Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 14, Issue 2 2018
http://www.tandfonline.com/toc/khvi20/current

Review
Development of Middle East Respiratory Syndrome Coronavirus vaccines – advances and challenges
Heeyoun Cho, Jean-Louis Excler, Jerome H. Kim & In-Kyu Yoon
Pages: 304-313
Published online: 29 Nov 2017

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 14, Issue 2 2018
http://www.tandfonline.com/toc/khvi20/current

Article
Awareness of and willingness to be vaccinated by human papillomavirus vaccine among junior middle school students in Jinan, China
Li Xue, Wenqi Hu, Haiman Zhang, Zhongling Xie, Xi Zhang, Fanghui Zhao, Youlin Qiao, Lijie Gao & Wei Ma
Pages: 404-411
Published online: 01 Dec 2017

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 14, Issue 2 2018
http://www.tandfonline.com/toc/khvi20/current

Review
Global economic evaluation of oral cholera vaccine: A systematic review
Siew Li Teoh, Surachai Kotirum, Raymond C. W. Hutubessy & Nathorn Chaiyakunapruk
Pages: 420-429
Published online: 15 Dec 2017
Abstract
World Health Organization recommends oral cholera vaccine (OCV) to prevent and control cholera, but requires cost-effectiveness evidence. This review aimed to provide a critical appraisal and summary of global economic evaluation (EE) studies involving OCV to guide future EE study. Full EE studies, published from inception to December 2015, evaluating OCV against cholera disease were included. The included studies were appraised using WHO guide for standardization of EE of immunization programs. Out of 14 included studies, almost all (13/14) were in low- and middle-income countries. Most studies (11/14) evaluated mass vaccination program. Most of the studies (9/14) incorporated herd protective effect. The most common influential parameters were cholera incidence, OCV coverage, herd protection and OCV price. OCV vaccination is likely to be cost-effective when targeted at the population with high-risk of cholera and poor access to health care facilities when herd protection effect is incorporated and OCV price is low.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 14, Issue 2 2018
http://www.tandfonline.com/toc/khvi20/current

Article
Pharmacists as vaccinators: An analysis of their experiences and perceptions of their new role
Sandra Gerges, Elizabeth Peter, Susan K. Bowles, Shelley Diamond, Lucie Marisa Bucci, Anne Resnick & Anna Taddio
Pages: 471-477
Published online: 19 Dec 2017

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 14, Issue 2 2018
http://www.tandfonline.com/toc/khvi20/current

Review
Health literacy and vaccination: A systematic review
Chiara Lorini, Francesca Santomauro, Martina Donzellini, Leonardo Capecchi, Angela Bechini, Sara Boccalini, Paolo Bonanni & Guglielmo Bonaccorsi
Pages: 478-488
Published online: 06 Dec 2017

International Journal of Community Medicine and Public Health
Vol 5, No 2 (2018) February 2018
http://www.ijcmph.com/index.php/ijcmph/issue/view/35

Review Articles
Emerging infectious diseases: MERS-COV, the new Betacoronavirus pandemic
Mohammed Alaenazi, Hmoud Algarni, Saeed Alqahtani, Raed Aldahmeshi, Sabah Almutairi, Alaa Alaskar
DOI: 10.18203/2394-6040.ijcmph20180042
Abstract
Both the recent MERS-CoV and the past SARS-CoV indicate that new pathogens would probably emerge. Because it is not possible to predict when or where a new epidemic would occur, this continues to be a challenging issue for physicians and healthcare organizations. Furthermore, there are prophylactic vaccines or effective treatment for these infections and little is known about the origin and the zoonotic transmission of MERS-CoV which hinders the progress of its spread to humans. MERS-CoV is highly pathogenic, exhibiting high fatality rate than the former human corona virus SARS and can obviously be transmitted through several routes, with higher incidence in compromised healthcare settings. Currently, efforts to manage MERS-CoV spared should be directed towards developing educational programs, targeting the public and more importantly health care providers. For one major concern, this infection has and still could pose potential to spread rapidly across the globe, especially during religious mass gathering originating from a MERS-CoV hot spot (i.e., Hajj). Continued epidemiologic surveillance and vigilance remains crucial to compact this virus, or any future mutation.

JAMA Pediatrics
February 2018, Vol 172, No. 2, Pages 105-204
http://archpedi.jamanetwork.com/issue.aspx

Viewpoint
Reducing the Underimmunization of Transplant Recipients
Amy G. Feldman, MD, MSCS; Chris Feudtner, MD, PhD, MPH; Allison Kempe, MD, MPH
JAMA Pediatr. 2018;172(2):111-112. doi:10.1001/jamapediatrics.2017.3990
This Viewpoint proposes a strategy to reduce the underimmunization of pediatric transplant recipient
Vaccine-preventable infections (VPIs) are a common and serious complication after pediatric liver transplantation; in the first 2 years after transplant, 1 of 6 transplant recipients requires hospitalization for VPI, which is associated with graft injury, morbidity, and sometimes mortality.1 These hospitalizations can increase the cost of the transplant-associated hospitalization by $70 000.1

The Lancet
Feb 10, 2018 Volume 391 Number 10120 p513-630 e6
http://www.thelancet.com/journals/lancet/issue/current

Articles
Safety, tolerability, and immunogenicity of two Zika virus DNA vaccine candidates in healthy adults: randomised, open-label, phase 1 clinical trials
Martin R Gaudinski, Katherine V Houser, Kaitlyn M Morabito, Zonghui Hu, Galina Yamshchikov, Ro Shauna Rothwell, Nina Berkowitz, Floreliz Mendoza, Jamie G Saunders, Laura Novik, Cynthia S Hendel, LaSonji A Holman, Ingelise J Gordon, Josephine H Cox, Srilatha Edupuganti, Monica A McArthur, Nadine G Rouphael, Kirsten E Lyke, Ginny E Cummings, Sandra Sitar, Robert T Bailer, Bryant M Foreman, Katherine Burgomaster, Rebecca S Pelc, David N Gordon, Christina R DeMaso, Kimberly A Dowd, Carolyn Laurencot, Richard M Schwartz, John R Mascola, Barney S Graham, Theodore C Pierson, Julie E Ledgerwood, Grace L Chen and the VRC 319 and VRC 320 study teams

Preliminary aggregate safety and immunogenicity results from three trials of a purified inactivated Zika virus vaccine candidate: phase 1, randomised, double-blind, placebo-controlled clinical trials
Kayvon Modjarrad, Leyi Lin, Sarah L George, Kathryn E Stephenson, Kenneth H Eckels, Rafael A De La Barrera, Richard G Jarman, Erica Sondergaard, Janice Tennant, Jessica L Ansel, Kristin Mills, Michael Koren, Merlin L Robb, Jill Barrett, Jason Thompson, Alison E Kosel, Peter Dawson, Andrew Hale, C Sabrina Tan, Stephen R Walsh, Keith E Meyer, James Brien, Trevor A Crowell, Azra Blazevic, Karla Mosby, Rafael A Larocca, Peter Abbink, Michael Boyd, Christine A Bricault, Michael S Seaman, Anne Basil, Melissa Walsh, Veronica Tonwe, Daniel F Hoft, Stephen J Thomas, Dan H Barouch, Nelson L Michael

Review
The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health
Nick Watts, Markus Amann, Sonja Ayeb-Karlsson, Kristine Belesova, Timothy Bouley, Maxwell Boykoff, Peter Byass, Wenjia Cai, Diarmid Campbell-Lendrum, Jonathan Chambers, Peter M Cox, Meaghan Daly, Niheer Dasandi, Michael Davies, Michael Depledge, Anneliese Depoux, Paula Dominguez-Salas, Paul Drummond, Paul Ekins, Antoine Flahault, Howard Frumkin, Lucien Georgeson, Mostafa Ghanei, Delia Grace, Hilary Graham, Rébecca Grojsman, Andy Haines, Ian Hamilton, Stella Hartinger, Anne Johnson, Ilan Kelman, Gregor Kiesewetter, Dominic Kniveton, Lu Liang, Melissa Lott, Robert Lowe, Georgina Mace, Maquins Odhiambo Sewe, Mark Maslin, Slava Mikhaylov, James Milner, Ali Mohammad Latifi, Maziar Moradi-Lakeh, Karyn Morrissey, Kris Murray, Tara Neville, Maria Nilsson, Tadj Oreszczyn, Fereidoon Owfi, David Pencheon, Steve Pye, Mahnaz Rabbaniha, Elizabeth Robinson, Joacim Rocklöv, Stefanie Schütte, Joy Shumake-Guillemot, Rebecca Steinbach, Meisam Tabatabaei, Nicola Wheeler, Paul Wilkinson, Peng Gong, Hugh Montgomery, Anthony Costello
The Lancet Countdown tracks progress on health and climate change and provides an independent assessment of the health effects of climate change, the implementation of the Paris Agreement,¹ and the health implications of these actions. It follows on from the work of the 2015 Lancet Commission on Health and Climate Change,² which concluded that anthropogenic climate change threatens to undermine the past 50 years of gains in public health, and conversely, that a comprehensive response to climate change could be “the greatest global health opportunity of the 21st century”.
 

Nature
Volume 554 Number 7691 pp145-264 8 February 2018
http://www.nature.com/nature/current_issue.html

World View
Let’s move beyond the rhetoric: it’s time to change how we judge research
Five years ago, the Declaration on Research Assessment was a rallying point. It must now become a tool for fair evaluation, urges Stephen Curry.

Nature Medicine
February 2018, Volume 24 No 2 pp113-246
http://www.nature.com/nm/journal/v24/n2/index.html

Articles
Prevention of tuberculosis in rhesus macaques by a cytomegalovirus-based vaccine – pp130 – 143
Scott G Hansen, Daniel E Zak, Guangwu Xu, Julia C Ford, Emily E Marshall, Daniel Malouli, Roxanne M Gilbride, Colette M Hughes, Abigail B Ventura, Emily Ainslie, Kurt T Randall, Andrea N Selseth, Parker Rundstrom, Lauren Herlache, Matthew S Lewis, Haesun Park, Shannon L Planer, John M Turner, Miranda Fischer, Christina Armstrong, Robert C Zweig, Joseph Valvo, Jackie M Braun, Smitha Shankar, Lenette Lu, Andrew W Sylwester, Alfred W Legasse, Martin Messerle, Michael A Jarvis, Lynn M Amon, Alan Aderem, Galit Alter, Dominick J Laddy, Michele Stone, Aurelio Bonavia, Thomas G Evans, Michael K Axthelm, Klaus Früh, Paul T Edlefsen & Louis J Picker
doi:10.1038/nm.4473
Complete vaccine-mediated immune control of highly pathogenic Mycobacterium tuberculosis is possible if immune effector responses can intercept the infection at its earliest stages.
 

