POLIO [to 23 May 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 20 May 2015
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: Ministers of Health from around the world are meeting in Geneva, Switzerland, this week for the annual World Health Assembly. The Ministers will discuss a number of topics related to public health, including polio eradication. The Global Polio Eradication Initiative has prepared a status report for delegates. The report and an accompanying resolution are expected to inform the discussions.
:: The 11th report of the Independent Monitoring Board has been published this week, reporting on progress towards polio eradication and making recommendations.
:: Polio staff continue to offer support to the humanitarian response to the devastating earth quakes in Nepal. Read more
:: Liberia and Sierra Leone have both conducted polio and measles vaccination campaigns during April and May. These are the first campaigns conducted in these countries since 2013 (due to the Ebola outbreak). Polio staff in these countries continue to assist in the Ebola outbreak response efforts
Selected excerpts from Country-specific Reports [No new polio cases reported]
Pakistan
:: One new case of wild poliovirus type 1 (WPV1) was reported this week, with onset of paralysis in Charsada district of Khyber Pakhtunkhwa. This most recent case had onset of paralysis on 20 April. The total number of WPV1 cases for 2015 is now 23 (and remains 306 for 2014).

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The Rocky Road to Zero
The Independent Monitoring Board of the Global Polio Eradication Initiative
Eleventh Report: May 2015 :: 24 pages
Pdf of Report: 11th report of the Independent Monitoring Board
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…CONCLUSIONS AND RECOMMENDATIONS
Over recent years, the IMB has witnessed the polio programme improving its system, and improving performance as a result. But further fundamental work of system redesign remains to be done.

The IMB emphasizes that recent gains should be applauded, but should not be a source of triumphalism. There will be some temptation to coast; to think that it is now just a matter of time. The rocky road to eradication does not allow for coasting.

The IMB has made a series of recommendations intended to catalyse the further changes that are required. No crystal ball can now tell when polio will be eradicated. No crystal ball is required to know that polio will not be eradicated until the system is perfectly designed to so.

Speed in improving the system is key. Without the discipline of fast implementation, the polio virus will still be circulating more than a year from now – in short, the programme will have granted the polio virus permission to keep on paralyzing children for more than another whole year after the last failed deadline of ending transmission. It will be the polio virus celebrating, not the programme.

AFGHANISTAN
1.The IMB recommends that Afghanistan’s Minister of Health appoints a very senior official with the skills and credibility to lead the programme day-to-day on the Minister’s behalf.

2.The IMB recommends that programme officials from the Southern and Eastern regions of Afghanistan visit the Emergency Operations Centres of Pakistan at once, and return with lessons that can be appropriately applied in Afghanistan with urgency.

NIGERIA
3.The IMB recommends that the new President of Nigeria makes a clear public declaration that polio cannot yet be considered gone from Nigeria, and sets out and leads a plan to achieve polio-free certification in 2017.

PAKISTAN
4.The IMB recommends that Pakistan’s National Task Force meets at least monthly until polio transmission is stopped, to oversee strict implementation of the National Emergency Action Plan. The National Task Force should particularly ensure that a monthly meeting of each Chief Secretary with their Deputy Commissioners goes ahead without exception, and with full attendance, to tightly oversee implementation of the National Emergency Action Plan in each province.

5.The IMB recommends that Pakistan’s National Task Force, within the next four weeks, resolves the issues that are resulting in front-line workers not being properly paid, to stall any further deterioration in morale amongst this crucial group, which could be fatal to the programme.

OUTBREAKS
6.The IMB recommends that the Polio Oversight Board explicitly re-affirm that the programme’s planning – in and beyond the endemic countries – should be based on what is needed to achieve eradication, not limited by what funds are available, and that more funding should be sought in the event of a shortfall. The IMB further recommends that the Polio Partners Group formally endorse this approach, and actively seek to mobilise further funds that may be required. The work of the Financial Accountability Committee is critical in ensuring that finances are well-managed, and that donors have the appropriate information and assurances.

THE NEED TO HARNESS THE POWER OF PEOPLE
7.The IMB recommends that the GPEI partner agencies convene an urgent meeting to i) leave no stone unturned in urgently recruiting more top-notch staff into the polio-infected and highest-risk countries, cutting through red-tape as needed to achieve this, ii) explicitly analyse whether the best people are currently in the places where they are needed the most.

SURVEILLANCE FIT FOR THE PRESENT AND FUTURE
8.The IMB recommends that the program should expedite activity to improve surveillance, aiming to reach global-certification standard by the end of 2015. Any uncertainty about what global-certification standard now constitutes (particularly the role of environmental surveillance) should be clarified with input from the Global Certification Commission.

SIMPLE DROPS OF VACCINE
9.The IMB recommends that in the endemic and priority countries, vaccine wastage be urgently reduced to 15% as an absolute maximum in every subnational area, starting by full implementation of the programme’s standard operating procedure for reporting on vaccine utilization and stock balance.

VACCINE-DERIVED POLIO VIRUS: A POTENTIAL SHOW-STOPPER
10.The IMB recommends that the Prime Minister of Pakistan and the President of Nigeria each receive a monthly briefing on stopping circulating vaccine-derived polio virus in their countries, to ensure that neither country stands in the way of the planned global withdrawal of trivalent oral polio vaccine.

PERSISTENTLY MISSED CHILDREN
11.The IMB recommends that an urgent global polio summit is convened on the subject of the persistently missed child, charged with the task of producing a plan that will cut the number of such children by 50% within six months.

PERFORMANCE: MOVING FROM THE ORDINARY TO THE EXTRAORDINARY
12.The IMB recommends that the GPEI makes funds immediately available to appoint a company with an established track record in process redesign and quality improvement. This company should deploy staff to work in each of the Emergency Operations Centres and at global programme management level. The IMB asks that this recommendation is implemented urgently with the company selected by 1st July 2015, teams in place by 1st August 2015 and initial improvement results posted by the time of the IMB’s next meeting, in October 2015.

WHO Regionals [to 23 May 2015]

WHO African Region AFRO
:: Dr Moeti urges intensified actions to address heart diseases in children 19 May 2015
:: Burundian crisis triggers emerging humanitarian emergency in Tanzania – 19 May 2015

WHO Region of the Americas PAHO
:: PAHO/WHO honors Nicaragua, Uruguay and four tobacco control advocates with the 2015 World No Tobacco Day awards 05/22/2015

WHO South-East Asia Region SEARO
:: Access to maternal and child health care in Nepal brings joy amid destruction [undated]

WHO European Region EURO
:: Day 4 of the World Health Assembly: highlights for the European Region 22-05-2015
:: Moving environment and health forwards 22-05-2015
:: Day 3 of the World Health Assembly: highlights for the European Region 21-05-2015
:: Day 2 of the World Health Assembly: highlights for the European Region 20-05-2015

WHO Eastern Mediterranean Region EMRO
:: WHO Regional Director calls for respect and safety for health care workers and facilities 21 May 2015
:: WHO delivers additional medicines and medical supplies to Yemen 18 May 2015

WHO Western Pacific Region
No new digest content identified.

UNAIDS calls for sustained commitment to develop an effective HIV vaccine

GENEVA, 18 May 2015—On HIV Vaccine Awareness Day, UNAIDS is calling for a renewed global commitment to finding an effective HIV vaccine.

“A vaccine would be a major step towards ending the AIDS epidemic,” said UNAIDS Executive Director Michel Sidibé. “There have been encouraging recent scientific advances that give us hope for the future development of an HIV vaccine.”

UNAIDS is committed to leaving nobody behind in the HIV response. A major advantage of vaccines is that they promote equity and can be used effectively in all communities and settings, including those where many other health services can be harder to deliver.

Studies show that an HIV vaccine is possible. The RV144 vaccine trial in 2009 lowered the rate of HIV infection by 31%. There is much hope that ongoing research will build on this trial and deliver results. Newer vaccine candidates, as well as neutralizing antibodies, are also being studied.

Vaccines have eradicated smallpox, and polio is close to eradication. Vaccines have also effectively controlled diphtheria, pertussis, tetanus, mumps, measles and rubella, among other infectious diseases.

However, in 2013, HIV vaccine research and development saw the largest decline in investment since 2008. In order to transform promising concepts into an effective and accessible vaccine increased and sustained funding will be critical.

GAVI Watch [to 23 May 2015]
http://www.gavialliance.org/library/news/press-releases/
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:: The Arab League supports Gavi efforts on immunisation and saving children’s lives with vaccines
Support will enhance advocacy efforts across Arab League countries
Geneva, 19 May 2015 – The Arab League has agreed to collaborate with Gavi, the Vaccine Alliance on advocating for children in the world’s poorest countries to be immunised against vaccine-preventable diseases, as part of a Memorandum of Understanding (MoU) signed between the two organisations.
The agreement – the first between the Arab League and Gavi – will support the Alliance’s 2016-2020 strategic goals. Both organisations will advocate through the education sector – parents, teachers and pupils – and society as a whole for the improvement of women and children’s health by scaling up immunisation coverage…

New US poll shows most parents (83%) want their teens and young adults to be vaccinated against meningococcal disease

PHILADELPHIA, May 19, 2015 /PRNewswire/ — GlaxoSmithKline (@GSKUS) today announced the results of an online consumer poll, conducted by Harris Poll on behalf of GSK, of US parents with children ages 16 to 21 years, and young people of the same age range, gauging the knowledge of and attitudes related to meningococcal disease*.

Results from this new, national poll serve as a reminder to parents and high school/college-aged individuals to talk to a healthcare professional to learn if meningococcal disease vaccination is right for them, and determine how to get up to date on vaccinations this summer. US adolescents/young adults are at greater risk for contracting meningococcal disease due to increased likelihood of being in community settings that foster close contact with people (e.g., residence halls, military and other camps).

Key findings of the Harris online poll include:
:: The majority of parents (83%) report wanting their children to be vaccinated against all vaccine-preventable serogroups of bacteria that cause meningococcal disease. The five serogroups of bacteria that cause the overwhelming majority of cases in the US are A, B, C, W-135 and Y.
:: Less than half of parents say they have talked to their child about how the disease is spread (42%) or its early symptoms (38%).
:: Less than half of young people (49%) know that meningococcal disease can lead to serious health complications, which may include hospitalization, hearing loss or amputation.
:: Only about one third of young people (35%) correctly identified college students as a high risk group for the disease. Only 22% know that it is possible to die within 24 hours of early symptoms.
:: Of those parents whose child has been vaccinated against meningococcal disease, 88% don’t know which serogroups of bacteria their child is vaccinated against…

Annals of Internal Medicine
19 May 2015, Vol. 162. No. 10
http://annals.org/issue.aspx

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Original Research | 19 May 2015
IMPROVING PATIENT CARE
Attitudes Toward Risk and Informed Consent for Research on Medical Practices: A Cross-sectional Survey
Mildred K. Cho, PhD; David Magnus, PhD; Melissa Constantine, PhD, MPAff; Sandra Soo-Jin Lee, PhD; Maureen Kelley, PhD; Stephanie Alessi, JD; Diane Korngiebel, DPhil; Cyan James, PhD; Ellen Kuwana, MS; Thomas H. Gallagher, MD; Douglas Diekema, MD, MPH; Alexander M. Capron, LLB; Steven Joffe, MD, MPH; and Benjamin S. Wilfond, MD
Abstract
Background: The U.S. Office for Human Research Protections has proposed that end points of randomized trials comparing the effectiveness of standard medical practices are risks of research that would require disclosure and written informed consent, but data are lacking on the views of potential participants.
Objective: To assess attitudes of U.S. adults about risks and preferences for notification and consent for research on medical practices.
Design: Cross-sectional survey conducted in August 2014.
Setting: Web-based questionnaire.
Patients: 1095 U.S. adults sampled from an online panel (n = 805) and an online convenience river sample (n = 290).
Measurements: Attitudes toward risk, informed consent, and willingness to participate in 3 research scenarios involving medical record review and randomization of usual medical practices.
Results: 97% of respondents agreed that health systems should evaluate standard treatments. Most wanted to be asked for permission to participate in each of 3 scenarios (range, 75.2% to 80.4%), even if it involved only medical record review, but most would accept nonwritten (oral) permission or general notification if obtaining written permission would make the research too difficult to conduct (range, 70.2% to 82.7%). Most perceived additional risk from each scenario (range, 64.0% to 81.6%).
Limitation: Use of hypothetical scenarios and a nonprobability sample that was not fully representative of the U.S. population.
Conclusion: Most respondents preferred to be asked for permission to participate in observational and randomized research evaluating usual medical practices, but they are willing to accept less elaborate approaches than written consent if research would otherwise be impracticable. These attitudes are not aligned with proposed regulatory guidance.
Primary Funding Source: National Center for Advancing Translational Sciences at the National Institutes of Health.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 23 May 2015)

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Research article
Does a voucher program improve reproductive health service delivery and access in Kenya?
Rebecca Njuki, Timothy Abuya, James Kimani, Lucy Kanya, Allan Korongo, Collins Mukanya, Piet Bracke, Ben Bellows, Charlotte Warren BMC Health Services Research 2015, 15:206 (23 May 2015)
Abstract (provisional)
Background
Current assessments on Output-Based Aid (OBA) programs have paid limited attention to the experiences and perceptions of the healthcare providers and facility managers. This study examines the knowledge, attitudes, and experiences of healthcare providers and facility managers in the Kenya reproductive health output-based approach voucher program.
Methods
A total of 69 in-depth interviews with healthcare providers and facility managers in 30 voucher accredited facilities were conducted. The study hypothesized that a voucher program would be associated with improvements in reproductive health service provision. Data were transcribed and analyzed by adopting a thematic framework analysis approach. A combination of inductive and deductive analysis was conducted based on previous research and project documents. Results
Facility managers and providers viewed the RH-OBA program as a feasible system for increasing service utilization and improving quality of care. Perceived benefits of the program included stimulation of competition between facilities and capital investment in most facilities. Awareness of family planning (FP) and gender-based violence (GBV) recovery services voucher, however, remained lower than the maternal health voucher service. Relations between the voucher management agency and accredited facilities as well as existing health systems challenges affect program functions.
Conclusions
Public and private sector healthcare providers and facility managers perceive value in the voucher program as a healthcare financing model. They recognize that it has the potential to significantly increase demand for reproductive health services, improve quality of care and reduce inequities in the use of reproductive health services. To improve program functioning going forward, there is need to ensure the benefit package and criteria for beneficiary identification are well understood and that the public facilities are permitted greater autonomy to utilize revenue generated from the voucher program.

