Science
25 March 2016 Vol 351, Issue 6280
http://www.sciencemag.org/current.dtl

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Policy Forum
Ethics review for international data-intensive research
By Edward S. Dove, David Townend, Eric M. Meslin, Martin Bobrow, Katherine Littler, Dianne Nicol, Jantina de Vries, Anne Junker, Chiara Garattini, Jasper Bovenberg, Mahsa Shabani, Emmanuelle Lévesque, Bartha M. Knoppers
Science25 Mar 2016 : 1399-1400
Summary
Historically, research ethics committees (RECs) have been guided by ethical principles regarding human experimentation intended to protect participants from physical harms and to provide assurance as to their interests and welfare. But research that analyzes large aggregate data sets, possibly including detailed clinical and genomic information of individuals, may require different assessment. At the same time, growth in international data-sharing collaborations adds stress to a system already under fire for subjecting multisite research to replicate ethics reviews, which can inhibit research without improving the quality of human subjects’ protections (1, 2). “Top-down” national regulatory approaches exist for ethics review across multiple sites in domestic research projects [e.g., United States (3, 4), Canada (5), United Kingdom, (6), Australia (7)], but their applicability for data-intensive international research has not been considered. Stakeholders around the world have thus been developing “bottom-up” solutions. We scrutinize five such ef orts involving multiple countries around the world, including resource-poor settings (table S1), to identify models that could inform a framework for mutual recognition of international ethics review (i.e., the acceptance by RECs of the outcome of each other’s review).

Vaccine
Volume 34, Issue 16, Pages 1863-1986 (7 April 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/16
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Brief report
Preparing for future efficacy trials of severe malaria vaccines
Pages 1865-1867
Bronner P. Gonçalves, D. Rebecca Prevots, Edward Kabyemela, Michal Fried, Patrick E. Duffy
Abstract
Severe malaria is a major cause of mortality in children, but comprises only a small proportion of Plasmodium falciparum infections in naturally exposed populations. The evaluation of vaccines that prevent severe falciparum disease will require clinical trials whose primary efficacy endpoint will be severe malaria risk during follow-up. Here, we show that such trials are feasible with fewer than 1000 participants in areas with intense malaria transmission during the age interval when severe malaria incidence peaks.

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Regular papers
Severity of mumps disease is related to MMR vaccination status and viral shedding
Original Research Article
Pages 1868-1873
Sigrid Gouma, Susan J.M. Hahné, Daphne B. Gijselaar, Marion P.G. Koopmans, Rob S. van Binnendijk
Abstract
Background
During recent years, various mumps outbreaks have occurred among measles, mumps, and rubella (MMR) vaccinated persons in various countries worldwide, including the Netherlands. We studied mumps virus shedding in MMR vaccinated and unvaccinated mumps patients and related these findings to clinical data.
Methods
In this study, we included 1112 mumps patients of whom diagnostic samples were tested positive in our laboratory between 1 January 2007 and 31 December 2014. We compared mumps virus shedding and severity of disease between patients who had received 2 doses of MMR (n = 592) and unvaccinated mumps patients (n = 195). Mumps virus shedding in saliva and urine specimens was measured by qPCR. Severity of disease was studied in a subset of patients with clinical data available.
Results
Mumps patients who had received 2 MMR doses shed less often mumps virus in their urine than unvaccinated patients. Salivary viral loads were higher at day of onset of disease in twice MMR vaccinated patients with viruria than in twice MMR vaccinated patients without viruria. However, salivary viral loads did not significantly differ between patients who had received 2 MMR doses and unvaccinated patients. Bilateral parotitis and orchitis were less often reported in patients who had received 2 MMR doses than in unvaccinated patients. Furthermore, the prevalence of bilateral parotitis and orchitis was higher among twice MMR vaccinated patients with viruria than among twice MMR vaccinated patients without viruria.
Conclusions
MMR vaccination was associated with less severe disease among mumps patients. Systemic spread of virus was associated with more severe disease. The elevated salivary viral loads in patients with systemic mumps disease suggest that these patients pose a higher risk for mumps virus transmission. Our study contributes to the understanding of mumps virus pathogenesis and shows the protective effect of MMR vaccination on severity of disease.

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Can high overall human papillomavirus vaccination coverage hide sociodemographic inequalities? An ecological analysis in Canada
Original Research Article
Pages 1874-1880
Melanie Drolet, Shelley L. Deeks, Erich Kliewer, Grace Musto, Pascal Lambert, Marc Brisson
Abstract
Background
Human papillomavirus (HPV) vaccination programs have been implemented in more than 50 countries. These programs offer tremendous promise of reducing HPV-related disease burden. However, failure to achieve high coverage among high-risk groups may mitigate program success and increase inequalities. We examined sociodemographic inequalities in HPV vaccination coverage in 4 Canadian provinces (Quebec (QC), Ontario (ON), Manitoba (MB), British Columbia (BC)).
Methods
We obtained annual HPV vaccination coverage of pre-adolescent girls at provincial and regional levels, from the start of programs to 2012/2013. Regions refer to administrative areas responsible for vaccine implementation and monitoring (there are 18/36/10/16 regions in QC/ON/MB/BC). We obtained regions’ sociodemographic characteristics from Statistics Canada Census. We used univariate weighted linear regression to examine the associations between regions’ sociodemographic characteristics and HPV vaccination coverage.
Results
Provincial HPV vaccination coverage is generally high (QC:78%; ON:80%; MB:64%, BC:69%, 2012/13). QC had the highest provincial vaccination coverage since the program start, but had the greatest inequalities. In QC, regional HPV vaccination coverage was lower in regions with higher proportions of socially deprived individuals, immigrants, and/or native English speakers (p < 0.0001). These inequalities remained stable over time. Regional-level analysis did not reveal inequalities in ON, MB and BC.
Conclusion
School-based HPV vaccination programs have resulted in high vaccination coverage in four Canadian provinces. Nonetheless, high overall coverage did not necessarily translate into equality in coverage. Future work is needed to understand underlying causes of inequalities and how this could impact existing inequalities in HPV-related diseases and overall program success.

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LGBT health and vaccinations: Findings from a community health survey of Lexington-Fayette County, Kentucky, USA
Original Research Article
Pages 1909-1914
Jeff Jones, Asheley Poole, Vivian Lasley-Bibbs, Mark Johnson
Abstract
Data on adult immunization coverage at the state level and for LGBT Americans in particular are sparse. This study reports the results of a 2012 Lexington-Fayette County, Kentucky, community health assessment’s results asking about eight adult vaccinations among 218 lesbian, gay, bisexual, and transgendered (LGBT) respondents. Researchers collected data using an online survey distributed through LGBT social media, posters, and LGBT print media. The LGBT sample largely matches the demographics of the county as a whole except this group reports higher level of education and fewer uninsured individuals. Among LGBT respondents, immunization prevalence reaches 68.0% (annual Influenza), 65.7% (Hepatitis B), 58.8% (Chickenpox/Varicella), 55.9% (Hepatitis A), 41.2% (Smallpox), and 25.8% (Pneumonia). Among respondents who are currently within the recommended 19–26 years age range for the Human Papillomavirus (HPV) vaccine, the LGBT females are less likely to report receiving the vaccine (15.4%) compared to the national coverage percentage of 34.5%. Males, however, are more likely to have received the vaccine (10.3%) than the national percentage of 2.3%. The small number of LGBT seniors in the study report a much higher prevalence of the Shingles (Herpes Zoster) vaccines than for U.S. seniors 60 and older (71.4% compared to 20.1% nationally). LGBT respondents report higher percentages of adult vaccination.

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Japanese Society for Vaccinology papers
Universal varicella vaccine immunization in Japan
Review Article
Pages 1965-1970
Tetsushi Yoshikawa, Yoshiki Kawamura, Masahiro Ohashi

Development and introduction of inactivated poliovirus vaccines derived from Sabin strains in Japan
Review Article
Pages 1975-1985

Vaccine
Volume 34, Issue 15, Pages 1739-1862 (4 April 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/15

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Original Research Article
Knowledge and attitudes about Ebola vaccine among the general population in Sierra Leone
Pages 1767-1772
Xiang Huo, Guoqing Shi, Xinxu Li, Xuehui Lai, Liquan Deng, Feng Xu, Mingquan Chen, Qiang Wei, Thomas Samba, Xiaofeng Liang
Abstract
Background
Clinical trials of Ebola vaccine are ongoing. Before it becomes commercially available, understanding the Ebola vaccine-related knowledge and attitude of the general population is imperative to developing an effective vaccine coverage strategy.
Methods
We conducted a survey including 400 participants from general communities of the West Area Rural District, Sierra Leone. Knowledge and attitudes about Ebola vaccine were investigated, and the determinants of having knowledge and a positive attitude toward accepting vaccination were identified.
Results
Over half (55.8%) of the participants were aware of Ebola vaccine. About 60% of the participants were willing to be study subjects if the Ebola vaccine clinical trial were conducted in their communities. Most of the participants (72.5%) were willing to take Ebola vaccination if it was free of charge. Given that the vaccination was not free, the proportion willing to pay a fee to take the vaccination declined dramatically to 26.6%. Using a forward step-wise logistic model, monthly salary was identified as the single determinant (OR for every 100,000 Leones increase: 1.17, 95%CI: 1.04–1.31) for awareness of Ebola vaccine, which was identified as the determinant (OR: 1.88, 95%CI: 1.17–3.02) for free vaccination uptake willingness. The combination of monthly salary, monthly average income of family members and their interaction was found to be associated with charged vaccination uptake willingness.
Discussion
Measures are still needed to promote the Ebola vaccine awareness and knowledge updating. Free or low-priced vaccine could increase the vaccination acceptability of the general community population significantly.

Vaccine
Volume 34, Issue 15, Pages 1739-1862 (4 April 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/15

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Does frequent residential mobility in early years affect the uptake and timeliness of routine immunisations? An anonymised cohort study
Original Research Article
Pages 1773-1777
Hayley A. Hutchings, Annette Evans, Peter Barnes, Melanie A. Healy, Michelle James-Ellison, Ronan A. Lyons, Alison Maddocks, Shantini Paranjothy, Sarah E. Rodgers, Frank Dunstan
Abstract
Background
There are conflicting findings regarding the impact of residential mobility on immunisation status. Our aim was to determine whether there was any association between residential mobility and take up of immunisations and whether they were delayed in administration.
Methods
We carried out a cohort analysis of children born in Wales, UK. Uptake and time of immunisation were collected electronically. We defined frequent movers as those who had moved: 2 or more times in the period prior to the final scheduled on-time date (4 months) for 5 in 1 vaccinations; and 3 or more times in the period prior to the final scheduled on-time date (12 months) for MMR, pneumococcal and meningitis C vaccinations. We defined immunisations due at 2–4 months delayed if they had not been given by age 1; and those due at 12–13 months as delayed if they had not been given by age 2.
Results
Uptake rates of routine immunisations and whether they were given within the specified timeframe were high for both groups. There was no increased risk (odds ratios (95% confidence intervals) between frequent movers compared to non-movers for the uptake of: primary MMR 1.08 (0.88–1.32); booster Meningitis C 1.65 (0.93–2.92); booster pneumococcal 1.60 (0.59–4.31); primary 5 in 1 1.28 (0.92–1.78); and timeliness: primary MMR 0.92 (0.79–1.07); booster Meningitis C 1.26 (0.77–2.07); booster pneumococcal 1.69 (0.23–12.14); and primary 5 in 1 1.04 (0.88–1.23).
Discussion
Findings suggest that children who move home frequently are not adversely affected in terms of the uptake of immunisations and whether they were given within a specified timeframe. Both were high and may reflect proactive behaviour in the primary healthcare setting to meet Government coverage rates for immunisation.

Vaccine
Volume 34, Issue 15, Pages 1739-1862 (4 April 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/15

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Adverse events following HPV vaccination, Alberta 2006–2014
Original Research Article
Pages 1800-1805
Xianfang C. Liu, Christopher A. Bell, Kimberley A. Simmonds, Lawrence W. Svenson, Margaret L. Russell
Abstract
Background
In Canada, private purchase of human papilloma virus (HPV) vaccines has been possible since 2006. In Alberta, Canada, a publicly funded quadrivalent HPV vaccine program began in the 2008/2009 school year. There have been concerns about adverse events, including venous thromboembolism (VTE) associated with HPV vaccines. We describe the frequencies of adverse events following HPV vaccination among Alberta females aged 9 years or older and look at VTE following HPV vaccination.
Methods
We used the Alberta Immunization and Adverse Reaction to Immunization (Imm/ARI) repository (publicly funded vaccine), the population-based Pharmaceutical Information Network (PIN) information system (dispensing of a vaccine), and the Alberta Morbidity and Ambulatory Care Abstract reporting system (MACAR) for June 1, 2006–November 19, 2014. Deterministic data linkage used unique personal identifiers. We identified all reported adverse events following immunization (AEFI) and all emergency department (ED) utilization or hospitalizations within 42 days of immunization. We calculated the frequency of AEFI by type, rates per 100,000 doses of HPV vaccine administered and the frequencies of ICD-10-CA codes for hospitalizations and emergency department visits.
Results
Over the period 195,270 females received 528,913 doses of HPV vaccine. Of those receiving at least one dose, 192 reported one or more AEFI events (198 AEFI events), i.e., 37.4/100,000 doses administered (95% CI 32.5–43.0). None were consistent with VTE. Of the women who received HPV vaccine 958 were hospitalized and 19,351 had an ED visit within 42 days of immunization. Four women who had an ED visit and hospitalization event were diagnosed with VTE. Three of these had other diagnoses known to be associated with VTE; the fourth woman had VTE among ED diagnoses but not among those for the hospitalization.
Conclusions
Rates of AEFI after HPV immunization in Alberta are low and consistent with types of events seen elsewhere.

