Annals of Internal Medicine
3 February 2015, Vol. 162. No. 3
http://annals.org/issue.aspx

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older: United States, 2015* FREE
David K. Kim, MD; Carolyn B. Bridges, MD; Kathleen H. Harriman, PhD, MPH, RN, on behalf of the Advisory Committee on Immunization Practices

Editorial
Adult Immunization 2015: Another Pearl of Pneumococcal Protection
Sandra Adamson Fryhofer, MD

Ideas and Opinions | 20 January 2015
Drug and Vaccine Access in the Ebola Epidemic: Advising Caution in Compassionate Use FREE
Andrew Hantel, MD; and Christopher Olusola Olopade, MD, MPH
[+] Article and Author Information
Ann Intern Med. 2015;162(2):141-142. doi:10.7326/M14-2002
This article was published online first at http://www.annals.org on 14 October 2014.

Ethical Guidance on the Use of Life-Sustaining Therapies for Patients With Ebola in Developed Countries ONLINE FIRST
Scott D. Halpern, MD, PhD; and Ezekiel J. Emanuel, MD, PhD
Article and Author Information
Ann Intern Med. Published online 30 December 2014 doi:10.7326/M14-2611
The authors discuss ethical issues in the provision of life-sustaining therapies, such as cardiopulmonary resuscitation and dialysis, to patients with Ebola being cared for in developed countries

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 7 February 2015)

Research article
Streamlined research funding using short proposals and accelerated peer review: an observational study
Adrian G Barnett12*, Danielle L Herbert13, Megan Campbell12, Naomi Daly24, Jason A Roberts24, Alison Mudge24 and Nicholas Graves12
Author Affiliations
BMC Health Services Research 2015, 15:55 doi:10.1186/s12913-015-0721-7
Published: 7 February 2015
Abstract (provisional)
Background
Despite the widely recognised importance of sustainable health care systems, health services research remains generally underfunded in Australia. The Australian Centre for Health Services Innovation (AusHSI) is funding health services research in the state of Queensland. AusHSI has developed a streamlined protocol for applying and awarding funding using a short proposal and accelerated peer review.
Method
An observational study of proposals for four health services research funding rounds from May 2012 to November 2013. A short proposal of less than 1,200 words was submitted using a secure web-based portal. The primary outcome measures are: time spent preparing proposals; a simplified scoring of grant proposals (reject, revise or accept for interview) by a scientific review committee; and progressing from submission to funding outcomes within eight weeks. Proposals outside of health services research were deemed ineligible.
Results
There were 228 eligible proposals across 4 funding rounds: from 29% to 79% were shortlisted and 9% to 32% were accepted for interview. Success rates increased from 6% (in 2012) to 16% (in 2013) of eligible proposals. Applicants were notified of the outcomes within two weeks from the interview; which was a maximum of eight weeks after the submission deadline. Applicants spent 7 days on average preparing their proposal. Applicants with a ranking of reject or revise received written feedback and suggested improvements for their proposals, and resubmissions composed one third of the 2013 rounds.
Conclusions
The AusHSI funding scheme is a streamlined application process that has simplified the process of allocating health services research funding for both applicants and peer reviewers. The AusHSI process has minimised the time from submission to notification of funding outcomes.

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 7 February 2015)

Research article
Pertussis outbreak in university students and evaluation of acellular pertussis vaccine effectiveness in Japan
Megumi Hara, Mami Fukuoka, Katsuya Tashiro, Iwata Ozaki, Satoko Ohfuji, Kenji Okada, Takashi Nakano, Wakaba Fukushima, Yoshio Hirota BMC Infectious Diseases 2015, 15:45 (6 February 2015)

Research article
An effective strategy for influenza vaccination of healthcare workers in Australia: experience at a large health service without a mandatory policy
Kristina Heinrich-Morrison, Sue McLellan, Ursula McGinnes, Brendan Carroll, Kerrie Watson, Pauline Bass, Leon J Worth, Allen C Cheng BMC Infectious Diseases 2015, 15:42 (6 February 2015)

Research article
An outbreak following importation of wild poliovirus in Xinjiang Uyghur Autonomous Region, China, 2011
Hai-Bo Wang, Wen-Zhou Yu, Xin-Qi Wang, Fuerhati Wushouer, Jian-Ping Wang, Dong-Yan Wang, Fu-Qiang Cui, Jing-Shan Zheng, Ning Wen, Yi-Xin Ji, Chun-Xiang Fan, Hui-Ling Wang, Gui-Jun Ning, Guo-Hong Huang, Dong-Mei Yan, Qi-Ru Su, Da-Wei Liu, Guo-Ming Zhang, Kathleen H Reilly, Jing Ning, Jian-Ping Fu, Sha-Sha Mi, Hui-Ming Luo, Wei-Zhong Yang BMC Infectious Diseases 2015, 15:34 (31 January 2015)
Abstract | Provisional PDF | PubMed

BMC Public Health
(Accessed 7 February 2015)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
The influence of partial public reimbursement on vaccination uptake in the older population: a cross-sectional study
Sheena M Mc Hugh1*, John Browne1, Ciaran O’Neill2 and Patricia M Kearney1
Author Affiliations
BMC Public Health 2015, 15:83 doi:10.1186/s12889-015-1356-7
Published: 5 February 2015
Abstract (provisional)
Background
Flu vaccination is recommended annually for high risk groups. However, in Ireland, free access to vaccination is not universal for those in high risk groups; the vaccine and consultation are only free for those with a medical card, a means tested scheme. Few private health insurance policies cover the cost of attendance for vaccination in general practice. The aim was to examine the influence of this reimbursement policy on vaccination coverage among older adults.
Methods
Cross-sectional wave 1 data from The Irish Longitudinal Study on Ageing (TILDA) were analysed (2009?2011). TILDA is a nationally representative prospective cohort study of adults aged ?50, sampled using multistage stratified clustered sampling. Self-reported entitlement to healthcare was categorised as 1) medical card only 2) private health insurance only, 3) both and 4) neither. The outcome was responses to `have you ever had a flu shot?. Multivariate logistic regression was used, adjusting for age and need.Results68.6% of those defined as clinically high-risk received the flu vaccination in the past (95% CI?=?67-71%). Those with a medical card were almost twice as likely to have been vaccinated, controlling for age and chronic illness (OR?=?1.9, 95% CI?=?1.5-2.5, p?=?<0.001).
Conclusions
Having a medical card increased the likelihood of being vaccinated, independent of age and need. The mismatch between vaccination guidelines and reimbursement policy is creating unequal access to recommended services among high risk groups.

British Medical Journal
07 February 2015(vol 350, issue 7994)
http://www.bmj.com/content/350/7994

Analysis
International donations to the Ebola virus outbreak: too little, too late?
BMJ 2015;350:h376 (Published 03 February 2015)
Karen Grépin examines the pledges made to the Ebola crisis, how much has actually reached affected countries, and the lessons to be learnt
…In this article, I examine the level and speed of the international donations to tackle the Ebola epidemic and how they aligned with evolving estimates of funds required to bring the epidemic under control. Understanding what has and has not worked well in the early phases of this crisis can help us learn from it and prepare for future humanitarian and public health emergencies. My analysis considers only international donations captured in the UN Office for the Coordination of Humanitarian Affairs’ (OCHA) financial tracking system (http://fts.unocha.org, box), which does not capture all resources that have been pledged to the outbreak…
Key messages
:: Pledges to the Ebola outbreak have reached at least $2.89bn
:: However, only about one third of these resources have been be disbursed to countries
:: Delays have occurred in requests for funding and translating pledges into paid contributions
:: New mechanisms to speed up disbursements could help in future crises

Clinical Infectious Diseases (CID)
Volume 60 Issue 4 February 15, 2015
http://cid.oxfordjournals.org/content/current

Editor’s choice: Durability of Antibody Response Against Hepatitis B Virus in Healthcare Workers Vaccinated as Adults
Naveen Gara, Adil Abdalla, Elenita Rivera, Xiongce Zhao, Jens M. Werner, T. Jake Liang, Jay H. Hoofnagle, Barbara Rehermann, and Marc G. Ghany
Clin Infect Dis. (2015) 60 (4): 505-513 doi:10.1093/cid/ciu867
Protective antibody levels persist long-term in a majority of healthcare workers after initial immunization. Those without protective levels have a rapid and robust response to a booster vaccine, suggesting that immunologic memory is long-lasting and booster vaccination is probably unnecessary.

Hepatitis A and B Immunity and Vaccination in Chronic Hepatitis B and C Patients in a Large United States Cohort
Emily Henkle, Mei Lu, Lora B. Rupp, Joseph A. Boscarino, Vinutha Vijayadeva, Mark A. Schmidt,
and Stuart C. Gordon for the Chronic Hepatitis Cohort Study (CHeCS) Investigators
Clin Infect Dis. (2015) 60 (4): 514-522 doi:10.1093/cid/ciu879
Abstract Full Text (HTML) Full Text (PDF)
Among Chronic Hepatitis Cohort Study patients, approximately 40% of chronic hepatitis B and C patients were potentially susceptible to hepatitis A or B. Clinicians should consider antibody testing and vaccination for this vulnerable population.

Cost Effectiveness and Resource Allocation
(Accessed 7 February 2015)
http://www.resource-allocation.com/

Research
Cost-effectiveness of using a social franchise network to increase uptake of oral rehydration salts and zinc for childhood diarrhea in rural Myanmar
Bishai D, Sachathep K, LeFevre A, Thant HNN, Zaw M, Aung T, McFarland W, Montagu D et al. Cost Effectiveness and Resource Allocation 2015, 13:3 (5 February 2015)
Abstract (provisional)
Introduction
This paper examines the cost-effectiveness of achieving increases in the use of oral rehydration solution and zinc supplementation in the management of acute diarrhea in children under 5 years through social franchising. The study uses cost and outcome data from an initiative by Population Services International (PSI) in 3 townships of Myanmar in 2010 to promote an ORS-Zinc product called ORASEL.
Background
The objective of this study was to determine the incremental cost-effectiveness of a strategy to promote ORS-Z use through private sector franchising compared to standard government and private sector practices.
Methods
Costing from a societal perspective included program, provider, and household costs for the 2010 calendar year. Program costs including ORASEL program launch, distribution, and administration costs were obtained through a retrospective review of financial records and key informant interviews with staff in the central Yangon office. Household out of pocket payments for diarrheal episodes were obtained from a household survey conducted in the study area and additional estimates of household income lost due to parental care-giving time for a sick child were estimated. Incremental cost-effectiveness relative to status quo conditions was calculated per child death and DALY averted in 2010. Health effects included deaths and DALYs averted; the former modeled based on coverage estimates from a household survey that were entered into the Lives Saved Tool (LiST). Uncertainty was modeled with Monte Carlo methods.
Findings
Based on the model, the promotional strategy would translate to 2.85 (SD 0.29) deaths averted in a community population of 1 million where there would be 81,000 children under 5 expecting 48,373 cases of diarrhea. The incremental cost effectiveness of the franchised approach to improving ORASEL coverage is estimated at a median $5,955 (IQR: $3437-$7589) per death averted and $214 (IQR: $127-$287) per discounted DALY averted.
Interpretation
Investing in developing a network of private sector providers and keeping them stocked with ORS-Z as is done in a social franchise can be a highly cost-effective in terms of dollars per DALY averted.

Eurosurveillance
Volume 20, Issue 5, 05 February 2015
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Editorials
Influenza – the need to stay ahead of the virus
by S van der Werf, D Lévy-Bruhl

Rapid communications
Low effectiveness of seasonal influenza vaccine in preventing laboratory-confirmed influenza in primary care in the United Kingdom: 2014/15 mid–season results
by RG Pebody, F Warburton, J Ellis, N Andrews, C Thompson, B von Wissmann, HK Green, S Cottrell, J Johnston, S de Lusignan, C Moore, R Gunson, C Robertson, J McMenamin, M Zambon

Reduced cross-protection against influenza A(H3N2) subgroup 3C.2a and 3C.3a viruses among Finnish healthcare workers vaccinated with 2013/14 seasonal influenza vaccine
by A Haveri, N Ikonen, I Julkunen, A Kantele, VJ Anttila, E Ruotsalainen, H Nohynek, O Lyytikäinen, C Savolainen-Kopra

Research articles
Interim estimates of 2014/15 influenza vaccine effectiveness in preventing laboratory-confirmed influenza-related hospitalisation from the Serious Outcomes Surveillance Network of the Canadian Immunization Research Network, January 2015
by SA McNeil, MK Andrew, L Ye, F Haguinet, TF Hatchette, M ElSherif, J LeBlanc, A Ambrose, A McGeer, JE McElhaney, M Loeb, D MacKinnon-Cameron, R Sharma, G Dos Santos, V Shinde, on behalf of the Investigators of the Serious Outcomes Surveillance Network of the Canadian Immunization Research Network (CIRN)

Globalization and Health
[Accessed 7 February 2015]
http://www.globalizationandhealth.com/

Research
Reverse innovation: an opportunity for strengthening health systems
Anne W Snowdon12*, Harpreet Bassi12, Andrew D Scarffe12 and Alexander D Smith12
Author Affiliations
Globalization and Health 2015, $article.volume.volumeNumber:2 doi:10.1186/s12992-015-0088-x
Published: 7 February 2015
Abstract (provisional)
Background
Canada, when compared to other OECD countries, ranks poorly with respect to innovation and innovation adoption while struggling with increasing health system costs. As a result of its failure to innovate, the Canadian health system will struggle to meet the needs and demands of both current and future populations. The purpose of this initiative was to explore if a competition-based reverse innovation challenge could mobilize and stimulate current and future leaders to identify and lead potential reverse innovation projects that address health system challenges in Canada.
Methods
An open call for applications took place over a 4-month period. Applicants were enticed to submit to the competition with a $50,000 prize for the top submission to finance their project. Leaders from a wide cross-section of sectors collectively developed evaluation criteria and graded the submissions. The criteria evaluated: proof of concept, potential value, financial impact, feasibility, and scalability as well as the use of prize money and innovation team.
Results
The competition received 12 submissions from across Canada that identified potential reverse innovations from 18 unique geographical locations that were considered developing and/or emerging markets. The various submissions addressed health system challenges relating to education, mobile health, aboriginal health, immigrant health, seniors health and women?s health and wellness. Of the original 12 submissions, 5 finalists were chosen and publically profiled, and 1 was chosen to receive the top prize.
Conclusions
The results of this initiative demonstrate that a competition that is targeted to reverse innovation does have the potential to mobilize and stimulate leaders to identify reverse innovations that have the potential for system level impact. The competition also provided important insights into the capacity of Canadian students, health care providers, entrepreneurs, and innovators to propose and implement reverse innovation in the context of the Canadian health system.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 7 February 2015]

Commentary
Informing the establishment of the WHO global observatory on health research and development: a call for papers
Taghreed Adam, John-Arne Røttingen, Marie-Paule Kieny Health Research Policy and Systems 2015

Infectious Diseases of Poverty
[Accessed 7 February 2015]
http://www.idpjournal.com/content

Research Article
Incidence of human rabies exposure and associated factors at the Gondar Health Center, Ethiopia: a three-year retrospective study
Meseret Yibrah, Debasu Damtie Infectious Diseases of Poverty 2015, 4:3 (2 February 2015)
Abstract | Provisional PDF | Editor’s summary
A three year retrospective study revealed a significant incidence of human rabies exposure in Ethiopia. This study also depicted being male and living in urban areas as a potential risk factor for human rabies exposure. Image: Canine rabies is a significant problem in Ethiopia.

