Obstetrics & Gynecology
May 2015 – Volume 125 – Issue 5
http://journals.lww.com/greenjournal/Pages/currenttoc.aspx

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Effect of Adverse Media Reports and Abeyance of Governmental Recommendation of Human Papillomavirus Vaccine in Japan [368].
Tanaka, Yusuke MD; Enomoto, Takayuki MD, PhD; Kimura, Tadashi MD; Matsuo, Koji MD; Takata, Tomomi MD, PhD; Yagi, Asami
Abstract
INTRODUCTION: Administration of the human papillomavirus (HPV) vaccine decreased dramatically in Japan after extensive news of the adverse vaccine events and suspension of the governmental recommendation for the vaccine. In this study, we investigated the knowledge and acceptance of vaccinated adolescents concerning cervical cancer, cancer screening, and the HPV vaccine. Furthermore, we analyzed whether and how much the news affected acceptance of the vaccination.
METHODS: This study was conducted as a part of Osaka Clinical resEArch of HPV vacciNe (OCEAN) study. A questionnaire was distributed to 2,777 study registrants.
RESULTS: The response rate was 38%. A recognition rate of the news of the vaccine’s adverse events was 80%; it was 68% for awareness of the government’s announcement of the suspension of its recommendation for the vaccine. Among those who had a chance to hear or see the negative news during their vaccination period, 46 (60%) continued vaccination while knowing of the news, 22 (29%) discontinued vaccination, and nine (11%) continued vaccination without an awareness of the news. Reports of the vaccine’s adverse events were the main reason for not continuing the vaccination series. Those who consulted doctors after hearing the adverse news were significantly more likely to continue their vaccinations than those who did not.
CONCLUSION: Our results should help in understanding the need of a strong promotion of vaccine use and cancer screening after future retraction of the recommendation suspension. This may apply for other countries with an unsatisfactory rate of HPV vaccination as a result of fears of adverse vaccine events.

Preventive Medicine
Available online 3 May 2015

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Correlates of HPV vaccine uptake in school-based routine vaccination of preadolescent girls in Norway: A register-based study of 90,000 girls and their parents
Bo Terning Hansena, Suzanne Campbella, Emily Burgerb, Mari Nygårda,
Abstract
Objective
To assess demographic, socioeconomic and behavioural correlates of HPV vaccination of preadolescent girls in a publicly funded, school-based vaccination programme.
Methods
Data for all Norwegian girls born 1997–1999, eligible for routine school-based HPV vaccination in 2009–2011 (n = 90,842), and their registered mother and father, were merged from national registries. Correlates of girl vaccination status were analysed by unadjusted and multivariable logistic regression.
Results
In total, 78.2% of the girls received the first dose of the HPV vaccine, 74.6% received three doses, and 94.8% received the MMR vaccine. Correlates associated with initiation of HPV vaccination included parental age, income and education, maternal occupational status and cervical screening attendance, and girl receipt of the MMR vaccine. Rates of completion of HPV vaccination among initiators were high, and disparities in completion were negligible. Maternal and paternal correlates of daughter HPV vaccination status were similar.
Conclusions
Routine school-based vaccination generally provides equitable delivery, yet some disparities exist. Information campaigns designed to reach the sub-groups with relatively low vaccine uptake could reduce disparities. In none of the sub-groups investigated did uptake of the HPV vaccine approach that of the MMR vaccine, further demonstrating a general potential for improvement in HPV vaccine uptake.

Nursing Research
May/June 2015 – Volume 64 – Issue 3 – p 177–189
http://journals.lww.com/nursingresearchonline/pages/currenttoc.aspx

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Nursing Case Management, Peer Coaching, and Hepatitis A and B Vaccine Completion Among Homeless Men Recently Released on Parole: Randomized Clinical Trial
Nyamathi, Adeline; Salem, Benissa E.; Zhang, Sheldon; Farabee, David; Hall, Betsy; Khalilifard, Farinaz; Leake, Barbara
Abstract
Background: Although hepatitis A virus (HAV) and hepatitis B virus (HBV) infections are vaccine-preventable diseases, few homeless parolees coming out of prisons and jails have received the hepatitis A and B vaccination series.
Objectives: The study focused on completion of the HAV and HBV vaccine series among homeless men on parole. The efficacy of three levels of peer coaching (PC) and nurse-delivered interventions was compared at 12-month follow-up: (a) intensive peer coaching and nurse case management (PC-NCM); (b) intensive PC intervention condition, with minimal nurse involvement; and (c) usual care (UC) intervention condition, which included minimal PC and nurse involvement. Furthermore, we assessed predictors of vaccine completion among this targeted sample.
Methods: A randomized control trial was conducted with 600 recently paroled men to assess the impact of the three intervention conditions (PC-NCM vs. PC vs. UC) on reducing drug use and recidivism; of these, 345 seronegative, vaccine-eligible subjects were included in this analysis of completion of the Twinrix HAV/HBV vaccine. Logistic regression was added to assess predictors of completion of the HAV/HBV vaccine series and chi-square analysis to compare completion rates across the three levels of intervention.
Results: Vaccine completion rate for the intervention conditions were 75.4% (PC-NCM), 71.8% (PC), and 71.9% (UC; p = .78). Predictors of vaccine noncompletion included being Asian and Pacific Islander, experiencing high levels of hostility, positive social support, reporting a history of injection drug use, being released early from California prisons, and being admitted for psychiatric illness. Predictors of vaccine series completion included reporting having six or more friends, recent cocaine use, and staying in drug treatment for at least 90 days.
Discussion: Findings allow greater understanding of factors affecting vaccination completion in order to design more effective programs among the high-risk population of men recently released from prison and on parole.

Journal of Patient-Centered Research and Reviews
Volume 2, Issue 2 (2015)
http://digitalrepository.aurorahealthcare.org/jpcrr/

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System Alignment for VaccinE Delivery (SAVED): Qualitative Interviews Inform a Technology-Based Intervention to Improve Influenza and Pneumococcal Vaccination Rates
Sarah L. Cutrona, University of Massachusetts Medical SchoolFollow
Larry Garber, Meyers Primary Care Institute
Lloyd Fisher, University of Massachusetts Medical School
Peggy Preusse, Reliant Medical Group
Sarah L. Goff, Baystate Medical Center
Meera Sreedhara, Meyers Primary Care Institute
Madeline Jackson, Meyers Primary Care Institute
Devi Sundaresan, Reliant Medical Group
Kathleen M. Mazor, Meyers Primary Care Institute
Abstract
Background/Aims: Influenza and pneumococcal vaccines are beneficial but underutilized. Patient interviews may help identify effective outreach strategies and increase vaccination rates.
Methods: We conducted in-depth qualitative interviews with a purposive sample of adults whose primary care physicians were part of a large multispecialty group practice in central Massachusetts. Interviews occurred between April and October 2014, with individuals who were not up to date on either influenza or pneumococcal vaccines. The goal of the interviews was to: (a) understand barriers to influenza and pneumococcal vaccination, and (b) inform development of provider educational materials and patient outreach materials.
Results: We interviewed 14 people, 57% under age 65 (8 out of 14); 64% female (9 out of 14) (additional interviews are in process). Major themes included trust, influence of family and friends, and impact of vaccination choice on others. Many participants trusted their doctor’s recommendations but did not trust vaccine safety and efficacy. In some cases, the safety of influenza vaccines was compared unfavorably with other vaccines because “they make it up fresh each year” as compared to a vaccine where “it has been given for years.” The majority of participants cited relationships of family, friends or coworkers as influencing their own vaccination decision. While some participants cited concern for others’ health as a reason to get vaccinated (“it’s not fair if you get sick and spread it to everybody else”), others voiced concerns that care-giving responsibilities could be compromised if the vaccine induced illness. Several participants had not previously heard of the pneumococcal vaccine. Preferred modes of information on vaccination included verbal and electronic; hard-copy handouts were preferred by slightly fewer patients. When asked about effective messaging, some responded unfavorably to message components perceived to be condescending or intrusive (“our records indicate that you haven’t yet gotten this vaccine”).
Discussion: We identified several potential barriers to vaccination for patients who were not up to date with influenza or pneumococcal vaccination. Based on these findings, we are developing patient messages that include references to protecting the health of friends and family but which minimize language implying that the sender has been monitoring vaccination behavior.

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.

AFP
http://www.afp.com/
UN struggles to stem new rise in Haiti cholera cases
8 May 2015
United Nations (United States) (AFP) – A deadly cholera epidemic in Haiti that experts say was introduced by UN peacekeepers from Nepal is on the rise, with hundreds of new cases registered weekly, a UN official said Thursday.
Pedro Medrano, the UN coordinator for Haiti’s cholera outbreak, said years of work to beat back the disease are in jeopardy as donors turn away from the emergency.
“Unfortunately because of lack of resources and of the rainy season, in the last six months we have moved from a thousand new cases a month to almost a thousand a week, ” Medrano told AFP in an interview.
The UN official predicts more than 50,000 new cases this year, up from 28,000 last year, the lowest level since the outbreak began in October 2010.
More than 8,800 people have died from cholera and 736,000 Haitians have been infected since the outbreak that expert studies have shown was brought to the island by Nepalese troops…

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The Atlantic
http://www.theatlantic.com/magazine/
Accessed 9 May 201
Bill Gates’s Quest to Determine Why Children Are Dying – The Atlantic
Olga Khazan
May 6, 2015
When it comes to child deaths, the world has made great strides in the past 25 years. “In 1990, one in ten children in the world died before age 5,” Bill and Melinda Gates write on their blog. But thanks to things like vaccines and better nutrition, “today, it’s one in 20.”
The death rate for children younger than one month has proven harder to budge. Newborns account for 44 percent of all childhood deaths, and health experts aren’t sure why. They know it might have something to do with prematurity, or infections, or complications during delivery. But they often don’t know exactly what happened right after a given birth that brought death just a few weeks later. Was the baby not dried off properly? Did the umbilical cord get infected?
In order to better understand the drivers of mortality for all children, on Wednesday, the Bill & Melinda Gates Foundation announced that it’s investing $75 million in a series of surveillance sites that will gather data “about how, where and why children are getting sick and dying,” according to the release. This Child Health and Mortality Prevention Surveillance Network, or CHAMPS, will be spread initially throughout six locations in Africa and South Asia. It will rely on field workers to take biopsies of children who have perished and on beefed-up laboratories that will perform medical testing…

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Brookings
http://www.brookings.edu/
Accessed 9 May 2015
What does the past tell us about the future? Possibilities for child survival in 2030
John McArthur | May 7, 2015
As the Millennium Development Goals approach their 2015 deadline, debates are in full swing about what might form appropriate targets for Sustainable Development Goals (SDG) to 2030 and beyond. At the intergovernmental level, there is active debate around setting a formal SDG target at perhaps 20 or 25 for 2030. Meanwhile Bill and Melinda Gates recently made a high-profile “bet” that global under-5 child mortality will drop from around 46 per 1,000 live births today to 23 by 2030.
In considering potential new goals, a first step is to adopt a clear set of terms. Trajectories usually extrapolate from recent trends. Projections imply assumptions about the future. Possibilities examine potential outcomes under a range of scenarios. Why care about such basic word choices? Simply put, because we need to ensure past trajectories don’t lead to flawed projections that limit our thinking regarding future possibilities…

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CSIS
http://csis.org/
The United States Should Take a Proactive Stance on Polio Eradication Legacy Planning
By Nellie Bristol
May 6, 2015
The U.S. government is a staunch supporter of the ongoing global effort to eradicate polio. It has contributed more than $2 billion to the cause, providing invaluable resources for vaccine purchases, communications, and social mobilization. The U.S. Centers for Disease Control and Prevention and the U.S. Agency for International Development have provided funding and technical assistance for everything from program to disease surveillance and response to laboratory strengthening. While eradication remains elusive—with Pakistan now producing the bulk of the disease—solid support from the United States has helped the Global Polio Eradication Initiative reduce the number of reported polio cases worldwide by more than 99 percent. Given its significant support for the polio program and the potential for polio resources to contribute to other global health priorities, the U.S. government should actively champion polio “legacy planning” over the next several years.
Download PDF file of “The United States Should Take a Proactive Stance on Polio Eradication Legacy Planning”

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Forbes
http://www.forbes.com/
Accessed 9 May 2015
Will Sanofi’s Big Bet On Vaccines Pull It Out Of Its Diabetes Slump?
Arlene Weintraub Contributor
1 May 2015
…Sanofi flipped the standard model of production, choosing to invest in manufacturing capacity long before anyone could say for certain the vaccine would succeed. Michael Watson, vice president of global immunization policy at Sanofi, says the company chose that route so it could get the vaccines to the countries that needed it the most right out of the gate. “Historically it has taken five to 10 years to get vaccines out to lower-income countries,” Watson said in a phone interview shortly after the World Vaccine Conference, held in early April in Washington, D.C., where he was a featured speaker. “What we said with dengue is that we would go ahead and invest in [production] right up front. So we took a risk.”
After more than 20 years of stops and starts, and an estimated $1.5 billion in R&D costs, Sanofi is now preparing to apply for approval for the vaccine in several countries. During a conference call with analysts after the first-quarter results were released, Sanofi’s vaccines chief, Olivier Charmeil, said he expects the first licenses to be granted in Asia and Latin America in the second half of 2015.
Sanofi has several other vaccines in the pipeline, including a late-stage combination shot for children that protects against six diseases. But the company is constantly fighting headwinds in the market that Watson refers to as the “Five A’s” of vaccine development: access, awareness, acceptance, availability, and activation.
In developing countries, access to standard vaccines like polio and diphtheria-tetanus-pertussis (DTP) has been one of the biggest challenges, Watson says, but not because vaccines are unaffordable. “Most children don’t get polio or DTP [vaccines], which cost 12 and 19 cents respectively,” Watson says. “So while some of the newer vaccines were quite expensive to begin with, actually bringing those prices down hasn’t solved the access problem to those one in five children who are not getting anything.”
To combat the access problem, Sanofi is pilot testing research programs in Mexico, Romania, and the African country of Gabon aimed at understanding why coverage gaps are occurring and then developing plans to address the issues. Last year, Watson says, the Mexican government took what it learned from the research and developed a plan to expand access to the flu vaccine. Vaccination rates have risen 60% there in the last year, he says.
As for access to the dengue vaccine, that’s where the flipped production model comes into play, Watson says. The company’s goal is to make the vaccine available in large quantities in the countries where the disease is endemic. He expects Sanofi will still see a significant return on its investment—just not in the same way vaccines makers did in the past. “Rather than taking the old-fashioned route, which was to start with a smaller volume of higher-priced vaccines, we’re going for much higher volume initially,” Watson says. “It’s a much bigger risk, but for everybody’s benefit, we need to do it.”

