New England Journal of Medicine
February 19, 2015 Vol. 372 No. 8
http://www.nejm.org/toc/nejm/medical-journal

Editorial
HPV “Coverage”
Anne Schuchat, M.D.
N Engl J Med 2015; 372:775-776 February 19, 2015 DOI: 10.1056/NEJMe1415742
This article has no abstract; the first 100 words appear below.
This issue of the Journal presents a milestone in expanding the coverage of cancers associated with the human papillomavirus (HPV). Joura and colleagues1 report the results of a randomized, controlled trial of a new 9-valent HPV vaccine versus a quadrivalent HPV vaccine in more than 14,000 young women. The authors found that the new vaccine had an efficacy of nearly 97% against high-grade cervical, vulvar, and vaginal disease related to HPV types 31, 33, 45, 52, and 58. In the intention-to-treat analysis, the 9-valent vaccine was not found to be more beneficial than the quadrivalent vaccine, presumably because so many . . .

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Original Article
A 9-Valent HPV Vaccine against Infection and Intraepithelial Neoplasia in Women
Elmar A. Joura, M.D., Anna R. Giuliano, Ph.D., Ole-Erik Iversen, M.D., Celine Bouchard, M.D., Constance Mao, M.D., Jesper Mehlsen, M.D., Edson D. Moreira, Jr., M.D., Yuen Ngan, M.D., Lone Kjeld Petersen, M.D., Eduardo Lazcano-Ponce, M.D., Punnee Pitisuttithum, M.D., Jaime Alberto Restrepo, M.D., Gavin Stuart, M.D., Linn Woelber, M.D., Yuh Cheng Yang, M.D., Jack Cuzick, Ph.D., Suzanne M. Garland, M.D., Warner Huh, M.D., Susanne K. Kjaer, M.D., Oliver M. Bautista, Ph.D., Ivan S.F. Chan, Ph.D., Joshua Chen, Ph.D., Richard Gesser, M.D., Erin Moeller, M.P.H., Michael Ritter, B.A., Scott Vuocolo, Ph.D., and Alain Luxembourg, M.D., Ph.D. for the Broad Spectrum HPV Vaccine Study
N Engl J Med 2015; 372:711-723 February 19, 2015 DOI: 10.1056/NEJMoa1405044
Abstract
Background
The investigational 9-valent viruslike particle vaccine against human papillomavirus (HPV) includes the HPV types in the quadrivalent HPV (qHPV) vaccine (6, 11, 16, and 18) and five additional oncogenic types (31, 33, 45, 52, and 58). Here we present the results of a study of the efficacy and immunogenicity of the 9vHPV vaccine in women 16 to 26 years of age.
Methods
We performed a randomized, international, double-blind, phase 2b–3 study of the 9vHPV vaccine in 14,215 women. Participants received the 9vHPV vaccine or the qHPV vaccine in a series of three intramuscular injections on day 1 and at months 2 and 6. Serum was collected for analysis of antibody responses. Swabs of labial, vulvar, perineal, perianal, endocervical, and ectocervical tissue were obtained and used for HPV DNA testing, and liquid-based cytologic testing (Papanicolaou testing) was performed regularly. Tissue obtained by means of biopsy or as part of definitive therapy (including a loop electrosurgical excision procedure and conization) was tested for HPV.
Results
The rate of high-grade cervical, vulvar, or vaginal disease irrespective of HPV type (i.e., disease caused by HPV types included in the 9vHPV vaccine and those not included) in the modified intention-to-treat population (which included participants with and those without prevalent infection or disease) was 14.0 per 1000 person-years in both vaccine groups. The rate of high-grade cervical, vulvar, or vaginal disease related to HPV-31, 33, 45, 52, and 58 in a prespecified per-protocol efficacy population (susceptible population) was 0.1 per 1000 person-years in the 9vHPV group and 1.6 per 1000 person-years in the qHPV group (efficacy of the 9vHPV vaccine, 96.7%; 95% confidence interval, 80.9 to 99.8). Antibody responses to HPV-6, 11, 16, and 18 were noninferior to those generated by the qHPV vaccine. Adverse events related to injection site were more common in the 9vHPV group than in the qHPV group.
Conclusions
The 9vHPV vaccine prevented infection and disease related to HPV-31, 33, 45, 52, and 58 in a susceptible population and generated an antibody response to HPV-6, 11, 16, and 18 that was noninferior to that generated by the qHPV vaccine. The 9vHPV vaccine did not prevent infection and disease related to HPV types beyond the nine types covered by the vaccine. (Funded by Merck; ClinicalTrials.gov number, NCT00543543).

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 21 February 2015)

Assessing the Direct Effects of the Ebola Outbreak on Life Expectancy in Liberia, Sierra Leone and Guinea
February 19, 2015 • Research
Abstract
Background:
An EVD outbreak may reduce life expectancy directly (due to high mortality among EVD cases) and indirectly (e.g., due to lower utilization of healthcare and subsequent increases in non-EVD mortality). In this paper, we investigated the direct effects of EVD on life expectancy in Liberia, Sierra Leone and Guinea (LSLG thereafter).
Methods:
We used data on EVD cases and deaths published in situation reports by the World Health Organization (WHO), as well as data on the age of EVD cases reported from patient datasets. We used data on non-EVD mortality from the most recent life tables published prior to the EVD outbreak. We then formulated three scenarios based on hypotheses about a) the extent of under-reporting of EVD cases and b) the EVD case fatality ratio. For each scenario, we re-estimated the number of EVD deaths in LSLG and we applied standard life table techniques to calculate life expectancy.
Results:
In Liberia, possible reductions in life expectancy resulting from EVD deaths ranged from 1.63 year (low EVD scenario) to 5.56 years (high EVD scenario), whereas in Sierra Leone, possible life expectancy declines ranged from 1.38 to 5.10 years. In Guinea, the direct effects of EVD on life expectancy were more limited (<1.20 year).
Conclusions:
Our high EVD scenario suggests that, due to EVD deaths, life expectancy may have declined in Liberia and Sierra Leone to levels these two countries had not experienced since 2001-2003, i.e., approximately the end of their civil wars. The total effects of EVD on life expectancy may however be larger due to possible concomitant increases in non-EVD mortality during the outbreak.

PLoS One
[Accessed 21 February 2015]
http://www.plosone.org/

Human Papillomavirus Vaccine Uptake among Individuals with Systemic Inflammatory Diseases
Candace H. Feldman, Linda T. Hiraki, Huichuan Lii, John D. Seeger, Seoyoung C. Kim
Research Article | published 18 Feb 2015 | PLOS ONE 10.1371/journal.pone.0117620

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Optimal Vaccination in a Stochastic Epidemic Model of Two Non-Interacting Populations
Edwin C. Yuan, David L. Alderson, Sean Stromberg, Jean M. Carlson
Research Article | published 17 Feb 2015 | PLOS ONE 10.1371/journal.pone.0115826

Vaccine
Volume 33, Issue 11, Pages 1299-1418 (10 March 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/11

Adolescent decision making about participation in a hypothetical HIV vaccine trial
Original Research Article
Pages 1331-1337
Andreia B. Alexander, Mary A. Ott, Michelle A. Lally, Kevin Sniecinski, Alyne Baker, Gregory D. Zimet, the Adolescent Trials Network for HIV/AIDS Interventions
Abstract
Purpose
The purpose of this study was to examine the process of adolescent decision-making about participation in an HIV vaccine clinical trial, comparing it to adult models of informed consent with attention to developmental differences.
Methods
As part of a larger study of preventive misconception in adolescent HIV vaccine trials, we interviewed 33 male and female 16–19-year-olds who have sex with men. Participants underwent a simulated HIV vaccine trial consent process, and then completed a semistructured interview about their decision making process when deciding whether or not to enroll in and HIV vaccine trial. An ethnographic content analysis approach was utilized.
Results
Twelve concepts related to adolescents’ decision-making about participation in an HIV vaccine trial were identified and mapped onto Appelbaum and Grisso’s four components of decision making capacity including understanding of vaccines and how they work, the purpose of the study, trial procedures, and perceived trial risks and benefits, an appreciation of their own situation, the discussion and weighing of risks and benefits, discussing the need to consult with others about participation, motivations for participation, and their choice to participate.
Conclusion
The results of this study suggest that most adolescents at high risk for HIV demonstrate the key abilities needed to make meaningful decisions about HIV vaccine clinical trial participation.

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Cost–benefit comparison of two proposed overseas programs for reducing chronic Hepatitis B infection among refugees: Is screening essential?
Original Research Article
Pages 1393-1399
Amelia Jazwa, Margaret S. Coleman, Julie Gazmararian, La’Marcus T. Wingate, Brian Maskery, Tarissa Mitchell, Michelle Weinberg
Abstract
Background
Refugees are at an increased risk of chronic Hepatitis B virus (HBV) infection because many of their countries of origin, as well as host countries, have intermediate-to-high prevalence rates. Refugees arriving to the US are also at risk of serious sequelae from chronic HBV infection because they are not routinely screened for the virus overseas or in domestic post-arrival exams, and may live in the US for years without awareness of their infection status.
Methods
A cohort of 26,548 refugees who arrived in Minnesota and Georgia during 2005–2010 was evaluated to determine the prevalence of chronic HBV infection. This prevalence information was then used in a cost–benefit analysis comparing two variations of a proposed overseas program to prevent or ameliorate the effects of HBV infection, titled ‘Screen, then vaccinate or initiate management’ (SVIM) and ‘Vaccinate only’ (VO). The analyses were performed in 2013. All values were converted to US 2012 dollars.
Results
The estimated six year period-prevalence of chronic HBV infection was 6.8% in the overall refugee population arriving to Minnesota and Georgia and 7.1% in those ≥6 years of age. The SVIM program variation was more cost beneficial than VO. While the up-front costs of SVIM were higher than VO ($154,084 vs. $73,758; n = 58,538 refugees), the SVIM proposal displayed a positive net benefit, ranging from $24 million to $130 million after only 5 years since program initiation, depending on domestic post-arrival screening rates in the VO proposal.
Conclusions
Chronic HBV infection remains an important health problem in refugees resettling to the United States. An overseas screening policy for chronic HBV infection is more cost–beneficial than a ‘Vaccination only’ policy. The major benefit drivers for the screening policy are earlier medical management of chronic HBV infection and averted lost societal contributions from premature death.

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Factors that affect voluntary vaccination of children in Japan
Original Research Article
Pages 1406-1411
Aiko Shono, Masahide Kondo
Abstract
Some important vaccinations are not included in the routine childhood immunization schedule in Japan. Voluntary vaccinations are usually paid as an out-of-pocket expense. Low voluntary vaccination coverage rates and high target disease incidence are assumed to be a consequence of voluntary vaccination. Therefore, this study aimed to explore factors associated with voluntary vaccination patterns in children. We conducted an online survey of 1243 mothers from a registered survey panel who had at least one child 2 months to <3 years of age. The voluntary vaccination mainly correlated positively with annual household income and mothers’ positive opinions about voluntary vaccinations, but negatively with number of children. Financial support, especially for low income households and households with more than one child, may motivate parents to vaccinate their children. Communication is also an important issue. More opportunities for education and information about voluntary vaccinations should be provided to mothers without distinguishing between voluntary and routine vaccination.

From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary
Clinical and Translational Medicine
Published online: 14 February 2015
Vaccination in children with allergy to non active vaccine components
Fabrizio Franceschini1 , Paolo Bottau2 , Silvia Caimmi3 , Giuseppe Crisafulli4 , Liotti Lucia5 , Diego Peroni6 , Francesca Saretta7 , Mario Vernich8 , Carlotta Povesi Dascola9 and Carlo Caffarelli10
1. Pediatric Unit, “Ospedali Riuniti”, University Hospital, Ancona, Italy
2. Pediatric Unit, Imola Hospital, Imola, Italy
3. Pediatric Unit, Department of Pediatrics, University of Pavia, Pavia, Italy
4. Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
5. Pediatric Unit, Civic Hospital, Senigallia, Italy
6. Clinica Pediatrica Unit, University of Ferrara, Ferrara, Italy
7. Pediatric Unit, Palmanova Hospital, Palmanova, Italy
8. Pediatric Unit, Bollate Hospital, Bollate, Italy
9. Clinica Pediatrica Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
10. Clinica Pediatrica Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, 43123 Parma, Italy
Abstract
Childhood immunisation is one of the greatest public health successes of the last century. Vaccines contain an active component (the antigen) which induces the immune response. They may also contain additional components such as preservatives, additives, adjuvants and traces of other substances. This review provides information about risks of hypersensitivity reactions to components of vaccines. Furthermore, recommendations to avoid or reduce reactions to vaccine components have been detailed.

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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Financial Times
http://www.ft.com/home/uk
Accessed 21 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 21 February 2015
15 Myths About Anti-Vaxxers, Debunked – Part 1
This is part one of a three-part series. Here are parts two and three. Alongside the measles cases that have spread across the country since late December has been a rising awareness among parents and the media of a problem that medical professionals and public health officials have been battling for […]
Tara Haelle, Contributor Feb 17, 2015
15 Myths About Anti-Vaxxers, Debunked – Part 2
This is part two in a three-part series. Here are parts one and three. Yesterday’s post introduced the first five misconceptions much of the public and the media have about parents who don’t vaccinate – and I’ve already heard some pushback. Regardless of whether parents fully, partially or never vaccinate, we all […]
15 Myths About Anti-Vaxxers, Debunked – Part 3
This is part three in a three-part series. Here are parts one and two. At last we arrive at the final installment in common myths about parents who don’t vaccinate (here are the first and second installments). The first post in this series focused on the tendency to think of all […]

The Huffington Post
http://www.huffingtonpost.com/
Accessed 21 February 2015
About our Health Care System
Vaccinations – Balancing Community and Individual Liberties and Rights
18 February 2015
William Pierce
The measles outbreak has brought the United States face-to-face with a critically important question that spills over into many other areas and is in many ways at the heart of our political debate: How do we balance the protection of individual liberty with the liberties and rights of the community we all live in?
Vaccines are one of the true miracles of modern medicine. We have wiped out smallpox worldwide, are closing in on polio and have nearly eradicated measles, mumps, chickenpox in this country. That is, until recently, when we began to see a resurgence of measles, mumps and whooping cough in the United States. This is attributable to less-than-desirable vaccination rates nation-wide, but mostly in clustered areas around the country. The current measles outbreak is the most recent consequence of the purposeful inaction of too many of our fellow citizens.
This brings us to the issue of individual liberty versus community liberty…

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New York Times
http://www.nytimes.com/
Accessed 21 February 2015
New Approach to Blocking H.I.V. Raises Hopes for an AIDS Vaccine
in monkeys that it may be able to function as a vaccine against AIDS, the scientists who designed it reported Wednesday. H.I.V. has defied more than 30 years of conventional efforts to fashion a vaccine. The new
February 19, 2015 – By DONALD G. McNEIL Jr –

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Scientific American
http://www.scientificamerican.com/
Accessed 21 February 2015
How to Get More Parents to Vaccinate Their Kids
A look at the financial and behavioral nudges that can provide incentives for change
February 19, 2015 |By Dina Fine Maron

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Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 21 February 2015
Essay
The Return of the Vaccine Wars
The controversy over vaccines is as old as vaccination itself
By David Oshinsky
Feb. 20, 2015 3:22 p.m. ET
The controversy over vaccines is as old as vaccination itself. When Edward Jenner, a brilliant English country doctor, discovered the vaccine for smallpox in 1796, he faced as much criticism as praise. Ministers thundered against tampering with the Lord’s grand design. The economist Thomas Malthus worried that vaccines would lead to dangerous population increases. The very idea of injecting animal matter into the human body struck many as dangerous and repulsive. Cartoons appeared showing cows’ horns sprouting from the heads of recently vaccinated children…

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Washington Post
http://www.washingtonpost.com/
Accessed 21 February 2015
Measles infections in California grow to 123
The number of measles cases in California has reached 123 in the wake of a December outbreak at Disneyland.
Associated Press | Health & Science | Feb 20, 2015
Washington state panel mulls bill to trim vaccine exemptions
Personal or philosophical opposition to vaccines would not be an authorized exemption for the parents of school-age children under a measure that received a public hearing before a House committee on Tuesday, drawing at least two dozen opponents to the proposed change.
Associated Press | Health & Science | Feb 17, 2015
Amid measles outbreak, few rules on teacher vaccinations
While much of the attention in the ongoing measles outbreak has focused on student vaccination requirements and exemptions, less attention has been paid to another group in the nation’s classrooms: Teachers and staff members, who, by and large, are not required to be vaccinated.
Associated Press | Health & Science | Feb 16, 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.