Research Article
Assessment of research productivity of Arab countries in the field of infectious diseases using Web of Science database
Waleed M Sweileh, Samah W Al-Jabi, Alaeddin Abuzanat, Ansam F Sawalha, Adham S AbuTaha, Mustafa A Ghanim, Sa¿ed H Zyoud Infectious Diseases of Poverty 2015, 4:2 (2 February 2015)
Abstract | Provisional PDF | Editor’s summary
Arab countries, like other developing poor countries, suffer from various types of infectious diseases. Some of these diseases might be endemic or unique to the Arab countries. However, Arab countries are still lagging behind in research in the field of infectious diseases. More efforts and further financial support are needed to encourage research and publications in this field. Image: Dr. Adham Abu Taha doing microbiological testing for specimens at An-Najah National University.

Journal of Global Infectious Diseases (JGID)
January-March 2015 Volume 7 | Issue 1 Page Nos. 1-50
http://www.jgid.org/currentissue.asp?sabs=n

Editorial
State of Globe: Rabies: The lethality since antiquity!
Inder Maurya, Ketan Vagholkar, Bhavesh Patel, Mohsin Siddiqui, Shreshtha Tiwari, Premkumar Maurya
DOI:10.4103/0974-777X.150880

Journal of Medical Internet Research
Vol 17, No 2 (2015): February
http://www.jmir.org/2015/2

Knowledge, Attitudes, and Practices Regarding Avian Influenza A (H7N9) Among Mobile Phone Users: A Survey in Zhejiang Province, China
Hua Gu, Zhenggang Jiang, Bin Chen, Jueman (Mandy) Zhang, Zhengting Wang, Xinyi Wang, Jian Cai, Yongdi Chen, Dawei Zheng, Jianmin Jiang
JMIR mHealth uHealth 2015 (Feb 04); 3(1):e15

The Lancet
Feb 07, 2015 Volume 385 Number 9967 p481-576 e5-e6
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Don’t forget health when you talk about human rights
The Lancet
Last week, Human Rights Watch (HRW) released World Report 2015, their 25th annual global review documenting human rights practices in more than 90 countries and territories in 2014. The content is based on a comprehensive investigation by HRW staff, together with in-country human rights activists. In his opening essay, HRW’s Executive Director, Kenneth Roth, writes, “The world has not seen this much tumult in a generation…it can seem as if the world is unravelling”. Indeed, this 656-page report is a grim read in a year marked by extensive conflict and extreme violence.

The Lancet Global Health
Feb 2015 Volume 3 Number 2 e62-e112
http://www.thelancet.com/journals/langlo/issue/current

Editorial
All about the money
Zoë Mullan
Open Access
DOI: http://dx.doi.org/10.1016/S2214-109X(15)70003-3
Summary
It’s finally 2015: a year by the end of which extreme poverty and hunger are to be eradicated, maternal and child mortality are to be drastically reduced, and the trajectory of the global incidence of HIV, tuberculosis, and malaria are to be reversed. Much has been written about where the Millennium Development Goals succeeded and failed as global targets, and what has changed in the world since 2000. Much work has also been done to establish what happens next. In his synthesis report on the post-2015 agenda released last month, UN Secretary-General Ban Ki-Moon summarised and annotated this work, ultimately backing the 17 goals proposed by the Open Working Group on Sustainable Development Goals as the basis for a truly transformative agenda.

Articles
Effect of self-collection of HPV DNA offered by community health workers at home visits on uptake of screening for cervical cancer (the EMA study): a population-based cluster-randomised trial
Dr Silvina Arrossi, PhD, Laura Thouyaret, BSc, Rolando Herrero, PhD, Alicia Campanera, MD, Adriana Magdaleno, BSc, Milca Cuberli, MSc, Paula Barletta, BSc, Rosa Laudi, MD, Liliana Orellana, PhD, the EMA Study team
EMA Study team members listed at end of reportOpen Access
DOI: http://dx.doi.org/10.1016/S2214-109X(14)70354-7
Open access funded by the Author(s)
Summary
Background
Control of cervical cancer in developing countries has been hampered by a failure to achieve high screening uptake. HPV DNA self-collection could increase screening coverage, but implementation of this technology is difficult in countries of middle and low income. We investigated whether offering HPV DNA self-collection during routine home visits by community health workers could increase cervical screening.
Methods
We did a population-based cluster-randomised trial in the province of Jujuy, Argentina, between July 1, 2012, and Dec 31, 2012. Community health workers were eligible for the study if they scored highly on a performance score, and women aged 30 years or older were eligible for enrolment by the community health worker. 200 community health workers were randomly allocated in a 1:1 ratio to either the intervention group (offered women the chance to self-collect a sample for cervical screening during a home visit) or the control group (advised women to attend a health clinic for cervical screening). The primary outcome was screening uptake, measured as the proportion of women having any HPV screening test within 6 months of the community health worker visit. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02095561.
Findings
100 community health workers were randomly allocated to the intervention group and 100 were assigned to the control group; nine did not take part. 191 participating community health workers (94 in the intervention group and 97 in the control group) initially contacted 7650 women; of 3632 women contacted by community health workers in the intervention group, 3049 agreed to participate; of 4018 women contacted by community health workers in the control group, 2964 agreed to participate. 2618 (86%) of 3049 women in the intervention group had any HPV test within 6 months of the community health worker visit, compared with 599 (20%) of 2964 in the control group (risk ratio 4•02, 95% CI 3•44–4•71).
Interpretation
Offering self-collection of samples for HPV testing by community health workers during home visits resulted in a four-fold increase in screening uptake, showing that this strategy is effective to improve cervical screening coverage. This intervention reduces women’s barriers to screening and results in a substantial and rapid increase in coverage. Our findings suggest that HPV testing could be extended throughout Argentina and in other countries to increase cervical screening coverage.
Funding
Instituto Nacional del Cáncer (Argentina).

New England Journal of Medicine
February 5, 2015 Vol. 372 No. 6
http://www.nejm.org/toc/nejm/medical-journal

Editorial
Ebola in West Africa at One Year — From Ignorance to Fear to Roadblocks
Jeffrey M. Drazen, M.D., Edward W. Campion, M.D., Eric J. Rubin, M.D., Ph.D., Stephen Morrissey, Ph.D., and Lindsey R. Baden, M.D.
N Engl J Med 2015; 372:563-564 February 5, 2015 DOI: 10.1056/NEJMe1415398

It has been a year since the first case associated with the current Ebola virus outbreak in West Africa was identified and just over 8 months since we first started reporting on the outbreaks that stemmed from that patient in Guinea.1 Today’s posts at NEJM.org include an anniversary update on the fight against Ebola virus disease (EVD).2 It is painfully clear that the world’s initial handling of this dangerous outbreak was far from optimal, but we now appear to be making progress in the battle. This headway is evidenced by the observations that the rate of appearance of new cases is not as high as had been predicted by the World Health Organization or the U.S. Centers for Disease Control and Prevention in September 2014 and that outcomes may be improving at some Ebola treatment units.2,3

Patients in the hardest-hit areas are able to receive care at one of many Ebola treatment units that have been set up in West Africa. These units now offer hope for patients with EVD in places where 6 months ago there was little care available and little hope. The ongoing case finding and contact tracing are essential to preventing new outbreak clusters. Staffing the treatment units, tracing contacts, and providing basic health care services for the populations in the most severely affected areas, where the health care infrastructure has been devastated, are just a few of the tasks that must be performed if the battle against Ebola is to be won. If we don’t bring this outbreak to a halt now, it may again expand throughout the region and spread to other parts of the world. To deliver a victory, we need more volunteers who are willing to serve, to live in austere conditions, and to put themselves in harm’s way. All estimates indicate that the number of personnel needed far exceeds the current supply. We need to make it easier for those who want to help in the fight against Ebola to do so.

That brings us to academic medical centers in the United States. As the Ebola outbreak has burned its way deep into Guinea, Liberia, and Sierra Leone, in one of the worst acute public health crises in 50 years, our academic medical centers have sat largely on the sidelines. They have spent a fortune preparing their facilities and staff for the much-feared scenario of a local patient with possible Ebola virus infection. What has been lacking is leadership to help quell the crisis where it is actually happening. The problem is more than a lack of effective, positive leadership, as Rosenbaum reports4: the difficulties created by many academic medical centers for trainees and staff who want to go to West Africa to help control this outbreak are more akin to roadblocks. This response stands in contrast to that in the United Kingdom, where the Wellcome Trust has encouraged academic institutions to join the fight and has provided emergency funding for their research initiatives, and to that of the U.S. National Institute of Allergy and Infectious Diseases, which is offering extensions for grant renewals to people who have taken time to participate in Ebola mitigation efforts.

The medical centers that have helped pave the way for their personnel to fight Ebola deserve praise. The leaders of academic medical centers that have put roadblocks in the path of those wishing to serve need to rethink their priorities. They should be making it easier, not harder, for altruistic physicians, nurses, and other health care providers to help care for the sick and control the Ebola epidemic in West Africa. Our medical centers have immense resources and expertise; the countries wracked by Ebola have almost none. Something is wrong when some of the greatest health care centers in the world are not helping in the fight against this disastrously dangerous threat to human health. We ask the leaders of every medical center in the country to figure out how to make it possible for their staff, and even qualified trainees, to help on the ground in West Africa. And once the leaders have decided what to do, they need to tell their risk managers and their lawyers to make it work, rather than make decisions based on the worst-case scenarios and risks to their reputation, image, and market share painted by corporate advisors and legal staff. If in a year’s time this epidemic has not been controlled, we will have only ourselves to blame.

Pediatrics
February 2015, VOLUME 135 / ISSUE 2
http://pediatrics.aappublications.org/current.shtml

Article
Safety of Measles-Containing Vaccines in 1-Year-Old Children
Nicola P. Klein, MD, PhDa, Edwin Lewis, MPHa, Bruce Fireman, MAa, Simon J. Hambidge, MD, hDb, Allison Naleway, PhDc, Jennifer C. Nelson, PhDd, Edward A. Belongia, MDe, W. Katherine Yih, PhD, MPHf, James D. Nordin, MD, MPHg, Rulin C. Hechter, MD, PhDh, Eric Weintraub, MPHi, and Roger Baxter, MDa
Author Affiliations
aKaiser Permanente Vaccine Study Center, Oakland, California;
bKaiser Permanente Colorado Institute for Health Research, Denver and Department of Ambulatory Care Services, Denver Health, Denver, Colorado;
cThe Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon;
dGroup Health Cooperative and the University of Washington, Seattle, Washington;
eCenter for Clinical Epidemiology & Population Health, Marshfield Clinic Research Foundation, Marshfield, Wisconsin;
fHarvard Pilgrim Health Care Institute, Boston, Massachusetts;
gHealthPartners Research Foundation, Minneapolis, Minnesota;
hResearch and Evaluation, Kaiser Permanente Southern California, Pasadena, California; and
iImmunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
Abstract
BACKGROUND AND OBJECTIVES: All measles-containing vaccines are associated with several types of adverse events, including seizure, fever, and immune thrombocytopenia purpura (ITP). Because the measles-mumps-rubella-varicella (MMRV) vaccine compared with the separate measles-mumps-rubella (MMR) and varicella (MMR + V) vaccine increases a toddler’s risk for febrile seizures, we investigated whether MMRV is riskier than MMR + V and whether either vaccine elevates the risk for additional safety outcomes.
METHODS: Study children were aged 12 to 23 months in the Vaccine Safety Datalink from 2000 to 2012. Nine study outcomes were investigated: 7 main outcomes (anaphylaxis, ITP, ataxia, arthritis, meningitis/encephalitis, acute disseminated encephalomyelitis, and Kawasaki disease), seizure, and fever. Comparing MMRV with MMR + V, relative risk was estimated by using stratified exact binomial tests. Secondary analyses examined post-MMRV or MMR + V risk versus comparison intervals; risk and comparison intervals were then contrasted for MMRV versus MMR+V.
RESULTS: We evaluated 123 200 MMRV and 584 987 MMR + V doses. Comparing MMRV with MMR + V, risks for the 7 main outcomes were not significantly different. Several outcomes had few or zero postvaccination events. Comparing risk versus comparison intervals, ITP risk was higher after MMRV (odds ratio [OR]: 11.3 [95% confidence interval (CI): 1.9 to 68.2]) and MMR + V (OR: 10 [95% CI: 4.5 to 22.5]) and ataxia risk was lower after both vaccines (MMRV OR: 0.8 [95% CI: 0.5 to 1]; MMR + V OR: 0.8 [95% CI: 0.7 to 0.9]). Compared with MMR + V, MMRV increased risk of seizure and fever 7 to 10 days after vaccination.
CONCLUSIONS: This study did not identify any new safety concerns comparing MMRV with MMR + V or after either the MMRV or the MMR + V vaccine. This study provides reassurance that these outcomes are unlikely after either vaccine.

