WHO & Regional Offices [to 12 Jan 2019]

WHO & Regional Offices [to 12 Jan 2019]

“Zero polio transmission and health for all”, WHO Director-General gives new year’s wish to the people of Afghanistan and Pakistan
8 January 2019   News Release
WHO Director-General Dr Tedros Adhanom Ghebreyesus highlighted WHO’s commitment to the final push to eradicate polio on a 4-day visit to Afghanistan and Pakistan – the only two countries where wild poliovirus cases were reported last year. He also commended the governments of both countries for their efforts to provide universal access to health services…

::::::

144th Session of the WHO Executive Board
24 January – 1 February 2019 Coordinated Universal Time
Geneva, Switzerland
[See selected agenda content in Milestones above]

 

::::::

 Weekly Epidemiological Record, 11 January 2019, vol. 94, 01/02 (pp. 1–16)
:: Meeting of the International Task Force for Disease Eradication, April 2018
:: Immunization and Vaccine-related Implementation Research Advisory Committee (IVIR-AC) recommendations  September 2018

::::::

WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO

Selected Featured News
:: New Hope with Ebola Drug Trial  11 January 2019
WHO Region of the Americas PAHO
– No new announcement identified

WHO South-East Asia Region SEARO
:: Polio-free WHO South-East Asia Region
Sanjit Das
On 13 January this year WHO South-East Asia Region marks eight years since the last case of wild poliovirus.
The Region continues to be polio-free due to ongoing efforts by member countries, partners and the people themselves to ensure all children are protected with polio vaccines.
A strict vigil is being maintained against polioviruses.

WHO European Region EURO
:: Close collaboration yields progress on TB prevention and care in the Russian Federation 09-01-2019

WHO Eastern Mediterranean Region EMRO
:: WHO delivers medical supplies to support emergency health care in north-east Syria 9 January 2019
:: WHO Director-General visits Afghanistan for continued efforts on polio eradication and health financing  5 January 2019
WHO Western Pacific Region
– No new announcement identified

 

CDC/ACIP [to 12 Jan 2019]

CDC/ACIP [to 12 Jan 2019]

http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html
Friday, January 11, 2019
CDC Provides First In-Season Estimates of Flu Illnesses, Medical Visits, and Hospitalizations
According to new data released by CDC, so far during the 2018-2019 season between about 6 and 7 million people have been sick with flu, up to half of those people have sought medical care for their illness, and between 69,000 and 84,000 people have been hospitalized from flu.  This is the first time these estimates— which cover the period from October 1, 2018 through January 5, 2019— are being provided during the flu season. CDC has estimated the burden of flu since 2010…

MMWR News Synopsis for Friday, January 1, 2019
Establishing a Baseline for Cervical Cancer Screening Coverage — India, 2015–2016
Among women ages 30-49, fewer than one in three Indian women in the age range for screening for cervical cancer reported having been screened. Measuring cervical cancer screening and identifying socioeconomic factors associated with the acceptance of screening can be used to plan targeted interventions, screening campaigns, and evaluation to help India meet the goal of universal cervical cancer screening. Cervical cancer is the second leading cause of new cancer cases among women in India. In 2016, the Ministry of Health and Family Welfare of India recommended population-based cervical cancer screening for all women ages 30-65 years. In 2015-16, for the first time, one of the largest national surveys (over 700,000 women) conducted in India asked reproductive-aged women if they had ever been screened for cervical cancer. Fewer than one in three Indian women (ages 30-49) reported having been screened for cervical cancer. There was substantial geographic variation, and screening rates were higher among women with more education, greater wealth, and who had ever been married.

 

Announcements

Announcements
 
 
BMGF – Gates Foundation  [to 12 Jan 2019]
http://www.gatesfoundation.org/Media-Center/Press-Releases
No new digest content identified.
 
 
Bill & Melinda Gates Medical Research Institute    [to 12 Jan 2019]
https://www.gatesmri.org/
The Bill & Melinda Gates Medical Research Institute is a non-profit biotech organization. Our mission is to develop products to fight malaria, tuberculosis, and diarrheal diseases—three major causes of mortality, poverty, and inequality in developing countries. The world has unprecedented scientific tools at its disposal; now is the time to use them to save the lives of the world’s poorest people
No new digest content identified.
 
 
CARB-X   [to 12 Jan 2019]
https://carb-x.org/
CARB-X is a non-profit public-private partnership dedicated to accelerating antibacterial research to tackle the global rising threat of drug-resistant bacteria.
No new digest content identified.
 
 
 
CEPI – Coalition for Epidemic Preparedness Innovations  [to 12 Jan 2019]
http://cepi.net/
Posted on 07TH JAN 2019 by Mario Christodoulou
CEPI launches call for proposals to develop vaccines against Rift Valley fever and Chikungunya viruses
OSLO (Norway)
The Coalition for Epidemic Preparedness Innovations (CEPI) has launched a call for proposals to develop human vaccines against Rift Valley fever and Chikungunya viruses. This will be CEPI’s third call for proposals since January, 2017. USD$ 48 million of funding will be made available through this call and it is expected to fund up to eight projects.
The broadening of CEPI’s vaccine portfolio to include Rift Valley fever and Chikungunya viruses has been based on wide consultation and advice from CEPI’s Scientific Advisory Committee and on three main criteria: the public health impact of these diseases, that no vaccines are currently available for human use, and the feasibility of vaccine development.
This opportunity will be open, worldwide, to research and development organisations with expertise in vaccine development. The closing date for funding applications is March 5, 2019…
 
 
EDCTP    [to 12 Jan 2019]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials
Latest news
No new digest content identified.
 
 
Emory Vaccine Center    [to 12 Jan 2019]
http://www.vaccines.emory.edu/
No new digest content identified.
 
 
European Medicines Agency  [to 12 Jan 2019]
http://www.ema.europa.eu/ema/
News and press releases
No new digest content identified.
 
 
European Vaccine Initiative  [to 12 Jan 2019]
http://www.euvaccine.eu/news-events
No new digest content identified.
 
 
FDA [to 12 Jan 2019]
January 07, 2019
Statement from FDA Commissioner Scott Gottlieb, M.D., on the agency’s new actions under the Pre-Cert Pilot Program to promote a more efficient framework for the review of safe and effective digital health innovations
 
 
Fondation Merieux  [to 12 Jan 2019]
http://www.fondation-merieux.org/
Mérieux Foundation co-organized event
Dengue pre-vaccination screening based on serostatus: rapid tests and implementation strategies
January 14 – 16, 2019 – Les Pensières Center for Global Helath, Veyrier du Lac (France)
 
 
Gavi [to 12 Jan 2019]
https://www.gavi.org/
No new digest content identified.
 
 
GHIT Fund   [to 12 Jan 2019]
https://www.ghitfund.org/newsroom/press
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that devastate the world’s poorest people. Other funders include six Japanese pharmaceutical
No new digest content identified.
 
 
Global Fund  [to 12 Jan 2019]
https://www.theglobalfund.org/en/news/
11 January 2019
Global Fund Announces US$14 Billion Target to Step Up the Fight Against AIDS, TB and Malaria Ahead of Lyon Conference in October 2019
[See Milestones above for detail]
 
 
Hilleman Laboratories   [to 12 Jan 2019]
http://www.hillemanlabs.org/
No new digest content identified.
 
