UNAIDS [to 4 June 2016]

UNAIDS [to 4 June 2016]
http://www.unaids.org/en/resources/presscentre/

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03 June 2016 |
Calling on innovators, implementers, investors, activists and leaders to Fast-Track ending the AIDS epidemic by 2030
UNAIDS Executive Director, Michel Sidibé, stresses the importance of a people-centred approach at up-coming United Nations General Assembly High-Level Meeting on Ending AIDS

NEW YORK/GENEVA, 3 June 2016—The AIDS epidemic has defined the global health agenda for an entire generation. The first AIDS-related deaths were diagnosed over 30 years ago and HIV rapidly became a global crisis. The epidemic threatened all countries and had the power to destabilize the most vulnerable nations. By 2000, AIDS had wiped out decades of development gains.

Today, many nations have taken great steps in getting ahead of the epidemic. South Africa, for example, has reduced the number of new HIV infections from 600 000 in 2000 to 340 000 in 2014. Life expectancy has risen in many of the most severely affected countries in sub-Saharan Africa as access to HIV prevention, testing and treatment has been scaled up. Worldwide, there are now more than 17 million people living with HIV accessing live-saving antiretroviral treatment.

But as world leaders grapple with a growing number of global concerns and threats, including massive displacement, climate change and an uncertain economic outlook—it would be a misstep to let up on the response to HIV. Here are three reasons why AIDS deserves continued attention and a Fast-Track approach:
:: To restore dignity, health and hope to the people left behind in the AIDS response.
:: To build robust and resilient societies ready to face future health crises
:: To serve as a beacon for what can be achieved through international solidarity and political will…

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30 May 2016
UNAIDS announces 2 million more people living with HIV on treatment in 2015, bringing new total to 17 million

Sabin Vaccine Institute [to 4 June 2016]

Sabin Vaccine Institute [to 4 June 2016]
http://www.sabin.org/updates/ressreleases

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Thursday, June 2, 2016
Statement on G7 Summit from Dr. Peter Hotez
WASHINGTON, D.C. — On May 26-27, 2016, at the Group of 7 (G7) Summit, the leaders of Japan, the United States, the United Kingdom, Germany, Canada, Italy and France affirmed a commitment to neglected tropical diseases (NTDs).

G7 nations pledged to drive research and development for NTDs and other conditions not adequately addressed by the market. From the G7 Ise-Shima Vision for Global Health, G7 nations will:
:: Implement policies to encourage the development of and access to medical products for those diseases.
:: Encourage G7 countries to support “push (e.g. support to cover R&D cost)” and “pull (e.g. making advance purchase and support creating markets/demands)” incentives, promote well-coordinated Public-Private Partnership to develop new vaccines, drugs and alternative therapies as exemplified by the Global Health Innovative Technology Fund (GHIT) and the Innovative Medicines Initiative (IMI).
:: Work to strengthen collaboration between research institutions, funding organizations and policy makers across G7 countries, building on the G7-process for mapping of R&D activities on NTDs and poverty-related diseases initiated in 2015 and now underway in 2016.

The Sabin Vaccine Institute applauds Japan, host of this year’s summit, for its ongoing leadership in the fight against NTDs, particularly in research and innovation for new tools to accelerate the fight against NTDs. Just days before the Summit, Japan announced its $130 million replenishment of the GHIT Fund, a global funding platform for research into new tools against HIV/AIDS, tuberculosis, malaria and NTDs.

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Statement of Dr. Peter Hotez, President of the Sabin Vaccine Institute and Director of its Product Development Partnership:
“I am pleased to see a renewed commitment from the G7 to address the scourge of NTDs. Creating market incentives for new tools against NTDs will help make it possible for interested scientists to engage in this research, and most importantly, will help get much needed new products into the hands of those who need them faster. Japan is leading by example with the GHIT Fund replenishment, and I hope to see the other member states step up to the challenge of NTD R&D in similar ways.

“More than 1.4 billion people around the world suffer from NTDs. The global effort to control and eliminate these diseases of poverty has treated more people than ever before with medication donated by pharmaceutical companies. But just half of people who require treatment receive it. Eliminating NTDs requires a two-pronged approach – investing in R&D for new vaccines, medications and diagnostics, while also scaling-up access to currently available treatments.

“We must ensure that communities are getting the care they need and that we will have new tools to finish the fight against NTDs. The estimated annual funding gap for NTD treatment is $220 million dollars – it’s a paltry amount in the G7 countries’ budgets. And, in fact, we are now seeing that NTDs are present in alarming numbers in impoverished communities in many nations, not just low-income countries. G7 leaders should increase their investment in NTD treatment to address this issue now as we pursue vaccines and other tools that may eventually eliminate these diseases for good.

“With regard to innovation, we are advancing and testing a new generation of ‘anti-poverty vaccines’ to combat the world’s most debilitating NTDs. These vaccine for helminth infections, Chagas disease, leishmaniasis, and other NTDs would not only improve global public health, but also help lift the bottom billion out of poverty.

“Sabin is asking the G7 to go beyond its current commitments by raising an additional annual investment of $220 million over the next five years to scale up access to treatments. We also encourage the G7 Health Ministers to expand upon the Heads of States’ declaration by proposing concrete, financially backed initiatives to tackle NTDs through both increased R&D and also access to currently existing treatments at their meeting in September.”

European Medicines Agency [to 4 June 2016]

European Medicines Agency [to 4 June 2016]
http://www.ema.europa.eu/

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03/06/2016
Regulation of advanced therapy medicines
Report details concrete proposals to encourage development and authorisation of advanced therapy medicinal products (ATMPs) in the EU
The European Medicines Agency (EMA) today published a report from a multi-stakeholder expert meeting held on 27 May 2016 to explore possible ways to foster the development of ATMPs in Europe and expand patients’ access to these new treatments.

ATMPs comprise gene therapies, tissue engineered products and somatic cell therapies. These medicines have the potential to reshape the treatment of a wide range of conditions, particularly in disease areas where conventional approaches are inadequate. However, eight years since EU legislation on ATMPs entered into force in 2008, only five ATMPs are currently authorised. At the same time clinical trials investigating ATMPs appear to represent a fast-growing field of interest, underlining the need to better support innovation through a coherent and appropriate regulatory environment.

“We have organised this meeting with all relevant stakeholders to discuss concrete proposals on how we can nurture a regulatory environment that encourages development of ATMPs, safeguards public health and, ultimately, facilitates timely access for patients to much needed treatments,” said EMA’s Executive Director Guido Rasi in his opening address…

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01/06/2016
First statistics on PRIME are released
Four medicines in development are accepted under the scheme
The European Medicines Agency (EMA) has released today the outcome of the assessment of the first batch of applications received from medicine developers for its PRIME (PRIority MEdicines) scheme, a new initiative that aims to foster research on and development of medicines that have the potential to address an unmet medical need.

18 applications for PRIME were received as of 6 April 2016 and subsequently assessed by EMA’s Scientific Advice Working Party, Committee for Advanced therapies (CAT) and Committee for Medicinal Products for Human Use (CHMP). Four medicines have been accepted for PRIME.

EMA is making available detailed information on the applications that have been granted or denied access to PRIME, including statistics on the type of applicants, the therapeutic areas represented and the data supporting the applications…

FDA [to 4 June 2016]

FDA [to 4 June 2016]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm

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June 02, 2016
Statement from FDA Commissioner Robert Califf, M.D. on the release of the final individual patient expanded access form

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What’s New for Biologics
Influenza Virus Vaccine for the 2016-2017 Season
Posted: 6/3/2016

May 20, 2016 Clinical Review – Flucelvax Quadrivalent (PDF – 679KB)
Posted: 6/2/2016

Expanded Access
Posted: 6/2/2016

PATH [to 4 June 2016]

PATH [to 4 June 2016]
http://www.path.org/news/index.php

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Announcement | May 31, 2016
PATH welcomes Governor Gary Locke to its board of directors
PATH’s board of directors has voted to appoint former Washington State Governor Gary Locke to the board. Governor Locke’s years of experience in government and diplomacy will strengthen the board’s expertise in international relations, commerce, and organizational management…

Journal Watch

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

American Journal of Tropical Medicine and Hygiene – June 2016; 94 (6)

American Journal of Tropical Medicine and Hygiene
June 2016; 94 (6)
http://www.ajtmh.org/content/current

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Editorial
The Development of Small Animal Models for Zika Virus Vaccine Efficacy Testing and Pathological Assessment
Am J Trop Med Hyg 2016 94:1187-1188; Published online May 2, 2016, doi:10.4269/ajtmh.16-0277
Aaron C. Brault and Richard A. Bowen

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Long-Term Safety and Immunogenicity of a Tetravalent Live-Attenuated Dengue Vaccine and Evaluation of a Booster Dose Administered to Healthy Thai Children
Am J Trop Med Hyg 2016 94:1348-1358; Published online March 28, 2016, doi:10.4269/ajtmh.15-0659
Veerachai Watanaveeradej, Sriluck Simasathien, Mammen P. Mammen, Jr., Ananda Nisalak, Elodie Tournay, Phirangkul Kerdpanich, Rudiwilai Samakoses, Robert J. Putnak, Robert V. Gibbons, In-Kyu Yoon, Richard G. Jarman, Rafael De La Barrera, Philippe Moris, Kenneth H. Eckels, Stephen J. Thomas, and Bruce L. Innis
Abstract
We evaluated the safety and immunogenicity of two doses of a live-attenuated, tetravalent dengue virus vaccine (F17/Pre formulation) and a booster dose in a dengue endemic setting in two studies. Seven children (7- to 8-year-olds) were followed for 1 year after dose 2 and then given a booster dose (F17/Pre formulation), and followed for four more years (Child study). In the Infant study, 49 2-year-olds, vaccinated as infants, were followed for approximately 3.5 years after dose 2 and then given a booster dose (F17) and followed for one additional year. Two clinically notable events were observed, both in dengue vaccine recipients in the Infant study: 1 case of dengue approximately 2.7 years after dose 2 and 1 case of suspected dengue after booster vaccinations. The booster vaccinations had a favorable safety profile in terms of reactogenicity and adverse events reported during the 1-month follow-up periods. No vaccine-related serious adverse events were reported during the studies. Neutralizing antibodies against dengue viruses 1–4 waned during the 1–3 years before boosting, which elicited a short-lived booster response but did not provide a long-lived, multivalent antibody response in most subjects. Overall, this candidate vaccine did not elicit a durable humoral immune response

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Improving Capture of Vaccine History: Case Study from an Evaluation of 10-Valent Pneumococcal Conjugate Vaccine Introduction in Kenya
Am J Trop Med Hyg 2016 94:1400-1402; Published online May 2, 2016, doi:10.4269/ajtmh.15-0783
Aaron M. Harris, George Aol, Dominic Ouma, Godfrey Bigogo, Joel M. Montgomery, Cynthia G. Whitney, Robert F. Breiman, and Lindsay Kim
Abstract
With the accelerated introduction of new vaccines in low-income settings, understanding immunization program performance is critical. We sought to improve immunization history acquisition from Ministry of Health vaccination cards during a vaccine impact study of 10-valent pneumococcal conjugate vaccine on pneumococcal carriage among young children in Kenya in 2012 and 2013. We captured immunization history in a low proportion of study participants in 2012 using vaccination cards. To overcome this challenge, we implemented a household-based reminder system in 2013 using community health workers (CHWs), and increased the retrieval of vaccine cards from 62% in 2012 to 89% in 2013 (P < 0.001). The home-based reminder system using CHWs is an example of an approach that improved immunization history data quality in a resource-poor setting.

Implementation of coordinated global serotype 2 oral poliovirus vaccine cessation: risks of inadvertent trivalent oral poliovirus vaccine use

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 4 June 2016)

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Research article
Implementation of coordinated global serotype 2 oral poliovirus vaccine cessation: risks of inadvertent trivalent oral poliovirus vaccine use
Radboud J. Duintjer Tebbens, Lee M. Hampton and Kimberly M. Thompson
BMC Infectious Diseases 2016 16:237
Published on: 1 June 2016
Abstract
Background
The endgame for polio eradication includes coordinated global cessation of oral poliovirus vaccine (OPV), starting with the cessation of vaccine containing OPV serotype 2 (OPV2) by switching all trivalent OPV (tOPV) to bivalent OPV (bOPV). The logistics associated with this global switch represent a significant undertaking, with some possibility of inadvertent tOPV use after the switch.
Methods
We used a previously developed poliovirus transmission and OPV evolution model to explore the relationships between the extent of inadvertent tOPV use, the time after the switch of the inadvertent tOPV use and corresponding population immunity to serotype 2 poliovirus transmission, and the ability of the inadvertently introduced viruses to cause a serotype 2 circulating vaccine-derived poliovirus (cVDPV2) outbreak in a hypothetical population. We then estimated the minimum time until inadvertent tOPV use in a supplemental immunization activity (SIA) or in routine immunization (RI) can lead to a cVDPV2 outbreak in realistic populations with properties like those of northern India, northern Pakistan and Afghanistan, northern Nigeria, and Ukraine.
Results
At low levels of inadvertent tOPV use, the minimum time after the switch for the inadvertent use to cause a cVDPV2 outbreak decreases sharply with increasing proportions of children inadvertently receiving tOPV. The minimum times until inadvertent tOPV use in an SIA or in RI can lead to a cVDPV2 outbreak varies widely among populations, with higher basic reproduction numbers, lower tOPV-induced population immunity to serotype 2 poliovirus transmission prior to the switch, and a lower proportion of transmission occurring via the oropharyngeal route all resulting in shorter times. In populations with the lowest expected immunity to serotype 2 poliovirus transmission after the switch, inadvertent tOPV use in an SIA leads to a cVDPV2 outbreak if it occurs as soon as 9 months after the switch with 0.5 % of children aged 0–4 years inadvertently receiving tOPV, and as short as 6 months after the switch with 10–20 % of children aged 0–1 years inadvertently receiving tOPV. In the same populations, inadvertent tOPV use in RI leads to a cVDPV2 outbreak if 0.5 % of OPV RI doses given use tOPV instead of bOPV for at least 20 months after the switch, with the minimum length of use dropping to at least 9 months if inadvertent tOPV use occurs in 50 % of OPV RI doses.
Conclusions
Efforts to ensure timely and complete tOPV withdrawal at all levels, particularly from locations storing large amounts of tOPV, will help minimize risks associated with the tOPV-bOPV switch. Under-vaccinated populations with poor hygiene become at risk of a cVDPV2 outbreak in the event of inadvertent tOPV use the soonest after the tOPV-bOPV switch and therefore should represent priority areas to ensure tOPV withdrawal from all OPV stocks.

