Clinical Therapeutics – October 2017  Volume 39, Issue 10

Clinical Therapeutics
October 2017  Volume 39, Issue 10
http://www.clinicaltherapeutics.com/current

Commentaries
Enhancing the Pediatric Drug Development Framework to Deliver Better Pediatric Therapies Tomorrow
Christina Bucci-Rechtweg
p1920–1932
Published online: August 14, 2017

International Children’s Advisory Network: A Multifaceted Approach to Patient Engagement in Pediatric Clinical Research
Meghan Gwara, Sharon Smith, Christine Woods, Elizabeth Sheeren, Hampton Woods
p1933–1938
Published online: September 21, 2017

Reviews
Roles of Clinical Research Networks in Pediatric Drug Development
Mark A. Turner, Sabah Attar, Saskia N. de Wildt, Gilles Vassal, Laura Mangiarini, Carlo Giaquinto
p1939–1948
Published online: September 21, 2017

Frameworks for Evaluating Medicines in Children
Mark A. Turner, Steven Hirschfeld
p1949–1958
Published online: September 26, 2017

Information overload in consumers of health-related information: a scoping review protocol

JBI Database of Systematic Review and Implementation Reports
October 2017 – Volume 15 – Issue 10
http://journals.lww.com/jbisrir/Pages/currenttoc.aspx

Systematic Review Protocols
Information overload in consumers of health-related information: a scoping review protocol
Lee, Kenneth; Roehrer, Erin; Cummings, Elizabeth
JBI Database of Systematic Reviews and Implementation Reports. 15(10):2457-2463, October 2017.

A Devastating Delay — Zika and the Implementation Gap

New England Journal of Medicine
October 19, 2017  Vol. 377 No. 16
http://www.nejm.org/toc/nejm/medical-journal

Perspective
A Devastating Delay — Zika and the Implementation Gap
Stephanie R. Morain, Ph.D., M.P.H., Susan H. Wootton, M.D., and Catherine Eppes, M.D., M.P.H.
N Engl J Med 2017; 377:1505-1507 October 19, 2017 DOI: 10.1056/NEJMp1707273
[Initial text]
The epidemic of Zika in the Americas and the virus’s effects on fetal development have jolted the U.S. medical community and the broader public. Zika’s relatively recent emergence has necessitated rapid research on its virology and pathogenesis, transmission, clinical manifestations, and diagnosis. The medical community has risen to this challenge admirably. Though a PubMed search for articles about Zika published before the 2015 outbreak in Brazil yielded fewer than 110 results, a similar search in July 2017 yielded more than 3000. The National Institutes of Health has identified several high-priority areas of Zika research, and at least 15 related trials are actively enrolling participants, including several vaccine clinical trials.
Developing knowledge to guide prevention and clinical management of Zika virus disease is critical, and these efforts should continue. However, this focus on knowledge acquisition has overshadowed another critical need — namely, ensuring that new knowledge is disseminated to frontline providers and used to improve care…

Economic benefits of sharing and redistributing influenza vaccines when shortages occurred

PLoS One
http://www.plosone.org/

Research Article
Economic benefits of sharing and redistributing influenza vaccines when shortages occurred
Recurrent influenza outbreak has been a concern for government health institutions in Taiwan. Over 10% of the population is infected by influenza viruses every year, and the infection has caused losses to both health and the economy. Approximately three million free vaccine doses are ordered and administered to high-risk populations at the beginning of flu season to control the disease. The government recommends sharing and redistributing vaccine inventories when shortages occur. While this policy intends to increase inventory flexibility, and has been proven as widely valuable, its impact on vaccine availability has not been previously reported.
Sheng-I Chen
Research Article | published 17 Oct 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0186418

A systematic review of factors affecting vaccine uptake in young children

Vaccine
Volume 35, Issue 45, Pages 6041-6254 (27 October 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/45?sdc=1

Biosecurity
Reviews
A systematic review of factors affecting vaccine uptake in young children
Review Article
Pages 6059-6069
Louise E. Smith, Richard Amlôt, John Weinman, Jenny Yiend, G. James Rubin
Abstract
Background
Many parents make a conscious decision not to vaccinate their child. Multiple beliefs and perceptions surround this choice. If uptake of routine child vaccination is to increase, public health communications about vaccines must be informed by evidence on the factors affecting uptake.
Method
We conducted a systematic review to investigate psychological, social and contextual factors associated with uptake of routine vaccines in young children. Studies were included if they reported analyses of the association between psychological factors and uptake or included parents’ self-reported reasons for or against vaccination.
Results
Our search identified 9110 citations after deduplication. Sixty-eight citations describing sixty-four studies were included in the review. The quality of the studies was mixed. There is strong evidence for an association between vaccination uptake and: not perceiving vaccines to cause adverse effects; general positive attitudes towards vaccination; positive vaccine recommendations; and perceiving fewer practical difficulties of vaccination. While there was good evidence for an association between vaccination and perceived susceptibility to the illness, evidence for an association between perceived severity of an illness and vaccination was weak. Other factors associated with vaccination include knowledge about the vaccine, social influences and trust in the healthcare profession. Having increased information about the vaccine was associated with vaccination, but the influence of different sources of information needs more research.
Conclusion
Understanding which factors are consistently associated with the decision to vaccinate one’s child is important to identify messages which should be targeted by public health communications about routine child vaccinations.

Association of both consistency and strength of self-reported clinician recommendation for HPV vaccination and HPV vaccine uptake among 11- to 12-year-old children

Vaccine
Volume 35, Issue 45, Pages 6041-6254 (27 October 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/45?sdc=1

Association of both consistency and strength of self-reported clinician recommendation for HPV vaccination and HPV vaccine uptake among 11- to 12-year-old children
Original Research Article
Pages 6122-6128
Lila J. Finney Rutten, Jennifer L. St. Sauver, Timothy J. Beebe, Patrick M. Wilson, Debra J. Jacobson, Chun Fan, Carmen Radecki Breitkopf, Susan T. Vadaparampil, Kathy L. MacLaughlin, Robert M. Jacobson
Abstract
Purpose
We tested the hypotheses that consistency and strength of clinician recommendation of the human papillomavirus (HPV) vaccination would be associated with vaccine delivery rates.
Methods
From October 2015 through January 2016, we conducted a survey of primary care clinicians (n = 227) in Southeastern Minnesota to evaluate clinician behaviors regarding HPV vaccination. The survey response rate was 41.0% (51 clinical sites). We used the Rochester Epidemiology Project, a clinical data linkage infrastructure, to ascertain clinical site-level HPV vaccination rates. We examined associations of clinician self-reports of both the consistency and strength of their recommendations for HPV vaccination for patients aged 11–12 years (n = 14,406) with site-level vaccination rates.
Results
The majority of clinicians reported consistently (always or usually) recommending the HPV vaccine to females (79.0%) and to males (62.2%); 71.9% of clinicians reported strongly recommending the vaccine to females while 58.6% reported strongly recommending to males. Consistency and strength of recommending the HPV vaccine was significantly higher among those practicing in pediatrics and board certified in pediatrics compared to family medicine. Higher rates of initiation (1 dose) [Incidence Rate Ratio (IRR) = 1.05; 95% CI (1.01–1.09)] and completion (3 doses) [IRR = 1.08; 95% CI (1.02–1.13)] were observed among clinical sites where, on average, clinicians more frequently reported always or usually recommending the vaccine for females compared to sites where, on average, clinicians reported recommending the vaccine less frequently. Similarly, higher rates of initiation [IRR = 1.03; 95% CI (1.00–1.06)] and completion [IRR = 1.04; CI (1.00, 1.08)] were observed among sites where clinicians reported strongly recommending the vaccine to females more frequently compared to sites where, on average, clinicians reported strongly recommending the HPV vaccine less frequently; similar associations were observed for male initiation [IRR = 1.05; CI (1.02,1.08)] and completion [IRR = 1.05; 95% CI (1.01, 1.09)].
Conclusions
Consistency and strength of HPV vaccination recommendation was associated with higher vaccination rates.

Media/Policy Watch

Media/Policy Watch

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

We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.
 
The Atlantic
http://www.theatlantic.com/magazine/
Accessed 21 October 2017
Will the World’s Most Worrying Flu Virus Go Pandemic?
There’s good news and bad news.
Ed Yong
Oct 19, 2017

Foreign Policy
http://foreignpolicy.com/
Accessed 21 October 2017
Essay
Yemen’s Humanitarian NightmareThe Real Roots of the Conflict
November/December 2017
Asher Orkaby
 

New York Times
http://www.nytimes.com/
Accessed 21 October 2017
The Long War on Polio, as Recalled by Its Generals
“Coffee With Polio Experts” videos may be amateurish, but they are full of insights explaining why polio eradication has been such a struggle.
October 20, 2017 – By DONALD G. McNEIL Jr – Health – Print Headline: “”

Marburg Hemorrhagic Fever Kills 1 Person in Uganda
One Ugandan has died of Marburg, a highly infectious disease that, like Ebola, manifests as a viral hemorrhagic fever, Uganda’s health minister said Thursday.
October 19, 2017 – By THE ASSOCIATED PRESS – World – Print Headline: “Marburg Hemorrhagic Fever Kills 1 Person in Uganda”

Vaccines and Global Health: The Week in Review_14 October 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_14 October 2017

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

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

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

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

Milestones :: Perspectives

Milestones :: Perspectives
 
Meeting: SAGE Strategic Advisory Group of Experts on Immunization (SAGE)
17 – 19 October 2017
Executive Board Room, WHO Headquarters, Geneva, Switzerland
:: Draft agenda pdf, 110kb  As of 27 September 2017
:: Background documents
 
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Attack on vaccines sets back immunization efforts in eastern Syrian Arab Republic
13 October 2017 | GENEVA – The World Health Organization has received reports of an attack on medical facilities in eastern Syrian Arab Republic that has destroyed the only vaccines cold room in al-Mayadeen district, Deir Ezzor Governorate.

More than 100,000 doses of measles vaccines and 35,000 doses of polio vaccines were stored in these facilities, alongside equipment, syringes, and stocks for all vaccine-preventable childhood diseases.

If confirmed, this would set back the efforts of WHO and health partners to protect the children of Deir Ezzor from preventable childhood diseases, including polio. WHO and local partners have intensified efforts to respond to an outbreak of polio that has affected 48 children in the Syrian Arab Republic since March this year.

“WHO has made strenuous efforts in cooperation with health authorities to deliver vaccines to protect the children living in these areas from disease,” said Elizabeth Hoff, WHO Representative in the Syrian Arab Republic. “We unequivocally condemn these actions. Vaccines are not a legitimate target of war.”

“Until a new cold room is built and the required cold chain equipment — including solar fridges, cold boxes and vaccine carriers — are delivered, this will delay the implementation of routine immunization for vulnerable children in the area,” Hoff added.

WHO has supported 23 polio campaigns since the first outbreak in 2013 and helped to establish 1,148 sentinel sites across the country, of which more than 35% are in hard-to-reach and besieged areas, including al-Mayadeen in Deir Ezzor Govenorate.

The last polio vaccination campaign in Deir Ezzor reached 252,768 children aged 0-59 months.
 
