Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 21 May 2016]

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Research Article
Shrinking the malaria map in China: measuring the progress of the National Malaria Elimination Programme
Tao Hu, Yao-Bao Liu, Shao-Sen Zhang, Zhi-Gui Xia, Shui-Sen Zhou, Jun Yan, Jun Cao and Zhan-Chun Feng
Published on: 19 May 2016

Infectious Agents and Cancer
http://www.infectagentscancer.com/content
[Accessed 21 May 2016]

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Review
Open Access
Price and affordability of direct-acting antiviral regimens for hepatitis C virus in the United States
Elana S. Rosenthal and Camilla S. Graham
Infectious Agents and Cancer201611:24
DOI: 10.1186/s13027-016-0071-z
Abstract
Hepatitis C virus is a serious infection causing cirrhosis, liver cancer, and death. The recent development of direct-acting antivirals has dramatically improved tolerability of treatment and rates of cure. However, the high price of these medications has often limited access to care and resulted in rationing of medications in the United States to those with advanced liver disease, access to specialist care, and without active substance use. This review assesses the way pharmaceutical prices are established and how pricing of directly acting antiviral regimens in the United States has impacted access to treatment for hepatitis C virus.

International Journal of Epidemiology
Volume 45 Issue 2 April 2016
http://ije.oxfordjournals.org/content/current

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Editorials
African partnerships through the H3Africa Consortium bring a genomic dimension to longitudinal population studies on the continent
Michèle Ramsay1,*, Osman Sankoh2,3,
as members of the AWI-Gen study and the H3Africa Consortium
Author Affiliations
1Sydney Brenner Institute for Molecular Bioscience and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,
2INDEPTH Network, Kanda, Accra, Ghana and
3Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
*Corresponding author. E-mail: michele.ramsay@wits.ac.za
[Extract]
A health and epidemiological transition is enveloping the African continent from the southern and northern regions where the prevalence of obesity has rapidly increased over the past three decades.1 In the wake of the transition to increased urbanization follow increased rates of hypertension, stroke and type 2 diabetes (T2D). Despite the widespread HIV, TB and malaria epidemics, age-standardized mortality for non-communicable diseases (the probability of dying from one of the four main NCDs—CVD, cancer, chronic respiratory disease and diabetes) between the ages of 30 and 70 years (comparable estimates for 2012) is over 25% in South Africa compared with less than 15% in North America and Europe.2

Good health-related epidemiological data from most African populations are sparse. When accessing global data on non-communicable diseases, it becomes clear that many African countries have no data; in some there is sporadic reporting on specific variables and then there are pockets of excellent data, albeit usually on smaller cohorts, or only in specific regions. For this reason, African health data are often modelled and predictions are based on models that are supported with little and sub-optimal information. This highlights an urgent need to support more systematic approaches to collecting epidemiological data in Africa…

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Health Policies and Interventions
Loss of confidence in vaccines following media reports of infant deaths after hepatitis B vaccination in China
Int. J. Epidemiol. (2016) 45 (2): 441-449 doi:10.1093/ije/dyv349
Wenzhou Yu, Dawei Liu, Jingshan Zheng, Yanmin Liu, Zhijie An, Lance Rodewald, Guomin Zhang, Qiru Su, Keli Li, Disha Xu, Fuzhen Wang, Ping Yuan, Wei Xia, Guijun Ning, Hui Zheng,
Yaozhu Chu, Jian Cui, Mengjuan Duan, Lixin Hao, Yuqing Zhou, Zhenhua Wu, Xuan Zhang,
Fuqiang Cui, Li Li, and Huaqing Wang
Abstract
Background: China reduced hepatitis B virus (HBV) infection by 90% among children under 5 years old with safe and effective hepatitis B vaccines (HepB). In December 2013, this success was threatened by widespread media reports of infant deaths following HepB administration. Seventeen deaths and one case of anaphylactic shock following HBV vaccination had been reported.
Methods: We conducted a telephone survey to measure parental confidence in HepB in eleven provinces at four points in time; reviewed maternal HBV status and use of HepB for newborns in birth hospitals in eight provinces before and after the event; and monitored coverage with hepatitis B vaccine and other programme vaccines in ten provinces.
Results: HepB from the implicated company was suspended during the investigation, which showed that the deaths were not caused by HepB vaccination. Before the event, 85% respondents regarded domestic vaccines as safe, decreasing to 26.7% during the event. During the height of the crisis, 30% of parents reported being hesitant to vaccinate and 18.4% reported they would refuse HepB. Use of HepB in the monitored provinces decreased by 18.6%, from 53 653 doses the week before the event to 43 688 doses during the week that Biokangtai HepB was suspended. Use of HepB within the first day of life decreased by 10% among infants born to HBsAg-negative mothers, and by 6% among infants born to HBsAg-positive mothers. Vaccine refusal and HepB birth dose rates returned to baseline within 2 months; confidence increased, but remained below baseline.
Conclusions: The HBV vaccine event resulted in the suspension of a safe vaccine, which was associated with a decline of parental confidence, and refusal of vaccination. Suspension of a vaccine can lead to loss of confidence that is difficult to recover. Timely and credible investigation, accompanied by proactive outreach to stakeholders and the media, may help mitigate negative impact of future coincidental adverse events following immunization.