– pdf version:  A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_14 February 2015

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

– Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
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– Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.
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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

Editor’s Note:
The continuing measles outbreak in the U.S. – traced to DisneyLand park in California and active in several U.S. states – continues to generate significant public debate about vaccines, hesitancy, parental responsibility, mandates, and the U.S. federal and state government’s role in assuring immunization against infectious diseases generally. Please see Journal Watch and Media Watch below to see additional content and commentary on these issues.

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PAHO: Recent measles outbreaks point to gaps in elimination efforts in the Americas
PAHO/WHO urges stepped-up surveillance and other measures to prevent the spread of measles cases imported from other regions
Washington, D.C., 10 February 2015 (PAHO/WHO) — Recent measles outbreaks in the United States and Brazil suggest that immunization rates in some areas have dropped below levels needed to prevent the spread of cases imported into the Americas, Pan American Health Organization/World Health Organization (PAHO/WHO) experts said today.

“Thanks to high levels of immunization, the Americas have been on track for more than a decade to be formally declared free of measles,” said Dr. Cuauhtemoc Ruiz, head of PAHO/WHO’s immunization program. “Maintaining high levels of vaccine coverage is key to preventing and halting outbreaks and to protect our populations from the constant threat of imported cases.”

Measles has been considered eliminated from the Americas since 2002, due to the absence of endemic transmission of the disease. An international verification committee has been compiling evidence to support a formal declaration of the region as measles-free. This would make the Americas the world’s first region to eliminate measles, in line with its similar achievements in eliminating smallpox in the 1970s and polio in the 1990s. Currently the region is also on track to be certified as free of rubella.

All these achievements have been the result of the region’s success in achieving high levels of immunization, through routine immunization programs and mass vaccination campaigns such as the annual Vaccination Week in the Americas, which PAHO/WHO has spearheaded for the past 13 years .

Now, measles elimination “is facing major challenges, with several ongoing importations of measles in some countries,” PAHO/WHO said in an epidemiological alert distributed yesterday to member countries across the region. The alert urges countries to strengthen measles surveillance activities and to “take appropriate measures to protect residents in the Americas against measles and rubella.”…

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WHO Fact Sheet: Measles
10 February 2015

EBOLA/EVD [to 14 February 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

WHO: Ebola Situation Report – 11 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 (table 3)…
Foreign Medical Teams meeting on the Ebola response
17-19 February 2015
The World Health Organization holds Foreign Medical Teams meeting on the Ebola response on 17-19 February 2015 in Geneva.
The participants will discuss: the Foreign Medical Teams in phase II of the Ebola response – getting to zero; best practices at country level; the future of Foreign Medical Teams, priorities and next steps.

Sierra Leone’s Rescue Team: Ebola survivors supporting each other
13 February 2015 — The “Rescue Team”, an association set up by Ebola survivors to help fellow survivors trying to put their lives back together again, is now exploring ways to contribute to the Ebola outbreak response in Sierra Leone.

Increasing community engagement for Ebola on-air
10 February 2015 — WHO’s social mobilization team is using radio to reach communities with information about how to prevent the spread of Ebola in Sierra Leone. “Now we are moving beyond awareness and knowledge, building into deep community engagement and ownership, where the community is key. It is vital that everyone in the community knows their role in achieving this goal,” says Zainab Akiwumi, who leads the social mobilization team in Sierra Leone.

UNMEER [to 14 February 2015]
https://ebolaresponse.un.org/un-mission-ebola-emergency-response-unmeer

:: UNMEER Condemns Attacks Against Ebola Responders in Guinea 14 Feb 2015

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Editor’s Note:
Based on our continuing assessment of the depth, range and continuity of UNMEER’s daily External Situation Reports, we have suspended analysis and summarization of them with this edition of Week in Review. They are available in pdf form at: https://ebolaresponse.un.org/resources

Ebola/EVD: U.S. Announcements [to 14 February 2015]

U.S. Update on Ebola Response Includes Withdrawal of Almost All U.S. Troops from West Africa
[Excerpt: Text and Video]
Ten months ago, the first U.S. personnel deployed to West Africa to fight the Ebola outbreak on the frontlines in West Africa. This epidemic has grown into the deadliest Ebola outbreak the world has ever seen — and the President is committed to treating and tackling Ebola as both a national security priority, and an example of American leadership.
The U.S. has built, coordinated, and led a worldwide response to the Ebola outbreak while strengthening our preparedness here at home. And thanks to the hard work of our military members, civilian responders, and health care workers, we have dramatically bent the curve of the epidemic. Cases are down 80 percent from peak levels. With this improved outlook, the President is planning to bring virtually all of the troops who deployed to the region home by April 30, while continuing to ramp up our civilian response beyond the 10,000 civilian workers who are already involved in our response effort…
U.S. White House – FACT SHEET: Progress in Our Ebola Response at Home and Abroad – February 11, 2015

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CDC/MMWR Watch [to 14 February 2015]
http://www.cdc.gov/media/index.html
:: MMWR Weekly, February 13, 2015 / Vol. 64 / No. 5
– Addressing Needs of Contacts of Ebola Patients During an Investigation of an Ebola Cluster in the United States — Dallas, Texas, 2014
– Use of Group Quarantine in Ebola Control — Nigeria, 2014

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USAID [to 14 February 2015]
http://www.usaid.gov/
United States Announces Additional Results in Grand Challenge to Fight Ebola
February 11, 2015
Innovations support current Ebola response and future epidemic preparedness
The U.S. Agency for International Development (USAID) announced today additional nominees for awards in the Fighting Ebola: a Grand Challenge for Development. A collaborative expert review identified 12 innovations that can reinforce the response to current and future Ebola outbreaks.

Statement from USAID Administrator, Rajiv Shah on the Ebola Response Transition
February 10, 2015
Our nation’s life-saving response to the worst Ebola epidemic in history represents an impressive display of American values, commitment, and ingenuity. Even as the headlines have slowed, the tireless work of thousands of frontline health care workers and disasters responders has not. In a year marked by an unprecedented number of humanitarian crises—from South Sudan to Syria— we remain committed to providing help in an emergency, regardless of danger or difficulty. It is one of the most profound expressions of who we are as the American people.

Industry Watch [to 14 February 2015]
:: Novavax Announces Initiation of Ebola Vaccine Phase 1 Clinical Trial Supported by Non-Human Primate Challenge Data and Documented Rapid Manufacturing Capabilities
GAITHERSBURG, Md., Feb. 12, 2015 (GLOBE NEWSWIRE) — Novavax, Inc. (Nasdaq:NVAX), a clinical-stage vaccine company focused on the discovery, development and commercialization of recombinant nanoparticle vaccines and adjuvants, today announced that enrollment has begun in a Phase 1 clinical trial of its Ebola virus glycoprotein (GP) recombinant nanoparticle vaccine candidate adjuvanted with Matrix-M™ (Ebola GP Vaccine) in healthy subjects. Novavax initiated the development of its Ebola GP Vaccine shortly after the publication of the genetic sequence of the 2014 Ebola Makona strain (previously referred to as the 2014 Ebola Guinea strain), which is responsible for the current Ebola epidemic in West Africa. In an expedited time-frame, from the publication of the Makona sequence in September 2014, Novavax has developed the vaccine, scaled-up GMP manufacturing, delivered positive results from multiple relevant animal models, including a non-human primate challenge study, and today initiated a Phase 1 clinical trial…

POLIO [to 14 February 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 11 February 2014
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

:: Nearly 230,000 children are to be vaccinated against polio during a 2-week campaign in Jeddah, Saudi Arabia, which launched on 8 February. Health teams will visit homes, health centers, shopping malls, airports, seaports and other places where people gather to reach every child. More
:: In January, the Expert Review Committee on Polio Eradication and Immunization (ERC) met in Nigeria to review progress and challenges. Whilst 6 months have passed since the most recent case of wild poliovirus was confirmed, the ERC concluded that Nigeria has a long way to go before this tentative progress can be taken as evidence that transmission of the virus has stopped. The ERC emphasized the importance of guarding against complacency in Nigeria, maintaining political commitment to increasing immunity levels in all areas, coordinating across borders with neighbouring countries, and strengthening planning for the potential of new wild poliovirus cases.

Selected country report content:
Pakistan
:: Two new wild poliovirus type 1 (WPV1) cases were reported in the past week. One case was reported in Khyber Pakhtunkhwa (KP) province, in Peshawar district, the first case in this district to be reported in 2015; and the other in the Federally Administered Tribal Areas (FATA), in South Waziristan with onset of paralysis in 2014. The total number of WPV1 cases in 2014 is now 306, and 7 for 2015. The most recent onset of paralysis was on 17 January 2015 in Peshawar.
:: One case of type 2 circulating vaccine-derived poliovirus (cVDPV2) has been reported this week in the Khigadap district of Sindh province, with onset of paralysis on 13 December. The number of cVDPV cases reported in 2014 is now 21.

West Africa
:: Even as polio programme staff across West Africa help to control the Ebola outbreak affecting the region, efforts are being made in those countries not affected by Ebola to vaccinate children against polio to create a buffer zone surrounding the affected countries. The Ebola crisis in western Africa continues to have an impact on the implementation of polio eradication activities in Liberia, Guinea and Sierra Leone. Twenty two experts from the National Polio Surveillance Programme (NPSP) in India have been deployed for 3 months to strengthen surveillance systems and data collection for the Ebola response, demonstrating the polio legacy in action.

WHO & Regionals [to 14 February 2015]
.
:: Global Alert and Response (GAR): Disease Outbreak News (DONs)
– 13 February 2015 Middle East respiratory syndrome coronavirus (MERS-CoV) – The Philippines
– 12 February 2015 Human infection with avian influenza A(H5N6) virus – China
– 11 February 2015 Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
– 11 February 2015 Middle East respiratory syndrome coronavirus (MERS-CoV) – Qatar
– 11 February 2015 Middle East respiratory syndrome coronavirus (MERS-CoV) – United Arab Emirates
.

:: The Weekly Epidemiological Record (WER) 13 February 2015, vol. 90, 7 (pp. 45–56) includes:
:: Maternal and neonatal tetanus elimination: validation surveys in Lao People’s Democratic Republic, December 2013

.
WHO Regional Offices

WHO African Region AFRO
:: Cholera prevention measures reduce transmission among displaced people in South Sudan – 09 February 2015

WHO Region of the Americas PAHO
:: New PAHO/WHO publication gives guidance on early diagnosis of childhood cancer (02/12/2015)

:: Recent measles outbreaks point to gaps in elimination efforts in the Americas (02/10/2015)

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

WHO European Region EURO
:: WHO opens office on primary health care in Kazakhstan 11-02-2015

WHO Eastern Mediterranean Region EMRO
:: Mobile clinics bring health services to communities in need in Iraq
7 February 2015 – In December 2014, WHO handed over 12 mobile medical clinics to the Federal Ministry of Health of Iraq and the Ministry of Health of the Kurdistan region to support the provision of primary health care services in underserved areas housing populations in need. Funding for the clinics was provided by Saudi Arabia. Four clinics were deployed to the Dohuk governorate, in which a large influx of large internally displaced people has put enormous pressure on the health system and its ability to deliver health care services…

WHO Western Pacific Region
No new digest content identified.

IAVI Watch [14 February 2015]
http://www.iavi.org/press-releases/2015

IAVI RECEIVES GSK FUNDING FOR THE HUMAN VACCINES PROJECT TO ACCELERATE DEVELOPMENT OF VACCINES FOR INFECTIOUS DISEASES AND CANCER
February 13, 2015
NEW YORK – The International AIDS Vaccine Initiative (IAVI) has received a grant of US$350,000 from GSK to support implementation of the Human Vaccines Project, a new public-private partnership seeking to transform global disease prevention by collaboratively addressing some of the principal scientific problems impeding vaccine development across diseases.

The GSK grant will help to establish the Project’s global consortium and plan its research program. The funding builds on a grant last year to IAVI by the Robert Wood Johnson Foundation for a series of workshops to explore how to accelerate development of vaccines via a Human Vaccines Project, by tackling the major scientific challenges impeding vaccine R&D through greater collaboration, increased knowledge sharing, and innovation. The first workshop, held in February 2014, focused on the scientific challenges to vaccine development, at which leading vaccine experts endorsed the Project’s objectives and helped to frame its scientific plan.

Wayne C. Koff, IAVI Chief Scientific Officer and founding member of the Human Vaccines Project Board, announced the GSK grant during a symposium at the AAAS 2015 Annual Meeting in San Jose, CA…

[U.S.] National Adult Immunization Plan – National Vaccine Program Office
DRAFT: February 5, 2015
Executive Summary
Vaccination is considered one of the most important public health achievements of the 20th century and continues to offer great promise in the 21st century. Vaccines save lives and improve the quality of life by preventing serious infectious diseases and their consequences. However, the benefits of vaccination are not realized equally across the U.S. population. Adult vaccination rates remain low in the United States, and significant racial and ethnic disparities also exist.

