Nature – 21 April 2016

Nature
Volume 532 Number 7599 pp282-408 21 April 2016
http://www.nature.com/nature/current_issue.html

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Editorials
Monkeying around
China, with its freedom from the ethical pressures experienced by researchers elsewhere, is poised to become the go-to country for work on non-human primates.

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World View
The Paris Agreement has solved a troubling problem
By endorsing a limit of 1.5 °C, the climate negotiations have effectively defined what society considers dangerous, says Simon L. Lewis.

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Comment
Track climate pledges of cities and companies
Data transparency is key to accounting for how local governments and the private sector are contributing to global emissions reduction, say Angel Hsu and colleagues.

New England Journal of Medicine – April 21, 2016

New England Journal of Medicine
April 21, 2016 Vol. 374 No. 16
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
Partnerships, Not Parachutists, for Zika Research
David L. Heymann, M.D., Joanne Liu, M.D., and Louis Lillywhite, M.B., B.Ch.
[Free full-text]
N Engl J Med 2016; 374:1504-1505 April 21, 2016 DOI: 10.1056/NEJMp1602278
Initial text
When the director-general of the World Health Organization (WHO) declared that the recently reported clusters of microcephaly and other neurologic disorders represent a Public Health Emergency of International Concern (PHEIC), she called for increased research into their cause, including the question of whether the Zika virus is the source of the problem.1 The declaration provides an opportunity to step up the pace of research in order to find the answer to some important questions more quickly. It could not only facilitate the accumulation of knowledge about the relationship between the Zika virus and microcephaly, but also accelerate the study of newer technologies for mosquito control, which could have far-reaching effects on global health security beyond controlling Zika infections.
But to answer these research questions effectively and maximize their contribution to enhancing health security, we believe it is critical that research be conducted collaboratively. Building and strengthening public health capacities (in part through collaborative research) are central to the International Health Regulations, an international agreement of all WHO member countries designed to strengthen health security…

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Perspective
Zika Virus as a Cause of Neurologic Disorders
Nathalie Broutet, M.D., Ph.D., Fabienne Krauer, M.Sc., Maurane Riesen, M.Sc., Asheena Khalakdina, Ph.D., Maria Almiron, M.Sc., Sylvain Aldighieri, M.D., Marcos Espinal, M.D., Nicola Low, M.D., and Christopher Dye, D.Phil.
N Engl J Med 2016; 374:1506-1509 April 21, 2016 DOI: 10.1056/NEJMp1602708
Final text
… Even with limited evidence linking Zika virus to neurologic disorders, the severe potential risks demand decisive, immediate action to protect public health. The WHO recommends applying key interventions such as intensive mosquito control; personal protection against mosquito bites; provision of appropriate clinical care for all patients with Guillain–Barré syndrome and for women before, during, and after pregnancy; and prevention of Zika virus transmission through sexual contact or blood transfusion.4 Most of these are not new interventions, but they do need strengthening. Populations must be informed of the potential current and future risks of neurologic disorders, wherever the virus is being or could be locally transmitted and in other regions inhabited by the mosquito vectors. As the putative link between Zika virus and neurologic disorders is reinforced, refined, or even refuted, public health measures will be adjusted accordingly.

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Review Article
Zika Virus
Lindsey R. Baden, M.D., editor; Lyle R. Petersen, M.D., M.P.H., Denise J. Jamieson, M.D., M.P.H., Ann M. Powers, Ph.D., and Margaret A. Honein, Ph.D., M.P.H.
N Engl J Med 2016; 374:1552-1563 April 21, 2016 DOI: 10.1056/NEJMra1602113

Vaccine Effectiveness of Polysaccharide Vaccines Against Clinical Meningitis – Niamey, Niger, June 2015

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 23 April 2016)

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Research Article
Vaccine Effectiveness of Polysaccharide Vaccines Against Clinical Meningitis – Niamey, Niger, June 2015
April 18, 2016 ·
Introduction: In 2015, a large outbreak of serogroup C meningococcal meningitis hit Niamey, Niger, in response to which a vaccination campaign was conducted late April. Using a case-control study we measured the vaccine effectiveness (VE) of tri – (ACW) and quadrivalent (ACYW) polysaccharide meningococcal vaccines against clinical meningitis among 2-15 year olds in Niamey II district between April 28th and June 30th 2015.
Methods: We selected all clinical cases registered in health centers and conducted a household- vaccination coverage cluster survey (control group). We ascertained vaccination from children/parent reports. Using odds of vaccination among controls and cases, we computed VE as 1-(Odds Ratio). To compute VE by day since vaccination, we simulated a density case control design randomly attributing recruitment dates to controls based on case dates of onset (3 controls per case). We calculated the number of days between vaccination and the date of onset/recruitment and computed VE by number of days since vaccination using a cubic-spline model. We repeated this simulated analysis 500 times and calculated the mean VE and the mean lower and upper bound of the 95% confidence interval (CI).
Results: Among 523 cases and 1800 controls, 57% and 92% were vaccinated respectively. Overall, VE at more than 10 days following vaccination was 84% (95%CI: 75-89) and 97% (94-99) for the tri- and quadrivalent vaccines respectively. VE at days 5 and 10 after trivalent vaccination was 84% (95% CI: 74-91) and 89% (95% CI: 83-93) respectively. It was 88% (95% CI: 75-94) and 95.8% (95% CI: 92 -98) respectively for the quadrivalent vaccine.
Conclusion: Results suggest a high VE of the polysaccharide vaccines against clinical meningitis, an outcome of low specificity, and a rapid protection after vaccination. We identified no potential biases leading to VE overestimation. Measuring VE and rapidity of protection against laboratory confirmed meningococcal meningitis is needed.

Experimental Treatment of Ebola Virus Disease with TKM-130803: A Single-Arm Phase 2 Clinical Trial

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 23 April 2016)

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Research Article
Experimental Treatment of Ebola Virus Disease with TKM-130803: A Single-Arm Phase 2 Clinical Trial
Jake Dunning, Foday Sahr, Amanda Rojek, Fiona Gannon, Gail Carson, Baimba Idriss, Thomas Massaquoi, Regina Gandi, Sebatu Joseph, Hassan K. Osman, Timothy J. G. Brooks, Andrew J. H. Simpson, Ian Goodfellow, Lucy Thorne, Armando Arias, Laura Merson, Lyndsey Castle, Rebecca Howell-Jones, Raul Pardinaz-Solis, Benjamin Hope-Gill, Mauricio Ferri, Jennifer Grove, Mark Kowalski, Kasia Stepniewska, Trudie Lang, John Whitehead, Piero Olliaro, Mohammed Samai, Peter W. Horby, for the RAPIDE-TKM trial team
| published 19 Apr 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1001997
Abstract
Background
TKM-130803, a small interfering RNA lipid nanoparticle product, has been developed for the treatment of Ebola virus disease (EVD), but its efficacy and safety in humans has not been evaluated.
Methods and Findings
In this single-arm phase 2 trial, adults with laboratory-confirmed EVD received 0.3 mg/kg of TKM-130803 by intravenous infusion once daily for up to 7 d. On days when trial enrolment capacity was reached, patients were enrolled into a concurrent observational cohort. The primary outcome was survival to day 14 after admission, excluding patients who died within 48 h of admission.
After 14 adults with EVD had received TKM-130803, the pre-specified futility boundary was reached, indicating a probability of survival to day 14 of ≤0.55, and enrolment was stopped. Pre-treatment geometric mean Ebola virus load in the 14 TKM-130803 recipients was 2.24 × 109 RNA copies/ml plasma (95% CI 7.52 × 108, 6.66 × 109). Two of the TKM-130803 recipients died within 48 h of admission and were therefore excluded from the primary outcome analysis. Of the remaining 12 TKM-130803 recipients, nine died and three survived. The probability that a TKM-130803 recipient who survived for 48 h will subsequently survive to day 14 was estimated to be 0.27 (95% CI 0.06, 0.58). TKM-130803 infusions were well tolerated, with 56 doses administered and only one possible infusion-related reaction observed. Three patients were enrolled in the observational cohort, of whom two died.
Conclusions
Administration of TKM-130803 at a dose of 0.3 mg/kg/d by intravenous infusion to adult patients with severe EVD was not shown to improve survival when compared to historic controls.

National- and state-level impact and cost-effectiveness of nonavalent HPV vaccination in the United States

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 23 April 2016)

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Biological Sciences – Population Biology:
National- and state-level impact and cost-effectiveness of nonavalent HPV vaccination in the United States
David P. Durham, Martial L. Ndeffo-Mbah, Laura A. Skrip, Forrest K. Jones, Chris T. Bauch, and Alison P. Galvani
PNAS 2016 ; published ahead of print April 18, 2016, doi:10.1073/pnas.1515528113
Significance
Vaccination protects against human papilloma virus (HPV)-induced cervical cancer, but coverage varies markedly across the United States. The nonavalent vaccine produces greater health benefits than the bivalent and quadrivalent vaccines at a lower societal cost. Because of the impact of herd immunity, any expansion in coverage will be much more effective in reducing cancer incidence and healthcare costs if targeted in those states with the lowest coverage. Because of interstate migration and the long duration between HPV infection and resultant cervical cancer, much of the benefit of vaccination will be realized beyond a state’s borders. Therefore, both cervical cancer incidence and expenditure can be substantially reduced if the states coordinate policies to promote expansion of coverage, particularly for the new nonavalent vaccine.
Abstract
Every year in the United States more than 12,000 women are diagnosed with cervical cancer, a disease principally caused by human papillomavirus (HPV). Bivalent and quadrivalent HPV vaccines protect against 66% of HPV-associated cervical cancers, and a new nonavalent vaccine protects against an additional 15% of cervical cancers. However, vaccination policy varies across states, and migration between states interdependently dilutes state-specific vaccination policies. To quantify the economic and epidemiological impacts of switching to the nonavalent vaccine both for individual states and for the nation as a whole, we developed a model of HPV transmission and cervical cancer incidence that incorporates state-specific demographic dynamics, sexual behavior, and migratory patterns. At the national level, the nonavalent vaccine was shown to be cost-effective compared with the bivalent and quadrivalent vaccines at any coverage despite the greater per-dose cost of the new vaccine. Furthermore, the nonavalent vaccine remains cost-effective with up to an additional 40% coverage of the adolescent population, representing 80% of girls and 62% of boys. We find that expansion of coverage would have the greatest health impact in states with the lowest coverage because of the decreasing marginal returns of herd immunity. Our results show that if policies promoting nonavalent vaccine implementation and expansion of coverage are coordinated across multiple states, all states benefit both in health and in economic terms.

Science – 22 April 2016

Science
22 April 2016 Vol 352, Issue 6284
http://www.sciencemag.org/current.dtl

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In Depth
Refugee crisis brings new health challenges
By Kai Kupferschmidt
Science22 Apr 2016 : 391-392
Imported pathogens are a much bigger threat to migrants than they are to Europeans.
Summary
More than a million refugees and migrants entered Europe last year, mostly from Syria, Afghanistan, and Iraq. This exodus is creating new challenges for European public health officials. Many of the migrants come from countries where public health systems are in disarray, and some are infected with pathogens that are rare, or even unheard of, in Europe. Germany saw a 30% increase in the number of tuberculosis cases in 2015; doctors also need to be prepared for diseases they have never seen before. Still, scientists say that the influx of unusual infections is far less a threat to native-born Europeans than to the health of the refugees themselves.

