Journal of Community Health
Volume 43, Issue 3, June 2018
https://link.springer.com/journal/10900/43/3/page/1
Original Paper
Male Undergraduates’ HPV Vaccination Behavior: Implications for Achieving HPV-Associated Cancer Equity
Hee Yun Lee, Katherine Lust, Suzanne Vang, Jay Desai
Journal of Pediatrics
May 2018 Volume 196, p1-334
http://www.jpeds.com/current
Original Articles
Education of parents and providers is needed to optimize life-saving immunizations for children with sickle cell disease
Sarah S. Long
Published in issue: May 2018
Journal of Pediatrics
May 2018 Volume 196, p1-334
http://www.jpeds.com/current
Pneumococcal and Meningococcal Vaccination among Michigan Children with Sickle Cell Disease
Abram L. Wagner, Nijika Shrivastwa, Rachel C. Potter, Sarah K. Lyon-Callo, Matthew L. Boulton
Published online: March 16, 2018
Journal of Public Health Management & Practice
May/June 2018 – Volume 24 – Issue 3
https://journals.lww.com/jphmp/pages/currenttoc.aspx
Research Full Report
Planning and Implementing Immunization Billing Programs at State and Local Health Departments: Barriers and Possible Solutions
Corriero, Rosemary; Redmon, Ginger
Journal of Public Health Management and Practice. 24(3):248-254, May/June 2018.
The Lancet
Apr 28, 2018 Volume 391 Number 10131 p1637-1748 e19
http://www.thelancet.com/journals/lancet/issue/current
Editorial
Addressing decreasing vaccine coverage in the EU
The Lancet
In recent years, the European Union (EU) has seen large outbreaks of vaccine-preventable diseases such as measles due to declining vaccine coverage, supply shortages, and growing vaccine hesitancy. To address the challenges facing vaccination programmes, the European Commission set an ambitious goal: to put together a Recommendation to strengthen cooperation against vaccine-preventable diseases in EU countries. A roadmap for the Recommendation was published on Dec 4, 2017, and was opened for public consultation for 4 weeks. The European Academies Science Advisory Council (EASAC) and the Federation of European Academies of Medicine (FEAM) publicly responded to the roadmap on April 19.
EASAC and FEAM warned the European Commission against a one-size-fits-all approach. They state that solutions to improve vaccine coverage need to be tailored to each member state, and that the proposal to align and coordinate vaccination schedules in the member states will most likely be “an enormous and futile effort”. The Recommendation should recognise that not all vaccines are of equal relevance for public health and individual protection, and should include a priority list for vaccines that are in high need. It should present strategies to invest in research and innovation for vaccines that need improvement. Furthermore, to tackle vaccine hesitancy with optimal communication approaches, the input of social scientists will be essential. EASAC and FEAM also call for the establishment of a European vaccination card and registry, to track vaccination status across the EU, and a monitoring system for vaccine shortage.
The Recommendation has the potential to be momentous, bringing together EU member states in a common goal towards better vaccine coverage. As we went to press, a proposal for the Recommendation was scheduled to be published on April 26. The European Commission should take heed of the medical community’s feedback to clarify the scope and aims of the proposal, or risk continuing to lose the gains for public health brought by immunisation in Europe.
Lancet Global Health
May 2018 Volume 6 Number 5 e469-e592
http://www.thelancet.com/journals/langlo/issue/current
Editorial
#VaccinesWork… don’t they?
The Lancet Global Health
One hundred years ago in April 1918, as American soldiers landed on European soil in the final months of World War I, so did a virus detected a month earlier at an army training facility in Kansas, USA, accelerating what would be the first wave of the 1918 flu pandemic. The exact origin of the pandemic is not known, but the culprit is: it was an influenza A(H1N1) virus, the kind that would again emerge and spread worldwide in 2009, causing this time a reported (and probably underestimated) 19 000 deaths. Global health has come a long way since then: the development of influenza vaccines, including a potentially universal one granting protection against all flu strains, and preparation for pandemic influenza are now integral parts of health and security efforts. Yet 100 years later, influenza prevention is not free of debate and controversy, and neither is the field of vaccines and immunisation.
Vaccination has contributed tremendously to global health. Since the creation of the Expanded Programme on Immunization in 1974, it has saved countless lives and improved the living conditions of millions of people. So as we near the end of the Decade of Vaccines, with its promise of universal access to immunization by 2020 via the Global Vaccine Action Plan (GVAP), it seems almost paradoxical that global coverage of such a successful and cost-effective tool is showing only sluggish progress. Results of the 2017 report from WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) on implementation of the GVAP were concerning, as slow improvement in vaccination coverage, misalignment of strategies and funding, and external threats to progress were evoked. SAGE will meet this April as part of its twice-yearly schedule and while there may be some progress to celebrate, pressures on vaccination efforts will certainly continue to permeate the discussions.
Conflicts, instability, and humanitarian disasters are especially challenging and disrupt efforts to reach those most in need of vaccines. Examples abound in today’s geopolitical state of affairs and among the most heart-wrenching is the situation of the Rohingyas stranded in Cox’s Bazaar and Bandarban, Bangladesh, where as Delan Devakumar describes in a Comment in this issue, the risks of the monsoon season are coupled with outbreaks of measles and diphtheria. In east Ghouta, in spite of an emergency vaccination campaign against measles, rubella, tuberculosis, hepatitis, and polio, Syrian refugees remain vulnerable to diseases. Weakened health systems such as Venezuela’s are susceptible to resurgence of diseases that threaten decade-long regional efforts, such as measles elimination in the Americas. Venezuela also shares a border with Brazil, where a high risk of urban yellow fever transmission has prompted a nationwide vaccination campaign.
Another impediment to progress is true political commitment to an issue that has complex budgetary implications, particularly in countries where economic progress is such that they are transitioning out of international financial assistance. One example is Nigeria, which, following rebasing, qualifies out of GAVI in spite of paltry immunisation coverage indicators and the continuing threat of polio. In this case, GAVI’s board has agreed to an exceptional support plan beyond 2020, and Bill Gates announced in March that he would support the country’s immunisation efforts by paying up a US$76 million loan from Japan. The question is whether ad-hoc interventions of this type would be repeated with other transitioning countries.
Vaccination efforts are also clearly aligned with the Universal Health Coverage (UHC) agenda, but financing and service delivery plans on the road to UHC might affect the way immunisation programmes and services are prioritised, adding uncertainty. Beyond budgetary considerations, vaccine policies must strike the right balance between imposing vaccination or giving a choice, to parents in particular, in environments where vaccine skepticism can be high. Recent laws making several childhood vaccines mandatory in France and Italy have generated much debate and highlighted the reality that the power of vaccines can be threatened in countries on the full spectrum of national incomes, and not only where lack of access is due to lack of resources.
There is no doubt that vaccines work: they save lives, they are the best investment a country could make for its citizens. Yet immunisation only really works when all the pressures on coverage, those mentioned above and many more, are relieved in a collective effort. The theme of this year’s World Immunization Week on April 24–30, “Protected Together, #VaccinesWork” is a good reminder of that.
Lancet Global Health
May 2018 Volume 6 Number 5 e469-e592
http://www.thelancet.com/journals/langlo/issue/current
Articles
National and regional under-5 mortality rate by economic status for low-income and middle-income countries: a systematic assessment
Fengqing Chao, Danzhen You, Jon Pedersen, Lucia Hug, Leontine Alkema
Lancet Infectious Diseases
May 2018 Volume 18 Number 5 p475-582 e147-e182
http://www.thelancet.com/journals/laninf/issue/current
Editorial
Plotting a route to a universal influenza vaccine
The Lancet Infectious Diseases
Lancet Infectious Diseases
May 2018 Volume 18 Number 5 p475-582 e147-e182
http://www.thelancet.com/journals/laninf/issue/current
Review
Effectiveness of national and subnational infection prevention and control interventions in high-income and upper-middle-income countries: a systematic review
Lesley Price, Jennifer MacDonald, Lynn Melone, Tracey Howe, Paul Flowers, Kay Currie, Evonne Curran, Valerie Ness, Debbie Waddell, Sarkis Manoukian, Agi McFarland, Claire Kilpatrick, Julie Storr, Anthony Twyman, Benedetta Allegranzi, Jacqui Reilly
Summary
Evidence-based guidance for national infection prevention and control (IPC) programmes is needed to support national and global capacity building to reduce health-care-associated infection and antimicrobial resistance. In this systematic review we investigate evidence on the effectiveness of IPC interventions implemented at national or subnational levels to inform the development of WHO guidelines on the core components of national IPC programmes. We searched CENTRAL, CINAHL, Embase, MEDLINE, and WHO IRIS databases for publications between Jan 1, 2000, and April 19, 2017. 29 studies that met the eligibility criteria (ie, economic evaluations, cluster-randomised trials, non-randomised trials, controlled before-and-after studies, and interrupted time-series studies exploring the effective of these interventions) were categorised according to intervention type: multimodal, care bundles, policies, and surveillance, monitoring, and feedback. Evidence of effectiveness was found in all categories but the best quality evidence was on multimodal interventions and surveillance, monitoring, and feedback. We call for improvements in study design, reporting of research, and quality of evidence particularly from low-income countries, to strengthen the uptake and international relevance of IPC interventions.