Vaccine
Volume 34, Issue 15, Pages 1739-1862 (4 April 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/15

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The economic cost of measles: Healthcare, public health and societal costs of the 2012–13 outbreak in Merseyside, UK
Original Research Article
Pages 1823-1831
Sam Ghebrehewet, Dominic Thorrington, Siobhan Farmer, James Kearney, Deidre Blissett, Hugh McLeod, Alex Keenan

Impact and cost-effectiveness of a second tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine dose to prevent pertussis in the United States
Original Research Article
Pages 1832-1838
Hajime Kamiya, Bo-Hyun Cho, Mark L. Messonnier, Thomas A. Clark, Jennifer L. Liang

A measles outbreak in a middle school with high vaccination coverage and evidence of prior immunity among cases, Beijing, P.R. China
Original Research Article
Pages 1853-1860
Rui Ma, Li Lu, Jiazi Zhangzhu, Meng Chen, Xiali Yu, Fengshuang Wang, Xiaoran Peng, Jiang

Value in Health
March 2016 Volume 19, Issue 2, p123-296
http://www.valueinhealthjournal.com/current

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Systematic Reviews
Sources and Characteristics of Utility Weights for Economic Evaluation of Pediatric Vaccines: A Systematic Review
Michael Herdman, Amanda Cole, Christopher K. Hoyle, Victoria Coles, Stuart Carroll, Nancy Devlin
p255–266
Published online: December 29 2015
Abstract
Background
Cost-effectiveness analysis of pediatric vaccines for infectious diseases often requires quality-of-life (utility) weights.
Objective
To investigate how utility weights have been elicited and used in this context.
Methods
A systematic review was conducted of studies published between January 1990 and July 2013 that elicited or used utility weights in cost-effectiveness analyses of vaccines for pediatric populations. The review focused on vaccines for 17 infectious diseases and is presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology.
Results
A total of 6410 titles and abstracts and 225 full-text articles were reviewed. Of those selected for inclusion (n = 101), 15 articles described the elicitation of utility weights and 86 described economic modeling studies using utilities. Various methods were used to generate utilities, including time trade-off, contingent valuation, and willingness to pay, as well as a preference-based measure with associated value sets, such as the EuroQol five-dimensional questionnaire or the Health Utilities Index. In modeling studies, the source of utilities used was often unclear, poorly reported, or based on weak underlying evidence. We found no articles that reported on the elicitation or use of utilities in diphtheria, polio, or tetanus.
Conclusions
The scarcity of appropriate utility weights for vaccine-preventable infectious diseases in children and a lack of standardization in their use in economic assessments limit the ability to accurately assess the benefits associated with interventions to prevent infectious diseases. This is an issue that should be of concern to those making decisions regarding the prevention and treatment of infectious childhood illnesses.

Child Care, Health and Development
2016 Mar 15.
” I think they’re all basically the same”: parents’ perceptions of human papilloma virus (HPV) vaccine compared with other adolescent vaccines.
doi: 10.1111/cch.12331. [Epub ahead of print]
Ogunbajo A1, Hansen CE2, North AL1, Okoloko E1, Niccolai LM1,3,4.
Abstract
BACKGROUND:
Human papillomavirus (HPV) vaccination is recommended for routine administration at ages 11-12 years. However, uptake is lower than for other vaccines that are also routinely recommended for adolescents (MCV4 and Tdap). Understanding parental perceptions of HPV vaccine compared with other vaccines may help to inform strategies to increase uptake.
METHODS:
Parents and caregivers (n = 45) of adolescents ages 10-18 years from a low-income, ethnic minority population participated in a qualitative study. Interviews were transcribed verbatim and coded for emergent themes.
RESULTS:
Many participants perceived the HPV vaccine to be similar to other routine vaccines. Noted similarities included the vaccines’ ability to prevent disease, similar methods of administration and belief in health care providers’ recommendation. Some parents noted the greater benefit of HPV vaccine in preventing cancer, which was viewed as a serious disease. Parents also noted the different mode of transmission (sexual) for HPV, which evoked mixed opinions.
CONCLUSION:
Overall, most participants viewed the HPV vaccine in a positive light and similar to other adolescent vaccines with the added benefit of cancer prevention. Strategies that treat all three vaccines equally such as presenting them similarly as a ‘bundle’ to parents or considering policy initiatives such as school entry requirements might help increase raise coverage for HPV vaccine.

American Journal of Obstetrics and Gynecology
Available online 18 March 2016
Rates of Human Papillomavirus Vaccine Uptake amongst Girls Five Years after Introduction of Statewide Mandate in Virginia
In Press, Accepted Manuscript — Note to users
Ryan D. Cuff, MD1, Tommy Buchanan, MD2, Elizabeth Pelkofski, MD3, Jeffrey Korte, PhD4,
Susan P. Modesitt, MD5, Jennifer Young Pierce, MD2
Abstract
Background
The Commonwealth of Virginia enacted statewide school-entry Human Papillomavirus (HPV) vaccine mandate in 2008 requiring all girls to receive the vaccine prior to starting the 8th grade. The mandate, one of very few in the country, has been in effect for five years. This study assesses the impact that it has had on the rates of HPV uptake.
Objective
To evaluate uptake HPV vaccine amongst girls presenting for well-child care 5 years after introduction of statewide mandate in Virginia in October 2008.
Study Design
This prospective cohort study utilized the Clinical Data Repository (CDR) at the University of Virginia (UVA) to identify girls aged 11-12 who presented for well-child care from January – December 2014. Billing and diagnosis codes were used to establish HPV vaccine administration. Those identified through the CDR were then contacted by advance letter followed by a representative from the UVA Center for Survey Research (CSR) who invited the responsible parent or guardian to complete a 50-item telephone questionnaire. Questionnaire results were used to inform objective findings and to assess parental attitudes related to HPV vaccination.
Findings were compared against those of Pierce, et al (2013), which evaluated HPV vaccination levels in a similar cohort of patients in 2008, prior to mandate enactment in order to assess relative change attributable to vaccine mandate.
Results
Nine hundred eight girls were identified through the CDR, 50.9% received at least one dose of HPV vaccine. White race and private insurance coverage were found to be negatively associated with HPV vaccine uptake (RR 0.74 and 0.71, 95% CI 0.64-0.85 and 0.62-0.81, respectively). Black race and public insurance coverage were found to be positively associated with vaccine uptake (RR 1.35 and 1.39, 95% CI 1.17-1.55 and 1.22-1.58, respectively). When comparing to the previous study, there has been no change in HPV vaccine uptake or distribution of uptake after the introduction of the statewide mandate for HPV vaccination.
Conclusions
Statewide HPV vaccine mandate has had no impact on the overall rate of HPV vaccination, nor has it diminished the previously-described racial or payer disparities in vaccine uptake in school-aged girls presenting for well-child care in the state of Virginia.

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 26 March 2016
Uganda to jail parents over missed vaccinations
25 March 2016
Parents who fail to vaccinate their children in Uganda will face six months in jail, according to a new law signed by President Yoweri Museveni.
It also requires children to have an immunisation card to allow them to go to school.
The law will help the government reach its vaccination target, Health Minister Sarah Achieng Opendi told the BBC.
Some parents and members of a religious cult have refused to allow their children vaccinated, she says.
The government’s vaccination campaign targets several life-threatening diseases including polio and meningitis…

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The Economist
http://www.economist.com/
Accessed 26 March 2016
Vaccination
A jab in time
Some Western countries have lower vaccination rates than poor parts of Africa. Anti-vaxxers are not the main culprits
Mar 26th 2016

HPV vaccines
The cost of embarrassment
A jab to ward off cervical cancer is standard for girls. Should boys have it, too?

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Forbes
http://www.forbes.com/
Accessed 26 March 2016
Thank You, Robert DeNiro, For Doing the Right Thing For Autistic Individuals And Children
Robert DeNiro and the Tribeca Film Festival have removed the film Vaxxed, made by Andrew Wakefield from the festival.
Tara Haelle, Contributor Mar 26, 2016

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New York Times
http://www.nytimes.com/
Accessed 26 March 2016
Health
Robert De Niro Defends Screening of Anti-Vaccine Film at Tribeca Festival
By PAM BELLUCK and MELENA RYZIK
MARCH 25, 2016
In a decision that has dredged up the widely debunked link between vaccines and autism, the Tribeca Film Festival plans to screen a film by a discredited former doctor whose research caused widespread alarm about the issue.

The film, “Vaxxed: From Cover-Up to Catastrophe,” is directed and co-written by Andrew Wakefield, an anti-vaccination activist and an author of a study — published in the British medical journal The Lancet, in 1998 — that was retracted in 2010. In addition to the retraction of the study, which involved 12 children, Britain’s General Medical Council, citing ethical violations and a failure to disclose financial conflicts of interest, revoked Mr. Wakefield’s medical license.

On the festival’s website, the biographical material about Mr. Wakefield does not mention that he was stripped of his license or that his Lancet study was retracted. Rather, it says that the Lancet study “would catapult Wakefield into becoming one of the most controversial figures in the history of medicine.”

On Friday, Robert De Niro, one of the festival’s founders, said in a statement issued through the festival’s publicists that he supported the plan to show the movie next month, although he said he was “not personally endorsing the film,” nor was he against vaccination….
[see Forbes story above in which the film is reported to have been pulled from the Festival]

China Vaccine Scandal Stokes Anger as Regulators Come Under Fire
March 23, 2016 – By REUTERS
SHANGHAI — A widening scandal over illegal vaccine sales in China has sparked anger and drawn criticism from the government over glaring loopholes in the regulation of the world’s second-largest medicine market. Police detained 37.

China Detains Dozens After Sales of Poorly Stored Vaccines
By THE ASSOCIATED PRESSMARCH 22, 2016, 10:48 P.M. E.D.T.
BEIJING — Police in eastern China have detained 37 people implicated in a scandal involving the selling of poorly refrigerated and probably ineffective vaccines, state media reported Wednesday.
The scandal came to light after police last month announced the detentions of a woman and daughter thought to have sold nearly $100 million worth of the suspect products nationwide since 2011.
The scandal re-enforces longstanding concerns among the public over the safety of food and medicine. Nine pharmaceutical wholesalers believed to have sold the vaccines are being investigated.
Chinese Premier Li Keqiang issued orders late Tuesday for government administrations to work together to conduct a thorough investigation. Along with prosecuting the criminals involved, government officials found guilty of negligence should be held to account, Li said, according to the official government website.
“This vaccine safety incident has created deep concern among the public and laid bare numerous regulatory loopholes,” Li was quoted as saying.
The Food and Drug Administration on Monday ordered a thorough check on where the vaccines were distributed and how they may have been used. The central government administration demanded local authorities investigate the nine wholesalers believed to have sold the vaccines.
The vaccines included those for hepatitis B, rabies, mumps and Japanese encephalitis.

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Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 26 March 2016
De Niro’s Tribeca festival pulls anti-vaccination film
26 min ago
Robert De Niro is removing the anti-vaccination documentary “Vaxxed” from the lineup of his Tribeca Film Festival, after initially defending its inclusion.
Associated Press | National | Mar 26, 2016

China’s Vaccine Scandal Reveals System’s Flaws
March 25, 2016 7:44 am ET

India to Vaccinate Millions of Children Against Deadly Rotavirus
By Suryatapa Bhattacharya
March 25, 2016 1:47 am ET

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Washington Post
http://www.washingtonpost.com/
Accessed 26 March 2016
China crackdown on problem vaccines nets 130 suspects
Chinese police say a crackdown on expired and improperly stored vaccines has netted 130 suspects and more than 20,000 doses of the suspect medications.
Associated Press | Foreign | Mar 24, 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_19 March 2016

– blog edition: comprised of the approx. 35+ entries posted below on 20 March 2016.

– Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
.
– 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 19 March 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

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Zika virus, Microcephaly and Guillain-Barré syndrome – 17 March 2016
WHO Situation Report: Read the full situation report
Summary
:: From 1 January 2007 to 16 March 2016, Zika virus transmission was documented in a total of 59 countries and territories. Cuba and Dominica are the latest to report autochthonous (local) transmission of Zika virus on 14 and 15 March, respectively. Five of these countries and territories reported a Zika virus outbreak that is now over. Three countries (France, Italy and United States of America) have reported locally acquired infection in the absence of any known mosquito vectors, probably through sexual transmission.

:: The geographical distribution of Zika virus has steadily widened since the virus was first detected in the Americas in 2014. Autochthonous Zika virus transmission has been reported in 33 countries and territories of this region.

:: So far an increase in microcephaly and other fetal malformations has been reported in Brazil and French Polynesia, although two additional cases linked to a stay in Brazil were detected in the United States of America and Slovenia.

:: In the context of Zika virus circulation 12 countries or territories have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases.

:: The mounting evidence from observational, cohort and case-control studies indicates that Zika virus is highly likely to be a cause of microcephaly, GBS and other neurologic disorders. Among the tasks ahead are to further quantify the risk of neurologic disorders following Zika virus infection, and to investigate the biological mechanisms that lead to neurologic disorders.

:: The global prevention and control strategy launched by WHO as a Strategic Response Framework encompasses surveillance, response activities and research, and this situation report is organized under those headings.

