CDC/ACIP [to 16 January 2016]
http://www.cdc.gov/media/index.html

Transcript for CDC Telebriefing: Zika Virus Travel Alert
SATURDAY, JANUARY 16, 2016

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CDC issues interim travel guidance related to Zika virus for 14 Countries and Territories in Central and South America and the Caribbean
FRIDAY, JANUARY 15, 2016
Regions and certain countries where Zika virus transmission is ongoing: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and the Commonwealth of Puerto Rico.

This alert follows reports in Brazil of microcephaly and other poor pregnancy outcomes in babies of mothers who were infected with Zika virus while pregnant. However, additional studies are needed to further characterize this relationship. More studies are planned to learn more about the risks of Zika virus infection during pregnancy…

NIH [to 16 January 2016]
http://www.nih.gov/news/releases.htm

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January 14, 2016
Dengue vaccine enters phase 3 trial in Brazil
— Investigational vaccine to prevent ‘breakbone fever’ developed at NIH.
A large-scale clinical trial to evaluate whether a candidate vaccine can prevent the mosquito-borne illness dengue fever has been launched in Brazil. The vaccine, TV003, was developed by scientists in the laboratory of Stephen Whitehead, Ph.D., at NIH’s National Institute of Allergy and Infectious Diseases (NIAID). The Butantan Institute, a non-profit producer of immunobiologic products for Brazil, licensed the NIAID dengue vaccine technology and is sponsoring the placebo-controlled, multi-center Phase 3 trial using test vaccine produced in Sao Paulo…

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January 12, 2016
New NIH awards will support development of therapeutic alternatives to traditional antibiotics
— NIAID has awarded approximately $5 million in funding for 24 research projects seeking to develop non-traditional therapeutics for bacterial infections.

IVI [to 16 January 2016]
http://www.ivi.org/web/www/home

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[Undated]
New affordable oral cholera vaccine receives prequalification by the World Health Organization
– Oral cholera vaccine manufactured by Korean company EuBiologics following technology transfer from the International Vaccine Institute (IVI)
– Vaccine developed through international public-private partnership involving IVI and EuBiologics
– Euvichol will be used to protect the world’s underprivileged populations from cholera

SEOUL, KOREA – EuBiologics Co., Ltd. (EuBiologics) and the International Vaccine Institute (IVI) announced today that Euvichol®, an inactivated oral cholera vaccine (OCV), recently received prequalification from the World Health Organization (WHO). Developed to protect against epidemic and endemic cholera, the two-dose oral vaccine is low-cost and ready to use in a single-dose vial, facilitating its use in mass immunization programs in low-income countries.

“I am very pleased that Euvichol®, a vaccine whose development was enabled by IVI, was prequalified by WHO,” said Dr. Jerome Kim, IVI’s Director General. “This milestone shows that public-private partnerships – such as that between IVI and EuBiologics – are effective in developing vaccines against diseases of the poor like cholera.”…

…“The prequalification of Euvichol® demonstrates the power of partnerships to successfully develop vaccines,” said Dr. Anita Zaidi, Head of Enteric and Diarrheal Diseases at the Bill & Melinda Gates Foundation. “We are pleased to be a part of this effort and congratulate IVI and Eubiologics for this major milestone. Euvichol®will go a long way in easing global cholera vaccine supply constraints at the global level, however a lot remains to be done to make sure the cholera vaccine will be used in populations and countries where cholera is a problem.”

IAVI International AIDS Vaccine Initiative [to 16 January 2016]
http://www.iavi.org/press-releases/2016

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January 15, 2016
Study Provides Additional Insights for AIDS Vaccine Design
A new study helps AIDS vaccine researchers further understand how HIV interacts with its host, and how some people naturally produce antibodies against the virus’ many variants. The study, authored by researchers from the International AIDS Vaccine Initiative (IAVI) and partners, was published 14 January in PLOS Pathogens…

The new study suggests that both viral and host factors may be critical for the development of such broadly neutralizing antibodies (bNAbs), and that one “supersite” on HIV’s envelope protein may be a particularly favorable target for vaccine design. This research utilized samples from 439 newly infected volunteers in Protocol C, a large observational study by IAVI and partners in Eastern and South Africa supported by the United States Agency for International Development (USAID). About 15 percent developed bNAb responses, on average three years after infection. Gender, age and geographical origin appeared to have no influence on the development of bNAbs. However, the study showed that broad neutralization was associated with high viral load, low levels of particular immune cells, infection with one particular HIV subtype, and the presence of a particular gene in the host.

“These findings add to the important lessons that AIDS vaccine science continues to learn from large observational studies like Protocol C,” said Mark Feinberg, IAVI President and CEO. “The volunteers who participate in these studies are critical and valued partners in the effort to design a safe and effective AIDS vaccine.”

“Broadly Neutralizing Antibody Responses in a Large Longitudinal Sub-Saharan HIV Primary Infection Cohort,” by Elise Landais, Pascal Poignard, et al.

Sabin Vaccine Institute [to 16 January 2016]
http://www.sabin.org/updates/pressreleases

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January 13, 2016
Kenneth Kelley and Jordan Orange Join Sabin Vaccine Institute Board of Trustees
WASHINGTON, D.C. —— The Sabin Vaccine Institute (Sabin) is pleased to announce the election of Kenneth Kelley, M.B.A., and Jordan Orange, M.D., Ph.D., to its Board of Trustees. Mr. Kelley is a Harvard Senior Advanced Leadership Fellow, focusing on global health, biosecurity and the market inefficiency leading to a lack of vaccines against neglected tropical diseases (NTDs) and emerging pandemic threats. Dr. Orange is chief of Immunology, Allergy and Rheumatology, and professor and section head for Immunology, Allergy and Rheumatology in the pediatrics department at Baylor College of Medicine.

Global Fund [to 16 January 2016]
http://www.theglobalfund.org/en/news/

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12 January 2016
Challenges and Opportunities in 2016: Mark Dybul Looks Ahead
It is an exciting time in global health, and an extremely challenging one. Mark Dybul, Executive Director of the Global Fund spoke about current trends.

:: What are the greatest challenges and opportunities in 2016?
The road ahead calls for new thinking, for practical solutions that serve people who are being left behind. In global health, we have to think about our work beyond the disease or development paradigms, and focus on the person. How do we find innovative ways to empower individuals? Connecting education and health, especially where it enables girls to become women with opportunity, is an area that needs more work.

Building resilient and sustainable systems for health is another. Making a health clinic accessible may mean hiring more health workers, or an innovative health insurance scheme, but it also can mean lifting stigma and discrimination. Whatever helps an individual remove barriers to health, especially for key populations.

We face very serious challenges. Achieving impact in the last decade was relatively easy because the need was so great – almost anything you did had impact. However, the next stage of ending the epidemics involves confronting social and cultural issues. Our investments have to be more focused, nuanced and interwoven. And we have to put human beings at the center of our response

Climate change and the refugee crisis are big challenges for the world to deal with. By building lasting health programs and systems that boost the capacity and resilience of a country’s health system and its people, the Global Fund mission can play its part in improving humanity in a way that is connected with other challenges.

:: What do you mean when you speak of the need to put human beings at the center of our response?
If a scientific or medical response to the three epidemics was enough to end them, our mission would be complete. We already have the tools to defeat HIV, TB and malaria, but the diseases are still with us. Putting human beings at the center of our response means going beyond the work we have already done. We have to work hard to reach key populations, expanding programs we have and finding new ways, too. We have to think about stigma and poverty, and how they are connected with epidemics.

Overall, we have to expand access to health care and education and economic empowerment – powerful tools for the prevention and treatment of HIV, TB and malaria.

Whether it’s a 14 year old girl in Lesotho or a migrant forestry worker in Myanmar, every human being should be empowered to make smart decisions about their health, not subjected to the lottery of infectious disease. Education is one avenue toward progress, and linking education, especially for girls, must be a priority.

The Global Fund has a strong record of putting human beings at the center of its approach, inspired by solidarity and compassion. Today, we can point to great results: the partnership has saved more than 17 million lives, through the end of 2014. Each life saved represents expanded opportunity and greater social justice for families and communities worldwide – it inspires even greater belief in the power of the human spirit and what we can achieve by working together.

:: What gives you hope about ending the epidemics?
Every time a health program assists a girl to make powerful, positive decision about her health, or prevents a mother from transmitting HIV to her baby, or protects a young child from malaria or a grown man from tuberculosis, we are adding to the momentum of human opportunity and progress. When girls are given the opportunity to stay in school, and make informed choices that allow them to grow into empowered women, it breeds human progress. Wherever I see that, it contributes to my hope and my confidence that we can get there. But there still is a tremendous amount of work to do, and it is going to take more commitment, and a commitment to news ways of thinking, to get us there.

European Medicines Agency [to 16 January 2016]
http://www.ema.europa.eu/

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15/01/2016
Meeting highlights from the Pharmacovigilance Risk Assessment Committee (PRAC) 11-14 January 2016
Measuring the impact of pharmacovigilance activities – PRAC adopts new strategy
The Pharmacovigilance Risk Assessment Committee (PRAC), at its January meeting, adopted a ‘Strategy on measuring the impact of pharmacovigilance activities’. The new strategy details how to gather data and knowledge on the concrete effect of measures and processes meant to ensure the safe use of medicines for patients in the European Union (EU)…

Measuring the impact of such activities is crucial in order to know whether the measures taken to minimise the risks of a medicine have been effective. Measuring the impact of pharmacovigilance activities also allows regulators to determine which activities are most successful and so helps to promote best practice and improve pharmacovigilance.

The new strategy adopted by the PRAC builds on existing activities in the Member States and the Agency and relies on a collaborative approach with stakeholders. The strategy will focus on four areas: measuring the effectiveness of risk-minimisation measures on specific products; measuring the effect of specific pharmacovigilance processes (e.g. spontaneous reporting of suspected adverse reactions, signal management); investigating how to ensure engagement of key stakeholders (e.g. patients, healthcare professionals); and further improving methodologies to determine the effect of pharmacovigilance activities on public health…

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12/01/2016
Human medicines: highlights of 2015
93 medicines recommended for approval – 39 new active substances
The European Medicines Agency (EMA) has released an overview of its 2015 key recommendations in relation to the marketing authorisations of new medicines and the safety monitoring of authorised medicines…

WIPO World Intellectual Property Organization [to 16 January 2016]
http://www.wipo.int/pressroom/en/

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Jan 14, 2016 PR/2016/787
WIPO Re:Search Welcomes Institut Pasteur as Consortium Surpasses 100 Members
WIPO Re:Search has now surpassed 100 members and is just shy of 100 agreements to share intellectual property in the fight against neglected tropical diseases, tuberculosis and malaria – both significant milestones for the consortium as it heads into its fifth full year of operation.

The storied French research foundation Institut Pasteur became the 101st member of WIPO Re:Search last month as the consortium also signed its 99th collaboration to bring together research bodies aiming to promote new diagnostics, vaccines and treatments for diseases that afflict more than one billion people worldwide, largely in poorer regions.

“WIPO Re:Search continues to expand its network across the globe, bringing together leading research organizations from developing and developed countries to share intellectual property and scientific data in order to accelerate drug discovery to fight against diseases that affect the world’s most-vulnerable populations,” said WIPO Director General Francis Gurry. “Institut Pasteur now brings more than a century of pioneering research in medicine and vaccines to that effort, further strengthening the work of this unique collaboration.”

WIPO Re:Search allows organizations to share their intellectual property, compounds, expertise, facilities and know-how royalty-free with qualified researchers worldwide working on new solutions for the maladies, which affect more than one billion people across the globe…

“By joining the WIPO Re:Search consortium, Institut Pasteur looks forward to furthering its longstanding commitment to combating infectious diseases and its mission together with the Institut Pasteur International Network in 33 countries to contribute solving global health issues, in particular through technology transfer and partnerships”, said Christian Bréchot, President of the Institut Pasteur…

GHIT Fund [to 16 January 2016]
https://www.ghitfund.org/
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that devastate the world’s poorest people. Other funders include six Japanese pharmaceutical companies, the Japanese Government and the Bill & Melinda Gates Foundation.

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2015.12.17
Event Report: International Conference on Universal Health Coverage in the New Development Era
The Government of Japan, Japan International Cooperation Agency (JICA) and Japan Center for International Exchange (JCIE) co-hosted the International Conference on Universal Health Coverage (UHC) in the New Development Era: Toward Building Resilient and Sustainable Health Systems on December 16, 2015 in Tokyo, Japan. The conference explored the role of the UHC in the transition from the Millennium Development Goals (MDGs) to the 2030 Agenda for Sustainable Development and in enhancing preparedness and responses to health crises based on lessons learned from the recent Ebola crisis. Experts in global health, such as leaders from the Bill & Melinda Gates Foundation, Global Fund, World Bank Group, and World Health Organization participated…

£3bn a year needed to prepare the world for future pandemics
13 January 2016
An investment of less than 50p per year for every person on the planet (£3bn/$4.5bn total) would make the world significantly more resilient to the threat of infectious disease, according to a group of international experts convened in the wake of the Ebola crisis.

The report of the Commission on Creating a Global Health Risk Framework for the Future, published today, highlights infectious diseases as one of the biggest risks facing humankind. It estimates that pandemics cost the world more than £40bn ($60bn) each year, and match wars and natural disasters in their capacity to endanger human life and health and disrupt societies.

Yet compared with other high-profile threats to human and economic security – such as war, terrorism, nuclear disasters, natural catastrophes and financial crises – preparation for pandemics has received chronic under-investment.

The Commission recommends that urgent action be taken during 2016 to increase private, philanthropic and government spending on pandemic preparedness. It lays out comprehensive recommendations for bolstering the world’s ability to prevent and prepare for future disease outbreaks, including:
:: Reinforcing national public health capabilities and infrastructure as the first line of defence against potential pandemics, especially in low-income countries.

:: Establishing a permanent WHO Center for Health Emergency Preparedness and Response, with sustainable funding and operational independence, which would lead and co-ordinate defences and action against pandemic threats.

:: Accelerating research and development in the infectious disease arena, through annual global investment of at least £686m ($1bn) a year in prevention and treatment of threats, and a co-ordinating body to prioritise and oversee this.

The Wellcome Trust sponsored the creation of the Commission and the report, in partnership with seven other philanthropic and government organisations including the Bill and Melinda Gates Foundation and the Rockefeller Foundation, in response to the Ebola outbreak that began in 2014. It was coordinated by the US National Academy of Medicine.

