Vaccines — Open Access Journal
(Accessed 21 June 2014)
http://www.mdpi.com/journal/vaccines
Review:
Novel GMO-Based Vaccines against Tuberculosis: State of the Art and Biosafety Considerations
by Amaya Leunda, Aline Baldo, Martine Goossens, Kris Huygen, Philippe Herman and Marta Romano
Vaccines 2014, 2(2), 463-499; doi:10.3390/vaccines2020463 – published online 16 June 2014
Abstract:
Novel efficient vaccines are needed to control tuberculosis (TB), a major cause of morbidity and mortality worldwide. Several TB vaccine candidates are currently in clinical and preclinical development. They fall into two categories, the one of candidates designed as a replacement of the Bacille Calmette Guérin (BCG) to be administered to infants and the one of sub-unit vaccines designed as booster vaccines. The latter are designed as vaccines that will be administered to individuals already vaccinated with BCG (or in the future with a BCG replacement vaccine). In this review we provide up to date information on novel tuberculosis (TB) vaccines in development focusing on the risk assessment of candidates composed of genetically modified organisms (GMO) which are currently evaluated in clinical trials. Indeed, these vaccines administered to volunteers raise biosafety concerns with respect to human health and the environment that need to be assessed and managed.

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

Nature Reviews Immunology
Published online: 13 June 2014 doi:10.1038/nri3694
Perspectives
From empiricism to rational design: a personal perspective of the evolution of vaccine development
Ennio De Gregorio & Rino Rappuoli
Abstract
Vaccination, which is the most effective medical intervention that has ever been introduced, originated from the observation that individuals who survived a plague or smallpox would not get the disease twice. To mimic the protective effects of natural infection, Jenner — and later Pasteur — inoculated individuals with attenuated or killed disease-causing agents. This empirical approach inspired a century of vaccine development and the effective prophylaxis of many infectious diseases. From the 1980s, several waves of new technologies have enabled the development of novel vaccines that would not have been possible using the empirical approach. The technological revolution in the field of vaccination is now continuing, and it is delivering novel and safer vaccines. In this Timeline article, we provide our views on the transition from empiricism to rational vaccine design.

Journal of Acquired Immune Deficiency Syndromes
2014, 66 Suppl 2:S209-16
Lessons Learned From HPV Vaccine Delivery in Low-Resource Settings and Opportunities for HIV Prevention, Treatment, and Care Among Adolescents.
Tsu VD, Cernuschi T, LaMontagne DS
*PATH, Seattle, WA; and GAVI Alliance Secretariat, Geneva, Switzerland.
Abstract
BACKGROUND: Human papillomavirus (HPV) vaccines to prevent cervical cancer have become available in recent years and presented a new challenge to health systems, since they prevent a sexually transmitted virus and are most effective if they are delivered to young adolescent girls, a group not widely served by other health programs. Demonstration and pilot HPV vaccination programs undertaken in the past 7-8 years in low-resource settings have produced lessons that may be more broadly applied to other adolescent health interventions, particularly to those that attempt to reduce human immunodeficiency virus (HIV) infection. METHODS: A systematic literature review was undertaken to identify formal and informal evaluations of HPV vaccine use in low- and middle-income countries. Special attention was devoted to the detailed evaluations carried out on large demonstration projects in India, Peru, Uganda, and Vietnam.
RESULTS: These lessons fall into 2 main categories: service delivery operations and community outreach and mobilization. Operational issues included venue and timing of vaccinations, definition of target population, micro-planning and coordination, integration with other services, and training. Community issues included consent, messages and channels, endorsement and support, and timing of mobilization efforts.
DISCUSSION: Careful planning, good coordination across sectors and levels, and sensitive attention to the expressed needs for information and preferences for communication channels among youth, parents, and communities more broadly were among the key lessons that are relevant for HIV interventions, but many of the smaller details were also important.
CONCLUSIONS: Applying or adapting these lessons to adolescent HIV services could accelerate effective program design and enhance success.

American Journal of Public Health
First Look
Sources of Racial/Ethnic Differences in Awareness of HIV Vaccine Trials
Michael P. Arnold, PhD, MPH, MSW, Michele Andrasik, PhD, Stewart Landers, JD, MCP, Shelly Karuna, MD, MPH, Matthew J. Mimiaga, ScD, MPH, Steven Wakefield, Kenneth Mayer, MD, Susan Buchbinder, MD, and Beryl A. Koblin, PhDMP Arnold, M Andrasik, S Landers, S Karuna… – American journal of public …, 2014
(Am J Public Health. Published online ahead of print June 12, 2014: e1–e7. doi:10.2105/AJPH.2014.301893)
Abstract
Objectives. We explored the relative effects of 2 awareness components—exposure and attention—on racial/ethnic differences in HIV vaccine trial awareness among men who have sex with men (MSM).
Methods. Surveys assessing awareness of and attitudes toward HIV vaccine trials were administered to 1723 MSM in 6 US cities. Proxy measures of exposure included use of HIV resources and other health care services, community involvement, income, and residence. Attention proxy measures included research attitudes, HIV susceptibility, and HIV message fatigue. Using logistic regression models, we assessed the extent to which these proxies accounted for racial/ethnic differences in vaccine trial awareness.
Results. White MSM reported significantly (P  < .01) higher rates of HIV vaccine trial awareness (22%) compared with Latino (17%), Black (13%) and “other” (13%) MSM. Venue-based exposure proxies and research-directed attitudinal attention proxies were significantly associated with awareness, but only accounted for the White-Latino disparity in awareness. No proxies accounted for the White-Black or White-“other” differentials in awareness.
Conclusions. Sources of disparities in awareness of HIV vaccine trials remain to be explained. Future trials seeking to promote diverse participation should explore additional exposure and attention mediators.

Special Focus Newsletters
RotaFlash
June 20, 2014
http://vad.cmail2.com/t/r-e-xkhdild-mhyjuirjk-j/
Lead Story – 8th African Rotavirus Symposium highlights science, policy, and progress
Delegates empowered to advocate for sustained rotavirus vaccine introduction

Media Release: PAHO/WHO steps up surveillance and information exchange during FIFA World Cup
Monitoring helps health authorities respond effectively and promptly to potential health risks during mass-attendance events
Excerpt
Washington, D.C., 11 June 2014 (PAHO/WHO) – The Pan American Health Organization/World Health Organization (PAHO/WHO) is conducting an enhanced surveillance and activating mechanisms of information exchange about public health events during the 2014 FIFA World Cup, which takes place in Brazil from 12 June to 13 July.

The goal is to rapidly detect any events that could have an impact on regional or global public health, enabling health authorities to take timely and appropriate action to respond to risks and minimize any impact on people’s health.

In the coming days, hundreds of thousands of people will travel to Brazil to attend soccer matches taking place in 12 World Cup venues. Intensified international travel and population movement associated with mass events such as the World Cup can have an impact in the host country as well as at the regional or global level. For the host country, mass gatherings can overload health services because of the large numbers of people, and visitors from other parts of the world can potentially import or export infectious diseases.

To ensure early detection of public health events, PAHO/WHO is intensifying disease and event surveillance from 5 June to 25 July. The increased surveillance will cover not only events in Brazil but also events elsewhere in the Americas and in other regions that could have an impact on the World Cup.

PAHO/WHO is sharing daily reports generated through this stepped-up surveillance with health authorities in Brazil and in other countries of the Americas and worldwide.

A series of health resources for travelers to the 2014 FIFA World Cup is available on the PAHO/WHO website. The resources include an interactive map with health information related to cities hosting the World Cup games…

UNICEF Watch [to 14 June2014]
http://www.unicef.org/media/media_71724.html

:: Measles threatens thousands of Somali children
Joint UNICEF/WHO Press Release
Excerpt
/GAROWE/HARGEISA, Somalia, 10 June 2014 – Outbreaks of measles in several regions have left thousands of Somali children at risk of disability or death if they are not urgently vaccinated against the highly contagious disease.

In March and April 2014 there were over 1350 suspected cases of measles – four times the number seen during the same period last year and nearly 1000 cases were reported in May alone.
In response, the health authorities, with the support of UNICEF, the World Health Organization (WHO) and partners, conducted small scale vaccination campaigns and will carry out larger emergency campaigns in the most affected areas of Bari, Nugaal, Mudug, Banadir and Lower Juba in June targeting half a million children under five.

‘We have a very high number of malnourished Somali children,’ said Sikander Khan, UNICEF Somalia Representative. ‘Malnourished children here are more susceptible to disease – and are more likely to die or suffer lifelong disability such as blindness, deafness or brain damage as a result of contracting measles.’

Two decades of conflict have decimated Somalia’s health sector, leaving the country with some of the worst health and nutrition indicators in the world. An estimated one in five children dies before their fifth birthday – with measles as one of the main causes.

‘This is extremely alarming. There is a very poor health care system due to the years of conflict,’ said Dr. Ghulam Popal, WHO Somalia Representative. ‘We know there have been extremely low immunization rates among Somali children and we need to urgently ensure as many as possible are vaccinated.’

It is estimated that less than a third of Somali children under one year were vaccinated against measles in 2013 through routine immunization services. In some areas in central and southern Somalia insecurity has meant that immunization coverage is as low as 15 per cent.

WHO and UNICEF say that a nationwide measles campaigns need to be urgently conducted to prevent thousands of avoidable deaths. This would involve vaccinating about 5 million children and youth from 9 months to 15 years at an estimated cost of US$ 9 million….

WHO: Global Alert and Response (GAR) – Disease Outbreak News [to 14 June2014]
http://www.who.int/csr/don/en/

:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 13 June 2014
…The National IHR Focal Points of Saudi Arabia, the United Arab Emirates (UAE) and the
Islamic Republic of Iran recently reported additional laboratory-confirmed cases of infection
with Middle East respiratory syndrome coronavirus (MERS-CoV) to WHO….
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 11 June 2014
:: Ebola virus disease, West Africa – update 10 June 2014
…WHO does not recommend any travel or trade restrictions be applied to Guinea, Liberia, or
Sierra Leone based on the current information available for this event.
:: Human infection with avian influenza A(H7N9) virus – update 10 June 2014

WHO: Update on MERS-CoV transmission from animals to humans, and interim recommendations for at-risk groups
13 June 2014
[Excerpt]
Over the past year, several investigations into the animal source of MERS-CoV have been conducted. MERS-CoV genetic sequences from humans and camels in Egypt, Oman, Qatar and Saudi Arabia demonstrate a close link between the virus found in camels and that found in people in the same geographic area. These and other studies have found MERS-CoV antibodies in camels in Africa and the Middle East.
Preliminary results from an ongoing investigation in Qatar show that people working closely with camels (e.g. farm workers, slaughterhouse workers and veterinarians) may be at higher risk of MERS-CoV infection than people who do not have regular close contacts with camels. In Qatar and several other countries, animals, including goats, cows, sheep, water buffalo, swine and wild birds, have been tested for antibodies to MERS-CoV, with no positive results. The absence of antibodies in these animals indicates that the likelihood of other animals having a substantial role in transmission of MERS-CoV is very low. These studies provide evidence that camels are a likely primary source of the MERS-CoV that is infecting humans.
The current pattern of disease appears to be the result of repeated introductions of the virus from camels to people, resulting in limited human-to-human transmission, but not in sustained transmission. Therefore, discovery of the routes of transmission, whether direct or indirect, between camels and people, is critical to stopping transmission of the virus…

POLIO [to 14 June 2014]

GPEI Update: Polio this week – As of 11 June 2014
Global Polio Eradication Initiative
Editor’s Excerpt and text bolding
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: The Technical Advisory Groups (TAGs) on Polio Eradication in Afghanistan and Pakistan met in Islamabad, Pakistan, last week. The TAG recognized the important progress in Afghanistan and concluded that the country is in a strong position to interrupt endemic transmission of the virus in 2014, provided the country addresses the remaining challenges and risks. These include ensuring the programme is a priority with the new government, reaching children in inaccessible areas, focusing on missed children, strengthening cross-border and transit vaccination and preparing for the displacement of people from infected areas of Pakistan.
:: In terms of polio eradication in Pakistan, the TAG concluded that the country is not in a position to interrupt transmission without radical change in reservoir areas including Federally Administered Tribal Areas – FATA, Peshawar and Karachi. To put the program back on the path to polio eradication, the TAG recommended full political commitment and ownership, mobilization of national assets including the army and administrative machinery, restoration of vaccination in FATA and addressing insecurity and chronic gaps in reservoirs and high risk areas. The TAG also recommended that all provinces integrate communications and social mobilization activities in their planning and operations.
Nigeria
:: Three new cVDPV2 cases were reported in the past week including two cases from Damboa LGA, Borno state, and one case from the previously uninfected Jere LGA, Borno state. The most recent cVDPV2 case had onset of paralysis on 3 May from Damboa LGA, Borno state. The total number of cVDPV2 cases for 2014 is seven.
Pakistan
:: Four new WPV1 cases were reported in the past week including two cases from North Waziristan, Federally Administered Tribal Areas – FATA, and two cases from Bannu, Khyber Pakhtunkhwa – KP. The most recent WPV1 case had onset of paralysis on 19 May from Bannu. The total number of WPV1 cases reported from Pakistan for 2014 is 75.
Central Africa
:: A new WPV1 case was reported this week from Equatorial Guinea. The case is from Ebebiyin district, Kie Ntem province, and had onset of paralysis on 3 April. The total number of WPV1 cases in Equatorial Guinea in 2014 is four. The cases are linked to an ongoing outbreak in neighboring Cameroon, which has reported four cases in 2013 and three cases in 2014. The most recent NIDs in Equatorial Guinea took place on 28 May and the next rounds of activities are planned for mid-July and August.

