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

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

BMJ Open
2018;8:e021335
doi: 10.1136/bmjopen-2017-021335
Adolescent self-consent for vaccinations: protocol for a mixed methods systematic review
H Fisher, M Hickman, J Macleod, S Audrey – BMJ open, 2018
Abstract
Introduction The recent global expansion of routine adolescent vaccination programmes has the potential to protect young people against the acquisition of infectious disease and improve their health. Although in many countries the legal framework supports young people to provide consent for medical interventions if they are considered competent, written parental consent can act as a barrier to uptake as it is frequently a condition of adolescent vaccination programmes. The aim of this systematic review protocol is to document the methods which will be used to identify, appraise and synthesise the available qualitative and quantitative evidence to address: (1) whether implementation of adolescent self-consent procedures can increase vaccination uptake and (2) the barriers and facilitators to implementation of adolescent self-consent procedures.
Methods and analysis Comprehensive search strategy of all relevant electronic databases for both qualitative and quantitative studies using predefined inclusion and exclusion criteria. At least two authors will independently review titles and abstracts, extract data and assess the methodological quality of eligible primary studies, resolving disagreements by consensus. Quantitative studies will be reported narratively and where possible pooled in a meta-analysis using a random-effects model. The findings of qualitative primary studies will be extracted, interpreted and synthesised to identify overarching themes as well as similarities and differences within those themes.
Ethics and dissemination As this systematic review involves analysis of secondary data, the study does not require ethical approvals. We will use our findings to assess whether the evidence supports the hypothesis that self-consent procedures can increase coverage of adolescent vaccination programmes. We will identify barriers and facilitators to the implementation of adolescent self-consent for vaccination and make recommendations for policy makers and practitioners in relation to consent procedures within vaccination programmes for young people.
PROSPERO registration number CRD42017084509.

 

 

Media/Policy Watch

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 Atlantic
http://www.theatlantic.com/magazine/
Accessed 26 May 2018
Vaccines Alone Won’t Beat Ebola
24 May 2018
A deep understanding of the Congo’s culture and time-honored public-health tactics are the keys to controlling the outbreak.
 
The Economist
http://www.economist.com/
Accessed 26 May 2018

How to contain an Ebola outbreak – Back to blood
The world has learned a lot from the previous epidemic
May 24th 2018

The Ebola outbreak in Congo can probably be contained
Stopping the next epidemic
May 24th 2018

 
Forbes
http://www.forbes.com/
Accessed 26 May 2018
Another Anti-Vax Paper Bites The Dust. But Not Quickly Enough.
Steven Salzberg, Contributor
     Nature’s mega-journal, Scientific Reports, just retracted a paper over the objections of the authors. The paper was a badly flawed effort to “prove” that the HPV vaccine is harmful. Despite near-immediate condemnation from many scientists, the journal took 1.5 years to retract it.

Foreign Policy
http://foreignpolicy.com/
Accessed 26 May 2018
Trump Is in a Coma on Public Health
May 21, 2018
Amid the latest Ebola outbreak, the Trump administration is handing leadership to Angela Merkel — and she’s not out to protect American interests.
Laurie Garrett

New York Times
http://www.nytimes.com/
Accessed 26 May 2018
New Ebola Tactics Raise Hope but May Sow Confusion
24 May 2018

Infection Alert After Dying Ebola Patients Taken to Congo Prayer Meeting
24 May 2018

Think Tanks et al

Think Tanks et al
 
 
Council on Foreign Relations
http://www.cfr.org/
Accessed 26 May 2018
May 21, 2018
Health Policy and Initiatives A Conversation About the 71st World Health Assembly and the World Health Organization
Nearly one year has elapsed since the seventieth World Health Assembly elected Dr. Tedros Adhanom Ghebreyesus as the new director-general of the World Health Organization. This meeting of CFR’s Globa…
Event by Ariel Pablos-Méndez , and Werner Obermeyer

Vaccines and Global Health: The Week in Review 19 May 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_19 May 2018

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

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

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

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

World Health Assembly :: Director-General brings ambitious agenda for change to World Health Assembly

Milestones :: Perspectives

World Health Assembly
21–26 May 2018
Geneva
Main Documents: http://apps.who.int/gb/e/e_wha71.html
A71/1 Rev.1 – Provisional agenda
 
Director-General brings ambitious agenda for change to World Health Assembly
18 May 2018 – News Release
After one year in office, WHO Director-General, Dr Tedros Adhanom Ghebreyesus will open the Seventy-first World Health Assembly next week in Geneva with an ambitious agenda for change that aims to save 29 million lives by 2023.

Ministers of Health and other delegates from WHO’s 194 Member States will meet to discuss a range of issues, including the 13th General Programme of Work, which is WHO’s 5-year strategic plan to help countries meet the health targets of the Sustainable Development Goals (SDGs).

“This is a pivotal health Assembly. On the occasion of WHO’s 70th anniversary, we are celebrating 7 decades of public health progress that have added 25 years to global life expectancy, saved millions of children’s lives, and made huge inroads into eradicating deadly diseases such as smallpox and, soon, polio,” said Dr Tedros.

“But the latest edition of the World Health Statistics, published yesterday, shows just how far we still have to go.  Too many people are still dying of preventable diseases, too many people are being pushed into poverty to pay for health care out of their own pockets and too many people are unable to get the health services they need. This is unacceptable,” he added.

Next week’s Health Assembly will open against the backdrop of a new outbreak of Ebola in central Africa, a stark reminder that global health risks can erupt at any time and that fragile health systems in any country pose a risk for the rest of the world.

The WHO General Programme of Work, designed to address these challenges and accelerate progress towards the SDGs, is the result of 12 months of intensive discussion with countries, experts and partners, and centres on the “triple billion” targets:
1 billion more people benefitting from universal health coverage
1 billion more people better protected from health emergencies
1 billion more people enjoying better health and well-being.
 
“We are transforming how we work to achieve our vision of a world in which health is a right for all. We are changing the way we do business,” Dr Tedros said.

Other topics that will be covered at this year’s World Health Assembly include WHO’s work in health emergencies, polio, physical activity, vaccines, the global snakebite burden and rheumatic heart disease…
 
 

WHO concerned as one Ebola case confirmed in urban area of Democratic Republic of the Congo :: Statement on the 1st meeting of the IHR Emergency Committee regarding the Ebola outbreak in 2018 :: FAQ on Ebola virus disease vaccine

Milestones :: Perspectives

EBOLA/EVD  [to 19 May 2018]
http://www.who.int/ebola/en/

WHO concerned as one Ebola case confirmed in urban area of Democratic Republic of the Congo
17 May 2018   News Release
One new case of Ebola virus disease (EVD) has been confirmed in Wangata, one of the three health zones of Mbandaka, a city of nearly 1.2 million people in Equateur Province in northwestern Democratic Republic of the Congo.

The Ministry of Health of the Democratic Republic of the Congo announced the finding, after laboratory tests conducted by the Institut National de Recherche Biomédicale (INRB) confirmed one specimen as positive for EVD.

Until now, all the confirmed Ebola cases were reported from Bikoro health zone, which is also in Equateur Province but at a distance of nearly 150 km from Mbandaka. The health facilities in Bikoro have very limited functionality and the affected areas are difficult to reach, particularly during the current rainy season, as the roads are often impassable.

“This is a concerning development, but we now have better tools than ever before to combat Ebola,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO and our partners are taking decisive action to stop further spread of the virus.”

WHO is deploying around 30 experts to conduct surveillance in the city and is working with the Ministry of Health and partners to engage with communities on prevention and treatment and the reporting of new cases.

“The arrival of Ebola in an urban area is very concerning and WHO and partners are working together to rapidly scale up the search for all contacts of the confirmed case in the Mbandaka area,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.
WHO is also working with Médecins Sans Frontières (MSF) and other partners to strengthen the capacity of health facilities to treat Ebola patients in special isolation wards.

As of 15 May, a total of 44 Ebola virus disease cases have been reported: 3 confirmed, 20 probable, and 21 suspected.

WHO partners in the DRC Ebola response include:
The International Federation of Red Cross and Red Crescent Societies (IFRC), the Congolese Red Cross (Congo ICRC), the  Red Cross of the Democratic Republic of the Congo (DRC ICRC), Médecins Sans Frontières (MSF), the Disaster Relief Emergency Fund (DREF), the Africa Centers for Disease Control and Prevention (Africa-CDC), the US Centers for Disease Control and Prevention (US-CDC), the World Food Programme (WFP), UNICEF, UNOCHA, MONUSCO, International Organization for Migration (IOM), the FAO Emergency Management Centre – Animal Health (EMC-AH), the International Humanitarian Partnership (IHP), Gavi – the Vaccine Alliance, the African Field Epidemiology Network (AFENET), the UK Public Health Rapid Support team, the EPIET Alumni Network (EAN), and the International Organisation for Animal Health (OIE) and and the Emerging Diseases Clinical Assessment and Response Network (EDCARN). Additional coordination and technical support is forthcoming through the Global Outbreak Alert and Response Network (GOARN) and Emergency Medical Teams (EMT).

