International Journal of Community Medicine and Public Health
Vol 6, No 5 (2019) May 2019
https://www.ijcmph.com/index.php/ijcmph/issue/view/50

 
Original Research Articles
Delivery point immunization in tertiary care hospital in Eastern India and challenges
Bharati Das, Puspanjali Khuntia, Lucy Das, Jayashree Pattnaik
DOI: 10.18203/2394-6040.ijcmph20191467Bharati Das, Puspanjali Khuntia, Lucy Das, Jayashree Pattnaik

International Journal of Community Medicine and Public Health
Vol 6, No 5 (2019) May 2019
https://www.ijcmph.com/index.php/ijcmph/issue/view/50

 
A retrospective study on timeliness of vaccination among children aged 0 to 23 months in a rural area of Pondicherry
Padmavathi Subbiah, Anandaraj Rajagopal, Vijay Kantilal Chavada, Kavita P. Vasudevan
DOI: 10.18203/2394-6040.ijcmph20191831

JAMA
April 23/30, 2019, Vol 321, No. 16, Pages 1547-1642
http://jama.jamanetwork.com/issue.aspx

 
Editorial
Lowering Cost and Increasing Access to Drugs Without Jeopardizing Innovation
Robert M. Califf, MD; Andrew Slavitt, MBA
[Initial text]
US drug costs have reached unacceptable and unsustainable levels. Evidence shows that “financial toxicity” arising from drug costs and other medical expenses is reducing financial security for many families1 and prompting difficult choices, as patients defer or forgo therapies they cannot afford.2 In stark contrast, comparable countries negotiate drug prices and use drugs more effectively. Recent data suggest that other high-income countries have an average life expectancy approximately 3 to 5 years longer than that of the United States, which ranks last among high-income countries and is losing ground compared with peer nations.3 Although drug prices account for only part of these trends, they nevertheless add to disparities that dominate the trajectories of US health outcomes.
An effective policy solution to this problem must satisfy the core requirements of reducing drug costs and increasing access to beneficial drugs, while continuing to incentivize development of new therapies. The path forward requires a sustainable, fair payment system in which drug prices reflect the value provided and reward innovations that improve outcomes. Four Viewpoints in this issue of JAMA4–7 recommend different but overlapping approaches for achieving these goals…

Journal of Global Ethics
Volume 15, Issue 1, 2019
http://www.tandfonline.com/toc/rjge20/current
Special Issue: Indian Global Ethics Initiative

 
introduction
An Indian global ethics initiative
Shashi Motilal & Jay Drydyk
Pages: 1-5
Published online: 22 Apr 2019
ABSTRACT
In what sense must global ethics be global? In one sense, it must deal with global issues. In another, it must not be parochial but inclusive of normative views from around the world. So far, global ethics has met the first standard much better than the second. Authors based in the global South contribute approximately 5% of the internationally published research on global ethics. With this in mind, the co-editors of this special issue sought to bring more perspectives, experiences, and authors from India into the international global ethics conversation, and so they launched the Indian Global Ethics Initiative. Their first step, this special issue, presents Indian experience and authors on topics including urban development, care ethics, women’s empowerment, fair trade, distorted policy research, poverty, and health. Much of this work is grounded by the authors’ experience in policy-making and advocacy for social and global justice. The co-editors invite contact from interested readers who would like to join and continue this Indian Global Ethics Initiative, as well as readers who would like to take similar initiatives in other regions.

The Lancet
Apr 27, 2019 Volume 393Number 10182p1669-1772, e39
https://www.thelancet.com/journals/lancet/issue/current 

 
Editorial
Measles eradication: a goal within reach, slipping away
The Lancet
[See Milestones – Measles above for full text]

Lancet Global Health
Apr 2019 Volume 7Number 4e385-e532
http://www.thelancet.com/journals/langlo/issue/current

 
Editorial
The true meaning of leaving no one behind
The Lancet Global Health
Sometimes it is important to go back to basics. For human interaction, one of the basics is language, the system of communication that, when applied at its best, allows us to understand each other, share, cooperate, and pull each other towards a better place. When on a collective journey towards a common objective such as the Sustainable Development Goals, with a rallying cry of “leaving no one behind” and a central aim of “reaching the furthest behind first”, this system of communication is fundamental to move beyond just the rhetorical: to be truly reached, the furthest one behind will need to understand what she is being told, and most likely, that exchange will have to be done in her own language. That principle should apply to all aspects of development, including global health.

With roughly 7000 living languages in the world, miscommunication is inevitable, but there are times and places when particular care should be taken to ensure that the message is clear and fully understood. Take the highly volatile situation of Ebola in eastern Democratic Republic of the Congo (DRC) for instance. Since the outbreak was declared in August 2018, there have been over 1000 confirmed and probable cases in North Kivu and Ituri provinces. Because the trauma of conflict has compounded the impact of the outbreak on the population, community engagement and ownership of the response are particularly important in the DRC. Last month, Translators without Borders released the results of a rapid studyevaluating the effectiveness of risk communication materials on Ebola used in North Kivu. The results are striking: they show that materials used for the response—posters, brochures, and consent forms for the Ebola vaccine, some in French, some in standard or local Congolese Swahili—are not fully understood. Basic vocabulary in French related to Ebola was not recognised in focus groups and half of the participants misinterpreted a poster inviting the sick to present to the nearest health centre as the complete opposite, that they would not be welcome there. Consent forms used for the Ebola vaccine were also generally misunderstood, as they contained words in standard Swahili, French, and English that were not known to the participants, raising further ethical issues. This study presents the epitome of where and when the basics of language should be better applied to reach “the furthest behind” in global health.

Global health research in general should concern itself with language. As in most scientific fields, English is established as the dominant tongue. Some will rightfully argue that researchers need a lingua franca, a common language in which to communicate, but English is not strictly that: for some (indeed, a minority) it is their mother tongue, but for the rest it is a second language, one that can be mastered at varying levels of fluency, or not mastered at all. That clearly implies that when it comes to the handiwork of research—the searching for funds, the publishing, the reading, the presenting—not everyone is on the same plane, and some are left behind. A Comment published this week presents the reflections and ideas of a group of francophone researchers during a workshop at the Africa Health Agenda International Conference (AHAIC) in Kigali, Rwanda, last month on this very issue. Our readers will appreciate that we could not in good conscience publish this Comment in any language other than French, and will, we hope, take the extra step of accessing the English translation in the supplementary material if needed. The main message is that linguistic isolation and the barriers it creates are real and deeply ingrained, but also that there is a way forward. The solutions will require more consideration of the needs of different linguistic groups, the creation of support networks, and more linguistic collaboration in general. One initiative that fits neatly within these criteria is the Science and Language Mobility Scheme Africa, led by the African Academy of Sciences in partnership with the Wellcome Trust and Institut Pasteur. This brand-new programme funds research done by anglophone, francophone, and maybe soon lusophone researchers in language regions other than their own, in order to strengthen scientific collaboration while building language skills and improving cultural understanding between researchers from different linguistic backgrounds.

Such efforts are to be applauded. Leaving no one behind will require more than glancing back from a position of linguistic power and hoping everyone follows. It will require everyone, journals included, to reach out to the other and find concrete solutions to this most basic dilemma.

Lancet Global Health
Apr 2019 Volume 7Number 4e385-e532
http://www.thelancet.com/journals/langlo/issue/current

 
Comment
Are expensive vaccines the best investment in low-income and middle-income countries?
Lone Simonsen, Maarten van Wijhe, Robert Taylor
[Initial text]
In a new study in The Lancet Global Health, John Ojal and colleagues project that the use of ten-valent pneumococcal conjugate vaccine (PCV10) will be cost-effective in Kenya after international donor support for vaccine programmes ends in around 2027. Until now, Kenya has relied on funding from Gavi, the international vaccine alliance, to fund its PCV programme. But because Gavi withdraws support from countries as their economies grow, Kenya will have to bear the full $9 per child cost for a three-dose course of PCVs starting in 2027. For Kenya, where annual per capita actual expenditure for health is around $70 (about 5% of GDP), that is not a trivial cost.
Kenya is not alone in having to decide whether expensive vaccines are worth the money, as many other lower-middle-income countries with growing economies will soon lose international support. For these countries, careful evaluation of the cost-effectiveness and affordability of such programmes, and how they hold up against alternative investments in population health, are essential. The current study is a much-appreciated effort to provide important insights to countries around the world as they struggle to decide how best to spend scarce resources…

Lancet Global Health
Apr 2019 Volume 7Number 4e385-e532
http://www.thelancet.com/journals/langlo/issue/current

 
Articles
Sustaining pneumococcal vaccination after transitioning from Gavi support: a modelling and cost-effectiveness study in Kenya
John Ojal, Ulla Griffiths, Laura L Hammitt, Ifedayo Adetifa,Donald Akech, Collins Tabu,
J Anthony G Scott, Stefan Flasche
Summary
Background
In 2009, Gavi, the World Bank, and donors launched the pneumococcal Advance Market Commitment, which helped countries access more affordable pneumococcal vaccines. As many low-income countries begin to reach the threshold at which countries transition from Gavi support to self-financing (3-year average gross national income per capita of US$1580), they will need to consider whether to continue pneumococcal conjugate vaccine (PCV) use at full cost or to discontinue PCV in their childhood immunisation programmes. Using Kenya as a case study, we assessed the incremental cost-effectiveness of continuing PCV use.
Methods
In this modelling and cost-effectiveness study, we fitted a dynamic compartmental model of pneumococcal carriage to annual carriage prevalence surveys and invasive pneumococcal disease (IPD) incidence in Kilifi, Kenya. We predicted disease incidence and related mortality for either continuing PCV use beyond 2022, the start of Kenya’s transition from Gavi support, or its discontinuation. We calculated the costs per disability-adjusted life-year (DALY) averted and associated 95% prediction intervals (PI).
Findings
We predicted that if PCV use is discontinued in Kenya in 2022, overall IPD incidence will increase from 8·5 per 100 000 in 2022, to 16·2 per 100 000 per year in 2032. Continuing vaccination would prevent 14 329 (95% PI 6130–25 256) deaths and 101 513 (4386–196 674) disease cases during that time. Continuing PCV after 2022 will require an estimated additional US$15·8 million annually compared with discontinuing vaccination. We predicted that the incremental cost per DALY averted of continuing PCV would be $153 (95% PI 70–411) in 2032.
Interpretation
Continuing PCV use is essential to sustain its health gains. Based on the Kenyan GDP per capita of $1445, and in comparison to other vaccines, continued PCV use at full costs is cost-effective (on the basis of the assumption that any reduction in disease will translate to a reduction in mortality). Although affordability is likely to be a concern, our findings support an expansion of the vaccine budget in Kenya.
Funding
Wellcome Trust and Gavi, the Vaccine Alliance.