.
Article
Variation in Rotavirus Vaccine Coverage by Provider Location and Subsequent Disease Burden
Leila C. Sahni, MPHa, Jacqueline E. Tate, PhDb, Daniel C. Payne, PhD, MSPHb, Umesh D. Parashar, MBBS, MPHb, and Julie A. Boom, MDa,c
Author Affiliations
aImmunization Project, Texas Children’s Hospital, Houston, Texas;
bDivision of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and
cDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas
Abstract
BACKGROUND: Rotavirus vaccines were introduced in the United States in 2006. Full-series coverage is lower than for other vaccines, and disease continues to occur. We examined variation in vaccine coverage among provider locations and correlated coverage with the detection of rotavirus in children who sought treatment of severe acute gastroenteritis (AGE).
METHODS: Vaccine records of children enrolled in an AGE surveillance program were obtained and children were grouped by the location that administered each child’s 2-month vaccines. Cases were children with laboratory-confirmed rotavirus AGE; controls were children with rotavirus-negative AGE or acute respiratory infection. Location-level coverage was calculated using ≥1 dose rotavirus vaccine coverage among controls and classified as low (<40%), medium (≥40% to <80%), or high (≥80%). Rotavirus detection rates among patients with AGE were calculated by vaccine coverage category.
RESULTS: Of controls, 80.4% (n = 1123 of 1396) received ≥1 dose of rotavirus vaccine from 68 locations. Four (5.9%) locations, including a NICU, were low coverage, 22 (32.3%) were medium coverage, and 42 (61.8%) were high coverage. In low-coverage locations, 31.4% of patients with AGE were rotavirus-positive compared with 13.1% and 9.6% in medium- and high-coverage locations, respectively. Patients with AGE from low-coverage locations had 3.3 (95% confidence interval 2.4–4.4) times the detection rate of rotavirus than patients with AGE from high vaccine coverage locations.
CONCLUSIONS: We observed the highest detection of rotavirus disease among locations with low rotavirus vaccine coverage, suggesting that ongoing disease transmission is related to failure to vaccinate. Educational efforts focusing on timely rotavirus vaccine administration to age-eligible infants are needed.

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Article
Geographic Clusters in Underimmunization and Vaccine Refusal
Tracy A. Lieu, MD, MPHa, G. Thomas Ray, MBAa, Nicola P. Klein, MD, PhDa,b, Cindy Chung, MDc, and Martin Kulldorff, PhDd
Author Affiliations
aDivision of Research, Kaiser Permanente Northern California, Oakland, California;
bVaccine Study Center, Kaiser Permanente, Oakland, California;
cDepartment of Pediatrics, San Rafael Medical Center, Kaiser Permanente Northern California, San Rafael, California; and
dDepartment of Population Medicine, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts
Abstract
BACKGROUND AND OBJECTIVE: Parental refusal and delay of childhood vaccines has increased in recent years and is believed to cluster in some communities. Such clusters could pose public health risks and barriers to achieving immunization quality benchmarks. Our aims were to (1) describe geographic clusters of underimmunization and vaccine refusal, (2) compare clusters of underimmunization with different vaccines, and (3) evaluate whether vaccine refusal clusters may pose barriers to achieving high immunization rates.
METHODS: We analyzed electronic health records among children born between 2000 and 2011 with membership in Kaiser Permanente Northern California. The study population included 154 424 children in 13 counties with continuous membership from birth to 36 months of age. We used spatial scan statistics to identify clusters of underimmunization (having missed 1 or more vaccines by 36 months of age) and vaccine refusal (based on International Classification of Diseases, Ninth Revision, Clinical Modification codes).
RESULTS: We identified 5 statistically significant clusters of underimmunization among children who turned 36 months old during 2010–2012. The underimmunization rate within clusters ranged from 18% to 23%, and the rate outside them was 11%. Children in the most statistically significant cluster had 1.58 (P < .001) times the rate of underimmunization as others. Underimmunization with measles, mumps, rubella vaccine and varicella vaccines clustered in similar geographic areas. Vaccine refusal also clustered, with rates of 5.5% to 13.5% within clusters, compared with 2.6% outside them.
CONCLUSIONS: Underimmunization and vaccine refusal cluster geographically. Spatial scan statistics may be a useful tool to identify locations with challenges to achieving high immunization rates, which deserve focused intervention.

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Review Article
Duration of Pertussis Immunity After DTaP Immunization: A Meta-analysis
Ashleigh McGirr, MPH and David N. Fisman, MD, MPH, FRCPC
Author Affiliations
Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
Abstract
BACKGROUND AND OBJECTIVES: Pertussis incidence is increasing, possibly due to the introduction of acellular vaccines, which may have decreased the durability of immune response. We sought to evaluate and compare the duration of protective immunity conferred by a childhood immunization series with 3 or 5 doses of diphtheria-tetanus-acellular pertussis (DTaP).
METHODS: We searched Medline and Embase for articles published before October 10, 2013. Included studies contained a measure of long-term immunity to pertussis after 3 or 5 doses of DTaP. Twelve articles were eligible for inclusion; 11 of these were included in the meta-analysis. We assessed study quality and used meta-regression models to evaluate the relationship between the odds of pertussis and time since last dose of DTaP and to estimate the probability of vaccine failure through time.
RESULTS: We found no significant difference between the annual odds of pertussis for the 3- versus 5-dose DTaP regimens. For every additional year after the last dose of DTaP, the odds of pertussis increased by 1.33 times (95% confidence interval: 1.23–1.43). Assuming 85% vaccine efficacy, we estimated that 10% of children vaccinated with DTaP would be immune to pertussis 8.5 years after the last dose. Limitations included the statistical model extrapolated from data and the different study designs included, most of which were observational study designs.
CONCLUSIONS: Although acellular pertussis vaccines are considered safer, the adoption of these vaccines may necessitate earlier booster vaccination and repeated boosting strategies to achieve necessary “herd effects” to control the spread of pertussis.

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Quality Report
Quality Improvement Initiative to Increase Influenza Vaccination in Pediatric Cancer Patients
Jason L. Freedman, MD, MSCEa, Anne F. Reilly, MD, MPHa,b, Stephanie C. Powell, MSNc, and
L. Charles Bailey, MD, PhDa,b
Author Affiliations
aDivision of Oncology, and
cDepartment of Nursing, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
bDepartment of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Abstract
BACKGROUND: Pediatric patients with cancer face more severe complications of influenza than healthy children. Although Centers for Disease Control and Prevention guidelines recommend yearly vaccination in these patients, in our large academic center, <60% of oncology patients receiving chemotherapy were immunized at baseline. Our objective was to increase this rate through a multifaceted quality improvement initiative.
METHODS: Eligible patients were >6 months old, within 1 year of receiving chemotherapy, >100 days from stem cell transplant, and had ≥1 outpatient oncology visit between September 1, 2012, and March 31, 2013. Five interventions were instituted concomitantly: (1) family education: influenza/vaccine handouts were provided to families in clinic waiting rooms; (2) health informatics: daily lists of outpatients due for immunization were generated from the electronic medical record and sent automatically to triage staff and nurses; (3) outpatient clinic: patients due for vaccination were given colored wristbands during triage to alert providers; (4) inpatient: vaccine order was built into admission order set; and (5) provider education: staff education was provided at conferences on screening of patients, vaccine ordering, and documentation of refusals/contraindications.
RESULTS: The complete influenza immunization rate increased by 20.1% to 64.5%, and the proportion of patients receiving ≥1 dose of vaccination increased by 22.9% to 77.7%. Similar changes were noted across all cancer types, with highest rates of immunization in leukemia/lymphoma patients (86.8%) and lowest in patients after stem cell transplant (66.7%).
CONCLUSIONS: Technology, education, and multidisciplinary clinical process changes increased influenza vaccination rates. Ongoing efforts are targeting subgroups with lowest rates of immunization.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 7 February 2015)

Measles Vaccination Coverage Survey in Moba, Katanga, Democratic Republic of Congo, 2013: Need to Adapt Routine and Mass Vaccination Campaigns to Reach the Unreached
February 2, 2015 • Research
Julita Gil Cuesta, Narcisse Mukembe, Palle Valentiner-Branth, Pawel Stefanoff, Annick Lenglet
The Democratic Republic of Congo (DRC) has committed to eliminate measles by 2020. In 2013, in response to a large outbreak, Médecins Sans Frontières conducted a mass vaccination campaign (MVC) in Moba, Katanga, DRC. We estimated the measles vaccination coverage for the MVC, the Expanded Programme on Immunization routine measles vaccination (EPI) and assessed reasons for non-vaccination.
We conducted a household-based survey among caretakers of children aged 6 months-15 years in Moba from November to December 2013. We used a two-stage-cluster-sampling, where clusters were allocated proportionally to village size and households were randomly selected from each cluster. The questionnaire included demographic variables, vaccination status (card or oral history) during MVC and EPI and reasons for non-vaccination. We estimated the coverage by gender, age and the reasons for non-vaccination and calculated 95% confidence intervals (95% CI).
We recruited 4,768 children living in 1,684 households. The MVC coverage by vaccination card and oral history was 87% (95% CI 84-90) and 66% (95% CI 61-70) if documented by card. The EPI coverage was 76% (95% CI 72-81) and 3% (95% CI 1-4) respectively. The MVC coverage was significantly higher among children previously vaccinated during EPI 91% (95% CI 88-93), compared to 74% (95% CI 66-80) among those not previously vaccinated. Six percent (n=317) of children were never vaccinated. The main reason for non-vaccination was family absence 68% (95% CI 58-78).
The MVC and EPI measles coverage was insufficient to prevent the recurrence of outbreaks in Moba. Lack of EPI vaccination and lack of accessibility by road were associated with lower MVC coverage. We recommend intensified social mobilization and extended EPI and MVCs to increase the coverage of absent residents and unreached children. Routine and MVCs need to be adapted accordingly to improve coverage in hard-to-reach populations in DRC.
Conclusions
We estimated 87% coverage of the MVC in response to the measles outbreak in Moba territory. This coverage may be insufficient to prevent future outbreaks. Lack of a EPI vaccination and lack of accessibility by road were associated with lower MVC campaign coverage. Absence during the MVC and EPI vaccination were the main reasons for non-vaccination. On the basis of these conclusions, we recommend more accessible vaccination sites for each village in order to improve vaccination coverage during EPI and MVCs. We recommend improved social mobilization of the population through extended vaccination time in less accessible villages and to give notice well ahead of vaccination days. Campaign staff must emphasise children and their parents the importance of keeping the vaccination cards. EPI and MVCs need to be adapted accordingly to face these logistical and communication barriers. Hence, the vaccination of hard-to-reach children can contribute to meet the goal of measles elimination in DRC and similar settings.

PLoS Medicine
(Accessed 7 February 2015)
http://www.plosmedicine.org/

Enabling Dynamic Partnerships through Joint Degrees between Low- and High-Income Countries for Capacity Development in Global Health Research: Experience from the Karolinska Institutet/Makerere University Partnership
Nelson Sewankambo, James K. Tumwine, Göran Tomson, Celestino Obua, Freddie Bwanga, Peter Waiswa, Elly Katabira, Hannah Akuffo, Kristina Persson, Stefan Peterson
Health in Action | published 03 Feb 2015 | PLOS Medicine 10.1371/journal.pmed.1001784
Summary Points
:: Partnerships between universities in high- and low-income countries have the potential to increase research capacity in both settings.
:: We describe a partnership between the Karolinska Institutet in Sweden and Makerere University in Uganda that includes a joint PhD degree program and sharing of scientific ideas and resources.
:: Ten years of financial support from the Swedish International Development Cooperation Agency has enabled 44 graduated PhD students and more than 500 peer-reviewed articles, the majority with a Ugandan as first author.
:: The collaborative research environment is addressing Ugandan health and health system priorities, in several cases resulting in policy and practice reforms.
:: Even though all Ugandan PhD graduates have remained in the country and 13 have embarked on postdoc training, remaining institutional challenges include developing functioning research groups, grant writing, network building at Makerere, and continued funding on both sides of the partnership.