The Weekly Epidemiological Record (WER) for 13 June 2014, vol. 89, 24 (pp. 257–264) includes:
:: Progress towards measles elimination – Eastern Mediterranean Region, 2008–2012
http://www.who.int/entity/wer/2014/wer8924.pdf?ua=1

CDC/MMWR Watch [to 14 June2014]
http://www.cdc.gov/mmwr/mmwr_wk.html

MMWR for June 13, 2014 / Vol. 63 / No. 23 includes:
:: Progress Toward Measles Elimination — Eastern Mediterranean Region, 2008–2012

:: Announcement: Recommendation Regarding Increasing Vaccination Rates Through Use of Immunization Information Systems — Community Preventive Services Task Force
Excerpt
Task Force Finding
The Community Preventive Services Task Force recommends immunization information systems (IIS) on the basis of strong evidence of effectiveness in increasing vaccination rates.
Evidence is considered strong based on the findings from 108 published studies and 132 conference abstracts showing that IIS are effective in increasing vaccination rates and reducing vaccine-preventable disease through their capabilities to:
:: Create or support effective interventions such as client reminder and recall systems, provider assessment and feedback, and provider reminders
:: Determine client vaccination status for decisions made by clinicians, health departments, and schools
:: Guide public health responses to outbreaks of vaccine-preventable disease
:: Inform assessments of vaccination coverage, missed vaccination opportunities, invalid dose administration, and disparities in vaccination coverage; and
:: Facilitate vaccine management and accountability
Read the full Task Force Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps…

Global Fund Watch [to 14 June2014]
http://www.theglobalfund.org/en/mediacenter/announcements/

Media Release
UNITAID and the Global Fund Announce Formal Collaboration
13 June 2014
Excerpt
GENEVA – UNITAID and the Global Fund to Fight AIDS, Tuberculosis and Malaria have signed a collaboration agreement around a market-shaping agenda to maximize the value for money from each organization’s investments.

Both organizations invest to increase access to health products for HIV/AIDS, tuberculosis and malaria for those who need them most. UNITAID focuses on global product markets, investing to speed up and increase access to better adapted and more affordable commodities, and Global Fund investments support countries in efforts to expand health programs, including health products.

The new agreement focuses on three main areas: More rapid development and uptake of high-quality adapted medicines and diagnostics geared toward increasing access for underserved populations; Promoting simpler treatments, including fixed-dose combinations and point-of-care diagnostics that improve adherence and reduce patients’ pill burden; Improving value for money of donor investments by achieving greater market improvements with resulting public health impact….

European Medicines Agency Watch [to 14 June2014]
http://www.ema.europa.eu/ema/

European Medicines Agency agrees policy on publication of clinical trial data with more user-friendly amendments
12 June 2014
The European Medicines Agency Management Board on 12 June 2014 agreed the policy on publication of clinical trial data, together with more user-friendly amendments proposed by EMA Executive Director Guido Rasi, that will not only allow the Agency to proactively publish clinical trial data that are submitted as part of marketing authorisation applications, but also give the possibility to download, save and print the trial data for academic and non-commercial research purposes…

BMC Medical Ethics
(Accessed 14 June2014)
http://www.biomedcentral.com/bmcmedethics/content

Debate
Child’s assent in research: Age threshold or personalisation?
Marcin Waligora, Vilius Dranseika and Jan Piasecki
Author Affiliations
BMC Medical Ethics 2014, 15:44 doi:10.1186/1472-6939-15-44
Published: 13 June 2014
Abstract (provisional)
Background
Assent is an important ethical and legal requirement of paediatric research. Unfortunately, there are significant differences between the guidelines on the details of assent.
Discussion
What often remains unclear is the scope of the assent, the procedure for acquiring it, and the way in which children’s capacity to assent is determined. There is a general growing tendency that suggests that the process of assent should be personalised, that is, tailored to a particular child. This article supports the idea of personalisation. However, we also propose placing limits on personalisation by introducing a suggested requirement of assent starting at a school-age threshold. In some situations RECs/IRBs and researchers could reduce the suggested threshold.

Globalization and Health
[Accessed 14 June2014]
http://www.globalizationandhealth.com/

Commentary
Health diplomacy: a new approach to the Muslim world?
Suleman M, Ali R and Kerr DJ
Globalization and Health 2014, 10:50 (13 June 2014)

Research
Mobile health for non-communicable diseases in Sub-Saharan Africa: a systematic review of the literature and strategic framework for research
Bloomfield GS, Vedanthan R, Vasudevan L, Kithei A, Were M and Velazquez EJ
Globalization and Health 2014, 10:49 (13 June 2014)

Research
Community empowerment and involvement of female sex workers in targeted sexual and reproductive health interventions in Africa: a systematic review
Moore L, Chersich MF, Steen R, Reza-Paul S, Dhana A, Vuylsteke B, Lafort Y and Scorgie F
Globalization and Health 2014, 10:47 (10 June 2014)

Research
Systematic review of facility-based sexual and reproductive health services for female sex workers in Africa
Dhana A, Luchters S, Moore L, Lafort Y, Roy A, Scorgie F and Chersich M
Globalization and Health 2014, 10:46 (10 June 2014)

Health and Human Rights
Volume 16, Issue 1
http://www.hhrjournal.org/

Climate Justice and the Right to Health – A Special Issue
Foreword
Mary Robinson, President of the Mary Robinson Foundation-Climate Justice
Excerpt
…In recent years, climate justice is emerging as a discipline that addresses the interlinked challenges of climate change, human rights, and development. At a time when the need for multidisciplinary research is gaining ground, climate justice provides a useful framing for interdisciplinary collaborations.
Climate justice highlights the impacts of climate change on the vulnerable, marginalized, and poor, who are disproportionally affected by extreme weather events, such as floods, storms, and droughts, and slow onset events, such as sea level rise and glacial melt. They are the people who have their homes destroyed, face increasing struggles to feed themselves and their families, and are more susceptible to diseases while having their access to health care diminished.
Climate change is already undermining many of their basic human rights—to food and water, to shelter and health. Climate justice points out that the undermining of these essential rights is an injustice—largely because those who are most affected by the negative impacts are least responsible for the causes of the problem. The concept shows how global develop¬ment issues and climate change are inextricably linked, as for example when the incidence of a disease like malaria, that we have been making progress on eradicating, starts to rise again due to climatic changes….
…Articles in this special issue examine the disproportionate impacts of climate change on vulnerable groups, including indigenous peoples. A case is made for climate change mitigation policies informed by human rights and with clear health and equity co-benefits. The links between climate justice and the right to health are presented, including an analysis of the links between the right to food and the right to health in the context on increasing dependency on food aid of low nutritional value. Several papers present a strong case for human rights law guiding procedural responses to climate change and its negative impacts on health….
…It is important at this juncture, with two international processes working on issues of human development and climate change coming to conclusion in 2015, that the value of a climate justice approach is demonstrated and used to inform these policy frameworks. This special edition is a welcome contribution to this endeavor.

International Journal of Epidemiology
Volume 43 Issue 3 June 2014
http://ije.oxfordjournals.org/content/current

The non-specific effects of vaccines and other childhood interventions: the contribution of INDEPTH Health and Demographic Surveillance Systems
Osman Sankoh1,2,3,*, Paul Welaga1,4, Cornelius Debpuur1,4, Charles Zandoh1,5, Stephney Gyaase1,5, Mary Atta Poma1,6, Martin Kavao Mutua1,7, SM Manzoor Ahmed Hanifi1,8, Cesario Martins1,9, Eric Nebie1,10, Moubassira Kagoné1,10, Jacques BO Emina1 and Peter Aaby1,9
Author Affiliations
1INDEPTH Network, Accra, Ghana, 2School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, 3Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, 4Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, 5Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, 6Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, 7African Population and Health Research Centre, Nairobi, Kenya, 8Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, 9Bandim Health Project, Bandim, Guiné-Bissau and 10Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
Accepted April 3, 2014.
Abstract
Most childhood interventions (vaccines, micronutrients) in low-income countries are justified by their assumed effect on child survival. However, usually the interventions have only been studied with respect to their disease/deficiency-specific effects and not for their overall effects on morbidity and mortality. In many situations, the population-based effects have been very different from the anticipated effects; for example, the measles-preventive high-titre measles vaccine was associated with 2-fold increased female mortality; BCG reduces neonatal mortality although children do not die of tuberculosis in the neonatal period; vitamin A may be associated with increased or reduced child mortality in different situations; effects of interventions may differ for boys and girls. The reasons for these and other contrasts between expectations and observations are likely to be that the immune system learns more than specific prevention from an intervention; such training may enhance or reduce susceptibility to unrelated infections. INDEPTH member centres have been in an ideal position to document such additional non-specific effects of interventions because they follow the total population long term. It is proposed that more INDEPTH member centres extend their routine data collection platform to better measure the use and effects of childhood interventions. In a longer perspective, INDEPTH may come to play a stronger role in defining health research issues of relevance to low-income countries.

Commentary: Potential implications of non-specific effects of childhood vaccines
Harshpal Singh Sachdev
Author Affiliations
Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi 110016, India.
Abstract
The World Health Organization states that: ‘A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe, its toxins or one of its surface proteins. The agent stimulates the body’s immune system to recognize the agent as foreign, destroy it, and ‘remember’ it, so that the immune system can more easily recognize and destroy any of these microorganisms that it later encounters’.1 This statement is in conformity with the usual scientific and lay perceptions that vaccines have only specific disease-protective effects. However, historically it has been suspected that Vaccinia2 and BCG vaccination3 confer protection against non-targeted infectious diseases. Emerging evidence suggests that vaccines can positively or negatively affect the resistance to other infectious diseases—the so-called non-specific effects of vaccines or non-specific immunomodulation by vaccines. The bulk of this evidence has been generated from Guinea-Bissau by researchers led by Peter Aaby. The current status of global evidence has been summarized by them in this issue of IJE4 and elsewhere.5 On this basis, they also suggest a new definition of vaccines: ‘A vaccine is a biological preparation that improves immunity to a particular disease and at the same …

The Lancet
Jun 14, 2014 Volume 383 Number 9934 p2019 – 2098 e19 – 21
http://www.thelancet.com/journals/lancet/issue/current

Comment
Mass gatherings medicine: international cooperation and progress
Ziad A Memish a b, Alimuddin Zumla c, Brian McCloskey d, David Heymann e f, Abdullah A Al Rabeeah a, Maurizio Barbeschi g, Richard Horton h
Excerpt
In July, 2012, we discussed plans to move the complex public health issues surrounding mass gatherings into a formal scientific discipline, and to create a global network for mass gatherings research, training, and capacity development.1, 2 We believed that it was important for this network to be led by Saudi Arabia, since the country has extensive experience through many decades of managing millions of pilgrims from 184 countries at the largest yearly recurring religious mass gathering in the world—the Hajj. Subsequently, the Saudi Government and WHO3 strongly supported mass gatherings medicine as a scientific discipline, establishing the Saudi Global Center for Mass Gathering Medicine (GCMGM), with its headquarters in Riyadh and membership from other Gulf countries,4 and a virtual research network linked with other WHO collaborating centres for mass gatherings. This network has brought together global academic and public health institutions with complementary expertise to gather and translate the most appropriate public health policy evidence for use by countries that host, or plan to host, mass gathering events…
…Mass gatherings medicine provides an opportunity to generate a wealth of knowledge and expertise, and sharing the experiences of organisers can assist in shaping a positive legacy and provide valuable lessons for organisers of future events. The value to planners of mass gatherings and their governments in sharing best practices is clear, as is the need for new operational research into mass gatherings, with systematic collection and analysis of data to inform planning activities for future events. Through provision of scientific evidence, the GCMGM aims to drive the best health promotion and prevention guidelines and practice, including health education for attendees of mass gatherings across different contexts. The Hajj provides an ideal model for research into mass gatherings that recur yearly in the same location, and the very large sporting events provide a different context and complementary opportunities for research and training. Substantial gaps in research remain, particularly in relation to mass gatherings in low-resource settings and in unplanned or spontaneous mass gatherings….