BMC Public Health (Accessed 4 June 2016)

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 4 June 2016)

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Research article
Greek health professionals’ perceptions of the HPV vaccine, state policy recommendations and their own role with regards to communication of relevant health information
Every year in Europe 60,000 women develop cervical cancer and 30,000 die from the disease. HPV vaccines are currently believed to constitute an important element of cervical cancer control strategy. Currently …
Christina Karamanidou and Kostas Dimopoulos
BMC Public Health 2016 16:467
Published on: 3 June 2016
Abstract
Background
Every year in Europe 60,000 women develop cervical cancer and 30,000 die from the disease. HPV vaccines are currently believed to constitute an important element of cervical cancer control strategy. Currently in Greece, the HPV vaccine is given on demand after prescription by a healthcare professional. Health care professionals’ role is key as they are in a position to discuss HPV vaccination with parents, adolescents and young women. This study is aiming to explore health care professionals’ perceptions of the HPV vaccine, state policy recommendations and their own role with regards to communication of relevant health information.
Methods
This was an in-depth, qualitative study, employing a stratified, purposeful sampling. Fifteen face-to-face, semi-structured interviews were conducted with health care professionals from a variety of disciplines: pediatrics, obstetrics and gynecology, infectious diseases, pharmacy, dermatology, general practice. Thematic qualitative analysis was used to analyze participants’ accounts.
Results
Five major themes were identified: health care professionals’ perceptions towards the HPV vaccine (recognition of importance, concerns about safety, effectiveness and impact of long-term use), animosity between medical specialties (territorial disputes among professional bodies, role advocacy, role limitations), health care professionals’ perceptions of the public’s attitudes (effects of cultural beliefs, health professionals’ attitudes, media and family), the role of the state (health policy issues, lack of guidance, unmet expectations) and their own role (provision of health information, sex education).
Conclusions
Health professionals’ concerns, lack of role definition and uniform information provision have led to territorial disputes among professional bodies and distrust among different medical specialties. Positive and negative judgements deriving from a multitude of sources have resulted in the confusion of the general public, as manifested by low vaccination rates. Due to the lack of clear regulation of vaccination prescription, administration and mode of delivery, factors such as lack of knowledge, cultural beliefs and personal attitudes have shaped the vaccination landscape. These factors have neither been explored nor addressed prior to the initiation of this public health effort and as such there is an evident less than efficient use of resources.

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Research article
Migrant integration policies and health inequalities in Europe
Research on socio-economic determinants of migrant health inequalities has produced a large body of evidence. There is lack of evidence on the influence of structural factors on lives of fragile groups…
Margherita Giannoni, Luisa Franzini and Giuliano Masiero
BMC Public Health 2016 16:463
Published on: 1 June 2016

Bulletin of the World Health Organization – Volume 94, Number 6, June 2016, 405-480

Bulletin of the World Health Organization
Volume 94, Number 6, June 2016, 405-480
http://www.who.int/bulletin/volumes/94/6/en/

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EDITORIALS
Defining the syndrome associated with congenital Zika virus infection
Anthony Costello, Tarun Dua, Pablo Duran, Metin Gülmezoglu, Olufemi T Oladapo, William Perea, João Pires, Pilar Ramon-Pardo, Nigel Rollins & Shekhar Saxena
http://dx.doi.org/10.2471/BLT.16.176990

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Innovation for healthy ageing: a call for papers
Islene Araujo de Carvalho, Isabella Aboderin, Eri Arikawa-Hirasawa, Matteo Cesari, Yoshiaki Furukawa, Luis Miguel Gutierrez Robledo, John E Morley, Anne Margriet Pot, Jean-Yves Reginster, Greg Shaw, Naoko Tomita & John R Beard
http://dx.doi.org/10.2471/BLT.16.176743

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Charting a path to end the AIDS epidemic
Michel Sidibé
http://dx.doi.org/10.2471/BLT.16.176875

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Research
Recommendations for dealing with waste contaminated with Ebola virus: a Hazard Analysis of Critical Control Points approach
Kelly L Edmunds, Samira Abd Elrahman, Diana J Bell, Julii Brainard, Samir Dervisevic, Tsimbiri P Fedha, Roger Few, Guy Howard, Iain Lake, Peter Maes, Joseph Matofari, Harvey Minnigh, Ahmed A Mohamedani, Maggie Montgomery, Sarah Morter, Edward Muchiri, Lutendo S Mudau, Benedict M Mutua, Julius M Ndambuki, Katherine Pond, Mark D Sobsey, Mike van der Es, Mark Zeitoun & Paul R Hunter
Objective
To assess, within communities experiencing Ebola virus outbreaks, the risks associated with the disposal of human waste and to generate recommendations for mitigating such risks.
Methods
A team with expertise in the Hazard Analysis of Critical Control Points framework identified waste products from the care of individuals with Ebola virus disease and constructed, tested and confirmed flow diagrams showing the creation of such products. After listing potential hazards associated with each step in each flow diagram, the team conducted a hazard analysis, determined critical control points and made recommendations to mitigate the transmission risks at each control point.
Findings
The collection, transportation, cleaning and shared use of blood-soiled fomites and the shared use of latrines contaminated with blood or bloodied faeces appeared to be associated with particularly high levels of risk of Ebola virus transmission. More moderate levels of risk were associated with the collection and transportation of material contaminated with bodily fluids other than blood, shared use of latrines soiled with such fluids, the cleaning and shared use of fomites soiled with such fluids, and the contamination of the environment during the collection and transportation of blood-contaminated waste.
Conclusion
The risk of the waste-related transmission of Ebola virus could be reduced by the use of full personal protective equipment, appropriate hand hygiene and an appropriate disinfectant after careful cleaning. Use of the Hazard Analysis of Critical Control Points framework could facilitate rapid responses to outbreaks of emerging infectious disease.

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Research
Vaccination timing of low-birth-weight infants in rural Ghana: a population-based, prospective cohort study
Maureen O’Leary, Sara Thomas, Lisa Hurt, Sian Floyd, Caitlin Shannon, Sam Newton, Gyan Thomas, Seeba Amenga-Etego, Charlotte Tawiah-Agyemang, Lu Gram, Chris Hurt, Rajiv Bahl, Seth Owusu-Agyei, Betty Kirkwood & Karen Edmond
http://dx.doi.org/10.2471/BLT.15.159699
Objective
To investigate delays in first and third dose diphtheria–tetanus–pertussis (DTP1 and DTP3) vaccination in low-birth-weight infants in Ghana, and the associated determinants.
Methods
We used data from a large, population-based vitamin A trial in 2010–2013, with 22 955 enrolled infants. We measured vaccination rate and maternal and infant characteristics and compared three categories of low-birth-weight infants (2.0–2.4 kg; 1.5–1.9 kg; and < 1.5 kg) with infants weighing ≥ 2.5 kg. Poisson regression was used to calculate vaccination rate ratios for DTP1 at 10, 14 and 18 weeks after birth, and for DTP3 at 18, 22 and 24 weeks (equivalent to 1, 2 and 3 months after the respective vaccination due dates of 6 and 14 weeks).
Findings
Compared with non-low-birth-weight infants (n = 18 979), those with low birth weight (n = 3382) had an almost 40% lower DTP1 vaccination rate at age 10 weeks (adjusted rate ratio, aRR: 0.58; 95% confidence interval, CI: 0.43–0.77) and at age 18 weeks (aRR: 0.63; 95% CI: 0.50–0.80). Infants weighing 1.5–1.9 kg (n = 386) had vaccination rates approximately 25% lower than infants weighing ≥ 2.5 kg at these time points. Similar results were observed for DTP3. Lower maternal age, educational attainment and longer distance to the nearest health facility were associated with lower DTP1 and DTP3 vaccination rates.
Conclusion
Low-birth-weight infants are a high-risk group for delayed vaccination in Ghana. Efforts to improve the vaccination of these infants are warranted, alongside further research to understand the reasons for the delays.

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POLICY & PRACTICE
Priority-setting for achieving universal health coverage
Kalipso Chalkidou, Amanda Glassman, Robert Marten, Jeanette Vega, Yot Teerawattananon, Nattha Tritasavit, Martha Gyansa-Lutterodt, Andreas Seiter, Marie Paule Kieny, Karen Hofman & Anthony J Culyer
http://dx.doi.org/10.2471/BLT.15.155721
Abstract
Governments in low- and middle-income countries are legitimizing the implementation of universal health coverage (UHC), following a United Nation’s resolution on UHC in 2012 and its reinforcement in the sustainable development goals set in 2015. UHC will differ in each country depending on country contexts and needs, as well as demand and supply in health care. Therefore, fundamental issues such as objectives, users and cost–effectiveness of UHC have been raised by policy-makers and stakeholders. While priority-setting is done on a daily basis by health authorities – implicitly or explicitly – it has not been made clear how priority-setting for UHC should be conducted. We provide justification for explicit health priority-setting and guidance to countries on how to set priorities for UHC.

Syrian refugees in Lebanon: the search for universal health coverage

Conflict and Health
http://www.conflictandhealth.com/
[Accessed 4 June 2016]

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Debate
Syrian refugees in Lebanon: the search for universal health coverage
Karl Blanchet, Fouad M. Fouad and Tejendra Pherali
Published on: 1 June 2016
Abstract
The crisis in Syria has forced more than 4 million people to find refuge outside Syria. In Lebanon, in 2015, the refugee population represented 30 % of the total population. International health assistance has been provided to refugee populations in Lebanon. However, the current humanitarian system has also contributed to increase fragmentation of the Lebanese health system. Ensuring universal health coverage to vulnerable Lebanese, Syrian and Palestinian refugees will require in Lebanon to redistribute the key functions and responsibilities of the Ministry of Health and its partners to generate more coherence and efficiency.

Epidemiology and Infection – Volume 144 – Issue 09 – July 2016

Epidemiology and Infection
Volume 144 – Issue 09 – July 2016
http://journals.cambridge.org/action/displayIssue?jid=HYG&tab=currentissue

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Short Report
Arboviruses
Potential exposure to Zika virus for foreign tourists during the 2016 Carnival and Olympic Games in Rio de Janeiro, Brazil
M. N. BURATTINI, F. A. B. COUTINHO, L. F. LOPEZ, R. XIMENES, M. QUAM, A. WILDER-SMITH and E. MASSAD
DOI: http://dx.doi.org/10.1017/S0950268816000649, Published online: 04 April 2016
[No abstract]

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Original Papers
Polio
Effective case/infection ratio of poliomyelitis in vaccinated populations
G. BENCSKÓa1a2 and T. FERENCIa3 c1 id1
a1 Polymer Chemistry Research Group, Institute of Materials and Environmental Chemistry, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
a2 Institute of Chemistry, Eötvös Loránd University, Budapest, Hungary
a3 John von Neumann Faculty of Informatics, Physiological Controls Group, Óbuda University, Budapest, Hungary
SUMMARY
Recent polio outbreaks in Syria and Ukraine, and isolation of poliovirus from asymptomatic carriers in Israel have raised concerns that polio might endanger Europe. We devised a model to calculate the time needed to detect the first case should the disease be imported into Europe, taking the effect of vaccine coverage – both from inactivated and oral polio vaccines, also considering their differences – on the length of silent transmission into account by deriving an ‘effective’ case/infection ratio that is applicable for vaccinated populations. Using vaccine coverage data and the newly developed model, the relationship between this ratio and vaccine coverage is derived theoretically and is also numerically determined for European countries. This shows that unnoticed transmission is longer for countries with higher vaccine coverage and a higher proportion of IPV-vaccinated individuals among those vaccinated. Assuming borderline transmission (R = 1·1), the expected time to detect the first case is between 326 days and 512 days in different countries, with the number of infected individuals between 235 and 1439. Imperfect surveillance further increases these numbers, especially the number of infected until detection. While longer silent transmission does not increase the number of clinical diseases, it can make the application of traditional outbreak response methods more complicated, among others.

The European Journal of Public Health – Volume 26, Issue 3, 1 June 2016

The European Journal of Public Health
Volume 26, Issue 3, 1 June 2016
http://eurpub.oxfordjournals.org/content/26/3?current-issue=y

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Viewpoint
Public health needs of migrants, refugees and asylum seekers in Europe, 2015: Infectious disease aspects
Jan C. Semenza, Paloma Carrillo-Santisteve, Herve Zeller, Andreas Sandgren, Marieke J. van der Werf, Ettore Severi, Lucia Pastore Celentano, Emma Wiltshire, Jonathan E. Suk, Irina Dinca, Teymur Noori, Piotr Kramarz
DOI: http://dx.doi.org/10.1093/eurpub/ckw023 372-373 First published online: 6 April 2016
Extract
In the first 10 months of 2015 the total number of asylum applications to the European Asylum Support Office (EASO) recorded by European Union (EU) countries exceeded the 1 million mark, an unprecedented level since the establishment of the EU. Syria has been the most common country of origin of asylum applications, followed by Afghanistan and Iraq.1 However, these figures do not take unregistered migrants into account: in the same time period, 500 000 undocumented border crossing detections were recorded on the EU’s external borders, according to Frontex.2 In the light of these developments, the European Centre for Disease Prevention and Control (ECDC) assessed the public health needs of migrants or individuals that are applying for asylum or refugee status, through: (i) interviews with 14 experts from Member States and Non-Governmental Organizations with first-hand experience working with migrant populations (7–11 August 2015); (ii) a non-systematic review of available evidence (peer-reviewed publications and relevant ECDC risk assessments); and (c) an expert meeting on the prevention of infectious diseases among newly arrived migrants in the EU and European Economic Area (EEA) (12–13 November 2015).3–5
Reception system for newly arrived migrants
A recurrent theme across all the expert consultations conducted by ECDC was the need to establish a reception system for newly arrived migrants. In primary reception centres, a health assessment should be carried out immediately upon arrival. Equipping these reception areas with primary care and public health services facilitates screening, vaccination and treatment (if required) of individuals free of charge. The organisers of reception areas should consider adequately stocking them with rapid tests (e.g. for malaria) and providing instant treatment and care to patients. Such rapid interventions are the best course of action to detect and prevent onwards spread of cases of infectious disease, through the identification and management of infectious diseases with potential for …

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Infectious Diseases
Detrimental effects of introducing partial compulsory vaccination: experimental evidence
Cornelia Betsch, Robert Böhm
DOI: http://dx.doi.org/10.1093/eurpub/ckv154 378-381 First published online: 21 August 2015
Abstract
Background: During outbreaks of vaccine-preventable diseases, compulsory vaccination is sometimes discussed as a last resort to counter vaccine refusal. Besides ethical arguments, however, empirical evidence on the consequences of making selected vaccinations compulsory is lacking. Such evidence is needed to make informed public health decisions. This study therefore assesses the effect of partial compulsory vaccination on the uptake of other voluntary vaccines.
Method: A total of 297 (N) participants took part in an online experiment that simulated two sequential vaccination decisions using an incentivized behavioural vaccination game. The game framework bases on epidemiological, psychological and game-theoretical models of vaccination. Participants were randomized to the compulsory vaccination intervention (n = 144) or voluntary vaccination control group (n = 153), which determined the decision architecture of the first of two decisions. The critical second decision was voluntary for all participants. We also assessed the level of anger, vaccination attitude and perceived severity of the two diseases.
Results: Compulsory vaccination increased the level of anger among individuals with a rather negative vaccination attitude, whereas voluntary vaccination did not. This led to a decrease in vaccination uptake by 39% in the second voluntary vaccination (reactance).
Conclusion: Making only selected vaccinations compulsory can have detrimental effects on the vaccination programme by decreasing the uptake of voluntary vaccinations. As this effect occurred especially for vaccine hesitant participants, the prevalence of vaccine hesitancy within a society will influence the damage of partial compulsory vaccination.

