Milestones :: Perspectives
 
Ebola – Democratic Republic of the Congo

WHO –
Ebola virus disease – Democratic Republic of the Congo
Disease outbreak news   ::  7 September 2018
[Excerpt]
…WHO risk assessment
This outbreak of EVD is affecting north-eastern provinces of the Democratic Republic of the Congo, which border Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include the transportation links between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations; and the displacement of Congolese refugees to neighbouring countries. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri may hinder the implementation of response activities. Based on this context, the public health risk was assessed to be high at the national and regional levels, and low globally.
As the risk of national and regional spread remains high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. WHO will continue to work with neighbouring countries and partners to ensure health authorities are alerted and are operationally ready to respond…

05: Situation report on the Ebola outbreak in North Kivu 
4 September 2018
The 1 September 2018 marks one month since the declaration of the Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces, Democratic Republic of the Congo. The Ministry of Health, WHO and partners have made progress in response to the outbreak during this time. Recent trends (Figure 1) suggest that control measures are working; however, these trends must be interpreted with caution.
Since our last situation report on 28 August 2018 (External situation report 4), an additional 11 new EVD cases (8 confirmed and 3 probable) and seven new deaths have been reported. Nine other suspected cases are currently under investigation to confirm or exclude EVD…

::::::
 
In eastern DRC, nearly 2.5 million people reached in effort to contain Ebola outbreak – UNICEF
KINSHASA/DAKAR/NEW YORK/GENEVA, 5 September 2018 – UNICEF and its partners have now reached 2,454,000 people with Ebola prevention messages since the start of the latest outbreak in the eastern part of the Democratic Republic of the Congo (DRC). Ebola awareness and prevention efforts have been rolled out in seven health zones, in close collaboration with the local communities, including 1,715 local community workers.

“An increasing number of communities are now aware of Ebola and how to prevent its transmission,” said Dr Gianfranco Rotigliano, UNICEF Representative in the DRC. “The active involvement of concerned communities is key to stopping the spread of the disease. We are working closely with them to promote handwashing and good hygiene practices, to accept dignified and safe funerals and to identify and assist people that might be infected with the virus.”

At-risk populations are being reached through community engagement, interpersonal communication, public animations, radio, door-to-door activities, church meetings and adolescent groups. Prevention messages are shared in French, Lingala, Swahili and Nande so that everyone can learn how to protect oneself against the virus and contain its spread.

Eight Ebola survivors have joined the communication teams, sharing their experiences with local communities and stressing the importance of early detection and treatment of people with Ebola-like symptoms.

UNICEF continues to put children at the heart of its response to the outbreak. In support of local authorities, since the beginning of the response, UNICEF and its partners have:
:: Briefed and engaged in communication activities 2,560 influential leaders and representatives of different social and professional networks;
:: Sensitized more than 4,500 people eligible for the Ebola vaccination about the benefits of the vaccine;
:: Provided safe drinking water to more than 500,000 people in the affected areas;
:: Assisted 91 unaccompanied children and orphans as well as 101 families  affected by the disease;
:: Trained more than 150 psychosocial workers to support affected families and their children;
:: Trained and deployed 7 nutrition specialists to ensure nutritional assistance to the patients in the Ebola Treatment Centres in Mangina and Beni;
:: Installed 972 hand washing units and distributed 324 laser thermometers in 162 targeted schools in Mangina and Beni.

In the context of the start of the school year, UNICEF is continuing its prevention efforts in schools, while pursuing its efforts in communication, WASH and psycho-social assistance to families that have been affected by the virus.

Milestones :: Perspectives

Statement on the Lake Chad Region – Berlin Humanitarian Conference
by Dr Rick Brennan, WHO Director of Emergency Operations
Berlin, Germany   3 September 2018
Distinguished delegates,
As others have observed today, the narrative and dialogue around the Lake Chad Basin crisis has matured significantly since we met in Oslo last year.

We need to make the humanitarian-development peace nexus concrete. There is a general recognition that robust and principled humanitarian action is necessary – but not sufficient – to meet the needs of the people in the region. There is also an acknowledgment that root causes must be met, resilience of communities and institutions built, and the humanitarian-development-peace nexus operationalized.

Our challenge remains to shift from agreeing on these concepts and principles, to ensuring their concrete implementation – and to identify the solutions that Mark Lowcock constantly urges us to develop.

There are unique opportunities for effective implementation of the New Way or Working within the Lake Chad Basin sub-region, especially within the health sector. In fact, there is probably no better opportunity in the world today than the Lake Chad Basin region to demonstrate that it is possible to effectively implement the New Way of Working. And it is the view of WHO and our health sector partners, that health presents unique opportunities in this regard.

Humanitarian health response has been effective to date and must be sustained. Humanitarian health action has already documented some remarkable achievements over the past two years in Northeast Nigeria. Through progressively expanding access to essential health services – and working in collaboration with other life-saving sectors – we have documented a sharp drop in mortality in Northeast Nigeria. Mortality rates, which were dramatically elevated above emergency thresholds early in the response, are now within normal limits, at least among those populations to whom we have access. Last year, a collaborative malaria control effort with the Ministry of Health, UNICEF and other partners averted at least 6500 childhood deaths due to malaria. We have also jointly responded effectively to major outbreaks of measles, cholera, meningitis and polio. You may recall that polio established its foothold back in Africa due to the crisis in Northeast Nigeria.

Resilience in the health sector must be built at individual and systems levels. While we all aim to maintain a strong humanitarian response for the short-to medium- term, we see several important opportunities to build the resilience of both individuals and the health system. Firstly, there are few factors that make individuals more resilient physically and mentally than good health and strong nutritional status. Continued strengthening of the coverage and quality of essential health services will help to ensure that individuals are both resistant to disease and recover more rapidly when they do become ill.

Similarly, we need to make the health system itself resilient. Perhaps the best example of this is through building its capacities to prevent, detect and respond to outbreaks of infectious diseases. The Lake Chad region is remarkably prone to outbreaks of disease that have crossed borders, such as meningitis, cholera and hepatitis E. Building capacities for disease surveillance, laboratory diagnosis, and rapid response is vital to the resilience of any health system – and this is nowhere more evident than in the Lake Chad region.

Good governance is essential for sustainable health system development. We also need to be concrete about how we lay the foundations of longer-term health system recovery and development. This can be a complex process, as we have learned in other contexts. But I would like to highlight a sine qua non for sustainable development within the health sector – and that is good governance and leadership. All of the support from international partners will come to naught in the longer term unless authorities at all levels take strong ownership of the health system, ensure transparent management processes and provide an inclusive voice for communities. Involvement of civil society and the private sector has been demonstrated to contribute to health system recovery in several examples and we need to accelerate this process in the context of Lake Chad.

The health sector can contribute to peacebuilding. Finally, the health sector can play its own modest role in advancing peace and reconciliation. Public health campaigns can be opportunities for humanitarian pauses and can be a leading wedge for opening up humanitarian access. Polio vaccinations have helped to open access for other health services in Northeast Nigeria, for example. Re-establishing health services can be a confidence and trust-building process. This is especially true when they are extended to populations who have historically been neglected by central authorities and when they are designed to address longer-term inequities.

In summary, ladies and gentlemen, we must collectively move from agreeing on what needs to be done, to taking concrete steps to implement the humanitarian-development-peace nexus across all sectors. Conceptual frameworks and good intentions and are not enough – we must implement, and we must do so with the full engagement of communities and national partners.

Milestones :: Perspectives
World Organisation for Animal Health (OIE)   [to 8 Sep 2018]
http://www.oie.int/en/for-the-media/press-releases/2018/

7 September 2018
Countries reaffirm political will to globally eradicate Peste des petits ruminants
The aim is to stamp out a virus, which kills millions of sheep and goats each year, and thus protect the livelihoods of hundreds of millions of poor rural families.