.
Lancet Series –mass gatherings medicine

Hajj: infectious disease surveillance and control
Prof Ziad A Memish FRCPC a b c d, Prof Alimuddin Zumla FRCP a e f, Rafat F Alhakeem MD a d, Abdullah Assiri MD d, Abdulhafeez Turkestani MD d, Khalid D Al Harby MD d, Mohamed Alyemni PhD d, Khalid Dhafar MD d, Philippe Gautret MD g, Maurizio Barbeschi PhD a h, Brian McCloskey MD a i, Prof David Heymann MD a j k, Abdullah A Al Rabeeah FRCS a d, Jaffar A Al-Tawfiq FACP l m
Summary
Religious festivals attract a large number of pilgrims from worldwide and are a potential risk for the transmission of infectious diseases between pilgrims, and to the indigenous population. The gathering of a large number of pilgrims could compromise the health system of the host country. The threat to global health security posed by infectious diseases with epidemic potential shows the importance of advanced planning of public health surveillance and response at these religious events. Saudi Arabia has extensive experience of providing health care at mass gatherings acquired through decades of managing millions of pilgrims at the Hajj. In this report, we describe the extensive public health planning, surveillance systems used to monitor public health risks, and health services provided and accessed during Hajj 2012 and Hajj 2013 that together attracted more than 5 million pilgrims from 184 countries. We also describe the recent establishment of the Global Center for Mass Gathering Medicine, a Saudi Government partnership with the WHO Collaborating Centre for Mass Gatherings Medicine, Gulf Co-operation Council states, UK universities, and public health institutions globally.

London 2012 Olympic and Paralympic Games: public health surveillance and epidemiology
Brian McCloskey FFPH a b, Tina Endericks MBA b, Mike Catchpole FRCP c, Maria Zambon FRCPath d, Jim McLauchlin PhD e, Nandini Shetty FRCPath l, Rohini Manuel FRCPath l, Deborah Turbitt FFPH l, Gillian Smith FFPH f, Paul Crook MSc g, Ettore Severi MSc h, Jane Jones MFPH i, Sue Ibbotson FFPH j, Roberta Marshall FFPH k, Catherine A H Smallwood m, Nicolas Isla MSc n, Prof Ziad A Memish FRCP a o p, Abdullah A Al-Rabeeah FRCS a o, Maurizio Barbeschi PhD a m, David L Heymann FMEDSci a l q r, Alimuddin Zumla FRCP a s t
Summary
Mass gatherings are regarded as potential risks for transmission of infectious diseases, and might compromise the health system of countries in which they are hosted. The evidence for increased transmission of infectious diseases at international sporting mass gatherings that attract many visitors from all over the world is not clear, and the evidence base for public health surveillance, epidemiology, and response at events such as the Olympics is small. However, infectious diseases are a recognised risk, and public health planning is, and should remain, a crucial part of the overall planning of sporting events. In this Series paper, we set out the planning and the surveillance systems that were used to monitor public health risks during the London 2012 Olympic and Paralympic Games in the summer of 2012, and draw attention to the public health issues—infectious diseases and chemical, radiation, and environmental hazards—that arose. Although the absolute risk of health-protection problems, including infectious diseases, at sporting mass gatherings is small, the need for reassurance of the absence of problems is higher than has previously been considered; this could challenge conventional public health surveillance systems. Recognition of the limitations of health-surveillance systems needs to be part of the planning for future sporting events.

Euro 2012 European Football Championship Finals: planning for a health legacy
Catherine A H Smallwood DPhil a, Katherine G Arbuthnott BMBCh a, Barbara Banczak-Mysiak MD h, Mariya Borodina MD c, Ana Paula Coutinho MSc e, Lara Payne-Hallström MSc g, Elzbieta Lipska MD i, Viktor Lyashko MD j, Miroslaw Miklasz MD l, Paulina Miskiewicz MD l, Dorit Nitzan MD b, Igor Pokanevych MD b, Marek Posobkiewicz MD h, Gerald Rockenschaub MD f, Malgorzata Sadkowska-Todys PhD k, Svetlana Sinelnik d, Daniel Smiley PhD c, Rysard Tomialoic MSc q, Volodimir Yurchenko MD d, Prof Ziad A Memish FRCPC m, Prof David Heymann MD n o p, Tina Endericks MBA r, Brian McCloskey FFPH r, Prof Alimuddin Zumla FRCP s t, Maurizio Barbeschi PhD a
Summary
The revised international health regulations offer a framework that can be used by host countries to organise public health activities for mass gatherings. From June 8, to July 1, 2012, Poland and Ukraine jointly hosted the Union of European Football Associations European Football Championship Finals (Euro 2012). More than 8 million people from around the world congregated to watch the games. Host countries and international public health agencies planned extensively to assess and build capacity in the host countries and to develop effective strategies for dissemination of public health messages. The effectiveness of public health services was maximised through rapid sharing of information between parties, early use of networks of experienced individuals, and the momentum of existing national health programmes. Organisers of future mass gatherings for sporting events should share best practice and their experiences through the WHO International Observer Program. Research about behaviour of large crowds is needed for crowd management and the evidence base translated into practice. A framework to measure and evaluate the legacy of Euro 2012 is needed based on the experiences and the medium-term and long-term benefits of the tournament.

The Lancet Global Health
Jun 2014 Volume 2 Number 6 e301 – 363
http://www.thelancet.com/journals/langlo/issue/current

Early Online Publication, 10 June 2014
Cost-effectiveness of female human papillomavirus vaccination in 179 countries: a PRIME modelling study
Mark Jit PhD a b, Marc Brisson PhD c d e, Allison Portnoy MSPH f, Dr Raymond Hutubessy PhD g
Summary
Background
Introduction of human papillomavirus (HPV) vaccination in settings with the highest burden of HPV is not universal, partly because of the absence of quantitative estimates of country-specific effects on health and economic costs. We aimed to develop and validate a simple generic model of such effects that could be used and understood in a range of settings with little external support.
Methods
We developed the Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model to assess cost-effectiveness and health effects of vaccination of girls against HPV before sexual debut in terms of burden of cervical cancer and mortality. PRIME models incidence according to proposed vaccine efficacy against HPV 16/18, vaccine coverage, cervical cancer incidence and mortality, and HPV type distribution. It assumes lifelong vaccine protection and no changes to other screening programmes or vaccine uptake. We validated PRIME against existing reports of HPV vaccination cost-effectiveness, projected outcomes for 179 countries (assuming full vaccination of 12-year-old girls), and outcomes for 71 phase 2 GAVI-eligible countries (using vaccine uptake data from the GAVI Alliance). We assessed differences between countries in terms of cost-effectiveness and health effects.
Findings
In validation, PRIME reproduced cost-effectiveness conclusions for 24 of 26 countries from 17 published studies, and for all 72 countries in a published study of GAVI-eligible countries. Vaccination of a cohort of 58 million 12-year-old girls in 179 countries prevented 690 000 cases of cervical cancer and 420 000 deaths during their lifetime (mostly in low-income or middle-income countries), at a net cost of US$4 billion. HPV vaccination was very cost effective (with every disability-adjusted life-year averted costing less than the gross domestic product per head) in 156 (87%) of 179 countries. Introduction of the vaccine in countries without national HPV vaccination at present would prevent substantially more cases of cervical cancer than in countries with such programmes, although the disparity has narrowed since 2012. If 71 phase 2 GAVI-eligible countries adopt vaccination according to forecasts, then in 2070 GAVI Alliance-funded vaccination could prevent 200 000 cases of cervical cancer and 100 000 deaths in some of the highest-burden countries.
Interpretation
Large between-country disparities exist for HPV vaccination, with countries with the most to gain yet to introduce national HPV vaccination. Support from the GAVI Alliance could help to reduce such disparities, but a substantial burden will remain even after presently projected vaccine introductions.
Funding
WHO.

Medical Decision Making (MDM)
July 2014; 34 (5)
http://mdm.sagepub.com/content/current

Framing Options as Choice or Opportunity
Does the Frame Influence Decisions?
Purva Abhyankar, PhD, Barbara A. Summers, PhD, Galina Velikova, MD, PhD, Hilary L. Bekker, PhD
Abstract
Objective. Health professionals must enable patients to make informed decisions about health care choices through unbiased presentation of all options. This study examined whether presenting the decision as “opportunity” rather than “choice” biased individuals’ preferences in the context of trial participation for cancer treatment.
Methods. Self-selecting healthy women (N = 124) were randomly assigned to the following decision frames: opportunity to take part in the trial (opt-in), opportunity to be removed from the trial (opt-out), and choice to have standard treatment or take part in the trial (choice). The computer-based task required women to make a hypothetical choice about a real-world cancer treatment trial. The software presented the framed scenario, recorded initial preference, presented comprehensive and balanced information, traced participants’ use of information during decision making, and recorded final decision. A posttask paper questionnaire assessed perceived risk, attitudes, subjective norm, perceived behavioral control, and satisfaction with decision.
Results. Framing influenced women’s immediate preferences. Opportunity frames, whether opt-in or opt-out, introduced a bias as they discouraged women from choosing standard treatment. Using the choice frame avoided this bias. The opt-out opportunity frame also affected women’s perceived social norm; women felt that others endorsed the trial option. The framing bias was not present once participants had had the opportunity to view detailed information on the options within a patient decision aid format. There were no group differences in information acquisition and final decisions. Sixteen percent changed their initial preference after receiving full information.
Conclusions. A “choice” frame, where all treatment options are explicit, is less likely to bias preferences. Presentation of full information in parallel, option-by-attribute format is likely to “de-bias” the decision frame. Tailoring of information to initial preferences would be ill-advised as preferences may change following detailed information.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 14 June2014)

Policy Forum
Antiretroviral Therapy for Refugees and Internally Displaced Persons: A Call for Equity
Joshua B Mendelsohn mail, Paul Spiegel, Marian Schilperoord, Nadine Cornier, David A. Ross
Published: June 10, 2014
DOI: 10.1371/journal.pmed.1001643
Summary Points
:: Available evidence suggests that refugees and internally displaced persons (IDPs) in stable settings can sustain high levels of adherence and viral suppression.
:: Moral, legal, and public health principles and recent evidence strongly suggest that refugees and IDPs should have equitable access to HIV treatment and support.
:: Exclusion of refugees and IDPs from HIV National Strategic Plans suggests that they may not be included in future national funding proposals to major donors.
:: Levels of viral suppression among refugees and nationals documented in a stable refugee camp suggest that some settings require more intensive support for all population groups.
:: Detailed recommendations are provided for refugees and IDPs accessing antiretroviral therapy in stable settings.

PLoS Neglected Tropical Diseases
May 2014
http://www.plosntds.org/article/browseIssue.action

Viewpoints
Social Sciences Research on Infectious Diseases of Poverty: Too Little and Too Late?
José Azoh Barry mail
Published: June 12, 2014
DOI: 10.1371/journal.pntd.0002803
Introduction
Infectious diseases of poverty, also labeled tropical diseases or neglected tropical diseases (NTDs) and caused by pathogenic agents (viruses, bacteria, fungi, and other parasites), are viciously more prevalent among poor people. Though being preventable for the most part in a cost-effective way, they are devastating. These are, to name a few, Chagas disease, schistosomiasis, malaria, leprosy, visceral leishmaniasis, lymphatic filariasis, Buruli ulcer, and onchocerciasis. Besides the vicious circle these diseases maintain with dire conditions of poverty, an increased microbial resistance to some therapeutic drugs adds to the complexity of health disparities and human suffering among the socially disadvantaged, marginalized, and prejudiced against. Fostering virtuous circles (as opposed to vicious circles) against infections of poverty and putting the disenfranchised first are primary concerns for social scientists engaged with research into infectious diseases of poverty. The historical role of social science research into these diseases, its current impacts, substantial contributions, and opportunities and interests for future endeavors are the focus of this article. Persistent disruptions and their propensity to wholly hamper productivity, derail economic and social progress, and deny child development are part of the complex reality to look into. In forcing the displacement of populations and creating chaos, they increase the risk for the spread of infections and maintain the infected poor in a downward spiral of poverty through their capacity of securing the vicious relationship with NTDs. Rather than compassion for inequalities, vulnerabilities, deprivations and misery, or bad fate, foci such as social justice, preparedness, and empowerment are of utmost importance. The case for bridging the divide among scientific disciplines has been strongly made over the years by scholars and outside of academic institutions. Acknowledging the importance of interdisciplinary science and contemplating the need for funded multidisciplinary research is hopeful for broadening the expertise needed to tackle these multidimensional afflictions. However, it should also call for a cautious enthusiasm…

Science
13 June 2014 vol 344, issue 6189, pages 1197-1316
http://www.sciencemag.org/current.dtl

Policy Forum
Public Health
Measuring the path toward malaria elimination
Thomas S. Churcher1, Justin M. Cohen2, Joseph Novotny2,3, Nyasatu Ntshalintshali2,3, Simon Kunene4, Simon Cauchemez1,5,*
Author Affiliations
1Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
2Clinton Health Access Initiative, Boston, MA 02127, USA.
3Global Health Group, University of California, San Francisco, CA 94143, USA.
4National Malaria Control Program, Manzini, Swaziland.
5Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France.
Summary
In many parts of the world, malaria elimination—defined by the World Health Organization (WHO) as the absence of locally acquired malaria cases in the country—is being considered as a target because of recent successes in reducing disease burden (1, 2). Rigorous evaluation of malaria elimination programs is essential for financial and political support to be maintained. Yet such evaluation remains challenging, and appropriate metrics to ascertain “success” are needed.