The U.S. Department of Health and Human Services National Vaccine Plan (NVP), released in 2010, is a road map for vaccines and immunization programs for the decade 2010–2020. While the NVP provides a vision for improving protection from vaccine-preventable diseases across the lifespan, vaccination coverage levels among adults are not on track to meet Healthy People 2020 targets. The National Vaccine Advisory Committee and numerous stakeholder groups have emphasized the need for focused attention on adult vaccines and vaccination.1 The National Adult Immunization Plan (NAIP) outlined here results from the recognition that progress has been slow, and there is a need for a national adult immunization strategic plan.

The NAIP is a five-year national plan. As a national plan, it will require engagement from a wide range of stakeholders to achieve its full vision. The plan emphasizes collaboration and prioritization of efforts that will have the greatest impact. The NAIP also aims to leverage the unique opportunity presented by the implementation of the Affordable Care Act.
The NAIP is intended to facilitate coordinated action by federal and nonfederal partners to protect public health and achieve optimal prevention of infectious diseases and their consequences through vaccination of adults. The NAIP includes indicators to draw attention to and track progress against core goals. These indicators will measure progress against set standards and inform future implementation and quality improvement efforts. The plan establishes four key goals, each of which is supported by objectives and strategies to guide implementation through 2020:

Goal 1: Strengthen the adult immunization infrastructure.
Goal 2: Improve access to adult vaccines.
Goal 3: Increase community demand for adult immunizations.
Goal 4: Foster innovation in adult vaccine development and vaccination-related technologies.

Achieving the goals of the NAIP is facilitated by agreement on plan priorities and coordination of the wide range of programs that support them. The Assistant Secretary for Health serves as the director of the National Vaccine Program and will lead the NAIP and its implementation. In support of this mission, NVPO will facilitate collaboration and coordinate the monitoring of progress for the NAIP.

The American Journal of Bioethics
Volume 15, Issue 2, 2015
http://www.tandfonline.com/toc/uajb20/current

Collectivizing Rescue Obligations in Bioethics
Jeremy R. Garretta*
DOI: 10.1080/15265161.2014.990163
pages 3-11
Published online: 12 Feb 2015
Abstract
Bioethicists invoke a duty to rescue in a wide range of cases. Indeed, arguably, there exists an entire medical paradigm whereby vast numbers of medical encounters are treated as rescue cases. The intuitive power of the rescue paradigm is considerable, but much of this power stems from the problematic way that rescue cases are conceptualized—namely, as random, unanticipated, unavoidable, interpersonal events for which context is irrelevant and beneficence is the paramount value. In this article, I critique the basic assumptions of the rescue paradigm, reframe the ethical landscape in which rescue obligations are understood, and defend the necessity and value of a wider social and institutional view. Along the way, I move back and forth between ethical theory and a concrete case where the duty to rescue has been problematically applied: the purported duty to regularly return incidental findings and individual research results in genomic and genetic research.
[Open Peer Commentaries are included reacting to this article]

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 14 February 2015)

Research article
Historical account of the national health insurance formulation in Kenya: experiences from the past decade
Timothy Abuya, Thomas Maina, Jane Chuma BMC Health Services Research 2015, 15:56 (12 February 2015)

Research article
Streamlined research funding using short proposals and accelerated peer review: an observational study
Adrian G Barnett, Danielle L Herbert, Megan Campbell, Naomi Daly, Jason A Roberts, Alison Mudge, Nicholas Graves BMC Health Services Research 2015, 15:55 (7 February 2015)

BMC Public Health
(Accessed 14 February 2015)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Health care providers’ perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia: a systematic literature review of qualitative and quantitative data
Ulrika Loi, Kristina Gemzell-Danielsson, Elisabeth Faxelid, Marie Klingberg-Allvin
BMC Public Health 2015, 15:139 (12 February 2015)

Research article
Effectiveness of short message services reminder on childhood immunization programme in Kadoma, Zimbabwe – a randomized controlled trial, 2013
Donewell Bangure, Daniel Chirundu, Notion Gombe, Tawanda Marufu, Gibson Mandozana, Mufuta Tshimanga, Lucia Takundwa
BMC Public Health 2015, 15:137 (12 February 2015)

Research article
The world health organization’s health promoting schools framework: a Cochrane systematic review and meta-analysis
Rebecca Langford1*, Christopher Bonell2, Hayley Jones1, Theodora Pouliou1, Simon Murphy3, Elizabeth Waters4, Kelli Komro5, Lisa Gibbs4, Dan Magnus1 and Rona Campbell1
Author Affiliations
BMC Public Health 2015, 15:130 doi:10.1186/s12889-015-1360-y
Published: 12 February 2015
Abstract (provisional)
Background
Healthy children achieve better educational outcomes which, in turn, are associated with improved health later in life. The World Health Organization’s Health Promoting Schools (HPS) framework is a holistic approach to promoting health and educational attainment in school. The effectiveness of this approach has not yet been rigorously reviewed.
Methods
We searched 20 health, education and social science databases, and trials registries and relevant websites in 2011 and 2013.We included cluster randomised controlled trials. Participants were children and young people aged four to 18?years attending schools/colleges. HPS interventions had to include the following three elements: input into the curriculum; changes to the school’s ethos or environment; and engagement with families and/or local communities. Two reviewers identified relevant trials, extracted data and assessed risk of bias. We grouped studies according to the health topic(s) targeted. Where data permitted, we performed random-effects meta-analyses.
Results
We identified 67 eligible trials tackling a range of health issues. Few studies included any academic/attendance outcomes. We found positive average intervention effects for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small. On average across studies, we found little evidence of effectiveness for zBMI (BMI, standardized for age and gender), and no evidence for fat intake, alcohol use, drug use, mental health, violence and bullying others. It was not possible to meta-analyse data on other health outcomes due to lack of data. Methodological limitations were identified including reliance on self-reported data, lack of long-term follow-up, and high attrition rates.
Conclusion
This Cochrane review has found the WHO HPS framework is effective at improving some aspects of student health. The effects are small but potentially important at a population level.

Research article
Barriers to modern contraceptive methods uptake among young women in Kenya: a qualitative study
Rhoune Ochako, Mwende Mbondo, Stephen Aloo, Susan Kaimenyi, Rachel Thompson, Marleen Temmerman, Megan Kays
BMC Public Health 2015, 15:118 (10 February 2015)

BMC Research Notes
(Accessed 14 February 2015)
http://www.biomedcentral.com/bmcresnotes/content

Short Report
Wealth and under-nourishment among married women in two impoverished nations: evidence from Burkina Faso and Congo Democratic Republic
Ayo Adebowale, Martin Palamuleni, Clifford Odimegwu BMC Research Notes 2015, 8:34 (8 February 2015)

Conflict and Health
[Accessed 14 February 2015]
http://www.conflictandhealth.com/

Research
Assessing the experiences of intra-uterine device users in a long-term conflict setting: a qualitative study on the Thailand-Burma border
Gedeon J, Hsue SN, Walsh M, Sietstra C, MarSan H and Foster AM Conflict and Health 2015, 9:6 (12 February 2015)

Cost Effectiveness and Resource Allocation
(Accessed 14 February 2015)
http://www.resource-allocation.com/

Research
Revisiting the cost-effectiveness of universal HPV-vaccination in Denmark accounting for all potentially vaccine preventable HPV-related diseases in males and females
Olsen J and Jørgensen TR Cost Effectiveness and Resource Allocation 2015, 13:4 (11 February 2015)
Abstract (provisional)
Objective
The purpose of this study was to assess the consequences of a national immunization program with HPV vaccine for both boys and girls in Denmark, including the prophylactic effects on all potentially vaccine preventable HPV-associated diseases in male and female.
Methods
The study focussed on the quadrivalent vaccine which protects against HPV type 6, 11, 16 and 18, and the vaccine’s protection against genital warts, cervical intraepithelial neoplasia, cervical cancer, anogenital cancer (anal, penile, vaginal and vulvar cancer) and head and neck cancer (oral cavity, oropharyngeal, hypopharyngeal and laryngeal cancer) were included in the analyses. In general, the analysis was performed in two phases. First, an agent-based transmission model that described the HPV transmission without and with HPV vaccination was applied. Second, an analysis of the incremental costs and effects was performed. The model did not include naturally-acquired immunity to HPV in the simulations.
Results
In the base case result (i.e. vaccination of girls only, 85% vaccination rate, private market price at ? 123 per dose ex. VAT) an ICER of 3583 ?/QALY (3-dose regime) is estimated when all HPV-related diseases are taken into account. Vaccination of girls & boys vs. vaccination of girls only an ICER of 28,031 ?/QALY (2-dose regime) and 41,636 ?/QALY (3-dose regime) is estimated.
Conclusions
Extension of the current HPV programme in Denmark to include boys and girls is a cost effective preventive intervention that would lead to a faster prevention of cancers, cancer precursors and genital warts in men and women.

Eurosurveillance
Volume 20, Issue 6, 12 February 2015
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Surveillance and outbreak reports
Surveillance of infant pertussis in Sweden 1998–2012; severity of disease in relation to the national vaccination programme
by RM Carlsson, K von Segebaden, J Bergström , AM Kling, L Nilsson

Review articles
Timeliness of epidemiological outbreak investigations in peer-reviewed European publications, January 2003 to August 2013
by EC van de Venter, I Oliver, JM Stuart

Globalization and Health
[Accessed 14 February 2015]
http://www.globalizationandhealth.com/

Debate
Strengthening health systems in low-income countries by enhancing organizational capacities and improving institutions
Swanson RC, Atun R, Best A, Betigeri A, de Campos F, Chunharas S, Collins T, Currie G et al. Globalization and Health 2015, 11:5 (12 February 2015)

Research
Maternal mortality: a cross-sectional study in global health
Sajedinejad S, Majdzadeh R, Vedadhir AA, Tabatabaei MG and Mohammad K Globalization and Health 2015, 11:4 (12 February 2015)

Infectious Diseases of Poverty
[Accessed 14 February 2015]
http://www.idpjournal.com/content

Research Article
An ecohealth assessment of poultry production clusters (PPCs) for the livelihood and biosecurity improvement of small poultry producers in Asia
Libin Wang, Edi Basuno, Tuan Nguyen, Worapol Aengwanich, Nyak Ilham and Xiaoyun Li
Infectious Diseases of Poverty 2015, 4:6 doi:10.1186/2049-9957-4-6
Published: 9 February 2015
Abstract (provisional)
Background
Poultry production cluster (PPC) programs are key strategies in many Asian countries to engage small commercial poultry producers in high-value production chains and to control infectious poultry diseases. This study assessed the multiple impacts of PPCs through a transdisciplinary ecohealth approach in four Asian countries, and drew the implications for small producers to improve their livelihoods and reduce the risk of spreading infectious diseases in the poultry sector.
Methods
The data collection combined both quantitative and qualitative methods. It comprised: formal structured household survey questionnaires, measuring the biosecurity level of poultry farms with a biosecurity score card; and key informant interviews. Descriptive statistics were used to process the quantitative data and a content analysis was used to process the qualitative data.
Results
This research found that poultry farms in clusters do not necessarily have better economic performance than those outside PPCs. Many farmers in PPCs only consider them to be an advantage for expanding the scale of their poultry operations and improving household incomes, and they are less concerned about–and have limited capacities to–enhancing biosecurity and environmental management. We measured the biosecurity level of farms in PPCs through a 14-item checklist and found that biosecurity is generally very low across all sample sites. The increased flies, mosquitoes, rats, and smells in and around PPCs not only pollute the environment, but also cause social conflicts with the surrounding communities.
Conclusion
This research concluded that a poultry cluster, mainly driven by economic objectives, is not necessarily a superior model for the control of infectious diseases. The level of biosecurity in PPCs was found to be low. Given the intensity of poultry operations in PPCs (farms are densely packed into clusters), and the close proximity to residential areas of some PPCs, the risk of spreading infectious diseases, in fact, increases. Good management and collective action for implementing biosecurity measures are key for small producers in PPCs to address common challenges and pursue health-based animal production practices.

JAMA
February 10, 2015, Vol 313, No. 6
http://jama.jamanetwork.com/issue.aspx

Viewpoint | February 10, 2015
The 2014 Ebola Outbreak and Mental Health: Current Status and Recommended Response
FREE
James M. Shultz, MS, PhD1; Florence Baingana, MB, ChB, MMed (Psychiatry), MSc (HPPF)2; Yuval Neria, PhD3
Author Affiliations
JAMA. 2015;313(6):567-568. doi:10.1001/jama.2014.17934.

…CONCLUSIONS
Fear reactions are predictable and pervasive and may exacerbate disease spread in pandemic areas. Efforts to develop effective treatments and vaccines should be coupled with a response to help with efforts to control preventable viral transmission and support the psychological needs of the public overall as well as infected patients, family members, health care workers, and other responders. The West Africa pandemic provides insights into the psychological consequences associated with a “worst case scenario” event involving a highly virulent infectious disease. An effective response is essential both in West Africa to address the psychosocial needs associated with population-wide direct exposure to disease, death, and distress; and in the United States, to counterbalance fear-driven behaviors and policy making with prudent and effective preparedness for emerging infectious diseases.

The Lancet
Feb 14, 2015 Volume 385 Number 9968 p577-662 e7-e11
http://www.thelancet.com/journals/lancet/issue/current

Comment
Older people’s health in sub-Saharan Africa
Isabella A G Aboderin, John R Beard
Published Online: 05 November 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61602-0

Awareness is growing that the world’s population is rapidly ageing. Although much of the related policy debate is about the implications for high-income countries, attention is broadening to less developed settings.1 Middle-income country populations, in particular, are generally ageing at a much faster rate than was the case for today’s high-income countries, and the health of their older populations could be substantially worse.2 However, little consideration has been given to issues of old age in sub-Saharan Africa, which remains the world’s poorest and youngest region.3 Development and health agendas for that region, including those being discussed in relation to targets to succeed the Millennium Development Goals,4 understandably centre on how to increase the capacity of and opportunities for the region’s young people. Yet strong arguments exist for why the health of older people (aged 60 years and older) should not be overlooked. Not least is the substantial size of these populations—already double the number of older adults in northern Europe—which is expected to grow faster than anywhere else, increasing from 46 million in 2015 to 157 million by 2050.5 Furthermore, life expectancy at age 60 years in sub-Saharan Africa is 16 years for women and 14 years for men, suggesting that, for those who survive early life, a long old age is already a reality.2

However, perhaps the most important reason to consider the older population in present plans for increased human and economic wellbeing in sub-Saharan Africa is that, contrary to common assumptions, older Africans play roles that are crucial to achievement of this wellbeing. Within families, older people are often carers or guardians of younger kin. They directly shape younger generations’ access to health, education, and other capabilities, and thus their future human capital. The extent of older people’s caregiving is increasingly recognised in the context of HIV/AIDS—more than 60% of orphaned children in Namibia and Zimbabwe, for example, are looked after by their grandmothers.5 This care function is also important in everyday settings of poverty or labour-related parental absence—in the urban slums of Nairobi, Kenya, for instance, more than 30% of older women and 20% of older men (aged 60 years or older) care for one or more non-biological child (African Population and Health Research Center, Centre for Research on Ageing, University of Southampton, unpublished).

