Maternal and Child Health Journal
Volume 21, Issue 12, December 2017
https://link.springer.com/journal/10995/21/12/page/1
Original Paper
Influences on Immunization Decision-Making among US Parents of Young Children
This study assessed influences on vaccination decisions among parents of young children and examined common vaccination information and advice sources.
Yunmi Chung, Jay Schamel, Allison Fisher…
New England Journal of Medicine
November 30, 2017 Vol. 377 No. 22
http://www.nejm.org/toc/nejm/medical-journal
Original Article
HIV Prevention Efforts and Incidence of HIV in Uganda
Kate Grabowski, Ph.D., David M. Serwadda, M.B., Ch.B., M.P.H., Ronald H. Gray, M.D., Gertrude Nakigozi, M.B., Ch.B., Ph.D., Godfrey Kigozi, M.B., Ch.B., Ph.D., Joseph Kagaayi, M.B., Ch.B., Ph.D., Robert Ssekubugu, M.S.P.H., Fred Nalugoda, Ph.D., Justin Lessler, Ph.D., M.H.S., Thomas Lutalo, Ph.D., Ronald M. Galiwango, M.B., Ch.B., Sc.M., Fred Makumbi, Ph.D., Xiangrong Kong, Ph.D., Donna Kabatesi, M.D., M.P.H., Stella T. Alamo, M.D., M.P.H., Steven Wiersma, M.D., M.P.H., Nelson K. Sewankambo, M.B., Ch.B., Aaron A.R. Tobian, M.D., Ph.D., Oliver Laeyendecker, Ph.D., Thomas C. Quinn, M.D., Steven J. Reynolds, M.D., M.P.H., Maria J. Wawer, M.D., and Larry W. Chang, M.D., M.P.H., for the Rakai Health Sciences Program*
N Engl J Med 2017; 377:2154-2166 November 30, 2017 DOI: 10.1056/NEJMoa1702150
To assess the effect of a combination strategy for prevention of human immunodeficiency virus (HIV) on the incidence of HIV infection, we analyzed the association between the incidence of HIV and the scale-up of antiretroviral therapy (ART) and medical male circumcision in Rakai, Uganda. Changes in population-level viral-load suppression and sexual behaviors were also examined.
Pediatrics
December 2017, VOLUME 140 / ISSUE 6
http://pediatrics.aappublications.org/content/140/6?current-issue=y
Articles
Web-based Social Media Intervention to Increase Vaccine Acceptance: A Randomized Controlled Trial
Jason M. Glanz, Nicole M. Wagner, Komal J. Narwaney, Courtney R. Kraus, Jo Ann Shoup, Stanley Xu, Sean T. O’Leary, Saad B. Omer, Kathy S. Gleason, Matthew F. Daley
Pediatrics Dec 2017, 140 (6) e20171117; DOI: 10.1542/peds.2017-1117
In this RCT, we compare vaccination outcomes in infants of pregnant women exposed to either a VSM intervention, a VI Web site, or UC.
Articles
4-Valent Human Papillomavirus (4vHPV) Vaccine in Preadolescents and Adolescents After 10 Years
Daron G. Ferris, Rudiwilai Samakoses, Stanley L. Block, Eduardo Lazcano-Ponce, Jaime Alberto Restrepo, Jesper Mehlsen, Archana Chatterjee, Ole-Erik Iversen, Amita Joshi, Jian-Li Chu, Andrea Likos Krick, Alfred Saah, Rituparna Das
Pediatrics Dec 2017, 140 (6) e20163947; DOI: 10.1542/peds.2016-3947
This report summarizes the immunogenicity, effectiveness, and safety of the 4vHPV vaccine in adolescent and preadolescent subjects after 10 years.
PLoS Medicine
http://www.plosmedicine.org/
(Accessed 2 December 2017)
Editorial
The end of HIV: Still a very long way to go, but progress continues
Steven G. Deeks, Sharon R. Lewin, Linda-Gail Bekker
| published 30 Nov 2017 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002466
PLoS Medicine
http://www.plosmedicine.org/
(Accessed 2 December 2017)
Collection Review
malERA: An updated research agenda for malaria elimination and eradication
Regina N. Rabinovich, Chris Drakeley, Abdoulaye A. Djimde, B. Fenton Hall, Simon I. Hay, Janet Hemingway, David C. Kaslow, Abdisalan Noor, Fredros Okumu, Richard Steketee, Marcel Tanner, Timothy N. C. Wells, Maxine A. Whittaker, Elizabeth A. Winzeler, Dyann F. Wirth, Kate Whitfield, Pedro L. Alonso
| published 30 Nov 2017 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002456
Abstract
Achieving a malaria-free world presents exciting scientific challenges as well as overwhelming health, equity, and economic benefits. WHO and countries are setting ambitious goals for reducing the burden and eliminating malaria through the “Global Technical Strategy” and 21 countries are aiming to eliminate malaria by 2020. The commitment to achieve these targets should be celebrated. However, the need for innovation to achieve these goals, sustain elimination, and free the world of malaria is greater than ever. Over 180 experts across multiple disciplines are engaged in the Malaria Eradication Research Agenda (malERA) Refresh process to address problems that need to be solved. The result is a research and development agenda to accelerate malaria elimination and, in the longer term, transform the malaria community’s ability to eradicate it globally.
PLoS Medicine
http://www.plosmedicine.org/
(Accessed 2 December 2017)
Collection Review
malERA: An updated research agenda for diagnostics, drugs, vaccines, and vector control in malaria elimination and eradication
The malERA Refresh Consultative Panel on Tools for Malaria Elimination
| published 30 Nov 2017 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002455
Abstract
Since the turn of the century, a remarkable expansion has been achieved in the range and effectiveness of products and strategies available to prevent, treat, and control malaria, including advances in diagnostics, drugs, vaccines, and vector control. These advances have once again put malaria elimination on the agenda. However, it is clear that even with the means available today, malaria control and elimination pose a formidable challenge in many settings. Thus, currently available resources must be used more effectively, and new products and approaches likely to achieve these goals must be developed. This paper considers tools (both those available and others that may be required) to achieve and maintain malaria elimination. New diagnostics are needed to direct treatment and detect transmission potential; new drugs and vaccines to overcome existing resistance and protect against clinical and severe disease, as well as block transmission and prevent relapses; and new vector control measures to overcome insecticide resistance and more powerfully interrupt transmission. It is also essential that strategies for combining new and existing approaches are developed for different settings to maximise their longevity and effectiveness in areas with continuing transmission and receptivity. For areas where local elimination has been recently achieved, understanding which measures are needed to maintain elimination is necessary to prevent rebound and the reestablishment of transmission. This becomes increasingly important as more countries move towards elimination.
PLoS Medicine
http://www.plosmedicine.org/
(Accessed 2 December 2017)
Collection Review
malERA: An updated research agenda for health systems and policy research in malaria elimination and eradication
The malERA Refresh Consultative Panel on Health Systems and Policy Research
| published 30 Nov 2017 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002454
Collection Review
malERA: An updated research agenda for combination interventions and modelling in malaria elimination and eradication
The malERA Refresh Consultative Panel on Combination Interventions and Modelling
Collection Review | published 30 Nov 2017 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002453
Collection Review
malERA: An updated research agenda for characterising the reservoir and measuring transmission in malaria elimination and eradication
The malERA Refresh Consultative Panel on Characterising the Reservoir and Measuring Transmission
Collection Review | published 30 Nov 2017 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002452
Collection Review
malERA: An updated research agenda for basic science and enabling technologies in malaria elimination and eradication
The malERA Refresh Consultative Panel on Basic Science and Enabling Technologies
Collection Review | published 30 Nov 2017 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002451
Collection Review
malERA: An updated research agenda for insecticide and drug resistance in malaria elimination and eradication
The malERA Refresh Consultative Panel on Insecticide and Drug Resistance
Collection Review | published 30 Nov 2017 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002450
PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 2 December 2017)
Research Article
The importance of thinking beyond the water-supply in cholera epidemics: A historical urban case-study
Matthew D. Phelps, Andrew S. Azman, Joseph A. Lewnard, Marina Antillón, Lone Simonsen, Viggo Andreasen, Peter K. M. Jensen, Virginia E. Pitzer
| published 27 Nov 2017 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0006103
Conclusions/Significance
Spatially targeted cholera interventions, such as reactive vaccination or sanitation/hygiene campaigns in hotspot neighborhoods, would likely have been more effective in this epidemic than control measures aimed at interrupting long-cycle transmission, such as improving municipal water quality. We recommend public health planners consider programs aimed at interrupting short-cycle transmission as essential tools in the cholera control arsenal.
PLoS One
http://www.plosone.org/
Research Article
Safety and efficacy of an oxycodone vaccine: Addressing some of the unique considerations posed by opioid abuse
D. Raleigh, S. J. Peterson, M. Laudenbach, F. Baruffaldi, F. I. Carroll, S. D. Comer, H. A. Navarro, T. L. Langston, S. P. Runyon, S. Winston, M. Pravetoni, P. R. Pentel
| published 01 Dec 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0184876
Cost-effectiveness of expanding childhood routine immunization against Neisseria meningitidis serogroups C, W and Y with a quadrivalent conjugate vaccine in the African meningitis belt
Andreas Kuznik, Garba Iliyasu, Mohammed Lamorde, Mustapha Mahmud, Baba M. Musa, Ibrahim Nashabaru, Stephen Obaro, Idris Mohammed, Abdulrazaq G. Habib
Research Article | published 30 Nov 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0188595
Modelling the effects of quadrivalent Human Papillomavirus (HPV) vaccination in Puerto Rico
Ana Patricia Ortiz, Karen J. Ortiz-Ortiz, Moraima Ríos, José Laborde, Amit Kulkarni, Matthew Pillsbury, Andreas Lauschke, Homero A. Monsanto, Cecile Marques-Goyco
Research Article | published 30 Nov 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0184540
Predictors of seasonal influenza vaccination among older adults in Thailand
Prabda Praphasiri, Darunee Ditsungnoen, Supakit Sirilak, Jarawee Rattanayot, Peera Areerat, Fatimah S. Dawood, Kim A. Lindblade
Research Article | published 29 Nov 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0188422
Vaccine
Volume 35, Issue 50
http://www.sciencedirect.com/journal/vaccine/vol/35/issue/50
Conference report
Moving forward on strengthening and sustaining National Immunization Technical Advisory Groups (NITAGs) globally: Recommendations from the 2nd global NITAG network meeting
Open access
Pages 6925–6930
Noni E. MacDonald, Philippe Duclos, Ole Wichmann, Louise Henaff, … Rupa Rajbhandari Singh
Abstract
National Immunization Technical Advisory Groups (NITAGs) provide independent, evidence-informed advice to assist their governments in immunization policy formation. This is complex work and many NITAGs face challenges in fulfilling their roles. Inter-country NITAG collaboration opportunities have the potential to enhance NITAG function and grow the quality of recommendations. Hence the many requests for formation of a network linking NITAGs together so they can learn from each other. The first Global NITAG Network (GNN) meeting, held in 2016, led to a push to launch the GNN and grow the network. At the second GNN meeting, held June 28–29, 2017 in Berlin, the GNN was formally inaugurated. Participants discussed GNN governance, reflected on the April 2017 Strategic Advisory Group of Experts (SAGE) on Immunization conclusions concerning strengthening of NITAGs and also shared NITAG experiences in evaluation and inter-country collaborations and independence. They also discussed the role of Regional Technical Advisory Groups on Immunization (RTAGs) and regional networks. A number of issues were raised including NITAGs and communications, dissemination of recommendations and vaccine implementation as well as implications of off-label recommendations. Participants were alerted to immunization evidence assessment sites and value of sharing of resources. They also discussed potential GNN funding opportunities, developed an action plan for 2017–18 and selected a Steering Committee to help move the GNN forward. All participants agreed on the importance of the GNN and the value in attracting more countries to join the GNN.