 
Statement on the 1st meeting of the IHR Emergency Committee regarding the Ebola outbreak in 2018
The 1st meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) regarding the Ebola Virus Disease (EVD) outbreak in the Democratic Republic of the Congo took place on Friday 18 May 2018, from 11:00 to 14:00 Geneva time (CET).

Emergency Committee conclusion
It was the view of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have not currently been met.

Meeting
Members and advisors of the Emergency Committee met by teleconference. Presentations were made by representatives of the Democratic Republic of the Congo on recent developments, including measures taken to implement rapid control strategies, and existing gaps and challenges in the outbreak response. During the informational session, the WHO Secretariat provided an update on and assessment of the Ebola outbreak.

The Committee’s role was to provide to the Director-General their views and perspectives on:
Whether the event constitutes a Public Health Emergency of International Concern (PHEIC)
If the event constitutes a PHEIC, what Temporary Recommendations should be made.

Current situation
On 8 May, WHO was notified by the Ministry of Health of the Democratic Republic of the Congo of two lab-confirmed cases of Ebola Virus Disease occurring in Bikoro health zone, Equateur province. Cases have now also been found in nearby Iboko and Mbandaka. From 4 April to 17 May 2018, 45 EVD cases have been reported, including in three health care workers, and 25 deaths have been reported. Of these 45 cases, 14 have been confirmed. Most of these cases have been in the remote Bikoro health zone, although one confirmed case is in Mbandaka, a city of 1.2 million, which has implications for its spread.

Nine neighbouring countries, including Congo-Brazzaville and Central African Republic, have been advised that they are at high risk of spread and have been supported with equipment and personnel.

Key Challenges
After discussion and deliberation on the information provided, the Committee concluded these key challenges:
:: The Ebola outbreak in the Democratic Republic of the Congo has several characteristics that are of particular concern: the risk of more rapid spread given that Ebola has now spread to an urban area; that there are several outbreaks in remote and hard to reach areas; that health care staff have been infected, which may be a risk for further amplification.
:: The risk of international spread is particularly high since the city of Mbandaka is in proximity to the Congo river, which has significant regional traffic across porous borders.
:: There are huge logistical challenges given the poor infrastructure and remote location of most cases currently reported; these factors affect surveillance, case detection and confirmation, contact tracing, and access to vaccines and therapeutics.

However, the Committee also noted the following:
:: The response by the government of the Democratic Republic of the Congo, WHO and partners has been rapid and comprehensive.
:: Interventions underway provide strong reason to believe that the outbreak can be brought under control, including: enhanced surveillance, establishment of case management facilities, deployment of mobile laboratories, expanded engagement of community leaders, establishment of an airbridge, and other planned interventions.
:: In addition, the advanced preparations for use of the investigational vaccine provide further cause for optimism for control

In conclusion, the Emergency Committee, while noting that the conditions for a PHEIC are not currently met, issued Public Health Advice as follows:
:: Government of the Democratic Republic of the Congo, WHO, and partners remain engaged in a vigorous response – without this, the situation is likely to deteriorate significantly. This response should be supported by the entire international community.
:: Global solidarity among the scientific community is critical and international data should be shared freely and regularly.
:: It is particularly important there should be no international travel or trade restrictions.
:: Neighbouring countries should strengthen preparedness and surveillance.
:: During the response, safety and security of staff should be ensured, and protection of responders and national and international staff should prioritised.
:: Exit screening, including at airports and ports on the Congo river, is considered to be of great importance; however entry screening, particularly in distant airports, is not considered to be of any public health or cost-benefit value.
:: Robust risk communication (with real-time data), social mobilisation, and community engagement are needed for a well-coordinated response and so that those affected understand what protection measures are being recommended;
:: If the outbreak expands significantly, or if there is international spread,  the Emergency Committee will be reconvened.

The Committee emphasized the importance of continued support by WHO and other national and international partners towards the effective implementation and monitoring of this advice.

Based on this advice, the reports made by the affected States Parties, and the currently available information, the Director-General accepted the Committee’s assessment and on 18 May 2018 did not declare the Ebola outbreak in the Democratic Republic of the Congo a Public Health Emergency of International Concern (PHEIC). In light of the advice of the Emergency Committee, WHO advises against the application of any travel or trade restrictions. The Director-General thanked the Committee Members and Advisors for their advice.

FAQ on Ebola virus disease vaccine
14 May 2018

 

First-ever WHO list of essential diagnostic tests to improve diagnosis and treatment outcomes

Milestones :: Perspectives

First-ever WHO list of essential diagnostic tests to improve diagnosis and treatment outcomes
15 May 2018
WHO today published its first Essential Diagnostics List, a catalogue of the tests needed to diagnose the most common conditions as well as a number of global priority diseases.
“An accurate diagnosis is the first step to getting effective treatment,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “No one should suffer or die because of a lack of diagnostic services, or because the right tests were not available.”

The list concentrates on in vitro tests – i.e. tests of human specimens like blood and urine. It contains 113 products: 58 tests are listed for detection and diagnosis of a wide range of common conditions, providing an essential package that can form the basis for screening and management of patients.  The remaining 55 tests are designed for the detection, diagnosis and monitoring of “priority” diseases such as HIV, tuberculosis, malaria, hepatitis B and C, human papillomavirus and syphilis.

Some of the tests are particularly suitable for primary health care facilities, where laboratory services are often poorly resourced and sometimes non-existent; for example, tests that can rapidly diagnose a child for acute malaria or glucometers to test diabetes.  These tests do not require electricity or trained personnel.  Other tests are more sophisticated and therefore intended for larger medical facilities.

“Our aim is to provide a tool that can be useful to all countries, to test and treat better, but also to use health funds more efficiently by concentrating on the truly essential tests,” says Mariângela Simão, WHO Assistant Director-General for Access to Medicines, Vaccines and Pharmaceuticals. “Our other goal is to signal to countries and developers that the tests in the list must be of good quality, safe and affordable.”

For each category of test, the Essential Diagnostics List specifies the type of test and intended use, format, and if appropriate for primary health care or for health facilities with laboratories. The list also provides links to WHO Guidelines or publications and, when available, to prequalified products.

Similar to the WHO Essential Medicines List, which has been in use for four decades, the Essential Diagnostics List is intended to serve as a reference for countries to update or develop their own list of essential diagnostics. In order to truly benefit patients, national governments will need to ensure appropriate and quality-assured supplies, training of health care workers and safe use. To that end, WHO will provide support to countries as they adapt the list to the local context…

First edition of the WHO Model List of Essential In Vitro Diagnostics (EDL)
  

Emergencies

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 15 May 2018 [GPEI]
Summary of newly-reported viruses this week:
Afghanistan: One new wild poliovirus type 1 (WPV1)  positive environmental sample has been reported, in Kandahar province.
Pakistan: One new WPV1  positive environmental sample has been reported, in Sindh.

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WHO Grade 3 Emergencies  [to 19 May 2018]

:: Reaching out with mental health services for displaced Syrians  16-05-2018

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WHO Grade 2 Emergencies  [to 19 May 2018]
[Several emergency pages were not available at inquiry]

UNICEF: Over 16K babies born in Rohingya camps in Bangladesh
Khmer Times (Cambodia)/Reuters (5/18/2018),
More than 16,000 babies have been born in Rohingya refugee camps in Bangladesh in the past nine months, and only 3,000 of them were delivered in medical facilities, according to UNICEF. “Around 60 babies a day are taking their first breath in appalling conditions, away from home, to mothers who have survived displacement, violence, trauma and, at times, rape,” says UNICEF representative Edouard Beigbeder.

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Yemen 
:: Yemen Humanitarian Update Covering 8 – 14 May 2018 | Issue 15

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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Somalia
:: OCHA Somalia Flash Update #5 – Humanitarian impact of heavy rains | 15 May 2018 [EN/SO]

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

EBOLA/EVD  [to 19 May 2018]
http://www.who.int/ebola/en/
[See Milestones above for detail]

 

WHO & Regional Offices [to 19 May 2018]

WHO & Regional Offices [to 19 May 2018]

See Milestones above for coverage of Ebola and Yemen.
 
Weekly Epidemiological Record, 18 May 2018, vol. 93, 20 (pp. 249–304)
Editorial
Dr Peter Salama
Deputy Director-General
Emergency Preparedness and Response

The WHO Health Emergencies (WHE) programme was established in 2016 to strengthen WHO capacity to prevent, detect and respond to emergencies. Over the last two years the WHE has markedly strengthened systems and processes to detect and manage hazards. This includes through more systematic assessment of notifications and alerts and through development and implementation of the Emergency Response Frame­work. Each month the programme assesses 7000 signals of potential public health concern. Around 30 of these require field investigation.