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Effectiveness of a pay-for-performance intervention to improve maternal and child health services in Afghanistan: a cluster-randomized trial
Cyrus Y Engineer, Elina Dale, Anubhav Agarwal, Arunika Agarwal, Olakunle Alonge, Anbrasi Edward, Shivam Gupta, Holly B Schuh, Gilbert Burnham, and David H Peters
Int. J. Epidemiol. (2016) 45 (2): 451-459 doi:10.1093/ije/dyv362
Abstract
Background: A cluster randomized trial of a pay-for-performance (P4P) scheme was implemented in Afghanistan to test whether P4P could improve maternal and child (MCH) services.
Methods: All 442 primary care facilities in 11 provinces were matched by type of facility and outpatient volume, and randomly assigned to the P4P or comparison arm. P4P facilities were given bonus payments based on the MCH services provided. An endline household sample survey was conducted in 72 randomly selected matched pair catchment areas (3421 P4P households; 3427 comparison).The quality of services was assessed in 81 randomly sampled matched pairs of facilities. Data collectors and households were blinded to the intervention assignment. MCH outcomes were assessed at the cluster level.
Results: There were no substantial differences in any of the five MCH coverage indicators (P4P vs comparison): modern contraception(10.7% vs 11.2% (P = 0.90); antenatal care: 56.2% vs 55.6% (P = 0.94); skilled birth attendance (33.9% vs 28.5%, P = 0.17); postnatal care (31.2% vs 30.3%, P = 0.98); and childhood pentavalent3 vaccination (49.6 vs 52.3%, P = 0.41), or in the equity measures. There were substantial increases in the quality of history and physical examinations index (P = 0.01); client counselling index (P = 0.01); and time spent with patients (P = 0.05). Health workers reported limited understanding about the bonuses.
Conclusions: The intervention had minimal effect, possibly due to difficulties communicating with health workers and inattention to demand-side factors. P4P interventions need to consider management and community demand issues.

JAMA
May 17, 2016, Vol 315, No. 19
http://jama.jamanetwork.com/issue.aspx

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Viewpoint
The New Era of Informed Consent: Getting to a Reasonable-Patient Standard Through Shared Decision Making FREE
Erica S. Spatz, MD, MHS; Harlan M. Krumholz, MD, SM; Benjamin W. Moulton, JD, MPH

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

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Original Paper
Development of a Cost-Effective Educational Tool to Promote Acceptance of the HPV Vaccination by Hispanic Mothers
Doerthe Brueggmann, Neisha Opper, Juan Felix, David A. Groneberg, Daniel R. MishellJr., Jenny M. Jaque
Abstract
Although vaccination against the Human Papilloma Virus (HPV) reduces the risk of related morbidities, the vaccine uptake remains low in adolescents. This has been attributed to limited parental knowledge and misconceptions. In this cross sectional study, we assessed the (1) clarity of educational material informing Hispanic mothers about HPV, cervical cancer and the HPV vaccine, (2) determined vaccination acceptability and (3) identified predictors of vaccine acceptance in an underserved health setting. 418 Hispanic mothers received the educational material and completed an anonymous survey. 91 % of participants understood most or all of the information provided. 77 % of participants reported vaccine acceptance for their children; this increased to 84 % when only those with children eligible to receive vaccination were included. Significant positive predictors of maternal acceptance of the HPV vaccine for their children were understanding most or all of the provided information, older age and acceptance of the HPV vaccine for themselves. Concerns about safety and general dislike of vaccines were negatively associated with HPV vaccine acceptance. Prior knowledge, level of education, previous relevant gynecologic history, general willingness to vaccinate and other general beliefs about vaccines were not significantly associated with HPV vaccine acceptance. The majority of participants reported understanding of the provided educational material. Vaccine acceptability was fairly high, but was even higher among those who understood the information. This study documents a cost-effective way to provide Hispanic mothers with easy-to-understand HPV-related information that could increase parental vaccine acceptability and future vaccine uptake among their children.

