BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 15 April 2017)

Research article
Health workers perceptions and attitude about Ghana’s preparedness towards preventing, containing, and managing Ebola Virus Disease
Philip Baba Adongo, Philip Teg-Nefaah Tabong, Emmanuel Asampong, Joana Ansong, Magda Robalo and Richard M. Adanu
BMC Health Services Research 2017 17:266
Published on: 12 April 2017
Abstract
Background
Ebola virus is highly infectious and the disease can be very fatal. The World Health Organization has declared the 2014–2015 Ebola Virus Disease outbreak a Public Health Emergency of International Concern. In response to this, preparations were made in various health facilities and entry points across Ghana. This study explored health workers perceptions, and attitude about Ghana’s preparedness towards preventing and containing Ebola Virus Disease.
Methods
We conducted a qualitative study in five (5) of the ten (10) regions in Ghana. Five focus group discussions (N = 44) were conducted among nurses; one in each region. In addition, ten (10) health workers (2 in each region) who are members of regional Ebola Virus Disease task force were recruited and interviewed. In the Greater Accra, Volta and Western regions that have ports, six (6) port health officials: two in each of these regions were also interviewed. The interviews were recorded digitally and transcribed verbatim. Thematic content analysis was used to analyze the transcripts with the aid of NVivo 10 software.
Results
The results of this study showed that Ghanaian health workers perceived the screening at various ports as important and ongoing but felt that the screenings at in-land ports were being undermined by the use of unapproved routes. Training of health workers was also being carried out in all the regions, however, there was a general perception among 33 out of 44 nurses that majority of health workers have not received training on Ebola Virus Disease prevention and management. Logistical challenges were also reported as some health facilities did not have adequate Personal Protective Equipment. In facilities where equipment was available, they were stored in places which are not easily accessible to health workers at all times of the day. Human resource preparation was also perceived to be a challenge as health workers (38/44 of nurses) generally expressed fear and unwillingness to work in Ebola treatment centres in the event of an outbreak in Ghana.
Conclusions
Our study concludes that preparatory work for Ebola Virus Disease prevention and containment in Ghana is perceived as inadequate by health workers. Ghana needs to strengthen preparation in the area of training of health workers, provision and accessibility of Personal Protective Equipment and incentives for health workers to better position her to contain and manage any Ebola Virus Disease outbreak.

BMC Infectious Diseases

(Accessed 15 April 2017)

Research article
Long-term impact of self-financed rotavirus vaccines on rotavirus-associated hospitalizations and costs in the Valencia Region, Spain
Rotavirus vaccines are available in Spain from 2007. They are recommended by the Spanish Pediatric Association, but not funded by the National Health System (NHS) and its coverage rate reached 40-50%…Despite the low-medium vaccine coverage, the introduction of rotavirus vaccines had a specific coverage-related response impact in the hospitalizations for RVAGE and AGE in children < 5 years and their use substantially reduced hospital related costs. The model used reassures that the estimated impact is due to the vaccination and not to other external factors.
Alejandro Orrico-Sanchez, Mónica López-Lacort, Silvia Pérez-Vilar and Javier Díez-Domingo
BMC Infectious Diseases 2017 17:267
Published on: 11 April 2017

BMC Infectious Diseases

(Accessed 15 April 2017)

Research article
Is the impact of childhood influenza vaccination less than expected: a transmission modelling study
To reduce the burden of severe influenza, most industrialized countries target specific risk-groups with influenza vaccines, e.g. the elderly or individuals with comorbidities. Since children are the main spre…
Felix Weidemann, Cornelius Remschmidt, Silke Buda, Udo Buchholz, Bernhard Ultsch and Ole Wichmann
BMC Infectious Diseases 2017 17:258
Published on: 11 April 2017

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 15 April 2017]

Debate
A systematic tale of two differing reviews: evaluating the evidence on public and private sector quality of primary care in low and middle income countries
Jorge Coarasa, Jishnu Das, Elizabeth Gummerson and Asaf Bitton
Published on: 12 April 2017
Abstract
Systematic reviews are powerful tools for summarizing vast amounts of data in controversial areas; but their utility is limited by methodological choices and assumptions. Two systematic reviews of literature on the quality of private sector primary care in low and middle income countries (LMIC), published in the same journal within a year, reached conflicting conclusions. The difference in findings reflects different review methodologies, but more importantly, a weak underlying body of literature. A detailed examination of the literature cited in both reviews shows that only one of the underlying studies met the gold standard for methodological robustness. Given the current policy momentum on universal health coverage and primary health care reform across the globe, there is an urgent need for high quality empirical evidence on the quality of private versus public sector primary health care in LMIC.

International Journal of Community Medicine and Public Health
Vol 4, No 4 (2017) April 2017
http://www.ijcmph.com/index.php/ijcmph/issue/view/22

Original Research Articles
Status of oral polio vaccination program for international travellers and its determinants: an experience from a designated centre of West Bengal
Manisha Sarkar, Urmila Dasgupta, Saikat Bhattacharya, Krishna Das Bhattacharyya, Salil Kumar Bhattacharya
Abstract
Background: In order to maintain the polio free status of India, it is vital to monitor the ongoing oral polio vaccination for international travellers. The aim of the study was to determine the status of oral polio vaccination program for international travellers from India to polio infected countries and to find out the determinants of deviation from proposed guidelines.
Methods: A descriptive cross-sectional study was conducted among 101 International travellers from November 2014 to April 2015 at a designated Polio vaccination centre for international travellers in Kolkata. A pre-designed pre-tested schedule was used to collect oral polio vaccination related details. The travellers who gave consent were eligible for the study. Data was expressed in terms of mean, median, standard deviation etc. Association between variables was tested by Chi square test.
Results: 32.7% of the travellers had inadequate gap between OPV & travel. Knowledge of gap between OPV and travel was perceived more from health centres and travel agencies than mass media. Inadequate gap was more among lower age group, males, those with information source as mass media, official purpose of visit, those with incorrect knowledge regarding the gap requirement and those who maintained at least four weeks gap between OPV and yellow fever vaccine.
Conclusions: Wrong information from the source is responsible for wrong knowledge among the travellers which leads to inadequate gap between OPV and travel. It is crucial to increase awareness among the vaccinators and international travellers in order to contribute towards global polio eradication

JAMA
April 11, 2017, Vol 317, No. 14, Pages 1391-1490
http://jama.jamanetwork.com/issue.aspx

Viewpoint
Achieving Universal Coverage Without Turning to a Single PayerLessons From 3 Other Countries
Regina E. Herzlinger, DBA; Barak D. Richman, JD, PhD; Richard J. Boxer, MD
JAMA. 2017;317(14):1409-1410. doi:10.1001/jama.2017.1475
This Viewpoint references national health insurance mandates in Switzerland, Singapore, and Germany as examples of how to achieve universal health care coverage with private-sector insurance systems.

Journal of Medical Ethics
April 2017 – Volume 43 – 4
http://jme.bmj.com/content/current
[Reviewed earlier]
Online First – Research ethics

Paper
Vaccine testing for emerging infections: the case for individual randomisation
Nir Eyal1,
Marc Lipsitch2
http://dx.doi.org/10.1136/medethics-2015-103220
Abstract
During the 2014–2015 Ebola outbreak in Guinea, Liberia and Sierra Leone, many opposed the use of individually randomised controlled trials to test candidate Ebola vaccines. For a raging fatal disease, they explained, it is unethical to relegate some study participants to control arms. In Zika and future emerging infections, similar opposition may hinder urgent vaccine research, so it is best to address these questions now. This article lays out the ethical case for individually randomised control in testing vaccines against many emerging infections, including lethal infections in low-income countries, even when at no point in the trial do the controls receive the countermeasures being tested. When individual randomisation is feasible—and it often will be—it tends to save more lives than alternative designs would. And for emerging infections, individual randomisation also tends as such to improve care, access to the experimental vaccine and prospects for all participants relative to their opportunities absent the trial, and no less than alternative designs would. That obtains even under placebo control and without equipoise—requiring which would undermine individual randomisation and the alternative designs that opponents proffered. Our arguments expound four often-neglected factors: benefits to non-participants, benefits to participants once a trial is over including post-trial access to the study intervention, participants’ prospects before randomisation to arms and the near-inevitable disparity between arms in any randomised controlled trial.

The Lancet
Apr 15, 2017 Volume 389 Number 10078 p1491-1580
http://www.thelancet.com/journals/lancet/issue/current
Editorial
Defunding the UNFPA: sign of the times
The Lancet
Published: 15 April 2017
It was expected but still devastating. The US State Department on April 3 announced a defunding of the UN organisation for family planning and reproductive health, the UNFPA. The USA claimed the agency “supports, or participates in the management of, a programme of coercive abortion or involuntary sterilisation in China”, invoking the Kemp-Kasten Amendment prohibiting US funding of organisations involved in such activities. The UNFPA strenuously denies this allegation.

The removal of support, a loss of US$75 million for UNFPA, is a blow to an agency that ensures access to contraception and maternal and child health services, and fights against gender violence, child marriage, and female genital mutilation in more than 150 countries worldwide. In 2015, the USA was among the largest donors to UNFPA, which is currently facing a $140 million shortfall. Previous Republican presidencies withheld funding from UNFPA for similar antiabortion reasons. But the current US Administration’s invocation of Kemp-Kasten and its broadening of the related Global Gag rule appear to be a more direct attack on women’s lives and rights.

Extra chilling is that the White House rationalised UNFPA’s defunding despite their own memo stating no evidence of direct UN engagement in forced abortions or sterilisation in China. This clear play of politics over evidence shows them comfortable aligning health policy with an ideological agenda, but also shamelessly nonchalant with a lack of facts. This apparent disregard for truth in policy making is a worrying sign of things to come for other UN agencies and indeed women’s health.

In fact, the dismay over the UNFPA defunding masks the depressing reality of the low-level and priority of health funding for women. With the USA’s annual foreign assistance budget of about $40 billion, its $75 million for UNFPA is a tiny drop in the bucket. Republican representative John Shimkus absurdly asked during a recent US health-care debate why men should have to pay for prenatal care. To follow the US lead would send a message that the world does not care for women. Other countries should stridently reject this misogyny and harken support for UNFPA to continue its essential work.

New England Journal of Medicine
April 13, 2017  Vol. 376 No. 15
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Yellow Fever — Once Again on the Radar Screen in the Americas
Catharine I. Paules, M.D., and Anthony S. Fauci, M.D.
[See Featured Journal Content above for full text]

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Perspective
The Perils of Trumping Science in Global Health — The Mexico City Policy and Beyond
Nathan C. Lo, B.S., and Michele Barry, M.D.
N Engl J Med 2017; 376:1399-1401 April 13, 2017 DOI: 10.1056/NEJMp1701294

.

Perspective
Ensuring Access to Injectable Generic Drugs — The Case of Intravesical BCG for Cntenabove for full text]Bladder Cancer
Benjamin J. Davies, M.D., Thomas J. Hwang, A.B., and Aaron S. Kesselheim, M.D., J.D., M.P.H.
N Engl J Med 2017; 376:1401-1403 April 13, 2017 DOI: 10.1056/NEJMp1615697
Limits on access to injectable generic drugs force providers to use potentially less effective alternatives, current patients to discontinue therapy, and some new patients to receive more invasive interventions. Yet shortages of important generic drugs remain frequent.

