Vaccine
Volume 35, Issue 2, Pages 201-410 (5 January 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/2

Kinetics of antibody-secreting cell and fecal IgA responses after oral cholera vaccination in different age groups in a cholera endemic country
Original Research Article
Pages 321-328
Marjahan Akhtar, Firdausi Qadri, Taufiqur R. Bhuiyan, Sarmin Akter, Tanzeem A. Rafique, Arifuzzaman Khan, Laila N. Islam, Amit Saha, Ann-Mari Svennerholm, Anna Lundgren
Abstract
Immune responses to oral enteric vaccines in children and infants may be influenced by factors such as age, previous priming with related microorganisms and breast feeding. In this study, we aimed to determine optimal time points to assess immune responses to oral enteric vaccines in different clinical specimens. This was done by investigating antibody secreting cell (ASC) and fecal antibody responses on different days after vaccination using the licensed oral cholera vaccine Dukoral, containing cholera toxin B-subunit (rCTB) and inactivated Vibrio cholerae bacteria, as a model vaccine.
Two vaccine doses were given 2 weeks apart to infants (6–11 months), young children (12–18 months), toddlers (19 months–5 years) and adults in a cholera endemic country (Bangladesh). IgA ASC responses, as determined by the antibodies in lymphocyte supernatant (ALS) assay, plasma IgA and IgG responses and secretory IgA (SIgA) responses in extracts of fecal samples were evaluated 4/5 and 7 days after each vaccination.
After the first vaccine dose, anti-CTB ALS IgA responses in adults and toddlers were high and comparable on day 5 and 7, while responses were low and infrequent in young children. After the second dose, highest ALS responses were detected on day 5 among the time points studied in all age groups and the responses declined until day 7. In contrast, plasma IgA and IgG anti-CTB responses were high both on day 5 and 7 after the second dose. Fecal SIgA responses in young children and infants were highest on day 7 after the second dose.
Our results suggest that ASC/ALS responses to two doses of the oral cholera vaccine Dukoral and related oral vaccines should be analyzed earlier than previously recommended (day 7) at all ages. Fecal antibody responses should preferably be analyzed later than ASC/ALS responses to detect the highest antibody responses.

Vaccine
Volume 35, Issue 2, Pages 201-410 (5 January 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/2

Beyond expectations: Post-implementation data shows rotavirus vaccination is likely cost-saving in Australia
Original Research Article
Pages 345-352
J.F. Reyes, J.G. Wood, P. Beutels, K. Macartney, P. McIntyre, R. Menzies, N. Mealing, A.T. Newall
Abstract
Background
Universal vaccination against rotavirus was included in the funded Australian National Immunisation Program in July 2007. Predictive cost-effectiveness models assessed the program before introduction.
Methods
We conducted a retrospective economic evaluation of the Australian rotavirus program using national level post-implementation data on vaccine uptake, before-after measures of program impact and published estimates of excess intussusception cases. These data were used as inputs into a multi-cohort compartmental model which assigned cost and quality of life estimates to relevant health states, adopting a healthcare payer perspective. The primary outcome was discounted cost per quality adjusted life year gained, including or excluding unspecified acute gastroenteritis (AGE) hospitalisations.
Results
Relative to the baseline period (1997–2006), over the 6 years (2007–2012) after implementation of the rotavirus program, we estimated that ∼77,000 hospitalisations (17,000 coded rotavirus and 60,000 unspecified AGE) and ∼3 deaths were prevented, compared with an estimated excess of 78 cases of intussusception. Approximately 90% of hospitalisations prevented were in children Conclusion
The inclusion of herd impact and declines in unspecified AGE hospitalisations resulted in the value for money achieved by the Australian rotavirus immunisation program being substantially greater than predicted by pre-implementation models, despite the potential increased cases of intussusception. This Australian experience is likely to be relevant to high-income countries yet to implement rotavirus vaccination programs.

* * * *

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

Papillomavirus Research
In Press, Accepted Manuscript — Note to users
Available online 6 January 2017
Human papillomavirus (HPV) in young woman in Britain: Population-based evidence of the effectiveness of the bivalent immunisation programme and burden of quadrivalent and 9-valent vaccine types
C Tanton, D Mesher, S Beddows, K Soldan, S Clifton… – Papillomavirus Research, 2017
Abstract
Background
In 2008, the UK introduced an HPV immunisation programme in girls. Population-based prevalence estimates of bivalent (HPV-16/18), quadrivalent (HPV-6/11/16/18) and 9-valent (HPV-6/11/16/18/31/33/45/52/58) vaccine types, and comparison over time, are needed to monitor impact, evaluate effectiveness and guide decision-making on vaccination strategies.
Methods
The third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) in 2010-12, tested urine for HPV from 2,569 sexually-experienced women aged 16–44. We report type-specific HPV prevalence and compare results with 1,798 women in Natsal-2 (1999–2001) using age-adjusted prevalence ratios (APR).
Findings
In Natsal-3, 4.2% of women aged 16-44y were positive for HPV-16/18 and 2.9% for HPV-6/11. In 16–20 year olds, 4.5%, 10.8% and 20.7% had at least one bivalent, quadrivalent or 9-valent vaccine type, respectively. Three-dose vaccine coverage was 52.0% in women aged 18-20y. In this age group, HPV-16/18 prevalence was lower in Natsal-3 than Natsal-2 (5.8% vs 11.2%; APR=0.48[95%CI: 0.24–0.93]), however, prevalences of HPV-6/11, HPV-31/33/45 and HPV-52/58 were unchanged. HPV-16/18 prevalence was also unchanged in women aged 21-44y (APR=0.85[0.61–1.19).
Interpretation
These probability surveys provide evidence of the impact of the bivalent immunisation programme. Reductions were specific to HPV-16/18 and to the age group eligible for vaccination. However, substantial vaccine-preventable HPV remains.

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

Journal of the American Pharmacists Association
Article in Press
Interventions to improve dissemination and implementation of Hepatitis B vaccination in patients with diabetes
Thomas Matta, Katherine O’Neal, Jeremy Johnson, Sandra Carter, Michelle Lamb, Lourdes Planas
DOI: http://dx.doi.org/10.1016/j.japh.2016.11.004
Abstract
Objective
The purpose of this study was to assess provider awareness of routine vaccinations recommended for patients with diabetes and to determine whether pharmacist-led interventions are associated with increased provider implementation of recommendations for hepatitis B vaccination.
Methods
This study was conducted in 3 phases at 2 outpatient clinics affiliated with an academic institution. In phase 1, adults with diabetes who visited the clinics between January and November 2012 and who were eligible for the hepatitis B vaccine were identified. In phase 2, medical residents were surveyed twice for vaccine recommendations and reasons for (not) recommending the hepatitis B vaccine, specifically. Residents were then provided a pharmacist-led in-service about hepatitis B vaccine recommendations. The third phase was initiated in April 2013, following postintervention observation from December 2012 through March 2013.
Results
Forty-eight of 100 (48%) medical residents attended the in-service and completed both surveys, with 77% indicating they did not recommend the hepatitis B vaccine. During phase 1, 1441 patients were identified, 0.6% (n = 8) of whom had received at least the first dose of the series. In phase 3, 946 patients were identified with 1.7% (n = 16) having received at least the first dose (P = 0.007).
Conclusion
An attempt to disseminate updated recommendations to providers via educational in-service was successful in increasing the percentage of eligible patients vaccinated with the hepatitis B vaccine.

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

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

Forbes
http://www.forbes.com/
Accessed 14 January 2017
AMA And Family Doctors Rip Trump Vaccine Commission
Jan 10, 2017
Bruce Japsen, Contributor
The American Medical Association and the American Academy of Family Physicians Tuesday night blasted the Trump administration idea that a new commission on vaccine safety was needed.

Foreign Policy

Home

Accessed 14 January 2017
Donald Trump and the Anti-Vaxxer Conspiracy Theorists
The president-elect’s dangerous views on the safety of vaccines threaten the lives of millions of Americans.
11 January 2017
By Laurie Garrett
Things are getting down and dirty now. And millions of lives are at stake. I cannot possibly state strongly enough how dangerous it is that President-elect Donald Trump has embraced the notion that vaccination is the cause of autism.
Robert F. Kennedy Jr., a celebrated vaccine skeptic, met with Trump on Jan. 10. Speaking to reporters outside Trump Tower in Manhattan after the meeting, Kennedy said he will chair a commission “on vaccine safety and scientific integrity” at Trump’s request, because, “we ought to be debating the science.”…

The Guardian
http://www.guardiannews.com/
Accessed 14 January 2017
Opinion
Trump’s vaccine conspiracy theories are a threat to your children
Vaccines have been shown safe and effective. When he hints otherwise, the president-elect is gambling with young lives
13 January 2017
Celine Gounder
Whether Trump is creating a commission on vaccine safety or autism, the message is clear. Trump is offering prominent support to the conspiracy theory that vaccines cause autism. The science on vaccines is very clear: they are safe and effective.