Beyond the family, older African people have key economic roles. In most sub-Saharan African countries, older people largely remain in the labour force,6 particularly in smallholder agriculture, which encompasses the bulk of food production and must be revitalised if nutrition security and sufficient job opportunities are to be ensured for younger generations. As a result of selective rural–urban outmigration, incapacity, or uninterest of younger adults in farming, older people constitute a substantial share of smallholders. In Kenya, for example, the average age of a farmer is estimated to be 60 years.7 Similarly, preliminary analyses of national survey data from Malawi and Kenya show close to 20% of decision makers on smallholder land use in both countries to be aged 60 years and older (African Population and Health Research Center, unpublished). The extent to which older African people can execute their social and economic functions effectively depends heavily on their physical and mental capacity.8, 9 Conversely, if their health deteriorates to a point at which they themselves need care, the responsibility is likely to fall on female younger kin, whose own health, and employment and education opportunities, can be affected.10 Impaired health in older age in sub-Saharan Africa thus affects not only older individuals, but families, communities, and prospects for development more broadly.

Yet older African people face a large morbidity and disability burden, particularly from chronic disease. Our preliminary analysis of 2010 Global Burden of Disease data identifies cardiovascular and circulatory disease, nutritional deficiencies, cirrhosis of the liver, and diabetes as major causes of disability-adjusted life years in sub-Saharan Africa’s older population. Moreover, representative surveys of older adults’ health show high rates of hypertension,11 musculoskeletal disease,12 visual impairment,13 functional limitations,9 and depression.14 Additionally, infectious diseases continue to affect older Africans, underscored by a substantial prevalence of HIV infection and its exacerbating effect on several non-communicable diseases.15 At the same time, evidence of heterogeneity in health and function within older populations and the importance of modifiable factors in shaping it underscore the importance of health-promoting interventions to enable successful ageing in the region.16 Yet a large proportion of, or even most, older Africans lack the requisite care—results of the WHO Study on Adult Health and Ageing11 in Ghana, for example, showed 96% of those with hypertension to have no adequate treatment for the disorder.

A crucial but often omitted perspective is a comparison with younger age groups. Illness and disability rates of older people substantially outstrip those of younger adults.17, 18 This contrasts starkly with findings from high-income countries that show older age to be an increasingly unreliable predictor of greater morbidity or impaired function.19 Yet, despite having worse health than younger age groups, older people in sub-Saharan Africa have been observed to use health services substantially less than younger people do.17, 18 This disparity points to possible age-based inequalities in access to health care that need attention in addition to the widely considered axes of inequities in health (ie, economic status, sex, ethnic origin, or rural or urban residence).

Barriers to health care faced by older African people include absence of an escort or high costs of transport to health providers, and private sector fees for medicines or treatment.18, 20 Older patients use commercial providers because of the unavailability, perceived poor quality, or age insensitivity of services in government facilities.18 These providers, in a bid to achieve the health Millennium Development Goals, typically remain focused on services for infectious diseases, children, and reproductive age adults.18, 20 The supply-side difficulties are exacerbated by important demand-side factors. Such obstacles include resource allocation norms within poor families, which can prioritise the needs of the young at the expense of the old, and older adults’ often little appreciation of the value of, or need for, management of asymptomatic chronic disease.18, 20

In view of the direct importance of older African people’s physical and mental health for the achievement of core development goals, their burden of ill health and likely inequitable access to necessary care provide compelling economic and social grounds for action. These needs should be incorporated into emergent frameworks for attainment of universal health coverage in sub-Saharan Africa in the form of a commitment to maintenance of health and function across the entire life course. Essential action on non-communicable diseases, in particular, will need to extend beyond a focus on prevention of early mortality from key diseases to include provision of chronic care for key non-fatal disorders that affect the function of older populations. However, such a commitment will need to be accompanied by concerted evidence generation if it is to be converted into practice. Such research will need to: better define health needs and care gaps for older Africans; identify feasible and effective models for adaptation of health systems in sub-Saharan Africa; and persuade decision makers to invest in these models.
Longitudinal studies such as the WHO Study on Adult Health and Ageing or 10/66 dementia research are starting to improve understanding of priority intervention needs in a small number of sub-Saharan African countries. However, further social and epidemiological investigations are needed in these and other national contexts. These studies will need to be complemented by assessments of effectiveness of the few existing health financing, human resource, essential medicine or technology, and service delivery approaches targeted at older people in sub-Saharan Africa, and by design and testing of new models.

Lastly, national evidence on possible age-based health inequities and economic effects of ill health in the older population is needed to help garner political will for action. Such information could be generated—as part of the called-for data revolution for the post-Millennium Development Goals agenda—through systematic expansions to sampling, data collection, or analysis protocols of routine surveys, such as Demographic and Health Surveys, regularly undertaken by countries in sub-Saharan Africa. The fact that developing-country governments have launched a joint Commission on Ageing in Developing Countries bodes well. This Commission should help promote the necessary research and operationalisation of emerging findings by policy makers and external drivers of health-system development in sub-Saharan Africa.
We declare no competing interests.
References
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Payne, CF, Mkandawire, J, and Kohler, HP. Disability transitions and health expectancies among adults 45 years and older in Malawi: a cohort-based model. PLoS Med. 2013; 10: e1001435
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Bekibele, CO and Gureje, O. Self-reported visual impairment and impact on vision-related activities in an elderly Nigerian population: report from the Ibadan Study of Ageing. Ophthalmic Epidemiol. 2008; 15: 250–256
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Mills, EJ, Barnighausen, T, and Negin, J. HIV and aging—preparing for the challenges ahead. N Engl J Med. 2012; 366: 1270–1273
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The Lancet
Feb 14, 2015 Volume 385 Number 9968 p577-662 e7-e11
http://www.thelancet.com/journals/lancet/issue/current

Articles
A population-based, multifaceted strategy to implement antenatal corticosteroid treatment versus standard care for the reduction of neonatal mortality due to preterm birth in low-income and middle-income countries: the ACT cluster-randomised trial
Dr Fernando Althabe, MD, José M Belizán, MD, Elizabeth M McClure, PhD, Jennifer Hemingway-Foday, MPH, Mabel Berrueta, MD, Agustina Mazzoni, MD, Alvaro Ciganda, BIT, Prof Shivaprasad S Goudar, MD, Prof Bhalachandra S Kodkany, MD, Prof Niranjana S Mahantshetti, MD, Prof Sangappa M Dhaded, DM, Geetanjali M Katageri, MD, Prof Mrityunjay C Metgud, MD, Anjali M Joshi, BAMS, Prof Mrutyunjaya B Bellad, MD, Narayan V Honnungar, MBBS, Prof Richard J Derman, MD, Sarah Saleem, MBBS, Omrana Pasha, MD, Sumera Ali, MD, Farid Hasnain, PhD,
Prof Robert L Goldenberg, MD, Fabian Esamai, MBChB, Paul Nyongesa, MD, Silas Ayunga, MD, Edward A Liechty, MD, Ana L Garces, MD, Lester Figueroa, MD, Prof K Michael Hambidge, MD, Nancy F Krebs, MD, Prof Archana Patel, MD, Anjali Bhandarkar, MD, Manjushri Waikar, MD, Prof Patricia L Hibberd, MD, Prof Elwyn Chomba, MD, Prof Waldemar A Carlo, MD, Angel Mwiche, MD, Melody Chiwila, RN, Albert Manasyan, MD, Sayury Pineda, MD, Sreelatha Meleth, PhD, Vanessa Thorsten, MPH, Kristen Stolka, MPH, Dennis D Wallace, PhD, Marion Koso-Thomas, MD, Prof Alan H Jobe, MD, Prof Pierre M Buekens, MD
Published Online: 15 October 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61651-2
Summary
Background
Antenatal corticosteroids for pregnant women at risk of preterm birth are among the most effective hospital-based interventions to reduce neonatal mortality. We aimed to assess the feasibility, effectiveness, and safety of a multifaceted intervention designed to increase the use of antenatal corticosteroids at all levels of health care in low-income and middle-income countries.
Methods
In this 18-month, cluster-randomised trial, we randomly assigned (1:1) rural and semi-urban clusters within six countries (Argentina, Guatemala, India, Kenya, Pakistan, and Zambia) to standard care or a multifaceted intervention including components to improve identification of women at risk of preterm birth and to facilitate appropriate use of antenatal corticosteroids. The primary outcome was 28-day neonatal mortality among infants less than the 5th percentile for birthweight (a proxy for preterm birth) across the clusters. Use of antenatal corticosteroids and suspected maternal infection were additional main outcomes. This trial is registered with ClinicalTrials.gov, number NCT01084096.
Findings
The ACT trial took place between October, 2011, and March, 2014 (start dates varied by site). 51 intervention clusters with 47 394 livebirths (2520 [5%] less than 5th percentile for birthweight) and 50 control clusters with 50 743 livebirths (2258 [4%] less than 5th percentile) completed follow-up. 1052 (45%) of 2327 women in intervention clusters who delivered less-than-5th-percentile infants received antenatal corticosteroids, compared with 215 (10%) of 2062 in control clusters (p<0•0001). Among the less-than-5th-percentile infants, 28-day neonatal mortality was 225 per 1000 livebirths for the intervention group and 232 per 1000 livebirths for the control group (relative risk [RR] 0•96, 95% CI 0•87–1•06, p=0•65) and suspected maternal infection was reported in 236 (10%) of 2361 women in the intervention group and 133 (6%) of 2094 in the control group (odds ratio [OR] 1•67, 1•33–2•09, p<0•0001). Among the whole population, 28-day neonatal mortality was 27•4 per 1000 livebirths for the intervention group and 23•9 per 1000 livebirths for the control group (RR 1•12, 1•02–1•22, p=0•0127) and suspected maternal infection was reported in 1207 (3%) of 48 219 women in the intervention group and 867 (2%) of 51 523 in the control group (OR 1•45, 1•33–1•58, p<0•0001).
Interpretation
Despite increased use of antenatal corticosteroids in low-birthweight infants in the intervention groups, neonatal mortality did not decrease in this group, and increased in the population overall. For every 1000 women exposed to this strategy, an excess of 3•5 neonatal deaths occurred, and the risk of maternal infection seems to have been increased.
Funding
Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The Lancet
Feb 14, 2015 Volume 385 Number 9968 p577-662 e7-e11
http://www.thelancet.com/journals/lancet/issue/current

Series
Subjective wellbeing, health, and ageing
Prof Andrew Steptoe, DPhil, Prof Angus Deaton, PhD, Prof Arthur A Stone, PhD
Published Online: 05 November 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(13)61489-0
Summary
Subjective wellbeing and health are closely linked to age. Three aspects of subjective wellbeing can be distinguished—evaluative wellbeing (or life satisfaction), hedonic wellbeing (feelings of happiness, sadness, anger, stress, and pain), and eudemonic wellbeing (sense of purpose and meaning in life). We review recent advances in the specialty of psychological wellbeing, and present new analyses about the pattern of wellbeing across ages and the association between wellbeing and survival at older ages. The Gallup World Poll, a continuing survey in more than 160 countries, shows a U-shaped relation between evaluative wellbeing and age in high-income, English speaking countries, with the lowest levels of wellbeing in ages 45–54 years. But this pattern is not universal. For example, respondents from the former Soviet Union and eastern Europe show a large progressive reduction in wellbeing with age, respondents from Latin America also shows decreased wellbeing with age, whereas wellbeing in sub-Saharan Africa shows little change with age. The relation between physical health and subjective wellbeing is bidirectional. Older people with illnesses such as coronary heart disease, arthritis, and chronic lung disease show both increased levels of depressed mood and impaired hedonic and eudemonic wellbeing. Wellbeing might also have a protective role in health maintenance. In an analysis of the English Longitudinal Study of Ageing, we identify that eudemonic wellbeing is associated with increased survival; 29•3% of people in the lowest wellbeing quartile died during the average follow-up period of 8•5 years compared with 9•3% of those in the highest quartile. Associations were independent of age, sex, demographic factors, and baseline mental and physical health. We conclude that the wellbeing of elderly people is an important objective for both economic and health policy. Present psychological and economic theories do not adequately account for the variations in patterns of wellbeing with age across different parts of the world. The apparent association between wellbeing and survival is consistent with a protective role of high wellbeing, but alternative explanations cannot be ruled out at this stage.

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Series
Macroeconomic implications of population ageing and selected policy responses
Prof David E Bloom, PhD, Somnath Chatterji, MD, Paul Kowal, PharmD, Peter Lloyd-Sherlock, PhD, Prof Martin McKee, DSc, Bernd Rechel, PhD, Larry Rosenberg, MPA, James P Smith, PhD
Published Online: 05 November 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61464-1
Summary
Between now and 2030, every country will experience population ageing—a trend that is both pronounced and historically unprecedented. Over the past six decades, countries of the world had experienced only a slight increase in the share of people aged 60 years and older, from 8% to 10%. But in the next four decades, this group is expected to rise to 22% of the total population—a jump from 800 million to 2 billion people. Evidence suggests that cohorts entering older age now are healthier than previous ones. However, progress has been very uneven, as indicated by the wide gaps in population health (measured by life expectancy) between the worst (Sierra Leone) and best (Japan) performing countries, now standing at a difference of 36 years for life expectancy at birth and 15 years for life expectancy at age 60 years. Population ageing poses challenges for countries’ economies, and the health of older populations is of concern. Older people have greater health and long-term care needs than younger people, leading to increased expenditure. They are also less likely to work if they are unhealthy, and could impose an economic burden on families and society. Like everyone else, older people need both physical and economic security, but the burden of providing these securities will be falling on a smaller portion of the population. Pension systems will be stressed and will need reassessment along with retirement policies. Health systems, which have not in the past been oriented toward the myriad health problems and long-term care needs of older people and have not sufficiently emphasised disease prevention, can respond in different ways to the new demographic reality and the associated changes in population health. Along with behavioural adaptations by individuals and businesses, the nature of such policy responses will establish whether population ageing will lead to major macroeconomic difficulties.