PNAS – Proceedings of the National Academy of Sciences of the United States
of America
http://www.pnas.org/content/early/
[Accessed 15 April 2017]
Editorial – Biological Sciences – Medical Sciences:
Simply put: Vaccination saves lives
Walter A. Orenstein and
Rafi Ahmed
PNAS 2017 ; published ahead of print April 10, 2017, doi:10.1073/pnas.1704507114
[See full text in Featured Journal Content at top]

Perspective: Emerging infectious diseases: A proactive approach
David E. Bloom, Steven Black, and Rino Rappuoli
PNAS 2017 ; published ahead of print April 10, 2017, doi:10.1073/pnas.1701410114
Abstract
Infectious diseases are now emerging or reemerging almost every year. This trend will continue because a number of factors, including the increased global population, aging, travel, urbanization, and climate change, favor the emergence, evolution, and spread of new pathogens. The approach used so far for emerging infectious diseases (EIDs) does not work from the technical point of view, and it is not sustainable. However, the advent of platform technologies offers vaccine manufacturers an opportunity to develop new vaccines faster and to reduce the investment to build manufacturing facilities, in addition to allowing for the possible streamlining of regulatory processes. The new technologies also make possible the rapid development of human monoclonal antibodies that could become a potent immediate response to an emergency. So far, several proposals to approach EIDs have been made independently by scientists, the private sector, national governments, and international organizations such as the World Health Organization (WHO). While each of them has merit, there is a need for a global governance that is capable of taking a strong leadership role and making it attractive to all partners to come to the same table and to coordinate the global approach.

Biological Sciences – Ecology – Physical Sciences – Statistics:
El Niño and the shifting geography of cholera in Africa
Sean M. Moore, Andrew S. Azman, Benjamin F. Zaitchik, Eric D. Mintz, Joan Brunkard, Dominique Legros, Alexandra Hill, Heather McKay, Francisco J. Luquero, David Olson, and Justin Lessler
PNAS 2017 ; published ahead of print April 10, 2017, doi:10.1073/pnas.1617218114
Significance
In the wake of the 2015–2016 El Niño, multiple cholera epidemics occurred in East Africa, including the largest outbreak since the 1997–1998 El Niño in Tanzania, suggesting a link between El Niño and cholera in Africa. However, little evidence exists for this link. Using high-resolution mapping techniques, we found the cholera burden shifts to East Africa during and following El Niño events. Throughout Africa, cholera incidence increased three-fold in El Niño-sensitive regions, and 177 million people experienced an increase in cholera incidence. Without treatment, the case fatality rate can reach 50%, but accessible, appropriate care nearly eliminates mortality. Climatic forecasts predicting El Niño events 6–12 mo in advance could trigger public health preparations and save lives.
Abstract
The El Niño Southern Oscillation (ENSO) and other climate patterns can have profound impacts on the occurrence of infectious diseases ranging from dengue to cholera. In Africa, El Niño conditions are associated with increased rainfall in East Africa and decreased rainfall in southern Africa, West Africa, and parts of the Sahel. Because of the key role of water supplies in cholera transmission, a relationship between El Niño events and cholera incidence is highly plausible, and previous research has shown a link between ENSO patterns and cholera in Bangladesh. However, there is little systematic evidence for this link in Africa. Using high-resolution mapping techniques, we find that the annual geographic distribution of cholera in Africa from 2000 to 2014 changes dramatically, with the burden shifting to continental East Africa—and away from Madagascar and portions of southern, Central, and West Africa—where almost 50,000 additional cases occur during El Niño years. Cholera incidence during El Niño years was higher in regions of East Africa with increased rainfall, but incidence was also higher in some areas with decreased rainfall, suggesting a complex relationship between rainfall and cholera incidence. Here, we show clear evidence for a shift in the distribution of cholera incidence throughout Africa in El Niño years, likely mediated by El Niño’s impact on local climatic factors. Knowledge of this relationship between cholera and climate patterns coupled with ENSO forecasting could be used to notify countries in Africa when they are likely to see a major shift in their cholera risk.

Proceedings of the Royal Society B
12 April 2017; volume 284, issue 1852
http://rspb.royalsocietypublishing.org/content/284/1852?current-issue=y
Genetics and genomics

Research article:
Adaptation to infectious disease exposure in indigenous Southern African populations
Katharine A. Owers, Per Sjödin, Carina M. Schlebusch, Pontus Skoglund, Himla Soodyall, Mattias Jakobsson
Abstract
Genetic analyses can provide information about human evolutionary history that cannot always be gleaned from other sources. We evaluated evidence of selective pressure due to introduced infectious diseases in the genomes of two indigenous southern African San groups—the Khomani who had abundant contact with other people migrating into the region and the more isolated Ju|’hoansi. We used a dual approach to test for increased selection on immune genes compared with the rest of the genome in these groups. First, we calculated summary values of statistics that measure genomic signatures of adaptation to contrast selection signatures in immune genes and all genes. Second, we located regions of the genome with extreme values of three selection statistics and examined these regions for enrichment of immune genes. We found stronger and more abundant signals of selection in immune genes in the Khomani than in the Ju|’hoansi. We confirm this finding within each population to avoid effects of different demographic histories of the two populations. We identified eight immune genes that have potentially been targets of strong selection in the Khomani, whereas in the Ju|’hoansi, no immune genes were found in the genomic regions with the strongest signals of selection. We suggest that the more abundant signatures of selection at immune genes in the Khomani could be explained by their more frequent contact with immigrant groups, which likely led to increased exposure and adaptation to introduced infectious diseases.

Science
14 April 2017 Vol 356, Issue 6334
http://www.sciencemag.org/current.dtl

Editorial
Research integrity revisited
By Marcia McNutt, Robert M. Nerem
Science14 Apr 2017 : 115
Summary
The U.S. public and private sectors invest billions of dollars and countless hours of highly skilled labor into scientific research every year, an investment that delivers enormous benefits to society. Integrity is indispensable to the orderly and efficient progress of this research. Regrettably, there have been some well-publicized breakdowns in scientific integrity and reported cases of irreproducible research. A new report from the U.S. National Academies of Sciences, Engineering, and Medicine (NASEM), Fostering Integrity in Research, recommends specific steps to secure a future based on integrity and reliability (www.nap.edu/catalog/21896/). These include establishing a new Research Integrity Advisory Board (RIAB) and taking stronger actions to discourage and eliminate practices that are clearly detrimental to research.

Science
14 April 2017 Vol 356, Issue 6334
http://www.sciencemag.org/current.dtl

Personalized tumor vaccines keep cancer in check
By Jocelyn Kaiser
Science14 Apr 2017 : 122 Restricted Access
A new approach enlists a tumor’s own mutated proteins.
Summary
A new approach to fighting cancer that tailors a vaccine to mutated proteins in an individual’s tumor is gaining traction. In two small clinical trials, a personalized vaccine appears to have helped prevent early relapses in a total of 12 people with skin cancer. These “neoantigen” vaccines also may have helped several others by boosting the power of a new type of cancer drug that uses a different mechanism to unleash an immune attack on the tumor. The two studies, one presented last week at the annual meeting of the American Association for Cancer Research in Washington, D.C., are promising. But larger trials will be needed to show whether the vaccines help extend the lives of cancer patients.

Science
14 April 2017 Vol 356, Issue 6334
http://www.sciencemag.org/current.dtl

Feature
Epidemic Insurance
Jon Cohen
Science  14 Apr 2017:
Vol. 356, Issue 6334, pp. 125-127
DOI: 10.1126/science.356.6334.125
Summary
In the wake of the West Africa Ebola epidemic that ended in 2015, public health officials, pharmaceutical companies, government scientists, and academic researchers have struggled to improve the way the world responds to outbreaks of emerging infections. The most powerful tool, a vaccine, does not exist for dozens of these diseases and a new push is underway to streamline R&D for these commercially unattractive products. A new organization, the Coalition for Epidemic Preparedness Innovations (CEPI), was launched and has raised half a billion dollars to work on three of these vaccines. GlaxoSmithKline, one of only four large vaccinemakers in the world, has proposed devoting one of its idle manufacturing plants to be a facility dedicated to making vaccines for emerging infections, and is seeking CEPI funding. But other vaccinemakers have different ideas about how best to improve the response. And many of the people at the front of reinventing the way the world responds to emerging infections stress that the problem in need of fixing is much larger than simply manufacturing novel vaccines.

Science Translational Medicine
12 April 2017  Vol 9, Issue 385
http://stm.sciencemag.org/
[New issue; No digest content identified]

Focus
Engagement of the medical-technology sector with society
By David Williams, Elazer R. Edelman, Milica Radisic, Cato Laurencin, Darrel Untereker
Science Translational Medicine12 Apr 2017 Full Access
The medical-technology sector must educate society in an unbiased rational way about the successes and benefits of biotechnology innovation.

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A dose-dependent plasma signature of the safety and immunogenicity of the rVSV-Ebola vaccine in Europe and Africa
By Angela Huttner, Christophe Combescure, Stéphane Grillet, Mariëlle C. Haks, Edwin Quinten, Christine Modoux, Selidji Todagbe Agnandji, Jessica Brosnahan, Julie-Anne Dayer, Ali M. Harandi, Laurent Kaiser, Donata Medaglini, Tom Monath, VEBCON and VSV-EBOVAC Consortia, Pascale Roux-Lombard, Peter G. Kremsner, Tom H. M. Ottenhoff, Claire-Anne Siegrist
Science Translational Medicine12 Apr 2017 Restricted Access
A specific plasma signature reveals the critical role of monocytes in the VSV-vectored Ebola vaccine immunogenicity and safety.
Monocytes make their mark in Ebola vaccination
A VSV-vectored Ebola vaccine was used in Guinea during the recent outbreak and has now been shown to be incredibly effective in preventing infection. However, the vaccine itself did cause somewhat severe reactions in some subjects, including fever and arthritis. Huttner et al. examined longitudinal plasma samples from vaccine recipients in Europe and Africa to identify a signature of the immune response and adverse events. The signature of monocyte-derived cytokines held true in both cohorts, suggesting that it could also be applied to other vaccine trials to determine immunogenicity and reactogenicity.
Abstract
The 2014–2015 Ebola epidemic affected several African countries, claiming more than 11,000 lives and leaving thousands with ongoing sequelae. Safe and effective vaccines could prevent or limit future outbreaks. The recombinant vesicular stomatitis virus–vectored Zaire Ebola (rVSV-ZEBOV) vaccine has shown marked immunogenicity and efficacy in humans but is reactogenic at higher doses. To understand its effects, we examined plasma samples from 115 healthy volunteers from Geneva who received low-dose (LD) or high-dose (HD) vaccine or placebo. Fifteen plasma chemokines/cytokines were assessed at baseline and on days 1, 2 to 3, and 7 after injection. Significant increases in monocyte-mediated MCP-1/CCL2, MIP-1β/CCL4, IL-6, TNF-α, IL-1Ra, and IL-10 occurred on day 1. A signature explaining 68% of cytokine/chemokine vaccine-response variability was identified. Its score was higher in HD versus LD vaccinees and was associated positively with vaccine viremia and negatively with cytopenia. It was higher in vaccinees with injection-site pain, fever, myalgia, chills, and headache; higher scores reflected increasing severity. In contrast, HD vaccinees who subsequently developed arthritis had lower day 1 scores than other HD vaccinees. Vaccine dose did not influence the signature despite its influence on specific outcomes. The Geneva-derived signature associated strongly (ρ = 0.97) with that of a cohort of 75 vaccinees from a parallel trial in Lambaréné, Gabon. Its score in Geneva HD vaccinees with subsequent arthritis was significantly lower than that in Lambaréné HD vaccinees, none of whom experienced arthritis. This signature, which reveals monocytes’ critical role in rVSV-ZEBOV immunogenicity and safety across doses and continents, should prove useful in assessments of other vaccines.

