International Journal of Infectious Diseases
April 2015 Volume 33, p1
http://www.ijidonline.com/current

Prognosis of neonatal tetanus in the modern management era: an observational study in 107 Vietnamese infants
Phung Khanh Lam, Huynh T. Trieu, Inke Nadia D. Lubis, Huynh T. Loan, Tran Thi Diem Thuy, Bridget Wills, Christopher M. Parry, Nicholas P.J. Day, Phan T. Qui, Lam Minh Yen, C. Louise Thwaites
p7–11
Published online: December 11, 2014
Open Access

Evolution of pneumococcal infections in adult patients during a four-year period after vaccination of a pediatric population with 13-valent pneumococcal conjugate vaccine
Antoni Payeras, Aroa Villoslada, Margarita Garau, Mª. Neus Salvador, Mª. Carmen Gallegos
p22–27
Published online: December 22, 2014
Open Access

JAMA
January 27, 2015, Vol 313, No. 4
http://jama.jamanetwork.com/issue.aspx

Viewpoint | January 27, 2015
Sharing and Reporting the Results of Clinical Trials
Kathy L. Hudson, PhD1; Francis S. Collins, MD, PhD1
JAMA. 2015;313(4):355-356. doi:10.1001/jama.2014.10716.
This Viewpoint advocates initiating greater transparency in reporting results of clinical trials as a responsibility that will benefit the health of many.
The principle of data sharing dates to the dawn of scientific discovery—it is how researchers from different disciplines and countries form collaborations, learn from others, identify new scientific opportunities, and work to turn newly discovered information into shared knowledge and practical advances. When research involves human volunteers who agree to participate in clinical trials to test new drugs, devices, or other interventions, this principle of data sharing properly assumes the role of an ethical mandate. These participants are often informed that such research might not benefit them directly, but may affect the lives of others. If the clinical research community fails to share what is learned, allowing data to remain unpublished or unreported, researchers are reneging on the promise to clinical trial participants, are wasting time and resources, and are jeopardizing public trust.

Viewpoint | January 27, 2015
Maximizing Antiretroviral Therapy in Developing CountriesThe Dual Challenge of Efficiency and Quality
Christopher J. L. Murray, MD, DPhil1
JAMA. 2015;313(4):359-360. doi:10.1001/jama.2014.16376.
This Viewpoint discusses the need for improvement in both efficiency and quality of antiretroviral therapy programs in developing countries.
The rapid scale-up of antiretroviral therapy (ART) has been one of the great achievements of global health in the last decade. Declines in deaths from human immunodeficiency virus (HIV)/AIDS in high-income countries following the adoption of highly active ART starting in 1996 are well documented. In low-resource settings, demographic surveillance sites have recorded marked decreases in death rates with the scale-up of ART. In its modeling efforts, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that global mortality declined by 35% from 2005 to 2013, with much of the decline related to ART scale-up.1 The Global Burden of Disease (GBD) collaboration recently estimated that 19 million extra years of life have been gained as a result of ART and prevention of mother-to-child transmission of HIV.2

Journal of Epidemiology & Community Health
February 2015, Volume 69, Issue 2
http://jech.bmj.com/content/current

Exposure to genocide and risk of suicide in Rwanda: a population-based case–control study
Wilson Rubanzana, Bethany L Hedt-Gauthier, Joseph Ntaganira, Michael D Freeman
J Epidemiol Community Health 2015;69:117-122 Published Online First: 8 December 2014 doi:10.1136/jech-2014-204307
Abstract
Background
In Rwanda, an estimated one million people were killed during the 1994 genocide, leaving the country shattered and social fabric destroyed. Large-scale traumatic events such as wars and genocides have been linked to endemic post-traumatic stress disorder, depression and suicidality. The study objective was to investigate whether the 1994 genocide exposure is associated with suicide in Rwanda.
Methods
We conducted a population-based case–control study. Suicide victims were matched to three living controls for sex, age and residential location. Exposure was defined as being a genocide survivor, having suffered physical/sexual abuse in the genocide, losing a first-degree relative in the genocide, having been convicted for genocide crimes or having a first-degree relative convicted for genocide. From May 2011 to May 2013, 162 cases and 486 controls were enrolled countrywide. Information was collected from the police, local village administrators and family members.
Results
After adjusting for potential confounders, having been convicted for genocide crimes was a significant predictor for suicide (OR=17.3, 95% CI 3.4 to 88.1). Being a survivor, having been physically or sexually abused during the genocide, and having lost a first-degree family member to genocide were not significantly associated with suicide.
Conclusions
These findings demonstrate that individuals convicted for genocide crimes are experiencing continued psychological disturbances that affect their social reintegration into the community even 20 years after the event. Given the large number of genocide perpetrators reintegrated after criminal courts and Gacaca traditional reconciling trials, suicide could become a serious public health burden if preventive remedial action is not identified.

The Lancet
Jan 31, 2015 Volume 385 Number 9966 p393-480
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Women’s, children’s, and adolescents’ health: who will lead?
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60135-0
Summary
Last week, Somalia became the 195th country to ratify the Convention on the Rights of the Child (CRC), making the USA the only UN member state yet to ratify the treaty. The CRC, adopted by the UN General Assembly in 1989, is a landmark international agreement delivering a comprehensive set of rights for the world’s youngest citizens; Somalia should be applauded for its move. The news comes in a year that is critical for children, and for women. In less than a month in Delhi, India (Feb 26–27), a consultation will take place on transitioning the Global Strategy for Women’s and Children’s Health (2010–15) into a post-2015 environment.

Articles
Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis
Li Liu, PhD, Shefali Oza, MSc, Daniel Hogan, PhD, Jamie Perin, PhD, Prof Igor Rudan, MD, Prof Joy E Lawn, MD, Prof Simon Cousens, MA, Colin Mathers, PhD, Prof Robert E Black, MD
Published Online: 30 September 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61698-6
Summary
Background
Trend data for causes of child death are crucial to inform priorities for improving child survival by and beyond 2015. We report child mortality by cause estimates in 2000–13, and cause-specific mortality scenarios to 2030 and 2035.
Methods
We estimated the distributions of causes of child mortality separately for neonates and children aged 1–59 months. To generate cause-specific mortality fractions, we included new vital registration and verbal autopsy data. We used vital registration data in countries with adequate registration systems. We applied vital registration-based multicause models for countries with low under-5 mortality but inadequate vital registration, and updated verbal autopsy-based multicause models for high mortality countries. We used updated numbers of child deaths to derive numbers of deaths by causes. We applied two scenarios to derive cause-specific mortality in 2030 and 2035.
Findings
Of the 6•3 million children who died before age 5 years in 2013, 51•8% (3•257 million) died of infectious causes and 44% (2•761 million) died in the neonatal period. The three leading causes are preterm birth complications (0•965 million [15•4%, uncertainty range (UR) 9•8−24•5]; UR 0•615–1•537 million), pneumonia (0•935 million [14•9%, 13•0–16•8]; 0•817–1•057 million), and intrapartum-related complications (0•662 million [10•5%, 6•7–16•8]; 0•421–1•054 million). Reductions in pneumonia, diarrhoea, and measles collectively were responsible for half of the 3•6 million fewer deaths recorded in 2013 versus 2000. Causes with the slowest progress were congenital, preterm, neonatal sepsis, injury, and other causes. If present trends continue, 4•4 million children younger than 5 years will still die in 2030. Furthermore, sub-Saharan Africa will have 33% of the births and 60% of the deaths in 2030, compared with 25% and 50% in 2013, respectively.
Interpretation
Our projection results provide concrete examples of how the distribution of child causes of deaths could look in 15–20 years to inform priority setting in the post-2015 era. More evidence is needed about shifts in timing, causes, and places of under-5 deaths to inform child survival agendas by and beyond 2015, to end preventable child deaths in a generation, and to count and account for every newborn and every child.
Funding
Bill & Melinda Gates Foundation.

Review
Countdown to 2015 and beyond: fulfilling the health agenda for women and children
Jennifer Harris Requejo, PhD, Prof Jennifer Bryce, EdD, Aluisio JD Barros, PhD, Prof Peter Berman, PhD, Prof Zulfiqar Bhutta, PhD, Mickey Chopra, MD, Bernadette Daelmans, MD, Andres de Francisco, PhD, Prof Joy Lawn, PhD, Blerta Maliqi, PhD, Elizabeth Mason, MD, Holly Newby, MS, Carole Presern, PhD, Ann Starrs, MPA, Prof Cesar G Victora, PhD
Published Online: 29 June 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)60925-9
Summary
The end of 2015 will signal the end of the Millennium Development Goal era, when the world can take stock of what has been achieved. The Countdown to 2015 for Maternal, Newborn, and Child Survival (Countdown) has focused its 2014 report on how much has been achieved in intervention coverage in these groups, and on how best to sustain, focus, and intensify efforts to progress for this and future generations. Our 2014 results show unfinished business in achievement of high, sustained, and equitable coverage of essential interventions. Progress has accelerated in the past decade in most Countdown countries, suggesting that further gains are possible with intensified actions. Some of the greatest coverage gaps are in family planning, interventions addressing newborn mortality, and case management of childhood diseases. Although inequities are pervasive, country successes in reaching of the poorest populations provide lessons for other countries to follow. As we transition to the next set of global goals, we must remember the centrality of data to accountability, and the importance of support of country capacity to collect and use high-quality data on intervention coverage and inequities for decision making. To fulfill the health agenda for women and children both now and beyond 2015 requires continued monitoring of country and global progress; Countdown is committed to playing its part in this effort.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 31 January 2015)

A Model of the 2014 Ebola Epidemic in West Africa with Contact Tracing
January 30, 2015 • Research
A differential equations model is developed for the 2014 Ebola epidemics in Sierra Leone and Liberia. The model describes the dynamic interactions of the susceptible and infected populations of these countries. The model incorporates the principle features of contact tracing, namely, the number of contacts per identified infectious case, the likelihood that a traced contact is infectious, and the efficiency of the contact tracing process. The model is first fitted to current cumulative reported case data in each country. The data fitted simulations are then projected forward in time, with varying parameter regimes corresponding to contact tracing efficiencies. These projections quantify the importance of the identification, isolation, and contact tracing processes for containment of the epidemics.

Projected Treatment Capacity Needs in Sierra Leone
January 30, 2015 • Research
Abstract
Background:
The ongoing outbreak of Ebola Virus Disease in West Africa requires immediate and sustained input from the international community in order to curb transmission. The CDC has produced a model that indicates that to end the outbreak by pushing the reproductive number below one, 25% of the patients must be placed in an Ebola Treatment Unit (ETC) and 45% must be isolated in community settings in which risk of disease transmission is reduced and safe burials are provided. In order to provide firmer targets for the international response in Sierra Leone, we estimated the national and international personnel and treatment capacity that may be required to reach these percentages.
Methods:
We developed a compartmental SEIR model that was fitted to WHO data and local data allowing the reproductive number to change every 8 weeks to forecast the progression of the EVD epidemic in Sierra Leone. We used the previously estimated 2.5x correction factor estimated by the CDC to correct for underreporting. Number of personnel required to provide treatment for the predicted number of cases was estimated using UNMEER and UN OCHA requests for resources required to meet the CDC target of 70% isolation.
Results:
As of today (2014-12-04), we estimate that there are 810 (95% CI=646 to 973) EVD active cases in treatment, with an additional 3751 (95% CI=2778 to 4723) EVD cases unreported and untreated. To reach the CDC targets today, we need 1140 (95% CI=894 to 1387) cases in ETCs and 2052 (95% CI=1608 to 2496) at home or in a community setting with a reduced risk for disease transmission. In 28 days (2015-01-01), we will need 1309 (95% CI=804 to 1814) EVD cases in ETCs and 2356 (95% CI=1447 to 3266) EVD cases at reduced risk of transmission. If the current transmission rate is not reduced, up to 3183 personnel in total will be required in 56 days (2015-01-29) to operate ETCs according to our model.
Conclusions:
The current outbreak will require massive input from the international community in order to curb the transmission through traditional containment mechanisms by breaking the chains of transmission in Sierra Leone. If sufficient treatment facilities, healthcare workers and support personnel are not rapidly deployed, the increasing number of cases will be overwhelming. In addition to supporting isolation and treatment mechanisms, other viable control options, such as the development of an effective vaccine, should be supported.

