American Journal of Infection Control
April 2019 Volume 47, Issue 4, p351-478
http://www.ajicjournal.org/current
Major Articles
Infection control influence of Middle East respiratory syndrome coronavirus: A hospital-based analysis
Jaffar A. Al-Tawfiq, Rana Abdrabalnabi, Alla Taher, Shantymole Mathew, Kamal Abdul Rahman
p431–434
Published online: November 27, 2018
American Journal of Infection Control
April 2019 Volume 47, Issue 4, p351-478
http://www.ajicjournal.org/current
Brief Reports
Understanding influenza vaccination rates and reasons for refusal in caregivers and household contacts of cancer patients
Stephanie A. Price, Sara Podczervinski, Kim MacLeod, Lois Helbert, Steven A. Pergam
p468–470
Published online: December 4, 2018
American Journal of Preventive Medicine
April 2019 Volume 56, Issue 4, p477-630
http://www.ajpmonline.org/current
Research Articles
Influenza Vaccination Coverage Among Pregnant Women in the U.S., 2012–2015
Helen Ding, Katherine E. Kahn, Carla L. Black, Alissa O’Halloran, Peng-Jun Lu, Walter W. Williams
p477–486
Published online: February 16, 2019
American Journal of Preventive Medicine
April 2019 Volume 56, Issue 4, p477-630
http://www.ajpmonline.org/current
Compressed Influenza Vaccination in U.S. Older Adults: A Decision Analysis
Kenneth J. Smith, Glenson France, Mary Patricia Nowalk, Jonathan M. Raviotta, Jay DePasse, Angela Wateska, Eunha Shim, Richard K. Zimmerman
e135–e141
Published online: February 14, 2019
American Journal of Preventive Medicine
April 2019 Volume 56, Issue 4, p477-630
http://www.ajpmonline.org/current
Review Articles
Human Papillomavirus Vaccine Interventions in the U.S.: A Systematic Review and Meta-analysis
Ana M. Rodriguez, Thuy Quynh N. Do, Michael Goodman, Kathleen M. Schmeler, Sapna Kaul, Yong-Fang Kuo
p591–602
Published online: February 15, 2019
Abstract
Context
Despite current recommendations, human papillomavirus vaccine uptake remains low. A systematic review and meta-analysis assessed the effectiveness of interventions targeting human papillomavirus vaccine initiation and completion among children, adolescents, and young adults aged 9–26 years.
Evidence acquisition
Three electronic databases (CINAHL, OVID, and Web of Science) were searched for articles published in English peer-reviewed journals between January 2006 and January 2017 of U.S. studies that evaluated intervention strategies and reported post-intervention human papillomavirus vaccine initiation or completion rates among individuals aged 9–26 years. Study characteristics and outcomes were extracted. Data were collected in 2016 and analyzed in 2017.
Evidence synthesis
Reviewers screened 983 unique titles and abstracts, read 241 full-text articles, and extracted data from 30 articles meeting the inclusion criteria (12 behavioral, ten environmental, four informational, and four combination strategies). Published EQUATOR (Enhancing the Quality and Transparency of Health Research) guidelines were used to assess study quality. Random effects meta-analyses were conducted. The meta-analyses included 17 RCTs and quasi-experiments involving 68,623 children, adolescents, and young adults. The pooled relative incidence estimates were 1.84 (95% CI=1.36, 2.48) for human papillomavirus vaccine initiation and 1.50 (95% CI=1.23, 1.83) for completion. Behavioral and informational interventions doubled human papillomavirus vaccine initiation (relative incidence estimate=2.04, 95% CI=1.36, 3.06 and relative incidence estimate=1.92, 95% CI=1.27, 2.91, respectively). Behavioral interventions increased completion by 68% (relative incidence estimate=1.68, 95% CI=1.25, 2.27).
Conclusions
Evidence supports behavioral interventions for increasing human papillomavirus vaccine initiation and completion. Future studies are needed to assess the effectiveness of interventions in reaching diverse populations and reducing missed opportunities for human papillomavirus vaccination.
American Journal of Public Health
April 2019 109(4)
http://ajph.aphapublications.org/toc/ajph/current
INDUSTRY SUPPORT
Pharmaceutical Industry Support of US Patient Advocacy Organizations: An International Context
Government, Health Law, Health Policy, Ethics
So-Yeon Kang, Ge Bai, Laura Karas and Gerard F. Anderson
109(4), pp. 559–561
Abstract
Objectives. To examine whether the share of pharmaceutical industry funds allocated to patient advocacy organizations (PAOs) is disproportionately large in the United States relative to other industrialized countries and to compare pharmaceutical companies’ disclosure practices across industrialized countries.
Methods. We examined funding of PAOs among the 10 largest pharmaceutical companies in 2016. We compared funding allocated to organizations across 8 large industrialized countries and pharmaceutical companies’ disclosure practices in each country.
Results. Only 6 of the 10 largest pharmaceutical companies disclosed their financial transactions with PAOs in the United States. All 10 companies disclosed transactions in France, Germany, and the United Kingdom, with varying levels of disclosure in other countries. In 2016, the 6 companies that disclosed transactions in the United States allocated 74% of their patient advocacy funding ($88 million) in the United States.
Conclusions. The disproportionate funding of US PAOs in the absence of any disclosure requirements suggests that the United States should consider adoption of regulatory actions to enhance the transparency of relationships between the pharmaceutical industry and PAOs, and to ensure the integrity of public health decision-making.
BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 30 Mar 2019)
Research article
| 28 March 2019
Responsible data sharing in international health research: a systematic review of principles and norms
Authors: Shona Kalkman, Menno Mostert, Christoph Gerlinger, Johannes J. M. van Delden and Ghislaine J. M. W. van Thiel
Abstract
Background
Large-scale linkage of international clinical datasets could lead to unique insights into disease aetiology and facilitate treatment evaluation and drug development. Hereto, multi-stakeholder consortia are currently designing several disease-specific translational research platforms to enable international health data sharing. Despite the recent adoption of the EU General Data Protection Regulation (GDPR), the procedures for how to govern responsible data sharing in such projects are not at all spelled out yet. In search of a first, basic outline of an ethical governance framework, we set out to explore relevant ethical principles and norms.
Methods
We performed a systematic review of literature and ethical guidelines for principles and norms pertaining to data sharing for international health research.
Results
We observed an abundance of principles and norms with considerable convergence at the aggregate level of four overarching themes: societal benefits and value; distribution of risks, benefits and burdens; respect for individuals and groups; and public trust and engagement. However, at the level of principles and norms we identified substantial variation in the phrasing and level of detail, the number and content of norms considered necessary to protect a principle, and the contextual approaches in which principles and norms are used.