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New York Times
http://www.nytimes.com/
Accessed 9 May 2015
Africa
Liberia, Ravaged by Ebola, Faces a Future Without It
By NORIMITSU ONISHI
MAY 8, 2015
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After Nearly Claiming His Life, Ebola Lurked in a Doctor’s Eye
By DENISE GRADY MAY 7, 2015
Before he contracted Ebola, Dr. Ian Crozier had two blue eyes. After he was told he was cured of the disease, his left eye turned green. Credit Emory Eye Center
ATLANTA — When Dr. Ian Crozier was released from Emory University Hospital in October after a long, brutal fight with Ebola that nearly ended his life, his medical team thought he was cured. But less than two months later, he was back at the hospital with fading sight, intense pain and soaring pressure in his left eye.
Test results were chilling: The inside of Dr. Crozier’s eye was teeming with Ebola….
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Health
Tracing the Ebola Outbreak, Scientists Hunt a Silent Epidemic
By SHERI FINK- MAY 5, 2015
Scientists are using blood samples collected throughout the Ebola outbreak to map the virus’s spread from country to country by tracking tiny mutations in its gene sequences.
The picture is not yet complete, but intriguing discoveries have been made. Virus mutations first detected in Sierra Leone last spring were found later in Liberia and Mali, and scientists are examining whether this resulted from the chance movements of people across borders.
While some scientists think it is unlikely that the mutations made a difference in how the virus functioned, others are looking at whether this version of the virus had properties that made it more capable of causing infection…
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Science
Review: Paul Offit’s ‘Bad Faith’ Explores Casualties of Doctrine
Books
By ABIGAIL ZUGER, M.D.
MAY 4, 2015

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US News & World Report
http://www.usnews.com/
Vaccines: Why There Is Really No Debate At All
As states continue to clarify laws about exemptions, here’s what we must remember.
By Elaine Cox, M.D. May 4, 2015

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Washington Post
http://www.washingtonpost.com/
Accessed 9 May 2015
A horrifying reminder of what life without vaccines was really like [polio]
By Ana Swanson May 4
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Making polio history
The Post’s View
By Editorial Board May 3
PAKISTAN NOW stands as the main barrier to the global elimination of wild poliovirus. In two other countries where it is endemic, things are going well: There hasn’t been a case in Nigeria in nine months, and there has been only one in Afghanistan so far this year. Outbreaks last year in Syria, Iraq and other parts of Africa have been contained. Consider the progress: In 1988, there were more than 125 countries where polio was endemic. But now, all eyes are on Pakistan as the high season approaches for transmission of the virus. Plans are in place for the fight, methods are known, good intentions declared. Now a nation often weakened by its own internal chaos must deliver.

The poliovirus is highly contagious, largely strikes children under 5 years old and can cause permanent paralysis. The oral vaccine is effective if it can be given to enough children to prevent and interrupt transmission.

Last year, Pakistan recorded 306 cases, which was the highest in 15 years and 85 percent of all those in the entire world. A review of the program in October declared, “Pakistan’s polio programme is a disaster.” The review found inadequate political backing, poor public health programs and little engagement at the local level. “Something big has to change in Pakistan,” the review concluded. Then, Pakistan began this year with a terrible surge of attacks on vaccination teams in what looked like a new campaign by Taliban militants. Violence is a major disruption to the vaccination effort, tearing a hole in the prevention net and allowing the virus to spread.

For two years, children in North and South Waziristan could not be vaccinated because local leaders suspended the campaigns. Then a military operation in the North Waziristan and Khyber tribal areas in the last six months of 2014 displaced nearly a million people. The movement created risks of the virus spreading, but it also opened up a window of opportunity to vaccinate children who had been inaccessible. Outbreaks occur even in more stable areas in Pakistan, where there are clusters of unvaccinated children.

ortunately, research shows that parents have a high degree of acceptance of the need for oral polio vaccines, although suspicion and distrust still linger in some places.
Pakistan is rallying. There have been only 22 cases so far this year, compared with almost 60 at this time last year. Violence has abated, at least in the past month. Emergency operations centers, an important innovation to help monitor the virus, have been set up. Experts also applaud another recent tactic, the recruitment of female volunteers to work on vaccination in their own communities with approval from local religious and tribal leaders. This approach seems to be making headway in previously inaccessible areas. Pakistan’s political leadership also has vowed a renewed campaign.

In the end, the only metric that really counts with polio is getting to zero. The world has never been closer. Pakistan could do much to push this disease into the history books.

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

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– Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
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– Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.
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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– The Wistar Institute Vaccine Center
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

EBOLA/EVD [to 2 May 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

WHO: Ebola Situation Report – 29 April 2015
[Excerpts]
SUMMARY
:: A total of 33 confirmed cases of Ebola virus disease (EVD) was reported in the week to 26 April. Two areas, Forecariah in Guinea and Kambia in Sierra Leone, accounted for 25 (76%) of all confirmed cases reported. Improved community engagement in these areas is required to ensure that all remaining chains of transmission can be tracked and ultimately brought to an end…

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
:: There have been a total of 26,277 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone (figure 1, table 1), with 10,884 reported deaths (outcomes for many cases are unknown). A total of 22 new confirmed cases were reported in Guinea, 0 in Liberia, and 11 in Sierra Leone in the 7 days to 26 April…

WHO strategic response plan 2015: West Africa Ebola outbreak
WHO
ISBN 978 92 4 150869 8 :: 27 pages
pdf: Ebola response strategic plan 2015
Overview
The outbreak of the Ebola virus disease in West Africa is unprecedented in its scale, severity, and complexity. Guinea, Liberia and Sierra Leone are still affected by this outbreak, and are struggling to control the epidemic against a backdrop of extreme poverty, weak health systems and social customs that make breaking human-to-human transmission difficult. While encouraging progress has been made, there is still a considerable effort required to stop all chains of transmission in the affected countries, prevent the spread of the disease to neighbouring countries and to safely re-activate life-saving essential health services.

Strategic objectives for WHO
1. Stop transmission of the Ebola virus in affected countries
2. Prevent new outbreaks of the Ebola virus in new areas and countries
3. Safely reactivate essential health services and increase resilience
4. Fast-track Ebola research and development
5. Coordinate national and international Ebola response

…OVERALL STRATEGY
The next step in the response is crucial: to build on the progress and lessons to date, especially on the critical role of communities. A critical step will be to limit the spread of the virus to the coastal areas of the three high-transmission countries before the onset of the rainy season in April–May 2015. The priority is to identify and isolate all new cases by the end of May, and to confirm that they have come from known transmission chains and contact lists….

…Conclusion
In collaboration with our partners, WHO is determined to support the affected countries to reach zero cases of Ebola virus disease in West Africa and to facilitate the early recovery of the health sector. The successful strategies and lessons already learned in the fight against this devastating disease underpin the pragmatic approach and practical activities encompassed in this new strategic plan for 2015. Getting to zero cases through rigorous surveillance and extensive and thorough case finding, case investigation and management, and contact tracing can only be achieved with the vigilance and close collaboration of our partners and the governments of the most-affected nations. Most importantly, at the district and community levels we need to anticipate and pre-empt resistance, demanding new ways of working and behavioural adaptations of service providers.
The response efforts must continue in earnest because, without the elimination of Ebola, the planned reactivation of essential services disrupted by the epidemic and the future recovery of the countries’ fragile economies and service infrastructures cannot successfully begin. WHO is working with its partners to make sure a positive legacy remains after this crisis; a legacy that encompasses strengthened health systems and a resilience and preparedness.

WHO convenes Meeting for the Assisted Review of the Janssen Ebola Zaire Vaccine Clinical Trials Application by Representatives of Ethics Committee and National Regulatory Authority of Sierra Leone in Accra Ghana
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Accra, 27 April 2015 – Despite signs of the Ebola Virus Disease (EVD) epidemic abating in West Africa, efforts continue to find an effective vaccine that can fight the virus both now and for future generations. As the race for an Ebola vaccine continues, experts gathered in Ghana from 8-10 April 2015 to review the clinical trial application for the Janssen Ebola Zaire Vaccine that will take place in Sierra Leone.

The meeting aimed to review the scientific and ethical aspects of the proposed vaccine trial in Sierra Leone to evaluate the immune response, identify any side effects and determine its effectiveness.

The meeting facilitated by WHO under the platform of the African Vaccine Regulatory Forum (AVAREF) was attended by 60 expert representatives of the Ethics Committee and the Pharmacy Board of Sierra Leone with support from Ghana’s Food and Drug Authority (GFDA), Health Canada, the European Medicines Agency, the Medicines and Healthcare Products Regulatory Agency (MHRA) United Kingdom, and the United States Food and Drug Administration (US FDA). This meeting provided a forum for a thorough discussion on all scientific and ethical aspects of the proposed phase III clinical trial.

The meeting comes at a time when, despite the number of cases reducing, the goal of zero cases has not been reached. As at 15 April, the outbreak, which has persisted for more than a year, has infected 25,826 people and resulted in 10,704 deaths, according to WHO. There still remains a need to develop a vaccine capable of protecting the population in this epidemic and any future ones

The importance of collaborative partnerships in this regard is critical. WHO Coordinator of Regulatory System Strengthening, Director of Essential Medicines and Health Products (EMP) Department, Mr. Michael Ward explains the partnership with AVAREF, “WHO plays a key enabling role in supporting the AVAREF network, so that it may fulfil its potential in accelerating the availability of preventative vaccines and other important therapies for the people of Africa.”

The meeting concluded with a signed agreement by Sierra Leone and Crucell Holland B.V., study sponsor and one of the Janssen Pharmaceutical Companies of Johnson & Johnson noting that further documentation and timelines are required before a final regulatory decision could be provided. AVAREF Chair Dr Beno Yakubu said, “Under the platform of AVAREF, this meeting is an indication of the due diligence taken by the pharmaceutical companies and partners to jointly ensure that the clinical trial process is of the highest ethical and scientific standards to ensure the safety of the volunteers and patients who will ultimately receive the vaccine.”

The meeting was co-chaired by Health Canada (Dr Lindsay Elmgren, Director, Centre for Biologics Evaluation), Ghana National Regulation Authority (NRA) CEO (Mr Hudu Mogtari) and the AVAREF Chair Dr Beno Yakubu).

About the vaccine regimen:
The Ebola vaccine regimen in development at the Janssen Pharmaceutical Companies of Johnson & Johnson, which was discovered in a collaborative research program with the National Institutes of Health, uses a prime-boost combination of two components that are based on AdVac® technology from Crucell Holland B.V., one of the Janssen Pharmaceutical Companies, and the MVA-BN® technology from Bavarian Nordic. The company is collaborating with numerous partners, including London School of Hygiene and Tropical Medicine and Inserm, to accelerate the development of the vaccine regimen. Evaluation of the vaccine regimen commenced with Phase I clinical trial at the Oxford Vaccine Group in December 2014 and this has been followed by Phase 1 studies in the United States (US) and Africa (Kenya, Uganda, Tanzania).

POLIO [to 2 May 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 29 April 2015
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: Our thoughts are with the people of Nepal, where the polio infrastructure is closely involved in relief operations. Polio staff are often among the first to respond in emergencies by utilizing their local knowledge and strong systems to plan, monitor and implement the response.
:: Following a year since the last detection of wild poliovirus in the environment, Israel has been moved from the International Health Regulations (IHR) list of countries infected with poliovirus to the list of countries no longer infected but vulnerable to the international spread of polio. The Emergency Committee of the IHR met on 24 April for the fifth time to discuss the temporary recommendations and a report will be released shortly. More.
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Selected excerpts from Country-specific Reports
Pakistan
:: One new WPV1 case was reported in this week in Peshawar district of Khyber Pakhtunkhwa Province. This most recent case had onset of paralysis on 29 March. The total number of WPV1 cases for 2015 is now 22 (and remains 306 for 2014)
:: Efforts are ongoing to strengthen the implementation of the ‘low season’ emergency operations plan. Strong, functional Emergency Operations Centres (EOCs) are now operational both at the federal and provincial levels. Strategies are focusing on clearly identifying reasons for missed children, and putting in place area-specific mechanisms to overcome area-specific challenges. Independent monitoring is being strengthened and rolled out across wider geographic areas to provide a clearer assessment of quality and associated gaps.
:: Activities are focusing on known infected areas, but also areas deemed at high-risk but which have not reported polio cases. Environmental surveillance indicates widespread transmission of polioviruses, not just in known infected areas but also in areas without cases. Environmental surveillance is proving to be an instrumental supplemental surveillance tool enabling a clearer epidemiological picture.