Vaccine – Volume 34, Issue 20, Pages 2291-2402 (29 April 2016)

Vaccine
Volume 34, Issue 20, Pages 2291-2402 (29 April 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/20

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Editorial
Another emerging arbovirus, another emerging vaccine: Targeting Zika virus
Pages 2291-2293
Ricardo Palacios, Gregory A. Poland, Jorge Kalil
Excerpt
…There are three main current strategies to control further outbreaks of ZIKV: vector control, supportive treatment of affected patients, and protection through immunization. None of them is a fully effective stand-alone strategy; rather, they are combined options to address a broad public health issue with the current tools available. While vector control is the ideal option as it simultaneously impacts other mosquito-borne transmission of several diseases, sustainable and durable measures to do so are not widely available. In that regard, one of the next challenges is to measure the efficacy of mosquito control measures using the reduction of human cases, rather than only entomological parameters, as the appropriate metric. Of immediate need is the development of a vaccine, as well as other therapeutic and prophylactic products, to address this public health emergency.
What is clear is that significantly enhanced research efforts are urgently needed. We suggest a research agenda that includes the following:
.1 Better understand ZIKV as a zoonotic disease in humans, the molecular evolution of ZIKV, and its adaptation to humans and specific geographic regions.
.2 Better understand the immunology and pathophysiology of human ZIKV infection.
.3 Determine whether ZIKV infection is causative of CMRM and of GBS in humans.
.4 Better understand the pathophysiology of ZIKV infection in pregnant women and the effect of the developing fetus.
.5 Better understand the pathophysiology of ZIKV infection in relation to GBS.
.6 Develop an animal model of human ZIKV infection that recapitulates the important elements of immunology and pathophysiology in humans. Such a model is useful in better understanding the disease and its consequences, and in the development of diagnostic kits, mmunotherapeutics and vaccines.
.7 Fund research to develop novel ZIKV vaccine candidates and bring promising candidates through the development process to licensure.
.8 Fund research to develop antivirals and immunotherapeutics for treatment of ZIKV infections.
Much of the above could be accelerated by the establishment of a global research fund to address emerging and rapidly pandemic viruses such as ZIKV and others, particularly in regard to the above items and the development of antivirals and vaccines…

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Commentary
Every rabies death is a veterinary and health system failure until proven otherwise
Pages 2294-2295
David N. Durrheim
No abstract

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Estimating the public health importance of the CYD-tetravalent dengue vaccine: Vaccine preventable disease incidence and numbers needed to vaccinate
Original Research Article
Pages 2397-2401
Bradford D. Gessner, Annelies Wilder-Smith
Abstract
Background
To evaluate the potential public health impact of the live attenuated tetravalent Sanofi Pasteur dengue vaccine (CYD-TDV) we analyzed data from the reported clinical trials to calculate vaccine preventable disease incidence (VPDI) and number needed to vaccinate (NNV) based on the licensure indication for persons age 9 years and above.
Methods
VPDI is defined as incidence in an unvaccinated population X vaccine efficacy (VE), and thus incorporates both VE and the underlying burden of disease. NNV was calculated as 100,000 divided by VPDI divided by 2-year length of study. We compared these values to data for three newer vaccines that are currently integrated into some national immunization programs in Asia and Latin America, namely pneumococcal conjugate, Haemophilus influenzae type b, and rotavirus vaccines.
Results
In the Asian-Pacific trial, in the first 25 months after the first dose of the dengue vaccine, CYD-TDV prevented annually 2639 cases of virologically confirmed dengue for every 100,000 persons vaccinated, for an NNV of 18. In the Latin American trial, given the overall lower annual dengue incidence compared to Asia, VPDI was 1707, and NNV 28. For the Asian-Pacific and Latin American studies, the VPDIs for hospitalized virologically confirmed disease at the trials’ end were 638 and 239 per 100,000 population per year, respectively, with NNVs of 75 and 201. VPDI for confirmed dengue hospitalization was higher than that for Hib vaccine against Hib meningitis or all cause severe pneumonia while lower than that for rotavirus vaccine against severe rotavirus gastroenteritis.
Conclusions
Our analysis found that the CYD-TDV dengue vaccine had favorable VPDI and NNV, also when compared to existing vaccines used in Latin America and Asia. VPDI and NNV varied by serotype distribution, extent of prior dengue exposure (baseline seroprevalence) and country. These findings will help policy-makers decide where and how to introduce this vaccine post-licensure.

From Google Scholar – HPV [to 23 April 2016]

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

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Cancer Epidemiology Biomarkers & Prevention
doi: 10.1158/1538-7755.DISP15-B90
March 2016 25; B90
Abstract B90: Predictors of HPV vaccine initiation and completion among Hispanic mothers of 11-17 year old daughters living along the Texas-Mexico border
DY Morales-Campos, DA Parra-Medina –
Abstract
Background: Cervical cancer incidence and mortality are higher for Hispanic women along the Texas-Mexico border than for other female population groups. Incidence could be reduced if teenaged Hispanic girls received the HPV vaccine before they became sexually active. However, few Hispanic girls compared to U.S. girls receive all three HPV vaccine doses (31% vs 36%), which prevent cervical cancer. Mothers are crucial to the success of HPV vaccine uptake efforts, but few studies have examined predictors of vaccine initiation and completion. The purpose of this study is to assess predictors (socio-demographics, HPV and vaccine knowledge, and vaccine self-efficacy) of vaccine initiation and completion.
Methods: We utilized baseline data from an outreach and education program utilizing promotoras and peer educators to deliver health education to mothers and daughters to increase HPV knowledge and promote HPV immunization. Our analyses utilized data from mothers of never vaccinated girls (n=371) to examine the association between the predictors and vaccine initiation and completion. To control for potential confounders, we conducted multivariable logistic regression analyses.
Results: Findings showed both health insurance (Initiators AOR: 0.27; 95% CI= .09, .79; Completers AOR: 0.29; 95% CI= .10, .83) and program status (Initiators AOR: 3.04; 95% CI= 1.76, 5.26; Completers AOR: 2.21; 95% CI= 1.27, 3.58) were associated with HPV vaccine initiation and completion among mothers. Results also showed preferred language (AOR: 0.15; 95% CI= .04, .53) and health status (AOR: 0.52; 95% CI= .29, .92) were associated with series initiation.
Conclusions: Findings suggest mothers who spoke English, had health insurance, and reported having good health were at lower odds of vaccine initiation. Also, mothers with health insurance also had lower odds of series completion. Mothers who participated in the program compared to the brochure only group were more likely to initiate and complete the vaccine series. These findings assist in identifying appropriate intervention strategies to enhance vaccine initiation in border communities at risk for cervical cancer.

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Cancer Epidemiology Biomarkers & Prevention
doi: 10.1158/1538-7755.DISP15-A51
March 2016 25; A51
Abstract A51: Racial and gender disparities in knowledge and awareness of HPV and HPV vaccine in a national sample of US adults
EA Boakye, BB Tobo, N Osazuwa-Peters
Abstract
Background: Nearly 80 million people in the U.S. are currently infected with at least one of two strains of human papillomavirus (HPV), which is associated with 70% of cervical, and more than 90% of oropharyngeal, cancers. Racial/ethnic disparities in cervical cancer are pervasive, with non-Hispanic Black and Hispanic women experiencing disproportionately higher incidence and mortality rates than other racial or ethnic groups. Further, although it has been almost 10 years since the approval of the first of three HPV vaccines for boys and girls, disparities in knowledge and awareness about HPV and the HPV vaccine persist, and vaccination rates are suboptimal. The goal of this study was to assess racial/ethnic and gender disparities in the knowledge and awareness of HPV and the HPV vaccine among US adults.
Methods: Cross-sectional data were obtained from the Health Information National Trends Survey Cycles 3 and 4 (HINTS; N=6,862). Descriptive statistics and multivariable logistic regression were used to assess racial/ethnic and gender disparities in HPV knowledge and HPV vaccination awareness.
Results: Sixty-six percent of Americans had heard of HPV and the HPV vaccine; and seventy percent knew that HPV causes cervical cancer. However, we found racial/ethnic and gender disparities in knowledge and awareness of HPV and the HPV vaccine. In multivariate analyses, females were 3.28 times (95% CI: 2.62 – 4.09) more likely to have heard of HPV, and 3.86 times (95% CI: 3.11 – 4.79) more likely to have heard of the HPV vaccine compared to males. Non-Hispanic Blacks were 33% (95% CI: 0.47 – 0.96) and 44% (95% CI: 0.39 – 0.81) less likely than non -Hispanic Whites to have heard of HPV and the HPV vaccine, respectively. There was no significant difference between Hispanics and non-Hispanic Whites regarding HPV knowledge; however, Hispanics were 53% (95% CI: 0.34 – 0.64) less likely than non-Hispanic Whites to have heard of the HPV vaccine. Females were more likely than males to know that HPV causes cervical cancer (OR = 1.49, 95% CI: 1.13 – 1.96). Non-Hispanic Blacks were 48% (95% CI: 0.35 – 0.76) less likely to know that HPV causes cervical cancer compared to non-Hispanic Whites. However, there was no statistically significant difference between Hispanics and non-Hispanic Whites regarding awareness that HPV causes cervical cancer. Forty-six percent of Americans were aware that HPV often clears on its own without treatment.
Conclusions: Non-Hispanic Blacks and males suffer the greatest disparities associated with knowledge and awareness of HPV and the HPV vaccine. Increasing awareness about the HPV vaccine may help improve vaccination uptake, especially among males and minority populations. Thus, future interventions targeting males and minority populations, for whom knowledge gaps currently exist, are needed. There is also a need to improve physician-patient communications to maximize physician discussion of the HPV vaccine with patients and parents of children eligible for the HPV vaccine.

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Cancer Epidemiology Biomarkers & Prevention
doi: 10.1158/1538-7755.DISP15-B58
March 2016 25; B58
Abstract B58: Assessing university students’ sexual risk behavior, knowledge of the human papillomavirus,(HPV), HPV vaccine, and association between HPV and …
N Osazuwa-Peters, KM Christopher, C Geneus
Abstract
Background/Objectives: There has been a 225% increase in the incidence of oropharyngeal cancer, a sub-site of head and neck cancer, in the United States in the last three decades. This massive increase is largely associated with HPV, a sexually transmitted infection that peaks in prevalence among adolescents and young adults of college age. This study aimed at assessing sexual risk-taking behavior among university students, analyzing predictors of HPV vaccine initiation, as well as assessing levels of knowledge of the association between HPV and head and neck cancer.
Methods: An anonymous online cross-sectional survey was distributed to 921 university students between the ages of 19-26 years. The survey elicited sociodemographic characteristics, HPV and HPV vaccine knowledge, and barriers and facilitators for vaccine initiation and completion.
Results: Seven-hundred and forty-six students completed the survey; primarily female (68%), White (78%), and non-smokers (96%). Among participants, 61.7% have had vaginal sex and 70.7% oral sex. A greater number of participants have had multiple (4 or more) oral sexual partners than vaginal sexual partners (25.5% vs. 20.3%). Average age at first vaginal and oral sex onset were similar (18.41 vs. 17.80 years). Almost half of participants (49%) had completed all 3-doses of the HPV vaccine, and 60% had received at least one dose. Only 38% had a high knowledge of association between HPV and head and neck cancer.
After adjusting for covariables, it was found that HPV knowledge was the main predictor of HPV vaccine initiation. Those with a higher level of knowledge of HPV were more likely to have initiated the vaccine (aOR = 1.04, 95% CI 1.00-1.08). Additionally, there were decreased odds of initiating HPV vaccine as age increased (aOR = 0.83, 95% CI 0.75-0.90); and participant single or dating (aOR 1.72, 95% CI 1.12-2.65) and not currently dating (aOR 1.91, 95% CI 1.22-2.99) had higher odds of initiating the vaccine than those in committed relationships, including marriage.
Race was a significant predictor of knowledge of association between HPV and head and neck cancer. Non-White students were 2.25 times (95% CI: 1.14 – 4.45) more likely to have low knowledge compared to White students.
Conclusions: Sexual risk-taking behavior associated with HPV infection is high among university students, while knowledge of the association between HPV and head and neck cancer is low. These findings provide impetus for developing specifically targeted interventions that serve to increase head and neck cancer knowledge, improve HPV vaccine education and uptake, and mitigate sexual risk-taking behaviors among college-aged students.

Media/Policy Watch [to 23 April 2016]

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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New York Times
http://www.nytimes.com/
Accessed 23 April 2016
China’s Vaccine Scandal Threatens Public Faith in Immunizations
…Now, the country’s immunization program faces a backlash of public distrust that critics say has been magnified by the government’s ingrained secrecy.

Song Zhendong, like many parents here, said he was reluctant to risk further vaccinations for his 10-month-old son.

“If he can avoid them in the future, we will not get them,” said Mr. Song, a businessman. “Why didn’t we learn about this sooner? If there’s a problem with vaccines for our kids, we should be told as soon as the police knew. Aren’t our children the future of the nation?”

