Compliance with immunization and a biological risk assessment of health care workers as part of an occupational health surveillance program: The experience of a university hospital in southern Italy

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American Journal of Infection Control
April 2020 Volume 48, Issue 4, p355-470
http://www.ajicjournal.org/current

 

Compliance with immunization and a biological risk assessment of health care workers as part of an occupational health surveillance program: The experience of a university hospital in southern Italy
Francesco Paolo Bianchi, Luigi Vimercati, Francesca Mansi, Sara De Nitto, Pasquale Stefanizzi, Letizia Alessia Rizzo, Grazia Rita Fragnelli, Enza Sabrina Silvana Cannone, Luigi De Maria, Angela Maria Vittoria Larocca, Silvio Tafuri
p368–374
Published online: November 18, 2019

Estimating Malaria Incidence through Modeling Is a Good Academic Exercise, but How Practical Is It in High-Burden Settings?

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American Journal of Tropical Medicine and Hygiene
Volume 102, Issue 4, April 2020
http://www.ajtmh.org/content/journals/14761645/102/4

 

Editorial
Estimating Malaria Incidence through Modeling Is a Good Academic Exercise, but How Practical Is It in High-Burden Settings?
Yazoume Ye and Andrew Andrada
Pages: 701–702
https://doi.org/10.4269/ajtmh.20-0120

Developing a Road Map to Spread Genomic Knowledge in Africa: 10th Conference of the African Society of Human Genetics, Cairo, Egypt

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American Journal of Tropical Medicine and Hygiene
Volume 102, Issue 4, April 2020
http://www.ajtmh.org/content/journals/14761645/102/4

 

Meeting Report
Developing a Road Map to Spread Genomic Knowledge in Africa: 10th Conference of the African Society of Human Genetics, Cairo, Egypt
Ghada Y. El-Kamah, Amal M. Mohamed, Yehia Z. Gad, Sonia Abdelhak, Branwen J. Hennig, Raj S. Ramesar, Guida Landouré, Amadou Gaye, Melanie J. Newport, Scott M. Williams and Michèle Ramsay
Pages: 719–723
https://doi.org/10.4269/ajtmh.19-0408
The tenth conference of the African Society of Human Genetics was held in Egypt with the theme “Human Genetics and Genomics in Africa: Challenges for Both Rare and Common Genetic Disorders.” Current research was presented, and we discussed visions for the future of genomic research on the African continent. In this report, we summarize the presented scientific research within and relevant to Africa as presented by both African and non-African scientists. We also discuss the current situation concerning genomic medicine and genomic research within the continent, difficulties in implementing genetic services and genomic medicine in Africa, and a road map to overcome those difficulties and meet the needs of the African researchers and patients.

Effect of age at vaccination on the measles vaccine effectiveness and immunogenicity: systematic review and meta-analysis

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BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 28 Mar 2020)

 

Effect of age at vaccination on the measles vaccine effectiveness and immunogenicity: systematic review and meta-analysis
The objectives of this review were to evaluate the effect of age at administration of the first dose of a measles-containing vaccine (MCV1) on protection against measles and on antibody response after one- and…
Authors: Sara Carazo, Marie-Noëlle Billard, Amélie Boutin and Gaston De Serres
Citation: BMC Infectious Diseases 2020 20:251
Content type: Research article
Published on: 29 March 2020

The fiscal value of human lives lost from coronavirus disease (COVID-19) in China

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BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content
(Accessed 28 Mar 2020)

 

The fiscal value of human lives lost from coronavirus disease (COVID-19) in China
Authors: Joses M. Kirigia and Rose Nabi Deborah Karimi Muthuri
Citation: BMC Research Notes 2020 13:198
Content type: Research note
Published on: 1 April 2020
Abstract
Objective
According to the WHO coronavirus disease (COVID-19) situation report 35, as of 24th February 2020, there was a total of 77,262 confirmed COVID-19 cases in China. That included 2595 deaths. The specific objective of this study was to estimate the fiscal value of human lives lost due to COVID-19 in China as of 24th February 2020.
Results
The deaths from COVID-19 had a discounted (at 3%) total fiscal value of Int$ 924,346,795 in China. Out of which, 63.2% was borne by people aged 25–49 years, 27.8% by people aged 50–64 years, and 9.0% by people aged 65 years and above. The average fiscal value per death was Int$ 356,203. Re-estimation of the economic model alternately with 5% and 10 discount rates led to a reduction in the expected total fiscal value by 21.3% and 50.4%, respectively. Furthermore, the re-estimation of the economic model using the world’s highest average life expectancy of 87.1 years (which is that of Japanese females), instead of the national life expectancy of 76.4 years, increased the total fiscal value by Int$ 229,456,430 (24.8%).

