JAMA
April 26, 2016, Vol 315, No. 16
http://jama.jamanetwork.com/issue.aspx

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Special Communication | April 26, 2016
The Association Between Income and Life Expectancy in the United States, 2001-2014
Raj Chetty, PhD1; Michael Stepner, BA2; Sarah Abraham, BA2; Shelby Lin, MPhil3; Benjamin Scuderi, BA4; Nicholas Turner, PhD5; Augustin Bergeron, MA4; David Cutler, PhD4
Author Affiliations
JAMA. 2016;315(16):1750-1766. doi:10.1001/jama.2016.4226.
Abstract
Importance
The relationship between income and life expectancy is well established but remains poorly understood.
Objectives
To measure the level, time trend, and geographic variability in the association between income and life expectancy and to identify factors related to small area variation.
Design and Setting
Income data for the US population were obtained from 1.4 billion deidentified tax records between 1999 and 2014. Mortality data were obtained from Social Security Administration death records. These data were used to estimate race- and ethnicity-adjusted life expectancy at 40 years of age by household income percentile, sex, and geographic area, and to evaluate factors associated with differences in life expectancy.
Exposure
Pretax household earnings as a measure of income.
Main Outcomes and Measures
Relationship between income and life expectancy; trends in life expectancy by income group; geographic variation in life expectancy levels and trends by income group; and factors associated with differences in life expectancy across areas.
Results
The sample consisted of 1,408,287,218 person-year observations for individuals aged 40 to 76 years (mean age, 53.0 years; median household earnings among working individuals, $61 175 per year). There were 4 114 380 deaths among men (mortality rate, 596.3 per 100,000) and 2,694,808 deaths among women (mortality rate, 375.1 per 100,000). The analysis yielded 4 results. First, higher income was associated with greater longevity throughout the income distribution. The gap in life expectancy between the richest 1% and poorest 1% of individuals was 14.6 years (95% CI, 14.4 to 14.8 years) for men and 10.1 years (95% CI, 9.9 to 10.3 years) for women. Second, inequality in life expectancy increased over time. Between 2001 and 2014, life expectancy increased by 2.34 years for men and 2.91 years for women in the top 5% of the income distribution, but by only 0.32 years for men and 0.04 years for women in the bottom 5% (P < .001 for the differences for both sexes). Third, life expectancy for low-income individuals varied substantially across local areas. In the bottom income quartile, life expectancy differed by approximately 4.5 years between areas with the highest and lowest longevity. Changes in life expectancy between 2001 and 2014 ranged from gains of more than 4 years to losses of more than 2 years across areas. Fourth, geographic differences in life expectancy for individuals in the lowest income quartile were significantly correlated with health behaviors such as smoking (r=-0.69, P  < .001), but were not significantly correlated with access to medical care, physical environmental factors, income inequality, or labor market conditions. Life expectancy for low-income individuals was positively correlated with the local area fraction of immigrants (r = 0.72, P < .001), fraction of college graduates (r= 0.42, P < .001), and government expenditures (r=0.57, P < .001).
Conclusions and Relevance
In the United States between 2001 and 2014, higher income was associated with greater longevity, and differences in life expectancy across income groups increased over time. However, the association between life expectancy and income varied substantially across areas; differences in longevity across income groups decreased in some areas and increased in others. The differences in life expectancy were correlated with health behaviors and local area characteristics

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Editorials:
Associations Between Money and Death; Angus Deaton, PhD
Improving Opportunity, Population Health, and Well-being Collectively; Steven H. Woolf, MD, MPH; Jason Q. Purnell, PhD, MPH
Income, Longevity, and Community Health; J. Michael McGinnis, MD, MPP

Journal of Health Care for the Poor and Underserved (JHCPU)
Volume 27, Number 2, May 2016 Supplement
https://muse.jhu.edu/issue/33442

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Introduction to Public Health and Incarceration: Social Justice Matters
Overview Providing health care in jails, prisons, half-way houses, and community-supervised correctional programs, correctional facilities, and community systems has a direct effect on health outcomes of incarcerated populations. Moreover, effective linkages to a myriad of services upon release and assistance with community reintegration are key components for reducing recidivism. In an effort to highlight some of the disparity issues and challenges in corrections, we offer this issue, titled, Public Health and Incarceration: Social Justice Matters. In 2012, U.S. state prison systems, comprising 50 independent entities, incarcerated over 1.3 million people, of whom a disproportionate share were minorities, primarily African Americans and Hispanics. Despite recent reports that 2012 marked a decrease in the number of imprisonments of males and females, the U.S. continues to lead the world in incarceration of its residents. The reported decrease in incarceration may be attributed to alternative sentences, such as probation, which maintains individuals under correctional supervision.

Mass incarceration disrupts families and affects health status and the quality of life within families. Prisoners are more likely than the general population to have chronic health conditions and infectious diseases. In 2012, 43.9% of offenders reported a chronic condition, relative to 31.0% of the general population; 21.0% of offenders had had an infectious disease, relative to 4.8% of the general population. The disparities in mental health and substance abuse are equally troubling. These health risks are not proportionately distributed across populations. African American males have an imprisonment rate of 2,841 per 100,000; Hispanic males have a rate of 1,158 per 100,000; and White males have a rate of 463 per 100,000. There are similar disparities for African American and Hispanic females relative to Whites.

Although some of the health problems experienced by offenders are addressed during their incarceration, many are not addressed upon their release, which poses serious health risks for the former offenders and for the local communities to which they return. Health problems of former offenders become those of the local community, where there may be little knowledge and discussion related to the intersections of corrections, public health, and reentry for this subset of a vulnerable population.

This special issue of the JHCPU-with a focus on disparities related to racial and ethnic minorities, reentry, and public health-explores innovative research, services, and programs that deal with the health of the offender population. The social justice system is burdened with imperfections deleterious to health equity. The system disproportionately lessens the life opportunities of African Americans, Latinos, and other disadvantaged ethnic minority groups. Eliminating such imperfections is a formidable task, but nevertheless one that must be accomplished if the nation is to achieve true health equity.

The articles in this issue of the JHCPU report on strategies for change. In the commentary by Ferguson, et al., a strong case is made that systems change is the “order of the day”; this case is eloquently presented as a “Call for Action.” While there have been many other such appeals, this call offers recommendations for clinical practice, criminal justice studies, health science institutions, and communities. Much like the compelling call for action in Michelle Alexander’s book, The New Jim Crow: Mass Incarceration in the Age of Colorblindness, a stage is set for sector stakeholders to move in a new direction, one involving sector accountability without compromise. We must change the mass incarceration practices and eliminate their catastrophic effects on racial and ethnic minorities, in the U.S. In the manuscript by Coughlin, Lewis, and Smith, developments in ethics in the context of the racial/ethnic disparities that exist in corrections, are discussed. Ethical considerations in clinical and public health research on HIV in prison and jail settings are considered. Factors in mental health research are summarized, along with issues pertaining to research involving female inmates. The ethics of research involving incarcerated people extends beyond traditional ethical concerns related to human subjects to include issues in the domains of bioethics and public health ethics. Tamburello and Ferguson present a commentary on marginalized individuals diagnosed with mental health conditions and the medication-prescribing practices in correctional facilities. Several articles in this issue concern incarcerated women specifically…

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Commentaries
Ethical and Social Issues in Health Research Involving Incarcerated People
pp. 18-28
Steven S. Coughlin, Sharon R. Lewis, Selina A. Smith
Abstract:
The use of inmates in research in the U.S. was restricted by the recommendations of the National Commission and by federal regulations and guidelines that followed. By the 1980s, many health care officials became concerned about the exclusion of inmates from experimental treatments for human immunodeficiency virus infection (HIV). These developments in ethics occurred in the context of racial/ethnic disparities in health. In this article, ethical considerations in clinical and public health research on HIV in prison and jail settings are considered. Ethical considerations in mental health research are summarized as well as issues pertaining to research involving female inmates. Issues related to oversight of research involving incarcerated people are considered along with the ethics of public health research. The ethics of research involving incarcerated people extends beyond traditional issues in human subjects ethics to include issues within the domains of bioethics and public health ethics.

Journal of Patient-Centered Research and Reviews
Volume 3, Issue 2 (2016)
http://digitalrepository.aurorahealthcare.org/jpcrr/

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Topic Synopsis
Is 13-Valent Pneumococcal Conjugate Vaccine (PCV13) Combined With 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23) Superior to PPSV23 Alone for Reducing Incidence or Severity of Pneumonia in Older Adults? A Clin-IQ
Starla Hayward, Lou Ann Thompson, and Andrea McEachern

Journal of Public Health Policy
Volume 37, Issue 2 (May 2016)
http://www.palgrave-journals.com/jphp/journal/v37/n2/index.html

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Editorial
How to understand the results of the climate change summit: Conference of Parties21 (COP21) Paris 2015 FREE
Our Co-Editor reports on developments from Paris, where he joined 40,000 people in November at the Summit at Le Bourget
Anthony Robbins
J Public Health Pol 37: 129-132; advance online publication, January 7, 2016; doi:10.1057/jphp.2015.47

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Viewpoints
Zika virus: An international emergency? FREE
A distinguished Mexican researcher anguishes about next steps to control this epidemic and its frightening consequences
Adolfo Martinez Palomo
J Public Health Pol 37: 133-135; advance online publication, February 25, 2016; doi:10.1057/jphp.2016.11
Abstract
This Viewpoint discusses the World Health Organization’s Declaration on 1 February 2016 that the epidemic infection caused by the Zika virus is a public health emergency of international concern – the basis of the decision and controversy surrounding it.

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Viewpoints
Unhealthy marketing of pharmaceutical products: An international public health concern
Shai Mulinari
J Public Health Pol 37: 149-159; advance online publication, February 25, 2016; doi:10.1057/jphp.2016.6
Abstract
I consider the current state of pharmaceutical marketing vis-à-vis ethical and legal standards and advocate measures to improve it. There is abundant evidence of unethical or illicit marketing. It fuels growing concerns about undue corporate influence over pharmaceutical research, education, and consumption. The most extensive evidence of industry transgressions comes from the United States (US), where whistle-blowers are encouraged by financial rewards to help uncover illicit marketing and fraud. Outside the US increasing evidence of transgressions exists. Recently I have observed a range of new measures to align pharmaceutical marketing practices with ethical and legal standards. In the interest of public health, I highlight the need for additional and more profound reforms to ensure that information about medicines supports quality and resource-efficient care

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Original Articles
Misconceptions about Ebola virus disease among lay people in Guinea: Lessons for community education
Lonzozou Kpanake, Komlantsè Gossou, Paul Clay Sorum, and Etienne Mullet
J Public Health Pol 37: 160-172; advance online publication, February 11, 2016; doi:10.1057/jphp.2016.1
Abstract
To characterize the perception of Ebola virus disease (EVD) in Guinea, we administered, from November 2014 to February 2015, a questionnaire to a convenience sample of 200 lay people in Conakry and a group of 8 physicians. We found widespread misconceptions among lay people, including that praying to God can protect against EVD, that traditional healers are more competent than physicians in treating EVD, that people get infected through physical proximity without contact, that the Ebola epidemic is the result of Western bioterrorism experiments, that Western medical staff disseminated the virus, and that the purpose of quarantine measures is to hasten the death of Ebola patients. Major educational interventions, sensitive to local cultural beliefs, are needed to overcome the misconceptions about Ebola in Guinea.

Journal of the Royal Society – Interface
01 April 2016; volume 13, issue 117
http://rsif.royalsocietypublishing.org/content/current

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Life Sciences–Mathematics interface
Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination
Amy Wesolowski, Keitly Mensah, Cara E. Brook, Miora Andrianjafimasy, Amy Winter, Caroline O. Buckee, Richter Razafindratsimandresy, Andrew J. Tatem, Jean-Michel Heraud, C. Jessica E. Metcalf
J. R. Soc. Interface 2016 13 20151101; DOI: 10.1098/rsif.2015.1101. Published 27 April 2016
Abstract
Few countries in Africa currently include rubella-containing vaccination (RCV) in their immunization schedule. The Global Alliance for Vaccines Initiative (GAVI) recently opened a funding window that has motivated more widespread roll-out of RCV. As countries plan RCV introductions, an understanding of the existing burden, spatial patterns of vaccine coverage, and the impact of patterns of local extinction and reintroduction for rubella will be critical to developing effective programmes. As one of the first countries proposing RCV introduction in part with GAVI funding, Madagascar provides a powerful and timely case study. We analyse serological data from measles surveillance systems to characterize the epidemiology of rubella in Madagascar. Combining these results with data on measles vaccination delivery, we develop an age-structured model to simulate rubella vaccination scenarios and evaluate the dynamics of rubella and the burden of congenital rubella syndrome (CRS) across Madagascar. We additionally evaluate the drivers of spatial heterogeneity in age of infection to identify focal locations where vaccine surveillance should be strengthened and where challenges to successful vaccination introduction are expected. Our analyses indicate that characteristics of rubella in Madagascar are in line with global observations, with an average age of infection near 7 years, and an impact of frequent local extinction with reintroductions causing localized epidemics. Modelling results indicate that introduction of RCV into the routine programme alone may initially decrease rubella incidence but then result in cumulative increases in the burden of CRS in some regions (and transient increases in this burden in many regions). Deployment of RCV with regular supplementary campaigns will mitigate these outcomes. Results suggest that introduction of RCV offers a potential for elimination of rubella in Madagascar, but also emphasize both that targeted vaccination is likely to be a lynchpin of this success, and the public health vigilance that this introduction will require.

