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

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

Milestones – Perspectives

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Substantial decline in global measles deaths, but disease still kills 90,000 per year
Joint Press Release: WHO, UNICEF, Gavi, CDC
GENEVA/NEW YORK /ATLANTA, 26 October 2017 – In 2016, an estimated 90, 000 people died from measles – an 84 per cent drop from more than 550, 000 deaths in 2000 – according to a new report published today by leading health organizations. This marks the first time global measles deaths have fallen below 100, 000 per year.

“Saving an average of 1.3 million lives per year through measles vaccine is an incredible achievement and makes a world free of measles seem possible, even probable, in our lifetime,” says Dr Robert Linkins, of the Measles and Rubella Initiative (MR&I) and Branch Chief of Accelerated Disease Control and Vaccine Preventable Diseases at the Centers for Disease Control and Prevention. M&RI is a partnership formed in 2001 of the American Red Cross, the US Centers for Disease Control and Prevention, the United Nations Foundation, UNICEF, and WHO.

Since 2000, an estimated 5.5 billion doses of measles-containing vaccines have been provided to children through routine immunization services and mass vaccination campaigns, saving an estimated 20.4 million lives.

“We have seen a substantial drop in measles deaths for more than two decades, but now we must strive to reach zero measles cases,” says Dr Jean-Marie Okwo-Bele, Director of WHO’s Department of Immunization, Vaccines and Biologicals. “Measles elimination will only be reached if measles vaccines reach every child, everywhere.”

The world is still far from reaching regional measles elimination goals. Coverage with the first of two required doses of measles vaccine has stalled at approximately 85 per cent since 2009, far short of the 95 per cent coverage needed to stop measles infections, and coverage with the second dose, despite recent increases, was only 64 per cent in 2016.

Far too many children – 20.8 million – are still missing their first measles vaccine dose. More than half of these unvaccinated children live in six countries: Nigeria (3.3 million), India (2.9 million), Pakistan (2.0 million), Indonesia (1.2 million), Ethiopia (0.9 million), and Democratic Republic of the Congo (0.7 million). Since measles is a highly contagious viral disease, large outbreaks continue to occur in these and other countries in Europe and North America, putting children at risk of severe health complications such as pneumonia, diarrhoea, encephalitis, blindness, and death.

Agencies noted that progress in reaching measles elimination could be reversed when polio-funded resources supporting routine immunization services, measles and rubella vaccination campaigns, and surveillance, diminish and disappear following polio eradication. Countries with the greatest number of measles deaths rely most heavily on polio-funded resources and are at highest risk of reversing progress after polio eradication is achieved.

“This remarkable drop in measles deaths is the culmination of years of hard work by health workers, governments and development agencies to vaccinate millions of children in the world’s poorest countries,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, one of the world’s largest supporters of measles immunization programmes. “However we cannot afford to be complacent. Too many children are still missing out on lifesaving vaccines. To reach these children and set ourselves on a realistic road to measles elimination we need to dramatically improve routine immunization backed by strong health systems.”

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Weekly Epidemiological Record, 27 October 2017, vol. 92, 43 (pp. 649–660)
:: Progress towards regional measles elimination – worldwide, 2000–2016
 
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Milestones :: Perspectives
 
The Human Vaccines Project Launches New Initiative To Accelerate Development Of Universally Effective Influenza Vaccines
NEW YORK, Oct. 26, 2017 /PRNewswire-USNewswire/ — The Human Vaccines Project, a public-private partnership with a mission to decode the immune system to advance human health, announced today the launch of the Universal Influenza Vaccine Initiative (UIVI), a first-of-its-kind program that will address the underlying scientific barrier impeding the development of broadly protective, universal influenza vaccines: the human immune response.

According to the World Health Organization (WHO), influenza is estimated to kill between 250,000 and 500,000 people around the world every year. As the world becomes more interconnected, the risks for a new pandemic continue to increase, carrying the potential for widespread social, economic and political upheaval. A universal vaccine, once developed, would protect everyone regardless of age, gender and geography against all strains of influenza, making significant strides toward preventing a global catastrophe.

“While great progress has been made in understanding the influenza virus, seasonal vaccines are not consistently effective and people remain highly vulnerable,” said Wayne C. Koff, PhD, President and CEO of the Human Vaccines Project. “The public health disaster of the 1918 pandemic that infected a third of the world’s population and killed over 50 million looms heavy. We are long overdue to solve this very real global health threat.”

Koff adds, “There are many public and private sector resources dedicated to developing new and improved influenza vaccines, but they are all primarily focused on one part of the problem – making the vaccine. What makes the UIVI distinct is that we are focusing on understanding the second part of the puzzle – the human immune response. We have to find out what generates an effective immune response against influenza in all populations in order for a vaccine to be maximally effective.”

The Project’s influenza vaccine initiative, led by Dr. James Crowe Jr., Director of the Vanderbilt Vaccine Center, and Dr. Clarence B. Creech, Director of the Vanderbilt Vaccine Research Program at the Vanderbilt University Medical Center in Nashville, Tenn., will launch a series of influenza vaccine clinical trials in globally diverse populations beginning early in 2018.

Researchers based at the Project’s scientific hubs at the University of California San Diego, The Scripps Research Institute, the La Jolla Institute for Allergy and Immunology, and the J. Craig Venter Institute, and partners at the University of British Columbia and the Lawrence Livermore National Laboratory, will conduct a broad spectrum analysis of blood and tissue samples from vaccinated and infected individuals, coupled with artificial intelligence-driven computer simulation models, to decipher the elements of protection against influenza and determine why some people are protected while others are not…

Cholera
 
Mortality and Morbidity Weekly Bulletin (MMWB) – Cox’s Bazar, Bangladesh   Volume No 2: 22 October 2017
[Excerpt]
5.1 Cholera vaccination campaign in Cox’s Bazar and Bandarban
Since August 2017, an influx of approximately 600,000 from Myanmar arrived in Bangladesh. Overcrowding, bad sanitation and malnutrition were prevalent and outbreaks of cholera resulting in thousands of cases anticipated. Considering lack of safe drinking water, proper sanitation facilities and poor personal hygiene practices, the UMN camps of two sub-districts, Teknaf and Ukhia, were at high risk of spreading cholera as experience from similar situations in other countries has shown. Moreover, it has been reported that a huge number of people are suffering from acute watery diarrhoea.

Based on field assessments conducted by WHO in the newly established settlements and makeshift camps, the water and sanitation conductions are dire. Sanitation facilities range between 1 latrine per 1,000 to 5,000 people, open defecation is a widespread practice. Coupled with rainfall these pose serious public health threats…

On 10 October 2017, the Government of Bangladesh launched an oral cholera vaccination (OCV) campaign with the support of WHO for 10 days, targeting over 650,000 people in 11 camps/settlements in Cox’s Bazar district, Chittagong division. It was the first OCV campaign to be conducted in the country, and comes at a critical time after UMNs influx to the country since August 2017.

Because of the large numbers of UMNs living in the camps and within the host community and the limited supply of OCV, the vaccination campaign in Cox’s Bazar Bangladesh was limited to UMN camps at full capacity or overcrowded and to all host community areas. The large influx of UMNs increased uncertainty about the size of the target population, data from the most recent measles vaccination campaign (2017) were used to estimate the population aged >1-year-old.

The vaccination campaign was preceded by extensive social mobilization efforts to inform the community of the benefits, availability and necessity of the vaccine. The main message included that vaccination is a preventive measure against cholera that supplements, but does not replace, other traditional cholera control measures such as improving access to safe water and sanitation and hygiene measures/interventions.

The vaccination strategy included a combination of fixed sites and mobile teams for door-to-door vaccine delivery. The vaccine cold chain was maintained, and vaccines were transported using a sufficient number of vaccine carriers and ice packs for a door-to-door strategy.     Experience from WHO’s technical staff supported the implementation of this campaign during the public health emergency.

As of October 18, 2017, a total of 700,487 persons were reported to have been vaccinated of them; 691,574 representing 105% % (691,574/658,372) of the target population (Table 2). An additional 8,913 (not included in the original micro-plan) were vaccination in 2 sites; Anjumanpara, and Sabrang Entry Point…
 
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Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 25 October 2017 [GPEI]
:: On 24 October, millions of people around the globe engaged in actions for World Polio Day. Highlights included the 5th annual World Polio Day event, bringing together experts and celebrities to share progress on the road to polio eradication, hosted by Rotary and the Bill & Melinda Gates Foundation in Seattle, Washington, USA; and a show of support from individuals, national governments, and media outlets around the world.

:: Read World Polio Day coverage about the unsung heroes of polio eradication and how we are ending polio. From the field, read Polio and Me: A Syrian Doctor’s Story, how one man became a doctor to end polio and protect children from the disease that crippled him as a young boy.
In a remarkable endorsement, German Chancellor Angela Merkel used her weekly podcast to draw attention to the World Polio Day (celebrated in Germany on 28 October) and the considerable progress in polio eradication.

:: Summary of newly-reported viruses this week:
…Afghanistan: Two new wild poliovirus 1 (WPV1) positive environmental samples reported, one from Nangarhar and one from Kandahar provinces.
…Pakistan: One new wild poliovirus 1 (WPV1) positive environmental sample reported, in Sindh province.
…Additionally, an advance notification was received this week of a new WPV1 case in Afghanistan from Shahwalikot district in Kandahar province.  The case will be officially reflected in next week’s global data reporting.

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Situation reports on the polio outbreak in Syria
Situation update 24 October 2017
Key highlights
:: No new cases of cVDPV2 were reported this week. The total number of cVDPV2 cases remains 52. All confirmed cases to date have had onset of paralysis before 25 August 2017
:: Two immunization rounds have now been completed in both Deir Ez-Zor and Raqqa governorates bringing the first phase of the outbreak response to a close. Post Campaign Monitoring results for the second Raqqa round are still being compiled into a final report. However, initial data reports 84% of children were reported as vaccinated through market surveys
:: IPV campaign activities aiming to reach children aged between 2-23 months in 2 districts of Raqqa governorate (Raqqa and Thawra) have now concluded. Work is on ongoing to start this activity in Tell Abyad district as quickly as possible
:: A review of the ongoing risks of continued polio transmission in Syria has been conducted and critical contingency planning is in development for any potential breakthrough cases in known outbreak zones or spread of virus to new areas of the country
:: On World Polio Day (October 24) the polio programme thanks the dedicated vaccinators who work tirelessly to reach every child, the parents who demand the vaccine for their children and the donors who commit the funds necessary to finance eradication efforts

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Bill Gates: Polio will be eradicated this year, the endgame is near
CNBC | 24 October 2017
:: In 1988 — when wild poliovirus was in more than 125 countries, paralyzing 350,000 people every year — the World Health Assembly launched the Global Polio Eradication Initiative to help eliminate the disease through a mass immunization campaign.
:: In 2007 the Bill and Melinda Gates Foundation joined other major health organizations already committed to the GPEI, contributing nearly $3 billion toward eradicating polio by 2020.
:: Today 12 cases of poliovirus exist in two countries, and the Gates Foundation is optimistic the last case of polio could be seen this year.
Tuesday marks Rotary International’s fifth annual World Polio Day, co-hosted by the Bill and Melinda Gates Foundation, and there is much cause for celebration: It is very possible that 2017 may see the end of the wild poliovirus — nearly two years earlier than Bill Gates predicted.    “What we’re looking at now is sort of the endgame of polio eradication,” says Dr. Jay Wenger, who leads the Gates Foundation’s polio eradication efforts. “We are closer than ever, and we’re optimistic that we can see the end of wild poliovirus disease by as early as this year,” he said…

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World Polio Day: Gavi’s role in polio eradication
24 October marks World Polio Day, when the global community celebrates the immense progress and considers the work ahead to ensure no child suffers from polio again.
Gavi works with the Global Polio Eradication Initiative (GPEI) to support one of the fastest roll-outs of a new vaccine in the history of vaccination.
In partnership with GPEI, we support the introduction of at least one dose of inactivated polio vaccine (IPV) in all Gavi-supported countries…

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WHO Grade 3 Emergencies  [to 28 October 2017]
The Syrian Arab Republic
:: WHO reinforces health care services for thousands of people in newly accessible areas of Ar-Raqqa governorate, Syria
24 October 2017, Damascus, Syria — As areas in Ar-Raqqa governorate become accessible, WHO continues to strengthen health care services for thousands of people in the area through the delivery of 5 tons of medicines and medical supplies with support from the United Kingdom Department for International Development, the European Union and Norway24 October 2017, Damascus, Syria — As areas in Ar-Raqqa governorate become accessible, the World Health Organization (WHO) continues to strengthen health care services for thousands of people in the area through the delivery of medicines and medical supplies to Al-Tabqa National Hospital, northwest of Ar-Raqqa city…
:: Situation reports on the polio outbreak in Syria
Situation update 24 October 2017
[See Polio above]

Yemen
:: Daily epidemiology bulletin, 25 October 2017
Cholera:
872,415 – Suspected cases
2,180 – Associated deaths
0.25%  – Case Fatality Rate
96%  – Governorates affected   ( 22 / 23 governorates )
92%  – Districts affected   ( 305 / 333 districts )

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WHO Grade 2 Emergencies  [to 28 October 2017]
Myanmar
::  Situation Report: 8 – Emergency type: Bangladesh/Myanmar: Rakhine Conflict 2017
Date: 20 October 2017
KEY HIGHLIGHTS
:: As of 17 October 2017, cumulative number of new arrivals in all sites of Ukiah, Teknaf, Cox’s Bazar and Ramu: 589,000, including 46,000 in host communities, 313,000 in Kutupalong Balukhali and 161 000 in new spontaneous sites.
:: By end of 8th day of the Oral Cholera Vaccine campaign, 700,487 people were vaccinated, reaching 106% of the total estimated target population. No immediate adverse events from immunization were reported.
:: First Morbidity Mortality Weekly Bulletin built on the Early Warning and Response System (daily data received from MoHFW and various service providers operating in settlements in Myanmar and CXB) provides data on the prevailing epidemiological situation for the period 25 August to 10 October.
:: MSF has issued an urgent appeal for humanitarian assistance, even as it scales up its response by hiring additional 800 staff, increasing five-fold their strength staff on the ground in Cox’s Bazar to 1,000.
:: WASH situation in temporary settlements in Shah Porir Dwip and Kerontuli/Chakmarkul show improvement though accessing safe water continues to be a challenge.
:: UN Humanitarian Advisor Mr Henry Glorieux and UN Humanitarian Specialist Mr Kazi from UNRC office visited the new and existing settlements in CXB for the OCV campaign and other public health efforts.

