BMC Public Health
(Accessed 28 February 2015)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Diarrhea and health inequity among Indigenous children in Brazil: results from the First National Survey of Indigenous People’s Health and Nutrition
Ana Lúcia Escobar1, Carlos EA Coimbra2*, James R Welch2, Bernardo L Horta3, Ricardo Ventura Santos24 and Andrey M Cardoso2
Author Affiliations
BMC Public Health 2015, 15:191 doi:10.1186/s12889-015-1534-7
Published: 27 February 2015
Abstract (provisional)
Background
Globally, diarrhea is the second leading cause of death among children under five. In Brazil, mortality due to diarrhea underwent a significant reduction in recent decades principally due to expansion of the primary healthcare network, use of oral rehydration therapy, reduced child undernutrition, and improved access to safe drinking water. The First National Survey of Indigenous People’s Health and Nutrition in Brazil, conducted in 2008–2009, was the first survey based on a nationwide representative sample to study the prevalence of diarrhea and associated factors among Indigenous children in the country.
Methods
The survey assessed the health and nutritional status of Indigenous children < 5 years of age based on a representative sample of major Brazilian geopolitical regions. A stratified probabilistic sampling was carried out for Indigenous villages. Within villages, children < 5 years of age in sampled households were included in the study. Interviews were based on a seven day recall period. Prevalence rates of acute diarrhea were calculated for independent variables and hierarchical multivariable analyses were conducted to assess associations.
Results
Information on diarrhea was obtained for 5,828 children (95.1% of the total sample). The overall prevalence of diarrhea was 23.5%. Regional differences were observed, with the highest rate being in the North (38.1%). Higher risk of diarrhea was observed among younger children and those who had less maternal schooling, lower household socioeconomic status, undernutrition (weight-for-age deficit), presence of another child with diarrhea in the household, and occurrence of upper respiratory infection.
Conclusions
According to results of the First National Survey of Indigenous People’s Health and Nutrition, almost a quarter of Indigenous children throughout the country had diarrhea during the previous week. This prevalence is substantially higher than that documented in 2006 for Brazilian children < 5 years generally (9.4%). Due to its exceedingly multicausal nature, the set of associated variables that remained associated with child diarrhea in the final multivariable model provide an excellent reflection of the diverse social and health inequities faced by Indigenous peoples in contemporary Brazil.

Research article
Public preferences for vaccination and antiviral medicines under different pandemic flu outbreak scenarios
Helena Rubinstein1, Afrodita Marcu2, Lucy Yardley2 and Susan Michie1*
Author Affiliations
BMC Public Health 2015, 15:190 doi:10.1186/s12889-015-1541-8
Published: 27 February 2015
Abstract (provisional)
Background
During the 2009-2010 A(H1N1) pandemic, many people did not seek care quickly enough, failed to take a full course of antivirals despite being authorised to receive them, and were not vaccinated. Understanding facilitators and barriers to the uptake of vaccination and antiviral medicines will help inform campaigns in future pandemic influenza outbreaks. Increasing uptake of vaccines and antiviral medicines may need to address a range of drivers of behaviour. The aim was to identify facilitators of and barriers to being vaccinated and taking antiviral medicines in uncertain and severe pandemic influenza scenarios using a theoretical model of behaviour change, COM-B.
Methods
Focus groups and interviews with 71 members of the public in England who varied in their at-risk status. Participants responded to uncertain and severe scenarios, and to messages giving advice on vaccination and antiviral medicines. Data were thematically analysed using the theoretical framework provided by the COM-B model.
Results
Influences on uptake of vaccines and antiviral medicines – capabilities, motivations and opportunities – are part of an inter-related behavioural system and different components influenced each other. An identity of being healthy and immune from infection was invoked to explain feelings of invulnerability and hence a reduced need to be vaccinated, especially during an uncertain scenario. The identity of being a ‘healthy person’ also included beliefs about avoiding medicine and allowing the body to fight disease ‘naturally’. This was given as a reason for using alternative precautionary behaviours to vaccination. This identity could be held by those not at-risk and by those who were clinically at-risk.
Conclusions
Promoters and barriers to being vaccinated and taking antiviral medicines are multi-dimensional and communications to promote uptake are likely to be most effective if they address several components of behaviour. The benefit of using the COM-B model is that it is at the core of an approach that can identify effective strategies for behaviour change and communications for the future. Identity beliefs were salient for decisions about vaccination. Communications should confront identity beliefs about being a ‘healthy person’ who is immune from infection by addressing how vaccination can boost wellbeing and immunity.

Research article
Child survival and BCG vaccination: a community based prospective cohort study in Uganda
Victoria Nankabirwa12*, James K Tumwine3, Proscovia M Mugaba3, Thorkild Tylleskär4, Halvor Sommerfelt25 and for the PROMISE- EBF Study Group
Author Affiliations
BMC Public Health 2015, 15:175 doi:10.1186/s12889-015-1497-8
Published: 22 February 2015
Abstract
Background
Data on non-specific effects of BCG vaccination in well described, general population African cohorts is scanty. We report the effects of BCG vaccination on post-neonatal infant and post-infancy mortality in a cohort of children in Mbale, Eastern Uganda.
Methods
A community-based prospective cohort study was conducted between January 2006 and February 2014. A total of 819 eligible pregnant women were followed up for pregnancy outcomes and survival of their children up to 5 years of age. Data on the children’s BCG vaccination status was collected from child health cards at multiple visits between 3 weeks and 7 years of age. Data was also collected on mothers’ residence, age, parity, household income, self-reported HIV status as well as place of birth. Multivariable Cox proportional hazards regression models taking into account potential confounders were used to estimate the association between BCG vaccination and child survival.
Results
The neonatal mortality risk was 22 (95% CI: 13, 35), post-neonatal infant mortality 21 (12, 34) per 1,000 live births and the mortality risk among children between 1 and 5 years of age (post-infancy) was 63 (47, 82) per 1,000 live births. The median age at BCG vaccination was 4 days. Out of 819 children, 647 (79%) had received the BCG vaccine by 24 weeks of age. In the adjusted analysis, the rate of post-neonatal death among infants vaccinated with BCG tended to be nearly half of that among those who had not received the vaccine (adjusted HR: 0.47; 95% CI: 0.14, 1.53). BCG vaccination was associated with a lower rate of death among children between 1 and 5 years of age (adjusted HR: 0.26; 95% CI: 0.14, 0.48).
Conclusion
The risk of early childhood death in Mbale, Uganda is unacceptably high. BCG vaccination was associated with an increased likelihood of child survival.

British Medical Journal
28 February 2015(vol 350, issue 7997)
http://www.bmj.com/content/350/7997

Clinical Review
Multidrug resistant tuberculosis
James Millard, clinical lecturer in global health1,
Cesar Ugarte-Gil, epidemiologist2,
David A J Moore, professor of infectious diseases & tropical medicine3
BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h882 (Published 26 February 2015) Cite this as: BMJ 2015;350:h882

The bottom line
– Multidrug resistant tuberculosis refers to tuberculosis with resistance to at least rifampicin and isoniazid
– Multidrug resistant tuberculosis is increasingly common; however, there is a large shortfall between the estimated total number of cases and the numbers diagnosed and treated
– Diagnosis is hampered by lack of access to quality assured diagnostics, although newer, rapid molecular and phenotypic methods may go some way to improving this situation
– Compared with drug susceptible tuberculosis, treatment for multidrug resistant tuberculosis requires the use of drug regimens that are prolonged (18-24 months), less efficacious, and noticeably more toxic; new drugs and regimens are becoming available for the first time in decades and ongoing trials should define how best they should be used
– Worldwide, treatment success is only around 50%; however, several settings, including some low income countries, have proved that higher success rates are achievable

Bulletin of the World Health Organization
Volume 93, Number 3, March 2015, 133-208
http://www.who.int/bulletin/volumes/93/3/en/

Research
Assessing the potential for improvement of primary care in 34 countries: a cross-sectional survey
Willemijn LA Schäfer, Wienke GW Boerma, Anna M Murante, Herman JM Sixma, François G Schellevis & Peter P Groenewegen
Abstract
Objective
To investigate patients’ perceptions of improvement potential in primary care in 34 countries.
Methods
We did a cross-sectional survey of 69 201 patients who had just visited general practitioners at primary-care facilities. Patients rated five features of person-focused primary care – accessibility/availability, continuity, comprehensiveness, patient involvement and doctor–patient communication. One tenth of the patients ranked the importance of each feature on a scale of one to four, and nine tenths of patients scored their experiences of care received. We calculated the potential for improvement by multiplying the proportion of negative patient experiences with the mean importance score in each country. Scores were divided into low, medium and high improvement potential. Pair-wise correlations were made between improvement scores and three dimensions of the structure of primary care – governance, economic conditions and workforce development.
Findings
In 26 countries, one or more features of primary care had medium or high improvement potentials. Comprehensiveness of care had medium to high improvement potential in 23 of 34 countries. In all countries, doctor–patient communication had low improvement potential. An overall stronger structure of primary care was correlated with a lower potential for improvement of continuity and comprehensiveness of care. In countries with stronger primary care governance patients perceived less potential to improve the continuity of care. Countries with better economic conditions for primary care had less potential for improvement of all features of person-focused care.
Conclusion
In countries with a stronger primary care structure, patients perceived that primary care had less potential for improvement.

Systematic Review
The burden of child maltreatment in China: a systematic review
Xiangming Fang, Deborah A Fry, Kai Ji, David Finkelhor, Jingqi Chen, Patricia Lannen & Michael P Dunne
Abstract
Objective
To estimate the health and economic burdens of child maltreatment in China.
Methods
We did a systematic review for studies on child maltreatment in China using PubMed, Embase, PsycInfo, CINAHL-EBSCO, ERIC and the Chinese National Knowledge Infrastructure databases. We did meta-analyses of studies that met inclusion criteria to estimate the prevalence of child neglect and child physical, emotional and sexual abuse. We used data from the 2010 global burden of disease estimates to calculate disability-adjusted life-years (DALYs) lost as a result of child maltreatment.
Findings
From 68 studies we estimated that 26.6% of children under 18 years of age have suffered physical abuse, 19.6% emotional abuse, 8.7% sexual abuse and 26.0% neglect. We estimate that emotional abuse in childhood accounts for 26.3% of the DALYs lost because of mental disorders and 18.0% of those lost because of self-harm. Physical abuse in childhood accounts for 12.2% of DALYs lost because of depression, 17.0% of those lost to anxiety, 20.7% of those lost to problem drinking, 18.8% of those lost to illicit drug use and 18.3% of those lost to self-harm. The consequences of physical abuse of children costs China an estimated 0.84% of its gross domestic product – i.e. 50 billion United States dollars – in 2010. The corresponding losses attributable to emotional and sexual abuse in childhood were 0.47% and 0.39% of the gross domestic product, respectively.
Conclusion
In China, child maltreatment is common and associated with large economic losses because many maltreated children suffer substantial psychological distress and might adopt behaviours that increase their risk of chronic disease.

Systematic Review
Participants’ understanding of informed consent in clinical trials over three decades: systematic review and meta-analysis
Nguyen Thanh Tam, Nguyen Tien Huy, Le Thi Bich Thoa, Nguyen Phuoc Long, Nguyen Thi Huyen Trang, Kenji Hirayama & Juntra Karbwang
Abstract
Objective
To estimate the proportion of participants in clinical trials who understand different components of informed consent.
Methods
Relevant studies were identified by a systematic review of PubMed, Scopus and Google Scholar and by manually reviewing reference lists for publications up to October 2013. A meta-analysis of study results was performed using a random-effects model to take account of heterogeneity.
Findings
The analysis included 103 studies evaluating 135 cohorts of participants. The pooled proportion of participants who understood components of informed consent was 75.8% for freedom to withdraw at any time, 74.7% for the nature of study, 74.7% for the voluntary nature of participation, 74.0% for potential benefits, 69.6% for the study’s purpose, 67.0% for potential risks and side-effects, 66.2% for confidentiality, 64.1% for the availability of alternative treatment if withdrawn, 62.9% for knowing that treatments were being compared, 53.3% for placebo and 52.1% for randomization. Most participants, 62.4%, had no therapeutic misconceptions and 54.9% could name at least one risk. Subgroup and meta-regression analyses identified covariates, such as age, educational level, critical illness, the study phase and location, that significantly affected understanding and indicated that the proportion of participants who understood informed consent had not increased over 30 years.
Conclusion
The proportion of participants in clinical trials who understood different components of informed consent varied from 52.1% to 75.8%. Investigators could do more to help participants achieve a complete understanding.

Policy & Practice
Big data in global health: improving health in low- and middle-income countries
Rosemary Wyber, Samuel Vaillancourt, William Perry, Priya Mannava, Temitope Folaranmi & Leo Anthony Celi
Abstract
Over the last decade, a massive increase in data collection and analysis has occurred in many fields. In the health sector, however, there has been relatively little progress in data analysis and application despite a rapid rise in data production. Given adequate governance, improvements in the quality, quantity, storage and analysis of health data could lead to substantial improvements in many health outcomes. In low- and middle-income countries in particular, the creation of an information feedback mechanism can move health-care delivery towards results-based practice and improve the effective use of scarce resources. We review the evolving definition of big data and the possible advantages of – and problems in – using such data to improve health-care delivery in low- and middle-income countries. The collection of big data as mobile-phone based services improve may mean that development phases required elsewhere can be skipped. However, poor infrastructure may prevent interoperability and the safe use of patient data. An appropriate governance framework must be developed and enforced to protect individuals and ensure that health-care delivery is tailored to the characteristics and values of the target communities.

Epidemics
Volume 11, In Progress (June 2015)
http://www.sciencedirect.com/science/journal/17554365

Optimal prophylactic vaccination in segregated populations: When can we improve on the equalising strategy?
Original Research Article
Pages 7-13
Matt J. Keeling, J.V. Ross
Abstract
Highlights
– Allocating prophylactic vaccination in a segregated population is a key issue.
– The equalising strategy (ES) has been proposed as an optimal means of vaccination.
– However, the ES only holds for density-dependent transmission,
– We consider more realistic types of transmission and show the ES can be improved.
– This highlights the possibility of more targeted vaccination strategies

Pneumococcal vaccination in older adults in the era of childhood vaccination: Public health insights from a Norwegian statistical prediction study
Original Research Article
Pages 24-31
Anneke Steens, Didrik F. Vestrheim, Birgitte Freiesleben de Blasio
Abstract
Highlights
– Prediction analysis estimates a nearly elimination of PCV13-IPD among the 65+.
– Combining PCV13 and PPV23 likely has highest impact on IPD prevention in the 65+.
– Increasing PPV23 uptake will prevent more IPD cases than adding PCV13 to PPV23.
– The preventive potential of pneumococcal vaccines may decrease among the 65+.