The Lancet
Apr 30, 2016 Volume 387 Number 10030 p1789-1878 e25
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
The next Director-General of WHO
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(16)30358-0
Summary
WHO last week fired a starting pistol to launch the election for its next Director-General. The final vote does not take place until May, 2017. Procedures have been substantially revised since 2012, when Margaret Chan was elected to serve a second term. It is likely that this lengthy process will therefore be more transparent, accountable, and disputatious (and considerably less corrupt) than past elections.

[Excerpt]
…The deadline for member states to nominate candidates is Sept 22. Several prominent individuals have already disclosed their intentions to stand. Philippe Douste-Blazy served two terms as France’s Minister of Health and subsequently became Foreign Minister. He has been a leader on innovative financing for health and has chaired UNITAID since 2006. Tedros Adhanom Ghebreyesus is currently Ethiopia’s Minister of Foreign Affairs. He was Minister of Health from 2005–12. The African Union has endorsed him as the sole African candidate for Director-General. Sania Nishtar, Pakistan’s former Minister of Health (among several other government portfolios), has had a distinguished career as a civil society leader. She founded the influential non-governmental organisation Heartfile in 1999. All three candidates are highly accomplished global health leaders, which bodes well for the future of WHO…

New England Journal of Medicine
April 28, 2016 Vol. 374 No. 17
http://www.nejm.org/toc/nejm/medical-journal

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Original Article
Phase 1 Trials of rVSV Ebola Vaccine in Africa and Europe
Selidji T. Agnandji, M.D., Angela Huttner, M.D., Madeleine E. Zinser, M.D., Patricia Njuguna, M.Med., Christine Dahlke, Ph.D., José F. Fernandes, M.D., Sabine Yerly, M.Sc., Julie-Anne Dayer, M.D., Verena Kraehling, Ph.D., Rahel Kasonta, Ph.D., Akim A. Adegnika, M.D., Ph.D., Marcus Altfeld, M.D., Ph.D., Floriane Auderset, Ph.D., Emmanuel B. Bache, M.Sc., Nadine Biedenkopf, Ph.D., Saskia Borregaard, Ph.D., Jessica S. Brosnahan, M.H.Sc., Rebekah Burrow, B.Sc., Christophe Combescure, Ph.D., Jules Desmeules, M.D., Markus Eickmann, Ph.D., Sarah K. Fehling, Ph.D., Axel Finckh, M.D., Ana Rita Goncalves, Ph.D., Martin P. Grobusch, M.D., Ph.D., Jay Hooper, Ph.D., Alen Jambrecina, M.D., Anita L. Kabwende, M.D., Gürkan Kaya, M.D., Ph.D., Domtila Kimani, B.Sc., Bertrand Lell, M.D., Barbara Lemaître, M.Sc., Ansgar W. Lohse, M.D., Marguerite Massinga-Loembe, Ph.D., Alain Matthey, M.D., Benjamin Mordmüller, M.D., Anne Nolting, M.D., Caroline Ogwang, M.B., Ch.B., Michael Ramharter, M.D., Jonas Schmidt-Chanasit, M.D., Stefan Schmiedel, M.D., Peter Silvera, Ph.D., Felix R. Stahl, M.D., Ph.D., Henry M. Staines, D.Phil., Thomas Strecker, Ph.D., Hans C. Stubbe, M.D., Benjamin Tsofa, Ph.D., Sherif Zaki, M.D., Ph.D., Patricia Fast, M.D., Ph.D., Vasee Moorthy, Ph.D., Laurent Kaiser, M.D., Sanjeev Krishna, Sc.D., Stephan Becker, Ph.D., Marie-Paule Kieny, Ph.D., Philip Bejon, Ph.D., Peter G. Kremsner, M.D., Marylyn M. Addo, M.D., Ph.D., and Claire-Anne Siegrist, M.D.*
N Engl J Med 2016; 374:1647-1660 April 28, 2016 DOI: 10.1056/NEJMoa1502924

Abstract
Background
The replication-competent recombinant vesicular stomatitis virus (rVSV)–based vaccine expressing a Zaire ebolavirus (ZEBOV) glycoprotein was selected for rapid safety and immunogenicity testing before its use in West Africa.
Methods
We performed three open-label, dose-escalation phase 1 trials and one randomized, double-blind, controlled phase 1 trial to assess the safety, side-effect profile, and immunogenicity of rVSV-ZEBOV at various doses in 158 healthy adults in Europe and Africa. All participants were injected with doses of vaccine ranging from 300,000 to 50 million plaque-forming units (PFU) or placebo.
Results
No serious vaccine-related adverse events were reported. Mild-to-moderate early-onset reactogenicity was frequent but transient (median, 1 day). Fever was observed in up to 30% of vaccinees. Vaccine viremia was detected within 3 days in 123 of the 130 participants (95%) receiving 3 million PFU or more; rVSV was not detected in saliva or urine. In the second week after injection, arthritis affecting one to four joints developed in 11 of 51 participants (22%) in Geneva, with pain lasting a median of 8 days (interquartile range, 4 to 87); 2 self-limited cases occurred in 60 participants (3%) in Hamburg, Germany, and Kilifi, Kenya. The virus was identified in one synovial-fluid aspirate and in skin vesicles of 2 other vaccinees, showing peripheral viral replication in the second week after immunization. ZEBOV-glycoprotein–specific antibody responses were detected in all the participants, with similar glycoprotein-binding antibody titers but significantly higher neutralizing antibody titers at higher doses. Glycoprotein-binding antibody titers were sustained through 180 days in all participants.
Conclusions
In these studies, rVSV-ZEBOV was reactogenic but immunogenic after a single dose and warrants further evaluation for safety and efficacy. (Funded by the Wellcome Trust and others; ClinicalTrials.gov numbers, NCT02283099, NCT02287480, and NCT02296983; Pan African Clinical Trials Registry number, PACTR201411000919191.)

New England Journal of Medicine
April 28, 2016 Vol. 374 No. 17
http://www.nejm.org/toc/nejm/medical-journal
Original Article
A Monovalent Chimpanzee Adenovirus Ebola Vaccine Boosted with MVA
Katie Ewer, Ph.D., Tommy Rampling, M.R.C.P., Navin Venkatraman, M.R.C.P., Georgina Bowyer, B.A., Danny Wright, M.Sc., Teresa Lambe, Ph.D., Egeruan B. Imoukhuede, M.D., Ruth Payne, M.R.C.P., Sarah Katharina Fehling, Ph.D., Thomas Strecker, Ph.D., Nadine Biedenkopf, Ph.D., Verena Krähling, Ph.D., Claire M. Tully, B.A., Nick J. Edwards, B.Sc., Emma M. Bentley, B.Sc., Dhanraj Samuel, Ph.D., Geneviève Labbé, Ph.D., Jing Jin, Ph.D., Malick Gibani, M.R.C.P., Alice Minhinnick, M.B., Ch.B., Morven Wilkie, M.R.C.P., Ian Poulton, Dip.H.E., Natalie Lella, B.A., Rachel Roberts, M.Sc., Felicity Hartnell, M.B., B.S., Carly Bliss, B.A., Kailan Sierra-Davidson, B.A., Jonathan Powlson, B.Sc., Eleanor Berrie, Ph.D., Richard Tedder, M.B., B.Chir., Francois Roman, M.D., Iris De Ryck, Ph.D., Alfredo Nicosia, Ph.D., Nancy J. Sullivan, Ph.D., Daphne A. Stanley, M.S., Olivier T. Mbaya, M.D., Julie E. Ledgerwood, D.O., Richard M. Schwartz, Ph.D., Loredana Siani, Ph.D., Stefano Colloca, Ph.D., Antonella Folgori, Ph.D., Stefania Di Marco, Ph.D., Riccardo Cortese, M.D., Edward Wright, Ph.D., Stephan Becker, Ph.D., Barney S. Graham, M.D., Richard A. Koup, M.D., Myron M. Levine, M.D., Ariane Volkmann, Ph.D., Paul Chaplin, Ph.D., Andrew J. Pollard, Ph.D., Simon J. Draper, D.Phil., W. Ripley Ballou, M.D., Alison Lawrie, Ph.D., Sarah C. Gilbert, Ph.D., and Adrian V.S. Hill, D.M.
N Engl J Med 2016; 374:1635-1646 April 28, 2016 DOI: 10.1056/NEJMoa1411627

Abstract
Background
The West African outbreak of Ebola virus disease that peaked in 2014 has caused more than 11,000 deaths. The development of an effective Ebola vaccine is a priority for control of a future outbreak.
Methods
In this phase 1 study, we administered a single dose of the chimpanzee adenovirus 3 (ChAd3) vaccine encoding the surface glycoprotein of Zaire ebolavirus (ZEBOV) to 60 healthy adult volunteers in Oxford, United Kingdom. The vaccine was administered in three dose levels — 1×1010 viral particles, 2.5×1010 viral particles, and 5×1010 viral particles — with 20 participants in each group. We then assessed the effect of adding a booster dose of a modified vaccinia Ankara (MVA) strain, encoding the same Ebola virus glycoprotein, in 30 of the 60 participants and evaluated a reduced prime–boost interval in another 16 participants. We also compared antibody responses to inactivated whole Ebola virus virions and neutralizing antibody activity with those observed in phase 1 studies of a recombinant vesicular stomatitis virus–based vaccine expressing a ZEBOV glycoprotein (rVSV-ZEBOV) to determine relative potency and assess durability.
Results
No safety concerns were identified at any of the dose levels studied. Four weeks after immunization with the ChAd3 vaccine, ZEBOV-specific antibody responses were similar to those induced by rVSV-ZEBOV vaccination, with a geometric mean titer of 752 and 921, respectively. ZEBOV neutralization activity was also similar with the two vaccines (geometric mean titer, 14.9 and 22.2, respectively). Boosting with the MVA vector increased virus-specific antibodies by a factor of 12 (geometric mean titer, 9007) and increased glycoprotein-specific CD8+ T cells by a factor of 5. Significant increases in neutralizing antibodies were seen after boosting in all 30 participants (geometric mean titer, 139; P<0.001). Virus-specific antibody responses in participants primed with ChAd3 remained positive 6 months after vaccination (geometric mean titer, 758) but were significantly higher in those who had received the MVA booster (geometric mean titer, 1750; P<0.001).
Conclusions
The ChAd3 vaccine boosted with MVA elicited B-cell and T-cell immune responses to ZEBOV that were superior to those induced by the ChAd3 vaccine alone. (Funded by the Wellcome Trust and others; ClinicalTrials.gov number, NCT02240875.)

Science Translational Medicine
27 April 2016 Vol 8, Issue 336
http://stm.sciencemag.org/

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Editorial
An incentive-based approach for improving data reproducibility
By Michael Rosenblatt
Science Translational Medicine27 Apr 2016 : 336ed5
A scientist who has worked in both academia and industry offers an incentive-based and nonprescriptive proposal to reduce data irreproducibility.

Vaccine
Volume 34, Issue 22, Pages 2467-2526 (11 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/22
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Regular papers
Cost-effectiveness of an influenza vaccination program offering intramuscular and intradermal vaccines versus intramuscular vaccine alone for elderly
Original Research Article
Pages 2469-2476
Man-Kit Leung, Joyce H.S. You
Abstract
Background
Intradermal (ID) injection is an alternative route for influenza vaccine administration in elderly with potential improvement of vaccine coverage. This study aimed to investigate the cost-effectiveness of an influenza vaccination program offering ID vaccine to elderly who had declined intramuscular (IM) vaccine from the perspective of Hong Kong public healthcare provider.
Methods
A decision analytic model was used to simulate outcomes of two programs: IM vaccine alone (IM program), and IM or ID vaccine (IM/ID program) in a hypothetic cohort of elderly aged 65 years. Outcome measures included influenza-related direct medical cost, infection rate, mortality rate, quality-adjusted life years (QALYs) loss, and incremental cost per QALY saved (ICER). Model inputs were derived from literature. Sensitivity analyses evaluated the impact of uncertainty of model variables.
Results
In base-case analysis, the IM/ID program was more costly (USD52.82 versus USD47.59 per individual to whom vaccine was offered) with lower influenza infection rate (8.71% versus 9.65%), mortality rate (0.021% versus 0.024%) and QALYs loss (0.00336 versus 0.00372) than the IM program. ICER of IM/ID program was USD14,528 per QALY saved. One-way sensitivity analysis found ICER of IM/ID program to exceed willingness-to-pay threshold (USD39,933) when probability of influenza infection in unvaccinated elderly decreased from 10.6% to 5.4%. In 10,000 Monte Carlo simulations of elderly populations of Hong Kong, the IM/ID program was the preferred option in 94.7% of time.
Conclusions
An influenza vaccination program offering ID vaccine to elderly who had declined IM vaccine appears to be a highly cost-effective option.

