Author Archives: davidrcurry

Underlying trend, seasonality, prediction, forecasting and the contribution of risk factors: an analysis of globally reported cases of Middle East Respiratory Syndrome Coronavirus

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Epidemiology and Infection
Volume 146 – Issue 11 – August 2018
https://www.cambridge.org/core/journals/epidemiology-and-infection/latest-issue

MERS-CoV
Original Paper
Underlying trend, seasonality, prediction, forecasting and the contribution of risk factors: an analysis of globally reported cases of Middle East Respiratory Syndrome Coronavirus
Omar B. Da’ar, Anwar E. Ahmed
https://doi.org/10.1017/S0950268818001541
Published online: 11 June 2018, pp. 1343-1349

Managing emerging transnational public health security threats: lessons learned from the 2014 West African Ebola outbreak

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Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 28 Jul 2018]

Research
Managing emerging transnational public health security threats: lessons learned from the 2014 West African Ebola outbreak
Pandemics pose significant security/stability risks to nations with fragile infrastructures. We evaluated characteristics of the 2014 West African Ebola outbreak to elucidate lessons learned for managing trans…
Authors: Aaron M. Wendelboe, Micah McCumber, Julie Erb-Alvarez, Nicholas Mould, Richard W. Childs and James L. Regens
Citation: Globalization and Health 2018 14:75
Published on: 27 July 2018

Strengthening health system leadership for better governance: what does it take?

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Health Policy and Planning
Volume 33, Issue suppl_2, July 2018
https://academic.oup.com/heapol/issue/33/suppl_2
SUPPLEMENT: Experiences of African health system leadership and its development

Editorial
Strengthening health system leadership for better governance: what does it take?
Lucy Gilson; Irene Akua Agyepong
Health Policy and Planning, Volume 33, Issue suppl_2, 1 July 2018, Pages ii1–ii4, https://doi.org/10.1093/heapol/czy052
Abstract
This editorial provides an overview of the six papers included in this special supplement on health leadership in Africa. Together the papers provide evidence of leadership in public hospital settings and of initiatives to strengthen leadership development. On the one hand, they demonstrate both that current leadership practices often impact negatively on staff motivation and patient care, and that contextual factors underpin poor leadership. On the other hand, they provide some evidence of the positive potential of new forms of participatory leadership, together with ideas about what forms of leadership development intervention can nurture new forms of leadership. Finally, the papers prompt reflection on the research needed to support the implementation of such interventions.

Clinician perspectives on strategies to improve patient maternal immunization acceptability in obstetrics and gynecology practice settings

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Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 14, Issue 7 2018
http://www.tandfonline.com/toc/khvi20/current

Clinician perspectives on strategies to improve patient maternal immunization acceptability in obstetrics and gynecology practice settings
Paula M. Frew, Laura A. Randall, Fauzia Malik, Rupali J. Limaye, Andrew Wilson, Sean T. O’Leary, Daniel Salmon, Meghan Donnelly, Kevin Ault, Matthew Z. Dudley, Vincent L. Fenimore & Saad B. Omer
Pages: 1548-1557
Published online: 15 Feb 2018

A retrospective and prospective look at strategies to increase adolescent HPV vaccine uptake in the United States

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Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 14, Issue 7 2018
http://www.tandfonline.com/toc/khvi20/current

Review
A retrospective and prospective look at strategies to increase adolescent HPV vaccine uptake in the United States
Katharine J. Head, Erika Biederman, Lynne A. Sturm & Gregory D. Zimet
Pages: 1626-1635
Published online: 23 Feb 2018

Misinformation on vaccination: A quantitative analysis of YouTube videos

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Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 14, Issue 7 2018
http://www.tandfonline.com/toc/khvi20/current

Article
Misinformation on vaccination: A quantitative analysis of YouTube videos
Gabriele Donzelli, Giacomo Palomba, Ileana Federigi, Francesco Aquino, Lorenzo Cioni, Marco Verani, Annalaura Carducci & Pierluigi Lopalco
Pages: 1654-1659
Published online: 10 May 2018

Willingness to pay for an Ebola vaccine during the 2014–2016 ebola outbreak in West Africa: Results from a U.S. National sample

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Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 14, Issue 7 2018
http://www.tandfonline.com/toc/khvi20/current

Article
Willingness to pay for an Ebola vaccine during the 2014–2016 ebola outbreak in West Africa: Results from a U.S. National sample
Julia E. Painter, Michael E. von Fricken, Suyane Viana de O. Mesquita & Ralph J. DiClemente
Pages: 1665-1671
Published online: 15 Feb 2018

Evaluation of the impact of Shandong illegal vaccine sales incident on immunizations in China

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Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 14, Issue 7 2018
http://www.tandfonline.com/toc/khvi20/current

Article
Evaluation of the impact of Shandong illegal vaccine sales incident on immunizations in China
Lei Cao, Jingshan Zheng, Lingsheng Cao, Jian Cui & Qiyou Xiao
Pages: 1672-1678
Published online: 19 Jun 2018
ABSTRACT
A case of illegal vaccine sales in Shandong province, China, (hereinafter, the incident), which caused a lack of confidence among vaccination recipients and public panic, was uncovered in March 2016. We conducted a study comprising two cross-sectional surveys: at two months (May 2016) and seven months (October 2016) after the incident. The study aimed to evaluate the impact on immunizations; investigate the variation of the immunization coverage of the National Immunization Program Vaccines (NIPV) and the sales volume growth rate of Category II vaccines; and understand the reasons for non-vaccination and perspectives on immunization. The immunization coverage of NIPV decreased by 5.6 percentage points in the first survey, with a decline of 11.1 in the region of the incident, and decreased by 0.6 in the second survey compared to same period in 2015. The sales volume growth rate of Category II vaccines decreased by 25.8% in the study area and by 48.8% in the region of the incident in April 2016 compared to April 2015. Overall, 15.8% of respondents in the first survey and 7.0% in the second survey did not vaccinate their children according to the NIPV schedule because of the incident (X2=78.463, P<0.05). The vaccination was likely affected by the incident in varying degrees, especially in the involved region and particularly in relation to Category II vaccines. Overall, 34% of respondents avoided Category II vaccines for their children, indicating that it will take considerable time to eliminate the negative stigma associated with the incident.