Eurosurveillance
Volume 20, Issue 8, 26 February 2015
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Rapid communications
Effectiveness of influenza vaccination programme in preventing hospital admissions, Valencia, 2014/15 early results
by J Puig-Barberà, A Mira-Iglesias, M Tortajada-Girbés, FX López-Labrador, A Belenguer-Varea, M Carballido-Fernández, E Carbonell-Franco, C Carratalá-Munuera, R Limón-Ramírez, J Mollar-Maseres, M del Carmen Otero-Reigada, G Schwarz-Chavarri, J Tuells, V Gil-Guillén, for the Valencia Hospital Network for the Study of Influenza and Respiratory Viruses Disease

Globalization and Health
[Accessed 28 February 2015]
http://www.globalizationandhealth.com/

Debate
Why language matters: insights and challenges in applying a social determination of health approach in a North-South collaborative research program
Spiegel JM, Breilh J and Yassi A Globalization and Health 2015, 11:9 (27 February 2015)

Debate
Preparing for Ebola Virus Disease in West African countries not yet affected: perspectives from Ghanaian health professionals
Nyarko Y, Goldfrank L, Ogedegbe G, Soghoian S, de-Graft Aikins A and NYU-UG-KBTH Ghana Ebola Working Group Globalization and Health 2015, 11:7 (26 February 2015)
Abstract (provisional)
Background
The current Ebola Virus Disease (EVD) epidemic has ravaged the social fabric of three West African countries and affected people worldwide. We report key themes from an agenda-setting, multi-disciplinary roundtable convened to examine experiences and implications for health systems in Ghana, a nation without cases but where risk for spread is high and the economic, social and political impact of the impending threat is already felt.
Discussion
Participants’ personal stories and the broader debates to define fundamental issues and opportunities for preparedness focused on three inter-related themes. First, the dangers of the fear response itself were highlighted as a threat to the integrity and continuity of quality care. Second, healthcare workers’ fears were compounded by a demonstrable lack of societal and personal protections for infection prevention and control in communities and healthcare facilities, as evidenced by an ongoing cholera epidemic affecting over 20,000 patients in the capital Accra alone since June 2014. Third, a lack of coherent messaging and direction from leadership seems to have limited coordination and reinforced a level of mistrust in the government’s ability and commitment to mobilize an adequate response. Initial recommendations include urgent investment in the needed supplies and infrastructure for basic, routine infection control in communities and healthcare facilities, provision of assurances with securities for frontline healthcare workers, establishment of a multi-sector, “all-hazards” outbreak surveillance system, and engaging directly with key community groups to co-produce contextually relevant educational messages that will help decrease stigma, fear, and the demoralizing perception that the disease defies remedy or control.
Summary
The EVD epidemic provides an unprecedented opportunity for West African countries not yet affected by EVD cases to make progress on tackling long-standing health systems weaknesses. This roundtable discussion emphasized the urgent need to strengthen capacity for infection control, occupational health and safety, and leadership coordination. Significant commitment is needed to raise standards of hygiene in communities and health facilities, build mechanisms for collaboration across sectors, and engage community stakeholders in creating the needed solutions. It would be both devastating and irresponsible to waste the opportunity.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 28 February 2015]

Research
Developing and refining the methods for a ‘one-stop shop’ for research evidence about health systems
John N Lavis, Michael G Wilson, Kaelan A Moat, Amanda C Hammill, Jennifer A Boyko, Jeremy M Grimshaw and Signe Flottorp
Health Research Policy and Systems 2015, 13:10 doi:10.1186/1478-4505-13-10
Published: 25 February 2015
Abstract (provisional)
Background
Policymakers, stakeholders and researchers have not been able to find research evidence about health systems using an easily understood taxonomy of topics, know when they have conducted a comprehensive search of the many types of research evidence relevant to them, or rapidly identify decision-relevant information in their search results.
Methods
To address these gaps, we developed an approach to building a ‘one-stop shop’ for research evidence about health systems. We developed a taxonomy of health system topics and iteratively refined it by drawing on existing categorization schemes and by using it to categorize progressively larger bundles of research evidence. We identified systematic reviews, systematic review protocols, and review-derived products through searches of Medline, hand searches of several databases indexing systematic reviews, hand searches of journals, and continuous scanning of LISTSERVS and websites. We developed an approach to providing ‘added value’ to existing content (e.g., coding systematic reviews according to the countries in which included studies were conducted) and to expanding the types of evidence eligible for inclusion (e.g., economic evaluations and health system descriptions). Lastly, we developed an approach to continuously updating the online one-stop shop in seven supported languages.
Results
The taxonomy is organized by governance, financial, and delivery arrangements and by implementation strategies. The ‘one-stop shop’, called Health Systems Evidence, contains a comprehensive inventory of evidence briefs, overviews of systematic reviews, systematic reviews, systematic review protocols, registered systematic review titles, economic evaluations and costing studies, health reform descriptions and health system descriptions, and many types of added-value coding. It is continuously updated and new content is regularly translated into Arabic, Chinese, English, French, Portuguese, Russian, and Spanish.
Conclusions
Policymakers and stakeholders can now easily access and use a wide variety of types of research evidence about health systems to inform decision-making and advocacy. Researchers and research funding agencies can use Health Systems Evidence to identify gaps in the current stock of research evidence and domains that could benefit from primary research, systematic reviews, and review overviews.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 11, Issue 1, 2015
http://www.tandfonline.com/toc/khvi20/11/1#.VPJsQS5nBhU

Impact of universal vaccination against varicella in Italy-Experiences from eight Italian Regions
Angela Bechini, Sara Boccalini, Vincenzo Baldo, Silvia Cocchio, Paolo Castiglia, Tolinda Gallo, Sandro Giuffrida, Francesco Locuratolo, Silvio Tafuri, Domenico Martinelli, Rosa Prato, Emanuele Amodio, Francesco Vitale & Paolo Bonanni
pages 63-71

Effectiveness of interventions that apply new media to improve vaccine uptake and vaccine coverage – A systematic review
Anna Odone, Antonio Ferrari, Francesca Spagnoli, Sara Visciarelli, Abigail Shefer, Cesira Pasquarella & Carlo Signorelli
pages 72-82

Routine surveillance of adverse events following immunization as an important tool to monitor vaccine safety – The two-years’ experience of the Liguria Region, Italy
Cristiano Alicino, Caterina Merlano, Simona Zappettini, Sergio Schiaffino, Giovanni Della Luna, Cristina Accardo, Roberto Gasparini, Paolo Durando & Giancarlo Icardi
pages 91-94

Influenza vaccination among healthcare workers in Italy – the experience of a large tertiary acute-care teaching hospital
Cristiano Alicino, Rocco Iudici, Ilaria Barberis, Chiara Paganino, Roberto Cacciani, Monica Zacconi, Angela Battistini, Dorotea Bellina, Anna Maria Di Bella, Antonella Talamini, Laura Sticchi, Alessandra Morando, Filippo Ansaldi & Paolo Durando
pages 95-100

Adult vaccination – Current recommendations and future prospects
Kena A Swanson, H Josef Schmitt, Kathrin U Jansen & Annaliesa S Anderson
pages 150-155

Safety and tolerability of 13-valent pneumococcal conjugate vaccine in the elderly
An observational study in Liguria Region, Italy
Paolo Durando, Roberto Rosselli, Ilaria Cremonesi, Andrea Orsi, Erika Albanese, Ilaria Barberis, Chiara Paganino, Cecilia Trucchi, Mariano Martini, Lorenzo Marensi, Valter Turello, the Ligurian Pneumococcal Study Group, Alessandro Bregante, Roberto Cacciani, Rocco Iudici, Diego La Marca, Leonardo Pedano, Amadio Franco Petrucci, Maria Santolini, Valentina Sbisà & Monica Zacconi
pages 172-177

Facilitators and barriers HPV unvaccinated girls after 5 years of program implementation
Alberto Firenze, Maria Grazia Laura Marsala, Valentina Bonanno, Marianna Maranto, Clara Ferrara, Lucia Giovannelli & Vincenzo Restivo
pages 240-244

Implication of health care personnel in measles transmission – The need for updated immunization status in the move towards eradication of measles in Catalonia
Núria Torner, Ruben Solano, Cristina Rius, Angela Domínguez & the Measles Elimination Program Surveillance Network of Catalonia, Spain
pages 288-292

International Journal of Epidemiology
Volume 44 Issue 1 February 2015
http://ije.oxfordjournals.org/content/current

Data Resource Profile: The sentinel panel of districts: Tanzania’s national platform for health impact evaluation
Gregory S Kabadi1,3,*, Eveline Geubbels1, Isaac Lyatuu1, Paul Smithson1, Richard Amaro1,
Sylvia Meku2, Joanna A Schellenberg3 and Honorati Masanja1
Abstract
The Sentinel Panel of Districts (SPD) consists of 23 districts selected to provide nationally representative data on demographic and health indicators in Tanzania. The SPD has two arms: SAVVY and FBIS. SAVVY (SAmple Vital registration with Verbal autopsY) is a demographic surveillance system that provides nationally representative estimates of mortalities based on age, sex, residence and zone. SAVVY covers over 805 000 persons, or about 2% of the Tanzania mainland population, and uses repeat household census every 4–5 years, with ongoing reporting of births, deaths and causes of deaths. The FBIS (Facility-Based Information System) collects routine national health management information system data. These health service use data are collected monthly at all public and private health facilities in SPD districts, i.e. about 35% of all facilities in Mainland Tanzania. Both SAVVY and FBIS systems are capable of generating supplementary information from nested periodic surveys. Additional information about the design of the SPD is available online: access to some of SPD’s aggregate data can be requested by sending an e-mail to [hmasanja@ihi.or.tz].

.
Infant birthweight and risk of childhood cancer: international population-based case control studies of 40 000 cases
Kate A O’Neill1,4,*, Michael FG Murphy2,4, Kathryn J Bunch3,4, Susan E Puumala5, Susan E Carozza6, Eric J Chow7, Beth A Mueller7, Colleen C McLaughlin8, Peggy Reynolds9, Tim J Vincent4, Julie Von Behren9 and Logan G Spector10
Author Affiliations
1Department of Paediatrics, 2Nuffield Department of Obstetrics and Gynaecology, 3National Perinatal Epidemiology Unit, 4Formerly of the Childhood Cancer Research Group, University of Oxford, Oxford, UK, 5Sanford Research Center, Sioux Falls, SD, USA, 6College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA, 7Fred Hutchinson Cancer Research Center, Seattle, WA, USA, 8New York State Department of Health, Albany, NY, USA, 9Cancer Prevention Institute of California, Berkeley, CA, USA and 10Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
Accepted December 15, 2014.
Abstract
Background: High birthweight is an established risk factor for childhood leukaemia. Its association with other childhood cancers is less clear, with studies hampered by low case numbers.
Methods: We used two large independent datasets to explore risk associations between birthweight and all subtypes of childhood cancer. Data for 16 554 cases and 53 716 controls were obtained by linkage of birth to cancer registration records across five US states, and 23 772 cases and 33 206 controls were obtained from the UK National Registry of Childhood Tumours. US, but not UK, data were adjusted for gestational age, birth order, plurality, and maternal age and race/ethnicity.
Results: Risk associations were found between birthweight and several childhood cancers, with strikingly similar results between datasets. Total cancer risk increased linearly with each 0.5 kg increase in birthweight in both the US [odds ratio 1.06 (95% confidence interval 1.04, 1.08)] and UK [1.06 (1.05, 1.08)] datasets. Risk was strongest for leukaemia [USA: 1.10 (1.06, 1.13), UK: 1.07 (1.04, 1.10)], tumours of the central nervous system [USA: 1.05 (1.01, 1.08), UK: 1.07 (1.04, 1.10)], renal tumours [USA: 1.17 (1.10, 1.24), UK: 1.12 (1.06, 1.19)] and soft tissue sarcomas [USA: 1.12 (1.05, 1.20), UK: 1.07 (1.00, 1.13)]. In contrast, increasing birthweight decreased the risk of hepatic tumours [USA: 0.77 (0.69, 0.85), UK: 0.79 (0.71, 0.89) per 0.5 kg increase]. Associations were also observed between high birthweight and risk of neuroblastoma, lymphomas, germ cell tumours and malignant melanomas. For some cancer subtypes, risk associations with birthweight were non-linear. We observed no association between birthweight and risk of retinoblastoma or bone tumours.
Conclusions: Approximately half of all childhood cancers exhibit associations with birthweight. The apparent independence from other factors indicates the importance of intrauterine growth regulation in the aetiology of these diseases.

JAMA
February 24, 2015, Vol 313, No. 8
http://jama.jamanetwork.com/issue.aspx

Viewpoint | February 24, 2015
Sharing Clinical Trial Data – Maximizing Benefits, Minimizing Risk FREE
Bernard Lo, MD1
Author Affiliations
JAMA. 2015;313(8):793-794. doi:10.1001/jama.2015.292.
[Excerpt]
…The Institute of Medicine (IOM) has issued a consensus, peer-reviewed, publicly available report that recommends how to promote responsible clinical trial data sharing while minimizing the risks and burdens of sharing.4 The report distinguished sharing trial data from sharing a summary of trial results, which is already expected. Data sharing does not necessarily mean posting data on a public website without conditions.
The committee first articulated principles to guide sharing of clinical trial data: (1) maximize the benefits while minimizing the risks of sharing clinical trial data; (2) respect individual participants whose data are shared; (3) increase public trust in clinical trials and the sharing of trial data; and (4) conduct the sharing of clinical trial data in a fair manner….

Nature
Volume 518 Number 7540 pp456-568 26 February 2015
http://www.nature.com/nature/current_issue.html

Nature | Comment
Data sharing: Make outbreak research open access
Nathan L. Yozwiak, Stephen F. Schaffner& Pardis C. Sabeti
25 February 2015
Establish principles for rapid and responsible data sharing in epidemics
Last April, five months into the largest Ebola outbreak in history, an international group of researchers sequenced three viral genomes, sampled from patients in Guinea1. The data were made public that same month. Two months later, our group at the Broad Institute in Cambridge, Massachusetts, sequenced 99 more Ebola genomes, from patients at the Kenema Government Hospital in Sierra Leone.

We immediately uploaded the data to the public database GenBank (see go.nature.com/aotpbk). Our priority was to help curb the outbreak. Colleagues who had worked with us for a decade were at the front lines and in immediate danger; some later died. We were amazed by the surge of collaboration that followed. Numerous experts from diverse disciplines, including drug and vaccine developers, contacted us. We also formed unexpected alliances — for instance, with a leading evolutionary virologist, who helped us to investigate when the strain of virus causing the current outbreak arose….

…In an increasingly connected world, rapid sequencing, combined with new ways to collect clinical and epidemiological data, could transform our response to outbreaks. But the power of these potentially massive data sets to combat epidemics will be realized only if the data are shared as widely and as quickly as possible. Currently, no good guidelines exist to ensure that this happens….

…The Kenema way
As a first step, we call on health agencies such as the World Health Organization, the US Centers for Disease Control and Prevention and Médecins Sans Frontières, as well as genome-sequencing centres and other research institutions, to convene a meeting this year — similar to that held in Bermuda in 1996. Attendees must include scientists, funders, ethicists, biosecurity experts, social scientists and journal editors.

We urge researchers working on outbreaks to embrace a culture of openness. For our part, we have released all our sequence data as soon as it has been generated, including that from several hundred more Ebola samples we recently received from Kenema. We have listed the research questions that we are pursuing at virological.org and through GenBank, and we plan to present our results at virological.org as we generate them, for others to weigh in on. We invite people either to join our publication, or to prepare their own while openly laying out their intentions online. We have also made clinical data for 100 patients publicly available and have incorporated these into a user-friendly data-visualization tool, Mirador, to allow others to explore the data and uncover new insights.