Lancet Respiratory Medicine
May 2018 Volume 6 Number 5 p315-402 e16-e18
http://www.thelancet.com/journals/lanres/issue/current
Editorial
Fake medicines: fighting on all fronts
The Lancet Respiratory Medicine
The illegal market in fake medicines is a growing threat and is harming patients the world over—this was the headline of Fight the Fakes, an event at University College London (UCL) on March 16, 2018, which aimed to provoke action on the urgent global issue of falsified and substandard medicines.
A recent WHO report estimated that about 1 in 10 medical products circulating in countries of low and middle income is either substandard or falsified. Fake drugs are being produced by organised criminals who can turn large profits. Factories are set up that can create packaging and medication inserts that perfectly resemble the real drugs; this packaging is then filled with cheaply made tablets or solutions that contain no active ingredient whatsoever, or in some cases contain dangerous substances. All too often, these harmful counterfeits find their way into pharmacies and clinics in countries of low and middle income. At the Fight the Fakes event, Michael Deats of WHO showed footage of a raid on a fake medicines factory in West Africa; glass bottles were being filled with “antimicrobials” to be dispensed to children with lung infections, but the liquid being decanted from filthy plastic canisters not only contained no active ingredient, it was also heavily contaminated with Escherichia coli.
Antimicrobials and antimalarials are the most commonly reported fake drugs. A modelling study based on data from the WHO report estimated that between 79 000 and 169 000 children might be dying each year from pneumonia because they are being treated with fake antibiotics. Data on all classes of drugs are patchy, but a 2013 study of pharmacies in 19 countries found that 9·1% of tuberculosis drugs sampled did not contain enough active ingredient or failed disintegration tests. Failure rate was 16·6% in Africa, 10·1% in India, and 3·9% in other middle-income countries.
Speaking at the Fight the Fakes event, Professor Ibrahim Abubakar (UCL) noted that in the case of tuberculosis, as well as some other infectious diseases, fake drugs do not just cause harm to the individual patient, but they also contribute to the development of resistant strains that can affect society as a whole.
A second WHO report on surveillance and monitoring of substandard and falsified drugs identified three main drivers of the problem in countries of low and middle income: constrained access to safe and affordable medical products, lack of good governance, and weak technological capacity. For these drivers to be addressed, political will and public awareness will be required.
Higher-income countries face a slightly different set of problems. Lynda Scammell of the MHRA said that the incidence of fake drugs making their way into the official supply chain in the UK (ie, being dispensed by the NHS) is very low; however, a growing number of people are buying medicines online. Often, these drugs are bought from websites that look legitimate, but the supply chain is opaque, increasing the risk of falsified or substandard drugs being taken. Additionally, prescription-only medications are frequently bought online without any consultation or appropriate medical advice.
Substandard medical devices bought online are also a problem; Scammell cited syphilis testing kits that always give a negative result or dental drills with a tendency to fall apart in the middle of procedures. Both of these are examples of products seized during Operation Pangea, co-ordinated by INTERPOL, which aims to tackle the illegal sale of medicines and devices online. As well as seizing packages as they come through customs, Pangea targets internet service providers for illegal medicine websites and the payments systems that they use.
The conversation around the complex issue of fake medicines can often be rather sterile, focusing on the need for supply chain oversight, country-level surveillance, and public awareness campaigns. Although these are all important weapons in the fight, it is important to remember that this is a human issue that brings misery and suffering to people daily. In his presentation, Michael Deats showed video footage of five children from a rural area of the Democratic Republic of Congo who were among 1000 young people admitted to hospital with the same set of symptoms: dystonia, paralysis of the upper limbs, and protruding tongue. He explained that an investigation by Medecins Sans Frontieres eventually found that all the children had been given yellow tablets labelled as diazepam, which had been prescribed to treat malarial convulsions; however, when tested, the tablets were found to contain haloperidol, an antipsychotic, which had been purposefully mislabelled as diazepam to sell it. 11 of the children died. This shocking example highlights that this is an urgent issue that is not receiving the attention it deserves.
Lancet Respiratory Medicine
May 2018 Volume 6 Number 5 p315-402 e16-e18
http://www.thelancet.com/journals/lanres/issue/current
Articles
Efficacy, immunogenicity, and safety evaluation of an MF59-adjuvanted quadrivalent influenza virus vaccine compared with non-adjuvanted influenza vaccine in children: a multicentre, randomised controlled, observer-blinded, phase 3 trial
Timo Vesikari, Judith Kirstein, Grace Devota Go, Brett Leav, Mary Ellen Ruzycky, Leah Isakov, Marianne de Bruijn, Janine Oberye, Esther Heijnen
New England Journal of Medicine
April 26, 2018 Vol. 378 No. 17
http://www.nejm.org/toc/nejm/medical-journal
Original Article
Azithromycin to Reduce Childhood Mortality in Sub-Saharan Africa
Jeremy D. Keenan, M.D., M.P.H., Robin L. Bailey, M.D., Sheila K. West, Ph.D., Ahmed M. Arzika, M.S., John Hart, M.D., Jerusha Weaver, M.P.H., Khumbo Kalua, M.B., B.S., M.Med., Ph.D., Zakayo Mrango, M.D., M.P.H., Kathryn J. Ray, M.S., Catherine Cook, M.P.H., Elodie Lebas, R.N.,
Kieran S. O’Brien, M.P.H., Paul M. Emerson, Ph.D., Travis C. Porco, Ph.D., M.P.H., and Thomas M. Lietman, M.D. for the MORDOR Study Group*
Abstract
Background
We hypothesized that mass distribution of a broad-spectrum antibiotic agent to preschool children would reduce mortality in areas of sub-Saharan Africa that are currently far from meeting the Sustainable Development Goals of the United Nations.
Methods
In this cluster-randomized trial, we assigned communities in Malawi, Niger, and Tanzania to four twice-yearly mass distributions of either oral azithromycin (approximately 20 mg per kilogram of body weight) or placebo. Children 1 to 59 months of age were identified in twice-yearly censuses and were offered participation in the trial. Vital status was determined at subsequent censuses. The primary outcome was aggregate all-cause mortality; country-specific rates were assessed in prespecified subgroup analyses.
Conclusions
Among postneonatal, preschool children in sub-Saharan Africa, childhood mortality was lower in communities randomly assigned to mass distribution of azithromycin than in those assigned to placebo, with the largest effect seen in Niger. Any implementation of a policy of mass distribution would need to strongly consider the potential effect of such a strategy on antibiotic resistance. (Funded by the Bill and Melinda Gates Foundation; MORDOR ClinicalTrials.gov number, NCT02047981.)
PLoS Medicine
http://www.plosmedicine.org/
(Accessed 28 April 2018)
Perspective
From surviving to thriving: What evidence is needed to move early child-development interventions to scale?
Mark Tomlinson
| published 24 Apr 2018 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002557
Public Health
May 2018 Volume 158, p1-202
http://www.publichealthjrnl.com/current
Special issue on Migration: A global public health issue
Edited by Sian M Griffiths, Roger YN Chung
Editors’ Choice
Migration: a core public health ethics issue
Wild, A. Dawson
Published online: March 29, 2018
Migration is a core issue of public health ethics and must take a case-based approach: seeking to identify the specific ethical dimensions and vulnerabilities in each particular context. Public health as a practice, built upon the core value of justice, requires the protection and promotion of migrants’ well-being (even if this produces tension with immigration services). Ethical analysis should take all phases of migration into account: before, during and after transit. We argue that migration policies, at least as they relate to migrants’ well-being, should be founded upon a shared humanity, respect for human rights and on the idea that effective public health cannot and should not be confined within the borders and to the citizens of any host country.