New Yorker
http://www.newyorker.com/
Accessed 14 January 2017
Trump’s Dangerous Support for Conspiracies About Autism and Vaccines
By Michael Specter
January 11, 2017

New York Times

Accessed 14 January 2017
Anti-Vaccine Activist Says Trump Wants Him to Lead Panel on Immunization Safety
10 January 2017

Washington Post
http://www.washingtonpost.com/
The United States already has a vaccine safety commission. And it works really well, experts say.
The federal panel was established more than 50 years ago and consists of medical and scientific experts as well as a consumer representative.
Lena H. Sun | National/health-science | Jan 13, 2017

The race to develop a vaccine: Scientists inch closer to preventing Zika
12 January 2017
Several companies and U.S. government institutions are racing to develop a vaccine to prevent infection from the Zika virus. The vaccine candidates to date, which use a variety of approaches, are in different stages of development…

The Post’s View: If Trump keeps stoking vaccine fears, he will endanger children’s lives
The president-elect’s meeting with a leading vaccine skeptic sent a troubling signal about a critical children’s health issues.
Editorial Board | Editorial-Opinion | Jan 12, 2017
PRESIDENT-ELECT Donald Trump’s transition team tried to tamp down the report from leading vaccine skeptic Robert F. Kennedy Jr. that Mr. Trump had asked him to lead a new panel on the safety of childhood inoculations. The president-elect, we were told, is only exploring the possibility of forming a government commission on autism. But by even entertaining the idea, Mr. Trump — who has his own troubling history when it comes to vaccine safety — gives new life to debunked conspiracy theories tying autism to vaccines. That in turn endangers children’s lives.
Mr. Trump met Tuesday with Mr. Kennedy, a longtime opponent of mandatory vaccination laws who once characterized the shots children receive to guard against illness as a holocaust. The meeting at Trump Tower, which Mr. Kennedy told reporters was requested by Mr. Trump, caused immediate and understandable concern in the medical community.
“It gives it a quasi-legitimacy that I frankly find frightening,” William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University, told the New York Times. Theories about a link between vaccines and conditions such as autism have been thoroughly discredited in numerous scientific studies that have established — without any question — the safety of vaccines.
Yet Mr. Trump, 10 days away from taking the oath of office for president, thought it important enough to meet with a leading proponent of conspiracy theories about vaccines, someone who, by the way, holds a law — not a medical — degree. Mr. Trump’s past comments about vaccines — “massive combined inoculations to small children is the cause for big increase in autism,” he tweeted in 2012 — betray an ignorant distrust of vaccines.
If Mr. Trump wants to make attacking autism a priority, he should be applauded. But he needs to go about it responsibly. Experts will tell him that the diagnosis of autism is more prevalent than in the past not because there is an “epidemic,” as he once claimed, but because the definition of autism spectrum disorder has grown more inclusive. And they will assure him there is no connection to vaccines. He will endanger the health of millions of children if he fans doubts about vaccine safety.

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

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

– pdf version:  A pdf of the current issue is available here: vaccines-and-global-health_the-week-in-review_14-january-2017

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

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

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

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

Vaccines and Global Health: The Week in Review
7 January 2017
Center for Vaccine Ethics & Policy (CVEP)

This weekly digest targets news, events, announcements, articles and research in the vaccine and global health ethics and policy space and is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage.

Vaccines and Global Health: The Week in Review is also posted in pdf form and as a set of blog posts at https://centerforvaccineethicsandpolicy.wordpress.com/. This blog allows full-text searching of over 8,000 entries.
Comments and suggestions should be directed to
David R. Curry, MS
Editor and
Executive Director
Center for Vaccine Ethics & Policy
david.r.curry@centerforvaccineethicsandpolicy.org

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

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

Editor’s Note:
Vaccines and Global Health: The Week in Review resume publication with this 7 January 2017 edition following the end-of-year holiday period.

Milestones :: Perspectives

EBOLA/EVD [to 7 January 2017]
http://www.who.int/ebola/en/
“Threat to international peace and security” (UN Security Council)

Editor’s Note:
A special edition of Vaccines and Global Health: The Week in Review was published on 23 December, providing a summary of major announcements and analysis on Ebola vaccine development and trial results as published in The Lancet – Online First on 22 December 2016, with a 23 December 2016 news release by WHO. The full text of this edition is available here: https://centerforvaccineethicsandpolicy.net/2017/01/02/vaccines-and-global-health-the-week-in-review-ebola-vaccines-update/

:::::::

Emergencies

WHO Grade 3 Emergencies [to 7 January 2017]
Iraq
:: WHO’s response to trauma cases saves hundreds of lives in Iraq
5 January 2016 – Since 17 October 2016, WHO has supported the Government of Iraq and the Kurdish Regional Government with emergency lifesaving health services, including emergency medicines and other medical supplies like trauma and surgery kits. These supplies are meant to support the increasing number of trauma cases received at trauma stabilization points and en route to the final points of performing surgery.

The Syrian Arab Republic –
:: Aid workers share experiences of evacuations from eastern Aleppo, Syria
3 January 2017 – Intensified fighting in eastern Aleppo starting in July 2016 resulted in thousands of people injured and killed, and has deprived the civilian population of essential services, including health care. On 13 December, a plan to evacuate civilians was announced by WHO and partners. The first evacuations from besieged neighbourhoods in eastern Aleppo took place 15 December 2016.
:: Regional Situation Reports
December highlights
…WHO Syria: Provided over 346,000 treatments across conflict lines to Aleppo and Homs governorates. This represents 45% of 780,000 treatments delivered this month.
…WHO Iraq: Concluded the second round of the national oral cholera vaccination campaign between 07 and 09 December in the Kurdistan Region.
…WHO Jordan: Assisted in establishing a polio control room under the leadership of the Ministry of Health, which includes WHO, UNICEF, nongovernmental organizations and Royal Medical Services.
…WHO Turkey: Completed a polio campaign in Kobani area in northern Syria covering more than 17 000 children under 5 years of age. Kobane is accessed for the first time since December 2014 due to security tensions and subsequent border blockade.

South Sudan –
:: Read the latest cholera situation report pdf, 1.08Mb 29 December 2016
[Excerpt]
ORAL Cholera Vaccination (OCV)
To increase immunity, there is a need for two rounds of oral cholera vaccination. The population of Bentiu PoC when the last two rounds were conducted in June 2015 was about 70,000. The current population has increased to 120,000. OCV coverage survey conducted by WHO/IOM in December 2016 showed that the OCV coverage stands at 40%. This is therefore not adequate to prevent transmission…

Nigeria – No new announcements identified.
Yemen – No new announcements identified.

WHO Grade 2 Emergencies [to 7 January 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.

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
:: Iraq: Mosul Humanitarian Response Situation Report #14 (26 December 2016-1 January 2017)

Syria
:: UNHRD Operations Overview: Support to Current Humanitarian Crises (as of 04 January 2017) 5 Jan 2017
:: Syrian Arab Republic: Aleppo Situation Report No. 12 (04 January 2017) [EN/AR]
:: Statement on Syria UN Humanitarian Chief 31 Dec 2016

Yemen – No new announcements identified.

Corporate Emergencies
Haiti
Haiti: Hurricane Matthew – Situation Report No. 30 (26 December 2016)
…62,000 Children received routine vaccinations Source: UNICEF

::::::

UNICEF [to 7 January 2017]

http://www.unicef.org/media/media_89711.html
PORT-AU-PRINCE, 4 January 2017
Three months after Matthew, UNICEF and its partners continue to bring assistance to affected population
[Text bolding by Editor]
Almost three months after hurricane Matthew, UNICEF and its partners continue to deliver humanitarian aid to those most affected by the category 4 storm.

Over 2 million people including 900,000 children were affected by the hurricane, of which 1.4 million require humanitarian assistance including 600,000 children.  In addition to the personal losses of homes and crops, over 716 schools, and many health facilities and the existing sanitation infrastructure all suffered damage.

Together with the government of Haiti, UNICEF and its partners have been able to ensure safe water is available daily to over 281,000 individuals, including over 118,000 children.  UNICEF contributed to the cholera vaccination campaign, in November that reached 807,395 people, ensuring the delivery also of information regarding the prevention of cholera. Over 309,213 children between the ages of 1-14 years are included in this figure. In the health sector, UNICEF has restored the cold-chain systems of 37 facilities, has equipped 35 malnutrition outpatient treatment centers in Grand’Anse and South and two inpatient facilities in each of these departments. In education, UNICEF has completed the restoration of 14 schools, with another 107 in various stages of progress.  These restored schools have made it possible for 4,200 students to return to class.  In total, it’s expected that over 36,000 students will return to the schools rehabilitated by UNICEF.

UNICEF works closely with communities on malnutrition that continues to affect children and adults as they struggle to recover from the extended drought and the subsequent effects of hurricane Matthew including persistent risk of disease and loss of livelihood.  UNICEF protection interventions are supporting families that have lost their livelihoods, aimed at preventing child separation; it is common for parents to place their children in residential care facilities in the often-false expectation that they will receive access to education that parents can no longer afford.  Economic stress is also known to lead to violence, and increased social tension which combine to increase the potential for child abuse and neglect…

“Three months after Matthew, we can already see improvements: safe water is increasingly available, the vast majority of schools have reopened as have a number of health facilities; and areas that are the most difficult to access are receiving assistance. UNICEF is continuing to fulfil its mandate and obligations to emergency and development efforts, “said Marc Vincent, UNICEF Representative in Haiti…

::::::

Zika virus [to 7 January 2017]
http://www.who.int/emergencies/zika-virus/en/

Zika situation report – 05 January 2017
Full report: http://apps.who.int/iris/bitstream/10665/252762/1/zikasitrep5Jan17-eng.pdf?ua=1
Key Updates
:: Countries and territories reporting mosquito-borne Zika virus infections for the first time in the past week:
… None
:: Countries and territories reporting microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection for the first time in the past week:
… None
:: Countries and territories reporting Guillain-Barré syndrome (GBS) cases associated with Zika virus infection for the first time in the past week:
… None
:: This is the last weekly situation report. Going forward, the reports will be published every two weeks. The next report will be issued on 19 January.
Analysis
:: Overall, the global risk assessment has not changed. Zika virus continues to spread geographically to areas where competent vectors are present. Although a decline in cases of Zika infection has been reported in some countries, or in some parts of countries, vigilance needs to remain high.

Zika Open [to 7 January 2017]
[Bulletin of the World Health Organization]
:: All papers available here
No new papers identified.

CDC Highlights Significant Contributions in the Fight against Zika in 2016
FRIDAY, DECEMBER 30, 2016
Seventy years after CDC was founded to fight mosquitoes that carried malaria, CDC found itself entrenched in combat with another mosquito-borne illness, Zika virus.

::::::

POLIO [to 7 January 2017]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 4 January 2017
:: Summary of newly-reported viruses this week (see country-specific sections below for further details): Pakistan:  three positive environmental samples (wild poliovirus type 1 – WPV1)

:: New this week: new webinars on outbreak response – check the last item in Resources for Polio Eradicators to learn about outbreak response protocols, cold chain logistics, and evaluating communications in outbreaks, among others. These webinars complement the guidelines and protocols developed by GPEI partners.

Country Updates [Selected Excerpts]
Pakistan
:: Three WPV1-positive environmental samples were reported in the past week from Quetta, Balochistan, collected on 12 December; Rawalpindi, Punjab, collected on 10 December; and Peshawar, Khyber Pakhtunkhwa (KP), collected on 10 December.
:: An outbreak response activity using monovalent oral polio vaccine type 2 (mOPV2) is being implemented this week in Quetta, in response to a confirmed circulating vaccine-derived poliovirus type 2 (cVDPV2) in the area, in line with internationally-agreed outbreak response protocols.  The Ministry of Health, supported by the World Health Organization (WHO) and partners, is further strengthening active search for cases of acute flaccid paralysis (AFP), and conducting an in-depth field investigation to more clearly ascertain the extent of circulation of the cVDPV2.