Nature
Volume 518 Number 7538 pp137-268 12 February 2015
http://www.nature.com/nature/current_issue.html

Nature | Editorial
Spot the difference
The US measles outbreak highlights why most states should reconsider their vaccination rules.
11 February 2015
Over the past decade, increasing numbers of US parents have chosen not to vaccinate their children against diseases such as whooping cough, mumps and measles. The consequence has been a periodic return of these historical scourges, in localized outbreaks of a few dozen to a few hundred people. These episodes often appear in local news reports, some of which warn that lower vaccination rates could result in a nationwide outbreak.

Reading the US news media over the past two weeks, you might conclude that that day has come. The current US measles outbreak, which began in December and was first reported in late January, has blown up into a national debate over the rights of parents to decide whether their children should be vaccinated. But by global standards, it is a tempest in a teapot: as of 6 February, measles had struck 121 people in 17 states and the District of Columbia.

Those numbers are unremarkable. Since October, a measles outbreak has affected more than 370 people in Germany; it saw almost 1,800 cases in 2013 and more than 1,600 in 2011. The Philippines had more than 50,000 cases in 2014. The United Kingdom had only 137 cases last year, but in both 2012 and 2013 it had close to 2,000 (see page 148).
In fact, even by US standards, the current outbreak is not unprecedented. Last year, a much larger outbreak was sparked by Amish missionaries returning from the Philippines to Ohio, where low vaccination rates among the community caused 383 cases.

Perhaps that incident stayed out of the national spotlight because it was an unusual set of circumstances that occurred in an isolated rural community. But the current outbreak centres on ‘the happiest place on Earth’ — Disneyland in southern California. At least 42 people seem to have been exposed to measles at the theme park, which receives an estimated 16 million visits a year.
Fortunately for the public’s health, attention around the outbreak has come down in favour of vaccination and against the myths about its dangers. Public opinion has turned against parents and physicians who are suspicious of vaccines. Two potential Republican presidential candidates, Governor Chris Christie of New Jersey and Senator Rand Paul of Kentucky, at first declared that parents should have the right to decide whether their children are vaccinated, and then had to clarify their positions in the face of harsh criticism.

Whether or not the theme park’s involvement in the episode contributed to the media coverage, Disneyland’s cherished place in US culture makes it ideal for an infectious-disease outbreak. It is popular with international tourists eager for a quintessential American experience, who as a group are less likely than US residents to be vaccinated. The park also hosts large numbers of infants less than one year old — younger than the age at which the first measles shot is generally given in the United States.

And Disneyland is at the epicentre of the US anti-vaccine movement. Although 94.7% of US children entering school at around age 5 are vaccinated against measles, in hundreds of California schools the percentage of vaccinated children falls well short of the 92% considered necessary to produce the ‘herd immunity’ that prevents transmission of the disease. The state’s public-health department reports that 2.54% of children entered school in 2014 with an exemption from vaccination based on personal belief.

The federal government has little say in who gets a measles shot — those rules are written by individual states. Most, like California, allow parents to send their children to school unvaccinated by claiming a religious or philosophical objection to the practice. But two — Mississippi and West Virginia — allow only medical exceptions. And that, many observers have argued, is why Mississippi, one of the poorest states in the union, has the highest percentage of 5-year-old children who have received vaccination for measles, mumps and rubella.

Last month, the Mississippi state legislature was considering a bill to allow the same types of personal-belief exemption that most other states allow. But on 3 February, a committee in the state’s House of Representatives killed the proposal. On 4 February, legislators in California said that they would introduce a bill to adopt the same strict rules as Mississippi. And several other states, including Maine, Minnesota and Oregon, are considering measures that would require parents to consult with a physician about vaccines before being granted an exemption.

That is a step in the right direction. Parents, of course, have the right to decide what is best for their children. But when it comes to vaccination, those decisions should be based on complete and accurate information about the risks and benefits.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 14 February 2015)

Temporal Changes in Ebola Transmission in Sierra Leone and Implications for Control Requirements: a Real-time Modelling Study
February 10, 2015 • Research
Abstract
Background: Between August and November 2014, the incidence of Ebola virus disease (EVD) rose dramatically in several districts of Sierra Leone. As a result, the number of cases exceeded the capacity of Ebola holding and treatment centres. During December, additional beds were introduced, and incidence declined in many areas. We aimed to measure patterns of transmission in different regions, and evaluate whether bed capacity is now sufficient to meet future demand.

Methods: We used a mathematical model of EVD infection to estimate how the extent of transmission in the nine worst affected districts of Sierra Leone changed between 10th August 2014 and 18th January 2015. Using the model, we forecast the number of cases that could occur until the end of March 2015, and compared bed requirements with expected future capacity.

Results: We found that the reproduction number, R, defined as the average number of secondary cases generated by a typical infectious individual, declined between August and December in all districts. We estimated that R was near the crucial control threshold value of 1 in December. We further estimated that bed capacity has lagged behind demand between August and December for most districts, but as a consequence of the decline in transmission, control measures caught up with the epidemic in early 2015.

Conclusions: EVD incidence has exhibited substantial temporal and geographical variation in Sierra Leone, but our results suggest that the epidemic may have now peaked in Sierra Leone, and that current bed capacity appears to be sufficient to keep the epidemic under-control in most districts.

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Estimating Drivers of Autochthonous Transmission of Chikungunya Virus in its Invasion of the Americas
February 10, 2015 • Research
Abstract
Background
Chikungunya is an emerging arbovirus that has caused explosive outbreaks in Africa and Asia for decades and invaded the Americas just over a year ago. During this ongoing invasion, it has spread to 45 countries where it has been transmitted autochthonously, infecting nearly 1.3 million people in total.
Methods
Here, we made use of weekly, country-level case reports to infer relationships between transmission and two putative climatic drivers: temperature and precipitation averaged across each country on a monthly basis. To do so, we used a TSIR model that enabled us to infer a parametric relationship between climatic drivers and transmission potential, and we applied a new method for incorporating a probabilistic description of the serial interval distribution into the TSIR framework.
Results
We found significant relationships between transmission and linear and quadratic terms for temperature and precipitation and a linear term for log incidence during the previous pathogen generation. The lattermost suggests that case numbers three to four weeks ago are largely predictive of current case numbers. This effect is quite nonlinear at the country level, however, due to an estimated mixing parameter of 0.74. Relationships between transmission and the climatic variables that we estimated were biologically plausible and in line with expectations.
Conclusions
Our analysis suggests that autochthonous transmission of Chikungunya in the Americas can be correlated successfully with putative climatic drivers, even at the coarse scale of countries and using long-term average climate data. Overall, this provides a preliminary suggestion that successfully forecasting the future trajectory of a Chikungunya outbreak and the receptivity of virgin areas may be possible. Our results also provide tentative estimates of timeframes and areas of greatest risk, and our extension of the TSIR model provides a novel tool for modeling vector-borne disease transmission.

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High-resolution Genomic Surveillance of 2014 Ebolavirus Using Shared Subclonal Variants
February 9, 2015 • Research
Abstract
Background: Viral outbreaks, such as the 2014 ebolavirus, can spread rapidly and have complex evolutionary dynamics, including coinfection and bulk transmission of multiple viral populations. Genomic surveillance can be hindered when the spread of the outbreak exceeds the evolutionary rate, in which case consensus approaches will have limited resolution. Deep sequencing of infected patients can identify genomic variants present in intrahost populations at subclonal frequencies (i.e. <50%). Shared subclonal variants (SSVs) can provide additional phylogenetic resolution and inform about disease transmission patterns.

Methods: We use metrics from population genetics to analyze data from the 2014 ebolavirus outbreak in Sierra Leone and identify phylogenetic signal arising from SSVs. We use methods derived from information theory to measure a lower bound on transmission bottleneck size.

Results and Conclusions: We identify several SSV that shed light on phylogenetic relationships not captured by consensus-based analyses. We find that transmission bottleneck size is larger than one founder population, yet significantly smaller than the intrahost effective population. Our results demonstrate the important role of shared subclonal variants in genomic surveillance.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 14 February 2015)

Viewpoints
The Newest “Omics”—Metagenomics and Metabolomics—Enter the Battle against the Neglected Tropical Diseases
Geoffrey A. Preidis ,
Affiliation: Section of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, United States of America
Peter J. Hotez
Affiliations: National School of Tropical Medicine, Department of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, Houston, Texas, United States of America, Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, Houston, Texas, United States of America, James A. Baker III Institute for Public Policy, Rice University, Houston, Texas, United States of America, Department of Biology, Baylor University, Waco, Texas, United States of America
Published: February 12, 2015
DOI: 10.1371/journal.pntd.0003382

Introduction
The international Human Microbiome Project [1,2] trumpeted the coming of age of the field of metagenomics, the study of entire communities of microbes and their contributions to health and disease. Metagenomic analyses are most often undertaken by sequencing the bacterial 16S ribosomal RNA (rRNA) subunit or by whole metagenome shotgun sequencing, typically on a massively parallel pyrosequencing platform. These technologies have expanded the scope of traditional culture-dependent microbiological methods and have enhanced our understanding of the rich microbial communities that inhabit the intestine, skin, oral cavity, and genitourinary tract and how these commensal microbes interact with both pathogen and host.

In parallel, the field of metabolomics emerged as the systematic, nonbiased analysis of all low-molecular-weight small molecules, or metabolites, produced by a system in response to an environmental stimulus. Metabolites are secreted into body fluids by host and microbial cells, measured by mass spectrometry–based approaches, and aligned against libraries of known biochemicals. These techniques have been used to gain insights into mechanisms of pathogenesis and to identify new biomarkers of disease. Metabolomics also offers clues to the presence and function of microbes living deep within the small bowel that are difficult to sample directly and highlights the complex relationship between resident microbes, host metabolism, pharmacotherapeutic action, and relative health or disease.

Metagenomics and metabolomics are the two most rapidly advancing “omics” technologies and lie at either end of the “omics cascade” [3]; the former identifies the genetic potential of a community, whereas the latter reports the actual biology that produces a phenotype. These fields have enabled discoveries pertinent to a number of human conditions—namely, acute gastroenteritis, antibiotic-associated diarrhea, inflammatory bowel disease, irritable bowel syndrome, liver disease, undernutrition, and obesity—and have begun to shed new light on multiple aspects of the neglected tropical diseases. Moreover, there are exciting opportunities to now pair metagenomic and metabolomic data in order to gain new and unprecedented insights into the host–parasite relationship. Here, we explore the nascent metagenomic and metabolomic contributions to the diagnosis, pathogenesis, treatment, and prevention (including vector control) of neglected tropical diseases. We then look ahead to the full potential of the postgenomics era and consider how metagenomics and metabolomics could help in the control and elimination of these diseases…

Vaccine
Volume 33, Issue 10, Pages 1231-1298 (3 March 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/10

Immunodeficiency-related vaccine-derived poliovirus (iVDPV) cases: A systematic review and implications for polio eradication
Review Article
Pages 1235-1242
Jean Guo, Sara Bolivar-Wagers, Nivedita Srinivas, Marisa Holubar, Yvonne Maldonado
Abstract
Background
Vaccine-derived polioviruses (VDPVs), strains of poliovirus mutated from the oral polio vaccine, pose a challenge to global polio eradication. Immunodeficiency-related vaccine-derived polioviruses (iVDPVs) are a type of VDPV which may serve as sources of poliovirus reintroduction after the eradication of wild-type poliovirus. This review is a comprehensive update of confirmed iVDPV cases published in the scientific literature from 1962 to 2012, and describes clinically relevant trends in reported iVDPV cases worldwide.
Methods
We conducted a systematic review of published iVDPV case reports from January 1960 to November 2012 from four databases. We included cases in which the patient had a primary immunodeficiency, and the vaccine virus isolated from the patient either met the sequencing definition of VDPV (>1% divergence for serotypes 1 and 3 and >0.6% for serotype 2) and/or was previously reported as an iVDPV by the World Health Organization.
Results
We identified 68 iVDPV cases in 49 manuscripts reported from 25 countries and the Palestinian territories. 62% of case patients were male, 78% presented clinically with acute flaccid paralysis, and 65% were iVDPV2. 57% of cases occurred in patients with predominantly antibody immunodeficiencies, and the overall all-cause mortality rate was greater than 60%. The median age at case detection was 1.4 years [IQR: 0.8, 4.5] and the median duration of shedding was 1.3 years [IQR: 0.7, 2.2]. We identified a poliovirus genome VP1 region mutation rate of 0.72% per year and a higher median percent divergence for iVDPV1 cases. More cases were reported from high income countries, which also had a larger age variation and different distribution of immunodeficiencies compared to upper and lower middle-income countries.
Conclusion
Our study describes the incidence and characteristics of global iVDPV cases reported in the literature in the past five decades. It also highlights the regional and economic disparities of reported iVDPV cases.

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Vaccines — Open Access Journal
(Accessed 14 February 2015)
http://www.mdpi.com/journal/vaccines

Review: M2e-Based Universal Influenza A Vaccines
by Lei Deng, Ki Joon Cho, Walter Fiers and Xavier Saelens
Vaccines 2015, 3(1), 105-136; doi:10.3390/vaccines3010105 – published 13 February 2015
Abstract:
The successful isolation of a human influenza virus in 1933 was soon followed by the first attempts to develop an influenza vaccine. Nowadays, vaccination is still the most effective method to prevent human influenza disease. However, licensed influenza vaccines offer protection against antigenically matching viruses, and the composition of these vaccines needs to be updated nearly every year. Vaccines that target conserved epitopes of influenza viruses would in principle not require such updating and would probably have a considerable positive impact on global human health in case of a pandemic outbreak. The extracellular domain of Matrix 2 (M2e) protein is an evolutionarily conserved region in influenza A viruses and a promising epitope for designing a universal influenza vaccine. Here we review the seminal and recent studies that focused on M2e as a vaccine antigen. We address the mechanism of action and the clinical development of M2e-vaccines. Finally, we try to foresee how M2e-based vaccines could be implemented clinically in the future.