Lancet Infectious Diseases

Lancet Infectious Diseases
May 2019 Volume 19 Number 5 p449-558, e148-e186
http://www.thelancet.com/journals/laninf/issue/current
Comment

 
Ebola: public trust, intermediaries, and rumour in the DR Congo
Joe Trapido

Lancet Infectious Diseases
May 2019 Volume 19 Number 5 p449-558, e148-e186
http://www.thelancet.com/journals/laninf/issue/current

 
A new social sciences network for infectious threats
Tamara Giles-Vernick, et al

Lancet Infectious Diseases
May 2019 Volume 19 Number 5 p449-558, e148-e186
http://www.thelancet.com/journals/laninf/issue/current

 
Articles
Immunogenicity and reactogenicity of ten-valent versus 13-valent pneumococcal conjugate vaccines among infants in Ho Chi Minh City, Vietnam: a randomised controlled trial
Beth Temple, Nguyen Trong Toan, Vo Thi Trang Dai, Kathryn Bright, Paul Vincent Licciardi, Rachel Ann Marimla, Cattram Duong Nguyen, Doan Y Uyen, Anne Balloch, Tran Ngoc Huu, Edward Kim Mulholland
Open Access

Lancet Infectious Diseases
May 2019 Volume 19 Number 5 p449-558, e148-e186
http://www.thelancet.com/journals/laninf/issue/current

 
Institutional trust and misinformation in the response to the 2018–19 Ebola outbreak in North Kivu, DR Congo: a population-based survey
Patrick Vinck, Phuong N Pham, Kenedy K Bindu, Juliet Bedford, Eric J Nilles
Summary
Background
The current outbreak of Ebola in eastern DR Congo, beginning in 2018, emerged in a complex and violent political and security environment. Community-level prevention and outbreak control measures appear to be dependent on public trust in relevant authorities and information, but little scholarship has explored these issues. We aimed to investigate the role of trust and misinformation on individual preventive behaviours during an outbreak of Ebola virus disease (EVD).
Methods
We surveyed 961 adults between Sept 1 and Sept 16, 2018. We used a multistage sampling design in Beni and Butembo in North Kivu, DR Congo. Of 412 avenues and cells (the lowest administrative structures; 99 in Beni and 313 in Butembo), we randomly selected 30 in each city. In each avenue or cell, 16 households were selected using the WHO Expanded Programme on Immunization’s random walk approach. In each household, one adult (aged ≥18 years) was randomly selected for interview. Standardised questionnaires were administered by experienced interviewers. We used multivariate models to examine the intermediate variables of interest, including institutional trust and belief in selected misinformation, with outcomes of interest related to EVD prevention behaviours.
Findings
Among 961 respondents, 349 (31·9%, 95% CI 27·4–36·9) trusted that local authorities represent their interest. Belief in misinformation was widespread, with 230 (25·5%, 21·7–29·6) respondents believing that the Ebola outbreak was not real. Low institutional trust and belief in misinformation were associated with a decreased likelihood of adopting preventive behaviours, including acceptance of Ebola vaccines (odds ratio 0·22, 95% CI 0·21–0·22, and 1·40, 1·39–1·42) and seeking formal health care (0·06, 0·05–0·06, and 1·16, 1·15–1·17).
Interpretation
The findings underscore the practical implications of mistrust and misinformation for outbreak control. These factors are associated with low compliance with messages of social and behavioural change and refusal to seek formal medical care or accept vaccines, which in turn increases the risk of spread of EVD.
Funding
The Harvard Humanitarian Initiative Innovation Fund.

Lancet Infectious Diseases
May 2019 Volume 19 Number 5 p449-558, e148-e186
http://www.thelancet.com/journals/laninf/issue/current

 
Review
Venezuela’s humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region
Maria E Grillet et al,
Summary
In the past 5–10 years, Venezuela has faced a severe economic crisis, precipitated by political instability and declining oil revenue. Public health provision has been affected particularly. In this Review, we assess the impact of Venezuela’s health-care crisis on vector-borne diseases, and the spillover into neighbouring countries. Between 2000 and 2015, Venezuela witnessed a 359% increase in malaria cases, followed by a 71% increase in 2017 (411,586 cases) compared with 2016 (240 613). Neighbouring countries, such as Brazil, have reported an escalating trend of imported malaria cases from Venezuela, from 1538 in 2014 to 3129 in 2017. In Venezuela, active Chagas disease transmission has been reported, with seroprevalence in children (<10 years), estimated to be as high as 12·5% in one community tested (n=64). Dengue incidence increased by more than four times between 1990 and 2016. The estimated incidence of chikungunya during its epidemic peak is 6975 cases per 100 000 people and that of Zika virus is 2057 cases per 100,000 people. The re-emergence of many vector-borne diseases represents a public health crisis in Venezuela and has the possibility of severely undermining regional disease elimination efforts. National, regional, and global authorities must take action to address these worsening epidemics and prevent their expansion beyond Venezuelan borders.

Lancet Respiratory Medicine

Lancet Infectious Diseases
May 2019 Volume 19 Number 5 p449-558, e148-e186
http://www.thelancet.com/journals/laninf/issue/current

 
Review
Venezuela’s humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region
Maria E Grillet et al,
Summary
In the past 5–10 years, Venezuela has faced a severe economic crisis, precipitated by political instability and declining oil revenue. Public health provision has been affected particularly. In this Review, we assess the impact of Venezuela’s health-care crisis on vector-borne diseases, and the spillover into neighbouring countries. Between 2000 and 2015, Venezuela witnessed a 359% increase in malaria cases, followed by a 71% increase in 2017 (411,586 cases) compared with 2016 (240 613). Neighbouring countries, such as Brazil, have reported an escalating trend of imported malaria cases from Venezuela, from 1538 in 2014 to 3129 in 2017. In Venezuela, active Chagas disease transmission has been reported, with seroprevalence in children (<10 years), estimated to be as high as 12·5% in one community tested (n=64). Dengue incidence increased by more than four times between 1990 and 2016. The estimated incidence of chikungunya during its epidemic peak is 6975 cases per 100 000 people and that of Zika virus is 2057 cases per 100,000 people. The re-emergence of many vector-borne diseases represents a public health crisis in Venezuela and has the possibility of severely undermining regional disease elimination efforts. National, regional, and global authorities must take action to address these worsening epidemics and prevent their expansion beyond Venezuelan borders.

Nature
Volume 568 Issue 7753, 25 April 2019
http://www.nature.com/nature/current_issue.html

 
World View | 24 April 2019
Rein in the four horsemen of irreproducibility
Dorothy Bishop describes how threats to reproducibility, recognized but unaddressed for decades, might finally be brought under control.

Nature Reviews Genetics
Volume 20 Issue 5, May 2019
https://www.nature.com/nrg/volumes/20/issues/4 

 
Comment | 14 March 2019
Balancing uncertainty with patient autonomy in precision medicine
Variants of unknown significance (VUS) are genetic variants whose association with disease risk is unknown. The authors posit that VUS should not inform clinical decision-making as the benefits of returning this genetic information to patients undergoing genetic testing are outweighed by the potential for harm.
By the nature of their unknown pathogenicity, variants of unknown significance (VUS) should not inform clinical decisions for genetic carrier testing; nevertheless, VUS are increasingly returned to patients. We argue that the benefits of returning VUS to patients are outweighed by the potential for individual and health-care system-level harm.
Samantha Pollard, Sophie Sun & Dean A. Regier

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 27 Apr 2019)

 
Perspective
Tuberculosis vaccines: Rising opportunities
Johan Vekemans, Katherine L. O’Brien, Jeremy Farrar
| published 23 Apr 2019 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002791
A vaccine preventing pulmonary tuberculosis (TB) in adults is needed but has long been considered an elusive goal. Times are changing in the field of TB vaccines, though, with recent results boosting confidence in the feasibility of a TB vaccine with potential as a decisive tool in the fight against TB.

Mycobacterium tuberculosis (Mtb), the causative agent of TB, is the leading cause of death from any single infectious pathogen. In 2017, an estimated 10 million people developed TB, and 1.6 million people died of the disease. Approximately 1.7 billion people—23% of the world’s population—have latent TB infection (LTBI) and carry the risk of developing TB during their lifetime. The emergence of Mtb strains resistant to TB drugs causes a major growing burden of hard-to-treat infections. An estimated 558,000 people developed drug-resistant TB in 2017, 82% of which were multidrug-resistant cases; 230,000 deaths were due to drug-resistant TB [1].

Important efforts are being directed to TB control through the WHO End TB Strategy, which set ambitious targets for reduction of disease burden. However, current trends fall well short of those needed to meet the goals [1]. Last year, the United Nation’s High-Level Meeting on TB renewed the commitment to fight TB, but it is clear that current approaches are insufficient, highlighting the importance of research and development for new tools [2]. Disease impact and health–economic modelling has shown the value of a vaccine that would prevent pulmonary TB in adults not only for those immunized but also by reducing transmission to others [3].

Such a vaccine, long considered an elusive goal, may now be close at hand, given new clinical trial results from a Phase 2b trial in South Africa and Zambia [4]. Two doses of the M72/AS01E, an adjuvanted fusion protein construct based on two TB antigens, was shown to provide 54% (90% CI 14%–75%) protection against pulmonary TB in individuals with LTBI over an average 2.3 years of follow-up. Secondary analyses, based on a limited number of cases and therefore subject to caution, suggest that there was no waning of effect over time and that protection may be highest in younger individuals. Data from follow-up through an additional year are awaited in the coming months. In this study, the point estimate of vaccine efficacy was above what had been predefined as a preferred lower target level by WHO [5].

The lack of reliable models to predict human protection in early clinical development did not allow confidence building in this product before the trial results were known, and further investments had not been planned. Decisions are now needed for financial investments to support further clinical development, progression to Phase 3 evaluation, and preparation of the downstream pathway to affordable access and use.

Various clinical development options should be considered. A vaccine with characteristics as demonstrated in the Phase 2b trial may be of significant interest in endemic regions characterized by high attack rates, where most young adults have been infected. Proof-of-concept remains to be established for people who don’t have LTBI, especially for geographical regions where transmission intensity is lower. As existing results suggest the vaccine prevented the natural course of progression from infection to pulmonary disease, it would be relevant to investigate similar immunotherapeutic effects in subjects who live or lived in contact with TB patients or in subjects known to have recently converted diagnostic markers of infection.

Testing for use as a therapeutic adjunct to improve outcomes of drug treatment in TB patients should also be considered. Children, older individuals in countries where the epidemic is driven by TB reactivation [6] and specific high-risk groups such as HIV-infected people, should also be considered for evaluation in order to not be denied a potential protective intervention.

Although advancing the evaluation of M72/AS01 is now a major priority, it is not the only important progress in the TB vaccine field.

Another promising breakthrough emerged from a recent study in South Africa evaluating the effect of Bacillus Calmette-Guérin (BCG) revaccination in people vaccinated with BCG at birth and with no evidence of LTBI [7]. The coprimary endpoints of this trial were not achieved; however, secondary analyses suggested that BCG revaccination reduced the proportion of sustained conversion of in vitro markers of LTBI by 45%. The clinical significance of this new finding is unknown, especially in light of past studies that have shown no impact of BCG revaccination on TB [8–9], which formed the evidence base for WHO not recommending BCG revaccination [10]. The risk of disseminated BCG disease in subjects with immunosuppression would constitute an important obstacle to BCG revaccination strategies in HIV and TB coendemic areas. This research signal nevertheless constitutes an important opportunity to characterize immunological mechanisms of protection against Mtb infection, and such investigations are planned.

Recent early-stage developments are also cause for optimism. As presented in a recent review, new constructs in preclinical testing include recombinant cytomegalovirus (CMV)-based candidates inducing atypical immune responses and supporting investigations in previously unexplored territory in the science of TB vaccinology; new imaging techniques allow for monitoring of TB progression in vaccinated primate models of experimental infection; attempts to develop safe human models of experimental infections are being developed; the role of the route of vaccination is being explored; and immune markers of TB risk are increasingly being identified, with the potential to inform rationale vaccine design, testing pathways, and eventually support regulatory-acceptable accelerating bridging steps [11]. The pipeline of other products in clinical development is diverse, with a variety of live-attenuated or killed mycobacteria-derived candidates (DAR-901, MTBVAC, RUTI, Vaccae, VPM001), adjuvanted recombinant proteins (H56:IC31, ID93/GLA-SE), and recombinant viral vectors (MVA85A, ChAdOx1.85A, MVA85A, Ad5 Ag85A, MVA85A-IMX313, TB/FLU-04L), progressing through human evaluation [12].