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WHO supports Cabo Verde in managing Zika virus
18 March 2016 — Although the number of cases of Zika in Cabo Verde is declining, the Minister of Health announced on 15 March the first case of microcephaly. Investigations are underway to determine if this case of microcephaly is linked to Cabo Verde’s outbreak of Zika virus. Responding to a request from the Ministry of Health in Cabo Verde, WHO is sending a team to the country.
Read the note to the media

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Latest updates
:: Mosquito control works if implemented well; new control tools in the pipeline
18 March 2016
:: Damn the mosquitoes! Full speed ahead!
15 March 2016

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Guidance for health workers
:: Entomological surveillance for Aedes spp.
15 March 2016

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Zika Open
[Bulletin of the World Health Organization]
:: All papers available here
Posted: 14 March 2016
Detection of immunoglobulin G responses in Haitian children exposed to chikungunya, dengue, and malaria using a multiplex bead assay
– Mathieu JP Poirier, Delynn M Moss, Karla R Feeser, Thomas G Streit, Gwong-Jen J Chang, Matthew Whitney, Brandy J Russell, Barbara W Johnson, Alison J Basile, Christin H Goodman, Amanda K Barry, & Patrick J Lammie
http://dx.doi.org/10.2471/BLT.16.173252

Posted: 16 March 2016
Evolution of cases of microcephaly and neurological abnormalities suggestive of congenital infection in Brazil: 2015-2016
– Antonio JLA Cunha, Maria Clara Magalhães-Barbosa, Fernanda Lima-Setta & Arnaldo Prata-Barbosa
http://dx.doi.org/10.2471/BLT.16.173583

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CDC/ACIP [to 19 March 2016]
http://www.cdc.gov/media/index.html
SATURDAY, MARCH 19, 2016
CDC adds Cuba 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 Cuba…

FRIDAY, MARCH 18, 2016
New CDC Laboratory Test for Zika Virus Authorized for Emergency Use by FDA
In response to a request from the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration (FDA) yesterday issued an Emergency Use Authorization (EUA) for the Trioplex Real-time RT-PCR Assay, a diagnostic tool for Zika virus that will be distributed to qualified laboratories. The assay allows doctors to tell if an individual is currently infected with chikungunya, dengue, or Zika using one test, instead of having to perform three separate tests to determine which infection one might have…

MMWR – March 18, 2016 / Vol. 65 / No. 10
:: Revision to CDC’s Zika Travel Notices: Minimal Likelihood for Mosquito-Borne Zika Virus Transmission at Elevations Above 2,000 Meters

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EU supports Zika research with €10 million
European Commission – Press release Brussels, 15 March 2016
The European Commission is today releasing €10 million for research on the Zika virus, currently affecting large parts of Latin America.

The most affected country is Brazil, where the World Health Organisation (WHO) has declared that the recent cluster of severe brain malformations in new-borns may be linked to the virus. While the risk of transmission of the Zika virus in the EU is low, there is currently no treatment or vaccine against the virus, and diagnostic tests for infections are not widely available.

The funding, which comes from the Horizon 2020 EU research and innovation funding programme, will go into projects that will first have to prove the link between the virus and severe brain malformations reported in newborn children. If proven, researchers could then move on to combatting the Zika virus, including developing diagnostics and testing potential treatments or vaccines…

EBOLA/EVD [to 19 March 2016]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

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Ebola Situation Reports
[While no announcement of a change in reporting cycle is evident, we deduce that Ebola Situation Reports have been reduced to a bi-weekly cycle given the spacing of the last few reports – previous update: Ebola Situation Report – 2 March 2016]

Ebola Situation Report – 16 March 2016
SUMMARY
:: Human-to-human transmission linked to the most recent cluster of 2 cases of Ebola virus disease (EVD) first reported from Sierra Leone on 14 January will be declared to have ended on 17 March, 42 days after the second and last case in the cluster provided a second consecutive negative blood sample (RT-PCR) and was discharged. Human-to-human transmission linked to the most recent cluster of cases in Liberia was declared to have ended on 14 January 2016. Guinea was declared free of Ebola transmission linked directly to the original outbreak on 29 December 2015, and will complete its 90-day period of enhanced surveillance on 27 March 2016.

:: With guidance from WHO and other partners, ministries of health in Guinea, Liberia, and Sierra Leone have plans to deliver a package of essential services to safeguard the health of the estimated more than 10 000 survivors. So far over 350 male survivors in Liberia have accessed semen screening and counselling services. In addition, over 2600 survivors in Sierra Leone have accessed a general health assessment and eye exam.

:: To manage the residual risks of Ebola reintroduction or re-emergence, WHO has supported the implementation of enhanced surveillance systems in Guinea, Liberia, and Sierra Leone to alert authorities to cases of febrile illness or death that may be related to EVD. In the week to 13 March, 1611 alerts were reported in Guinea from all of the country’s 34 prefectures. All alerts were reports of community deaths. Over the same period, 9 operational laboratories in Guinea tested a total of 370 new and repeat samples (17 samples from live patients and 353 from community deaths) from 17 of the country’s 34 prefectures. In Liberia, 663 alerts were reported from all of the country’s 15 counties, most of which (544) were related to live patients. The country’s 5 operational laboratories tested 595 new and repeat samples (399 from live patients and 196 from community deaths) for Ebola virus over the same period, compared with 921 samples the previous week. In Sierra Leone 1494 alerts were reported from the country’s 14 districts. The majority of alerts (1142) were for community deaths. 952 new and repeat samples (19 from live patients and 933 from community deaths) were tested for Ebola virus by the country’s 7 operational laboratories over the same period.

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WHO: New Ebola cases confirmed in Guinea as WHO warns of more possible flare ups
18 March 2016
Conakry — WHO has dispatched a team of specialists to the southern prefecture of Nzérékoré after 2 new cases of Ebola were detected and confirmed in a rural village.
Guinean health officials in the region alerted WHO and partners on 16 March to 3 unexplained deaths in recent weeks in the village of Koropara and said other members of the same family are currently showing symptoms characteristic of Ebola.
Guinea’s Ministry of Health, WHO, the US Centers for Disease Control and UNICEF sent in investigators on 17 March. Samples were taken from 4 individuals. A mother and her 5-year-old son, relatives of the deceased, confirmed positive for Ebola virus disease in lab tests. The 2 have been taken to a treatment facility.
In coordination with Guinea’s Ministry of Health, WHO has deployed an initial team of epidemiologists, surveillance experts, vaccinators, social mobilizers, contact tracers and an anthropologist today to support an inter-agency response. More specialists are expected to arrive in the coming days. Response teams will work to investigate the origin of the new infections and to identify, isolate, vaccinate and monitor all contacts of the new cases and those who died.
Guinea’s National Emergency Response Centre is convening a meeting 18 March to further coordinate a rapid response to contain the country’s first re-emergence of Ebola since its original outbreak was declared over on 29 December 2015…

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WHO statement on end of Ebola flare-up in Sierra Leone
WHO statement
17 March 2016
WHO joins the government of Sierra Leone in marking the end of the recent flare-up of Ebola virus disease in the country. As of today, 17 March, 42 days have passed, two incubation cycles of the virus, since the last person confirmed to have Ebola virus disease in the country tested negative for a second time.

This latest flare-up of Ebola brings to 3,590 the number of lives lost in Sierra Leone to an epidemic that devastated families and communities across the country and disrupted every aspect of life.
Today marks another milestone in the country’s effort to defeat Ebola. WHO commends Sierra Leone’s government, partners and people on the effective and swift response to this latest outbreak. From nurses, vaccinators and social mobilizers to contact tracers, counsellors and community leaders, Sierra Leoneans in affected districts mobilized quickly and their involvement and dedication was instrumental and impactful.

The rapid containment of the flare-up was also a real-time demonstration of the increased capacity at the national, district and community level to respond to Ebola outbreaks and other health emergencies and mitigate their impact. Investments made in rapid response teams, surveillance, lab diagnostics, risk communication, infection prevention and control measures and other programmes were put to the test and clearly paid off.

However, WHO continues to stress that Sierra Leone, as well as Liberia and Guinea, are still at risk of Ebola flare-ups, largely due to virus persistence in some survivors, and must remain on high alert and ready to respond…

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IOM / International Organization for Migration [to 19 March 2016]
http://www.iom.int/press-room/press-releases
Infectious Disease Holding Units Installed at Four Border Posts in Ghana
03/15/16
Ghana – IOM Ghana in partnership with the Government of Ghana installed four infectious disease holding units at Sampa and Elubo Points of Entry (border with Cote d’Ivoire), as well as the Hamile and Paga Points of Entry (border with Burkina Faso), to enhance the screening and surveillance capacities for Ebola Virus Disease (EVD) and other communicable diseases at these key border posts.
The holding units will facilitate the isolation of suspected cases of infectious diseases prior to their referral to the nearest health facilities for further management.

The holding units are equipped with examination couches, washrooms, hand washing sinks and a store room which is stocked with Personal Protective Equipment (including disposable gloves, disposable face masks, hand sanitizers, disposable aprons) as well as hygiene and cleaning equipment, and laser infra-red thermometers. The units also have their own individual sewer systems which are separate from the general public sewage system to avoid contamination…

…The IOM Chief of Mission in Ghana, Sylvia Lopez-Ekra said…“The Ebola epidemic in West Africa taught us two important things: First that the spread of Ebola was fueled among other things by the inability to control and screen population movements across borders, and second, that sick travelers should be swiftly identified and cared for with extra caution. With these new infectious disease holding units we are making an important contribution to addressing those two issues.”…

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Trials of a New Vaccine for Ebola to Take Place at RUSAL’s Medical Centre in Guinea
MOSCOW, March 16, 2016 /PRNewswire/ —
UC RUSAL, a leading global aluminium producer, co-organized a roundtable discussion “Ebola vaccine from Russia: the first lessons and outlook into the future”. The Minister of Health, Veronika Skvortsova and the Head of the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (“Rospotrebnadzor”), Anna Popova joined RUSAL President Oleg Deripaska at the event. Via a teleconference facility, the Guinean President Alpha Conde addressed the President of Russia, Vladimir Putin and the entire world community to express his appreciation.

The Minister of Health, Veronika Skvortsova noted that the Ebola vaccine has been developed in Russia under the working directive of the President and has obtained Russian state registration. In addition, the Russian Federation has allocated financing for “field trials” of the new vaccine. Two thousand citizens of the Republic of Guinea will be vaccinated at the first stage with trials planned at the Research and Clinical Diagnostics Centre for Epidemiological and Microbiological Studies, founded by RUSAL in Guinea.

RUSAL has been operating in Guinea for over 10 years and is the largest foreign employer in the country. RUSAL opened a specialized Centre for the treatment of Ebola in Kindia, with total investment in the Centre amounting to around USD10 million…

POLIO [to 19 March 2016]
Public Health Emergency of International Concern (PHEIC)

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Polio this week as of 16 March 2016
:: A new short film shown at the Ministerial Conference on Immunization in Africa, held in Addis Ababa, Ethiopia, demonstrates the value of the polio infrastructure in serving broader health goals. Watch the video here.
:: There is one month to go until the globally synchronized switch from the trivalent to bivalent oral polio vaccine. Learn more about 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 Jacobabad district, Sindh province, with onset of paralysis on 16 February. The total number of WPV1 cases for 2016 is now 6, compared to 19 reported for 2015 at this point last year.
:: One new WPV1 environmental positive sample was reported in the past week, in Quetta district of Balochistan, with collection date of 12 February.
:: National Immunization Days (NIDs) are currently ongoing in the country using tOPV

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WHO: Sudan: monitoring for polio across sub-Saharan sands
WHO and the Ministry of Health actively search for cases of acute flaccid paralysis among the Rashaida tribal community, Gedarif State, Sudan. Gedarif borders with Ethiopia and is considered a high-risk area.

14 March 2016 – For years polio has been a thorn in the side of the Ministry of Health of Sudan and WHO who have worked together to stave off the debilitating disease. Although now officially polio free, Sudan is considered one of the most at-risk countries in WHO’s Eastern Mediterranean Region. Protracted conflict and insecurity has weakened the national health system and compromised people’s access to basic health services, including routine immunization. Mass internal displacement, nomadic population movement and inaccessible areas have made it challenging for health workers to reach every child under-5 years of age across the country with repeat doses of oral polio vaccine (OPV). And porous borders and refugee influxes from neighbouring countries have compounded logistical challenges and the country’s vulnerability to cross-border infection.