Tropical Medicine & International Health
March 2015 Volume 20, Issue 3 Pages 251–406
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2014.20.issue-1/issuetoc

Original Article
Getting the basic rights – the role of water, sanitation and hygiene in maternal and reproductive health: a conceptual framework
Oona M. R. Campbell1,*, Lenka Benova1, Giorgia Gon1, Kaosar Afsana2 and Oliver Cumming3
Article first published online: 22 DEC 2014
DOI: 10.1111/tmi.12439
Abstract
Objective
To explore linkages between water, sanitation and hygiene (WASH) and maternal and perinatal health via a conceptual approach and a scoping review.
Methods
We developed a conceptual framework iteratively, amalgamating three literature-based lenses. We then searched literature and identified risk factors potentially linked to maternal and perinatal health. We conducted a systematic scoping review for all chemical and biological WASH risk factors identified using text and MeSH terms, limiting results to systematic reviews or meta-analyses. The remaining 10 complex behavioural associations were not reviewed systematically.
Results
The main ways poor WASH could lead to adverse outcomes are via two non-exclusive categories: 1. ‘In-water’ associations: (a) Inorganic contaminants, and (b) ‘water-system’ related infections, (c) ‘water-based’ infections, and (d) ‘water borne’ infections. 2. ‘Behaviour’ associations: (e) Behaviours leading to water-washed infections, (f) Water-related insect-vector infections, and (g-i) Behaviours leading to non-infectious diseases/conditions. We added a gender inequality and a life course lens to the above framework to identify whether WASH affected health of mothers in particular, and acted beyond the immediate effects. This framework led us to identifying 77 risk mechanisms (67 chemical or biological factors and 10 complex behavioural factors) linking WASH to maternal and perinatal health outcomes.
Conclusion
WASH affects the risk of adverse maternal and perinatal health outcomes; these exposures are multiple and overlapping and may be distant from the immediate health outcome. Much of the evidence is weak, based on observational studies and anecdotal evidence, with relatively few systematic reviews. New systematic reviews are required to assess the quality of existing evidence more rigorously, and primary research is required to investigate the magnitude of effects of particular WASH exposures on specific maternal and perinatal outcomes. Whilst major gaps exist, the evidence strongly suggests that poor WASH influences maternal and reproductive health outcomes to the extent that it should be considered in global and national strategies.

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

European Health Psychologist – Bulletin of the European Health Psychology Society
Vol 16, No 6 (2014)
http://www.ehps.net/ehp/index.php/contents/issue/view/21/showToc

Experiences of Child Vaccine Providers With the National Immunization Programme and Their Dialogue With Parents
I.A. Harmsen , R. A.C. Ruiter , G. Kok , T.G.W. Paulussen , H.E. de Melker , L. Mollema
Abstract
Background:
Child Vaccine Providers (CVP) work at Child Welfare Centers (CWC), administer vaccines and communicate with parents about the National Immunization Programme (NIP). We performed this quantitative study to get more insight in CVPs attitude, their need for information and education, and their experience with educating (critical) parents who visit the CWC.
Methods:
We conducted a cross-sectional on-line self-report questionnaire. In total, 1427 CVPs received, and 432 CVPs completed the questionnaire (response rate = 30.3%). Findings: Half of the CVPs (52.2%) indicated that they sometimes avoid discussion with parents. CVPs give 1-2 minutes education during a consult about the NIP to parents, but prefer 2-5 minutes, while 11.8% of the CVPs do not give education at all.
Discussion:
CVPs indicated not having enough time to fulfill the information need of parents, we think that CWCs should schedule an extra consult, or information meeting when parents have many questions. CVPs have a need for education in how to communicate with parents, therefore Public Health Institutes should develop training for CVPs about how to communicate with parents.

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New England Journal of Medicine
This article was published on January 28, 2015, at NEJM.org.
DOI: 10.1056/NEJMoa1411627

[PDF] A Monovalent Chimpanzee Adenovirus Ebola Vaccine—Preliminary Report
Tommy Rampling, M.R.C.P., Katie Ewer, Ph.D., Georgina Bowyer, B.A., Danny Wright, M.Sc., Egeruan B. Imoukhuede, M.D., Ruth Payne, M.R.C.P., Felicity Hartnell, M.B., B.S., Malick Gibani, M.R.C.P., Carly Bliss, B.A., Alice Minhinnick, M.B., Ch.B., Morven Wilkie, M.R.C.P., Navin Venkatraman, M.R.C.P., Ian Poulton, Dip.H.E., Natalie Lella, B.A., Rachel Roberts, M.Sc., Kailan Sierra-Davidson, B.A., Verena Kr.hling, Ph.D., Eleanor Berrie, Ph.D., Francois Roman, M.D., Iris De Ryck, Ph.D., Alfredo Nicosia, Ph.D., Nancy J. Sullivan, Ph.D., Daphne A. Stanley, M.S., Julie E. Ledgerwood, D.O., Richard M. Schwartz, Ph.D., Loredana Siani, Ph.D., Stefano Colloca, Ph.D., Antonella Folgori, Ph.D., Stefania Di Marco, Ph.D., Riccardo Cortese, M.D., Stephan Becker, Ph.D., Barney S. Graham, M.D., Richard A. Koup, M.D., Myron M. Levine, M.D., Vasee Moorthy, D.Phil., Andrew J. Pollard, Ph.D., Simon J. Draper, D.Phil., W. Ripley Ballou, M.D., Alison Lawrie, Ph.D., Sarah C. Gilbert, Ph.D., and Adrian V.S. Hill, D.M.
Abstract
Background
The West African outbreak of Ebola virus disease has caused more than 8500 deaths. A vaccine could contribute to outbreak control in the region. We assessed a monovalent formulation of a chimpanzee adenovirus 3 (ChAd3)–vectored vaccine encoding the surface glycoprotein of Zaire ebolavirus (EBOV), matched to the outbreak strain.
Methods
After expedited regulatory and ethics approvals, 60 healthy adult volunteers in Oxford, United Kingdom, received a single dose of the ChAd3 vaccine at one of three dose levels: 1×1010 viral particles, 2.5×1010 viral particles, and 5×1010 viral particles (with 20 participants per group). Safety was assessed over the next 4 weeks. Antibodies were measured on enzyme-linked immunosorbent assay (ELISA) and T-cell responses on enzyme-linked immunospot (ELISpot) and flow-cytometry assays.
Results
No safety concerns were identified at any of the dose levels studied. Fever developed in 2 of the 59 participants who were evaluated. Prolonged activated partial-thromboplastin times and transient hyperbilirubinemia were observed in 4 and 8 participants, respectively. Geometric mean antibody responses on ELISA were highest (469 units; range, 58 to 4051; 68% response rate) at 4 weeks in the high-dose group, which had a 100% response rate for T cells on ELISpot, peaking at day 14 (median, 693 spot-forming cells per million peripheral-blood mononuclear cells). Flow cytometry revealed more CD4+ than CD8+ T-cell responses. At the vaccine doses tested, both antibody and T-cell responses were detected but at levels lower than
those induced in macaques protected by the same vaccine.
Conclusions
The ChAd3 monovalent vaccine against EBOV was immunogenic at the doses tested.
(Funded by the Wellcome Trust and others; ClinicalTrials.gov number, NCT02240875.)

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Blood
December 6, 2014; Blood: 124 (21)

Turning a Tumor into a Vaccine Factory: In Situ Vaccination for Low-Grade Lymphoma
Thomas Marron, MD PhD1, Nina Bhardwaj, MD PhD*,1, Elizabeth Crowley*,2, Tibor Keler, PhD*,3, Thomas A. Davis, MD3, and Joshua Brody, MD*,1
Abstract
BACKGROUND:
Lymphomas are the 5th most common cancer in the U.S. and most are incurable with standard therapy. Previously, we completed three trials of ‘in situ vaccination’ – combining low-dose radiotherapy (XRT) with intratumoral administration of TLR9 agonist (CpG). We demonstrated induction of anti-tumor CD8 T cell responses and clinical remissions of patients’ non-irradiated sites of disease, lasting up to 4+ years. One limitation may have been the paucity of intratumoral dendritic cells (DC). DC are uniquely able to endocytose dying (e.g. irradiated) tumor cells for cross-presentation to anti-tumor CD8 T cells.
METHODS:
Flt3L– the predominant DC differentiation factor– induces tumor leukocyte infiltration and regression of lymphoma tumors pre-clinically and a new formulation of this cytokine -CDX-301- was shown to mobilize BDCA-1 and BDCA-3 DC subsets in an early phase trial. These DC subsets respond to several TLR agonists and cross-present antigens more effectively than plasmacytoid DC (the CpG-responsive DC subset). We initiated a phase I/II study of a new iteration of the in situ vaccine, adding Flt3L-priming and replacing the prior TLR9 agonist with the TLR3 agonist poly-ICLC (Fig 1A).
The vaccine consists of:
– intratumoral Flt3L administration to increase DC within the tumor
– low-dose XRT to induce immunogenic tumor cell death and release tumor-associated antigens, and
– intratumoral poly-ICLC administration to activate tumor antigen-loaded DC.
RESULTS:
Six patients have been enrolled, two patients have completed therapy. Treated patients had 2-200-fold increases in BDCA1 and BDCA3 intratumoral DC after Flt3L administration and marked DC activation after XRT and poly-ICLC. Both treated patients have had partial remissions of untreated sites per Cheson criteria, persisting or improving for >6 months after vaccination. These include regressions of bulky lymph nodes (Fig 1B), as well as peripheral blood (Fig1C) and bone marrow disease. A patient with significant peripheral blood tumor burden experienced >10-fold decrease in malignant B cells with concurrent increase in non-tumor B cells, suggesting a degree of cell specificity in the tumor-killing mechanism. Adverse effects have been mild.
CONCLUSIONS:
Preliminary results suggest that the Flt3L-primed in situ vaccine is feasible, safe and immunologically and clinically effective, warranting further study.

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.

Brookings
http://www.brookings.edu/
Accessed 7 February 2015
Blog Post
What the Anti-Vaxxers are Getting Dangerously Wrong
February 6, 2015, Kavita Patel and Rio I. Hart

CNN
http://money.cnn.com/
Accessed 7 February 2015
CNNMoney Reports
The money behind the vaccine skeptics
[Video] By Kate Trafecante @CNNMoney
Well-funded family foundations are backing the movement to get parents to question vaccines.

Council on Foreign Relations
http://www.cfr.org/
Accessed 7 February 2015
Transcript
Media Call: Measles Outbreak in the United States
with Laurie Garrett, Richard E. Besser, Thomas E. Novotny February 6, 2015
Laurie Garrett, CFR’s senior fellow for global health, and Richard Besser, ABC News’ chief health and medical editor join Thomas Novotny, San Diego University’s associate director for border and global health, for a conference call on the recent measles outbreak in the United States and its effect on public health.

Backgrounder
Ebola Virus
by Danielle Renwick February 5, 2015
The 2014 Ebola outbreak that killed thousands in West Africa has spurred new efforts to improve regional health-care systems and global responses.

Expert Brief
The Year of the Flu
by Laurie Garrett February 4, 2015
Health experts are already calling 2015 one of the most complicated ever for influenza outbreaks, and the prevalence of lethal strains normally found in birds is especially troubling, writes CFR’s Laurie Garrett.

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The Economist
http://www.economist.com/
Accessed 7 February 2015
Of vaccines and vacuous starlets – The Economist
Jan 31, 2015 – The measles vaccine, now combined with those for mumps and rubella, is safe and effective. Yet some parents believe the opposite and refuse…

Politics and vaccinations – What experts say, and what people hear
Feb 5th 2015, 15:47 by N.L. | CHICAGO
EVERY day seems to bring a new story of a politician saying something stupid or evasive about vaccines. Rand Paul frets that they might cause mental disorders. Chris Christie said that his own children had taken their shots but that “parents need to have some measure of choice”. Barack Obama, who once waffled on this subject, has declared his strong support for vaccinating children against measles, as has Hillary Clinton. The airwaves and the internet are filled with discussions about whether or not vaccines are safe. Health officials are worried that the discussion itself could scare more parents into shunning them…

Financial Times
http://www.ft.com/home/uk
Accessed 7 February 2015

February 7-8, 2015
Spots of Resistance
By Leslie Hook and Sarah Mishkin
A measles outbreak linked to a mass infection at Disneyland has sparked a fierce debate in the U.S. about whether more should be done to persuade “anti-vaxxers” to immunise their children.

February 4, 2015 6:29 pm
Merck defends children’s vaccines after measles outbreak
David Crow in New York and Andrew Ward in London
Merck has launched a staunch defence of its childhood vaccines, after an outbreak of measles in California prompted a nationwide debate on the safety of infant immunisation.
Roger Perlmutter, Merck’s head of research and development, told the Financial Times that childhood vaccines were “one of the major triumphs that medical science has ever made”.
“We are extremely proud of what we have been able to do to vanquish paediatric diseases that cause enormous suffering and death,” added Mr Perlmutter.
Merck is the sole provider of immunisations against common childhood diseases in the US through its combination measles, mumps and rubella (MMR) and Proquad products.
Mr Perlmutter called on the government and other advocacy groups to do more to reassure the public about the safety of vaccines. He said there was a limit to how much Merck could do because “there are many who believe we are in some way prejudiced by virtue of being a commercial entity”…

Forbes
http://www.forbes.com/
Accessed 7 February 2015
RAND Corporation MD: Some Educated Parents Misunderstand Critical Vaccine Information
This is the second part of a story on the cost of measles. Read the first part, “Measles Outbreaks Cost Taxpayers Millions.” One way to save money, time and suffering caused by outbreaks of measles and other preventable, contagious diseases, such as whooping cough, is to vaccinate. A dose costs $20 to […]
Vanessa McGrady, Contributor Feb 06, 2015

Why Debate Over Vaccines And Autism Will Continue
How do you win a debate, when the arguments you’re presented with keep changing? Such is the problem with the dispute over whether vaccines – and specifically the shot for measles, mumps, and rubella – cause autism. At first, the theory of disease was related to a 1998 study, published in […]
Scott Gottlieb, Contributor Feb 04, 2015

Sears and Gordon: Should Misleading Vaccine Advice Have Professional Consequences?
In the midst of this measles outbreak, everyone has started talking about extreme anti-vaccine advocates (such as that crazy cardiologist in Arizona who I’m not going to give free publicity to) or politicians stepping into it about “freedom of choice” (see Chris Christie’s and Rand Paul’s recent statements). But extremists […]
Tara Haelle, Contributor Feb 03, 2015

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New Yorker
http://www.newyorker.com/
Accessed 7 February 2015
News Desk: The New Yorker
2 days ago … Talking to Vaccine Resisters. By Seth Mnookin.Measles, the most infectious microbe known to humanity, is making a comeback

February 6, 2015
The Political Scene: Fear of Vaccines
By The New Yorker
“Where is my child’s liberty if she is made sick by the freedom of someone else not to be vaccinated?” says the New Yorker staff writer Michael Specter about the politics of falling inoculation numbers. Specter joins fellow staff writer Ryan Lizza and host Dorothy Wickenden on this week’s Political Scene podcast to discuss the anti-vaccination movement and American hostility to science.
They discuss the origins of suspicions about vaccines, the history of government responses to epidemics, the change in popular attitudes toward science during the George W. Bush Administration, and President Obama’s inability to convince some Americans that vaccinations are safe for their children. “When he champions something, it polarizes the issue,” says Lizza. “If he says the sky is blue, people may start to question that.”
You can listen to the full episode in the stream above. You can also subscribe to the podcast for free on iTunes or via RSS. Listen to the latest episodes of all New Yorker podcasts here.