Kenema means ‘translucent, clear like a river stream’ or ‘open to the public gaze’9. To honour the memory of our colleagues who died at the forefront of the Ebola outbreak, and to ensure that no future epidemic is as devastating, let’s work openly in outbreaks.

New England Journal of Medicine
February 26, 2015 Vol. 372 No. 9
http://www.nejm.org/toc/nejm/medical-journal

Review Article
Enduring and Emerging Challenges of Informed Consent
Christine Grady, Ph.D.
N Engl J Med 2015; 372:855-862 February 26, 2015 DOI: 10.1056/NEJMra1411250
The author summarizes emerging standards for informed consent as the underpinning of ethical research in humans.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 28 February 2015)

Hesitancy, Trust and Individualism in Vaccination Decision-Making
February 25, 2015 • Editorial
Related Articles The article is part of the PLOS Currents Outbreaks “Vaccine Hesitancy Collection“. Editorial Based on recent trends, outbreaks of measles and other vaccine-preventable diseases could be more commonplace in the coming years, even in countries where such diseases have been considered eliminated or under control. In 2014, the United States reported over 600 […]

Vaccine Narratives and Public Health: Investigating Criticisms of H1N1 Pandemic Vaccination
February 25, 2015 • Commentary
Vaccine hesitancy is often understood and explored on the level of individual decision-making. However, questions surrounding the risk and efficacy of vaccination are evident in wider public discourse; social narratives of vaccination inform and impact on the individual level. This paper takes a narrative analysis approach from the sociology of health to examine data drawn from a wider study on global public health responses to the H1N1 pandemic. The paper concentrates upon criticisms to mass vaccination as recounted within the Council of Europe’s debate of the handling of H1N1. It shows that three narratives were particularly dominant: problematizing the use of vaccination as a public health response; criticising the efficacy of the vaccines; and, questioning the safety of the strategy. This debate presents an important case study in understanding the way in which vaccines are problematized within the public discourse.

Factors Associated with Intention to Receive Influenza and Tetanus, Diphtheria, and Acellular Pertussis (Tdap) Vaccines during Pregnancy: A Focus on Vaccine Hesitancy and Perceptions of Disease Severity and Vaccine Safety
February 25, 2015 • Research
BACKGROUND: Improving influenza and tetanus, diphtheria and acellular pertussis (Tdap) vaccine coverage among pregnant women is needed.
PURPOSE: To assess factors associated with intention to receive influenza and/or Tdap vaccinations during pregnancy with a focus on perceptions of influenza and pertussis disease severity and influenza vaccine safety.
METHODS: Participants were 325 pregnant women in Georgia recruited from December 2012 – April 2013 who had not yet received a 2012/2013 influenza vaccine or a Tdap vaccine while pregnant. Women completed a survey assessing influenza vaccination history, likelihood of receiving antenatal influenza and/or Tdap vaccines, and knowledge, attitudes and beliefs about influenza, pertussis, and their associated vaccines.
RESULTS: Seventy-three percent and 81% of women believed influenza and pertussis, respectively, would be serious during pregnancy while 87% and 92% believed influenza and pertussis, respectively, would be serious to their infants. Perception of pertussis severity for their infant was strongly associated with an intention to receive a Tdap vaccine before delivery (p=0.004). Despite perceptions of disease severity for themselves and their infants, only 34% and 44% intended to receive antenatal influenza and Tdap vaccines, respectively. Forty-six percent had low perceptions of safety regarding the influenza vaccine during pregnancy, and compared to women who perceived the influenza vaccine as safe, women who perceived the vaccine as unsafe were less likely to intend to receive antenatal influenza (48% vs. 20%; p < 0.001) or Tdap (53% vs. 33%; p < 0.001) vaccinations.
CONCLUSIONS: Results from this baseline survey suggest that while pregnant women who remain unvaccinated against influenza within the first three months of the putative influenza season may be aware of the risks influenza and pertussis pose to themselves and their infants, many remain reluctant to receive influenza and Tdap vaccines antenatally. To improve vaccine uptake in the obstetric setting, our findings support development of evidence-based vaccine promotion interventions which emphasize vaccine safety during pregnancy and mention disease severity in infancy.

Why Are Young Adults Affected? Estimating Measles Vaccination Coverage in 20-34 Year Old Germans in Order to Verify Progress Towards Measles Elimination
February 25, 2015 • Research
Background:
The introduction of measles vaccination into routine childhood vaccination programmes has led to a shift of disease burden and incidence among young adults. This was confirmed by the recent rise in measles cases and outbreaks throughout Europe. To prevent outbreaks and eliminate measles, one of the key objectives of the WHO Europe measles elimination framework is achieving overall vaccination coverage of ≥95% in the population on a district level.
In the absence of national registers, data on vaccination coverage in Germany is recorded at the age of school entry, through insurance refund claim data and population studies. Vaccination status (VS) of young adults is largely unknown.
Methods:
We assessed measles vaccination coverage in young adults aged 20-34 years on a district level of the German Federal State of Rhineland-Palatinate. The knowledge and attitude towards immunization of unvaccinated to vaccinated young adults were compared using Likert questions. We used proportional allocation for stratified random sampling across 36 counties. We mailed a self-administered questionnaire with pre-paid return envelopes along with an offer to complete online. Prior to calculating coverage we tested for non-responder bias using logistic regression.
Results:
465 (28%) of 1,637 persons contacted responded (mail: 23%, online: 5%). More women responded than men (odds ratio (OR)=2.1; 95% confidence intervall (CI)=1.7-2.6) but age did not vary between responders and non-responders. Vaccination coverage was 90% (95%CI=87%-93%) for one and 56% (95%CI=51%-61%) for two doses. We found a statistically significant association between receiving two doses and age group. The 20-24 years age group had a 2.3 higher incidence rate ratio (95%CI=1.7-3.2) than the reference group of 30-34 year old to have received two doses of measles vaccination. The group of 25-29 year old had a 1.5 higher incidence rate (95%CI=1.0-2.1) than the reference group to have received two doses of measles vaccination.
Conclusions:
Coverage has failed to reach the WHO Europe elimination goal of 95% measles vaccination in the general population. Targeted approaches including enlistment of occupational health services and checking vaccination status during general practitioner (GP) visits are needed to increase vaccination uptake in this age group in order to achieve measles elimination.

Vaccine Hesitancy: Clarifying a Theoretical Framework for an Ambiguous Notion
February 25, 2015 • Commentary
Today, according to many public health experts, public confidence in vaccines is waning. The term “vaccine hesitancy” (VH) is increasingly used to describe the spread of such vaccine reluctance. But VH is an ambiguous notion and its theoretical background appears uncertain. To clarify this concept, we first review the current definitions of VH in the public health literature and examine its most prominent characteristics. VH has been defined as a set of beliefs, attitudes, or behaviours, or some combination of them, shared by a large and heterogeneous portion of the population and including people who exhibit reluctant conformism (they may either decline a vaccine, delay it or accept it despite their doubts) and vaccine-specific behaviours. Secondly, we underline some of the ambiguities of this notion and argue that it is more a catchall category than a real concept. We also call into question the usefulness of understanding VH as an intermediate position along a continuum ranging from anti-vaccine to pro-vaccine attitudes, and we discuss its qualification as a belief, attitude or behaviour. Thirdly, we propose a theoretical framework, based on previous literature and taking into account some major structural features of contemporary societies, that considers VH as a kind of decision-making process that depends on people’s level of commitment to healthism/risk culture and on their level of confidence in the health authorities and mainstream medicine.

Measuring Vaccine Confidence: Introducing a Global Vaccine Confidence Index
February 25, 2015 • Research
Background.
Public confidence in vaccination is vital to the success of immunisation programmes worldwide. Understanding the dynamics of vaccine confidence is therefore of great importance for global public health. Few published studies permit global comparisons of vaccination sentiments and behaviours against a common metric. This article presents the findings of a multi-country survey of confidence in vaccines and immunisation programmes in Georgia, India, Nigeria, Pakistan, and the United Kingdom (UK) – these being the first results of a larger project to map vaccine confidence globally.
Methods.
Data were collected from a sample of the general population and from those with children under 5 years old against a core set of confidence questions. All surveys were conducted in the relevant local-language in Georgia, India, Nigeria, Pakistan, and the UK. We examine confidence in immunisation programmes as compared to confidence in other government health services, the relationships between confidence in the system and levels of vaccine hesitancy, reasons for vaccine hesitancy, ultimate vaccination decisions, and their variation based on country contexts and demographic factors.
Results.
The numbers of respondents by country were: Georgia (n=1000); India (n=1259); Pakistan (n=2609); UK (n=2055); Nigerian households (n=12554); and Nigerian health providers (n=1272). The UK respondents with children under five years of age were more likely to hesitate to vaccinate, compared to other countries. Confidence in immunisation programmes was more closely associated with confidence in the broader health system in the UK (Spearman’s ρ=0.5990), compared to Nigeria (ρ=0.5477), Pakistan (ρ=0.4491), and India (ρ=0.4240), all of which ranked confidence in immunisation programmes higher than confidence in the broader health system. Georgia had the highest rate of vaccine refusals (6 %) among those who reported initial hesitation. In all other countries surveyed most respondents who reported hesitating to vaccinate went on to receive the vaccine except in Kano state, Nigeria, where the percentage of those who ultimately refused vaccination after initially hesitating was as high as 76%) Reported reasons for hesitancy in all countries were classified under the domains of “confidence,” “convenience,” or “complacency,” and confidence issues were found to be the primary driver of hesitancy in all countries surveyed.

PLoS Medicine
(Accessed 28 February 2015)
http://www.plosmedicine.org/

Humanitarian Access to Unapproved Interventions in Public Health Emergencies of International Concern
Jerome Amir Singh
Essay | published 24 Feb 2015 | PLOS Medicine 10.1371/journal.pmed.1001793
Summary Points
– Time-sensitive access to unapproved experimental interventions should be permitted on humanitarian grounds when patients or communities are facing death or irreversible disease progression and no other efficacious diagnostic, preventive, or therapeutic alternative exists.
– Regulatory deficits could stymie time-sensitive efforts to contain public health threats when no efficacious curative, therapeutic, or preventive interventions exist to counter the threat in question.
– United States regulatory mechanisms may provide useful guidance from a regulatory perspective to policy makers grappling with how to adequately prepare for, or respond to, potential or emerging public health emergencies.
– Access to unapproved experimental interventions should be underpinned by a robust monitoring and evaluation component that will inform product development and licensure.
– A global-level rapid-response governance framework for the employment of unapproved interventions in humanitarian contexts should be established as a matter of urgency.

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The Movement of Multidrug-Resistant Tuberculosis across Borders in East Africa Needs a Regional and Global Solution
Kevin P. Cain, Nina Marano, Maureen Kamene, Joseph Sitienei, Subroto Mukherjee, Aleksandar Galev, John Burton, Orkhan Nasibov, Jackson Kioko, Kevin M. De Cock
Policy Forum | published 24 Feb 2015 | PLOS Medicine 10.1371/journal.pmed.1001791
Summary Points
– Multidrug-resistant tuberculosis (MDR TB) and other deadly infectious diseases commonly occur in states suffering from political turmoil and armed conflict.
– The same conditions that promote MDR TB and other diseases often diminish the capacity of the public health system to address these needs, leading patients to seek care in other countries.
– In East Africa, a large number of patients from Somalia with MDR TB crossed the border to Kenya seeking treatment. While diagnostic capacity for MDR TB exists in Somalia, treatment capacity does not.
– Identification and management of such diseases need to be a priority for countries in the region both for humanitarian purposes and for the protection of their own residents. Often diseases will need to be diagnosed and treated outside of the country in which they are occurring.
– The solutions must be regional and global. Control of an infectious disease, such as MDR TB, must be focused at its source to be successful. Its control cannot depend on the existing capacity of the country in which it happens to occur.

PLoS One
[Accessed 28 February 2015]
http://www.plosone.org/

Care Seeking Behaviour for Children with Suspected Pneumonia in Countries in Sub-Saharan Africa with High Pneumonia Mortality
Aaltje Camielle Noordam, Liliana Carvajal-Velez, Alyssa B. Sharkey, Mark Young, Jochen W. L. Cals
Research Article | published 23 Feb 2015 | PLOS ONE 10.1371/journal.pone.0117919
Abstract
Pneumonia is the leading cause of childhood mortality in sub-Saharan Africa (SSA). Because effective antibiotic treatment exists, timely recognition of pneumonia and subsequent care seeking for treatment can prevent deaths. For six high pneumonia mortality countries in SSA we examined if children with suspected pneumonia were taken for care, and if so, from which type of care providers, using national survey data of 76530 children. We also assessed factors independently associated with care seeking from health providers, also known as ‘appropriate’ providers. We report important differences in care seeking patterns across these countries. In Tanzania 85% of children with suspected pneumonia were taken for care, whereas this was only 30% in Ethiopia. Most of the children living in these six countries were taken to a primary health care facility; 86, 68 and 59% in Ethiopia, Tanzania and Burkina Faso respectively. In Uganda, hospital care was sought for 60% of children. 16–18% of children were taken to a private pharmacy in Democratic Republic of Congo (DRC), Tanzania and Nigeria. In Tanzania, children from the richest households were 9.5 times (CI 2.3–39.3) more likely to be brought for care than children from the poorest households, after controlling for the child’s age, sex, caregiver’s education and urban-rural residence. The influence of the age of a child, when controlling for sex, urban-rural residence, education and wealth, shows that the youngest children (<2 years) were more likely to be brought to a care provider in Nigeria, Ethiopia and DRC. Urban-rural residence was not significantly associated with care seeking, after controlling for the age and sex of the child, caregivers education and wealth. The study suggests that it is crucial to understand country-specific care seeking patterns for children with suspected pneumonia and related determinants using available data prior to planning programmatic

Pneumonia
Vol 6 (2015)
https://pneumonia.org.au/index.php/pneumonia/issue/current
.
Correspondence
Childhood Pneumonia Screener: a concept
Keith Grimwood
Abstract
To the Editor:
I congratulate Räsänen and Gavriely for their recent thought-provoking article describing how mobile ‘smart’ phone technology could assist in diagnosing and managing pneumonia in children from developing countries lacking well-established healthcare systems and infrastructure [1]. In the article they describe their plans for first developing, then validating, implementing and finally evaluating a pneumonia screening tool, which if successful could act as a model for improving healthcare delivery in resource-poor settings. Read the full Letter to the Editor here

Full article – Childhood Pneumonia Screener: a concept

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH)
December 2014 Vol. 36, No. 6
http://www.paho.org/journal/index.php?option=com_content&view=article&id=151&Itemid=266&lang=en

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ARTÍCULOS DE INVESTIGACIÓN ORIGINAL / ORIGINAL RESEARCH ARTICLES
Agendas de investigación priorizadas: un recurso estratégico para la salud en América Latina [Priority research agendas: a strategic resource for health in Latin America]
Francisco Becerra-Posada, Nelly Salgado de Snyder,Luis Gabriel Cuervo y Gabriela Montorzi

SPECIAL SECTION / SECCIÓN ESPECIAL
Preparación de los adultos mayores en los Estados Unidos para hacer frente a los desastres naturales: encuesta a escala nacional [Preparedness for natural disasters among older US adults: a nationwide survey]
Tala M. Al-rousan, Linda M. Rubenstein y Robert B. Wallace

Science
27 February 2015 vol 347, issue 6225, pages 921-1040
http://www.sciencemag.org/current.dtl

Review
Systems integration for global sustainability
Jianguo Liu1,*, Harold Mooney2, Vanessa Hull1, Steven J. Davis3, Joanne Gaskell4, Thomas Hertel5, Jane Lubchenco6, Karen C. Seto7, Peter Gleick8, Claire Kremen9, Shuxin Li1
Author Affiliations
1Center for Systems Integration and Sustainability, Department of Fisheries and Wildlife, Michigan State University, East Lansing, MI, USA.
2Department of Biology, Stanford University, Stanford, CA, USA.
3Department of Earth System Science, University of California, Irvine, CA, USA.
4World Bank, Washington, DC, USA.
5Department of Agricultural Economics, Purdue University, West Lafayette, IN, USA.
6Department of Integrative Biology, Oregon State University, Corvallis, OR, USA.
7School of Forestry and Environmental Studies, Yale University, New Haven, CT, USA.
8The Pacific Institute, Oakland, CA, USA.
9Department of Environmental Science, Policy and Management, University of California, Berkeley, CA, USA.
Abstract
BACKGROUND
Many key global sustainability challenges are closely intertwined (examples are provided in the figure). These challenges include air pollution, biodiversity loss, climate change, energy and food security, disease spread, species invasion, and water shortages and pollution. They are interconnected across three dimensions (organizational levels, space, and time) but are often separately studied and managed. Systems integration—holistic approaches to integrating various components of coupled human and natural systems (for example, social-ecological systems and human-environment systems) across all dimensions—is necessary to address complex interconnections and identify effective solutions to sustainability challenges.