Brussels, 7 September 2018 – Over 45 countries today renewed their commitment to globally eradicate by 2030, Peste des petits ruminants (PPR), a highly contagious and devastating disease responsible for the death of millions of sheep and goats each year. At the same time, countries urged resource partners and the development community to contribute in bridging the PPR Global Eradication Programme’s US$340 million funding gap.

The decision to reaffirm this international political engagement and encourage resource partners to join the fight against the disease came at the global conference: Partnering and investing for a PPR-free world, organised by the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations, and hosted by the European Commission in Brussels…

…The PPR Global Control and Eradication Strategy was initially adopted at a 2015 conference in Abidjan jointly organized by FAO and the OIE. Through a 2017-2021 PPR Global Eradication Programme, countries formulated  National Strategic Plans, which detail the steps for assessing, controlling, and eradicating the PPR virus, maintaining PPR virus freedom, as well as the financial resources required and committed by national authorities to implement these plans…

PPR Global Control and Eradication Strategy
FAP, OiE   2015: 8 pages
Foreword
Peste des petits ruminants (PPR) can severely affect small ruminants in almost 70 countries in Africa, the Middle East and parts of Asia. It is a highly contagious disease that causes USD 1.5 to 2 billion in losses each year in regions that are home to over 80% of the world’s sheep and goats and to more than 330 million of the world’s poorest people, many of whom depend on them for their livelihoods. The disease threatens food security and the livelihoods of smallholders and prevents animal husbandry sectors from achieving their economic potential. Reducing the number of PPR-endemic countries is therefore a shared interest and should be considered a Global Public Good.

PPR, as one of the most damaging of all animal diseases, is among the priority diseases indicated in the FAO-OIE Global Framework for the Progressive Control of Transboundary Animal Diseases (GF-TADs) 5 Year Action Plan. In response to recommendations of GF-TADs, a resolution by the World Assembly of Delegates of the OIE and recommendations of the Committee on Agriculture (COAG) and the Council of FAO, the GF-TADs Working group has developed the PPR Global Control and Eradication Strategy (hereinafter the ‘Global Strategy’), which is being presented at the FAO and OIE International Conference for the Control and Eradication of peste des petits ruminants to be held in Abidjan (Côte d’Ivoire), from 31 March to 2 April 2015.

The Global Strategy described in this document is not a ‘stand-alone’ activity designed for PPR control and eradication only. It will allow progress to be made in other fields, with the  strengthening of Veterinary Services as a cornerstone of the strategy which will provide the necessary enabling environment to control other animal diseases through a cost-effective combination of activities against several major diseases of small ruminants…

[Excerpt]
4.4. Vaccines
One of the key conditions for the success of the global rinderpest eradication programme was the use a rinderpest vaccine that was highly efficacious in protecting animals against all rinderpest virus strains. A similar tool also exists for the prevention and control of PPR. Indeed efficient live attenuated PPR vaccines are available that can induce lifelong protective immunity in vaccinated animals (see Annex 3.2).

Currently more than 20 manufacturers produce PPR vaccine. Therefore, it will be of the utmost importance for the products of all these manufacturers, before their use in the field, to be certified as meeting OIE vaccine quality standards (24) to ensure their efficacy. In that regard, the certification body should be an independent institution such as the African Union Pan-African Veterinary Vaccine Centre (AU-PANVAC), which ensures the quality control of various veterinary vaccines, including PPR vaccine, in Africa. PANVAC is an OIE and FAO Collaborating/ Reference Centre for quality control of veterinary vaccines.

Current PPR virus (PPRV) attenuated vaccines are thermolabile and to avoid their thermal inactivation they require uninterrupted maintenance of the cold chain until their application to the animal. The currently commercially available vaccines are in freeze-dried form and they are stable for at least two years at 2°C to 8°C and for several years at –20°C. Once the vaccine is reconstituted, it needs to be utilised as soon as possible, but not later than 30 minutes after dilution. Most of the PPR-endemic regions have a hot climate and they usually have poor infrastructure to maintain the cold chain needed to preserve vaccine potency and efficacy. To address this constraint, many research laboratories have succeeded in improving the freeze-drying conditions in the presence of cryoprotectants to obtain a thermostable PPR vaccine product. It is expected that the continued transfer of these newer technologies to vaccine
manufacturers will improve the quality of the final products delivered in the field.

Consideration should be given to the constitution of regional vaccine banks to ensure vaccine availability in case of emergencies. The OIE has established vaccine banks using the concept of virtual rolling stocks (32): the supplier (vaccine production companies selected through calls for tender based on international standards) produces the vaccines when needed or a limited physical stock of vaccines remains with the supplier and is renewed on a rolling basis under terms and conditions contractually defined with the OIE. This concept enables the rapid supply of an emergency stock of vaccines to infected countries in order to vaccinate animal populations at risk and to progressively achieve eradication wherever possible. The concept can also serve the purpose of delivering quality vaccine for the annual control programmes, in a non-emergency situation…

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 4 September 2018 [GPEI]
Summary of new viruses this week:
Papua New Guinea – three new cases of circulating vaccine-derived poliovirus type 1 (cVDPV1). No new cases of wild poliovirus.
Afghanistan and Pakistan continue to detect WPV1 through environmental sampling, indicating sustained transmission.

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

WHO Grade 3 Emergencies  [to 8 Sep 2018]
Nigeria 
:: WHO statement from the High-level conference on the Lake Chad Region  3 September 2018
[See Milestones above for full text]

The Syrian Arab Republic
:: Generous donation of medical equipment from Japan boosts public health services in Syria
3 September 2018

Iraq  – No new announcements identified
South Sudan  – No new announcements identified
Yemen  – No new announcements identified
 
::::::
 
WHO Grade 2 Emergencies  [to 8 Sep 2018]
Cameroon  – No new announcements identified
Central African Republic  – No new announcements identified.
Democratic Republic of the Congo – No new announcements identified
Ethiopia  – No new announcements identified.
Libya – No new announcements identified.
Myanmar  – No new announcements identified
Niger  – No new announcements identified.
Ukraine – No new announcements identified

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

::::::

UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Somalia   
:: Humanitarian Bulletin Somalia, 1 August – 5 September 2018
HIGHLIGHTS

• Food security improving, but nutrition levels remain critical.
• Rise in forced evictions raises concern
• Children < 5 targeted in nationwide polio campaign…

Ethiopia  – No new announcements identified.

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

EBOLA/EVD  [to 8 Sep 2018]
http://www.who.int/ebola/en/
Disease outbreak news
:: Ebola virus disease – Democratic Republic of the Congo  7 September 2018
:: 05: Situation report on the Ebola outbreak in North Kivu  4 September 2018
 [See Milestones above for more detail]

MERS-CoV [to 8 Sep 2018]
http://who.int/emergencies/mers-cov/en/
– No new announcements identified.
 
Yellow Fever  [to 8 Sep 2018]
http://www.who.int/csr/disease/yellowfev/en/
– No new announcements identified.

Zika virus  [to 8 Sep 2018]
http://www.who.int/csr/disease/zika/en/
– No new announcements identified.