Emerging Infectious Diseases
Volume 21, Number 6—June 2015
http://wwwnc.cdc.gov/eid/

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Research
Cost-effectiveness of Chlamydia Vaccination Programs for Young Women
Kwame Owusu-Edusei , Harrell W. Chesson, Thomas L. Gift, Robert C. Brunham, and Gail Bolan
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K. Owusu-Edusei Jr, H.W. Chesson, T.L. Gift, G. Bolan); University of British Columbia, Vancouver, British Columbia, Canada (R.C. Brunham)
Abstract
We explored potential cost-effectiveness of a chlamydia vaccine for young women in the United States by using a compartmental heterosexual transmission model. We tracked health outcomes (acute infections and sequelae measured in quality-adjusted life-years [QALYs]) and determined incremental cost-effectiveness ratios (ICERs) over a 50-year analytic horizon. We assessed vaccination of 14-year-old girls and catch-up vaccination for 15–24-year-old women in the context of an existing chlamydia screening program and assumed 2 prevaccination prevalences of 3.2% by main analysis and 3.7% by additional analysis. Estimated ICERs of vaccinating 14-year-old girls were $35,300/QALY by main analysis and $16,200/QALY by additional analysis compared with only screening. Catch-up vaccination for 15–24-year-old women resulted in estimated ICERs of $53,200/QALY by main analysis and $26,300/QALY by additional analysis. The ICER was most sensitive to prevaccination prevalence for women, followed by cost of vaccination, duration of vaccine-conferred immunity, and vaccine efficacy. Our results suggest that a successful chlamydia vaccine could be cost-effective.

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Ebola Risk Perception in Germany, 2014 PDF Version [PDF – 1.14 MB – 7 pages]
N. Rübsamen et al.
Knowledge about actual risks was poor, creating the potential for inappropriate behavior changes.

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Research
Oral Cholera Vaccine Coverage, Barriers to Vaccination, and Adverse Events following Vaccination, Haiti, 2013 1
Rania A. Tohme , Jeannot François, Kathleen Wannemuehler, Preetha Iyengar, Amber Dismer, Paul Adrien, Terri B. Hyde, Barbara J. Marston, Kashmira Date, Eric D. Mintz, and Mark A. Katz
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (R.A. Tohme, K. Wannemuehler, P. Iyengar, A. Dismer, T.B. Hyde, B.J. Marston, K. Date, E. Mintz); Ministry of Public Health and Population, Port-au-Prince, Haiti (J. Francois, P. Adrien); Centers for Disease Control and Prevention, Port-au-Prince (M.A. Katz)
Abstract
In 2013, the first government-led oral cholera vaccination (OCV) campaign in Haiti was implemented in Petite Anse and Cerca Carvajal. To evaluate vaccination coverage, barriers to vaccination, and adverse events following vaccination, we conducted a cluster survey. We enrolled 1,121 persons from Petite Anse and 809 persons from Cerca Carvajal, categorized by 3 age groups (1–4, 5–14, >15 years). Two-dose OCV coverage was 62.5% in Petite Anse and 76.8% in Cerca Carvajal. Two-dose coverage was lowest among persons >15 years of age. In Cerca Carvajal, coverage was significantly lower for male than female respondents (69% vs. 85%; p<0.001). No major adverse events were reported. The main reason for nonvaccination was absence during the campaign. Vaccination coverage after this campaign was acceptable and comparable to that resulting from campaigns implemented by nongovernmental organizations. Future campaigns should be tailored to reach adults who are not available during daytime hours.

The European Journal of Public Health
Volume 25, Issue 3, 01 June 2015
http://eurpub.oxfordjournals.org/content/25/3

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Vaccination coverage for measles, mumps and rubella in anthroposophical schools in Gelderland, The Netherlands
Judith H.E. Klomp , Alies van Lier , Wilhelmina L.M. Ruijs Eur J Public Health (2015) 25 (3): 501-505 DOI: http://dx.doi.org/10.1093/eurpub/cku178 First published online: 18 November 2014 (5 pages)
Abstract
Background: Social clustering of unvaccinated children in anthroposophical schools occurs, as inferred from various measles outbreaks that can be traced to these schools. However, accurate vaccination coverage data of anthroposophical schools are not widely available.
Methods:
In 2012, we performed a survey to estimate the vaccination coverage in three different grades of 11 anthroposophical schools in Gelderland, The Netherlands. We also gauged the opinion on childhood vaccination of the parents and compared these with the results of a national survey. In 2014, we were also able to obtain the registered total vaccination coverage per school from the national vaccination register to compare this with our survey data.
Results:
The self-reported MMR vaccination coverage (2012) in the three grades of the schools in our study was 83% (range 45–100% per school). The registered total vaccination coverage (2014) was 78% (range 59–88% per school). The 95% confidence intervals of the two different vaccination coverages overlap for all schools. The parents in this study were less convinced about the beneficial effect of vaccinations and more worried about the possible side effects of vaccination compared with parents in general.
Conclusion:
Despite high overall vaccination coverage, the WHO goal to eliminate measles and rubella will not easily be achieved when social clustering of unvaccinated children in anthroposophical schools remains.

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Low measles vaccination coverage among medical residents in Marseille, France: reasons for non-vaccination, March 2013
Teija Korhonen , Ariane Neveu , Alexis Armengaud , Caroline Six , Kostas Danis , Philippe Malfait
DOI: http://dx.doi.org/10.1093/eurpub/cku254 512-517 First published online: 12 February 2015
Abstract
Background:
During 2008–12, France and Europe experienced large measles outbreaks, involving also healthcare workers (HCW). We aimed to estimate the vaccination coverage (VC) of measles among medical residents of the University of Aix/Marseille, in South-Eastern France.
Methods:
In March 2013, we conducted a cross-sectional study among all medical residents of the Medical Faculty of Aix/Marseille. We used a self-administered questionnaire to collect information on self-reported VC and reasons for vaccination and non-vaccination. We compared proportions, using the chi-squared test and prevalence ratios (PRs) with 95% confidence intervals (95% CIs).
Results:
Of 1152 eligible residents, 703 (61%) participated in the study and 95 (14%; 95% CI: 12–17%) reported having had measles in the past. Of all participants, 613 (93%; 95% CI: 91–95%) reported having been vaccinated against measles and 389 (76%; 95% CI: 73–80%) received two doses. Only 268 (38%) reported having visited an occupational health physician. Vaccinated individuals were more likely to report easy access to vaccination as the main motivation for measles vaccination, compared with unvaccinated residents (435; 71% and 21; 45%; P < 0.001, respectively).
Conclusions:
VC among the medical residents of the University of Aix/Marseille was well below the recommended 95% coverage for two doses of measles vaccination. The majority of the study participants had not visited an occupational health doctor. Lack of easy access seems to represent major barriers to measles vaccination. We recommend that the student union, occupational health services and hospitals co-operate and address these problems in order to improve VC in this group.

Eurosurveillance
Volume 20, Issue 20, 21 May 2015
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Rapid communications
Genome sequence analysis of Ebola virus in clinical samples from three British healthcare workers, August 2014 to March 2015
by A Bell, K Lewandowski, R Myers, D Wooldridge, E Aarons, A Simpson, R Vipond, M Jacobs, S Gharbia, M Zambon
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Post-vaccine measles in a child with concomitant influenza, Sicily, Italy, March 2015
by F Tramuto, P Dones, C D’Angelo, N Casuccio, F Vitale

Journal of Global Infectious Diseases (JGID)
April-June 2015 Volume 7 | Issue 2 Page Nos. 53-94
http://www.jgid.org/currentissue.asp?sabs=n

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State of the globe: Ebola outbreak in the western world: Are we really ready?
Miguel Reina-Ortiz1, Ismael Hoare1, Vinita Sharma2, Ricardo Izurieta1
1 Department of Global Health, College of Public Health, University of South Florida, Florida, USA
2 Department of Community and Family Health, College of Public Health, University of South Florida, Florida, USA
Excerpt
…In summary, if we are to prevent an Ebola outbreak to ever occur in the Western World, we would need to consider the additional following steps: Educate the population to avoid overflowing of healthcare services, but at the same time to recognize early symptoms properly; implement triage units or sentinel posts closer to the most vulnerable populations (if and when needed); care for the uninsured; educate and train healthcare workers; establish sterilizing units directly under the command of Health Departments; and recruit and train staff and volunteers. We deem the prospects of an Ebola outbreak to occur in the US and the Western World still very low; however, we believe it is important to address the weaknesses in our healthcare systems to be better prepared for such a challenge should it occur.

Journal of Health Care for the Poor and Underserved (JHCPU)
Volume 26, Number 2, May 2015 Supplement
https://muse.jhu.edu/journals/journal_of_health_care_for_the_poor_and_underserved/toc/hpu.26.2A.html
SUPPLEMENT FOCUS: Shining the Light on Asian American, Native Hawaiian, and Pacific Islander Health

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Introduction: Shining the Light on Asian American, Native Hawaiian, and Pacific Islander Health
Winston Tseng, Simona C. Kwon
Author’s Note: In liieu of an abstract, here is a brief excerpt of the content:
The United States’s diverse Asian American and Native Hawaiian and Pacific Islander (AA and NHPI) populations have grown faster than those of any other racial/ethnic group over the past three decades.* , Out of the shadows and into the light, the health and health care issues faced by our AA and NHPI communities across the U.S., its territories, and freely associated states matter more and more to the vitality and future of the nation.

In 2015, we mark the 30th anniversary of the Heckler Report, the seminal Report of the Secretary’s Task Force on Black and Minority Health documenting national health inequities by race and ethnicity, which led to the establishment of the Office of Minority Health by Congress in 1986. Notably, the report concluded that Asian/Pacific Islanders in aggregrate were healthier than any other racial group in the U.S. In this supplement, Ponce and colleagues– Ko Chin and Caballero* present a community perspective on the leadership of Assistant Secretary for Health, Dr. Howard Koh, and his work in shepherding new national health equity initiatives, including the Patient Protection and Affordable Care Act of 2010, the reauthorization of the Office of Minority Health (OMH), the creation of the first national U.S. Department of Health and Human Services (HHS) Plan for Asian American, Native Hawaiian, and Pacific Islander Health, and the new HHS data standards for race, ethnicity, sex, primary language, and disability status from Section 4302 of the Affordable Care Act (ACA)., In addition, the National Standards for Culturally and Linguistically Appropriate Service in Health and Health Care were updated in 2013 to provide a comprehensive framework of health and health care organizations for the delivery of culturally respectful and linguistically responsive care and services to all. We honor the heroes and transformative ideas that have worked to advance AA and NHPI health equity.

Asian American and NHPI advocates, researchers, and community leaders have also made tremendous strides in building local and regional community coalitions to document health disparities and advance health equity on behalf of our diverse communities over the past decades., In this supplement, Trinh-Shevrin and colleagues
Authors across the articles by Huang, Islam, is to focus on addressing NHPI health conditions and health care services. This work ahead of us must start with recognizing the effects of structural racism, federal policies, and U.S. occupation on NHPI health, if it is to address racial justice and restore the agency and civil rights of NHPI indigenous communities across Hawaii, the Pacific Islands, and the continental U.S.

The health equity goals of the HHS Action Plan to Reduce Racial and Ethnic Health Disparities, National Stakeholder Strategy for Achieving Health Equity and Healthy People 2020 offer an opportunity for strengthening public-private partnerships between government and communities to document further the structural health inequities disfavoring AA and NHPI populations., The new HHS data standards that examine granular ethnicity and primary languages, as they are implemented across national surveys (e.g., National Health and Nutrition Examination Survey, National Health Interview Survey, Behavioral Risk Factors Surveillance System, Youth Risk Behavioral Surveillance System) and administrative health data systems (e.g., Medicare, Medicaid, Medical Expenditure Panel Survey, Physician Quality Reporting Initiative, and Uniform Data System) and reported through Healthy People 2020 and other public health dissemination venues, will allow us to track and monitor many key health issues facing AA and NHPI populations for the first time at a national level.

The National Stakeholder Strategy for Achieving Health Equity defines health equity as the “attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”24[page 9] The definition of disparities by HHS and the Healthy People program has changed over time; initially the term disparities was understood as denoting disparities by race and ethnicity and focused on health behaviors and conditions. The conception of disparities in Healthy People 2020 is much broader today and includes health disparities by race and ethnicity, gender, sexual orientation, disability status, and geography as well as an examination of other…

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 4 Issue 2 June 2015
http://jpids.oxfordjournals.org/content/current

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Vaccine Exemptions: When Do Individual Rights Trump Societal Good?
Paul A. Offit
Author Affiliations
The Children’s Hospital of Philadelphia
Abramson Research Building
Philadelphia, Pennsylvania
Excerpt
To the Editors—This year’s measles epidemic is different.
Last year, in 2014, about 650 people in the United States suffered measles, an outbreak larger than any in 20 years. Neither the press nor the public took much notice.
This year, as of February 17, 2015, more than 140 people have been infected with measles in 17 states. Now, the media and the public have surely taken notice. For about 2 weeks, articles appeared daily in every major newspaper and segments aired on every national television program. ABC, NBC, CBS, CNN, FOX, as well as the New York Times, Washington Post, and Wall Street Journal covered the 2015 measles outbreak in the manner of a national emergency. Why the difference? One possibility is that, at the current rate, this year’s outbreak will be twice as large as last year’s. But the more likely difference is where these outbreaks occurred. Last year’s outbreak centered on an insular Amish community in Ohio; this year’s epicenter was Disneyland—a shared space, a commons. Disneyland, “the happiest place on earth,”…

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Challenges in the Surveillance of Invasive Pneumococcal Disease in the Postvaccination Era
Kattia Camacho-Badilla1, Luiza H. Falleiros-Arlant2, José Brea3 and María L. Avila-Aguero1
Author Affiliations
1Pediatric Infectious Diseases Service, Hospital Nacional de Niños, “Dr. Carlos Sáenz Herrera”, San José, Costa Rica
2Pediatrics, Facultade de Medicina da Universidade de Santos, Sao Paulo, Brazil
3Pediatrics, Centro Universitario Médico del Este, Santo Domingo, Dominican Republic
Accepted April 6, 2015.
Excerpt
Worldwide, meningitis and pneumonia are the leading cause of morbidity and mortality in children. Invasive pneumococcal disease (IPD) is the leading cause of vaccine-preventable deaths, accounting for 11% of deaths in children <5 years globally in the pre-pneumococcal conjugate vaccine (PCV) era [1], and it causes significant disease burden in Latin America (LA) and the Caribbean.

