American Journal of Preventive Medicine
April 2017 Volume 52, Issue 4, p417-556, e95-e122
http://www.ajpmonline.org/current

Research Articles
Parental-Reported Full Influenza Vaccination Coverage of Children in the U.S.
Yusheng Zhai, Tammy A. Santibanez, Katherine E. Kahn, Anup Srivastav
e103–e113
Published online: December 22, 2016
Abstract
Introduction
Depending upon influenza vaccination history, children aged 6 months–8 years need one or two doses of influenza vaccine to be considered fully vaccinated. The objectives of this study were to quantify the percentage of children aged 6 months–8 years who were fully vaccinated against influenza based on parental report, overall, by state, and by sociodemographic characteristics, and to examine sociodemographic characteristics associated with being fully vaccinated.
Methods
Data from the National Immunization Survey-Flu for the 2012–2013 and 2013–2014 influenza seasons were analyzed in 2015 using the Kaplan–Meier method to produce vaccination coverage estimates. Wald chi-square tests were used to test for bivariate associations, and Cox proportional hazards models were used to test for demographic characteristics independently associated with the child being fully vaccinated.
Results
The percentages of children aged 6 months–8 years who were fully vaccinated during the 2012–2013 and 2013–2014 influenza seasons were 41.0% and 45.2%, respectively. Full vaccination varied widely by state and was more likely for children requiring only one dose. Based on the statistical models, children likely to be fully vaccinated were older, non-black, had a mother with an education >12 years, or lived in a high-income household.
Conclusions
Most children in the U.S. are not fully vaccinated against influenza. Reminder systems and interventions that reduce or remove barriers to children receiving their second doses of influenza vaccine may improve full influenza vaccination coverage among all children.

American Journal of Preventive Medicine
April 2017 Volume 52, Issue 4, p417-556, e95-e122
http://www.ajpmonline.org/current

Research Articles
Parental-Reported Full Influenza Vaccination Coverage of Children in the U.S.
Yusheng Zhai, Tammy A. Santibanez, Katherine E. Kahn, Anup Srivastav
e103–e113
Published online: December 22, 2016
Abstract
Introduction
Depending upon influenza vaccination history, children aged 6 months–8 years need one or two doses of influenza vaccine to be considered fully vaccinated. The objectives of this study were to quantify the percentage of children aged 6 months–8 years who were fully vaccinated against influenza based on parental report, overall, by state, and by sociodemographic characteristics, and to examine sociodemographic characteristics associated with being fully vaccinated.
Methods
Data from the National Immunization Survey-Flu for the 2012–2013 and 2013–2014 influenza seasons were analyzed in 2015 using the Kaplan–Meier method to produce vaccination coverage estimates. Wald chi-square tests were used to test for bivariate associations, and Cox proportional hazards models were used to test for demographic characteristics independently associated with the child being fully vaccinated.
Results
The percentages of children aged 6 months–8 years who were fully vaccinated during the 2012–2013 and 2013–2014 influenza seasons were 41.0% and 45.2%, respectively. Full vaccination varied widely by state and was more likely for children requiring only one dose. Based on the statistical models, children likely to be fully vaccinated were older, non-black, had a mother with an education >12 years, or lived in a high-income household.
Conclusions
Most children in the U.S. are not fully vaccinated against influenza. Reminder systems and interventions that reduce or remove barriers to children receiving their second doses of influenza vaccine may improve full influenza vaccination coverage among all children.

American Journal of Public Health
Volume 107, Issue 4 (April 2017)
http://ajph.aphapublications.org/toc/ajph/current

AJPH LAW & ETHICS – ZIKA
Engaging Human Rights in the Response to the Evolving Zika Virus Epidemic
American Journal of Public Health: April 2017, Vol. 107, No. 4: 525–531
Jennifer J. K. Rasanathan, Sarah MacCarthy, Debora Diniz, Els Torreele, Sofia Gruskin
ABSTRACT
In late 2015, an increase in the number of infants born with microcephaly in poor communities in northeast Brazil prompted investigation of antenatal Zika infection as the cause. Zika now circulates in 69 countries, and has affected pregnancies of women in 29 countries.
Public health officials, policymakers, and international organizations are considering interventions to address health consequences of the Zika epidemic. To date, public health responses have focused on mosquito vector eradication, sexual and reproductive health services, knowledge and technology including diagnostic test and vaccine development, and health system preparedness.
We summarize responses to date and apply human rights and related principles including nondiscrimination, participation, the legal and policy context, and accountability to identify shortcomings and to offer suggestions for more equitable, effective, and sustainable Zika responses.

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 1 April 2017)

Research article
Systematic review of cost-effectiveness analyses for combinations of prevention strategies against human papillomavirus (HPV) infection: a general trend
Frédéric Gervais, Kyle Dunton, Yiling Jiang and Nathalie Largeron
BMC Public Health 2017 17:283
Published on: 28 March 2017
Abstract
Background
Due to the arrival of multi-valent HPV vaccines, it is more and more important to have a better understanding of the relationship between vaccination and screening programmes. This review aimed to: (1) collect published evidence on the cost-effectiveness profile of different HPV prevention strategies and, in particular, those combining vaccination with changes in screening practices; (2) explore the cost-effectiveness of alternative preventive strategies based on screening and vaccination.
Methods
A systematic literature review was conducted in order to identify the relevant studies regarding the cost-effectiveness of prevention strategies against HPV infection. Analysis comparing the modelling approaches between studies was made along with an assessment of the magnitude of impact of several factors on the cost-effectiveness of different screening strategies.
Results
A total of 18 papers were quantitatively summarised within the narrative. A high degree of heterogeneity was found in terms of how HPV prevention strategies have been assessed in terms of their economic and epidemiological impact, with variation in screening practice and valence of HPV vaccination found to have large implications in terms of cost-effectiveness.
Conclusions
This review demonstrated synergies between screening and vaccination. New prevention strategies involving multi-valence vaccination, HPV DNA test screening, delayed commencement and frequency of screening could be implemented in the future. Strategies implemented in the future should be chosen with care, and informed knowledge of the potential impact of all possible prevention strategies. Highlighted in this review is the difficulty in assessing multiple strategies. Appropriate modelling techniques will need to be utilised to assess the most cost-effective strategies.

Bulletin of the World Health Organization
Volume 95, Number 4, April 2017, 241-312
http://www.who.int/bulletin/volumes/95/4/en/

EDITORIALS
Antimicrobial resistance: translating political commitment into national action
Hajime Inoue & Ren Minghui
http://dx.doi.org/10.2471/BLT.17.191890

Bulletin of the World Health Organization
Volume 95, Number 4, April 2017, 241-312
http://www.who.int/bulletin/volumes/95/4/en/

Progress in promoting data sharing in public health emergencies
Katherine Littler, Wee-Ming Boon, Gail Carson, Evelyn Depoortere, Sophie Mathewson, Daniel Mietchen, Vasee S Moorthy, Denise O’Connor, Cathy Roth & Carlos Segovia
http://dx.doi.org/10.2471/BLT.17.192096
In February 2016, the World Health Organization (WHO) declared the Zika virus-related cluster of microcephaly cases and other neurological disorders reported in Brazil, a Public Health Emergency of International Concern (PHEIC).1 Following the declaration, over 30 global health bodies issued a joint statement committing to data sharing to ensure that the global response to the Zika virus and future emergencies, could be informed by the best and most current evidence.2 The statement represented a concerted effort by those involved to address past failures of timely access to relevant data. It also highlighted the lack of a clear path to implementation for data sharing during public health emergencies. In March 2016, the Global Research Collaboration for Infectious Disease Preparedness (GloPID-R) established a data-sharing working group which has been working in coalition with other stakeholders including WHO, scientists, nongovernmental organizations, journals and other agencies. 3 This group is working to identify barriers to data sharing in public health emergencies that should be addressed to better prepare for any future epidemic. We review the progress since the joint statement was made, outline the key challenges related to data sharing and summarize the group’s activities to date.

The experiences from the 2013–2016 Ebola virus disease outbreak and the 2015 Zika virus outbreak demonstrated the importance of research in public health emergencies and the difficulties associated with sharing research findings rapidly and outside of conventional scientific publications.4–7 Research – whether epidemiological, genetic, preclinical, microbiological, behavioural or operational – can generate new knowledge about an outbreak in rapidly changing situations. Research can inform risk communication, surveillance, clinical care, product development and other interventions. The WHO consensus and policy statements called for a paradigm shift in information sharing in public health emergencies and described the particularities to consider in dealing with different data types. 8,9

Despite these efforts, rapid data sharing during public health emergencies remains challenging for various reasons. First, there are limited incentives for researchers and other people responding to the emergency to share data. Second, there is a lack of appropriate infrastructure for data sharing such as repositories and information technology platforms. Such rapid data sharing requires a clear governance structure that ensures a balance between privacy and access, as well as adheres to national and international ethical and legal requirements. Implementation of calls for data sharing is hampered by barriers, including: (i) inequity in capacity and funding between researchers in high-and low-income settings; (ii) varying concepts of data ownership by data providers and data users; (iii) no clear mechanism for attribution and academic recognition for data providers and data users related to published products; (iv) costs and varying degrees of access to data management systems within research groups or institutions; (v) reputational risk from premature sharing of data and results; (vi) ethical and regulatory issues related to privacy and consent in the context of experimental treatment and clinical care; (vii) access to the benefits of research; (viii) concerns about loss of potential financial benefits from eventual commercialization and intellectual property rights.10

The GloPID-R working group has developed, and requests comment on, a set of principles to underpin future implementation of timely data sharing.11 These new principles draw on others, such as the FAIR Guiding Principles for scientific data management and stewardship,12 and are intended to provide an initial framework for discussion. The group is also preparing case studies to document data-sharing practices in past emergencies; developing a decision tool to guide data sharing to address knowledge gaps in outbreaks and has commissioned studies on good practice and standards. The intention is to use the emerging evidence base to inform the design and implementation of new systems and approaches that address the data needs of the different groups responding to public health emergencies. The collective work is intended to support WHO’s Research and Development Blueprint and include other stakeholders, such as the Global Outbreak Alert and Response Network and the Coalition for Epidemic Preparedness.

Effective data sharing requires flexibility by all stakeholders to adapt to unforeseen events and challenges. A data-sharing system needs to allow collaboration between stakeholders in the absence of pre-existing relationships and all collaborators need to adhere to fundamental ethical principles of data use. Above all, it must ensure that people in all affected countries benefit from timely access to evidence-based interventions in emergencies.

Bulletin of the World Health Organization
Volume 95, Number 4, April 2017, 241-312
http://www.who.int/bulletin/volumes/95/4/en/

RESEARCH
Increased immunization coverage addresses the equity gap in Nepal
Ashish KC, Viktoria Nelin, Hendrikus Raaijmakers, Hyung Joon Kim, Chahana Singh & Mats Målqvist
http://dx.doi.org/10.2471/BLT.16.178327
Abstract
Objective
To compare immunization coverage and equity distribution of coverage between 2001 and 2014 in Nepal.
Methods
We used data from the Demographic and Health Surveys carried out in 2001, 2006 and 2011 together with data from the 2014 Multiple Indicator Cluster Survey. We calculated the proportion, in mean percentage, of children who had received Bacille Calmette–Guérin (BCG) vaccine, three doses of polio vaccine, three doses of diphtheria–pertussis–tetanus (DPT) vaccine and measles vaccine. To measure inequities between wealth quintiles, we calculated the slope index of inequality (SII) and relative index of inequality (RII) for all surveys.
Findings
From 2001 to 2014, the proportion of children who received all vaccines at the age of 12 months increased from 68.8% (95% confidence interval, CI: 67.5–70.1) to 82.4% (95% CI: 80.7–84.0). While coverage of BCG, DPT and measles immunization statistically increased during the study period, the proportion of children who received the third dose of polio vaccine decreased from 93.3% (95% CI: 92.7–93.9) to 88.1% (95% CI: 86.8–89.3). The poorest wealth quintile showed the greatest improvement in immunization coverage, from 58% to 77.9%, while the wealthiest quintile only improved from 84.8% to 86.0%. The SII for children who received all vaccines improved from 0.070 (95% CI: 0.061–0.078) to 0.026 (95% CI: 0.013–0.039) and RII improved from 1.13 to 1.03.
Conclusion
The improvement in immunization coverage between 2001 and 2014 in Nepal can mainly be attributed to the interventions targeting the disadvantaged populations.