Dr Jeremy Farrar, Director of the Wellcome Trust and a member of the Commission’s International Oversight Group, said:
“Few global events match epidemics and pandemics in potential to disrupt human security and inflict loss of life and economic and social damage. Yet for many decades, the world has invested far less in preventing, preparing for and responding to these threats than in comparable risks to international and financial security.

“Today’s report shows that by spending the equivalent of around 40p a year for every person on the planet, we could make our world much safer against the threat of infectious disease outbreaks.
“The cornerstones of the proposed framework must be the creation of a strong, independent WHO Center to lead outbreak preparedness and response, and an expert body to galvanise the research and development of vaccines, therapies, diagnostics and other tools.

“While the WHO has already taken welcome steps to improve co-ordination of health emergency preparedness and response, the report rightly recommends further change, with a central body that is a permanent part of the WHO system and that has considerable operational independence and a sustainable budget.

“The report is also right to recommend the creation of a WHO expert committee to inspire, support and oversee research and development into vaccines, drugs and other countermeasures. This would allow this essential field to benefit from the legitimacy and authority of the WHO, while ensuring that investment decisions are made by people with the expertise to judge health need and scientific merit. This panel could act as a convening and co-ordinating body that linked parallel efforts to finance and prioritise research and development in specialised fields such as vaccines, drug-resistant infections and personal protective equipment.

“The Commission should be congratulated on an excellent report, with recommendations that are clear, necessary and achievable. What we need to see now is action. The WHO’s leadership and its member states must make 2016 the year in which we learn the lessons of past epidemics and pandemics and implement these valuable measures, to build a more resilient global health system.”

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 16 January 2016)

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Research article
Postal recruitment and consent obtainment from index cases of narcolepsy
Access to research volunteers may be hampered by low numbers of cases and few eligible participants for rare diseases in clinical settings.
Gambo Aliyu and Salah M. Mahmud
BMC Medical Ethics 2016 17:6
Published on: 16 January 2016

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Debate
Developing a new justification for assent
Amanda Sibley, Andrew J. Pollard, Raymond Fitzpatrick and Mark Sheehan
BMC Medical Ethics 2016 17:2
Published on: 12 January 2016
Abstract
Background
Current guidelines do not clearly outline when assent should be attained from paediatric research participants, nor do they detail the necessary elements of the assent process. This stems from the fact that the fundamental justification behind the concept of assent is misunderstood. In this paper, we critically assess three widespread ethical arguments used for assent: children’s rights, the best interests of the child, and respect for a child’s developing autonomy. We then outline a newly-developed two-fold justification for the assent process: respect for the parent’s pedagogical role in teaching their child to become an autonomous being and respect for the child’s moral worth.
Discussion
We argue that the ethical grounding for the involvement of young children in medical decision-making does not stem from children’s rights, the principle of best interests, or respect for developing autonomy. An alternative strategy is to examine the original motivation to engage with the child. In paediatric settings there are two obligations on the researcher: an obligation to the parents who are responsible for determining when and under what circumstances the child develops his capacity for autonomy and reasoning, and an obligation to the child himself. There is an important distinction between respecting a decision and encouraging a decision. This paper illustrates that the process of assent is an important way in which respect for the child as an individual can be demonstrated, however, the value lies not in the child’s response but the fact that his views were solicited in the first place.
Summary
This paper demonstrates that the common justifications for the process of assent are incomplete. Assent should be understood as playing a pedagogical role for the child, helping to teach him how specific decisions are made and therefore helping him to become a better decision-maker. How the researcher engages with the child supports his obligation to the child’s parents, yet why the researcher engages with the child stems from the child’s moral worth. Treating a child as having moral worth need not mean doing what they say but it may mean listening, considering, engaging or involving them in the decision.

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

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Research article
Comparing the quality of pro- and anti-vaccination online information: a content analysis of vaccination-related webpages
Gabriele Sak, Nicola Diviani, Ahmed Allam and Peter J. Schulz
BMC Public Health 2016 16:38
Published on: 15 January 2016

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Research article
Sociocultural determinants of anticipated oral cholera vaccine acceptance in three African settings: a meta-analytic approach
Neisha Sundaram, Christian Schaetti, Sonja Merten, Christian Schindler, Said M. Ali, Erick O. Nyambedha, Bruno Lapika, Claire-Lise Chaignat, Raymond Hutubessy and Mitchell G. Weiss
BMC Public Health 2016 16:36
Published on: 14 January 2016
Abstract
Background
Controlling cholera remains a significant challenge in Sub-Saharan Africa. In areas where access to safe water and sanitation are limited, oral cholera vaccine (OCV) can save lives. Establishment of a global stockpile for OCV reflects increasing priority for use of cholera vaccines in endemic settings. Community acceptance of vaccines, however, is critical and sociocultural features of acceptance require attention for effective implementation. This study identifies and compares sociocultural determinants of anticipated OCV acceptance across populations in Southeastern Democratic Republic of Congo, Western Kenya and Zanzibar.
Methods
Cross-sectional studies were conducted using similar but locally-adapted semistructured interviews among 1095 respondents in three African settings. Logistic regression models identified sociocultural determinants of OCV acceptance from these studies in endemic areas of Southeastern Democratic Republic of Congo (SE-DRC), Western Kenya (W-Kenya) and Zanzibar. Meta-analytic techniques highlighted common and distinctive determinants in the three settings.
Results
Anticipated OCV acceptance was high in all settings. More than 93 % of community respondents overall indicated interest in a no-cost vaccine. Higher anticipated acceptance was observed in areas with less access to public health facilities. In all settings awareness of cholera prevention methods (safe food consumption and garbage disposal) and relating ingestion to cholera causation were associated with greater acceptance. Higher age, larger households, lack of education, social vulnerability and knowledge of oral rehydration solution for self-treatment were negatively associated with anticipated OCV acceptance. Setting-specific determinants of acceptance included reporting a reliable income (W-Kenya and Zanzibar, not SE-DRC). In SE-DRC, intention to purchase an OCV appeared unrelated to ability to pay. Rural residents were less likely than urban counterparts to accept an OCV in W-Kenya, but more likely in Zanzibar. Prayer as a form of self-treatment was associated with vaccine acceptance in SE-DRC and W-Kenya, but not in Zanzibar.
Conclusions
These cholera-endemic African communities are especially interested in no-cost OCVs. Health education and attention to local social and cultural features of cholera and vaccines would likely increase vaccine coverage. High demand and absence of insurmountable sociocultural barriers to vaccination with OCVs indicate potential for mass vaccination in planning for comprehensive control or elimination.

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Research article
Factors associated with incomplete childhood immunization in Arbegona district, southern Ethiopia: a case – control study
The prevention of child mortality through immunization is one of the most cost-effective and widely applied public health interventions. In Ethiopia, the Expanded Program on Immunization (EPI) schedule is rare…
Abel Negussie, Wondewosen Kassahun, Sahilu Assegid and Ada K. Hagan
BMC Public Health 2016 16:27
Published on: 12 January 2016

British Medical Journal
14 January 2016 (vol 352, issue 8040)
http://www.bmj.com/content/352/8040

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Safety of live attenuated influenza vaccine in young people with egg allergy: multicentre prospective cohort study
BMJ 2015; 351 :h6291 (Published 08 December 2015)
Paul J Turner, clinician scientist and clinical senior lecturer1, honorary consultant2, Jo Southern, clinical research lead2, Nick J Andrews, senior statistician2, Elizabeth Miller, consultant epidemiologist2, Michel Erlewyn-Lajeunesse, consultant paediatric allergist3 on behalf of the SNIFFLE-2 Study
Abstract
Study question
How safe is live attenuated influenza vaccine (LAIV), which contains egg protein, in young people with egg allergy?
Methods
In this open label, phase IV intervention study, 779 young people (2-18 years) with egg allergy were recruited from 30 UK allergy centres and immunised with LAIV. The cohort included 270 (34.7%) young people with previous anaphylaxis to egg, of whom 157 (20.1%) had experienced respiratory and/or cardiovascular symptoms. 445 (57.1%) had doctor diagnosed asthma or recurrent wheeze. Participants were observed for at least 30 minutes after vaccination and followed-up by telephone 72 hours later. Participants with a history of recurrent wheeze or asthma underwent further follow-up four weeks later. The main outcome measure was incidence of an adverse event within two hours of vaccination in young people with egg allergy.
Study answer and limitations
No systemic allergic reactions occurred (upper 95% confidence interval for population 0.47% and in participants with anaphylaxis to egg 1.36%). Nine participants (1.2%, 95% CI 0.5% to 2.2%) experienced mild symptoms, potentially consistent with a local, IgE mediated allergic reaction. Delayed events potentially related to the vaccine were reported in 221 participants. 62 participants (8.1%, 95% CI for population 6.3% to 10.3%) experienced lower respiratory tract symptoms within 72 hours, including 29 with parent reported wheeze. No participants were admitted to hospital. No increase in lower respiratory tract symptoms occurred in the four weeks after vaccination (assessed with asthma control test). The study cohort may represent young people with more severe allergy requiring specialist input, since they were recruited from secondary and tertiary allergy centres.
What this study adds
LAIV is associated with a low risk of systemic allergic reactions in young people with egg allergy. The vaccine seems to be well tolerated in those with well controlled asthma or recurrent wheeze.
Funding, competing interests, data sharing
This report is independent research commissioned and funded by a Department of Health policy research programme grant to the National Vaccine Evaluation Consortium. Additional funding was provided by the NIHR Clinical Research Networks, Health Protection Scotland (Edinburgh site), and Health & Social Care Services in Northern Ireland (Belfast site). PJT and MEL had support from the Department of Health for the submitted work; PJT has received research grants from the Medical Research Council and NIHR. No additional data available.
Study registration
ClinicalTrials.gov (NCT02111512) and the EU Clinical Trials Register EudraCT (2014-001537-92).

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Editorials
Live attenuated influenza vaccine for children with egg allergy
BMJ 2015; 351 :h6656 (Published 09 December 2015)
Policies should change to allow vaccination, after compelling new evidence of safety.

Eurosurveillance
Volume 21, Issue 2, 14 January 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Rapid Communications
Zika virus infection in a traveller returning from the Maldives, June 2015
by E Korhonen, E Huhtamo, T Smura, H Kallio-Kokko, M Raassina, O Vapalahti

Multidrug-resistant bacteria in unaccompanied refugee minors arriving in Frankfurt am Main, Germany, October to November 2015
by U Heudorf, B Krackhardt, M Karathana, N Kleinkauf, C Zinn

Multidrug-resistant organisms detected in refugee patients admitted to a University Hospital, Germany June-December 2015
by C Reinheimer, V Kempf, S Göttig, M Hogardt, T Wichelhaus, F O’Rourke, C Brandt

Respiratory diphtheria in an asylum seeker from Afghanistan arriving to Finland via Sweden, December 2015
by J Sane, T Sorvari, M Wideström, H Kauma, U Kaukoniemi, E Tarkka, T Puumalainen, M Kuusi, M Salminen, O Lyytikäinen

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 16 January 2016]

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Research
The development of ORACLe: a measure of an organisation’s capacity to engage in evidence-informed health policy
Steve R Makkar, Tari Turner, Anna Williamson, Jordan Louviere, Sally Redman, Abby Haynes, Sally Green, Sue Brennan Health Research Policy and Systems 2016, 14:4 (14 January 2016)
Abstract
Background
Evidence-informed policymaking is more likely if organisations have cultures that promote research use and invest in resources that facilitate staff engagement with research. Measures of organisations’ research use culture and capacity are needed to assess current capacity, identify opportunities for improvement, and examine the impact of capacity-building interventions. The aim of the current study was to develop a comprehensive system to measure and score organisations’ capacity to engage with and use research in policymaking, which we entitled ORACLe (Organisational Research Access, Culture, and Leadership).
Method
We used a multifaceted approach to develop ORACLe. Firstly, we reviewed the available literature to identify key domains of organisational tools and systems that may facilitate research use by staff. We interviewed senior health policymakers to verify the relevance and applicability of these domains. This information was used to generate an interview schedule that focused on seven key domains of organisational capacity. The interview was pilot-tested within four Australian policy agencies. A discrete choice experiment (DCE) was then undertaken using an expert sample to establish the relative importance of these domains. This data was used to produce a scoring system for ORACLe.
Results
The ORACLe interview was developed, comprised of 23 questions addressing seven domains of organisational capacity and tools that support research use, including (1) documented processes for policymaking; (2) leadership training; (3) staff training; (4) research resources (e.g. database access); and systems to (5) generate new research, (6) undertake evaluations, and (7) strengthen relationships with researchers. From the DCE data, a conditional logit model was estimated to calculate total scores that took into account the relative importance of the seven domains. The model indicated that our expert sample placed the greatest importance on domains (2), (3) and (4).
Conclusion
We utilised qualitative and quantitative methods to develop a system to assess and score organisations’ capacity to engage with and apply research to policy. Our measure assesses a broad range of capacity domains and identifies the relative importance of these capacities. ORACLe data can be used by organisations keen to increase their use of evidence to identify areas for further development.

International Journal of Infectious Diseases
January 2016 Volume 42, p1-74
http://www.ijidonline.com/issue/S1201-9712%2815%29X0012-9

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Editorial
Why is Pakistan a threat to “The Polio Eradication and Endgame Strategic Plan 2013–2018”? A look into the past decade
Tariq Khan, Bilal Haider Abbasi, Mubarak Ali Khan, Akhtar Nadhman
p4–6
Published online: November 16 2015
Abstract
The fight against endemic polio transmission is restricted to three countries: Pakistan, Afghanistan, and Nigeria. In 2012, when the world saw the lowest numbers of cases from polio-reporting countries, the World Health Organization (WHO) initiated a comprehensive strategy, “The Polio Eradication and Endgame Strategic Plan 2013–2018”.1 The plan (as it will be called from this point onwards) aims at: (1) wild polio virus (WPV) interruption by the end of 2014, (2) a strengthened immunization system and cessation of oral polio vaccine (OPV), (3) containment and certification, and (4) the quest for maintenance of a polio-free world by 2018.