 
Human Vaccines Project   [to 12 Jan 2019]
http://www.humanvaccinesproject.org/media/press-releases/
No new digest content identified.
 
 
IAVI  [to 12 Jan 2019]
https://www.iavi.org/newsroom
No new digest content identified.
 
 
IFFIm
http://www.iffim.org/library/news/press-releases/
No new digest content identified.
 
 
IVAC  [to 12 Jan 2019]
https://www.jhsph.edu/research/centers-and-institutes/ivac/index.html
No new digest content identified.
 
 
IVI   [to 12 Jan 2019]
http://www.ivi.int/
IVI News & Announcements
January 4, 2019
IVI Director General addresses ‘neglected diseases’ in STAT News
 
 
JEE Alliance  [to 12 Jan 2019]
https://www.jeealliance.org/
No new digest content identified.
 
 
MSF/Médecins Sans Frontières  [to 12 Jan 2019]
http://www.msf.org/
Selected News; Project Updates, Reports
No new digest content identified.
 
 
NIH  [to 12 Jan 2019]
http://www.nih.gov/news-events/news-releases
January 10, 2019
The science is clear: with HIV, undetectable equals untransmittable
— NIH officials discuss scientific evidence and principles underlying the U=U concept.
ARTICLE: RW Eisinger, CW Dieffenbach, AS Fauci. HIV viral load and transmissibility of HIV infection: undetectable equals untransmittable. Journal of the American Medical Association DOI: 10.1001/jama.2018.21167 (2019).

January 10, 2019
AI approach outperformed human experts in identifying cervical precancer
— Algorithm could revolutionize cervical cancer screening, especially in low-resource settings
 
 
PATH  [to 12 Jan 2019]
https://www.path.org/media-center/
No new digest content identified.
 
 
Sabin Vaccine Institute  [to 12 Jan 2019]
http://www.sabin.org/updates/pressreleases
No new digest content identified.
 
 
UNAIDS [to 12 Jan 2019]
http://www.unaids.org/en
Selected Press Releases/Reports/Statements
10 January 2019
Traversing rivers and jungles to reach indigenous peoples in remote parts of Brazil
Indigenous health worker Jijuké Hukanaru Karajá works as a nurse in the Indigenous Health District of Araguaia, named after one of Brazil’s major rivers located in the eastern Amazon basin. She has been working with indigenous peoples for many years and criss-crosses between Brazil’s cities and indigenous villages to provide crucial health services. Ms Karajá feels very proud to be a part of the Brazilian indigenous public health system, having followed in her father’s footsteps…
 
 
UNICEF  [to 12 Jan 2019]
https://www.unicef.org/media/press-releases
Selected Press Releases/Reports/Statements
No new digest content identified.
 
 
Vaccine Confidence Project  [to 12 Jan 2019]
http://www.vaccineconfidence.org/
No new digest content identified.
 
 
Vaccine Education Center – Children’s Hospital of Philadelphia  [to 12 Jan 2019]
http://www.chop.edu/centers-programs/vaccine-education-center
No new digest content identified.
 
 
Wellcome Trust  [to 12 Jan 2019]
https://wellcome.ac.uk/news
No new digest content identified.
 
 
The Wistar Institute   [to 12 Jan 2019]
https://www.wistar.org/news/press-releases
Press Release
Jan. 8, 2019
First-in-Class DNA-encoded Monoclonal Antibody Therapy Rapidly Advances into the Clinic
Multisector collaboration yields first-in-human clinical trial for testing novel Zika antibody therapy. 
 
 
World Organisation for Animal Health (OIE)   [to 12 Jan 2019]
http://www.oie.int/en/for-the-media/press-releases/2018/
No new digest content identified.

::::::
 
BIO    [to 12 Jan 2019]
https://www.bio.org/insights/press-release
Jan 11 2019
BIO Applauds House Passage of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act
“Members of the House have sent a strong signal to the American people about their commitment to prioritizing health security by providing the resources needed to fully prepare for and defend against biological threats. Strengthening the pipeline of medical products, drugs and devices that will safeguard the nation during an emergency or pandemic is vital to our national security.”
 
 
DCVMN – Developing Country Vaccine Manufacturers Network  [to 12 Jan 2019]
http://www.dcvmn.org/
No new digest content identified.
 
 
IFPMA   [to 12 Jan 2019]
http://www.ifpma.org/resources/news-releases/
10 January 2019
R&D biopharmaceutical industry embraces NEW Code of Practice to boost business integrity worldwide
:: The new Code of Practice in place from 1 January 2019, imposes a complete ban on gifts and promotional aids
:: Industry moves beyond compliance and reaffirms its commitment to ensuring an ethical framework as a way to increase integrity and trust
:: Industry presents new Code to patients and healthcare professionals
 
 
PhRMA    [to 12 Jan 2019]
http://www.phrma.org/press-room
No new digest content identified.

 

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

 

 

Research ethics oversight in Norway: structure, function, and challenges

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 12 Jan 2019)

Debate
Research ethics oversight in Norway: structure, function, and challenges
While the development and evaluation of clinical ethics services in Norway has been recognized internationally, the country’s research ethics infrastructure at times may have been less well developed. In 2016, media interest in the controversial nature of some health services research and pilot studies highlighted gaps in the system with certain types of research having no clear mechanisms through which they may be given due independent consideration. It is not clear that new legislation, implemented in 2017, will address this problem.
Authors: R. Froud, T. J. Meza, K. O. Ernes and A. M. Slowther
Citation: BMC Health Services Research 2019 19:24
Published on: 10 January 2019

Rates of hospitalization and death for all-cause and rotavirus acute gastroenteritis before rotavirus vaccine introduction in Kenya, 2010–2013

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 12 Jan 2019)

Research article
Rates of hospitalization and death for all-cause and rotavirus acute gastroenteritis before rotavirus vaccine introduction in Kenya, 2010–2013
Rotavirus vaccine was introduced in Kenya immunization program in July 2014. Pre-vaccine disease burden estimates are important for assessing vaccine impact.
Authors: Richard Omore, Sammy Khagayi, Billy Ogwel, Reuben Onkoba, John B. Ochieng, Jane Juma, Stephen Munga, Collins Tabu, Sergon Kibet, J. Pekka Nuorti, Frank Odhiambo, Jason M. Mwenda, Robert F. Breiman, Umesh D. Parashar and Jacqueline E. Tate
Citation: BMC Infectious Diseases 2019 19:47
Published on: 11 January 2019
 

Participants’ awareness of ethical compliance, safety and protection during participation in pharmaceutical industry clinical trials: a controlled survey

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 12 Jan 2019)