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Iraq
:: Humanitarians are reaching thousands of recently displaced people [EN/AR/KU]  Report
(Baghdad, 21 October 2017) – Humanitarian partners are reaching thousands of people with emergency assistance on a daily basis.
During the past week, well over 100,000 civilians fled from Kirkuk, Makhmur and Tuz Khurmatu districts. Smaller numbers fled Zummar. The situation remains very fluid, with people sometimes fleeing for less than 24 hours before returning home.
Partners are rushing to provide assistance to highly vulnerable families. More than 15,000 emergency food rations were distributed and mobile medical teams are visiting camps and villages to provide health care. Emergency support including water, blankets, hygiene items and household kits is being distributed in areas hosting displaced people…

Syrian Arab Republic
:: 26 Oct 2017  First rehabilitated health centre in eastern Aleppo city, Syria, opens with WHO support
…The centre re-opened in September 2017 with 5 specialized clinics for internal medicine, reproductive health and child care, and orthopedic and dermatological care. Services are provided by 34 health workers, including 10 physicians and 12 nurses,” said Dr Hamdi Noufal, director of the Saad Ibn Abi Waqas health centre.
“Since its re-opening, the centre has treated more than 2400 patients,” Dr Noufal added…

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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  – No new announcements identified
Ethiopia – No new announcements identified
Nigeria  – No new announcements identified
Somalia  – No new announcements identified

WHO & Regional Offices [to 28 October 2017]

 
Latest news
Delivering kits for diabetes and hypertension during humanitarian crises
23 October 2017 – To treat people for noncommunicable diseases during humanitarian crises, WHO has developed and started delivering kits of medicines and equipment for people living with diabetes, hypertension, and related conditions.  [Video]

Director-General rescinds Goodwill Ambassador appointment
22 October 2017 – WHO Director-General Dr Tedros has rescinded the appointment of H.E. President Robert Mugabe as WHO Goodwill Ambassador for Noncommunicable Diseases in Africa.
:: Read WHO Statement

 
Highlights
Vaccinating pregnant women against influenza
October 2017 – Immunizing future mothers against influenza is key for preventing complications during gestation, and for protecting future mothers and newborns. In the Region of the Americas, 32 countries and territories vaccinate pregnant women against influenza, a public health problem that for future mothers, newborns, and other high-risk populations can mean severe disease, complications, and hospitalization.
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Weekly Epidemiological Record, 27 October 2017, vol. 92, 43 (pp. 649–660)
:: Progress towards regional measles elimination – worldwide, 2000–2016
:: Monthly report on dracunculiasis cases, January-September 2017
 
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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Nationwide house-house polio supplementary immunization campaign starts in Sierra Leone
27 October 2017
:: WHO and ITU to use digital technology to strengthen public health services in Africa  27 October 2017
:: Rumours, Misinformation and Negative Beliefs underpin the Current Marburg Outbreak in Uganda  27 October 2017
:: South Sudan boosts Polio immunization coverage on the World Polio Day to keep the disease at bay  26 October 2017
:: Rwanda conducted a national vaccination campaign on Measles and Rubella integrated in Mother and Child Health Week  25 October 2017
:: Gambia observes World Mental Health day: WHO and partners engage stakeholders to create healthy work places  25 October 2017
Rwanda celebrated the World Mental Health Day 2017  25 October 2017
On 10th October, Rwanda joined other countries all over the World to…
:: United Nations Day: WHO South Sudan offers essential promotive health services in commemoration of UN’s 72nd Anniversary  25 October 2017
:: Kuwait Fund and WHO in $4million multi-year agreement to tackle Neglected Tropical Diseases in Africa  24 October 2017
:: WHO, UNICEF and Rotary International urge to sustain the polio-free status of Ethiopia
24 October 2017
:: Ministry of Health, WHO experts highlight results of life-saving programme for children under five.  23 October 2017
:: Training clinicians to provide lifesaving emergency care for women and newborns
23 October 2017
:: WHO promptly responds to Marburg Outbreak in Eastern Uganda  23 October 2017
:: WHO calls for strengthening of laboratory systems in efforts to fulfill their important role in the fight against infectious and chronic diseases.23 October 2017

WHO Region of the Americas PAHO
:: The Region of the Americas leads in the vaccination of pregnant women against influenza (10/24/2017)

WHO South-East Asia Region SEARO
::  Mortality and Morbidity Weekly Bulletin (MMWB) – Cox’s Bazar, Bangladesh   Volume No 2: 22 October 2017
[Excerpt]
5.1 Cholera vaccination campaign in Cox’s Bazar and Bandarban
[See Cholera above for detail]

WHO European Region EURO
:: 15th anniversary of polio-free certification in the European Region – but the hard work to prevent future cases is not over 24-10-2017
:: WHO supports polio vaccination campaign for nearly 200 000 Syrian children from Turkey 24-10-2017

WHO Eastern Mediterranean Region EMRO
:: WHO Regional Adviser for Nutrition recognized as food fortification champion  25 October 2017
:: Danger in the rubble: fighting leishmaniasis in Syria  23 October 2017
 

CDC/ACIP [to 28 October 2017]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html
Press Release
Thursday, October 26, 2017
Getting Ahead of the Next Pandemic: Is the World Ready?
…A new article released today in CDC’s Emerging Infectious Diseases (EID) journal details early results of CDC’s global health security work through collaboration with 17 partner countries. Implementing the Global Health Security Agenda in 17 Countries: Contributions by the Centers for Disease Control and Prevention shows how CDC is accelerating progress toward a world more prepared for public health threats. Part of EID’s new Global Health Security Supplement, the article outlines CDC-supported progress during the first two years of GHSA implementation…

MMWR News Synopsis for October 26, 2017
:: Timeliness of Receipt of Early Childhood Vaccinations Among Children of Immigrants — Minnesota, 2016
This study demonstrates vaccination disparities between children with U.S.-born parents and children with immigrant parents, as well as disparities by mother’s country of birth. Additional studies are needed to identify barriers to vaccination faced by groups with lower vaccination coverage and to inform the development of effective strategies to address these barriers. This study used data from the Minnesota Immunization Information Connection (MIIC) and the Office of Vital Records to measure childhood vaccination coverage and examine coverage differences across selected demographic characteristics at ages 2, 6, 18, and 36 months for children born in Minnesota in 2011 and 2012. Coverage levels were higher for children with two U.S.-born parents compared with children having at least one foreign-born parent at all four ages. When children were divided into groups by mother’s country of birth, some groups were vaccinated at higher rates than were children of U.S.-born mothers (Mexico, Central and South America), and others at much lower rates (Somalia, Eastern Europe). Outreach to groups with lower vaccination rates may be needed to improve vaccination coverage in young children.

Increased Risk for Mother-to-Infant Transmission of Hepatitis C Virus Among Medicaid Recipients ― Wisconsin, 2011–2015
Health care providers can protect babies from hepatitis C virus (HCV) infections by testing for, treating, and curing HCV infection among women of childbearing age. Practices for HCV screening of pregnant women and babies born to HCV-infected mothers should be improved to prevent serious but preventable complications among mothers and babies. Increasing injection drug use, suspected to be linked with America’s growing opioid epidemic, has led to rapid increases of new HCV infections among young adults. The rise in new HCV infections among young adults could affect the next generation when the virus is passed from mothers to babies. About 6 percent of babies born to HCV-infected mothers will get the virus. Trends in HCV infection during pregnancy and infant testing were estimated using Wisconsin Medicaid and Public Health Surveillance data. Between 2011 and 2015, among the Wisconsin Medicaid population, the proportion of women who had HCV infection during pregnancy increased 93 percent, from 2.7 to 5.2 per 1,000 births. Of the babies born to women with HCV infection, only 34 percent were tested for HCV per CDC recommendations.

Rapid Field Response to a Cluster of Illnesses and Deaths — Sinoe County, Liberia, April–May, 2017
The rapid detection and control of the meningococcal disease outbreak in Liberia demonstrates how post-Ebola improvements in public health capacities are contributing to global health security. In April 2017, Liberia’s Ministry of Health reported a cluster of illnesses and deaths from an unknown cause. Within 24 hours, a response was initiated to identify cases, monitor at-risk persons, and prevent additional illnesses. During the 2014 Ebola epidemic, it took the country more than 90 days to coordinate a response. This significant decrease in response time reflects capabilities established during and after Ebola with CDC and partner support. Enhanced in-country laboratory capacity contributed to rapid diagnosis, ruling out Ebola in less than 24 hours, while effective case management and supportive treatment increased survival among patients even before the confirmation of meningococcal disease as the cause. CDC-supported efforts toward strengthening global health security led to effective management and control of this outbreak.

Rapid Laboratory Identification of Neisseria meningitidis Serogroup C as the Cause of an Outbreak — Liberia, 2017
Rapid laboratory detection and response allowed a cluster of unexplained illness, initially suspected to be Ebola virus disease, to be identified as serogroup C meningococcal disease. This was an unusual outbreak of serogroup C meningococcal disease in a country that typically does not report meningitis outbreaks and that is not in the African meningitis belt. Prompt and accurate detection of outbreaks allows public health officials to respond quickly and implement appropriate control measures. In April 2017, an unexplained cluster of 31 cases and 13 deaths surrounding a funeral was reported in Liberia. Initially suspected as Ebola virus disease in this previously affected country, rapid laboratory detection and response from CDC identified Neisseria meningitidis serogroup C as the cause of the outbreak. This bacterium causes meningococcal disease, which includes meningitis and bloodstream infections. Laboratory confirmation helped Liberian health authorities administer antibiotic prophylaxis to more than 200 people in order to prevent secondary cases of this deadly disease. This was an unusual presentation of serogroup C meningococcal disease with a high case-fatality rate, high prevalence of gastrointestinal symptoms, and low prevalence of fever. This extremely unusual meningococcal disease outbreak in Liberia, a country not in the African meningitis belt, highlights the importance of rapid laboratory confirmation in an outbreak investigation.

Progress Toward Regional Measles Elimination — Worldwide, 2000–2016
For the first time, there were fewer than 100,000 annual estimated measles deaths in 2016 due to stable measles-containing vaccine (MCV1) coverage, increasing second-dose (MCV2) coverage, and measles vaccination campaigns. Vaccination efforts need to be strengthened in order to reduce these preventable deaths to zero. During 2000–2016, measles vaccination prevented an estimated 20.4 million deaths worldwide. The number of countries providing the second dose of measles-containing vaccine through routine immunization services increased to 85 percent; in 2016, global MCV2 coverage was 64 percent. Also during 2000-2016, annual reported measles cases decreased 87 percent and annual measles deaths decreased 84 percent. Despite advances, the WHO 2015 milestones haven’t been met. Only one WHO region, the Americas, has been declared free of measles. To eliminate measles, countries and their partners need to focus on increasing vaccination coverage through sustained investments in health systems, strengthening surveillance systems, using surveillance data to drive programmatic actions, securing political commitment, raising the visibility of measles elimination goals, and mitigating the threat of decreasing resources once polio eradication is achieved.

Announcements

CEPI – Coalition for Epidemic Preparedness Innovations  [to 28 October 2017]
http://cepi.net/
[Undated]
CEPI vaccine R&D pipeline and cost tracking survey
CEPI is inviting you to participate in a survey that is mapping vaccine research and development pipelines and associated costs for emerging infectious diseases.
The survey is open until 10 November 2017.
To achieve its strategic objectives, and to make efficient use of its financial resources, CEPI needs to draw on a variety of vaccine candidates and leverage diversity of product development partners. CEPI is currently building up a comprehensive knowledge base on available vaccine candidates and their current status, in order to serve vaccine preparedness needs against non-commercial epidemic disease threats…

EDCTP    [to 28 October 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
No new digest content identified.

European Medicines Agency  [to 28 October 2017]
http://www.ema.europa.eu/ema/
27/10/2017
Meeting highlights from the Pharmacovigilance Risk Assessment Committee (PRAC) 23-26 October 2017

26/10/2017
EU scientific opinion: how to assess progress on reduction of antimicrobial resistance and antimicrobial consumption
ECDC, EFSA & EMA recommend set of indicators to measure progress in EU Member States
A set of indicators will assist European Union (EU) Member States to assess their progress in reducing the use of antimicrobials and combatting antimicrobial resistance (AMR). These indicators have been established by the European Food Safety Authority (EFSA), the European Medicines Agency (EMA) and the European Centre for Disease Prevention and Control (ECDC), following a request from the European Commission…
 
 
FDA [to 28 October 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
What’s New in Biologics
October 20, 2017 Approval Letter – SHINGRIX (PDF – 74KB)
Posted: 10/23/2017
 
 
Gavi [to 28 October 2017]
http://www.gavi.org/library/news/press-releases/
26 October 2017
Substantial decline in global measles deaths, but disease still kills 90,000 per year
Joint news release CDC/Gavi/UNICEF/WHO.
[See Milestones above for more detail]

24 October 2017
Gavi and the Aspen Institute to strengthen health management capacity in developing countries
Malawi will be the first country to benefit from the new partnership
Geneva, 24 October 2017 – Gavi, the Vaccine Alliance and the Aspen Institute have joined forces to strengthen national leadership, management and coordination of Malawi’s immunisation programme through the Aspen Management Partnership for Health (AMP Health). The partnership will improve managerial capacity to support Gavi’s mission to ensure that every child in Malawi is protected with life-saving vaccines…

Throughout 2016, Gavi began to roll out a series of interventions aimed at strengthening Expanded Programme for Immunization (EPI) teams and national coordination forums. This included embedding peer coaches within the EPI teams in Malawi and Papua New Guinea, for example. This initiative is run in partnership with the Aspen Management Partnership for Health and Dalberg Global Development Advisors. We also developed a set of tools and training courses to help strengthen the capacity of coordination forums.

A new training programme for EPI managers will combine a mentoring component with online learning and in-person group sessions. We will further boost the management capacity of EPI teams by funding critical positions for a time-limited period.

The partnership between Gavi and the Aspen Institute seeks to address these challenges by embedding a management partner into Malawi’s immunisation team, who will coach staff and build capacity to improve the performance of the immunisation programme.

“At Gavi we know that effective management of immunisation programmes is key to building strong health systems and extending those systems to reach all children who desperately need them”, said Dr Seth Berkley, CEO of Gavi. “Our partnership with the Aspen Institute is one of many innovative investments in effective management that Gavi is rolling out. Aspen’s leadership and management expertise will be an important boost to our mission to ensure no child goes without lifesaving vaccines”, he added….
 
 
GHIT Fund   [to 28 October 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 ·
No new digest content identified.