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Perspective
Impacts of neglected tropical disease on incidence and progression of HIV/AIDS, tuberculosis, and malaria: scientific links
G.G. Simon
Management Sciences for Health, Arlington VA, USA
DOI: http://dx.doi.org/10.1016/j.ijid.2015.11.006
Highlights
:: The neglected tropical diseases (NTDs) share a high degree of geographic overlap with malaria and HIV.
:: Research suggests that NTDs can impact HIV, tuberculosis, and malaria disease progression.
:: Immunological, epidemiological, and social cofactors contribute to disease impact.
Summary
The neglected tropical diseases (NTDs) are the most common infections of humans in Sub-Saharan Africa. Virtually all of the population living below the World Bank poverty figure is affected by one or more NTDs. New evidence indicates a high degree of geographic overlap between the highest-prevalence NTDs (soil-transmitted helminths, schistosomiasis, onchocerciasis, lymphatic filariasis, and trachoma) and malaria and HIV, exhibiting a high degree of co-infection. Recent research suggests that NTDs can affect HIV and AIDS, tuberculosis (TB), and malaria disease progression. A combination of immunological, epidemiological, and clinical factors can contribute to these interactions and add to a worsening prognosis for people affected by HIV/AIDS, TB, and malaria. Together these results point to the impacts of the highest-prevalence NTDs on the health outcomes of malaria, HIV/AIDS, and TB and present new opportunities to design innovative public health interventions and strategies for these ‘big three’ diseases. This analysis describes the current findings of research and what research is still needed to strengthen the knowledge base of the impacts NTDs have on the big three.

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Reviews
Bridging the gap between evidence and policy for infectious diseases: How models can aid public health decision-making
Gwenan M. Knight, Nila J. Dharan, Gregory J. Fox, Natalie Stennis, Alice Zwerling, Renuka Khurana, David W. Dowdy
p17–23
Published online: November 3 2015
Highlights
:: Mathematical models are under-utilized in public health.
:: We discuss the current use of infectious disease modelling with a case study.
:: We lay out the methods and limitations of modelling infectious diseases.
:: We present a framework for improved interaction between public health and modellers.
:: This could lead to more transparent and evidence-driven policy decisions.
Summary
The dominant approach to decision-making in public health policy for infectious diseases relies heavily on expert opinion, which often applies empirical evidence to policy questions in a manner that is neither systematic nor transparent. Although systematic reviews are frequently commissioned to inform specific components of policy (such as efficacy), the same process is rarely applied to the full decision-making process. Mathematical models provide a mechanism through which empirical evidence can be methodically and transparently integrated to address such questions. However, such models are often considered difficult to interpret. In addition, models provide estimates that need to be iteratively re-evaluated as new data or considerations arise. Using the case study of a novel diagnostic for tuberculosis, a framework for improved collaboration between public health decision-makers and mathematical modellers that could lead to more transparent and evidence-driven policy decisions for infectious diseases in the future is proposed. The framework proposes that policymakers should establish long-term collaborations with modellers to address key questions, and that modellers should strive to provide clear explanations of the uncertainty of model structure and outputs. Doing so will improve the applicability of models and clarify their limitations when used to inform real-world public health policy decisions.

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Original Reports
Age and Ebola viral load correlate with mortality and survival time in 288 Ebola virus disease patients
Jin Li, Hui-Juan Duan, Hao-Yang Chen, Ying-Jie Ji, Xin Zhang, Yi-Hui Rong, Zhe Xu, Li-Jian Sun, Ji-Yuan Zhang, Li-Ming Liu, Bo Jin, Jian Zhang, Ning Du, Hai-Bin Su, Guang-Ju Teng, Yue Yuan, En-Qiang Qin, Hong-Jun Jia, Shu Wang, Tong-Sheng Guo, Ye Wang, Jin-Song Mu, Tao Yan, Zhi-Wei Li, Zheng Dong, Wei-Min Nie, Tian-Jun Jiang, Chen Li, Xu-Dong Gao, Dong Ji, Ying-Jie Zhuang, Lei Li, Li-Fu Wang, Wen-Gang Li, Xue-Zhang Duan, Yin-Ying Lu, Zhi-Qiang Sun, Alex B.J. Kanu, Sheku M. Koroma, Min Zhao, Jun-Sheng Ji, Fu-Sheng Wang
p34–39
Published online: October 30 2015

Journal of Medical Ethics
January 2016, Volume 42, Issue 1
http://jme.bmj.com/content/current

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Viewpoint
To research (or not) that is the question: ethical issues in research when medical care is disrupted by political action: a case study from Eldoret, Kenya
Darlene R House1,2, Irene Marete2,3, Eric M Meslin2,3,4
Author Affiliations
1Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
2Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
3Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
4Center for Bioethics, Indiana University, Indianapolis, Indiana, USA
Correspondence to Dr Darlene R House, Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; dhouse@iupui.edu
Abstract
While considerable attention has been focused on understanding the myriad of ethical analysis in international research in low and middle income countries, new issues always arise that have not been anticipated in guidelines or studied extensively. The disruption of medical care arising as a direct result of political actions, including strikes, postelection violence and related activities, is one such issue that leaves physician-researchers struggling to manage often conflicting professional responsibilities. This paper discusses the ethical conflicts that arise for physician-researchers, particularly when disruption threatens the completion of a study or completion is possible but at the expense of not addressing unmet medical needs of patients. We review three pragmatic strategies and the ethical issues arising from each: not starting research, stopping research that has already started, and continuing research already initiated. We argue that during episodes of medical care disruption, research that has been started can be continued only if the ethical standards imposed at the beginning of the study can continue to be met; however, studies that have been approved but not yet started should not begin until the disruption has ended and ethical standards can again be assured.

The Lancet
Jan 16, 2016 Volume 387 Number 10015 p199-310
http://www.thelancet.com/journals/lancet/issue/current

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Articles
Under-5 mortality in 2851 Chinese counties, 1996–2012: a subnational assessment of achieving MDG 4 goals in China
Yanping Wang, Xiaohong Li, Maigeng Zhou, Shusheng Luo, Juan Liang, Chelsea A Liddell, Matthew M Coates, Yanqiu Gao, Linhong Wang, Chunhua He, Chuyun Kang, Shiwei Liu, Li Dai, Austin E Schumacher, Maya S Fraser, Timothy M Wolock, Amanda Pain, Carly E Levitz, Lavanya Singh, Megan Coggeshall, Margaret Lind, Yichong Li, Qi Li, Kui Deng, Yi Mu, Changfei Deng, Ling Yi, Zheng Liu, Xia Ma, Hongtian Li, Dezhi Mu, Jun Zhu, Christopher J L Murray, Haidong Wang
Summary
Background
In the past two decades, the under-5 mortality rate in China has fallen substantially, but progress with regards to the Millennium Development Goal (MDG) 4 at the subnational level has not been quantified. We aimed to estimate under-5 mortality rates in mainland China for the years 1970 to 2012.
Methods
We estimated the under-5 mortality rate for 31 provinces in mainland China between 1970 and 2013 with data from censuses, surveys, surveillance sites, and disease surveillance points. We estimated under-5 mortality rates for 2851 counties in China from 1996 to 2012 with the reported child mortality numbers from the Annual Report System on Maternal and Child Health. We used a small area mortality estimation model, spatiotemporal smoothing, and Gaussian process regression to synthesise data and generate consistent provincial and county-level estimates. We compared progress at the county level with what was expected on the basis of income and educational attainment using an econometric model. We computed Gini coefficients to study the inequality of under-5 mortality rates across counties.
Findings
In 2012, the lowest provincial level under-5 mortality rate in China was about five per 1000 livebirths, lower than in Canada, New Zealand, and the USA. The highest provincial level under-5 mortality rate in China was higher than that of Bangladesh. 29 provinces achieved a decrease in under-5 mortality rates twice as fast as the MDG 4 target rate; only two provinces will not achieve MDG 4 by 2015. Although some counties in China have under-5 mortality rates similar to those in the most developed nations in 2012, some have similar rates to those recorded in Burkina Faso and Cameroon. Despite wide differences, the inter-county Gini coefficient has been decreasing. Improvement in maternal education and the economic boom have contributed to the fall in child mortality; more than 60% of the counties in China had rates of decline in under-5 mortality rates significantly faster than expected. Fast reduction in under-5 mortality rates have been recorded not only in the Han population, the dominant ethnic majority in China, but also in the minority populations. All top ten minority groups in terms of population sizes have experienced annual reductions in under-5 mortality rates faster than the MDG 4 target at 4·4%.
Interpretation
The reduction of under-5 mortality rates in China at the country, provincial, and county level is an extraordinary success story. Reductions of under-5 mortality rates faster than 8·8% (twice MDG 4 pace) are possible. Extremely rapid declines seem to be related to public policy in addition to socioeconomic progress. Lessons from successful counties should prove valuable for China to intensify efforts for those with unacceptably high under-5 mortality rates.
Funding
National “Twelfth Five-Year” Plan for Science and Technology Support, National Health and Family Planning Commission of The People’s Republic of China, Program for Changjiang Scholars and Innovative Research Team in University, the National Institute on Aging, and the Bill & Melinda Gates Foundation.

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Series
Antimicrobials: access and sustainable effectiveness
Exploring the evidence base for national and regional policy interventions to combat resistance
Osman A Dar, Rumina Hasan, Jørgen Schlundt, Stephan Harbarth, Grazia Caleo, Fazal K Dar, Jasper Littmann, Mark Rweyemamu, Emmeline J Buckley, Mohammed Shahid, Richard Kock, Henry Lishi Li, Haydar Giha, Mishal Khan, Anthony D So, Khalid M Bindayna, Anthony Kessel, Hanne Bak Pedersen, Govin Permanand, Alimuddin Zumla, John-Arne Røttingen, David L Heymann

Antimicrobials: access and sustainable effectiveness
International cooperation to improve access to and sustain effectiveness of antimicrobials
Christine Årdal, Kevin Outterson, Steven J Hoffman, Abdul Ghafur, Mike Sharland, Nisha Ranganathan, Richard Smith, Anna Zorzet, Jennifer Cohn, Didier Pittet, Nils Daulaire, Chantal Morel, Zain Rizvi, Manica Balasegaram, Osman A Dar, David L Heymann, Alison H Holmes, Luke S P Moore, Ramanan Laxminarayan, Marc Mendelson, John-Arne Røttingen

PLoS One
http://www.plosone.org/
[Accessed 16 January 2016]

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Spatiotemporal Evolution of Ebola Virus Disease at Sub-National Level during the 2014 West Africa Epidemic: Model Scrutiny and Data Meagreness
Eva Santermans, Emmanuel Robesyn, Tapiwa Ganyani, Bertrand Sudre, Christel Faes, Chantal Quinten, Wim Van Bortel, Tom Haber, Thomas Kovac, Frank Van Reeth, Marco Testa, Niel Hens, Diamantis Plachouras
Research Article | published 15 Jan 2016 | PLOS ONE
10.1371/journal.pone.0147172

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Research Article
Quantifying Access Disparities in Response Plans
Saratchandra Indrakanti ,
Armin R. Mikler, Martin O’Neill II, Chetan Tiwari
Published: January 15, 2016
DOI: 10.1371/journal.pone.0146350
Abstract
Effective response planning and preparedness are critical to the health and well-being of communities in the face of biological emergencies. Response plans involving mass prophylaxis may seem feasible when considering the choice of dispensing points within a region, overall population density, and estimated traffic demands. However, the plan may fail to serve particular vulnerable subpopulations, resulting in access disparities during emergency response. For a response plan to be effective, sufficient mitigation resources must be made accessible to target populations within short, federally-mandated time frames. A major challenge in response plan design is to establish a balance between the allocation of available resources and the provision of equal access to PODs for all individuals in a given geographic region. Limitations on the availability, granularity, and currency of data to identify vulnerable populations further complicate the planning process. To address these challenges and limitations, data driven methods to quantify vulnerabilities in the context of response plans have been developed and are explored in this article.

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Research Article
Human Papillomavirus Infection and Vaccination: Awareness and Knowledge of HPV and Acceptability of HPV Vaccine among Mothers of Teenage Daughters in Weihai, Shandong, China
Yang Yu, Minglei Xu, Jiandong Sun, Ruiying Li, Meilan Li, Jianguang Wang, Dongfeng Zhang, Aiqiang Xu
Research Article | published 14 Jan 2016 | PLOS ONE
10.1371/journal.pone.0146741

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Research Article
Efficacy of PPV23 in Preventing Pneumococcal Pneumonia in Adults at Increased Risk – A Systematic Review and Meta-Analysis
Julia Schiffner-Rohe, Annika Witt, Jana Hemmerling, Christof von Eiff, Friedrich-Wilhelm Leverkus
Research Article | published 13 Jan 2016 | PLOS ONE
10.1371/journal.pone.0146338

PLoS Pathogens
http://journals.plos.org/plospathogens/
(Accessed 16 January 2016)

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Research Article
Broadly Neutralizing Antibody Responses in a Large Longitudinal Sub-Saharan HIV Primary Infection Cohort
Elise Landais, Xiayu Huang, Colin Havenar-Daughton, Ben Murrell, Matt A. Price, Lalinda Wickramasinghe, Alejandra Ramos, Charoan B. Bian, Melissa Simek, Susan Allen, Etienne Karita,
William Kilembe, Shabir Lakhi, [ … ],ascal Poignard
Published: January 14, 2016
DOI: 10.1371/journal.ppat.1005369
Abstract
Broadly neutralizing antibodies (bnAbs) are thought to be a critical component of a protective HIV vaccine. However, designing vaccines immunogens able to elicit bnAbs has proven unsuccessful to date. Understanding the correlates and immunological mechanisms leading to the development of bnAb responses during natural HIV infection is thus critical to the design of a protective vaccine. The IAVI Protocol C program investigates a large longitudinal cohort of primary HIV-1 infection in Eastern and South Africa. Development of neutralization was evaluated in 439 donors using a 6 cross-clade pseudo-virus panel predictive of neutralization breadth on larger panels. About 15% of individuals developed bnAb responses, essentially between year 2 and year 4 of infection. Statistical analyses revealed no influence of gender, age or geographical origin on the development of neutralization breadth. However, cross-clade neutralization strongly correlated with high viral load as well as with low CD4 T cell counts, subtype-C infection and HLA-A*03(-) genotype. A correlation with high overall plasma IgG levels and anti-Env IgG binding titers was also found. The latter appeared not associated with higher affinity, suggesting a greater diversity of the anti-Env responses in broad neutralizers. Broadly neutralizing activity targeting glycan-dependent epitopes, largely the N332-glycan epitope region, was detected in nearly half of the broad neutralizers while CD4bs and gp41-MPER bnAb responses were only detected in very few individuals. Together the findings suggest that both viral and host factors are critical for the development of bnAbs and that the HIV Env N332-glycan supersite may be a favorable target for vaccine design.
Author Summary
Understanding how HIV-1-broadly neutralizing antibodies (bnAbs) develop during natural infection is essential to the design of an efficient HIV vaccine. We studied kinetics and correlates of neutralization breadth in a large sub-Saharan African longitudinal cohort of 439 participants with primary HIV-1 infection. Broadly nAb responses developed in 15% of individuals, on average three years after infection. Broad neutralization was associated with high viral load, low CD4+ T cell counts, virus subtype C infection and HLA*A3(-) genotype. A correlation with high overall plasma IgG levels and anti-Env binding titers was also found. Specificity mapping of the bnAb responses showed that glycan-dependent epitopes, in particular the N332 region, were most commonly targeted, in contrast to other bnAb epitopes, suggesting that the HIV Env N332-glycan epitope region may be a favorable target for vaccine design.

