Monthly Archives: August 2018

Immunization Completion in Infants Born at Low Birth Weight

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Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 7, Issue 3, September 2018
https://academic.oup.com/jpids/issue

Original Articles and Commentaries
Immunization Completion in Infants Born at Low Birth Weight
Matt Nestander; Jay Dintaman; Apryl Susi; Gregory Gorman; Elizabeth Hisle-Gorman
Journal of the Pediatric Infectious Diseases Society, Volume 7, Issue 3, 17 August 2018, Pages e58–e64, https://doi.org/10.1093/jpids/pix079
Low birth weight significantly affects immunization completion, even after controlling for prematurity, neonatal illness, provider consistency, access to care, well-child care, and outpatient visits. Complete well-child care visits are associated with immunization completion.

On the road to universal health care in Indonesia, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

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The Lancet
https://www.thelancet.com/journals/lancet/issue/current
Aug 18, 2018 Volume 392 Number 10147 p531-612

Articles
On the road to universal health care in Indonesia, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
Nafsiah Mboi, Indra Murty Surbakti, Indang Trihandini, Iqbal Elyazar, Karen Houston Smith, Pungkas Bahjuri Ali, Soewarta Kosen, Kristin Flemons, Sarah E Ray, Jackie Cao, Scott D Glenn, Molly K Miller-Petrie, Meghan D Mooney, Jeffrey L Ried, Dina Nur Anggraini Ningrum, Fachmi Idris, Kemal N Siregar, Pandu Harimurti, Robert S Bernstein, Tikki Pangestu, Yuwono Sidharta, Mohsen Naghavi, Christopher J L Murray, Simon I Hay

On reducing the risk of vaccine-associated paralytic poliomyelitis in the global transition from oral to inactivated poliovirus vaccine

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The Lancet
https://www.thelancet.com/journals/lancet/issue/current
Aug 18, 2018 Volume 392 Number 10147 p531-612

Viewpoint
On reducing the risk of vaccine-associated paralytic poliomyelitis in the global transition from oral to inactivated poliovirus vaccine
Xiangdong Peng, Xiaojiang Hu, Miguel A Salazar
Owing to the concerted efforts of countries worldwide, the incidence of paralytic poliomyelitis due to wild poliovirus infection has been reduced to its lowest on record. Wild poliovirus type 2 has not been detected since 1999 and was certified to have been eradicated in 2015.  No case of paralytic poliomyelitis caused by wild poliovirus type 3 has been reported since 2012, and all cases detected since 2013 have been due to wild poliovirus type 1.  In 2016, only 37 cases of paralytic poliomyelitis caused by wild poliovirus infection were reported, and that number decreased to 22 in 2017. Global eradication of wild poliovirus—the long-awaited outcome of decades of effort—is finally in sight.

Vaccine scandal and confidence crisis in China

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The Lancet
https://www.thelancet.com/journals/lancet/issue/current
Aug 04, 2018 Volume 392 Number 10145 p359-450  e6

Editorial
Vaccine scandal and confidence crisis in China
The Lancet
In July, China experienced its “worst public health crisis in years” as stated by South China Morning Post. Chinese vaccine maker Changsheng Biotechnology was found to have fabricated production and inspection records and to have arbitrarily changed process parameters and equipment during its production of freeze-dried human rabies vaccines. Furthermore, substandard diphtheria, pertussis, and tetanus (DPT) vaccines produced by Changsheng Biotechnology were administered to 215 184 Chinese children; and 400 520 substandard DPT vaccines produced by Wuhan Institute of Biological Products were sold in Hebei and Chongqing. On July 25, China’s drug regulator launched an investigation into all vaccine producers across the country. 15 people from Changsheng Biotechnology, including the chairman, have been detained by Chinese authorities.

This latest vaccine scandal follows on from a series of fake and substandard food and drugs issues in China. As a result, many parents have lost faith in the vaccine system. Although no cases of death or other severe consequences relevant to the substandard rabies and DPT vaccines have been documented as of July 31, the substandard vaccines have been reported as being poisonous in social media and on the internet.

The immediate action to investigate the national vaccine industry is crucial to deal with the vaccine scandal. However, such action alone will not end public distrust and dissent towards vaccines. The national immunisation programme has helped China achieve tremendous health gains. However, the current vaccine confidence crisis seriously threatens this programme.

Above all, it is the government’s responsibility to ensure that the vaccines produced and used in China are effective and safe. To restore and sustain the public’s confidence in China’s vaccine quality and safety, it is urgent for the government to reflect on and reform where necessary the country’s vaccine regulatory system. A better understanding of the concerns of the public and more transparent and open regulation are essential to protect millions of children from preventable illnesses.