Global Climate Anomalies and Potential Infectious Disease Risks: 2014-2015
January 26, 2015 • Research
Abstract
Background:
The El Niño/Southern Oscillation (ENSO) is a global climate phenomenon that impacts human infectious disease risk worldwide through droughts, floods, and other climate extremes. Throughout summer and fall 2014 and winter 2015, El Niño Watch, issued by the US National Oceanic and Atmospheric Administration, assessed likely El Niño development during the Northern Hemisphere fall and winter, persisting into spring 2015.
Methods:
We identified geographic regions where environmental conditions may increase infectious disease transmission if the predicted El Niño occurs using El Niño indicators (Sea Surface Temperature [SST], Outgoing Longwave Radiation [OLR], and rainfall anomalies) and literature review of El Niño-infectious disease associations.
Results:
SSTs in the equatorial Pacific and western Indian Oceans were anomalously elevated during August-October 2014, consistent with a developing weak El Niño event. Teleconnections with local climate is evident in global precipitation patterns, with positive OLR anomalies (drier than average conditions) across Indonesia and coastal southeast Asia, and negative anomalies across northern China, the western Indian Ocean, central Asia, north-central and northeast Africa, Mexico/Central America, the southwestern United States, and the northeastern and southwestern tropical Pacific. Persistence of these conditions could produce environmental settings conducive to increased transmission of cholera, dengue, malaria, Rift Valley fever, and other infectious diseases in regional hotspots as during previous El Niño events.
Discussion and Conclusions:
The current development of weak El Niño conditions may have significant potential implications for global public health in winter 2014-spring 2015. Enhanced surveillance and other preparedness measures in predicted infectious disease hotspots could mitigate health impacts.

PLoS Medicine
(Accessed 31 January 2015)
http://www.plosmedicine.org/

Supporting Those Who Go to Fight Ebola
Michelle M. Mello, Maria W. Merritt, Scott D. Halpern
Editorial | published 26 Jan 2015 | PLOS Medicine 10.1371/journal.pmed.1001781
…Conclusion
Given the opportunities for HCPs to care for patients in desperate need and help avert global harm, the consistency of such service with HCPs’ professional ethics and AMCs’ missions, and institutions’ ability to manage risks attributable to HCPs’ temporary absence and return to work, health care institutions should routinely support willing and qualified HCPs’ service in West Africa. At a minimum, institutions should not impede employees from fulfilling their perceived professional duties to help the sick and, thereby, to do their part in responding to a global public health emergency. This means refraining from adverse action against those who choose to travel, arranging for others to provide the services the travelers normally render, and not imposing restrictions that exceed CDC recommendations for returning travelers.

Ideally, institutions would go further and actively promote HCPs’ service by enabling them to go as employees and preserving the full net of support and protection this status confers in the US, including travel insurance, worker’s compensation coverage, and pay. Such institutions would also assume liability for harms to third parties, although these situations would likely be rare.

Finally, institutions could fulfill their ethical responsibilities to contribute to the fight against Ebola in different ways. Some hospitals might step forward as primary centers of care for Ebola patients domestically while others focus on facilitating HCPs services’ abroad. However institutions choose to address these responsibilities, it is heartening that there are HCPs who wish to provide care in West Africa. This heroism is remarkable and reflects a deep humanitarian instinct. It calls for validation, not discouragement, by health care institutions.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 31 January 2015)

The Onchocerciasis Vaccine for Africa—TOVA—Initiative
Peter J. Hotez, Maria Elena Bottazzi, Bin Zhan, Benjamin L. Makepeace, Thomas R. Klei, David Abraham, David W. Taylor, Sara Lustigman
Editorial | published 29 Jan 2015 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003422
New supportive health intervention technologies, including a vaccine, may be required in order to achieve onchocerciasis (river blindness) elimination targets. A new transatlantic partnership has been established to develop and test an onchocerciasis vaccine for Africa…

…OVA Initiative is now establishing a roadmap for developing a vaccine to meet one of the two described TPPs, with plans to take at least one candidate forward to phase two trials (proof-of-concept trial for efficacy) by 2020. Among the key activities envisioned for TOVA Initiative is a program of confirmatory preclinical testing, optimization, and down-selection in the O. ochengi–cow model under conditions of natural exposure, together with scale-up process development, pilot manufacture, toxicology testing, regulatory filing, and phase one clinical testing. Indeed, TOVA Initiative is poised to lead on the development of this important new tool to aid in the elimination of onchocerciasis.

An onchocerciasis vaccine for Africa would build on past investments in OCP and APOC and support future investments planned under PENDA to help achieve elimination of onchocerciasis [19]. TOVA has begun to explore innovative financing mechanisms from major foundations, governments in North America, Europe, and elsewhere, as well as some of the major development banks committed to poverty reduction in sub-Saharan Africa. We strongly encourage the global public health community to embrace the prospect of an onchocerciasis vaccine and to incorporate plans for a vaccine’s development into future public policy and strategic plan considerations.

Vaccine
Volume 33, Issue 8, Pages 943-1098 (18 February 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/8

Commentary
Open vial policy in India—A commentary
Pages 943-945
S.K. Panigrahi, S. Mahapatro

Reviews
An assessment of enterotoxigenic Escherichia coli and Shigella vaccine candidates for infants and children
Review Article
Pages 954-965
Richard I. Walker
Abstract
Highlights
:: ETEC and Shigella are the most important bacterial pathogens for which there is no licensed vaccine.
:: Cellular and subunit vaccine approaches are currently under development for both pathogens.
:: There are several possible strategies for maximizing the potential benefit of these vaccines.
:: Impact studies show that ETEC and Shigella vaccines could strongly benefit global public health.

Regulatory considerations in the clinical development of vaccines indicated for use during pregnancy
Review Article
Pages 966-972
Jeffrey N. Roberts, Marion F. Gruber
Abstract
Despite supportive public health policies (e.g., ACIP recommendations), the potential for providing clinical benefit through maternal immunization has yet to be fully realized. For vaccines already licensed and approved for use in adults, specific FDA approval for use during pregnancy to prevent disease in the mother and/or infant may have a significant impact on uptake and usage in pregnant women. In addition, for either a licensed vaccine or a novel vaccine, FDA approval for use during pregnancy would result in labeling that would serve as a resource for practitioners and would facilitate the safe and effective use of the vaccine during pregnancy.
In the U.S., while many vaccines are approved for use in adults and most are not contraindicated for use in pregnant women, no vaccine is licensed for use specifically during pregnancy. Among the perceived obstacles hindering the clinical development of vaccines for use in pregnancy, regulatory issues are frequently cited. One aim of this article is to address the perceived regulatory obstacles. General concepts and regulatory considerations for clinical safety and effectiveness evaluations for vaccines indicated for use during pregnancy will be discussed. This discussion is not intended to establish data requirements or to articulate agency policy or guidance regarding specific vaccine products.

Human papillomavirus vaccination: Assessing knowledge, attitudes, and intentions of college female students in Lebanon, a developing country
Original Research Article
Pages 1001-1007
Mohammed Dany, Alissar Chidiac, Anwar H. Nassar
Abstract
Human papillomavirus (HPV) infection is a common cause for genital warts and cervical cancer. Developing countries in the Middle East such as Lebanon are traditionally considered to be conservative societies with low incidence of sexually transmitted infections. However, nowadays, there is an unexpected increase in the incidence of HPV infections among Middle Eastern females. Thus, the objective of this study is to assess the behavioral perceptions of HPV vaccination among female students attending an academic institution in Lebanon. This cross-sectional study invited 512 students to complete a self-administered questionnaire that assessed the knowledge, attitudes, and intentions towards HPV vaccination. Data analysis included the calculation of knowledge scores ranging from 0 to 100, attitude scores ranging from most positive (1) to most negative (5), and intention scores ranging from lowest intention (0) to highest intention (10). With a response rate of n = 215 (42%), 36.5% never heard of the vaccine before, and only 16.5% were already HPV vaccinated. The median knowledge score of 52.7% ± 1.71 reflects poor to moderate knowledge. Still, the median attitude score of 2.47 ± 0.05 shows a general positive attitude towards HPV vaccination where most of the participants agreed that female college students in Lebanon have a good chance of contracting HPV (62.1%) and that all gynecologists should recommend the vaccine (76.0%). Students in graduate programs, health related majors, and those who are vaccinated had significantly higher knowledge scores compared with students in undergraduate programs, non-health related majors, and HPV non-vaccinated students, respectively. Finally, the survey helped in increasing the intention to obtain HPV vaccine as the intention score increased significantly from 5.24 ± 0.27 before the students went through the survey to 6.98 ± 0.22 after the students completed the survey. Our study highlights the importance of offering guidance to female college students about HPV and its vaccination in developing countries where the incidence of sexually transmitted infections is on the rise.

Intussusception risk after RotaTeq vaccination: Evaluation from worldwide spontaneous reporting data using a self-controlled case series approach
Original Research Article
Pages 1017-1020
Sylvie Escolano, Catherine Hill, Pascale Tubert-Bitter
Abstract
The increased risk of intussusception after vaccination with the rhesus-human reassortant rotavirus vaccine Rotashield led to its withdrawal in 2005. We assess the risk of intussusception following the pentavalent rotavirus vaccine (RV5) on the basis of worldwide reports to the manufacturer up to May 2014, using a self-controlled case series. The method had to be modified to account for the under-reporting, a specific feature of pharmacovigilance spontaneous reports. The risk of intussusception occurring in either of the 0- to 2-day, 3- to 7-day or 8- to 14-day risk periods, was compared to the risk in the 15- to 30-day period. A total of 502 cases occurring 0–30 days after a vaccine dose were studied, including 188 cases after the first dose, 190 cases after the second dose, and 124 cases after the third dose. The incidence risk ratio relative to the control period was highest for the 3- to 7-day period and equal to 3.45 (95% CI 1.84–6.55), 1.63 (0.86–3.13) and 1.73 (0.86–3.51) after the first, second and third dose, respectively. Rotavirus vaccination with RV5 increases the risk of intussusception 3–7 days following vaccination, mainly after the first dose and marginally after the second and third doses. The risk is small and restricted to a short time window. It does not outweigh the benefit of the vaccination, but parents of vaccinated infants should be informed in order to react appropriately to the first symptoms. With appropriate assumptions about the reporting rate, spontaneous reports of adverse events after vaccination can be studied to evaluate vaccine safety.

Vaccine-criticism on the internet: New insights based on French-speaking websites
Original Research Article
Pages 1063-1070
Jeremy K. Ward, Patrick Peretti-Watel, Heidi J Larson, Jocelyn Raude, Pierre Verger
Abstract
The internet is playing an increasingly important part in fueling vaccine related controversies and in generating vaccine hesitant behaviors. English language Antivaccination websites have been thoroughly analyzed, however, little is known of the arguments presented in other languages on the internet. This study presents three types of results: (1) Authors apply a time tested content analysis methodology to describe the information diffused by French language vaccine critical websites in comparison with English speaking websites. The contents of French language vaccine critical websites are very similar to those of English language websites except for the relative absence of moral and religious arguments. (2) Authors evaluate the likelihood that internet users will find those websites through vaccine-related queries on a variety of French-language versions of google. Queries on controversial vaccines generated many more vaccine critical websites than queries on vaccination in general. (3) Authors propose a typology of vaccine critical websites. Authors distinguish between (a) websites that criticize all vaccines (“antivaccine” websites) and websites that criticize only some vaccines (“vaccine-selective” websites), and between (b) websites that focus on vaccines (“vaccine-focused” websites) and those for which vaccines were only a secondary topic of interest (“generalist” websites). The differences in stances by groups and websites affect the likelihood that they will be believed and by whom. This study therefore helps understand the different information landscapes that may contribute to the variety of forms of vaccine hesitancy. Public authorities should have better awareness and understanding of these stances to bring appropriate answers to the different controversies about vaccination.

