Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 16 July 2016]

.
Commentary
Civil society: the catalyst for ensuring health in the age of sustainable development
Julia Smith, Kent Buse and Case Gordon
Published on: 16 July 2016
Abstract
Sustainable Development Goal Three is rightly ambitious, but achieving it will require doing global health differently. Among other things, progressive civil society organisations will need to be recognised and supported as vital partners in achieving the necessary transformations. We argue, using illustrative examples, that a robust civil society can fulfill eight essential global health functions. These include producing compelling moral arguments for action, building coalitions beyond the health sector, introducing novel policy alternatives, enhancing the legitimacy of global health initiatives and institutions, strengthening systems for health, enhancing accountability systems, mitigating the commercial determinants of health and ensuring rights-based approaches. Given that civil society activism has catalyzed tremendous progress in global health, there is a need to invest in and support it as a global public good to ensure that the 2030 Agenda for Sustainable Development can be realised.

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 16 July 2016]

.
Research Article
Optimal control analysis of Ebola disease with control strategies of quarantine and vaccination
Muhammad Dure Ahmad, Muhammad Usman, Adnan Khan and Mudassar Imran
Published on: 13 July 2016
Abstract
Background
The 2014 Ebola epidemic is the largest in history, affecting multiple countries in West Africa. Some isolated cases were also observed in other regions of the world.
Method
In this paper, we introduce a deterministic SEIR type model with additional hospitalization, quarantine and vaccination components in order to understand the disease dynamics. Optimal control strategies, both in the case of hospitalization (with and without quarantine) and vaccination are used to predict the possible future outcome in terms of resource utilization for disease control and the effectiveness of vaccination on sick populations. Further, with the help of uncertainty and sensitivity analysis we also have identified the most sensitive parameters which effectively contribute to change the disease dynamics. We have performed mathematical analysis with numerical simulations and optimal control strategies on Ebola virus models.
Results
We used dynamical system tools with numerical simulations and optimal control strategies on our Ebola virus models. The original model, which allowed transmission of Ebola virus via human contact, was extended to include imperfect vaccination and quarantine. After the qualitative analysis of all three forms of Ebola model, numerical techniques, using MATLAB as a platform, were formulated and analyzed in detail. Our simulation results support the claims made in the qualitative section.
Conclusion
Our model incorporates an important component of individuals with high risk level with exposure to disease, such as front line health care workers, family members of EVD patients and Individuals involved in burial of deceased EVD patients, rather than the general population in the affected areas. Our analysis suggests that in order for R 0 (i.e., the basic reproduction number) to be less than one, which is the basic requirement for the disease elimination, the transmission rate of isolated individuals should be less than one-fourth of that for non-isolated ones. Our analysis also predicts, we need high levels of medication and hospitalization at the beginning of an epidemic. Further, optimal control analysis of the model suggests the control strategies that may be adopted by public health authorities in order to reduce the impact of epidemics like Ebola.

JAMA
July 12, 2016, Vol 316, No. 2
http://jama.jamanetwork.com/issue.aspx

.
Viewpoint | July 12, 2016
An HIV Vaccine -Mapping Uncharted Territory FREE
Anthony S. Fauci, MD1
JAMA. 2016;316(2):143-144. doi:10.1001/jama.2016.7538.
Scaling up access to antiretroviral therapy and proven approaches to HIV prevention potentially could control the HIV/AIDS pandemic and reduce it to a low level of endemicity. However, a safe and effective HIV vaccine would help reach this goal more quickly and in a more sustained way.

The scientific quest for an HIV vaccine spans nearly 3 decades and has taken multiple pathways, including attempts to induce antibody responses, T-cell responses, or combinations of both. These efforts have included human efficacy trials of monomeric HIV envelope glycoproteins, vectors containing inserts of HIV genes expressing envelope and other viral proteins, and prime-boost regimens that combine both approaches.1

So far, the only HIV vaccine efficacy trial to show promise was the RV144 trial conducted in Thailand. For immunogens, this study used a canarypox vector expressing HIV genes as a prime, followed by 2 booster injections of a recombinant HIV envelope glycoprotein.2 The trial resulted in a very modest vaccine efficacy of 31%. Neither broadly neutralizing antibodies nor cytolytic CD8+ T-cell responses were associated with protection against infection. Rather, IgG antibodies against the V1V2 region of the HIV envelope protein were associated with reduced infection.3 Efforts are now under way to improve on the results of RV144 in a southern African population by using multiple boosts, modified vectors, and adjuvants.

In addition to the follow-up of RV144, major HIV vaccine efforts have been launched in another direction: inducing broadly neutralizing antibodies (bNAbs) that can neutralize a wide range of HIV variants and hence afford protection against the rapidly mutating virus.1

Neutralizing antibodies have long been considered the “gold standard” of protection for vaccines against viruses because of the consistent observation that essentially all viral infections induce neutralizing antibodies, typically within days of infection. If the patient survives the infection, neutralizing antibodies usually clear the virus and provide lifelong protection against subsequent exposure to the same virus. Thus, the proof of concept for the development of a vaccine for most viruses is already provided by natural infection, and vaccines that optimally mimic natural infection have been the norm.

Not so for an HIV vaccine. The antigens presented by HIV to the immune system in natural infection do not elicit an adequate immune response to clear a virus that integrates,4 as evidenced by the lack of documented immune-mediated clearance of the virus by any known HIV-infected individual. HIV elicits high levels of broadly neutralizing antibodies in only a fraction of patients, usually only after a period of 2 or more years.1 With HIV, proving it is even possible for a vaccine to induce such antibodies is being explored by vaccinologists who are working in previously uncharted territory.

In their pursuit of bNAbs against HIV, scientists have used technologies that never before had been required (or even considered) in developing vaccines for other pathogens.1 These include x-ray crystallography and more recently cryoelectron microscopy to determine the native conformation of HIV envelope; novel cellular cloning technologies to isolate the rare B cells that recognize HIV envelope epitopes; high-throughput deep sequencing of B-cell genes and the unprecedented interrogation of the B-cell lineage to identify unmutated, germline B cells that might bind to known HIV envelope epitopes; and approaches to “steering” the B-cell lineage to make bNAbs.

The leading candidate for an HIV vaccine immunogen that elicits bNAbs is the viral envelope glycoprotein in forms that present native envelope epitopes. The HIV envelope is inherently unstable; in natural infection it preferentially presents to the immune system epitopes that elicit antibodies that are not broadly neutralizing, and that would be inadequate in the context of a vaccine. Investigators have determined that non-neutralizing antibodies bind to structures displayed on the unstable envelope, whereas several bNAbs bind readily to structural elements expressed on an experimentally stabilized envelope trimer.

A reasonable assumption, then, would be that the stable HIV envelope trimer may serve as a component of an immunogen to engage the relevant HIV-specific B-cell repertoire and induce it to produce bNAbs. Using the structural biological tools of x-ray crystallography and most recently the elegant technique of cryoelectron microscopy, investigators have successfully identified the near-native structure of the envelope trimer and stabilized it by insertion of various mutations.5 However, that was only the first step. The next step is to engage (if possible) the unmutated, naive B cells that give rise to bNAbs. These B cells are rare, occurring as infrequently as 1 in 2.5 million cells.

A major challenge encountered by scientists is that certain HIV envelope epitopes to which naturally occurring bNAbs bind do not bind to any identifiable germline B cell. Another potential obstacle was observed in an animal model: vaccination with a stable envelope trimer induced autologous neutralizing antibodies but not bNAbs.6 Thus, the process of generating bNAbs did not achieve its intended goal.
Subsequent efforts have been intensively directed at overcoming the inability to get past autologous neutralizing antibodies and proceed to production of bNAbs, notably with a new strategy that has been called “B-cell lineage design.” This concept was exemplified by a fortuitous experiment of nature. In an acute HIV infection study with extremely close follow-up of study participants, a patient who became infected was studied from the very earliest point after acute HIV infection.7 Scientists closely monitored the evolution of the antibody response and how the virus mutated to escape that evolving immune response. What unfolded was a back-and-forth of mutating virus escaping the immune response and the immune response evolving to keep up with the mutating virus. At the end of more than 2 years, the virus had coaxed along the immune response to produce antibodies that were broadly neutralizing for a wide variety of archived HIV isolates. However, the patient still had virus that was not neutralized by the resulting bNAb.7 Nonetheless, this observation fortified the concept of “B-cell lineage design” and the pursuit of sequential stimulation of the B-cell lineage with slightly different immunogens that mimic the evolving and mutating virus. Clearly, this strategy is quite different from the classic approach in vaccinology of priming and boosting with essentially the same antigen. The technically complex and intense interrogation and engagement of the B-cell limb of the immune response has provided some of the most elegant scientific studies performed in the context of vaccine development. However, it is unclear whether the application of this approach will be feasible in the context of a vaccine for millions of people.

Indeed, the field of HIV vaccinology is in uncharted territory. If efforts in developing an HIV vaccine based on the induction of bNAbs are successful, this achievement will represent the most elegant and complex scientific approach toward any vaccine in history. In contrast, if unsuccessful, this experience will be recorded as the most highly sophisticated and scientifically elegant proof that the development of such a vaccine is impossible. Hopefully, the former and not the latter will be true.

.
Viewpoint
Marking Time in the Global HIV/AIDS Pandemic FREE
Gerald Friedland, MD
[Excerpt]
…The IAS conference returns to Durban in July 2016, and presents a unique opportunity to review the 15 years since the landmark 2000 meeting. It will document the current status of the global pandemic and consider and plan the future goals and strategies for the global struggle against HIV/AIDS.

Remarkably, a historic turn of events has been achieved during the past 15 years, representing perhaps one of the greatest scientific, medical, and public health realignment of resources between rich and poor. Resources and expertise have been shifted toward those poorer communities and populations in the world where the epidemic has reached full force. Research support has increased and has demonstrated the importance of new treatment and prevention tools and strategies of global benefit. Local governments and international agencies such as the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization; the Global Fund on AIDS, Tuberculosis, and Malaria; the US President’s Emergency Plan for AIDS Relief; other nations’ programs; nongovernmental organizations; academic institutions; private philanthropy; and other efforts have been assembled to meaningfully counteract the global pandemic, providing evidence-based prevention and treatment and attempting to reduce many of the issues of equity and health disparities at the pandemic’s core.

New HIV infections have declined by 35% since 2000 and the number of people accessing ART globally has doubled every 3 to 4 years, increasing exponentially from an estimated 690 000 in 2000 (the vast majority in the developed world) to 3 million in 2007 and to 17 million people at the end of 2015.3 Of these, 10.3 million (61%) were in sub-Saharan Africa. Global coverage of ART increased from less than 5% in 2000 to 46% at the end of 2015.4 South Africa has the largest HIV epidemic in the world, with an estimated 6.3 million people living with HIV in 2013, but now has initiated ART for nearly 3.4 million people living with HIV/AIDS, more than any other country in the world.4 Studies have demonstrated a restoration of life expectancy on a population level, similar to what had been seen in the United States after the introduction of ART5 and population-based declines in HIV transmission were shown as ART was rolled out.

The past 15 years also have seen a large increase in effective HIV prevention tools, including condoms, harm reduction, male circumcision, and vaginal microbicides as well as structural (ie, policies, laws, institutional, and administrative approaches) and community-based approaches. The availability and use of ART remains the most potent tool, both as treatment and prevention of new infections in maternal to child transmission, HIV discordant partners,6 and, most recently, as preexposure prophylaxis.7 All of these strategies, including those that address fundamental human rights, must be used in combination to provide the greatest benefit. With these effective tools and strategies, is the world now on the cusp of another epochal change in the pandemic?

The power of combining treatment and prevention has resulted in the formulation by UNAIDS of the 90-90-90 strategy to be accomplished by 2020.8 This is defined as 90% of all people living with HIV will know their HIV status, 90% of these will receive sustained ART, and 90% of these will have viral suppression. Further extending this to 2030 with a strategy of 95-95-95 is estimated to avert an additional 17.6 million HIV infections and 10.8 million AIDS-related deaths between 2016 and 2030,8 and carries the expectation that the pandemic will be eliminated (ie, the global prevalence of HIV will be reduced to a negligible amount and no longer represent a global public health threat).

However, enormous challenges remain in reaching these goals. They include the difficulties of engaging key populations with the treatment and prevention benefits, the fragility and weakness of the health care systems needed for their delivery, the fact that neither a vaccine nor cure is expected within this time frame and ART remains a lifelong therapy with challenges of linkage to care, medication adherence, and loss to follow-up all impinging on sustained viral suppression. Continued stigma and intractable human rights challenges, comorbidities, such as tuberculosis (the leading cause of mortality in people living with HIV/AIDS), and increasingly drug-resistant tuberculosis, all pose major hurdles.

In addition, it is unclear whether the costs to local and international communities will be bearable, estimated as increasing from the current $19 billion per year to $36 billion per year, and whether political will can be sustained over time.9 A central question at the 2016 IAS conference will be if, with the now-available powerful prevention and treatment tools, these goals and strategies are realistic and attainable or, at best, only aspirational.

The accomplishments of the past 15 years were similarly deemed unrealistic and aspirational, and perhaps such a triumph of global success will be repeated and the HIV/AIDS pandemic not only can be reversed, but contained. The 2016 IAS meeting in Durban will again provide a view of the present and a glimpse into the future of the still disastrous and volatile HIV/AIDS pandemic.