Amidst this complex and volatile sociopolitical environment, the Ministry of Health with the support of WHO and other partners has managed to keep Sudan polio free. However, in order to maintain this status, more than ever, vigilance is required…

WHO & Regionals [to 19 March 2016]

WHO SAGE Meeting
Geneva: 12 – 14 April 2016.
:: Draft agenda pdf, 145kb As of 11 March 2016

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Weekly Epidemiological Record (WER) 18 March 2016, vol. 91, 11 (pp. 133–144)
Contents
133 Zoonotic influenza viruses: antigenic and genetic characteristics and development of candidate vaccine viruses for pandemic preparedness
143 Monthly report on dracunculiasis cases, January 2016

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Disease Outbreak News (DONs)
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 16 March 2016
:: Chikungunya – Argentina 14 March 2016
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 14 March 2016

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WHO: Syria 5 years on – delivering health against all odds
15 March 2016 – After five years of a brutal and senseless conflict over 250 000 Syrians have been killed and over half the population forced from their homes out of fear and want.
In the past few weeks however, we are seeing signs of momentum, fragile glimmers of hope. As humanitarians we welcome progress where it means real change..
:: View the photo story
:: Watch the video
:: Read the news release

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:: WHO Regional Offices
WHO African Region AFRO
:: Official visit of Dr Matshidiso Moeti, WHO Regional Director for Africa to China
Brazzaville, 18 March 2016 – The WHO Regional Director for Africa, Dr Matshidiso Moeti will begin a 4 day official visit to China from 22 to 25 March 2016 at the invitation of the Chinese government. The visit is aimed at further exploring areas of mutual interest in health with a view to having a more structured collaboration between WHO and the Chinese government.
:: Guinea: Two (2) confirmed Ebola cases in Koropara village in Nzérékoré – 18 March 2016
:: WHO statement on the end of the Ebola flare-up in Sierra Leone – 17 March 2016

WHO Region of the Americas PAHO
:: Regional Parliamentary Front against Tuberculosis in the Americas launched in Brazil (03/16/2016)

WHO South-East Asia Region SEARO
:: Media Statement – Create Healthy Environments to Save Lives
15 March 2016

WHO European Region EURO
:: Zika virus vectors and risk of spread in the WHO European Region 18-03-2016
:: TB elimination at stake unless Europe cares urgently for vulnerable, poor and marginalized populations and migrants 17-03-2016
:: Antibiotic awareness drives digital conversation in European countries 16-03-2016
:: Informing policy for young people’s health 15-03-2016
:: New WHO study reveals that while smoking by school-aged children has declined significantly, young people’s health and well-being is being undermined by gender and social inequalities 15-03-2016

WHO Eastern Mediterranean Region EMRO
:: New shipment of health supplies arrives in Taiz City
18 March 2016
:: Sudan: monitoring for polio across sub-Saharan sands
14 March 2016
:: Mobile medical clinics connect patients to health care in camps in Iraq
13 March 2016

WHO Western Pacific Region
:: Zika Outbreak Response in Tonga: Providing Special Care for Pregnant Women
TONGA, 16 March 2016 – On 1 February 2016, the Ministry of Health declared a Zika outbreak in the Kingdom of Tonga. Coincidentally, it was on the same day that the World Health Organization (WHO) announced that the recent cluster of microcephaly cases and other neurological disorders reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes a Public Health Emergency of International Concern (PHEIC) as per the International Heath Regulations (IHR, 2005). Pregnant women living in or travelling to areas of Zika virus transmission are given special care in Tonga as the Zika virus may cause microcephaly in babies.

CDC/ACIP [to 19 March 2016]
http://www.cdc.gov/media/index.html
[see Zika coverage above which includes CDC briefing content]

MMWR – March 18, 2016 / Vol. 65 / No. 10
:: Human Rabies — Missouri, 2014
:: Use of Vaccinia Virus Smallpox Vaccine in Laboratory and Health Care Personnel at Risk for :: Occupational Exposure to Orthopoxviruses — Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2015
:: Revision to CDC’s Zika Travel Notices: Minimal Likelihood for Mosquito-Borne Zika Virus Transmission at Elevations Above 2,000 Meters

UN Blocked From Delivering Aid to Besieged Areas in Syria
Voice of America – Lisa Schlein
March 17, 2016 1:41 PM
GENEVA—
The United Nations is appealing to the Syrian government to provide the permits needed to send humanitarian aid convoys into besieged and hard-to-reach areas and to allow a life-saving vaccination campaign for children to go ahead.

United Nations convoys have delivered desperately needed humanitarian assistance to nearly 260,000 people living in those areas of Syria since the beginning of the year. Aid agencies aim to reach more than 1 million people before the end of April.

The U.N., however, says it has not received permission to enter six areas – most government-controlled – where hundreds of thousands of people have received no relief supplies for more than one year. It is calling for the blockade of these places to be lifted.

Jan Egeland is the special adviser to the U.N. special envoy for Syria. Egeland says he is particularly concerned by the government’s refusal to allow medical relief supplies, including surgical and trauma care equipment, to be delivered.

“We are not able to get through medical personnel. We are not able to get medical assessment personnel. We are not able to do medical evacuations from besieged areas and even some hard-to-reach areas. So people are dying,” said Egeland.

Egeland says the inability to get medical supplies and personnel into these areas could jeopardize an important national vaccination campaign planned for between April 18 and 24. He says the campaign aims to inoculate the millions of children who are not vaccinated against killer diseases in Syria.

“That would be part of a three-phase vaccination campaign …against a number of diseases that are now threatening to spread in Syria because the vaccination rate is now in many areas down to 50 or 60 percent, which is a prescription for epidemic disease,” he said.

Egeland says children will be vaccinated against polio, measles and other communicable diseases. A cluster of 22 cases of polio was detected in Syria in October 2013. The country had been free of the crippling disease since 1999.

Egeland says the disease was eventually brought under control, but he warns polio could spread again in the country and across borders if the planned vaccination campaign does not go ahead…

European Vaccine Initiative [to 19 March 2016]
http://www.euvaccine.eu/news-events

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IPROVE: Roadmap launched 16 March
:: Roadmap to bolster vaccine innovation launched in European Parliament
:: IPROVE roadmap informs strategic decisions on the priorities for future vaccine investment
Brussels, 16 March 2016
The “Innovation Partnership for a Roadmap on Vaccines in Europe” (IPROVE) – financed under the EU 7th Framework Programme (FP7) – today launched a strategy setting out a vision for vaccine research and innovation in Europe over the next 20 years.

The roadmap, which is the first of its kind, was launched during a special European Parliament event that took place on the 16th of March and was hosted by MEPs Francoise Grossetête, Cristian-Silviu Busoi and Markus Ferber. Key opinion leaders in the field of vaccine research and development attended the event including representatives from the European Commission, the European Parliament, European Union Member States and a broad representation of the vaccines community including academia, industry, civil society and regulatory bodies.

The IPROVE roadmap will inform strategic decisions on the priorities for future vaccine investment in innovation and technological development at European Union and individual Member State level. Through a bottom-up approach involving all key stakeholders in the European vaccine field, the strategy aims to overcome fragmentation and remove bottlenecks to translation of breakthrough research into innovative vaccines.

Following a two year consultation period, the plan covers the critical areas of intervention relevant to the entire innovation value chain, defines priorities and makes recommendations to support and accelerate research in vaccines, to help steer European competitiveness in this field for the delivery and benefit of innovative prophylactic and therapeutic vaccines.

The IPROVE roadmap focuses on seven main thematic topics of consultation;
:: Vaccine R&D
:: Therapeutic Vaccines
:: Production and Manufacturing
:: Infrastructures
:: Vaccine SME needs
:: Training
:: Communications and Acceptance of Vaccination

Ruxandra Draghia-Akli, Director of the Health Directorate DG Research & Innovation at the European Commission comments; “The FP7-funded IPROVE project is an important contributor to build a strategic vision for future European activities in the entire innovation chain for vaccines, and to maintain Europe’s leading position in this important area of research, which is close to the hearts of European citizens.”

Speaking on the launch of the first vaccine R&D roadmap for Europe, Michael Watson, IPROVE Chair and former Head Global Policy at SANOFI adds; “We urge all of the key vaccination stakeholders to embrace IPROVE as a shared starting point that will drive and pull Europe and the world to new heights in vaccination development”.

The IPROVE consortium comprises four renowned organisations in the vaccine field in Europe: Vaccines Europe (VE), a specialised group within the European Federation of Pharmaceutical Industries and Associations (EFPIA) representing all major research-based vaccine global companies as well SMEs operating in Europe; the European Vaccine Initiative (EVI), a leading European Product Development Partnership supporting the development of effective, accessible, and affordable vaccines against diseases of poverty; the Sclavo Vaccines Association (SVA), a non-profit association whose main objective is to promote vaccine research targeted towards the discovery and study of advanced immunisation technologies; and EATRIS, a European consortium of academic institutions of excellence in translational research, working together to advance candidates into clinical development.

You can read or download the roadmap document at: www.iprove-roadmap.eu

EDCTP [to 19 March 2016]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials.

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17 March 2016
Joep Lange Institute for global healthcare improvement officially launched
The Joep Lange Institute (JLI) was officially inaugurated in Amsterdam, The Netherlands on 15 March 2016. High-level speakers and participants from civil society, industry, politics and global health research backgrounds attended. JLI is “an activist institute, inspired by the life and work of Joep Lange” and its goal is to make health markets work for the poor in countries where the (health care) system fails the people. The institute is closely linked to the Amsterdam Institute for Global Health and Development (AIGHD).

Gavi [to 19 March 2016]
http://www.gavialliance.org/library/news/press-releases/

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17 March 2016
Gavi welcomes new record low price for pneumococcal vaccine
GSK commitment is latest step towards improving access to PCV but challenges remain

17 March 2016 – A new commitment from GlaxoSmithKline (GSK) to provide pneumococcal vaccine at the lowest ever price was today welcomed by Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. The new price will be set at US$ 3.05 for doses being provided from 2017, a reduction of 10% from the current price of $3.40.

The commitment was announced by GSK’s Chief Executive, Sir Andrew Witty, at an event in Washington DC. The price will be available through the pilot Advance Market Commitment (AMC) to all Gavi countries and, for countries using the vaccine when they transition from Gavi support, it will continue to be available at this price for 10 years after transition.

“This price reduction is good news for everyone who wants to see children protected against the leading cause of pneumonia,” said Dr Berkley. “Sustainable pricing is one important objective of Gavi’s supply and procurement strategy, along with secure supply and product innovation. Healthy long term vaccine markets are critical to ensuring that the immunisation systems being built in developing countries today will benefit children for generations to come.”

Pneumococcal vaccines protect against pneumococcal disease, which is the leading cause of pneumonia. In 2015, pneumonia claimed the lives of 922,000 children under the age of five, accounting for around 15% of deaths worldwide of children in this age group, making it the largest vaccine-preventable killer of children.

Gavi began supporting developing countries to introduce pneumococcal vaccines in 2010. Since then, more than 50 countries have introduced the vaccine into their routine immunisation schedule with close to 50 million children now fully immunised against the disease…

NIH [to 19 March 2016]
http://www.nih.gov/news/releases.htm

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Experimental dengue vaccine protects all recipients in virus challenge study
March 16, 2016 — Vaccine developed by NIH and FDA scientists.

A clinical trial in which volunteers were infected with dengue virus six months after receiving either an experimental dengue vaccine developed by scientists from the National Institutes of Health (NIH) or a placebo injection yielded starkly contrasting results. All 21 volunteers who received the vaccine, TV003, were protected from infection, while all 20 placebo recipients developed infection. The study, published in Science Translational Medicine, underscores the importance of human challenge studies, in which volunteers are exposed to disease-causing pathogens under carefully controlled conditions.

“The findings from this trial are very encouraging to those of us who have spent many years working on vaccine candidates to protect against dengue, a disease that is a significant burden in much of the world and is now endemic in Puerto Rico,” said Stephen Whitehead, Ph.D., of NIH’s National Institute of Allergy and Infectious Diseases (NIAID). “In fact, these results informed the recent decision by officials at Brazil’s Butantan Institute to advance the TV003 vaccine into a large phase 3 efficacy trial.”…
[See Journal Watch below for Editor’s Summary and Abstract]

Fondation Merieux [to 19 March 2016]
Mission: Contribute to global health by strengthening local capacities of developing countries to reduce the impact of infectious diseases on vulnerable populations.
http://www.fondation-merieux.org/news

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17 March 2016, Lyon (France)
Fondation Mérieux and 3 Foundations Publish the 1st Edition of Humanitarian Alternatives
Humanitarian Alternatives launched its inaugural issue. Fondation Mérieux, the French Red-Cross Fund, the Action Against Hunger Foundation and the Handicap International Foundation collaborated to initiate and support this bilingual humanitarian journal with an international scope. The journal will be published three times a year with each issue devoted to a specific topic. This first edition focuses on the Ebola virus and what it reveals about the humanitarian sector.

The ambition of Humanitarian Alternatives is to bring together researchers and humanitarian stakeholders to reflect upon and create a more dynamic exchange on current practices and development within the humanitarian sector. Universities, including the UQAM of Montreal and the University of Lyon, are also contributing to the project.

Sabin Vaccine Institute [to 19 March 2016]
http://www.sabin.org/updates/ressreleases

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03.17.16
Sabin Publishes on Challenges and Way Forward for Effective Dengue Vaccine Communication and Advocacy
International efforts to improve dengue communication and advocacy have increased over the last years, as dengue becomes one of the fastest spreading vector-borne diseases. However, few concerted efforts have been agreed upon at the international level to effectively communicate about dengue vaccines. The recent approvals in Mexico, the Philippines, Brazil and El Salvador of the first dengue vaccine, Dengvaxia®, coupled with the progress of seven other vaccine candidates, call for urgent focus on this topic. Dengue-endemic countries need scientific evidence to inform their decisions on vaccine introduction. Waiting to plan until vaccine licensure, as routinely occurs, may unnecessarily delay access to dengue vaccines in developing countries by years.