Vaccine
Volume 34, Issue 22, Pages 2467-2526 (11 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/22
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Stability of live attenuated rotavirus vaccine with selected preservatives and primary containers
Original Research Article
Pages 2483-2489
Manjari Lal, Courtney Jarrahian, Changcheng Zhu, Nancy A. Hosken, Chris L. McClurkan, David M. Koelle, Eugene Saxon, Andrew Roehrig, Darin Zehrung, Dexiang Chen
Abstract
Rotavirus infection, which can be prevented by vaccination, is responsible for a high burden of acute gastroenteritis disease in children, especially in low-income countries. An appropriate formulation, packaging, and delivery device for oral rotavirus vaccine has the potential to reduce the manufacturing cost of the vaccine and the logistical impact associated with introduction of a new vaccine, simplify the vaccination procedure, and ensure that the vaccine is safely and accurately delivered to children. Single-dose prefilled presentations can be easy to use; however, they are typically more expensive, can be a bottleneck during production, and occupy a greater volume per dose vis-à-vis supply chain storage and medical waste disposal, which is a challenge in low-resource settings. Multi-dose presentations used thus far have other issues, including increased wastage of vaccine and the need for separate delivery devices. In this study, the goals were to evaluate both the technical feasibility of using preservatives to develop a liquid multi-dose formulation and the primary packaging alternatives for orally delivered, liquid rotavirus vaccines. The feasibility evaluation included evaluation of commonly used preservatives for compatibility with rotavirus vaccines and stability testing of rotavirus vaccine in various primary containers, including Lameplast’s plastic tubes, BD’s oral dispenser version of Uniject™ (Uniject DP), rommelag’s blow-fill-seal containers, and MEDInstill’s multi-dose vial and pouch. These presentations were compared to a standard glass vial. The results showed that none of the preservatives tested were compatible with a live attenuated rotavirus vaccine because they had a detrimental effect on the viability of the virus. In the presence of preservatives, vaccine virus titers declined to undetectable levels within 1 month. The vaccine formulation without preservatives maintained a stability profile over 12 months in all primary containers that was similar to its profile in standard glass vials. This study demonstrates that there are multiple options for the primary container for rotavirus vaccines intended for oral delivery. Selection of an optimal primary container should take into consideration additional factors, including stability as well as cold chain volume, usability, cost, and manufacturing feasibility.

Vaccine
Volume 34, Issue 22, Pages 2467-2526 (11 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/22
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HPV vaccine uptake among overweight and obese US adolescents: An analysis of the National Health and Nutrition Examination Survey (NHANES) 2009–2014
Original Research Article
Pages 2501-2506
Maria E. Sundaram, Susan M. Mason, Nicole E. Basta
Abstract
Background
Human papillomavirus (HPV) vaccine uptake in the US is suboptimal; identifying risk factors associated with low vaccine uptake is critical to increase vaccination coverage. Some evidence suggests body mass index (BMI) is associated with low HPV vaccine uptake and increased risk of HPV infection in adults. BMI may therefore be an important factor in targeting HPV vaccine to US adolescents.
Methods
We investigated the relationship between BMI categories (underweight, normal weight, overweight and obese) and HPV vaccine uptake in 4109 adolescents (9–18 years old) using data from the 2009 to 2014 National Health and Nutrition Examination Survey (NHANES). We used modified Poisson regression to assess the relationship between BMI and receipt of at least one HPV vaccine, and BMI and completion of the vaccine three-dose series. We assessed the relationship between BMI and age at first HPV vaccination using linear regression.
Results
Receipt of at least one dose of HPV vaccine was low in both females (35%) and males (10%). High BMI was not associated with initiation of the HPV vaccine series, age at first HPV vaccination, or completion of the HPV vaccine three-dose course.
Conclusions
We found no evidence that high BMI is associated with reduced initiation or completion of the HPV vaccination series, or age at initiation of the three-dose course among a general population sample of US adolescents. Our results suggest that efforts to increase HPV vaccine uptake need not consider targeting by weight status at this time.

Vaccine
Volume 34, Issue 22, Pages 2467-2526 (11 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/22
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The effect of diarrheal disease on bivalent oral polio vaccine (bOPV) immune response in infants in Nepal
Original Research Article
Pages 2519-2526
Cristina V. Cardemil, Concepcion Estivariz, Laxman Shrestha, Jeevan B. Sherchand, Arun Sharma, Howard E. Gary Jr., M. Steven Oberste, William C. Weldon III, Michael D. Bowen, Jan Vinjé, W. William Schluter, Abhijeet Anand, Ondrej Mach, Susan Y. Chu
Abstract
Background
A globally-coordinated phase out of all type 2 containing oral polio vaccine (OPV) is planned for April 2016 during which bivalent 1 + 3 OPV (bOPV) will replace trivalent OPV (tOPV) in routine immunization schedules and campaigns. Diarrhea impairs the immune response to tOPV, but the effect of diarrhea on bOPV is unknown.
Methods
Infants aged 6 weeks to 11 months, who had received 5 loose stools per day (OR = 0.36, 95% CI 0.21–0.62).
Conclusions
Diarrhea reduced the immune response to bOPV. Provision of additional doses of polio vaccine is necessary to maintain high population immunity in areas with high prevalence of diarrheal disease.
Clinical trial registry
This study is registered at clinicaltrials.gov as NCT01559636.

Vaccine
Volume 34, Issue 21, Pages 2403-2466 (5 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/21

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Review
Hepatitis B control among children in the Eastern Mediterranean Region of the World Health Organization
Review Article
Pages 2403-2409
Robert D. Allison, Nadia Teleb, Salah Al Awaidy, Hossam Ashmony, James P. Alexander, Minal K. Patel
Abstract
In the pre-vaccination era, the prevalence of chronic hepatitis B virus (HBV) infection in the World Health Organization (WHO) Eastern Mediterranean Region (EMR) ranged from two to seven percent in a total population of over 580 million people. Mortality estimates place cirrhosis among the top ten causes of years of life lost in the EMR. The region has made notable achievements, improving coverage from only 6% in 1992, when WHO recommended hepatitis B vaccination of all infants, to 83% in 2014. Member states adopted a hepatitis B control target in 2009 to reduce chronic hepatitis B virus infection prevalence to less than one percent among children aged

Vaccine
Volume 34, Issue 21, Pages 2403-2466 (5 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/21
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Can the vaccine adverse event reporting system be used to increase vaccine acceptance and trust?
Original Research Article
Pages 2424-2429
Laura D. Scherer, Victoria A. Shaffer, Niraj Patel, Brian J. Zikmund-Fisher
Abstract
Vaccine refusal has an impact on public health, and the human pappillomavirus (HPV) vaccine is particularly underutilized. Research suggests that it may be difficult to change vaccine-related attitudes, and there is currently no good evidence to recommend any particular intervention strategy. One reason for vaccine hesitancy is lack of trust that vaccine harms are adequately documented and reported, yet few communication strategies have explicitly attempted to improve this trust. This study tested the possibility that data from the vaccine adverse event reporting system (VAERS) can be used to increase trust that vaccine harms are adequately researched and that potential harms are disclosed to the public, and thereby improve perceptions of vaccines. In the study, participants were randomly assigned to one of three communication interventions. All participants read the Centers for Disease Control (CDC) vaccine information statement (VIS) for the HPV vaccine. Two other groups were exposed to additional information about VAERS, either summary data or full detailed reports of serious adverse events from 2013. Results showed that the CDC’s VIS alone significantly increased perceptions of vaccine benefits and decreased perceived risks. Participants who were also educated about VAERS and given summary data about the serious adverse events displayed more trust in the CDC and greater HPV vaccine acceptance relative to the VIS alone. However, exposure to the detailed VAERS reports significantly reduced trust in the CDC and vaccine acceptance. Hence, general information about the VAERS data slightly increased trust in the CDC and improved vaccine acceptance, but the specific VAERS reports negatively influenced both trust and acceptance. Implications for communicating about vaccines are discussed.

Vaccine
Volume 34, Issue 21, Pages 2403-2466 (5 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/21
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SMS text message reminders to improve infant vaccination coverage in Guatemala: A pilot randomized controlled trial
Original Research Article
Pages 2437-2443
Gretchen J. Domek, Ingrid L. Contreras-Roldan, Sean T. O’Leary, Sheana Bull, Anna Furniss, Allison Kempe, Edwin J. Asturias
Abstract
Background
Patient reminder systems are an evidence-based way to improve childhood vaccination rates but are difficult to implement in low- and middle-income countries (LMICs). Short Message Service (SMS) texts may offer a potential low-cost solution, especially in LMICs where mobile phones are becoming more ubiquitous.
Objective
To determine if an SMS-based vaccination reminder system aimed at improving completion of the infant primary immunization series is feasible and acceptable in Guatemala.
Methods
A pilot randomized controlled trial was conducted at two public health clinics in Guatemala City. Infants aged 8–14 weeks presenting for the first dose of the primary immunization series were enrolled in March–April 2013. Participants randomized into the intervention received three SMS reminders one week before the second and third dose. A follow-up acceptability survey was administered to both groups.
Results
The participation rate was 86.8% (321/370); 8 did not own a cell phone and 12 could not use SMS. 96.9% of intervention parents were sent at least one SMS reminder prior to visit 2 and 96.3% prior to visit 3. Both intervention and usual care participants had high rates of vaccine and visit completion, with a non-statistically significant higher percentage of children in the intervention completing both visit 2 (95.0% vs. 90.1%, p = .12) and visit 3 (84.4% vs. 80.7%, p = .69). More intervention vs. usual care parents agreed that SMS reminders would be helpful for remembering appointments (p < .0001), agreed to being interested in receiving future SMS reminders (p < .0001), and said that they would be willing to pay for future SMS reminders (p = .01).
Conclusion
This proof of concept evaluation showed that a new application of SMS technology is feasible to implement in a LMIC with high user satisfaction. Larger studies with modifications in the SMS system are needed to determine effectiveness (Clinical Trial Registry NCT01663636).

American Journal of Men’s Health
2016 Apr 22. pii: 1557988316645155. [Epub ahead of print]
Factors Associated With HPV Vaccine Initiation, Vaccine Completion, and Accuracy of Self-Reported Vaccination Status Among 13-to 26-Year-Old Men.
Thomas R1, Higgins L2, Ding L3, Widdice LE3, Chandler E3, Kahn JA4.
Abstract
Human papillomavirus (HPV) vaccination coverage in young men is suboptimal. The aims of this study were (a) to examine HPV vaccination and factors associated with HPV vaccination in men 13 to 26 years of age and (b) to examine and determine factors associated with accurate self-report of vaccination. Young men (n = 400) recruited from a teen health center and a sexually transmitted disease (STD) clinic completed a survey. Accuracy was defined as correct report of at least one dose and number of doses. Mean age was 21.5 years, 104 (26.0%) received at least one vaccine dose and 49 (12.3%) received all three doses. Factors significantly associated with receipt of at least one dose in multivariable models included recruitment site (teen health center vs. STD clinic, adjusted odds ratio [AOR] = 2.75), public versus other insurance (AOR = 2.12), and age (AOR = 0.68). Most young men accurately reported their vaccination status but accuracy of report differed by age: 50.6% of 14- to 18-year-olds, 75.9% of 19- to 21-year-olds, and 93.2% of 22- to 26-year-olds. Most (293, 73.3%) accurately reported number of doses received. Age was associated with accuracy of self-report of at least one vaccine dose (AOR = 1.42), while recruitment site (STD vs. teen health center, AOR = 2.56) and age (AOR = 1.44) were associated with accuracy of self-report of number of vaccine doses. In conclusion, HPV initiation and completion in this study sample were low. Teen health center attendance, public insurance, and younger age were associated with vaccine initiation; older age and STD clinic setting were associated with accurate vaccination self-report.