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Experimental Ebola vaccines elicit year-long immune response
October 11, 2017 —
NIH reports final data from large clinical trial in West Africa.
Results from a large randomized, placebo-controlled clinical trial in Liberia show that two candidate Ebola vaccines pose no major safety concerns and can elicit immune responses by one month after initial vaccination that last for at least one year. The findings, published in the October 12 issue of the New England Journal of Medicine, are based on a study of 1,500 adults that began during the West Africa Ebola outbreak. The trial is being conducted by a U.S.-Liberia clinical research collaboration known as the Partnership for Research on Ebola Virus in Liberia (PREVAIL), established in 2014 in response to the request from the Liberian Minister of Health to the U.S. Secretary of Health and Human Services. The trial is sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH) and involves scientists and clinicians from Liberia and the United States.

“This clinical trial has yielded valuable information that is essential for the continued development of these two Ebola vaccine candidates and also demonstrates that well-designed, ethically sound clinical research can be conducted during an epidemic,” said NIAID Director Anthony S. Fauci, M.D. “A safe and effective vaccine would be a critically important addition to classical public health measures in controlling inevitable future Ebola outbreaks.”

PREVAIL conducts collaborative biomedical research in accordance with best practices, to advance science, strengthen health policy and practice, and improve the health of people in Liberia and around the world. The partnership launched this first study, PREVAIL 1, in February 2015.  Originally designed to enroll 28,000 volunteers, the trial was scaled back to a Phase 2 study when the decline in new Ebola cases made it impossible to conduct a large efficacy study.
“In Liberia, we have demonstrated to the global community that rigorous scientific research can take place in a developing sub-Saharan African country when a mutually beneficial partnership is developed,” noted Dr. Bernice T. Dahn, Liberia’s Minister of Health. “The work of PREVAIL, ranging from the Ebola vaccine to the Ebola survivor studies, clearly manifest the prospects of such a sustainable partnership and clinical research platform.”

The co-leaders of the trial are Stephen B. Kennedy, M.D., M.P.H., senior research scientist at the University of Liberia-Pacific Institute for Research and Evaluation (UL-PIRE) Africa Center, an infectious disease research center; Fatorma Bolay, Ph.D., director, Public Health and Medical Research at the National Public Health Institute of Liberia; and H. Clifford Lane, M.D., NIAID’s clinical director…
 

An HIV Vaccine is Essential for Ending the HIV/AIDS Pandemic

JAMA
New Online – Published October 9, 2017. doi:10.1001/jama.2017.13505
Viewpoint
An HIV Vaccine is Essential for Ending the HIV/AIDS Pandemic
Anthony S. Fauci, MD1
Today, highly effective modalities of HIV treatment and prevention are available, and these essential tools, if properly implemented, could end the current HIV/AIDS pandemic. Yet, the pandemic continues.1

Most of the major infectious diseases affecting humans, such as smallpox, polio, and yellow fever, have required effective vaccines for their control and in some cases elimination, and so the question arises whether the HIV/AIDS pandemic can be effectively addressed without an HIV vaccine. The answer to that question is not straightforward, but needs to be addressed from both a theoretical and a practical standpoint. Theoretically, the HIV pandemic can be ended without an HIV vaccine. More than 30 highly effective anti-HIV drugs are currently available. When given in combinations of 3 or more, these medications can durably suppress the virus such that patients who are treated soon after infection and continue therapy throughout their lifetime can expect to have an almost-normal life expectancy.

Importantly, effective treatment can reduce the level of virus in a person with HIV so low that it is extremely unlikely that this person will transmit the virus to his or her uninfected sexual partner. This concept is referred to as “treatment as prevention.” Therefore, theoretically, if most or all of the people living with HIV in the world could be identified, accessed, and treated, it would be possible to stop all infections and end the epidemic. People who are uninfected, but whose behavior or life situation puts them at high risk of HIV infection, can take a single pill containing 2 anti-HIV drugs and decrease the likelihood of acquiring HIV infection. This approach—“preexposure prophylaxis” or PrEP—can lower the risk of acquiring HIV through sexual activity by more than 90%, or from injection drug use by more than 70% if the medications are taken consistently.2 Accordingly, if both of these treatment and prevention modalities were effectively implemented throughout the world, the HIV/AIDS pandemic would end.

However, from a practical standpoint, ending the HIV/AIDS pandemic without a vaccine is possible, although it is unlikely. Although an estimated 19.5 million of the estimated 36.7 million HIV-infected people globally are receiving anti-HIV therapy (an extraordinary accomplishment), more than 17 million people are not receiving therapy.1 This leaves a substantial treatment gap. These 17 million people can continue to infect others, allowing the pandemic to be sustained. In addition, although PrEP is highly effective in preventing acquisition of HIV among people at high risk of infection, only a very small percentage of these individuals are actually taking these medications. In the United States, it is estimated that only approximately 10% of people who could benefit from PrEP are actually receiving it,3 and this proportion is much smaller elsewhere in the world.1

The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set an ambitious target to help end the HIV pandemic.1 Called “90-90-90,” the goal for 2020 is to have 90% of HIV-infected people throughout the world know their HIV status, 90% of people diagnosed with HIV receiving anti-HIV treatment, and 90% of people who receive treatment having their virus suppressed to undetectable levels. If successful, the result would be that an estimated 73% of all people in the world with HIV would have undetectable viral levels. Since suppressed viral levels result in a marked reduction in the risk of HIV transmission to other individuals, mathematical models suggest that achieving the 90-90-90 goal would reverse the kinetics and trajectory of global HIV disease such that it would no longer be of pandemic proportions. A recent study in rural Kenya and Uganda demonstrated that implementation of community-based testing and treatment resulted in increased HIV diagnosis, initiation of antiretroviral therapy and viral suppression, and the study communities reached the UNAIDS target within 2 years.4 In addition, some entire countries have been successful in reaching the goal of 73%, largely through the efforts of the President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. However, the global figure for achieving this goal in all countries is just 44%.1 Also, modeling studies have suggested that in certain high-prevalence regions of the world, the geographic dispersion of the infected population, would make it extremely difficult to reach them effectively with HIV treatment.5

The question also arises whether it is economically feasible to end the HIV pandemic in the absence of a vaccine. In this regard, the resource requirements to achieve such a goal are continually increasing. The 19.5 million people currently receiving anti-HIV drugs must be maintained on these medications for the rest of their lives; at the same time, anti-HIV drugs need to be provided to the 17.2 million infected, but untreated people. Furthermore, the estimated 1.8 million people who are newly infected with HIV each year1 also need to be treated. In addition, the cost of providing PrEP and other prevention services to the millions of people who are at risk for HIV infection is substantial. In 2016, UNAIDS estimated that the total investments needed for an adequate treatment and prevention response for HIV in low- and middle-income countries between 2016 and 2030 would amount to approximately $350 billion.6 Against this backdrop, a recent Kaiser Family Foundation and UNAIDS study found that donor-government funding for HIV decreased by 7% in 2016, which represents the lowest funding level since 2010.7

Despite the remarkable gains in the treatment and prevention of HIV infection, development of an effective HIV vaccine will likely be necessary to achieve a durable end to the HIV pandemic. An important question is how effective that vaccine must be. One vaccine tested in a large vaccine trial8 in Thailand reduced the risk of infection by 31%, a figure inadequate to justify licensure of the vaccine. In contrast, other vaccines used in controlling or ending global outbreaks have been much more effective. For example, the measles, polio, and yellow fever vaccines are nearly 100% effective. Given the difficulty for the human immune system to mount a protective response against HIV, it is extremely unlikely that an HIV vaccine will be as effective as those other proven vaccines.

In fact, modeling studies have suggested that if current treatment and prevention efforts are continued and an HIV vaccine that is about 50% effective is developed and deployed, millions of additional new HIV infections could be averted, and the pandemic could slow substantially.9

Despite extraordinary advances in the treatment and prevention of HIV infection, it is theoretically possible to end the HIV epidemic by aggressively and effectively implementing these interventions, although from a practical standpoint this goal would be difficult to achieve. Therefore, development of a moderately effective vaccine together with optimal implementation of existing treatment and prevention modalities could end the current HIV pandemic. Recent advances in HIV vaccine research provide hope that at least a moderately effective vaccine can be developed. It is critical to continue to accelerate a robust research effort in that direction while aggressively scaling-up the implementation of current treatment and prevention tools. To do anything less would lead to failure, which for HIV is not an option.

Reference at title link above

 

Cholera

Cholera
 
World’s second largest oral cholera vaccination campaign kicks off at Rohingya camps in Bangladesh
COX’S BAZAR, Bangladesh, 10 October 2017 – A massive cholera immunization campaign started today near Cox’s Bazar, Bangladesh, to protect newly arrived Rohingya and host communities from the life-threatening diarrheal disease. 900 000 doses of the vaccine have been mobilized and are being delivered by more than 200 mobile vaccination teams, making it the second largest oral cholera vaccination campaign ever.

The campaign, which is led by the Ministry of Health and supported by the World Health Organization (WHO) and UNICEF, is being held in Ukhiya and Teknaf, where more than half a million people have arrived from across the border since August, joining vast numbers already residing in a series of settlements and camps.

The first round of the campaign will cover 650,000 people aged one year and older. The second round will commence on 31 October and will target 250,000 children between one and five years with an additional dose of the vaccine for added protection.

“This is the second largest oral vaccination campaign in the world after Haiti in 2016,” says Edouard Beigbeder, UNICEF Representative in Bangladesh. “Cholera is a dangerous disease, especially among children living in cramped, unhygienic conditions. Prevention is essential.”

In the last week, at least 10,292 cases of diarrhoea have been reported and treated from across the settlements and camps. WHO has warned of the potential for an outbreak of cholera.

UNICEF and WHO are supporting the Ministry of Health with planning, distribution, volunteer orientation, operational costs and monitoring.

“Emergency vaccination saves lives. The risk of cholera is clear and present, and the need for decisive action apparent,” says Dr. N Paranietharan, WHO Representative to Bangladesh. “WHO is committed to mobilizing its full technical and operational capacity to support the Ministry and our partners to protect, promote and secure the health of this immensely vulnerable population.”

In Ukhiya 150 teams have been deployed to vaccinate the target population, while 55 teams have been deployed in Teknaf. Each team is comprised of five members.  Though vaccination can provide life-saving protection against cholera, it supplements but does not replace other traditional cholera control measures such as access to clean water, adequate sanitation and good hygiene.

To help meet present water, sanitation and hygiene needs, UNICEF is working to scale up its interventions and communication on safe practices, and is prepositioning critical supplies for case management. WHO is monitoring water quality and working with the Department of Public Health Engineering to increase local laboratory capacity, has raised an early warning, alert and response emergency surveillance system, and has prepositioned life-saving supplies to ensure a rapid response if and when an outbreak occurs. In addition, the WHO-led Health Sector has supported the Ministry set up diarrhea treatment centres among other response-oriented interventions.