Vaccines — Open Access Journal
(Accessed 14 June2014)
http://www.mdpi.com/journal/vaccines
Review
Therapeutic Vaccine Strategies against Human Papillomavirus
by Hadeel Khallouf, Agnieszka K. Grabowska and Angelika B. Riemer
Vaccines 2014, 2(2), 422-462; doi:10.3390/vaccines2020422 (doi registration under processing) – published online 13 June 2014
Abstract
High-risk types of human papillomavirus (HPV) cause over 500,000 cervical, anogenital and oropharyngeal cancer cases per year. The transforming potential of HPVs is mediated by viral oncoproteins. These are essential for the induction and maintenance of the malignant phenotype. Thus, HPV-mediated malignancies pose the unique opportunity in cancer vaccination to target immunologically foreign epitopes. Therapeutic HPV vaccination is therefore an ideal scenario for proof-of-concept studies of cancer immunotherapy. This is reflected by the fact that a multitude of approaches has been utilized in therapeutic HPV vaccination design: protein and peptide vaccination, DNA vaccination, nanoparticle- and cell-based vaccines, and live viral and bacterial vectors. This review provides a comprehensive overview of completed and ongoing clinical trials in therapeutic HPV vaccination (summarized in tables), and also highlights selected promising preclinical studies. Special emphasis is given to adjuvant science and the potential impact of novel developments in vaccinology research, such as combination therapies to overcome tumor immune suppression, the use of novel materials and mouse models, as well as systems vaccinology and immunogenetics approaches.

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

The Role of Race in Vaccine Acceptance in Routine and Crisis Contexts
Sandra Quinn, PhD
142nd APHA Annual Meeting and Exposition 2014
Session Objectives: To effectively tailor communications to promote vaccine uptake, researchers must examine the social, cultural, familial and structural factors that may influence vaccine uptake. In this session, we will explore and compare vaccine disparities and communication inequalities in the context of Public Health Critical Race Praxis.

Understanding HPV Vaccine Uptake Among Cambodian American Girls
142nd APHA Annual Meeting and Exposition 2014
Linda Ko, PhD , Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA; Vicky Taylor, MD, MPH , Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Nancy Burke, PhD , Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Channdara Sos, MBA , Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA
Qi Liu, MS , Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada
Hoai Do, MPH , Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA; Jocelyn Talbot, BA , Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Yutaka Yasui, PhD , School of Public Health, University of Alberta, Edmonton, AB, Canada ;Roshan Bastani, PhD , UCLA School of Public Health, Department of Health Policy and Management, Jonsson Comprehensive Cancer Center, Cancer Prevention and Control Research, Los Angeles, CA
Abstract
Introduction: Cervical cancer incidence rates vary substantially among racial/ethnic groups in the US with women of Southeast Asian descent having the highest rates. Up to 70% of cervical cancers could be prevented by widespread use of the HPV vaccine. There is a lack of information about HPV vaccine uptake among Southeast Asian girls. Our objective was to examine HPV vaccination barriers, facilitators, and uptake in a Cambodian immigrant community.
Methods: We conducted a telephone survey of Cambodian women with daughters who were age-eligible for HPV vaccination in 2013. Our study group included 86 Cambodian mothers who lived in the Seattle metropolitan area.
Results: Nearly all (96%) of our survey participants were foreign-born and over one-half (51%) had limited English proficiency. The proportions of mothers who reported their daughter had initiated and completed the HPV vaccine series were only 29% and 14%, respectively. Higher levels of vaccine uptake were significantly associated with mothers having heard about the HPV vaccine from a health professional and having received a recent Pap test. Commonly cited barriers to HPV vaccination included lack of knowledge about the HPV vaccine, not having received a physician recommendation for HPV vaccination, and thinking the HPV vaccine is unnecessary in the absence of health problems.
Conclusion: Linguistically and culturally appropriate HPV educational programs should be developed and implemented in Cambodian immigrant communities. These programs should aim to enhance understanding of disease prevention measures, increase knowledge about the HPV vaccine, and empower women to ask their daughters’ doctors for HPV vaccination.

BMC Infectious Diseases
Accessed 14 June 2014
http://www.biomedcentral.com/bmcinfectdis/content
A systematic review of the epidemiology of hepatitis E virus in Africa
Jong-Hoon Kim1, Kenrad E Nelson2, Ursula Panzner1, Yogita Kasture1, Alain B Labrique2 and Thomas F Wierzba1*
Abstract
Background
Hepatitis E Virus (HEV) infection is a newly recognized serious threat to global public health and Africa is suspected to be among the most severely affected regions in the world. Understanding HEV epidemiology in Africa will expedite the implementation of evidence-based control policies aimed at preventing the spread of HEV including policies for the use of available resources such as HEV vaccines.
Methods
Here we present a comprehensive review of HEV epidemiology in Africa based on published data. We searched for articles on HEV epidemiology in Africa from online databases such as PubMed, Scopus, and ISI Web of Science and critically reviewed appropriate publications to extract consistent findings, identify knowledge gaps, and suggest future studies.
Results
Taking a particularly high toll in pregnant women and their fetuses, HEV has infected human populations in 28 of 56 African countries. Since 1979, 17 HEV outbreaks have been reported about once every other year from Africa causing a reported 35,300 cases with 650 deaths.
Conclusions
In Africa, HEV infection is not new, is widespread, and the number of reported outbreaks are likely a significant underestimate. The authors suggest that this is a continent-wide public health problem that deserves the attention of local, regional and international agencies to implement control policies that can save numerous lives, especially those of pregnant women and their fetuses.

The Brussels G7 Summit Declaration
European Commission – MEMO/14/402 05/06/2014
Excerpt
…21. We remain committed to the Muskoka Initiative on maternal, newborn and child health, and welcome the call made at the Saving Every Woman, Every Child Summit in Toronto to accelerate progress on this global priority. In addition we are committed to ensuring sexual and reproductive health and reproductive rights, and ending child, early and forced marriage and female genital mutilation and other harmful practices. The health and well-being of women and children are improved through ensuring universal access to affordable, quality, essential health services, strengthening health, education and child protection systems and improving nutrition and access to immunisation. We recognise the impact of the GAVI Alliance (Global Alliance for Vaccines and Immunisation) and welcome its efforts to expand access to vaccines to an additional 300 million children during 2016-2020. We welcome Germany’s offer to host the second replenishment in early 2015, reaffirm our commitment, and call on other public and private donors to contribute to the replenishment of the GAVI Alliance. We reaffirm our commitment to an AIDS free generation and to the Global Fund to fight AIDS, Tuberculosis and Malaria to reduce the burden of these three major infectious diseases on eligible countries and regions.

22. To address the threat posed by infectious diseases, we support the Global Health Security Agenda and commit to working with partner countries to strengthen compliance with the World Health Organisation’s (WHO) International Health Regulations and enhance health security around the world. We commit to working across sectors to prevent, detect and respond to infectious diseases, whether naturally occurring, accidental, or the result of a deliberate act by a state or non-state actor. That includes building global capacity so that we are better prepared for threats such as the recent Ebola outbreak in West Africa and working together, in close cooperation with WHO, to develop a Global Action Plan on antimicrobial resistance….

G7 Summit in Brussels, 4 – 5 June 2014: Background note and facts about the EU’s role and actions
European Commission – MEMO/14/392 03/06/2014
Excerpt
4. Development
…On 20 May, the EU announced that it will provide €25 million per year in the period 2014-2020 to fund vaccines and immunisation programmes worldwide through the GAVI alliance – more than double than previously committed. Since 2003, the European Commission has committed over €83 million to the GAVI Alliance, coming in part from the Development Co-operation Instrument (DCI) and in part from the European Development Fund (EDF). Thanks to donors like the EU, close to half a billion children have been immunised since 2000, resulting in 6 million lives saved….
WHO: Global Alert and Response (GAR) – Disease Outbreak News [to 7 June 2014]
http://www.who.int/csr/don/en/
:: Ebola virus disease, West Africa – update 4 June 2014
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 4 June 2014

WHO concludes a MERS-CoV risk assessment mission in the United Arab Emirates
6 June 2014
Excerpt
A team from the WHO and technical partners from the Global Outbreak Alert and Response Network (GOARN) has concluded a 5 day mission in United Arab Emirates (UAE).
The team assessed the risk posed by the Middle East respiratory syndrome coronavirus, or MERS-CoV in the country. The team consisted of 6 experts in coordination, epidemiology, infection prevention and control, food safety and the human-animal interface, and risk communication.
Health authorities in the UAE had invited WHO to review the current situation after an upsurge in MERS-CoV infections in April. Upon arrival, the WHO team met with H.E Mr Abdul Rahman bin Mohammed Al Owais, the Minister of Health, in Dubai to discuss the mission.
Investigation and evaluation
During the mission, the team had extensive meetings with experts from Health Authority Abu Dhabi, Dubai Health Authority and the Abu Dhabi Food Control Authority. The team visited the hospital to which two-thirds of the country’s cases can be traced, in order to review the epidemiological investigation and assess the infection prevention and control measures that have been applied. The WHO team evaluated the work done on investigating possible exposure routes, transmission patterns, and the clinical situation.
“We are impressed by the amount of data and information generated during the investigation of MERS cases by UAE to help better understand MERS- CoV. This knowledge is of utmost importance to the rest of the world to better discover the source of the virus and the routes of transmissions from animals to humans, “said Peter Ben Embarek, WHO team leader.
“The UAE health authorities have been following up diligently on the MERS-CoV cases, including repeated laboratory testing to check when cases have been cleared of the virus. This data will make an important contribution to the risk assessment and to guide the health response internationally,” Ben Embarek concluded.
Need to share experience and knowledge
The preliminary result of the mission indicates that the cases in UAE do not show evidence of sustained human to human infection. The recent upsurge of cases in Abu Dhabi appears to have been caused by a combination of factors, including a breach in infection prevention and control measures in health care settings, active surveillance and increase in community acquired cases…
http://www.who.int/features/2014/mers-cov-risk-assessment/en/

WHO: Global Alert and Response (GAR) – Disease Outbreak News [to 7 June 2014]
http://www.who.int/csr/don/en/
:: Ebola virus disease, West Africa – update 4 June 2014
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 4 June 2014

WHO concludes a MERS-CoV risk assessment mission in the United Arab Emirates
6 June 2014
Excerpt
A team from the WHO and technical partners from the Global Outbreak Alert and Response Network (GOARN) has concluded a 5 day mission in United Arab Emirates (UAE).
The team assessed the risk posed by the Middle East respiratory syndrome coronavirus, or MERS-CoV in the country. The team consisted of 6 experts in coordination, epidemiology, infection prevention and control, food safety and the human-animal interface, and risk communication.

Health authorities in the UAE had invited WHO to review the current situation after an upsurge in MERS-CoV infections in April. Upon arrival, the WHO team met with H.E Mr Abdul Rahman bin Mohammed Al Owais, the Minister of Health, in Dubai to discuss the mission.

Investigation and evaluation
During the mission, the team had extensive meetings with experts from Health Authority Abu Dhabi, Dubai Health Authority and the Abu Dhabi Food Control Authority. The team visited the hospital to which two-thirds of the country’s cases can be traced, in order to review the epidemiological investigation and assess the infection prevention and control measures that have been applied. The WHO team evaluated the work done on investigating possible exposure routes, transmission patterns, and the clinical situation.

“We are impressed by the amount of data and information generated during the investigation of MERS cases by UAE to help better understand MERS- CoV. This knowledge is of utmost importance to the rest of the world to better discover the source of the virus and the routes of transmissions from animals to humans, “said Peter Ben Embarek, WHO team leader.

“The UAE health authorities have been following up diligently on the MERS-CoV cases, including repeated laboratory testing to check when cases have been cleared of the virus. This data will make an important contribution to the risk assessment and to guide the health response internationally,” Ben Embarek concluded.

Need to share experience and knowledge
The preliminary result of the mission indicates that the cases in UAE do not show evidence of sustained human to human infection. The recent upsurge of cases in Abu Dhabi appears to have been caused by a combination of factors, including a breach in infection prevention and control measures in health care settings, active surveillance and increase in community acquired cases…
http://www.who.int/features/2014/mers-cov-risk-assessment/en/

.