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

Journal of Family Planning & Reproductive Health Care
Online First
doi:10.1136/jfprhc-2014-100896
Article
Comparing risk behaviours of human papillomavirus-vaccinated and non-vaccinated women
Laura Sadler1, Stephen A Roberts2, Gail Hampal3, Dona McManus4, Debashis Mandal5, Loretta Brabin6
Author Affiliations
1Research Associate, Institute of Cancer Sciences, University of Manchester, Manchester, UK
2Senior Lecturer in Medical Statistics, Centre for Biostatistics, University of Manchester, Manchester, UK
3Sister, Department of Genitourinary Medicine, Warrington and Halton Hospitals NHS Foundation Trust, Cheshire, UK
4Departmental Manager, Department of Genitourinary Medicine, Warrington and Halton Hospitals NHS Foundation Trust, Cheshire, UK
5Consultant in Genitourinary Medicine, Department of Genitourinary Medicine, Warrington and Halton Hospitals NHS Foundation Trust, Cheshire, UK and Senior Lecturer, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
6Reader in Women’s Health, Institute of Cancer Sciences, University of Manchester, Manchester, UK
Received 7 February 2014
Revised 5 November 2014
Accepted 1 December 2014
Published Online First 20 January 2015
Abstract
Background
Since September 2008, a national vaccine programme in the UK has offered routine human papillomavirus (HPV) vaccination to young women aged 12–13 years. A catch-up programme also offered HPV vaccination to women born after 1 September 1990.
Aim
To compare indicators of risk and preventive behaviours among young women attending genitourinary medicine (GUM) clinics who had, and had not, received at least one dose of HPV vaccine.
Methods
Clinical histories and HPV vaccination status were obtained from 363 participants eligible for HPV vaccination (Cervarix®) in the UK vaccination programme (born after 1 September 1990) attending GUM clinics in the North West of England. Using logistic regression, markers of sexual and non-sexual risk behaviours were compared between vaccinated and unvaccinated women.
Results
At least one dose of HPV vaccine had been received by 63.6% (n=231) of participants. Unvaccinated women demonstrated higher levels of risky behaviour than those who had undergone HPV vaccination. Unvaccinated women were significantly more likely to have had three or more partners in the last 6 months, attended the clinic with symptoms, not used a condom at first sexual intercourse, had anal intercourse with their last sexual contact, to have tested positive for Chlamydia trachomatis diagnosis at the clinic visit and to be a current smoker.
Conclusions
In the UK, where vaccine coverage is high, failure to initiate HPV vaccination amongst GUM attendees is a marker of high-risk behaviours. As a result, HPV vaccination status should be ascertained as part of an individual’s clinical history by sexual health services to ensure advice and counselling is provided to those at greatest risk of HPV-associated disease.

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Special Focus Newsletters
RotaFlash – February 9, 2015
– Significant reductions in rotavirus-related hospitalizations in Malawi
– Argentina and Tajikistan introduce rotavirus vaccines, bringing worldwide total to 75

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.

The Atlantic
http://www.theatlantic.com/magazine/
Accessed 14 February 2015

Vaccines Are Profitable, So What?
Bourree Lam Feb 10 2015, 7:50 AM ET
Yes, Big Pharma is making money from immunizations. But that doesn’t mean anyone should skip the shots.
…So while the vaccine industry is likely more profitable now than in the 1970s or 1980s, this is the result of global market forces, not a reason to skip a child’s vaccinations: Pharmaceutical companies need incentives to keep producing vaccines, because regardless of profits the economic and social benefits of vaccination are huge—in lives and the billions of dollars saved. A study released last year estimated that fully immunizing babies resulted in $10 saved for every dollar spent, about $69 billion total. “Vaccines are one of the most cost-effective interventions we have,” says Halsey.

In the U.S., a study looking at the benefits of vaccination between 1994 and 2013 estimated a net savings of $295 billion in direct costs and $1.38 trillion in total societal costs. Looking at the last 50 years of the vaccine market, it’s absurd to think profits could have ever been the sole motivation of vaccine production. In fact, 83 percent of Americans believe that the MMR vaccine is safe. Profits from vaccine production aren’t a valid argument against vaccinations—the most important question is whether vaccines are safe and effective, and the answer is unambiguously yes.

Why Is Germany So Calm About Its Measles Outbreak?
A bigger flare-up of the contagious disease has a different cause—and has prompted a much more placid reaction.
Adam Chandler Feb 9 2015, 5:28 PM E

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Foreign Affairs
http://www.foreignaffairs.com/
Accessed 14 February 2015

Good Thing Chris Christie Isn’t the Governor of Congo
Poor countries from India to Zambia are making huge gains against preventable killers like measles — just as rich countries are falling behind.
By Laurie Garrett February 9, 2015
…If the backlash against non-vaccinators continues to grow, Christie (and others like fellow presidential candidates Ben Carson, who insists illegal immigrants are responsible for measles, and Rand Paul, who has struggled to balance his libertarian views of free choice against support for public health) may realize they have made the wrong political gamble in playing with public health. A deep, emotional polarization already divides public health advocates and those who dream of global measles eradication versus parental-choice promoters who feel even scant hypothetical vaccine risks are too much burden for their babies to bear. This vaccine polarization has been vociferous and often angry for many years. It would be tragic not only for the children of America, but for the measles-fighting world as a whole, if efforts to achieve American herd immunity against the virus were stymied by U.S. political polarization. Measles infects both Democrats and Republicans, and the vaccine protects the children of conservatives and of liberals equally well…

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The Huffington Post
http://www.huffingtonpost.com/
Accessed 14 February 2015

Don’t Politicize Vaccinations
6 February 2015
by Rosalynn Carter (former First Lady)
For more than four decades, I have joined with many others working to ensure the timely vaccination of children, and today I am saddened to see an outbreak of measles infecting more than 100 people in 14 states, many of them vulnerable infants. Our country has achieved the highest immunization rates in history and thankfully the vast majority of parents are choosing to vaccinate their children on time. Yet, some parents today are being swayed by misinformation that has caused them to delay or decline vaccinating their children, jeopardizing the health of many others. I want all people to know that immunizations are safe, and that they work…

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Los Angeles Times
The measles outbreaks that matter the most aren’t happening here
10 February 2015
By Andrea Gay
The measles outbreak linked to Disneyland has heightened public debate about the effect of anti-vaccination sentiment, and what can be characterized as a luxury of choice in the United States. Understandably, much of the dialogue is focused on whether to vaccinate kids. It’s critical to address these issues so we can dispel myths about immunization and reemphasize the important benefits of vaccines. But there is another conversation that we’re not having, one that is equally important to making sure measles outbreaks don’t happen in the United States: how to stop measles outside our borders….

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New Yorker
http://www.newyorker.com/
Accessed 14 February 2015

Comment February 16, 2015 Issue
Not Immune
By Margaret Talbot
Twenty-five years ago, when a doctor named Robert Ross was the deputy health commissioner of Philadelphia, a measles epidemic swept the country. Until this year’s outbreak, which started at Disneyland and has so far sickened more than a hundred people, the 1989-91 epidemic was the most alarming that the United States had seen since 1963, when the measles vaccine was introduced. Nationwide, there were more than fifty-five thousand cases and eleven thousand hospitalizations; a hundred and twenty-three people died. Most of those infected were unimmunized babies and toddlers, predominantly poor and minority kids living in cities…

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New York Times
http://www.nytimes.com/
Accessed 14 February 2015

Africa
Red Cross Faces Attacks at Ebola Victims’ Funerals
By PAM BELLUCK
FEB. 12, 2015
Red Cross volunteers helping to safely bury people who die of Ebola in Guinea have been attacked in recent days by people attending the funerals, complicating efforts to stop the spread of the disease.
The International Federation of Red Cross and Red Crescent Societies reported Thursday that since March, the organization’s burial teams in Guinea have been attacked verbally or physically 10 times a month on average. Most recently, on Sunday in Forécariah, two volunteers were beaten as they tried to carry out a safe burial…

The Opinion Pages | Editorial
Reform After the Ebola Debacle
By THE EDITORIAL BOARD
FEB. 10, 2015
The World Health Organization’s anemic performance in handling the Ebola outbreaks in West Africa may yield one positive outcome: sweeping, and long overdue, institutional reforms to improve its ability to respond more quickly to the next outbreak of a lethal infectious disease. Scrambling to answer growing criticism, the W.H.O.’s executive board recently endorsed changes to enhance the agency’s rapid response capabilities.

The reforms call for well-trained public health workers to rush to the aid of beleaguered countries and an emergency fund to support their initial operations, among other advances. One big question, which can only be answered in practice, is whether the organization’s 194 member states will set aside their typical politicking on behalf of national self-interests and allow it to function as the global health leader it ought to be.

As of Feb. 6, Ebola had infected more than 22,000 people and killed more than 9,000 of them, mostly in the three West African nations of Guinea, Liberia and Sierra Leone, with a smattering of cases in other countries. The number of new cases of Ebola had been falling steadily in those three countries but recently ticked back up for the first time this year in all three, according to the W.H.O.’s latest weekly report. There were 124 new confirmed cases, up from 99 the week before.

That could be a momentary statistical aberration or a harbinger of worse to come as the rainy season makes it increasingly difficult to reach remote areas where the virus may still be lurking.

The agency’s lapses in confronting the Ebola outbreaks have been blamed, rightly, on poor leadership at its headquarters in Geneva and its regional office in Africa. Dr. Margaret Chan, the director general and a Hong Kong pediatrician who got her job thanks to pressure from the Chinese government, failed to respond quickly when Ebola first emerged in West Africa.

Only after a nongovernmental organization, Doctors Without Borders, repeatedly warned that the epidemic was out of control and the virus had spread to the populous neighboring country of Nigeria did Dr. Chan finally declare the outbreak a public health emergency of international concern.

The agency’s regional office in Africa was also slow to respond, partly because it was staffed by politically appointed people of little competence and partly because it feared that declaring a widespread emergency would tarnish the reputation and international trade of afflicted countries.

The resolution adopted by the W.H.O.’s executive board signals a heightened willingness to be more aggressive and could go a long way toward addressing these deficiencies. It calls for the agency to create a global cadre of public health workers trained to deal with a crisis, to establish a $100 million emergency fund that could be tapped quickly without waiting for donations from advanced nations to come dribbling in, and a commitment by the executive-director to ensure that regional staff members are selected for their expertise. The proposals are expected to be approved by the agency’s governing body, the World Health Assembly, in May.

In another promising sign of change, a highly regarded physician from Botswana was appointed last month as the new regional director for Africa. She promised to introduce competency tests for the staff and audits of job performance by outside consultants, among other changes.

But the long-term issue of adequate financing for the W.H.O. will remain. Budget cuts reduced the agency’s ability to monitor outbreaks even before Ebola arrived in West Africa. And the agency has not been given power to demand actions it thinks member nations should perform. With the epidemic appearing to ebb in West Africa, the danger remains that the drive for reform could lose steam as well

.The Opinion Pages | Op-Ed Contributor
What Would Jesus Do About Measles?
By PAUL A. OFFIT
FEB. 10, 2015
PHILADELPHIA — MEASLES is back. Last year, about 650 cases were reported in the United States — the largest outbreak in almost 20 years. This year, more than a hundred have already been reported.
Parents have chosen not to vaccinate their children because they can; 19 states have philosophical exemptions to vaccination, and 47 have religious exemptions. The other reason is that parents are not scared of the disease. But I’m scared. I lived through the 1991 Philadelphia measles epidemic….
…In the wake of the current epidemic, several states have proposed legislation modifying or eliminating philosophical exemptions to vaccination. No lawmaker, however, dares to touch religious exemptions. It’s political dynamite. But with an estimated 30,000 children in the United States unvaccinated for religious reasons, that is a dangerous mistake.
Parents shouldn’t be allowed to martyr their children — or in this case, those with whom their children have come in contact. Religious exemptions to vaccination are a contradiction in terms. In the good name of all religions, they should be eliminated.

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Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 14 February 2015

Measles Vaccine Debate Hits Home at California School
The measles outbreak and debate over vaccinations has hit close to home at Julian Charter School in California, where many parents have opted out of getting their children immunized.
02/11/15

Dan Henninger: Vaccines and Politicized Science
Jenny McCarthy knows the credibility of science is a house of cards.
02/11/15

U.S. Measles Cases for 2015 Rise 18.6% Over Past Week
The number of measles cases in the U.S. this year rose 18.6% over the past week, to 121 people in 17 states, federal health officials says.
02/09/15

Vaccines: Delays, Too, Pose Risks
While parents who don’t vaccinate their children have been the focus of the recent measles outbreak, experts say vaccine delayers compose a larger and growing group that may expose the most vulnerable population to vaccine-preventable diseases.
02/09/15

Doctors Work to Ease Vaccine Fears
Pediatricians face growing numbers of parents who question or reject vaccinations for their children. Now, public health experts are working on new ways to help these doctors hone their pitches to families.
02/09/15

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Washington Post
http://www.washingtonpost.com/
Accessed 14 February 2015

12 February 2015
The polio vaccine killed my father. But that’s not a reason to oppose vaccines.
Individual risk is a necessary part of public health.
By Nuria Sheehan
My father was one in 5 million. That’s the probability of getting polio after being in contact with someone who has received the oral polio vaccine. I got the vaccine as an infant. And somehow the weakened form of the virus within it managed to infect my father. He spent nine months in intensive care, eventually becoming entirely paralyzed except for one eyelid with which he agonizingly communicated with my mother. A year after I was born, he was dead….

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

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

Editor’s Note:
A measles outbreak in the U.S. – traced to Disney Land park in California and now active in several U.S. states – has spawned a significant public debate about vaccines, hesitancy, parental responsibility, mandates, and the U.S. federal and state government’s role in assuring immunization against infectious diseases generally. This debate has generated assertions, refinements and retractions by politicians, pundits and public health officials over the last week. Please see Media Watch below to see a summary of this activity, which was still very active as we published this edition. Reactions to this activity has included statements of support for vaccines as a key preventive health measure, including the statement below by the American Osteopathic Association.

American Osteopathic Association Affirms Safety and Effectiveness of Vaccines
Feb 06, 2015
Amid continuing outbreaks of preventable illnesses, the American Osteopathic Association reiterated its support for CDC vaccination protocols and cited the importance of a fully vaccinated population on the public health of the nation….