 

Emergencies

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 4 October 2017 [GPEI]
:: Summary of newly-reported viruses this week:
Syria: one new circulating vaccine derived poliovirus 2 (cVDPV2) case reported, from Mayadeen district, Deir Ez-Zor governorate.  Two new cVDPV2 positives from healthy children, both from Mayadeen district. Afghanistan: two new wild poliovirus 1 (WPV1) positive environmental samples reported in Nangarhar province.
Pakistan: three new wild poliovirus 1 (WPV1) positive environmental samples reported in

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WHO Grade 3 Emergencies  [to 14 October 2017]
The Syrian Arab Republic
:: WHO responds to critical health needs of displaced populations in Al-Tabqa city, Ar-Raqqa Governorate  18 October 2017
:: Syria cVDPV2 outbreak situation report 17, 10 October 2017
 
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WHO Grade 2 Emergencies  [to 14 October 2017]
Myanmar
:: Situation Report 5 – 5 October 2017
 KEY HIGHLIGHTS
:: As of 5 October 2017, cumulative new arrivals in all sites of Ukiah, Tekna, Cox’s Bazar and Ramu was 515,000, of which 198 000 are in makeshift settlements, 225,000 in new spontaneous sites and 92,000 in host communities.
:: At the weekly health sector coordination meeting, the revised humanitarian response plan was shared, targeting 1.2 million people in need and the present requirement across sectors totalling USD 434 million. The health sector is targeting to reach these 1.2 million people in need with USD 48 million.
:: An oral cholera vaccine (OCV) campaign will be rolled out in two phases. 1st dose of OCV vaccination campaign is scheduled for 10-16 October, targeting 650 000 people (new arrival population and host communities) aged 1 year and above including pregnant women. 2 weeks after the first dose, the 2nd dose would be given to children under 5 years of age to be given.
:: Oral cholera vaccination campaign kicks off at Rohingya camps in Bangladesh
 [See Cholera above for more detail]

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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
:: One year on from the start of the battle for Mosul, hundreds of thousands of civilians need…
(Baghdad, 12 October 2017) One year after the start of the military campaign to retake Mosul from the Islamic State of Iraq and the Levant (ISIL), 673,000 Muslawis are still displaced from their homes; 274,000 are living in 18 camps and emergency sites surrounding the city; 400,000 are staying with family, friends or in rented accommodation.

Syrian Arab Republic
:: 13 Oct 2017  Growing concerns for Syrian civilians amid intense fighting in Al Raqqa and Deir ez-Zor

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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.
Ethiopia
:: 13 Oct 2017  Ethiopia: Humanitarian Response Situation Report No.14 (August – September 2017)

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

EBOLA/EVD  [to 14 October 2017]
http://www.who.int/ebola/en/
Experimental Ebola vaccines elicit year-long immune response
October 11, 2017 — NIH reports final data from large clinical trial in West Africa.
[See Milestones/Perspectives above for more detail]

MERS-CoV [to 14 October 2017]
http://www.who.int/emergencies/mers-cov/en/
DONs
Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
9 October 2017
Between 31 August and 26 September 2017, the national IHR focal point of Saudi Arabia reported nine additional cases of Middle East Respiratory Syndrome (MERS), including four deaths. In addition, four deaths from previously reported cases were reported…
 

WHO & Regional Offices [to 14 October 2017]

WHO & Regional Offices [to 14 October 2017]
 
WHO to establish commission on noncommunicable diseases
10 October 2017 – Dr Tedros Adhanom Ghebreyesus, the WHO’s Director-General, today announced the establishment of a new High-level global Commission on Noncommunicable Diseases (NCDs). The announcement came at the 64th Session of WHO’s Regional Committee for the Eastern Mediterranean being held in Islamabad, 9-12 October. The commission’s aim is to identify innovative ways to curb the world’s biggest causes of death and extend life expectancy for millions of people.
Read the statement

Sixty-eighth session of the Regional Committee for the Western Pacific
10 October 2017 — The WHO Regional Committee for the Western Pacific today opened its 68th session in Brisbane, Australia. The annual meeting brings together ministers of health and senior officials from 37 countries and areas to decide on issues that affect the health and well-being of the Region’s peoples.

Highlights
Investing in disaster prevention for a healthier world
October 2017 – The International Day for Disaster Reduction (IDDR) reminds us of the importance of putting health at the centre of action to prevent, prepare for, respond to and recover from emergencies and disasters. Millions of people are killed, injured or made sick each year by natural and manmade disasters.

Nepal tackles diabetic retinopathy
October 2017 – Diabetic retinopathy, which contributes to 2.6% of blindness in the world, can be a challenging disease for many countries to manage, because doing so involves two different parts of the health system, that which cares for patients with diabetes and that which cares for patients with vision loss. A lack of coordination can lead to people missing out on essential services, enduring long waits or traveling far from home to receive care.

Progressing the Sustainable Development Goals through Health in All Policies
October 2017 – WHO and the Government of South Australia have published the case study book on Health in All Policies (HiAP), which describes experiences from around the world in the context of the 2030 Sustainable Development Agenda.

WHO scales up response to plague in Madagascar
October 2017 – WHO is rapidly scaling up its response to an outbreak of plague that has spread to the capital and port towns, infecting more than 100 people in just a few weeks.

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Weekly Epidemiological Record, 13 October 2017, vol. 92, 41 (pp. 609–624)
:: Executive summary of the 9th meeting of the WHO working group RT-PCR for the detection and subtyping of influenza viruses
:: Executive summary of the 6th meeting of the WHO Expert Working Group of the GISRS for Surveillance of Antiviral Susceptibility
:: Continuing risk of meningitis due to Neisseria meningitidis serogroup C in Africa: revised recommendations from a WHO expert consultation
:: Progress towards eliminating onchocerciasis in the WHO Region of the Americas: elimination of transmission in the north-east focus of the Bolivarian Republic of Venezuela
 
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5 October 2017
GIN September 2017 pdf, 2.74Mb
 
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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: With USAID’s support, WHO strengthens integrated diseases surveillance and response for timely and effective public health action in South Sudan  13 October 2017
:: WHO Regional Director for Africa begins official visit to Nigeria  11 October 2017
:: The World Mental Health Day commemorated in South Sudan  11 October 2017

WHO Region of the Americas PAHO
:: Eradicating hunger in Latin America and the Caribbean by 2030 is becoming increasingly unlikely (10/10/2017)

WHO South-East Asia Region SEARO
:: WHO, partners implement 900 000 dose oral cholera vaccination campaign in Cox’s Bazaar  10 Oct 2017

WHO European Region EURO
:: World Obesity Day: Understanding the social consequences of obesity 10-10-2017
:: “We’re doctors but we’re also human”: helping Syrian health workers handle severe stress 09-10-2017

WHO Eastern Mediterranean Region EMRO
:: 64th session of the Regional Committee for the Eastern Mediterranean concludes in Pakistan
12 October 2017, Islamabad, Pakistan – Members of WHO’s Regional Committee for the Eastern Mediterranean today concluded their 64th Session, endorsing a number of resolutions that will have a positive impact on the health of populations in countries of the Eastern Mediterranean Region.
Among the topics discussed were cancer, climate change, the health of adolescents and antimicrobial resistance…

WHO Western Pacific Region
:: Countries pledge to fund priority public health services; make medicines, the health workforce and food safer
BRISBANE, Australia, 12 October 2017 – Governments from across the Region today pledged to take action to ensure the safety of medicines and competence of health workers. They also agreed on frameworks for the financing of priority health services and for making food safer. Ministers and senior officials at the 68th session of the World Health Organization (WHO) Regional Committee for the Western Pacific also noted progress in areas of public health including: noncommunicable diseases, tobacco control, mental health, tuberculosis (TB), hepatitis, traditional medicine, and gender and health…
:: World Health Organization Director-General Dr Tedros appoints Cook Islands’ Elizabeth Iro as WHO’s Chief Nursing Officer
BRISBANE, Australia, 12 October 2017 – Director-General Dr Tedros Adhanom Ghebreyesus today appointed Ms Elizabeth Iro as the Chief Nursing Officer at the World Health Organization (WHO). Ms Iro is a registered nurse, and the Cook Islands’ current Secretary of Health. With this announcement, Dr Tedros fulfils a commitment he made during his transition to the Director-General role to appoint a nurse to his senior team. “I am thrilled to welcome Ms Iro to our team as WHO’s Chief Nursing Officer,” said Dr Tedros.
 

CDC/ACIP [to 14 October 2017]

CDC/ACIP [to 14 October 2017]
http://www.cdc.gov/media/index.html

MMWR News Synopsis for October 12, 2017
:: Vaccination Coverage Among Children in Kindergarten — United States, 2016–2017 School Year
Getting vaccines at the recommended ages protects children from serious vaccine-preventable diseases before they start school. For the 2016-2017 school year, vaccination coverage among kindergartners remained high. Immunization programs conduct annual kindergarten vaccination assessments to monitor school entry vaccination coverage. For the 2016-17 school year, vaccination coverage among kindergartners remained high and exemptions remained low. Based on the data:
:: Median vaccination coverage was 94.0 percent for two doses of measles, mumps, and rubella vaccine; 94.5 percent for the state-required number of doses of diphtheria, tetanus, and acellular pertussis vaccine; and 93.8 percent for two doses of varicella vaccine.
:: Median exemption level was 2.0 percent.
:: Median proportion of kindergartners under a grace period or provisional enrollment was 2.0 percent, the same as in 2015–16.
School assessment allows immunization programs to focus on schools with lower vaccination coverage and higher exemption levels, and encourages follow up with undervaccinated students to ensure kindergartners are protected from vaccine-preventable diseases.

Announcements

Announcements

 
CEPI – Coalition for Epidemic Preparedness Innovations  [to 14 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 14 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
9 October 2017
EDCTP joins forces with WHO AFRO and TDR to fund implementation research
A new partnership has been formed between EDCTP, TDR (the Special Programme for Research and Training in Tropical Diseases), and the World Health Organization’s Regional Office for Africa (WHO AFRO) in recognition of a mutual interest in strengthening the capacity for health research in African countries. Collaboration between these three partners has been realised through a recently launched call “Joint WHO-AFRO/TDR/EDCTP Small Grants Scheme for implementation research on infectious diseases of poverty”, which will close on 30 November 2017…

European Medicines Agency  [to 14 October 2017]
http://www.ema.europa.eu/ema/
13/10/2017
Meeting highlights from the Committee for Medicinal Products for Human Use (CHMP) 9-12 October 2017
One generic medicine recommended for approval …
 
 
FDA [to 14 October 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
October 11, 2017 –
Statement by FDA Commissioner Scott Gottlieb, M.D. on new steps by FDA to advance patient engagement in the agency’s regulatory work
The Food and Drug Administration is hosting a pioneering event today: the first meeting of the Patient Engagement Advisory Committee or PEAC. It’s a significant step forward in the FDA’s efforts to broaden its engagement with patients – and to deepen the involvement of patients in our regulatory activities.
This is the agency’s first advisory committee that’s comprised solely of patients, care-partners, and those who represent their needs. Founded by the FDA’s Center for Devices and Radiological Health (CDRH), it reflects CDRH’s commitment to keep patients at the center of their work.
The FDA’s work requires us to establish objective, consistent criteria on which we base our decisions. But ultimately, the criteria we use to judge benefit and risk turn on the parameters that matter to patients.
Involving the end-user – the patient – in identifying health priorities and outcomes desired from health interventions is critically important…
 
 
Global Fund [to 14 October 2017]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
News
Global Fund and The Union Deepen Partnership to Fight TB
11 October 2017
The Global Fund to Fight AIDS, Tuberculosis and Malaria and the International Union against Tuberculosis and Lung Disease, also known as The Union, announced a partnership agreement to deepen their shared commitment to end tuberculosis as an epidemic.
News
Partners Launch Global Effort to Find Missing Cases of TB
09 October 2017
Global health partners and implementers from 13 countries with a high burden of tuberculosis launched an ambitious program to find and treat an additional 1.5 million missing cases of TB by the end of 2019. The new initiative is critically important to stopping the spread of TB and to reaching the global goal of ending TB as an epidemic by 2030.
 