Neurology
April 21, 2016
Association Between Influenza Vaccination and Development of Guillain-Barré Syndrome in Adults: A Vaccine Safety Datalink (VSD) and Vaccine Adverse Event Reporting System (VAERS) Study (S53.007)
Francisco Gomez2, Mohammad El-Ghanem4, Abu Nasar1 and Nizar Souayah3
Abstract
Objective: To investigate whether there is correlation between Guillain-Barré Syndrome (GBS) and influenza vaccination in adults, utilizing Vaccine Adverse Event Reporting System (VAERS), and vaccine safety datalink (VSD) databases Background: There are reports of GBS after influenza vaccination, efforts have been undertaken to find a link between the two Methods: Data from VAERS and VSD were used during 1991-2000 time period. Two approaches utilized: self-controlled case series and case-centered. Six weeks after vaccination was defined as the risk period of possible cause effect between vaccination and GBS. Results: There were 69 VSD and 62 VAERS GBS cases after vaccination. VSD mean age was 65.9±12.07 and VAERS 55.83±15.4 years. Male distribution in VSD and VAERS was 64[percnt] and 53[percnt] respectively (p0.221) The incidence of GBS after vaccination in the VSD population was 2/100,000 Using case centered analysis, there was no significant difference between the risk and control periods in the VSD database ( 10[percnt] vs 8.5[percnt] p0.771). Similar results were observed with self-controlled case design. However in VAERS most cases were reported within the risk period. (96.5[percnt] vs 3.5[percnt] p< 0.001). Conclusions: There was no significant increase in incidence of GBS after influenza vaccination in the risk period compared to the control period or the general population in the VSD database. There is a significant difference in the distribution of GBS cases between VSD and VAERS. Several factors may explain this discrepancy: VSD is an active surveillance system whereas VAERS is a passive surveillance system, case ascertainment was different between databases and no case in VAERS fulfilled Brighton criteria, all VSD, but not VAERS patients belong to one health care system, and acute event close to the vaccination date are more reported than events occurring late after vaccination.

Clinical Microbiology and Infection
Available online 26 April 2016
Potential safety issues and other factors that may affect the introduction and uptake of rotavirus vaccines
N Aliabadi, JE Tate, UD Parashar
Summary
Rotavirus vaccines have demonstrated significant impact in reducing the burden of morbidity and mortality from childhood diarrhea in countries that have implemented routine vaccination to date. Despite this success, in many countries, rotavirus vaccine coverage remains lower than that of other routine childhood vaccines. Several issues may potentially affect vaccine uptake, namely safety concerns related to intussusception with consequent age restrictions on rotavirus vaccination, contamination with porcine circovirus, vaccine-derived reassortant strains, and hospitalization in newborn nurseries at time of administration of live, oral rotavirus vaccine. In addition to these safety concerns, other factors may also affect uptake, including lower vaccine efficacy in the developing world, potential emergence of strains escaping from vaccine protection resulting in lower overall impact of a vaccination program, and sustainable vaccine financing. Although further work is needed to address some of these concerns, global policy bodies have reaffirmed that the benefits of rotavirus vaccination outweigh the risks and vaccine use is recommended globally.

Health Education
Vol. 116, Issue 4, 2016
Intention of college students to receive the human papillomavirus vaccine
K Richards, K Weare –
Abstract:
Purpose
The current study set out to better understand what influences the intentions of college students to receive the human papillomavirus (HPV) vaccine. HPV is the most common sexually transmitted infection in the U.S. and cancers related to HPV are on the rise.
Design/methodology/approach
A 2×2 experimental design was used to predict the intentions. Messages were created that manipulated the level of severity and vulnerability to determine which would increase intentions to receive the HPV vaccine. Each of the 278 participants viewed a message that contained one severity message (high or low) and one vulnerability message (high or low).
Findings
Regression was used to determine that elements of the protection motivation theory (PMT) such as vulnerability and fear, along with norms, and information seeking explained a significant portion of the variance in intent to be vaccinated (R2=.40, F(4,268)=44.47, p<.001). Norms had the most influence on intention (β = .42, p<.001), next was vulnerability (β = .21, p<.001) then fear (β = .16, p=.002), and finally information seeking (β = .10, p=.01).
Originality/value
The current college age population did not have the opportunity to be vaccinated early and the recent (2011) recommendation that males get vaccinated makes this research valuable to those designing vaccination messages. The current study shows that norms were the most influential variable in regards to increasing intent to get vaccinated.

Media/Policy Watch
This section is intended to alert readers to substantive news, analysis and opinion from the general media 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.

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Huffington Post
http://www.huffingtonpost.com/impact/
Accessed 30 April 2016
Vaccines: A Global Health Success Story That Keeps Us On Our Toes
| 26 April 2016
by Flavia Bustreo, WHO ADG and Vice Chair of Gavi, and Marie-Paule Kieny, WHO ADG , Health Systems and Innovation
Suspense and high stakes
It’s no secret that vaccines are considered one of the greatest global health achievements. Every year they avert an estimated 2 to 3 million deaths.

During the last two centuries, vaccines have eradicated smallpox, reduced global child mortality rates, and prevented countless birth defects and lifelong disabilities, such as paralysis from polio.
But, the success story of vaccination is not yet finished.

There’s still a book waiting to be written that’s guaranteed to keep all of us, not just global health experts, up at night. Fortunately, many of the chapters full of suspense, high stakes and perseverance are being written right now…
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New York Times
http://www.nytimes.com/
Accessed 30 April 2016
6 Measles Cases Reported in Memphis Area, Exceeding Rest of U.S.
April 27, 2016 – By DANIEL VICTOR and CATHERINE SAINT LOUIS
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TIME
http://time.com/
Accessed 30 April 2016
Historic Global Vaccine Rollout Could End Polio Forever
27 April 2016
by Walter Orenstein, Associate Director of the Emory Vaccine Center
‘Never before in the history of vaccines have we collaborated on this scale, this quickly’
Let’s start simple: Imagine you need to vaccinate a child against a terrible disease. You acquire and administer the correct dosage to protect that child from a debilitating virus. Now, imagine doing that across a whole city. You train health workers, distribute the vaccine to every health facility, explain the process to parents and monitor closely to make sure all children in the city are being reached. Now, do it for a whole district. A whole country. 155 countries. Do all of that in just two weeks. It’s happening right now, all around the world. Between April 17 and May 1, health workers, governments and communities are working together to execute the largest, fastest effort in history to rollout a vaccine in routine immunization systems, as one of the final steps to end polio forever…
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Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 30 April 2016
Advocates hold NYC protest over price of pneumonia vaccine
April 27, 2016 1:26 pm ET
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Washington Post
http://www.washingtonpost.com/
Accessed 30 April 2016
Congress heads out with no resolution on Zika, Puerto Rico
Congress accomplished relatively little in a short work period, missing deadlines on the budget and on helping Puerto Rico with its financial crisis as lawmakers began a weeklong break.
Andrew Taylor | AP | Business | Apr 30, 2016

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

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

– pdf version:  A pdf of the current issue is available here:  Vaccines and Global Health_The Week in Review_23 April 2016

– blog edition: comprised of the approx. 35+ entries posted below on 24 April 2016.

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

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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

World Immunization Week 2016: Close the immunization gap
21 April 2016 | Geneva – During World Immunization Week 2016, held 24-30 April, WHO highlights recent gains in immunization coverage, and outlines further steps countries can take to “Close the Immunization Gap” and meet global vaccination targets by 2020.

“Last year immunization led to some notable wins in the fight against polio, rubella and maternal and neonatal tetanus,” says Dr Margaret Chan, WHO Director-General. “But they were isolated wins. Polio was eliminated in 1 country, tetanus in 3, and rubella in 1 geographical region. The challenge now is to make gains like this the norm.”

Immunization averts 2 to 3 million deaths annually; however, an additional 1.5 million deaths could be avoided if global vaccination coverage improves. Today, an estimated 18.7 million infants – nearly 1 in 5 children – worldwide are still missing routine immunizations for preventable diseases, such as diphtheria, pertussis and tetanus…

Zika virus [to 23 April 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

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Zika situation report
14 April 2016
Zika virus, Microcephaly and Guillain-Barré syndrome
Read the full situation report
Summary
:: From 1 January 2007 to 20 April 2016, Zika virus transmission was documented in a total of 66 countries and territories.

:: Mosquito-borne transmission:
>> 42 countries are experiencing a first outbreak of Zika virus since 2015, with no previous evidence of circulation, and with ongoing transmission by mosquitos.
>> 17 countries have reported evidence of Zika virus transmission prior to 2015, with or without ongoing transmission or have reported an outbreak since 2015 that is now over.

:: Person-to-person transmission:
>> Eight countries have now reported evidence of person-to-person transmission of Zika virus, other than mosquito-borne transmission (Argentina, Chile, France, Italy, New Zealand, Peru, Portugal and the United States of America).

:: In the week to 20 April, no additional countries have reported mosquito-borne Zika virus transmission. Peru and Portugal are the latest countries to report person-to-person transmission.

:: Microcephaly and other fetal malformations potentially associated with Zika virus infection or suggestive of congenital infection have been reported in six countries (Brazil, Cabo Verde, Colombia, French Polynesia, Martinique and Panama). Two cases, each linked to a stay in Brazil, were detected in Slovenia and the United States of America. A further case, linked to a brief stay in Mexico, Guatemala and Belize, was detected in a pregnant woman in the United States of America.

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Disease Outbreak News (DONs)
:: 22 April 2016 Zika virus infection – Papua New Guinea
:: 21 April 2016 Zika virus infection – Peru
:: 20 April 2016 Zika virus infection – Saint Lucia

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Zika Open [to 23 April 2016]
[Bulletin of the World Health Organization]
:: All papers available here New papers below:
Analysis of the genetic divergence in Asian strains of ZIKA virus with reference to 2015-2016 outbreaks
– Jatin Shrinet, Aditi Agrawal, Raj K Bhatnagar & Sujatha Sunil
Posted: 22 April 2016
http://dx.doi.org/10.2471/BLT.16.176065
pdf, 2.38Mb

Clinical comparison, standardization and optimization of Zika virus molecular detection
– Victor M. Corman, Andrea Rasche, Cecile Baronti, Souhaib Aldabbagh, Daniel Cadar, Chantal B.E.M. Reusken, Suzan D. Pas, Abraham Goorhuis, Janke Schinkel, Richard Molenkamp, Beate M. Kuemmerer, Tobias Bleicker, Sebastian Brünink, Monika Eschbach-Bludau, Anna M. Eis-Hübinger, Marion P. Koopmans, Jonas Schmidt-Chanasit, Martin P. Grobusch, Xavier de Lamballerie, Christian Drosten, & Jan Felix Drexler
Posted: 19 April 2016
http://dx.doi.org/10.2471/BLT.16.175950

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CDC/ACIP [to 23 April 2016]
http://www.cdc.gov/media/index.html
FRIDAY, APRIL 22, 2016
CDC and OSHA Issue Interim Guidance for Protecting Workers from Occupational Exposure to Zika Virus
The Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) today issued new guidance and information for protecting workers from occupational exposure to Zika…

MONDAY, APRIL 18, 2016
CDC adds Belize to interim travel guidance related to Zika virus
CDC is working with other public health officials to monitor for ongoing Zika virus? transmission. Today, CDC posted a Zika virus travel notice for Belize. CDC has issued travel notices…

MMWR April 22, 2016 / Vol. 65 / No. 15
:: Patterns in Zika Virus Testing and Infection, by Report of Symptoms and Pregnancy Status — United States, January 3–March 5, 2016

EBOLA/EVD [to 23 April 2016]
“Threat to international peace and security” (UN Security Council)

Editor’s Note:
Following last week’s decision by WHO, we have removed the Public Health Emergency of International Concern (PHEIC) designation we have carried above. We have not identified any action by the UN Security Council to change the “Threat to international peace and security” designation. We will continue to present Ebola updates in this space for the near-term, and monitor whether the Security Council takes action on the threat designation.
The last “Ebola Situation Update” is dated 30 March 2016 and we observe that WHO has established an Ebola Situation Report archive, indicating that this may be the final situation report. There is no announcement on this evident on the website.

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The role of training in the West Africa Ebola response
April 2016
The magnitude of the 2014-2015 West Africa Ebola outbreak combined with a dearth of local and international expertise in tackling the disease necessitated training on a mass scale. Over the duration of the epidemic, WHO and partners trained more than 8,000 health professionals from over 80 nations, including the Ebola-affected countries.

The training courses focused on protecting first responders through disease-specific information and safety measures and preparing them for a range of specific Ebola response functions, including treatment of Ebola patients, case tracking, safe burials, epidemiology and infection prevention and control.
To better understand the impact of the trainings, WHO commissioned a review, which was conducted by an independent, external body.

:: Read the review, its conclusions and its recommendations

POLIO [to 23 April 2016]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 20 April 2016
:: The globally synchronized switch from the trivalent to bivalent oral polio vaccine, the first stage of objective 2 of the Polio Eradication and Endgame Strategic Plan 2013-2018, is underway between 17 April and 1 May. Follow a live update of which countries have undergone the switch here. Learn more about the rationale for the switch through this series of videos.

:: The Strategic Advisory Group of Experts on immunization (SAGE) met on the 12 to 14 April to discuss polio eradication. The official report from there meeting is available here.

:: The final communique of the Organisation of Islamic Cooperation (OIC) Istanbul Summit, adopted by OIC Heads of State and Government, reaffirmed the importance of preserving the health and wellbeing of children as a duty of parents and society as prescribed by Islam, and appealed to religious scholars and leaders to support polio eradication efforts.