 

Who calls the shots? The ethics of adolescent self-consent for HPV vaccination

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Journal of Medical Ethics
August 2018 – Volume 44 – 8
http://jme.bmj.com/content/current

Law, ethics and medicine
Who calls the shots? The ethics of adolescent self-consent for HPV vaccination (26 July, 2018)
Suchi Agrawal, Stephanie R Morain
Abstract
While the human papillomavirus (HPV) vaccine is medically indicated to reduce the risk of genital warts and certain types of cancer, rates of HPV vaccination repeatedly fall short of public health goals. Individual-level factors contributing to low vaccination rates are well documented. However, system-level barriers, particularly the need for parental consent, have been less explored. To date, there is no legal or ethical consensus in the USA regarding whether adolescents might permissibly self-consent to the HPV vaccine. Consequently, there is considerable variability in medical practice at the provider and state level. In this essay, we explore the ethical acceptability of vaccinating adolescents for HPV without parental consent. We argue that the same ethical considerations that justify permitting minors to consent to treatment for sexual and reproductive health care—namely, public health benefit and adolescents’ developing autonomy—similarly justify permitting minors to consent to HPV vaccination. Based on this analysis, we conclude that allowing adolescents to self-consent to the HPV vaccine is ethically justifiable and should be reflected in US state policies.

Reporting suspected abuse or neglect in research involving children

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Journal of Medical Ethics
August 2018 – Volume 44 – 8
http://jme.bmj.com/content/current

Research ethics
Reporting suspected abuse or neglect in research involving children (26 July, 2018)
David B Resnik, Duncan C Randall
Abstract
In this article, we explore the ethical issues related to the reporting of suspected abuse or neglect in research involving children. Ethical dilemmas related to reporting child maltreatment are often complex because the rights of children and their adult caregivers may conflict and determinations of abuse or neglect are socially constructed judgments that depend on particular circumstances. We argue that when reporting is legally mandated, investigators must follow the law and report their suspicions to Child Protective Services. When reporting is not legally mandated, investigators still have an ethical obligation to report to help prevent additional maltreatment and allow children to obtain access to services needed to recover from abuse or neglect. We also argue that investigators should include plans and procedures in the research protocol for making reports and training research staff in recognising evidence of child abuse or neglect. Although investigators should report evidence of abuse or neglect that is discovered incidentally, they have no mandate to actively search for such evidence when it is not related to the study’s objectives. Investigators should also inform parents and children about their obligations to report suspected abuse or neglect.

Public Perception Analysis of Tweets During the 2015 Measles Outbreak: Comparative Study Using Convolutional Neural Network Models

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Journal of Medical Internet Research
Vol 20, No 7 (2018): July
http://www.jmir.org/2018/7

Infodemiology and Infoveillance
Public Perception Analysis of Tweets During the 2015 Measles Outbreak: Comparative Study Using Convolutional Neural Network Models
Jingcheng Du, Lu Tang, Yang Xiang, Degui Zhi, Jun Xu, Hsing-Yi Song, Cui Tao
J Med Internet Res 2018 (Jul 09); 20(7):e236

Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society—Lancet Commission

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The Lancet
Jul 28, 2018 Volume 392 Number 10144 p253-358
https://www.thelancet.com/journals/lancet/issue/current

The Lancet Commissions
Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society—Lancet Commission
Linda-Gail Bekker, George Alleyne, Stefan Baral, Javier Cepeda, Demetre Daskalakis, David Dowdy, Mark Dybul, Serge Eholie, Kene Esom, Geoff Garnett, Anna Grimsrud, James Hakim, Diane Havlir, Michael T Isbell, Leigh Johnson, Adeeba Kamarulzaman, Parastu Kasaie, Michel Kazatchkine, Nduku Kilonzo, Michael Klag, Marina Klein, Sharon R Lewin, Chewe Luo, Keletso Makofane, Natasha K Martin, Kenneth Mayer, Gregorio Millett, Ntobeko Ntusi, Loyce Pace, Carey Pike, Peter Piot, Anton Pozniak, Thomas C Quinn, Jurgen Rockstroh, Jirair Ratevosian, Owen Ryan, Serra Sippel, Bruno Spire, Agnes Soucat, Ann Starrs, Steffanie A Strathdee, Nicholas Thomson, Stefano Vella, Mauro Schechter, Peter Vickerman, Brian Weir, Chris Beyrer

Key messages

:: The HIV pandemic is not on track to end, and the prevailing discourse on ending AIDS has bred a dangerous complacency and may have hastened the weakening of global resolve to combat HIV

:: Existing HIV tools and strategies are insufficient, and although dramatic gains can be made through maximizing existing prevention and treatment strategies, the HIV pandemic is likely to remain a major global challenge for the foreseeable future

:: Tens of millions of people will require sustained access to antiretroviral therapy for decades to come, vigilance will be needed to prevent a resurgence of the epidemic as the largest-ever generation of young people age into adolescence and young adulthood, and intensified efforts are required to address HIV among populations and settings that are being left behind

:: Allowing the pandemic to rebound after achieving such remarkable progress would not only increase the human and financial costs of HIV, but it would potentially demoralise the global health field and diminish support for similarly ambitious global health undertakings

:: A rejuvenated global effort on HIV is essential; to renew and strengthen the global HIV response, the world’s impressive commitment to the scaling up of HIV treatment services must be matched by a similarly robust commitment to expanded access to HIV prevention

