CDC/ACIP [to 2 September 2017]
http://www.cdc.gov/media/index.html

Tuesday, August 29, 2017
Forum on the Diagnosis, Evaluation, and Management of Zika Virus Infection among Infants – Media Advisory

Friday, September 01, 2017
CDC Emergency Operations Center activates to support response to Hurricane Harvey

MMWR News Synopsis for August 31, 2017
:: Awareness, Beliefs, and Actions Concerning Zika Virus Among Pregnant Women and Community Members — U.S. Virgin Islands, November–December 2016
Building in a rapid assessment during an outbreak response offers essential information to local public health authorities about their interventions. This feedback can improve communication and intervention strategies that inform and protect people. From November 15 to December 9, 2016, as part of a collaboration with the CDC, the U.S. Virgin Islands Department of Health conducted interviews with 269 pregnant women and community members living in the U.S.V.I. to assess awareness, beliefs, and actions related to Zika virus and local prevention and control efforts. Most respondents said they believed Zika to be a serious health concern but many were not aware of how Zika is or spread. Information collected enabled program planners to tailor efforts to address needs related to mosquito control, and also provided feedback about how messages were being received, perceived, and acted upon. Recognizing prevention program strengths and deficiencies allowed program planners to reframe and refocus messaging to educate the public about Zika transmission and emphasize protective actions.

Announcements
 
FDA [to 2 September 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
Selected Press Announcements
August 31, 2017 –
Statement from Center for Drug Evaluation and Research Director Janet Woodcock regarding safety concerns related to investigational use of Keytruda in multiple myeloma

August 30, 2017 –
FDA approval brings first gene therapy to the United States

August 29, 2017 –
FDA approves new antibacterial drug

FDA approves first U.S. treatment for Chagas disease

August 28, 2017 –
Statement from FDA Commissioner Scott Gottlieb, M.D. on the FDA’s new policy steps and enforcement efforts to ensure proper oversight of stem cell therapies and regenerative medicine
 
IAVI  [to 2 September 2017]
https://www.iavi.org/
August 15, 2017
IAVI Partnership with MSD Aims to Improve HIV Prevention for People Who Need it Most
IAVI ramped up its efforts to engage communities to better understand the future of HIV prevention this month with the addition of three Richard T. Clark (RTC) Fellows as part of the 2017 MSD Fellowship for Global Health.
The program seeks to build non-governmental organizations’ (NGO) capacity and to make sustainable and systematic improvements in health-service delivery for people in greatest need. IAVI was one of 10 NGOs selected to participate in the program this year, and the Fellows will support IAVI’s mission to develop HIV vaccines and other prevention modalities for people who bear the greatest burden of HIV globally – particularly women, youth, men who have sex with men, sex workers, and mobile communities in sub-Saharan Africa….

August 14, 2017
The Right APPROACH: IAVI Clinical Network Helps Janssen Assess Promising Mosaic HIV Vaccine
Scientists at the International AIDS Society conference in Paris recently announced that in an early-stage clinical trial, a new HIV vaccine regimen generated antibody responses in 100 percent of volunteers in most arms of the study. The global pharmaceutical company Janssen led the trial, known as APPROACH, which amongst others is supported by the International AIDS Vaccine Initiative (IAVI) and its clinical research center (CRC) partners in Africa. Volunteers recruited by PSF in Kigali, Rwanda, and UVRI-IAVI in Entebbe, Uganda – both part of the IAVI-Africa Clinical Research Network – were among those who participated.
Paul Stoffels, Chief Scientific Officer at Janssen’s parent company Johnson & Johnson, said in a press release: “In recent years, a new optimism has emerged that we will find an effective HIV vaccine in our lifetime. The results from today’s study add to that belief and we look forward to advancing to the next stage of clinical development as quickly as possible.”…
 
MSF/Médecins Sans Frontières  [to 2 September 2017]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
Drug to Treat Chagas Disease to Become Available in the U.S.
August 31, 2017
Pharmaceutical company Chemo Group announced today that it will make a drug to treat the neglected tropical disease Chagas available to people in the United States. The U.S. Food and Drug Administration’s (FDA) approval of the drug, benznidazole, means that Chagas pediatric patients in the U.S. could receive access to a therapy that Doctors Without Borders/Médecins Sans Frontières (MSF) has been using for decades to treat people living with Chagas across Latin America. Though Chagas affects an estimated 300,000 people in the U.S., the treatment was previously only available through the Centers for Disease Control and Prevention and was not FDA approved.
 
NIH  [to 2 September 2017]
http://www.nih.gov/news-events/news-releases
August 30, 2017
Sequencing all 24 human chromosomes uncovers rare disorders
— Study from NIH and other institutions may help improve prenatal genetic screening

August 30, 2017
NIAID scientists illuminate mechanism of increased cardiovascular risks with HIV
— Tick saliva molecule blocks process in human cells, nonhuman primates.

UNAIDS [to 2 September 2017]
http://www.unaids.org/en
Statement
WHO, UNAIDS STATEMENT ON HIV TESTING SERVICES: NEW OPPORTUNITIES AND
ONGOING CHALLENGES
29 August 2017 :: 8 pages
PDF: http://www.unaids.org/sites/default/files/media_asset/2017_WHO-UNAIDS_statement_HIV-testing-services_en.pdf
…WHO and UNAIDS do not support mandatory or compulsory testing of individuals on public health grounds. HIV testing, no matter how it is delivered, must always respect personal choice and adhere to ethical and human rights principles…
 
UNICEF  [to 2 September 2017]
https://www.unicef.org/media/
Selected News Releases
UNICEF scaling up its emergency response in Bangladesh
DHAKA, 31 August 2017 – UNICEF with partners are scaling up the emergency response in the flood-affected northern and central parts of Bangladesh. UNICEF is also providing urgent support in Cox’s Bazar district with the recent influx of Rohingya children and their families. Children are the hardest hit and require the support to survive and outlive the physical and mental trauma of flood and displacement.

More than 180 million people lack basic drinking water in countries ravaged by conflict or unrest – UNICEF
NEW YORK/STOCKHOLM, 29 August 2017 – More than 180 million people do not have access to basic drinking water in countries affected by conflict, violence and instability* around the world, UNICEF warned today, as World Water Week gets under way.

Spread of acute watery diarrhoea and suspected cholera slows in Yemen amid unprecedented response efforts from unsung local heroes
AMMAN/SANA’A, 28 August, 2017 – The Yemeni people continue to be hit by an unprecedented and mostly man-made humanitarian crisis. Amid the suffering, ordinary Yemenis are leading a heroic daily fight against acute watery diarrhoea and cholera which is now paying off.
 
Wellcome Trust  [to 2 September 2017]
https://wellcome.ac.uk/news
News / Published: 29 August 2017
UK science centres get £13 million for public engagement
Wellcome is giving £13 million in funding to five science centres around the UK to encourage new and different ideas that will help to make science more accessible. 
The funding has been awarded through the Inspiring Science Fund.
 
::::::
 
DCVMN – Developing Country Vaccine Manufacturers Network  [to 2 September 2017]
http://www.dcvmn.org/
25 September 2017 to 28 September 2017
DCVMN Annual General Meeting
Seoul / Korea
 
PhRMA    [to 2 September 2017]
http://www.phrma.org/press-room
August 30, 2017
PhRMA Announces Dr. Richard Moscicki as New Chief Medical Officer and Executive Vice President
PhRMA today announced Richard A. Moscicki, M.D. will join the organization as chief medical officer and executive vice president.

Journal Watch

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

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

American Journal of Preventive Medicine
September 2017 Volume 53, Issue 3, p275-404, e79-e122
http://www.ajpmonline.org/current

Research Articles
Feasibility of Text Message Influenza Vaccine Safety Monitoring During Pregnancy
Melissa S. Stockwell, Maria Cano, Kathleen Jakob, Karen R. Broder, Cynthia Gyamfi-Bannerman, Paula M. Castaño, Paige Lewis, Angela Barrett, Oidda I. Museru, Ormarys Castellanos, Philip S. LaRussa
p282–289
Published online: May 8, 2017

Impact of Provider Recommendation on Tdap Vaccination of Adolescents Aged 13–17 Years
Peng-jun Lu, David Yankey, Jenny Jeyarajah, Alissa O’Halloran, Sarah A. Meyer, Laurie D. Elam-Evans, Sarah Reagan-Steiner
p373–384
Published online: May 8, 2017

Topics in Education
Vaccine Education of Medical Students: A Nationwide Cross-sectional Survey
Solen Kernéis, Caroline Jacquet, Aurélie Bannay, Thierry May, Odile Launay, Pierre Verger, Céline Pulcini on behalf of the EDUVAC Study Group
e97–e104
Published online: February 22, 2017

American Journal of Public Health
September 2017  107(9)
http://ajph.aphapublications.org/toc/ajph/current

ZIKA
Zika and Reproductive Rights in Brazil: Challenge to the Right to Health
Pablo K. Valente
107(9), pp. 1376–1380
Abstract
The Zika virus epidemic rapidly spread across Brazil and Latin America, gaining international attention because of the causal relationship between Zika and birth defects. The high number of cases in Brazil has been attributed to a failure of the state to contain the epidemic and protect the affected people, especially women. Therefore, the public health crisis created by Zika exposed a stark conflict between Brazil’s constitutional right to health and the long-standing violation of reproductive rights in the country.
Although health is considered to be a right of all in Brazil, women struggle with barriers to reproductive services and lack of access to safe and legal abortions. In response to the epidemic, women’s rights advocates have filed a lawsuit with Brazil’s supreme court that requires the decriminalization of abortion upon the diagnosis of Zika virus.
However, the selective decriminalization of abortion may lead to negative social consequences and further stigmatization of people with disabilities. A solution to the reproductive health crisis in Brazil must reconcile women’s right to choose and the rights of people with disabilities.

American Journal of Public Health
September 2017  107(9)
http://ajph.aphapublications.org/toc/ajph/current

POLIO
Per Diems in Polio Eradication: Perspectives From Community Health Workers and Officials
Svea Closser, Anat Rosenthal, Judith Justice, Kenneth Maes, Marium Sultan, Sarah Banerji, Hailom Banteyerga Amaha, Ranjani Gopinath, Patricia Omidian and Laetitia Nyirazinyoye
107(9), pp. 1470–1476
Abstract
Nearly all global health initiatives give per diems to community health workers (CHWs) in poor countries for short-term work on disease-specific programs. We interviewed CHWs, supervisors, and high-level officials (n = 95) in 6 study sites across sub-Saharan Africa and South Asia in early 2012 about the per diems given to them by the Global Polio Eradication Initiative. These per diems for CHWs ranged from $1.50 to $2.40 per day.
International officials defended per diems for CHWs with an array of arguments, primarily that they were necessary to defray the expenses that workers incurred during campaigns. But high-level ministry of health officials in many countries were concerned that even small per diems were unsustainable. By contrast, CHWs saw per diems as a wage; the very small size of this wage led many to describe per diems as unjust.
Per diem polio work existed in the larger context of limited and mostly exploitative options for female labor. Taking the perspectives of CHWs seriously would shift the international conversation about per diems toward questions of labor rights and justice in global health pay structures.

BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content
(Accessed 2 September 2017)

Research article
Perceptions of human papillomavirus vaccination of adolescent schoolgirls in western Uganda and their implications for acceptability of HPV vaccination: a qualitative study
Human papillomavirus (HPV) vaccination has been perceived in diverse ways some of which encourage its uptake while others could potentially deter its acceptability. This study explored community member’s perce…
Andrew Kampikaho Turiho, Elialilia Sarikieli Okello, Wilson Winstons Muhwezi and Anne Ruhweza Katahoire
BMC Research Notes 2017 10:431
Published on: 30 August 2017

Bulletin of the World Health Organization
Volume 95, Number 9, September 2017, 609-664
http://www.who.int/bulletin/volumes/95/9/en/

EDITORIALS
Syphilis screening and treatment: integration with HIV services
Melanie M Taylor, Mary Kamb, Dadong Wu & Sarah Hawkes
http://dx.doi.org/10.2471/BLT.17.200923

Addressing vulnerability of pregnant refugees
Mary Malebranche, Kara Nerenberg, Amy Metcalfe & Gabriel E Fabreau
http://dx.doi.org/10.2471/BLT.17.193664

RESEARCH
Pneumococcal conjugate vaccines and hospitalization of children for pneumonia: a time-series analysis, South Africa, 2006–2014
Alane Izu, Fatima Solomon, Susan A Nzenze, Azwifarwi Mudau, Elizabeth Zell, Katherine L O’Brien, Cynthia G Whitney, Jennifer Verani, Michelle Groome & Shabir A Madhi
http://dx.doi.org/10.2471/BLT.16.187849

Estimated economic impact of vaccinations in 73 low- and middle-income countries, 2001–2020
Sachiko Ozawa, Samantha Clark, Allison Portnoy, Simrun Grewal, Meghan L Stack, Anushua Sinha, Andrew Mirelman, Heather Franklin, Ingrid K Friberg, Yvonne Tam, Neff Walker, Andrew Clark, Matthew Ferrari, Chutima Suraratdecha, Steven Sweet, Sue J Goldie, Tini Garske, Michelle Li, Peter M Hansen, Hope L Johnson & Damian Walker
http://dx.doi.org/10.2471/BLT.16.178475
Abstract [HTML]
Objective
To estimate the economic impact likely to be achieved by efforts to vaccinate against 10 vaccine-preventable diseases between 2001 and 2020 in 73 low- and middle-income countries largely supported by Gavi, the Vaccine Alliance.
Methods
We used health impact models to estimate the economic impact of achieving forecasted coverages for vaccination against Haemophilus influenzae type b, hepatitis B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitidis serogroup A, rotavirus, rubella, Streptococcus pneumoniae and yellow fever. In comparison with no vaccination, we modelled the costs – expressed in 2010 United States dollars (US$) – of averted treatment, transportation costs, productivity losses of caregivers and productivity losses due to disability and death. We used the value-of-a-life-year method to estimate the broader economic and social value of living longer, in better health, as a result of immunization.
Findings
We estimated that, in the 73 countries, vaccinations given between 2001 and 2020 will avert over 20 million deaths and save US$ 350 billion in cost of illness. The deaths and disability prevented by vaccinations given during the two decades will result in estimated lifelong productivity gains totalling US$ 330 billion and US$ 9 billion, respectively. Over the lifetimes of the vaccinated cohorts, the same vaccinations will save an estimated US$ 5 billion in treatment costs. The broader economic and social value of these vaccinations is estimated at US$ 820 billion.
Conclusion
By preventing significant costs and potentially increasing economic productivity among some of the world’s poorest countries, the impact of immunization goes well beyond health

Epidemiology and Infection
Volume 145 – Issue 12 – September 2017
https://www.cambridge.org/core/journals/epidemiology-and-infection/latest-issue

Acute Flaccid Paralysis
Original Papers
Characterization of group B coxsackieviruses isolated from non-polio acute flaccid paralysis patients in Pakistan: vital assessment before polio eradication
ANGEZ, S. SHAUKAT, R. ZAHRA, M. M. ALAM, S. SHARIF, A. KHURSHID, Y. ARSHAD, M. SULEMAN, G. MUJTABA, S. S. Z. ZAIDI
DOI: https://doi.org/10.1017/S0950268817001522
Published online: 25 July 2017, pp. 2473-2481

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 2 September 2017]

Review
A realist synthesis of cross-border patient movement from low and middle income countries to similar or higher income countries
Jo Durham and Sarah J. Blondell
Published on: 29 August 2017
Abstract
Patient travel across borders to access healthcare is becoming increasingly common and widespread. Patients moving from high income to middle income countries for healthcare is well documented, with patients seeking treatments that are cheaper or more readily available than at home. Less well understood is when patients move from one low income country to another or from a low income country to a higher income country. In this paper, a realist review was undertaken to explore why, in what contexts and how patients from lower income countries travel to countries with the same, or more advanced, economies for planned healthcare. Based on an initial scoping of the literature and discussions with key informants, we generated an initial theory and set of propositions about why, how, who and in what contexts people across international borders for planned healthcare. We then systematically located and synthesized (1) peer-reviewed studies from the Scopus, Emblaze, Web of Science and Econlit databases; (2) non-indexed reports using key informants and Google; and (3) papers from the reference lists of included documents, to glean supportive or contradictory evidence for our initial propositions. As we reviewed the literature and extracted our data, we drew on the work of Pierre Bourdieu to understand the interplay between material and non-material capital and cognitive processes in decisions to cross borders for healthcare. Patient travel was largely undertaken due to a lack of services in the home country and/or unacceptability of local services, with decisions on when, and where, to travel, usually made within the patient’s social networks. They were able to travel via use of multiple resources, including social networks, economic and cultural capital, and habitus. Those patients with greater volumes of the aforementioned factors had greater healthcare options; however, even those with limited resources engaged in patient travel. Patient movement challenges traditional ways of thinking about public health and the notion of health systems contained within the nation state. Further research is needed to better understand the effects of patient travel, and how to harness the benefits of patient travel without exacerbating existing health inequalities.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 2 September 2017]

Research
Knowledge sharing in global health research – the impact, uptake and cost of open access to scholarly literature
In 1982, the Annals of Virology published a paper showing how Liberia has a highly endemic potential of Ebola warning health authorities of the risk for potential outbreaks; this journal is only available by subs…
Elise Smith, Stefanie Haustein, Philippe Mongeon, Fei Shu, Valéry Ridde and Vincent Larivière
Health Research Policy and Systems 2017 15:73
Published on: 29 August 2017

International Journal of Community Medicine and Public Health
Vol 4, No 9 (2017)  September 2017
http://www.ijcmph.com/index.php/ijcmph/issue/view/26

Reviews
Models to predict H1N1 outbreaks: a literature review
Anirudh V. Mutalik
DOI: 10.18203/2394-6040.ijcmph201

Assessment of knowledge, attitude and perception among mothers towards immunization in a tertiary care teaching hospital
Sarfaraz Md., Athira A., Lakshmi Mani Deepa Thotamsetty, Sree Anoohya Ravilla, Naresh Nadikudi, H. Doddayya
Abstract
Background: The knowledge, attitude and perception (KAP) of parents is an important factor for better immunization coverage. Previous studies showed misconceptions on parent’s knowledge towards childhood immunization. This study aimed at promoting the childhood immunization by providing information and knowledge to mothers regarding immunization.
Methods: A prospective interventional study was conducted on 103 mothers for a period of six months in a tertiary care teaching hospital, Karnataka. The study was divided into Pre-intervention and post-intervention phases and was performed using a KAP questionnaire.
Results: 103 mothers were enrolled in the study, of which 77 (74.75%) mothers were uneducated which was the main reason for lack of knowledge on immunization. Most of the mothers in pre-intervention phase got score in the range of 2-4 and in post-intervention phase they got score in the range of 10-12. A significant difference was observed in the Pre and Post-intervention scores which indicated that level of knowledge among mothers was improved after counseling session. Chi-square test was used to analyse the pre and post- intervention scores and was found to be significant (p<0.01). Out of 103 mothers who had attended counseling session on immunization 80 (77.66%) children were immunized, 23 (22.66%) were partially immunized and no one was unimmunized.
Conclusions: It was therefore suggested that proper health education and health promotion interventions be taken as measures to improve knowledge, attitude and perception of mothers towards immunization as a disease prevention tool.

 International Journal of Infectious Diseases
September 2017 Volume 62, p1-126
http://www.ijidonline.com/issue/S1201-9712(17)X0008-8

Original Reports
Too young to be vaccinated: hospitalizations caused by varicella among children in the first year of life
Ewelina Gowin, Jacek Wysocki, Michał Michalak, Danuta Januszkiewicz-Lewandowska
p52–55
Published online: July 19, 2017

Journal of Medical Ethics
September 2017 – Volume 43 – 9
http://jme.bmj.com/content/current

Research ethics
Paper: Vaccine testing for emerging infections: the case for individual randomisation
Nir Eyal, Marc Lipsitch
Abstract
During the 2014–2015 Ebola outbreak in Guinea, Liberia and Sierra Leone, many opposed the use of individually randomised controlled trials to test candidate Ebola vaccines. For a raging fatal disease, they explained, it is unethical to relegate some study participants to control arms. In Zika and future emerging infections, similar opposition may hinder urgent vaccine research, so it is best to address these questions now. This article lays out the ethical case for individually randomised control in testing vaccines against many emerging infections, including lethal infections in low-income countries, even when at no point in the trial do the controls receive the countermeasures being tested. When individual randomisation is feasible—and it often will be—it tends to save more lives than alternative designs would. And for emerging infections, individual randomisation also tends as such to improve care, access to the experimental vaccine and prospects for all participants relative to their opportunities absent the trial, and no less than alternative designs would. That obtains even under placebo control and without equipoise—requiring which would undermine individual randomisation and the alternative designs that opponents proffered. Our arguments expound four often-neglected factors: benefits to non-participants, benefits to participants once a trial is over including post-trial access to the study intervention, participants’ prospects before randomisation to arms and the near-inevitable disparity between arms in any randomised controlled trial.