Conclusions
While providing some helpful leads for further work on a coherent governance framework for data sharing, the current collection of principles and norms prompts important questions about how to streamline terminology regarding de-identification and how to harmonise the identified principles and norms into a coherent governance framework that promotes data sharing while securing public trust.
BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 30 Mar 2019)
Forum
‘Fit-for-purpose?’ – challenges and opportunities for applications of blockchain technology in the future of healthcare
Blockchain is a shared distributed digital ledger technology that can better facilitate data management, provenance and security, and has the potential to transform healthcare. Importantly, blockchain represen…
Authors: Tim K. Mackey, Tsung-Ting Kuo, Basker Gummadi, Kevin A. Clauson, George Church, Dennis Grishin, Kamal Obbad, Robert Barkovich and Maria Palombini
Citation: BMC Medicine 2019 17:68
Published on: 27 March 2019
BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 30 Mar 2019)
Research article
Strategies to improve maternal vaccination acceptance
In England, influenza and pertussis vaccination has been recommended for all pregnant women since 2010 and 2012 respectively. However, in some areas, vaccination uptake rates have been low. A qualitative study…
Authors: R. Wilson, P. Paterson and H. J. Larson
Citation: BMC Public Health 2019 19:342
Published on: 25 March 2019
Clinical Trials
Volume 16 Issue 2, April 2019
https://journals.sagepub.com/toc/ctja/16/2
Ethics
Making the case for completion bonuses in clinical trials
Emily A Largent, Holly Fernandez Lynch
First Published December 20, 2018; pp. 176–182
Preview
Attrition is a serious problem in many clinical trials. The practice of offering completion bonuses—financial incentives offered to participants on the condition that they remain in a trial until they reach a prespecified study endpoint—is one means of addressing attrition. Despite their practical appeal, however, completion bonuses remain ethically controversial due to concern that they will coerce or unduly influence participants to not exercise their right to withdraw from a trial. Although this interaction with the right to withdraw does render completion bonuses conceptually distinct from other incentive payments offered to research participants, we argue here that completion bonuses are never coercive and, in the context of effective institutional review board oversight, are unlikely to be unduly influential. Nonetheless, because completion bonuses may in some cases still encourage unreasonable continued participation in a study, additional safeguards are appropriate. Rejecting completion bonuses entirely is, however, unnecessary and would problematically fail to address the significant ethical problems associated with participant attrition.
Clinical Trials
Volume 16 Issue 2, April 2019
https://journals.sagepub.com/toc/ctja/16/2
Reviews
Conducting clinical trials—costs, impacts, and the value of clinical trials networks: A scoping review
Colene Bentley, Sonya Cressman, Kim van der Hoek, Karen Arts, Janet Dancey, Stuart Peacock
First Published January 10, 2019; pp. 183–193
Conclusion
Key findings from the review are: 1) delayed trial activation has costs to budgets and research; 2) poor accrual leads to low-value trials and wasted resources; 3) the pharmaceutical industry can be a pragmatic, if problematic, partner in clinical research; 4) organizational know-how and successful research collaboration are benefits of network/cooperative groups; and 5) there are spillover benefits of clinical trials to healthcare systems, including better health outcomes, enhanced research capacity, and drug cost avoidance. There is a need for more economic evaluations of the benefits of clinical research, such as health system use (or avoidance) and health outcomes in cities and health authorities with institutions that conduct clinical research, to demonstrate the affordability of clinical trials, despite their high cost.
Ethics & Human Research
Volume 41, Issue 2 Pages: 1-40 March-April 2019
https://onlinelibrary.wiley.com/journal/25782363
The Scientific Value and Validity of Research
Articles
A Framework for Assessing Scientific Merit in Ethical Review of Clinical Research
Ariella Binik, Spencer Phillips Hey
Pages: 2-13
First Published: 20 March 2019
ABSTRACT
Ethics guidelines and commentary suggest that a central function of research ethics committees is to assess the scientific merit of the protocols they review. However, some commentators object to this role, and evidence suggests that the assessment of scientific merit is a significant source of confusion and animosity between ethics committees and clinical investigators. In this essay, we argue that ethics committees should assess the scientific value and validity of research protocols and that new decision‐making tools are needed to help them do so in a systematic, transparent, and reliable way. We present a novel ethical framework that can assist in this task.
Ethics & Human Research
Volume 41, Issue 2 Pages: 1-40 March-April 2019
https://onlinelibrary.wiley.com/journal/25782363
The Scientific Value and Validity of Research
Anticipatory Waivers of Consent for Pediatric Biobanking
Jane A. Hartsock, Peter H. Schwartz, Amy C. Waltz, Mary A. Ott
Pages: 14-21
First Published: 20 March 2019
ABSTRACT
As pediatric biobank research grows, additional guidance will be needed about whether researchers should always obtain consent from participants when they reach the legal age of majority. Biobanks struggle with a range of practical and ethical issues related to this question. We propose a framework for the use of anticipatory waivers of consent that is empirically rooted in research that shows that children and adolescents are often developmentally capable of meaningful deliberation about the risks and benefits of participation in research. Accordingly, bright‐line legal concepts of majority or competency do not accurately capture the emerging capacity for autonomous decision‐making of many pediatric research participants and unnecessarily complicate the issues about contacting participants at the age of majority to obtain consent for the continued or first use of their biospecimens that were obtained during childhood. We believe the proposed framework provides an ethically sound balance between the concern for potential exploitation of vulnerable populations, the impetus for the federal regulations governing research with children, and the need to conduct valuable research in the age of genomic medicine.
Genome Medicine
https://genomemedicine.biomedcentral.com/articles
[Accessed 24 Nov 2018]
Research
Encircling the regions of the pharmacogenomic landscape that determine drug response
Authors: Adrià Fernández-Torras, Miquel Duran-Frigola and Patrick Aloy
Citation: Genome Medicine 2019 11:17
Published on: 26 March 2019
Abstract
Background
The integration of large-scale drug sensitivity screens and genome-wide experiments is changing the field of pharmacogenomics, revealing molecular determinants of drug response without the need for previous knowledge about drug action. In particular, transcriptional signatures of drug sensitivity may guide drug repositioning, prioritize drug combinations, and point to new therapeutic biomarkers. However, the inherent complexity of transcriptional signatures, with thousands of differentially expressed genes, makes them hard to interpret, thus giving poor mechanistic insights and hampering translation to clinics.
Methods
To simplify drug signatures, we have developed a network-based methodology to identify functionally coherent gene modules. Our strategy starts with the calculation of drug-gene correlations and is followed by a pathway-oriented filtering and a network-diffusion analysis across the interactome.
Results
We apply our approach to 189 drugs tested in 671 cancer cell lines and observe a connection between gene expression levels of the modules and mechanisms of action of the drugs. Further, we characterize multiple aspects of the modules, including their functional categories, tissue-specificity, and prevalence in clinics. Finally, we prove the predictive capability of the modules and demonstrate how they can be used as gene sets in conventional enrichment analyses.