ADVANCES
One major advance has been recognizing Earth as a large, coupled human and natural system consisting of many smaller coupled systems linked through flows of information, matter, and energy and evolving through time as a set of interconnected complex adaptive systems. A number of influential integrated frameworks (such as ecosystem services, environmental footprints, human-nature nexus, planetary boundaries, and telecoupling) and tools for systems integration have been developed and tested through interdisciplinary and transdisciplinary inquiries. Systems integration has led to fundamental discoveries and sustainability actions that are not possible by using conventional disciplinary, reductionist, and compartmentalized approaches. These include findings on emergent properties and complexity; interconnections among multiple key issues (such as air, climate, energy, food, land, and water); assessment of multiple, often conflicting, objectives; and synergistic interactions in which, for example, economic efficiency can be enhanced while environmental impacts are mitigated. In addition, systems integration allows for clarification and reassignment of environmental responsibilities (for example, among producers, consumers, and traders); mediation of trade-offs and enhancement of synergies; reduction of conflicts; and design of harmonious conservation and development policies and practices.

OUTLOOK
Although some studies have recognized spillover effects (effects spilling over from interactions among other systems) or spatial externalities, there is a need to simultaneously consider socioeconomic and environmental effects rather than considering them separately. Furthermore, identifying causes, agents, and flows behind the spillover effects can help us to understand better and hence manage the effects across multiple systems and scales. Integrating spillover systems with sending and receiving systems through network analysis and other advanced analytical methods can uncover hidden interrelationships and lead to important insights. Human-nature feedbacks, including spatial feedbacks (such as those among sending, receiving, and spillover systems), are the core elements of coupled systems and thus are likely to play important roles in global sustainability. Systems integration for global sustainability is poised for more rapid development, and transformative changes aimed at connecting disciplinary silos are needed to sustain an increasingly telecoupled world.

Among Brazil, China, the Caribbean, and the Sahara Desert in Africa, there are complex human-nature interactions across space, time, and organizational levels. Deforestation in Brazil due to soybean production provides food for people and livestock in China. Food trade between Brazil and China also contributes to changes in the global food market, which affects other areas around the world, including the Caribbean and Africa, that also engage in trade with China and Brazil. Dust particles from the Sahara Desert in Africa—aggravated by agricultural practices—travel via the air to the Caribbean, where they contribute to the decline in coral reefs and soil fertility and increase asthma rates. These in turn affect China and Brazil, which have both invested heavily in Caribbean tourism, infrastructure, and transportation. Nutrient-rich dust from Africa also reaches Brazil, where it improves forest productivity.

.
Perspective
Virology
Delineating Ebola entry
Darryl Falzarano1, Heinz Feldmann2
Author Affiliations
1Vaccine and Infectious Disease Organization–International Vaccine Centre, University of Saskatchewan, Saskatoon, SK Canada.
2Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Hamilton, MT, USA.
The means by which Ebola virus enters a cell are becoming less mysterious. Although a definitive cell surface receptor for the virus, if there is one, remains to be identified, the mechanism of gaining entry is beginning to be fleshed out. Once inside the cell, the importance of numerous sequential processes is becoming better understood. On page 995 of this issue, Sakurai et al. (1) add another element to the viral entry pathway by showing that a calcium channel called two-pore channel 2 (TPC2) is required for release of the viral genome into the host cell.

.
Report
Two-pore channels control Ebola virus host cell entry and are drug targets for disease treatment
Yasuteru Sakurai1, Andrey A. Kolokoltsov2, Cheng-Chang Chen3, Michael W. Tidwell4, William E. Bauta4, Norbert Klugbauer5, Christian Grimm3, Christian Wahl-Schott3, Martin Biel3, Robert A. Davey1,*
Author Affiliations
1Texas Biomedical Research Institute, San Antonio, TX, USA.
2The University of Texas Medical Branch, Galveston, TX, USA.
3Center for Integrated Protein Science Munich (CIPSM) at the Department of Pharmacy–Center for Drug Research, Ludwig-Maximilians-Universität München, Munich, Germany.
4Southwest Research Institute, San Antonio, TX, USA.
5Institute for Experimental and Clinical Pharmacology and Toxicology, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany.
Abstract
Ebola virus causes sporadic outbreaks of lethal hemorrhagic fever in humans, but there is no currently approved therapy. Cells take up Ebola virus by macropinocytosis, followed by trafficking through endosomal vesicles. However, few factors controlling endosomal virus movement are known. Here we find that Ebola virus entry into host cells requires the endosomal calcium channels called two-pore channels (TPCs). Disrupting TPC function by gene knockout, small interfering RNAs, or small-molecule inhibitors halted virus trafficking and prevented infection. Tetrandrine, the most potent small molecule that we tested, inhibited infection of human macrophages, the primary target of Ebola virus in vivo, and also showed therapeutic efficacy in mice. Therefore, TPC proteins play a key role in Ebola virus infection and may be effective targets for antiviral therapy.

Vaccines — Open Access Journal
(Accessed 28 February 2015)
http://www.mdpi.com/journal/vaccines

Article: Beliefs and Opinions of Health Care Workers and Students Regarding Influenza and Influenza Vaccination in Tuscany, Central Italy
by Guglielmo Bonaccorsi, Francesca Santomauro, Barbara Rita Porchia, Giuditta Niccolai, Elettra Pellegrino, Paolo Bonanni and Chiara Lorini
Vaccines 2015, 3(1), 137-147; doi:10.3390/vaccines3010137 – published 26 February 2015
Abstract:
Immunization of health care workers (HCWs) against influenza has been associated with improvements in patient safety. The aim of this study is to assess the beliefs, attitudes, and knowledge of HCWs and health profession students regarding influenza. An anonymous questionnaire was distributed to HCWs in three local Florentine healthcare units, at Careggi University Teaching Hospital, and to students in health profession degree programs. A total of 2576 questionnaires were fully completed. A total of 12.3% of subjects responded that they were “always vaccinated” in all three of the seasonal vaccination campaigns studied (2007–2008 to 2009–2010), 13.1% had been vaccinated once or twice, and 74.6% had not received vaccinations. Although the enrolled subjects tended to respond that they were “never vaccinated,” they considered influenza to be a serious illness and believed that the influenza vaccine is effective. The subjects who refused vaccination more frequently believed that the vaccine could cause influenza and that it could have serious side effects. More than 60% of the “always vaccinated” group completely agreed that HCWs should be vaccinated. Self-protection and protecting family members or other people close to the respondent from being infected and representing potential sources of influenza infection can be considered motivating factors for vaccination. The results highlight the importance of improving vaccination rates among all HCWs through multi-component interventions. Knowledge of influenza should be reinforced.

From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary
African Journal of Reproductive Health
Vol 18 Issue 4 2014
Effect of school-based human papillomavirus (HPV) vaccination on adolescent girls’ knowledge and acceptability of the HPV vaccine in Ibanda district in Uganda
Turiho, Andrew Kampikaho, Okello, Elialilia S., Muhwezi, Wilson W., Harvey, Steve Byakika-Kibwika, Pauline Meya, David Katahoire, Anne R.
Abstract
From 2008 to 2011, schoolgirls were vaccinated against HPV in two districts in Uganda following sensitization. This study assessed girls’ knowledge of cervical cancer and HPV vaccine, and their acceptance of future vaccination of friends and hypothetical daughters. The cross-sectional, mixed methods comparative study was conducted in two districts. Univariate, bivariate, logistic regression and thematic analyses were done. HPV vaccination was positively associated with knowledge (Crude OR: 5.31, CI: 3.19-8.86; p = 0.000); but knowledge (Adjusted OR: 1.13, CI: 0.56-2.28; p = 0.73) and HPV vaccination (Adjusted OR: 0.92, CI: 0.16-5.36; p = 0.93) did not predict vaccine acceptability. Seemingly important motivations for vaccine acceptance were: its role in cancer prevention and advancement of reproductive health, minimal side effects, and positive peer role models. Major deterrents to vaccine acceptance were: rumours and misconceptions about possible side effects, perceived inadequate information about vaccine, and fear of side effects.

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

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

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BBC
http://www.bbc.co.uk/
Accessed 28 February 2015
28 February 2015 Last updated at 17:53 ET
Ebola outbreak: Sierra Leone vice-president quarantined
The vice-president of Sierra Leone has put himself into quarantine after one of his bodyguards died from Ebola.
Samuel Sam-Sumana said he would stay out of contact with others for 21 days as a precaution.
There was optimism the virus was on the decline in Sierra Leone at the end of last year but there has been a recent increase in confirmed cases.
Nearly 10,000 people have died in the outbreak, the vast majority in Guinea, Liberia and Sierra Leone.
‘Taking no chances’
Mr Sam-Sumana said on Saturday that he had chosen to be quarantined to “lead by example” after the death of his bodyguard, John Koroma, last week.
He told Reuters news agency that he was “very well” and showing no signs of the illness, but said he did not want to “take chances”.
His staff have also been placed under observation.
He is the country’s first senior government figure to subject himself to a voluntary quarantine…

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Financial Times
http://www.ft.com/home/uk
Accessed 28 February 2015
Ebola spurs healthcare insurance debate
16 February 2015
The one good thing to come from the Ebola outbreak in west Africa is a fresh debate on the urgency of improving access to basic healthcare and, in turn, the need for moves towards universal heathcare coverage. Years of neglect of prevention and treatment help explain why the lethal infection claimed thousands of lives in Sierra Leone, Liberia and Guinea, whereas it was effectively contained in Europe and North America. To some, the events have underlined the broader benefits of investment in health as a way not only to cut illness and death but also to support broader development. Given the poor response, Ebola has sharply set back economies in the region.

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Forbes
http://www.forbes.com/
Accessed 28 February 2015
Naturopaths–Not What The Doctor Ordered For Vaccine Exemptions
There are lots of reasons why measles, having gone to Disneyland, is enjoying a comeback around the United States and Canada. Unfounded fears of autism scare some parents. Others buy the daffy conspiracy theory that pharmaceutical companies are just pushing vaccination to make a buck. Some parents invoke religious concerns […]
Arthur Caplan, Contributor Feb 24, 2015
Anti-Vaxxers Are Spreading Concern
Does the anti-vaxxer movement reflect a generation of parents who are less concerned with the public good?
Neil Howe, Contributor Feb 27, 2015

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The Guardian
http://www.guardiannews.com/
Accessed 28 February 2015
Measles death in Germany prompts calls for mandatory vaccinations
Death of 18-month-old boy is the first fatality among 574 reported cases in the country’s worst measles outbreak in more than a decade
23 February 2015

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New York Times
http://www.nytimes.com/
Accessed 28 February 2015
Fatality Rate Is Falling in West African Ebola Clinics
New York Times | 26 February 2015
As the Ebola epidemic in West Africa wanes, physicians from Doctors Without Borders are confronting a mystery: More of their patients are surviving. They do not know why. “The reasons are really unclear,” said Dr. Gilles van Cutsem, who helped run the agency’s response in Liberia and gave a presentation describing its experience at an AIDS conference here.

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Washington Post
http://www.washingtonpost.com/
Accessed 28 February 2015
Oregon considers banning most vaccine exemptions
Jennifer Margulis has her kids vaccinated and she gets shots herself. But she doesn’t like the idea of government telling parents they must get their children immunized…
Associated Press | Health & Science | Feb 28, 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

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

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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

POLIO [to 21 February 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 18 February 2014
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: The fourth meeting of the International Health Regulations Emergency Committee concerning the international spread of wild poliovirus is convening this week. Outcomes and the Committee’s final report will be made available on http://www.polioeradication.org.
:: It has been six months since the most recent case of wild poliovirus on the African continent had onset of paralysis, in Somalia on 11 August. Twelve months of absence of wild poliovirus, with certification-quality surveillance, will be necessary for the Horn of Africa outbreak to be declared as closed.
Selected country report content:
Afghanistan
:: On 15 – 17 February in most areas and 22 – 24 February in the south, Subnational Immunization Days (SNIDs) will take place across the entire south and east of the country, using bivalent OPV. The next National Immunization Days (NIDs) are planned for 15 – 17 March using trivalent OPV in most areas, and inactivated polio vaccine (IPV) combined with bivalent OPV in some areas of Hilmand, Kandahar and Nangarhar.

Four kidnapped polio workers are found dead in Pakistan
BBC News | 17 February 2015
Four members of a polio vaccination team have been found shot dead in south-west Pakistan, four days after being abducted.
Police said that the bodies of a health worker, his driver and two security guards were found in the region of Balochistan.
The team were seized on Friday by Taliban militants, security officials said.
Militants say polio teams are spies or that the vaccine causes infertility…

EBOLA/EVD [to 21 February 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

WHO: Ebola Situation Report – 18 February 2015
[Excerpt; Editor’s text bolding]

SUMMARY
Total weekly case incidence increased for the second consecutive week, with 144 new confirmed cases reported in the week to 8 February. Guinea reported a sharp increase in incidence, with 65 new confirmed cases compared with 39 the week before. Transmission remains widespread in Sierra Leone, which reported 76 new confirmed cases, while the resurgence in cases in the western district of Port Loko continued for a second week. Liberia continues to report a low number of new confirmed cases.

Despite improvements in case finding and management, burial practices, and community engagement, the decline in case incidence has stalled. The spike in cases in Guinea and continued widespread transmission in Sierra Leone underline the considerable challenges that must still be overcome to get to zero cases. The infrastructure, systems, and people needed to end the epidemic are now in place; response measures must now be fully implemented.

The surge of new confirmed cases reported by Guinea was driven primarily by transmission in the capital, Conakry (21 confirmed cases) and the western prefecture of Forecariah (26 confirmed cases). Community engagement continues to be a challenge in Conakry and Forecariah, and in Guinea more widely. Almost one-third of the country’s EVD-affected prefectures reported at least one security incident in the week to 8 February. Effective contact tracing, which relies on the cooperation of communities, has also proved challenging. In the week to 1 February, just 7 of 42 cases arose among registered contacts. A total of 34 unsafe burials were reported, with 21 EVD-positive deaths reported in the community.