While the statements from the UN High-Level Meeting are welcome, transforming discovery and vaccine candidates into products that can have impact takes more than declarations of support. Funding levels, unfortunately, are insufficient, and the US$1.3 billion annual funding gap in TB research needs to be filled [12]. More funding should be targeted to support TB vaccine research, which has been estimated at US$74 million in 2017, a surprisingly low figure as compared to the US$174 and US$700 million allocated to, respectively, malaria and HIV vaccine R&D [13] when considering the scientific opportunity, unmet need, and investment case [14].

Progress toward TB elimination will require vigorously pursuing the potential contribution of novel TB vaccines propelled by new evidence recently made available. Advocates working on TB as a major global health problem should lead decision-makers toward this realization. The possibility to transform the opportunities into action will be a test of the collective ability of the global health community to succeed in developing and using vaccines aimed at addressing diseases disproportionately affecting the poor. The world needs better operating models supporting prompt progress from vaccine efficacy proof-of-concept to evaluation for use and impact in support of policy decision and funding for implementation. A sense of responsibility toward global health from the corporate sector manufacturing vaccines is needed as well as from the public and philanthropic sector, through the setup of functional public–private partnerships supported by innovative funding mechanisms. Opportunities are rising in the search for tools to prevent TB; let us not squander this chance. Now is the time for mobilization toward vaccine impact against TB.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 27 Apr 2019)

Controlling latent TB tuberculosis infection in high-burden countries: A neglected strategy to end TB
Gavin J. Churchyard, Sue Swindells
Perspective | published 23 Apr 2019 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002787

PLoS One
http://www.plosone.org/
[Accessed 27 Apr 2019]

Research Article
Influenza vaccination of pregnant women in Paris, France: Knowledge, attitudes and practices among midwives
Paul Loubet, Catherine Nguyen, Espérie Burnet, Odile Launay
Research Article | published 25 Apr 2019 PLOS ONE
https://doi.org/10.1371/journal.pone.0215251

PLoS Pathogens
http://journals.plos.org/plospathogens/
[Accessed 27 Apr 2019]

Research Article
Detection of post-vaccination enhanced dengue virus infection in macaques: An improved model for early assessment of dengue vaccines
Maria Beatriz Borges, Renato Sergio Marchevsky, Renata Carvalho Pereira, Ygara da Silva Mendes, Luiz Gustavo Almeida Mendes, Leonardo Diniz-Mendes, Michael A. Cruz, Ouafaâ Tahmaoui, Sébastien Baudart, Marcos Freire, Akira Homma, Kirsten Schneider-Ohrum, David W. Vaughn, Yannick Vanloubbeeck, Clarisse Lorin, Marie-Pierre Malice, Elena Caride, Lucile Warter
| published 22 Apr 2019 PLOS Pathogens
https://doi.org/10.1371/journal.ppat.1007721
Abstract
The need for improved dengue vaccines remains since the only licensed vaccine, Dengvaxia, shows variable efficacy depending on the infecting DENV type, and increases the risk of hospitalization for severe dengue in children not exposed to DENV before vaccination. Here, we developed a tetravalent dengue purified and inactivated vaccine (DPIV) candidate and characterized, in rhesus macaques, its immunogenicity and efficacy to control DENV infection by analyzing, after challenge, both viral replication and changes in biological markers associated with dengue in humans. Although DPIV elicited cross-type and long-lasting DENV-neutralizing antibody responses, it failed to control DENV infection. Increased levels of viremia/RNAemia (correlating with serum capacity at enhancing DENV infection in vitro), AST, IL-10, IL-18 and IFN-γ, and decreased levels of IL-12 were detected in some vaccinated compared to non-vaccinated monkeys, indicating the vaccination may have triggered antibody-dependent enhancement of DENV infection. The dengue macaque model has been considered imperfect due to the lack of DENV-associated clinical signs. However, here we show that post-vaccination enhanced DENV infection can be detected in this model when integrating several parameters, including characterization of DENV-enhancing antibodies, viremia/RNAemia, and biomarkers relevant to dengue in humans. This improved dengue macaque model may be crucial for early assessment of efficacy and safety of future dengue vaccines.
Author summary
Dengue virus (DENV) is responsible for the most widespread arboviral disease affecting humans. A pre-existing suboptimal immunity to DENV is accepted as being the major risk factor for severe dengue. Thus, if vaccination does not elicit optimal DENV-specific immunity, a vaccine might, instead, increase the risk of severe dengue in vaccinated individuals, as seen with the only licensed vaccine (Dengvaxia) in children naïve to DENV at vaccination. It is thus crucial to assess dengue vaccine safety at the earliest development stages, ideally in the preclinical stage. The dengue macaque model has been used to assess preclinical efficacy of dengue vaccines, with post-challenge DENV replication as the sole efficacy endpoint. However, this model had not predicted the Dengvaxia-associated safety signals. Here we characterized, in macaques, a dengue purified and inactivated vaccine (DPIV) candidate for its immunogenicity and efficacy/safety. Using a multiparameter approach, including characterization of viral replication and biomarkers relevant to dengue/severe dengue in humans, we were able to detect vaccine-associated safety signals in this model. While these results enabled us to discontinue at an early stage the DPIV development, this improved dengue macaque model may also be instrumental for early assessment of efficacy/safety of future dengue vaccines.

Public Health
Volume 169 Pages 1-202, A1-A2 (April 2019)
https://www.sciencedirect.com/journal/public-health/vol/169/suppl/C
Research article Abstract only

Assessing the potential outcomes of achieving the World Health Organization global non-communicable diseases targets for risk factors by 2025: is there also an economic dividend?
M. Devaux, A. Lerouge, B. Ventelou, Y. Goryakin, … M. Cecchini
Pages 173-179

Public Health
Volume 169 Pages 1-202, A1-A2 (April 2019)
https://www.sciencedirect.com/journal/public-health/vol/169/suppl/C

Review article Open access
Economic evaluations of public health implementation-interventions: a systematic review and guideline for practice
P. Reeves, K. Edmunds, A. Searles, J. Wiggers

Science
26 April 2019 Vol 364, Issue 6438
http://www.sciencemag.org/current.dtl

Editorial
Health for all
By Seth Berkley, Henrietta Fore
Science26 Apr 2019 : 309
Summary
Imagine a world where affordable, quality health care is available to every person, and where infectious disease and infant and maternal mortality are as rare in the poorest parts as they are in wealthier countries. The world has already come a long way toward meeting this goal. But to finish the job, we need to change our thinking.

To be sure, the incidence of child mortality and cases of deadly infectious diseases have dropped dramatically around the world. For example, polio, which once paralyzed a thousand children every day, has been eliminated from all but three countries, with just 33 cases last year. Measles cases, despite a recent, alarming global surge, are now a fraction of what they were four decades ago. All this was made possible because global health organizations and the governments of lower-income countries have worked together to provide the most vulnerable communities access to essential health care interventions, such as clean water, sanitation, and vaccinations.

And yet, 1 in 10 children are still missing out. Most are the hardest to reach, whether they live in remote rural villages, conflict zones, among the swelling numbers of displaced people, or in rapidly growing urban slums where they might be undetected by formal health systems. Meeting their needs will require focusing more on health interventions that have both the greatest reach and are conduits to other health services for vulnerable communities. Childhood vaccination does precisely this. Vaccination reaches more children—more than 85%, who are inoculated against a range of infectious diseases—than any other health intervention globally.
When a child gets access to vaccines, it benefits that child’s community. With vaccines come supply chains, logistics, cold storage, trained health care staff, data monitoring, disease surveillance, and health care records. Parents and siblings often come along with the child who is being vaccinated, giving them potential access to a host of other health interventions—from neonatal and maternal health care to malaria prevention measures, and sexual and reproductive health and education.

Achieving health for all will also require a change in mindset. We must examine the barriers that deny health care to so many others. Such barriers can take different practical, cultural, or social forms, but identifying them can inform the development of new tailored solutions. If parents have too far to travel, for example, then build more health facilities closer to those who need them. Similarly, the lack of after-hours vaccination clinics or the use of male vaccinators in some settings can prevent or deter attendance. Also, traditional paper medical records may make it difficult for health care workers to know who is missing out because parents may rarely attend the same clinic twice.

This new mindset will require a shift in business models. Instead of seeking solutions that have the greatest utilitarian value, it could be better to look for innovative solutions that have an intended disproportionate impact, largely benefiting the few rather than the many. For example, in Tanzania, the Electronic Immunization Register, a tablet-based system, is giving vaccinators access to records across entire regions regardless of which clinic they are in. This is enabling them to proactively track which children are missing out.

As the 2030 deadline looms for the United Nations Sustainable Development Goals (SDGs), targets driving a broad range of development efforts today, providing health for all is likely to become increasingly more difficult. The good news is that nations have already taken the first major step with the SDG Global Action Plan, a commitment made last year by global health agencies to unite around efforts to accelerate progress. The hope is to start implementing a plan in September 2019. Health for all is achievable, but this vision requires new thinking by everyone.

Science
26 April 2019 Vol 364, Issue 6438
http://www.sciencemag.org/current.dtl

In Depth
Dengue researcher faces charges in vaccine fiasco
By Fatima Arkin
Science26 Apr 2019 : 320 Restricted Access
Rose Capeding could face years in prison for role in tests.
Summary
Rose Capeding, former head of the dengue department of the Research Institute for Tropical Medicine in Manila, has been indicted in a series of criminal cases over the failed introduction in the Philippines of Dengvaxia, a vaccine against dengue that was yanked from the market in 2017 because of safety issues. In February, a panel of prosecutors concluded that there is probable cause to indict Capeding and 19 others for “reckless imprudence resulting [in] homicide,” because of their role in the vaccine’s approval and rollout. If convicted of accusations leveled at her by the national Department of Justice, Capeding could face up to 48 years in prison. Many scientists have come to her defense.