During the last year the WHE has supported operations to control and manage Ebola in Democratic Republic of Congo, Marburg in Uganda, pneumonic plague in Madagascar, cholera, diphtheria and the collapse of the health system in Yemen, chemical events in Syria, war related injuries in Iraq, the Rohingya refugee crisis in Bangladesh to name but a few.

This special edition of the Weekly Epidemiology Record provides a flavour of some of the work that WHE is doing with partners to strengthen global capacity to prepare, prevent, detect, respond to and recover from public health emergencies with the goal of creating a safer world.

The first set of articles focuses on WHE’s work to strengthen surveillance and risk assessment including through the use of technology. Teams in AFRO, SEARO and PAHO document the tools they are using to assess and understand their hazards. WHO describe the use of Spatial analysis to map out geographical zones for the most common haemorrhagic fevers, chikungunya, yellow fever, Zika virus, plague, anthrax, meningitis, cholera and malaria. SEARO outlines how they have used multiple tools to understand their capacity gaps and vulnerabilities in order to guide investments in risk reduction and preparedness. In the Americas they are adapting tools for surveillance and operational readi­ness to take into account changes in social behaviours from urbanisation, travel and trade. And finally the article on the Epidemic Intelligence from Open Sources (EIOS) shows how a multi-agency collaboration is using open source data to support early detection, verification and assessment of public health risks allowing better identification of events that warrant more detailed risk analysis.

The second set of articles presents some examples of the WHE work in strengthening country preparedness. The article on Early Warning, Alert and Response outlines work that is ongoing to develop a robust tool that can be applied in both routine and emergency contexts with the aim of making EWAR processes smoother and more efficient. The piece on Asia Pacific Strategy for Emerging Diseases and Public Health Emer­gencies (APSED) shares lessons learnt in rolling out a common framework for building core capacity across two WHO regions for application beyond Asia and the Pacific in order to strengthen global health security.

The third set of articles focuses on mechanisms and initiatives to support smoother and more rapid responses to emergencies starting with a piece on our newly adapted Incident Management System which is helping ensure a more predictable and effective response in many settings. The piece on vaccine stockpiles outlines the importance behind these stockpiles and the importance of transparent and clear governance in ensuring equi­table access to vaccines ensuring maximum public health impact, in particular where managing multiple requests for the same vaccine are being made.

And finally the pieces on Ukraine and on DARES in Yemen help us look to the future, providing two exam­ples of WHEs work with governments and partners can use emergency operations to deliver public health outcomes and to catalyse and stimulate broader health system reform and system strengthening.

These pieces provide an opportunity to reflect on how far we have come in building a stronger WHO emergen­cies programme. But our work is not done. This next year will see our work continue as we support govern­ments to ensure compliance with the International Health Regulations, and as we work across WHO and with development and humanitarian partners to coor­dinate our support in fragile and conflict settings to prevent health system collapse whilst continuing to access and provide critical services to populations in need.
I thank you for your support and we look forward to serving you further.

:: Mapping the distribution and risk of epidemics in the WHO African Region
:: A health emergency risk profile of the South-East Asia Region
:: Importance of surveillance for preparedness and country readiness in a hazard-prone region
:: The Epidemic Intelligence from Open Sources initiative: a collaboration to harmonize and standardize early detection and epidemic intelligence among public health organizations
:: Early Warning, Alert and Response (EWAR): a key area for countries in preparedness and response to health emergencies
:: Confronting health security threats: The Asia–Pacific Strategy for Emerging Diseases and Public Health Emergencies to advance core capacity for the International Health Regulations (2005)
:: Adapting the Incident Management System for response to health emergencies – early experience of WHO
:: Access to life-saving vaccines during outbreaks: a spotlight on governance
:: Crisis in Ukraine as an opportunity for rebuilding a more responsive primary health care system
:: Who DARES wins. Delivering accelerated results effectively and sustainably
:: Implementation of the International Health Regulation (2005) in Oman: progress, lessons learnt and way forward
:: Accelerating implementation of the International Health Regulations (2005): the interface between health systems and health security

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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: Statement on the 1st meeting of the IHR Emergency Committee regarding the Ebola outbreak in 2018  19 May 2018
:: WHO concerned as one Ebola case confirmed in urban area of Democratic Republic of the Congo  17 May 2018
:: WHO supports stabilization centres to treat malnourished children in South Sudan 17 May 2018
 
WHO European Region EURO
:: European Immunization Week helps highlight and boost the positive impact of vaccines 17-05-2018
:: The WHO Barcelona Course on Health Financing for Universal Health Coverage now open for application 16-05-2018
:: Reaching out with mental health services for displaced Syrians 16-05-2018
:: Belarus pilot project shows the way to people-centred TB services 16-05-2018

WHO Eastern Mediterranean Region EMRO
:: Last nationwide vaccination campaign in Afghanistan starts before the high transmission season for poliovirus  6 May 2018

WHO Western Pacific Region
:: Doing it for themselves: Peer-led HIV testing in Viet Nam improves access to care
7 May 2018

 

CDC/ACIP [to 19 May 2018]

CDC/ACIP [to 19 May 2018]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html

Wednesday, May 16, 2018
New Rapid Rabies Test Could Revolutionize Testing and Treatment
A new rabies test developed at the Centers for Disease Control and Prevention (CDC) could mean people exposed to potentially rabid animals could forego the weeks-long regimen of shots to prevent the deadly disease.
The new test, designed for use in animals, can more easily and precisely diagnose rabies infection, according to a study published today in PLOS One. The new LN34 test is simpler and easier to use than current tests. During the pilot study, it produced no false negatives, fewer false positive, and fewer inconclusive results. It could allow doctors and patients to make better informed decisions about who needs treatment for rabies, which is nearly always fatal once symptoms start.
The LN34 test can also be run on testing platforms already widely used in the U.S. and worldwide, without any extra training. And it yields results even from decomposing animal brain tissue. The current gold-standard for rabies testing in animals is the direct fluorescent antibody (DFA) test, which can only be interpreted by laboratory workers with special skills, extensive training, and a specific type of microscope…

MMWR News Synopsis for May 17, 2018
Community-Based Services to Improve Testing and Linkage to Care Among Non-U.S.-Born Persons with Chronic Hepatitis B Virus Infection – Three U.S. Programs, October 2014-September 2017
   Strategic partnerships with public health departments, medical clinics, and community organizations are successful in developing hepatitis B programs that offer community-based testing services and linkage to care in hard to reach, non-U.S.-born populations.
In the United States, 70 percent of people living with chronic hepatitis B virus (HBV) infection are non-U.S. born. To mitigate morbidity and mortality associated with HBV among this heavily impacted population, CDC funded a cooperative agreement to develop hepatitis B testing and linkage to care programs serving non-U.S.-born people from October 2014 to September 2017. This report summarizes the efforts of these programs and their partnerships with primary care centers, community-based services, and public health departments. Among the findings: 7.5 percent of program participants tested positive for HBV; 85 percent of those who tested positive attended at least one medical visit; and 78 percent received recommended care.

Trends in Antiretroviral Therapy Eligibility and Coverage Among HIV-Infected Children Aged <15 Years – 20 PEPFAR-Supported Sub-Saharan African Countries, 2012-2016
   A CDC analysis of 20 African countries shows that more children living with HIV were on treatment in 2016 than in 2012, but 56 percent remain without treatment. More work is needed to control the HIV epidemic among children by diagnosing those living with HIV, and starting and maintaining them on treatment.
A CDC analysis of 20 African countries, supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), shows more children living with HIV are on antiretroviral therapy (ART), which can help them live longer, healthier lives. The study revealed the percentage of HIV-positive children on ART in these countries increased from 24 percent in 2012 to 44 percent in 2016. However, 56 percent of children living with HIV were not receiving treatment in 2016. The study also showed that 13 of the 20 countries adopted the 2016 World Health Organization guidelines, which expanded treatment eligibility to all children by 2016. The research suggests that more work is needed to control the HIV epidemic by increasing diagnosis of HIV-positive children, as well as starting and maintaining them on treatment.