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 16 January 2016)

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Biological Sciences – Immunology and Inflammation
Systems biology of immunity to MF59-adjuvanted versus nonadjuvanted trivalent seasonal influenza vaccines in early childhood
Helder I. Nakaya, Elizabeth Clutterbuck, Dmitri Kazmin, Lili Wang, Mario Cortese, Steven E. Bosinger, Nirav B. Patel, Daniel E. Zak, Alan Aderem, Tao Dong, Giuseppe Del Giudice, Rino Rappuoli, Vincenzo Cerundolo, Andrew J. Pollard, Bali Pulendran, and Claire-Anne Siegrist
PNAS 2016 ; published ahead of print January 11, 2016, doi:10.1073/pnas.1519690113 Author Affiliations
Significance
Vaccines are one of the most cost-effective public health tools in history and offer a means to probe the human immune system. Recent advances have applied the tools of systems biology to study immune responses to vaccination in humans. Here we describe the application of this “systems vaccinology” approach to studying immunity to vaccination of 14- to 24-mo-old children with the inactivated influenza vaccine, administered with or without the MF59 adjuvant. These results reveal important new insights about the dynamics of the innate and adaptive responses to vaccination in this population, and identify potential correlates of immunity to vaccination in children.
Abstract
The dynamics and molecular mechanisms underlying vaccine immunity in early childhood remain poorly understood. Here we applied systems approaches to investigate the innate and adaptive responses to trivalent inactivated influenza vaccine (TIV) and MF59-adjuvanted TIV (ATIV) in 90 14- to 24-mo-old healthy children. MF59 enhanced the magnitude and kinetics of serum antibody titers following vaccination, and induced a greater frequency of vaccine specific, multicytokine-producing CD4+ T cells. Compared with transcriptional responses to TIV vaccination previously reported in adults, responses to TIV in infants were markedly attenuated, limited to genes regulating antiviral and antigen presentation pathways, and observed only in a subset of vaccinees. In contrast, transcriptional responses to ATIV boost were more homogenous and robust. Interestingly, a day 1 gene signature characteristic of the innate response (antiviral IFN genes, dendritic cell, and monocyte responses) correlated with hemagglutination at day 28. These findings demonstrate that MF59 enhances the magnitude, kinetics, and consistency of the innate and adaptive response to vaccination with the seasonal influenza vaccine during early childhood, and identify potential molecular correlates of antibody responses.

Vaccine
Volume 34, Issue 5, Pages 597-702 (27 January 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/5

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Original Research Article
Cost-utility analysis of dengue vaccination in a country with heterogeneous risk of dengue transmission
Pages 616-621
Pablo Wenceslao Orellano, Julieta Itati Reynoso, Hans-Christian Stahl, Oscar Daniel Salomon
Abstract
Background
Dengue is one of the most important vector-borne diseases worldwide, and annually, nearly 390 million people are infected and 500,000 patients are hospitalized for severe dengue. Argentina has great variability in the risk of dengue transmission due to eco-climatic reasons. Currently no vaccines are available for dengue even though several vaccines are under development.
Objective
The aim of this study was to estimate the cost-effectiveness of a dengue vaccine in a country with heterogeneous risk of dengue transmission like Argentina.
Methods
The analysis was carried out from a societal perspective using a Markov model that included both vaccine and disease parameters. Utility was measured as disability adjusted life years (DALYs) averted, and the incremental cost-effectiveness ratio (ICER) of the vaccination was expressed in 2014 American dollars (US$) per DALY averted. One-way and probabilistic sensitivity analyses were performed to evaluate uncertainty in model outcomes, and a threshold analysis was conducted to estimate the highest possible price of the vaccine.
Results
The ICER of the vaccination program was found to be US$ 5714 per DALY averted. This value is lower than 3 times the per capita GDP of Argentina (US$ 38,619 in 2014); 54.9% of the simulations were below this value. If a vaccination program would be implemented the maximum vaccine price per dose has to be US$1.49 for a vaccination at national level or US$28.72 for a targeted vaccination in high transmission areas.
Conclusions
These results demonstrate that vaccination against dengue would be cost-effective in Argentina, especially if carried out in predetermined regions at high risk of dengue transmission. However, these results should be interpreted with caution because the probabilistic sensitivity analysis showed that there was considerable uncertainty around the ICER value. The influence of variations in vaccine efficacy, cost and other important parameters are discussed in the text.

Vaccine
Volume 34, Issue 5, Pages 597-702 (27 January 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/5

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Adolescent, parent and societal preferences and willingness to pay for meningococcal B vaccine: A Discrete Choice Experiment
Original Research Article
Pages 671-677
H.S. Marshall, G. Chen, M. Clarke, J. Ratcliffe
Abstract
Objective
Meningococcal B (MenB) vaccines have been licensed in many countries with private purchase the only option until recently, when a funded programme was introduced in the UK. The aim of this study was to explore adolescent/parental values for a variety of salient vaccine attributes (cost, effectiveness, side effect profile) to assess preferences and willingness-to-pay (WTP) for a MenB vaccine.
Methodology
A national cross-sectional population study was conducted in Australia using Discrete Choice Experiment methodology to assess adolescent/parent/adult preferences for attributes related to MenB vaccine.
Results
2003 adults and 502 adolescents completed the survey in 2013. The majority of participants were willing to be vaccinated with MenB vaccine with vaccination opt-out chosen by 11.9% of adolescents and parents, and 18.2% of non-parent adults. A mixed logit regression model examining adolescent/adult preferences indicated consistent findings; the higher the effectiveness, the longer the duration of protection, the less chance of adverse events and the lower the cost, the more likely respondents were to agree to vaccination. For an ideal MenB vaccine, including the most favoured level of each attribute summed together (90% effectiveness, 10 year duration, 1 injection, no adverse events) adolescents would pay AU$251.60 and parents AU$295.10. Adolescents and parents would pay AU$90.70 or AU$127.20 for 90% vaccine effectiveness vs AU$18.50 or AU$16.70 for 70% effectiveness and would want to be financially compensated for 50% effectiveness; pay AU$63.30 or AU$76.40 for 10 years protection; and pay AU$48.50 or AU$49.20 for no vaccine related adverse events. A slight fever post vaccination was a preferred choice with parents and adolescents willing to pay AU$9.60 or AU$12.30 for this attribute.
Conclusions
Vaccine effectiveness, adverse events and duration of immunity are important drivers for parental and adolescent decisions about WTP for MenB vaccine and should be included in discussions on the benefits, risks and cost.

Vaccine
Volume 34, Issue 5, Pages 597-702 (27 January 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/5

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Knowledge, attitudes, beliefs, and behaviors of parents and healthcare providers before and after implementation of a universal rotavirus vaccination program
Original Research Article
Pages 687-695
Donna M. MacDougall, Beth A. Halperin, Joanne M. Langley, Donna MacKinnon-Cameron, Li Li, Scott A. Halperin, for the Maritime Universal Rotavirus Vaccination Program (MURVP)
Abstract
Objective
In Canada, rotavirus vaccine is recommended for all infants, but not all provinces/territories have publicly funded programs. We compared public and healthcare provider (HCP) knowledge, attitudes, beliefs, and behaviors in a province with a public health nurse-delivered, publicly funded rotavirus vaccination program to a province with a publicly funded, physician-delivered program. A third province with no vaccination program acted as a control.
Design
Information about knowledge, attitudes, beliefs, and behaviors of parents whose children were eligible for the universal program and healthcare providers responsible for administering the vaccine were collected through the use of two validated surveys distributed in public health clinics, physicians’ offices, and via e-mail. Early and postvaccine-program survey results were compared.
Results
A total of 722 early implementation and 709 postimplementation parent surveys and 180 early and 141 postimplementation HCP surveys were analyzed. HCP and public attitudes toward rotavirus vaccination were generally positive and didn’t change over time. More parents postprogram were aware of the NACI recommendation and the vaccination program and reported that their healthcare provider discussed rotavirus infection and vaccine with them. Prior to the program across all sites, more physicians than nurses were aware of the national recommendation regarding rotavirus vaccine. In the postprogram survey, however, more nurses were aware of the national recommendation and their provincial universal rotavirus vaccination program. Nurses had higher knowledge scores than physicians in the postprogram survey (p < 0.001). Parents of young infants were also more knowledgeable about rotavirus and rotavirus vaccine in the two areas where universal programs were in place (p < 0.001).
Conclusions
Implementation of a universal rotavirus vaccination program was associated with an increase in knowledge and more positive attitudes toward rotavirus vaccine amongst parents of eligible infants. Nurses involved in a public health-delivered vaccination program were more knowledgeable and had more positive attitudes toward the vaccine than physicians in a jurisdiction where vaccine was physician-delivered.

Vaccine
Volume 34, Issue 4, Pages 401-596 (20 January 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/4

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Validity of the estimates of oral cholera vaccine effectiveness derived from the test-negative design
Original Research Article
Pages 479-485
Mohammad Ali, Young Ae You, Dipika Sur, Suman Kanungo, Deok Ryun Kim, Jacqueline Deen, Anna Lena Lopez, Thomas F. Wierzba, Sujit K. Bhattacharya, John D. Clemens
Abstract
Background
The test-negative design (TND) has emerged as a simple method for evaluating vaccine effectiveness (VE). Its utility for evaluating oral cholera vaccine (OCV) effectiveness is unknown. We examined this method’s validity in assessing OCV effectiveness by comparing the results of TND analyses with those of conventional cohort analyses.
Methods
Randomized controlled trials of OCV were conducted in Matlab (Bangladesh) and Kolkata (India), and an observational cohort design was used in Zanzibar (Tanzania). For all three studies, VE using the TND was estimated from the odds ratio (OR) relating vaccination status to fecal test status (Vibrio cholerae O1 positive or negative) among diarrheal patients enrolled during surveillance (VE = (1 − OR)×100%). In cohort analyses of these studies, we employed the Cox proportional hazard model for estimating VE (=1 − hazard ratio)×100%).
Results
OCV effectiveness estimates obtained using the TND (Matlab: 51%, 95% CI:37–62%; Kolkata: 67%, 95% CI:57–75%) were similar to the cohort analyses of these RCTs (Matlab: 52%, 95% CI:43–60% and Kolkata: 66%, 95% CI:55–74%). The TND VE estimate for the Zanzibar data was 94% (95% CI:84–98%) compared with 82% (95% CI:58–93%) in the cohort analysis. After adjusting for residual confounding in the cohort analysis of the Zanzibar study, using a bias indicator condition, we observed almost no difference in the two estimates.
Conclusion
Our findings suggest that the TND is a valid approach for evaluating OCV effectiveness in routine vaccination programs.

Vaccine
Volume 34, Issue 4, Pages 401-596 (20 January 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/4

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Commentary
Commentary on: “Seasonal influenza vaccine dose distribution in 195 countries (2004–2013): Little progress in estimated global vaccination coverage”
Pages 401-402
David M. Salisbury
[No abstract]

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Brief report
The potential acceptability of infant vaccination against malaria: A mapping of parental positions in Togo
Pages 408-412
Lonzozou Kpanake, Paul Clay Sorum, Etienne Mullet
Abstract
Objective
To map the acceptability to parents in Togo of infant vaccination against malaria.
Methods
From July to October 2014, a study of 209 parents of infants in Togo was conducted to assess their willingness to have their infants vaccinated against malaria. Participants were exposed to 48 vignettes, designed using the main constructs of health-protective theories.
Results
Five qualitatively different positions were found, which were labeled Neighbors’ Attitude (5%), Cost Only (21%), Neighbors’ Attitude and Cost (22%), Risk and Cost (33%), and Always Vaccine (20%).
Conclusion
The diversity of parental positions regarding vaccinating their infants against malaria implies that malaria vaccination campaigns in Togo, and possibly in other sub-Saharan African countries, must not be “one size fits all,” but must be tailored in design and implementation to match the diversity of parents’ needs and views.

Obstetrics & Gynecology
Post Author Corrections: January 07, 2016
Maternal Immunization With an Investigational Trivalent Group B Streptococcal Vaccine: A Randomized Controlled Trial.
Donders, Gilbert G.G. MD, PhD; Halperin, Scott A. MD; Devlieger, Roland MD, PhD; Baker, Sherryl PhD; Forte, Pietro BA; Wittke, Frederick MD; Slobod, Karen S. MD; Dull, Peter M. MD
doi: 10.1097/AOG.0000000000001190
Original Research: PDF Only
Published Ahead-of-Print
Abstract
OBJECTIVE: To evaluate the safety and immunogenicity of an investigational trivalent group B streptococcal vaccine in pregnant women and antibody transfer to their newborns.
METHODS: The primary outcome of this observer-blind, randomized study was to estimate placental antibody transfer rates at birth. Secondary outcomes included measurement of serotype-specific antibodies at screening, 30 days postvaccination, at delivery, and 91 days postpartum, infant antibody levels at 3 months of age, the potential effect on routine infant diphtheria vaccination at 1 month after the third infant series dose, and safety in mother and infant participants through at least 5 months postpartum. Sample size was based on 60 participants in the vaccine group giving a probability of observing at least one adverse event of 90% if the actual rate of the event was 3.8%.
RESULTS: From September 2011 to October 2013, 86 pregnant women were allocated in a 3:2 ratio to receive an investigational group B streptococcal vaccine containing glycoconjugates of serotypes Ia, Ib, and III or placebo. Demographics were similar across groups. Transfer ratios were 66-79% and maternal geometric mean concentrations increased 16-, 23-, and 20-fold by delivery against serotypes Ia, Ib, and III, respectively, Women with no detectable antibodies at inclusion had lower responses than those with detectable antibodies. Three months after birth, infant antibody concentrations were 22-25% of birth levels. Antidiphtheria geometric mean concentrations were similar across groups. In the vaccine and placebo groups, 32 of 51 women (63%) and 26 of 35 women (74%) reported adverse effects, respectively.
CONCLUSION: The investigational vaccine was well-tolerated without safety signals in recipients and their infants or interference with routine infant diphtheria vaccination, although further studies on safety and effectiveness are needed. The investigational vaccine was immunogenic for all serotypes, particularly among women with detectable antibody levels at baseline. Antibody transfer to neonates was at similar levels to other maternally administered polysaccharide vaccines.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, http://www.clinicaltrials.gov, NCT01446289.