:: The World Health Assembly (WHA) Report on Poliomyelitis has been published. The report summarises the status against the Polio Endgame Plan and Resolution WHA68.3, adopted by the WHA in May 2015.

:: Around the world, countries that remain vulnerable to polio are continuing to vaccinate children and build immunity, as shown in Jordan through this series of photographs.

Selected Country Levels Updates [excerpted]
Afghanistan
:: One new case of wild poliovirus type 1 (WPV1) was reported in the past week in Shigal Wa Shelten district of Kunar province with onset of paralysis on 27 March. The total number of WPV1 cases for 2016 is now three, compared to one reported by this date in 2015.
Pakistan
:: One new WPV1 environmental positive sample was reported in the past week from Sukkur district of Sindh province, with a collection date of 19 March.
:: Efforts continue to further strengthen surveillance activities in all provinces of the country to ensure that no child is missed with the vaccine
Madagascar
:: The third Outbreak Response Assessment in Madagascar found that the surveillance system is not yet strong enough to conclude that polio transmission has been interrupted. Thirty-nine high-risk districts have been identified to receive focused attention.

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Pakistan polio: Seven killed in anti-vaccination attack
BBC News – 20 April 2016
Seven Pakistani policemen, three of whom were guarding polio workers, have been killed in Karachi, officials say.
Eight gunmen on motorcycles fired at a group of three police guards and later at a van containing four officers, officials told the Pakistan Tribune.

Islamist militants oppose vaccination, saying it is a Western conspiracy to sterilise Pakistani children.

In January, 15 people were killed in a bomb attack on a vaccination centre in the south-western city of Quetta.

Reward
Polio workers called off the vaccination drive in Karachi following the attack, despite the home minister’s order to continue, the Tribune reported.

According to Pakistan’s Dawn newspaper, police have offered a reward of 5 million rupees (£33,000) for information on the killers, and 2 million rupees (£13,000) compensation to the victims’ families.

Talking to reporters at the scene, Sindh police Inspector General AD Khawaja said polio drops would be “administered to our children at all costs” and said security for polio teams would be increased…

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Vaccination Boost for Pakistan’s Children: World Bank and Partners Provide New Funding for Immunization
Washington DC, April 21, 2016—The World Bank approved today an International Development Association (IDA) credit of $50 million to increase the availability of vaccines for infectious diseases, including polio, for children under two years of age in Pakistan.

The National Immunization Support Project (NISP) is supporting the country’s Expanded Program on Immunization (EPI) that aims to immunize all children against eight vaccine preventable diseases: tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus, hepatitis B, haemophilus influenza type b (Hib), and measles. Strengthening EPI will also support Pakistan’s access to newer vaccines which are either in the process of roll out (pneumococcal vaccine) or under planning (rotavirus vaccine).

The Project is also receiving additional support of $80 million grant from a World Bank administered multi-donor trust fund, Gavi – the Vaccine Alliance, and the United States Agency for International Development. The Bill and Melinda Gates Foundation is also supporting the project through an innovative partial conversion of the IDA credit into a grant upon successful achievement of project objectives.

“Pakistan is grappling with the public health emergency of polio virus transmission. Ensuring strong routine immunization services is the first essential pillar in polio eradication”, says Illango Patchamuthu, World Bank Country Director for Pakistan. “The World Bank and other development partners are working with the Government of Pakistan to strengthen routine immunization services at the critical endgame stage of polio eradication, particularly as Pakistan introducesinjectable polio vaccine into its routine schedule”.

The project will incentivize provincial government capacity for rigorous monitoring and effective implementation of its program, including strengthened vaccine logistics, and deploying and expanding qualified technical and managerial personnel.

“Pakistan’s performance in maternal and child health remains weak and inadequate immunization coverage is a major challenge. Childhood immunization against vaccine preventable diseases can help in significant reductions in disability and death”, says Robert Oelrichs, World Bank Task Team Leader of the Project. “The project will establish linkages of the federal and provincial EPI cells with private sector health providers and health-related civil society organizations (CSOs) working in low coverage catchment areas – especially urban slums.”

Children under two years of age in Pakistan are the main beneficiaries of NISP – particularly children belonging to the poorest households in which immunization coverage is lowest. In addition, all children will benefit from strengthened polio and measles interventions.

The credit is financed by IDA, the World Bank’s fund for the poor, with a maturity of 25 years, including a grace period of 5 years.

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WHO African Region AFRO
:: African countries withdraw type 2 component of polio vaccine
Brazzaville, 22 April 2016 – As the world gets closer to global polio eradication, all 47 countries in the African Region are joining the rest of the world to switch from trivalent Oral Polio Vaccine (tOPV) to bivalent Oral Polio Vaccine (bOPV) in routine immunization schedules.

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WHO Eastern Mediterranean Region EMRO
:: National polio immunization campaign concludes in Yemen
Sana’a, 21 April 2016 – This week, a national house-to-house polio immunization campaign, organized by the Ministry of Public Health and Population and supported by WHO and UNICEF, concluded in Yemen. More than 4.5 million children under the age of 5 were successfully vaccinated by more than 40 000 health workers. Yemen has been polio free since 2006.
:: Libya completes first polio campaign since 2014 21 April 2016
:: Keeping up the fight against polio: maintaining population immunity in Jordan 19 April 2016

WHO & Regional Offices [to 23 April 2016]

Weekly Epidemiological Record (WER) 22 April 2016, vol. 91, 16 (pp. 209–216)
Contents:
209 Meningitis control in countries of the African meningitis belt, 2015

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Call for expressions of interest on tablet and smartphone app regarding in WHO Immunization Summary pdf, 50kb
18 April 2016
Deadline for application: 13 May 2016

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Disease Outbreak News (DONs)
:: 22 April 2016 Cholera – United Republic of Tanzania
:: 22 April 2016 Yellow Fever – China
:: 22 April 2016 Zika virus infection – Papua New Guinea
:: 22 April 2016 Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
:: 21 April 2016 Elizabethkingia – United States of America
:: 21 April 2016 Zika virus infection – Peru
:: 20 April 2016 Zika virus infection – Saint Lucia

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Highlights
Process to elect next Director-General of WHO begins
April 2016 — Member States can now nominate candidates to be the new head of WHO, the global public health body. This is the first step in a rigorous process which will culminate in a final vote at the World Health Assembly in May 2017.

Health and social effects of nonmedical cannabis use
April 2016 — Cannabis is the most commonly used psychoactive drug across the globe. A new WHO report examines nonmedical cannabis use, with a focus on the impact of cannabis on young people and the effects of long-term frequent use.

Global Leprosy Strategy 2016-2020
April 2016 — WHO’s new global leprosy strategy, “Accelerating towards a leprosy-free world”, focuses on strengthening government ownership and partnerships, stopping leprosy and its complication, and ending discrimination while promoting inclusion.

Yellow fever vaccination campaign extended in Angola
April 2016 — With 250 deaths and 1908 suspected cases of yellow fever reported since December 2015, Angola’s Ministry of Health, WHO, and partners have extended the vaccination campaign to 2 of the 5 provinces reporting local transmission in Angola.

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:: WHO Regional Offices
WHO African Region AFRO
:: African countries withdraw type 2 component of polio vaccine
Brazzaville, 22 April 2016 – As the world gets closer to global polio eradication, all 47 countries in the African Region are joining the rest of the world to switch from trivalent Oral Polio Vaccine (tOPV) to bivalent Oral Polio Vaccine (bOPV) in routine immunization schedules.
:: Angola extends yellow fever vaccination campaign to Huambo and Benguela provinces
19 April 2016 – As Angola grapples with its worst yellow fever outbreak in decades, the Ministry of Health, with the support of the World Health Organization (WHO) and partners have extended the vaccination campaign beyond the capital Luanda into Huambo and Benguela – 2 of the other 5 provinces reporting local transmission.

WHO Region of the Americas PAHO
:: Some 60 million people set to benefit from vaccines during Vaccination Week in the Americas (04/22/2016)

WHO South-East Asia Region SEARO
:: One year on, health partners review Nepal quake response, call for scaling up emergency preparedness 21 April 2016
:: WHO launches new global strategy seeking accelerated efforts to end leprosy 20 April 2016

WHO European Region EURO
:: From over 90 000 cases to zero in two decades: the European Region is malaria free 20-04-2016

WHO Eastern Mediterranean Region EMRO
:: National polio immunization campaign concludes in Yemen
Sana’a, 21 April 2016 – This week, a national house-to-house polio immunization campaign, organized by the Ministry of Public Health and Population and supported by WHO and UNICEF, concluded in Yemen. More than 4.5 million children under the age of 5 were successfully vaccinated by more than 40 000 health workers. Yemen has been polio free since 2006.
:: Libya completes first polio campaign since 2014 21 April 2016
:: Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks 21 April 2016
:: Keeping up the fight against polio: maintaining population immunity in Jordan
19 April 2016

WHO Western Pacific Region
:: Ending malaria: A priority in the Western Pacific Region
MANILA, 22 April 2016 – On World Malaria Day (25 April), the World Health Organization (WHO) in the Western Pacific Region calls on governments and partners to accelerate malaria control and elimination efforts in the Region and beyond by 2030.

CDC/ACIP [to 23 April 2016]
http://www.cdc.gov/media/index.html
[see Zika coverage above which includes CDC briefing content]

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MMWR April 22, 2016 / Vol. 65 / No. 15
:: Patterns in Zika Virus Testing and Infection, by Report of Symptoms and Pregnancy Status — United States, January 3–March 5, 2016
:: Notes from the Field: Development of a Contact Tracing System for Ebola Virus Disease — Kambia District, Sierra Leone, January–February 2015
:: Announcement: World Malaria Day — April 25, 2016

Two-thirds of unimmunized children live in conflict-affected countries – UNICEF
Press release
World Immunization Week –24-30th April
NEW YORK/GENEVA, 22 April 2016 – Almost two-thirds of children who have not been immunized with basic vaccines live in countries that are either partially or entirely affected by conflict, UNICEF said ahead of World Immunization Week.

Of countries in conflict, South Sudan has the highest percentage of unimmunized children, with 61 per cent not receiving the most basic childhood vaccines, followed by Somalia (58 per cent) and Syria (57 per cent).

“Conflict creates an ideal environment for disease outbreaks,” said UNICEF Chief of Immunization Robin Nandy. ”Children miss out out on basic immunizations because of the breakdown – and sometimes deliberate destruction – of vital health services. Even when medical services are available, insecurity in the area often prevents them from reaching children.”

Measles, diarrhoea, respiratory infections and malnutrition are major causes of childhood illness and death, and in conflict and emergencies, their effects can worsen. When children contract measles in non-conflict settings, fewer than 1 per cent of them die. In areas where crowding and malnutrition are rife, such as refugee camps, child deaths from measles can soar to up to 30 per cent of cases. Overcrowding and lack of basic necessities like food, water and shelter make children even more vulnerable to disease.

Areas in conflict also see the killing of health workers and the destruction of medical facilities, supplies and equipment, all of which have a disastrous effect on children’s health.
:: Conflict-affected areas in Pakistan and Afghanistan are the last remaining strongholds of the crippling poliovirus, now eliminated from the rest of the world. n Syria, immunization levels have plummeted from over 80 per cent in 2010, prior to the conflict, to 43 per cent in 2014. Polio resurfaced in the country in 2013, after 14 years with no cases.
:: In the Democratic Republic of Congo, over 2,000 suspected cases of measles have already been reported in 2016, with 17 deaths, most of them among children under 5 years old.

Vaccination – particularly against highly contagious measles – is a high priority in humanitarian emergencies and is a central part of UNICEF’s response to protect children’s health in such settings.
:: In Syria, a vaccination campaign planned to start on 24 April will target young children who have missed out on routine vaccination, especially those in besieged and hard-to-reach areas. Many of these children, born since the conflict began, have never been vaccinated.
:: In Yemen, despite fierce fighting across the country, UNICEF-supported vaccination campaigns immunized 2.4 million children against measles and rubella in January and 4.6 million children against polio in April 2016.
:: In Libya, the first nationwide polio immunization campaign in two years was completed in April. Earlier this month UNICEF shipped 1.5 million doses of vaccines to Tripoli.
:: Over 36 million children are being reached with polio vaccinations across Pakistan, where polio cases have dropped 65 per cent since 2015.
:: During 2014–2015, UNICEF supported emergency immunization campaigns against measles for more than 23 million children in Iraq, Syria and Yemen.

In emergencies and conflicts, UNICEF works with partners to restart the cold chain for vaccines and other essential medical supplies; put health teams back in place; and train health workers to provide immunization, nutrition screening, vitamin A supplements and medical treatment for women and children.

Immunization in conflict helps revive other badly needed health services. For example, in conflict-affected areas of Iraq, Syria and Yemen, health workers also offer health and nutrition services, as well as care for childhood illnesses, to populations who come forward in response to immunization campaigns.