Monitoring equity in universal health coverage with essential services for neglected tropical diseases: an analysis of data reported for five diseases in 123 countries over 9 years

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Lancet Global Health
Sep 2018 Volume 6 Number 9 e933-e1044
http://www.thelancet.com/journals/langlo/issue/current

Articles
Monitoring equity in universal health coverage with essential services for neglected tropical diseases: an analysis of data reported for five diseases in 123 countries over 9 years
Christopher Fitzpatrick, Mathieu Bangert, Pamela Sabina Mbabazi, Alexei Mikhailov, Honorat Zouré, Maria Polo Rebollo, Magda Robalo Correia e Silva, Gautam Biswas

Long-term effectiveness of one and two doses of a killed, bivalent, whole-cell oral cholera vaccine in Haiti: an extended case-control study

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Lancet Global Health
Sep 2018 Volume 6 Number 9 e933-e1044
http://www.thelancet.com/journals/langlo/issue/current

Long-term effectiveness of one and two doses of a killed, bivalent, whole-cell oral cholera vaccine in Haiti: an extended case-control study
Molly F Franke, Ralph Ternier, J Gregory Jerome, Wilfredo R Matias, Jason B Harris, Louise C Ivers
No study of long-term protection following killed oral cholera vaccination has been done outside of the historically cholera-endemic areas of south Asia, or has examined protection after a single-dose vaccination regimen. To address this, we examined the duration of protection of the standard two-dose regimen and an incomplete regimen of one dose up to 4 years after vaccination in Haiti…In a setting of epidemic and newly endemic cholera in Haiti, single-dose vaccination with killed, bivalent, whole-cell oral cholera vaccination provided short-term protection; however, vaccination with two doses was required for long-term protection, which lasted up to 4 years after vaccination. These results add to the evidence in support of the use of killed, bivalent, whole-cell oral cholera vaccination as part of comprehensive cholera control plans.

Impact of monovalent rotavirus vaccine on diarrhoea-associated post-neonatal infant mortality in rural communities in Malawi: a population-based birth cohort study

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Lancet Global Health
Sep 2018 Volume 6 Number 9 e933-e1044
http://www.thelancet.com/journals/langlo/issue/current

Impact of monovalent rotavirus vaccine on diarrhoea-associated post-neonatal infant mortality in rural communities in Malawi: a population-based birth cohort study
Naor Bar-Zeev, Carina King, Tambosi Phiri, James Beard, Hazzie Mvula, Amelia C Crampin, Ellen Heinsbroek, Sonia Lewycka, Jacqueline E Tate, Umesh D Parashar, Anthony Costello, Charles Mwansambo, Robert S Heyderman, Neil French, Nigel A Cunliffe for the VacSurv Consortium

Keep off-target effects in focus

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Nature Medicine
Volume 24 Issue 8, August 2018
https://www.nature.com/nm/volumes/24/issues/8

Editorial | 06 August 2018
Keep off-target effects in focus
Concerns about potential unintended DNA changes that might accidentally arise from CRISPR gene editing have emerged to varying degrees with the advent of the technology. As new therapies move from bench to bedside, scientists need to redouble their efforts to document the spectrum of these off-target effects while also acknowledging the reality that a certain degree of risk is embedded in many promising and successful medical therapies.

Accreditation of Clinical Research Sites — Moving Forward

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New England Journal of Medicine
http://www.nejm.org/toc/nejm/medical-journal
August 2, 2018  Vol. 379 No. 5

Perspective
Accreditation of Clinical Research Sites — Moving Forward
Greg Koski, Ph.D., M.D., Larry Kennedy, Ph.D., Mary F. Tobin, Ph.D., and Matthew Whalen, Ph.D.
An initiative to design a system of accreditation that would improve and ensure the quality, performance, and safety of clinical trial sites is now coming to fruition. An initial set of quality standards is being made available by request.

Pediatricians and Global Health: Opportunities and Considerations for Meaningful Engagement

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Pediatrics
August 2018, VOLUME 142 / ISSUE 2
http://pediatrics.aappublications.org/content/142/2?current-issue=y

State-of-the-Art Review Article
Pediatricians and Global Health: Opportunities and Considerations for Meaningful Engagement
Gitanjli Arora, Emily Esmaili, Michael B. Pitt, Andrea Green, Lisa Umphrey, Sabrina M. Butteris, Nicole E. St Clair, Maneesh Batra, Cliff O’Callahan, on behalf of the Global Health Task Force of the American Board of Pediatrics
Pediatrics Aug 2018, 142 (2) e20172964; DOI: 10.1542/peds.2017-2964
In this review, we describe opportunities, resources, and important personal and professional considerations for US-based pediatric practitioners who are engaged in GCH.

Research Consent at the Age of Majority: Preferable but not Obligatory

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Pediatrics
August 2018, VOLUME 142 / ISSUE 2
http://pediatrics.aappublications.org/content/142/2?current-issue=y

Ethics Rounds
Research Consent at the Age of Majority: Preferable but not Obligatory
Kyle B. Brothers, Benjamin S. Wilfond
Pediatrics Aug 2018, 142 (2) e20173038; DOI: 10.1542/peds.2017-3038
There are important reasons for researchers to seek consent when participants turn 18 years old, but these must be balanced with scientific priorities.

Reconsidering the Need for Reconsent at 18

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Pediatrics
August 2018, VOLUME 142 / ISSUE 2
http://pediatrics.aappublications.org/content/142/2?current-issue=y

Reconsidering the Need for Reconsent at 18
Benjamin E. Berkman, Dana Howard, David Wendler
Pediatrics Aug 2018, 142 (2) e20171202; DOI: 10.1542/peds.2017-1202
In this article, we challenge the prevailing view that researchers must attempt to obtain consent at 18 years of age to continue doing research with stored samples.
 