WHO & Regional Offices [to 8 Sep 2018]

Launch of new global estimates on levels of physical activity in adults
5 September 2018 | News Release

Protecting women in Solomon Islands from cervical cancer
4 September 2018 – Feature story

WHO airlifts over 500 tons of essential medicines and medical supplies to Yemen
3 September 2018 | News Release

::::::
 
Weekly Epidemiological Record, 7 September 2018, vol. 93, 36 (pp. 457–476)
:: Dengue vaccine: WHO position paper – September 2018
[Excerpt]
…WHO position
The live attenuated dengue vaccine CYD-TDV has been shown in clinical trials to be efficacious and safe in persons who have had a dengue virus infection in the past (seropositive individuals), but carries an increased risk of severe dengue in those who experience their first
natural dengue infection after vaccination (seronegative individuals). Countries should consider introduction of the dengue vaccine CYD-TDV only if the minimization of risk among seronegative individuals can be assured.62

For countries considering vaccination as part of their dengue control programme, pre-vaccination screening is the recommended strategy. 63 With this strategy, only persons with evidence of a past dengue infection would be vaccinated (based on an antibody test, or on a documented laboratory confirmed dengue infection in the past). If pre-vaccination screening is not feasible, vaccination without individual screening could be considered in areas with recent documentation of seroprevalence rates of at least 80% by age 9 years.

Screening tests would need to be highly specific to avoid vaccinating truly seronegative persons and to have high sensitivity to ensure that a high proportion of seropositive persons are vaccinated. Conventional serological testing for dengue virus IgG (e.g. dengue IgG ELISA)
is available in most dengue endemic countries, and could be used to identify persons who have had a past dengue infection. However, such laboratory-based assays do not provide results at the point of care. Point-of-care tests, i.e. RDTs, would facilitate the implementation of the pre-vaccination screening strategy, but to date none have been validated or licensed specifically for the detection of past dengue infection. Use of currently available IgG-containing RDTs – despite their lower sensitivity for detection of past dengue infection compared with conventional dengue IgG ELISA – could be considered in high transmission settings until better RDTs for determining serostatus become available.

No screening test is likely to be 100% specific due to potential cross-reactivity with other flaviviruses. In settings with high dengue seroprevalence, a test with lower specificity might be acceptable as the proportion of seronegative individuals incorrectly vaccinated would be low. A pre-vaccination screening strategy may also be considered in low-to-moderate transmission settings. In settings with low seroprevalence a test with high specificity is needed. Given the limitations regarding specificity, some seronegative individuals may be vaccinated because of a false positive test result. Furthermore, as vaccine-induced protection against dengue in seropositive individuals is high but not complete, breakthrough disease will occur in some seropositive vaccinees. These limitations will need to be communicated to populations offered vaccination.

Decisions about implementing a pre-vaccination screening strategy with the currently available tests will require careful assessment at the country level, including consideration of the sensitivity and specificity of available tests and of local priorities, dengue epidemiology, country-specific dengue hospitalization rates, and affordability of both CYD-TDV and screening tests.

Decisions about implementing a seroprevalence criterion-based vaccination strategy without individual screening in areas with documented seroprevalence rates of at least 80% at age 9 years will require population serosurveys at high resolution, i.e. at district and sub-district level. Careful assessment is required with regard to the feasibility and cost of population seroprevalence studies. Communication needs to ensure appropriate and full disclosure of the risks of vaccination of persons with unknown serostatus.

Vaccination should be considered as part of an integrated dengue prevention and control strategy. There is an ongoing need to adhere to other disease preventive measures such as well-executed and sustained vector control. Individuals, whether vaccinated or not, should
seek prompt medical care in if dengue-like symptoms occur. Vaccinated patients should  continue to be offered the best evidence-based clinical care for all patients with dengue…

62 Evidence to recommendation Table 1: Consideration of Dengue Vaccine. Geneva:
World Health Organization; 2018 – http://www.who.int/immunization/policy/position_
papers/E2R_1_dengue_2018.pdf
63 Evidence to recommendation Table 2: Seroprevalence and screening and vaccination
strategy. Geneva: World Health Organization; 2018 – http://www.who.int/immunization/
policy/position_papers/E2R_2_dengue_2018.pdf
 
::::::
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: South Sudan intensifies Ebola preparedness in response to the outbreak in Democratic Republic of Congo  07 September 2018
:: WHO scales up response as Borno declares another outbreak of cholera  06 September 2018
:: Uganda targets over 1,600,000 persons for Cholera vaccination campaign  05 September 2018

WHO Region of the Americas PAHO
No new digest content identified.
 
WHO South-East Asia Region SEARO
:: Countries in WHO South-East Asia to intensify efforts to control dengue, eliminate malaria
:: Strengthen emergency medical teams for better response to disasters: WHO
:: Dr Poonam Khetrapal Singh unanimously nominated for second term as Regional Director WHO South-East Asia
:: Countries in WHO South-East Asia Region resolve to make essential medical products accessible, affordable to all
 
WHO European Region EURO
:: WHO launches a cutting-edge package to scale up risk communication capacity in the European Region in 5 steps 06-09-2018
:: Confirmed case of MERS-CoV in United Kingdom 03-09-2018

WHO Eastern Mediterranean Region EMRO
:: Generous donation from Japan boosts public health services in Syria  3 September 2018
:: WHO airlifts over 500 tons of essential medicines and medical supplies to Yemen  3 September 2018
:: Palestinian casualties of Gaza demonstrations  3 September 2018
: 14 million children in Afghanistan to be immunized against measles   1 September 2018

WHO Western Pacific Region
:: WHO continues to support flood response activities in Attapeu Province  3 September 2018
 

CDC/ACIP [to 8 Sep 2018]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html

Latest News
CDC guidance to travelers as influenza season nears
Friday, September 7, 2018

MMWR News Synopsis for September 6, 2018

Assessment of State, Local, and Territorial Zika Planning and Preparedness Activities — United States, June 2016–July 2017
The ability of health departments to prepare for and respond to emerging public health challenges is pivotal to protect the health of all Americans.  The 2015-2016 Zika virus epidemic demonstrated how health departments, with the assistance of CDC, were able to quickly adapt and enhance planning to respond to a new threat. During the 2015-2016 Zika virus epidemic, CDC awarded $25 million in supplemental funding to 41 states, eight territories and four metropolitan areas to support preparedness and response efforts.  This report is the first to present a snapshot of preparedness activities performed by grant recipients and demonstrates improving readiness in the event Zika virus were to emerge in the future.  Health departments need to be ready to adapt to emerging public health challenges. The ability of state, local and territorial governments to adapt quickly in response to the arrival of Zika virus was because of the 16 years of preparedness coordination between CDC and health departments across the country.

Progress Toward Poliovirus Containment Implementation — Worldwide, 2017–2018
Poliovirus containment requires global participation and is essential to ensure polio is not reintroduced into the population after polio eradication. As the world progresses toward polio disease eradication, polioviruses in laboratories and other facilities must be securely contained to prevent release back into the human population. The global poliovirus containment initiative, essential to maintaining a polio-free world, is underway in every country and currently focuses on the poliovirus serotype that has been declared eradicated (type 2). Facilities with type 2 poliovirus must undergo a rigorous certification process including audits from a national authority. In addition, facilities around the world must inspect specimen inventories to ensure that samples were not collected at a time and place when poliovirus was in circulation in the community. While there are many challenges in implementing this complex international program, important poliovirus containment achievements have been made in the last year.

Africa CDC   [to 8 Sep 2018]
https://au.int/en/africacdc
September 03, 2018

African Union conducts pre deployment training workshop for health workers destined to fight Ebola in North Kivu and Ituri provinces in DRC

China CDC 
http://www.chinacdc.cn/en/

Website not responding at inquiry

Announcements

 
AERAS  [to 8 Sep 2018]
http://www.aeras.org/pressreleases
No new digest content identified.
 
 
BMGF – Gates Foundation  [to 8 Sep 2018]
http://www.gatesfoundation.org/Media-Center/Press-Releases
No new digest content identified.

Bill & Melinda Gates Medical Research Institute    [to 8 Sep 2018]
https://www.gatesmri.org/
The Bill & Melinda Gates Medical Research Institute is a non-profit biotech organization. Our mission is to develop products to fight malaria, tuberculosis, and diarrheal diseases—three major causes of mortality, poverty, and inequality in developing countries. The world has unprecedented scientific tools at its disposal; now is the time to use them to save the lives of the world’s poorest people
No new digest content identified.