Cholera Epidemic – Lusaka, Zambia, 2017-2018
Cholera will remain a global health risk until underlying and widespread water, sanitation and hygiene gaps are addressed. Under a new strategy called “Ending Cholera,” the Global Task Force for Cholera Control, chaired by WHO, recently proposed investments in water, sanitation, and hygiene; emergency preparedness; and cholera vaccination in cholera hotspots to reduce cholera deaths by 90 percent and eliminate local cholera transmission in 20 countries by 2030.
A recent cholera outbreak in Lusaka, Zambia demonstrates the need for rapid and robust responses during initial stages of outbreaks, enhanced surveillance, and access to chlorinated drinking water. The outbreak began in October 2017 and resulted in almost 5,000 cases and 93 deaths in the capital city of Lusaka. Of the local water sources tested, 73 percent had insufficient chlorine levels and one third had fecal contamination. During January–February 2018, the Zambian government and partners collaborated to improve water supplies, provide education, and administer oral cholera vaccine. However, heavy flooding and widespread water shortages led to a resurgence of cholera in March. Cholera remains a significant global public health problem with about 3 million cases each year and over a billion people at risk for infection, primarily due to contaminated drinking water.

Register for upcoming June ACIP meeting
June 20-21, 2018
Deadline for registration:
Non-US Citizens: May 16, 2018
US Citizens: June 11, 2018
Registration is NOT required to watch the live meeting webcast or to listen via telephone.

ECDC – European Centre for Disease Prevention and Control  [to 19 May 2018]

ECDC – European Centre for Disease Prevention and Control  [to 19 May 2018]

https://ecdc.europa.eu/en/home
Data
Vaccination coverage for the first dose of rubella-containing vaccine by country, 2016, EU/EEA countries
map – 18 May 2018
 
Data
Distribution of rubella cases by country, February 2018 in EU/EEA countries
map – 18 May 2018
 
Publication
Communicable disease threats report, 13-19 May 2018, Week 20
publication – 18 May 2018
 
Data
Distribution of measles deaths by country, April 2017–March 2018, EU/EEA countries
map – 18 May 2018

Announcements

Announcements

European Medicines Agency  [to 19 May 2018]
http://www.ema.europa.eu/ema/
18/05/2018
Meeting highlights from the Pharmacovigilance Risk Assessment Committee (PRAC) 14-17 May 2018
PRAC concludes two referrals, maintains recommendation on HES solutions for infusion and issues precautionary advice on HIV medicine

 
European Vaccine Initiative  [to 19 May 2018]
http://www.euvaccine.eu/news-events
16 May 2018
European-African partnership to advance the development of a Leishmania vaccine
Phase II clinical trials in Sudan of a therapeutic vaccine to prevent post kala azar dermal leishmaniasis to be supported by European & Developing Countries Clinical Trials Partnership
 
 
Gavi [to 19 May 2018]
http://www.gavi.org/library/news/press-releases/
19 May 2018
Gavi welcomes call for coordinated global action against cervical cancer
Alliance pledges to continue support for vaccines
– Gavi, the Vaccine Alliance today welcomed the call for coordinated global action against cervical cancer made by the World Health Organization Director-General, Dr Tedros Adhanom Ghebreyesus. Sustainable disease control through significant investments and holistic health system approaches are the first steps on the path to elimination of cervical cancer. Gavi pledged to continue its work to help countries access and introduce vaccines against human papillomavirus (HPV), the primary cause of cervical cancer…

Global Fund [to 19 May 2018]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
News
France to Host Global Fund Replenishment Conference
16 May 2018
… The conference aims to raise new funds and mobilize partners toward ending AIDS, TB and malaria by 2030 in alignment with the Sustainable Development Goals. Held once every three years, the conference convenes leaders from governments, civil society, the private sector and communities affected by the three most devastating infectious diseases.
“As one of the founding partners of the Global Fund, France is demonstrating great leadership and sustained commitment in global health,” said Peter Sands, Executive Director of the Global Fund. “We are extremely grateful to President Macron for leading efforts to renew and expand our impact, to the benefit of millions of people.”
France is Global Fund’s second-largest donor, committing more than €4.2 billion to the Global Fund since 2002…
 
 
IAVI  [to 19 May 2018]
https://www.iavi.org/
May 18, 2018
IAVI Announces Renewed Support from the Danish Government
The International AIDS Vaccine Initiative (IAVI) is pleased to announce renewed funding from the Danish Government, a longtime partner in the mission to develop a safe, effective, and accessible HIV vaccine. IAVI will receive a total of DKK 20 million (USD $3.18 million) from 2018-2021, administered by the Danish Ministry of Foreign Affairs (Danida).
“IAVI is grateful to the Danish government for its renewed investment in the development of an HIV vaccine, and for its continuing attention to the needs of communities disproportionally affected by the disease,” said Dr. Mark Feinberg, MD, PhD, IAVI President and CEO. “We applaud the Ministry’s sustained commitment to combatting HIV/AIDS, and we are proud to count the people of Denmark among our partners toward expediting the development of an effective HIV vaccine, and ultimately, achieving the goal of a world without AIDS.”…
 
 
MSF/Médecins Sans Frontières  [to 19 May 2018]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
Syria: Children with Chronic Conditions Continue to Suffer from Consequences of War
May 18, 2018
The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) has begun providing treatment for children in northeast Syria suffering from thalassemia, a life-threatening, chronic blood disorder requiring regular blood transfusions and chelation treatment, for which there is limited care across the country.

Press release
“Unacceptable and inhuman” violence by Israeli army against Palestinian protesters in Gaza
MAY 14, 2018—As teams from Doctors Without Borders/Médecins Sans Frontières (MSF) treat people wounded today in Gaza, Marie-Elisabeth Ingres, MSF representative in the Occupied Palestinian Territories, provided the following statement:

 
NIH  [to 19 May 2018]
http://www.nih.gov/news-events/news-releases
May 18, 2018
Experimental MERS treatments enter clinical trial
NIH-sponsored trial to test two human monoclonal antibodies.
Enrollment has begun in an early-stage clinical trial testing the safety of two human monoclonal antibodies (mAbs) designed to treat people infected with Middle East respiratory syndrome coronavirus (MERS-CoV). The trial is sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and is funded in part by the Biomedical Advanced Research and Development Authority, part of the Office of the Assistant Secretary for Preparedness and Response, Department Health and Human Services.

May 18, 2018
NIH statement on HIV Vaccine Awareness Day – May 18, 2018
HIV remains a burden to individuals and communities in the United States and abroad.
NIAID-supported scientists in clinics and laboratories around the world are following two complementary paths to expedite the development of an HIV vaccine. The empirical approach relies on building upon prior partial success with additional observation and experimentation to advance vaccine candidates into human clinical trials. Scientists also are pursuing a second, theoretical approach that designs vaccine candidates based on the reasonable assumption that a certain type of immune response would protect against HIV infection.

The empirical approach was reinvigorated in 2009 when results from the large RV144 clinical trial in Thailand showed for the first time that an investigational vaccine regimen could confer a degree of protection, albeit modest, against HIV. Today, NIH and our global partners are continuing to build upon the findings from RV144 and other HIV vaccine studies.

Two large HIV vaccine efficacy clinical trials are now ongoing in southern Africa. HVTN 702 launched in late 2016 and is designed to determine whether an experimental vaccine regimen based on the one used in RV144 can safely prevent HIV infection among adults in South Africa. The study team is enrolling 5,400 HIV-negative, sexually active men and women aged 18 to 35 years at 15 sites, and results are expected in late 2020.

In late 2017, NIAID and partners launched HVTN 705/HPX2008, also known as Imbokodo, a large proof-of-concept clinical trial in southern Africa to assess whether an experimental vaccine regimen is safe and able to prevent HIV infection. This regimen includes a “mosaic” vaccine designed to induce immune responses against a wide variety of global HIV strains. The investigators aim to enroll 2,600 HIV-negative women, and results are expected in 2021.

The theoretical approach to developing an HIV vaccine involves studying the immune response to HIV infection and finding ways to generate and enhance that response through vaccination. Some of these strategies aim to prevent HIV infection by developing broadly neutralizing antibodies, better understanding the structure of the virus, and generating a protective cellular response.

Researchers are studying the passive transfer of broadly neutralizing antibodies that could provide people with long-acting protection against HIV infection. This concept is being tested in two large clinical trials in the Americas and Africa to determine whether giving people an intravenous infusion of the antibody VRC01 every eight weeks is safe, tolerable, and effective at preventing HIV infection.

Other powerful antibodies also may provide protection against HIV. In September 2017, NIAID scientists and partners from the Paris-based pharmaceutical company Sanofi reported that a three-pronged antibody made in the laboratory protected monkeys from infection better than did the individual antibodies from which the engineered antibody is derived. This new antibody binds to three different sites on the virus, in contrast to natural, single-site antibodies, which could make it more difficult for HIV to escape. Plans are underway to conduct early phase clinical trials of this “trispecific” antibody in the expectation that it could eventually be used for long-acting HIV prevention and treatment.

