Partnering to Fight Pneumonia, the “Forgotten Killer” of Children
Huffington Post – 31 October 2017
We have “eradication” targets for polio, “elimination” targets for malaria, and “generation-free” targets for HIV/AIDS, but for a disease that kills more children under five than all three combined, we have…well…very little.

Pneumonia, which has been attracting less than 2 percent of international development assistance for health, and low national health funding, kills nearly 1 million children every year.

But change is brewing, driven by new leaders, new alignments between governments, businesses, United Nations’ agencies and non-governmental organizations (NGOs), and technological innovations with the potential to dramatically improve the cost-effectiveness of care in low and middle income countries.

Thirty organizations are joining forces in a public-private partnership with an ambitious, measurable goal: to end preventable child pneumonia deaths by 2030.

The Every Breath Counts Coalition will be announced at UNICEF headquarters in New York on November 3rd, at a special event co-hosted by the Bill and Melinda Gates Foundation and “la caixa” Foundation in honor of World Pneumonia Day.

We are all deeply concerned about pneumonia’s high death toll – each year 178,000 newborns and 773,000 children under five die according to UNICEF – and the slow rate of decline. Between 2000 and 2015, child pneumonia deaths fell by 47 percent, compared to 85 percent for measles, 61 percent for AIDS, 58 percent for malaria and 57 percent for diarrhea. We need faster progress.

The situation is particularly dire in sub-Saharan Africa. Due to a combination of low vaccine coverage, breastfeeding rates and female literacy, and high malnutrition and solid cooking fuel use, this region is home to the largest populations of children at greatest risk of death from pneumonia.

Most of the child pneumonia deaths happen in just 15 countries. Countries like Chad, Nigeria, Angola, Niger, Somalia, Mali, the Democratic Republic of Congo, Afghanistan, Pakistan and Ethiopia are especially vulnerable. Focused national and international efforts to identify and close gaps in pneumonia prevention, diagnosis and treatment in these countries could prevent more than 250,000 child deaths from pneumonia each year.

Expanding pneumococcal vaccine coverage across countries is an important priority. In addition, improving access to health services and health workers and ensuring that they have the proper diagnostic and treatment tools like pulse oximetry, child-friendly antibiotics and oxygen are key. Working more directly with mothers and families to improve breastfeeding rates, child nutrition and female literacy will also boost progress across all countries. Children who are malnourished are nine times more likely to die from pneumonia.

To stop children dying from pneumonia, the governments most affected will need to lead ambitious national efforts to mobilize attention and resources toward pneumonia prevention, diagnosis and treatment, especially at primary health care level. In addition to enhanced domestic resources, countries will also need to target a greater share of their foreign health aid to fighting pneumonia, especially if they are eligible for Global Financing Facility funding from the World Bank and/or receive support from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Efforts to better integrate the management of the “febrile” child will not only impro treatment outcomes, but also the rational use of drugs and combat antimicrobial resistance.

In addition to investing more to help governments with the largest populations of at-risk children fight pneumonia, the Every Breath Counts Coalition will enlist the support of existing child pneumonia initiatives, including the United4Oxygen Alliance, HO2PE, the Pneumonia Innovations Network, Stop Pneumonia/World Pneumonia Day, the ARIDA Project, the Save the Children and GSK partnership, as well as work underway by Results for Development and the Clinton Health Access Initiative. Every Breath Counts will also build bridges between the focus countries and the various innovation pipelines, including Saving Lives at Birth and Grand Challenges Canada and relevant research underway, including the multi-country enhanced community management and clean cooking trials.

Focused efforts in a sub-set of countries where children are most vulnerable are critical, as these countries will not achieve the Sustainable Development Goals relating to child survival nor fulfill their obligations to the Global Strategy for Women’s, Children’s and Adolescents’ Health without a special push to reduce child pneumonia deaths.

It’s time to bring together our collective efforts and support country government efforts to ensure that no child dies of a disease we know how to prevent, diagnose and treat.

We hope you’ll join us,

Carolyn Miles, CEO, Save the Children (US)
Lisa Bonadonna, Global Head, Access to Medicines, GSK
David Fleming, Vice President, PATH
Joe Kiani, CEO, Masimo
Stefan Peterson, Chief of Health, UNICEF
Kate Schroder, Vice President, Clinton Health Access Initiative
Kevin Watkins, CEO, Save the Children (UK)

For more information on Every Breath Counts, please visit www.stoppneumonia.org
 

Cholera
 
[See Second phase of cholera, polio vaccination begins in Cox’s Bazar for vulnerable population [SEAR/PR/1670, Bangladesh, 4 November 2017] in WHO Grade 2 Emergencies –
Myanmar below]

Cholera in Yemen — An Old Foe Rearing Its Ugly Head
Firdausi Qadri, Ph.D., M.D., Taufiqul Islam, M.B.B.S., M.P.H., and John D. Clemens, M.D.
New England Journal of Medicine
November 1, 2017  DOI: 10.1056/NEJMp1712099

Yemen, a country with a population of approximately 25 million located at the southern tip of the Arabian Peninsula, is now experiencing one of the largest cholera outbreaks in recent history. The outbreak, which began in late October 2016 and is reportedly due to Vibrio cholerae O1, serotype Ogawa, followed on the heels of civil conflict between Houthi rebels and the internationally recognized Yemeni regime. Beginning in the capital, Sana’a, it spread rapidly, and by December 2016, cases had been reported in 15 of the country’s 22 governorates and municipalities. The outbreak appeared to be in decline by March 2017, when a cold wave hit the country, but it resurged dramatically in April (see map)

Cholera Attack Rate in the Governorates of Yemen, 2017.), coincident with heavy rains that may have contaminated drinking water sources, and was amplified by war-related destruction of municipal water and sewage systems. In September, the World Health Organization (WHO) announced that there have been about 700,000 cases and more than 2000 deaths from cholera (in addition to the 10,000 other deaths caused by the conflict), and the epidemic had spread to all governorates and municipalities except one.1 Although the epidemic seems to be slowing again somewhat, 5000 suspected cholera cases were still being reported every day as of late September.

Even before the conflict, Yemen was among the poorest of the Arab countries, beset by circumstances that made it ripe for cholera, a waterborne disease with fecal–oral transmission. Afflicted by droughts and a lack of water, it was considered among the most water-stressed countries in the world. According to WHO–UNICEF statistics, in 2014 only 53% of the population used improved sanitation facilities and only 55% had access to drinking water from improved water sources.2 Since the onset of the conflict, the situation has worsened markedly. Millions of people have been displaced and now live under conditions with inadequate shelter, water, sanitation, and food. Delivery of health care has been limited by the destruction by air strikes of approximately half the health sector facilities, including hospitals and clinics. In addition, about 30,000 health care workers have not received their salaries during the past year, and many have fled the country.

A naval and air blockade of rebel-controlled areas has contributed to shortages of food, fuel, and medical supplies. Bombing has destroyed water and sanitation infrastructure in some areas, and many sanitation workers have been on strike for several months. A massive fuel shortage has led to the disruption of sewage management and wastewater treatment facilities and a lack of electricity to run water pumps. The WHO has estimated that approximately 15 million people lack access to basic health care and potable water and sanitation. At least 17 million face food insecurity, 7 million are at risk for famine, and 2 million children are malnourished.

Considering the extremely hazardous conditions and other major challenges in this war-ravaged country, the WHO, UNICEF, other international agencies, nongovernmental organizations, and Yemeni health care providers have mounted an extraordinary response and have limited the overall case fatality rate of reported cholera cases to a relatively low 0.5%.3 These organizations have also made efforts to supply chlorinated water, restore the operationalization of water-treatment plants, provide hygiene kits with soap and chlorination tablets, and provide training in water-sanitation–hygiene behaviors to help prevent cholera. Yet, as Tedros Adhanom Ghebreyesus, the WHO director-general, recently emphasized, “Yemen’s health workers are operating in impossible conditions. Thousands of people are sick, but there are not enough hospitals, not enough medicines, not enough clean water. These doctors and nurses are the backbone of the health response — without them we can do nothing in Yemen. They must be paid their wages so that they can continue to save lives.”4

Inactivated vibrio whole-cell oral cholera vaccines (OCVs), given as a two-dose regimen, are now internationally accepted as tools for the control of epidemic and endemic cholera. A global stockpile of these vaccines, managed by the International Societies of the Red Cross and Red Crescent, UNICEF, the WHO, and Doctors without Borders (Médecins sans Frontières), with the WHO as the secretariat, and funded by Gavi, the Vaccine Alliance, has been in operation since 2013. This stockpile has largely been allocated for the control of epidemics and for use in humanitarian crises, and to date it has been deployed in cholera outbreaks in Africa, Asia, Haiti, and the Middle East. In late June 2017, a request was made on behalf of Yemen for 3.4 million doses, and the decision was made to release 1 million doses — at the time the most doses ever to be deployed from the stockpile in its 4-year history. However, several weeks later, a meeting in Sana’a of local ministries as well as United Nations and other aid agencies resulted in retraction of the request for vaccine. Various aid agencies have been quoted by the media explaining that resources would be better spent on existing preventive and therapeutic approaches to the epidemic, that mass immunization would be logistically difficult in this setting, and that the impact of vaccination would be minimal because the epidemic had spread so widely.