Vaccine
Volume 35, Issue 19, Pages 2531-2612 (2 May 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/19

Original Research Article
Influenza vaccination responses: Evaluating impact of repeat vaccination among health care workers
Pages 2558-2568
Vivian K.Y. Leung, Louise A. Carolan, Leon J. Worth, Susan A. Harper, Heidi Peck, Danielle Tilmanis, Karen L. Laurie, Monica A. Slavin, Sheena G. Sullivan
Abstract
Objective
To compare the antibody response to influenza between health care workers (HCWs) who have received multiple vaccinations (high vaccination group) and those who have received fewer vaccinations (low vaccination group).
Design
Prospective serosurvey.
Setting
Tertiary referral hospital.
Participants
Healthcare workers.
Methods
Healthcare workers were vaccinated with the 2015 southern hemisphere trivalent influenza vaccine. Influenza antibody titres were measured pre-vaccination, 21–28 days post-vaccination and 6 months post-vaccination. Antibody titres were measured using the haemagglutination inhibition assay. Levels of seropositivity and estimated geometric mean titres were calculated.
Results
Of the 202 HCWs enrolled, 182 completed the study (143 high vaccination and 39 low vaccination). Both vaccination groups demonstrated increases in post-vaccination geometric mean titres, with greater gains in the low vaccination group. Seropositivity remained high in both high and low vaccination groups post-vaccination. The highest fold rise was observed among HCWs in the low vaccination group against the H3N2 component of the vaccine.
Conclusions
Both high and low vaccination groups in our study demonstrated protective antibody titres post-vaccination. The findings from the current study are suggestive of decreased serological response among highly vaccinated HCWs. More studies with larger sample sizes and a greater number of people in the vaccine-naïve and once-vaccinated groups are required to confirm or refute these findings before making any policy changes.

Vaccine
Volume 35, Issue 19, Pages 2531-2612 (2 May 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/19

Vaccination and blood sampling acceptability during Ramadan fasting month: A cross-sectional study in Conakry, Guinea
Original Research Article
Pages 2569-2574
Nathan Peiffer-Smadja, Ramatou Ouedraogo, Eric D’Ortenzio, Papa Ndiaga Cissé, Zahra Zeggani, Abdoul Habib Beavogui, Sylvain Landry Faye, Frédéric Le Marcis, Yazdan Yazdanpanah, Vinh-Kim Nguyen
Abstract
Introduction
There are few data on the acceptability of vaccination or blood sampling during Ramadan fasting month in Muslim countries. This could impact vaccination campaigns, clinical trials or healthcare during Ramadan.
Methods
Using a semi-structured questionnaire, we conducted a cross-sectional study on 201 practising Muslims and 10 religious leaders in Conakry, Guinea in the wake of the recent epidemic Ebola epidemic. Acceptability of vaccination and blood sampling during Ramadan were investigated as well as reasons for refusal.
Results
Vaccination was judged acceptable during Ramadan by 46% (93/201, 95% CI 0.40–0.53) of practising Muslims versus 80% (8/10, 95% CI 0.49–0.94) of religious leaders (p = 0.11). Blood sampling was judged acceptable during Ramadan by 54% (108/201, 95% CI 0.47–0.60) of practising Muslims versus 80% (8/10, 95% CI 0.49–0.94) of religious leaders (p = 0.19). The percentage of participants that judged both blood sampling and vaccination acceptable during Ramadan was 40% (81/201, 95% CI 0.34–0.47) for practising Muslims versus 80% (8/10, 95% CI 0.49–0.94) for religious leaders (p = 0.048). The most common reasons for refusal of vaccination or blood sampling were that nothing should enter or leave the body during Ramadan (43%), that adverse events could lead to breaking the fast (32%), that blood should not be seen during Ramadan (9%) and that the Quran explicitly forbids it (9%).
Discussion
Although most Muslims leaders and scientists consider that injections including immunization and blood sampling should be authorized during Ramadan, many Muslims in our study judged vaccination or blood sampling unacceptable when fasting. Widely available recommendations on healthcare during Ramadan would be useful to inform Muslims.

Vaccine
Volume 35, Issue 19, Pages 2531-2612 (2 May 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/19

Assessment of sex-specific differences in adverse events following immunization reporting in Ontario, 2012–15
Original Research Article
Pages 2600-2604
Tara Harris, Jyotsna Nair, Jill Fediurek, Shelley L. Deeks
Abstract
We assessed sex-specific trends within passive vaccine safety surveillance in Ontario, Canada. AEFIs reported following vaccines administered between 2012 and 2015 were included. There were 2466 AEFI reports; 66.2% were female. Annualized reporting rates were 5.9 and 3.1 per 100,000 population, for females and males respectively. The female:male reporting rate ratio (RRR) was 1.9. Sex-specific differences by age group were greatest in adults 18–64 years (RRR 6.3); whereas there were no differences in children

Value in Health
April 2017 Volume 20, Issue 4, p519-726
http://www.valueinhealthjournal.com/current

Patient-Reported Outcomes
Balancing the Optimal and the Feasible: A Practical Guide for Setting Up Patient Registries for the Collection of Real-World Data for Health Care Decision Making Based on Dutch Experiences
Saskia de Groot, Naomi van der Linden, Margreet G. Franken, Hedwig M. Blommestein, Brenda Leeneman, Ellen van Rooijen, J.J.M. (Koos) van der Hoeven, Michel W. Wouters, Hans M. Westgeest, Carin A. Uyl-de Groot
p627–636
Published online: April 6, 2016
Abstract
Objectives
The aim of this article was to provide practical guidance in setting up patient registries to facilitate real-world data collection for health care decision making.
Methods
This guidance was based on our experiences and involvement in setting up patient registries in oncology in the Netherlands. All aspects were structured according to 1) mission and goals (“the Why”), 2) stakeholders and funding (“the Who”), 3) type and content (“the What”), and 4) identification and recruitment of patients, data handling, and pharmacovigilance (“the How”).
Results
The mission of most patient registries is improving patient health by improving the quality of patient care; monitoring and evaluating patient care is often the primary goal (“the Why”). It is important to align the objectives of the registry and agree on a clear and functional governance structure with all stakeholders (“the Who”). There is often a trade off between reliability, validity, and specificity of data elements and feasibility of data collection (“the What”). Patient privacy should be carefully protected, and address (inter-)national and local regulations. Patient registries can reveal unique safety information, but it can be challenging to comply with pharmacovigilance guidelines (“the How”).
Conclusions
It is crucial to set up an efficient patient registry that serves its aims by collecting the right data of the right patient in the right way. It can be expected that patient registries will become the new standard alongside randomized controlled trials due to their unique value.

Value in Health                   
April 2017 Volume 20, Issue 4, p519-726
http://www.valueinhealthjournal.com/current

Methodology
Cost-Effectiveness Thresholds in Global Health: Taking a Multisectoral Perspective
Michelle Remme, Melisa Martinez-Alvarez, Anna Vassall
p699–704
Published online: January 3, 2017
Open Access
Abstract
Good health is a function of a range of biological, environmental, behavioral, and social factors. The consumption of quality health care services is therefore only a part of how good health is produced. Although few would argue with this, the economic framework used to allocate resources to optimize population health is applied in a way that constrains the analyst and the decision maker to health care services. This approach risks missing two critical issues: 1) multiple sectors contribute to health gain and 2) the goods and services produced by the health sector can have multiple benefits besides health. We illustrate how present cost-effectiveness thresholds could result in health losses, particularly when considering health-producing interventions in other sectors or public health interventions with multisectoral outcomes. We then propose a potentially more optimal second best approach, the so-called cofinancing approach, in which the health payer could redistribute part of its budget to other sectors, where specific nonhealth interventions achieved a health gain more efficiently than the health sector’s marginal productivity (opportunity cost). Likewise, other sectors would determine how much to contribute toward such an intervention, given the current marginal productivity of their budgets. Further research is certainly required to test and validate different measurement approaches and to assess the efficiency gains from cofinancing after deducting the transaction costs that would come with such cross-sectoral coordination.

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

Public Health
Volume 148, July 2017, Pages 66–68
Short Communication
Zika, sexual transmission and prudent public health policy
K.M. Folkers, , A.L. Caplan, L.H. Igel
Highlights
:: There is significant debate about whether the Zika virus can be considered a sexually transmitted infection (STI).
:: Epidemiologically, Zika may not be an STI, but considering it one contributes to prudent public health policy.
:: Classifying Zika as an STI may increase access to testing, identify at risk partners, and educate the public on safer sex.

Birth Defects Research
Early View
Brief Report
Major Birth Defects after Vaccination Reported to the Vaccine Adverse Event Reporting System (VAERS), 1990 to 2014
PL Moro, J Cragan, P Lewis, L Sukumaran
DOI: 10.1002/bdra.2362
Abstract
Background
Major birth defects are important infant outcomes that have not been well studied in the postmarketing surveillance of vaccines given to pregnant women. We assessed the presence of major birth defects following vaccination in the Vaccine Adverse Event Reporting System (VAERS), a national spontaneous reporting system used to monitor the safety of vaccines in the United States.
Methods
We searched VAERS for reports of major birth defects during January 1, 1990, through December 31, 2014. We excluded birth defects from vaccines that had been studied in pregnancy registries or other epidemiological studies (e.g., human papilloma virus, varicella, measles/mumps/rubella, and anthrax vaccines). Birth defects were categorized into trimester of vaccination and classified based on the organs and/or systems affected. If several birth defects affecting different systems were described, we classified those as multiple body systems. Empirical Bayesian data mining was used to assess for disproportionate reporting.
Results
We identified 50 reports of major birth defects; in 28 reports, the vaccine was given during the first trimester; 25 were reports with single vaccines administered. Birth defects accounted for 0.03% of all reports received by VAERS during the study period and 3.2% of pregnancy reports; reported defects affected predominately the musculoskeletal (N = 10) or nervous (N = 10) systems. No unusual clusters or specific birth defects were identified.
Conclusion
This review of the VAERS database found that major birth defects were infrequently reported, with no particular condition reported disproportionally. Birth defects after routine maternal vaccination will continue to be monitored in VAERS for signals to prompt future studies. Birth Defects Research 00:000–000, 2017.

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.

Forbes
http://www.forbes.com/
Accessed 15 April 2017
The March For Science May Be Flawed, But It’s More Than Worthy Of Your Support
Kavin Senapathy, Contributor
Apr 14, 2017
This march is representative of a fight that began long before President Trump—the one of the scientific method as an ever-standing touchstone of the truth versus exploitation of science to bolster alternative facts.

The Guardian
http://www.guardiannews.com/
Accessed 15 April 2017
Polio in Afghanistan: ‘Americans bomb our children daily, why would they care?’
Sune Engel Rasmussen
10 April 2017
After being denied access by the Taliban for 15 months, health workers this week resumed a vaccination campaign against polio in parts of Kunduz province in northern Afghanistan.

The Taliban block on polio vaccinations left an estimated 170,000 children without inoculation, endangering a campaign that has almost eradicated the disease in Afghanistan. Days before the Taliban allowed vaccinators access, a 14-month-old girl in the Afghan province of Kunduz was found to have been paralysed by polio.

Until it was blocked, leaving about 170,000 children in Kunduz province without inoculations, the scheme had almost eradicated the disabling viral disease in Afghanistan. But polio can spread quickly, with even a single case potentially enough to widen the disease’s footprint. When the girl in Kunduz’s Dasht-e-Archi district became the third child this year diagnosed with polio, Taliban commanders relented.

Local commanders have long been the main obstacle to polio vaccinators in Kunduz. Qari Bashir, the Taliban health chief in the province, had demanded construction of a clinic in Char Dara district to treat civilians and wounded fighters, on a par with clinics in government-held areas. But the WHO does not build trauma clinics.