Media/Policy Watch  [to 16 January 2016]
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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Financial Times
http://www.ft.com/home/uk
Accessed 16 January 2016
January 13, 2016
Suicide bomber kills 14 at Pakistan polio vaccination clinic

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Forbes
http://www.forbes.com/
Accessed 16 January 2016
With First Texas Zika Case, Vaccine Desperately Needed, Expert Says
A recent U.S. case of Zika, a tropical disease linked to serious birth defects in the children of infected pregnant women, was diagnosed in the Houston area of Texas two days ago. This case was an imported case, so the individual arrived in the U.S. from Latin America with the illness…
Tara Haelle, Contributor
Jan 13, 2016

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The Guardian
http://www.guardiannews.com/
Accessed 16 January 2016
HPV vaccine rates higher in poor and Latino communities, study finds
:: Findings unusual as underserved typically have limited healthcare access
:: HPV is most common sexually transmitted infection in US
Thursday 14 January 2016 06.00 EST
Rates for the human papillomavirus (HPV) vaccine in the US are highest in communities that are predominantly Latino and poor, according to a report released Thursday that depicts a sharp turn in public health trends.

In high poverty communities, 61.1% of girls were given the first shot in the series, compared with 52.4% in low poverty communities, according to the American Association for Cancer Research’s report, the first to look at geography in relation to HPV vaccination rates.

“You’re finding everything is inverse essentially,” said Kevin Henry, lead author of the study, which is being published in Cancer Epidemiology, Biomarkers & Prevention. “You’re finding that the wealthier people have less vaccination yet they have more resources so in some respects they should be higher.”
The HPV vaccination rate was found to be higher among black people, American Indian/Alaska natives and Latinos compared with caucasian and Asian people. And girls whose families live below the poverty line also started taking the vaccination more frequently than women above the poverty line.

This is unusual because underserved communities typically have limited access to healthcare and take up public health initiatives like preventive screenings and immunizations at a lower rate…

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New York Times
http://www.nytimes.com/
Accessed 16 January 2016
Brazil to Fund Development of Vaccine for Zika Virus
January 16, 2016 – By THE ASSOCIATED PRESS SAO PAULO — The Brazilian government announced it will direct funds to a biomedical research center to help develop a vaccine against a virus linked to brain damage in babies.
Health Minister Marcelo Castro said Friday that the goal is for the Sao Paulo-based Butantan Institute to develop “in record time” a vaccine for Zika, which is spread through mosquito bites.
Institute director Jorge Kalil said that is expected take 3 to 5 years.
Brazil is currently experiencing the largest known outbreak of Zika. The virus has been linked to a recent surge in birth defects including microcephaly, a rare condition in which newborns have smaller than normal heads and their brains do not develop properly.
The Health Ministry says 3,530 babies have been born with microcephaly in the country since October. Fewer than 150 such cases were seen in all of 2014.
Most have been concentrated in Brazil’s poor northeast, though cases in Rio de Janeiro and other big cities have also been on the rise, prompting people to stock up on mosquito repellent.
Some women of means have left the country to spend their pregnancies in the United States or Europe to avoid infection.
The Zika virus is spread by the Aedes aegypti mosquito, which can also carry dengue and chikungunya…

Suicide Bomb Near Polio Center in Pakistan Kills at Least 16
By IHSANULLAH TIPU MEHSUDJAN. 13, 2016
ISLAMABAD, Pakistan — At least 16 people were killed on Wednesday in a suicide bombing outside a polio vaccination center in the southwestern Pakistani city of Quetta, officials and witnesses said.
Thirteen of the victims were police officers, said Syed Imtiaz Shah, a senior official with the Quetta police. He said the officers were there to guard polio workers, who are often targeted by Islamist militants in Pakistan.
The attack came on the third day of a vaccination campaign in the province of Baluchistan, of which Quetta is the capital. The bomber, who was also killed, walked up to police officers and detonated what Mr. Shah said amounted to more than 20 pounds of explosives.
A spokesman for the Pakistani Taliban, Muhammad Khurrasani, claimed responsibility for the attack on the militants’ behalf. Two civilians and a paramilitary police officer were also killed, and 10 police officers and nine civilians were wounded…

Zuckerberg Wades Into Vaccine Debate With Baby Shots Photo
Facebook founder and chief executive Mark Zuckerberg has dropped himself into the riotous social media debate over childhood vaccines after posting photos of himself taking his newborn daughter to get immunization shots at the doctor’s office.
January 11, 2016 – By REUTERS –

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

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

– pdf version:  A pdf of the current issue is available here:  Vaccines and Global Health_The Week in Review_16 January 2016

– blog edition: comprised of the approx. 35+ entries posted below on 17 January 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.

.
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

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

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

– pdf version:  A pdf of the current issue is available here:  Vaccines and Global Health_The Week in Review_9 January 2016

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

.
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

EBOLA/EVD [to 9 January 2016]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

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Ebola Situation Report – 6 January 2016
SUMMARY
:: No confirmed cases of Ebola virus disease (EVD) were reported in the week to 3 January. On 29 December, WHO declared that human-to-human transmission of Ebola virus has ended in Guinea, after the completion of 42 days with zero cases since the last person confirmed to have EVD received a second consecutive negative blood test for Ebola virus RNA. Guinea has now entered a 90-day period of heightened surveillance. Guinea, Liberia, and Sierra Leone have all now succeeded in interrupting human-to-human transmission linked to the original outbreak in West Africa.

:: Human-to-human transmission linked to the most recent cluster of cases in Liberia will be declared to have ended on 14 January 2016, 42 days after the 2 most-recent cases received a second consecutive negative test for Ebola virus, if no further cases are reported. In Sierra Leone, human-to-human transmission linked to the primary outbreak was declared to have ended on 7 November 2015. The country has now entered a 90-day period of enhanced surveillance scheduled to conclude on 5 February 2016.

:: The most recent cluster of cases in Liberia was the result of the re-emergence of Ebola virus that had persisted in a previously infected individual. Although the probability of such re-emergence events is low, the risk of further transmission following a re-emergence underscores the importance of implementing a comprehensive package of services for survivors that includes the testing of appropriate bodily fluids for the presence of Ebola virus RNA. The governments of Liberia and Sierra Leone, with support from partners including WHO and the US Centres for Disease Control and Prevention, have implemented voluntary semen screening and counselling programmes for male survivors in order to help affected individuals understand their risk and take necessary precautions to protect close contacts. 405 male survivors had accessed semen screening services up to 3 January 2016 in Liberia and Sierra Leone. A network of clinical services for survivors is also being expanded in Liberia and Sierra Leone, with plans for comprehensive national policies for the care of EVD survivors due to be completed in January 2016. To date approximately 3000 survivors have accessed basic care services…

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WHO – Ebola Vaccine Target Product Profile
5 January 2016 :: 16 pages
Overview
During the course of the high level WHO meetings on Ebola vaccine development, it was agreed that WHO would develop Ebola vaccine target product profiles (TPP) to provide guidance on WHO’s preferences for Ebola vaccines of two categories (for reactive use and prophylactic use).
The target audience for the WHO Ebola vaccine TPP are all those working to improve characteristics of currently tested Ebola vaccines. The TPP is also relevant to those developing Ebola vaccines that have not yet reached the clinical development phase.
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WHO Ebola Vaccine TPP pdf, 403kb
Excerpt
This document considers two scenarios for use of an Ebola virus disease (EVD) vaccine, which have different preferred characteristics:
a) Reactive/emergency use in the face of an outbreak to prevent EVD in vaccinated individuals as well as interrupt chains of virus transmission to terminate outbreaks. Use will be in populations experiencing an outbreak, in populations geographically close to an outbreak and at high risk for importation of EVD cases from areas experiencing an outbreak:
:: Durability of protection: Less critical than rapidly achieving high rates of protection as the emphasis is interrupting transmission and terminating the outbreak.
:: Stability/storage: Amenable to stockpiling for future outbreaks of EVD.
:: Risk/benefit profile: Acceptability based on the assumption those vaccinated are at high risk of exposure to Ebola virus with relatively high EVD-associated mortality rate.

b) Prophylactic use to protect frontline workers (including healthcare workers, deploying international workers and others at particularly high risk of EVD due to their profession such as ancillary staff and those dealing with burials)
:: Durability of protection: A more prominent preferred characteristic than for reactive/emergency use
:: Risk/benefit profile: assumes that some of those vaccinated may not be as at high risk as the target group for reactive use.

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Introduction
This document is intended to serve as guidance for scientists, regulators, and funding agencies, and for industry groups. It is relevant to those groups who wish to obtain WHO policy recommendations for use, and WHO prequalification of their products to maximise supply volumes for use of EVD vaccines, and meet the public health need related to future EVD outbreaks.
In order to reach the stage of use in countries most affected by Ebola outbreaks, vaccines will need to be prequalified by WHO, and be included within the remit of WHO policy recommendations for use. An essential requirement prior to WHO prequalification is licensure by an NRA considered functional by WHO.

All the requirements contained in WHO guidelines for WHO policy recommendation and prequalification will also apply. The criteria below lay out some of the considerations that will be relevant in WHO’s case-by-case assessments of EVD vaccines in the future.
None of the characteristics in the tables below dominates over any other. Therefore should a vaccine’s profile be sufficiently superior to the critical characteristics under one or more categories, this may outweigh failure to meet another specific critical characteristic. Vaccines which fail to meet multiple critical characteristics are unlikely to achieve favourable outcomes from WHO’s processes.

A generic description of WHO’s Vaccine Prequalification process can be found at the end of this document…

MERS-CoV [to 9 January 2016]
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Disease Outbreak News (DONs)
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Oman
7 January 2016
On 3 January 2016, the National IHR Focal Point of Oman notified WHO of 1 additional case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection.

:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
4 January 2016
Between 29 November and 17 December 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 4 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 2 deaths.

WHO & Regionals [to 9 January 2016]
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Life-saving health supplies blocked in Yemen
7 January 2016 — WHO calls for immediate access to Taiz City for the delivery of life-saving health supplies. The health situation continues to deteriorate as more than 250 000 people have been living in a state of virtual siege since November 2015. All of the city’s 6 hospitals have been forced to partially close services and are overwhelmed with injured patients. Humanitarian organizations are struggling to deliver medical and surgical supplies due to the insecurity.

GIN December 2015 pdf, 3.02Mb 6 January 2016

Weekly Epidemiological Record (WER) 8 January 2016, vol. 91, 1 (pp. 1–12):
1 WHO informal consultation on surveillance of respiratory syncytial virus on the WHO Global Influenza Surveillance and Response System (GISRS) platform, 25–27 March 2015, Geneva, Switzerland
3 Detection of influenza virus subtype A by polymerase chain reaction: WHO external quality assessment programme summary analysis, 2015

Disease Outbreak News (DONs)
:: 8 January 2016 Microcephaly – Brazil
:: 8 January 2016 Zika virus infection – United States of America – Puerto Rico
:: 7 January 2016 Middle East respiratory syndrome coronavirus (MERS-CoV) – Oman
:: 4 January 2016 Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
:: 4 January 2016 Human infection with avian influenza A(H5N6) virus – China

Stories from Countries
:: Insecurity drives health workers out of Yemen 7 January 2016
:: WHO fosters local, global collaboration to fight NCDs 6 January 2016
:: Surviving the war to fight diabetes as a refugee 5 January 2016
:: Shouldering the care of refugees 5 January 2016
:: WHO Regional Offices
WHO African Region AFRO
No new digest content identified.

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

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

WHO European Region EURO
:: How can we best protect non-smokers from exposure to tobacco smoke?
05-01-2016

WHO Eastern Mediterranean Region EMRO
:: WHO calls for immediate access to Taiz City for delivery of life-saving health supplies
7 January 2015, Sana’a, Yemen – The World Health Organization is concerned about the deteriorating health situation in Taiz, where more than 250 000 people have been living in a state of virtual siege since November 2015. All of city’s 6 hospitals have been forced to partially close some services, and are overwhelmed with injured patients. Humanitarian organizations are struggling to deliver medical and surgical supplies due to the insecurity…

WHO Western Pacific Region
No new digest content identified.

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

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06 January 2016
Historic partnership between Gavi and India to save millions of lives
Targeted new support will ensure new vaccines reach children across the country.
New Delhi, 6 January 2016 – The Government of India and Gavi, the Vaccine Alliance, have today announced a partnership that will help save the lives of millions of Indian children through increased access to vaccines.

India is due to begin transitioning away from Gavi support from 2017 and is expected to begin fully self-financing all its vaccine programmes by 2021. Under the partnership strategy, Gavi will provide up to US$ 500 million between 2016 and 2021 to support India’s immunisation programme, after which India will completely transition out of Gavi support. The new partnership will accelerate the introduction of modern, highly-efficacious vaccines in India, protecting children against the leading causes of disease, including pneumonia and severe diarrhoea, which combined claim the lives of more than 200,000 Indian children under the age of five every year.

Support will also be made available for the measles-rubella combined vaccine. This vaccine protects children against measles, a highly infectious disease that kills almost 30,000 children in India every year, as well as congenital rubella syndrome, which causes severe deformities and disabilities through the spread of the virus from pregnant women to their babies. Gavi will also provide future assistance for India to introduce the human papillomavirus vaccine, should the Government approve its introduction. This vaccine protects women against the leading cause of cervical cancer, a disease that kills 70,000 Indian women every year.

Through this new partnership Gavi-supported vaccines administered between 2016 and 2021 are expected to prevent several hundred thousand deaths. By helping to establish these vaccines in India’s routine immunisation schedule and by strengthening existing immunisation and health systems to extend coverage and improve access, millions of children will benefit from the work being undertaken now for generations to come.

The Government of India already has a priority of reaching every child with vaccines, as is evidenced by its new Mission Indradhanush initiative, which aims to reduce the number of children who get sick or die from preventable diseases by ensuring that the number of infants receiving all vaccines included within the Universal Immunisation Programme (UIP) exceeds 90% within the next five years. Through the modernisation and strengthening of health systems under this new partnership, Gavi support will also help towards this goal and help engage with a broader community of stakeholders within India…

WHO – Cholera vaccine supply set to double, easing global shortage
8 January 2016
The global supply of oral cholera vaccines is set to double after WHO approved a third producer, helping to address global shortages and expand access in more countries.
Globally, OCV production is low, with demands currently exceeding supply. Sudan and Haiti last year made requests to WHO for supplies of vaccines to conduct pre-emptive vaccination campaigns that could not be filled because of the global shortage.