GAVI [to 2 May 2015]
http://www.gavialliance.org/library/news/press-releases/
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28 April 2015
More than two million Congolese children per year to be protected against polio
Democratic Republic of Congo to introduce Inactivated Polio Vaccine with Gavi and partners’ support.

Kinshasa, 28 April 2015 – More than two million children in the Democratic Republic of Congo will benefit from Inactivated Polio Vaccine (IPV) every year as the country celebrates African Vaccination Week by introducing the vaccine into its routine immunisation schedule…

…The first doses of the vaccine will be delivered this month in four provinces (Bandundu, Bas Congo, Equateur and Kinshasa),a further four provinces (Kasaï Occidental, Kasaï Oriental, Katanga and Maniema) will introduce the vaccine in May and children in the final three provinces (North and South Kivu, Province Orientale) will receive the vaccine in June.

“As long as a child somewhere is not protected against this crippling disease, every child is at risk,” said Anuradha Gupta, deputy CEO of Gavi, the Vaccine Alliance. “Gavi fully supports the government in its efforts to strengthen its immunisation system as high routine coverage establishes a strong base for population immunity to prevent polio outbreaks and builds a sustainable platform for the introduction of IPV and other lifesaving vaccines. Immunisation is not just about protecting children against a disease, it is about unlocking the productivity potential of individuals, communities and countries.”

Strong routine immunisation systems are critical to reach polio elimination targets and prevent thousands of cases of disease and death. The Democratic Republic of Congo, with support from its partners, has improved its routine immunisation coverage and seen the percentage of children receiving DTP3 (three doses of diphtheria, tetanus, pertussis) rise from 25% in 1999 to 72% in 2013. However, geographical challenges as well as conflicts and insecurity have resulted in large differences between provinces.

DRC has been polio-free since the end of 2011 but for many years it was among the most affected countries worldwide. The year before DRC was declared polio-free, 93 cases were recorded. The challenge now for the Congolese health system and other partners is to make sure that polio does not return, and increase routine immunisation coverage against other diseases…

:: Statement – Gavi’s relationship with India
Clarification from Gavi, the Vaccine Alliance
Geneva, 30 April 2015 – Following a recent newspaper report regarding the relationship between Gavi, the Vaccine Alliance and India, Gavi would like to clarify the following points:
An article published recently in an Indian newspaper stated that Gavi was withdrawing funding from India, thereby jeopardising the Government of India’s ongoing efforts to improve immunisation coverage. That is not the case.

Gavi remains a committed partner of India and we will continue to support the country in its endeavours to immunise more of its children against life-threatening diseases.
Thanks to its growing economy, India is projected to reach the threshold of US$ 1,580 Gross National Income per capita which means it has entered what is known as the ‘graduation’ phase in relation to Gavi support.

Over the next five years, Gavi and India will work together towards financing the introductions of some new vaccines and assuring that these will ultimately have budget provisions within the Government of India budget so that children in India continue to have access to vaccines for generations to come.

Gavi applauds the excellent work by the Government of India to improve immunisation coverage under Mission Indradhanush and its work to protect the lives of children living in 201 of the most at risk districts in the country.

Gavi’s work with India
Gavi currently supports pentavalent vaccine which offers protection against five diseases (diphtheria-tetanus-pertussis (DTP), hepatitis B, and Haemophilius influenzae type b) as well as providing funding to help India to strengthen its health systems.

Between 2000 and 2015, Gavi has disbursed more than US$ 240 million to help India to immunse its children against life-threatening diseases. Additionally, Gavi has committed $107 million to support health systems strengthening in India, which is likely to play a role in the success of Mission Indradhanush, over the next five years

IVI Watch [to 2 May 2015]
http://www.ivi.org/web/www/home
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:: IVI joins forces with Kia Motors, Korea, Malawi, and WHO to conduct emergency vaccination in flood-hit areas in Malawi
– Southern region in Malawi hit by cholera outbreak due to recent massive flooding.
– International efforts ongoing to stem the potentially explosive deadly outbreak among other post-flood relief measures.
– IVI teams up with Kia Motors, South Korea’s Ministry of Foreign Affairs, Malawi’s Ministry of Health, and the World Health Organization to vaccinate 160,000 people against cholera in Nsanje District.
[Undated]
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Seoul, Korea – The International Vaccine Institute (IVI), in collaboration with Kia Motors, the Ministry of Foreign Affairs of the Republic of Korea (MOFA), Malawi’s Ministry of Health, and the World Health Organization (WHO) conducted an emergency cholera vaccination campaign in Nsanje District in southern Malawi in response to concerns over a rapidly spreading cholera outbreak. The campaign, which targeted vaccinating 160,000 people, was launched on March 31, 2015.

The floods that hit Nsanje District in January this year have killed 176 people and displaced more than 200,000 people. Malawian President Peter Mutharika declared it a national crisis and urged the international community to provide assistance. Amid the situation, an increasing number of cholera cases have been reported in camps for internally displaced persons and surrounding areas. A total of 329 cases have been confirmed since the outbreak began in February, with half of all cases reported in two weeks through April 10.

In the wake of mounting concerns over a potentially explosive outbreak that could kill and sicken thousands as seen in Haiti in 2010 and South Sudan in 2013, IVI, Malawi’s Ministry of Health, and WHO have worked together to rapidly deploy the oral cholera vaccine as an emergency measure to control the outbreak and prevent its further spread.

Since 2013, Kia Motors has been supporting IVI on a survey of areas considered to be at high risk for cholera in Malawi and on preparations for a pilot cholera vaccination demonstration project. However, when the floods struck and a cholera outbreak emerged in southern Malawi in early 2015, Kia Motors responded to the crisis by supporting the procurement of vaccines needed for the emergency vaccination. In addition, the Korean Ministry of Foreign Affairs has quickly responded to the humanitarian crisis by providing emergency funding to IVI for the vaccination.

“We are thrilled to have the opportunity to provide help in a small way to flood-affected people in a disaster situation through the cholera vaccination project in Malawi,” Chang Muk Choi, the head of CSR Management Team at Kia Motors Corporation said, “Going forward, Kia will redouble efforts to become a company that helps meet the need of our society.”

The emergency vaccination campaign uses an oral cholera vaccine that was developed by IVI through an international product development partnership with collaborators from Korea, India, Sweden, Vietnam and the United States. The vaccine, Shanchol, (manufactured by Shantha Biotechnics, part of the Sanofi Group) was approved by WHO for global use in 2011. The vaccine is given in two doses and protects against cholera for up to five years…

UNICEF [to 2 May 2015]
http://www.unicef.org/media/media_78364.html
:: One week after Nepal earthquake UNICEF warns of disease risk for children
KATHMANDU, 2 May 2015 – One week on from the earthquake in Nepal, UNICEF says the health and wellbeing of children affected by the disaster are hanging in the balance – as many have been left homeless, in deep shock and with no access to basic care. With the monsoon season only a few weeks away, children will be at heightened risk of diseases like cholera and diarrhoeal infections, as well as being more vulnerable to the threat of landslides and floods.

:: Life-saving UNICEF supplies reach Nepal to help 1.7 million children severely affected by earthquake
KATHMANDU, Nepal / NEW YORK, 30 April 2015 – Over the past 48 hours, UNICEF has delivered 29 metric tonnes of humanitarian supplies to Nepal including tents and tarpaulins, water purification tablets, first aid and hygiene kits, as part of ongoing efforts to reach at least 1.7 million children living in areas hardest hit by the earthquake. Over the coming days, UNICEF is planning additional aid items to arrive in Kathmandu.

:: UNICEF delivers lifesaving supplies to Aden as Yemen runs out of medicine, equipment
SANA’A, Yemen/AMMAN, Jordan, 28 April 2015 – A UNICEF shipment of urgent medical supplies reached Yemen today and will benefit more than 500,000 people, mostly women and children, for the next three months.

Sabin Vaccine Institute Watch [to 2 May 2015]
http://www.sabin.org/updates/pressreleases
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9th International Conference on Typhoid, Invasive NTS Disease Held in Bali, Indonesia
BALI, INDONESIA — May 1, 2015 —The Coalition against Typhoid (CaT), in collaboration with Bio Farma, began the 9th International Conference on Typhoid and Invasive NTS Disease in Bali, Indonesia, with more than 200 public health experts from around the world in attendance. Over the next three days, they will discuss strategies to combat typhoid and invasive non-typhoidal salmonella (iNTS) disease. Experts will present their research on disease burdens, the cost effectiveness of intervention strategies and global policy recommendations for invasive salmonelloses.

Global Fund [to 2 May 2015]
http://www.theglobalfund.org/en/mediacenter/newsreleases/

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Global Fund Launches Human Rights Complaints Procedure
27 April 2015
GENEVA – The Global Fund partnership has launched a human rights complaints procedure as part of its commitment to protect and promote human rights in the context of fighting AIDS, tuberculosis and malaria.

The complaints mechanism allows individuals to submit a complaint to the Global Fund’s Office of the Inspector General if any of five minimum human rights standards is believed to have been violated by an implementer of Global Fund grants, in line with the partnership’s commitment to the highest standards of accountability.

Any individual can contact the Office of the Inspector General by email, by telephone or through the Global Fund’s website. All information will remain confidential, and anyone making a complaint can also choose to remain anonymous.

All Global Fund-supported programs are required to meet minimum human rights standards aimed at guaranteeing that Global Fund investments do not infringe upon human rights, that they increase access to quality services and maximize the potential impact of health interventions.

The information in the complaint will be carefully assessed to identify the seriousness of the allegations, and whether to conduct an investigation. The Global Fund welcomes information that will enable action to improve services.

“The Global Fund needs to know about any human rights infringements in the programs we support,” said Inspector General Mouhamadou Diagne. “We encourage all to speak up using our whistle-blowing channels which are free, safe and confidential.”

The five minimum human rights standards are:
:: non-discriminatory access to services for all, including people in detention;
:: employing only scientifically sound and approved medicines or medical practices;
:: not employing methods that constitute torture or that are cruel, inhuman or degrading;
:: respecting and protecting informed consent, confidentiality and the right to privacy concerning medical testing, treatment or health services rendered; and
:: avoiding medical detention and involuntary isolation, to be used only as a last resort.

Principal Recipients are required to identify the risk that any of these standards may be violated. Where a risk is identified, they may need to develop a mitigation plan to ensure violations do not occur. Principal Recipients must also reflect these five standards in agreements with sub-recipients and suppliers and disclose to the Global Fund any cases of non-compliance with the standards.

The Global Fund partnership is committed to removing human rights barriers that reduce access to health programs, and undermine efforts to end HIV, TB and malaria as epidemics.

Global evidence on inequities in rural health protection
New data on rural deficits in health coverage for 174 countries
ILO – ESS (Extension of Social Security) Paper Series No. 47
Edited by Xenia Scheil-Adlung, ILO
2015 :: 83 pages
Summary (English)
This paper presents global estimates on rural/urban disparities in access to health-care services. The report uses proxy indicators to assess key dimensions of coverage and access involving the core principles of universality and equity. Based on the results of the estimates, policy options are discussed to close the gaps in a multi-sectoral approach addressing issues and their root causes both within and beyond the health sector.

Foreword
While inequities in health protection are increasingly recognized as an important issue in current policy debates on universal health coverage (UHC) and in the post-2015 agenda, the rural/urban divide is largely ignored. A key reason for disregarding equity in coverage and access to health care of large parts of the population relates to the nearly complete absence of disaggregated data providing sufficient information at national, regional and global level. Only vague and fragmented information, often limited to microdata, can be found.

Given this gap in information, it is hardly possible to quantify and assess the extent of disparities and deficits experienced by rural populations as regards key aspects of their rights to health and social protection; the availability, affordability and financial protection of needed health services; and increases or decreases in inequities. Further, governments and policy-makers lack evidence to set priorities, and thus face challenges in addressing the issues that are spread over various policy domains including health, social protection, labour market and more generally economic and fiscal policies.

This paper presents and analyses for the first time related global, regional and national data. It is developed and made available by the ILO. The data allow investigating both the extent of and major causes of rural/urban inequities in coverage and access to health care. Further, it discusses impacts and policy options to achieve more equitable results.
The data development and related assessments provided in this paper are anchored in the framework of universal health protection along the lines of international legal standards, particularly the ILO Social Protection Floors Recommendation, 2012 (No. 202) and the UN Resolution on Universal Health Coverage (12 December 2012).

The paper has been developed as part of the mandate of the ILO Areas of Critical Importance (ACI) on Decent Work in the Rural Economy as well as the ACI on Creating and Extending Social Protection Floors, and has been reviewed by a significant number of experts in relevant development agencies. It highlights the needs of disadvantaged, marginalized and vulnerable rural populations and contributes to related global research products and statistics. Further, it provides guidance to ILO member States on establishing and extending social protection floors for all as a fundamental element of national social security systems.

The evidence provided in the paper suggests that inequalities in coverage and access to health care exist globally, in every region and nearly every country. In fact, the place of residence can be considered as the entry door or key barrier to accessing needed health care. Against this background, the paper aims at contributing to the development of urgently needed policy responses realizing the universal human rights to social protection and health, particularly for rural populations.