Seven new confirmed cases were reported in the east-Guinean prefecture of Lola. A field team is currently deployed to Côte d’Ivoire to assess the state of preparedness in western areas of the country that border Lola.

Follow-up preparedness missions are planned for Mali and Senegal later this month, culminating in a tri-partite meeting between Guinea, Mali, and Senegal to strengthen cross-border surveillance.

A total of 3 confirmed cases was reported from Liberia. All of the cases originated from the same area of Montserrado county, linked to a single chain of transmission.

Following the steep decline in case incidence in Sierra Leone from December until the end of January, incidence has now stabilized. A total of 76 cases were reported in the week to 8 February, a decrease from the 80 confirmed cases reported in the week to 1 February, but higher than the 65 confirmed cases reported in the week to 25 January. Transmission remains widespread, with 7 districts reporting new confirmed cases. A total of 41 unsafe burials were reported in the week to 8 February.

The case fatality rate among hospitalized cases (calculated from all confirmed and probable hospitalized cases with a reported definitive outcome) remains high, between 53% and 60%.

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
There have been almost 23,000 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone (table 1), with almost 9000 reported deaths (outcomes for many cases are unknown). A total of 65 new confirmed cases were reported in Guinea, 3 in Liberia, and 76 in Sierra Leone in the 7 days to 8 February (data missing for 8 February in Liberia). At the start of the epidemic many reported suspected cases were genuine cases of EVD. At this stage, with improved surveillance systems in place, a far smaller proportion of suspected cases are confirmed to have EVD. Consequently, the incidence of new confirmed cases gives a more accurate picture of the epidemic.

A stratified analysis of cumulative confirmed and probable cases indicates that the number of cases in males and females is similar (table 2). Compared with children (people aged 14 years and under), people aged 15 to 44 are approximately three times more likely to be affected. People aged 45 and over are almost four times more likely to be affected than are children.

A total of 830 confirmed health worker infections have been reported in the 3 intense-transmission countries; there have been 488 reported deaths…
WHO: Guinea: Reopening schools safely – partnering with families and communities
16 February 2015

18 February 2015
SG/SM/16536-GA/11621
In General Assembly Meeting on Ebola, Secretary-General Urges Member States to Sustain Crucial Work, Provide Resources Needed to Reach ‘Zero Cases’
[Excerpt; Editor’s text bolding]
We met five months ago when the world was coming to terms with an unprecedented outbreak of Ebola in West Africa. The outbreak was gaining ground every hour, outpacing response efforts.

You recognized the grave threat that Ebola posed to the region and beyond. You welcomed the deployment of the United Nations Mission for Ebola Emergency Response — UNMEER — the first of its kind in the history of the United Nations.

Local, national, regional and international capacities mobilized in solidarity with the affected communities and countries to support nationally led response efforts. With the leadership of Presidents Condé, Koroma and Sirleaf Johnson, national Governments and communities took proactive steps to protect themselves, leading to reduced risks of infection and lower incidence rates.

Today, we face a critical turning point. The pattern of the Ebola outbreak has changed. 2015 has seen a significant decline in the number of new Ebola cases in the three affected countries. Liberia, once the worst affected country with several hundred cases per week, has been steadily reporting fewer than five cases per week for the past month, all isolated to a single chain of transmission in one county.

While overall figures remain much lower than what we saw in 2014, incidence rates rose again in Guinea and Sierra Leone in recent weeks. More than half of those newly infected have not been in contact with people known to have had Ebola. This reminds us that setbacks can quickly follow apparent gains, and highlights the need for constant vigilance and active surveillance, even in unaffected areas.

The response now faces a complicating factor: the impending rainy season, which will lead to increases in other diseases and impede road access for responders. To get the situation further under control, the UN system, through UNMEER, is mobilizing surge efforts to support national and local authorities in Guinea and Sierra Leone. We are accelerating our work to reach the targets set by the Presidents of the Mano River Union on 15 February — zero cases in 60 days, by mid-April.

A strong, effective response can bring the spread of Ebola under control. But, if communities, Governments and partners stop being vigilant, resort to unsafe practices and fail to conduct active surveillance, and if donors decide not to finance this vital push, flare-ups will occur. This could lead to a serious recurrence of the outbreak.

Too much progress has been made and too much is at stake to afford complacency. We must finish the job. Our collective efforts have made remarkable progress. We have succeeded in averting the worst-case scenarios we feared. There are encouraging signs that the worst of the outbreak is behind us. But, much important work lies ahead until the affected countries reach zero cases and begin the transition to reconstruction and recovery.

I call on all responders to redouble their efforts, and on donors to stay the course. Under the technical leadership of the World Health Organization, the UN system will continue supporting efforts to get to zero through active surveillance, case management and community engagement. The UN system will also contribute to the safe revival of essential services.

As the situation improves, the time will come for critical functions to transition progressively and seamlessly from UNMEER to the UN agencies, funds and programmes. Significant additional resources will be required by the UN system.

My Special Envoy, Dr. Nabarro, will continue to mobilize the resources needed to fill critical gaps, including through my Trust Fund. The UN system will work with national Governments and regional partners to ensure that the investments made in the fight to stop Ebola serve as a basis for longer-term recovery efforts. We must help the affected countries to become more resilient. Ebola must not be allowed to take hold again in the region.

I appeal to you today to stay engaged and sustain this crucially important work. Let us provide the resources needed to get to zero. Let us ensure that reconstruction and recovery can occur without delay. Let us translate the lessons from this collective effort into building stronger national systems for health security…
Letter from the Secretary-General to the President of the General Assembly: Work on the UN in response to the Ebola outbreak [120-day report], A/69/759 (10 February 2015)

UNMEER [to 21 February 2015]
https://ebolaresponse.un.org/un-mission-ebola-emergency-response-unmeer

:: Statements from United Nations officials and Coalition partners.
19 Feb 2015
– Special Representative and Head of UNMEER’s remarks at the Ministry of Information, Cultural Affairs and Tourism Press Briefing in Monrovia

18 Feb 2015
– Special Representative and Head of UNMEER’s statement at the informal plenary meeting of the General Assembly on Ebola
– President of the General Assembly’s statement at the informal plenary meeting of the General Assembly on Ebola
– Dr. David Nabarro’s statement at the informal plenary meeting of the General Assembly on Ebola

17 Feb 2015
– Remarks by Dr. David Nabarro at the Opening of the International Responders’ Meeting, WHO/Geneva

CDC/MMWR Watch [to 21 February 2015]
http://www.cdc.gov/media/index.html

:: Ebola containment strategy succeeding in Liberia – Friday, February 20, 2015
Data reveal dramatic impact of Rapid Isolation and Treatment of Ebola (RITE) strategy
The Rapid Isolation and Treatment of Ebola (RITE) strategy is helping to end the Ebola epidemic in Liberia, according to new data reported in this week’s Morbidity and Mortality Weekly Report (MMWR).
The strategy—a rapid, coordinated response to Ebola cases in remote areas—is now being used in Sierra Leone and Guinea….

:: MMWR Weekly, February 20, 2015 / Vol. 64 / No. 6
– Update on Progress in Selected Public Health Programs After the 2010 Earthquake and Cholera Epidemic — Haiti, 2014
– Measles Outbreak — California, December 2014–February 2015

WHO urges governments to increase investment to tackle 17 neglected tropical diseases
News release
19 February 2015 ¦ GENEVA – WHO urges affected countries to scale up their investment in tackling 17 neglected tropical diseases in order to improve the health and well-being of more than 1.5 billion people. This investment would represent as little as 0.1% of current domestic expenditure on health in affected low- and middle-income countries for the period 2015-2030.

Neglected tropical diseases cause blindness, disfigurement, permanent disability and death, particularly among the poor…

“Increased investments by national governments can alleviate human misery, distribute economic gains more evenly and free masses of people long trapped in poverty,” says WHO Director-General Dr Margaret Chan.

Progress
The report highlights progress made in recent years, largely attributed to a scale-up of control interventions in reaching the poorest. For example, in 2012 alone, more than 800 million people were treated for at least one neglected tropical disease. In 2014 there were just 126 cases reported of Dracunculiasis (guinea-worm disease), compared to almost 1800 in 2010 and 3.5 million in the mid-1980s. Eradication of this disease is achievable with continued effort and investment.
Need for increased domestic investment targets

The report sets specific investment targets for many of the 17 diseases. It stresses that countries must make firm and sustainable budgetary commitments if they are to meet WHO targets and accelerate progress.

The investments
:: An annual investment of US$ 2.9 billion until 2020 (including vector control), is required to reach targets set in 2012 in the WHO Roadmap for 2015-2020.
:: For the following 10 years (2021-2030), investment requirements will drop to US$ 1.6 billion per year. Annual investments will continue to decrease as diseases are reduced or eliminated.
:: This adds up to a total investment of US$ 34 billion (over 16 years) and excludes cost of donated medicines and other in-kind contributions.
The impacts
:: By 2017, the number of people receiving preventive treatment for at least one of the diseases should reach 1.5 billion. As diseases are reduced or eliminated, the number of people needing and receiving treatment will obviously fall. Early detection of some neglected tropical diseases will allow more children to continue school and adults to work while reducing the costs associated with treating more advanced forms of these diseases.
:: Moving towards universal health coverage will ensure that all people have access to preventive and curative health services for neglected tropical diseases without the risk of financial hardship when paying for them.
:: Investing to overcome the impact of neglected tropical diseases – Third WHO report on neglected tropical diseases

WHO & Regionals [to 21 February 2015]
:: Global Alert and Response (GAR): Disease Outbreak News (DONs)
– 16 February 2015 Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia

:: The Weekly Epidemiological Record (WER) 20 February 2015, vol. 90, 8 (pp. 57–68) includes:
– Meningococcal A conjugate vaccine: updated guidance, February 2015
– Preparation for Ebola in Côte d’Ivoire: WHO Ebola response and preparedness support team, October 2014
– Monthly report on dracunculiasis cases, January– December 2014
In an updated position paper published in today’s edition, WHO emphasizes the importance of completing mass vaccination campaigns in individuals aged 1 to 29 years in all countries in the African meningitis belt, and the need to conduct high quality surveillance and vaccine programme evaluation in those countries

:: WHO Regional Offices
WHO African Region AFRO
:: Plague in Madagascar: need for heightened vigilance
[Undated] Since September 2014, 283 suspected, probable or confirmed cases, including 74 deaths have been reported for all affected areas in Madagascar. The outbreak peaked in November and December but has slowed for the time being. Health officials are keeping a close watch over the situation as the plague season on the island continues until April. The district of Amparafavarola, in the central highlands, has been one of the most heavily affected areas, where cases of pneumonic plague have been reported…

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

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

WHO European Region EURO
:: Medical supplies from WHO reach Donetsk as part of UN aid convoy 21-02-2015
:: New tool helps countries identify foods with too much fat, sugar and salt 19-02-2015
:: WHO increases humanitarian efforts as crisis in Ukraine continues 17-02-2015

WHO Eastern Mediterranean Region EMRO
:: WHO responds to increasing health needs in Yemen 16 February 2015

WHO Western Pacific Region
Getting everyone in the picture by 2024
16 February 2015 – If someone asks you to prove who you are, you would show them your passport or birth certificate. However, many children are born and people of all ages die without their births and deaths ever recorded. Countries need to know how many people are born and die each year – and the main causes of their deaths – to develop well-functioning health systems. Many Pacific Island countries do not have adequate civil registration and vital statistics systems…

China, World Bank and WHO Collaborate to Support ‘Deep Water’ Phase of Health Reforms
Joint World Bank-WHO-government health reform study launched in Beijing
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On February 12, 2015, the World Bank Group and the World Health Organization (WHO) launched a new collaboration with the Government of China to support the next phase of China’s health system reforms.

Over the last five years, China has undertaken the biggest health reform in history – with remarkable results: 95 per cent of China’s 1.39 billion citizens now have access to a basic health insurance package, up from 30 per cent in 2003.

Yet, for China to build a strong, sustainable, equitable, and cost-effective health system equipped to meet current and future challenges, deepening of reforms is needed.
At the request of senior government officials, the World Bank and the World Health Organization are collaborating with China’s Ministry of Finance, National Health and Family Planning Commission (NHFPC) and Ministry of Human Resources and Social Security, with support from the Bill & Melinda Gates Foundation, to analyze current constraints within the health reform process and identify practical solutions.

“In 2009, the Government of China launched an ambitious national health reform program to provide affordable, equitable and effective health care for all by 2020,” said Bert Hofman, World Bank Country Director for China.

“Impressive progress has been made in that time: health insurance coverage has increased, and access to health care has greatly improved. But the increasing rates of non-communicable disease like diabetes, hypertension and cancer coupled with an ageing population—and worryingly high prevalence rates key risk factors such as smoking—mean that pressing challenges for the health service delivery system remain,” Hofman said.

“China is now entering the ‘deep water’ phase of the health reform project, where crossing the river will require more than just feeling the stones,” said Dr. Vivian Lin, Director Health Systems in the WHO Western Pacific Regional Office.

“We are delighted to be collaborating with the World Bank to support the Government of China as it navigates this crucial next phase of health reform. China now has an unprecedented opportunity to innovate and develop new models of health service delivery that are truly people-centered and meet the needs and demands of China’s vast population,” Dr. Lin said.

The World Bank-WHO collaboration with China’s Ministry of Finance, NHFPC, and Ministry of Human Resources and Social Security will deliver recommendations to the government on the practical and concrete actions required to build a health care system for the future later this year.

GAVI Watch [to 21 February 2015]
http://www.gavialliance.org/library/news/press-releases/
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:: Immunisation leaders call for increased political support for immunisation in Pakistan
High-level mission shines spotlight on challenges facing immunisation services in Pakistan
Islamabad
19 February 2015 – Childhood immunisation in Pakistan is at a crossroads and strong political will is required to ensure that the lives of millions of children are not put at risk, three global health leaders warned today.

Almost three million children miss out on a full course of the most basic vaccines every year in Pakistan, leaving them vulnerable to life-threatening diseases. Immunisation coverage rates across the country vary widely with some districts seeing very few children protected against diseases such as diphtheria, pertussis, tetanus, measles and bacterial pneumonia….

A high-level mission including Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, Dr Ala Alwan, Regional Director for the Eastern Mediterranean region at the World Health Organization, and Dr Geeta Rao Gupta, Deputy Executive Director of UNICEF is meeting with leaders in Islamabad to set out their concerns and offer their support to Pakistan moving forwards…

…“Deaths among under five years children attributable to vaccine preventable diseases constitute up to 25% of the total deaths among this age group in developing countries, including Pakistan,” said Dr Ala Alwan, WHO Regional Director for the Eastern Mediterranean. “Pakistan is not on track for achieving MDG4 which aims at reducing child mortality by two thirds by 2015. Increasing routine vaccination coverage will significantly contribute to decreasing infant and child deaths and achieving MDG4.”