Speaking to the Guardian, Bashir confirmed his demand for a clinic but said there were other concerns. Chief among them was a suspicion among villagers that polio teams could be infiltrated by spies.

Polio was a top issue in village council meetings, Bashir said. But while some locals argued he was obliged to allow vaccinations, others warned him not to trust foreign-run health teams, a scepticism Bashir shared.

“Every day, the Americans are bombing Afghan children. I don’t think this was so important to them,” he said…

Milestones :: Perspectives

Guinea: Battling a Large-Scale Measles Epidemic
April 06, 2017 – MSF Press Release
Less than a year after the official end of the Ebola outbreak, the Guinean health system continues to struggle.

NEW YORK/CONAKRY, GUINEA, APRIL 7, 2017—The international medical humanitarian organization Doctors without Borders/Médecins Sans Frontières (MSF), along with the Guinean Ministry of Health (MoH), is launching today a large-scale measles vaccination campaign in Conakry. Since the beginning of the year there have been 3,468 confirmed cases and 14 deaths dues to measles in Guinea, with most cases in the Conakry and Nzérékoré districts.

Routine vaccination in Guinea was drastically reduced during the 2014-2015 Ebola epidemic, both because most resources and attention were geared towards the management of Ebola and, mainly, due to fear. People stayed away from health facilities, and vaccination activities were suspended because of infection risks, leaving thousands of young children unprotected against easily preventable diseases. A nation-wide vaccination campaign was organized by authorities one year ago for children who had missed or never received their vaccines. Despite this catch-up effort, a measles epidemic was declared on February 8, 2017.

“The fact that a new epidemic occurs barely a year after a massive vaccination campaign is a worrying sign of the weakness of health care in Guinea,” said Ibrahim Diallo, MSF’s representative in Guinea. “Major problems remain in the health system, undermining its capacity to prevent and respond to outbreaks effectively and timely.”

After the devastating Ebola epidemic that killed over 11,000 people and severely affected the health systems of the three most affected countries—Guinea, Sierra Leone, and Liberia—the World Health Organization (WHO) and leading public health experts insisted on the importance of rebuilding responsive health systems in the three countries and equipping and supporting them to better manage similar or new health crises.

According to the United Nations (UN) body in charge of Ebola response, only 18 percent of the funds disbursed to support the countries during the Ebola outbreak were meant for recovery. International donor commitments to strengthen health systems has focused on improving disease surveillance to assure early detection and response to outbreaks, such as Ebola. However, today, faced with a large outbreak of measles, MSF in Conakry and Alima in Nzérokoré district are currently the only non-governmental organizations providing support to the MoH for the vaccination campaign in the worst affected districts. WHO and UNICEF have pledged support to other affected districts across the country, though it is still under discussion.

“If Ebola was a wake-up call, since then the world seems to have fallen back asleep,” said Dr. Mit Philips, MSF’s health policy analyst. “As shown by this measles outbreak, the concrete impact of the promises of funding, support and training made during and after the Ebola crisis still remain to be felt by ordinary Guineans. The country is still facing today the same problems that it was facing then, largely alone, in spite of the international public commitments to build better and more responsive health systems.”

To contain the measles epidemic, MSF and the MoH in Conakry is mobilizing 126 teams of 13 people, spread out across 164 vaccination sites in the city of three million people. All children from six months up to 10 years old will be vaccinated over the next nine days. MSF also supports 30 health centers in Conakry to care for children suffering from mild cases of measles, as well as a hospital referral center for severe cases.

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Socio-economic costs of Zika virus in Latin America and the Caribbean to reach $7-$18 billion over three years
The epidemic will have a long-term impact, disproportionately affecting the poorest and most vulnerable communities, and could contribute to widening inequalities in the region.

New York, 6 April 2017 – The socio-economic cost of the recent spread of the Zika virus in Latin America and the Caribbean will total an estimated US$7-18 billion between 2015 and 2017 according to an impact assessment launched today by the United Nations Development Programme (UNDP), in partnership with the International Federation of Red Cross and Red Crescent Societies (IFRC).

The new report, “A Socio-economic impact assessment of Zika virus in Latin America and the Caribbean: with a focus on Brazil, Colombia and Suriname” provides an up-to-date analysis of the socio-economic and human development implications of the epidemic.

With research on the Zika virus still on-going, there continues to be considerable uncertainty surrounding the spread and medical conditions associated with the virus. That said, the report clearly concludes that the Zika epidemic will have significant short and long-term impacts in the economic and socials spheres in the Americas.

“Aside from tangible losses to GDP and to economies heavily dependent on tourism, and the stresses on health care systems, the long-term consequences of the Zika virus can undermine decades of social development, hard-earned health gains and slow progress towards the Sustainable Development Goals”, said Jessica Faieta, UN Assistant Secretary-General and UNDP Director for Latin America and the Caribbean…

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Africa Centres for Diseases Control and Prevention launches new networks to fight health threats in Africa
Two new surveillance and laboratory networks will be built in all regions of Africa to accelerate outbreak detection, enhance disease intelligence and prevention, and combat antimicrobial resistance
Addis Ababa, 29 March 2017- African and international public health experts from governments, universities, and non-governmental organisations met from 27th to 29th March to coordinate prevention and response to disease threats in Africa through surveillance and laboratory networks. The recently launched Africa Centres for Disease Control and Prevention (Africa CDC) is committed to strengthening Africa’s disease intelligence, outbreak response, and prevention capacity through surveillance and laboratory networks. At the meeting, Africa CDC and partners established the Regional Integrated Surveillance and Laboratory Networks (Africa CDC RISLNET). These surveillance and laboratory networks will be established by Africa CDC’s five Regional Collaborating Centers (RCCs) in Egypt, Nigeria, Gabon, Zambia, and Kenya in collaboration with all available public health assets in their region, including universities, national public health institutes, private laboratories, centres of excellence, non-governmental organizations, and veterinary networks.

“This is the new spirit of practicing public health in Africa. We will be partnering effectively, collaborating closely, and using efficiently all public health assets in each region of Africa to improve detection and response,” said Dr. John Nkengasong, the Director of the Africa Centres of Disease Control and Prevention.

Africa CDC RISLNET will serve as the platform to implement Africa CDC’s 5 year strategic plan, which was endorsed by its Governing Board last week. Between 2017 and 2018, Africa CDC will support countries and regions to map existing surveillance and laboratory networks, including private laboratories.

Africa CDC is also committed to combating resistance to antibiotics, which are estimated to cause about 4 million deaths per year in Africa by 2050. To begin to address this severe threat, Africa CDC also launched the Antimicrobial Resistance Surveillance Network (Africa CDC AMRSNET). This new network will work closely with the World Health Organisation’s (WHO) Global Antimicrobial Resistance Surveillance Systems to strengthen capacity on the continent for surveillance, including through regional task-based and structured mentorship programmes.

Africa CDC will use proven models of medical education to build a community of practice to fight antimicrobial resistance, providing better care to more people where they live…

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Featured Journal Content

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 8 April 2017)
Research article
Improving immunization in Afghanistan: results from a cross-sectional community-based survey to assess routine immunization coverage
Raveesha R. Mugali, Farooq Mansoor, Sardar Parwiz, Fazil Ahmad, Najibullah Safi, Ariel Higgins-Steele and Sherin Varkey
BMC Public Health 2017 17:290
Published on: 4 April 2017
Abstract
Background
Despite progress in recent years, Afghanistan is lagging behind in realizing the full potential of immunization. The country is still endemic for polio transmission and measles outbreaks continue to occur. In spite of significant reductions over the past decade, the mortality rate of children under 5 years of age continues to remain high at 91 per 1000 live births.
Methods
The study was a descriptive community-based cross sectional household survey. The survey aimed to estimate the levels of immunization coverage at national and province levels. Specific objectives are to: establish valid baseline information to monitor progress of the immunization program; identify reasons why children are not immunized; and make recommendations to enhance access and quality of immunization services in Afghanistan. The survey was carried out in all 34 provinces of the country, with a sample of 6125 mothers of children aged 12–23 months.
Results
Nationally, 51% of children participating in the survey received all doses of each antigen irrespective of the recommended date of immunization or recommended interval between doses. About 31% of children were found to be partially vaccinated. Reasons for partial vaccination included: place to vaccinate child too far (23%), not aware of the need of vaccination (17%), no faith in vaccination (16%), mother was too busy (15%), and fear of side effects (11%).
Conclusion
The innovative mechanism of contracting out delivery of primary health care services in Afghanistan, including immunization, to non-governmental organizations is showing some positive results in quickly increasing coverage of essential interventions, including routine immunization. Much ground still needs to be covered with proper planning and management of resources in order to improve the immunization coverage in Afghanistan and increase survival and health status of its children.

Emergencies

WHO Grade 3 Emergencies  [to 8 April 2017]
Iraq  –
Special health situation report from Mosulpdf, 646kb  1 April 2017

South Sudan  –
WHO supports new initiative to more easily allow people living in South Sudan’s rural communities to access health services
Juba, 3 April 2017 – The World Health Organization (WHO) is supporting the Republic of South Sudan’s Ministry of Health and partners to roll-out a new approach to community health service delivery called the Boma Health Initiative. Currently, only 40% of people in South Sudan are within reach of health facilities and have consistent access to primary health care services. The Boma Health Initiative seeks to provide sustainable delivery of essential health care and public health programmes at the community level.

The Syrian Arab Republic  –
WHO alarmed by use of highly toxic chemicals as weapons in Syria
5 April 2017 | GENEVA – WHO is alarmed by serious reports of the use of highly toxic chemicals in an attack in Khan Shaykhun, southern rural Idleb, Syria. According to Health Cluster partners on the ground treating the patients, at least 70 people have died and hundreds more have been affected. Doctors in Idleb are reporting that dozens of patients suffering from breathing difficulties and suffocation have been admitted to hospitals in the governorate for urgent medical attention, many of them women and children.

Nigeria – No new announcements identified
Yemen – No new announcements identified

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WHO Grade 2 Emergencies  [to 8 April 2017]
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.

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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. 
Iraq
:: Iraq: Mosul Humanitarian Response Situation Report No. 27 (27 March – 2 April 2017) [EN/KU]
:: Mosul Humanitarian Crisis, 4 April 2017

Syria  
:: 7 Apr 2017  Syrian Arab Republic: 2016 Humanitarian Dashboard, January – December 2016
:: 4 April 2017  Syria crisis: UN Humanitarian Chief welcomes donor pledges of $6 billion to help people in need in…
:: 4 Apr 2017  UN Humanitarian Chief –  Opening remarks at the ‘Humanitarian situation inside Syria: Needs, challenges and way forward” thematic session of the Brussels conference on Supporting the Future of Syria and the Region

Yemen –
:: 4 April 2017  Statement on behalf of the Humanitarian Country Team in Yemen, on the Critical Importance to Maintain Al Hudaydah Port Open [EN/AR]

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POLIO [to 8 April 2017]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 5 April 2017
:: Last week, the Technical Advisory Group Consultation on Polio Eradication in Pakistan convened in Islamabad, to review current epidemiology and strategies to eradicate remaining strains of transmission for the rest of the year. See ‘Pakistan’ section below for more.
 

Country Updates [Selected Excerpts]
New cases or environmental samples reported across the monitored country/region settings: Afghanistan, Pakistan, Nigeria, Lake Chad Basin. Guinea and West Africa, and Lao People’s Democratic Republic have been removed from the monitored geographies list.
:: No new activity reported

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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.

Zika virus  [to 8 April 2017]
http://www.who.int/emergencies/zika-virus/en/
WHO: Study on the persistence of Zika virus in body fluids
April 2017 – Over the course of 2016, WHO along with the global research community quickly built evidence that Zika virus transmission through sex was not only possible, but more common than previously assumed. But many questions still remain unanswered.