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Report Press Release
More than half of the global rural population excluded from health care
ILO report shows huge differences in health care access between rural and urban areas worldwide.
27 April 2015
GENEVA (ILO News) – A new ILO report shows that 56 per cent of people living in rural areas worldwide do not have access to essential health-care services – more than double the figure in urban areas, where 22 per cent are not covered…

…The highest number of people in rural areas who are not covered by essential health-care services is in Africa where it amounts to 83 per cent. The most affected countries also face the highest levels of poverty.

The largest differences between rural and urban areas, however, exist in Asia. For example, in Indonesia the percentage of people that are not covered is twice as high in rural areas as in urban areas.

“Decades of underinvestment in health interrupted efforts to develop national health systems and ultimately resulted in the neglect of health in rural areas. This has a huge human cost. Health is a human right and should be provided to all residents within a country,” said Isabel Ortiz, Director of the ILO’s Social Protection Department .

Lack of health workers in rural areas
The ILO study further finds that even if access to health care is guaranteed by law, people in rural areas remain excluded from health care because such laws are not enforced where they live.

The situation is worsened by the lack of health workers in the world’s rural areas. Although half of the world’s population lives in them, only 23 per cent of the global health workforce is deployed to rural areas. The ILO estimates that 7 million out of the total 10.3 million health workers who are lacking globally are needed in these areas.

Africa and Latin America are the two regions where this problem is most acute. In Nigeria, for example, more than 82 per cent of the rural population is excluded from health-care services due to insufficient numbers of health workers compared to 37 per cent in urban areas.

Underfunding is closely linked to the unavailability of services. The ILO study shows that financial resource gaps are nearly twice as high in rural than in urban areas. The largest gaps are found in Africa. However, significant inequities also exist in Asia and Latin America.

The extent of impoverishing out-of-pocket payments (OOPs) is also high in rural areas. The study shows that rural populations in Africa and Asia are burdened with OOPs that amount to 42 and 46 per cent of total health expenditure respectively. In many Asian countries such as Afghanistan, Bangladesh, Cambodia and Sri Lanka, OOPs are two to three times higher in rural than in urban areas.

“The lack of legal coverage, insufficient numbers of health workers, inadequate funding, and high OOPs have created life-threatening inequities in many countries,” said Xenia Scheil-Adlung, Health Policy Coordinator at the ILO.

“Strengthening both the demand and supply side of services is crucial when moving towards universal health protection, particularly in rural areas. Legal health coverage is necessary, but not sufficient. Only when quality services are actually made available and affordable for all those in need can effective access to health care be ensured,” she added.

Closing the gaps
The study explains that closing rural health access gaps requires a comprehensive and systematic approach that simultaneously addresses missing rights, health workers, funding, financial protection and quality. Such an approach needs to be based on the principles of universality and equity and calls for solidarity in financing and burden sharing.

“Addressing such inequities needs to consider the specific characteristics of rural populations, including high poverty rates and informality of work. This means moving from charity to rights, the provision of health workers with decent working conditions that enhance productivity, and the minimization of out-of-pocket payments by patients to avoid poverty. It also requires complementary socio-economic and labour market policies to trigger inclusive economic growth,” said Scheil-Adlung.

The study highlights the key role that national social protection floors can play in reducing and eliminating rural/urban gaps through human rights-based approaches. In this sense, it points to the importance of ILO Recommendation 202 on social protection floors .

“This study shows that investing in rural health, as part of a national health system, is affordable and yields significant economic and social returns. Progress towards universal health protection is possible in any country, irrespective of its level of income,” Ortiz concludes.

American Journal of Infection Control
May 2015 Volume 43, Issue 5, p423-546, e1-e17
http://www.ajicjournal.org/current

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Cleaning and disinfecting environmental surfaces in health care: Toward an integrated framework for infection and occupational illness prevention
Margaret M. Quinn, Paul K. Henneberger, National Institute for Occupational Safety and Health (NIOSH), National Occupational Research Agenda (NORA) Cleaning and Disinfecting in Healthcare Working Group
p424–434
Published online: March 17, 2015
Open Access
Preview
The Cleaning and Disinfecting in Healthcare Working Group of the National Institute for Occupational Safety and Health, National Occupational Research Agenda, is a collaboration of infection prevention and occupational health researchers and practitioners with the objective of providing a more integrated approach to effective environmental surface cleaning and disinfection (C&D) while protecting the respiratory health of health care personnel.

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Planning and response to Ebola virus disease: An integrated approach
Philip W. Smith, Kathleen C. Boulter, Angela L. Hewlett, Christopher J. Kratochvil, Elizabeth J. Beam, Shawn G. Gibbs, John-Martin J. Lowe, Michelle M. Schwedhelm
p441–446
Preview
The care of patients with Ebola virus disease (EVD) requires the application of critical care medicine principles under conditions of stringent infection control precautions. The care of patients with EVD requires a number of elements in terms of physical layout, personal protective apparel, and other equipment. Provision of care is demanding in terms of depth of staff and training. The key to safely providing such care is a system that brings many valuable skills to the table, and allows communication between these individuals.

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Influenza vaccination uptake and its socioeconomic determinants in the older adult Iranian population: A national study
Parisa Taheri Tanjani, Mehran Babanejad, Farid Najafi
e1–e5
Published online: March 20, 2015
Preview
The relationship between socioeconomic status and influenza vaccine uptake has a different pattern in different societies. The objective of this study was to assess the socioeconomic factors influencing influenza vaccination uptake in the older adult Iranian population.

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 2 May 2015)

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Research article
Clinical trialist perspectives on the ethics of adaptive clinical trials: a mixed-methods analysis
Laurie J Legocki, William J Meurer, Shirley Frederiksen, Roger J Lewis, Valerie L Durkalski, Donald A Berry, William G Barsan, Michael D Fetters BMC Medical Ethics 2015, 16:27 (3 May 2015)

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 2 May 2015)

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Research article
Impact of a community-based perinatal and newborn preventive care package on perinatal and neonatal mortality in a remote mountainous district in Northern Pakistan
Zahid A Memon, Gul N Khan, Sajid B Soofi, Imam Y Baig, Zulfiqar A Bhutta BMC Pregnancy & Childbirth 2015, 15:106 (30 April 2015)
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Research article
Effect of an integrated maternal health intervention on skilled provider’s care for maternal health in remote rural areas of Bangladesh: a pre and post study
Nafisa Huq, Anisuddin Ahmed, Nafis Haque, Moyazzam Hossaine, Jamal Uddin, Faisal Ahmed, MA Quaiyum BMC Pregnancy & Childbirth 2015, 15:104 (28 April 2015)

BMC Public Health
http://www.biomedcentral.com/bmcpublichealth/content
(Accessed 2 May 2015)

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Research article
The role of vaccination coverage, individual behaviors, and the public health response in the control of measles epidemics: an agent-based simulation for California
Fengchen Liu, Wayne T A Enanoria, Jennifer Zipprich, Seth Blumberg, Kathleen Harriman, Sarah F Ackley, William D Wheaton, Justine L Allpress, Travis C Porco
BMC Public Health 2015, 15:447 (1 May 2015)
Abstract (provisional)
Background
Measles cases continue to occur among susceptible individuals despite the elimination of endemic measles transmission in the United States. Clustering of disease susceptibility can threaten herd immunity and impact the likelihood of disease outbreaks in a highly vaccinated population. Previous studies have examined the role of contact tracing to control infectious diseases among clustered populations, but have not explicitly modeled the public health response using an agent-based model.
Methods
We developed an agent-based simulation model of measles transmission using the Framework for Reconstructing Epidemiological Dynamics (FRED) and the Synthetic Population Database maintained by RTI International. The simulation of measles transmission was based on interactions among individuals in different places: households, schools, daycares, workplaces, and neighborhoods. The model simulated different levels of immunity clustering, vaccination coverage, and contact investigations with delays caused by individuals’ behaviors and/or the delay in a health department’s response. We examined the effects of these characteristics on the probability of uncontrolled measles outbreaks and the outbreak size in 365 days after the introduction of one index case into a synthetic population.
Results
We found that large measles outbreaks can be prevented with contact investigations and moderate contact rates by having (1) a very high vaccination coverage (≥ 95%) with a moderate to low level of immunity clustering (≤ 0.5) for individuals aged less than or equal to 18 years, or (2) a moderate vaccination coverage (85% or 90%) with no immunity clustering for individuals (≤18 years of age), a short intervention delay, and a high probability that a contact can be traced. Without contact investigations, measles outbreaks may be prevented by the highest vaccination coverage with no immunity clustering for individuals (≤18 years of age) with moderate contact rates; but for the highest contact rates, even the highest coverage with no immunity clustering for individuals (≤18 years of age) cannot completely prevent measles outbreaks.
Conclusions
The simulation results demonstrated the importance of vaccination coverage, clustering of immunity, and contact investigations in preventing uncontrolled measles outbreaks.

BMC Public Health
http://www.biomedcentral.com/bmcpublichealth/content
(Accessed 2 May 2015)

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Research article
Mistrust surrounding vaccination recommendations by the Japanese government: results from a national survey of working-age individuals
Koji Wada, Derek R Smith
BMC Public Health 2015, 15:426 (26 April 2015)
Abstract
Background
Considering that public attitudes on vaccine safety and effectiveness are known to influence the success of vaccination campaigns, an increased understanding of socio-demographic characteristics might help improve future communication strategies and lead to greater rates of vaccination uptake. This study investigated associations between mistrust for governmental vaccine recommendations and the socio-demographic characteristics of working-age individuals in Japan.
Methods
A web-based, cross-sectional survey of vaccination attitudes was conducted among 3140 Japanese people aged 20 to 69 years. Multiple logistic regression analysis was used to examine statistical associations between vaccination attitudes and socio-demographic characteristics, including the participant’s most trusted information resources, demographic factors and general health conditions.
Results
A total of 893 (28.4%) individuals reported a general mistrust towards the Japanese government’s recommendations for vaccination. Respondents who did not trust official government sources were more likely to consider friends, the internet and books (for both genders); family members and newspapers (among women only); and television (among men only), as the most trusted resources for vaccination-related information. Relatively poor health in men was associated with a general mistrust of vaccination recommendations (adjusted Odds Ratio (aOR): 1.37, 95% Confidence Interval (95% CI): 1.07-1.69). A trend towards worsening general health was also associated with decreasing trust in vaccination recommendations by female respondents as follows: those reporting relatively good health (aOR: 1.24, 95% CI: 1.02-1.47); relatively poor health (aOR: 1.55, 95% CI: 1.22-1.90); and poor health (aOR: 2.10, 95% CI: 1.41-2.63) (p for trend < 0.05).
Conclusions
Overall, this study suggests that communication strategies for rebuilding public trust in vaccination safety need to be urgently addressed in Japan. Such protocols must consider the information sources that working-age populations are most likely to utilize in this country, as well as their general health conditions, especially among females.

BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content
(Accessed 2 May 2015)
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Research article
Uptake of influenza vaccination in pregnancy amongst Australian Aboriginal and Torres Strait Islander women: a mixed-methods pilot study
Kerry-Ann F O’Grady, Melissa Dunbar, Linda G Medlin, Kerry K Hall, Maree Toombs, Judith Meiklejohn, Lisa McHugh, Peter D Massey, Amy Creighton, Ross M Andrews BMC Research Notes 2015,
Abstract (provisional)
Background
Influenza infection during pregnancy causes significant morbidity and mortality. Immunisation against influenza is recommended during pregnancy in several countries however, there are limited data on vaccine uptake, and the determinants of vaccination, in pregnant Australian Aboriginal and/or Torres Islander women. This study aimed to collect pilot data on vaccine uptake and attitudes towards, and perceptions of, maternal influenza vaccination in this population in order to inform the development of larger studies.
Methods
A mixed-methods study comprised of a cross-sectional survey and yarning circles (focus groups) amongst Aboriginal and Torres Strait Islander women attending two primary health care services. The women were between 28 weeks gestation and less than 16 weeks post-birth. These data were supplemented by data collected in an ongoing national Australian study of maternal influenza vaccination. Aboriginal research officers collected community data and data from the yarning circles which were based on a narrative enquiry framework. Descriptive statistics were used to analyse quantitative data and thematic analyses were applied to qualitative data.
Results
Quantitative data were available for 53 women and seven of these women participated in the yarning circles. The proportion of women who reported receipt of an influenza vaccine during their pregnancy was 9/53. Less than half of the participants (21/53) reported they had been offered the vaccine in pregnancy. Forty-three percent reported they would get a vaccine if they became pregnant again. Qualitative data suggested perceived benefits to themselves and their infants were important factors in the decision to be vaccinated but there was insufficient information available to women to make that choice.
Conclusions
The rates of influenza immunisation may continue to remain low for Aboriginal and/or Torres Strait Islander women during pregnancy. Access to services and recommendations by a health care worker may be factors in the lower rates. Our findings support the need for larger studies directed at monitoring and understanding the determinants of maternal influenza vaccine uptake during pregnancy in Australian Aboriginal and Torres Strait Islander women. This research will best be achieved using methods that account for the social and cultural contexts of Aboriginal and Torres Strait Islander communities in Australia.