“Children affected by conflict are pushed into a downward spiral of deprivation that robs them of their health and, by extension, their futures. Vaccination can help to break this vicious cycle,” said Nandy. “Immunization is a vital service that deserves and requires protection from all parties to a conflict.”

Gavi [to 23 April 2016]
http://www.gavialliance.org/library/news/press-releases/

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22 April 2016
Gavi tackling environmental challenges head on
Commitment to seek improvements in sustainability.
Geneva, 22 April 2016 – Gavi, the Vaccine Alliance has today published, for World Earth Day, an updated statement on Environmental Sustainability. The statement recognises the impact that issues such as resource scarcity, environmental degradation and climate change are having on global disease trends and how this can disproportionately affect children living in the countries Gavi supports. Immunisation can be a powerful tool to help countries protect the health of people.

Changes in temperature and rainfall can lead to increased prevalence and spread of vector- and water-borne diseases. Existing immunisation programmes can be severely disrupted by population displacement and resource scarcity, leading to further risks of disease outbreaks.

Gavi’s implementing partners have put in place a number of environmental sustainability policies and safeguards that guide Gavi programmes. The Alliance also encourages countries to have immunisation waste management plans compliant with WHO standards. Gavi promotes cold chain equipment improvements and for corporate procurement, Gavi requires its suppliers to comply with internationally recognised standards.

In 2016, Gavi is committed to exploring ways of making Vaccine Alliance programmes more environmentally friendly, while at the same time maintaining high standards of quality and safety. Gavi’s Secretariat will also conduct an audit of its corporate policies to reassess their environmental impact and take any relevant action to reduce the environmental impact of its activities.

Global Fund [to 23 April 2016]
http://www.theglobalfund.org/
21 April 2016
United Methodist Church Makes Major Contribution
GENEVA – The United Methodist Church’s contribution to the Global Fund has reached US$20 million, strongly supporting malaria programs in most-affected countries in Africa.

“We thank the United Methodist Church for their relentless efforts in the fight against malaria,” said Mark Dybul, Executive Director of the Global Fund. “This is the largest contribution ever received from a faith-based organization and it’s extremely encouraging to see partners of all sectors coming together to eliminate malaria.”
The people of The United Methodist Church and the Global Fund joined forces in the fight against malaria through the Imagine No Malaria campaign, which aims to raise US$75 million to address the impact of malaria in Africa through prevention, treatment, communication and education.

Bishop Thomas J. Bickerton, chair of the United Methodist Global Health Initiative, announced the latest contribution to the Global Fund ahead of World Malaria Day, April 25…

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21 April 2016
MCM Joins Partnership to Support Global Health
SEOUL, South Korea – MCM, the luxury travel goods brand from South Korea, announced that it will support global health by contributing US$10 million through (RED) over the next 10 years…

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20 April 2016
Portugal Makes New Pledge to the Global Fund
GENEVA – The Global Fund to Fight AIDS, TB and Malaria welcomed a pledge by Portugal for renewed financial support in 2016, just ahead of the Global Fund’s replenishment for the three-year period beginning in 2017.

Ambassador Pedro Nuno Bártolo announced Portugal’s contribution during a meeting at the Global Fund office in Geneva: “A partnership with the Global Fund is more than just providing a financial contribution, it’s about global solidarity. We are very honored to make this contribution.”

Mark Dybul, Executive Director of the Global Fund said: “It’s very important that Portugal is back at the table. We appreciate the efforts of Portugal to partner with the Global Fund in this important year.”

Portugal pledged €50,000 for 2016, doubling its contribution so far in the 2014-2016 funding period. The country also contributes technical assistance to Global Fund-supported programs in some Portuguese-speaking countries in order to improve the efficiency of grant implementation. In Guinea Bissau, for example, the Global Fund and the government of Portugal are currently working together to provide technical assistance to grants.

Fondation Merieux [to 23 April 2016]
Mission: Contribute to global health by strengthening local capacities of developing countries to reduce the impact of infectious diseases on vulnerable populations.
http://www.fondation-merieux.org/news

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19 April 2016
Inauguration of Charles Mérieux Infectiology Center of Brazil in Rio Branco
Rio Branco (Brazil)
Fondation Mérieux provides the 1st high level (BSL3) lab in the Amazon, along with a training and research center.

…the Charles Mérieux Infectiology Center and its Rodolphe Mérieux Laboratory at the Fundhacre Hospital in Rio Branco. The 400 m2 center, which includes 245 m2 of laboratories, was built through a partnership between the State of Acre, Fundhacre Hospital, the NGO SOS Amazonia, the University of Salvador de Bahia and Fondation Mérieux.

The center will perform 3 vital missions:
:: Service: providing patients with quality diagnosis for improved care.
:: Training: contributing to training students in clinical biology and infectious diseases.
:: Research: conducting projects that address public health issues in Brazil, especially hepatitis.

The creation of the Charles Mérieux Infectiology Center and Rodolphe Mérieux Laboratory is an important milestone in the fight against viral hepatitis, a major public health problem in the Amazon, which affects thousands of patients. The center will provide training for laboratory personnel and enable the development of fundamental and clinical research in the region. The Rodolphe Mérieux Laboratory will also perform routine testing as well as infectious disease surveillance for research programs. It has the only high biosafety level laboratory (BSL3) in the region, three biosafety level 2 (BSL2) laboratories and rooms dedicated to techniques such as molecular biology…

NIH [to 23 April 2016]
http://www.nih.gov/news-events/news-releases

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April 19, 2016
NIH study finds factors that may influence influenza vaccine effectiveness
Long-held approach to predicting seasonal influenza vaccine effectiveness may need to be revisited.
The long-held approach to predicting seasonal influenza vaccine effectiveness may need to be revisited, new research suggests. Currently, seasonal flu vaccines are designed to induce high levels of protective antibodies against hemagglutinin (HA), a protein found on the surface of the influenza virus that enables the virus to enter a human cell and initiate infection. New research conducted by scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, found that higher levels of antibody against a different flu surface protein — neuraminidase (NA) — were the better predictor of protection against flu infection and its unpleasant side effects. Neuraminidase, which is not currently the main target antigen in traditional flu vaccines, enables newly formed flu viruses to exit the host cell and cause further viral replication in the body.

The findings, from a clinical trial in which healthy volunteers were willingly exposed to naturally occurring 2009 H1N1 influenza type A virus, appear online today in the open-access journal mBio (link is external):

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mBio
doi: 10.1128/mBio.00417-16
19 April 2016 mBio vol. 7 no. 2 e00417-16
Evaluation of Antihemagglutinin and Antineuraminidase Antibodies as Correlates of Protection in an Influenza A/H1N1 Virus Healthy Human Challenge Model
Matthew J. Memolia, Pamela A. Shawb, Alison Hana, Lindsay Czajkowskia, Susan Reeda, Rani Athotaa, Tyler Bristola, Sarah Fargisa, Kyle Risosa, John H. Powersc, Richard T. Davey Jr.d, Jeffery K. Taubenbergera
Author Affiliations
aViral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
bPerelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
cDivision of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
dClinical Research Section, Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
ABSTRACT
Despite long-term investment, influenza continues to be a significant worldwide problem. The cornerstone of protection remains vaccination, and approved vaccines seek to elicit a hemagglutination inhibition (HAI) titer of ≥1:40 as the primary correlate of protection. However, recent poor vaccine performance raises questions regarding the protection afforded and whether other correlates of protection should be targeted. A healthy volunteer challenge study was performed with a wild-type 2009 A(H1N1)pdm influenza A challenge virus at the NIH Clinical Center to evaluate two groups of participants with HAI titers of ≥1:40 and IMPORTANCE
This study represents the first time the current gold standard for evaluating influenza vaccines as set by the U.S. Food and Drug Administration and the European Medicines Agency Committee for Medicinal Products for Human Use, a “protective” hemagglutination inhibition (HAI) titer of ≥1:40, has been evaluated in a well-controlled healthy volunteer challenge study since the cutoff was established. We used our established wild-type influenza A healthy volunteer human challenge model to evaluate how well this antibody titer predicts a reduction in influenza virus-induced disease. We demonstrate that although higher HAI titer is predictive of some protection, there is stronger evidence to suggest that neuraminidase inhibition (NAI) titer is more predictive of protection and reduced disease. This is the first time NAI titer has been clearly identified in a controlled trial of this type to be an independent predictor of a reduction in all aspects of influenza.

IVAC [International Vaccine Access Center] [to 23 April 2016]
http://www.jhsph.edu/research/centers-and-institutes/ivac/about-us/news.html

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[Undated]
Dose Per Container Partnership (DPCP) Launched
IVAC is pleased to become a member of JSI Research and Training Institute’s Dose Per Container Partnership (DPCP) . Three members of the IVAC/Johns Hopkins Bloomberg School of Public Health, including Bruce Lee, Lois Privor-Dumm and Dan Salmon are now providing their expertise to an issue that has been an important concern for the team over the past several years. Projects leading up and contributing to this initiative included the Primary Container Roundtable, HERMES modeling efforts and work around vaccine safety and confidence. The aim of the partnership is to use Dose per Container (DPC) information to support vaccine product and program decision making in order to optimize high, equitable, timely, safe and cost-effective coverage. This work will involve documentation of current policies and processes in combination with studies that document the programmatic implications of vaccine presentation. Programmatic implications of DCP, which include cost, cost per dose delivered (including wastage), equitable and timely coverage, compliance with the multi-dose vial policy, healthcare worker perceptions, safety and missed opportunities, will be assessed in country so that the evidence case for sometimes complex decisions can be supported through a better understanding of the relationship between DPC and the various immunization and health system variables. Tools will be developed and data disseminated to help countries make better decisions about the key trade-offs between cost and health impact.

European Medicines Agency [to 23 April 2016]
http://www.ema.europa.eu/

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22/04/2016
First DNA vaccine in the EU recommended for use in salmon
Clynav to protect Atlantic salmon from serious infectious disease
The European Medicines Agency (EMA) has recommended granting a marketing authorisation in the European Union (EU) for Clynav, a DNA vaccine to protect Atlantic salmon against Salmon Pancreas Disease (SPD) caused by salmon alphavirus subtype 3.

SPD is a serious infectious disease which causes damage to the heart, pancreas and skeletal muscle and can lead to the death of salmon. The disease has become established in some Member States and outbreaks of SPD cause significant losses in salmon farms in the EU.

Clynav is the first DNA vaccine to be recommended for marketing authorisation in the EU. A DNA vaccine consists of a genetic sequence that triggers the production of proteins directly in the cells of the vaccinated animal. These proteins stimulate a protective immune response, in the case of Clynav against salmon alphavirus subtype 3, thereby preventing or reducing the impact of the disease should the fish subsequently be exposed to this virus…

EDCTP [to 23 April 2016]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials.

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20 April 2016
Abstract submission for the Eighth EDCTP Forum is now open
EDCTP is pleased to announce that as of today the service for submission of abstracts for the Eighth Forum is open. Till 24 June 2016, we welcome abstracts for presentation at the EDCTP Forum in Lusaka, Zambia, from 6-9 November 2016. The Forum is organised by EDCTP in partnership with the Ministry of Health of the Republic of Zambia. Since 2014, the Republic of Zambia is a member of the EDCTP-Association and a Participating State in the EDCTP2 programme.
Go to EDCTP 2016 Forum website.

European Vaccine Initiative [to 23 April 2016]
http://www.euvaccine.eu/news-events

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20 April 2016
Sanofi – Institut Pasteur Awards (SIPA) 2016
Call for Nominations
Sanofi and the Institut Pasteur are pleased to announce the Sanofi – Institut Pasteur 2016 Awards.

These Awards will honor and support four scientists, whose outstanding research shows real progress in the life sciences that contributes to global public health, specifically in the following fields:
– Tropical and neglected diseases
– Immunology
– Drug resistance
– Neuroscience

Investing in Nutrition: The Foundation for Development
World Bank, Results for Development Institute, and 1,000 Days – with support from the Bill & Melinda Gates Foundation and the Children’s Investment Fund Foundation
April 2016 :: 8 pages
Pdf: http://thousanddays.org/tdays-content/uploads/Investing-in-Nutrition-The-Foundation-for-Development.pdf

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Introduction
Every year, malnutrition claims the lives of 3 million children under age five and costs the global economy billions of dollars in lost productivity and health care costs. Yet those losses are almost entirely preventable. A large body of scientific evidence shows that improving nutrition
during the critical 1,000 day window from a woman’s pregnancy to her child’s second birthday has the potential to save lives, help millions of children develop fully and thrive, and deliver greater economic prosperity.1, 2, 3, 4, 5, 6

There is an urgent need for global action on nutrition. In 2012, the 194 member states of the World Health Assembly (WHA) endorsed the first-ever global targets to improve nutrition focusing on six areas: stunting, exclusive breastfeeding, wasting, anemia, low birth weight, and overweight. And while some
of the targets were enshrined within Sustainable Development Goal 2, which commits to end malnutrition in all its forms by the year 2030, the world is not on track to achieve any of the six nutrition targets.