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 6, Issue 3, 1 September 2017,
https://academic.oup.com/jpids/issue

ORIGINAL ARTICLES
The Effect of 13-Valent Pneumococcal Conjugate Vaccine on the Serotype Distribution and Antibiotic Resistance Profiles in Children With Invasive Pneumococcal Disease
Claudia L Gaviria-Agudelo; Alejandro Jordan-Villegas; Carla Garcia; George H McCracken, Jr.
Journal of the Pediatric Infectious Diseases Society, Volume 6, Issue 3, 1 September 2017, Pages 253–259, https://doi.org/10.1093/jpids/piw005

LITERATURE REVIEW
Defining Pediatric Diarrhea in Low-Resource Settings
Gillian A Levine; Judd L Walson; Hannah E Atlas; Laura M Lamberti; Patricia B Pavlinac
Journal of the Pediatric Infectious Diseases Society, Volume 6, Issue 3, 1 September 2017, Pages 289–293, https://doi.org/10.1093/jpids/pix024

Journal of Public Health Policy
Volume 38, Issue 3, August 2017
https://link.springer.com/journal/41271/38/3/page/1

Review Article
Overview of influenza vaccination policy in Beijing, China: Current status and future prospects
Yi Zhang, David J Muscatello, Quanyi Wang, Peng Yang…

The Lancet
Sep 02, 2017 Volume 390 Number 10098 p913-1004
http://www.thelancet.com/journals/lancet/issue/current

Articles
Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study
Ting Shi, David A McAllister, Katherine L O’Brien, Eric A F Simoes, Shabir A Madhi, Bradford D Gessner, Fernando P Polack, Evelyn Balsells, Sozinho Acacio, Claudia Aguayo, Issifou Alassani, Asad Ali, Martin Antonio, Shally Awasthi, Juliet O Awori, Eduardo Azziz-Baumgartner, Henry C Baggett, Vicky L Baillie, Angel Balmaseda, Alfredo Barahona, Sudha Basnet, Quique Bassat, Wilma Basualdo, Godfrey Bigogo, Louis Bont, Robert F Breiman, W Abdullah Brooks, Shobha Broor, o, Rodrigo A Fasce, Daniel R Feikin, Luzhao Feng, Angela Gentile, Aubree Gordon, Doli Goswami, Sophie Goyet, Michelle Groome, Natasha Halasa, Siddhivinayak Hive, Nusrat Homaira, Stephen R C Howie, Jorge Jara, Imane Jroundi, Cissy B Kartasasmita, Najwa Khuri-Bulos, Karen L Kotloff, Anand Krishnan, Romina Libster, Olga Lopez, Marilla G Lucero, Florencia Lucion, Socorro P Lupisan, Debora N Marcone, John P McCracken, Mario Mejia, Jennifer C Moisi, Joel M Montgomery, David P Moore, Cinta Moraleda, Jocelyn Moyes, Patrick Munywoki, Kuswandewi Mutyara, Mark P Nicol, D James Nokes, Pagbajabyn Nymadawa, Maria Tereza da Costa Oliveira, Histoshi Oshitani, Nitin Pandey, Gláucia Paranhos-Baccalà, Lia N Phillips, Valentina Sanchez Picot, Mustafizur Rahman, Mala Rakoto-Andrianarivelo, Zeba A Rasmussen, Barbara A Rath, Annick Robinson, Candice Romero, Graciela Russomando, Vahid Salimi, Pongpun Sawatwong, Nienke Scheltema, Brunhilde Schweiger, J Anthony G Scott, Phil Seidenberg, Kunling Shen, Rosalyn Singleton, Viviana Sotomayor, Tor A Strand, Agustinus Sutanto, Mariam Sylla, Milagritos D Tapia, Somsak Thamthitiwat, Elizabeth D Thomas, Rafal Tokarz, Claudia Turner, Marietjie Venter, Sunthareeya Waicharoen, Jianwei Wang, Wanitda Watthanaworawit, Lay-Myint Yoshida, Hongjie Yu, Heather J Zar, Harry Campbell, Harish Nair for RSV Global Epidemiology NetworkNigel Bruce, Dana Bruden, Philippe Buchy, Stuart Campbell, Phyllis Carosone-Link, Mandeep Chadha, James Chipeta, Monidarin Chou, Wilfrido Clara, Cheryl Cohen, Elizabeth de Cuellar, Duc-Anh Dang, Budragchaagiin Dash-yandag, Maria Deloria-Knoll, Mukesh Dherani, Tekchheng Eap, Bernard E Ebruke, Marcela Echavarria, Carla Cecília de Freitas Lázaro Emediat
946
Open Access

Lancet Global Health
Sep 2017 Volume 5 Number 9 e838-e947
http://www.thelancet.com/journals/langlo/issue/current

Articles
Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries
Karin Stenberg, Odd Hanssen, Tessa Tan-Torres Edejer, Melanie Bertram, Callum Brindley, Andreia Meshreky, James E Rosen, John Stover, Paul Verboom, Rachel Sanders, Agnès Soucat
e875

The global burden of tuberculosis mortality in children: a mathematical modelling study
Peter J Dodd, Courtney M Yuen, Charalambos Sismanidis, James A Seddon, Helen E Jenkins
e898

Lancet Infectious Diseases
Sep 2017 Volume 17 Number 9 p883-1002  e280-e305
http://www.thelancet.com/journals/laninf/issue/current

Comment
The challenges of cholera at the 2017 Hajj pilgrimage
Alimuddin Zumla, Brian McCloskey, Tina Endericks, Esam I Azhar, Eskild Petersen
Published: 10 August 2017
DOI: http://dx.doi.org/10.1016/S1473-3099(17)30454-1
In September, 2017, up to 2 million pilgrims from all continents will arrive in Saudi Arabia for the annual Hajj pilgrimage.1 Living and worshipping together in crowded conditions will expose the pilgrims and the local Saudi Arabian community to a range of imported and local infections.1 Over the past 5 years the Hajj has focused attention on new and re-emerging infectious diseases with epidemic potential such as the Middle East respiratory syndrome coronavirus (MERS-CoV), Zika virus, and pan-antibiotic-resistant bacteria—global health security threats that are ongoing and under active surveillance.2 This year the explosive outbreak of cholera in Yemen,3 from where many pilgrims originate, represents a serious risk to all pilgrims during the Hajj, and has the potential for global spread after the pilgrims return to their countries of origin. As of July 21, 2017, the cholera epidemic in Yemen has affected an estimated 356 600 people and caused 1800 deaths, with 5000 new active cases reported every day.4

Cholera at the Hajj is not new.5 During the 1821 Hajj, 20,000 pilgrims died as a result of the global cholera epidemic, which started in India in 1817 and spread across the world. Another cholera epidemic during the 1865 Hajj killed 15,000 of 90,000 pilgrims, and spread worldwide, including to the USA and Europe, with 200,000 deaths.5 Dealing with infectious disease outbreaks and outbreak prevention at the Hajj has been a public health priority for Saudi Arabia because repeated endemic outbreaks of diarrhoeal diseases have occurred as a result of various pathogens prevalent in countries from which pilgrims originate. Since the 1865 outbreak, the Saudi Arabian health authorities have been well prepared to respond to an outbreak and have not had a major cholera outbreak, largely because of improvements to infrastructures for surveillance, rapid detection, and control through the Hajj Command and Control Centre.1 They have ensured hygienic living conditions for pilgrims, and easy and free access to washing facilities, purified water, and health services.1

The latest overall cholera prevalence in Yemen has been estimated at 266 per 10,000 population.6 In 2016, 19,500 Yemenis obtained a visa for the Hajj. If the attack rate is the same in a similar number of Yemeni pilgrims planning to attend the Hajj in 2017, up to roughly 582 cases of cholera can be expected. Notably, about 80% of individuals infected with Vibrio cholerae do not show symptoms and remain undetected, but are infectious. Thus, cholera poses substantial public health challenges for the 2017 Hajj. The ongoing cholera epidemic in Yemen calls for extreme caution and requires that particular attention is given to prevention, surveillance, and control measures. Advances in the development and assessment of new cholera vaccines provide hope for better control.7 The WHO Strategic Advisory Group of Experts (SAGE) on immunisation8 concluded at their meeting in April, 2017, that there is mounting evidence over the past 3 years that high coverage with oral cholera vaccine (OCV) results in a significant reduction of cholera transmission in various settings.

Three killed whole-cell OCVs have been prequalified by WHO—Dukoral (Valneva, Stockholm, Sweden), Shanchol (Shantha Biotechnics, Hyderabad, India), and Euvichol (EuBiologics, Seoul, South Korea). All three vaccines have good safety profiles and greater than 60% effectiveness against cholera disease for at least 3 years after two doses. In 2013, WHO formally established an OCV stockpile, which consists of Shanchol and Euvichol. Thus, mandating the cholera vaccine for pilgrims from Yemen, and those countries where cholera is endemic, might be prudent and requires practical and feasible recommendations.

WHO and Saudi Arabia should jointly commission a risk assessment to review the potential benefits, risks, costs, and practicalities of cholera vaccination and come up with feasible recommendations that should be operationally, clinically, financially, and politically sustainable. These recommendations should be included in the 2017 Saudi Arabian health requirements for pilgrims.9 Furthermore, WHO guidelines on measures to prevent cholera and community awareness campaigns should be put into practice and strictly implemented. Proactive health education campaigns, implemented before, during, and after the Hajj, using leaflets and social media targeting all pilgrims and local Saudi Arabia populations, are required. These campaigns should include recommendations for basic hygienic toilet practice, including hand-washing after defecation and before handling food and eating, and health-seeking behaviour for those who develop symptoms. Meanwhile, the focus on cholera must not deter the Saudi Arabian authorities from remaining vigilant with regard to other epidemic-prone gastrointestinal and respiratory tract pathogens.2
   We declare no competing interests. All authors have links with the Global Centre for Mass Gatherings Medicine.
   References at title link.