Vaccine
Volume 35, Issue 50
http://www.sciencedirect.com/journal/vaccine/vol/35/issue/50
Commentary
A behavioral economics approach to the failed HPV vaccination program in Japan
Open access
Pages 6931–6933
Asami Yagi, Yutaka Ueda, Tadashi Kimura
Short communications
Driving immunization through the Medicare Annual Wellness Visit: A growing opportunity
Pages 6938–6940
Angela K. Shen, Rob Warnock, Jeffrey A. Kelman
This study analyzes Medicare Part B fee-for-service claims from 2011 to 2016 to assess AWV and seasonal influenza and pneumococcal conjugate vaccinations utilization over time.
Original research article
Dengue vaccine supplies under endemic and epidemic conditions in three dengue-endemic countries: Colombia, Thailand, and Vietnam
Pages 6957–6966
Jung-Seok Lee, Jacqueline K. Lim, Duc Anh Dang, Thi Hien Anh Nguyen, Andrew Farlow
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 Guardian
http://www.guardiannews.com/
Accessed 2 December 2017
Japanese Doctor wins 2017 John Maddox prize for countering HPV vaccine misinformation
30 November 2017
A Japanese doctor who has stood up to a campaign of misinformation around a common anti-cancer vaccine has won a prestigious prize for championing evidence in the face of hostility and personal threats.
Riko Muranaka at Kyoto University was awarded the 2017 John Maddox prize on Thursday for her efforts to explain the safety of the human papilloma virus (HPV) vaccine amid strong opposition from anti-vaccine activists and a small group of academics.
Muranaka was praised by colleagues for her courage and leadership as she endured insults, litigation and attempts to undermine her professional status as the HPV vaccine came under attack in Japan. While the jab is used without fuss in many countries, in Japan and some other nations, fears raised by campaigners have hit vaccine uptake rates…
New Yorker
http://www.newyorker.com/
Accessed 2 December 2017
Lake Chad: The World’s Most Complex Humanitarian Disaster
A Reporter at Large By Ben Taub
December 4, 2017 Issue
Boko Haram, climate change, predatory armies, and extreme hunger are converging on a marginalized population in Central Africa.
New York Times
http://www.nytimes.com/
Accessed 2 December 2017
Ravaged by Cholera, Yemen Faces 2nd Preventable Scourge: Diphtheria
Aid officials said the Saudi blockade of Yemen was now impeding their ability to fight diphtheria, once thought to have been largely eradicated.
December 01, 2017 – By RICK GLADSTONE – World – Print Headline: “Diphtheria Threatens To Escalate In Yemen”
Philippines Suspends Dengue Shots After Drug Firm’s Warning
More than 740,000 students have already received Dengvaxia vaccinations, which could pose health risks for people not previously infected.
December 01, 2017 – By FELIPE VILLAMOR
[See Milestones/Perspectives above for additional details]
Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 2 December 2017
World
In Rwanda, Drones Deliver Medical Supplies to Remote Areas
By Robert Lee Hotz
Dec. 1, 2017 5:48 am ET
Several drone companies are using cutting-edge technology to deliver essential medical supplies to remote areas—and, in the process, gaining experience that could be used for shipments in more densely populated places.
Think Tanks et al
Center for Global Development
http://www.cgdev.org/page/press-center
Accessed 2 December 2017
Blog Post
New Evidence on the Health Loss but not the Health Gain from WHO’s 2009 AIDS Treatment Guidelines
12/1/17
Mead Over
We here at CGD tend to be critical of international agencies like WHO or the UNDP for establishing targets or guidelines without sufficient consideration of the impacts, for good and ill, of those guidelines in the affected countries. Such guidelines often apply standards more appropriate to rich countries and then pressure poor countries to behave as if they were rich.
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_25 Nov 2017
– 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
Milestones :: Perspectives
Editor’s Note
We generally reserve this section of our digest for major strategic announcements and significant milestones in the vaccines/immunization space. We share below the text from a retirement laudation plaque that represents, in our view, such a milestone.
******
In Recognition of Exemplary Leadership in Advancing Immunization Globally,
We Hereby Honor
Dr. Jean M-Marie Okwo-Bele
Director of Immunization, Vaccines and Biologicals
World Health Organization
2004-2017
We thank you for your passion, unconditional commitment, and enduring dedicated service to public health.</em
Your legacy will live on in the many lives you have touched.
Your Friends, Colleagues and Partners Worldwide
November 2017
******
We understand that Okwo received this laudation during a celebratory event at the close of the SAGE meeting in October. Okwo’s retirement commences following his last day official working day at WHO on 29 November 2017.
We wish him a splendid next adventure…
::::::
::::::
IVI [to 25 November 2017]
http://www.ivi.int/
Commemorating our 20th anniversary, IVI thanks donors, partners for support
IVI expresses our deepest gratitude to all the donors and supporters for your commitment and generosity to the Institute over the past 20 years. In particular, we wish to thank our donors and partners who joined us at our 20th Anniversary Forum held on November 15.
The Forum brought together 170 scientists, partners and friends of IVI from across Korea and around the world, including Dr. Park Neung-hoo, Minister of Health and Welfare of Korea. Present at the Celebration and Dinner were some 120 donors and supporters, including awardees of plaques who were honored for their outstanding commitment and contribution to IVI. As we move into IVI’s third decade, we look forward to the continuing friendship and partnership with our donors and partners to make an even bigger impact in vaccine science and global public health in the years ahead.
We are pleased to share with you images of the commemorative events and greetings on our 20th Anniversary from donors, partners and friends of IVI below.
Press release: http://www.ivi.int/?mod=document&uid=954&page_id=12463
Photo images of the 20th Anniversary Forum and Celebrations: https://www.flickr.com/photos/internationalvaccineinstitute/albums/72157666609937919
Emergencies
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 22 November 2017 [GPEI]
:: On the 14 November, the 15th IHR Emergency Committee convened to review the risk of international spread of poliovirus. The committee agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC), and recommended the extension of revised Temporary Recommendations for a further three months.
:: To mark World Children’s Day, we reported on how the polio eradication programme helps deliver a bright future to children in Nigeria.
:: Summary of newly-reported viruses this week:
…Afghanistan: Four new wild poliovirus type 1 (WPV1) positive environmental samples, three collected from Kandahar province, and one from Kabul province.
…Pakistan: One new WPV1 positive environmental sample, collected from Sindh province.
…Syria: Seven new circulating vaccine derived poliovirus type 2 (cVDPV2) cases reported, all from Deir Ez-Zor governorate.
::::::
Statement of the 15th IHR Emergency Committee regarding the international spread of poliovirus
WHO statement
14 November 2017
[Excerpts; Editor’s text bolding]
The fifteenth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened by the Director-General on 14 November 2017 at WHO headquarters with members, advisers and invited member states attending via teleconference.
The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV). The Secretariat presented a report of progress for affected IHR States Parties subject to Temporary Recommendations. The following IHR States Parties presented an update on the current situation and the implementation of the WHO Temporary Recommendations since the Committee last met on 3 August 2017: Afghanistan, the Democratic Republic of Congo (DR Congo), Nigeria, Pakistan and the Syrian Arab Republic.
Wild polio
Overall the Committee was encouraged by continued steady progress in all three WPV1 infected countries, Afghanistan, Nigeria and Pakistan and the fall in the number of cases globally, and that international spread remained limited to between Afghanistan and Pakistan only. While falling transmission in these three countries decreased the risk of international spread, the consequences of any failure to prevent spread would increasingly be a set-back to eradication and a risk to public health, as funding winds down in the coming years.
The Committee commended the high-level commitment seen in both Afghanistan and Pakistan, and the high degree of cooperation and coordination, particularly targeting the high risk mobile populations that cross the international border, such as nomadic groups, local populations straddling the border, seasonal migrant workers and their families, repatriating refugees (official and informal), and guest children (children staying with relatives across the border). Stopping transmission in these populations remains a major challenge that cannot be under-estimated, underlining the critical continuing need for cross border activities in surveillance and vaccination.
The Committee commended the achievements in Pakistan that have resulted in the number of cases falling to just five so far in 2017; achievements included the improved accessibility, improved communication to reduce missed children and better quality supplementary immunization activities (SIA). However, WPV1 transmission continues to be widespread geographically as detected by environmental surveillance and this remains a source of major concern, notwithstanding that the intensity of environmental surveillance is now higher than previously, meaning the probability of environmental detection is now higher.
The Committee was concerned by the ongoing risks to eradication posed by the number of inaccessible and missed children in Afghanistan, particularly in the southern region resulting in ten cases to date in 2017.
The Committee was impressed by the innovations that continue to be made in Nigeria to reach children in Borno, but was very concerned that although the number of inaccessible settlements has fallen, there remains a substantial population in Borno state that is totally inaccessible, including around 160,000 – 200,000 children aged under five. The Committee concluded that there is a substantial risk that polioviruses are still circulating in these inaccessible areas. Nigeria also reported on ongoing efforts to ensure vaccination at international borders (including at airports), other transit points, IDP camps and in other areas where nomadic populations existed, but the Committee felt that efforts to date were inadequate. The Committee also noted that routine immunization, particularly in high risk areas of northern Nigeria, is performing poorly and along with polio eradication has been made a national priority. Although it is over 13 months since the last detection of WPV1 in Nigeria, the recent outbreak response assessment by global polio experts concluded ongoing transmission could not be ruled out.
There was ongoing concern about the Lake Chad basin region, and for all the countries that are affected by the insurgency, with the consequent lack of services and presence of IDPs and refugees. The risk of international spread from Nigeria to the Lake Chad basin countries or further afield in sub-Saharan Africa remains high. The Committee was encouraged that the Lake Chad basin countries including, Cameroon, Chad, the Central African Republic (CAR), Niger and Nigeria continued to be committed to sub-regional coordination of immunization and surveillance activities. However, there is concern about the Lake Chad islands which are currently inaccessible and also about significant gaps in population immunity exist in some areas of these countries in border areas with Borno, and the ongoing population movement in the sub-region was a major challenge.