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New York Times
http://www.nytimes.com/
Accessed 7 February 2015
Paul on Vaccines, Thin Line Between Medicine and Politics
February 07, 2015 – By THE ASSOCIATED PRESS – U.S. – Print Headline: “Paul on Vaccines, Thin Line Between Medicine and Politics”

Ebola Drug Aids Some in a Study in West Africa
Favipiravir — 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 virus…
February 05, 2015 – By SHERI FINK – Science – Print Headline: “Ebola Drug Aids Some in a Study in West Africa”

Ebola: Sierra Leone Officials Criticize Travel Relaxation
FREETOWN, Sierra Leone — Although Ebola cases are declining in West Africa, Sierra Leone officials are worried that the president’s decision to lift travel restrictions may re-ignite the spread of the deadly disease. President
February 03, 2015 – By THE ASSOCIATED PRESS –

Measles Outbreak Proves Delicate Issue to G.O.P. Field
February 03, 2015 – By JEREMY W. PETERS and RICHARD PÉREZ-PEÑA –

As Ebola Ebbs in Africa, Focus Turns From Death to Life
February 01, 2015 – By NORIMITSU

The Vaccine Lunacy
February 01, 2015 – By FRANK BRUNI – Opinion – Print Headline: “The Vaccine Lunacy”

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Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 7 February 2015
Video: Measles: How the Unvaccinated Put the ‘Herd’ at Risk
A measles outbreak in California has scientists concerned about the disease making a resurgence. Why do health officials track vaccinations so closely? WSJ’s Jason Bellini has #TheShortAnswer.
23 Hours ago Video – WSJ

Behind the Numbers: Herd Immunity
Herd immunity relies upon a certain vaccination rate–92%-94% in the case of measles–to safeguard those in the herd who can’t or won’t get immunized. And that rate has been threatened by the anti-vaccination trend.
The Numbers — Yesterday 03:56:00 PM

The Weird Vaccine Panic
Rand Paul joins the Santa Monica left by indulging bad science.
02/03/15
Opinion

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Washington Post
http://www.washingtonpost.com/
Accessed 7 February 2015
Opinions
Revoke the license of any doctor who opposes vaccination
By Arthur L. Caplan February 6
…When politicians ignore the evidence, fail to cite appropriate medical authorities, and rely on hearsay and rumor, with the result that people — out of ignorance or error — don’t vaccinate their children, we can and should deny them elective office. When a doctor does so, we should demand that he forfeit his right to use his medical degree to misinform, confuse or lie.

UNMEER [UN Mission for Ebola Emergency Response] @UNMEER #EbolaResponse

Editor’s Note: UNMEER’s website is aggregating and presenting content from various sources including its own External Situation Reports, press releases, statements and other formats.
We present a composite below from the week ending 7 February 2015. We also note that 1) a regular information category in these reports – human rights – has apparently eliminated as it no longer appears in any of the continuing updates, and 2) the content level of these reports continues, in our view, to trend less informative and less coherent. We will review continuing coverage of this material over the next few weeks.

UNMEER External Situation Reports
UNMEER External Situation Reports are issued daily (excepting Saturday) with content organized under these headings:
– Highlights
– Key Political and Economic Developments
– Human Rights
– Response Efforts and Health
– Logistics
– Outreach and Education
– Resource Mobilisation
– Essential Services
– Upcoming Events
The “Week in Review” will present highly-selected elements of interest from these reports. The full daily report is available as a pdf using the link provided by the report date.

:: 07 Feb 2015 UNMEER External Situation Reports
No report posted.

:: 05 Feb 2015 UNMEER External Situation Report
KEY POINTS
:: Case incidence increased in all three countries for the first time this year
:: Community resistance remains a concern in pockets of affected countries
:: Logistics Cluster continues to coordinate delivery of critical relief items
Response Efforts and Health
4. 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. 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. 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.
8. In Sierra Leone, UNDP and UNMEER continue to provide support to the efforts of the National Ebola Response Centre (NERC), to implement the revised Hazard Policy payment aimed at re-classifying Ebola Response Workers (ERWs) based on real risks and further ensuring fiduciary sustainability and compliance. Biometric verification of ERWs commenced last week in Western Area. As of 1 February about 10,000 ERWs were verified, with several fraudulent ERWs in the Western Area discovered and reported to the Anti-Corruption Commission.
Essential Services
16. The Periodic Intensified Routine Immunization (PIRI) campaign teams reported community resistance in some parts of the districts at the IMS meeting in Grand Gedeh County. The misconception about Ebola vaccines trials, ongoing in Monrovia, persists in various districts (Cavalla, Gbao and Putu districts) where some of the town chiefs rejected the vaccination exercise in their communities.

:: 04 Feb 2015 UNMEER External Situation Report
Logistics
8. WFP, in coordination with the Government of Liberia, UNMEER and UNICEF, is providing logistics support for the transportation of WASH supplies for the safe re-opening of schools in Liberia. Dispatches are planned to commence on 4 February in Nimba County and are planned to be completed in all 15 counties by 15 February ahead of the school start date on 2 March. Dispatches will be conducted by road, air and sea transport. In total over 7,000 kits (some 2,700m3) will be delivered to over 4,000 schools serving one million students.
9. The WFP-led Emergency Telecommunications Cluster is providing Internet access for 1,112 humanitarian staff in 59 locations across Guinea, Liberia and Sierra Leone.
Essential Services
15. UNICEF Guinea distributed more than 31,720 household hygiene kits to 222,040 people in Ebola-affected areas. This brings the total number of household kits distributed since the beginning of the outbreak to 81,252 and the number of beneficiaries to 568,764. In support of government efforts as students returned to schools and universities, UNICEF distributed 25,800 school hygiene kits benefitting 1,467,252 students.
17. UNMEER facilitated a rapid assessment of three border crossing points along the Liberia/Bong country – Guinea border, namely Jowah, Gboata and Garmu. The joint team composed of the CDC and UNMEER was led by the Director of Operations in the Bureau of Immigration and Naturalization (BIN), Liberia. The joint team interacted with border officials who reported the crossing were officially closed in July 2014, but illegal crossings continue due to extensive family, cultural and economic ties on both sides. The border officials reported that each border post is manned by 10-15 personnel, which is insufficient for ensuring the necessary patrolling of the border area. The CDC experts also held extensive discussions with the medical personnel at Joseph Clinic in Jowah, a regional medical facility that provides medical care for the population across 5 areas, including to patients from Guinea (especially before the outbreak). Medical personnel at Jowah Clinic emphasized the need for a joint health team and Infection Prevention and Control (IPC) resources before officially re-opening the borders.

:: 03 Feb 2015 UNMEER External Situation Report
Key Political and Economic Developments
1. WHO reports that 3 phase III trial collaborations are planned: a ring vaccination trial in Guinea, organized through a large international collaboration including WHO and MSF; a randomized-controlled trial in Liberia, under a Liberian government–US-NIH collaboration, due to begin week of 2 February; and a stepped-wedge trial in Sierra Leone under a Sierra Leonean-US-CDC collaboration. Strong emphasis is being given to effective communication and engagement with communities to build trust, address concerns about clinical trials and vaccination campaigns and ensure that volunteers can make informed choices. WHO will continue its facilitator role as trials move forward, in particular by ensuring that national regulatory oversight and patient safety remain top priorities. WHO’s efforts in R&D for Ebola have had one overriding objective: to help end the epidemic and provide insurance against future epidemics.
3. The Ministry of Education in Liberia has postponed the reopening of schools to allow for continued preparation for the safe re-opening of schools. Schools were initially planned to re-open on 2 February.

:: 02 Feb 2015 UNMEER External Situation Report
Response Efforts and Health
5. In the previous week, WFP supplied food commodities to quarantined households and six quarantined communities in Port Loko District, Sierra Leone. In addition, WFP provided one month rations in Kenema Township where 29 new households were recently quarantined and to hotspots in Kono District. With CIDO, WFP completed food distributions for over 5,800 beneficiaries in Rotifunk community in Moyamba.

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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– pdf version:  A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_31 January 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

GAVI Watch [to 31 January 2015]
http://www.gavialliance.org/library/news/press-releases/

World leaders make record-breaking commitment to protect poorest children with vaccines – Gavi Press Release
Support puts Gavi, the Vaccine Alliance on the path to immunise a further 300 million children and save up to six million more lives
[Excerpts]

Berlin, 27 January 2015 – Hundreds of millions of children living in the world’s poorest countries will receive life-saving vaccines as a result of record-breaking financial commitments made today at the Gavi Pledging Conference, hosted in Berlin by German Federal Chancellor Angela Merkel.

The new pledges, totalling US$ 7.5 billion, will enable countries to immunise an additional 300 million children, leading to 5 to 6 million premature deaths being averted and economic benefits of between US$ 80 and US$ 100 billion for developing countries through productivity gains and savings in treatment and transportation costs and caretaker wages.

Chancellor Merkel was joined in Berlin by H.E. Dr Jakaya Mrisho Kikwete, President of the United Republic of Tanzania, and H.E. Mr Ibrahim Boubacar Keïta, President of the Republic of Mali, Erna Solberg, Prime Minister of Norway, Donald Kaberuka, President of the African Development Bank, Bill Gates, Co-Chair of the Bill & Melinda Gates Foundation, ministers from more than 20 implementing and donor countries, civil society groups, CEOs of vaccine manufacturing companies, UN agencies and others who came together to secure commitments to fully fund Gavi-supported immunisation programmes in developing countries between 2016 and 2020.

Additionally, China, Oman, Qatar and Saudi Arabia made pledges to Gavi for the first time. China’s pledge means that all BRICS countries are now making financial contributions towards childhood immunisation through Gavi.

Developing countries are also increasing their financial contributions towards immunisation. Between 2016 and 2020, Gavi forecasts that implementing countries will allocate a combined total of around US$ 1.2 billion, which is additional to the funding provided by donors, towards their Gavi-supported programmes through the Alliance’s co-financing policy. This country ownership is vital to increasing the long-term sustainability of vaccine programmes…

Vaccine manufacturers
Ahead of the conference, vaccine manufacturers committed to maintaining affordable vaccine prices, a move that will not only help Gavi buy more doses with the money secured but also increase the sustainability of vaccine programmes. Countries whose economic status means they are no longer eligible for Gavi support will still have access to many vaccines at the same price Gavi pays for a number of years.

“Thanks to our donors, Gavi will be able to support developing countries to protect the lives of hundreds of millions of children,” said Dagfinn Høybråten, Chair of the Gavi Board. “We believe that vaccines should reach every child because this is one of the most effective ways of reducing preventable deaths in the poorest countries. The commitments made today will ensure Gavi can make a telling contribution towards the global community’s goal of ending extreme poverty by 2030.”

All donors
The US$ 7.5 billion raised today comes from a mix of pledges from 17 sovereign donors – for the first time almost all donors have made pledges for the full five-year funding period – the European Commission and private sector partners. Of the support from sovereign donors, US$ 252 million was committed to the International Finance Facility for Immunisation (IFFIm).

Additionally, Gavi announced today that the Gavi Matching Fund, a fund that doubles private sector contributions and impact, will be renewed for the 2016-2020 period with the support of the Bill & Melinda Gates Foundation, the Netherlands and other sponsors.

The US$ 7.5 billion pledged for Gavi’s replenishment will be combined with US$ 2 billion in already assured resources, including nearly US$ 1.2 billion from IFFIm, for the 2016-2020 period to enable Gavi to meet the US$ 9.5 billion cost of funding vaccine programmes in developing countries over the five year period.

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Global leaders gathered in Berlin to mobilize funds for global immunization programmes – WHO Press Release
27 January 2015
With bold new commitments from major public and private donors during this Decade of Vaccines, the success of today’s pledging conference signals a renewed global effort to dramatically accelerate action to extend the full benefits of immunization to children and women in the world’s poorest countries.

Under the leadership of German Chancellor Angela Merkel and Germany’s G7 Presidency, donors have today committed US$ 7.539 billion over the next five years to deliver vaccines and immunization to Gavi-supported countries. With this funding, Gavi, the Vaccine Alliance will be able to help countries immunize an additional 300 million children with the 11* vaccines recommended by WHO for infants.

Immunization programmes have acted as a pathfinder for universal health coverage and the development of stronger health systems. The Global Vaccine Action Plan (GVAP), has set ambitious targets for achieving universal access of vaccines and immunizations and Gavi is a critical contributor towards ensuring these goals are met by 2020.

“WHO sets technical specifications for vaccines and prequalifies all vaccines employed in Gavi-supported programmes ,” said Dr Jean-Marie Okwo-Bele, Director of the WHO Department of Immunization, Vaccines and Biologicals. “Gavi benefits from WHO’s input on issues ranging from cold chain and vaccine management, monitoring and evaluation, to training and post-introduction analysis of vaccines. Working together with other Vaccine Alliance partners, WHO is committed to ensure that the present gains and investments are sustained, so that countries can increase their immunization coverage and eventually take over full financing of their immunization programmes.”