The vaccine producer, a South Korean company, is the latest oral cholera vaccine (OCV) manufacturer to be approved under the WHO’s pre-qualification programme, which ensures that drugs and vaccines bought by countries and international procurement agencies such as the United Nations Children’s Fund (UNICEF) meet acceptable standards of quality, safety and efficacy.

The addition of an additional pre-qualified vaccine producer is expected to double global supply to 6 million doses for 2016, with the potential for further increased production in the future. This additional capacity will contribute to reversing a vicious cycle of low demand, low production, high price and inequitable distribution, to a virtuous cycle of increased demand, increased production, reduced price and greater equity of access…

In 2013 the WHO created the world’s first OCV stockpile, undertaking to buy and use 2 million doses a year in order to stabilize and create demand for the vaccines…

Access to OCV has been further improved by a commitment of US$115 million over 5 years from Gavi, the Vaccine Alliance, to expand availability and the use of vaccine in countries with endemic cholera. Since the OCV stockpile was created more vaccines have been distributed and used than in the previous 15 years. A total of 21 OCV deployments of about 4 million doses to 11 countries have been used in various contexts: humanitarian crises in Cameroon, Haiti, Iraq, Nepal, South Sudan, and United Republic of Tanzania; outbreaks in Guinea and Malawi; and in endemic hotspots such as Bangladesh and Democratic Republic of the Congo…

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Geneva Press Briefing: WHO, IOM, UNHCR, OHCHR
8 Jan 2016
[Editor’s Note: Included in this press briefing is an extended report on the new OCV vaccine which received WHO pre-qualification in late December and its implication as above given by Stephen Martin of the WHO OCV stockpile program. His comments begin at about 05:24 in the video and runs for about 25 minutes.]

American Journal of Infection Control
January 2016 Volume 44, Issue 1, p1-124, e1-e7
http://www.ajicjournal.org/current

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APIC survey finds U.S. healthcare facilities are more prepared to confront Ebola compared to last year: Staffing and infection control resources remain issues
Published in issue: January 01 2016
Preview
Nine in 10 hospital-based APIC members believe their facilities are better prepared today than a year ago to receive a patient with a highly lethal infectious disease like Ebola, but more than half (55 percent) say their facilities have not provided additional resources to support their infection prevention and control (IPC) programs as a result of the Ebola crisis, according to a recent APIC survey.

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Immunity of nursing students to measles, mumps, rubella, and varicella in Yozgat, Turkey
Çiğdem Kader, Ayse Erbay, Nazan Kılıç Akça, Muhammet Fevzi Polat, Sevinç Polat
e5–e7
Published online: October 3 2015
Preview
Measles, mumps, rubella, and varicella (MMRV) are vaccine-preventable diseases. The aim of this study was to determine the vaccination status of first-year nursing students in Turkey. The sample used was 180 students and immunoglobulin G antibodies against MMRV viruses were determined quantitatively by enzyme-linked immunosorbent assay. Immunity rates to MMRV were 82.8%, 83.3%, 98.3%, and 100%, respectively. The results of this study showed that all of the students were immune to varicella and 32.8% of the students were not immune to at least 1 of the viruses covered by the measles, mumps, and rubella vaccine.

American Journal of Preventive Medicine
January 2016 Volume 50, Issue 1, p1-128, e1-e32
http://www.ajpmonline.org/current

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Brief Reports
Influenza Vaccination Coverage Among People With High-Risk Conditions in the U.S.
Alissa C. O’Halloran, Peng-jun Lu, Walter W. Williams, Carolyn B. Bridges, James A. Singleton
e15–e26
Published online: July 31 2015
Preview
During annual influenza epidemics, rates of serious illness and death are higher among those who have medical conditions, such as pulmonary disease, diabetes, or heart disease, which place them at increased risk of influenza complications. Annual influenza vaccination was recommended for people with high-risk conditions as early as 1960.

American Journal of Public Health
Volume 106, Issue 1 (January 2016)
http://ajph.aphapublications.org/toc/ajph/current

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Increasing the Incidence and Influence of Systematic Reviews on Health Policy and Practice
Iain Chalmers, DSc, and Daniel M. Fox, PhD
Iain Chalmers is a co-founder of the Cochrane Collaboration (www.cochrane.org) and the James Lind Initiative, Oxford, UK. Daniel Fox is president emeritus of the Milbank Memorial Fund, New York, NY.
Abstract
Why do people make practice and policy decisions in health care and public health without reference to relevant research, or only to biased samples of relevant research evidence? This illogical behavior doesn’t serve the interests of health service users or the public, yet it remains usual. One reason is that most reports of research do not help. Even very prestigious journals publish reports of new studies without acknowledging that readers need to know what the new evidence has added to the totality of trustworthy evidence relevant to the questions addressed.1
Waste in the conduct and reporting of research is a scientific, ethical, and economic scandal, especially because half of the potentially relevant research does not even get reported (see, for example, http://www.alltrials.net). Nevertheless, it is important that systematic use is made of those reports of research that are accessible. In this editorial we consider the increased availability of systematic reviews of research, some of their positive effects on policy and practice, and limitations in the current use of systematic reviews. We end by offering suggestions for enhancing the effectiveness of systematic reviews.

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The Health of the Newest Americans: How US Public Health Systems Can Support Syrian Refugees
Clea A. McNeely, DrPH, MALyn Morland, MSW, MA
Clea A. McNeely is with the Center for the Study of Youth and Political Conflict and the Department of Public Health, University of Tennessee, Knoxville. Lyn Morland is with the Division of Innovation, Policy, and Research, Bank Street College of Education, New York, NY.
ABSTRACT
The statistics are stunning: 1.9 million Syrian refugees in Turkey, 1.7 million in Lebanon, 630 000 in Jordan, 506 000 in the European Union, and 1883 in the United States.1–3 The United States will admit an additional 10 000 Syrian refugees during the next fiscal year, at which point Syrians will constitute approximately 18% of the total refugee population admitted in 2016.4 But this is not a public health emergency in the United States.
The media attention and national concern about Syrian refugees does provide an opportunity, however, to improve our public health system’s capacity to serve all refugees. With commitment and grit, several communities have increased refugees’ access to quality health services that span the full spectrum from preventive screening to management of complex chronic conditions. These promising practices demonstrate the feasibility of providing efficient, accessible and effective health services for even the most linguistically and economically marginalized members of our communities. As Beth Farmer, the director of International Counseling and Community Services in Washington State put it: “If we fix the healthcare system for refugees—make it understandable and easily accessible—we fix it for everyone” (telephone communication, October 2015).

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Sociodemographic Predictors of Vaccination Exemptions on the Basis of Personal Belief in California
American Journal of Public Health: January 2016, Vol. 106, No. 1: 172–177.
Michelle M. Mello, Y. Tony Yang, Paul L. Delamater, Timothy F. Leslie,
Abstract
Objectives. We examined the variability in the percentage of students with personal belief exemptions (PBEs) from mandatory vaccinations in California schools and communities according to income, education, race, and school characteristics.
Methods. We used spatial lag models to analyze 2007–2013 PBE data from the California Department of Public Health. The analyses included school- and regional-level models, and separately examined the percentage of students with exemptions in 2013 and the change in percentages over time.
Results. The percentage of students with PBEs doubled from 2007 to 2013, from 1.54% to 3.06%. Across all models, higher median household income and higher percentage of White race in the population, but not educational attainment, significantly predicted higher percentages of students with PBEs in 2013. Higher income, White population, and private school type significantly predicted greater increases in exemptions from 2007 to 2013, whereas higher educational attainment was associated with smaller increases.
Conclusions. Personal belief exemptions are more common in areas with a higher percentage of White race and higher income.

American Journal of Tropical Medicine and Hygiene
January 2016; 94 (1)
http://www.ajtmh.org/content/current
Successful Global Health Research Partnerships: What Makes Them Work?
Chandy C. John*, George Ayodo and Philippa Musoke
Author Affiliations
Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, Indiana; Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya; Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
Abstract
There are many successful global health research partnerships, but little information is available about what makes them successful. We asked 14 research colleagues from Uganda, Kenya, and the United States who have extensive global health research experience about what they considered the top three factors that led to or impeded successful international research collaborations. Four key factors were identified: 1) mutual respect and benefit, 2) trust, 3) good communication, and 4) clear partner roles and expectations. Initial and ongoing assessment of these factors in global health research partnerships may prevent misunderstandings and foster a collaborative environment that leads to successful research.

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Burden of Norovirus and Rotavirus in Children After Rotavirus Vaccine Introduction, Cochabamba, Bolivia
Casey L. McAtee*, Rachel Webman, Robert H. Gilman, Carolina Mejia, Caryn Bern, Sonia Apaza,
Susan Espetia, Mónica Pajuelo, Mayuko Saito, Roxanna Challappa, Richard Soria, Jose P. Ribera,
Daniel Lozano and Faustino Torrico
Author Affiliations
Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana; Department of Surgery, New York University, New York; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Asociación Benéfica PRISMA, Lima, Peru; CEADES Salud y Medio Ambiente, Cochabamba, Bolivia; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francico, California; Hospital Albina R. de Patiño, Cochabamba, Bolivia
Abstract
The effectiveness of rotavirus vaccine in the field may set the stage for a changing landscape of diarrheal illness affecting children worldwide. Norovirus and rotavirus are the two major viral enteropathogens of childhood. This study describes the prevalence of norovirus and rotavirus 2 years after widespread rotavirus vaccination in Cochabamba, Bolivia. Stool samples from hospitalized children with acute gastroenteritis (AGE) and outpatients aged 5–24 months without AGE were recruited from an urban hospital serving Bolivia’s third largest city. Both viruses were genotyped, and norovirus GII.4 was further sequenced. Norovirus was found much more frequently than rotavirus. Norovirus was detected in 69/201 (34.3%) of specimens from children with AGE and 13/71 (18.3%) of those without diarrhea. Rotavirus was detected in 38/201 (18.9%) of diarrheal specimens and 3/71 (4.2%) of non-diarrheal specimens. Norovirus GII was identified in 97.8% of norovirus-positive samples; GII.4 was the most common genotype (71.4% of typed specimens). Rotavirus G3P[8] was the most prevalent rotavirus genotype (44.0% of typed specimens) and G2P[4] was second most prevalent (16.0% of typed specimens). This community is likely part of a trend toward norovirus predominance over rotavirus in children after widespread vaccination against rotavirus

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 9 January 2016)

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Commentary
Infection prevention and control of the Ebola outbreak in Liberia, 2014–2015: key challenges and successes
Catherine Cooper, Dale Fisher, Neil Gupta, Rose MaCauley and Carmem L. Pessoa-Silva
Published on: 5 January 2016
Abstract
Prior to the 2014–2015 Ebola outbreak, infection prevention and control (IPC) activities in Liberian healthcare facilities were basic. There was no national IPC guidance, nor dedicated staff at any level of government or healthcare facility (HCF) to ensure the implementation of best practices. Efforts to improve IPC early in the outbreak were ad hoc and messaging was inconsistent. In September 2014, at the height of the outbreak, the national IPC Task Force was established with a Ministry of Health (MoH) mandate to coordinate IPC response activities. A steering group of the Task Force, including representatives of the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (CDC), supported MoH leadership in implementing standardized messaging and IPC training for the health workforce. This structure, and the activities implemented under this structure, played a crucial role in the implementation of IPC practices and successful containment of the outbreak. Moving forward, a nationwide culture of IPC needs to be maintained through this governance structure in Liberia’s health system to prevent and respond to future outbreaks.

BMJ Open
2016, Volume 6, Issue 1
http://bmjopen.bmj.com/content/current

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Global health
Systematic review of the literature on viral persistence and sexual transmission from recovered Ebola survivors: evidence and recommendations
Anna Thorson1,2, Pierre Formenty1, Clare Lofthouse1, Nathalie Broutet1
Author Affiliations
1World Health Organization (WHO), Geneva, Switzerland
2Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
Published 7 January 2016
Abstract
Objective The main aim of this article is to present a comprehensive, systematic review on evidence of sexual transmission from Ebola survivors and persistence of Ebola virus in body fluids of relevance to sexual transmission, and additionally to review condom effectiveness against sexual transmission of Ebola.
Design We performed a systematic review of viral persistence in body fluids of relevance to sexual transmission of Ebola survivors and evidence of sexual transmission of Ebola, and carried out a targeted review of condom effectiveness.
Results We identified nine published original articles presenting results on persistence of Ebola virus in relevant body fluids, or reporting suspect sexual transmission from Ebola survivors. We also included unpublished reports from the current 2014/2015 Ebola epidemic in West Africa. We found no articles reporting on condom effectiveness, but have included a targeted review on general condom efficacy and effectiveness.
Conclusions We conclude that the risk of sexual transmission from people who have recovered from Ebola cannot be ruled out. We found the longest duration of persistent Ebola RNA in a relevant body fluid from a survivor, to be reported from a man in Sierra Leone who had reverse transcriptase PCR (RT-PCR) positive semen 284 days after symptom onset. In line with current WHO recommendations. We recommend that men are offered the possibility to test their semen regularly for presence of Ebola RNA from3 months post-symptom onset. Safe sex practices including sexual abstinence, or else condom use, are recommended by WHO until semen has tested negative twice, or in absence of testing for at least 6 months post-symptom onset. Based on evidence reviewed, we conclude that male and female latex condoms offer some protection against EBOV compared to no condom use. Survivors should be offered access to care and prevention, in order to provide them with possibilities to mitigate any risks that may occur, and efforts should be linked to destigmatising activities.

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Global health
Factors associated with declining under-five mortality rates from 2000 to 2013: an ecological analysis of 46 African countries
Aaron M Kipp1,2, Meridith Blevins1,3, Connie A Haley1,2, Kasonde Mwinga4, Phanuel Habimana4, Bryan E Shepherd1,3, Muktar H Aliyu1,5, Tigest Ketsela4, Sten H Vermund1,6
Author Affiliations
1Vanderbilt Institute for Global Health, Nashville, Tennessee, USA
2Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
3Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
4World Health Organization/Regional Office for Africa, Brazzaville, Congo
5Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
6Pediatrics Vanderbilt University School of Medicine, Nashville, Tennessee, USA
Published 8 January 2016
Abstract
Objective Inadequate overall progress has been made towards the 4th Millennium Development Goal of reducing under-five mortality rates by two-thirds between 1990 and 2015. Progress has been variable across African countries. We examined health, economic and social factors potentially associated with reductions in under-five mortality (U5M) from 2000 to 2013.
Setting Ecological analysis using publicly available data from the 46 nations within the WHO African Region.
Outcome measures We assessed the annual rate of change (ARC) of 70 different factors and their association with the annual rate of reduction (ARR) of U5M rates using robust linear regression models.
Results Most factors improved over the study period for most countries, with the largest increases seen for economic or technological development and external financing factors. The median (IQR) U5M ARR was 3.6% (2.8 to 5.1%). Only 4 of 70 factors demonstrated a strong and significant association with U5M ARRs, adjusting for potential confounders. Higher ARRs were associated with more rapidly increasing coverage of seeking treatment for acute respiratory infection (β=0.22 (ie, a 1% increase in the ARC was associated with a 0.22% increase in ARR); 90% CI 0.09 to 0.35; p=0.01), increasing health expenditure relative to gross domestic product (β=0.26; 95% CI 0.11 to 0.41; p=0.02), increasing fertility rate (β=0.54; 95% CI 0.07 to 1.02; p=0.07) and decreasing maternal mortality ratio (β=−0.47; 95% CI −0.69 to −0.24; p<0.01). The majority of factors showed no association or raised validity concerns due to missing data from a large number of countries.
Conclusions Improvements in sociodemographic, maternal health and governance and financing factors were more likely associated with U5M ARR. These underscore the essential role of contextual factors facilitating child health interventions and services. Surveillance of these factors could help monitor which countries need additional support in reducing U5M.