CARB-X   [to 8 Sep 2018]
https://carb-x.org/
CARB-X is a non-profit public-private partnership dedicated to accelerating antibacterial research to tackle the global rising threat of drug-resistant bacteria.
No new digest content identified.

 
CEPI – Coalition for Epidemic Preparedness Innovations  [to 8 Sep 2018]
http://cepi.net/
No new digest content identified.

EDCTP    [to 8 Sep 2018]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials
3 September 2018
EDCTP launches €2.25 M emergency funding initiative in response to Ebola outbreak in the Democratic Republic of Congo
Today, the European & Developing Countries Clinical Trials Partnership (EDCTP) launched an emergency funding initiative ‘Mobilisation of research funds in case of Public Health Emergencies’ to support research activities in response to the  Ebola Virus Disease (EVD) outbreak in the Democratic Republic of Congo. Applications for research funding must be submitted by 10 September 2018.

Emory Vaccine Center    [to 8 Sep 2018]
http://www.vaccines.emory.edu/
No new digest content identified.

European Medicines Agency  [to 8 Sep 2018]
http://www.ema.europa.eu/ema/
07/09/2018
Meeting highlights from the Pharmacovigilance Risk Assessment Committee (PRAC) 3-6 September 2018
PRAC elects new vice-chair [Dr Martin Huber from Germany]
At its monthly meeting, the European Medicines Agency’s (EMA) Pharmacovigilance Risk Assessment Committee (PRAC) did not start or conclude a new referral.

 
European Vaccine Initiative  [to 8 Sep 2018]
http://www.euvaccine.eu/news-events
No new digest content identified.
 
 
FDA [to 8 Sep 2018]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
September 05, 2018
Statement from FDA Commissioner Scott Gottlieb, M.D., on the agency’s global efforts to help assure product quality and transparency at foreign drug manufacturing facilities
… We’ve established a framework to help assure that drug products all meet the same high-quality standards, regardless of where they’re manufactured; and whether they’re brand name or generic products, or prescription or over-the-counter drugs. Today, we’re announcing several steps that improve on that effort.
Helping assure the quality and safety of globally produced products requires a variety of efforts at different times throughout the lifecycle of a drug’s manufacturing and finishing. Our inspections and surveillance of manufacturing facilities are an integral part of this oversight. We need to make sure that our inspections are prioritized based on potential risks to patients, and that we’re using our resources efficiently.
Today, to add greater transparency around our site selection model, we’re publishing our internal policy for how manufacturing facilities are prioritized and scheduled for surveillance inspections. Our policy explains how a facility’s compliance history, recall trends, time since last inspection, inherent risk of the drug being manufactured, processing complexity and other factors are all weighed and considered…
 
 
Fondation Merieux  [to 8 Sep 2018]
http://www.fondation-merieux.org/
Mérieux Foundation event
Global challenges in vaccine acceptance science and programs
September 24 – 26, 2018 – Les Pensieres Center for Global Health, Veyrier du Lac (France)
 
 
Gavi [to 8 Sep 2018]
http://www.gavi.org/library/news/press-releases/
No new digest content identified.

 
GHIT Fund   [to 8 Sep 2018]
https://www.ghitfund.org/newsroom/press
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that devastate the world’s poorest people. Other funders include six Japanese pharmaceutical
No new digest content identified.

Global Fund [to 8 Sep 2018]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
News
India Supports Global Fund Efforts to Mobilize Funds
05 September 2018
India announced today it would host the Global Fund’s Preparatory Meeting of the Sixth Replenishment in New Delhi in February 2019, an important milestone to mobilize funds aimed at accelerating the end of AIDS, TB and malaria as epidemics.
 
Hilleman Laboratories   [to 8 Sep 2018]
http://www.hillemanlabs.org/
Date: 09/01/2018
Hilleman Laboratories partners with innovative Future Vaccine Manufacturing Hub
Hilleman Laboratories, an equal joint-venture partnership between MSD and Wellcome Trust, is honored to be one of the key partners of the new Future Vaccine Manufacturing Hub led by Imperial College London. The hub has been established to increase immunisation coverage across the globe and improve the response to disease outbreaks through the rapid and cost-effective deployment of vaccines. £10 million of funding has been granted by the UK Department for Health, and will be managed by the Engineering and Physical Sciences Research Council (EPSRC).
The all-new Future Vaccine Manufacturing Hub aims to address two major challenges facing creation of future vaccine manufacturing systems:
:: How to design vaccine production systems that can produce tens of thousands of new doses within weeks of a new threat being identified
:: How to improve current manufacturing processes and change the way vaccines are manufactured, stabilized and stored so that existing and new diseases can be prevented effectively, at reduced costs…
 
 
Human Vaccines Project   [to 8 Sep 2018]
http://www.humanvaccinesproject.org/media/press-releases/
No new digest content identified.
 
 
IAVI  [to 8 Sep 2018]
https://www.iavi.org/
No new digest content identified.

 
IFFIm
http://www.iffim.org/library/news/press-releases/
No new digest content identified.

IVAC  [to 8 Sep 2018]
https://www.jhsph.edu/research/centers-and-institutes/ivac/index.html
No new digest content identified.
 
 
IVI   [to 8 Sep 2018]
http://www.ivi.int/
Undated
IVI’s 18th Vaccinology Course gathers 120 international participants from 19 countries in Seoul September 3-7
:: Annual Course to update on the recent development in vaccinology, including basics of immunology, epidemiology, vaccine design and development
:: Featured experts include: Stanley Plotkin (University of Pennsylvania), Dr. Barney Graham (US NIH), Dr. Randy Schoepp (USAMRID), Dr. Andy Pollard (University of Oxford), and Dr. Eric Mintz (US CDC)
:: Donor-supported fellowship invites 12 developing country participants to help increase country capacities in vaccines, immunization
:: Week-long course supported by GlaxoSmithKlein, EuBiologics, Sky 72 Golf Club, Seoul Metropolitan City, and Community Chest of Korea – Incheon
 
 
JEE Alliance  [to 8 Sep 2018]
https://www.jeealliance.org/
No new digest content identified.
 
 
MSF/Médecins Sans Frontières  [to 8 Sep 2018]
http://www.msf.org/
Selected Press Releases/Statements
DRC 2018 Ebola outbreaks
North Kivu: MSF treats 65 Ebola patients in first month
Project Update 7 Sep 2018
Médecins Sans Frontières (MSF) has treated 65 patients confirmed to be diagnosed with Ebola in the first month of intervention in the latest Ebola outbreak, in North Kivu, Democratic Republic of Congo (DRC). This number is more than 80 percent  of the total number of confirmed patients hospitalised in Ebola Treatment Centres so far during this epidemic. Of the patients confirmed Ebola positive in Mangina Ebola Treatment Centre, 29 have recovered and returned to their families. Three patients remain under treatment…

Central African Republic
“The tip of the iceberg”: Stream of patients offer glimpse into scale of sexual violence
Project Update 7 Sep 2018

Libya
Evacuation of refugees and migrants out of Libya is urgently needed
Press Release 7 Sep 2018

Mexico
Abductions and violence, the price to pay to cross Mexico
Project Update 3 Sep 2018

 
NIH  [to 8 Sep 2018]
http://www.nih.gov/news-events/news-releases
September 5, 2018
Clinical trial testing topical cream plus influenza vaccine in progress
— Cream regimen could boost immunity.
A Phase 1 clinical trial examining whether a topical cream can enhance the immune response conferred by a “pre-pandemic” influenza vaccine is underway at Baylor College of Medicine in Houston. Investigators are evaluating whether imiquimod cream, which is commonly used to treat genital warts and certain skin cancers, can boost the body’s immune response to an H5N1 influenza vaccine. The trial is enrolling 50 healthy adults ages 18-50 years. Baylor is one of the Vaccine and Treatment Evaluation Units (VTEUs) — a network of clinical research sites that can rapidly enroll large volunteer cohorts to evaluate experimental vaccines against infectious diseases. The VTEUs are funded and managed by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health…

PATH  [to 8 Sep 2018]
https://www.path.org/media-center/
No new digest content identified.