Vaccine
Volume 33, Issue 7, Pages 833-942 (11 February 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/7

Visualizing knowledge and attitude factors related to influenza vaccination of physicians
Original Research Article
Pages 885-891
Ane Antón-Ladislao, Susana García-Gutiérrez, Núria Soldevila, Fernando González-Candelas, Pere Godoy, Jesús Castilla, José María Mayoral, Jenaro Astray, Vicente Martín, Sonia Tamames, Diana Toledo, Urko Aguirre, Angela Domínguez, the CIBERESP Working Group for the Survey on Influenza Vaccination in Primary Health Care Workers
Abstract
Purpose
To characterize groups of primary healthcare physicians according to sociodemographic data, years of professional experience and knowledge of and attitudes to influenza, and to evaluate differences between groups with respect to influenza vaccination in the 2011–2012 season.
Methods
We carried out an anonymous web survey of Spanish primary healthcare physicians in 2012. Information on vaccination, and knowledge of and attitudes to influenza was collected. Multiple correspondence analysis and cluster analysis were used to define groups of physicians.
Results
We included 835 physicians and identified three types. Type B were physicians with low professional experience of influenza. Types A and C were physicians with high professional experience with influenza, type A also had a high awareness of influenza and seasonal vaccination. Types A and C were older and more often male than type B (p < 0.0001). Knowledge of influenza was greatest in type A and lowest in type B. Awareness of influenza was greatest in type A and lowest in type C. In type A, 71.0% of physicians were vaccinated in the 2011–2012 season, compared with 48.1% and 33.6% from types B and C, respectively (p < 0.001).
Conclusions
Additional efforts should be made to increase interest and concerns about preventing the transmission of influenza in physicians who do not believe influenza is a severe disease and are not concerned about its transmission.

Evaluation of invalid vaccine doses in 31 countries of the WHO African Region
Original Research Article
Pages 892-901
Manas K. Akmatov, Elizabeth Kimani-Murage, Frank Pessler, Carlos A. Guzman, Gérard Krause, Lothar Kreienbrock, Rafael T. Mikolajczyk
Abstract
We examined (a) the fraction of and extent to which vaccinations were administered earlier than recommended (age-invalid) or with too short intervals between vaccine doses (interval-invalid) in countries of the World Health Organisation (WHO) African Region and (b) individual- and community-level factors associated with invalid vaccinations using multilevel techniques. Data from the Demographic and Health Surveys conducted in the last 10 years in 31 countries were used. Information about childhood vaccinations was based on vaccination records (n = 134,442). Invalid vaccinations (diphtheria, tetanus, pertussis [DTP1, DTP3] and measles-containing vaccine (MCV)) were defined using the WHO criteria. The median percentages of invalid DTP1, DTP3 and MCV vaccinations across all countries were 12.1% (interquartile range, 9.4–15.2%), 5.7% (5.0–7.6%), and 15.5% (10.0–18.1%), respectively. Of the invalid DTP1 vaccinations, 7.4% and 5.5% were administered at child’s age of less than one and two weeks, respectively. In 12 countries, the proportion of invalid DTP3 vaccinations administered with an interval of less than two weeks before the preceding dose varied between 30% and 50%. In 13 countries, the proportion of MCV doses administered at child’s age of less than six months varied between 20% and 45%. Community-level variables explained part of the variation in invalid vaccinations. Invalid vaccinations are common in African countries. Timing of childhood vaccinations should be improved to ensure an optimal protection against vaccine-preventable infections and to avoid unnecessary wastage in these economically deprived countries.

Reducing the loss of vaccines from accidental freezing in the cold chain: The experience of continuous temperature monitoring in Tunisia
Original Research Article
Pages 902-907
John Lloyd, Patrick Lydon, Ramzi Ouhichi, Michel Zaffran
Abstract

Optimizing energy for a ‘green’ vaccine supply chain
Original Research Article
Pages 908-913
John Lloyd, Steve McCarney, Ramzi Ouhichi, Patrick Lydon, Michel Zaffran
Abstract
Highlights
:: High energy efficiency in storing and delivering vaccines reduced the recurrent costs of distribution.
:: Adopting a system of planned vaccine deliveries by dedicated electric vehicle was more reliable and timely.
:: Solar modules on the roofs of stores linked to the electrical grid, generate enough ‘green’ energy for storage and transport.
:: ‘Green’ distribution systems for vaccines and medicines meet an increasing need for cooling in public health programmes.

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

Special Focus Newsletters
TBVI (Tuberculosis Vaccine Initiative) Newsletter – January 2015
– New TBVI senior leadership
– 24.6 million euros for TB vaccine R&D

Dengue Vaccine Initiative Newsletter – First Edition 2015
– 2014 Dengue Vaccine Candidates in Review
Lancet Oncology
Volume 16, No. 2, p133–134, February 2015
http://www.thelancet.com/journals/lanonc/issue/current
Comment
Towards a global cancer fund
Franco Cavalli, Rifat Atun
DOI: http://dx.doi.org/10.1016/S1470-2045(15)70012-4
Summary
The annual death toll from cancer has risen by almost 40% since 1990,1 and this increase is set to continue. Deaths from cancer are projected to increase from the present level of around 8 million a year to more than 13 million by 2030, with most of the burden being in poorer countries.2 Once a problem almost exclusive to rich countries, cancer is rapidly becoming a leading cause of death and disability in poor countries, where cancer survival is much lower than in the affluent parts of the world—eg, breast cancer survival in the Gambia is below 15%.

… In 2014, leading international experts met at the WOF to promote sustainable new models of public–private partnership to find new cancer therapies that could make a real difference in patients worldwide. … Such a fund should draw on the experience of the three innovative financing mechanisms that have reached a global scale, namely the Global Fund to Fight AIDS, Tuberculosis, and Malaria, GAVI, and UNITAID. These organisations have introduced novel approaches in each step of the innovative finance value chain—ie, resource mobilisation, pooling, channelling, resource allocation, and implementation—and integrated these steps to successfully mobilise more than $30 billion in 10 years from diverse sources, which they have channeled rapidly to low-income and middle-income countries to address HIV/AIDS, malaria, tuberculosis, and vaccine-preventable diseases in children…

Media/Policy Watch

BBC
http://www.bbc.co.uk/
Accessed 31 January 2015
Ebola outbreak: Virus mutating, scientists warn
BBC News | 29 January 2015
Scientists tracking the Ebola outbreak in Guinea say the virus has mutated. Researchers at the Institut Pasteur in France, which first identified the outbreak last March, are investigating whether it could have become more contagious. More than 22,000 people have been infected with Ebola and 8,795 have died in Guinea, Sierra Leone and Liberia.

Ebola crisis: World ‘dangerously unprepared’ for future pandemics
BBC | 28 January 2015
The world is “dangerously unprepared” for future deadly pandemics like the Ebola outbreak in West Africa, the president of the World Bank has warned. Jim Yong Kim, speaking in Washington, said it was vital that governments, corporations, aid agencies and insurance companies worked together to prepare for future outbreaks. He said they needed to learn lessons from the Ebola crisis.

The Economist
http://www.economist.com/
Accessed 31 January 2015
Measles returns: Of vaccines and vacuous starlets
The Economist | 29 January 2015

The Guardian
http://www.guardiannews.com/
Accessed 31 January 2015
Bill Gates predicts HIV vaccine by 2030
The Guardian | 24 January 2015
Bill Gates believes that a vaccine and new intensive drugs to combat HIV should be available by 2030 and end most new cases of the virus that has killed millions in the past three decades…Gates was also optimistic about the battle against malaria, where work on a vaccine is more advanced than for HIV. GSK filed the world’s first malaria vaccine for approval in July 2014. “We won’t see the end of Aids,” Gates told the Davos forum on Friday. “But both for malaria and Aids we’re seeing the tools that will let us do 95-100% reduction. Those tools will be invented during this 15-year period.”

The Huffington Post
http://www.huffingtonpost.com/
Accessed 31 January 2015
2015: Full Speed Ahead
The Huffington Post | 26 January 2015
by Orin Levine
We are already midway through the first month of the 2015—and more importantly, midway through the Decade of Vaccines. With much to accomplish, I compiled a quick list of the 10 advances in global health and vaccinations I would like to see in 2015: A fully-funded Gavi, the Vaccine Alliance, with Alliance partners energized by that success and driving to achieve its ambitious goal of preventing 5 to 6 million deaths and increasing access to vaccines for everyone. Strong routine immunization is a platform for child health programs and makes a big contribution to ending preventable child death.

Reuters
http://www.reuters.com/
Accessed 31 January 2015
Liberia Ebola vaccine trial “challenging” as cases tumble
Reuters | 25 January 2015
A steep fall in Ebola cases in Liberia will make it hard to prove whether experimental vaccines work in a major clinical trial about to start in the country, the head of the U.S. National Institutes of Health (NIH) said on Saturday. The NIH might have to move some testing to neighbouring Sierra Leone, while regulators could end up approving Ebola shots based on efficacy data from animal tests backed by only limited human evidence, Francis Collins told Reuters…”It’s going to be a hard trial,” Collins said on the sidelines of the World Economic Forum in Davos. “It’s possible we may have to move some of the effort to Sierra Leone, which is unfortunately in not quite such a good position as Liberia”… Nonetheless, vaccines could still be submitted to regulators using efficacy data from non-human primate experiments, plus proof of safety and immune system response in humans.

Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 31 January 2015
A New Index Measures Impact Pharma Has on Infectious Diseases
Wall Street Journal | 23 January 2015
The pharmaceutical industry regularly boasts that its efforts to develop treatments for infectious diseases in poor nations are making a difference. But for those wondering how to gauge those efforts, a new metric has been created. The Global Health Impact Index measures three factors: the need for several important drugs for three specific infectious diseases: tuberculosis, HIV/AIDS and malaria; the effectiveness of the available treatments; and the number of people who can access those drugs. The rankings estimate the amount of death and disability the drugs are alleviating…there is currently no way to determine the extent to which drug makers and their products are having a desired effect, according to Nicole Hassoun, an associate philosophy professor at Binghamton University, who developed the index.

Fear Measles, Not Vaccines
Wall Street Journal | 26 January 2015
A measles outbreak traced to the Disneyland theme park in California has infected nearly 70 people since December. Even before this alarming episode, 2014 saw the worst U.S. measles outbreak in two decades. What else happened last year? More than 13,000 parents nationwide claimed on forms that vaccinating their children from preventable diseases like measles violated their “personal beliefs.” Most of these parents are motivated by irrational fears. It is human to be nervous about injecting foreign substances into a child’s body, but should parents be more afraid of the vaccine or the virus? With measles, there is no question: The virus is the danger.

Ebola/EVD: Additional Coverage [to 31 January 2015]

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 31 January 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.

:: 30 Jan 2015 UNMEER External Situation Report
Key Political and Economic Developments
1. Addressing the Stakeholder Meeting on Ebola, convened by the Chairperson of the AU Commission in Addis Ababa on 29 January, SRSG Ould Cheikh Ahmed called on all leaders to maintain commitment until the goal of zero cases is reached. The SRSG underscored that situation is still perilous as Ebola is still present in more than 25 of the 66 districts, counties and prefectures in the region.
Response Efforts and Health
3. On 29 January in Sierra Leone, UNMEER joined the government and UNDP to launch a month-long exercise to revise the hazard payment policy for Ebola Response Workers (ERWs). The reclassification exercise will now ensure that response work is based on real risks, save cost and at the same time ensure that hazard pay is sustainable. A local ICT firm is assisting in computerizing a database workers, which may among others provide details that reflects the trends in the Ebola fight. The hazard incentive programme is funded by the World Bank, the African Development Bank and DFID, with technical guidance, implementation and coordination support provided by UNDP and UNMEER.
Logistics
8. WFP is coordinating with WHO, UNICEF and other key partners to harmonise the supply chain of essential items for the three affected countries, in line with the shift in focus of the Ebola response to a district-by-district approach and early recovery activities. WFP has augmented its storage capacity at the Main Logistics Hub at Roberts International Airport, Monrovia, from four to six Mobile Storage Units (MSUs), in response to an increasingly high volume of supplies coming into Liberia via air transport.
Resource Mobilisation
11. The OCHA Ebola Virus Outbreak Overview of Needs and Requirements, now totaling USD 2.27 billion, has been funded for USD 1.22 billion, which is around 54% of the total ask.
12. The Ebola Response Multi-Partner Trust Fund currently has USD 135.8 million in commitments. In total USD 140 million has been pledged.
Essential Services
15. Preparation of school infection prevention and control (IPC) kits to facilitate the safe reopening of more than 4,000 schools in Liberia began in UNICEF’s Monrovia warehouse. Each kit is designed to support essential hygiene and sanitation measures and health screening for 150 students. Additionally, UNMEER attended a 2-day WHO supported Training of Trainers (ToT) workshop organized by the County Health Team (CHT) of Rivercess for 16 Ministry of Education (MoEd) personnel including County Education Officer, District Education Officers, Education Consultants and professionals to enhance awareness on EVD in preparation for the opening of schools next week. The trained group will later train 538 teachers and support staff in the entire county. The training was jointly developed by the government and partners.