Vaccine derived poliovirus
The Committee commended the efforts made in some very challenging circumstances in DR Congo and the Syrian Arab Republic. These outbreaks highlighted the presence of vulnerable under-immunized populations in areas with inaccessibility, either due to conflict or geographical remoteness. Furthermore, the delay in detection of these outbreaks illustrated that serious gaps in surveillance exist in many areas of the world, often related to weak health systems or to conflict resulting in disrupted health systems.
In DRC, there has been transmission after the initial SIA’s with geographical spread outside the health zones covered, into Tanganyika, necessitating further rounds with mOPV2. Risks are compounded by poor surveillance in many areas, and widespread gaps in population immunity.
The Committee was very concerned by the size of the outbreak in the Syrian Arab Republic, and the difficulty of reaching target populations because of the conflict. As type 2 population immunity rapidly wanes, the risk of spread within the Syrian Arab Republic and beyond its borders will increase substantially, meaning urgent action is needed to stop transmission. The Committee commended countries surrounding the outbreak zone that are responding to prevent importation, particularly among Syrian refugees in Lebanon, Jordan, and Turkey. The Committee urged any country receiving Syrian refugees, particularly from Deir Ez-Zor and Raqqa, to ensure polio vaccination with IPV.
The Committee noted with concern the recent detection of a single highly diverged VDPV2 in sewage in Mogadishu in Somalia, with genetic evidence of more than three years of replication without detection.
Conclusion
The Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC), and recommended the extension of revised Temporary Recommendations for a further three months. The Committee considered the following factors in reaching this conclusion:
:: cVDPVs also pose a risk for international spread, which without an urgent response with appropriate measures threatens vulnerable populations as noted above;
:: The large number of cases in the Syrian outbreak within a short space of time and close to the international border with Iraq in the context of ongoing population movement because of conflict, considerably heightens the risk of international spread;
:: The ongoing circulation of cVDPV2 in DR Congo, Nigeria, Pakistan and the Syrian Arab Republic demonstrates significant gaps in population immunity at a critical time in the polio endgame;
:: The ongoing urgency to prevent type 2 cVDPVs following the globally synchronized withdrawal of the type 2 component of the oral poliovirus vaccine in April 2016, noting that population immunity to type 2 polioviruses is rapidly waning;
:: The ongoing challenges of improving routine immunization in areas affected by insecurity and other emergencies
:: The global shortage of IPV which poses an additional risk.
…
Additional considerations
The Committee noted that in all the infected and vulnerable countries, routine immunization was generally quite poor, if not nationally, then in sub-national pockets. The Committee strongly encourages all these countries to make further efforts to improve routine immunization, and requested international partners to support these countries in rapidly improving routine immunization coverage to underpin eradication.
The Committee also strongly encouraged countries newly infected with WPV or cVDPV to act with a great degree of urgency in responding to outbreaks as national public health emergencies, and to ensure emergency operations are used to facilitate this accelerated response…
Based on the current situation regarding WPV1 and cVDPV, and the reports made by Afghanistan, DR Congo, Nigeria, Pakistan, and the Syrian Arab Republic, the Director-General accepted the Committee’s assessment and on 20 November 2017 determined that the situation relating to poliovirus continues to constitute a PHEIC, with respect to WPV1 and cVDPV…
::::::
Syria cVDPV2 outbreak situation report 23: 21 November 2017
Situation update 21 November 2017
…Seven (7) new cases of cVDPV2 were reported this week— 4 cases from Mayadeen and 3 from Boukamal district, Deir Ez-Zor governorate. The most recent case (by date of onset) is 9 September 2017 from Mayadeen district.
…The total number of confirmed cVDPV2 cases is 70.
…Outbreak response teams are planning a third mass immunization round to reach children under 5 with mOPV2 in areas where evidence of virus transmission continues.
…A request from the Syrian Ministry of Health for up to one (1) million doses of mOPV2 and 500 000 inactivated polio vaccine doses is being processed to ensure readiness for the second phase of the outbreak response
…Subnational immunization days aiming to reach children under 5 with bOPV started this week in areas of Rural Damascus, districts of Damascus, Homs, Aleppo and accessible areas of Deir Ez-Zor city. Children aged 2-23 months will also be reached with supplementary IPV during the subnational campaign, particularly in areas with large IDP populations.
…A joint supervisory team is monitoring the IPV campaign in all areas of Damascus, with a focus on areas where there are large IDP populations from Deir Ez-Zor to ensure campaign quality.
::::::
::::::
WHO Grade 3 Emergencies [to 25 November 2017]
The Syrian Arab Republic
:: WHO gravely concerned by deteriorating situation in eastern Ghouta, Syrian Arab Republic
22 November 2017, Damascus, Syrian Arab Republic – Seven people have been killed and 42 people injured in Damascus city and surrounding areas in recent days.
In eastern Ghouta, Rural Damascus, local health authorities report that during a 4-day period alone from 14 to 17 November, 84 people were killed, including 17 children and 6 women; and 659 people were injured, including 127 children and 87 women.
During the same period, more than 200 surgical operations were conducted in eastern Ghouta’s overwhelmed and under-resourced hospitals.
Despite escalating violence and increasing humanitarian needs, life-saving medicines, medical equipment, and surgical supplies are prevented from entering the area…
:: Polio- Situation update 21 November 2017
[See Polio above for detail]
South Sudan
:: WHO in collaboration with the Ministry of Health established water quality control to prevent water-borne diseases in South Sudan
21 November 2017 Juba — The cost of delivering safe water, sanitation and hygiene services is a public health concern in South Sudan. To ensure high quality, sustainable water quality testing, monitoring and surveillance, WHO provided mobile water quality and safety testing kits to the National Public Health Laboratory. The mobile kits are to be used to test and monitor the quality and safety of water in the country.
Yemen
:: Yemen – Cholera Response W46 2017 [Nov 13-Npv 19]
Highlights
Cumulative figures
-The cumulative total from 27 April 2017 to 19 Nov 2017 is 945,362 suspected cholera cases and 2,211 associated deaths, (CFR 0.23%), 1049 have been confirmed by culture.
-The median age of suspected cases is (20) and the median age of death is (38)
– 59.3 % of death were severe cases at admission
– The total proportion of severe cases among the suspected cases is 18%
– The national attack rate is 343.26 per 10,000. The five governorates with the highest cumulative attack rates per 10,000 remain Amran (801), Al Mahwit (760), Al Dhale’e (641), Abyan (491) and Sana’a (459).
– Children under 5 years old represent 27.8% of total suspected cases.
– In total, 20,884 rapid diagnostic tests (RDT) have been performed which represents 22.1% coverage.
– 2,375 cultures have been performed which represents 22.6% coverage.
– The last positive culture was on 7 Nov 2017 in Al Garahi district
– Among the 305 affected districts, 43 districts in 12 governorates (Abyen, Al Baydha, Al Hudei deh, Al mahrah, Hajjah, Lahj ,Marib, Mokal l a, Sa’dah, Seyoun, Shabwah, Taizz) did not report any suspected case the last three consecutive 3 weeks.
Governorate and District level
– At governorate level, the trend from W43-W45 decrease or was stable in all governorates.
– No district is reporting a CFR higher than 1%.
Trends
– The weekly number of cases is decreasing for the 10th consecutive week.
– The weekly proportion of severe cases has significantly decreased representing now 10% of the admitted cases.
-The use of RDTs has significantly increased since week 40.
Week 46
– 14,955 suspected cases and 6 associated deaths were reported.
– 10 % are severe cases
– 924 RDTs were performed, 176 were positive
– 0 Positive culture
::::::
WHO Grade 2 Emergencies [to 25 November 2017]
Myanmar
:: Weekly Situation Report 4 – 22 November 2017
Key Highlights
…As of 21 November 2017, the cumulative number of new arrivals in all sites was 622,000. …This number includes over 341,000 arrivals in Kutupalong Balukhali expansion site, 235,000 in other camps and settlements, and 46,000 arrivals in host communities.
…153,765 adolescents and children received measles vaccination
…WHO Mental Health Gap Action Training commenced
Situation Overview
Approximately 170 health care facilities are known to be operating across all camps and settlements. However, many of these facilities provide a basic level of services and referrals for additional services within camps and outside of the camps remains a challenge. Government hospital facilities are overcrowded and do not have the resources to cope with the high volumes of referral patients. Moreover, the services provided are not standardized and the quality of health care services varies considerably.
The latest EWARS data show that fevers of unexplained origin are the most commonly reported disease (29%), followed acute respiratory infections (27%) and acute watery diarrhoea (21%). In view of the low immunization coverage among the Rohingya population, strengthening vaccination programmes is a priority.
Potential outbreaks of diarrhoeal diseases including
Rohingya refugees in Bangladesh: Health Sector Bulletin No. 1
Period: 01 October – 15 November 2017
[1] Health Situation
Around 1.2 million people are estimated to be in need of health assistance. This number includes both newly arrived Rohingyas from Myanmar since 25 August, and their host communities. Based on the public health situation analysis published on 10 October 2017, WHO has graded this crisis as a level 3 emergency. the highest possible rating.
…
[5.4] Vaccines and Immunization
Challenges
The baseline coverage for routine immunization is low. This, combined with crowded living conditions, lack of adequate water and sanitation and reported levels of high malnutrition, represents a public health risk to both the new arrivals and the host population.
Health Sector Response
The health sector has conducted several vaccination campaigns. In the first campaign, which ended on 3 October 2017, 135 519 children under 15 years of age were vaccinated against measles and rubella, 72 334 children under 5 years of age were vaccinated against polio and 72 064 children received Vitamin A.
To mitigate the outbreak of cholera, the International Coordinating Group (ICG) on Vaccine Provision mobilized 900,000 doses of oral cholera vaccine (OCV) for a large-scale cholera vaccination campaign among recently arrived Rohingyas and their host communities. The health sector worked with the MOHFW to plan, train volunteers, fund, implement and monitor this campaign. The campaign to administer the first dose (targeting 650 000 individuals over one year of age) was successfully implemented from 10 to 18 October 2017. It reached a total of 712 797 people, 179 848 of whom were children aged from one to five years old. To help improve personal hygiene, vaccinators handed out soap to each person vaccinated.
From 4 to 9 November 2017, the health sector supported the MOHFW in implementing the second phase of a cholera and polio vaccination campaign for children. A total of 199 472 children aged between one and five years received a second dose of oral cholera vaccine for added protection (estimated target population: 180 000), and 236 696 children under five years received oral polio vaccine (estimated target population: 210 000).
