Journal of Medical Internet Research
Viewpoint

The Significance of Witness Sensors for Mass Casualty Incidents and Epidemic Outbreaks
Chih-Long Pan, Chih-Hao Lin, Yan-Ren Lin, Hsin-Yu Wen, Jet-Chau Wen
J Med Internet Res 2018 (Feb 02); 20(2):e39
ABSTRACT
Due to the increasing number of natural and man-made disasters, mass casualty incidents occur more often than ever before. As a result, health care providers need to adapt in order to cope with the overwhelming patient surge. To ensure quality and safety in health care, accurate information in pandemic disease control, death reduction, and health quality promotion should be highlighted. However, obtaining precise information in real time is an enormous challenge to all researchers of the field. In this paper, innovative strategies are presented to develop a sound information network using the concept of “witness sensors.” To overcome the reliability and quality limitations of information obtained through social media, researchers must focus on developing solutions that secure the authenticity of social media messages, especially for matters related to health. To address this challenge, we introduce a novel concept based on the two elements of “witness” and “sensor.” Witness sensors can be key players designated to minimize limitations to quality of information and to distinguish fact from fiction during critical events. In order to enhance health communication practices and deliver valid information to end users, the education and management of witness sensors should be further investigated, especially for implementation during mass casualty incidents and epidemic outbreaks.

The Lancet

Jan 27, 2018 Volume 391 Number 10118 p281-400  e2-e4
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Yellow fever: a major threat to public health
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.

The Lancet
Jan 27, 2018 Volume 391 Number 10118 p281-400  e2-e4
http://www.thelancet.com/journals/lancet/issue/current

The Lancet Commissions
The Lancet Commission on pollution and health
Philip J Landrigan, Richard Fuller, Nereus J R Acosta, Olusoji Adeyi, Robert Arnold, Niladri (Nil) Basu, Abdoulaye Bibi Baldé, Roberto Bertollini, Stephan Bose-O’Reilly, Jo Ivey Boufford, Patrick N Breysse, Thomas Chiles, Chulabhorn Mahidol, Awa M Coll-Seck, Maureen L Cropper, Julius Fobil, Valentin Fuster, Michael Greenstone, Andy Haines, David Hanrahan, David Hunter, Mukesh Khare, Alan Krupnick, Bruce Lanphear, Bindu Lohani, Keith Martin, Karen V Mathiasen, Maureen A McTeer, Christopher J L Murray, Johanita D Ndahimananjara, Frederica Perera, Janez Potočnik, Alexander S Preker, Jairam Ramesh, Johan Rockström, Carlos Salinas, Leona D Samson, Karti Sandilya, Peter D Sly, Kirk R Smith, Achim Steiner, Richard B Stewart, William A Suk, Onno C P van Schayck, Gautam N Yadama, Kandeh Yumkella, Ma Zhong
462
Pollution is the largest environmental cause of disease and premature death in the world today. Diseases caused by pollution were responsible for an estimated 9 million premature deaths in 2015—16% of all deaths worldwide—three times more deaths than from AIDS, tuberculosis, and malaria combined and 15 times more than from all wars and other forms of violence. In the most severely affected countries, pollution-related disease is responsible for more than one death in four.

Lancet Global Health
Feb 2018 Volume 6 Number 2 e121-e228
http://www.thelancet.com/journals/langlo/issue/current