An Evaluation of Global Hazard Communication with Ethical Considerations

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PLOS Currents: Disasters
http://currents.plos.org/disasters/
[Accessed 18 Aug 2018]

An Evaluation of Global Hazard Communication with Ethical Considerations
August 7, 2018 · Review
Introduction: Despite the large number of hazards occurring every year, it is often only the most catastrophic and rapidly occurring hazards that are covered in detail by major news outlets. This can result in an under-reporting of smaller or slowly evolving hazards such as drought. Furthermore, the type or country in which the hazard occurs may have a bearing on whether it receives media coverage. The Public Health England (PHE) global weekly hazards bulletin is designed to inform subscribers of hazards occurring in the world in a given week regardless of location or type of natural hazard. This paper will aim to examine whether the bulletin is reporting these events in a way that matches a number of international disaster databases.  It will also seek to answer if biases within media outlets reporting of an event is impacting on the types of hazards and events being covered.  Through the analysis of data collected, it is hoped to be able to consider the ethical implications of such a bulletin service and provide recommendations on how the service might be improved in the future.
Methods: The study used a year’s worth of global hazards bulletins sent by Public Health England.  These bulletins aim to communicate hazards in the form of compiled articles from news outlets around the world. Data from these bulletins was collected and analysed by hazard type and the country in which hazards occurred.  It was then compared to recognised hazard databases to assess similarities and differences in the hazards being reported via media or through dedicated hazard databases. The recognised hazard databases were those run by the Emergency Events Database (EM-DAT), European Civil Protection and Humanitarian Aid Operations (ECHO) and National Aeronautics and Space Administration (NASA) respectively.
Results: The PHE bulletin overall was found to be comparable to other global hazard or disaster databases in terms of hazards included by both country and type of hazard. The PHE bulletin covered a greater number of unique hazard events than the other databases and also covered more types of hazard. It also gave more frequent coverage to the United Kingdom and Canada than the other databases, with other countries appearing less frequently. More generally, the PHE bulletin and the databases it was compared to appear to focus more on hazards either occurring in developed countries or fast-onset ones such as landslides or floods. On the other hand, slow-onset hazards such as drought or those occurring in developing countries appear to be under-reported and are given less importance in both the bulletin and databases.
Discussion and recommendations” We recommend that the resources compared review their inclusion criteria and assess whether the discrepancies in hazard type and country can be ratified through changes in how hazards are assessed for inclusion. More research should be undertaken to assess whether similar findings arise when comparing databases in other areas within the remit of public health.

The 2015 Outbreak of Severe Influenza in Kashmir, North India: Emergence of a New Clade of A/H1n1 Influenza Virus

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PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
[Accessed 18 Aug 2018]

The 2015 Outbreak of Severe Influenza in Kashmir, North India: Emergence of a New Clade of A/H1n1 Influenza Virus
August 8, 2018 · Research Article
Introduction: Following the initial outbreak of A/H1N1pdm09, periodic resurgences of the virus, with variable morbidity and mortality, have been reported from various parts of India including the temperate Kashmir region of northern India. An outbreak of A/H1N1 with high morbidity and mortality was reported in early 2015 across India with a high morbidity and mortality. We studied patients during the outbreak in Kashmir.
Methods: Patients (n=1780, age 1 month to 90 years, median 35 years) presenting with acute respiratory illness to a tertiary care hospital in Srinagar, Kashmir from October 2014 to April 2015 were recruited. After clinical data recording, combined throat and nasal swabs were collected in viral transport medium and tested by real-time RT-PCR for influenza viruses. All influenza A positive samples were further subtyped using primers and probes for A/H1N1pdm09 and A/H3 whereas influenza B samples were further subtyped into B/Yamagata and B/Victoria lineages. Virus isolation, hemagglutination inhibition testing, sequencing and phylogenetic analysis was carried out using standard procedures. Testing for H275Y mutation was done to determine sensitivity to oseltamivir. All patients received symptomatic therapy and influenza positive patients were administered oseltamivir.
Results: Of the 1780 patients, 540 (30%) required hospitalization and 533 tested positive for influenza [influenza A=517(A/H1N1pdm09=437, A/H3N2=78 with co-infection of both in 2 cases); influenza B=16 (B/Yamgata=15)]. About 14% (n=254) had been vaccinated against influenza, having received the NH 2014-15 vaccine, 27 (11.3%) of these testing positive for influenza.  Sixteen patients, including 4 pregnant females, died due to multi-organ failure. HA sequencing depicted that 2015 isolates belonged to Clade 6B.1. No H275Y mutation was reported from A/H1N1 positives.
Conclusion: Resurgent outbreak of A/H1N1pdm09, with emergence of clade 6B.1, in 2014-15 resulted in high rate of hospitalizations, morbidity and mortality. Periodic resurgences and appearance of mutants emphasize continued surveillance so as to identify newer mutations with potential for outbreaks and severe outcomes.

The 2016-2017 Chikungunya Outbreak in Karachi

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PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
[Accessed 18 Aug 2018]

The 2016-2017 Chikungunya Outbreak in Karachi
August 7, 2018 · Research Article
Introduction: Chikungunya is an incipient disease, caused by Chikungunya virus (CHKV) that belongs to genus alphavirus of the family Togaviridae.
Materials and Methods: In this study, during an outbreak of CHKV in Dec 2016 in Karachi, Pakistan, samples were collected from patients presenting with fever, tiredness and pain in muscles and joints. Total 126 sera were tested for the presence of Chikungunya infection through ELISA and Real-time Reverse Transcriptase PCR assay.
Results and Discussion: This study showed that approx 79.4% samples were positive for CHKV. To our knowledge, this is the first reported outbreak from last decades in which the presence of CHKV is confirmed in Karachi while affecting such large no. of individuals.. Conclusion: CHKV diagnosis should be considered by the scientists and clinicians as a differential diagnosis in febrile patients, and appropriate control strategies must be adopted for its surveillance.