Bulletin of the World Health Organization
Volume 93, Number 5, May 2015, 285-360
http://www.who.int/bulletin/volumes/93/5/en/

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EDITORIALS
Knowledge for effective action to improve the health of women, children and adolescents in the post-2015 era: a call for papers
Flavia Bustreo & Robin Gorna
doi: 10.2471/BLT.15.156521

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Research
Surveys of measles vaccination coverage in eastern and southern Africa: a review of quality and methods used
Reinhard Kaiser, Messeret E Shibeshi, Jethro M Chakauya, Emelda Dzeka, Balcha G Masresha, Fussum Daniel & Nestor Shivute
Abstract
Objective
To assess the methods used in the evaluation of measles vaccination coverage, identify quality concerns and provide recommendations for improvement.
Methods
We reviewed surveys that were conducted to evaluate supplementary measles immunization activities in eastern and southern Africa during 2012 and 2013. We investigated the organization(s) undertaking each survey, survey design, sample size, the numbers of study clusters and children per study cluster, recording of immunizations and methods of analysis. We documented sampling methods at the level of clusters, households and individual children. We also assessed the length of training for field teams at national and regional levels, the composition of teams and the supervision provided.
Findings
The surveys were conducted in Comoros, Eritrea, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Swaziland, Uganda, Zambia and Zimbabwe. Of the 13 reports we reviewed, there were weaknesses in 10 of them for ethical clearance, 9 for sample size calculation, 6 for sampling methods, 12 for training structures, 13 for supervision structures and 11 for data analysis.
Conclusion
We recommend improvements in the documentation of routine and supplementary immunization, via home-based vaccination cards or other records. For surveys conducted after supplementary immunization, a standard protocol is required. Finally, we recommend that standards be developed for report templates and for the technical review of protocols and reports. This would ensure that the results of vaccination coverage surveys are accurate, comparable, reliable and valuable for programme improvement.

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Research
A multimedia consent tool for research participants in the Gambia: a randomized controlled trial
Muhammed Olanrewaju Afolabi, Nuala McGrath, Umberto D’Alessandro, Beate Kampmann, Egeruan B Imoukhuede, Raffaella M Ravinetto, Neal Alexander, Heidi J Larson, Daniel Chandramohan & Kalifa Bojang
Abstract
Objective
To assess the effectiveness of a multimedia informed consent tool for adults participating in a clinical trial in the Gambia.
Methods
Adults eligible for inclusion in a malaria treatment trial (n = 311) were randomized to receive information needed for informed consent using either a multimedia tool (intervention arm) or a standard procedure (control arm). A computerized, audio questionnaire was used to assess participants’ comprehension of informed consent. This was done immediately after consent had been obtained (at day 0) and at subsequent follow-up visits (days 7, 14, 21 and 28). The acceptability and ease of use of the multimedia tool were assessed in focus groups.
Findings
On day 0, the median comprehension score in the intervention arm was 64% compared with 40% in the control arm (P = 0.042). The difference remained significant at all follow-up visits. Poorer comprehension was independently associated with female sex (odds ratio, OR: 0.29; 95% confidence interval, CI: 0.12–0.70) and residing in Jahaly rather than Basse province (OR: 0.33; 95% CI: 0.13–0.82). There was no significant independent association with educational level. The risk that a participant’s comprehension score would drop to half of the initial value was lower in the intervention arm (hazard ratio 0.22, 95% CI: 0.16–0.31). Overall, 70% (42/60) of focus group participants from the intervention arm found the multimedia tool clear and easy to understand.
Conclusion
A multimedia informed consent tool significantly improved comprehension and retention of consent information by research participants with low levels of literacy.

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Systematic Reviews
Strategies to increase the demand for childhood vaccination in low- and middle-income countries: a systematic review and meta-analysis
Mira Johri, Myriam Cielo Pérez, Catherine Arsenault, Jitendar K Sharma, Nitika Pant Pai, Smriti Pahwa & Marie-Pierre Sylvestre
Abstract
Objective
To investigate which strategies to increase demand for vaccination are effective in increasing child vaccine coverage in low- and middle-income countries.
Methods
We searched MEDLINE, EMBASE, Cochrane library, POPLINE, ECONLIT, CINAHL, LILACS, BDSP, Web of Science and Scopus databases for relevant studies, published in English, French, German, Hindi, Portuguese and Spanish up to 25 March 2014. We included studies of interventions intended to increase demand for routine childhood vaccination. Studies were eligible if conducted in low- and middle-income countries and employing a randomized controlled trial, non-randomized controlled trial, controlled before-and-after or interrupted time series design. We estimated risk of bias using Cochrane collaboration guidelines and performed random-effects meta-analysis.
Findings
We identified 11 studies comprising four randomized controlled trials, six cluster randomized controlled trials and one controlled before-and-after study published in English between 1996 and 2013. Participants were generally parents of young children exposed to an eligible intervention. Six studies demonstrated low risk of bias and five studies had moderate to high risk of bias. We conducted a pooled analysis considering all 11 studies, with data from 11 512 participants. Demand-side interventions were associated with significantly higher receipt of vaccines, relative risk (RR): 1.30, (95% confidence interval, CI: 1.17–1.44). Subgroup analyses also demonstrated significant effects of seven education and knowledge translation studies, RR: 1.40 (95% CI: 1.20–1.63) and of four studies which used incentives, RR: 1.28 (95% CI: 1.12–1.45).
Conclusion
Demand-side interventions lead to significant gains in child vaccination coverage in low- and middle-income countries. Educational approaches and use of incentives were both effective strategies.

Clinical Infectious Diseases (CID)
Volume 60 Issue 10 May 15, 2015
http://cid.oxfordjournals.org/content/current

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Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine Against Invasive Disease and Hospital-Treated Pneumonia Among People Aged ≥65 Years: A Retrospective Case-Control Study
Maya Leventer-Roberts, Becca S. Feldman, Ilan Brufman, Chandra J. Cohen-Stavi, Moshe Hoshen, and Ran D. Balicer
Clin Infect Dis. (2015) 60 (10): 1472-1480 doi:10.1093/cid/civ096
Abstract
This large, population-based study confirmed that the 23-valent pneumococcal polysaccharide vaccine is effective against invasive pneumococcal disease among adults aged ≥65 years. However, the vaccine was not found to be effective in preventing community-acquired pneumonia requiring hospitalization.

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Adverse Events Following Measles, Mumps, and Rubella Vaccine in Adults Reported to the Vaccine Adverse Event Reporting System (VAERS), 2003–2013
Lakshmi Sukumaran, Michael M. McNeil, Pedro L. Moro, Paige W. Lewis, Scott K. Winiecki, and Tom T. Shimabukuro
Clin Infect Dis. (2015) 60 (10): e58-e65 doi:10.1093/cid/civ061
Abstract
Limited data exist on the safety of measles, mumps, and rubella (MMR) vaccine in adults. In our review of reports to the Vaccine Adverse Event Reporting System, no new or unexpected safety concerns for adult MMR vaccination were detected.

Clinical Therapeutics
April 2015 Volume 37, Issue 4, p687-924
http://www.clinicaltherapeutics.com/current

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The Impact of 2-Dose Routine Measles, Mumps, Rubella, and Varicella Vaccination in France on the Epidemiology of Varicella and Zoster Using a Dynamic Model With an Empirical Contact Matrix
Mario J.N.M. Ouwens, Kavi J. Littlewood, Christophe Sauboin, Bertrand Téhard, François Denis, Pierre-Yves Boëlle, Sophie Alain
p816–829.e10
Published online: February 25, 2015
Open Access
Preview
Varicella has a high incidence affecting the vast majority of the population in France and can lead to severe complications. Almost every individual infected by varicella becomes susceptible to herpes zoster later in life due to reactivation of the latent virus. Zoster is characterized by pain that can be long-lasting in some cases and has no satisfactory treatment. Routine varicella vaccination can prevent varicella. The vaccination strategy of replacing both doses of measles, mumps, and rubella (MMR) with a combined MMR and varicella (MMRV) vaccine is a means of reaching high vaccination coverage for varicella immunization.

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Cost-Effectiveness of Routine Varicella Vaccination Using the Measles, Mumps, Rubella and Varicella Vaccine in France: An Economic Analysis Based on a Dynamic Transmission Model for Varicella and Herpes Zoster
Kavi J. Littlewood, Mario J.N.M. Ouwens, Christophe Sauboin, Bertrand Tehard, Sophie Alain, François Denis
p830–841.e7
Published online: February 23, 2015
Open Access
Preview
Each year in France, varicella and zoster affect large numbers of children and adults, resulting in medical visits, hospitalizations for varicella- and zoster-related complications, and societal costs. Disease prevention by varicella vaccination is feasible, wherein a plausible option involves replacing the combined measles, mumps, and rubella (MMR) vaccine with the combined MMR and varicella (MMRV) vaccine. This study aimed to: (1) assess the cost-effectiveness of adding routine varicella vaccination through MMRV, using different vaccination strategies in France; and (2) address key uncertainties, such as the economic consequences of breakthrough varicella cases, the waning of vaccine-conferred protection, vaccination coverage, and indirect costs.

Cost Effectiveness and Resource Allocation
http://www.resource-allocation.com/
(Accessed 2 May 2015)

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Commentary
Health care: the challenge to deal with uncertainty and value judgment
Marcos Bosi Ferraz
Cost Effectiveness and Resource Allocation 2015, 13:8 (1 May 2015)
Abstract (provisional)
The exponential increase of knowledge in the life sciences field, more specifically in health sciences, in the past few years has brought additional levels of complexity when deciding and implementing strategies in the health care system. A predominantly paternalistic way to decide about available options to maintain or improve individual or collective health has been moving to a shared-decision model considering the empowered patient. In spite of the reduction of uncertainty when making health and health care decisions due to the advancement in scientific methods, and, in spite of the asymmetry of information, knowledge and power to make decisions, we are progressively recognizing the importance of individuals, the target of the intervention, to express their preferences and to take an active role in the decision making process. Health care stakeholders, recognizing the scarcity of resources available and the fortunate ever increasing amount of applicable knowledge and its corresponding interventions to improve the population quantity and quality of life, should stimulate society to address and discuss health care issues that will guide critical choices and define health care priorities based mostly on judgment and the best evidence available.

Cost Effectiveness and Resource Allocation
http://www.resource-allocation.com/
(Accessed 2 May 2015)

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Research
Cost-effectiveness of live oral attenuated human rotavirus vaccine in Tanzania
Ruhago GM, Ngalesoni FN, Robberstad B and Norheim OF Cost Effectiveness and Resource Allocation 2015, 13:7 (28 April 2015)
Abstract (provisional)
Background
Globally, diarrhoea is the second leading cause of morbidity and mortality, responsible for the annual loss of about 10% of the total global childhood disease burden. In Tanzania, Rotavirus infection is the major cause of severe diarrhoea and diarrhoeal mortality in children under five years. Immunisation can reduce the burden, and Tanzania added rotavirus vaccine to its national immunisation programme in January 2013. This study explores the cost effectiveness of introducing rotavirus vaccine within the Tanzania Expanded Programme on Immunisation (EPI).
Methods
We quantified all health system implementation costs, including programme costs, to calculate the cost effectiveness of adding rotavirus immunisation to EPI and the existing provision of diarrhoea treatment (oral rehydration salts and intravenous fluids) to children. We used ingredients and step down costing methods. Cost and coverage data were collected in 2012 at one urban and one rural district hospital and a health centre in Tanzania. We used Disability Adjusted Life Years (DALYs) as the outcome measure and estimated incremental costs and health outcomes using a Markov transition model with weekly cycles up to a five-year time horizon.
Results
The average unit cost per vaccine dose at 93% coverage is US$ 8.4, with marked difference between the urban facility US$ 5.2; and the rural facility US$ 9.8. RV1 vaccine added to current diarrhoea treatment is highly cost effective compared to diarrhoea treatment given alone, with incremental cost effectiveness ratio of US$ 112 per DALY averted, varying from US$ 80–218 in sensitivity analysis. The intervention approaches a 100% probability of being cost effective at a much lower level of willingness-to-pay than the US$609 per capita Tanzania gross domestic product (GDP).
Conclusions
The combination of rotavirus immunisation with diarrhoea treatment is likely to be cost effective when willingness to pay for health is higher than USD 112 per DALY. Universal coverage of the vaccine will accelerate progress towards achievement of the child health Millennium Development Goals.

Development in Practice
Volume 25, Issue 4, 2015
http://www.tandfonline.com/toc/cdip20/current

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Increasing access to rural maternal health services in Zambia through demand-side interventions
Cathy Green, Miniratu Soyoola, Mary Surridge, Abdul Razak Badru, Dynes Kaluba, Paula Quigley & Tendayi Kureya
pages 450-464
DOI:10.1080/09614524.2015.1027148
Published online: 24 Apr 2015
Abstract
This paper examines a demand-side intervention that significantly increased access to maternal health services in rural Zambia in a context where skilled birth attendance rates had been stagnant for over two decades. Aspects of the intervention design that were crucial to the programme’s success were the participatory and adult learning-centred approach used to mobilise intervention communities, the use of a community volunteer model, and the design’s sensitivity and responsiveness to underlying social factors and problems. The demand-side intervention is already being scaled up in six districts, and is highly suitable for national level scale-up.

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 2 May 2015]

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Commentary
Sustaining the gains made in malaria control and elimination
Randall A Kramer, Adriane Lesser Infectious Diseases of Poverty 2015, 4:26 (3 May 2015)
Abstract (provisional)
Significant progress has been made in the last 25 years to reduce the malaria burden, but considerable challenges remain. These gains have resulted from large investments in a range of control measures targeting malaria. Fana and co-authors find a strong relationship between education level and net usage with malaria parasitemia in pregnant women, suggesting the need for targeted control strategies. Mayala and co-workers find important links between agriculture and malaria with implications for inter-sectoral collaboration for malaria control.