EBOLA/EVD [to 7 February 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

WHO: Ebola Situation Report – 4 February 2015
[Excerpt; Editor’s text bolding]
SUMMARY
:: Weekly case incidence increased in all three countries for the first time this year. There were 124 new confirmed cases reported in the week to 1 February: 39 in Guinea, 5 in Liberia, and 80 in Sierra Leone.
:: Continued community resistance, increasing geographical spread in Guinea and widespread transmission in Sierra Leone, and a rise in incidence show that the EVD response still faces significant challenges.
:: As the wet season approaches, there is an urgent need to end the outbreak in as wide an area as possible, especially in remote areas that will become more difficult to access.
:: Guinea reported 39 new confirmed cases, compared with 30 the previous week. An unsafe burial that took place in early January in the eastern prefecture of Lola, on the border with Côte d’Ivoire, has so far resulted in an outbreak of 11 confirmed cases. A further confirmed case in the northern prefecture of Siguiri, on the border with Mali, also originated in Lola.
:: The north Guinean prefecture of Tougué, which also borders Mali, has reported its first 2 confirmed cases. Both cases originated in the western prefecture of Dubreka.
::: In light of the recent increase in cases in northern Guinea, cross-border meetings between Guinea, Mali, and Senegal are planned to strengthen coordination of surveillance. A rapid-response team has also arrived in the border area between Lola, Guinea, and Côte d’Ivoire to assess risk and strengthen surveillance.
:: A total of 80 new cases were reported in Sierra Leone in the week to 1 February, compared with 65 the previous week. The western districts of Port Loko and the capital Freetown are the worst-affected areas. Nine of 14 districts in the country reported at least 1 confirmed case, up from 7 districts in the previous week.
:: The target is for 100% of new cases to arise among registered contacts, so that each and every chain of transmission can be tracked and terminated. In Guinea in the week to 25 January, 14 of 26 (54%) new confirmed and probable cases in arose among registered contacts; in Liberia in the 9 days to 31 January, 7 of 7 (100%) new confirmed cases arose among registered contacts; and in Sierra Leone in the week to 18 January 26 of 121 (21%) confirmed cases arose among registered contacts.
:: The case fatality rate among hospitalized cases (calculated from all confirmed and probable hospitalized cases with a reported definitive outcome) is between 50% and 61% in the 3 intense-transmission countries.
:: A total of 822 confirmed health worker infections have been reported in the 3 intense-transmission countries; there have been 488 reported deaths.
:: A total of 10 of 34 prefectures in Guinea reported at least one security incident or other form of refusal to cooperate in the week to 1 February. No counties in Liberia and 3 districts in Sierra Leone reported at least one similar incident during the week to 27 January.

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
:: There have been almost 22 500 reported confirmed, probable, and suspected cases (Annex 1) of EVD in Guinea, Liberia and Sierra Leone (table 1), with almost 9000 reported deaths (outcomes for many cases are unknown). A total of 39 new confirmed cases were reported in Guinea, 5 in Liberia, and 80 in Sierra Leone in the 7 days to 1 February.
:: 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 822 confirmed health worker infections have been reported in the 3 intense-transmission countries; there have been 488 reported deaths (table 3)….

NIH Watch [to 7 February 2015]
http://www.nih.gov/news/index.html

:: Ebola Vaccine Trial Opens in Liberia
Study Led by Liberia-NIH Partnership Will Test Two Experimental Vaccines
Feb. 2, 2015
A large clinical trial to assess the safety and efficacy of two experimental vaccines to prevent Ebola virus infection is now open to volunteers in Liberia. The trial is being led by a recently formed Liberia-U.S. clinical research partnership and is sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. The Partnership for Research on Ebola Vaccines in Liberia or PREVAIL, a Phase 2/3 study, is designed to enroll approximately 27,000 healthy men and women aged 18 years and older.

One vaccine candidate, cAd3-EBOZ, uses a chimpanzee-derived cold virus to deliver Ebola virus genetic material from the Zaire strain of virus causing the outbreak in Liberia. Published interim results from a Phase 1 trial of this vaccine, which was co-developed by NIAID scientists and GlaxoSmithKline, provided necessary safety information and showed that it prompted immune responses to the outer coat of Ebola virus. The other candidate, VSV-ZEBOV, employs vesicular stomatitis virus, an animal virus that primarily affects cattle, to carry an Ebola virus gene segment. The VSV-ZEBOV vaccine was developed by the Public Health Agency of Canada and licensed to NewLink Genetics Corporation through its wholly owned subsidiary BioProtection Systems Corporation. Phase 1 trial results of this vaccine also provided safety information and showed that it prompted immune responses to the outer coat of Ebola virus. These results have not yet been published but were made available to the regulatory bodies reviewing the study.

“The scale of the current Ebola outbreak in West Africa is unprecedented, and specific medical countermeasures are needed for this and future outbreaks,” said NIAID Director Anthony S. Fauci, M.D. “It is imperative that any potential countermeasures, including vaccines, be tested in a manner that conforms to the highest ethical and safety standards in clinical trials designed to provide a clear answer to the question of whether a candidate vaccine is safe and can prevent infection. This trial is designed to provide such answers.”

In addition to healthy adults in the general population, the trial will seek volunteers from groups at particular risk of Ebola infection, including health care workers, communities with ongoing transmission, contact tracers and members of burial teams. Social mobilization and community engagement activities began in Montserrado County, where the Liberian capital Monrovia is located, before the trial started and will continue in order to successfully recruit thousands of participants.

Participants will be assigned at random to one of three equal-sized groups. Volunteers in one group will receive a placebo (saline) injection, while the others will receive a single injection of either the cAd3-EBOZ vaccine or the VSV-ZEBOV vaccine. In addition to including a placebo group, the trial will be double-blinded, meaning that neither volunteers nor staff will know whether a vaccine or placebo was administered. A randomized, double-blind, placebo-controlled trial is considered the “gold standard” in clinical research. All participants will be advised on how to minimize the risk of becoming infected with Ebola virus and will be contacted by study staff about one week after the injection and then monthly for the duration of the study, which is currently expected to last about twelve months.

Given the current decline in the number of new Ebola cases in Liberia, study investigators anticipate the need for flexibility in the conduct and design of the trial to address the changing nature of the outbreak.

The co-leaders of the trial are Stephen B. Kennedy, M.D., MPH, secretary-general of the Liberia College of Physicians and Surgeons; Fatorma Baloy, Ph.D., director, Liberian Institute for Biomedical Research; and H. Clifford Lane, M.D., NIAID’s deputy director for clinical research and special projects. The pharmaceutical company GlaxoSmithKline (Research Triangle Park, North Carolina) will supply the cAd3-EBOZ investigational vaccine; Merck (Kenilworth, New Jersey) and NewLink Genetics, Inc. (Ames, Iowa) will supply the VSV-ZEBOV candidate. Additional information about the study is available at ClinicalTrials.gov using the identifier NCT02344407.

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Chimerix Focusing Efforts on CMV and Adenovirus Pivotal Trials
Brincidofovir Will Not Be Considered in Further Clinical Trials in Ebola Virus Disease
DURHAM, N.C., Jan. 30, 2015 (GLOBE NEWSWIRE) — Chimerix, Inc. (Nasdaq:CMRX), a biopharmaceutical company developing novel, oral antivirals in areas of high unmet medical need, today announced that after discussion with the U.S. Food and Drug Administration, the company is ceasing further participation in all current and future clinical studies of brincidofovir for Ebola Virus Disease (EVD), including the study announced in December in Liberia sponsored by investigators at the University of Oxford and the supportive Phase 2 study of brincidofovir for EVD, Study 205.

Over the last several weeks the number of new cases of confirmed Ebola Virus Disease in Liberia has decreased significantly, with only a handful of patients enrolled to date in the single-arm study of brincidofovir led by the University of Oxford and ISARIC (International Severe Acute Respiratory and Emerging Infection Consortium) with operational support from Médecins Sans Frontières (MSF).

The decision to cease further study of brincidofovir in individuals with Ebola Virus Disease does not impact the company’s continued focus on advancing brincidofovir in pivotal studies of CMV prevention in recipients of allogeneic hematopoietic transplant and for the treatment of adenovirus infection in immunocompromised patients.

“We were honored to be able to work with the researchers at University of Oxford and ISARIC together with MSF to initiate the first clinical trial of an investigational agent during an outbreak. The progress in controlling the Ebola outbreak in Liberia is to be commended,” said M. Michelle Berrey, MD, MPH, President and CEO of Chimerix. “Chimerix will continue to push forward with our development of brincidofovir for the prevention and treatment of serious viral infections in transplant recipients and other immunocompromised patients.”

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MSF/Médecins Sans Frontières [to 7 February 2015]
Selected Press Releases/Field News
Ebola Drug Trial in Liberia Halted
February 04, 2015
BRUSSELS/NEW YORK—A trial of the experimental Ebola drug brincidofovir in Liberia has officially ended due to a significant drop in the number of new Ebola cases and the drug manufacturer’s decision to withdraw from the trial, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières said Tuesday.

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Ebola Drug Aids Some in a Study in West Africa
By SHERI FINK
New York Times
February 4, 2015
[Excerpt]
For the first time, a drug is showing promising signs of effectiveness in Ebola patients participating in a study. The medicine, which interferes with the virus’s ability to copy itself, seems to have halved mortality — to 15 percent, from 30 percent — in patients with low to moderate levels of Ebola in their blood, researchers have found. It had no effect in patients with more virus in their blood, who are more likely to die.

The drug, approved as an influenza treatment in Japan last year, was generally well tolerated.
“The results are encouraging in a certain phase of the disease,” Dr. Sakoba Keita, director of disease control for the Guinean Ministry of Health, said in a telephone interview. The drug is being tested in Guinea, one of the three West African countries most affected by the Ebola crisis.

The details of the early findings have not yet been announced, but they raise questions about which patients, if any, outside the study should be offered treatment with the drug, favipiravir. “These are very difficult, agonizing decisions,” said Susan Ellenberg, a professor of biostatistics at the University of Pennsylvania’s Perelman School of Medicine, who was not involved in the research. She cautioned that early results were sometimes not borne out.

The drug has been provided on an emergency basis to Ebola patients in European countries, but not in Africa. The Japanese maker of the drug announced in October that it had 20,000 courses of treatment in stock. The epidemic is now ebbing but is not over. The World Health Organization on Wednesday reported 124 new cases in Guinea, Sierra Leone and Liberia in the week that ended on Sunday, warning of an increased geographical spread in Guinea and a rise in new cases in all three countries for the first time this year.

Early reports of the interim results of the drug trial have created unanticipated complications, delaying the testing of at least one other therapy as researchers reconsidered plans and some doctors pressed to make favipiravir more widely available.

Researchers and health authorities have been quietly debating whether and when to release the preliminary results of the study. The dilemmas they face echo those from the early years of the AIDS epidemic. Because mortality was so high in a disease with no proven treatment, there was demand to provide experimental therapies to everyone.

The results for the drug favipiravir are based on an analysis of 69 patients older than 14 who have received it at two sites in Guinea since December. The survival rates of those with low to moderate levels of virus in their blood were significantly better than those of patients previously treated at a center run by Doctors Without Borders in Guéckédou, Guinea….

IMF [to 7 February 2015]
http://www.imf.org/external/news/default.aspx

IMF Establishes a Catastrophe Containment and Relief Trust to Enhance Support for Eligible Low Income Countries Hit by Public Health Disasters
Press Release No. 15/34
February 5, 2015
The Ebola epidemic in parts of West Africa is a humanitarian disaster that has drawn the attention of the international community to the threat posed by the rapid spread of life-threatening infectious diseases, both within and across international boundaries.

On February 4, 2015, the Executive Board of the International Monetary Fund (IMF) met to consider how the Fund could better support low-income countries hit by such public health disasters. This would take into account both the humanitarian case for providing such support and the wider international interest in supporting vigorous action to contain and halt a potential regional or global pandemic at the earliest possible stage.

To help meet these objectives, the Board approved the establishment of a new Catastrophe Containment and Relief (CCR) Trust, as a vehicle to provide exceptional support to countries confronting major natural disasters, including life-threatening, fast-spreading epidemics but also other types of catastrophic disasters, such as massive earthquakes. For eligible countries confronting epidemics that meet specified criteria, the IMF would use CCR trust fund resources to provide grants as a supplement to its conventional loan support. The grants would be used to pay off future debt service payments, thus reducing the country’s debt burden and freeing up resources to tackle relief and recovery challenges.

Subject to Board approval of requests from the individual countries, it is expected that the CCR trust would provide grants-for-debt relief of close to $100 million for the three countries affected by Ebola in West Africa –Liberia, Sierra Leone, and Guinea. These funds would come in addition to the $130 million of assistance provided in September 2014 and to a second round of new concessional loans amounting to about $160 million to be considered soon by the Executive Board.

At the conclusion of the Executive Board meeting on the CCR, IMF Managing Director Christine Lagarde stated: “I welcome the establishment of the Catastrophe Containment Relief Trust. It aims at enhancing our support to the countries in Africa hit by Ebola, as well as other low income countries that may be affected by public health disasters in the future. This is a strong example of the IMF demonstrating flexibility and innovation in responding to the needs of our global membership.”

Background
The primary tool through which the Fund supports low income countries confronting natural disasters is through the speedy provision of its interest-free loans to the affected countries, whether by expanding the amounts being provided under a pre-existing Fund financial program with the member or by disbursing funds under the Rapid Credit Facility (RCF).

In their November 2014 meeting in Brisbane, the G-20 called on the Bretton Woods Institutions to continue their strong support to countries severely affected by the Ebola outbreak through a combination of concessional loans, debt relief and grants, and asked the institutions to explore new, flexible mechanisms to address the economic effects of future comparable crises. The CCR Trust is the Fund’s response to that call. It replaces the Post-Catastrophe Debt Relief (PCDR) Trust established on June 25, 2010 in the wake of a massive earthquake in Haiti, and expands the circumstances under which the Fund can provide exceptional assistance to its low income members to include public health disasters.

Through the new instrument, the Fund is able to quickly and flexibly adjust its policies in the face of unexpected international developments, including pandemics, to serve the needs of its membership, especially the most vulnerable.

POLIO [to 7 February 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 4 February 2014
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: Over 6 months have passed since the most recent case of wild poliovirus (WPV) type 1 had onset of paralysis in Nigeria. However, at least 12 months must pass without detection of WPV, in the presence of certification quality surveillance, before Nigeria would be considered as having stopped transmission of WPV. Polio-free certification of Nigeria (and the entire WHO African region) would follow only after 3 years with high quality surveillance have passed without identifying WPV. Intensified efforts are ongoing in the country not just to eradicate WPV, but also to urgently stop the circulating vaccine-derived poliovirus type 2 outbreak which continues to affect the country.
:: Ministers of Health, health leaders and experts from around the world convened in Geneva last week at WHO’s Executive Board meeting to set global public health policies. Participants were encouraged by progress towards a polio free world yet warned that as long as the disease remains anywhere, children everywhere are at risk. Read more

Selected country report content:
Nigeria
:: One new type 2 circulating vaccine-derived poliovirus (cVDPV2) case was reported this week in Gujba district of Yobe province (previously uninfected in 2014) with onset of paralysis on 3 November. The most recent case had onset of paralysis on 16 November in Barde district of Yobe state. The total number of cVDPV2 cases for 2014 in Nigeria is now 30.
National Immunization Days (NIDs) are taking place on 21 – 25 March using trivalent OPV.
Pakistan
:: Three new wild poliovirus type 1 (WPV1) cases were reported in the past week, all with onset of paralysis in 2015. One case was reported in Khyber Pakhtunkhwa (KP) province, in Nowshera district; one in the Federally Administered Tribal Areas (FATA), in South Waziristan; and one in Sindh province, in Kambar district. Each of these cases is the first in these districts for 2015. :: The total number of WPV1 cases in 2014 remains 305, and is now 6 for 2015. The most recent onset of paralysis was on 7 January, with one case in FATA and one in KP.
:: To urgently address the intense transmission affecting the country, the government has put in place emergency measures to take advantage of the current ‘low season’ for poliovirus transmission. A ‘low season plan’ has been established, based on lessons learned on accessing populations in insecure areas, engaging communities and fixing remaining operational challenges. Implementation is being overseen by Emergency Operations Centres at federal and provincial levels to ensure accountability for the quality of polio eradication operations. More.
:: The Technical Advisory Group (TAG) on polio eradication in Pakistan is meeting on 14 – 15 February to review the current epidemiological situation and the current status of the low transmission plan implementation.
West Africa
:: Even as polio programme staff across West Africa help to control the Ebola outbreak affecting the region, efforts are being made in those countries not affected by Ebola to vaccinate children against polio to create a buffer zone surrounding the affected countries. The Ebola crisis in western Africa continues to have an impact on the implementation of polio eradication activities in Liberia, Guinea and Sierra Leone. Supplementary immunization activities (SIAs) in these countries have been postponed and the quality of acute flaccid paralysis surveillance markedly decreased throughout 2014.