:: 29 Jan 2015 UNMEER External Situation Report
Key Political and Economic Developments
1. The International Finance Corporation (IFC) announced plans to invest USD 30 million, to support Small and Medium Enterprises (SMEs) and the creation of jobs in Guinea.
Response Efforts and Health
5. In Sierra Leone, WFP and UNICEF jointly distributed food and WASH kits to over 500 quarantined households in the Western Area, including Waterloo. WFP also provided over 90mt of assorted food commodities to five quarantined communities in Port Loko District, Thigbono, Musaia, Bailor Wharf 1, Bailor Warf 2 and Petifu Walla. WFP with its cooperating partner CIDO has so far distributed assorted food commodities to approximately 39,000 households in Waterloo, with distributions ongoing to reach over 47,000 households targeted by general food distributions in this area.
8. WHO reports that 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.
Logistics
11. The WFP-led Logistics Cluster continues to facilitate the transportation and storage of essential relief items on behalf of the humanitarian community. Since September 2014, over 35,000m3 of cargo has been transported and over 52,000m3 stored, across Guinea, Liberia and Sierra Leone.
Outreach and Education
16. WHO reports that a total of 27 sub-prefectures in Guinea reported at least one security incident or other forms 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.
17. Awareness of EVD transmission remains a challenge in pockets in Guinea. A group of youth threw stones at a Guinean Red Cross (GRC) vehicle, on a mission to disinfect a house in Koulé, N’Zérékoré, despite prior arrangement with local authorities.
Essential Services
18. In Guinea, UNMEER observes that the process of a full return to normal school activities continues at varying rates. Reports range from increasing numbers/attendance rates in the main high school in Kankan to delays in commencing university classes and in some cases boycotting of schools by students due to rumours that thermoflash thermometer are transmitting EDV.

:: 28 Jan 2015 UNMEER External Situation Report
Upcoming Events
14. On 29 January, UNDP will organize in New York a high-level event on Ebola recovery. From the UN Secretary-General’s initiative, a partnership has developed between the UN, the EU, the World Bank and the African Development Bank to support the national EVD recovery strategies of the affected countries to facilitate governments’ recovery priorities and reach agreement on areas of integrated support. This high-level event is an opportunity to update Members States on progress in this regard and share information on preliminary findings.

:: 27 Jan 2015 UNMEER External Situation Report
Key Political and Economic Developments
1. On 26 January, Senegal reopened its land borders with Guinea. Senegal had reopened air and sea borders on 14 November 2014, after closing all borders on 21 August 2014.
Outreach and Education
11. UNDP is training hundreds of community police officers to help keep EVD case numbers down and prevent future outbreaks. 450 newly trained officers have begun sharing information with communities in Matoto, in Guinea’s capital Conakry, enhance public awareness to help stop EVD spread and to build more trust between the public and the security services.
Essential Services
15. In Guinea, UNICEF in collaboration with other partners undertook a vaccination catch-up programme in 19 high risk health districts during its Child Health Days. While in Liberia, the second phase of the Periodic Intensification of Routine Immunization drive is set to begin to reach children aged under five with the measles vaccine. UNICEF is also financing the cold chain and vaccination teams in addition to leading social mobilisation efforts.
16. Under the leadership of the Liberian Ministry of Health, UNICEF is a key partner in the upcoming assessment and development of a budgeted health plan to building resilient health systems in Liberia. Discussions are underway on the scope and level of preparedness for this assessment. Eight thematic groups were formed, namely: (1) context and policies, (2) health governance, (3) health workforce, (4) healthcare financing, (5) health information and surveillance, (6) technology, medicines, supply chain management systems, (7) health service delivery, and (8) health infrastructure and logistics.

:: 26 Jan 2015 UNMEER External Situation Report
Key Political and Economic Developments
1. In an address to the nation on 22 January, President Koroma of Sierra Leone, declared the nation’s goal to move towards the target of zero cases by 31 March. The President announced the easing of restriction of movement; he highlighted measures for the safe re-opening of schools to be in the third and fourth week in March are underway. The President emphasized that the nation needs to continue to focus on surveillance and contact tracing; enhance social mobilisation and community engagement efforts; refrain from washing and touching corpses; and not to relent until Sierra Leone gets to zero cases for 42 days and until Liberia and Guinea have had zero cases for 42 days. He also underscored the importance of building the national surveillance capacity and resilient healthcare system to interrupt transmission and prevent future outbreaks.
Logistics
6. The WFP-led Emergency Telecommunication (ET) cluster is constructing towers (17x24m in height) across the three affected countries, in order to widen the coverage of internet in hard to reach locations. More Wi-Fi hotspots will now be available to the humanitarian community, as the ET cluster is in the process of constructing towers in six locations in Guinea; in three locations in Liberia; and in six locations in Sierra Leone.
Outreach and Education
13. In Guinea, UNICEF in partnership with CARITAS has set up 20 social Mediation Councils comprised of religious leaders of all faiths to act on resistance across the country; the social mediation councils have been deployed to communities reporting resistance. UNICEF, Research for Common Ground and the Ministry of Youth continue to use the platform provided by African Cup to scale social mobilization featuring football legends, Guinea national team and Miss Guinea.
14. On 24 January, WHO Guinea with support from CDC, IOM, UNMEER Guinea, Liberia and Sierra Leone organised a cross-border community-based consultative meeting in Nongowa, Guéckédou Prefecture, reuniting state, security and health officials from the tri-border area districts, prefectures and chiefdoms. 24 local community leaders from Liberia and Sierra Leone attended the meeting with support from UNMEER field teams. WHO representatives across the tri-border area districts – Guéckédou (Guinea), Kailahum (Sierra Leone) and Lofa (Liberia) led the discussions which were chaired by the prefect of Guéckédou. These were followed by a series of focus groups sessions. The objectives of the meeting was to share updates on the epidemiological reports; experiences and lessons learned as well as explore ways to strengthen cross border community engagement, surveillance and notification mechanisms, among all stakeholders.

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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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
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Associate Faculty, Division of Medical Ethics, NYU Medical School

136th WHO Executive Board starts with special session on Ebola – Live Webcast
23 January 2015 — The 136th session of the WHO Executive Board will run from Monday, 26 January 2015. On Sunday, 25 January, the Board will hold a special session on the Ebola emergency. The special session will review the current state of WHO’s Ebola response and make recommendations for future large-scale and sustained outbreaks and emergencies. It will also discuss preparedness in non-affected countries and regions.
Live webcast: Sunday 25 January 2015 from 10:00 to 13:00 and 15:00 to 18:00 CET
– Special session – English http://www.who.int/mediacentre/executive-board-live/en/

World Health Organization update on Ebola outbreak in West Africa
23 Jan 2015
Speaker: Dr Bruce Aylward, WHO Assistant Director-General in charge of the Ebola operational response
Video: http://webtv.un.org/watch/world-health-organization-press-conference-geneva-15-january-2015/4006783074001

Major milestone for GSK/NIH candidate Ebola vaccine as first doses shipped to Liberia for use in phase III clinical trial
23 January 2015, Issued: London, UK
Healthcare workers among those to be vaccinated in large-scale trial involving up to 30,000 people due to start in the coming weeks
GSK has announced that the first batch of its candidate Ebola vaccine is being shipped to west Africa and is expected to arrive in Liberia later today Friday 23 January. The shipment, containing an initial 300 vials of the candidate vaccine, is the first to arrive in one of the main Ebola affected countries and will be used to start the first large-scale efficacy trial of experimental Ebola vaccines in the coming weeks.

The candidate vaccine is currently being tested in five small phase I clinical trials in the UK, USA, Switzerland and Mali, involving around 200 healthy volunteers in total. Initial data from these trials show that the candidate vaccine has an acceptable safety profile, including in a west African population, and across the different doses evaluated. Based on the safety and immunological data available from these trials, GSK has selected the most appropriate dosage level to advance to the next phases of clinical testing. Results from the first of the phase I studies were published in November 2014 and results from the remaining phase I studies will be published in the coming months.

The selected dose will now be tested in a large phase III clinical trial led by the US National Institutes of Health (NIH) which is expected to involve up to 30,000 people, one third of whom will receive GSK’s candidate Ebola vaccine. It will compare the candidate vaccine to a control vaccine to assess whether the immune response seen in phase I trials actually translates into meaningful protection against Ebola. This trial will begin in Liberia in the coming weeks, subject to regulatory approval, with further shipments of vaccines to follow.

Dr Moncef Slaoui, Chairman of Global Vaccines at GSK, said: “Shipping the vaccine today is a major achievement and shows that we remain on track with the accelerated development of our candidate Ebola vaccine. The initial phase I data we have seen are encouraging and give us confidence to progress to the next phases of clinical testing which will involve the vaccination of thousands of volunteers, including frontline healthcare workers. If the candidate vaccine is able to protect these people, as we hope it will, it could significantly contribute to efforts to bring this epidemic under control and prevent future outbreaks.
“It is important to remember that this vaccine is still in development and any potential future use in mass vaccination campaigns will depend on whether WHO, regulators and other stakeholders are satisfied that the vaccine candidate provides protection against Ebola without causing significant side effects and how quickly large quantities of vaccine can be made.”

GSK is working closely with the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) in the USA to assist with the design and to potentially support trials in other affected countries – Sierra Leone and Guinea – in the coming months. In parallel, GSK plans to begin large phase II safety trials in non-affected west African countries.

The candidate Ebola vaccine shipped today was co-developed by the NIH’s National Institute of Allergy and Infectious Diseases (NIAID) and Okairos, a biotechnology company acquired by GSK in 2013. It uses a type of chimpanzee cold virus, known as chimpanzee adenovirus type 3 (ChAd3), as a carrier to deliver benign genetic material from the Zaire strain of the Ebola virus, which is responsible for the current Ebola outbreak in west Africa. GSK has been working with the NIH to accelerate development in response to the current Ebola epidemic.

Davos: UN launches $1 billion appeal for global Ebola response
21 January 2015
The United Nations today appealed for $1 billion needed for the first six months of 2015 to sustain the momentum to stamp out Ebola in West Africa, where ‘the epidemic has started to turn’ in all three of the worst-hit countries – Guinea, Liberia and Sierra Leone.

“We’re beginning to see an overall decline in number of new cases each week,” Dr. David Nabarro, the UN Special Envoy on Ebola, told a news conference in Davos, Switzerland, at the 2015 World Economic Forum, where global leaders from across business, Government, international organizations, academia and civil society are gathered for strategic dialogues on events and trends shaping the world.

Valerie Amos, UN Emergency Relief Coordinator, also welcomed the “early signs of reduction of Ebola in all three countries” but noted the need to remain vigilant.

And as the Secretary-General of the United Nations [Ban Ki-moon] said yesterday, complacency would be our worst enemy,” Ms. Amos, who is also the UN Under-Secretary-General for Humanitarian Affairs told reporters.

The appeal was launched by Ms. Amos and Dr. Nabarro, who are in Davos where there are some 20 scheduled events at the World Economic Forum devoted to the global fight against the Ebola epidemic…

Press Conference Needs and Requirements for a Global Ebola Response
Valerie Amos, UN Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, and David Nabarro, the UN Secretary-General’s Special Envoy on Ebola, present the latest Overview of the UN system and partners’ Requirements for the Ebola Response. This is an appeal for funds to support the efforts of the national governments of Guinea, Liberia and Sierra Leone as they identify and treat people affected by Ebola, ensure a rapid end to the outbreak, re-establish essential social services and improve people’s food and nutrition security. The appeal includes funds needed for enabling nearby countries to reduce their people’s risk of Ebola infection.