Bulletin of the World Health Organization
Volume 95, Number 4, April 2017, 241-312
http://www.who.int/bulletin/volumes/95/4/en/

A randomized controlled study of socioeconomic support to enhance tuberculosis prevention and treatment, Peru
Tom Wingfield, Marco A Tovar, Doug Huff, Delia Boccia, Rosario Montoya, Eric Ramos, Sumona Datta, Matthew J Saunders, James J Lewis, Robert H Gilman & Carlton A Evans
http://dx.doi.org/10.2471/BLT.16.170167

SYSTEMATIC REVIEWS
Under-five mortality according to maternal survival: a systematic review and meta-analysis
Lana Clara Chikhungu, Marie-Louise Newell & Nigel Rollins
http://dx.doi.org/10.2471/BLT.15.157149

POLICY & PRACTICE
Lessons learnt from 12 oral cholera vaccine campaigns in resource-poor settings
Amber Hsiao, Sachin N Desai, Vittal Mogasale, Jean-Louis Excler & Laura Digilio
http://dx.doi.org/10.2471/BLT.16.175166

Emerging Infectious Diseases
Volume 23, Number 4—April 2017
wwwnc.cdc.gov/eid/

Perspective
Biologic Evidence Required for Zika Disease Enhancement by Dengue Antibodies PDF Version [PDF – 780 KB – 5 pages]
S. B. Halstead
Abstract
The sudden appearance of overt human Zika virus infections that cross the placenta to damage fetal tissues, target sexual organs, and are followed in some instances by Guillain-Barré syndrome raises questions regarding whether these outcomes are caused by genetic mutations or if prior infection by other flaviviruses affects disease outcome. Because dengue and Zika viruses co-circulate in the urban Aedes aegypti mosquito–human cycle, a logical question, as suggested by in vitro data, is whether dengue virus infections result in antibody-dependent enhancement of Zika virus infections. This review emphasizes the critical role for epidemiologic studies (retrospective and prospective) in combination with the studies to identify specific sites of Zika virus infection in humans that are needed to establish antibody-dependent enhancement as a possibility or a reality.

The European Journal of Public Health
Volume 27, Issue 2, 1 April 2017
https://academic.oup.com/eurpub/issue/27/2

Viewpoints
Written informed consent in health research is outdated
Eur J Public Health (2017) 27 (2): 194-195.
R. Broekstra; E.L.M. Maeckelberghe; R.P. Stolk
[Initial text]
Reference to the Declaration of Helsinki as assurance for ethical principles for medical research involving human subjects has become a meaningless mantra. The participants’ relationship with researchers has been distrusted-based with Written Informed Consent (WIC) hereinafter referred to as WIC) placed as an important barrier to protect participants’ autonomy. Today the mantra is dictated by many details in consent forms and ever more strict regulations. Globally, especially in Europe as well the USA, establishment of privacy and protection of research subject regulations reveal similar obstacles and critiques, for example in the recently accepted European General Data Protection Regulation and the proposed changes to the Common Rule from September 2015. In a digital revolution ethical principles need to be reassured in a novel way, especially for the increasing use of data…

The European Journal of Public Health
Volume 27, Issue 2, 1 April 2017
https://academic.oup.com/eurpub/issue/27/2

Infectious Diseases
Low vaccination coverage of Greek Roma children amid economic crisis: national survey using stratified cluster sampling
Dimitris Papamichail, Ioanna Petraki, Chrisoula Arkoudis, Agis Terzidis, Emmanouil Smyrnakis, Alexis Benos, Takis Panagiotopoulos
Abstract
Background: Research on Roma health is fragmentary as major methodological obstacles often exist. Reliable estimates on vaccination coverage of Roma children at a national level and identification of risk factors for low coverage could play an instrumental role in developing evidence-based policies to promote vaccination in this marginalized population group. Methods: We carried out a national vaccination coverage survey of Roma children. Thirty Roma settlements, stratified by geographical region and settlement type, were included; 7–10 children aged 24–77 months were selected from each settlement using systematic sampling. Information on children’s vaccination coverage was collected from multiple sources. In the analysis we applied weights for each stratum, identified through a consensus process. Results: A total of 251 Roma children participated in the study. A vaccination document was presented for the large majority (86%). We found very low vaccination coverage for all vaccines. In 35–39% of children ‘minimum vaccination’ (DTP3 and IPV2 and MMR1) was administered, while 34–38% had received HepB3 and 31–35% Hib3; no child was vaccinated against tuberculosis in the first year of life. Better living conditions and primary care services close to Roma settlements were associated with higher vaccination indices. Conclusions: Our study showed inadequate vaccination coverage of Roma children in Greece, much lower than that of the non-minority child population. This serious public health challenge should be systematically addressed, or, amid continuing economic recession, the gap may widen. Valid national estimates on important characteristics of the Roma population can contribute to planning inclusion policies.

Global Health: Science and Practice (GHSP)
March 24, 2017, 5 (1)
http://www.ghspjournal.org/content/current

EDITORIALS
Can We Expect Results-Based Financing to Improve Quality of Care?
Performance-based incentives as currently employed appear poorly adapted for improving quality of clinical processes. They mainly measure structural items that, while easier to measure, are remote from actual clinical quality, and they could even perversely lead to heightened attention to those factors at the expense of clinical quality.
Glob Health Sci Pract 2017;5(1):1-3. First published online March 15, 2017. http://dx.doi.org/10.9745/GHSP-D-17-00069

REVIEWS
Quality of Care in Performance-Based Financing: How It Is Incorporated in 32 Programs Across 28 Countries
Structural aspects of quality such as equipment and infrastructure were the most frequently measured, with some measurement of processes of clinical care. Further examination is warranted to assess whether variations in how quality of care is incorporated into performance-based financing programs lead to differential effects.
Jessica Gergen, Erik Josephson, Martha Coe, Samantha Ski, Supriya Madhavan, Sebastian Bauhoff
Glob Health Sci Pract 2017;5(1):90-107. First published online March 15, 2017. http://dx.doi.org/10.9745/GHSP-D-16-00239

Health Economics, Policy and Law
Volume 12 – Issue 2 – April 2017
http://www.cambridge.org/core/journals/health-economics-policy-and-law/latest-issue
Special Issue: Towards a Global Framework for Health Financing
Editorial
Global health financing towards 2030 and beyond
Trygve Ottersen, David B. Evans, Elias Mossialos, John-Arne Røttingen
DOI: https://doi.org/10.1017/S1744133116000372
Published online: 23 March 2017, pp. 105-111

Universal health coverage and healthy lives for all are now widely shared goals and central to the 2030 Agenda for Sustainable Development. Despite significant progress over the last decades, the world is still far from reaching these goals. Billions of people lack basic coverage of health services, live with unnecessary pain and disability, or have their lives cut short by avoidable or treatable conditions (Jamison et al., 2013; Murray et al., 2015; World Health Organization, World Bank, 2015). At the same time, millions are pushed into poverty simply because they need to use health services and must pay for them out-of-pocket. Fundamental to this situation is the way health interventions and the health system are financed. Numerous countries spend less than is required to ensure even the most essential health services, scarce funds are wasted, out-of-pocket payments remain high and disadvantaged groups get the least public resources despite having the greatest needs.

It is clear that today’s global and national arrangements for health financing need to change, and this is a multifaceted endeavour. It is about domestic financing of health systems, joint financing of global public goods and external financing of health systems. It is about resource mobilisation, pooling and effective use. And it is about economics, politics, public health, human rights, law and ethics. To get health financing right, these areas, functions and perspectives must all be integrated and aligned.

Chatham House Working Group
The need for a broad and fresh look at global health financing was the starting premise for the Chatham House Centre on Global Health Security Working Group on Health Financing. The Group was established in 2011, following a conference at the Centre marking the 10th anniversary of the Commission on Macroeconomics and Health (Commission on Macroeconomics and Health, 2001). The mandate was to revisit the central themes addressed by the Commission and develop updated recommendations in light of new knowledge and developments since 2001. The Working Group would also build on the insights of three other landmark reports: the World Development Report 1993 Investing in Health (World Bank, 1993), the 2009 final report of the Taskforce on Innovative International Financing for Health Systems (HLTF, 2009), and the 2010 World Health Report Health Systems Financing: The Path to Universal Coverage (World Health Organization, 2010).

To facilitate a broad view on health financing, the Working Group brought together members with diverse backgrounds and perspectives from 15 countries. This included policy makers, researchers in multiple fields, representatives of civil society, and representatives of national and international institutions. The group met three times, and multiple working papers were prepared to form the basis for the final report, entitled Shared Responsibilities for Health: A Coherent Global Framework for Health Financing (Røttingen et al., 2014), which was launched during the World Health Assembly in 2014.

The report characterises key economic, epidemiological and institutional transitions and describe how these come with both challenges and opportunities for health financing. Against that background, a set of policy responses is offered, encapsulated in 20 recommendations for making progress towards a coherent global framework for health financing. These recommendations pertain to domestic financing of health systems, joint financing of global public goods for health, external financing of health systems and the cross-cutting issues of accountability and agreement on a new framework.

This issue
This special issue addresses all these questions and does so more broadly and more in depth than the Working Group’s Report could do. Health Economics, Policy and Law serves as an ideal platform for such a wide-ranging health policy issue, where economics, politics and legal considerations need to converge. While most contributions are in the form of academic articles, the close link to practical policy has been sought maintained throughout…

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 1 April 2017]

Commentary
Development of the Good Health Research Practice course: ensuring quality across all health research in humans
Quality and ethics need to be embedded into all areas of research with human participants. Good Clinical Practice (GCP) guidelines are international ethical and scientific quality standards for designing, cond…
Patricia Henley, Varalakshmi Elango, Olaf Horstick, Riris Andono Ahmad, Christine Maure, Pascal Launois, Corinne Merle, Jamila Nabieva and Yodi Mahendradhata
Health Research Policy and Systems 2017 15:28
Published on: 31 March 2017

Research
The impact on healthcare, policy and practice from 36 multi-project research programmes: findings from two reviews
We sought to analyse the impacts found, and the methods used, in a series of assessments of programmes and portfolios of health research consisting of multiple projects.
Steve Hanney, Trisha Greenhalgh, Amanda Blatch-Jones, Matthew Glover and James Raftery
Health Research Policy and Systems 2017 15:26
Published on: 28 March 2017

International Journal of Epidemiology
Volume 45 Issue 6 December 2016
http://ije.oxfordjournals.org/content/current

Interventions
Non-specific effects of BCG vaccination on morbidity among children in Greenland: a population-based cohort study
S Haahr; SW Michelsen; M Andersson; K Bjorn-Mortensen; B Soborg …
Abstract
Background: The potential non-specific effects of BCG (Bacillus Calmette-Guérin) vaccination, with reported reduction of infectious disease morbidity among vaccinated children, in addition to the protective effect against tuberculosis (TB), are highly debated. In Greenland, BCG vaccination was introduced in 1955, but temporarily discontinued from 1991 to 1996 due to nationwide policy changes. Using the transient vaccination stop, we aimed to investigate possible non-specific effects of BCG vaccination by measuring nation-wide hospitalization rates due to infectious diseases other than TB among vaccinated and unvaccinated children.
Methods: A retrospective cohort study including all children born in Greenland aged 3 months to 3 years from 1989 to 2004. A personal identification number assigned at birth allowed for follow-up through national registers. Information on hospitalization due to infectious diseases was obtained from the Greenlandic inpatient register using ICD-8 and ICD-10 codes. Participants with notified TB were censored. Incidence rate ratios (IRR) were estimated using Poisson regression.
Results: Overall, 19 363 children, hereof 66% BCG-vaccinated, were followed for 44 065 person-years and had 2069 hospitalizations due to infectious diseases. IRRs of hospitalization in BCG-vaccinated as compared with BCG-unvaccinated children were 1.07 [95% confidence interval (CI) 0.96–1.20] for infectious diseases overall, and specifically 1.10 (95% CI 0.98–1.24) for respiratory tract infections. Among BCG-vaccinated children aged 3 to 11 months, the IRR of hospitalization due to infectious diseases was 1.00 (95% CI 0.84–1.19) as compared with BCG-unvaccinated children.
Conclusion: Our results do not support the hypothesis that neonatal BCG vaccination reduces morbidity in children caused by infectious diseases other than TB.