WHO & Regionals [to 7 February 2015]

:: 136th WHO Executive Board session
26 January–3 February 2015
Geneva, Switzerland
Documentation

:: Global Alert and Response (GAR): Disease Outbreak News (DONs)
– Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 3 February 2015
– Human infection with avian influenza A(H7N9) virus – Canada 1 February 2015

:: The Weekly Epidemiological Record (WER) 6 February 2015, vol. 90, 6 (pp. 33–40)
Contents
33 Chagas disease in Latin America: an epidemiological update based on 2010 estimates
43 Monthly report on dracunculiasis cases, January– November 2014

:: GIN January 2015 pdf, 1.82Mb
30 January 2015

:: Cholera prevention measures reduce transmission in South Sudan
6 February 2015 — When violence erupted in South Sudan, tens of thousands of people fled the conflict and sought refuge in United Nations bases in the hopes of protection. As the rainy season approached it increased the risk of water-borne diseases, like cholera, and the potential for explosive outbreaks in congested camps. A timely decision to start cholera prevention and control measures, averted illness and death among the vulnerable camp inhabitants who had been at high-risk of the disease.

:: Preventing premature cancer deaths
4 February 2015 — Annually there are 14 million new cases of cancer and over 8 million people die from cancer, with 60% of deaths in Africa, Asia and Central and South America. WHO is working with countries to build solutions to reduce premature deaths from cancers through its global drive to prevent premature deaths from NCDs by 25% by 2025.
Read the commentary on cancer and tobacco
WHO Regional Offices

WHO African Region AFRO
No new digest content identified.

WHO Region of the Americas PAHO
:: PAHO/WHO says accessible, cost-effective measures can prevent premature cancer deaths (02/02/2015)

WHO South-East Asia Region SEARO
:: Beat cancer: Prevent, detect early 04 February 2015

WHO European Region EURO
:: WHO strengthens health operations in eastern Ukraine 06-02-2015
:: Influenza season underway in WHO European Region 04-02-2015

WHO Eastern Mediterranean Region EMRO
No new digest content identified.

WHO Western Pacific Region
No new digest content identified.

CDC/MMWR Watch [to 7 February 2015]
http://www.cdc.gov/media/index.html

:: MMWR Weekly, February 6, 2015 / Vol. 64 / No. 4
– Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2015
– Advisory Committee on Immunization Practices Recommended Immunization Schedules for Persons Aged 0 Through 18 Years — United States, 2015
– Vaccination Coverage Among Adults, Excluding Influenza Vaccination — United States, 2013
– Update: Ebola Virus Disease Epidemic — West Africa, January 2015
– Outbreaks of Avian Influenza A (H5N2), (H5N8), and (H5N1) Among Birds — United States, December 2014–January 2015
– Announcements: Guidance Available for Implementing and Managing Contact Tracing for Ebola in Countries Without Ebola Outbreaks

BMGF – Gates Foundation Watch [to 7 February 2015]

Stanford launches major effort to expedite vaccine discovery with $50 million grant
Stanford Report, January 29, 2015
[Excerpt]
Stanford University today announced that it has received a grant from the Bill & Melinda Gates Foundation to accelerate efforts in vaccine development. The $50 million grant over 10 years will build on existing technology developed at Stanford and housed in the Human Immune Monitoring Core, and will establish the Stanford Human Systems Immunology Center. The center aims to better understand how the immune system can be harnessed to develop vaccines for the world’s most deadly infectious diseases….

PATH Watch [to 7 February 2015]
http://www.path.org/news/

:: Press release | February 06, 2015
PATH names Kathy Cahill as vice president for International Development
Public health expert to serve on executive leadership team and oversee PATH’s international presence

:: Announcement | February 01, 2015
PATH, partners team up to unlock lifesaving health innovation in India
Unique collaboration joins PATH, Unitus Seed Fund, Pfizer, and partners to increase access to health products and services, support Indian entrepreneurs, and improve health throughout India

:: Innovative health sector financing: the Vaccine Independence Initiative
30 January 2015
This week the UNICEF Board is considering expanding the Vaccine Independence Initiative (VII). This financing mechanism was launched almost 25 years ago in 1991 to decouple the procurement of vaccines from the payment for these vaccines by countries out of national budgets. We caught up with PATH’s chief strategy officer Amie Batson, who has an intimate connection with this program….Q: What is next for the VII? A: During its meeting this week, the UNICEF Board is considering expanding the VII ten-fold (from $10 million to $100 million) to cover prefinancing of vaccines as well as many health products like bednets treated with long-lasting insecticide and supplies needed for Ebola response. As countries graduate from Gavi and other donor support, there are increasing demands for mechanisms such as the VII that create greater financial flexibility.

Flu Care in Day Care: The Impact of Vaccination Requirements
A Report by the National Foundation for Infectious Diseases
January 2015 :: 10 pages
Overview
Despite the availability of safe and effective vaccines, tens of thousands of young children in the United States are hospitalized each year for influenza (flu). To protect as many young children as possible, New Jersey, Connecticut, and New York City have each implemented influenza vaccine requirements for children enrolled in licensed preschools, child care, or day care centers.* The National Foundation for Infectious Diseases (NFID), in collaboration with the Association of Immunization Managers (AIM), brought together key professionals from all three jurisdictions to discuss the challenges and key lessons learned in the planning and implementation of the regulations. These professionals were joined by immunization stakeholders, including members of the Childhood Influenza Immunization Coalition (CIIC). This report presents case studies from each jurisdiction along with an integrated set of lessons learned and key elements of successful programs (page 6) to help others considering implementing similar regulations.

American Journal of Tropical Medicine and Hygiene
February 2015; 92 (2)
http://www.ajtmh.org/content/current

Editorial
Perspectives on Ebola
Philip J. Rosenthal and Daniel G. Bausch
Am J Trop Med Hyg 2015 92:219-220; Published online January 12, 2015, doi:10.4269/ajtmh.14-0831
[Free Access]
An unprecedented epidemic of Ebola virus disease (EVD) unfolded in West Africa in 2014. The epidemic has been well described in the popular press and in regular reports from public health authorities. The medical literature has necessarily been slower in describing the epidemic, but comprehensive reports are now appearing, offering valuable accounts of the clinical features, epidemiology, and public health consequences of this terrifying disease. The American Society of Tropical Medicine and Hygiene (ASTMH) has been deeply involved with the EVD outbreak. Numerous ASTMH members have played major roles in addressing the epidemic, including clinicians and epidemiologists working at the front lines of the epidemic at great personal risk, public health authorities guiding control efforts in Africa and elsewhere, and drug and vaccine experts working to rush effective products to the field. The annual meeting of the ASTMH served as a forum for timely expert discussions on EVD, but also highlighted the political challenges of this particular crisis, as some experts were prevented from attending the ASTMH meeting as a result of ill-founded concerns about the consequences of their recent travel to West Africa. In this issue of the American Journal of Tropical Medicine and Hygiene (AJTMH) we offer a series of Perspectives from individuals active in addressing the EVD epidemic.

As with other large disasters, the full toll of the EVD epidemic is difficult to fathom. The numbers are clear. As of the end of 2014, nearly 20,000 cases of EVD and 7,000 deaths have been reported to the World Health Organization (WHO). These numbers are likely underestimates caused by underreporting. Furthermore, although these numbers are much lower than those seen for our greatest tropical medicine challenges, the impact of the epidemic can easily be underappreciated. EVD is quite unique, even among severe infectious diseases, in causing massive disruption to societies, and in particular to the healthcare infrastructure. In affected areas of Africa, in addition to the huge direct toll of EVD, all aspects of healthcare have been torn apart. Management and control of the most important serious infectious diseases, including neonatal infections, human immunodeficiency virus (HIV) infection, tuberculosis, malaria, and other neglected diseases have been greatly disrupted. “Band-aid” solutions, such as widespread distribution of artemisinin-based combination therapies to decrease the incidence of non-Ebola febrile illnesses, have unknown efficacy, and may cause new problems, such as selection of drug resistance and loss of community confidence in the healthcare system. Outside of Africa, responses to the EVD epidemic have often been driven by fear, misguided estimates of risk, and political considerations.

Most often, we in the scientific community appropriately focus on the data—the numbers of cases, the epidemiologic characteristics, and the efficacies of new interventions. In this process we may lose sight of the fact that a crisis such as the EVD epidemic is inherently personal. People are getting infected, suffering, and dying. In the case of this epidemic, much more so than in most humanitarian disasters, many of the victims are the healthcare workers and scientists who have willingly put themselves in harm’s way to help alleviate the suffering of others. In this issue of the AJTMH we offer Perspectives focusing on the personal side of the epidemic, considering in particular the points of view of health workers as caregivers at risk, as patients, and as those working to improve our ability to manage and control this epidemic. Two perspectives, from Adaora Igonoh and Will Pooley, offer accounts from those who put themselves at personal risk caring for patients with EVD, and then contracted the disease themselves. Another, from Lewis Rubinson, offers an account of a potential Ebola virus exposure that led to complex consequences. Susan McClellan offers an account from one of the many non-African healthcare providers who eagerly put themselves at risk. Perspectives addressing an improved response to EVD include a discussion of how, despite some steps in the right direction, the public health community failed to best prepare for a potential hemorrhagic fever outbreak by Daniel Bausch, a consideration of rethinking discharge policy in seriously stressed EVD clinics by Tim O’Dempsey and others, and a comprehensive commentary on clinical preparedness for those providing EVD care from David Brett-Major and many others. Considering the political consequences of responses to the epidemic outside Africa, perspectives from groups led by Ramin Asgary and Piero Olliaro detail the consequences of the misguided effort of the State of Louisiana to protect public health by preventing attendance at the annual meeting of the ASTMH in New Orleans by anyone who had recently traveled to affected countries in West Africa.

The West African EVD epidemic is still unfolding. This enormous disaster is likely to have long-range consequences, with impacts on efforts to control all tropical diseases in addition to specific effects on viral hemorrhagic fever preparedness and far-reaching impacts on the affected countries. Regardless of the future overall course, the epidemic will remain deeply personal, with obvious consequences on affected patients and families, but also on health workers. We hope that the Perspectives in this issue of the AJTMH will help readers to appreciate the personal side of this epidemic, both as a major humanitarian disaster and as a formidable challenge for the international public health community.

Perspective Pieces
My Experience as an Ebola Patient
Adaora K. Igonoh
Am J Trop Med Hyg 2015 92:221-222; Published online December 22, 2014, doi:10.4269/ajtmh.14-0763
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Ebola: Perspectives from a Nurse and Patient
Will Pooley
Am J Trop Med Hyg 2015 92:223-224; Published online January 5, 2015, doi:10.4269/ajtmh.14-0762
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From Clinician to Suspect Case: My Experience After a Needle Stick in an Ebola Treatment Unit in Sierra Leone
Lewis Rubinson
Am J Trop Med Hyg 2015 92:225-226; Published online December 15, 2014, doi:10.4269/ajtmh.14-0769
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Ebola: My Head is Full of Stories
Susan L. F. McLellan
Am J Trop Med Hyg 2015 92:227-228; Published online December 22, 2014, doi:10.4269/ajtmh.14-0801
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The Year That Ebola Virus Took Over West Africa: Missed Opportunities for Prevention
Daniel G. Bausch
Am J Trop Med Hyg 2015 92:229-232; Published online January 5, 2015, doi:10.4269/ajtmh.14-0818
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Being Ready to Treat Ebola Virus Disease Patients
David M. Brett-Major, Shevin T. Jacob, Frederique A. Jacquerioz, George F. Risi, William A. Fischer II, Yasuyuki Kato, Catherine F. Houlihan, Ian Crozier, Henry Kyobe Bosa, James V. Lawler, Takuya Adachi, Sara K. Hurley, Louise E. Berry, John C. Carlson, Thomas. C. Button, Susan L. McLellan, Barbara J. Shea, Gary G. Kuniyoshi, Mauricio Ferri, Srinivas G. Murthy, Nicola Petrosillo, Francois Lamontagne, David T. Porembka, John S. Schieffelin, Lewis Rubinson, Tim O’Dempsey, Suzanne M. Donovan, Daniel G. Bausch, Robert A. Fowler, and Thomas E. Fletcher
Am J Trop Med Hyg 2015 92:233-237; Published online December 15, 2014, doi:10.4269/ajtmh.14-0746
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Rethinking the Discharge Policy for Ebola Convalescents in an Accelerating Epidemic
Tim O’Dempsey, S. Humarr Khan, and Daniel G. Bausch
Am J Trop Med Hyg 2015 92:238-239; Published online December 1, 2014, doi:10.4269/ajtmh.14-0719
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Ebola Policies That Hinder Epidemic Response by Limiting Scientific Discourse
Ramin Asgary, Julie A. Pavlin, Jonathan A. Ripp, Richard Reithinger, and Christina S. Polyak
Am J Trop Med Hyg 2015 92:240-241; Published online January 5, 2015, doi:10.4269/ajtmh.14-0803
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Out of (West) Africa—Who Lost in the End?
Piero Olliaro, Estrella Lasry, and Amanda Tiffany
Am J Trop Med Hyg 2015 92:242-243; Published online December 15, 2014, doi:10.4269/ajtmh.14-0753
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International Aid and Natural Disasters: A Pre- and Post-Earthquake Longitudinal Study of the Healthcare Infrastructure in Leogane, Haiti
Maxwell Kligerman, Michele Barry, David Walmer, and Eran Bendavid
Am J Trop Med Hyg 2015 92:448-453; Published online December 15, 2014, doi:10.4269/ajtmh.14-0379
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