MERS-CoV [to 8 April 2017]
http://www.who.int/emergencies/mers-cov/en/
Disease outbreak news
Middle East respiratory syndrome coronavirus (MERS-CoV) – Qatar   
4 April 2017
Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
3 April 2017

Yellow Fever  [to 8 April 2017]
http://www.who.int/emergencies/yellow-fever/en/
Disease outbreak news
Yellow fever – Brazil  4 April 2017
Updates on yellow fever vaccination recommendations for international travellers related to the current situation in Brazil

EBOLA/EVD  [to 8 April 2017]
http://www.who.int/ebola/en/
[See CDC reports below]

WHO & Regional Offices [to 8 April 2017]

Highlights
World Health Day – 7 April 2017
Depression: let’s talk
7 April 2017 – Depression is the leading cause of ill health and disability worldwide. More than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015. WHO is leading a global campaign on depression for World Health Day 2017, with the goal of enabling more people with mental disorders to live healthy, productive lives.

World Health Day 2017 – High-level event on mental health and depression in the context of the 2030 Agenda for Sustainable Development
[Event Video: 2:25:58]
Depression affects people of all ages, from all walks of life, in all countries. Untreated depression can prevent people from working and participating in family and community life.
WHO’s “Depression: Let’s Talk” campaign seeks to promote a better understanding of depression, prevention and treatment mechanisms, and the underlying importance of talking about depression as a vital component for reducing stigmas and supporting recovery.

 
Reference Guide: Developing health financing strategy
April 2017 – A new guide published by WHO examines policy development for health financing, expanding on areas including revenue raising, pooling revenues, purchasing services, benefit design, and rationing mechanisms. Health financing is key to improving health system performance and progressing towards universal health coverage (UHC).

WHO alarmed by use of highly toxic chemicals as weapons in Syria
   April 2017 – WHO is alarmed by serious reports of the use of highly toxic chemicals in an attack in Khan Shaykhun, southern rural Idleb, Syria. According to Health Cluster partners on the ground treating the patients, at least 70 people have died and hundreds more have been affected.

Study on the persistence of Zika virus in body fluids
April 2017 – Over the course of 2016, WHO along with the global research community quickly built evidence that Zika virus transmission through sex was not only possible, but more common than previously assumed. But many questions still remain unanswered.

WHO calls for increased support for health aid in Syria and refugee-hosting neighbouring countries
April 2017 – In Syria, limited specialized medical staff, ambulances, equipment and medical supplies have led to growing numbers of deaths which could have been prevented. Large numbers of wounded Syrians continue to die or face permanent disabilities as a result of limited access to medical care

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Weekly Epidemiological Record, 7 April 2017, vol. 92, 14 (pp. 165–180)
Surveillance systems to track progress towards polio eradication worldwide, 2015–2016
Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2017
Monthly report on dracunculiasis cases, January– December 2016

GIN March 2017  pdf, 1.77Mb   3 April 2017

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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
No new digest content identified.

WHO Region of the Americas PAHO
:: Ismael Cala joins PAHO’s World Health Day Campaign (04/06/2017)
:: PAHO trains more than 100 journalists from the Americas on responsible coverage of suicide to prevent ‘suicide contagion’ (04/06/2017)

WHO South-East Asia Region SEARO
No new digest content identified.
 
WHO European Region EURO
:: Journalists in Tajikistan expand skills for reporting on tobacco 07-04-2017
:: Policy dialogue proposed during visit of Minister of Health of Latvia to WHO/Europe 07-04-2017
:: Greek Government hosts broad policy dialogue on public health reform 05-04-2017
:: Tackling mild depression: “iCBT was perfect for me.” 04-04-2017
:: Major health gains achieved through working together: 15 years of the South-eastern Europe Health Network and beyond 03-04-2017
: Examples of investing in health from the South-eastern Europe Health Network 03-04-2017

WHO Eastern Mediterranean Region EMRO
:: WHO alarmed by use of highly toxic chemicals as weapons in Syria  5 April 2017
:: WHO releases new guidance on malaria elimination  5 April 2017
:: WHO and Morocco sign Country Cooperation Strategy for 2017–2021  2 April 2017

WHO Western Pacific Region
No new digest content identified.

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CDC/ACIP [to 8 April 2017]
http://www.cdc.gov/media/index.html
Transcript
TUESDAY, APRIL 4, 2017
CDC Telebriefing: New Vital Signs Report – Zika Virus
New Vital Signs Report – Possible Zika virus infections in 44 U.S. states: What can healthcare providers do to help protect pregnant women and their babies?

Press Release
TUESDAY, APRIL 4, 2017
About 1 in 10 U.S. pregnant women with confirmed Zika infection had a fetus or baby with birth defects in 2016
Of the 250 pregnant women who had confirmed Zika infection in 2016, 24 – or about 1 in 10 of them – had a fetus or baby with Zika-related birth…

Press Release
MONDAY, APRIL 3, 2017
CDC Study Finds Flu Vaccine Saves Children’s Lives
   A new CDC study published today in Pediatrics is the first of its kind to show that flu vaccination significantly reduced a child’s risk of dying from influenza.

MMWR: https://www.cdc.gov/mmwr/index2017.html
MMWR Weekly April 7, 2017 / No. 13
[Excerpts]
:: HIV Services Provided by STD Programs in State and Local Health Departments — United States, 2013–2014
:: Surveillance Systems to Track Progress Toward Polio Eradication — Worldwide, 2015–2016
:: Vital Signs: Update on Zika Virus–Associated Birth Defects and Evaluation of All U.S. Infants with Congenital Zika Virus Exposure — U.S. Zika Pregnancy Registry, 2016
:: Announcement: Sexually Transmitted Diseases Awareness Month — April 2017

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Announcements
 
IVI   [to 8 April 2017]
http://www.ivi.int/
April 3,2017
Korean Ministry of Health and Welfare, International Vaccine Institute (IVI) sign agreement on vaccine development and delivery cooperation
– Agreement to collaborate on vaccine R&D projects, capacity-building, and information-exchange programs between IVI, universities, research institutes and industry
– IVI Director General Jerome Kim thanks Korea for its support of global health R&D and vows to increase IVI’s cooperation with Korea
SEOUL, KOREA – The Ministry of Health & Welfare of the Republic of Korea (MOH) and the International Vaccine Institute (IVI) signed a memorandum of understanding (MOU) on a collaboration to advance global public health, and to develop and deliver vaccines and related technologies for developing countries. Dr. Chung Chin-youb, Minister of Health & Welfare, visited the IVI headquarters at Seoul National University Research Park on April 3rd and exchanged the MOU with IVI Director General Dr. Jerome Kim, and discussed plans on mutual cooperation between Korea and the institute.

Established in 1997, IVI was the first international organization headquartered in Korea.  As IVI’s host country, Korea provides funding through its Official Development Assistance (ODA) to the institute for its vaccine research and operations. Up until recently, the institute was under the Ministry of Education. This MOU is a revision of the MOU signed in 2013 between the Ministry of Education and IVI, and includes newly added areas of support and expanded cooperation between IVI and MOH such as joint vaccine R&D projects and capacity-building initiatives.

Under the purview of MOH, IVI will continue to receive funding from the Korean government to support its operations as per the original host country agreement signed between IVI and Korea. The Ministry will also continue to support IVI’s vaccine research and development activities to help the institute fulfill its mission of making safe, effective and affordable vaccines available for global health.

Finally IVI and the Ministry agreed to actively support exchange and cooperation programs in Korea by collaborating more with Korean universities, research institutes and the life sciences industry.  Notably, IVI and the Korean Centers for Disease Control will partner to develop vaccines against norovirus and hepatitis A…
 
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NIH  [to 8 April 2017]
http://www.nih.gov/news-events/news-releases
April 5, 2017
Monoclonal antibody cures Marburg infection in monkeys
— NIH-funded groups preparing for next filovirus outbreak.
Scientists funded by the National Institutes of Health have found that an experimental treatment cured 100 percent of guinea pigs and rhesus monkeys in late stages of infection with lethal levels of Marburg and Ravn viruses, relatives of the Ebola virus. Although the Marburg and Ravn viruses are less familiar than Ebola virus, both can resemble Ebola in symptoms and outcomes in people, and both lack preventive and therapeutic countermeasures.

NIDA announces recipients of 2017 Avant-Garde Awards for HIV/AIDS research
April 5, 2017 — NIH awards highlight novel approaches to HIV prevention and treatment.
The National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, today announced that three scientists have been selected to receive the 2017 Avant-Garde Award for HIV/AIDS Research. The winning proposals focus on a variety of novel approaches, including: improving HIV prevention through effective gene therapies; enhancing innate (natural) immunity against HIV and other related viruses; and developing new small-molecule drugs to treat HIV-1 infection.

The three scientists will each receive $500,000 per year for five years to support their research, subject to the availability of funds. NIDA’s tenth annual Avant-Garde Award competition is intended to stimulate high-impact research that may lead to groundbreaking opportunities for the prevention and treatment of HIV/AIDS in drug users.

“With nearly 37 million people living with HIV worldwide, it is essential that researchers continue to develop effective prevention and treatment strategies for those suffering from this devastating disease, including people with substance use disorders,” said NIDA Director Nora D. Volkow, M.D. “These scientists are pioneering exciting new approaches aimed at preventing and treating new cases of HIV and helping people at risk live longer, healthier lives.”

Awardees are listed below:
Michael Farzan, Ph.D., The Scripps Research Institute
Project: A safety switch for an effective HIV-1 vaccine
Dr. Farzan plans to use preclinical models to explore safe and effective gene therapies for the long-term prevention of HIV infection in high-risk populations, such as injection drug users. He will use an adeno-associated virus to deliver broadly neutralizing antibodies (bNAbs) or eCD4-Ig, proteins that prevent HIV-1 from infecting cells. His group will also explore safety switch mechanisms to control bNAbs and eCD4-Ig, thereby increasing safety during long-term exposure to these molecules.

Eric M. Poeschla, Ph.D., University of Colorado Denver
Project: Novel Approaches to Innate Immunity Against HIV-1 and Other Co-infection Viruses
Dr. Poeschla will use animal and human cells to explore the use of viral RNA-dependent RNA polymerase (RdRP) to enhance broad-spectrum (innate) immunity against various viruses, including HIV-1. Evidence suggests that this stable innate immune system activation does not trigger autoimmunity or inflammatory pathways. This approach may also protect against viruses that infect people with addiction.

Peter S. Kim, Ph.D., Stanford University
Project: Making the HIV-1 gp41 pocket amenable to small-molecule drug discovery
Dr. Kim’s group proposes a strategy that alters the HIV-1 gp41 region, thereby increasing structural rigidity in this region. This will enhance testing of new therapeutics that target the gp41 pocket to prevent HIV infection. Because the pocket is structurally similar across different HIV-1 strains, these therapeutics could treat patients, including people with substance use disorders, who are at higher risk of developing resistance to one or more classes of anti-HIV drugs…

International scientific teams find potential approach against parasites
April 3, 2017 — Research teams from the National Institutes of Health and abroad have identified the first inhibitor of an enzyme long thought to be a potential drug target for fighting disease-causing parasites and bacteria. The teams, led by NIH’s National Center for Advancing Translational Sciences (NCATS) and University of Tokyo scientists, sorted through more than 1 trillion small protein fragments called cyclic peptides to uncover two that could shut down the enzyme. The finding, reported April 3, 2017 in Nature Communications, could set the stage for the potential development of new types of antimicrobial drugs…

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Sabin Vaccine Institute  [to 8 April 2017]
http://www.sabin.org/updates/pressreleases
Tuesday, April 4, 2017
Public Health Experts Discuss Vaccines, Antibiotic Resistance and Surveillance at Conference on Typhoid and Other Invasive Salmonelloses
KAMPALA, UGANDA – April 4, 2017 – Today, the Sabin Vaccine Institute opened the 10th International Conference on Typhoid and Other Invasive Salmonelloses in Kampala, Uganda. Over the course of the three day conference, more than 300 experts from around the world have gathered to discuss new typhoid-related research, as well as how to turn this evidence into action in the fight against typhoid.