 
Global Fund [to 28 October 2017]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
News
Global Fund Names Finalist Candidates for Executive Director
23 October 2017
The Global Fund Board named four finalist candidates for Executive Director, and is scheduled to select one at a Board meeting on 14 November 2017.
:: Simon Bland is the Director of the New York Office of the Joint United Nations Programme on HIV/AIDS. He served as the Chair of the Global Fund Board from 2011 to 2013. Formerly, he worked for three decades at the Department for International Development of the United Kingdom, and led its operations in Kenya.
:: Frannie Leautier is the former Senior Vice President of the African Development Bank where she was a key member of President Adesina’s transition team. Previously, she was Chief Executive Officer of the African Capacity Building Foundation, after a successful career at the World Bank, during which she spent time as Chief of Staff to President Wolfensohn, and ran the World Bank Institute, the institution’s capacity building branch.
:: Peter Sands is the former Group Chief Executive of Standard Chartered Bank. He began his career at McKinsey & Company. After having spent a sustained period leading a major bank with global operations in relevant countries, he has held a fellowship at Harvard, and immersed himself in a range of global public health projects.
:: Anil Soni is a senior executive at Mylan, the global pharmaceutical company, co-leading development, sales, and partnerships for medicines to prevent and treat HIV/AIDS, tuberculosis, malaria and hepatitis C. He was closely involved in the early years of the Global Fund as an adviser to Richard Feachem, after which he led the advocacy work of Friends of the Global Fight in Washington, DC. He spent six years at the Clinton Health Access Initiative, latterly as its Chief Executive.
 
 
 
Human Vaccines Project   [to 28 October 2017]
http://www.humanvaccinesproject.org/media/press-releases/
Oct 26, 2017
The Human Vaccines Project Launches New Initiative To Accelerate Development Of Universally Effective Influenza Vaccines
NEW YORK, Oct. 26, 2017 /PRNewswire-USNewswire/ — The Human Vaccines Project, a public-private partnership with a mission to decode the immune system to advance human health, announced today the launch of the Universal Influenza Vaccine Initiative (UIVI), a first-of-its-kind program that will address the underlying scientific barrier impeding the development of broadly protective, universal influenza vaccines: the human immune response…
[See Milestones above for more detail]

IVAC  [to 28 October 2017]
http://www.jhsph.edu/research/centers-and-institutes/ivac/index.html
September 2017
VIEW-hub Report: Global Vaccine Introduction and Implementation – A report on current global access to new childhood vaccines
New vaccine introduction updates (since June 2017) include:
– Seychelles has introduced rotavirus vaccine
– Liberia has introduced IPV
 
 
IVI   [to 28 October 2017]
http://www.ivi.int/
Oct 25, 2017
IVI secures $2,850,057 supplemental grant for SETA Program
The International Vaccine Institute (IVI) has just secured a $2,850,057 supplemental grant for the Severe Typhoid in Africa (SETA) Program from the Bill & Melinda Gates Foundation. With the addition of the latest grant, total SETA grant revenue has reached $9,528,322.
The SETA program led by IVI’s Epidemiology Unit will continue to carry out severe typhoid surveillance activities in Burkina Faso, the Democratic Republic of the Congo, Ghana, Ethiopia, Nigeria and Madagascar in close collaboration with local and international partners, IVI laboratories in charge of assessing immune responses in typhoid patients; the Policy and Economic Research Department, which is responsible for typhoid cost analyses; and the Biostatistics and Data Management Department.  Of note, SETA/TSAP (Typhoid Fever Surveillance in Africa Program) data has helped inform WHO-SAGE recommendations for future usage of typhoid conjugate vaccines. Final SETA data will be available by Q1/2020.
 
[undated]
IVI acquires  $797,000 grant to support licensure of OCV in Bangladesh
The International Vaccine Institute has acquired a grant of $797,519 from the Bill & Melinda Gates Foundation to support Incepta for the development and production of Cholvax®, which was developed with technology transfer from IVI. Managed by IVI’s Development and Delivery Unit, the grant will support Incepta applying for licensure of Cholvax, in Bangladesh. The D&D Unit will conduct this project in collaboration with the Bangladeshi company and IVI’s Vaccine Process Development Unit, to ensure the successful completion of this project by September 2018

October 10, 2017
Vaccine investment brings 16-fold return… partnering with Bill Gates
– Jerome Kim, International Vaccine Institute Director General
– On the occasion of the 20th anniversary of IVI’s development and delivery of cholera and other vaccines
By Kim Sung-mo, The Chosun Ilbo
“Investment in vaccines can bring a 16-fold return, and a $1 investment can result in $16 in savings through disease prevention,” said Jerome Kim (58), IVI Director General, citing research by Johns Hopkins University in an interview marking the institute’s 20th anniversary.
The Director General added, “IVI developed an oral cholera vaccine that has been introduced in Haiti and Malawi and elsewhere, saving the lives of children and the impoverished in developing countries.”…
 
 
NIH  [to 28 October 2017]
http://www.nih.gov/news-events/news-releases
October 26, 2017
NIH study identifies new targets for anti-malaria drugs
 — The deadliest malaria parasite needs two proteins to infect red blood cells.
The deadliest malaria parasite needs two proteins to infect red blood cells and exit the cells after it multiplies, a finding that may provide researchers with potential new targets for drug development, according to researchers funded by the National Institutes of Health. Their study appears in the latest issue of Science…
In the current study, researchers sought to uncover the role of plasmepsins IX and X, two of the 10 types of plasmepsin proteins produced by P. falciparum for metabolic and other processes. They created malaria parasites that lacked plasmepsin IX or X under experimental conditions and compared them to those that had the two proteins.
 
 
PATH  [to 28 October 2017]
http://www.path.org/news/index.php
Press release | October 24, 2017
Global Alliance Releases New Tools to Guide Evidence-based Solutions Across Health, Development, and Environment
London, United Kingdom, October 25, 2017 — The Bridge Collaborative, a global alliance of 90 organizations from 23 countries, today released two new tools to assist decision-makers solving big challenges facing health, development, and the environment.
The Bridge Collaborative Practitioner’s Guide on Principles and Guidance for Cross-sector Action Planning and Evidence Evaluation and the policy-focused Call to Action for Health, Environment, and Development Leaders were developed to accelerate progress towards building a shared, cross-sector evidence base that informs strategies, shapes policies, and directs funding decisions to achieve concrete solutions. These resources are available at: www.bridgecollaborativeglobal.org…

Press release | October 23, 2017
US leadership and sustained funding urgently needed to prevent pandemics
New PATH report warns that gains from investments to stop Ebola and Zika outbreaks are at risk
Washington, DC, October 24, 2017 — Recent progress made in protecting Americans and people around the world from pandemics is at risk of being lost if US support is not sustained, PATH warns in a new report titled “Healthier World, Safer America: A US Government Roadmap for International Action to Prevent the Next Pandemic.” Programs established or strengthened with supplemental funding to thwart outbreaks of Ebola and Zika face a drastic cut in funding if the US administration and Congress do not act to protect these investments.
“Unfortunately, global health security funding too often comes in reaction to a crisis rather than ahead of time, when we can make more cost-effective and sustainable investments in systems that help stop disease outbreaks at their source, before they spread to our shores,” said Carolyn Reynolds, Vice President of Policy and Advocacy at PATH. “The US and the world are just beginning to reap the benefits of efforts made post-Ebola. Now is not the time to step back.”…

Sabin Vaccine Institute  [to 28 October 2017]
http://www.sabin.org/updates/pressreleases
October 22, 2017
Health Leaders Gather in Dubai for Regional Workshop on Adolescent Health and Immunization
DUBAI, UNITED ARAB EMIRATES –– Today, the Sabin Vaccine Institute (Sabin) convened public health leaders from across the Middle East and North Africa for a two-day interactive workshop to share experiences and strategies in strengthening adolescent health and immunization.

UNICEF  [to 28 October 2017]
https://www.unicef.org/media/
27 October, 2017
Growing number of unaccompanied refugee and migrant children in Greece in urgent need of shelter, care and protection
ATHENS/GENEVA, 27 October 2017 – Only a third of the nearly 3,000 unaccompanied refugee and migrant children currently in Greece are receiving proper shelter and care, UNICEF warned today. The children’s agency is urging key policy and legal reforms to help keep vulnerable children safe.

Substantial decline in global measles deaths, but disease still kills 90 000 per year
GENEVA/NEW YORK /ATLANTA, 26 October 2017– In 2016, an estimated 90,000 people died from measles – an 84 per cent drop from more than 550 000 deaths in 2000 – according to a new report published today by leading health organizations. This marks the first time global measles deaths have fallen below 100 000 per year.
[See Milestones above for more detail]

Two months since outbreak of violence in Myanmar, Rohingya refugee children still at acute risk
NEW YORK/GENEVA/DHAKA, 23 October 2017 – Nearly two months since Rohingya families began fleeing en masse to Bangladesh, thousands of children and women are still without basic lifesaving services, UNICEF said today.
 
 
DCVMN – Developing Country Vaccine Manufacturers Network  [to 28 October 2017]
http://www.dcvmn.org/
26 October 2017
Inaugural address of the DCVMN 2017 Annual Meeting in Seoul
by Deok Cheol Kwon, Deputy Minister of Health and Welfare 26th September 2017
 
 
IFPMA   [to 28 October 2017]
http://www.ifpma.org/resources/news-releases/
Published on: 26 October 2017
Global coalition in the fight against falsified medicines meets in Brussels as it welcomes its 35th partner
Wednesday, 25 October 2017, Brussels – Fight the Fakes campaign partners representing healthcare professionals, academia, NGOs, the generic and research-based pharmaceutical industry, healthcare distributers, and consumer protection organizations met this week to work on their future plans to raise awareness of the widespread sale and use of falsified medicines across the world and the dangers associated with these fake products.
With virtually all countries around the world impacted by fake medicines, and potentially 15% of medicines worldwide and up to 30% in some regions being fake, this a real danger to public health. By passing themselves off as something they are not, fake medicines put patients at risk for continued illness, disability, or even death. Some estimates put the number of deaths by falsified medicines at 700,000 per year. In addition, online sale of medicines is an increasing international threat, as there are more than 40,000 “active rogue online pharmacies” at active at any one time.  Fake medicines represent a crime against patients and are a danger to public health, contributing to resistance of genuine treatments and undermining confidence in health systems.
As the campaign approaches its four-year anniversary, Fight the Fakes is gathering pace in its efforts to inform, inspire, empower, and mobilize communities against fake medicines; as well as building up further momentum to call for the creation and strict application of legislative and regulatory frameworks. Partners today reinforced their commitment to the campaign and the issue of falsified medicines, committing themselves to tangible actions to further raise the profile of this global health threat.
IFPMA proudly joined this meeting as one of the founding members of this coalition…Today, Fight the Fakes is proud to also announce that the National Association of Boards of Pharmacy (NABP) has joined the campaign, bringing the total number of partners to 35…
 
 
 
Industry Watch  [to 28 October 2017]
:: CDC’s Advisory Committee on Immunization Practices recommends Shingrix as the preferred vaccine for the prevention of shingles for adults aged 50 and up
Committee recommends immunization for up to 62 million additional adults in the US
LONDON, Oct. 25, 2017 /PRNewswire/ — GlaxoSmithKline plc [LSE/NYSE: GSK] today announced that the US Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) voted in favor of three recommendations for the use of Shingrix (Zoster Vaccine Recombinant, Adjuvanted) for the prevention of shingles (herpes zoster):
:: Herpes Zoster subunit vaccine (Shingrix) is recommended for the prevention of herpes zoster and related complications for immunocompetent adults aged 50 years and older.
:: Herpes Zoster subunit vaccine (Shingrix) is recommended for the prevention of herpes zoster and related complications for immunocompetent adults who previously received Zoster Vaccine Live (Zostavax).
:: Herpes Zoster subunit vaccine (Shingrix) is preferred over Zoster Vaccine Live (Zostavax) for the prevention of herpes zoster and related complications.
The new recommendations mean up to 62 million more adults in the US should be immunized, approximately 42 million aged 50-59 years old and 20 million who have previously been vaccinated against shingles…

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 Preventive Medicine
November 2017 Volume 53, Issue 5, p567-744, e155-e200
http://www.ajpmonline.org/current

Research Articles
Vaccination Coverage of Adolescents With Chronic Medical Conditions
Annika M. Hofstetter, Stewin Camargo, Karthik Natarajan, Susan L. Rosenthal, Melissa S. Stockwell
p680–688
Published online: September 16, 2017
Abstract
Introduction
Adolescents with chronic medical conditions (CMCs) are at increased risk of vaccine-preventable infections. Little is known about their vaccine uptake.
Methods
This retrospective cohort study included 3,989 adolescents aged 11–17 years receiving care at academically affiliated pediatric clinics between August 2011 and June 2013. Data were abstracted from the medical center’s electronic health record and immunization registry in 2014. Vaccination coverage, timeliness, and missed opportunities were evaluated and analyzed in 2015–2016.
Results
Adolescents with CMCs had lower human papillomavirus vaccination initiation than those without CMCs (81.3% vs 85.0%), although this difference was only observed in stratified analysis among males (adjusted relative risk=0.90, 95% CI=0.85, 0.96), aged 13–17 years (adjusted relative risk=0.94, 95% CI=0.91, 0.98), and those with more primary care visits (adjusted relative risk=0.94, 95% CI=0.91, 0.98). Adolescents with CMCs had greater influenza vaccination coverage and timeliness than those without CMCs (2011–2012 season: 66.9% vs 50.1%; adjusted hazards ratio=1.27, 95% CI=1.15, 1.40; 2012–2013 season: 73.8% vs 64.5%; adjusted hazards ratio=1.20, 95% CI=1.10, 1.31). Only 32.1% and 18.2% of eligible adolescents had received pneumococcal polysaccharide and 13-valent pneumococcal conjugate vaccines, respectively. Missed opportunities were higher among adolescents with versus without CMCs for human papillomavirus vaccination initiation (4.2 vs 2.7, p<0.001), meningococcal vaccination (4.0 vs 2.9, p<0.001), and influenza vaccination (2011–2012 season: 2.1 vs 1.7, p<0.001; 2012–2013 season: 2.0 vs 1.6, p<0.001). Missed opportunities for pneumococcal vaccination were common.
Conclusions
Pockets of undervaccination and missed opportunities exist among adolescents with CMCs. Greater, more timely influenza vaccination suggests that optimal vaccination of high-risk adolescents is possible.