Research article
Participants’ awareness of ethical compliance, safety and protection during participation in pharmaceutical industry clinical trials: a controlled survey
Authors: Gerardo González-Saldivar, René Rodríguez-Gutiérrez, Jose Luis Viramontes-Madrid, Alejandro Salcido-Montenegro, Neri Alejandro Álvarez-Villalobos, Victoria González-Nava and José Gerardo González-González
Citation: BMC Medical Ethics 2019 20:2
Published on: 8 January 2019
Abstract
Background
The rapid increase of industry-sponsored clinical research towards developing countries has led to potentially complex ethical issues to assess. There is scarce evidence about the perception of these participants about the ethical compliance, security, and protection. We sought to evaluate and contrast the awareness and perception of participants and non-participants of industry-sponsored research trials (ISRT) on ethical, safety, and protection topics.
Methods
A Cases-control survey conducted at twelve research sites in México. Previous and current participants of ISRT (cases) as well as non-participants (controls) with one of four chronic diseases, were asked to complete the survey which focused on ethical compliance and protection issues of ISRT, and the perception of participating in a trial.
Results
A total of 604 cases and 604 controls were surveyed. Cases significantly answered that ethics committees are aware of what is happening in studies (50.5% vs. 33.8%, P = ≤ 0.001), and that medical care of industry-sponsored research trials is better than their usual medical care (77.2% vs. 38.2%, P = < 0.001). The same proportion of cases and controls thought patients must receive economical reimbursement for participating in a research study (49.5% vs. 53.1%, P = 0.205). The informed consent of the pharmaceutical clinical trial was fully read by 90.4% of the cases. Most cases were satisfied or very satisfied with their overall study participation (35.6 and 62.3%, respectively).
Conclusion
Previous and current participants of industry-sponsored research trials have a more positive attitude towards ethics committees, the quality of medical care of the research trials, and the main purpose of economical reimbursements, when compared to non-participants.

 

 

The impact of repeated vaccination on influenza vaccine effectiveness: a systematic review and meta-analysis

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 12 Jan 2019)

Research article
The impact of repeated vaccination on influenza vaccine effectiveness: a systematic review and meta-analysis
Conflicting results regarding the impact of repeated vaccination on influenza vaccine effectiveness (VE) may cause confusion regarding the benefits of receiving the current season’s vaccine.
Authors: Lauren C. Ramsay, Sarah A. Buchan, Robert G. Stirling, Benjamin J. Cowling, Shuo Feng, Jeffrey C. Kwong and Bryna F. Warshawsky
Citation: BMC Medicine 2019 17:9
Published on: 10 January 2019

Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 12 Jan 2019)

Research article
Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination
Understanding reasons for and against vaccination from the parental perspective is critical for designing vaccination campaigns and informing other interventions to increase vaccination uptake in Canada. The o…
Authors: Deborah A. McNeil, Melissa Mueller, Shannon MacDonald, Sheila McDonald, Vineet Saini, James D. Kellner and Suzanne Tough
Citation: BMC Public Health 2019 19:49
Published on: 10 January 2019

Screening of more than 2000 Hungarian healthcare workers’ anti-measles antibody level: results and possible population-level consequences

Epidemiology and Infection
Volume 147 – 2019
https://www.cambridge.org/core/journals/epidemiology-and-infection/latest-issue

Original Paper
Screening of more than 2000 Hungarian healthcare workers’ anti-measles antibody level: results and possible population-level consequences

  1. Lengyel, A. Marossy, N. Ánosi, S. L. Farkas, B. Kele, É. Nemes-Nikodém, V. Szentgyörgyi, I. Kopcsó, M. Mátyus

https://doi.org/10.1017/S0950268818002571
Published online: 11 September 2018, e7
Abstract
Due to the European measles epidemic and the increased number of imported cases, it can be theorised that the risk of exposure among Hungarian healthcare workers (HCWs) has increased. In 2017, the increased measles circulation in the region led to the emergence of smaller local and hospital epidemics. Therefore, our objective was to determine the herd immunity in the high-risk group of HCWs. A hospital-based study of detecting anti-measles IgG activity was performed in 2017 and included 2167 employees of the Military Medical Centre (Hungary). The screening of HCWs presented a good general seropositivity (90.6%). The highest seroprevalence value (99.1%) was found in the age group of 60 years or older. The lowest number of seropositive individuals was seen in the 41–45 years (86.2%) age group, indicating a significant herd immunity gap between groups. Regarding the Hungarian data, there might be gaps in the seroprevalence of the analysed HCWs, implying that susceptible HCWs may generate healthcare-associated infections. This study suggests that despite the extensive vaccination and high vaccine coverage, it is still important to monitor the level of protective antibodies in HCWs, or in a representative group of the whole population of Hungary, and possibly in other countries as well.

 

The determinants of vaccination in a semi-rural area of Vientiane City, Lao People’s Democratic Republic: a qualitative study

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 12 Jan 2019]

Research
The determinants of vaccination in a semi-rural area of Vientiane City, Lao People’s Democratic Republic: a qualitative study
Immunisation is a cost-effective and highly efficacious public health intervention, saving over 20 million lives in the last two decades due to decreases in childhood bacterial infections. In the Lao People’s …
Authors: Vanphanom Sychareun, Lucy Rowlands, Phoutsomphong Vilay, Jo Durham and Alison Morgan
Citation: Health Research Policy and Systems 2019 17:2
Published on: 9 January 2019

Human Papillomavirus Vaccination and School Entry RequirementsPolitically Challenging, but Not Impossible

JAMA Pediatrics
January 2019, Vol 173, No. 1, Pages 3-112
http://archpedi.jamanetwork.com/issue.aspx

Viewpoint
Human Papillomavirus Vaccination and School Entry RequirementsPolitically Challenging, but Not Impossible
Ellen Daley, PhD, MPH; Erika Thompson, PhD, MPH; Gregory Zimet, PhD
JAMA Pediatr. 2019;173(1):6-7. doi:10.1001/jamapediatrics.2018.3327
This Viewpoint promotes implementing state-level school entry requirements for the human papillomavirus vaccine for US adolescents.

Participant Protection in Phase 1 Pediatric Cancer Trials

JAMA Pediatrics
January 2019, Vol 173, No. 1, Pages 3-112
http://archpedi.jamanetwork.com/issue.aspx

Participant Protection in Phase 1 Pediatric Cancer Trials
Jonathan Kimmelman, PhD; Marcin Waligora, PhD; Holly Fernandez Lynch, JD, MBe
JAMA Pediatr. 2019;173(1):8-9. doi:10.1001/jamapediatrics.2018.3629
This Viewpoint describes changes in the regulatory environment for phase 1 research involving children and discusses improvements to patient protection.

Duration of Pediatric Clinical Trials Submitted to the US Food and Drug Administration

JAMA Pediatrics
January 2019, Vol 173, No. 1, Pages 3-112
http://archpedi.jamanetwork.com/issue.aspx

Original Investigation
Duration of Pediatric Clinical Trials Submitted to the US Food and Drug Administration
Kanecia O. Zimmerman, MD, MPH; P. Brian Smith, MD, MPH, MHS; Ann W. McMahon, MD, MS; et al.
JAMA Pediatr. 2019;173(1):60-67. doi:10.1001/jamapediatrics.2018.3227
This study characterizes the duration of clinical trials submitted to the US Food and Drug Administration for pediatric drug approvals, with a focus on drugs used for long-term therapy.
Safety and Immunogenicity of Early Bacillus Calmette-Guérin Vaccination in Infants Who Are Preterm and/or Have Low Birth Weights- A Systematic Review and Meta-analysis
Shiraz Badurdeen, MRCPCH; Andrew Marshall, DPhil; Hazel Daish, MRCPCH; et al.
open access
JAMA Pediatr. 2019;173(1):75-85. doi:10.1001/jamapediatrics.2018.4038
This systematic review and meta-analysis examines the safety and efficacy of bacillus Calmette-Guérin vaccination at birth or later points in infants who are preterm and/or had low birth weights compared with ones who are full term and/or had normal birth weights.