The faulty vaccines have become the latest lightning rod for widespread, often visceral distrust of China’s medical system, and a rebuff to what many Chinese critics see as President Xi Jinping’s bulldozing, top-down rule….
April 19, 2016 – By CHRIS BUCKLEY –

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TIME
http://time.com/
Accessed 23 April 2016
China Has Begun Cracking Down on Parents Protesting Substandard Vaccines
Charlie Campbell / Beijing
April 21, 2016
Hundreds were allegedly detained for intending to join a demonstration in Beijing on Tuesday
Angry parents who congregated at Beijing’s National Health and Family Planning Commission on Tuesday to protest last month’s vaccine scandal have complained of intimidation and arbitrary arrest by security officials.

Almost 70 of the more than 1,000 who gathered also filed lawsuits to Beijing No. 1 Intermediate People’s Court to demand retribution for the scandal, which involved $90 million of improperly stored and expired vaccines being distributed across the country over four years. Protesters claim this caused hundreds of children to fall ill with a range of debilitating conditions.
“Our children have suffered varying degrees of harm and disability as a result of immunization injections,” the lawsuit reads, according to Radio Free Asia (RFA). “Some have even lost the ability to live independently.”…

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Think Tanks et al

CSIS Center for Strategic and International Studies
http://csis.org/press/browse/all/all/press_release
Accessed 23 April 2016
CSIS Releases Documentary Film: “Ebola in America: Epidemic of Fear”
Press Release
Apr 22, 2016
WASHINGTON April 22, 2016 – The Center for Strategic and International Studies (CSIS) today released ” Ebola in America: Epidemic of Fear ” a feature-length documentary film that tells the story of the 2014

Vaccines and Global Health: The Week in Review 16 April 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_16 April 2016

blog edition: comprised of the approx. 35+ entries posted below on 18 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

Summary of the April 2016 meeting of the Strategic Advisory Group of Experts on immunization

Summary of the April 2016 meeting of the Strategic Advisory Group of Experts on immunization
WHO SAGE Meeting, Geneva: 12 – 14 April 2016 :: 4 pages
[Summary Section Headings]
:: Dengue Vaccine [recommendation]
:: Polio Eradication [IVP and OPV2 withdrawal]
:: Pre-empting and responding to vaccine supply shortages
:: Missed opportunities for vaccination
:: Other Issues
* Implementation Research as part of vaccine program development
* Immunization-specific indicator in the SDG Indicator Framework
* RSV (respiratory syncytial virus) vaccine pipeline,
* Immunization in the context of HSS and UHC
* New “second-year-of-life” immunization platform

New recommendations for dengue vaccine
6 April 2016 — Dengue is the world’s most extensively spread mosquito-borne virus – in the last 60 years, global incidence of the disease has increased 30-fold. The WHO Strategic Advisory Group of Experts (SAGE) on immunization has recommended that a vaccine for dengue, called Dengvaxia (CYD-TDV), be considered for use in geographic settings with high endemicity.

Zika virus [to 16 April 2016]

Zika virus [to 16 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 13 April 2016, Zika virus transmission was documented in a total of 64 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 mosquitoes.
*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:
*Six countries have now reported evidence of person-to-person transmission of Zika virus, other than mosquito-borne transmission (Argentina, Chile, France, Italy, New Zealand and the United States of America).

:: In the week to the 13 April, two additional countries have reported mosquito-borne Zika virus transmission: Belize and Saint Lucia.

:: 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 additional cases, each linked to a stay in Brazil, were detected in Slovenia and the United States of America.

:: In the context of Zika virus circulation, 13 countries and territories worldwide have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases.

:: Based on a growing body of research, there is scientific consensus that Zika virus is a cause of microcephaly and GBS.

:: The global prevention and control strategy launched by the World Health Organization (WHO) as a Strategic Response Framework encompasses surveillance, response activities and research. This situation report is organized under those headings.

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Disease Outbreak News (DONs)
:: 12 April 2016 Zika virus infection – Viet Nam
:: 9 April 2016 Microcephaly – France – Martinique

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Zika Open [to 16 April 2016]
[Bulletin of the World Health Organization]
:: All papers available here
No new papers identified in the last week

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CDC/ACIP [to 16 April 2016]
http://www.cdc.gov/media/index.html
THURSDAY, APRIL 14, 2016
Transcript for CDC Telebriefing: Zika Virus Update – 4-13-2016

WEDNESDAY, APRIL 13, 2016
CDC Adds Saint Lucia to Interim Travel Guidance Related to Zika Virus – Media Statement

WEDNESDAY, APRIL 13, 2016
CDC Concludes Zika Causes Microcephaly and Other Birth Defects
Scientists at the Centers for Disease Control and Prevention (CDC) have concluded, after careful review of existing evidence, that Zika virus is a cause of microcephaly and other severe fetal brain defects. In the report published in the New England Journal of Medicine, the CDC authors describe a rigorous weighing of evidence using established scientific criteria.

“This study marks a turning point in the Zika outbreak. It is now clear that the virus causes microcephaly. We are also launching further studies to determine whether children who have microcephaly born to mothers infected by the Zika virus is the tip of the iceberg of what we could see in damaging effects on the brain and other developmental problems,” said Tom Frieden, M.D., M.P.H., director of the CDC. “We’ve now confirmed what mounting evidence has suggested, affirming our early guidance to pregnant women and their partners to take steps to avoid Zika infection and to health care professionals who are talking to patients every day. We are working to do everything possible to protect the American public.”

Background
The report notes that no single piece of evidence provides conclusive proof that Zika virus infection is a cause of microcephaly and other fetal brain defects. Rather, increasing evidence from a number of recently published studies and a careful evaluation using established scientific criteria supports the authors’ conclusions.
The finding that Zika virus infection can cause microcephaly and other severe fetal brain defects means that a woman who is infected with Zika during pregnancy has an increased risk of having a baby with these health problems. It does not mean, however, that all women who have Zika virus infection during pregnancy will have babies with problems. As has been seen during the current Zika outbreak, some infected women have delivered babies that appear to be healthy.

Establishing this causal relationship between Zika and fetal brain defects is an important step in driving additional prevention efforts, focusing research activities, and reinforcing the need for direct communication about the risks of Zika. While one important question about causality has been answered, many questions remain. Answering these will be the focus of ongoing research to help improve prevention efforts, which ultimately may help reduce the effects of Zika virus infection during pregnancy.

At this time, CDC is not changing its current guidance as a result of this finding. Pregnant women should continue to avoid travel to areas where Zika is actively spreading. If a pregnant woman travels to or lives in an area with active Zika virus transmission, she should talk with her healthcare provider and strictly follow steps to prevent mosquito bites and to prevent sexual transmission of Zika virus. We also continue to encourage women and their partners in areas with active Zika transmission to engage in pregnancy planning and counseling with their health care providers so that they know the risks and the ways to mitigate them.

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MMWR April 15, 2016 / Vol. 65 / No. 14
:: Male-to-Male Sexual Transmission of Zika Virus — Texas, January 2016
:: Survey of Blood Collection Centers and Implementation of Guidance for Prevention of Transfusion-Transmitted Zika Virus Infection — Puerto Rico, 2016

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USAID [to 16 April 2016]
http://www.usaid.gov/news-information/press-releases
April 13, 2016
USAID Announces $30 Million Grand Challenge to Combat Zika and Future Disease Threats
Call for ideas now open; initial focus on improved tools to prevent and respond to Zika
Today the U.S. Agency for International Development (USAID) launched Combating Zika and Future Threats: A Grand Challenge for Development, calling innovators around the world to submit groundbreaking ideas to enhance our ability to respond to the current Zika outbreak and generate cutting-edge technologies and approaches that better prepare the world to address the disease threats of tomorrow.

EBOLA/EVD [to 16 April 2016]

EBOLA/EVD [to 16 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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Looking, hopefully, towards an Ebola-free future
15 April 2016 — WHO, partners and affected countries are stepping up planning for how to use an Ebola vaccine in response to an outbreak. The Ebola outbreak that struck Guinea, Liberia, and Sierra Leone in 2014 prompted the search, on an exceptionally accelerated schedule, for a vaccine to prevent the disease. Although there has been more than one promising candidate, the vesicular stomatitis virus-ebola virus (VSV-EBOV) vaccine was selected.

POLIO [to 16 April 2016]

POLIO [to 16 April 2016]
Public Health Emergency of International Concern (PHEIC)

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Polio this week as of 13 April 2016
:: 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 [see link below]
:: Canada has announced a contribution of $ 40 million Canadian Dollars to support the eradication of polio in Pakistan over the next three years.
:: 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 will start on 17 April 2016. Learn more about preparations for the switch here. Learn more about the rationale for the switch through this series of videos.
Selected Country Levels Updates [excerpted]
Pakistan
:: One new case of wild poliovirus type 1 (WPV1) was reported in the last week, in Bannu district, Khyber Pakhtunkhwa, with onset of paralysis on 22 March. The total number of WPV1 cases for 2016 is now 8, compared to 21 reported at the same date last year.

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UNICEF [to 16 April 2016]
http://www.unicef.org/media/media_89711.html
Polio-Free World in Sight as Largest Vaccine Rollout in History Kicks Off
GENEVA, 14 April 2016 – Next week marks the beginning of the largest and fastest globally coordinated rollout of a vaccine into routine immunization programs in history. Between 17 April and 1 May, 155 countries and territories around the world will stop using the trivalent oral polio vaccine (tOPV), which protects against all three strains of wild poliovirus, and replace it with bivalent OPV (bOPV), which protects against the remaining two wild polio strains, types 1 and 3. This effort will provide better protection for children against polio, particularly those most vulnerable to infection.

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Poliomyelitis: Report by the secretariat
69th World Health Assembly (May 2016)
A69/25
8 April 2016
[Initial paragraphs]
1. Strong progress continues to be made towards each of the four objectives of the Polio Eradication and Endgame Strategic Plan 2013–2018 (the Endgame Plan). With only Afghanistan and Pakistan remaining endemic for poliomyelitis, wild poliovirus transmission is at the lowest levels in history, with the fewest-ever reported cases from the fewest-ever affected countries.

2. The declaration of international spread of wild poliovirus as a Public Health Emergency of International Concern and the temporary recommendations promulgated under the International Health Regulations (2005) remain in effect. In September 2015, the Polio Oversight Board of the Global Polio Eradication Initiative reviewed progress and concluded that wild poliovirus transmission is more likely to be interrupted in 2016 than in 2015. This delay shifts the predicted date for certification of global polio eradication to 2019 and increases the cost of completing polio eradication by US$ 1500 million. In October 2015, WHO’s Strategic Advisory Group of Experts on immunization confirmed its recommendation that the withdrawal of oral polio vaccines containing the type 2 component should occur during the period 17 April–1 May 2016 in all countries that are using trivalent oral polio vaccine through a globally-synchronized replacement of this vaccine by the bivalent oral polio vaccine. The Group also reaffirmed that, in preparation for this global event, it is crucial that countries meet established deadlines to identify facilities holding wild or vaccine-derived poliovirus type 2, destroy all type 2 poliovirus materials and, only where necessary, appropriately contain type 2 poliovirus in essential poliovirus facilities. The Executive Board at its 138th session noted an earlier version of this report.1 The text of the report has been updated and revised in light of the Board’s deliberations…

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Weekly Epidemiological Record (WER) 15 April 2016, vol. 91, 15 (pp. 193–208)
Contents
193 Polio surveillance: tracking progress towards eradication, worldwide, 2014–2015
203 Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2015

UN OCHA [to 16 April 2016]

UN OCHA [to 16 April 2016]
http://www.unocha.org/media-resources/press-releases

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15 Apr 2016
Yemen: Assistant Secretary-General for Humanitarian Affairs and Deputy Emergency Relief Coordinator, Kyung-Wha Kang statement to the Security Council on the Humanitarian Situation in Yemen
[Excerpt]
…At the same time, UN agencies and partners continue to ramp up ongoing relief efforts across the country. Coinciding with the start of the Cessation of Hostilities, a nation-wide polio vaccination campaign targeting around five million children was successfully launched with the support of UNICEF, WHO and the World Bank. This extraordinary effort has involved more than 19,000 mobile vaccination teams of over 46,000 health workers, and some 5,000 vehicles that were rented to facilitate monitoring across all governorates. Around 3.5 million people are receiving food assistance each month from the WFP. So far this year, around 2.2 million people have been reached with health interventions in 22 governorates through the procurement of medicines, the provision of trauma kits, immunizations, and the maintaining of an uninterrupted supply chain management system…

WHO & Regional Offices [to 16 April 2016]

WHO & Regional Offices [to 16 April 2016]

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Weekly Epidemiological Record (WER) 15 April 2016, vol. 91, 15 (pp. 193–208)
Contents
193 Polio surveillance: tracking progress towards eradication, worldwide, 2014–2015
203 Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2015
207 Who African Region Immunization Technical Advisory Group: Call for Nominations

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Disease Outbreak News (DONs)
:: 14 April 2016 Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
:: 13 April 2016 Yellow fever – Angola
:: 12 April 2016 Zika virus infection – Viet Nam
:: 11 April 2016 Yellow Fever – Democratic Republic of the Congo
:: 9 April 2016 Microcephaly – France – Martinique

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Highlights
WHO and partners protect more than 1 million people from cholera
April 2016 — In 2015, more than 1 million people in 7 high-risk countries received the oral cholera vaccine. This extraordinary measure was taken to contain several cholera outbreaks from spreading further.