.
Editorials
Condomless Sex With Virologically Suppressed HIV-Infected Individuals: How Safe Is It? FREE
Eric S. Daar, MD; Katya Corado, MD

Antiretrovirals for HIV Treatment and Prevention: The Challenges of Success FREE
Kenneth H. Mayer, MD; Douglas S. Krakower, MD

Visions for an AIDS-Free Generation: Red Ribbons of Hope FREE
Preeti N. Malani, MD, MSJ

.

Original Investigations
Effect of Patient Navigation With or Without Financial Incentives on Viral Suppression Among Hospitalized Patients With HIV Infection and Substance Use: A Randomized Clinical Trial FREE
Lisa R. Metsch, PhD; Daniel J. Feaster, PhD; Lauren Gooden, PhD; Tim Matheson, PhD; Maxine Stitzer, PhD; Moupali Das, MD; Mamta K. Jain, MD; Allan E. Rodriguez, MD; Wendy S. Armstrong, MD; Gregory M. Lucas, MD, PhD; Ank E. Nijhawan, MD; Mari-Lynn Drainoni, PhD; Patricia Herrera, MD; Pamela Vergara-Rodriguez, MD; Jeffrey M. Jacobson, MD; Michael J. Mugavero, MD; Meg Sullivan, MD; Eric S. Daar, MD; Deborah K. McMahon, MD; David C. Ferris, MD; Robert Lindblad, MD; Paul VanVeldhuisen, PhD; Neal Oden, PhD; Pedro C. Castellón, MPH; Susan Tross, PhD; Louise F. Haynes, MSW; Antoine Douaihy, MD; James L. Sorensen, PhD; David S. Metzger, PhD; Raul N. Mandler, MD; Grant N. Colfax, MD; Carlos del Rio, MD
Includes: Supplemental Content

.
Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy FREE
Alison J. Rodger, MD; Valentina Cambiano, PhD; Tina Bruun, RN; Pietro Vernazza, MD; Simon Collins; Jan van Lunzen, PhD; Giulio Maria Corbelli; Vicente Estrada, MD; Anna Maria Geretti, MD; Apostolos Beloukas, PhD; David Asboe, FRCP; Pompeyo Viciana, MD; Félix Gutiérrez, MD; Bonaventura Clotet, PhD; Christian Pradier, MD; Jan Gerstoft, MD; Rainer Weber, MD; Katarina Westling, MD; Gilles Wandeler, MD; Jan M. Prins, PhD; Armin Rieger, MD; Marcel Stoeckle, MD; Tim Kümmerle, PhD; Teresa Bini, MD; Adriana Ammassari, MD; Richard Gilson, MD; Ivanka Krznaric, PhD; Matti Ristola, PhD; Robert Zangerle, MD; Pia Handberg, RN; Antonio Antela, PhD; Sris Allan, FRCP; Andrew N. Phillips, PhD; Jens Lundgren, MD; for the PARTNER Study Group
Includes: CME, Supplemental Content
Editorial: Condomless Sex With Virologically Suppressed HIV-Infected Individuals;
Eric S. Daar, MD; Katya Corado, MD

.
Association of Medical Male Circumcision and Antiretroviral Therapy Scale-up With Community HIV Incidence in Rakai, Uganda FREE
Xiangrong Kong, PhD; Godfrey Kigozi, MB, ChB, PhD; Joseph Ssekasanvu, MS; Fred Nalugoda, PhD; Gertrude Nakigozi, MD, MPH; Anthony Ndyanabo, MSc; Tom Lutalo, MS; Steven J. Reynolds, MD, MPH; Robert Ssekubugu, MHS; Joseph Kagaayi, MB, ChB, PhD; Eva Bugos, BS; Larry W. Chang, MD, MPH; Pilgrim Nanlesta, PhD; Grabowski Mary, PhD; Amanda Berman, MSPH, MPhil; Thomas C. Quinn, MD; David Serwadda, MB, ChB, MMed, MPH; Maria J. Wawer, MD, MSH; Ronald H. Gray, MD, MSc
Includes: CME, Supplemental Content

.

Special Communication
Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2016 Recommendations of the International Antiviral Society–USA Panel FREE
Huldrych F. Günthard, MD; Michael S. Saag, MD; Constance A. Benson, MD; Carlos del Rio, MD; Joseph J. Eron, MD; Joel E. Gallant, MD, MPH; Jennifer F. Hoy, MBBS, FRACP; Michael J. Mugavero, MD, MHSc; Paul E. Sax, MD; Melanie A. Thompson, MD; Rajesh T. Gandhi, MD; Raphael J. Landovitz, MD; Davey M. Smith, MD; Donna M. Jacobsen, BS; Paul A. Volberding, MD
Includes: CME, Supplemental Content
Editorial: Antiretrovirals for HIV Treatment and Prevention; Kenneth H. Mayer, MD; Douglas S. Krakower, MD

.

From the JAMA Network
Reaching High-Risk Patients for HIV Preexposure Prophylaxis FREE
James Riddell IV, MD; Jonathan A. Cohn, MD, MS

Journal of Community Health
Volume 41, Issue 4, August 2016
http://link.springer.com/journal/10900/41/3/page/1

.
Original Paper
Factors Influencing Seasonal Influenza Vaccination Uptake in Emergency Medical Services Workers: A Concept Mapping ApproachFactors Influencing Seasonal Influenza Vaccination Uptake in Emergency Medical Services Workers: A Concept Mapping Approach
Dipti P. Subramaniam, Elizabeth A. Baker, Alan P. Zelicoff…

.

Original Paper
Poor HPV vaccine-related awareness and knowledge among Utah Latinas overdue for recommended cancer screenings
Brynn Fowler, Julia Bodson, Echo L. Warner, Jane Dyer…

New England Journal of Medicine
July 14, 2016 Vol. 375 No. 2
http://www.nejm.org/toc/nejm/medical-journal

.
Perspective
History of Clinical Trials: Medicine, Monopoly, and the Premodern State — Early Clinical Trials
A. Rankin and J. Rivest

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
[Accessed 16 July 2016]

.
The Vaccination of 35,000 Dogs in 20 Working Days Using Combined Static Point and Door-to-Door Methods in Blantyre, Malawi
Andrew D Gibson, Ian G Handel, Kate Shervell, Tarryn Roux, Dagmar Mayer, Stanford Muyila, Golden B Maruwo, Edwin M. S Nkhulungo, Rachel A Foster, Patrick Chikungwa, Bernard Chimera, Barend M.deC Bronsvoort, Richard J Mellanby, Luke Gamble
Research Article | published 14 Jul 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004824

.

Safety Overview of a Recombinant Live-Attenuated Tetravalent Dengue Vaccine: Pooled Analysis of Data from 18 Clinical Trials
Sophia Gailhardou, Anna Skipetrova, Gustavo H. Dayan, John Jezorwski, Melanie Saville, Diane Van der Vliet, T. Anh Wartel
Research Article | published 14 Jul 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004821

.

Post-Marketing Surveillance of Human Rabies Diploid Cell Vaccine (Imovax) in the Vaccine Adverse Event Reporting System (VAERS) in the United States, 1990‒2015
Pedro L. Moro, Emily Jane Woo, Wendy Paul, Paige Lewis, Brett W. Petersen, Maria Cano
Research Article | published 13 Jul 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004846

PLoS One
http://www.plosone.org/
[Accessed 16 July 2016]

.
Research Article
Community Willingness to Participate in a Dengue Study in Aceh Province, Indonesia
Harapan Harapan, Samsul Anwar, Aslam Bustaman, Arsil Radiansyah, Pradiba Angraini, Riny Fasli, Salwiyadi Salwiyadi, Reza Akbar Bastian, Ade Oktiviyari, Imaduddin Akmal, Muhammad Iqbalamin, Jamalul Adil, Fenni Henrizal, Darmayanti Darmayanti, Rovy Pratama, Jonny Karunia Fajar, Abdul Malik Setiawan, Allison Imrie, Ulrich Kuch, David Alexander Groneberg, R. Tedjo Sasmono, Meghnath Dhimal, Ruth Müller
Research Article | published 12 Jul 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0159139
Abstract
Background
Dengue virus infection is the most rapidly spreading vector-borne disease in the world. Essential research on dengue virus transmission and its prevention requires community participation. Therefore, it is crucial to understand the factors that are associated with the willingness of communities in high prevalence areas to participate in dengue research. The aim of this study was to explore factors associated with the willingness of healthy community members in Aceh province, Indonesia, to participate in dengue research that would require phlebotomy.
Methodology/Principal Findings
A community-based cross-sectional study was carried out in nine regencies and municipalities of Aceh from November 2014 to March 2015. Interviews using a set of validated questionnaires were conducted to collect data on demography, history of dengue infection, socioeconomic status, and knowledge, attitude and practice regarding dengue fever. Two-step logistic regression and Spearman’s rank correlation (rs) analysis were used to assess the influence of independent variables on dependent variables. Among 535 participants, less than 20% had a good willingness to participate in the dengue study. The factors associated with good willingness to participate were being female, working as a civil servant, private employee or entrepreneur, having a high socioeconomic status and good knowledge, attitude and practice regarding dengue. Good knowledge and attitude regarding dengue were positive independent predictors of willingness to participate (OR: 2.30 [95% CI: 1.36–3.90] and 3.73 [95% CI: 2.24–6.21], respectively).
Conclusion/Significance
The willingness to participate in dengue research is very low among community members in Aceh, and the two most important associated factors are knowledge and attitude regarding dengue. To increase participation rate, efforts to improve the knowledge and attitude of community members regarding dengue fever and dengue-related research is required before such studies are launched.

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 16 July 2016)

.
Social Sciences – Social Sciences – Biological Sciences – Medical Sciences:
Equity and length of lifespan are not the same
Benjamin Seligman, Gabi Greenberg, and Shripad Tuljapurkar
PNAS 2016 ; published ahead of print July 11, 2016, doi:10.1073/pnas.1601112113
Significance
We find that the causes of death that have led to greater equality among lifespans are different from the causes that have led to longer average lifespan, also called life expectancy. Control of leading causes of death, such as heart disease, increased life expectancy, whereas medical interventions on infant mortality led to greater equality. Action to promote health equity will require further mitigation of the killers of young people rather than solely focusing on the most common causes of death.
Abstract
Efforts to understand the dramatic declines in mortality over the past century have focused on life expectancy. However, understanding changes in disparity in age of death is important to understanding mechanisms of mortality improvement and devising policy to promote health equity. We derive a novel decomposition of variance in age of death, a measure of inequality, and apply it to cause-specific contributions to the change in variance among the G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States) from 1950 to 2010. We find that the causes of death that contributed most to declines in the variance are different from those that contributed most to increase in life expectancy; in particular, they affect mortality at younger ages. We also find that, for two leading causes of death [cancers and cardiovascular disease (CVD)], there are no consistent relationships between changes in life expectancy and variance either within countries over time or between countries. These results show that promoting health at younger ages is critical for health equity and that policies to control cancer and CVD may have differing implications for equity.

Reproductive Health
http://www.reproductive-health-journal.com/content
[Accessed 16 July 2016]

.
Study protocol
Zika virus infection in pregnant women in Honduras: study protocol
Although there is increasing evidence for a relationship between symptomatic Zika virus (ZIKV) maternal infection, and microcephaly, a firm causal relation has yet to be established by epidemiologic studies.
Pierre Buekens, Jackeline Alger, Fernando Althabe, Eduardo Bergel, Amanda M. Berrueta, Carolina Bustillo, Maria-Luisa Cafferata, Emily Harville, Karla Rosales, Dawn M. Wesson and Concepcion Zuniga
Reproductive Health 2016 13:82
Published on: 16 July 2016

.

Research
Male involvement in reproductive, maternal and child health: a qualitative study of policymaker and practitioner perspectives in the Pacific
The importance of involving men in reproductive, maternal and child health programs is increasingly recognised globally. In the Pacific region, most maternal and child health services do not actively engage ex…
Jessica Davis, Joseph Vyankandondera, Stanley Luchters, David Simon and Wendy Holmes
Reproductive Health 2016 13:81
Published on: 16 July 2016

Risk Management and Healthcare Policy
Volume 9, 2016
https://www.dovepress.com/risk-management-and-healthcare-policy-archive56
[Accessed 16 July 2016]

.
Original Research
The Lebanese–Syrian crisis: impact of influx of Syrian refugees to an already weak state
Cherri Z, Arcos González P, Castro Delgado R
Risk Management and Healthcare Policy 2016, 9:165-172
Published Date: 14 July 2016
Abstract
Background: Lebanon, a small Middle Eastern country facing constant political and national unity challenges with a population of approximately 300,000 Palestinian and Iraqi refugees, has welcomed more than 1.2 million Office of the United Nations Commissioner for Refugees (UNHCR)-registered Syrian refugees since 2012. The Government of Lebanon considers individuals who crossed Lebanese–Syrian borders since 2011 as “displaced”, emphasizing its long-standing position that Lebanon is not a state for refugees, refusing to establish camps, and adopting a policy paper to reduce their numbers in October 2014. Humanitarian response to the Syrian influx to Lebanon has been constantly assembling with the UNHCR as the main acting body and the Lebanon Crisis Response Plan as the latest plan for 2016.
Methods: Review of secondary data from gray literature and reports focusing on the influx of Syrian refugees to Lebanon by visiting databases covering humanitarian response in complex emergencies. Limitations include obtaining majority of the data from gray literature and changing statistics due to the instability of the situation.
Results: The influx of Syrian refugees to Lebanon, an already weak and vulnerable state, has negatively impacted life in Lebanon on different levels including increasing demographics, regressing economy, exhausting social services, complicating politics, and decreasing security as well as worsened the life of displaced Syrians themselves.
Conclusion: Displaced Syrians and Lebanese people share aggravating hardships of a mutual and precarious crisis resulting from the Syrian influx to Lebanon. Although a lot of response has been initiated, both populations still lack much of their basic needs due to lack of funding and nonsustainable program initiatives. The two major recommendations for future interventions are to ensure continuous and effective monitoring and sustainability in order to alleviate current and future suffering in Lebanon.