American Journal of Preventive Medicine
November 2017 Volume 53, Issue 5, p567-744, e155-e200
http://www.ajpmonline.org/current

Current Issues
Translating Economic Evidence for Public Health: Knowledge Brokers and the Interactive Systems Framework
Richard W. Puddy, Diane M. Hall
e185–e189
Abstract
The May 2016 special issue of the American Journal of Preventive Medicine on using economics to inform U.S. public health policy highlighted several ways that economics has been used in public health and suggested additional opportunities to accelerate public health impact.1 This special issue was a first of its kind, and was much needed, long overdue, and highlighted the contributions of economics in informing public health policy. Furthering this work requires sustained momentum and a broader application of economics to U.S.

American Journal of Public Health
November 2017  107(11)
http://ajph.aphapublications.org/toc/ajph/current

ROLE OF LAW
Advancing the Right to Health—The Vital Role of Law
Lawrence O. Gostin, Roger S. Magnusson, Rüdiger Krech, David W. Patterson, Steven A. Solomon, Derek Walton, Gian Luca Burci, Katharina Ó Cathaoir, Sarah A. Roache and Marie-Paule Kieny
107(11), pp. 1755–1756
[No abstract]

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 28 October 2017)

Research article
Spatio-temporal pattern analysis for evaluation of the spread of human infections with avian influenza A(H7N9) virus in China, 2013–2014
Wen Dong, Kun Yang, Quanli Xu, Lin Liu and Juan Chen
Published on: 24 October 2017

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 28 October 2017)

Research article
Collaborative partnership and the social value of clinical research: a qualitative secondary analysis
Protecting human subjects from being exploited is one of the main ethical challenges for clinical research. However, there is also a responsibility to protect and respect the communities who are hosting the research. Recently, attention has focused on the most efficient way of carrying out clinical research, so that it benefits society by providing valuable research while simultaneously protecting and respecting the human subjects and the communities where the research is conducted. Collaboration between partners plays an important role and that is why we carried out a study to describe how collaborative partnership and social value are emerging in clinical research.
Sanna-Maria Nurmi, Arja Halkoaho, Mari Kangasniemi and Anna-Maija Pietilä
BMC Medical Ethics 2017 18:57
Published on: 25 October 2017

Humanitarian Exchange Magazine
http://odihpn.org/magazine/the-humanitarian-consequences-of-violence-in-central-america/
Number 70   October 2017

Special Feature: The Lake Chad Basin: an overlooked crisis?
by Humanitarian Practice Network October 2017
The 70th edition of Humanitarian Exchange, co-edited with Joe Read, focuses on the humanitarian crisis in Nigeria and the Lake Chad Basin. The violence perpetrated by Boko Haram and the counter-insurgency campaign in Nigeria, Cameroon, Chad and Niger has created a humanitarian crisis affecting some 17 million people. Some 2.4 million have been displaced, the vast majority of them in north-eastern Nigeria. Many are living in desperate conditions, without access to sufficient food or clean water. The Nigerian government’s focus on defeating Boko Haram militarily, its reluctance to acknowledge the scale and gravity of the humanitarian crisis and the corresponding reticence of humanitarian leaders to challenge that position have combined to undermine the timeliness and effectiveness of the response…

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 13, Issue 10 2017
http://www.tandfonline.com/toc/khvi20/current

Article
Cost effectiveness of a practice-based intervention to improve vaccination rates in adults less than 65-years-old
Kenneth J. Smith, Mary Patricia Nowalk, Chyongchiou J. Lin & Richard K. Zimmerman
Pages: 2207-2212
Published online: 22 Aug 2017

Article
Assessment of the potential public health impact of Herpes Zoster vaccination in Germany
Desmond Curran, Desirée Van Oorschot, Lijoy Varghese, Lidia Oostvogels, Tomas Mrkvan, Romulo Colindres, Alfred von Krempelhuber & Anastassia Anastassopoulou
Pages: 2213-2221
Published online: 14 Jul 2017

Commentary
Safety of oral cholera vaccines during pregnancy in developing countries
Ashraful Islam Khan, Md Taufiqul Islam & Firdausi Qadri
Pages: 2245-2246
Published online: 21 Aug 2017

meeting report
The 2017 Keystone Symposium on HIV Vaccines
Christopher A. Cottrell & Andrew B. Ward
Pages: 2348-2351
Published online: 08 Aug 2017

JAMA
October 24/31, 2017, Vol 318, No. 16, Pages 1517-1622
http://jama.jamanetwork.com/issue.aspx

Viewpoint
An HIV Vaccine Is Essential for Ending the HIV/AIDS Pandemic
Anthony S. Fauci, MD
JAMA. 2017;318(16):1535-1536. doi:10.1001/jama.2017.13505
In this Viewpoint, Anthony Fauci discusses the limits of current treatment and prevention approaches to the HIV epidemic and proposes that the addition of an HIV vaccine is necessary to slow and end it.

JAMA Guide to Statistics and Methods
Bayesian Analysis: Using Prior Information to Interpret the Results of Clinical Trials
Melanie Quintana, PhD; Kert Viele, PhD; Roger J. Lewis, MD, PhD
JAMA. 2017;318(16):1605-1606. doi:10.1001/jama.2017.15574
This JAMA Guide to Statistics and Methods discusses the Bayesian approach to integrating or updating information from previous studies with newly obtained data to yield a final quantitative summary of the information.

Nature 
Volume 550 Number 7677 pp429-554  26 October 2017
http://www.nature.com/nature/current_issue.html

Editorials
Data science can improve aid distribution
Online platforms can help to steer emergency response and ensure money is well spent.

Comment
The Human Cell Atlas: from vision to reality
As an ambitious project to map all the cells in the human body gets officially under way, Aviv Regev, Sarah Teichmann and colleagues outline some key challenges.

Letters
The prevalence of Plasmodium falciparum in sub-Saharan Africa since 1900
Robert W. Snow, Benn Sartorius, David Kyalo, Joseph Maina, Punam Amratia+ et al.
Spatial and temporal modelling of a large dataset of Plasmodium falciparum prevalence rates reveals cycles and trends of malaria transmission in sub-Saharan Africa over a 115 year period.

New England Journal of Medicine
October 26, 2017  Vol. 377 No. 17
http://www.nejm.org/toc/nejm/medical-journal

HIV Drug Resistance — An Emerging Threat to Epidemic Control
Beyrer and A. Poznia
… A recent report from the WHO, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and the Centers for Disease Control and Prevention (CDC) showed that the prevalence of HIV drug resistance has increased from 11% to 29% since the global rollout of ART in 2001.1 The report was based on findings from 16 surveys in 14 countries that used the WHO’s recommended approach to population-based sampling for HIV drug resistance among patients in public ART programs, supplemented by data from two population-based HIV impact assessments conducted through the President’s Emergency Plan for AIDS Relief (PEPFAR) in Malawi and Zimbabwe.
It is worrisome that in 6 of 11 countries surveyed — Argentina, Guatemala, Namibia, Nicaragua, Uganda, and Zimbabwe — the rate of pretreatment drug resistance surpassed 10% among people receiving ART for the first time (see graph– Pretreatment HIV Drug Resistance to Nonnucleoside Reverse Transcriptase Inhibitors in 11 Countries.). Here HIV drug resistance was defined as resistance to nonnucleoside reverse transcriptase inhibitors (NNRTIs), core drugs in most low- and middle-income countries’ first-line regimens for HIV. Among people with past exposure to ART (those restarting treatment or women with past perinatal exposure) the rate of NNRTI resistance is even higher: 21.6% (95% confidence interval [CI], 13.8 to 32.2).1 A recent report from South Africa revealed that among children 18 months old or younger identified through early infant diagnoses, NNRTI resistance was found in 63.7% (95% CI, 59.0 to 68.4).1
How significant is the increase in resistance to HIV treatment? And what can be done to mitigate it?
 

New England Journal of Medicine
October 26, 2017  Vol. 377 No. 17
http://www.nejm.org/toc/nejm/medical-journal

 
Clinical Implications of Basic Research
A CRISPR Way to Diagnose Infectious Diseases
A.M. Caliendo and R.L. Hodinka
A new method for detecting infectious disease involves the use of a genetic probe and an enzyme that is activated once the probe specifically binds the DNA of the pathogen.

PLOS Currents: Disasters
http://currents.plos.org/disasters/
[Accessed 28 October 2017]

The United Nations Material Assistance to Survivors of Cholera in Haiti: Consulting Survivors and Rebuilding Trust
October 23, 2017 · Brief Report
Introduction: In August 2016, the United Nations (U.N.) Secretary General acknowledged the U.N.’s role in the cholera epidemic that has beset Haiti since 2010. Two months later, the Secretary General issued a historic apology to the Haitian people before the U.N. General Assembly, for the organization’s insufficient response to the cholera outbreak. These steps are part of the U.N.’s “new approach” to cholera in Haiti, which also includes launching a material assistance package for those most affected by cholera.
Methods: This paper draws on the authors’ experience and findings from consultations with more than 60,000 victims and communities affected by disasters and violence in a dozen countries. We reviewed the literature on best practices for consultation with and outreach to communities affected by development and transitional justice programming, and reviewed our own findings from previous studies with a view to identifying recommendations for ensuring that the assistance package reflects the views of people affected by cholera.
Results: The assistance package program is an opportunity to rebuild the relationship between the victims and the United Nations. This can only be achieved if victims are informed and engaged in the process. This consultation effort is also an opportunity to answer a set of key questions related to the nature, structure, and implementation of the victims’ assistance program, but also how the program may be designed to contribute to rebuilding Haitians’ confidence in the U.N. as an institution that promotes peace, human rights, and development.
Discussion: We recommend that the consultations must be accompanied by an outreach effort that provides clear, accurate information on the assistance program, so that it begins to establish a dialogue between the U.N. and cholera victims. Finally, we conclude by offering a number of concrete next steps that the U.N. can take to kick start the consultation process.

PNAS – Proceedings of the National Academy of Sciences of the United States
of America
http://www.pnas.org/content/early/
[Accessed 28 October 2017]

Biological Sciences – Microbiology:
Synergistic malaria vaccine combinations identified by systematic antigen screening
Leyla Y. Bustamante, Gareth T. Powell, Yen-Chun Lin, Michael D. Macklin, Nadia Cross, Alison Kemp, Paula Cawkill, Theo Sanderson, Cecile Crosnier, Nicole Muller-Sienerth, Ogobara K. Doumbo, Boubacar Traore, Peter D. Crompton, Pietro Cicuta, Tuan M. Tran, Gavin J. Wright, and Julian C. Rayner
PNAS 2017 ; published ahead of print October 23, 2017, doi:10.1073/pnas.1702944114

Science         
27 October 2017  Vol 358, Issue 6362
http://www.sciencemag.org/current.dtl
Special Issue: Neuroscience: In search of new concepts

Neuroscience: In search of new concepts
By Peter Stern
Every year, tens of thousands of researchers gather for the Society for Neuroscience meeting. The lecture theaters and poster halls are full of smart and hardworking individuals. Every year, we return home from the conference excited about all the facts learned and insights gained. However, despite the collective efforts of so many bright people, there is still much progress to be made in tackling the big questions in our field. Could it be that we are interpreting our data with outdated concepts? Most of the dominant concepts in present-day neuroscience, after all, were developed 50 to more than 100 years ago.
This special issue questions some of our approaches. Do the many diverse lines of inquiry in neuroscience need a broader set of animal models? How are resources best balanced between big data projects and smaller-scale focused projects?
On the conceptual side, how do we define a brain region—such as, for example, the prefrontal cortex? What is consciousness, and what makes it different from the many unconscious processes in our brain? Why do computers presently lack consciousness, and when might they acquire it?
The concepts of space and time are essential to how we see the world. Neuroscientists should take a fresh look at the emergence of these concepts in the brain and think about how to investigate them.
These are exciting times for neuroscience, but conceptual challenges still remain, as outlined in the Reviews in this issue. With many questions still open, it is time for our community to embrace and address these challenges.

Science         
27 October 2017  Vol 358, Issue 6362
http://www.sciencemag.org/current.dtl
Special Issue: Neuroscience: In search of new concepts

Policy Forum
Ethics of maternal vaccination
By A. T. Chamberlain, J. V. Lavery, A. White, S. B. Omer
Science27 Oct 2017 : 452-453 Restricted Access
Involvement of women is critical in establishing guidelines
Summary
Innovations in vaccine science have given us an incredible opportunity to leverage the maternal immune system to improve maternal, fetal, and infant health outcomes. Maternal vaccination reduces the risk of infant infection primarily through the transfer of protective maternal antibodies to the fetus (1). Although a growing number of countries are adopting maternal vaccine programs against diseases like influenza and pertussis, and there is an increased focus on including pregnant women in trials for new vaccines, there is little discussion of the ethical underpinnings of maternal vaccine programs (2). We see the proposals thus far as being overly paternalistic, founded on a too-limited conception of risk-benefit analyses that has potential to derail the development and use of lifesaving vaccines. By contrast, an ethical approach focused on mothers’ primary interests in protecting themselves and their children could serve as the basis of the ethical framework that guides vaccine policies.

Science Translational Medicine
25 October 2017  Vol 9, Issue 413
http://stm.sciencemag.org/

Research Articles
Evolution-informed forecasting of seasonal influenza A (H3N2)
By Xiangjun Du, Aaron A. King, Robert J. Woods, Mercedes Pascual
Science Translational Medicine25 Oct 2017 Full Access
A transmission model including virus evolution quantified from genetic sequences produces H3N2 influenza forecasts ahead of the season.

Vaccine
Volume 35, Issue 47, Pages 6355-6468 (7 November 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/47?sdc=1

Review
A brief review on the immunological scenario and recent developmental status of vaccines against enteric fever
Review Article
Pages 6359-6366
Debaki Ranjan Howlader, Hemanta Koley, Suhrid Maiti, Ushasi Bhaumik, Priyadarshini Mukherjee, Shanta Dutta
Abstract
Enteric fever has been one of the leading causes of severe illness and deaths worldwide. S. Typhi and S. Paratyphi A, B and C are important enteric fever-causing organisms globally. This infection causes about 21 million cases among which 222,000 typhoid related deaths occurred in 2015. These estimates do not reflect the ultimate and real status of the disease due to the lack of unified diagnostic and proper reporting system from typhoid endemic and other regions. Current control strategies have become increasingly ineffective due to the emergence of multi-drug resistance among the strains. This situation worsens the disease-burden in developing as well as in developed countries. Moreover the emergence of S. Paratyphi A as a major enteric fever-causing organism in several Asian countries, demands a prophylactic measure at this hour. Other than two licensed vaccines of S. Typhi, there are no exsisting vaccines for S. Paratyphi A. Moreover, travelers returning from endemic regions are becoming more susceptible to have these infections. In this situation, a need for bivalent approach is required where a single immunogen (consisting from each organism) will be effective against the disease. In this review, we have focused on the general information about typhoidal fever, its spread and epidemiology in brief and the present status of typhoidal vaccines and its future. This review highlights existing gaps in the typhoidal salmonellae research with a special emphasis on the status of present typhoidal salmonellae vaccine research.