Pakistani city launches new polio campaign after rare strain found
Reuters By Gul Yousafzai |
2 January 2017 QUETTA, Pakistan
Pakistan began a special five-day polio immunisation campaign in the southwestern city of Quetta on Monday for children under five after a rare strain of the virus was found in sewage samples, officials said.
Local officials said they had recruited Muslim clerics to promote the immunisations for 400,000 children after past programmes were met with resistance and even violence by extremists.
“The religious leaders were … asking the people to give their children anti-polio drops in their sermons in the mosques in rural areas of Baluchistan,” said Syed Faisal Ahmed, coordinator of the local Emergency Operation Centre.
Pakistan is one of just three countries in the world, along with Afghanistan and Nigeria, that have endemic polio, a once-common childhood virus that can cause paralysis or death.
Last year, Pakistan reported a record low of 19 cases, Ahmed said, with only one of them in Baluchistan province, of which Quetta is the capital.
The new campaign follows the detection of the rare Type 2 strain of polio in sewage samples taken by the World Health Organization in November, Ahmed said. The WHO reported the findings last week.
No cases of the Type 2 strain have been reported in humans in Quetta but it has been added to the vaccine as a precaution. The more common type of polio is Type 1, with no human cases of Type 2 reported for more than a decade.
“We have achieved major goals in combating polio disease, but still we have to strive more to declare Pakistan a polio-free country,” Ahmed said…

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

Yellow Fever [to 7 January 2017]
http://www.who.int/emergencies/yellow-fever/en/

Editor’s Note:
The last situation report was published 28 October 2016 here: Yellow fever situation report .We will maintain this section to monitor for additional updates and other announcements.

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

WHO & Regional Offices [to 7 January 2017]

140th session of the Executive Board
23 January–1 February 2017, Geneva

Working as one UN for environmental health
3 January 2017 – There are many compelling reasons to clean up the global environment. One of the most pressing is that a polluted environment is deadly: every year, 1 in 4 people die from diseases associated with air, water or soil pollution. The United Nations Environment Programme (UNEP), the World Meteorological Organization (WMO) and WHO are creating a global mechanism to bring together the environment and health sectors.
Commentary

Highlights
Response to trauma cases saves hundreds of lives in Iraq
January 2017 – Since 17 October 2016, WHO has supported the Government of Iraq and the Kurdish Regional Government with emergency lifesaving health services, including emergency medicines and other medical supplies like trauma and surgery kits.

Aid workers share experiences of evacuations from eastern Aleppo, Syria
January 2017 – Intensified fighting in eastern Aleppo starting in July 2016 resulted in thousands of people injured and killed, and has deprived the civilian population of essential services, including health care. The first evacuations from besieged neighbourhoods in eastern Aleppo took place 15 December 2016.

Weekly Epidemiological Record, 6 January 2017, vol. 92, 1 (pp. 1–12)
:: Status of new vaccine introduction – worldwide, September 2016
:: Detection of Sabin-like type 2 poliovirus after global cessation of trivalent oral poliovirus vaccine in Hyderabad and Ahmedabad, India, August–September 2016

:: WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
No new announcements identified.

WHO Region of the Americas PAHO
:: Toward the end of polio: The vaccine ‘switch’ in the Americas (12/29/2016)
:: 2016: the year Zika evolved from an emergency into a long-term public health challenge (12/29/2016)

WHO South-East Asia Region SEARO
No new announcements identified.

WHO European Region EURO
:: Experiences of evacuations from eastern Aleppo, Syria 06-01-2017

WHO Eastern Mediterranean Region EMRO
:: WHO’s response to trauma cases saves hundreds of lives in Iraq
5 January 2017 – Since 17 October 2016, WHO has supported the Government of Iraq and the Kurdish Regional Government with emergency lifesaving health services, including emergency medicines and other medical supplies like trauma and surgery kits. These supplies are meant to support the increasing number of trauma cases received at trauma stabilization points and en route to the final points of performing surgery.
:: WHO welcomes continued support from the Government of France and European Union Member States 6 January 2017
:: WHO provides lifesaving HIV medicines in Benghazi, Libya 3 January 2017

WHO Western Pacific Region
No new announcements identified.

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

CDC/ACIP [to 7 January 2017]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/
Press Release
FRIDAY, DECEMBER 30, 2016
CDC Highlights Significant Contributions in the Fight against Zika in 2016
Seventy years after CDC was founded to fight mosquitoes that carried malaria, CDC found itself entrenched in combat with another mosquito-borne illness, Zika virus.

MMWR Weekly January 6, 2017/No. 52
[Excerpts]
:: Human Rabies — Puerto Rico, 2015
:: Zika Virus —10 Public Health Achievements in 2016 and Future Priorities
:: Notes from the Field: Compliance with Postexposure Prophylaxis for Exposure to Bacillus anthracis Among U.S. Military Personnel — South Korea, May 2015
:: Notes from the Field: Detection of Sabin-Like Type 2 Poliovirus from Sewage After Global Cessation of Trivalent Oral Poliovirus Vaccine — Hyderabad and Ahmedabad, India, August–September 2016

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

Announcements

Human Vaccines Project [to 7 January 2017]
http://www.humanvaccinesproject.org/media/press-releases/
January 4, 2017
Moderna Joins the Human Vaccines Project to Help Advance Fundamental Understanding of the Immune System
Public-Private Consortium Collaborating to Generate New Immunological Insights, Accelerate Development of Vaccines and Immunotherapies
CAMBRIDGE, Mass. — Moderna Therapeutics, a clinical stage biotechnology company pioneering messenger RNA (mRNA) Therapeutics to create a new generation of transformative medicines for patients, announced today that it will join the Human Vaccines Project, a non-profit public-private partnership focused on decoding the human immune system to accelerate the development of vaccines and immunotherapies against major infectious diseases and cancer. Moderna will join the global, cross-sector consortium of academic research centers, biopharmaceutical companies, governments and non-profit organizations in sharing knowledge and resources to generate key insights about immunological protection, and address primary scientific hurdles to developing new vaccines and immunotherapies.

“We are proud to support the important efforts of the Human Vaccines Project to unlock basic understanding of the immune system and translate this knowledge to accelerate infectious disease vaccines and cancer immunotherapies,” said Michael Watson, President of Valera, Moderna’s infectious disease-focused venture. “Collaborating with biopharma, academic, non-profit and government organizations has been a key focus of Moderna’s strategy to advance the promise of mRNA science for patients. We look forward to contributing to this consortium in kind, helping advance knowledge about human immunity that, ultimately, could help people around the world.”

Moderna currently has four mRNA-based infectious disease vaccines in clinical study and another four infectious disease vaccines advancing toward the clinic. The company is also developing an mRNA-based personalized cancer vaccine…

“We are honored to have Moderna join the Human Vaccines Project’s efforts to address the immunologic challenges impeding development of new and improved vaccines and immunotherapies for major infectious diseases and cancers,” said Wayne C. Koff, President and CEO, Human Vaccines Project. By harnessing recent technological advances from biomedical, computational, and engineering sciences, including Moderna’s transformative mRNA platform, the Project offers the potential to decode the human immune system, accelerate product development, and usher in a new era of global disease prevention.”

::::::

Coalition for Epidemic Preparedness Innovations (CEPI) [to 7 January 2017]
http://cepi.net/
CEPI Newsletter 6 January 2017
[Excerpts]
Message from the Interim CEPI CEO
“We have a new year ahead of us. The end of last year provided a gift for all of us – the
Ebola vaccine that has been tried out in Guinea during the outbreak in 2015 has proven to
be highly protective against Ebola virus disease. CEPI grew out of both the good and bad
experiences from the Ebola outbreak; the global mechanisms did not work as intended,
but a tremendous collaborative effort made them work. The confirmation of the
protectiveness of the vaccine, as documented in the Lancet, demonstrates that we are
able to achieve great things when we work together across borders. Let us all celebrate
this is as an inspiration for our future work through CEPI.
A new year is ahead of us, and important milestones are right around the corner. Already
on 19 January CEPI will launch officially at the World Economic Forum’s annual meeting
in Davos…
John-Arne Røttingen, Interim CEPI CEO

Partners Forum
In an earlier newsletter, news about the establishment of a CEPI Partners Forum was
shared. We are now pleased to announce that the Partners Forum is officially open for
sign-on. To become a member of the Partners Forum, kindly follow this link and sign on to
the online “Partners Statement”. Here you will also find more information about the forum
and its envisioned functions.

::::::

PATH [to 7 January 2017]
http://www.path.org/news/index.php
Announcement | December 27, 2016
PATH welcomes Peggy Johnson and Deanna Oppenheimer to its board of directors
PATH’s board of directors has voted to appoint Peggy Johnson and Deanna Oppenheimer to the board. Ms. Johnson brings diverse experience in business development, strategic partnerships, and investment management, while Ms. Oppenheimer enhances the board’s expertise in global finance, brand marketing, banking and communications…

::::::

FDA [to 7 January 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
What’s New for Biologics
:: CBER Vaccine ICSR Implementation – Consolidated Dictionary Business Rules (XLSX – 118KB)
Updated: 1/6/2017
:: FY 2016 Report from the Director Posted: 1/5/2017
:: Public Workshop: Emerging Tick-Borne Diseases and Blood Safety Posted: 1/4/2017

::::::

The Vaccine Confidence Project [to 7 January 2017]
http://www.vaccineconfidence.org/
Confidence Commentary
Message for the New Year: The answer is blowin’ in the wind
Heidi Larson | 4 Jan, 2017
[Excerpt]
…If we look around at the public health landscape at the start of 2017, there are a number of challenges ahead, not the least of which is growing anti-microbial resistance, which is becoming increasingly urgent. Another area, which is keeping a number of people awake at night and which I would consider the number one concern of the Vaccine Confidence Project, is the threat of a highly fatal flu pandemic.

In a 2016 year-end interview on BBC Radio with the UK’s Chief Medical Officer Sally Davies, Bill Gates revealed his concerns about the vulnerability of the world to the next flu pandemic. In short, his assessment was that we’re not ready for the next “big one” when it comes to epidemics. “I cross my fingers that some epidemic like a flu doesn’t come along in the next 10 years,” says Mr Gates, confident that we will develop better tools and approaches over the next decade, but soberly expressing concerns that if we are faced with a quickly spreading fatal strain of the flu today, “it would be a tragedy.”  In short, we couldn’t manage it.