No one has a better sense of the challenges in logistics and safety of conducting a mass immunization campaign than workers on the ground. And it is undoubtedly true that the request for vaccination came late; had vaccination been implemented earlier, it might have been helpful in containing the epidemic. It’s possible, however, that it was not too late in the epidemic for vaccination to help: experience has demonstrated that deployment of OCV, reactively, in epidemics can be effective.5 And if the current case count is reliable, we may estimate that roughly 7 million to 14 million people, in a population of 25 million, have been infected. Yet admittedly, a million doses would probably be far too few to have a major impact in controlling the entire countrywide epidemic. Plans are reportedly being discussed for a much more massive allocation of doses for a mass immunization program at a later date.

Though we have not been directly involved in the public health response to this outbreak, we can offer a few general observations. First, Yemen before the epidemic, like Haiti before its ongoing epidemic, had a profile in terms of water, sanitation, and hygiene that made it extremely vulnerable to a cholera epidemic on the heels of a humanitarian emergency. When we think of the geographic reach of cholera, we should recognize not only places that report cases of the disease but also places that are at high risk for it.

Second, although prior to this epidemic Yemen had not reported cholera since the 1980s, the magnitude of this epidemic and the evisceration of the country’s infrastructure by the war place Yemen at high risk for continued endemic cholera in the future, much as appears to have happened in Haiti, where a massive cholera epidemic occurred in 2010 after approximately 100 years without cholera.

Finally, despite important efforts by the WHO and other international organizations to create and deploy the OCV global stockpile, that stockpile is currently inadequate. Moreover, we lack validated predictive tools to identify humanitarian emergencies posing so high a risk of cholera that the doses of OCV should be deployed preemptively, as well as tools to flag incipient outbreaks that are destined to become so large that doses should be deployed early. Greater funding for the stockpile and more work on the development of both improved predictive tools and improved water and sanitation are important priorities.

Featured Journal Content

Bulletin of the World Health Organization
Published online: 19 October 2017)
Implementation research: reactive mass vaccination with single-dose oral cholera vaccine, Zambia
Marc Poncin,a Gideon Zulu,b Caroline Voute,a Eva Ferreras,c Clara
Mbwili Muleya,b Kennedy Malama,b Lorenzo Pezzoli,d Jacob Mufunda,e
Hugues Robert,a Florent Uzzeni,a Francisco J Luquero,c Elizabeth
Chizemab & Iza Cigleneckia
This online first version has been peer-reviewed, accepted and edited, but not formatted and finalized with corrections from authors and proofreaders
Abstract
Objective
To describe the implementation and feasibility of an innovative mass vaccination strategy – based on single-dose oral cholera vaccine – to curb a cholera epidemic in a large urban setting.
Method
In April 2016, in the early stages of a cholera outbreak in Lusaka, Zambia, the health ministry collaborated with Médecins Sans Frontières and the World Health Organization in organizing a mass vaccination campaign, based on single-dose oral cholera vaccine. Over a period of 17 days, partners mobilized 1700 health ministry staff and community volunteers for community sensitization, social mobilization and vaccination activities in 10 townships. On each day, doses of vaccine were delivered to vaccination sites and administrative coverage was estimated.
Findings
Overall, vaccination teams administered 424_100 doses of vaccine to an estimated target population of 578_043, resulting in an estimated administrative coverage of 73.4%. After the campaign, few cholera cases were reported and there was no evidence of the disease spreading within the vaccinated areas. The total cost of the campaign – 2.31 United States dollars (US$) per dose – included the relatively low cost of local delivery – US$_0.41 per dose.
Conclusion
We found that an early and large-scale targeted reactive campaign using a single-dose oral vaccine, organized in response to a cholera epidemic within a large city, to be feasible and appeared effective. While cholera vaccines remain in short supply, the maximization of the number of vaccinees in response to a cholera epidemic, by the use of just one dose per member of an at-risk ommunity, should be considered.
 

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 1November 2017 [GPEI]
:: This month Harvard University and National Public Radio (NPR) hosted an online forum to discuss how social data shines a global spotlight on polio’s last challenges.

:: Summary of newly-reported viruses this week:
…Afghanistan: One new wild poliovirus type 1 (WPV1) case, reported in Shahwalikot district in Kandahar province. Three new wild poliovirus 1 (WPV1) positive environmental samples reported, one from Kandahar and two from Hilmand provinces.
…Pakistan: Two new wild poliovirus 1 (WPV1) positive environmental samples reported, one from Sindh and one from Khyber Pakhtunkhwa provinces. Democratic Republic of the Congo (DRC): One new circulating vaccine derived poliovirus type 2 (cVDPV2) case reported, in Tanganika province.
…Syria:  One new circulating vaccine derived poliovirus type 2 (cVDPV2) case reported, in Deir Ez-Zor governorate.

:: Additionally, an advance notification was received this week of a new WPV1 case in Afghanistan from Batikot district in Nangarhar province, onset 11 October.  The case will be officially reflected in next week’s global data reporting.

::::::

Syria cVDPV2 outbreak situation report 20: 31 October 2017
:: One (1) new case of cVDPV2 was reported this week from Mayadeen, Deir Ez-Zor governorate. The date of onset of the case was 18 August 2017. The most recent case (by date of onset) remains 25 August.
:: The total number of cVDPV2 cases is 53.
:: Third party independent monitoring results for the second outbreak response round for Raqqa governorate have been received. Reported coverage of targeted children is 69% (measured by parental recall through a house to house survey). Market surveys reported much higher coverage of 84%.
:: Sixteen (16) new refrigerator trucks have been provided by UNICEF to transport vaccine and maintain cold chain for ongoing response activities and outreach.
:: WHO is supporting the upgrade of laboratory facilities to enable more sophisticated techniques to be conducted in country for the detection of poliovirus. WHO is also supporting the establishment of environmental surveillance in country by end of 2017.

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WHO Grade 3 Emergencies  [to 4 November 2017]
The Syrian Arab Republic
:: Syria cVDPV2 outbreak situation report 20, 31 October 2017
 [See Polio above]

Yemen
:: Daily epidemiology bulletin, 30 October 2017
Cholera:
887, 440 – Suspected cases
2,184 – Associated deaths
0.25%  – Case Fatality Rate
96%  – Governorates affected   ( 22 / 23 governorates )
92%  – Districts affected   ( 305 / 333 districts )

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WHO Grade 2 Emergencies  [to 4 November 2017]
Myanmar
::  Second phase of cholera, polio vaccination begins in Cox’s Bazar for vulnerable population
SEAR/PR/1670
Cox’s Bazar, Bangladesh, 4 November 2017 – The second phase of the oral cholera vaccination drive began today to provide an additional dose of the vaccine to children of newly arrived Rohingya population against the deadly diarrheal disease. The children are also being administered oral polio vaccine.

Nearly 180,000 children aged between one and five years are expected to receive the second dose of oral cholera vaccine (OCV), while around 210,000 children up to the age of five years will be vaccinated against polio in a six-day immunization campaign in Ukhia and Teknaf sub-districts of Cox’s Bazar and Naikhanchari in Bandarban district.

The campaign is being conducted by The Ministry of Health and Family Welfare (MoHFW) with support from WHO, UNICEF, International Centre for Diarrhoeal Disease Research, Bangladesh, IOM, UNHCR and local and international NGO’s.

“These large scale immunization drives against cholera and polio reflect the commitment of the health sector to take all possible measures to protect the health of these vulnerable population,” Dr. N. Paranietharan, WHO Representative to Bangladesh, said. “Children being among the most vulnerable, the vaccination campaign is an important and commendable effort of the Ministry of Health and Family Welfare and health partners”, he added.

The previous oral cholera vaccine campaign, launched on 10 October, covered 700 487 people aged one year and above, 176 482 of them children aged one to five years. 900 000 doses of oral cholera vaccine were mobilized following a risk assessment conducted by MoHFW, with the support from WHO, UNICEF, IOM and Médecins Sans Frontières (MSF), in late September. The International Coordinating Group (ICG) on vaccine provision released OCV within a day of the Bangladesh government’s request, while GAVI, the Vaccine Alliance, provided financial support.