Public preferences for vaccination programmes during pandemics caused by pathogens transmitted through respiratory droplets – a discrete choice experiment in four European countries, 2013

Eurosurveillance
Volume 21, Issue 22, 02 June 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Research Articles
Public preferences for vaccination programmes during pandemics caused by pathogens transmitted through respiratory droplets – a discrete choice experiment in four European countries, 2013
by D Determann, IJ Korfage, A Fagerlin, EW Steyerberg, MC Bliemer, HA Voeten, JH Richardus, MS Lambooij, EW de Bekker-Grob
Abstract
This study aims to quantify and compare preferences of citizens from different European countries for vaccination programme characteristics during pandemics, caused by pathogens which are transmitted through respiratory droplets. Internet panel members, nationally representative based on age, sex, educational level and region, of four European Union Member States (Netherlands, Poland, Spain, and Sweden, n=2,068) completed an online discrete choice experiment. These countries, from different geographical areas of Europe, were chosen because of the availability of high-quality Internet panels and because of the cooperation between members of the project entitled Effective Communication in Outbreak Management: development of an evidence-based tool for Europe (ECOM). Data were analysed using panel latent class regression models. In the case of a severe pandemic scenario, vaccine effectiveness was the most important characteristic determining vaccination preference in all countries, followed by the body that advises on vaccination. In Sweden, the advice of family and/or friends and the advice of physicians strongly affected vaccine preferences, in contrast to Poland and Spain, where the advice of (international) health authorities was more decisive. Irrespective of pandemic scenario or vaccination programme characteristics, the predicted vaccination uptakes were lowest in Sweden, and highest in Poland. To increase vaccination uptake during future pandemics, the responsible authorities should align with other important stakeholders in the country and communicate in a coordinated manner.

Globalization and Health [Accessed 4 June 2016]

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 4 June 2016]

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Review
Towards sustainable partnerships in global health: the case of the CRONICAS Centre of Excellence in Chronic Diseases in Peru
Human capital requires opportunities to develop and capacity to overcome challenges, together with an enabling environment that fosters critical and disruptive innovation. Exploring such features is necessary …
J. Jaime Miranda, Antonio Bernabé-Ortiz, Francisco Diez-Canseco, Germán Málaga, María K. Cárdenas, Rodrigo M. Carrillo-Larco, María Lazo-Porras, Miguel Moscoso-Porras, M. Amalia Pesantes, Vilarmina Ponce, Ricardo Araya, David Beran, Peter Busse, Oscar Boggio, William Checkley, Patricia J. García…
Globalization and Health 2016 12:29
Published on: 2 June 2016

Out-of-pocket payments and community-wide health outcomes: an examination of influenza vaccination subsidies in Japan

Health Economics, Policy and Law
Volume 11 – Issue 03 – July 2016
http://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissue

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Articles
Out-of-pocket payments and community-wide health outcomes: an examination of influenza vaccination subsidies in Japan
Yoko Ibukaa1 c1 and Shun-ichiro Besshoa2
a1 Graduate School of Economics and Management, Tohoku University, Miyagi, Japan
a2 Faculty of Economics, Keio University, Tokyo, Japan
Abstract
While studies have shown that reductions in out-of-pocket payments for vaccination generally encourages vaccination uptake, research on the impact on health outcomes has rarely been examined. Thus, the present study, using municipal-level survey data on a subsidy programme for influenza vaccination in Japan that covers the entire country, examines how reductions in out-of-pocket payments for vaccination among non-elderly individuals through a subsidy programme affected regional-level influenza activity. We find that payment reductions are negatively correlated with the number of weeks with a high influenza alert in that region, although the correlation varied across years. At the same time, we find no significant correlation between payment reductions and the total duration of influenza outbreaks (i.e. periods with a moderate or high alert). Given that a greater number of weeks with a high alert indicates a severer epidemic, our findings suggest that reductions in out-of-pocket payments for influenza vaccination among the non-elderly had a positive impact on community-wide health outcomes, indicating that reduced out-of-pocket payments contributes to the effective control of severe influenza epidemics. This suggests that payment reductions could benefit not only individuals by providing them with better access to preventive care, as has been shown previously, but also communities as a whole by shortening the duration of epidemics.

Productivity losses associated with tuberculosis deaths in the World Health Organization African region

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 4 June 2016]

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Research Article
Productivity losses associated with tuberculosis deaths in the World Health Organization African region
In 2014, almost half of the global tuberculosis deaths occurred in the World Health Organization (WHO) African Region. Approximately 21.5 % of the 6 060 742 TB cases (new and relapse) reported to the WHO in 20…
Joses Muthuri Kirigia and Rosenabi Deborah Karimi Muthuri
Infectious Diseases of Poverty 2016 5:43
Published on: 1 June 2016

The Lancet – Jun 04, 2016

The Lancet
Jun 04, 2016 Volume 387 Number 10035 p2263-2350
http://www.thelancet.com/journals/lancet/issue/current
Editorial
World Humanitarian Summit: next steps crucial
The Lancet
Summary
Ban Ki-moon’s final flagship initiative for his tenure as UN Secretary-General, the World Humanitarian Summit, was held in Istanbul, Turkey, last week (May 23–24). The meeting, the first of its kind, was marred in controversy before it started, with Médecins Sans Frontières boycotting the event because it did not believe that it would address the weaknesses in humanitarian action and emergency response. Other non-governmental organisations (NGOs) were sceptical too. Were they right?

The Lancet Infectious Diseases – Jun 2016

The Lancet Infectious Diseases
Jun 2016 Volume 16 Number 6 p619-752 e82-e107
http://www.thelancet.com/journals/laninf/issue/current

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Comment
Mandating influenza vaccine for Hajj pilgrims
Mohammad Alfelali, Amani S Alqahtani, Osamah Barasheed, Robert Booy, Harunor Rashid
DOI: http://dx.doi.org/10.1016/S1473-3099(16)30064-0
The risk of acquisition and transmission of respiratory tract infections including influenza is considerably enhanced among attendees of the Hajj pilgrimage.1 Influenza vaccine has been recommended by the Saudi Ministry of Health since 2005 for all pilgrims, particularly for those at increased risk of severe disease.2 The Saudi Ministry of Health is now seriously considering mandating influenza vaccine for all pilgrims,3 and the Saudi Thoracic Society has already urged consideration of a “strict vaccination strategy” for Hajj and Umrah visitors.

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Articles
Effect of the introduction of pneumococcal conjugate vaccination on invasive pneumococcal disease in The Gambia: a population-based surveillance study
Grant A Mackenzie, Philip C Hill, David J Jeffries, Ilias Hossain, Uchendu Uchendu, David Ameh, Malick Ndiaye, Oyedeji Adeyemi, Jayani Pathirana, Yekini Olatunji, Bade Abatan, Bilquees S Muhammad, Augustin E Fombah, Debasish Saha, Ian Plumb, Aliu Akano, Bernard Ebruke, Readon C Ideh, Bankole Kuti, Peter Githua, Emmanuel Olutunde, Ogochukwu Ofordile, Edward Green, Effua Usuf, Henry Badji, Usman N A Ikumapayi, Ahmad Manjang, Rasheed Salaudeen, E David Nsekpong, Sheikh Jarju, Martin Antonio, Sana Sambou, Lamin Ceesay, Yamundow Lowe-Jallow, Momodou Jasseh, Kim Mulholland, Maria Knoll, Orin S Levine, Stephen R Howie, Richard A Adegbola, Brian M Greenwood, Tumani Corrah
703
Open Access
Summary
Background
Little information is available about the effect of pneumococcal conjugate vaccines (PCVs) in low-income countries. We measured the effect of these vaccines on invasive pneumococcal disease in The Gambia where the 7-valent vaccine (PCV7) was introduced in August, 2009, followed by the 13-valent vaccine (PCV13) in May, 2011.
Methods
We conducted population-based surveillance for invasive pneumococcal disease in individuals aged 2 months and older who were residents of the Basse Health and Demographic Surveillance System (BHDSS) in the Upper River Region, The Gambia, using standardised criteria to identify and investigate patients. Surveillance was done between May, 2008, and December, 2014. We compared the incidence of invasive pneumococcal disease between baseline (May 12, 2008–May 11, 2010) and after the introduction of PCV13 (Jan 1, 2013–Dec 31, 2014), adjusting for changes in case ascertainment over time.
Findings
We investigated 14 650 patients, in whom we identified 320 cases of invasive pneumococcal disease. Compared with baseline, after the introduction of the PCV programme, the incidence of invasive pneumococcal disease decreased by 55% (95% CI 30–71) in the 2–23 months age group, from 253 to 113 per 100 000 population. This decrease was due to an 82% (95% CI 64–91) reduction in serotypes covered by the PCV13 vaccine. In the 2–4 years age group, the incidence of invasive pneumococcal disease decreased by 56% (95% CI 25–75), from 113 to 49 cases per 100 000, with a 68% (95% CI 39–83) reduction in PCV13 serotypes. The incidence of non-PCV13 serotypes in children aged 2–59 months increased by 47% (−21 to 275) from 28 to 41 per 100 000, with a broad range of serotypes. The incidence of non-pneumococcal bacteraemia varied little over time.
Interpretation
The Gambian PCV programme reduced the incidence of invasive pneumococcal disease in children aged 2–59 months by around 55%. Further surveillance is needed to ascertain the maximum effect of the vaccine in the 2–4 years and older age groups, and to monitor serotype replacement. Low-income and middle-income countries that introduce PCV13 can expect substantial reductions in invasive pneumococcal disease.
Funding
GAVI’s Pneumococcal vaccines Accelerated Development and Introduction Plan (PneumoADIP), Bill & Melinda Gates Foundation, and the UK Medical Research Council.

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Articles
The global burden of dengue: an analysis from the Global Burden of Disease Study 2013
Jeffrey D Stanaway, Donald S Shepard, Eduardo A Undurraga, Yara A Halasa, Luc E Coffeng, Oliver J Brady, Simon I Hay, Neeraj Bedi, Isabela M Bensenor, Carlos A Castañeda-Orjuela, Ting-Wu Chuang, Katherine B Gibney, Ziad A Memish, Anwar Rafay, Kingsley N Ukwaja, Naohiro Yonemoto, Christopher J L Murray
Summary
Background
Dengue is the most common arbovirus infection globally, but its burden is poorly quantified. We estimated dengue mortality, incidence, and burden for the Global Burden of Disease Study 2013.
Methods
We modelled mortality from vital registration, verbal autopsy, and surveillance data using the Cause of Death Ensemble Modelling tool. We modelled incidence from officially reported cases, and adjusted our raw estimates for under-reporting based on published estimates of expansion factors. In total, we had 1780 country-years of mortality data from 130 countries, 1636 country-years of dengue case reports from 76 countries, and expansion factor estimates for 14 countries.
Findings
We estimated an average of 9221 dengue deaths per year between 1990 and 2013, increasing from a low of 8277 (95% uncertainty estimate 5353–10 649) in 1992, to a peak of 11 302 (6790–13 722) in 2010. This yielded a total of 576 900 (330 000–701 200) years of life lost to premature mortality attributable to dengue in 2013. The incidence of dengue increased greatly between 1990 and 2013, with the number of cases more than doubling every decade, from 8·3 million (3·3 million–17·2 million) apparent cases in 1990, to 58·4 million (23·6 million–121·9 million) apparent cases in 2013. When accounting for disability from moderate and severe acute dengue, and post-dengue chronic fatigue, 566 000 (186 000–1 415 000) years lived with disability were attributable to dengue in 2013. Considering fatal and non-fatal outcomes together, dengue was responsible for 1·14 million (0·73 million–1·98 million) disability-adjusted life-years in 2013.
Interpretation
Although lower than other estimates, our results offer more evidence that the true symptomatic incidence of dengue probably falls within the commonly cited range of 50 million to 100 million cases per year. Our mortality estimates are lower than those presented elsewhere and should be considered in light of the totality of evidence suggesting that dengue mortality might, in fact, be substantially higher.
Funding
Bill & Melinda Gates Foundation.

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Review
HIV-exposed, uninfected infants: new global challenges in the era of paediatric HIV elimination
Ceri Evans, MBBCh, Christine E Jones, PhD, Dr Andrew J Prendergast, DPhil
Published Online: 31 March 2016
DOI: http://dx.doi.org/10.1016/S1473-3099(16)00055-4
Summary
The number of infants infected with HIV is declining with the rise in interventions for the elimination of paediatric HIV infection, but the number of uninfected infants exposed to HIV through their HIV-infected mothers is increasing. Interest in the health outcomes of HIV-exposed, uninfected infants has grown in the past decade, with several studies suggesting that these infants have increased mortality rates, increased infectious morbidity, and impaired growth compared with HIV-unexposed infants. However, heterogeneous results might reflect the inherent challenges in studies of HIV-exposed, uninfected infants, which need large populations with appropriate, contemporaneous comparison groups and repeated HIV testing throughout the period of breastfeeding. We review the effects of HIV exposure on mortality, morbidity, and growth, discuss the immunological abnormalities identified so far, and provide an overview of interventions that could be effective in this susceptible population. As the number of infants infected with HIV declines, the health needs of HIV-exposed, uninfected infants should be prioritised further, to ensure that post-2015 Sustainable Development Goals are achieved.

Lancet Global Health – Jun 2016 Volume 4 Number 6 e344-e426

Lancet Global Health
Jun 2016 Volume 4 Number 6 e344-e426
http://www.thelancet.com/journals/langlo/issue/current

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Articles
Achieving maternal and child health gains in Afghanistan: a Countdown to 2015 country case study
Nadia Akseer, Ahmad S Salehi, S M Moazzem Hossain, M Taufiq Mashal, M Hafiz Rasooly, Zaid Bhatti, Arjumand Rizvi, Zulfiqar A Bhutta

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Articles
Child health and nutrition in Peru within an antipoverty political agenda: a Countdown to 2015 country case study
Luis Huicho, Eddy R Segura, Carlos A Huayanay-Espinoza, Jessica Niño de Guzman, Maria Clara Restrepo-Méndez, Yvonne Tam, Aluisio J D Barros, Cesar G Victora, Peru Countdown Country Case Study Working Group

New England Journal of Medicine – June 2, 2016 Vol. 374 No. 22

New England Journal of Medicine
June 2, 2016 Vol. 374 No. 22
http://www.nejm.org/toc/nejm/medical-journal

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Editorial
Clinical Trials Series
Janet Woodcock, M.D., James H. Ware, Ph.D., Pamela W. Miller, John J.V. McMurray, M.D., David P. Harrington, Ph.D., and Jeffrey M. Drazen, M.D.
N Engl J Med 2016; 374:2167 June 2, 2016 DOI: 10.1056/NEJMe1601510
Clinical trials are our best vehicle for turning medical information that we may think is true into evidence that we know, within reasonable limits, to be true. Since the introduction of random assignments to treatment in the 1930s,1 the clinical trial has been in continuous evolution. Among the major milestones have been the development of methods to perform randomization; the convening of data and safety monitoring committees; the formulation of stopping guidelines for safety, efficacy, and futility; and many others. Indeed, the clinical trial landscape is far different today from what it was over 80 years ago, when investigators first confronted the conundrum of how to obtain unbiased data that could be used to guide clinical practice. Today, trials range from a single person2 to 100,000 people, from a single lab to hundreds of centers around the world, from simple two-arm randomizations to increasingly complex study designs.