Conclusions
Network biology strategies like module detection are able to digest the outcome of large-scale pharmacogenomic initiatives, thereby contributing to their interpretability and improving the characterization of the drugs screened.
Global Health: Science and Practice (GHSP)
Vol. 7, No. 1 March 22, 2019
http://www.ghspjournal.org/content/current
EDITORIALS
Scale and Ambition in the Engagement of Private Providers for Tuberculosis Care and Prevention
William A. Wells
Global Health: Science and Practice March 2019, 7(1):3-5; https://doi.org/10.9745/GHSP-D-19-00074
The tuberculosis (TB) community knows the importance of engaging private providers to reach critical TB targets, and knows how to engage successfully. The next challenge is to transition such efforts to government stewardship and financing in order to reach scale.
Globalization and Health
http://www.globalizationandhealth.com/
Review
A narrative review of health research capacity strengthening in low and middle-income countries: lessons for conflict-affected areas
Authors: Gemma Bowsher, Andreas Papamichail, Nassim El Achi, Abdulkarim Ekzayez, Bayard Roberts, Richard Sullivan and Preeti Patel
Citation: Globalization and Health 2019 15:23
Published on: 26 March 2019
Abstract
Conducting health research in conflict-affected areas and other complex environments is difficult, yet vital. However, the capacity to undertake such research is often limited and with little translation into practice, particularly in poorer countries. There is therefore a need to strengthen health research capacity in conflict-affected countries and regions.
In this narrative review, we draw together evidence from low and middle-income countries to highlight challenges to research capacity strengthening in conflict, as well as examples of good practice. We find that authorship trends in health research indicate global imbalances in research capacity, with implications for the type and priorities of research produced, equity within epistemic communities and the development of sustainable research capacity in low and middle-income countries. Yet, there is little evidence on what constitutes effective health research capacity strengthening in conflict-affected areas. There is more evidence on health research capacity strengthening in general, from which several key enablers emerge: adequate and sustained financing; effective stewardship and equitable research partnerships; mentorship of researchers of all levels; and effective linkages of research to policy and practice.
Strengthening health research capacity in conflict-affected areas needs to occur at multiple levels to ensure sustainability and equity. Capacity strengthening interventions need to take into consideration the dynamics of conflict, power dynamics within research collaborations, the potential impact of technology, and the wider political environment in which they take place.
Health Economics, Policy and Law
Volume 14 – Special Issue 2 – April 2019
https://www.cambridge.org/core/journals/health-economics-policy-and-law/latest-issue
SPECIAL ISSUE: Frontiers of Health Policy Research
If the enhancement of human freedom is both the main object and the primary means to development (Sen, 1999), then good individual and population health are both ends and means to development and freedom in all countries, regardless of their current ranking on the Human Development Index or other indexes on wealth, prosperity and well-being…
This special issue on the ‘frontiers in health policy research’ focuses attention on three distinct areas of inquiry. One set of papers analyses efforts to improve the quality of care and increase the value of care that health systems purchase. A second set of articles focuses on issues of health behaviour and social determinants of health. Finally, the third set of articles presents differing views on how to predict the adequacy of supply of medical professionals. The range of these articles illustrates, not only the exciting breadth of health policy research, but the degree to which scholars within this field are addressing issues of high importance to policy makers around the world. We think it is fair to claim that all of the articles address issues that are on the ‘frontier’ of health policy in the sense that they attempt to provide answers to questions that policy makers around the world are currently grappling with…
Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 30 Mar 2019]
Commentary
Studying social accountability in the context of health system strengthening: innovations and considerations for future work
There is a growing body of research on the role of social accountability in bringing about more accessible and better-quality healthcare. Here, we refer to social accountability as “citizens’ efforts at ongoing meaningful collective engagement with public institutions for accountability in the provision of public goods” (Joshi, World Dev 99:160–172, 2017). These processes have multiple interrelated components and sub-processes and engage a range of actors in community-driven, often unpredictable and context-dependent actions, which pose many methodological challenges for researchers. In June 2017, scientists and implementers working in this area came together to share experiences, discuss approaches, identify research gaps and consider directions for future studies. This paper shares learnings from this discussion.
Authors: Victoria Boydell, Heather McMullen, Joanna Cordero, Petrus Steyn and James Kiare
Citation: Health Research Policy and Systems 2019 17:34
Published on: 29 March 2019
JAMA
March 26, 2019, Vol 321, No. 12, Pages 1135-1228
http://jama.jamanetwork.com/issue.aspx
Viewpoint
HIV in the United States – Getting to Zero Transmissions by 2030
Ingrid Katz, MD, MHS; Ashish K. Jha, MD, MPH
free access
JAMA. 2019;321(12):1153-1154. doi:10.1001/jama.2019.1817
This Viewpoint discusses 3 challenges that need to be overcome to meet the new US goal of reducing HIV transmissions to zero by 2030: prevention in high-risk communities, reducing infected individuals’ viral loads to undetectable levels, and addressing socioeconomic, racial, and geographic HIV-associated disparities.
JAMA
March 26, 2019, Vol 321, No. 12, Pages 1135-1228
http://jama.jamanetwork.com/issue.aspx
Editorial
Ending the HIV Epidemic – A Plan for the United States
Anthony S. Fauci, MD; Robert R. Redfield, MD; George Sigounas, MS, PhD; Michael D. Weahkee, MHA, MBA; Brett P. Giroir, MD
JAMA
March 26, 2019, Vol 321, No. 12, Pages 1135-1228
http://jama.jamanetwork.com/issue.aspx
Viewpoint
The True Cost of Measles Outbreaks During the Postelimination Era
Maria E. Sundaram, MSPH, PHD; L. Beryl Guterman, MSPH; Saad B. Omer, MBBS, MPH, PhD
free access
JAMA. 2019;321(12):1155-1156. doi:10.1001/jama.2019.1506
This Viewpoint reviews measles outbreaks in the United States since the year 2000 attributable to vaccine hesitancy, refusal, and exemption, and specifies the costs to individuals, society, and health systems as a result.
Journal of Medical Ethics
April 2019 – Volume 45 – 4
http://jme.bmj.com/content/current
Original research
Does One Health require a novel ethical framework?