Science Translational Medicine
13 July 2016 Vol 8, Issue 347
http://stm.sciencemag.org/

.
Editorial
Moving at the speed of science: Regulatory flexibility for unmet medical needs
By Mikael Dolsten
Science Translational Medicine13 Jul 2016 : 347ed10
Biomedical science stops for no one, and the regulatory process must continue to keep up.

Editor’s Choice
Zika meets its match
By Alex K. Shalek
Science Translational Medicine13 Jul 2016 : 347ec112
Both DNA and inactivated virus vaccines against Zika afford full, antibody-mediated protection in murine models.

Vaccine
Volume 34, Issue 33, Pages 3711-3920 (19 July 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/33

.
Perceptions of oral cholera vaccine and reasons for full, partial and non-acceptance during a humanitarian crisis in South Sudan
Original Research Article
Pages 3823-3827
Dorothy Peprah, Jennifer J. Palmer, G. James Rubin, Abdinasir Abubakar, Alejandro Costa, Stephen Martin, William Perea, Heidi J. Larson
Abstract
Oral cholera vaccination (OCV) campaigns were conducted from February to April 2014 among internally displaced persons (IDPs) in the midst of a humanitarian crisis in Juba, South Sudan. IDPs were predominantly members of the Nuer ethnic group who had taken refuge in United Nations bases following the eruption of violence in December 2013. The OCV campaigns, which were conducted by United Nations and non-governmental organizations (NGOs) at the request of the Ministry of Health, reached an estimated 85–96% of the target population. As no previous studies on OCV acceptance have been conducted in the context of an on-going humanitarian crisis, semi-structured interviews were completed with 49 IDPs in the months after the campaigns to better understand perceptions of cholera and reasons for full, partial or non-acceptance of the OCV. Heightened fears of disease and political danger contributed to camp residents’ perception of cholera as a serious illness and increased trust in United Nations and NGOs providing the vaccine to IDPs. Reasons for partial and non-acceptance of the vaccination included lack of time and fear of side effects, similar to reasons found in OCV campaigns in non-crisis settings. In addition, distrust in national institutions in a context of fears of ethnic persecution was an important reason for hesitancy and refusal. Other reasons included fear of taking the vaccine alongside other medication or with alcohol. The findings highlight the importance of considering the target populations’ perceptions of institutions in the delivery of OCV interventions in humanitarian contexts. They also suggest a need for better communication about the vaccine, its side effects and interactions with other substances.

Vaccine
Volume 34, Issue 33, Pages 3711-3920 (19 July 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/33

.
Original Research Article
The effect of mass vaccination campaigns against polio on the utilization of routine immunization services: A regression discontinuity design
Pages 3817-3822
Stephane Helleringer, Patrick O. Asuming, Jalaa Abdelwahab
Abstract
Background
In most low and middle-income countries (LMIC), vaccines are primarily distributed by routine immunization services (RI) at health facilities. Additional opportunities for vaccination are also provided through mass vaccination campaigns, conducted periodically as part of disease-specific initiatives. It is unclear whether these campaigns are detrimental to RI services, or wether they may stimulate the utilization of RI.
Methods
Unobserved confounders and reverse causality have limited existing evaluations of the effects of mass vaccination campaigns on RI services. We explored the use of a regression discontinuity design (RDD) to measure these effects more precisely. This is a quasi-experimental method, which exploits random variations in birth dates to identify the causal effects of vaccination campaigns. We applied RDD to survey data on a nationwide vaccination campaign against Polio conducted in Bangladesh.
Results
We compared systematically the children born immediately before vs. after the vaccination campaign. These two groups had similar background characteristics, but differed by their exposure to the vaccination campaign. Contrary to previous studies, exposure to the campaign had positive effects on RI utilization. Children exposed to the campaign received between 0.296 and 0.469 additional doses of DPT vaccine by age 4 months than unexposed children.
Conclusions
RDD constitutes a promising tool to assess the effects of mass vaccination campaigns on RI services. It could be tested in additional settings, using larger and more precise datasets. It could also be extended to measure the effects of other disease-specific interventions on the functioning of health systems, in particular those that occur at a discrete point in time and/or include age-related eligibility criteria.

Vaccine
Volume 34, Issue 33, Pages 3711-3920 (19 July 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/33

.
Original Research Article
The effect of mass vaccination campaigns against polio on the utilization of routine immunization services: A regression discontinuity design
Pages 3817-3822
Stephane Helleringer, Patrick O. Asuming, Jalaa Abdelwahab
Abstract
Background
In most low and middle-income countries (LMIC), vaccines are primarily distributed by routine immunization services (RI) at health facilities. Additional opportunities for vaccination are also provided through mass vaccination campaigns, conducted periodically as part of disease-specific initiatives. It is unclear whether these campaigns are detrimental to RI services, or wether they may stimulate the utilization of RI.
Methods
Unobserved confounders and reverse causality have limited existing evaluations of the effects of mass vaccination campaigns on RI services. We explored the use of a regression discontinuity design (RDD) to measure these effects more precisely. This is a quasi-experimental method, which exploits random variations in birth dates to identify the causal effects of vaccination campaigns. We applied RDD to survey data on a nationwide vaccination campaign against Polio conducted in Bangladesh.
Results
We compared systematically the children born immediately before vs. after the vaccination campaign. These two groups had similar background characteristics, but differed by their exposure to the vaccination campaign. Contrary to previous studies, exposure to the campaign had positive effects on RI utilization. Children exposed to the campaign received between 0.296 and 0.469 additional doses of DPT vaccine by age 4 months than unexposed children.
Conclusions
RDD constitutes a promising tool to assess the effects of mass vaccination campaigns on RI services. It could be tested in additional settings, using larger and more precise datasets. It could also be extended to measure the effects of other disease-specific interventions on the functioning of health systems, in particular those that occur at a discrete point in time and/or include age-related eligibility criteria.

Vaccine
Volume 34, Issue 33, Pages 3711-3920 (19 July 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/33

.
Conference report
The Cape Town Declaration on Vaccines 2012: Unlocking the full potential of vaccines in Africa
Pages 3713-3714
Charles S. Wiysonge, Zainab Waggie, Anthony Hawkridge, Barry D. Schoub, Shabir A. Madhi, Helen Rees, Gregory D. Hussey, on behalf of delegates of the first International African Vaccinology Conference
Abstract
Delegates at the first International African Vaccinology Conference noted, with dismay, that many African children have limited access to existing and new vaccines as a consequence of weak immunisation programmes, lack of political will, and high vaccine prices. This inequality is a denial of the African child her basic right to a healthy life, and jeopardises long term economic growth on the continent. In addition, there is insufficient emphasis in Africa on adolescent and adult immunisation. The delegates documented various concerns and made various commitments; contained in this Cape Town Declaration on Vaccines, adopted on 11 November 2012. Finally, delegates confirmed their agreement with the goals and strategic objectives of the Global Vaccine Action Plan, and committed to hold African leaders accountable for its implementation during the Decade of Vaccines. The full list of registered conference delegates is provided as supplementary data to this manuscript.

Vaccine
Volume 34, Issue 33, Pages 3711-3920 (19 July 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/33

.
Commentary
Considerations for the development of Zika virus vaccines
Pages 3711-3712
K.A.O. Martins, J.M. Dye, S. Bavari
1. Introduction
The current Zika virus outbreak has galvanized the public health community, resulting in calls for rapid action from entities including the World Health Organization and the United States government. The response to Zika virus is perhaps the first of its kind, and it has been influenced by the lessons learned from the response to the 2014 Ebola virus outbreak in West Africa. However, Zika virus is not Ebola virus. Prior to 2016, there were only 133 publications on “Zika” in the PubMed database, and a large number of these publications were commentaries or reviews lacking primary research data. In contrast, work had been underway for decades on the development of an Ebola virus vaccine, laying the groundwork for an expedited response in 2014. The broader research community’s extensive experience with dengue virus vaccine development and with the pros and cons of different vaccine platforms has led to speculation that a Zika virus vaccine can be accelerated, potentially with clinical trials initiating by the end of 2016 [1]. However, there are unique attributes of Zika virus, as well as many unanswered questions about the virus, that will need to be considered before a potential vaccine is administered to the public.

The close phylogenetic relationship between the flaviviruses has complicated diagnostic efforts for multiple members of this family, because antibody elicited by the viruses is cross-reactive [2]. Definitive diagnosis of Zika virus infection in individuals with previous flavivirus infection therefore requires detection of viral RNA by PCR, which is only achievable during approximately a two week window early in infection. Efforts are underway to develop serological assays to differentiate the flavivirus infections, which would significantly advance our understanding of the epidemiology of Zika virus. However, the cross-reactivity of antibody elicited by other flaviviruses with Zika virus may be more than a diagnostic inconvenience. Cross-reactivity will need to be considered in the context of the efficacy of potential vaccine candidates in the at-risk population…

Media/Policy Watch
This section is intended to alert readers to substantive news, analysis and opinion from the general media 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 16 July 2016
Fighting Zika Without Additional Funding
Public-health officials are strategizing how to combat the virus with no new money on the horizon—and Congress away for the summer.
Nora Kelly
Zika is here. But Congress is gone.
Lawmakers adjourned this week for a seven-week summer recess without passing additional money to fight the Zika virus. Now, federal public-health officials are weighing how to stop the spread of infections with no new money coming down the pipeline—and with further budget battles near-guaranteed in the fall. “We will do the best we can to protect Americans,” said Tom Frieden, the Centers for Disease Control and Prevention director. But “there are projects that will not happen because the funding isn’t available.”…

.

BBC
http://www.bbc.co.uk/
Accessed 16 July 2016
16 Jul 2016
BBC Trending: India’s ‘Anti-Vaccine Mafia’
[Audio]
…A Facebook post lamenting the death of teenage boy in India – from diphtheria – has shone a light on an anti-vaccination movement that appears to be gaining ground.
Published Date
BBC World Service

13 Jul 2016
Meningitis B vaccine extension rejected
Health campaigners say they are “hugely dismayed” that the meningitis B vaccine will not be extended to all children in the UK under the age of two.
It was introduced across the UK last year for babies aged up to 12 months.
But experts from the Joint Committee on Vaccination and Immunisation (JCVI) said there was not enough of the vaccine for a catch-up programme.
A petition calling for older children to be vaccinated was signed by more than 800,000 people earlier this year…

.

New York Times
http://www.nytimes.com/
Accessed 16 July 2016
Suspected Congo Yellow Fever Cases Up 38 Percent in Last Three Weeks: WHO
KINSHASA — The number of suspected yellow fever cases in the Democratic Republic of Congo has jumped 38 percent in the last three weeks, the World Health Organization (WHO) said on Friday, as health officials prepare to launch a vaccination campaign next week.
Congo’s government last month declared a yellow fever epidemic in the capital Kinshasa and two provinces that border Angola, where the worst outbreak of the disease in decades has killed about 350 people.
As of July 11, Congo had recorded 1,798 suspected cases since the start of the outbreak in January, WHO said in a weekly report, up from 1,307 on June 24. Seventy-five people are believed to have died from the disease in Congo, it said.
July 15, 2016 – By REUTERS –

Congress Takes a Vacation Without Doing Anything About Zika
Opinion by THE EDITORIAL BOARD
Members of Congress are leaving Washington for seven weeks without passing a bill to pay for the fight against Zika. Their failure to do so will delay the public health response to the mosquito-borne virus that causes birth defects, unnecessarily putting thousands of people at risk.
As of July 7, 649 pregnant women appeared to be infected with Zika in American states and territories and nine babies had been born with birth defects linked to the virus. Public health experts believe that these numbers are likely to increase in the coming weeks as mosquitoes become more prevalent, especially in Florida, Hawaii and Texas. This calls for swift action by the government, but instead, the Republicans who control Congress are trying to exploit the crisis to advance ideological causes…
July 15, 2016

Vaccines and Global Health: The Week in Review is a weekly digest  summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated with the current issue date

.– Request an Email Summary: Vaccines and Global Health : The Week in Review is published as a single email summary, scheduled for release each Saturday evening before midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.

– pdf version:  A pdf of the current issue is available here:  Vaccines and Global Health_The Week in Review_9 July 2016

– blog edition: comprised of the approx. 35+ entries posted below.

– Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
.
– Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.

.
David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy

Zika virus [to 9 July 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

.

Zika situation report – 7 July 2016
Full report: http://apps.who.int/iris/bitstream/10665/246180/1/zikasitrep7Jul16-eng.pdf?ua=1

Summary
[Excerpt]
:: WHO and partners have established a definition of what constitutes an outbreak, endemic transmission, and the interruption of vector-borne transmission in order to better characterize the level of transmission of Zika virus infection (Table 1, Fig. 2). In addition, this will facilitate public health recommendations for residents and travellers. Based on these definitions, countries and territories reporting mosquito-borne Zika virus transmission were reclassified.

:: As of 6 July 2016, 65 countries and territories (Fig. 1, Table 1) have reported evidence of vector-borne Zika virus transmission since 2007 (62 of these countries and territories have reported evidence of vector-borne Zika virus transmission since 2015):
…48 countries and territories with a first reported outbreak from 2015 onwards (Table 1).
…Four countries are classified as having possible endemic transmission or have reported evidence of local vector-borne Zika infections in 2016.
…13 countries and territories have reported evidence of local vector-borne Zika infections in or before 2015, but without documentation of cases in 2016, or with outbreak terminated.