Earlier, in a rapidly organized vaccination campaign for measles, rubella and polio, 72 334 children up to five years of age were administered oral polio vaccine between 16 September to 4 October…

::::::

Outbreaks and Emergencies Bulletin, Week 43: 21 – 27 October 2017
The WHO Health Emergencies Programme is currently monitoring 44 events in the region. This week’s edition covers key ongoing events, including:
:: Marburg virus disease in Uganda
:: Plague in Madagascar
:: Malaria in Cabo Verde
:: Dengue fever in Côte d’Ivoire
:: Cholera in Zambia
:: Cholera in north-east Nigeria.
Week 43: 21 – 27 October 2017

::::::
::::::
 
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: Humanitarian Bulletin, October 2017 | Issued on 2 November
HIGHLIGHTS
…Military operations to retake the last major territory held by ISIL begin in western Anbar.
184,000 people are currently displaced by recent unrest in northern governorates.
…Almost 62,000 people return to Hawiga a month after it is retaken, to a lack of services and explosive hazard contamination.
…Heaters, fuel and sanitation upgrades are urgently needed in camps across Iraq as winter approaches.
…IHF launches $14 million reserve allocation for Hawiga.

Syrian Arab Republic
:: 1 Nov 2017  Turkey | Syria: Border Crossings Status 1 November 2017 [EN/AR/TR]
:: Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Mark Lowcock: Statement to the Security Council on the humanitarian situation in Syria, 30 October 2017 [EN/AR]

::::::

UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Ethiopia
:: 30 Oct 2017   Ethiopia Humanitarian Bulletin Issue 39 | 16 – 29 October 2017
…Ethiopia begins civil registration of refugees for the first time in history as the number of refugees in country nears the one million mark….

ROHINGYA CRISIS
:: ISCG Situation Update: Rohingya Refugee Crisis, Cox’s Bazar – 2 November 2017
607,000 new arrivals are reported as of 31 October, according to IOM Needs and Population Monitoring, UNHCR and other field reports. The dataset and full report is available online.
Partners reported today that an estimated 3,000 arrivals have crossed Naf river and are currently staying in no man’s land near Anjumapara border (Palongkhali union). They are expected to continue into Bangladesh. NPM is keeping track of them and verifying the information.
…607,000 Cumulative arrivals since 25 Aug
…329,000 Arrivals in Kutupalong Expansion Site
…46,000 Arrivals in host communities

Somalia 
:: Horn of Africa: Humanitarian Impacts of Drought – Issue 11 (3 November 2017)
…DISEASE OUTBREAKS
Measles cases rise in Somalia and Ethiopia, while number of AWD and/or Cholera cases declines. In Somalia, more than 18,000 cases of measles were recorded between January and September 2017; four times the number of cases reported during the same period in 2015 and 2016. Most recently, 12 suspected cases were reported at an IDP settlement in Waajid district, Bakool region. A nationwide campaign to vaccinate 4.2 million children is planned for November-December. Meanwhile, there has been a significant reduction in new AWD/cholera cases in Somalia over the past three months, with no deaths reported during this period. To date, 77,783 cholera cases and 1,159 deaths have been reported in 2017. In Ethiopia, 3,151 measles cases have been reported and four districts in the Oromia (Babile and Jima Spe town, East Hararge zone) and Somali (Afder and Warder) regions reached the measles outbreak threshold in September…
:: Humanitarian Bulletin Somalia, 01 – 30 October 2017
…Measles cases remain at epidemic levels as new AWD/cholera cases reduce…
 

WHO & Regional Offices [to 4 November 2017]
 
Latest news
WHO meeting concludes with commitment to delivering results in countries
2 November 2017 – This week more than 260 of the WHO’s leaders from headquarters, regional and country offices gathered in Geneva to discuss how to transform WHO into an organization that is better able to deliver meaningful improvements in health to the world’s people. It was first time that WHO’s new Director-General, Dr Tedros Adhanom Ghebreyesus, has had the opportunity to meet face-to-face with all senior leadership in the same room.
[See Milestones above for full Statement]

Madagascar plague: preventing regional spread
2 November 2017 – More than 1800 suspected, probable, or confirmed plague cases were reported in Madagascar from August to late October 2017, resulting in 127 deaths. WHO has moved quickly in response to this unusually severe outbreak by supporting the Government of Madagascar, while at the same time working with nearby countries and territories to prevent regional spread.
DONs
Plague – Madagascar
2 November 2017

Close to 3 million people access hepatitis C cure
31 October 2017 – On the eve of the World Hepatitis Summit in Brazil, WHO reports increasing global momentum in the response to viral hepatitis. A record 3 million people were able to obtain treatment for hepatitis C over the past two years, and 2.8 million more people embarked on lifelong treatment for hepatitis B in 2016.

WHO report signals urgent need for greater political commitment to end tuberculosis
30 October 2017 – Global efforts to combat tuberculosis (TB) have saved an estimated 53 million lives since 2000 and reduced the TB mortality rate by 37%, according to the Global TB Report 2017, released by WHO today.

 
Highlights
WHO helps Kenya guard against Marburg Virus Disease
November 2017 – WHO is helping the Kenyan Ministry of Health guard against the spread of Marburg Virus Disease from neighbouring Uganda. Health authorities are strengthening preparedness measures in Trans Nzoia and West Pokot counties along the border with Uganda, where an outbreak was officially declared on 19 October.

Global Nutrition Summit 2017: Milan
November 2017 – Building upon the spirit and outcomes of the L’Aquila Food Security Initiative, the Milan Expo 2015, the 2nd International Conference on Nutrition (ICN2) and the G7 Summit in Taormina, the Nutrition for Growth Stakeholder Group will organize a day-long, high-level summit on nutrition and food for a healthier future which is co-facilitated and co-hosted by the Italian G7 Presidency, the City of Milan and Ministry of Health: the Milan Global Nutrition Summit.

Video: The eHealth journey in Latvia
October 2017 – The Ministry of Health of Latvia has created a national programme of electronic health (eHealth). As part of an ambitious, long-term national health reform agenda, the eHealth programme has been a key element of ensuring that Latvian people receive the right care in the right place and at the right time.

Using digital technology to strengthen public health services in Africa
October 2017 – With Africa currently undergoing a digital revolution, WHO and the International Telecommunications Union (ITU) signed a Cooperation Agreement, on using digital services to save lives and improve people’s health.

::::::

Weekly Epidemiological Record, 3 November 2017, vol. 92, 44 (pp. 661–680)
:: Update on vaccine-derived polioviruses worldwide, January 2016–June 2017
:: Progress with the implementation of rotavirus surveillance and vaccines in countries of the WHO African Region, 2007–2016
 
::::::
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Health Workers urged to Work with Communities to Stop Marburg  04 November 2017
:: WHO helps Kenya guard against Marburg Virus Disease  03 November 2017
:: Strengthening Medicines Quality Control in Tanzania  03 November 2017
:: Fostering partnerships for health: WHO and partners conduct a joint field visit  02 November 2017
:: Madagascar plague: mitigating the risk of regional spread  02 November 2017
:: Bringing the human and animal health sectors closer: The National Bridging Workshop
02 November 2017
:: Integrated campaign tackles malaria and polio in north-eastern Nigeria  01 November 2017
:: Experts begin second wave of polio outbreak response assessment in Nigeria.  31 October 2017
:: Routine immunization in Nigeria gets a bolster from the European Union  29 October 2017

WHO Region of the Americas PAHO
:: PAHO/WHO Malaria Champion awards go to Brazil, Haiti, and Dominican Republic (11/03/2017)

WHO South-East Asia Region SEARO
::  Second phase of cholera, polio vaccination begins in Cox’s Bazar  4 November 2017

WHO European Region EURO
:: The eHealth journey in Latvia 02-11-2017

WHO Eastern Mediterranean Region EMRO
:: WHO-supported field hospitals in Iraq respond to injured patients as danger for war-related trauma remains  29 October 2017
 

CDC/ACIP [to 4 November 2017]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html

MMWR News Synopsis for November 2, 2017
Vaccination Coverage Among Children Aged 19–35 Months — United States, 2016
CDC encourages parents to protect their children from vaccine-preventable diseases by ensuring their children receive all recommended vaccines on schedule. Vaccination is the best way to reduce illness and death from vaccine-preventable diseases in young children. Data from the 2016 National Immunization Survey-Child (NIS-Child) were used to assess vaccination coverage with recommended vaccines among children aged 19–35 months in the United States. Based on the data, coverage with recommended vaccines for children aged 19–35 months continues to be high and stable, but remains below 90 percent for vaccines that require booster doses during the second year of life and for more recently recommended vaccines. Differences in coverage by race/ethnicity, poverty status, and insurance status indicate that improvements are needed in the immunization safety net (that is, access to and delivery of age-appropriate immunization to all children, regardless of insurance or financial status).