At the end of November, in an interview in the Wall Street Journal, the Director of the US Centers for Disease Control, Tom Frieden, shared a similar sentiment. “Frankly, pandemic influenza is what worries us most.”

According to WHO, the “normal” seasonal flu epidemics cause serious illness in three to five million people around the world and between 250,00-500,000 people die of influenza every year. And, those are not the most virulent strains.

If we reflect on the global panic around Ebola’s fatal spread, the total death toll was just over 11,000. This is not to underestimate the extensive social and economic turmoil it also caused, but just to put the flu risk in perspective. The 1918 ‘Spanish’ flu pandemic infected 500 million people across the world, spread as far as remote Pacific islands and the Arctic, and resulted in the deaths of 50 to 100 million people (three to five percent of the world’s population).

Why is there such a difference between our more complacent attitude towards influenza versus more panic-prone anxieties around Ebola? Known versus unknown. Familiar versus unfamiliar.  One of the challenges for pandemic flu preparedness  is the widespread perception that “it’s just the flu”.

If I were to choose one new year’s message, it is that we need to work harder in peaceful times to build resilience. We can start by taking flu more seriously – ourselves, our families and neighbours…

::::::

Industry Watch [to 7 January 2017]
:: Sanofi Pasteur and MSD end joint vaccines business in Europe
Paris, France – January 2, 2017 – Sanofi and its vaccines global business unit Sanofi Pasteur confirmed today the end of their vaccine joint-venture with MSD (known as Merck & Co. Inc., in the United States and Canada), Sanofi Pasteur MSD (SPMSD). Sanofi Pasteur and MSD will separately pursue their own vaccine strategies in Europe, integrating their respective European vaccines business into their operations. The change in operations took effect January 1, 2017.
Since its announcement in March 2016, the project has been managed in an open dialogue with the SPMSD employees, unions and relevant external stakeholders, in compliance with the applicable rules and regulations. During the transitional period following the announcement of the ending of the joint-venture, SPMSD and Sanofi and Merck, its shareholders, have been focused on a smooth and orderly transition while achieving their public healthcare goals and upholding their commitments to their employees, customers and business partners.
Each company will be able to define its own vaccines strategy to benefit public health and create value for patients, healthcare professionals, and payers. In November 2015, as part of its strategic roadmap 2020, Sanofi announced that it would reshape its portfolio, namely through sustained leadership in vaccines.

:: PaxVax Partners with National Institutes of Health and Department of Defense to Develop a New Virus-Like Particle Vaccine to Fight the Spread of Chikungunya
REDWOOD CITY, Calif., Jan. 5, 2017 /PRNewswire/ — PaxVax announced today its partnership with the National Institutes of Health (NIH) and United States Department of Defense (DoD) on its chikungunya vaccine program. According to the terms of the collaboration, PaxVax has in-licensed the NIH virus-like particle (VLP) vaccine technology for chikungunya with plans to bring the vaccine through full commercialization. NIH has already completed a phase 1 trial, and is currently assessing the vaccine in a phase 2 trial. For the past year, PaxVax has been working to develop a commercial manufacturing process and the necessary release assays. In addition to conducting its own trials, PaxVax will work with the Walter Reed Army Institute of Research (WRAIR)—a DoD biomedical research laboratory—to conduct an additional clinical trial to assess the potential advantages of an alum adjuvant in the vaccine formulation.

:: US FDA Grants Orphan Drug Designation to Yisheng Biopharma’s PIKA Rabies Vaccine
Jan 04, 2017
The U.S. Food and Drug Administration (FDA) has granted orphan drug designation for its lead vaccine candidate, PIKA rabies vaccine, which is an innovative rabies vaccine independently developed by Yisheng Biopharma, using its proprietary toll-like receptor-3 (TLR-3) activation technology.

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

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

No new content identified.

* * * *

Journal Watch
Vaccines and Global Health: The Week in Review continues its weekly scanning of key peer-reviewed journals to identify and cite articles, commentary and editorials, books reviews and other content supporting our focus on vaccine ethics and policy. Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher.
If you would like to suggest other journal titles to include in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

American Journal of Infection Control
January 2017 Volume 45, Issue 1, p1-104, e1-e22
http://www.ajicjournal.org/current

Commentaries
Our health care workers need more than infection prevention best practice while caring for patients with novel and highly pathogenic infections
Mary-Louise McLaws
p4–5
Published online: November 14, 2016
[No abstract]

American Journal of Preventive Medicine
January 2017 Volume 52, Issue 1, p1-134, e1-e32
http://www.ajpmonline.org/current

Research Articles
Herpes Zoster Vaccine Coverage in Older Adults in the U.S., 2007–2013
Dongmu Zhang, Kelly Johnson, Chrisann Newransky, Camilo J. Acosta
e17–e23
Published online: October 26, 2016
Open Access
Abstract
Introduction
This study aimed to assess the coverage of herpes zoster (HZ) vaccine among a large cohort of insured individuals aged ≥50 years from 2007 to 2013, and to determine the factors associated with being vaccinated for adults aged ≥60 years.
Methods
This was a retrospective, observational study using the MarketScan® database conducted in 2015. The study population was U.S. adults aged ≥60 years during 2007−2013 and 50–59 years during 2011–2013. The claims of each eligible subject were evaluated post–index date to assess HZ vaccine uptake. Multivariate analyses were performed to understand factors associated with receiving HZ vaccine.
Results
A total of 6,746,476 adults aged ≥60 years and 6,770,294 adults aged 50–59 years were identified. By 2013, 1.7% of adults aged 50–59 years, 23.9% of adults aged 60–64 years, and 14.5% of adults aged ≥65 years received HZ vaccine. Adults aged ≥65 years were less likely to receive HZ vaccine than those aged 60–64 years (hazard ratio [HR]=0.543; 95% CI=0.539, 0.547). Adults who were female, immunocompetent, and had more outpatient hospital, doctor office, and pharmacy visits were more likely to receive HZ vaccine. Adults who received influenza vaccine were more likely to receive HZ vaccine (HR=1.841; 95% CI=1.830, 1.853).
Conclusions
Estimated HZ vaccine coverage is 19.5% in adults aged ≥60 years, which is lower than the Healthy People 2020 target of 30%. Providers should identify every opportunity for HZ vaccination to assure that older adults are protected from HZ, a vaccine-preventable disease.

American Journal of Public Health
Volume 107, Issue 1 (January 2017)
http://ajph.aphapublications.org/toc/ajph/current

VACCINES
The Dangerous Curve and The Guardrail: Disease and Vaccination
Robert James Kim-Farley, MD, MPH

AJPH LAW & ETHICS – VACCINES
Parental Refusal of Childhood Vaccines and Medical Neglect Laws
Efthimios Parasidis, Douglas J. Opel
American Journal of Public Health: January 2017, Vol. 107, No. 1: 68–71.
Abstract
Objectives. To examine the relation of vaccine refusal and medical neglect under child welfare laws.
Methods. We used the Westlaw legal database to search court opinions from 1905 to 2016 and identified cases in which vaccine refusal was the sole or a primary reason in a neglect proceeding. We also delineated if religious or philosophical exemptions from required school immunizations were available at the time of adjudication.
Results. Our search yielded 9 cases from 5 states. Most courts (7 of 9) considered vaccine refusal to constitute neglect. In the 4 cases decided in jurisdictions that permitted religious exemptions, courts either found that vaccine refusal did not constitute neglect or considered it neglect only in the absence of a sincere religious objection to vaccination.
Conclusions. Some states have a legal precedent for considering parental vaccine refusal as medical neglect, but this is based on a small number of cases. Each state should clarify whether, under its laws, vaccine refusal constitutes medical neglect.

American Journal of Public Health
Volume 107, Issue 1 (January 2017)
http://ajph.aphapublications.org/toc/ajph/current

AJPH RESEARCH – VACCINES
Trends in Personal Belief Exemption Rates Among Alternative Private Schools: Waldorf, Montessori, and Holistic Kindergartens in California, 2000–2014
Julia M. Brennan, Robert A. Bednarczyk, Jennifer L. Richards, Kristen E. Allen, Gohar J. Warraich, Saad B. Omer
American Journal of Public Health: January 2017, Vol. 107, No. 1: 108–112.
ABSTRACT
Objectives. To evaluate trends in rates of personal belief exemptions (PBEs) to immunization requirements for private kindergartens in California that practice alternative educational methods.
Methods. We used California Department of Public Health data on kindergarten PBE rates from 2000 to 2014 to compare annual average increases in PBE rates between schools.
Results. Alternative schools had an average PBE rate of 8.7%, compared with 2.1% among public schools. Waldorf schools had the highest average PBE rate of 45.1%, which was 19 times higher than in public schools (incidence rate ratio = 19.1; 95% confidence interval = 16.4, 22.2). Montessori and holistic schools had the highest average annual increases in PBE rates, slightly higher than Waldorf schools (Montessori: 8.8%; holistic: 7.1%; Waldorf: 3.6%).
Conclusions. Waldorf schools had exceptionally high average PBE rates, and Montessori and holistic schools had higher annual increases in PBE rates. Children in these schools may be at higher risk for spreading vaccine-preventable diseases if trends are not reversed.

American Journal of Public Health
Volume 107, Issue 1 (January 2017)
http://ajph.aphapublications.org/toc/ajph/current

SYSTEMATIC REVIEWS
Evidence and Health Policy: Using and Regulating Systematic Reviews
Daniel M. Fox
American Journal of Public Health: January 2017, Vol. 107, No. 1: 88–92.

Systematic Review: A Method at Risk for Being Corrupted
Lisa Bero
American Journal of Public Health: January 2017, Vol. 107, No. 1: 93–96.