In addition, the health sector continues to support the MOHFW’s efforts to strengthen routine vaccination. Approximately 100 vaccinators have been trained on the current routine Expanded Programme on Immunization (EPI) schedule, key EPI messages, the importance of maintaining the cold chain, monitoring vaccine vials, injection safety, registration, reporting and waste management. Polio, measles and tetanus immunization began on 11 November from static sites within the camps. Through these static sites, to date 719 children have been vaccinated against polio, 589 children against measles and 476 pregnant women against tetanus.
Additionally, since 1 November, 970 children (6 months – 15 years) passing through the two transit sites have been vaccinated against measles and rubella (MR) and 1038 children under five years received oral polio vaccine (bOPV).
Establishing the routine Expanded Programme on Immunization (EPI) in camps and settlements and setting up vaccination posts at entry points into Bangladesh are both key to controlling measles and other diseases. However, in response to the significant increase in measles cases, MoHFW and health sector have agreed to rapidly initiate a measles campaign targeting 360 000 children under 15 for MR vaccination. In view of the urgency of the situation, the campaign is planned to start on 18 November and microplanning has begun…
::::::
WHO AFRO – Outbreaks and Emergencies Bulletin, Week 46: 11 – 17 November 2017
The WHO Health Emergencies Programme is currently monitoring 46 events in the region. This week’s edition covers key ongoing events, including:
:: Dengue fever in Burkina Faso,
:: Plague in Madagascar,
:: Lassa fever in Nigeria,
:: Marburg virus disease in Uganda,
:: Humanitarian Crisis in Central African Republic,
:: Humanitarian Crisis in the Democratic Republic of the Congo.
::::::
::::::
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
:: 25 Nov 2017 Urgent Call to Address Gender-based Violence in Syria [EN/AR]
Yemen
:: 24 Nov 2017 – Yemen: Impact of the closure of seaports and airports on the humanitarian situation – Situation Update 3 | 23 November 2017
:: 24 Nov 2017 – Yemen Humanitarian Bulletin Issue 29 | 20 November 2017
::::::
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.
ROHINGYA CRISIS
:: ISCG Situation Update: Rohingya Refugee Crisis, Cox’s Bazar – 23 November 2017
::::::
::::::
Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.
Yellow Fever [to 25 November 2017]
http://www.who.int/csr/disease/yellowfev/en/
Disease outbreak news
Yellow fever – Brazil – 24 November 2017
WHO & Regional Offices [to 25 November 2017]
Uganda steps up to support women subjected to violence
24 November 2017 – Violence against women is a global public health problem. In Uganda more than half of all women have experienced violence at least once in their life, most likely from an intimate partner.
In response Uganda has developed the National Action Plan on the Elimination of Gender-based Violence. To date more than 400 health workers have been trained, helping to address violence against women….
The paradox of migrant women care workers
21 November 2017 – Migrating in the same numbers as men, many migrant women take on personal care work in informal and home-based settings – often without social protection, labour rights, or health care.
A new WHO report shows an emerging paradox: that migrant women carers support health and social systems, while their own health care and other needs may be unfulfilled.
WHO Report
::::::
Weekly Epidemiological Record, 24 November 2017, vol. 92, 47 (pp. 717–728)
:: Progress towards poliomyelitis eradication: Pakistan, January 2016–September 2017
:: Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2017
::::::
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Experts ramp up efforts to leave no one behind 24 November 2017
Brazzaville, 24 November 2017 – With growing momentum to ensure that…
:: Call for behaviour change in antibiotic use and prescription 24 November 2017
:: Making health services a safe place for women: Uganda steps up to support women subjected to violence 24 November 2017
:: Monitoring the efficacy of antimalarial medicines in Tanzania 23 November 2017
:: Promoting Interagency Collaboration to Ensure Pharmaceutical Manufacturing Development in Ethiopia 23 November 2017
:: Political will and evidence-based action to end TB in the African Region a must – WHO Regional Director for Africa 23 November 2017
23 November 2017 – World Health Organization (WHO) Africa…
:: WHO in collaboration with the Ministry of Health established water quality control testing hub within the National Public Health Laboratory to guide water safety management and prevent water-borne diseases in South Sudan 22 November 2017
:: EU commended for renewed commitment to boost Africa’s health development Africa on course to reach health some targets by 2030 21 November 2017
:: World Antibiotics Awareness Week in Tanzania 21 November 2017
:: Tackling antibiotic resistance in Sierra Leone 20 November 2017
WHO European Region EURO
:: Leaving no one behind in eliminating violence against women 24-11-2017
:: WHO/Europe introduces sustainable health workforce toolkit at Dublin Forum 24-11-2017
:: New HEN report reveals gaps in protection of refugees and migrants from vaccine-preventable diseases 21-11-2017
:: University of Pécs designated as WHO Collaborating Centre for migration and health 21-11-2017
:: Health in focus at the UN Climate Change Conference 21-11-2017
WHO Eastern Mediterranean Region EMRO
:: WHO gravely concerned by deteriorating situation in eastern Ghouta, Syria 22 November 2017
:: Islamic Advisory Group launches training manual on polio eradication, mother and child health and immunization 22 November 2017
CDC/ACIP [to 25 November 2017]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html
Wednesday, November 15, 2017
MMWR News Synopsis for November 24, 2017
Public Health Economic Burden Associated with Two Single Measles Case Investigations — Colorado, 2016–2017
CDC Media Relations
404-639-3286
Even a single measles case is expensive and burdensome to public health agencies. Measles can be prevented by a safe and effective vaccine. Measles outbreaks in the United States occur after introduction from international travelers and can be amplified in undervaccinated communities. Effective interruption of transmission requires timely case investigation. The Tri-County Health Department in the metropolitan Denver area assessed the total economic burden of two measles case investigations. Each case exposed hundreds of people, prompting a complex and coordinated response by multiple public health agencies. Public health costs of disease investigation in the first and second case were an estimated $49,769 and $15,573, respectively. Single measles cases prompted extensive public health action and were costly and resource intensive for local public health agencies.
Progress Toward Poliomyelitis Eradication – Pakistan, January 2016-September 2017
Interruption of wild poliovirus (WPV) circulation, and therefore eradication, is within reach in Pakistan. Despite progress made during 2016, virus is still detected in the environment of high-risk areas in the country, and children continue to be missed by vaccination efforts. These factors pose a challenge to the goal of achieving zero cases. To reach this goal, Pakistan must continue heightened polio surveillance, respond aggressively to any new cases, and vaccinate all children. Pakistan is one of three countries – including Afghanistan and Nigeria –where WPV has never stopped circulating. During 2017, Pakistan made significant improvements to its polio eradication program. As a result, the number of reported polio cases decreased by 69 percent, with five WPV cases compared to 16 cases reported during the same period in 2016. Despite the decrease, the virus continues to circulate in certain areas and children continue to be missed by immunization campaigns.
::::::
Africa CDC [to 25 November 2017]
https://au.int/en/africacdc
No new digest content identified.
::::::
China CDC [to 25 November 2017]
http://www.chinacdc.cn/en/ne/
No new digest content identified.
Announcements
European Medicines Agency [to 25 November 2017]
http://www.ema.europa.eu/ema/
24/11/2017
New guidelines on good manufacturing practices for advanced therapies
Adaptations ensure a high level of quality for ATMPs and patient protection
European Vaccine Initiative [to 25 November 2017]
http://www.euvaccine.eu/news-events
20 November 2017
MVVC2 study published
EDCTP funded MVVC2 study published today in Frontiers in Immunology: showing safety and immunogenicity of malaria vectored…
FDA [to 25 November 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnoncements/default.htm
November 21, 2017 –
FDA approves first two-drug regimen for certain patients with HIV
The U.S. Food and Drug Administration today approved Juluca, the first complete treatment regimen containing only two drugs to treat certain adults with human immunodeficiency virus type 1 (HIV-1) instead of three or more drugs included in standard HIV treatment. Juluca is a fixed-dose tablet containing two previously approved drugs (dolutegravir and rilpivirine) to treat adults with HIV-1 infections whose virus is currently suppressed on a stable regimen for at least six months, with no history of treatment failure and no known substitutions associated with resistance to the individual components of Juluca…
IAVI [to 25 November 2017]
https://www.iavi.org/
November 21, 2017
New Findings to Help HIV Scientists Establish ‘Template’ for Potent Antibodies
Natural-infection studies in Africa and India continue to inform HIV vaccine design
New data published today in Immunity further illuminate how some human beings generate powerful, HIV-blocking antibodies. Led by scientists at the International AIDS Vaccine Initiative (IAVI) and The Scripps Research Institute (TSRI), the results offer important insight into a potential AIDS vaccine design.
“Uncovering the process by which neutralizing antibodies develop is critical to HIV vaccine design,” said Elise Landais, Senior Research Scientist with IAVI and lead author of the study. “A small fraction of people living with HIV can naturally produce exceptionally powerful and broad antibodies that could prevent HIV from infecting their immune cells, but not until several years post-infection – long after that protection can help them. But it is of enormous interest to vaccine researchers.”…
MSF/Médecins Sans Frontières [to 25 November 2017]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
MSF: India’s Decision to Give Pfizer Unmerited Patent on Lifesaving Pneumonia Vaccine Limits Access for Children Globally
November 20, 2017
At High Court of Delhi hearing tomorrow, Doctors Without Borders will urge India to remain the “pharmacy of the developing world” and rethink decision that solidifies Pfizer monopoly on critical pneumonia vaccine
Sabin Vaccine Institute [to 25 November 2017]
http://www.sabin.org/updates/pressreleases
Monday, November 20, 2017
Journalists Gather for Information Session on Vaccines
BUENOS AIRES, ARGENTINA – Today, the Sabin Vaccine Institute (Sabin) convened journalists from across Latin America to contribute to their understanding of the science of vaccines…
During the three-day information session hosted by Sabin, in partnership with the Universidad I Salud and the Centro de Estudos para la Prevención y el Control de Enfermedades Transmisibles, journalists will learn from public health experts about clinical trials, vaccine safety, how to communicate the impact of immunization, and basic epidemiology and immunology of vaccines, among other topics. By bringing together public health experts and 25 journalists from 18 countries, the information session will provide Latin American journalists with a baseline understanding of vaccines, vaccine safety and related global health issues….
UNAIDS [to 25 November 2017]
http://www.unaids.org/en
Update
Global ministerial conference ends with adoption of the Moscow Declaration to End TB
23 November 2017
A global ministerial conference held in Moscow, Russian Federation, on 16 and 17 November that united more than 1000 participants, including 75 ministers and 114 country delegations, concluded with the adoption of the Moscow Declaration to End TB.
The Moscow Declaration to End TB is a new commitment to increase multisectoral action and enhance accountability in the global TB response towards ending tuberculosis (TB) by 2030. The declaration will also inform the first United Nations General Assembly High-Level Meeting on TB, in 2018, which will seek to advance commitments to end TB from heads of state and government.
The declaration outlines the importance of international action to address key areas to respond to TB: sustainable financing, pursuing science, research and development and the establishment of a multisectoral accountability framework.