:: Guinea-Bissau is the latest country to report mosquito-borne Zika virus transmission.

:: Eleven countries have reported evidence of person-to-person transmission of Zika virus, probably via a sexual route (Table 2). Spain is the latest country to report Zika infection through person-to-person transmission.

:: As of 6 July 2016, microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection or suggestive of congenital infection have been reported by 13 countries or territories. Three of those countries reported microcephaly cases born from mothers with a recent travel history to Zika-affected countries in Latin America (Table 3).

:: As of 6 July, the United States Centers for Disease Control and Prevention (US-CDC) reported seven live-born infants with birth defects and five pregnancy losses with birth defects with laboratory evidence of possible Zika virus infection.

:: In the context of Zika virus circulation, 15 countries and territories worldwide have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases (Table 4).

:: Based on research to date, there is scientific consensus that Zika virus is a cause of microcephaly and GBS…

.

Zika Open [to 9 July 2016]
[Bulletin of the World Health Organization]
:: All papers available here
Kinetics of Zika virus persistence in semen
– Ralph MHG Huits, Birgit De Smet, Kevin K Ariën, Marjan Van Esbroeck, Bouke C de Jong, Emmanuel Bottieau & Lieselotte Cnops
Posted: 6 July 2016
http://dx.doi.org/10.2471/BLT.16.181370

Non-vector transmission of flaviviruses, with implications for the Zika virus
– Poojan Shrestha, Gail Carson & Peter Horby
Posted: 6 July 2016
http://dx.doi.org/10.2471/BLT.16.17768

.

CDC/ACIP [to 9 July 2016]
http://www.cdc.gov/media/index.html
Media Statement
WEDNESDAY, JULY 6, 2016
U.S. Centers for Disease Control and Prevention and Environmental Protection Agency Urge Commonwealth of Puerto Rico to Consider Aerial Spraying as Part of Integrated Mosquito Control to Reduce Zika-Associated Birth Defects
Acting on data from multiple scientific studies in Puerto Rico that show that Zika is spreading rapidly and is a major risk to pregnant women and their fetuses, the Centers for Disease Control and Prevention (CDC) and the Environmental Protection Agency (EPA) recommend the people and the government of Puerto Rico consider implementing aerial spraying as part of an integrated mosquito control program.

“Multiple independent data sources indicate that at current trends thousands of pregnant women in Puerto Rico will catch Zika,” said CDC Director Tom Frieden, M.D., M.P.H. “The continental United States has been using aerial spraying for decades to reduce mosquito populations, and we urge the people of Puerto Rico to consider using the same proven and safe tactic.”

“Our recommendations for mosquito control in Puerto Rico are the same as our recommendations for mosquito control elsewhere in the United States—integrated pest management,” said EPA Administrator Gina McCarthy. “An integrated and comprehensive approach includes reducing places where mosquitoes lay eggs, keeping them out of houses, and reducing the populations of both larval and adult mosquitoes by treating areas with EPA-approved products. We strongly encourage the people of Puerto Rico to consider aerial spraying as this approach is safe for people and a proven way of controlling the spread of mosquitoes that transmit diseases from Zika to dengue to chikungunya.”…

.

UNESCO [to 9 July 2016]
http://en.unesco.org/news
05 July 2016
Inform, Engage, Investigate: Lessons Learned from Zika Outbreak
Inaccurate communications, isolated populations and sensationalist coverage acutely exacerbate risks during crisis and disaster situations. In such sensitive contexts, and especially in health-related emergencies, journalists must impart populations with accurate news and verified information to prevent misinformation and rumors which could result in fatal choices.

The core principles of media, such as diversity of sources, editorial independence and quality coverage, must be emergency-proof. On this basis, UNESCO is organizing a two-day workshop entitled “Inform, Engage, Investigate: Media and humanitarians in crisis situations – Lessons learned from Zika outbreak”, which will be held in Panama City, Panama from 14 to 15 July 2016 with participation of the International Federation of the Red Cross (IFRC) and the World Health Organization (WHO)…

EBOLA/EVD [to 9 July 2016]
“Threat to international peace and security” (UN Security Council)

[Editor’s Note:
We deduce that WHO has suspended issuance of new Situation Reports after resuming them for several weekly cycles. The most recent report posted is EBOLA VIRUS DISEASE – Situation Report – 10 JUNE 2016 ]

.

CDC/ACIP [to 9 July 2016]
http://www.cdc.gov/media/index.html
Press Release
THURSDAY, JULY 7, 2016
CDC Releases Detailed History of the 2014-2016 Ebola Response in MMWR
The Centers for Disease Control and Prevention (CDC) today will release a detailed account of the agency’s work on the largest, longest outbreak response in the agency’s history: the Ebola…

MMWR Weekly: July 8, 2016 / Vol. 65 / No. 26
:: Notes from The Field: Ebola Virus Disease Cluster — Northern Sierra Leone, January 2016

POLIO [to 9 July 2016]
Public Health Emergency of International Concern (PHEIC)

.

Polio this week as of 06 July 2016
:: The Pakistan Technical Advisory Group met in Islamabad on 28 – 29 June, and concluded that a united focus between partners and enhanced community ownership of programme interventions has been key to continuing progress in the country towards eradicating polio. More.

:: The Nigeria Expert Review Committee on Polio Eradication and Routine Immunization met in Abuja on 21 – 22 June, and emphasised that the strategy in Nigeria must now shift from interrupting transmission to staying polio free, sustaining the hard-won gains, strengthening routine immunization and responding to outbreaks of vaccine-derived polioviruses. More.

:: The Technical Advisory Group on polio eradication for Afghanistan will be meeting next week in Kabul to review progress towards interrupting the transmission of polio and to discuss solutions to the upcoming challenges.

Selected Country Levels Updates [excerpted]
Pakistan
:: One new case of wild poliovirus type 1 (WPV1) was reported in the past week in South Waziristan agency in the Federally Administered Tribal Areas (FATA) with onset of paralysis on 18 June. The total number of WPV1 cases for 2016 is now 13, compared to 26 at this time in 2015.

Yellow Fever [to 9 July 2016]
http://www.who.int/emergencies/yellow-fever/en/

.

Yellow Fever – Situation Report – 8 July 2016
Full Report: http://apps.who.int/iris/bitstream/10665/246189/1/yellowsitrep-8Jul2016-eng.pdf?ua=1
Excerpt:
…The risk of spread
Two additional countries have reported confirmed yellow fever cases imported from Angola: Kenya (two cases) and People’s Republic of China (11 cases). These cases highlight the risk of international spread through non-immunised travellers.

Seven countries (Brazil, Chad, Colombia, Ghana, Guinea, Peru and Uganda) are currently reporting yellow fever outbreaks or sporadic cases not linked to the Angolan outbreak.

Vaccination
WHO Strategic Advisory Group of Experts (SAGE) on Immunization reviewed existing evidence that demonstrates that using a fifth of a standard vaccine dose would still provide protection against the disease for at least 12 months and possibly longer. This approach, known as fractional dosing, is under consideration as a short-term measure, in the context of a potential vaccine shortage in emergencies.

Risk assessment
The outbreak in Angola remains of high concern due to:
:: Persistent local transmission despite the fact that approximately 15 million people have been vaccinated;
:: Local transmission has been reported in 12 highly populated provinces including Luanda.
:: The continued extension of the outbreak to new provinces and new districts.
:: High risk of spread to neighbouring countries. As the borders are porous with substantial cross-border social and economic activities, further transmission cannot be excluded. Viraemic travelling patients pose a risk for the establishment of local transmission especially in countries where adequate vectors and susceptible human populations are present;
:: Risk of establishment of local transmission in other provinces where no autochthonous cases are reported;
:: High index of suspicion of ongoing transmission in hard-to-reach areas like Cabinda;

In DRC, the outbreak has spread to three provinces. Given the limited availability of vaccines, the large Angolan community in Kinshasa, the porous border between Angola and DRC, and the presence and the activity of the vector Aedes in the country, the outbreak might extend to other provinces, in particular Kasai, Kasai Central and Lualaba.

The virus in Angola and DRC is largely concentrated in main cities; however, there is a high risk of spread and local transmission to other provinces in both countries. In addition, the risk is high for potential spread to bordering countries, especially those classified as low-risk (i.e. Namibia, Zambia) and where the population, travelers and foreign workers are not vaccinated for yellow fever.

Some African countries (Chad, Ghana, Guinea, Republic of Congo and Uganda) and some countries in South America (Brazil, Colombia and Peru) have reported cases of yellow fever in 2016. These events are not related to the Angolan outbreak, but there remains a need for vaccines in those countries, which poses additional strain on the limited global yellow fever vaccine stockpile.

.

IFRC appeals for 1.4 million Swiss francs to help stop yellow fever outbreak in Angola
Published: 6 July 2016
Luanda/Geneva, 6 July 2016 – The International Federation of Red Cross and Red Crescent Societies (IFRC) today launched a 1.4 million Swiss franc emergency appeal to support the Angola Red Cross respond to the worst yellow fever outbreak in the country in 30 years…

“Angola Red Cross volunteers and staff are conducting door-to-door visits, engaging people in radio debates and providing advice on what people can do to reduce the risk of falling ill with yellow fever. This includes suggesting measures in the home and community to eliminate sites where mosquitoes can breed.

“Red Cross volunteers are also explaining why vaccination is important and the need for a vaccination campaign.”

Community-based solutions to tackle yellow fever are at the forefront of the Red Cross response. Angola Red Cross volunteers and staff have close links with the local communities and long-standing experience in responding to vector-borne diseases such as malaria, dengue and chikungunya.

The IFRC appeal will support the Angola Red Cross to scale up its activities and reach 9 million people through community engagement, health care, and hygiene promotion.

“The need for a large-scale community engagement approach is increasingly important as vaccination campaigns scale up,” said Dr Julie Lyn Hall, IFRC Director of Health. “As much as we try to provide solutions, it is the communities who are the drivers of the response and are the key to the success of it.

“Efforts will focus on effective and sustained two-way communication and engagement with communities, as the most effective means to tackle yellow fever and build a lasting community understanding of how to prevent and control it,” Dr Hall added…

WHO & Regional Offices [to 9 July 2016]

Paris conference sets agenda for climate and health
8 July 2016 – Climate change is causing frequent epidemics of cholera, widespread dengue, and extreme weather events – WHO estimates that tens of thousands of deaths occur each year as a result. At the Second Global Conference on Health and Climate delegates presented key recommendations for the Marrakech Climate Change Conference (COP22) to reduce the health risks of climate change.
:: Read the conclusions from the conference

.

Disease Outbreak News (DONs)
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 6 July 2016

.

:: WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Kenya takes steps to save mothers’ lives, showing why better data matters
In 2013, Kenya’s Ministry of Health was faced with a debate over the alarming rate of women dying in childbirth: was the cause deep-rooted cultural values, or could lives be saved with policy interventions?

WHO Region of the Americas PAHO
:: PAHO/WHO congratulates Uruguay for successfully defending tobacco control policies against tobacco industry challenges (07/09/2016)

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

WHO European Region EURO
:: Universal health coverage in action at European Development Days 06-07-2016

WHO Eastern Mediterranean Region EMRO
Website not responding at inquiry

WHO Western Pacific Region
No new digest content identified.

CDC/ACIP [to 9 July 2016]
http://www.cdc.gov/media/index.html

.
Press Release
THURSDAY, JULY 7, 2016
CDC Releases Detailed History of the 2014-2016 Ebola Response in MMWR
The Centers for Disease Control and Prevention (CDC) today will release a detailed account of the agency’s work on the largest, longest outbreak response in the agency’s history: the Ebola…

.

Media Statement
WEDNESDAY, JULY 6, 2016
U.S. Centers for Disease Control and Prevention and Environmental Protection Agency Urge Commonwealth of Puerto Rico to Consider Aerial Spraying as Part of Integrated Mosquito Control to Reduce Zika-Associated Birth Defects
Acting on data from multiple scientific studies in Puerto Rico that show that Zika is spreading rapidly and is a major risk to pregnant women and their fetuses, the Centers for Disease Control and Prevention (CDC) and the Environmental Protection Agency (EPA) recommend the people and the government of Puerto Rico consider implementing aerial spraying as part of an integrated mosquito control program.
“Multiple independent data sources indicate that at current trends thousands of pregnant women in Puerto Rico will catch Zika,” said CDC Director Tom Frieden, M.D., M.P.H. “The continental United States has been using aerial spraying for decades to reduce mosquito populations, and we urge the people of Puerto Rico to consider using the same proven and safe tactic.”
“Our recommendations for mosquito control in Puerto Rico are the same as our recommendations for mosquito control elsewhere in the United States—integrated pest management,” said EPA Administrator Gina McCarthy. “An integrated and comprehensive approach includes reducing places where mosquitoes lay eggs, keeping them out of houses, and reducing the populations of both larval and adult mosquitoes by treating areas with EPA-approved products. We strongly encourage the people of Puerto Rico to consider aerial spraying as this approach is safe for people and a proven way of controlling the spread of mosquitoes that transmit diseases from Zika to dengue to chikungunya.”…

.

