Arab Republic
:: 22 Sep 2017  1.2 million children affected by Syrian crisis are benefiting from education through Education Above All Foundation and partners
:: Under-Secretary-General and Emergency Relief Coordinator Mr. Mark Lowcock: Remarks at High-level Meeting on Syria in Margins of the General Assembly  Report  UN Headquarters, New York, New York, September 21, 2017

Iraq
:: OCHA Iraq | Hawiga Flash Update #1: Hawiga Humanitarian Response, 21 September 2017
:: Iraq: Returnees face new, unimaginable hardships  22 Sep 2017  Report from UN Office for the Coordination of Humanitarian Affairs

Yemen  
:: Yemen Humanitarian Bulletin Issue 27 | 20 September 2017
HIGHLIGHTS
… Nearly 700,000 suspected cholera cases and over 2,000 associated deaths have been reported since 27 April.
…1.7 million people in acute need live in districts with highest access constraints.
..78 per cent of households are economically worse off than they were two years ago.
..8,530 people have been killed since March 2015, and 48,848 injured. More than 1,500 schools are damaged or destroyed.

::::::

UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Nigeria 
:: US$ 9.9 million urgently needed to respond to cholera outbreak in North-East Nigeria
18 September, 2017
The United Nations and its partners are urgently appealing for $9.9 million to respond to the current cholera outbreak in Borno State, north-east Nigeria, and prevent further outbreaks in high-risk areas. A Cholera Response and Prevention plan has been developed to address the immediate needs of 3.7 million people that could be affected by the outbreak…
 
::::::
::::::
 
Bangladesh Restricts Rohingya Refugees, Starts Immunization
New York Times/AP | 17 September 2017
COX’S BAZAR, Bangladesh — Bangladeshi authorities are taking steps to restrict the movement of Muslim Rohingya refugees living in crowded border camps after fleeing violence in Myanmar, whose military chief maintains that the chaos was the work of extremists seeking a stronghold in the country.
Bangladesh has been overwhelmed with more than 400,000 Rohingya who fled their homes in the last three weeks amid a crisis the U.N. describes as ethnic cleansing..
…With the U.N. saying there are some 240,000 children among the refugees living in dire conditions, Bangladeshi authorities have kicked off a massive immunization drive. Abdus Salam, the top government administrator in the Cox’s Bazar district hospital, said that some 150,000 children would be immunized over seven days for measles, rubella and polio.
“There are a lot of weak and malnourished children among the new arrivals,” UNICEF’s representative in Bangladesh, Edouard Beigbeder, said in an email. “If proper preventive measures are not taken, highly infectious diseases, especially measles, could even cause an outbreak…
 
::::::
::::::
 
Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.
 
MERS-CoV [to 23 September 2017]
http://www.who.int/emergencies/mers-cov/en/
DONS
Middle East respiratory syndrome coronavirus (MERS-CoV) – United Arab Emirates
21 September 2017 [One additional case]

WHO & Regional Offices [to 23 September 2017]

Promoting migrant health – striving for peace and decent life for all
22 September 2017 – WHO Director-General Dr Tedros’ remarks at the UN General Assembly on migrant health

Highlights
Leaders at United Nations General Assembly step up end malaria for good
September 2017 – Country leaders and senior officials from across Africa, Europe, Asia Pacific and the Americas announced new political and financial commitments to accelerate the global fight towards eliminating malaria – a disease that claims the life of a child every two minutes and puts half the world at risk.

WHO condemns attacks on hospitals and health workers in Syria
September 2017 – Multiple reported attacks on health facilities and personnel today in Syria have killed and injured health workers and disrupted health services for thousands of people.

Cambodia and the Lao People’s Democratic Republic wipe out trachoma
September 2017 – Trachoma is the leading infectious cause of blindness worldwide. WHO congratulated the Kingdom of Cambodia and the Lao People’s Democratic Republic on eliminating trachoma as a public health problem.

WHO provides critical support to step-up health services delivery in Cox’s Bazar, Bangladesh
September 2017 – Since 25 August more than 400 000 people are estimated to have crossed from Myanmar to Bangladesh following violence in Rakhine state, Myanmar. WHO is providing governments of Bangladesh and Myanmar essential drugs and medical supplies, cholera kits, and emergency medical kits.