Systematic Reviews for Policymaking: Muddling Through
Trisha Greenhalgh, Kirsti Malterud
American Journal of Public Health: January 2017, Vol. 107, No. 1: 97–99.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 7 January 2017)

Research article
Selection of essential medicines for South Africa – an analysis of in-depth interviews with national essential medicines list committee members
The South African (SA) public health system has employed an Essential Medicines List (EML) with Standard Treatment Guidelines (STGs) in the public sector since 1996. To date no studies have reported on the pro…
Velisha Ann Perumal-Pillay and Fatima Suleman
BMC Health Services Research 2017 17:17
Published on: 7 January 2017

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 7 January 2017)

Research article
Outbreak of Middle East respiratory syndrome coronavirus in Saudi Arabia: a retrospective study
The Middle East respiratory syndrome (MERS) is proposed to be a zoonotic disease. Dromedary camels have been implicated due to reports that some confirmed cases were exposed to camels. Risk factors for MERS co…
Fadilah Sfouq Aleanizy, Nahla Mohmed, Fulwah Y. Alqahtani and Rania Ali El Hadi Mohamed
BMC Infectious Diseases 2017 17:23
Published on: 5 January 2017

Research article
Pneumococcal carriage and antibiotic susceptibility patterns from two cross-sectional colonization surveys among children aged <5 years prior to the introduction of 10-valent pneumococcal conjugate vaccine — Kenya, 2009–2010
Pneumococci are spread by persons with nasopharyngeal colonization, a necessary precursor to invasive disease. Pneumococcal conjugate vaccines can prevent colonization with vaccine serotype strains. In 2011, K…
Miwako Kobayashi, Laura M. Conklin, Godfrey Bigogo, Geofrey Jagero, Lee Hampton, Katherine E. Fleming-Dutra, Muthoni Junghae, Maria da Gloria Carvalho, Fabiana Pimenta, Bernard Beall, Thomas Taylor, Kayla F. Laserson, John Vulule, Chris Van Beneden, Lindsay Kim, Daniel R. Feikin…
BMC Infectious Diseases 2017 17:25
Published on: 5 January 2017

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 7 January 2017)

Research article
Characteristics and knowledge synthesis approach for 456 network meta-analyses: a scoping review
Network meta-analysis (NMA) has become a popular method to compare more than two treatments. This scoping review aimed to explore the characteristics and methodological quality of knowledge synthesis approaches underlying the NMA process.
Wasifa Zarin, Areti Angeliki Veroniki, Vera Nincic, Afshin Vafaei, Emily Reynen, Sanober S. Motiwala, Jesmin Antony, Shannon M. Sullivan, Patricia Rios, Caitlin Daly, Joycelyne Ewusie, Maria Petropoulou, Adriani Nikolakopoulou, Anna Chaimani, Georgia Salanti, Sharon E. Straus…
BMC Medicine 2017 15:3
Published on: 5 January 2017

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 7 January 2017)

Study protocol
Sun protection to improve vaccine effectiveness in children in a high ambient ultraviolet radiation and rural environment: an intervention study
Caradee Y. Wright, Patricia N. Albers, Angela Mathee, Zamantimande Kunene, Catherine D’Este, Ashwin Swaminathan and Robyn M. Lucas
BMC Public Health 2017 17:37
Published on: 6 January 2017
Abstract
Background
Vaccination is a mainstay of preventive healthcare, reducing the incidence of serious childhood infections. Ecological studies have demonstrated an inverse association between markers of high ambient ultraviolet (UV) radiation exposure (e.g., sunny season, low latitude of residence) and reduction in the vaccination-associated immune response. Higher sun exposure on the day prior to and spanning the day of vaccination has been associated with a reduced antigen-specific immune response independent of skin pigmentation. The South African Department of Health’s Expanded Programme on Immunisation provides free vaccinations in government primary health care clinics. In some areas, these clinics may have only a small waiting room and patients wait outside in full sun conditions. In rural areas, patients may walk several kilometres to and from the clinic. We hypothesised that providing sun protection advice and equipment to mothers of children (from 18 months) who were waiting to be vaccinated would result in a more robust immune response for those vaccinated.
Methods
We conducted an intervention study among 100 children receiving the booster measles vaccination. We randomised clinics to receive (or not) sun protection advice and equipment. At each clinic we recorded basic demographic data on the child and mother/carer participants, their sun exposure patterns, and the acceptability and uptake of the provided sun protection. At 3–4 weeks post-vaccination, we measured measles IgG levels in all children.
Discussion
This is the first intervention study to assess the effect of sun protection measures on vaccine effectiveness in a rural, real-world setting. The novel design and rural setting of the study can contribute much needed evidence to better understand sun exposure and protection, as well as factors determining vaccine effectiveness in rural Africa, and inform the design of immunisation programmes. (TRN PACTCR201611001881114, 24 November 2016, retrospective registration)

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 7 January 2017)

Research article
Will they lead by example? Assessment of vaccination rates and attitudes to human papilloma virus in millennial medical students
Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. It is also well established that HPV viruses are responsible for a variety of cancers. Little is known about t…
Nelia M. Afonso, Maurice J. Kavanagh, Stephanie M. Swanberg, Jeanne M. Schulte, Tracy Wunderlich and Victoria C. Lucia
BMC Public Health 2017 17:35
Published on: 6 January 2017

Bulletin of the World Health Organization
Volume 95, Number 1, January 2017, 1-84
http://www.who.int/bulletin/volumes/94/11/en/

EDITORIALS
Working as one UN to address the root environmental causes of ill health
Margaret Chan, Erik Solheim & Petteri Taalas
Bulletin of the World Health Organization 2017;95:2. doi: http://dx.doi.org/10.2471/BLT.16.189225
There are many compelling reasons why we need to clean up the global environment. One of the most pressing is that a polluted environment is a deadly one. Every year, almost 12.6 million people die from diseases associated with environmental hazards, such as air, water or soil pollution, and climate change.1 That is one in four deaths worldwide.1

We now know that the single greatest environmental risk to human health is through our most basic need – the air that we breathe.1 For years, governments have struggled to improve access to energy so they can promote economic development. But the largely unsustainable energy path that the world has followed has come at an unacceptable cost. Air pollution, overwhelmingly resulting from energy production and use, causes heart and lung diseases and cancer, resulting in approximately 6.5 million deaths each year.2

The energy sources that cause the release of deadly air pollutants, such as black carbon, also release greenhouse gases, including methane and carbon dioxide. Together, these drive climate change, which threatens to undermine all of the environmental conditions on which human lives depend – food, water, and shelter.3

By 2050, 66% of the world’s population will live in urban areas, which are often characterized by pollution as well as heavy traffic, poor housing, limited access to water and sanitation services and other health risks.4

Environmental risks to health, like many of the challenges facing our world, are too complex and interconnected to be dealt with by simplistic, short-term solutions or by individual actors. That’s why the 2030 agenda for sustainable development, adopted by all countries, is so important. This, the world’s first ever global development plan, offers a unique opportunity for coherent, long-term action by all of society for all of society.5

Many governments are now bringing several ministries and departments together, for example linking up environment, climate and health sectors, to take joint action. We saw this recently at the Conference of the Parties to the United Nations Framework Convention on Climate Change when ministers of health and environment answered a call by the Government of Morocco to sign the Marrakech Ministerial Declaration on Health, Environment and Climate Change.6 The declaration recognizes that there is currently no global mechanism to bring the environment and health sectors together to work on saving lives and protecting the planet, and calls on the relevant United Nations (UN) agencies to put a mechanism in place.6

The challenge now is to follow up this declaration with actions.

Simple interventions, such as reducing vehicle emissions and investments in rapid transit systems, will save lives. Benin, Côte d’Ivoire, Ghana, Nigeria and Togo have committed to introduce low sulphur fuels by July 2017. Athens, Madrid, Mexico City and Paris plan to ban diesel vehicles by 2025. Implementing proven interventions to address short-lived climate pollutants could save over 2.4 million lives a year, and reduce global warming by approximately 0.5 C, by 2050.7 In many cases the benefits will more than cover the cost of intervention.
Failure to take into account the health impacts of air pollution and other environmental damages is estimated to amount to a US$ 5.3 trillion dollar subsidy to polluting energy sources.8 Failure to protect populations from environmental risks is not just a human cost, but places an additional strain on health services. Health service-related cost is among the largest financial burdens for governments and individuals.

Just as it is in both the individual and the collective interest of countries and ministries to work together to address complex problems, it is essential for all UN agencies to work more closely together to support them.

The United Nations Environment Programme (UNEP), the World Meteorological Organization (WMO) and the World Health Organization (WHO) are working together to support countries to follow through on the aims of the Marrakech Declaration. We are committed to joining our technical and financial resources behind a single environment and health plan. Air pollution will be our first priority due to the huge health impacts that it causes, as well as its close links with other risks, such as climate change and chemical contamination.

Each of us will bring our wealth of expertise in either climate, health or environment. WMO, through national meteorological agencies and their network of ground and remote-sensing stations, provides the essential data on climate, and air quality conditions, and facilitates the delivery of related weather and climate services. UNEP works with Member States’ Ministries of Environment and other key policy-makers to help prevent and reverse environmental degradation, thereby supporting individuals and communities. WHO, with national Ministries of Health, monitors and assesses health exposures and health impacts, and provides guidance on how to reduce them.

By June 2017 our agencies will have developed a joint plan, seeking wider engagement from other agencies and from the scientific, environment and health communities at large. In the words of the African proverb: “If you want to go fast, go alone. If you want to go far, go together.”

References
Prüss-Ustün A, Wolf J, Corvalán C, Neira M, editors. Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016. Available from: http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1 [cited 2016 Dec 5].

Ambient air pollution: A global assessment of exposure and burden of disease. Geneva: World Health Organization; 2016. Available from: http://www.who.int/iris/bitstream/10665/250141/1/9789241511353-eng.pdf?ua=1 [cited 2016 Dec 5].

Reducing global health risks through mitigation of short-lived climate pollutants. Scoping report for policy-makers. Geneva: World Health Organization; 2015. Available from: http://apps.who.int/iris/bitstream/10665/189524/1/9789241565080_eng.pdf?ua=1 [cited 2016 Dec 5].

World urbanization prospects. The 2014 revision. Highlights (ST/ESA/SER.A/352). New York: United Nations; 2014. Available from: https://esa.un.org/unpd/wup/Publications/Files/WUP2014-Highlights.pdf [cited 2016 Dec 5].

Transforming our world: the 2030 agenda for sustainable development. New York: United Nations; 2015.
Marrakech ministerial declaration on health, environment and climate change. In: Conference of the parties to the United Nations framework convention on climate change. (UNFCCC COP22), 15 November 2016. Marrakesh: Morocco; 2016. Available from: http://www.who.int/globalchange/mediacentre/events/Ministerial-declaration-EN.pdf?ua=1 [cited 2016 Dec 5].