(16 February, 2019) Free
Jane Johnson, Chris Degeling
Abstract
Emerging infectious diseases (EIDs) remain a significant and dynamic threat to the health of individuals and the well-being of communities across the globe. Over the last decade, in response to these threats, increasing scientific consensus has mobilised in support of a One Health (OH) approach so that OH is now widely regarded as the most effective way of addressing EID outbreaks and risks. Given the scientific focus on OH, there is growing interest in the philosophical and ethical dimensions of this approach, and a nascent OH literature is developing in the humanities. One of the key issues raised in this literature concerns ethical frameworks and whether OH merits the development of its very own ethical framework. In this paper, we argue that although the OH approach does not demand a new ethical framework (and that advocates of OH can coherently adhere to this approach while deploying existing ethical frameworks), an OH approach does furnish the theoretical resources to support a novel ethical framework, and there are benefits to developing one that may be lost in its absence. We begin by briefly explaining what an OH approach to the threats posed by EIDs entails before outlining two different ways of construing ethical frameworks. We then show that although on one account of ethical frameworks there is no need for OH to generate its own, there may be advantages for its advocates in doing so.
Journal of Medical Internet Research
Vol 21, No 3 (2019): March
https://www.jmir.org/2019/3
JMIR Public Health Surveill 2019 (Mar 27); 5(1):e12480
Characterizing Trends in Human Papillomavirus Vaccine Discourse on Reddit (2007-2015): An Observational Study
Yuki Lama, Dian Hu, Amelia Jamison, Sandra Crouse Quinn, David A. Broniatowski
Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 8, Issue 1, March 2019
https://academic.oup.com/jpids/issue
PIDS ANNUAL AWARDS
Vaccine Hesitancy, History, and Human Nature: The 2018 Stanley A. Plotkin Lecture
Gary S Marshall
Journal of the Pediatric Infectious Diseases Society, Volume 8, Issue 1, March 2019, Pages 1–8, https://doi.org/10.1093/jpids/piy082
Navigating the waters of vaccine hesitancy requires a view towards history and a deep understanding of how humans think. Getting children vaccinated is as much, or more, about connecting with people as it is about communicating scientific information.
Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 8, Issue 1, March 2019
https://academic.oup.com/jpids/issue
INVITED REVIEW
Advancing Pediatric Antibacterial Drug Development: A Critical Need to Reinvent our Approach
Gary J Noel; Sumathi Nambiar; John Bradley
Journal of the Pediatric Infectious Diseases Society, Volume 8, Issue 1, March 2019, Pages 60– 62
Abstract
The Clinical Trials Transformation Initiative convened with several groups in the pediatric antibacterial drug development community with the goal of identifying challenges and recommending ways to improve current practice. Attention to 5 major areas hold the promise of making new antibiotics available for use in children as soon as possible after they are approved for use in adults.
The Lancet
Mar 30, 2019 Volume 393Number 10178p1261-1384
https://www.thelancet.com/journals/lancet/issue/current
Articles
Scaling up prevention and treatment towards the elimination of hepatitis C: a global mathematical model
The revolution in hepatitis C virus (HCV) treatment through the development of direct-acting antivirals (DAAs) has generated international interest in the global elimination of the disease as a public health threat. In 2017, this led WHO to establish elimination targets for 2030. We evaluated the impact of public health interventions on the global HCV epidemic and investigated whether WHO’s elimination targets could be met.
Alastair Heffernan, Graham S Cooke, Shevanthi Nayagam, Mark Thursz, Timothy B Hallett
Open Access
The Lancet
Mar 30, 2019 Volume 393Number 10178p1261-1384
https://www.thelancet.com/journals/lancet/issue/current
The Lancet Commissions
Building a tuberculosis-free world: The Lancet Commission on tuberculosis
Michael J A Reid, et al
Tuberculosis can be treated, prevented, and cured. Rapid, sustained declines in tuberculosis deaths in many countries during the past 50 years provide compelling evidence that ending the pandemic is feasible. Yet this disease—which has plagued humanity since before recorded history and has killed hundreds of millions of people over the past two centuries—remains a relentless scourge. In 2017, 1·6 million people died from tuberculosis, including 300 000 people with HIV, representing more deaths than any other infectious disease. Moreover, in many parts of the world, drug-resistant forms of tuberculosis threaten struggling control efforts. The world can no longer ignore the enormous pall cast by the tuberculosis epidemic. Going forward, the global tuberculosis response must be an inclusive, comprehensive response within the broader sustainable development agenda. No one-size-fits-all approach can succeed.
Lancet Global Health
Apr 2019 Volume 7Number 4e385-e532
http://www.thelancet.com/journals/langlo/issue/current
Editorial
Access to medicines—business as usual?
The Lancet Global Health
High medicine prices are never far from the headlines, affecting access for everyone from those living in the world’s most advanced economies to those in the least developed. The pharmaceutical industry, projected to be worth almost $1·6 trillion by 2020, is widely vilified for its role in this. Pharmaceutical companies are notoriously opaque in disclosing the exact costs involved in bringing a new medicine to the market. Industry-sponsored research suggests that the overall cost is around $2·6 billion.
Pressure is mounting on the industry. In February, seven global pharmaceutical company executives appeared before a Senate Finance Committee to answer questions on the high cost of prescription medicines in the United States. In 2016, the UN Secretary General’s High-Level Panel on Access to Medicines called on the sector to report on its actions to improve access and establish “direct board-level responsibility and accountability on improving access”. So, how has the industry responded?
The latest Access to Medicine Index, published last November, found that while all 20 pharmaceutical companies assessed have some form of access initiative in place, a small group of companies account for the most activity. The Index also identified company best practices, for example, programmes offering discounted prices or donating products. These initiatives are a step in the right direction but their actual impact on access is unclear.
In this month’s issue, Peter Rockers and colleagues report on the impact of one such initiative—Novartis Access, a new programme providing a portfolio of medicines for non-communicable diseases (NCDs) including cardiovascular diseases, type 2 diabetes, respiratory illnesses and breast cancer, at a wholesale price of $1 per treatment per month. Using a cluster-randomised controlled trial (RCT), the authors evaluated the effect of Novartis Access on the availability and price of NCD medicines in health facilities and homes in the first programme country, Kenya. After 15 months the authors found that the programme significantly increased the availability of amlodipine and metformin at health facilities but had no effect on the availability or price of the portfolio overall. They also found no impact on availability of the medicines at the household level.
Reducing the price of NCD medicines as part of an industry-led initiative did not translate into a change in access in Kenya, at least not during the first year. There are several possible reasons for this lack of uptake, including limited awareness of the programme, timing of regulatory approval and import, the medicines offered might not be the most sought-after treatments for NCDs, and the choice of distributor may have inadvertently excluded those who prefer to purchase their medicines from the private sector.
In an accompanying commentary, Imran Manji and Sonak Pastakia discuss how a wholesale price of $1 per treatment per month might not actually represent a discount, for example, hydrochlorothiazide, an alternative to amlodipine, typically costs less than $0·30 per month and might be preferred by both patients and providers. They note that “deriving impact from enhancing availability of medications is much more complicated than just having the products on shelves” and point to the need for collaboration with all levels of the health system. The World Health Organization (WHO) has addressed the multidimensional nature of improving access and the importance of a health systems approach in its draft Roadmap for Access 2019–2023, which outlines ten priority areas, including fair pricing, management of intellectual property, and procurement and supply chain management.