::::::

Weekly Epidemiological Record, 22 September 2017, vol. 92, 38 (pp. 557–572)
:: Global leishmaniasis update, 2006–2015: a turning point in leishmaniasis surveillance
:: Control of visceral leishmaniasis in Somalia: achievements in a challenging scenario, 2013–2015
 
::::::
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: WHO with funding from the Government of Canada inaugurates newly constructed maternity complexes in Awiel and Kuajok  21 September 2017
:: Mitigating health risks in the wake of disaster  21 September 2017
Borno applauds WHO’s response to cholera outbreak.  20 September 2017
:: Polio eradication: Experts say Nigeria not ‘out of the woods yet’.  20 September 2017
:: One year after Nigeria emergency declaration.  19 September 2017
: WHO and partners respond to flood crises in the former Northern Bahr el Ghazal and Upper Nile States of South Sudan  19 September 2017
:: Cholera vaccination campaign begins in north-eastern Nigeria 18 September 2017
WHO supports capacity building for enforcement of and compliance with tobacco control regulations in Zanzibar  18 September 2017
: WHO convenes experts to enhance capacity for schistosomiasis control across the sub-Sahara Region  18 September 2017

WHO Region of the Americas PAHO
:: Region of the Americas eliminates maternal and neonatal tetanus (09/21/2017)
:: WHO launches new NCDs Progress Monitor (09/18/2017)

WHO European Region EURO
:: WHO receives British Medical Association (BMA) Medical Book Awards 21-09-2017
:: Prevention and control of NCDs: a business case in Kyrgyzstan 21-09-2017
:: RC67 concludes: “Our message is reaching further and higher” 18-09-2017
:: Chikungunya outbreak confirmed in Italy 18-09-2017

WHO Eastern Mediterranean Region EMRO
:: Regional launch of the third Patient Safety Challenge: Medication without harm
21 September 2017 – The regional launch of the third Patient Safety Challenge: “Medication without harm”, was held in Muscat, Oman, from 17 to 18 September 2017. The focus of the challenge is on strengthening health systems to reduce medication errors with the goal of reducing the level of severe, avoidable harm related to medications by 50% over 5 years.

WHO Western Pacific Region
:: Cambodia and the Lao People’s Democratic Republic wipe out trachoma—leading infectious cause of blindness
MANILA | 19 September 2017 – The World Health Organization (WHO) today congratulated the Kingdom of Cambodia and the Lao People’s Democratic Republic on eliminating trachoma as a public health problem. Trachoma is an eye disease caused by infection with Chlamydia trachomatis bacteria. It is the leading infectious cause of blindness worldwide.

::::::
::::::
 
CDC/ACIP [to 23 September 2017]
http://www.cdc.gov/media/index.html
Press Release
Sustaining Global Health Security is Critical to Protecting America’s National Security – Digital Press Kit Thursday, September 21, 2017

MMWR News Synopsis for September 21, 2017
:: HIV Care Outcomes Among Men Who Have Sex With Men With Diagnosed HIV Infection — United States, 2015
:: Trends in Cervical Cancer Screening in Title X Funded Health Centers — United States, 2005-2015
: Update to CDC’s U.S. Medical Eligibility Criteria for Contraceptive Use, 2016: Revised Recommendations for the Use of Hormonal Contraception Among Women at High Risk for HIV Infection

Announcements
 
BMGF – Gates Foundation  [to 23 September 2017]
http://www.gatesfoundation.org/Media-Center/Press Releases
SEPTEMBER 20, 2017
Bill and Melinda Gates Host Inaugural ‘Goalkeepers’ Event to Engage a New Generation of Leaders in the Fight Against Poverty and Disease
Prime Minister Trudeau and President Obama join other leaders from business, technology, media and entertainment to help speed progress toward the ‘Global Goals’

EDCTP    [to 23 September 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
20 September 2017
Nigeria becomes 29th member of EDCTP
EDCTP is pleased to welcome Nigeria as its 29th member country.  As a member of the EDCTP Association, it will…
 
Gavi [to 23 September 2017]
http://www.gavi.org/library/news/press-releases/
18 September 2017
Cholera vaccination campaign begins in north-eastern Nigeria
Mass vaccination effort will target over 915,000 people to contain cholera outbreak in Borno state.
[See Cholera above for more detail]
 
GHIT Fund   [to 23 September 2017]
https://www.ghitfund.org/
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that devastate the world’s poorest people. Other funders include six Japanese pharmaceutical ·
2017.09.19      
Event Report: World Leaders for Universal Health Coverage (UHC): A High-Level Discussion at the United Nations on Achieving the SDGs Through Health for All
On September 18, leaders from the GHIT Fund attended, an event convened on the sidelines of the 72nd United Nations General Assembly in New York City. Dr. Kiyoshi Kurokawa, Chair of the GHIT Fund, served as a featured speaker.
 
 
MSF/Médecins Sans Frontières  [to 23 September 2017]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
Nigeria: MSF Scales Up Activities as Cholera Outbreak Continues to Spread Across Borno State
September 18, 2017
As new cases of cholera emerge in Monguno, Dikwa, and Maiduguri, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) continues to scale up its response in Borno state, including recently opening an additional cholera treatment unit (CTU) near Muna Garage camp.
 