:: The HIV response must make common cause with the broader global health field to herald a new era of global solidarity for health, and specific action is urgently needed to respond to the rapidly rising health toll associated with non-communicable diseases, including taking health into account in the development of public policies of all kinds. HIV services should, where feasible, be integrated with broader health services, in co-located sites where possible, with the aim of improving both HIV-related and non-HIV-specific health outcomes; greater integration of HIV and global health must preserve and build on key attributes of the HIV response, including participatory community and civil society engagement and an ironclad commitment to human rights, gender equality, and equitable access to health and social justice

:: The new era of global health solidarity should focus on the development of robust, flexible, people-centred health systems to end communicable diseases, develop effective measures to address the steady rise of non-communicable diseases, achieve universal health coverage, provide coordinated services tailored to the needs of health service users, and effectively address the social and structural determinants of health

Implications of converging conflicts, emergencies, and mass gatherings for global health security

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Lancet Global Health
Aug 2018 Volume 6 Number 8 e811-e932
http://www.thelancet.com/journals/langlo/issue/current

Comment
Implications of converging conflicts, emergencies, and mass gatherings for global health security
Habida Elachola, Seydou Doumbia, Rana F Kattan, Ibrahim Abubakar, Ziad A Memish
In 2017, 29 countries received UN humanitarian assistance, with coverage reaching 93 million people.1 In 2014–15, three west African countries experienced Ebola-virus-related emergencies that adversely affected health systems.2 Man-made and natural emergencies lead to weakening or cessation of disease control efforts and surveillance systems, allowing outbreaks of infectious diseases to go undetected before reaching epidemic thresholds.3 Ample historical evidence suggests an ecological association between conflicts and diseases; examples include the Roman civil war in 165–189 (the Antonine plague), the Crimean war in 1854–55 (cholera), and World War 2 in 1939–45 (diphtheria).4

The consequences of ongoing conflicts and recent emergencies transcend nations and affect public health in all countries. With international travel, diseases with short incubation periods and high infectiousness, such as measles,5 have the potential to find a niche in marginalised populations worldwide. The emergence of measles in 14 European countries in 2017, and more recently in Venezuela, underscores the fact that although conflict-related disruptions might be unique to developing countries, they create infectious reservoirs that pose a risk to stable and developed health systems. Yemen’s cholera outbreak persists amidst the ongoing conflict. Outbreaks of cholera, Ebola, and yellow fever happened in The Democratic Republic of the Congo amidst a long conflict. The post-earthquake epidemic of south Asian cholera in Haiti in 2010–12, which was transmitted by Nepalese UN peacekeepers,6 is perhaps the most recent reminder that despite advances in all aspects of disease surveillance and prevention services, disease will continue to spread via unsuspected routes of transmission.

Several aspects of conflicts and emergencies are of concern during mass gatherings. First, the UN has recorded more conflicts in the Middle Eastern and African regions than in other regions. These regions also constitute the largest group of countries participating in the Hajj, with a population that amounts to more than 90% of all international pilgrims (table). In 2018, 12 million pilgrims are expected to visit Saudi Arabia for both Hajj and Umrah.7 Second, because of the substantial interconnectedness of the affected regions through international air travel, migration, and trade, even countries that do not have conflicts become transit points for potential disease transmission. Third, nearly half of all deaths from infectious diseases affect people in the African region (16 of the 29 countries in humanitarian crisis are home to 93% of pilgrims), making this region a very vulnerable hotspot for emerging diseases. The Asia and Pacific regions (with two of 29 countries in humanitarian crisis) are affected by drug-resistant tuberculosis, cholera, malaria, and emerging strains of avian influenza.7, 8, 9 Finally, from anecdotal evidence of the spread of 1957 influenza to national and international meningococcal meningitis outbreaks and polio during the Hajj, mass gatherings have been linked to infectious disease transmission due to factors such as overcrowding, high numbers of viral influenza-like illness, and the gathering of millions of people in a small geographical area.7, 8, 9

In view of the disruption of public health systems in conflicted regions and countries, mass gathering events are an opportunity for one-stop sentinel surveillance and public health interventions with rapid tests, storage infrastructure for biological specimens for future investigation, and assessment of measures to stop transmission.10 This opportunity for multicountry surveillance programmes in a single venue and within a specific timeframe is of particular interest to regions and countries in conflict and to international partners. The 2009 pH1N1 pandemic and the Hajj showed the potential of mass gatherings for disease surveillance and assessment of control measures.11

No single intervention can address all aspects of disease transmission during mass gatherings amidst ongoing conflicts, but a combination of efforts by host and home countries of visitors and pilgrims can help prepare for outbreaks. Available tools include education and awareness-generating programmes provided before departure and during travel to mass gatherings as well as during predeparture health visits, mandatory travel vaccinations, visa restrictions (as appropriate), arrival and departure health checks at points of entry or departure, prophylaxis for known diseases (such as for polio provided at Jeddah airport during the Hajj for pilgrims arriving from countries with ongoing transmission, and temperature and symptom screening for Ebola virus during outbreaks), surveillance using live electronic reporting, and easily accessible care and prevention activities at venues of mass gathering.7, 10, 11 Support and coordination with some international entities, including WHO, the International Air Transport Association, and transportation companies, will help improve results with these measures. Adequate financing might not be available from one country alone, and collective contribution would be necessary.12 No single entity can fully be responsible for the implementation of these measures, and collaboration and coordination are key to success.