MMWR Weekly: July 8, 2016 / Vol. 65 / No. 26
:: Human Papillomavirus–Associated Cancers — United States, 2008–2012
:: Notes from The Field: Ebola Virus Disease Cluster — Northern Sierra Leone, January 2016

IAVI – International AIDS Vaccine Initiative [to 9 July 2016]
http://www.iavi.org/

.
July 8, 2016
Eric Goosby Appointed as the New IAVI Board Chair and Anne VanLent Appointed Vice-Chair
Board member Lord Norman Fowler elected Lord Speaker for the United Kingdom’s House of Lords

New York, New York – Former U.S. Global AIDS Coordinator Eric Goosby has been appointed as the new Chair of the Board of Directors of the International AIDS Vaccine Initiative (IAVI). He succeeds Alex Coutinho, who has chaired IAVI’s Board since December 2013 and who stepped down from the Board after nine years of service. The Board also appointed long-time member and distinguished life sciences industry executive Anne VanLent as Vice Chair. Following his election as Lord Speaker for the United Kingdom’s House of Lords the Rt. Hon. the Lord Norman Fowler has stepped down from the Board on which he served since 2013….

FDA [to 9 July 2016]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm

.
What’s New for Biologics
Vaccines for Use During Pregnancy to Protect Young Infants from Disease – FDA Update
Updated: 7/6/2015
DATE: June 30, 2016
TIME: 1:00pm EDT
LENGTH: 30 minutes
Did you know that vaccinating pregnant women may protect the mother and/or her infant from infectious diseases?
Vaccines, as with all products regulated by FDA, undergo a rigorous review of laboratory and clinical data to ensure their safety and effectiveness. Currently, there are no vaccines approved by FDA specifically for use during pregnancy to protect the infant.

On Thursday, June 30th, FDA hosted a webinar on the use of vaccines during pregnancy to benefit both the mother and the infant. Marion Gruber, PhD, Director, Office of Vaccines Research and Review with FDA’s Center for Biologics Evaluation and Research, discussed how vaccinating mothers during pregnancy may protect young infants against infectious diseases, the global interest in this topic, and the role of FDA in assuring these vaccines are safe and effective.

After the presentation, there was an opportunity to ask questions.
:: Presentation Slides: Vaccines For Use in Pregnancy to Protect Young Infants from Disease (PDF – 761KB)
:: View recorded webinar: https://collaboration.fda.gov/p3pn03mr0z6/

.

July 7, 2016 Approval Letter – FLUAD (PDF – 28KB)
Posted: 7/8/2016

July 1, 2016 Approval Letter – Flublok (PDF – 28KB)
Posted: 7/5/2016

July 1, 2016 Approval Letter – AFLURIA (PDF – 29KB)
Posted: 7/5/2016

July 1, 2016 Approval Letter – Flucelvax Quadrivalent (PDF – 29KB)
Posted: 7/5/2016

July 1, 2016 Approval Letter – FluMist Quadrivalent (PDF – 29KB)
Posted: 7/5/2016

July 1, 2016 Approval Letter – Fluvirin (PDF – 28KB)
Posted: 7/5/2016

July 1, 2016 Approval Letter – Fluarix Quadrivalent (PDF – 49KB)
Posted: 7/5/2016

July 1, 2016 Approval Letter – Fluzone Quadrivalent (PDF – 43KB)
Posted: 7/5/2016

July 1, 2016 Approval Letter – Fluzone (PDF – 43KB)
Posted: 7/5/2016

July 1, 2016 Approval Letter – FluLaval Quadrivalent (PDF – 43KB)
Posted: 7/5/2016

NIH [to 9 July 2016]
http://www.nih.gov/news-events/news-releases

.
July 6, 2016
NIH awards $55 million to build million-person precision medicine study
— Launch expected later this year

NIH funds Zika virus study involving U.S. Olympic team
July 5, 2016 — Researchers will monitor potential infections among group of U.S. athletes traveling to Brazil.

PREVAIL treatment trial for men with persistent Ebola viral RNA in semen opens in Liberia
July 5, 2016 — Six-month study will enroll 60 to 120 Ebola virus disease survivors.

EDCTP [to 9 July 2016]
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.
8 July 2016
EDCTP awards 2016 now open to nominations
The European & Developing Countries Clinical Trials Partnership (EDCTP) invites nominations to the following awards: Scientific Leadership Award, Outstanding Female…

6 July 2016
Announcement of 2016 calls for proposals
In 2016, EDCTP will launch nine calls for proposals to support clinical research and related activities. These calls are worth approximately € 138.6 M in research against poverty-related and neglected infectious diseases.
The launch of these calls follows from the approval of the EDCTP work plan for 2016 by the European Commission and the General Assembly of the EDCTP Association.

Fondation Merieux [to 9 July 2016]
Mission: Contribute to global health by strengthening local capacities of developing countries to reduce the impact of infectious diseases on vulnerable populations.
http://www.fondation-merieux.org/news

.
6 July 2016, Paris (France)
Grandes Tueuses: an on-line documentary series on the biggest public health threats The saga of 14 major killers told through 70 short films
Despite major advances, epidemics and pandemics continue to devastate human health and lives in the 21st century. Malnutrition, bacteria and viruses are the causes of the lethal diseases that the Grandes Tueuses (Big Killers) series tracks across the globe. The multimedia approach and portraits of patients, healthcare professionals and scientists make the series as entertaining as it is informative. Created for distribution via the web, the films are designed to raise public awareness and educate teams working in the field.

.

6 July 2016, Vientiane (Laos)
8th Annual GABRIEL Research Network Meeting in Laos
Scientists from 25 countries present research results on infectious diseases threatening developing countries.

European Vaccine Initiative [to 9 July 2016]
http://www.euvaccine.eu/news-events

.
News
Promotion at EVI
08 July 2016
Congratulations to Thorsten Kohaut, whose well deserved promotion to Chief Financial Officer came into effect on 1 May 2016.

News
EDCTP awards 2016 open for nominations
08 July 2016
The European & Developing Countries Clinical Trials’ Partnership (EDCTP) invites nominations to the following awards: Scientific Leadership Award, Outstanding Female Scientist Award and Outstanding Research Team Award.

News
EVI welcomes two new team members
07 July 2016
EVI extends a warm welcome to two new team members. Hilde Depraetere joined EVI on 1 July as Senior Project Manager, and yesterday 6 July Leah Williams commenced duties as Programme Manager Assistant.

Industry Watch [to 9 July 2016]
:: Sanofi Pasteur Signs Research Agreement for Zika Vaccine
July 06, 2016
– Walter Reed Army Institute of Research to transfer technology –
Paris, France – July 6, 2016 – Sanofi and its vaccines global business unit Sanofi Pasteur announced today a Cooperative Research and Development Agreement with the Walter Reed Army Institute of Research (WRAIR) on the co-development of a Zika vaccine candidate. According to the terms of the agreement, WRAIR will transfer its Zika purified inactivated virus (ZPIV) vaccine technology to Sanofi Pasteur, opening the door for a broader collaboration with the U.S. government.

The agreement also includes Sanofi Pasteur’s production of clinical material in compliance with current GMP (Good Manufacturing Practices) to support phase II testing, optimization of the upstream process to improve production yields, and characterization of the vaccine product. Sanofi Pasteur will also create a clinical development and regulatory strategy.

WRAIR will share data related to the development of immunologic assays designed to measure neutralizing antibody responses following natural infection and vaccination with ZPIV, biologic samples generated during the performance of non-human primate studies, and biologic samples generated during the performance of human safety and immunogenicity studies using ZPIV. WRAIR, the National Institute of Allergy and Infectious Diseases (NIAID)–part of the U.S. National Institutes of Health (NIH), and the Biomedical Advanced Research and Development Authority (BARDA)–part of the Health & Human Services (HHS) Office of the Assistant Secretary of Preparedness and Response–have been coordinating pre-clinical development of the candidate encouraged by new, pre-clinical research conducted by WRAIR and the Beth Israel Deaconess Medical Center1. NIAID will sponsor a series of phase 1 ZPIV trials while the technology transfer process is occurring.

“In addition to exploring our own vaccine technology used in our new dengue fever vaccine, we are looking at other pathways to get a Zika vaccine into the clinic as soon as possible. Therefore, this exciting collaboration with the WRAIR creates the opportunity to rapidly move forward,” said David Loew, Executive Vice President, Head of Sanofi Pasteur.

John Shiver, PhD, Sr. VP for R&D at Sanofi Pasteur, explained that while simultaneously working on the WRAIR technology, Sanofi Pasteur is performing pre-clinical studies, utilizing a technology previously and successfully developed for both its dengue fever and Japanese encephalitis vaccines. “Zika, Japanese encephalitis, and dengue belong to the same family of viruses (Flavivirus), are transmitted by the same type of mosquito, and share some similarities at the genetic level, and we already licensed vaccines against those flaviviruses.”

However, he continued, since that pathway will take longer to get a Zika vaccine candidate into the clinic, Sanofi Pasteur has been exploring partnerships with external experts to rapidly advance a vaccine candidate. “We’re looking at this from both a short- and long-term perspective, collaborating to get into the clinic quicker to provide a vaccine in response to the current emergency, and adapting our own technology to ensure production capacity of a vaccine for years to come.”…

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
5 July 2016, Vol. 165. No. 1
http://annals.org/issue.aspx

,
Original Research
Cost-Effectiveness of HIV Preexposure Prophylaxis for People Who Inject Drugs in the United States
Cora L. Bernard, MS; Margaret L. Brandeau, PhD; Keith Humphreys, PhD; Eran Bendavid, MD, MS; Mark Holodniy, MD; Christopher Weyant, MS; Douglas K. Owens, MD, MS; and Jeremy D. Goldhaber-Fiebert, PhD
Abstract
Background: The total population health benefits and costs of HIV preexposure prophylaxis (PrEP) for people who inject drugs (PWID) in the United States are unclear.
Objective: To evaluate the cost-effectiveness and optimal delivery conditions of PrEP for PWID.
Design: Empirically calibrated dynamic compartmental model.
Data Sources: Published literature and expert opinion.
Target Population: Adult U.S. PWID.
Time Horizon: 20 years and lifetime.
Intervention: PrEP alone, PrEP with frequent screening (PrEP+screen), and PrEP+screen with enhanced provision of antiretroviral therapy (ART) for individuals who become infected (PrEP+screen+ART). All scenarios are considered at 25% coverage.
Outcome Measures: Infections averted, deaths averted, change in HIV prevalence, discounted costs (in 2015 U.S. dollars), discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.
Results of Base-Case Analysis: PrEP+screen+ART dominates other strategies, averting 26 700 infections and reducing HIV prevalence among PWID by 14% compared with the status quo. Achieving these benefits costs $253 000 per QALY gained. At current drug prices, total expenditures for PrEP+screen+ART could be as high as $44 billion over 20 years.
Results of Sensitivity Analysis: Cost-effectiveness of the intervention is linear in the annual cost of PrEP and is dependent on PrEP drug adherence, individual transmission risks, and community HIV prevalence.
Limitation: Data on risk stratification and achievable PrEP efficacy levels for U.S. PWID are limited.
Conclusion: PrEP with frequent screening and prompt treatment for those who become infected can reduce HIV burden among PWID and provide health benefits for the entire U.S. population, but, at current drug prices, it remains an expensive intervention both in absolute terms and in cost per QALY gained.
Primary Funding Source: National Institute on Drug Abuse.

.

Reviews
Addressing Infection Prevention and Control in the First U.S. Community Hospital to Care for Patients With Ebola Virus Disease: Context for National Recommendations and Future Strategies
Kristin J. Cummings, MD, MPH; Mary J. Choi, MD, MPH; Eric J. Esswein, MSPH, CIH; Marie A. de Perio, MD; Joshua M. Harney, MS, CIH; Wendy M. Chung, MD, MS; David L. Lakey, MD; Allison M. Liddell, MD; and Pierre E. Rollin, MD
Abstract
Health care personnel (HCP) caring for patients with Ebola virus disease (EVD) are at increased risk for infection with the virus. In 2014, a Texas hospital became the first U.S. community hospital to care for a patient with EVD; 2 nurses were infected while providing care. This article describes infection control measures developed to strengthen the hospital’s capacity to safely diagnose and treat patients with EVD. After admission of the first patient with EVD, a multidisciplinary team from the Centers for Disease Control and Prevention (CDC) joined the hospital’s infection preventionists to implement a system of occupational safety and health controls for direct patient care, handling of clinical specimens, and managing regulated medical waste. Existing engineering and administrative controls were strengthened. The personal protective equipment (PPE) ensemble was standardized, HCP were trained on donning and doffing PPE, and a system of trained observers supervising PPE donning and doffing was implemented. Caring for patients with EVD placed substantial demands on a community hospital. The experiences of the authors and others informed national policies for the care of patients with EVD and protection of HCP, including new guidance for PPE, a rapid system for deploying CDC staff to assist hospitals (“Ebola Response Team”), and a framework for a tiered approach to hospital preparedness. The designation of regional Ebola treatment centers and the establishment of the National Ebola Training and Education Center address the need for HCP to be prepared to safely care for patients with EVD and other high-consequence emerging infectious diseases.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 9 July 2016)

.
Research article
Clinical and demographic correlates of medication and visit adherence in a large randomized controlled trial
Patient characteristics are associated with adherence, which has implications for planning clinical research or designing payment systems that reward superior outcomes. It is unclear to what extent clinician e…
Jeff Whittle, José-Miguel Yamal, Jeffrey D. Williamson, Charles E. Ford, Jeffrey L. Probstfield, Barbara L. Beard, Horia Marginean, Bruce P. Hamilton, Pamela S. Suhan and Barry R. Davis
BMC Health Services Research 2016 16:236
Published on: 8 July 2016

.