Journal of Global Ethics
Volume 11, Issue 1, 2015
http://www.tandfonline.com/toc/rjge20/.U2V-Elf4L0l#.VAJEj2N4WF8

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Forum: The Sustainable Development Goals [8 articles plus introduction below]
INTRODUCTION: The Sustainable Development Goals Forum
DOI:10.1080/17449626.2015.1021091
Eric Palmer*
pages 3-9
Abstract
This introduction notes the contributions of various authors to the first issue of the Journal of Global Ethics 2015 Forum and briefly explains the United Nations process through which the sustainable development goals have been formulated up to the receipt by the General Assembly, in August 2014, of the Report of the Open Working Group of the General Assembly on Sustainable Development Goals (UN A/68/970). The goals are identified as a confluence of distinct streams of UN work attended to variously by policy experts and political figures in the past several decades. Sources include, most obviously, the Millennium Declaration of 2000 and the Millennium Development Goals, but also the 1992 United Nations Conference on Environment and Development, the Human Development Reports of 1990 forward, and the 1987 Brundtland Report.

The Lancet
May 02, 2015 Volume 385 Number 9979 p1697-1802
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
Migrant crisis in the Mediterranean
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60875-3
Summary
In October, 2014, the British Government quietly announced its decision to withdraw support for Mare Nostrum, a search and rescue operation for migrants in the Mediterranean Sea. “We do not support planned search and rescue operations in the Mediterranean,” said Baroness Anelay, to avoid “an unintended ‘pull factor’, encouraging more migrants to attempt the dangerous sea crossing and thereby leading to more tragic and unnecessary deaths.” As of April 27, more than 1700 men, women, and children—each seeking a better and safer life in Europe—have drowned trying to cross the Mediterranean, compared with 96 over the same period in 2014.

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Comment
Ageing, health, and social care: reframing the discussion
Daniel Davis, Carol Brayne
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60466-4
Summary
The current age structure of the UK population is radically different from that at inception of the National Health Service (NHS) in 1948, and health inequalities are widening fastest in people aged 65 years and older.1 On the one hand there are fit, highly advantaged people at advanced ages for whom functional limitations and disability are postponed (ie, compression of morbidity);2 and, on the other, there are those who age faster and die earlier, with a higher prevalence of chronic diseases, at least partly related to lifetimes of disadvantage and social environments that have not led to healthy ageing.

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Comment
Health and sustainable development: a call for papers
Richard Horton, Zoë Mullan
Open Access
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60504-9

In just under 5 months’ time, the aspiration for the next 15 years of development efforts will be signed off at the UN General Assembly in New York, USA. These Sustainable Development Goals (SDGs) are already at an advanced stage of drafting—17 ambitious goals and 169 targets (panel), which have been criticised even by the UN General Secretary for being too voluminous.1 Amid this multitude of outcomes, those pertaining to health are reduced from three Millennium Development Goals to one SDG. What does this mean for global health research?

It means an opportunity. As we concern ourselves with the prominence of health in the new agenda, it’s easy to forget that (human) development is by definition people-centred, and that living a long, healthy, and creative life is its cornerstone.2 The expansion of the new goals to encompass many (if not all3) of the enablers of an enriched life, for our generation and for those that follow, represents an opportunity to lift ourselves out of the silos we so decry and to embrace other disciplines that underlie the purpose of our own.
As the SDGs, in whatever final form they take, are unveiled in September, 2015, The Lancet and The Lancet Global Health will begin to curate a special issue on sustainable development, to be published in April, 2016. As part of this special issue, we seek original research articles that cross two or more of the key disciplines of the SDGs: poverty, nutrition, health, education, economics, gender equality, water and sanitation, energy, urban planning, conservation, and climate change. Multidisciplinary authorship is a must. The deadline is Sept 15, 2015, and submissions should be made online.

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Viewpoint
WHO’s new End TB Strategy
Dr Mukund Uplekar, MD, Diana Weil, MSc, Knut Lonnroth, MD, Ernesto Jaramillo, MD, Christian Lienhardt, MD, Hannah Monica Dias, MSc, Dennis Falzon, MD, Katherine Floyd, PhD, Giuliano Gargioni, MD, Haileyesus Getahun, MD, Christopher Gilpin, MD, Philippe Glaziou, MD, Malgorzata Grzemska, MD, Fuad Mirzayev, MD, Hiroki Nakatani, MD, Mario Raviglione, MD, for WHO’s Global TB Programme
Published Online: 23 March 2015
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60570-0
Summary
On May 19, 2014, the 67th World Health Assembly (WHA) adopted WHO’s “Global strategy and targets for tuberculosis prevention, care and control after 2015”.1 This post-2015 global tuberculosis strategy, labelled the End TB Strategy, was shaped during the past 2 years. A wide range of stakeholders—from ministries of health and national tuberculosis programmes to technical and scientific institutions, financial and development partners, civil society and health activists, non-governmental organisations, and the private sector—contributed to its development.

Pediatrics
May 2015, VOLUME 135 / ISSUE 5
http://pediatrics.aappublications.org/current.shtml

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Article
The Early Benefits of Human Papillomavirus Vaccination on Cervical Dysplasia and Anogenital Warts
Leah M. Smith, MSca, Erin C. Strumpf, PhDa,b, Jay S. Kaufman, PhDa, Aisha Lofters, MD, PhDc,
Michael Schwandt, MD, MPHd, and Linda E. Lévesque, BScPhm, PhDe,f
Author Affiliations
aDepartments of Epidemiology, Biostatistics, and Occupational Health, and
bEconomics, McGill University, Montreal, Quebec, Canada;
cDepartment of Family and Community Medicine, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada;
dDepartment of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada;
eDepartment of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada; and
fInstitute for Clinical Evaluative Sciences-Queen’s Health Services Research Facility, Kingston, Ontario, Canada
Abstract
BACKGROUND: Despite widespread promotion of quadrivalent human papillomavirus (qHPV) vaccination for young girls, there is limited information on the vaccine’s real-world effectiveness and none on the effectiveness of qHPV vaccination programs. We assessed the impact of the qHPV vaccine and Ontario’s grade 8 qHPV vaccination program on cervical dysplasia and anogenital warts (AGW).
METHODS: By using administrative health databases of Ontario, Canada, we identified a population-based retrospective cohort of girls in grade 8 before (2005/2006–2006/2007) and after (2007/2008–2008/2009) program implementation. Vaccine exposure was ascertained in grades 8 to 9 and outcomes in grades 10 to 12. A quasi-experimental approach known as regression discontinuity was used to estimate absolute risk differences (RDs), relative risks (RRs), and 95% confidence intervals (CIs) attributable to vaccination and program eligibility (intention-to-treat analysis).
RESULTS: The cohort comprised 131 781 ineligible and 128 712 eligible girls (n = 260 493). We identified 2436 cases of dysplasia and 400 cases of AGW. Vaccination significantly reduced the incidence of dysplasia by 5.70 per 1000 girls (95% CI −9.91 to −1.50), corresponding to a relative reduction of 44% (RR 0.56; 95% CI 0.36 to 0.87). Program eligibility also had a significant protective effect on dysplasia: RD −2.32/1000 (95% CI −4.02 to −0.61); RR 0.79 (95% CI 0.66 to 0.94). Results suggested decreases in AGW attributable to vaccination (RD −0.83/1000, 95% CI −2.54 to 0.88; RR 0.57, 95% CI 0.20 to 1.58) and program eligibility (RD −0.34/1000, 95% CI −1.03 to 0.36; RR 0.81, 95% CI 0.52 to 1.25).
CONCLUSIONS: This study provides strong evidence of the early benefits of qHPV vaccination among girls aged 14 to 17 years, offering additional justification for not delaying vaccination

Pediatrics
May 2015, VOLUME 135 / ISSUE 5
http://pediatrics.aappublications.org/current.shtml

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Article
Childhood Vaccination Coverage Rates Among Military Dependents in the United States
Angela C. Dunn, MD, MPHa,b, Carla L. Black, PhD, MPHc, John Arnold, MDd, Stephanie Brodine, MDb, Jill Waalen, MD, MPHa,b, and Nancy Binkin, MD, MPHb
Author Affiliations
aDepartment of Family and Preventive Medicine, University of California San Diego, La Jolla, California;
bGraduate School of Public Health, San Diego State University, San Diego, California;
cCenters for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia; and
dDepartment of Pediatrics, Naval Medical Center San Diego, San Diego, California
Abstract
BACKGROUND AND OBJECTIVES: The Military Health System provides universal coverage of all recommended childhood vaccinations. Few studies have examined the effect that being insured by the Military Health System has on childhood vaccination coverage. The purpose of this study was to compare the coverage of the universally recommended vaccines among military dependents versus other insured and uninsured children using a nationwide sample of children.
METHODS: The National Immunization Survey is a multistage, random-digit dialing survey designed to measure vaccination coverage estimates of US children aged 19 to 35 months old. Data from 2007 through 2012 were combined to permit comparison of vaccination coverage among military dependent and all other children.
RESULTS: Among military dependents, 28.0% of children aged 19 to 35 months were not up to date on the 4:3:1:3:3:1 vaccination series excluding Haemophilus influenzae type b vaccine compared with 21.1% of all other children (odds ratio: 1.4; 95% confidence interval: 1.2–1.6). After controlling for sociodemographic characteristics, compared with all other US children, military dependent children were more likely to be incompletely vaccinated (odds ratio: 1.3; 95% confidence interval: 1.1–1.5).
CONCLUSIONS: Lower vaccination coverage rates among US military dependent children might be due to this population being highly mobile. However, the lack of a military-wide childhood immunization registry and incomplete documentation of vaccinations could contribute to the lower vaccination coverage rates seen in this study. These results suggest the need for further investigation to evaluate vaccination coverage of children with complete ascertainment of vaccination history, and if lower immunization rates are verified, assessment of reasons for lower vaccination coverage rates among military dependent children.

Pediatrics
May 2015, VOLUME 135 / ISSUE 5
http://pediatrics.aappublications.org/current.shtml

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Article
First Use of a Serogroup B Meningococcal Vaccine in the US in Response to a University Outbreak
Lucy A. McNamara, PhD, MSa,b, Alice M. Shumate, PhDa,c, Peter Johnsen, MDd, Jessica R. MacNeil, MPHb, Manisha Patel, MDb, Tina Bhavsar, PharmDe, Amanda C. Cohn, MDb, Jill Dinitz-Sklar, MPHc,f, Jonathan Duffy, MD, MPHg, Janet Finnie, MBA, LSWd, Denise Garon, MSc, Robert Hary, MA, MBAh, Fang Hu, PhDb, Hajime Kamiya, MD, PhD, MPHa,b, Hye-Joo Kim, PharmDe,
John Kolligian Jr, PhDd, Janet Neglia, MDd, Judith Oakleyd, Jacqueline Wagner, MSd, Kathy Wagner, MPHd, Xin Wang, PhDb, Yon Yu, PharmDe, Barbara Montana, MD, MPHc, Christina Tan, MD, MPHc, Robin Izzo, MSd, and Thomas A. Clark, MD, MPHb
Author Affiliations
aEpidemic Intelligence Service Program, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services,
bDivision of Bacterial Diseases, National Center for Immunization and Respiratory Diseases,
eRegulatory Affairs, Office of the Director, and
gImmunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
cNew Jersey Department of Health, Trenton, New Jersey;
dPrinceton University, Princeton, New Jersey;
fMercer County Division of Public Health, Trenton, New Jersey; and
hPrinceton Health Department, Princeton, New Jersey
Abstract
BACKGROUND: In 2013–2014, an outbreak of serogroup B meningococcal disease occurred among persons linked to a New Jersey university (University A). In the absence of a licensed serogroup B meningococcal (MenB) vaccine in the United States, the Food and Drug Administration authorized use of an investigational MenB vaccine to control the outbreak. An investigation of the outbreak and response was undertaken to determine the population at risk and assess vaccination coverage.
METHODS: The epidemiologic investigation relied on compilation and review of case and population data, laboratory typing of meningococcal isolates, and unstructured interviews with university staff. Vaccination coverage data were collected during the vaccination campaign held under an expanded-access Investigational New Drug protocol.
RESULTS: Between March 25, 2013, and March 10, 2014, 9 cases of serogroup B meningococcal disease occurred in persons linked to University A. Laboratory typing results were identical for all 8 isolates available. Through May 14, 2014, 89.1% coverage with the 2-dose vaccination series was achieved in the target population. From the initiation of MenB vaccination through February 1, 2015, no additional cases of serogroup B meningococcal disease occurred in University A students. However, the ninth case occurred in March 2014 in an unvaccinated close contact of University A students.
CONCLUSIONS: No serogroup B meningococcal disease cases occurred in persons who received 1 or more doses of 4CMenB vaccine, suggesting 4CMenB may have protected vaccinated individuals from disease. However, the ninth case demonstrates that carriage of serogroup B Neisseria meningitidis among vaccinated persons was not eliminated.