Vaccine
Volume 35, Issue 47, Pages 6355-6468 (7 November 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/47?sdc=1

Regular papers
A formative research-guided educational intervention to improve the knowledge and attitudes of seniors towards influenza and pneumococcal vaccinations
Original Research Article
Pages 6367-6374
Hanley J. Ho, Yin Ying Chan, Muhamad Alif bin Ibrahim, Anurupa A. Wagle, Christina M. Wong, Angela Chow
Abstract
Background
Adult influenza and pneumococcal vaccination rates in Singapore are low, and factors influencing knowledge and attitudes of seniors towards influenza, pneumonia and their respective vaccines are not well-known. Our study aims to understand the barriers and facilitators towards getting influenza and pneumococcal vaccinations among seniors in Singapore, and subsequently inform the conduct of a relevant community-based educational intervention, as well as evaluate the intervention outcomes.
Methods
We performed a mixed methods study with two components: Firstly, formative research was conducted among community-dwelling seniors, using focus group discussions (FGDs), to understand their knowledge and attitudes towards influenza, pneumonia and their respective vaccines. Next, a quantitative study was conducted to evaluate knowledge of seniors and the effectiveness of an educational intervention.
Results
Four FGDs were organised with 32 participants, who were predominantly female, of lower educational background, and residing in government rental flats. Participants had varying levels of knowledge and many misconceptions about influenza, pneumonia and their respective vaccinations, with concerns about side effects and vaccine effectiveness. The formative research results were used to inform a community-based educational intervention for seniors. Our subsequent evaluation included 604 elderly participants, mainly from lower educational and socio-economic strata, who initially demonstrated poor knowledge scores (median score 5 out of 9, IQR 4-5). Following our intervention, median knowledge score improved to 7 (IQR 6-8) (p < .0001). Significant improvements in knowledge scores were observed across genders, age strata, education levels, and housing types.
Discussion
Our formative research identified knowledge gaps among community-dwelling seniors which affected their attitudes towards vaccination uptake. Key findings were taken into consideration when implementing the educational intervention. Our community-based intervention was effective in improving knowledge and attitudes, and could be used as a cue to action for short-term behaviour changes.

Vaccine
Volume 35, Issue 47, Pages 6355-6468 (7 November 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/47?sdc=1

Timeliness of childhood vaccination in the Federated States of Micronesia
Original Research Article
Pages 6404-6411
Ashley Tippins, Andrew J. Leidner, Mehreen Meghani, Aja Griffin, Louisa Helgenberger, Mawuli Nyaku, J. Michael Underwood
Abstract
Background
Vaccination coverage is typically measured as the proportion of individuals who have received recommended vaccine doses by the date of assessment. This approach does not provide information about receipt of vaccines by the recommended age, which is critical for ensuring optimal protection from vaccine-preventable diseases (VPDs).
Objective
To assess vaccination timeliness in the Federated States of Micronesia (FSM), and the projected impact of suboptimal vaccination in the event of an outbreak.
Methods
Timeliness of the 4th dose of diphtheria, tetanus, and acellular pertussis vaccine (DTaP) and 1st dose of measles, mumps, and rubella vaccine (MMR) among children 24–35 months was assessed in FSM. Both doses are defined as on time if administered from 361 through 395 days in age. Timeliness was calculated by one-way frequency analysis, and dose delays, measured in months after recommended age, were described using inverse Kaplan-Meier analysis. A time-series susceptible-exposed-infected-recovery (TSEIR) model simulated measles outbreaks in populations with on time and late vaccination.
Results
Total coverage for the 4th dose of DTaP ranged from 36.6% to 98.8%, and for the 1st dose of MMR ranged from 80.9% to 100.0% across FSM states. On time coverage for the 4th dose of DTaP ranged from 3.2% to 52.3%, and for the 1st dose of MMR ranged from 21.1% to 66.9%. Maximum and median dose delays beyond the recommended age varied by state. TSEIR models predicted 10.8–13.7% increases in measles cases during an outbreak based on these delays.
Conclusions
In each of the FSM states, a substantial proportion of children received DTaP and MMR doses outside the recommended timeframe. Children who receive vaccinations later than recommended remain susceptible to VPDs during the period they remain unvaccinated, which may have a substantial impact on health systems during an outbreak. Immunization programs should consider vaccination timeliness in addition to coverage as a measure of susceptibility to VPDs in young children.

Vaccine
Volume 35, Issue 47, Pages 6355-6468 (7 November 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/47?sdc=1

Using best-worst scaling to rank factors affecting vaccination demand in northern Nigeria
Original Research Article
Pages 6429-6437
Sachiko Ozawa, Chizoba Wonodi, Olufemi Babalola, Tukur Ismail, John Bridges
Abstract
Background
Understanding and ranking the reasons for low vaccination uptake among parents in northern Nigeria is critical to implement effective policies to save lives and prevent illnesses. This study applies best-worst scaling (BWS) to rank various factors affecting parents’ demand for routine childhood immunization.
Methods
We conducted a household survey in Nahuche, Zamfara State in northern Nigeria. Nearly two hundred parents with children under age five were asked about their views on 16 factors using a BWS technique. These factors focused on known attributes that influence the demand for childhood immunization, which were identified from a literature review and reviewed by a local advisory board. The survey systematically presented parents with subsets of six factors and asked them to choose which they think are the most and least important in decisions to vaccinate children. We used a sequential best-worst analysis with conditional logistic regression to rank factors.
Results
The perception that vaccinating a child makes one a good parent was the most important motivation for parents in northern Nigeria to vaccinate children. Statements related to trust and social norms were ranked higher in importance compared to those that highlighted perceived benefits and risks, healthcare service, vaccine information, or opportunity costs. Fathers ranked trust in the media and views of their leaders to be of greatest importance, whereas mothers placed greater importance on social perceptions and norms. Parents of children without routine immunization ranked their trust in local leaders about vaccines higher in considerations, and the media’s views lower, compared to parents with children who received routine immunization.
Conclusions
Framing immunization messages in the context of good parenting and hearing these messages from trusted information sources may motivate parental uptake of childhood vaccines. These results are useful to policymakers to prioritize resources in order to increase awareness and demand for childhood immunization.

Vaccine
Volume 35, Issue 47, Pages 6355-6468 (7 November 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/47?sdc=1

Understanding vaccine hesitancy in polio eradication in northern Nigeria
Original Research Article
Pages 6438-6443
Sebastian Taylor, Mahmud Khan, Ado Muhammad, Okey Akpala, Marit van Strien, Chris Morry, Warren Feek, Ellyn Ogden
Abstract
Background
Vaccine hesitancy constitutes a major threat to the Global Polio Eradication Initiative (GPEI), and to further expansion of routine immunisation. Understanding hesitancy, leading in some cases to refusal, is vital to the success of GPEI. Re-emergence of circulating wild poliovirus in northern Nigeria in mid-2016, after 24 months polio-free, gives urgency to this. But it is equally important to protect and sustain the global gains available through routine immunisation in a time of rising scepticism and potential rejection of specific vaccines or immunisation more generally.
Methods and findings
This study is based on a purposive sampling survey of 1653 households in high- and low-performing rural, semiurban and urban areas of three high-risk states of northern Nigeria in 2013–14 (Sokoto, Kano and Bauchi). The survey sought to understand factors at household and community level associated with propensity to refuse polio vaccine.
Wealth, female education and knowledge of vaccines were associated with lower propensity to refuse oral polio vaccine (OPV) among rural households. But higher risk of refusal among wealthier, more literate urban household rendered these findings ambiguous. Ethnic and religious identity did not appear to be associated with risk of OPV refusal.
Risk of vaccine refusal was highly clustered among households within a small sub-group of sampled settlements. Contrary to expectations, households in these settlements reported higher levels of expectation of government as service provider, but at the same time lesser confidence in the efficacy of their relations with government.
Conclusions
Results suggest that strategies to address the micro-political dimension of vaccination – expanding community-level engagement, strengthening the role of local government in public health, and enhancing public participation of women – should be effective in reducing non-compliance, as an important set of strategies complementary to conventional didactic/educational approaches and working through religious and traditional ‘influencers’.

Vaccine
Volume 35, Issue 47, Pages 6355-6468 (7 November 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/47?sdc=1

County-level assessment of United States kindergarten vaccination rates for measles mumps rubella (MMR) for the 2014–2015 school year
Original Research Article
Pages 6444-6450
Sheryl A. Kluberg, Denise P. McGinnis, Yulin Hswen, Maimuna S. Majumder, Mauricio Santillana, John S. Brownstein
Abstract
United States kindergarten measles-mumps-rubella (MMR) vaccination rates are typically reported at the state level by the Centers for Disease Control and Prevention (CDC). The lack of local MMR data prevents identification of areas with low vaccination rates that would be vulnerable to the spread of disease. We collected county-level vaccination rates for the 2014–2015 school year with the objective of identifying these regions.
We requested county-level kindergarten vaccination data from state health departments, and mapped these data to visualize geographic patterns in achievement of the 95% MMR vaccination target. We aggregated the county-level data to the state level for comparison against CDC state estimates. We also analyzed the relationship of MMR vaccination level with county-level and state-level poverty (using U.S. census data), using both a national mixed model with state as a random effect, and individual linear regression models by state.
We received county vaccination data from 43 states. The median kindergarten MMR vaccination rate was 96.0% (IQR 89–98) across all counties, however, we estimated that 48.4% of the represented counties had vaccination rates below 95%. Our state estimates closely reflected CDC values. Nationally, every 10% increase in under-18 county poverty was associated with a 0.24% increase in MMR vaccination rates (95% CI: −0.07%; 0.54%), but the direction of this relationship varied by state.
We found that county data can reveal vaccination trends that are unobservable from state-level data, but we also discovered that the current availability of county-level data is inadequate. Our findings can be used by state health departments to identify target areas for vaccination programs.

Vaccine
Volume 35, Issue 46, Pages 6255-6354 (1 November 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/46?sdc=1

Conference report
Estimating the full public health value of vaccination
Pages 6255-6263
Bradford D. Gessner, David Kaslow, Jacques Louis, Kathleen Neuzil, Katherine L. O’Brien, Valentina Picot, Tikki Pang, Umesh D. Parashar, Mitra Saadatian-Elahi, Christopher B. Nelson
Abstract
There is an enhanced focus on considering the full public health value (FPHV) of vaccination when setting priorities, making regulatory decisions and establishing implementation policy for public health activities. Historically, a therapeutic paradigm has been applied to the evaluation of prophylactic vaccines and focuses on an individual benefit-risk assessment in prospective and individually-randomized phase III trials to assess safety and efficacy against etiologically-confirmed clinical outcomes. By contrast, a public health paradigm considers the population impact and encompasses measures of community benefits against a range of outcomes. For example, measurement of the FPHV of vaccination may incorporate health inequity, social and political disruption, disruption of household integrity, school absenteeism and work loss, health care utilization, long-term/on-going disability, the development of antibiotic resistance, and a range of non-etiologically and etiologically defined clinical outcomes.
Following an initial conference at the Fondation Mérieux in mid-2015, a second conference (December 2016) was held to further describe the efficacy of using the FPHV of vaccination on a variety of prophylactic vaccines. The wider scope of vaccine benefits, improvement in risk assessment, and the need for partnership and coalition building across interventions has also been discussed during the 2014 and 2016 Global Vaccine and Immunization Research Forums and the 2016 Geneva Health Forum, as well as in numerous publications including a special issue of Health Affairs in February 2016.
The December 2016 expert panel concluded that while progress has been made, additional efforts will be necessary to have a more fully formulated assessment of the FPHV of vaccines included into the evidence-base for the value proposition and analysis of unmet medical need to prioritize vaccine development, vaccine licensure, implementation policies and financing decisions. The desired outcomes of these efforts to establish an alternative framework for vaccine evaluation are a more robust vaccine pipeline, improved appreciation of vaccine value and hence of its relative affordability, and greater public access and acceptance of vaccines.

Vaccine
Volume 35, Issue 46, Pages 6255-6354 (1 November 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/46?sdc=1

Cost-effectiveness of HPV vaccination in the context of high cervical cancer incidence and low screening coverage
Original Research Article
Pages 6329-6335
Triin Võrno, Katrin Lutsar, Anneli Uusküla, Lee Padrik, Terje Raud, Rainer Reile, Oliver Nahkur, Raul-Allan Kiivet
Abstract
Background
Estonia has high cervical cancer incidence and low screening coverage. We modelled the impact of population-based bivalent, quadrivalent or nonavalent HPV vaccination alongside cervical cancer screening.
Methods
A Markov cohort model of the natural history of HPV infection was used to assess the cost-effectiveness of vaccinating a cohort of 12-year-old girls with bivalent, quadrivalent or nonavalent vaccine in two doses in a national, school-based vaccination programme. The model followed the natural progression of HPV infection into subsequent genital warts (GW); premalignant lesions (CIN 1–3); cervical, oropharyngeal, vulvar, vaginal and anal cancer. Vaccine coverage was assumed to be 70%. A time horizon of 88 years (up to 100 years of age) was used to capture all lifetime vaccination costs and benefits. Costs and utilities were discounted using an annual discount rate of 5%.
Results
Vaccination of 12-year-old girls alongside screening compared to screening alone had an incremental cost-effectiveness ratio (ICER) of €14,007 (bivalent), €14,067 (quadrivalent) and €11,633 (nonavalent) per quality-adjusted life-year (QALY) in the base-case scenario and ranged between €5367–21,711, €5142–21,800 and €4563–18,142, respectively, in sensitivity analysis. The results were most sensitive to changes in discount rate, vaccination regimen, vaccine prices and cervical cancer screening coverage.
Conclusion
Vaccination of 12-year-old girls alongside current cervical cancer screening can be considered a cost-effective intervention in Estonia. Adding HPV vaccination to the national immunisation schedule is expected to prevent a considerable number of HPV infections, genital warts, premalignant lesions, HPV related cancers and deaths. Although in our model ICERs varied slightly depending on the vaccine used, they generally fell within the same range. Cost-effectiveness of HPV vaccination was found to be most dependent on vaccine cost and duration of vaccine immunity, but not on the type of vaccine used.