Private sector makes new pledges to support childhood immunisation in developing countries – – Gavi Press Release
Vaccine manufacturers and private firms set out commitments ahead of major Gavi conference
[Press release excerpts]
Berlin, 26 January 2015 – Gavi, the Vaccine Alliance today welcomed new commitments from a number of private sector partners towards its mission to immunise children in developing countries…

…“It is encouraging to see vaccine manufacturers increasingly recognising the importance of sustainable vaccine markets for developing countries,” said Gavi CEO Dr Seth Berkley. “The commitments made today will help us make more vaccine doses available at a lower cost and will support countries as they move towards financing and sustaining their own immunisation programmes. This will lead to more children being protected and more deaths being averted.”

Commitments
The following commitments were announced today.
:: Biological E is offering a five-year price commitment to Gavi graduated countries for its pentavalent vaccine.
:: GSK extended it price freeze commitment so that developing countries that graduate from Gavi support will be able to continue to purchase vaccines against pneumonia, diarrhoea and cervical cancer at significantly discounted Gavi prices for a decade after graduation. GSK also reaffirmed that if the company identifies new manufacturing efficiencies that reduce the costs of producing these vaccines, it will pass those savings on to Gavi and its donor.
:: Janssen reaffirmed its pledge of making its pentavalent vaccine available at UNICEF prices to Gavi graduated countries over the next five years. Janssen also announced the launch of its pentavalent vaccine in cPAD, a compact Prefilled Auto-Disable injection system which helps improve injection safety.
:: Panacea Biotech extends its pledge, first made in June 2011, to support all Gavi graduated countries by offering a five-year price freeze on all vaccination programmes started with Gavi support. The price freeze commences from the first calendar year during which a country stops receiving Gavi support.
:: Pfizer agreed to reduce the price per dose for its pneumococcal vaccine, from US$ 3.30 per dose to US$ 3.10 per dose for the new 4-dose vial presentation, which is expected to be introduced under the Advance Market Commitment programme in 2016. This new lower price will be extended to all Gavi-eligible and graduated countries until the end of 2025.
:: Sanofi Pasteur committed to expand the production of yellow fever vaccine to address chronic shortages, and promised to offer Gavi-level pricing for Gavi graduated countries until the end of 2018. The company will also continue to contribute to the polio endgame by providing inactivated polio vaccine to Gavi countries for delivery in routine immunisation. The company also announced the expansion of its EPIVAC vaccinator training programme in Nigeria, in collaboration with Agence de Médecine Préventive.
:: Serum Institute of India reduced its price for their pentavalent vaccines supplied to Gavi that is valued at approximately US$ 50 million dollars over the next two years.
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Ebola
Additionally, Merck and NewLink Genetics committed to provide their investigational Ebola (rVSV-EBOV) vaccine to Gavi-eligible countries at the lowest possible access price.

In a statement, the International Federation of Pharmaceutical Manufacturers and & Associations (IFPMA) said: “Vaccines are recognised as one of the most cost-effective health interventions, with potential for substantive, positive impact on health, productivity, and well-being across the globe. IFPMA member companies are proud of their role to help support strong immunisation programmes through ensuring sustainable research and development, manufacturing and availability of high-quality vaccines.”…
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Four new partnerships
Gavi today announced four new partnerships to support immunisation in developing countries:
:: Alwaleed Bin Talal Foundation of Saudi Arabia – Supporting Gavi through direct funding for vaccine purchases in Timor Leste, Kiribati, Armenia, Azerbaijan, Moldova, and Guyana.
:: Comic Relief – The popular United Kingdom (UK) charity announced that it will expand its partnership with Gavi into the United States in 2015 and has agreed to continue supporting Gavi through donations raised during its annual events, Red Nose Day and Sport Relief in the UK.
:: IKEA Foundation – The independent charitable foundation that oversees IKEA’s global philanthropy is partnering with Gavi to provide catalytic funding to increase injection safety.
:: UPS – The global logistics provider will work with Gavi to leverage the expertise of its Global Healthcare Logistics Strategy Group to develop and implement an executive training and mentorship programme to enhance the capability of local supply chain leaders who will go on to build robust immunisation supply chains.

In addition, last week at the World Economic Forum, the International Federation of Pharmaceutical Wholesalers (IFPW), Star Syringe and Hindustan Syringes and Medical Devices (HMD) all made commitments to support Gavi’s mission. The commitment from IFPW represents the first of its kind for the global pharmaceutical wholesale industry.

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Industry Watch [to 31 January 2015]
:: BE Pledges Its Offering of 5 Year Price Commitment to GAVI Graduated Countries – 26 January 2015

:: GSK extends its price-freeze commitment to ten years for countries graduating from Gavi support – 26 January 2015

:: JANSSEN PLEDGE TO GAVI [QUINVAXEM] – 26 January 2015

:: PANACEA BIOTEC’S STATEMENT: GAVI – 26 January 2015

:: Pfizer Commits to Further Reduce Price for Prevenar 13 in the World’s Poorest Countries Through 2025 – January 26, 2015

:: Sanofi Pasteur Statement of Support – GAVI Alliance – January 26, 2015

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BMGF – Gates Foundation Watch [to 31 January 2015]
http://www.gatesfoundation.org/Media-Center/Press-Releases
:: Hundreds of Millions More Children to Receive Protection against Deadly Diseases, a Chance at a Healthy Future
Jan 27, 2015
The Bill & Melinda Gates Foundation today announced a five-year, US$1.55 billion commitment to Gavi, the Vaccine Alliance, to bring life-saving vaccines to children in the world’s poorest countries. The commitment was announced at the Gavi Replenishment Conference in Berlin…

WHO: Ebola Situation Report – 28 January 2015
[Excerpt; Editor’s Text Bolding]
SUMMARY
:: The response to the EVD epidemic has now moved to a second phase, as the focus shifts from slowing transmission to ending the epidemic. To achieve this goal as quickly as possible, efforts have moved from rapidly building infrastructure to ensuring that capacity for case finding, case management, safe burials, and community engagement is used as effectively as possible.
:: For the first time since the week ending 29 June 2014, there have been fewer than 100 new confirmed cases reported in a week in the 3 most-affected countries. A combined total of 99 confirmed cases were reported from the 3 countries in the week to 25 January: 30 in Guinea, 4 in Liberia, and 65 in Sierra Leone.
:: Case incidence continues to fall in Liberia and Sierra Leone. Guinea reported 30 confirmed cases in the week to 25 January, up from 20 confirmed cases in the previous week.
:: The north Guinean prefecture of Mali, which borders Senegal, has reported its first confirmed case.
:: In the week to 18 January, 6 of 20 (30%) new confirmed and probable cases in Guinea arose among registered contacts. During the week to 25 January, 2 of 4 (50%) new confirmed cases in Liberia arose among known contacts. Equivalent data are not yet available for Sierra Leone. The target is for 100% of new cases to arise among known contacts, so that each and every chain of transmission can be tracked and terminated.
:: In the 21 days to 25 January, it took an average of 0.7 days in Guinea, 0.5 days in Liberia, and 0.8 days in Sierra Leone for a patient sample to go from collection through to the communication of the laboratory test result to a national ministry of health. The target is to have results within 24 hours of sample collection.
:: The case fatality rate among hospitalized cases (calculated from all hospitalized cases with a reported definitive outcome) is between 54% and 62% in the 3 intense-transmission countries, with no indication of an improvement over time.
:: All health care facilities in the 3 most-affected countries are assessed for their compliance with minimum standards of infection prevention and control (IPC), with the aim that 100% of facilities meet such standards. Data will soon be available on the proportion of health facilities that meet minimum IPC standards.
:: A total of 816 confirmed health worker infections have been reported in the 3 intense-transmission countries; there have been 488 reported deaths. Neither Guinea nor Sierra Leone reported a health worker infection in the week to 25 January. Liberia reported 2 health worker infections during the same period, compared with 0 cases the previous week.
:: A total of 27 sub-prefectures in Guinea reported at least one security incident or other form of refusal to cooperate in the week to 21 January. A total of 2 districts in Liberia and 4 districts in Sierra Leone reported at least one similar incident during the same reporting period.

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
:: There have been in excess of 22,000 reported confirmed, probable, and suspected cases (Annex 1) of EVD in Guinea, Liberia and Sierra Leone (table 1), with almost 8800 deaths (outcomes for many cases are unknown). A total of 30 new confirmed cases were reported in Guinea, 4 in Liberia, and 65 in Sierra Leone in the 7 days to 25 January.
:: 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 816 confirmed health worker infections have been reported in the 3 intense-transmission countries; there have been 488 reported deaths…

WHO Ebola R&D Effort – vaccines, therapies, diagnostics
30 January update
[Full text; Editor’s text bolding]
Since August, when the Ebola outbreak was declared a global public health emergency, WHO has convened a series of consultations and high-level meetings with key experts and stakeholders involved in the research, development, regulation and funding of potential medical solutions for Ebola. Based on concerted expert advice, the best evidence available, and ethical oversight, WHO` has prioritized a number of products for further investigation through human testing. These products now include three lead candidate vaccines (with a possible fourth slated for clinical trials in the near future), a shortlist of antivirals and experimental drugs, and convalescent whole blood and plasma. In addition, WHO is working on a number of emergency procedures with countries and other partners for assessment and fast-track development of adapted diagnostics, as well as joint reviews of vaccine clinical trial protocols to expedite study approvals and potential large-scale introduction.

VACCINES
Two vaccine candidates started human clinical trials in September and are about to enter phase II and III trials in a number of African countries, including the three affected countries. The vaccines are cAd3-ZEBOV, developed by GlaxoSmithKline (GSK) in collaboration with the United States National Institutes for Health, and the rVSV-ZEBOV vaccine, developed by the Public Health Agency of Canada and licensed to NewLink Genetics, who recently licensed the product to Merck Vaccines USA. These two vaccines’ manufacturers presented promising safety data at a WHO high-level meeting on Ebola vaccines on 8 January this year.

A third vaccine candidate developed by Johnson & Johnson (J&J) is in phase I trials in the United Kingdom and is planned to start further studies in Africa in the coming weeks and potentially a large-scale efficacy trial in Sierra Leone in the second trimester of 2015.
A number of other vaccines are in the development pipeline. These include a vaccine being developed by Novavax and others being developed in China, Russia and the USA.

Phase II and III trials imminent –
The GSK and Merck vaccine candidates are about to enter phase II and III trials in a number of African countries, including the three affected countries. Three phase III trial collaborations are planned: a ring vaccination trial in Guinea, organized through a large international collaboration including WHO and MSF; a randomized-controlled trial in Liberia, under a Liberian government – US-NIH collaboration; and a stepped-wedge trial in Sierra Leone under a Sierra Leonean-US-CDC collaboration. Each trial will test the efficacy of a single dose of one or both vaccine candidates. In the meantime, phase II trials of the GSK vaccine are slated to start in Cameroon, Ghana, Mali, Nigeria and Senegal in the coming weeks.

Production capacity adequate –
At a WHO high-level meeting on Ebola vaccines on 8 January the manufacturers assured the international community that enough supplies would be available for testing, with production capacity for several million doses, in case of deployment.

An effective vaccine will be an asset however the epidemic evolves –
While the current course of the epidemic may be narrowing the window of opportunity for testing the vaccines’ efficacy, there is consensus that an effective vaccine would be an invaluable addition to the tools currently used to end the outbreak. A vaccine may be necessary to eliminate the disease should current control measures succeed in bringing transmission down to very low levels, and would act as an insurance policy against future outbreaks.

Continued efforts in community engagement –
Strong emphasis is being given to effective communication and engagement with communities, both to build trust and allay concerns about clinical trials and vaccination campaigns. Work to sensitize health workers and communities at trial sites has been ongoing since November, in collaboration with UNICEF and civil society.

Funding for up to 12 million doses –
A December meeting of Gavi’s (the Vaccine Alliance’s) Executive Board endorsed a US$ 300 million funding envelope for the purchase of up to an estimated 12 million doses of vaccine.

Regulatory pathways are being finalized –
WHO is facilitating a process to devise an emergency regulatory pathway, with the aim of enabling the rapid introduction of vaccines for clinical trials and general distribution without any compromise of scientific standards or rigour. Regulators from the affected countries and from the wider African region have committed to working closely on these matters with WHO and with manufacturers and trial sponsors. For their part, manufacturers have stated their readiness to generate whatever data are required for licensure.
More about Vaccines

TREATMENTS
Blood and blood products
Convalescent whole blood donated by Ebola recovered patients is currently being administered in Sierra Leone in a trial run by the government. A trial of convalescent plasma has begun in Liberia – under the auspices of ClinicalRM (a clinical research organization) with the US government and the Bill and Melinda Gates Foundation; and Guinea is planning to start a plasma trial in the next weeks through a partnership between its National Blood Transfusion Service, institutes in Belgium, the UK, France and MSF.

So far, plasma trials have not managed to enroll a sufficient number of patients to provide evidence of efficacy. Efforts are being made to identify alternative sites for the studies, but preparation of clinical trial sites is technically and operationally complex. Data from whole blood trials in Sierra Leone is currently being analyzed.

Assessments of national capacities for delivering safe blood products outside of clinical trial settings and plans for recovery and strengthening of national blood transfusion services in the three countries are expected to continue in the coming months. In addition, WHO in collaboration with partners is establishing standards for the therapeutic use of antibodies.

Medicines
A number of pre-existing medicines already approved for treating non-Ebola diseases have been considered for re-purposing to treat Ebola because they have demonstrated efficacy against the virus in test tubes (in vitro). The advantage of considering re-purposing of drugs is that these are readily available, and their safety is known.