Articles
Monitoring universal health coverage within the Sustainable Development Goals: development and baseline data for an index of essential health services
Daniel R Hogan, Gretchen A Stevens, Ahmad Reza Hosseinpoor, Ties Boerma
Summary
Background
Achieving universal health coverage, including quality essential service coverage and financial protection for all, is target 3.8 of the Sustainable Development Goals (SDG). As a result, an index of essential health service coverage indicators was selected by the UN as SDG indicator 3.8.1. We have developed an index for measuring SDG 3.8.1, describe methods for compiling the index, and report baseline results for 2015.
Methods
16 tracer indicators were selected for the index, which included four from within each of the categories of reproductive, maternal, newborn, and child health; infectious disease; non-communicable diseases; and service capacity and access. Indicator data for 183 countries were taken from UN agency estimates or databases, supplemented with submissions from national focal points during a WHO country consultation. The index was computed using geometric means, and a subset of tracer indicators were used to summarise inequalities.
Findings
On average, countries had primary data since 2010 for 72% of the final set of indicators. The median national value for the service coverage index was 65 out of 100 (range 22–86). The index was highly correlated with other summary measures of health, and after controlling for gross national income and mean years of adult education, was associated with 21 additional years of life expectancy over the observed range of country values. Across 52 countries with sufficient data, coverage was 1% to 66% lower among the poorest quintile as compared with the national population. Sensitivity analyses suggested ranks implied by the index are fairly stable across alternative calculation methods.
Interpretation
Service coverage within universal health coverage can be measured with an index of tracer indicators. Our universal health coverage service coverage index is simple to compute by use of available country data and can be refined to incorporate relevant indicators as they become available through SDG monitoring.
Funding
Ministry of Health, Japan, and the Rockefeller Foundation.

Lancet Global Health
Feb 2018 Volume 6 Number 2 e121-e228
http://www.thelancet.com/journals/langlo/issue/current

Progress on catastrophic health spending in 133 countries: a retrospective observational study
Adam Wagstaff, Gabriela Flores, Justine Hsu, Marc-François Smitz, Kateryna Chepynoga, Leander R Buisman, Kim van Wilgenburg, Patrick Eozenou

Progress on impoverishing health spending in 122 countries: a retrospective observational study
Adam Wagstaff, Gabriela Flores, Marc-François Smitz, Justine Hsu, Kateryna Chepynoga, Patrick Eozenou

Prevalence of chronic obstructive pulmonary disease in the global population with HIV: a systematic review and meta-analysis
Jean Joel Bigna, Angeladine Malaha Kenne, Serra Lem Asangbeh, Aurelie T Sibetcheu
e193

Lancet Infectious Diseases
Feb 2018 Volume 18 Number 2 p123-226  e33-e63
http://www.thelancet.com/journals/laninf/issue/current

Editorial
The dengue vaccine dilemma
The Lancet Infectious Diseases

Lancet Infectious Diseases
Feb 2018 Volume 18 Number 2 p123-226  e33-e63
http://www.thelancet.com/journals/laninf/issue/current