Public Health
May 2018 Volume 158, p1-202
http://www.publichealthjrnl.com/current
Special issue on Migration: A global public health issue
Edited by Sian M Griffiths, Roger YN Chung
Themed papers
Migrant children within Europe: a systematic review of children’s perspectives on their health experiences
Curtis, J. Thompson, H. Fairbrother
p71–85
Published online: April 4, 2018
Public Health
May 2018 Volume 158, p1-202
http://www.publichealthjrnl.com/current
Special issue on Migration: A global public health issue
Edited by Sian M Griffiths, Roger YN Chung
Reason for immigration and immigrants’ health
Giuntella, Z.L. Kone, I. Ruiz, C. Vargas-Silva
p102–109
Published online: March 22, 2018
Public Health
May 2018 Volume 158, p1-202
http://www.publichealthjrnl.com/current
Special issue on Migration: A global public health issue
Edited by Sian M Griffiths, Roger YN Chung
Vaccination status and needs of asylum-seeking children in Denmark: a retrospective data analysis
C.S. Nakken, M. Skovdal, L.B. Nellums, J.S. Friedland, S. Hargreaves, M. Norredam
p110–116
Published online: April 10, 2018
Open Access
Public Health
May 2018 Volume 158, p1-202
http://www.publichealthjrnl.com/current
Special issue on Migration: A global public health issue
Edited by Sian M Griffiths, Roger YN Chung
Access to childhood immunisation services and its determinants among recent and settled migrants in Delhi, India
Y.S. Kusuma, S. Kaushal, A.B. Sundari, B.V. Babu
p135–143
Published online: March 27, 2018
Public Health
May 2018 Volume 158, p1-202
http://www.publichealthjrnl.com/current
Special issue on Migration: A global public health issue
Edited by Sian M Griffiths, Roger YN Chung
Original Research
Racial disparities in vaccination for seasonal influenza in early childhood
Anandappa, E. Adjei Boakye, W. Li, W. Zeng, T. Rebmann, J.J. Chang
p1–8
Published online: March 7, 2018
Public Health
May 2018 Volume 158, p1-202
http://www.publichealthjrnl.com/current
Special issue on Migration: A global public health issue
Edited by Sian M Griffiths, Roger YN Chung
Vaccination coverage among children and adolescents below 18 years of age in French Guiana: inventory and determinant factors
Koïvogui, A. Carbunar, L.-M. Imounga, C. Laruade, S. Laube
p15–24
Published online: March 8, 2018
Public Health
May 2018 Volume 158, p1-202
http://www.publichealthjrnl.com/current
Special issue on Migration: A global public health issue
Edited by Sian M Griffiths, Roger YN Chung
Short Communication
Ethical considerations in the uptake of influenza vaccination by healthcare workers
A.H. Carter, S.M. Yentis
p61–63
Published online: March 22, 2018
Science Translational Medicine
25 April 2018 Vol 10, Issue 438
http://stm.sciencemag.org/
Research Articles
A digital microfluidic system for serological immunoassays in remote settings
By Alphonsus H. C. Ng, Ryan Fobel, Christian Fobel, Julian Lamanna, Darius G. Rackus, Aimee Summers, Christopher Dixon, Michael D. M. Dryden, Charis Lam, Man Ho, Nooman S. Mufti, Victor Lee, Mohd Afiq Mohd Asri, Edward A. Sykes, M. Dean Chamberlain, Rachael Joseph, Maurice Ope, Heather M. Scobie, Alaine Knipes, Paul A. Rota, Nina Marano, Paul M. Chege, Mary Njuguna, Rosemary Nzunza, Ngina Kisangau, John Kiogora, Michael Karuingi, John Wagacha Burton, Peter Borus, Eugene Lam, Aaron R. Wheeler
Science Translational Medicine25 Apr 2018 Restricted Access
Abstract
Serosurveys are useful for assessing population susceptibility to vaccine-preventable disease outbreaks. Although at-risk populations in remote areas could benefit from this type of information, they face several logistical barriers to implementation, such as lack of access to centralized laboratories, cold storage, and transport of samples. We describe a potential solution: a compact and portable, field-deployable, point-of-care system relying on digital microfluidics that can rapidly test a small volume of capillary blood for disease-specific antibodies. This system uses inexpensive, inkjet-printed digital microfluidic cartridges together with an integrated instrument to perform enzyme-linked immunosorbent assays (ELISAs). We performed a field validation of the system’s analytical performance at Kakuma refugee camp, a remote setting in northwestern Kenya, where we tested children aged 9 to 59 months and caregivers for measles and rubella immunoglobulin G (IgG). The IgG assays were determined to have sensitivities of 86% [95% confidence interval (CI), 79 to 91% (measles)] and 81% [95% CI, 73 to 88% (rubella)] and specificities of 80% [95% CI, 49 to 94% (measles)] and 91% [95% CI, 76 to 97% (rubella)] (measles, n=140; rubella, n=135) compared with reference tests (measles IgG and rubella IgG ELISAs from Siemens Enzygnost) conducted in a centralized laboratory. These results demonstrate a potential role for this point-of-care system in global serological surveillance, particularly in remote areas with limited access to centralized laboratories.
Science Translational Medicine
25 April 2018 Vol 10, Issue 438
http://stm.sciencemag.org/
Perspective
Fundamental science behind today’s important medicines
By Jonathan M. Spector, Rosemary S. Harrison, Mark C. Fishman
Science Translational Medicine25 Apr 2018 Restricted Access
Today’s most transformative medicines exist because of fundamental discoveries that were made without regard to practical outcome and with their relevance to therapeutics only appearing decades later.
Systematic Reviews
https://systematicreviewsjournal.biomedcentral.com/articles
[Accessed 28 April 2018]
Protocol
An updated protocol for a systematic review of implementation-related measures
Implementation science is the study of strategies used to integrate evidence-based practices into real-world settings (Eccles and Mittman, Implement Sci. 1(1):1, 2006). Central to the identification of replicable, feasible, and effective implementation strategies is the ability to assess the impact of contextual constructs and intervention characteristics that may influence implementation, but several measurement issues make this work quite difficult.
Authors: Cara C. Lewis, Kayne D. Mettert, Caitlin N. Dorsey, Ruben G. Martinez, Bryan J. Weiner, Elspeth Nolen, Cameo Stanick, Heather Halko and Byron J. Powell
Citation: Systematic Reviews 2018 7:66
Published on: 25 April 2018
Vaccine
Volume 36, Issue 20 Pages 2743-2916 (11 May 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/20
Commentary
Back to the future – Is the drug repositioning concept applicable to vaccines?
Open access
Pages 2743-2744
Klaus Schwamborn
Vaccine
Volume 36, Issue 20 Pages 2743-2916 (11 May 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/20
Reviews
Use of hepatitis A vaccine for post-exposure prophylaxis in individuals over 40 years of age: A systematic review of published studies and recommendations for vaccine use
Review article
Pages 2745-2750
Ruth Link-Gelles, Megan G. Hofmeister, Noele P. Nelson
Vaccine
Volume 36, Issue 20 Pages 2743-2916 (11 May 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/20
Strategies for increasing uptake of vaccination in pregnancy in high-income countries: A systematic review
Review article
Pages 2751-2759
Kate Alexandra Bisset, Pauline Paterson
Vaccine
Volume 36, Issue 20 Pages 2743-2916 (11 May 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/20
Direct-to-adolescent text messaging for vaccine reminders: What will parents permit?
Original research article
Pages 2788-2793
James R. Roberts, Kristen Morella, Erin H. Dawley, Christi A. Madden, … Paul M. Darden
Vaccine
Volume 36, Issue 20 Pages 2743-2916 (11 May 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/20
Effectiveness of influenza vaccination for children in Japan: Four-year observational study using a large-scale claims database
Open access – Original research article
Pages 2809-2815
Natsumi Shibata, Shinya Kimura, Takahiro Hoshino, Masato Takeuchi, Hisashi Urushihara
Vaccine
Volume 36, Issue 20 Pages 2743-2916 (11 May 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/20
Parents’ preferences for interventions to improve childhood immunization uptake in northern Nigeria
Original research article
Pages 2833-2841
Sachiko Ozawa, Mo Zhou, Chizoba Wonodi, Hui-Han Chen, John F.P. Bridges
Vaccine
Volume 36, Issue 20 Pages 2743-2916 (11 May 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/20
A comparative cost analysis of the Vaccination Program for US-bound Refugees
Open access – Original research article
Pages 2896-2901
Heesoo Joo, Brian Maskery, Tarissa Mitchell, Andrew Leidner, … Michelle Weinberg
Vaccine
Volume 36, Issue 20 Pages 2743-2916 (11 May 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/20
Vaccine delivery to newly arrived refugees and estimated costs in selected U.S. clinics, 2015
Original research article
Pages 2902-2909
Clelia Pezzi, Audrey McCulloch, Heesoo Joo, Jennifer Cochran, … Deborah Lee
Abstract
Background
Newly arrived refugees are offered vaccinations during domestic medical examinations. Vaccination practices and costs for refugees have not been described with recent implementation of the overseas Vaccination Program for U.S.-bound Refugees (VPR). We describe refugee vaccination during the domestic medical examination and the estimated vaccination costs from the US government perspective in selected U.S. clinics.
Vaccines — Open Access Journal
http://www.mdpi.com/journal/vaccines
(Accessed 28 April 2018)
Open Access Perspective
Development and Regulation of Novel Influenza Virus Vaccines: A United States Young Scientist Perspective
by Surender Khurana
Vaccines 2018, 6(2), 24; https://doi.org/10.3390/vaccines6020024 – 27 April 2018
Abstract
Vaccination against influenza is the most effective approach for reducing influenza morbidity and mortality. However, influenza vaccines are unique among all licensed vaccines as they are updated and administered annually to antigenically match the vaccine strains and currently circulating influenza strains. Vaccine efficacy of each selected influenza virus vaccine varies depending on the antigenic match between circulating strains and vaccine strains, as well as the age and health status of the vaccine recipient. Low vaccine effectiveness of seasonal influenza vaccines in recent years provides an impetus to improve current seasonal influenza vaccines, and for development of next-generation influenza vaccines that can provide broader, long-lasting protection against both matching and antigenically diverse influenza strains. This review discusses a perspective on some of the issues and formidable challenges facing the development and regulation of the next-generation influenza vaccines.
Media/Policy Watch
This watch section is intended to alert readers to substantive news, analysis and opinion from the general media and selected think tanks and similar organizations on vaccines, immunization, global public health and related themes. Media Watch is not intended to be exhaustive, but indicative of themes and issues CVEP is actively tracking. This section will grow from an initial base of newspapers, magazines and blog sources, and is segregated from Journal Watch above which scans the peer-reviewed journal ecology.