A clinical trial of the drug favipiravir (Toyama, Japan), has started in Guinea. Trials are being run by Inserm, MSF and the Guinean government and initial results are expected in the coming weeks. One other re-purposed drug, amiodarone, has been used to treat patients in Sierra Leone outside of a clinical trial setting, but it is unclear whether it provides any benefit.

Other products that are still under development and are not registered for any disease are also being taken into small efficacy trials early in 2015. One of these is brincidofovir (Chimerix, USA), which was originally developed for treating cytomegalovirus but has activity against Ebola virus.

Others are medicines that were specifically developed for Ebola, including the monoclonal antibody cocktail ZMapp (Leafbio, USA) and small inhibitory ribonucleic acid (siRNA) (Tekmira, USA, Canada). All of these have been used compassionately in a few expatriated Ebola patients.

Sierra Leone is planning an ethics review for trials involving both siRNA and brincidofovir, and is considering trials with a number of the above-mentioned products. ZMapp is being tested in a small-scale clinical trial in the UK under the auspices of Oxford University. Initial data from this trial should be available in February.

The scientific community is currently testing in non-human primates a wide range of other drugs that have been proposed as potential therapies and will be taking the most promising into clinical trials.

DIAGNOSTICS
In October 2014, WHO published a Target Product Profile for novel rapid and simpler Ebola in vitro diagnostics and introduced an emergency procedure under its Prequalification Programme for rapid assessment of Ebola in vitro diagnostics for UN procurement to affected countries. The first in vitro diagnostic (an RT-PCR kit for laboratories) was considered eligible for WHO procurement in November. In the same month, WHO called on manufacturers to develop rapid and easy to use point-of-care diagnostics that are better suited for use in the affected countries, where health infrastructure and trained personnel are largely lacking. The call was followed by a consultation, on 12 December, where diagnostic experts joined WHO and the NGO FIND to plan for accelerated development, production and deployment of adapted and rapid Ebola tests.

Two types of rapid diagnostics are now undergoing evaluation in Sierra Leone and Guinea by multiple organizations including WHO. The most promising type is the rapid, integrated nucleic acid PCR test, which is highly sensitive and thus believed to be more effective in case finding. The other type is the antigen detection test; this type is easier to use but likely to be less sensitive. However, the rapidly decreasing number of cases and subsequent fewer blood samples available may make the evaluation of current and future tests more challenging.
More about Diagnostics

Looking forward
Sustained alignment between partners carrying out clinical trials is of paramount importance. WHO will continue its facilitator role as trials move forward, in particular by ensuring that national regulatory oversight and patient safety remain top priorities. To that end, a high-level meeting on R&D efforts across preventive and therapeutic areas is being planned for April this year to build on progress so far.
At the same time, WHO is working with Ebola affected countries, development partners and financing institutions to finalise national plans for recovery and building resilient health systems.

UNMEER [to 31 January 2015]
[Please see selected excerpts from UNMEER’s daily External Situation Reports at the end on this edition]
:: Statement by Ismail Ould Cheikh Ahmed, Special Representative and Head of UNMEER, to the UN-AU Meeting on Ebola
29 Jan 2015

WHO & Regionals [to 31 January 2015]
:: 136th WHO Executive Board session
26 January–3 February 2015
Geneva, Switzerland

Documentation
– Provisional agenda
– Main documents

Resolutions to 31 January 2015
– EB136.R1 – Global technical strategy and targets for malaria 2016–2030
– EB136.R2 – Appointment of the Regional Director for Africa
– EB136.R3 – Expression of appreciation to Dr Luis Gomes Sambo
– EB136.R4 – Appointment of the Regional Director for Europe
– EB136.R5 – Yellow fever risk mapping and recommended vaccination for travellers
– EB136.R6 – The recommendations of the review committee on second extensions for establishing national public health capacities and on IHR implementation
– EB136.R7 – Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage

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:: Global Alert and Response (GAR): Disease Outbreak News (DONs)
– Human infection with avian influenza A(H7N9) virus – China 27 January 2015

:: The Weekly Epidemiological Record (WER) 30 January 2015, vol. 90, 5 (pp. 25–32) includes:
– Schistosomiasis: number of people treated worldwide in 2013

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WHO Regional Offices

WHO African Region AFRO
Press Releases
:: WHO Executive Board appoints Dr Matshidiso Moeti as new Regional Director for Africa
GENEVA, 27 January 2015 — The WHO Executive Board, currently holding its 136th session, has appointed Dr Matshidiso Rebecca Moeti as the new Regional Director for WHO’s Africa Region. Dr Moeti was nominated Regional Director by the health ministers of the 47 Member States of the WHO African Region at the annual Regional Committee for Africa in Cotonou, Benin, in November 2014. Dr Moeti will take up her appointment for a five-year term on 1 February 2015, succeeding Dr Luis Gomes Sambo who has served as Regional Director for the past 10 years…
:: “Intensify surveillance” to beat Ebola says Dr Moeti – 27 January 2015
:: Learn from the past to build better for the future – 26 January 2015

WHO Region of the Americas PAHO
:: Canada reports the Americas’ first case of avian influenza A (H7N9) in humans (01/28/2015)

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

WHO European Region EURO
:: Zsuzsanna Jakab appointed WHO Regional Director for Europe for second term 27-01-2015

WHO Eastern Mediterranean Region EMRO
:: Devastating Middle East polio outbreak on verge of being stopped, say experts 27 January 2015

WHO Western Pacific Region
No new digest content identified.

CDC/MMWR Watch [to 31 January 2015]
http://www.cdc.gov/media/index.html

:: Transcript for CDC Telebriefing: Measles in the United States, 2015
Thursday, January 29, 2015 at 03:30 E.T.
[Excerpt; Editor’s formatting]
…ANNE SCHUCHAT: Thank you so much for joining us this afternoon. I want to talk to you today about measles and here’s why. It’s only January and we have already had a very large number of measles cases. As many cases as we have all year in typical years. This worries me and I want to do everything possible to prevent measles from getting a foothold in the United States and becoming endemic again. I want to make sure that parents who think that measles is gone and haven’t made sure that they or their children are vaccinated are aware that measles is still around and it can be serious and that MMR vaccine is safe and effective and highly recommended.

From January until January 1 until January 28, 2015, a total of 84 people in 14 states have been reported as having measles. Most of these cases are part of an ongoing large multistate outbreak linked to the Disneyland resort theme parks in Orange County, California. CDC is working with state and local health departments to control this outbreak which started in late December.

Many of you know that in 2014, the U.S. experienced the highest number of measles cases we had reported in 20 years, over 600. Many of the people who got measles last year were linked to travelers who had gotten measles from the Philippines, where an extremely large outbreak of over 50,000 cases was occurring. Although we aren’t sure exactly how this year’s outbreak began, we assume that someone got infected overseas, visited the Disneyland parks and spread the disease to others.

Infected people in this outbreak here in the U.S. this year have exposed others in a variety of settings including school, day cares, emergency departments, outpatient clinics and airplanes. The information that we have is preliminary and the data are changing. We will be updating our website every Monday with the latest total counts. However, based on what we know now, we’re seeing more adults than we have seen in a typical outbreak. Children are also getting measles. The majority of the adults and children that are reported to us for which we have information did not get vaccinated or don’t know whether they have been vaccinated. This is not a problem with the measles vaccine not working; this is a problem of the measles vaccine not being used…

…Measles is still common around the world and we estimate about 20 million cases each year. In 2013, about 145,700 people died of measles across the world. Measles can come into our country easily through visitors or when Americans travel abroad and bring it back. It can be a serious disease for people of all ages. Even in developed countries like the U.S., for every thousand children who get measles, one to three of them die despite the best treatment. In the U.S. from 2001-2013, 28% of young children who had measles had to be treated in the hospital. Measles can also result in complications. In children they can develop pneumonia, lifelong brain damage or deafness. Of course measles spreads when an infected person breathes, coughs, or sneezes and people don’t always know they are infectious, because you can spread the disease before the rash is evident…

…This [outbreak] is a wake-up call to make sure we keep measles from regaining a foothold in our country protecting our most vulnerable babies and others, by assuring everyone who can be protected from measles is appropriately vaccinated. The very large outbreaks we have seen around the world often started with a small number of cases. I have told you before that France went from about 40 cases a year to over 10,000 cases in a year. It’s only January and we have already had 84 cases. Let’s work together to keep these numbers down and to keep measles from returning to plague our communities….

:: MMWR Weekly, January 30, 2015 / Vol. 64 / No. 2
– Update on the Epidemiology of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection, and Guidance for the Public, Clinicians, and Public Health Authorities — January 2015
– Public Health Response to Commercial Airline Travel of a Person with Ebola Virus Infection — United States, 2014
– A Plan for Community Event-Based Surveillance to Reduce Ebola Transmission — Sierra Leone, 2014–2015

European Medicines Agency Watch [to 31 January 2015]
:: 26/01/2015
Central repository to facilitate assessment of medicines safety reports
EMA launches electronic platform for European regulators …

PATH Watch [to 31 January 2015]
http://www.path.org/news/

Walking together for immunization: 15 years and counting
Vaccines Work | 23 January 2015
by Steve Davis
…PATH celebrates 15 years of partnership with Gavi in creating access to lifesaving vaccines and strong immunization systems that reach all children everywhere, and we look forward to continuing that partnership and to seeing global leaders stand with us in support of child health later this month. By continuing to walk together, let’s see just how far we can go.

Global Fund [to 31 January 2015]
:: Global Fund Applauds GAVI’s Replenishment – 27 January 2015

:: Global Fund Welcomes Appointment of Eric Goosby – 26 January 2015
The Global Fund applauded the appointment of Eric Goosby as the United Nations Special Envoy on Tuberculosis.

DCVMN / PhRMA / EFPIA / IFPMA / BIO Watch [to 31 January 2015]

:: Pentavalent Vaccine from BioFarma is ready for international supply
DCVMN Press Release 31-January-2015
On 16th December 2014, the 5 in 1 Vaccine (Diphtheria, Tetanus, Pertussis, Hepatitis B, Haemophilus influenzae type b) produced by BioFarma has been granted a Pre-qualification (PQ) of the World Health Organization (WHO). Hence this product is added to the vaccines listed by the WHO to be purchased through UNICEF, PAHO and other international agencies and countries in the world…

:: Growing support for shared ethical principles from healthcare and medicines providers
Growing support for shared ethical principles from healthcare and medicines providers
26 JANUARY 2015
[IFPMA Press Release – excerpt]
Geneva, 26 January 2015 – The International Hospital Federation (IHF) and the International Generic Pharmaceutical Alliance (IGPA) today endorsed efforts by founding partners of the Consensus Framework for Ethical Collaboration to promote common ethical principles worldwide when delivering solutions to address patients’ needs.

This endorsements fall on the first anniversary of the Consensus Framework when partners met on the fringe of the World Health Organization’s Executive Board meeting to celebrate implementation of the framework at national level. Countries currently looking to build a set of joint national ethical health practices inspired by the Consensus Framework include Austria, Belarus, Canada, China, Japan, Mexico, Russia, Philippines, Thailand, and the United Kingdom.
Signatories of the Consensus Framework comprise the International Alliance of Patients’ Organizations (IAPO), International Council of Nurses (ICN), International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), International Pharmaceutical Federation (FIP) and the World Medical Association (WMA).

“The Consensus Framework has today become stronger as its provision can now apply across the whole healthcare community”, said Dr. Xavier Deau, President of the WMA. “Actions undertaken under the Framework will guide interactions between millions of patients and nurses, pharmacists, doctors, dentists and hospitals, as well as the research-based and generic pharmaceutical industries worldwide”, added Stephen McMahon, Interim Chief Executive Officer, IAPO.

Today’s endorsements also coincide with the establishment of the Consensus Framework Endorsement Guidelines. The Framework does not override existing individual codes and guidelines; instead, it highlights and reinforces the existing commitments held by each individual organization. By endorsing the Framework, collaborating organizations, like IGPA and IHF, commit both at global and national levels to ethical conduct and interactions that uphold high standards and integrity to ensure the well-being of patients worldwide. The Consensus Framework is voluntary and has no formal enforcement mechanism…

American Journal of Infection Control
February 2015 Volume 43, Issue 2, p99-198
http://www.ajicjournal.org/current

Influenza vaccination rates and beliefs about vaccination among nursing home employees
Jill D. Daugherty, MPH, PhD, Sarah C. Blake, MA, PhD, Jessica M. Grosholz, MA, PhD, Saad B. Omer, MBBS, MPH, PhD, LuMarie Polivka-West, MS, David H. Howard, PhD
DOI: http://dx.doi.org/10.1016/j.ajic.2014.08.021
Highlights
:: We surveyed nearly 2,000 nursing home staff members from 37 agencies regarding their influenza vaccination policies and procedures.
:: During the most recent influenza season, approximately 54% of nursing home staff members had received the influenza vaccine.
:: Black and younger nursing home employees were less likely to obtain the vaccine than white or older employees.
:: Certain beliefs and/or attitudes toward the influenza vaccine had a statistically significant impact on the likelihood that respondents had received the vaccine.
Abstract
Background
Recent studies have suggested that vaccination of nursing home staff members may reduce the incidence of influenza among nursing home residents. Current national estimates of employee vaccination rates (around 50%) indicate that residents may be at an unnecessarily high risk of contracting influenza. This article reports on the influenza vaccination rates and attitudes toward the vaccine among employees in 37 nursing homes in 3 states.
Methods
Nursing home employees were surveyed at nursing homes in Florida, Georgia, and Wisconsin in 2011-2012. Completed surveys were received from a total of 1,965 employees.
Results
Approximately 54% of the employees surveyed received the vaccination during the 2010-2011 and 2011-2012 influenza seasons. Nursing home–level staff vaccination rates varied widely, from 15%-97%. Black and younger employees were less likely to receive the vaccine. Employee vaccination rates in nursing homes that used incentives were 12 percentage points higher than those that did not use incentives (P = .08).
Conclusion
Low vaccination rates among nursing home workers may put residents at increased risk for influenza-related morbidity and mortality. The Centers for Medicare and Medicaid Services may consider employee vaccination rates as a quality indicator in addition to resident vaccination rates. Our findings support the use of a trial to test the use of incentives to increase employee vaccination rates.