PharmacoEconomics
Volume 36, Issue 2, February 2018
https://link.springer.com/journal/40273/36/2/page/1

Editorial
Towards a New Framework for Addressing Structural Uncertainty in Health Technology Assessment Guidelines
Salah Ghabri, Irina Cleemput, Jean-Michel Josselin
Introduction
Providing scientific advice and recommendations for public decision making entails identifying, selecting and weighing evidence derived from multiple sources of information through a systematic approach, while taking into account ethical, cultural and societal factors. Integrated in the evaluation process are exchanges between regulatory agencies, private firms, scientific experts and government representatives.
In the case of drugs and medical devices, health technology assessment (HTA) agencies are increasingly commissioned to evaluate innovations in order to provide government with recommendations and advice on reimbursement and/or pricing. To undertake this task, HTA agencies [1, 2, 3, 4, 5, 6] in Europe and elsewhere have developed methodological guidelines on the economic evaluation of health technologies [7]. One component of these guidelines deals with ways for both manufacturers (pharmaceutical and medical device firms) and HTA agencies evaluators (modelers, economists and public health experts) to address uncertainty…

PLoS One
http://www.plosone.org/
[Accessed 10 February 2018]

Research Article
Impact and cost-effectiveness of different vaccination strategies to reduce the burden of pneumococcal disease among elderly in the Netherlands
Dominic Thorrington, Leo van Rossum, Mirjam Knol, Hester de Melker, Hans Rümke, Eelko Hak, Albert Jan van Hoek
Research Article | published 09 Feb 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0192640

Research Article
Randomized controlled trial on promoting influenza vaccination in general practice waiting rooms
Christophe Berkhout, Amy Willefert-Bouche, Emmanuel Chazard, Suzanna Zgorska-Maynard-Moussa, Jonathan Favre, Lieve Peremans, Grégoire Ficheur, Paul Van Royen
Research Article | published 09 Feb 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0192155

Prehospital & Disaster Medicine
Volume 33 – Issue 1 – February 2018
https://www.cambridge.org/core/journals/prehospital-and-disaster-medicine/latest-issue

Original Research
A Quantitative Systematic Review and Meta-Analysis of the Effectiveness of Oral Cholera Vaccine as a Reactive Measure in Cholera Outbreaks
Patricia Schwerdtle, Coretta-Kings Onekon, Katrina Recoche
https://doi.org/10.1017/S1049023X17007166
Published online: 10 January 2018, pp. 2-6
Abstract
The efficacy of oral cholera vaccines (OCVs) in laboratory conditions has been established, and the World Health Organization (WHO; Geneva, Switzerland) has recommended their preventative use in high-risk settings. The WHO recommendation has not been fully operationalized, nor has it been extended to apply to the reactive use of OCVs in real field epidemic conditions due to concerns about potential resource diversion, feasibility, cost, and acceptability. The purpose of this study is to assess and synthesize existing evidence of OCV effectiveness when used reactively in real field conditions.
A systematic review and meta-analysis was conducted involving studies that investigated vaccine effectiveness when used as a reactive measure; that is, cases had reached epidemic threshold and a cholera epidemic was declared in real field epidemic conditions. OVID Medline (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA), CINAHL (EBSCO Information Services; Ipswich, Massachusetts USA), and EMBASE (Elsevier; Amsterdam, Netherlands), along with grey literature, were systematically searched using pre-determined criteria. Two independent reviewers identified studies that met the selection criteria and data were extracted using validated tools. Pooled estimates were obtained using fixed effect models.
Of the 347 articles that met the inclusion criteria, four studies were retrieved for meta-analysis (three were case-control studies and one was a case-cohort study) involving a total of 1,509 participants and comprising 175 cases and 1,334 case controls. The effectiveness of one or two doses of either Shanchol (Shantha Biotechnics; India) or ORC-Vax (Vabiotech; Vietnam) OCVs showed a combined vaccine effectiveness of 75% (95% CI, 61-84).
A positive association was demonstrated between the reactive use of OCVs and protection against cholera. This supported the WHO recommendation to utilize OCVs reactively as an additional measure to the standard cholera epidemic response package.

Science        
09 February 2018   Vol 359, Issue 6376
http://www.sciencemag.org/current.dtl

Review
Programming gene and engineered-cell therapies with synthetic biology
By Tasuku Kitada, Breanna DiAndreth, Brian Teague, Ron Weiss
Science 09 Feb 2018
Toward programmed therapeutics
Advances in synthetic biology are enabling the development of new gene and cell therapies. Kitada et al. review recent successes in areas such as cancer immunotherapy and stem cell therapy, point out the limitations of current approaches, and describe prospects for using synthetic biology to overcome these challenges. Broader adoption of these therapies requires precise, context-specific control over cellular behavior. Gene circuits can be built to give sophisticated control over cellular behaviors so that therapeutic functions can, for example, be programmed to activate in response to disease biomarkers.
Structured Abstract
BACKGROUND
Gene and engineered-cell therapies promise new treatment modalities for incurable or difficult-to-treat diseases. First-generation gene and engineered-cell therapies are already used in the clinic, including an ex vivo gene-replacement therapy for adenosine deaminase deficiency, chimeric antigen receptor (CAR) T cell therapies for certain types of leukemias and lymphomas, an adeno-associated virus gene therapy for inherited retinal diseases, and investigational therapies for β-thalassemia, sickle cell disease, hemophilia, and spinal muscular atrophy. Despite these early successes, safety concerns may hamper the broader adoption of some of these approaches: For example, overexpression of a therapeutic gene product with a narrow therapeutic window may be toxic, and excessive activation of T cells can be fatal. More-sophisticated control over cellular activity would allow us to reliably “program” cells with therapeutic behaviors, leading to safer and more effective gene and engineered-cell therapies as well as new treatments.
ADVANCES
Recent advances in synthetic biology are enabling new gene and engineered-cell therapies. These developments include engineered biological sensors that can detect disease biomarkers such as microRNAs and cell-surface proteins; genetic sensors that respond to exogenous small molecules; and new methods for interacting with various components of the cell—editing DNA, modulating RNA, and interfacing with endogenous signaling networks. These new biological modules have therapeutic potential on their own and can also serve as building blocks for sophisticated synthetic gene “circuits” that precisely control the strength, timing, and location of therapeutic function. This advanced control over cellular behavior will facilitate the development of treatments that address the underlying molecular causes of disease as well as provide viable therapeutic strategies in situations where the biomolecular targets have been previously considered “undruggable.”
Recent publications have demonstrated several strategies for designing complex therapeutic genetic programs by combining basic sensor, regulatory, and effector modules. These strategies include (i) external small-molecule regulation to control therapeutic activity postdelivery, (ii) sensors of cell-specific biomarkers that activate therapeutic activity only in diseased cells and tissues, and/or (iii) feedback control loops that maintain homeostasis of bodily systems. Example therapeutic systems include a genetic circuit that senses two specific cell-surface markers to activate CAR T cells only in the presence of target cancer cells, a circuit that programmatically differentiates pancreatic progenitor cells into insulin-secreting β-like cells, and a gene network that senses the amount of psoriasis-associated cytokines to release immune-modulatory proteins only during flare-ups. These proof-of-concept systems may lead to new treatments that are dramatically safer and more effective than current therapies.
OUTLOOK
Rapid progress in synthetic biology and related fields is bringing therapeutic gene circuits ever closer to the clinic. Ongoing efforts in modeling and simulating mammalian genetic circuits will reduce the number of circuit variants that need to be tested to achieve the desired behavior. The platforms used to test genetic circuits are also evolving to more closely resemble the actual human environment in which the circuits will operate. Human organoid, tissue-on-a-chip, and whole-blood models will enable higher-throughput circuit characterization and optimization in a more physiologically relevant setting. Progress in nucleic acid delivery will improve the safety and efficiency with which therapeutic nucleic acids are introduced to target cells, and new methods for immunomodulation will suppress or mitigate unwanted immune responses. Together, these advances will accelerate the development and adoption of synthetic biology-based gene and engineered-cell therapies.

Social Science & Medicine
Volume 196 Pages 1-246 (January 2018)
https://www.sciencedirect.com/journal/social-science-and-medicine/vol/196/suppl/C

Regular articles
“Do-it-yourself”: Vaccine rejection and complementary and alternative medicine (CAM)
Original research article
Pages 106-114
Katie Attwell, Paul R. Ward, Samantha B. Meyer, Philippa J. Rokkas, Julie Leask
Abstract
In this article, we elucidate a symbiotic relationship between complementary and alternative medicine (CAM) and rejection of, or hesitancy towards, vaccination. In Fremantle, Western Australia, and Adelaide, South Australia, we conducted in-depth interviews from September 2013–December 2015 with 29 parents who had refused or delayed some or all of their children’s vaccines. Our qualitative analysis found that for many, their do-it-yourself ethic and personal agency was enhanced by self-directed CAM use, alongside (sometimes informal) CAM practitioner instruction. Reifying ‘the natural,’ these parents eschewed vaccines as toxic and adulterating, and embraced CAM as a protective strategy for immune systems before, during and after illness. Users saw CAM as harm-free, and when it came to experiences that non-users might interpret as demonstrating CAM’s ineffectiveness, they rationalised to the contrary. They also generally glossed over its profit motive. CAM emerged as part of an expert system countering Western medicine. CAM’s faces were trusted and familiar, and its cottage capitalism appeared largely free from the taint of “Big Pharma.” A few parents employed a scientific critique of CAM modalities – and a minority were dubious of its profit motive – but others rejected the epistemology underpinning biomedicine, framing CAM as a knowledge not poisoned by avarice; a wisdom whose very evidence-base (anecdote and history) was demeaned by an arrogant scientific process only permitting belief in that which could be quantified. However, all parents engaged with Western medicine for broken bones and, sometimes, medical diagnoses. Our analysis suggests that pro-vaccination health professionals, policymakers and information-providers seeking to address the role of CAM in vaccine rejection face significant challenges due to the epistemic basis of some parents’ decisions. However, we make some suggestions for professional practice and policy to enhance trust in vaccination.

Social Science & Medicine
Volume 196 Pages 1-246 (January 2018)
https://www.sciencedirect.com/journal/social-science-and-medicine/vol/196/suppl/C

The possible worlds of global health research: An ethics-focused discourse analysis
Original research article
Pages 142-149
Ben Brisbois, Katrina Plamondon
Abstract
Representations of the world enable global health research (GHR), discursively constructing sites in which studies can legitimately take place. Depoliticized portrayals of the global South frequently obscure messy legacies of colonialism and motivate technical responses to health problems with political and economic root causes. Such problematic representations of the world have not yet been rigorously examined in relation to global health ethics, a major site of scholarly effort towards GHR that promotes justice and fairness. We carried out a discourse analysis of four guidance documents relevant to the ethical practice of GHR, purposively selecting texts covering different genres (UN documents and journal articles) and prominent GHR foci (HIV and clinical trials). In light of increasing acknowledgement of the lessons Indigenous health scholarship holds for global health ethics, the four analyzed texts also included a set of principles developed to support Indigenous nation-building. Three of four documents featured global disparities as reasons for ethical caution. These inequalities appeared without explanation or causes, with generation of new scientific knowledge following as a logical response to such disparities. The fourth – Indigenous health-focused – document clearly identified ‘colonialism’ as a reason for both inequities in society, and related harmful research practices. Solutions to disparities in this text did not necessarily involve cutting-edge research, but focused instead on empowerment and responsiveness to community priorities and needs. These contrasting representations of the world were accomplished in ways that depended on texts’ ‘participants’, or the people they represented; specific vocabularies or language usages; intertextual relationships to prior texts; and overall objectives or intentions of the author(s). Our results illustrate how ethics and other guidance documents serve as an important terrain for constructing, naturalizing or contesting problematic representations of the world of GHR.

Social Science & Medicine
Volume 196 Pages 1-246 (January 2018)
https://www.sciencedirect.com/journal/social-science-and-medicine/vol/196/suppl/C

“One of the greatest medical success stories:” Physicians and nurses’ small stories about vaccine knowledge and anxieties
Original research article
Pages 182-189
Terra Manca
Abstract
In recent years, the Canadian province of Alberta experienced outbreaks of measles, mumps, pertussis, and influenza. Even so, the dominant cultural narrative maintains that vaccines are safe, effective, and necessary to maintain population health. Many vaccine supporters have expressed anxieties that stories contradicting this narrative have lowered herd immunity levels because they frighten the public into avoiding vaccination. As such, vaccine policies often emphasize educating parents and the public about the importance and safety of vaccination.    These policies rely on health professionals to encourage vaccine uptake and assume that all professionals support vaccination.
Health professionals, however, are socially positioned between vaccine experts (such as immunologists) and non-experts (the wider public). In this article, I discuss health professionals’ anxieties about the potential risks associated with vaccination and with the limitations of Alberta’s immunisation program. Specifically, I address the question: If medical knowledge overwhelmingly supports vaccination, then why do some professionals continue to question certain vaccines? To investigate this topic, I interviewed twenty-seven physicians and seven nurses. With stock images and small stories that interviewees shared about their vaccine anxieties, I challenge the common assumption that all health professionals support vaccines uncritically. All interviewees provided generic statements that supported vaccination and Alberta’s immunisation program, but they expressed anxieties when I asked for details. I found that their anxieties reflected nuances that the culturally dominant vaccine narrative overlooks. Particularly, they critiqued the influence that pharmaceutical companies, the perceived newness of specific vaccines, and the limitations of medical knowledge and vaccine schedules.

Vaccine
Volume 36, Issue 7 Pages 915-1026 (8 February 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/7

Meeting Report
Meeting report: Global vaccine and immunization research forum
Open access
Pages 915-920
Andrew Q. Ford, Nancy Touchette, B. Fenton Hall, Angela Hwang, Joachim Hombach
Abstract
Building on the success of the first Global Vaccine and Immunization Research Forum (GVIRF), the World Health Organization, the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health in the United States of America, and the Bill & Melinda Gates Foundation convened the second GVIRF in March 2016. Leading scientists, vaccine developers, and public health officials from around the world discussed scientific advances and innovative technologies to design and deliver vaccines as well as novel tools and approaches to increase the uptake of vaccines throughout the world. This report summarizes the discussions and conclusions from the forum participants.