We declare no competing interests. [References at title link above]

WHO preferred product characteristics for new vaccines against tuberculosis

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Lancet Infectious Diseases
Aug 2018 Volume 18 Number 8 p813-924  e217-e258
http://www.thelancet.com/journals/laninf/issue/current

Comment
WHO preferred product characteristics for new vaccines against tuberculosis
Lewis K Schrager, Padmapriyadarsini Chandrasekaran, Bernard H Fritzell, Mark Hatherill, Paul-Henri Lambert, Helen McShane, Nadia Tornieporth, Johan Vekemans
Just a few months away from the UN General Assembly’s first ever meeting on tuberculosis, it is useful to emphasise a central assumption of the WHO’s End TB strategy: a new vaccine against tuberculosis halting the spread of drug-sensitive and drug-resistant Mycobacterium tuberculosis strains is required to reach the expressed goals…1

 

Antimalarial activity of single-dose DSM265, a novel plasmodium dihydroorotate dehydrogenase inhibitor, in patients with uncomplicated Plasmodium falciparum or Plasmodium vivax malaria infection: a proof-of-concept, open-label, phase 2a study

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Lancet Infectious Diseases
Aug 2018 Volume 18 Number 8 p813-924  e217-e258
http://www.thelancet.com/journals/laninf/issue/current

Articles
Antimalarial activity of single-dose DSM265, a novel plasmodium dihydroorotate dehydrogenase inhibitor, in patients with uncomplicated Plasmodium falciparum or Plasmodium vivax malaria infection: a proof-of-concept, open-label, phase 2a study
Alejandro Llanos-Cuentas, Martin Casapia, Raúl Chuquiyauri, Juan-Carlos Hinojosa, Nicola Kerr, Maria Rosario, Stephen Toovey, Robert H Arch, Margaret A Phillips, Felix D Rozenberg, Jade Bath, Caroline L Ng, Annie N Cowell, Elizabeth A Winzeler, David A Fidock, Mark Baker, Jörg J Möhrle, Rob Hooft van Huijsduijnen, Nathalie Gobeau, Nada Araeipour, Nicole Andenmatten, Thomas Rückle, Stephan Duparc

Safety, pharmacokinetics, and immunogenicity of a co-formulated cocktail of three human monoclonal antibodies targeting Ebola virus glycoprotein in healthy adults: a randomised, first-in-human phase 1 study

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Lancet Infectious Diseases
Aug 2018 Volume 18 Number 8 p813-924  e217-e258
http://www.thelancet.com/journals/laninf/issue/current

Safety, pharmacokinetics, and immunogenicity of a co-formulated cocktail of three human monoclonal antibodies targeting Ebola virus glycoprotein in healthy adults: a randomised, first-in-human phase 1 study
Sumathi Sivapalasingam, Mohamed Kamal, Rabih Slim, Romana Hosain, Weiping Shao, Randall Stoltz, Joseph Yen, Laura G Pologe, Yuan Cao, Michael Partridge, Giane Sumner, Leah Lipsich

Effect of Dengue Serostatus on Dengue Vaccine Safety and Efficacy  

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New England Journal of Medicine
July 26, 2018   Vol. 379 No. 4
http://www.nejm.org/toc/nejm/medical-journal

Original Articles
Effect of Dengue Serostatus on Dengue Vaccine Safety and Efficacy  
Saranya Sridhar, M.B., B.S., D.Phil., Alexander Luedtke, Ph.D., Edith Langevin, M.Sc., Ming Zhu, Ph.D., Matthew Bonaparte, Ph.D., Tifany Machabert, M.Sc., Stephen Savarino, M.D., M.P.H., Betzana Zambrano, M.D., Annick Moureau, M.Sc., Alena Khromava, M.D., M.P.H., Zoe Moodie, Ph.D., Ted Westling, B.S., Cesar Mascareñas, M.D., Carina Frago, M.D., Margarita Cortés, M.D., Danaya Chansinghakul, M.D., Fernando Noriega, M.D., Alain Bouckenooghe, M.D., M.P.H., Josh Chen, Ph.D., Su-Peing Ng, M.B., B.S., Peter B. Gilbert, Ph.D., Sanjay Gurunathan, M.D., and Carlos A. DiazGranados, M.D.

Identifying Areas at Greatest Risk for Recent Zika Virus Importation — New York City, 2016

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PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
[Accessed 28 Jul 2018]

Identifying Areas at Greatest Risk for Recent Zika Virus Importation — New York City, 2016
July 25, 2018 · Research Article

Introduction: The New York City Department of Health and Mental Hygiene sought to detect and minimize the risk of local, mosquito-borne Zika virus (ZIKV) transmission. We modeled areas at greatest risk for recent ZIKV importation, in the context of spatially biased ZIKV case ascertainment and no data on the local spatial distribution of persons arriving from ZIKV-affected countries.

Methods: For each of 14 weeks during June-September 2016, we used logistic regression to model the census tract-level presence of any ZIKV cases in the prior month, using eight covariates from static sociodemographic census data and the latest surveillance data, restricting to census tracts with any ZIKV testing in the prior month. To assess whether the model discriminated better than random between census tracts with and without recent cases, we compared the area under the receiver operating characteristic (ROC) curve for each week’s fitted model versus an intercept-only model applied to cross-validated data. For weeks where the ROC contrast test was significant at P < 0.05, we output and mapped the model-predicted individual probabilities for all census tracts, including those with no recent testing.

Results: The ROC contrast test was significant for 8 of 14 weekly analyses. No covariates were consistently associated with the presence of recent cases. Modeled risk areas fluctuated across these 8 weeks, with Spearman correlation coefficients ranging from 0.30 to 0.93, all P < 0.0001. Areas in the Bronx and upper Manhattan were in the highest risk decile as of late June, while as of late August, the greatest risk shifted to eastern Brooklyn.

Conclusion: We used observable characteristics of areas with recent, known travel-associated ZIKV cases to identify similar areas with no observed cases that might also be at-risk each week. Findings were used to target public education and Aedes spp. mosquito surveillance and control. These methods are applicable to other conditions for which biased case ascertainment is suspected and knowledge of how cases are geographically distributed is important for targeting public health activities.