NIH  [to 23 September 2017]
http://www.nih.gov/news-events/news-releases
September 20, 2017
Immune cells may heal bleeding brain after strokes
NIH-funded preclinical rodent study points to neutrophils for potential treatment options.

September 20, 2017
Three-in-one antibody protects monkeys from HIV-like virus
NIH and Sanofi scientists prepare to test antibody in people.
 
PATH  [to 23 September 2017]
http://www.path.org/news/index.php
Press release | September 17, 2017
New global coalition will boost access to medicines and products for chronic diseases
The coalition, led by PATH, brings together multisectoral partners to reduce the toll of noncommunicable diseases, including diabetes, hypertension, and cardiovascular disease.
New York, September 18, 2017—A multisectoral partnership today launched a first-of-its-kind global coalition dedicated to increasing access to essential medicines and health products to prevent and treat noncommunicable diseases (NCDs) and conditions, including diabetes, hypertension, and cardiovascular disease.
The new Coalition for Access to NCD Medicines & Products brings together governments, the private sector, philanthropic and academic institutions, and nongovernmental organizations to tackle barriers countries face in procuring, supplying, and distributing essential medicines and technologies and ensuring they are used effectively. PATH will serve as the coalition secretariat.
The coalition will partner with countries to help them achieve the World Health Organization target of 80 percent availability of affordable technologies and essential medicines, including generics, required to treat NCDs in both public and private facilities.
The launch event, alongside the United Nations General Assembly in New York, features an interactive panel of global health leaders and influencers from across sectors sharing their perspectives on the opportunities ahead to reduce the toll of NCDs….

UNAIDS [to 23 September 2017]
http://www.unaids.org/en
Press release
New high-quality antiretroviral therapy to be launched in South Africa, Kenya and over 90 low-and middle-income countries at reduced price
   [Undated] New York – A breakthrough pricing agreement has been announced which will accelerate the availability of the first affordable, generic, single-pill HIV treatment regimen containing dolutegravir (DTG) to public sector purchasers in low- and middle-income countries (LMICs) at around US$75 per person, per year. The agreement is expected to accelerate treatment rollout as part of global efforts to reach all 36.7 million people living with HIV with high-quality antiretroviral therapy. UNAIDS estimates that in 2016, just over half (19.5 million) of all people living with HIV had access to the lifesaving medicines.
DTG, a best-in-class integrase inhibitor, is widely used in high-income countries and is recommended by the World Health Organization (WHO) as an alternative first-line HIV regimen, as well as a preferred treatment by the U.S. Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents, among many others. In addition to improving treatment quality and retention, widespread use of DTG is expected to lower the cost of first-line HIV treatment regimens while also reducing the need for more expensive second- and third-line regimens. In July 2017, WHO issued guidance to countries on how to safely and rapidly transition to DTG-based antiretroviral treatment.
This agreement, announced by the governments of South Africa and Kenya, together with the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Clinton Health Access Initiative (CHAI), the Bill & Melinda Gates Foundation (BMGF), Unitaid, the United Kingdom’s Department for International Development (DFID), the United States President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. Agency for International Development (USAID), and the Global Fund to Fight AIDS, Tuberculosis and Malaria, with Mylan Laboratories Limited and Aurobindo Pharma, takes an important step toward ensuring the availability of worldwide high-quality treatment for HIV.
“This agreement will improve the quality of life for millions of people living with HIV,” said UNAIDS Executive Director Michel Sidibé. “To achieve the 90-90-90 treatment targets, newer, affordable and effective treatment options must be made available—from Baltimore to Bamako—without any delay.”…

Press release
UNAIDS calls to quicken the pace of action to end AIDS
World leaders come together to renew the urgency around ending AIDS as part of the Sustainable Development Goals
GENEVA/NEW YORK, 21 September 2017—The President of Uganda, Yoweri Museveni, in collaboration with UNAIDS, brought together six heads of state or government to accelerate action and get countries on the Fast-Track to end AIDS. World leaders joined around 500 partners from government, the private sector and civil society on the sidelines of the United Nations General Assembly to reinvigorate political leadership around HIV.
The Fast-Track approach is saving more and more lives. In 2016, 19.5 million people—more than half the 36.7 million people living with HIV—were accessing life-saving treatment. The number of people who died from AIDS-related illnesses has been reduced by nearly half since 2005, and the global number of new HIV infections has been reduced by 11% since 2010.
However, the pace of action is still not enough to end the AIDS epidemic as a public health threat by 2030…

UNICEF  [to 23 September 2017]
https://www.unicef.org/media/
23 September 2017
Education at risk for thousands of children after successive earthquakes in Mexico – UNICEF
MEXICO CITY/NEW YORK, 23 September 2017 – Nearly 5,100 schools have been damaged or destroyed in Mexico following two powerful earthquakes that struck less than two weeks apart, threatening access to education for thousands of children – UNICEF said today.