Genomic insights into the 2016–2017 cholera epidemic in Yemen

Nature 
Volume 565 Issue 7738, 10 January 2019
http://www.nature.com/nature/current_issue.html

Letter | 02 January 2019
Genomic insights into the 2016–2017 cholera epidemic in Yemen
Isolates of the Vibrio cholerae O1 serotype Ogawa from Yemen are from a single sublineage of the seventh pandemic El Tor (7PET) lineage and are susceptible to several commonly used antibiotics as well as to polymyxins.
François-Xavier Weill, Daryl Domman […]  & Marie-Laure Quilici

Actively personalized vaccination trial for newly diagnosed glioblastoma

Nature 
Volume 565 Issue 7738, 10 January 2019
http://www.nature.com/nature/current_issue.html

Letter | 19 December 2018
Actively personalized vaccination trial for newly diagnosed glioblastoma
In a phase I trial, highly individualized peptide vaccines against unmutated tumour antigens and neoepitopes elicited sustained responses in CD8+ and CD4+ T cells, respectively, in patients with newly diagnosed glioblastoma.
Norbert Hilf, Sabrina Kuttruff-Coqui […]  & Wolfgang Wick

Medicine in the digital age

Nature Medicine
Volume 25 Issue 1, January 2019
https://www.nature.com/nm/volumes/24/issues/12
Medicine in the digital age
As Nature Medicine celebrates its 25th anniversary, we bring our readers a special Focus on Digital Medicine that highlights the new technologies transforming medicine and healthcare, as well as the related regulatory challenges ahead.

Editorial | 07 January 2019
Medicine in the digital age
As Nature Medicine celebrates its 25th anniversary, we bring you a special Focus on Digital Medicine that highlights the new technologies transforming medicine and healthcare, as well as the related regulatory challenges ahead.

Twenty-five ways clinical trials have changed in the last 25 years

Nature Medicine
Volume 25 Issue 1, January 2019
https://www.nature.com/nm/volumes/24/issues/12
Medicine in the digital age
As Nature Medicine celebrates its 25th anniversary, we bring our readers a special Focus on Digital Medicine that highlights the new technologies transforming medicine and healthcare, as well as the related regulatory challenges ahead.

News Feature | 07 January 2018
Twenty-five ways clinical trials have changed in the last 25 years
Exploring the evolution, from analysis and endpoints to registration and regulations
Mike May

Privacy in the age of medical big data

Nature Medicine
Volume 25 Issue 1, January 2019
https://www.nature.com/nm/volumes/24/issues/12
Medicine in the digital age
As Nature Medicine celebrates its 25th anniversary, we bring our readers a special Focus on Digital Medicine that highlights the new technologies transforming medicine and healthcare, as well as the related regulatory challenges ahead.

Review Article | 07 January 2019
Privacy in the age of medical big data
The increased amount of health care data collected brings with it ethical and legal challenges for protecting the patient while optimizing health care and research.

  1. Nicholson Price II  & I. Glenn Cohen

Disease and Famine as Weapons of War in Yemen

New England Journal of Medicine
January 10, 2019  Vol. 380 No. 2
http://www.nejm.org/toc/nejm/medical-journal

Perspective 
Disease and Famine as Weapons of War in Yemen
Amir M. Mohareb, M.D.,
and Louise C. Ivers, M.D., M.P.H., D.T.M.&H.
Audio Interview
Interview with Dr. Amir Mohareb on the humanitarian crisis and violations of medical neutrality in Yemen. (10:45)Download
The infliction of suffering in the war in Yemen has particularly toxic characteristics that demand attention from health care providers worldwide: the destruction of health care facilities and the spread of disease and hunger as apparent means of waging war.

 

Economic burden of dengue in Indonesia

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 12 Jan 2019)

Economic burden of dengue in Indonesia
Mardiati Nadjib, Ery Setiawan, Septiara Putri, Joshua Nealon, Sophie Beucher, Sri Rezeki Hadinegoro, Vetty Yulianty Permanasari, Kurnia Sari, Tri Yunis Miko Wahyono, Erna Kristin, Dewa Nyoman Wirawan, Hasbullah Thabrany
Research Article | published 10 Jan 2019 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0007038
Abstract
Background
Dengue is associated with significant economic expenditure and it is estimated that the Asia Pacific region accounts for >50% of the global cost. Indonesia has one of the world’s highest dengue burdens; Aedes aegypti and Aedes albopictus are the primary and secondary vectors. In the absence of local data on disease cost, this study estimated the annual economic burden during 2015 of both hospitalized and ambulatory dengue cases in Indonesia.
Methods
Total 2015 dengue costs were calculated using both prospective and retrospective methods using data from public and private hospitals and health centres in three provinces: Yogyakarta, Bali and Jakarta. Direct costs were extracted from billing systems and claims; a patient survey captured indirect and out-of-pocket costs at discharge and 2 weeks later. Adjustments across sites based on similar clinical practices and healthcare landscapes were performed to fill gaps in cost estimates. The national burden of dengue was extrapolated from provincial data using data from the three sites and applying an empirically-derived epidemiological expansion factor.
Results
Total direct and indirect costs per dengue case assessed at Yogyakarta, Bali and Jakarta were US$791, US$1,241 and US$1,250, respectively. Total 2015 economic burden of dengue in Indonesia was estimated at US$381.15 million which comprised US$355.2 million for hospitalized and US$26.2 million for ambulatory care cases.
Conclusion
Dengue imposes a substantial economic burden for Indonesian public payers and society. Complemented with an appropriate weighting method and by accounting for local specificities and practices, these data may support national level public health decision making for prevention/control of dengue in public health priority lists.

Author summary
Dengue, an infection transmitted by mosquitos, is a public health concern particularly in tropical/subtropical areas and the Asia Pacific region where it is associated with a significant cost to society. Indonesia has one of the world’s highest dengue burdens but Indonesia-specific data on cost are lacking. To estimate the annual economic burden of dengue in Indonesia, this study collected data from public/private hospitals and health centres in three provinces (Yogyakarta, Bali and Jakarta) during 2015. We estimated cost of illness using the societal perspective: calculations of costs included those that were directly paid by the healthcare system, as well as costs incurred by the patients (or their family/care givers) and their lost productivity. The costs from the three provinces were then used as the basis for extrapolating cost of illness in Indonesia. The authors confirmed that dengue imposed a substantial economic burden for Indonesian public payers and society. Based on 2015 data, the authors estimated total economic burden of dengue in Indonesia at US$381.15 million. Of this, US$355.2 million related to patients treated in hospitals and US$26.2 million was for patients treated in health centres. Establishing a better understanding of the burden of dengue in Indonesia will help to guide public health decision-making at a national level and support prevention and control initiatives for this disease.