In this issue, we inaugurate a series of articles called “The Changing Face of Clinical Trials,” in which we examine the current challenges in the design, performance, and interpretation of clinical trials. The series will deal with contemporary challenges that affect clinical trialists today. It is not meant to be a course in clinical trial performance; rather, the articles are written by trialists for trialists about issues that face us all. We plan to cover new trial designs, current issues related to the performance of clinical trials, how to deal with unexpected events during the progress of trials, difficulties in the interpretation of trial findings, and challenges faced by specific sectors of trialists, including those working for large or small companies; the viewpoint of regulators who use trial data in their decision making will also be included. Each review article will define a specific issue of interest and illustrate it with examples from actual practice. The articles will occasionally be accompanied by Perspective pieces to bring additional history and color to the topic. We begin with an article on integrating comparative effectiveness trials into patient care,3 accompanied by a history of clinical trials.4 We have enjoyed putting the series together for you, and we hope that it will stimulate thought and discussion.

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Review Article
Integrating Randomized Comparative Effectiveness Research with Patient Care
Louis D. Fiore, M.D., M.P.H., and Philip W. Lavori, Ph.D.
N Engl J Med 2016; 374:2152-2158 June 2, 2016 DOI: 10.1056/NEJMra1510057
Clinical trials of interventions in common practice can be built into the workflow of an electronic medical record. The authors review four such trials and highlight the strengths and weaknesses of this approach to gathering information.

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Medicine and Society
Assessing the Gold Standard — Lessons from the History of RCTs
Laura E. Bothwell, Ph.D., Jeremy A. Greene, M.D., Ph.D., Scott H. Podolsky, M.D., and David S. Jones, M.D., Ph.D.
N Engl J Med 2016; 374:2175-2181 June 2, 2016 DOI: 10.1056/NEJMms160459
Over the past 70 years, randomized, controlled trials (RCTs) have reshaped medical knowledge and practice. Popularized by mid-20th-century clinical researchers and statisticians aiming to reduce bias and enhance the accuracy of clinical experimentation, RCTs have often functioned well in that role. Yet the past seven decades also bear witness to many limitations of this new “gold standard.” The scientific and political history of RCTs offers lessons regarding the complexity of medicine and disease and the economic and political forces that shape the production and circulation of medical knowledge…

PLoS Currents: Outbreaks (Accessed 4 June 2016)

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 4 June 2016)

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Research Article
Maintaining Maternal and Child Health Services During the Ebola Outbreak: Experience from Pujehun, Sierra Leone
June 2, 2016 ·
Background: During the Ebola outbreak the overall confidence of the population in the national health system declined in Sierra Leone, with a reduction in the use of health services. The objective of this study is to provide information on understanding of how Ebola impacted maternal and child health services in Sierra Leone. Data come from an operational setting which is representative of the communities affected by the outbreak.
Methods: By integrating hospital registers and contact tracing form data with healthcare workers and local population interviews, the transmission chain was reconstructed. Data on the utilization of maternal and neonatal health services were collected from the local district’s Health Management Information System. The main measures put in place to control the Ebola epidemic were: the organization of a rapid response to the crisis by the local health authorities; triage, contact tracing and quarantine; isolation, clinical management and safe burials; training and community sensitization.
Results: A total of 49 case patients were registered between July and November 2014 in the Pujehun district. Hospitalization rate was 89%. Overall, 74.3% of transmission events occurred between members of the same family, 17.9% in the community and 7.7% in hospital. The mean number of contacts investigated per case raised from 11.5 in July to 25 in September 2014. The 2014 admission trend in the pediatric ward shows a decrease after beginning of June: the reduction was almost significant in the period July-December (p 0.05). The admission in the maternity ward showed no statistical differences in comparison with the previous year (p 0.07). Also the number of deliveries appeared to be similar to the previous year, without significant variations (p 0.41).
Conclusion: The Ebola outbreak reduced the number of patients at hospital level in Pujehun district. However, the activities undertaken to manage Ebola, reduced the spread of infection and the impact of the disease in mothers and children. A number of reasons which may explain these results are presented and discussed.

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Travel Volume to the United States from Countries and U.S. Territories with Local Zika Virus Transmission
May 31, 2016 · Research Article
Introduction: Air, land, and sea transportation can facilitate rapid spread of infectious diseases. In May 2015 the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infection in Brazil. As of March 8, 2016, the U.S. Centers for Disease Control and Prevention (CDC) had issued travel notices for 33 countries and 3 U.S. territories with local Zika virus transmission.
Methods: Using data from five separate datasets from 2014 and 2015, we estimated the annual number of passenger journeys by air and land border crossings to the United States from the 33 countries and 3 U.S. territories listed in the CDC’s Zika travel notices as of March 8, 2016. We also estimated the annual number of passenger journeys originating in and returning to the United States (primarily on cruises) with visits to seaports in areas with local Zika virus transmission. Because of the adverse pregnancy and birth outcomes that have been associated with Zika virus disease, the number of passenger journeys completed by women of childbearing age and pregnant women was also estimated.
Results: An estimated 216.3 million passenger journeys by air, land, and sea are made annually to the United States from areas with local Zika virus transmission (as of March 8). The destination states with the largest numbers of arrivals were Texas (by land) and Florida (by air and sea). An estimated 51.7 million passenger journeys were made by women of childbearing age and an estimated 2.3 million were made by pregnant women.
Conclusion: Travel volume analyses provide important information that can be used to effectively target public health interventions as well as direct public health resources and efforts at local, regional, and country-specific levels.

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Using Phenomenological Models to Characterize Transmissibility and Forecast Patterns and Final Burden of Zika Epidemics
May 31, 2016 · Research Article
Background: The World Health Organization declared the ongoing Zika virus (ZIKV) epidemic in the Americas a Public Health Emergency of International Concern on February 1, 2016. ZIKV disease in humans is characterized by a “dengue-like” syndrome including febrile illness and rash. However, ZIKV infection in early pregnancy has been associated with severe birth defects, including microcephaly and other developmental issues. Mechanistic models of disease transmission can be used to forecast trajectories and likely disease burden but are currently hampered by substantial uncertainty on the epidemiology of the disease (e.g., the role of asymptomatic transmission, generation interval, incubation period, and key drivers). When insight is limited, phenomenological models provide a starting point for estimation of key transmission parameters, such as the reproduction number, and forecasts of epidemic impact.
Methods: We obtained daily counts of suspected Zika cases by date of symptoms onset from the Secretary of Health of Antioquia, Colombia during January-April 2016. We calibrated the generalized Richards model, a phenomenological model that accommodates a variety of early exponential and sub-exponential growth kinetics, against the early epidemic trajectory and generated predictions of epidemic size. The reproduction number was estimated by applying the renewal equation to incident cases simulated from the fitted generalized-growth model and assuming gamma or exponentially-distributed generation intervals derived from the literature. We estimated the reproduction number for an increasing duration of the epidemic growth phase.
Results: The reproduction number rapidly declined from 10.3 (95% CI: 8.3, 12.4) in the first disease generation to 2.2 (95% CI: 1.9, 2.8) in the second disease generation, assuming a gamma-distributed generation interval with the mean of 14 days and standard deviation of 2 days. The generalized-Richards model outperformed the logistic growth model and provided forecasts within 22% of the actual epidemic size based on an assessment 30 days into the epidemic, with the epidemic peaking on day 36.
Conclusion: Phenomenological models represent promising tools to generate early forecasts of epidemic impact particularly in the context of substantial uncertainty in epidemiological parameters. Our findings underscore the need to treat the reproduction number as a dynamic quantity even during the early growth phase, and emphasize the sensitivity of reproduction number estimates to assumptions on the generation interval distribution.

PLoS Medicine (Accessed 4 June 2016)

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 4 June 2016)

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Research Article
Prices, Costs, and Affordability of New Medicines for Hepatitis C in 30 Countries: An Economic Analysis
Swathi Iyengar, Kiu Tay-Teo, Sabine Vogler, Peter Beyer, Stefan Wiktor, Kees de Joncheere, Suzanne Hill
Research Article | published 31 May 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002032

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Perspective
A Revolution in Treatment for Hepatitis C Infection: Mitigating the Budgetary Impact
Elliot Marseille, James G. Kahn
| published 31 May 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002031

PLoS One [Accessed 4 June 2016]

PLoS One
http://www.plosone.org/
[Accessed 4 June 2016]

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Research Article
Rapid Ethical Assessment on Informed Consent Content and Procedure in Hintalo-Wajirat, Northern Ethiopia: A Qualitative Study
Serebe Abay, Adamu Addissie, Gail Davey, Bobbie Farsides, Thomas Addissie
Research Article | published 03 Jun 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0157056

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Cross-Border Cholera Outbreaks in Sub-Saharan Africa, the Mystery behind the Silent Illness: What Needs to Be Done?
Godfrey Bwire, Maurice Mwesawina, Yosia Baluku, Setiala S. E. Kanyanda, Christopher Garimoi Orach
Research Article | published 03 Jun 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0156674

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Immunogenicity and Safety of the 13-Valent Pneumococcal Conjugate Vaccine versus the 23-Valent Polysaccharide Vaccine in Unvaccinated HIV-Infected Adults: A Pilot, Prospective Controlled Study
Francesca Lombardi, Simone Belmonti, Massimiliano Fabbiani, Matteo Morandi, Barbara Rossetti, Giacinta Tordini, Roberto Cauda, Andrea De Luca, Simona Di Giambenedetto, Francesca Montagnani
Research Article | published 03 Jun 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0156523

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Understanding Vaccine Hesitancy in Canada: Results of a Consultation Study by the Canadian Immunization Research Network
Eve Dubé, Dominique Gagnon, Manale Ouakki, Julie A. Bettinger, Maryse Guay, Scott Halperin, Kumanan Wilson, Janice Graham, Holly O. Witteman, Shannon MacDonald, William Fisher, Laurence Monnais, Dat Tran, Arnaud Gagneur, Juliet Guichon, Vineet Saini, Jane M. Heffernan, Samantha Meyer, S. Michelle Driedger, Joshua Greenberg, Heather MacDougall, Canadian Immunization Research Network
Research Article | published 03 Jun 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0156118

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Intention to Accept Pertussis Vaccination for Cocooning: A Qualitative Study of the Determinants
Olga Visser, Jeannine L. A. Hautvast, Koos van der Velden, Marlies E. J. L. Hulscher
Research Article | published 02 Jun 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0155861

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Scoping Review of the Zika Virus Literature
Lisa A. Waddell, Judy D. Greig
Research Article | published 31 May 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0156376

Digital epidemiology reveals global childhood disease seasonality and the effects of immunization

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 4 June 2016)
Biological Sciences – Ecology:
Digital epidemiology reveals global childhood disease seasonality and the effects of immunization
Kevin M. Bakker, Micaela Elvira Martinez-Bakker, Barbara Helm, and Tyler J. Stevenson
PNAS 2016 ; published ahead of print May 31, 2016, doi:10.1073/pnas.1523941113
Significance
Disease surveillance systems largely focus on infectious diseases with high mortality, whereas less severe diseases often go unreported. Using chicken pox as an example, we demonstrate that Internet queries can be used as a proxy for disease incidence when reporting is lacking. We established that Google Trends accurately reflected clinical cases in countries with surveillance, and thus population-level dynamics of chicken pox. Then, we discovered robust seasonal variation in query behavior, with a striking latitudinal gradient on a global scale. Next, we showed that real-time data-mining of queries could forecast the timing and magnitude of outbreaks. Finally, our analyses revealed that countries with government-mandated vaccination programs have significantly reduced seasonality of queries, indicating vaccination efforts mitigated chicken pox outbreaks.
Abstract
Public health surveillance systems are important for tracking disease dynamics. In recent years, social and real-time digital data sources have provided new means of studying disease transmission. Such affordable and accessible data have the potential to offer new insights into disease epidemiology at national and international scales. We used the extensive information repository Google Trends to examine the digital epidemiology of a common childhood disease, chicken pox, caused by varicella zoster virus (VZV), over an 11-y period. We (i) report robust seasonal information-seeking behavior for chicken pox using Google data from 36 countries, (ii) validate Google data using clinical chicken pox cases, (iii) demonstrate that Google data can be used to identify recurrent seasonal outbreaks and forecast their magnitude and seasonal timing, and (iv) reveal that VZV immunization significantly dampened seasonal cycles in information-seeking behavior. Our findings provide strong evidence that VZV transmission is seasonal and that seasonal peaks show remarkable latitudinal variation. We attribute the dampened seasonal cycles in chicken pox information-seeking behavior to VZV vaccine-induced reduction of seasonal transmission. These data and the methodological approaches provide a way to track the global burden of childhood disease and illustrate population-level effects of immunization. The global latitudinal patterns in outbreak seasonality could direct future studies of environmental and physiological drivers of disease transmission.

Risk Management and Healthcare Policy Volume 9, 2016 [Haiti: Cholera ; Ethics in Ebola Response]

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

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Original Research
Video
Haiti’s progress in achieving its 10-year plan to eliminate cholera: hidden sickness cannot be cured
Koski-Karell V, Farmer PE, Isaac B, Campa EM, Viaud L, Namphy PC, Ternier R, Ivers LC
Risk Management and Healthcare Policy 2016, 9:87-100
Published Date: 24 May 2016
Abstract:
Since the beginning of the cholera epidemic in Haiti 5 years ago, the prevalence of this deadly water-borne disease has fallen far below the initial rates registered during its explosive outset. However, cholera continues to cause extensive suffering and needless deaths across the country, particularly among the poor. The urgent need to eliminate transmission of cholera persists: compared to the same period in 2014, the first 4 months of 2015 saw three times the number of cholera cases. Drawing upon epidemiology, clinical work (and clinical knowledge), policy, ecology, and political economy, and informed by ethnographic data collected in a rural area of Haiti called Bocozel, this paper evaluates the progress of the nation’s 10-year Plan for the Elimination of Cholera. Bocozel is a rice-producing region where most people live in extreme poverty. The irrigation network is decrepit, the land is prone to environmental shocks, fertilizer is not affordable, and the government’s capacity to assist farmers is undermined by resource constraints. When peasants do have rice to sell, the price of domestically grown rice is twice that of US-imported rice. Canal water is not only used to irrigate thousands of acres of rice paddies and sustain livestock, but also to bathe, wash, and play, while water from wells, hand pumps, and the river is used for drinking, cooking, and bathing. Only one out of the three government-sponsored water treatment stations in the research area is still functional and utilized by those who can afford it. Latrines are scarce and often shared by up to 30 people; open defecation remains common. Structural vulnerabilities cut across all sectors – not just water, sanitation, health care, and education, but agriculture, environment, (global and local) commerce, transportation, and governance as well. These are among the hidden sicknesses that impede Haiti and its partners’ capacity to eliminate cholera.