Lancet Infectious Diseases
Sep 2017 Volume 17 Number 9 p883-1002  e280-e305
http://www.thelancet.com/journals/laninf/issue/current

Articles
Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015
GBD Diarrhoeal Diseases Collaborators
909
Open Access

Impact of the introduction of pneumococcal conjugate vaccination on pneumonia in The Gambia: population-based surveillance and case-control studies
Grant A Mackenzie, Philip C Hill, Shah M Sahito, David J Jeffries, Ilias Hossain, Christian Bottomley, Uchendu Uchendu, David Ameh, Malick Ndiaye, Chidebereh D Osuorah, Oyedeji Adeyemi, Jayani Pathirana, Yekini Olatunji, Bade Abatan, Ebirim Ahameefula, Bilquees S Muhammad, Augustin E Fombah, Debasish Saha, Roslyn Mackenzie, Ian Plumb, Aliu Akano, Bernard Ebruke, Readon C Ideh, Bankole Kuti, Peter Githua, Emmanuel Olutunde, Ogochukwu Ofordile, Edward Green, Effua Usuf, Henry Badji, Usman N A Ikumapayi, Ahmad Manjang, Rasheed Salaudeen, E David Nsekpong, Sheikh Jarju, Martin Antonio, Sana Sambou, Lamin Ceesay, Yamundow Lowe-Jallow, Dawda Sowe, Momodou Jasseh, Kim Mulholland, Maria Knoll, Orin S Levine, Stephen R Howie, Richard A Adegbola, Brian M Greenwood, Tumani Corrah
965
Open Access

An update of the global burden of pertussis in children younger than 5 years: a modelling study
Karene Hoi Ting Yeung, Philippe Duclos, E Anthony S Nelson, Raymond Christiaan W Hutubessy
974

Year-round influenza immunisation during pregnancy in Nepal: a phase 4, randomised, placebo-controlled trial
Mark C Steinhoff, Joanne Katz, Janet A Englund, Subarna K Khatry, Laxman Shrestha, Jane Kuypers, Laveta Stewart, Luke C Mullany, Helen Y Chu, Steven C LeClerq, Naoko Kozuki, Monica McNeal, Adriana M Reedy, James M Tielsch
981

Review
Insights from clinical research completed during the west Africa Ebola virus disease epidemic
Amanda Rojek, Peter Horby, Jake Dunning
e280

Lancet Respiratory Medicine
Sep 2017 Volume 5 Number 9 p667-760  e29
http://www.thelancet.com/journals/lanres/issue/current

Articles
Comparative effectiveness of high-dose versus standard-dose influenza vaccination on numbers of US nursing home residents admitted to hospital: a cluster-randomised trial
Stefan Gravenstein, H Edward Davidson, Monica Taljaard, Jessica Ogarek, Pedro Gozalo, Lisa Han, Vincent Mor

Maternal and Child Health Journal
Volume 21, Issue 9, September 2017
https://link.springer.com/journal/10995/21/8/page/1
Special Issue on Long Acting Reversible Contraception (LARC) in the Global Context

OriginalPaper
Evaluating a LARC Expansion Program in 14 Sub-Saharan African Countries: A Service Delivery Model for Meeting FP2020 Goals
Thoai D. Ngo, Olivia Nuccio, Shreya K. Pereira…

Nature 
Volume 548 Number 7669 pp499-618   31 August 2017
http://www.nature.com/nature/current_issue.html

Articles
Identification of essential genes for cancer immunotherapy
Shashank J. Patel, Neville E. Sanjana, Rigel J. Kishton, Arash Eidizadeh, Suman K. Vodnala+ et al.
The authors describe a two-cell-type CRISPR screen to identify tumour-intrinsic genes that regulate the sensitivity of cancer cells to effector T cell function.

Pediatrics
September 2017, VOLUME 140 / ISSUE 3
http://pediatrics.aappublications.org/content/140/3?current-issue=y

Articles
Epidemiology of Acute Otitis Media in the Postpneumococcal Conjugate Vaccine Era
Ravinder Kaur, Matthew Morris, Michael E. Pichichero
Pediatrics Sep 2017, 140 (3) e20170181; DOI: 10.1542/peds.2017-0181
In this 10-year prospective study, we capture the epidemiology and risk factors of AOM and the otitis-prone condition in the PCV era.

Vaccine Education During Pregnancy and Timeliness of Infant Immunization
Priya Veerasingam, Cameron C. Grant, Carol Chelimo, Kathryn Philipson, Catherine A. Gilchrist, Sarah Berry, Polly Atatoa Carr, Carlos A. Camargo, Susan Morton
Pediatrics Sep 2017, 140 (3) e20163727; DOI: 10.1542/peds.2016-3727
We identify pregnant women’s sources of immunization information and determine the associations of receiving encouraging or discouraging information with their infants’ immunization timeliness.

Vaccine-Preventable Diseases Requiring Hospitalization
Gregory Williamson, Bilaal Ahmed, Parvathi S. Kumar, Barbara E. Ostrov, Jessica E. Ericson
Pediatrics Sep 2017, 140 (3) e20170298; DOI: 10.1542/peds.2017-0298
Through a retrospective chart review, this study determined the incidence of VPDs in central-Pennsylvania Amish, Mennonite, and non-Plain children requiring hospitalization.
Open Access

Commentaries
Vaccines and Outpatient Antibiotic Stewardship
Adam L. Hersh, Katherine E. Fleming-Dutra
Pediatrics Sep 2017, 140 (3) e20171695; DOI: 10.1542/peds.2017-1695

Adverse Events Following Immunization: Will It Happen Again?
Sean T. O’Leary, Yvonne A. Maldonado
Pediatrics Sep 2017, 140 (3) e20171760; DOI: 10.1542/peds.2017-1760

Review Articles
Open Access
Risk of Recurrence of Adverse Events Following Immunization: A Systematic Review
Joseline Guetsop Zafack, Gaston De Serres, Marilou Kiely, Marie-Claude Gariépy, Isabelle Rouleau, Karina Anne-Marie Top, for the Canadian Immunization Research Network
Pediatrics Sep 2017, 140 (3) e20163707; DOI: 10.1542/peds.2016-3707
This systematic review presents the risk of recurrence of AEFIs in patients who receive subsequent doses of vaccine.

Special Article
Methodological and Ethical Issues in Pediatric Medication Safety Research
Delesha Carpenter, Daniel Gonzalez, George Retsch-Bogart, Betsy Sleath, Benjamin Wilfond
Pediatrics Sep 2017, 140 (3) e20170195; DOI: 10.1542/peds.2017-0195
This executive summary describes current challenges to conducting pediatric medication safety research and highlights state-of-the-art methodologies to overcome these challenges.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 2 September 2017)

Policy Platform
The francophone network on neglected tropical diseases
Jean Jannin, Philippe Solano, Isadora Quick, Patrice Debre
| published 31 Aug 2017 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0005738
[Excerpt]
…Launching and organization of the network
The Réseau Francophone sur les Maladies Tropicales Négligées (RFMTN) was officially launched on 8 April 2016 in Montpellier. This network, established under the auspices of the alliance for health and life sciences (AVIESAN), promotes collaboration between French research institutions and gathers research institutions, researchers, medical doctors, NGOs (having operational projects in the field of NTDs), the pharmaceutical industry, foundations, and DEC stakeholders. Its goal is to fill gaps on NTDs thanks to a reinforced contribution of France and to focus on elimination of NTDs. The network seeks to federate French and francophone institutions and individuals working on NTDs and to strengthen relations between NTDs stakeholders. It promotes interinstitutional collaborations on translational research, training, and implementation of elimination projects and aims at raising awareness of NTDs. Finally, it also envisions bridging with other existing European and African NTD networks.
The network, based on individual membership, is also open to associations and scientific societies. It is run by a secretariat hosted by Aviesan and is supported by a scientific and strategic committee comprising the member institutions, DEC stakeholders, industry, and NGOs.
The RFMTN has decided to focus on the “elimination of NTDs,” addressing some key questions:
How do we define ad hoc and implement control activities in order to sustain the targets of the Roadmap?
In the context of very low prevalence prevailing when approaching or reaching elimination targets, what can be done to offer a new spectrum of research to scientists in order to develop adequate tools (diagnostics, treatments, vaccines, vector-control tools) adapted to this context? How can industries and national governments be convinced to stay on board and maintain their efforts? How can we avoid the “punishment of success” by convincing donors to continue providing funding when prevalence of diseases is becoming very low?…

PLoS One
http://www.plosone.org/
[Accessed 2 September 2017]

Research Article
Stakeholder perceptions of communication about vaccination in two regions of Cameroon: A qualitative case study
Heather Ames, Diangha Mabel Njang, Claire Glenton, Atle Fretheim, Jessica Kaufman, Sophie Hill, Afiong Oku, Julie Cliff, Yuri Cartier, Xavier Bosch-Capblanch, Gabriel Rada, Artur Manuel Muloliwa, Angela Oyo-Ita, Awah Paschal Kum, Simon Lewin
Research Article | published 31 Aug 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0183721

Equalizing access to pandemic influenza vaccines through optimal allocation to public health distribution points
Hsin-Chan Huang, Bismark Singh, David P. Morton, Gregory P. Johnson, Bruce Clements, Lauren Ancel Meyers
Research Article | published 30 Aug 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0182720

Science         
01 September 2017  Vol 357, Issue 6354
http://www.sciencemag.org/current.dtl

Policy Forum
Influence, integrity, and the FDA: An ethical framework
By Spencer Phillips Hey, I. Glenn Cohen, Eli Y. Adashi, Aaron S. Kesselheim
Science01 Sep 2017 : 876-877 Restricted Access
Summary
Among the core missions of the U.S. Food and Drug Administration (FDA) are protecting public health by assuring the safety and efficacy of drugs, biologics, and medical devices and advancing public health by promoting scientific research and medical innovation (1). According to its mandate, the decisions made by the FDA in fulfilling these missions should be guided by scientific considerations, not economic or political ones. However, several recent, high-profile episodes have highlighted the fact that the FDA is buffeted by many external influences (2, 3). Such controversies require us to distinguish between legitimate influences that would improve the FDA or enhance its regulatory mission, illegitimate influences that seek to corrupt or undermine the agency, and influences that may be legitimate but nevertheless harm public health or patient outcomes. We present a decision framework to assist regulators, policy-makers, judges, physicians, and the public in evaluating the legitimacy and value of external influences on the FDA.

Science Translational Medicine
30 August 2017  Vol 9, Issue 405
http://stm.sciencemag.org/

Focus
Subcutaneous drug delivery: An evolving enterprise
By Graham B. Jones, David S. Collins, Michael W. Harrison, Nagarajan R. Thyagarajapuram, Justin M. Wright
Science Translational Medicine30 Aug 2017 Restricted Access
Recent advances in subcutaneous drug delivery and device design are transforming the biopharmaceutical sector and improving patient care.

Research Articles
Increased adaptive immune responses and proper feedback regulation protect against clinical dengue
By Etienne Simon-Lorière, Veasna Duong, Ahmed Tawfik, Sivlin Ung, Sowath Ly, Isabelle Casadémont, Matthieu Prot, Noémie Courtejoie, Kevin Bleakley, Philippe Buchy, Arnaud Tarantola, Philippe Dussart, Tineke Cantaert, Anavaj Sakuntabhai
Science Translational Medicine30 Aug 2017 Full Access
Increased activation of adaptive immunity and proper feedback mechanisms can eliminate dengue viral infection without clinical symptoms.