The conference, the First World Health Organization Global Ministerial Conference on Ending Tuberculosis in the Sustainable Development Era: a Multisectoral Response, was opened by the President of the Russian Federation, Vladimir Putin. It was attended by high-level United Nations leaders, including Amina J. Mohammed, the United Nations Deputy Secretary-General, Tedros Adhanom Ghebreyesus, the World Health Organization Director-General, and Michel Sidibé, the UNAIDS Executive Director…
[See last week’s edition for more detail]
UNICEF [to 25 November 2017]
https://www.unicef.org/media/
Geneva Palais Briefing Note: Urgent measures to improve hygiene practices underway inside Rohingya refugee camps
GENEVA, 21 November 2017 – This is a summary of what was said by Christophe Boulierac, UNICEF Spokesperson in Geneva – to whom quoted text may be attributed – at today’s press briefing at the Palais des Nations in Geneva.
Despite progress, 180 million children face bleaker prospects than their parents – UNICEF
NEW YORK, 20 November 2017 – Despite global progress, 1 in 12 children worldwide live in countries where their prospects today are worse than those of their parents, according to a UNICEF analysis conducted for World Children’s Day.
Wellcome Trust [to 25 November 2017]
https://wellcome.ac.uk/news
November 21, 2017 STAT
First Opinion
Focused projects can help Tedros restore confidence in the WHO
By Jeremy Farrar
Like many people around the world, I was dismayed last month by the appointment of Robert Mugabe, the embattled president of Zimbabwe, as a World Health Organization goodwill ambassador. While I believe it is important for the WHO to work with political leaders of every variety, Mugabe’s record in Zimbabwe, which has led to incredible pressure for him to step down, made him profoundly unsuitable for such a role. That wasn’t the only reason this decision seemed so extraordinary to me: It stands as an outlier amid many very sound judgments made by Tedros Adhanom Ghebreyesus, WHO’s newly elected director-general.
In his first 100 days in office, Tedros, as he is known, has assembled an able and extremely diverse senior leadership team. He has also engaged meaningfully and constructively with critics — not least by quickly reversing the Mugabe appointment and without equivocation. He acknowledged a misstep and, I believe, deserves our support because his leadership is a critical opportunity to rebuild the WHO into the force it should be in global health.
Tedros’s election has given him a mandate that no other head of a United Nations agency can claim. His election was the first of its kind in terms of transparency and openness, complete with manifestos, an election platform, and a vote among all WHO member states. His legitimacy, coupled with focused minds at WHO after the failures of Ebola, means he can do what the global health community has been asking the WHO director-general to do for decades: lead its member states with an ambitious program of effective and measurable work, rather than simply reacting passively to their diverse wishes…
Reports/Research/Analysis/Commentary/Conferences/Meetings/Book Watch/Tenders
Vaccines and Global Health: The Week in Review has expanded its coverage of new reports, books, research and analysis published independent of the journal channel covered in Journal Watch below. Our interests span immunization and vaccines, as well as global public health, health governance, and associated themes. If you would like to suggest content to be included in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org
Women on the move: Migration, care work and health
World Health Organization
2017 : 102 pages
ISBN: 978-92-4-151314-2
PDFs: Women on the move: Full report
Women on the move: Policy brief
Executive Summary [Excerpt; text bolding from original]
Ageing in late industrial and middle-income economies, combined with rising demographic dependency ratios and female labour force participation, has led to emerging care deficits in many developed and developing countries. Around the world, more women are entering the labour force, thus taking them away from traditional unpaid caring roles.
This report focuses largely on one population group: women migrant care workers who provide home-based personal care. However, many of the issues, and the next steps suggested here, also apply to other migrants and refugees – particularly women and girls – as well as to other socially excluded and marginalized groups engaged in paid and unpaid care work across the world.
Without a doubt, women migrant care workers play an increasingly prominent role in securing and protecting the health status of others and are contributing both to health in the broadest sense and to health systems. Yet relatively little is known about their own health status, the health implications to their families of their out-migration, and the extent of their important contributions to health systems. Around the world, care workers are overwhelmingly female, and many are migrants. This report documents how, despite making a large contribution to global public health, they are exposed to many health risks themselves, while enjoying few labour market and health protections. The report also underscores that paid and unpaid care work is central to the broad health and well-being of individuals, their families and communities, as well as society at large.
The care paradox: global public health and the role of migrant women care workers
Increasingly, immigrant women are being imported into receiving country economies to care, often in informal settings, and are frequently engaged by private households, without full access to social protection and labour rights. Yet this group of migrants provides essential care services and, increasingly, health-care services, thus contributing to health systems and to health and well-being worldwide.
As the leading normative agency on health, the World Health Organization (WHO) calls attention to the paradox that migrant women care workers buttress health systems in countries with shortfalls in health-care provision, while their own rights to health may be eroded and their health-care needs are unfulfilled. Migrant women care workers act as a cushion for states that lack adequate public provision for long-term care, child care and care for the sick.
Unmet needs and growing demand for care
Home-based personal care – whether for older persons, children, or those with chronic diseases or disabilities – constitutes an important component of modern health systems. This applies to both high-income countries, where formal health-care institutions and services are struggling to meet the growing demand for such care, as well as to middle- and lower-income countries and regions where home-based care relieves the demand for, and expense of, institutional care. In all societies there is a cultural preference for care “in the family” or for “ageing in place”.
One area in which the care deficit in receiving countries is particularly pronounced is long-term care for older persons. Critical shortages of long-term care workers make quality services unavailable for large parts of the global population aged 65 years and over. The extent of the unmet need varies worldwide, but in Europe alone the shortage is estimated at around 2.3 million formal long-term care workers.
The policy architecture related to care work, migration and women
The unique status of migrant women care workers as both providers and consumers of health and social care requires that both sending and receiving countries reflect on this paradox and work urgently, and much more collaboratively, to overcome challenges, contradictions, gaps and inconsistencies in international, regional, national and subnational policies, laws and programmes across all relevant sectors. This report proposes the integration of policy actions – and of gender, equity and human rights approaches – to mediate concerns about care deficits and decent and safe work in the care sector as a crucial component of maintaining global and national public health.
Why this report?
WHO initiated this report in response to growing global political interest in population health and development, particularly noting discussions at the 42nd G7 meeting in Japan in May 2016 which called for more attention to migrants and their role in paid and unpaid care work. It is hoped that this report, and its reflection on potential next steps, will foster further debate about approaches to ensure that the global community meets its obligations to leave no one behind in securing long-term equitable and sustainable development. The analysis is also shaped by commitments to the principles of human rights, the Tanahashi Framework on health service coverage and evaluation, the United Nations Migration Governance Framework,i the Framework of priorities and guiding principles for a World Health Assembly Resolution on the health of migrants and refugees, the concept of progressive universalism towards achieving universal health coverage (UHC), and the 2030 Agenda for Sustainable Developmentii with its overarching goal of leaving no one behind…
[See also full-text of Lancet editorial “Caring for migrant health-care workers” in Journal Watch below]
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
Annals of Internal Medicine
21 November 2017 Vol: 167, Issue 10
http://annals.org/aim/issue
Ideas and Opinions
Proposed U.S. Funding Cuts Threaten Progress on Antimicrobial Resistance
Antimicrobial resistance (AMR) is an escalating public health crisis that kills patients, threatens national security, and reduces the safety of medical procedures essential to save and enhance lives. Many types of complex medical care can be complicated by serious infections and rely on the availability of safe, effective antimicrobial drugs. In the past 2 years, national and global leaders have united against this threat, making tangible progress. However, budget cuts of a historic magnitude proposed by the Trump administration now threaten to undo this progress, placing patients in grave danger.
The Centers for Disease Control and Prevention (CDC) estimates that at least 2 million persons in the United States acquire antibiotic-resistant infections each year, resulting in at least 23 000 deaths. Antibiotic resistance is estimated to cost our health system more than $20 billion annually (1). Approximately 700 000 deaths are attributable to AMR each year globally. By 2050, a total of 350 million cumulative deaths will likely be attributable to AMR if current trends continue (2), and multidrug-resistant tuberculosis will account for most of these deaths (3).
Annals of Internal Medicine
21 November 2017 Vol: 167, Issue 10
http://annals.org/aim/issue
Editorials
Unraveling the Epidemiology of Oral Human Papillomavirus Infection
The burden of oral cancer in the United States has been evolving for at least 2 decades. Gains in head and neck cancer control afforded by a period effect of reduced tobacco exposure have been displaced by competing cohort effects of increasing sexual exposure to human papillomavirus (HPV) infection and subsequent increases in HPV-associated head and neck cancer, particularly oropharyngeal cancer (1). The male predominance of oropharyngeal cancer in the United States is paralleled by a much higher prevalence of oral HPV infection and a stronger relationship between number of sexual partners and oral HPV prevalence in men than women (2). The reason the risk for oral HPV infection differs between men and women remains unclear, particularly because the prevalence of genital HPV infection is similar in both sexes.
Oral Human Papillomavirus Infection: Differences in Prevalence Between Sexes and Concordance With Genital Human Papillomavirus Infection, NHANES 2011 to 2014
BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 25 November 2017)
Research article
Applying systems biology to biomedical research and health care: a précising definition of systems medicine
Systems medicine has become a key word in biomedical research. Although it is often referred to as P4-(predictive, preventive, personalized and participatory)-medicine, it still lacks a clear definition and is…
Authors: Sebastian Schleidgen, Sandra Fernau, Henrike Fleischer, Christoph Schickhardt, Ann-Kristin Oßa and Eva C. Winkler
Citation: BMC Health Services Research 2017 17:761
Published on: 21 November 2017
BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 25 November 2017)
Research article
Efficacy and safety of pertussis vaccination for pregnant women – a systematic review of randomised controlled trials and observational studies
Authors: Marie Furuta, Jacqueline Sin, Edmond S. W. Ng and Kay Wang
Citation: BMC Pregnancy and Childbirth 2017 17:390
Published on: 22 November 2017
Abstract
Background
Worldwide, pertussis remains a major health problem among children. During the recent outbreaks of pertussis, maternal antenatal immunisation was introduced in several industrial countries. This systematic review aimed to synthesize evidence for the efficacy and safety of the pertussis vaccination that was given to pregnant women to protect infants from pertussis infection.
Methods
We searched literature in the Cochrane Central Register of Controlled Trials, Medline, Embase, and OpenGrey between inception of the various databases and 16 May 2016. The search terms included ‘pertussis’, ‘whooping cough’, ‘pertussis vaccine,’ ‘tetanus, diphtheria and pertussis vaccines’ and ‘pregnancy’ and ‘perinatal’.