 

Sexual transmission of Zika virus and other flaviviruses: A living systematic review

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PLoS Medicine
http://www.plosmedicine.org/
(Accessed 28 Jul 2018)

Research Article
Sexual transmission of Zika virus and other flaviviruses: A living systematic review
Michel Jacques Counotte, Caron Rahn Kim, Jingying Wang, Kyle Bernstein, Carolyn D. Deal, Nathalie Jeanne Nicole Broutet, Nicola Low
| published 24 Jul 2018 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002611

One million dog vaccinations recorded on mHealth innovation used to direct teams in numerous rabies control campaigns

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PLoS One
http://www.plosone.org/
[Accessed 28 Jul 2018]

Research Article
One million dog vaccinations recorded on mHealth innovation used to direct teams in numerous rabies control campaigns
Andrew D. Gibson, Stella Mazeri, Frederic Lohr, Dagmar Mayer, Jordana L. Burdon Bailey, Ryan M. Wallace, Ian G. Handel, Kate Shervell, Barend M.deC. Bronsvoort, Richard J. Mellanby, Luke Gamble
Research Article | published 26 Jul 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0200942

Estimating the cost-effectiveness of an infant 13-valent pneumococcal conjugate vaccine national immunization program in China

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PLoS One
http://www.plosone.org/
[Accessed 28 Jul 2018]

Research Article
Estimating the cost-effectiveness of an infant 13-valent pneumococcal conjugate vaccine national immunization program in China
Kunling Shen, Matthew Wasserman, Dongdong Liu, Yong-Hong Yang, Junfeng Yang, Greg F. Guzauskas, Bruce C. M. Wang, Betsy Hilton, Raymond Farkouh
| published 25 Jul 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0201245
 

A renewed focus on preventing malaria in pregnancy

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Reproductive Health
http://www.reproductive-health-journal.com/content
[Accessed 28 Jul 2018]

Commentary
|   27 July 2018
A renewed focus on preventing malaria in pregnancy
Authors: Erin K. Ferenchick, Elaine Roman, Katherine Wolf, Lia Florey, Susan Youll, Viviana Mangiaterra, Koki Agarwal and Julie Gutman
Abstract
While much progress has been achieved globally in the fight against malaria, the significant financial investments made to date have not translated into scaled-up malaria in pregnancy (MiP) prevention efforts. Mothers and newborns remain at risk, and now is the time to refocus efforts. Against the backdrop of a new global health architecture embodied by the principles of Every Women, Every Child and driven by the work of the H6 Partnership, Global Financing Facility, strong bilaterals and key financiers, there is a new and timely juncture to advocate for MiP. Recent updates in the WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience present an opportunity to strengthen MiP as a core maternal and child health issue and position MiP prevention as a priority.

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

 

 

 

Marvelous models

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Science         
27 July 2018  Vol 361, Issue 6400
http://www.sciencemag.org/current.dtl
Special Issue – Frontiers in computation

Introduction to special issue

Marvelous models
By Michael Funk, Colin Norman, Keith T. Smith, Jelena Stajic, Jake Yeston
Science27 Jul 2018 : 342-343
Scientists learn about the world by observing, manipulating, measuring, and abstracting. To make sure that they truly understand their system, and to gain insight beyond what experimental data can provide, many also turn to building mathematical models. Some models are based directly on fundamental physical laws, but most rely on approximations. The computational costs vary widely—from exactly solvable models to those that require all the computer power you can get. This power has become increasingly accessible; throw in the recent forays of artificial intelligence into scientific computing and the tantalizing promise of quantum computers, and it’s clear that exciting times are ahead.

In this special issue, we highlight several areas of scientific computing that have seen recent progress. A feature article by Science reporter Paul Voosen focuses on an ambitious and controversial project, backed by high-tech philanthropists, to leverage breakthroughs in artificial intelligence, satellite imaging, and high-resolution simulations to create a new climate model. Kent and Kotliar reflect on two complementary approaches to predicting the properties of materials in which electrons are inextricably correlated with one another. Bottaro and Lindorff-Larsen report on the simulation of biological molecules, where recent progress has been driven by advances in theory and methods and tighter integration of experimental constraints. Sanchez-Lengeling and Aspuru-Guzik review approaches that use machine learning to design chemical structures that bear a desired characteristic. Finally, Brügmann describes how to simulate the complex equations that govern four-dimensional spacetime in Einstein’s theory of general relativity, focusing on the example of gravitational waves produced by merging black holes.

 

 

 

 

Assessing imprecision in Cochrane systematic reviews: a comparison of GRADE and Trial Sequential Analysis

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Systematic Reviews
https://systematicreviewsjournal.biomedcentral.com/articles
[Accessed 28 Jul 2018]

Methodology
Assessing imprecision in Cochrane systematic reviews: a comparison of GRADE and Trial Sequential Analysis
The evaluation of imprecision is a key dimension of the grading of the confidence in the estimate. Grading of Recommendations Assessment, Development and Evaluation (GRADE) gives recommendations on how to down…
Authors: Greta Castellini, Matteo Bruschettini, Silvia Gianola, Christian Gluud and Lorenzo Moja
Citation: Systematic Reviews 2018 7:110
Published on: 28 July 2018

A report on the status of vaccination in Europe

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Vaccine
Volume 36, Issue 33   Pages 4963-5106 (9 August 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/33

Review
A report on the status of vaccination in Europe
Open access – Review article
Pages 4979-4992
Shazia Sheikh, Eliana Biundo, Soizic Courcier, Oliver Damm, … Norman Begg
Abstract

Vaccine policy, decision processes and outcomes vary widely across Europe. The objective was to map these factors across 16 European countries by assessing (A) national vaccination strategy and implementation, (B) attributes of healthcare vaccination systems, and (C) outcomes of universal mass vaccination (UMV) as a measure of how successful the vaccination policy is.