Progress in Childhood Vaccination Data in Immunization Information Systems — United States, 2013–2016
Incremental progress in four Immunization Information System (IIS) priority areas was noted since 2013, but continued effort is needed to implement these critical functionalities among all IISs. IISs are computerized, population-based systems that consolidate vaccination data from providers for clinical and public health use. Data from 2013–2016 were analyzed to assess progress made in four priority areas: 1) pediatric data completeness, 2) bidirectional data exchange with electronic health records, 3) pediatric clinical decision support for immunizations, and 4) ability to generate jurisdictional and provider-level vaccination coverage estimates. Progress was noted since 2013, but continued effort is needed to implement these functionalities among all IISs. Success in these priority areas bolsters public health practitioners’ ability to attain high childhood vaccination coverage and prepares IISs to develop more advanced functionalities. Success also supports the achievement of federal immunization objectives, including using IISs as supplemental sampling frames for vaccination coverage surveys.

Update on Vaccine-Derived Polioviruses — Worldwide, January 2016–June 2017
Vaccine-derived polioviruses will continue to cause rare outbreaks and infect individuals with immune deficiencies until all use of oral poliovirus vaccine can cease after wild poliovirus transmission is eradicated. Vaccine-derived polioviruses (VDPVs) are strains genetically divergent from the oral poliovirus vaccine (OPV) that fall into three categories: 1) circulating VDPVs (cVDPVs) from outbreaks, 2) immunodeficiency-associated VDPVs (iVDPVs) from patients with primary immunodeficiencies, and 3) ambiguous VDPVs (aVDPVs) that cannot be more definitively identified. During January 2016–June 2017, new cVDPV outbreaks were identified in the Democratic Republic of the Congo and Syria, and residual cVDPV2 circulation was detected in Nigeria and Pakistan. Fourteen newly identified persons in 10 countries were found to excrete iVDPVs. Because >94 percent of cVDPVs since 2006 and 69 percent of iVDPVs since OPV introduction are type 2, WHO coordinated worldwide replacement of trivalent OPV with bivalent OPV (types 1 and 3) in April 2016.

Implementation of Rotavirus Surveillance and Vaccine Introduction — World Health Organization African Region Countries, 2007–2016
Rotavirus vaccines have been rapidly implemented in the majority of countries in the WHO African region and their use has resulted in substantial declines in the burden of severe rotavirus disease. Rotavirus is a leading cause of severe childhood diarrhea globally, estimated to have caused 120,000 deaths among children ages <5 years in sub-Saharan Africa in 2013. In 2009, the World Health Organization (WHO) recommended routine rotavirus vaccination of all children worldwide. As of December 2016, 31 of 47 (66 percent) countries in the WHO African Region had introduced rotavirus vaccination into their national schedules, with an overall coverage of 77 percent for a full vaccine series. In 12 countries with available data before and after rotavirus vaccine introduction, the proportion of childhood diarrhea hospitalizations that were rotavirus-positive declined 33 percent, from 39 percent to 26 percent. These results support introduction of rotavirus vaccine in the remaining countries in the region and continuation of rotavirus surveillance to monitor impact.

Announcements
 
CEPI – Coalition for Epidemic Preparedness Innovations  [to 4 November 2017]
http://cepi.net/
Latest News  [Undated]
IT platform vendor
CEPI seeks a vendor for new IT platform

Chikungunya Workshop
The Department of Biotechnology, India (DBT) and Coalition for Epidemic Preparedness Innovations (CEPI) are organising a workshop “Chikungunya vaccines- challenges, opportunities and possibilities” on 5th and 6th February 2018 in Delhi, India. This workshop will bring together international delegates for two days of intense dialogue on ideas, data, challenges and opportunities related to Chikungunya vaccine development
To ensure we have good mix of participants and allow for vivid discussions, participation in the workshop is invitation only. All speakers and participants will be invited to the workshop in the next couple of weeks…

EDCTP    [to 4 November 2017]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials
3 November 2017
GSK and EDCTP launch joint call for Senior Fellowship proposals
In response to the growing challenge of non-communicable diseases (NCDs) in Africa, GSK and EDCTP will launch a joint call…

1 November 2017
Vacancy: Project Officer for The Hague Office
We are looking for a Project Officer to be based at the EDCTP office in The Hague. The Project Officer…

European Medicines Agency  [to 4 November 2017]
http://www.ema.europa.eu/ema/
31/10/2017
EU-US mutual recognition of inspections of medicines manufacturers enters operational phase
Major milestone is a testimony to mutual trust …

30/10/2017
How to develop vaccines and medicines that prevent and treat respiratory syncytial virus (RSV) infection
New guideline to facilitate development of vaccines and treatments out for consultation until April 2018…

European Vaccine Initiative  [to 4 November 2017]
http://www.euvaccine.eu/news-events
01 November 2017
New funding to support novel DNA vaccine for therapy of leishmaniasis
Fresh funding has been awarded by the GHIT Fund to EVI and its partners from Nagasaki University, German biopharmaceutical firm Mologen AG, Charité – Universitätsmedizin Berlin and the London School of Hygiene and Tropical Medicine (LSHTM) to support the completion of the preclinical development of a novel leishmaniasis vaccine candidate and for preparing the conduct of a future Phase I clinical trial.

31 October 2017
EVI Annual Report 2016 now available
The EVI 2016 Annual Report provides an overview of all the activities EVI was involved in during 2016.
 
 
FDA [to 4 November 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
October 31, 2017 –
FDA takes unprecedented step toward more efficient global pharmaceutical manufacturing inspections
The U.S. Food and Drug Administration has determined the agency will recognize eight European drug regulatory authorities as capable of conducting inspections of manufacturing facilities that meet FDA requirements. The eight regulatory authorities found to be capable are those located in: Austria, Croatia, France, Italy, Malta, Spain, Sweden and the United Kingdom.
This achievement marks an important milestone to successful implementation and operationalization of the amended Pharmaceutical Annex to the 1998 U.S.-European Union (EU) Mutual Recognition Agreement (MRA) that enables U.S. and EU regulators to utilize each other’s good manufacturing practice inspections of pharmaceutical manufacturing facilities.
“At a time in which medical product manufacturing is truly a global enterprise, there is much to be gained by partnering with regulatory counterparts to reduce duplicative efforts and maximize global resources while realizing the greatest bang for our collective inspectional buck,” said FDA Commissioner Scott Gottlieb, M.D. “By partnering with these countries we can create greater efficiencies and better fulfill our public health goals, relying on the expertise of our colleagues and refocusing our resources on inspections in higher risk countries.”…
 
 
GHIT Fund   [to 4 November 2017]
https://www.ghitfund.org/
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that devastate the world’s poorest people. Other funders include six Japanese pharmaceutical ·
2017.10.31      Press Room
GHIT Fund Accelerates Promising Efforts to Find New Treatments, Vaccines and Diagnostics for Malaria, Tuberculosis, Leishmaniasis and Mycetoma
The Global Health Innovative Technology (GHIT) Fund, a unique Japanese public-private partnership formed to battle infectious diseases around the globe, today announced US$16.7 million to support development of new compounds for fighting malaria and tuberculosis, a leishmaniasis vaccine and drug, and a treatment for a long-ignored flesh-eating infection. The new investments also will allow scientists to pursue a critically needed diagnostic tool for detecting a relapsing form of malaria when it is hiding in the liver during its dormant phase.
Among new support for malaria drug development is US$ 1.59M to Medicines for Malaria Venture (MMV) and Takeda Pharmaceuticals to develop an antimalarial drug candidate DSM265. DSM265 targets an essential enzyme, dihydroorotate dehydrogenase (DHODH), which is a critical part of the parasite making its own DNA. This completely new mode of action for an antimalarial drug will be critical in the face of resistance to both the artemisinin and partner-drug components of the current gold standard artemisinin combination treatments (ACTs) for malaria. In early-stage human testing, DSM265 has exhibited an exciting potential to both cure and prevent malaria caused by the deadly Plasmodium falciparum malaria parasite. It has already been tested in patients, where, in a study last year, 12 out of 13 patients with P. falciparum malaria were cured with a single dose of 400-milligrams. The final medicine would be a combination of DSM265 with another active compound, and so we expect even better results with a combination medicine…

IVAC  [to 4 November 2017]
http://www.jhsph.edu/research/centers-and-institutes/ivac/index.html
Latest IVAC News  [Undated]
IVAC Progress Report finds stubborn gap in reaching intervention targets among countries heavily burdened by childhood pneumonia and diarrhea 
Why are pneumonia and diarrhea still responsible for 1 of every 4 deaths in children under 5? Released today, IVAC’s 2017 Pneumonia and Diarrhea Progress Report: Driving Progress through Equitable Investment and Action (PDPR) explores factors slowing progress in the most impacted countries against the world’s two biggest killers of young children…
IVAC’s Progress Report, issued annually since the Johns Hopkins Center helped establish World Pneumonia Day in 2009, also delves for the first time into the economic cost of the illnesses and sheds light on the complex relationship between childhood illnesses and poverty. Children in low-resource settings are at higher risk for illness; at the same time, pneumonia and diarrhea can contribute to the cycle of poverty.
Read the full report here.