Where do we stand today in understanding dengue vaccines? What has been done to generate knowledge in this area and how has it been communicated? The Sabin Vaccine Institute seeks to answer these questions in a new publication titled “International Dengue Vaccine Communication and Advocacy: Challenges and Way Forward,” published today in a Dengue Special Edition of Expert Review of Vaccines. This special edition also includes important updates on dengue vaccine development…

PATH [to 19 March 2016]
http://www.path.org/news/index.php

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Announcement | March 16, 2016
PATH welcomes two new members to its board of directors
PATH’s board of directors has voted to appoint two new members: Dr. Laurie Michaels and Dr. Peter G. Smith. Drs. Michaels and Smith will deepen the expertise of the board, particularly in the areas of vaccine research and safety, create greater flexibility between donors and grantees, and strengthen relationships among nonprofit, academic, multilateral, and philanthropic groups…

National Foundation for Infectious Diseases (NFID) [to 19 March 2016]
http://www.nfid.org/newsroom/press-releases

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March 8, 2016
Honoring Infectious Disease Heroes
Bethesda, MD (March 8, 2016)
– The National Foundation for Infectious Diseases (NFID) will honor Robert E. Black, MD, MPH; Diane E. Griffin, MD, PhD; and Larry K. Pickering, MD for their significant and lasting contributions to global public health a t the 2016 NFID Awards Dinner on Thursday, May 5, 2016 in Bethesda, MD.

IVI [to 19 March 2016]
http://www.ivi.org/web/www/home

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16 March 2916
The International Vaccine Institute (IVI) is pleased to announce the publication of the “Typhoid Fever Surveillance in Africa Program (TSAP)” supplement of Clinical Infectious Diseases.
The seminal publication contains 15 original articles that report significant research findings from the TSAP Program. TSAP was established by IVI in 2009 to fill the data void concerning invasive Salmonella disease in sub-Saharan Africa, and to estimate the burden of bloodstream infections caused by the key pathogen, Salmonella enterica serovar Typhi. IVI, in collaboration with various partners, conducted standardized disease surveillance and other studies in a network of 13 sentinel sites in 10 sub-Saharan African countries. The supplement is the culmination of four years of a landmark study that aimed to definitively determine the burden of invasive Salmonella disease in Africa.

The supplement is open-access and can be viewed at: http://cid.oxfordjournals.org/content/62/suppl_1.toc

.Major findings:
:: High incidences of disease by Salmonella Typhi and invasive non-typhoidal Salmonella (iNTS) in children :: High incidences of typhoid fever in both rural and urban populations
:: Positive correlation between iNTS disease and malaria endemicity
:: Prevalence of resistance to first-line antimicrobial agents seen in both S. Typhi and iNTS isolates in some locations
:: Evidence of NTS excretion in stool may indicate possible disease transmission
:: Patients with fever who sought health care were assessed across all 13 sites; pivotal for disease burden surveillance and incidence analysis

Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks
WHO – A Prüss-Ustün, J Wolf, C Corvalán, R Bos and M Neira
March 2016 :: 176 pages
ISBN 978 92 4 156519 6

Executive Summary (excerpt)
In 2012, this present study estimates, 12.6 million deaths globally, representing 23% (95% CI: 13–34%) of all deaths, were attributable to the environment. When accounting for both death and disability, the fraction of the global burden of disease due to the environment is 22% (95% CI: 13–32%). In children under five years, up to 26% (95% CI: 16–38%) of all deaths could be prevented, if environmental risks were removed. Of the 12.6 million deaths attributable to the environment, 8.1 million (15%) were estimated using comparative risk assessment (CRA) methods, and the remaining 4.5 million using a combination of methods including expert opinion.

This study provides an approximate estimate of how much disease can be prevented by
reducing the environmental risks to health. It includes a meta-synthesis of key evidence
relating diseases and injuries to the environment. It brings together quantitative estimates of
the disease burden attributable to the environment using a combination of approaches that
includes CRA, epidemiological data, transmission pathways and expert opinion. The synthesis
of evidence linking 133 diseases and injuries, or their groupings, to the environment has been
reviewed to provide an overall picture of the disease burden that could be prevented through
healthier environments.

Environmental risks to health are defined, in this study, as “all the physical, chemical and
biological factors external to a person, and all related behaviours, but excluding those natural
environments that cannot reasonably be modified.” To increase the policy relevance of this
study, its focus is on that part of the environment which can reasonably be modified…

Download: Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks
pdf, 2.41Mb

American Journal of Infection Control
March 2016 Volume 44, Issue 3, p253-372, e15-e36
http://www.ajicjournal.org/current

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Major Articles
Nosocomial transmission of Ebola virus disease on pediatric and maternity wards: Bombali and Tonkolili, Sierra Leone, 2014
Angela C. Dunn, Tiffany A. Walker, John Redd, David Sugerman, Jevon McFadden, Tushar Singh, Joseph Jasperse, Brima Osaio Kamara, Tom Sesay, James McAuley, Peter H. Kilmarx
p269–272
Published online: October 30 2015

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Brief Reports
Barriers of influenza vaccination in health care personnel in France
Zoher Kadi, MD, Mohamed-Lamine Atif, MD, Annie Brenet, RN, Sylvain Izoard, PharmD,
Pascal Astagneau, MD, PhD
DOI: http://dx.doi.org/10.1016/j.ajic.2015.09.027
Highlights
:: A self-assessment questionnaire on influenza vaccination was proposed to every health care facility in the Picardie region (Northern France).
:: A total of 67 health care facilities participated, including 3,213 health care personnel.
:: Despite the annual influenza vaccination for health care personnel being supported by the health authority in France, vaccination coverage in health care personnel was reported as 22%.
:: Lack of knowledge was the most important barrier of influenza vaccination in health care personnel.

To identify barriers against influenza vaccination of health care personnel in Northern France, a cross-sectional study was conducted in health care facilities. A total of 3,213 questionnaires from 67 health care facilities were completed. In multivariate analysis using a logistic model, influenza vaccine coverage in health care personnel was significantly associated with level of knowledge about influenza disease and vaccine.

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 19 March 2016)

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Research article
Negative attitude and low intention to vaccinate universally against varicella among public health professionals and parents in the Netherlands: two internet surveys
Prior to introduction of universal varicella vaccination, it is crucial to gain insight into the willingness to vaccinate among the population.
Alies van Lier, Alma Tostmann, Irene A. Harmsen, Hester E. de Melker, Jeannine L. A. Hautvast and Wilhelmina L. M. Ruijs
BMC Infectious Diseases 2016 16:127
Published on: 15 March 2016

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Study protocol
Clinical evaluation of dengue and identification of risk factors for severe disease: protocol for a multicentre study in 8 countries
The burden of dengue continues to increase globally, with an estimated 100 million clinically apparent infections occurring each year.
Thomas Jaenisch, Dong Thi Hoai Tam, Nguyen Tan Thanh Kieu, Tran Van Ngoc, Nguyen Tran Nam, Nguyen Van Kinh, Sophie Yacoub, Ngoun Chanpheaktra, Varun Kumar, Lucy Lum Chai See, Jameela Sathar, Ernesto Pleités Sandoval, Gabriela Maria Marón Alfaro, Ida Safitri Laksono, Yodi Mahendradhata, Malabika Sarker…
BMC Infectious Diseases 2016 16:120
Published on: 11 March 2016

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 19 March 2016)

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Commentary
Open Access
Reporting transparency: making the ethical mandate explicit
Stuart G. Nicholls, Sinéad M. Langan, Eric I. Benchimol and David Moher
BMC Medicine201614:44
DOI: 10.1186/s12916-016-0587-5
Published: 16 March 2016
Abstract
Improving the transparency and quality of reporting in biomedical research is considered ethically important; yet, this is often based on practical reasons such as the facilitation of peer review. Surprisingly, there has been little explicit discussion regarding the ethical obligations that underpin reporting guidelines. In this commentary, we suggest a number of ethical drivers for the improved reporting of research. These ethical drivers relate to researcher integrity as well as to the benefits derived from improved reporting such as the fair use of resources, minimizing risk of harms, and maximizing benefits. Despite their undoubted benefit to reporting completeness, questions remain regarding the extent to which reporting guidelines can influence processes beyond publication, including researcher integrity or the uptake of scientific research findings into policy or practice. Thus, we consider investigation on the effects of reporting guidelines an important step in providing evidence of their benefits.

Eurosurveillance
Volume 21, Issue 11, 17 March 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Rapid Communications
Measles outbreak in a refugee settlement in Calais, France: January to February 2016
by G Jones, S Haeghebaert, B Merlin, D Antona, N Simon, M Elmouden, F Battist, M Janssens, K Wyndels, P Chaud
Abstract
We report a measles outbreak in a refugee settlement in Calais, France, between 5 January and 11 February 2016. In total, 13 confirmed measles cases were identified among migrants, healthcare workers in hospital and volunteers working on site. A large scale vaccination campaign was carried out in the settlement within two weeks of outbreak notification. In total, 60% of the estimated target population of 3,500 refugees was vaccinated during the week-long campaign.

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Research Articles
Risk assessment, risk management and risk-based monitoring following a reported accidental release of poliovirus in Belgium, September to November 2014
by E Duizer, S Rutjes, A Husman, J Schijven
Abstract
On 6 September 2014, the accidental release of 1013 infectious wild poliovirus type 3 (WPV3) particles by a vaccine production plant in Belgium was reported. WPV3 was released into the sewage system and discharged directly to a wastewater treatment plant (WWTP) and subsequently into rivers that flowed to the Western Scheldt and the North Sea. No poliovirus was detected in samples from the WWTP, surface waters, mussels or sewage from the Netherlands. Quantitative microbial risk assessment (QMRA) showed that the infection risks resulting from swimming in Belgium waters were above 50% for several days and that the infection risk by consuming shellfish harvested in the eastern part of the Western Scheldt warranted a shellfish cooking advice. We conclude that the reported release of WPV3 has neither resulted in detectable levels of poliovirus in any of the samples nor in poliovirus circulation in the Netherlands. This QMRA showed that relevant data on water flows were not readily available and that prior assumptions on dilution factors were overestimated. A QMRA should have been performed by all vaccine production facilities before starting up large-scale culture of WPV to be able to implement effective interventions when an accident happens.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 19 March 2016]

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Review
Evidence for Health I: Producing evidence for improving health and reducing inequities
In an ideal world, researchers and decision-makers would be involved from the outset in co-producing evidence, with local health needs assessments informing the research agenda and research evidence informing …
Anne Andermann, Tikki Pang, John N Newton, Adrian Davis and Ulysses Panisset
Health Research Policy and Systems 2016 14:18
Published on: 14 March 2016

Review
Evidence for Health II: Overcoming barriers to using evidence in policy and practice
Even the highest quality evidence will have little impact unless it is incorporated into decision-making for health. It is therefore critical to overcome the many barriers to using evidence in decision-making,…
Anne Andermann, Tikki Pang, John N. Newton, Adrian Davis and Ulysses Panisset
Health Research Policy and Systems 2016 14:17
Published on: 14 March 2016

Review
Evidence for Health III: Making evidence-informed decisions that integrate values and context
Making evidence-informed decisions with the aim of improving the health of individuals or populations can be facilitated by using a systematic approach. While a number of algorithms already exist,
Anne Andermann, Tikki Pang, John N Newton, Adrian Davis and Ulysses Panisset
Health Research Policy and Systems 2016 14:16
Published on: 14 March 2016

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 12, Issue 2, 2016
http://www.tandfonline.com/toc/khvi20/current

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Reviews
The potential impact of pneumococcal conjugate vaccine in Africa: Considerations and early lessons learned from the South African experience
DOI:10.1080/21645515.2015.1084450
Shabir A Madhi & Marta C Nunes
pages 314-325
Abstract
The introduction of pneumococcal conjugate vaccine (PCV) into the South African public immunization program since 2009 adopted a novel vaccination schedule of 3 doses at 6, 14 and 40 weeks of age. Over the past 5 y it has been shown that infant PCV immunization in South Africa is effective in reducing the burden of invasive pneumococcal disease (IPD) among HIV-infected and HIV-uninfected children. Furthermore, indirect protection of unvaccinated age-groups (including high risk groups such as HIV-infected adults) against IPD was demonstrated despite the absence of any substantial catch-up campaign of older children. This indirect effect against IPD is corroborated by the temporal reduction in vaccine-serotype colonization among age-groups targeted for PCV immunization as well as unvaccinated HIV-infected and HIV-uninfected adults, which was evident within 2 y of PCV introduction into the immunization program. Vaccine effectiveness has also been demonstrated in children against presumed bacterial pneumonia. The evaluation of the impact of PCV in South Africa, however, remains incomplete. The knowledge gaps remaining include the evaluation of PCV on the incidence of all-cause pneumonia hospitalization among vaccinated and unvaccinated age-groups. Furthermore, ongoing surveillance is required to determine whether there is ongoing replacement disease by non-vaccine serotypes, which could offset the early gains associated with the immunization program in the country.

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Review
Prevention of pneumococcal infections during mass gathering
DOI:10.1080/21645515.2015.1058456
Jaffar A Al-Tawfiq & Ziad A Memish
pages 326-330
Abstract
The interest in mass gathering and its implications has been increasing due to globalization and international travel. The potential occurrence of infectious disease outbreaks during mass gathering is most feared. In this context, respiratory tract infections are of great concern due to crowding in a limited space which facilitates and magnifies the potential of disease spread among attendees. Pneumococcal disease is best described among pilgrims to Makkah and vaccination is one of the methods for the prevention of this disease. Pneumonia was described in a mass gathering with a prevalence of 4.8/100,000 pilgrims and contributes to 15–39% of hospitalizations. Various studies showed that 7–37% of pilgrims are 65 y of age or older. The uptake of pneumococcal vaccine among pilgrims is low at 5%. There is no available data to make strong recommendations for S. pneumoniae vaccination of all pilgrims, it is important that a high risk population receive the indicated vaccination. We reviewed the available literature on the burden of pneumococcal infections during mass gathering and evaluate the available literature on pneumococcal vaccinations for attendees of mass gathering.