International Journal of Epidemiology
Volume 45 Issue 6 December 2016
http://ije.oxfordjournals.org/content/current

Commentary: BCG has no beneficial non-specific effects on Greenland. An answer to the wrong question?
Christine Stabell Benn; Signe Sørup

Journal of Pediatrics
April 2017 Volume 183, p1-206
http://www.jpeds.com/current

The Editors’ Perspectives
Underimmunization drives community outbreaks of pertussis
Sarah S. Long
Published in issue: April 2017

Original Articles
The Timing of Pertussis Cases in Unvaccinated Children in an Outbreak Year: Oregon 2012
Steve G. Robison, Juventila Liko
p159–163
Published online: January 12, 2017

Lancet Global Health
Apr 2017 Volume 5 Number 4 e370-e466
http://www.thelancet.com/journals/langlo/issue/current
Comment

The role of mobile phone-based interventions to improve routine childhood immunisation coverage
Abdul Momin Kazi

Articles
Mobile phone-delivered reminders and incentives to improve childhood immunisation coverage and timeliness in Kenya (M-SIMU): a cluster randomised controlled trial
Dustin G Gibson, Benard Ochieng, E Wangeci Kagucia, Joyce Were, Kyla Hayford, Lawrence H Moulton, Orin S Levine, Frank Odhiambo, Katherine L O’Brien, Daniel R Feikin
Summary
Background
As mobile phone access continues to expand globally, opportunities exist to leverage these technologies to support demand for immunisation services and improve vaccine coverage. We aimed to assess whether short message service (SMS) reminders and monetary incentives can improve immunisation uptake in Kenya.
Methods
In this cluster-randomised controlled trial, villages were randomly and evenly allocated to four groups: control, SMS only, SMS plus a 75 Kenya Shilling (KES) incentive, and SMS plus 200 KES (85 KES=USD$1). Caregivers were eligible if they had a child younger than 5 weeks who had not yet received a first dose of pentavalent vaccine. Participants in the intervention groups received SMS reminders before scheduled pentavalent and measles immunisation visits. Participants in incentive groups, additionally, received money if their child was timely immunised (immunisation within 2 weeks of the due date). Caregivers and interviewers were not masked. The proportion of fully immunised children (receiving BCG, three doses of polio vaccine, three doses of pentavalent vaccine, and measles vaccine) by 12 months of age constituted the primary outcome and was analysed with log-binomial regression and General Estimating Equations to account for correlation within clusters. This trial is registered with ClinicalTrials.gov, number NCT01878435.
Findings
Between Oct 14, 2013, and Oct 17, 2014, we enrolled 2018 caregivers and their infants from 152 villages into the following four groups: control (n=489), SMS only (n=476), SMS plus 75 KES (n=562), and SMS plus 200 KES (n=491). Overall, 1375 (86%) of 1600 children who were successfully followed up achieved the primary outcome, full immunisation by 12 months of age (296 [82%] of 360 control participants, 332 [86%] of 388 SMS only participants, 383 [86%] of 446 SMS plus 75 KES participants, and 364 [90%] of 406 SMS plus 200 KES participants). Children in the SMS plus 200 KES group were significantly more likely to achieve full immunisation at 12 months of age (relative risk 1·09, 95% CI 1·02–1·16, p=0·014) than children in the control group.
Interpretation
In a setting with high baseline immunisation coverage levels, SMS reminders coupled with incentives significantly improved immunisation coverage and timeliness. Given that global immunisation coverage levels have stagnated around 85%, the use of incentives might be one option to reach the remaining 15%.
Funding
Bill & Melinda Gates Foundation.

The contribution of poor and rural populations to national trends in reproductive, maternal, newborn, and child health coverage: analyses of cross-sectional surveys from 64 countries
Cesar G Victora, Aluisio J D Barros, Giovanny V A França, Inácio C M da Silva, Liliana Carvajal-Velez, Agbessi Amouzou

Population coverage of artemisinin-based combination treatment in children younger than 5 years with fever and Plasmodium falciparum infection in Africa, 2003–2015: a modelling study using data from national surveys
Adam Bennett, Donal Bisanzio, Joshua O Yukich, Bonnie Mappin, Cristin A Fergus, Michael Lynch, Richard E Cibulskis, Samir Bhatt, Daniel J Weiss, Ewan Cameron, Peter W Gething, Thomas P Eisele

Lancet Infectious Diseases
Apr 2017 Volume 17 Number 4 p349-460 e107-e127
http://www.thelancet.com/journals/laninf/issue/current

Comment
Vaccine compliance and the 2016 Arkansas mumps outbreak
Maimuna S Majumder, Colleen M Nguyen, Emily L Cohn, Yulin Hswen, Sumiko R Mekaru, John S Brownstein

Lancet Infectious Diseases
Apr 2017 Volume 17 Number 4 p349-460 e107-e127
http://www.thelancet.com/journals/laninf/issue/current

Articles
30-year trends in admission rates for encephalitis in children in England and effect of improved diagnostics and measles-mumps-rubella vaccination: a population-based observational study
Mildred A Iro, Manish Sadarangani, Raphael Goldacre, Alecia Nickless, Andrew J Pollard, Michael J Goldacre
Summary
Background
Encephalitis is a serious neurological disorder, yet data on admission rates for all-cause childhood encephalitis in England are scarce. We aimed to estimate admission rates for childhood encephalitis in England over 33 years (1979–2011), to describe trends in admission rates, and to observe how these rates have varied with the introduction of vaccines and improved diagnostics.
Methods
We did a retrospective analysis of hospital admission statistics for encephalitis for individuals aged 0–19 years using national data from the Hospital Inpatient Enquiry (HIPE, 1979–85) and Hospital Episode Statistics (HES, 1990–2011). We analysed annual age-specific and age-standardised admission rates in single calendar years and admission rate trends for specified aetiologies in relation to introduction of PCR testing and measles-mumps-rubella (MMR) vaccination. We compared admission rates between the two International Classification of Diseases (ICD) periods, ICD9 (1979–94) and ICD10 (1995–2011).
Findings
We found 16 571 encephalitis hospital admissions in the period 1979–2011, with a mean hospital admission rate of 5·97 per 100 000 per year (95% CI 5·52–6·41). Hospital admission rates declined from 1979 to 1994 (ICD9; annual percentage change [APC] −3·30%; 95% CI −2·88 to −3·66; p<0·0001) and increased between 1995 and 2011 (ICD10; APC 3·30%; 2·75–3·85; p<0·0001). Admissions for measles decreased by 97% (from 0·32 to 0·009) and admissions for mumps encephalitis decreased by 98% (from 0·60 to 0·01) after the introduction of the two-dose MMR vaccine. Hospital admission rates for encephalitis of unknown aetiology have increased by 37% since the introduction of PCR testing.
Interpretation
Hospital admission rates for all-cause childhood encephalitis in England are increasing. Admissions for measles and mumps encephalitis have decreased substantially. The numbers of encephalitis admissions without a specific diagnosis are increasing despite availability of PCR testing, indicating the need for strategies to improve aetiological diagnosis in children with encephalitis.
Funding
None.

Lancet Infectious Diseases
Apr 2017 Volume 17 Number 4 p349-460 e107-e127
http://www.thelancet.com/journals/laninf/issue/current

Personal View
Adapting to the global shortage of cholera vaccines: targeted single dose cholera vaccine in response to an outbreak in South Sudan
Lucy A Parker, John Rumunu, Christine Jamet, Yona Kenyi, Richard Laku Lino, Joseph F Wamala, Allan M Mpairwe, Iza Ciglenecki, Francisco J Luquero, Andrew S Azman, Jean-Clement Cabrol
Summary
Shortages of vaccines for epidemic diseases, such as cholera, meningitis, and yellow fever, have become common over the past decade, hampering efforts to control outbreaks through mass reactive vaccination campaigns. Additionally, various epidemiological, political, and logistical challenges, which are poorly documented in the literature, often lead to delays in reactive campaigns, ultimately reducing the effect of vaccination. In June 2015, a cholera outbreak occurred in Juba, South Sudan, and because of the global shortage of oral cholera vaccine, authorities were unable to secure sufficient doses to vaccinate the entire at-risk population—approximately 1 million people. In this Personal View, we document the first public health use of a reduced, single-dose regimen of oral cholera vaccine, and show the details of the decision-making process and timeline. We also make recommendations to help improve reactive vaccination campaigns against cholera, and discuss the importance of new and flexible context-specific dose regimens and vaccination strategies.

New England Journal of Medicine
March 30, 2017 Vol. 376 No. 13
http://www.nejm.org/toc/nejm/medical-journal

Perspective
From Trial to Target Populations — Calibrating Real-World Data
Mehdi Najafzadeh, Ph.D., and Sebastian Schneeweiss, M.D., Sc.D.
N Engl J Med 2017; 376:1203-1205 March 30, 2017 DOI: 10.1056/NEJMp1614720
One difficulty in translating clinical trial findings for target patient populations is that risk factors in trials and electronic health care databases are measured in different ways. We therefore need a way to calibrate our measurements between these two data worlds.

New England Journal of Medicine
March 30, 2017 Vol. 376 No. 13
http://www.nejm.org/toc/nejm/medical-journal

Original Article
Quadrivalent HPV Vaccination and the Risk of Adverse Pregnancy Outcomes
Nikolai M. Scheller, M.D., Björn Pasternak, M.D., Ph.D., Ditte Mølgaard-Nielsen, M.Sc., Henrik Svanström, Ph.D., and Anders Hviid, Dr.Med.Sci.
N Engl J Med 2017; 376:1223-1233 March 30, 2017 DOI: 10.1056/NEJMoa1612296
Abstract
Background
The quadrivalent human papillomavirus (HPV) vaccine is recommended for all girls and women 9 to 26 years of age. Some women will have inadvertent exposure to vaccination during early pregnancy, but few data exist regarding the safety of the quadrivalent HPV vaccine in this context.
Methods
We assessed a cohort that included all the women in Denmark who had a pregnancy ending between October 1, 2006, and November 30, 2013. Using nationwide registers, we linked information on vaccination, adverse pregnancy outcomes, and potential confounders among women in the cohort. Women who had vaccine exposure during the prespecified time windows were matched for propensity score in a 1:4 ratio with women who did not have vaccine exposure during the same time windows. Outcomes included spontaneous abortion, stillbirth, major birth defect, small size for gestational age, low birth weight, and preterm birth.
Results
In matched analyses, exposure to the quadrivalent HPV vaccine was not associated with significantly higher risks than no exposure for major birth defect (65 cases among 1665 exposed pregnancies and 220 cases among 6660 unexposed pregnancies; prevalence odds ratio, 1.19; 95% confidence interval [CI], 0.90 to 1.58), spontaneous abortion (20 cases among 463 exposed pregnancies and 131 cases among 1852 unexposed pregnancies; hazard ratio, 0.71; 95% CI, 0.45 to 1.14), preterm birth (116 cases among 1774 exposed pregnancies and 407 cases among 7096 unexposed pregnancies; prevalence odds ratio, 1.15; 95% CI, 0.93 to 1.42), low birth weight (76 cases among 1768 exposed pregnancies and 277 cases among 7072 unexposed pregnancies; prevalence odds ratio, 1.10; 95% CI, 0.85 to 1.43), small size for gestational age (171 cases among 1768 exposed pregnancies and 783 cases among 7072 unexposed pregnancies; prevalence odds ratio, 0.86; 95% CI, 0.72 to 1.02), or stillbirth (2 cases among 501 exposed pregnancies and 4 cases among 2004 unexposed pregnancies; hazard ratio, 2.43; 95% CI, 0.45 to 13.21).
Conclusions
Quadrivalent HPV vaccination during pregnancy was not associated with a significantly higher risk of adverse pregnancy outcomes than no such exposure. (Funded by the Novo Nordisk Foundation and the Danish Medical Research Council.)

New England Journal of Medicine
March 30, 2017  Vol. 376 No. 13
http://www.nejm.org/toc/nejm/medical-journal

Review Article
Maternal Immunization
Saad B. Omer, M.B., B.S., M.P.H., Ph.D.
N Engl J Med 2017; 376:1256-1267 March 30, 2017 DOI: 10.1056/NEJMra1509044
Infants can be protected against a variety of dangerous infections early in life through immunity transferred from their mothers. This article reviews the efficacy of maternal immunization in the prevention of infections in babies too young to be immunized directly.

New England Journal of Medicine
March 30, 2017  Vol. 376 No. 13
http://www.nejm.org/toc/nejm/medical-journal

Editorial
Ensuring Vaccine Safety in Pregnant Women
Kathryn M. Edwards, M.D.
N Engl J Med 2017; 376:1280-1282 March 30, 2017 DOI: 10.1056/NEJMe1701337
[Initial text]
In this issue of the Journal, investigators from Denmark present a comprehensive review of the adverse pregnancy outcomes encountered in women who received quadrivalent human papillomavirus (HPV) vaccine during pregnancy, as compared with those who did not.1 The investigators assembled data on all the pregnancies in Denmark that occurred within a 7-year period, and they used nationwide registries to identify the dates of pregnancy, pregnancy outcomes, and maternal characteristics, including receipt of HPV vaccine and dates of vaccine administration. Vaccinated women and unvaccinated women were propensity-score matched in a 1:4 ratio, and pregnancy outcomes were compared.