These advances and ongoing investigations provide cautious optimism that the development of an HIV vaccine is making headway. With each new finding, and with gratitude to those who volunteer for HIV vaccine clinical trials, we move further along the pathway toward a vaccine. On this HIV Vaccine Awareness Day, we are encouraged by the progress that has been made, and pledge to continue our pursuit of the goal of developing a safe and effective HIV vaccine that could help end the HIV pandemic…
 
UNAIDS [to 19 May 2018]
http://www.unaids.org/en
Feature story
Ending double jeopardy for women with HIV
18 May 2018
…To address the disproportionate risk of cervical cancer among women living with HIV and the need for increased rates of screening and treatment in sub-Saharan Africa, PEPFAR the George W. Bush Institute and UNAIDS recently announced a new partnership—the Partnership to End AIDS and Cervical Cancer—designed to effectively eliminate cervical cancer deaths among women living with HIV in sub-Saharan Africa within a generation. The partnership will build on successful efforts over the past seven years of the Pink Ribbon Red Ribbon initiative and, pending Congressional approval, will be supported by an initial investment of US$ 30 million from PEPFAR.
“When we confront suffering—when we save lives—we breath hope into devastated populations, strengthen and stabilize society, and make our country and the world safer,” said President George W. Bush. “This week, we are announcing the next phase of our partnership with the United States President’s Emergency Plan for AIDS Relief and UNAIDS: a plan to effectively eliminate cervical cancer amongst HIV-positive women within a generation.”

Feature story
Women living with HIV in Rajasthan push for social protection and economic opportunities
17 May 2018
Women living with HIV in Rajasthan, India, have come together to lobby the State Government of Rajasthan for improved provision of social protection services. The Global Alliance for Human Rights and the Rajasthan Network of People Living with HIV organized an advocacy session in Jaipur on 15 May with more than 100 women living with HIV during which they presented their needs, including dairy booths for income generation and schooling for adolescents living with HIV…

UNICEF  [to 19 May 2018]
https://www.unicef.org/media/
Selected Press Releases/Reports
UNICEF calls for the urgent protection of children in the Central African Republic
BANGUI, Central African Republic, 12 May 2018 – A dramatic increase in violence in the Central African Republic in the first part of 2018 has forced at least 55,000 people, including 28,600 children to flee because of brutality and violence in their communities.

Wellcome Trust  [to 19 May 2018]
https://wellcome.ac.uk/news
Explainer / Published: 17 May 2018
Sharing Clinical Trial Data: what it means for you
Wellcome has joined ClinicalStudyDataRequest.com (opens in a new tab) (CSDR), a data-sharing initiative involving academic research funders and pharmaceutical companies. Jen O’Callaghan, from our Open Research team, explains why and what it means for researchers.
As a global research foundation, we’re dedicated to ensuring that the outputs of the research we fund – including clinical trial data – can be accessed and used in ways that will advance medical science by building on previous findings and exploring new questions.

CSDR (opens in a new tab) is a website portal for listing and sharing clinical trial datasets. Originally established to provide a way for researchers to access trial data from a consortium of 15 pharmaceutical companies, CSDR has expanded to include data from academic-led trials.
Data continues to be held by the study team and is only shared with data requestors following a successful data access request.

Update to Wellcome’s policy on clinical trials
Today, we’ve launched an updated policy on clinical trials.
The policy now:
:: makes it clearer what you need to do before, during and after you complete a trial funded by Wellcome
:: brings our requirements into line with the WHO joint statement on public disclosure of results from clinical trials (opens in a new tab), which Wellcome signed up to in May 2017
:: requires you to post summary results in the same registry as the one in which the trial was registered
:: requires you to publish a trial protocol and statistical analysis plan before you start a trial.
Through the policy, we strongly encourage Wellcome-funded researchers to use CSDR for sharing trial data.
If you’re already funded by Wellcome, you’re encouraged to adopt our new policy, but it’s not a requirement. You must abide by the policy in place at the time you received your funding. The same grant terms and conditions will still apply…

::::::
 
BIO    [to 19 May 2018]
https://www.bio.org/insights/press-release
access to the medicines they need …”

DCVMN – Developing Country Vaccine Manufacturers Network  [to 19 May 2018]
http://www.dcvmn.org/
access to the medicines they need …”
 
PhRMA    [to 19 May 2018]
http://www.phrma.org/press-room
access to the medicines they need …”

Journal Watch

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

Accounting for equity considerations in cost-effectiveness analysis: a systematic review of rotavirus vaccine in low- and middle-income countries

BMC Cost Effectiveness and Resource Allocation
http://resource-allocation.biomedcentral.com/
(Accessed 19 May 2018)

Review
18 May 2018
Accounting for equity considerations in cost-effectiveness analysis: a systematic review of rotavirus vaccine in low- and middle-income countries
Authors: Marie-Anne Boujaoude, Andrew J. Mirelman, Kim Dalziel and Natalie Carvalho
Abstract
Background
Cost-effectiveness analysis (CEA) is frequently used as an input for guiding priority setting in health. However, CEA seldom incorporates information about trade-offs between total health gains and equity impacts of interventions. This study investigates to what extent equity considerations have been taken into account in CEA in low- and middle-income countries (LMICs), using rotavirus vaccination as a case study.
Methods
Specific equity-related indicators for vaccination were first mapped to the Guidance on Priority Setting in Health Care (GPS-Health) checklist criteria. Economic evaluations of rotavirus vaccine in LMICs identified via a systematic review of the literature were assessed to explore the extent to which equity was considered in the research objectives and analysis, and whether it was reflected in the evaluation results.
Results
The mapping process resulted in 18 unique indicators. Under the ‘disease and intervention’ criteria, severity of illness was incorporated in 75% of the articles, age distribution of the disease in 70%, and presence of comorbidities in 5%. For the ‘social groups’ criteria, relative coverage reflecting wealth-based coverage inequality was taken into account in 30% of the articles, geographic location in 27%, household income level in 8%, and sex at birth in 5%. For the criteria of ‘protection against the financial and social effects of ill health’, age weighting was incorporated in 43% of the articles, societal perspective in 58%, caregiver’s loss of productivity in 45%, and financial risk protection in 5%. Overall, some articles incorporated the indicators in their model inputs (20%) while the majority (80%) presented results (costs, health outcomes, or incremental cost-effectiveness ratios) differentiated according to the indicators. Critically, less than a fifth (17%) of articles incorporating indicators did so due to an explicit study objective related to capturing equity considerations. Most indicators were increasingly incorporated over time, with a notable exception of age-weighting of DALYs.
Conclusion
Integrating equity criteria in CEA can help policy-makers better understand the distributional impact of health interventions. This study illustrates how equity considerations are currently being incorporated within CEA of rotavirus vaccination and highlights the components of equity that have been used in studies in LMICs. Areas for further improvement are identified.

Demand-side determinants of timely vaccination of oral polio vaccine in social mobilization network areas of CORE Group polio project in Uttar Pradesh, India

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 19 May 2018)

Research article
Demand-side determinants of timely vaccination of oral polio vaccine in social mobilization network areas of CORE Group polio project in Uttar Pradesh, India
Children who receive all doses of scheduled vaccines reduce their susceptibility to vaccine-preventable diseases. In India, full immunization coverage has increased significantly. However, only a small proport…
Authors: Manojkumar Choudhary, Roma Solomon, Jitendra Awale and Rina Dey
Citation: BMC Infectious Diseases 2018 18:222
Published on: 16 May 2018

Mother-to-child transmission of HIV infection and its associated factors in Ethiopia: a systematic review and meta-analysis

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 19 May 2018)

Research article
Mother-to-child transmission of HIV infection and its associated factors in Ethiopia: a systematic review and meta-analysis
Mother-to-child transmission (MTCT) is the main mode of HIV transmission in children under 15 years old. This problem is significant in the Sub-Saharan African countries, where more than 80% of children living…
Authors: Getachew Mullu Kassa
Citation: BMC Infectious Diseases 2018 18:216
Published on: 10 May 2018

Using digital health to enable ethical health research in conflict and other humanitarian settings

Conflict and Health
http://www.conflictandhealth.com/
[Accessed 19 May 2018]

Review
14 May 2018
Using digital health to enable ethical health research in conflict and other humanitarian settings
Authors: Eric D. Perakslis
Abstract
Conducting research in a humanitarian setting requires quantifiable quality measures to ensure ethical study conduct. Digital health technologies are proven to improve research study quality and efficacy via automated data collection, improvement of data reliability, fidelity and resilience and by improved data provenance and traceability. Additionally, digital health methodologies can improve patient identity, patient privacy, study transparency, data sharing, competent informed consent, and the confidentiality and security of humanitarian operations. It can seem counterintuitive to press forward aggressively with digital technologies at a time of heightened population vulnerability and cyber security concerns, but new approaches are essential to meet the rapidly increasing demands of humanitarian research. In this paper we present the case for the digital modernization of humanitarian research in conflict and other humanitarian settings as a vehicle for improved research quality and ethics.