The findings might not be positive, but Rockers’ study is an important and overdue addition to the literature on industry-led efforts to improve access to medicines—an area that has been understudied so far. By scrutinising their access programme in an RCT, subjecting it to the rigours of peer review and publishing in an open-access journal, Novartis is setting the standard for how the industry should transparently report on its social programmes.
For now, it’s business as usual, but the debate over pricing and access is not showing any signs of abating. Last week, Italy’s Minister for Health, Giulia Grillo, proposed a draft resolution that aims to provide WHO “with an authoritative mandate to strengthen WHOs technical work on the transparency of the costs of research and development, and the transparency of prices.” We look forward to discussions of this proposal and further developments at the 72nd session of the World Health Assembly in May.
Lancet Global Health
Apr 2019 Volume 7Number 4e385-e532
http://www.thelancet.com/journals/langlo/issue/current
Articles
Effect of Novartis Access on availability and price of non-communicable disease medicines in Kenya: a cluster-randomised controlled trial
Peter C Rockers, Richard O Laing, Paul G Ashigbie, Monica A Onyango, Carol K Mukiira, Veronika J Wirtz
Summary
Background
Novartis Access is a Novartis programme that offers a portfolio of non-communicable disease medicines at a wholesale price of US$1 per treatment per month in low-income and middle-income countries. We evaluated the effect of Novartis Access in Kenya, the first country to receive the programme.
Methods
We did a cluster-randomised controlled trial in eight counties in Kenya. Counties (clusters) were randomly assigned to the intervention or the control group with a covariate-constrained randomisation procedure that maximised balance on a set of demographic and health variables. In intervention counties, public and non-profit health facilities were allowed to purchase Novartis Access medicines from the Mission for Essential Drugs and Supplies (MEDS). Data were collected from all facilities served by MEDS and a sample of households in study counties. Households were eligible if they had at least one adult patient who had been diagnosed and prescribed medicines for one of the non-communicable diseases targeted by the programme: hypertension, heart failure, dyslipidaemia, type 2 diabetes, asthma, or breast cancer. Primary outcomes were availability and price of portfolio medicines at health facilities, irrespective of brand; and availability of medicines at patient households. Impacts were estimated with intention-to-treat analysis. This trial is registered with ClinicalTrials.gov (NCT02773095).
Findings
On March 8, 2016, we randomly assigned eight clusters to intervention (four clusters; 74 health facilities; 342 patients) or control (four clusters; 63 health facilities; 297 patients). 69 intervention and 58 control health facilities, and 306 intervention and 265 control patients were evaluated after a 15 month intervention period (last visit February 28, 2018). Novartis Access significantly increased the availability of amlodipine (adjusted odds ratio [aOR] 2·84, 95% CI 1·10 to 7·37; p=0·031) and metformin (aOR 4·78, 95% CI 1·44 to 15·86; p=0·011) at health facilities, but did not affect the availability of portfolio medicines overall (adjusted β [aβ] 0·05, 95% CI −0·01 to 0·10; p=0·096) or their price (aβ 0·48, 95% CI −1·12 to 0·72; p=0·500). The programme did not affect medicine availability at patient households (aOR 0·83, 95% CI 0·44 to 1·57; p=0·569).
Interpretation
Novartis Access had little effect in its first year in Kenya. Access programmes operate within complex health systems and reducing the wholesale price of medicines might not always or immediately translate to improved patient access. The evidence generated by this study will inform Novartis’s efforts to improve their programme going forward. The study also contributes to the public evidence base on strategies for improving access to medicines globally.
Funding
Sandoz International (a subsidiary of Novartis International).
Research in context
Evidence before this study
In 2016, we conducted a systematic review to identify published evaluations of pharmaceutical industry-led access programmes in low-income and middle-income countries and to assess the quality of the available evidence on the effect of these programmes. First, we developed a list of industry-led access programmes by reviewing the Health Partnerships Directory of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). Information from the directory was supplemented with information from reports published by the Access to Medicine Index and annual and corporate social responsibility reports for non-IFPMA companies. On May 1, 2016, we searched PubMed, Google Web, and Google Scholar for published evaluations of identified access programmes, using as search terms the name of the programme, the name of the company, the focus disease, and the focus countries. We did not set restrictions on the publication date of evaluations. We identified 120 access programmes that fit our criteria, seven of which had at least one published evaluation. We reviewed all of the published evaluations and assessed their quality using the GRADE system. None of the evaluations were rated as high quality and three were rated as moderate quality. We found no previous evaluations that used a randomised controlled trial design. None of the published evaluations provided clear evidence on the effect of a price reduction programme similar to Novartis Access.
Added value of this study
To our knowledge, this study is the first randomised controlled trial assessing the effect of a pharmaceutical industry-led access to medicines programme. We found that Novartis Access, a programme offering a portfolio of non-communicable disease medicines at a wholesale price of US$1 per treatment per month in Kenya, had little effect during its first year on the availability of medicines at facilities. Although the programme significantly increased the availability of amlodipine and metformin at health facilities, there was no effect on medicine prices or on availability at patient households. The study contributes to the public evidence base on strategies for improving access to non-communicable diseases medicines in low-income and middle-income countries. The study also contributes to ongoing discussions on the role of measurement and transparency in establishing accountability for private sector social programmes.
Implications of all the available evidence
Novartis Access is one of a growing number of pharmaceutical industry-led access programmes. Few of these programmes have been rigorously evaluated, and little is known about their effect or which strategies work best to improve access. This study suggests that offering a portfolio of medicines at a reduced price might not lead to immediate improvements in patient access. In order to build a more robust evidence base on this important topic and ensure accountability, rigorous measurement and transparent reporting should be adopted as a standard for pharmaceutical industry efforts to improve access to medicines globally. This study demonstrates that pharmaceutical companies can use robust, high-quality methods to evaluate their access programmes.
Lancet Global Health
Apr 2019 Volume 7Number 4e385-e532
http://www.thelancet.com/journals/langlo/issue/current
Comment
The ethical imperative to treat NCDs during research in Africa
Majaliwa Mzombwe, Bernard Desderius, Saidi Kapiga, Luke Smart, Robert Peck
Lancet Global Health
Apr 2019 Volume 7Number 4e385-e532
http://www.thelancet.com/journals/langlo/issue/current
Articles
Estimates of case-fatality ratios of measles in low-income and middle-income countries: a systematic review and modelling analysis
Allison Portnoy, Mark Jit, Matthew Ferrari, Matthew Hanson, Logan Brenzel, Stéphane Verguet
Lancet Infectious Diseases
Apr 2019 Volume 19Number 4p339-448, e109-e147
http://www.thelancet.com/journals/laninf/issue/current
Editorial
Trust issues
The Lancet Infectious Diseases
In November, 2017, we published an Editorial on measles vaccination, calling for strong interventions to curb preventable diseases. 18 months later, how have things changed? As reported in a news story in this issue, 229,000 cases of measles were reported in 2018, and 98 countries reported an increase in cases compared with 2017. Measles is a global health crisis and it is getting worse. Although the reasons vary by country, mistrust and misplaced reluctance to vaccinate, largely related to unfounded fears over safety, are important contributing factors from the Philippines to France, from Ukraine to the USA. WHO has named vaccine hesitancy as one of the top ten threats to global health in 2019.