According to data published by the Pan American Health Organization (PAHO) in July 2014, 25 countries from LA and the Caribbean have introduced PCVs in their immunization schedules. Bolivia is the latest country that has introduced the 13-PCV in their national immunization program. The First Latin American Meeting of Pneumococcus: Epidemiology and Impact of Pneumococcal Conjugate Vaccines was held in San José, Costa Rica in August 2014 given the importance of analyzing the data of the post-PCVs era and its impact since their introduction in different countries…

The Lancet
May 23, 2015 Volume 385 Number 9982 p2015-2120
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
Strengthening clinical research in children and young people
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60974-6
Summary
“The time has come to protect children and young people through research not from research”, said Bobbie Farsides, Professor of Bioethics at Brighton and Sussex Medical School and Chair of the Working Party for the Nuffield Council on Bioethics, which published its report Children and clinical research: ethical issues on May 14. “It will always be easier to say ‘no’ to research with children on the grounds that it’s too difficult, but we should challenge the idea that it is acceptable to continue to offer health care to children without seeking to improve the evidence base for many of the treatments provided”, added Farsides. [Download the report]

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Articles
Socioeconomic inequalities in adolescent health 2002–2010: a time-series analysis of 34 countries participating in the Health Behaviour in School-aged Children study
Dr Frank J Elgar, PhD, Timo-Kolja Pförtner, PhD, Irene Moor, MSc, Bart De Clercq, MSc, Gonneke W J M Stevens, PhD, Candace Currie, PhD
Published Online
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61460-4
Summary
Background
Information about trends in adolescent health inequalities is scarce, especially at an international level. We examined secular trends in socioeconomic inequality in five domains of adolescent health and the association of socioeconomic inequality with national wealth and income inequality.
Methods
We undertook a time-series analysis of data from the Health Behaviour in School-aged Children study, in which cross-sectional surveys were done in 34 North American and European countries in 2002, 2006, and 2010 (pooled n 492 788). We used individual data for socioeconomic status (Health Behaviour in School-aged Children Family Affluence Scale) and health (days of physical activity per week, body-mass index Z score [zBMI], frequency of psychological and physical symptoms on 0–5 scale, and life satisfaction scored 0–10 on the Cantril ladder) to examine trends in health and socioeconomic inequalities in health. We also investigated whether international differences in health and health inequalities were associated with per person income and income inequality.
Findings
From 2002 to 2010, average levels of physical activity (3·90 to 4·08 days per week; p<0·0001), body mass (zBMI −0·08 to 0·03; p<0·0001), and physical symptoms (3·06 to 3·20, p<0·0001), and life satisfaction (7·58 to 7·61; p=0·0034) slightly increased. Inequalities between socioeconomic groups increased in physical activity (−0·79 to −0·83 days per week difference between most and least affluent groups; p=0·0008), zBMI (0·15 to 0·18; p<0·0001), and psychological (0·58 to 0·67; p=0·0360) and physical (0·21 to 0·26; p=0·0018) symptoms. Only in life satisfaction did health inequality fall during this period (−0·98 to −0·95; p=0·0198). Internationally, the higher the per person income, the better and more equal health was in terms of physical activity (0·06 days per SD increase in income; p<0·0001), psychological symptoms (−0·09; p<0·0001), and life satisfaction (0·08; p<0·0001). However, higher income inequality uniquely related to fewer days of physical activity (−0·05 days; p=0·0295), higher zBMI (0·06; p<0·0001), more psychological (0·18; p<0·0001) and physical (0·16; p<0·0001) symptoms, and larger health inequalities between socioeconomic groups in psychological (0·13; p=0·0080) and physical (0·07; p=0·0022) symptoms, and life satisfaction (−0·10; p=0·0092).
Interpretation
Socioeconomic inequality has increased in many domains of adolescent health. These trends coincide with unequal distribution of income between rich and poor people. Widening gaps in adolescent health could predict future inequalities in adult health and need urgent policy action.
Funding
Canadian Institutes of Health Research.

Science
22 May 2015 vol 348, issue 6237, pages 833-940
http://www.sciencemag.org/current.dtl

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Report
Encouraging sanitation investment in the developing world: A cluster-randomized trial
Raymond Guiteras1, James Levinsohn2, Ahmed Mushfiq Mobarak2,*
Author Affiliations
1Department of Economics, University of Maryland, College Park, MD 20742, USA.
2School of Management, Yale University, New Haven, CT 06520, USA.
Abstract
Poor sanitation contributes to morbidity and mortality in the developing world, but there is disagreement on what policies can increase sanitation coverage. To measure the effects of alternative policies on investment in hygienic latrines, we assigned 380 communities in rural Bangladesh to different marketing treatments—community motivation and information; subsidies; a supply-side market access intervention; and a control—in a cluster-randomized trial. Community motivation alone did not increase hygienic latrine ownership (+1.6 percentage points, P = 0.43), nor did the supply-side intervention (+0.3 percentage points, P = 0.90). Subsidies to the majority of the landless poor increased ownership among subsidized households (+22.0 percentage points, P < 0.001) and their unsubsidized neighbors (+8.5 percentage points, P = 0.001), which suggests that investment decisions are interlinked across neighbors. Subsidies also reduced open defecation by 14 percentage points (P < 0.001).

Vaccine
Volume 33, Issue 25, Pages 2851-2954 (9 June 2015)
http://www.sciencedirect.com/science/journal/0264410X/33

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The Benin experience: How computational modeling can assist major vaccine policy changes in low and middle income countries
Pages 2858-2861
Bruce Y. Lee, Benjamin Schreiber, Angela R. Wateska, Diana L. Connor, Hamadou M. Dicko, Philippe Jaillard, Mercy Mvundura, Carol Levin, Mélanie Avella, Leila A. Haidari, Shawn T. Brown
Abstract
While scientific studies can show the need for vaccine policy or operations changes, translating scientific findings to action is a complex process that needs to be executed appropriately for change to occur. Our Benin experience provided key steps and lessons learned to help computational modeling inform and lead to major policy change. The key steps are: engagement of Ministry of Health, identifying in-country “champions,” directed and efficient data collection, defining a finite set of realistic scenarios, making the study methodology transparent, presenting the results in a clear manner, and facilitating decision-making and advocacy. Generating scientific evidence is one component of policy change. Enabling change requires orchestration of a coordinated set of steps that heavily involve key stakeholders, earn their confidence, and provide them with relevant information. Our Benin EVM + CCEM + HERMES Process led to a decision to enact major changes and could serve as a template for similar approaches in other countries.

Vaccine
Volume 33, Issue 25, Pages 2851-2954 (9 June 2015)
http://www.sciencedirect.com/science/journal/0264410X/33

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Parental reminder, recall and educational interventions to improve early childhood immunisation uptake: A systematic review and meta-analysis
Review Article
Pages 2862-2880
Hannah Harvey, Nadja Reissland, James Mason
Abstract
Vaccination is one of the most effective ways of reducing childhood mortality. Despite global uptake of childhood vaccinations increasing, rates remain sub-optimal, meaning that vaccine-preventable diseases still pose a public health risk. A range of interventions to promote vaccine uptake have been developed, although this range has not specifically been reviewed in early childhood. We conducted a systematic review and meta-analysis of parental interventions to improve early childhood (0–5 years) vaccine uptake. Twenty-eight controlled studies contributed to six separate meta-analyses evaluating aspects of parental reminders and education. All interventions were to some extent effective, although findings were generally heterogeneous and random effects models were estimated.
Receiving both postal and telephone reminders was the most effective reminder-based intervention (RD = 0.1132; 95% CI = 0.033–0.193). Sub-group analyses suggested that educational interventions were more effective in low- and middle-income countries (RD = 0.13; 95% CI = 0.05–0.22) and when conducted through discussion (RD = 0.12; 95% CI = 0.02–0.21). Current evidence most supports the use of postal reminders as part of the standard management of childhood immunisations. Parents at high risk of non-compliance may benefit from recall strategies and/or discussion-based forums, however further research is needed to assess the appropriateness of these strategies.

Vaccine
Volume 33, Issue 25, Pages 2851-2954 (9 June 2015)
http://www.sciencedirect.com/science/journal/0264410X/33

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The 23-valent pneumococcal polysaccharide vaccine is effective in elderly adults over 75 years old—Taiwan’s PPV vaccination program
Original Research Article
Pages 2897-2902
Ying-Huang Tsai, Meng-Jer Hsieh, Chee-Jen Chang, Yu-Wen Wen, Han-Chung Hu, Yen-Nan Chao, Yhu-Chering Huang, Cheng-Ta Yang, Chung-Chi Huang
Abstract
Background
Pneumococcal infection is a serious cause of mortality and morbidity in the elderly. A nationwide pneumococcal polysaccharide vaccine (PPV) program for elderly adults aged 75 years and older was conducted in Taiwan in 2008. The efficacy of the PPV in this very elderly population was evaluated.
Methods
The data were analyzed using the Taiwan National Health Insurance Research Database (NHIRD), the cause-of-death registration database and the invasive pneumococcal disease (IPD) notification database of Taiwan’s Ministry of Health and Welfare. The efficacy of PPV administration in this very elderly population was evaluated using multivariate logistic regression after propensity score matching (PSM). The rates of IPD, death from IPD, pneumonia hospitalization, death from pneumonia, and all-cause mortality were compared for those who did and did not receive the PPV.
Results
Among the 1078,955 eligible people, 318,257 (29.5%) received the PPV, and 760,698 (70.5%) were not vaccinated. Using PSM to adjust for confounding factors, including age, gender, influenza vaccination status, associated chronic diseases and health care utilization, those who received the PPV had significantly lower odds ratios (ORs) for IPD (OR = 0.24, 95% CI = 0.123–0.461, p < 0.001), death from IPD (OR = 0.09, 95% CI = 0.011–0.704, p < 0.022, p < 0.001), pneumonia hospitalization (OR = 0.40, 95% CI = 0.395–0.415, p < 0.001), death from pneumonia (OR = 0.07, 95% CI = 0.059–0.082, p < 0.001), and all-cause mortality (OR = 0.07, 95% CI = 0.069–0.072, p < 0.001) compared with those who were not vaccinated.
Conclusions
PPV vaccination in the previous year was associated with a 60% reduction in pneumonia hospitalization, a 76% reduction in IPD, and a greater than 90% reduction in death from pneumonia, IPD and all causes among people over 75 years old in Taiwan. Data from subsequent years in Taiwan and similar populations elsewhere are needed to evaluate the contribution of underlying variations in the mortality rate and the confounding effects of prior disease severity to these findings.

Vaccines — Open Access Journal
(Accessed 23 May 2015)
http://www.mdpi.com/journal/vaccines

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Review: Gavi HPV Programs: Application to Implementation
by Celina M. Hanson, Linda Eckert, Paul Bloem and Tania Cernuschi
Vaccines 2015, 3(2), 408-419; doi:10.3390/vaccines3020408 – published 20 May 2015
Abstract
Developing countries disproportionately suffer from the burden of cervical cancer yet lack the resources to establish systematic screening programs that have resulted in significant reductions in morbidity and mortality in developed countries. Human Papillomavirus (HPV) vaccination provides an opportunity for primary prevention of cervical cancer in low-resource settings through vaccine provision by Gavi The Vaccine Alliance. In addition to the traditional national introduction, countries can apply for a demonstration program to help them make informed decisions for subsequent national introduction. This article summarizes information from approved Gavi HPV demonstration program proposals and preliminary implementation findings. After two rounds of applications, 23 countries have been approved targeting approximately 400,000 girls for vaccination. All countries are proposing primarily school-based strategies with mixed strategies to locate and vaccinate girls not enrolled in school. Experiences to date include: Reaching marginalized girls has been challenging; Strong coordination with the education sector is key and overall acceptance has been high. Initial coverage reports are encouraging but will have to be confirmed in population based coverage surveys that will take place later this year. Experiences from these countries are consistent with existing literature describing other HPV vaccine pilots in low-income settings.

Media/Policy Watch  [to 23 May 2015]
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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Center for Global Development
http://www.cgdev.org/
Accessed 23 May 2015
Global Public Goods for Development: How Much and What For
5/18/15
Nancy Birdsall and Anna Diofasi
| 18 May 2015
Updated May 19, 2015
Global public goods (GPGs) provide benefits to people in both rich and poor countries. They play a crucial role in safeguarding the social, economic, and political progress of the past century. They are fundamental to managing global risks such as climate change, infectious diseases, and financial crises that can harm developing countries disproportionately; and in exploiting opportunities, such as new vaccines, that can benefit them especially. Yet very little is known about how much governments spend on GPGs that matter for developing countries. What scant publicly available information there is we have gathered here for an initial and provisional estimate. Our list is necessarily selective and conservative as none of the major institutions with a global mission – including the World Bank and WHO – report on the funds or programs they dedicate to global public goods, nor have they agreed on any standard definition of GPGs. Our compilation of spending on development-related global public goods in 2012 adds up to about $14 billion (Table 1 and Table 2), equivalent to a little over 10 percent of global spending on official development assistance that year…

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Council on Foreign Relations
http://www.cfr.org/
Accessed 23 May 2015
The Health of Nations: The WHO’s Moment of Truth
by Stewart M. Patrick and Guest Blogger for Stewart M. Patrick
The Ebola outbreak in West Africa underscored how vulnerable the world has become to infectious disease—and how vital it is to invest in global health security. Not since the H1N1 pandemic of 2009 had an epidemic garnered so much attention—and inspired so much fear—worldwide. But this window is closing fast. As Ebola has waned in West Africa, so has the political momentum for reforming the World Health Organization (WHO). The World Health Assembly (WHA), which opened Monday in Geneva, offers what may be the last chance to restore the badly tarnished credibility of the WHO and preserve its central role in pandemic preparedness and response…

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The Economist
http://www.economist.com/
Accessed 23 May 2015
Development aid
It’s not what you spend
How to make aid to poor countries work better
May 23rd 2015 The Economist | 23 May 2015
FOR decades rich countries have sought to foster global development with aid. But all too often there is little to show for their spending, now over $135 billion a year and rising. Success depends on political will in recipient countries, says Erik Solheim of the Development Assistance Committee of the OECD, a club of mostly rich countries that includes the biggest donors. And that may well be lacking.
What donors will pay for may not be what recipients deem a priority. So poor countries’ governments say what they must to get cash, and often fail to keep their side of the deal. Aid to build schools may be used to give fat contracts to allies, and the schools left empty. Ambulances bought by donors may rust on the kerb, waiting for spare parts.
Now donors are trying a new approach: handing over aid only if outcomes improve. “Cash on delivery” sees donors and recipients set targets, for example to cut child mortality rates or increase the number of girls who finish school, and agree on how much will be paid if they are met. Conventional approaches still account for the lion’s share of international aid. But several countries, including Britain and Norway, and big private donors, including the Bill and Melinda Gates Foundation, are experimenting with cash-on-deliver…

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The Guardian
http://www.guardiannews.com/
Accessed 23 May 2015
Vaccine-free childcare ‘potentially catastrophic’, says industry group
Prospect of day care centres aimed at parents of unvaccinated children who are losing the childcare benefit condemned by Early Childhood Australia
21 May 2015
Moves by parents to open “vaccine-free” and “unvaccinated-friendly” day care centres in response to the federal government’s “no jab, no pay” policy have been described as “potentially catastrophic” by Early Childhood Australia, the peak advocacy body for early childcare.
In April the social services minister, Scott Morrison, announced that by next year, parents who refused to vaccinate their children on the grounds of being “conscientious objectors” would no longer receive the childcare benefit, childcare rebate and the family tax benefit part A end-of-year supplement.
The move has prompted some parents who do not vaccinate their children, and who will not be able to afford childcare as a result, to explore other options.
On social media, one woman has begun advertising the “Vaccine Free Family Day Care” centre on the page of an anti-vaccine group, which she says will open in Dromana, Victoria, start taking enrolments from 22 June, and charge $7 an hour for a minimum of eight hours a day…

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New York Times
http://www.nytimes.com/
Accessed 23 May 2015
U.S. Bird Flu Causes Egg Shortage, Emergency Measures
OF LIFE OR DEATH For some companies, having an adequate supply of fertilized eggs can be a matter of life or death. Some vaccine makers, including Merck & Co Inc, maintain their own hen flocks to produce eggs used for incubating
May 23, 2015 – 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 May 2015

– blog edition: comprised of the approx. 35+ entries posted below on this date.

– Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
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– Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.
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– Support:  If you would like to join the growing list of individuals who support this service and its contribution to their roles in public health, clinical practice, government, IGOs/NGOs, research, industry and academia, please visit this page at The Wistar Institute, our co-founder and fiduciary, and follow the relevant steps . Thank you…

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

Nepal earthquake 2015 – Grade 3 emergency
:: Health situation report No. 16pdf, 281kb 15 May 2015

:: Nepal ramps up disease surveillance after earthquakes 15 May 2015

:: Global Health Cluster
..Health Cluster 4Ws – 13 May 2015xlsx, 360kb
..Health Cluster Bulletin No. 2pdf, 2.26Mb 12 May 2015

:: WHO South-East Asia Region SEARO
.. Emergency preparedness pays off as Kathmandu hospitals respond to earthquakes  13 May 2015
.. Continuing care for tuberculosis, diabetes and heart patients in earthquake hit Nepal  10 May 2015

EBOLA/EVD [to 16 May 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

WHO: Ebola Situation Report – 13 May 2015
[Excerpts]
SUMMARY
:: A total of 9 confirmed cases of Ebola virus disease (EVD) was reported in the week to 10 May: the lowest weekly total this year. Guinea reported a total of 7 cases, Sierra Leone reported 2. For the first time since the beginning of the outbreak in Sierra Leone, the country reported zero confirmed cases for more than 2 consecutive days in the week to 10 May. As at 12 May, Sierra Leone has reported 8 consecutive days without a confirmed case. The EVD outbreak in Liberia was declared over on 9 May, after 42 complete days elapsed since the burial of the last confirmed case. The country has now entered a 3-month period of heightened vigilance. WHO will maintain an enhanced presence in the country until the end of 2015, with a particular focus on areas that border Guinea and Sierra Leone….

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
:: There have been a total of 26,724 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone (figure 1, table 1), with 11,065 reported deaths (this total includes reported deaths among probable and suspected cases, although outcomes for many cases are unknown). A total of 7 new confirmed cases were reported in Guinea and 2 in Sierra Leone in the 7 days to 10 May. The outbreak in Liberia was declared over on 9 May…

Editor’s Note
Prepared in time for engagement during the upcoming World Health Assembly, the first report of the Ebola assessment panel is excerpted below. The panel will present its final report after visiting and consulting with the affected countries, currently set for June 2015.
The panel is chaired by Barbara Stocking, President of Murray Edwards College, University of Cambridge the United Kingdom and former chief executive of Oxfam GB; Professor Jean-Jacques Muyembe-Tamfun, Director-General of the National Institute for Biomedical Research, Democratic Republic of the Congo; Dr Faisal Shuaib, Head of the National Ebola Emergency Operations Center, Nigeria; Dr Carmencita Alberto-Banatin, independent consultant and advisor on health emergencies and disasters, Philippines; Professor Julio Frenk, Dean of the Faculty, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; and Professor Ilona Kickbusch, Director of the Global Health Programme at the Graduate Institute of International and Development Studies, Geneva, Switzerland.

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Ebola Interim Assessment Panel
Report by the Secretariat A68/25
WHO – SIXTY-EIGHTH WORLD HEALTH ASSEMBLY
Provisional agenda item 16.1
8 May 2015 :: 12 pages
Pdf: http://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_25-en.pdf

[Selected Excerpts]
19. Now is the historic political moment for world leaders to give WHO new relevance and empower it to lead in global health. A strengthened, well-funded WHO can support all countries as they prepare to meet the challenges of increasing global interdependence and shared vulnerability. In response, the Secretariat needs to take serious steps to earn this leadership role in relation to outbreaks and emergency response and to regain the trust of the international community.

20. At present, WHO does not have the operational capacity or culture to deliver a full emergency public health response. A number of options have been suggested by different organizations and individuals: (i) a new agency should be established for health emergencies; (ii) the emergency part of the health response should be led by another United Nations agency; or (iii) investments should be made so that the operational capacity of WHO for emergency response is fully in place.

21. The panel recommends that the third option should be pursued with vigour. Establishing a new agency would take time to put in place and substantial new resources would be required to establish its basic administrative systems, and operational response capacity. A new agency would, in any case, have to rely on and coordinate with WHO for public health and technical resources, creating an unnecessary interface. Similarly, if another United Nations agency were expected to develop health operational capacity, it too would need to coordinate in depth with WHO, especially with respect to the International Health Regulations (2005). All this suggests that, as WHO already has the mandate to deliver on operational response, it would be a far more effective and efficient use of resources to make WHO fit for purpose. This will require the resources and political will of the Member States.

22. The Panel puts this recommendation to the Health Assembly now so that the overarching strategic direction is clear and that change can be driven forward quickly. If Member States agree to this strategic direction, then matters such as the Global Health Emergency Workforce and the proposed Contingency Fund can immediately move to implementation, so that the world is better placed to respond to significant public health emergencies.

23. A WHO that is capable of adequately responding to public health emergencies requires deep and substantial organizational change. The reaffirmation of WHO’s mandate in these emergencies should not be given lightly. This will require accountability and monitoring. Below we set out the key implications…

WHO Director-General addresses high-level meeting on Ebola R&D
Dr Margaret Chan, Director-General of the World Health Organization
Opening remarks at a WHO Ebola research and development forum
11 May 2015
Distinguished scientists, representatives of industry, colleagues in public health, ladies and gentlemen,

Good morning and a warm welcome to this high-level meeting. I thank you for your time and expertise.

The Ebola R&D effort has mobilised people, institutions and resources in ways never seen before. This is one positive outcome in an otherwise horrific human calamity.

New tools have been developed with unprecedented speed, though the window of opportunity for testing some is closing. On Saturday, WHO declared an end to the outbreak in Liberia. This is a monumental achievement in by far the worst outbreak since Ebola emerged in 1976.

Prior to the current outbreak, Ebola was considered a rare disease. Much about the disease and its causative agent was poorly understood. Your work has increased that understanding considerably. We are likely very close to having a vaccine that can protect against Ebola.

We have 4 rapid diagnostics to detect infection, and 2 of these are point-of-care. We have much more information about which therapeutic interventions may or may not work.
This is a contribution to scientific knowledge, but it is also a contribution to better preparedness. Thanks to your work, the world will be far better equipped to respond when the next Ebola outbreak inevitably occurs.

You have achieved something even bigger. What we see emerging, over a very short time, is a new model for the accelerated development, testing, and approval of new medical products during emergencies caused by any emerging or re-emerging infectious disease.

Your collaborative efforts prove that the traditional R&D model can be adapted, timeframes can be compressed, and partnerships that are otherwise unlikely can be formed.
The implications are huge. Many other serious diseases have no vaccines or therapeutic options, and some of these diseases have epidemic potential.

The job now is to harness the lessons from Ebola to create a new R&D framework that can be used for any epidemic-prone disease, in any infectious disease emergency.
This is what you will be discussing over the next 2 days: an R&D preparedness plan with clear rules, well-defined platforms for information sharing, and agreed procedures to expedite development and clinical trials.

In emergencies, coordination is the first essential element. Timely and transparent information sharing is the second.

The more we know about what other partners have discovered or achieved, the better equipped we will be to make informed decisions and take the right next steps with the greatest possible speed.

In this sense, the R&D response to Ebola marks an historical, ground-breaking event. Public research institutes, private funders, civil society, countries, and industry have united, in unprecedented ways, to defend the world against a deadly and deeply dreaded disease.

Many of you present today were part of this army. I hope the world will recognize what your engagement means, also as a contribution to future preparedness.
I wish you every success over the coming 2 days and eagerly await the outcome of your discussions.

POLIO [to 16 May 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 13 May 2015
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: Ministers of Health from around the world will meet in Geneva, Switzerland, next week for the annual World Health Assembly. The Ministers will discuss a number of topics related to public health, including polio eradication. The Global Polio Eradication Initiative has prepared a status report for delegates. The report and an accompanying resolution are expected to inform the discussions.
:: The latest semi-annual status report has been published and covers the period July to December 2014. The report provides an in-depth epidemiological and programmatic update for endemic, re-infected and high-risk countries.
:: Liberia and Sierra Leone have conducted polio and measles vaccination campaigns during the first week of May. These are the first campaigns conducted in these countries since 2013 (due to the Ebola outbreak). Polio staff in these countries continue to assist in the Ebola outbreak response efforts
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Selected excerpts from Country-specific Reports [No new polio cases reported]

WHO & Regionals [to 16 May 2015]
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:: Racing to combat an unprecedented meningitis outbreak in Niger
15 May 2015 — WHO and partners have sent an international expert team and negotiated provision of over half a million doses of vaccine to help Niger combat an unprecedented outbreak of meningococcal meningitis. This outbreak is the first large-scale meningitis outbreak caused by strain C to hit any country in Africa’s meningitis belt and has caused 5,855 suspected cases including 406 deaths.
Read the situation assessment
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:: Sixty-eighth World Health Assembly
15 May 2015 — The Sixty-eighth session of the World Health Assembly takes place in Geneva 18–26 May 2015, as officials from 194 Member States begin their annual review of the activities of WHO and set new priorities for the future. The main functions of the World Health Assembly are to determine the policies of the Organization and review and approve the proposed programme budget. The Health Assembly is held every May in Geneva, Switzerland.
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:: Global Alert and Response (GAR) – Disease Outbreak News (DONs)
.. Rapidly growing outbreak of meningococcal disease in Niger 15 May 2015
.. Human infection with avian influenza A(H7N9) virus – China 14 May 2015
.. Ebola virus disease – Italy 13 May 2015

:: The Weekly Epidemiological Record (WER) 15 May 2015, vol. 90, 20 (pp. 217–252) includes
.. Set of interviews
.. Epidemics timeline
.. Emerging and re-emerging infectious threats in the 21st century
.. Middle East respiratory syndrome coronavirus (MERS-CoV): current situation 3 years after the virus was first identified
.. Plague in Madagascar: overview of the 2014– 2015 epidemic season

:: Millennium Development Goals (MDGs) – Fact sheet N°290
Updated May 2015
Key facts
..Globally, the number of deaths of children under 5 years of age fell from 12.7 million in 1990 to 6.3 million in 2013.
..In developing countries, the percentage of underweight children under 5 years old dropped from 28% in 1990 to 17% in 2013.
..Globally, new HIV infections declined by 38% between 2001 and 2013.
..Existing cases of tuberculosis are declining, along with deaths among HIV-negative tuberculosis cases.
..In 2010, the world met the United Nations Millennium Development Goals target on access to safe drinking-water, as measured by the proxy indicator of access to improved drinking-water sources, but more needs to be done to achieve the sanitation target.

:: World Health Statistics 2015
World Health Statistics 2015 contains WHO’s annual compilation of health-related data for its 194 Member States, and includes a summary of the progress made towards achieving the health-related Millennium Development Goals (MDGs) and associated targets.
WHO presents World Health Statistics 2015 as an integral part of its ongoing efforts to provide enhanced access to comparable high-quality statistics on core measures of population health and national health systems.
DOWNLOAD THE FULL REPORT: English

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:: WHO Regional Offices
WHO African Region AFRO
:: Renowned public health experts and leaders endorse a vision for an Africa Health Transformation Programme to enhance health in the African Region – 14 May 2015

WHO Region of the Americas PAHO
:: LGBT health sees progress and challenges 15 years after homosexuality ceased being considered a disease (05/15/2015)
:: PAHO/WHO urges more attention to blood pressure control (05/14/2015)
:: PAHO/WHO highlights need to train more nursing personnel (05/12/2015)
:: New studies show immunization remains a ‘best buy’ in the fight against vaccine-preventable diseases (05/11/2015)

WHO South-East Asia Region SEARO
:: Emergency preparedness pays off as Kathmandu hospitals respond to earthquakes
13 May 2015
:: Continuing care for tuberculosis, diabetes and heart patients in earthquake hit Nepal
10 May 2015

WHO European Region EURO
:: First confirmed Ebola case in Italy 14-05-2015
:: Better hospital care for children 11-05-2015
:: WHO/Europe supports translation of European Vaccine Action Plan into national immunization plans in Gavi-supported countries
12-05-2015
A workshop to build capacity for comprehensive multi-year planning (cMYP) on immunization in countries eligible for support from the Global Alliance for Vaccines and Immunization (Gavi) took place on 27–29 April 2015 in Copenhagen, Denmark.
Continuation of GAVI support to countries is conditional on submission of updated cMYPs, which provide strategic guidance to national immunization programmes and stakeholders. WHO/Europe organized the workshop to help Armenia, Azerbaijan, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Ukraine and Uzbekistan identify critical aspects to be considered while developing their next cMYP, in line with revised WHO–United Nations Children’s Fund cMYP development guidelines and new costing and financing tool.
The process of updating cMYPs for the upcoming cycle (2016-2020) is also a vital time to translate the goals, objectives and proposed actions of the European Vaccine Action Plan 2015–2020 (EVAP) into national immunization plans.
Cross-border collaboration combined with tailored support to countries
Approximately 35 immunization programme managers and programme staff in charge of vaccine management and logistics, surveillance of vaccine-preventable diseases and immunization financing attended the workshop, along with WHO experts and representatives of partner agencies. Working together to improve planning of national immunization programmes allowed the participants to share experiences and best practices across national borders.
The workshop also provided WHO/Europe the opportunity to assess what technical assistance each country needs to finalize its cMYP. Based on this assessment, tailored support will be provided to countries at different stages of the planning process to ensure that development of cMYPs is aligned with national commitments and plans as laid out in the EVAP.

WHO Eastern Mediterranean Region EMRO
:: WHO to deliver additional medicines and medical supplies to Yemen
15 May 2015, Amman, Jordan — WHO is scaling up its provision of medicines and medical supplies to Yemen during the current humanitarian pause. Today, WHO is sending more than 20 tonnes of medicines and medical supplies to Hodeida, comprising international emergency health kits, trauma kits, surgical supply kits, emergency diarrhoeal disease kits, and water, sanitation and hygiene items for more than 120 000 beneficiaries. More than 300 000 people have been newly displaced in Yemen since March, and almost 8.6 million people are in need of health services around the country.
:: Morocco joins the International Agency for Research on Cancer 16 May 2015
:: Egypt: upsurge in H5N1 human and poultry cases but no change in transmission pattern of infection 15 May 2015
:: WHO–Kuwait partnership to help the people of Syria
15 May 2015

WHO Western Pacific Region
:: Four innovative Pacific projects receive WHO Healthy Islands Recognition
YANUCA ISLAND, 11 May 2015 – As part of the Eleventh Pacific Health Ministers Meeting, the World Health Organization (WHO) awarded four innovative projects in Commonwealth of the Northern Mariana Islands, Samoa, Tokelau and Vanuatu with the WHO Healthy Islands Recognition for the outstanding work by health and community leaders in the Pacific.