Vaccine
Volume 36, Issue 7 Pages 915-1026 (8 February 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/7

WHO articles
Report on WHO meeting on immunization in older adults: Geneva, Switzerland, 22–23 March 2017
Open access
Pages 921-931
Teresa Aguado, Jane Barratt, John R. Beard, Bonnie B. Blomberg, … Justin R. Ortiz

Abstract
Many industrialized countries have implemented routine immunization policies for older adults, but similar strategies have not been widely implemented in low- and middle-income countries (LMICs). In March 2017, the World Health Organization (WHO) convened a meeting to identify policies and activities to promote access to vaccination of older adults, specifically in LMICs. Participants included academic and industry researchers, funders, civil society organizations, implementers of global health interventions, and stakeholders from developing countries with adult immunization needs. These experts reviewed vaccine performance in older adults, the anticipated impact of adult vaccination programs, and the challenges and opportunities of building or strengthening an adult and older adult immunization platforms. Key conclusions of the meeting were that there is a need for discussion of new opportunities for vaccination of all adults as well as for vaccination of older adults, as reflected in the recent shift by WHO to a life-course approach to immunization; that immunization in adults should be viewed in the context of a much broader model based on an individual’s abilities rather than chronological age; and that immunization beyond infancy is a global priority that can be successfully integrated with other interventions to promote healthy ageing. As WHO is looking ahead to a global Decade of Healthy Ageing starting in 2020, it will seek to define a roadmap for interdisciplinary collaborations to integrate immunization with improving access to preventive and other healthcare interventions for adults worldwide.

Vaccine
Volume 36, Issue 7 Pages 915-1026 (8 February 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/7

Estimation of expected dengue seroprevalence from passive epidemiological surveillance systems in selected areas of Argentina: A proxy to evaluate the applicability of dengue vaccination
Original research article
Pages 979-985
Pablo Orellano, Darío Vezzani, Nancy Quaranta, Julieta Reynoso, Oscar Daniel Salomón
Abstract
Background
Current recommendations about dengue vaccination by the World Health Organization depend on seroprevalence levels and serological status in populations and individuals. However, seroprevalence estimation may be difficult due to a diversity of factors. Thus, estimation through models using data from epidemiological surveillance systems could be an alternative procedure to achieve this goal.
Objective
To estimate the expected dengue seroprevalence in children of selected areas in Argentina, using a simple model based on data from passive epidemiological surveillance systems.
Methods
A Markov model using a simulated cohort of individuals from age 0 to 9 years was developed. Parameters regarding the reported annual incidence of dengue, proportion of inapparent cases, and expansion factors for outpatient and hospitalized cases were considered as transition probabilities. The proportion of immune population at 9 years of age was taken as a proxy of the expected seroprevalence, considering this age as targeted for vaccination. The model was used to evaluate the expected seroprevalence in Misiones and Salta provinces and in Buenos Aires city, three settings showing different climatic favorability for dengue.
Results
The estimates of the seroprevalence for the group of 9-year-old children for Misiones was 79% (95%CI:46–100%), and for Salta 22% (95%CI:14–30%), both located in northeastern and northwestern Argentina, respectively. Buenos Aires city, from central Argentina, showed a likely seroprevalence of 7% (95%CI: 3–11%). According to the deterministic sensitivity analyses, the parameter showing the highest influence on these results was the probability of inapparent cases.
Conclusions
This model allowed the estimation of dengue seroprevalence in settings where this information is not available. Particularly for Misiones, the expected seroprevalence was higher than 70% in a wide range of scenarios, thus in this province a vaccination strategy directed to seropositive children of >9 years should be analyzed, including further considerations as safety, cost-effectiveness, and budget impact.

Vaccine
Volume 36, Issue 7 Pages 915-1026 (8 February 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/7

The cost-effectiveness of trivalent and quadrivalent influenza vaccination in communities in South Africa, Vietnam and Australia
Open access – Original research article
Pages 997-1007
Pieter T. de Boer, Joel K. Kelso, Nilimesh Halder, Thi-Phuong-Lan Nguyen, … George J. Milne
Abstract
Background
To inform national healthcare authorities whether quadrivalent influenza vaccines (QIVs) provide better value for money than trivalent influenza vaccines (TIVs), we assessed the cost-effectiveness of TIV and QIV in low-and-middle income communities based in South Africa and Vietnam and contrasted these findings with those from a high-income community in Australia.
Methods
Individual based dynamic simulation models were interfaced with a health economic analysis model to estimate the cost-effectiveness of vaccinating 15% of the population with QIV or TIV in each community over the period 2003–2013. Vaccination was prioritized for HIV-infected individuals, before elderly aged 65+ years and young children. Country or region-specific data on influenza-strain circulation, clinical outcomes and costs were obtained from published sources. The societal perspective was used and outcomes were expressed in International$ (I$) per quality-adjusted life-year (QALY) gained.
Results
When compared with TIV, we found that QIV would provide a greater reduction in influenza-related morbidity in communities in South Africa and Vietnam as compared with Australia. The incremental cost-effectiveness ratio of QIV versus TIV was estimated at I$4183/QALY in South Africa, I$1505/QALY in Vietnam and I$80,966/QALY in Australia.
Conclusions
The cost-effectiveness of QIV varied between communities due to differences in influenza epidemiology, comorbidities, and unit costs. Whether TIV or QIV is the most cost-effective alternative heavily depends on influenza B burden among subpopulations targeted for vaccination in addition to country-specific willingness-to-pay thresholds and budgetary impact.
 

From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary
 
Medicine
February 2018 – Volume 97 – Issue 5 – p e9773
Research Article: Observational Study
Vaccination coverage and associated factors for receipt of the 23-valent pneumococcal polysaccharide vaccine in Taiwan: A nation-wide community-based study
Chen, Chang-Hua MD, MSc, PhDa,b; Wu, Ming-Shiang MHAc; Wu, I-Chien MD, MSc, PhDc,*
Abstract

Older adults, particularly those with chronic obstructive pulmonary disease, are advised to receive 23-valent pneumococcal polysaccharide vaccine (PPV23). However, the PPV23 vaccination rate in Taiwan and the determinants of receipt remain unclear.

We analyzed the data of 1475 community-dwelling older adults aged ≥75 years who participated in the Healthy Aging Longitudinal Study in Taiwan. Each participant received assessments of PPV23 status, sociodemographic factors (age, sex, education level, marital status, living alone, and occupation), and health-related factors (chronic diseases, smoking status, alcohol intake, physical activities, cognitive status, and physical performance). PPV23 rate was defined as the number of participants who reported receiving free PPV23 divided by the total number of candidates for free PPV23. Multinomial logistic regression analysis was applied to investigate the sociodemographic and health-related determinants of PPV23 status.

A PPV23 vaccination rate of 20.7% (305/1475) was observed. Participants who were female, current smokers, and had a low peak expiratory flow were associated with PPV23 nonreceipt (all P <.05). Of the participants who had a low peak expiratory flow, low education status, and physical inactivity were associated with PPV23 nonreceipt (all P <.05).

The PPV23 vaccination rate among adults aged ≥75 years was low. Older adults who were women, current smokers, or who had a low PEF were less likely to receive the PPV23. These findings support continual efforts to improve the PPV23 coverage rate in vulnerable populations.

Media/Policy Watch
This watch section is intended to alert readers to substantive news, analysis and opinion from the general media and selected think tanks and similar organizations on vaccines, immunization, global public health and related themes. Media Watch is not intended to be exhaustive, but indicative of themes and issues CVEP is actively tracking. This section will grow from an initial base of newspapers, magazines and blog sources, and is segregated from Journal Watch above which scans the peer-reviewed journal ecology.
We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.
 
The Economist
http://www.economist.com/
Accessed 10 February 2018
Prescriptions for fighting epidemics
8 February 2018
EPIDEMICS have plagued humanity since the dawn of settled life. Yet success in conquering them remains patchy. That is because the standard response, in the words of the World Bank’s president Jim Yong Kim, is a cycle of “panic, neglect, panic, neglect”. It need not be that way, argues Jonathan Quick in “The End of Epidemics”. A doctor and a public-health veteran who has worked in more than 70 countries and at the World Health Organisation (WHO), Mr Quick rounds up examples of failures and triumphs to show what stops epidemics from flaring up.

Why the current flu crisis is so severe – The Economist explains
7 February 2018
… As a result, the current flu vaccine, developed early last year, has been less effective than usual. Reports from Australia, where the flu season arrives half a year earlier than in the north, plus early analysis from Canada, indicate efficacy against H3N2 as low as 10%, instead of the more typical 30%-60%.
 
Financial Times
http://www.ft.com/home/uk
Accessed 10 February 2018
Pneumonia is the single biggest killer of children in world’s poorest countries
5 February 2018
Letter by Kevin Watkins, Harry Campbell, Kim Mulholland, Devi Sridhar
…Aid donors and pharmaceutical companies have a role to play. Development agencies should be attaching as much weight to pneumonia as they are to other killers, like malaria. That means supporting the development of national action plans to combat the disease, while building more effective public-private partnerships. Far more could be done through Gavi, the Global Vaccines Alliance, to lower the price and extend the reach of vaccines. We also believe aid donors and companies could be doing more to ensure that advances in diagnostic technologies and treatments reach the most disadvantaged children.
 
 
New York Times
http://www.nytimes.com/
Accessed 10 February 2018
Sanofi Rejects Philippine Plea for Refund on Used Vaccines
5 February 2018
A Sanofi Pasteur official said Monday that the French drugmaker couldn’t comply with the Philippines’ request for a refund of dengue vaccines injected on hundreds of thousands of children because it would imply that the drug is ineffective. Thomas Triomphe, Sanofi Pasteur’s Asia-Pacific chief, told a House of Representatives hearing that it’s clear in “absolute terms” that the Philippines would reduce dengue infections more by using the company’s Dengvaxia vaccine than by halting its use.

Sanofi: No Proof That Vaccine Linked to Philippines Deaths
Drugmaker Sanofi insists there’s no evidence of a link between the world’s first dengue vaccine and chil   dren’s deaths in the Philippines.
Feb 7, 2018

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_3 Feb 2018

– 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

17 January 2018
DCVMN and the Future Vaccine Manufacturing Hub launched a novel partnership for responsible innovation in emerging countries
[See Milestones above for more  detail]   London – A new research hub has been set up in the UK to improve vaccine coverage in developing countries and improve the response to life-threatening outbreaks like Ebola and Zika through the rapid deployment of vaccines.
This new effort, called the Future Vaccine Manufacturing Hub, led by Imperial College London and including other world-leading institutions, with a £10million funding by the UK’s Department for Health, will be collaborating with the Developing Countries Vaccine Manufacturers’ Network (DCVMN) on manufacturing projects initially in Bangladesh, China, India, Uganda and Vietnam, with expansion into other countries. The hub will build on new developments in life sciences, immunology and process systems to address challenges.
New approaches to be explored include the rapid production of yeast and bacterially-expressed particles that mimic components of infectious agents; development of synthetic RNA vaccines; manufacturing design and protein stabilization to preserve vaccines at high temperatures, avoiding the need for cold-chain.
There are currently 19.5 million infants that do not have access to basic vaccines and the deaths of one-third of children under five could be prevented with vaccinations. Lead investigator on the project, Professor Robin Shattock, said: “Many of these deaths, whether they are a result of polio, diphtheria measles or other infections, could be prevented through immunization, and the research hub will look to overcome hurdles in this field. We will also help to empower countries most at risk of infections to meet their local vaccine needs.”
“We are privileged to join the Hub’s research and educational efforts, collaborating with the Imperial College London, to advance the incorporation of new vaccine manufacturing technologies in emerging countries to benefit its people” said Dr. Sonia Pagliusi, Executive Secretary of DCVMN International.
 
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Engineering and Physical Sciences Research Council (EPSRC) [U.K.] Grant
Future Vaccine Manufacturing Hub: Advancing the manufacture and deployment of cost effective vaccines
EPSRC Grant Reference: EP/R013764/1  01 December 201 7—31 March 2021  £9,947,570
PI: Shattock, Professor RJ, Imperial College London
Grant Summary
Vaccine manufacturing systems have undergone evolutionary optimisation over the last 60 years, with occasional disruptions due to new technology (e.g. mammalian cell cultures replacing egg-based systems for seasonal influenza vaccine manufacture). Global vaccination programmes have been a great success but the production and distribution systems from vaccines still suffer from costs associated with producing and purifying vaccines and the need to store them between 2 and 8 degrees C. This can be a challenge in the rural parts of low and middle income countries where 24 million children do not have access to appropriate vaccinations every year. An additional challenge is the need to rapidly respond to new threats, such as the Ebola and Zika viruses, that continue to emerge.