Research article
Organizational factors associated with Health Care Provider (HCP) influenza campaigns in the Veterans health care system: a qualitative study
It is an important goal to vaccinate a high proportion of health care providers (HCPs) against influenza, to prevent transmission to patients. Different aspects of how a HCP vaccination campaign is conducted m…
Zayd Razouki, Troy Knighton, Richard A. Martinello, Pamela R. Hirsch, Kathleen M. McPhaul, Adam J. Rose and Megan McCullough
BMC Health Services Research 2016 16:211
Published on: 4 July 2016

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 9 July 2016)

.
Commentary
Frugal innovation in medicine for low resource settings
Viet-Thi Tran and Philippe Ravaud
BMC Medicine 2016 14:102
Published on: 7 July 2016
Abstract
Whilst it is clear that technology is crucial to advance healthcare: innovation in medicine is not just about high-tech tools, new procedures or genome discoveries. In constrained environments, healthcare providers often create unexpected solutions to provide adequate healthcare to patients. These inexpensive but effective frugal innovations may be imperfect, but they have the power to ensure that health is within reach of everyone. Frugal innovations are not limited to low-resource settings: ingenuous ideas can be adapted to offer simpler and disruptive alternatives to usual care all around the world, representing the concept of “reverse innovation”. In this article, we discuss the different types of frugal innovations, illustrated with examples from the literature, and argue for the need to give voice to this neglected type of innovation in medicine.

.

Research article
Association between trial registration and treatment effect estimates: a meta-epidemiological study
Agnès Dechartres, Philippe Ravaud, Ignacio Atal, Carolina Riveros and Isabelle Boutron
BMC Medicine 2016 14:100
Published on: 4 July 2016
Abstract
Background
To increase transparency in research, the International Committee of Medical Journal Editors required, in 2005, prospective registration of clinical trials as a condition to publication. However, many trials remain unregistered or retrospectively registered. We aimed to assess the association between trial prospective registration and treatment effect estimates.
Methods
This is a meta-epidemiological study based on all Cochrane reviews published between March 2011 and September 2014 with meta-analyses of a binary outcome including three or more randomised controlled trials published after 2006. We extracted trial general characteristics and results from the Cochrane reviews. For each trial, we searched for registration in the report’s full text, contacted the corresponding author if not reported and searched ClinicalTrials.gov and the International Clinical Trials Registry Platform in case of no response. We classified each trial as prospectively registered (i.e. registered before the start date); retrospectively registered, distinguishing trials registered before and after the primary completion date; and not registered. Treatment effect estimates of prospectively registered and other trials were compared by the ratio of odds ratio (ROR) (ROR Results
We identified 67 meta-analyses (322 trials). Overall, 225/322 trials (70 %) were registered, 74 (33 %) prospectively and 142 (63 %) retrospectively; 88 were registered before the primary completion date and 54 after. Unregistered or retrospectively registered trials tended to show larger treatment effect estimates than prospectively registered trials (combined ROR = 0.81, 95 % CI 0.65–1.02, based on 32 contributing meta-analyses). Trials unregistered or registered after the primary completion date tended to show larger treatment effect estimates than those registered before this date (combined ROR = 0.84, 95 % CI 0.71–1.01, based on 43 contributing meta-analyses).
Conclusions
Lack of trial prospective registration may be associated with larger treatment effect estimates.

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 9 July 2016)

.
Research article
Economic interventions to improve population health: a scoping study of systematic reviews
Mishal S. Khan, Bernie Y. Guan, Jananie Audimulam, Francisco Cervero Liceras, Richard J. Coker and Joanne Yoong
BMC Public Health 2016 16:528
Published on: 7 July 2016
Abstract
Background
Recognizing the close relationship between poverty and health, national program managers, policy-makers and donors are increasingly including economic interventions as part of their core strategies to improve population health. However, there is often confusion among stakeholders about the definitions and operational differences between distinct types of economic interventions and financial instruments, which can lead to important differences in interpretation and expectations.
Methods
We conducted a scoping study to define and clarify concepts underlying key economic interventions – price interventions (taxes and subsidies), income transfer programs, incentive programs, livelihood support programs and health-related financial services – and map the evidence currently available from systematic reviews.
Results
We identified 195 systematic reviews on economic interventions published between 2005 and July 2015. Overall, there was an increase in the number of reviews published after 2010. The majority of reviews focused on price interventions, income transfer programs and incentive programs, with much less evidence available from systematic reviews on livelihood support programs and health-related financial services. We also identified a lack of evidence on: health outcomes in low income countries; unintended or perverse outcomes; implementation challenges; scalability and cost-effectiveness of economic interventions.
Conclusions
We conclude that while more research is clearly needed to assess suitability and effectiveness of economic interventions in different contexts, before interventions are tested and further systematic reviews conducted, a consistent and accurate understanding of the fundamental differences in terminology and approaches is essential among researchers, public health policy makers and program planners.

Bulletin of the World Health Organization
Volume 94, Number 7, July 2016, 481-556
http://www.who.int/bulletin/volumes/94/7/en/

.
EDITORIALS
Creating a supportive legal environment for universal health coverage
David Clarke, Dheepa Rajan & Gerard Schmets
http://dx.doi.org/10.2471/BLT.16.173591
[Initial text]
In this edition of the Bulletin, Marks-Sultan et al.1 propose that the World Health Organization (WHO) should provide capacity-building for drafting health laws in Member States. They highlight that WHO has the authority and credibility to work with countries to make their national laws easier to access, understand, monitor and evaluate. WHO’s new technical support work related to universal health coverage (UHC) laws is a good example of its support for Member States in this important area.
Strengthening countries’ legal and regulatory frameworks and engaging in universal health coverage-compliant law reforms has been missing from the universal health coverage agenda. WHO calls on Member States to align their health system policies with universal health coverage goals such as equity, efficiency, health service quality and financial risk protection. Strengthening health systems using health laws and legal frameworks is a pivotal means for attaining these goals2 and achieving sustainable results in health security and resilience…

EDITORIALS
Improving reporting of health estimates
Gretchen A Stevens, Daniel R Hogan & Ties Boerma
http://dx.doi.org/10.2471/BLT.16.179259

RESEARCH
Health policy and systems research training: global status and recommendations for action
Tara M Tancred, Meike Schleiff, David H Peters & Dina Balabanova
http://dx.doi.org/10.2471/BLT.15.162818
Objective
To investigate the characteristics of health policy and systems research training globally and to identify recommendations for improvement and expansion.
Methods
We identified institutions offering health policy and systems research training worldwide. In 2014, we recruited participants from identified institutions for an online survey on the characteristics of the institutions and the courses given. Survey findings were explored during in-depth interviews with selected key informants.
Findings
The study identified several important gaps in health policy and systems research training. There were few courses in central and eastern Europe, the Middle East, North Africa or Latin America. Most (116/152) courses were instructed in English. Institutional support for courses was often lacking and many institutions lacked the critical mass of trained individuals needed to support doctoral and postdoctoral students. There was little consistency between institutions in definitions of the competencies required for health policy and systems research. Collaboration across disciplines to provide the range of methodological perspectives the subject requires was insufficient. Moreover, the lack of alternatives to on-site teaching may preclude certain student audiences such as policy-makers.
Conclusion
Training in health policy and systems research is important to improve local capacity to conduct quality research in this field. We provide six recommendations to improve the content, accessibility and reach of training. First, create a repository of information on courses. Second, establish networks to support training. Third, define competencies in health policy and systems research. Fourth, encourage multidisciplinary collaboration. Fifth, expand the geographical and language coverage of courses. Finally, consider alternative teaching formats.

PERSPECTIVES
Research capacity for sexual and reproductive health and rights
Rita Kabra, Moazzam Ali, A Metin Gulmezoglu & Lale Say
http://dx.doi.org/10.2471/BLT.15.163261
[Initial text]
Research is important for improving health outcomes and is a critical element of a functioning health system. Without locally generated data and analysis, well-intentioned programmes do not often respond to the realities where they are implemented.1 Hence strengthening research capacity in low-and middle-income countries is one of the most powerful, cost–effective and sustainable measures of advancing health, health care and development.2
The world health report 2013: research for universal health coverage referred to research capacity as “the abilities of individuals, institutions and networks, nationally and internationally, to undertake and disseminate research findings of the highest quality”.3 The report provides examples of efforts that build research capacity by national and international agencies focusing on the particular element of capacity building. However, best results in capacity building are obtained when there are interactions between individuals, institutions and networks to support research. For example, graduate and postgraduate training are more likely to be effective when the host institutions are also strong.3
Since 1990 the number of initiatives on strengthening research capacity in low- and middle-income countries has increased to over 300.4 However, in many countries there is still insufficient capacity to engage in research that will influence evidence-based policies and programming at country level.5 Lack of funding, expertise in preparing manuscripts for publication6 and protected time for research pursuits, as well as the infrastructure of institutions, are key constraints faced by researchers.7…

Developing World Bioethics
August 2016 Volume 16, Issue 2 Pages 61–120
http://onlinelibrary.wiley.com/doi/10.1111/dewb.2016.16.issue-2/issuetoc

.
EDITORIAL
Zika virus, women and ethics (pages 62–63)
Debora Diniz
Version of Record online: 5 JUL 2016 | DOI: 10.1111/dewb.12119
[No abstract]

.

ORIGINAL ARTICLES
The Challenges of Research Informed Consent in Socio-Economically Vulnerable Populations: A Viewpoint From the Democratic Republic of Congo (pages 64–69)
Marion Kalabuanga, Raffaella Ravinetto, Vivi Maketa, Hypolite Muhindo Mavoko, Blaise Fungula, Raquel Inocêncio da Luz, Jean-Pierre Van Geertruyden and Pascal Lutumba
Version of Record online: 7 SEP 2015 | DOI: 10.1111/dewb.12090
Abstract
In medical research, the ethical principle of respect for persons is operationalized into the process of informed consent. The consent tools should be contextualized and adapted to the different socio-cultural environment, especially when research crosses the traditional boundaries and reaches poor communities. We look at the challenges experienced in the malaria Quinact trial, conducted in the Democratic Republic of Congo, and describe some lessons learned, related to the definition of acceptable representative, the role of independent witness and the impact of socio-economic vulnerability.
To ensure children’s protection, consent is required by the parents or, in their absence, by a legally mandated representative. In our setting, children’s responsibility is often entrusted permanently or temporarily to relatives or friends without a tribunal mandate. Hence, a notion of ‘culturally acceptable representative’ under supervision of the local Ethics Committee may be more suitable.
To ensure protection of illiterate subjects, an independent witness is required to confirm that the consent was freely given. However, in low-literacy contexts, potential witnesses often don’t have any previous relationship with patient and there may be power-unbalance in their relationship, rather than genuine dialogue.
In poor communities, trial participation may be seen as an opportunity to secure access to healthcare. Poverty may also lead to ‘competition’ to access the research-related benefits, with a risk of disturbance at societal or household level.
Adjusting consent procedures to sociocultural and socioeconomic realities is essential for fulfilling the underlying ethical principles. This requires a collaborative dialogue between researchers, regulators and ethics committees.

.

ORIGINAL ARTICLES
Attitudes toward Post-Trial Access to Medical Interventions: A Review of Academic Literature, Legislation, and International Guidelines (pages 70–79)
Kori Cook, Jeremy Snyder and John Calvert
Version of Record online: 5 JUN 2015 | DOI: 10.1111/dewb.12087
Abstract
There is currently no international consensus around post-trial obligations toward research participants, community members, and host countries. This literature review investigates arguments and attitudes toward post-trial access. The literature review found that academic discussions focused on the rights of research participants, but offered few practical recommendations for addressing or improving current practices. Similarly, there are few regulations or legislation pertaining to post-trial access. If regulatory changes are necessary, we need to understand the current arguments, legislation, and attitudes towards post-trial access and participants and community members. Given that clinical trials conducted in low-income countries will likely continue, there is an urgent need for consideration of post-trial benefits for participants, communities, and citizens of host countries. While this issue may not be as pressing in countries where participants have access to healthcare and medicines through public schemes, it is particularly important in regions where this may not be available.

Emerging Infectious Diseases
Volume 22, Number 7—July 2016
http://wwwnc.cdc.gov/eid/

.
Synopses
A Literature Review of Zika Virus PDF Version [PDF – 800 KB – 8 pages]
A. R. Plourde and E. M. Bloch
Abstract
Zika virus is a mosquitoborne flavivirus that is the focus of an ongoing pandemic and public health emergency. Previously limited to sporadic cases in Africa and Asia, the emergence of Zika virus in Brazil in 2015 heralded rapid spread throughout the Americas. Although most Zika virus infections are characterized by subclinical or mild influenza-like illness, severe manifestations have been described, including Guillain-Barre syndrome in adults and microcephaly in babies born to infected mothers. Neither an effective treatment nor a vaccine is available for Zika virus; therefore, the public health response primarily focuses on preventing infection, particularly in pregnant women. Despite growing knowledge about this virus, questions remain regarding the virus’s vectors and reservoirs, pathogenesis, genetic diversity, and potential synergistic effects of co-infection with other circulating viruses. These questions highlight the need for research to optimize surveillance, patient management, and public health intervention in the current Zika virus epidemic.