Vaccine
Volume 35, Issue 37, Pages 4825-5080 (5 September 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/37?sdc=1

Short Communications
Utilization and impact of European immunization week to increase measles, mumps, rubella vaccine uptake in Austria in 2016
Pages 4836-4839
Kreidl, Catharina de Kat, EIW Tyrol-Study Group
Abstract
This paper describes engagement in European Immunization Week (EIW) in Tyrol, Austria in April 2016 and an assessment of its possible impact on demand for measles, mumps, rubella vaccination (MMR).
It further describes the output of a knowledge, attitudes and practice (KAP) survey conducted during EIW, showing that 93% (188/202) of respondents were in favor of vaccination in general and 90% (192/214) perceived MMR vaccination to be important. MMR vaccination was perceived as important by more participants than other vaccinations.
The number of MMR doses administered by public health services in the province of Tyrol during EIW was greater than in the previous week, and EIW activities thus potentially resulted in increased MMR vaccine uptake in Tyrol during the observed period. The annual EIW campaign provides important opportunities to address vaccine hesitancy by raising awareness about immunization, to identify barriers to immunization and test possible solutions.

Vaccine
Volume 35, Issue 37, Pages 4825-5080 (5 September 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/37?sdc=1

Reviews
The benefit of the doubt or doubts over benefits? A systematic literature review of perceived risks of vaccines in European populations
Review Article
Pages 4840-4850
Emilie Karafillakis, Heidi J. Larson, On behalf of the ADVANCE consortium
Abstract
Objectives
The success of vaccination strategies depends in part on population perceptions of benefits and risks of vaccines and related confidence in vaccination. Better knowledge of public concerns about vaccines and what is driving them is needed to inform vaccination strategies and communications. This literature reviewer examined studies on vaccine and vaccination risk perceptions and concerns across European populations.
Methods
A systematic literature review was conducted to identify studies published between 2004 and 2014 in Europe. A descriptive analysis was performed.
Findings
A total of 145 articles were selected, most of which were conducted in the UK, the Netherlands and France and studied seasonal influenza, HPV and pandemic influenza vaccination. Across all countries and vaccines, the primary area of concern was vaccine safety, followed by perceptions of low likelihood of contracting vaccine-preventable diseases (VPDs), perceived low severity of VPDs, beliefs that vaccines do not work, and overall lack of information. Concerns were found to be vaccine-, country- and population-specific.
Conclusion
In addition to identifying concerns about vaccination in Europe, this study confirmed the notion that individuals have many safety concerns about vaccination and often believe that the risks of vaccination outweigh their benefits. More research needs to be conducted to explore the impact of different types of communication strategies, which would frame the benefits of vaccination as well as risks of not vaccinating. Strategies to better inform public perceptions of vaccines should include the provision of unbiased, comprehensive information tailored to population information needs, and delivered using multiple and new communication technologies such as social media.

Vaccine
Volume 35, Issue 37, Pages 4825-5080 (5 September 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/37?sdc=1

Original Research Articles
Acceptability of microneedle-patch vaccines: A qualitative analysis of the opinions of parents
Pages 4896-4904
Marshall, A. Fleming, A.C. Moore, L.J. Sahm
Abstract
Introduction
Vaccines incorporated into microneedle-based patch platforms offer advantages over conventional hypodermic injections. However, the success and clinical utility of these platforms will depend on its acceptance among stakeholders. Minimal focus has been placed on determining parents’ acceptability of microneedle-patch vaccines intended for paediatric use. This qualitative study probes the perceived acceptability of microneedle technology for paediatric vaccination in a parent population.
Research design and methodology
Focus groups (n=6) were convened through purposive sampling of Cork city primary schools. Discussions were audio-recorded, transcribed verbatim, anonymised, independently verified and analysed by thematic analysis, with constant comparison method applied throughout.
Results
The opinions of 32 parents were included. All participants declared that their children were fully vaccinated. Five core themes were identified and defined as: (i) concern, (ii) suitability for paediatric use, (iii) potential for parental administration, (iv) the role of the healthcare professional and (v) special populations. Drivers for acceptance include; concerns with current vaccines and vaccination programmes; attributes of microneedle-patch (reduced pain, bleeding, fear and increased convenience) and endorsement by a healthcare professional. Barriers to acceptance include; lack of familiarity, concerns regarding feasibility and suitability in paediatrics, allergic potential, inability to confirm delivery and potential reduction in vaccine coverage.
Conclusion
This is the first study to explore parental acceptance of microneedle-patch vaccines. Capturing the opinions of parents, the ultimate decision makers in paediatric vaccination, is crucial in the understanding of the eventual uptake of microneedle technology and therefore adds to literature currently available. This study has revealed that even “vaccine-acceptors”; parents who agree with, or do not question vaccination, will question the safety and efficacy of this novel method. Participants in this study remained tentative. However, the study has also revealed that endorsement by healthcare professionals could reduce this tentativeness, thereby identifying the role of healthcare professionals in disseminating information and providing support to parents. An increased awareness of developments in microneedle technology is needed to permit informed decision-making by parents.

Vaccine
Volume 35, Issue 37, Pages 4825-5080 (5 September 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/37?sdc=1

Cost-benefit analyses of supplementary measles immunisation in the highly immunized population of New Zealand
Original Research Article
Pages 4913-4922
D.T.S. Hayman, J.C. Marshall, N.P. French, T.E. Carpenter, M.G. Roberts, T. Kiedrzynski
Abstract
As endemic measles is eliminated from countries through increased immunisation, the economic benefits of enhanced immunisation programs may come into question. New Zealand has suffered from outbreaks after measles introductions from abroad and we use it as a model system to understand the benefits of catch up immunisation in highly immunised populations. We provide cost-benefit analyses for measles supplementary immunisation in New Zealand. We model outbreaks based on estimates of the basic reproduction number in the vaccinated population (Rv, the number of secondary infections in a partially immunised population), based on the number of immunologically-naïve people at district and national levels, considering both pre- and post-catch up vaccination scenarios. Our analyses suggest that measles Rv often includes or exceeds one (0.18–3.92) despite high levels of population immunity. We calculate the cost of the first 187 confirmed and probable measles cases in 2014 to be over NZ$1 million (∼US$864,200) due to earnings lost, case management and hospitalization costs. The benefit-cost ratio analyses suggest additional vaccination beyond routine childhood immunisation is economically efficient. Supplemental vaccination-related costs are required to exceed approximately US$66 to US$1877 per person, depending on different scenarios, before supplemental vaccination is economically inefficient. Thus, our analysis suggests additional immunisation beyond childhood programs to target naïve individuals is economically beneficial even when childhood immunisation rates are high.

Vaccine
Volume 35, Issue 37, Pages 4825-5080 (5 September 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/37?sdc=1

Targeted human papillomavirus vaccination for young men who have sex with men in Australia yields significant population benefits and is cost-effective
Original Research Article
Pages 4923-4929
Lei Zhang, David G. Regan, Jason J. Ong, Manoj Gambhir, Eric P.F. Chow, Huachun Zou, Matthew Law, Jane Hocking, Christopher K. Fairley
Abstract
Background
We investigated the effectiveness and cost-effectiveness of a targeted human papillomavirus (HPV) vaccination program for young (15–26) men who have sex with men (MSM).
Methods
We developed a compartmental model to project HPV epidemic trajectories in MSM for three vaccination scenarios: a boys program, a targeted program for young MSM only and the combination of the two over 2017–2036. We assessed the gain in quality-adjusted-life-years (QALY) in 190,000 Australian MSM.
Results
A targeted program for young MSM only that achieved 20% coverage per year, without a boys program, will prevent 49,283 (31,253–71,500) cases of anogenital warts, 191 (88–319) person-years living with anal cancer through 2017–2036 but will only stablise anal cancer incidence. In contrast, a boys program will prevent 82,056 (52,100–117,164) cases of anogenital warts, 447 (204–725) person-years living with anal cancers through 2017–2036 and see major declines in anal cancer. This can reduce 90% low- and high-risk HPV in young MSM by 2024 and 2032, respectively, but will require vaccinating ≥84% of boys. Adding a targeted program for young MSM to an existing boys program would prevent an additional 14,912 (8479–21,803) anogenital wart and 91 (42–152) person-years living with anal cancer. In combination with a boys’ program, a catch-up program for young MSM will cost an additional $AUD 6788 ($4628–11,989) per QALY gained, but delaying its implementation reduced its cost-effectiveness.
Conclusions
A boys program that achieved coverage of about 84% will result in a 90% reduction in HPV. A targeted program for young MSM is cost-effective if timely implemented.

Vaccine
Volume 35, Issue 37, Pages 4825-5080 (5 September 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/37?sdc=1

Implementation of HPV vaccination guidelines in a diverse population in Los Angeles: Results from an environmental scan of local HPV resources and needs
Original Research Article
Pages 4930-4935
Lourdes Baezconde-Garbanati, Brianna A. Lienemann, Marisela Robles, Ethel Johnson, Kathleen Sanchez, Rita Singhal, Jane Steinberg, Jenny M. Jaque, Mary Ann Pentz, Stephen Gruber
Abstract
Research shows that vaccination against human papillomavirus (HPV) infection is one of the most effective methods for reducing risk for cervical cancer; it also protects against other HPV-related cancers. Controversies exist regarding HPV vaccination in several communities; which may in part explain why although rates of HPV vaccination are increasing nationwide, Los Angeles County (LAC) data show that many adolescents are still not vaccinated. These adolescents remain at high-risk for infection. Using community-based participatory principles, we conducted an environmental scan that included a literature review, the development of a community advisory board, community feedback from HPV community meetings, and interviews with stakeholders to understand attitudes toward HPV vaccination and their impact in follow through with HPV vaccines. Twenty-eight key stakeholders participated in our coalition comprised of community organizations and clinics with strong ties to the local community. This is the only coalition dedicated exclusively to improving HPV vaccine uptake in LAC. Of these, twenty-one participated in an environmental scan via qualitative interviews about HPV vaccination programs, service delivery priorities, and proposed steps to increase HPV vaccination uptake in LAC. The environmental scan revealed targets for future efforts, barriers to HPV uptake, and next steps for improving local HPV vaccination uptake rates. The environmental scan also identified local HPV vaccination interventions and resources. Although LAC has developed important efforts for vaccination, some interventions are no longer being implemented due to lack of funds; others have not been evaluated with sufficient outcome data. The risk for cervical and other HPV-related cancers could be greatly reduced in LAC if a multilevel, multicultural, and multilingual approach is taken to better understand rates of HPV vaccination uptake, particularly among racial/ethnic minorities and LGBTQ youth. Our environmental scan provides guidance on attitudes toward vaccination, and how best to address the needs of LAC families and providers.