CDC/MMWR/ACIP Watch [to 16 May 2015]
http://www.cdc.gov/media/index.html

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:: MMWR Weekly May 15, 2015 / Vol. 64 / No. 18
.. Controlling the Last Known Cluster of Ebola Virus Disease — Liberia, January–February 2015
.. Initiation of a Ring Approach to Infection Prevention and Control at Non-Ebola Health Care Facilities — Liberia, January–February 2015

GAVI [to 16 May 2015]
http://www.gavialliance.org/library/news/press-releases/

:: Qatar pledges support for Gavi to save children’s lives with vaccines
Funding will help Vaccine Alliance protect millions of children from infectious disease.
DOHA, 14 May 2015 – The Qatar Development Fund and Gavi, the Vaccine Alliance signed today a landmark Contribution Agreement, under which the State of Qatar agreed to make a multi-year financial pledge to help immunise children in the world’s poorest countries against vaccine-preventable diseases.
Under the agreement, Qatar committed to provide an initial US$ 10 million to Gavi to support immunisation programmes in the period between 2016 and 2020. The funding will be provided through the Qatar Development Fund and follows the announcement at the Gavi Pledging Conference, held in Berlin in January 2015, that Qatar intends to commit funding to the Vaccine Alliance…
…“The State of Qatar is committed to helping the international coalition save children’s lives and protect people’s health through cooperation with the Global Alliance for Vaccines and Immunization Organization by increasing access to immunisation in developing countries,” said Khalifa Al-Kuwari, General Director of Qatar Development Fund…

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:: IFFIm awarded prize for ‘Innovation in Islamic Finance 2015’
12 May 2015
Third global award given for IFFIm’s November sukuk transaction.

European Medicines Agency Watch [to 16 May 2015]
http://www.ema.europa.eu/ema/
:: Safety monitoring of medicines: EMA to screen medical literature for 400 active substance groups
12/05/2015
New service will improve safety monitoring of medicines and simplify pharmacovigilance activities for companies

The European Medicines Agency (EMA) has published the list of active substances and a reference to the journals that will be covered by its new medical literature monitoring service. This service will start with a limited number of active substances on 1 July 2015 and will be fully rolled out in September 2015. A guide, a training video and a document detailing the inclusion and exclusion criteria to be used when screening the literature are also available on a dedicated webpage.

Medical literature is an important source of information on suspected adverse reactions reported on medicines. The European Union’s (EU) pharmacovigilance legislation has given EMA responsibility for the monitoring of selected medical literature for a defined list of active substances used in medicines and for entering identified reports of suspected adverse reactions in EudraVigilance, the EU adverse drug reaction collection and management system…

IOM: Scaling Program Investments for Young Children Globally: Evidence from Latin America and the Caribbean—Workshop in Brief
May 14, 2015
Authors: Amanda Pascavis, Rapporteur
Forum on Investing in Young Children Globally; Board on Children, Youth, and Families; Board on Global Health; Institute of Medicine; National Research Council
Pdf: http://www.nap.edu/catalog.php?record_id=21748
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Overview
On November 11, 2014, the Forum on Investing in Young Children Globally of the Institute of Medicine and National Research Council, in partnership with Fundação Maria Cecilia Souto Vidigal (FMCSV) in São Paulo, Brazil, held a 1-day workshop. The purpose of this interactive public workshop was to highlight efforts made to scale program investments across health, education, nutrition, and social protection that aim to improve children’s developmental potential. Invited speakers and public participants explored four topics on scaling up program investments: evidence of impact for effective investments in young children; scalability of investments; sustainability of investments; and governance.
Presenters highlighted evidence on effective investments in programs and interventions in Latin America, including an account of their strengths and challenges. Speakers addressed scalability and sustainability of program investments and how to maintain quality at scale, with a focus on approaches in culturally and ethnically diverse contexts and issues of decentralization, local capacity, and information systems for monitoring and evaluation. Presentations and discussions included policy perspectives on scaling up programs. This brief summary of the workshop highlights the topics raised by panelists, moderators, and public participants, while also including possible directions for further discussion. It represents the viewpoints of individual session participants and should not be viewed as consensus conclusion or recommendations of the workshop as a whole. A full summary of the workshop will be available in summer 2015

Expanding Opportunities for the Next Generation, Early Childhood Development in the Middle East and North Africa – Directions in development; human development
World Bank Group
May 07, 2015 :: 343 pages
Authors: El-Kogali, Safaa El Tayeb; Krafft, Caroline Gould;
Pdf:
http://documents.worldbank.org/curated/en/2015/01/23811898/expanding-opportunities-next-generation-early-childhood-development-middle-east-north-africa
The report fills a critical research gap by providing the first comprehensive analysis of the state of early childhood development (ECD) in the Middle East and North Africa (MENA).

Abstract
Early childhood is the most important stage of human development. In the Middle East and North Africa (MENA), there is little research and inadequate investment in this crucial stage of life. This book assesses the state of early childhood development (ECD) in MENA from before birth through age five, examining multiple dimensions of early development including health, nutrition, socio-emotional development, early learning, and early work. The book begins with a discussion of the importance of ECD as a critical foundation for later development, and also as a stage of life when inequality and social exclusion begin. ECD in MENA is set in a global context, and then countries within MENA are compared, with chapters on ECD in Algeria, Djibouti, Egypt, Iraq, Jordan, Lebanon, Libya, Morocco, Syria, Tunisia, West Bank and Gaza, and Yemen. As well as illustrating the state of ECD, the chapters assess risk and protective factors for early development and the extent of inequality in early childhood. A discussion of policies and programs that can enhance ECD illustrates how inequality and shortfalls in early development can be effectively addressed. This book will be of interest to anyone interested in the state of human development and inequality in MENA.

Contents Overview
The first chapter offers an overview of the evidence that the period from before birth to age five is the most important stage of human development. This period is especially crucial as deficits at this early stage tend to be irreversible and to perpetuate cycles of poverty and inequality. The many dimensions of healthy ECD, from proper healthcare and nutrition to early development activities, are identified along with the range of related indicators used to measure the state of ECD in the region.

Chapter 2 offers a comparison with other regions of the world, for a better understanding of the state of ECD in MENA,. The twelve countries of the region are also compared, to establish benchmarks and identify country-specific deficits in ECD. The chapter includes an analysis of the factors that influence ECD, as there is significant inequality of access to key development activities even in the region’s more developed countries.

Chapter 3 shows that economic growth alone will not address the many shortfalls in the region’s ECD. Targeted interventions are needed. The chapter provides a way forward with a number of approaches from around the world that have been implemented successfully and which would benefit children in MENA.

Country analyses:
:: Algeria which has achieved good immunization rates but has high rates of stunting due to malnutrition, and where a child’s social and economic background influences the chances of healthy development.
:: Djibouti where prenatal and delivery care is now almost universal but child mortality rates are still high and less than one third of children are fully immunized by the age of one.
:: Egypt where stunting is a major and persistent problem and disadvantaged children are the least likely to benefit from early schooling, although immunization rates have reached 92%.
:: Iraq where only half of children are receiving regular prenatal care, less than two-thirds are fully immunized and access to key development activities is closely related to social and economic background.
:: Jordan which has achieved near universal coverage for prenatal and neonatal care, and while rates for stunting are low there is large variation in nutrition status, with a child from the poorest segment of society seven times as likely to be stunted as a child from the richest.
:: Lebanon which has also achieved near universal coverage for prenatal and neonatal care but where only half of all children are fully immunized by age one and poorer children are more likely to be stunted.
:: Libya before the current crisis, where 87% of all children were fully immunized but only half had access to iodized salt, essential for cognitive development, and more than one fifth were stunted.
:: Morocco where 90% of children are fully immunized but almost one third are stunted and deaths in the first month and year of life are above regional averages, with the poorest children facing greater risk of death.
:: Syria before the current crisis, where 96% of births were assisted by a skilled attendant but only 78% of one-year-olds were fully immunized and over one quarter of all children were stunted.
:: Tunisia which has achieved near universal prenatal and delivery care and early mortality has fallen below regional averages, but children in rural areas have one third the chance of urban children to attend early education and 22% of children aged 5 are engaged in child labor.
:: West Bank and Gaza which has achieved near universal coverage for prenatal and delivery care but stunting remains a persistent problem and there are large differences in access to early care and education between advantaged and disadvantaged children.
:: Yemen before the current crisis where less than half of all births received prenatal care and children were more than twice as likely to die before their first birthday (7%) as they were to attend early childhood education (3%).

BMC Public Health
http://www.biomedcentral.com/bmcpublichealth/content
(Accessed 16 May 2015)
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Research article
Motives of Dutch persons aged 50 years and older to accept vaccination: a qualitative study
Renske Eilers, Paul Krabbe, Hester de Melker BMC Public Health 2015, 15:493 (16 May 2015)
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Review
Urban health indicators and indices: current status
Richard Rothenberg1*, Christine Stauber1, Scott Weaver1, Dajun Dai2, Amit Prasad3 and Megumi Kano3
Author Affiliations
BMC Public Health 2015, 15:494 doi:10.1186/s12889-015-1827-x
Published: 16 May 2015
Abstract (provisional)
Though numbers alone may be insufficient to capture the nuances of population health, they provide a common language of appraisal and furnish clear evidence of disparities and inequalities. Over the past 30 years, facilitated by high speed computing and electronics, considerable investment has been made in the collection and analysis of urban health indicators, environmental indicators, and methods for their amalgamation. Much of this work has been characterized by a perceived need for a standard set of indicators. We used publication databases (e.g. Medline) and web searches to identify compilations of health indicators and health metrics. We found 14 long-term large-area compilations of health indicators and determinants and seven compilations of environmental health indicators, comprising hundreds of metrics. Despite the plethora of indicators, these compilations have striking similarities in the domains from which the indicators are drawn—an unappreciated concordance among the major collections. Research with these databases and other sources has produced a small number of composite indices, and a number of methods for the amalgamation of indicators and the demonstration of disparities. These indices have been primarily used for large-area (nation, region, state) comparisons, with both developing and developed countries, often for purposes of ranking. Small area indices have been less explored, in part perhaps because of the vagaries of data availability, and because idiosyncratic local conditions require flexible approaches as opposed to a fixed format. One result has been advances in the ability to compare large areas, but with a concomitant deficiency in tools for public health workers to assess the status of local health and health disparities. Large area assessments are important, but the need for small area action requires a greater focus on local information and analysis, emphasizing method over prespecified content.

British Medical Journal
16 May 2015(vol 350, issue 8008)
http://www.bmj.com/content/350/8008

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Editorials
Who should be vaccinated against HPV?
BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h2244 (Published 12 May 2015) Cite this as: BMJ 2015;350:h2244
Karen Canfell, director1

As richer countries consider vaccinating males, the focus for lower income countries should remain on cervical cancer prevention
Vaccination of girls against the human papillomavirus (HPV) has been implemented in most developed countries, driven by prevention of cervical cancer as a public health priority. Bivalent (Cervarix, GSK) and quadrivalent (Gardasil, Merck) vaccines protect against subsequent infection with oncogenic HPV16/18, and quadrivalent vaccine protects against HPV6/11, which cause anogenital warts. Although HPV vaccination effectively protects against external genital lesions and anal intraepithelial neoplasia in males, only a few jurisdictions have so far recommended universal vaccination of boys. These include Australia, Austria, two Canadian provinces, and the United States. In other countries, a cautious approach has been due, in part, to uncertainties around the population level impact and cost effectiveness of vaccination of boys.

In a linked article, Bogaards and colleagues (doi:10.1136/bmj.h2016) estimated the benefits to men of offering HPV vaccination to boys.1 They used a dynamic simulation and a bayesian synthesis to integrate the evidence on HPV related cancers in men. The analysis takes account of indirect protection from female vaccination: heterosexual men will benefit from reduced HPV circulation in females, so if coverage in girls is high the incremental benefit of vaccinating boys is driven by prevention of the residual burden of anal cancer in men who have sex with men.

The findings reinforce those of prior analyses that found that adding boys to established vaccination programmes in girls becomes less cost effective as female coverage increases.2 The cost effectiveness of vaccination of boys also depends on other local issues, especially vaccine type and vaccine and administration costs. A threshold total cost per vaccinated boy for cost effectiveness can be identified at any level of coverage in girls: such analyses can provide policy makers with the maximum rational vaccine price appropriate to the local environment. If vaccine coverage in girls is lower, however, the most effective use of resources is likely to involve increasing coverage in girls, if feasible.2 3

In some countries, vaccination of boys might not be cost effective, even at lower vaccine prices, due to higher administration costs.3 Recent developments towards reduced dose schedules could help. In 2013 the European Medical Agency recommended a two dose schedule for the bivalent vaccine in girls, in 2014 the United Kingdom switched to a two dose schedule, and the World Health Organization now recommends two doses for girls <15. Two dose schedules are the most cost effective option for girls provided protection lasts for ≥20 years4 and reduced dose schedules in boys are also likely to increase cost effectiveness if adequate efficacy is maintained.

Bogaards and colleagues highlight the importance of vaccination for prevention of anal cancer in men who have sex with men. In part due to uncertainties in natural history, the effectiveness of anal cancer screening is not established.5 Primary prevention with targeted vaccination of men who have sex with men is an attractive option and is potentially more cost effective than universal vaccination of boys. The US Advisory Committee on Immunization Practices already recommends vaccination of men who have sex with men up to the age of 26 years.6 Older men who have sex with men could also potentially benefit. The UK’s Joint Committee on Vaccination and Immunisation, as an interim position, recently stated that a programme to vaccinate men aged 16-40 who have sex with men with a quadrivalent vaccine should be considered, if cost effective.7 Lower coverage rates expected with targeted versus universal male vaccination are an important consideration, and the two approaches are not mutually exclusive.

Several other new developments should be factored in to future policy decisions. A recent study showed that the bivalent vaccine is effective in women aged ≥25 without a history of HPV disease.8 With a transition to primary HPV screening occurring in several countries, an interesting possibility to be evaluated involves “screen and vaccinate” strategies in older women—that is, offering HPV screening, followed by vaccination for HPV negative women with extended (or perhaps no) recall for this group. Secondly, a nonavalent vaccine (Gardasil9, Merck), which protects against an extra five HPV types,9 has recently been recommended for use in the US.6 In women, this will increase protection against cervical cancer in those who are fully vaccinated (from about 70% to about 90%)10 but as most HPV cancers in men are attributed to types included in current vaccines,1 tiered pricing structures for new generation vaccines based on differential incremental benefits (and thus differential cost effectiveness thresholds) in girls versus boys could be considered.

All these policy decisions must consider burden of disease, safety, effectiveness, acceptability, equity, and cost effectiveness. Although the focus in developed countries has now, appropriately, shifted to considering these issues for boys, men who have sex with men, and older women, broader efforts to prevent cervical cancer should remain the priority in low and middle income countries. Of the 610 000 cancers annually attributable to HPV worldwide, 87% are cancers of the cervix, and three quarters of these occur in countries with a low or medium human development index.11 Even if a substantial majority of young girls in such counties were vaccinated, hundreds of millions of older women would remain at risk—vaccination alone will not prevent an expected increase in cervical cancers in the next few decades, driven by population ageing. Here, the priority focus should be the development of integrated programmes for vaccinating young girls and screening older women. Based on experience in developed countries, this will also provide benefits for men through indirect vaccine protection.