Science Translational Medicine
24 April 2019 Vol 11, Issue 489
http://stm.sciencemag.org/
Research Articles
Diagnosis of genetic diseases in seriously ill children by rapid whole-genome sequencing and automated phenotyping and interpretation
By Michelle M. Clark, Amber Hildreth, Sergey Batalov, Yan Ding, Shimul Chowdhury, Kelly Watkins, Katarzyna Ellsworth, Brandon Camp, Cyrielle I. Kint, Calum Yacoubian, Lauge Farnaes, Matthew N. Bainbridge, Curtis Beebe, Joshua J. A. Braun, Margaret Bray, Jeanne Carroll, Julie A. Cakici, Sara A. Caylor, Christina Clarke, Mitchell P. Creed, Jennifer Friedman, Alison Frith, Richard Gain, Mary Gaughran, Shauna George, Sheldon Gilmer, Joseph Gleeson, Jeremy Gore, Haiying Grunenwald, Raymond L. Hovey, Marie L. Janes, Kejia Lin, Paul D. McDonagh, Kyle McBride, Patrick Mulrooney, Shareef Nahas, Daeheon Oh, Albert Oriol, Laura Puckett, Zia Rady, Martin G. Reese, Julie Ryu, Lisa Salz, Erica Sanford, Lawrence Stewart, Nathaly Sweeney, Mari Tokita, Luca Van Der Kraan, Sarah White, Kristen Wigby, Brett Williams, Terence Wong, Meredith S. Wright, Catherine Yamada, Peter Schols, John Reynders, Kevin Hall, David Dimmock, Narayanan Veeraraghavan, Thomas Defay, Stephen F. Kingsmore
Science Translational Medicine24 Apr 2019 Restricted Access
A streamlined genetic diagnosis pipeline
When treating seriously ill children, time is of the essence. Clark et al. built an automated pipeline to analyze EHR data and genome sequencing data from dried blood spots to deliver a potential diagnosis for hospitalized, often critically ill, children with suspected genetic diseases. Their pipeline required minimal user intervention, increasing usability and shortening time to diagnosis, delivering a provisional finding in a median time of less than 24 hours. Although this pipeline would need to be adapted for use at different hospital systems, such an automated tool could aid clinicians to expedite an accurate genetic disease diagnosis, potentially hastening lifesaving changes to patient care.
Abstract
By informing timely targeted treatments, rapid whole-genome sequencing can improve the outcomes of seriously ill children with genetic diseases, particularly infants in neonatal and pediatric intensive care units (ICUs). The need for highly qualified professionals to decipher results, however, precludes widespread implementation. We describe a platform for population-scale, provisional diagnosis of genetic diseases with automated phenotyping and interpretation. Genome sequencing was expedited by bead-based genome library preparation directly from blood samples and sequencing of paired 100-nt reads in 15.5 hours. Clinical natural language processing (CNLP) automatically extracted children’s deep phenomes from electronic health records with 80% precision and 93% recall. In 101 children with 105 genetic diseases, a mean of 4.3 CNLP-extracted phenotypic features matched the expected phenotypic features of those diseases, compared with a match of 0.9 phenotypic features used in manual interpretation. We automated provisional diagnosis by combining the ranking of the similarity of a patient’s CNLP phenome with respect to the expected phenotypic features of all genetic diseases, together with the ranking of the pathogenicity of all of the patient’s genomic variants. Automated, retrospective diagnoses concurred well with expert manual interpretation (97% recall and 99% precision in 95 children with 97 genetic diseases). Prospectively, our platform correctly diagnosed three of seven seriously ill ICU infants (100% precision and recall) with a mean time saving of 22:19 hours. In each case, the diagnosis affected treatment. Genome sequencing with automated phenotyping and interpretation in a median of 20:10 hours may increase adoption in ICUs and, thereby, timely implementation of precise treatments.

Vaccine
Volume 37, Issue 19 Pages 2527-2642 (1 May 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/19
Short communication Abstract only
Development and acceptability of a video-based vaccine promotion tutorial for obstetric care providers
A.T. Chamberlain, R.J. Limaye, S.T. O’Leary, P.M. Frew, … S.B. Omer
Pages 2532-2536

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

Health Promotion International
Published: 21 April 2019
HPV vaccine, Twitter, and gay, bisexual and other men who have sex with men
A Budenz, A Klassen, A Leader, K Fisher, E Yom-Tov…
Abstract
This study aimed to quantify human papillomavirus (HPV) vaccine Twitter messaging addressing gay, bisexual and other men who have sex with men (GB+MSM) and describes messaging by vaccine sentiment (attitudes towards vaccine) and characteristics (topic of messaging). Between August 2014 and July 2015, we collected 193 379 HPV-related tweets and classified them by vaccine sentiment and characteristics. We analysed a subsample of tweets containing the terms ‘gay’, ‘bisexual’ and ‘MSM’ (N = 2306), and analysed distributions of sentiment and characteristics using chi-square. HPV-related tweets containing GB+MSM terms occupied 1% of our sample. The subsample had a largely positive vaccine sentiment. However, a proportion of ‘gay’ and ‘bisexual’ tweets did not mention the vaccine, and a proportion of ‘gay’ and ‘MSM’ tweets had a negative sentiment. Topics varied by GB+MSM term—HPV risk messaging was prevalent in ‘bisexual’ (25%) tweets, and HPV transmission through sex/promiscuity messaging was prevalent in ‘gay’ (18%) tweets. Prevention/protection messaging was prevalent only in ‘MSM’ tweets (49%). Although HPV vaccine sentiment was positive in GB+MSM messaging, we identified deficits in the volume of GB+MSM messaging, a lack of focus on vaccination, and a proportion of negative tweets. While HPV vaccine promotion has historically focused on heterosexual HPV transmission, there are opportunities to shape vaccine uptake in GB+MSM through public health agenda setting using social media messaging that increases knowledge and minimizes HPV vaccine stigma. Social media-based HPV vaccine promotion should also address the identities of those at risk to bolster vaccine uptake and reduce the risk of HPV-attributable cancers.

Media/Policy Watch
This watch section is intended to alert readers to substantive news, analysis and opinion from the general media and selected think tanks and similar organizations on vaccines, immunization, global public health and related themes. Media Watch is not intended to be exhaustive, but indicative of themes and issues CVEP is actively tracking. This section will grow from an initial base of newspapers, magazines and blog sources, and is segregated from Journal Watch above which scans the peer-reviewed journal ecology.
We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.

The Atlantic
http://www.theatlantic.com/magazine/
Accessed 27 Apr 2019
Health
Measles and the Limits of Facts
At its core, the resurgence of the once-defeated disease in the U.S. is a failure of communication.
James Hamblin Apr 26, 2019

How to Talk to an Anti-vax Relative
The question of whether vaccinations should be a duty or a choice is dividing families.
Ashley Fetters Apr 22, 2019

BBC
http://www.bbc.co.uk/
Accessed 27 Apr 2019
[No new, unique, relevant content]

The Economist
http://www.economist.com/
Accessed 27 Apr 2019
[No new, unique, relevant content]

Financial Times
http://www.ft.com/home/uk
Accessed 27 Apr 2019
[No new, unique, relevant content]

Forbes
http://www.forbes.com/
Accessed 27 Apr 2019
Rare Disease R&D Investments Likely To Grow In Biopharma
Given these advantages, it is hard to believe that rare diseases won’t take up a bigger proportion of biopharma R&D dollars in the future.
Apr 24, 2019
By John LaMattina Contributor

Foreign Affairs
http://www.foreignaffairs.com/
Accessed 27 Apr 2019
[No new, unique, relevant content]

Foreign Policy
http://foreignpolicy.com/
Accessed 27 Apr 2019
[No new, unique, relevant content]

The Guardian
http://www.guardiannews.com/
Accessed 27 Apr 2019
Anti-vaxxers are taking populism to a new, deadly level
Gaby Hinsliff
27 Apr 2019

Measles is on the march again – but scare tactics won’t improve vaccination rates
Andre Spicer
26 Apr 2019

New Yorker
http://www.newyorker.com/
Accessed 27 Apr 2019
[No new, unique, relevant content]

New York Times
http://www.nytimes.com/
Accessed 27 Apr 2019
U.S.
More Than 700 at 2 California Universities Under Quarantine Amid Measles Outbreak
The number of staff members and students who were under quarantine on Friday was up by about 400 from the day before, according to the authorities.
April 26

Health
Religious Objections to the Measles Vaccine? Get the Shots, Faith Leaders Say
Devout parents who are worried about vaccines often object to ingredients from pigs or fetuses. But the leaders of major faiths have examined these fears and still vigorously endorse vaccination.
April 26

U.S.
Trump Tells Americans: Go Get Your Measles Vaccination
U.S. President Donald Trump on Friday urged Americans to protect themselves with the measles vaccination as the number of cases of the once-eradicated disease in the United States hit the highest levels since 2000.
April 26

Asia Pacific
Polio Vaccinator Is Shot and Killed in Pakistan
The woman was part of a vaccination campaign. Another worker in her team was injured. A total of three polio workers have been killed this week as unfounded rumors against vaccines spread.
April 25

Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 27 Apr 2019
Essay
The Founding Generation Also Had to Fight ‘Anti-Vaxxers’
By Mark Honigsbaum
In the 1720s, Cotton Mather supported an early form of inoculation; Washington, Jefferson and Adams followed suit.
Appeared in the April 26, 2019, print edition.

Review & Outlook
‘They Have to Get the Shots’
By The Editorial Board
Measles is spreading again, so urging vaccination is vital.
Appeared in the April 26, 2019, print edition.

Washington Post
http://www.washingtonpost.com/
Accessed 27 Apr 2019
[No new, unique, relevant content]

Think Tanks et al

Brookings
http://www.brookings.edu/
Accessed 27 Apr 2019
[No new relevant content]

Center for Global Development
http://www.cgdev.org/page/press-center
[No new relevant content]

CSIS
https://www.csis.org/
Accessed 27 Apr 2019
[No new relevant content]

Council on Foreign Relations
http://www.cfr.org/
Accessed 27 Apr 2019
[No new relevant content]

Kaiser Family Foundation
https://www.kff.org/search/?post_type=press-release
Accessed 27 Apr 2019
April 23, 2019 Fact Sheet
The President’s Malaria Initiative and Other U.S. Government Global Malaria Efforts
This fact sheet provides a snapshot of global malaria efforts and examines the U.S. government’s role in addressing malaria worldwide, including current programs, funding, and key issues.

Milestones :: Perspectives :: Research

UNICEF launches #VaccinesWork campaign to inspire support for vaccines
Amid growing outbreaks of vaccine-preventable diseases, UNICEF’s campaign will use social media to show that most parents trust vaccines to protect their children
17/04/2019
NEW YORK, 18 April 2019 – UNICEF is launching a new global campaign on 24 April to emphasize the power and safety of vaccines among parents and wider social media users.

The campaign will run alongside World Immunization Week from 24 to 30 April to spread the message that together communities, including parents, can protect everyone through vaccines.

#VaccinesWork has long been used to bring together immunization advocates online. This year, UNICEF is partnering with the Bill & Melinda Gates Foundation, the World Health Organization (WHO), and Gavi, the Vaccine Alliance to encourage even greater reach. The Bill & Melinda Gates Foundation will contribute USD$ 1 to UNICEF for every like or share of social media posts using the hashtag #VaccinesWork in April, up to USD$1 million, to ensure all children get the life-saving vaccines they need…

… “We want the awareness that #VaccinesWork to go viral,” said Robin Nandy, UNICEF’s Chief of Immunization. “Vaccines are safe, and they save lives. This campaign is an opportunity to show the world that social media can be a powerful force for change and provide parents with trustworthy information on vaccines.”

The campaign is part of a global, week-long celebration under the theme, Protected Together: Vaccines Work, to honour Vaccine Heroes – from parents and community members to health workers and innovators.

“More children than ever before are being reached with vaccines today,” said Violaine Mitchell, Interim Director of Vaccine Delivery at the Bill & Melinda Gates Foundation. “We are delighted to work with UNICEF and all the global and country partners around the world who are working tirelessly to ensure all children, especially those in the world’s poorest countries, can be protected from life-threatening infectious diseases.”

Despite the benefits of vaccines, an estimated 1.5 million children died of vaccine-preventable diseases in 2017. While this is often due to lack of access to vaccines, in some countries, families are delaying or refusing to vaccinate their children because of complacency or skepticism about vaccines. This has resulted in several outbreaks, including an alarming surge in measles, especially in higher-income countries. Uncertainty about vaccines on digital and social media platforms is one of the factors driving this trend.

That is why the centerpiece of this UNICEF campaign is a 60-second animated film, “Dangers,” which, along with illustrated animations for social media posts and posters, is based on the relatable insight that kids, by their very nature, are little daredevils who are constantly putting themselves in danger. Available in Arabic, Chinese, French, Hindi, Russian, Spanish and Tagalog, the video explains that while parents can’t prevent all the dangers their kids get themselves into, they can use vaccination to help prevent the dangers that get into their kids.