  1. Eleven countries use standardised assessment frameworks to inform vaccine recommendations. Only Sweden horizon scans new technologies, uses standard assessments, systematic literature and health economic reviews, and publishes its decision rationale. Time from European marketing authorisation to UMV implementation varies despite these standard frameworks. Paediatric UMV recommendations (generally government-funded) are relatively comparable, however only influenza vaccine is widely recommended for adults.
  2. Fourteen countries aim to report annually on national vaccine coverage rates (VCRs), as well as have target VCRs per vaccine across different age groups. Ten countries use either electronic immunisation records or a centralised registry for childhood vaccinations, and seven for other age group vaccinations.
  3. National VCRs for infant (primary diphtheria tetanus pertussis (DTP)), adolescent (human papillomavirus (HPV)) and older adult (seasonal influenza) UMV programmes found ranges of: 89.1% to 98.2% for DTP-containing vaccines, 5% to 85.9% for HPV vaccination, and 4.3% to 71.6% for influenza vaccine. Regarding reported disease incidence, a wide range was found across countries for measles, mumps and rubella (in children), and hepatitis B and invasive pneumococcal disease (in all ages).

These findings reflect an individual approach to vaccination by country. High VCRs can be achieved, particularly for paediatric vaccinations, despite different approaches, targets and reporting systems; these are not replicated in vaccines for other age groups in the same country. Additional measures to improve VCRs across all age groups are needed and could benefit from greater harmonisation in target setting, vaccination data collection and sharing across EU countries.

 

 

Cost-effectiveness of an Adjuvanted Recombinant Zoster Vaccine in older adults in the United States

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Vaccine
Volume 36, Issue 33   Pages 4963-5106 (9 August 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/33

Original research article
Cost-effectiveness of an Adjuvanted Recombinant Zoster Vaccine in older adults in the United States
Open access –
Pages 5037-5045
Curran, B. Patterson, L. Varghese, D. Van Oorschot, … B. Yawn

Parental predictors of HPV vaccine initiation among low-income Hispanic females aged 11–17 years

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Vaccine
Volume 36, Issue 33   Pages 4963-5106 (9 August 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/33

Original research article
Parental predictors of HPV vaccine initiation among low-income Hispanic females aged 11–17 years
Pages 5084-5090
Serena A. Rodriguez, Lara S. Savas, Elizabeth Baumler, Alan G. Nyitray, … Maria E. Fernandez

 

Avian Influenza A Virus Pandemic Preparedness and Vaccine Development

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Vaccines — Open Access Journal
http://www.mdpi.com/journal/vaccines
(Accessed 28 Jul 2018)

Review  Open Access
Avian Influenza A Virus Pandemic Preparedness and Vaccine Development
by Rory D. de Vries, Sander Herfst and Mathilde Richard
Vaccines 2018, 6(3), 46; https://doi.org/10.3390/vaccines6030046 – 25 July 2018
Abstract
Influenza A viruses can infect a wide range of hosts, creating opportunities for zoonotic transmission, i.e., transmission from animals to humans, and placing the human population at constant risk of potential pandemics. In the last hundred years, four influenza A virus pandemics have had a devastating effect, especially the 1918 influenza pandemic that took the lives of at least 40 million people. There is a constant risk that currently circulating avian influenza A viruses (e.g., H5N1, H7N9) will cause a new pandemic. Vaccines are the cornerstone in preparing for and combating potential pandemics. Despite exceptional advances in the design and development of (pre-)pandemic vaccines, there are still serious challenges to overcome, mainly caused by intrinsic characteristics of influenza A viruses: Rapid evolution and a broad host range combined with maintenance in animal reservoirs, making it near impossible to predict the nature and source of the next pandemic virus. Here, recent advances in the development of vaccination strategies to prepare against a pandemic virus coming from the avian reservoir will be discussed. Furthermore, remaining challenges will be addressed, setting the agenda for future research in the development of new vaccination strategies against potentially pandemic influenza A viruses.

Why Is Eradicating Typhoid Fever So Challenging: Implications for Vaccine and Therapeutic Design

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Vaccines — Open Access Journal
http://www.mdpi.com/journal/vaccines
(Accessed 28 Jul 2018)

Review  Open Access
Why Is Eradicating Typhoid Fever So Challenging: Implications for Vaccine and Therapeutic Design
by Yi-An Yang, Alexander Chong and Jeongmin Song
Vaccines 2018, 6(3), 45; https://doi.org/10.3390/vaccines6030045 – 24 July 2018
Abstract
Salmonella enterica serovar Typhi (S. Typhi) and S. Paratyphi, namely typhoidal Salmonellae, are the cause of (para) typhoid fever, which is a devastating systemic infectious disease in humans. In addition, the spread of multidrug-resistant (MDR) and extensively drug-resistant (XDR) S. Typhi in many low and middle-income countries poses a significant risk to human health. While currently available typhoid vaccines and therapeutics are efficacious, they have some limitations. One important limitation is the lack of controlling individuals who chronically carry S. Typhi. However, due to the strict host specificity of S. Typhi to humans, S. Typhi research is hampered. As a result, our understanding of S. Typhi pathogenesis is incomplete, thereby delaying the development and improvement of prevention and treatment strategies. Nonetheless, to better combat and contain S. Typhi, it is vital to develop a vaccine and therapy for controlling both acutely and chronically infected individuals. This review discusses how scientists are trying to combat typhoid fever, why it is so challenging to do so, which approaches show promise, and what we know about the pathogenesis of S. Typhi chronic infection

 