Involving patients and the public in medical and health care research studies: An exploratory survey on participant recruiting and representativeness from the perspective of study authors

PLoS One
http://www.plosone.org/
[Accessed 12 Jan 2019]

Research Article
Involving patients and the public in medical and health care research studies: An exploratory survey on participant recruiting and representativeness from the perspective of study authors
Jonas Lander, Holger Langhof, Marie-Luise Dierks
Research Article | published 07 Jan 2019 PLOS ONE
https://doi.org/10.1371/journal.pone.0204187
Abstract
Research on patient and public involvement so far concentrates on defining involvement, describing its methods, and analyzing involvement practices in various individual research disciplines. There is little empirical data on the process of and aims for selecting (lay) PPI participants, and to what extend they can and should be representative of the population at large. To explore practices and perceptions on these issues and on future PPI conduct more generally, we sent an electronic survey to authors who published involvement activities as part of their studies in medical and social science journals. We identified such authors with a systematic search of five databases and applied descriptive statistics for analysis. Of those who returned the survey (n = 127 of 315; 40%), most had previously conducted involvement activities (73%). 45% reported more than one type of involvement, e.g. consultation and deliberation and participation (14%) and to have recruited more than one type of participant for their PPI activity (56%), e.g. ‘lay publics’ and ‘expert publics’ (33% of 71). Representativeness was often seen as a crucial objective when selecting PPI participants, while less than half found it very easy (9%) or rather easy (34%) to select participants. Many respondents considered achieving good representativeness difficult (52%) or very difficult (17%). They identified significant respective challenges and desired more guidance on various aspects of planning and conducting PPI (56%). 55% thought that the concept of “involvement” should be changed or improved. We conclude that recruiting lay people for PPI activities and deciding about and handling representativeness are controversial in current PPI practice, given the manifold challenges mentioned by the survey respondents. Our findings may inform further research particularly regarding–the potentially many cases of–unpublished PPI.

 

Resource use, costs, and approval times for planning and preparing a randomized clinical trial before and after the implementation of the new Swiss human research legislation

PLoS One
http://www.plosone.org/
[Accessed 12 Jan 2019]

Research Article
Resource use, costs, and approval times for planning and preparing a randomized clinical trial before and after the implementation of the new Swiss human research legislation
Benjamin Speich, Nadine Schur, Dmitry Gryaznov, Belinda von Niederhäusern, Lars G. Hemkens, Stefan Schandelmaier, Alain Amstutz, Benjamin Kasenda, Christiane Pauli-Magnus, Elena Ojeda-Ruiz, Yuki Tomonaga, Kimberly McCord, Alain Nordmann, Erik von Elm, Matthias Briel, Matthias Schwenkglenks, a collaboration of the MARTA (MAking Randomized Trials Affordable) and ASPIRE (Adherence to Standard Protocol Items: REcommendations for interventional trials) Study Groups
Research Article | published 11 Jan 2019 PLOS ONE
https://doi.org/10.1371/journal.pone.0210669

Invasive pneumococcal diseases in children and adults before and after introduction of the 10-valent pneumococcal conjugate vaccine into the Austrian national immunization program

PLoS One
http://www.plosone.org/
[Accessed 12 Jan 2019]

Invasive pneumococcal diseases in children and adults before and after introduction of the 10-valent pneumococcal conjugate vaccine into the Austrian national immunization program
Lukas Richter, Daniela Schmid, Elisabeth Eva Kanitz, Ines Zwazl, Eva Pöllabauer, Joanna Jasinska, Heinz Burgmann, Michael Kundi, Ursula Wiedermann
Research Article | published 10 Jan 2019 PLOS ONE
https://doi.org/10.1371/journal.pone.0210081

Facilitators and barriers for healthcare providers to recommend HPV vaccination to attendees of public sexually transmitted diseases clinics in Hong Kong, China

PLoS One
http://www.plosone.org/
[Accessed 12 Jan 2019]

Facilitators and barriers for healthcare providers to recommend HPV vaccination to attendees of public sexually transmitted diseases clinics in Hong Kong, China
Ying Ying Lee, Zixin Wang
Research Article | published 09 Jan 2019 PLOS ONE
https://doi.org/10.1371/journal.pone.0209942
 
 

Challenges and strategies for developing efficacious and long-lasting malaria vaccines

Science Translational Medicine
09 January 2019  Vol 11, Issue 474
http://stm.sciencemag.org/

Review
Challenges and strategies for developing efficacious and long-lasting malaria vaccines
By James G. Beeson, Liriye Kurtovic, Carlota Dobaño, D. Herbert Opi, Jo-Anne Chan, Gaoqian Feng, Michael F. Good, Linda Reiling, Michelle J. Boyle
Science Translational Medicine09 Jan 2019 Restricted Access
New knowledge and strategies are emerging to enable the development of an efficacious and long-lasting vaccine against malaria.
Abstract
Although there has been major recent progress in malaria vaccine development, substantial challenges remain for achieving highly efficacious and durable vaccines against Plasmodium falciparum and Plasmodium vivax malaria. Greater knowledge of mechanisms and key targets of immunity are needed to accomplish this goal, together with new strategies for generating potent, long-lasting, functional immunity against multiple antigens. Implementation considerations in endemic areas will ultimately affect vaccine effectiveness, so innovations to simplify and enhance delivery are also needed. Whereas challenges remain, recent exciting progress and emerging knowledge promise hope for the future of malaria vaccines.

 

Protocol for a systematic review of the effects of interventions for vaccine stock management

Systematic Reviews
https://systematicreviewsjournal.biomedcentral.com/articles
[Accessed 12 Jan 2019]

Protocol
Protocol for a systematic review of the effects of interventions for vaccine stock management
Inadequate vaccine stock management in health facilities leads to vaccine stock-outs. The latter threatens the success of immunisation programmes. Countries have used various approaches to reduce stock-outs an…
Authors: Chinwe Juliana Iwu, Anelisa Jaca, Leila H. Abdullahi, Ntombenhle Judith Ngcobo and Charles Shey Wiysonge
Citation: Systematic Reviews 2019 8:14
Published on: 8 January 2019

Would immunization be the same without cross-reactivity?

Vaccine
Volume 37, Issue 4  Pages 539-676 (21 January 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/4

Review article  Open access
Would immunization be the same without cross-reactivity?
Ivo Vojtek, Philippe Buchy, T. Mark Doherty, Bernard Hoet
Pages 539-549
Abstract
“Cross-reactivity” (the observed immune response against pathogen types not specifically targeted by the vaccine antigen composition) and “cross-protection” (clinical protection against related non-vaccine microorganism types) are vaccinology concepts that are attracting renewed interest in the context of disease prevention. National health authorities are collecting mounting evidence of the importance of cross-reactivity. For some vaccines, this has been substantiated by cross-protection data from clinical studies and/or post-licensure data, where their introduction into immunization programmes has shown beneficial impacts on disease caused by related non-vaccine microorganisms. This knowledge has influenced the way new vaccines are designed, developed, and evaluated in real-life settings. Some of the new vaccines are now designed with the specific aim of having a greater breadth of protection. Ideal vaccine antigens therefore include epitopes with conserved homology across related pathogen types, because it is not always possible to include the antigens of all the individual types of a given pathogen species. The use of novel adjuvants with greater immunostimulatory properties can also contribute to improved overall vaccine cross-reactivity, as could the use of antigen delivery platforms. The growing body of evidence allows us to better understand the full impact of vaccines – beyond vaccine-type disease – which should be taken into consideration when assessing the full value of vaccination programmes.