WHO: World travel advice on MERS-CoV for pilgrimages [Umra and Hajj]
3 June 2014
Excerpt
I. Introduction
…The virus appears to be circulating widely throughout the Arabian Peninsula and most MERS cases have been reported by the Kingdom of Saudi Arabia. While most cases have occurred among residents, some cases have occurred among visitors. Based on currently available information, the overall risk for visitors to acquire MERS infection appears to be low.
The currently known epidemiological patterns indicate some infections occur in communities. Cases detected in the community may arise from contact with infected animals or unprocessed products from infected animals, from person-to-person spread in the community, or from acquisition in the healthcare setting by individuals who remained living in the community. Studies are underway to determine the relative contribution of all of these, but the studies are not yet complete. Other infections have occurred in hospitals, primarily when hospitalization of an infected patient, coupled with suboptimal infection control and prevention practices, has led to hospital transmission and outbreaks. Finally, infection among families has been seen and may reflect either person to person transmission or possibly exposure to a common source. At this time, the understanding of how MERS is transmitted is not complete, and we await the results of the studies in progress. There is no information at this time to suggest that widespread transmission is occurring in communities.
Since April 2014, there was an increased number of cases, notably in the Kingdom of Saudi Arabia and in the United Arab Emirates in both communities and health care setting. The latest information on MERS-CoV can be found here:
http://www.who.int/csr/disease/coronavirus_infections/en/
II. Effective communication of risk information
It is important for countries to use all practical and effective means possible to communicate information on a range of issues before, during and after Umra and Hajj to all key groups, including the following:
:: travellers to Umra and Hajj, particularly vulnerable groups within this population;
:: public health officials;
:: health care staff responsible for the care of ill pilgrims;
:: transportation and tourism industries; and
:: the general public.
[Text continues with specific recommendation for country actions before, during and after Umra and Hajj]
III. Measures at borders and for conveyances
WHO does not recommend the application of any travel or trade restrictions or entry screening.
WHO encourages countries to provide information on MERS and this travel advice to transport operators and ground staff, and about self-reporting of illness by travellers.
As provided by the IHR, countries should ensure that:
:: routine measures are in place at point of entry for assessing ill travellers detected on board conveyances (such as planes and ships) and at entry;
:: procedures and means are in place for communicating information on ill travellers between conveyance and points of entry as well as between points of entry and national health authorities;
:: safe transportation of symptomatic travellers to hospitals or designated facilities for clinical assessment and treatment is organized….

Polio [to 7 June 2014]

Independent Monitoring Board of the Global Polio Eradication Initiative: Ninth Report
May 2014 52 pages
Excerpts from Executive Summary; Editor’s bolded text
EXECUTIVE SUMMARY
Eighteen months ago, as 2012 drew to a close, optimism was running high for the Global Polio Eradication Initiative. Polio transmission in India had been interrupted. The three remaining endemic countries (Pakistan, Nigeria, Afghanistan) had made significant programmatic improvements. Some believed that success was imminent; that polio would soon be history.

Within a matter of months, this optimism quickly unwound:
::Targeted killing of polio vaccinators in Pakistan shocked the world and created major operational constraints.
:: Polio virus entered Waziristan, a part of Pakistan in which polio vaccination had been – and remains – banned by Taliban commanders.
:: The national structure for managing polio eradication in Pakistan was dismantled at a time when it needed to be strengthened.
:: Nigeria’s security situation deteriorated. Here too, vaccinators tragically lost their lives and the program’s operations were severely impaired.
:: Nigeria polio virus was exported to southern Somalia, where it infected a population unprotected against polio because of an al-Shabab ban on vaccination that remains in place.
:: Pakistan polio virus spread to Syria, causing a major outbreak amidst the country’s civil war.
:: Pakistan polio virus spread also to Israel, West Bank and Gaza, and Iraq, and Nigeria polio virus to Cameroon and Equatorial Guinea – each outbreak over-stretching the global program’s resources and credibility.

In 2012, there were 223 polio cases in five countries. In 2013, there were 407 cases in eight countries…

…In 1988 (26 years ago now) every country in the world resolved to eradicate polio. Most managed to do so by the year 2000. For the last 14 years, we have been witnessing the excruciatingly long tail of completing global eradication. The “last 1%”, a phrase that only three years ago was an inspiring rallying call to finish the job, is becoming an open goal for eye-rolling cynics. Every additional polio year costs lives and money, saps morale, puts future donations at risk and holds the public health world back from making further health gains. The goal of stopping global polio transmission has been serially missed. The deadline year of 2000 came and went; so did 2004; and so too did 2012.

As the end-2014 deadline fast approaches, Nigeria and Pakistan are both at risk of failing to stop transmission in time (with Pakistan’s risk extreme). There is a significant risk of one or more of the current outbreaks becoming prolonged. There is serious risk of failure to anticipate and prevent an outbreak elsewhere. Given these factors, the IMB’s considered analysis is that the latest strategic plan goal of interrupting transmission by the end of 2014 stands at extreme risk.

The World Health Assembly has rightly declared polio eradication a programmatic emergency for global public health. WHO has rightly called the spread of polio a public health emergency of international concern. There is every reason why polio must be eradicated – and fast. Failure to do so is inexcusable. This last 1% cannot be allowed to drag on any longer. The program is failing children and families in the poorest parts of the world. These broken promises mean that every child paralysed in 2015 will be a child grossly let down, their paralysis an avoidable catastrophe.

All eyes must now be focused on minimising the number of such avoidable catastrophes – on ensuring that Nigeria succeeds in 2014; on Pakistan rebuilding a program that can succeed soon after; and on preventing and responding to outbreaks with consistency and vigour.

The IMB makes 11 recommendations:
1. We recommend the establishment of an Emergency Operations Center (EOC) in Pakistan, which builds upon Pakistan’s recent experiences in responding to natural disasters and other countries’ experiences in emergency polio response. Top-level civil servants, senior representatives of national, regional and local government, religious leaders as well as military leaders should be a key part of this process. We urge that this new body be fully operational by 1 July 2014.
2. We recommend that the heads of the Global Polio Eradication Initiative core partner agencies meet urgently with the President and Prime Minister of Pakistan to support their essential leadership of the Pakistan polio eradication program, and to offer every possible assistance in establishing the new EOC as a strong national body with the power, resources and capacity to drive transformative action.
3. We recommend that the President of Nigeria galvanizes action to gain the pledge of all national, state and local candidates in the forthcoming election, together with traditional and religious leaders, to protect the polio eradication program from disruption and politicization, returning it to its humanitarian role in saving the lives of Nigerian children.
4. We recommend that the Polio Oversight Board ensures that the promised Central Africa outbreak coordinator is installed by 1 July 2014, resourced appropriately, and that the Board formally investigates why the program’s response in Central Africa has been much weaker than in the Horn of Africa or in the Middle East.
5. We recommend that a new, dedicated team be established at global level to focus on outbreak response, its first job being to substantially strengthen the outbreak response Standard Operating Procedures to ensure that future responses will be consistently excellent.
6. We recommend that a dedicated team be established at global level to rapidly improve the program’s approach to outbreak prevention in the Red List countries and beyond. Scenarios and exercises should form a key part of its activities.
7. We recommend that the core partners meet in person to agree upon a way to address the three improvement aims for securing communities’ greater trust, based on the analysis of social mobilisation in our report.
8. We recommend that WHO relax its grip on the training of vaccinators and their supervisors, allowing UNICEF, CDC and other partners to contribute, particularly to enhance the interpersonal communication skills of vaccinators
9. We recommend that Pakistan and Nigeria take urgent steps to license additional oral polio vaccines so that they can be used within the next six months, in order to create greater flexibility in global vaccine supply.
10. We recommend that current concerns and unease about the transparency and communication of the polio eradication budget are properly and openly addressed. This might best be achieved by a frank discussion at the Polio Oversight Board.
11. We recommend, in relation to the management review that is underway, that the Polio Oversight Board appoints an advisory panel of four seasoned executives and management experts, who have experience of running or advising some of the most complex enterprises in the world, to help shape the management consultants’ analysis and recommendations before they are finalized for the Polio Oversight Board.

.

GPEI Update: Polio this week – As of 4 June 2014
Global Polio Eradication Initiative
Editor’s Excerpt – Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: The Independent Monitoring Board (IMB) has released its ninth quarterly report assessing progress toward polio eradication, including recommendations to overcome challenges. The board noted the progress in Nigeria and Afghanistan, and expressed alarm about the situation in Pakistan, highlighting the high likelihood that transmission of virus will continue into 2015. While the IMB commended the outbreak responses in the Middle East and the Horn of Africa, it also expressed concern about the activities in Central Africa, and recommended stronger global capacity and processes for outbreak response. The full report is available here [see excerpt above]
:: The GPEI mourns the passing of Dr. Ciro de Quadros, a member of the IMB and a true hero in the effort to protect all children from vaccine-preventable diseases.
:: Speaking at Rotary International’s Annual Convention in Sydney on 1 June, Australian Prime Minister Tony Abbott announced his government’s AUD$100 million commitment for polio eradication. Read more here.
Pakistan
:: Four new WPV1 cases were reported in the past week including two cases from North Waziristan, Federally Administered Tribal Areas – FATA, one case from Bannu, Khyber Pakhtunkhwa – KP, and one case from the previously uninfected district of Karachi (District of Sindh Industrial and Trading Estate), Sindh. The most recent WPV1 case had onset of paralysis on 15 May from North Waziristan. The total number of WPV1 cases reported from Pakistan for 2014 is 71.
Horn of Africa
:: A case of polio due to wild poliovirus type 1 (WPV1) was reported last week from Jariban district in Mudug province, Somalia, with onset of paralysis on 11 May. This is the second case of polio in the Horn of Africa this year. The other case was reported from Ethiopia with onset of paralysis on 5 January.

GAVI Watch [to 7 June 2014]
http://www.gavialliance.org/library/news/press-releases/

:: GAVI Alliance thanks Norway for its support to the polio endgame strategy
Geneva, 5 June 2014
Excerpt
…In an agreement signed this week in Oslo, Norway has committed to contribute US$190 million (NOK 1.14 billion) to the GAVI Alliance’s polio work for the period 2014-2019. This will support the Alliance’s effort to complement GPEI’s work, strengthening routine immunisation and introducing inactivated polio vaccine (IPV) in GAVI-supported countries.
“Norway’s leadership in global health is legendary, this additional support for inactivated polio immunisation and strengthening routine immunisation inspires the world to work together for a world without polio,” said Dr Seth Berkley, CEO of the GAVI Alliance.
“I am delighted that we have signed an agreement with GAVI to support global efforts to eradicate polio,” said Børge Brende, Norwegian Minister for Foreign Affairs. “We have a unique opportunity to eradicate this infectious and debilitating disease, but it will require an extra effort if we are to succeed.”…

:: Children’s Investment Fund Foundation to invest in GAVI Alliance HPV programmes
London, 4 June 2014
Excerpt
The Children’s Investment Fund Foundation (CIFF) will invest US$25 million in the GAVI Alliance “to protect girls and women in developing countries from the leading cause of cervical cancer.” The funding will be matched by the UK’s Department for International Development through the GAVI Matching Fund.
CIFF chief executive Michael Anderson announced the new funding at the UK launch of the End Cervical Cancer Now campaign, held at the Houses of Parliament today. The event was attended by H.E. Lordina Dramani Mahama, the First Lady of Ghana, and H.E. Dr Maria da Luz Dai Guebuza, the first Lady of Mozambique as well as GAVI Alliance CEO Dr Seth Berkley and Baroness Northover…
… “Our investment in the GAVI Alliance will have a major impact on the lives of women and families in developing countries,” said Michael Anderson. “HPV vaccine brings a double benefit for adolescent girls. Not only does it protect them from a terrible disease but it gives them the opportunity to access health services and engage with healthcare professionals, in many cases for the first time in a number of years.”
“Cervical cancer is a devastating disease that kills women at exactly the time when their families need them most,” said GAVI CEO Dr Seth Berkley. “I am pleased that CIFF is showing incredible support for our goal of reaching 30 million girls in 40 countries with this vital vaccine by 2020.”…

The Weekly Epidemiological Record (WER) for 6 June 2014, vol. 89, 23 (pp. 245–256) includes:
:: Review of the 2013–2014 winter influenza season, northern hemisphere
http://www.who.int/entity/wer/2014/wer8923.pdf?ua=1

UNICEF Watch [to 7 June 2014]
http://www.unicef.org/media/media_71724.html

:: UNICEF Executive Board puts spotlight on Africa’s children
:: Liberia’s immunization programme gets a 15-generator boost from UNICEF and GAVI
MONROVIA, Liberia, 6 June 2014 – UNICEF has officially handed over 15 generators to the Government of Liberia to help ensure all children are immunized with vaccines that have been properly and safely stored.

CDC/MMWR Watch [to 7 June 2014]
http://www.cdc.gov/mmwr/mmwr_wk.html

MMWR June 6, 2014 / Vol. 63 / No. 22
:: Influenza Activity — United States, 2013–14 Season and Composition of the 2014–15 Influenza Vaccines
:: Measles — United States, January 1–May 23, 2014

Bill & Melinda Gates Foundation announces funding for 55 projects from 12 countries through its Grand Challenges Explorations (GCE) initiative
June 3, 2014, SEATTLE
Excerpt
…Three projects were awarded additional funding following progress made during the first phase of the GCE grant, totaling $2.3 million. These projects include two to improve the vaccine cold chain:
:: During Phase I of their project, Nancy Muller at PATH in the United States developed a straightforward method to eliminate vaccine freezing by adding specialized material that acts as a thermal buffer between ice packs and vaccines. In Phase II, PATH will assist at least one manufacturing partner in bringing a new World Health Organization Performance, Quality, and Safety-qualified freeze-safe vaccine carrier to market.
:: In Phase I, Nithya Ramanathan at Nexleaf Analytics in the United States developed its ColdTrace remote temperature monitoring sensor, which was deployed in 17 clinics in Kenya and Haiti and proved able to provide real-time alerts that help prevent vaccine spoilage. In Phase II, Nexleaf will install ColdTrace in 500 clinics across Kenya, India, and Mozambique to show the impact of remote temperature monitoring and further develop its low-cost platform to improve cold chain infrastructure…

UNICEF: 2013 Supply Annual Report
June 2014 88 pages
In 2013, UNICEF procured over $2.8 billion in supplies and services. UNICEF’s work in monitoring the procurement of supplies, their quality, and timeliness in their delivery is
critical to ensuring the right supplies are available when children need them, wherever they are.
Introduction
Excerpt
At the heart of UNICEF’s supply and logistics strategies is the goal of reaching the most disadvantaged and excluded children. In 2013, an opportunity for reflection, planning and consolidation has allowed the supply function to position itself to support the achievement of equity as highlighted in UNICEF’s Strategic Plan for 2014 – 2017.