Footnotes
Research, doi:10.1136/bmj.h2016

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Research
Direct benefit of vaccinating boys along with girls against oncogenic human papillomavirus: bayesian evidence synthesis
BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h2016 (Published 12 May 2015) Cite this as: BMJ 2015;350:h2016
Johannes A Bogaards, senior researcher12, Jacco Wallinga, senior researcher2, Ruud H Brakenhoff, professor3, Chris J L M Meijer, professor4, Johannes Berkhof, associate professor1
Author affiliations
Abstract
Objective
To assess the reduction in the vaccine preventable burden of cancer in men if boys are vaccinated along with girls against oncogenic human papillomavirus (HPV).
Design
Bayesian evidence synthesis approach used to evaluate the impact of vaccination against HPV types 16 and 18 on the burden of anal, penile, and oropharyngeal carcinomas among heterosexual men and men who have sex with men. The reduced transmission of vaccine-type HPV from vaccination of girls was assumed to lower the risk of HPV associated cancer in all men but not to affect the excess risk of HPV associated cancers among men who have sex with men.
Setting
General population in the Netherlands.
Intervention
Inclusion of boys aged 12 into HPV vaccination programmes.
Main outcome measures
Quality adjusted life years (QALYs) and numbers needed to vaccinate.
Results
Before HPV vaccination, 14.9 (95% credible interval 12.2 to 18.1) QALYs per thousand men were lost to vaccine preventable cancers associated with HPV in the Netherlands. This burden would be reduced by 37% (28% to 48%) if the vaccine uptake among girls remains at the current level of 60%. To prevent one additional case of cancer among men, 795 boys (660 to 987) would need to be vaccinated; with tumour specific numbers for anal, penile, and oropharyngeal cancer of 2162, 3486, and 1975, respectively. The burden of HPV related cancer in men would be reduced by 66% (53% to 805) if vaccine uptake among girls increases to 90%. In that case, 1735 boys (1240 to 2900) would need to be vaccinated to prevent an additional case; with tumour specific numbers for anal, penile, and oropharyngeal cancer of 2593, 29107, and 6484, respectively.
Conclusions
Men will benefit indirectly from vaccination of girls but remain at risk of cancers associated with HPV. The incremental benefit of vaccinating boys when vaccine uptake among girls is high is driven by the prevention of anal carcinomas, which underscores the relevance of HPV prevention efforts for men who have sex with men.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 11, Issue 4, 2015
http://www.tandfonline.com/toc/khvi20/current

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A review of economic evaluations of 13-valent pneumococcal conjugate vaccine (PCV13) in adults and the elderly
Open access
DOI:10.1080/21645515.2015.1011954
S Dirmesropiana, JG Wooda, CR MacIntyreab & AT Newalla*
pages 818-825
Abstract
The 13-valent pneumococcal conjugated vaccine (PCV13) is already recommended for some adult groups and is being considered for wider use in many countries. In order to identify the strengths and limitations of the existing economic evaluation studies of PCV13 in adults and the elderly a literature review was conducted. The majority of the studies identified (9 out of 10) found that PCV13 was cost-effective in adults and/or the elderly. However, these results were based on assumptions that could not always be informed by robust evidence. Key uncertainties included the efficacy of PCV13 against non-invasive pneumonia and the herd immunity effect of childhood vaccination programs. Emerging trial evidence on PCV13 in adults from the Netherlands offers the ability to parameterize future economic evaluations with empirical efficacy data. However, it is important that these estimates are used thoughtfully when they are transferred to other settings

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Cost-effectiveness analysis of a vaccination program for the prevention of herpes zoster and post-herpetic neuralgia in adults aged 50 and over in Germany
Open access
DOI:10.1080/21645515.2015.1011561
Emmanuelle Préauda*, Mathieu Uharta, Katharina Böhmb, Pamela Aidelsburgerb, Delphine Angerc, Florence Bianicc & Nathalie Largerona
pages 884-896
Abstract
Herpes zoster (HZ; shingles) is a common viral disease that affects the nerves and surrounding skin causing a painful dermatomal rash and leading to debilitating complications such as, mainly, post-herpetic neuralgia (PHN). Currently, there is no effective treatment for HZ and PHN. The objective of this study was to assess the cost-effectiveness of a HZ vaccination program in Germany. An existing Markov Model was adapted to the German healthcare setting to compare a vaccination policy to no vaccination on a lifetime time-horizon, considering 2 scenarios: vaccinating people starting at the age of 50 or at the age of 60 years, from the perspective of the statutory health insurance (SHI) and the societal perspective. According to the perspective, vaccinating 20% of the 60+ German population resulted in 162,713 to 186,732 HZ and 31,657 to 35,793 PHN cases avoided. Corresponding incremental cost-effectiveness ratios (ICER) were 39,306 €/QALY from the SHI perspective and 37,417 €/QALY from a societal perspective. Results for the 50+ German population ranged from 336,468 to 394,575 HZ and from 48,637 to 56,087 PHN cases avoided from the societal perspective. Corresponding ICER were 39,782 €/QALY from a SHI perspective and 32,848 €/QALY from a societal perspective. Sensitivity analyses showed that results are mainly impacted by discount rates, utility values and use of alternative epidemiological data.The model indicated that a HZ vaccination policy in Germany leads to significant public health benefits and could be a cost-effective intervention. The results were robust and consistent with local and international existing literature.

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Evaluation of a vaccination strategy by serosurveillance data: The case of varicella
Open access
DOI:10.1080/21645515.2015.1009818
Silvio Tafuri*, Maria Serena Gallonea, Maria Filomena Gallonea, Maria Giovanna Cappellia, Maria Chironnaa & Cinzia Germinarioa
pages 897-900
Abstract
Serological studies have many important epidemiologic applications. They can be used to investigate acquisition of various infections in different populations, measure the induction of an immune response in the host, evaluate the persistence of antibody, identify appropriate target groups and the age for vaccination. Serological studies can also be used to determine the vaccine efficacy. Since 1995 a varicella vaccine is available and it has been recommended in several countries (e.g. USA, Australia, Canada, Costa Rica, Ecuador, etc.). Nevertheless few varicella seroprevalence studies in countries that adopted an URV are available. It is related to the relatively recent introduction of the vaccination and to the lack of structured and collaborative surveillance systems based on serosurvey at national or regional level. Varicella seroprevalence data collected before the introduction of vaccination strategies allowed to establish the age of vaccination (e.g., indicated the opportunity to offer the vaccine to Italian susceptible adolescents). In the post-vaccination era, seroprevalence data demonstrated vaccine as immunogenic and excluded an increase of the age of infection linked to the vaccination strategy. New seroprevalence studies should be performed to answer to open questions, such as the long-term immunity and the change of the herpes zoster epidemiological pattern related to the vaccine.

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Vaccination attitudes and mobile readiness: A survey of expectant and new mothers
Open access
DOI:10.1080/21645515.2015.1009807
Katherine M Atkinsona, Robin Ducharmeab, Jacqueline Westeindea, Sarah E Wilsoncd, Shelley L Deekscd, Dante Pascalie & Kumanan Wilsonabef*
pages 1039-1045
Abstract
Sub-optimal vaccination coverage and recent outbreaks of vaccine-preventable diseases serve as a reminder that vaccine hesitancy remains a concern. ImmunizeCA, a new smartphone app to help track immunizations, may address several reasons for not vaccinating. We conducted a study to describe demographic variables, attitudes, beliefs and information sources regarding pediatric vaccination in a sample of childbearing women who were willing to download an immunization app. We also sought to measure their current mobile usage behaviors and determine if there is an association between participant demographics, attitudes, beliefs and information sources regarding pediatric vaccination and mobile usage. We recruited participants using a combination of passive and active methods at a tertiary care hospital in Ottawa, Canada. We used surveys to collect demographic information, examine attitudes, behavior, and information sources regarding immunization and self-reported mobile phone usage. A total of 54 women participated. The majority had positive attitudes toward vaccination (96%) and intended to vaccinate their children (98%). Participants were interested in information on pediatric vaccination (94%), and found information from public health the most reliable and accessible (78%). Participants also trusted immunization information from their doctor or nurse and public health (83%) more than other sources. There was variability in participant use of mobile apps for other purposes. The median participant mobile readiness score was 3.2. We found no significant associations between participant age, behavior and attitudes regarding vaccination and mobile readiness scores. This is the first evaluation of mobile readiness for a smartphone app to track immunizations. Our findings suggest that there exists an opportunity to provide reliable information on vaccination through mobile devices to better inform the public, however predictors of individual engagement with these technologies merits further study.

International Health
Volume 7 Issue 3 May 2015
http://inthealth.oxfordjournals.org/content/current

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Noma: neglected, forgotten and a human rights issue
M. Leila Sroura,*, Klaas W. Marckb and Denise Baratti-Mayerc
Author Affiliations
aHealth Frontiers, Bhan Tat Khao, Vientiane, Laos
bDutch Noma Foundation, De Pôlle 24, 9084BT Goutum, The Netherlands
cGESNOMA (Geneva Study Group on Noma), Service of Plastic and Reconstructive Surgery, Geneva University Hospitals, Geneva, Switzerland
Abstract
Noma, an orofacial gangrene and opportunistic infection, affects primarily malnourished children living in extreme poverty. Neglected, forgotten, unknown by most health workers, noma results in death, disfigurement and disability of some of the world’s most vulnerable children. Noma is a biological indicator of multiple human rights violations, including the right to food. International support and national attention in countries with noma are lacking. The end of neglect of noma can lead to the elimination of this horrific childhood disease.

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Patients struggle to access effective health care due to ongoing violence, distance, costs and health service performance in Afghanistan
Niamh Nic Carthaigha, Benoit De Gryseb, Abdul Sattar Esmatic, Barak Nizard, Catherine Van Overloope, Renzo Frickee, Jehan Bseisoa, Corinne Bakere, Tom Decroof and Mit Philipsa,*
Author Affiliations
aMédecins Sans Frontières–Operational Centre Brussels, Advocacy and Analysis Unit, Brussels
bMédecins Sans Frontières–Operational Centre Brussels, Afghanistan Mission, Kabul
cMinistry of Health–Afghanistan, Direction Ahmad Shah Baba District Hospital, Kabul, Afghanistan
dMinistry of Health–Afghanistan, Direction Boost Provincial Hospital, Helmand, Afghanistan
eMédecins Sans Frontières–Operational Centre Brussels, Operational Department, Brussels
fMédecins Sans Frontières–Operational Centre Brussels, Operational Research Unit, Brussels
Abstract
Background
The Afghan population suffers from a long standing armed conflict. We investigated patients’ experiences of their access to and use of the health services.
Methods
Data were collected in four clinics from different provinces. Mixed methods were applied. The questions focused on access obstacles during the current health problem and health seeking behaviour during a previous illness episode of a household member.
Results
To access the health facilities 71.8% (545/759) of patients experienced obstacles. The combination of long distances, high costs and the conflict deprived people of life-saving healthcare. The closest public clinics were underused due to perceptions regarding their lack of availability or quality of staff, services or medicines. For one in five people, a lack of access to health care had resulted in death among family members or close friends within the last year.
Conclusions
Violence continues to affect daily life and access to healthcare in Afghanistan. Moreover, healthcare provision is not adequately geared to meet medical and emergency needs. Impartial healthcare tailored to the context will be vital to increase access to basic and life-saving healthcare.

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Health worker perceptions of integrating mobile phones into community case management of malaria in Saraya, Senegal
Demetri A. Blanasa,*, Youssoupha Ndiayeb, Matthew MacFarlanec, Isaac Mangab, Ammar Siddiquid, Olivia Veleze, Andrew S. Kanterf, Kim Nicholsg and Nils Hennigd
Author Affiliations
aHarlem Residency in Family Medicine, Institute for Family Health, New York, New York, 10029, USA
bHealth District of Saraya, Senegalese Ministry of Health, Saraya, Senegal
cCenter on Child Protection, Jakarta, Indonesia
dMount Sinai Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
eICF International, New York, New York, 10028, USA
fEarth Institute, Columbia University, New York, New York, 10027, USA
gAfrican Services Committee, New York, New York, 10027, USA
Abstract
Background
Although community case management of malaria increases access to life-saving care in isolated settings, it contends with many logistical challenges. Mobile phone health information technology may present an opportunity to address a number of these barriers.
Methods
Using the wireless adaptation of the technology acceptance model, this study assessed availability, ease of use, usefulness, and job relevance of mobile phones by health workers in Saraya, Senegal.
Results
This study conducted seven key informant interviews with government health workers, and three focus groups and 76 surveys with lay health workers. Principal findings included that mobile phones are already widely available and used, and that participants valued using phones to address training, stock management, programme reporting, and transportation challenges.
Conclusions
By documenting widespread use of mobile phones and health worker perceptions of their most useful applications, this paper provides a framework for their integration into the community case management of malaria programme in Saraya, Senegal.

Journal of Infectious Diseases
Volume 211 Issue 16 May 1, 2015
http://jid.oxfordjournals.org/content/current

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Can epidemiology inform global health and development targets?
Alan D Lopez
Author Affiliations
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
[Initial text]
In 2015, the global health and development community will collectively assess the progress of nations towards achieving the Millennium Development Goals (MDGs), an ambitious framework for human development based on broad principles of equity, solidarity and poverty reduction. Of the 12 goals established to measure social and economic progress, three (MDG4, MDG5 and MDG6) relate directly to health development; reduction of child mortality, reduction of maternal mortality; and progress against the global epidemics of HIV/AIDS, malaria and tuberculosis, respectively.1 There has been much debate about whether global goals with explicit targets are useful or not in stimulating action by countries and donors to improve health. Whereas broad development goals are likely to receive strong endorsement by countries, the addition of specific targets might well be unwelcome, particularly if they are perceived as being too ambitious. Worse, the global focus on targets for the MDGs has driven a culture of accountability with an almost singular focus on whether a country is likely to achieve the specified targets or not, to the detriment of other important measures of progress. The political imperative that countries have no doubt felt to accelerate progress with health development because of the existence of the MDGs is laudable, and real, but it has not necessarily been the ideal policy environment to do so, for five principal reasons.

First, recent global assessments have suggested that only about one-quarter of all countries, and less than one in five developing countries, will achieve MDGs 4 and 5, obscuring the very substantial progress in reducing child mortality, for example, that has occurred in sub-Saharan Africa, India and much of eastern Europe since 2000.2–4 In many countries, these accelerated declines have been due to the success of bold public policies, and financing, to scale-up and ensure delivery of bed nets …

The Lancet
May 16, 2015 Volume 385 Number 9981 p1917-2014 e47-e48
http://www.thelancet.com/journals/lancet/issue/current

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Comment
For every woman, every child, everywhere: a universal agenda for the health of women, children, and adolescents
Sarah Zeid, Flavia Bustreo, Maha Taysir Barakat, Peter Maurer, Kate Gilmore
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60766-8
Summary
Preventable mortality and morbidity among women, adolescents, and children are severe in humanitarian settings. Data from the Organisation for Economic Co-operation and Development on 50 fragile states show that 60% of preventable maternal deaths, 53% of deaths in children younger than 5 years, and 45% of neonatal deaths take place in fragile settings of conflict, displacement, and natural disasters.1–3 Worldwide, women and children are up to 14 times more likely than men to die in a disaster.4

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World Report
Ebola vaccine trial in west Africa faces criticism
Miriam Shuchman
Published Online: 12 May 2015
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60938-2
WHO has come under fire for its running of the Ebola ring vaccine trial in Guinea, with critics highlighting inadequate care of participants and patients. Miriam Shuchman report

PLoS Medicine
(Accessed 16 May 2015)
http://www.plosmedicine.org/

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A Global Biomedical R&D Fund and Mechanism for Innovations of Public Health Importance
Manica Balasegaram, Christian Bréchot, Jeremy Farrar, David Heymann, Nirmal Ganguly, Martin Khor, Yves Lévy, Precious Matsoso, Ren Minghui, Bernard Pécoul, Liu Peilong, Marcel Tanner, John-Arne Røttingen
Essay | published 11 May 2015 | PLOS Medicine 10.1371/journal.pmed.1001831
Summary Points
:: Anti-microbial resistance, emerging infectious diseases, and neglected diseases are all important public health concerns and priorities with serious market failures, deficits, and identified needs in biomedical innovation.
:: It is important to reconcile, rather than fragment, the needs of these three priority areas by considering an umbrella framework for specifically financing and coordinating research and development (R&D) that delivers innovation while securing patient access.
:: A sizeable, sustainably financed global R&D fund and mechanism that promotes coordination, collaboration, and utilization of new and innovative incentives should be set up to cover all three priority areas.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 16 May 2015)

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Prospects for Malaria Elimination in Mesoamerica and Hispaniola
Sócrates Herrera, Sergio Andrés Ochoa-Orozco, Iveth J. González, Lucrecia Peinado, Martha L. Quiñones, Myriam Arévalo-Herrera
Review | published 14 May 2015 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003700
Abstract
Malaria remains endemic in 21 countries of the American continent with an estimated 427,000 cases per year. Approximately 10% of these occur in the Mesoamerican and Caribbean regions. During the last decade, malaria transmission in Mesoamerica showed a decrease of ~85%; whereas, in the Caribbean region, Hispaniola (comprising the Dominican Republic [DR] and Haiti) presented an overall rise in malaria transmission, primarily due to a steady increase in Haiti, while DR experienced a significant transmission decrease in this period.