Pediatrics
April 2017, VOLUME 139 / ISSUE 4
http://pediatrics.aappublications.org/content/139/3?current-issue=y

Articles
Bacteremia in Children 3 to 36 Months Old After Introduction of Conjugated Pneumococcal Vaccines
Tara L. Greenhow, Yun-Yi Hung, Arnd Herz
Pediatrics Apr 2017, 139 (4) e20162098; DOI: 10.1542/peds.2016-2098

Pneumococcal Vaccine Response After Exposure to Parasites in Utero, in Infancy, or Mid-Childhood
Monica Nayakwadi Singer, Claire Heath, Jackson Muinde, Virginia Gildengorin, Francis M. Mutuku, David Vu, Dunstan Mukoko, Christopher L. King, Indu J. Malhotra, Charles H. King, A. Desirée LaBeaud
Pediatrics Apr 2017, 139 (4) e20162781; DOI: 10.1542/peds.2016-2781

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
[Accessed 1 April 2017]

Research Article
Spatial Determinants of Ebola Virus Disease Risk for the West African Epidemic
March 31, 2017 ·
Introduction: Although many studies have investigated the probability of Ebola virus disease (EVD) outbreaks while other studies have simulated the size and speed of EVD outbreaks, few have investigated the environmental and population-level predictors of Ebola transmission once an outbreak is underway. Identifying strong predictors of transmission could help guide and target limited public health resources during an EVD outbreak. We examined several environmental and population-level demographic predictors of EVD risk from the West African epidemic. Methods: We obtained district-level estimates from the World Health Organization EVD case data, demographic indicators obtained from the Demographic and Health surveys, and satellite-derived temperature, rainfall, and land cover estimates. A Bayesian hierarchical Poisson model was used to estimate EVD risk and to evaluate the spatial variability explained by the selected predictors. Results: We found that districts had greater risk of EVD with increasing proportion of households not possessing a radio (RR 2.79, 0.90-8.78; RR 4.23, 1.16-15.93), increasing rainfall (RR 2.18; 0.66-7.20; 5.34, 1.20-23.90), and urban land cover (RR 4.87, 1.56-15.40; RR 5.74, 1.68-19.67). Discussion: The finding of radio ownership and reduced EVD transmission risk suggests that the use of radio messaging for control and prevention purposes may have been crucial in reducing the EVD transmission risk in certain districts, although this association requires further study. Future research should examine the etiologic relationships between the identified risk factors and human-to-human transmission of EVD with a focus on factors related to population mobility and healthcare accessibility, which are critical features of epidemic propagation and control.

PLoS One
http://www.plosone.org/
[Accessed 1 April 2017]

Research Article
The role of intervention mapping in designing disease prevention interventions: A systematic review of the literature
Rayyan M. Garba, Muktar A. Gadanya
Research Article | published 30 Mar 2017 PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0174438
Abstract
Objective
To assess the role of Intervention Mapping (IM) in designing disease prevention interventions worldwide.
Methods
Systematic search and review of the relevant literature—peer-reviewed and grey—was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines.
Findings
Only five of the twenty two included studies reviewed were RCTs that compared intervention using IM protocol with placebo intervention, and provided the outcomes in terms of percentage increase in the uptake of disease-prevention programmes, and only one of the five studies provided an effect measure in the form of relative risk (RR=1.59, 95% CI=1.08–2.34, p=0.02). Of the five RCTs, three were rated as strong evidences, one as a medium evidence and one as a weak evidence, and they all reported statistically significant difference between the two study groups, with disease prevention interventions that have used the intervention mapping approach generally reported significant increases in the uptake of disease-prevention interventions, ranging from 9% to 28.5% (0.0001 ≤ p ≤ 0.02), On the other hand, all the 22 studies have successfully identified the determinants of the uptake of disease prevention interventions that is essential to the success of disease prevention programmes.
Conclusion
Intervention Mapping has been successfully used to plan, implement and evaluate interventions that showed significant increase in uptake of disease prevention programmes. This study has provided a good understanding of the role of intervention mapping in designing disease prevention interventions, and a good foundation upon which subsequent reviews can be guided.

PNAS – Proceedings of the National Academy of Sciences of the United States
of America
http://www.pnas.org/content/early/
[Accessed 1 April 2017]

Biological Sciences – Population Biology:
Comparing nonpharmaceutical interventions for containing emerging epidemics
Corey M. Peak, Lauren M. Childs, Yonatan H. Grad, and Caroline O. Buckee
PNAS 2017 ; published ahead of print March 28, 2017, doi:10.1073/pnas.1616438114
Significance
Quarantine and symptom monitoring of contacts with suspected exposure to an infectious disease are key interventions for the control of emerging epidemics; however, there does not yet exist a quantitative framework for comparing the control performance of each intervention. Here, we use a mathematical model of seven case-study diseases to show how the choice of intervention is influenced by the natural history of the infectious disease, its inherent transmissibility, and the intervention feasibility in the particular healthcare setting. We use this information to identify the most important characteristics of the disease and setting that need to be considered for an emerging pathogen to make an informed decision between quarantine and symptom monitoring.
Abstract
Strategies for containing an emerging infectious disease outbreak must be nonpharmaceutical when drugs or vaccines for the pathogen do not yet exist or are unavailable. The success of these nonpharmaceutical strategies will depend on not only the effectiveness of isolation measures but also the epidemiological characteristics of the infection. However, there is currently no systematic framework to assess the relationship between different containment strategies and the natural history and epidemiological dynamics of the pathogen. Here, we compare the effectiveness of quarantine and symptom monitoring, implemented via contact tracing, in controlling epidemics using an agent-based branching model. We examine the relationship between epidemic containment and the disease dynamics of symptoms and infectiousness for seven case-study diseases with diverse natural histories, including Ebola, influenza A, and severe acute respiratory syndrome (SARS). We show that the comparative effectiveness of symptom monitoring and quarantine depends critically on the natural history of the infectious disease, its inherent transmissibility, and the intervention feasibility in the particular healthcare setting. The benefit of quarantine over symptom monitoring is generally maximized for fast-course diseases, but we show the conditions under which symptom monitoring alone can control certain outbreaks. This quantitative framework can guide policymakers on how best to use nonpharmaceutical interventions and prioritize research during an outbreak of an emerging pathogen.

PNAS – Proceedings of the National Academy of Sciences of the United States
of America
http://www.pnas.org/content/early/
[Accessed 1 April 2017]

Biological Sciences – Medical Sciences:
Meta-assessment of bias in science
Daniele Fanelli, Rodrigo Costas, and John P. A. Ioannidis
PNAS 2017 ; published ahead of print March 20, 2017, doi:10.1073/pnas.1618569114
Significance
Science is said to be suffering a reproducibility crisis caused by many biases. How common are these problems, across the wide diversity of research fields? We probed for multiple bias-related patterns in a large random sample of meta-analyses taken from all disciplines. The magnitude of these biases varied widely across fields and was on average relatively small. However, we consistently observed that small, early, highly cited studies published in peer-reviewed journals were likely to overestimate effects. We found little evidence that these biases were related to scientific productivity, and we found no difference between biases in male and female researchers. However, a scientist’s early-career status, isolation, and lack of scientific integrity might be significant risk factors for producing unreliable results.
Abstract
Numerous biases are believed to affect the scientific literature, but their actual prevalence across disciplines is unknown. To gain a comprehensive picture of the potential imprint of bias in science, we probed for the most commonly postulated bias-related patterns and risk factors, in a large random sample of meta-analyses taken from all disciplines. The magnitude of these biases varied widely across fields and was overall relatively small. However, we consistently observed a significant risk of small, early, and highly cited studies to overestimate effects and of studies not published in peer-reviewed journals to underestimate them. We also found at least partial confirmation of previous evidence suggesting that US studies and early studies might report more extreme effects, although these effects were smaller and more heterogeneously distributed across meta-analyses and disciplines. Authors publishing at high rates and receiving many citations were, overall, not at greater risk of bias. However, effect sizes were likely to be overestimated by early-career researchers, those working in small or long-distance collaborations, and those responsible for scientific misconduct, supporting hypotheses that connect bias to situational factors, lack of mutual control, and individual integrity. Some of these patterns and risk factors might have modestly increased in intensity over time, particularly in the social sciences. Our findings suggest that, besides one being routinely cautious that published small, highly-cited, and earlier studies may yield inflated results, the feasibility and costs of interventions to attenuate biases in the literature might need to be discussed on a discipline-specific and topic-specific basis.

Science Translational Medicine
29 March 2017 Vol 9, Issue 383
http://stm.sciencemag.org/

Research Articles
Using geospatial mapping to design HIV elimination strategies for sub-Saharan Africa
By Brian J. Coburn, Justin T. Okano, Sally Blower
Science Translational Medicine29 Mar 2017 Restricted Access
Mapping the geographic dispersion pattern of HIV-infected individuals in a sub-Saharan African country reveals the challenge to eliminating HIV.
Mapping a path to HIV elimination
About ~25 million individuals in sub-Saharan Africa are living with HIV. In new work, Coburn et al. design HIV elimination strategies for this region. The authors focused on Lesotho, where ~25% of the population is infected with HIV. They combined several large data sets and constructed a map that revealed the countrywide geographic dispersion pattern of HIV-infected individuals. They estimated that ~20% of the population lives in urban areas, and almost all rural communities have at least one HIV-infected individual. Their analyses showed that the spatial dispersion of Lesotho’s population hinders, and may even prevent, the elimination of HIV. This may hold true for other predominantly rural countries in sub-Saharan Africa.
Abstract
Treatment as prevention (TasP) has been proposed by the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) as a global strategy for eliminating HIV. The rationale is that treating individuals reduces their infectivity. We present a geostatistical framework for designing TasP-based HIV elimination strategies in sub-Saharan Africa. We focused on Lesotho, where ~25% of the population is infected. We constructed a density of infection map by gridding high-resolution demographic data and spatially smoothing georeferenced HIV testing data. The map revealed the countrywide geographic dispersion pattern of HIV-infected individuals. We found that ~20% of the HIV-infected population lives in urban areas and that almost all rural communities have at least one HIV-infected individual. We used the map to design an optimal elimination strategy and identified which communities should use TasP. This strategy minimized the area that needed to be covered to find and treat HIV-infected individuals. We show that UNAIDS’s elimination strategy would not be feasible in Lesotho because it would require deploying treatment in areas where there are ~4 infected individuals/km2. Our results show that the spatial dispersion of Lesotho’s population hinders, and may even prevent, the elimination of HIV.

Science Translational Medicine
29 March 2017 Vol 9, Issue 383
http://stm.sciencemag.org/

Report
Estimation of polio infection prevalence from environmental surveillance data
By Yakir Berchenko, Yossi Manor, Laurence S. Freedman, Ehud Kaliner, Itamar Grotto, Ella Mendelson, Amit Huppert
Science Translational Medicine29 Mar 2017 Restricted Access
Close monitoring of virus shed into sewage systems allows quantitative surveillance of a polio outbreak
Keeping an eye on polio
As the eyes are a mirror of the soul, a city’s sewage is a reflection of its people’s health. Berchenko et al. take advantage of a natural experiment in southern Israel to quantify this relationship for polio. By measuring virus shed into sewage waste in cities in which a known number of people received a live polio vaccine, the authors created tools that can be used to monitor polio incidence in other cities. Thus, virus levels in sewage waste can give an early warning of the reappearance of viral disease or verify its absence.
Abstract
A major obstacle to eradicating polio is that poliovirus from endemic countries can be reintroduced to polio-free countries. Environmental surveillance (ES) can detect poliovirus from sewage or wastewaters samples, even in the absence of patients with paralysis. ES is underused, in part because its sensitivity is unknown. We used two unique data sets collected during a natural experiment provided by the 2013 polio outbreak in Israel: ES data from different locations and records of supplemental immunization with the live vaccine. Data from the intersecting population between the two data sets (covering more than 63,000 people) yielded a dose-dependent relationship between the number of poliovirus shedders and the amount of poliovirus in sewage. Using a mixed-effects linear regression analysis of these data, we developed several quantitative tools, such as (i) ascertainment of the number of infected individuals from ES data for application during future epidemics elsewhere, (ii) evaluation of the sensitivity of ES, and (iii) determination of the confidence level of the termination of poliovirus circulation after an outbreak. These results will be valuable in monitoring future outbreaks with ES, and this approach could be used to certify poliovirus elimination or to validate the need for more containment efforts.