Assessing the timeliness of vaccine administration in children under five years in India, 2013

Vaccine
Volume 37, Issue 4  Pages 539-676 (21 January 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/4

Research article  Abstract only
Assessing the timeliness of vaccine administration in children under five years in India, 2013
Abram L. Wagner, Luke M. Shenton, Brenda W. Gillespie, Joseph L. Mathew, Matthew L. Boulton
Pages 558-564

Variations in reason for intention not to vaccinate across time, region, and by race/ethnicity, NIS-Teen (2008–2016)

Vaccine
Volume 37, Issue 4  Pages 539-676 (21 January 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/4

Research article  Abstract only
Variations in reason for intention not to vaccinate across time, region, and by race/ethnicity, NIS-Teen (2008–2016)
Jacqueline M. Hirth, Erika L. Fuchs, Mihyun Chang, Maria E. Fernandez, Abbey B. Berenson
Pages 595-601

Variations in reason for intention not to vaccinate across time, region, and by race/ethnicity, NIS-Teen (2008–2016)

Vaccine
Volume 37, Issue 4  Pages 539-676 (21 January 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/4

Research article  Abstract only
Variations in reason for intention not to vaccinate across time, region, and by race/ethnicity, NIS-Teen (2008–2016)
Jacqueline M. Hirth, Erika L. Fuchs, Mihyun Chang, Maria E. Fernandez, Abbey B. Berenson
Pages 595-601

The potential effects of introducing microneedle patch vaccines into routine vaccine supply chains

Vaccine
Volume 37, Issue 4  Pages 539-676 (21 January 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/4

Research article  Abstract only
The potential effects of introducing microneedle patch vaccines into routine vaccine supply chains
Patrick T. Wedlock, Elizabeth A. Mitgang, Fayad Elsheikh, Jim Leonard, … Bruce Y. Lee
Pages 645-651

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

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

Frontiers in Immunology
2019   doi: 10.3389/fimmu.2019.00008
Strategies to Improve Cancer Vaccine Efficacy
K Vermaelen –
More than many other fields in medicine, cancer vaccine development has been plagued by a wide gap between the massive amounts of highly encouraging preclinicalencouraging preclinical data on one hand, and the disappointing clinical results on the other. It is clear now that traditional approaches from the infectious diseasesdiseases’ vaccine field cannot be borrowed as such to treat cancer.
In this review we will highlights some of the strategies developed to improve vaccine formulations for oncology, including research into more powerful or “smarter” adjuvants to elicit anti-tumoral cellular immune responses.
As an illustration of the difficulties in translating smart preclinical strategies into real benefit for the cancer patient, we will discuss the difficult road of vaccine development in lung cancer is given as example.
Finally, an outline is provided of we will provide an overview of the combinatorial strategies that leverage the increasing knowledge on tumor-associated immune suppressive networks. Indeed, combining with drugs that target the dominant immunosuppressive pathway in a given tumor promises to will unlock the true power of cancer vaccines and potentially offer long-term protection from disease relapse.
 
 

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 12 Jan 2019
[No new, unique, relevant content]
 
 
BBC
http://www.bbc.co.uk/
Accessed 12 Jan 2019
[No new, unique, relevant content]
 
 
The Economist
http://www.economist.com/
Accessed 12 Jan 2019
[No new, unique, relevant content]
 
 
Financial Times
http://www.ft.com/home/uk
Accessed 12 Jan 2019
[No new, unique, relevant content]
 
 
Forbes
http://www.forbes.com/
Accessed 12 Jan 2019
[No new, unique, relevant content]
 
 
Foreign Affairs
http://www.foreignaffairs.com/
Accessed 12 Jan 2019
[No new, unique, relevant content]
 
 
Foreign Policy
http://foreignpolicy.com/
Accessed 12 Jan 2019
[No new, unique, relevant content]
 
 
The Guardian
http://www.guardiannews.com/
Accessed 12 Jan 2019
[No new, unique, relevant content]
 
 
New Yorker
http://www.newyorker.com/
Accessed 12 Jan 2019
[No new, unique, relevant content]
 
 
New York Times
http://www.nytimes.com/
Accessed 12 Jan 2019
[No new, unique, relevant content]
 
 
Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 12 Jan 2019
[No new, unique, relevant content]
 
 
Washington Post
http://www.washingtonpost.com/
Accessed 12 Jan 2019

Opinions
Italy’s right wing is waging a dangerous attack on vaccinations
Michael Gerson · Dec 10, 2018
… Italy’s right-wing coalition government — composed of conservatives and Internet-based populists (including former communists) — has provided a political home for the anti-vaccination movement. The hard core of that movement, according to public-health surveys, is quite small. But its arguments reinforce the questions and fears of a broader 15 to 20 percent of the Italian population who are seriously hesitant about vaccination.

A 2017 Italian law expanding the number of mandatory vaccinations from four to 10 produced significantly greater coverage, as well as a populist backlash. Italy’s new interior minister has said the requirements are “useless and in many cases dangerous.” One senator from the government coalition has compared vaccination scars to “branding for beasts.” The new health minister recently sacked the government’s entire, 30-member science advisory panel, presumably to obtain advice more amenable to populist ideology.

The arguments of the Italian anti-vaccination movement are the same as elsewhere. Its members believe vaccinations are somehow associated with either autism, tumors or allergies. Since there is no reputable science to support this view — none at all — they turn to the language of parental choice and “more freedom” for families in health care. And they often add a conspiratorial element, accusing Big Pharma of making a profit from unnecessary vaccinations…

Vaccines and Global Health: The Week in Review :: 05 January 2019

.– 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_5 jan 2019

– 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

144th Session of the WHO Executive Board

Milestones :: Perspectives

 

144th Session of the WHO Executive Board

24 January – 1 February 2019 Coordinated Universal Time
Geneva, Switzerland
Selected Agenda Content
EB144/1 – Provisional agenda
EB144/1 (annotated) – Provisional agenda (annotated)

EB144/8 – Public health preparedness and response
Report of the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme

EB144/9 – Polio Eradication
EB144/10 – Polio Transition

EB144/11 Rev.1 – Implementation of the 2030 Agenda for Sustainable Development

EB144/12 – Universal health coverage
Primary health care towards universal health coverage
EB144/13 – Universal health coverage
Community health workers delivering primary health care: opportunities and challenges
EB144/14 – Universal health coverage
Preparation for the high-level meeting of the United Nations General Assembly on universal health coverage

EB144/17 – Medicines, vaccines and health products
Access to medicines and vaccines
EB144/18 – Medicines, vaccines and health products
Cancer medicines
EB144/19 – Follow-up to the high-level meetings of the United Nations General Assembly on health-related issues
Antimicrobial resistance

EB144/21 – Follow-up to the high-level meetings of the United Nations General Assembly on health-related issues
Ending tuberculosis

EB144/23 – Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines and other benefits
Implementation of decision WHA71(11) (2018)

EB144/24 – Member State mechanism on substandard and falsified medical products

EB144/27 – Promoting the health of refugees and migrants
Draft global action plan, 2019–2023

Ebola – Democratic Republic of the Congo

Milestones :: Perspectives

Ebola – Democratic Republic of the Congo

 
21: Situation report on the Ebola outbreak in North Kivu 
27 December 2018 [Excerpts]
Situation Update
…As of 25 December 2018, a total of 585 EVD cases, including 537 confirmed and 48 probable cases (Table 1), were reported from 16 health zones in the two neighbouring provinces of North Kivu and Ituri (Figure 1), of which 13 reported at least one confirmed case in the last 21 days (5-25 December 2018). Over this period, 117 confirmed cases were reported from 13 health zones, the majority of which were concentrated in major urban centres and towns in Katwa (30), Komanda (20), Beni (15), Butembo (15), and Mabalako (15), which remain the main hotspots of this outbreak.