Typhoid fever, an illness caused by the bacteria Salmonella Typhi, kills an estimated 220,000 people, primarily children, each year. Currently available typhoid vaccines are underutilized in low- and middle-income countries, including many countries in Africa and Asia. Vaccines for other, nontyphoidal strains of Salmonella bacteria are not available. Typhoid is treated with antibiotics, but the recent rise of antibiotic-resistant typhoid and nontyphoidal Salmonella has increased the burden of treatment on health systems and families. There is an urgent need for new effective vaccines and policies to help prevent the disease and its transmission in communities. Preventing typhoid will minimize the need to treat this serious infection and will also reduce the danger of antibiotic resistance.

There has been significant progress in typhoid vaccine development. New typhoid conjugate vaccines offer important advantages over prior vaccines, including longer duration of protection, the ability to protect young children, and the potential for delivery with other vaccines in routine immunization of infants. Conjugate vaccines have the potential to dramatically reduce the burden of typhoid around the world and, consequently, help to prevent the occurrence of antibiotic resistance. The research shared at Sabin’s conference – the world’s only such meeting devoted to typhoid and other invasive salmonelloses – will inform discussions at the World Health Organization later this month, when experts gather to review recommendations on the use of typhoid vaccines…

“This conference comes at a pivotal moment for global action on typhoid,” said Bruce Gellin, president of Global Immunization at the Sabin Vaccine Institute. “…To have the greatest impact, we need to review the evidence for these vaccines and consider the vaccination programs in which they will be delivered. The discussions and debates over the next three days at this conference will help the researchers, policy makers and advocates meet the urgent need for prevention and control.”…

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AERAS  [to 8 April 2017]
http://www.aeras.org/pressreleases
Aeras Updates – Quarterly Newsletter
5 April 2017
:: Aeras celebrates World TB Day 2017
:: World TB Day Europe: Personal Stories and Focusing on AMR
:: Aeras Asia: Leveraging Social Media to Promote World TB Day Messages
:: Aeras Africa: Using World TB Day to Spark Discussion About TB R&D

 
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Global Fund [to 8 April 2017]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=

News
Global Fund Welcomes Italy’s €140 million Contribution
07 April 2017
The Global Fund to Fight AIDS, Tuberculosis and Malaria welcomed a contribution of €140 million from the government of Italy for the three-year period beginning in 2017, a strong demonstration of Italy’s leadership in global health.

News
The Global Fund and Pink Ribbon Red Ribbon Partner to Prevent and Control Cervical Cancer
06 April 2017
Today, leaders of the Global Fund to Fight AIDS, Tuberculosis and Malaria and Pink Ribbon Red Ribbon signed an agreement to collaborate on programming to prevent cervical cancer. HIV positive women are up to five times more likely to develop cervical cancer, so routine screening and treatment is essential for this population. Screening and treatment for cervical pre-cancer is a cost-effective intervention, costing less than $25 per woman. Pink Ribbon Red Ribbon will work with countries to integrate cervical cancer programming into their HIV/AIDS grants from the Global Fund, building on efforts by national governments and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

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FDA [to 8 April 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
April 07, 2017
FDA approves two hepatitis C drugs for pediatric patients

 What’s New for Biologics
:: February 8, 2017 Transcript – Identification and Characterization of the Infectious Disease Risks of Human Cells, Tissues, and Cellular and Tissue-based Products (PDF – 2.7MB)
Posted: 4/4/2017
:: February 9, 2017 Transcript – Identification and Characterization of the Infectious Disease Risks of Human Cells, Tissues, and Cellular and Tissue-based Products (PDF – 1.4MB)
Posted: 4/4/2017
 

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Wellcome Trust  [to 8 April 2017]
https://wellcome.ac.uk/news
News / Published: 7 April 2017
Public invited to help tackle antibiotic resistance
A new citizen science project, BashTheBug (opens in a new tab), has been launched to study antibiotic resistance in tuberculosis (TB).
On the Zooniverse website (opens in a new tab), volunteers are shown a series of small, circular wells each containing Mycobacterium tuberculosis, which causes TB, and a different dose of an antibiotic.
They are then asked to identify wells in which the bacteria have grown, helping the researchers to determine which antibiotics are effective at killing each specific strain of TB.
“Antibiotic resistance is a global threat, and accurately and rapidly diagnosing drug-resistant disease places a huge strain on hospital laboratories,” says Dr Philip Fowler, lead researcher on the BashTheBug project.
“Knowing which antibiotics are effective against a particular bacterial infection is crucial for effectively treating a patient, while also limiting the opportunity for the bug to develop antibiotic-resistance and then be passed onto other people.”
“Cultivating and examining TB plates is a time-consuming process, but by enlisting extra help online we hope to examine over 40 million images, something we could never do on our own…

 
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Industry Watch  [to 8 April 2017]
:: Takeda Completes Enrollment of More Than 20,000 Children and Adolescents in Global Phase 3 Trial of Dengue Vaccine Candidate
   Tetravalent Immunization against Dengue Efficacy Study (TIDES) trial evaluates the efficacy of two doses of vaccine candidate TAK-003, administered three months apart, to protect against all four strains of dengue virus, regardless of previous dengue exposure
   Study includes children and adolescents ages 4 through 16 years in eight dengue-endemic countries across Latin America and Asia
   Achieving enrollment demonstrates Takeda’s commitment to advancing global vaccine business and addressing unmet needs in dengue prevention
April 05, 2017 08:00 AM Eastern Daylight Time
OSAKA, Japan–(BUSINESS WIRE)–Takeda Pharmaceutical Company Limited today announced that it has completed enrollment of 20,100 children and adolescents ages 4 through 16 in its global, pivotal Phase 3 Tetravalent Immunization against Dengue Efficacy Study (TIDES) trial, a double-blind, randomized and placebo-controlled study designed to evaluate the efficacy, safety and immunogenicity of its live-attenuated tetravalent dengue vaccine candidate (TAK-003).1 Takeda initiated the TIDES trial, the largest vaccine clinical trial for Takeda to date, in September 2016 and completed enrollment in less than seven months.1 …
“The successful enrollment of more than 20,000 children and adolescents in this Phase 3 trial, across several continents, and on an ambitious timeline, while maintaining a clear focus on quality and subject safety, reflects Takeda’s prioritization of dengue and the substantial capabilities of our global organization,” said Rajeev Venkayya, MD, President of the Global Vaccine Business Unit at Takeda…

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 Tropical Medicine and Hygiene
Volume 96, Issue 4, 2017
http://www.ajtmh.org/content/current

Perspective Pieces
Impacts on Global Health from Nursing Research
Authors: Kimberly Baltzell, Monica McLemore, Mona Shattell and Sally Rankin
https://doi.org/10.4269/ajtmh.16-0918
Infectious disease continues to adversely affect populations in low- and middle-income countries. Investments in solutions often focus on technology, yet health-care workers remain in short supply. Nurses are the largest cadre of health-care workers and are largely responsible for patient care around the world. In fact, it is estimated that nurses care for nine out of every 10 patients seen. Importantly, sound nursing science contributes to solutions that directly impact patient care, especially those that pertain to infectious disease. Here we share several examples of nursing science that are improving care delivery in three global health areas: human immunodeficiency virus testing and prevention strategies in Malawi, family planning in Kenya, and response to Ebola virus disease.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 8 April 2017)

Research article
A systematic review of strategies to increase access to health services among children in low and middle income countries
Tess Bright, Lambert Felix, Hannah Kuper and Sarah Polack
BMC Health Services Research 2017 17:252
Published on: 5 April 2017
Abstract
Background
Universal Health Coverage is widely endorsed as the pivotal goal in global health, however substantial barriers to accessing health services for children in low and middle-income countries (LMIC) exist. Failure to access healthcare is an important contributor to child mortality in these settings. Barriers to access have been widely studied, however effective interventions to overcome barriers and increase access to services for children are less well documented.
Methods
We conducted a systematic review of effectiveness of interventions aimed at increasing access to health services for children aged 5 years and below in LMIC. Four databases (EMBASE, Global Health, MEDLINE, and PSYCINFO) were searched in January 2016. Studies were included if they evaluated interventions that aimed to increase: health care utilisation; immunisation -uptake; and compliance with medication or referral. Randomised controlled trials and non-randomised controlled study designs were included in the review. A narrative approach was used to synthesise results.
Results
Fifty seven studies were included in the review. Approximately half of studies (49%) were conducted in sub-Saharan Africa. Most studies were randomised controlled trials (n = 44; 77%) with the remaining studies employing non-randomised designs. Very few studies were judged as high quality. Studies evaluated a diverse range of interventions and various outcomes. Supply side interventions included: delivery of services at or closer to home and service level improvements (eg. integration of services). Demand side interventions included: educational programmes, text messages, and financial or other incentives. Interventions that delivered services at or closer to home and text messages were in general associated with a significant improvement in relevant outcomes. A consistent pattern was not noted for the remaining studies.
Conclusions
This review fills a gap in the literature by providing evidence of the range and effectiveness of interventions that can be used to increase access for children aged ≤5 years in LMIC. It highlights some intervention areas that seem to show encouraging trends including text message reminders and delivery of services at or close to home. However, given the methodological limitations found in existing studies, the results of this review must be interpreted with caution.

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 8 April 2017)

Research article
Modelling the therapeutic dose range of single low dose primaquine to reduce malaria transmission through age-based dosing
Low-dose primaquine is a key candidate for use in malaria transmission reduction and elimination campaigns such as mass drug administration (MDA). Uncertainty about the therapeutic dose range (TDR) required fo…
Daniel Joseph Hayes, Clifford George Banda, Alexandra Chipasula-Teleka and Dianne Janette Terlouw
BMC Infectious Diseases 2017 17:254
Published on: 8 April 2017

Research article
Decline in hospitalization for genital warts in the Veneto region after an HPV vaccination program: an observational study
Human papillomavirus (HPV) is one of the most common sexually transmitted pathogens. This observational study was conducted to estimate the trend of hospitalization for genital warts (GWs) in the Veneto region…
Silvia Cocchio, Tatjana Baldovin, Chiara Bertoncello, Alessandra Buja, Patrizia Furlan, Mario Saia and Vincenzo Baldo
BMC Infectious Diseases 2017 17:249
Published on: 5 April 2017

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 8 April 2017)

Debate
A critique of the regulation of data science in healthcare research in the European Union
John M. M. Rumbold and Barbara K. Pierscionek
BMC Medical Ethics 2017 18:27
Published on: 8 April 2017
Abstract
The EU offers a suitable milieu for the comparison and harmonisation of healthcare across different languages, cultures, and jurisdictions (albeit with a supranational legal framework), which could provide improvements in healthcare standards across the bloc. There are specific ethico-legal issues with the use of data in healthcare research that mandate a different approach from other forms of research. The use of healthcare data over a long period of time is similar to the use of tissue in biobanks. There is a low risk to subjects but it is impossible to gain specific informed consent given the future possibilities for research. Large amounts of data on a subject present a finite risk of re-identification. Consequently, there is a balancing act between this risk and retaining sufficient utility of the data. Anonymising methods need to take into account the circumstances of data sharing to enable an appropriate balance in all cases. There are ethical and policy advantages to exceeding the legal requirements and thereby securing the social licence for research. This process would require the examination and comparison of data protection laws across the trading bloc to produce an ethico-legal framework compatible with the requirements of all member states. Seven EU jurisdictions are given consideration in this critique.