Shindell D, Kuylenstierna JC, Vignati E, van Dingenen R, Amann M, Klimont Z, et al. Simultaneously mitigating near-term climate change and improving human health and food security. Science. 2012 Jan 13;335(6065):183–9. http://dx.doi.org/10.1126/science.1210026 pmid: 22246768

Coady D, Parry I, Sears L, Shang B. How large are global energy subsidies? IMF working paper (WP/15/105). Washington: International Monetary Fund; 2015. Available from: https://www.imf.org/external/pubs/ft/wp/2015/wp15105.pdf [cited 2016 Dec 5].

Bulletin of the World Health Organization
Volume 95, Number 1, January 2017, 1-84
http://www.who.int/bulletin/volumes/94/11/en/

RESEARCH
Countries’ response to WHO’s travel recommendations during the 2013–2016 Ebola outbreak
Wendy Rhymer & Rick Speare
http://dx.doi.org/10.2471/BLT.16.171579
Abstract
Objective
To determine how, during the 2013–2016 Ebola outbreak in western Africa, States Parties to the World Health Organization’s (WHO) 2005 International Health Regulations (IHR) followed the IHR’s international travel recommendations.
Methods
In 2015, we used the Google search engine to investigate the 196 States Parties to the 2005 IHR. Information detailing Ebola-related travel regulations or restrictions of each State Party was sourced first from official government websites and then from travel and news websites. When limited, conflicting or no relevant information was found on a government website, an email inquiry was sent to a corresponding embassy in an Anglophone country.
Findings
We collected relevant and non-conflicting data for each of 187 States Parties. Of these, 43 (23.0%) prohibited the entry of foreigners who had recently visited a country with widespread Ebola transmission and another 15 (8.0%) imposed other substantial restrictions on such travellers: the requirement to produce a medical certificate documenting no infection with Ebola (n = 8), mandatory quarantine (n = 6) or other restrictions (n = 1).
Conclusion
In responding to the 2013–2016 Ebola outbreak, countries had variable levels of adoption of the 2005 IHR’s international travel recommendations. We identified 58 (31.0%) States Parties that exceeded or disregarded the recommendations. There is a need for more research to understand and minimize deviations from such recommendations.

Bulletin of the World Health Organization
Volume 95, Number 1, January 2017, 1-84
http://www.who.int/bulletin/volumes/94/11/en/

PERSPECTIVES
Improving health-care quality in resource-poor settings
Bejoy Nambiar, Dougal S Hargreaves, Chelsea Morroni, Michelle Heys, Sonya Crowe, Christina Pagel, Felicity Fitzgerald, Susana Frazao Pinheiro, Delan Devakumar, Sue Mann, Monica Lakhanpaul, Martin Marshall & Tim Colbourn
http://dx.doi.org/10.2471/BLT.16.170803
Excerpt
Elements to consider when improving health-care quality in resource-poor settings:
Systems thinking
Health systems are dynamic complex adaptive systems, where all parts need to be considered. These parts are (i) the inter-relationships between the patient, clinical and nonclinical workers in the health system; (ii) the different levels of the health system ranging from the community to tertiary referral system; and (iii) the required human and material resources and training, supervision and management structures.
Participatory approach
Participatory, grounded and bottom-up approaches involving health-care professionals, patients and communities as well as researchers-in-residence are important to understand health systems. Participation also increases buy-in to quality improvement efforts and enables design and implementation of interventions that are effective in specific contexts, consider sociocultural beliefs and build accountability.
Accountability
The people involved in making health systems work must be accountable to the individuals and local communities the health system is serving. Data for decision-making is important as it can be used to encourage and track quality improvements and, when useful metrics are chosen, can also be a mechanism by which the health system can be held accountable.
Evidence-based
Evidence on what works to improve quality of care in low-resource settings is scarce. We propose an evidence-based approach that supports data harmonization while at the same time maintaining the highest standards of scientific and academic rigor.
Innovative evaluation
Both plausibility and probability evaluation designs should be used as part of a research strategy to rigorously determine whether quality improvement interventions can work and how, why and in what circumstances they work. Using a range of research strategies from theory-based evaluation to cluster randomized controlled trials is important.

Bulletin of the World Health Organization
Volume 95, Number 1, January 2017, 1-84
http://www.who.int/bulletin/volumes/94/11/en/

PERSPECTIVES
Documenting attacks on health workers and facilities in armed conflicts
Preeti Patel, Fawzia Gibson-Fall, Richard Sullivan & Rachel Irwin
http://dx.doi.org/10.2471/BLT.15.168328
[Initial text]
During armed conflicts, international humanitarian law (which regulates the conduct of parties engaged in war) protects health-care workers and health facilities, the wounded and the sick. In the first half of 2016, however, the international medical charity Médecins Sans Frontières (MSF) reported several attacks on health facilities and workers in Afghanistan, the Central African Republic, South Sudan, the Syrian Arab Republic and Yemen.1 These events have attracted media attention to a phenomenon of contemporary armed conflict that has important ramifications for the health, humanitarian, legal and security sectors.2 In December 2015, the Stockholm Peace Research Institute and the Conflict and Health Research Group at King’s College London convened a workshop in London on Eliminating violence against health workers: from theory to practice. Participants from MSF, the International Committee of the Red Cross (ICRC), Medical Aid for Palestinians and academic organizations discussed current trends in violence against health workers and attacks on health facilities, presented research findings and highlighted key debates and research gaps in evidence.
Some important lessons can be drawn from ICRC’s Health Care in Danger campaign, MSF’s Medical Care Under Fire campaign, as well as other organizations such as Physicians for Human Rights, which has recently documented mass atrocities in the Syrian Arab Republic as well as the impact of the Syrian conflict on the health sector.3–5 There is a perception of an increase in the number of health workers being killed and facilities being accidentally destroyed (so-called collateral damage) or deliberated targeted during armed conflicts. Comprehensive databases have been set up by independent research organizations to record major incidents of violence against aid workers, such as the Aid Worker Security Database of Humanitarian Outcomes and the Security in Numbers Database from Insecurity Insight.6 However, even these do not currently provide health-specific data. The absence of baseline and routine data relating to attacks on health workers and health facilities makes it difficult to identify actual rising trends. Most of the available data sources do not capture violence on local health workers, who seem to bear the brunt of most attacks. Data disaggregated by sex are also lacking…6

Clinical Therapeutics
December 2016 Volume 38, Issue 12, p2509-2710
http://www.clinicaltherapeutics.com/issue/S0149-2918(16)X0012-4

Pharmacovigilance Update: Pharmacovigilance in the New Millemium
Pharmacovigilance in the New Millennium
Paul Beninger, MD, MBA
Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts

Modern pharmacovigilance (PV) is very much a creature of the new millennium. Yes, we usually recognize the thalidomide tragedy as it unfolded in the 1950s as the pivotal event on both sides of the Atlantic that triggered the development of an international systematic approach to managing drug safety issues. (The reader is referred to an excellent detailed chronology of this subject up to and including the thalidomide tragedy by Myles Stephens, The Dawn of Drug Safety.1) This led to the World Health Organization-led consensus document International Drug Monitoring: The Role of National Centres.2 There was traction and “drug safety” took off, evolving over several decades as a discipline and as an organizational structure.

The larger trans-national infrastructure of PV, including its definitions and activities, was gradually shaped by the ground-breaking activities of CIOMS (The Council for International Organizations of Medical Sciences) and ICH (The International Conference on Harmonisation). These can be viewed as dyadic “content and process”—CIOMS creating much of the content through consensus, and ICH working through the various governmental jurisdictions to create the regulatory processes that implemented the content created by CIOMS.

Yet, to return to the New Millennium, to meet the needs of wholly new areas of PV, the full spectrum of the modern professional landscape has only taken shape since the beginning of this millennium: case management, signal management, and benefit risk management, each with two dimensions of medical and operational activities. In larger companies, these are distinct professional areas. They are complemented with experts in database management, periodic report preparation, and tracking activities that have all become their own specialties. In many, if not most, regions of the world, there is also the Qualified Person for Pharmacovigilance (QPPV), a role that evolved into its own discipline. Thus, departments in large companies now have hundreds of professionals employed in PV.

In recognition of the substantive evolution and growth in the field of PV, Clinical Therapeutics is presenting two Specialty Updates, this month and in April 2017, to highlight some of the advances and challenges in present-day PV. This month, we are publishing “Pharmacovigilance and Biomedical Informatics: A Model for Future Development,” which examines how the ad hoc interactions between these two disciplines have advanced PV processes over the past decade and also shows how a systematic approach can facilitate many new opportunities for potential advances in PV.3 The article “What Can Big Data Offer the Pharmacovigilance of Orphan Drugs?” emphasizes that new technologies cannot be applied carte blanche but require more subtle consideration. Finally, the article “The US FDA’s Risk Evaluation and Mitigation Strategy (REMS) Program – current status and future directions” shows that the introduction of new regulatory disciplines can benefit from mid-course correction as new information becomes available.4, 5 We hope you enjoy these articles.

Clinical Therapeutics
December 2016 Volume 38, Issue 12, p2509-2710
http://www.clinicaltherapeutics.com/issue/S0149-2918(16)X0012-4

Commentaries
Pharmacovigilance and Biomedical Informatics: A Model for Future Development
Paul Beninger, Michael A. Ibara
p2514–2525
Published online: November 29, 2016

The US Food and Drug Administration’s Risk Evaluation and Mitigation Strategy (REMS) Program – Current Status and Future Direction
Jasmanda Wu, Juhaeri Juhaeri
p2526–2532
Published online: December 1, 2016

What Can Big Data Offer the Pharmacovigilance of Orphan Drugs?
John Price
p2533–2545
Published online: December 1, 2016

Contemporary Clinical Trials
Volume 52, Pages 1-100 (January 2017)
http://www.sciencedirect.com/science/journal/15517144/52

Study Design, Statistical Design, Study Protocols
Design of a long-term follow-up effectiveness, immunogenicity and safety study of women who received the 9-valent human papillomavirus vaccine
Original Research Article
Pages 54-61
Alain Luxembourg, Susanne K. Kjaer, Mari Nygard, Misoo C. Ellison, Thomas Group, J. Brooke Marshall, David Radley, Alfred Saah
Abstract
The 9-valent human papillomavirus (HPV) (9vHPV) vaccine targets four HPV types (6/11/16/18) also covered by the quadrivalent HPV (qHPV) vaccine and five additional types (31/33/45/52/58). Vaccine efficacy to prevent HPV infection and disease was established in a Phase III clinical study in women 16–26 years of age. A long-term follow-up (LTFU) study has been initiated as an extension of the Phase III clinical study to assess effectiveness of the 9vHPV vaccine up to at least 14 years after the start of vaccination. It includes participants from Denmark, Norway and Sweden and uses national health registries from these countries to assess incidence of cervical pre-cancers and cancers due to the 7 oncogenic types in the vaccine (HPV 16/18/31/33/45/52/58). Incidences will be compared to the estimated incidence rate in an unvaccinated cohort of similar age and risk level. This LTFU study uses a unique design: it is an extension of a Phase III clinical study and also has elements of an epidemiological study (i.e., endpoints based on standard clinical practice; surveillance using searches from health registries); it uses a control chart method to determine whether vaccine effectiveness may be waning. Control chart methods which were developed in industrial and manufacturing settings for process and production monitoring, can be used to monitor disease incidence in real-time and promptly detect a decrease in vaccine effectiveness. Experience from this innovative study design may be applicable to other medicinal products when long-term outcomes need to be assessed, there is no control group, or outcomes are rare.