We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.
The Atlantic
http://www.theatlantic.com/magazine/
Accessed 28 April 2018
What Bill Gates Fears Most
The threat of a flu pandemic clouds even his legendary optimism, so he’s launching an initiative to prevent one.
Apr 27, 2018
The Economist
http://www.economist.com/
Accessed 28 April 2018
A killer in the making – A strain of typhoid could become virtually untreatable
Drug-resistance makes a bug extremely worrying
Apr 28th 2018
Universal health care, worldwide, is within reach
28 April 2018
Foreign Affairs
http://www.foreignaffairs.com/
Accessed 28 April 2018
Security
The New Killer Pathogens – Countering the Coming Bioweapons Threat
Kate Charlet
May/June 2018 Essay
New York Times
http://www.nytimes.com/
Accessed 28 April 2018
Infant Deaths Fall Sharply in Africa With Routine Antibiotics
25 April 2017
Two doses a year of an antibiotic can sharply cut death rates among infants in poor countries, perhaps by as much as 25 percent among the very young, researchers reported on Wednesday. Their large study of nearly 200,000 children in three African countries — raises the exciting possibility that deploying antibiotics as doctors do vaccines could rapidly reduce deaths among newborns and infants…
Reuters
EU wants coordinated vaccine push against measles, other diseases
26 April 2018
The European Commission urged EU member states on Thursday to cooperate more closely in fighting diseases such as measles and flu, saying vaccines against them were among the most powerful and cost-effective public health measures. Setting out the Commission’s plans, health and food safety commissioner Vytenis Andriukaitis said all European Union member states should develop and implement national or regional vaccination plans by 2020 and include in them a target of at least 95 percent coverage for measles…
STAT news
The vaccine dilemma: how experts weigh benefits for many against risks for a few [Dengvaxia]
By Helen Branswell | 23 April 2018.
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
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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
Milestones :: Perspectives
Summary of the Meeting of the WHO Strategic Advisory Group of Experts on immunization, 17-18 April 2018
The Strategic Advisory Group of Experts [SAGE] on Immunization1 met on 17–18 April 2018. This full report will be published on 8 June 2018 in the Weekly Epidemiological Record.
Malaria Vaccine Implementation Programme
SAGE was informed on the progress made on the implementation of the recommendation
made by SAGE and the Malaria Policy Advisory Committee (MPAC) in October 2015 on pilot
studies for the RTS,S/AS01 malaria vaccine. SAGE was provided an overview of the Malaria
Vaccine Implementation Programme (MVIP) and given a status update of preparatory
activities in the three pilot countries (Ghana, Kenya, Malawi).
The pilots consist of three components: 1) Sub-national introduction of the malaria vaccine in areas with moderate to high malaria transmission led by country immunization
programmes; 2) Rigorous evaluation, supported by country-based research institutions, to
measure the programmatic feasibility of delivering RTS,S/AS01, the vaccine’s impact on
mortality (overall and sex-specific) and the vaccine’s safety in the context of routine
immunization, with an emphasis on meningitis and cerebral malaria; 3) the manufacturer-sponsored observational Phase 4 studies with hospital and active surveillance as part of the
vaccine’s Risk Management Plan agreed between the manufacturer and the European
Medicines Agency (EMA) taking place in a small sub-set of the pilot areas.
SAGE was reassured that uptake of the RTS,S/A01 vaccine, as well as use of other vaccines
and childhood health interventions will be monitored through countries’ routine data
monitoring systems; three consecutive cross-sectional household surveys will provide
representative community estimates of RTS,S/AS01 coverage, along with coverage
estimates for other vaccines, for recommended malaria prevention and control measures,
and for other childhood health interventions of interest. In addition, a qualitative research
study will explore and document any changes in health-seeking behaviours and on health
service provision that may occur upon RTS,S/AS01 introduction. SAGE re-emphasized the
importance of communication and community engagement to ensure acceptance and
understanding of the new vaccine in the context of other malaria control interventions.
Experience from other efforts related to strengthening the second year of life (2YL) platform
could prove useful.
SAGE was reassured that the evaluation has been sufficiently powered to assess whether
the safety signals (i.e., meningitis and cerebral malaria) and the imbalance in mortality
between males and females identified during the Phase 3 trial are causally related to
RTS,S/AS01 vaccination.
SAGE agreed on the importance of having a framework to clarify how data collected through
the MVIP might be used to answer identified questions and inform future policy
recommendations for vaccine use beyond the pilots. SAGE specifically recommended the
modelling inputs incorporate different scenarios and levels of uncertainty to enable
interpretation of the MVIP results in the context of real world settings.
1 See http://www.who.int/immunization/sage/en/index.html, accessed April 20April 2018
Polio eradication
SAGE acknowledged the ongoing efforts of the Global Polio Eradication Initiative (GPEI) and
the progress achieved towards wild polio virus (WPV) eradication. SAGE shared concern
over continuing WPV circulation in Pakistan and Afghanistan through the active corridors of
transmission, as manifested through the continued detection of WPV1 in environmental
samples during 2016 and 2017.
SAGE noted that the IPV supply is sufficient to introduce IPV in routine immunization
globally in 2018, but not to conduct catch up campaigns for cohorts that did not receive IPV
because of supply constraints. SAGE reviewed the available data on fractional IPV (fIPV) and
emphasized that two doses of fIPV are superior to one full IPV dose. SAGE agreed that IPV
should not be used routinely in outbreak response except in specific situations such as
where there is co-circulation of WPV1 and cVDPV2 and in these instances fIPV should be
used. In addition, SAGE recommended that instead of using term “fractional” for fIPV, GPEI
should think of other term such as “intradermal” to avoid impression that fIPV is substandard.
Studies to examine duration of immunity and protection following two doses of
fIPV are in progress.
SAGE reviewed the Post Certification Strategy (PCS). This is a high-level working document
which aims to guide Member States and stakeholders on the polio-essential functions
required to sustain a polio-free world after WPV eradication and dissolution of GPEI. The
PCS does not provide specific or detailed country level guidance. Its aim is to serve as a
roadmap to ensure that the oversight, infrastructure and funding is in place to 1) contain
polioviruses, 2) protect populations from polio, and 3) retain capacity to detect and respond
to any poliovirus event. SAGE endorsed the content and approach of the PCS and agreed to
submit it for discussion at the World Health Assembly in May 2018.
In order to align GAP III and SAGE recommendations on IPV schedules, SAGE reviewed
recommendations on IPV schedules in countries with Poliovirus-Essential Facilities (PEFs).
While the majority of the 29 countries hosting PEFs are located in Europe and North
America, and have introduced exclusive or sequential IPV schedules, some countries are
currently only using a single dose of IPV (together with bOPV) in their immunization
schedule.
SAGE endorsed the proposal to align the recommendations on future IPV schedule for
countries hosting PEFs storing or manipulating WPVs and/or Sabin/OPV and recommends
that those countries with PEFs using a single dose of IPV should adjust their IPV schedule,
coverage targets and geographical scope as soon as possible but no later than at the time of
all OPV cessation.
SAGE requested the program to explore the extent to which a legal instrument such as the
International Health Regulation (IHR) could be used to ensure compliance with poliovirus
containment requirements defined in GAP III and the Containment Certification Scheme.
Policy recommendations on the use of the first licensed dengue vaccine
[See separate announcement just below]
Measles and Rubella
SAGE noted the substantial progress in the reduction of global measles incidence and
mortality since 2000. However, concerns were expressed around resurgence of measles in
some areas, particularly in the European region, and the measles outbreak in Venezuela that
has put the elimination status of the American Region at risk.
SAGE reviewed preliminary modelled scenarios, designed to approach an investment case
(IC) for measles and rubella eradication. The investment case in development is planned as
part of the response to the GVAP 2017 resolution at the World Health Assembly (WHA) to
provide a report to the 73rd WHA in 2020 on the epidemiology, resource requirements, and
feasibility of measles and rubella eradication.
SAGE recommended that the Measles Rubella (MR) Working Group (WG) should revise the
key scenarios to include a baseline scenario that reflects current vaccination efforts and
disease in the countries and a separate mortality reduction scenario, besides the
“eradication as soon as possible” scenario. The MR WG was requested to develop additional
eradication scenarios with different timelines and with different levels of achievements (for
example, elimination in all but a few countries and including the costs of reaching
inaccessible pockets and hard-to-reach populations). SAGE also highlighted the importance
of the inclusion of total cost when a decision regarding a global eradication target is
considered, as well as the cost of elimination-standard surveillance. Furthermore, the IC
should consider including the contribution of measles and rubella eradication effort towards
the prevention of other vaccine preventable diseases. This IC model is currently under
review by IVIR-AC and a revised version will be presented to SAGE for recommendations.
SAGE also reviewed the guidance tool for endemic countries on prioritizing measles and
rubella control/elimination activities in order to increase population immunity, prevent
outbreaks and achieve elimination. The approach proposed four country categories that
take into consideration the disease epidemiology, population immunity and capacity to
carry out elimination strategies. Guidance was then provided within each category on how
to best prioritize the control or elimination interventions/activities. SAGE agreed with the
overall approach and highlighted the need to include sub-national and sub-groups within
countries when assessing and addressing immunity gaps and the importance of including
civil society organizations (CSOs) and community participation as important elements for
successful interventions.