 
Hilleman Laboratories   [to 14 October 2017]
http://www.hillemanlabs.org/
12/10/2017
Hilleman Labs achieves successful outcome of Phase I/II Clinical Trial of its Oral Cholera Vaccine Hillchol
New Delhi: Delivering on its mission to develop affordable vaccines for global health, Hilleman Laboratories today announced that it has successfully completed the Phase I/II Clinical Trials of its novel Oral Cholera Vaccine HillcholTM to address growing need to stop Cholera in the developing world.
The Phase I/II clinical study was conducted in partnership with the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Results of the clinical trials were announced at the Vaccines for Enteric Diseases Conference 2017 recently held in Albufeira, Portugal…

Hilleman Labs successfully completes Phase I/II Clinical Trial of its Heat Stable Rotavirus Vaccine (HSRV)
12th October 2017, New Delhi: Making headway towards providing the developing nations an affordable and easy-to-use Heat Stable Rotavirus Vaccine (HSRV), Hilleman Laboratories, a joint-venture between Merck Sharp & Dohme (MSD) and the Wellcome Trust, today announced the successful completion of Phase I/II clinical trial of its oral vaccine against the deadly Rotavirus disease.
The study was conducted in partnership with the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)…
 
IAVI  [to 14 October 2017]
https://www.iavi.org/
October 2017
IAVI REPORT – VOL. 21, NO. 3, 2017
:: Decisive Moments in Wake of Paris
:: Stumbling on Greatness
:: PrEParing to Prevent HIV
:: In Brief
 
MSF/Médecins Sans Frontières  [to 14 October 2017]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
Governments Must Step Up the Use of Newer Drugs to Fight Multidrug-Resistant TB
Guadalajara, Mexico, October 13, 2017—People with drug-resistant tuberculosis (DR-TB) are still not receiving two newer tuberculosis (TB) drugs, bedaquiline and delamanid, which have shown improved cure rates for the disease, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) at the 48th Union World Conference on Lung Health in Guadalajara, Mexico, where the global TB community is meeting.
 
 
NIH  [to 14 October 2017]
http://www.nih.gov/news-events/news-releases
October 12, 2017
NIH partners with 11 leading biopharmaceutical companies to accelerate the development of new cancer immunotherapy strategies for more patients
October 12, 2017 — Supports Cancer Moonshot goal to bring immunotherapy success to more patients in half the time.

Experimental Ebola vaccines elicit year-long immune response
October 11, 2017 — NIH reports final data from large clinical trial in West Africa.
[See Milestones/Perspectives above for more detail]

NIH completes atlas of human DNA differences that influence gene expression
October 11, 2017 — This atlas will be a critical resource for the scientific community.

Durable end to the HIV/AIDS pandemic likely will require an HIV vaccine
October 10, 2017 — From a practical standpoint, ending the HIV/AIDS pandemic without a vaccine is unlikely.
   AS Fauci. An HIV vaccine is essential for ending the HIV/AIDS pandemic. Journal of the American Medical Association DOI: 10.1001/jama.2017.13505 (2017) (link is external).
[See Milestones/Perspectives above for more detail]

UNAIDS [to 14 October 2017]
http://www.unaids.org/en
Update
International Day of the Girl Child: empowering girls before, during and after crises
11 October 2017
The International Day of the Girl Child, marked every year on 11 October, highlights and addresses the needs and challenges that girls face, while promoting their empowerment and human rights.
In many parts of the world, one of the key challenges that adolescent girls face is HIV. Globally, every week 6900 adolescent girls and young women aged 15–24 years are newly infected with HIV, yet only one in three adolescent girls and young women have comprehensive and correct knowledge of how to prevent HIV. In sub-Saharan Africa, three in four new HIV infections among 15–19-year-olds are among girls.
The theme of the International Day of the Girl Child 2017 is “EmPOWER girls: before, during and after crises”. War and conflict exacerbate the vulnerability of girls to child marriage, intensify inequality and make women and girls susceptible to both household and intimate partner violence, all of which increase the vulnerability of women and girls to HIV…

Press statement
UNAIDS and UNFPA launch road map to stop new HIV infections
Global HIV Prevention Coalition holds first meeting in Geneva, Switzerland, to find ways to strengthen and sustain political commitment for HIV prevention
GENEVA, 10 October 2017—As part of global efforts to end AIDS as a public health threat, UNAIDS, the United Nations Population Fund (UNFPA) and partners have launched a new road map to reduce new HIV infections. The HIV prevention 2020 road map was launched at the first meeting of the Global HIV Prevention Coalition. The coalition is chaired by the Executive Directors of UNAIDS and UNFPA and brings together United Nations Member States, civil society, international organizations and other partners as part of efforts to reduce new HIV infections by 75% by 2020…

Update
New fund for key populations in eastern Europe and central Asia
10 October 2017
The Elton John AIDS Foundation announced on 10 October a new funding initiative for key populations in eastern Europe and central Asia.
The Key Populations Fund for Eastern Europe and Central Asia will focus on prevention and treatment of both HIV and hepatitis C for the people in the region most vulnerable to HIV—people who inject drugs, gay men and other men who have sex with men and sex workers. Over the next three years, the fund will aim to reach 20 000 people in the region with prevention, testing and treatment services…

UNICEF  [to 14 October 2017]
https://www.unicef.org/media/
12 October, 2017
Violence in al-Mayadin district, Deir ez-Zor, reportedly destroys cold room and vaccines
AMMAN/DAMASCUS,– “UNICEF has received reports that ongoing violence in Deir ez-Zor in eastern Syria has destroyed a UNICEF-supported vaccine cold room in al-Mayadin district, with at least 140,000 doses of vaccines lost, including some planned for use in tackling vaccine-preventable childhood diseases in the area. UNICEF is currently verifying this alarming report.

UNICEF emergency supplies for Rohingya children en route to Cox’s Bazar
COX’S BAZAR, 14 September 2017 – UNICEF trucks filled with emergency water, sanitation and hygiene supplies for thousands of Rohingya children are headed to Cox’s Bazar, with a steady stream of supplies in the pipeline for the coming days and weeks.

World’s second largest oral cholera vaccination campaign kicks off at Rohingya camps in Bangladesh
COX’S BAZAR, Bangladesh, 10 October 2017 – A massive cholera immunization campaign started today near Cox’s Bazar, Bangladesh, to protect newly arrived Rohingya and host communities from the life-threatening diarrheal disease. 900,000 doses of the vaccine have been mobilized and are being delivered by more than 200 mobile vaccination teams, making it the second largest oral cholera vaccination campaign ever.
 
Wellcome Trust  [to 14 October 2017]
https://wellcome.ac.uk/news
News / Published: 13 October 2017
Global pledges to speed up action on superbugs
Wellcome is investing £2.4 million in a new project to track the global impact of superbugs as part of our ongoing efforts to help address this urgent global health threat.
The Global Burden of Disease AMR project will be launched today at our international Call to Action conference.

News / Published: 10 October 2017
Findings from new malaria database are ‘wake-up call’
Researchers have compiled and analysed 115 years of malaria data in Africa, providing the most detailed picture yet of where efforts to control malaria infection are being won and lost across the continent.
The largest data repository of any parasitic disease in the world, it includes 7.8 million blood samples from more than 30,000 locations in 43 countries.
The open access dataset (opens in a new tab) was collected and analysed by KEMRI-Wellcome Trust (opens in a new tab) researchers Professor Bob Snow, Abdisalan Noor and colleagues based in Kenya, and is the result of over 20 years of research funded by Wellcome.

::::::
 
PhRMA    [to 14 October 2017]
http://www.phrma.org/press-room
October 12, 2017
PhRMA, member companies and NIH create public-private partnership for immuno-oncology
A new public-private partnership will help build upon a new era in cancer treatment.

October 11, 2017
Amgen Chairman and CEO Robert A. Bradway Elected PhRMA Board Chairman-Elect
The Pharmaceutical Research and Manufacturers of America elected new officers to its board of directors.

Journal Watch

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

Spatial model for risk prediction and sub-national prioritization to aid poliovirus eradication in Pakistan

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 14 October 2017)

Research article
Spatial model for risk prediction and sub-national prioritization to aid poliovirus eradication in Pakistan
Laina D. Mercer, Rana M. Safdar, Jamal Ahmed, Abdirahman Mahamud, M. Muzaffar Khan, Sue Gerber, Aiden O’Leary, Mike Ryan, Frank Salet, Steve J. Kroiss, Hil Lyons, Alexander Upfill-Brown and Guillaume Chabot-Couture
Published on: 11 October 2017
Abstract
Background
Pakistan is one of only three countries where poliovirus circulation remains endemic. For the Pakistan Polio Eradication Program, identifying high risk districts is essential to target interventions and allocate limited resources.
Methods
Using a hierarchical Bayesian framework we developed a spatial Poisson hurdle model to jointly model the probability of one or more paralytic polio cases, and the number of cases that would be detected in the event of an outbreak. Rates of underimmunization, routine immunization, and population immunity, as well as seasonality and a history of cases were used to project future risk of cases.
Results
The expected number of cases in each district in a 6-month period was predicted using indicators from the previous 6-months and the estimated coefficients from the model. The model achieves an average of 90% predictive accuracy as measured by area under the receiver operating characteristic (ROC) curve, for the past 3 years of cases.
Conclusions
The risk of poliovirus has decreased dramatically in many of the key reservoir areas in Pakistan. The results of this model have been used to prioritize sub-national areas in Pakistan to receive additional immunization activities, additional monitoring, or other special interventions.