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Original Paper
Help-Seeking Behavior and Health Care Navigation by Bhutanese Refugees
Katherine Yun , Papia Paul, Parangkush Subedi, Leela Kuikel, Giang T. Nguyen, Frances K. Barg
Abstract
The objective of this study was to document barriers to care, help-seeking behaviors, and the impact of a community-based patient navigation intervention on patient activation levels among Bhutanese refugees in the U.S. Data sources comprised 35 intake and 34 post-intervention interviews with program participants, 14 intake and 14 post-intervention interviews with patient navigators, and 164 case notes. Textual data were analyzed using the constant comparison method. Patient activation level was assessed at both time points. Participants had limited English proficiency (97 %), limited literacy (69 %), and the lowest level of patient activation (69 %). Participants routinely experienced complex insurance access, coverage, and payment problems and had limited healthcare-related life skills. Help-seeking began within social networks, with high reliance on bilingual, literate family members perceived to have experience with “the system.” Help-seeking was not stigmatized and was instead consistent with societal norms valuing mutual assistance. Participants preferred helpers to act as proxies and required repeated social modeling by peers to gain confidence applying healthcare-related life skills. Following the intervention, only one-third reported the lowest level of patient activation (35 %) and one-third were highly activated (32 %). Bhutanese refugees overcome healthcare access barriers by seeking help from a network of support that begins within the community. Community health workers serving as patient navigators are readily sought out, and this approach is concordant with cultural expectations for mutual assistance. Community health workers serving immigrant groups should model healthcare-related life skills in addition to providing direct assistance.

Journal of Infectious Diseases
Volume 213 Issue 11 June 1, 2016
http://jid.oxfordjournals.org/content/current

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EDITORIAL COMMENTARY
Editor’s choice: Can Changes to Scheduling Enhance the Performance of Rotavirus Vaccines in Low-Income Countries?
J Infect Dis. (2016) 213 (11): 1673-1675 doi:10.1093/infdis/jiw026
Nigel A. Cunliffe and Gagandeep Kang

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VIRUSES
Editor’s choice: A Randomized, Controlled Trial of the Impact of Alternative Dosing Schedules on the Immune Response to Human Rotavirus Vaccine in Rural Ghanaian Infants
J Infect Dis. (2016) 213 (11): 1678-1685 doi:10.1093/infdis/jiw023
George Armah, Kristen D. C. Lewis, Margaret M. Cortese, Umesh D. Parashar, Akosua Ansah, Lauren Gazley, John C. Victor, Monica M. McNeal, Fred Binka, and A. Duncan Steele

Editor’s choice: Noninterference of Rotavirus Vaccine With Measles-Rubella Vaccine at 9 Months of Age and Improvements in Antirotavirus Immunity: A Randomized Trial
J Infect Dis. (2016) 213 (11): 1686-1693 doi:10.1093/infdis/jiw024
K. Zaman, Jessica A. Fleming, John C. Victor, Mohammad Yunus, Tajul Islam A. Bari, Tasnim Azim, Mustafizur Rahman, Syed Mohammad Niaz Mowla, William J. Bellini, Monica McNeal,
Joseph P. Icenogle, Ben Lopman, Umesh Parashar, Margaret M. Cortese, A. Duncan Steele,
and Kathleen M. Neuzil

Impact and Cost-effectiveness of 3 Doses of 9-Valent Human Papillomavirus (HPV) Vaccine Among US Females Previously Vaccinated With 4-Valent HPV Vaccine
J Infect Dis. (2016) 213 (11): 1694-1700 doi:10.1093/infdis/jiw046
Harrell W. Chesson, Jean-François Laprise, Marc Brisson, and Lauri E. Markowitz