Vaccine
Volume 35, Issue 37, Pages 4825-5080 (5 September 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/37?sdc=1

Benevolent personification of the MoH increases compliance with an emergency polio vaccination
Original Research Article
Pages 5006-5010
Golan Shahar, Gal Noyman-Veksler, Shai Itamar, David Greenberg, Itamar Grotto
Abstract
Objective
Parental compliance is crucial to the success of mass vaccination campaigns targeting children. Relying on psychological/neuroscientific research concerning the role of personification (i.e., viewing the inanimate as human) in behavior, the authors examined the effect of parents’ personification of the Israeli Ministry of Health (MoH) on compliance with a publicly controversial mass vaccination campaign, which was aimed at stopping the spread of a wild poliovirus.
Methods
Participants were 555 parents of children aged 9 or younger, residing in the center/north of Israel, an area covered by Phase 2 of the campaign. T1 assessment, employed two days prior to Phase 2, tapped into demographics, attitudes towards vaccination, intent to comply, and a benevolent personification of the MoH (i.e., “The MoH is caring”) vs. a malevolent personification of the MoH (“The MoH is hysteric”). T2 assessment, transpiring four months after the end of the campaign, addressed presence and reasons for (non-)compliance.
Results
The study’s overall compliance rate was 61.8%. The principal reason for compliance was “adherence to the recommendations of the MoH” (68.49%). In a multivariate logistic regression analysis, prospective predictors of compliance were: an early intent to comply (O.R. = 2.56, p = 0.000), being male (O. R. = 1.51, p = 0.023), and a benevolent personification of the MoH (O.R. = 1.21, p = 0.019).
Conclusion
Parents who experienced the Israeli MoH as a benevolent protagonist were more likely to comply with the mass vaccination campaign. Findings highlight the role of leadership in public health campaigns during emergencies.

Vaccine
Volume 35, Issue 37, Pages 4825-5080 (5 September 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/37?sdc=1

FDA licensure of and ACIP recommendations for vaccines
Original Research Article
Pages 5027-5036
Larry K. Pickering, Walter A Orenstein, Wellington Sun, Carol J. Baker
Abstract
Many healthcare providers are not familiar with the Food and Drug Administration (FDA) vaccine licensure process, the Advisory Committee on Immunization Practices (ACIP) vaccine recommendation process, and how FDA vaccine licensure and ACIP recommendations are related. Vaccines for use in the United States military and civilian populations are licensed by the FDA by several potential pathways but use of licensed vaccines in the civilian population should be based on recommendations made by the ACIP. In performing these distinct activities, FDA and ACIP function under different mandates. In this article, we discuss whether the FDA licensure pathways used to approve a vaccine impacts ACIP recommendation categories for vaccines licensed from 2006 to 2016.

Vaccine
Volume 35, Issue 37, Pages 4825-5080 (5 September 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/37?sdc=1

Feasibility of using global system for mobile communication (GSM)-based tracking for vaccinators to improve oral poliomyelitis vaccine campaign coverage in rural Pakistan
Original Research Article
Pages 5037-5042
Subhash Chandir, Vijay Kumar Dharma, Danya Arif Siddiqi, Aamir Javed Khan
Abstract
Despite multiple rounds of immunization campaigns, it has not been possible to achieve optimum immunization coverage for poliovirus in Pakistan. Supplementary activities to improve coverage of immunization, such as door-to-door campaigns are constrained by several factors including inaccurate hand-drawn maps and a lack of means to objectively monitor field teams in real time, resulting in suboptimal vaccine coverage during campaigns. Global System for Mobile Communications (GSM) – based tracking of mobile subscriber identity modules (SIMs) of vaccinators provides a low-cost solution to identify missed areas and ensure effective immunization coverage. We conducted a pilot study to investigate the feasibility of using GSM technology to track vaccinators through observing indicators including acceptability, ease of implementation, costs and scalability as well as the likelihood of ownership by District Health Officials. The real-time location of the field teams was displayed on a GSM tracking web dashboard accessible by supervisors and managers for effective monitoring of workforce attendance including ‘time in-time out’, and discerning if all target areas – specifically remote and high-risk locations – had been reached. Direct access to this information by supervisors eliminated the possibility of data fudging and inaccurate reporting by workers regarding their mobility. The tracking cost per vaccinator was USD 0.26/month. Our study shows that GSM-based tracking is potentially a cost-efficient approach, results in better monitoring and accountability, is scalable and provides the potential for improved geographic coverage of health services.

Vaccines — Open Access Journal
http://www.mdpi.com/journal/vaccines
(Accessed 2 September 2017)

Review
A Review of the Safety and Efficacy of Vaccines as Prophylaxis for Clostridium difficile Infections
by Mackenzie Henderson, Amanda Bragg, Germin Fahim, Monica Shah and Evelyn R. Hermes-DeSantis
Vaccines 2017, 5(3), 25; doi:10.3390/vaccines5030025 (registering DOI) – 2 September 2017
Abstract
This review aims to evaluate the literature on the safety and efficacy of novel toxoid vaccines for the prophylaxis of Clostridium difficile infections (CDI) in healthy adults. Literature searches for clinical trials were performed through MEDLINE, ClinicalTrials.gov, and Web of Science using the keywords bacterial vaccines, Clostridium difficile, and vaccine. English-language clinical trials evaluating the efficacy and/or safety of Clostridium difficile toxoid vaccines that were completed and had results posted on ClinicalTrials.gov or in a published journal article were included. Six clinical trials were included. The vaccines were associated with mild self-reported adverse reactions, most commonly injection site reactions and flu-like symptoms, and minimal serious adverse events. Five clinical trials found marked increases in antibody production in vaccinated participants following each dose of the vaccine. Clinical trials evaluating C. difficile toxoid vaccines have shown them to be well tolerated and relatively safe. Surrogate markers of efficacy (seroconversion and geometric mean antibody levels) have shown significant immune responses to a vaccination series in healthy adults, indicating that they have the potential to be used as prophylaxis for CDI. However, more research is needed to determine the clinical benefits of the vaccines.

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

International Journal of Epidemiology
Published: 31 August 2017
The duration of protection of school-aged BCG vaccination in England: a population -based case–control study
Punam Mangtani Patrick Nguipdop-Djomo Ruth H Keogh Jonathan AC Sterne Ibrahim Abubakar Peter G Smith Paul EM Fine Emilia Vynnycky John M Watson David Elliman … Show more
, dyx141, https://doi.org/10.1093/ije/dyx141
Abstract
Background: Evidence of protection from childhood Bacillus Calmette-Guerin (BCG) against tuberculosis (TB) in adulthood, when most transmission occurs, is important for TB control and resource allocation.
Methods: We conducted a population-based case–control study of protection by BCG given to children aged 12–13 years against tuberculosis occurring 10–29 years later. We recruited UK-born White subjects with tuberculosis and randomly sampled White community controls. Hazard ratios and 95% confidence intervals (CIs) were estimated using case–cohort Cox regression, adjusting for potential confounding factors, including socio-economic status, smoking, drug use, prison and homelessness. Vaccine effectiveness (VE = 1 – hazard ratio) was assessed at successive intervals more than 10 years following vaccination.
Results: We obtained 677 cases and 1170 controls after a 65% response rate in both groups. Confounding by deprivation, education and lifestyle factors was slight 10–20 years after vaccination, and more evident after 20 years. VE 10–15 years after vaccination was 51% (95% CI 21, 69%) and 57% (CI 33, 72%) at 15–20 years. Subsequently, BCG protection appeared to wane; 20–25 years VE = 25% (CI –14%, 51%) and 25–29 years VE = 1% (CI –84%, 47%). Based on multiple imputation of missing data (in 17% subjects), VE estimated in the same intervals after vaccination were similar [56% (CI 33, 72%), 57% (CI 36, 71%), 25% (–10, 48%), 21% (–39, 55%)].
Conclusions: School-aged BCG vaccination offered moderate protection against tuberculosis for at least 20 years, which is longer than previously thought. This has implications for assessing the cost-effectiveness of BCG vaccination and when evaluating new TB vaccines.
 

PLOS ONE
Published: August 25, 2017
Religion and HPV vaccine-related awareness, knowledge, and receipt among insured women aged 18-26 in Utah
J Bodson, A Wilson, EL Warner, D Kepka –
https://doi.org/10.1371/journal.pone.0183725
Abstract
Introduction
We investigate the associations between religious practice and human papillomavirus (HPV) vaccine-related awareness, knowledge, and receipt among young women in Utah.
Methods
We surveyed 326 insured women aged 18–26 by mail. Fisher’s Exact Tests and multivariable logistic regression models were used to evaluate the relations between religious practice and HPV vaccine-related outcomes. Data collection occurred January-December 2013; analyses were conducted June-September 2015.
Results
Multivariable analyses reveal that when controlling for age, educational attainment, and marital status, participants who practiced an organized religion were significantly less likely to have heard of HPV (aOR=0.25, p=0.0123), to have heard of the HPV vaccine (aOR=0.41, p=0.0368), to know how HPV is spread (aOR=0.45, p=0.0074), to have received a provider recommendation for the HPV vaccine (aOR=0.36, p=0.0332), and to have received at least one (aOR=0.50, p=0.0073) or all three (aOR=0.47, p=0.0026) doses of the HPV vaccine. Bivariate analyses produce parallel results.
Conclusions
Results indicate that religious young women in Utah are not only under-vaccinated, but are also under-informed about HPV and the HPV vaccine. These results suggest that suboptimal vaccine coverage among religious young women may present a serious health risk for the community. Strategies for educational interventions targeted to this population are discussed.

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 2 September 2017
A Serious Reaction After Vaccination Rarely Occurs Again With Later Immunization, Study Finds
Tara Haelle, Contributor
Aug 28, 2017
Very few serious adverse events after a vaccination occur with another vaccination, a new study finds.