Full Public Health Value Propositions for Vaccines (FPHVPs)
The remit of IVB includes accelerating development of vaccines against priority pathogens,
identified through its Product Development for Vaccines Advisory Committee (PDVAC), and
supporting countries with policy decisions to introduce vaccines once they become available.
In addition, many of the vaccines currently in development are expected to be targeted
towards specific populations, depending on the burden of disease and context-specific
epidemiology. In resource-poor settings, increasingly robust evidence will be needed to
justify the inclusion of new vaccines in the context of other disease interventions over and
above many other public health priorities. With this in mind, key stakeholders are
advocating that there is a need to broaden the evaluation of vaccine value beyond the
demonstration of individual, direct health benefits and related costs that support licensure
to the evaluation of broader economic, societal and indirect impacts of vaccination at a
population level. Consideration of these data and evidence requirements that inform policy
decisions, prior to undertaking phase III pivotal clinical studies, could help to prioritize the
vaccines that would have the greatest impact, and reduce delays between licensure and
introduction encountered by vaccines such as the RTS,S malaria vaccine.2
A conceptual framework of pathways between immunisation and its proposed broader
economic and social benefits has been developed3, leading to publications on “Estimating
the full public health value of vaccination” and proposed methodology and measures to
quantify the economic elements.4, 5 This novel global health paradigm considers the
population impact of vaccination and encompasses measures of community benefits against
a range of outcomes, such as improvements in health inequity, financial risk protection,
reduction in long-term/on-going disability and a decrease in the development of antibiotic
resistance. IVB, under the auspices of PDVAC and IVIR-AC, is building on these efforts, to
develop an approach for describing the Full (i.e. articulating both the individual and
population benefits) Public Health Value Proposition for vaccines where there is a clear
public health need for, but a lack of investment in, developing vaccines for LMIC markets.
This FPHVP approach was presented to SAGE for information and discussion.
2 O’Brien K et al. Mind the gap: jumping from vaccine licensure to routine use The Lancet 387 1887-1889, 2016.
3 Jit M et al. The broader economic impact of vaccination: reviewing and appraising the strength of evidence. BMC Med. 2015 Sep 3;13:209.
4 Gessner BD et al. Estimating the full public health value of vaccination. Vaccine. 2017 Nov 1;35(46):6255-6263.
5 Wilder-Smith A et al. The public health value of vaccines beyond efficacy: methods, measures and outcomes. BMC Med. 2017 Jul 26;15(1):138.
Milestones :: Perspectives
Revised SAGE recommendation on use of dengue vaccine
19 April 2018
WHO published the recommendations of the Strategic Advisory Group of Experts on Immunization (SAGE) on the use of Dengvaxia® on 27 May 2016, and subsequently a WHO position paper on dengue vaccine on 29 July 2016.
Following the disclosure of new data on Dengvaxia® by its manufacturer, Sanofi Pasteur, on 29 November 2017 (as described in more detail below), WHO`s Global Advisory Committee on Vaccine Safety (GACVS) and the WHO Secretariat published interim statements on December 7, 20171, and December 22, 20172, respectively. WHO initiated a process engaging independent external experts to review the data in detail, and reconvened the SAGE working group on dengue vaccines. This process has led to revised recommendations from SAGE on 18 April 2018. An updated WHO position paper on dengue vaccine will be published in September 2018.
The purpose of this document is to supplement the WHO ”Question and Answer” document from December December 22, 20172.
Dengue is the most frequent and rapidly spreading mosquito-borne virus. The first dengue vaccine, CYD-TDV (Dengvaxia®) is currently licensed in twenty countries. The key findings from two large Phase 3 trials involving over 30,000 participants aged 2 to 16 years included:
:: Vaccine efficacy against virologically confirmed dengue, over a 25-month period from the first dose of a three-dose immunization regimen among 9-16 year olds was 65.6% and in this age-group, vaccination reduced severe dengue by 93% and dengue hospitalizations by 82%.
:: An increased risk of hospitalized dengue was seen in the 2 to 5-year age group in Year 3 of follow-up.
:: At the time of SAGE April 2016 meeting, this increased risk was not observed in those aged 9 years and above.
Because of the higher efficacy of the vaccine against dengue and the absence of an observed increased risk of hospitalized dengue observed in older children, licensure of the vaccine was sought in 2015 with an indication of 9 years and above. Mathematical modelling suggested that the public health benefits of vaccination could be maximized if dengue seropositivity in the age group targeted for vaccination was high.
WHO issued its position on the use of CYD-TDV in July 2016 based on recommendations provided by SAGE in April 2016, principally, that countries interested in introducing the vaccine consider its use only in those aged 9 years and above, and in areas with a seroprevalence of ≥70%, and not in areas below 50%. SAGE noted that the evidence of the absence of a safety issue in seronegative individuals aged 9 and above was based on the limited data set of 10%-20% of the trial population, and highlighted the urgent need to better describe the long-term benefit-risk ratio of CYD-TDV in seronegative individuals.
On 29 November 2017, Sanofi Pasteur announced the results of additional studies to better describe the benefit-risk in seronegative individuals. This was made possible through the use of a newly developed NS1-based antibody assay applied to blood samples taken 13 months after vaccination to retrospectively infer dengue serostatus at time of first vaccination.
The new analyses from the long-term safety follow-up indicated that:
:: Overall population level benefit of vaccination remains favorable, but the vaccine performs differently in seropositive versus seronegative individuals.
:: Vaccine efficacy (VE) against virologically confirmed symptomatic dengue was high among inferred baseline seropositive participants ≥9 years of age: 76% (95%CI: 63.9, to 84.0), but much lower among baseline seronegative participants: 38.8% (95%CI: –0.9 to 62.9%) in the first 25 months after the first dose of vaccine.
:: There is an increased risk of hospitalized and severe dengue in seronegative individuals starting about 30 months after the first dose.
:: In areas of 70% dengue seroprevalence, over a 5-year follow-up, for every 4 severe cases prevented in seropositive, there would be one excess severe case in seronegative per 1,000 vaccinees; for every 13 hospitalizations prevented in seropositive vaccinees, there would be 1 excess hospitalization in seronegative vaccinees per 1,000 vaccinees.
In light of the new evidence on the long-term safety issue in seronegative individuals, balanced against the documented efficacy and safety in seropositive individuals, SAGE carefully considered two strategies: population seroprevalence criteria versus pre-vaccination screening. SAGE weighed up the feasibility of population seroprevalence studies and individual pre-vaccination screening, heterogeneity of seroprevalence between and within countries, potential vaccine coverage rates, public confidence in national vaccination programmes, perceptions of ethical considerations with regard to population level benefit versus individual level risk, and communication issues.
SAGE acknowledged that currently both “population seroprevalence criteria” and “pre-vaccination screening” are programmatically difficult approaches for achieving high population protection from dengue.
Updated SAGE recommendations on the use of CYD-TDV (Dengvaxia®)
For countries considering vaccination as part of their dengue control program, a “pre-vaccination screening strategy” would be the preferred option, in which only dengue-seropositive persons are vaccinated.
Conventional serological testing for dengue virus IgG (e.g. dengue IgG ELISA) could be used to identify persons who have had previous dengue infections. Sensitivity and specificity of dengue IgG ELISA should be assessed in a local context, and will depend on the prevalence of other flaviviruses, and past use of flavivirus vaccines (such as Japanese encephalitis and yellow fever vaccines).
Currently available rapid diagnostic tests – despite their lower sensitivity and specificity to detect past dengue infection compared with conventional dengue IgG ELISA – could be considered in high transmission settings until better tests are available. In settings with high dengue transmission (high numbers of seropositives), a test with lower specificity might be acceptable.
The pre-test probability of an individual being seropositive will be higher in settings with high transmission. However, a pre-vaccination screening strategy may also be considered in low to moderate transmission settings. In settings with low transmission (high numbers of seronegatives) a test with high specificity is needed.
Given that no assay will be 100% specific, some truly seronegative individuals may be vaccinated due to a false positive test result. Furthermore, although the efficacy against dengue infections in seropositive individuals is high, it is still not complete. Hence, the limitations of CYD-TDV will need to be clearly communicated to populations offered vaccination.
There is a continued need to adhere to other disease preventive measures and to seek prompt medical care in the event of dengue-like symptoms, regardless of whether vaccinated or not. Vaccination should be considered as part of an integrated dengue prevention and control strategy together with well-executed and sustained vector control and the best evidence-based clinical care for all patients with dengue.
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.
Age
Whether there are age-specific effects, independent of serostatus, is the subject of ongoing research. Currently, the vaccine should be used within the indicated age range, which is typically 9 to 45 years of age. The age to target for vaccination depends on the dengue transmission intensity in a given country, and will be lower in countries with high transmission, and higher in countries with low transmission. The optimal age group to be targeted is the age at which severe dengue disease incidence is highest, and this can be ascertained from national and subnational routine hospital surveillance data.