Sabin Vaccine Institute  [to 8 Sep 2018]
http://www.sabin.org/updates/pressreleases
No new digest content identified.
 
 
UNAIDS [to 8 Sep 2018]
http://www.unaids.org/en
5 September 2018
First ladies from Africa and China working towards a future free from AIDS
Read

UNICEF  [to 8 Sep 2018]
https://www.unicef.org/media/press-releases
Selected Press Releases/Reports/Statements
Statement
Statement by UNICEF Executive Director Henrietta Fore on the eve of Yemen peace talks
“The children of Yemen need to heal. They need justice. They need lasting peace, now.”
05/09/2018

Press release
In eastern DRC, nearly 2.5 million people reached in effort to contain Ebola outbreak – UNICEF
05/09/2018
[See Week in Review above for more detail]

Vaccine Confidence Project  [to 8 Sep 2018]
http://www.vaccineconfidence.org/
No new digest content identified.
 

Vaccine Education Center – Children’s Hospital of Philadelphia  [to 8 Sep 2018]
http://www.chop.edu/centers-programs/vaccine-education-center
No new digest content identified.
 
 
Wellcome Trust  [to 8 Sep 2018]
https://wellcome.ac.uk/news
Explainer / Published: 4 September 2018
Wellcome Flagships will focus on five health innovation challenges
Flagships are a new way of working for Wellcome. Director of Innovation Stephen Caddick explains what flagships are, how they’ll work and what we want to achieve.
One of the main ideas in our strategy, Innovation for Impact [PDF 200KB], is to identify a small number of health innovation challenges where we think a concerted effort could result in major, tangible improvements to people’s health.
Of course, this is easy to say and pretty hard to do. The key approach we’re using is based on building a series of linked activities, which we call Flagships.
We intend to commit up to £300m of our budget to five Flagships over the next six years. And we hope to work with partners who will share our commitment and help us to realise the ambition of each Flagship…
 
 
The Wistar Institute   [to 8 Sep 2018]
https://www.wistar.org/news/press-releases
Press Release
Sep. 6, 2018
Synthetic DNA Vaccine Effective Against Influenza A Virus Subtype That Is Responsible for More Severe Influenza Seasons
Compared with conventional vaccines, synthetic DNA vaccines can be manufactured faster and may avoid the need for annual vaccine reformulations.

Press Release
Sep. 5, 2018
Enhancing the Efficacy of Immune Checkpoint Inhibitor Therapy Using a Novel Treatment Combination
PHILADELPHIA — (Sept. 5, 2018) — A combination of a novel inhibitor of the protein CK2 (Casein kinase 2) and an immune checkpoint inhibitor has dramatically greater antitumor activity than either inhibitor alone, according to research from The Wistar Institute that was published online in Cancer Research.
Press Release
Sep. 4, 2018
Synthetic DNA Technology Provides a Novel Strategy for Effective Delivery of a Complex Anti-HIV Agent
PHILADELPHIA — (Sept. 4, 2018) — Scientists at The Wistar Institute have applied their synthetic DNA technology to engineer a novel eCD4-Ig anti-HIV agent and to enhance its potency in vivo, providing a new simple strategy for constructing complex therapeutics for infectious agents as well as for diverse implications in therapeutic delivery. This critical development was published online in the journal EBio Medicine.

World Organisation for Animal Health (OIE)   [to 8 Sep 2018]
http://www.oie.int/en/for-the-media/press-releases/2018/
7 September 2018
Countries reaffirm political will to globally eradicate Peste des petits ruminants
The aim is to stamp out a virus, which kills millions of sheep and goats each year, and thus protect the livelihoods of hundreds of millions of poor rural families.
[See Milestones above for detail]

::::::
 
BIO    [to 8 Sep 2018]
https://www.bio.org/insights/press-release
No new digest content identified.

DCVMN – Developing Country Vaccine Manufacturers Network  [to 8 Sep 2018]
http://www.dcvmn.org/
No new digest content identified.
 
IFPMA   [to 8 Sep 2018]
http://www.ifpma.org/resources/news-releases/
Policy Positions – Publications
:: IFPMA AMR Policy Position: Reimbursement and Health Technology Assessment Reform
:: IFPMA AMR Policy Position: Supporting sustainable investments in antimicrobial R&D
:: IFPMA AMR Policy Position: The need for AMR R&D pull incentives

PhRMA    [to 8 Sep 2018]
http://www.phrma.org/press-room
September 5, 2018
Nearly 1 in 5 Hospitals Marks Up Medicine Prices at Least 700 Percent
Nearly one in five hospitals marks up medicine prices 700 percent or more, according to a new analysis from the Moran Company that was commissioned by PhRMA.

Industry Watch [to 8 Sep 2018]
:: NIH Selects CEL-SCI’s LEAPS Rheumatoid Arthritis Vaccine for Commercialization Accelerator Program
September 05, 2018   VIENNA, Va.– CEL-SCI Corporation (NYSE American: CVM) announced today that the National Institutes of Health (NIH) selected CEL-SCI and its LEAPS* rheumatoid arthritis vaccine candidate as a Small Business Innovation Research/Small Business Technology Transfer (SBIR/STTR) Commercialization Accelerator Program Phase II awardee for 2018-2019. LEAPS has been specifically selected by the NIH for the Commercialization Transition Track, which provides technical assistance to awardee companies to move NIH-funded technologies towards commercialization and market readiness…

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

No new digest content identified.

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

American Journal of Infection Control
September 2018 Volume 46, Issue 9, p961-1082
http://www.ajicjournal.org/current

State of the Science Review
Social media and outbreaks of emerging infectious diseases: A systematic review of literature
Lu Tang, Bijie Bie, Sung-Eun Park, Degui Zhi
Published online: April 5, 2018
Highlights
:: A systematic review of published articles on social media and emerging infectious disease.
:: Three major approaches are identified: assessment of public opinion, organization’s social media use, and evaluation of information accuracy.
:: More theorization and methodologic rigor is needed.

American Journal of Infection Control
September 2018 Volume 46, Issue 9, p961-1082
http://www.ajicjournal.org/current

Major Articles
Unusual presentation of Middle East respiratory syndrome coronavirus leading to a large outbreak in Riyadh during 2017
Hala Amer, Abdulrahman S. Alqahtani, Hind Alzoman, Nawfal Aljerian, Ziad A. Memish
p1022–1025
Published online: April 13, 2018
 

American Journal of Public Health
September 2018   108(53)
http://ajph.aphapublications.org/toc/ajph/current

AJPH EDITORIALS – SUMMARY
Public Health Emergencies: Unpacking Medical Countermeasures Management for Preparedness and Response
Tanya Telfair LeBlanc PhD, MS, Christine Kosmos RN, MS, SBN, and Rachel Nonkin Avchen PhD, MS
Accepted: August 13, 2018
Published Online: September 07, 2018

American Journal of Public Health
September 2018   108(53)
http://ajph.aphapublications.org/toc/ajph/current

INFLUENZA
Taiwan’s Annual Seasonal Influenza Mass Vaccination Program—Lessons for Pandemic Planning
Immunization/Vaccines, Public Health Practice, Health Policy
Diane Meyer, Matthew P. Shearer, Yi-Chien Chih, Yu-Chen Hsu, Yung-Ching Lin and Jennifer B. Nuzzo
108(S3), pp. S188–S193
Abstract
Rapid medical countermeasure (MCM) dispensing is an important intervention during a public health emergency. In the United States, MCM planning and exercising efforts have largely focused on dispensing therapeutics, with less emphasis on mass vaccination operations that would require additional specialized staff and infrastructure. Difficulties in distributing vaccines during the 2009 H1N1 influenza pandemic highlighted the need for enhanced planning and exercising of plans for conducting mass vaccination campaigns.
In Taiwan, seasonal influenza mass vaccination campaigns are conducted annually, which both mitigate the effects of seasonal influenza and serve as functional exercises for mass vaccination operations during a pandemic. To identify lessons that can be applied to mass vaccination planning in the United States and elsewhere, we conducted an in-person observation and data review of Taiwan’s annual seasonal influenza mass vaccination efforts in October 2017.
We offer findings and recommendations for enhancing preparedness for seasonal and pandemic influenza and other public health emergencies that would require mass vaccination.