Defining ethical standards for the application of digital tools to population health research

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Bulletin of the World Health Organization
Volume 98, Number 4, April 2020, 229-296
https://www.who.int/bulletin/volumes/98/4/en/

 

POLICY & PRACTICE
Defining ethical standards for the application of digital tools to population health research
— Gabrielle Samuel & Gemma Derrick
http://dx.doi.org/10.2471/BLT.19.237370
There is growing interest in population health research, which uses methods based on artificial intelligence. Such research draws on a range of clinical and non-clinical data to make predictions about health risks, such as identifying epidemics and monitoring disease spread. Much of this research uses data from social media in the public domain or anonymous secondary health data and is therefore exempt from ethics committee scrutiny. While the ethical use and regulation of digital-based research has been discussed, little attention has been given to the ethics governance of such research in higher education institutions in the field of population health. Such governance is essential to how scholars make ethical decisions and provides assurance to the public that researchers are acting ethically. We propose a process of ethics governance for population health research in higher education institutions. The approach takes the form of review after the research has been completed, with particular focus on the role artificial intelligence algorithms play in augmenting decision-making. The first layer of review could be national, open-science repositories for open-source algorithms and affiliated data or information which are developed during research. The second layer would be a sector-specific validation of the research processes and algorithms by a committee of academics and stakeholders with a wide range of expertise across disciplines. The committee could be created as an off-shoot of an already functioning national oversight body or health technology assessment organization. We use case studies of good practice to explore how this process might operate.

Artificial intelligence and the ongoing need for empathy, compassion and trust in healthcare

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Bulletin of the World Health Organization
Volume 98, Number 4, April 2020, 229-296
https://www.who.int/bulletin/volumes/98/4/en/

 

Artificial intelligence and the ongoing need for empathy, compassion and trust in healthcare
— Angeliki Kerasidou
http://dx.doi.org/10.2471/BLT.19.237198
Empathy, compassion and trust are fundamental values of a patient-centred, relational model of health care. In recent years, the quest for greater efficiency in health care, including economic efficiency, has often resulted in the side-lining of these values, making it difficult for health-care professionals to incorporate them in practice. Artificial intelligence is increasingly being used in health care. This technology promises greater efficiency and more free time for health-care professionals to focus on the human side of care, including fostering trust relationships and engaging with patients with empathy and compassion. This article considers the vision of efficient, empathetic and trustworthy health care put forward by the proponents of artificial intelligence. The paper suggests that artificial intelligence has the potential to fundamentally alter the way in which empathy, compassion and trust are currently regarded and practised in health care. Moving forward, it is important to re-evaluate whether and how these values could be incorporated and practised within a health-care system where artificial intelligence is increasingly used. Most importantly, society needs to re-examine what kind of health care it ought to promote.

Artificial intelligence in health care: accountability and safety

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Bulletin of the World Health Organization
Volume 98, Number 4, April 2020, 229-296
https://www.who.int/bulletin/volumes/98/4/en/

 

Artificial intelligence in health care: accountability and safety
— Ibrahim Habli, Tom Lawton & Zoe Porter
http://dx.doi.org/10.2471/BLT.19.237487
The prospect of patient harm caused by the decisions made by an artificial intelligence-based clinical tool is something to which current practices of accountability and safety worldwide have not yet adjusted. We focus on two aspects of clinical artificial intelligence used for decision-making: moral accountability for harm to patients; and safety assurance to protect patients against such harm. Artificial intelligence-based tools are challenging the standard clinical practices of assigning blame and assuring safety. Human clinicians and safety engineers have weaker control over the decisions reached by artificial intelligence systems and less knowledge and understanding of precisely how the artificial intelligence systems reach their decisions. We illustrate this analysis by applying it to an example of an artificial intelligence-based system developed for use in the treatment of sepsis. The paper ends with practical suggestions for ways forward to mitigate these concerns. We argue for a need to include artificial intelligence developers and systems safety engineers in our assessments of moral accountability for patient harm. Meanwhile, none of the actors in the model robustly fulfil the traditional conditions of moral accountability for the decisions of an artificial intelligence system. We should therefore update our conceptions of moral accountability in this context. We also need to move from a static to a dynamic model of assurance, accepting that considerations of safety are not fully resolvable during the design of the artificial intelligence system before the system has been deployed.