Epidemics
Volume 16, In Progress (September 2016)
http://www.sciencedirect.com/science/journal/17554365

.
Regular Articles
Using age-stratified incidence data to examine the transmission consequences of pertussis vaccination
Original Research Article
Pages 1-7
J.C. Blackwood, D.A.T. Cummings, S. Iamsirithaworn, P. Rohani
Abstract
Pertussis is a highly infectious respiratory disease that has been on the rise in many countries worldwide over the past several years. The drivers of this increase in pertussis incidence remain hotly debated, with a central and long-standing hypothesis that questions the ability of vaccines to eliminate pertussis transmission rather than simply modulate the severity of disease. In this paper, we present age-structured case notification data from all provinces of Thailand between 1981 and 2014, a period during which vaccine uptake rose substantially, permitting an evaluation of the transmission impacts of vaccination. Our analyses demonstrate decreases in incidence across all ages with increased vaccine uptake – an observation that is at odds with pertussis case notification data in a number of other countries. To explore whether these observations are consistent with a rise in herd immunity and a reduction in bacterial transmission, we analyze an age-structured model that incorporates contrasting hypotheses concerning the immunological and transmission consequences of vaccines. Our results lead us to conclude that the most parsimonious explanation for the combined reduction in incidence and the shift to older age groups in the Thailand data is vaccine-induced herd immunity.

Eurosurveillance
Volume 21, Issue 27, 07 July 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

.
Rapid communications
An ongoing measles outbreak linked to a suspected imported case, Ireland, April to June 2016
by P Barrett, K Chaintarli, F Ryan, S Cotter, A Cronin, L Carlton, M MacSweeney, M McDonnell, J Connell, R Fitzgerald, D Hamilton, M Ward, R Glynn, C Migone

.

Research Articles
Sustained low rotavirus activity and hospitalisation rates in the post-vaccination era in Belgium, 2007 to 2014
by M Sabbe, N Berger, A Blommaert, B Ogunjimi, T Grammens, M Callens, K Van Herck, P Beutels, P Van Damme, J Bilcke

Global Public Health
Volume 11, Issue 7-8, 2016
http://www.tandfonline.com/toc/rgph20/current
Special Issue: The trouble with ‘Categories’: Rethinking men who have sex with men, transgender and their equivalents in HIV prevention and health promotion

.
Introduction
The trouble with ‘Categories’: Rethinking men who have sex with men, transgender and their equivalents in HIV prevention and health promotion
pages 819-823
Richard Parker, Peter Aggleton & Amaya G. Perez-Brumer
ABSTRACT
This double Special Issue of Global Public Health presents a collection of articles that seek more adequately to represent sexual and gender diversities and to begin to rethink the relationship to HIV prevention and health promotion – in both the resource rich nations of the global North, as well as in the more resource constrained nations of the global South. Reckoning with the reality that today the global response to HIV has failed to respond to the needs of gay, bisexual and other men who have sex with men, and transgender persons, we turn our attention to processes and practices of categorisation and classification, and the entanglement of the multiple social worlds that constitute our understanding of each of these categories and people within the categories. Jointly, these articles provide critical perspectives on how defining and redefining categories may impact the conceptual frameworks and empirical evidence that inform global understandings of HIV infection, those communities most vulnerable, and our collective response to the evolving HIV epidemic.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 9 July 2016]

.
Review
Why might regional vaccinology networks fail? The case of the Dutch-Nordic Consortium
Jan Hendriks and Stuart Blume
Globalization and Health 2016 12:38
Published on: 7 July 2016
Abstract
We analyzed an attempt to develop and clinically test a pneumococcal conjugate vaccine for the developing world, undertaken by public health institutions from the Netherlands, Sweden, Denmark, Norway and Finland: the Dutch Nordic Consortium (DNC), between 1990 and 2000. Our review shows that the premature termination of the project was due less to technological and scientific challenges and more to managerial challenges and institutional policies. Various impeding events, financial and managerial challenges gradually soured the initially enthusiastic collaborative spirit until near the end the consortium struggled to complete the minimum objectives of the project. By the end of 1998, a tetravalent prototype vaccine had been made that proved safe and immunogenic in Phase 1 trials in adults and toddlers in Finland. The planned next step, to test the vaccine in Asia in infants, did not meet approval by the local authorities in Vietnam nor later in the Philippines and the project eventually stopped.
The Dutch DNC member, the National Institute of Public Health and the Environment (RIVM) learned important lessons, which subsequently were applied in a following vaccine technology transfer project, resulting in the availability at affordable prices for the developing world of a conjugate vaccine against Haemophilus influenzae type b. We conclude that vaccine development in the public domain with technology transfer as its ultimate aim requires major front-end funding, committed leadership at the highest institutional level sustained for many years and a competent recipient-manufacturer, which needs to be involved at a very early stage of the development.
At the national level, RIVM’s policy to consolidate its national manufacturing task through securing a key global health position in support of a network of public vaccine manufacturers proved insufficiently supported by the relevant ministries of the Dutch government. Difficulties to keep up with high costs, high-risk innovative vaccine development and production in a public sector setting led to the gradual loss of production tasks and to the 2009 Government decision to privatize the vaccine production tasks of the Institute.

JAMA Pediatrics
July 2016, Vol 170, No. 7
http://archpedi.jamanetwork.com/issue.aspx

.
Viewpoint
Real-Time Sharing of Zika Virus Data in an Interconnected World FREE
Esper G. Kallas, MD, PhD; David H. O’Connor, PhD

.

Viewpoint
Leveraging Behavioral Insights to Promote Vaccine Acceptance: One Year After Disneyland
Alison M. Buttenheim, PhD, MBA; David A. Asch, MD, MBA
Extract
This Viewpoint discusses several approaches to increase vaccination acceptance in the United States 1 year after the measles outbreak that originated in Disneyland and has been attributed to parents who chose not to vaccinate their children.

An outbreak of measles originating in Disneyland in December 2014 that ultimately led to more than 100 cases has been attributed to parents who chose not to vaccinate their children. One year later, the United States remains vulnerable to outbreaks of vaccine-preventable diseases because parents continue to bypass the recommended childhood immunization schedule through exemptions from state-mandated immunizations at school entry. These personal choices affect everyone by weakening the herd immunity conferred by widespread vaccination…

Journal of Epidemiology & Community Health
July 2016, Volume 70, Issue 7
http://jech.bmj.com/content/current
Health inequalities
Trends in socioeconomic inequalities in self-assessed health in 17 European countries between 1990 and 2010
Yannan Hu, Frank J van Lenthe, Gerard J Borsboom, Caspar W N Looman, Matthias Bopp, Bo Burström, Dagmar Dzúrová, Ola Ekholm, Jurate Klumbiene, Eero Lahelma, Mall Leinsalu, Enrique Regidor, Paula Santana, Rianne de Gelder, Johan P Mackenbach
J Epidemiol Community Health 2016;70:644-652 Published Online First: 19 January 2016 doi:10.1136/jech-2015-206780
Abstract
Background Between the 1990s and 2000s, relative inequalities in all-cause mortality increased, whereas absolute inequalities decreased in many European countries. Whether similar trends can be observed for inequalities in other health outcomes is unknown. This paper aims to provide a comprehensive overview of trends in socioeconomic inequalities in self-assessed health (SAH) in Europe between 1990 and 2010.
Methods Data were obtained from nationally representative surveys from 17 European countries for the various years between 1990 and 2010. The age-standardised prevalence of less-than-good SAH was analysed by education and occupation among men and women aged 30–79 years. Socioeconomic inequalities were measured by means of absolute rate differences and relative rate ratios. Meta-analysis with random-effects models was used to examine the trends of inequalities.
Results We observed declining trends in the prevalence of less-than-good SAH in many countries, particularly in Southern and Eastern Europe and the Baltic states. In all countries, less-than-good SAH was more prevalent in lower educational and manual groups. For all countries together, absolute inequalities in SAH were mostly constant, whereas relative inequalities increased. Almost no country consistently experienced a significant decline in either absolute or relative inequalities.
Conclusions Trends in inequalities in SAH in Europe were generally less favourable than those found for inequalities in mortality, and there was generally no correspondence between the two when we compared the trends within countries. In order to develop policies or interventions that effectively reduce inequalities in SAH, a better understanding of the causes of these inequalities is needed.

Journal of Medical Internet Research
Vol 18, No 7 (2016): July
http://www.jmir.org/2016/7

.
Viewpoint
Are Randomized Controlled Trials the (G)old Standard? From Clinical Intelligence to Prescriptive Analytics
J Med Internet Res 2016 (Jul 06); 18(7):e185
Sven Van Poucke, Michiel Thomeer, John Heath, Milan Vukicevic
ABSTRACT
Despite the accelerating pace of scientific discovery, the current clinical research enterprise does not sufficiently address pressing clinical questions. Given the constraints on clinical trials, for a majority of clinical questions, the only relevant data available to aid in decision making are based on observation and experience. Our purpose here is 3-fold. First, we describe the classic context of medical research guided by Poppers’ scientific epistemology of “falsificationism.” Second, we discuss challenges and shortcomings of randomized controlled trials and present the potential of observational studies based on big data. Third, we cover several obstacles related to the use of observational (retrospective) data in clinical studies. We conclude that randomized controlled trials are not at risk for extinction, but innovations in statistics, machine learning, and big data analytics may generate a completely new ecosystem for exploration and validation.

The Lancet
Jul 09, 2016 Volume 388 Number 10040 p103-210 e1-e2
http://www.thelancet.com/journals/lancet/issue/current

.
Editorial
Indigenous health: a worldwide focus
The Lancet
Summary
If you are a member of the Baka, an Indigenous tribe in Cameroon, you can expect to live until you are aged about 35 years, which is about 12 years less than for the non-Indigenous people there. In Greenland you would be better off, at 73 years, but nonetheless this figure is 9 years less than that for the Danish population. Such discrepancies are recognised, but now we have such data for all regions of the world.

.

Comment
Addressing global health disparities among Indigenous peoples
Laurence J Kirmayer, Gregory Brass
Summary
In countries around the world, Indigenous peoples face great social disadvantages and poor health compared with the general population.1,2 In The Lancet, Ian Anderson and colleagues3 have documented significant disparities among 28 Indigenous populations from 23 countries compared with benchmark populations for several variables, including life expectancy at birth, maternal and infant mortality, and frequency of low birthweight and high birthweight infants. They also showed differences for Indigenous peoples in measures related to nutrition (eg, child malnutrition, childhood obesity, and adult obesity), and in key social indicators, including educational attainment and economic status.

.

Polio vaccination: preparing for a change of routine
Edward P K Parker, Nicholas C Grassly
Summary
The Global Polio Eradication Initiative is on the brink of a major milestone. As of April, 2016, the serotype 2 component of oral poliovirus vaccine (OPV) will be removed from all immunisation activities worldwide. This transition, which is the first step in the synchronised withdrawal of all OPV serotypes, is essential to the polio endgame strategy. Although wild type 2 polioviruses have not caused a case of paralytic disease since 1999, vaccine viruses of this serotype have continued to cause rare cases of vaccine-associated paralytic poliomyelitis in OPV recipients or their close contacts,1 and sporadic emergences of circulating vaccine-derived polioviruses, wherein Sabin poliovirus strains mutate to regain neurovirulence.

.

Articles
Indigenous and tribal peoples’ health (The Lancet–Lowitja Institute Global Collaboration): a population study
Ian Anderson, Bridget Robson, Michele Connolly, Fadwa Al-Yaman, Espen Bjertness, Alexandra King, Michael Tynan, Richard Madden, Abhay Bang, Carlos E A Coimbra Jr, Maria Amalia Pesantes, Hugo Amigo, Sergei Andronov, Blas Armien, Daniel Ayala Obando, Per Axelsson, Zaid Shakoor Bhatti, Zulfiqar Ahmed Bhutta, Peter Bjerregaard, Marius B Bjertness, Roberto Briceno-Leon, Ann Ragnhild Broderstad, Patricia Bustos, Virasakdi Chongsuvivatwong, Jiayou Chu, Deji, Jitendra Gouda, Rachakulla Harikumar, Thein Thein Htay, Aung Soe Htet, Chimaraoke Izugbara, Martina Kamaka, Malcolm King, Mallikharjuna Rao Kodavanti, Macarena Lara, Avula Laxmaiah, Claudia Lema, Ana María León Taborda, Tippawan Liabsuetrakul, Andrey Lobanov, Marita Melhus, Indrapal Meshram, J Jaime Miranda, Thet Thet Mu, Balkrishna Nagalla, Arlappa Nimmathota, Andrey Ivanovich Popov, Ana María Peñuela Poveda, Faujdar Ram, Hannah Reich, Ricardo V Santos, Aye Aye Sein, Chander Shekhar, Lhamo Y Sherpa, Peter Skold, Sofia Tano, Asahngwa Tanywe, Chidi Ugwu, Fabian Ugwu, Patama Vapattanawong, Xia Wan, James R Welch, Gonghuan Yang, Zhaoqing Yang, Leslie Yap
Summary
Background
International studies of the health of Indigenous and tribal peoples provide important public health insights. Reliable data are required for the development of policy and health services. Previous studies document poorer outcomes for Indigenous peoples compared with benchmark populations, but have been restricted in their coverage of countries or the range of health indicators. Our objective is to describe the health and social status of Indigenous and tribal peoples relative to benchmark populations from a sample of countries.
Methods
Collaborators with expertise in Indigenous health data systems were identified for each country. Data were obtained for population, life expectancy at birth, infant mortality, low and high birthweight, maternal mortality, nutritional status, educational attainment, and economic status. Data sources consisted of governmental data, data from non-governmental organisations such as UNICEF, and other research. Absolute and relative differences were calculated.
Findings
Our data (23 countries, 28 populations) provide evidence of poorer health and social outcomes for Indigenous peoples than for non-Indigenous populations. However, this is not uniformly the case, and the size of the rate difference varies. We document poorer outcomes for Indigenous populations for: life expectancy at birth for 16 of 18 populations with a difference greater than 1 year in 15 populations; infant mortality rate for 18 of 19 populations with a rate difference greater than one per 1000 livebirths in 16 populations; maternal mortality in ten populations; low birthweight with the rate difference greater than 2% in three populations; high birthweight with the rate difference greater than 2% in one population; child malnutrition for ten of 16 populations with a difference greater than 10% in five populations; child obesity for eight of 12 populations with a difference greater than 5% in four populations; adult obesity for seven of 13 populations with a difference greater than 10% in four populations; educational attainment for 26 of 27 populations with a difference greater than 1% in 24 populations; and economic status for 15 of 18 populations with a difference greater than 1% in 14 populations.
Interpretation
We systematically collated data across a broader sample of countries and indicators than done in previous studies. Taking into account the UN Sustainable Development Goals, we recommend that national governments develop targeted policy responses to Indigenous health, improving access to health services, and Indigenous data within national surveillance systems.
Funding
The Lowitja Institute.