A major expression of this commitment was reflected in the innovation, procurement and delivery strategies that underpinned UNICEF’s $2.8 billion expenditure on supplies supporting the health, education and protection of children in over 130 countries.

The needs of children were the focus of UNICEF’s immediate and large-scale supply response in emergencies. The devastation caused by Typhoon Haiyan in the Philippines, the intensified conflicts in the Central African Republic and South Sudan, and the prolonged suffering of Syrian children across several countries in the region, made plain the tragic consequences of humanitarian crises. Where children and families were caught in armed conflict, the re-emergence of polio, increasing child malnutrition and an absence of functioning schools highlighted a generation’s urgent need for emergency supplies to support programme interventions.

Work continued in supply chain strengthening and long-term capacity development with governments to help ensure that, day in and day out, children have access to essential supplies. UNICEF welcomed delegations from the Democratic Republic of the Congo, Kenya, and Nigeria to identify supply chain bottlenecks and develop solutions to improve the performance of immunization and health supply systems. The missions resulted in action plans targeting key segments of supply chains with performance improvements.

As a catalyst of achieving greater impact for children, monitoring supply chains is an evolving endeavour. UNICEF’s focus on lowering cost and improving performance capitalises on advances in technology, wider network coverage and greater use of mobile devices. UNICEF’s deepening expertise with its recently implemented Enterprise Resource Planning (ERP) system is improving the scope, timeliness and quality of data that supports analyses of processes and outcomes, and builds the evidence base for taking corrective and preventive action. These developments are enabling UNICEF and partners to create supply chain information networks that are more visible and efficient, and more inclusive of feedback from people who use UNICEF supplies…

BMC Public Health
(Accessed 7 June 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Qualitative study of the feasibility of HPV vaccine delivery to young adolescent girls in Vietnam: evidence from a government-implemented demonstration program
D Scott LaMontagne, Nguyen Quy Nghi, Le Thi Nga, Amynah Janmohamed, Dang Thi Huyen, Nguyen Tran Hien, Vivien Davis Tsu
BMC Public Health 2014, 14:
Abstract (provisional)
Background
Introduction of human papillomavirus (HPV) vaccine in national programs has proceeded apace since 2006, mostly in high-income countries. Recently concluded pilots of HPV vaccination in low-income countries have provided important lessons learned for these settings; however, rigorous evaluations of the feasibility of these delivery strategies that effectively reach young adolescents have been few. This paper presents results from a qualitative evaluation of a demonstration program which implemented school-based and health center-based HPV vaccinations to all girls in grade 6, or 11 years of age, for two years in four districts of Vietnam.
Methods
Using semi-structured interviews of 131 health and education staff from local, district, province, and national levels and 26 focus-group discussions with local project implementers (n = 153), we conducted a qualitative two-year evaluation to measure the impact of HPV vaccinations on the health and education systems.
Results
HPV vaccine delivery at schools or health centers was made feasible by: a. close collaboration between the health and education sectors, b. detailed planning for implementation, c. clearly defined roles and responsibilities for project implementers, d. effective management and supervision of vaccinations during delivery, and e. engagement with community organizations for support. Both the health and education systems were temporarily challenged with the extra workload, but the disruptions were short-lived (a few days for each of three doses) and perceived as worth the longer-term benefit of cervical cancer prevention.
Conclusion
The learning from Vietnam has identified critical elements for successful vaccine delivery that can provide a model for other countries to consider during their planning of national rollout of HPV vaccine.

British Medical Journal
07 June 2014 (Vol 348, Issue 7961)
http://www.bmj.com/%5Bfield_highwire_a_cpath-raw%5D-0

Editorial
H1N1 influenza vaccination during pregnancy
Deshayne B Fell, perinatal epidemiologist1, Linda Dodds, professor of obstetrics and gynecology and paediatrics2, Shelly McNeil, associate professor of medicine3, Noni E MacDonald, professor of pediatrics and microbiology and immunology3
Excerpt
H1N1 safety data look reassuring, but we need ongoing surveillance of all influenza vaccines given to pregnant women
to pregnant women from influenza infection have long been recognized.1 The recent 2009-10 H1N1 pandemic was no exception—pregnant women were at higher risk of severe H1N1 influenza illness compared with the general population,2 and those with H1N1 influenza had higher rates of adverse pregnancy outcomes than did uninfected pregnant women.3 Despite limited safety data for use of the monovalent H1N1 vaccines in pregnancy, pregnant women were widely prioritized for H1N1 vaccination programs.4 Fortunately, enhanced surveillance of pregnant women during the pandemic has enabled retrospective evaluation of the safety of monovalent H1N1 vaccine in obstetric populations around the world…

Research
Evaluation of safety of A/H1N1 pandemic vaccination during pregnancy: cohort study
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g3361 (Published 29 May 2014)
Cite this as: BMJ 2014;348:g3361
Abstract
Objective To assess the risk of maternal, fetal, and neonatal outcomes associated with the administration of an MF59 adjuvanted A/H1N1 vaccine during pregnancy.
Design Historical cohort study.
Setting Singleton pregnancies of the resident population of the Lombardy region of Italy.
Participants All deliveries between 1 October 2009 and 30 September 2010. Data on exposure to A/H1N1 pandemic vaccine, pregnancy, and birth outcomes were retrieved from regional databases. Vaccinated and non-vaccinated women were compared in a propensity score matched analysis to estimate risks of adverse outcomes.
Main outcome measures Main maternal outcomes included type of delivery, admission to intensive care unit, eclampsia, and gestational diabetes; fetal and neonatal outcomes included perinatal deaths, small for gestational age births, and congenital malformations.
Results Among the 86,171 eligible pregnancies, 6246 women were vaccinated (3615 (57.9%) in the third trimester and 2557 (40.9%) in the second trimester). No difference was observed in terms of spontaneous deliveries (adjusted odds ratio 1.02, 95% confidence interval 0.96 to 1.08) or admissions to intensive care units (0.95, 0.47 to 1.88), whereas a limited increase in the prevalence of gestational diabetes (1.26, 1.04 to 1.53) and eclampsia (1.19, 1.04 to 1.39) was seen in vaccinated women. Rates of fetal and neonatal outcomes were similar in vaccinated and non-vaccinated women. A slight increase in congenital malformations, although not statistically significant, was present in the exposed cohort (1.14, 0.99 to 1.31).
Conclusions Our findings add relevant information about the safety of the MF59 adjuvanted A/H1N1 vaccine in pregnancy. Residual confounding may partly explain the increased risk of some maternal outcomes. Meta-analysis of published studies should be conducted to further clarify the risk of infrequent outcomes, such as specific congenital malformations.

Bulletin of the World Health Organization
Volume 92, Number 6, June 2014, 385-464
http://www.who.int/bulletin/volumes/92/6/en/
Special theme: BRICS and global health

Impact of BRICS’ investment in vaccine development on the global vaccine market
Miloud Kaddar, Julie Milstien & Sarah Schmitt
Abstract
Brazil, the Russian Federation, India, China and South Africa – the countries known as BRICS – have made considerable progress in vaccine production, regulation and development over the past 20 years. In 1993, all five countries were producing vaccines but the processes used were outdated and non-standardized, there was little relevant research and there was negligible international recognition of the products. By 2014, all five countries had strong initiatives for the development of vaccine technology and had greatly improved their national regulatory capacity. South Africa was then the only BRICS country that was not completely producing vaccines. South Africa is now in the process of re-establishing its own vaccine production and passing beyond the stage of simply importing, formulating and filling vaccine bulks. Changes in the public sector’s price per dose of selected vaccines, the global market share represented by products from specific manufacturers, and the attractiveness, for multinational companies, of partnership and investment opportunities in BRICS companies have all been analysed. The results indicate that the BRICS countries have had a major impact on vaccine price and availability, with much of that impact attributable to the output of Indian vaccine manufacturers. China is expected to have a greater impact soon, given the anticipated development of Chinese vaccine manufacturers in the near future. BRICS’ accomplishments in the field of vaccine development are expected to reshape the global vaccine market and accelerate access to vaccines in the developing world. The challenge is to turn these expectations into strategic actions and practical outcomes.

The economic and social benefits of childhood vaccinations in BRICS
Andrew J Mirelman a, Sachiko Ozawa a & Simrun Grewal a
a. Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E8132, Baltimore, Maryland, 21205, United States of America.
Bulletin of the World Health Organization 2014;92:454-456. doi: http://dx.doi.org/10.2471/BLT.13.132597
Initial text
The international community has successfully promoted childhood vaccination as an essential public health intervention. This has been accomplished through efforts such as the World Health Organization’s (WHO) Expanded Programme on Immunization and more recently, the establishment of the Global Alliance for Vaccines and Immunization (GAVI Alliance), a global health partnership committed to ensuring access to low-cost immunization in developing countries. While such global efforts have resulted in large increases in vaccine coverage worldwide, there is still a large population that remains uncovered. Inadequate immunization coverage is apparent among middle-income countries. As middle-income countries do not receive support from the GAVI Alliance, lack of funds may account for low coverage, and vaccine delivery in these settings may suffer from inefficiencies that have been resolved in high-income countries.1
The potential benefits of expanded vaccine coverage are evident among the following five emerging economies: Brazil, the Russian Federation, India, China and South Africa – often referred to as BRICS. These countries have seen high economic growth in recent years – expanding their capacity to produce, procure and provide health care. The countries represent a range of lower-middle-income (India), upper-middle-income (Brazil, China and South Africa) and high-income (Russian Federation) countries. They include the two most populous countries in the world – China and India. Collectively, BRICS have a population of nearly 239 million children under the age of five years…

Clinical Infectious Diseases (CID)
Volume 58 Issue 12 June 15, 2014
http://cid.oxfordjournals.org/content/current

The State of Norovirus Vaccines
Stanley A. Plotkin, Section Editor, Kari Debbink1, Lisa C. Lindesmith2, and Ralph S. Baric1,2
Author Affiliations
1Department of Microbiology and Immunology
2Department of Epidemiology, University of North Carolina, Chapel Hill
Abstract
Noroviruses represent the most important cause of acute gastroenteritis worldwide; however, currently no licensed vaccine exists. Widespread vaccination that minimizes overall norovirus disease burden would benefit the entire population, but targeted vaccination of specific populations such as healthcare workers may further mitigate the risk of severe disease and death in vulnerable populations. While a few obstacles hinder the rapid development of efficacious vaccines, human trials for virus-like particle (VLP)-based vaccines show promise in both immune response and protection studies, with availability of vaccines being targeted over the next 5–10 years. Ongoing work including identification of important norovirus capsid antigenic sites, development of improved model systems, and continued studies in humans will allow improvement of future vaccines. In the meantime, a better understanding of norovirus disease course and transmission patterns can aid healthcare workers as they take steps to protect high-risk populations such as the elderly and immunocompromised individuals from chronic and severe disease.