Vaccination coverage among students from a German health care college
Carolin Mäding, MSc1, Carolin Jacob, MPH1, Carola Münch, BSc, Katharina von Lindeman, PhD, Jörg Klewer, MD, Joachim Kugler, MD
1Equally contributed to the manuscript.
Published Online: December 23, 2014
DOI: http://dx.doi.org/10.1016/j.ajic.2014.10.019
Highlights
:: Vaccination coverage among health care students is reviewed.
:: Unsatisfactory vaccination rates were found.
:: Significant association between age, sex, socioeconomic status, and vaccination coverage was found.
:: Health care students stated: Vaccinations are absolutely or in part necessary (97%).
Abstract
Health care students are at risk of acquiring and transmitting vaccine-preventable diseases. The purpose of this study was to assess their vaccination status and the influence of determining factors on their vaccination status. Unsatisfactory vaccination rates (43.8%-94.1%) and significant effects regarding age, sex, and socioeconomic status were found; therefore, there is an increased need for education and motivation for vaccinations in student training.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 31 January 2015)

Research article
Innovation in health service delivery: integrating community health assistants into the health system at district level in Zambia
Joseph Zulu, Anna-Karin Hurtig, John Kinsman, Charles Michelo BMC Health Services Research 2015, 15:38 (28 January 2015)

Research article
‘Deep down in their heart, they wish they could be given some incentives’: a qualitative study on the changing roles and relations of care among home-based caregivers in Zambia
Fabian Cataldo, Karina Kielmann, Tara Kielmann, Gitau Mburu, Maurice Musheke BMC Health Services Research 2015, 15:36 (28 January 2015)

BMC Public Health
(Accessed 31 January 2015)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Acceptability of financial incentives and penalties for encouraging uptake of healthy behaviours: focus groups
Emma L Giles, Falko F Sniehotta, Elaine McColl, Jean Adams BMC Public Health 2015, 15:58 (31 January 2015)

Bulletin of the World Health Organization
Volume 93, Number 2, February 2015, 65-132
http://www.who.int/bulletin/volumes/93/2/en/

SYSTEMATIC REVIEWS
The effectiveness of interventions to reduce the household economic burden of illness and injury: a systematic review
Beverley M Essue, Merel Kimman, Nina Svenstrup, Katharina Lindevig Kjoege, Tracey Lea Laba, Maree L Hackett & Stephen Jan
doi: 10.2471/BLT.14.139287
Abstract [HTML]
Objective
To determine the nature, scope and effectiveness of interventions to reduce the household economic burden of illness or injury.
Methods
We systematically reviewed reports published on or before 31 January 2014 that we found in the CENTRAL, CINAHL, Econlit, Embase, MEDLINE, PreMEDLINE and PsycINFO databases. We extracted data from prospective controlled trials and assessed the risk of bias. We narratively synthesized evidence.
Findings
Nine of the 4330 studies checked met our inclusion criteria – seven had evaluated changes to existing health-insurance programmes and two had evaluated different modes of delivering information. The only interventions found to reduce out-of-pocket expenditure significantly were those that eliminated or substantially reduced co-payments for a given patient population. However, the reductions only represented marginal changes in the total expenditures of patients. We found no studies that had been effective in addressing broader household economic impacts – such as catastrophic health expenditure – in the disease populations investigated.
Conclusion
In general, interventions designed to reduce the complex household economic burden of illness and injury appear to have had little impact on household economies. We only found a few relevant studies using rigorous study designs that were conducted in defined patient populations. The studies were limited in the range of interventions tested and they evaluated only a narrow range of household economic outcomes. There is a need for method development to advance the measurement of the household economic consequences of illness and injury and facilitate the development of innovative interventions to supplement the strategies based on health insurance.

Policy & Practice
Thresholds for the cost–effectiveness of interventions: alternative approaches
Elliot Marseille, Bruce Larson, Dhruv S Kazi, James G Kahn & Sydney Rosen
Many countries use the cost–effectiveness thresholds recommended by the World Health Organization’s Choosing Interventions that are Cost–Effective project (WHO-CHOICE) when evaluating health interventions. This project sets the threshold for cost–effectiveness as the cost of the intervention per disability-adjusted life-year (DALY) averted less than three times the country’s annual gross domestic product (GDP) per capita. Highly cost–effective interventions are defined as meeting a threshold per DALY averted of once the annual GDP per capita. We argue that reliance on these thresholds reduces the value of cost–effectiveness analyses and makes such analyses too blunt to be useful for most decision-making in the field of public health. Use of these thresholds has little theoretical justification, skirts the difficult but necessary ranking of the relative values of locally-applicable interventions and omits any consideration of what is truly affordable. The WHO-CHOICE thresholds set such a low bar for cost–effectiveness that very few interventions with evidence of efficacy can be ruled out. The thresholds have little value in assessing the trade-offs that decision-makers must confront. We present alternative approaches for applying cost–effectiveness criteria to choices in the allocation of health-care resources.

Perspectives
Rabies control in India: a need to close the gap between research and policy
Syed Shahid Abbas a & Manish Kakkar b
a. Institute of Development Studies, University of Sussex, Brighton, England.
b. Public Health Foundation of India, ISID Campus, 4 Vasant Kunj Institutional Area, New Delhi, 110070, India.
doi: http://dx.doi.org/10.2471/BLT.14.140723

Epidemiology and Infection
Volume 143 – Issue 03 – February 2015
http://journals.cambridge.org/action/displayIssue?jid=HYG&tab=currentissue

Immunisation
The impact of the media on the decision of parents in South Wales to accept measles-mumps-rubella (MMR) immunization
S. WALSHa1, D. Rh. THOMASa1, B. W. MASONa1 c1 and M. R. EVANSa1
a1 Public Health Wales Communicable Disease Surveillance Centre, Temple of Peace and Health, Cathays Park, Cardiff, UK
SUMMARY
A large measles outbreak occurred in South Wales in 2012/2013. The outbreak has been attributed to low take-up of measles-mumps-rubella (MMR) immunization in the early 2000s. To understand better the factors that led to this outbreak we present the findings of a case-control study carried out in the outbreak area in 2001 to investigate parents’ decision on whether to accept MMR. Parents who decided not to take-up MMR at the time were more likely to be older and better educated, more likely to report being influenced by newspapers [adjusted odds ratio (aOR) 3•07, 95% confidence interval (CI) 1•62–5•80], television (aOR 3•30, 95% CI 1•70–6•43), the internet (aOR 7•23, 3•26–16•06) and vaccine pressure groups (aOR 5•20, 95% CI 2•22–12•16), and less likely to be influenced by a health visitor (aOR 0•30, 95% CI 0•16–0•57). In this area of Wales, daily English-language regional newspapers, UK news programmes and the internet appeared to have a powerful negative influence. We consider the relevance of these findings to the epidemiology of the outbreak and the subsequent public health response.

Eurosurveillance
Volume 20, Issue 4, 29 January 2015
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Research articles
Interim estimates of 2014/15 vaccine effectiveness against influenza A(H3N2) from Canada’s Sentinel Physician Surveillance Network, January 2015
by DM Skowronski, C Chambers, S Sabaiduc, G De Serres, JA Dickinson, AL Winter, SJ Drews, K Fonseca, H Charest, JB Gubbay, M Petric, M Krajden, TL Kwindt, C Martineau, A Eshaghi, N Bastien, Y Li

Global Public Health
Volume 10, Issue 2, 2015
http://www.tandfonline.com/toc/rgph20/10/2#.VM2Niy5nBhU
Special Issue: Sexual and Reproductive Health and Rights for the next decades: What’s been achieved? What lies ahead?

Advancing sexual and reproductive health and rights in low- and middle-income countries: Implications for the post-2015 global development agenda
Adrienne Germain, Gita Sen, Claudia Garcia-Moreno & Mridula Shankar
pages 137-148
Open access
DOI:10.1080/17441692.2014.986177
Published online: 28 Jan 2015

THEME: INTEGRATED AND COMPREHENSIVE SRH SERVICES: A GLOBAL VIEW
Sexual and reproductive health: Progress and outstanding needs
Rachel C. Snow, Laura Laski & Massy Mutumba
pages 149-173
Open access
DOI:10.1080/17441692.2014.986178
Published online: 02 Jan 2015

Commentary: Actions to end violence against women: A multi-sector approach
Claudia García-Moreno & Marleen Temmerman
pages 186-188
Open access
DOI:10.1080/17441692.2014.986163
Published online: 28 Jan 2015

THEME: ADOLESCENTS’ HEALTH AND HUMAN RIGHTS
Sexual and reproductive health and rights in changing health systems
Gita Sen & Veloshnee Govender
pages 228-242
Open access
DOI:10.1080/17441692.2014.986161
Published online: 24 Dec 2014

THEME: SEXUAL HEALTH, HUMAN RIGHTS AND THE LAW
Advancing sexual health through human rights: The role of the law
Eszter Kismödi, Jane Cottingham, Sofia Gruskin & Alice M. Miller
pages 252-267
Open access
DOI:10.1080/17441692.2014.986175
Published online: 24 Dec 2014

Infectious Diseases of Poverty
[Accessed 31 January 2015]
http://www.idpjournal.com/content

Scoping Review
Ecohealth research in Southeast Asia: past, present and the way forward
Hung Nguyen-Viet, Siobhan Doria, Dinh Xuan Tung, Hein Mallee, Bruce A Wilcox and Delia Grace
Infectious Diseases of Poverty 2015, 4:5 doi:10.1186/2049-9957-4-5
Published: 29 January 2015
Abstract (provisional)
Ecohealth is a comprehensive approach to understanding health at its human, animal and environmental interface in a socio-ecological systems context. This approach was introduced widely in Southeast Asia (SEA) by the Canadian International Development Research Centre (IDRC) in the late 2000s. Aimed at addressing the problem of emerging infectious diseases (EIDs), numerous such projects and activities have been generated throughout the region. Ecohealth is increasingly converging with the One Health approach, as both movements emphasise a holistic understanding to health. We conducted a scoping review by considering all of the Ecohealth programmes, initiatives and projects that have been implemented in SEA since the introduction of the approach, and also gathered information from peer-reviewed literature. The objective of this paper is to review Ecohealth activities within SEA over the last 10 years to address the lessons learned, challenges faced and the way forward for Ecohealth in the region. Activities range from those focusing purely on capacity, projects focusing on research and projects covering both. Achievements to date include, for example, research contributing to the field of infectious diseases in relation to social ecological factors and associated urbanisation and agricultural intensification. Challenges remain at the project design and implementation level, in the available capacity and coordination to develop Ecohealth research teams in the countries, gauging teams’ assimilation of Ecohealth’s underlying tenets and their translation into sustainable disease prevention and control, as well as in the ability to scale up Ecohealth projects. We suggest that the way forward for Ecohealth should be from a regional perspective in terms of research, training and policy translation using Ecohealth in combination with the One Health approach.

International Health
Volume 109 Issue 2 February 2015
http://trstmh.oxfordjournals.org/content/109/2.toc
Special issue: Innovative community-based vector control interventions for improved dengue and Chagas disease prevention in Latin America

Innovative community-based vector control interventions for improved dengue and Chagas disease prevention in Latin America: introduction to the special issue
Johannes Sommerfelda,* and Axel Kroegera,b, Guest Editors

Dengue fever and Chagas disease are important public health problems in Latin America. Dengue is a re-emerging viral disease, mainly transmitted by Aedes aegyptii mosquitoes, leading to an increasing number of outbreaks notably in urban areas of the continent.1,2 Chagas disease, a parasitic disease transmitted by Triatomine bugs, is a major cause of morbidity and mortality among the continent’s rural poor and persisting in different social-ecological settings.3,4 In spite of their epidemiological difference, both are vector-borne neglected tropical diseases (NTDs) for which primary prevention can currently mainly be achieved through vector control.5

In the case of dengue, routine vector control usually consists of source reduction strategies, including larviciding and/or insecticide space-spraying.6 However, vertically organized and insecticide-based vector control efforts often lack effectiveness and sustainability, and the need for community-based vector control strategies that include environmental management has been highlighted.7–9 With Chagas disease, routine interventions are usually based on insecticide spraying to eliminate household infestation. With a focus on domestic transmission, the peri-domestic transmission context is often neglected.

Current strategies for integrated vector management call for the adaptation of vector control interventions to local vector ecology, epidemiology and resources.10 Therefore, further insights relevant to specific ecosystems, into transmission dynamics and the possibility of intersectoral ecosystem management programs for dengue and Chagas disease prevention and control are urgently needed. This will play a crucial function in defining locally relevant and appropriate interventions with the prospects for sustainable control of vector populations.

This special issue reports findings of a research and capacity building program on innovative community-based vector control interventions for improved dengue and Chagas disease prevention in Latin America. The overall objective of the research initiative was to improve dengue and Chagas disease prevention by better understanding, through multi-level/multi-scale and trans-disciplinary analysis, ecosystem-related, biological and social (‘eco-bio-social’) determinants, and to develop and evaluate community-based public health interventions targeting dengue and Chagas disease vector habitats and delivered through intersectoral actions. The research program was a collaborative effort between the Special Programme for Research and Training in Tropical Diseases (TDR) and the Ecosystems and Human Health Program of the International Development Research Centre (IDRC).