Region of the Americas eliminates maternal and neonatal tetanus
WASHINGTON/NEW YORK, 21 September 2017 – The Region of the Americas has eliminated maternal and neonatal tetanus (MNT), a disease that used to be responsible for the deaths of more than 10,000 newborns every year in the Americas.
[See Milestones above for more detail]

Only 15 countries worldwide have three essential national policies that support families with young children – UNICEF
NEW YORK, 21 September 2017 – Only 15 countries worldwide have three basic national policies that help guarantee the time and resources parents need to support their young children’s healthy brain development, UNICEF said today in a new report. Worse, 32 countries – home to one in eight of the world’s children under five – have none of these policies in place.

 
The Vaccine Confidence Project  [to 23 September 2017]
http://www.vaccineconfidence.org/
Confidence Commentary:
Harnessing innovation in public health
17 Sep 2017
The second Raffles Dialogue, hosted last week by the National University of Singapore schools of medicine, public health and public policy along with the National University Health System (NUHS), focused on “The Critical Role of Innovation” in the context of the broader theme of “Human Well-being and Security in 2030”.
It was attended by more than 100 global health experts and international participants.
In his opening address looking forward to 2030, Professor John Wong, chief executive of NUHS, urged the audience to consider Charles Darwin’s theory of natural selection, published in the mid-1800s, which emphasised that neither intelligence nor physical strength was the critical factor for survival.
Instead, the key to survival is the ability to adapt to change. More than 200 years later, this need to adapt is more pressing than ever…
The dialogue explored innovations in health, information and big data, financing and global governance. In the face of fast paced change, how will all this innovation weave together? How can societies ensure that the innovations are harnessed for positive disruptions, and not negative ones? How can these innovations help to advance equity, rather than drive inequities, with some benefiting more than others?
 
Wellcome Trust  [to 23 September 2017]
https://wellcome.ac.uk/news
News / Published: 21 September 2017
Superbug’s spread to Vietnam threatens malaria control
A highly drug-resistant strain of malaria has spread from western Cambodia to southern Vietnam.
Wellcome researchers warn that the spread of artemisinin drug-resistant Plasmodium falciparum C580Y is leading to alarming failure rates for Vietnam’s first-line malaria treatment – dihydroartemisinin (DHA)-piperaquine.
In a letter published in The Lancet Infectious Diseases (opens in a new tab), the scientists say the spread of the malaria superbug across the entire Mekong Sub-region, from western Cambodia to north-eastern Thailand, southern Laos and now into southern Vietnam, poses an urgent threat to malaria control…
 
News / Published: 20 September 2017
Genome editing sheds light on human embryo development
Researchers have used genome editing technology to reveal the role of a key gene in human embryos in the first few days of development.
It’s the first time that editing of the genome – the complete set of genes in a cell or organism – has been used to study gene function in human embryos.
The research could help scientists to better understand the biology of our early development…
 
Opinion / Published: 20 September 2017
Director’s update: sustaining a historically high spending level for Wellcome
In the next year, Wellcome will support more science, research and public engagement than ever before, spending over £1 billion on the people, places and projects that advance our mission of improving health by helping great ideas to thrive…
 
::::::
 
 
DCVMN – Developing Country Vaccine Manufacturers Network  [to 23 September 2017]
http://www.dcvmn.org/
25 September 2017 to 28 September 2017
DCVMN Annual General Meeting
Seoul / Korea
Download the Agenda

Journal Watch

   Vaccines and Global Health: The Week in Review continues its weekly scanning of key peer-reviewed journals to identify and cite articles, commentary and editorials, books reviews and other content supporting our focus on vaccine ethics and policy. Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher.

If you would like to suggest other journal titles to include in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 23 September 2017)

Research article
Progress and outcomes of health systems reform in the United Arab Emirates: a systematic review
The United Arab Emirates (UAE) government aspires to build a world class health system to improve the quality of healthcare and the health outcomes for its population. To achieve this it has implemented extens…
Erik Koornneef, Paul Robben and Iain Blair
BMC Health Services Research 2017 17:672
Published on: 20 September 2017

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 23 September 2017)

Research Article
Variation in loss of immunity shapes influenza epidemics and the impact of vaccination
Protective antibody immunity against the influenza A virus wanes in 2–7 years due to antigenic drift of the virus’ surface proteins. The duration of immune protection is highly variable because antigenic evolu… The models illustrate that variation in the duration of immunity impacts the long-term effectiveness of vaccination, and that vaccine effectiveness cannot be judged for each year in isolation. Our findings have implications for vaccination strategies that aim to maximize the vaccination coverage while extending the age range of persons eligible for vaccination.
Rutger G. Woolthuis, Jacco Wallinga and Michiel van Boven
BMC Infectious Diseases 2017 17:632
Published on: 19 September 2017