How to achieve trustworthy artificial intelligence for health

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Bulletin of the World Health Organization
Volume 98, Number 4, April 2020, 229-296
https://www.who.int/bulletin/volumes/98/4/en/

 

How to achieve trustworthy artificial intelligence for health
— Kristine Bærøe, Ainar Miyata-Sturm & Edmund Henden
http://dx.doi.org/10.2471/BLT.19.237289
Artificial intelligence holds great promise in terms of beneficial, accurate and effective preventive and curative interventions. At the same time, there is also awareness of potential risks and harm that may be caused by unregulated developments of artificial intelligence. Guiding principles are being developed around the world to foster trustworthy development and application of artificial intelligence systems. These guidelines can support developers and governing authorities when making decisions about the use of artificial intelligence. The High-Level Expert Group on Artificial Intelligence set up by the European Commission launched the report Ethical guidelines for trustworthy artificial intelligence in 2019. The report aims to contribute to reflections and the discussion on the ethics of artificial intelligence technologies also beyond the countries of the European Union (EU). In this paper, we use the global health sector as a case and argue that the EU’s guidance leaves too much room for local, contextualized discretion for it to foster trustworthy artificial intelligence globally. We point to the urgency of shared globalized efforts to safeguard against the potential harms of artificial intelligence technologies in health care.

Ensuring trustworthy use of artificial intelligence and big data analytics in health insurance

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Bulletin of the World Health Organization
Volume 98, Number 4, April 2020, 229-296
https://www.who.int/bulletin/volumes/98/4/en/

 

Ensuring trustworthy use of artificial intelligence and big data analytics in health insurance
— Calvin W L Ho, Joseph Ali & Karel Caals
http://dx.doi.org/10.2471/BLT.19.234732
Technological advances in big data (large amounts of highly varied data from many different sources that may be processed rapidly), data sciences and artificial intelligence can improve health-system functions and promote personalized care and public good. However, these technologies will not replace the fundamental components of the health system, such as ethical leadership and governance, or avoid the need for a robust ethical and regulatory environment. In this paper, we discuss what a robust ethical and regulatory environment might look like for big data analytics in health insurance, and describe examples of safeguards and participatory mechanisms that should be established. First, a clear and effective data governance framework is critical. Legal standards need to be enacted and insurers should be encouraged and given incentives to adopt a human-centred approach in the design and use of big data analytics and artificial intelligence. Second, a clear and accountable process is necessary to explain what information can be used and how it can be used. Third, people whose data may be used should be empowered through their active involvement in determining how their personal data may be managed and governed. Fourth, insurers and governance bodies, including regulators and policy-makers, need to work together to ensure that the big data analytics based on artificial intelligence that are developed are transparent and accurate. Unless an enabling ethical environment is in place, the use of such analytics will likely contribute to the proliferation of unconnected data systems, worsen existing inequalities, and erode trustworthiness and trust.

Artificial intelligence, diagnostic imaging and neglected tropical diseases: ethical implications

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Bulletin of the World Health Organization
Volume 98, Number 4, April 2020, 229-296
https://www.who.int/bulletin/volumes/98/4/en/

 

Artificial intelligence, diagnostic imaging and neglected tropical diseases: ethical implications
— Alon Vaisman, Nina Linder, Johan Lundin, Ani Orchanian-Cheff, Jean T Coulibaly, Richard KD Ephraim & Isaac I Bogoch
http://dx.doi.org/10.2471/BLT.19.237560

Ethical barriers to artificial intelligence in the national health service, United Kingdom of Great Britain and Northern Ireland

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Bulletin of the World Health Organization
Volume 98, Number 4, April 2020, 229-296
https://www.who.int/bulletin/volumes/98/4/en/

 

Ethical barriers to artificial intelligence in the national health service, United Kingdom of Great Britain and Northern Ireland
— Claire Louise Thompson & Heather May Morgan
http://dx.doi.org/10.2471/BLT.19.237230

Responding to Ebola in the Democratic Republic of Congo

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Humanitarian Exchange Magazine
Number 77, March 2020
https://odihpn.org/magazine/the-crisis-in-yemen/

 

Responding to Ebola in the Democratic Republic of Congo
by Humanitarian Practice Network
This edition of Humanitarian Exchange, co-edited with Anne Harmer, focuses on the response to the Ebola outbreak in the Democratic Republic of Congo (DRC). Although at the time of publication the outbreak appeared to have ended, over its course it claimed 2,200 lives, with more than 3,300 infected, making this the world’s second largest outbreak ever.