In addition, UNICEF experts will be answering questions about vaccination, including how vaccines work, how they are tested, why children should receive vaccines, as well as the risks of not vaccinating children in a timely manner.

Milestones :: Perspectives :: Research

Measles

New measles surveillance data for 2019 – WHO
15 April 2019, GENEVA – Measles cases have continued to climb into 2019. Preliminary global data shows that reported cases rose by 300 percent in the first three months of 2019, compared to the same period in 2018. This follows consecutive increases over the past two years.

While this data is provisional and not yet complete, it indicates a clear trend. Many countries are in the midst of sizeable measles outbreaks, with all regions of the world experiencing sustained rises in cases. Current outbreaks include the Democratic Republic of the Congo, Ethiopia, Georgia, Kazakhstan, Kyrgyzstan, Madagascar, Myanmar, Philippines, Sudan, Thailand and Ukraine, causing many deaths – mostly among young children.

Over recent months, spikes in case numbers have also occurred in countries with high overall vaccination coverage, including the United States of America as well as Israel, Thailand, and Tunisia, as the disease has spread fast among clusters of unvaccinated people…

::::::

New England Journal of Medicine
April 18, 2019   Vol. 380 No. 16
http://www.nejm.org/toc/nejm/medical-journal
Perspective
Measles in 2019 — Going Backward
Catharine I. Paules, M.D., Hilary D. Marston, M.D., M.P.H., and Anthony S. Fauci, M.D.

In 2000, the United States achieved a historic public health goal: the elimination of measles, defined by the absence of sustained transmission of the virus for more than 12 months. This achievement resulted from a concerted effort by health care practitioners and families alike, working to protect the population through widespread immunization. Unfortunately, that momentous achievement was short-lived, and localized measles outbreaks have recently been triggered by travel-related introductions of the virus by infected persons, with subsequent spread through under-vaccinated subpopulations. According to the Centers for Disease Control and Prevention, 555 cases of measles in 20 states had already been confirmed from January 1 through April 11, 2019 (see graph). The increase in measles cases in the United States mirrors patterns elsewhere: several other countries that had eliminated measles are now seeing resurgences.

Measles is a highly contagious cause of febrile illness typically seen in young children.1 It is transmitted primarily by means of respiratory droplets and small-particle aerosols and can remain viable in the air for up to 2 hours. Exposed people who are not immune have up to a 90% chance of contracting the disease, and each person with measles may go on to infect 9 to 18 others in a susceptible population.2

Most people with measles recover uneventfully after approximately 1 week of illness characterized by fever, malaise, coryza, conjunctivitis, cough, and a maculopapular rash. However, measles is by no means a trivial disease; before widespread vaccination, the virus caused 2 million to 3 million deaths globally per year.1 Even today, it remains a leading cause of vaccine-preventable illness and death worldwide, claiming more than 100,000 lives each

year.2 Common complications include secondary infections related to measles-induced immunosuppression, diarrhea, keratoconjunctivitis (which may lead to blindness, particularly in vitamin A–deficient populations), otitis media, and pneumonia (the leading cause of measles-related deaths). In approximately 1 in 1000 cases of measles, serious and often fatal neurologic complications such as acute disseminated encephalomyelitis and measles inclusion-body encephalitis occur, and most patients who survive these complications have long-term neurologic sequelae. In addition, a rare neurologic complication (affecting approximately 1 in 10,000 patients) called subacute sclerosing panencephalitis (SSPE) can occur years after measles virus infection, with a severe, progressive, and fatal course.

If the potential danger posed by measles is clear, so is the solution. Live-attenuated measles vaccines are among the most highly effective vaccines available (providing 97% protection with two doses, given at 12 to 15 months and 4 to 6 years of age), with a proven safety record.1 The most common side effects of the measles vaccine are a sore arm and fever. A small proportion of vaccinees (about 5%) will develop a rash; an even smaller proportion will have a febrile seizure or transient decrease in platelet counts. A very rare complication, meningoencephalitis, has been described, almost always in immunocompromised vaccinees.

Measles vaccination has prevented an estimated 21 million deaths worldwide since 2000.3

Despite these substantial gains, global elimination goals have not been met, and previous strides are now being threatened by a 31% increase in the number of measles cases reported globally between 2016 and 2017.3 The growing number of travel-related infections and local outbreaks in the United States reflects this alarming trend, yet the U.S. situation is dwarfed by outbreaks elsewhere in the world. For example, the World Health Organization (WHO) reported 117,075 measles cases and 1205 deaths in Madagascar between early October 2018 and early April 2019. Venezuela is also experiencing a large-scale epidemic, with endemic measles transmission now reestablished in a country where it had previously been eliminated.3 In Europe, the number of reported cases in 2018 was triple that in 2017 and 15 times that in 2016.4 In addition, it is likely that endemic measles has now been reestablished in several European countries where transmission had previously been interrupted.3

The resurgence in measles cases is all the more frustrating since the disease is entirely preventable through vaccination. Measles has all the components of an eradicable disease: there is a safe and highly effective vaccine, it has a readily diagnosable clinical syndrome, and it has no animal reservoir to maintain circulation.1 But because of the highly contagious nature of the virus, near-perfect vaccination coverage (herd immunity of 93 to 95%) is needed to effectively protect against a measles resurgence. Although there are valid reasons why some people might not be vaccinated, such as a medical contraindication due to marked immunosuppression, the failure to vaccinate too often stems from misconceptions about vaccine safety, especially those resulting from a now-debunked claim that posited a connection between the vaccine and autism. The growing antivaccination movement, based heavily on philosophical objections to vaccinations, poses a threat to public health. Vaccine hesitancy has been identified by the WHO as one of the top 10 threats to global health and is a serious hurdle to the global elimination and eradication of measles.

If we continue to lose ground on measles prevention through vaccination, we face the reemergence of measles into new populations, which will pose new and varied challenges. Historically, measles has been a disease of children, with severe disease seen primarily in children younger than 5 and those with poor nutritional status, particularly if they have vitamin A deficiency. The successful implementation of measles vaccination programs is changing the epidemiology of measles from seasonal epidemics in young children to sporadic cases in older children and adults, including pregnant women. Data assessing the effects of measles infection in these latter populations are sparse but are suggestive of increased morbidity and mortality.2

The greatest risk of measles-related complications occurs in immunosuppressed people. This population may have atypical presentations with severe complications that have not been documented in immunocompetent patients, such as giant-cell pneumonia and measles inclusion-body encephalitis. Exposure to measles in people with HIV infection has led to serious complications and even death. Higher rates of measles complications and deaths have also been reported in patients with cancer, patients with solid organ transplants, people receiving high-dose glucocorticoids, and those receiving immunomodulatory therapy for rheumatologic disease. People with profound immunosuppression cannot be safely vaccinated with the live-attenuated vaccine and must rely on herd immunity to protect them from measles infection.

Exposure to measles in the community certainly represents a danger to high-risk persons during a local outbreak; however, nosocomial transmission may pose an even greater threat and has been reported throughout the world. For example, during a measles outbreak in Shanghai in 2015, a single child with measles in a pediatric oncology clinic infected 23 other children, more than 50% of whom ended up with severe complications, and the case fatality rate was 21%.5 When the umbrella of herd immunity is compromised, such populations are highly vulnerable.

Unlike many infectious diseases, measles is a public health problem with a clear scientific solution. Measles vaccination is highly effective and safe. Each complication or death related to measles is a preventable tragedy that could have been avoided through vaccination. The recent upsurge in U.S. measles cases, including the worrisome number seen thus far in 2019, represents an alarming step backward. If this trend is not reversed, measles may rebound in full force in both the United States and other countries and regions where it had been eliminated. Promoting measles vaccination is a societal responsibility, with the ultimate goal of global elimination and eradication — relegating measles to the history books

Milestones :: Perspectives :: Research

DRC – Ebola

37: Situation report on the Ebola outbreak in North Kivu
16 April 2019
…Implementation of ring vaccination protocol
:: As of 16 April 2019, 101,195 contacts and contacts of contacts have been vaccinated. Of those 26,613 were contacts and 74,367 contacts of contacts. The vaccinated people at risk included 29,688 HCWs/FLWs, and 26,361 children 1-6 years old. Detailed micro-plans are also in use to monitor the progress and number of cases with and without rings. Table 2 provides an overview of the status as of 15 April 2019.

:: Between 2-4 April 2019, Strategic Advisory Group of Experts (SAGE) convened a meeting to review epidemiological data from North Kivu for children below 1 year of age and for lactating women. Although clinical data on the safety and efficacy of the rVSV-ZEBOV-GP Ebola vaccine for these two specific groups are absent, SAGE considers that the high attack rates and high case fatality ratios for these groups, together with the accumulating data on vaccine safety and efficacy for other groups, justify inclusion of children who are above the age of 6 months and of lactating women in the ongoing ring vaccination efforts in North Kivu. SAGE strongly urged the implementation of studies to evaluate additional Ebola candidate vaccines, including where possible in pregnant and lactating women and in infants. (Please see here for a summary of the SAGE meeting highlights)

:: On 12 April 2019, INRB and WHO published a preliminary analysis of the efficacy of RVSV-ZEBOV-GP emerging from the DRC outbreak data (Please see here for preliminary analysis). The data suggest high efficacy of this candidate vaccine and of the ring vaccination in this outbreak.

:: There are currently 23 vaccination teams comprised of 276 Congolese vaccinators with basic GCP training, 50 Congolese with formal GCP training, and 43 experienced Guinean/African GCP researchers.

:: There is continuation of ring vaccination in Beni, Katwa, Butembo, Mandima, Bunia, Vuhovi, and Lubero health zones around confirmed cases, as well as front-line providers in Goma.

:: Current vaccination strategies being employed on the ground include site by site vaccination, simultaneous vaccination of contacts and their contacts in the community, healthcare worker vaccination, and targeted geographic vaccination of areas where contacts of contacts cannot be clearly identified due to insecurity…

Disease Outbreak News (DONs) –
Ebola virus disease – Democratic Republic of the Congo
11 April 2019
The rise in number of Ebola virus disease (EVD) cases observed in the North Kivu provinces of the Democratic Republic of the Congo continues this week. During the last 21 days (20 March to 9 April 2019), 57 health areas within 11 health zones reported new cases…

…WHO and partners in Risk Communication and Community Engagement are continuing with activities to build and maintain a trusting relationship between communities and the Ebola response teams. Dialogues with community committees are ongoing in the hotspot areas of Butembo, Katwa, and Vuhovi, and form a key part of a larger increase ownership of the Ebola response by the communities. Information about community disquiet are systematically collected and monitored to ensure that any misunderstanding leading to reluctance, refusal, or resistance of the Ebola response is followed up with and resolved as quickly as possible. This has been made possible by feedback from the community members, received through ongoing dialogue and various research activities within both the Democratic Republic of the Congo, and neighbouring areas.