Articles
Immunogenicity and safety of one versus two doses of tetravalent dengue vaccine in healthy children aged 2–17 years in Asia and Latin America: 18-month interim data from a phase 2, randomised, placebo-controlled study
Xavier Sáez-Llorens, Vianney Tricou, Delia Yu, Luis Rivera, José Jimeno, Ana Cecilia Villarreal, Epiphany Dato, Sonia Mazara, Maria Vargas, Manja Brose, Martina Rauscher, Suely Tuboi, Astrid Borkowski, Derek Wallace
Summary
Background
Development of vaccines that are effective against all four dengue virus serotypes (DENV-1–4) in all age groups is important. Here, we present 18-month interim data from an ongoing study undertaken to assess the immunogenicity and safety of Takeda’s tetravalent dengue vaccine (TDV) candidate over 48 months in children living in dengue-endemic countries.
Methods
We undertook a phase 2, multicentre, randomised, double-blind, placebo-controlled study at three sites in the Dominican Republic, Panama, and the Philippines. We randomly assigned children aged 2–17 years to receive either two TDV doses 3 months apart (group 1), one TDV dose (group 2), one TDV dose and a booster dose 1 year later (group 3), or placebo (group 4). We did the randomisation (1:2:5:1) using an interactive web response system stratified by age. The primary endpoint of this 18-month interim analysis was DENV serotype-specific antibody geometric mean titres (GMTs) in the per-protocol immunogenicity subset on days 1, 28, 91, 180, 365, 393, and 540. Secondary safety endpoints were the proportions of participants with serious adverse events and with virologically confirmed dengue in the safety set, and solicited and unsolicited adverse events in the immunogenicity subset. This trial is registered with ClinicalTrials.gov, number NCT02302066.
Findings
Between Dec 5, 2014, and Feb 13, 2015, 1800 children were randomly assigned to group 1 (n=201), group 2 (n=398), group 3 (n=1002), and group 4 (n=199). 1794 participants received at least one dose of TDV or placebo (safety set), of whom 562 participated in the immunogenicity subset and 509 were included in the per-protocol set. Antibody titres remained elevated 18 months after vaccination in all TDV groups. At day 540, in groups 1, 2, 3, and 4, respectively, DENV-1 GMTs were 476 (95% CI 286–791), 461 (329–647), 1056 (804–1388), and 92 (49–173); DENV-2 GMTs were 1212 (842–1744), 1242 (947–1628), 1457 (1182–1796), and 177 (93–337); DENV-3 GMTs were 286 (171–478), 298 (205–433), 548 (411–730), and 78 (44–137); and DENV-4 GMTs were 98 (65–150), 102 (75–139), 172 (133–222), and 33 (21–52). Limited differences in GMTs were observed between groups 1 and 2 (in which participants received one and two doses of TDV, respectively). In baseline-seronegative participants, a 1-year booster clearly increased GMTs. Vaccine-related unsolicited adverse events occurred in 14 (2%) of 562 participants, but no vaccine-related serious adverse events arose. Symptomatic, virologically confirmed dengue was recorded in 21 (1·3%) of 1596 participants vaccinated with TDV compared with nine (4·5%) of 198 placebo recipients.
Interpretation
TDV was well tolerated and immunogenic against all four dengue serotypes, irrespective of baseline dengue serostatus. These data provide proof of concept for TDV and support the ongoing phase 3 efficacy assessment of two doses 3 months apart.
Funding
Takeda Vaccines.

Lancet Infectious Diseases
Feb 2018 Volume 18 Number 2 p123-226  e33-e63
http://www.thelancet.com/journals/laninf/issue/current

Review
Antimicrobial resistance among children in sub-Saharan Africa
Phoebe C M Williams, David Isaacs, James A Berkley
Open Access
Summary
Antimicrobial resistance is an important threat to international health. Therapeutic guidelines for empirical treatment of common life-threatening infections depend on available information regarding microbial aetiology and antimicrobial susceptibility, but sub-Saharan Africa lacks diagnostic capacity and antimicrobial resistance surveillance. We systematically reviewed studies of antimicrobial resistance among children in sub-Saharan Africa since 2005. 18 of 1075 articles reviewed met inclusion criteria, providing data from 67,451 invasive bacterial isolates from inconsistently defined populations in predominantly urban tertiary settings. Among neonates, Gram-negative organisms were the predominant cause of early-onset neonatal sepsis, with a high prevalence of extended-spectrum β-lactamase-producing organisms. Gram-positive bacteria were responsible for a high proportion of infections among children beyond the neon atal period, with high reported prevalence of non-susceptibility to treatment advocated by the WHO therapeutic guidelines. There are few up-to-date or representative studies given the magnitude of the problem of antimicrobial resistance, especially regarding community-acquired infections. Research should focus on differentiating resistance in community-acquired versus hospital-acquired infections, implementation of standardised reporting systems, and pragmatic clinical trials to assess the efficacy of alternative treatment regimens.

Medical Decision Making (MDM)
Volume 38, Issue 2, February 2018
http://mdm.sagepub.com/content/current