“The need to improve routine immunisation coverage in Pakistan cannot be overemphasised,” said Ms Geeta Rao Gupta, the Deputy Executive Director of UNICEF. “We realise the challenge Pakistan faces regarding immunisation and are determined to make 2015 a turning point for the country in terms of immunising all children, especially those living in marginalised communities and hard to reach areas. The fact that nearly 400,000 children under the age of five die in Pakistan every year from diseases which can be prevented through vaccine is simply not acceptable. These precious lives can and must be saved.”…

…The delegation calls for stronger collaboration between the federal and provincial level to tackle the variations in vaccination coverage across the country. Accountability of the Expanded Program on Immunization (EPI) is seen as critical to increase access to routine immunisation as well as recruitment and training of qualified EPI personnel coupled with improved reporting systems…

IVI Watch [to 21 February 2015]
http://www.ivi.org/web/www/home
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:: EuBiologics Acquires Licensure for New Cholera Vaccine
– First cholera vaccine made in Korea for use in developing world
– Global health partnership between EuBiologics and International Vaccine Institute to control cholera in poor countries
– Application for WHO approval underway

Seoul, South Korea [Undated] EuBiologics Co., Ltd. and the International Vaccine Institute (IVI) announced that the inactivated oral cholera vaccine (OCV) Euvichol obtained licensure for export from the South Korean Ministry of Food and Drug Safety on January 28, 2015, making this the first cholera vaccine produced in Korea and paving the way for vaccine approval by the World Health Organization (WHO). An application has already been submitted for obtaining WHO prequalification of Euvichol.

“After several years of hard work and effort, we are extremely pleased that Euvichol has been licensed since we are one step closer to WHO prequalification and ensuring access of the vaccine for the world’s poor,” said Mr. Yeong-Ok Baik, EuBiologics CEO, “We are thankful to IVI for their support in helping make this happen.”

Since 2010, EuBiologics and IVI have been collaborating on the development and production of a new inactivated oral cholera vaccine following technology transfer from IVI to EuBiologics. Their aim is to ensure a reliable global supply of safe, effective and affordable cholera vaccines to prevent and control endemic and epidemic cholera in the world’s poorest communities…

…In collaboration with partners in Vietnam, Sweden, the United States and South Korea, IVI reformulated the oral inactivated cholera vaccine and transferred the technology to Shantha Biotechnics (part of the Sanofi group), an Indian manufacturer. The vaccine Shanchol was licensed in India in 2009 and WHO-prequalified in 2011. In 2010, IVI transferred technology for the cholera vaccine to EuBiologics, which was unprecedented for a Korean company at the time. Euvichol will be the third internationally licensed vaccine against cholera (Shanchol and Dukoral produced by Crucell, part of Johnson & Johnson)…

NIH Watch [to 21 February 2015]
http://www.nih.gov/news/index.html
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:: NIH-supported clinical trials to evaluate long-acting, injectable antiretroviral drugs to prevent HIV infection
February 19, 2015 -The trial will be conducted in South Africa, the United States and Zimbabwe.

:: NIH-sponsored HIV vaccine trial launches in South Africa
February 19, 2015 — Early-stage trial aims to build on RV144 results.
A clinical trial called HVTN 100 has been launched in South Africa to study an investigational HIV vaccine regimen for safety and the immune responses it generates in study participants. This experimental vaccine regimen is based on the one tested in the U.S. Military HIV Research Program-led RV144 clinical trial in Thailand—the first study to demonstrate that a vaccine can protect people from HIV infection. The HVTN 100 vaccine regimen was designed to provide greater protection than the RV144 regimen and has been adapted to the HIV subtype that predominates in southern Africa. The results of the HVTN 100 trial, expected in two years, will help determine whether or not this vaccine regimen will be tested for efficacy in a large future study in South Africa.
“A safe and effective HIV vaccine is essential to reach a timely, sustained end to the HIV/AIDS pandemic,” said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. “The launch of HVTN 100 marks an important step forward in building upon the promising results of the RV144 trial to produce an HIV vaccine that could have a significant public health impact in southern Africa, where the HIV/AIDS pandemic is most pervasive.”…

:: NIH expands key tuberculosis research program
February 19, 2015 — Awards over seven years will fund four institutions that will act as a collaborative network.
The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, is expanding its Tuberculosis Research Units (TBRU) program in an effort to drive innovation in tuberculosis (TB) research. NIAID is awarding up to $15.2 million in fiscal year 2015 and as much as $105.3 million over seven years to fund four institutions that will act as a collaborative TBRU network…
…The new TBRU awards were made to the following institutions: :: Boston Medical Center, Boston; Brigham and Women’s Hospital, Boston; Emory University, Atlanta; Weill Cornell Medical College, New York City…

European Medicines Agency Watch [to 21 February 2015]
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:: Major European research project on monitoring and evaluation of medicines concludes
16/02/2015
The European Medicines Agency (EMA) hosted and broadcast a symposium on 19 and 20 February to mark the conclusion of the five-year Pharmacoepidemiological Research on Outcomes of Therapeutics by a European Consortium (PROTECT) project.

PROTECT’s goal is to strengthen the monitoring of the benefit-risk of medicines marketed in Europe by developing innovative methods. It is a public-private partnership of 34 European partners with EMA as the coordinator and GSK as the deputy coordinator. It is funded by the Innovative Medicines Initiative Joint Undertaking; partners include national medicines authorities, academic institutions and pharmaceutical companies.

The European Medicines Agency (EMA. PROTECT results may significantly influence practices in pharmacovigilance and benefit-risk evaluation. Therefore, during 2015, EMA will systematically scrutinise PROTECT’s research outputs in order to identify priority results that are robust and which if implemented, have the greatest potential to positively impact public health.

PATH Watch [to 21 February 2015]
http://www.path.org/news/index.php
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:: Innovative partnership expanded to bring to market dual detection test for neglected tropical diseases
Press release | February 18, 2015
PATH, Standard Diagnostics/Alere, and NIAID to collaborate on combined point-of-care rapid test for both river blindness and elephantiasis

:: Partners launch phase 2 safety study of a long-acting injectable to prevent HIV
Press release | February 18, 2015
New long-acting formulations may improve adherence and increase uptake, add an important tool to the portfolio of prevention interventions

Industry Watch [to 21 February 2015]
:: Sanofi Appoints Olivier Brandicourt as Chief Executive Officer
– Tenure as CEO will commence on April 2, 2015 –
Paris – February 19, 2015 – The Board of Directors unanimously appointed Olivier Brandicourt as Chief Executive Officer of Sanofi.

Olivier Brandicourt has 28 years of global experience in the pharmaceutical industry, most recently as Chairman of the Board of Management of Bayer HealthCare AG and member of the Executive Council of Bayer AG. Previously, Brandicourt held numerous positions of increasing responsibility within major global pharmaceutical groups, such as Parke-Davis/Warner-Lambert and Pfizer. Notably, Brandicourt served as a member of Pfizer’s global Executive Leadership Team from 2010 – 2013.

A physician by training, Olivier Brandicourt’s career includes several senior positions in Europe, Canada and the United States…

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:: Wellcome Trust-funded vaccines company acquired by GSK
20 February 2015
GlycoVaxyn, a Swiss-based biopharmaceutical company, which has received funding from the Wellcome Trust Innovations division, has been acquired by global pharma firm GlaxoSmithKline (GSK) for $190 million (approximately £124 million).

GlycoVaxyn, a spin off from the Swiss Federal Institute of Technology (ETH Zurich), has developed an innovative technology that enables the cost-effective manufacture of bioconjugate vaccines.

Bioconjugate vaccines are particularly effective against bacterial infections. They are made by joining sugar molecules called polysaccharides, found in the outer coating of many harmful bacteria, and proteins that together induce a more powerful immune response. GlycoVaxyn’s technology allows these conjugates to be mass-produced in live E. coli cells that have been genetically engineered.

GlycoVaxyn was awarded CHF 5.1 million by the Trust in 2012 to develop such a vaccine against the Shigella bacterium…A phase I study of GlycoVaxyn’s candidate Shigella vaccine, funded by the Wellcome Trust award, is due to start in the first quarter of 2015.

Dr Georgios Trichas, from the Innovations division at the Wellcome Trust, said:
“This is a fantastic outcome for GlycoVaxyn and the Wellcome Trust-funded project. We look forward to working with both companies in future to establish the safety and efficacy of the candidate Shigella vaccine in this area of urgent unmet medical need.”

Prior to the acquisition, GSK was a shareholder in GlycoVaxyn and the two have collaborated since 2012 on research using the latter’s innovative biological conjugation platform technology.

With this transaction, GSK has now purchased all shares in the company, valuing it at US$212 million (approximately £139 million). As well as Wellcome Trust funding, Glycovaxyn was also supported previously by investments from life science venture capital firms including Sofinnova Partners, Index Ventures and Edmond de Rothschild Investment Partners.

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:: MediVector Completes Patient Enrollment in Two Phase 3 Studies of Favipiravir for Influenza
-More than 2,000 patients enrolled in the Americas, Europe, Australia, New Zealand and South Africa; Favipiravir has potential to provide broad-spectrum coverage of multiple influenza strains-
BOSTON–(BUSINESS WIRE)–MediVector, Inc. today announced it has successfully completed enrollment in two FAVOR favipiravir Phase 3 studies in adults with uncomplicated influenza (often called the “flu”). The two studies enrolled 2,021 patients in participating clinics and practices in the Americas, Europe, Australia, New Zealand and South Africa. Favipiravir is an orally administered novel anti-viral compound with a unique mechanism of action that is active

“Completion of enrollment within a year of initiating these clinical trials is a significant accomplishment, and the resulting data from the carefully designed studies will lay the groundwork for filing an application for approval to market favipiravir in the U.S.,” Dr. Carol Epstein, Executive Vice President and Chief Medical Officer of MediVector, Inc. said. “Resistance to currently available influenza treatments is a growing problem, and there is an urgent need for a new broad-spectrum therapeutic with a different mechanism of action that is active against multiple strains of influenza viruses.”

The randomized, double-blind, placebo-controlled, multi-centered Phase 3 FAVOR studies are evaluating the time to alleviation of all primary influenza symptoms consistent with uncomplicated influenza, after treatment with favipiravir….

Pharmaceutical industry makes progress in cutting-edge R&D for neglected diseases
IFPMA – 19 February 2015
:: Report shows 13% annual increase of pharmaceutical R&D projects to develop treatments to eliminate and control neglected diseases. In 2014, 186 projects were underway.
:: 38 vaccines and treatments currently undergo clinical trials, 10 of which are in final stages. Projects include potential treatments and vaccines for TB, sleeping sickness, malaria, dengue, Chagas, schistosomiasis, intestinal worms and Ebola.
:: Pharmaceutical industry also works with WHO and other partners to implement 40 programs to support health system capacity-strengthening and donations.

Understanding Gavi’s Impact on Vaccination Rates
Center for Global Development | 9 February 2015
2/9/15
Sarah Dykstra, Amanda Glassman, Charles Kenny and Justin Sandefur
[Excerpt from blog announcement of new working paper and policy brief]
Last week, Gavi, the Vaccine Alliance, completed a $7.5 billion replenishment to fund its work on immunization in the world’s poorest countries between now and 2020. Gavi’s next step is to ensure that the money is used as effectively as possible to save lives and improve health.

Today, we’re launching a working paper and policy brief that we hope will be a helpful input to that discussion. We find that many of the vaccines provided by Gavi went to people who would have been vaccinated anyway, leading to little increase in overall vaccination rates — especially for the cheapest vaccines, and particularly in middle-income countries. Paradoxically, this is partially good news. Our results imply that if it’s possible to save lives with a vaccine that costs a few cents, most middle-income countries will do it with or without aid. But that doesn’t mean there’s no place for aid. First, the poorest countries in the world still struggle to roll out basic vaccines. Second, for newer vaccines that countries have not widely adopted on their own, we find signs of a positive impact of Gavi aid on vaccination rates…

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:: Working Paper: The Impact of Gavi on Vaccination Rates: Regression Discontinuity Evidence – Working Paper 394
Center for Global Development 2/9/15 :: 51 pages
Sarah Dykstra, Amanda Glassman, Charles Kenny, and Justin Sandefur
Download PDF
Abstract
Since 2001, an aid consortium known as Gavi has accounted for over half of vaccination expenditure in the 75 eligible countries with an initial per capita GNI below $1,000. Regression discontinuity (RD) estimates show aid significantly displaced other immunization efforts and failed to increase vaccination rates for diseases covered by cheap, existing vaccines. For some newer and more expensive vaccines, i.e., Hib and rotavirus, we found large effects on vaccination and limited fungibility, though statistical significance is not robust. These RD estimates apply to middle-income countries near Gavi’s eligibility threshold, and cannot rule out differential effects for the poorest countries.

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:: Brief: Refocusing Gavi for Greater Impact
Center for Global Development 2/9/15 :: 6 pages
Sarah Dykstra, Amanda Glassman, Charles Kenny, and Justin Sandefur
Download PDF
Summary
Gavi, the Vaccine Alliance, pools donor funds to increase immunization rates in developing countries. Vaccines have saved millions of lives. [1] Results from new research at the Center for Global Development suggest Gavi could save more lives by shifting support away from lower-cost vaccines provided to middle-income countries toward more underused vaccines and support to the poorest countries

American Journal of Public Health
Volume 105, Issue 3 (March 2015)
http://ajph.aphapublications.org/toc/ajph/current

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The Case for the World Health Organization’s Commission on Social Determinants of Health to Address Gender Identity
Frank Pega, PhD, MSc, and Jaimie F. Veale, PhD, MSc
Abstract
We analyzed the case of the World Health Organization’s Commission on Social Determinants of Health, which did not address gender identity in their final report.
We argue that gender identity is increasingly being recognized as an important social determinant of health (SDH) that results in health inequities. We identify right to health mechanisms, such as established human rights instruments, as suitable policy tools for addressing gender identity as an SDH to improve health equity.
We urge the World Health Organization to add gender identity as an SDH in its conceptual framework for action on the SDHs and to develop and implement specific recommendations for addressing gender identity as an SDH.

Annals of Internal Medicine
17 February 2015, Vol. 162. No. 4
http://annals.org/issue.aspx
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Research and Reporting Methods | 17 February 2015
Innovations in Data Collection, Management, and Archiving for Systematic Reviews
Tianjing Li, MD, MHS, PhD; S. Swaroop Vedula, MBBS, PhD; Nira Hadar, MS, PhD; Christopher Parkin, MS; Joseph Lau, MD; and Kay Dickersin, MA, PhD
Ann Intern Med. 2015;162(4):287-294. doi:10.7326/M14-1603
Abstract
Data abstraction is a key step in conducting systematic reviews because data collected from study reports form the basis of appropriate conclusions. Recent methodological standards and expectations highlight several principles for data collection. To support implementation of these standards, this article provides a step-by-step tutorial for selecting data collection tools; constructing data collection forms; and abstracting, managing, and archiving data for systematic reviews. Examples are drawn from recent experience using the Systematic Review Data Repository for data collection and management. If it is done well, data collection for systematic reviews only needs to be done by 1 team and placed into a publicly accessible database for future use. Technological innovations, such as the Systematic Review Data Repository, will contribute to finding trustworthy answers for many health and health care questions.