Globalization and Health
[Accessed 7 June 2014]
http://www.globalizationandhealth.com/

Review
The role of law and governance reform in the global response to non-communicable diseases
Roger S Magnusson and David Patterson
Author Affiliations
Globalization and Health 2014, 10:44 doi:10.1186/1744-8603-10-44
Published: 5 June 2014
Abstract (provisional)
Addressing non-communicable diseases (“NCDs”) and their risk-factors is one of the most powerful ways of improving longevity and healthy life expectancy for the foreseeable future – especially in low- and middle-income countries. This paper reviews the role of law and governance reform in that process. We highlight the need for a comprehensive approach that is grounded in the right to health and addresses three aspects: preventing NCDs and their risk factors, improving access to NCD treatments, and addressing the social impacts of illness. We highlight some of the major impediments to the passage and implementation of laws for the prevention and control of NCDs, and identify important practical steps that governments can take as they consider legal and governance reforms at country level.We review the emerging global architecture for NCDs, and emphasise the need for governance structures to harness the energy of civil society organisations and to create a global movement that influences the policy agenda at the country level. We also argue that the global monitoring framework would be more effective if it included key legal and policy indicators. The paper identifies priorities for technical legal assistance in implementing the WHO Global Action Plan for the Prevention and Control of NCDs 2013-2020. These include high-quality legal resources to assist countries to evaluate reform options, investment in legal capacity building, and global leadership to respond to the likely increase in requests by countries for technical legal assistance. We urge development agencies and other funders to recognise the need for development assistance in these areas. Throughout the paper, we point to global experience in dealing with HIV and draw out some relevant lessons for NCDs.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
June 2014 Volume 10, Issue 6
http://www.landesbioscience.com/journals/vaccines/toc/volume/10/issue/6/

Review
Commercializing diarrhea vaccines for travelers
Rosa López-Gigosos, Marina Segura-Moreno, Rosa Díez-Díaz, Elena Plaza and Alberto Mariscal
http://dx.doi.org/10.4161/hv.27737
Abstract
Continued growth in international travel and forecasts for a great increase in the number of people who travel from industrialized to emerging and developing countries make it necessary to develop and improve the capacity to provide health protection to travelers. Measures available to prevent some diseases include a currently limited number of marketed vaccines which represent extremely useful tools to protect travelers. Travelers very often experience diarrheal and gastrointestinal diseases for which some vaccines are available. Use of these vaccines should be evaluated based on traveler and travel destination and characteristics. Vaccines available include those against cholera, typhoid fever, hepatitis A, hepatitis E (only available in China), and rotavirus. The aim of this review is to provide an updated summary about each of the abovementioned vaccines that may be useful for making decisions regarding their use and assessing their indications in recommendations for travelers.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
June 2014 Volume 10, Issue 6
http://www.landesbioscience.com/journals/vaccines/toc/volume/10/issue/6/

Short Report
HPV vaccine uptake after introduction of the vaccine in Germany: An analysis of administrative data
Sabrina Hense, Kathrin Hillebrand, Johannes Horn, Rafael Mikolajczyk, Renate Schulze-Rath and Edeltraut Garbe
http://dx.doi.org/10.4161/hv.28450
Abstract
In Germany, vaccination against human papilloma virus (HPV) is recommended by the German Standing Vaccination Committee (STIKO) since March 2007 for girls aged 12–17 years. The vaccine is free of charge for this age group. Additionally, some statutory health insurance providers (SHI) offer reimbursement for women aged 18–26 years. Currently available information on the uptake or coverage of HPV vaccination is limited to specific regions, age groups, or study populations.
This report describes the HPV vaccine uptake in 2008 for females aged 12–26 years in Germany on a broad regional level based on data from one large SHI. HPV vaccinations were identified by outpatient codes used for reimbursement of vaccine administration. Vaccine uptake was calculated by dividing the number of females, who received at least one HPV vaccine dose by the number of female insurees in the respective age group. The overall study population consisted of 317,234 females, of whom 77,350 received at least one HPV vaccine dose in 2008. Vaccine uptake was 32.2% in the recommended age group, with a peak age at 14–16 years. In the age group of females aged 18–26 years, where HPV vaccination was not officially recommended by the STIKO, uptake was 12.3%. Vaccine uptake in 2008 reflects an early stage after the recommendation of HPV vaccination in 2007. Future changes in vaccine uptake should be further and more promptly monitored.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
June 2014 Volume 10, Issue 6
http://www.landesbioscience.com/journals/vaccines/toc/volume/10/issue/6/

Research Paper
Knowledge and risk perception of measles and factors associated with vaccination decisions in subjects consulting university affiliated public hospitals in Lyon, France, after measles infection
Abdoulaye Tour, Mitra Saadatian-Elahi, Daniel Floret, Bruno Lina, Jean-Sebastien Casalegno and Philippe Vanhems
Abstract
In 2011, a large number of European countries faced measles outbreaks, France accounting for more than half of the reported cases. The Rhône-Alpes region, located in south-east France, was one of the most affected provinces, with an incidence rate of 97.9 cases per 100,000 inhabitants. We conducted a retrospective survey of adults and parents of children consulting university affiliated public hospitals because of measles infections between January 1, 2010 and September 2012 in Lyon, France. Our main objectives were to evaluate: i) the level of study population knowledge of measles; ii) vaccination practices; and iii) changes in opinion with regard to measles vaccination after disease onset. Overall, 73.64% of patients were not vaccinated or partially vaccinated. The main reason for non-vaccination in children was inappropriate age while among non-vaccinated adults, 29.3% could not give any reason. In total, 29.1% of the responding parents and 24.2% of adult cases were opposed to vaccination “in principle”. Opposition to vaccination “in principle” was the third reason for non-vaccination. A large number of patients did not recognize measles as a serious illness and were unaware of its complications. Among parents of infected children, knowledge of transmission mode (odds ratio (OR) =5.9; 95% confidence interval (95% CI): 1.64-21.26), perceived severity of measles (OR=1.5; 95% CI: 1.06-2.13) and absence of hepatitis B vaccination (OR=0.17; 95% CI: 0.04-0.65) were independently associated with a more positive opinion about measles vaccination after disease onset. In adult patients, low education level (OR=3.39; 95% CI: 1.03-11.11) and lack of knowledge of sequelae (OR=10.19; 95% CI: 1.14-91.31) were linked with a more positive opinion. Individuals affected by vaccine-preventable diseases are interesting populations to study disease impact on vaccine perception.

Pediatrics
June 2014, VOLUME 133 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Article
Timely Versus Delayed Early Childhood Vaccination and Seizures
Simon J. Hambidge, MD, PhDa,b,c,d, Sophia R. Newcomer, MPHa, Komal J. Narwaney, MD, PhDa, Jason M. Glanz, PhDa,d, Matthew F. Daley, MDa,c, Stan Xu, PhDa, Jo Ann Shoupa, Ali Rowhani-Rahbar, MD, PhDe, Nicola P. Klein, MD, PhDf, Grace M. Lee, MD, MPHg,h, Jennifer C. Nelson, MPHi, Marlene Lugg, DrPHj, Allison L. Naleway, PhDk, James D. Nordin, MD, MPHl, Eric Weintraub, MPHm, and Frank DeStefano, MD, MPHm
Author Affiliations
aInstitute for Health Research, Kaiser Permanente Colorado, Denver, Colorado;
bDepartment of Community Health Services, Denver Health, Denver, Colorado;
cDepartment of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado;
dDepartment of Epidemiology, University of Colorado School of Public Health, Aurora, Colorado;
eDepartment of Epidemiology, School of Public Health, University of Washington, Seattle, Washington;
fKaiser Permanente Vaccine Study Center, Oakland, California;
gDepartment of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts;
hDivision of Infectious Diseases and Department of Laboratory Medicine, Boston Children’s Hospital, Boston, Massachusetts;
iGroup Health Research Institute, Seattle, Washington;
jDepartment of Research and Evaluation, Southern California Kaiser Permanente, Pasadena, California;
kKaiser Foundation Hospital Center for Health Research, Kaiser Northwest, Portland, Oregon;
lHealth Partners Research Foundation, Minneapolis, Minnesota; and
mImmunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Abstract
BACKGROUND: Little is known regarding the timing of childhood vaccination and postvaccination seizures.
METHODS: In a cohort of 323 247 US children from the Vaccine Safety Datalink born from 2004 to 2008, we analyzed the association between the timing of childhood vaccination and the first occurrence of seizure with a self-controlled case series analysis of the first doses of individual vaccines received in the first 2 years of life.
RESULTS: In infants, there was no association between the timing of infant vaccination and postvaccination seizures. In the second year of life, the incident rate ratio (IRR) for seizures after receipt of the first measles-mumps-rubella vaccine (MMR) dose at 12 to 15 months was 2.65 (95% confidence interval [CI] 1.99–3.55); the IRR after an MMR dose at 16 to 23 months was 6.53 (95% CI 3.15–13.53). The IRR for seizures after receipt of the first measles-mumps-rubella-varicella vaccine (MMRV) dose at 12 to 15 months was 4.95 (95% CI 3.68–6.66); the IRR after an MMRV dose at 16 to 23 months was 9.80 (95% CI 4.35 –22.06).
CONCLUSIONS: There is no increased risk of postvaccination seizure in infants regardless of timing of vaccination. In year 2, delaying MMR vaccine past 15 months of age results in a higher risk of seizures. The strength of the association is doubled with MMRV vaccine. These findings suggest that on-time vaccination is as safe with regard to seizures as delayed vaccination in the first year of life, and that delayed vaccination in the second year of life is associated with more postvaccination seizures than on-time vaccination.

Pediatrics
June 2014, VOLUME 133 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Article
Duration of Protection After Infant Hepatitis B Vaccination Series
Amy B. Middleman, MD, MSEd, MPHa, Carol J. Baker, MDb, Claudia A. Kozinetz, PhDb, Saleem Kamili, PhDc, Chi Nguyenb, Dale J. Hu, MDc, and Philip R. Spradling, MDc
Author Affiliations
aDepartment of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;
bDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas; and
cCenters for Disease Control and Prevention, Atlanta, Georgia
Abstract
BACKGROUND: Little is known about duration of protection after the infant primary series of hepatitis B (HB) vaccine in settings of low HB endemicity. This study sought to determine the proportion of adolescents immunized as infants who had protective titers of antibody to hepatitis B surface antigen (anti-HBs) before and after a challenge dose of vaccine.
METHODS: US-born 16- through 19-year-olds who received a recombinant HB vaccine 3-dose series initiated within 7 days of birth (group 1) or at ≥4 weeks of age (group 2) and completed by 12 months of age were enrolled. Participants had serologic testing before and 2 weeks after randomization to receive a challenge dose of 10 µg or 20 µg of Engerix-B. Baseline and postchallenge levels of anti-HBs were compared by group, challenge dosage, and demographic and behavioral characteristics.
RESULTS: At baseline, 24% had protective anti-HBs levels of ≥10 IU/mL; 92% achieved protective levels after challenge dose. Although group 1 had a lower proportion of seroprotection at baseline, group and challenge dosage were not associated with postchallenge proportion of seroprotection. Being in group 2, higher test dosage, higher baseline geometric mean titer, and nonwhite race were associated with significantly higher geometric mean titer after challenge dose.
CONCLUSIONS: More than 90% of study participants immunized against HB as infants exhibited a seroprotective response to a challenge dose of vaccine. Duration of protection from the primary infant HB vaccine series extended through the adolescent years in the setting of low HB endemicity.

Pharmacoeconomics
Volume 32, Issue 6, June 2014
http://link.springer.com/journal/40273/32/5/page/1

Are Current Cost-Effectiveness Thresholds for Low- and Middle-Income Countries Useful? Examples from the World of Vaccines
A. T. Newall, M. Jit, R. Hutubessy
Abstract
The World Health Organization’s CHOosing Interventions that are Cost Effective (WHO-CHOICE) thresholds for averting a disability-adjusted life-year of one to three times per capita income have been widely cited and used as a measure of cost effectiveness in evaluations of vaccination for low- and middle-income countries (LMICs). These thresholds were based upon criteria set out by the WHO Commission on Macroeconomics and Health, which reflected the potential economic returns of interventions. The CHOICE project sought to evaluate a variety of health interventions at a subregional level and classify them into broad categories to help assist decision makers, but the utility of the thresholds for within-country decision making for individual interventions (given budgetary constraints) has not been adequately explored. To examine whether the ‘WHO-CHOICE thresholds’ reflect funding decisions, we examined the results of two recent reviews of cost-effectiveness analyses of human papillomavirus and rotavirus vaccination in LMICs, and we assessed whether the results of these studies were reflected in funding decisions for these vaccination programmes. We found that in many cases, programmes that were deemed cost effective were not subsequently implemented in the country. We consider the implications of this finding, the advantages and disadvantages of alternative methods to estimate thresholds, and how cost perspectives and the funders of healthcare may impact on these choices

PLoS One
[Accessed 7 June 2014]
http://www.plosone.org/

Research Article
Epidemic Process over the Commute Network in a Metropolitan Area
Kenta Yashima mail,
Akira Sasaki
Published: June 06, 2014
DOI: 10.1371/journal.pone.0098518
Abstract
An understanding of epidemiological dynamics is important for prevention and control of epidemic outbreaks. However, previous studies tend to focus only on specific areas, indicating that application to another area or intervention strategy requires a similar time-consuming simulation. Here, we study the epidemic dynamics of the disease-spread over a commute network, using the Tokyo metropolitan area as an example, in an attempt to elucidate the general properties of epidemic spread over a commute network that could be used for a prediction in any metropolitan area. The model is formulated on the basis of a metapopulation network in which local populations are interconnected by actual commuter flows in the Tokyo metropolitan area and the spread of infection is simulated by an individual-based model. We find that the probability of a global epidemic as well as the final epidemic sizes in both global and local populations, the timing of the epidemic peak, and the time at which the epidemic reaches a local population are mainly determined by the joint distribution of the local population sizes connected by the commuter flows, but are insensitive to geographical or topological structure of the network. Moreover, there is a strong relation between the population size and the time that the epidemic reaches this local population and we are able to determine the reason for this relation as well as its dependence on the commute network structure and epidemic parameters. This study shows that the model based on the connection between the population size classes is sufficient to predict both global and local epidemic dynamics in metropolitan area. Moreover, the clear relation of the time taken by the epidemic to reach each local population can be used as a novel measure for intervention; this enables efficient intervention strategies in each local population prior to the actual arrival.