Vaccine
Volume 35, Issue 17, Pages 2101-2278 (19 April 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/17
Building Next Generation Immunization Supply Chains
Edited by Bruce Y. Lee, Benjamin Schreiber and Raja Rao
Articles organized under thematic areas:
:: Making the Case: how immunization supply chains impact vaccine coverage
:: Challenges
:: Toward next generation supply chains: Successful pilots
:: Toward next generation supply chains: Promising ideas and innovations
:: Toward next generation supply chains: Upstream solutions

Vaccine
Volume 35, Issue 16, Pages 1985-2100 (11 April 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/16

Reviews
Facilitators and barriers of parental attitudes and beliefs toward school-located influenza vaccination in the United States: Systematic review
Review Article
Pages 1987-1995
Gloria J. Kang, Rachel K. Culp, Kaja M. Abbas
Abstract
The study objective was to identify facilitators and barriers of parental attitudes and beliefs toward school-located influenza vaccination in the United States. In 2009, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention expanded their recommendations for influenza vaccination to include school-aged children. We conducted a systematic review of studies focused on facilitators and barriers of parental attitudes toward school-located influenza vaccination in the United States from 1990 to 2016. We reviewed 11 articles by use of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework. Facilitators were free/low cost vaccination; having belief in vaccine efficacy, influenza severity, and susceptibility; belief that vaccination is beneficial, important, and a social norm; perception of school setting advantages; trust; and parental presence. Barriers were cost; concerns regarding vaccine safety, efficacy, equipment sterility, and adverse effects; perception of school setting barriers; negative physician advice of contraindications; distrust in vaccines and school-located vaccination programs; and health information privacy concerns. We identified the facilitators and barriers of parental attitudes and beliefs toward school-located influenza vaccination to assist in the evidence-based design and implementation of influenza vaccination programs targeted for children in the United States and to improve influenza vaccination coverage for population-wide health benefits.

Vaccine
Volume 35, Issue 16, Pages 1985-2100 (11 April 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/16

Impact of meningococcal C conjugate vaccination four years after introduction of routine childhood immunization in Brazil
Original Research Article
Pages 2025-2033
Ana Lucia Andrade, Ruth Minamisava, Lisia Moura Tomich, Ana Paula Lemos, Maria Cecilia Gorla, Maria Cristina de Cunto Brandileone, Carla Madga S. Domingues, Camile de Moraes, Gabriela Policena, Ana Luiza Bierrenbach, Meningococcal Study Group
Abstract
Background
Routine infant immunization with meningococcal C conjugate (MCC) vaccination started in Brazil in November 2010, scheduled at three and five months plus a booster at 12–15 months of age. No catch-up was implemented. We assessed the impact of vaccination on meningococcal C disease (MenC) four years after vaccination start in the National Immunization Program.
Methods
We performed an ecological quasi-experimental design from 2008 to 2014 using a deterministic linkage between the National Notification and the National Reference Laboratory databases for meningitis. We conducted an interrupted time-series analysis considering Brazil except for Salvador municipality, because an epidemic of serogroup C disease occurred in this city, which prompted a mass vaccination campaign with catch-up for adolescents in 2010. Observed MenC rates in the post-vaccination period were compared to expected rates calculated from the pre-vaccination years. Results for Salvador were presented as descriptive data. An additional time-series analysis was performed for the state of São Paulo.
Results
A total of 18,136 MenC cases were analyzed. The highest incidence rates were observed for infants aged Conclusion
After four years of infants and toddlers vaccination start, MenC invasive disease reduced in the target population. This investigation provide a robust baseline to ascertain how much the upcoming catch-up dose in 12–13 years of age will accelerate the decrease in MenC incidence rates among youths in Brazil.

Vaccine
Volume 35, Issue 16, Pages 1985-2100 (11 April 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/16

Bacille Calmette-Guérin (BCG) vaccination at birth and antibody responses to childhood vaccines. A randomised clinical trial
Original Research Article
Pages 2084-2091
Thomas Nørrelykke Nissen, Nina Marie Birk, Gaby Smits, Dorthe Lisbeth Jeppesen, Lone Graff Stensballe, Mihai G. Netea, Fiona van der Klis, Christine Stabell Benn, Ole Pryds, The Calmette Study Group
Abstract
Introduction
BCG vaccination has been associated with beneficial non-specific effects on child health. Some immunological studies have reported heterologous effects of vaccines on antibody responses to heterologous vaccines. Within a randomised clinical trial of Bacille Calmette-Guérin (BCG) vaccination at birth, The Danish Calmette Study, we investigated the effect of BCG at birth on the antibody response to the three routine vaccines against DiTeKiPol/Act-Hib and Prevenar 13 in a subgroup of participants.
Methods
Within 7 days after birth, children were randomised 1:1 to BCG vaccination or to the control group (no intervention). After three routine vaccinations given at age 3, 5 and 12 months, antibodies against DiTeKiPol/Act-Hib and Prevenar 13 (Streptococcus pneumoniae serotype type 4, 6B, 9V, 14, 18C, 19F and 23F) were measured 4 weeks after the third vaccine dose.
Results
Among the 300 included children (178 BCG; 122 controls), almost all children (>96%) had antibody responses above the protective levels. Overall BCG vaccination at birth did not affect the antibody level. When stratifying by ‘age at randomisation’ we found a possible inducing effect of BCG on antibodies against B. pertussis and all pneumococcal serotypes, when BCG was given after the first day of life. Girls had significantly higher antibody levels for Haemophilus influenza type b and pneumococcus than boys.
Conclusions and relevance
Three routine vaccinations with DiTeKiPol/Act-Hib and Prevenar 13 induced sero-protective levels in almost all children. No overall effect of neonatal BCG vaccination was observed.

Vaccine
Volume 35, Issue 15, Pages 1817-1984 (4 April 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/15

Childhood pneumococcal disease in Africa – A systematic review and meta-analysis of incidence, serotype distribution, and antimicrobial susceptibility
Review Article
Pages 1817-1827
Pui-Ying Iroh Tam, Beth K. Thielen, Stephen K. Obaro, Ann M. Brearley, Alexander M. Kaizer, Haitao Chu, Edward N. Janoff
Abstract
Background
Determining the incidence, disease-associated serotypes and antimicrobial susceptibility of invasive pneumococcal disease (IPD) among children in Africa is essential in order to monitor the impact of these infections prior to widespread introduction of the pneumococcal conjugate vaccine (PCV).
Methods
To provide updated estimates of the incidence, serotype distribution, and antimicrobial susceptibility profile of Streptococcus pneumoniae causing disease in Africa, we performed a systematic review of articles published from 2000 to 2015 using Ovid Medline and Embase. We included prospective and surveillance studies that applied predefined diagnostic criteria. Meta-analysis for all pooled analyses was based on random-effects models.
Results
We included 38 studies consisting of 386,880 participants in 21 countries over a total of 350,613 person-years. The pooled incidence of IPD was 62.6 (95% CI 16.9, 226.5) per 100,000 person-years, including meningitis which had a pooled incidence of 24.7 (95% CI 11.9, 51.6) per 100,000 person-years. The pooled prevalence of penicillin susceptibility was 78.1% (95% CI 61.9, 89.2). Cumulatively, PCV10 and PCV13 included 66.9% (95% CI 55.9, 76.7) and 80.6% (95% CI 66.3, 90.5) of IPD serotypes, respectively.
Conclusions
Our study provides an integrated and robust summary of incidence data, serotype distribution and antimicrobial susceptibility for S. pneumoniae in children ≤5 years of age in Africa prior to widespread introduction of PCV on the continent. The heterogeneity of studies and wide range of incidence rates across the continent indicate that surveillance efforts should be intensified in all regions of Africa to improve the integrity of epidemiologic data, vaccine impact and cost benefit. Although the incidence of IPD in young children in Africa is substantial, currently available conjugate vaccines are estimated to cover the majority of invasive disease-causing pneumococcal serotypes. These data provide a reliable baseline from which to monitor the impact of the broad introduction of PCV.

Vaccine
Volume 35, Issue 15, Pages 1817-1984 (4 April 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/15

Systematic review of the cost-effectiveness of influenza immunization programs
Review Article
Pages 1828-1843
Eon E.K. Ting, Beate Sander, Wendy J. Ungar
Abstract
Background
Seasonal influenza immunization programs vary widely across jurisdictions. In Canada, some provinces offer universal programs while others target specific population groups. However, whether targeted or universal programs provide more benefit and value-for-money is unclear. The cost-effectiveness of influenza immunization programs was systematically reviewed to inform policy.
Methods
Citation databases and the grey literature were searched for economic evaluations of influenza immunization programs. Eligible studies were appraised using the Scottish Intercollegiate Guidelines Network (SIGN) checklist with supplemental WHO vaccine-related questions. Data from high quality studies was extracted and the studies reviewed.
Results
A total of 41influenza immunization studies were identified. Of these, 31 were high quality. For pregnant and postpartum women, vaccinating all versus only high risk women study results ranged from dominance (less costly and more effective) to $9773 per QALY gained (societal) and from dominance to $58,000 per QALY gained (healthcare system). Studies of vaccinating all versus only high risk children found vaccination to be dominant to $47,000 per QALY gained (societal), and dominant to $18,000 per QALY gained (healthcare system). Vaccinating high risk adults was highly cost-effective and vaccinating health care workers resulted in $35,000 per QALY gained. Results for healthy working adults were mixed and sensitive to vaccine uptake, efficacy, and productivity loss.
Conclusions
From the societal perspective, vaccination was cost-effective for children, pregnant and postpartum women, high risk groups, and in some cases, healthy working age adults. Immunization programs using group administration are more cost-effective than programs using individual administration. The perspective, programmatic design, setting, and inclusion of herd immunity affects cost-effectiveness. In regions with targeted programs, re-evaluating “high risk” criteria and consideration of a universal program is warranted.

Vaccine
Volume 35, Issue 15, Pages 1817-1984 (4 April 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/15

The ADVANCE Code of Conduct for collaborative vaccine studies
Review Article
Pages 1844-1855
Xavier Kurz, Vincent Bauchau, Patrick Mahy, Steffen Glismann, Lieke Maria van der Aa, François Simondon, for the ADVANCE consortium
Abstract
Lessons learnt from the 2009 (H1N1) flu pandemic highlighted factors limiting the capacity to collect European data on vaccine exposure, safety and effectiveness, including lack of rapid access to available data sources or expertise, difficulties to establish efficient interactions between multiple parties, lack of confidence between private and public sectors, concerns about possible or actual conflicts of interest (or perceptions thereof) and inadequate funding mechanisms. The Innovative Medicines Initiative’s Accelerated Development of VAccine benefit-risk Collaboration in Europe (ADVANCE) consortium was established to create an efficient and sustainable infrastructure for rapid and integrated monitoring of post-approval benefit-risk of vaccines, including a code of conduct and governance principles for collaborative studies. The development of the code of conduct was guided by three core and common values (best science, strengthening public health, transparency) and a review of existing guidance and relevant published articles. The ADVANCE Code of Conduct includes 45 recommendations in 10 topics (Scientific integrity, Scientific independence, Transparency, Conflicts of interest, Study protocol, Study report, Publication, Subject privacy, Sharing of study data, Research contract). Each topic includes a definition, a set of recommendations and a list of additional reading. The concept of the study team is introduced as a key component of the ADVANCE Code of Conduct with a core set of roles and responsibilities. It is hoped that adoption of the ADVANCE Code of Conduct by all partners involved in a study will facilitate and speed-up its initiation, design, conduct and reporting. Adoption of the ADVANCE Code of Conduct should be stated in the study protocol, study report and publications and journal editors are encouraged to use it as an indication that good principles of public health, science and transparency were followed throughout the study.

Vaccine
Volume 35, Issue 15, Pages 1817-1984 (4 April 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/15

Assessing misclassification of vaccination status: Implications for studies of the safety of the childhood immunization schedule
Original Research Article
Pages 1873-1878
Matthew F. Daley, Jason M. Glanz, Sophia R. Newcomer, Michael L. Jackson, Holly C. Groom, Marlene M. Lugg, Huong Q. McLean, Nicola P. Klein, Eric S. Weintraub, Michael M. McNeil
Abstract
Background
To address public concern about the safety of the childhood immunization schedule, the Institute of Medicine recommended observational studies comparing adverse health outcomes of fully vaccinated children to children under-vaccinated due to parental choice. Misclassification of vaccination status could bias such studies.
Objective
To assess risk of misclassification of vaccination status within the Vaccine Safety Datalink (VSD).
Design/methods
A retrospective cohort study was conducted in three phases. In phase 1, electronic health record (EHR) data were used to identify patterns of under-vaccination during the first 24 months of life potentially due to parental choice. In phase 2, a random sample of records of under-vaccinated children was manually reviewed. In phase 3, a separate sample of parents were surveyed to assess whether EHR data accurately reflected their child’s vaccination status. Phases 1 and 2 were conducted at 6 VSD sites, phase 3 at 1 site.
Results
The study cohort included 361,901 children born 2004 through 2012. By 24 months of age, 198,249 (54.8%) were fully vaccinated with no delays, 84,698 (23.4%) experienced delays but were fully vaccinated by 24 months of age, 4865 (1.3%) received no vaccines, 3789 (1.0%) delayed starting vaccination until ≥4 months of age, 4781 (1.3%) had consistent vaccine-limiting (≤2 vaccines per visit), and the remaining 65,519 (18.1%) were missing vaccine series or doses. When a diagnosis code for vaccine refusal was present in EHR data, encounter notes confirmed vaccine refusal as the reason for under-vaccination for nearly 100% of sampled records. Parent surveys confirmed these findings. Parents of under-vaccinated children were more likely to report visiting an alternative medical provider than parents of fully vaccinated children.
Conclusions
Specific groups of children, under-vaccinated due to parental choice, can be identified with relatively low likelihood of misclassification of vaccination status using EHR-based vaccine data and diagnosis codes.