Results
We included 15 articles in this review, which represented 12 study populations, involving a total of 203,835 mother-infant pairs from the US, the UK, Belgium, Israel, and Vietnam. Of the included studies, there were two randomised controlled trials (RCTs) and the rest were observational studies. Existing evidence suggests that vaccinations administered during 19–37 weeks of gestation are associated with significantly increased antibody levels in the blood of both mothers and their newborns at birth compared to placebo or no vaccination. However, there is a lack of robust evidence to suggest whether these increased antibodies can also reduce the incidence of pertussis (one RCT, n=48, no incidence in either group) and pertussis-related severe complications (one observational study) or mortality (no study) in infants. Meanwhile, there is no evidence of increased risk of serious complications such as stillbirth (e.g. one RCT, n=103, RR=0, meaning no case in the vaccine group), or preterm birth (two RCTs, n=151, RR=0.86, 95%CI: 0.14–5.21) related to administration of the vaccine during pregnancy.
Conclusion
Given that pertussis infection is increasing in many countries and that newborn babies are at greatest risk of developing severe complications from pertussis, maternal vaccination in the later stages of pregnancy should continue to be supported while further research should fill knowledge gaps and strengthen evidence of its efficacy and safety.
BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 25 November 2017)
Research article
Estimating disease burden of a potential A(H7N9) pandemic influenza outbreak in the United States
Since spring 2013, periodic emergence of avian influenza A(H7N9) virus in China has heightened the concern for a possible pandemic outbreak among humans, though it is believed that the virus is not yet human-t…
Authors: Walter Silva, Tapas K. Das and Ricardo Izurieta
Citation: BMC Public Health 2017 17:898
Published on: 25 November 2017
Research article
Assessing the impact of the Lebanese National Polio Immunization Campaign using a population-based computational model
After the re-introduction of poliovirus to Syria in 2013, Lebanon was considered at high transmission risk due to its proximity to Syria and the high number of Syrian refugees. However, after a large-scale nat…
Authors: Ali Alawieh, Zahraa Sabra, E. Farris Langley, Abdul Rahman Bizri, Randa Hamadeh and Fadi A. Zaraket
Citation: BMC Public Health 2017 17:902
Published on: 25 November 2017
Clinical Therapeutics
November 2017 Volume 39, Issue 11, p2117-2330
http://www.clinicaltherapeutics.com/current
TECHNOLOGY IN RESEARCH UPDATE: Social Media and Drug Development
Oncology Update: Gastrointestinal Tract Malignancies
#PatientVoiceMatters: How Social Media Is Bringing Patients and Biopharmaceutical Companies Together to Improve Drug Development
Stella Stergiopoulos
p2170–2172
Published online: October 31, 2017
Original Research
Mapping the Landscape of Patient-centric Activities Within Clinical Research
Mary Jo Lamberti, Josephine Awatin
p2196–2202
Published online: October 9, 2017
Original Research
Mapping the Landscape of Patient-centric Activities Within Clinical Research
Mary Jo Lamberti, Josephine Awatin
p2196–2202
Published online: October 9, 2017
Global Public Health
Volume 13, 2017 Issue 1
http://www.tandfonline.com/toc/rgph20/current
Article
Framing post-pandemic preparedness: Comparing eight European plans
Martin Holmberg & Britta Lundgren
Pages: 99-114
Published online: 07 Mar 2016
ABSTRACT
Framing has previously been studied in the field of pandemic preparedness and global health governance and influenza pandemics have usually been framed in terms of security and evidence-based medicine on a global scale. This paper is based on the pandemic preparedness plans, published after 2009, from eight European countries. We study how pandemic preparedness is framed and how pandemic influenza in general is narrated in the plans. All plans contain references to ‘uncertainty’, ‘pandemic phases’, ‘risk management’, ‘vulnerability’ and ‘surveillance’. These themes were all framed differently in the studied plans. The preparedness plans in the member states diverge in ways that will challenge the ambition of the European Union to make the pandemic preparedness plans interoperable and to co-ordinate the member states during future pandemics.
Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 25 November 2017]
Research
Map of biomedical research in Cameroon; a documentary review of approved protocols from 1997 to 2012
Over the last decade, there has been a rapid increase in biomedical research in Cameroon. However, the question of whether these research projects target major health priorities, vulnerable populations and geographic locations at risk remains to be answered. The aim of this paper is to describe the state of biomedical research in Cameroon which is a key determinant that would guide future health care policies and promote equitable access to healthcare.
Ebile Akoh Walter, Ateudjieu Jerome, Djuidje Ngounoue Marceline, Martin Ndinakie Yakum and Watcho Pierre
Published on: 21 November 2017
Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 25 November 2017]
Research
Development of a framework to improve the utilisation of malaria research for policy development in Malawi
The existing gap between research evidence and public health practice has attributed to the unmet Millennium Development Goals in Africa and consequently, has stimulated the development of frameworks to enhanc…
Chikondi Mwendera, Christiaan de Jager, Herbert Longwe, Charles Hongoro, Kamija Phiri and Clifford M. Mutero
Health Research Policy and Systems 2017 15:97
Published on: 21 November 2017
Humanitarian Exchange Magazine
http://odihpn.org/magazine/the-humanitarian-consequences-of-violence-in-central-america/
Number 70 October 2017
Special Feature: The Lake Chad Basin: an overlooked crisis?
by Humanitarian Practice Network October 2017
The 70th edition of Humanitarian Exchange, co-edited with Joe Read, focuses on the humanitarian crisis in Nigeria and the Lake Chad Basin. The violence perpetrated by Boko Haram and the counter-insurgency campaign in Nigeria, Cameroon, Chad and Niger has created a humanitarian crisis affecting some 17 million people. Some 2.4 million have been displaced, the vast majority of them in north-eastern Nigeria. Many are living in desperate conditions, without access to sufficient food or clean water. The Nigerian government’s focus on defeating Boko Haram militarily, its reluctance to acknowledge the scale and gravity of the humanitarian crisis and the corresponding reticence of humanitarian leaders to challenge that position have combined to undermine the timeliness and effectiveness of the response…
[Reviewed earlier]
Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 6, Issue 4 December 2017
https://academic.oup.com/jpids/issue
ORIGINAL ARTICLES
Sustained High Effectiveness of RotaTeq on Hospitalizations Attributable to Rotavirus-Associated Gastroenteritis During 4 Years in Finland
Maria Hemming-Harlo; Timo Vesikari; Matti Uhari; Marjo Renko; Marjo Salminen …
Journal of the Pediatric Infectious Diseases Society, Volume 6, Issue 4, 24 November 2017, Pages 317–323, https://doi.org/10.1093/jpids/piw061
Missed Opportunities for Human Papillomavirus Vaccine Initiation in an Insured Adolescent Female Population
Claudia M Espinosa; Gary S Marshall; Charles R Woods; Qianli Ma; Derek Ems …
Journal of the Pediatric Infectious Diseases Society, Volume 6, Issue 4, 24 November 2017, Pages 360–365, https://doi.org/10.1093/jpids/pix067
In this cohort of nearly 15000 11-year-old girls with insurance (commercial or Medicaid), the human papillomavirus vaccine was administered at only 1 in 4 well-adolescent visits and approximately one-third of vaccine-related visits, which suggests a substantial number of missed opportunities.
LITERATURE REVIEW
Treatment With Quadrivalent Human Papillomavirus Vaccine for Juvenile-Onset Recurrent Respiratory Papillomatosis: Case Report and Review of the Literature
Tomohiro Katsuta; Yusuke Miyaji; Paul A Offit; Kristen A Feemster
Journal of the Pediatric Infectious Diseases Society, Volume 6, Issue 4, 24 November 2017, Pages 380–385, https://doi.org/10.1093/jpids/pix063
Current evidence to support the efficacy of adjuvant therapies, including therapeutic use of the quadrivalent human papillomavirus vaccine, for juvenile-onset recurrent respiratory papillomatosis is inconsistent. Prophylactic use of the currently available human papillomavirus vaccine in adolescents is the most effective strategy for preventing JoRRP among their children in the future.
Nature
Volume 551 Number 7681 pp413-528 23 November 2017
http://www.nature.com/nature/current_issue.html
Editorials
Research health needs a dedicated group
A US Research Integrity Advisory Board is long overdue. Such a leadership body would mitigate bad practices and strengthen good research.
Research integrity is often taken to mean misconduct and its prevention. But the integrity of research enfolds much broader dimensions that represent the health — technical, ethical, social and psychological — of research activity. Each of these aspects can be too easily undermined, whether at the level of a university or company department, a research group leader, a research group or an institute. Efforts to preserve integrity need more support.
Many officials in universities and funding agencies increasingly acknowledge how the pressures of academic life undermine the capacity of their researchers to provide due diligence, such as checking the validity of results and mentoring younger scientists. This is compounded by the ever more acute pressures on those younger scientists to deliver high levels of achievement. This combination yields a potentially toxic environment for research, all too ripe for shoddiness or even fraud — and one that an increasing proportion of excellent researchers are voting against with their feet. The costs in wasted research funds are substantial. The United States can take a step forward to help redress the situation, a move that is urgently needed and that can also inspire research leaders and communities in other countries.
Committees at the US National Academies of Sciences, Engineering, and Medicine have twice looked at how to support research integrity (in its more conventional, fraud-busting definition). And both times — in 1992 and 2017 — their recommendations included a proposal for a Research Integrity Advisory Board (RIAB). This year’s report, Fostering Integrity in Research, recommends that the RIAB should be independent of government or other institutions, and funded by subscriptions from stakeholder bodies such as universities and funders.
Such a body would indeed be valuable, and even more so if it were to pursue a broader research-health agenda. It could establish best practices and improve research environments, develop new approaches to incentives and to documenting contributions to research, and develop consensus over standards and penalties for various types of misconduct. It could produce training resources on ethics, and other topics that would help new research-group leaders. It might also encourage funders to introduce conditions of compliance on grants. And it could push for more funds to support efforts by research groups to deliver good research and good mentoring. Funders will jib at the challenge of monitoring compliance, but this important work must start somewhere, and they have remarkable leverage. The RIAB would need a small staff, who would work with others in the research system. It would not take on the role of adjudicating particular cases of misconduct.
One might argue that it is the job of heads of universities and their departments and institutes to develop standards. But the realities of economic and other pressures on institutional leaders divert attention that many would wish to devote to this challenge. Indeed, a functioning RIAB would help to provide university leaders with the clout needed to develop positive changes in culture and practice that are too often resisted by researchers.
The bad news is that, despite the consistent and strong recommendations and the evident need for such a body, there is no discernible gathering of momentum that would help the research community to create one. And the political environment hardly suggests that the federal government will take the lead.
But there are ways forward, nevertheless. By focusing on the broadest agendas, which include support for good research ‘health’ and leadership, alongside measures against bad conduct, the emphasis can be placed where it should be: on a significantly better return in robust research results per dollar of research investment, with researchers better trained to meet today’s demands.