BMC Medical Ethics

(Accessed 8 April 2017)

Research article
The ECOUTER methodology for stakeholder engagement in translational research
Madeleine J. Murtagh, Joel T. Minion, Andrew Turner, Rebecca C. Wilson, Mwenza Blell, Cynthia Ochieng, Barnaby Murtagh, Stephanie Roberts, Oliver W. Butters and Paul R Burton
BMC Medical Ethics 2017 18:24
Published on: 4 April 2017

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 8 April 2017)

Research article
Ethical issues in public health surveillance: a systematic qualitative review
Corinna Klingler, Diego Steven Silva, Christopher Schuermann, Andreas Alois Reis, Abha Saxena and Daniel Strech
BMC Public Health 2017 17:295
Published on: 4 April 2017
Abstract
Background
Public health surveillance is not ethically neutral and yet, ethics guidance and training for surveillance programmes is sparse. Development of ethics guidance should be based on comprehensive and transparently derived overviews of ethical issues and arguments. However, existing overviews on surveillance ethics are limited in scope and in how transparently they derived their results. Our objective was accordingly to provide an overview of ethical issues in public health surveillance; in addition, to list the arguments put forward with regards to arguably the most contested issue in surveillance, that is whether to obtain informed consent.

Methods

Ethical issues were defined based on principlism. We assumed an ethical issue to arise in surveillance when a relevant normative principle is not adequately considered or two principles come into conflict. We searched Pubmed and Google Books for relevant publications. We analysed and synthesized the data using qualitative content analysis.

Results

Our search strategy retrieved 525 references of which 83 were included in the analysis. We identified 86 distinct ethical issues arising in the different phases of the surveillance life-cycle. We further identified 20 distinct conditions that make it more or less justifiable to forego informed consent procedures.

Conclusions

This is the first systematic qualitative review of ethical issues in public health surveillance resulting in a comprehensive ethics matrix that can inform guidelines, reports, strategy papers, and educational material and raise awareness among practitioners.

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 8 April 2017)

Research article
Improving immunization in Afghanistan: results from a cross-sectional community-based survey to assess routine immunization coverage
Raveesha R. Mugali, Farooq Mansoor, Sardar Parwiz, Fazil Ahmad, Najibullah Safi, Ariel Higgins-Steele and Sherin Varkey
BMC Public Health 2017 17:290
Published on: 4 April 2017
Abstract
Background
Despite progress in recent years, Afghanistan is lagging behind in realizing the full potential of immunization. The country is still endemic for polio transmission and measles outbreaks continue to occur. In spite of significant reductions over the past decade, the mortality rate of children under 5 years of age continues to remain high at 91 per 1000 live births.

Methods

The study was a descriptive community-based cross sectional household survey. The survey aimed to estimate the levels of immunization coverage at national and province levels. Specific objectives are to: establish valid baseline information to monitor progress of the immunization program; identify reasons why children are not immunized; and make recommendations to enhance access and quality of immunization services in Afghanistan. The survey was carried out in all 34 provinces of the country, with a sample of 6125 mothers of children aged 12–23 months.

Results

Nationally, 51% of children participating in the survey received all doses of each antigen irrespective of the recommended date of immunization or recommended interval between doses. About 31% of children were found to be partially vaccinated. Reasons for partial vaccination included: place to vaccinate child too far (23%), not aware of the need of vaccination (17%), no faith in vaccination (16%), mother was too busy (15%), and fear of side effects (11%).

Conclusion

The innovative mechanism of contracting out delivery of primary health care services in Afghanistan, including immunization, to non-governmental organizations is showing some positive results in quickly increasing coverage of essential interventions, including routine immunization. Much ground still needs to be covered with proper planning and management of resources in order to improve the immunization coverage in Afghanistan and increase survival and health status of its children.

Clinical Therapeutics
March 2017 Volume 39, Issue 3, p451-664
http://www.clinicaltherapeutics.com/issue/S0149-2918(17)X0003-9

Editorial
Current Insights in the Placebo and Nocebo Phenomena
Seetal Dodd, PhD
We have arranged a series of review and original research reports that are both up-to-date and timely. The articles are from leading researchers in different countries, and they provide insight into the range of ongoing research investigating the placebo and nocebo phenomena.

The word placebo has a Latin origin and a long history of use; however, the context in which the word is used has changed over time. Nocebo is a modern word that has been made up from the word placebo. In common usage, a placebo or nocebo effect occurs when an inert substance creates a beneficial or harmful effect in a person who takes it. The concept is also extended beyond the administration of inert substances.1 In a research setting, active placebos are pharmacologically active controls that are not considered to be effective for the index symptoms being treated. Active placebos have also been used in clinical settings, where an active agent has been given to a patient even though the pharmacologic action of the active agent is not known to be beneficial for treating the patient’s diagnosed condition, typically to meet a patient’s expectation that he or she will receive a treatment. Similarly, a nocebo response can occur with an inert or noninert substance as a worsening of the diagnosed condition or as treatment-emergent adverse effects. Moreover, when indication-appropriate active treatment is administered, the therapeutic effect may be a combination of the pharmacologic activity of the treating agent and a placebo effect, as demonstrated in an experiment of open and hidden analgesic administration using an infusion pump where pain relief was significantly reduced when the patients were unaware that an analgesic was being administered.2

It is also common usage to refer to all improvement in a placebo arm of a randomized clinical trial (RCT) as a placebo response and all worsening and adverse events as a nocebo response, even though fluctuation of symptoms occurs with the natural progression of many illnesses. It is often impossible to discern between a genuine placebo response and fluctuation in symptom severity that may have occurred without administering a placebo or between a nocebo response and highly prevalent physical ailments, such as headache or nausea. Consequently, the terms placebo and nocebo are used differently by different authors or even by the same authors when reporting different studies.

In placebo-controlled RCTs, a mean change in the primary outcome from baseline to treatment end point is commonly described as the placebo response. For researchers whose objectives is to demonstrate efficacy of treatment in the active arm of the RCT, it does not matter whether the change from baseline for individuals in the placebo arm of an RCT is a genuine placebo response driven by expectancy and the treatment environment or is attributable to fluctuations in illness severity that may occur during the illness. What matters to these researchers is that there is a statistically significant difference in outcome between participants in the placebo and active arms of the RCT. Alternatively, for researchers investigating the placebo phenomenon itself, experiments are tightly controlled to measure only the response to the placebo itself, typically, in healthy participants.

There is a need for considerable further research investigating the placebo and nocebo phenomena that will increase our scientific and theoretical knowledge about these phenomena and broaden our understanding of their clinical relevance. This requires researchers working in a broad range of fields.

In this issue of Clinical Therapeutics, experts in nocebo and placebo research contribute new insights into the mechanisms and characteristics of the phenomena. The article by Weimer et al3 reports an experiment on the placebo effects for treating nausea, investigating whether altering the levels of expectation of receiving an active agent when actually receiving a placebo can influence treatment outcomes. The article by by Bartels et al4 reports an experiment in which cognitive schemas with regard to memory and expectations are assessed as moderators of placebo and nocebo responses.

Also in this issue, Enck et al5 contribute a review article that describes a wealth of recent research into placebo and nocebo effects but highlights the gaps in current research. Two other review articles are contributed by researchers in Australia, Spain, and Portugal, one reviewing current knowledge regarding the scientific and theoretical basis of the nocebo and placebo phenomena6 and the other investigating the importance and effect of the nocebo and placebo phenomena in clinical research and clinical practice.7

This issue accurately represents the current understanding of the nocebo and placebo phenomena and the limitation in the current knowledge. Gaps still exist in the way placebo and nocebo are conceptualized. As suggested by Enck et al,5 gaps exist in our understanding of the basic science of the placebo response, especially outside placebo analgesia research. In addition, within clinical populations, identifying placebo and nocebo responders remains problematic. I hope that readers enjoy this issue and find it informative.

Clinical Therapeutics
March 2017 Volume 39, Issue 3, p451-664
http://www.clinicaltherapeutics.com/issue/S0149-2918(17)X0003-9

Reviews
Unsolved, Forgotten, and Ignored Features of the Placebo Response in Medicine
Paul Enck, Sibylle Klosterhalfen, Katja Weimer
p458–468
Published online: December 2, 2016

A Review of the Theoretical and Biological Understanding of the Nocebo and Placebo Phenomena
Seetal Dodd, Olivia M. Dean, João Vian, Michael Berk
p469–476
Published online: February 1, 2017

The Placebo and Nocebo Phenomena: Their Clinical Management and Impact on Treatment Outcomes
Victor Chavarria, João Vian, Círia Pereira, João Data-Franco, Brisa S. Fernandes, Michael Berk, Seetal Dodd
p477–486
Published online: February 22, 2017

Global Health Action
Volume 10, 2017 – Issue 1
http://www.tandfonline.com/toc/zgha20/10/1?nav=tocList

Review
The impact of the worldwide Millennium Development Goals campaign on maternal and under-five child mortality reduction: ‘Where did the worldwide campaign work most effectively?’
Seungman Cha
Article: 1267961
Published online: 07 Feb 2017

Rapid communication
The real-life number of neonatal doses of Bacille Calmette-Guérin vaccine in a 20-dose vial
Frederik Schaltz-Buchholzer, Hannah Nørtoft Frankel & Christine Stabell Benn
Article: 1267964
Published online: 27 Jan 2017

Review article
Who is a community health worker? – a systematic review of definitions
Abimbola Olaniran, Helen Smith, Regine Unkels, Sarah Bar-Zeev & Nynke van den Broek
Article: 1272223
Published online: 27 Jan 2017

Health Affairs
April 2017; Volume 36, Issue 4
http://content.healthaffairs.org/content/current
Issue Focus: Maternity Coverage, Children, Disability & More
Maternity & Children’s Coverage

State And Federal Coverage For Pregnant Immigrants: Prenatal Care Increased, No Change Detected For Infant Health
Laura R. Wherry, Rachel Fabi, Adam Schickedanz, and Brendan Saloner
Health Aff April 2017 36:607-615; doi:10.1377/hlthaff.2016.1198

Low-Income Children With Chronic Conditions Face Increased Costs If Shifted From CHIP To Marketplace Plans
Alon Peltz, Amy J. Davidoff, Cary P. Gross, and Marjorie S. Rosenthal
Health Aff April 2017 36:616-625; doi:10.1377/hlthaff.2016.1280

Global Health
Industry-Led Access-To-Medicines Initiatives In Low- And Middle-Income Countries: Strategies And Evidence
Peter C. Rockers, Veronika J. Wirtz, Chukwuemeka A. Umeh, Preethi M. Swamy, and Richard O. Laing
Health Aff April 2017 36:706-713; doi:10.1377/hlthaff.2016.1213
Abstract
Global biopharmaceutical companies are increasingly establishing access-to-medicines (AtM) initiatives in low- and middle-income countries. We reviewed the initiatives of twenty-one research-based global biopharmaceutical companies to assess their strategies for improving access and the quality of evidence on the impact of their initiatives. The number of operating initiatives increased from 17 in 2000 to 102 in 2015. Of the 120 different AtM initiatives identified, 48 percent used a medicine donation strategy, and 44 percent used a price reduction strategy. While companies have frequently claimed that their initiatives have had positive impacts, we found published evaluations for only seven initiatives, and nearly all of the evaluations were of low (62 percent) or very low (32 percent) quality. It is clear that the biopharmaceutical industry has increased its commitment to improving access to medicines in low- and middle-income countries. However, companies should do more to generate high-quality evidence on their initiatives, and the global health community should do more to assist the developing of evidence about the initiatives.