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
 
Oman Medical Journal
Volume 33 Issue 4 (Jul 2018)
Original Articles
A snapshot of Influenza surveillance, vaccine recommendations, and vaccine access, drivers, and barriers in selected middle Eastern and North African countries
S Al Awaidy, A Althaqafi, G Dbaibo – Oman Medical Journal, 2018
Abstract:
Objectives: Influenza is a vaccine-preventable acute respiratory viral infection that causes epidemics annually around the globe. A regional influenza stakeholder network (MENA-ISN) comprised of experts assessed the status of influenza prevention and control using a structured survey.
Methods: A survey questionnaire was used to obtain information from each participating country on surveillance system, the burden of disease, influenza vaccination programs, recommendations, funding and access for vaccine and vaccination, target rate, coverage rate monitoring, and drivers and barriers to influenza vaccination.
Results: Out of the 10 countries that participated, nine had an influenza surveillance system and vaccination policy, and seven had World Health Organization (WHO) accredited reference laboratory. Three countries had burden of disease data available and eight had a reimbursement vaccine policy. Influenza vaccine was available in five countries through the Ministry of Health whereas in others, pharmacies also dispensed for the private sector. In all countries, prescribers were physicians, and vaccinators, which could be physicians, nurses, and pharmacists. Eight countries had a set vaccination target rate and only three monitored the influenza coverage rates. Drivers and barriers of vaccination were similar in all countries.
Conclusions: Despite existing policies, influenza vaccination coverage remains far below the WHO recommendations. Increased awareness and effective implementation of policies with collaboration of stakeholders can help increase the rates to reach WHO targets.
 
 
Book: HIV Vaccines and Cure: The Path Towards Finding an Effective Cure and Vaccine
Linqi Zhang, Sharon R. Lewin
Springer, Jul 20, 2018 – 318 pages
This book provides a comprehensive review of the major barriers to HIV cure and vaccine. It covers the fundamental virology and immunology leading to HIV transmission, protection from infection and long term HIV persistence on antiretroviral therapy. In addition, strategies being tested to eliminate persistent HIV and the rational design of vaccines to induce protective immunity are covered. This book also discusses the challenges related to the design of clinical trials for testing the safety and efficacy of these innovative approaches. This book will provide a systematic overview and also discuss controversial issues for researchers in virology and immunology, as well as practicing physicians, and scientists in the pharmaceutical industry.

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 28 Jul 2018
Science
The Deleted WeChat Post That Fueled China’s Vaccine Scandal
It alleged a complex web of corruption going back decades.
Sarah ZhangKaren Yuan
Jul 25, 2018
A vaccine scandal in China began building slowly and then suddenly, this weekend, it was everywhere at once.
The story began back in November, when a large vaccine manufacturer called Changsheng Biotechnology Co. was forced to recall 252,600 ineffective doses of vaccines for DPT (diphtheria, pertussis, and tetanus). Then earlier this July, a government investigation caught Changsheng falsifying data about its rabies vaccine, and a local food and drug administration fined the company 3.44 million yuan, or approximately $500,000, over the faulty DPT vaccines.
Over the weekend, an anonymous post recounting all this and more went viral on the Chinese social network WeChat. In addition to the recent developments, it alleged a complex web of corruption that went back decades, involving other vaccines for hepatitis B and chicken pox. The post was deleted the next day.

But by then, a full-blown national scandal had erupted. The Chinese government this week scrambled to put out statements assuring a prompt investigation. President Xi Jinping described the situation as “vile and shocking.” Police on Monday announced the swift arrest of four of the company’s executives, including its chairwoman.

Changsheng’s vaccines have not yet been tied to any deaths or illnesses, but the story caught on because it so perfectly echoed many scandals that have rocked China in recent years. In 2016, for example, a hospital pharmacist sold two million doses of vaccines improperly stored in an “overheated, dilapidated storeroom.” That came after scandals over tainted milk, infant formula, pork, cooking oil, and water. The scandals, one after another, have undermined trust in the government’s ability to keep the public safe…
 

BBC
http://www.bbc.co.uk/
Accessed 28 Jul 2018
[No new, unique, relevant content]
 

The Economist
http://www.economist.com/
Accessed 28 Jul 2018
A vaccine scandal shakes trust in China’s government
More than 200,000 babies may have been given substandard jabs
Jul 26th 2018 | BEIJING
 
Financial Times
http://www.ft.com/home/uk
Accessed 28 Jul 2018
[No new, unique, relevant content]
 
Forbes
http://www.forbes.com/
Accessed 28 Jul 2018
[No new, unique, relevant content]

 

Foreign Affairs
http://www.foreignaffairs.com/
Accessed 28 Jul 2018
[No new, unique, relevant content]

 

Foreign Policy
http://foreignpolicy.com/
Accessed 28 Jul 2018
Welcome to the Next Deadly AIDS Pandemic
Laurie Garrett | 26 July 2018
The world thought it had fought the HIV virus to a stalemate — but its strategy was flawed in ways that are only now becoming clear.

The Guardian
http://www.guardiannews.com/
Accessed 28 Jul 2018
China
‘They are devils’: China’s parents demand answers over vaccine scandal
Protest groups want to know how hundreds of thousands of faulty vaccines came to be used
Lily Kuo in Beijing
Wed 25 Jul 2018
 

New Yorker
http://www.newyorker.com/
Accessed 28 Jul 2018
[No new, unique, relevant content]
 

New York Times
http://www.nytimes.com/
Accessed 28 Jul 2018
Asia Pacific
China Says Vaccine Maker Changsheng Broke Manufacturing Rules, Faked Records – Xinhua
July 27, 2018
BEIJING — China’s cabinet investigation group has found that vaccine maker Changsheng Bio-technology broke the law in manufacturing rabies vaccines, the state news agency Xinhua reported on Friday.
The investigation group said the company had systematically falsified production and testing records to avoid regulatory scrutiny, according to Xinhua.
“The company used expired materials to produce some rabies vaccine and falsified the production date,” the investigation group found.
“To cover up violations, the company systematically fabricated production and testing records.”
China has launched sweeping spot checks on vaccine makers around the country after Changsheng was found to have falsified data and sold ineffective vaccines for children…

 

Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 28 Jul 2018
Review & Outlook
China’s Vaccine Scandal
Children get phony protection but officials aren’t held accountable.
By The Editorial Board
July 27, 2018
Xi Jinping boasts that he is building the “Chinese Dream” of a strong and prosperous nation, but the vision of China’s supreme leader is losing some of its luster. Over the past couple of weeks parents in China have learned that a compulsory public-health program injected an unknown number of children with substandard vaccines. They are understandably furious.