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Paediatrics
Infant outcomes after exposure to Tdap vaccine in pregnancy: an observational study
Tony Walls1, Patricia Graham1,2, Helen Petousis-Harris3, Linda Hill4, Nicola Austin1,2
Author Affiliations
1Department of Paediatrics, University of Otago, Christchurch, New Zealand
2Canterbury District Health Board, Christchurch, New Zealand
3Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
4Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
Published 6 January 2016
Abstract
Objective Pertussis vaccination during pregnancy has recently been recommended in both the USA and UK to prevent pertussis infection in infants. While there are no apparent safety concerns about the administration of Tdap vaccine during pregnancy, there is only limited safety data available. We aimed to closely monitor infants exposed to Tdap during pregnancy to look for any adverse outcomes that may be attributable to the vaccine.
Design This was a prospective observational study, collecting information to evaluate the safety of Tdap vaccine for infants exposed during pregnancy. Infants were followed for between 6 and 12 months after birth, with 84% completing 12 months of follow-up. Information was obtained from objective sources including routine health visits and vaccination records wherever possible, as well as frequent parental reports.
Setting The Canterbury region of New Zealand.
Patients A cohort of 403 infants whose mothers had received Tdap vaccine.
Main outcome measures Gestational age at birth, growth parameters, congenital anomalies, immunisation status and timeliness of immunisation, development of pertussis infection.
Results There were no significant differences in birth weight, gestational age at birth, congenital anomalies or infant growth as compared with baseline population data. Infants of mothers who had received the vaccine were more likely to receive their vaccinations on time during infancy. No cases of pertussis occurred in this cohort despite high rates of disease in the community. We have not found any adverse events attributable to vaccine exposure.
Conclusions These data add to the growing pool of evidence that the administration of Tdap vaccine during pregnancy is an appropriate strategy for reducing the burden of pertussis in infants.
Clinical trial registration Australia New Zealand Clinical Trials Registry ACTRN12613001045707.

Bulletin of the World Health Organization
Volume 94, Number 1, January 2016, 1-76
http://www.who.int/bulletin/volumes/94/1/en/

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Editorials
Health systems strengthening, universal health coverage, health security and resilience
Joseph Kutzin a & Susan P Sparkes a
a. World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland.
Bulletin of the World Health Organization 2016;94:2. doi: http://dx.doi.org/10.2471/BLT.15.165050
Initial text
Global and national initiatives focused on health systems strengthening, universal health coverage, health security, and resilience suffer when these terms are not well understood or believed to be different ways of saying the same thing. Here we aim to facilitate understanding and highlight key policy considerations by identifying critical attributes of each concept and emphasizing the distinction between ends and means in health policy…

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Research
Estimating mortality using data from civil registration: a cross-sectional study in India
Mamta Gupta, Chalapati Rao, PVM Lakshmi, Shankar Prinja & Rajesh Kumar
Abstract
Objective
To analyse the design and operational status of India’s civil registration and vital statistics system and facilitate the system’s development into an accurate and reliable source of mortality data.
Methods
We assessed the national civil registration and vital statistics system’s legal framework, administrative structure and design through document review. We did a cross-sectional study for the year 2013 at national level and in Punjab state to assess the quality of the system’s mortality data through analyses of life tables and investigation of the completeness of death registration and the proportion of deaths assigned ill-defined causes. We interviewed registrars, medical officers and coders in Punjab state to assess their knowledge and practice.
Findings
Although we found the legal framework and system design to be appropriate, data collection was based on complex intersectoral collaborations at state and local level and the collected data were found to be of poor quality. The registration data were inadequate for a robust estimate of mortality at national level. A medically certified cause of death was only recorded for 965 992 (16.8%) of the 5 735 082 deaths registered.
Conclusion
The data recorded by India’s civil registration and vital statistics system in 2011 were incomplete. If improved, the system could be used to reliably estimate mortality. We recommend improving political support and intersectoral coordination, capacity building, computerization and state-level initiatives to ensure that every death is registered and that reliable causes of death are recorded – at least within an adequate sample of registration units within each state.

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Policy & Practice
An integrated national mortality surveillance system for death registration and mortality surveillance, China
Shiwei Liu, Xiaoling Wu, Alan D Lopez, Lijun Wang, Yue Cai, Andrew Page, Peng Yin, Yunning Liu, Yichong Li, Jiangmei Liu, Jinling You & Maigeng Zhou
Abstract
In China, sample-based mortality surveillance systems, such as the Chinese Center for Disease Control and Prevention’s disease surveillance points system and the Ministry of Health’s vital registration system, have been used for decades to provide nationally representative data on health status for health-care decision-making and performance evaluation. However, neither system provided representative mortality and cause-of-death data at the provincial level to inform regional health service needs and policy priorities. Moreover, the systems overlapped to a considerable extent, thereby entailing a duplication of effort. In 2013, the Chinese Government combined these two systems into an integrated national mortality surveillance system to provide a provincially representative picture of total and cause-specific mortality and to accelerate the development of a comprehensive vital registration and mortality surveillance system for the whole country. This new system increased the surveillance population from 6 to 24% of the Chinese population. The number of surveillance points, each of which covered a district or county, increased from 161 to 605. To ensure representativeness at the provincial level, the 605 surveillance points were selected to cover China’s 31 provinces using an iterative method involving multistage stratification that took into account the sociodemographic characteristics of the population. This paper describes the development and operation of the new national mortality surveillance system, which is expected to yield representative provincial estimates of mortality in China for the first time.

Contemporary Clinical Trials
Volume 46, Pages 1-122 (January 2016)
http://www.sciencedirect.com/science/journal/15517144/46

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Original Research Article
Design of a multi-arm randomized clinical trial with no control arm
Pages 12-17
Amalia Magaret, Derek C. Angus, Neill K.J. Adhikari, Patrick Banura, Niranjan Kissoon, James V. Lawler, Shevin T. Jacob
Abstract
Background
Clinical trial designs that include multiple treatments are currently limited to those that perform pairwise comparisons of each investigational treatment to a single control. However, there are settings, such as the recent Ebola outbreak, in which no treatment has been demonstrated to be effective; and therefore, no standard of care exists which would serve as an appropriate control.
Methods/design
For illustrative purposes, we focused on the care of patients presenting in austere settings with critically ill ‘sepsis-like’ syndromes. Our approach involves a novel algorithm for comparing mortality among arms without requiring a single fixed control. The algorithm allows poorly-performing arms to be dropped during interim analyses. Consequently, the study may be completed earlier than planned. We used simulation to determine operating characteristics for the trial and to estimate the required sample size.
Results
We present a potential study design targeting a minimal effect size of a 23% relative reduction in mortality between any pair of arms. Using estimated power and spurious significance rates from the simulated scenarios, we show that such a trial would require 2550 participants. Over a range of scenarios, our study has 80 to 99% power to select the optimal treatment. Using a fixed control design, if the control arm is least efficacious, 640 subjects would be enrolled into the least efficacious arm, while our algorithm would enroll between 170 and 430. This simulation method can be easily extended to other settings or other binary outcomes.
Conclusion
Early dropping of arms is efficient and ethical when conducting clinical trials with multiple arms.

Development in Practice
Volume 26, Issue 1, 2016
http://www.tandfonline.com/toc/cdip20/current

Articles
Assessing the fit of RapidSMS for maternal and new-born health: perspectives of community health workers in rural Rwanda
DOI:10.1080/09614524.2016.1112769
Purity Mwendwa
ABSTRACT
This article examines field results that show the potential for mobile health (mHealth) technologies to support community health workers (CHWs) in delivering basic maternal and new-born services in Rwanda. The fit of RapidSMS, a UNICEF/Ministry of Health (MOH) mHealth technology is examined through focus groups with CHWs. The results highlight the need for more training in the use of RapidSMS, continued upgrading of mobile phones, devising innovative ways of charging mobile phones, and ensuring the availability of ambulances. We suggest that CHW supervision be a two-way process built into RapidSMS utilising real-time communication to enhance effectiveness.

Emerging Infectious Diseases
Volume 22, Number 1—January 2016
http://wwwnc.cdc.gov/eid/

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Human Papillomavirus Prevalence and Herd Immunity after Introduction of Vaccination Program, Scotland, 2009–2013 PDF Version [PDF – 527 KB – 9 pages]
R. L. Cameron et al.
Summary
Prevalence was reduced, and early evidence indicates herd immunity.

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Human Papillomavirus Vaccination at a Time of Changing Sexual Behavior PDF Version [PDF – 390 KB – 6 pages]
I. Baussano et al.
Summary
Early vaccination may prevent infections in populations undergoing age-specific changes in sexual activity.

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Effectiveness of Ring Vaccination as Control Strategy for Ebola Virus Disease PDF Version [PDF – 463 KB – 4 pages]
A. J. Kucharski et al.
Abstract
Using an Ebola virus disease transmission model, we found that addition of ring vaccination at the outset of the West Africa epidemic might not have led to containment of this disease. However, in later stages of the epidemic or in outbreaks with less intense transmission or more effective control, this strategy could help eliminate the disease.
…Conclusions
Ring vaccination enhances standard public health measures of contact tracing, isolation, and community engagement (14) and could be effective when such measures are in place. However, if standard measures are not working because many cases are not in known transmission chains, as in West Africa in early 2014, ring vaccination might be insufficient to contain the outbreak. If an EVD vaccine is shown to be efficacious, our results suggest that mass vaccination, or hybrid strategies involving mass and ring vaccinations, might need to be considered alongside ring vaccination when planning for future outbreaks.

The European Journal of Public Health
Volume 25, Issue 6, 1 December 2015
http://eurpub.oxfordjournals.org/content/25/6

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Editorials
Categorizations of migrants and ethnic minorities—are they useful for decisions on public health interventions?
Allan Krasnik
DOI: http://dx.doi.org/10.1093/eurpub/ckv177 907
Extract
Decisions regarding population-based preventive interventions require convincing measures of health and risks. Is it justified to initiate special community programs on diabetes prevention among migrants on the basis of a higher prevalence of diabetes than in the non-migrant population? Even as we know that diabetes is not a problem for the majority of the migrants? And that diabetes is also a problem for many non-migrants—however less prevalent? Relative risks and differences in prevalence of risks and diseases between groups are often used to justify such new programs for selected groups and communities based on certain characteristics such as ethnicity, migrant status, family situation or socio-economic position.
Mulinari et al.1 question the use of broad categorizations as instruments for predicting individual health problems using the area of ethnicity, migration and health as an example, and warn against the practice of only including measures of association in the consideration of public health interventions. Instead, these kinds of measures should always be reported together with measures of discriminatory accuracy…

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Editor’s Choice
Questioning the discriminatory accuracy of broad migrant categories in public health: self-rated health in Sweden
Shai Mulinari, Anna Bredström, Juan Merlo
DOI: http://dx.doi.org/10.1093/eurpub/ckv099 911-917
Abstract
Background: Differences between natives and migrants in average risk for poor self-rated health (SRH) are well documented, which has lent support to proposals for interventions targeting disadvantaged minority groups. However, such proposals are based on measures of association that neglect individual heterogeneity around group averages and thereby the discriminatory accuracy (DA) of the categories used (i.e. their ability to discriminate the individuals with poor and good SRH, respectively). Therefore, applying DA measures rather than only measures of association our study revisits the value of broad native and migrant categorizations for predicting SRH.
Design, setting and participants: We analyzed 27 723 individuals aged 18–80 who responded to a 2008 Swedish public health survey. We performed logistic regressions to estimate odds ratios (ORs), predicted risks and the area under the receiver operating characteristic curve (AU-ROC) as a measure of epidemiological DA.
Results: Being born abroad was associated with higher odds of poor SRH (OR = 1.75), but the AU-ROC of this variable only added 0.02 units to the AU-ROC for age alone (from 0.53 to 0.55). The AU-ROC increased, but remained unsatisfactorily low (0.62), when available social and demographic variables were included.
Conclusions: Our results question the use of broad native/migrant categorizations as instruments for forecasting individual SRH. Such simple categorizations have a very low DA and should be abandoned in public health practice. Measures of association and DA should be reported together whenever an intervention is being considered, especially in the area of ethnicity, migration and health.

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How do economic crises affect migrants’ risk of infectious disease? A systematic-narrative review
Alexander Kentikelenis, Marina Karanikolos, Gemma Williams, Philipa Mladovsky, Lawrence King, Anastasia Pharris, Jonathan E. Suk, Angelos Hatzakis, Martin McKee, Teymur Noori, David Stuckler
DOI: http://dx.doi.org/10.1093/eurpub/ckv151 937-944 First published online: 28 August 2015
Abstract
Background: It is not well understood how economic crises affect infectious disease incidence and prevalence, particularly among vulnerable groups. Using a susceptible-infected-recovered framework, we systematically reviewed literature on the impact of the economic crises on infectious disease risks in migrants in Europe, focusing principally on HIV, TB, hepatitis and other STIs.
Methods: We conducted two searches in PubMed/Medline, Web of Science, Cochrane Library, Google Scholar, websites of key organizations and grey literature to identify how economic changes affect migrant populations and infectious disease. We perform a narrative synthesis in order to map critical pathways and identify hypotheses for subsequent research.
Results: The systematic review on links between economic crises and migrant health identified 653 studies through database searching; only seven met the inclusion criteria. Fourteen items were identified through further searches. The systematic review on links between economic crises and infectious disease identified 480 studies through database searching; 19 met the inclusion criteria. Eight items were identified through further searches. The reviews show that migrant populations in Europe appear disproportionately at risk of specific infectious diseases, and that economic crises and subsequent responses have tended to exacerbate such risks. Recessions lead to unemployment, impoverishment and other risk factors that can be linked to the transmissibility of disease among migrants. Austerity measures that lead to cuts in prevention and treatment programmes further exacerbate infectious disease risks among migrants. Non-governmental health service providers occasionally stepped in to cater to specific populations that include migrants.
Conclusions: There is evidence that migrants are especially vulnerable to infectious disease during economic crises. Ring-fenced funding of prevention programs, including screening and treatment, is important for addressing this vulnerability.