Schedule
In the absence of data on vaccine efficacy and safety with fewer than three doses, CYD-TDV is recommended as a three dose series given 6 months apart. Should a vaccine dose be delayed for any reason, it is not necessary to restart the course and the next dose in the series should be administered.
Booster
There are currently no data on the use of booster doses. Additional studies to determine the utility of a booster dose and its best timing are under way. Accordingly, there is no current recommendation for a booster dose.
Research priorities
Development of a highly sensitive and specific rapid diagnostic test to determine serostatus, and assessment of simplified immunization schedules and booster needs should be prioritized.
Milestones :: Perspectives
Global Fund Joins Movement to Halve Malaria by 2023
LONDON, 18 April 2018
– The Global Fund to Fight AIDS, Tuberculosis and Malaria joined leaders at the Malaria Summit London 2018 to call for reducing malaria by one half across the Commonwealth in the coming five years. Collective action aims to prevent 350 million cases of malaria and save 650,000 lives, predominately children and pregnant women who are most at risk.
The Global Fund acts as a catalyst for mobilizing resources, and through co-financing mechanisms has leveraged US$355 million of donor funding to generate US$2 billion in domestic public funding in 46 countries affected by malaria.
“To defeat an infectious disease like malaria you have to hit it hard – and you have to keep hitting it until it’s gone,” said Peter Sands, Executive Director of the Global Fund. “There are compelling, hard-nosed economic reasons for ridding the world of malaria. We risk a resurgence, and we can’t let that happen.”
Since 2000, extraordinary progress has been made in the fight against malaria, with sharp reductions in malaria cases and deaths. But those declines have stalled and even reversed in some regions, while global investments have plateaued. Malaria still kills about 450,000 people a year – including a young child every two minutes – and there is a risk of resurgence as mosquitoes become more resistant to insecticides and malaria parasites become resistant to the current first-line treatments.
The Malaria Summit was co-hosted by the governments of the UK, Swaziland and Rwanda as part of the Commonwealth Heads of Government Meeting, and convened by the Bill & Melinda Gates Foundation and the RBM Partnership to End Malaria, to galvanize more funding.
The Global Fund is increasingly using co-financing mechanisms to ensure that donor contributions to fight malaria are matched by domestic investment.
The Bill & Melinda Gates Foundation announced it will extend its investments in malaria by an additional US$1 billion (£700 million) through 2023 to fund research and development efforts and to reduce the burden of the disease.
The UK Government re-affirmed its commitment to spend £500 million a year on malaria to 2020-21, and announced a further £100 million commitment to the Global Fund to match new contributions from private donors pound for pound. The Bill & Melinda Gates Foundation pledged £50 million in matching funds, and the Global Fund committed to raising another £50 million among the private sector.
Uganda committed to establishing a dedicated malaria fund – the Presidential Malaria Fund Uganda – to help mobilize additional resources of US$785 million by 2020 to accelerate national progress against malaria.
Emergencies
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 17 April 2018 [GPEI]
Summary of newly-reported viruses this week:
Pakistan: Two new wild poliovirus type 1 (WPV1) positive environmental samples have been reported, one in Sindh province, and one in Balochistan province.
Kenya: Notification of a circulating vaccine-derived poliovirus type 2 (cVPDV2) detected from an environmental sample has been confirmed, linked to the cVDPV2 confirmed from Somalia in March. No cases of paralysis associated with this virus have been detected in either country.
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Yemen
UNICEF – Military action on and around water infrastructure jeopardizes efforts to prevent another outbreak of cholera in Yemen
AMMAN, 17 April 2018 – “Yemen continues to be one of the world’s most water-scarce countries. Access to drinking water is extremely costly for the most vulnerable people: 8.6 million children in Yemen don’t have sufficient access to water, sanitation and hygiene services.
“Since 2015, the escalation of conflict has only exacerbated this already dire situation, with attacks and military action on and around water infrastructure cutting off even more people from access to safe drinking water.
“Earlier this week, the Al-Hamazat water system in the Sehar district in Sa’ada governorate was completely destroyed in an attack that left 7,500 people, including internally displaced families, without water. During the attack, the nearby solar energy system which provides power to the water system was also severely damaged. The same water system came under attack and was destroyed in 2015. UNICEF rebuilt it in 2017.
“At the same time, armed groups have launched military attacks from sites close to water points.
“Access to clean water is especially critical to prevent waterborne diseases from spreading further in the war-torn country. Last year, Yemen had the biggest outbreak of cholera/acute watery diarrhea in the world and the likelihood of another outbreak looms if access to water continues to be jeopardized.
“UNICEF is calling on all parties to the conflict wherever they are in Yemen and those who have influence over them to protect basic civilian infrastructure. In line with international humanitarian law, all parties to the conflict should immediately stop attacks on civilians and civilian infrastructure and any military activities near or from these facilities including schools, hospitals, water facilities and keep children out of harm’s way.”
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WHO Grade 3 Emergencies [to 21 April 2018]
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WHO Grade 2 Emergencies [to 21 April 2018]
Democratic Republic of the Congo
:: 5 April 2018 Reanalysing the humanitarian context to better redefine priorities for action [FR]
— The crisis in the Democratic Republic of the Congo affect more than 13.1 million people, specally affected areas are Tanganyika, Kasai region, Kivus and Ituri. WHO national experts from the Health Emergency Management Team (WHE) and other Country Office clusters (epidemiologists, logisticians, internal and external communications, data managers, finance and travel services etc.), and international experts deployed in the Democratic Republic of the Congo gathered together to review WHO emergency operations in the county…
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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
:: Syrian Arab Republic: The Humanitarian Crisis in Syria as of 15 April 2018 [EN/AR] 18 Apr 2018
KEY MESSAGES
…As humanitarian needs remain staggering in terms of their scale, severity and complexity, no amount of humanitarian assistance and protection services can offset the lack of a political solution.
…Against this backdrop, the overall conditions for safe, dignified, voluntary and sustainable returns are not yet in place in Syria, with the need for a coherent response to the needs of IDPs and returnees based on humanitarian and protection principles paramount…
DRC
:: Democratic Republic of the Congo: CERF allocations overview 2017-2018 (as of 12 April 2018…
Yemen
:: Yemen Humanitarian Update Covering 10 – 16 April 2018 | Issue 11
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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Ethiopia
:: Ethiopia: Conflict Displacement Situation Report #3 (17 April 2018)
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Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.
MERS-CoV [to 21 April 2018]
http://www.who.int/emergencies/mers-cov/en/
Maps and epicurves
:: Epicurve of confirmed global cases of MERS-CoV png, 213kb 20 April 2018
:: Global map of countries with confirmed cases of MERS-CoV gif, 2.42Mb 20 April 2018
WHO & Regional Offices [to 21 April 2018]
Latest News
Vaccine hesitancy in the Federation of Bosnia and Herzegovina
19 April 2018
Immunization rates in the Federation of Bosnia and Herzegovina are as low as 40% in some areas and continuing to decline, increasing the risk of large disease outbreaks. But, no one knows precisely why.
Growing vaccine hesitancy, misinformation in social media, lack of trust in the health system, a shortage of health workers and supply issues are all suspected reasons for low coverage rates. However, these are mostly assumptions with little evidence.
Highlights
Revised SAGE recommendation on use of dengue vaccine
April 2018 – Dengue is the most frequent and rapidly spreading mosquito-borne virus. The first dengue vaccine, CYD-TDV (Dengvaxia®) is currently licensed in 20 countries. The key findings from 2 large Phase 3 trials involving over 30,000 participants.
[See Milestones above for detail]
Urgent action needed to tackle the double burden of malnutrition
April 2018 – Under nutrition, obesity and diet-related noncommunicable diseases are leading to catastrophic costs to individuals, to communities and to national healthcare systems in Africa. According to experts nutritional status, a critical component of a person’s health and wellbeing, must be recognized as a key building block towards achieving Universal Health Coverage and the Sustainable Development Goals by 2030.
WHO continues to serve communities affected by PNG quake
April 2018 – Fifty days after a 7.5 magnitude earthquake hit Papua New Guinea (PNG), limited delivery of essential health services has resumed in earthquake-affected provinces. However, thousands remain vulnerable to health threats as they continue to live in crowded temporary settlements with inadequate access to clean water and medical services.
New hepatitis data highlight need for urgent global response
April 2017 – New WHO data reveal that an estimated 325 million people worldwide are living with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. The WHO Global hepatitis report, 2017 shows the majority of these people lack access to life-saving testing and treatment.