New Yorker
http://www.newyorker.com/
Accessed 2 September 2017
Annals of Medicine
August 22, 2016 Issue
The Race for a Zika Vaccine
In the throes of an epidemic, researchers investigate how to inoculate against the disease.
By Siddhartha Mukherjee

New York Times
http://www.nytimes.com/
Accessed 2 September 2017
Court Dismisses Remaining Lawsuit Against U.N. on Haiti Cholera
24 August 2017
The last remaining class-action lawsuit against the United Nations over the cholera epidemic in Haiti was thrown out Thursday by a federal judge, who upheld the organization’s assertion of diplomatic immunity.
In an order filed in Federal District Court in Brooklyn, Judge Sandra L. Townes said the lawsuit, which accused the United Nations of responsibility because the cholera was introduced into Haiti by infected United Nations peacekeepers from Nepal seven years ago, had been dismissed for “lack of subject-matter jurisdiction.”…

Washington Post
http://www.washingtonpost.com/
Accessed 2 September 2017
FDA cracks down on stem-cell clinics, including one using smallpox vaccine in cancer patients
28 August 2017
The Food and Drug Administration on Monday announced a crackdown on stem-cell clinics offering on “unapproved and potentially dangerous” treatments, including an outfit in California that has been using the smallpox vaccine on seriously ill cancer patients.
U.S. marshals on Friday raided San Diego-based StemImmune Inc. and seized the vaccine, which the FDA said had been combined with stem cells derived from fat to create an unapproved product. The concoction was injected intravenously and directly into patients’ tumors at the California Stem Cell Treatment Centers in Rancho Mirage and Beverly Hills, the agency said.
FDA Commissioner Scott Gottlieb, in a statement on the case, said the agency “will not allow deceitful actors to take advantage of vulnerable patients by purporting to have treatments or cures for serious diseases without any proof that they actually work.”…
In the California case, the FDA said it had “serious concerns” about how StemImmune obtained the smallpox vaccine, which is not commercially available. The vaccine typically is reserved for people at high risk for smallpox, such as members of the military.
The vaccine is made from a live virus called vaccinia, which is a poxvirus that is similar to smallpox but less harmful. The vaccine can’t cause smallpox, but for people with compromised immune systems — as is the case with many cancer patients — exposure can result in life-threatening medical problems, including myocarditis, which is an inflammation of the heart muscle.
StemImmune obtained at least some of the vaccine from the Centers for Disease Control and Prevention, which controls the civilian supply. Thomas Skinner, a CDC spokesman said that the company had requested the vaccine to inoculate researchers who were doing cancer research involving the vaccinia virus.
In recent years, the vaccine, which was used to stamp out smallpox, has increasingly been tested as an anti-cancer tool, including as a way to prompt the immune system to attack malignancies…

Think Tanks et al

Center for Global Development  
http://www.cgdev.org/page/press-center
Accessed 2 September 2017
Research in the Time of Ebola: How We Can Do Better
Blog Post
8/29/17
Mead Over and Roxanne Oroxom
The 2014-2015 Ebola outbreak in West Africa was a disturbing demonstration of the inadequacy of international institutions to assist the affected peoples or learn how to better treat and prevent their illness. Experts on a CGD panel discussed their experiences working on crisis response during the Ebola outbreak—and how we can do better.

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_26 August 2017

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

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

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

Milestones :: Perspectives
 
Editor’s Note
We generally reserve this section of our digest for major strategic announcements and significant milestones in the vaccines/immunization space. We share below the text from a WHO recognition that represents, in our view, such a milestone.

“WHO would like to express its thanks and appreciation for the contribution and leadership for the advancement of global health by Dr. Philippe Duclos, Secretary to the Strategic Advisory Group of Experts (SAGE) on Immunization 2005 – 2017”

We understand that WHO held a celebratory event this past Friday to recognize the retirement and final service day of Dr. Philippe Duclos, Executive Secretary to SAGE for many years as indicated. For those who may have served in roles leading and facilitating the development and implementation of global normative standards (in health or any human endeavor) it is clear that it requires an extraordinary mix of technical competence, political skill, and other sensibilities rarely found together.

Phil Duclos evidenced these attributes splendidly and navigated the changing ecology of SAGE with aplomb. His leadership was critical to the many achievements of SAGE during his tenure.

For our part, CVEP found Phil to be ever patient, ever engaged, and ever open to us and the CSO community, which has been a growing part of that SAGE ecology.

We wish him a splendid next adventure, wherever that may take him.

Emergencies

POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 23 August 2017 [GPEI]
:: Read the latest polio updates from WHO Pakistan and from WHO Afghanistan to see information on cases, surveillance and vaccination campaigns.
:: The remarkable impact of frontline workers:  read about Khalida, a frontline health worker in Karachi, Pakistan, and her incredible efforts to forge a path to trust in vaccines.
:: Summary of newly-reported viruses this week:  No new viruses reported this week.

::::::
 
Situation reports on the polio outbreak in Syria
Situation update 22 August 2017
:: No new cases of cVDPV2 were reported this week. The total number of cVDPV2 cases remains 33. All confirmed cases to date have had onset of paralysis before 11 July 2017.
:: Final lab results are pending for an additional 11 poliovirus type-2 (PV2) isolates (7 from Mayadeen and 3 from Boukamal districts, Deir Ez-Zor governorate, and 1 from Thawra district, Raqqa governorate).
:: Raqqa governorate concluded its first immunization round on 17 August. According to administrative data, 103,720 children were vaccinated, representing 86% campaign coverage. Additional coverage data from independent third party monitoring is being evaluated.
:: The second immunization round in Deir Ez-Zor governorate is expected to start this week. The second immunization round for Raqqa is being planned for after Eid.
:: Under International Health Regulations (2005) (IHR), WHO’s Emergency Committee has issued temporary recommendations for Syria as a ‘state infected with cVDPV2 with potential risk of international spread’.
:: The total number of AFP cases detected in Deir Ez-Zor governorate since the beginning of 2017 is 118 (87 from Mayadeen, 11 from Deir Ez-Zor, and 20 from Boukamal districts).
Raqqa governorate has reported 16 AFP cases (5 from Raqqa, 10 from Tell Abyad, and 1 from Thawra districts).
:: Homs governorate has reported 27 AFP cases (12 from Homs city, 12 from Rastan, 1 from Tadmour and 2 from Talkalakh districts).
 
::::::

WHO Grade 3 Emergencies  [to 26 August 2017]
Iraq  
:: Health services for people fleeing the crisis in Iraq
21 August 2017 – As hundreds of people flee the crisis in Telafar, a city west of Mosul, Iraq, WHO and health partners in collaboration with the health authority have established static and mobile medical clinics to offer 24/7 lifesaving emergency and primary health care services to meet the urgent needs of people fleeing the crisis.
 
The Syrian Arab Republic –
:: Situation reports on the polio outbreak in Syria  22 August 2017
 [See Polio above for more detail]

::::::

UNOG – REGULAR PRESS BRIEFING BY THE INFORMATION SERVICE
25 August 2017
[Excerpt]
Syria immunization programmes
Christian Lindmeier, for the World Health Organization, said that routine immunization programmes restarted in North-West Syria, starting in the spring of 2017 with technical support and guidance from WHO.
As of August 2017, more than 35 centres in the areas of Idlib and Hama offered vaccinations against tuberculosis, measles, rubella, mumps, polio, hepatitis B, diphtheria, tetanus, whooping cough and a special influenza type.
During the years of the crisis, basic vaccines were not always available and clinics and hospitals in some areas could not offer immunization or were even destroyed. During the crisis, WHO’s field office in Gaziantep, Turkey, had worked with UNICEF to do short term vaccination campaigns that lasted several weeks, with vaccination teams fanning out to reach children in remote areas of Northern Syria.
However on-going outbreaks in Syria indicated low vaccine coverage and WHO had worked with local NGOs and local clinics to re-establish centres. In July 2017 alone, thanks to the immunization work at these centres, more than 20,000 children the North-East area were vaccinated with the pentavalent vaccine which protects against hepatitis B, diphtheria, tetanus, whooping cough and the Haemophilus influenza type B.
WHO partners planned to re-establish routine vaccination programmes in dozens more centres in North West by the end of 2017.
Answering questions, Mr. Lindmeier explained that records of immunization had been lost in many cases, with people being displaced; it was very difficult to obtain figures on the number of children who might have died or been sick as a result of low immunization. He also said that, before the war, the level of immunization had been above 95%, but that it was difficult to ascertain the level today.  Ongoing outbreaks of polio and measles were indicators that the vaccination level was too low in Syria.
Answering another question, Mr. Lindmeier said that WHO provided supplies to partners on the ground such as NGOs as well as hospitals or health centres, which in turn negotiated with authorities which, in the areas concerned, would be opposition groups.
On immunization, Christophe Boulierac, for the United Nations Children’s Fund (UNICEF), added that the second round of polio vaccination in Deir ez-Zor had started on 22 August.  On that first day, 14% of the total target had already been reached.

::::::
::::::
 
UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Iraq
:: OCHA Iraq | Telafar Flash Update #1: Telafar Humanitarian Response, 20 August 2017 [EN/AR/KU]
:: Thousands of civilians fleeing Telafar are at extreme risk [EN/AR/KU] Report
Published on 20 Aug 2017

Syrian Arab Republic
:: 25 Aug 2017  Displaced, disoriented and shocked, children from Raqqa and Deir-ez-Zor need urgent assistance and protection [EN/AR]
:: Joint Statement on Civilian Casualties Due to Coalition Airstrikes in Ar-Raqqa City [EN/AR]
Report Published on 22 Aug 2017 —
Ali Al-Za’tari, the Humanitarian Coordinator for Syria, and Ramesh Rajasingham, the Regional Humanitarian Coordinator for Syria a.i, express their deep concern over the significant number of civilians reportedly killed in the last few days due to the use of explosive ordnances, including through Coalition airstrikes, against targets of the Islamic State of Iraq and the Levant (ISIL) in densely populated neighborhoods of Ar-Raqqa city…

::::::

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
:: 22 Aug 2017  Ethiopia Weekly Humanitarian Bulletin, 21 August 2017

DRC
:: Bulletin humanitaire R.D. Congo – Numéro 3 | 21 août 2017
 

WHO & Regional Offices [to 26 August 2017]

New vision and strengthened partnership for WHO and China
21 August 2017 | GENEVA – WHO Director-General Tedros Adhanom Ghebreyesus concluded a 3-day official visit to the People’s Republic of China paving the way for stronger and more strategic WHO-China collaborations. Outcomes of his visit included a new financial contribution to WHO from China, and strengthened commitments to improve the health of billions of people in the 60 countries in the Belt and Road Initiative.

World Humanitarian Day
21 August 2017 – Dr Tedros honoured the heroic people who have died for the humanitarian cause, and thanked those who continue to devote their lives to helping the world’s most vulnerable people – in so many different countries, in such difficult circumstances.

Preventing spread of disease after Sierra Leone mudslide
21 August 2017 – WHO is working closely with the Government of Sierra Leone to prevent the spread of infectious diseases such as malaria and cholera in the wake of last week’s mudslides and flooding in Freetown. The Organization is also working with partners to ensure ongoing health care for the injured and displaced, and to provide psychological aid to those coping with trauma.

::::::
 
Disease outbreak news
:: Chikungunya – France   25 August 2017

::::::

Weekly Epidemiological Record, 25 August 2017, vol. 92, 34 (pp. 477–500)
:: Cholera vaccines: WHO position paper – August 2017
:: Monthly report on dracunculiasis cases, January-June 2017

::::::
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Africa on the verge of winning the fight against Neglected Tropical Disease
Brazzaville, Congo. 24 August 2017 – For more than 40 years, the World Health Organization (WHO) has worked to control river blindness (onchocerciasis), the second major infectious cause of blindness in Africa. Today, 30 years after a major donation of medication by Merck & Co, a pharmaceutical company, and after 20 years of the success of the African Program for Onchocerciasis Control (APOC) the reduction of the disease intensity has allowed WHO to shift the goal from control to elimination – a really ambitious achievement.
The unprecedented donation of medication “as much as needed for as long as needed”, combined with innovative distribution mechanism from WHO was protecting more than 110 million people annually in 19 countries by 2015, when the APOC program closed. It prevented over 40,000 cases of blindness every year between 1995 and 2015…

:: Acting on the call (AOTC) 2017 Summit kicks off in Addis Ababa: “Let’s make the world a better place for mothers and children”
Addis Ababa, 24th August, 2017: The 4th Acting On The Call (AOTC) conference started on the 24th August 2017 at the African Union, Addis Ababa Ethiopia with a theme “Overcoming Critical Barriers to Maternal and Child Survival”. The AOTC conference which is hosted by the governments of Ethiopia and India gathered more than 500 participants from 24 countries and held in the presence of the President of the Federal Republic of Ethiopia, Ministers and high level policymakers from the public and private sectors, NGOs and UN agencies including UN Women, UNICEF, UNFPA and WHO. .. 