The US National Academies should take the lead. They should propose a working group to develop the agenda and practicalities of an RIAB. The necessary funds should be solicited from federal funders, including the National Institutes of Health and the National Science Foundation, and from private foundations. The group’s deliverables would include a set of priorities, evidence of buy-in from stakeholders, and a timeline for achievements over five- and ten-year timescales. The RIAB is a necessary step towards a culture of research health that can counteract the adverse pressures that so many researchers currently face. We all need it to happen.
doi: 10.1038/d41586-017-07330-5
Nature
Volume 551 Number 7681 pp413-528 23 November 2017
http://www.nature.com/nature/current_issue.html
Editorials
Rewarding negative results keeps science on track
Creating a culture of replication takes prizes, grants and magnanimity — as well as publications.
New England Journal of Medicine
November 23, 2017 Vol. 377 No. 21
http://www.nejm.org/toc/nejm/medical-journal
Perspective
Cholera in Yemen — An Old Foe Rearing Its Ugly Head
Qadri, T. Islam, and J.D. Clemens
Free Full Text
PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
[Accessed 25 November 2017]
Detecting Local Zika Virus Transmission in the Continental United States: A Comparison of Surveillance Strategies
November 22, 2017 · Research Article
Introduction: The 2015-2017 Zika virus (ZIKV) epidemic in the Americas has driven efforts to strengthen surveillance systems and to develop interventions, testing, and travel recommendations. In the continental U.S. and Hawaii, where limited transmission has been observed, detecting local transmission is a key public health objective. We assessed the effectiveness of three general surveillance strategies for this situation: testing all pregnant women twice during pregnancy, testing blood donations, and testing symptomatic people who seek medical care in an emergency department (ED).
Methods: We developed a simulation model for each surveillance strategy and simulated different transmission scenarios with varying population sizes and infection rates. We then calculated the probability of detecting transmission, the number of tests needed, and the number of false positive test results.
Results: The probability of detecting ZIKV transmission was highest for testing ED patients with Zika symptoms, followed by pregnant women and blood donors, in that order. The magnitude of the difference in probability of detection between strategies depended on the incidence of infection. Testing ED patients required fewer tests and resulted in fewer false positives than surveillance among pregnant women. The optimal strategy identified was to test ED patients with at least two Zika virus disease symptoms. This case definition resulted in a high probability of detection with relatively few tests and false positives.
Discussion: In the continental U.S. and Hawaii, where local ZIKV transmission is rare, optimizing the probability of detecting infections while minimizing resource usage is particularly important. Local surveillance strategies will be influenced by existing public health system infrastructure, but should also consider the effectiveness of different approaches. This analysis demonstrated differences across strategies and indicated that testing symptomatic ED patients is generally a more efficient strategy for detecting transmission than routine testing of pregnant women or blood donors.
PLoS Medicine
http://www.plosmedicine.org/
(Accessed 25 November 2017)
Research Article
The US President’s Malaria Initiative, Plasmodium falciparum transmission and mortality: A modelling study
Peter Winskill, Hannah C. Slater, Jamie T. Griffin, Azra C. Ghani, Patrick G. T. Walker
| published 21 Nov 2017 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002448
Abstract
Background
Although significant progress has been made in reducing malaria transmission globally in recent years, a large number of people remain at risk and hence the gains made are fragile. Funding lags well behind amounts needed to protect all those at risk and ongoing contributions from major donors, such as the President’s Malaria Initiative (PMI), are vital to maintain progress and pursue further reductions in burden. We use a mathematical modelling approach to estimate the impact of PMI investments to date in reducing malaria burden and to explore the potential negative impact on malaria burden should a proposed 44% reduction in PMI funding occur.
Methods and findings
We combined an established mathematical model of Plasmodium falciparum transmission dynamics with epidemiological, intervention, and PMI-financing data to estimate the contribution PMI has made to malaria control via funding for long-lasting insecticide treated nets (LLINs), indoor residual spraying (IRS), and artemisinin combination therapies (ACTs). We estimate that PMI has prevented 185 million (95% CrI: 138 million, 230 million) malaria cases and saved 940,049 (95% CrI: 545,228, 1.4 million) lives since 2005. If funding is maintained, PMI-funded interventions are estimated to avert a further 162 million (95% CrI: 116 million, 194 million) cases, saving a further 692,589 (95% CrI: 392,694, 955,653) lives between 2017 and 2020. With an estimate of US$94 (95% CrI: US$51, US$166) per Disability Adjusted Life Year (DALY) averted, PMI-funded interventions are highly cost-effective. We also demonstrate the further impact of this investment by reducing caseloads on health systems. If a 44% reduction in PMI funding were to occur, we predict that this loss of direct aid could result in an additional 67 million (95% CrI: 49 million, 82 million) cases and 290,649 (95% CrI: 167,208, 395,263) deaths between 2017 and 2020. We have not modelled indirect impacts of PMI funding (such as health systems strengthening) in this analysis.
Conclusions
Our model estimates that PMI has played a significant role in reducing malaria cases and deaths since its inception. Reductions in funding to PMI could lead to large increases in the number of malaria cases and deaths, damaging global goals of malaria control and eliminatio
PLoS Medicine
http://www.plosmedicine.org/
(Accessed 25 November 2017)
Perspective
Closing the gaps in the HIV care continuum
Ruanne V. Barnabas, Connie Celum
| published 21 Nov 2017 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002443
[No abstract]
Science
24 November 2017 Vol 358, Issue 6366
http://www.sciencemag.org/current.dtl
Editorial
Blurring disciplinary boundaries
By Gordon McBean, Alberto Martinelli
Science24 Nov 2017 : 975
Summary
The ambitious and integrated framework of the United Nations (UN) Sustainable Development Goals (SDGs) demonstrates that complex global problems span the natural and social sciences and that solutions to such problems demand a joint approach of the two. Despite decades of efforts toward better integration, much of society still presumes a stark divide between the disciplines, and most scientists continue to be trained, evaluated, and rewarded in disciplinary silos. The recent merger of the International Council for Science (ICSU) and the International Social Science Council (ISSC)—leading international councils of the natural and social sciences, respectively—sends a powerful message that the future of science depends on collapsing the walls between academic disciplines.
Science Translational Medicine
22 November 2017 Vol 9, Issue 417
http://stm.sciencemag.org/
Perspective
What evidence do we need for biomarker qualification?
By Chris Leptak, Joseph P. Menetski, John A. Wagner, Jiri Aubrecht, Linda Brady, Martha Brumfield, William W. Chin, Steve Hoffmann, Gary Kelloff, Gabriela Lavezzari, Rajesh Ranganathan, John-Michael Sauer, Frank D. Sistare, Tanja Zabka, David Wholley
Science Translational Medicine22 Nov 2017 Restricted Access
Predictable steps are needed to determine the evidence required for confident use of a biomarker in drug development.
Abstract
Biomarkers can facilitate all aspects of the drug development process. However, biomarker qualification—the use of a biomarker that is accepted by the U.S. Food and Drug Administration—needs a clear, predictable process. We describe a multistakeholder effort including government, industry, and academia that proposes a framework for defining the amount of evidence needed for biomarker qualification. This framework is intended for broad applications across multiple biomarker categories and uses.
Travel Medicine and Infectious Diseases
September 2017 Volume 19
http://www.travelmedicinejournal.com/
Editorial
The Hajj and Umrah: Health protection matters
Dipti Patel
Vol. 19, p1
Published online: October 23, 2017
Travel Medicine and Infectious Diseases
September 2017 Volume 19
http://www.travelmedicinejournal.com/
Review
Expected immunizations and health protection for Hajj and Umrah 2018 —An overview
Jaffar A. Al-Tawfiq, Philippe Gautret, Ziad A. Memish
Vol. 19, p2–7
Published online: October 13, 2017
Abstract
Background
The annual Hajj and Umrah are one of the largest recurring religious mass gatherings across the globe drawing pilgrims from more than 185 countries. The living circumstances and activities of the pilgrims may create an environment for the occurrence and spread of communicable diseases. Each year, the Health authority of the Kingdom of Saudi Arabia, in coordination with international health authorities, updates health requirements for pilgrims. The Hajj for 2017 took place from August 24 to September 5, 2017. Here, we review the expected obligations for immunizations for the 2018 Hajj and Umrah.
Results
The Hajj and Umrah vaccine requirements include mandatory vaccinations against yellow fever, quadrivalent meningococcal polysaccharide (every 3 years) or conjugated (every 5 years) vaccines and poliomyelitis vaccine. Influenza vaccine utilizing the 2016 (Southern Hemisphere vaccine to all pilgrims) was recommended but was not obligatory for pilgrims. Ciprofloxacin is required for individuals >12 years excluding pregnant women as chemoprophylaxis to be given at the port of entry for Pilgrims coming from the meningitis belt. With the ongoing outbreaks of measles in Europe, it is recommended that all pilgrims have an updated immunization against vaccine-preventable diseases (diphtheria, tetanus, pertussis, polio, measles and mumps).
Conclusion
The mandatory vaccines remain the same with continued vigilance for the development of any new or emerging infectious diseases. Continuing surveillance for Zika virus, cholera and MERS-CoV are ongoing.
Vaccine
Volume 35, Issue 48, Part B Pages 6583–6774 (4 December 2017)
http://www.sciencedirect.com/journal/vaccine/vol/35/issue/48/part/PB
European Court of Justice ruling on vaccine liability and its implications for the United States
Pages 6583–6584
Tony Yang
[No abstract]
Vaccine
Volume 35, Issue 48, Part B Pages 6583–6774 (4 December 2017)
http://www.sciencedirect.com/journal/vaccine/vol/35/issue/48/part/PB
Short communications
Enhancing the role of vaccines in combatting antimicrobial resistance
Open access
Pages 6591–6593
Charles Clift, David M. Salisbury
Abstract
Interest in addressing antimicrobial resistance (AMR) has grown recently but little effort has been made to consider how existing and new vaccines could impact on AMR. A 2017 Chatham House meeting considered the role of vaccines and how to demonstrate their value through their impact on AMR. Ways existing vaccines have reduced antibiotic prescribing and the prevalence of some resistant organisms were reviewed. Other new vaccines could have a similar impact. In gonorrhoea, where complete resistance has developed, vaccine may be the best option. Valuing the impact of vaccines on AMR was challenging: there were difficult methodological issues and a lack of data for modelling. A participant poll suggested priorities for accelerated vaccine development were tuberculosis, typhoid, influenza, RSV and gonorrhoea. More evidence is needed to convince policymakers but that vaccine development projects should be considered by funders on the same basis as those for new antibiotics or diagnostics.