Lack of trust is also central to another of the world’s major health emergencies: the Ebola virus disease outbreak in DR Congo. The epidemic is focused in the northeast of the country, where conflict, political tensions, and social grievances have instilled fear and suspicion in much of the local population. 40% of new cases so far this year have been in people who died in the community (ie, they hadn’t been to a treatment centre), and a large proportion of cases, particularly in Katwa and Butembo, cannot be linked to any other patients, suggesting that unknown chains of transmission exist. If patients are wary of seeking proper care, and if contact tracing cannot be done, the outbreak will not be stopped.
Mistrust has also manifested with more direct and violent consequences in DR Congo. Médecins Sans Frontières (MSF) has reported dozens of attacks on its workers in the region. In February, two treatment centres were attacked and burned down, forcing MSF to suspend its activities in Katwa and Butembo. Joanne Liu, the president of MSF, has been quoted as describing the atmosphere towards the response as “toxic”.
The importance of community engagement to build trust was well recognised in the aftermath of the west Africa Ebola epidemic, but the difficulties of the DR Congo outbreak have led to the use of coercion against patients and their contacts, and a reliance on police and UN peacekeepers for security has further alienated the local population. MSF has criticised the use of coercion in DR Congo, and in an interview with STAT, Liu has said that “using police to force people into complying with health measures is not only unethical, it’s totally counterproductive“. WHO is taking a different tack: on March 9, it announced that it had sought further support from UN and local police forces to protect treatment centres, despite recognising the importance of “maintaining the neutrality of the response”.
As for trust in measles vaccination, a Danish study of more than 650,000 children once again confirms that measles, mumps, and rubella (MMR) vaccination is not associated with autism. But while the findings are welcome, the paper will not change the beliefs of anti-vaccination advocates. The safety of MMR was already well established before this study—a shortage of reliable scientific evidence is not the problem. And in countries such as the USA, the dangers of not vaccinating have been shown repeatedly, most recently in an outbreak of measles among mainly unvaccinated children in Washington and Oregon, as reported in our March issue. Rather, it is the abundance of misinformation and distrust of authority that must be addressed. Social media companies such as YouTube and Facebook have made changes to begin to stem the tide of misleading claims, but the impact of these initiatives remains to be seen.
An anti-vaxxer in California, USA, for example, is vastly different from someone potentially exposed to Ebola in rural DR Congo. Yet there are similarities in their mistrust. A belief that vaccines cause autism or that Ebola is a government ploy likely has as much to do with wider grievances and distrust of authority as with the specifics of the scientific evidence and education. Part of the problem is that a lack of faith in government, the health-care system, and pharmaceutical companies is not always irrational. In DR Congo, the postponement of elections in the regions affected by Ebola has been considered to be motivated more by politics than by public health (the region is a stronghold for opposition to the ruling party). The poverty and conflict in the region have long been neglected. In the USA, the country is plagued by prescription opioid misuse fuelled by aggressive pharmaceutical marketing, the people of Flint, MI, have been without safe drinking water for 3 years, and the most basic drugs are often unaffordable because of profit-driven health care. Little wonder that some individuals question the authorities’ desire to prioritise their wellbeing. It is impossible to build trust while at the same time abusing it.
Lancet Infectious Diseases
Apr 2019 Volume 19Number 4p339-448, e109-e147
http://www.thelancet.com/journals/laninf/issue/current
Articles
The global burden of typhoid and paratyphoid fevers: a systematic analysis for the Global Burden of Disease Study 2017
GBD 2017 Typhoid and Paratyphoid Collaborators
Lancet Infectious Diseases
Apr 2019 Volume 19Number 4p339-448, e109-e147
http://www.thelancet.com/journals/laninf/issue/current
Articles
Maternal pertussis vaccination and its effects on the immune response of infants aged up to 12 months in the Netherlands: an open-label, parallel, randomised controlled trial
Daan Barug, Inge Pronk, arlies A van Houten, Florens G A Versteegh, Mirjam J Knol, Jan van de Kassteele, Guy A M Berbers, Elisabeth A M Sanders, Nynke Y Rots
Lancet Infectious Diseases
Apr 2019 Volume 19Number 4p339-448, e109-e147
http://www.thelancet.com/journals/laninf/issue/current
Lancet Infectious Diseases
Apr 2019 Volume 19Number 4p339-448, e109-e147
http://www.thelancet.com/journals/laninf/issue/current
Review
The efficacy, effectiveness, and immunogenicity of influenza vaccines in Africa: a systematic review
Benjamin B Lindsey, Edwin P Armitage, Beate Kampmann, Thushan I de Silva
Lancet Infectious Diseases
Apr 2019 Volume 19Number 4p339-448, e109-e147
http://www.thelancet.com/journals/laninf/issue/current
Review
Maternal immunisation to improve the health of HIV-exposed infants
Angela M Bengtson, Alan M Sanfilippo, Brenna L Hughes, David A Savitz
Nature
Volume 567 Issue 7749, 28 March 2019
http://www.nature.com/nature/current_issue.html
Editorial | 22 March 2019
Building trust is essential to combat the Ebola outbreak
Researchers can do more to contain the escalating public-health crisis in the Democratic Republic of the Congo.
Nature Genetics
Volume 51 Issue 4, April 2019
https://www.nature.com/ng/volumes/51/issues/4
Editorial | 29 March 2019
Genetics for all
Genetic resources and analyses overwhelmingly center on individuals of European ancestry. We encourage the community to embrace a global approach to genetic and genomic studies to address imbalances in the composition of cohorts and the subsequent translatability of findings.
Nature Genetics
Volume 51 Issue 4, April 2019
https://www.nature.com/ng/volumes/51/issues/4
Perspective | 29 March 2019
Clinical use of current polygenic risk scores may exacerbate health disparities
This Perspective discusses scientific and ethical considerations regarding the clinical use of polygenic risk scores, highlighting the pressing need to diversify cohorts for genetic studies beyond European-ancestry populations.