Download audio: http://webcasts.weforum.org/widget/1/davos2015?p=1&pi=1&a=66503

WHO: Ebola response roadmap – Situation report 21 January 2015
[Excerpt]
SUMMARY
:: Case incidence continues to fall in Guinea, Liberia, and Sierra Leone, with a halving time of 1.4 weeks in Guinea, 2.0 weeks Liberia, and 2.7 weeks in Sierra Leone. A combined total of 145 confirmed cases were reported from the 3 countries in the week to 18 January: 20 in Guinea, 8 in Liberia, and 117 in Sierra Leone.
:: Mali has been declared free of Ebola virus disease (EVD) after completing 42 days since the last case tested negative for EVD.
:: Surveillance and information sharing will be increased in the border districts of Guinea-Bissau, Côte d’Ivoire, Mali and Senegal adjacent to the 3 intense-transmission countries.
:: Each of the intense-transmission countries has sufficient capacity to isolate and treat patients, with more than 2 treatment beds per reported confirmed, probable and suspected case. The planned numbers of beds in each country has now been reduced in accordance with falling case incidence.
:: Similarly, each country has sufficient capacity to bury all people known to have died from EVD.
:: Guinea, Liberia and Sierra Leone report that between 89% and 99% of registered contacts are monitored each day, though the number of contacts traced per EVD case remains lower than expected in many districts. In the week to 11 January, 53% of new confirmed cases in Guinea arose from known contacts; in the period between 1 January and 15 January, 53% of new confirmed cases in Liberia arose from known contacts. Equivalent data are not yet available for Sierra Leone.
:: There are currently 27 laboratories providing case-confirmation services in the 3 intense-transmission countries. Five more laboratories are planned in order to meet demand. The mean time between sample collection to sample testing in the 21 days to 18 January was 1.37 days in Guinea, 2.03 days in Liberia, and 2.32 days in Sierra Leone, although several districts in Guinea have yet to report data.
:: Case fatality among hospitalized patients (calculated from all hospitalized patients with a reported definitive outcome) is between 57% and 59% in the 3 intense-transmission countries, with no detectable improvement since the onset of the epidemic.
:: A total of 828 health worker infections have been reported in the 3 intense-transmission countries; there have been 499 reported deaths. The incidence of health worker infections has fallen in Liberia and Sierra Leone, but rose in Guinea throughout December.
:: As an indication of community engagement, 71% of districts in Guinea and 100% of districts in Sierra Leone have a list of key religious leaders who promote safe and dignified burials. No data are available for Liberia. Incidents of community resistance to safe burials and contact tracing continue to be reported in all 3 countries, although they are most common in Guinea.

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
:: There have been in excess of 21,000 reported confirmed, probable, and suspected cases (Annex 1) of EVD in Guinea, Liberia and Sierra Leone (table 1), with more than 8600 deaths (outcomes for many cases are unknown). A total of 20 new confirmed cases were reported in Guinea, 8 in Liberia, and 117 in Sierra Leone in the 7 days to 18 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 828 health worker infections have been reported in the 3 intense-transmission countries; there have been 499 reported deaths (table 3)…

Statement on the 4th meeting of the IHR Emergency Committee regarding the 2014 Ebola outbreak in West Africa
WHO statement
21 January 2015
The fourth meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) 2005 regarding the Ebola virus disease (EVD, or “Ebola”) outbreak in West Africa was conducted with members and advisors of the Emergency Committee on Tuesday, 20 January 2015.

This meeting was convened to review, in accordance with IHR provisions, whether the event continued to constitute a Public Health Emergency of International Concern and, if so, whether this warranted an extension or revision of the three -month date of the expiration of the temporary recommendations, which were first issued on 8 August 2014 and extended on 22 September 2014 and 23 October 2014.

Developments since the Committee’s last meeting were reviewed, including the most recent epidemiological situation. The Committee noted that the number of Ebola cases is decreasing in all three of the most affected countries.

Since the previous meeting, three countries have declared the end of Ebola transmission: Spain, the United States of America, and Mali. One case was imported into the United Kingdom of Great Britain and Northern Ireland (UK), in a health care worker who returned from Sierra Leone and was asymptomatic on exit screening and during travel; she became ill after arrival in the UK.

The Committee expressed concern that additional measures affecting travel, transport and trade that go beyond the temporary recommendations have been put in place in more than 40 countries.

Current response and preparedness activities were reviewed, as well as recent scaling up of the response. Priorities and strategies for moving towards zero cases were presented.

Guinea, Liberia, Sierra Leone, Mali and UK provided an update on and assessment of the Ebola situation in their countries, including progress towards implementation of the temporary recommendations.

Even though a few cases have occurred outside the three most affected countries, the measures recommended appear to have been helpful in limiting further international spread, including the exportation of disease from the three most affected countries.

It was the unanimous view of the Committee that the event continues to constitute a Public Health Emergency of International Concern. The Committee reviewed the temporary recommendations previously issued and stated that all previous temporary recommendations should remain in effect.

The committee provided the following additional advice to the Director-General for her consideration in addressing the Ebola outbreak in accordance with the IHR.

Recommendations for the most affected countries (Guinea, Liberia, Sierra Leone)
The Committee strongly reiterated the previous temporary recommendation on exit screening and highlighted the value of exit screening in these three countries. Exit screening remains critical for minimizing the risk of exportation of Ebola cases. The three most affected countries should maintain robust exit screening until Ebola transmission is confirmed to have stopped in these countries. The Committee again urged affected countries to provide WHO regularly with the number of people screened at international airports and the outcomes of exit screening. The international community should support a sustainable approach to this exit screening.

Recommendations for countries sharing borders with Guinea, Liberia and Sierra Leone
These countries should be conducting active surveillance, including in border areas, and engaging in cross-border cooperation, information and asset sharing, and continued vigilance for new cases. National governments should empower local communities that have land crossings at shared national borders to be part of these activities.

Recommendations for all countries
The Committee reaffirmed the need to avoid unnecessary interference with international travel and trade, as specified in Article 2 of the IHR 2005. The Committee noted that more than 40 countries have implemented additional measures, such as quarantine of returning travellers and refusal of entry. Such measures are impeding the recruitment and return of international responders. They also have harmful effects on local populations by increasing stigma and isolation, and by disrupting livelihoods and economies.

The Committee concluded that the primary emphasis must continue to be on ‘getting to zero’ Ebola cases, by stopping the transmission of Ebola within the three most affected countries. This action is the most important step for preventing international spread. Complacency is the biggest risk to not getting to zero cases. Continued vigilance is essential.

The Director-General thanked the Committee members and advisors for their advice and requested their reassessment of this situation within three months or earlier should circumstances require.

Briefing on the Ebola virus outbreak – General Assembly, Informal meeting of the plenary, 69th session
20 Jan 2015
Informal meeting of the plenary, to hear a briefing by Mr. Ismail Ould Cheikh Ahmed, Special Representative and Head of the United Nations Mission for Ebola Emergency Response (UNMEER), concerning the public health crisis emanating from the Ebola virus outbreak.

A letter from the Secretary-General addressed to the President of the General Assembly, containing a report on progress made in the Ebola response, was issued in document A/69/720.

Video: http://webtv.un.org/watch/briefing-on-the-ebola-virus-outbreak-general-assembly-informal-meeting-of-the-plenary-69th-session/4000843020001

Text: Statement by Ismail Ould Cheikh Ahmed, Special Representative and Head of UNMEER, to the UN General Assembly

Letter dated 12 January 2015 from the Secretary-General addressed to the President of the General Assembly  A/69/720 :: 21 pages, General Assembly, Sixty-ninth session; Agenda item 124; Global health and foreign policy

WHO: Protecting fans from Ebola at the Africa Cup of Nations
23 January 2015 — Thanks to preparedness activities by Equatorial Guinea’s Ministry of Health, FIFA and WHO, the one million people gathered in Equatorial Guinea for the 2015 Africa Cup of Nations are able to focus more on footie than on fears of Ebola. So what does it take to ensure that capacities are in place to prevent, identify and respond to potential Ebola virus transmission at such a large mass gathering?
Read the story from Equatorial Guinea

UNICEF [to 24 January 2015]
http://www.unicef.org/media/media_71508.html

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Media Releases [selected]
As schools reopen in Guinea, UNICEF helps efforts to reduce Ebola transmission risk
DAKAR/NEW YORK/GENEVA, 20 January 2015 – As schools reopen in Guinea, UNICEF and partners are helping reduce as much as possible the risk of Ebola transmission, training teachers to implement safety measures such as daily temperature screening, and supplying thermometers and handwashing kits for schools.

World Bank [to 24 January 2015]
http://www.worldbank.org/en/news/all

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Ebola: Most African Countries Avoid Major Economic Loss but Impact on Guinea, Liberia, Sierra Leone Remains Crippling
Africa-wide impact in 2015The Bank Group expects sub-Saharan Africa to grow at 4.6 percent in 2015, down from a 5.0 percent forecast in June 2014. Projections have been lowered because of global events, including the West African Ebola epidemic as well as the net effect of winners and losers from a steep fall in the global prices of oil and other commodities. Key risks to this projected growth include a renewed spread of Ebola, violent insurgencies, further reductions in commodity prices, and volatile global financial conditions.Much of the economic impact of Ebola beyond the epicenter of directly affected West African countries is based on fear, as was the case during the SARS outbreak in East Asia a decade ago…
January 20, 2015

POLIO [to 24 January 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 21 January 2014
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: Ministers of Health from around the world will convene next week at WHO’s Executive Board meeting, to set global public health policies. Among other topics, representatives are expected to review the current polio epidemiology and global preparedness plans for the phased removal of oral polio vaccines. A report has been prepared, to facilitate discussions, available here and below.
:: In Nigeria, the Expert Review Committee on Polio Eradication and Routine Immunization (ERC) is meeting this week to discuss aggressive strategies to urgently eradicate both wild- and vaccine-derived polioviruses in the country as rapidly as possible.
:: The first wild poliovirus type 1 (WPV1) case of 2015 is reported this week, from Pakistan. The case had onset of paralysis on 3 January, from Khyber Pakhtunkhwa. See ‘Pakistan’ section for more.
:: Bill and Melinda Gates, co-chairs of the Bill & Melinda Gates Foundation, this week published their annual letter, outlining how they believe the world will look like in 15 years. In the letter, they highlight the urgent need to eradicate polio. “Destroying a disease utterly is a very difficult thing to do – so difficult in fact, that it’s happened only once in history, when smallpox was eradicated in 1980. But if we keep working hard… we can get polio out of Africa this year and out of every country in the world in the next several years.”

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Selected country report content:
Pakistan
:: Seven new wild poliovirus type 1 (WPV1) cases were reported in the past week, including the first case with onset of paralysis in 2015. The total number of WPV1 cases in 2014 is 303, and one for 2015 (onset of paralysis on 3 January, from Khyber Pakhtunkhwa – KP).
:: Pakistan accounts for more than 85% of all WPV1 cases worldwide in 2014.
:: To urgently address the intense transmission affecting the country, the government has put in place emergency measures to take advantage of the upcoming ‘low season’ for poliovirus transmission (in the early part of 2015). A ‘low season plan’ has been established, based on lessons learned on accessing populations in insecure areas, engaging communities and fixing remaining operational challenges. Implementation is overseen by Emergency Operations Centres at federal and provincial levels to ensure accountability for the quality of polio eradication operations. More
West Africa
:: Even as polio programme staff across West Africa support efforts to control the Ebola outbreak affecting the region, efforts are being made in those countries not affected by Ebola to vaccinate children against polio to create a buffer zone surrounding the Ebola-affected countries. The Ebola crisis in western Africa continues to have an impact on the implementation of polio eradication activities in Liberia, Guinea and Sierra Leone. Supplementary immunization activities (SIAs) in these countries have been postponed and the quality of acute flaccid paralysis surveillance has markedly decreased throughout 2014.
:: NIDs are planned using bivalent oral polio vaccine (OPV) in Niger and Benin on 27 February to 2 March, and Subnational Immunization Days (SNIDs) tentatively in Mali in February with dates to be confirmed. From 27 to 31 March, NIDs will take place in Benin, Burkina Faso, Côte d’Ivoire, Mali, Niger and Senegal using trivalent OPV. NIDs are also scheduled on those dates for the three Ebola-affected countries Guinea, Liberia and Sierra Leone.

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Poliomyelitis: Report by the secretariat
WHO 136th Executive Board (January 2015)
EB136/21 – 16 January 2015 – Provisional agenda item 8.2

WHO  [to 24 January 2015]
:: 136th WHO Executive Board session
26 January–3 February 2015 –
– Main Documents: http://apps.who.int/gb/e/e_eb136.html

:: Noncommunicable diseases take 16 million lives prematurely annually
19 January 2015 — Urgent government action is needed to meet global targets to reduce the burden of noncommunicable diseases (NCDs), and prevent the annual toll of 16 million people dying prematurely – before the age of 70 – from heart and lung diseases, stroke, cancer and diabetes, according to a new WHO report. The report states that most premature NCD deaths are preventable.
– Read the news release on the new NCDs status report
– Read the NCDs status report

:: Global Alert and Response (GAR): Disease Outbreak News (DONs)
– Middle East respiratory syndrome coronavirus (MERS-CoV) – Oman 23 January 2015
– Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 20 January 2015
– Human infection with avian influenza A(H7N9) virus – China 19 January 2015

:: The Weekly Epidemiological Record (WER) for 23 January 2015, vol. 90,4 (pp. 17–24) includes –
Global Advisory Committee on Vaccine Safety, 3–4 December 2014

WHO Regional Offices

WHO African Region AFRO
Press Releases
:: More than 2.5 million people reached in emergency response campaign with anti-malarial medicines in Sierra Leone – 22 January 2015
:: Meningitis A vaccine now recommended in routine immunization schedules
Brazzaville, 20 January 2015 – The World Health Organization (WHO) now recommends the conjugate meningitis A vaccine MenAfriVac® to be introduced in routine immunization schedules in sub-Saharan Africa. This recommendation ensures that infants are protected against meningitis and population-wide immunity is maintained.The use of the MenAfriVac® vaccine to prevent meningitis A epidemics is one of the greatest vaccination success stories in public health history and highlights what partners can accomplish when unified by a compelling cause. In 2014, the MenAfriVac® campaigns reached more than 63 million people with remarkable success.