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 8 April 2017]

Scoping Review
The cross-cutting contribution of the end of neglected tropical diseases to the sustainable development goals
Mathieu Bangert, David H. Molyneux, Steve W. Lindsay, Christopher Fitzpatrick and Dirk Engels
Infectious Diseases of Poverty 2017 6:73
Published on: 4 April 2017
Abstract
The Sustainable Development Goals (SDGs) call for an integrated response, the kind that has defined Neglected Tropical Diseases (NTDs) efforts in the past decade.

NTD interventions have the greatest relevance for SDG3, the health goal, where the focus on equity, and its commitment to reaching people in need of health services, wherever they may live and whatever their circumstances, is fundamentally aligned with the target of Universal Health Coverage. NTD interventions, however, also affect and are affected by many of the other development areas covered under the 2030 Agenda. Strategies such as mass drug administration or the programmatic integration of NTD and WASH activities (SDG6) are driven by effective global partnerships (SDG17). Intervention against the NTDs can also have an impact on poverty (SDG1) and hunger (SDG2), can improve education (SDG4), work and economic growth (SDG8), thereby reducing inequalities (SDG10). The community-led distribution of donated medicines to more than 1 billion people reinforces women’s empowerment (SDG5), logistics infrastructure (SDG9) and non-discrimination against disability (SDG16). Interventions to curb mosquito-borne NTDs contribute to the goals of urban sustainability (SDG11) and resilience to climate change (SDG13), while the safe use of insecticides supports the goal of sustainable ecosystems (SDG15). Although indirectly, interventions to control water- and animal-related NTDs can facilitate the goals of small-scale fishing (SDG14) and sustainable hydroelectricity and biofuels (SDG7).

NTDs proliferate in less developed areas in countries across the income spectrum, areas where large numbers of people have little or no access to adequate health care, clean water, sanitation, housing, education, transport and information. This scoping review assesses how in this context, ending the epidemic of the NTDs can impact and improve our prospects of attaining the SDGs.

JAMA
April 4, 2017, Vol 317, No. 13, Pages 1291-1388
http://jama.jamanetwork.com/issue.aspx

The JAMA Forum
April 4, 2017
Vaccines and the Trump Administration
Joshua M. Sharfstein, MD1
JAMA. 2017;317(13):1305-1306. doi:10.1001/jama.2017.2311
Initial Text
Writing recently in the New York Times, infectious disease physician Peter Hotez warned: “It’s looking as if 2017 could become the year when the anti-vaccination movement gains ascendancy in the United States and we begin to see a reversal of several decades in steady public health gains. The first blow will be measles outbreaks in America.”

These fears have everything to do with the new administration in Washington, DC. During the campaign, Donald Trump met with discredited British physician Andrew Wakefield, who first alleged a connection between the measles, mumps, and rubella (MMR) vaccine and autism in a now-retracted Lancet article. Then, in a September 2015 primary debate, Trump himself suggested that vaccines cause autism. In January, Robert F. Kennedy Jr, known for his engagement with vaccine conspiracies, emerged from a meeting with the President-elect to claim that he will lead a new vaccine safety commission…

JAMA Pediatrics
April 1, 2017, Vol 171, No. 4, Pages 313-404
http://archpedi.jamanetwork.com/issue.aspx

Viewpoint
Implementing Public Health Goals for Human Immunodeficiency Virus Infection Through Law
Rhonda Gay Hartman, JD JAMA Pediatr. 2017;171(4):315-316. doi:10.1001/jamapediatrics.2016.4366
This Viewpoint discusses laws that favor confidential access to HIV testing and treatment for adolescents, as a way of achieving public health goals for HIV infection.

Viewpoint
Social Justice and the Provision of Health Care for Poor Children
Andrew D. Racine, MD, PhD
JAMA Pediatr. 2017;171(4):316-317. doi:10.1001/jamapediatrics.2016.4567
This Viewpoint asks whether the provision of health care to underserved children is an act of social justice.

Journal of Infectious Diseases
Volume 215, Issue 5  1 March 2017
http://jid.oxfordjournals.org/content/current

OBITUARY
Donald Ainslie (D. A.) Henderson, MD, MPH (1928–2016) Smallpox Eradication: Leadership and Legacy

Viruses
Development of a Global Respiratory Severity Score for Respiratory Syncytial Virus Infection in Infants
Mary T. Caserta; Xing Qiu; Brenda Tesini; Lu Wang; Amy Murphy

Effectiveness of Human Papillomavirus Vaccination on Prevalence of Vaccine Genotypes in Young Sexually Active Women in France
Isabelle Heard; Laura Tondeur; Laurence Arowas; Marie Demazoin; Michaël Falguières …

Journal of the Royal Society – Interface
01 April 2017; volume 14, issue 129
http://rsif.royalsocietypublishing.org/content/current
Life Sciences–Mathematics interface
Research article:

Exploring the high-resolution mapping of gender-disaggregated development indicators
C. Bosco, V. Alegana, T. Bird, C. Pezzulo, L. Bengtsson, A. Sorichetta, J. Steele, G. Hornby, C. Ruktanonchai, N. Ruktanonchai, E. Wetter, A. J. Tatem
J.R. Soc. Interface 2017 14 20160825; DOI: 10.1098/rsif.2016.0825. Published 5 April 2017
Open Access
Abstract
Improved understanding of geographical variation and inequity in health status, wealth and access to resources within countries is increasingly being recognized as central to meeting development goals. Development and health indicators assessed at national or subnational scale can often conceal important inequities, with the rural poor often least well represented. The ability to target limited resources is fundamental, especially in an international context where funding for health and development comes under pressure. This has recently prompted the exploration of the potential of spatial interpolation methods based on geolocated clusters from national household survey data for the high-resolution mapping of features such as population age structures, vaccination coverage and access to sanitation. It remains unclear, however, how predictable these different factors are across different settings, variables and between demographic groups. Here we test the accuracy of spatial interpolation methods in producing gender-disaggregated high-resolution maps of the rates of literacy, stunting and the use of modern contraceptive methods from a combination of geolocated demographic and health surveys cluster data and geospatial covariates. Bayesian geostatistical and machine learning modelling methods were tested across four low-income countries and varying gridded environmental and socio-economic covariate datasets to build 1×1 km spatial resolution maps with uncertainty estimates. Results show the potential of the approach in producing high-resolution maps of key gender-disaggregated socio-economic indicators, with explained variance through cross-validation being as high as 74–75% for female literacy in Nigeria and Kenya, and in the 50–70% range for many other variables. However, substantial variations by both country and variable were seen, with many variables showing poor mapping accuracies in the range of 2–30% explained variance using both geostatistical and machine learning approaches. The analyses offer a robust basis for the construction of timely maps with levels of detail that support geographically stratified decision-making and the monitoring of progress towards development goals. However, the great variability in results between countries and variables highlights the challenges in applying these interpolation methods universally across multiple countries, and the importance of validation and quantifying uncertainty if this is undertaken.

The Lancet
Apr 08, 2017 Volume 389 Number 10077 p1369-1490 e5
http://www.thelancet.com/journals/lancet/issue/current

Comment
Eliminating maternal and neonatal tetanus and closing the immunity gap
Craig Burgess, Francois Gasse, Robert Steinglass, Ahmadu Yakubu, Azhar Abid Raza, Kari Johansen
Summary
Although progress has been made in achieving maternal and neonatal tetanus elimination (MNTE), WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) noted at its October, 2016, meeting that the 2015 goal for MNTE had been missed. Maternal and neonatal tetanus is still to be eliminated in 18 countries (Afghanistan, Angola, Central African Republic, Chad, DR Congo, Ethiopia, Guinea, Haiti, Kenya, Mali, Nigeria, Pakistan, Papua New Guinea, Philippines, Somalia, Sudan, South Sudan, and Yemen).

The Lancet
Apr 08, 2017 Volume 389 Number 10077 p1369-1490 e5
http://www.thelancet.com/journals/lancet/issue/current

Series
America: Equity and Equality in Health
Mass incarceration, public health, and widening inequality in the USA
Christopher Wildeman, Emily A Wang
Summary
In this Series paper, we examine how mass incarceration shapes inequality in health. The USA is the world leader in incarceration, which disproportionately affects black populations. Nearly one in three black men will ever be imprisoned, and nearly half of black women currently have a family member or extended family member who is in prison. However, until recently the public health implications of mass incarceration were unclear. Most research in this area has focused on the health of current and former inmates, with findings suggesting that incarceration could produce some short-term improvements in physical health during imprisonment but has profoundly harmful effects on physical and mental health after release. The emerging literature on the family and community effects of mass incarceration points to negative health impacts on the female partners and children of incarcerated men, and raises concerns that excessive incarceration could harm entire communities and thus might partly underlie health disparities both in the USA and between the USA and other developed countries. Research into interventions, policies, and practices that could mitigate the harms of incarceration and the post-incarceration period is urgently needed, particularly studies using rigorous experimental or quasi-experimental designs.

The Lancet
Apr 08, 2017 Volume 389 Number 10077 p1369-1490 e5
http://www.thelancet.com/journals/lancet/issue/current

America: Equity and Equality in Health
Population health in an era of rising income inequality: USA, 1980–2015
Jacob Bor, Gregory H Cohen, Sandro Galea
Summary
Income inequality in the USA has increased over the past four decades. Socioeconomic gaps in survival have also increased. Life expectancy has risen among middle-income and high-income Americans whereas it has stagnated among poor Americans and even declined in some demographic groups. Although the increase in income inequality since 1980 has been driven largely by soaring top incomes, the widening of survival inequalities has occurred lower in the distribution—ie, between the poor and upper-middle class. Growing survival gaps across income percentiles since 2001 reflect falling real incomes among poor Americans as well as an increasingly strong association between low income and poor health. Changes in individual risk factors such as smoking, obesity, and substance abuse play a part but do not fully explain the steeper gradient. Distal factors correlated with rising inequality including unequal access to technological innovations, increased geographical segregation by income, reduced economic mobility, mass incarceration, and increased exposure to the costs of medical care might have reduced access to salutary determinants of health among low-income Americans. Having missed out on decades of income growth and longevity gains, low-income Americans are increasingly left behind. Without interventions to decouple income and health, or to reduce inequalities in income, we might see the emergence of a 21st century health-poverty trap and the further widening and hardening of socioeconomic inequalities in health.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 8 April 2017)

Research Article
Demographic transition and the dynamics of measles in six provinces in China: A modeling study
Sheng Li, Chao Ma, Lixin Hao, Qiru Su, Zhijie An, Fubao Ma, Shuyun Xie, Aiqiang Xu, Yanyang Zhang, Zhengrong Ding, Hui Li, Lisa Cairns, Huaqing Wang, Huiming Luo, Ning Wang, Li Li, Matthew J. Ferrari
| published 04 Apr 2017 PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002255

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 8 April 2017)

Research Article
Development of a glycoconjugate vaccine to prevent invasive Salmonella Typhimurium infections in sub-Saharan Africa
Scott M. Baliban, Mingjun Yang, Girish Ramachandran, Brittany Curtis, Surekha Shridhar, Rachel S. Laufer, Jin Y. Wang, John Van Druff, Ellen E. Higginson, Nicolas Hegerle, Kristen M. Varney, James E. Galen, Sharon M. Tennant, Andrew Lees, Alexander D. MacKerell Jr., Myron M. Levine, Raphael Simon
| published 07 Apr 2017 PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0005493