 
MSF/Médecins Sans Frontières  [to 4 November 2017]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
MSF Secures Generic Hepatitis C Treatment at $120 Compared to $147,000 Launch Price Tag
October 31, 2017
The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) announced today it can now purchase generic hepatitis C medicines for as low as $1.40 per day, or $120 per 12-week treatment course, for two key medicines used to treat and cure this disease, sofosbuvir and daclatasvir. This dramatic price reduction—which will benefit patients in countries where MSF can supply generic versions—illustrates the importance of generic options, which could, if expanded, help countries provide treatment for millions of people and improve public health by preventing the spread of this disease.
 
 
NIH  [to 4 November 2017]
http://www.nih.gov/news-events/news-releases
October 31, 2017
NIH establishes new research in social epigenomics to address health disparities
— Grant program to break new ground in genomics and health disparities research.
The National Institutes of Health will award 10 grants to support social epigenomics research in health disparities. This investigator-initiated research is being funded as part of the Social Epigenomics Research Focused on Minority Health and Health Disparities research program, which seeks to support research to better understand the drivers of health disparities. The National Institute on Minority Health and Health Disparities (NIMHD), part of the National Institutes of Health, will commit $26.2 million over five years, subject to available funds, for nine awards. An additional award under this initiative will be funded by the National Cancer Institute (NCI) – also part of NIH…

UNAIDS [to 4 November 2017]
http://www.unaids.org/en
Feature story
Living with HIV but dying from tuberculosis
03 November 2017
Global progress to End TB not fast enough to reach global TB and HIV targets
Tuberculosis (TB) retains its undesirable status as the leading infectious cause of death globally. According to the latest WHO Global Tuberculosis Report 2017 launched this week, global progress in reducing new tuberculosis (TB) cases and deaths is insufficient to meet the global targets for TB and HIV, despite most deaths being preventable with early diagnosis and appropriate treatment of tuberculosis and HIV.
As part of global efforts to advance the response to TB is now being pushed higher up the global development agenda with hundreds of global leaders attending the first WHO Global Ministerial Conference on Ending TB in Moscow from 14-17 November and a dedicated United Nations General Assembly High-Level Meeting on TB in 2018…

Update
New app helps treatment adherence for people living with HIV
30 October 2017
A new mobile app for people living with HIV, Life4me+, is now available for free in 156 countries and in six languages—Armenian, English, Estonian, German, Russian and Ukrainian. The app was created by a German–Russian activist living with HIV and his team and aims to simplify medical information and treatment for people living with HIV in eastern Europe and central Asia and beyond.
The app was developed based on the experiences of its developers and HIV activists. For people living with HIV, the app works like a personal electronic patient card. It allows users to stay in touch with doctors online, saving and displaying test results, a calendar of blood tests and a prescription history, and sets up reminders about when to take medication and schedule appointments. There are also functions for recording weight, chest volume, blood pressure, disease history, HIV drug resistance, etc…

UNICEF  [to 4 November 2017]
https://www.unicef.org/media/
02 November 2017
9,500 children dying from diarrhoea each year in Afghanistan – UNICEF
KABUL, NILI, Afghanistan, 02 November 2017 – Although the number of children under five years dying from diarrhoea each year in Afghanistan has dropped below 10,000 for the first time, the disease still claims the lives of 26 children each day across the country, UNICEF said today.
 
 
Wellcome Trust  [to 4 November 2017]
https://wellcome.ac.uk/news
News / Published: 1 November 2017
New group to advise Wellcome on diversity and inclusion
The first meeting of Wellcome’s new steering group for Diversity & Inclusion (D&I) takes place this week.
It’s the next step in our commitment to increase the diversity of the people we fund, engage with and employ, and create a research culture in which everyone feels able to contribute their ideas…
Who’s who in the D&I steering group
The group has 12 external members – Catherine Brown, Andrea Callender, Prof Jane Clarke, Lenna Cumberbatch, Dr Robbie Dushinsky, Liz Ellis, Patrick Johnson, Elizabeth Lynch, Katherine Rake, Dr Nicola Rollock, David Ruebain and Adrian Shooter. Together, they have extensive experience of leading on D&I initiatives in a broad mix of settings, from corporate, healthcare and higher education to research environments and public engagement.

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

Global tuberculosis report 2017
WHO – November 2017 :: 262 pages
Abstract
WHO has published a global TB report every year since 1997. The main aim of the report is to provide a comprehensive and up-to-date assessment of the TB epidemic, and of progress in prevention, diagnosis and treatment of the disease at global, regional and country levels. This is done in the context of recommended global TB strategies and targets endorsed by WHO’s Member States and broader development goals set by the United Nations.
PDF: Full report

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
November 01, 2017 Volume 45, Issue 11, p1175-1296, e119-e148
http://www.ajicjournal.org/current

Major Articles
Workplace interventions associated with influenza vaccination coverage among health care personnel in ambulatory care settings during the 2013-2014 and 2014-2015 influenza seasons
Xin Yue, Carla Black, Sarah Ball, Sara Donahue, Marie A. De Perio, A. Scott Laney, Stacie Greby
p1243–1248
Published online: July 3, 2017

BMC Cost Effectiveness and Resource Allocation
http://resource-allocation.biomedcentral.com/
(Accessed 4 November 2017)

Methodology
Disease control programme support costs: an update of WHO-CHOICE methodology, price databases and quantity assumptions
Estimating health care costs, either in the context of understanding resource utilization in the implementation of a health plan, or in the context of economic evaluation, has become a common activity of healt…
Melanie Y. Bertram, Karin Stenberg, Callum Brindley, Jina Li, Juliana Serje, Rory Watts and Tessa Tan-Torres Edejer
Cost Effectiveness and Resource Allocation 2017 15:21
Published on: 26 October 2017

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 4 November 2017)

Research
Survey of programmatic experiences and challenges in delivery of hepatitis B and C testing in low- and middle-income countries
There have been few reports on programmatic experience of viral hepatitis testing and treatment in resource-limited settings. To inform the development of the 2017 World Health Organization (WHO) viral hepatit…
Azumi Ishizaki, Julie Bouscaillou, Niklas Luhmann, Stephanie Liu, Raissa Chua, Nick Walsh, Sarah Hess, Elena Ivanova, Teri Roberts and Philippa Easterbrook
BMC Infectious Diseases 2017 17(Suppl 1):696
Published on: 1 November 2017

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 4 November 2017)

Research
Values, preferences and current hepatitis B and C testing practices in low- and middle-income countries: results of a survey of end users and implementers
Access to hepatitis B virus (HBV) and hepatitis C virus (HCV) diagnostics remains a key bottleneck in scale-up of access to HBV and HCV treatment, particularly in low- and middle-income countries (LMICs) that …
Elena Ivanova Reipold, Alessandra Trianni, Douglas Krakower, Stefano Ongarello, Teri Roberts, Philippa Easterbrook and Claudia Denkinger
BMC Infectious Diseases 2017 17(Suppl 1):702
Published on: 1 November 2017

BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content
(Accessed 4 November 2017)

Research article
Vaccine-related poliovirus shedding in trivalent polio vaccine and human immunodeficiency virus status: analysis from under five children
Poliomyelitis is an acute viral infection caused by poliovirus and transmitted via the fecal–oral route. The causative agent is one of the three serotypes of poliovirus (serotypes 1, 2, 3) that differ slightly…
Joanne Hassan, Laura Wangai, Peter Borus, Christopher Khayeka–Wandabwa, Lucy Wanja Karani, Mercy Kithinji and Michael Kiptoo
BMC Research Notes 2017 10:555
Published on: 3 November 2017

Bulletin of the World Health Organization
Volume 95, Number 11, November 2017, 729-792
http://www.who.int/bulletin/volumes/95/11/en/
LESSONS FROM THE FIELD

Tetanus in adult males, Bugando Medical Centre, United Republic of Tanzania
Riaz Aziz, Robert N Peck, Samuel Kalluvya, Bernard Kenemo, Alphonce Chandika & Jennifer A Downs
http://dx.doi.org/10.2471/BLT.16.185546

EMBO Reports
01 November 2017; volume 18, issue 11
http://embor.embopress.org/content/18/11?current-issue=y
Opinion
The Council of Europe should not reaffirm the ban on germline genome editing in humans
The Council of Europe plans to urge member states to sign and ratify the Oviedo Convention that would ban all inheritable modifications of the human germline. Such a policy would prevent research to develop new therapeutic options for inheritable diseases in Europe and is in sharp contrast to international developments.
Peter Sykora, Arthur Caplan

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

International Journal of Community Medicine and Public Health
Vol 4, No 11 (2017)
http://www.ijcmph.com/index.php/ijcmph/issue/view/32

Original Research Articles
Immunization coverage in an urban resettlement colony of district Gautam-Budh Nagar, Uttar Pradesh, India using WHO 30×7 cluster sampling technique
Harsh Mahaja n, Shalini Srivastava, S. Nagesh
DOI: 10.18203/2394-6040.ijcmph20174660