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

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WHO South-East Asia Region SEARO
:: India: first to adapt the Global Monitoring Framework on noncommunicable diseases (NCDs)
January 2015
Every year, roughly 5.8 million Indians die from heart and lung diseases, stroke, cancer and diabetes. In other words, 1 in 4 Indians risks dying from an NCD before they reach the age of 70. Full story – India: first to adapt the Global Monitoring Framework on NCDs

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WHO European Region EURO
:: Ukraine health system buckling under weight of humanitarian crisis 19-01-2015

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WHO Eastern Mediterranean Region EMRO
:: WHO provides support for hearing impaired children in Iraq
22 January 2015 – WHO and the Ministry of Health of the Kurdistan region have provided cochlear implants to 20 internally displaced and refugee children in Iraq as part of a larger WHO disability prevention and reduction project targeting internally displaced persons, refugees and affected host communities in Dohuk. WHO is also providing support to strengthen health services. To continue to improve its humanitarian response in Iraq, WHO requires more financial resources. Of the US$ 187 million needed, the Organization has so far raised only US$ 55 million (29%).

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WHO Western Pacific Region
No new digest content identified.

California measles outbreak expands to 78 cases; more likely
By Rosanna Xia and Rong-Gong Lin II
Los Angeles Times, January 23,2 015

The measles outbreak centered in California continues to expand, with officials now confirming 78 cases of the illness in seven states and Mexico.

The California Department of Public Health said there are now 68 cases in the state – 48 that have been directly linked to being at Disneyland or Disney California Adventure last month. Some people also visited one or both of the parks while infectious in January.

The measles outbreak has also spread beyond those who visited Disneyland in December and January and is infecting people in the broader community…
…The California patients range in age from 7 months to 70 years. The vaccination status is known for 39 of the patients. Of those, 32 were unvaccinated, one had received partial vaccination and seven were fully vaccinated.

Of the cases in California, about one in four have had to be hospitalized, officials said.

Disneyland officials confirmed to The Times that five Disneyland employees have been diagnosed with measles. All Disneyland employees who could have been in contact with those five have been asked to provide vaccination records or do a blood test that shows they have built immunity to the disease.
Any employees who had not been vaccinated or could not confirm their immunity status have been asked to go on paid leave until their status could be confirmed, company officials said.

Healthcare officials said it is safe to go Disneyland and other venues with large crowds if you are immunized for measles…

European Medicines Agency Watch [to 24 January 2015]
21/01/2015

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:: New international standard to improve safety of medicines
New EMA guide will help industry and regulatory authorities to implement changes
The European Medicines Agency (EMA) has published a guide to support the implementation of a new international standard for the safety monitoring of medicines in the European Union (EU). The so-called ISO ICSR standard improves the reporting of suspected side effects of medicines in Individual Case Safety Reports (ICSRs). The use of the new international standard will take effect on 1 July 2016.

ISO ICSR aims to establish the same format for the reports on individual cases of suspected side effects in patients due to a medicine across the world. It also is expected to include better information on medicines that might be associated with an adverse drug reaction and on the therapeutic uses of those medicines.

In addition, the standard also strengthens personal data protection in the records of ICSRs collected by pharmaceutical companies and regulatory authorities.

FDA Watch [to 24 January 2015]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm

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:: FDA approves a second vaccine to prevent serogroup B meningococcal disease
January 23, 2015
The U.S. Food and Drug Administration today approved Bexsero, a vaccine to prevent invasive meningococcal disease caused by Neisseria meningitidis serogroup B in individuals 10 through 25 years of age.

Bexsero is the second vaccine approved by the FDA in the past three months to prevent this disease. The agency approved the first meningococcal serogroup B vaccine in October 2014. Before these approvals, existing approved meningococcal vaccines in the U.S. covered only four of the five main serogroups of N. meningitidis bacteria that cause meningococcal disease: A, C, Y and W…

… “With today’s approval of Bexsero, the U.S. now has two vaccines for the prevention of serogroup B meningococcal disease,” said Karen Midthun, M.D., director of the FDA’s Center for Biologics Evaluation and Research. “The approval of these vaccines represents a major public health accomplishment toward preventing this life-threatening disease.”…

Industry Watch [to 24 January 2015]
:: Novartis Bexsero vaccine approved by FDA for the prevention of meningitis B, the leading cause of bacterial meningitis in the US
Jan 23, 2015, 18:35 ET
Novartis announced today that the US Food and Drug Administration (FDA) has granted accelerated approval of Bexsero® (Meningococcal Group B Vaccine [recombinant, adsorbed]) for active immunization to prevent invasive meningococcal disease caused by serogroup B (also known as meningitis…

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:: Major milestone for GSK/NIH candidate Ebola vaccine as first doses shipped to Liberia for use in phase III clinical trial
23 January 2015, Issued: London, UK
Healthcare workers among those to be vaccinated in large-scale trial involving up to 30,000 people due to start in the coming weeks [see full press release above in Ebola/EVD section]

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:: Prevenar 13 Receives CHMP Positive Opinion For Prevention Of Vaccine-Type Pneumococcal Pneumonia in Adults
January 22, 2015 11:21 AM Eastern Standard Time
NEW YORK–(BUSINESS WIRE)–Pfizer Inc. (NYSE:PFE) announced today that the European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) has adopted a positive opinion recommending that the indication for Prevenar 13* (pneumococcal polysaccharide conjugate vaccine [13-valent, adsorbed]) be expanded to include the prevention of pneumonia caused by the 13 pneumococcal serotypes in the vaccine in adults 18 years and older. Prevenar 13 is currently approved in Europe for the prevention of invasive pneumococcal disease (IPD) in the same population. The CHMP’s positive opinion will now be reviewed by the European Commission (EC). The decision on whether to approve Prevenar 13 for this indication will be made by the EC and will be applicable to all European Union member states plus Iceland, Lichtenstein and Norway…

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:: Specialty Vaccine Company PaxVax Appoints Nima Farzan as President
January 21, 2015
REDWOOD CITY, Calif.–(BUSINESS WIRE)–PaxVax, Inc., a specialty vaccine company focused on travel and biodefense, today announced the appointment of Nima Farzan as President and Chief Operating Officer (COO). Mr. Farzan, who has served as PaxVax COO for the past three years, will be responsible for the company’s global operations including the finance, production and commercial functions. The company also announced today that Mr. Farzan has joined the PaxVax Board of Directors. Kenneth Kelley will continue to serve as the company’s Chief Executive Officer and as a Director….

BMGF – Gates Foundation Watch [to 24 January 2015]
http://www.gatesfoundation.org/Media-Center/Press-Releases

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:: Bill and Melinda Gates Release 2015 Annual Letter: “Our Big Bet for the Future”
SEATTLE (January 21, 2015)— Today, Bill and Melinda Gates share their 2015 Annual Letter.
“Our Big Bet for the Future” addresses the breakthroughs they see coming over the next fifteen years that will improve the lives of people in poor countries faster than at any other time in history.
Annual Letter segment – One: Health Child deaths will go down, and more diseases will be wiped out

Meeting Twenty: The Presidential Commission for the Study of Bioethical Issues – Focus on the current Ebola virus disease (EVD) epidemic
February 5-6, 2015, Washington, D.C.
Federal Register Notice
Agenda
Watch the live webcast Feb. 5-6
Location: The Hamilton Crowne Plaza Hotel, 1001 14th St. NW, Washington, DC 20005

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The Commission is considering three areas of ethical concern raised by public health emergency response with a focus on the current Ebola virus disease (EVD) epidemic. The first area concerns U.S. public policies that restrict association or movement (such as quarantine), which have recently been proposed and/or employed for health care workers and military personnel returning from countries affected by EVD in western Africa.

The second area concerns the ethics of placebo-controlled trials in the context of public health emergencies, and the EVD epidemic specifically, where the drug undergoing testing might be effective against the disease causing the emergency.
The third area of concern is the ethical considerations relevant to collecting and storing biospecimens during a public health emergency, such as the EVD epidemic, and sharing these
specimens and associated data internationally for future research…

The Bioethics Commission Requests Comment on Ethical Considerations in the EVD Response
…The Commission is particularly interested in receiving public commentary regarding the following issues in the context of public health emergency response generally and the EVD epidemic specifically:
:: Ethical and scientific standards for public health emergency response;
:: Ethical and scientific standards that guide the use of quarantine or other movement restrictions during public health emergencies;
:: The impact of quarantine or other movement restrictions on the availability or willingness of health workers to volunteer to contain the epidemic in disease-affected areas;
:: The impact of quarantine or other movement restrictions on public fear and anxiety about potential threats to public health;
:: How U.S. public policy and public health response to the current EVD epidemic might or should affect public attitudes to, and further U.S. policy and public health response to, other current and future public health issues and emergencies;
:: Ethical and scientific standards for placebo-controlled trials during public health emergencies;
:: Ethical and scientific standards for collection, storage, and international sharing of biospecimens and associated data during public health emergencies.

Annals of Internal Medicine
20 January 2015, Vol. 162. No. 2
http://annals.org/issue.aspx

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Ideas and Opinions | 20 January 2015
Drug and Vaccine Access in the Ebola Epidemic: Advising Caution in Compassionate Use
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.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 24 January 2015)

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Research article
Cost to households in treating maternal complications in northern Ghana: a cross sectional study
Maxwell Ayindenaba Dalaba12*, Patricia Akweongo3, Raymond Akawire Aborigo24, Happiness Pius Saronga15, John Williams2, Gifty Apiung Aninanya2, Rainer Sauerborn1 and Svetla Loukanova1
Author Affiliations
BMC Health Services Research 2015, 15:34 doi:10.1186/s12913-014-0659-1
Published: 22 January 2015
Abstract (provisional)
Background
The cost of treating maternal complications has serious economic consequences to households and can hinder the utilization of maternal health care services at the health facilities. This study estimated the cost of maternal complications to women and their households in the Kassena-Nankana district of northern Ghana.
Methods
We carried out a cross-sectional study between February and April 2014 in the Kassena-Nankana district. Out of a total of 296 women who were referred to the hospital for maternal complications from the health centre level, sixty of them were involved in the study. Socio-demographic data of respondents as well as direct and indirect costs involved in the management of the complications at the hospital were collected from the patient’s perspective. Analysis was performed using STATA 11.ResultsOut of the 60 respondents, 60% (36) of them suffered complications due to prolonged labour, 17% (10) due to severe abdominal pain, 10%(6) due to anaemia/malaria and 7%(4) due to pre-eclampsia . Most of the women who had complications were primiparous and were between 21?25 years old. Transportation cost accounted for the largest cost, representing 32% of total cost of treatment. The median direct medical cost was US$8.68 per treatment, representing 44% of the total cost of treatment. Indirect costs accounted for the largest proportion of total cost (79%). Overall, the median expenditure by households on both direct and indirect costs per complication was US$32.03. Disaggregating costs by type of complication, costs ranged from a median of US$58.33 for pre-eclampsia to US$6.84 for haemorrrhage. The median number of days spent in the hospital was 2?days – five days for pre-eclampsia. About 33%( 6) of households spent more than 5% of annual household expenditure and therefore faced catastrophic payments.
Conclusion
Although maternal health services are free in Ghana, women still incur substantial costs when complications occur and face the risk of incurring catastrophic health expenditure.