Choices in vaccine trial design in epidemics of emerging infections

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PLoS Medicine
http://www.plosmedicine.org/
(Accessed 18 Aug 2018)

Policy Forum
Choices in vaccine trial design in epidemics of emerging infections
Rebecca Kahn, Annette Rid, Peter G. Smith, Nir Eyal, Marc Lipsitch
| published 07 Aug 2018 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002632
Summary points
:: The 2014–2016 Ebola epidemic highlighted variations in the design of randomized trials to evaluate investigational vaccines in an emergency setting. Here, we summarize scientific, ethical, and feasibility considerations relevant to different trial designs.
:: We focus on four fundamental choices in designing a trial of an experimental vaccine in the setting of an emerging infectious disease for which no proven vaccines exist: randomization unit, trial population, comparator intervention, and trial implementation. We also consider three ethical issues relevant to trial design: the social and scientific value of the trial, its risk–benefit profile, and the fairness of participant selection.
:: We believe that individual rather than cluster randomization is better suited for estimating the direct protective effect of a vaccine, a measure of great intrinsic interest. Individual randomization should therefore be the default strategy for evaluating investigational vaccines during epidemics.
:: Trial participants may be selected either from the general population or from a group at high risk of exposure to infection, depending on the characteristics of the infection together with statistical, fairness, and feasibility considerations.
:: Use of a placebo control, rather than an active control or delayed intervention, is likely to maximize the social and scientific value of the trial because it facilitates double-blinding and removes concerns that the comparison intervention may affect the incidence of the disease under study.
:: Starting the trial at approximately the same time for all participants should minimize the time required to obtain a result. Such a strategy will be facilitated when sufficient supplies of the investigational vaccine and control interventions (if any) are available at the start of a trial, when the geographic area for the trial is clearly identified (and anticipated to have continuing disease transmission throughout the trial), and when logistics permit rapid recruitment of the entire trial population. Otherwise, a stepped rollout may be necessary, in which recruitment to the trial is staggered over a period.

A collaborative translational research framework for evaluating and implementing the appropriate use of human genome sequencing to improve health

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PLoS Medicine
http://www.plosmedicine.org/
(Accessed 18 Aug 2018)

Essay
A collaborative translational research framework for evaluating and implementing the appropriate use of human genome sequencing to improve health
Muin J. Khoury, W. Gregory Feero, David A. Chambers, Lawrence E. Brody, Nazneen Aziz, Robert C. Green, A. Cecile J.W. Janssens, Michael F. Murray, Laura Lyman Rodriguez, Joni L. Rutter, Sheri D. Schully, Deborah M. Winn, George A. Mensah
| published 02 Aug 2018 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002631
Summary points
:: There is currently insufficient scientific evidence to support routine nondiagnostic use of germline genome sequencing in healthcare settings and population screening, but an increasing number of health systems are piloting genomic sequencing projects for clinical care.
:: In principle, numerous diagnostic or prognostic tests based on genes or variants could be used for different purposes across the life span, and an evidence-based approach is urgently needed to evaluate their possible clinical utility and facilitate appropriate implementation.
:: We discuss a translational research framework that features collaboration among multiple health systems with already available genome sequencing data, intervention information, and clinical outcomes. The framework is based on evaluating the impact of genetic information on improving health outcomes with study designs that depend on the evolving level of evidence for specific intended clinical uses.
:: In addition to observational studies, randomized controlled trials will be needed to assess health benefits, harms, and costs based on returning or not returning the results of selected genes/variants to patients, providers, or both, for specific clinical scenarios.
:: The proposed approach will allow learning health systems to collect clinical utility evidence in a research environment and develop the necessary capacity for appropriate integration of sequencing alongside other medical services.

 

Hajj, Umrah, and the neglected tropical diseases

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PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 18 Aug 2018)

Viewpoints
Hajj, Umrah, and the neglected tropical diseases
Mashal M. Almutairi, Waleed Saleh Alsalem, Mazen Hassanain, Peter J. Hotez
| published 16 Aug 2018 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0006539
… In this report, we focus on the major NTDs that have either been introduced into the Middle East through Hajj and Umrah pilgrimages from tropical disease–endemic countries of Asia and Africa or where importation from Saudi Arabia to other parts of the world are possible. In some cases, these diseases have now become endemic in Saudi Arabia and elsewhere in the MENA region. Our report emphasizes the recent scientific literature published within the last five years….

Is the priority review voucher program stimulating new drug development for tropical diseases?