A study on immunization coverage of 12-23 months children in urban areas of Kanchipuram district, Tamil Nadu
Duraimurugan Murugesan, Ramasubramanian R.
DOI: 10.18203/2394-6040.ijcmph20174486

Assessment of knowledge and attitude of medical and nursing students towards screening for cervical carcinoma and HPV vaccination in a tertiary care teaching hospital
Sunite A. Ganju, Neha Gautam, Vijay Barwal, Sohini Walia, Shriya Ganju
DOI: 10.18203/2394-6040.ijcmph20174826

International Journal of Infectious Diseases
November 2017 Volume 64, p1-106
http://www.ijidonline.com/issue/S1201-9712(17)X0011-8

Perspective
A situational analysis of current antimicrobial governance, regulation, and utilization in South Africa
Natalie Schellack, Deon Benjamin, Adrian Brink, Adriano Duse, Kim Faure, Debra Goff, Marc Mendelson, Johanna Meyer, Jacqui Miot, Olga Perovic, Troy Pople, Fatima Suleman, Moritz van Vuuren, Sabiha Essack
p100–106
Published online: September 8, 2017

Knowledge and practices related to plague in an endemic area of Uganda
Kiersten J. Kugeler, Titus Apangu, Joseph D. Forrester, Kevin S. Griffith, Gordian Candini, Janet Abaru, Jimmy F. Okoth, Harriet Apio, Geoffrey Ezama, Robert Okello, Meghan Brett, Paul Mead
p80–84
Published online: September 18, 2017

Journal of Community Health
Volume 42, Issue 6, December 2017
https://link.springer.com/journal/10900/42/6/page/1

Original Paper
Factors Associated with HPV Vaccination in Young Males
Kelli M. Fuller, Leslie Hinyard
Abstract
Human papilloma virus (HPV) affects both men and women; however, recommendations for HPV vaccination among men were not issued in the United States until 2011. The purpose of this study was to describe and compare characteristics of men who did and did not report receiving at least one dose of the HPV vaccine. Data from the ten states that completed the HPV vaccination module in the 2013 Behavioral Risk Factor Surveillance System (BRFSS) were included in the study. Young men ages 18–26 were included (N = 1624). Categorical variables were compared between those who did and did not receive the HPV vaccine using Chi square. Logistic regression was used to examine the odds of HPV vaccination by the above factors. Only 16.5% of men reported at least one dose of HPV vaccine. Having health insurance, having a primary doctor, and receiving an HIV test were predictive of HPV vaccination. Men in Texas were more likely to report HPV vaccination than all other states. Overall, HPV vaccination is low in men. Targeted interventions for improving HPV vaccination rates in men are warranted, especially for those without health insurance or a routine source of care

Journal of Infectious Diseases
Volume 216, Issue suppl_6  1 October 2017
https://academic.oup.com/jid/issue
Towards Zero New TB Infections: Research Needs for Halting TB Transmission
SUPPLEMENT ARTICLES

Getting to Zero New Tuberculosis Infections: Insights From the National Institutes of Health/US Centers for Disease Control and Prevention/Bill & Melinda Gates Foundation Workshop on Research Needs for Halting Tuberculosis Transmission
N Sarita Shah; Peter Kim; Bavesh Davandra Kana; Roxana Rustomjee
The Journal of Infectious Diseases, Volume 216, Issue suppl_6, 3 November 2017, Pages S627–S628, https://doi.org/10.1093/infdis/jix311
Extract
Tuberculosis caused an estimated 1.4 million deaths in 2015 and now ranks as the leading infectious disease cause of mortality in the world [1]. An additional 1.7 billion people are currently infected with Mycobacterium tuberculosis and are at risk of developing active tuberculosis disease. The challenge to eliminate tuberculosis has never been more relevant and urgent. Unfortunately, efforts to bring this global epidemic under control have been hampered by inadequate understanding of the epidemiology, biology, and effective interventions that directly address tuberculosis transmission. Identifying the key drivers of transmission and…

Journal of Infectious Diseases
Volume 216, Issue suppl_6  1 October 2017
https://academic.oup.com/jid/issue

Designing and Evaluating Interventions to Halt the Transmission of Tuberculosis
David W Dowdy; Alison D Grant; Keertan Dheda; Edward Nardell; Katherine Fielding …
The Journal of Infectious Diseases, Volume 216, Issue suppl_6, 3 November 2017, Pages S654–S661, https://doi.org/10.1093/infdis/jix320

Research Roadmap for Tuberculosis Transmission Science: Where Do We Go From Here and How Will We Know When We’re There?
Sara C Auld; Anne G Kasmar; David W Dowdy; Barun Mathema; Neel R Gandhi …
The Journal of Infectious Diseases, Volume 216, Issue suppl_6, 3 November 2017, Pages S662–S668, https://doi.org/10.1093/infdis/jix353

Journal of Medical Ethics
November 2017 – Volume 43 – 11
http://jme.bmj.com/content/current
Political philosophy & medical ethics

Paper: The case against libertarian arguments for compulsory vaccination
Justin Bernstein
Abstract
In a recent paper in this journal, Jason Brennan correctly notes that libertarians struggle to justify a policy of compulsory vaccination. The most straightforward argument that justifies compulsory vaccination is that such a policy promotes welfare. But libertarians cannot make this argument because they claim that the state is justified only in protecting negative rights, not in promoting welfare. I consider two representative libertarian attempts to justify compulsory vaccination, and I argue that such arguments are unsuccessful. They either fail to show that the state is justified in implementing the policy or overgeneralise. I suggest that Brennan’s solution is especially well motivated insofar as it addresses the shortcomings of these arguments. Brennan argues that we violate the rights of others by participating in an activity that imposes an unacceptable collective risk of harm. Going unvaccinated is an activity that imposes an unacceptable collective risk of harm, and thus amounts to a rights violation. So, the state can implement a policy of compulsory vaccination I object, however, that Brennan’s delineation of acceptable and unacceptable risk implicitly rests on classical liberal rather than libertarian principles; he justifies compulsory vaccination on the grounds that it promotes welfare. I also object that Brennan’s argument would entail significant departures from libertarian institutional arrangements. This leaves libertarians with a choice: they can develop new arguments to demonstrate that their position is compatible with compulsory vaccination, or they can accept that their view entails the impermissibility of compulsory vaccination, and argue that this is not an unpalatable implication of their view.

Journal of Patient-Centered Research and Reviews
Volume 4, Issue 4 (2017)
http://digitalrepository.aurorahealthcare.org/jpcrr/
Health Disparities and Inequities: Part I

Supplements
Six-Year Experience of Influenza Vaccination as a Condition of Employment for a Large Regional Health Care System
John R. Brill, Mark Hermanoff, Angela Tonozzi, Mary Jo Capodice, Jennifer Farrar, and Zarina Dawoodbhai
Conclusion: An influenza program as a condition of employment leads to high levels of immunization of HCW, with minimal impact on HCW retention and satisfactory satisfaction among HCW.

Lancet Infectious Diseases
Nov 2017 Volume 17 Number 11 p1099-1218   e334-e382
http://www.thelancet.com/journals/laninf/issue/current

Editorial
The imperative of vaccination
The Lancet Infectious Diseases
Vaccination is one of the most effective public health interventions and it has been instrumental in saving lives and greatly changing the burden of many infectious diseases over the past 100 years. However, the very effectiveness of vaccines has made some diseases rare, and most of us are less likely to witness first hand the devastating consequences of vaccine-preventable diseases. This fact, combined with misinformation, suspicion about vaccines, and mistrust of governments and health authorities, have prompted many parents to override concerns about the diseases themselves and oppose the vaccination of their children.

Although vaccination is usually recommended by local health authorities, in many countries immunisation rates for diseases such as measles have dropped well below the 95% threshold set by WHO. This threshold is deemed necessary to maintain the herd immunity that guarantees protection for babies too young to be vaccinated, elderly people, immunosuppressed individuals, and those who cannot be vaccinated for other medical reasons. In the past year, low immunisation rates have caused a surge in the number of cases of measles and related deaths in several countries, such as Romania, Italy, and France. Similarly, the drop in vaccination is the cause of two cases of tetanus reported in Italy in recent months, after the disease had not been seen in the country for more than 30 years. The rise in cases of vaccine-preventable diseases secondary to lower immunisation rates is becoming a serious public health problem and as François Chast, head of pharmacology at Paris hospitals (Paris, France), said, “It is urgent to fight the speeches of anti-science and anti-vaccination lobbies that play on fear, they show nothing and rely on a few, very rare side effects to discredit vaccines that save millions of lives.”