Alicia R. Martin, Masahiro Kanai […] & Mark J. Daly
Nature Reviews Immunology
Volume 19 Issue 4, April 2019
https://www.nature.com/nri/volumes/19/issues/4
Review Article | 24 January 2019
Adaptive immune responses to primary and secondary dengue virus infections
The existence of four different serotypes of dengue virus poses a challenge to vaccine development, as pre-existing immunity can lead to severe disease during infection with a heterologous serotype. This Review analyses the mechanisms of protective and pathological adaptive immune responses in primary and secondary dengue infection.
Ashley L. St. John & Abhay P. S. Rathore
Abstract
Dengue is the leading mosquito-borne viral illness infecting humans. Owing to the circulation of multiple serotypes, global expansion of the disease and recent gains in vaccination coverage, pre-existing immunity to dengue virus is abundant in the human population, and secondary dengue infections are common. Here, we contrast the mechanisms initiating and sustaining adaptive immune responses during primary infection with the immune pathways that are pre-existing and reactivated during secondary dengue. We also discuss new developments in our understanding of the contributions of CD4+ T cells, CD8+ T cells and antibodies to immunity and memory recall. Memory recall may lead to protective or pathological outcomes, and understanding of these processes will be key to developing or refining dengue vaccines to be safe and effective.
New England Journal of Medicine
March 28, 2019 Vol. 380 No. 13
http://www.nejm.org/toc/nejm/medical-journal
Perspective
Social Media in the Age of the “New Polio”
Riley Bove, M.D.
When her son developed acute flaccid myelitis, a neurologist turned to a parent support group on Facebook, where she found recommended rehabilitation experts, information on electrical stimulation devices, templates for letters to insurers, and other key information.
PLoS Medicine
http://www.plosmedicine.org/
(Accessed 30 Mar 2019)
Policy Forum
A whole-health–economy approach to antimicrobial stewardship: Analysis of current models and future direction
Monsey McLeod, Raheelah Ahmad, Nada Atef Shebl, Christianne Micallef, Fiona Sim, Alison Holmes
| published 29 Mar 2019 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002774
Summary points
:: Antimicrobial stewardship (AMS) strategies are widely implemented in single healthcare sectors and organisations; however, the extent and impact of integrated AMS initiatives across the whole health economy are unknown.
:: Assessing degree of integration of AMS across the whole health economy and its impact is essential if we are to achieve a ‘One Health’ approach to addressing antimicrobial resistance (AMR), and therefore we searched systematically for and analysed published examples of integrated AMS initiatives to address this gap.
:: Application of a system-level framework to analyse integration of AMS initiatives across and within healthcare sectors shows that integration is emerging but needs strengthening.
:: Findings from a small number of evaluations in high-income countries suggest that antimicrobial prescribing and healthcare-associated infections can be reduced using a multisectoral integrated AMS approach.
:: More robust research designs to evaluate and understand the impact of multisectoral integrated AMS are needed, particularly with respect to differing health systems in different countries and local organisational contexts.
:: Our analysis highlights a number of challenges and ways forward for enhancing the delivery of AMS through an integrated approach.
PLoS Medicine
http://www.plosmedicine.org/
(Accessed 30 Mar 2019)
Editorial
Measles vaccination: A matter of confidence and commitment
Richard Turner, on behalf of the PLOS Medicine Editors
| published 26 Mar 2019 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002770
Prominent among the anxieties of our times are those regarding health and disease. Not only are ageing populations expected to suffer an increased burden of noncommunicable diseases in the future, but risks of and harms from existing and emerging infectious diseases could also increase, owing to population growth, migration, climate change, and other factors. At the population level, it is clear that the hard-won gains in medicine and public health brought about by vaccination, antimicrobial and other treatments, and improved sanitation will need to be sustained, broadened, and intensified to protect and provide for an increasing proportion of the human population. Global aspirations, including those set out in the Sustainable Development Goals, are unambiguous in setting out an anticipated future trajectory of improved health, well-being, and prosperity.
Measles, a highly contagious viral infection, is in various respects the perfect example of a threat to health that respects neither aspirations nor boundaries between developed and developing countries. Complications of measles infection include pneumonia (the most common cause of death in children with measles), encephalitis, ear infections that can lead to permanent deafness, and diarrhoea. Although a safe and very effective two-dose vaccination schedule has been available and widely deployed since the 1960s, the need for very high and consistent vaccination coverage to elicit herd immunity means that the disease burden and harms of measles remain substantial. WHO reports that globally, in an apparent uptrend of cases occurring in 2017, measles led to an estimated 110,000 deaths, most in children aged under 5 years [1]. Tragically, these deaths were unavoidable, given the estimated 20.8 million children in low- and middle-income countries who had not received a single dose of measles vaccine through routine programmes in that year.
In the 53 high- and middle-income countries that make up its European region, WHO has indicated that around 82,500 cases of measles were reported in 2018, an alarmingly high number even among a population in excess of 900 million people, and a greater than 3-fold increase since 2017 [2]. There were 72 reported deaths in children and adults. Here, the European Vaccine Action Plan 2015–2020 recognizes the need for high and consistent levels of vaccine coverage yet acknowledges the difficulties in meeting the challenges of achieving high and equitable coverage, owing to the existing pronounced variations in national and regional coverage with measles vaccination.
In the United States, despite the declared elimination of measles in 2000, outbreaks have been well documented in recent years—the outbreak in Southern California during December 2014–February 2015 involved at least 125 cases [3]. Among these cases, a substantial proportion were in people known not to have been vaccinated, including infants who were too young to have been protected and individuals who had chosen not to receive measles vaccination (i.e., 49 people were unvaccinated among the 110 cases identified in California). More recently, an outbreak in Clark County, Washington State has been widely reported in the past few weeks, and at the time of writing there had been 65 confirmed measles cases in this area [4]. In 2018, writing in PLOS Medicine, Jacqueline Olive and colleagues highlighted clusters of people claiming nonmedical exemptions from measles vaccination in states where this is permitted by law [5]. The authors noted that ‘new foci of antivaccine activities are being established in major metropolitan areas, rendering select cities vulnerable for vaccination-preventable diseases.’ It is difficult to imagine a future scenario without repeated and serious measles outbreaks in the US and elsewhere, given the gaps in protection against the disease. A cautionary indication of the extent to which the dangers of so-called ‘vaccine hesitancy’ can escalate is in the Philippines, where there are reported to have been thousands of measles cases and at least 189 deaths since the beginning of 2019, mainly in children [6].