In an effort to address the feedback received and specific concerns over the outbreak response, guided visits of the Ebola Treatment Centres (ETCs) in various affected areas have been organized. Students and community associations who attended these guided visits to the ETCs can see first-hand how EVD patients are treated and help stop the potential dissemination of misinformation surrounding EVD and the ongoing response efforts…

Emergencies

POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 17 April 2019
:: Co-chairs of Immunization Management Group (IMG) announced that the global goal set out in 2013 of 126-OPV using countries to introduce 1 dose of IPV in their immunization programme has been achieved.
:: Eminent Islamic religious scholars from Afghanistan and Pakistan came together in Muscat, Oman for the first ever joint Ulama Conference, under the aegis of the Islamic Advisory Group (IAG). for polio eradication The IAG convened religious scholars in a bid to appreciate their value as community leaders and secure bilateral support for polio eradication efforts across the joint poliovirus transmission corridors. At the end of the two-day conference, the scholars issued a joint declaration in support of the polio efforts. Watch the Opening Session here. Read the declaration here.
:: In keeping with the recommendations of the Emergency Committee under the International Health Regulations (IHR), Afghanistan and Pakistan have introduced an all-age polio vaccination for travelers crossing international borders to increase general population immunity the common wild poliovirus transmission corridor. Read more.

Summary of new viruses this week:
:: Afghanistan—three wild poliovirus type 1 (WPV1)-positive environmental samples;
:: Pakistan—three WPV1-positive environmental samples;
:: Nigeria—one circulating vaccine-derived type 2 (cVDPV2) case and seven cVDPV2-positive environmental samples.

::::::

Joining hands across the border
All travellers crossing the border between Pakistan and Afghanistan are vaccinated against polio, regardless of age
GPEI  16/04/2019
On both sides of the historical 2640-kilometre-long border between Pakistan and Afghanistan, communities maintain close familial ties with each other. The constant year-round cross border movement makes for easy wild poliovirus transmission in the common epidemiological block.

As a new tactic in their joint efforts to defeat poliovirus circulation, Afghanistan and Pakistan have introduced all-age polio vaccination for travellers crossing the international borders in efforts to increase general population immunity against polio and to help stop the cross-border transmission of poliovirus. The official inauguration of the all-age vaccination effort took place on 25 March 2019 at the border crossings in Friendship Gate (Chaman-Spin Boldak) in the south, and in Torkham in the north…

…It is estimated that the Friendship Gate border alone receives a daily foot traffic of 30 000. Travellers include women and men of all ages, from children to the elderly.

Pakistan and Afghanistan first increased the age for polio vaccination at the border in January 2016, from children under five years to those up to 10 years old. The decision was in line with the recommendations of the Emergency Committee under the International Health Regulations (IHR) which declared the global spread of polio a “public health emergency of international concern”,

The all-age vaccination against polio at the border crossings serves a practical implementation of another recommendation of the IHR Committee: that Pakistan and Afghanistan should “further intensify cross­border efforts by significantly improving coordination at the national, regional and local levels to substantially increase vaccination coverage of travelers crossing the border and of high risk cross­border populations.

…As part of the newly introduced all-age vaccination, all people above 10 years of age who are given OPV at the border are issued a special card as proof of vaccination. The card remains valid for one year and exempts regular crossers from receiving the vaccination again. Children under 10 years of age will be vaccinated each time they cross the border.

Before all-age vaccination began at Friendship Gate and Torkham, public officials held extensive communication outreach both sides of the border to publicize the expansion of vaccination activities from children under 10 to all ages. Radio messages were played in regional languages, and community engagement sessions sensitized people who regularly travel across the border. Banners and posters were displayed at prominent locations….

::::::
::::::

Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.

WHO Grade 3 Emergencies  [to 20 Apr 2019]
Bangladesh – Rohingya crisis
:: Bi‐weekly Situation Report 7 – 11 April 2019

HIGHLIGHTS
:: Ten new diphtheria cases were reported in week 14, (1 confirmed, 9 suspected), bringing the total number of reported case-patients to 8 545.
:: To gain an understanding of how women and men perceive immunization in camps, WHO organized two focus group discussions.
:: Water Quality Surveillance round 10 has been started in all refugee areas.

Varicella Update
A total of 2161 varicella cases were reported this week via weekly report form (2783 cases in week 13).
Risk Communication
WHO organized, two separate focus group discussions (FGDs), one for only women of all ages, and another of only men of all ages, held at the Camp 14 in Ukhiya of the Cox’s Bazar district. This was to gain an understanding of how women and men perceive immunization in the camps. The questions were kept open-ended to understand perception and attitude related to importance of Immunization, importance of Immunization schedule and compliance, gaps in communication with respect to immunization. Observations from these FGDs revealed that everyone in both the groups had heard about necessity of immunization but did not have clear reasons to believe or act. People opted for it because it is a free service and they trust health workers. Absence of knowledge about relevance of complying with the immunization schedule and dangers of missing out on any vaccine was identified.

Cyclone Idai
:: Cyclone-affected communities in Zimbabwe being vaccinated against cholera
Campaign targets nearly 500,000 people in Chimanimani and Chipinge
HARARE, Zimbabwe, 16 April 2019 – An oral cholera vaccine (OCV) campaign targeting some 487,825 people began Tuesday in Zimbabwe in the two districts most affected by cyclone Idai.
During the campaign all residents of Chimanimani and Chipinge districts aged 12 months and older will receive the vaccine to protect them against cholera.
While there have been no reported cases of cholera in the cyclone-affected areas in Zimbabwe, the Zimbabwe Ministry of Health and Child Care is launching the campaign, with support from UNICEF and the World Health Organization (WHO), as a proactive, preventative measure.
Funded by Gavi, the Vaccine Alliance, more than 975 000 OCV doses will be administered in two rounds for full immunity. The second dose will be given approximately two weeks after the first…

Democratic Republic of the Congo
:: 37: Situation report on the Ebola outbreak in North Kivu  16 April 2019
:: Disease Outbreak News (DONs) – Ebola virus disease – Democratic Republic of the Congo
11 April 2019
[See Ebola above for detail]

Myanmar  – No new digest announcements identified
Nigeria – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified
Syrian Arab Republic – No new digest announcements identified
Yemen  – No new digest announcements identified

::::::
 
WHO Grade 2 Emergencies  [to 20 Apr 2019]
Brazil (in Portugese)
:: Últimas notícias – Cerca de 70 milhões de pessoas serão vacinadas durante a Semana de Vacinação nas Américas  18 de abril de 2019

Cameroon  – No new digest announcements identified
Iraq – No new digest announcements identified
Libya – No new digest announcements identified
occupied Palestinian territory  – No new digest announcements identified
Sudan – No new digest announcements identified
Central African Republic  – No new digest announcements identified
Ethiopia – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Niger – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

::::::
 

WHO Grade 1 Emergencies  [to 20 Apr 2019]
Afghanistan – No new digest announcements identified
Chad  – No new digest announcements identified
Indonesia – Sulawesi earthquake 2018  – No new digest announcements identified
Kenya   – No new digest announcements identified
Lao People’s Democratic Republic  – No new digest announcements identified
Mali  – No new digest announcements identified
Namibia – viral hepatitis  – No new digest announcements identified
Peru  – No new digest announcements identified
Philippines – Tyhpoon Mangkhut  – No new digest announcements identified
Tanzania  – No new digest announcements identified

::::::
::::::

UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic  
:: Syria: Humanitarian Response in Al Hol camp, Situation report No. 2
 
Yemen – No new digest announcements identified

::::::

UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
CYCLONE IDAI
:: 20 April 2019   Mozambique: Cyclone Idai & Floods Situation Report No. 16 (A …
:: 18 April 2019   Zimbabwe: Floods Situation Report No. 3, As of 17 April 2019

WHO & Regional Offices [to 20 Apr 2019]

17 April 2019   News release
WHO releases first guideline on digital health interventions
WHO today released new recommendations on 10 ways that countries can use digital health technology, accessible via mobile phones, tablets and computers, to improve people’s health and essential services.
“Harnessing the power of digital technologies is essential for achieving universal health coverage,” says WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Ultimately, digital technologies are not ends in themselves; they are vital tools to promote health, keep the world safe, and serve the vulnerable.”
Over the past two years, WHO systematically reviewed evidence on digital technologies and consulted with experts from around the world to produce recommendations on some key ways such tools may be used for maximum impact on health systems and people’s health…

13 April 2019   News release
At WHO Forum on Medicines, countries and civil society push for greater transparency and fairer prices
At a global forum on fair pricing and access to medicines, delegates from governments and civil society organizations called for greater transparency around the cost of research and development as well as production of medicines, to allow buyers to negotiate more affordable prices.

The forum, co-hosted by the World Health Organization (WHO) and the Government of South Africa, aimed to provide a global platform for frank discussion among all stakeholders – including governments, civil society organizations and the pharmaceutical industry – in order to identify strategies to reduce medicine prices and expand access for all.

The affordability of medicines has long been a concern for developing countries, but today it is also a global one. Each year, 100 million people fall into poverty because they have to pay for medicines out-of-pocket. High-income countries’ health authorities are increasingly having to ration medicines for cancer, hepatitis C and rare diseases. The problem extends to older medicines whose patents have expired, such as insulin for diabetes.

“Medical innovation has little social value if most people cannot access its benefits,” said Dr Mariângela Simão, WHO Assistant Director General for Medicines and Health Products.  “This is a global human rights issue – everyone has a right to access quality healthcare.”

A report commissioned by WHO in 2017 showed that the cost of production of most medicines on WHO’s Essential Medicines List was a small fraction of the final price paid by governments, patients or insurance schemes. Some delegates at the forum noted that a lack of transparency around prices paid by governments means that many low- and middle-income countries pay higher prices for certain medicines than wealthier countries do.

There was consensus that countries can take an initial step towards fostering greater transparency by sharing price information. Countries from the so-called Beneluxa network have already joined forces to share such information, and the results have been promising. The data highlights discrepancies in what different countries are paying and can serve as a powerful tool to negotiate reduced prices. WHO’s database on vaccine markets and shortages – MI4A – was also highlighted at the forum as a useful tool to achieve competitive vaccine prices.

The event highlighted other successful examples of countries’ collaboration around achieving more affordable medicine prices; these include pooled procurement and voluntary sharing of policies. If several countries in the same region purchase medicines as a block, they can negotiate reduced prices due to the larger volume of medicines purchased.  And European countries led by Austria have been sharing different policies to expand access to medicines through the WHO-supported PPRI (Pharmaceutical Pricing and Reimbursement Policies).

Industry bodies at the forum expressed support for the goal of access to medicines for all, and expressed their commitment to the Sustainable Development Agenda, which calls for partnership with the private sector to address global challenges such as access to medicines.

WHO will launch a public online consultation in the coming weeks to collect views and suggestions for a definition of what actually constitutes a ‘fair price’ from relevant stakeholders.

::::::

 
Weekly Epidemiological Record, 19 April 2019, vol. 94, 16 (pp. 189–196)
:: Joint External Evaluation of the International Health Regulations (2005): common priority actions for improvement in the Eastern Mediterranean Region

::::::

WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: WHO Africa mourns the loss of a colleague killed in a hospital attack in the Democratic Republic of the Congo  19 April 2019
:: Cyclone-affected communities in Zimbabwe being vaccinated against cholera: Campaign targets nearly 500,000 people in Chimanimani and Chipinge  17 April 2019
:: WHO and partners successfully vaccinate over 400,000 children against Measles in Borno State -Target 838,582 children more.  12 April 2019

WHO Region of the Americas PAHO
:: Colombia, an example to follow in the effort of ensuring ‘health for all” (04/19/2019)
:: Director General of WHO recognizes Colombia’s solidarity in ensuring the health of migrants (04/19/2019)
:: Nearly 70 million people to be vaccinated during Vaccination Week of the Americas (04/18/2019)

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

WHO European Region EURO
:: Celebrating universal health coverage across the WHO European Region 17-04-2019

WHO Eastern Mediterranean Region EMRO
No new digest content identified.