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PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 18 Aug 2018)

Research Article
Is the priority review voucher program stimulating new drug development for tropical diseases?
Kirk W. Kerr, Thomas C. Henry, Kathleen L. Miller
| published 09 Aug 2018 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0006695

Exploring the risk of severe outcomes and the role of seasonal influenza vaccination in pregnant women hospitalized with confirmed influenza, Spain, 2010/11-2015/16

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PLoS One
http://www.plosone.org/
[Accessed 18 Aug 2018]

Research Article
Exploring the risk of severe outcomes and the role of seasonal influenza vaccination in pregnant women hospitalized with confirmed influenza, Spain, 2010/11-2015/16
Clara Mazagatos, Concepción Delgado-Sanz, Jesús Oliva, Alin Gherasim, Amparo Larrauri, the Spanish Influenza Surveillance System
Research Article | published 08 Aug 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0200934

Direct, indirect and total effectiveness of bivalent HPV vaccine in women in Galicia, Spain

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PLoS One
http://www.plosone.org/
[Accessed 18 Aug 2018]

Direct, indirect and total effectiveness of bivalent HPV vaccine in women in Galicia, Spain
Jesus Purriños-Hermida, María Isolina Santiago-Pérez, Mercedes Treviño, Rafaela Dopazo, Angelina Cañizares, Isolina Bonacho, Matilde Trigo, M. Eva Fernández, Ana Cid, David Gómez, Patricia Ordóñez, Amparo Coira, M. J. Armada, Magdalena Porto, Sonia Perez, Alberto Malvar-Pintos, on behalf of the HPV Vaccine Impact Surveillance Working Group of Galicia
Research Article | published 03 Aug 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0201653

The challenge of HPV vaccination uptake and opportunities for solutions: Lessons learned from Alabama

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Preventive Medicine
Volume 113  Pages 1-156 (August 2018)
https://www.sciencedirect.com/journal/preventive-medicine/vol/113/suppl/C

Regular Articles
The challenge of HPV vaccination uptake and opportunities for solutions: Lessons learned from Alabama
Original research article
Pages 124-131
Sarah E. Dilley, Sylvia Peral, J. Michael Straughn, Isabel C. Scarinci
Abstract
The human papillomavirus (HPV) vaccine is an important tool for cancer prevention. However, vaccination rates in Alabama, a state with high rates of HPV-related cancers, remain below the national average. Our objective was to develop a comprehensive assessment of HPV vaccination in our state, with the goal to make recommendations for tailored multilevel interventions. A multimodal approach with quantitative and qualitative data was used to determine barriers and facilitators to HPV vaccination in Alabama. This included a survey of pediatric care providers and structured interviews with pediatricians, parents, nurses and community stakeholders. Two separate investigators evaluated the interview transcripts for major themes that occurred in 65% or more interviews. Major barriers included lack of knowledge, concerns about vaccine safety, and the link between the HPV vaccine and sexuality. Qualitative interviews further revealed barriers such as misinformation received from the internet and parental vaccine hesitancy. Opportunities for increasing vaccination include parental education, establishment of a reminder system, increasing access to HPV vaccine providers, and education for providers. Additional facilitators revealed through interviews included: trust in physicians, using the internet or social media to propagate positive messaging, physicians and clinical staff education, utilizing existing technology more effectively, highlighting nurses’ roles as partners in HPV prevention, and the potential of schools as a venue for promotion of the vaccine. Our data are consistent with prior research showing major barriers to HPV vaccination. Several recommendations for optimizing HPV vaccination uptake in Alabama on the patient, provider and system level are given.

 

 

Thematic issue: Economics of NCDs

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Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH)

http://www.paho.org/journal/index.php?option=com_content&view=featured&Itemid=101
Thematic issue: Economics of NCDs
The global health burden of noncommunicable diseases (NCDs) is large and growing, as this group of diseases already accounts for 70% of total deaths. Global evidence indicates that the high health burden of NCDs translates into significant economic and social costs that threaten to diminish the quality of life of millions of individuals, impoverish families, jeopardize universal health coverage, and increase health disparities within and between countries. Evidence consistently shows that the NCD epidemic cannot be tackled through interventions and policies in the health sector alone. In particular, prevention measures that address NCD risk factors involve a range of sectors including finance, trade, education, agriculture, and transportation. As economics has become the common language among decision makers across sectors, it is imperative that health authorities leverage economic information to more effectively communicate the urgency of tackling NCDs and related risk factors.

This thematic issue of the Pan American Journal of Public Health is part of a continued collaboration between the Public Health Agency of Canada (PHAC) and PAHO/WHO to fa­cilitate intragovernmental dialogue for a better understanding of NCD issues by making economic evidence available in the Americas, and to assist countries in integrating economic approaches into their NCD prevention and control policies.

[Reviewed earlier]

 

The Ethical Foundations of Risk Analysis

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Risk Analysis          
Volume 38, Issue 8  Pages: 1519-1761  August 2018
https://onlinelibrary.wiley.com/toc/15396924/current

Perspectives
The Ethical Foundations of Risk Analysis
Daniel J. Rozell
Pages: 1529-1533
First Published: 19 January 2018
Abstract
In the field of risk analysis, the normative value systems underlying accepted methodology are rarely explicitly discussed. This perspective provides a critique of the various ethical frameworks that can be used in risk assessments and risk management decisions. The goal is to acknowledge philosophical weaknesses that should be considered and communicated in order to improve the public acceptance of the work of risk analysts.