Accelerating progress against malnutrition will require investment in both proven nutrition interventions and research to understand how to bring promising solutions to scale in a cost-effective manner.7…

…This brief summarizes the analysis of the costs, impacts, and investments needed to achieve the targets and how governments, donors, the private sector, foundations, and others can come together to finance these at scale.

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Key Messages
.1 Global action is urgently needed to tackle the pervasive problem of malnutrition.

.2 Reaching the targets to reduce stunting among children and anemia in women, increase exclusive breastfeeding rates, and mitigate the impact of wasting will require an average annual investment of $7 billion over the next 10 years. This is in addition to the $3.9 billion the world currently spends on nutrition annually.

.3 To catalyze progress toward the global nutrition targets, priority should be given to a set of the most cost-effective actions which can be scaled up immediately. Financing this more limited set of actions will require an additional annual investment of just over $2 billion for the next 10 years. The majority of this annual investment would come from country governments and donors, $1.4 billion and $650 million, respectively, while innovative financing mechanisms and
households fund the remaining gap.

.4 When combined with other health and poverty reduction efforts, this priority investment can yield significant returns: an estimated 2.2 million lives can be saved and there will be 50 million fewer cases of stunting in 2025 compared to in 2015.

.5 Achieving the targets is within reach if all partners work together to immediately step up in investments in nutrition

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PRESS RELEASE
Global Leaders Launch First-Ever Investment Framework for Nutrition and Call for Immediate Action
April 18, 2016
Additional nutrition investment of $2.2 billion/year over 10 years could save 2.2 million lives and reduce the number of stunted children by 50 million
… “An investment in nutrition can help make every other investment in health and development pay off,” said Bill Gates, co-chair of the Bill & Melinda Gates Foundation and keynote speaker at the event. “And while progress is possible, it is not inevitable. With the release of today’s analysis by the World Bank and Results for Development, we know there are proven, cost-effective tools to combat malnutrition – such as food fortification and breastfeeding. Investments in these interventions will help ensure millions more children globally have the opportunity to survive and thrive.”

Malnutrition is the underlying cause in nearly half of deaths of children under age five every year. In addition, millions more women and children bear the burden of poor health caused by malnutrition and the global economy loses billions of dollars due to lost productivity and health care costs. Yet these losses are almost entirely preventable. Investing in nutrition gives children the foundation for a healthy, productive life and establishes a foundation for sustainable global progress in health and development. The 2015 Global Nutrition Report indicates that every $1 of investment in nutrition yields $16 in benefits across health and productivity.

“The unconscionably high rates of childhood stunting in middle- and low-income countries—30 and 45 percent – are a damning indictment on us all,” said Jim Yong Kim, President, the World Bank Group. “Stunted growth has life-long consequences not only for the individual, but for countries as well, in an increasingly digitalized and service-oriented economy. Equal opportunity for all is an empty slogan if we don’t address this issue.”…

Annals of Internal Medicine
19 April 2016, Vol. 164. No. 8
http://annals.org/issue.aspx

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History of Medicine
Judging the Past: How History Should Inform Bioethics
Barron H. Lerner, MD, PhD; and Arthur L. Caplan, PhD
Bioethics has become a common course of study in medical schools, other health professional schools, and graduate and undergraduate programs. An analysis of past ethical scandals, as well as the bioethics apparatus that emerged in response to them, is often central to the discussion of bioethical questions. This historical perspective on bioethics is invaluable and demonstrates how, for example, the infamous Tuskegee syphilis study was inherently racist and how other experiments exploited mentally disabled and other disadvantaged persons. However, such instruction can resemble so-called Whig history, in which a supposedly more enlightened mindset is seen as having replaced the “bad old days” of physicians behaving immorally.

Bioethical discourse—both in the classroom and in practice—should be accompanied by efforts to historicize but not minimize past ethical transgressions. That is, bioethics needs to emphasize why and how such events occurred rather than merely condemning them with an air of moral superiority. Such instruction can reveal the complicated historical circumstances that led physician-researchers (some of whom were actually quite progressive in their thinking) to embark on projects that seem so unethical in hindsight. Such an approach is not meant to exonerate past transgressions but rather to explain them. In this manner, students and practitioners of bioethics can better appreciate how modern health professionals may be susceptible to the same types of pressures, misguided thinking, and conflicts of interest that sometimes led their predecessors astray.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 23 April 2016)

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Research article
Assessment of medicines use pattern using World Health Organization’s Prescribing, Patient Care and Health facility indicators in selected health facilities in eastern Ethiopia
Arebu I. Bilal, Ebrahim D. Osman and Anwar Mulugeta
BMC Health Services Research 2016 16:144
Published on: 23 April 2016 Abstract
Abstract
Background
About one-third of the world’s population lack access to essential medicines and this is further compounded by inappropriate prescription, dispensing, sale and use of the available medicines. The objective of the study was to assess the patterns of medicine use among health facilities in eastern Ethiopia using World Health Organization’s Prescribing, Patient Care and Health facility indicators.
Methods
A cross sectional study was carried out in eight randomly selected health centers and data were collected retrospectively as well as prospectively. Prescribing indicators were assessed retrospectively using 636 prescriptions selected by systematic random sampling technique among prescriptions filled between September 2013 and September 2014. Patient care indicators were assessed prospectively by interviewing 708 patients from the health facilities. Health facilities were assessed through observation. Data were entered and analyzed using Statistical Packages for Social Sciences version 20. P-value less than 0.05 at 95 % confidence interval considered for significance of relationships for associations in statistical tests.
Results
The average number of medicines per prescription was 2.2 with standard deviation of 0.8. The proportion of medicines prescribed by generic name was 97 and 92 % of the prescribed medicines were included in List of Essential Medicines for Ethiopia, Prescriptions containing antibiotics and injections constituted (82.5 and 11.2 %) respectively. Of the total of 1426 medicines prescribed, 49.6 % were antibiotics, with amoxicillin (33.3 %) and co-trimoxazole (16.0 %) being the most commonly prescribed agents. The average consultation and dispensing times were 5.6 and 2.7 min, respectively. Among the medicines dispensed, 64.0 % were adequately labeled and the proportion of patients with adequate knowledge about medicines was 69 %.
Conclusion
The prescribing and dispensing practices in the health facilities are fairly good and are not that far from the standard WHO requirements. However, there is a need to do more on some issues, including prescribing practice of antibiotics, average number of medicines per prescription, and patients’ dosage form knowledge

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 23 April 2016)

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Research article
Treatment outcomes for patients with Middle Eastern Respiratory Syndrome Coronavirus (MERS CoV) infection at a coronavirus referral center in the Kingdom of Saudi Arabia
Mohammed Al Ghamdi, Khalid M. Alghamdi, Yasmeen Ghandoora, Ameera Alzahrani, Fatmah Salah, Abdulmoatani Alsulami, Mayada F. Bawayan, Dhananjay Vaidya, Trish M. Perl and Geeta Sood
BMC Infectious Diseases 2016 16:174
Published on: 21 April 2016
Abstract
Background
Middle Eastern Respiratory Syndrome coronavirus (MERS-CoV) is a poorly understood disease with no known treatments. We describe the clinical features and treatment outcomes of patients with laboratory confirmed MERS-CoV at a regional referral center in the Kingdom of Saudi Arabia.
Methods
In 2014, a retrospective chart review was performed on patients with a laboratory confirmed diagnosis of MERS-CoV to determine clinical and treatment characteristics associated with death. Confounding was evaluated and a multivariate logistic regression was performed to assess the independent effect of treatments administered.
Results
Fifty-one patients had an overall mortality of 37 %. Most patients were male (78 %) with a mean age of 54 years. Almost a quarter of the patients were healthcare workers (23.5 %) and 41 % had a known exposure to another person with MERS-CoV. Survival was associated with male gender, working as a healthcare worker, history of hypertension, vomiting on admission, elevated respiratory rate, abnormal lung exam, elevated alanine transaminase (ALT), clearance of MERS-CoV on repeat PCR polymerase chain reaction (PCR) testing, and mycophenolate mofetil treatment. Survival was reduced in the presence of coronary artery disease, hypotension, hypoxemia, CXR (chest X-ray) abnormalities, leukocytosis, creatinine >1 · 5 mg/dL, thrombocytopenia, anemia, and renal failure. In a multivariate analysis of treatments administered, severity of illness was the greatest predictor of reduced survival.
Conclusions
Care for patients with MERS-CoV remains a challenge. In this retrospective cohort, interferon beta and mycophenolate mofetil treatment were predictors of increased survival in the univariate analysis. Severity of illness was the greatest predictor of reduced survival in the multivariate analysis. Larger randomized trials are needed to better evaluate the efficacy of these treatment regimens for MERS-CoV.

Contemporary Clinical Trials
Volume 48, In Progress (May 2016)
http://www.sciencedirect.com/science/journal/15517144/48

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Clinical Trial Management and Optimization
Systematic collection of patient reported outcome research data: A checklist for clinical research professionals
Original Research Article
Pages 21-29
Leslie Wehrlen, Mike Krumlauf, Elizabeth Ness, Damiana Maloof, Margaret Bevans
Abstract
Understanding the human experience is no longer an outcome explored strictly by social and behavioral researchers. Increasingly, biomedical researchers are also including patient reported outcomes (PROs) in their clinical research studies not only due to calls for increased patient engagement in research but also healthcare. Collecting PROs in clinical research studies offers a lens into the patient’s unique perspective providing important information to industry sponsors and the FDA. Approximately 30% of trials include PROs as primary or secondary endpoints and a quarter of FDA new drug, device and biologic applications include PRO data to support labeling claims. In this paper PRO, represents any information obtained directly from the patient or their proxy, without interpretation by another individual to ascertain their health, evaluate symptoms or conditions and extends the reference of PRO, as defined by the FDA, to include other sources such as patient diaries.
Consumers and clinicians consistently report that PRO data are valued, and can aide when deciding between treatment options; therefore an integral part of clinical research. However, little guidance exists for clinical research professionals (CRPs) responsible for collecting PRO data on the best practices to ensure quality data collection so that an accurate assessment of the patient’s view is collected. Therefore the purpose of this work was to develop and validate a checklist to guide quality collection of PRO data. The checklist synthesizes best practices from published literature and expert opinions addressing practical and methodological challenges CRPs often encounter when collecting PRO data in research settings.

Eurosurveillance
Volume 21, Issue 16, 21 April 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Editorials
Importance of timely monitoring of seasonal influenza vaccine effectiveness
by RG Pebody, K Mølbak

Surveillance report
Pandemic vaccination strategies and influenza severe outcomes during the influenza A(H1N1)pdm09 pandemic and the post-pandemic influenza season: the Nordic experience
by J Gil Cuesta, P Aavitsland, H Englund, Ó Gudlaugsson, SH Hauge, O Lyytikäinen, G Sigmundsdóttir, A Tegnell, M Virtanen, the Nordic influenza comparison group, T Grove Krause

Systematic review
Concordance of interim and final estimates of influenza vaccine effectiveness: a systematic review
by VK Leung, BJ Cowling, S Feng, SG Sullivan

Review articles
Lessons learnt to keep Europe polio-free: a review of outbreaks in the European Union, European Economic Area, and candidate countries, 1973 to 2013
by T Derrough, A Salekeen

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 23 April 2016]

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Review
The Pan-University Network for Global Health: framework for collaboration and review of global health needs
M. S. Winchester, R. BeLue, T. Oni, U. Wittwer-Backofen, D. Deobagkar, H. Onya, T. A. Samuels, S. A. Matthews, C. Stone and C. Airhihenbuwa
Published on: 21 April 2016
Abstract
In the current United Nations efforts to plan for post 2015-Millennium Development Goals, global partnership to address non-communicable diseases (NCDs) has become a critical goal to effectively respond to the complex global challenges of which inequity in health remains a persistent challenge. Building capacity in terms of well-equipped local researchers and service providers is a key to bridging the inequity in global health. Launched by Penn State University in 2014, the Pan University Network for Global Health responds to this need by bridging researchers at more than 10 universities across the globe. In this paper we outline our framework for international and interdisciplinary collaboration, as well the rationale for our research areas, including a review of these two themes. After its initial meeting, the network has established two central thematic priorities: 1) urbanization and health and 2) the intersection of infectious diseases and NCDs. The urban population in the global south will nearly double in 25 years (approx. 2 billion today to over 3.5 billion by 2040). Urban population growth will have a direct impact on global health, and this growth will be burdened with uneven development and the persistence of urban spatial inequality, including health disparities. The NCD burden, which includes conditions such as hypertension, stroke, and diabetes, is outstripping infectious disease in countries in the global south that are considered to be disproportionately burdened by infectious diseases. Addressing these two priorities demands an interdisciplinary and multi-institutional model to stimulate innovation and synergy that will influence the overall framing of research questions as well as the integration and coordination of research.