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Review
Critical role of ethics in clinical management and public health response to the West Africa Ebola epidemic
Folayan MO, Haire BG, Brown B
Risk Management and Healthcare Policy 2016, 9:55-65
Published Date: 12 May 2016
Abstract:
The devastation caused by the Ebola virus disease (EVD) outbreak in West Africa has brought to the fore a number of important ethical debates about how best to respond to a health crisis. These debates include issues related to prevention and containment, management of the health care workforce, clinical care, and research design, all of which are situated within the overarching moral problem of severe transnational disadvantage, which has very real and specific impacts upon the ability of citizens of EVD-affected countries to respond to a disease outbreak. Ethical issues related to prevention and containment include the appropriateness and scope of quarantine and isolation within and outside affected countries. The possibility of infection in health care workers impelled consideration of whether there is an obligation to provide health services where personal protection equipment is inadequate, alongside the issue of whether the health care workforce should have special access to experimental treatment and care interventions under development. In clinical care, ethical issues include the standards of care owed to people who comply with quarantine and isolation restrictions. Ethical issues in research include appropriate study design related to experimental vaccines and treatment interventions, and the sharing of data and biospecimens between research groups. The compassionate use of experimental drugs intersects both with research ethics and clinical care. The role of developed countries also came under scrutiny, and we concluded that developed countries have an obligation to contribute to the containment of EVD infection by contributing to the strengthening of local health care systems and infrastructure in an effort to provide fair benefits to communities engaged in research, ensuring that affected countries have ready and affordable access to any therapeutic or preventative interventions developed, and supporting affected countries on their way to recovery from the impact of EVD on their social and economic lives.

Vaccine (3 June 2016): WHO Product Development for Vaccines Advisory Committee (PDVAC) Pipeline Analyses for 25 Pathogens

Vaccine
Volume 34, Issue 26, Pages 2863-3006 (3 June 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/25

Issue Focus: WHO Product Development for Vaccines Advisory Committee (PDVAC) Pipeline Analyses for 25 Pathogens
Edited by Birgitte K. Giersing, Kayvon Modjarrad and Vasee S. Moorthy

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Preface
The 2016 Vaccine Development Pipeline: A special issue from the World Health Organization Product Development for Vaccine Advisory Committee (PDVAC)
Under a Creative Commons license
Birgitte K. Giersing, Kayvon Modjarrad, David C. Kaslow, Jean-Marie Okwo-Bele, Vasee S. Moorthy
doi:10.1016/j.vaccine.2016.04.041
Open Access
Infectious diseases are the leading cause of death among children and adolescents globally, and one of the primary causes of mortality in adults. Most of these deaths disproportionately burden low- and middle-income countries (LMICs) and are attributable to infectious diseases that include diarrheal illnesses, lower respiratory infections, human immunodeficiency virus, tuberculosis and malaria. Socio-economic gains have translated into improvements in sanitation systems, clean water supplies, early diagnosis and healthcare accessibility and delivery, with consequent reductions in infectious disease incidence and mortality. However, for the majority of the world’s population, large scale advancements in public health infrastructure are still far off. For these communities, high-impact, low-cost public health interventions remain a key strategy for driving down the preventable infectious disease incidence and mortality. Principal among these cost-effective measures is immunization; however, some vaccines are unavailable, inaccessible, and/or unaffordable for the populations most in need. Global national immunization programmes, partially financed through the Gavi vaccine alliance, are estimated to save 2–3 million lives per year with the existing vaccines – and these could be even more impactful if greater levels of coverage could be achieved. Investments into the research, development and deployment of vaccines and delivery technologies against the deadliest and most widespread pathogens are, therefore, likely to yield considerable dividends in global health.

There are approximately 600 vaccine candidates in development against an estimated 110 pathogens [1]. Considering the resource constraints in vaccine development, there is a need to rationally identify the approaches that are most likely to succeed and then prioritize among these candidates. Additionally, as the routine immunization schedule expands, it becomes increasingly important to have strong, evidence-based justifications for investing in the development of new vaccines with a high likelihood of success. Just as innovation should be applied to the domain of vaccines in the development pipeline, there is room for improvement of some licensed vaccines with respect to cost-effectiveness and coverage in order to maximize their public health impact. This special issue, however, focuses its review on the research and development (R&D) pipeline of vaccines against 25 pathogens for which no licensed vaccines currently exists but for which there is high public health importance, as identified by the World Health Organization (WHO) Product Development for Vaccines Advisory Committee (PDVAC). PDVAC is a body of independent experts that was established in 2014 to guide WHO and the vaccine development community along the pathway toward the goal of licensure and deployment in countries of highest disease burden. As such, PDVAC’s remit is to advise on the acceleration of vaccine candidates at Phase 2 of clinical evaluation or earlier and report its proceedings from its meetings to the WHO’s principal committee on immunization policy recommendations: the Strategic Advisory Group of Experts on Immunization (SAGE).

PDVAC also has a contributory role within the framework of the R&D Blueprint at WHO for R&D preparedness and emergency research response in the emerging pathogen area. When WHO declares a Public Health Emergency of International Concern (PHEIC), PDVAC may be tasked with forming a working group to facilitate development of guidance tools for the vaccine development community in the context of the emergency. For example, as this issue goes to press, a PDVAC Working Group is developing a WHO Zika vaccine Target Product Profile [2].

The landscape analyses in this issue are intended as structured overviews of the key considerations for vaccine development, not as exhaustive literature reviews. They are authored by independent subject matter experts in each field and follow a template set forth by the PDVAC committee. Each report summarizes the biological evidence for a vaccine’s feasibility, the data on proof-of-concept studies, existing knowledge gaps, the technical and regulatory hurdles to vaccine licensure, and the prospects for donor funding and procurement of the product. The compendium of pathogens highlighted in this issue was agreed upon by PDVAC in 2015 [3]. Each year, pathogens and diseases to be reviewed is modified to incorporate new areas where vaccine development activity is progressing, and in 2016, Zika will be discussed. In this way, PDVAC remains at the cutting edge of product development issues, with oversight across a broad spectrum of R&D activity, ensuring that its contributions are relevant and impactful to vaccine developers, regulators, donors and policy makers.

[References at link above]

HPV vaccine decision-making among young men who have sex with men

Health Education Journal
May 31, 2016 0017896916647988

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HPV vaccine decision-making among young men who have sex with men
Christopher W Wheldona, Ellen M Daleya, Eric R Buhib, Julie A Baldwinc, Alan G Nyitrayd, Anna R Giulianoe
Abstract
Objective: Human papilloma virus (HPV) vaccination is recommended for all men who have sex with men (MSM) in the USA until the age of 26 years. Despite this recommendation, vaccine uptake remains low. The purpose of this study was to (1) describe salient beliefs related to HPV vaccination among young MSM; (2) determine factors that underlie these beliefs; and (3) describe a model for HPV vaccine decision-making.
Design: Qualitative descriptive study.
Setting: Central Florida, USA.
Method: Semi-structured interviews (N = 22).
Results: The majority of respondents had heard of the HPV vaccine, but generally perceived HPV as a women’s health issue. Salient behavioural beliefs about HPV vaccination described physical (such as lowering risk and promoting overall health) and psychological benefits (such as protecting sex partners and providing peace of mind). There was some concern regarding the risks of vaccination including contracting HPV from the vaccine, not knowing if it would be effective, and side effects. Normative influences on decision-making were minimal. Availability, cost and convenience were among the most salient external control factors discussed. Issues surrounding disclosure of sexual orientation, as well as the competence and sensitivity of healthcare providers in dealing with issues of sexuality, were key factors in HPV-related beliefs.
Conclusion: Addressing the specific beliefs and concerns expressed by MSM can help to improve the effectiveness of health education interventions promoting vaccination.

A multivariate approach to data analysis of vaccine clinical trials.

The Journal of Immunology
May 1, 2016 vol.196

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A multivariate approach to data analysis of vaccine clinical trials.
M Coccia1, F Nozay1, L De Mot1, Avisek Deyati1, E Jogert1, R van der Most1 and R van den Berg1
Author Affiliations
1GlaxoSmithKline, Belgium
Abstract
Despite significant progress in prevention, diagnosis and treatment, Malaria and Tuberculosis (TB) remain major health challenges. In 2014 WHO estimated that ≈438000 people died from Malaria and ≈1.5 million from TB, mainly in resource-poor countries. Vaccines represent a cost-effective and efficient method of preventing infectious diseases. The development of vaccines for TB and Malaria would significantly contribute to reducing disease burden, particularly with the emergence of drug-resistant pathogens. GSK’s Malaria vaccine, Mosquirix™ (RTS,S/AS01), received a positive opinion from European regulators for the prevention of Malaria in young children in sub-Saharan Africa. GSK’s candidate vaccine for TB (M72/AS01) induces robust TB-specific CD4 T-cell responses in humans, and it is undergoing phase IIb clinical trials. System biology approaches can support vaccines at different stages of development by identifying molecular signatures that drive responses to vaccination. Here, we describe the application of systems vaccinology to the analysis of gene expression data from clinical trials for Malaria and TB candidate vaccines. Our analysis aimed to identify early predictors of vaccine efficacy in Malaria clinical trials and to detect signatures associated with reactogenicity in the early development of a TB vaccine. To better capture the multidimensional nature of the data, we used multivariate analysis approaches such as Partial Least Squares regression. Additionally, biological interpretation of our results allowed us to pinpoint biological processes linked with response to vaccination, advancing our understanding of vaccine mode of action.

Media/Policy Watch [to 4 June 2016]

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.

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Forbes
http://www.forbes.com/
Accessed 4 June 2016
Preemies Get Boost in Pertussis Protection From Mom’s Vaccination
Preemies can also benefit from a pertussis vaccine in pregnancy.
Tara Haelle, Contributor Jun 02, 2016 [No new, unique, relevant content]

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Foreign Affairs
http://www.foreignaffairs.com/
Accessed 4 June 2016
1 June 2016
Pakistan’s Quiet Revolution Against Polio
While Pakistan’s path to eradication hasn’t been easy, there is now reason for optimism.
…Unfortunately, violent attacks — which have, at times, affected health workers and those who protect them — have overshadowed this remarkable progress.

These incidents are tragic, although not entirely unexpected. The polio virus has, historically, thrived in regions experiencing political turmoil and conflict. In fact, many of the places where polio still has a strong hold are insecure areas of Afghanistan and Pakistan. So health workers like Naseeba, who go bravely and tirelessly door-to-door, are working in some of the most challenging environments on Earth.

Even in the face of this violence, the dedication to stopping polio in Pakistan extends to all levels of society. In order to reach all of Pakistan’s 35 million children, nearly a quarter of a million clinicians, mothers, religious leaders, security personnel, community members, and government officials have come together to support eradication efforts…

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Foreign Policy
http://foreignpolicy.com/
Accessed 4 June 2016
27 May 2016
Laurie Garrett: WHO’s Fairy Dust Financing
…The organization responsible for international public health is increasing its budget by millions of dollars — but its plan for coming up with the cash to help battle epidemics like Zika isn’t grounded in reality.… That kind of preparedness begins with leadership and mutual trust between the institutions of public health, political leaders, and the populations they are supposed to serve. This is a feat that WHO has not, by any measure, accomplished…

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New York Times
http://www.nytimes.com/
Accessed 4 June 2016
The Opinion Pages | Editorial
Hustling Dollars for Public Health
By THE EDITORIAL BOARD
JUNE 2, 2016
On Tuesday, a woman infected with the Zika virus gave birth to a girl with microcephaly, a malformed head, in New Jersey. Federal officials say there are more than 300 pregnant women possibly infected with Zika around the country. Yet every time an emergency like this happens, public health officials must go begging bowl in hand to Congress for the funds to deal with it. And as the current squabble between Republicans and President Obama over money for the Zika virus shows, there’s no guarantee of significant or even timely relief.

The obvious answer is to establish a permanent pool of money that federal health authorities can tap into quickly, much like the disaster relief fund that enables the Federal Emergency Management Agency to respond quickly to hurricanes and other natural disasters.

Such a fund would allow agencies like the Centers for Disease Control and Prevention to mobilize their resources to contain emerging threats like Zika and Ebola before they become large-scale problems. The money would be used for research, for vaccine development and to prevent the spread of the disease in the United States and overseas.

Zika is just such a threat. It is primarily transmitted by mosquitoes, can cause birth defects and has been linked to neurological disorders in adults. A study published in The New England Journal of Medicine last week estimated that the risk of microcephaly in newborns ranged from 1 percent to 13 percent for women infected with Zika in the first trimester.

A bill introduced by Representative Rosa DeLauro, a Connecticut Democrat, would put $5 billion into an existing public health emergency fund that was created in 1983 but has been largely dormant. The fund currently has a balance of just $57,000. In the Senate, Bill Cassidy, a Louisiana Republican and a doctor, has said he plans to introduce a bill that would provide emergency funds, though he has offered few details.

Some Republicans are likely to oppose setting aside the money. Many in the House have been reluctant to spend money on Zika; last month they passed a bill to provide $622 million to fight the disease, which is a lot less than the $1.1 billion the Senate approved and the $1.9 billion Mr. Obama has asked for.

Despite the concerns of fiscal conservatives, the health emergency fund could save lives and money. Consider Ebola. Had the American government moved quickly to help Guinea, Liberia and Sierra Leone fight that virus early in 2014, the disease might not have killed more than 11,000 people or caused a global panic. But the United States was slow to react, approving $5.4 billion for the disease in December 2014, months after it had caused or was suspected to have caused nearly 7,000 deaths and after Ebola cases had been confirmed in the United States.

That money was used to send doctors and nurses to West Africa, to help strengthen health systems in the affected countries, and for research. Some Ebola projects are still active, including vaccine development and testing. In public health, “the sooner you can get there the more effective you can be,” said Dr. Thomas Frieden, the C.D.C. director. “You can change the trajectory of an epidemic in a way that is very, very important.”