WHO Western Pacific Region
No new digest content identified.

CDC/ACIP [to 20 Apr 2019]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html

MMWR News Synopsis for Friday, April 19, 2019
Estimated Number of Cases of High-Grade Cervical Lesions Diagnosed Among Women — United States, 2008 and 2016
This first estimate of U.S. cervical precancers using population-based data, including the decline in detection of precancers in women under 30 years old, is important in understanding precancer trends across all age groups and helps explain the impact of changing cervical cancer prevention strategies, including HPV vaccination and cervical cancer screening guidelines. We report the first estimate of the number of high-grade cervical precancers (CIN2+ cases) in the United States using population-based data. In 2008, before vaccine impact, an estimated 216,000 women were diagnosed with CIN2+, and 10 years after vaccine introduction, an estimated 196,000. In 2008, 55% of cervical precancers were detected in women less than 30 years of age; in 2016, only 36% of cervical precancers were diagnosed in this age group. This decline reflects both the impact of the U.S. HPV vaccination program and changes in cervical cancer screening recommendations between 2008 and 2016. Some of the changes include initiating cervical cancer screening at an older age, incorporating HPV testing as part of screening, and having longer intervals between screenings. Overall, an estimated 76% of cervical precancers were attributable to HPV vaccine types.

Outbreak of Human Immunodeficiency Virus Infection Among Heterosexual Persons Who Inject Drugs and Are Living Homeless — Seattle, Washington, 2018
Vulnerability to outbreaks of HIV infection among people who inject drugs is widespread throughout the U.S. and control of these outbreaks requires sustained vigilance and rapid public health responses. Public health officials in King County, WA, identified a cluster of 14 cases of HIV infection diagnosed between February and November 2018 among homeless heterosexuals, most of whom were injecting drugs. This cluster was part of a larger, almost 300% increase in new HIV diagnoses among heterosexuals who injected drugs in King County between 2017 and 2018. That this outbreak occurred in King County, the first urban area in the U.S. to achieve World Health Organization goals for HIV diagnosis and treatment and despite the presence of a syringe exchange program that distributed over 7 million syringes in 2018, highlights the fact that vulnerability to outbreaks of HIV among people who inject drugs is widespread.

Africa CDC   [to 20 Apr 2019]

https://au.int/en/africacdc

No new digest content identified.

China CDC 

http://www.chinacdc.cn/en/

New website launched…no “news” or “announcements” page identified. Link to National Health Commission of the People’s Republic of China not responding at inquiry [20 Apr 2019]

Announcements

 
Paul G. Allen Frontiers Group    [to 20 Apr 2019]
https://www.alleninstitute.org/news-press/
News
Gene drives get a precision upgrade
April 16, 2019
Method to fine tune DNA could be used to engineer malaria-resistant mosquitoes, reduce
 
 
BMGF – Gates Foundation [to 20 Apr 2019]
http://www.gatesfoundation.org/Media-Center/Press-Releases
No new digest content identified.
 
 
Bill & Melinda Gates Medical Research Institute [to 20 Apr 2019]
https://www.gatesmri.org/
The Bill & Melinda Gates Medical Research Institute is a non-profit biotech organization. Our mission is to develop products to fight malaria, tuberculosis, and diarrheal diseases—three major causes of mortality, poverty, and inequality in developing countries. The world has unprecedented scientific tools at its disposal; now is the time to use them to save the lives of the world’s poorest people
No new digest content identified.
 
 
CARB-X [to 20 Apr 2019]

Home

CARB-X is a non-profit public-private partnership dedicated to accelerating antibacterial research to tackle the global rising threat of drug-resistant bacteria.
No new digest content identified.
 
 
CEPI – Coalition for Epidemic Preparedness Innovations [to 20 Apr 2019]

Home page

No new digest content identified.
 
 
Clinton Health Access Initiative, Inc. (CHAI) [to 20 Apr 2019]

About

No new digest content identified.
EDCTP    [to 20 Apr 2019]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials
Latest news
15 April 2019
WANECAM consortium kicks off clinical study for next-generation antimalarial drug
The West African Network for Clinical Trials of Antimalarial Drugs (WANECAM), a consortium of ten academic organisations in Africa and Europe, starts off the ‘WANECAM 2’ study in Bamako, Mali with a meeting on 15 April 2019. EDCTP invests EUR 10 million in the project. WANECAM will conduct clinical trials of a novel antimalarial combination comprising KAF156 (ganaplacide) and lumefantrine in a new once-daily formulation. The project is led by Professor Abdoulaye Djimdé of the Université des Sciences, Techniques et Technologies de Bamako…The above message is based on the consortium press release (PDF)…
 
 
Emory Vaccine Center [to 20 Apr 2019]
http://www.vaccines.emory.edu/
No new digest content identified.
 
 
European Medicines Agency [to 20 Apr 2019]
http://www.ema.europa.eu/ema/
News and press releases
No new digest content identified.
 
 
European Vaccine Initiative [to 20 Apr 2019]
http://www.euvaccine.eu/news-events
Latest news
No new digest content identified.
 
 
FDA [to 20 Apr 2019]
https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
No new digest content identified.
 
 
Fondation Merieux [to 20 Apr 2019]

Accueil

No new digest content identified.
 
 
Gavi [to 20 Apr 2019]
https://www.gavi.org/
Latest News
Challenging impossible: eight game-changing approaches to vaccination
17 April 2019
Making sure that vaccines reach as many children as possible around the world requires a healthy dose of innovation. For World Immunization Week 2019, we are showcasing a series of innovations – from cutting-edge to low-tech – that further our mission to create equal access to new and underused vaccines for children living in the world’s poorest countries.
 
 
GHIT Fund [to 20 Apr 2019]
https://www.ghitfund.org/newsroom/press
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that devastate the world’s poorest people. Other funders include six Japanese pharmaceutical
No new digest content identified.

Global Fund [to 20 Apr 2019]
https://www.theglobalfund.org/en/news/
News
No new digest content identified.

Hilleman Laboratories [to 20 Apr 2019]
http://www.hillemanlabs.org/
No new digest content identified.

Human Vaccines Project [to 20 Apr 2019]

Press Releases

No new digest content identified.

IAVI [to 20 Apr 2019]
https://www.iavi.org/newsroom
No new digest content identified.

IFFIm
http://www.iffim.org/library/news/press-releases/
09 April 2019
IFFIm issues sukuk to the Islamic Development Bank
Private transaction raised US$ 50 million for immunisation.
 
 
IFRC   [to 20 Apr 2019]
http://media.ifrc.org/ifrc/news/press-releases/
Selected Press Releases, Announcements
Syria: Heaviest flooding in decade worsens humanitarian crisis in Al Hasakeh region
Damascus/Beirut/Geneva, 17 April 2019 – Heavy rains have caused the worst flooding in a decade across Syria’s Al Hasakeh region, where 118,000 people are facing near complete destruction of their homes and livelihoods. The majority of the affected popu …
17 April 2019
 
 
Iran
Iran floods: Two million people in need of humanitarian aid
Tehran/Geneva, 15 April 2019 – An estimated 2 million people – one in every 40 people in Iran – need humanitarian assistance as a result of the massive floods that have swept across the country. Heavy rains and flash floods have affected more than 2,00 …
15 April 2019
 
 
Mozambique
Mozambique Cyclone: Signs of recovery, but long road still ahead
Beira/Nairobi/Geneva, 14 April 2019 – One month after the worst disaster in Mozambique’s recent history, signs of recovery are beginning to emerge as people return home and as the deadly cholera outbreak appears to be starting to abate. However, hundre …
14 April 2019
 
 
IVAC  [to 20 Apr 2019]
https://www.jhsph.edu/research/centers-and-institutes/ivac/index.html
No new digest content identified.
 
 
IVI   [to 20 Apr 2019]
http://www.ivi.int/
IVI News & Announcements
[Undated]
IVI-led CAPTURA consortium wins Fleming Fund award for work on antimicrobial resistance (AMR) data across Asia
SEOUL, South Korea — An international consortium, led by the International Vaccine Institute (IVI), has received funding from the UK’s Fleming Fund Regional Grants to conduct the Capturing Data on Antimicrobial Resistance (AMR) Patterns and Trends in Use in Regions of Asia (CAPTURA) project. The CAPTURA consortium also includes the Public Health Surveillance Group (PHSG), the Brigham and Women’s Hospital, and the University of Oxford’s Big Data Institute (BDI)…
 
 
JEE Alliance  [to 20 Apr 2019]
https://www.jeealliance.org/
Selected News and Events
Strategic Partnership for International Health Regulations (2005) and Health Security
19.4.2019
The implementation of the International Health Regulations (2005) Monitoring and Evaluation Framework will draw on WHO’s convening role to facilitate strategic cooperation and generate
 
 
MSF/Médecins Sans Frontières  [to 20 Apr 2019]
http://www.msf.org/
Selected News; Project Updates, Reports [as presented on website]
DRC Ebola outbreaks
Crisis update – April 2019
Crisis Update 18 Apr 2019
 
 
Ethiopia
Alarming rates of malnutrition among displaced people in sout…
Press Release 17 Apr 2019
 
 
Libya
Detained refugees trapped, Libyan families flee, as fighting worsens in Tripoli
Project Update 17 Apr 2019
 
 
Cyclone Idai & Southern Africa flooding
MSF emergency response to Cyclone Idai and flooding
Crisis Update 17 Apr 2019
 
 
Colombia
Assisting Venezuelan migrants in Colombia
Project Update 17 Apr 2019
 
 
South Sudan
There’s a lot to be done to address the uncountable health needs
Voices from the Field 16 Apr 2019
 
 
NIH  [to 20 Apr 2019]
http://www.nih.gov/news-events/news-releases
April 18, 2019
NIH funds study in four states to reduce opioid related deaths by 40 percent over three years
— Findings to serve as a blueprint for communities nationwide
 
 
Decline in measles vaccination is causing a preventable global resurgence of the disease
April 18, 2019 — Decline in measles vaccination is causing a preventable global resurgence of the disease
[See Milestones/Perspectives above for details]
 
 
In rare cases, immune system fails despite HIV suppression
April 18, 2019 — NIH scientists identify paradoxical response to HIV medication in five individuals
 
 
Novel antibody may suppress HIV for up to four months
April 17, 2019 — NIH researchers, international collaborators report results of small, open-label study
 
 
Gene therapy restores immunity in infants with rare immunodeficiency disease
April 17, 2019 — NIH scientists and funding contributed to development of experimental treatment
 
 
PATH  [to 20 Apr 2019]
https://www.path.org/media-center/
No new digest content identified.
 
 
Sabin Vaccine Institute  [to 20 Apr 2019]
http://www.sabin.org/updates/pressreleases
No new digest content identified.
 
 
UNAIDS [to 20 Apr 2019]
http://www.unaids.org/en
Selected Press Releases/Reports/Statements
18 April 2019
Cyclone Idai flood survivors ‘just want to go home’
 
 
16 April 2019
Côte d’Ivoire signals renewed will to tackle issue of user fees for HIV services
 
 
15 April 2019
Urgent action needed to address HIV in Haut Mbomou, Central African Republic
 
 
15 April 2019
Parental consent is required in the majority of countries worldwide
 
 
UNICEF  [to 20 Apr 2019]
https://www.unicef.org/media/press-releases
Selected Statements, Press Releases, Reports
Statement
Children’s lives and well-being in danger as fighting intensifies in Tripoli, Libya
Joint statement by Henrietta Fore, UNICEF Executive Director, and Virginia Gamba, Special Representative of the Secretary-General for Children and Armed Conflict
18/04/2019
 
 
Press release
Cyclone Idai: Education at risk for more than 305,000 children in Mozambique – UNICEF
More than 3,400 classrooms damaged or destroyed in storm
18/04/2019
 
 
Press release
UNICEF launches #VaccinesWork campaign to inspire support for vaccines
Amid growing outbreaks of vaccine-preventable diseases, UNICEF’s campaign will use social media to show that most parents trust vaccines to protect their children
17/04/2019
[See Milestones/Perspectives above for details]
 
 
Press release
6,000 children reunited with families after years of separation in South Sudan
17/04/2019
 
 
Vaccine Confidence Project  [to 20 Apr 2019]
http://www.vaccineconfidence.org/
No new digest content identified.
 