In the lead article, Natalie Roberts reflects on the extent to which humanitarian actors have applied learning from the outbreak in West Africa in 2014–2016. Richard Kojan and colleagues report on the NGO ALIMA’s flexible, patient-centred approach to reducing mortality, Marcela Ascuntar reflects on lessons learned from community feedback and Bernard Balibuno, Emanuel Mbuna Badjonga and Howard Mollett highlight the crucial role faith-based organisations have played in the response. In their article, Theresa Jones, Noé Kasali and Olivia Tulloch outline the work of the Bethesda counselling centre in Beni, which provides support to grieving families. Reflecting on findings from a recent assessment by Translators without Borders, Ellie Kemp describes the challenges involved in providing clear and accessible information on Ebola and the response, and Sung Joon Park and colleagues explain how humane care and treatment can help increase trust and confidence in the response. Stephen Mugamba and his co-authors highlight the importance of community involvement in Ebola research, and Gillian McKay and her co-authors examine the impact of the Ebola outbreak and response on sexual and reproductive health services.

Stacey Mearns, Kiryn Lanning and Michelle Gayer present an Ebola Readiness Roadmap to support NGOs in preparing for an outbreak, while Edward Kumakech, Maurice Sadlier, Aidan Sinnott and Dan Irvine report on a Gap Analysis tool looking at the communication, community engagement and compliance tracking activities that need to be in place before an Ebola vaccine is deployed. Emanuele Bruni and colleagues describe the development of a new monitoring and evaluation framework for strategic response planning. The edition ends with an article by Adelicia Fairbanks, who argues for an acceptance strategy in the DRC to improve security and access for responding agencies.

Potential Legal Liability for Withdrawing or Withholding Ventilators During COVID-19Assessing the Risks and Identifying Needed Reforms

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JAMA
March 24/31, 2020, Vol 323, No. 12, Pages 1111-1216
http://jama.jamanetwork.com/issue.aspx

 

Online First
April 1, 2020
Viewpoint
Potential Legal Liability for Withdrawing or Withholding Ventilators During COVID-19Assessing the Risks and Identifying Needed Reforms
I. Glenn Cohen, JD; Andrew M. Crespo, JD; Douglas B. White, MD, MAS
free access has active quiz
JAMA. Published online April 1, 2020. doi:10.1001/jama.2020.5442
This Viewpoint discusses the legal risks to health care workers and hospital systems from withdrawing or withholding ventilation from COVID-19 patients and cites a Maryland statute that offers legal immunity to clinicians making good faith decisions under emergency conditions as an example for other states to follow.

A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic

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JAMA
March 24/31, 2020, Vol 323, No. 12, Pages 1111-1216
http://jama.jamanetwork.com/issue.aspx

 

Viewpoint
March 27, 2020
A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic
Douglas B. White, MD, MAS; Bernard Lo, MD
free access is active quiz has multimedia online first
JAMA. 2020; doi: 10.1001/jama.2020.5046
This Viewpoint describes a framework for rationing ventilators during the COVID-19 pandemic should intensive care units find themselves with more patients than they can care for, using a score-based system that incorporates patients’ likelihood of surviving to hospital discharge and beyond and their role in the public health response to the outbreak.

Giving patients a voice: implementing patient and public involvement to strengthen research in sub-Saharan Africa

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Journal of Epidemiology & Community Health
April 2020 – Volume 74 – 4
https://jech.bmj.com/content/74/4

 

Commentary
Giving patients a voice: implementing patient and public involvement to strengthen research in sub-Saharan Africa (31 January, 2020)
Carol Bedwell, Tina Lavender
…Active involvement in research and healthcare is very much expected and is well established within many high-income settings. However, in low-income settings, PPI is in its infancy, with few researchers understanding the concept.4 This may lead to a failure to match health need with appropriate research,5 particularly when the research agenda is set by others, leading to acknowledged power imbalances.6 In such settings, empowerment of individuals is low and patients are not included in research design or conduct. In sub-Saharan Africa, gender inequalities mean that women have limited input into both healthcare-related decisions and research.7 Experience of working in these settings highlighted that this is the case even in research which is women-centred, such as maternity care…