American Journal of Public Health
September 2018   108(53)
http://ajph.aphapublications.org/toc/ajph/current

Key Elements for Conducting Vaccination Exercises for Pandemic Influenza Preparedness
Immunization/Vaccines, Public Health Practice, Injury/Emergency Care/Violence
Jonathan D. Lehnert, Danielle L. Moulia, Neil C. Murthy, Amy Parker Fiebelkorn, Sara J. Vagi, Stephanie A. Dopson and Samuel B. Graitcer
108(S3), pp. S194–S195

BMJ Global Health
September 2018 – Volume 3 – 5
https://gh.bmj.com/content/3/5

Editorial
The sex gap in neonatal mortality and the AIDS epidemic in sub-Saharan Africa
(7 September, 2018)
Sanni Yaya, Setou Diarra, Marie Christelle Mabeu, Roland Pongou

BMJ Global Health
September 2018 – Volume 3 – 5
https://gh.bmj.com/content/3/5

Research
Institutionalising an evidence-informed approach to guideline development: progress and challenges at the World Health Organization
(8 September, 2018)
Unni Gopinathan, Steven J Hoffman

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 8 Sep 2018)

Research article
Cost-benefit analysis of vaccination: a comparative analysis of eight approaches for valuing changes to mortality and morbidity risks
There is increasing interest in estimating the broader benefits of public health interventions beyond those captured in traditional cost-utility analyses. Cost-benefit analysis (CBA) in principle offers a way …
Authors: Minah Park, Mark Jit and Joseph T. Wu
Citation: BMC Medicine 2018 16:139
Published on: 5 September 2018

Bulletin of the World Health Organization
Volume 96, Number 9, September 2018, 589-664
http://www.who.int/bulletin/volumes/96/9/en/
Special theme: health and the sustainable development goals

EDITORIALS
The role of health in achieving the sustainable development goals
– Shambhu Acharya, Vivian Lin & Natasha Dhingra
http://dx.doi.org/10.2471/BLT.18.221432

Bulletin of the World Health Organization
Volume 96, Number 9, September 2018, 589-664
http://www.who.int/bulletin/volumes/96/9/en/
Special theme: health and the sustainable development goal

POLICY & PRACTICE
Health promotion and the agenda for sustainable development, WHO Region of the Americas
– Kira Fortune, Francisco Becerra-Posada, Paulo Buss, Luiz Augusto C Galvão, Alfonso Contreras, Matthew Murphy, Caitlin Rogger, Gabriela E Keahon & Andres de Francisco
http://dx.doi.org/10.2471/BLT.17.204404

Bulletin of the World Health Organization
Volume 96, Number 9, September 2018, 589-664
http://www.who.int/bulletin/volumes/96/9/en/
Special theme: health and the sustainable development goals

Gender, health and the 2030 agenda for sustainable development
– Mary Manandhar, Sarah Hawkes, Kent Buse, Elias Nosrati & Veronica Magar
http://dx.doi.org/10.2471/BLT.18.211607

Bulletin of the World Health Organization
Volume 96, Number 9, September 2018, 589-664
http://www.who.int/bulletin/volumes/96/9/en/
Special theme: health and the sustainable development goals

Measuring health inequalities in the context of sustainable development goals
– Ahmad Reza Hosseinpoor, Nicole Bergen, Anne Schlotheuber & John Grove
http://dx.doi.org/10.2471/BLT.18.210401

Bulletin of the World Health Organization
Volume 96, Number 9, September 2018, 589-664
http://www.who.int/bulletin/volumes/96/9/en/
Special theme: health and the sustainable development goals

PERSPECTIVES
Universal health coverage and community engagement
– Asiya Odugleh-Kolev & John Parrish-Sprowl
http://dx.doi.org/10.2471/BLT.17.202382

Current Opinion in Infectious Diseases
October 2018 – Volume 31 – Issue 5
https://journals.lww.com/co-infectiousdiseases/pages/currenttoc.aspx

GASTROINTESTINAL INFECTIONS
Cholera: recent updates
Weil, Ana A.; Ryan, Edward T.
Current Opinion in Infectious Diseases. 31(5):455-461, October 2018.
Abstract:
Purpose of review
In this review, we will examine updates in cholera epidemiology, advances in our understanding of pathogenesis and protective immunity, and changes to prevention strategies.
Recent findings
New modeling techniques and molecular epidemiology have led to advancements in our understanding of how Vibrio cholerae has persisted and re-emerged in new areas during the seventh pandemic. Use of next-generation sequencing has shed new light on immune responses to disease and vaccination, and the role of the gut microbiome in cholera. Increased efficacy and availability of vaccines have made long-term goals of global control of cholera more achievable.
Summary
Advancements in our understanding of immunity and susceptibility to V. cholerae , in addition to an increased global commitment to disease prevention, have led to optimism for the future of cholera prevention.

Epidemiology and Infection
Volume 146 – Issue 13 – October 2018
https://www.cambridge.org/core/journals/epidemiology-and-infection/latest-issue

Arboviruses
Opinions – For Debate
Is vaccinating monkeys against yellow fever the ultimate solution for the Brazilian recurrent epizootics?
Eduardo Massad, Mônica Manir Miguel, Francisco Antonio Bezerra Coutinho
https://doi.org/10.1017/S0950268818002273
Published online: 14 August 2018, pp. 1622-1624

Epidemiology and Infection
Volume 146 – Issue 13 – October 2018
https://www.cambridge.org/core/journals/epidemiology-and-infection/latest-issue

Measles
Short Paper
Mass vaccination response to a measles outbreak is not always possible. Lessons from a London prison
 Junghans, C. Heffernan, A. Valli, K. Gibson
https://doi.org/10.1017/S0950268818001991
Published online: 19 July 2018, pp. 1689-1691
Abstract
In this study, we describe a contained measles outbreak in a London prison, the second such outbreak in a custodial setting. Once vaccination commenced, just under a third of eligible prisoners were immunised due to a low uptake of the vaccine. We conducted a root-cause analysis in order to identify factors which may have prevented or altered the course of the outbreak. Our analysis revealed that many of the factors identified are those that cannot be easily changed. It is unlikely that mass vaccination at the time, even in the absence of some of the more easily rectifiable issues, could have fully avoided further cases in the event of a mass outbreak. Both measles outbreaks in a custodial setting started with a member of staff and immunisation status of the staff were largely unknown. We argue that mass vaccination following an outbreak in a prison is unlikely to fully prevent a mass outbreak, and that implementing opt-out testing, empirical vaccination and insisting on full immunisation of staff are most likely to both prevent and contain outbreaks in the future.