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Weekly Epidemiological Record, 20 April 2018, vol. 93, 16 (pp. 201–220)
Rabies vaccines: WHO position paper – April 2018
WHO Strategic Advisory Group of Experts (SAGE) on immunization: request for nominations
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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: WHO supports South Sudan to strengthen health promotion strategic actions 19 April 2018
:: Botswana Excels in the 2018 National Measles Laboratory Review For Accreditation 18 April 2018
:: New data from Africa allays fears of bowel obstruction from rotavirus vaccine 18 April 2018
:: Malawi administers Oral Cholera Vaccine to over 500,000 people in Lilongwe Urban 17 April 2018
WHO Region of the Americas PAHO
:: 70 million people to be vaccinated as part of Vaccination Week in the Americas (04/19/2018)
WHO European Region EURO
:: WHO delivers 185 tonnes of medical supplies to improve access to health services in northern Syria 20-04-2018
:: Evidence shows banning asbestos has no negative economic impact 19-04-2018
:: Day 3 of high-level meeting Health Systems Respond to NCDs: opportunities and challenges for accelerated response 19-04-2018
:: Day 2 of high-level meeting Health Systems Respond to NCDs: Learning from good examples and real-time problem solving in policy labs 18-04-2018
:: Day 1 of high-level meeting Health Systems Respond to NCDs: focus on equity and people centredness 17-04-2018
WHO Eastern Mediterranean Region EMRO
:: WHO scales up support to mitigate child malnutrition in Yemen
18 April 2018 – As the conflict in Yemen continues unabated, the situation worsens, with more than 1.8 million children under the age of 5 acutely malnourished, including 500 000 children suffering from severe acute malnutrition, requiring immediate admission into therapeutic nutrition programmes. Responding to rising malnutrition rates in Yemen, WHO is providing life-saving treatment for children with severe acute malnutrition and medical complications, supporting 47 centres, with 3 more planned in 2018, to cope with the rising needs for malnutrition treatment services.
:: Addressing emergency care in Afghanistan 18 April 2018
:: Health worker shot in the leg during Gaza demonstrations April 2018
WHO Western Pacific Region
:: 50 days on, WHO continues to serve communities affected by PNG quake
PORT MORESBY, 16 April 2018 – Fifty days after a 7.5 magnitude earthquake hit Papua New Guinea (PNG), limited delivery of essential health services has resumed in earthquake-affected provinces. However, thousands remain vulnerable to health threats as they continue to live in crowded temporary settlements with inadequate access to clean water and medical services. More than 500 000 were affected by the earthquake that struck on 26 February.
CDC/ACIP [to 21 April 2018]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html
MMWR News Synopsis for April 19, 2018
Recommendations of the Advisory Committee on Immunization Practices for Use of a Hepatitis B Vaccine with a Novel Adjuvant
On February 21, 2018, the Advisory Committee on Immunization Practices (ACIP) recommended the use of HEPLISAV-B (HepB-CpG) vaccine, a 2-dose series hepatitis B vaccine for use in people 18 years of age or over. Hepatitis B vaccination is the primary means of preventing infections and complications caused by hepatitis B virus. Prior to making this recommendation, the ACIP Hepatitis Vaccines Work Group conducted a systematic review of the existing evidence to determine that the benefits of protection with two doses administered over one month make the HEPLISAV-B (HepB-CpG) vaccine an important option for prevention of hepatitis B in at-risk persons.
Africa CDC [to 21 April 2018]
https://au.int/en/africacdc
April 21, 2017
Presentation_Africa CDC Symposium
ECDC – European Centre for Disease Prevention and Control [to 21 April 2018]
https://ecdc.europa.eu/en/home
13 Apr 2018
Measles cases increase significantly in the last month in a number of EU/EEA countries
Monthly measles and rubella monitoring report, April 2018
Measles cases continue to increase in a number of EU/EEA countries. The highest number of cases to date in 2018 were in Romania (1 709), Greece (1 463) France (1 346) and Italy (411) respectively.
Thirteen deaths have also been reported by these countries in 2018. Although cases in Romania and Greece remain high, of particular concern is the situation in France and Italy, with cases almost tripling in France since the previous update in March, and more than doubling in Italy. This is according to the most recent measles data collected by ECDC through epidemic intelligence and published in the Communicable Diseases Threats Report (CDTR) today…
Announcements
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BMGF – Gates Foundation [to 21 April 2018]
http://www.gatesfoundation.org/Media-Center/Press-Releases
APRIL 13, 2018
Bill & Melinda Gates Foundation Appoints Amy Pollack as Director of Maternal, Newborn & Child Health
SEATTLE, April 13, 2018 – The Bill & Melinda Gates Foundation today announced that Amy Pollack, MD, FACOG, FACPM has been named director of Maternal, Newborn & Child Health. She will assume her position on May 7, 2018.
Pollack joins the foundation from Medtronic, where she most recently served as the Chief Safety Officer and set the strategy and policy for medical safety across the company’s global business groups. Pollack has more than 25 years of experience in domestic and international health, including work in clinical practice; as the CEO of an international women’s health non-profit; and as an executive in early-stage medical device businesses, social venture capital, and industry. She has led global health multilateral negotiations for disruptive technologies, and she led national working groups in U.S. government policy change around the HPV vaccine, cervical cytology, and prostate cancer. Pollack is board certified in Obstetrics and Gynecology and Preventive Medicine.
“Amy brings deep experience in domestic and global health, strategy development, and in leading high-performing teams of technical experts,” said Chris Elias, president, Global Development at the Bill & Melinda Gates Foundation. “She will play a central role in the foundation’s efforts to save the lives of women, newborns, and children around the world.”…
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FDA [to 21 April 2018]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
April 17, 2018 –
Statement from FDA Commissioner Scott Gottlieb, M.D., on new efforts to enhance and modernize the FDA’s approach to medical device safety and innovation
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Fondation Merieux [to 21 April 2018]
http://www.fondation-merieux.org/
April 20, 2018
The Mérieux Foundation presents the results of two studies on pneumonia at the European Congress ECCMID 2018
The Mérieux Foundation is participating in the 28th European Congress of Clinical Microbiology and Infectious Diseases, held in Madrid, Spain from April 21-24. During this European congress devoted to microbiology and infectious diseases, the Foundation has two oral presentations and three posters.
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Gavi [to 21 April 2018]
http://www.gavi.org/library/news/press-releases/
18 April 2018
United Arab Emirates to host Gavi 2018 mid-term review
The high-level event will celebrate 10 million lives saved since Gavi’s inception, launching its next replenishment cycle.
Abu Dhabi/Geneva, 18 April 2018 – The Minister of State for International Cooperation for the United Arab Emirates (UAE) HE Reem Al Hashimy announced today that the UAE will host the Gavi 2018 mid–term review.
The high-level conference will take place in Abu Dhabi on 10-11 December 2018 and will lay out a vision for the future of the Gavi model, providing an opportunity to take stock of Gavi’s performance halfway through the current strategic period (2016-2020). The conference will outline new ways of working with partners, allowing Gavi to forge new alliances with the private sector and adopt transformative solutions to advance the global immunisation agenda…
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Global Fund [to 21 April 2018]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
18 April 2018
Global Fund Joins Movement to Halve Malaria by 2023
The Global Fund today joins leaders meeting at the Malaria Summit London 2018 in a call to reduce malaria by one half across the Commonwealth in the next five years. Such collective actions aims to prevent 350 million cases of malaria and save 650,000 lives, predominately children and pregnant women.
[See Milestones above for more detail]
News
Global Fund Applauds UK’s Leadership in Fight Against Malaria
17 April 2018
Today the United Kingdom’s International Development Secretary Penny Mordaunt announced a £100 million fund to fight malaria to be matched by the private sector, which will be used to support priority countries with mosquito nets, indoor sprays and the strengthening of health systems.
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NIH [to 21 April 2018]
http://www.nih.gov/news-events/news-releases
April 16, 2018
Genetically altered broadly neutralizing antibodies protect monkeys from HIV-like virus
— NIH scientists report single dose elicited long-term protection.
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PATH [to 21 April 2018]
http://www.path.org/news/index.php
Press release | April 17, 2018
PATH and Mologic advance a new diagnostic test to support malaria elimination
Test will expand the range of diagnostic options available to guide treatment of Plasmodium vivax
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UNAIDS [to 21 April 2018]
http://www.unaids.org/en
20 April 2018
Feature story
An historic opportunity to end AIDS in Africa
A new report released by UNAIDS shows that ending the AIDS epidemic in Africa can be reached if investments are secured and plans are in place for long-term sustainability.
The report, Turning point for Africa: An historic opportunity to end AIDS as a public health threat by 2030 and launch a new era of sustainability recommends developing country-tailored sustainability plans to enable transition towards domestic ownership and financing at each country’s own pace. It also highlights that sustainable progress will require changing policies, increasing human resources for health, increasing efficiencies and addressing systemic inequalities.
The Executive Director of UNAIDS Michel Sidibé presented the new report to African Ministers of Finance, multilateral partners and other senior officials at a meeting on optimizing investments and partnerships to end AIDS in Africa organized by the United States Department of Treasury and the United States President’s Emergency Plan for AIDS Relief (PEPFAR).
Update
VI Eastern Europe and Central Asia Conference on HIV/AIDS opens in Moscow
20 April 2018
A record 3000 delegates from more than sixty countries, including representatives of civil society, scientific institutions, the private sector and governments, gathered in Moscow from 18 to 20 April 2018 to participate in the sixth Eastern Europe and Central Asia Conference on HIV/AIDS. The conference focused on four major tracks: prevention, science and treatment, civil society, and international cooperation.