WHO scales up malaria response in Yemen
April 2016 — The risk of a malaria epidemic is high in Yemen, with high fuel costs, shortages of health workers, violence, and internal displacement preventing an effective and timely response. WHO is working closely with the Ministry of Public Health and Population to address these challenges.

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WHO fact sheets
:: Dengue and severe dengue 15 April 2016
:: Poliomyelitis 12 April 2016
:: Mental health: strengthening our response 11 April 2016
:: Dementia 11 April 2016
:: Headache disorders 11 April 2016
:: Echinococcosis 11 April 2016

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:: WHO Regional Offices
WHO African Region AFRO
:: WHO regional office for Africa – Call for Nominations: Regional Immunization Technical Advisory Group (RITAG)
12 April 2016

WHO Region of the Americas PAHO
No new digest content identified.

WHO South-East Asia Region SEARO
No new digest content identified.

WHO European Region EURO
:: Health information at your fingertips 15-04-2016
:: Europe shapes new action plans on HIV/AIDS and viral hepatitis 12-04-2016
:: European Health Information Initiative expands by 7 members at 4th Steering Group Meeting 12-04-2016

WHO Eastern Mediterranean Region EMRO
:: Updated guidelines for chronic hepatitis C infection 14 April 2016
;; WHO scales up malaria response in Yemen 13 April 2016
:: Investing in treatment for depression and anxiety leads to fourfold return 13 April 2016

WHO Western Pacific Region
No new digest content identified.

CDC/ACIP [to 16 April 2016]

CDC/ACIP [to 16 April 2016]
http://www.cdc.gov/media/index.html
[see Zika coverage above which includes CDC briefing content]

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MMWR April 15, 2016 / Vol. 65 / No. 14
:: Male-to-Male Sexual Transmission of Zika Virus — Texas, January 2016
:: Survey of Blood Collection Centers and Implementation of Guidance for Prevention of Transfusion-Transmitted Zika Virus Infection — Puerto Rico, 2016
:: Announcement: National Infant Immunization Week — April 16–23, 2016

AERAS [to 16 April 2016]

AERAS [to 16 April 2016]
http://www.aeras.org/pressreleases

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April 11, 2016
Aeras to Join the Human Vaccines Project to Accelerate Global Disease Prevention and Control
Rockville, Maryland and New York, New York,– Aeras and the Human Vaccines Project announced a new collaboration aimed at accelerating the development of vaccines and immunotherapies for key global populations.

The Human Vaccines Project is a new global initiative that brings together leading academic centers, industry, nonprofits and governments in a global discovery consortium to solve the primary scientific hurdles impeding the development of vaccines and immune-driven therapies.

“Understanding the principles of human immunity represents one of the great frontiers of science and is a key to accelerating the development of vaccines against complex diseases such as tuberculosis, HIV and malaria,” said Jacqueline E. Shea, Ph.D., Chief Executive Officer of Aeras. “The Human Vaccines Project, with its network of public and private sector partners, provides a new focus on vaccine and immunotherapeutic development.”

Under the Project’s scientific plan, a global network of leading research and development (R&D) groups will conduct extensive clinical research studies aimed at decoding the immune system, facilitated by state-of-the-art bioinformatics and machine learning. Such studies will be conducted in diverse global populations, enabling for the first time a detailed understanding of how human immunity is influenced by genetics, age and environment…

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April 12, 2016
Biomarker Discovery Offers Hope for New TB Vaccine
Aeras is excited to share the following news release from Oxford University, about Aeras-funded research that was published today in the journal Nature Communications. We look forward to continuing our partnership with Oxford University and reaching our shared goal of developing new, effective TB vaccines.

Global Fund [to 16 April 2016]

Global Fund [to 16 April 2016]
http://www.theglobalfund.org/

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13 April 2016
Global Fund Named as Leader in Aid Transparency
GENEVA – The Global Fund to Fight AIDS, Tuberculosis and Malaria was ranked among the top five organizations and nations that are major donors of global aid for its transparency and accountability, a report published on Wednesday showed.

Released by the non-profit Publish What You Fund, the AID Transparency Index also showed that the Global Fund ranked first in three of the operational categories – performance, related documents, and basic information.
Mark Dybul, Executive Director of the Global Fund, said the results of the report underlined the organization’s unwavering commitment to transparency and accountability as it pursues its mandate to end AIDS, TB and malaria as epidemics…

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11 April 2016
New Zealand Announces Early Contribution to the Global Fund
GENEVA – New Zealand has announced that it will make an early contribution to the Global Fund, one of the first countries to pledge in support of the Global Fund’s replenishment for the three-year period beginning in 2017.

Ambassador Vangelis Vitalis announced the contribution during a meeting at the Global Fund offices in Geneva. “Lifting the burden of HIV, tuberculosis and malaria helps build prosperity and security, both in the Pacific and around the world. New Zealand is pleased to play its part in the Global Fund partnership,” Dr. Vitalis said.

Marijke Wijnroks, Chief of Staff of the Global Fund, signed the agreement with Dr. Vitalis on 8 April. “We are very pleased that New Zealand is in the Global Fund partnership in this important year.”

New Zealand’s contribution is worth NZ$1 million. The announcement followed news in March 2016 that the European Union pledged a significant increase in its contribution to the Global Fund for the next three years…

PATH [to 16 April 2016]

PATH [to 16 April 2016]
http://www.path.org/news/index.php
Press release | April 11, 2016
Innovative partnership brings to market new tools for neglected tropical diseases
New tools will support disease elimination for both river blindness and elephantiasis

Seattle and Seoul, April 11, 2016 – PATH and Standard Diagnostics (SD)/Alere announced today the commercial availability of two rapid diagnostic tools for onchocerciasis and lymphatic filariasis. Designed for use in disease surveillance, the antibody-based tests are part of a suite of diagnostic innovations intended to support the elimination of neglected tropical diseases (NTDs), a group of illnesses that affect more than a billion people worldwide…

Industry Watch [to 16 April 2016]

Industry Watch [to 16 April 2016]
:: Vaccines a 28 Billion-Dollar Market, Kalorama Information Study Finds
Apr 13, 2016,
Revenues earned by manufacturers of vaccines worldwide reached $27.6 billion in 2015, up from $24.7 billion in 2014 as sales in all segments expanded. The world vaccines market is predicted to increase at a compound annual rate of 7.6% during 2013 – 2022, reaching $45.1 billion in 2022…

Estimating the cost-effectiveness profile of a universal vaccination programme with a nine-valent HPV vaccine in Austria

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 16 April 2016)

Research article
Estimating the cost-effectiveness profile of a universal vaccination programme with a nine-valent HPV vaccine in Austria
HPV is a major cancer-causing factor in both sexes in the cervix, vulva, vagina, anus, penis, oropharynx as well as the causal factor in other diseases such as genital warts and recurrent respiratory papilloma…
L. Boiron, E. Joura, N. Largeron, B. Prager and M. Uhart
BMC Infectious Diseases 2016 16:153
Published on: 16 April 2016
Abstract
Background
HPV is a major cancer-causing factor in both sexes in the cervix, vulva, vagina, anus, penis, oropharynx as well as the causal factor in other diseases such as genital warts and recurrent respiratory papillomatis. In the context of the arrival of a nonavalent HPV vaccine (6/11/16/18/31/33/45/52/58), this analysis aims to estimate the public health impact and the incremental cost-effectiveness of a universal (girls and boys) vaccination program with a nonavalent HPV vaccine as compared to the current universal vaccination program with a quadrivalent HPV vaccine (6/11/16/18), in Austria.
Method
A dynamic transmission model including a wide range of health and cost outcomes related to cervical, anal, vulvar, vaginal diseases and genital warts was calibrated to Austrian epidemiological data. The clinical impact due to the 5 new types was included for cervical and anal diseases outcomes only. In the base case, a two-dose schedule, lifelong vaccine type-specific protection and a vaccination coverage rate of 60 % and 40 % for girls and boys respectively for the 9-year old cohorts were assumed. A cost-effectiveness threshold of €30,000/QALY-gained was considered.
Results
Universal vaccination with the nonavalent vaccine was shown to reduce the incidence of HPV16/18/31/33/45/52/58 -related cervical cancer by 92 %, the related CIN2/3 cases by 96 % and anal cancer by 83 % and 76 % respectively in females and males after 100 years, relative to 75 %, 76 %, 80 % and 74 % with the quadrivalent vaccine, respectively. Furthermore, the nonavalent vaccine was projected to prevent an additional 14,893 cases of CIN2/3 and 2544 cases of cervical cancer, over 100 years. Depending on the vaccine price, the strategy was shown to be from cost-saving to cost-effective.
Conclusion
The present evaluation showed that vaccinating 60 % of girls and 40 % of boys aged 9 in Austria with a 9-valent vaccine will substantially reduce the incidence of cervical cancer, CIN and anal cancer compared to the existing strategy. The vaccination strategies performed with the 9-valent vaccine in the current study were all found to be cost-effective compared to the current quadrivalent vaccination strategy by considering a cost-effectiveness threshold of 30,000€/QALY gained.

BMC Public Health (Accessed 16 April 2016)

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 16 April 2016)

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Research article
Effect of pay for performance to improve quality of maternal and child care in low- and middle-income countries: a systematic review
Pay for Performance (P4P) mechanisms to health facilities and providers are currently being tested in several low- and middle-income countries (LMIC) to improve maternal and child health (MCH).
Ashis Das, Saji S. Gopalan and Daniel Chandramohan
BMC Public Health 2016 16:321
Published on: 14 April 2016

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Research article
Projected economic evaluation of the national implementation of a hypothetical HIV vaccination program among adolescents in South Africa, 2012
Nishila Moodley, Glenda Gray and Melanie Bertram
BMC Public Health 2016 16:330
Published on: 14 April 2016
Abstract
Background
Adolescents in South Africa are at high risk of acquiring HIV. The HIV vaccination of adolescents could reduce HIV incidence and mortality. The potential impact and cost-effectiveness of a national school-based HIV vaccination program among adolescents was determined.
Method
The national HIV disease and cost burden was compared with (intervention) and without HIV vaccination (comparator) given to school-going adolescents using a semi-Markov model. Life table analysis was conducted to determine the impact of the intervention on life expectancy. Model inputs included measures of disease and cost burden and hypothetical assumptions of vaccine characteristics. The base-case HIV vaccine modelled cost at US$ 12 per dose; vaccine efficacy of 50 %; duration of protection of 10 years achieved at a coverage rate of 60 % and required annual boosters. Incremental cost-effectiveness ratios (ICER) were calculated using life years gained (LYG) serving as the outcome measure. Sensitivity analyses were conducted on the vaccine characteristics to assess parameter uncertainty.
Results
The HIV vaccination model yielded an ICER of US$ 5 per LYG (95 % CI ZAR 2.77–11.61) compared with the comparator, which is considerably less than the national willingness-to-pay threshold of cost-effectiveness. This translated to an 11 % increase in per capita costs from US$ 80 to US$ 89. National implementation of this intervention could potentially result in an estimated cumulative gain of 23.6 million years of life (95 % CI 8.48–34.3 million years) among adolescents age 10–19 years that were vaccinated. The 10 year absolute risk reduction projected by vaccine implementation was 0.42 % for HIV incidence and 0.41 % for HIV mortality, with an increase in life expectancy noted across all age groups. The ICER was sensitive to the vaccine efficacy, coverage and vaccine pricing in the sensitivity analysis.
Conclusions
A national HIV vaccination program would be cost-effective and would avert new HIV infections and decrease the mortality and morbidity associated with HIV disease. Decision makers would have to discern how these findings, derived from local data and reflective of the South African epidemic, can be integrated into the national long term health planning should a HIV vaccine become available.