Health Affairs
Vol. 37 , No. 9  September 2018
https://www.healthaffairs.org/toc/hlthaff/current

September 2018 | California: Leading The Way?
Research Article  Pharmaceuticals & Medical Technology
Mandatory Health Care Provider Counseling For Parents Led To A Decline In Vaccine Exemptions In California
Malia Jones, Alison M. Buttenheim, Daniel Salmon, and Saad B. Omer
Abstract
Receipt of childhood vaccinations in the US has been declining, and outbreaks of preventable infectious diseases have become more common. In response, in 2014 California implemented a policy change for exemptions from mandatory vaccines for school enrollment. Data on fifteen successive cohorts of kindergarteners enrolled in public and private schools between school years 2001–02 and 2015–16 were analyzed for changes in vaccination trends. The results show an increase in the prevalence and clustering of vaccine exemptions from 2001–02 through 2013–14, followed by a modest decline after implementation of a policy mandating health care provider counseling for vaccine exemption. Clustering of vaccine exemptions increased over the study period and was less responsive to the policy change than were exemption rates overall. Nor did the policy change uniformly reduce the clustering of at-risk students across counties. Trends in the use of conditional admission showed strong school-level clustering and remained relatively stable. The policy change was effective at reducing exemption rates but did not uniformly reduce clustering of exemptions. The results suggest the need to evaluate the causes of local-area clustering and to adopt a statewide policy that addresses clustering of vaccine exemptions within schools and counties.

Health Equity
Volume 2 Issue 1  Jun 2018
https://www.liebertpub.com/toc/heq/2/1

Open Access
Factors Associated with Human Papillomavirus Vaccination Among Diverse Adolescents in a Region with Low Human Papillomavirus Vaccination Rates
Deanna Kepka, Julia Bodson, Djin Lai, Ana Sanchez-Birkhead, Jeannette Villalta, Valentine Mukundente, Fahina Tavake-Pasi, France A. Davis, Doriena Lee, Edwin Napia,
Ryan Mooney, Heather Coulter, and Louisa A. Stark
Pages:223–232
Published Online:1 September 2018
https://doi.org/10.1089/heq.2018.0028
Abstract Introduction: This study assesses the sociodemographic facilitators and barriers to human papillomavirus (HPV) vaccination for diverse teens in a region with low HPV vaccination rates.

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 8 Sep 2018]

Research Article
Establishing research priorities in prevention and control of vector-borne diseases in urban areas: a collaborative process
In 2015, following a call for proposals from the Special Programme for Research and Training in Tropical Diseases (TDR), six scoping reviews on the prevention and control of vector-borne diseases in urban area…
Authors: Christian Dagenais, Stéphanie Degroote, Mariam Otmani Del Barrio, Clara Bermudez-Tamayo and Valéry Ridde
Citation: Infectious Diseases of Poverty 2018 7:85
Published on: 3 September 2018

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 8 Sep 2018]

Scoping Review
Scoping review on vector-borne diseases in urban areas: transmission dynamics, vectorial capacity and co-infection
Transmission dynamics, vectorial capacity, and co-infections have substantial impacts on vector-borne diseases (VBDs) affecting urban and suburban populations. Reviewing key factors can provide insight into pr…
Authors: Marcus Eder, Fanny Cortes, Noêmia Teixeira de Siqueira Filha, Giovanny Vinícius Araújo de França, Stéphanie Degroote, Cynthia Braga, Valéry Ridde and Celina Maria Turchi Martelli
Citation: Infectious Diseases of Poverty 2018 7:90
Published on: 3 September 2018

International Journal of Infectious Diseases
August 2018 Volume 73, Supplement, p1-398
https://www.ijidonline.com/issue/S1201-9712(18)X0007-1
18th ICID abstract supplement 2018

Rotavirus massive vaccination in Argentina: better than we expected
Although Latin America has seen a rapid and successful introduction of rotavirus vaccines since 2006, Argentina only incorporated monovalent vaccine into its National Immunization Program in 2015. No specific surveillance strategy has yet been designed to accurately measure the impact of this recent introduction on the diarrheal disease burden in our country. Thus, we assessed post-vaccine introduction data (all-cause acute diarrhea and rotavirus laboratory confirmed cases, and genotype distribution), compared to pre-vaccination period in children under 5 years of age in Argentina.
Degiuseppe, J. Stupka
Published in issue: August 2018

International Journal of Infectious Diseases
August 2018 Volume 73, Supplement, p1-398
https://www.ijidonline.com/issue/S1201-9712(18)X0007-1
18th ICID abstract supplement 2018

An economic evaluation of Varicella vaccination in Argentina
Giglio, M.E. Perez Carrega, J. Montes, H. Monsanto, J. Kyle, V. daniels, L. Wolfson
Published in issue: August 2018

JAMA
September 4, 2018, Vol 320, No. 9, Pages 849-948
http://jama.jamanetwork.com/issue.aspx

Viewpoint
Oral Rehydration Therapy for Diarrheal Diseases: A 50-Year Perspective
Roger I. Glass, MD, PhD; Barbara J. Stoll, MD
JAMA. 2018;320(9):865-866. doi:10.1001/jama.2018.10963
In this Viewpoint, Roger I. Glass traces the discovery of the oral rehydration solution during a cholera epidemic in Bangladesh in the 1960s to treat severe diarrhea by promoting electrolyte balance and attributes oral rehydration therapy with saving hundreds of thousands of lives in the last 50 years

JAMA
September 4, 2018, Vol 320, No. 9, Pages 849-948
http://jama.jamanetwork.com/issue.aspx

Gaps in the Clinical Management of Influenza – A Century Since the 1918 Pandemic
Timothy M. Uyeki, MD, MPH, MPP; Robert A. Fowler, MD, MDCM, MSc; William A. Fischer II, MD
JAMA. 2018;320(8):755-756. doi:10.1001/jama.2018.8113
This Viewpoint reviews advances in the surveillance, diagnosis, and treatment of influenza since the 1918 pandemic, and identifies key clinical questions to address in advance of the next outbreak, including optimal treatment for hospitalized and critically ill patients and those with secondary bacterial pneumonia.

JAMA
September 4, 2018, Vol 320, No. 9, Pages 849-948
http://jama.jamanetwork.com/issue.aspx

Real-World Evidence and Real-World Data for Evaluating Drug Safety and Effectiveness
Jacqueline Corrigan-Curay, JD, MD; Leonard Sacks, MD; Janet Woodcock, MD
JAMA. 2018;320(9):867-868. doi:10.1001/jama.2018.10136
In this Viewpoint, Janet Woodcock and CDER colleagues discuss recent FDA initiatives to investigate the adequacy of electronic health record (EHR) and patient database data for research purposes and to understand if and how real-world observational data might be analyzed in ways that mimic or can be as reliable as randomized trials.

JAMA
September 4, 2018, Vol 320, No. 9, Pages 849-948
http://jama.jamanetwork.com/issue.aspx

Promoting Patient Interests in Implementing the Federal Right to Try Act
Holly Fernandez Lynch, JD, MBE; Patricia J. Zettler, JD; Ameet Sarpatwari, JD, PhD
JAMA. 2018;320(9):869-870. doi:10.1001/jama.2018.9880
This Viewpoint reviews provisions of the US Right to Try Act, which allows patients with life-threatening conditions access to investigational drugs without FDA approval, and calls for clarifications around patient and drug eligibility, reporting requirements, and differences from the FDA’s Expanded Access program to minimize potential harms from the law.

JAMA Pediatrics
September 2018, Vol 172, No. 9, Pages 793-896
http://archpedi.jamanetwork.com/issue.aspx

Editorial
Costs, Consequences, and Policy Responses of Vaccine-Preventable Disease Outbreaks
Jason L. Schwartz, PhD
Abstract
Vaccine hesitancy poses a growing threat to the success of vaccination efforts worldwide. In the United States, support for routine childhood vaccination, as reflected in national vaccination rates, has remained very strong despite concerns among some parents over the necessity or safety of recommended vaccines.1 However, national vaccination coverage data mask the presence of clusters of large numbers of unvaccinated children in specific communities,2 which understates the risks of vaccine-preventable diseases for these individuals and those around them, as well as the magnitude of the challenge that public health officials face when outbreaks occur in these areas.