WHO European Region EURO
:: Chikungunya cases reported in France 25-08-2017
:: Report shows progress towards Health 2020 targets 24-08-2017
:: Towards tobacco-free generations: stopping second-hand smoke and smoking initiation among children 22-08-2017

WHO Eastern Mediterranean Region EMRO
:: WHO and health authorities deliver 24/7 health services for hundreds of people fleeing the crisis in Telafar, Iraq   Baghdad, 22 August 2017
 
WHO Western Pacific Region
:: New vision and strengthened partnership for WHO and China   21 August 2017

CDC/ACIP [to 26 August 2017]
http://www.cdc.gov/media/index.html
Thursday, August 24, 2017
Most U.S. teens are getting cancer-preventing vaccine
CDC encourages parents to protect children from cancers caused by HPV
Six out of 10 U.S. parents are choosing to get the human papillomavirus (HPV) vaccine for their children, according to a report published in this week’s Morbidity and Mortality Weekly Report. The Centers for Disease Control and Prevention (CDC) recommends parents get two doses of HPV vaccine for their children at ages 11 or 12 to protect against cancers caused by HPV infections. Although most children are getting their first dose of HPV vaccine, many children are not completing the vaccination series.

“I’m pleased with the progress, but too many teens are still not receiving the HPV vaccine – which leaves them vulnerable to cancers caused by HPV infection,” said CDC Director Brenda Fitzgerald, M.D. “We need to do more to increase the vaccination rate and protect American youth today from future cancers tomorrow.”

Adolescents who get the first dose of HPV vaccine before their 15th birthday need two doses of HPV vaccine to be protected against cancers caused by HPV. Teens and young adults who start the series at ages 15 through 26 years need three doses of HPV vaccine to be protected against cancers caused by HPV.

Teen HPV vaccination: key findings
The annual National Immunization Survey-Teen (NIS-Teen) report, which examines vaccination coverage among U.S. adolescents, found that 60 percent of teens ages 13 to 17 received one or more doses of HPV vaccine in 2016, an increase of 4 percentage points from 2015.

The report also showed that HPV vaccination is becoming more common among boys. The difference in vaccination rates between boys and girls has been narrowing in recent years. About 65 percent of girls received the first dose of HPV vaccine compared to 56 percent of boys receiving the first dose. These latest estimates represent a 6 percentage point increase from 2015 for boys, while rates for girls were similar to 2015.

Despite these increases, areas for improvement remain. While most adolescents have received the first dose of HPV vaccine, only 43 percent of teens are up to date on all the recommended doses of HPV vaccine. HPV vaccination rates were also lower in rural and less urban areas compared to more urban areas…

MMWR News Synopsis for August 24, 2017
:: National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2016
Human Papilloma Vvirus (HPV) vaccination prevents cancer. Six out of 10 U.S. parents are choosing to get the HPV vaccine for their children. Although most children are getting their first dose of HPV vaccine, many children are not completing the vaccination series. CDC recommends 11- to 12-year-olds get two doses of HPV vaccine at least six months apart. Most U.S. parents are getting the first dose of HPV vaccine for their child, according to the latest estimates from the National Immunization Survey-Teen. In 2016, 60 percent of teens aged 13-17 years received one or more doses of HPV vaccine, an increase of 4 percentage points from 2015. The gap in HPV vaccination rates between boys and girls continues to narrow. Roughly 65 percent of girls received the first dose of HPV vaccine compared to 56 percent of boys who received the first dose of HPV vaccine. Although most children are getting their first dose of HPV vaccine, there continue to be many children who do not complete the vaccination series. HPV vaccination coverage is lower in rural and less urban areas. Those communities could benefit from additional efforts to increase coverage. Recent changes to HPV vaccine recommendations make it easier for parents to protect their children at the recommended ages. CDC recommends 11 to 12 year olds get two doses of HPV vaccine at least six months apart.

Announcements
 
EDCTP    [to 26 August 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
22 August 2017
Workshop to launch EDCTP Alumni Network in October
Since its inception, EDCTP has invested in support for individual researchers at different stages of their careers through an evolving…

European Medicines Agency  [to 26 August 2017]
http://www.ema.europa.eu/ema/
23/08/2017
Strengthening EU-US cooperation in medicine inspections
New commitment allows FDA to share full inspection reports with European Commission and EMA …
 
 
Gavi [to 26 August 2017]
http://www.gavi.org/library/news/press-releases/
23 August 2017
Gavi, the Vaccine Alliance welcomes Haiti’s commitment to immunisation
Government commits to fund vaccines and to strengthen its national immunisation programme to protect more Haitian children.
… According to WHO and UNICEF estimates, in 2016 Haiti had 58% coverage for Diphtheria-Tetanus-Pertussis vaccine (DTP3), the lowest rate in the Americas. While the country remains polio, measles and rubella free, recent outbreaks like diphtheria show the potential consequences of weak vaccine coverage. Significant inequity across provinces, districts as well as urban and rural areas also need to be addressed to reduce under five child mortality from 69 to 25/1,000 by 2030 and thereby reach the Sustainable Development Goal for Health (SDG).
“The Prime Minister’s commitment also encourages Gavi and partners to further scale up support to the country”, said Anuradha Gupta. “In the near future, we hope that Haiti will further prioritise investments in health to advance Universal Health Coverage so that all Haitians can have access to quality health services including immunisation.”…

Gavi welcomes contribution from the United Arab Emirates
US$ 5 million pledge will support INFUSE initiative, started in 2016 to help modernise vaccine delivery systems
Geneva, 21 August 2017 – The United Arab Emirates (UAE) has committed US$ 5 million to Gavi, the Vaccine Alliance, to support its Innovation for Uptake, Scale and Equity in Immunisation (INFUSE) initiative. Launched at the 2016 World Economic Forum meeting in Davos, INFUSE helps developing countries accelerate the introduction of tried and tested technology which will modernise their immunisation systems…
 
IVI   [to 26 August 2017]
http://www.ivi.int/
August 22, 2017
ICMR, Department of Health and Family Welfare of MOHFW sign MoU with International Vaccine Institute to support vaccine development in India
The Indian Council of Medical Research (ICMR) under the Department of Health Research and the Department of Health and Family Welfare of the Ministry of Health and Family Welfare(MOHFW) signed a tripartite memorandum of understanding today with the International Vaccine Institute (IVI)to collaborate on vaccine research and development. The agreement will also strengthen the relationship between IVI and India…
 
MSF/Médecins Sans Frontières  [to 26 August 2017]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
Indian Patent Office Delivers Major Blow to Affordable Pneumonia Vaccine Hopes
August 22, 2017
 
NIH  [to 26 August 2017]
http://www.nih.gov/news-events/news-releases
August 22, 2017
Scientists develop infection model for tick-borne flaviviruses
— Researchers say the work will greatly increase knowledge about how flaviviruses infect ticks.

UNAIDS [to 26 August 2017]
http://www.unaids.org/en
Update
Ending stigma and discrimination in health centres in Mexico
25 August 2017
Mexico has taken steps to strengthen access to health-care services by lesbian, gay, bisexual, transgender and intersex (LGBTI) people. A new Ministry of Health code of conduct aims to put an end to stigma and discrimination based on gender identity and sexual orientation in all health centres in the country.
Establishing guidelines and specific actions for the provision of health-care services, the code of conduct will be implemented throughout the national health system to guarantee effective access to health by respecting the dignity and autonomy of LGBTI people…

Update
UNAIDS fully compliant with UN-SWAP
22 August 2017
UNAIDS has been recognized for meeting or exceeding all of the 15 performance indicators of the United Nations System-wide Action Plan on Gender Equality and the Empowerment of Women (UN-SWAP), a year ahead of the deadline established by the United Nations System Chief Executives Board for Coordination….
 
Wellcome Trust  [to 26 August 2017]
https://wellcome.ac.uk/news
News / Published: 25 August 2017
A global call for action on drug-resistant infections
A global conference in October will accelerate action on tackling drug-resistant infections, one of the greatest health and economic challenges of our time.
The conference, in Berlin on 12 and 13 October 2017, is organised by Wellcome in partnership with the UK and Thai governments and the UN Foundation. It will support the work of the Antimicrobial Resistance Inter-Agency Coordination Group (IACG).
The event is an opportunity for national governments and multilateral institutions to come together with the civil society, private and philanthropic sectors to focus on the most critical gaps in tackling the development and spread of drug-resistant infections, and to commit to concerted and tangible actions…

News / Published: 24 August 2017
Leprosy turns immune system against itself
Researchers have shown for the first time how leprosy bacteria damage nerves by infiltrating the immune cells that are meant to protect us. 
The research found that leprosy hijacks the immune system, turning an important repair mechanism into one that causes potentially irreparable damage to nerve cells….

Journal Watch

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

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

BMC Cost Effectiveness and Resource Allocation
http://resource-allocation.biomedcentral.com/
(Accessed 26 August 2017)

Research
Cost-effectiveness analysis of a universal mass vaccination program with a PHiD-CV 2+1 schedule in Malaysia
Xiao Jun Wang, Ashwini Saha and Xu-Hao Zhang
Published on: 22 August 2017
Conclusions
A PHiD-CV 2+1 universal mass vaccination program could substantially reduce pneumococcal disease burden versus no vaccination, and was expected to be cost-effective in Malaysia. A PHiD-CV 2+1 program was also expected to be a dominant choice over a PCV13 2+1 program in Malaysia.

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 26 August 2017)

Research article
Distribution of Streptococcus pneumoniae serotypes in the northeast macro-region of São Paulo state/Brazil after the introduction of conjugate vaccine
Infections caused by Streptococcus pneumoniae (Spn) still challenge health systems around the world, even with advances in vaccination programs. The present study evaluated the frequency of various Spn serotypes …
Marta Inês Cazentini Medeiros, Samanta Cristine Grassi Almeida, Maria Luiza Leopoldo Silva Guerra, Paulo da Silva, Ana Maria Machado Career and Denise de Andrade
BMC Infectious Diseases 2017 17:590
Published on: 25 August 2017