Modeling Poliovirus Transmission in Pakistan and Afghanistan to Inform Vaccination Strategies in Undervaccinated Subpopulations

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Risk Analysis          
Volume 38, Issue 8  Pages: 1519-1761  August 2018
https://onlinelibrary.wiley.com/toc/15396924/current

Original Research Article
Modeling Poliovirus Transmission in Pakistan and Afghanistan to Inform Vaccination Strategies in Undervaccinated Subpopulations
Radboud J. Duintjer Tebbens, Mark A. Pallansch, Stephen L. Cochi, Derek T. Ehrhardt, Noha H. Farag, Stephen C. Hadler, Lee M. Hampton, Maureen Martinez, Steve G.F. Wassilak, Kimberly M. Thompson
Pages: 1701-1717
First Published: 03 January 2018
Abstract
Due to security, access, and programmatic challenges in areas of Pakistan and Afghanistan, both countries continue to sustain indigenous wild poliovirus (WPV) transmission and threaten the success of global polio eradication and oral poliovirus vaccine (OPV) cessation. We fitted an existing differential‐equation‐based poliovirus transmission and OPV evolution model to Pakistan and Afghanistan using four subpopulations to characterize the well‐vaccinated and undervaccinated subpopulations in each country. We explored retrospective and prospective scenarios for using inactivated poliovirus vaccine (IPV) in routine immunization or supplemental immunization activities (SIAs). The undervaccinated subpopulations sustain the circulation of serotype 1 WPV and serotype 2 circulating vaccine‐derived poliovirus. We find a moderate impact of past IPV use on polio incidence and population immunity to transmission mainly due to (1) the boosting effect of IPV for individuals with preexisting immunity from a live poliovirus infection and (2) the effect of IPV‐only on oropharyngeal transmission for individuals without preexisting immunity from a live poliovirus infection. Future IPV use may similarly yield moderate benefits, particularly if access to undervaccinated subpopulations dramatically improves. However, OPV provides a much greater impact on transmission and the incremental benefit of IPV in addition to OPV remains limited. This study suggests that despite the moderate effect of using IPV in SIAs, using OPV in SIAs remains the most effective means to stop transmission, while limited IPV resources should prioritize IPV use in routine immunization.

 

Building an evidence base for stakeholder engagement

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Science         
http://www.sciencemag.org/current.dtl
10 August 2018  Vol 361, Issue 6402

Policy Forum  SCIENCE AND SOCIETY
Building an evidence base for stakeholder engagement
James V. Lavery
See all authors and affiliations
Science  10 Aug 2018:
Vol. 361, Issue 6402, pp. 554-556
DOI: 10.1126/science.aat8429
Summary
Science is a social enterprise. Many scientific programs interact with a wide range of communities and stakeholders to secure various types of access and permission, to seek cooperation and collaboration for scientific studies, to fulfill regulatory and ethical requirements, and to try to shape research strategies and to improve the translation of their findings into policy or practice. But these interactions are motivated disproportionately by the interests and goals of the scientific programs and less by the need to elicit and understand their implications for stakeholders. However, there is increasing recognition that substantive community and stakeholder engagement (CSE) can improve the performance, and even make or break the success, of some science programs by providing a means of navigating, and responding to, the complex social, economic, cultural, and political settings in which science programs are conducted. For CSE to become more widely accepted by funders and researchers, and to contribute more conspicuously to the success of science programs and policy, it will have to establish a more coherent and convincing body of evidence about the nature of CSE strategies and their specific contributions to the performance of science programs.

Health of the Hajj

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Science         
http://www.sciencemag.org/current.dtl
10 August 2018  Vol 361, Issue 6402

Editorial
Health of the Hajj
By Ziad A. Memish
Science10 Aug 2018 : 533
Summary
For 5 days, starting 19 August, Saudi Arabia will host the Hajj, the world’s largest annual religious pilgrimage, where people from over 180 countries will converge on Mecca. Infectious disease transmission associated with this mass transnational movement of people is well known—malaria in 632 CE, meningitis in 1987 and 2000, polio in 2004, and pandemic influenza in 2009. As the former Deputy Minister of Public Health for Saudi Arabia, I know how immense the challenge is to ensure that the country is prepared to contain the spread of infectious disease and maintain public well-being during this event. Although major progress has been made over the past 30 years in Saudi Arabia and in pilgrimage countries, there is still much more to do to avoid a health catastrophe, given that the pilgrim quota may grow to 2.2 million by 2020.
 

A genome-wide net to catch and understand cancer

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Science Translational Medicine
http://stm.sciencemag.org/
15 August 2018  Vol 10, Issue 454
[New issue; No digest content identified]

08 August 2018  Vol 10, Issue 453
Focus
A genome-wide net to catch and understand cancer
By Neville E. Sanjana
Science Translational Medicine08 Aug 2018 Restricted Access
Genome-scale forward genetic screens elucidate the genetic basis of therapeutic resistance, tumor evolution, and metastasis in diverse human cancers.

01 August 2018  Vol 10, Issue 452
[No digest content identified]

To talk better about vaccines, we should talk less about vaccines

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Vaccine
Volume 36, Issue 34   Pages 5107-5218 (16 August 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/33

Commentary
To talk better about vaccines, we should talk less about vaccines
Open access
Pages 5107-5108
Francesco Gesualdo, Nicola Zamperini, Alberto E. Tozzi
…Conclusion
While continuing to provide evidence on the efficacy and safety of vaccines, we propose a reframing of vaccine communication that focuses on the positive, emotional values of immunizations.
This change of perspective requires a strong opening to multidisciplinary collaboration. New, possibly disruptive information strategies can arise from the cross-fertilization among clinicians, vaccine researchers, behavioral scientists, journalists and communication experts.
Since evidence on the effectiveness of this approach are currently missing, we suggest that a new research agenda is set on investigating the effectiveness of vaccine promotion strategies based on positive messages and on integrated communication. The challenge of this research field is that one size does not fit all. Therefore, potential differences among subgroups and in different national and subnational contexts should be considered and investigated to better tailor communication strategies.
We believe that the proposed approach could give a new boost to vaccine confidence, in the interest of the community at large, and of children and their future.