Review
Theory and strategy for Pneumococcal vaccines in the elderly
DOI:10.1080/21645515.2015.1075678
Ho Namkoong, Makoto Ishii, Yohei Funatsu, Yoshifumi Kimizuka, Kazuma Yagi, Takahiro Asami, Takanori Asakura, Shoji Suzuki, Testuro Kamo, Hiroshi Fujiwara, Sadatomo Tasaka, Tomoko Betsuyaku & Naoki Hasegawa
pages 336-343
Open access
Abstract
Pneumonia is the fourth-leading cause of death globally, and Streptococcus pneumoniae is the most important causative pathogen. Because the incidence of pneumococcal diseases is likely to increase with the aging society, we should determine an optimal strategy for pneumococcal vaccination. While consensus indicates that 23-valent pneumococcal polysaccharide vaccine prevents invasive pneumococcal diseases (IPD), its effects on community-acquired pneumonia (CAP) remain controversial. Recently, a 13-valent pneumococcal conjugate vaccine (PCV13) was released. The latest clinical study (CAPiTA study) showed that PCV13 reduced vaccine-type CAP and IPD. Based on these results, the Advisory Committee on Immunization Practices recommended initial vaccination with PCV13 for the elderly. Scientific evidence regarding immunosenescence is needed to determine a more ideal vaccination strategy for the elderly with impaired innate and adaptive immunity. Continuing research on the cost effectiveness of new vaccine strategies considering constantly changing epidemiology is also warranted.

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Short Report
Low vaccine coverage among children born to HIV infected women in Niamey, Niger
DOI:10.1080/21645515.2015.1069451
Hyppolite Kuekou Tchidjou, Maria Fenicia Vescio, Martin Sanou Sobze, Animata Souleyman, Paola Stefanelli, Adalbert Mbabia, Ide Moussa, Bruno Gentile, Vittorio Colizzi & Giovanni Rezza
pages 540-544
Abstract
Background: The effect of mother’s HIV-status on child vaccination is an important public health issue in countries with high HIV prevalence. We conducted a study in a primary healthcare center located in Niamey, the capital of Niger, which offers free of charge services to HIV positive and/or underprivileged mothers, with the aim of assessing: 1) vaccination coverage for children 0–36 months old, born to HIV-infected mothers, and 2) the impact of maternal HIV status on child vaccination. Methods: Mothers of children less than 36 months old attending the center were interviewed, to collect information on vaccines administered to their child, and family’s socio-demographic characteristics. Results: Overall, 502 children were investigated. Children of HIV-seropositive mothers were less likely to receive follow up vaccinations for Diphtheria-Tetanus-Pertussis (DTP) than those of HIV-seronegative mothers, with a prevalence ratio (PR) of 2.03 (95%CI: 1.58–2.61). Children born to HIV-seropositive mothers were less likely to miss vaccination for MMR than those born to HIV negative mothers, with a RR of 0.46 (95%CI: 0.30–0.72). Conclusions: Vaccine coverage among children born to HIV infected mothers was rather low. It is important to favor access to vaccination programs in this population.

International Journal of Epidemiology
Volume 45 Issue 1 February 2016
http://ije.oxfordjournals.org/content/current

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Infectious Diseases
Risk factors for transmission of Ebola or Marburg virus disease: a systematic review and meta-analysis
Julii Brainard, Lee Hooper, Katherine Pond, Kelly Edmunds, and Paul R Hunter
Int. J. Epidemiol. (2016) 45 (1): 102-116 doi:10.1093/ije/dyv307
Abstract
Background: The Ebola virus disease outbreak that started in Western Africa in 2013 was unprecedented because it spread within densely populated urban environments and affected many thousands of people. As a result, previous advice and guidelines need to be critically reviewed, especially with regard to transmission risks in different contexts.
Methods: Scientific and grey literature were searched for articles about any African filovirus. Articles were screened for information about transmission (prevalence or odds ratios especially). Data were extracted from eligible articles and summarized narratively with partial meta-analysis. Study quality was also evaluated.
Results: A total of 31 reports were selected from 6552 found in the initial search. Eight papers gave numerical odds for contracting filovirus illness; 23 further articles provided supporting anecdotal observations about how transmission probably occurred for individuals. Many forms of contact (conversation, sharing a meal, sharing a bed, direct or indirect touching) were unlikely to result in disease transmission during incubation or early illness. Among household contacts who reported directly touching a case, the attack rate was 32% [95% confidence interval (CI) 26–38%]. Risk of disease transmission between household members without direct contact was low (1%; 95% CI 0–5%). Caring for a case in the community, especially until death, and participation in traditional funeral rites were strongly associated with acquiring disease, probably due to a high degree of direct physical contact with case or cadaver.
Conclusions: Transmission of filovirus is unlikely except through close contact, especially during the most severe stages of acute illness. More data are needed about the context, intimacy and timing of contact required to raise the odds of disease transmission. Risk factors specific to urban settings may need to be determined.

JAMA
March 15, 2016, Vol 315, No. 11
http://jama.jamanetwork.com/issue.aspx

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Viewpoint
Innovations in Health Care Delivery
Does the Country of Origin Matter in Health Care Innovation Diffusion?
Matthew Harris, DPhil, MBBS, FFPH; Yasser Bhatti, DPhil, MSc, MoT, MSc, BEng; Ara Darzi, OM, KBE, PC, FRS, FMedSci
This Viewpoint discusses the need to examine how perceptions of the country of origin may of health care innovations proposed for US settings may influence diffusion of these innovations.

There is no shortage of US health care research centers advocating the adoption of innovations from other countries. The Institute for Healthcare Improvement (Boston, MA), the Commonwealth Fund (New York, NY), Innovations in Health at Duke University (Durham, NC), and the Network for Excellence in Healthcare Innovation (Cambridge, MA) are all promoting innovations from low-, middle-, and high-income countries for potential adoption into the United States. However, does it matter to patients if a proposed innovation is from India, rather than from, say, Sweden; or from Rwanda, rather than from, say, the United Kingdom? Very little is known about whether and how the country of origin of a proposed innovation matters in its diffusion…

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Editorial | March 15, 2016
Toward High-Reliability Vaccination Efforts in the United States
Matthew M. Davis, MD, MAPP1,2,3,4,5
Author Affiliations
JAMA. 2016;315(11):1115-1117. doi:10.1001/jama.2016.1529.
Infectious disease eradication is a major public health achievement. Smallpox is the only human infectious disease that has been eliminated by deliberate intervention, and this was accomplished using strategic global immunization efforts. The public generally understands that effective vaccination is a key component of infectious disease prevention and eradication; for example, there has been substantial recent public interest in vaccination for emerging global health threats such as avian influenza, Ebola, and Zika virus…

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Review
Association Between Vaccine Refusal and Vaccine-Preventable Diseases in the United States: A Review of Measles and Pertussis
FREE
Varun K. Phadke, MD; Robert A. Bednarczyk, MS, PhD; Daniel A. Salmon, MPH, PhD; Saad B. Omer, MBBS, MPH, PhD
Includes: CME, Supplemental Content, Author Video Interviews, JAMA Report Video, Author Interview
Abstract
Importance
Parents hesitant to vaccinate their children may delay routine immunizations or seek exemptions from state vaccine mandates. Recent outbreaks of vaccine-preventable diseases in the United States have drawn attention to this phenomenon. Improved understanding of the association between vaccine refusal and the epidemiology of these diseases is needed.
Objective
To review the published literature to evaluate the association between vaccine delay, refusal, or exemption and the epidemiology of measles and pertussis, 2 vaccine-preventable diseases with recent US outbreaks.
Evidence Review
Search of PubMed through November 30, 2015, for reports of US measles outbreaks that have occurred since measles was declared eliminated in the United States (after January 1, 2000), endemic and epidemic pertussis since the lowest point in US pertussis incidence (after January 1, 1977), and for studies that assessed disease risk in the context of vaccine delay or exemption.
Findings
We identified 18 published measles studies (9 annual summaries and 9 outbreak reports), which described 1416 measles cases (individual age range, 2 weeks-84 years; 178 cases younger than 12 months) and more than half (56.8%) had no history of measles vaccination. Of the 970 measles cases with detailed vaccination data, 574 cases were unvaccinated despite being vaccine eligible and 405 (70.6%) of these had nonmedical exemptions (eg, exemptions for religious or philosophical reasons, as opposed to medical contraindications; 41.8% of total). Among 32 reports of pertussis outbreaks, which included 10,609 individuals for whom vaccination status was reported (age range, 10 days-87 years), the 5 largest statewide epidemics had substantial proportions (range, 24%-45%) of unvaccinated or undervaccinated individuals. However, several pertussis outbreaks also occurred in highly vaccinated populations, indicating waning immunity. Nine reports (describing 12 outbreaks) provided detailed vaccination data on unimmunized cases; among 8 of these outbreaks from 59% through 93% of unvaccinated individuals were intentionally unvaccinated.
Conclusions and Relevance
A substantial proportion of the US measles cases in the era after elimination were intentionally unvaccinated. The phenomenon of vaccine refusal was associated with an increased risk for measles among people who refuse vaccines and among fully vaccinated individuals. Although pertussis resurgence has been attributed to waning immunity and other factors, vaccine refusal was still associated with an increased risk for pertussis in some populations.

Nature
Volume 531 Number 7594 pp275-408 17 March 2016
http://www.nature.com/nature/current_issue.html

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Supplement
Outlook: Urban health and well-being
With more than half of the world’s population already living in cities and further growth expected, the health of urban dwellers is crucial to global well-being. This Nature Outlook explores some of the obstacles to a healthy, happy urban life – and the development of strategies to overcome them.
Free full access [Sponsored]
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Urban health and well-being
Richard Hodson
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The rise of the urbanite
Stephanie Pain
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Mobility: The urban downshift
Sarah DeWeerdt
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Flooding: Water potential
James M. Gaines
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Green space: A natural high
Natasha Gilbert
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Stress: The privilege of health
Amy Maxmen
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Perspective: City farming needs monitoring
Andrew A. Meharg
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Disease: Poverty and pathogens
Michael Eisenstein
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Policy: Urban physics
Kevin Pollock

PLOS Currents: Disasters
http://currents.plos.org/disasters/
[Accessed 19 March 2016]

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A Comparative Analysis of Disaster Risk, Vulnerability and Resilience Composite Indicators
March 14, 2016 · Research Article
Abstract
Introduction: In the past decade significant attention has been given to the development of tools that attempt to measure the vulnerability, risk or resilience of communities to disasters. Particular attention has been given to the development of composite indices to quantify these concepts mirroring their deployment in other fields such as sustainable development. Whilst some authors have published reviews of disaster vulnerability, risk and resilience composite indicator methodologies, these have been of a limited nature. This paper seeks to dramatically expand these efforts by analysing 106 composite indicator methodologies to understand the breadth and depth of practice.
Methods: An extensive search of the academic and grey literature was undertaken for composite indicator and scorecard methodologies that addressed multiple/all hazards; included social and economic aspects of risk, vulnerability or resilience; were sub-national in scope; explained the method and variables used; focussed on the present-day; and, had been tested or implemented. Information on the index construction, geographic areas of application, variables used and other relevant data was collected and analysed.
Results: Substantial variety in construction practices of composite indicators of risk, vulnerability and resilience were found. Five key approaches were identified in the literature, with the use of hierarchical or deductive indices being the most common. Typically variables were chosen by experts, came from existing statistical datasets and were combined by simple addition with equal weights. A minimum of 2 variables and a maximum of 235 were used, although approximately two thirds of methodologies used less than 40 variables. The 106 methodologies used 2298 unique variables, the most frequently used being common statistical variables such as population density and unemployment rate. Classification of variables found that on average 34% of the variables used in each methodology related to the social environment, 25% to the disaster environment, 20% to the economic environment, 13% to the built environment, 6% to the natural environment and 3% were other indices. However variables specifically measuring action to mitigate or prepare for disasters only comprised 12%, on average, of the total number of variables in each index. Only 19% of methodologies employed any sensitivity or uncertainty analysis and in only a single case was this comprehensive.
Discussion: A number of potential limitations of the present state of practice and how these might impact on decision makers are discussed. In particular the limited deployment of sensitivity and uncertainty analysis and the low use of direct measures of disaster risk, vulnerability and resilience could significantly limit the quality and reliability of existing methodologies. Recommendations for improvements to indicator development and use are made, as well as suggested future research directions to enhance the theoretical and empirical knowledge base for composite indicator development.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 19 March 2016)

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On the Seasonal Occurrence and Abundance of the Zika Virus Vector Mosquito Aedes Aegypti in the Contiguous United States
March 16, 2016 · Research Article
Abstract
Introduction: An ongoing Zika virus pandemic in Latin America and the Caribbean has raised concerns that travel-related introduction of Zika virus could initiate local transmission in the United States (U.S.) by its primary vector, the mosquito Aedes aegypti.
Methods: We employed meteorologically driven models for 2006-2015 to simulate the potential seasonal abundance of adult Aedes aegypti for fifty cities within or near the margins of its known U.S. range. Mosquito abundance results were analyzed alongside travel and socioeconomic factors that are proxies of viral introduction and vulnerability to human-vector contact.
Results: Meteorological conditions are largely unsuitable for Aedes aegypti over the U.S. during winter months (December-March), except in southern Florida and south Texas where comparatively warm conditions can sustain low-to-moderate potential mosquito abundance. Meteorological conditions are suitable for Aedes aegypti across all fifty cities during peak summer months (July-September), though the mosquito has not been documented in all cities. Simulations indicate the highest mosquito abundance occurs in the Southeast and south Texas where locally acquired cases of Aedes-transmitted viruses have been reported previously. Cities in southern Florida and south Texas are at the nexus of high seasonal suitability for Aedes aegypti and strong potential for travel-related virus introduction. Higher poverty rates in cities along the U.S.-Mexico border may correlate with factors that increase human exposure to Aedes aegypti.
Discussion: Our results can inform baseline risk for local Zika virus transmission in the U.S. and the optimal timing of vector control activities, and underscore the need for enhanced surveillance for Aedes mosquitoes and Aedes-transmitted viruses.