Value in Health                   
October–November 2017 Volume 20, Issue 9
http://www.valueinhealthjournal.com/current

ISPOR 20th Annual European Congress Research Abstracts
Break out Sessions
Would a Two-Dose Rotavirus Vaccine Improve Health Outcomes While Reducing Costs in the Sultanate of Oman?
X Li, Y Shehata, A Marijam, K Meszaros, S Noibi
Rotavirus is the most common cause of diarrhoea in young children. A recent study in Oman showed no significant disease reductions despite improved healthcare facilities and infection control measures. This study evaluated whether a paediatric vaccination programme with a two-dose Human Rotavirus Vaccine (HRV) would be cost-effective in Oman.

Value in Health                   
October–November 2017 Volume 20, Issue 9
http://www.valueinhealthjournal.com/current

Differences In Vaccine Pricing Between High-Income And Low-Income Markets
I Fadeyi, T McLean, F Tavella, L Heron
Published in issue: October-November, 2017
The aim of this study is to evaluate vaccine pricing and the differences in the costs of vaccines between high income (HICs) and low income (LICs) countries.

Value in Health                   
October–November 2017 Volume 20, Issue 9
http://www.valueinhealthjournal.com/current

Cost-Effectiveness of Additional Vaccination of Boys Against HPV In Germany
O Damm, J Horn, B Ultsch, S Scholz, R Mikolajczyk, M Wiese-Posselt, T Harder, O Wichmann, W Greiner
Published in issue: October-November, 2017
Routine vaccination of girls against human papillomavirus (HPV) was introduced in Germany in 2007. In an independently funded model-based study, HPV vaccination of girls was found to be a cost-effective intervention in Germany. However, the cost-effectiveness of vaccinating boys remained unclear, particularly because the previous study did not consider all relevant aspects (i.e. two-dose schedule, broader spectrum of HPV-associated cancers, ninevalent vaccine). The objective of this study was to estimate the cost-effectiveness of adding boys to the existing immunisation strategy in Germany.

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

Hepatology International
First Online: 24 October 2017
Point of View
Mother-to-infant transmission of hepatitis B virus: challenges and perspectives
YF Shih, CJ Liu
Abstract
Chronic hepatitis B virus (HBV) infection due to perinatal mother-to-infant transmission (MTIT) remains a serious global health problem. Despite passive-active immunoprophylaxis using hepatitis B vaccination with or without hepatitis B immunoglobulin (HBIg), up to 8–10% of newborns still acquire HBV infection. Understanding the mechanisms of MTIT is essential for the interruption of HBV transmission. There are three possible routes of transmission: intrauterine transmission, transmission during delivery (intrapartum) and postnatal transmission through close contact or breast milk (postpartum). Overall, positivity for hepatitis B e antigen (HBeAg) and the high viral load of the mothers are the two most important risk factors related to MTIT of HBV. This article briefly reviews the viral factors related to MTIT of HBV and discusses the issues that warrant further investigation.

Journal of AIDS and Clinical Research
2017 Vol.8 No.3 pp.676 ref.21
Regulatory and ethical approval timelines for HIV vaccine studies: an analysis of International AIDS Vaccine Initiative (IAVI) sponsored studies in East and Southern Africa
P Bahati, Z Omungo, B Bender, J Rono – Journal of AIDS and Clinical Research, 2017
Abstract
Background: There has not been a systematic analysis of factors affecting ethics and regulatory timelines of HIV Vaccine trials and epidemiologic studies in Eastern and Southern Africa. We analyzed regulatory and ethics approval timelines and associated factors for HIV vaccine clinical trials and epidemiologic studies in Kenya, Uganda, Rwanda, South Africa and Zambia using data collected from seven Clinical Research Centers (CRCs) from 2001 to 2015.
Methodology: Staff responsible for regulatory issues at CRCs provided archived data on ethical and regulatory review time-frames which were then validated with the sponsor central database. A semi structured questionnaires was administered to establish qualitative information on perceived factors affecting efficiency of approval processes and potential solutions. Quantitative data analysis was conducted using Excel. Qualitative data were analyzed using an open coding to analyze and elicit general themes.
Findings: Data on submission for 23 clinical trials and 51 epidemiological study protocols were analyzed. Across all seven CRCs it took on average of 178 and 108 days to obtain full authorization to commence clinical trials and epidemiological studies, respectively. These timelines are shorter than the average found in other disease fields in Africa but seem longer than approval timelines in the USA and the EU that are estimated at 15-45 days and 43-75 days, respectively. We found that countries with sequential, rather than parallel, submission procedures had longer review timelines. Clinical trial approval timelines that were longer than 200 days were associated with amendment submissions prior to initial approval and with investigational products that required institutional biosafety committee reviews. Lengthier approval timelines were also associated with epidemiological studies with more invasive procedures.
Conclusion: Strategies to further shorten timelines will need to focus on adoption of parallel approval processes; increase frequency of ethical review meetings and capacity strengthening of ethical review institutions.

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

We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.
 
 
The Atlantic
http://www.theatlantic.com/magazine/
Accessed 28 October 2017
Why Do We Need Separate Chicken-Pox and Shingles Vaccines?
The two diseases are caused by the same virus but strike different groups of people.
Sarah Zhang   Oct 25, 2017
“It’s a real paradigm shift because there are no vaccines that perform so extraordinarily well for people in their 70s and their 80s.”

 
National Geographic
https://www.nationalgeographic.com/magazine/
Accessed 28 October 2017
Here’s Why Vaccines Are So Crucial
If children in poor countries got the shots that rich countries take for granted, hundreds of thousands of young lives could be saved.
By Cynthia Gorney

New York Times
http://www.nytimes.com/
Accessed 28 October 2017
Health
The Long War on Polio, as Recalled by Its Generals
By DONALD G. McNEIL Jr. OCT. 20, 2017
‘Coffee With Polio Experts” will not be picked up by Hulu anytime soon, but there is something compelling in these short videos put out by the Global Polio Eradication Initiative.
The formula is simple: Doctors who have spent years fighting polio in the world’s most remote regions sit down over coffee with a World Health Organization representative to tell war stories.
The production values are amateurish — cups rattle, the bustle of the coffee shop intrudes. But the tales can be gripping, and they are recalled by soldiers who save lives rather than taking them…
 
Washington Post
http://www.washingtonpost.com/
Accessed 28 October 2017
Mom jailed for not vaccinating son doesn’t want future shots
Associated Press · National · Oct 28, 2017
PONTIAC, Mich. — A suburban Detroit mother who served jail time for violating a court order to have her son vaccinated is asking a judge to prevent any future vaccinations.
The Detroit Free Press reports that 40-year-old Rebecca Bredow’s lawyer Clarence Dass says she will have to convince an Oakland County judge that avoiding future vaccinations is “in the best interests of the child.” Bredow opposes vaccines, but her ex-husband, the boy’s father, wants the boy vaccinated.
An Oakland County judge earlier this month sent the Ferndale woman to jail for five days for ignoring a Sept. 27 order to vaccinate the child.
Dass has said in court filings that Bredow “believes that the risks to vaccinations outweigh the benefits.” A judge hasn’t yet scheduled a hearing on Bredow’s latest request.

Think Tanks et al
 
 
Council on Foreign Relations
http://www.cfr.org/
Accessed 28 October 2017
Ending Polio in Nigeria Once and for All
Blog Post by Toyin Saraki
October 26, 2017

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_21 October 2017

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

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

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.

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

Milestones :: Perspectives
 
Dr Mahmoud Fikri
WHO statement
17 October 2017
Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization announces with great sadness the death of Dr Mahmoud M Fikri, WHO Regional Director for the Eastern Mediterranean.

The Organization extends its sincere condolences to Dr Fikri’s family and his colleagues and friends throughout WHO and the Eastern Mediterranean Region.

Dr Fikri assumed his duties as Regional Director on 1 February 2017. He was on his way to attend the WHO Global Conference on NCDs in Montevideo, Uruguay when he died.

Dr Fikri had previously served as Adviser to the Minister of Health of United Arab Emirates, and had been a prominent regional public health figure for many years.

WHO supports the immunization of 874,000 people against yellow fever in Nigeria
News release
16 October 2017 | Geneva – The Government of Nigeria has launched a campaign to immunize 873 837 people against yellow fever in the states of Kwara and Kogi.

The ten-day campaign began on Friday, 13 October 2017, and mobilizes more than 200 health workers and volunteers. It targets residents aged 9 months to 45 years old.

“This campaign aims to ensure that people living in high-risk areas are protected from yellow fever, and to prevent the disease from spreading to other parts of the country,” said Dr. Wondimagegnehu Alemu, WHO Nigeria Representative.

WHO has been working with health authorities on its implementation in nine local government areas in Kwara State and two in Kogi State.

Nigeria has requested support from the International Coordination Group (ICG) on vaccine provision for yellow fever. A global stockpile of 6 million doses of the yellow fever vaccine is available for countries to access, with the support of Gavi, the Vaccine Alliance.

WHO and health partners have been supporting the Government’s response to the outbreak since the first case of yellow fever was confirmed in Oke Owa Community, Ifelodun Local Government Area of Kwara state on 12 September.

WHO has deployed experts to Nigeria to support surveillance and investigation, lab testing, public health measures, and engagement with at-risk communities. An Emergency Operations Centre has been activated in the area to coordinate the response.

WHO – Subnational immunization coverage data
140 member states from all WHO regions have shared 2016 subnational data
17 October 2017
In 2017 and for the first time worldwide, WHO has collected and is publishing subnational immunization coverage data reported by its member states. Member states were asked to report their numerator (number of doses administered), denominator (number of eligible individuals) and coverage data (% of eligible individuals receiving the relevant dose of vaccine) for the first and third dose of DTP-containing vaccines (DTP1, DTP3) and measles containing vaccine (MCV1) from their second administrative level (“admin2” often called districts). The data collection is done through the WHO/UNICEF Joint Reporting Form process.

In 2017, 140 member states have shared their subnational data, either from their first subnational administrative level (“admin1”) or admin2 level for DTP1, DTP3 and/or MCV1. Data has been shared for over 20,000 admin1 and/or admin2, and represents about two-third of the total number of surviving infants worldwide. Among them, 94 member states report coverage for DTP3 at admin2 level (bubble charts from 83 of these countries are accessible at the bottom of this page). Of note is that the size of the target population (in the case of DTP3, the number of infants surviving at 12 months of age) of reporting districts varies significantly from a district to another. Indeed the median number of surviving infants in all reported districts is 400, ranging from a population of surviving infants of 1 in the smallest districts to more than 485,000 in the largest (Karachi, Pakistan).

National coverage data often conceals large inequalities in coverage and access within the country, that can be discovered through subnational monitoring. Targeting specific subnational areas with focused interventions will help countries achieve high and equitable coverage and meet their GVAP targets.

WHO and UNICEF are increasing efforts to gather subnational coverage data and support countries in improving the quality and use of the subnational coverage data to take actions to achieve high and equitable immunization coverage.

Resources
Descriptive analysis of subnational data pptx, 7.66Mb
Limitations related to globally reported subnational immunization data pdf, 341kb
Access 83 country visuals for DTP3 at administrative level (data as of 15 July 2017)

Cholera
 
Over 700 000 people vaccinated against cholera in Cox’s Bazar
SEAR/PR/1669
Cox’s Bazar, Bangladesh, 20 October 2017 – More than 700 000 people over the age of one year have been administered oral cholera vaccine in the first phase of a campaign here to protect the newly arrived Rohingya population and their host communities against the deadly diarrheal disease.

“The coverage is commendable as the oral cholera vaccination campaign was planned and rolled out against very tight timelines. It demonstrates the commitment of the Ministry of Health, Bangladesh, partners on the ground, as well as partners such as GAVI and the International Coordinating Group on vaccine provision, to help secure the health and wellbeing of these immensely vulnerable people,” said Dr N Paranietharan, WHO Representative to Bangladesh.

The first phase of the oral cholera vaccination (OCV) campaign covered 700 487 people aged one year and above, 179 848 of them children aged between one and five years. The campaign was launched on 10 October to cover 650 000 people. The second phase is scheduled for early November to give an additional OCV dose to children aged between one and five years, for added protection.

“The campaign has successfully vaccinated nearly 180,000 children aged one to five years. We will organize another round for these children to provide them with a second dose that will better protect them against this dangerous disease,” said Edouard Beigbeder, UNICEF Representative in Bangladesh…
 
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Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 18 October 2017 [GPEI]
:: On Tuesday [above], Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, announced with great sadness the death of Dr Mahmoud M Fikri, WHO Regional Director for the Eastern Mediterranean (EMRO) Region. His leadership and dedication to public health, and unwavering support for polio eradication in Syria, Afghanistan and Pakistan will be greatly missed. The GPEI extends its sincere condolences to Dr Fikri’s family and his many colleagues and friends throughout WHO and the EMRO Region.

:: Summary of newly-reported viruses this week:
…Afghanistan: one new wild poliovirus type 1 (WPV1) case reported from Nangarhar province. Two new wild poliovirus 1 (WPV1) positive environmental samples reported, one from Hilmand and one from Kandahar provinces.
…Pakistan: three new wild poliovirus 1 (WPV1) positive environmental samples reported, two in Balochistan province and one in Sindh province. See country-specific sections for further details. Syria: four new circulating vaccine derived poliovirus 2 (cVDPV2) cases reported in Deir Ez-Zor governorate, three from Mayadeen district, and one from Boukamal district. One new cVDPV2 positive from a healthy child in Mayadeen district.

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Situation reports on the polio outbreak in Syria
Situation update 17 October 2017
:: Four (4) new cases of cVDPV2 were reported this week— three (3) from Mayadeen district and one (1) from Boukamal district, Deir Ez-Zor governorate.
:: The total number of confirmed cVDPV2 cases is 52.
:: The second immunization round for Raqqa concluded on 13 October. According to administrative data, a total of 144,414 children aged 0-59m were vaccinated with mOPV2. The numbers of children reported vaccinated represented 96% of a revised estimated target calculated according to updated micro-plans.
:: IPV is being administered to children aged between 2-23 months in 2 districts, Raqqa and Thawra. The campaign in Raqqa and Thawra is ongoing.
:: 540,000 Aqua tabs were distributed to families together with vaccination in areas of Rural Raqqa (Salhabiyah, Khilah, Al-Rasheed camp, Hesha, Karama town and camp) during the second Raqqa campaign.
:: New areas were reached this round in the Thawra desert, where 4,550 children (representing 65% of the target) under 5 were vaccinated after a gap of 18 months.