Epidemiological link of a major cholera outbreak in Greater Accra region of Ghana, 2014

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 14 October 2017)

Research article
Epidemiological link of a major cholera outbreak in Greater Accra region of Ghana, 2014
Cholera remains an important public health challenge globally. Several pandemics have occurred in different parts of the world and have been epidemiologically linked by different researchers to illustrate how …
Kennedy Ohene-Adjei, Ernest Kenu, Delia Akosua Bandoh, Prince Nii Ossah Addo, Charles Lwanga Noora, Priscillia Nortey and Edwin Andrew Afari
BMC Public Health 2017 17:801
Published on: 11 October 2017

Viral taxonomyThe effect of metagenomics on understanding the diversity and evolution of viruses

EMBO Reports
01 October 2017; volume 18, issue 10
http://embor.embopress.org/content/18/10?current-issue=y

Science & Society
Viral taxonomyThe effect of metagenomics on understanding the diversity and evolution of viruses
The advent of next‐generation sequencing and metagenomics is challenging viral taxonomy to define and characterize viruses along with providing novel insights into the vast diversity of viruses and their evolution.
Philip Hunter

Resilience and 21st century public health

The European Journal of Public Health
Volume 27, Issue 5, October 2017
https://academic.oup.com/eurpub/issue/27/5

Editorials
Resilience and 21st century public health
Erio Ziglio; Natasha Azzopardi-Muscat; Lino Briguglio
European Journal of Public Health, Volume 27, Issue 5, 1 October 2017, Pages 789–790, https://doi.org/10.1093/eurpub/ckx116
Extract
The concept of ‘resilience’ is recently being increasingly used in academia, professional bodies, business, human rights and civil society organizations and in a wide-range of policy sectors. Its use in the field of public health has long been part and parcel of preventive policies designed to promote a long-term, holistic and socio-economic developmental approach to individual, community health and wellbeing. With today’s protracted economic crisis, it is more vital than ever to be clear about its particular significance if we are to foster lasting and meaningful action to strengthen resilience to improve health and well-being.
Resilience can be strengthened at individual, community and system levels. There are at least four types of resilience capacity that can be applied to these levels, usually referred to as absorptive, adaptive, anticipatory and transformative…

The perspective of gender on the Ebola virus using a risk management and population health framework: a scoping review

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 14 October 2017]

Scoping Review
The perspective of gender on the Ebola virus using a risk management and population health framework: a scoping review
In the three decades since the first reported case of Ebola virus, most known index cases have been consistently traced to the hunting of “bush meat”, and women have consistently recorded relatively high fatal…
Miriam N. Nkangu, Oluwasayo A. Olatunde and Sanni Yaya
Infectious Diseases of Poverty 2017 6:135
Published on: 11 October 2017

WHO launches new leadership, new priorities

The Lancet
Oct 14, 2017 Volume 390 Number 10104 p1715-1810   e25-e26
http://www.thelancet.com/journals/lancet/issue/current

WHO launches new leadership, new priorities
The Lancet
Published: 14 October 2017
WHO’s Director-General, Dr Tedros, last week launched his new cabinet to widespread acclaim. His mix of deputy and assistant director-generals is made up of nine women (two-thirds of his leadership team) with a geographical spread across 14 countries. India, Brazil, Saudi Arabia, South Africa, and Barbados are all newly represented. The announcement also translated Tedros’s verbal promises into structural commitments. New priorities include Universal Health Coverage, climate change, and access to medicines. His cabinet is diverse, talented, and experienced. Now it’s all about WHO’s actions. A special session of the Executive Board will be convened in November to agree a future global programme of work for the agency.

There are important questions to resolve. How will the new team in Geneva work with regional directors and regional offices? Will the expanded number of priorities and larger executive team create more silos within an organisation that is already partly paralysed by inefficiency? Will the optimism engendered by Dr Tedros’s election be backed by donor investment to a chronically impoverished WHO? Internally, the director-general has signalled to staff that he wants urgent and profound organisational change. Reports suggest that he is likely to appoint a transformation czar and hire McKinsey consultants to manage the change.

Dr Tedros is said to be obsessed by impact, which is welcome. WHO is at its best when it amplifies its voice and reach by establishing radical and innovative initiatives led by internationally recognised technical or political leaders. This was the lesson of Gro Harlem Brundtland’s term as director-general. The goal of transformational change is good. But it might be more practical for WHO to deliver on a limited number of tangible and feasible objectives rather than speaking in terms of broad generalities and aspirations. Dr Tedros and his team will be judged on specific and measurable successes—such as pandemic protection and stronger health systems.

The announcement last week has brought additional and valuable momentum to the renewal of WHO. The agency must now raise its political game.

 

Building the foundations for sustainable development: a case for global investment in the capabilities of adolescents

The Lancet
Oct 14, 2017 Volume 390 Number 10104 p1715-1810   e25-e26
http://www.thelancet.com/journals/lancet/issue/current

Health Policy
Building the foundations for sustainable development: a case for global investment in the capabilities of adolescents
Peter Sheehan, Kim Sweeny, Bruce Rasmussen, Annababette Wils, Howard S Friedman, Jacqueline Mahon, George C Patton, Susan M Sawyer, Eric Howard, John Symons, Karin Stenberg, Satvika Chalasani, Neelam Maharaj, Nicola Reavley, Hui Shi, Masha Fridman, Alison Welsh, Emeka Nsofor, Laura Laski
Summary
Investment in the capabilities of the world’s 1.2 billion adolescents is vital to the UN’s Sustainable Development Agenda. We examined investments in countries of low income, lower-middle income, and upper-middle income covering the majority of these adolescents globally to derive estimates of investment returns given existing knowledge. The costs and effects of the interventions were estimated by adapting existing models and by extending methods to create new modelling tools. Benefits were valued in terms of increased gross domestic product and averted social costs. The initial analysis showed high returns for the modelled interventions, with substantial variation between countries and with returns generally higher in low-income countries than in countries of lower-middle and upper-middle income. For interventions targeting physical, mental, and sexual health (including a human papilloma virus programme), an investment of US$4·6 per capita each year from 2015 to 2030 had an unweighted mean benefit to cost ratio (BCR) of more than 10·0, whereas, for interventions targeting road traffic injuries, a BCR of 5·9 (95% CI 5·8–6·0) was achieved on investment of $0·6 per capita each year. Interventions to reduce child marriage ($3·8 per capita each year) had a mean BCR of 5·7 (95% CI 5·3–6·1), with the effect high in low-income countries. Investment to increase the extent and quality of secondary schooling is vital but will be more expensive than other interventions—investment of $22·6 per capita each year from 2015 to 2030 generated a mean BCR of 11·8 (95% CI 11·6–12·0). Investments in health and education will not only transform the lives of adolescents in resource-poor settings, but will also generate high economic and social returns. These returns were robust to substantial variation in assumptions. Although the knowledge base on the impacts of interventions is limited in many areas, and a major research effort is needed to build a more complete investment framework, these analyses suggest that comprehensive investments in adolescent health and wellbeing should be given high priority in national and international policy.

Misdirections in Informed Consent — Impediments to Health Care Innovation

New England Journal of Medicine
October 12, 2017  Vol. 377 No. 15
http://www.nejm.org/toc/nejm/medical-journal

Misdirections in Informed Consent — Impediments to Health Care Innovation
David A. Asch, M.D., M.B.A., Tracy A. Ziolek, M.S., and Shivan J. Mehta, M.D., M.B.A., M.S.H.P.
N Engl J Med 2017; 377:1412-1414 October 12, 2017 DOI: 10.1056/NEJMp1707991

Phase 2 Placebo-Controlled Trial of Two Vaccines to Prevent Ebola in Liberia

New England Journal of Medicine
October 12, 2017  Vol. 377 No. 15
http://www.nejm.org/toc/nejm/medical-journal

Original Article
Phase 2 Placebo-Controlled Trial of Two Vaccines to Prevent Ebola in Liberia
Stephen B. Kennedy, M.D., Fatorma Bolay, Ph.D., Mark Kieh, M.D., Greg Grandits, M.S., Moses Badio, M.Sc., Ripley Ballou, M.D., Risa Eckes, B.S.N., Mark Feinberg, M.D., Ph.D., Dean Follmann, Ph.D., Birgit Grund, Ph.D., Swati Gupta, Dr.P.H., Lisa Hensley, Ph.D., Elizabeth Higgs, M.D., Krisztina Janosko, B.S., Melvin Johnson, B.Sc., Francis Kateh, M.D., James Logue, M.S., Jonathan Marchand, M.S., Thomas Monath, M.D., Martha Nason, Ph.D., Tolbert Nyenswah, M.P.H., François Roman, Ph.D., Eric Stavale, M.S., Julian Wolfson, Ph.D., James D. Neaton, Ph.D., and H. Clifford Lane, M.D., for the PREVAIL I Study Group*
N Engl J Med 2017; 377:1438-1447 October 12, 2017 DOI: 10.1056/NEJMoa1614067
Abstract
Background
The safety and efficacy of vaccines to prevent Ebola virus disease (EVD) were unknown when the incidence of EVD was peaking in Liberia.
Full Text of Background…
Methods
We initiated a randomized, placebo-controlled, phase 3 trial of the chimpanzee adenovirus 3 vaccine (ChAd3-EBO-Z) and the recombinant vesicular stomatitis virus vaccine (rVSV∆G-ZEBOV-GP) in Liberia. A phase 2 subtrial was embedded to evaluate safety and immunogenicity. Because the incidence of EVD declined in Liberia, the phase 2 component was expanded and the phase 3 component was eliminated.
Full Text of Methods…
Results
A total of 1500 adults underwent randomization and were followed for 12 months. The median age of the participants was 30 years; 36.6% of the participants were women. During the week after the administration of vaccine or placebo, adverse events occurred significantly more often with the active vaccines than with placebo; these events included injection-site reactions (in 28.5% of the patients in the ChAd3-EBO-Z group and 30.9% of those in the rVSV∆G-ZEBOV-GP group, as compared with 6.8% of those in the placebo group), headache (in 25.1% and 31.9%, vs. 16.9%), muscle pain (in 22.3% and 26.9%, vs. 13.3%), feverishness (in 23.9% and 30.5%, vs. 9.0%), and fatigue (in 14.0% and 15.4%, vs. 8.8%) (P<0.001 for all comparisons); these differences were not seen at 1 month. Serious adverse events within 12 months after injection were seen in 40 participants (8.0%) in the ChAd3-EBO-Z group, in 47 (9.4%) in the rVSV∆G-ZEBOV-GP group, and in 59 (11.8%) in the placebo group. By 1 month, an antibody response developed in 70.8% of the participants in the ChAd3-EBO-Z group and in 83.7% of those in the rVSV∆G-ZEBOV-GP group, as compared with 2.8% of those in the placebo group (P<0.001 for both comparisons). At 12 months, antibody responses in participants in the ChAd3-EBO-Z group (63.5%) and in those in the rVSV∆G-ZEBOV-GP group (79.5%) remained significantly greater than in those in the placebo group (6.8%, P<0.001 for both comparisons).
Full Text of Results…
Conclusions
A randomized, placebo-controlled phase 2 trial of two vaccines that was rapidly initiated and completed in Liberia showed the capability of conducting rigorous research during an outbreak. By 1 month after vaccination, the vaccines had elicited immune responses that were largely maintained through 12 months. (Funded by the National Institutes of Allergy and Infectious Diseases and the Liberian Ministry of Health; PREVAIL I ClinicalTrials.gov number, NCT02344407.)

 

First Wave of the 2016-17 Cholera Outbreak in Hodeidah City, Yemen – Acf Experience and Lessons Learned

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
[Accessed 14 October 2017]

First Wave of the 2016-17 Cholera Outbreak in Hodeidah City, Yemen – Acf Experience and Lessons Learned
October 13, 2017 · Research Article
Introduction: Although cases were reported only in 2010 and 2011, cholera is probably endemic in Yemen. In the context of a civil war, a cholera outbreak was declared in different parts of the country October 6th, 2016. This paper describes the ACF outbreak response in Hodeidah city from October 28th, 2016 to February 28th, 2017 in order to add knowledge to this large outbreak.
Methods: The ACF outbreak response in Hodeidah city included a case management component and prevention measures in the community. In partnership with the Ministry of Public Health and Population of Yemen (MoPHP), the case management component included a Cholera Treatment Center (CTC) implemented in the Al Thoraw hospital, 11 Oral Rehydration Therapy Corners (ORTCs) and an active case finding system. In partnership with other stakeholders, prevention measures in the community, including access to safe water and hygiene promotion, were implemented in the most affected communities of the city.
Results: From October 28th, 2016 until February 28th, 2017, ACF provided care to 8,270 Acute Watery Diarrhea (AWD) cases, of which 5,210 (63%) were suspected cholera cases, in the CTC and the 11 ORTCs implemented in Hodeidah city. The attack rate was higher among people living in Al Hali district, with a peak in November 2016. At the CTC, 8% of children under 5 years-old also presented with Severe Acute Malnutrition (SAM). The Case-Fatality Rate (CFR) was low (0.07%) but 15% of admitted cases defaulted for cultural and security reasons. Environmental management lacked the information to appropriately target affected areas. Financial resources did not allow complete coverage of the city.
Conclusion: Response to the first wave of a large cholera outbreak in Hodeidah city was successful in maintaining a CFR <1% in the CTC. However, considering the actual context of Yemen and its water infrastructure, much more efforts are needed to control the current outbreak resurgence.