The development of a “first responder” strategy for the latter means that there are two different types of challenges that future vaccine manufacturing systems will have to overcome:
1. How to design a flexible modular production system, that once a new threat is identified and sequenced, can switch into manufacturing mode and produce of the order of 10,000 doses in a matter of weeks as part of localised containment strategy?
2. How to improve and optimise existing manufacturing processes and change the way vaccines are manufactured, stabilised and stored so that costs are reduced, efficiencies increased and existing and new diseases prevented effectively?
Our proposed programme has been developed with LMIC partners as an integrated approach that will bring quick wins to challenge 2 while building on new developments in life sciences, immunology and process systems to bring concepts addressing challenge 1 to fruition.
Examples of strategies for challenge 1 are RNA vaccines. The significant advantage of synthetic RNA vaccines is the ability to rapidly manufacture many thousands of doses within a matter of weeks. This provides a viable business model not applicable to other technologies with much longer lag phases for production (viral vectors, mammalian cell culture), whereby procurement of the vaccine can be made on a needs basis avoiding the associated costs of stockpiling vaccines for rapid deployment, monitoring their on going stability and implementing a cycle of replacement of expired stock. In addition, low infrastructure and equipment costs make it feasible to establish manufacture in low-income settings, where all required equipment has potential to be run from a generator driven electrical supply in the event of power shortage. This fits the concept of a distributed, flexible platform technology, in that once a threat is identified, the specific genetic code can be provided to the manufacturing process and the doses of the specific vaccine can be produced without delay. Additional concepts that we will explore in this category include the rapid production of yeast and bacterially expressed particles that mimic membrane expressed components of pathogenic viruses and bacteria.
Examples of strategies for challenge 2 build on our work on protein stabilisation which has been shown to preserve the function of delicate protein enzymes at temperatures over 100 degrees C. We shall exploit this knowledge to develop new vaccine stabilisation and formulation platforms. These can be used in two ways: (a) to support the last few miles of delivery from centralised cold chains to patients through reformulation and (b) for direct production of thermally stable forms, i.e. vaccines that retain their activity for months despite being not being refrigerated.
We believe that the best way to deliver these step changes in capability and performance is through a team-based approach that applies deep integration in two dimensions: between UK and LMIC partners to ensure that all the LMIC considerations are “baked in” from the start and between different disciplines accounting for the different expertise that will be required to meet the challenges.

PLOS Currents: Disasters
http://currents.plos.org/disasters/
[Accessed 3 February 2018]
Research Article
Infectious Disease Risk and Vaccination in Northern Syria after 5 Years of Civil War: The MSF Experience
February 2, 2018 ·
Alan de Lima Pereira, Rosamund Southgate, Hikmet Ahmed, Penelope O’Connor, Vanessa Cramond, Annick Lenglet
Abstract
Introduction: In 2015, following an influx of population into Kobanê in northern Syria, Médecins Sans Frontières (MSF) in collaboration with the Kobanê Health Administration (KHA) initiated primary healthcare activities. A vaccination coverage survey and vaccine-preventable disease (VPD) risk analysis were undertaken to clarify the VPD risk and vaccination needs. This was followed by a measles Supplementary Immunization Activity (SIA). We describe the methods and results used for this prioritisation activity around vaccination in Kobanê in 2015.
Methods: We implemented a pre-SIA survey in 135 randomly-selected households in Kobanê using a vaccination history questionnaire for all children <5 years. We conducted a VPD Risk Analysis using MSF ‘Preventive Vaccination in Humanitarian Emergencies’ guidance to prioritize antigens with the highest public health threat for mass vaccination activities. A Measles SIA was then implemented and followed by vaccine coverage survey in 282 randomly-selected households targeting children <5 years.
Results: The pre-SIA survey showed that 168/212 children (79.3%; 95%CI=72.7-84.6%) had received one vaccine or more in their lifetime. Forty-three children (20.3%; 95%CI: 15.1-26.6%) had received all vaccines due by their age; only one was <12 months old and this child had received all vaccinations outside of Syria. The VPD Risk Analysis prioritised measles, Haemophilus Influenza type B (Hib) and Pneumococcus vaccinations. In the measles SIA, 3410 children aged 6-59 months were vaccinated. The use of multiple small vaccination sites to reduce risks associated with crowds in this active conflict setting was noted as a lesson learnt. The post-SIA survey estimated 82% (95%CI: 76.9-85.9%; n=229/280) measles vaccination coverage in children 6-59 months.
Discussion: As a result of the conflict in Syria, the progressive collapse of the health care system in Kobanê has resulted in low vaccine coverage rates, particularly in younger age groups. The repeated displacements of the population, attacks on health institutions and exodus of healthcare workers, challenge the resumption of routine immunization in this conflict setting and limit the use of SIAs to ensure sustainable immunity to VPDs. We have shown that the risk for several VPDs in Kobanê remains high.
Conclusion: We call on all health actors and the international community to work towards re-establishment of routine immunisation activities as a priority to ensure that children who have had no access to vaccination in the last five years are adequately protected for VPDs as soon as possible.

Yellow Fever

Eliminating Yellow Fever Epidemics (EYE) Strategy: Meeting demand for yellow fever vaccines :: A joint statement by WHO, UNICEF and Gavi
29 January 2018
Vaccination is the most powerful known measure for yellow fever prevention: a single dose can provide life-long immunity at a cost of approximately US$1. Ensuring adequate vaccine supply is available to reach all those at-risk is a constant challenge and the main purpose of the Eliminate Yellow Fever Epidemics (EYE) Strategy partnership, steered by WHO, UNICEF and Gavi, the Vaccine Alliance.

Yellow Fever vaccines are currently manufactured by four WHO-prequalified suppliers. Since 2001, annual yellow fever vaccine production has quadrupled from 20 million to 80 million doses. Output is estimated to increase even further in the coming years. Through the EYE partnership, 1,4 billion yellow fever vaccine doses are expected to be delivered to countries with high yellow fever risk by 2026.

Despite efforts to increase yellow fever vaccine production, there is still a risk that supply will fail to meet demand in Africa if demand reaches the highest projected levels, according to a Gavi study1. In seeking to address this eventuality, the EYE Partnership works closely with manufacturers and yellow fever at-risk countries to plan and ensure vaccines are available in the locations and volume required.

Expanded needs for yellow fever vaccine are a result of a resurgence of yellow fever epidemics in Africa and more recently in Latin America. These resurgences are due to a combination of changing epidemiology and other risk factors including population movement and climate change. These needs are being addressed through routine immunization, preventive mass campaigns, catch-up campaigns (where vaccine coverage is low) and outbreak response (when vaccines need to be supplied rapidly to avoid further spread of the disease).

The International Coordination Group (ICG) coordinates the timely and equitable provision of vaccines during outbreaks. It maintains an emergency stockpile of 6 million doses of yellow fever vaccine funded by Gavi, which is continually replenished.

Demand for yellow fever vaccine has also increased in recent years due to the growing number of countries implementing routine immunization programmes with the support of Gavi. Another important part of the rising demand is the result of efforts, carried out within the framework of the EYE Strategy, to guarantee that yellow fever at-risk countries effectively implement preventive mass vaccination campaigns of all age groups, which frequently require large supply.

With the aim of identifying areas at highest risk, a comprehensive risk analysis and prioritization methodology is being developed to identify areas which should be given priority for preventive mass campaigns. An inaugural meeting on this topic was held on 14-15 December 2017 gathering global experts in WHO, Geneva. Outcomes from the meeting, including risk maps, will support EYE to optimize the allocation of vaccine resources.

Within the framework of the EYE Strategy, detailed plans for vaccine roll-out based on epidemiological risks and priorities are being elaborated. They will support the matching of vaccine supply and demand. This effort is informed by previous work in this area, such as the introduction of the Meningococcal meningitis A vaccine in Africa (MenAfriVac), in 2011, an example of vaccine stock management within the framework of an integrated disease and outbreak control strategy.

WHO, UNICEF, Gavi and all EYE partners are committed to ensuring that every person at-risk of yellow fever is protected. Through combined effort, we are confident that yellow fever epidemics can be eliminated by 2026, and that vaccine supplies can be managed to adequately meet demand.

::::::

Yellow fever: a major threat to public health
Editorial
The Lancet | 3 February 2018
The world’s largest fractional-dose vaccination campaign for yellow fever started on Jan 25 in Brazil, with the support of WHO. The campaign attempts to avoid the urban transmission cycle, not seen in the country since 1942. 33 people have died due to yellow fever between Jan 14 and 23, while the number of confirmed cases in the country has reached more than 130.

Although more cases of yellow fever were recorded in Brazil in 2016–17, the recent outbreak has extended into a much larger area, including highly populated cities, making it more threatening to public health. These large cities are infested by Aedes aegypti, the urban yellow fever vector, which can transmit the disease from person to person. The number of people at risk is also increasing in other tropical regions, such as South America and Africa.

Due to a global shortage of the vaccine, in outbreak emergencies WHO recommends fractional dosing to protect more people by using less antigen in each dose. Whereas studies have shown that a fifth of the standard dose can provide the same immunity as the standard full dose for at least 12 months, it is not clear how long the immunity ultimately lasts.

For routine immunisation, the standard full dose, recommended by WHO since 2013, is thought to confer lifelong protection, although supporting evidence for this view is not strong. Some Brazilian experts believe that a booster vaccine 10 years after the primary vaccination should be administered to guarantee lifetime protection.

As a zoonotic disease, with a reservoir in non-human primates, it is unlikely that yellow fever will be eradicated. However, epidemics can be prevented if populations are protected by routine immunisation and if mass vaccination campaigns are implemented quickly in response to an outbreak. A coalition of partners led by WHO, UNICEF, and Gavi, the Vaccine Alliance, aims to eliminate yellow fever epidemics worldwide by 2026. To achieve this goal, there is an urgent need for research to clarify the duration of protective levels of immunity provided by fractionated and full-dose yellow fever vaccines to support development of effective vaccination programmes.
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Dengvaxia
We continue to monitor developments associated with Dengvaxia. We did not identify any new press releases or statements on the Sanofi website.
 
‘Stop PAO autopsies on suspected Dengvaxia victims’
Ex-DOH chief Esperanza Cabral and other doctors urge the DOJ to stop PAO’s autopsies on 14 children who supposedly died due to Dengvaxia
February 03, 2018
By Michael Bueza
MANILA, Philippines – A group of doctors, including former health secretary Esperanza Cabral, urged the Department of Justice (DOJ) to stop the Public Attorney’s Office (PAO) from conducting autopsies on 14 children who supposedly died due to the controversial dengue vaccine Dengvaxia.
In a statement Saturday, February 3, the group Doctors for Public Welfare said it makes “no sense for any more families to be subjected to the torture of having a loved one exhumed and cut up, only to find out that no useful information was derived from the cruel act.”
“We urge the Department of Justice to order the PAO to stop performing autopsies on these children, and to leave the matter of determining the cause of death to competent forensic pathologists,” the doctors said.
The group issued the statement after forensic pathologists from the University of the Philippines-Philippine General Hospital (UP-PGH) presented their diagnosis on these deaths on Friday, February 2…

Kids’ vaccination rate down to 60% after Dengvaxia scare – DOH
Health Undersecretary Enrique Domingo appeals to parents to continue getting ‘tried and tested’ vaccines for their children to avoid diseases like polio, diphtheria, measles, and tetanus
February 02, 2018
By Mara Cepeda
MANILA, Philippines – The Department of Health (DOH) is alarmed as more and more parents are refusing to avail of the government’s various vaccination programs following the Dengvaxia mess.
Health Undersecretary Enrique Domingo said on Friday, February 2, that only about 60% of Filipino children are getting their scheduled vaccines, when the DOH’s annual vaccination rate target is around 85%.
“I think we are down to 60% coverage, kasi dati gusto natin diyan mga 85% (because we usually want the figure at 85%). I don’t know exactly the exact figures but siguro (maybe) by the end of the year, we’ll get a more exact figure. But the local experience right now is the uptake of our vaccination programs is really going down,” Domingo in a press conference on Friday.
The health official made the statement on the same day that the DOH and the experts panel from the University of the Philippines-Philippine General Hospital bared the results of the analysis of 14 cases of children who died after getting vaccinated with Sanofi Pasteur’s Dengvaxia dengue vaccine.
Three vaccinated children developed and died of dengue, 9 died due to various diseases they got after their vaccination, while the cause of death of the last two cases remain unknown.
Domingo explained that parents have become so scared after Sanofi announced Dengvaxia may lead a person to develop severe dengue if he or she had not been infected by the virus prior to immunization. (READ: TIMELINE: Dengue immunization program for public school students)
The parents are now refusing to avail of free government vaccines that could prevent their kids from getting other preventable diseases like polio and measles.
Domingo said this explains the recent measles outbreak in Davao. He added parents are even avoiding deworming initiatives from the DOH.
   “We really just like to implore all of our parents na kung nagkaroon po tayo ng duda, kung nagkaroon po talaga tayo ng problema dito sa bakunang [Dengvaxia na] ito, hindi po dapat madamay ‘yong ibang bakuna (We really just like to implore all of our parents that if you have doubts, if you had problems with the Dengvaxia vaccine, don’t let other vaccines be affected by it),” said Domingo.
   “[Ito ay] dahil napakarami nating bakuna na magpoprotekta sa anak ninyo, sa polio, sa diphtheria, sa tigdas, sa tetanus. Mga tried and tested po ito at kailangan maibigay ito sa ating mga anak,” he added. (This is because we have countless other vaccines that can protect your child from polio, diphtheria, measles, and tetanus. They are tried and tested, and it is vital that your children get them.)
Health Secretary Francisco Duque III made the same appeal to parents as soon as he suspended the dengue vaccination program in December 2017…