.

Humoral and intestinal immunity induced by new schedules of bivalent oral poliovirus vaccine and one or two doses of inactivated poliovirus vaccine in Latin American infants: an open-label randomised controlled trial
Edwin J Asturias, Ananda S Bandyopadhyay, Steve Self, Luis Rivera, Xavier Saez-Llorens, Eduardo Lopez, Mario Melgar, James T Gaensbauer, William C Weldon, M Steven Oberste, Bhavesh R Borate, Chris Gast, Ralf Clemens, Walter Orenstein, Miguel O’Ryan G, José Jimeno, Sue Ann Costa Clemens, Joel Ward, Ricardo Rüttimann, Latin American IPV001BMG Study Group
Summary
Background
Replacement of the trivalent oral poliovirus vaccine (tOPV) with bivalent types 1 and 3 oral poliovirus vaccine (bOPV) and global introduction of inactivated poliovirus vaccine (IPV) are major steps in the polio endgame strategy. In this study, we assessed humoral and intestinal immunity in Latin American infants after three doses of bOPV combined with zero, one, or two doses of IPV.
Methods
This open-label randomised controlled multicentre trial was part of a larger study. 6-week-old full-term infants due for their first polio vaccinations, who were healthy on physical examination, with no obvious medical conditions and no known chronic medical disorders, were enrolled from four investigational sites in Colombia, Dominican Republic, Guatemala, and Panama. The infants were randomly assigned by permuted block randomisation (through the use of a computer-generated list, block size 36) to nine groups, of which five will be discussed in this report. These five groups were randomly assigned 1:1:1:1 to four permutations of schedule: groups 1 and 2 (control groups) received bOPV at 6, 10, and 14 weeks; group 3 (also a control group, which did not count as a permutation) received tOPV at 6, 10, and 14 weeks; group 4 received bOPV plus one dose of IPV at 14 weeks; and group 5 received bOPV plus two doses of IPV at 14 and 36 weeks. Infants in all groups were challenged with monovalent type 2 vaccine (mOPV2) at 18 weeks (groups 1, 3, and 4) or 40 weeks (groups 2 and 5). The primary objective was to assess the superiority of bOPV–IPV schedules over bOPV alone, as assessed by the primary endpoints of humoral immunity (neutralising antibodies—ie, seroconversion) to all three serotypes and intestinal immunity (faecal viral shedding post-challenge) to serotype 2, analysed in the per-protocol population. Serious and medically important adverse events were monitored for up to 6 months after the study vaccination. This study is registered with ClinicalTrials.gov, number NCT01831050, and has been completed.
Findings
Between May 20, 2013, and Aug 15, 2013, 940 eligible infants were enrolled and randomly assigned to the five treatment groups (210 to group 1, 210 to group 2, 100 to group 3, 210 to group 4, and 210 to group 5). One infant in group 1 was not vaccinated because their parents withdrew consent after enrolment and randomisation, so 939 infants actually received the vaccinations. Three doses of bOPV or tOPV elicited type 1 and 3 seroconversion rates of at least 97·7%. Type 2 seroconversion occurred in 19 of 198 infants (9·6%, 95% CI 6·2–14·5) in the bOPV-only groups, 86 of 88 (97·7%, 92·1–99·4) in the tOPV-only group (p<0·0001 vs bOPV-only), and 156 of 194 (80·4%, 74·3–85·4) infants in the bOPV–one dose of IPV group (p<0·0001 vs bOPV-only). A further 20 of 193 (10%) infants in the latter group seroconverted 1 week after mOPV2 challenge, resulting in around 98% of infants being seropositive against type 2. After a bOPV–two IPV schedule, all 193 infants (100%, 98·0–100; p<0·0001 vs bOPV-only) seroconverted to type 2. IPV induced small but significant decreases in a composite serotype 2 viral shedding index after mOPV2 challenge. 21 serious adverse events were reported in 20 patients during the study, including two that were judged to be possibly related to the vaccines. Most of the serious adverse events (18 [86%] of 21) and 24 (80%) of the 30 important medical events reported were infections and infestations. No deaths occurred during the study.
Interpretation
bOPV provided humoral protection similar to tOPV against polio serotypes 1 and 3. After one or two IPV doses in addition to bOPV, 80% and 100% of infants seroconverted, respectively, and the vaccination induced a degree of intestinal immunity against type 2 poliovirus.
Funding
Bill & Melinda Gates Foundation.

.

Review
The global response to HIV in men who have sex with men
Chris Beyrer, Stefan D Baral, Chris Collins, Eugene T Richardson, Patrick S Sullivan, Jorge Sanchez, Gift Trapence, Elly Katabira, Michel Kazatchkine, Owen Ryan, Andrea L Wirtz, Kenneth H Mayer
Summary
Gay, bisexual, and other men who have sex with men (MSM) continue to have disproportionately high burdens of HIV infection in countries of low, middle, and high income in 2016. 4 years after publication of a Lancet Series on MSM and HIV, progress on reducing HIV incidence, expanding sustained access to treatment, and realising human rights gains for MSM remains markedly uneven and fraught with challenges. Incidence densities in MSM are unacceptably high in countries as diverse as China, Kenya, Thailand, the UK, and the USA, with substantial disparities observed in specific communities of MSM including young and minority populations. Although some settings have achieved sufficient coverage of treatment, pre-exposure prophylaxis (PrEP), and human rights protections for sexual and gender minorities to change the trajectory of the HIV epidemic in MSM, these are exceptions. The roll-out of PrEP has been notably slow and coverage nowhere near what will be required for full use of this new preventive approach. Despite progress on issues such as marriage equality and decriminalisation of same-sex behaviour in some countries, there has been a marked increase in anti-gay legislation in many countries, including Nigeria, Russia, and The Gambia. The global epidemic of HIV in MSM is ongoing, and global efforts to address it remain insufficient. This must change if we are ever to truly achieve an AIDS-free generation.

.

Viewpoint
Who’s been left behind? Why sustainable development goals fail the Arab world
Abbas El-Zein, Jocelyn DeJong, Philippe Fargues, Nisreen Salti, Adam Hanieh, Helen Lackner
Summary
A set of Sustainable Development Goals (SDGs) was adopted by the UN General Assembly in September, 2015. The Arab world, alongside other regions, has problems of poverty, poor health, and substantial environmental degradation—ie, the kind of problems that the SDGs aim to address.1–5 Evidence of persistent infectious disease in low-income and middle-income Arab countries exists, alongside increased prevalence of non-communicable diseases in all Arab countries,6,7 high out-of-pocket health expenditure,8 poor access to safe water, as well as violent conflict, persistent foreign interventions, and high levels of social and political fragmentation that result in weak health systems and diminished rights to health.

The Lancet Infectious Diseases
Jul 2016 Volume 16 Number 7 p753-866 e108-e138
http://www.thelancet.com/journals/laninf/issue/current

.
Editorial
Yellow fever: the consequences of neglect
The Lancet Infectious Diseases
Summary
Yellow fever is a vector-borne viral disease endemic to Africa and Americas that represented a major challenge for public health until the early 1930s, when a vaccine was developed. Mass immunisation campaigns have greatly reduced its incidence and now yellow fever is mainly reported in small outbreaks in tropical forests where it is maintained through a sylvatic cycle involving monkeys as a natural reservoir. Yet, it was known that an urban outbreak of yellow fever in a large city in the tropics would present challenges for control because such setting combines many and diverse risk factors for the disease, such as high population density, frail public-health infrastructures, and high density of mosquitoes.

.

Articles
Testing the hypothesis that treatment can eliminate HIV: a nationwide, population-based study of the Danish HIV epidemic in men who have sex with men
Justin T Okano, Danielle Robbins, Laurence Palk, Jan Gerstoft, Niels Obel, Sally Blower

.

Prevalence and burden of HCV co-infection in people living with HIV: a global systematic review and meta-analysis
Lucy Platt, Philippa Easterbrook, Erin Gower, Bethan McDonald, Keith Sabin, Catherine McGowan, Irini Yanny, Homie Razavi, Peter Vickerman

Lancet Global Health
Jul 2016 Volume 4 Number 7 e427-e501
http://www.thelancet.com/journals/langlo/issue/current
Editorial
The right(s) approach to Zika
The Lancet Global Health
Summary
The Zika virus epidemic is spreading: 63 countries are now reporting transmission, over 1500 cases of related microcephaly or CNS malformations have been confirmed this year, and knowledge on the disease is advancing slowly. Adding to the tension around Zika, at the epicentre of the outbreak, Brazil is bracing for a large-scale mass gathering: the Olympic and Paralympic Games 2016 in Rio de Janeiro. Conflicting opinions on the need to postpone or cancel the Games have been expressed, but during the 69th World Health Assembly last month, the WHO issued clear public health advice on the matter: the Games will not significantly change the international spread of the virus and travellers can reduce their risk of contracting the disease by following simple prevention measures such as avoiding mosquito bites with repellents and adequate clothing, practising safe sex, staying in air-conditioned housing, and avoiding areas with poor water and sanitation.

.

Comment
Global disparities in HPV vaccination
Ophira Ginsburg
Summary
Cervical cancer is the fourth most common cancer in women globally, but remains the second most common cancer (after breast cancer) in many low-income and middle-income countries, and is still more common than breast cancer in sub-Saharan Africa.1 Most new cervical cancer cases (85%) and deaths (88%) occur in low-income and middle-income countries, where health systems are often fragmented or fragile, and where most have not yet implemented effective national cervical cancer screening programmes.

.

Articles
Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis
Laia Bruni, Mireia Diaz, Leslie Barrionuevo-Rosas, Rolando Herrero, Freddie Bray, F Xavier Bosch, Silvia de Sanjosé, Xavier Castellsagué
Summary
Background
Since 2006, many countries have implemented publicly funded human papillomavirus (HPV) immunisation programmes. However, global estimates of the extent and impact of vaccine coverage are still unavailable. We aimed to quantify worldwide cumulative coverage of publicly funded HPV immunisation programmes up to 2014, and the potential impact on future cervical cancer cases and deaths.
Methods
Between Nov 1 and Dec 22, 2014, we systematically reviewed PubMed, Scopus, and official websites to identify HPV immunisation programmes worldwide, and retrieved age-specific HPV vaccination coverage rates up to October, 2014. To estimate the coverage and number of vaccinated women, retrieved coverage rates were converted into birth-cohort-specific rates, with an imputation algorithm to impute missing data, and applied to global population estimates and cervical cancer projections by country and income level.
Findings
From June, 2006, to October, 2014, 64 countries nationally, four countries subnationally, and 12 overseas territories had implemented HPV immunisation programmes. An estimated 118 million women had been targeted through these programmes, but only 1% were from low-income or lower-middle-income countries. 47 million women (95% CI 39–55 million) received the full course of vaccine, representing a total population coverage of 1·4% (95% CI 1·1–1·6), and 59 million women (48–71 million) had received at least one dose, representing a total population coverage of 1·7% (1·4–2·1). In more developed regions, 33·6% (95% CI 25·9–41·7) of females aged 10–20 years received the full course of vaccine, compared with only 2·7% (1·8–3·6) of females in less developed regions. The impact of the vaccine will be higher in upper-middle-income countries (178,192 averted cases by age 75 years) than in high-income countries (165,033 averted cases), despite the lower number of vaccinated women (13·3 million vs 32·2 million).
Interpretation
Many women from high-income and upper-middle-income countries have been vaccinated against HPV. However, populations with the highest incidence and mortality of disease remain largely unprotected. Rapid roll-out of the vaccine in low-income and middle-income countries might be the only feasible way to narrow present inequalities in cervical cancer burden and prevention.
Funding
PATH, Instituto de Salud Carlos III, and Agència de Gestió d’Ajuts Universitaris i de Recerca (AGAUR)

Nature Medicine
July 2016, Volume 22 No 7 pp693-705
http://www.nature.com/nm/journal/v22/n6/index.html

.
Editorial
Vouching for access – p693
doi:10.1038/nm.4151
The US Food and Drug Administration’s priority review voucher system for drugs to treat neglected disease has come under scrutiny for lacking preconditions that ensure fair pricing of the products that they aim to usher forward. That loophole needs to be closed.

Commentary
A roadmap for MERS-CoV research and product development: report from a World Health Organization consultation – pp701 – 705
Kayvon Modjarrad, Vasee S Moorthy, Peter Ben Embarek, Maria Van Kerkhove, Jerome Kim & Marie-Paule Kieny
doi:10.1038/nm.4131
As part of the World Health Organization (WHO) R&D Blueprint initiative, leading stakeholders on Middle East respiratory syndrome coronavirus (MERS-CoV) convened to agree on strategic public-health goals and global priority research activities that are needed to combat MERS-CoV.