PLoS Neglected Tropical Diseases (Accessed 14 October 2017)

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 14 October 2017)

Research Article
Modeling the environmental suitability of anthrax in Ghana and estimating populations at risk: Implications for vaccination and control
Ian T. Kracalik, Ernest Kenu, Evans Nsoh Ayamdooh, Emmanuel Allegye-Cudjoe, Paul Nokuma Polkuu, Joseph Asamoah Frimpong, Kofi Mensah Nyarko, William A. Bower, Rita Traxler, Jason K. Blackburn
| published 13 Oct 2017 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0005885

Is mass drug administration against lymphatic filariasis required in urban settings? The experience in Kano, Nigeria
Dung D. Pam, Dziedzom K. de Souza, Susan Walker, Millicent Opoku, Safiya Sanda, Ibrahim Nazaradeen, Ifeoma N. Anagbogu, Chukwu Okoronkwo, Emmanuel Davies, Elisabeth Elhassan, David Molyneux, Moses J. Bockarie, Benjamin G. Koudou
Research Article | published 11 Oct 2017 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0006004

Insights and efforts to control rabies in Zambia: Evaluation of determinants and barriers to dog vaccination in Nyimba district
Carolyn Patricia Mulipukwa, Boyd Mudenda, Allan Rabson Mbewe
Research Article | published 09 Oct 2017 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0005946

Understanding the perceived logic of care by vaccine-hesitant and vaccine-refusing parents: A qualitative study in Australia

PLoS One
http://www.plosone.org/

Understanding the perceived logic of care by vaccine-hesitant and vaccine-refusing parents: A qualitative study in Australia
Paul R. Ward, Katie Attwell, Samantha B. Meyer, Philippa Rokkas, Julie Leask
Research Article | published 12 Oct 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0185955

Assessing the individual risk of fecal poliovirus shedding among vaccinated and non-vaccinated subjects following national health weeks in Mexico

PLoS One
http://www.plosone.org/

Assessing the individual risk of fecal poliovirus shedding among vaccinated and non-vaccinated subjects following national health weeks in Mexico
Leticia Ferreyra-Reyes, Luis Pablo Cruz-Hervert, Stephanie B. Troy, ChunHong Huang, Clea Sarnquist, Guadalupe Delgado-Sánchez, Sergio Canizales-Quintero, Marisa Holubar, Elizabeth Ferreira-Guerrero, Rogelio Montero-Campos, Mauricio Rodríguez-Álvarez, Norma Mongua-Rodriguez, Yvonne Maldonado, Lourdes García-García
Research Article | published 12 Oct 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0185594

Violence, insecurity, and the risk of polio: A systematic analysis

PLoS One
http://www.plosone.org/

Violence, insecurity, and the risk of polio: A systematic analysis
Kia Guarino, Arend Voorman, Maxime Gasteen, Donte Stewart, Jay Wenger
Research Article | published 11 Oct 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0185577
Conclusion
National virologic and immunologic indicators understate the risk of poliovirus spread in areas with violence and insecurity, and the inclusion of such factors improves precision. In addition, the link between violence and incidence of disease highlights the broader challenge of implementing health interventions in conflict areas. We discuss practical implications of this work in understanding and measuring the risks to polio eradication and other global health initiatives, and the policy implications of the need to reach vulnerable populations in conflict zones.

Experiences of operational costs of HPV vaccine delivery strategies in Gavi-supported demonstration projects

PLoS One
http://www.plosone.org/

Experiences of operational costs of HPV vaccine delivery strategies in Gavi-supported demonstration projects
Siobhan Botwright, Taylor Holroyd, Shreya Nanda, Paul Bloem, Ulla K. Griffiths, Anissa Sidibe, Raymond C. W. Hutubessy
Research Article | published 10 Oct 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0182663
Abstract
From 2012 to 2016, Gavi, the Vaccine Alliance, provided support for countries to conduct small-scale demonstration projects for the introduction of the human papillomavirus vaccine, with the aim of determining which human papillomavirus vaccine delivery strategies might be effective and sustainable upon national scale-up. This study reports on the operational costs and cost determinants of different vaccination delivery strategies within these projects across twelve countries using a standardized micro-costing tool. The World Health Organization Cervical Cancer Prevention and Control Costing Tool was used to collect costing data, which were then aggregated and analyzed to assess the costs and cost determinants of vaccination. Across the one-year demonstration projects, the average economic and financial costs per dose amounted to US$19.98 (standard deviation ±12.5) and US$8.74 (standard deviation ±5.8), respectively. The greatest activities representing the greatest share of financial costs were social mobilization at approximately 30% (range, 6–67%) and service delivery at about 25% (range, 3–46%). Districts implemented varying combinations of school-based, facility-based, or outreach delivery strategies and experienced wide variation in vaccine coverage, drop-out rates, and service delivery costs, including transportation costs and per diems. Size of target population, number of students per school, and average length of time to reach an outreach post influenced cost per dose. Although the operational costs from demonstration projects are much higher than those of other routine vaccine immunization programs, findings from our analysis suggest that HPV vaccination operational costs will decrease substantially for national introduction. Vaccination costs may be decreased further by annual vaccination, high initial investment in social mobilization, or introducing/strengthening school health programs. Our analysis shows that drivers of cost are dependent on country and district characteristics. We therefore recommend that countries carry out detailed planning at the national and district levels to define a sustainable strategy for national HPV vaccine roll-out, in order to achieve the optimal balance between coverage and cost.

Determinants of human papillomavirus vaccination uptake among adolescent girls: A theory-based longitudinal study among Hong Kong Chinese parents

Preventive Medicine
Volume 102, Pages 1-126 (September 2017)
http://www.sciencedirect.com/science/journal/00917435/102?sdc=1

Original Research Article
Determinants of human papillomavirus vaccination uptake among adolescent girls: A theory-based longitudinal study among Hong Kong Chinese parents
Pages 24-30
Linda Dong-Ling Wang, Wendy Wing Tak Lam, Richard Fielding

The value of multi-country joint regulatory reviews: The experience of a WHO joint technical consultation on the CYD-TDV (Dengvaxia®) dossier

Vaccine
Volume 35, Issue 43, Pages 5731-5946 (13 October 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/43?sdc=1

The value of multi-country joint regulatory reviews: The experience of a WHO joint technical consultation on the CYD-TDV (Dengvaxia®) dossier
Pages 5731-5733
Kirsten Vannice, Liliana Chocarro, Michael Pfleiderer, Ahmed Bellah, Michael Ward, In-Kyu Yoon, Joachim Hombach

Data and product needs for influenza immunization programs in low- and middle-income countries: Rationale and main conclusions of the WHO preferred product characteristics for next-generation influenza vaccines

Vaccine
Volume 35, Issue 43, Pages 5731-5946 (13 October 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/43?sdc=1

Data and product needs for influenza immunization programs in low- and middle-income countries: Rationale and main conclusions of the WHO preferred product characteristics for next-generation influenza vaccines
Pages 5734-5737
Kathleen M. Neuzil, Joseph S. Bresee, Fernando de la Hoz, Kari Johansen, Ruth A. Karron, Anand Krishnan, Shabir A. Madhi, Punam Mangtani, David J. Spiro, Justin R. Ortiz, On behalf of the WHO Preferred Product Characteristics for Next-Generation Influenza Vaccines Advisory Group

WHO position on the use of fractional doses – June 2017, addendum to vaccines and vaccination against yellow fever WHO: Position paper – June 2013

Vaccine
Volume 35, Issue 43, Pages 5731-5946 (13 October 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/43?sdc=1

WHO position on the use of fractional doses – June 2017, addendum to vaccines and vaccination against yellow fever WHO: Position paper – June 2013
Pages 5751-5752
World Health Organization

The impact of 10-valent and 13-valent pneumococcal conjugate vaccines on hospitalization for pneumonia in children: A systematic review and meta-analysis

Vaccine
Volume 35, Issue 43, Pages 5731-5946 (13 October 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/43?sdc=1

Reviews
The impact of 10-valent and 13-valent pneumococcal conjugate vaccines on hospitalization for pneumonia in children: A systematic review and meta-analysis
Review Article
Pages 5776-5785
Cristiano Alicino, Chiara Paganino, Andrea Orsi, Matteo Astengo, Cecilia Trucchi, Giancarlo Icardi, Filippo Ansaldi
Abstract
Background
This systematic review and meta-analysis aimed at summarizing available data on the impact of PCV10 and PCV13 in reducing the incidence of CAP hospitalizations in children aged <5 years.
Methods
A systematic search of the literature was conducted. We included time-series analyses and before-after studies, reporting the incidence of hospitalization for pneumonia in the periods before and after the introduction of PCV10 or PCV13 into the immunization program. Pooled estimates of Incidence Rate Ratio (IRR) were calculated by using a random-effects meta-analytic model. Results were stratified according to age-groups (<24 months and 24–59 months) and case definitions of pneumonia (clinically and radiologically confirmed pneumonia).
Results
A total of 1533 potentially relevant articles were identified. Of these, 12 articles were included in the analysis. In children aged <24 months, the meta-analysis showed a reduction of 17% (95%CI: 11–22%, p-value < 0.001) an of 31% (95%CI: 26–35%, p-value < 0.001) in the hospitalization rates respectively for clinically and radiologically confirmed pneumonia, respectively, after the introduction of the novel PCVs.
In children aged 24–59 months, the meta-analysis showed a reduction of 9% (95%CI: 5–14%, p-value < 0.001) and of 24% (95%CI: 12–33%, p-value < 0.001) in the hospitalization rates for clinically and radiologically confirmed pneumonia, respectively, after the introduction of the novel PCVs.
High heterogeneity was detected among studies evaluating the hospitalization rate for clinically and radiologically confirmed pneumonia.
Conclusions
The results of this study revealed a significant impact of PCV10 and PCV13 in reducing the hospitalizations for pneumonia, particularly in children aged <24 months and for radiologically confirmed disease. Further appropriately designed studies, comparing the impact of PCV10 and PCV13, are needed in order to obtain solid data on which to establish future immunization strategies.