Trends in case incidence reflect the continuation of the outbreak across these geographically dispersed areas. The general decrease in the weekly incidence observed in Beni since late October is continuing; however, the outbreak is intensifying in Butembo and Katwa, and new clusters have emerged in other health zones.

Forty-one additional deaths among confirmed and probable cases occurred since our last report on 18 December 2018. Overall, 356 cases have died (case fatality 61%), including 308 among confirmed cases. As of 25 December 2018, 201 patients have recovered and been discharged from ETCs.

A healthcare worker from Mabalako has been reported among the new cases, bringing the number of healthcare workers affected to 54, with 18 deaths…

Case management

On 24 November 2018, MoH announced the launch of a randomized control trial for Ebola therapeutics. This first-ever multi-drug randomized control trial within an outbreak setting, is an important step towards finding an effective evidence-based treatment for Ebola. The trial is coordinated by WHO and led and sponsored by the Democratic Republic of the Congo’s National Institute for Biomedical Research (INRB) which is the principal investigator. The trial has begun in the ALIMA Ebola treatment center (ETC) in Beni, where patients are enrolled in the study after obtaining voluntary informed consent.

Other ETCs continue to provide therapeutics under the MEURI (compassionate use) protocol, in collaboration with the MoH and the INRB, together with supportive care measures. WHO is providing technical clinical expertise on-site and is assisting with the creation of a data safety management board. UNICEF is providing nutritional treatment and psychological support for all hospitalized patients.

As of 25 December 2018, a total of 131 patients were hospitalised in transit centres and ETCs, of whom 29 were laboratory confirmed.

…Implementation of ring vaccination protocol
On 25 December 2018, 138 contacts were vaccinated, along with 201 contacts of contacts and 62 front line workers in 12 vaccination centres.
From 17 to 26 December 2018, 5,491 new people were vaccinated, The cumulative number of people vaccinated as of 26 December 2018 was 53 610.
Vaccination rings were opened around confirmed cases in Vutetse, Kanzulinzuli, Keyshero, Matanda, Muchanga, Vungi, Nyankunde, Wanamahika, and Aloya…

::::::

DONs Ebola virus disease – Democratic Republic of the Congo   
28 December 2018
[Excerpt]
…WHO risk assessment
This outbreak of EVD is affecting north-eastern provinces of the country bordering Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include: travel between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis, malaria), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri at times limits the implementation of response activities. WHO’s risk assessment for the outbreak is currently very high at the national and regional levels; the global risk level remains low. WHO continues to advice against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on currently available information.

As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. The International Health Regulations (IHR 2005) Emergency Committee has advised that failing to intensify these preparedness and surveillance activities would lead to worsening conditions and further spread. WHO will continue to work with neighbouring countries and partners to ensure that health authorities are alerted and are operationally prepared to respond.

::::::

WHO Director-General concludes New Year visit to Ebola-affected areas in the Democratic Republic of the Congo
3 January 2019, News Release, Geneva
WHO Director-General Dr Tedros Adhanom Ghebreyesus traveled over the New Year to Ebola-affected areas in the Democratic Republic of the Congo (DRC) to review the response at this critical phase. Efforts to end the outbreak are continuing after recent disruptions, but further interruptions could have serious consequences, he warned.

Civil unrest resulted in vandalism to an Ebola transit centre in Beni and several other health facilities last week. The insecurity slowed down vaccinations and epidemiological surveillance and follow-up for several days.

“I’m concerned about the impact of the recent disruptions at this critical moment. This outbreak is occurring in the most difficult context imaginable. To end it the response needs to be supported and expanded, not further complicated. Ebola is unforgiving, and disruptions give the virus the advantage,” said Dr Tedros….

Director of the Wellcome Trust and Chair of WHO’s Research and Development Blueprint Dr Jeremy Farrar joined the mission to see the outbreak first-hand.

“I came away humbled by the dedication of the Ebola responders, but worried by the immense challenges they face in such a complex environment. This outbreak is in a critical phase. It is vital the international community recognizes this and ensures the DRC and WHO have the support needed to ensure this outbreak does not spiral out of control,” Dr Farrar said…

::::::

Statement on disruptions to the Ebola response in the Democratic Republic of the Congo
by Dr Tedros Adhanom Ghebreyesus, WHO Director-General
28 December 2018   Statement  Geneva
WHO and partners are continuing to respond to the Ebola outbreak in North Kivu and Ituri provinces in the Democratic Republic of the Congo, despite a deterioration of the security situation since yesterday morning.

Yesterday our teams in Beni were unable to carry out critical field work, including vaccinations, contact tracing, and following up on alerts of potential new cases. Protests at government buildings in Beni spilled over to an Ebola transit centre, frightening people waiting for Ebola test results and the staff who were caring for them. Staff at the centre temporarily withdrew and most suspected cases were transferred to a nearby treatment centre.

In Butembo, some alerts of potential cases were investigated and confirmed cases were referred to treatment centres but teams were unable to trace contacts or to conduct vaccinations.

Response activities have not been interrupted in other affected areas.

We have reached a critical point in the Ebola response. After an intensification of field activities, we were seeing hopeful signs in many areas, including a recent decrease in cases in Beni.

These gains could be lost if we suffer a period of prolonged insecurity, resulting in increased transmission. That would be a tragedy for the local population, who have already suffered too much.

Our teams in Beni and Butembo are doing everything possible to continue responding, despite the challenging security environment. For example, in Beni, contact tracing is being resumed with the support of local community relays, and WHO is supporting local health authorities to undertake other critical surveillance functions where possible.

In general, the communities in affected areas have been supportive of the response. We ask for everyone to protect health facilities and provide access for responders to the affected populations so that we can stop this outbreak. The population must also have safe access to transit and treatment centres that save lives and stop the spread of Ebola.

Working side by side with the Ministry of Health and our partners, our priority is to end the outbreak. We hope to return to full operations as soon as possible while remaining committed to ensuring the safety of all staff deployed. We cannot afford to take a step back at this critical point in the response

 

Emergencies

Emergencies

POLIO
Public Health Emergency of International Concern (PHEIC)
– No new announcements identified

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

Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.

WHO Grade 3 Emergencies  [to 5 Jan 2019]
Democratic Republic of the Congo
:: 21: Situation report on the Ebola outbreak in North Kivu  27 December 2018
:: DONs Ebola virus disease – Democratic Republic of the Congo   28 December 2018
[See Milestones above for more detail]

Bangladesh – Rohingya crisis
:: Weekly Situation Report 57 – 27 December 2018
[Excerpt]

KEY HIGHLIGHTS
:: About 30 health facilities have received exemption from restricted movement during the election period and will remain open to provide essential health services.
:: About 363 411 people (110.6%) benefited from the OCV campaign including 264,280 people (117.5%) from Rohingya population.
:: Since February 2018 to date, a total of 35,148 BCG doses have been given children and 19 906 Td doses to pregnant women.