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 5 Issue 2 June 2016
http://jpids.oxfordjournals.org/content/current

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ORIGINAL ARTICLES AND COMMENTARIES
Meningococcal Serogroup B Bivalent rLP2086 Vaccine Elicits Broad and Robust Serum Bactericidal Responses in Healthy Adolescents
J Ped Infect Dis (2016) 5 (2): 152-160 doi:10.1093/jpids/piv039
Timo Vesikari, Lars Østergaard, Javier Diez-Domingo, Jacek Wysocki, Carl-Erik Flodmark, Johannes Beeslaar, Joseph Eiden, Qin Jiang, Kathrin U. Jansen, Thomas R. Jones, Shannon L. Harris, Robert E. O’Neill, Laura J. York, Graham Crowther, and John L. Perez

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Immunogenicity, Safety, and Tolerability of Bivalent rLP2086 Meningococcal Group B Vaccine Administered Concomitantly With Diphtheria, Tetanus, and Acellular Pertussis and Inactivated Poliomyelitis Vaccines to Healthy Adolescents
J Ped Infect Dis (2016) 5 (2): 180-187 doi:10.1093/jpids/piv064
Timo Vesikari, Jacek Wysocki, Johannes Beeslaar, Joseph Eiden, Qin Jiang, Kathrin U. Jansen,
Thomas R. Jones, Shannon L. Harris, Robert E. O’Neill, Laura J. York, and John L. Perez

The Lancet
May 21, 2016 Volume 387 Number 10033 p2063-2162 e26-e27
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
No health workforce, no global health security
The Lancet
Summary
Since the recent epidemics of Ebola, MERS, and Zika viruses, the ever-present threat of pandemic influenza, and now the menace of a yellow fever crisis, the notion of global health security has risen to the top of concerns facing the 194 member states attending next week’s 69th World Health Assembly (WHA) in Geneva, Switzerland. Without global health security, the common goal of a more sustainable and resilient society for human health and wellbeing will be unattainable.

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Articles
Association between Zika virus and microcephaly in French Polynesia, 2013–15: a retrospective study
Simon Cauchemez, Marianne Besnard, Priscillia Bompard, Timothée Dub, Prisca Guillemette-Artur, Dominique Eyrolle-Guignot, Henrik Salje, Maria D Van Kerkhove, Véronique Abadie, Catherine Garel, Arnaud Fontanet, Henri-Pierre Mallet
Summary
Background
The emergence of Zika virus in the Americas has coincided with increased reports of babies born with microcephaly. On Feb 1, 2016, WHO declared the suspected link between Zika virus and microcephaly to be a Public Health Emergency of International Concern. This association, however, has not been precisely quantified.
Methods
We retrospectively analysed data from a Zika virus outbreak in French Polynesia, which was the largest documented outbreak before that in the Americas. We used serological and surveillance data to estimate the probability of infection with Zika virus for each week of the epidemic and searched medical records to identify all cases of microcephaly from September, 2013, to July, 2015. Simple models were used to assess periods of risk in pregnancy when Zika virus might increase the risk of microcephaly and estimate the associated risk.
Findings
The Zika virus outbreak began in October, 2013, and ended in April, 2014, and 66% (95% CI 62–70) of the general population were infected. Of the eight microcephaly cases identified during the 23-month study period, seven (88%) occurred in the 4-month period March 1 to July 10, 2014. The timing of these cases was best explained by a period of risk in the first trimester of pregnancy. In this model, the baseline prevalence of microcephaly was two cases (95% CI 0–8) per 10,000 neonates, and the risk of microcephaly associated with Zika virus infection was 95 cases (34–191) per 10,000 women infected in the first trimester. We could not rule out an increased risk of microcephaly from infection in other trimesters, but models that excluded the first trimester were not supported by the data.
Interpretation
Our findings provide a quantitative estimate of the risk of microcephaly in fetuses and neonates whose mothers are infected with Zika virus.
Funding
Labex-IBEID, NIH-MIDAS, AXA Research fund, EU-PREDEMICS.