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WHO Grade 3 Emergencies  [to 21 October 2017]
The Syrian Arab Republic
:: WHO health supplies revive weakened health facilities in besieged Deir-Ez-Zor Governorate in Syria
17 October, 2017, Damascus, Syria – A WHO shipment of health supplies delivered through the Syrian Arab Red Crescent to besieged Deir-Ez-Zor governorate in Syria has helped struggling health facilities deliver life-saving health services to thousands of people.
The 14–ton shipment includes medicines for trauma care, treatment of burns, antibiotics; anti-allergens; cardiovascular medicines; and oral rehydration salts. In total, the supplies are sufficient for almost 1800 trauma cases and 260,000 medical treatments…
:: Situation reports on the polio outbreak in Syria
Situation update 17 October 2017
[See Polio above]

Nigeria
WHO supports the immunization of 874,000 people against yellow fever in Nigeria
News release 16 October 2017
[See Milestones above for more detail]
 
South Sudan
Read the latest health situation report pdf, 2.07Mb  13 October 2017
Republic of South Sudan
CHOLERA SITUATION AND RESPONSE UPDATES
13 OCTOBER 2017
Epidemic trends
:: Cholera transmission has continued to decline countrywide with only three counties [Juba,
Budi, and Fangak] reporting cholera cases in the last four weeks [38-41, 2017].
:: In week 41, four out of 13 samples from Juba tested positive for Vibrio cholerae.

::::::
::::::
 
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
:: Thousands of Families from Kirkuk Are Returning [EN/AR/KU]
(Baghdad, 17 October 2017): In the past 48 hours, an estimated 61,200 people have been displaced in areas around Kirkuk. Humanitarian partners have dispatched mobile health clinics and are providing hot meals and food parcels to families who have fled. In coming days, partners will be providing 3,000 emergency food rations and hygiene items to families sheltering in public spaces.
“Authorities have confirmed that the majority of displaced families from Kirkuk are already returning to their homes in Kirkuk city,” said Ms. Lise Grande, Humanitarian Coordinator for Iraq. “Most of the families who are still displaced are staying with families and host communities.”…

Syrian Arab Republic
:: 19 Oct 2017  North East Syria Dashboard – September 2017
…Up to 7,000 civilians remain trapped in Ar-Raqqa city and face increasingly deteriorating humanitarian conditions and protection concerns. Despite the risks of exposure to mines, snipers and military operations, some civilians have fled.
…Displacements from and within Deir-ez-Zor Governorate continued due to heavy fighting and airstrikes. An estimated 63,902 people have been displaced from 1 September to 8 October.
…The overall protection situation for civilians remains of high concern across north-eastern Syria, with ISIL reportedly actively preventing civilians attempting to flee the area.
…Large influxes of IDPs from Deir-ez-Zor Governorate are straining existing capacities and services in IDP sites resulting in increased protection needs.

::::::

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.
Ethiopia
:: 20 Oct 2017  Ethiopia HRD 2017: Status Update, 19 October 2017
Since the revision of the Humanitarian Requirements Document (HRD) in August 2017, the humanitarian context in Ethiopia has continued to evolve which has led the Government and humanitarian partners to further adjust the HRD requirements. In the food sector the needs have been revised slightly upwards to accommodate an increase in the number of beneficiaries through the inclusion of 4 million former Productive Safety Net Programme (PSNP) clients in the HRD. In other sectors such as health and nutrition, needs have also continued to increase mainly due to the deteriorating nutrition situation in Somali region, increase in the number of displaced people, as well as the Fall Army Worm (FAW) outbreak that continues to ravage crops throughout the country….
 

WHO & Regional Offices [to 21 October 2017]
 
Latest news
WHO supports containment of rare virus on Uganda-Kenya border
20 October 2017 – WHO is working to contain an outbreak of Marburg virus disease that has appeared in eastern Uganda on the border with Kenya.

Governments commit to reduce suffering and deaths from noncommunicable diseases
18 October 2017 – Heads of State and Government and ministers from around the world today committed to new and bold action to reduce suffering and death from noncommunicable diseases (NCDs), primarily heart and lung diseases, cancers and diabetes, the world’s leading killers.
 
Highlights
Responding to children and adolescents who have been sexually abused
October 2017 – Sexual abuse of children and adolescents is a gross violation of their rights and a global public health problem. It adversely affects the health of children and adolescents. Health care providers are in a unique position to provide an empathetic response to children and adolescents who have been sexually abused.

Evaluation of the election of the Director-General of WHO
October 2017 – The Sixty-fifth World Health Assembly decided, in resolution WHA65.15 (2012), that an evaluation, open to all Member States, will be conducted by the Executive Board within one year from the appointment of the next Director-General of WHO, to assess the efficacy of the revised process and methods for the election of the Director-General, in order to discuss any need for further enhancing fairness, transparency and equity among the Member States of the six regions of WHO.

WHO delivers lifesaving trauma medicines and supplies for victims of Mogadishu blasts
October 2017 – WHO has delivered lifesaving blood supplies and trauma care medicines as part of its emergency response to the bombings in Mogadishu, Somalia on 14 October, in which more than 275 people were killed and more than 300 people severely injured.

Handwashing an affordable way to prevent diseases and save lives
October 2017 – Global Handwashing Day is an opportunity to design, test, and replicate creative ways to encourage people to wash their hands with soap at critical times.

::::::

Weekly Epidemiological Record, 20 October 2017, vol. 92, 42 (pp. 625–648)
:: Recommended composition of influenza virus vaccines for use in the 2018 southern hemisphere influenza season
:: Zoonotic influenza viruses: antigenic and genetic characteristics and development of candidate vaccine viruses for pandemic preparedness
 
::::::
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: South Sudan conducts Joint External Evaluation of Core capacities for International Health Regulation (2005) 20 October 2017
:: WHO supports containment of rare virus on Uganda-Kenya border20 October 2017
:: WHO supports Bayelsa state to rapidly contain outbreak of Monkeypox virus. 20 October 2017
:: WHO facilitates training on contact tracing for health professionals and volunteers on Plague
:: Namibia Continues to invest in Polio Eradication  19 October 2017
:: Monkey pox virus-Sultan dispels rumours linking outbreak to vaccine safety. 18 October 2017
:: Suspected cases from Seychelles test negative for plague  18 October 2017
:: Supporting the mental health needs of frontline responders 18 October 2017
:: WHO supports the immunization of 874 000 people against yellow fever in Nigeria 16 October 2017

WHO Region of the Americas PAHO
:: Governments commit to reduce suffering and deaths from noncommunicable diseases (10/19/2017)

WHO South-East Asia Region SEARO
:: Over 700 000 people vaccinated against cholera in Cox’s Bazar  20 October 2017
[See Cholera above for more detail]

WHO European Region EURO
:: European Region makes huge gains in NCD response, but needs faster progress 19-10-2017
:: Obituary: Dr Mahmoud M. Fikri, WHO Regional Director for the Eastern Mediterranean Region 18-10-2017
:: Using taxes to beat NCDs: success story in Hungary 17-10-2017
:: Giving influenza vaccination a boost among older people 16-10-2017
:: Nurse Gladis leads the way on influenza vaccination in Jönköping, Sweden 16-10-2017

WHO Eastern Mediterranean Region EMRO
:: WHO delivers additional trauma care supplies to patients injured in Mogadishu attacks, Somalia  19 October 2017
:: Tenfold increase in childhood and adolescent obesity in four decades  11 October 2017

CDC/ACIP [to 21 October 2017]
http://www.cdc.gov/media/index.html
Press Release
Thursday, October 19, 2017
CDC updates guidance for infants born to mothers with possible Zika virus infection during pregnancy – Press Release
This update includes information that has become available since the August 2016 release of the previous guidance.

MMWR News Synopsis for October 19, 2017
:: Update: Interim Guidance for the Diagnosis, Evaluation and Management of Infants with Possible Congenital Zika Virus Infection — United States, October 2017
CDC’s updated interim clinical guidance for infants born to mothers with possible Zika virus infection during pregnancy will provide helpful, interpretable information for families and their healthcare providers. The Centers for Disease Control and Prevention (CDC) issued updated interim clinical guidance for health care providers caring for infants born to mothers with possible Zika virus infection during pregnancy. This update includes information that has become available since the August 2016 release of the previous guidance. Zika virus continues to be a public health threat to pregnant women and their infants, although at lower levels than during the recent epidemic in the Americas. The updated guidance is intended to provide helpful, interpretable information for families and their healthcare providers.

HIV Testing, Linkage to HIV Medical Care, and Interviews for Partner Services Among Women — 61 Health Department Jurisdictions, United States, Puerto Rico, and the U.S. Virgin Islands, 2015
To reduce and eventually eliminate HIV infection among women in the United States, HIV testing programs need to improve early linkage to HIV medical care among HIV-positive women who are not in care – even if it is not the first time they are diagnosed with HIV infection. A new analysis showed that six in 10 women who tested positive for HIV infection via CDC-funded HIV tests had already been diagnosed with HIV infection through a previous test. The vast majority (87 percent) of women who were previously diagnosed were not in HIV medical care at the time of testing, suggesting they were never linked to care or had fallen out of care. Black women were significantly less likely than white women to be linked to HIV medical care within 90 days of the current test. HIV testing is essential – not only to identify new infections, but also to link people with new or previous diagnoses to medical care to achieve viral suppression. To reduce and eventually eliminate HIV infection among women in the United States, HIV testing programs need to improve early linkage to HIV medical care among HIV-positive women who are not in care – even if it is not the first time they are diagnosed with HIV infection.

Tdap Vaccination Coverage During Pregnancy — Selected Sites, United States, 2006–2015
Gina DiGravio
Boston University School of Medicine
Tdap vaccination during pregnancy has increased between 2006 and 2017, from <1% in the years before the recommendation to 53% in 2015. However, this coverage is far short of the ACIP recommendation that every woman receive Tdap vaccine during each pregnancy. Since 2012 the Advisory Committee on Immunization Practices has recommended Tdap vaccination during each pregnancy. From 2006 through 2015, Tdap vaccination coverage in pregnant women participating  in the Birth Defects Study of the Slone Epidemiology Center at Boston University increased from <1% before 2010 to 28% in 2013 and reached 53% in 2015. Although Tdap coverage has increased in recent years, Tdap vaccine coverage remains far below the recommendation that every woman be vaccinated during each pregnancy. Increasing vaccination coverage during pregnancy could help reduce the impact of pertussis on infant morbidity and mortality.

Knowledge, Attitudes, and Practices Related to Ebola Virus Disease at the End of a National Epidemic — Guinea, August 2015
Regional variations in Ebola-related KAP in Guinea, after more than one year of a massive epidemic, reinforce the need for targeted health communication strategies during epidemic response. The findings also highlight the importance of health promotion efforts to prevent sporadic transmission or future outbreaks of Ebola, including messages that aim to address misconceptions about transmission and prevention and to address stigma that survivors might face as they recover from a devastating disease, rebuild their lives, and reintegrate into communities. Efforts to improve the public’s knowledge, attitudes, and practices (KAP) about Ebola Virus Disease (Ebola) were important in controlling the 2014–2016 Ebola epidemic in Guinea, Sierra Leone, and Liberia. A national survey conducted in Guinea in August 2015 found regional variations in Ebola-related KAP.  Results suggest that tailoring health communication by region might be more effective than a uniform, national approach. Most participants understood key aspects of Ebola transmission and prevention and intended to use safer burial practices for relatives with suspected Ebola. However, misconceptions about Ebola transmission were widespread, and many participants expressed concern about being near Ebola survivors.

Reporting Deaths Among Children Aged <5 Years After the Ebola Virus Disease Epidemic — Bombali District, Sierra Leone, 2015–2016
Child mortality surveillance in settings with limited vital registration can be strengthened by using multiple data sources, which together capture community and facility deaths. Mortality surveillance and national death reporting are limited in Sierra Leone, a country with one of the highest mortality rates in the world among children ages <5 years. To inform efforts to strengthen surveillance of stillbirths and deaths in children ages <5 years, multiple surveillance streams in Bombali Sebora chiefdom were retrospectively reviewed. Analysis of multiple death reporting streams, including the 1-1-7 phone alert system established during the Ebola virus disease outbreak, improved collection of data about deaths among children ages <5 years and stillbirths. Community-based reporting strategies, such as phone alerts, can be implemented in countries with incomplete death registration to supplement vital events records and strengthen child mortality surveillance.
 

Announcements
 
 
BMGF – Gates Foundation  [to 21 October 2017]
http://www.gatesfoundation.org/Media-Center/Press-Releases
OCTOBER 16, 2017
Bill & Melinda Gates Foundation Releases Open-Source Software to Support Efforts that Expand Access to Financial Services in Developing Countries
New code reduces complexity and cost of building payment platforms that connect poor customers to merchants, banks, mobile money providers, governments

EDCTP    [to 21 October 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
18 October 2017
EDCTP requests proposals for conference management services
EDCTP is soliciting proposals from conference management companies for the provision of services for the Ninth EDCTP Forum…

European Medicines Agency  [to 21 October 2017]
http://www.ema.europa.eu/ema/
20/10/2017
Unparalleled access to clinical data – one year on
Over 3,000 clinical documents published, 3,600 registered users and positive stakeholder feedback …

20/10/2017
New action plan to foster development of advanced therapies
Actions address specific challenges identified by stakeholders
… ATMPs are medicines for human use that are based on genes or cells. These therapies offer ground-breaking new opportunities for the treatment of disease and injury. They are particularly important for severe, untreatable or chronic diseases for which conventional approaches have proven to be inadequate.
ATMPs can be classified into four main groups: gene therapy medicinal products, somatic cell therapy medicinal products, tissue engineered medicinal products and combined ATMPs. EMA has received 18 marketing authorisation applications since the ATMP regulation came into force in 2009. Nine products have been approved.
The Agency’s Committee for Advanced Therapies (CAT) plays a central role in the scientific assessment of ATMPs, as it provides the expertise needed to evaluate these medicines. Other initiatives include European Commission research programmes, the innovation offices in the national competent authorities and EMA’s PRIME scheme…

17/10/2017
EMA’s procedural handling of safety review was complete and independent
EMA’s procedural handling of safety review was complete and independent
European Ombudsman concludes her inquiry into the HPV vaccines referral
The European Medicines Agency (EMA) has welcomed the decision from the European Ombudsman which concludes that there was no maladministration by the Agency in the handling of its safety review of human papillomavirus (HPV) vaccines.
The conclusions of this review were that the available evidence does not support that two specific syndromes, complex regional pain syndrome (CRPS) and postural orthostatic tachycardia syndrome (POTS) in young women and girls are caused by HPV vaccines. These vaccines are given to prevent infections with the most common types of HPV which can cause cervical cancer, other HPV-related cancers and pre-cancerous conditions.
The procedure was conducted by EMA’s Pharmacovigilance Risk Assessment Committee’s (PRAC) in 2015.
The Ombudsman’s review followed a complaint which expressed concerns about aspects of the PRAC’s handling of the referral procedure.
Following her inquiry into the procedural aspects complained about, the Ombudsman concluded that her inquiry did not identify any procedural issues that could have negatively affected the work and conclusions of the PRAC referral procedure. The examination of scientific evidence was complete and it was independent.
The Ombudsman also considered that EMA’s conflicts of interest policy was fully complied with during the referral procedure on HPV vaccines and that no conflicts of interest were detected.
The Agency welcomes two suggestions made by the Ombudsman to further improve the information on its scientific assessments that it provides to the public and will now explore ways to address these.