SITUATION OVERVIEW
:: There are an estimated 908,000 Rohingya refugees (215,796 families) in Cox’s Bazar, according to the latest Needs and Population Monitoring (NPM) round 12 exercise. The Rohingya refugees continue to arrive in Bangladesh, though the overall influx has slowed since the onset of the crisis in late August 2017. Rohingya refugees have continued to arrive in Bangladesh, though in much fewer numbers than the initial influx in late 2017. More than 15,247 new arrivals were reported from 1 January to 30 November 2018 (source: UNHCR). The refugees continue to face compounding vulnerabilities including health.
:: Over the past one year, WHO and the health sector partners responded to the health needs of the affected populations by supporting government health facilities with human resources, renovations and medical supplies; ensuring availability of essential medicines and other supplies through logistics support; maintaining a strong disease surveillance system; delivering vaccination campaigns and strengthening

 

Syrian Arab Republic
:: SIDA donation helps WHO support health care services in southern Syria [Swedish International Development Cooperation Agency]  27 December 2018

Yemen
:: Cholera and malnutrition in Yemen threatens millions

27 December 2018
…WHO works closely with the Ministry of Health and WASH cluster partners to contain cholera outbreaks, offering technical and logistical support to strengthen disease surveillance, assist diarrhoeal treatment and oral rehydration centres, train health workers on case management, deploy rapid response teams and improve sanitation and access to safe water.
There have been 280,198 suspected cases of cholera since the beginning of 2018, and 372 associated deaths. Children under 5 account fort 32% of the total suspected cases. Cholera has been reported in 22 out of Yemen’s 23 governorates, and 306 out of the country’s 333 districts.

Myanmar – No new announcements identified
Nigeria – No new announcements identified
Somalia – No new announcements identified
South Sudan – No new announcements identified

::::::

WHO Grade 2 Emergencies  [to 5 Jan 2019]
occupied Palestinian territory
:: 1.2 million people in the occupied Palestinian territory are in need of humanitarian health assistance – December 2018

Libya
:: WHO condemns attack on Al Jala Hospital in Benghazi
27 December 2018 – The World Health Organization (WHO) strongly condemns the armed attack on Al Jala Hospital in Benghazi, Libya, on 25 December. The attack resulted in damage to the hospital infrastructure.

Brazil (in Portugese) – No new announcements identified
Cameroon  – No new announcements identified
Central African Republic  – No new announcements identified
Ethiopia – No new announcements identified
Hurricane Irma and Maria in the Caribbean – No new announcements identified
– No new announcements identified
Iraq – No new announcements identified
MERS-CoV – No new announcements identified
Niger – No new announcements identified
Sao Tome and Principe Necrotizing Cellulitis (2017) – No new announcements identified
Sudan – No new announcements identified
Ukraine – No new announcements identified
Zimbabwe – No new announcements identified

WHO-AFRO: Outbreaks and Emergencies Bulletin, Week 52: 22 – 28 December 2018
The WHO Health Emergencies Programme is currently monitoring 59 events in the region. This week’s edition covers key ongoing events, including:
:: Ebola virus disease outbreak in the Democratic Republic of the Congo
:: Measles in Madagascar
:: Humanitarian crisis in Nigeria.

 
::::::
 

WHO Grade 1 Emergencies  [to 5 Jan 2019]
Afghanistan
Chad
Indonesia – Sulawesi earthquake 2018
Kenya
Lao People’s Democratic Republic
Mali
Namibia – viral hepatitis
Peru
Philippines – Tyhpoon Mangkhut
Tanzania

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

UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic   – No new announcements identified
Yemen – No new announcements identified

::::::

UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Ethiopia 
:: Operational Plan for Rapid Response: Internal Displacement around Kamashi and Assosa (Benishangul Gumuz) and East and West Wollega (Oromia), 26 December 2018

Somalia 
:: Humanitarian Bulletin Somalia, 1 – 31 December 2018

::::::

“Other Emergencies”
Indonesia: Central Sulawesi Earthquake
:: 24 December 2018  –  Central Sulawesi Earthquake & Tsunami – Humanitarian Country Team Situation Report #10 (as of 10 December 2018)

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

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 5 Jan 2019]
http://www.who.int/ebola/en/
:: 19: Situation report on the Ebola outbreak in North Kivu  12 December 2018
:: DONs Ebola virus disease – Democratic Republic of the Congo   13 December 2018
[See Milestones above for more detail]

MERS-CoV [to 5 Jan 2019]
http://who.int/emergencies/mers-cov/en/
No new announcements identified.

Yellow Fever  [to 5 Jan 2019]
http://www.who.int/csr/disease/yellowfev/en/
No new announcements identified.

Zika virus  [to 5 Jan 2019]
http://www.who.int/csr/disease/zika/en/
No new announcements identified.

 

 

WHO & Regional Offices [to 5 Jan 2019]

WHO & Regional Offices [to 5 Jan 2019]

144th Session of the WHO Executive Board
24 January – 1 February 2019 Coordinated Universal Time
Geneva, Switzerland
[See selected agenda content in Milestones above]

 ::::::

 
WHO Director-General concludes New Year visit to Ebola-affected areas in the Democratic Republic of the Congo
3 January 2019, News Release, Geneva
[See Ebola above for detail]

 
Statement on disruptions to the Ebola response in the Democratic Republic of the Congo
by Dr Tedros Adhanom Ghebreyesus, WHO Director-General
28 December 2018   Statement  Geneva
[See Ebola above for detail]

::::::

WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: WHO Director-General applauds Uganda’s Ebola preparedness response  03 January 2019
:: Ethiopia launched new guideline for reaching missed tuberculosis cases  27 December 2018

WHO Region of the Americas PAHO
– No new announcement identified

WHO South-East Asia Region SEARO
– No new announcement identified

WHO European Region EURO
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WHO Eastern Mediterranean Region EMRO
:: WHO condemns attack on Al Jala Hospital in Benghazi  27 December 2018
:: SIDA donation helps WHO support health care services in southern Syria  27 December 2018

WHO Western Pacific Region
– No new announcement identified

 

CDC [U.S.] – MMWR News Synopsis for Friday, January 4, 2019

CDC/ACIP [to 5 Jan 2019]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html
 
MMWR News Synopsis for Friday, January 4, 2019
Human Rabies — Virginia, 2017
While human rabies deaths are rare in the United States, they are still highly prevalent in many other countries. Travelers to other countries should consult the CDC Yellow Book and their medical provider prior to travels to countries where rabies is present, particularly if they are engaging in activities that will put them in close proximity to animals such as dogs, cats, and wildlife. A 65-year-old Virginia resident died from rabies after being bitten by a puppy while vacationing in India. Rabies is a highly lethal virus, but is preventable when medical care and vaccination are sought shortly after an exposure. Unfortunately, the victim did not seek medical care after the bite, and six weeks later developed the first signs of rabies after returning to her home in Virginia. Despite intensive medical care, the victim passed away. Rabies is primarily transmitted by bites from animals when virus in the saliva is introduced into a victim’s body. In very rare occasions, non-bite transmission may occur when saliva infects fresh open wounds or mucous membranes (such as the eyes or mouth). A public health investigation identified 72 hospital staff with suspected exposures to infectious materials; all were advised to receive vaccination.