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Effect of Human Papillomavirus vaccination of daughters on the cervical screening uptake of their non-vaccinated mothers
Angela M. Spencer, Stephen A. Roberts, Arpana Verma, Julietta Patnick, Peter Elton, Loretta Brabin Eur J Public Health (2015) 25 (6): 1097-1100 DOI: http://dx.doi.org/10.1093/eurpub/ckv146 First published online: 8 August 2015 (4 pages)

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 9 January 2016]

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Editorial
Envisioning a Global Health Partnership Movement
Andrew Jones
Globalization and Health201612:1
DOI: 10.1186/s12992-015-0138-4
Published: 6 January 2016
Initial text
“A universal truth: No health without a workforce” was the rallying cry of the flagship report commissioned by the Global Health Workforce Alliance Secretariat and the World Health Organization [1] and one which must be embraced if the aspiration for universal health coverage is ever to be realised [2]. One in seven people will never see a qualified health worker in their lives. The world will be short of 12.9 million health-care workers by 2035. The figures speak for themselves. It has never been clearer that there has to be a major global effort to recruit, educate and train health workers.
As the international development community prepare for the delivery of the next set of development goals, focus must include a meaningful revitalisation of the concept of partnership and a shift from short-term global interests to strengthening systems in low and middle-income countries. The Sustainable Development Goals call on new forms of partnership that speak to co-development rather than traditional models of international development – mutuality, co-learning and a recognition that we gain as much as we give by working through partnerships. It is time for donors and governments to look beyond monetary contributions to also consider what resources, expertise and technology that, if shared, could result in mutual benefit. In this sense, health partnerships offer a vision of the way in which learning and knowledge-exchange will take place in the future…

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 9 January 2016]

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Research
Mapping the use of research to support strategies tackling maternal and child health inequities: evidence from six countries in Africa and Latin America
Emily Vargas, Victor Becerril-Montekio, Miguel Gonzalez-Block, Patricia Akweongo, Cynthia Hazel, Maria Cuembelo, Felix Limbani, Wanderley Bernardo, Fernando Muñoz
Published: 7 January 2016
Abstract
Background
Striving to foster collaboration among countries suffering from maternal and child health (MCH) inequities, the MASCOT project mapped and analyzed the use of research in strategies tackling them in 11 low- and middle-income countries. This article aims to present the way in which research influenced MCH policies and programs in six of these countries – three in Africa and three in Latin America.
Methods
Qualitative research using a thematic synthesis narrative process was used to identify and describe who is producing what kind of research, how research is funded, how inequities are approached by research and policies, the countries’ research capacities, and the type of evidence base that MCH policies and programs use. Four tools were designed for these purposes: an online survey for researchers, a semi-structured interview with decision makers, and two content analysis guides: one for policy and programs documents and one for scientific articles.
Results
Three modalities of research utilization were observed in the strategies tackling MCH inequities in the six included countries – instrumental, conceptual and symbolic. Instrumental utilization directly relates the formulation and contents of the strategies with research results, and is the least used within the analyzed policies and programs. Even though research is considered as an important input to support decision making and most of the analyzed countries count five or six relevant MCH research initiatives, in most cases, the actual impact of research is not clearly identifiable.
Conclusions
While MCH research is increasing in low- and middle-income countries, the impact of its outcomes on policy formulation is low. We did not identify a direct relationship between the nature of the financial support organizations and the kind of evidence utilization within the policy process. There is still a visible gap between researchers and policymakers regarding their different intentions to link evidence and decision making processes.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 11, Issue 12, 2015
http://www.tandfonline.com/toc/khvi20/current

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Research Papers
Missed opportunities for Hepatitis B vaccination among diabetic patients
pages 2806-2810
Lale Ozisik, Mine Durusu Tanriover, Nursel Calik Basaran, S Gul Oz & Serhat Unal

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Short Report
Acceptance of intradermal inactivated influenza vaccines among hospital staff following 2 seasonal vaccination campaigns
pages 2827-2830
Laura Goodliffe, Brenda L Coleman, Allison J McGeer & The Department of Occupational Health Wellness and Safety

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Commentary
Current status and uptake of influenza vaccination over time among senior adults in the United States
pages 2849-2851
Peng-jun Lu, Alissa O’Halloran, Helen Ding, Stacie M Greby & Walter W Williams
Abstract
Influenza is a major cause of morbidity and mortality among older adults in the United States, who may also have chronic medical conditions that place them at high risk for complications from influenza. The U.S. Public Health Service recommended influenza vaccination of adults ≥65 y and chronically ill persons since 1961 and beginning with the 2010–11 influenza season, the Advisory Committee on Immunization Practices (ACIP) has expanded its recommendation to vaccinate all persons 6 months of age and older. Medicare coverage for influenza vaccination began in 1993. However, despite the presence of a safe and effective vaccine, long-standing recommendations on vaccination, and federal financial support for vaccination, vaccination levels among adults ≥65 y are not optimal. Studies have shown that influenza vaccination coverage among U.S. adults ≥ 65 y steadily increased from 30.1% in 1989 to 64.2% in 1997, but plateaued near 65% from 1998 to 2013. Increasing influenza vaccination coverage among older adults in the United States will require more cooperation among health-care providers, professional organizations, vaccine manufacturers, and public health departments to raise public awareness about the benefits of influenza vaccination and to ensure continued administration of vaccinations throughout the influenza season.

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Commentaries
The Centers for Disease Control and Prevention’s public health response to monitoring Tdap safety in pregnant women in the United States
pages 2872-2879
Pedro L Moro, Michael M McNeil, Lakshmi Sukumaran & Karen R Broder
Abstract
In 2010, in response to a widespread pertussis outbreak and neonatal deaths, California became the first state to recommend routine administration of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during pregnancy. In 2011, the Advisory Committee on Immunization Practices (ACIP) followed with a similar recommendation for Tdap vaccination during pregnancy for previously unvaccinated women. In 2012, this recommendation was expanded to include Tdap vaccination of every pregnant woman during each pregnancy. These recommendations were based on urgent public health needs and available evidence on the safety of other inactivated vaccines during pregnancy. However, there were limited data on the safety of Tdap during pregnancy. In response to the new ACIP recommendations, the Centers for Disease Control and Prevention (CDC) implemented ongoing collaborative studies to evaluate whether vaccination with Tdap during pregnancy adversely affects the health of mothers and their offspring and provide the committee with regular updates. The current commentary describes the public health actions taken by CDC to respond to the ACIP recommendation to study and monitor the safety of Tdap vaccines in pregnant women and describes the current state of knowledge on the safety of Tdap vaccines in pregnant women. Data from the various monitoring activities support the safety of Tdap use during pregnancy.

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Research Papers
Overcoming barriers to HPV vaccination: A randomized clinical trial of a culturally-tailored, media intervention among African American girls
pages 2883-2894
Ralph J DiClemente, Colleen Crittenden Murray, Tracie Graham & Julia Still
Abstract
Although genital HPV is the most prevalent STI in the US, rates of vaccination uptake among high-risk subgroups remain low. Investigations of vaccine compliance have mainly targeted mother-daughter dyads, which in some settings may prove difficult. This study examines an innovative culturally tailored, computer-delivered media-based strategy to promote HPV vaccine uptake. Data, inclusive of sociodemographics, sexual behaviors, knowledge, attitudes, and beliefs about HPV and vaccination were collected via ACASI from 216 African American adolescent females (ages 14–18 years) seeking services in family planning and STI public health clinics in metropolitan Atlanta. Data were obtained prior to randomization and participation in an interactive media-based intervention designed to increase HPV vaccination uptake. Medical record abstraction was conducted 7 month post-randomization to assess initial vaccine uptake and compliance. Participants in the intervention were more compliant to vaccination relative to a placebo comparison condition (26 doses vs. Seventeen doses; p=0.12). However, vaccination series initiation and completion were lower than the national average. Thorough evaluation is needed to better understand factors facilitating HPV vaccine uptake and compliance, particularly perceived susceptibility and the influence of the patient-provider encounter in a clinical setting.

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Vaccination uptake by vaccine-hesitant parents attending a specialist immunization clinic in Australia
pages 2895-2903
Thomas A Forbes, Alissa McMinn, Nigel Crawford, Julie Leask & Margie Danchin
Abstract
Vaccine hesitancy (VH) is an issue of global concern. The quality of communication between healthcare providers and parents can influence parental immunization acceptance. We aimed to describe immunization uptake following specialist immunization clinic (SIC) consultation for Australian children of VH parents as a cohort, and according to pre-clinic parental position on immunization. At a single tertiary pediatric SIC (RCH, Melbourne) a retrospective descriptive study classified VH families according to 3 proposed parental positions on immunization at initial clinic attendance. Immunization status at follow up was ascertained via the Australian Children’s Immunization Register and National HPV Program Register and compared between groups. Of the VH cohort, 13/38 (34%) families were classified as hesitant, 21 (55%) as late/selective vaccinators and 4 (11%) as vaccine refusers. Mean follow up post-SIC attendance was 14.5 months. For the overall VH cohort, the majority chose selective immunization (42%) following SIC consultation. When analyzed by pre-clinic parental position on immunization, there was a trend for hesitant families to proceed with full immunization, selective families to continue selective immunization and refusing families to remain unimmunised (p < 0.0001). The most commonly omitted vaccines were hepatitis B (66%) and Haemophilus influenzae type B (55%), followed by the meningococcal C conjugate vaccine (53%) and measles, mumps and rubella vaccine (53%). Immunization outcome appears to correlate with pre-clinic parental position on immunization for the majority of families attending a SIC in Australia, with selective immunization the most common outcome. Tailored communication approaches based on parental position on immunization may optimise clinic resources and engagement of families, but require prospective research evaluation.

International Journal of Epidemiology
Volume 44 Issue 6 December 2015
http://ije.oxfordjournals.org/content/current

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Early Life
Institutional deliveries weakly associated with improved neonatal survival in developing countries: evidence from 192 Demographic and Health Surveys
Günther Fink*, Rebecca Ross and Kenneth Hill
Author Affiliations
Harvard T.H. Chan School of Public Health, Boston, MA, USA
Abstract
Background: Child and maternal mortality remain high in many developing countries. A principal strategy used in low- and middle-income countries is increasing the proportion of pregnancies delivered at facilities. Although this strategy is reasonable with high quality facilities, evidence for the protective effects of facility deliveries is mixed.
Methods: We pooled 1.47 million birth records collected by the Demographic and Health Surveys to estimate the association between institutional deliveries and early neonatal mortality. Subsample analysis and instrumental variable estimation were used to assess and correct the extent to which mortality differentials are biased by an increased likelihood of facility attendance for high-risk deliveries.
Results: No associations between institutional deliveries and early neonatal mortality were found in the pooled sample [adjusted odds ratio (aOR) 0.995, 95% confidence interval (CI) 0.966-1.025)]. When stratified by facility type, protective effects were found for private facilities (aOR 0.876, 95% CI 0.840-0.914), but not for public hospitals or health centres. Significant protective effects were found when past behaviour was used to eliminate selection bias generated by short-term responses to medical need (aOR 0.884, 95% CI 0.814-0.961). At the community and country levels, strong positive associations were found between early neonatal mortality among facility deliveries and the prevalence of institutional deliveries.
Conclusion: Facility deliveries have the potential to reduce early neonatal mortality in developing countries. The results presented suggest that the quality, utilization and protective effects of institutional deliveries vary widely across countries; major improvements in both utilization and quality of care will be needed to achieve further improvements in maternal and child health.

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Effect of fortified complementary food supplementation on child growth in rural Bangladesh: a cluster-randomized trial
Parul Christian, Saijuddin Shaikh, Abu Ahmed Shamim, Sucheta Mehra, Lee Wu, Maithilee Mitra, Hasmot Ali, Rebecca D Merrill, Nuzhat Choudhury, Monira Parveen, Rachel D Fuli, Md Iqbal Hossain, Md Munirul Islam, Rolf Klemm, Kerry Schulze, Alain Labrique, Saskia de Pee,
Tahmeed Ahmed, and Keith P West, Jr
Author Affiliations
1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,
2JiVitA Project, Gaibandha, Bangladesh,
3Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh,
4United Nations World Food Programme, IDB Bhaban, Dhaka, Bangladesh and
5Office of Nutrition Advisor, United Nations World Food Programme, Rome, Italy
Abstract
Background: Growth faltering in the first 2 years of life is high in South Asia where prevalence of stunting is estimated at 40–50%. Although nutrition counselling has shown modest benefits, few intervention trials of food supplementation exist showing improvements in growth and prevention of stunting.
Methods: A cluster-randomized controlled trial was conducted in rural Bangladesh to test the effect of two local, ready-to-use foods (chickpea and rice-lentil based) and a fortified blended food (wheat-soy-blend++, WSB++) compared with Plumpy’doz, all with nutrition counselling vs nutrition counselling alone (control) on outcomes of linear growth (length and length-for-age z-score, LAZ), stunting (LAZ < −2), weight-for-length z-score (WLZ) and wasting (WLZ < −2) in children 6–18 months of age. Children (n = 5536) were enrolled at 6 months of age and, in the food groups, provided with one of the allocated supplements daily for a year.
Results: Growth deceleration occurred from 6 to 18 months of age but deceleration in LAZ was lower (by 0.02–0.04/month) in the Plumpy’doz (P = 0.02), rice-lentil (< 0.01), and chickpea (< 0.01) groups relative to control, whereas WLZ decline was lower only in Plumpy’doz and chickpea groups. WSB++ did not impact on these outcomes. The prevalence of stunting was 44% at 18 months in the control group, but lower by 5–6% (P ≤ 0.01) in those receiving Plumpy’doz and chickpea. Mean length and LAZ at 18 months were higher by 0.27–0.30 cm and 0.07–0.10 (all P < 0.05), respectively, in all four food groups relative to the control.
Conclusions: In rural Bangladesh, small amounts of daily fortified complementary foods, provided for a year in addition to nutrition counselling, modestly increased linear growth and reduced stunting at 18 months of age.