Philippines: 3 Deaths May Be Linked to Dengue Vaccinations
New York Times | 2 February 2018
MANILA, Philippines — Philippine health officials said Friday that the deaths of three children injected with a Sanofi Pasteur dengue vaccine may have “causal association” to the inoculation, including two who may have died because the vaccine failed.
The Philippine government halted its massive immunization drive last year after Sanofi said a study showed the vaccine may increase the risks of dengue in people vaccinated prior to infection. More than 830,000 children were injected with the Dengvaxia vaccine, health officials said.
“This issue continues to sow fear and confusion, especially to the parents of children who have been injected with Dengvaxia,” Health Secretary Francisco Duque III’s office said in a statement. “We aim to give clarity on the issues with an honest and objective reporting of the evidence and science.”
Duque said further study was needed on the vaccine. Investigators found no evidence the rest of the 14 reported child deaths were related to the vaccine.
Dr. Juliet Sio-Aguilar, who led the investigation, told a news conference that only one of the three dead children had developed dengue antibodies, which would have served as a protection against an infection, but still died.
“We really want to know what happened,” she said.
Sanofi Pasteur officials did not immediately issue any comment.

 
DOH CONVENES COMMAND CONFERENCE ON DENGVAXIA
Secretary Duque issues directives to regions and hospitals to prioritize the needs of vaccinated children
Republic of the Philippines – Department of Health
Press Release/ January 30, 2018
[text bolding from original]
 
To formulate policy and set guidelines on addressing the issues surrounding the rollout of Dengvaxia vaccine, the Department of Health under the leadership of Secretary Francisco T. Duque III held a command conference bringing together the Department’s Executive Committee, Regional Directors, Hospital Chiefs and program managers, experts from the Research Institute for Tropical Medicine and the Food and Drug Administration, members of the Expert Panel on Dengvaxia, and the World Health Organization Representative Office in the Philippines.

Chaired by DOH Chief-of-Staff Undersecretary Mario Villaverde, the high-level conference provided a valuable opportunity for the top DOH officials from all over the country to update themselves on the issues and concerns associated with Dengvaxia, share the best practices and challenges faced by affected regions, and discuss guidelines prepared by the Task Force convened by the Secretary of Health in December of last year.

Secretary Duque closed the conference by issuing a set of directives to be immediately pursued and enforced by the entire DOH which will be subject to amendments as the need arises during their implementation.

SECRETARY’S DIRECTIVES
“Considering all the discussions, resolutions, and other outputs of this Joint Executive Committee Meeting and Command Conference on Dengvaxia, I, the Secretary of Health, hereby direct the following:
The Dengue Task Force:
(a) has approved in principle three interim guidelines to address the issues and concerns as a result of the Dengue vaccination initiative subject to the final review of the Expert Panel:
[i] Surveillance – instituting a mechanism of enhanced surveillance over the next five years initially covering admitted cases following immunization, and then expanding to a reporting system covering outpatient settings through health centers, clinics, LGUs, and regional offices.
[ii] Dengue case management and patient referral – emphasizing on the early diagnosis and proper case management of Dengue; and, establishing a network of both public and private hospitals which can provide services to patients.
[iii] Risk communication – giving correct information to allay unfounded fears based on misconceptions; provide basic information on Dengue and the 4S approach to prevent infection; constantly updating the public on DOH’s efforts in addressing the concerns of vaccinees; and, designating public health advocates at the regional offices and hospitals who can help patients navigate through the health system so that their health needs are adequately and expeditiously addressed.
These interim guidelines are immediately effective once approved subject to specific period of implementation and revisions as we learn more from our experience.

(b) shall review the policy and processes on the introduction of new antigens in our national immunization program;

(c) shall study other proposed guidelines to enhance the delivery of public health vaccination programs;
[i] Financing and reimbursement of hospitalized cases of adverse events following immunization using PhilHealth, the Medical Assistance Program, and other possible financing sources. For the regional offices to negotiate with private providers not to charge beyond the PhilHealth case rates.
[ii] Vaccine Injury Compensation;
[iii] Autopsy of alleged deaths following Dengvaxia immunization; and,
[iv] Laboratory diagnosis and confirmatory test.

(d) shall pursue possible legislative reforms that emerged from this issue by:
[i] Strengthening the mandate of RITM to be an independent research arm on infectious diseases, not influenced by the industry; and,
[ii] Strengthening the independence of FDA in exercising its mandate to protect the public in regulating health products.

(e) shall be constantly vigilant about possible/emerging concerns that may arise from this issue.
In relation to this, I would also like to reiterate my request to the Expert Panel to give guidance to the DOH on determining the causality of adverse events specifically following Dengue vaccine immunization.

The Regional Directors are to do the following:
(a) give a human face to the efforts of the DOH by reaching out to the parents and patients, and to show compassion particularly to the bereaved parents and relatives;
(b) document, sustain, and institutionalize best practices that have been developed in the course of addressing the crisis in their respective areas; and,
(c) lead the operationalization of policies in their covered provinces/cities and provide feedback.

The Concerned DOH Hospitals are to:
[a] extend their utmost service to appropriately manage the health and psychosocial concerns of Dengvaxia vaccinees;
[b] raise the level of scientific and administrative discussion among personnel and officials to further enhance the capabilities of their respective units in dealing with such crisis.

For the future directions of the Department on public health programs:
[a] The design and implementation of public health programs should consider the universal principles of respect for persons, beneficence, nonmaleficence, and justice.
[b] Exercise of prudence in introducing new health technologies, noting that they should be based on rigorous scientific and economic evaluation, considering other factors when implementing the program in the real world.

I would like to extend my heartfelt gratitude to everyone present today. Your participation and cooperation are vital in addressing these issues on Dengvaxia. I anticipate with optimism the same degree of participation and cooperation in operationalizing these directives in the days to come. With this, I give my full trust and confidence in the decisions you will make as well as the execution of such directives in your own respective offices.”

Featured Journal Content

PLOS Medicine
30 January 2018
What’s coming for health science and policy in 2018? Global experts look ahead in their field
The PLOS Medicine Editors, Soumya Swaminathan, Robin S. Room, Louise C. Ivers, Graham Hillis, Rebecca F. Grais, Zulfiqar A. Bhutta, Peter Byass
[Excerpts]
Infectious disease outbreaks in Yemen: A man-made disaster that has a solution
Louise Ivers
One thousand days of war in Yemen have resulted in many thousands of civilian deaths as well as deliberate destruction of health infrastructure and water infrastructure and disruption in the payment of thousands of public servants [12]. Restrictions on imports have prevented access to food, medicine, and humanitarian supplies [13]. In 2017, almost 1 million cases of suspected cholera were reported in the country, and although laboratory infrastructure is lacking to confirm every single case, the sheer scale of the epidemic of watery diarrhea is staggering. Frontline workers have privately reported their fears that cholera is being deliberately used as a weapon of war by parties to the conflict. Publicly, despite pleas from health workers and UN agencies for humanitarian space to provide relief, blockades and bombings continue. Diphtheria cases are now also on the rise—a painful disease, with a high mortality rate that occurs when vaccination rates are too low.
These epidemics, as well as the dire lack of access to food (already 400,000 children with severe acute malnourishment), do not bode well for 2018 [14]. Even if the fighting stopped tomorrow, the impact of these health crises would be felt for a generation. The continued hostilities are like a genocidal experiment to demonstrate just how badly the destruction of a health system can destroy the health of a nation. Every one of these medical emergencies—cholera, diphtheria, famine—is completely preventable and treatable. Without an end to the conflict, or at a minimum an agreement to open corridors of reliable safe humanitarian access, the ordinary people of Yemen will continue to suffer despite the fact that the public health community has the knowledge and the tools to stop the epidemics and save lives.
…

Beyond words: US federal funding for public health and science
Rebecca Grais
According to media reports, Centers for Disease Control and Prevention (CDC) officials prohibited the use of 7 words and phrases in developing budget requests [21]. CDC and US Department of Health and Human Services (HHS) officials responded to reports by stating that there was no ban or censorship [22,23]. Media coverage has centered on either condoning the “ban” as evidence of the administration’s commitment to reducing government spending or on denouncing it as yet another piece of evidence of the administration’s antiscience agenda.
There is no doubt that evidence-based policy solutions and protecting vulnerable populations have not been a priority of this administration, with or without a word ban. Budget cuts or simply maintaining current funding to the CDC, as well as to National Institutes of Health (NIH) and other science and public health agencies and initiatives, will be felt directly through the scale back of existing public health programs, research funding, and initiatives. They will be felt indirectly by reinforcing the message that certain populations and conditions are not of interest to the US government. Cuts or removal of some programs, such as the HHS Secretary’s Minority AIDS Initiative Fund (SMAIF) [24], which provides funding to reduce HIV-related health disparities in racial and ethnic minority communities, would have dire consequences for the most vulnerable. Irrespective of whether words are banned or simply avoided by CDC staff, the consequences of such cutbacks remain the same for vulnerable populations, whose words are often not heard at all.
 

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 31 January 2018 [GPEI]
:: New on http://polioeradication.org/: As part of the GPEI’s plan to capture and share lessons learnt since its inception, the programme has released detailed best practice guides for active surveillance for polio eradication, monitoring the quality of polio eradication campaign performance, and microplanning.
:: Last week, Member states and partners met to discuss polio transition and keeping the world polio-free after eradication at the WHO Executive Board Meeting.
:: Chris Maher, a long-time polio eradicator and a central part of the polio programme, has been recognised in the Australia Day honours list named as an Officer of the Order of Australia. His recognition comes for his distinguished service to community and international public health through technical, operational and management roles in the global eradication of poliomyelitis.

:: Weekly country updates as of 31 January 2018
Afghanistan:  
:: Advance notification has been received of two new cases of wild poliovirus type 1 (WPV1) in Kandahar province. One case occurred in Shawalikot district, with onset on 5 January 2018, and one occurred in Boldak district, with onset on 6 January 2018. These cases will be confirmed in next week’s data reporting, raising the number of officially reported WPV1 cases in Afghanistan in 2018 to three.
::  Five new WPV1 positive environmental samples were reported this week. One sample was collected in Lashkargah district, Hilmand province on 26 December 2017, and one was collected in Kandahar district, Kandahar province, on 27 December 2017. On 8 January 2018, two samples were collected in Kandahar district, Kandahar province and one sample was collected from Lashkargah district, Hilmand province.…
Pakistan:
:: Two new WPV1 positive environmental samples have been reported, one collected from Sindh province, and one from Balochistan province.

::::::
 
Syria cVDPV2 outbreak situation report 32, 30 January 2018
Situation update 30 January 2018
:: No new cases of cVDPV2 were reported this week. The total number of cVDPV2 cases remains 74. The most recent case (by date of onset of paralysis) is 21 September 2017 from Boukamal district, Deir Ez-Zor governorate.
:: The first round (mOPV2) of the second phase of the outbreak response has been completed in all the targeted governorates (Deir Ez-Zor, Homs, Hasakah and Raqqa). The campaign was extended for 2 days in some areas to ensure low performing pockets were covered.
:: According to administrative reports a total of 665 736 children under 5 years were vaccinated with mOPV2, representing 96% of the total estimated target.
:: On 29 January, the Syrian Ministry of Health, World Health Organization and UNICEF met with a communication specialist deployed to support the outbreak response to coordinate on the implementation of communication microplans at lower district and lower levels.
:: Preparations continue for the second vaccination round which will utilize IPV. Global Polio Eradication Initiative (GPEI) partners continue to assist.