Vaccine
Volume 35, Issue 15, Pages 1817-1984 (4 April 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/15

Health professional feedback on HPV vaccination roll-out in a developing country
Original Research Article
Pages 1886-1891
Collette Venturas, Kanayo Umeh
Abstract
Background
Worldwide, Zambia has the highest cervical cancer incidence rates (58.4/100,000 per year) and mortality rates (36.2/100,000 per year). The human papilloma virus (HPV) vaccine is considered a vital preventative measure against cervical cancer, particularly in sub-Saharan countries, such as Zambia. Past research suggests health professionals’ experiences with HPV vaccination rollout can have practical implications for effective delivery.
Objective
To explore health professionals’ perspectives on the HPV vaccination programme in Zambia.
Methods
Researcher travelled to Zambia and conducted semi-structured interviews with fifteen health professionals working in private, government, and missionary clinics/hospitals. Observation was conducted for triangulation purposes. Thematic analysis was used to analyse the data.
Findings
Five main themes emerged; medical misconceptions about the HPV vaccination, particularly with regards to infertility; fear of the unknown, including possible side effects and inadequate empirical research; need for prior desensitisation to resolve cultural barriers prior to vaccination rollout; a rural-urban divide in health awareness, particularly in relation to cancer vaccines; and economic concerns associated with access to the HPV vaccination for most of the Zambian population.
Conclusion
Overall, the findings indicate that an essential avenue for facilitating HPV vaccination rollout in Zambia is by implementing a pre-rollout community effort that removes or softens cultural barriers, particularly in rural areas. It is also essential to correct erroneous HPV presumptions health professionals may have around infertility. Affordability remains a seemingly intractable hindrance that hampers HPV vaccination rollout in Zambia.

Vaccine
Volume 35, Issue 15, Pages 1817-1984 (4 April 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/15

Analysis of the effects of individual and community level factors on childhood immunization in Malawi
Original Research Article
Pages 1907-1917
Peter Austin Morton Ntenda, Kun-Yang Chuang, Fentanesh Nibret Tiruneh, Ying-Chih Chuang
Abstract
Background
Empirical evidence regarding the relationship between childhood immunization and individual- and community-level factors in low-income countries has received little attention. We compared the trends and the effects of a wide range of individual- and community-level socioeconomic factors on the likelihood of a child being immunized between 2004 and 2010 in Malawi.
Methods
We used data from the 2004 and 2010 Malawi Demographic and Health Survey and applied generalized estimating logistic regression equation to analyze data respectively on 2042 and 3496 children aged 12–23 months. We compared the relationship between individual- and community-level socioeconomic factors and a child’s vaccination status for four basic vaccines recommended by the World Health Organization: bacillus Calmette-Guérin (BCG) vaccine, diphtheria-tetanus-pertussis (DPT3) vaccine, oral polio vaccine (OPV3), and measles-containing vaccine 1 (MCV1).
Results
The trends of vaccination had a similar pattern in 2004 and 2010. The coverage of the four vaccinations was highest for BCG and lowest for OPV3 and complete immunization was higher in 2010. The multivariate analyses show that mother’s low education, having one or none antenatal visits, having no immunization card, having immunization card but not seen, residing in poor households, and living in central region were the most significant factors associated with decreased odds of achieving vaccination coverage and complete vaccination in both 2004 and 2010. However, maternal education was more likely to be associated with children’s immunization in 2010, while the geographical region was more likely to be associated with children’s immunization in 2004.
Conclusions
There were marked improvements in the national immunization coverage from 2004 to 2010. In order to achieve complete immunization, to further enhance the national immunization coverage as well as to lessen the gaps and disparities in childhood vaccination in Malawi, policy makers should design interventions based on the factors addressed in this study.

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

Cold Spring Harbor Perspectives in Biology
Published in Advance March 27, 2017, doi: 10.1101/cshperspect.a031583
What Is the Predictive Value of Animal Models for Vaccine Efficacy in Humans? Consideration of Strategies to Improve the Value of Animal Models
RS Herati, EJ Wherry –
Abstract
Animal models are an essential feature of the vaccine design toolkit. Although animal models have been invaluable in delineating the mechanisms of immune function, their precision in predicting how well specific vaccines work in humans is often suboptimal. There are, of course, many obvious species differences that may limit animal models from predicting all details of how a vaccine works in humans. However, careful consideration of which animal models may have limitations should also allow more accurate interpretations of animal model data and more accurate predictions of what is to be expected in clinical trials. In this article, we examine some of the considerations that might be relevant to cross-species extrapolation of vaccine-related immune responses for the prediction of how vaccines will perform in humans.

Journal of Community Health
First Online: 22 March 2017 DOI: 10.1007/s10900-017-0328-5
Practices and Attitudes of Missouri School Nurses Regarding Immunization Records and Select Immunizations of Graduating High School Seniors
Darson L. Rhodes, Michele Draper, Kendra Woolman, Carol Cox
Abstract
School nurses play a key role in maintaining a healthy student population, and one of their roles includes maintaining vaccination records. Further, they can play an important role in advocating for human papillomavirus (HPV) and meningococcal vaccination for students. All Missouri public high school nurses were sent an electronic survey addressing the knowledge, attitudes, and practices regarding immunization records and HPV and meningococcal vaccination of high school seniors. Approximately 75% of nurses reported their schools did not have or they did not know if the school had a written policy regarding the release of vaccination records. Approximately 1/2 and 1/3 of nurses do not communicate with parents/students about HPV or meningococcal vaccines, respectively. Although most favorable toward meningococcal, nurses had positive attitudes toward both vaccines. Recommendations include establishment of written policies regarding vaccination record release, and future research should focus on evaluating school nurses’ communication methods regarding HPV and meningococcal vaccination.

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

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

The Economist
http://www.economist.com/
Accessed 1 April 2017

Taking stock – Managing supplies of vaccines is a huge problem
New research asks how often vaccines are exposed to temperatures below the lower limit
Mar 30th 2017

New York Times
http://www.nytimes.com/
Accessed 1 April 2017

Meningitis C Kills 282 in Nigeria Amid Shortage of Vaccines
March 30, 2017 –

UN Sends 3.5M Emergency Yellow Fever Vaccines to Brazil
March 30, 2017

As Cholera Spreads, Somalia Begins Vaccination Campaign
March 27, 2017

Think Tanks et al

Brookings
http://www.brookings.edu/
Accessed 1 April 2017
TechTank
Brookings report assesses health governance capacity in low- and middle-income countries
Jake Schneider, John Villasenor, and Darrell M. West
Wednesday, March 29, 2017
[See Research above for more detail]

Milestones :: Perspectives :: Featured Journal Content

From coast to coast: Africa unites to tackle threat of polio
116 million children to be immunized from coast to coast across the continent, as regional emergency outbreak response intensifies
GENEVA/BRAZZAVILLE/NEW YORK/DAKAR, 24 March 2017 –  More than 190,000 polio vaccinators in 13 countries across west and central Africa will immunize more than 116 million children over the next week, to tackle the last remaining stronghold of polio on the continent.

The synchronized vaccination campaign, one of the largest of its kind ever implemented in Africa, is part of urgent measures to permanently stop polio on the continent. All children under five years of age in the 13 countries – Benin, Cameroon, Central African Republic, Chad, Côte d’Ivoire, Democratic Republic of Congo, Guinea, Liberia, Mali, Mauritania, Niger, Nigeria and Sierra Leone – will be simultaneously immunized in a coordinated effort to raise childhood immunity to polio across the continent. In August 2016, four children were paralysed by the disease in security-compromised areas in Borno state, north-eastern Nigeria, widely considered to be the only place on the continent where the virus maintains its grip.

“Twenty years ago, Nelson Mandela launched the pan-African ‘Kick Polio Out of Africa’ campaign,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “At that time, every single country on the continent was endemic to polio, and every year, more than 75,000 children were paralysed for life by this terrible disease. Thanks to the dedication of governments, communities, parents and health workers, this disease is now beaten back to this final reservoir.”

Dr Moeti cautioned, however, that progress was fragile, given the epidemic-prone nature of the virus. Although confined to a comparatively small region of the continent, experts warned that the virus could easily spread to under-protected areas of neighbouring countries. That is why regional public health ministers from five Lake Chad Basin countries – Cameroon, Central African Republic, Chad, Niger, and Nigeria – declared the outbreak a regional public health emergency and have committed to multiple synchronized immunization campaigns…

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New England Journal of Medicine
March 23, 2017  Vol. 376 No. 12
http://www.nejm.org/toc/nejm/medical-journal
Editorial
Rotavirus Vaccines — A New Hope
Mathuram Santosham, M.D., M.P.H., and Duncan Steele, Ph.D.
N Engl J Med 2017; 376:1170-1172 March 23, 2017 DOI: 10.1056/NEJMe1701347

Rotavirus gastroenteritis is the leading cause of diarrhea-associated hospitalization and death in children younger than 5 years of age,1 with more than 85% of the approximately 200,000 annual rotavirus deaths occurring in Africa and Asia.2 Since improvements in water, sanitation, and hygiene do not prevent rotavirus transmission, as they do with the spread of bacterial enteropathogens, the implementation of a rotavirus vaccine is essential to prevent death and complications from childhood diarrhea.

Two rotavirus vaccines — Rotarix (an attenuated G1P8 rotavirus manufactured by GlaxoSmithKline) and RotaTeq (containing five human–bovine reassortant rotaviruses, manufactured by Merck), attained prequalification by the World Health Organization (WHO) in 2008, which paved the way for UNICEF vaccine procurement through the financing mechanisms of the Gavi Alliance. These vaccines, which have been introduced in 42 Gavi-eligible countries and in 6 countries that have been designated as low-income and middle-income, have had a major effect on rotavirus deaths and hospitalizations in all settings.3

However, the uptake of rotavirus vaccines has slowed for various reasons, including supply constraints, high cost, and programmatic concerns for national immunization programs, particularly cold-chain capacity.4 Gavi countries have predominantly selected the attenuated G1P8 rotavirus vaccine,5 which has a smaller vaccine vial size and comes with a vaccine vial monitor for temperature monitoring. The two approved rotavirus vaccines have a liquid ready-to-use formulation. However, issues of cost of the vaccine and vaccine supply remain.
With Gavi support, low-income countries can procure rotavirus vaccines with a minimal copayment of 40 cents (in U.S. currency) per course, and Gavi cofinances the remainder of the UNICEF price (which ranges from $4.50 to $10.50). Low-income and middle-income countries, which are not Gavi-eligible, pay substantially higher costs for rotavirus vaccines.5 Gavi’s principles for vaccine-supply security emphasize the need for multiple manufacturers in the market to drive down prices while establishing sufficient vaccine supply. This protocol will become more critical as countries transition from Gavi support owing to socioeconomic development.

Fortunately, the situation is improving. In 2013, an indigenously developed rotavirus vaccine (ROTAVAC, Bharat Biotech International) was licensed in India and has been introduced in the routine childhood immunization program in four Indian states, with expanded rollout expected this year. This vaccine is under consideration for WHO prequalification, which would make it eligible for UNICEF procurement and Gavi subsidy. Bharat Biotech has committed to a cost of approximately $3.00 per course for global public markets.

In this issue of the Journal, Isanaka and colleagues6 document the safety and efficacy of an oral bovine rotavirus pentavalent vaccine (BRV-PV) developed by Serum Institute of India. The vaccine, which the investigators evaluated in an impoverished setting in Niger, had a reported efficacy of 66.7%,6 which is similar to that of other licensed rotavirus vaccines in similar settings. Efficacy data from an Indian study are pending. Despite this modest efficacy, the absolute public health benefits of vaccination are large, given the tremendous disease burden.

Estimates suggest that rotavirus vaccines have the potential to prevent 2.46 million childhood deaths and 83 million disability-adjusted life-years during the period from 2011 through 2030.7
The authors describe a rotavirus vaccine that is thermostable for 24 months at 37°C and for 6 months at 40°C, which may provide advantages for vaccine delivery in remote areas where cold-chain capacity is limited. However, this vaccine is freeze-dried, and practitioners in many countries may prefer other rotavirus vaccines that have liquid all-in-one formulations to simplify programmatic considerations. The projected cost of this heat-stable vaccine falls between the Gavi prices for the two currently used vaccines. The availability of vaccines from several manufacturers will increase global supply.