To tackle this worrying and unjustified drop in vaccination rates, some countries are considering, or have already implemented, the introduction of mandatory vaccination for children. Following the example of the state of California, USA, and Australia, the Italian Government passed in June, without prior public consultation, a law that made vaccination for ten diseases (polio, diphtheria, tetanus, hepatitis B, pertussis, Haemophilus influenzae type B, measles, varicella, mumps, and rubella) mandatory for children aged between 1 and 16 years. In 2020, after collection of new data on vaccination rates, the government will re-evaluate whether or not vaccination for measles, rubella, varicella, and mumps should still be mandatory. Unvaccinated children are not allowed to attend kindergardens and must be vaccinated before starting primary school, or their parents will incur heavy financial penalties. France will adopt a similar policy by making vaccination mandatory for 11 diseases (including also meningitis C) from 2018 onwards. Australia has gone even further with its so-called no jab-no play (banning the enrolment of unvaccinated children in preschool and childcare centres) and so-called no jab-no pay (under which parents of unvaccinated children lose government benefits and welfare rebates) policies.

The introduction of mandatory vaccination has sparked controversy among parents who feel deprived of their freedom to make decisions about the health of their children. A concern raised by such vaccine-hesitant parents is the chance of adverse events, such as neurodevelopmental problems, potentially linked to vaccination. In reality, although vaccines, like any medical intervention, can have adverse events, these outcomes are so rare that they are, by far, outweighed by the benefits of vaccination. As Michael Gannon, the president of the Australian Medical Association (Barton, Australia), said, “You are 10 000 times more likely to be brain damaged by measles than you are by its vaccination.” Unfortunately, the anti-vaccine movement seems to prefer to ignore the bulk of scientific evidence in support of the safety of vaccines.

Public health problems such as the surge in cases of vaccine-preventable diseases need to be addressed with strong interventions that maximise societal benefits; making vaccination mandatory, albeit temporarily, should not be seen as an infringement of personal rights. Nobody would rationally advocate for vaccination if there were alternatives or if scientific evidence showed that the risk of adverse events outweighed the protection against infectious diseases. But the reality is that vaccines are still one of the safest options to prevent infectious diseases and judgement should be based on facts, not unfounded fears.

Lancet Infectious Diseases
Nov 2017 Volume 17 Number 11 p1099-1218   e334-e382
http://www.thelancet.com/journals/laninf/issue/current

Comment
Understanding commitment to polio vaccination
Kathleen M O’Reilly

Yellow fever vaccination: estimating coverage
Annelies Wilder-Smith

Articles
Understanding threats to polio vaccine commitment among caregivers in high-priority areas of Afghanistan: a polling study
Gillian K SteelFisher, Robert J Blendon, Sherine Guirguis, William Lodge II, Hannah Caporello, Vincent Petit, Michael Coleman, Matthew R Williams, Sardar Mohammad Parwiz, Melissa Corkum, Scott Gardner, Eran N Ben-Porath

Global yellow fever vaccination coverage from 1970 to 2016: an adjusted retrospective analysis
Freya M Shearer, Catherine L Moyes, David M Pigott, Oliver J Brady, Fatima Marinho, Aniruddha Deshpande, Joshua Longbottom, Annie J Browne, Moritz U G Kraemer, Kathleen M O’Reilly, Joachim Hombach, Sergio Yactayo, Valdelaine E M de Araújo, Aglaêr A da Nóbrega, Jonathan F Mosser, Jeffrey D Stanaway, Stephen S Lim, Simon I Hay, Nick Golding, Robert C Reiner Jr

Lancet Respiratory Medicine
Nov 2017 Volume 5 Number 11 p835-908   e31-e34
http://www.thelancet.com/journals/lanres/issue/current

Editorial
Where are the innovations in tuberculosis drug discovery?
The Lancet Respiratory Medicine
WHO has released a report that highlights a serious lack of antibiotics in clinical development; a worrying finding in an era of antimicrobial resistance. The report identifies a particular shortage of antibiotics under development for multidrug-resistant tuberculosis, which is a disease that kills a quarter of a million people every year.

The WHO analysis aimed to identify products that were in clinical development up to May, 2017, for the treatment of tuberculosis, Clostridium difficile, and diseases caused by pathogens on the WHO priority pathogen list. WHO also assessed whether these products were innovative. Their definition of innovative was based on whether they were a new chemical class, had a new target or binding site, had a new mode of action, or had no cross resistance to other antibiotic classes. For tuberculosis, they found that only seven products are currently in clinical development. Five of these products are categorised as innovative, but only one—pretomanid—is in phase 3 clinical development. These figures are an improvement on 2000, when no tuberculosis drugs were in clinical development and the TB Alliance was formed to address the issue. However, the figures are still well short of the targets set out by the Stop TB Partnership Global Plan 2011–2105. Additionally, only two new antibiotics for tuberculosis have reached the market in over 70 years—delamanid and bedaquiline—but limited access to these newly licensed drugs has been highlighted, with fewer than 5% of people in need being treated with them according to Medecins Sans Frontieres. Reasons for the restricted access include their high price, and the drugs not being registered in many high-burden countries.

The limited drug pipeline for tuberculosis can be attributed to a substantial lack of funding. According to the US-based Treatment Action Group, global funding for all tuberculosis research and development almost doubled between 2005 and 2011; however, funding has plateaued since 2009. In 2015, total global funding was US$620 million, which is far from the 2011–2015 Global Plan’s target of $2·2 billion. Treatment Action Group notes that the reduced funding in 2015 was due to the payment cycles of major funders, and declining investment from the largest pharmaceutical funder, Otsuka, whose new drug delamanid is in the final stages of phase 3 clinical trials.

In this context, it is welcome news that the Global Antibiotic Research and Development Partnership (GARDP) announced more than €56 million has been raised to fund an initiative to fight antibiotic resistance. The partnership was launched in May, 2016, by WHO and the Drugs for Neglected Diseases initiative, with the aim of developing and delivering new treatments for bacterial infections for which drug resistance is present or emerging, or for which current treatments are inadequate. GARDP will target products that the pharmaceutical industry will likely not develop due to lack of profitability or other reasons, and will pilot the use of alternative incentive models, removing the link between the cost of research and development and the sales of antibiotics. GARDP has four main focus areas: sexually transmitted infections, a programme to revive abandoned antibiotic development projects, neonatal sepsis, and paediatric antibiotics. However, it has no specific programme to tackle multidrug-resistant tuberculosis.

Despite poor funding for tuberculosis research and development, the latest analyses of the Global Burden of Disease study show that deaths caused by tuberculosis in 2016 were down by nearly 21% since 2006, and the incidence of tuberculosis was down by 1·7%. However, this rate of decline is not sufficient to meet the UN Sustainable Development Goal to end the epidemic of tuberculosis by 2030, with not a single country projected to achieve this goal. The identification of new drugs is not the only strategy for tackling tuberculosis; efforts are also being made to improve diagnosis, infection prevention and control, and to ensure appropriate use of existing and future antibiotics in the human, animal, and agricultural sectors. But without innovations in the market to help develop new treatments for multidrug-resistant tuberculosis, the UN Sustainable Development Goal will remain out of reach.

Medical Decision Making (MDM)
Volume 37, Issue 8, November 2017
http://mdm.sagepub.com/content/current

Original Articles
From Data to Improved Decisions: Operations Research in Healthcare Delivery
Muge Capan, PhD, Anahita Khojandi, PhD, Brian T. Denton, PhD, Kimberly D. Williams, MPH, Turgay Ayer, PhD, Jagpreet Chhatwal, PhD, Murat Kurt, PhD, Jennifer Mason Lobo, PhD, Mark S. Roberts, MD, Greg Zaric, PhD, Shengfan Zhang, PhD, J. Sanford Schwartz, MD
First Published April 19, 2017; pp. 849–859

Effects of Anti- Versus Pro-Vaccine Narratives on Responses by Recipients Varying in Numeracy: A Cross-sectional Survey-Based Experiment
Wändi Bruine de Bruin, PhD, Annika Wallin, PhD, Andrew M. Parker, PhD, JoNell Strough, PhD, Janel Hanmer, MD PhD
First Published May 5, 2017; pp. 860–870

The Milbank Quarterly
A Multidisciplinary Journal of Population Health and Health Policy
September 2017  Volume 95, Issue 3  Pages 447–682

http://onlinelibrary.wiley.com/doi/10.1111/milq.2017.95.issue-3/issuetoc
Op-Eds
The World Health Organization’s Ninth Director-General: The Leadership of Tedros Adhanom (pages 457–461)
LAWRENCE O. GOSTIN
Version of Record online: 21 JUN 2017 | DOI: 10.1111/1468-0009.12269

New England Journal of Medicine
November 2, 2017  Vol. 377 No. 18
http://www.nejm.org/toc/nejm/medical-journal

Perspective
A Renewed Focus on Maternal Health in the United States
R.L. Molina and L.E. Pace
[Excerpt]
…Maternal mortality is usually defined as the death of a woman during pregnancy or within 42 days after delivery when the cause is directly or indirectly related to pregnancy. The maternal mortality ratio in the United States (28 deaths per 100,000 live births in 2013) is low compared with the average ratio in low-income regions (230 deaths per 100,000 live births).2 However, it has more than doubled since 1990 (see graph). Maternal Mortality in the United States, 1990–2013.) and is higher than the maternal mortality ratio in most high-income countries; Canada, for example, had 11 maternal deaths per 100,000 live births in 2013.2 Furthermore, most high-income countries have seen maternal mortality decrease in recent years. High maternal mortality in the United States as compared with other high-income countries and the continuing upward trend highlight gaps in our care for reproductive-age women that are particularly worrisome in light of some lawmakers’ recent efforts to reduce access to health insurance and reproductive health care….