Giving public health officials a blank check would be unwise. But creating a system that is at once generous and disciplined by strong internal controls should be possible. Money in the present health emergency fund, for instance, can be used only when the secretary of health and human services declares an emergency. The secretary has to notify Congress of that decision and report how the money was spent within 90 days of the end of the fiscal year.
Without a less restricted fund, health officials fighting Zika have had to move money and scientists away from programs focused on other diseases, like Ebola, malaria and dengue. Robbing existing programs is sure to hurt public health the longer it goes on.

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Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 4 June 2016
Zika Draws U.S. Researchers Into a Race for Understanding
By Jo Craven McGinty
June 3, 2016 10:13 am ET

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Washington Post
http://www.washingtonpost.com/
Accessed 4 June 2016
Health officials now confirm 11 cases of measles in Arizona
An outbreak of measles that began with an inmate at a federal detention center for immigrants in central Arizona has now grown to 11 confirmed cases, officials said Monday.
Associated Press | National | May 30, 2016

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Think Tanks et al
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Center for Global Development
http://www.cgdev.org/
Accessed 4 June 2016
Innovation for Development: Why Are We not Getting to Scale?
Event
6/13/16
Development depends on innovation. New ideas, new funding mechanisms and new technologies save and improve lives, from vaccines to solar lamps to Development Impact Bonds. But even if innovations reach a million people, they still fall short of the billion who live in poverty.

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Council on Foreign Relations
http://www.cfr.org/
Accessed 4 June 2016
Expert Brief
| 31 May 2016
Back to the Future of Global Health Security
Authors: Thomas J. Bollyky, Senior Fellow for Global Health, Economics, and Development, and Steve Davis, President and CEO of PATH
…To improve pandemic preparedness we must embrace the hard-won lessons of the past decade in global health, not ignore them. This is true in deploying people and resources to prepare for the inevitability of future outbreaks, but even more so when it comes to accelerating the development of the medical tools to diagnose, treat, and prevent those infectious disease outbreaks from turning into epidemics, or even pandemics…

Vaccines and Global Health: The Week in Review 28 May 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_28 May 2016

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

Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
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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.

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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU School of Medicine

World Health Assembly – WHA69 – Geneva 23-28 May 2016.

Editor’s Note:
The WHA was still in session today as this edition was in completion. We will provide a summary of key resolutions and other actions from WHA and the Executive Board in next week’s edition and going forward. Below are the current press release updates on WHA.

World Health Assembly – WHA69
Geneva 23-28 May 2016.
:: Main Documents

WHO Executive Board EB139
30–31 May 2016
Main Documents

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Sixty-ninth World Health Assembly update
News release
27 MAY 2016 | GENEVA – Delegates at the World Health Assembly have agreed resolutions and decisions on air pollution, chemicals, the health workforce, childhood obesity, violence, noncommunicable diseases, and the election of the next Director-General…

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World Health Assembly agrees new Health Emergencies Programme
News release
25 MAY 2016 | GENEVA – WHO Member States today agreed to one of the most profound transformations in the Organization’s history, establishing a new Health Emergencies Programme. The programme adds operational capabilities for outbreaks and humanitarian emergencies to complement its traditional technical and normative roles.

The new programme is designed to deliver rapid, predictable, and comprehensive support to countries and communities as they prepare for, face or recover from emergencies caused by any type of hazard to human health, whether disease outbreaks, natural or man-made disasters or conflicts.

WHO will provide leadership within the context of the International Health Regulations and health, in relation to the broader humanitarian and disaster-management system. As health cluster lead, it will draw on the respective strengths and expertise of a wide range of partners and Member States.

In order to fulfil these new responsibilities, delegates agreed a budget of US$ 494 million for the Programme for 2016−2017. This is an increase of US$160 million to the existing Programme Budget for WHO’s work in emergencies.

Delegates welcomed the progress WHO has made in developing the new Health Emergencies Programme, noting the new implementation plan and timeline, and the establishment of an Independent Oversight and Advisory Committee for the new programme.

They encouraged the ongoing collaboration with the United Nations Office for the Coordination of Humanitarian Affairs to align the management of disease outbreaks and other biological emergencies with the mechanisms and capacities of the Inter-Agency Standing Committee.

They requested the WHO Director-General to report to the Seventieth World Health Assembly on progress made in establishing and operationalizing the programme.

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World Health Assembly agrees resolutions on women, children and adolescents, and healthy ageing
26 May 2016

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World Health Assembly highlights importance of multisectoral action on health
24 May 2016

Zika virus [to 28 May 2016]

Zika virus [to 28 May 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

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WHO public health advice regarding the Olympics and Zika virus
28 May 2016 – Based on current assessment, cancelling or changing the location of the 2016 Olympics will not significantly alter the international spread of Zika virus. Brazil is one of almost 60 countries and territories which to-date report continuing transmission of Zika by mosquitoes. People continue to travel between these countries and territories for a variety of reasons. The best way to reduce risk of disease is to follow public health travel advice.

…Based on the current assessment of Zika virus circulating in almost 60 countries globally and 39 countries in the Americas, there is no public health justification for postponing or cancelling the games. WHO will continue to monitor the situation and update our advice as necessary….

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Zika situation report- 26 May 2016
Read the full situation report
Summary
:: As of 25 May 2016, 60 countries and territories report continuing mosquito-borne transmission of which:
…46 countries are experiencing a first outbreak of Zika virus since 2015, with no previous evidence of circulation, and with ongoing transmission by mosquitos.
…14 countries reported evidence of Zika virus transmission between 2007 and 2014, with ongoing transmission.

:: In addition, four countries or territories have reported evidence of Zika virus transmission between 2007 and 2014, without ongoing transmission: Cook Islands, French Polynesia, ISLA DE PASCUA – Chile and YAP (Federated States of Micronesia).

:: Ten countries have reported evidence of person-to-person transmission of Zika virus, probably via a sexual route.

:: In the week to 25 May 2016, no new country reported on mosquito-borne or person-to-person Zika virus transmission.

:: As of 25 May 2016, microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection or suggestive of congenital infection, have been reported by ten countries or territories. Infection of the mothers took place in eight different countries, for one additional case the precise country in Latin America is not determined. Spain is the latest country to report a case of microcephaly associated with Zika virus in a returning pregnant traveller.

:: Two cases of microcephaly and other neurological abnormalities are currently under verification in the Bolivarian Republic of Venezuela and Costa Rica.

:: In the context of Zika virus circulation, 13 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. One GBS case associated with Zika virus infection in a returning traveller to the Netherlands has been reported. A case of GBS from Guadeloupe is under verification.

:: Sequencing of the virus that causes the Zika outbreak in Cabo Verde showed that the virus is of the Asian lineage and the same as the one that circulates in Brazil. The precise implication of this finding is yet to be determined.

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

:: The global Strategic Response Framework launched by WHO in February 2016 encompasses surveillance, response activities and research. An interim report has been published on some of the key activities being undertaken jointly by WHO and international, regional and national partners in response to this public health emergency. A revised strategy for the period July 2016 to December 2017 is currently being developed with partners and will be published in mid-June.

:: WHO has developed new advice and information on diverse topics in the context of Zika virus. WHO’s latest information materials, news and resources to support corporate and programmatic risk communication, and community engagement are available online.

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Zika Open [to 28 May 2016]
[Bulletin of the World Health Organization]
:: All papers available here
RESEARCH IN EMERGENCIES
Accuracy of ultrasound scanning relative to reference tests for prenatal diagnosis of microcephaly in the context of Zika virus infection: a systematic review of diagnostic test accuracy
– Ezinne C Chibueze, Alex JQ Parsons, Katharina da Silva Lopes, Takemoto Yo, Toshiyuki Swa, Chie Nagata, Nobuyuki Horita, Naho Morisaki, Olukunmi O Balogun, Amarjargal Dagvadorj, Erika Ota, Rintaro Mori, Olufemi T Oladapo
Posted: 25 May 2016
http://dx.doi.org/10.2471/BLT.16.178301

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CDC/ACIP [to 28 May 2016]
http://www.cdc.gov/media/index.html
THURSDAY, MAY 26, 2016
CDC adds Argentina to interim travel guidance related to Zika virus
Today, CDC posted a Zika virus travel notice for Argentina. Local transmission of Zika virus infection (Zika) has been reported in Tucumán Province, Argentina.

THURSDAY, MAY 26, 2016
CDC Director Addresses National Press Club
CDC Director Tom Frieden, M.D., M.P.H., discussed the latest news and developments in the Zika virus outbreak today at the National Press Club.

MMWR May 27, 2016 / Vol. 65 / No. 20
:: Possible Zika Virus Infection Among Pregnant Women — United States and Territories, May 2016
:: Notice to Readers: Changes in the Presentation of Zika Virus Disease, Non-Congenital Infection, and Addition of Zika Virus Congenital Infection to Notifiable Diseases and Mortality Table I

EBOLA/EVD [to 28 May 2016]

EBOLA/EVD [to 28 May 2016]
“Threat to international peace and security” (UN Security Council)

Editor’s Note:
It appears that weekly Ebola Situation Reports have resumed. We will present the first page summary and risk assessment here.

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EBOLA VIRUS DISEASE – SITUATION REPORT 26 MAY 2016
Summary
:: The Public Health Emergency of International Concern (PHEIC) related to Ebola in West Africa was lifted on 29 March 2016. A total of 28 616 confirmed, probable and suspected cases have been reported in Guinea, Liberia and Sierra Leone, with 11 310 deaths.

:: In the latest cluster, seven confirmed and three probable cases of Ebola virus disease (EVD) were reported between 17 March and 6 April from the prefectures of N’Zerekore (nine cases) and Macenta (one case) in south-eastern Guinea. In addition, three confirmed cases were reported between 1 and 5 April from Monrovia in Liberia; these cases, the wife and two children of the Macenta case, travelled from Macenta to Monrovia.

:: The index case of this cluster (a 37-year-old female from Koropara sub-prefecture in N’Zerekore) had symptom onset on or around 15 February and died on 27 February without a confirmed diagnosis. The source of her infection is likely to have been due to exposure to infected body fluid from an Ebola survivor.

:: In Guinea, the last case tested negative for Ebola virus for the second time on 19 April. In Liberia, the last case tested negative for the second time on 28 April.

:: The 42-day (two incubation periods) countdown must elapse before the outbreak can be declared over in Guinea and Liberia. This is due to end on 31 May in Guinea and on 9 June in Liberia.

:: Having contained the last Ebola virus outbreak in March 2016, Sierra Leone has maintained heightened surveillance with testing of all reported deaths and prompt investigation and testing of all suspected cases. The testing policy will be reviewed on the 30 June.

Risk assessment:
For the outbreak to be declared over, a 42-day countdown must pass after the last case tested negative for Ebola virus for the second time. This countdown is due to elapse on 31 May in Guinea and on 9 June in Liberia. Until then, active surveillance in Guinea and Liberia will continue. The performance indicators suggest that Guinea, Liberia and Sierra Leone still have variable capacity to prevent, detect (epidemiological and laboratory surveillance) and respond to new outbreaks (Table 1). The risk of additional outbreaks originating from exposure to infected survivor body fluids remains and requires sustained.

POLIO [to 28 May 2016]

POLIO [to 28 May 2016]
Public Health Emergency of International Concern (PHEIC)

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Statement on the 9th IHR Emergency Committee meeting regarding the international spread of poliovirus
WHO statement
20 May 2016
[Excerpts; Editor’s text bolding]
The 9th meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened via teleconference by the Director¬ General on 12th May 2016. As with the seventh and eighth meetings, the Emergency Committee reviewed the data on wild poliovirus as well as circulating vaccine-¬derived polioviruses (cVDPV). The latter is important as cVDPVs reflect serious gaps in immunity to poliovirus due to weaknesses in routine immunization coverage in otherwise polio-¬free countries. In addition, any further spread of type 2 cVDPVs is a public health emergency following the globally synchronized withdrawal of type 2 OPV completed 1st May 2016…

…Conclusion
The Committee unanimously agreed that the international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC), and recommended the extension of the Temporary Recommendations for a further three months. The Committee considered the following factors in reaching this conclusion:
:: The continued international spread of wild poliovirus during 2015 and 2016 involving Pakistan and Afghanistan.
:: The current special and extraordinary context of being closer to polio eradication than ever before in history.
:: The risk and consequent costs of failure to eradicate globally one of the world’s most serious vaccine preventable diseases. Even though globally transmission has fallen and therefore the likelihood of international spread has also fallen, the consequences and impact of international spread should it occur become more serious, and this possibility is greater if global complacency sets in.
:: The continued necessity of a coordinated international response to improve immunization and surveillance for wild poliovirus, stop its international spread and reduce the risk of new spread.
:: The serious consequences of further international spread for the increasing number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies. Populations in these fragile states are vulnerable to outbreaks of polio. Outbreaks in fragile states are exceedingly difficult to control and threaten the completion of global polio eradication during its end stage.
:: The importance of a regional approach and strong cross¬border cooperation, as much international spread of polio occurs over land borders, while recognizing that the risk of distant international spread remains from zones with active poliovirus transmission.
:: Additionally with respect to cVDPV:
…cVDPVs also pose a risk for international spread, and if there is no urgent response with appropriate measures, particularly threaten vulnerable populations as noted above;
…the emergence and circulation of VDPVs in four WHO regions demonstrates significant gaps in population immunity at a critical time in the polio endgame;
…there is a particular urgency of preventing type 2 cVDPVs following the globally synchronized withdrawal of type 2 component of the oral poliovirus vaccine in April 2016;
…the ongoing challenges of improving routine immunization in areas affected by insecurity and other emergencies, including Ebola; and
…the global shortage of IPV poses fresh challenges…

…The Committee recognised that the communication message explaining why a PHEIC is being maintained should be carefully prepared. On the one hand the world is applauding the successful switch from tOPV to bOPV and the reduction of new cases of wild poliovirus, while on the other hand a PHEIC is being maintained to ensure that all possible measures are brought to bear to support these final phases of polio eradication. This apparent paradox needs careful explanation.

Based on the advice concerning wild poliovirus and cVDPV, and the reports made by Afghanistan, Pakistan, Nigeria, Lao People’s Democratic Republic and Guinea, the Director¬ General accepted the Committee’s assessment and on 20 May 2016 determined that the events relating to poliovirus continue to constitute a PHEIC, with respect to wild poliovirus and cVDPV. The Director ¬General endorsed the Committee’s recommendations for ‘States currently exporting wild polioviruses or cVDPV’, for ‘States infected with wild poliovirus or cVDPV but not currently exporting’ and for ‘States no longer infected by wild poliovirus, but which remain vulnerable to international spread, and states that are vulnerable to the emergence and circulation of VDPV’ and extended the Temporary Recommendations as revised by the Committee under the IHR to reduce the international spread of poliovirus, effective 20 May 2016.