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Ideas and Opinions | 17 February 2015
Ethical Guidance on the Use of Life-Sustaining Therapies for Patients With Ebola in Developed Countries
Scott D. Halpern, MD, PhD; and Ezekiel J. Emanuel, MD, PhD
Article and Author Information
Ann Intern Med. 2015;162(4):304-305. doi:10.7326/M14-2611
This article was published online first at http://www.annals.org on 30 December 2014

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 21 February 2015)

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Research article
Community health workers improve diabetes care in remote Australian Indigenous communities: results of a pragmatic cluster randomized controlled trial
Robyn A McDermott, Barbara Schmidt, Cilla Preece, Vickie Owens, Sean Taylor, Ming Li, Adrian Esterman
BMC Health Services Research 2015, 15:68 (19 February 2015)
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Research article
The impact of human immunodeficiency virus (HIV) service scale-up on mechanisms of accountability in Zambian primary health centres: a case-based health systems analysis
Stephanie M Topp, Jim Black, Martha Morrow, Julien M Chipukuma, Wim Van Damme
BMC Health Services Research 2015, 15:67 (18 February 2015)
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Research article
An innovation for improving maternal, newborn and child health (MNCH) service delivery in Jigawa State, northern Nigeria: a qualitative study of stakeholders’ perceptions about clinical mentoring
Ekechi Okereke, Jamilu Tukur, Amina Aminu, Jean Butera, Bello Mohammed, Mustapha Tanko, Ibrahim Yisa, Benson Obonyo, Mike Egboh
BMC Health Services Research 2015, 15:64 (15 February 2015)
Abstract | Full text | PDF

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 21 February 2015)

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Research article
Modelling the return on investment of preventively vaccinating healthcare workers against pertussis
Luqman Tariq12, Marie-Josée J Mangen3, Anke Hövels1, Gerard Frijstein4 and Hero de Boer4*
Author Affiliations
BMC Infectious Diseases 2015, 15:75 doi:10.1186/s12879-015-0800-8
Published: 19 February 2015
Abstract (provisional)
Background
Healthcare workers (HCWs) are at particular risk of acquiring pertussis and transmitting the infection to high-risk susceptible patients and colleagues. In this paper, the return on investment (ROI) of preventively vaccinating HCWs against pertussis to prevent nosocomial pertussis outbreaks is estimated using a hospital ward perspective, presuming an outbreak occurs once in 10 years.
Methods
Data on the pertussis outbreak on the neonatology ward in 2004 in the Academic Medical Center Amsterdam (The Netherlands) was used to calculate control costs and other outbreak related costs. The study population was: neonatology ward staff members (n = 133), parents (n = 40), neonates (n = 20), and newborns transferred to other hospitals (n = 23). ROI is presented as the amount of Euros saved in averting outbreaks by investing one Euro in preventively vaccinating HCWs. Sensitivity analysis was performed to study the robustness of the ROI. Results are presented at 2012 price level.
Results
Total nosocomial pertussis outbreak costs were €48,682. Direct control costs (i.e. antibiotic therapy, laboratory investigation and outbreak management control) were €11,464. Other outbreak related costs (i.e. sick leave of HCWs; restrictions on the neonatology ward, savings due to reduced working force required) accounted for €37,218. Vaccination costs were estimated at €12,208. The ROI of preventively vaccinating HCWs against pertussis was 1:4, meaning 4 Euros could be saved by every Euro invested in vaccinating HCWs to avert outbreaks. ROI was sensitive to a lower vaccine price, considering direct control costs only, average length of stay of neonates on the neonatology ward, length of patient uptake restrictions, assuming no reduced work force due to ward closer and presuming more than one outbreak to occur in 10 years’ time.
Conclusion
From a hospital ward perspective, preventive vaccination of HCWs against pertussis to prevent nosocomial pertussis outbreaks results in a positive ROI, presuming an outbreak occurs once in 10 years.

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Research article
Factors associated with seasonal influenza vaccine uptake among children in Japan
Aiko Shono1* and Masahide Kondo2
Author Affiliations
BMC Infectious Diseases 2015, 15:72 doi:10.1186/s12879-015-0821-3
Published: 18 February 2015
Abstract
Background
Seasonal influenza vaccine was once part of the routine immunization schedule that is routinely offered to all children in Japan, but it is now excluded from the schedule. This study aimed to investigate factors influential to parents’ decision to have their children receive seasonal influenza vaccine, as well as types of seasonal influenza vaccine information that is given to parents.
Methods
We conducted a cross-sectional online survey of 555 participants who have at least one child younger than 13 years of age. Respondents were asked to categorize the history of influenza vaccination of their youngest child as either ‘annual’ , ‘sometimes’ , or ‘never’. Participants were also asked about potentially influential factors in their decision to have their children receive a seasonal influenza vaccine.
Results
A total of 75% of respondents answered that their youngest child had received a seasonal influenza vaccine, and 57% of respondents answered that their child receives the vaccine every year. The higher income group was more likely than the lowest income group to have a history of influenza vaccine uptake. A recommendation from a pediatrician or school/nursery to have their child vaccinated was also positively associated with a history of influenza vaccine uptake. The most common reason for a pediatrician’s recommendation was ‘it leads to milder symptoms if infected’.
Conclusions
The main finding of the study is a significant association between household income and influenza vaccination of the youngest child in the household. We also found that cost could be a barrier to vaccinating children in low income households and that information from pediatricians and schools/nurseries could motivate parents to have their children vaccinated.

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Research article
Pneumococcal meningitis and vaccine effects in the era of conjugate vaccination: results of 20 years of nationwide surveillance in Germany
Matthias Imöhl1*, Jens Möller1, Ralf René Reinert1, Stephanie Perniciaro1, Mark van der Linden1 and Orhan Aktas2
Author Affiliations
BMC Infectious Diseases 2015, 15:61 doi:10.1186/s12879-015-0787-1
Published: 14 February 2015
Abstract
Background
Long-term complications and a case mortality rate of 7.5% make meningitis caused by Streptococcus pneumoniae a serious clinical threat. In 2006, a general pneumococcal conjugate vaccination (PCV) recommendation was issued for all children under 2 years in Germany. Here, we investigate serotype changes in meningitis cases after this vaccine recommendation.
Methods
The German National Reference Center for Streptococci (NRCS) has conducted surveillance for invasive pneumococcal disease (IPD) in Germany since 1992. Pneumococcal isolates were serotyped by the Neufeld’s Quellung reaction and antibiotic susceptibility was tested using the broth microdilution method.
Results
Of 22,204 IPD isolates sent to the NRCS from July 1992 to June 2013, 3,086 were meningitis cases. Microbiological and statistical investigations were performed to characterize and quantify all meningitis cases, focusing on changes reflecting implementation of the national PCV recommendation. 1,766 isolates (57.2% of meningitis cases) were from adults (≥16 years) and 1,320 isolates (42.8%) originated from children (<16 years). Overall, the leading serotypes were 14 (9.7%), 7F (7.8%), 3 (6.9%), 19F (5.7%) and 23F (5.0%). Among children, serotypes 14 (16.2%), 7F (8.9%) and 19F (7.1%) were most common, whereas among adults, serotypes 3 (9.6%), 7F (6.9%), 22F (5.0%), 23F (4.9%) and 14 (4.8%) were most prevalent. After the introduction of general PCV7/10/13 vaccination a significant decrease for most vaccine serotypes was observed. Generally, the differences in antibiotic nonsusceptibility between children <16 years and adults ≥16 were low. For macrolides in the pre-PCV7 period, a significantly higher proportion of resistant isolates was found in children (25.1%), compared to the post-vaccination period (9.7%; p<0.0001).
Conclusions
Implementation of the pneumococcal conjugate vaccines broadly reduced vaccine-type meningitis cases. Changes in serotype prevalence must be continuously monitored to observe future trends concerning pneumococcal meningitis.

Clinical Infectious Diseases (CID)
Volume 60 Issue 5 March 1, 2015
http://cid.oxfordjournals.org/content/current

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Review of Enterovirus 71 Vaccines
Pele Chong1,2, Chia-Chyi Liu1, Yen-Hung Chow1,2, Ai-Hsiang Chou1, and Michel Klein3
1Vaccine Research and Development Center, National Health Research Institutes, Zhunan Town
2Graduate Institute of Immunology, China Medical University, Taichung, Taiwan
3VaxiBio Inc, Toronto, Ontario, Canada
Stanley A. Plotkin, Section Editor
Abstract
Enterovirus 71 (EV71) and coxsackieviruses are the major causative agents of hand, foot, and mouth disease (HFMD) outbreaks worldwide and have a significant socioeconomic impact, particularly in Asia. Formalin-inactivated (FI) EV71 vaccines evaluated in human clinical trials in China, Taiwan, and Singapore were found to be safe and to elicit strong neutralizing antibody responses against EV71 currently circulating in Asia. The results from 3 different phase 3 clinical trials performed in young children (6–60 months) indicate that the efficacy of FI-EV71 vaccines is >90% against EV71-related HFMDs and >80% against EV71-associated serious diseases, but the vaccines did not protect against coxsackievirus A16 infections. Here we discuss the critical factors affecting EV71 vaccine product registration, including clinical epidemiology, antigenic shift issues in cross-protection and vaccine strain selection, standardized animal models for potency testing, and cost-effective manufacturing processes for potential incorporation of FI-EV71 vaccine into Expanded Programme on Immunization vaccines.

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Maternal Influenza Immunization and Birth Outcomes of Stillbirth and Spontaneous Abortion: A Systematic Review and Meta-analysis
Kristin N. Bratton1,2, Melissa T. Wardle1,2, Walter A. Orenstein1,2,3,4, and Saad B. Omer1,2,5
Author Affiliations
1Department of Epidemiology
2Hubert Department of Global Health, Rollins School of Public Health, Emory University
3Department of Medicine, Division of Infectious Diseases
4Influenza Pathogenesis and Immunology Research Center
5Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
Abstract
Despite strong evidence that maternal influenza vaccination during pregnancy is safe, uptake of influenza vaccination during pregnancy remains low. We identified studies that assessed outcomes of stillbirth or spontaneous abortion after administration of influenza vaccine during pregnancy. We conducted a literature search in November 2013 that yielded 447 total citations. After removal of duplicates and studies deemed not relevant based on the title and abstract, 36 records underwent a full text review and 7 studies were included in the final review. Where possible, adjusted results were included in the meta-analysis. Women in the influenza vaccine group had a lower likelihood of stillbirth (relative risk [RR], 0.73; 95% confidence interval [CI], .55–.96); this association was similar when restricted to the H1N1pdm09 vaccine (RR, 0.69; 95% CI, .53–.90). The pooled estimate for spontaneous abortion was not significant (RR, 0.91; 95% CI, .68–1.22). These analyses add to the evidence base for the safety of influenza vaccination in pregnancy.

Emerging Infectious Diseases
Volume 21, Number 3—March 2015
http://wwwnc.cdc.gov/eid/

Dispatch
Postmortem Stability of Ebola Virus
Joseph Prescott, Trenton Bushmaker, Robert Fischer, Kerri Miazgowicz, Seth Judson, and Vincent J. Munster
Author affiliations: National Institutes of Health, Hamilton, Montana, USA
Abstract
The ongoing Ebola virus outbreak in West Africa has highlighted questions regarding stability of the virus and detection of RNA from corpses. We used Ebola virus–infected macaques to model humans who died of Ebola virus disease. Viable virus was isolated 7 days posteuthanasia; viral RNA was detectable for 10 weeks

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Research
Evaluation of the Benefits and Risks of Introducing Ebola Community Care Centers, Sierra Leone PDF Version [PDF – 509 KB – 7 pages]
A. J. Kucharski et al.
These centers could lead to a decline in cases, even if virus containment is imperfect.

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Dispatches
Regional Spread of Ebola Virus, West Africa, 2014 PDF Version [PDF – 583 KB – 4 pages]
G. Rainisch et al.

Treatment of Ebola Virus Infection with Antibodies from Reconvalescent Donors PDF Version [PDF – 313 KB – 3 pages]
T. R. Kreil

Eurosurveillance
Volume 20, Issue 7, 19 February 2015
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Surveillance and outbreak reports
The impact of a national routine immunisation programme initiated in 1999 on Hepatitis A incidence in Israel, 1993 to 2012
by H Levine, E Kopel, E Anis, N Givon-Lavi, R Dagan

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Research articles
Comparative safety evaluation of 7-valent and 13-valent pneumococcal vaccines in routine paediatric vaccinations in four Italian regions, 2009 to 2011
by F Trotta, C Rizzo, C Santuccio, A Bella, the Pharmacovigilance Study Group on Pneumococcal Vaccination in Children

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Review articles
Assessment of human influenza pandemic scenarios in Europe
by C Napoli, M Fabiani, C Rizzo, M Barral, J Oxford, JM Cohen, L Niddam, P Goryński, A Pistol, C Lionis, S Briand, A Nicoll, P Penttinen, C Gauci, A Bounekkar, S Bonnevay, A Beresniak

Globalization and Health
[Accessed 21 February 2015]
http://www.globalizationandhealth.com/

Debate
The ecosystem approach to health is a promising strategy in international development: lessons from Japan and Laos
Takashi Asakura1*, Hein Mallee2, Sachi Tomokawa3, Kazuhiko Moji4 and Jun Kobayashi5
Author Affiliations
Globalization and Health 2015, $article.volume.volumeNumber:3 doi:10.1186/s12992-015-0093-0
Published: 16 February 2015
Abstract (provisional)
Background
An ecological perspective was prominently present in the health promotion movement in the 1980s, but this seems to have faded. The burden of disease the developing world is facing cannot be addressed solely by reductionist approaches. Holistic approaches are called for that recognize the fundamentally interdependent nature of health and other societal, developmental, and ecosystem related factors in human communities. An ecosystem approach to human health (ecohealth) provides a good starting point to explore these interdependencies.
Discussion
Development assistance is often based on the assumption that developed countries can serve as models for developing ones. Japan has provided lavish assistance to Laos for example, much of it going to the development of transport networks. However, there is little sign that there is an awareness of the potentially negative environmental and health impacts of this assistance. We argue that the health consequences of environmental degradation are not always understood, and that developing countries need to consider these issues. The ecohealth approach is useful when exploring this issue. We highlight three implications of the ecohealth approach: (1) The WHO definition of health as a state of complete physical, mental and social well-being emphasized that health is more than the absence of disease. However, because this approach may involve an unattainable goal, we suggest that health should be defined in the ecosystem context, and the goal should be to attain acceptable and sustainable levels of health through enabling people to realize decent livelihoods, and to pursue their life purpose; (2) The increasing interconnectedness of ecosystems in a globalizing world requires an ethical approach that considers human responsibility for the global biosphere. Here, ecohealth could be a countervailing force to our excessive concentration on economy and technology; and (3) If ecohealth is to become a positive agent of change in the global health promotion movement, it will have to find a secure place in the educational curriculum.
Summary
This article presents a brief case study of Japan’s development assistance to Laos, and its environmental and health implications, as an illustration of the ecohealth approach. We highlight three implications of the ecohealth perspective.

Journal of Immigrant and Minority Health
Volume 17, Issue 1, February 2015
http://link.springer.com/journal/10903/17/1/page/1

Original Paper
Awareness and Knowledge of Human Papillomavirus (HPV) Among Ethnically Diverse Women Varying in Generation Status
L. M. Garcini, K. E. Murray…
Pages 29-36

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Original Paper
Development and Initial Testing of Messages to Encourage Tuberculosis Testing and Treatment Among Bacille Calmette-Guerin (BCG) Vaccinated Persons
Joan M. Mangan, Sebastian Galindo-Gonzalez…
Pages 79-88 .