Network of Ethical Relationships model for global North–South population health research

Global Public Health
Volume 13, 2017   Issue 7
http://www.tandfonline.com/toc/rgph20/current

Article
Network of Ethical Relationships model for global North–South population health research
Karen Morrison, Sandra Tomsons, Angela Gomez & Martin Forde
Pages: 819-842
Published online: 12 Jan 2017
ABSTRACT
Although a substantial body of literature exists that details how to address ethical issues and provide oversight for traditional research study designs, there currently is very little guidance available to researchers on how to deal with the unique and novel challenges that arise when conducting research that goes outside of these well-defined boundaries. One such example is North–South (N-S) team-based global population health (GPH) research. This paper presents a Network of Ethical Relationships (NER) model which can allow GPH researchers better understand and resolve ethical issues that arise in N-S collaborative research efforts. The NER model elucidates some of the core relationships involved in GPH research and sheds light on the complex milieu of moral, institutional, societal and legal processes in which it is embedded. The utility of the NER model is examined by reviewing 14 GPH research teams, looking at two relationships in more detail – Researcher–Ethics Board, and Researcher–Funder relationships. The paper argues that improved dialogue and flexibility in the application of formal ethical rules and procedures can lead to research being conducted in a more ethical manner since it better accounts for the multitude of voices and perspectives influencing researchers’ choices and actions.

Humanitarian response in urban areas

Humanitarian Exchange Magazine
Number 71  March 2018
https://odihpn.org/magazine/humanitarian-response-urban-areas/

Humanitarian response in urban areas
Humanitarian crises are increasingly affecting urban areas either directly, through civil conflict, hazards such as flooding or earthquakes, urban violence or outbreaks of disease, or indirectly, through hosting people fleeing these threats. The humanitarian sector has been slow to understand how the challenges and opportunities of working in urban spaces necessitate changes in how they operate. For agencies used to working in rural contexts, the dynamism of the city, with its reliance on markets, complex systems and intricate logistics, can be a daunting challenge. Huge, diverse and mobile populations complicate needs assessments, and close coordination with other, often unfamiliar, actors is necessary.

[Reviewed earlier]

Precision Medicine, Genome Sequencing, and Improved Population Health

JAMA
May 15, 2018, Vol 319, No. 19, Pages 1953-2054
http://jama.jamanetwork.com/issue.aspx

Viewpoint
Precision Medicine, Genome Sequencing, and Improved Population Health
Gregory Feero, MD, PhD; Catherine A. Wicklund, MS, CGC; David Veenstra, PharmD, PhD
JAMA. 2018;319(19):1979-1980. doi:10.1001/jama.2018.2925
This Viewpoint summarizes a 2017 NASEM Roundtable on Genomics and Precision Health that shared experiences of US health systems with use of genome sequencing for clinical and research applications and that explored how the sequencing programs might advance models for data sharing and collaborative implementation research; generate evidence regarding the benefits, harms, and value of precision medicine; and reduce disparities through partnerships with diverse populations.

In the Era of Precision Medicine and Big Data, Who Is Normal?

JAMA
May 15, 2018, Vol 319, No. 19, Pages 1953-2054
http://jama.jamanetwork.com/issue.aspx

In the Era of Precision Medicine and Big Data, Who Is Normal?
Arjun K. Manrai, PhD; Chirag J. Patel, PhD; John P. A. Ioannidis, MD, DSc
JAMA. 2018;319(19):1981-1982. doi:10.1001/jama.2018.2009
In this Viewpoint, John Ioannidis and colleagues discuss the challenges and potential benefits of defining what is “healthy” in an era of precision medicine, when defining normal will require that each person be assigned to an increasingly narrow and granular reference population.

Mumps: A Pain in the Neck

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 7, Issue 2  June 2018
https://academic.oup.com/jpids/issue

On Vaccination
Mumps: A Pain in the Neck
Stanley A Plotkin
Journal of the Pediatric Infectious Diseases Society, Volume 7, Issue 2, 15 May 2018, Pages 91–92, https://doi.org/10.1093/jpids/piy038
Extract
Of the 3 components of the measles-mumps-rubella (MMR) vaccine, the measles and rubella components are fulfilling their tasks of providing long-lasting immunity; however, the mumps component has not been as successful. Frequent outbreaks of mumps have been occurring in previously vaccinated young adults, particularly when they live in groups such as in universities or military barracks [1–6]. In my opinion, the causes of the problem are clear—poor B-cell memory after vaccination and a change in the genotype of the circulating mumps strains that makes them less affected by antibodies to the vaccine strain. Decreased boosts from exposure to wild-type…

Investing in non-communicable disease prevention and management to advance the Sustainable Development Goals

The Lancet
May 19, 2018 Volume 391 Number 10134 p1965-2078
http://www.thelancet.com/journals/lancet/issue/current

Series
The Lancet Taskforce on NCDs and economics
Investing in non-communicable disease prevention and management to advance the Sustainable Development Goals
Rachel Nugent, Melanie Y Bertram, Stephen Jan, Louis W Niessen, Franco Sassi, Dean T Jamison, Eduardo González Pier, Robert Beaglehole

Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the Sustainable Development agenda

The Lancet
May 19, 2018 Volume 391 Number 10134 p1965-2078
http://www.thelancet.com/journals/lancet/issue/current

The Lancet Taskforce on NCDs and economics
Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the Sustainable Development agenda
Louis W Niessen, Diwakar Mohan, Jonathan K Akuoku, Andrew J Mirelman, Sayem Ahmed, Tracey P Koehlmoos, Antonio Trujillo, Jahangir Khan, David H Peters

Action to address the household economic burden of non-communicable diseases

The Lancet
May 19, 2018 Volume 391 Number 10134 p1965-2078
http://www.thelancet.com/journals/lancet/issue/current

The Lancet Taskforce on NCDs and economics
Action to address the household economic burden of non-communicable diseases
Stephen Jan, Tracey-Lea Laba, Beverley M Essue, Adrian Gheorghe, Janani Muhunthan, Michael Engelgau, Ajay Mahal, Ulla Griffiths, Diane McIntyre, Qingyue Meng, Rachel Nugent, Rifat Atun

Equity impacts of price policies to promote healthy behaviours

The Lancet
May 19, 2018 Volume 391 Number 10134 p1965-2078
http://www.thelancet.com/journals/lancet/issue/current

The Lancet Taskforce on NCDs and economics
Equity impacts of price policies to promote healthy behaviours
Franco Sassi, Annalisa Belloni, Andrew J Mirelman, Marc Suhrcke, Alastair Thomas, Nisreen Salti, Sukumar Vellakkal, Chonlathan Visaruthvong, Barry M Popkin, Rachel Nugent
2059

Investing in non-communicable diseases: an estimation of the return on investment for prevention and treatment services

The Lancet
May 19, 2018 Volume 391 Number 10134 p1965-2078
http://www.thelancet.com/journals/lancet/issue/current

The Lancet Taskforce on NCDs and economics
Investing in non-communicable diseases: an estimation of the return on investment for prevention and treatment services
Melanie Y Bertram, Kim Sweeny, Jeremy A Lauer, Daniel Chisholm, Peter Sheehan, Bruce Rasmussen, Senendra Raj Upreti, Lonim Prasai Dixit, Kenneth George, Samuel Deane

Ethics of randomized trials in a public health emergency

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 19 May 2018)

Viewpoints
Ethics of randomized trials in a public health emergency
Alex John London, Olayemi O. Omotade, Michelle M. Mello, Gerald T. Keusch
| published 17 May 2018 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0006313
The 2014–2015 outbreak of Ebola in West Africa claimed over 11,000 lives and laid bare the challenges of responding to a large-scale, swiftly evolving public health emergency. Prominent among these difficulties was disagreement about the ethics of conducting clinical research during epidemics and whether clinical trials of vaccines and therapeutics should employ randomization and concurrent controls. To facilitate rapid, well-coordinated responses to future public health emergencies, the United States National Academies of Sciences, Engineering, and Medicine established a committee to assess the clinical trials conducted in Guinea, Sierra Leone, and Liberia during the outbreak. The key findings and conclusions regarding ethical issues raised about conducting research during public health crises are briefly described here and are fully evaluated in the Committee’s report [1].

First, the Committee concluded that “research is an essential component in epidemic response, as it is the only way to learn how to improve care for current and future patients and to potentially prevent an epidemic from occurring again” [1]. For diseases like Ebola, outbreaks provide the only setting in which clinical trials can be conducted to determine efficacy and safety of investigational products for treating or preventing infection, because results from animal models cannot be reliably extrapolated to humans, [2] and human challenge studies are not possible. Although some clinicians perceived conflict between their clinical obligations and the mission of research, conducting clinical trials during outbreaks is indispensable to determining which interventions actually advance the humanitarian mission of minimizing mortality and morbidity.