The significant malaria reduction observed recently in the region prompted the launch of an initiative for Malaria Elimination in Mesoamerica and Hispaniola (EMMIE) with the active involvement of the National Malaria Control Programs (NMCPs) of nine countries, the Regional Coordination Mechanism (RCM) for Mesoamerica, and the Council of Health Ministries of Central America and Dominican Republic (COMISCA). The EMMIE initiative is supported by the Global Fund for Aids, Tuberculosis and Malaria (GFATM) with active participation of multiple partners including Ministries of Health, bilateral and multilateral agencies, as well as research centers. EMMIE’s main goal is to achieve elimination of malaria transmission in the region by 2020. Here we discuss the prospects, challenges, and research needs associated with this initiative that, if successful, could represent a paradigm for other malaria-affected regions.

PLoS One
[Accessed 16 May 2015]
http://www.plosone.org/

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Research Article
“The One Who Chases You Away Does Not Tell You Go”: Silent Refusals and Complex Power Relations in Research Consent Processes in Coastal Kenya
Dorcas M. Kamuya, Sally J. Theobald, Vicki Marsh, Michael Parker, Wenzel P. Geissler, Sassy C. Molyneux
Published: May 15, 2015
DOI: 10.1371/journal.pone.0126671
Abstract
Consent processes have attracted significant research attention over the last decade, including in the global south. Although relevant studies suggest consent is a complex negotiated process involving multiple actors, most guidelines assume consent is a one-off encounter with a clear ‘yes’ or ‘no’ decision. In this paper we explore the concept of ‘silent refusals’, a situation where it is not clear whether potential participants want to join studies or those in studies want to withdraw from research, as they were not actively saying no. We draw on participant observation, in-depth interviews and group discussions conducted with a range of stakeholders in two large community based studies conducted by the KEMRI Wellcome Trust programme in coastal Kenya. We identified three broad inter-related rationales for silent refusals: 1) a strategy to avoid conflicts and safeguard relations within households, – for young women in particular—to appear to conform to the wishes of elders; 2) an approach to maintain friendly, appreciative and reciprocal relationships with fieldworkers, and the broader research programme; and 3) an effort to retain study benefits, either for individuals, whole households or wider communities. That refusals and underlying rationales were silent posed multiple dilemmas for fieldworkers, who are increasingly recognised to play a key interface role between researchers and communities in many settings. Silent refusals reflect and reinforce complex power relations embedded in decisions about research participation, with important implications for consent processes and broader research ethics practice. Fieldworkers need support to reflect upon and respond to the ethically charged environment they work in.

Science
15 May 2015 vol 348, issue 6236, pages 729-832
http://www.sciencemag.org/current.dtl
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In Depth
Infectious Diseases
Ebola survivors fight back in plasma studies
Martin Enserink*
In the Guinean capital, Conakry, 90 people have so far been treated in a clinical trial that aims to seek whether plasma from Ebola survivors can help patients. Animal studies of similar therapies had yielded mixed results, and the findings of a small human study in 1995 were ambiguous. The study aims to recruit 130 patients, but enrollment has ground to a halt because the last Ebola patient in Conakry was discharged on 28 April. Results are expected later this year, but researchers acknowledge that they will be difficult to interpret because the study has no control arm.

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Policy Forum
Public Health
Linking funds to actions for global health emergencies
C. J. Standley, E. M. Sorrell, S. Kornblet, A. Vaught, J. E. Fischer, R. Katz*
Author Affiliations
Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA.
The failings of the international community’s response to the Ebola virus disease outbreak in West Africa underscore the need for new mechanisms for governance and mobilization of resources for timely, coordinated responses to public health threats (1). Creating a global finance mechanism, ideally tied to existing global health frameworks, is a first step. The World Bank recently announced it would create a Pandemic Emergency Facility (PEF). The next necessary element is a trigger to release those funds to support rapid and effective responses during early phases of a public health event. With the World Health Assembly convening soon, we suggest how the World Health Organization’s (WHO’s) International Health Regulations (IHR) present such an initiator.

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Perspective
Cancer Immunotherapy
Neo approaches to cancer vaccines
Lélia Delamarre, Ira Mellman, Mahesh Yadav
Author Affiliations
Genentech, South San Francisco, CA 94080, USA.
The recent success of cancer immunotherapies is rapidly changing the face of both cancer care and cancer biology. The excitement has been driven by various antibodies that block so-called “immune checkpoints” to enhance antitumor immune responses (1). Although this approach has produced durable responses for patients across a variety of tumor types, it is also the case that only a minority of patients benefit from these agents. It seems likely that among patients who do not respond or respond poorly to immunotherapies, there will be individuals who lack preexisting antitumor T cell responses. In principle, this situation can be addressed with antitumor vaccines, a strategy that has yet to yield much success despite decades of effort. The recent finding that tumor-specific mutations (neoantigens) may drive potent antitumor responses has provided hope and prompted renewed interest in the field (2). On page 803 of this issue, Carreno et al. (3) report, in a first proof of concept study, that CD8 T cell responses to tumor neoantigens can be enhanced through vaccination in melanoma patients.

Vaccine
Volume 33, Issue 24, Pages 2735-2850 (4 June 2015)
http://www.sciencedirect.com/science/journal/0264410X/33
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Immunogenicity of poliovirus vaccines in chronically malnourished infants: A randomized controlled trial in Pakistan
Original Research Article
Pages 2757-2763
Ali Faisal Saleem, Ondrej Mach, Farheen Quadri, Asia Khan, Zaid Bhatti, Najeeb ur Rehman, Sohail Zaidi, William C. Weldon, Steven M. Oberste, Maha Salama, Roland W. Sutter, Anita K.M. Zaidi
Abstract
Reaching high population immunity against polioviruses (PV) is essential to achieving global polio eradication. Efficacy of oral poliovirus vaccine (OPV) varies and is lower among children living in tropical areas with impoverished environments. Malnutrition found as a risk factor for lower serological protection against PV. We compared whether inactivated polio vaccine (IPV) can be used to rapidly close the immunity gap among chronically malnourished (stunted) infants in Pakistan who will not be eligible for the 14 week IPV dose in routine EPI schedule. A phase 3, multicenter 4-arm randomized controlled trial conducted at five Primary Health Care (PHC) centers in Karachi, Pakistan. Infants, 9–12 months were stratified by length for age Z score into chronically malnourished and normally nourished. Infants were randomized to receive one dose of either bivalent OPV (bOPV) alone or bOPV + IPV. Baseline seroprevalence of PV antibodies and serum immune response to study vaccine dose were assessed by neutralization assay. Vaccine PV shedding in stool was evaluated 7 days after a bOPV challenge dose. Sera and stool were analyzed from 852/928 (92%) enrolled children. At baseline, the seroprevalence was 85.6% (n = 386), 73.6% (n = 332), and 70.7% (n = 319) in malnourished children against PV types 1, 2 and 3 respectively; and 94.1% (n = 448), 87.0% (n = 441) and 83.6% (n = 397) in the normally nourished group (p < 0.05). Children had previously received 9–10 doses of bOPV (80%) or tOPV (20%). One dose of IPV + bOPV given to malnourished children increased their serological protection (PV1, n = 201, 97.6%; PV2, n = 198, 96.1% and PV3, n = 189, 91.7%) to parity with normally nourished children who had not received IPV (p = <0.001). Seroconversion and boosting for all three serotypes was significantly more frequent in children who received IPV + bOPV than in those with bOPV only (p < 0.001) in both strata. Shedding of polioviruses in stool did not differ between study groups and ranged from 2.4% (n = 5) to 7.1% (n = 15). In malnourished children the shedding was reduced after bOPV + IPV compared to bOPV only.
Chronically malnourished infants were more likely to be unprotected against polioviruses than normal infants. bOPV + IPV helped close the immunity gap better than bOPV alone.

Vaccine
Volume 33, Issue 24, Pages 2735-2850 (4 June 2015)
http://www.sciencedirect.com/science/journal/0264410X/33
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An extended cost-effectiveness analysis of publicly financed HPV vaccination to prevent cervical cancer in China
Original Research Article
Pages 2830-2841
Carol E. Levin, Monisha Sharma, Zachary Olson, Stéphane Verguet, Ju-Fang Shi, Shao-Ming Wang, You-Lin Qiao, Dean T. Jamison, Jane J. Kim
Abstract
Introduction
Cervical cancer screening and existing health insurance schemes in China fall short of reaching women with prevention and treatment services, especially in rural areas where the disease burden is greatest. We conducted an extended cost-effectiveness analysis (ECEA) to evaluate public financing of HPV vaccination to prevent cervical cancer, adding new dimensions to conventional cost-effectiveness analysis through an explicit inclusion of equity and impact on financial risk protection.
Methods
We synthesized available epidemiological, clinical, and economic data from China using an individual-based Monte Carlo simulation model of cervical cancer to estimate the distribution of deaths averted by income quintile, comparing vaccination plus screening against current practice. We also estimated reductions in cervical cancer incidence, net costs to the government (HPV vaccination costs minus cervical cancer treatment costs averted), and patient cost savings, as well as the incremental government health care costs per death averted.
Results
HPV vaccination is cost-effective across all income groups when the cost is less than US $50 per vaccinated girl. Compared to screening alone, adding preadolescent HPV vaccination followed by cervical cancer screening in adulthood could reduce cancer by 44 percent across all income groups, while providing relatively higher financial protection to the poorest women. The absolute numbers of cervical cancer deaths averted and the financial risk protection from HPV vaccination are highest among women in the lowest quintile; women in the bottom income quintiles received higher benefits than those in the upper wealth quintiles. Patient cost savings represent a large proportion of poor women’s average per capita income, reaching 60 percent among women in the bottom income quintile and declining to 15 percent among women in the wealthiest quintile

Vaccine
Volume 33, Issue 24, Pages 2735-2850 (4 June 2015)
http://www.sciencedirect.com/science/journal/0264410X/33
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Effect of multiple, simultaneous vaccines on polio seroresponse and associated health outcomes
Original Research Article
Pages 2842-2848
Michael P. Broderick, M. Steven Oberste, Deborah Moore, Sandra Romero-Steiner, Christian J. Hansen, Dennis J. Faix
Abstract
Background
Administration of multiple simultaneous vaccines to infants, children, and military recruits is not uncommon. However, little research exists to examine associated serological and health effects, especially in adults.
Method
We retrospectively examined 416 paired serum specimens from U.S. military subjects who had received the inactivated polio vaccine (IPV) alone or in combination with either 1 other vaccine (4 group). Each of the 2 groups was subdivided into 2 subgroups in which Tdap was present or absent.
Results
The >4 group was associated with a higher proportion of polio seroconversions than the 4 subgroup that excluded Tdap showed no difference between them (p > 0.1). However, the >4 subgroup that included Tdap had significantly more seroconversions than either the 4 subgroup that excluded Tdap (p < 0.01). Overall, at least 98% of subjects were at or above the putative level of seroprotection both pre- and post-vaccination, yet at least 81% of subjects seroconverted. In an analysis of 400 of the subjects in which clinic in- and outpatient encounters were counted over the course of 1 year following vaccinations, there was no significant difference between the 2 groups (p > 0.1).
Conclusion
A combination of >4 vaccines including IPV appeared to have an immunopotentiation effect on polio seroconversion, and Tdap in particular was a strong candidate for an important role. The dose of IPV we studied in our subjects, who already had a high level of seroprotection, acted as a booster. In addition, there appear to be no negative health consequences from receiving few versus more multiple simultaneous vaccinations.

Vaccine
Volume 33, Supplement 1, Pages A1-A254 (7 May 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/supp/S1

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Supplement – Expanding the Evidence Base to Inform Vaccine Introduction: Program Costing and Cost-effectiveness Analyses
pp. A1-A254 (7 May 2015)
Perspectives on expanding the evidence base to inform vaccine introduction: Program costing and cost-effectiveness analyses
Jon Kim Andrusa, Damian G. Walkerb,
doi:10.1016/j.vaccine.2015.01.001

Over the past decade, the Pan American Health Organization’s (PAHO) ProVac Initiative has worked with countries to promote the development and use of evidence for immunization policymaking [1]. This supplement features examples of ProVac’s country-led research and other partner efforts in this area with an emphasis on analyses of cost-effectiveness, program costs and financial flows. The findings from these studies represent one important outcome of a broader objective to strengthen and institutionalize national capacity to generate, assess, interpret and use local data in the decision making process. Achieving this broader objective has always been a guiding principle of ProVac’s work [2].

Due to the success of ProVac, PAHO has received numerous requests for similar support from countries outside of the Americas Region. Therefore, in 2011, the ProVac International Working Group was formed with the aim of transferring the ProVac Initiative’s methods and tools to other WHO regions [3]. The International Working Group includes the Agence de Médicine Préventive (AMP), the United States’ Centers for Disease Control and Prevention (CDC), the Program for Appropriate Technologies in Health (PATH), PAHO, the Sabin Vaccine Institute, and World Health Organization headquarters and its regional offices for Africa (AFRO), Eastern Mediterranean (EMRO) and Europe (EURO). A total of 17 countries in these three regions received training from the International Working Group over a two year period resulting in nine cost-effectiveness studies [3].

The impact of ProVac’s mission to increase national capacity to make evidence-based immunization policy is difficult to quantify. However, cost-effectiveness analyses in this supplement demonstrate the quality of evidence a national team can produce for their own decision making use when given access to flexible tools and training. Nine studies were supported through the ProVac IWG platform and results from Albania, Croatia, Egypt, Georgia, Iran, Kenya, Senegal and Uganda are featured in this supplement [4], [5], [6], [7], [8], [9] and [10]. Another six studies featured in this supplement were from countries in the PAHO Region, including Argentina, Belize, Brazil, Honduras, Paraguay and Peru [11], [12], [13], [14], [15] and [16]. They were all led by national health professionals and stakeholders.