Vaccination status of children aged 1–4 years in Afghanistan and associated factors, 2015

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Vaccine
Volume 36, Issue 34   Pages 5107-5218 (16 August 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/33

Vaccination status of children aged 1–4 years in Afghanistan and associated factors, 2015
Original research article
Pages 5141-5149
Luke M. Shenton, Abram L. Wagner, Bradley F. Carlson, Mohammad Yousuf Mubarak, Matthew L. Boulton

Collecting and using reliable vaccination coverage survey estimates: Summary and recommendations from the “Meeting to share lessons learnt from the roll-out of the updated WHO Vaccination Coverage Cluster Survey Reference Manual and to set an operational research agenda around vaccination coverage surveys”, Geneva, 18–21 April 2017

Posted on by

Vaccine
Volume 36, Issue 34   Pages 5107-5218 (16 August 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/33

Collecting and using reliable vaccination coverage survey estimates: Summary and recommendations from the “Meeting to share lessons learnt from the roll-out of the updated WHO Vaccination Coverage Cluster Survey Reference Manual and to set an operational research agenda around vaccination coverage surveys”, Geneva, 18–21 April 2017
Open access – Original research article
Pages 5150-5159
Carolina Danovaro-Holliday, Emily Dansereau, Dale A. Rhoda, David W. Brown, … Marta Gacic-Dobo

Therapeutic Vaccines for Genitourinary Malignancies

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Vaccines — Open Access Journal
http://www.mdpi.com/journal/vaccines
(Accessed 18 Aug 2018)

Open Access  Review
Therapeutic Vaccines for Genitourinary Malignancies
by Giselle M. A. Dutcher and Mehmet Asim Bilen
Vaccines 2018, 6(3), 55; https://doi.org/10.3390/vaccines6030055 – 12 August 2018
Abstract
The field of genitourinary malignancies has been a showcase for therapeutic cancer vaccine success since the application of intravesicular Bacillus Calmette-Guerin (BCG) for bladder cancer in the 1970s and enjoyed a renaissance in 2010 with the US Food and Drug Administration (FDA) approval of sipuleucel-T for prostate cancer. Several vaccine strategies have emerged, such as autologous or allogeneic whole-tumor vaccines, DNA vaccines, use of viral vectors, and peptides as immunostimulatory adjuvants. Despite impressive early trials, vaccine monotherapy has achieved limited success in the clinical world; however, combinations of vaccine and immune checkpoint inhibition or vaccine and cytokine stimulation are expected to move the field forward. This article reviews pivotal trials of cancer vaccines in prostate, renal, and bladder cancer and ongoing trials combining vaccines with other immune therapy agents

Next Generation Cancer Vaccines—Make It Personal!

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Vaccines — Open Access Journal
http://www.mdpi.com/journal/vaccines
(Accessed 18 Aug 2018)

Open Access   Review
Next Generation Cancer Vaccines—Make It Personal!
by Angelika Terbuch and Juanita Lopez
Vaccines 2018, 6(3), 52; https://doi.org/10.3390/vaccines6030052 – 9 August 2018
Abstract
Dramatic success in cancer immunotherapy has been achieved over the last decade with the introduction of checkpoint inhibitors, leading to response rates higher than with chemotherapy in certain cancer types. These responses are often restricted to cancers that have a high mutational burden and show pre-existing T-cell infiltrates. Despite extensive efforts, therapeutic vaccines have been mostly unsuccessful in the clinic. With the introduction of next generation sequencing, the identification of individual mutations is possible, enabling the production of personalized cancer vaccines. Combining immune check point inhibitors to overcome the immunosuppressive microenvironment and personalized cancer vaccines for directing the host immune system against the chosen antigens might be a promising treatment strategy.

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

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

Epidemiology
August 1, 2018 – Volume Publish Ahead of Print
Timing of Rotavirus Vaccine Doses and Severe Rotavirus Gastroenteritis among Vaccinated Infants in Low-and Middle-Income Countries
JF Gruber, S Becker-Dreps, MG Hudgens… –
Abstract
Background: Altering rotavirus vaccine schedules may improve vaccine performance in low- and middle-income countries. We analyzed data from clinical trials of the monovalent (RV1) and pentavalent (RV5) rotavirus vaccines in low- and middle-income countries to understand the association between vaccine dose timing and severe rotavirus gastroenteritis incidence.
Methods: We assessed the association between variations in rotavirus vaccine administration schedules and severe rotavirus gastroenteritis risk. We used the complement of the Kaplan–Meier survival estimator to estimate risk differences for different schedules. To adjust risk differences (RDs) for confounding, we calibrated estimates in the vaccinated arm using estimates from the placebo arm.
Results: There were 3114 and 7341 children included from the RV1 and RV5 trials, respectively. The 18-month adjusted severe rotavirus gastroenteritis risk was 4.0% (95% confidence interval (CI): 1.1, 7.1) higher for those receiving their first RV5 dose at <6 versus ≥6 weeks. For RV1, there was a 4.0% (95% CI: 0.0, 8.2) increase in 12-month adjusted risk for a 4- versus 6-week interval between doses. Further analysis revealed those receiving their first RV5 dose at 3-4 and 5-7 weeks had 2.9% (95% CI: 0.8, 5.3) and 1.3% (95% CI: -0.3, 3.0), respectively, higher risk compared to those at 9-12 weeks. Those receiving their first dose at 8 weeks had the lowest risk [RD: -2.6% (95% CI: -5.4, -0.1)] compared to those at 9-12 weeks.
Conclusions: A modest delay in rotavirus vaccination start and increase in interval between doses may be associated with lower severe rotavirus gastroenteritis risk in low- and middle-income countries