Comparison of two control groups for estimation of oral cholera vaccine effectiveness using a case-control study design

Vaccine
Volume 35, Issue 43, Pages 5731-5946 (13 October 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/43?sdc=1

Regular Papers
Comparison of two control groups for estimation of oral cholera vaccine effectiveness using a case-control study design
Original Research Article
Pages 5819-5827
Molly F. Franke, J. Gregory Jerome, Wilfredo R. Matias, Ralph Ternier, Isabelle J. Hilaire, Jason B. Harris, Louise C. Ivers
Abstract
Background
Case-control studies to quantify oral cholera vaccine effectiveness (VE) often rely on neighbors without diarrhea as community controls. Test-negative controls can be easily recruited and may minimize bias due to differential health-seeking behavior and recall. We compared VE estimates derived from community and test-negative controls and conducted bias-indicator analyses to assess potential bias with community controls.
Methods
From October 2012 through November 2016, patients with acute watery diarrhea were recruited from cholera treatment centers in rural Haiti. Cholera cases had a positive stool culture. Non-cholera diarrhea cases (test-negative controls and non-cholera diarrhea cases for bias-indicator analyses) had a negative culture and rapid test. Up to four community controls were matched to diarrhea cases by age group, time, and neighborhood.
Results
Primary analyses included 181 cholera cases, 157 non-cholera diarrhea cases, 716 VE community controls and 625 bias-indicator community controls. VE for self-reported vaccination with two doses was consistent across the two control groups, with statistically significant VE estimates ranging from 72 to 74%. Sensitivity analyses revealed similar, though somewhat attenuated estimates for self-reported two dose VE. Bias-indicator estimates were consistently less than one, with VE estimates ranging from 19 to 43%, some of which were statistically significant.
Conclusions
OCV estimates from case-control analyses using community and test-negative controls were similar. While bias-indicator analyses suggested possible over-estimation of VE estimates using community controls, test-negative analyses suggested this bias, if present, was minimal. Test-negative controls can be a valid low-cost and time-efficient alternative to community controls for OCV effectiveness estimation and may be especially relevant in emergency situations.

An ensemble approach to predicting the impact of vaccination on rotavirus disease in Niger

Vaccine
Volume 35, Issue 43, Pages 5731-5946 (13 October 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/43?sdc=1

An ensemble approach to predicting the impact of vaccination on rotavirus disease in Niger
Original Research Article
Pages 5835-5841
Jaewoo Park, Joshua Goldstein, Murali Haran, Matthew Ferrari
Abstract
Recently developed vaccines provide a new way of controlling rotavirus in sub-Saharan Africa. Models for the transmission dynamics of rotavirus are critical both for estimating current burden from imperfect surveillance and for assessing potential effects of vaccine intervention strategies. We examine rotavirus infection in the Maradi area in southern Niger using hospital surveillance data provided by Epicentre collected over two years. Additionally, a cluster survey of households in the region allows us to estimate the proportion of children with diarrhea who consulted at a health structure. Model fit and future projections are necessarily particular to a given model; thus, where there are competing models for the underlying epidemiology an ensemble approach can account for that uncertainty. We compare our results across several variants of Susceptible-Infectious-Recovered (SIR) compartmental models to quantify the impact of modeling assumptions on our estimates. Model-specific parameters are estimated by Bayesian inference using Markov chain Monte Carlo. We then use Bayesian model averaging to generate ensemble estimates of the current dynamics, including estimates of , the burden of infection in the region, as well as the impact of vaccination on both the short-term dynamics and the long-term reduction of rotavirus incidence under varying levels of coverage. The ensemble of models predicts that the current burden of severe rotavirus disease is 2.6–3.7% of the population each year and that a 2-dose vaccine schedule achieving 70% coverage could reduce burden by 39–42%.

Improving Influenza Vaccination Rate among Primary Healthcare Workers in Qatar

Vaccines — Open Access Journal
http://www.mdpi.com/journal/vaccines
(Accessed 14 October 2017)

Open Access
Article
Improving Influenza Vaccination Rate among Primary Healthcare Workers in Qatar
by Khalid H. Elawad, Elmoubasher A. Farag, Dina A. Abuelgasim, Maria K. Smatti, Hamad E. Al-Romaihi, Mohammed Al Thani, Hanan Al Mujalli, Zienab Shehata, Merin Alex, Asmaa A. Al Thani and Hadi M. Yassine
Vaccines 2017, 5(4), 36; doi:10.3390/vaccines5040036 – 10 October 2017
Abstract
The purpose of this study was to improve influenza vaccination, and determine factors influencing vaccine declination among health care workers (HCW) in Qatar. We launched an influenza vaccination campaign to vaccinate around 4700 HCW in 22 Primary Health Care Corporation (PHCC) centers in Qatar between 1st and 15th of November, 2015. Our target was to vaccinate 60% of all HCW. Vaccine was offered free of charge at all centers, and information about the campaign and the importance of influenza vaccination was provided to employees through direct communication, emails, and social media networks. Staff were reported as vaccinated or non-vaccinated using a declination form that included their occupation, place of work and reasons for declining the vaccine. Survey responses were summarized as proportional outcomes. We exceeded our goal, and vaccinated 77% of the target population. Only 9% declined to take the vaccine, and the remaining 14% were either on leave or had already been vaccinated. Vaccine uptake was highest among aides (98.1%), followed by technicians (95.2%), and was lowest amongst pharmacists (73.2%), preceded by physicians (84%). Of those that declined the vaccine, 34% provided no reason, 18% declined it due to behavioral issues, and 21% declined it due to medical reasons. Uptake of influenza vaccine significantly increased during the 2015 immunization campaign. This is attributed to good planning, preparation, a high level of communication, and providing awareness and training to HCW with proper supervision and monitoring

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

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

Papillomavirus Research
Volume 4, December 2017, Pages 72-78
Human papillomavirus (HPV) vaccine coverage achievements in low and middle-income countries 2007–2016
Introduction
Since 2007, HPV vaccine has been available to low and middle income countries (LAMIC) for small-scale ‘demonstration projects’, or national programmes. We analysed coverage achieved in HPV vaccine demonstration projects and national programmes that had completed at least 6 months of implementation between January 2007–2016.
Open Forum Infectious Diseases
Volume 4, Issue suppl_1, 1 October 2017, Pages S325
Human Papillomavirus (HPV) Knowledge, Vaccine Acceptability and Acceptability of Text Message Reminders for Vaccine Doses in Adolescents Presenting to an Urban Emergency Department (ED)
Waridibo E Allison, MBBS PhD Ada Rubin, BA Deborah Levine, MD
Conclusion
Adolescents find it acceptable to receive HPV vaccination in these EDs and text message reminders for subsequent vaccine doses. Exploration of initial HPV vaccination of unvaccinated adolescents in the ED, with follow up doses in more traditional clinic settings aided by text message reminders warrants further investigation. Though a challenging care environment, the ED should not be ignored as a potential site for public health interventions such as HPV vaccination in adolescents.

 

Media/Policy Watch

Media/Policy Watch

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

We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.
 
Forbes
http://www.forbes.com/
Accessed 14 October 2017
What’s In The Smallpox Vaccine?
K.N. Smith, Contributor
We still don’t know where the virus in smallpox vaccine actually came from, but a new genetic study offers a tantalizing clue.

Foreign Policy
http://foreignpolicy.com/
Accessed 14 October 2017
Yemen’s Man-Made Cholera Outbreak Is About to Break a Record
In Haiti, it took seven years for the number of cholera cases to surpass 800,000. In Yemen, it’s taken several months.
Dan De Luce | October 9, 2017

New York Times
http://www.nytimes.com/
Accessed 14 October 2017
WHO Says Attack on Syria Vaccine Store Leaves Children at Risk
The World Health Organization said on Friday it had received reports of an attack on medical facilities in eastern Syria that had destroyed a store containing more than 130,000 vaccine doses against measles and polio.
October 13, 2017 – By REUTERS – World –

California Declares Emergency to Fight Hepatitis A Outbreak
California Gov. Jerry Brown on Friday declared a state of emergency to combat a hepatitis A outbreak that has claimed 18 lives in San Diego.
October 13, 2017 – By THE ASSOCIATED PRESS – U

GlaxoSmithKline’s Shingles Vaccine Gets Approval in Canada
Canadian health regulators have approved GlaxoSmithKline’s key shingles vaccine, the company said on Friday.
October 13, 2017 – By REUTERS –

Washington Post
http://www.washingtonpost.com/
Accessed 14 October 2017
The mother jailed for refusing to vaccinate her son says she would ‘do it all over again’
Lindsey Bever and Kristine Phillips · National/health-science · Oct 13, 2017
 

Think Tanks et al

Think Tanks et al

Center for Global Development  
http://www.cgdev.org/page/press-center
Accessed 14 October 2017
Health in a Time of Austerity – Can Fiscal Measures Help?
Event
10/26/17
In many countries, it is difficult to raise taxes and therefore difficult to increase spending on health care. Nevertheless, many of the factors that determine population health—and how it is distributed among citizens—do not involve spending more on healthcare services, per se. Rather, the burden of many non-communicable diseases and external injuries can be influenced by creative reform of taxes and subsidies. Taxing tobacco, alcohol, and sugar-sweetened beverages can reduce consumption of products which contribute to cardiovascular disease, traffic accidents, and diabetes. Subsidies for condoms, vaccines, and TB diagnostics can reduce the prevalence of many important infectious diseases. Ramanan Laxminarayan, Director of the Center for Disease Dynamics, Economics & Policy, will present findings from his research with Ian Parry at the International Monetary Fund on the potential for health gains from taxes and subsidies. This lunchtime talk will be moderated by William Savedoff, Senior Fellow at the Center for Global Development.

Defining Benefits for Universal Health Care—How Governments Can Get the Most Bang for Their Health Care Buck
Blog Post
10/10/17
Amanda Glassman and Rebecca Forman
Vaccinate children against measles and mumps or pay for the costs of dialysis treatment for kidney disease patients? Pay for cardiac patients to undergo lifesaving surgery, or channel money toward efforts to prevent cardiovascular disease in the first place? For universal health care (UHC) to become a reality, policymakers looking to make their money go as far as possible must make tough life-or-death choices like these.

Vaccines and Global Health: The Week in Review 7 October 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_7 October 2017

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

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

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

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

Milestones :: Perspectives

Milestones :: Perspectives
 
New WHO leadership team announced
3 October 2017 – This morning, WHO Director-General Dr Tedros Adhanom Ghebreyesus announced his senior leadership team.

The new team includes former ministers of health, some of the world’s leading physicians, scientists and researchers, and programmatic experts in universal health coverage, health emergencies, communicable and noncommunicable diseases, climate and environmental health, and women’s, adolescents’ and children’s health. Individually and collectively, they have a wealth of experience across government, private sector, multilateral, civil society and academic organizations.

“The team represents 14 countries, including all WHO regions, and is more than 60% women, reflecting my deep-held belief that we need top talent, gender equity and a geographically diverse set of perspectives to fulfil our mission to keep the world safe,” said Dr Tedros.

Deputy Directors-General
:: Dr Soumya Swaminathan will be Deputy Director-General for Programmes and Jane Ellison will be Deputy Director-General for Corporate Operations.
Dr Soumya Swaminathan has more than 30 years of experience in clinical care, research and translating those findings into programs. She most recently served as Secretary of the Department of Health Research in India and as Director General of the Indian Council of Medical Research.
Jane Ellison brings with her more than 30 years of experience in government, commerce and change management. Most recently, she was the Special Parliamentary Adviser to the UK’s Chancellor of the Exchequer. She also served as the UK’s Public Health Minister from 2014 to 2016.
In addition, Dr Peter Salama will remain in his role as the Executive Director of the Health Emergencies Programme.