 
Vaccine Education Center – Children’s Hospital of Philadelphia  [to 20 Apr 2019]
http://www.chop.edu/centers-programs/vaccine-education-center
No new digest content identified.
 
 
Wellcome Trust  [to 20 Apr 2019]
https://wellcome.ac.uk/news
News | 17 April 2019
Four ways we’re working with DFID to thwart epidemics
To prevent future epidemics and improve the response to ones that are already happening, there needs to be evidence, knowledge and the right tools. To help provide these, Wellcome is working with the UK Department for International Development (DFID) in a five-year initiative.
 
 
The Wistar Institute   [to 20 Apr 2019]
https://www.wistar.org/news/press-releases
 
 
Press Release
Apr. 17, 2019
Identification of a Critical Regulator of Immune Suppressive Cells Reveals a Novel Target for Cancer Immunotherapy
Pharmacological block of the FATP2 protein selectively inhibits myeloid-derived suppressor cells and shows antitumor effects in preclinical models.
 
 
Press Release
Apr. 18, 2019
Innovative Synthetic DNA-based Cancer Immunotherapy Approach Shows Tumor-clearing Ability in Preclinical Models
PHILADELPHIA — (April 18, 2019) — Wistar scientists have developed a novel synthetic DNA approach for patient-specific production of cancer-targeting molecules called bispecific T cell engagers. DNA-encoded bispecific T cell engagers (dBiTEs) designed against the HER2 protein were tested in preclinical models of ovarian cancer and induced tumor regression, demonstrating the potential of this novel approach for immunotherapy. Study results were published online in JCI Insights.
 
 
World Organisation for Animal Health (OIE)   [to 20 Apr 2019]
http://www.oie.int/en/for-the-media/press-releases/2019/
No new digest content identified.

 
BIO    [to 20 Apr 2019]
https://www.bio.org/insights/press-release
Apr 16 2019
Biotechnology Industry Takes Action To Diversify Leadership
The Biotechnology Innovation Organization (BIO) announced today the “Right Mix Matters” campaign to increase diversity and inclusion in the biotech industry. Following on its previously announced goals to increase gender, racial, ethnic and LGBTQ representation on biotech company boards, in C-suites and in functional leadership positions, BIO is providing specific tools to accelerate diversity and thereby advance an even more globally competitive industry.

DCVMN – Developing Country Vaccine Manufacturers Network [to 20 Apr 2019]
http://www.dcvmn.org/
No new digest content identified.

IFPMA [to 20 Apr 2019]

News Releases

No new digest content identified.

PhRMA [to 20 Apr 2019]
http://www.phrma.org/press-room
No new digest content identified.

Journal Watch

   Vaccines and Global Health: The Week in Review continues its weekly scanning of key peer-reviewed journals to identify and cite articles, commentary and editorials, books reviews and other content supporting our focus on vaccine ethics and policy. Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher.

If you would like to suggest other journal titles to include in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

Annals of Internal Medicine
16 April 2019 Vol: 170, Issue 8
http://annals.org/aim/issue

Editorials
Further Evidence of MMR Vaccine Safety: Scientific and Communications Considerations

Annals of Internal Medicine
16 April 2019 Vol: 170, Issue 8
http://annals.org/aim/issue

Original Research |16 April 2019
Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study Free
Anders Hviid, DrMedSci; Jørgen Vinsløv Hansen, PhD; Morten Frisch, DrMedSci; Mads Melbye, DrMedSci
Abstract
Background:
The hypothesized link between the measles, mumps, rubella (MMR) vaccine and autism continues to cause concern and challenge vaccine uptake.
Objective:
To evaluate whether the MMR vaccine increases the risk for autism in children, subgroups of children, or time periods after vaccination.
Design:
Nationwide cohort study.
Setting:
Denmark.
Participants:
657 461 children born in Denmark from 1999 through 31 December 2010, with follow-up from 1 year of age and through 31 August 2013.
Measurements:
Danish population registries were used to link information on MMR vaccination, autism diagnoses, other childhood vaccines, sibling history of autism, and autism risk factors to children in the cohort. Survival analysis of the time to autism diagnosis with Cox proportional hazards regression was used to estimate hazard ratios of autism according to MMR vaccination status, with adjustment for age, birth year, sex, other childhood vaccines, sibling history of autism, and autism risk factors (based on a disease risk score).
Results:
During 5 025 754 person-years of follow-up, 6517 children were diagnosed with autism (incidence rate, 129.7 per 100 000 person-years). Comparing MMR-vaccinated with MMR-unvaccinated children yielded a fully adjusted autism hazard ratio of 0.93 (95% CI, 0.85 to 1.02). Similarly, no increased risk for autism after MMR vaccination was consistently observed in subgroups of children defined according to sibling history of autism, autism risk factors (based on a disease risk score) or other childhood vaccinations, or during specified time periods after vaccination.
Limitation:
No individual medical charts were reviewed.
Conclusion:
The study strongly supports that MMR vaccination does not increase the risk for autism, does not trigger autism in susceptible children, and is not associated with clustering of autism cases after vaccination. It adds to previous studies through significant additional statistical power and by addressing hypotheses of susceptible subgroups and clustering of cases.
Primary Funding Source:
Novo Nordisk Foundation and Danish Ministry of Health.
 

Annals of Internal Medicine
16 April 2019 Vol: 170, Issue 8
http://annals.org/aim/issue

Original Research |16 April 2019
Development and Performance of a Checklist for Initial Triage After an Anthrax Mass Exposure Event
Nathaniel Hupert, MD, MPH; Marissa Person, MSPH; Dan Hanfling, MD; Rita M. Traxler, MHS; William A. Bower, MD; Katherine Hendricks, MD, MPH&TM
Background:
Population exposure to Bacillus anthracis spores could cause mass casualties requiring complex medical care. Rapid identification of patients needing anthrax-specific therapies will improve patient outcomes and resource use.

Annals of Internal Medicine
16 April 2019 Vol: 170, Issue 8
http://annals.org/aim/issue

Ideas and Opinions
Deliberate Indifference: Inadequate Health Care in U.S. Prisons
Ashley Hurst, JD, MDiv, MA; Brenda Castañeda, JD; Erika Ramsdale, MD
Whether health care should be a fundamental right in the United States is an ongoing debate. However, one group—incarcerated persons—has a constitutionally protected right to adequate health care. Nevertheless, there is a growing epidemic of inadequate health care in U.S. prisons. Shrinking prison budgets, a prison population that is the highest in the world, and for-profit health care contracts all contribute to this epidemic. The medical community has an obligation to respond by providing and advocating for adequate health care for incarcerated persons.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 20 Apr 2019)

Research article
Healthcare professionals’ knowledge, attitude and acceptance of influenza vaccination in Saudi Arabia: a multicenter cross-sectional study
All healthcare professionals (HCPs) are at high risk of influenza infection. Therefore, immunization is recommended for all HCPs. Due to safety and effectiveness concerns, HCPs have a low vaccination rate. Thi…
Authors: Thamir M. Alshammari, Kazeem B. Yusuff, Muhammad Majid Aziz and Gehad M. Subaie
Citation: BMC Health Services Research 2019 19:229
Published on: 15 April 2019

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 20 Apr 2019)

Opinion
|   17 April 2019
Data management and sharing policy: the first step towards promoting data sharing
Authors: Naomi Waithira, Brian Mutinda and Phaik Yeong Cheah

Child Care, Health and Development
Volume 45, Issue 3  Pages: 313-472  May 2019
https://onlinelibrary.wiley.com/toc/13652214/current

REVIEW ARTICLES  Open Access
The usefulness and acceptability of a personal health record to children and young people living with a complex health condition: A realist review of the literature
 There are a growing number of children and young people (CYP) with chronic health needs or complex disabilities. Increasingly, CYP with life‐limiting or life‐threatening conditions are surviving into adulthood. Communication between CYP, their family, and health professionals can be challenging. The use of a personal health record (PHR) is one potential strategy for improving communication by promoting CYP’s health advocacy skills. However, PHR implementation has proved difficult due to technical, organisational, and professional barriers. The aim of this realist review is to identify the factors, which help or hinder the use of PHRs with CYP living with a complex health condition.
Janet Diffin, Bronagh Byrne, Helen Kerr, Jayne Price, Aine Abbott, Dorry McLaughlin, Peter O’Halloran
Pages: 313-332
First Published: 28 February 2019

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 20 Apr 2019]

Research
|   15 April 2019
How are evidence generation partnerships between researchers and policy-makers enacted in practice? A qualitative interview study
Evidence generation partnerships between researchers and policy-makers are a potential method for producing more relevant research with greater potential to impact on policy and practice. Little is known about how such partnerships are enacted in practice, however, or how to increase their effectiveness. We aimed to determine why researchers and policy-makers choose to work together, how they work together, which partnership models are most common, and what the key (1) relationship-based and (2) practical components of successful research partnerships are.
Authors: Anna Williamson, Hannah Tait, Fadi El Jardali, Luke Wolfenden, Sarah Thackway, Jessica Stewart, Lyndal O’Leary and Julie Dixon

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 20 Apr 2019]

Commentary
|   18 April 2019
Health and immunisation services for the urban poor in selected countries of Asia
Asia is a region that is rapidly urbanising. While overall urban health is above rural health standards, there are also pockets of deep health and social disadvantage within urban slum and peri-urban areas that represent increased public health risk. With a focus on vaccine preventable disease and immunisation coverage, this commentary describes and analyses strengths and weaknesses of existing urban health and immunisation strategy, with a view to recommending strategic directions for improving access to immunisation and related maternal and child health services in urban areas across the region. The themes discussed in this commentary are based on the findings of country case studies published by the United Nations Childrens Fund (UNICEF)  on the topic of immunisation and related health services for the urban poor in Cambodia, Indonesia, Mongolia, Myanmar, the Philippines, and Vietnam.
Authors: John Grundy, Xiaojun Wang, Kunihiko Chris Hirabayashi, Richard Duncan, Dexter Bersonda, Abu Obeida Eltayeb, Godwin Mindra and Robin Nandy

International Journal of Infectious Diseases
March 2019 Volume 80, Supplement, S1-S84
https://www.ijidonline.com/issue/S1201-9712(19)X0005-3

Articles
Tuberculosis and integrated child health — Rediscovering the principles of Alma Ata
Anne K. Detjen, Shaffiq Essajee, Malgorzata Grzemska, Ben J. Marais
S9–S12
Published online: February 27, 2019
Highlights
:: The renewed commitment to Primary Health Care (PHC) presents an opportunity to reconsider latent synergies and novel partnerships for child health and development.
:: TB and HIV partners need to align better and jointly formulate strategies to scale up pediatric TB and HIV in an integrated MNCH and PHC context.
:: Integrated, family-centered approaches, implemented at the community and primary care facility level are key for bridging the pediatric TB and HIV gaps.