The Director¬ General thanked the Committee Members and Advisors for their advice and requested their reassessment of this situation within the next three months

::::::

Polio this week as of 25 May 2016
:: This week, health ministers from around the world are convening in Geneva for the annual World Health Assembly (WHA). Among other public health topics, delegates will review and discuss the latest global polio epidemiology. The GPEI has set up a WHA-specific polio website, with the key documents that are guiding discussions.

:: At the Women Deliver conference in Copenhagen focusing on solutions to the health, economic and social challenges facing girls and women, the Government of Canada announced a Can$19.9 million contribution to Nigeria’s polio eradication efforts.

:: From 17 April to 1 May, 155 countries and territories participated in the historic trivalent to bivalent oral polio vaccine switch, withdrawing the type two component of the vaccine to protect future generations against circulating vaccine-derived polioviruses. Track the switch live.

The Trivalent to Bivalent Oral Polio Vaccine Switch
:: Between 17 April and 1 May, the type 2 component of the oral polio vaccine (OPV) is being removed from use through aglobally synchronized switch from the trivalent to bivalent oral polio vaccine. This is the first stage of objective 2 of the Polio Eradication and Endgame Strategic Plan 2013-2018 to withdraw OPV in a phased manner starting with the type 2 component following the eradication of wild poliovirus type 2 in September 2015.

:: Follow a live update of which countries have undergone the switch. Learn more about why the switch is such an important part of ensuring a polio-free world through this series of videos.

:: The following indicators are being carefully tracked to ensure the switch goes smoothly. As of 24 May:
…155 of 155 (100%) countries and territories have stopped using the trivalent oral polio vaccine.
…Independent monitoring to ensure the switch goes smoothly has begun in 152 countries (100%).
…The National Validation Committee has received switch monitoring data in 145 countries (95%).
…The WHO Regional Offices has received the National Validation Report from 147 countries (95%).

Selected Country Levels Updates [excerpted]
Pakistan
:: One new case of wild poliovirus type 1 (WPV1) was reported in the past week, from Bannu district in Khyber Pakhtunkhwa (KP) province with onset of paralysis on 26 April. It is the most recent case in the country, and brings the total number of WPV1 cases for 2016 to 11, compared to 23 at this date in 2015.
:: Four new WPV1 environmental positive samples were reported in the past week: two collected from Sindh province in the districts of Khi Gulshan-Iqbal and Jacobabad on 15 and 10 March respectively, one in the Rawalpindi district of Punjab on 14 April, and the most recent in Peshawar district of Khyber Pakhtunkhwa on 22 April. Although four positives were reported this week, two duplicates were removed, thus the total went from 17 to 19 environmental positives.
:: Efforts continue to further strengthen surveillance activities in all provinces of the country

Yellow Fever [to 28 May 2016]

Yellow Fever [to 28 May 2016]
http://www.who.int/emergencies/yellow-fever/en/

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Yellow Fever – Situation Report – 26 May 2016
Full Report:
http://www.who.int/emergencies/yellow-fever/situation-reports/26-may-2016/en/
Summary:
Angola: 2536 suspected cases
As of 25 May 2016, Angola has reported 2536 suspected cases of yellow fever with 301 deaths. Among those cases, 747 have been laboratory confirmed. Despite vaccination campaigns in Luanda, Huambo and Benguela provinces, circulation of the virus persists in some districts. Vaccination campaigns started on 16 May in Cuanza Sul, Huila and Uige provinces. Lunda Norte has reported, for the first time since the beginning of the outbreak, 5 autochthonous laboratory confirmed cases in 2 districts.
Three countries have reported confirmed yellow fever cases imported from Angola: Democratic Republic of The Congo (DRC) (41 cases), Kenya (2 cases) and People’s Republic of China (11 cases). This highlights the risk of international spread through nonimmunised travellers.

Democratic Republic of The Congo: 48 laboratory confirmed cases
On 22 March 2016, the Ministry of Health of DRC confirmed cases of yellow fever in connection with Angola. The government officially declared the yellow fever outbreak on 23 April. As of 25 May, DRC has reported three probable cases and 48 laboratory confirmed cases: 41 of those are imported from Angola, reported in Kongo Central, Kinshasa and Kwango (formerly Bandundu) provinces, two are autochthonous cases in Ndjili, Kinshasa and in Matadi, Kongo Central provinces. The possibility of locally acquired infection is under investigation for at least three non-classified cases in both Kongo Central (Muanda district) and Kwango provinces.

Uganda: 60 suspect cases
In Uganda, the Ministry of Health notified yellow fever cases in Masaka district on 9 April 2016. As of 25 May, 60 suspected cases, of which seven are laboratory confirmed, have been reported from three districts: Masaka, Rukungiri and Kalangala. According to sequencing results, those clusters are not epidemiologically linked to Angola.

The risk of spread
The virus in Angola and DRC is largely concentrated in main cities. The risk of spread and local transmission to other provinces in Angola, DRC and Uganda remains a serious concern. There is also a high risk of potential spread to bordering countries especially those previously classified as low-risk for yellow fever disease (i.e. Namibia, Zambia) and where the population, travellers and foreign workers are not vaccinated against yellow fever.
Confirmed yellow fever cases exported from Angola has been documented in Kenya (two cases) and People’s Republic of China (11 cases). This highlights the risk of international spread through non-immunised travellers.

Risk assessment
The outbreak in Angola remains of high concern due to:
:: Persistent local transmission in Luanda despite the fact that more than seven million people have been vaccinated.
:: Local transmission has been reported in seven highly populated provinces including Luanda. Luanda Norte is the province that most recently reported yellow fever transmission.
:: 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 crossborder 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.
:: Inadequate surveillance system capable of identifying new foci or areas of cases emerging.
:: High index of suspicion of ongoing transmission in areas hard to reach like Cabinda.

WHO & Regional Offices [to 28 May 2016]

WHO & Regional Offices [to 28 May 2016]

Weekly Epidemiological Record (WER) 27 May 2016, vol. 91, 21 (pp. 265–284)
Contents
265 Epidemic focus: Lassa Fever
266 Meeting of the Strategic Advisory Group of Experts on immunization, April 2016 – conclusions and recommendation

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Disease Outbreak News (DONs)
:: Lassa Fever – Nigeria 27 May 2016

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:: WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: WHO AFRO launches new project to help African countries control and eliminate neglected tropical diseases – 23 May 2016

WHO Region of the Americas PAHO
:: PAHO honors Canadian and U.S. academics, Brazilian NGO with regional 2016 World No Tobacco Day awards (05/26/2016)
:: PAHO and Lila Downs launch PSAs to promote prenatal care and save lives (05/25/2016)

WHO South-East Asia Region SEARO
:: Floods in Sri Lanka WHO Sit Rep 4 26 May 2016 pdf, 852kb

WHO European Region EURO
:: Day 2 of the World Health Assembly: Highlights for the European Region 26-05-2016
:: New tool: AirQ+ quantifies health impacts of air pollution 25-05-2016
:: Opening day of World Health Assembly: 2030 Agenda for Sustainable Development in focus 24-05-2016
:: Results of joint FAO/WHO Meeting on Pesticide Residues (JMPR) 24-05-2016

WHO Eastern Mediterranean Region EMRO
:: Kuwait supports kidney patients in Syria 24 May 2016

WHO Western Pacific Region
No new content identified.

CDC/ACIP [to 28 May 2016]

CDC/ACIP [to 28 May 2016]
http://www.cdc.gov/media/index.html

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THURSDAY, MAY 26, 2016
CDC adds Argentina to interim travel guidance related to Zika virus
Today, CDC posted a Zika virus travel notice for Argentina. Local transmission of Zika virus infection (Zika) has been reported in Tucumán Province, Argentina.

THURSDAY, MAY 26, 2016
CDC Director Addresses National Press Club
CDC Director Tom Frieden, M.D., M.P.H., discussed the latest news and developments in the Zika virus outbreak today at the National Press Club.

MMWR May 27, 2016 / Vol. 65 / No. 20
:: Possible Zika Virus Infection Among Pregnant Women — United States and Territories, May 2016
:: Notes from the Field: Outbreak of Serogroup B Meningococcal Disease at a University — California, 2016
:: Notes from the Field: Expanded Chemoprophylaxis Offered in Response to a Case of Meningococcal Meningitis in an Elementary School — Indiana, 2015
:: Notice to Readers: Changes in the Presentation of Zika Virus Disease, Non-Congenital Infection, and Addition of Zika Virus Congenital Infection to Notifiable Diseases and Mortality Table I

June ACIP meeting
June 22-23, 2016
Deadline for registration:
:: Non-US Citizens: May 20, 2016
:: US Citizens: June 6, 2016
Registration is NOT required to watch the live meeting webcast or to listen via telephone.
Draft June 22-23, 2016 Meeting Agenda[2 pages]

IOM, Partners Launch Vaccination Campaigns to Combat Measles in South Sudan

IOM, Partners Launch Vaccination Campaigns to Combat Measles in South Sudan
05/27/16
South Sudan – In response to an increase of measles cases, IOM South Sudan is teaming up with health agencies to vaccinate vulnerable people against the disease. IOM recently led vaccination campaigns for internally displaced persons (IDPs) in Bentiu and Malakal and additional campaigns are in progress.

Following several suspected cases of measles in the UN Protection of Civilians (PoC) sites in Bentiu and Malakal, IOM launched a vaccination campaign for children under five living in both sites. The campaigns vaccinated nearly 45,900 children in Bentiu and 7,300 children in Malakal, reaching over 90 percent of the target group.

The campaigns were implemented in collaboration with International Medical Corps, International Rescue Committee, Médecins Sans Frontières, UNICEF, WHO and World Relief. Led by IMC, the Malakal campaign was also expanded to Malakal town, vaccinating 919 children against the disease.

“The success of these campaigns is due to intensive social mobilization, effective collaboration and leadership of the Health Cluster. But routine immunizations should be strengthened both within and outside of PoC sites to reduce the likelihood of further measles cases, especially among children,” said IOM Migration Health Emergency Coordinator Dr. Andrew Mbala.

Measles is a highly contagious disease that can become life threatening if complications, such as pneumonia, arise. Children and displaced populations living in crowded areas are particularly vulnerable to outbreaks of measles and other contagious diseases.
An IOM Health Rapid Response Team is currently on the ground in Yirol East and West counties to provide measles vaccines for another 46,900 children under five. Health actors have reported 31 suspected measles cases in the two counties this year.

At IOM’s primary health care clinics in Bentiu and Malakal, as well as in Renk, IOM clinics are providing regular vaccinations against common diseases, such as tuberculosis, cholera and polio. Last week, IOM vaccinated 575 children through routine vaccinations.
To date in 2016, 1,321 suspected measles cases have been reported by the Health Cluster and South Sudan Ministry of Health.

Gavi [to 28 May 2016]

Gavi [to 28 May 2016]
http://www.gavialliance.org/library/news/press-releases/

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26 May 2016
Gavi welcomes price trend for pentavalent vaccine
Latest price information published by UNICEF.
Geneva, 26 May 2016 – Gavi, the Vaccine Alliance welcomes the continued trend of decreasing prices for five-in-one pentavalent vaccine. Prices for pentavalent doses to be supplied to Gavi-supported countries over the next two years have been published by UNICEF following the completion of the first stage of a multi-stage tender.

The pentavalent vaccine protects against five major infections in one shot: diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenza type b (Hib). It remains a cornerstone of Gavi’s immunisation efforts and is the first vaccine to have been introduced into the routine immunisation systems of all Gavi-supported countries…

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23 May 2016
World Humanitarian Summit – Gavi’s Fragility and Immunisation Policy
Gavi to review its response to humanitarian emergencies and fragile settings in 2016.
Geneva, 23 May 2016 – Gavi, the Vaccine Alliance remains committed to working in fragile settings and has increased its focus on the specific challenges they pose through its current Fragility and Immunisation policy.

Approved in 2012, the policy paths the way for flexible and country tailored approaches, in which approximately one third of Gavi funding is invested (nearly US$ 425 million in 2015). Under the terms of this policy, Gavi will continue to provide vaccines to governments for refugees and internally displaced populations in Gavi-supported countries.

In 2016, Gavi has committed to reviewing its response to humanitarian emergencies and fragile settings to ensure that the Alliance’s response is in line with best practices in such environments.

Under Gavi’s 2016-2020 strategy, the Vaccine Alliance has committed to reaching the un-reached with life-saving vaccines and investing in building resilient health systems. This includes investment in national laboratory and surveillance capacity strengthening in line with the core capacities of the international health regulations.

Recognising that outbreaks can create urgent needs with humanitarian consequences, existing efforts such as funding vaccine stockpiles for outbreak response will also continue to be enhanced. For example, Gavi has committed to purchasing the first generation Ebola vaccine for a global stockpile once a vaccine(s) is licensed and WHO recommended.

Gavi will remain committed to innovative engagement with partners and countries to help prepare, detect and respond to disease outbreaks and thereby help protect the health of millions of people including in fragile environments.

Global Fund [to 28 May 2016]

Global Fund [to 28 May 2016]
http://www.theglobalfund.org/

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25 May 2016
Wambo.org to Bring Better Access, Prices, Transparency to Global Health
GENEVA – The Global Fund to Fight AIDS, Tuberculosis and Malaria and the Government of Canada announced a new online marketplace today that is projected to save at least US$250 million in the coming four years by offering health implementers competitive prices for medicines and health commodities.

Simple and accessible, wambo.org provides up-to-date information on available products, prices, expected delivery time and tracking. Buyers and suppliers can use it as a safe and reliable tool for procuring quality-assured goods in less time and with lower financial risk.
Wambo.org also allows orders to be pooled, enabling even smaller buyers to achieve economies of scale for substantial savings. With an easy-to-use platform, it is set up to be an effective procurement tool for governments and civil society organizations that implement health grants, significantly supporting the common goal of building resilient and sustainable systems for health.

“Canada is taking concrete action to end for good three of the world’s most devastating diseases – AIDS, tuberculosis, and malaria – by 2030,” said Marie-Claude Bibeau, Canada’s Minister of International Development and La Francophonie. “By investing in wambo.org, Canada is leveraging technology to simplify procurement and create significant savings. This innovative platform allows countries to improve efficiency and deliver medicines and health products that will save lives.”

The Government of Canada is contributing CAD19 million (US$14.5 million) to help build and expand wambo.org. Canada, a leader in many aspects of global health, is also hosting the Global Fund’s Fifth Replenishment in Montreal in September 2016. UNITAID and the Clinton Health Access Initiative (CHAI) are also strategic partners in supporting the development of wambo.org…

PATH [to 28 May 2016]

PATH [to 28 May 2016]
http://www.path.org/news/index.php
Press release | May 26, 2016
Kakamega civil society leaders launch new alliance to improve health for women, newborns, and children
Kakamega, Kenya, May 27, 2016 – Today, twenty local civil society organizations dedicated to improving health and well-being in Kakamega County launched a new alliance to advocate for strengthened county policies and increased investment in maternal, newborn, and child health (MNCH).