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Unintended Pregnancies in Brazil – A Challenge for the Recommendation to Delay Pregnancy Due to Zika
March 16, 2016 · Discussion
Abstract
Because of the potential link between the ongoing Zika virus outbreak and a surge in the number of cases of congenital microcephaly, officials in Latin America have recommended that women postpone pregnancy until this association is firmly established or the outbreak subsides. However, in all these countries a large proportion of babies are still born out of unplanned pregnancies. Teenage girls are particularly at high risk, as they often lack access to preventive contraception methods, or the knowledge to use them appropriately. To gauge the magnitude of the barriers preventing the implementation of such a recommendation in Brazil, the country so far most affected by the Zika epidemic, we evaluated pregnancy rates in teenage girls, and their spatial heterogeneity in the country, in recent years (2012-2014). Nearly 20% of children born in Brazil today (~560,000 live births) are by teenage mothers. Birth incidence is far higher in the tropical and poorer northern states. However, in absolute terms most births occur in the populous southeastern states, matching to a large extent the geographic distribution of dengue (an indicator of suitable climatic and sociodemographic conditions for the circulation of Aedes mosquitoes). These findings indicate that recommendation to delay pregnancy will leave over half a million pregnant adolescents in Brazil vulnerable to infection every year if not accompanied by effective education and real access to prevention.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 19 March 2016)

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Research Article |
Routine Pediatric Enterovirus 71 Vaccination in China: a Cost-Effectiveness Analysis
Joseph T. Wu, Mark Jit, Yaming Zheng, Kathy Leung, Weijia Xing, Juan Yang, Qiaohong Liao, Benjamin J. Cowling, Bingyi Yang, Eric H. Y. Lau, Saki Takahashi, Jeremy J. Farrar, Bryan T. Grenfell, Gabriel M. Leung, Hongjie Yu
published 15 Mar 2016 | PLOS Medicine
10.1371/journal.pmed.1001975
Abstract
Background
China accounted for 87% (9.8 million/11.3 million) of all hand, foot, and mouth disease (HFMD) cases reported to WHO during 2010–2014. Enterovirus 71 (EV71) is responsible for most of the severe HFMD cases. Three EV71 vaccines recently demonstrated good efficacy in children aged 6–71 mo. Here we assessed the cost-effectiveness of routine pediatric EV71 vaccination in China.
Methods and Findings
We characterized the economic and health burden of EV71-associated HFMD (EV71-HFMD) in China using (i) the national surveillance database, (ii) virological surveillance records from all provinces, and (iii) a caregiver survey on the household costs and health utility loss for 1,787 laboratory-confirmed pediatric cases. Using a static model parameterized with these data, we estimated the effective vaccine cost (EVC, defined as cost/efficacy or simply the cost of a 100% efficacious vaccine) below which routine pediatric vaccination would be considered cost-effective. We performed the base-case analysis from the societal perspective with a willingness-to-pay threshold of one times the gross domestic product per capita (GDPpc) and an annual discount rate of 3%. We performed uncertainty analysis by (i) accounting for the uncertainty in the risk of EV71-HFMD due to missing laboratory data in the national database, (ii) excluding productivity loss of parents and caregivers, (iii) increasing the willingness-to-pay threshold to three times GDPpc, (iv) increasing the discount rate to 6%, and (v) accounting for the proportion of EV71-HFMD cases not registered by national surveillance. In each of these scenarios, we performed probabilistic sensitivity analysis to account for parametric uncertainty in our estimates of the risk of EV71-HFMD and the expected costs and health utility loss due to EV71-HFMD. Routine pediatric EV71 vaccination would be cost-saving if the all-inclusive EVC is below US$10.6 (95% CI US$9.7–US$11.5) and would remain cost-effective if EVC is below US$17.9 (95% CI US$16.9–US$18.8) in the base case, but these ceilings could be up to 66% higher if all the test-negative cases with missing laboratory data are EV71-HFMD. The EVC ceiling is (i) 10%–14% lower if productivity loss of parents/caregivers is excluded, (ii) 58%–84% higher if the willingness-to-pay threshold is increased to three times GDPpc, (iii) 14%–19% lower if the discount rate is increased to 6%, and (iv) 36% (95% CI 23%–50%) higher if the proportion of EV71-HFMD registered by national surveillance is the same as that observed in the three EV71 vaccine phase III trials. The validity of our results relies on the following assumptions: (i) self-reported hospital charges are a good proxy for the opportunity cost of care, (ii) the cost and health utility loss estimates based on laboratory-confirmed EV71-HFMD cases are representative of all EV71-HFMD cases, and (iii) the long-term average risk of EV71-HFMD in the future is similar to that registered by national surveillance during 2010–2013.
Conclusions
Compared to no vaccination, routine pediatric EV71 vaccination would be very cost-effective in China if the cost of immunization (including all logistical, procurement, and administration costs needed to confer 5 y of vaccine protection) is below US$12.0–US$18.3, depending on the choice of vaccine among the three candidates. Given that the annual number of births in China has been around 16 million in recent years, the annual costs for routine pediatric EV71 vaccination at this cost range should not exceed US$192–US$293 million. Our results can be used to determine the optimal vaccine when the prices of the three vaccines are known.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 19 March 2016)

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Editorial
The Zika Pandemic – A Perfect Storm?
Philip K. Russell
| published 18 Mar 2016 | PLOS Neglected Tropical Diseases
10.1371/journal.pntd.0004589

Research Article
Is Dengue Vector Control Deficient in Effectiveness or Evidence?: Systematic Review and Meta-analysis
Leigh R. Bowman, Sarah Donegan, Philip J. McCall
| published 17 Mar 2016 | PLOS Neglected Tropical Diseases
10.1371/journal.pntd.0004551

PLoS One
http://www.plosone.org/
[Accessed 19 March 2016]

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Research Article
Highest Vaccine Uptake after School-Based Delivery – A County-Level Evaluation of the Implementation Strategies for HPV Catch-Up Vaccination in Sweden
Moa Rehn, Ingrid Uhnoo, Sharon Kühlmann-Berenzon, Anders Wallensten, Pär Sparén, Eva Netterlid
| published 14 Mar 2016 | PLOS ONE
10.1371/journal.pone.0149857

Prehospital & Disaster Medicine
Volume 31 – Issue 02 – April 2016
https://journals.cambridge.org/action/displayIssue?jid=PDM&tab=currentissue

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Editorial
Zika Virus Association with Microcephaly: The Power for Population Statistics to Identify Public Health Emergencies
Samuel J. Stratton
DOI: http://dx.doi.org/10.1017/S1049023X16000170
Published online: 04 March 2016
[No abstract]

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Original Research
An Assessment of Collaboration and Disasters: A Hospital Perspective
Sabrina A. Adelainea1 c1, Kimberly Shoafa2 and Caitlin Harveya1
a1 University of California, Los Angeles (UCLA), Fielding School of Public Health, Los Angeles, California USA
a2 University of Utah, Division of Public Health, Salt Lake City, Utah USA
Abstract
Introduction There is no standard guidance for strategies for hospitals to use to coordinate with other agencies during a disaster.
Hypothesis/Problem This study analyzes successful strategies and barriers encountered by hospitals across the nation in coordinating and collaborating with other response agencies.
Methods Quantitative and qualitative data were collected from a web-based study from 577 acute care hospitals sampled from the 2013 American Hospital Association (AHA) database. The results were analyzed using descriptive statistics.
Results The most common barriers to collaboration are related to finances, ability to communicate, and personnel.

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Vaccination Against Seasonal or Pandemic Influenza in Emergency Medical Services
Alexandre Moser, Cédric Mabire, Olivier Hugli, Victor Dorribo, Giorgio Zanetti, Catherine Lazor-Blanchet and Pierre-Nicolas Carron
DOI: http://dx.doi.org/10.1017/S1049023X16000121
Published online: 09 February 2016
Abstract
Introduction Influenza is a major concern for Emergency Medical Services (EMS); EMS workers’ (EMS-Ws) vaccination rates remain low despite promotion. Determinants of vaccination for seasonal influenza (SI) or pandemic influenza (PI) are unknown in this setting.
Hypothesis The influence of the H1N1 pandemic on EMS-W vaccination rates, differences between SI and PI vaccination rates, and the vaccination determinants were investigated.
Methods A survey was conducted in 2011 involving 65 Swiss EMS-Ws. Socio-professional data, self-declared SI/PI vaccination status, and motives for vaccine refusal or acceptation were collected.
Results Response rate was 95%. The EMS-Ws were predominantly male (n=45; 73%), in good health (87%), with a mean age of 36 (SD=7.7) years. Seventy-four percent had more than six years of work experience. Self-declared vaccination rates were 40% for both SI and PI (PI+/SI+), 19% for PI only (PI+/SI-), 1.6% for SI only (PI-/SI+), and 39% were not vaccinated against either (PI-/SI-). Women’s vaccination rates specifically were lower in all categories but the difference was not statistically significant. During the previous three years, 92% of PI+/SI+ EMS-Ws received at least one SI vaccination; it was 8.3% in the case of PI-/SI- (P=.001) and 25% for PI+/SI- (P=.001). During the pandemic, SI vaccination rate increased from 26% during the preceding year to 42% (P=.001). Thirty percent of the PI+/SI+ EMS-Ws declared that they would not get vaccination next year, while this proportion was null for the PI-/SI- and PI+/SI- groups. Altruism and discomfort induced by the surgical mask required were the main motivations to get vaccinated against PI. Factors limiting PI or SI vaccination included the option to wear a mask, avoidance of medication, fear of adverse effects, and concerns about safety and effectiveness.
Conclusion Average vaccination rate in this study’s EMS-Ws was below recommended values, particularly for women. Previous vaccination status was a significant determinant of PI and future vaccinations. The new mask policy seemed to play a dual role, and its net impact is probably limited. This population could be divided in three groups: favorable to all vaccinations; against all, even in a pandemic context; and ambivalent with a “pandemic effect.” These results suggest a consistent vaccination pattern, only altered by exceptional circumstances.

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International Consensus on Key Concepts and Data Definitions for Mass-gathering Health: Process and Progress
Sheila A. Turris, Malinda Steenkamp, Adam Lund, Alison Hutton, Jamie Ranse, Ron Bowles, Katherine Arbuthnott, Olga Anikeeva and Paul Arbon
DOI: http://dx.doi.org/10.1017/S1049023X1600011X
Published online: 04 February 2016
Abstract
Mass gatherings (MGs) occur worldwide on any given day, yet mass-gathering health (MGH) is a relatively new field of scientific inquiry. As the science underpinning the study of MGH continues to develop, there will be increasing opportunities to improve health and safety of those attending events. The emerging body of MG literature demonstrates considerable variation in the collection and reporting of data. This complicates comparison across settings and limits the value and utility of these reported data. Standardization of data points and/or reporting in relation to events would aid in creating a robust evidence base from which governments, researchers, clinicians, and event planners could benefit. Moving towards international consensus on any topic is a complex undertaking. This report describes a collaborative initiative to develop consensus on key concepts and data definitions for a MGH “Minimum Data Set.” This report makes transparent the process undertaken, demonstrates a pragmatic way of managing international collaboration, and proposes a number of steps for progressing international consensus. The process included correspondence through a journal, face-to-face meetings at a conference, then a four-day working meeting; virtual meetings over a two-year period supported by online project management tools; consultation with an international group of MGH researchers via an online Delphi process; and a workshop delivered at the 19thWorld Congress on Disaster and Emergency Medicine held in Cape Town, South Africa in April 2015. This resulted in an agreement by workshop participants that there is a need for international consensus on key concepts and data definitions.

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Special Reports
Research and Evaluations of the Health Aspects of Disasters, Part VI: Interventional Research and the Disaster Logic Model
Marvin L. Birnbaum, Elaine K. Daily, Ann P. O’Rourke and Jennifer Kushner
DOI: http://dx.doi.org/10.1017/S1049023X16000017

Research and Evaluations of the Health Aspects of Disasters, Part VII: The Relief/Recovery Framework
Marvin L. Birnbaum, Elaine K. Daily and Ann P. O’Rourke
DOI: http://dx.doi.org/10.1017/S1049023X16000029

Preventive Medicine
Volume 84, Pages 1-98 (March 2016)
http://www.sciencedirect.com/science/journal/00917435/84

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Original Research Article
Predictors of influenza vaccine uptake during the 2009/10 influenza A H1N1v (‘swine flu’) pandemic: Results from five national surveys in the United Kingdom
Pages 57-61
You Kyung Julia Han, Susan Michie, Henry W.W. Potts, G. James Rubin
Highlights
:: We analysed data from UK telephone surveys conducted during the 2009/10 pandemic.
:: We explored reasons for accepting or declining the swine flu vaccination.
:: Main reasons given for declining were safety concerns and being generally healthy.
:: Believing the vaccine to be ineffective was strongly associated with declining it.