Redefining vulnerability in the era of COVID-19

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The Lancet
Apr 04, 2020 Volume 39 5Number 10230 p1089-1166, e62-e63
https://www.thelancet.com/journals/lancet/issue/current

 

Editorial
Redefining vulnerability in the era of COVID-19
The Lancet
What does it mean to be vulnerable? Vulnerable groups of people are those that are disproportionally exposed to risk, but who is included in these groups can change dynamically. A person not considered vulnerable at the outset of a pandemic can become vulnerable depending on the policy response. The risks of sudden loss of income or access to social support have consequences that are difficult to estimate and constitute a challenge in identifying all those who might become vulnerable. Certainly, amid the COVID-19 pandemic, vulnerable groups are not only elderly people, those with ill health and comorbidities, or homeless or underhoused people, but also people from a gradient of socioeconomic groups that might struggle to cope financially, mentally, or physically with the crisis.

The strategies most recommended to control the spread of COVID-19—social distancing and frequent handwashing—are not easy for the millions of people who live in highly dense communities with precarious or insecure housing, and poor sanitation and access to clean water. Often people living in these settings also have malnutrition, non-communicable diseases, and infectious diseases such as HIV/AIDS and tuberculosis. In South Africa, 15 million people live in townships where the incidence of HIV is around 25%. These immunocompromised populations are at greater risk to Covid-19. Another concern in African countries is that the response to COVID-19 will come at the expense of treating other diseases. For example, in the Democratic Republic of the Congo, the response to Ebola resulted in the resurgence of measles.

The effect of the policy response on children in the fight against COVID-19 is also a concern. On March 23, UNICEF reported that in Latin America and the Caribbean over 154 million children are temporarily out of school because of COVID-19. The impact of this policy is more far-reaching than just the loss of education—in this region, school food programmes benefit 85 million children, and the UN Food and Agriculture Organization assessed that these programmes constitute one of the most reliable daily sources of food for around 10 million children.

Questioning whether appropriate evidence exists to support the reduction of transmission through school closures, Richard Armitage and Laura Nellums considered the long-term risks of deepening social, economic, and health inequities for children in a letter published in The Lancet Global Health. A 2015 UN report analysing the socioeconomic effects of Ebola in Africa also highlighted the increased risks of pregnancy in young girls, school dropout, and child abuse.

The most vulnerable children are part of families in which parents have informal jobs and are not able to work from home. This predicament is particularly concerning in countries like India, where over 80% of its workforce is employed in the informal sector and a third of people work as casual labourers. In socioeconomically fragile settings, a lockdown policy can exacerbate health inequalities and the consequences need careful consideration to avoid reinforcing the vicious cycle between poverty and ill health. Human Rights Watch has reported that the lockdown in India has disproportionately affected marginalised communities because of the loss of livelihood and lack of food, shelter, health, and other basic necessities. Under this unprecedented challenge, governments must be mindful that strategies to address the pandemic should not further marginalise or stigmatise affected communities.

Vulnerable groups and health inequalities are also evident in developed countries. The USA is a stark reminder of the divide that exists in countries without a universal health-care system. For people who do not have private medical insurance, this pandemic might see them face the choice of devastating financial hardship or poor health outcomes, or both. During the 2009 H1N1 influenza pandemic in the USA, individuals with poorer health outcomes were those in the lowest socioeconomic groups. This same group of vulnerable people have now been caught in the middle of a major health emergency as a result of long-standing differences in affluence.

While responding to COVID-19, policy makers should consider the risk of deepening health inequalities. If vulnerable groups are not properly identified, the consequences of this pandemic will be even more devastating. Although WHO guidance should be followed, a one-size-fits-all model will not be appropriate. Each country must continually assess which members of society are vulnerable to fairly support those at the highest risk.