Health Affairs
April 2016; Volume 35, Issue 4
http://content.healthaffairs.org/content/current

Issue Focus: Patients’ & Consumers’ Use Of Evidence
ANALYSIS & COMMENTARY: The Ethical Imperative And Moral Challenges Of Engaging Patients And The Public With Evidence
Mildred Z. Solomon, Michael K. Gusmano, and Karen J. Maschke
Health Aff April 2016 35:583-589; doi:10.1377/hlthaff.2015.1392
Abstract
Engaging patients and the public with evidence is an ethical imperative because engagement is central to respect for persons and will likely improve health outcomes, facilitate the stewardship of resources, enhance prospects for justice, and build public trust. However, patient and public engagement is also morally complex, because evidence alone is never definitive. As patients and the public engage with evidence, value conflicts will arise and must be managed to achieve trustworthy decision making. We outline value conflicts likely to emerge in the following five settings: clinical care, health care organizations, public health, the regulatory context, and among payers. Using a variety of examples, we offer suggestions about how such conflicts may be managed, including providing more opportunities for democratic deliberation and having more explicit community discussion of how to balance personal choice and community well-being, transparent discussions of cost and quality outcomes, and greater patient engagement in community-based participatory research and the governance of learning health systems.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 23 April 2016]

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Research
The West African Health Organization’s experience in improving the health research environment in the ECOWAS region
Jude Aidam and Issiaka Sombié
Published on: 20 April 2016
Abstract
Background
The West African Health Organization (WAHO) implemented a research development program in West Africa during 2009–2013 using the Knowledge for Better Health Research Capacity Development Framework, developed by Pang et al. (Bull World Health Organ 81(11):815–820, 2003), on strategies used to improve the research environment. The framework has the following components: stewardship, financing, sustainable resourcing and research utilization. This paper describes how WAHO implemented this research development program in the West African region to help improve the research environment and lessons learnt.
Methods
This is a retrospective review of the regional research development program using a triangulation of activity reports, an independent evaluation and the authors’ experiences with stakeholders. This program was designed to address gaps along the components of the framework and to improve partnership. The activities, results and challenges are summarised for each component of the framework. The independent evaluation was conducted using over 180 semi-structured interviews of key stakeholders in the West African region and activity reports. WAHO and major stakeholders validated these findings during a regional meeting.
Results
All 15 ECOWAS countries benefited from this regional research development program. WAHO provided technical and financial support to eight countries to develop their policies, priorities and plans for research development to improve their research governance. WAHO, along with other technical and financial partners, organised many capacity-strengthening trainings in health systems research methodology, resource mobilization, ethical oversight and on HRWeb, a research information management platform. WAHO helped launch a regional network of health research institutions to improve collaboration between regional participating institutions. Further, WAHO developed strategic research partnerships and mobilised additional funding to support the program. The program supported 24 health research projects. High staff turnover, weak institutional capacities and ineffective collaboration were some of the challenges encountered during program activity implementation.
Conclusion
The regional collaborative approach to health research development using this framework was effective given the challenges in the West African region. The achievements particularly with improved research partnerships and funding helped strengthen local health research environments. This highlights WAHO’s role and the common experiences in the West African region in improving health research.

Humanitarian Exchange Magazine
Number 66 A pril 2016
http://odihpn.org/magazine/humanitarian-innovation/

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Special Focus: Humanitarian Innovation
by Humanitarian Practice Network and Kim Scriven April 2016
This edition of Humanitarian Exchange, co-edited with ELRHA Humanitarian Innovation Fund (HIF) manager Kim Scriven, focuses on innovation in the humanitarian sector.
:: Kim Scriven provides an overview of the rising interest in and funding for innovation, while highlighting what more needs to be done to improve the evidence base, relocate capacity and develop guidance.
:: In her article, Alice Obrecht proposes three success criteria for innovation based on case studies of HIF-funded innovation projects.
:: Nathaniel A. Raymond and Casey S. Harrity argue for clear ethnical and technical doctrine to guide the use of technology innovation.
:: Rahel Dette and Julia Steets explore the role of technology in monitoring aid in insecure environments.
:: Monica Zikusooka and colleagues report on using technology to conduct simulated field visits in Somalia.
:: Karen Kisakeni Sørensen highlights the challenges of innovating in the midst of armed conflict in her article on the use of technology in mine action in Ukraine.
:: Andrew Schroeder and Patrick Meier explore the opportunities and challenges posed by robotics.
:: Josiah Kaplan and Evan Easton-Calabria look at the opportunities and hazards of military innovation for the humanitarian sector.
:: Ben Ramalingam shares lessons on innovation in the Nepal earthquake response.
:: Elizabeth Gilmour discusses crowd-sourced mapping during the Nepal earthquake response.
:: Ronak Patel and Mihir Bhatt discuss a small-business micro-insurance programme in India.
:: Robert Hakiza and Evan Easton-Calabria elaborate on their research into urban micro-finance programmes run by refugees in Uganda.
:: Caetano Dorea describes the development of a new water filtration product.
:: Eric James and Laura James explore the potential of 3D printing of humanitarian supplies in the field.
:: Paul Currion offers personal reflection on the rise and decline of Humanitarian Information Centres (HICs).

Infectious Diseases of Poverty

[Accessed 23 April 2016]

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Opinion
The global spread of Zika virus: is public and media concern justified in regions currently unaffected?
Narayan Gyawali, Richard S. Bradbury and Andrew W. Taylor-Robinson
Published on: 19 April 2016

JAMA
April 19, 2016, Vol 315, No. 15
http://jama.jamanetwork.com/issue.aspx

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Preliminary Communication
Safety and Immunogenicity of Novel Adenovirus Type 26– and Modified Vaccinia Ankara–Vectored Ebola Vaccines: A Randomized Clinical Trial
Iain D. Milligan, MRCP; Malick M. Gibani, MRCP; Richard Sewell, BA; Elizabeth A. Clutterbuck, PhD; Danielle Campbell, BScN; Emma Plested; Elizabeth Nuthall, BSc; Merryn Voysey, MBiostat; Laura Silva-Reyes, MSc; M. Juliana McElrath, MD, PhD; Stephen C. De Rosa, MD; Nicole Frahm, PhD; Kristen W. Cohen, PhD; Georgi Shukarev, MD; Nicola Orzabal, BSc; Wilbert van Duijnhoven, MSc; Carla Truyers, PhD; Nora Bachmayer, PhD; Daniel Splinter, PhD; Nathaly Samy, MD; Maria Grazia Pau, PhD; Hanneke Schuitemaker, PhD; Kerstin Luhn, PhD; Benoit Callendret, PhD; Johan Van Hoof, MD; Macaya Douoguih, MD, MPH; Katie Ewer, PhD; Brian Angus, MD; Andrew J. Pollard, FRCPCH, PhD; Matthew D. Snape, FRCPCH, MD
Author Affiliations
1Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
2Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
3Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
4Janssen, Pharmaceutical Companies of Johnson & Johnson, Leiden, the Netherlands
5Bavarian Nordic, Martinsried, Germany
6Jenner Institute, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, United Kingdom
7National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, United Kingdom
8Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
Includes: Supplemental Content
JAMA. 2016;315(15):1610-1623. doi:10.1001/jama.2016.4218.

Abstract
Importance
Developing effective vaccines against Ebola virus is a global priority.
Objective
To evaluate an adenovirus type 26 vector vaccine encoding Ebola glycoprotein (Ad26.ZEBOV) and a modified vaccinia Ankara vector vaccine, encoding glycoproteins from Ebola virus, Sudan virus, Marburg virus, and Tai Forest virus nucleoprotein (MVA-BN-Filo).
Design, Setting, and Participants
Single-center, randomized, placebo-controlled, observer-blind, phase 1 trial performed in Oxford, United Kingdom, enrolling healthy 18- to 50-year-olds from December 2014; 8-month follow-up was completed October 2015.
Interventions
Participants were randomized into 4 groups, within which they were simultaneously randomized 5:1 to receive study vaccines or placebo. Those receiving active vaccines were primed with Ad26.ZEBOV (5 × 1010 viral particles) or MVA-BN-Filo (1 × 108 median tissue culture infective dose) and boosted with the alternative vaccine 28 or 56 days later. A fifth, open-label group received Ad26.ZEBOV boosted by MVA-BN-Filo 14 days later.
Main Outcomes and Measures
The primary outcomes were safety and tolerability. All adverse events were recorded until 21 days after each immunization; serious adverse events were recorded throughout the trial. Secondary outcomes were humoral and cellular immune responses to immunization, as assessed by enzyme-linked immunosorbent assay and enzyme-linked immunospot performed at baseline and from 7 days after each immunization until 8 months after priming immunizations.
Results
Among 87 study participants (median age, 38.5 years; 66.7% female), 72 were randomized into 4 groups of 18, and 15 were included in the open-label group. Four participants did not receive a booster dose; 67 of 75 study vaccine recipients were followed up at 8 months. No vaccine-related serious adverse events occurred. No participant became febrile after MVA-BN-Filo, compared with 3 of 60 participants (5%; 95% CI, 1%-14%) receiving Ad26.ZEBOV in the randomized groups. In the open-label group, 4 of 15 Ad26.ZEBOV recipients (27%; 95% CI, 8%-55%) experienced fever. In the randomized groups, 28 of 29 Ad26.ZEBOV recipients (97%; 95% CI, 82%- 99.9%) and 7 of 30 MVA-BN-Filo recipients (23%; 95% CI, 10%-42%) had detectable Ebola glycoprotein-specific IgG 28 days after primary immunization. All vaccine recipients had specific IgG detectable 21 days postboost and at 8-month follow-up. Within randomized groups, at 7 days postboost, at least 86% of vaccine recipients showed Ebola-specific T-cell responses.
Conclusions and Relevance
In this phase 1 study of healthy volunteers, immunization with Ad26.ZEBOV or MVA-BN-Filo did not result in any vaccine-related serious adverse events. An immune response was observed after primary immunization with Ad26.ZEBOV; boosting by MVA-BN-Filo resulted in sustained elevation of specific immunity. These vaccines are being further assessed in phase 2 and 3 studies.
Trial Registration
clinicaltrials.gov Identifier: NCT02313077

The Lancet
Apr 23, 2016 Volume 387 Number 10029 p1693-1788
http://www.thelancet.com/journals/lancet/issue/current

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Review
The path to eradication: a progress report on the malaria-eliminating countries
Gretchen Newby, Adam Bennett, Erika Larson, Chris Cotter, Rima Shretta, Allison A Phillips, Richard G A Feachem
Summary
In the past several years, as worldwide morbidity and mortality due to malaria have continued to decrease, the global malaria community has grown increasingly supportive of the idea of malaria eradication. In 2015, three noteworthy global documents were released—the WHO’s Global Technical Strategy for Malaria 2016–2030, the Roll Back Malaria Partnership’s Action and Investment to defeat Malaria 2016–2030, and From Aspiration to Action: What Will It Take to End Malaria?—that collectively advocate for malaria elimination and eradication and outline key operational, technical, and financial strategies to achieve progress toward malaria eradication. In light of this remarkable change in global attitudes toward malaria elimination and eradication, and as the malaria community debates how and when to embark on this ambitious goal, it is important to assess current progress along the path to eradication. Although low-income, high-burden countries are often the focus when discussing the substantial challenges of eradication, the progress toward elimination in middle-income, low-burden countries is a major driver of global progress and deserves better recognition. Additionally, although global support and guidance is essential for success, malaria elimination and eradication efforts will ultimately be driven at the country level and achieved in a collaborative manner, region by region. In this Review, we examine the present status of the 35 malaria-eliminating countries, summarise existing national and regional elimination goals and the regional frameworks that support them, and identify the most crucial enabling factors and potential barriers to achieving eradication by a theoretical end date of 2040.

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Public Health
Averting a malaria disaster: will insecticide resistance derail malaria control?
Janet Hemingway, Hilary Ranson, Alan Magill, Jan Kolaczinski, Christen Fornadel, John Gimnig, Maureen Coetzee, Frederic Simard, Dabiré K Roch, Clément Kerah Hinzoumbe, John Pickett, David Schellenberg, Peter Gething, Mark Hoppé, Nicholas Hamon
Summary
World Malaria Day 2015 highlighted the progress made in the development of new methods of prevention (vaccines and insecticides) and treatment (single dose drugs) of the disease. However, increasing drug and insecticide resistance threatens the successes made with existing methods. Insecticide resistance has decreased the efficacy of the most commonly used insecticide class of pyrethroids. This decreased efficacy has increased mosquito survival, which is a prelude to rising incidence of malaria and fatalities. Despite intensive research efforts, new insecticides will not reach the market for at least 5 years. Elimination of malaria is not possible without effective mosquito control. Therefore, to combat the threat of resistance, key stakeholders need to rapidly embrace a multifaceted approach including a reduction in the cost of bringing new resistance management methods to market and the streamlining of associated development, policy, and implementation pathways to counter this looming public health catastrophe.