Public Health Reports
Volume 131 , Issue Number 2 March/April 2016
http://www.publichealthreports.org/issuecontents.cfm?Volume=131&Issue=2

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Articles
Physician Attitudes Toward Adult Vaccines and Other Preventive Practices, United States, 2012
Laura P. Hurley, MD, MPH / Carolyn Bridges, MD / Rafael Harpaz, MD, MPH / Mandy A. Allison, MD, MSPH / Sean T. O’Leary, MD / Lori Crane, PhD, MPH / Michaela Brtnikova, Phd, MPH / Shannon Stokley, MPH / Brenda L. Beaty, MSPH / Andrea Jimenez-Zambrano, MPH / Allison Kempe, MD, MPH
ABSTRACT
Objectives. We described the following among U.S. primary care physicians: (1) perceived importance of vaccines recommended by the Advisory Commit¬tee on Immunization Practices relative to U.S. Preventive Services Task Force (USPSTF) preventive services, (2) attitudes toward the U.S. adult immunization schedule, and (3) awareness and use of Medicare preventive service visits.
Methods. We conducted an Internet and mail survey from March to June 2012 among national networks of general internists and family physicians.
Results. We received responses from 352 of 445 (79%) general internists and 255 of 409 (62%) family physicians. For a 67-year-old hypothetical patient, 540/606 (89%, 95% confidence interval [CI] 87, 92) of physicians ranked sea¬sonal influenza vaccine and 487/607 (80%, 95% CI 77, 83) ranked pneumococ¬cal vaccine as very important, whereas 381/604 (63%, 95% CI 59, 67) ranked Tdap/Td vaccine and 288/607 (47%, 95% CI 43, 51) ranked herpes zoster vaccine as very important (p0.001). All Grade A USPSTF recommendations were considered more important than Tdap/Td and herpes zoster vaccines. For the hypothetical patient aged 30 years, the number and percentage of physi¬cians who reported that the Tdap/Td vaccine (377/604; 62%, 95% CI 59, 66) is very important was greater than the number and percentage who reported that the seasonal influenza vaccine (263/605; 43%, 95% CI 40, 47) is very important (p0.001), and all Grade A and Grade B USPSTF recommendations were more often reported as very important than was any vaccine. A total of 172 of 587 physicians (29%) found aspects of the adult immunization schedule confusing. Among physicians aware of “Welcome to Medicare” and annual wellness visits, 492/514 (96%, 95% CI 94, 97) and 329/496 (66%, 95% CI 62, 70), respectively, reported having conducted fewer than 10 such visits in the previous month.
Conclusions. Despite lack of prioritization of vaccines by ACIP, physicians are prioritizing some vaccines over others and ranking some vaccines below other preventive services. These attitudes and confusion about the immunization schedule may result in missed opportunities for vaccination. Medicare preven¬tive visits are not being used widely despite offering a venue for delivery of preventive services, including vaccinations.

Qualitative Health Research
April 2016; 26 (5)
http://qhr.sagepub.com/content/current
Special Issue: Qualitative Contributions to Quantitative Inquiry

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Commentary
Adding Qualitative and Mixed Methods Research to Health Intervention Studies: Interacting With Differences
R. Burke Johnson and Judith Schoonenboom
Qual Health Res April 2016 26: 587-602, first published on December 9, 2015 doi:10.1177/1049732315617479
Abstract
The purpose of this article is to explain how to improve intervention designs, such as randomized controlled trials (RCTs), in health science research using a process philosophy and theory known as dialectical pluralism (DP). DP views reality as plural and uses dialectical, dialogical, and hermeneutical approaches to knowledge construction. Using DP and its “both/and” logic, and its attempt to produce new creative syntheses, researchers on heterogeneous teams can better dialogue with qualitative and mixed methods approaches, concepts, paradigms, methodologies, and methods to improve their intervention research studies. The concept of reflexivity is utilized but is expanded when it is a component of DP. Examples of strategies for identifying, inviting, and creating divergence and integrative strategies for producing strong mixed methods intervention studies are provided and illustrated using real-life examples.

Science Translational Medicine
16 March 2016 Vol 8, Issue 330
http://stm.sciencemag.org/

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Editorial
Once and future epidemics: Zika virus emerging
By Gary J. Nabel, Elias A. Zerhouni
Science Translational Medicine16 Mar 2016 : 330ed2
Zika virus again reminds us that we need a globally coordinated system to protect against outbreaks caused by perilous pathogens.

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Research Articles
The live attenuated dengue vaccine TV003 elicits complete protection against dengue in a human challenge model
By Beth D. Kirkpatrick, Stephen S. Whitehead, Kristen K. Pierce, Cecilia M. Tibery, Palmtama L. Grier, Noreen A. Hynes, Catherine J. Larsson, Beulah P. Sabundayo, Kawsar R. Talaat, Anna Janiak, Marya P. Carmolli, Catherine J. Luke, Sean A. Diehl, Anna P. Durbin
Science Translational Medicine16 Mar 2016 : 330ra36
Editor’s Summary
Dengue model rises to the challenge
Human efficacy testing remains a major hurdle in bringing new vaccine candidates to the clinic. In the absence of accepted correlates of protection, rounds of safety trials must be performed before efficacy can be tested in a large population in an endemic area. Kirkpatrick et al. have developed a controlled dengue human challenge model to assess the protective efficacy of the most clinically advanced dengue vaccine candidate. They found that TV003, a live attenuated dengue vaccine that induces antibodies to all four dengue virus serotypes, protected against infection of an attenuated virus in 21 recipients when compared with 20 nonvaccinated controls. This model may serve as an early check for dengue vaccine candidates, limiting the risk of conducting large unsuccessful trials.

Abstract
A dengue human challenge model can be an important tool to identify candidate dengue vaccines that should be further evaluated in large efficacy trials in endemic areas. Dengue is responsible for about 390 million infections annually. Protective efficacy results for the most advanced dengue vaccine candidate (CYD) were disappointing despite its ability to induce neutralizing antibodies against all four dengue virus (DENV) serotypes. TV003 is a live attenuated tetravalent DENV vaccine currently in phase 2 evaluation. To better assess the protective efficacy of TV003, a randomized double-blind, placebo-controlled trial in which recipients of TV003 or placebo were challenged 6 months later with a DENV-2 strain, rDEN2Δ30, was conducted. The primary endpoint of the trial was protection against dengue infection, defined as rDEN2Δ30 viremia. Secondary endpoints were protection against rash and neutropenia. All 21 recipients of TV003 who were challenged with rDEN2Δ30 were protected from infection with rDEN2Δ30. None developed viremia, rash, or neutropenia after challenge. In contrast, 100% of the 20 placebo recipients who were challenged with rDEN2Δ30 developed viremia, 80% developed rash, and 20% developed neutropenia. TV003 induced complete protection against challenge with rDEN2Δ30 administered 6 months after vaccination. TV003 will be further evaluated in dengue-endemic areas. The controlled dengue human challenge model can accelerate vaccine development by evaluating the protection afforded by the vaccine, thereby eliminating poor candidates from further consideration before the initiation of large efficacy trials.

Vaccine
Volume 34, Issue 14, Pages 1643-1738 (29 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/14
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Protective and immunological behavior of chimeric yellow fever dengue vaccine
Review Article
Pages 1643-1647
Scott B. Halstead, Philip K. Russell
Abstract.
Clinical observations from the third year of the Sanofi Pasteur chimeric yellow fever dengue tetravalent vaccine (CYD) trials document both protection and vaccination-enhanced dengue disease among vaccine recipients. Children who were 5 years-old or younger when vaccinated experienced a DENV disease resulting in hospitalization at 5 times the rate of controls. On closer inspection, hospitalized cases among vaccinated seropositives, those at highest risk to hospitalized disease accompanying a dengue virus (DENV) infection, were greatly reduced by vaccination. But, seronegative individuals of all ages after being vaccinated were only modestly protected from mild to moderate disease throughout the entire observation period despite developing neutralizing antibodies at high rates. Applying a simple epidemiological model to the data, vaccinated seronegative individuals of all ages were at increased risk of developing hospitalized disease during a subsequent wild type DENV infection. The etiology of disease in placebo and vaccinated children resulting in hospitalization during a DENV infection, while clinically similar are of different origin. The implications of the observed mixture of DENV protection and enhanced disease in CYD vaccinees are discussed.

Vaccine
Volume 34, Issue 14, Pages 1643-1738 (29 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/14
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Should professionals caring for children be vaccinated? Community perspectives on health care and child care worker immunisation
Original Research Article
Pages 1726-1732
Jane Tuckerman, Natalie Thomas, Helen S. Marshall
Abstract
Objective
Several immunisations including influenza and pertussis are specifically recommended for healthcare workers (HCW) and childcare workers (CCW). This study aimed to assess community attitudes to HCW and CCW immunisation recommendations for pertussis and seasonal influenza.
Methods
A cross-sectional study was conducted by Computer Assisted Telephone Interviewing (CATI) from April to May 2011. Statistical analyses used data weighted to the South Australian population by probability of selection, age, gender and geographical location using benchmarks derived from the 2009 Census population figures.
Results
Almost all respondents supported vaccination of HCWs and CCWs against pertussis and influenza. For pertussis, 95.3% agreed nurses, 94.9% agreed doctors and 94.7% agreed CCWs have an obligation to be vaccinated. For influenza, 91.4% agreed nurses, 90.7% agreed doctors and 89.9% agreed CCWs have an obligation to be vaccinated. We identified higher support for protection against pertussis compared to influenza for all three groups of workers (p < 0.001). There were higher concerns if CCWs compared to HCWs were not vaccinated against pertussis (OR = 2.78) and influenza (OR = 1.99). Young (18–30 years) and older age (60+ years) and lower educational attainment were predictors of support for HCWs and CCWs to be vaccinated against influenza. For pertussis, lower educational attainment was a predictor of support for HCWs immunisation.
Conclusions
Community support for CCW and HCW immunisation is strong with CCW immunisation was considered a priority. Pertussis immunisation was considered a higher priority than influenza immunisation for HCWs and CCWs. CCW immunisation should be considered for inclusion in public health immunisation programmes.

Vaccine
Volume 34, Issue 14, Pages 1643-1738 (29 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/14
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Affluence as a predictor of vaccine refusal and underimmunization in California private kindergartens
Original Research Article
Pages 1733-1738
Louise-Anne McNutt, Cristina Desemone, Erica DeNicola, Hassan El Chebib, Jessica A. Nadeau, Robert A. Bednarczyk, Jana Shaw
Abstract
Background
Non-medical vaccine exemption rates in California private schools far exceed those of public schools, but little is known about specific factors which may be associated with high exemption rates in private schools.
Methods
The percent of personal-belief exemptions (PBEs) among California public and private kindergartens were computed for 2000–2001 to 2014–2015 academic years. For the 2014–2015 academic year, a random sample of private schools was selected to investigate associations between kindergarten characteristics (tuition amount, religious affiliation) and vaccine profile (non-medical vaccine exemptions, vaccine coverage).
Results
The proportion of private kindergartens reporting 5% or more children with PBEs increased from 9% (2000–2001) to 34% (2013–2014), followed by a small decrease in 2014–2015 (31%). Overall, 93.7% (565/605) of kindergartens sampled in 2014–2015 had data available. Very high PBE levels (>20%) were seen among secular and non-Catholic, Christian kindergartens but not Roman Catholic, Jewish or Islamic kindergartens. However, the majority of schools at all tuition levels had fewer than 5% of children with a PBE. Kindergartens with an annual tuition of $10,000 or more were over twice as likely to have 20% or more children with PBEs than kindergartens with a lower tuition (p < .01). Additionally, the conditional admission proportions for kindergartens with tuitions of $10,000 or more were 39% compared to 22% for less expensive kindergartens (p < .01). Only about half of all private kindergartens had 95% coverage of the MMR (49%) and pertussis-containing vaccines (51%).
Conclusions
School-entry vaccination requirements are critical to preventing outbreaks of vaccine preventable diseases in the US. Nonmedical exemptions increased between the 2000–2001 and 2014–2015 academic years and appear to be associated with affluence, raising social justice concerns.

Chemical Engineering Research and Design
Available online 21 February 2016,
In Press, Accepted Manuscript
A review of integrated supply chain network design models: key issues for vaccine supply chains
Stef Lemmens, Catherine Decouttere, Nico Vandaele, Mauro Bernuzzi
doi:10.1016/j.cherd.2016.02.015
Highlights
:: We describe the key issues for the design of vaccine supply chains.
:: A literature review on model-based supply chain network design is conducted.
:: We study the applicability of these models to the design of vaccine supply chains.
:: The reviewed literature is insufficient to design vaccine supply chains.
Abstract
In general, vaccines are recognized as an important means to protect populations against infectious diseases. We show that vaccines do not behave like commodity goods and elaborate on the key issues for vaccine supply chain design. This paper reviews the literature on model-based supply chain network design in order to identify the applicability of these models to the key issues of the design of a vaccine supply chain. We study whether the decisions at strategic, tactical and operational levels of the reviewed literature are able to address vaccine supply chain key issues as limited shelf life, cold chain distribution and accessing remote areas. Furthermore, we provide an overview of how uncertainty is incorporated in the reviewed literature and is able to incorporate disease epidemics, tender procurement, lead time variability and demand variability. Our future vaccine supply chain network needs to be sustainable, hereby taking the preferences of different stakeholders into account for obtaining a set of economical, technological and value key performance indicators that need to be satisfied by the design. Finally, we discuss the real-life applicability of the research up to now and discuss similarities and dissimilarities of vaccine supply chains with other pharmaceutical supply chains