COVID-19 will not leave behind refugees and migrants

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The Lancet
Apr 04, 2020 Volume 39 5Number 10230 p1089-1166, e62-e63
https://www.thelancet.com/journals/lancet/issue/current

 

COVID-19 will not leave behind refugees and migrants
The Lancet
Never has the “leave no one behind” pledge felt more urgent. As nations around the world implement measures to control the spread of SARS-CoV-2, including lockdowns and restrictions on individuals’ movements, they must heed their global commitments. When member states adopted the UN 2030 Agenda for Sustainable Development, they promised to ensure no one will be left behind. Chief among the world’s most vulnerable people are refugees and migrants. The COVID-19 crisis puts these groups at enormous risk. Yet global pandemic efforts have so far failed in their duty of care to refugees and migrants.

There are millions of refugees and migrants in camps and detention centres worldwide. Resettlement procedures have been suspended by the UN. UNHCR reports that 34 countries hosting substantial refugee populations have seen local transmission of SARS-CoV-2. The often appalling conditions of migrant camps are fertile for infectious disease outbreaks. With few latrines and water supplies, basic hygiene to prevent spread is difficult. With extreme overcrowding, physical distancing is impossible.

In Europe, tens of thousands of migrants live in densely packed camps along the Mediterranean, without adequate medical personnel and infrastructure to cope. With no emergency COVID-19 plan in place by governments, Médicins san Frontières has demanded evacuation of 42 000 asylum seekers on the Greek islands to suitable accommodation. In a Lancet Comment, WHO leaders appeal for more attention for refugees and migrants, including in humanitarian settings, which are facing disruption of essential supplies of food, medicines, and aid workers.

The worst might be yet to come. 80% of refugees live in low-income and middle-income countries, the sites of the expected fourth wave of COVID-19 behind China, Europe, and the USA. Already, these settings have weak health-care systems, scarce protective equipment, and poor testing and treatment capacity. They need enormous global support to prepare for an impending crisis. This virus disregards all borders. COVID-19 responses must not overlook refugees and migrants.

Mass gathering events and reducing further global spread of COVID-19: a political and public health dilemma

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The Lancet
Apr 04, 2020 Volume 39 5Number 10230 p1089-1166, e62-e63
https://www.thelancet.com/journals/lancet/issue/current

 

Mass gathering events and reducing further global spread of COVID-19: a political and public health dilemma
Brian McCloskey, et al. on behalf of the WHO Novel Coronavirus-19 Mass Gatherings Expert Group

The case for replacing live oral polio vaccine with inactivated vaccine in the Americas

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The Lancet
Apr 04, 2020 Volume 39 5Number 10230 p1089-1166, e62-e63
https://www.thelancet.com/journals/lancet/issue/current

 

Viewpoint
The case for replacing live oral polio vaccine with inactivated vaccine in the Americas
Jorge A Alfaro-Murillo, et al
Abstract
Before the development of the inactivated poliovirus vaccine (IPV) and live oral poliovirus vaccine (OPV), sporadic outbreaks of poliomyelitis were reported to cause as many as 18 000 cases of paralysis and over 3000 deaths in the USA alone.1 The straightforward oral administration, high effectiveness, and relatively low cost of OPV was fundamental to the substantial reduction in polio achieved by mass vaccination campaigns. Wild polioviruses were certified by WHO to be eliminated throughout the Americas in 1994 . However, an adverse effect of OPV is vaccine-associated paralytic polio. Among the countries exclusively using OPV in 2012, an estimated 400 cases of vaccine-associated paralytic polio occurred that year.2 This burden is more than double the incidence of wild polio in 2019. 3 Vaccine-derived polioviruses (VDPV) can also spread from person to person, a process that led to more than 250 additional cases of paralysis during 2019. 4 The risk of paralytic polio associated with OPV spurred many countries to switch to the safer IPV. While IPV elicits a much weaker mucosal immune response than OPV, 5 and is thus less effective at averting transmission, it is very protective against disease. In the Americas, Canada transitioned to exclusive IPV use in 1995, the USA in 2000, Costa Rica in 2010, and Uruguay in 2012. However, the remaining 31 countries in the Americas ( appendix) continue to administer at least one dose of OPV.

Global burden of respiratory infections associated with seasonal influenza in children under 5 years in 2018: a systematic review and modelling study

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Lancet Global Health
Apr 2020 Volume 8 Number 4 e451-e611
http://www.thelancet.com/journals/langlo/issue/current

 

Global burden of respiratory infections associated with seasonal influenza in children under 5 years in 2018: a systematic review and modelling study
Xin Wang,et al. for the Respiratory Virus Global Epidemiology Network

Efficacy, immunogenicity, and safety of an oral influenza vaccine: a placebo-controlled and active-controlled phase 2 human challenge study

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Lancet Infectious Diseases
Apr 2020 Volume 20 Number 4 p383-510, e50-e78
http://www.thelancet.com/journals/laninf/issue/current

 

Articles
Efficacy, immunogenicity, and safety of an oral influenza vaccine: a placebo-controlled and active-controlled phase 2 human challenge study
David Liebowitz, et al.