PLoS One
[Accessed 7 June 2014]
http://www.plosone.org/

Research Article
The Potential Cost-Effectiveness of Quadrivalent versus Trivalent Influenza Vaccine in Elderly People and Clinical Risk Groups in the UK: A Lifetime Multi-Cohort Model
Laure-Anne Van Bellinghen, Genevieve Meier mail, Ilse Van Vlaenderen
Published: June 06, 2014
DOI: 10.1371/journal.pone.0098437
Abstract
Objective
To estimate the potential cost-effectiveness of quadrivalent influenza vaccine compared with trivalent influenza vaccine in the UK.
Methods
A lifetime, multi-cohort, static Markov model was constructed, with nine age groups each divided into healthy and at-risk categories. Influenza A and B were accounted for separately. The model was run in one-year cycles for a lifetime (maximum age: 100 years). The analysis was from the perspective of the UK National Health Service. Costs and benefits were discounted at 3.5%. 2010 UK vaccination policy (vaccination of people at risk and those aged ≥65 years) was applied. Herd effect was not included. Inputs were derived from national databases and published sources where possible. The quadrivalent influenza vaccine price was not available when the study was conducted. It was estimated at £6.72,15% above the trivalent vaccine price of £5.85. Sensitivity analyses used an incremental price of up to 50%.
Results
Compared with trivalent influenza vaccine, the quadrivalent influenza vaccine would be expected to reduce the numbers of influenza cases by 1,393,720, medical visits by 439,852 complications by 167,357, hospitalisations for complications by 26,424 and influenza deaths by 16,471. The estimated base case incremental cost-effectiveness ratio (ICER) was £5,299/quality-adjusted life-year (QALY). Sensitivity analyses indicated that the ICER was sensitive to changes in circulation of influenza virus subtypes and vaccine mismatch; all other parameters had little effect. In 96% of simulations the ICER was <£20,000/QALY. Since this analysis was completed, quadrivalent influenza vaccine has become available in the UK at a list price of £9.94. Using this price in the model, the estimated ICER for quadrivalent compared with trivalent vaccination was £27,378/QALY, still within the NICE cost-effectiveness threshold (£20,000-£30,000).
Conclusions
Quadrivalent influenza vaccine could reduce influenza disease burden and would be cost-effective compared with trivalent influenza vaccine in elderly people and clinical risk groups in the UK.

PLoS One
[Accessed 7 June 2014]
http://www.plosone.org/

Research Article
Direct Effect of 10-Valent Conjugate Pneumococcal Vaccination on Pneumococcal Carriage in Children Brazil
Ana Lucia Andrade mail, Yves Mauro Ternes, Maria Aparecida Vieira, Weslley Garcia Moreira, Juliana Lamaro-Cardoso, André Kipnis, Maria Regina Cardoso, Maria Cristina Brandileone,
Iaci Moura, Fabiana C. Pimenta, Maria da Gloria Carvalho, Fabricia Oliveira Saraiva, Cristiana Maria Toscano, Ruth Minamisava
Published: June 03, 2014
DOI: 10.1371/journal.pone.0098128
Abstract
Background
10-valent conjugate pneumococcal vaccine/PCV10 was introduced in the Brazilian National Immunization Program along the year of 2010. We assessed the direct effectiveness of PCV10 vaccination in preventing nasopharyngeal/NP pneumococcal carriage in infants.
Methods
A cross-sectional population-based household survey was conducted in Goiania Brazil, from December/2010-February/2011 targeting children aged 7–11 m and 15–18 m. Participants were selected using a systematic sampling. NP swabs, demographic data, and vaccination status were collected from 1,287 children during home visits. Main outcome and exposure of interest were PCV10 vaccine-type carriage and dosing schedules (3p+0, 2p+0, and one catch-up dose), respectively. Pneumococcal carriage was defined by a positive culture and serotyping was performed by Quellung reaction. Rate ratio/RR was calculated as the ratio between the prevalence of vaccine-types carriage in children exposed to different schedules and unvaccinated for PCV10. Adjusted RR was estimated using Poisson regression. PCV10 effectiveness/VE on vaccine-type carriage was calculated as 1-RR*100.
Results
The prevalence of pneumococcal carriage was 41.0% (95%CI: 38.4–43.7). Serotypes covered by PCV10 and PCV13 were 35.2% and 53.0%, respectively. Vaccine serotypes 6B (11.6%), 23F (7.8%), 14 (6.8%), and 19F (6.6%) were the most frequently observed. After adjusted for confounders, children who had received 2p+0 or 3p+0 dosing schedule presented a significant reduction in pneumococcal vaccine-type carriage, with PCV10 VE equal to 35.9% (95%CI: 4.2–57.1; p = 0.030) and 44.0% (95%CI: 14.–63.5; p = 0.008), respectively, when compared with unvaccinated children. For children who received one catch-up dose, no significant VE was detected (p = 0.905).
Conclusion
PCV10 was associated with high protection against vaccine-type carriage with 2p+0 and 3p+0 doses for children vaccinated before the second semester of life. The continuous evaluation of carriage serotypes distribution is likely to be useful for evaluating the long-term effectiveness and impact of pneumococcal vaccination on serotypes reduction.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 7 June 2014)

Research Article
Efficacy of Pneumococcal Nontypable Haemophilus influenzae Protein D Conjugate Vaccine (PHiD-CV) in Young Latin American Children: A Double-Blind Randomized Controlled Trial
Miguel W. Tregnaghi, Xavier Sáez-Llorens mail, Pio López, Hector Abate, Enrique Smith, Adriana Pósleman, Arlene Calvo, Digna Wong, Carlos Cortes-Barbosa, Ana Ceballos, Marcelo Tregnaghi, Alexandra Sierra, Mirna Rodriguez, [ … ], on behalf of the COMPAS Group
Published: June 03, 2014
DOI: 10.1371/journal.pmed.1001657
Abstract
Background
The relationship between pneumococcal conjugate vaccine–induced antibody responses and protection against community-acquired pneumonia (CAP) and acute otitis media (AOM) is unclear. This study assessed the impact of the ten-valent pneumococcal nontypable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) on these end points. The primary objective was to demonstrate vaccine efficacy (VE) in a per-protocol analysis against likely bacterial CAP (B-CAP: radiologically confirmed CAP with alveolar consolidation/pleural effusion on chest X-ray, or non-alveolar infiltrates and C-reactive protein ≥ 40 µg/ml); other protocol-specified outcomes were also assessed.
Methods and Findings
This phase III double-blind randomized controlled study was conducted between 28 June 2007 and 28 July 2011 in Argentine, Panamanian, and Colombian populations with good access to health care. Approximately 24,000 infants received PHiD-CV or hepatitis control vaccine (hepatitis B for primary vaccination, hepatitis A at booster) at 2, 4, 6, and 15–18 mo of age. Interim analysis of the primary end point was planned when 535 first B-CAP episodes, occurring ≥2 wk after dose 3, were identified in the per-protocol cohort. After a mean follow-up of 23 mo (PHiD-CV, n = 10,295; control, n = 10,201), per-protocol VE was 22.0% (95% CI: 7.7, 34.2; one-sided p = 0.002) against B-CAP (conclusive for primary objective) and 25.7% (95% CI: 8.4%, 39.6%) against World Health Organization–defined consolidated CAP. Intent-to-treat VE was 18.2% (95% CI: 5.5%, 29.1%) against B-CAP and 23.4% (95% CI: 8.8%, 35.7%) against consolidated CAP. End-of-study per-protocol analyses were performed after a mean follow-up of 28–30 mo for CAP and invasive pneumococcal disease (IPD) (PHiD-CV, n = 10,211; control, n = 10,140) and AOM (n = 3,010 and 2,979, respectively). Per-protocol VE was 16.1% (95% CI: −1.1%, 30.4%; one-sided p = 0.032) against clinically confirmed AOM, 67.1% (95% CI: 17.0%, 86.9%) against vaccine serotype clinically confirmed AOM, 100% (95% CI: 74.3%, 100%) against vaccine serotype IPD, and 65.0% (95% CI: 11.1%, 86.2%) against any IPD. Results were consistent between intent-to-treat and per-protocol analyses. Serious adverse events were reported for 21.5% (95% CI: 20.7%, 22.2%) and 22.6% (95% CI: 21.9%, 23.4%) of PHiD-CV and control recipients, respectively. There were 19 deaths (n = 11,798; 0.16%) in the PHiD-CV group and 26 deaths (n = 11,799; 0.22%) in the control group. A significant study limitation was the lower than expected number of captured AOM cases.

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH)
April 2014 Vol. 35, No. 4
http://www.paho.org/journal/index.php?option=com_content&view=article&id=143&Itemid=236&lang=en
Contribution of Mexico’s Universal Immunization Program to the Fourth Millennium Development Goal [Contribución del Programa de Vacunación Universal de México al cuarto Objetivo de Desarrollo del Milenio]
Vesta Richardson,1 Edgar Sánchez-Uribe,1 Marcelino Esparza-Aguilar,1
Alejandra Esteves-Jaramillo,1 and Lorena Suárez-Idueta1
Abstract
Objective. To identify and describe 1) progress achieved thus far in meeting the commitments of the Fourth Millennium Development Goal (MDG 4) in Mexico, mainly the contribution
of the Universal Immunization Program (UIP) over the last 20 years, and 2) new opportunities for further reducing mortality among children under 5 years old.
Methods. An observational, descriptive, retrospective study was carried out to examine registered causes of death in children under 5 between 1990 and 2010. Indicators were built
according to the recommendations of the United Nations.
Results. In 2010, deaths among children under 5 decreased 64.3% compared to the baseline (1990) figure. Of the total deaths of the children under 5, the neonatal period was the most
affected (52.8%), followed by the 1 to 11 months (30.9%), and the 12 to 59 months (16.2%) groups. A 34% overall mortality reduction was observed after the universalization of immunization
against influenza, rotavirus, and pneumococcus in children under 5.
Conclusions. Despite a significant reduction in under-5 mortality in Mexico over the last 20 years, largely due to the successes of the UIP, several challenges remain, particularly in
improving preventive and curative services during pre- and postnatal care.

La desigualdad en salud de grupos vulnerables de México: adultos mayores, indígenas y migrantes [Health inequality among vulnerable groups in Mexico: older adults, indigenous people, and migrants]
Clara Juárez-Ramírez, Margarita Márquez-Serrano, Nelly Salgado de Snyder, Blanca Estela elcastre-Villafuerte, María Guadalupe Ruelas-González y Hortensia Reyes-Morales
Synopsis
Health vulnerability refers to a lack of protection for specific population groups with specific health problems, as well as the disadvantages they face in solving them in comparison
with other population groups. This major public health problem has multiple and diverse causes, including a shortage of trained health care personnel and the lack of family, social, economic, and institutional support in obtaining care and minimizing health risks. Health vulnerability is a
dynamic condition arising from the confluence of multiple social determinants. This article attempts to describe the health situation of three vulnerable groups in Mexico—older adults, indigenous people, and migrants—and, after defining the needs of each, explore measures that could contribute to the design and implementation of public health policies better tailored to their respective needs.

Science
6 June 2014 vol 344, issue 6188, pages 1057-1196
http://www.sciencemag.org/current.dtl

Special Issue: Rethinking the Global Supply Chain
Introduction to Special Issue
Rethinking the global supply chain
Brad Wible, Jeffrey Mervis, Nicholas S. Wigginton
We are all part of a global economy, capable of producing and transporting seemingly anything, from anywhere, to anyone. Its lifeblood is an interconnected network of suppliers and producers, retailers and consumers, spanning the planet. But the public typically knows far more about Apple, Nike, and other brands than the logistics empires many tiers below, where firms such as Foxconn and Pou Chen connect vast underlying commodity and labor markets that are relatively hidden from the public eye. This sprawling web of supply chains can raise living standards, improve conditions for workers, and help alleviate poverty. But feeding its unquenchable thirst for energy, water, and other resources puts a strain on the planet. Finding ways to relieve that strain is an enormous challenge and will undoubtedly require greater traceability and transparency.

One step forward is providing better measurements and models and making efforts to standardize and coordinate their use. Researchers are intensely studying how to account for supply-chain demands on ecosystems by integrating carbon, water, energy, and other “footprints” into coordinated schemes (see Hoekstra and Wiedmann, p. 1114). They are also developing better ways to inventory material and energy inputs, from the conception of a product to its grave, via life-cycle assessment tools (see Hellweg and Milà i Canals, p. 1109).

Yet academic insights alone cannot solve these problems. The large-scale cooperation of industry is essential. Many companies and industries are seeking to improve how they collect, synthesize, standardize, and communicate supply-chain data to better inform decision-making (see O’Rourke, p. 1124). A study of the Brazilian Amazon shows how supply-chain initiatives in the beef and soy industries, interacting with economic, social, and policy drivers, can slow deforestation of one of the world’s major sources of biodiversity and carbon sequestration (see Nepstad et al., p. 1118).

Logistics and transportation are also ripe for improvement. One approach is drawing inspiration from the digital Internet to create a Physical Internet. The initiative envisions using standardized “packets” and protocols for shipping, and forging the types of industry-wide partnerships that are normally anathema to a free-market system, but perhaps necessary to reduce the congestion, pollution, and inefficiency that make the current system ultimately unsustainable (see Mervis, p. 1104). Although many companies may initially be motivated by improved efficiencies and profit margins, such improvements in supply chains hold out the hope of improving conditions for humanity (see Dooley, p. 1108).

Online: Podcast at http://www.sciencemag.org/special/supply