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Research article
Mobile phone text messaging interventions for HIV and other chronic diseases: an overview of systematic reviews and framework for evidence transfer
Lawrence Mbuagbaw123*, Sara Mursleen1, Lyubov Lytvyn1, Marek Smieja14, Lisa Dolovich5 and Lehana Thabane12678
Author Affiliations
BMC Health Services Research 2015, 15:33 doi:10.1186/s12913-014-0654-6
Published: 22 January 2015
Abstract (provisional)
Background
Strong international commitment and the widespread use of antiretroviral therapy have led to higher longevity for people living with human immune deficiency virus (HIV). Text messaging interventions have been shown to improve health outcomes in people living with HIV. The objectives of this overview were to: map the state of the evidence of text messaging interventions, identify knowledge gaps, and develop a framework for the transfer of evidence to other chronic diseases.
Methods
We conducted a systematic review of systematic reviews on text messaging interventions to improve health or health related outcomes. We conducted a comprehensive search of PubMed, EMBASE (Exerpta Medica Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycINFO, Web of Science (WoS) and the Cochrane Library on the 17th April 2014. Screening, data extraction and assessment of methodological quality were done in duplicate. Our findings were used to develop a conceptual framework for transfer.
Results
Our search identified 135 potential systematic reviews of which nine were included, reporting on 37 source studies, conducted in 19 different countries. Seven of nine (77.7%) of these reviews were high quality. There was some evidence for text messaging as a tool to improve adherence to antiretroviral therapy. Text messages also improved attendance at appointments and behaviour change outcomes. The findings were inconclusive for self-management of illness, treatment of tuberculosis and communicating results of medical investigations. The geographical distribution of text messaging research was limited to specific regions of the world. Prominent knowledge gaps included the absence of data on long term outcomes, patient satisfaction, and economic evaluations. The included reviews also identified methodological limitations in many of the primary studies.
Conclusions
Global evidence supports the use of text messaging as a tool to improve adherence to medication and attendance at scheduled appointments. Given the similarities between HIV and other chronic diseases (long-term medications, life-long care, strong link to behaviour and the need for home-based support) evidence from HIV may be transferred to these diseases using our proposed framework by integration of HIV and chronic disease services or direct transfer.

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Research article
How rural and urban parents describe convenience in the context of school-based influenza vaccination: a qualitative study
Candace Lind1*, Margaret L Russell2, Ramona Collins1, Judy MacDonald3, Christine J Frank1 and Amy E Davis4
Author Affiliations
BMC Health Services Research 2015, 15:24 doi:10.1186/s12913-014-0663-5
Published: 22 January 2015
Abstract (provisional)
Background
Seasonal influenza vaccine uptake among school-age children has been low, particularly among rural children, even in jurisdictions in Canada where this immunization is publicly funded. Providing this vaccination at school may be convenient for parents and might contribute to increased vaccine uptake, particularly among rural children. We explore the construct of convenience as an advantage of school based influenza vaccination. We also explore for rural urban differences in this construct.
Methods
Participants were parents of school-aged children from Alberta, Canada. We qualitatively analyzed focus group data from rural parents using a thematic template that emerged from prior work with urban parents. Both groups of parents had participated in focus groups to explore their perspectives on the acceptability of adding an annual influenza immunization to the immunization program that is currently delivered in Alberta schools. Data from within the theme of `convenience? from both rural and urban parents were then further explored for sub-themes within convenience.
Results
Data were obtained from nine rural and nine urban focus groups. The template of themes that had arisen from prior analysis of the urban data applied to the rural data. Convenience was a third level theme under Advantages. Five fourth level themes emerged from within convenience. Four of the five sub-themes were common to both rural and urban participants: reduction of parental burden to schedule, reduction in parental lost time, decrease in parental stress and increase in physical access points for influenza immunization. The fifth subtheme, increases temporal access to influenza immunization, emerged uniquely from the rural data.
Conclusions
Both rural and urban parents perceived that convenience would be an advantage of adding an annual influenza immunization to the vaccinations currently given to Alberta children at school. Improving temporal access to such immunization may be a more relevant aspect of convenience to rural than to urban parents.

Emerging Infectious Diseases
Volume 21, Number 2—February 2015
http://wwwnc.cdc.gov/eid/

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Perspective
Evaluation of Border Entry Screening for Infectious Diseases in Humans
Linda A. Selvey , Catarina Antão, and Robert Hall
Author affiliations: Curtin University, Perth, Western Australia, Australia (L.A. Selvey, C. Antão); Monash University, Melbourne, Victoria, Australia (R. Hall)
Abstract
In response to the severe acute respiratory syndrome (SARS) pandemic of 2003 and the influenza pandemic of 2009, many countries instituted border measures as a means of stopping or slowing the spread of disease. The measures, usually consisting of a combination of border entry/exit screening, quarantine, isolation, and communications, were resource intensive, and modeling and observational studies indicate that border screening is not effective at detecting infectious persons. Moreover, border screening has high opportunity costs, financially and in terms of the use of scarce public health staff resources during a time of high need. We discuss the border-screening experiences with SARS and influenza and propose an approach to decision-making for future pandemics. We conclude that outbreak-associated communications for travelers at border entry points, together with effective communication with clinicians and more effective disease control measures in the community, may be a more effective approach to the international control of communicable diseases.

The European Journal of Public Health
Volume 25, Issue 1, 01 February 2015
http://eurpub.oxfordjournals.org/content/24/6

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Migration and health
Suicide among immigrants in Europe—a systematic literature review
Jacob Spallek, Anna Reeske, Marie Norredam, Signe Smith Nielsen, Jessica Lehnhardt, Oliver Razum
Eur J Public Health (2015) 25 (1): 63-71
DOI: http://dx.doi.org/10.1093/eurpub/cku121
First published online: 5 August 2014 (9 pages)
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How do immigrants use primary health care services? A register-based study in Norway
Esperanza Diaz, Amaia Calderón-Larrañaga, Alexandra Prado-Torres, Beatriz Poblador-Plou, Luis-Andrés Gimeno-Feliu
Eur J Public Health (2015) 25 (1): 72-78
DOI: http://dx.doi.org/10.1093/eurpub/cku123
First published online: 1 August 2014 (7 pages)
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Caesarean section by immigrants’ length of residence in Norway: a population-based study
Ingvil K. Sørbye, Anne K. Daltveit, Johanne Sundby, Camilla Stoltenberg, Siri Vangen
Eur J Public Health (2015) 25 (1): 78-84
DOI: http://dx.doi.org/10.1093/eurpub/cku135
First published online: 5 September 2014 (7 pages)
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Remigration of migrants with severe disease: myth or reality?—a register-based cohort study
Marie Norredam, Oluf Hoejbjerg Hansen, Jørgen Holm Petersen, Anton E Kunst, Maria Kristiansen, Allan Krasnik, Charles Agyemang
Eur J Public Health (2015) 25 (1): 84-89
DOI: http://dx.doi.org/10.1093/eurpub/cku138
First published online: 8 September 2014 (6 pages)
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Sexual and gender-based violence in the European asylum and reception sector: a perpetuum mobile?
Ines Keygnaert, Sonia F. Dias, Olivier Degomme, Walter Devillé, Patricia Kennedy, András Kováts, Sara De Meyer, Nicole Vettenburg, Kristien Roelens, Marleen Temmerman
Eur J Public Health (2015) 25 (1): 90-96
DOI: http://dx.doi.org/10.1093/eurpub/cku066
First published online: 29 May 2014 (7 pages)

Journal of Pediatrics
February 2015 Volume 166, Issue 2, p215-506
http://www.jpeds.com/current

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Frequent Vaccination Missed Opportunities at Primary Care Encounters Contribute to Underimmunization
Linda Y. Fu, MD, MS, Kathleen Zook, RN, MPH, Janet Gingold, MD, MPH, Catherine W. Gillespie, PH, PhD, Christine Briccetti, MD, MPH, Denice Cora-Bramble, MD, MBA, Jill G. Joseph, MD, PhD, Rachel Y. Moon, MD
Received: June 17, 2014; Received in revised form: September 10, 2014; Accepted: October 24, 2014; Published Online: November 21, 2014
DOI: http://dx.doi.org/10.1016/j.jpeds.2014.10.066
Abstract
Objective
To examine missed opportunities to administer an eligible vaccination (MOs) and their contribution to underimmunization in contemporary pediatric practices.
Study design
This study was a retrospective analysis from 42 diverse pediatric practices located throughout the US. Medical records of 50 randomly selected children 3-18 months of age per practice were reviewed in Spring 2013. Immunization status for age and MOs were assessed as of each encounter and as of March 1, 2013.
Results
Of 2076 eligible patients, 72.7% (95% CI 67.6-77.9) were up-to-date with receipt of standard vaccines. Most children (82.4%; 95% CI 78.3-85.9) had at least 1 MO, and 37.8% (95% CI 30.0-46.2) had at least one MO to administer an overdue vaccination. After adjustment, risk of underimmunization was 3.5 times greater for patients who had ever experienced an MO for an overdue vaccination compared with those who had not (adjusted relative risk = 3.5; 95% CI 2.8-4.3). If all age-appropriate vaccinations had been administered at the last recorded encounter, 45.5% (95% CI 36.8-54.5) of the underimmunized patients would have been up to date at the time of assessment.
Conclusion
MOs were common and contributed substantially to underimmunization in this contemporary sample of diverse primary care practice settings.

Nature
Volume 517 Number 7535 pp411-522 22 January 2015
http://www.nature.com/nature/current_issue.html

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Nature | Article
A new antibiotic kills pathogens without detectable resistance
Losee L. Ling, Tanja Schneider, Aaron J. Peoples, Amy L. Spoering, Ina Engels, Brian P. Conlon, Anna Mueller, Till F. Schäberle, Dallas E. Hughes, Slava Epstein, Michael Jones, Linos Lazarides,
Victoria A. Steadman, Douglas R. Cohen, Cintia R. Felix, K. Ashley Fetterman, William P. Millett,
Anthony G. Nitti, Ashley M. Zullo, Chao Chen & Kim Lewis
Affiliations
Nature 517, 455–459 (22 January 2015)
doi:10.1038/nature14098
Abstract
Antibiotic resistance is spreading faster than the introduction of new compounds into clinical practice, causing a public health crisis. Most antibiotics were produced by screening soil microorganisms, but this limited resource of cultivable bacteria was overmined by the 1960s. Synthetic approaches to produce antibiotics have been unable to replace this platform. Uncultured bacteria make up approximately 99% of all species in external environments, and are an untapped source of new antibiotics. We developed several methods to grow uncultured organisms by cultivation in situ or by using specific growth factors. Here we report a new antibiotic that we term teixobactin, discovered in a screen of uncultured bacteria. Teixobactin inhibits cell wall synthesis by binding to a highly conserved motif of lipid II (precursor of peptidoglycan) and lipid III (precursor of cell wall teichoic acid). We did not obtain any mutants of Staphylococcus aureus or Mycobacterium tuberculosis resistant to teixobactin. The properties of this compound suggest a path towards developing antibiotics that are likely to avoid development of resistance.

New England Journal of Medicine
January 22, 2015 Vol. 372 No. 4
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
Foreseeable Risks? Informed Consent for Studies within the Standard of Care
Chana A. Sacks, M.D., and Celestine E. Warren, A.B.
N Engl J Med 2015; 372:306-307 January 22, 2015 DOI: 10.1056/NEJMp1415113
The Office for Human Research Protections has drafted guidelines on disclosing reasonably foreseeable risks in trials involving interventions that are within the standard of care. But what risks, aside from those already seen in clinical care, are reasonably foreseeable?

Pediatrics
January 2015, VOLUME 135 / ISSUE 1
http://pediatrics.aappublications.org/current.shtml
[Reviewed earlier]
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Published online January 19, 2015
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
(doi: 10.1542/peds.2014-2715)
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.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 24 January 2015)

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The Western Africa Ebola Virus Disease Epidemic Exhibits Both Global Exponential and Local Polynomial Growth Rates
January 21, 2015 • Research
Abstract
Background:
While many infectious disease epidemics are initially characterized by an exponential growth in time, we show that district-level Ebola virus disease (EVD) outbreaks in West Africa follow slower polynomial-based growth kinetics over several generations of the disease.
Methods:
We analyzed epidemic growth patterns at three different spatial scales (regional, national, and subnational) of the Ebola virus disease epidemic in Guinea, Sierra Leone and Liberia by compiling publicly available weekly time series of reported EVD case numbers from the patient database available from the World Health Organization website for the period 05-Jan to 17-Dec 2014.
Results:
We found significant differences in the growth patterns of EVD cases at the scale of the country, district, and other subnational administrative divisions. The national cumulative curves of EVD cases in Guinea, Sierra Leone, and Liberia show periods of approximate exponential growth. In contrast, local epidemics are asynchronous and exhibit slow growth patterns during 3 or more EVD generations, which can be better approximated by a polynomial than an exponential function.
Conclusions:
The slower than expected growth pattern of local EVD outbreaks could result from a variety of factors, including behavior changes, success of control interventions, or intrinsic features of the disease such as a high level of clustering. Quantifying the contribution of each of these factors could help refine estimates of final epidemic size and the relative impact of different mitigation efforts in current and future EVD outbreaks.