Safety and immunogenicity of a highly attenuated rVSVN4CT1-EBOVGP1 Ebola virus vaccine: a randomised, double-blind, placebo-controlled, phase 1 clinical trial

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Lancet Infectious Diseases
Apr 2020 Volume 20 Number 4 p383-510, e50-e78
http://www.thelancet.com/journals/laninf/issue/current

 

Safety and immunogenicity of a highly attenuated rVSVN4CT1-EBOVGP1 Ebola virus vaccine: a randomised, double-blind, placebo-controlled, phase 1 clinical trial
David K Clarke, ey al

Ivermectin as a novel complementary malaria control tool to reduce incidence and prevalence: a modelling study

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Lancet Infectious Diseases
Apr 2020 Volume 20 Number 4 p383-510, e50-e78
http://www.thelancet.com/journals/laninf/issue/current

 

Ivermectin as a novel complementary malaria control tool to reduce incidence and prevalence: a modelling study
Hannah C Slater, Brian D Foy, Kevin Kobylinski, Carlos Chaccour, Oliver J Watson, Joel Hellewell, Ghaith Aljayyoussi, Teun Bousema, Jeremy Burrows, Umberto D’Alessandro, Haoues Alout, Feiko O Ter Kuile, Patrick G T Walker, Azra C Ghani, Menno R Smit
Summary
Background
Ivermectin is a potential new vector control tool to reduce malaria transmission. Mosquitoes feeding on a bloodmeal containing ivermectin have a reduced lifespan, meaning they are less likely to live long enough to complete sporogony and become infectious. We aimed to estimate the effect of ivermectin on malaria transmission in various scenarios of use.
Methods
We validated an existing population-level mathematical model of the effect of ivermectin mass drug administration (MDA) on the mosquito population and malaria transmission against two datasets: clinical data from a cluster- randomised trial done in Burkina Faso in 2015 wherein ivermectin was given to individuals taller than 90 cm and entomological data from a study of mosquito outcomes after ivermectin MDA for onchocerciasis or lymphatic filariasis in Burkina Faso, Senegal, and Liberia between 2008 and 2013. We extended the existing model to include a range of complementary malaria interventions (seasonal malaria chemoprevention and MDA with dihydroartemisinin–piperaquine) and to incorporate new data on higher doses of ivermectin with a longer mosquitocidal effect. We consider two ivermectin regimens: a single dose of 400 μg/kg (1 × 400 μg/kg) and three consecutive daily doses of 300 μg/kg per day (3 × 300 μg/kg). We simulated the effect of these two doses in a range of usage scenarios in different transmission settings (highly seasonal, seasonal, and perennial). We report percentage reductions in clinical incidence and slide prevalence.
Findings
We estimate that MDA with ivermectin will reduce prevalence and incidence and is most effective in areas with highly seasonal transmission. In a highly seasonal moderate transmission setting, three rounds of ivermectin only MDA at 3 × 300 μg/kg (rounds spaced 1 month apart) and 70% coverage is predicted to reduce clinical incidence by 71% and prevalence by 34%. We predict that adding ivermectin MDA to seasonal malaria chemoprevention in this setting would reduce clinical incidence by an additional 77% in children younger than 5 years compared with seasonal malaria chemoprevention alone; adding ivermectin MDA to MDA with dihydroartemisinin–piperaquine in this setting would reduce incidence by an additional 75% and prevalence by an additional 64% (all ages) compared with MDA with dihydroartemisinin–piperaquine alone.
Interpretation
Our modelling predictions suggest that ivermectin could be a valuable addition to the malaria control toolbox, both in areas with persistently high transmission where existing interventions are insufficient and in areas approaching elimination to prevent resurgence.
Funding
Imperial College Junior Research Fellowship.