Second, to learn how to improve care, research must be designed to generate evidence that can support reliable inferences about safety and efficacy. The Committee concluded that “randomized controlled trials (RCTs) are the most reliable way to identify the relative benefits and risks of investigational products, and, except [in] rare circumstances… every effort should be made to implement them during epidemics” [1].

Third, the committee rejected the claim made by some stakeholders that due to Ebola’s high mortality rate, equipoise would not exist for studies of therapeutic interventions that included the possibility of randomization to a standard-of-care control arm [3]. In part, such claims reflect the mistaken idea that equipoise refers to a state of uncertainty in the mind of the individual researcher, in which each intervention is equally likely to be superior to the others. Thirty years ago, Freedman rejected this view because it would prohibit studies in situations in which researchers have a hunch that one intervention is superior to the others but in which the information on which that hunch is based is not sufficient to persuade other reasonable experts [4]. Similarly, it would prohibit research in cases where fully informed experts have conflicting judgments about which intervention is likely to prove superior for a particular indication [5]. The appropriate standard, known as clinical equipoise, holds that randomization is permissible when a state of conflict or uncertainty exists in the expert medical community about the relative clinical merits of a set of health interventions. Even if some expert clinicians have a preference for investigational interventions over the standard of care, clinical equipoise persists as long as other fully informed and expert clinicians would continue to treat patients with the standard of care [6].

In addition, the claim that randomized designs of interventions during the 2014 Ebola outbreak would have entailed the unethical withholding of potentially beneficial interventions from people in desperate need also rested on the unwarranted assumption that interventions in the early stages of development were more likely to be highly efficacious than to worsen participants’ already fragile condition. Available preclinical data did not support such enthusiasm. Even if it had, 90% of novel interventions fail to prove effective for any indication [7], a statistic that does not reflect the fact that even drugs eventually approved for some indication are often tested in a range of indications for which they are ineffective or even harmful. Absent this unwarranted presumption, randomization is ethically permissible.

Fourth, effectively communicating reliable scientific information to local communities—including uncertainty about the efficacy and safety of investigational interventions, a cornerstone of respectful community engagement—is an essential component of ethically responsible research. Public health emergencies are contexts of heightened uncertainty and mistrust. Public resistance to randomized trials in some Ebola-affected regions was fueled by a misconception that the interventions were highly efficacious “secret serums” [8]. This arose partly because of the higher survival rate for expatriates receiving investigational interventions who were also evacuated to their home countries, where they also received the highest level of supportive care in addition to any other treatment modality, compared to patients in West Africa [9]. In the face of initial opposition to randomized studies, some researchers and humanitarian organizations quickly concluded local communities would never accept such trials. But in fact, with effective community engagement and information sharing, one randomized therapeutic trial and three randomized vaccine studies were conducted in the waning stages of the outbreak in West Africa. The lesson—that informed communities that are engaged appropriately may indeed be willing to accept randomized studies—is crucial for future outbreaks.

This engagement, however, cannot be initiated late in the game. The Committee’s report includes several recommendations for increasing planning and preparedness during interepidemic periods so that reliable, ethically acceptable research can be organized, reviewed, and launched expeditiously when the next outbreak strikes.

Finally, to frontline caregivers facing overwhelming clinical need and acute shortages of supplies and manpower in the early stages of the outbreak, research felt like an unjustifiable diversion of scarce resources. The question of whether rigorous clinical trials of novel therapeutics and vaccines should or can be implemented during epidemic emerging infectious diseases has been affirmatively answered during the West Africa Ebola outbreak. The National Academies of Sciences, Engineering, and Medicine report emphasizes that sustained, coordinated international support for health systems in low- and middle-income countries is now of paramount importance. This includes investing in their medical infrastructure, enhancing their capacity to conduct public health surveillance and research, and ensuring that collaborations provide lasting benefits to affected communities.

Divergent humoral responses to 23-valent pneumococcal polysaccharide vaccine in critically-ill burn and neurosurgical patients

PLoS One
http://www.plosone.org/
[Accessed 19 May 2018]

Research Article
Divergent humoral responses to 23-valent pneumococcal polysaccharide vaccine in critically-ill burn and neurosurgical patients
Scott W. Mueller, Laura J. Baumgartner, Rob MacLaren, Robert Neumann, Arek J. Wiktor, Tyree H. Kiser, Gordon Lindberg, Luis Cava, Douglas N. Fish, Edward N. Janoff
Research Article | published 14 May 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0197037

Hostage authorship and the problem of dirty hands

Research Ethics
Volume 14, Issue 1, Jan – Mar 2018
http://journals.sagepub.com/toc/reab/current

Original Article; Non-Empirical
Hostage authorship and the problem of dirty hands
William Bülow, Gert Helgesson
First Published April 2, 2018; pp. 1–9
Preview
This article discusses gift authorship, the practice where co-authorship is awarded to a person who has not contributed significantly to the study. From an ethical point of view, gift authorship raises concerns about desert, fairness, honesty and transparency, and its prevalence in research is rightly considered a serious ethical concern. We argue that even though misuse of authorship is always bad, there are instances where accepting requests of gift authorship may nevertheless be the right thing to do. More specifically, we propose that researchers may find themselves in a situation much similar to the problem of dirty hands, which has been frequently discussed in political philosophy and applied ethics. The problem of dirty hands is relevant to what we call hostage authorship, where the researchers include undeserving authors unwillingly, and only because they find it unavoidable in order to accomplish a morally important research goal.

Meeting resistance

Science         
18 May 2018  Vol 360, Issue 6390
http://www.sciencemag.org/current.dtl

Special Issue: The Rise of Resistance
Introduction to special issue
Meeting resistance
By Caroline Ash
Science18 May 2018 : 726-727
Almost as soon as antibiotics were discovered to be valuable in medicine, resistance emerged among bacteria. Whenever mutating or recombining organisms are faced with extirpation, those individuals with variations that avert death will survive and reproduce to take over the population. This can happen rapidly among organisms that reproduce fast and outpace our efforts to combat them. Thus, our use of chemical entities to rid ourselves of clinical, domestic, and agricultural pathogens and pests has selected for resistance.
Today, we find ourselves at the nexus of an alarming acceleration of resistance to antibiotics, insecticides, and herbicides. Through chemical misuse, resistance also brings widespread collateral damage to natural, social, and economic systems. Resistance to antifungal agents poses a particular challenge because a limited suite of chemicals is used in both agricultural and clinical settings.
Evolution will always circumvent head-on attack by new biocides, and we may not be able to invent all the new products that we need. We must therefore harness evolutionary approaches to find smarter ways to minimize the erosion of chemical susceptibility. We now have it in our means to integrate a variety of approaches to pest and pathogen management, including rigorous regulation of prescription behavior, consistent use of clinical hygiene measures, physical barriers to crop pests, and alternative cropping regimes. We urgently need to revisit our reliance on chemicals to ensure our future medical and food security.

The broad socioeconomic benefits of vaccination

Science Translational Medicine
16 May 2018  Vol 10, Issue 441
http://stm.sciencemag.org/

Focus
The broad socioeconomic benefits of vaccination
By David E. Bloom, Victoria Y. Fan, J. P. Sevilla
Science Translational Medicine16 May 2018 Restricted Access
Evaluating vaccination programs according to their broad socioeconomic benefits, beyond their health benefits, will help to address the twin problems of vaccine underutilization and weak incentives for vaccine innovation.

Recent advances in the development of vaccines for chronic inflammatory autoimmune diseases

Vaccine
Volume 36, Issue 23  Pages 3191-3388 (31 May 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/23

Reviews
Recent advances in the development of vaccines for chronic inflammatory autoimmune diseases
Review article
Pages 3208-3220
Naru Zhang, Kutty Selva Nandakumar
Abstract
Chronic inflammatory autoimmune diseases leading to target tissue destruction and disability are not only causing increase in patients’ suffering but also contribute to huge economic burden for the society. General increase in life expectancy and high prevalence of these diseases both in elderly and younger population emphasize the importance of developing safe and effective vaccines. In this review, at first the possible mechanisms and risk factors associated with chronic inflammatory autoimmune diseases, such as rheumatoid arthritis (RA), multiple sclerosis (MS), systemic lupus erythematosus (SLE) and type 1 diabetes (T1D) are discussed. Current advances in the development of vaccines for such autoimmune diseases, particularly those based on DNA, altered peptide ligands and peptide loaded MHC II complexes are discussed in detail. Finally, strategies for improving the efficacy of potential vaccines are explored.