These analyses provide an important update to the cost-effectiveness literature on new vaccines from a diverse set of country contexts. With the exception of one cost-effectiveness analysis developed in a high-income country setting (Croatia) with no access to affordable vaccine prices, the findings from the cost-effectiveness research support the previously published evidence that pneumococcal conjugate, rotavirus and HPV vaccines represent good value for money, where disease burden is substantial and/or treatment costs are relatively high and the vaccines can be procured at an affordable price. All primary results from these analyses were subjected to sensitivity analyses to examine the robustness of the findings to changes in the values of key inputs and assumptions. For example, these analyses often considered vaccine price trends over time and other technical or programmatic uncertainties (i.e. booster doses, herd immunity and delivery strategies). Since many countries that received support from the ProVac IWG will graduate from Gavi subsidies in the coming years, these additional analyses were useful to explore the impact of price changes in the cost-effectiveness results. While the results are subject to uncertainty, the conclusions were stable.

The supplement also highlights a recent multi-country study on the costs and financing of routine immunization and new vaccines (EPIC) [17]. The EPIC study included six countries: Benin, Ghana, Honduras, Moldova, Uganda and Zambia. This work represents the first systematic evaluation of costs in countries with a baseline of routine immunization, while also estimating the incremental cost of new vaccines (pneumococcal and rotavirus) to the routine system [18].
The EPIC studies are unique in both the breadth and depth of the data collected from over 300 primary health care facilities across the six countries. An important outcome of this work was the development and use of a Common Approach to costing [17], as well as the creation of a community of practice around cost and financial analysis of immunization. The costing studies allow us to not only describe the range of total and unit costs of routine immunization (RI) [18], [19], [20] and [21], but also to evaluate more systematically the determinants of costs and productivity [22] and [23]. Finally, each country team undertook a financial mapping of the total resources available for routine immunization by source [24] and [25]. This work will be used to improve budgeting and planning of national immunization programs. The evidence will also be used to inform advocacy aimed at greater domestic resource mobilization.

Finally, leading researchers, decision makers and donors comment on the development and use of the data featured in this supplement from their perspective. The four commentaries highlight the following themes (1) the potential role of cost-effectiveness analysis in price negotiation; (2) the continued need for models and methodological approaches that can be adapted for use in low resource policy settings; and (3) the juxtaposition of supporting country-level decision making in the context of donor priority setting [26], [27], [28] and [29]. From Thailand’s Health Intervention and Technology Assessment Program’s (HITAP) perspective, cost-effectiveness data is critical in price negotiation for countries, like Thailand, that do not have access to donor subsidies or innovative financing mechanisms [26]. We see how the HITAP approach could easily be adapted in a context like Croatia, where PCV was found to be not cost-effective at the current assumed price of US$30-35 [8]. Decision support systems as a fundamental underpinning to making better choices with public monies are described from a decision scientist’s perspective in ‘The ProVac Initiative and evolving decision’support’ [27]. As we’ve seen with the implementation of ProVac, these systems require a long-term investment and commitment to building institutions that require and support an evidence-based approach.

We have only just begun with immunization programs but the lessons from the ProVac Initiative may serve to guide future work in promoting health technology assessment across the health sector. Lastly, Gavi and the immunization program manager from Honduras, a Gavi-graduating country, share perspectives on the increasing importance of priority-setting at country level for effective immunization policy and the support that Gavi-eligible countries may need today in order to enter into the near-term graduation from Gavi support [28] and [29]. All commentaries combined offer an insight into developing a forward thinking approach to the use of evidence for immunization decision making.

We hope the reader finds that this collection of articles provides useful insight into the work required to help countries strengthen their capacity to make evidence-based policy decisions. Accelerating national policy development on new vaccines adoption, together with rapid deployment of vaccines when appropriate, will contribute to saving more lives more quickly.

Disclaimer
The studies published herein include but are not limited to work conducted by the Pan American Health Organization’s ProVac Initiative, the ProVac International Working Group and the EPIC study with financial support from the Bill and Melinda Gates Foundation (grant no. OPP50788). The views expressed in each article are those of the authors alone and do not necessarily reflect the official policy or position of the Bill and Melinda Gates Foundation or the Pan American Health Organization.

Journal of the American Board of Family Medicine ( JABFM )
May-June 2015; 28 (3)
http://www.jabfm.org/content/current

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Impact of an Electronic Health Record (EHR) Reminder on Human Papillomavirus (HPV) Vaccine Initiation and Timely Completion
Mack T. Ruffin IV, MD, MPH, Melissa A. Plegue, MA, Pamela G. Rockwell, DO, Alisa P. Young, MD, Divya A. Patel, PhD and Mark W. Yeazel, MD, MPH
Abstract
Background: The initiation and timely completion of the human papillomavirus (HPV) vaccine in young women is critical. We compared the initiation and completion of the HPV vaccine among women in 2 community-based networks with electronic health records: 1 with a prompt and reminder system (prompted cohort) and 1 without (unprompted cohort).
Methods: Female patients aged 9 to 26 years seen between March 1, 2007, and January 25, 2010, were used as the retrospective cohort. Patient demographics and vaccination dates were extracted from the electronic health records.
Results: Patients eligible for the vaccine included 6019 from the prompted cohort and 9096 from the unprompted cohort. Mean age at initiation was 17.3 years in the prompted cohort and 18.1 years in the unprompted cohort. Significantly more (P < .001) patients initiated the vaccine in the prompted cohort (34.9%) compared with the unprompted cohort (21.5%). African Americans aged 9 to 18 years with ≥3 visits during the observation period were significantly more likely to initiate in the prompted cohort (P < .001). The prompted cohort was significantly more likely (P < .001) to complete the vaccine series in a timely manner compared with the unprompted cohort.
Conclusion: More patients aged 9 to 26 years initiated and achieved timely completion of the HPV vaccine series in clinics using an electronic health record system with prompts compared with clinics without prompts.

Philosophical Transactions of the Royal Society B: Biological Sciences:
19 June 2015; volume 370, issue 1671
Discussion meeting issue ‘Biological challenges to effective vaccines in the developing world’ organized and edited by Nicholas Grassly, Gagandeep Kang and Beate Kampmann

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Introduction:
Biological challenges to effective vaccines in the developing world
Nicholas C. Grassly, Gagandeep Kang, Beate Kampmann
Phil. Trans. R. Soc. B 2015 370 20140138; DOI: 10.1098/rstb.2014.0138. Published 11 May 2015

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Review article:
Searching for the human genetic factors standing in the way of universally effective vaccines
Alexander J. Mentzer, Daniel O’Connor, Andrew J. Pollard, Adrian V. S. Hill
Phil. Trans. R. Soc. B 2015 370 20140341; DOI: 10.1098/rstb.2014.0341. Published 11 May 2015

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Research article:
Genomics of immune response to typhoid and cholera vaccines
Partha P. Majumder
Phil. Trans. R. Soc. B 2015 370 20140142; DOI: 10.1098/rstb.2014.0142. Published 11 May 2015

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Research article:
The impact of maternal infection with Mycobacterium tuberculosis on the infant response to bacille Calmette–Guérin immunization
Patrice A. Mawa, Gyaviira Nkurunungi, Moses Egesa, Emily L. Webb, Steven G. Smith, Robert Kizindo, Mirriam Akello, Swaib A. Lule, Moses Muwanga, Hazel M. Dockrell, Stephen Cose, Alison M. Elliott
Phil. Trans. R. Soc. B 2015 370 20140137; DOI: 10.1098/rstb.2014.0137. Published 11 May 2015

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Review article:
Malnutrition and vaccination in developing countries
Andrew J. Prendergast
Phil. Trans. R. Soc. B 2015 370 20140141; DOI: 10.1098/rstb.2014.0141. Published 11 May 2015

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Review article:
Is infant immunization by breastfeeding possible?
Valerie Verhasselt
Phil. Trans. R. Soc. B 2015 370 20140139; DOI: 10.1098/rstb.2014.0139. Published 11 May 2015

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Review article:
Exploring the role of environmental enteropathy in malnutrition, infant development and oral vaccine response
Allissia A. Gilmartin, William A. Petri
Phil. Trans. R. Soc. B 2015 370 20140143; DOI: 10.1098/rstb.2014.0143. Published 11 May 2015

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Review article:
Potential for use of retinoic acid as an oral vaccine adjuvant
Mpala Mwanza-Lisulo, Paul Kelly
Phil. Trans. R. Soc. B 2015 370 20140145; DOI: 10.1098/rstb.2014.0145. Published 11 May 2015

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Review article:
Probiotics, antibiotics and the immune responses to vaccines
Ira Praharaj, Sushil M. John, Rini Bandyopadhyay, Gagandeep Kang
Phil. Trans. R. Soc. B 2015 370 20140144; DOI: 10.1098/rstb.2014.0144. Published 11 May 2015

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Review article:
Vaccinology in the era of high-throughput biology
Helder I. Nakaya, Bali Pulendran
Phil. Trans. R. Soc. B 2015 370 20140146; DOI: 10.1098/rstb.2014.0146. Published 11 May 2015

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Opinion piece:
Systems vaccinology: a promise for the young and the poor
Nelly Amenyogbe, Ofer Levy, Tobias R. Kollmann
Phil. Trans. R. Soc. B 2015 370 20140340; DOI: 10.1098/rstb.2014.0340. Published 11 May 2015

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Review article:
Factors influencing innate immunity and vaccine responses in infancy
Beate Kampmann, Christine E Jones
Phil. Trans. R. Soc. B 2015 370 20140148; DOI: 10.1098/rstb.2014.0148. Published 11 May 2015

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Opinion piece:
Can immunological principles and cross-disciplinary science illuminate the path to vaccines for HIV and other global health challenges?
Christopher B. Wilson, Christopher L. Karp
Phil. Trans. R. Soc. B 2015 370 20140152; DOI: 10.1098/rstb.2014.0152. Published 11 May 2015

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Review article:
Vaccines against enteric infections for the developing world
Cecil Czerkinsky, Jan Holmgren
Phil. Trans. R. Soc. B 2015 370 20150142; DOI: 10.1098/rstb.2015.0142. Published 11 May 2015

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Review article:
Delivering vaccines to the people who need them most
Michèle Anne Barocchi, Rino Rappuoli
Phil. Trans. R. Soc. B 2015 370 20140150; DOI: 10.1098/rstb.2014.0150. Published 11 May 2015

Reproductive Health
Volume 12 Supplement 1 [2015]
http://www.reproductive-health-journal.com/supplements/12/S1
Special Supplement – True costs of maternal death
Edited by Jose Belizan and Suellen Miller
An accompanying blog can be found here.
Publication charges for this supplement were funded by Family Care International and the FXB Center for Health and Human Rights. The articles have been through the journal’s standard peer review process for supplements. The Supplement Editors declare that they have no competing interests.

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Research
Intergenerational impacts of maternal mortality: Qualitative findings from rural Malawi
Junior Bazile, Jonas Rigodon, Leslie Berman, Vanessa M Boulanger, Emily Maistrellis, Pilira Kausiwa, Alicia Yamin Reproductive Health 2015, 12(Suppl 1):S1 (6 May 2015)

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Research
Continuing with “…a heavy heart” – consequences of maternal death in rural Kenya
Rohini Pande, Sheila Ogwang, Robinson Karuga, Radha Rajan, Aslihan Kes, Frank O Odhiambo, Kayla Laserson, Kathleen Schaffer Reproductive Health 2015, 12(Suppl 1):S2 (6 May 2015)

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Research
The economic burden of maternal mortality on households: evidence from three sub-counties in rural western Kenya
Aslihan Kes, Sheila Ogwang, Rohini Pande, Zayid Douglas, Robinson Karuga, Frank O Odhiambo, Kayla Laserson, Kathleen Schaffer Reproductive Health 2015, 12(Suppl 1):S3 (6 May 2015)

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Research
Consequences of maternal mortality on infant and child survival: a 25-year longitudinal analysis in Butajira Ethiopia (1987-2011)
Corrina Moucheraud, Alemayehu Worku, Mitike Molla, Jocelyn E Finlay, Jennifer Leaning, Alicia Yamin Reproductive Health 2015, 12(Suppl 1):S4 (6 May 2015)

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Research
“Without a mother”: caregivers and community members’ views about the impacts of maternal mortality on families in KwaZulu-Natal, South Africa
Lucia Knight, Alicia Yamin Reproductive Health 2015, 12(Suppl 1):S5 (6 May 2015)

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Research
Impacts of maternal mortality on living children and families: A qualitative study from Butajira, Ethiopia
Mitike Molla, Israel Mitiku, Alemayehu Worku, Alicia Yamin Reproductive Health 2015, 12(Suppl 1):S6 (6 May 2015)

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Research
The impacts of maternal mortality and cause of death on children’s risk of dying in rural South Africa: evidence from a population based surveillance study (1992-2013)
Brian Houle, Samuel J Clark, Kathleen Kahn, Stephen Tollman, Alicia Yamin Reproductive Health 2015, 12

Media/Policy Watch
This section is intended to alert readers to substantive news, analysis and opinion from the general media on vaccines, immunization, global; public health and related themes. Media Watch is not intended to be exhaustive, but indicative of themes and issues CVEP is actively tracking. This section will grow from an initial base of newspapers, magazines and blog sources, and is segregated from Journal Watch above which scans the peer-reviewed journal ecology.

We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.

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The Guardian
http://www.guardiannews.com/
Accessed 16 May 2015
Pay big pharma to solve antibiotics crisis, says UK government review
Jim O’Neill, economist appointed by David Cameron, says a global fund would incentivise drug firms to save millions of lives
14 May 2015
Pharmaceutical companies should be given cash incentives of up to $3bn to find and develop new antibiotics desperately needed to keep infections at bay, according to a UK government review. Jim O’Neill, the economist and former chair of Goldman Sachs Asset Management, asked to find solutions to the global antibiotic crisis, said at the launch of his report that a fund worth between $16bn and $37bn per decade would be enough to incentivise drug companies to turn their attentions to antibiotics.

The Antimicrobial Review (AMR) Committee proposals, he said, could “supercharge antibiotics discovery, potentially saving millions of lives for a fraction of the $100tn cost of inaction”. He estimated that globally, 10 million people could die every year from untreatable infections unless new antibiotics are discovered…

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New Yorker
http://www.newyorker.com/
Accessed 16 May 2015
The Brighter Side of Rabies – The New Yorker
May 6, 2015 … Callaway and his team began with a vaccine form of the rabies virus that was missing the hook-making gene, rendering it unable to jump …

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New York Times
http://www.nytimes.com/
Accessed 16 May 2015
Mexico Says Bacteria Contaminated Vaccine Blamed in 2 Deaths
Mexico’s public health system says a localized bacterial contamination appears to have been responsible for infant vaccine causing the deaths of two babies and the sickening of 31. The Mexican Institute for Social Security
May 13, 2015 –

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Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 16 May 2015
California Senate Approves School Vaccine Bill
Bill would prohibit parents from seeking exemptions because of religious or personal beliefs
Associated Press
May 14, 2015 2:53 p.m. ET
SACRAMENTO, Calif.—The state Senate has passed a bill aimed at increasing California’s school immunization rates…