Eastern Europe and Central Asia is the only region where the number of new HIV infections and AIDS-related death are still on the rise. The conference provides a unique opportunity to take stock of progress and discuss the challenges and transformation needed to get the Eastern Europe and Central Asia region on track to end AIDS…
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UNICEF [to 21 April 2018]
https://www.unicef.org/media/
Selected Press Releases
17 April 2018
Military action on and around water infrastructure jeopardizes efforts to prevent another outbreak of cholera in Yemen
AMMAN, 17 April 2018 – “Yemen continues to be one of the world’s most water-scarce countries. Access to drinking water is extremely costly for the most vulnerable people: 8.6 million children in Yemen don’t have sufficient access to water, sanitation and hygiene services.
[See Emergencies above for more detail]
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The Wistar Institute [to 21 April 2018]
https://www.wistar.org/news/press-releases
Press Release Apr. 19 2018
Wistar Team Receives Prestigious Award from National Clinical Research Forum for DNA-based Zika Research
The Wistar Institute and partners at the Perelman School of Medicine at the University of Pennsylvania, Inovio Pharmaceuticals, and GeneOne Life Science were recognized among the Top 10 Clinical Research Achievement Awards by the Clinical Research Forum for their ground-breaking phase 1 DNA-based Zika vaccine research – the first trial of a Zika vaccine in humans, which proved safe and effective. These study results were published in October in the New England Journal of Medicine…
Coalition for Epidemic Preparedness Innovations Supports MERS & Lassa Enhanced DNA Vaccine Technology to Expedite Vaccine Development
PHILADELPHIA — (April 19, 2018) — The Wistar Institute and Inovio Pharmaceuticals, Inc. are leading the charge to rapidly advance a Middle East Respiratory Syndrome (MERS) vaccine through phase II development as part of an innovative partnership with the Coalition for Epidemic Preparedness Innovations (CEPI). CEPI, which launched last year, aims to derail epidemics by speeding up the development of vaccines.
CEPI will fund nearly $56 million to support pre-clinical and clinical research of Inovio’s Lassa fever vaccine and to further develop a MERS DNA vaccine based on key technology generated in the lab of David B. Weiner, Ph.D., executive vice president, director of the Vaccine & Immunotherapy Center, and the W.W. Smith Endowed Chair in Cancer Research at The Wistar Institute. Wistar is a sub-awardee and will receive more than $4 million to support continuing MERS DNA vaccine technology research.
“Wistar is proud to be one of the first set of CEPI consortium members to receive funding that will accelerate development of vaccines for MERS and Lassa fever into efficacy trials in the next few years,” said Weiner. “In this day and age where diseases have no boarders, it is imperative that our vaccine arsenal is ready to react. The goal is for these vaccines to be available as soon as possible for global and on-site emergency deployment when needed.”…
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DCVMN – Developing Country Vaccine Manufacturers Network [to 21 April 2018]
http://www.dcvmn.org/
21 April 2018
Regional workshop: Optimization of vaccines’ manufacturing, containers and testing for global supply
7 May 2018 to 10 May 2018
Hyderabad / India
Industry Watch [to 21 April 2018]
:: Sanofi to invest €350 million in Canadian vaccine facility
April 12, 2018
Expansion demonstrates company’s commitment to innovation and leadership in global public health
New Toronto facility is one of the largest-ever investments by Sanofi in a single building
Significantly increases capacity to meet growing demand for pediatric and booster vaccine
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
BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 21 April 2018)
Research article
Assessment of an optimized manufacturing process for inactivated quadrivalent influenza vaccine: a phase III, randomized, double-blind, safety and immunogenicity study in children and adults
GSK has modified the licensed monovalent bulk manufacturing process for its split-virion inactivated quadrivalent influenza vaccine (IIV4) to harmonize the process among different strains, resulting in an incr…
Authors: Carine Claeys, Mamadou Drame, José García-Sicilia, Khalequ Zaman, Alfonso Carmona, Phu My Tran, Mariano Miranda, Federico Martinón-Torres, Franck Thollot, Michael Horn, Tino F. Schwarz, Ulrich Behre, José M. Merino, Iwona Sadowska-Krawczenko, Henryk Szymański, Peter Schu…
Citation: BMC Infectious Diseases 2018 18:186
Published on: 18 April 2018
BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 21 April 2018)
Research article
Estimating the number of unvaccinated Chinese workers against yellow fever in Angola
A yellow fever epidemic occurred in Angola in 2016 with 884 laboratory confirmed cases and 373 deaths. Eleven unvaccinated Chinese nationals working in Angola were also infected and imported the disease to Chi…
Authors: A. Wilder-Smith and E. Massad
Citation: BMC Infectious Diseases 2018 18:185
Published on: 17 April 2018
Humanitarian Exchange Magazine
Number 71 March 2018
https://odihpn.org/magazine/humanitarian-response-urban-areas/
Humanitarian response in urban areas
Humanitarian crises are increasingly affecting urban areas either directly, through civil conflict, hazards such as flooding or earthquakes, urban violence or outbreaks of disease, or indirectly, through hosting people fleeing these threats. The humanitarian sector has been slow to understand how the challenges and opportunities of working in urban spaces necessitate changes in how they operate. For agencies used to working in rural contexts, the dynamism of the city, with its reliance on markets, complex systems and intricate logistics, can be a daunting challenge. Huge, diverse and mobile populations complicate needs assessments, and close coordination with other, often unfamiliar, actors is necessary.
The Lancet
Apr 21, 2018 Volume 391 Number 10130 p1549-1636
http://www.thelancet.com/journals/lancet/issue/current
Comment
The Lancet Commission on malaria eradication
Ingrid Chen, Rebecca Cooney, Richard G A Feachem, Altaf Lal, Winnie Mpanju-Shumbusho
[Excerpt]
… The malaria community is reaching consensus that eradication is the only acceptable end goal. If we aim for anything short of eradication, the parasite and vector will become increasingly resistant to the drugs and insecticides available to combat the disease.8 Without eradication, sustained effort would also be needed indefinitely, as the disease would be able to return with a vengeance, particularly in tropical areas with high anopheline vectorial capacity. There is also a strong ethical imperative to eradicate malaria, a disease mainly affecting poor and marginalised people. Malaria eradication offers a massive return on investment: every dollar spent returns up to US$60 for the wellbeing of countries and their populations.9
With malaria eradication emerging as a pragmatic, ethical, and economically advantageous investment, the global health community needs more evidence to guide eradication strategies at national, regional, and global levels. To address this, The Lancet and the Malaria Elimination Initiative at the Global Health Group, University of California, San Francisco have convened the Lancet Commission on malaria eradication, designed to complement and supplement the WHO Strategic Advisory Group on malaria eradication. The Commission will elaborate the scientific, financial, and operational requirements to achieve malaria eradication. Some of the questions to be addressed by the Commission are shown in the panel. The Commission comprises 24 leaders in science, epidemiology, policy, finance, economics, and implementation (appendix). The Commissioners will meet two or three times over the next 12 months with the aim of publishing the Commission’s report in 2019.
Questions to be addressed by the Lancet Commission on malaria eradication
The Lancet Commission on malaria eradication will develop a comprehensive roadmap for the eradication of malaria. Questions to be tackled by the Commission include:
:: Why should we eradicate malaria and what return on investment can we expect?
:: What are the costs of eradication and who will pay?
:: How will global megatrends (eg, urbanisation) facilitate or impede malaria eradication?
:: In which countries will malaria eradication prove most difficult and where will the last battlegrounds be?
:: Which new game-changing technologies are likely to be essential to complete the eradication task?
:: How will malaria eradication support universal health coverage and vice versa?
:: How can programme implementation be strengthened at the national and subnational levels?
The Commission’s work will emphasise the dual imperative to shrink the malaria map, while intensely reducing the burden of disease in high transmission areas. The Commission will pay special attention to the endgame: the last battle that will probably play out in high transmission countries in equatorial Africa. The comprehensive synthesis developed by the Commission will be intended to propel continued progress towards elimination using available tools in parallel with the development of future innovations, including the potential use of CRISPR-Cas9 gene drive technology to modify parasites or mosquitoes.10, 11
While the task of malaria eradication will be formidable, 20 years of progress have brought us more than halfway there. This month is an important time for the malaria community. MIM reconvenes in Dakar, Senegal, after 21 years at the 7th MIM Pan African Malaria Conference on April 15–20, 2018, where researchers will share the latest research findings and agree on new strategies to advance elimination and eradication. Today the pace of scientific advance and innovation continues to accelerate with pilot studies to evaluate the first malaria vaccine underway.12 At the same time, leaders gather in London, UK, on April 16–20 at the Commonwealth Heads of Government Meeting where malaria is firmly on the agenda. The 53 Commonwealth countries are home to 60% of all malaria cases and 52% of all malaria deaths.2, 13 A bold commitment by the Commonwealth could greatly increase the prospect of malaria eradication within a generation.
The fight against malaria has made exceptional progress in the past decades. We are now poised to embark on a journey towards eradication. Building on this momentum and harnessing the combined energy and commitment of politicians, scientists, implementers, and the public and private sectors, we have both the opportunity and responsibility to create a world free of malaria.5
The Lancet
Apr 21, 2018 Volume 391 Number 10130 p1549-1636
http://www.thelancet.com/journals/lancet/issue/current
Seminar
Malaria
Elizabeth A Ashley, Aung Pyae Phyo, Charles J Woodrow
vaccines and global health :: ethics and policy 