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

WHO Grade 3 Emergencies  [to 3 February 2018]
The Syrian Arab Republic
:: Syria cVDPV2 outbreak situation report 32, 30 January 2018
[See Polio above for detail]

::::::
 
WHO Grade 2 Emergencies  [to 3 February 2018]
Bangladesh/Myanmar: Rakhine Conflict 2017
:: Over 350,000 children to get additional dose of diphtheria vaccine in Cox’s Bazar
SEAR/PR/1678
28 January 2018, Cox’s Bazar, Bangladesh – Stepping up efforts to curtail the ongoing diphtheria outbreak in Cox’s Bazar, WHO and UNICEF are working with Ministry of Health and Family Welfare to vaccinate over 350,000 children in the Rohingya camps and makeshift settlements with an additional dose of diphtheria vaccine.
“An additional dose of diphtheria vaccine is expected to further boost immunity of vulnerable children and help restrict diphtheria. These intense campaigns demonstrate the commendable efforts being made by Bangladesh to protect the health of a vulnerable population,” said Dr Bardan Jung Rana, World Health Organization’s ai Representative to Bangladesh…
:: Weekly Situation Report #11 – 29 January 2018

Central African Republic 
:: Responding to forgotten crises – Together with the United Nations Central Emergency Response Fund  27 January 2017

Democratic Republic of the Congo  
:: Cholera in Kinshasa – WHO is redeploying experts to control the epidemic
15 January 2018 Kinshasa — On a 24-hour working visit to the Democrati Republic of Congo’s capital, heavily affected by the cholera epidemic, Dr Matshidiso MOETI, WHO Regional Director for Africa, told the Minister of Health, Public Health, Dr Oly ILUNGA Monday, of a reinforced emergency support mechanism putting all the experts from the Country Office and those deployed in the Democratic Republic of the Congo (epidemiologists, logisticians, data managers, specialists in communication on risks, social mobilization and community engagement etc.) available to the DPS to strengthen the response against cholera.

::::::
::::::
 
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. 
Syrian Arab Republic
:: 2 Feb 2018  Monitoring Violence Against Health Care: Annual Report, 2017
:: Assistant-Secretary-General for Humanitarian Affairs and Deputy Emergency Relief Coordinator, Ms. Ursula Mueller, Statement to the Security Council on Syria, 30 January 2018
Report from UN Office for the Coordination of Humanitarian Affairs Published on 30 Jan 2018
:: Turkey | Syria: Recent Developments in Northwestern Syria (Idleb Governorate and Afrin District) (as of 30 January 2018)

Yemen 
:: 31 Jan 2018  Yemen: Escalation of armed clashes in Aden – Flash Update 3 | 31 January 2018
:: 30 Jan 2018  Statement by the Humanitarian Coordinator for Yemen Ad Interim, Stephen Anderson, on the Situation in Aden [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.
ROHINGYA REFUGEE CRISIS
:: ISCG Situation Update: Rohingya Refugee Crisis, Cox’s Bazar | 27 January 2018

Ethiopia  
:: 29 Jan 2018  Ethiopia: Conflict Displacement Situation Report (23 January 2018)
:: Emergency Relief Coordinator and Under-Secretary-General for Humanitarian Affairs, Mark Lowcock, remarks at the High-Level Event on the New Way of Working  Published on 28 Jan 2018

Somalia
:: Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Mark Lowcock: Opening Remarks at the Launch of the 2018 Somalia Humanitarian Response Plan and the Resilience and Recovery Framework  Published on 30 Jan 2018
 
::::::
::::::
 
Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.

MERS-CoV [to 3 February 2018]
http://www.who.int/emergencies/mers-cov/en/
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 26 January 2018
Between 9 December 2017 and 17 January 2018, the National IHR Focal Point of The Kingdom of Saudi Arabia reported 20 additional cases of Middle East Respiratory Syndrome (MERS), including nine deaths. In addition, one death from a previously reported case was reported to WHO…
:: MERS situation update, December 2017
At the end of December 2017, a total of 2,127 laboratory-confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV), including 757 associated deaths (case–fatality rate: 35.6%) were reported globally; the majority of these cases were reported from Saudi Arabia (1753 laboratory-confirmed cases, including 683 related deaths with a case–fatality rate of 38.9%). During the month of December, 6 laboratory-confirmed cases of MERS were reported globally as follows- 4 cases in Saudi Arabia including one associated death, one case in United Arab of Emirates and one case in Malaysia. No health-care associated transmission or hospital outbreak was reported during this month. The demographic…
 
Yellow Fever  [to 3 February 2018]
http://www.who.int/csr/disease/yellowfev/en/
:: Eliminating Yellow Fever Epidemics (EYE) Strategy: Meeting demand for yellow fever vaccines
A joint statement by WHO, UNICEF and Gavi. 29 January 2018
[See Milestones above for more detail]
 

WHO & Regional Offices [to 3 February 2018]
Latest news
High levels of antibiotic resistance found worldwide, new data shows
29 January 2018 — WHO’s first release of surveillance data on antibiotic resistance reveals high levels of resistance to a number of serious bacterial infections in both high- and low-income countries.
 
Cervical cancer prevention and control is saving lives in the Republic of Korea
2 February 2018 – The Republic of Korea is demonstrating how it is possible, through investment and expanded universal health coverage, to reduce illness and death through cervical cancer prevention and control, also a key focus of World Cancer Day on 4 February

Highlights
Proposed members announced for WHO Independent Commission on NCDs
January 2018 – Leaders in health, politics and development have accepted to participate in the first-ever WHO Independent Global High-level Commission on Noncommunicable diseases (NCDs), which aims to identify and propose bold and practical ways to curb the world’s leading causes of death and illness.

Kiribati Butiraoi ferry disaster
January 2018 – WHO and UNICEF send their deepest condolences to the people of Kiribati following the recent Butiraoi ferry disaster. This is a tragic event for the country of Kiribati, and we extend our thoughts to those affected families and communities. WHO and UNICEF are closely coordinating with the Government of Kiribati to support the emergency response.

$46 billion in productivity lost to cancer in major emerging economies
January 2018 – A new study published today in the journal Cancer Epidemiology evaluates for the first time the cost of productivity lost due to premature cancer deaths in several major emerging economies.

First online consultation of the Nurturing Care Framework for Early Childhood Development
January 2018 – In the first of two online consultations, WHO is seeking feedback from stakeholders on a global framework for early childhood development. This process will guide policy, programme, and budget support focused on early childhood development and the first 1000 days after conception, at country level.

::::::
 
Weekly Epidemiological Record, 26 January 2018, vol. 93, 04/05 (pp. 33–44)
:: Meeting of the International Task Force for Disease Eradication, October 2017
:: Fact sheet on tuberculosis (updated January 2018)

::::::
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: Tanzania prepares to provide vaccination against cervical cancer
02 February 2018
:: Major stakeholders review MoU on Routine Immunization progress in Borno and Kano states 
01 February 2018
:: WCO-Gambia staff introduced to the new Emergency Response Framework (ERF)
31 January 2018
:: WHO urges Karonga District Health Office to intensify Cholera outbreak interventions in identified risk areas of the district  31 January 2018
:: Advancing NTD elimination in Sierra Leone  31 January 2018

WHO South-East Asia Region SEARO
:: ‘Big 6’ countries of WHO South-East Asia Region meet to close measles’ immunity gap, accelerate elimination efforts   SEAR/PR/1679
New Delhi, 31 January 2018 – With nearly 4.8 million children in WHO South-East Asia Region missing measles vaccination every year, the ‘big six’ countries of the Region today shared their immunization challenges and lessons learnt for accelerating efforts to eliminate measles and control rubella by the year 2020.
“Eliminating measles would avert half a million deaths, while controlling rubella and Congenital Rubella Syndrome would promote health of pregnant woman and the infants they give life to,” said Dr Poonam Khetrapal Singh, Regional Director for WHO South-East Asia.
Two of the Region’s countries – Bhutan and Maldives – eliminated measles in 2017 while the others are carrying out large-scale immunization drives to achieve the same.
Nearly 500 million children in the Region are planned to be reached with measles and rubella containing vaccines through routine immunization and supplementary immunization campaigns in the next two years. Sharing challenges and lessons learnt from various recent achievements and initiatives will help member countries address their unique problems to close the immunity gap against measles, rubella and CRS, she said…
:: Over 350,000 children to get additional dose of diphtheria vaccine in Cox’s Bazar  28 January 2018,
 
WHO European Region EURO
::  Raising awareness of the link between alcohol and cancer 02-02-2018
::  Mayors unite in Copenhagen for a future of healthy cities 29-01-2018

WHO Eastern Mediterranean Region EMRO
:: WHO responds to humanitarian needs in Benghazi with the support of ECHO 28 January 2018
:: Afghanistan introduces rotavirus vaccine to protect infants and young children against severe diarrhoea  27 January 2018

CDC/ACIP [to 3 February 2018]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html
ACIP
February 21-22, 2018 Draft Meeting Agenda[2 pages]
Register for upcoming February ACIP meeting
February 21-22, 2018
Deadline for registration:
Non-US Citizens: January 24, 2018
US Citizens: February 5, 2018
 
MMWR News Synopsis for February 2, 2018 / No. 4
https://www.cdc.gov/mmwr/index2018.html
:: Notes from the Field: Public Health Response to a Human Immunodeficiency Virus Outbreak Associated with Unsafe Injection Practices — Roka Commune, Cambodia, 2016

Announcements

CEPI – Coalition for Epidemic Preparedness Innovations  [to 3 February 2018]
http://cepi.net/
24 January 2018
CEPI announces new permanent board
Media release, , London – Coalition for Epidemic Preparedness Innovations
Today, CEPI, the coalition launched one year ago to finance and coordinate the development of new vaccines to prevent and contain epidemics, announces the establishment of its new permanent Board.
The Board includes global leaders who have made extraordinary contributions to protecting and improving health, and who bring a wealth of expertise to CEPI as it moves into the next phase of its development.
CEPI’s new Board will have twelve members. Eight seats will be held by independent members, while four seats have been reserved for investors. The independent members are:
:: Dr Awa Coll-Seck, Minister of State and Former Minister of Health and social welfare of the Republic of Senegal
:: Jane Halton, (Chair), former Secretary of the Australian Department of Finance
:: Professor Cherry Gagandeep Kang, Christian Medical College Vellore
:: Dr Joanne Liu, International President, MSF
:: Dr John Nkengasong, Director of the Africa Centers for Disease Control and Prevention
:: Professor Peter Piot, Director of the London School of Hygiene & Tropical Medicine
:: Dr David Reddy, CEO, Medicines for Malaria Venture
:: Dr Rajeev Venkayya, President, Global Vaccine Business Unit, Takeda Pharmaceutical Company Limited
The four investor seats will be named by CEPI’s newly formed Investors Council. It is anticipated that three seats will be held by sovereign investors and one by a philanthropic investor.
Dr Richard Hatchett, CEO of CEPI, said: “I’m delighted to welcome these eminent experts to our     Board. This is a seminal moment in CEPI’s development as we invest in developing the vaccines and capabilities that the world currently lacks to prepare against future epidemics. CEPI is fortunate to have a Board of this calibre to advise us as we deliver our mission to make the world safer through new vaccines.”