Current Opinion in Infectious Diseases
February 2017 – Volume 30 – Issue 1 pp: v-vi,1-142
http://journals.lww.com/co-infectiousdiseases/pages/currenttoc.aspx

SEXUALLY TRANSMITTED DISEASES
Future prospects for new vaccines against sexually transmitted infections
Gottlieb, Sami L.; Johnston, Christine
Abstract
Purpose of review: This review provides an update on the need, development status, and important next steps for advancing development of vaccines against sexually transmitted infections (STIs), including herpes simplex virus (HSV), Neisseria gonorrhoeae (gonorrhea), Chlamydia trachomatis (chlamydia), and Treponema pallidum (syphilis).
Recent findings: Global estimates suggest that more than a million STIs are acquired every day, and many new and emerging challenges to STI control highlight the critical need for development of new STI vaccines. Several therapeutic HSV-2 vaccine candidates are in Phase I/II clinical trials, and one subunit vaccine has shown sustained reductions in genital lesions and viral shedding, providing hope that an effective HSV vaccine is on the horizon. The first vaccine candidate for genital chlamydia infection has entered Phase I trials, and several more are in the pipeline. Use of novel technological approaches will likely see viable vaccine candidates for gonorrhea and syphilis in the future. The global STI vaccine roadmap outlines key activities to further advance STI vaccine development.
Summary: Major progress is being made in addressing the large global unmet need for STI vaccines. With continued collaboration and support, these critically important vaccines for global sexual and reproductive health can become a reality.

Emerging Infectious Diseases
Volume 23, Number 1—January 2017
http://wwwnc.cdc.gov/eid/

Perspective
A Framework for Modeling Emerging Diseases to Inform Management PDF Version [PDF – 424 KB – 6 pages]
R. E. Russell et al.
Abstract
The rapid emergence and reemergence of zoonotic diseases requires the ability to rapidly evaluate and implement optimal management decisions. Actions to control or mitigate the effects of emerging pathogens are commonly delayed because of uncertainty in the estimates and the predicted outcomes of the control tactics. The development of models that describe the best-known information regarding the disease system at the early stages of disease emergence is an essential step for optimal decision-making. Models can predict the potential effects of the pathogen, provide guidance for assessing the likelihood of success of different proposed management actions, quantify the uncertainty surrounding the choice of the optimal decision, and highlight critical areas for immediate research. We demonstrate how to develop models that can be used as a part of a decision-making framework to determine the likelihood of success of different management actions given current knowledge.

Emerging Infectious Diseases
Volume 23, Number 1—January 2017
http://wwwnc.cdc.gov/eid/

Research
Oral Cholera Vaccine Coverage during an Outbreak and Humanitarian Crisis, Iraq, 2015 PDF Version [PDF – 757 KB – 8 pages]
E. Lam et al.
Abstract
During November–December 2015, as part of the 2015 cholera outbreak response in Iraq, the Iraqi Ministry of Health targeted ≈255,000 displaced persons >1 year of age with 2 doses of oral cholera vaccine (OCV). All persons who received vaccines were living in selected refugee camps, internally displaced persons camps, and collective centers. We conducted a multistage cluster survey to obtain OCV coverage estimates in 10 governorates that were targeted during the campaign. In total, 1,226 household and 5,007 individual interviews were conducted. Overall, 2-dose OCV coverage in the targeted camps was 87% (95% CI 85%–89%). Two-dose OCV coverage in the 3 northern governorates (91%; 95% CI 87%–94%) was higher than that in the 7 southern and central governorates (80%; 95% CI 77%–82%). The experience in Iraq demonstrates that OCV campaigns can be successfully implemented as part of a comprehensive response to cholera outbreaks among high-risk populations in conflict settings.

Global Health: Science and Practice (GHSP)
December 2016 | Volume 4 | Issue 4
http://www.ghspjournal.org/content/current

VIEWPOINTS
Improving the Safety and Security of Those Engaged in Global Health Traveling Abroad
We need to improve the safety and security of global health students, faculty, residents, and workers who travel abroad, particularly those affiliated with smaller organizations or educational programs that lack resources and protocols. We offer a checklist covering 6 core elements: (1) institutional commitment, (2) trainee and faculty participation, (3) safety and security assessment and analysis, (4) risk and hazard prevention, (5) safety training, and (6) program evaluation.
Ranit Mishori, Andrew Eastman, Jessica Evert
Glob Health Sci Pract 2016;4(4):522-528. http://dx.doi.org/10.9745/GHSP-D-16-00203

Global Health: Science and Practice (GHSP)
December 2016 | Volume 4 | Issue 4
http://www.ghspjournal.org/content/current

VIEWPOINTS
Social Mobilization and Community Engagement Central to the Ebola Response in West Africa: Lessons for Future Public Health Emergencies
Key lessons for the crucial components of social mobilization and community engagement in this context:
:: Invest in trusted local community members to facilitate community entrance and engagement.
:: Use key communication networks and channels with wide reach and relevance to the community, such as radio in low-resource settings or faith-based organizations.
:: Invest in strategic partnerships to tap relevant capacities and resources.
: Support a network of communication professionals who can deploy rapidly for lengthy periods.
Balance centralized mechanisms to promote consistency and quality with decentralized programming for flexibility and adaptation to local needs.
:: Evolve communication approaches and messaging over time with the changing outbreak patterns, e.g., from halting disease transmission to integration and support of survivors.
:: Establish clear communication indicators and analyze and share data in real time.
Amaya M Gillespie, Rafael Obregon, Rania El Asawi, Catherine Richey, Erma Manoncourt, Kshiitij Joshi, Savita Naqvi, Ade Pouye, Naqibullah Safi, Ketan Chitnis, Sabeeha Quereshi
Glob Health Sci Pract 2016;4(4):626-646. http://dx.doi.org/10.9745/GHSP-D-16-00226
ABSTRACT
Following the World Health Organization (WHO) declaration of a Public Health Emergency of International Concern regarding the Ebola outbreak in West Africa in July 2014, UNICEF was asked to co-lead, in coordination with WHO and the ministries of health of affected countries, the communication and social mobilization component—which UNICEF refers to as communication for development (C4D)—of the Ebola response. For the first time in an emergency setting, C4D was formally incorporated into each country’s national response, alongside more typical components such as supplies and logistics, surveillance, and clinical care. This article describes the lessons learned about social mobilization and community engagement in the emergency response to the Ebola outbreak, with a particular focus on UNICEF’s C4D work in Guinea, Liberia, and Sierra Leone. The lessons emerged through an assessment conducted by UNICEF using 4 methods: a literature review of key documents, meeting reports, and other articles; structured discussions conducted in June 2015 and October 2015 with UNICEF and civil society experts; an electronic survey, launched in October and November 2015, with staff from government, the UN, or any partner organization who worked on Ebola (N = 53); and key informant interviews (N = 5). After triangulating the findings from all data sources, we distilled lessons under 7 major domains: (1) strategy and decentralization: develop a comprehensive C4D strategy with communities at the center and decentralized programming to facilitate flexibility and adaptation to the local context; (2) coordination: establish C4D leadership with the necessary authority to coordinate between partners and enforce use of standard operating procedures as a central coordination and quality assurance tool; (3) entering and engaging communities: invest in key communication channels (such as radio) and trusted local community members; (4) messaging: adapt messages and strategies continually as patterns of the epidemic change over time; (5) partnerships: invest in strategic partnerships with community, religious leaders, journalists, radio stations, and partner organizations; (6) capacity building: support a network of local and international professionals with capacity for C4D who can be deployed rapidly; (7) data and performance monitoring: establish clear C4D process and impact indicators and strive for real-time data analysis and rapid feedback to communities and authorities to inform decision making. Ultimately, communication, community engagement, and social mobilization need to be formally placed within the global humanitarian response architecture with proper funding to effectively support future public health.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 7 January 2017]

Review
The link between the West African Ebola outbreak and health systems in Guinea, Liberia and Sierra Leone: a systematic review
Haitham Shoman, Emilie Karafillakis and Salman Rawaf
Published on: 4 January 2017
Abstract
Background
An Ebola outbreak started in December 2013 in Guinea and spread to Liberia and Sierra Leone in 2014. The health systems in place in the three countries lacked the infrastructure and the preparation to respond to the outbreak quickly and the World Health Organisation (WHO) declared a public health emergency of international concern on August 8 2014.
Objective
The aim of this study was to determine the effects of health systems’ organisation and performance on the West African Ebola outbreak in Guinea, Liberia and Sierra Leone and lessons learned. The WHO health system building blocks were used to evaluate the performance of the health systems in these countries.
Methods
A systematic review of articles published from inception until July 2015 was conducted following the PRISMA guidelines. Electronic databases including Medline, Embase, Global Health, and the Cochrane library were searched for relevant literature. Grey literature was also searched through Google Scholar and Scopus. Articles were exported and selected based on a set of inclusion and exclusion criteria. Data was then extracted into a spreadsheet and a descriptive analysis was performed. Each study was critically appraised using the Crowe Critical Appraisal Tool. The review was supplemented with expert interviews where participants were identified from reference lists and using the snowball method.
Findings
Thirteen articles were included in the study and six experts from different organisations were interviewed. Findings were analysed based on the WHO health system building blocks. Shortage of health workforce had an important effect on the control of Ebola but also suffered the most from the outbreak. This was followed by information and research, medical products and technologies, health financing and leadership and governance. Poor surveillance and lack of proper communication also contributed to the outbreak. Lack of available funds jeopardised payments and purchase of essential resources and medicines. Leadership and governance had least findings but an overarching consensus that they would have helped prompt response, adequate coordination and management of resources.
Conclusion
Ensuring an adequate and efficient health workforce is of the utmost importance to ensure a strong health system and a quick response to new outbreaks. Adequate service delivery results from a collective success of the other blocks. Health financing and its management is crucial to ensure availability of medical products, fund payments to staff and purchase necessary equipment. However, leadership and governance needs to be rigorously explored on their main defects to control the outbreak.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 7 January 2017]