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Original Paper
Understanding HPV Vaccination Among Latino Adolescent Girls in Three U.S. Regions
Beth A. Glenn, Jennifer Tsui…
Pages 96-103

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Original Paper
Low Human Papillomavirus (HPV) Vaccine Knowledge Among Latino Parents in Utah
Deanna Kepka, Echo L. Warner, Anita Y. Kinney…
Pages 125-131

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Original Paper
Parental Awareness and Dental Attendance of Children Among African Immigrants
Maryam S. Amin, Arnaldo Perez, Pawan Nyachhyon
Pages 132-138

Journal of Medical Ethics
March 2015, Volume 41, Issue 3
http://jme.bmj.com/content/current

Refugees, humanitarian aid and the right to decline vaccinations
A L Caplan, David R Curry
J Med Ethics 2015;41:276-277 Published Online First: 18 August 2014 doi:10.1136/medethics-2014-102383
[Abstract]

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 4 Issue 1 March 2015
http://jpids.oxfordjournals.org/content/current

Chikungunya Virus in the Caribbean: A Threat for All of the Americas
Enrique Gutierrez-Saravia1 and Camilo E. Gutierrez2
Author Affiliations
1SLIPE Board of Directors; Pediatric Infectious Diseases, Nueva Granada Military University, Bogotá, Colombia
2Pediatric Emergency Medicine, Boston University School of Medicine, MA
Received December 29, 2014.
Accepted January 5, 2015.
Extract
The first known autochthonous transmission of chikungunya virus (CHIKV) fever in the Western Hemisphere occurred in October 2013 in the French sector of the island of Saint Martin, approximately 150 miles east from Puerto Rico [1]. Chikungunya virus is a mosquito-borne arbovirus widely distributed in Africa, Southeast Asia, and India, but until the last decade it was responsible mainly for sporadic, limited outbreaks of illness [2–5]. Its recent epidemic spread through the Caribbean now poses a threat to the continental countries of South, Central, and North America [6–10].

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Systematic Review of Antibiotic Resistance Rates Among Gram-Negative Bacteria in Children With Sepsis in Resource-Limited Countries
Kirsty Le Doare1,2, Julia Bielicki2, Paul T. Heath2 and Mike Sharland2
Author Affiliations
1Wellcome Centre for Global Health Research, Imperial College, London
2Paediatric Infectious Diseases Research Group, St George’s University of London, UK
Received October 9, 2013.
Accepted January 16, 2014.
Abstract
Background
Gram-negative antimicrobial resistance (AMR) is of global concern, yet there are few reports from low- and low-middle-income countries, where antimicrobial choices are often limited.
Methods
This study offers a systematic review of PubMed, Embase, and World Health Organization (WHO) regional databases of Gram-negative bacteremia in children in low- and low-middle-income countries reporting AMR since 2001.
Results
Data included 30 studies comprising 71 326 children, of whom 7056 had positive blood cultures, and Gram-negative organisms were isolated in 4710 (66.8%). In neonates, Klebsiella pneumoniae median resistance to ampicillin was 94% and cephalosporins 84% in Asia; 100% and 50% in Africa. Large regional variations in resistance rates to commonly prescribed antibiotics for Salmonella spp. were identified. Multidrug resistance (resistance to ampicillin, chloramphenicol, and cotrimoxazole) was present in 30% (interquartile range [IQR], 0–59.6) in Asia and 75% (IQR, 30–85.4) in Africa.
Conclusions
There is a need for an international pediatric antimicrobial resistance surveillance system that collects local epidemiological data to improve the evidence base for the WHO guidance for childhood Gram-negative bacteremia.

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Susceptibility to Measles Among Perinatally HIV-Infected Adolescents and Young Adults
Lee E. Morris, Roberto Posada, Carole J. Hickman, Donald R. Latner, Tricia A. Singh, Alyssa Rautenberg, Jennifer Jao, William J. Bellini, and Rhoda Sperling
J Ped Infect Dis (2015) 4 (1): 63-66 doi:10.1093/jpids/pit054
Abstract

The Lancet Global Health
Volume 3, No. 3, e162–e168, March 2015
http://www.thelancet.com/journals/langlo/issue/current

Editorial
Ebola vaccines: an uncertain future?
Zoë Mullan
Published Online: 11 February 2015
Open Access
DOI: http://dx.doi.org/10.1016/S2214-109X(15)70083-5
On Jan 28, the preliminary phase 1 safety data for GlaxoSmithKline’s (GSK’s) candidate Ebola vaccine were published. The chimpanzee adenovirus vector (ChAd3) vaccine, which encodes a wild-type surface glycoprotein from Zaire Ebolavirus, raised no safety concerns in the 60 healthy volunteers from the UK tested and showed reasonable immunogenicity. Five days later, the first dose was given to a Liberian man as part of an expedited phase 3 trial in west Africa. Phase 1 trials of at least two other candidates are in progress: Merck’s Zaire-strain-encoding vesicular stomatitis virus (VSV) vector, and Johnson & Johnson’s heterologous prime-boost vaccine based on human Ad26 and modified vaccinia Ankara (MVA) vectors expressing Zaire strain glycoprotein.

The rapid roll-out of these trials has been tremendously impressive. Yet none of the vaccines were originally developed with African public health in mind: they were created out of fear that the virus could be used as a bioweapon. Concerns over limited market size and recipient governments’ ability to pay meant that the business case for a population-level Ebola vaccine was flimsy. Now, as the epidemic wanes and phase 3 trials and licensing become more complex, there is a risk that manufacturers will revert back to this previous state of thinking. Declining case numbers have already led drug manufacturer Chimerix to pull out of a trial of brincidofovir in Liberia. This is disheartening to say the least.

The reduction in incidence of Ebola virus disease has been brought about by means of a combination of scaled-up treatment capacity, safe burial practices, and rigorous case and contact finding. Vital communication and consultation work with communities has improved trust and understanding. But, as Brian McCloskey from the Office of the UN Special Envoy on Ebola was at pains to point out at a seminar in London last week, the outbreak cannot yet be considered under control. In fact a slight uptick in cases since the beginning of February illustrates his point. He further emphasised that the outlook is now not one of a single epidemic across three countries, but of perhaps 60 or more localised outbreaks with the very real potential to spread across borders into countries such as Mali and Côte d’Ivoire.

The UN’s response strategy is now moving away from a concentration on treating the vast volume of cases and towards elimination of transmission. Here vaccines play a vital role. It was ring vaccination—ie, the vaccination of a “ring” of individuals potentially exposed to a case—that saw the eradication of smallpox in 1980. Furthermore, as Peter Piot noted at the same seminar, Ebola’s ability to disrupt the whole health system by means of decimating the workforce is as potent a threat as its case–fatality rate. Vaccination of health workers could neutralise this threat. With the UN’s focus now on case and contact finding and with a still-uncertain epidemic trajectory, the drive to bring vaccines (and the more the better) to licensing and production should not falter.

So what of the realities of this for vaccine manufacturers? There is hope. First, a willingness to collaborate between governments, funding bodies, and companies has been key to the success of the vaccine trials so far. The phase 1 GSK vaccine trial in the UK, for example, was funded by the Wellcome Trust, the UK Department for International Development, the UK Medical Research Council, and the UK National Institute for Health Research. Financial support for its further development is being provided by the European Union, the Bill & Melinda Gates Foundation, and the Swiss Government. GSK has committed to scaling up vaccine production even as later-phase trials are ongoing. Second, governments are offering levers such as tax incentives and extended exclusivity rights to drive manufacturers on. And third, regulators are showing signs of flexibility in terms of accelerated licensure in the event that the waning epidemic delays the ability to demonstrate efficacy.

Vaccines are not a magic bullet. Nothing can replace the basic tenets of public health epidemiology and community mobilisation. But in the early days of a new outbreak in an unprepared population, as in all likelihood will happen again, vaccines can be a vital early weapon. Once we are reasonably assured of safety and efficacy, everything must be done to ensure that stockpiles are ready and the necessary clearances for their use are in place.

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Comment
Trafficking, migration, and health: complexities and future directions
Shira M Goldenberg
Open Access
DOI: http://dx.doi.org/10.1016/S2214-109X(15)70082-3
Summary
Documenting the health-related harms associated with human trafficking is crucial for the development of strategies to protect and promote the health of individuals who experience this serious human rights violation. In The Lancet Global Health, Ligia Kiss and colleagues1 report the results of a study of 1102 men, women, and children receiving post-trafficking services in Cambodia, Thailand, and Vietnam—the largest quantitative study of its kind. They document the health-related harms experienced by men, women, and children trafficked for sex work (32%), fishing (27%), and factory work (13%).

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Comment
Effectiveness of oral cholera vaccine in Haiti
Francisco J Luquero, David A Sack
DOI: http://dx.doi.org/10.1016/S2214-109X(15)70015-X
Summary
Although killed, whole-cell oral cholera vaccines (OCVs) have been known to be efficacious since 1986,1 and the bivalent whole-cell vaccine Shanchol has been licensed in India since 2009,2 OCV was not regarded as useful for controlling cholera outbreaks until recently.2 Many public health officials questioned the use of OCV,3 including concerns about its cost, the feasibility of undertaking large campaigns, the acceptability of OCV among vaccinated communities, and the possibility of diverting resources from other interventions.

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Articles
Dietary quality among men and women in 187 countries in 1990 and 2010: a systematic assessment
Fumiaki Imamura, Renata Micha, Shahab Khatibzadeh, Saman Fahimi, Peilin Shi, John Powles, Dariush Mozaffarian, on behalf of the Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (NutriCoDE)
e132
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Cost-effectiveness of two versus three or more doses of intermittent preventive treatment for malaria during pregnancy in sub-Saharan Africa: a modelling study of meta-analysis and cost data
Silke Fernandes, Elisa Sicuri, Kassoum Kayentao, Anne Maria van Eijk, Jenny Hill, Jayne Webster, Vincent Were, James Akazili, Mwayi Madanitsa, Feiko O ter Kuile, Kara Hanson
e143
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Health of men, women, and children in post-trafficking services in Cambodia, Thailand, and Vietnam: an observational cross-sectional study
Ligia Kiss, Nicola S Pocock, Varaporn Naisanguansri, Soksreymom Suos, Brett Dickson, Doan Thuy, Jobst Koehler, Kittiphan Sirisup, Nisakorn Pongrungsee, Van Anh Nguyen, Rosilyne Borland, Poonam Dhavan, Cathy Zimmerman
e154
Summary
Background
Trafficking is a crime of global proportions involving extreme forms of exploitation and abuse. Yet little research has been done of the health risks and morbidity patterns for men, women, and children trafficked for various forms of forced labour.
Methods
We carried out face-to-face interviews with a consecutive sample of individuals entering 15 post-trafficking services in Cambodia, Thailand, and Vietnam. We asked participants about living and working conditions, experience of violence, and health outcomes. We measured symptoms of anxiety and depression with the Hopkins Symptoms Checklist and post-traumatic stress disorder with the Harvard Trauma Questionnaire, and used adjusted logistic regression models to estimate the effect of trafficking on these mental health outcomes, controlling for age, sector of exploitation, and time in trafficking.
Findings
We interviewed 1102 people, of whom 1015 reached work destinations. Participants worked in various sectors including sex work (329 [32%]), fishing (275 [27%]), and factories (136 [13%]). 481 (48%) of 1015 experienced physical violence, sexual violence, or both, with 198 (35%) of 566 women and girls reporting sexual violence. 478 (47%) of 1015 participants were threatened and 198 (20%) were locked in a room. 685 (70%) of 985 who had data available worked 7 days per week and 296 (30%) of 989 worked at least 11 hours per day. 222 (22%) of 983 had a serious injury at work. 61•2% (95% CI 58•2–64•2) of participants reported symptom of depression, 42•8% (39•8–45•9) reported symptoms of anxiety, and 38•9% (36•0–42•0) reported symptoms of post-traumatic stress disorder. 5•2% (4•0–6•8) had attempted suicide in the past month. Participants who experienced extremely excessive overtime at work, restricted freedom, bad living conditions, threats, or severe violence were more likely to report symptoms of depression, anxiety, and post-traumatic stress disorder.
Interpretation
This is the first health study of a large and diverse sample of men, women, and child survivors of trafficking for various forms of exploitation. Violence and unsafe working conditions were common and psychological morbidity was associated with severity of abuse. Survivors of trafficking need access to health care, especially mental health care.

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Articles
Effectiveness of reactive oral cholera vaccination in rural Haiti: a case-control study and bias-indicator analysis
Dr Louise C Ivers, MBBCh, Isabelle J Hilaire, MD, Jessica E Teng, MPH, Charles P Almazor, MD, J Gregory Jerome, MD, Ralph Ternier, MD, Jacques Boncy, MD, Josiane Buteau, MD, Prof Megan B Murray, MD, Jason B Harris, MD, Molly F Franke, ScD
DOI: http://dx.doi.org/10.1016/S2214-109X(14)70368-7
Open access funded by the Author(s)
Summary
Background
Between April and June, 2012, a reactive cholera vaccination campaign was done in Haiti with an oral inactivated bivalent whole-cell vaccine. We aimed to assess the effectiveness of the vaccine in a case-control study and to assess the likelihood of bias in that study in a bias-indicator study.
Methods
Residents of Bocozel or Grand Saline who were eligible for the vaccination campaign (ie, age ≥12 months, not pregnant, and living in the region at the time of the vaccine campaign) were included. In the primary case-control study, cases had acute watery diarrhoea, sought treatment at one of three participating cholera treatment units, and had a stool sample positive for cholera by culture. For each case, four control individuals who did not seek treatment for acute watery diarrhoea were matched by location of residence, enrolment time (within 2 weeks of the case), and age (1–4 years, 5–15 years, and >15 years). Cases in the bias-indicator study were individuals with acute watery diarrhoea with a negative stool sample for cholera. Controls were selected in the same manner as in the primary case-control study. Trained staff used standard laboratory procedures to do rapid tests and stool cultures from study cases. Participants were interviewed to collect data on sociodemographic characteristics, risk factors for cholera, and self-reported vaccination. Data were analysed by conditional logistic regression, adjusting for matching factors.
Findings
From Oct 24, 2012, to March 9, 2014, 114 eligible individuals presented with acute watery diarrhoea and were enrolled, 25 of whom were subsequently excluded. 47 participants were analysed as cases in the vaccine effectiveness case-control study and 42 as cases in the bias-indicator study. 33 (70%) of 47 cholera cases self-reported vaccination versus 167 (89%) of 188 controls (vaccine effectiveness 63%, 95% CI 8–85). 27 (57%) of 47 cases had certified vaccination versus 147 (78%) of 188 controls (vaccine effectiveness 58%, 13–80). Neither self-reported nor verified vaccination was significantly associated with non-cholera diarrhoea (vaccine effectiveness 18%, 95% CI −208 to 78 by self-report and −21%, −238 to 57 by verified vaccination).
Interpretation
Bivalent whole-cell oral cholera vaccine effectively protected against cholera in Haiti from 4 months to 24 months after vaccination. Vaccination is an important component of efforts to control cholera epidemics.
Funding
National Institutes of Health, Delivering Oral Vaccines Effectively project, and Department of Global Health and Social Medicine at Harvard Medical School.