Emory Vaccine Center    [to 3 February 2018]
http://www.vaccines.emory.edu/
Jan. 30, 2018
2018 Japan Prize is awarded to Emory immunologist Max Cooper
By Sarah Mars Bowie | Woodruff Health Sciences Center |
The Japan Prize Foundation has announced Max D. Cooper, MD, as a laureate of the 2018 Japan Prize. Alongside Dr. Jacques Miller, Cooper is being awarded the prize in the category “Medical Science and Medicinal Science” for the discovery of the dual nature of adaptive immunity, which identified the cellular building blocks of the immune system as we understand it today.
The annual Japan Prize awards recognize individuals who are pioneers in their respective fields of medicinal science and resources, energy, environment and social infrastructure…

European Medicines Agency  [to 3 February 2018]
http://www.ema.europa.eu/ema/
01/02/2018
Strengthened guidance on follow-up and risk management for ATMP developers
Guideline to streamline procedures and better address the specific requirements of ATMP developers published for consultation…
 
FDA [to 3 February 2018]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
January 30, 2018
FDA, USDA announce formal agreement to bolster coordination and collaboration
U.S. Agriculture Secretary Sonny Perdue and FDA Commissioner Scott Gottlieb, M.D. announced at the White House today a formal agreement aimed at making the oversight of food more efficient and effective by bolstering coordination between the two agencies. The formal agreement outlines efforts to increase interagency collaboration, efficiency and effectiveness on produce safety and biotechnology activities, while providing clarity to manufacturers.
“Today, Commissioner Gottlieb and I signed a formal agreement to promote coordination and the streamlining of capacities and obligations on shared concerns and jurisdiction,” said Secretary Perdue. “Congress passed the Food Safety Modernization Act and assigned responsibilities to the USDA and the FDA. The USDA has the knowledge and expertise to support the FDA’s work related to farming. We at the USDA have a motto: Do Right, and Feed Everyone. We believe this joint effort will help us move one step closer to that goal.”…

Global Fund [to 3 February 2018]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
News
Burkina Faso and Global Fund Launch New Grants to Accelerate Progress against HIV, TB and Malaria
01 February 2018
OUAGADOUGOU – Burkina Faso and the Global Fund strengthened their partnership by launching four new grants that move toward ending epidemics of HIV, tuberculosis, malaria and strengthen health systems with a focus on community health systems and data quality.
The new investments will support efforts to scale up HIV programs to achieve the 90-90-90 targets by enrolling more than 93,000 people on antiretroviral treatment by 2020, and expanding HIV services, including access to prevention and treatment for key populations. The new grants also aim to strengthen the country’s supply-chain management, improve TB case detection, and procure 12 million mosquito nets for the 2019 mass distribution campaign.
…The four grants, worth a total of EUR130 million for the 2018-2020 implementation period, bring the total amount of Global Fund grants allocated to Burkina Faso to EUR427 million. The grants will be managed by le Programme d’Appui au Développement Sanitaire, le Comité National de Lutte contre le Sida — and l’Initiative Privée pour la lutte contre le SIDA/IPC…

News
Tanzania and Global Fund Sign New Grants to Accelerate End of Epidemics
30 January 2018
The Global Fund and health partners in Tanzania yesterday signed grant agreements to work toward ending the epidemics of HIV, tuberculosis and malaria.
 
MSF/Médecins Sans Frontières  [to 3 February 2018]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
Liberia: MSF Opens Pediatric Surgery Program
MONROVIA, LIBERIA/NEW YORK, JANUARY 31, 2018—Doctors Without Borders/Médecins Sans Frontières (MSF) opened a pediatric surgical program at Bardnesville Junction Hospital (BJH) on the outskirts of Liberia’s capital Monrovia on Jan. 11, with a goal of making surgical care more available for children in the country.

Press release
Syria: Deadly Airstrikes Damage Hospital Supported by MSF in Idlib
AMMAN, JORDAN/NEW YORK, JANUARY 29, 2018—Two airstrikes hit a hospital supported by Doctors Without Borders/Médecins Sans Frontières (MSF) in Syria’s Idlib governorate today, causing deaths and injuries and seriously damaging the facility, according to the hospital manager, who contacted MSF.

Press release
Mediterranean: 99 People Rescued From Sinking Dinghy, Many Others Presumed Drowned
New York, January 28, 2018—In a nightmarish day on the Mediterranean Sea yesterday, 99 survivors from a sinking rubber boat were rescued by the Aquarius, a search and rescue vessel run by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) and SOS MEDITERRANEE. An unknown number of men, women, and children are missing and presumed drowned. Two women are confirmed dead.

 
NIH  [to 3 February 2018]
http://www.nih.gov/news-events/news-releases
February 1, 2018
The Human Genome Project is awarded the Thai 2017 Prince Mahidol Award for the field of medicine
February 1, 2018 — The award will be received on behalf of the project by NHGRI Director Dr. Eric Green.

NIH launches partnership to improve success of clinical trials for patients with Parkinson’s disease
January 30, 2018 — Effort is part of the Accelerating Medicines Partnership to speed development of disease-altering treatments.

Roadmap to guide progress toward replacing animal use in toxicity testing
January 30, 2018 — Framework aims to provide more human relevant toxicology data.
 
 
PATH  [to 3 February 2018]
http://www.path.org/news/index.php
Announcement | February 01, 2018
LabCorp CEO Dave King becomes PATH board chair
PATH is pleased to announce that its board of directors has confirmed David P. King as board chair. Mr. King, who is chairman and CEO of LabCorp, a leading global life sciences company, has served on the PATH board since 2013.
“As a PATH board member, Dave has applied his private-sector experience to the biggest health challenges facing our world,” said Steve Davis, PATH’s president and CEO. “He is a brilliant business leader who is deeply committed to health equity, and we are delighted that he is now our board chair.”
Mr. King succeeds Dean Allen, who recently completed a three-year term as board chair…

Press release | January 31, 2018
DRC government steps up commitment to eliminating sleeping sickness by 2020
International partners support government in innovative approach to fight devastating disease

Announcement | January 30, 2018
New research consortium to evaluate evidence for single-dose HPV vaccination
Leading health and research institutions come together to evaluate the evidence for potential single-dose HPV vaccination schedule.
The Single-Dose HPV Vaccine Evaluation Consortium, coordinated by PATH and encompassing nine leading research institutions, has begun work to collate and synthesize existing evidence and evaluate new data on the potential for single-dose human papillomavirus (HPV) vaccine delivery.
While 80 countries and territories have introduced HPV vaccines on a two- or three-dose schedule into their national immunization schedules, rollout in low- and lower-middle-income countries has lagged. If demonstrated to be effective, single-dose HPV vaccination could significantly accelerate national vaccine introduction by simplifying programs and lowering procurement and delivery costs.
Funded by the Bill & Melinda Gates Foundation, the consortium will review existing evidence and evaluate new information available from trials and other observational studies on the effectiveness of a single-dose schedule in order to inform global policy discussions and guidance around HPV vaccination. A group of modeling experts within the consortium will also analyze data, identify critical data gaps, and conduct exploratory what-if scenarios to estimate the impact and cost-effectiveness of a single-dose schedule versus non-vaccination or two-dose schedules to inform decision-making.
The consortium, coordinated by PATH, includes Harvard University, the London School of Hygiene & Tropical Medicine, Université Laval, the University of British Columbia, the US Centers for Disease Control and Prevention, the US National Cancer Institute, Wits Reproductive Health and HIV Institute, and the World Health Organization.
In addition to the consortium members, representatives from the following institutions serve as advisors: the British Columbia Provincial Health Services Authority; International Agency for Research on Cancer; Medical Research Council Unit, The Gambia; Instituto Nacional de Salud Pública de Mexico; and Quebec Institut National de Santé Publique.

Announcement | January 29, 2018
PATH statement on official relations status with the World Health Organization
Executive Board votes for admission of PATH into official relations with the WHO
A statement from PATH’s Geneva Office Director Philippe Guinot follows:
“As PATH celebrates 40 years of supporting global health innovation, we welcome the approval of our official relations status with the World Health Organization. We have enjoyed a very close and productive collaborative relationship with WHO, and look forward to continuing to work side-by-side toward the advancement of public health in the future.”
 

UNAIDS [to 3 February 2018]
http://www.unaids.org/en
31 January 2018
African human rights body urges renewed efforts on human rights in response to HIV
On 27 January, the African Commission on Human and Peoples’ Rights (the African Commission) launched a groundbreaking report, HIV, the law and human rights in the African human rights system: key challenges and opportunities for rights-based responses.
The report addresses the key human rights challenges in the response to HIV, including inequality and discrimination towards people living with HIV, access to treatment and restrictive intellectual property regimes, conflict and migration, coercive HIV testing and counselling, restrictions on civil society and the criminalization of people living with HIV and key populations.
While noting the progress made in the response to HIV in Africa, the report expresses concerns about the populations left behind—young women and girls, prisoners, sex workers, men who have sex with men, transgender people and people who use drugs.
As well as the challenges, the report also highlights good practices from across the continent for responding to them, including law and policy reform, progressive court decisions and programmes to advance human rights protection and access to HIV and health services.
The development of the report is the result of three years of work involving inputs from various stakeholders, including people living with and affected by HIV, civil society and members of key populations.

UNICEF  [to 3 February 2018]
https://www.unicef.org/media/
31 January 2018
3 in 10 young people in conflict or disaster-stricken countries are illiterate – UNICEF
NEW YORK, 31 January 2018 – Nearly 3 in 10 young people aged between 15 and 24 years old – 59 million – living in countries affected by conflict or disaster are illiterate, triple the global rate, UNICEF said today.

UNICEF seeks $3.6 billion in emergency assistance for 48 million children caught up in catastrophic humanitarian crises
NEW YORK/GENEVA, 30 January 2018 – UNICEF appealed today for $3.6 billion to provide lifesaving humanitarian assistance to 48 million children living through conflict, natural disasters and other emergencies in 51 countries in 2018.

Wellcome Trust  [to 3 February 2018]
https://wellcome.ac.uk/news
News / Published: 25 January 2018
What our new strategy means for the Public Engagement Fund
We’ve developed an ambitious new strategy for our public engagement work and, as a result, we are making some changes to the Public Engagement Fund.
When we launched the Public Engagement Fund in January 2017 we said that the fund would evolve – as we learned from its implementation, and to reflect Wellcome’s changing vision.
After the changes, funding will still be open to anyone with a great project for engaging the public in Wellcome’s mission of improving health…

News / Published: 22 January 2018
New Wellcome office in Berlin will bolster global partnerships
News / Published: 22 January 2018
Wellcome is planning to open a small office in the German capital later this year so that we can work more closely with our international partners on shared priorities…

::::::
 

DCVMN – Developing Country Vaccine Manufacturers Network  [to 3 February 2018]
http://www.dcvmn.org/
17 January 2018
DCVMN and the Future Vaccine Manufacturing Hub launched a novel partnership for responsible innovation in emerging countries
[See Milestones above for more  detail]

Industry Watch   [to 3 February 2018]
:: Takeda’s Zika Vaccine Candidate Receives U.S. FDA Fast Track Designation
January 29, 2018
  The Fast Track designation highlights the significance of Zika and the need for a safe and effective vaccine to protect vulnerable populations
   A Phase 1 clinical trial (ZIK-101) was recently initiated to evaluate Takeda’s Zika vaccine candidate (TAK-426) in the continental U.S. and U.S. territories
   Takeda’s Zika program is supported by federal funds from Biomedical Advanced Research and Development Authority (BARDA), within the Office of the Assistant Secretary for Preparedness and Response in the U.S. Department of Health and Human Services

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
 

WHO-WIPO-WTO Technical Symposium on Sustainable Development Goals: Innovative technologies to promote healthy lives and well-being*
Date of the event: 26 February 2018 (09:00 to 17:15)
Location: Geneva, Switzerland (WHO Headquarters, Executive Board Room)
The event is open to Geneva-based delegations to WHO, WIPO and WTO, representatives of international and philanthropic organizations, experts on intellectual property and trade, civil society organizations and interested individuals and organizations.
The provisional programme of the event is available here.
Further details about the Symposium can be accessed here.
Background
The post-2015 Agenda for Sustainable Development sets out an ambitious plan for action: to reach and empower the most vulnerable and take action in areas of critical importance for humanity and the planet. The Sustainable Development Goals usher in a new era of global development that seeks to leave no one behind. Achievement of the SDGs will require a delicate choreography of interplay between all stakeholders.

Access to, and innovation in, health technologies is a requisite element for ensuring progress toward universal health coverage and achievement of the SDGs, namely SDG 3 Ensure healthy lives and promote well-being for all at all ages. Scientific progress, advances in health technologies and improved trade have contributed to unprecedented improvements in health outcomes. However, gains in life expectancy and quality of life are unequally distributed between low-, middle-, and high-income countries. Troubling inequalities in the burden of disease are, in part, attributed to the disparate access to health technologies. As a fundamental human right, the right of everyone to enjoy the highest attainable standard of physical and mental health obliges governments to ensure appropriate access to essential medicines.

The seventh technical symposium organized by WHO, WIPO, WTO will discuss challenges and opportunities for the international community to ensure that innovative technologies are developed and reach patients in order to realize the right to health and the health-related SDGs. The Symposium will offer a forum for an evidence-based exchange of views and experiences of the various stakeholders and representatives of the relevant sectors. Innovative, inclusive, and multi-stakeholder initiatives and partnerships that research, develop and facilitate access to novel, needs-based health technologies will be highlighted. The exchange will provide the basis for discussion and allow participants to achieve a better understanding of the benefits, drawbacks, and impact of the various available options.