Editorial
Building health research systems: WHO is generating global perspectives, and who’s celebrating national successes?
Stephen R. Hanney and Miguel A. González-Block
Published on: 28 December 2016
Abstract
In 2016, England’s National Institute for Health Research (NIHR) celebrated its tenth anniversary as an innovative national health research system with a focus on meeting patients’ needs. This provides a good opportunity to reflect on how the creation of the NIHR has greatly enhanced important work, started in 1991, to develop a health research system in England that is embedded in the National Health Service.
In 2004, WHO identified a range of functions that a national health research system should undertake to improve the health of populations. Health Research Policy and Systems (HRPS) has taken particular interest in the pioneering developments in the English health research system, where the comprehensive approach has covered most, if not all, of the functions identified by WHO. Furthermore, several significant recent developments in thinking about health research are relevant for the NIHR and have informed accounts of its achievements. These include recognition of the need to combat waste in health research, which had been identified as a global problem in successive papers in the Lancet, and an increasing emphasis on demonstrating impact. Here, pioneering evaluation of United Kingdom research, conducted through the impact case studies of the Research Excellence Framework, is particularly important. Analyses informed by these and other approaches identified many aspects of NIHR’s progress in combating waste, building and sustaining research capacity, creating centres of research excellence linked to leading healthcare institutions, developing research networks, involving patients and others in identifying research needs, and producing and adopting research findings that are improving health outcomes.
The NIHR’s overall success, and an analysis of the remaining problems, might have lessons for other systems, notwithstanding important advances in many countries, as described in papers in HRPS and elsewhere. WHO’s recently established Global Observatory for Health Research and Development provides an opportunity to promote some of these lessons. To inform its work, the Observatory is sponsoring a thematic series of papers in HRPS focusing on health research issues such as funding flows, priority setting, capacity building, utilisation and equity. While important papers on these have been published, this series is still open to new submissions.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 12, Issue 12, 2016
http://www.tandfonline.com/toc/khvi20/current

Review article
Comparison of dual influenza and pneumococcal polysaccharide vaccination with influenza vaccination alone for preventing pneumonia and reducing mortality among the elderly: A meta-analysis
Pages: 3056-3064
Published online: 14 Sep 2016
Yan-Yang Zhang, Xue-Feng Tang, Chang-Hui Du, Bin-Bing Wang, Zhen-Wang Bi & Bi-Rong Dong

Review
Influenza immunization during pregnancy: Benefits for mother and infant
Pages: 3065-3071
Published online: 05 Aug 2016
Isaac G. Sakala, Yoshikazu Honda-Okubo, Johnson Fung & Nikolai Petrovsky Director

Commentary
The safety of maternal immunization
Pages: 3132-3136
Published online: 19 Aug 2016
Annette K. Regan

Research Paper
How do parents and pediatricians arrive at the decision to immunize their children in the private sector? Insights from a qualitative study on rotavirus vaccination across select Indian cities
Pages: 3139-3145
Published online: 23 Nov 2016
Mathew Sunil George, Preeti Negandhi, Habib Hassan Farooqui, Anjali Sharma & Sanjay Zodpey

Reviews
Community pharmacies as sites of adult vaccination: A systematic review
Pages: 3146-3159
Published online: 15 Aug 2016
Randall C. Burson, Alison M. Buttenheim, Allison Armstrong & Kristen A. Feemster

Infectious Agents and Cancer

[Accessed 7 January 2017]

Research Article
Multiple HPV infections in female sex workers in Western Kenya: implications for prophylactic vaccines within this sub population
Whilst the imputed role of High Risk (HR) HPV infection in the development of cervical lesions and cancer has been established, the high number of HPV genotypes that Female Sex workers (FSW) harbour warrants that the synergistic effects of potential HR (pHR) and HR HPV genotypes be elucidated to assess the potential impact of prophylactic vaccines. This population in Kenya also harbours a number of other vaginal infections and STIs, including bacterial vaginosis (BV), trichomonas vaginalis (TV) and candida spp.
Sonia Menon, Davy van den Broeck, Rodolfo Rossi, Emilomo Ogbe and Hillary Mabeya
Infectious Agents and Cancer 2017 12:2
Published on: 6 January 2017

International Journal of Infectious Diseases
December 2016 Volume 53, p1-68
http://www.ijidonline.com/issue/S1201-9712(16)X0011-2
Reviews
Drivers of earlier infectious disease outbreak detection: a systematic literature review
Lindsay Steele, Emma Orefuwa, Petra Dickmann
p15–20
Published online: October 21, 2016
Highlights
Early detection of infectious disease outbreaks can lead to a decreased impact on populations. Numerous approaches to the earlier detection of outbreaks exist, and methods have been developed to measure progress on timeliness. Understanding why these surveillance approaches work and do not work will elucidate key drivers of early detection, and could guide interventions to achieve earlier detection. Without clarity about necessary conditions for earlier detection and their influencing factors, attempts to improve surveillance will be ad hoc and unsystematic.
This systematic literature review revealed that despite significant investment in early outbreak detection, there is very little evidence with respect to factors that influence earlier detection. More research is needed to guide intervention planning.

International Journal of Infectious Diseases
December 2016 Volume 53, p1-68
http://www.ijidonline.com/issue/S1201-9712(16)X0011-2

Original Reports
Clinical profile and containment of the Ebola virus disease outbreak in two large West African cities, Nigeria, July–September 2014
Chima Ohuabunwo, Celestine Ameh, Oyin Oduyebo, Anthony Ahumibe, Bamidele Mutiu, Adebola Olayinka, Wasiu Gbadamosi, Erika Garcia, Carolina Nanclares, Wale Famiyesin, Abdulaziz Mohammed, Patrick Nguku, Richard I. Koko, Joshua Obasanya, Durojaye Adebayo, Yemi Gbadegesin, Oni Idigbe, Olukayode Oguntimehin, Sara Nyanti, Charles Nzuki, Ismail Abdus-Salam, Joseph Adeyemi, Nnanna Onyekwere, Emmanuel Musa, David Brett-Major, Faisal Shuaib, Abdulsalami Nasidi
p23–29
Published online: August 27, 2016

JAMA Pediatrics
January 1, 2017, Vol 171, No. 1, Pages 3-100
http://archpedi.jamanetwork.com/issue.aspx

Original Investigation
Association Between Influenza Infection and Vaccination During Pregnancy and Risk of Autism Spectrum Disorder
Ousseny Zerbo, PhD; Yinge Qian, MS; Cathleen Yoshida, MA; et al.
online only
JAMA Pediatr. 2017;171(1):e163609. doi:10.1001/jamapediatrics.2016.3609
Key Points
Question  Is there an association between maternal influenza infection and vaccination and autism risk?
Findings  In a cohort study of 196,929 children, of whom 3103 had austism spectrum disorder, maternal influenza infection during pregnancy was not associated with increased autism risk. There was a suggestion of increased risk of autism spectrum disorders among children whose mothers received an influenza vaccination during their first trimester, but the association was statistically insignificant after adjusting for multiple comparisons, indicating that the finding could be due to chance.
Meaning  Our findings do not call for vaccine policy or practice changes but do suggest the need for additional studies.
Abstract
Importance
Maternal infections and fever during pregnancy are associated with increased risk for autism spectrum disorders (ASDs). To our knowledge, no study has investigated the association between influenza vaccination during pregnancy and ASD.
Objective
To investigate the association between influenza infection and vaccination during pregnancy and ASD risk.
Design, Setting, and Participants
This cohort study included 196 929 children born at Kaiser Permanente Northern California from January 1, 2000 to December 31, 2010, at a gestational age of at least 24 weeks.
Exposures
Data on maternal influenza infection and vaccination from conception date to delivery date, obtained from Kaiser Permanente Northern California inpatient and outpatient databases. Influenza infection was defined by the International Classification of Diseases, Ninth Revision, Clinical Modification codes or positive influenza laboratory test results.
Main Outcomes and Measures
Clinical diagnoses of ASDs identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes 299.0, 299.8, or 299.9 recorded in Kaiser Permanente Northern California electronic medical records on at least 2 occasions any time from birth through June 2015.
Results
Within this cohort of 196 929 children, influenza was diagnosed in 1400 (0.7%) mothers and 45 231 (23%) received an influenza vaccination during pregnancy. The mean (SD) ages of vaccinated and unvaccinated women were 31.6 (5.2) and 30.4 (5.6) years, respectively. A total number of 3101 (1.6%) children were diagnosed with ASD. After adjusting for covariates, we found that maternal influenza infection (adjusted hazard ratio, 1.04; 95% CI, 0.68-1.58) or influenza vaccination (adjusted hazard ratio, 1.10; 95% CI, 1.00-1.21) anytime during pregnancy was not associated with increased ASD risk. In trimester-specific analyses, first-trimester influenza vaccination was the only period associated with increased ASD risk (adjusted hazard ratio, 1.20; 95% CI, 1.04-1.39). However, this association could be due to chance (P = 0.1) if Bonferroni corrected for the multiplicity of hypotheses tested (n = 8). Maternal influenza vaccination in the second or third trimester was not associated with increased ASD risk.
Conclusions and Relevance
There was no association between maternal influenza infection anytime during pregnancy and increased ASD risk. There was a suggestion of increased ASD risk among children whose mothers received an influenza vaccination in their first trimester, but the association was not statistically significant after adjusting for multiple comparisons, indicating that the finding could be due to chance. These findings do not call for changes in vaccine policy or practice, but do suggest the need for additional studies on maternal influenza vaccination and autism.