During the past three decades, remarkable progress has been made in reducing mortality from diarrheal disease, but the goal of ending such deaths cannot be achieved without aggressive implementation of a comprehensive approach to diarrhea prevention and treatment, including providing access of rotavirus vaccines to every child regardless of economic status. Increased availability of low-cost, programmatically suitable vaccines in abundant supply will be key to achieving this goal.

Original Article
Efficacy of a Low-Cost, Heat-Stable Oral Rotavirus Vaccine in Niger
Sheila Isanaka, Sc.D., Ousmane Guindo, M.D., Celine Langendorf, Pharm.D., M.P.H., Amadou Matar Seck, M.D., Brian D. Plikaytis, M.Sc., Nathan Sayinzoga-Makombe, M.P.H., Monica M. McNeal, M.Sc., Nicole Meyer, M.Sc., Eric Adehossi, M.D., Ali Djibo, M.D., Bruno Jochum, M.S., and Rebecca F. Grais, Ph.D.
N Engl J Med 2017; 376:1121-1130 March 23, 2017 DOI: 10.1056/NEJMoa1609462
Abstract
Background
Each year, rotavirus gastroenteritis is responsible for about 37% of deaths from diarrhea among children younger than 5 years of age worldwide, with a disproportionate effect in sub-Saharan Africa.
Methods
We conducted a randomized, placebo-controlled trial in Niger to evaluate the efficacy of a live, oral bovine rotavirus pentavalent vaccine (BRV-PV, Serum Institute of India) to prevent severe rotavirus gastroenteritis. Healthy infants received three doses of the vaccine or placebo at 6, 10, and 14 weeks of age. Episodes of gastroenteritis were assessed through active and passive surveillance and were graded on the basis of the score on the Vesikari scale (which ranges from 0 to 20, with higher scores indicating more severe disease). The primary end point was the efficacy of three doses of vaccine as compared with placebo against a first episode of laboratory-confirmed severe rotavirus gastroenteritis (Vesikari score, ≥11) beginning 28 days after dose 3.
Results
Among the 3508 infants who were included in the per-protocol efficacy analysis, there were 31 cases of severe rotavirus gastroenteritis in the vaccine group and 87 cases in the placebo group (2.14 and 6.44 cases per 100 person-years, respectively), for a vaccine efficacy of 66.7% (95% confidence interval [CI], 49.9 to 77.9). Similar efficacy was seen in the intention-to-treat analyses, which showed a vaccine efficacy of 69.1% (95% CI, 55.0 to 78.7). There was no significant between-group difference in the risk of adverse events, which were reported in 68.7% of the infants in the vaccine group and in 67.2% of those in the placebo group, or in the risk of serious adverse events (in 8.3% in the vaccine group and in 9.1% in the placebo group); there were 27 deaths in the vaccine group and 22 in the placebo group. None of the infants had confirmed intussusception.
Conclusions
Three doses of BRV-PV, an oral rotavirus vaccine, had an efficacy of 66.7% against severe rotavirus gastroenteritis among infants in Niger. (Funded by Médecins sans Frontières Operational Center and the Kavli Foundation; ClinicalTrials.gov number, NCT02145000.)

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Editor’s Note:
Please note World TB Day announcements across this edition.

Emergencies

WHO Grade 3 Emergencies  [to 25 March 2017]
Iraq  –
WHO scales up disease surveillance reporting in East Mosul and Hamdaniya districts, Iraq
19 March 2017, Erbil, Iraq – The World Health Organization (WHO) and the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA) are scaling up disease surveillance activities in newly accessible areas of Ninewa governorate, Iraq, to reduce the risk of disease outbreaks. As a result of acute shortages of safe water, sanitation services, food, and electricity in East Mosul and Hamdaniya districts, current humanitarian conditions pose a high risk of communicable diseases among displaced persons, returnees, and host communities.

Nigeria – No new announcements identified
South Sudan  – No new announcements identified
The Syrian Arab Republic  – No new announcements identified
Yemen – No new announcements identified

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WHO Grade 2 Emergencies  [to 25 March 2017]
Cameroon  – No new announcements identified.
Central African Republic  – No new announcements identified.
Democratic Republic of the Congo – No new announcements identified.
Ethiopia – No new announcements identified.
Libya – No new announcements identified.
Myanmar – No new announcements identified.
Niger  – No new announcements identified.
Ukraine  – No new announcements identified.

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 UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 

Iraq
:: UN Expresses Profound Concern about Terrible Loss of Life in Western Mosul
Published on 24 Mar 2017
The United Nations is profoundly concerned by reports yesterday of a high number of civilian casualties in Al Aghawat Al Jadidah, a densely populated neighborhood in Mosul. Initial reports indicate hundreds of causalities.

“We are stunned by this terrible loss of life and wish to express our deepest condolences to the many families who have reportedly been impacted by this tragedy,” said Ms. Lise Grande, the Humanitarian Coordinator for Iraq.

“Nothing in this conflict is more important than protecting civilians,” said Ms. Grande.    “International humanitarian law is clear. Parties to the conflict — all parties – are obliged to do everything possible to protect civilians. This means that combatants cannot use people as human shields and cannot imperil lives through indiscriminate use of fire-power.”

As the fighting to retake Mosul intensifies, civilians are being put at extreme risk. “We fear for the families who are caught in the conflict,” said Ms. Grande. “Everything must be done to avoid civilian casualties.

:: Iraq: Humanitarian Bulletin, February 2017 | Issued on 23 March
:: Iraq: Mosul Humanitarian Response Situation Report No. 25 (13-19 March 2017)

Syria  
:: 24 Mar 2017   Emergency Telecommunications Cluster (ETC) Syria Operation, March 2017

Yemen –
:: 19 Mar 2017  Yemen Humanitarian Bulletin Issue 21 | As of 18 March 2017
HIGHLIGHTS
…Two years of conflict puts future of coming generations at great risk
..First UN cross-line medical aid delivery to Taizz city in months
…117,107 people migrate to Yemen from the Horn of Africa in 2016
…Cholera response gives promising results

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POLIO [to 25 March 2017]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 22 March 2017
:: From 25 to 28 March, synchronised polio campaigns will take place across 13 counties in west and central Africa including Nigeria, Chad, Cameroon, Guinea, Mali and Niger. Over 190 000 vaccinators will immunize more than 116 million children over the course of the campaigns..

Country Updates [Selected Excerpts]
New cases or environmental samples reported across the monitored country/region settings: Afghanistan, Pakistan, Nigeria, Lake Chad Basin, Guinea and West Africa, Lao People’s Democratic Republic.
:: No new case activity reported

 [See report on story on polio immunization across Africa in Milestones above]

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

 Yellow Fever  [to 25 March 2017]
http://www.who.int/emergencies/yellow-fever/en/
Disease outbreak news
20 March 2017
Updates on yellow fever vaccination recommendations for international travellers related to the current situation in Brazil

As of 16 March 2017, yellow fever virus transmission continues to expand towards the Atlantic coast of Brazil in areas not deemed to be at risk for yellow fever transmission prior to the revised risk assessment, supported by the scientific and technical advisory group on geographical yellow fever risk mapping (GRYF), and published by WHO in the Disease Outbreak News of 27 January 2017 and 6 March 2017; as well as on the WHO International Travel and Health website on 31 January 2017,14 February 2017, and 6 March 2017.

As of 16 March 2017, confirmed cases of yellow fever virus infection in humans were reported in Rio de Janeiro State, and epizootics and human cases are under investigation for yellow fever virus infection in São Paulo State. These reports are consistent with the increased yellow fever activity observed in other States (Espírito Santo and Minas Gerais) that share the same ecosystem — tropical and sub-tropical broad leaved forests. As of 16 March 2017, there is no evidence of human cases of yellow fever virus infection transmitted by Aedes aegypti, the vector that could sustain urban transmission of yellow fever.

The WHO Secretariat has determined that the State of Rio de Janeiro, with the exception of the urban areas of Rio de Janeiro City and Niterói, and the State of São Paulo, with the exception of the urban areas of São Paulo City and Campinas, should also be considered at risk for yellow fever transmission.

Consequently, vaccination against yellow fever is recommended for international travellers visiting those areas in the States of Rio de Janeiro and São Paulo. The typology of activities that international travellers anticipate to undertake while visiting areas determined to be at risk for yellow fever transmission should be weighted in the risk-benefit analysis informing the individual decision to be immunized against yellow fever.

There are no other additional changes with respect to other areas of Brazil determined to be at risk for yellow fever transmission in 2013, as published by WHO in the Disease Outbreak News on 31 January 2017 and 6 March 2017…

 EBOLA/EVD  [to 25 March 2017]
http://www.who.int/ebola/en/
No new digest content identified for this edition.

 MERS-CoV [to 25 March 2017]
http://www.who.int/emergencies/mers-cov/en/
No new digest content identified for this edition.

 Zika virus  [to 25 March 2017]
http://www.who.int/emergencies/zika-virus/en/
No new digest content identified for this edition.

WHO & Regional Offices [to 25 March 2017]

Highlights

10th meeting of the Strategic and Technical Advisory Group for Neglected Tropical Diseases
March 2017 – The meeting, taking place on 29–30 March 2017, will cover issues on Global Vector Control Response, examination of dossiers requesting the potential inclusion of diseases as NTDs, gaps in disease elimination, eradication of dracunculiasis, integrated data management, and the 2nd WHO NTD Global Partners’ Meeting.

Global Health Sector Strategy on Viral Hepatitis
March 2017 – Worldwide, approximately 240 million people have chronic hepatitis B infection and 80 million people have chronic hepatitis C infection. A dedicated portal has been developed for the first ever Global Health Sector Strategy on Viral Hepatitis 2016–2021.

Ad-hoc Interagency Coordination Group on antimicrobial resistance
March 2017 – At the UN General Assembly’s high-level meeting on antimicrobial resistance in September 2016, Member States requested the Secretary-General to establish, in consultation with WHO, the Food and Agriculture Organization, and the World Organisation for Animal Health, an ad-hoc interagency coordination group on antimicrobial resistance.

Weekly Epidemiological Record, 24 March 2017, vol. 92, 12 (pp. 129–144)
Zoonotic influenza viruses: antigenic and genetic characteristics and development of candidate vaccine viruses for pandemic preparedness

Disease outbreak news

:: Meningococcal disease – Nigeria  24 March 2017
:: Human infection with avian influenza A(H7N9) virus – China  23 March 2017
:: Yellow fever – Brazil  20 March 2017  [See Yellow Fever above]

:: WHO Regional Offices
Selected Press Releases, Announcements

WHO African Region AFRO
:: From coast to coast: Africa unites to tackle threat of polio – 23 March 2017
:: Dr Matshidiso Moeti on an official visit to Republic of Niger – 21 March 2017

WHO Region of the Americas PAHO
:: PAHO/WHO: “Let’s unite to end TB, leaving no one behind” (03/23/2017)

WHO South-East Asia Region SEARO
No new digest content identified.

WHO European Region EURO
:: World TB Day: leave no one behind 23-03-2017
:: France becomes one of the first countries in Region to recommend colour-coded nutrition labelling system 22-03-2017
:: World Water Day: good health and managing wastewater go hand-in-hand 22-03-2017
:: TB/HIV co-infections up 40% across Europe over the last five years 20-03-2017

WHO Eastern Mediterranean Region EMRO
:: World TB Day: Unite to End TB and alleviate the suffering of millions  22 March 2017
:: WHO reinforces monitoring of health facilities, services and resources in Syria  22 March 2017
:: WHO scales up disease surveillance reporting in East Mosul and Hamdaniya districts, Iraq
19 March 2017

WHO Western Pacific Region
:: Unite to End TB, by properly financing care MANILA, 24 March 2017

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CDC/ACIP [to 25 March 2017]
http://www.cdc.gov/media/index.html

MMWR Weekly March 24, 2017 / No. 11
[Excerpts]
:: World TB Day — March 24, 2017
:: Tuberculosis — United States, 2016
:: Tuberculosis Among Foreign-Born Persons Diagnosed ≥10 Years After Arrival in the United States, 2010–2015
:: Establishing a Timeline to Discontinue Routine Testing of Asymptomatic Pregnant Women for Zika Virus Infection — American Samoa, 2016–2017
:: Notes from the Field: Obstetric Tetanus in an Unvaccinated Woman After a Home Birth Delivery — Kentucky, 2016

Announcements

Gavi [to 25 March 2017]
http://www.gavi.org/library/news/press-releases/
21 March 2017
Gavi ‘effective and fit for purpose’
Network of 19 donor countries assesses Gavi, the Vaccine Alliance’s performance

Gavi is an effective, ‘fit for purpose’ organisation, scoring top ratings in a number key performance areas, according to the Multilateral Organisation Performance Assessment Network (MOPAN).