Even with progress, Kakamega County has among the highest rates of maternal and child deaths in Kenya…

PATH, an international nonprofit organization that has worked in partnership with local organizations and county governments in Kenya for more than a decade, helped to bring together the alliance. Comprised of community-based organizations with a strong presence in Kakamega County, the alliance will advocate for stronger MNCH policies at the county level…

European Medicines Agency [to 28 May 2016]

European Medicines Agency [to 28 May 2016]
http://www.ema.europa.eu/

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27/05/2016
Two new combination therapies against chronic hepatitis C
Direct-acting antivirals Epclusa and Zepatier recommended for approval
The European Medicines Agency (EMA) has recommended the granting of marketing authorisations in the European Union (EU) for two new combination therapies against chronic (long-term) hepatitis C virus (HCV) infection, Epclusa (sofosbuvir/velpatasvir) and Zepatier (grazoprevir/elbasvir).

HCV infection is a major European public health challenge. It affects between 0.4% and 3.5% of the population in different EU Member States and is the most common single cause of liver transplantation in the region.

Epclusa and Zepatier belong to a new generation of medicines for chronic HCV infection, direct-acting antivirals, that give high rates of cure of HCV infection and that have, in the past few years, reshaped the way this disease is treated. These medicines block the action of proteins which are essential for viral replication. Epclusa targets the proteins NS5B and NS5A, while Zepatier targets the proteins NS3/4A and NS5A…

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27/05/2016
Improving safety of first-in-human clinical trials
EMA starts EU-wide reflection on necessary changes to best practices
The European Medicines Agency (EMA) has started a review of the guidelines that describe first-in-human clinical trials and the data needed to enable their appropriate design and allow initiation. This is being done in cooperation with the European Commission and the Member States of the European Union (EU).

The review will identify which areas may need to be revised in the light of the tragic incident which took place during a Phase I first-in-human clincial trial in Rennes, France, in January 2016. The trial led to the death of one participant and hospitalisation of five others…

AERAS [to 28 May 2016]

AERAS [to 28 May 2016]
http://www.aeras.org/pressreleases

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May 23, 2016
Aeras Applauds Report and Recommendations by the Review on Antimicrobial Resistance
Aeras Applauds the Final Report and Recommendations by the United Kingdom Review on Antimicrobial Resistance

Rockville, MD,– Aeras applauds the Final Report and Recommendations released this week by the U.K. Review on Antimicrobial Resistance (Review) that highlights the extreme global health threat of antimicrobial resistance (AMR). The Review, led by economist Jim O’Neill, specifically notes the threat of multidrug-resistant tuberculosis (MDR-TB) and the imperative of increased global investment in research and development to save the millions of lives lost each year due to AMR related to tuberculosis (TB) and other infectious diseases.

The final report warns that if new therapies, diagnostics and a new vaccine are not introduced, MDR-TB will be responsible for 2.5 million deaths per year by 2050, or roughly one quarter of the forecasted 10 million deaths related to AMR – equating to one death due to MDR-TB every 12 seconds. An interim paper entitled Vaccines and Alternative Approaches: Reducing our Dependence on Antimicobials, published by the Review in February 2016, also emphasized the overwhelming need for new TB vaccines as an essential component of the global strategy to overcome TB and to address MDR-TB.

A key finding of the final report is that increased public and private investment in research and development will be essential to combatting AMR – saving millions of lives, as well as avoiding the serious economic impact of this global public health emergency…

GAPS IN VACCINE COVERAGE HIGHLIGHTED WITH NEW REPORT AND ONLINE TOOL – IVAC

IVAC [International Vaccine Access Center] [to 28 May 2016]
http://www.jhsph.edu/research/centers-and-institutes/ivac/about-us/news.html

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GAPS IN VACCINE COVERAGE HIGHLIGHTED WITH NEW REPORT AND ONLINE TOOL
New report informs WHA dialogue on the leading killers of children: pneumonia and diarrhea
As the 69th World Health Assembly discusses progress on the Global Vaccine Action Plan, a new data visualization platform—from the International Vaccine Access Center (IVAC) at the Johns Hopkins Bloomberg School of Public Health (JHSPH)—provides stark numbers on where shortfalls exist in vaccine introduction and coverage.

The Vaccine Information Epidemiology Window (VIEW-hub) incorporates data on Haemophilus influenzae type B (Hib) vaccine, pneumococcal conjugate vaccine (PCV) and rotavirus vaccine. Despite their effectiveness in preventing pneumonia and diarrhea, these pathogens and the conditions they cause continue to be leading causes of death worldwide among children under 5 years of age.

VIEW-hub shows where children are unvaccinated because either their country has not introduced the vaccine, or the country’s routine immunization services are not reaching them.

For example:
:: 42 percent of the world’s infants (56.1 million) are not receiving Hib vaccine;
:: 60 percent (80.7 million) are not receiving PCV;
:: 76 percent (102.8 million) are not receiving rotavirus vaccine.

What’s more, 72 percent of the global burden of pneumonia and diarrhea child deaths occur in just 15 countries—India, Nigeria, Pakistan, DRC, Angola, Ethiopia, Indonesia, Chad, Afghanistan, Niger, China, Sudan, Bangladesh, Somalia and the United Republic of Tanzania. The two countries with the greatest absolute burden, Nigeria and India, are in the early stages of introducing these vaccines.

“Asia, in particular, lags in rotavirus vaccine introduction,” points out Mathuram Santosham, MD, MPH, senior advisor at IVAC and chair of the Rotavirus Organization of Technical Allies (ROTA) Council. “No country in South or South-East Asia has introduced rotavirus vaccine nationally, and only three—India, Thailand and the Philippines—have introduced sub-nationally.”

Even among countries that have introduced Hib, PCV and rotavirus vaccines, coverage is not reaching target levels. According to the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD), from WHO and UNICEF, at least 90% of children should be immunized in countries where the vaccines are available.

In Africa, for example, 44 out of the 54 countries have introduced the PCV vaccine. However, only 8 countries have reached very high coverage rates (90-100 percent); close behind are only 9 countries with high coverage rates (80-89 percent), based on the 2015 WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) for 2014. This suggests that governments have made progress in decision making, but are lagging in policy implementation.
“If the ultimate goal is to reach as many children as possible with vaccines, introduction data isn’t enough,” says Kate O’Brien, MD, MPH, Executive Director of IVAC, “we need to look at coverage, how many kids in the country are actually getting the vaccines. New policies to allow vaccines into a country’s routine schedule does no good for children if they aren’t actually receiving them.”

With real-time data updates, VIEW-hub can be used to monitor introduction and implementation, and to develop strategies for accelerating progress on global and country levels. Data sources include the World Health Organization, Centers for Disease Control and Prevention, UNICEF, Gavi, Bill and Melinda Gates Foundation, government Ministry of Health websites and vetted media sources. VIEW-Hub is also monitoring vaccine impact evaluations, including for PCV and rotavirus vaccine. The full report is available here: http://www.jhsph.edu/research/centers-and-institutes/ivac/view-hub/IVAC-VIEWHub-Report-2016May.pdf
VIEW-hub is supported by grants from Gavi and the Bill and Melinda Gates Foundation.

G7 Ise-Shima – Vision for Global Health

Editor’s Note:
The “Vision for Global Health” is one a series of G7 communiques issued by the meeting. We highlight selected language around public health emergencies and mentions of vaccines and immunization from the Vision for Global Health below. We urge readers to review the full document (see link]

G7 Japan 2016 – Ise-Shima
http://www.japan.go.jp/g7/

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G7 Ise-Shima Vision for Global Health (PDF: 8 pages)
May 27, 2016
1-2. Funding mechanism to ensure prompt actions in public health emergencies
1) Recognizing that WHO should play a key leading and coordinating role in the event of an
outbreak, for prompt detection, containment and control of public health emergencies
particularly in the early stage, call on the international community to support the Contingency
Fund for Emergency (CFE) to enable swift initial response by the WHO.
2) Welcome the World Bank’s formal announcement of launching the Pandemic Emergency
Financing Facility (PEF) to support a surge response by governments, multilateral agencies and
NGOs, and invite the international community including G7 members to extend technical
support and financial contributions to this end.
3) Also call upon relevant international organizations to ensure coordination among the PEF and
their related funding mechanisms including the CFE.
4) Urge all countries to improve their prevention and preparedness against outbreaks and
incorporate measures for enhanced national health security over time.

1-3. Coordination arrangement on global public health emergencies
1) Invite the WHO and the Office for the Coordination of Humanitarian Affairs (OCHA) under UN
Secretary General to review, strengthen and formalize coordination arrangement among the
WHO, the UN and other relevant partners in global public health emergencies, while
strengthening existing coordination systems including the Inter Agency Standing Committee
(IASC) Cluster System led by OCHA, as envisioned by on-going processes including the final
report of and UNSG response to UN High-Level Panel, World Humanitarian Summit and WHO
governing body discussions.
2) Invite the WHO and OCHA to update on the progress of these deliberations at the G7 Health
Ministers Meeting in September 2016….

2-1-2. Support for health system strengthening in LICs/LMICs towards UHC
…3) Support LICs/LMICs’s nationally driven and owned efforts toward HSS which might include the following key contributors for the achievement of UHC with better preparedness for and
prevention against emergencies;…
…(iii) improving access to affordable, safe, effective, and quality assured, essential medicines,
vaccines and technologies to prevent, diagnose and treat medical problems…

2-2-1. Women, adolescent and children’s health
…4) Reaffirm the importance of immunization as one of key cost-effective measures to prevent the spread of infectious disease and address emerging pandemics and to this end:
(i) continue global efforts to achieve the targets established in the Global Vaccine Action Plan;
(ii) leverage and use immunization records including information sources such as Maternal and
Child Health(MCH) handbooks which highlight the importance of immunization and give
guidance to families; and
(iii) recognize the tremendous progress achieved towards polio eradication where global
eradication is now within reach, and reaffirm our commitment to achieve polio eradication
targets laid out in the GPEI Endgame Strategic Plan, and recognize the significant
contribution that the polio related assets, resources and infrastructure will have on
strengthening health systems and advancing UHC….

3-4. Improving access to AMR countermeasures
1) Improve access to effective vaccines, diagnostics, antimicrobials, alternate therapeutics.
2) Support Infection Prevention and Control such as good hygiene – in particular but not only in
LICs and LMICs to reduce healthcare – associated infections and health burden of AMR through
appropriate training and technologies, and bilateral or multilateral arrangement.
3) Promote R&D partnerships, and measure the effectiveness of such interventions of effective
vaccines, diagnostics, antimicrobials,

4-1-2. Promote R&D on AMR
1) Promote R&D to combat AMR, such as through “pull” incentives to address specific market
failures and funding for basic and applied research and development of new vaccines,
diagnostics, antimicrobials, alternative therapeutics as well as IPC, other behavioral
interventions, and antimicrobial stewardship programs…

4-2. Accelerate R&D such as testing and manufacturing and distribution of medical products for public health emergencies
1) Acknowledge the importance of ensuring mechanisms to accelerate R&D in public health
emergencies, and welcome the action to prevent epidemics such as WHO Blueprint, discussions
at Global Health Security Initiative and Global Research Collaboration for Infectious Disease
Preparedness (GloPID-R).
2) Explore the feasibility of partnerships such as the Vaccine Innovation for Pandemic
Preparedness Partnership to conduct a coordinated vaccine research and development.
3) Promote scientifically robust clinical trials on emerging infectious diseases for rapid research
responses in cases of outbreak…

Ministers adopt Africa’s key health policies

African Union [to 28 May 2016]
http://www.au.int/en/

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May 26, 2016 | Press Releases
Ministers adopt Africa’s key health policies
Geneva, Switzerland, 21 May 2016- Ahead of the Wold Health Assembly African Ministers of Health met on Saturday and adopted key health policy instruments that will provide the strategic direction for the continent for the next fifteen years. These health policy instruments were finalised by Member State Health experts meeting in Addis Ababa in April this year for consideration by health ministers.

“I am confident that the Africa Health Strategy will provide the strategic direction that is needed to create better performing health sectors and address the major challenges impeding our efforts to reduce the continent’s disease burden” said Dr. Mustapha Sidiki Kaloko, the Commissioner for Social Affairs at the African Union Commission.

The revised African Health Strategy provides the overarching superstructure to address Africa’s broad health and development agenda in the next 15 years. To strengthen health systems the strategy addresses issues related to health financing, governance and improved multi-sectoral partnerships. The framework also refocuses service delivery, community empowerment and seeks to expand social protection to address equity. The blueprint also prioritises human resources for health, commodity security, regulatory and support environment for provision of quality medicines and technologies, disease surveillance and disaster management.

“I commend the increasing role played by the African Union Commission in positioning health at a very high level on the continental agenda. These health policy instruments are important reference frameworks for addressing the unfinished agenda of the MDGs and for meeting the new SDG agenda” said Dr Matshidiso Moeti, the Regional Director for Africa, World Health Organisation.

During the meeting the Ministers of Health also adopted the Maputo Plan of Action (2016-2030) and the Catalytic Framework to end AIDS, TB and Eliminate Malaria in Africa by 2030. The revised Maputo Plan of Action provides a framework for the full implementation of the continental policy framework on Sexual and Reproductive Health and Rights. The action plan seeks to catalyse the expansion of contraceptive use, reduce levels of unsafe abortion, end child marriage, eradicate harmful traditional practices, eliminate all forms of violence and discrimination against women and girls and ensure access to services by young people.

The Catalytic Framework provides a business model for investing for impact to end AIDS, TB and Eliminate Malaria in Africa by 2030. The framework focusses on three strategic investment areas, each with clear catalytic actions. These areas are health systems strengthening, generation and use of evidence for policy and programme interventions and advocacy and capacity building.

During the meeting the Ministers of Health adopted the concept document on the establishment of the African Health Volunteers Corps which will operate within the umbrella of the recently established Africa Centres for Disease Control and Prevention. Through this dedicated Corps the Africa CDC’s capability to assemble, equip, and mobilise a deployable roster of volunteer medical and public health professionals will be assured. This will ensure rapid and effective responses to public health emergencies to Member States and address matters of global concern including health impacts of natural disasters and humanitarian crises.

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May 26, 2016 | Press Releases
Africa agrees on common position to the United Nations High-Level Meeting on Ending AIDS
Geneva, Switzerland, 21 May 2016- Ministers of Health meeting ahead of the World Health Assembly on Saturday deliberated and agreed on a Common African Position (CAP) to the United Nations General Assembly High-Level Meeting on Ending AIDS that will be taking place in New York from 8 to 10 June 2016.

“The Common Africa Position is critical in the political declaration negotiations that are ongoing. It is imperative that Africa negotiates as one block, highly impacted by AIDS, and demand a political declaration that commits to bold strategies that aim to end the AIDS epidemic as a public health threat by 2030”, said Dr. Mustapha Sidiki Kaloko, the Commissioner for Social Affairs at the African Union Commission…