COVID-19: delay, mitigate, and communicate

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Lancet Respiratory Medicine
Apr 2020 Volume 8 Number 4 p321-422, e14-e26
http://www.thelancet.com/journals/lanres/issue/current

 

Editorial
COVID-19: delay, mitigate, and communicate
The Lancet Respiratory Medicine
On March 11, 2020, WHO declared COVID-19 a pandemic and has called for governments to take “urgent and aggressive action” to change the course of the outbreak. As of March 12, 2020, the USA has suspended all travel from 26 European countries, and Italy is the latest country to enforce widespread lockdown measures to curb the spread of the virus. Robust plans and policies to avoid the disease trajectories seen in the worst-hit countries are urgently needed. These responses must be proportionate to each country’s situation and communicated in a clear and balanced way to avoid spreading fear and panic.

The UK preparedness plan for tackling COVID-19, informed by WHO guidance and launched on March 3, 2020, includes four phases: containment, delay, mitigation, and, alongside these, research to better understand the disease and its effects, and to address the challenges of imperfect diagnostic approaches and absence of proven treatments or a vaccine. Containment measures, aimed at preventing the disease from taking hold, are broadly in line with those of other European countries at a similar stage in the outbreak, encompassing early detection, isolation, and care of people already infected, with careful tracing and screening of their contacts. These measures might have staved off a sharp rise in cases, as seen in Italy, for now but case numbers are inevitably climbing. Although the controversial containment measures used in China have bought some time for other regions of the world, such strategies are unlikely to be replicated in Europe. The example of Singapore could be informative for many countries: having learned lessons from the severe acute respiratory syndrome epidemic of 2002–03, Singapore has so far managed the outbreak well, with rapid testing of suspected cases, clear public health messages from the outset, and by individuals taking action to protect themselves and others.

With cases approaching 500, the UK has now moved to the delay phase, a decision that has been criticised for coming too late. The delay phase aims to slow the spread and push the peak impact away from the winter season to reduce pressure on an already overstretched NHS. Social distancing strategies, some of which are already in place in other European countries, such as the cancellation of conferences and other large gatherings, reducing non-essential use of public transport, and closure of schools, are under consideration but yet to be implemented in the UK. Rather, simple but important containment measures such as handwashing are being promoted, as is self-isolation for 7 days for those with symptoms, which is thought to be more effective than school closures and bans on mass gatherings. Although the list of countries imposing tight restrictions on people who have travelled from regions with high caseloads is growing, the UK is unlikely to follow suit, and WHO does not recommend large-scale international travel restrictions or closure of borders owing to the major implications for trade, international collaboration, and supply chains for food and resources, including medical equipment. Decisions about delay strategies must be scientifically based and clearly justified to the public—via all communication platforms, including social media—to counter misinformation and avoid fuelling panic.

Mitigation planning for widely established infection—as seen in China, Italy, Iran, and South Korea—is essential to enable optimum care for patients, maintenance of essential hospital services, and provision of ongoing support for infected people in the community to minimise disruption to society, public services, and the economy in the event of a prolonged pandemic. The higher rates of severe or fatal cases in Italy compared with other countries with major outbreaks (eg, South Korea) might reflect the older population in affected regions of Italy and highlight the need to tailor mitigation plans to local demographics. Many health systems will be stretched beyond capacity by the demands of increasing COVID-19 caseloads. In the UK, for example, intensive care unit (ICU) bed numbers per person are already worryingly low compared with those of other European countries, so thorough surge capacity planning is needed. Interim strategies with makeshift intensive care facilities outside ICU settings could be provided to care for less severely affected patients, but such an approach would not be sustainable in the long term. Support for health-care professionals on the frontline should also be prioritised.

All governments must now take decisive action to more aggressively combat the outbreak. COVID-19 represents a substantial risk to large sections of the population, and especially elderly people and those with pre-existing health conditions. As the outbreak progresses, balanced, coherent, and consistent public health communication, based on science, will be essential.

Hospitals should act now to notify patients about research use of their data and biospecimens

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Nature Medicine
Volume 26 Issue 3, March 2020
https://www.nature.com/nm/volumes/26/issues/3

 

Comment | 11 March 2020
Hospitals should act now to notify patients about research use of their data and biospecimens
Private industry is increasingly soliciting hospitals to sell or share health data and biospecimens, but current laws offer more disclosure and consent protections for research participants than for patients receiving clinical care. Hospitals can offer more protections than required by law, however, and should move toward greater transparency with their patients about the research use of clinical health data and biospecimens to respect patients and avoid distrust.
Kayte Spector-Bagdady