Enhancing immunization during second year of life by reducing missed opportunities for vaccinations in 46 countries

Vaccine
Volume 36, Issue 23  Pages 3191-3388 (31 May 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/23

Enhancing immunization during second year of life by reducing missed opportunities for vaccinations in 46 countries
Original research article
Pages 3260-3268
Celina M. Hanson, Imran Mirza, Richard Kumapley, Ikechukwu Ogbuanu, … Robin Nandy
Abstract
Background
Delivering vaccination services during the second year of life (2YL)1 provides countries with an opportunity to achieve greater coverage, to provide booster doses and vaccines missed during the first year of life, as well as contribute towards disease control and elimination goals.
Methods
Using data from demographic health surveys (DHSs) conducted during 2010 to 2016, this paper explores the proportion of missed opportunities for vaccinations generally provided during routine immunization among children in their 2YL.
Results
DHS data in 46 countries surveyed 478,737 children, from which 169,259 children were 12–23 months old and had vaccination/health cards viewed by surveyors. From this group, 69,489 children aged 12–23 months had contact with health services in their 2YL. Three scenarios for a missed opportunity for vaccinations were analysed: (1) a child received one vaccine in the immunization schedule and was eligible for another vaccine, but did not receive any further vaccination, (2) a child received a vitamin A supplementation (VAS) and was due for a vaccine, but did not receive vaccines that were due, and (3) a child was taken to a health facility for a sick visit and was due (and eligible) for a vaccine, but did not receive the vaccine. A total of 16,409 (24%) children had one or more missed opportunities for vaccinations.
Conclusion
This analysis highlights the magnitude of the problem of missed opportunities in the 2YL. The global community needs to provide better streamlined guidance, policies and strategies to promote vaccination screenings at well-child and sick child visits in the 2YL. Where they do not exist, well-child visits in the 2YL should be established and strengthened.

Dengue vaccination during pregnancy – An overview of clinical trials data

Vaccine
Volume 36, Issue 23  Pages 3191-3388 (31 May 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/23

Dengue vaccination during pregnancy – An overview of clinical trials data
Open access – Original research article
Pages 3345-3350
Anna Skipetrova, Tram Anh Wartel, Sophia Gailhardou
Conclusion
In the small dataset assessed, no evidence of increased adverse pregnancy outcomes has been identified from inadvertent immunization of women in early pregnancy with CYD-TDV compared with the control group.

Attitudes, believes, determinants and organisational barriers behind the low seasonal influenza vaccination uptake in healthcare workers – A cross-sectional survey

Vaccine
Volume 36, Issue 23  Pages 3191-3388 (31 May 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/23

Attitudes, believes, determinants and organisational barriers behind the low seasonal influenza vaccination uptake in healthcare workers – A cross-sectional survey
Original research article
Pages 3351-3358
Lise Boey, Charlotte Bral, Mathieu Roelants, Antoon De Schryver, … Corinne Vandermeulen
 
 

Media/Policy Watch

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 Atlantic
http://www.theatlantic.com/magazine/
Accessed 19 May 2018
The First Urban Case of Ebola in the Congo Is a ‘Game Changer …
The stakes are higher now that the virus has reached a city of 1.2 million people.
Ed Yong  May 17, 2018
The current Ebola outbreak in the Democratic Republic of Congo has thus far been confined to remote rural areas, but one case has now been confirmed in Mbandaka, a city of almost 1.2 million people. “We are moving to a new phase of the epidemic, and we are putting all the means in place to respond to it in a quick and effective way,” said Oly Ilunga, the DRC’s minster of health, on Wednesday evening.
The outbreak initially hit the northwestern town of Bikoro and a nearby village called Ikoko-Impenge that is 30 kilometers away. Both are small and hard to reach, especially in the current rainy season, when roads become pockmarked with gullies and potholes. Mbandaka’s larger population, and its location on the Congo River, provides new opportunities for the virus to spread. And, at around 150 kilometers from Bikoro, it significantly widens the area affected by the outbreak. “Confirmation of urban Ebola in DRC is a game changer,” Peter Salama, from the World Health Organization, tweeted. “The challenge just got much, much tougher.”…
 
 
New York Times
http://www.nytimes.com/
Accessed 19 May 2018
Africa
Congo’s Health Ministry Says Doses of Ebola Vaccine Arrive
Thousands of doses of the experimental Ebola vaccine have arrived in Congo’s capital amid the latest outbreak of the deadly disease, the health ministry said Wednesday.
May 16. 2018

Vaccines and Global Health: The Week in Review 12 May 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_12 May 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.

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

WHO and partners working with national health authorities to contain new Ebola outbreak in the Democratic Republic of the Congo

Milestones :: Perspectives

EBOLA/EVD  [to 12 May 2018]
http://www.who.int/ebola/en/

WHO and partners working with national health authorities to contain new Ebola outbreak in the Democratic Republic of the Congo
11 May 2018   News Release  Geneva/Brazzaville/Kinshasa
The World Health Organization (WHO) and a broad range of partners are in the Democratic Republic of the Congo (DRC) working with the Government to contain an outbreak of Ebola virus disease (EVD) in Bikoro health zone, Equateur Province. The outbreak was declared three days ago.  WHO Director-General Dr Tedros Adhanom Ghebreyesus will travel to the DRC over the week-end to take stock of the situation and direct the continuing response in support of the national health authorities.

As of 11 May, 34 Ebola cases have been reported in the area in the past five weeks, including 2 confirmed, 18 probable (deceased) and 14 suspected cases. Five samples were collected from 5 patients and two have been confirmed by the laboratory. Bikoro health zone is 250 km from Mbandaka, capital of Equateur Province in an area of the country that is very hard to reach.

“WHO staff were in the team that first identified the outbreak. I myself am on my way to the DRC to assess the needs first-hand,” said Dr Tedros. “I’m in contact with the Minister of Health and have assured him that we’re ready to do all that’s needed to stop the spread of Ebola quickly. We are working with our partners to send more staff, equipment and supplies to the area.”

A multidisciplinary team including WHO experts, along with staff from the Provincial Division of Health and Médecins Sans Frontières (MSF), arrived in Bikoro on 10 May. This first group of responders is now gathering more data to understand the extent and drivers of the epidemic. The team will also set up an active case search and contact tracing, establish Ebola treatment units to care for patients, set up mobile labs, and engage the community on safe practices. WHO will also work with national authorities in planning further public health measures such as vaccination campaigns.

“WHO is supporting the Government of the Democratic Republic of the Congo in coordinating this response; this is the country’s ninth Ebola outbreak and there is considerable expertise in-country,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “However, any country facing such a threat may require international assistance. WHO and its partners including MSF, World Food Programme (WFP), UNICEF, International Federation of Red Cross and Red Crescent Societies (IFRC) and the Congolese Red Cross, UNOCHA and MONUSCO , US Centers for Disease Control and Prevention (US-CDC), the International Organization for Migration (IOM), are all stepping up their support.”

The response plan to the outbreak includes surveillance, case investigation, and contact tracing; community engagement and social mobilization; case management and infection prevention and control; safe and dignified burials; research response including the use of ring vaccination and antivirals; and coordination and operations support.

“It is too early to judge the extent of this outbreak,” said Dr Peter Salama, WHO Deputy Director-General for Emergency Preparedness and Response. “However, early signs including the infection of 3 health workers, the geographical extent of the outbreak, the proximity to transport routes and population centres, and the number of suspected cases indicate that stopping this outbreak will be a serious challenge. This will be tough and it will be costly. We need to be prepared for all scenarios.”

In its latest Disease Outbreak News, WHO lists the risks to surrounding countries as moderate. WHO has however, already alerted those countries and is working with them on border surveillance and preparedness for potential outbreaks. WHO does not at this time advise any restrictions on travel and trade to the Democratic Republic of the Congo.

DRC: Emergency Team Supports Rapid Response to Ebola Cases

Milestones :: Perspectives

MSF/Médecins Sans Frontières  [to 12 May 2018]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
DRC: Emergency Team Supports Rapid Response to Ebola Cases
May 09, 2018
An emergency team with the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) is working with the Ministry of Health in the Democratic Republic of Congo (DRC) and other international organizations to assess and support a rapid response to an Ebola outbreak in the country, confirmed by national health authorities on May 8. The MSF team is based in the Bikoro health zone of Equateur province and in Kinshasa. It will support the deployment of a rapid and tailored response to better detect suspected cases and contain the epidemic.
DRC occasionally experiences Ebola outbreaks; In the last few years, MSF has responded on a number of occasions, including to outbreaks in Likati (2017, three confirmed Ebola cases); Boende (2014, 24 confirmed Ebola cases); Isiro (2012); and Mweka (2007, 18 confirmed Ebola cases).
“MSF has worked alongside the Congolese authorities in the past to care for patients suffering from Ebola and bring outbreaks under control. At the moment, there is an experienced MSF team in Bikoro, made up of medics, water and sanitation experts, health promoters, logisticians, and an epidemiologist. The team is working with the national authorities and other international organizations to assess the situation and to ensure that the outbreak is contained.”
—Julien Raickman, MSF head of mission in DRC