 

Media/Policy Watch

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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 18 Aug 2018
[No new, unique, relevant content]
 
BBC
http://www.bbc.co.uk/
Accessed 18 Aug 2018
[No new, unique, relevant content]
 
The Economist
http://www.economist.com/
Accessed 18 Aug 2018
[No new, unique, relevant content]

 
Financial Times
http://www.ft.com/home/uk
Accessed 18 Aug 2018
[No new, unique, relevant content]
 
Forbes
http://www.forbes.com/
Accessed 18 Aug 2018
[No new, unique, relevant content]

Foreign Affairs
http://www.foreignaffairs.com/
Accessed 18 Aug 2018
How Congo Beat the Last Ebola Outbreak: The Crucial Role of International Cooperation
The Crucial Role of International Cooperation
By Ariana A. Berengaut
6 August 2018
Foreign Policy
http://foreignpolicy.com/
Accessed 18 Aug 2018
Argument
Parents’ Fears Are the Chinese Communist Party’s Biggest Nightmare
A huge vaccine scandal hits at Beijing’s most vulnerable point: children’s safety.
By Charles Rollet
| July 31, 2018, 11:46 AM

The Guardian
http://www.guardiannews.com/
Accessed 18 Aug 2018
[No new, unique, relevant content]
 
New Yorker
http://www.newyorker.com/
Accessed 18 Aug 2018
[No new, unique, relevant content]
 

New York Times
http://www.nytimes.com/
Accessed 18 Aug 2018
Asia Pacific
China Fires 10 Officials Over Bad Vaccines as Anger Mounts
President Xi Jinping is trying to quell a national outcry over the scandal and restore confidence in the health care system.
Aug. 17, 2018   By Javier C. Hernández
BEIJING — The Chinese leadership, bowing to immense public pressure, has fired 10 officials and punished dozens more in connection with a scandal over faulty vaccines that has undermined President Xi Jinping and fueled parent protests.
The government said on Saturday that it had removed six senior officials at the China Food and Drug Administration for their role in a scandal that left hundreds of thousands of children with faulty vaccines for diphtheria, tetanus and whooping cough. Another four officials accused of wrongdoing were fired on Thursday after a meeting of Mr. Xi and China’s top leaders.
The dismissals were the latest attempt to quell public anger over the affair, which has hurt confidence in the nation’s health care system and raised questions about Mr. Xi’s leadership. Criticism of officials and companies has swelled since news of the defective vaccines emerged on social media last month, and parents have organized protests to demand compensation for the affected families…

Asia Pacific
China Orders Recall From Overseas as Vaccine Scandal Churns
Investigators in China have begun recalling defective vaccines produced by a Chinese drugmaker from domestic and overseas markets, health authorities said.
Aug. 8, 2018
BEIJING — Investigators in China have begun recalling defective vaccines produced by a Chinese drugmaker from domestic and overseas markets, health authorities said.
Investigators found Changchun Changsheng Life Sciences Ltd. had blended expired fluids in its vaccines and falsified records from as early as April 2014, the National Health Commission said in a statement Tuesday.
The names of the overseas countries were not given, but the recall indicated the scandal gripping China may have spread to foreign markets, dealing a potentially heavy blow to the reputation of China’s sprawling pharmaceutical sector…

 
Sunday Review
Aug. 4, 2018
Anti-Vaccine Activists Have Taken Vaccine Science Hostage
The fear that even the slightest controversial findings will be distorted is leading to self-censorship.
By Melinda Wenner Moyer
 
Voice of America
Oral Cholera Vaccination Campaign in Yemen Falls Short
8 August 2018
More than one-quarter million people in Yemen have been immunized against cholera. But, the three-day oral cholera vaccination campaign, held by the World Health Organization and U.N. children’s fund between August 4 and 6, has fallen short of its mark by half.
The World Health Organization reports more than 3,000 local health workers have reached 266,000 people above the age of one with oral cholera vaccine. This is about half of the one-half million people WHO and partners had hoped to immunize against this deadly disease.
The three-day campaign took place in two districts of Yemen’s Hudeidah city and one district in Ibb Governorate. WHO Spokesman Tarik Jasarevic said these three districts were chosen because they were assessed to be the most vulnerable to an escalation of cholera.
He said health agencies are trying to prevent a recurrence of last year’s historic cholera epidemic.
“Yemen was facing the worst cholera outbreak with more than 1.1 million cases and more than 2,000 deaths.We want to preempt any possibility of new wave of cholera,” he said.
The World Health Organization warns Yemen may be on the brink of another cholera epidemic, which could be even worse than last year’s. This is because widespread malnutrition in this war-torn country has lessened peoples’ ability to fight off disease…

Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 18 Aug 2018
[No new, unique, relevant content]

Washington Post
http://www.washingtonpost.com/
Accessed 18 Aug 2018
[No new, unique, relevant content]