Vaccine
Volume 33, Issue 6, Pages 749-832 (4 February 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/6

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Use of placebos in Phase 1 preventive HIV vaccine clinical trials
Pages 749-752
Yunda Huang, Shelly T. Karuna, Holly Janes, Nicole Frahm, Martha Nason, Paul T. Edlefsen, James G. Kublin, Lawrence Corey, M. Juliana McElrath, Peter B. Gilbert
Abstract
Phase 1 preventive HIV vaccine trials are often designed as randomized, double-blind studies with the inclusion of placebo recipients. Careful consideration is needed to determine when the inclusion of placebo recipients is highly advantageous and when it is optional for achieving the study objectives of assessing vaccine safety, tolerability and immunogenicity. The inclusion of placebo recipients is generally important to form a reference group that ensures fair evaluation and interpretation of subjective study endpoints, or endpoints whose levels may change due to exposures besides vaccination. In some settings, however, placebo recipients are less important because other data sources and tools are available to achieve the study objectives.
Highlights
:: Study objectives and the research context drive the design of Phase 1 preventive HIV vaccine trials.
:: The inclusion of placebo recipients enables blinding and fair assessment of study endpoints.
:: The inclusion of placebo recipients provides valuable in-study reference data.
:: Placebo recipients are less important for vaccines with extensive safety data.
:: Placebo recipients are less important when baseline data are proper as reference information.

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How and why researchers use the number needed to vaccinate to inform decision making—A systematic review
Review Article
Pages 753-758
Ahmed Hashim, Vica Dang, Shelly Bolotin, Natasha S. Crowcroft
Abstract
Background
The number needed to vaccinate (NNV) is a measure that has been widely used in the scientific literature to draw conclusions about the usefulness and cost-effectiveness of various immunization programmes. The main objective of this review is to examine how and why the NNV has been used and reported in the published literature.
Methods
Electronic databases were searched and records were screened against the eligibility criteria by two independent authors. We included papers that reported and interpreted NNV.
Results
We identified 27 studies, the designs including observational studies, economic analyses, systematic reviews, and commentaries. The NNV has been used in the literature to describe three main themes: potential benefits of vaccination programmes, cost-effectiveness, and economic analyses, and modelling studies to compare different vaccination strategies.
Conclusions
NNV has been used in a wide variety of ways in the literature, yet there are no defined thresholds for what is a favourable NNV. Furthermore, the generalizability of the NNV is usually limited. Further work is required to determine the most appropriate use of this measure.

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Interventions to increase influenza vaccination rates in children with high-risk conditions—A systematic review
Review Article
Pages 759-770
N.W. Aigbogun, J.I. Hawker, A. Stewart
Highlights
:: Influenza is a common cause of morbidity and mortality, and children with high-risk conditions (HRCs) are more likely to be hospitalized with influenza than previously healthy children.
:: Despite recommendations by the World Health Organization (WHO), annual influenza vaccination rates in children with HRCs have remained low, especially when compared to rates in other risk groups such as the elderly and pregnant women.
:: This systematic review identifies, describes and compares studies of interventions to improve influenza vaccination rates in children with HRCs – we found good evidence that reminder letters are effective, but weak evidence of effectiveness of other strategies or combination of strategies.
:: There is a need for further research of these interventions, possibly outside the United States, as almost all of the studies included in this review originated from there.

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Asking about human papillomavirus vaccination and the usefulness of registry validation: A study of young women recruited using Facebook
Original Research Article
Pages 826-831
Bharathy Gunasekaran, Yasmin Jayasinghe, Julia M.L. Brotherton, Yeshe Fenner, Elya E. Moore, John D. Wark, Ashley Fletcher, Sepehr N. Tabrizi, Suzanne M. Garland
Abstract
Background
Australia was the first country to implement a government-funded National Human Papillomavirus (HPV) Vaccination Programme. We assessed HPV vaccine uptake comparing self-reported and Register validated estimates, and the knowledge and attitudes of young women with regards to HPV vaccination post-implementation of the programme.
Methods
Females, aged 16–25 years living in Victoria, Australia, were recruited using targeted advertising on Facebook from May to September 2010, to complete a web-based questionnaire.
Results
Geographic distribution, Indigenous and socio-economic status of the 278 participants were representative of the target population. Overall, 210/278 (76%) had heard of HPV vaccines, with 162/278 (58%) reporting receipt of at least one dose of vaccine, and 54 (19%) unsure. Verification of HPV vaccination status of 142 consenting participants (51%) showed 71% had received at least one dose. Main reasons for vaccination were for protection against HPV infection and cervical cancer (96%) and because it was free (87%), whereas unvaccinated women were uncertain of their eligibility (50%), concerned about adverse reactions (32%), or perceived that vaccination was not needed if they were monogamous (32%).
Conclusion
The potential utility of a vaccination register in the context of a national programme is apparent from the large proportion of young women who were unsure of their vaccine status. HPV vaccine knowledge among participants was relatively high suggesting the national programme has successfully communicated to the majority of eligible women, the purpose and limitations of the vaccine. Vigilance is needed to ensure that young women follow through with Pap testing in vaccine eligible cohorts. The ongoing vaccination programme for pre-adolescent girls and boys should communicate to parents that those with one sexual partner can still acquire HPV and that the safety of the vaccine is now well demonstrated.

Vaccine
Volume 33, Issue 5, Pages 585-748 (29 January 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/5

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Age at HPV vaccine initiation and completion among US adolescent girls: Trend from 2008 to 2012
Pages 585-587
Mahbubur Rahman, Christine J. McGrath, Jacqueline M. Hirth, Abbey B. Berenson
Highlights
:: We analyzed National Immunization Survey of Teens 2008–2012 data to examine what proportion of adolescent girls receives HPV vaccine at <13 years of age.
:: The weighted proportion of girls who initiated the vaccine at <13 years of age increased from 14.1% in 2008 to 55.9% in 2012.
:: Additional efforts are needed to increase HPV vaccine uptake among adolescent girls as only half of them receive this vaccine at ACIP recommended age.

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Supporting countries in establishing and strengthening NITAGs: Lessons learned from 5 years of the SIVAC initiative
Review Article
Pages 588-595
Alex Adjagba, Kamel Senouci, Robin Biellik, Nyambat Batmunkh, Pape Coumba Faye, Antoine Durupt, Bradford D. Gessner, Alfred da Silva
Abstract
To empower governments to formulate rational policies without pressure from any group, and to increase the use of evidence-based decision-making to adapt global recommendations on immunization to their local context, the WHO has recommended on multiple occasions that countries should establish National Immunization Technical Advisory Groups (NITAGs). The World Health Assembly (WHA) reinforced those recommendations in 2012 when Member States endorsed the Decade of Vaccines Global Vaccine Action Plan (GVAP). NITAGs are multidisciplinary groups of national experts responsible for providing independent, evidence-informed advice to health authorities on all policy-related issues for all vaccines across all populations. In 2012, according to the WHO–UNICEF Joint Reporting Form, among 57 countries eligible for immunization program financial support from the GAVI Alliance, only 9 reported having a functional NITAG. Since 2008, the Supporting Independent Immunization and Vaccine Advisory Committees (SIVAC) Initiative (at the Agence de Médecine Préventive or AMP) in close collaboration with the WHO and other partners has been working to accelerate and systematize the establishment of NITAGs in low- and middle-income countries. In addition to providing direct support to countries to establish advisory groups, the initiative also supports existing NITAGs to strengthen their capacity in the use of evidence-based processes for decision-making aligned with international standards. After 5 years of implementation and based on lessons learned, we recommend that future efforts should target both expanding new NITAGs and strengthening existing NITAGs in individual countries, along three strategic lines: (i) reinforce NITAG institutional integration to promote sustainability and credibility, (ii) build technical capacity within NITAG secretariats and evaluate NITAG performance, and (iii) increase networking and regional collaborations. These should be done through the development and dissemination of tools and guidelines, and information through a variety of adapted mechanisms.

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The role of parental attitudes and provider discussions in uptake of adolescent vaccines
Original Research Article
Pages 642-647
Vaughn I. Rickert, Susan J. Rehm, Matthew C. Aalsma, Gregory D. Zimet
Abstract
The purpose of this study was to examine the relationship between parental vaccine attitudes, the number of specific vaccines discussed with a provider, and immunization outcomes including discussing immunization with their teen, knowledge of adolescent vaccine schedule, and their son or daughter being up-to-date on recommended vaccines using a nationally weight sample. Parents completed an internet-based survey between December 2012 and January 2013 and we computed a vaccine attitude scale (higher scores indicating stronger and more positive attitudes toward vaccination of teen) for each parent and categorized them into one of three groups: low (n = 76), medium (n = 207) or high (n = 215). We also constructed a vaccine discussion scale representing the number of vaccines discussed with their adolescent’s physician. Parents who were identified as having high vaccine attitudes were significantly more likely to report their physician talked with them about a particular vaccine. Using logistic regression and controlling for respondent’s gender and age, income, and teen’s gender, we found medium as compared to low-attitude parents had a 6.21 (95%CI = 3.08, 12.51) greater odds of reporting that their teen had all recommended vaccines. Similarly, high as compared to low-attitude parents reported a 23.02 (95% CI = 11.27, 46.99) greater odds of having a teen who was up-to-date on recommended vaccines. We detected that for each additional vaccine discussed, there was a 1.24 (95%CI = 1.11, 1.39) increase in odds of the teen having all recommended vaccines. Parental immunization attitudes and provider discussion about vaccines are key ingredients to improving immunization rates among adolescents. While some parents may be reluctant to immunize their son or daughter with a recommended vaccine, vaccine-specific discussions between physicians and parents represent an important first step to continued discussions with providers regarding vaccination. Moreover, vaccine discussions must occur within the context of ongoing conversations about health and disease prevention.

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Using a school-based approach to deliver immunization—Global update
Original Research Article
Pages 719-725
Jos Vandelaer, Marianne Olaniran
Highlights
:: In 2012, school-based immunization was used in 95 out of 174 countries.
:: Tetanus and diphtheria toxoids are the most frequently administered antigens.
:: All school grades are targeted, but most countries give doses in first and sixth grade.
:: The approach can be a platform to reach school-aged children with immunization and other interventions but special approaches are needed to reach out-of-school and absent children.

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Expected cost effectiveness of high-dose trivalent influenza vaccine in US seniors
Pages 734-741
Ayman Chit, Julie Roiz, Benjamin Briquet, David P. Greenberg
Abstract
Objectives
Seniors are particularly vulnerable to complications resulting from influenza infection. Numerous influenza vaccines are available to immunize US seniors, and practitioners must decide which product to use. Options include trivalent and quadrivalent standard-dose inactivated influenza vaccines (IIV3 and IIV4 respectively), as well as a high-dose IIV3 (HD). Our research examines the public health impact, budget impact, and cost-utility of HD versus IIV3 and IIV4 for immunization of US seniors 65 years of age and older.
Methods
Our model was based on US influenza-related health outcome data. Health care costs and vaccine prices were obtained from the Centers for Medicare and Medicaid Services. Efficacies of IIV3 and IIV4 were estimated from various meta-analyses of IIV3 efficacy. The results of a head-to-head randomized controlled trial of HD vs. IIV3 were used to estimate relative efficacy of HD. Conservatively, herd protection was not considered.
Results
Compared to IIV3, HD would avert 195,958 cases of influenza, 22,567 influenza-related hospitalizations, and 5423 influenza-related deaths among US seniors. HD generates 29,023 more Quality Adjusted Life Years (QALYs) and a net societal budget impact of $154 million. The Incremental Cost Effectiveness Ratio (ICER) for this comparison is $5299/QALY. 71% of the probabilistic sensitivity analysis (PSA) simulations were <$100,000/QALY.
Compared to IIV4, HD would avert 169,257 cases of influenza, 21,222 hospitalizations and 5212 deaths. HD generates 27,718 more QALYs and a net societal budget impact of −$17 million and as such dominates IIV4. For this comparison, 81% of PSA simulations were <$100,000/QALY.
Conclusions
HD is expected to achieve significant reductions in influenza-related morbidity and mortality. Further, HD is a cost effective alternative to both IIV3 and IIV4 in seniors. Our conclusions were robust in the face of sensitivity analyses.