JAMA Pediatrics
September 2018, Vol 172, No. 9, Pages 793-896
http://archpedi.jamanetwork.com/issue.aspx

Original Investigation
Effectiveness of Live Attenuated vs Inactivated Influenza Vaccines in Children During the 2012-2013 Through 2015-2016 Influenza Seasons in Alberta, CanadaA Canadian Immunization Research Network (CIRN) Study
Sarah A. Buchan, PhD; Stephanie Booth, MPH; Allison N. Scott, PhD; et al.
Key Points
Question
Does vaccine effectiveness differ between live attenuated influenza vaccine and inactivated influenza vaccine in children and adolescents?
Findings
This test-negative study compared health administrative data and laboratory test results on respiratory specimens from 10,169 children and adolescents across 4 influenza seasons and found no significant differences in the odds of influenza infection between children who received live attenuated and those who received inactivated influenza vaccine. The only exception was influenza B during the 2015-2016 season, for which live attenuated influenza vaccine provided better protection than inactivated influenza vaccine.
Meaning
These results support receipt of either live attenuated influenza vaccine or inactivated influenza vaccine in this age group.

Journal of Medical Ethics
September 2018 – Volume 44 – 9
http://jme.bmj.com/content/current

Global medical ethics
Duty to provide care to Ebola patients: the perspectives of Guinean lay people and healthcare providers (22 August, 2018)
Aim To examine the views of Guinean lay people and healthcare providers (HCPs) regarding the acceptability of HCPs’ refusal to provide care to Ebola patients.
Lonzozou Kpanake, Tamba Kallas Tonguino, Paul Clay Sorum, Etienne Mullet

Nature 
Volume 561 Issue 7721, 6 September 2018
http://www.nature.com/nature/current_issue.html

Review Article | 05 September 2018
Facing up to the global challenges of ageing
Linda Partridge, Joris Deelen & P. Eline Slagboom
Abstract
Longer human lives have led to a global burden of late-life disease. However, some older people experience little ill health, a trait that should be extended to the general population. Interventions into lifestyle, including increased exercise and reduction in food intake and obesity, can help to maintain healthspan. Altered gut microbiota, removal of senescent cells, blood factors obtained from young individuals and drugs can all improve late-life health in animals. Application to humans will require better biomarkers of disease risk and responses to interventions, closer alignment of work in animals and humans, and increased use of electronic health records, biobank resources and cohort studies.

Nature Medicine
Volume 24 Issue 9, September 2018
https://www.nature.com/nm/volumes/24/issues/9

Editorial | 07 September 2018
Clarifying access to data
To facilitate access to and improve the discoverability of the data in our papers, Nature Medicine is making the data availability statement in our papers more prominent and its language more transparent.

Nature Reviews Immunology
Volume 18 Issue 9, September 2018
https://www.nature.com/nri/volumes/18/issues/8

Perspective | 05 June 2018
Antibodies and tuberculosis: finally coming of age?
Most candidate vaccines for tuberculosis are designed to boost cell-mediated immunity to Mycobacterium tuberculosis, the intracellular bacterium that causes the disease. This Opinion article considers the rationale for also harnessing antibody-mediated immunity in future tuberculosis vaccines.
Hao Li  & Babak Javid

New England Journal of Medicine
September 6, 2018   Vol. 379 No. 10
http://www.nejm.org/toc/nejm/medical-journal

Perspective
A New Threat to Immigrants’ Health — The Public-Charge
Krista M. Perreira, Ph.D., Hirokazu Yoshikawa, Ph.D., and Jonathan Oberlander, Ph.D.
[Initial text]
The United States is making major changes to its immigration policies that are spilling over into health policy. In one such change, the Trump administration is drafting a rule on “public charges” that could have important consequences for access to medical care and the health of millions of immigrants and their families.1 The concept of a public charge dates back to 19th-century immigration law. Under current guidelines, persons labeled as potential public charges can be denied legal entry to the United States. They can also be prevented from adjusting their status from a nonimmigrant visa category (e.g., a student or work visa) to legal permanent resident status. In addition, if they become public charges within the first 5 years after their admission to the United States, for reasons that existed before they came to the country, in rare cases they can be arrested and deported. Immigrants and their families consequently have strong incentives to avoid being deemed public charges.
Current guidelines define a public charge as a person who is primarily dependent on the government for more than half of personal income. In evaluating whether a person is likely to become a public charge, immigration officials take account of factors such as age, health, financial status, education, and skills…

New England Journal of Medicine
September 6, 2018   Vol. 379 No. 10
http://www.nejm.org/toc/nejm/medical-journal

The Violence of Uncertainty — Undermining Immigrant and Refugee Health
Breanne L. Grace, Ph.D., Rajeev Bais, M.D., M.P.H., and Benjamin J. Roth, Ph.D., M.S.W.
Immigrants and refugees in the United States have long faced structural violence due to unequal health care access. Now they’re being subjected to “the violence of uncertainty,” enacted through systematic instability that exacerbates inequality and generates fear.

Pediatrics
September 2018, VOLUME 142 / ISSUE 3
http://pediatrics.aappublications.org/content/142/3?current-issue=y

Articles
Legislation to Increase Uptake of HPV Vaccination and Adolescent Sexual Behaviors
Erin E. Cook, Atheendar S. Venkataramani, Jane J. Kim, Rulla M. Tamimi, Michelle D. Holmes
Pediatrics Sep 2018, 142 (3) e20180458; DOI: 10.1542/peds.2018-0458
Legislation to raise uptake of HPV vaccination among adolescents was not associated with increases in risky sexual behavior in this quasi-experimental study

Pediatrics
September 2018, VOLUME 142 / ISSUE 3
http://pediatrics.aappublications.org/content/142/3?current-issue=y

Prenatal Tetanus, Diphtheria, Acellular Pertussis Vaccination and Autism Spectrum Disorder
Tracy A. Becerra-Culqui, Darios Getahun, Vicki Chiu, Lina S. Sy, Hung Fu Tseng
Pediatrics Sep 2018, 142 (3) e20180120; DOI: 10.1542/peds.2018-0120
In this retrospective observational cohort study, we evaluate the association between Tdap vaccination during pregnancy and ASD in children in an integrated health care system in Southern California.

Pediatrics
September 2018, VOLUME 142 / ISSUE 3
http://pediatrics.aappublications.org/content/142/3?current-issue=y

Primary Ovarian Insufficiency and Adolescent Vaccination
Allison L. Naleway, Kathleen F. Mittendorf, Stephanie A. Irving, Michelle L. Henninger, Bradley Crane, Ning Smith, Matthew F. Daley, Julianne Gee
Pediatrics Sep 2018, 142 (3) e20180943; DOI: 10.1542/peds.2018-0943
We investigated the risk for young women of developing POI after adolescent vaccination. No increased risk was observed.

Pediatrics
September 2018, VOLUME 142 / ISSUE 3
http://pediatrics.aappublications.org/content/142/3?current-issue=y

Adoption of Serogroup B Meningococcal Vaccine Recommendations
Allison Kempe, Mandy A. Allison, Jessica R. MacNeil, Sean T. O’Leary, Lori A. Crane, Brenda L. Beaty, Laura P. Hurley, Michaela Brtnikova, Megan C. Lindley, Alison P. Albert
Pediatrics Sep 2018, 142 (3) e20180344; DOI: 10.1542/peds.2018-0344
We examined how primary care physicians are adopting the MenB vaccine after it received a category B recommendation by the ACIP in 2015.