Mr. Xi called the case “hideous and appalling,” and he has promised a thorough investigation. But websites and state-run media are only allowed to republish official pronouncements on the case, suggesting the authorities are still covering up the extent of the crime.

Last November officials in Jilin province found that the Changsheng Biotechnology Co. falsified production data for a diphtheria, pertussis and tetanus (DPT) vaccine. After national regulators found similar problems with Changsheng’s rabies vaccine this month, the provincial government revealed that problems with the DPT vaccine affected more than 250,000 doses. Another company in Wuhan was responsible for 400,000 faulty DPT injections.

On July 21 an anonymous report on the WeChat messaging platform, similar to WhatsApp, accused corrupt regulators of hiding the problems of vaccines made by Changsheng. That was plausible because officials have been disciplined for taking bribes from the company in the past. Online expressions of anger at the scandal exploded.

Chinese are particularly angry because similar cases have happened in recent years, followed by similar promises to crack down. In 2010 and 2013 hundreds of children were hospitalized and several died from faulty vaccines. Chinese companies have used official connections to avoid accountability for producing a range of defective products that kill and maim. In 2008 Chinese dairy companies knowingly sold infant formula that contained melamine, a chemical that damaged the kidneys of hundreds of thousands of children. At least six died. A decade later, many parents will only feed their children imported formula.

The official response follows a familiar pattern. Journalists and lawyers who try to follow up or investigate similar cases are jailed. The officials responsible are transferred to new posts, having learned that covering up scandals is more important than preventing them. Sun Xianze, one of the food-safety regulators disciplined in the 2008 dairy scandal, was in charge of drug safety until his retirement in March.

The scandal will hurt Mr. Xi’s plan to build the pharmaceutical industry as part of his “Made in China 2025” industrial policy. But the damage to the public’s faith in his administration is harder to quantify. Because the Communist Party is effectively above the law and China lacks a free media capable of being a watchdog, his promise to get to the bottom of the problem rings hollow.

Officials insist that Mr. Xi’s anticorruption campaign is a serious attempt to improve Communist Party governance and not merely a tool to remove political opponents. Ordinary Chinese can be forgiven for reaching a different conclusion as the health of children is sacrificed to protect the Party’s power. And Americans enamored of China’s supposed authoritarian efficiency might contemplate the cost of its lack of accountability.

 

Washington Post
http://www.washingtonpost.com/
Accessed 28 Jul 2018
Vaccine scandal gripping China could cause serious problems for the government
Rebecca Tan| 26 July 2018

Think Tanks et al

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Think Tanks et al
 
Brookings
http://www.brookings.edu/
Accessed 28 Jul 2018
[No new relevant content]

Center for Global Development  
http://www.cgdev.org/page/press-center
Accessed 28 Jul 2018
[No new relevant content]

CSIS
https://www.csis.org/
Accessed 28 Jul 2018
[No new relevant content]

Council on Foreign Relations
http://www.cfr.org/
Accessed 28 Jul 2018
July 24, 2018
China
Chinese Parents, Pharma Industry Worried Sick After Latest Vaccine Scandal
In a society that cherishes health, longevity, and continuation of the family line, there is a lingering and growing fear that the existing system is broken.

Vaccines and Global Health: The Week in Review :: 21 July 2018

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Vaccines and Global Health: The Week in Review is a weekly digest  summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated with the current issue date

.– Request an Email Summary: Vaccines and Global Health : The Week in Review is published as a single email summary, scheduled for release each Saturday evening before midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.

– pdf version:  A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_21 Jul 2018

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

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

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

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

Record number of infants vaccinated in 2017

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Milestones :: Perspectives

Record number of infants vaccinated in 2017
As over 19 million children miss out on vaccinations, UNICEF and WHO call for concerted efforts to reach all children
New York, 16 July 2018: A record 123 million infants were immunized globally in 2017 with at least one dose of the diphtheria-tetanus-pertussis vaccine , according to data released today by the World Health Organization and UNICEF.

The data shows that:
:: 9 out of every 10 infants received at least one dose of diphtheria-tetanus-pertussis (DTP) vaccine in 2017, gaining protection against these deadly diseases.
:: An additional 4.6 million infants were vaccinated globally in 2017 with three doses of the diphtheria-tetanus-pertussis vaccine compared to 2010.
:: 167 countries included a second dose of measles vaccine as part of their routine vaccination schedule.
:: 162 countries now use rubella vaccines and global coverage against rubella has increased from 35 per cent in 2010 to 52 per cent.
:: The human papillomavirus (HPV) vaccine was introduced in 80 countries to help protect women against cervical cancer.
::Additional vaccines are being included into the immunization schedule, such as new formulations of meningitis and polio vaccines.

Despite these successes, almost 20 million infants did not receive the benefits of full immunization in 2017, as they were not vaccinated with three doses of the diphtheria-tetanus-pertussis vaccine. Of these, almost 8 million (40 per cent) live in fragile or humanitarian settings, including countries affected by conflict. In addition, a growing share are from middle-income countries, where inequity and marginalization, particularly among the urban poor, prevent many from getting immunized. 

As populations grow, more countries need to increase their investments in immunization programmes. To reach all children  with much-needed vaccines, the world will need to vaccinate an estimated 20 million additional children every year with three doses of the diphtheria-tetanus-pertussis vaccine (DTP3); 45 million with a second dose of measles vaccine; and 76 million children with 3 doses of pneumococcal conjugate vaccine.

In support of these efforts, WHO and UNICEF are working to expand access to immunization by:
:: Strengthening the quality, availability and use of vaccine coverage data.
:: Better targeting resources.
:: Planning actions at sub-national levels and
:: Ensuring that vulnerable people can access vaccination services.
WHO/UNICEF 2017 country and regional immunization coverage data