Vaccine
Volume 35, Issue 48, Part B Pages 6583–6774 (4 December 2017)
http://www.sciencedirect.com/journal/vaccine/vol/35/issue/48/part/PB
Review
Recruitment barriers for prophylactic vaccine trials: A study in Belgium
Review article
Pages 6598–6603
Lauriane Harrington, Pierre Van Damme, Corinne Vandermeulen, Stéphanie Mali
Abstract
Recruitment of volunteers is one of the main challenges in clinical trial management, and there is little information about recruitment barriers for preventative vaccine trials. We investigated both the recruitment barriers and recruitment strategies for preventive vaccine trials in Belgium. A 10 min survey was used as well as interviews of staff at all clinical trial sites in Belgium that regularly perform vaccine trials. We observed that there are successful recruitment strategies and few recruitment issues for trials involving healthy adults and those over 65 years old. However, challenges face the recruitment of paediatric populations, pregnant women, patients and the very elderly (over 85 years old). From these results, we identified three priority areas to increase recruitment for prophylactic vaccine trials in Belgium. These are: the lack of public knowledge about infectious diseases; the lack of resources of healthcare professionals to take part in clinical trials; and the burden to potential volunteers to take part in a trial. These were discussed with stakeholders and solutions were proposed.
Vaccine
Volume 35, Issue 48, Part B Pages 6583–6774 (4 December 2017)
http://www.sciencedirect.com/journal/vaccine/vol/35/issue/48/part/PB
Original research article
Vaccine wastage in Nigeria: An assessment of wastage rates and related vaccinator knowledge, attitudes and practices
Pages 6751–6758
Aaron S. Wallace, Fred Willis, Eric Nwaze, Boubacar Dieng, … Tove K. Ryman
Abstract
Introduction
The introduction of new vaccines highlights concerns about high vaccine wastage, knowledge of wastage policies and quality of stock management. However, an emphasis on minimizing wastage rates may cause confusion when recommendations are also being made to reduce missed opportunities to routinely vaccinate children. This concern is most relevant for lyophilized vaccines without preservatives [e.g. measles-containing vaccine (MCV)], which can be used for a limited time once reconstituted.
Methods
We sampled 54 health facilities within 11 local government areas (LGAs) in Nigeria and surveyed health sector personnel regarding routine vaccine usage and wastage-related knowledge and practices, conducted facility exit interviews with caregivers of children about missed opportunities for routine vaccination, and abstracted vaccine stock records and vaccination session data over a 6-month period to calculate wastage rates and vaccine vial usage patterns.
Results
Nearly half of facilities had incomplete vaccine stock data for calculating wastage rates. Among facilities with sufficient data, mean monthly facility-level wastage rates were between 18 and 35% across all reviewed vaccines, with little difference between lyophilized and liquid vaccines. Most (98%) vaccinators believed high wastage led to recent vaccine stockouts, yet only 55% were familiar with the multi-dose vial policy for minimizing wastage. On average, vaccinators reported that a minimum of six children must be present prior to opening a 10-dose MCV vial. Third dose of diphtheria-tetanus-pertussis vaccine (DTP3) was administered in 84% of sessions and MCV in 63%; however, the number of MCV and DTP3 doses administered were similar indicating the number of children vaccinated with DTP3 and MCV were similar despite less frequent MCV vaccination opportunities. Among caregivers, 30% reported being turned away for vaccination at least once; 53% of these children had not yet received the missed dose.
Discussion
Our findings show inadequate implementation of vaccine management guidelines, missed opportunities to vaccinate, and lyophilized vaccine wastage rates below expected rates. Missed opportunities for vaccination may occur due to how the health system’s contradicting policies may force health workers to prioritize reduced wastage rates over vaccine administration, particularly for multi-dose vials.
From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary
Clinical Infectious Diseases
21 November 2017 Accepted Manuscript
Immunogenicity and protection from a single dose of internationally available killed oral cholera vaccine: a systematic review and meta-analysis
Anna Lena Lopez Jacqueline Deen Andrew S Azman Francisco J Luquero Suman Kanungo Shanta Dutta Lorenz von Seidlein David A Sack
Abstract
In addition to improved water supply and sanitation, the two-dose killed oral cholera vaccine (OCV) is an important tool for the prevention and control of cholera. We aimed to document the immunogenicity and protection (efficacy and effectiveness) conferred by a single OCV dose against cholera. The meta-analysis showed an estimated 73% and 77% of individuals seroconverted to the Ogawa and Inaba serotypes, respectively, after an OCV first dose. The estimates of single-dose vaccine protection from available studies are 87% at 2 months decreasing to 33% at 2 years. Current immunologic and clinical data suggest that protection conferred by a single dose of killed OCV may be sufficient to reduce short-term risk in outbreaks or other high-risk settings, which may be especially useful when vaccine supply is limited. However, until more data suggests otherwise, a second dose should be given as soon as circumstances allow to ensure robust protection.
Nature Scientific Reports
Published online: 22 November 2017
Article
Early vaccination protects against childhood leukemia: A systematic review and meta-analysis
Mostafa Ebraheem Morra, Nguyen Dang Kien […] Nguyen Tien Huy
Abstract
Leukemia is the most commonly diagnosed childhood cancer, although its etiology is still largely unknown. Growing evidence supports a role for infection in the etiology of acute lymphocytic leukemia (ALL), and the involvement of the immune system suggests that vaccination may also play a role. However, the findings presented in the published literature are inconsistent. Therefore, we conducted a PRISMA systematic review and meta-analysis. 14 studies were identified and meta-analyzed. Vaccinations studied comprised Bacillus Calmette-Guérin (BCG) vaccine, Triple vaccine, Hepatitis B vaccine (HBV), Polio, Measles, Rubella, Mumps, trivalent MMR vaccine and Haemophilus influenza type B (HiB) vaccine. We observed a protective association between any vaccination in the first year of life and risk of childhood leukemia (summary odds ratio (OR) 0.58 [95% confidence interval (CI) 0.36–0.91]). When individual vaccines were analysed, some evidence of an association was seen only for BCG (summary OR 0.73 [95% CI 0.50–1.08]). In conclusion, early vaccination appears to be associated with a reduced risk of childhood leukemia. This finding may be underpinned by the association observed for BCG. Given the relatively imprecise nature of the results of this meta-analysis, our findings should be interpreted cautiously and replicated in future studies.
The International Journal of Tuberculosis and Lung Disease
Volume 21, Number 12, 1 December 2017, pp. 1288-1293(6)
Knowledge of tuberculosis and vaccine trial preparedness in Lima, Peru
E Shu, ME Sobieszczyk, VG Sal y Rosas, P Segura…
Abstract
SETTING: A safe, effective vaccine would improve tuberculosis (TB) control worldwide. Extensive community engagement will be essential to ensure the interest and participation of populations at highest risk.
OBJECTIVE/METHOD: To inform the potential implementation of efficacy studies, we assessed TB knowledge, attitudes towards licensed vaccines and willingness to participate in future TB vaccine efficacy trials among 262 household contacts of 79 recently diagnosed pulmonary TB cases in Lima, Peru.
RESULTS: Overall knowledge of TB was low. Only 41.6% of household contacts perceived themselves as being at high risk of acquiring TB. Slightly above half (54.2%) indicated willingness to participate in a TB vaccine trial. After clustered analysis adjusting for homogeneity among families, willingness to enroll was associated with belief that receiving all recommended vaccinations is important (adjusted OR [aOR] 3.28, P = 0.016), desire to know more about TB risk factors and clinical trials (aOR 2.60, P = 0.004), older age (aOR 1.02, P = 0.027) and TB knowledge (aOR 0.05, P = 0.039).
CONCLUSION: Barriers to participation in TB vaccine trials exist among individuals at high risk for TB. Targeted education about TB risk factors, TB transmission and education about the clinical trial process will be critical for laying the groundwork for future vaccine trials.
Media/Policy Watch
This watch section is intended to alert readers to substantive news, analysis and opinion from the general media and selected think tanks and similar organizations on vaccines, immunization, global public health and related themes. Media Watch is not intended to be exhaustive, but indicative of themes and issues CVEP is actively tracking. This section will grow from an initial base of newspapers, magazines and blog sources, and is segregated from Journal Watch above which scans the peer-reviewed journal ecology.
We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.
BBC
http://www.bbc.co.uk/
Accessed 25 November 2017
Yemen war: First aid flights arrive since blockade
Nov 25, 2017
The first aid flights since the Saudi-led coalition imposed a blockade on rebel-held areas three weeks ago have landed in Yemen’s capital, Sanaa.
They include a UN flight carrying 1.9m doses of vaccines, Meritxell Relano, Unicef representative in Yemen tweeted…
Forbes
http://www.forbes.com/
Accessed 25 November 2017
Just Two Measles Cases Cost Taxpayers $68,192 In Colorado
Tara Haelle, Contributor
25 November 2017
The cost of the public health response to a single measles case can exceed $100,000 depending on circumstances.
HPV Vaccination Immunity Remains Strong 10 Years Later, Especially For Preteens
Tara Haelle, Contributor
22 November 2017
The vaccine against human papilloma virus (HPV) is safe and effective at preventing infection, according to new findings from one of the longest follow-up industry-funded studies of the four-strain HPV vaccine to date.
The study, published in Pediatrics, also revealed data supporting the rationale behind recommending the vaccine to boys and girls at 9-12 years old. Not only are these ages long before most kids become sexually active, but those who received the vaccine at these younger ages had stronger immunity against HPV than those who received the vaccine more than two years later…
Foreign Affairs
http://www.foreignaffairs.com/
Accessed 25 November 2017
Health Snapshot
Ready for a Global Pandemic?
The Trump Administration May Be Woefully Underprepared
Nov 21, 2017
Tom Inglesby and Benjamin Haas
Huffington Post
https://www.huffingtonpost.com/
Accessed 25 November 2017
Measles: eliminated, but not out of the game
| 16 November 2017
By Orin Levine
Washington Post
http://www.washingtonpost.com/
Accessed 25 November 2017
States prepare to shut down children’s health programs if Congress doesn’t act
Officials in nearly a dozen states are preparing to notify families that a crucial health insurance program for low-income children is running out of money for the first time since its creation two decades ago, putting coverage for many at risk by the end of the year…
Longtime physician William Rees remembers the years before CHIP’s safety net, when families without coverage would put off bringing a sick child to the doctor until symptoms were so severe they would end up in a hospital emergency room.
“Pediatrics is mostly preventive medicine, it’s so important what we do,” said Rees, who has practiced in Northern Virginia since 1975. “It’s about trying to keep up with routine visits. If [children] don’t have insurance, that often doesn’t happen, so CHIP keeps them in the system and they get their vaccines when they’re due.”…
Colby Itkowitz and Sandhya Somashekhar · Health-Environment-Science · Nov 23, 201
Think Tanks et al
Brookings
http://www.brookings.edu/
Accessed 25 November 2017
Future Development
State fragility is key to reaching the last mile in ending poverty
George Ingram and Jonathan Papoulidis
Tuesday, November 21, 2017
Fragile states are at the center of today’s global development crisis. By 2030, an estimated 80 percent of the world’s extreme poor will live in these perilous places. While international actors have broadened their focus to cover fragility, conflict, and violence, this has not come with high-level political calls to recognize “fragility as the new development frontier.” Fragility merits top billing and should encompass security reform, peace building, poverty reduction, environment, humanitarian assistance, and equity…
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_18 Nov 2017
– 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