Pharmacoeconomics
Volume 33, Issue 5, May 2015
http://link.springer.com/journal/40273/33/5/page/1

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A Review and Classification of Approaches for Dealing with Uncertainty in Multi-Criteria Decision Analysis for Healthcare Decisions
Henk Broekhuizen, Catharina G. M. Groothuis-Oudshoorn, Janine A. van Til, J. Marjan Hummel,
Abstract
Multi-criteria decision analysis (MCDA) is increasingly used to support decisions in healthcare involving multiple and conflicting criteria. Although uncertainty is usually carefully addressed in health economic evaluations, whether and how the different sources of uncertainty are dealt with and with what methods in MCDA is less known. The objective of this study is to review how uncertainty can be explicitly taken into account in MCDA and to discuss which approach may be appropriate for healthcare decision makers. A literature review was conducted in the Scopus and PubMed databases. Two reviewers independently categorized studies according to research areas, the type of MCDA used, and the approach used to quantify uncertainty. Selected full text articles were read for methodological details. The search strategy identified 569 studies. The five approaches most identified were fuzzy set theory (45 % of studies), probabilistic sensitivity analysis (15 %), deterministic sensitivity analysis (31 %), Bayesian framework (6 %), and grey theory (3 %). A large number of papers considered the analytic hierarchy process in combination with fuzzy set theory (31 %). Only 3 % of studies were published in healthcare-related journals. In conclusion, our review identified five different approaches to take uncertainty into account in MCDA. The deterministic approach is most likely sufficient for most healthcare policy decisions because of its low complexity and straightforward implementation. However, more complex approaches may be needed when multiple sources of uncertainty must be considered simultaneously.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 2 May 2015)

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2014 Ebola Outbreak: Media Events Track Changes in Observed Reproductive Number
April 28, 2015 • Commentary
In this commentary, we consider the relationship between early outbreak changes in the observed reproductive number of Ebola in West Africa and various media reported interventions and aggravating events. We find that media reports of interventions that provided education, minimized contact, or strengthened healthcare were typically followed by sustained transmission reductions in both Sierra Leone and Liberia. Meanwhile, media reports of aggravating events generally preceded temporary transmission increases in both countries. Given these preliminary findings, we conclude that media reported events could potentially be incorporated into future epidemic modeling efforts to improve mid-outbreak case projections.

PLoS One
[Accessed 2 May 2015]
http://www.plosone.org/

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Health Providers’ Perceptions of Clinical Trials: Lessons from Ghana, Kenya and Burkina Faso
Vibian Angwenyi, Kwaku-Poku Asante, Abdoulaye Traoré, Lawrence Gyabaa Febir, Charlotte Tawiah, Anthony Kwarteng, Alphonse Ouédraogo, Sodiomon Bienvenue Sirima, Seth Owusu-Agyei, Egeruan Babatunde Imoukhuede, Jayne Webster, Daniel Chandramohan, Sassy Molyneux, Caroline Jones
Research Article | published 01 May 2015 | PLOS ONE 10.1371/journal.pone.0124554
Abstract
Background
Clinical trials conducted in Africa often require substantial investments to support trial centres and public health facilities. Trial resources could potentially generate benefits for routine health service delivery but may have unintended consequences. Strengthening ethical practice requires understanding the potential effects of trial inputs on the perceptions and practices of routine health care providers. This study explores the influence of malaria vaccine trials on health service delivery in Ghana, Kenya and Burkina Faso.
Methods
We conducted: audits of trial inputs in 10 trial facilities and among 144 health workers; individual interviews with frontline providers (n=99) and health managers (n=14); and group discussions with fieldworkers (n=9 discussions). Descriptive summaries were generated from audit data. Qualitative data were analysed using a framework approach.
Results
Facilities involved in trials benefited from infrastructure and equipment upgrades, support with essential drugs, access to trial vehicles, and placement of additional qualified trial staff. Qualified trial staff in facilities were often seen as role models by their colleagues; assisting with supportive supervision and reducing facility workload. Some facility staff in place before the trial also received formal training and salary top-ups from the trials. However, differential access to support caused dissatisfaction, and some interviewees expressed concerns about what would happen at the end of the trial once financial and supervisory support was removed.
Conclusion
Clinical trials function as short-term complex health service delivery interventions in the facilities in which they are based. They have the potential to both benefit facilities, staff and communities through providing the supportive environment required for improvements in routine care, but they can also generate dissatisfaction, relationship challenges and demoralisation among staff. Minimising trial related harm and maximising benefits requires careful planning and engagement of key actors at the outset of trials, throughout the trial and on its’ completion.

Science
1 May 2015 vol 348, issue 6234, pages 473-604
http://www.sciencemag.org/current.dtl

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Infectious Diseases
In Guinea, a long, difficult road to zero Ebola cases
Martin Enserink*
Ebola is on the decline in Guinea, one of three West African hit hard by the epidemic. The country’s teeming capital of 2 million, Conakry, had only a single known case last week. As part of the endgame, hundreds of local workers have gone house to house in the remaining Ebola pockets in recent weeks to explain how Ebola spreads, encourage people to report suspected cases, and try to find any hidden Ebola patients or corpses. Distrust of the government, resentment against teams raising awareness, and rumors about the origins of the epidemic are still a problem.

Vaccine
Volume 33, Issue 21, Pages 2395-2516 (15 May 2015)
http://www.sciencedirect.com/science/journal/0264410X/33

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Internet activity as a proxy for vaccination compliance
Pages 2395-2398
Yuval Barak-Corren, Ben Y. Reis
Highlights
:: In Summer 2013 poliovirus was detected in Israel’s sewage system. In response, a nation-wide immunization campaign was launched.
:: We analyzed Internet search statistics by district for polio-related terms for the time period of this campaign.
:: We compared Internet search statistics with official reporting obtained from the MOH.
:: Internet searches were highly correlated with same district MOH reported vaccination rates (R = 0.786).
:: These findings suggest a novel method for monitoring vaccination campaigns

Vaccine
Volume 33, Issue 21, Pages 2395-2516 (15 May 2015)
http://www.sciencedirect.com/science/journal/0264410X/33

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Varicella in Europe—A review of the epidemiology and experience with vaccination
Review Article
Pages 2406-2413
Ida Glode Helmuth, Anja Poulsen, Camilla Hiul Suppli, Kåre Mølbak
Abstract
There is no consensus as regards the European varicella immunisation policy; some countries have introduced varicella vaccination in their routine childhood immunisation programs whereas others have decided against or are debating. With the aim of providing an overview of the epidemiology of varicella in Europe and addressing the different strategies and the experiences so far, we performed a review of epidemiological studies done in Europe from 2004 to 2014. Varicella is mainly a disease of childhood, but sero-epidemiological studies show regional differences in the proportion of susceptible adults. Hospitalisation due to varicella is not common, but complications and hospitalisation mainly affect previously healthy children, which underlines the importance of not dismissing varicella as a disease of little importance. The experience with universal vaccination in Europe shows that vaccination leads to a rapid reduction of disease incidence. Vaccine effectiveness is high and a protective herd effect is obtained. Experience with vaccination in Europe has not been long enough, though, to draw conclusions on benefits and drawbacks with vaccination as well as the capacity for national programs in Europe to maintain a sufficiently high coverage to prevent a change in age group distribution to older children and young adults or on the impact that varicella immunisation may have on the epidemiology of shingles.

Vaccine
Volume 33, Issue 21, Pages 2395-2516 (15 May 2015)
http://www.sciencedirect.com/science/journal/0264410X/33

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Actions improving HPV vaccination uptake – Results from a national survey in Italy
Original Research Article
Pages 2425-2431
Cristina Giambi, Martina Del Manso, Fortunato D’Ancona, Barbara De Mei, Ilaria Giovannelli, Chiara Cattaneo, Valentina Possenti, Silvia Declich, Local representatives for VALORE
Abstract
Background
In Italy, HPV vaccination is offered to 11-year-old girls since 2007. In 2012 coverage was 69%. Strategies for offering and promoting HPV vaccination and coverage rates (26–85%) vary among Regions and Local Health Authorities (LHAs). We conducted a national study to identify strategies to improve HPV vaccination uptake.
Methods
In 2011–2012 we invited the 178 LHAs to fill a web-questionnaire, inquiring implementation of HPV vaccination campaigns (immunization practices, logistics of vaccine delivery, training, activities to promote vaccination, barriers, local context). We described type of offer and vaccination promotion in each LHA and studied the association of these factors with vaccination coverage rates.
Results
We analyzed 133 questionnaires. The communication tools more frequently used to promote vaccination were: brochures/leaflets (92% of LHAs), fliers/posters (72%). Television (24%) and radio (15%) were less used. Using ≥3 communication channels was associated to a coverage ≥70% (ORadj = 5.9, 95%CI 2.0–17.4). The probability to reach a coverage ≥70% was higher if the invitation letter indicated a pre-assigned date for HPV vaccination (ORadj = 7.0, 95%CI 1.2–39.8) and >1 recall for non-respondents was planned (ORadj = 4.1, 95%CI 1.8–9.3). Immunization services and paediatricians were involved in informative and training activities in most LHAs (80–90%), instead general practitioners, women and family’s healthcare services and public gynaecologists in 60–70%, cervical cancer screening services and private gynaecologists in 20–40%. The main factors that negatively affected vaccination uptake were: poor participation to training events of professional profiles different from personnel of immunization services (reported by 58% LHAs), their mistrust towards HPV vaccination (55%) and insufficient resources (56%).
Conclusion
The synergy of multiple interventions is necessary for a successful vaccination programme. Practices such as pre-assigning vaccination date and repeatedly recalling non-respondents could improve vaccination uptake. Efforts are required to strengthen the training of different professional profiles and services and encourage their collaboration. Economical resources are needed to promote vaccination.

Vaccine
Volume 33, Issue 21, Pages 2395-2516 (15 May 2015)
http://www.sciencedirect.com/science/journal/0264410X/33

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Effectiveness of an oral cholera vaccine campaign to prevent clinically-significant cholera in Odisha State, India
Original Research Article
Pages 2463-2469
Thomas F. Wierzba, Shantanu K. Kar, Vijayalaxmi V. Mogasale, Anna S. Kerketta, Young Ae You, Prameela Baral, Hemant K. Khuntia, Mohammad Ali, Yang Hee Kim, Shyam Bandhu Rath, Anuj Bhattachan, Binod Sah
Abstract
Background
A clinical trial conducted in India suggests that the oral cholera vaccine, Shanchol, provides 65% protection over five years against clinically-significant cholera. Although the vaccine is efficacious when tested in an experimental setting, policymakers are more likely to use this vaccine after receiving evidence demonstrating protection when delivered to communities using local health department staff, cold chain equipment, and logistics.
Methods
We used a test-negative, case-control design to evaluate the effectiveness of a vaccination campaign using Shanchol and validated the results using a cohort approach that addressed disparities in healthcare seeking behavior. The campaign was conducted by the local health department using existing resources in a cholera-endemic area of Puri District, Odisha State, India. All non-pregnant residents one year of age and older were offered vaccine. Over the next two years, residents seeking care for diarrhea at one of five health facilities were asked to enroll following informed consent. Cases were patients seeking treatment for laboratory-confirmed V. cholera-associated diarrhea. Controls were patients seeking treatment for V. cholerae negative diarrhea.
Results
Of 51,488 eligible residents, 31,552 individuals received one dose and 23,751 residents received two vaccine doses. We identified 44 V. cholerae O1-associated cases and 366 non V. cholerae diarrhea controls. The adjusted protective effectiveness for persons receiving two doses was 69.0% (95% CI: 14.5% to 88.8%), which is similar to the adjusted estimates obtained from the cohort approach. A statistical trend test suggested a single dose provided a modicum of protection (33%, test for trend, p = 0.0091).
Conclusion
This vaccine was found to be as efficacious as the results reported from a clinical trial when administered to a rural population using local health personnel and resources. This study provides evidence that this vaccine should be widely deployed by public health departments in cholera endemic areas.

Vaccine
Volume 33, Issue 21, Pages 2395-2516 (15 May 2015)
http://www.sciencedirect.com/science/journal/0264410X/33

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Evaluation of anthrax vaccine safety in 18 to 20 year olds: A first step towards age de-escalation studies in adolescents
Original Research Article
Pages 2470-2476
James C. King Jr., M.D., Yonghong Gao Ph.D., Conrad P. Quinn Ph.D., Thomas M. Dreier Ph.D., Cabrini Vianney M.S., Eric M. Espeland Ph.D.
Abstract
Background/objectives
Anthrax vaccine adsorbed (AVA, BioThrax®) is recommended for post-exposure prophylaxis administration for the US population in response to large-scale Bacillus anthracis spore exposure. However, no information exists on AVA use in children and ethical barriers exist to performing pre-event pediatric AVA studies. A Presidential Ethics Commission proposed a potential pathway for such studies utilizing an age de-escalation process comparing safety and immunogenicity data from 18 to 20 year-olds to older adults and if acceptable proceeding to evaluations in younger adolescents. We conducted exploratory summary re-analyses of existing databases from 18 to 20 year-olds (n = 74) compared to adults aged 21 to 29 years (n = 243) who participated in four previous US government funded AVA studies.
Methods
Data extracted from studies included elicited local injection-site and systemic adverse events (AEs) following AVA doses given subcutaneously at 0, 2, and 4 weeks. Additionally, proportions of subjects with ≥4-fold antibody rises from baseline to post-second and post-third AVA doses (seroresponse) were obtained.
Results
Rates of any elicited local AEs were not significantly different between younger and older age groups for local events (79.2% vs. 83.8%, P = 0.120) or systemic events (45.4% vs. 50.5%, P = 0.188). Robust and similar proportions of seroresponses to vaccination were observed in both age groups.
Conclusions
AVA was safe and immunogenic in 18 to 20 year-olds compared to 21 to 29 year-olds. These results provide initial information to anthrax and pediatric specialists if AVA studies in adolescents are required.