In its second institutional review of the organisation, MOPAN commends Gavi as being both “strategic and nimble in meeting new vaccine challenges and countries’ evolving needs, while keeping a clear focus on its mission goals.” Gavi is also recognised as being a “strong model for sustainability”.

MOPAN is a network of 19 donor countries, representing 95% of Overseas Development Assistance (ODA), which assesses the effectiveness of the multilateral organisations that receive development and humanitarian funding.

“Gavi has a clear long-term vision based on a distinct business and partnership model” states the report. “It plays a catalytic role in expanding immunisation coverage and shaping the global vaccine market.”

The review, covering the period from 2014 to mid-2016, notes that Gavi demonstrates transparency and accountability in its operations, with strong compliance with fiduciary and social requirements and safeguards. It has recently strengthened its internal audit and risk management functions to meet its increased organisational ambition, complexity and size.
As a performance and results orientated organisation, “Gavi has a clear framework of indicators, targets and metrics at the country level. Results-based management is integral to its planning and grant allocation.”…

::::::

NIH [to 25 March 2017]
http://www.nih.gov/news-events/news-releases
March 24, 2017
NIH Statement on World Tuberculosis Day
— Statement of Christine F. Sizemore, PhD., Richard Hafner, M.D., and Anthony S. Fauci, M.D. National Institute of Allergy and Infectious Diseases.
Tuberculosis (TB) is one of the world’s most devastating infectious diseases. March 24th marks the day in 1882 when German microbiologist Robert Koch announced he had discovered Mycobacterium tuberculosis, the bacterium that causes this ancient scourge. Today, in recognition of World TB Day, the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), reasserts its commitment to improving our understanding of TB and how to prevent, diagnose and treat it. Around the globe, researchers and the public health community are united in working toward these goals.

TB is the world’s leading cause of death from an infectious disease, especially among women and children. The World Health Organization estimates that more than 1.8 million people worldwide died of TB in 2015. The symptoms of the disease, which is transmitted through the air and primarily affects the lungs, often begin with coughing, shortness of breath or swollen lymph nodes — but can end in death if left untreated. People with HIV are especially vulnerable: of deaths among people co-infected with HIV and TB, about one quarter are due to TB. In addition, the World Health Organization estimates that about one-third of the world’s population is infected with “latent” TB, in which people carry the bacterium while exhibiting no symptoms.  Five to 10 percent of these latent TB carriers risk developing active TB at some point in their lifetimes. For latent TB carriers who are infected with HIV, this risk is approximately 10 percent per year. Finally, it is important to note that smoking substantially increases TB disease occurrence and risk of death due to TB worldwide.

A safe and highly effective vaccine against TB will be a critical tool in ultimately controlling the infection. Currently, the only available vaccine against TB is bacille Calmette-Guerin (BCG), developed in 1921. While this vaccine offers protection against disseminated disease and death in children, it is much less effective against the transmissible pulmonary form of the disease in adults. NIAID supports research across the spectrum of basic, preclinical and clinical development to arrive at innovative new approaches toward the development of vaccines to prevent this disease…

.

NIH achieves milestone to accelerate multisite clinical studies
March 23, 2017 — CTSA Program paves way for nationwide single IRB mode
Developing new treatments for diseases often requires large numbers of clinical research participants enrolled in the same study at numerous geographical sites. These multisite clinical trials are well-positioned to discover whether a promising therapeutic is safe and effective, and may provide medical professionals with the information needed for treating their patients. However, the initiation of such studies may be delayed because each site typically relies on its own Institutional Review Boards (IRBs) to provide ethics reviews of the risks and benefits of the proposed research.

The National Institutes of Health is leading policy and programmatic initiatives to streamline this overly cumbersome process. NIH’s National Center for Advancing Translational Sciences (NCATS) announced today that all Clinical and Translational Science Awards (CTSA) Program sites have signed on to the NCATS Streamlined, Multisite, Accelerated Resources for Trials (SMART) IRB authorization agreement. This agreement — which now includes a total of more than 150 top medical research institutions — will enable all participating study sites to rely on the ethics review of one IRB for each study, making it possible to initiate multisite studies within weeks instead of months. For patients waiting to enroll in a study, this could make a life-saving difference.

The SMART IRB authorization agreement serves as a model to help investigators adhere to the NIH’s policy on single IRB use for multisite studies. This policy was designed to improve IRB efficiencies while ensuring the protection of research participants so that research can proceed expeditiously.

The authorization agreement effort was led by Harvard Catalyst, University of Wisconsin-Madison Institute for Clinical and Translational Research, and Dartmouth Synergy. Through these institutions, a team of NCATS-supported SMART IRB ambassadors facilitated and provided critical guidance and support to assist institutions in joining and implementing the SMART IRB authorization agreement.

“This milestone is a giant step toward a nationwide model for greater efficiency in IRB review, which is critical to getting more treatments to more patients more quickly,” said NCATS Director Christopher P. Austin, M.D. “It was made possible by the teamwork of hundreds of experts across the country who worked together to achieve what was thought to be impossible even a few years ago.”…

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Global Fund [to 25 March 2017]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
News
Global Fund and Inter-Parliamentary Union Sign MOU
23 March 2017
The Global Fund and the Inter-Parliamentary Union (IPU) have signed a memorandum of understanding to promote mutual advocacy, engage in joint technical work and raise awareness in the fight against AIDS, TB and malaria and building resilient and sustainable systems for health.

News
Senegal and the Global Fund Extend Their Partnership
21 March 2017
The Honorable Macky Sall, President of the Republic of Senegal, today welcomed a delegation from the Global Fund to Fight AIDS, Tuberculosis and Malaria led by Dr. Mark Dybul, Executive Director. The meeting marked the official signing of the Agreement on the Privileges and Immunities of the Global Fund, a symbolic step in strengthening the partnership between the Global Fund and Senegal that has been in place for 15 years. Senegal is now the 15th country to sign the agreement; Côte d’Ivoire, Togo, Burkina Faso, Rwanda as well as some ten European and African states have already done so.

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PATH [to 25 March 2017]
http://www.path.org/news/index.php
Announcement | March 23, 2017
PATH welcomes new promising study results for rotavirus vaccine candidate
A new article published today in the New England Journal of Medicine provides the results of a recent Phase 3 clinical trial conducted in Niger with a rotavirus vaccine candidate from India. The study, conducted by Médecins Sans Frontières (MSF) and Epicentre, evaluated the efficacy and safety of the pentavalent bovine-human reassortant rotavirus vaccine (BRV-PV) manufactured by Serum Institute of India Pvt. Ltd. in infants in Niger. Data from the trial revealed the BRV-PV to be highly efficacious for the prevention of severe rotavirus gastroenteritis and to have an excellent safety profile. In addition, the vaccine was transported and stored at ambient temperature, thus bypassing the typically challenging cold-chain requirements that apply to most other vaccines…

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UNAIDS [to 25 March 2017]
http://www.unaids.org/
Press release
UNAIDS warns that countries will miss the 2020 target of reducing HIV-associated TB deaths by 75% unless urgent action is taken
GENEVA, 24 March 2017—On World Tuberculosis Day, 24 March, UNAIDS is urging countries to do much more to reduce the number of tuberculosis (TB) deaths among people living with HIV. TB is the most common cause of hospital admission and death among people living with HIV. In 2015, 1.1 million people died from an AIDS-related illness—around 400 000 of whom died from TB, including 40 000 children.
“It is unacceptable that so many people living with HIV die from tuberculosis, and that most are undiagnosed or untreated,” said Michel Sidibé, Executive Director of UNAIDS. “Only by stepping up collaboration between HIV and tuberculosis programmes to accelerate joint action can the world reach its critical HIV and tuberculosis targets.”
Eight countries—the Democratic Republic of the Congo, India, Indonesia, Mozambique, Nigeria, South Africa, the United Republic of Tanzania and Zambia—account for around 70% of all TB deaths among people living with HIV. Scaling up action in these eight countries would put the world on track to reach the ambitious target in the 2016 United Nations Political Declaration on Ending AIDS of reducing TB-related deaths among people living with HIV by 75% by 2020…

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Wellcome Trust [to 25 March 2017]
https://wellcome.ac.uk/news
Published: 24 March 2017
Breakthrough in battle against resistant TB
A cutting-edge technique developed by Wellcome-funded researchers in Oxford means that tuberculosis (TB) can now be diagnosed much faster and more accurately.
The researchers’ method uses whole genome sequencing to quickly assess which strains of TB a patient is infected with. Patients will receive their diagnosis in just over a week, rather than waiting up to a month.
This will improve treatments and help reduce the spread of drug-resistant infections.
It will also be possible to improve identification and treatment of other resistant pathogens.
The news comes as World TB Day marks global efforts to eliminate a disease that infects 10 million people and kills 1.5 million each year. The spread of resistant strains of TB are of particular concern. In 2015, an estimated 480,000 people worldwide developed multidrug-resistant TB…

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EDCTP [to 25 March 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
24 March 2017
World TB day 2017: closing the gaps to end tuberculosis
Ending the tuberculosis (TB) epidemic by 2030 is one of the health targets of the Sustainable Development Goals. Although TB incidence has fallen by an average of 1.5% per year since 2000, TB is still one of the top 10 causes of death worldwide. Over 95% of TB deaths occur in low- and middle-income countries. In 2015, an estimated 480,000 people globally developed multidrug-resistant TB (MDR-TB). This ambitious aim to end the TB epidemic by 2030 can only be achieved by uniting efforts to close the research gaps…

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Industry Watch [to 25 March 2017]
:: Pfizer Receives Positive CHMP Opinion for TRUMENBA® for Prevention of Meningococcal Group B Disease
TRUMENBA Has Been Studied in a Global Clinical Development Program Evaluating the Vaccine in Adolescents and Adults1
The Majority of Meningococcal Disease Cases in Europe are Caused by Meningococcal Group B (MenB), with Adolescents and Young Adults at Increased Risk2
March 24, 2017
NEW YORK–(BUSINESS WIRE)–Pfizer Inc. (NYSE:PFE) today announced that the European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) has adopted a positive opinion recommending that TRUMENBA® (Meningococcal Group B Vaccine) be granted marketing authorization in the European Union (EU) for active immunization of individuals 10 years and older to prevent invasive meningococcal disease caused by Neisseria meningitidis serogroup B (MenB).3 The CHMP’s opinion will now be sent to the European Commission (EC) for final decision.
“This positive opinion by the CHMP to recommend marketing authorization of TRUMENBA in the EU is an additional step toward the fight to help protect individuals over 10 years of age from meningococcal disease caused by serogroup B, an uncommon yet devastating and life-threatening disease,” said Kathrin Jansen, Ph.D., senior vice president and head of Vaccine Research and Development for Pfizer Inc. “This decision further affirms the effectiveness and robust safety profile of TRUMENBA.”…

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AERAS [to 25 March 2017]
http://www.aeras.org/pressreleases
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BIO [to 25 March 2017]
http://www.bio.org/insights
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BMGF – Gates Foundation [to 25 March 2017]
http://www.gatesfoundation.org/Media-Center/Press-Releases
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CEPI – Coalition for Epidemic Preparedness Innovations [to 25 March 2017]
http://cepi.net/
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DCVMN [to 25 March 2017]
http://www.dcvmn.org/
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European Vaccine Initiative [to 25 March 2017]
http://www.euvaccine.eu/news-events
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FDA [to 25 March 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
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Fondation Merieux [to 25 March 2017]
http://www.fondation-merieux.org/news
Mission: Contribute to global health by strengthening local capacities of developing countries to reduce the impact of infectious diseases on vulnerable populations.
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GHIT Fund [to 25 March 2017]
https://www.ghitfund.org/
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that devastate the world’s poorest people. Other funders include six Japanese pharmaceutical companies, the Japanese Government and the Bill & Melinda Gates Foundation.
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Hilleman Laboratories [to 25 March 2017]
http://www.hillemanlabs.org/
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Human Vaccines Project [to 25 March 2017]
http://www.humanvaccinesproject.org/media/press-releases/
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IAVI – International AIDS Vaccine Initiative [to 25 March 2017]
http://www.iavi.org/
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IFPMA [to 25 March 2017]
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IVI [to 25 March 2017]
http://www.ivi.int/
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PhRMA [to 25 March 2017]
http://www.phrma.org/press-room
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Sabin Vaccine Institute [to 25 March 2017]
http://www.sabin.org/updates/pressreleases
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