The reasons for people not accepting vaccination against measles and other potentially fatal and readily preventable infections are, unfortunately, all too well known. Fears about potential harms of the combined measles, mumps, and rubella vaccination were raised by a discredited study published in The Lancet in 1998 and are continuing to circulate. As Peter Hotez, Dean of the National School of Tropical Medicine at Baylor College of Medicine, Houston, Texas, commented to PLOS Medicine, ‘the “anti-Vax” movement began as a fringe group but has now become a media empire in its own right, producing hundreds of websites, books, and videos. Even if a concerted effort were mounted against this movement, it could take years to be effective.’ Despite the volumes of scientific research and debate published in the intervening 20 years, supporting beyond reasonable doubt the overwhelmingly favourable benefit:risk assessment for vaccination against measles and other infectious diseases, levels of scepticism clearly persist and are being propagated in susceptible populations worldwide. It seems that the growth of social media has facilitated the development of geographically widespread communities with fixed yet indefensible opinions, where hearsay is spread intensively while robust medical evidence and guidance hold little sway.
It would probably be unwise to expect a single approach or constituency to be able to change minds opposed to vaccination. In the case of measles, high-quality surveillance activities alongside well-supported and planned vaccination programmes are essential to bring about progressive reductions in the high burden of morbidity and deaths in developing countries. In settings where limited public acceptance of measles vaccination is a danger, imaginative governmental and, where viable, civil society- or NGO-led information campaigns are needed to drive uptake of vaccination, alongside the essential underpinnings of culturally appropriate incentives and legal provisions. Healthcare professionals, who in many countries are generally trusted and enjoy a high level of confidence from the public, are likely to be an underused resource in conveying accurate information and advice on vaccines and vaccination through formal and informal routes. Ultimately, the question is one of altruism: everyone who has experienced the silent but long-lasting protection afforded by vaccination has the responsibility to promote understanding and acceptance of the benefits to others. Our neighbours and, most of all, their children, deserve nothing less.
[references at title link above]
PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 30 Mar 2019)
Research Article
Global expansion and redistribution of Aedes-borne virus transmission risk with climate change
Sadie J. Ryan, Colin J. Carlson, Erin A. Mordecai, Leah R. Johnson
| published 28 Mar 2019 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0007213
Author summary
The established scientific consensus indicates that climate change will severely exacerbate the risk and burden of Aedes-transmitted viruses, including dengue, chikungunya, Zika, and other significant threats to global health security. Here, we show more subtle impacts of climate change on transmission, caused primarily by differences between the more heat-tolerant Aedes aegypti and the more heat-limited Ae. albopictus. Within the next century, nearly a billion people could face their first exposure to viral transmission from either mosquito in the worst-case scenario, mainly in Europe and high-elevation tropical and subtropical regions. However, while year-round transmission potential from Ae. aegypti is likely to expand (particularly in south Asia and sub-Saharan Africa), Ae. albopictus transmission potential is likely to decline substantially in the tropics, marking a global shift towards seasonal risk as the tropics eventually become too hot for transmission by Ae. albopictus. Complete mitigation of climate change to a pre-industrial baseline may protect almost a billion people from arbovirus range expansions; however, middle-of-the-road mitigation could produce the greatest expansion in the potential for viral transmission by Ae. albopictus. In any scenario, mitigating climate change would shift the projected burden of both dengue and chikungunya (and potentially other Aedes transmitted viruses) from higher-income regions back onto the tropics, where transmission might otherwise begin to decline due to rising temperatures.
PLoS One
http://www.plosone.org/
[Accessed 30 Mar 2019]
Research Article
A systematic review of interventions to improve uptake of pertussis vaccination in pregnancy
Hassen Mohammed, Mark McMillan, Claire T. Roberts, Helen S. Marshall
Research Article | published 28 Mar 2019 PLOS ONE
https://doi.org/10.1371/journal.pone.0214538
Abstract
Background
Maternal pertussis vaccination has been introduced in several countries to prevent pertussis morbidity and mortality in infants too young to be vaccinated. Our review aimed to systematically collect and summarize the available evidence on the effectiveness of interventions used to improve pertussis vaccination uptake in pregnant women.
Methods
We conducted a systematic search of MEDLINE/PubMed, PMC and CINAHL. Before and after studies and those with a concurrent control group were considered for inclusion. Standardized effect sizes were described as the ratio of the odds to be vaccinated in the intervention group compared with the standard care group and absolute benefit increase (ABI) were calculated.
Results
Six studies were included in the review, of which three were randomized controlled trials (RCTs). Strategies to improve uptake were focused on healthcare providers, pregnant women, or enhancing vaccine access. Healthcare provider interventions included provider reminder, education, feedback and standing orders. Interventions directed at pregnant women focused solely on education. Observational studies showed: (1) the provision of maternal pertussis vaccination by midwives at the place of antenatal care has improved uptake of pertussis vaccine during pregnancy from 20% to 90%; (2) introduction of an automated reminder within the electronic medical record was associated with an improvement in the pertussis immunization rate from 48% to 97%; (3) an increase in prenatal pertussis vaccine uptake from 36% to 61% after strategies to increase provider awareness of recommendations were introduced. In contrast to these findings, interventions in all three RCTs (2 involved education of pregnant women, 1 had multi-component interventions) did not demonstrate improved vaccination uptake.
Conclusions
Based on the existing research, we recommend incorporating midwife delivered maternal immunization programs at antenatal clinics, use of a provider reminder system to target unvaccinated pregnant women and include maternal pertussis immunization as part of standard antenatal care.
Vaccine
Volume 37, Issue 15 Pages 2043-2166 (3 April 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/15
Research article Abstract only
“We are Muslims and these diseases don’t happen to us”: A qualitative study of the views of young Somali men and women concerning HPV immunization
Minnesota is home to the largest Somali immigrant population in the United States. Despite high rates of cervical cancer in this population, immunization rates for the human papillomavirus (HPV) are among the lowest in the nation. Targeting Somali young adults for catch-up vaccinations may be an important strategy for addressing these low rates. This study sought to understand the views of Somali young adults regarding HPV immunization.
Rebekah Pratt, Sharon W. Njau, Channelle Ndagire, Nicole Chaisson, … Jay Dirks
Pages 2043-2050
Vaccine
Volume 37, Issue 15 Pages 2043-2166 (3 April 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/15
Research article Abstract only
Assessing optimal use of the standard dose adjuvanted trivalent seasonal influenza vaccine in the elderly
Dominic Thorrington, Edwin van Leeuwen, Mary Ramsay, Richard Pebody, Marc Baguelin
Pages 2051-2056
Vaccine
Volume 37, Issue 15 Pages 2043-2166 (3 April 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/15
Research article Abstract only
Expressions of pro- and anti-vaccine sentiment on YouTube
Nikolaos Yiannakoulias, Catherine E. Slavik, Monika Chase
Pages 2057-2064
Vaccine
Volume 37, Issue 15 Pages 2043-2166 (3 April 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/15
Research article Open access
Simulated vaccine efficacy trials to estimate HIV incidence for actual vaccine clinical trials in key populations in Uganda
Andrew Abaasa, Stephen Nash, Yunia Mayanja, Matt Price, … Jim Todd
Pages 2065-2072
vaccines and global health :: ethics and policy 