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Research article
Measles susceptibility in young Thai men suggests need for young adult measles vaccination: a cross sectional study
Siriphan Gonwong, Thippawan Chuenchitra, Patchariya Khantapura, Dilara Islam and Carl J. Mason
BMC Public Health 2016 16:309
Published on: 11 April 2016
Abstract
Background
Measles remains a major public health concern in Thailand despite the introduction of vaccination since 1984. Similar to other countries, Thailand has experienced numerous measles outbreaks including adult communities such as university student dormitories, prisons, refugee camps, and military recruit camps. These outbreaks raise questions on the seroprotective antibody level in Thai adults.
Methods
To better understand measles susceptibility in young Thai adults, a retrospective measles seroprevalence study on repository serum specimens obtained with informed consent from young Thai men entering the Royal Thai Army (RTA) during 2007–2008 was conducted. A total of 7760 stratified randomized samples were chosen by residence province. Measles IgG titer was measured using a commercial IgG quantitative ELISA kit following the manufacturer’s instructions. An antibody level ≥ 250 International Units per Liter (IU/L) was interpreted as seropositive.
Results
The overall measles seroprevalence was 78.5 % (95 % Confidence Interval: 77.6–79.4 %) with geometric mean titer of 738 IU/L (95 % Confidence Interval: 716–760 IU/L). The measles seroprevalence by province ranged from 59.6 % to 93.1 %. A trend of decreasing seroprevalence in the younger cohorts despite increasing immunization coverage was found. Lower seroprevalence than vaccination coverage was observed in the youngest age group.
Conclusions
To achieve long term measles control and elimination, an integrated two doses vaccination strategy has been implemented in children in Thailand. This nationwide measles seroprevalence study in young adult RTA recruits found a measles seroprevalence lower than WHO’s recommendation for measles outbreak prevention and elimination. These results raise concerns for measles control in Thailand. Supplementary immunization in young adults is essential especially in high-risk and densely populated communities to establish herd immunity for outbreak prevention and elimination.

Tracing the scientific outputs in the field of Ebola research based on publications in the Web of Science

BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content
(Accessed 16 April 2016)

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Research article
Tracing the scientific outputs in the field of Ebola research based on publications in the Web of Science
Fengyun Yi, Pin Yang and Huifeng Sheng
BMC Research Notes 2016 9:221
Published on: 15 April 2016
Abstract
Background
Ebola virus disease (hereafter EVD or Ebola) has a high fatality rate. The devastating effects of the current epidemic of Ebola in West Africa have put the global health response in acute focus. In response, the World Health Organization (WHO) has declared the Ebola outbreak in West Africa as a “Public Health Emergency of International Concern”. A small proportion of scientific literature is dedicated to Ebola research.
Methods
To identify global research trends in Ebola research, the Institute for Scientific Information (ISI) Web of Science™ database was used to search for data, which encompassed original articles published from 1900 to 2013. The keyword “Ebola” was used to identify articles for the purposes of this review. In order to include all published items, the database was searched using the Basic Search method.
Results
The earliest record of literature about Ebola indexed in the Web of Science is from 1977. A total of 2477 publications on Ebola, published between 1977 and 2014 (with the number of publications increasing annually), were retrieved from the database. Original research articles (n = 1623, 65.5 %) were the most common type of publication. Almost all (96.5 %) of the literature in this field was in English. The USA had the highest scientific output and greatest number of funding agencies. Journal of Virology published 239 papers on Ebola, followed by Journal of Infectious Diseases and Virology, which published 113 and 99 papers, respectively. A total of 1911 papers on Ebola were cited 61,477 times.
Conclusion
This analysis identified the current state of research and trends in studies about Ebola between 1977 and 2014. Our bibliometric analysis provides a historical perspective on the progress in Ebola research.

Clinical features and neuroimaging (CT and MRI) findings in presumed Zika virus related congenital infection and microcephaly: retrospective case series study

British Medical Journal
16 April 2016 (vol 352, issue 8053)
http://www.bmj.com/content/353/8053

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Research Update
Clinical features and neuroimaging (CT and MRI) findings in presumed Zika virus related congenital infection and microcephaly: retrospective case series study
BMJ 2016; 353 :i1901 (Published 13 April 2016)
Maria de Fatima Vasco Aragao, neuroradiologist and professor of radiology1, Vanessa van der Linden, paediatric neurologist2, Alessandra Mertens Brainer-Lima, neuroradiologist and professor of radiology3, Regina Ramos Coeli, paediatric infectologist and professor4, Maria Angela Rocha, infectologist4, Paula Sobral da Silva, paediatric neurologist4, Maria Durce Costa Gomes de Carvalho, paediatric neurologist4, Ana van der Linden, paediatric neurologist5, Arthur Cesario de Holanda, medical student6, Marcelo Moraes Valenca, neurosurgeon and full professor of neurology and neurosurgery7
Abstract
Objective
To report radiological findings observed in computed tomography (CT) and magnetic resonance imaging (MRI) scans of the first cases of congenital infection and microcephaly presumably associated with the Zika virus in the current Brazilian epidemic.
Design
Retrospective study with a case series.
Setting
Association for Assistance of Disabled Children (AACD), Pernambuco state, Brazil.
Participants
23 children with a diagnosis of congenital infection presumably associated with the Zika virus during the Brazilian microcephaly epidemic.
Main outcome measures
Types of abnormalities and the radiological pattern of lesions identified on CT and MRI brain scans.
Results
Six of the 23 children tested positive for IgM antibodies to Zika virus in cerebrospinal fluid. The other 17 children met the protocol criteria for congenital infection presumably associated with the Zika virus, even without being tested for IgM antibodies to the virus—the test was not yet available on a routine basis. Of the 23 children, 15 underwent CT, seven underwent both CT and MRI, and one underwent MRI. Of the 22 children who underwent CT, all had calcifications in the junction between cortical and subcortical white matter, 21 (95%) had malformations of cortical development, 20 (91%) had a decreased brain volume, 19 (86%) had ventriculomegaly, and 11 (50%) had hypoplasia of the cerebellum or brainstem. Of the eight children who underwent MRI, all had calcifications in the junction between cortical and subcortical white matter, malformations of cortical development occurring predominantly in the frontal lobes, and ventriculomegaly. Seven of the eight (88%) children had enlarged cisterna magna, seven (88%) delayed myelination, and six each (75%) a moderate to severe decrease in brain volume, simplified gyral pattern, and abnormalities of the corpus callosum (38% hypogenesis and 38% hypoplasia). Malformations were symmetrical in 75% of the cases.
Conclusion
Severe cerebral damage was found on imaging in most of the children in this case series with congenital infection presumably associated with the Zika virus. The features most commonly found were brain calcifications in the junction between cortical and subcortical white matter associated with malformations of cortical development, often with a simplified gyral pattern and predominance of pachygyria or polymicrogyria in the frontal lobes. Additional findings were enlarged cisterna magna, abnormalities of corpus callosum (hypoplasia or hypogenesis), ventriculomegaly, delayed myelination, and hypoplasia of the cerebellum and the brainstem.

Spillover effect of HIV-specific foreign aid on immunization services in Nigeria

International Health
Volume 8 Issue 2 March 2016
http://inthealth.oxfordjournals.org/content/current

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Spillover effect of HIV-specific foreign aid on immunization services in Nigeria
Charles C. Chima* and Luisa Franzini
Author Affiliations
Division of Management, Policy and Community Health, The University of Texas School of Public Health, 1200 Pressler Street, Houston, Texas 77030, USA
*Corresponding author: Present address: Healthcare Transformation Initiatives, The University of Texas Health Science Center at Houston, 1200 Binz Street Houston TX 77004, USA; Tel: +1 832-231-4955; E-mail: chimacharles@gmail.com
Received December 13, 2014.
Revision received April 20, 2015.
Accepted April 20, 2015.
Abstract
Background
Health aid to Nigeria increased tremendously in the last decade and a significant portion of the funds were earmarked for HIV-associated programs. Studies on the impact of HIV-specific aid on the delivery of non-HIV health services in sub-Saharan Africa have yielded mixed results. This study assessed if there is a spillover effect of HIV-specific aid on childhood vaccinations in Nigeria.
Methods
Multivariate logistic regression models were used to estimate the effect of aid disbursements in a previous year on the receipt of vaccines at the individual level in a given year. Estimations were done for approximately 11 700 children using data from demographic and health surveys conducted in Nigeria in 2003 and 2008.
Results
US$1 increase in HIV aid per capita was associated with a decrease in the probability of receipt of vaccines by 8–31%: polio first dose decreased by 8%; polio final dose by 9%; diphtheria-pertussis-tetanus (DPT) first dose by 11%; DPT final dose by 19%; measles by 31%; final doses of polio and DPT plus measles vaccine by 8%.
Conclusions
HIV-specific aid had a negative spillover effect on immunization services in Nigeria over the study period. Donors may need to rethink their funding strategies in favour of more horizontal approaches.

Neglected Dimensions of Global Security: The Global Health Risk Framework Commission

JAMA
April 12, 2016, Vol 315, No. 14
http://jama.jamanetwork.com/issue.aspx

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Viewpoint
Neglected Dimensions of Global Security: The Global Health Risk Framework Commission
Lawrence O. Gostin, JD; Carmen C. Mundaca-Shah, MD, DrPH; Patrick W. Kelley, MD, DrPH

This Viewpoint discusses the Global Health Risk Framework Commission’s strategy to safeguard human and economic security from pandemic threats.

The world has experienced global health crises ranging from novel influenzas (H5N1 and H1N1) and coronaviruses (SARS and MERS) to the Ebola and Zika viruses. In each case, governments and international organizations seemed unable to react quickly and decisively. Health crises have unmasked critical vulnerabilities—weak health systems, failures of leadership, and political overreaction and underreaction. The Global Health Risk Framework Commission, for which the National Academy of Medicine served as the secretariat, recently set out a comprehensive strategy to safeguard human and economic security from pandemic threats (eTable in the Supplement).1

Exploitative, irresistible, and coercive offers: why research participants should be paid well or not at all

Journal of Global Ethics
Volume 12, Issue 1, 2016
http://www.tandfonline.com/toc/rjge20/.U2V-Elf4L0l#.VAJEj2N4WF8

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Articles
Exploitative, irresistible, and coercive offers: why research participants should be paid well or not at all
Sara Belfrage
pages 69-86
DOI:10.1080/17449626.2016.1150318
ABSTRACT
This paper begins with the assumption that it is morally problematic when people in need are offered money in exchange for research participation if the amount offered is unfair. Such offers are called ‘coercive’, and the degree of coerciveness is determined by the offer’s potential to cause exploitation and its irresistibility. Depending on what view we take on the possibility to compensate for the sacrifices made by research participants, a wish to avoid ‘coercive offers’ leads to policy recommendations concerning payment for participation. For sacrifices considered compensable, we ought to offer either no payment or payment at a level deemed fair, while for sacrifices deemed incompensable, we always ought to offer no payment because as compensation appears and increases, so too does coercion. This article provides a model for thinking of the way in which degrees of exploitativeness, irresistibility, and coerciveness interact with the size of the reward for compensable and incompensable cases. The conclusions are of particular relevance in contexts where potential research participants are poor or in other ways lack reasonably good options, as is often the case when international pharmaceutical companies or researchers based in the Global North place clinical trials in the Global South.

Yellow fever vaccine supply: a possible solution

The Lancet
Apr 16, 2016 Volume 387 Number 10028 p1591-1692
http://www.thelancet.com/journals/lancet/issue/current

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Comment
Yellow fever vaccine supply: a possible solution
Thomas P Monath, Jack P Woodall, Duane J Gubler, Thomas M Yuill, John S Mackenzie, Reinaldo M Martins, Paul Reiter, David L Heymann
Summary
The global threat of the emerging epidemic of yellow fever in Angola1 is underscored by the recent spread of similar Aedes aegypti mosquito-borne viruses including dengue, chikungunya, and now Zika. Since their emergence in the 1950s, dengue virus infection has been reported from more than 128 countries, the chikungunya virus has been reported from over 60 countries,2,3 while yellow fever, first identified as a viral infection in 1900, has been reported from more than 57 countries and is on the move once again.