The Assistant Director-General appointees are:
:: Dr Bernhard Schwartländer, Chef de Cabinet
:: Dr Naoko Yamamoto, Assistant Director-General for Universal Health Coverage and Health Systems Cluster
:: Professor Lubna A. Al-Ansary, Assistant Director-General for Metrics and Measurement
:: Dr Svetlana Akselrod, Assistant Director-General for Noncommunicable Diseases and Mental Health
: Ambassador Michèle Boccoz, Assistant Director-General for External Relations
:: Dr Ranieri Guerra, Assistant Director-General for Special Initiatives
:: Dr Ren Minghui, Assistant Director-General for Communicable Diseases
:: Dr Mariângela Batista Galvão Simão, Assistant Director-General for Drug Access, Vaccines and Pharmaceuticals
: Dr Princess Nothemba (Nono) Simelela, Assistant Director-General for Family, Women, Children and Adolescents
:: Mr Stewart Simonson, Assistant Director-General for General Management
: Dr Joy St John, Assistant Director-General for Climate and Other Determinants of Health

All of these appointees will be transitioning into their new roles over the next several weeks.

“I am thrilled to welcome this group of diverse, talented global health leaders to WHO and am grateful for the opportunity to work alongside them to ensure health for all.

“I also would like to acknowledge the work of my transition team, chaired by Dr Senait Fisseha, which has been instrumental not only in helping me seamlessly move into the Director-General role, but also in putting together this leadership team,” said Dr Tedros.
 
 
Editor’s Note:
We include the bios of two appointees whose portfolios seems most closely aligned to our Center’s focus. Bio sketches of all appointees above are available here
 
Dr Ren Minghui, Assistant Director-General for Communicable Diseases
Dr Ren Minghui has served as WHO Assistant Director-General for HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases since January 2016 and is continuing this work under his new title Assistant Director General for Communicable Diseases. Prior to this role, he was Director-General for International Cooperation in the National Health and Family Planning Commission of the People’s Republic of China. He brings nearly 30 years of public health experience, working on health policy and health reform in China’s Ministry of Health, where he focused primarily on health systems research and health insurance reform. Later, his work focused on international health cooperation, during which time he led a number of health committees and programmes, working closely with international partners. As part of this work, he oversaw the development of the China-Africa health cooperation process, initiated health cooperation with BRICS countries, and engaged in regional health cooperation with ASEAN, APEC and countries of the Greater Mekong subregion. In addition, he has served as Vice-chair of WHO’s Executive Board, a member of the UNAIDS Programme Coordinating Board, and a representative of the Board of the Global Fund to Fight AIDS, TB and Malaria. Dr Ren is a medical doctor and holds a PhD in Social Medicine and Health and a Masters in Public Health.

Dr Mariângela Batista Galvão Simão, Assistant Director-General for Drug Access, Vaccines and Pharmaceuticals
Dr Mariângela Batista Galvão Simão from Brazil has been appointed Assistant Director-General for Drug Access, Vaccines and Pharmaceuticals. Most recently, she was Director of Community Support, Social Justice and Inclusion at UNAIDS. In addition to her work at UNAIDS, she brings more than 30 years of experience working in the Brazilian public health system and has played an active role in enhancing access and decentralizing health services in the country. Between 2006 and 2010, she served as Director of the National STD/AIDS and Viral Hepatitis Department in the Brazilian Ministry of Health, where she led successful price negotiations with pharmaceutical companies to lower the price of HIV medication. During this time, she also represented the Brazilian Ministry of Health in the negotiations that led to the constitution of UNITAID in 2006, including its governing body, where she served as a board member until 2008. She was trained as a pediatrician in Brazil and holds an MSc degree in public health from University of London, United Kingdom

Cholera  

Cholera
 
Yemen
Field visits to Ibb and Hudaydah: Summary of immediate action points and recommendations, 20 September 2017
2 October 2017
:: As of 1 of October 2017, the cumulative total of suspected cholera cases reached 777,229 and 2134 associated deaths in 22 out of 23 governorates across the country.
:: The overall case fatality rate shows a noticeable decrease recording 0.27%. Raymah governorate continues to report the highest case fatality rate (0.93%).
:: Children under the age of 5 years represent 25.45% of the cases and 16.93% of deaths. Children under the age of 18 represent 60% of suspected cases.
:: People over the age of 60 continue to report the highest numbers of deaths (668 cases, 31.3%).
:: The trend at country level over the past 3 weeks is considered stable.
:: At governorate level, the trend decreased in 11 governorates ( Amarn -11%), (Al Dhalea -11%), ( Abyan -12%), ( Sana’a -22%), (Hajja, -10), ( Aden, -15%), ( Taiz,-10%), (Al Mahrah, -72%), ( shabwa, -58%), (Moklla, -21%) and ( Say’on, -100). The trend has increased in two governorates (Marib, +12 % and Sa’adah +25%).
 
::::::
 
UN: More Should Have Been Done to Fight Cholera in Yemen
By THE ASSOCIATED PRESSOCT. 3, 2017, 1:18 P.M. E.D.T.
GENEVA — The World Health Organization’s emergencies chief says the agency could have acted faster and sent more vaccines to fight a massive, deadly surge of cholera cases in war-battered Yemen this year.
Dr. Peter Salama still expressed optimism that “we are turning (the) corner” on the preventable, water-borne disease that has topped 700,000 suspected cases and caused more than 2,000 deaths this year.
Salama spoke to reporters Tuesday as the U.N. agency and its partners laid out ambitious projects to reduce the number of annual cholera deaths by 90 percent by 2030…
In Yemen, the country’s 2-1/2 war has devastated the health system and public services and put the country on the brink of famine. Yemen had been set to receive a million doses of cholera vaccine over the summer but the government opted not to take them.
Salama said the Yemen government said it didn’t believe that would be enough.
“Could WHO and the cholera-specific partners have scaled up more quickly the case-management work, and could we have tried to mobilize more doses for cholera vaccine given the very limited supply globally of cholera vaccine? I think so — yes,” Salama said…
 
::::::
::::::
 
Ending Cholera – A Global Roadmap to 2030
Global Task Force on Cholera Control
3 October 2017 :: 32 poges
:: Summary: Ending Cholera – A Global Roadmap to  2030 pdf, 3.07Mb
:: Ending Cholera – A Global Roadmap to 2030 pdf, 6.20Mb
Ending Cholera—A Global Roadmap to 2030 operationalises the new global strategy for cholera control at the country level and provides a concrete path toward a world in which cholera is no longer a threat to public health. By implementing the strategy between now and 2030, the Global Task Force on Cholera Control (GTFCC) partners will support countries to reduce cholera deaths by 90 percent. With the commitment of cholera-affected countries, technical partners, and donors, as many as 20 countries could eliminate disease transmission by 2030.
With input and support from the following partners: the Bill & Melinda Gates Foundation; the Centers for Disease Control and Prevention (CDC); Global Health Visions; Gavi, the Vaccine Alliance; International Federation of the Red Cross (IFRC); Johns Hopkins University; Medecins Sans Frontières (MSF); The Mérieux Foundation; the Task Force for Global Health; UNICEF; the Veolia Foundation; WaterAid; and from the WHO Health Emergencies Programme (WHE); Immunization, Vaccines and Biologicals (IVB); and Public Health, Environmental and Social Determinants (PHE) departments as well as the regional offices at the World Health Organization.
 
Video Press Conference
Launch of Global Roadmap to End Cholera – Press Conference (Geneva, 4 October 2017)
[Video: 1:19:39]
Speakers:
:: Dr Peter Salama, Director, WHO Health Emergencies
:: Julie Hall, Chief of Staff and Special Advisor on Health, IFRC
:: Seth Berkley, Chief Executive Officer, GAVI
:: Tim Wainwright, Chief Executive Officer, WaterAid
:: Benoit Miribel, Director General, Foundation Merieux
 
Media Release
Partners commit to reduce cholera deaths by 90 per cent by 2030
Joint press release – UNICEF, WHO and others join in renewed push on deadly disease

Geneva, 03 October 2017 – An ambitious new strategy to reduce deaths from cholera by 90 per cent by 2030 will be launched tomorrow by the Global Task Force on Cholera Control (GTFCC), a diverse network of more than 50 UN and international agencies, academic institutions, and NGOs that supports countries affected by the disease.
Cholera kills an estimated 95 000 people and affects 2.9 million more every year. Urgent action is needed to protect communities, prevent transmission and control outbreaks.
The GTFCC’s new plan, Ending Cholera: A Global Roadmap to 2030, recognizes that cholera spreads in endemic “hotspots” where predictable outbreaks of the disease occur year after year.
The Global Roadmap aims to align resources, share best practice and strengthen partnerships between affected countries, donors and international agencies. It underscores the need for a coordinated approach to cholera control with country-level planning for early detection and response to outbreaks. By implementing the Roadmap, up to 20 affected countries could eliminate cholera by 2030.

“The World Health Organization is proud to be part of this new joint initiative to stop deaths from cholera. The disease takes its greatest toll on the poor and the vulnerable – this is quite unacceptable. This roadmap is the best way we have to bring this to an end,” said Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organization.
“Every death from cholera is preventable with the tools available today, including use of the Oral Cholera Vaccine and improved access to basic safe water, sanitation and hygiene as set out in the Roadmap,” said Dr Tedros Adhanom Gebreyesus, Director General of the World Health Organization. “This is a disease of inequity that affects the poorest and most vulnerable. It is unacceptable that nearly two decades into the 21st century, cholera continues to destroy livelihoods and cripple economies. We must act together. And we must act now.”
Advances in the provision of water sanitation and hygiene (WASH) services have made Europe and North America cholera-free for several decades.  Today, although access to WASH is recognized as a basic human right by the United Nations, over 2 billion people worldwide still lack access to safe water and are potentially at risk of cholera. Weak health systems and low early detection capacity further contribute to the rapid spread of outbreaks.

“It is intolerable that so many of the world’s poorest and most vulnerable children should die as a result of cholera,” said Ted Chaiban, Director of UNICEF’s global programmes.  “We know how to prevent it. This requires the commitment and action from all sides, including investment in safe water and sanitation, key health interventions and engaging communities on basic health and hygiene behaviours. We can make a difference.”

Cholera disproportionally impacts communities already burdened by conflict, lack of infrastructure, poor health systems, and malnutrition. Protecting these communities before cholera strikes is significantly more cost-effective than continually responding to outbreaks.
The introduction of the oral cholera vaccine has been a game-changer in the battle to control cholera, bridging the gap between emergency response and longer-term control. Two WHO-approved oral cholera vaccines are now available and individuals can be fully vaccinated for just US$6 per person, protecting them from the disease for up to three years.
The Global Roadmap provides an effective mechanism to synchronize the efforts of countries, donors, and technical partners. It underscores the need for a multi-sectoral approach to cholera control with country-level planning for early detection and response to outbreaks.
By strengthening WASH in endemic “hotspots”, cholera outbreaks can be prevented. By detecting cholera outbreaks early, and responding immediately, large-scale uncontrolled outbreaks like the one observed in Yemen can be avoided – even in crisis situations.