European Vaccine Initiative  [to 21 October 2017]
http://www.euvaccine.eu/news-events
19 October 2017
EDUFLUVAC Final Meeting
After four years of collaborative research activities towards the development of a broadly reactive influenza vaccine, the European Commission-funded project EDUFLUVAC will be concluded by the end of October 2017. The EDUFLUVAC partners met for the final project meeting on 09-10 October in Brussels, Belgium to review the results generated and plan for future activities.
Promising pre-clinical results in different animal models have been obtained, but more research is needed to optimise the strategy undertaken by the consortium, which is based on the Epitope Dilution Phenomenon and the use of baculovirus-derived virus-like particles…

16 October 2017
TRANSVAC: European Vaccine Research and Development Infrastructure
Open Call for Vaccine Development Services
 
 
FDA [to 21 October 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
October 18, 2017 –
FDA approves CAR-T cell therapy to treat adults with certain types of large B-cell lymphoma
The U.S. Food and Drug Administration today approved Yescarta (axicabtagene ciloleucel), a cell-based gene therapy, to treat adult patients with certain types of large B-cell lymphoma who have not responded to or who have relapsed after at least two other kinds of treatment. Yescarta, a chimeric antigen receptor (CAR) T cell therapy, is the second gene therapy approved by the FDA and the first for certain types of non-Hodgkin lymphoma (NHL).
“Today marks another milestone in the development of a whole new scientific paradigm for the treatment of serious diseases. In just several decades, gene therapy has gone from being a promising concept to a practical solution to deadly and largely untreatable forms of cancer,” said FDA Commissioner Scott Gottlieb, M.D. “This approval demonstrates the continued momentum of this promising new area of medicine and we’re committed to supporting and helping expedite the development of these products. We will soon release a comprehensive policy to address how we plan to support the development of cell-based regenerative medicine. That policy will also clarify how we will apply our expedited programs to breakthrough products that use CAR-T cells and other gene therapies. We remain committed to supporting the efficient development of safe and effective treatments that leverage these new scientific platforms…
 
 
Gavi [to 21 October 2017]
http://www.gavi.org/library/news/press-releases/
16 October 2017
Attack on health facilities puts all Syrian children at risk
Gavi CEO urges all parties in Syria to stop attacks against health facilities following destruction of vaccine stocks and equipment.
 
 
GHIT Fund   [to 21 October 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 ·
2017.10.18      
Upcoming Event: GHIT R&D Forum on December 8th
… The 200-person R&D Forum on December 8th will create opportunities for GHIT’s development partners to share project overviews, R&D progress to date, and lessons learned over the past five years. The event offers unique opportunities to engage with scientists and experts across a multitude of organizations, as well as develop new partnerships to further build our community and accelerate global health R&D…
 
 
MSF/Médecins Sans Frontières  [to 21 October 2017]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
Doctors Without Borders Challenges Pfizer’s Unmerited Patent for Pneumonia Vaccine in Delhi High Court
NEW YORK/NEW DELHI, OCTOBER 13, 2017—The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières(MSF) filed a petition before the High Court of Delhi today to overturn a patent granted to Pfizer pharmaceutical corporation on the pneumococcal conjugate vaccine (PCV).
 
 
NIH  [to 21 October 2017]
http://www.nih.gov/news-events/news-releases
October 18, 2017
Norman Sharpless sworn in as director of the National Cancer Institute
— Succeeds Harold Varmus, M.D., who stepped down in March 2015.

Experts Outline Pathway to a Universal Influenza Vaccine
October 17, 2017 — NIH-Led meeting identifies knowledge gaps, development goals.
Scientists and clinicians from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and the California Institute of Technology discuss key considerations for developing a universal influenza vaccine in a meeting report appearing in the October 17 issue of Immunity. The report summarizes discussions from a workshop NIAID held June 28-29, 2017, in Rockville, Maryland, entitled, “Pathway to a Universal Influenza Vaccine.” The workshop brought together U.S. and international experts from academia, industry and government to identify knowledge gaps in influenza research and to set goals to fill these knowledge gaps. NIAID will use the report to develop a strategic plan and research agenda aimed at the development of a universal influenza vaccine.
 
 
PATH  [to 21 October 2017]
http://www.path.org/news/index.php
Announcement | October 18, 2017
Join PATH at the 66th American Society of Tropical Medicine and Hygiene Annual Meeting
PATH experts to share latest research and innovations to tackle malaria and other Neglected Tropical Diseases, underscore critical role of US in global health

UNAIDS [to 21 October 2017]
http://www.unaids.org/en
Update
20 October 2017
Civil society and WFP increasing food security in Ukraine
 
19 October 2017
UNAIDS urges United Republic of Tanzania to implement HIV Prevention 2020 Road Map
 
19 October 2017
Republic of Moldova to fund HIV prevention services for key populations
 
18 October 2017
Parliamentarians call for firm action towards ending the AIDS epidemic
 
17 October 2017
ILO’S VCT@WORK has reached 6 million workers

UNICEF  [to 21 October 2017]
https://www.unicef.org/media/
20 October, 2017
Violence in Myanmar driving up to 12,000 Rohingya refugee children into Bangladesh every week – UNICEF
DHAKA, BANGLADESH/GENEVA, 20 October 2017 – Desperate living conditions and waterborne diseases are threatening more than 320,000 Rohingya refugee children who have fled to southern Bangladesh since late August, including some 10,000 who crossed from Myanmar over the past few days, UNICEF said today.

7,000 newborns die every day, despite steady decrease in under-five mortality, new report says
NEW YORK/GENEVA/WASHINGTON, 19 October 2017 – Every day in 2016, 15,000 children died before their fifth birthday, 46 per cent of them – or 7,000 babies – died in the first 28 days of life, according to a new UN report.
 
 
Wellcome Trust  [to 21 October 2017]
https://wellcome.ac.uk/news
News / Published: 19 October 2017
First international awards in new Engagement Fellowships
Wellcome’s Engagement Fellowships for 2017 have been awarded to Sara Kenney, Alok Jha, Anita Shervington and our first international fellows, Elizabeth Kimani and Nabeel Peterson. 
Over the next three years the fellows will explore the topics of comic creation, science journalism, child nutrition, inclusion and equity in science.

::::::
 
 
Industry Watch  [to 21 October 2017]
:: FDA Approves GSK’s Shingles Vaccine with Agenus’ QS-21 Stimulon® Adjuvant
– SHINGRIX containing QS-21 Stimulon® demonstrates remarkable efficacy of greater than 90% in pooled studies against shingles
– Shingles is a major public health issue in the US, impacting as many as 1 in 3 adults over the age of 50 years
LEXINGTON, Mass., Oct. 20, 2017 /PRNewswire/ — Agenus Inc. (NASDAQ: AGEN), an immuno-oncology company with a pipeline of immune checkpoint antibodies and cancer vaccines, announced today that the US Food and Drug Administration (FDA) granted marketing authorization to GlaxoSmithKline’s (GSK) herpes zoster vaccine, SHINGRIX, containing Agenus’ proprietary immune adjuvant QS-21 Stimulon®. SHINGRIX is indicated for prevention of herpes zoster (also known as shingles) in adults aged 50 years and older. The addition of QS-21 Stimulon helps improve the vaccine’s effectiveness by boosting immune response in older adults who often experience age-related decline in immunity…

:: Lilly and CureVac Announce Global Collaboration to Develop mRNA Cancer Vaccines
– Immuno-oncology collaboration aims to develop up to five cancer vaccines that target neoantigens across multiple tumor types
– CureVac to receive an upfront payment of $50 million and an equity investment of €45 million
INDIANAPOLIS and TÜBINGEN, Germany, Oct. 18, 2017 /PRNewswire/ — Eli Lilly and Company and CureVac AG have announced a global immuno-oncology collaboration focused on the development and commercialization of up to five potential cancer vaccine products based on CureVac’s proprietary RNActive® technology. The companies will use messenger RNA (mRNA) technology that targets tumor neoantigens for a more robust anti-cancer immune response…
Under the terms of the agreement, CureVac will receive an upfront payment of $50 million and an equity investment of €45 million. CureVac is also eligible to receive more than $1.7 billion in development and commercialization milestones if all five vaccines are successfully developed, plus tiered royalties on product sales. Lilly is responsible for target identification, clinical development and commercialization. CureVac will be responsible for mRNA design, formulation and manufacturing of clinical supply and retains the option to co-promote the vaccine products in Germany.
CureVac’s proprietary RNActive technology will be used to deliver mRNA that ultimately directs the human immune system to target the encoded neoantigens. These tumor-specific neoantigens instruct the patient’s existing immune system to mount a selective and potent response to eradicate the cancer.

Reports/Research/Analysis/Commentary/Conferences/Meetings/Book Watch/Tenders

Vaccines and Global Health: The Week in Review has expanded its coverage of new reports, books, research and analysis published independent of the journal channel covered in Journal Watch below. Our interests span immunization and vaccines, as well as global public health, health governance, and associated themes. If you would like to suggest content to be included in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

7,000 newborns die every day, despite steady decrease in under-five mortality, new report says
At current trends, 30 million newborns will die within first 28 days of life between 2017 and 2030
News release
19 October 2017 | NEW YORK/GENEVA/WASHINGTON DC – Every day in 2016, 15,000 children died before their fifth birthday, 46% of them – or 7 000 babies – died in the first 28 days of life, according to a new UN report.

Levels and Trends in Child Mortality 2017, reveals that although the number of children dying before the age of five is at a new low– 5.6 million in 2016, compared with nearly 9.9 million in 2000 – the proportion of under-five deaths in the newborn period has increased from 41% to 46% during the same period.

“The lives of 50 million children under-five have been saved since 2000, a testament to the serious commitment by governments and development partners to tackle preventable child deaths,” said UNICEF Chief of Health, Stefan Swartling Peterson. “But unless we do more to stop babies from dying the day they are born, or days after their birth, this progress will remain incomplete. We have the knowledge and technologies that are required – we just need to take them where they are most needed.”

At current trends, 60 million children will die before their fifth birthday between 2017 and 2030, half of them newborns, according to the report released by UNICEF, the World Health Organization, the World Bank and the Population Division of UNDESA which make up the Inter-agency Group for Child Mortality Estimation (IGME)…
 
 
Levels & Trends in Child Mortality – Report 2017
Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation
PDF:
http://www.childmortality.org/files_v21/download/IGME%20report%202017%20child%20mortality%20final.pdf
CHILD SURVIVAL: KEY FACTS AND FIGURES
:: The world has made substantial progress in reducing child mortality in the past several decades. The total number of under-five deaths dropped to 5.6 (5.4, 6.0)1 million in 2016 from
12.6 (12.4, 12.8) million in 1990 – 15,000 every day compared with 35,000 in 1990.

:: Globally, the under-five mortality rate dropped to 41 (39, 44) deaths per 1,000 live births in 2016 from 93 (92, 95) in 1990 – a 56 (53, 58) per cent decline.

:: Globally, 2.6 (2.5, 2.8) million newborns died in 2016 – or 7,000 every day. Neonatal deaths
accounted for 46 per cent of all under-five deaths, increasing from 41 per cent in 2000.

:: The largest number of newborn deaths occurred in Southern Asia (39 per cent), followed by sub-Saharan Africa (38 per cent). Five countries accounted for half of all newborn deaths: India, Pakistan, Nigeria, the Democratic Republic of the Congo and Ethiopia.

:: The neonatal mortality rate fell by 49 per cent from 37 (36, 38) deaths per 1,000 live births in
1990 to 19 (18, 20) in 2016.

:: Children face the highest risk of dying in their first month of life, at a rate of 19 deaths per
1,000 live births. By comparison, the probability of dying after the first month but before reaching age 1 is 12 and after age 1 but before turning 5 is 11.

:: Progress is slower in reducing neonatal mortality rates than in reducing mortality rates in childrenaged 1–59 months. While neonatal mortality declined by 49 per cent, the mortality in children aged 1–59 months declined by 62 per cent from 1990 to 2016.

:: Disparities in child survival exist across regions and countries: in sub-Saharan Africa, approximately 1 child in 13 dies before his or her fifth birthday, while in the world’s high-income
countries the ratio is 1 in 189. Among newborns in sub-Saharan Africa, about 1 child in 36 dies inthe first month, while in the world’s high-income countries the ratio is 1 in 333.

:: Many lives can be saved if the gaps acrosscountries are closed. If all countries had reached
an under-five mortality rate at or below theaverage rate of high-income countries – 5.3 deaths per 1,000 live births – 87 percent of under-five deaths could have been averted, and almost 5 million children’s lives could have been saved in 2016.

:: If current trends continue with more than 50 countries falling short of the Sustainable Development Goal (SDG) target on child survival,some 60 million children under age 5 will die
between 2017 and 2030 – and half of them will be newborns.

:: If every country achieves the SDG target on child survival by 2030, an additional 10 million lives of children under age 5 will be saved throughout the period 2017–2030 – about half of them will be newborns.

:: Most under-five deaths are caused by diseases that are readily preventable or treatable with
proven, cost-effective interventions. Infectious diseases and neonatal complications are
responsible for the vast majority of under-five deaths globally.

:: The probability of dying among children aged 5–14 was 7.5 (7.2, 8.3) deaths per 1,000 children aged 5 in 2016 – substantially lower than among younger children. Still 1 (0.9, 1.1) million children aged 5–14 died in 2016. This is equivalent to 3,000 children in this age group dying every day. Among children aged 5–14, communicable diseases are a less prominent cause of death than among younger children, while other causes including injuries and
non-communicable diseases become important.

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