Global Health Security After Ebola: Four Global Commissions

The Milbank Quarterly
A Multidisciplinary Journal of Population Health and Health Policy
March 2016 Volume 94, Issue 1 Pages 1–223
http://onlinelibrary.wiley.com/doi/10.1111/1468-0009.2016.94.issue-1/issuetoc

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Op-Ed
Global Health Security After Ebola: Four Global Commissions (pages 34–38)
LAWRENCE O. GOSTIN
Article first published online: 14 MAR 2016 | DOI: 10.1111/1468-0009.12176

Clinical and Epidemiological Characterization of Laboratory-Confirmed Autochthonous Cases of Zika Virus Disease in Mexico

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 16 April 2016)

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Research Article
Clinical and Epidemiological Characterization of Laboratory-Confirmed Autochthonous Cases of Zika Virus Disease in Mexico
April 15, 2016 ·
Introduction: Since 2014, authoctonous circulation of Zika virus (ZIKV) in the Americas was detected (Easter Island, Chile). In May 2015, Brazil confirmed authoctonous ¬¬transmission and in October of that year Colombia reported their first cases. Now more than 52 countries have reported cases, including Mexico. To deal with this contingency in Mexico, several surveillance systems, in addition to systems for vector-borne diseases were strengthened with the participation of all health institutions. Also, the Ministry of Health defined an Action Plan against ZIKV for the whole country.
Methods: We analyzed 93 authoctonous cases of ZIKV disease identified by Epidemiological Surveillance System for Zika Virus in Mexico. All authoctonous cases confirmed by laboratory since November 25, 2015 to February 19, 2016 were included. A description of clinical and epidemiological characteristics of 93 cases of ZIKV disease are presenting and, we describe the Action Plan against this public health emergency.
Results: The distribution of cases by sex was 61 men and 32 women; mean age was 35 years old (S.D. 15, range 6-90). The main clinical features in the 93 cases were fever (96.6%), rash (93.3%), non-purulent conjunctivitis (88.8%), headache (85.4%), and myalgia (84.3%). No deaths were reported.
Conclusion: The ZIKV epidemic poses new challenges to public health systems. The information provided for basic, clinical, and epidemiological research, in addition to the data derived from epidemiological surveillance is essential. However, there are still many unanswered questions regarding mechanisms of transmission, complications, and impact of this virus.

The Future of the RTS,S/AS01 Malaria Vaccine: An Alternative Development Plan

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 16 April 2016)

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Essay
The Future of the RTS,S/AS01 Malaria Vaccine: An Alternative Development Plan
Roly Gosling, Lorenz von Seidlein
| published 12 Apr 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1001994
Summary Points
:: RTS,S/AS01 is the falciparum malaria vaccine candidate that is most advanced in development, globally.
:: In a large clinical trial in sub-Saharan African children, the protection conferred by RTS,S/AS01 was found to rapidly decline, particularly in infants.
:: Although RTS,S/AS01 was approved by the European Medicines Agency for active immunization of children aged 6 weeks to 17 months against malaria, the WHO did not recommend the inclusion of RTS,S/AS01 in the Expanded Programme of Immunisations (EPI).
:: Instead of aiming for inclusion of the vaccine in EPI, we propose that the future development of RTS,S/AS01 could take advantage of its high transient protective efficacy.
:: Adding the vaccine to intensive malaria elimination strategies in low-endemicity areas could be the critical factor in interrupting transmission.

Zika Virus Outbreak in Rio de Janeiro, Brazil: Clinical Characterization, Epidemiological and Virological Aspects

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 16 April 2016)

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Research Article
Zika Virus Outbreak in Rio de Janeiro, Brazil: Clinical Characterization, Epidemiological and Virological Aspects
Patrícia Brasil, Guilherme Amaral Calvet, André Machado Siqueira, Mayumi Wakimoto, Patrícia Carvalho de Sequeira, Aline Nobre, Marcel de Souza Borges Quintana, Marco Cesar Lima de Mendonça, Otilia Lupi, Rogerio Valls de Souza, Carolina Romero, Heruza Zogbi, Clarisse da Silveira Bressan, Simone Sampaio Alves, Ricardo Lourenço-de-Oliveira, Rita Maria Ribeiro Nogueira, Marilia Sá Carvalho, Ana Maria Bispo de Filippis, Thomas Jaenisch
| published 12 Apr 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004636

Zika virus in the Americas: Early epidemiological and genetic findings

Science
15 April 2016 Vol 352, Issue 6283
http://www.sciencemag.org/current.dtl

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Reports
Zika virus in the Americas: Early epidemiological and genetic findings
By Nuno Rodrigues Faria, Raimunda do Socorro da Silva Azevedo, Moritz U. G. Kraemer, Renato Souza, Mariana Sequetin Cunha, Sarah C. Hill, Julien Thézé, Michael B. Bonsall, Thomas A. Bowden, Ilona Rissanen, Iray Maria Rocco, Juliana Silva Nogueira, Adriana Yurika Maeda, Fernanda Giseli da Silva Vasami, Fernando Luiz de Lima Macedo, Akemi Suzuki, Sueli Guerreiro Rodrigues, Ana Cecilia Ribeiro Cruz, Bruno Tardeli Nunes, Daniele Barbosa de Almeida Medeiros, Daniela Sueli Guerreiro Rodrigues, Alice Louize Nunes Queiroz, Eliana Vieira Pinto da Silva, Daniele Freitas Henriques, Elisabeth Salbe Travassos da Rosa, Consuelo Silva de Oliveira, Livia Caricio Martins, Helena Baldez Vasconcelos, Livia Medeiros Neves Casseb, Darlene de Brito Simith, Jane P. Messina, Leandro Abade, José Lourenço, Luiz Carlos Junior Alcantara, Maricélia Maia de Lima, Marta Giovanetti, Simon I. Hay, Rodrigo Santos de Oliveira, Poliana da Silva Lemos, Layanna Freitas de Oliveira, Clayton Pereira Silva de Lima, Sandro Patroca da Silva, Janaina Mota de Vasconcelos, Luciano Franco, Jedson Ferreira Cardoso, João Lídio da Silva Gonçalves Vianez-Júnior, Daiana Mir, Gonzalo Bello, Edson Delatorre, Kamran Khan, Marisa Creatore, Giovanini Evelim Coelho, Wanderson Kleber de Oliveira, Robert Tesh, Oliver G. Pybus, Marcio R. T. Nunes, Pedro F. C. Vasconcelos
Science15 Apr 2016 : 345-349
Zika virus genomes from Brazil
The Zika virus outbreak is a major cause for concern in Brazil, where it has been linked with increased reports of otherwise rare birth defects and neuropathology. In a phylogenetic analysis, Faria et al. infer a single introduction of Zika to the Americas and estimated the introduction date to be about May to December 2013—some 12 months earlier than the virus was reported. This timing correlates with major events in the Brazilian cultural calendar associated with increased traveler numbers from areas where Zika virus has been circulating. A correlation was also observed between incidences of microcephaly and week 17 of pregnancy.
Abstract
Brazil has experienced an unprecedented epidemic of Zika virus (ZIKV), with ~30,000 cases reported to date. ZIKV was first detected in Brazil in May 2015, and cases of microcephaly potentially associated with ZIKV infection were identified in November 2015. We performed next-generation sequencing to generate seven Brazilian ZIKV genomes sampled from four self-limited cases, one blood donor, one fatal adult case, and one newborn with microcephaly and congenital malformations. Results of phylogenetic and molecular clock analyses show a single introduction of ZIKV into the Americas, which we estimated to have occurred between May and December 2013, more than 12 months before the detection of ZIKV in Brazil. The estimated date of origin coincides with an increase in air passengers to Brazil from ZIKV-endemic areas, as well as with reported outbreaks in the Pacific Islands. ZIKV genomes from Brazil are phylogenetically interspersed with those from other South American and Caribbean countries. Mapping mutations onto existing structural models revealed the context of viral amino acid changes present in the outbreak lineage; however, no shared amino acid changes were found among the three currently available virus genomes from microcephaly cases. Municipality-level incidence data indicate that reports of suspected microcephaly in Brazil best correlate with ZIKV incidence around week 17 of pregnancy, although this correlation does not demonstrate causation. Our genetic description and analysis of ZIKV isolates in Brazil provide a baseline for future studies of the evolution and molecular epidemiology of this emerging virus in the Americas.

Science Translational Medicine – 13 April 2016

Science Translational Medicine
13 April 2016 Vol 8, Issue 334
http://stm.sciencemag.org/

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Editorial
Global health partnerships: Are they working?
By Jonathan A. Muir, Jessica Farley, Allison Osterman, Stephen E. Hawes, Keith Martin, J. Stephen Morrison, King K. Holmes
Science Translational Medicine13 Apr 2016 : 334ed4
An assessment of global health collaborations highlights the advantages of synergies between global health research and training programs.

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Perspective
The Human Vaccines Project: A roadmap for cancer vaccine development
By Pedro Romero, Jacques Banchereau, Nina Bhardwaj, Mark Cockett, Mary L. Disis, Glenn Dranoff, Eli Gilboa, Scott A. Hammond, Robert Hershberg, Alan J. Korman, Pia Kvistborg, Cornelis Melief, Ira Mellman, A. Karolina Palucka, Irina Redchenko, Harlan Robins, Federica Sallusto, Theodore Schenkelberg, Stephen Schoenberger, Jeffrey Sosman, Özlem Türeci, Benoît Van den Eynde, Wayne Koff, George Coukos
Science Translational Medicine13 Apr 2016 : 334ps9
A concerted international effort is necessary to achieve clinically effective cancer vaccines.

A therapeutic HIV-1 vaccine enhances anti-HIV-1 immune responses in patients under highly active antiretroviral therapy

Vaccine
Volume 34, Issue 19, Pages 2157-2290 (27 April 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/19

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Original Research Article
A therapeutic HIV-1 vaccine enhances anti-HIV-1 immune responses in patients under highly active antiretroviral therapy
Pages 2225-2232
Frank Y. Tung, Jack K. Tung, Suresh Pallikkuth, Savita Pahwa, Margaret A. Fischl
Abstract
Background
HIV-1 specific cellular immunity plays an important role in controlling viral replication. In this first-in-human therapeutic vaccination study, a replication-defective HIV-1 vaccine (HIVAX) was tested in HIV-1 infected participants undergoing highly active antiretroviral therapy (HAART) to enhance anti-HIV immunity (Clinicaltrials.gov, identifier NCT01428596).
Methods
A010 was a randomized, placebo-controlled trial to evaluate the safety and the immunogenicity of a replication defective HIV-1 vaccine (HIVAX) given as a subcutaneous injection to HIV-1 infected participants who were receiving HAART with HIV-1 viral load 500 cells/mm3. HIV-1 specific immune responses were monitored by INF-γ enzyme linked immunospot (Elispot) and intracellular cytokine staining (ICS) assay after vaccination. Following the randomized placebo-controlled vaccination phase, subjects who received HIVAX vaccine and who met eligibility underwent a 12-week analytical antiretroviral treatment interruption (ATI). Viral load was monitored throughout the study.
Results
HIVAX was well tolerated in trial participants. Transient grade 1 to 2 (mild to moderate) injection site reactions occurred in 8 of 10 vaccinated participants. HIVAX was immunogenic in all vaccinated participants. The functionality of T cells was significantly enhanced after vaccination. Median viral load (3.45 log10 copies/ml, range of 96–12,830 copies/ml) at the end of the 12-week treatment interruption in HIVAX vaccinated group was significantly lower than the pre-treatment levels. Three vaccinated participants extended ATI for up to 2 years with stable CD4 cells and low viral loads.
Conclusions
HIVAX vaccine is generally safe, elicits strong anti-HIV-1 immune responses, and may play an important role in controlling viral load during treatment interruption in HIV-1 infected participants.