Vaccine
Volume 33, Issue 21, Pages 2395-2516 (15 May 2015)
http://www.sciencedirect.com/science/journal/0264410X/33

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Early exposure to the combined measles–mumps–rubella vaccine and thimerosal-containing vaccines and risk of autism spectrum disorder
Original Research Article
Pages 2511-2516
Yota Uno, Tokio Uchiyama, Michiko Kurosawa, Branko Aleksic, Norio Ozaki
Abstract
Objective
This case–control study investigated the relationship between the risk of Autism Spectrum Disorder (ASD) onset, and early exposure to the combined Measles–Mumps–Rubella (MMR) vaccine and thimerosal consumption measured from vaccinations in the highly genetically homogenous Japanese population.
Methods
Vaccination histories at 1, 3, 6, 12, 18, 24, and 36 months from birth were investigated in ASD cases (189 samples), and controls (224 samples) matching age and sex in each case. Crude odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated to determine relationship between MMR vaccination and ASD. The differences in mean values of the thimerosal dosage between cases and controls were analyzed using an unpaired t-test. MMR vaccination and thimerosal dosage were also investigated using a conditional multiple-regression model.
Results
There were no significant differences in MMR vaccination and thimerosal dosage between cases and controls at any age. Furthermore, the ORs (95% CIs) of MMR vaccination and thimerosal dosage associated with ASD in the conditional multiple regression model were, respectively, 0.875 (0.345–2.222) and 1.205 (0.862–1.683) at age 18 months, 0.724 (0.421–1.243) and 1.343 (0.997–1.808) at 24 months, and 1.040 (0.648–1.668) and 0.844 (0.632–1.128) at 36 months. Thus, there were no significant differences.
Conclusions
No convincing evidence was found in this study that MMR vaccination and increasing thimerosal dose were associated with an increased risk of ASD onset.

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

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PLoS Computational Biology
http://journals.plos.org/ploscompbiol/
Research Article
A change in vaccine efficacy and duration of protection explains recent rises in pertussis incidence in the United States.
Manoj Gambhir , Thomas A. Clark, Simon Cauchemez, Sara Y. Tartof, David L. Swerdlow, Neil M. Ferguson
Published: April 23, 2015
DOI: 10.1371/journal.pcbi.1004138
Abstract
Over the past ten years the incidence of pertussis in the United States (U.S.) has risen steadily, with 2012 seeing the highest case number since 1955. There has also been a shift over the same time period in the age group reporting the largest number of cases (aside from infants), from adolescents to 7–11 year olds. We use epidemiological modelling and a large case incidence dataset to explain the upsurge. We investigate several hypotheses for the upsurge in pertussis cases by fitting a suite of dynamic epidemiological models to incidence data from the National Notifiable Disease Surveillance System (NNDSS) between 1990–2009, as well as incidence data from a variety of sources from 1950–1989. We find that: the best-fitting model is one in which vaccine efficacy and duration of protection of the acellular pertussis (aP) vaccine is lower than that of the whole-cell (wP) vaccine, (efficacy of the first three doses 80% [95% CI: 78%, 82%] versus 90% [95% CI: 87%, 94%]), increasing the rate at which disease is reported to NNDSS is not sufficient to explain the upsurge and 3) 2010–2012 disease incidence is predicted well. In this study, we use all available U.S. surveillance data to: 1) fit a set of mathematical models and determine which best explains these data and 2) determine the epidemiological and vaccine-related parameter values of this model. We find evidence of a difference in efficacy and duration of protection between the two vaccine types, wP and aP (aP efficacy and duration lower than wP). Future refinement of the model presented here will allow for an exploration of alternative vaccination strategies such as different age-spacings, further booster doses, and cocooning.
Author Summary
Over the past ten years the incidence of pertussis in the United States (U.S.) has risen steadily, with 2012 seeing the highest case number since 1955. There has also been a shift over the same time period in the age group reporting the largest number of cases (aside from infants), from adolescents to 7–11 year olds. We investigate several hypotheses for the upsurge in pertussis cases by fitting a suite of epidemiological models to incidence data from the National Notifiable Disease Surveillance System (NNDSS) between 1990–2009. We find that: 1) the best-fitting model is one in which the vaccine efficacy and duration of protection of the acellular pertussis vaccine is lower than that of the whole-cell vaccine, 2) increasing the rate at which disease is reported to NNDSS is not sufficient to explain the upsurge and 3) 2010–2012 disease incidence is predicted well. These results demonstrate that the resurgence in pertussis in the U.S. can be explained by past changes in vaccination policy. However, our findings suggest that the efficacy of the currently-used acellular vaccine is not much lower than that of the whole-cell vaccine, and booster doses may be sufficient to curtail epidemics while vaccine research continues.

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Special Focus Newsletters
Dengue Vaccine Initiative Newsletter – Spring Edition

Media/Policy Watch

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Forbes
http://www.forbes.com/
Accessed 2 May 2015
Apr 27, 2015 11,782 views
How To Talk To Anti-Vaccine Advocates Without Your Head Exploding
Todd Essig , Contributor
Trying to talk with people who are self-righteous, certain and profoundly wrong is a toxic conversational mix. In fact, such conversations just might make your head explode. Unfortunately, the current risk of exploding heads is high because anti-vaccine advocates have mobilized to spread dangerous fear-mongering messages. Their actions are in response to others mobilizing legislative efforts to prevent more outbreaks of preventable disease, like the recent measles outbreak traced to California’s Disneyland. It’s quite a mess. Help is needed. So, read on for advice for how to prevent cranial detonation when talking with the anti-vaxers in your life…

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Foreign Policy
http://foreignpolicy.com/
Accessed 2 May 2015
Argument
The Next Victims of Ebola
The epidemic may be nearing “zero cases” — but it’s still disrupting the delivery of vaccines for measles, polio, and other deadly childhood diseases
By Ellen Johnson SIrleaf, Seth Berkley
April 27, 2015.

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The Huffington Post
http://www.huffingtonpost.com/
The Steps It Will Take to Get Every Child Vaccinated—Orin Levine
27 April 2015

Close the Immunization Gap! Get Vaccinated – Flavia Bustreo
25 April 2015

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Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 2 May 2015
Host of Ailments Plague African Ebola Survivors
Many now declared free of virus face eye disease and vision loss
30 April 2015

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

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– Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.
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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– The Wistar Institute Vaccine Center
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

UNICEF [to 25 April 2015]
http://www.unicef.org/media/media_78364.html

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:: Measles vaccination campaign aims to immunize over 2.6 million Syrian children
DAMASCUS, Syria, 24 April 2015 – A 10-day measles immunization campaign is underway in Syria to protect children from this deadly disease. Launched on 19 April, the campaign is aimed at children between six months and five years of age. Vaccination will be provided in 1,209 health centres, and nearly 6,000 health staff and mobile teams are participating in the campaign.

By the end of 2014, 594 children had been diagnosed with measles. Of these, almost half were not immunized. Since the conflict began in 2011, immunization rates across the country have fallen from 99 percent to just 52 per cent due to lack of access and severe damage to health infrastructure – nearly one third of the country’s health centres are either damaged or destroyed. UNICEF estimates that over 230,000 children in hard-to-reach areas across the country will likely miss out due to the ongoing conflict.

“In situations of conflict and upheaval, measles can be deadly, especially for children, which is why we must do everything possible to get all children vaccinated wherever they are across the country,” said Hanaa Singer, UNICEF Representative in Syria. “As long as children are left under-reached, the risk of children falling ill and diseases spreading will continue”.
The campaign coincides with World Immunization Week which focuses this year on “Closing the Gap” – sending a direct appeal to the global health community to focus on vaccinating the most marginalized children.

In Syria, the focus during this campaign will be on reaching displaced children. UNICEF estimates there are more than 3.8 million children internally displaced across the country, many of whom were missed out in previous measles campaigns. At least 646,000 are under the age of 5.

Children receiving the vaccines will also be checked for signs of malnutrition and provided with vital supplements and referral to medical services as needed.

This is the second campaign in less than a year. In 2014, UNICEF and partners reached 840,000 children with vaccination against measles.

UNICEF is supporting the Ministry of Health with the provision of vaccinations and syringes, cold chain equipment and the training of vaccinators. Mass media and community outreach activities are taking place including through the dissemination of short message services (SMS), community meetings, recreation activities and social media campaigns.

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:: Immunization drive under way for 3 million children in Ebola-hit countries
DAKAR/GENEVA, 24 April 2015 – For the first time since the start of the Ebola outbreak, Guinea, Liberia and Sierra Leone are conducting major nationwide immunization campaigns to protect millions of children against preventable but potentially deadly diseases.

As World Immunization Week is marked from April 24 to 30, the three countries most affected by Ebola aim to vaccinate more than three million children against diseases such as measles and polio in UNICEF-supported campaigns that involve the provision of vaccines and the training and deployment of thousands of immunization teams.

“While the effort to get to zero cases of Ebola continues, it’s critical that basic health services are restored,” said Manuel Fontaine, UNICEF’s Regional Director for West and Central Africa. “Stepping up immunization programs that were disrupted by the epidemic will save lives and prevent a reversal of the health gains that were made in these countries before the outbreak.”

In Sierra Leone, a mother and child health week begins today with the provision of Vitamin A, deworming pills and screening for malnutrition. More than 10,000 vaccinators and distributors will be going door-to-door across the country to deliver the interventions, which also include updates for those aged 0-23 months who have missed routine vaccinations. In May, an immunization drive for 1.5 million children under five will cover measles and polio.

A nationwide measles campaign got under way in Guinea on April 18 to vaccinate 1.3 million children aged six months to nine years. Some 100,000 children were vaccinated during an initial response to a measles outbreak in February. UNICEF also conducted community sensitization campaigns to inform the public of the safety of the vaccinations.

In Liberia, a campaign to provide measles and polio vaccinations to over 700,000 children under five years old is planned for May 8-14. UNICEF has supplied over 750,000 doses of measles vaccines, and, together with its partners is training more than 3,000 vaccinators and county health officials. It is also working with the Government of Liberia on nationwide social mobilization efforts to raise awareness of the campaign.

As the immunization campaigns are taking place while the threat of Ebola remains, vaccinators are following strict protocols including the use of protective wear, such as gloves and aprons, as well as regular handwashing.

More than 26,000 cases of Ebola and 10,000 deaths have been reported across the three countries where the outbreak has weakened already fragile health systems while disrupting routine health interventions.

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:: Nearly 8 million children in Sudan to be immunized against measles following deadly outbreak – UNICEF
KHARTOUM, Sudan/ GENEVA / NAIROBI 22 April 2015 – Following one of the worst measles outbreaks in Sudan’s recent history, the Ministry of Health with support from UNICEF, the Measles and Rubella Initiative (M&RI) and national partners, is launching a massive campaign to immunize 7.9 million children aged six months to 15 years against this life-threatening disease.

Since the start of the outbreak at the end of 2014, there have been 1,730 confirmed cases, 3,175 suspected cases and 22 fatalities. West Darfur remains the worst affected state, with 441 confirmed cases and five deaths. Kassala has had 365 confirmed cases and five deaths, while in Red Sea state there have been 263 cases and four deaths.

“Measles is a life threatening disease but one that can easily be prevented with timely immunization,” said Geert Cappelaere, UNICEF Representative in Sudan. “Every girl and boy must be reached no matter where they live. There are no excuses and no child can be left out.”

The campaign, which launches today will initially target 28 affected localities in six of the highest risk states, before expanding to other areas identified as being at risk of an outbreak. In total it will target 96 localities in 16 affected and “at risk” states.

The immunization campaign will be a complex operation, however, as ongoing conflict in some areas of Sudan could restrict humanitarian access. There are children in conflict zones in the Kordofans, Blue Nile and Darfur who have not received routine immunization since 2011. UNICEF has called on all parties to the fighting to facilitate humanitarian access so that these children can be reached.

Children are most at risk of the disease – children who are malnourished are even more vulnerable. In Sudan, some 36 per cent of children are stunted and the country has one of the highest levels of malnutrition in Africa. Of the total number of reported measles cases in Sudan, 69 per cent are below 15 years of age, including 52 per cent under the age of five. For malnourished children measles can cause serious complications, including blindness, ear infections, pneumonia and severe diarrhoea.

The upcoming campaign is expected to cost approximately US $13.9 million – funds that are needed to procure 9.6 million doses of vaccine, logistics, measles case management and activating social networks in communities to ensure local buy-in. UNICEF is appealing to all donors to make funding available to fight the outbreak, which is having a detrimental effect on the lives of children across Sudan and threatens neighboring countries. UNICEF, WHO and partners are coordinating with surrounding countries to stop this outbreak from crossing borders.

The measles virus is spread by respiratory transmission and is highly contagious. Up to 90 per cent of people without immunity who are sharing a house with an infected person will catch it.

EBOLA/EVD [to 25 April 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

WHO: Ebola Situation Report – 22 April 2015
[Excerpts]
SUMMARY
:: The decline in confirmed cases of Ebola virus disease (EVD) has halted over the last three weeks. To accelerate the decline towards zero cases will require stronger community engagement, improved contact tracing and earlier case identification. In the week to 19 April, a total of 33 confirmed cases was reported, compared with 37 and 30 in the preceding weeks.
:: In the week to 19 April, Guinea reported 21 confirmed cases, compared with 28 cases the previous week. Sierra Leone reported 12 confirmed cases, compared with 9 cases reported the previous week. Liberia reported no confirmed cases…

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
:: There have been a total of 26,044 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone (figure 1, table 1), with 10,808 reported deaths (outcomes for many cases are unknown). A total of 21 new confirmed cases were reported in Guinea, 0 in Liberia, and 12 in Sierra Leone in the 7 days to 19 April…