The joint technical symposia convened by WHO, WIPO and WTO build on the collaborative work undertaken by the three agencies to enhance capacity, including the trilateral study “Promoting Access to Medical Technologies and Innovation.”

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
February 2018 Volume 46, Issue 2, p123-244
http://www.ajicjournal.org/current

Major Articles
Systematic review of electronic surveillance of infectious diseases with emphasis on antimicrobial resistance surveillance in resource-limited settings
Pinyo Rattanaumpawan, Adhiratha Boonyasiri, Sirenda Vong, Visanu Thamlikitkul
p139–146
Published online: October 10, 2017
Abstract
Background
Electronic surveillance of infectious diseases involves rapidly collecting, collating, and analyzing vast amounts of data from interrelated multiple databases. Although many developed countries have invested in electronic surveillance for infectious diseases, the system still presents a challenge for resource-limited health care settings.
Methods
We conducted a systematic review by performing a comprehensive literature search on MEDLINE (January 2000-December 2015) to identify studies relevant to electronic surveillance of infectious diseases. Study characteristics and results were extracted and systematically reviewed by 3 infectious disease physicians.
Results
A total of 110 studies were included. Most surveillance systems were developed and implemented in high-income countries; less than one-quarter were conducted in low-or middle-income countries. Information technologies can be used to facilitate the process of obtaining laboratory, clinical, and pharmacologic data for the surveillance of infectious diseases, including antimicrobial resistance (AMR) infections. These novel systems require greater resources; however, we found that using electronic surveillance systems could result in shorter times to detect targeted infectious diseases and improvement of data collection.
Conclusions
This study highlights a lack of resources in areas where an effective, rapid surveillance system is most needed. The availability of information technology for the electronic surveillance of infectious diseases, including AMR infections, will facilitate the prevention and containment of such emerging infectious diseases.

American Journal of Infection Control
February 2018 Volume 46, Issue 2, p123-244
http://www.ajicjournal.org/current

Middle East respiratory syndrome coronavirus transmission among health care workers: Implication for infection control
Sarah H. Alfaraj, Jaffar A. Al-Tawfiq, Talal A. Altuwaijri, Marzouqa Alanazi, Nojoom Alzahrani, Ziad A. Memish
p165–168
Published online: September 25, 2017

American Journal of Preventive Medicine
February 2018 Volume 54, Issue 2, p157-324
http://www.ajpmonline.org/current

Research Articles
Immunization Practices of U.S. Obstetrician/Gynecologists for Pregnant Patients
Sean T. O’Leary, Laura E. Riley, Megan C. Lindley, Mandy A. Allison, Lori A. Crane, Laura P. Hurley, Brenda L. Beaty, Michaela Brtnikova, Margaret Collins, Alison P. Albert, Allison K. Fisher, Angela J. Jiles, Allison Kempe
p205–213
Published online: December 12, 2017

American Journal of Preventive Medicine
February 2018 Volume 54, Issue 2, p157-324
http://www.ajpmonline.org/current

Nativity Disparities in Human Papillomavirus Vaccination Among U.S. Adults
…few studies have explored whether vaccination differences exist by nativity status. Vaccination disparities have the potential to exacerbate HPV-related cancer disparities in the long term if left unaddressed. Therefore, the authors investigated whether there were significant differences in HPV vaccination initiation (one or more doses) and completion (three or more doses) between U.S.-born and foreign-born men and women.
Ashley E. Pérez, Madina Agénor, Kristi E. Gamarel, Don Operario
p248–258
Published online: December 11, 2017

American Journal of Preventive Medicine
February 2018 Volume 54, Issue 2, p157-324
http://www.ajpmonline.org/current

Review Articles
The Cost of Interventions to Increase Influenza Vaccination: A Systematic Review
Laura J. Anderson, Paul Shekelle, Emmett Keeler, Lori Uscher-Pines, Roberta Shanman, Sally Morton, Gursel Aliyev, Teryl K. Nuckols
p299–315
Published in issue: February 2018

American Journal of Public Health
February 2018   108(2)
http://ajph.aphapublications.org/toc/ajph/current
SOCIAL IMPACT BONDS

Social Impact Bonds as a Funding Method for Health and Social Programs: Potential Areas of Concern
Amy S. Katz, Benjamin Brisbois, Suzanne Zerger and Stephen W. Hwang
108(2), pp. 210–215
Abstract
Social Impact Bonds (SIBs) represent a new way to finance social service and health promotion programs whereby different types of investors provide an upfront investment of capital. If a given program meets predetermined criteria for a successful outcome, the government pays back investors with interest. Introduced in the United Kingdom in 2010, SIBs have since been implemented in the United States and across Europe, with some uptake in other jurisdictions.
We identify and explore selected areas of concern related to SIBs, drawing from literature examining market-based reforms to health and social services and the evolution of the SIB funding mechanism. These areas of concern include increased costs to governments, restricted program scope, fragmented policymaking, undermining of public-sector service provision, mischaracterization of the root causes of social problems, and entrenchment of systemically produced vulnerabilities.
We argue that it is essential to consider the long-term, aggregate, and contextualized effects of SIBs in order to evaluate their potential to contribute to public health. We conclude that such evaluations must explore the assumptions underlying the “common sense” arguments often used in support of SIBs.

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 27 January 2018)

Research article
Cost-effectiveness of increasing vaccination in high-risk adults aged 18–64 Years: a model-based decision analysis
Adults aged 18–64 years with comorbid conditions are at high risk for complications of certain vaccine-preventable diseases, including influenza and pneumococcal disease. The 4 Pillars™ Practice Transformation…
Authors: Angela R. Wateska, Mary Patricia Nowalk, Richard K. Zimmerman, Kenneth J. Smith and Chyongchiou J. Lin
Citation: BMC Infectious Diseases 2018 18:52
Published on: 25 January 2018

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 3 February 2018)

Debate
27 January 2018
Fake facts and alternative truths in medical research
Authors: Bjørn Hofmann
Background
Fake news and alternative facts have become commonplace in these so-called “post-factual times.” What about medical research – are scientific facts fake as well? Many recent disclosures have fueled the claim that scientific facts are suspect and that science is in crisis. Scientists appear to engage in facting interests instead of revealing interesting facts. This can be observed in terms of what has been called polarised research, where some researchers continuously publish positive results while others publish negative results on the same issue – even when based on the same data. In order to identify and address this challenge, the objective of this study is to investigate how polarised research produce “polarised facts.” Mammography screening for breast cancer is applied as an example

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 27 January 2018)

Research article
Rotavirus vaccine impact and socioeconomic deprivation: an interrupted time-series analysis of gastrointestinal disease outcomes across primary and secondary care in the UK
Rotavirus causes severe gastroenteritis in infants and young children worldwide. The UK introduced the monovalent rotavirus vaccine (Rotarix®) in July 2013. Vaccination is free of charge to parents, with two d…
Authors: Daniel Hungerford, Roberto Vivancos, Jonathan M. Read, Miren Iturriza-Gόmara, Neil French and Nigel A. Cunliffe
Citation: BMC Medicine 2018 16:10
Published on: 29 January 2018

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 3 February 2018)

Research article
Interventions to reduce post-acute consequences of diarrheal disease in children: a systematic review
Although acute diarrhea often leads to acute dehydration and electrolyte imbalance, children with diarrhea also suffer long term morbidity, including recurrent or prolonged diarrhea, loss of weight, and linear…
Authors: Patricia B. Pavlinac, Rebecca L. Brander, Hannah E. Atlas, Grace C. John-Stewart, Donna M. Denno and Judd L. Walson
Citation: BMC Public Health 2018 18:208
Published on: 1 February 2018

Bulletin of the World Health Organization
Volume 96, Number 2, February 2018, 77-144
http://www.who.int/bulletin/volumes/96/2/en/

RESEARCH
Implementation research: reactive mass vaccination with single-dose oral cholera vaccine, Zambia
Marc Poncin, Gideon Zulu, Caroline Voute, Eva Ferreras, Clara Mbwili Muleya, Kennedy Malama, Lorenzo Pezzoli, Jacob Mufunda, Hugues Robert, Florent Uzzeni, Francisco J Luquero, Elizabeth Chizema & Iza Ciglenecki
http://dx.doi.org/10.2471/BLT.16.189241
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 vaccines in response to a cholera epidemic, by the use of just one dose per member of an at-risk community, should be considered.

Bulletin of the World Health Organization
Volume 96, Number 2, February 2018, 77-144
http://www.who.int/bulletin/volumes/96/2/en/

SYSTEMATIC REVIEWS
Lessons learnt from implementation of the International Health Regulations: a systematic review
— Amitabh B Suthar, Lisa G Allen, Sara Cifuentes, Christopher Dye & Jason M Nagata
http://dx.doi.org/10.2471/BLT.16.189100

Abstract
Objective
To respond to the World Health Assembly call for dissemination of lessons learnt from countries that have begun implementing the International Health Regulations, 2005 revision; IHR (2005).
Methods
In November 2015, we conducted a systematic search of the following online databases and sources: PubMed®, Embase®, Global Health, Scopus, World Health Organization (WHO) Global Index Medicus, WHO Bulletin on IHR Implementation and the International Society for Disease Surveillance. We included identified studies and reports summarizing national experience in implementing any of the IHR (2005) core capacities or their components. We excluded studies that were theoretical or referred to IHR (1969). Qualitative systematic review methodology, including meta-ethnography, was used for qualitative synthesis.
Findings
We analysed 51 articles from 77 countries representing all WHO Regions. The meta-syntheses identified a total of 44 lessons learnt across the eight core capacities of IHR (2005). Major themes included the need to mobilize and sustain political commitment; to adapt global requirements based on local sociocultural, epidemiological, health system and economic contexts; and to conduct baseline and follow-up assessments to monitor the status of IHR (2005) implementation.
Conclusion
Although experiences of IHR (2005) implementation covered a wide global range, more documentation from Africa and Eastern Europe is needed. We did not find specific areas of weakness in monitoring IHR (2005); sustained monitoring of all core capacities is required to ensure effective systems. These lessons learnt could be adapted by countries in the process of meeting IHR (2005) requirements.

Bulletin of the World Health Organization
Volume 96, Number 2, February 2018, 77-144
http://www.who.int/bulletin/volumes/96/2/en/

POLICY & PRACTICE
Pandemic risk: how large are the expected losses?
— Victoria Y Fan, Dean T Jamison & Lawrence H Summers
http://dx.doi.org/10.2471/BLT.17.199588
Abstract
There is an unmet need for greater investment in preparedness against major epidemics and pandemics. The arguments in favour of such investment have been largely based on estimates of the losses in national incomes that might occur as the result of a major epidemic or pandemic. Recently, we extended the estimate to include the valuation of the lives lost as a result of pandemic-related increases in mortality. This produced markedly higher estimates of the full value of loss that might occur as the result of a future pandemic. We parametrized an exceedance probability function for a global influenza pandemic and estimated that the expected number of influenza-pandemic-related deaths is about 720,000 per year. We calculated that the expected annual losses from pandemic risk to be about 500 billion United States dollars – or 0.6% of global income – per year. This estimate falls within – but towards the lower end of – the Intergovernmental Panel on Climate Change’s estimates of the value of the losses from global warming, which range from 0.2% to 2% of global income. The estimated percentage of annual national income represented by the expected value of losses varied by country income grouping: from a little over 0.3% in high-income countries to 1.6% in lower-middle-income countries. Most of the losses from influenza pandemics come from rare, severe events.

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…

[Reviewed earlier]

Journal of Medical Ethics
February 2018 – Volume 44 – 2
http://jme.bmj.com/content/current

Research ethics
Paper: Informed consent in cluster randomised trials: new and common ethical challenges
(30 January, 2018)
Sapfo Lignou
Abstract
Cluster randomised trials are an increasingly important methodological tool in health research but they present challenges to the informed consent requirement. In the relatively limited literature on the ethics of cluster research there is not much clarity about the reasons for which seeking informed consent in cluster randomised trials may be morally challenging. In this paper, I distinguish between the cases where informed consent in cluster trials may be problematic due to the distinct features of ‘population-based’ interventions, which have not been adequately discussed in the research ethics literature, and the cases where informed consent may be problematic for reasons that investigators also encounter in other research designs. I claim that informed consent requirements in cluster trials should be adjusted to the level of risk involved, arguing for a more comprehensive notion of research risk than that currently found in the research ethics guidelines, and the amount of freedom to be sacrificed in relation to a particular research aim. I conclude that these two factors are the most important to consider when assessing whether a cluster study should proceed when informed consent is infeasible or difficult to obtain.