Epidemiological impact and cost-effectiveness of introducing vaccination against serogroup B meningococcal disease in France

Vaccine
Volume 34, Issue 19, Pages 2157-2290 (27 April 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/19

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Epidemiological impact and cost-effectiveness of introducing vaccination against serogroup B meningococcal disease in France
Original Research Article
Pages 2240-2250
Héloïse Lecocq, Isabelle Parent du Châtelet, Muhamed-Kheir Taha, Daniel Lévy-Bruhl, Benoit Dervaux
Abstract
Introduction
Despite its low incidence in France, invasive serogroup B meningococcal disease remains a public health concern. A new vaccine against the disease, Bexsero®, has been licensed in the EU. We studied the epidemiological impact and cost-effectiveness of routine vaccination using Bexsero® in order to inform the decision-making process regarding its potential inclusion in the vaccination schedule.
Methods
A multi-generational Markov model was used. Time horizon was set to 100 years. Five vaccination strategies were evaluated: infants at 3, 5, 6 and 13 months, toddlers at 13, 15 and 27 months and adolescents at 15 years provided 2 doses one month apart. A booster dose at 15 years old and a catch-up for 15 years old subjects during the first 15 years of the programme were added to the infant and toddler strategies. Costs per QALY gained were computed from a restricted societal perspective including direct costs only. Herd immunity was simulated in an alternative base-case scenario and sensitivity analyses.
Results
In the base-case analysis without herd immunity and with all cohorts vaccinated, at €40 per vaccine dose, routine infant vaccination would provide the lowest cost per QALY gained (€380,973) despite only preventing 18% of cases. Under the assumption of herd immunity, the adolescent vaccination would provide the lowest cost per QALY gained (€135,902) preventing 24% of cases. Infant vaccination with a late booster and catch-up would prevent 51% of cases with a cost of €188,511 per QALY gained.
Conclusions
Given current meningococcal epidemiology in France and the available data on the protection provided by Bexsero®, our modelling work showed that routine vaccination against serogroup B meningococcal disease is not cost-effective.

Acceptability of financial incentives or quasi-mandatory schemes to increase uptake of immunisations in preschool children in the United Kingdom: Qualitative study with parents and service delivery staff

Vaccine
Volume 34, Issue 19, Pages 2157-2290 (27 April 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/19

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Acceptability of financial incentives or quasi-mandatory schemes to increase uptake of immunisations in preschool children in the United Kingdom: Qualitative study with parents and service delivery staff
Original Research Article
Pages 2259-2266
Rebekah Jayne McNaughton, Jean Adams, Janet Shucksmith
Abstract
Introduction
Since the 1990s strenuous attempts have been made to rebuild trust in childhood immunisations. This study aimed to understand if financial incentives (FI) or quasi-mandatory schemes (QMS), e.g. mandating immunisations for entry to universal services such as day care or school, might be acceptable interventions to increase immunisations uptake for preschool children.
Material and methods
Parents and carers of preschool children (n = 91); health and other professionals (n = 18); and those responsible for developing and commissioning immunisation services (n = 6) took part in the study. Qualitative methods were employed to explore the acceptability of FI/QMS with stakeholders. Framework analysis was used to develop a coding framework that was applied to the whole dataset. Interpretations of the emergent themes were verified between researchers and presented to the project’s Parent Reference Group to ensure coherence and relevance.
Results
(1) FI: parents and professionals felt introducing FI was inappropriate. It was acknowledged FI may encourage families living in disadvantage to prioritise immunisation, but unintended consequences could outweigh any advantage. FI essentially changes behaviour into a cash transaction which many equated to bribery that could inadvertently create inequalities.
(2) QMS: parents and professionals highlighted the positives of introducing QMS, stating it felt natural, fair and less likely to create inequality. Despite QMS’ potential to positively impact on uptake there were concerns about the implementation and workability of such schemes.
Discussion and conclusion
FI for preschool immunisation may not be acceptable, within a UK context. Introducing FI could have detrimental effects on uptake if it were associated with bribery and coercion. Quasi-mandatory schemes, mandating immunisation for universal service entry, was the most acceptable option and could contribute to the normalising of immunisation. Future work would be needed to assess how this could be successfully implemented and if it did indeed increase uptake.

Media/Policy Watch [to 16 April 2016]

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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BBC
http://www.bbc.co.uk/
Accessed 16 April 2016
China to punish hundreds of officials over vaccine scandal
14 April 2016
The Chinese government has promised to punish 357 officials over a scandal involving the illegal sale of vaccines.
State media say 192 criminal cases have been filed. Improperly stored or transported vaccines were allegedly sent to 59 health institutions.
The government has said it will tighten procedures around vaccine-handling.
Anger over the scandal is widespread in China, where the alleged illegal vaccine ring had reportedly been in operation since 2011.
In April 2015 two women were arrested for selling some $88m (£61m) worth of vaccines.
Details were only made public last month, when the authorities issued a call demanding that suppliers come forward to help them trace potential victims.
China’s State Council said 357 officials faced demotion or losing their jobs and that 202 had been detained so far.
Health authorities have also urged people to continue coming forward for vaccinations.

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Forbes
http://www.forbes.com/
Accessed 16 April 2016
Apr 14, 2016
Zika Causes Birth Defects, But How Fast Can A Vaccine Be Developed?
…Public health workers have been struggling to address the threat of Zika since the first microcephaly cases following infection were reported in Brazil last year. Currently, primary preventive approaches are focused on controlling mosquito populations and protecting individuals, using repellent, screened windows and air conditioning. But the best approach, as Dr. Peter Hotez of Texas Children’s Hospital Center discussed in January, would be a vaccine.

Easier said than done. Despite hopes of having a vaccine “within months,” as the head of the National Institute of Allergy and Infectious Diseases claims is possible, vaccines typically take years to develop, explained Jay Nelson, PhD, a senior molecular virologist and founder and director of the Vaccine and Gene Therapy Institute at Oregon Health and Science University. He agreed that a vaccine is the most efficient and effective way to protect people, especially now that the virus appears to have mutated and poses a big threat to pregnant people and developing fetuses. But Zika is about 40% homologous to the dengue virus at the amino acid level, he explained, and a dengue vaccine has taken two decades to develop—and there still is not a highly effective, safe dengue vaccine.
Given the number of groups working on Zika vaccine development, however, it hopefully won’t take 20 years to develop one….

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New Yorker
Accessed 16 April 2016
April 14, 2016
With Summer Coming, Can the Zika Virus Be Contained?
By Joshua Lang
With no vaccine or antiviral treatment available so far, the only way to prevent an outbreak is to fight the virus’s main carrier: the mosquito.

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New York Times
http://www.nytimes.com/
Accessed 16 April 2016
The Looming Threat of Avian Flu
Last year’s outbreak showed just how difficult it is to protect America’s agricultural system from
devastating diseases. Next time it could be even worse.
April 17, 2016 – By MARYN MCKENNA –

The Opinion Pages | Editorial
On Zika, Congress Is Failing to Do Its Job
The Centers for Disease Control and Prevention has concluded that the Zika virus causes brain damage in babies born to infected women, which adds to the growing evidence that the virus is a major public health emergency. Yet Republicans in Congress are refusing to appropriate the money needed to respond to this crisis.

A Zika outbreak began last year in Brazil and has spread to other countries. In a paper published in The New England Journal of Medicine on Wednesday, C.D.C. researchers say there is enough evidence to determine that the mosquito-borne virus is causing microcephaly, a condition in which babies are born with small heads. Zika has also been linked to neurological disorders in adults.

President Obama asked Congress in February for more than $1.8 billion to fight Zika, but Republican lawmakers refused to act and said the government should use money that had been appropriated for other diseases, like Ebola. They have also made vague promises to provide more funds before the next fiscal year begins in October.

After weeks of fruitless talks with Congress, the administration said last week that it would shift nearly $600 million to anti-Zika efforts from Ebola and other programs. That is not sufficient and could increase the risk of another outbreak of Ebola, which remains a persistent threat. The World Health Organization says there have been new cases of that deadly disease in Liberia and Guinea recently.

The federal government has already been forced to hold back grants for state and local health departments because it needed the money for Zika programs. Congressional inaction is also depriving the fights against malaria and tuberculosis of money.

Lawmakers might be tempted to consider Zika a distant threat, but that is a dangerous misconception. There could be hundreds of thousands of Zika cases in Puerto Rico, with possibly hundreds of babies affected, according to Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases. As of Wednesday, 475 people were known to have the virus in American territories, 58 of them pregnant women, according to the C.D.C. A smaller number of cases have been reported in states involving people who contracted the virus while traveling.
Every weekday, get thought-provoking commentary from Op-Ed columnists, The Times editorial board and contributing writers from around the world.

Medical experts say that Zika can spread quickly without warning, in part because most infected people have mild symptoms or none at all. The mosquitoes known to spread Zika are found in 30 states, and experts say places like Florida, Louisiana and Texas are particularly at risk. Public health officials say Zika can also be transmitted by unprotected sex.

Government researchers and pharmaceutical companies are working on a Zika vaccine. Scientists are also perfecting mosquitoes genetically modified to produce offspring that die young, but that approach requires more testing. In addition to research, programs are needed to prevent infections by encouraging people, especially pregnant women and their families, to protect themselves from mosquitoes and to practice safe sex.

Having learned from its slow response to Ebola, the Obama administration is trying to move faster against Zika. But if Congress doesn’t do its job, the public will be put at needless risk.

Testimony on the US Response to the Ebola Epidemic in West Africa

Center for Global Development
http://www.cgdev.org/
Accessed 16 April 2016

Testimony on the US Response to the Ebola Epidemic in West Africa
4/8/16
Amanda Glassman
On April 7, 2016, CGD’s vice president for programs and director of global health policy Amanda Glassman testified before the Senate Foreign Relations Subcommittee on Africa and Global Health Policy at a hearing examining progress made in addressing the West Africa Ebola epidemic and its secondary effects.

Vaccines and Global Health: The Week in Review – 9 April 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_9 April 2016

blog edition: comprised of the approx. 35+ entries posted below on 10 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

Zika virus [to 9 April 2016]

Zika virus [to 9 April 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

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Zika situation report
7 April 2016
Zika virus, Microcephaly and Guillain-Barré syndrome
Read the full situation report
Summary
:: From 1 January 2007 to 6 April 2016, Zika virus transmission was documented in a total of 62 countries and territories. Five of these (Cook Islands, French Polynesia, ISLA DE PASCUA – Chile, YAP (Federated States of Micronesia) and New Caledonia) reported a Zika virus outbreak that has terminated. Six countries have now reported locally acquired infection through sexual transmission (Argentina, Chile, France, Italy, New Zealand and the United States of America). Viet Nam is the country to most recently report mosquito-borne Zika virus transmission.

:: In the Region of the Americas, the geographical distribution of Zika virus has steadily widened since the presence of the virus was confirmed in 2015. Mosquito-borne Zika virus transmission has been reported in 33 countries and territories of this region.

:: From 2007, mosquito-borne Zika virus cases have been reported in 17 countries and areas of the Western Pacific Region.

:: Microcephaly and other fetal malformations potentially associated with Zika virus infection or suggestive of congenital infection have been reported in Brazil (1046 cases), Cabo Verde (two cases), Colombia (seven cases), French Polynesia (eight cases), Martinique (three cases) and Panama (one case). Two additional cases, each linked to a stay in Brazil, were detected in the United States of America and Slovenia.

:: In the context of Zika virus circulation, 13 countries or territories worldwide have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases.

:: Based on a growing body of preliminary research, there is scientific consensus that Zika virus is a cause of microcephaly and Guillain-Barré syndrome.

:: The global prevention and control strategy launched by the World Health Organization (WHO) as a Strategic Response Framework encompasses surveillance, response activities and research. This situation report is organized under those headings.