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 4 November 2017)
Research Article

After the epidemic: Zika virus projections for Latin America and the Caribbean
Felipe J. Colón-González, Carlos A. Peres, Christine Steiner São Bernardo, Paul R. Hunter, Iain R. Lake
| published 01 Nov 2017 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0006007

Research Article
A multi-country study of the economic burden of dengue fever: Vietnam, Thailand, and Colombia
Jung-Seok Lee, Vittal Mogasale, Jacqueline K. Lim, Mabel Carabali, Kang-Sung Lee, Chukiat Sirivichayakul, Duc Anh Dang, Diana Cristina Palencia-Florez, Thi Hien Anh Nguyen, Arthorn Riewpaiboon, Pornthep Chanthavanich, Luis Villar, Brian A. Maskery, Andrew Farlow
| published 30 Oct 2017 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0006037

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

Health impact and cost-effectiveness of a domestically-produced rotavirus vaccine in India: A model based analysis
Johnie Rose, Laura Homa, Sharon B. Meropol, Sara M. Debanne, Roger Bielefeld, Claudia Hoyen, Mendel E. Singer
| published 03 Nov 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0187446

Catch-up HPV vaccination status of adolescents in relation to socioeconomic factors, individual beliefs and sexual behaviour
Maria Grandahl, Margareta Larsson, Tina Dalianis, Christina Stenhammar, Tanja Tydén, Ragnar Westerling, Tryggve Nevéus
Research Article | published 03 Nov 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0187193

The impact of antenatal care, iron–folic acid supplementation and tetanus toxoid vaccination during pregnancy on child mortality in Bangladesh
Tanvir Abir, Felix Akpojene Ogbo, Garry John Stevens, Andrew Nicolas Page, Abul Hasnat Milton, Kingsley Emwinyore Agho
Research Article | published 01 Nov 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0187090

Human-centred design in global health: A scoping review of applications and contexts
Alessandra N. Bazzano, Jane Martin, Elaine Hicks, Maille Faughnan, Laura Murphy
Research Article | published 01 Nov 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0186744
Abstract
Health and wellbeing are determined by a number of complex, interrelated factors. The application of design thinking to questions around health may prove valuable and complement existing approaches. A number of public health projects utilizing human centered design (HCD), or design thinking, have recently emerged, but no synthesis of the literature around these exists. The results of a scoping review of current research on human centered design for health outcomes are presented. The review aimed to understand why and how HCD can be valuable in the contexts of health-related research. Results identified pertinent literature as well as gaps in information on the use of HCD for public health research, design, implementation and evaluation. A variety of contexts were identified in which design has been used for health. Global health and design thinking have different underlying conceptual models and terminology, creating some inherent tensions, which could be overcome through clear communication and documentation in collaborative projects. The review concludes with lessons learned from the review on how future projects can better integrate design thinking with global health research.

The full benefits of adult pneumococcal vaccination: A systematic review
Elizabeth T. Cafiero-Fonseca, Andrew Stawasz, Sydney T. Johnson, Reiko Sato, David E. Bloom
Research Article | published 31 Oct 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0186903

Public Health Ethics
Volume 10, Issue 3  November 2017
http://phe.oxfordjournals.org/content/current

Vaccine Exemption Policies – A Discussion
Improving Nonmedical Vaccine Exemption Policies: Three Case Studies
Mark Christopher Navin; Mark Aaron Largent
Public Health Ethics, Volume 10, Issue 3, 1 November 2017, Pages 225–234, https://doi.org/10.1093/phe/phw047

Liberty, Fairness and the ‘Contribution Model’ for Non-medical Vaccine Exemption Policies: A Reply to Navin and Largent
Alberto Giubilini; Thomas Douglas; Julian Savulescu
Public Health Ethics, Volume 10, Issue 3, 1 November 2017, Pages 235–240, https://doi.org/10.1093/phe/phx014

Prioritizing Parental Liberty in Non-medical Vaccine Exemption Policies: A Response to Giubilini, Douglas and Savulescu
Mark C Navin; Mark A Largent
Public Health Ethics, Volume 10, Issue 3, 1 November 2017, Pages 241–243, https://doi.org/10.1093/phe/phx015

Qualitative Health Research
Volume 27, Issue 13, November 2017
http://qhr.sagepub.com/content/current
Special Issue: Medicines & Medications

Socialization, Indifference, and Convenience: Exploring the Uptake of Influenza Vaccine Among Medical Students and Early Career Doctors
Rhiannon Edge, Dawn Goodwin, Rachel Isba, Thomas Keegan
First Published July 24, 2017; pp. 1982–1993

Tropical Medicine & International Health
November 2017   Volume 22, Issue 11  Pages 1361–1462
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2017.22.issue-11/issuetoc

Original Research Papers
Authorship in paediatric research conducted in low- and middle-income countries: parity or parasitism? (pages 1362–1370)
Chris A. Rees, Heather Lukolyo, Elizabeth M. Keating, Kirk A. Dearden, Samuel A. Luboga, Gordon E. Schutze and Peter N. Kazembe
Version of Record online: 20 SEP 2017 | DOI: 10.1111/tmi.12966
Abstract
Objectives
Interest in global health has increased greatly in the past two decades. Concomitantly, the number and complexity of research partnerships between high-income (HIC) and low- and middle-income countries (LMICs) has grown. We aimed to determine whether there is authorship parity (equitable representation and author order) or parasitism (no authors from study countries) in paediatric research conducted in LMICs.
Methods
We reviewed all articles published from 2006 to 2015 in the four paediatric journals with the highest Eigenfactor scores. We limited our review to articles from LMICs and abstracted information on author affiliation and order, funding source and study design. We calculated Student’s t-tests and chi-square using Fisher’s exact test with Monte Carlo estimates.
Results
There were 24 169 articles published during the study period, and 1243 met inclusion criteria. Of those, 95.9% (n = 1,192) included at least one author affiliated with a LMIC. Among multicountry studies (n = 165), 40.4% did not include authors from every LMIC involved. Of the 9876 authors, most were affiliated with institutions from upper-middle-income countries (41.7%) and HICs (32.7%), with far fewer affiliated with lower middle-income (15.5%) and low-income countries (5.4%) (P < 0.001). In articles from low-income countries, first and last authors from HICs were more common than authors with low-income country affiliations (P < 0.001).
Conclusions
Authorship parasitism was rare overall but common in multicountry studies. In studies conducted in low-income countries, HIC authors more commonly occupied first and last author positions than authors from the study countries. Where LMIC authors make substantial contributions, researchers should strive for authorship parity.

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.
 
Foreign Affairs
http://www.foreignaffairs.com/
Accessed 4 November 2017
Foreign Aid  
Blockchain and Global Health
How the Technology Could Cut Waste and Reduce Fraud
Brian M. Till, Salim Afshar, Alex W. Peters, and John G. Meara

Foreign Policy
http://foreignpolicy.com/
Accessed 4 November 2017
Yemen’s Man-Made Cholera Outbreak Is About to Break a Record
In Haiti, it took seven years for the number of cholera cases to surpass 800,000. In Yemen, it’s taken several months.
The Cable |
Dan De Luce

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_28 October 2017

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

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

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

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

Milestones – Perspectives

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.

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

WHO & Regional Offices [to 28 October 2017]

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

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

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

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

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

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

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

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

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

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

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

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

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

Announcements

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

EDCTP    [to 28 October 2017]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials
No new digest content identified.

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

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

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

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

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

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

“At Gavi we know that effective management of immunisation programmes is key to building strong health systems and extending those systems to reach all children who desperately need them”, said Dr Seth Berkley, CEO of Gavi. “Our partnership with the Aspen Institute is one of many innovative investments in effective management that Gavi is rolling out. Aspen’s leadership and management expertise will be an important boost to our mission to ensure no child goes without lifesaving vaccines”, he added….
 
 
GHIT Fund   [to 28 October 2017]
https://www.ghitfund.org/
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that devastate the world’s poorest people. Other funders include six Japanese pharmaceutical ·
No new digest content identified.

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

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

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

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

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

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

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

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

Journal Watch

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

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

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

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

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

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

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

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

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

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

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

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