Original Articles
Using Cluster Analysis to Group Countries for Cost-effectiveness Analysis: An Application to Sub-Saharan Africa
Louise B. Russell, Gyan Bhanot, Sun-Young Kim, Anushua Sinha
First Published August 19, 2017; pp. 139–149
Abstract
Objective. To explore the use of cluster analysis to define groups of similar countries for the purpose of evaluating the cost-effectiveness of a public health intervention—maternal immunization—within the constraints of a project budget originally meant for an overall regional analysis.
Methods. We used the most common cluster analysis algorithm, K-means, and the most common measure of distance, Euclidean distance, to group 37 low-income, sub-Saharan African countries on the basis of 24 measures of economic development, general health resources, and past success in public health programs. The groups were tested for robustness and reviewed by regional disease experts.
Results. We explored 2-, 3- and 4-group clustering. Public health performance was consistently important in determining the groups. For the 2-group clustering, for example, infant mortality in Group 1 was 81 per 1,000 live births compared with 51 per 1,000 in Group 2, and 67% of children in Group 1 received DPT immunization compared with 87% in Group 2. The experts preferred four groups to fewer, on the ground that national decision makers would more readily recognize their country among four groups.
Conclusions. Clusters defined by K-means clustering made sense to subject experts and allowed a more detailed evaluation of the cost-effectiveness of maternal immunization within the constraint of the project budget. The method may be useful for other evaluations that, without having the resources to conduct separate analyses for each unit, seek to inform decision makers in numerous countries or subdivisions within countries, such as states or counties.

New England Journal of Medicine
February 1, 2018  Vol. 378 No. 5
http://www.nejm.org/toc/nejm/medical-journal

Health Policy Report
The Challenging Quest to Improve Rural Health Care
John K. Iglehart
In the United States, rural populations have a lower life expectancy than urban populations and face shortages of health care providers. This report discusses the challenges facing rural health care systems and efforts to expand the rural health care workforce.

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.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 3 February 2018)

Editorial
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
| published 30 Jan 2018 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002498

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.

BBC
http://www.bbc.co.uk/
Accessed 3 February 2018
3 Feb 2018
Philippines gripped by dengue vaccine fears

Forbes
http://www.forbes.com/
Accessed 3 February 2018
Despite Doubters, Moderna Raises $500 Million, Is Now Worth $7 Billion
Matthew Herper, Forbes Staff
Moderna Therapeutics, a biotechnology firm that is developing drugs that work on a genetic messaging system that is essentially to all living cells, has raised $500 million from a group of new and current investors.

Huffington Post UK
http://www.huffingtonpost.co.uk/
Accessed 3 February 2018
Why It’s Our Duty To Get Immunised
| 29 January 2018
…The flu outbreak is just one example of a crisis which could have been averted if the public was more proactive in its approach to managing its own health. The flu vaccine is widely available, for the price of a cinema ticket and at multiple convenient locations on the high street, ranging from independent pharmacies to high street chains and even supermarkets.

New York Times
http://www.nytimes.com/
Accessed 3 February 2018
U.S. Flu Outbreak Worsens; Hospitalizations Highest in Nearly a Decade: CDC
The U.S. flu outbreak worsened over the past week as more people headed to doctors’ offices and emergency rooms, with hospitalizations at the highest in nearly 10 years, U.S. health officials said on Friday.
Feb. 2, 2018

India Wants to Give Half a Billion People Free Health Care
1 February 2018
India announced on Thursday a sweeping plan to give half a billion poor Indians free access to health care, as Prime Minister Narendra Modi seeks to address rising demands for greater economic and social protections before national elections next year….The health care plan, part of the government’s 2018-19 budget presented on Thursday, would offer 100 million families up to 500,000 rupees, or about $7,860, of coverage each year. That sum, while small by Western standards, would be enough to cover the equivalent of five heart surgeries in India. Officials did not outline eligibility requirements, and many details of the program have yet to be finalized.

Scientific American
https://www.scientificamerican.com/
Accessed 3 February 2018
Seth Berkley: A Completely Preventable Public Health Crisis
1 February 2018
An outbreak of diphtheria in a Rohingya refugee camp in Bangladesh makes it clear that these people were living in substandard conditions before they fled Myanmar
… This deadly respiratory disease is as preventable as it is infectious, thanks to one of the most widely available vaccines in the world. So, while the densely populated conditions may have facilitated the spread of the disease, the refugee camps are not the cause. The fact that there is a diphtheria outbreak in the first place is a clear indication that these people did not have access to even the most basic vaccines and brings into question the conditions they were living in before they arrived at the camp. This outbreak is not the product of conditions within the camps, but rather a deadly legacy of the conditions in which they had been living before they fled Myanmar.