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Guidance for Health Workers
Surveillance for Zika virus infection, microcephaly and Guillain-Barré syndrome Interim Guidance
6 April 2016
This document provides interim recommendations for the surveillance of Zika virus infection, microcephaly and Guillain-Barré syndrome, in four different contexts and describes reporting requirements to WHO. Transmission refers to vector-borne transmission, unless specified differently. Autochthonous infection is considered to be an infection acquired in-country, i.e. among patients with no history of travel during the incubation period or who have travelled exclusively to non-affected areas during the incubation period. This document does not provide guidance on laboratory investigation or vector surveillance.
Number of pages: 9
Publication date: Updated 7 April 2016
Languages: English
WHO reference number: WHO/ZIKV/SUR/16.2 Rev.1

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Zika Open [to 9 April 2016]
[Bulletin of the World Health Organization]
:: All papers available here
No new papers identified in last week

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White House to redirect unused Ebola money to prepare for Zika virus
By Debra Goldschmidt, CNN
Updated 11:44 PM ET, Thu April 7, 2016
(CNN)In an effort to take immediate action against the Zika virus, the White House said it will redirect $589 million of existing funds, including $510 million which had been designated to fight Ebola.

The funding is needed for detection, prevention and response efforts, Health and Human Services Secretary Sylvia Burwell said Wednesday.

There are about 40 million people traveling between the continental United States and areas where the virus is circulating, according to Burwell.

The primary goal, she said, is to protect pregnant women and those who may become pregnant, because the virus is linked to a neurological birth defect and other fetal abnormalities. Experts agree that there are many unknowns when it comes to the virus and more is being learned every day…

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CDC/ACIP [to 9 April 2016]
http://www.cdc.gov/media/index.html
TUESDAY, APRIL 5, 2016
Transcript for CDC Telebriefing: Zika Summit Press Conference
Transcript for CDC telebriefing of the Zika Summit Press Conference

MONDAY, APRIL 4, 2016
CDC Adds Fiji 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 Fiji. CDC has issued travel notices…

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UN Women [to 9 April 2016]
http://www.unwomen.org/news/stories
Date: 07 April 2016
As World Health Day is commemorated globally, actions intensify in response to the Zika virus in Brazil
On World Health Day (7 April), UN Women and partners are beginning the second phase of targeted communication efforts around women’s rights in response to the Zika virus

EBOLA/EVD [to 9 April 2016]

EBOLA/EVD [to 9 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 above. We have not identified any action by the UN Security Council to change the “Threat to international peace and security” designation.

The last “Ebola Situation Update” is dated 30 March 2016 and may be the final situation report. We include two updates identified from WHO below.
We also recommend and include the link below to an editorial by Peter Hotez in PLoS Neglected Tropical Diseases, and refer readers to the full-text of Dr. Hotez’ editorial in the New York Times – “Zika is coming” – in Media Watch section near the end of this edition.

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Liberia and Guinea step up coordination to stem new cases of Ebola
7 April 2016 — WHO and Ministry of Health teams in Guinea and Liberia have established epidemiological links between new Ebola cases in Liberia and a current flare-up of Ebola in neighbouring Guinea following intensified case investigations and contact tracing.

Emergency response to Ebola flare underway in Liberia. Case investigation widens to Guinea
4 April 2016
WHO and Ministry of Health teams in Liberia and Guinea are investigating the origins of transmission in Liberia’s latest flare-up after learning that a woman who died from Ebola in Liberia last week had recently travelled from Guinea with her three young children.

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PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 9 April 2016)
Editorial
Neglected Tropical Diseases in the Anthropocene: The Cases of Zika, Ebola, and Other Infections
Peter J. Hotez
Published 08 Apr 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004648

POLIO [to 9 April 2016]

POLIO [to 9 April 2016]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 6 April 2016
:: 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.
:: There is one week to go until 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. Learn more about preparations for the switch here. Learn more about the rationale for the switch through this series of videos.

Selected Country Levels Updates [excerpted]
Pakistan
:: Five new WPV1 environmental positive samples were reported in the past week, with collection dates between 3 February and 12 March 2016. Two were collected from Sindh, one from Balochistan, one from Punjab and one from Khyber Pakhtunkhwa.
:: Sub-National Immunization Days (NIDs) are planned in April using bOPV.

WHO & Regional Offices [to 9 April 2016]

WHO & Regional Offices [to 9 April 2016]
World Health Day 2016: Action needed to halt rise in diabetes
6 April 2016 — The number of people living with diabetes has nearly quadrupled since 1980 to 422 million adults, with most living in developing countries. WHO is marking World Health Day, 7 April, by calling for action on diabetes. In its first “Global report on diabetes”, WHO highlights the need to step up prevention and treatment of the disease.
Read the news release

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Highlights
WHO Director-General visits Angola; urgent action needed to contain yellow fever outbreak
April 2016 — The Director-General of WHO, Dr Margaret Chan, arrived today in Angola’s capital Luanda for a two-day visit to assess the situation of the current outbreak of yellow fever virus.

General Assembly proclaims the Decade of Action on Nutrition
April 2016 — The United Nations General Assembly today agreed a resolution proclaiming the UN Decade of Action on Nutrition from 2016 to 2025. The resolution aims to trigger intensified action to end hunger and eradicate malnutrition worldwide, and ensure universal access to healthier and more sustainable diets.

The Weekly Epidemiological Record (WER) celebrates 90 years
April 2016 — On 1 April 1926, epidemiologists in the Health Office of the League of Nations, Geneva created the first WER. The publication’s mission was to provide the world with information about disease hazards that, at that time, mostly travelled by sea: plague, cholera, yellow fever, typhus and smallpox.

Austria: Measles in the spotlight
April 2016
In Austria, where elimination of measles is tantalizingly close, a creative and innovative campaign seeks to encourage vaccination among unimmunized adults.

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WHO SAGE Meeting
Geneva: 12 – 14 April 2016.
:: Draft agenda pdf, 121kb as of 18 March 2016

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Weekly Epidemiological Record (WER) 08 April 2016, vol. 91, 14 (pp. 181–192)
Contents:
181 A review of the role of training in WHO Ebola emergency response
186 Yellow fever urban outbreak in Angola and the risk of extension
192 Monthly report on dracunculiasis cases, January– February 2016

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Disease Outbreak News (DONs)
:: 8 April 2016 Lassa Fever – Sweden
:: 6 April 2016 Yellow Fever – Kenya
:: 6 April 2016 Yellow Fever – China

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:: WHO Regional Offices
WHO African Region AFRO
:: WHO Director General and WHO Regional Director for Africa Conclude Official Visit to Angola
7 April 2016, Luanda – The World Health Organization Regional Director for Africa, Dr Matshidiso Moeti and the Director-General of WHO, Dr Margaret Chan have concluded a three-day official visit to Angola. The visit aimed at assessing the ongoing efforts to prevent and control the yellow fever epidemic which has gripped the country since December 2015, and to identify ways of further strengthening support to Angola.

WHO Region of the Americas PAHO
:: PAHO offers to provide technical support for pilot studies of new mosquito control technologies (04/08/2016)
:: PAHO Director lauds Mexico’s soda tax as a model measure to fight diabetes (04/07/2016)
:: The number of people with diabetes in the Americas has tripled since 1980 (04/06/2016)
:: ‘Don Francisco’ joins PAHO to promote diabetes prevention and control (04/05/2016)

WHO South-East Asia Region SEARO
:: Urgent, concerted efforts needed to stem diabetes epidemic: WHO
SEAR/PR/1620
New Delhi, 29 March 2016: Countries in the WHO South-East Asia Region must take vigorous and concerted action to ‘prevent, treat and beat’ diabetes, a potentially fatal disease that has reached epidemic proportions and is expected to further increase in coming years.

WHO European Region EURO
:: Poliomyelitis (polio) and the vaccines used to eradicate it – questions and answers 08-04-2016
:: European countries to participate in global polio vaccine switch 08-04-2016
:: WHO calls for global action on diabetes 07-04-2016
:: World Health Day 2016: Living with diabetes and educating others 07-04-2016
:: Consensus on causal link between Zika and neurological disorders 06-04-2016

WHO Eastern Mediterranean Region EMRO
:: WHO condemns attack on Ma’arib Hospital, Yemen 6 April 2016
:: Kuwait boosts treatments for chronic diseases in Syria 6 April 2016
:: New WHO policy aims to lower sugar intake to fight obesity and overweight in the Region
5 April 2016

WHO Western Pacific Region
:: World Health Day 2016: Together on the front lines against diabetes
MANILA, 7 April 2016 – On World Health Day, the World Health Organization (WHO) in the Western Pacific Region stands with all Member States and partners to renew its commitment to advance the understanding of diabetes and calls on all communities across the Region to work together to effectively manage and prevent the disease.

Gavi [to 9 April 2016]

Gavi [to 9 April 2016]
http://www.gavialliance.org/library/news/press-releases/

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04 April 2016
Norway strengthens commitment to immunisation in developing countries
Increased funding will help immunise 300 million more children in the world’s poorest countries by 2020
Oslo, 7 April 2016 – Børge Brende, Norwegian Minister of Foreign Affairs, and Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, today signed an agreement that will see Norway commit NOK 6.25 billion (US$ 850 million) to support the immunisation of children living in the world’s poorest countries between 2016 and 2020.

This renewed commitment – first announced by Prime Minister Erna Solberg in January 2015 at the Gavi replenishment conference in Berlin – represents a 50% increase in the country’s direct support for Gavi in the 2011-2015 period, underlining Norway’s strong commitment to childhood immunisation. The funds will help Gavi support developing countries to immunise more than 300 million children by 2020, helping save five to six million lives…

Global Fund [to 9 April 2016]

Global Fund [to 9 April 2016]
http://www.theglobalfund.org/

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04 April 2016
Global Fund Names Rahul Singhal as Chief Risk Officer
GENEVA – The Global Fund to Fight AIDS, Tuberculosis and Malaria has named Rahul Singhal, a senior global risk management and treasury executive, as its new Chief Risk Officer.

Mr. Singhal has 28 years of experience in risk management in the financial services industry, building and leading risk management teams, and executing complex global initiatives including acquisitions and strategic investments. Mr. Singhal joined the Global Fund in October 2015 as Deputy Chief Risk Officer, and has been Acting Chief Risk Officer since January 2016…

PATH [to 9 April 2016]

PATH [to 9 April 2016]
http://www.path.org/news/index.php

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Announcement | April 04, 2016
PATH announces leader for malaria and neglected tropical diseases
Dr. Laurence Slutsker to lead PATH’s malaria and neglected tropical diseases portfolios

…As PATH’s director of malaria and NTD programs, Dr. Slutsker will lead the design and implementation of PATH’s public health programs and investments in malaria, oversee the organization’s broad portfolio of malaria control and elimination work, and expand PATH’s portfolio in NTDs.

In this role, he will work across the organization—from diagnostics and drugs to one of the world’s largest pipelines of malaria vaccine projects—to advance PATH’s comprehensive malaria strategy, and increase collaboration across a network of projects and geographies…

European Medicines Agency [to 9 April 2016]

European Medicines Agency [to 9 April 2016]
http://www.ema.europa.eu/

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04/04/2016
Extrapolation of data from adults to children can facilitate development of paediatric medicines
EMA releases draft reflection paper ahead of workshop in May
The European Medicines Agency (EMA) has published a preliminary version of its draft reflection paper which outlines a framework for the extrapolation of clinical trial data from adults to children to support the authorisation of new medicines for children.

Extrapolation of data aims to optimise the involvement of children in clinical studies, one of the objectives of the European Union Paediatric Regulation, by predicting how a medicine may work in children and adolescents on the basis of studies conducted in adults or other paediatric populations.

The draft reflection paper outlines a systematic approach to extrapolation of data from adults or other paediatric populations to children that is considered scientifically sound and reliable to support the authorisation of a medicine. The framework sets out when, to what extent, and how extrapolation can be applied and validated.

The principal steps of the extrapolation framework are:
:: Extrapolation concept: this consists of a systematic synthesis of all available data, including the use of modelling and simulation approaches, which aims to predict the differences with regard to pharmacokinetics/pharmacodynamics, disease progression, and clinical response to treatment between adults and children;
:: Extrapolation plan: this aims to propose optimal studies in the paediatric population in line with predictions identified by the extrapolation concept;
:: Confirmation and extrapolation: this phase aims to confirm the extrapolation concept on the basis of the data collected in children and adults. If the extrapolation concept cannot be fully confirmed, it should be updated and the extrapolation plan revised accordingly;
:: Mitigating uncertainty and risk: the limited data generated in the paediatric population may not be sufficient to resolve all uncertainties and assumptions of the extrapolation concept by the time of marketing authorisation. Additional follow-up data may be necessary to address uncertainties and to further evaluate assumptions. Measures to generate these data need to be proposed…