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Review
Costs, affordability, and feasibility of an essential package of cancer control interventions in low-income and middle-income countries: key messages from Disease Control Priorities, 3rd edition
Hellen Gelband, Rengaswamy Sankaranarayanan, Cindy L Gauvreau, Susan Horton, Benjamin O Anderson, Freddie Bray, James Cleary, Anna J Dare, Lynette Denny, Mary K Gospodarowicz, Sumit Gupta, Scott C Howard, David A Jaffray, Felicia Knaul, Carol Levin, Linda Rabeneck, Preetha Rajaraman, Terrence Sullivan, Edward L Trimble, Prabhat Jha, Disease Control Priorities-3 Cancer Author Group
Summary
Investments in cancer control—prevention, detection, diagnosis, surgery, other treatment, and palliative care—are increasingly needed in low-income and particularly in middle-income countries, where most of the world’s cancer deaths occur without treatment or palliation. To help countries expand locally appropriate services, Cancer (the third volume of nine in Disease Control Priorities, 3rd edition) developed an essential package of potentially cost-effective measures for countries to consider and adapt. Interventions included in the package are: prevention of tobacco-related cancer and virus-related liver and cervical cancers; diagnosis and treatment of early breast cancer, cervical cancer, and selected childhood cancers; and widespread availability of palliative care, including opioids. These interventions would cost an additional US$20 billion per year worldwide, constituting 3% of total public spending on health in low-income and middle-income countries. With implementation of an appropriately tailored package, most countries could substantially reduce suffering and premature death from cancer before 2030, with even greater improvements in later decades.

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Health Policy
The World report on ageing and health: a policy framework for healthy ageing
John R Beard, Alana Officer, Islene Araujo de Carvalho, Ritu Sadana, Anne Margriet Pot, Jean-Pierre Michel, Peter Lloyd-Sherlock, JoAnne E Epping-Jordan, G M E E (Geeske) Peeters, Wahyu Retno Mahanani, Jotheeswaran Amuthavalli Thiyagarajan, Somnath Chatterji
Summary
Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report.

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Health Policy
Protecting human security: proposals for the G7 Ise-Shima Summit in Japan
Japan Global Health Working Group
2155
Summary
In today’s highly globalised world, protecting human security is a core challenge for political leaders who are simultaneously dealing with terrorism, refugee and migration crises, disease epidemics, and climate change. Promoting universal health coverage (UHC) will help prevent another disease outbreak similar to the recent Ebola outbreak in west Africa, and create robust health systems, capable of withstanding future shocks. Robust health systems, in turn, are the prerequisites for achieving UHC. We propose three areas for global health action by the G7 countries at their meeting in Japan in May, 2016, to protect human security around the world: restructuring of the global health architecture so that it enables preparedness and responses to health emergencies; development of platforms to share best practices and harness shared learning about the resilience and sustainability of health systems; and strengthening of coordination and financing for research and development and system innovations for global health security. Rather than creating new funding or organisations, global leaders should reorganise current financing structures and institutions so that they work more effectively and efficiently. By making smart investments, countries will improve their capacity to monitor, track, review, and assess health system performance and accountability, and thereby be better prepared for future global health shocks.

Medical Decision Making (MDM)
May 2016; 36 (4)
http://mdm.sagepub.com/content/current

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Reviews
The Impact of Patient Participation in Health Decisions Within Medical Encounters: A Systematic Review
Med Decis Making May 2016 36: 427-452, first published on November 19, 2015 doi:10.1177/0272989X15613530
Marla L. Clayman, Carma L. Bylund, Betty Chewning, and Gregory Makoul
Abstract
Background: Although there are compelling moral arguments for patient participation in medical decisions, the link to health outcomes has not been systematically explored. Objective: Assess the extent to which patient participation in decision making within medical encounters is associated with measured patient outcomes. Methods: We conducted a primary search in PubMed—excluding non-English and animal studies—for articles on decision making in the context of the physician–patient relationship published through the end of February 2015, using the MeSH headings (Physician-Patient Relations [MeSH] OR Patient Participation [MeSH]) and the terms (decision OR decisions OR option OR options OR choice OR choices OR alternative OR alternatives) in the title or abstract. We also conducted a secondary search of references in all articles that met the inclusion criteria. Results: A thorough search process yielded 116 articles for final analysis. There was wide variation in study design, as well as measurement of patient participation and outcomes, among the studies. Eleven of the 116 studies were randomized controlled trials (RCTs). Interventions increased patient involvement in 10 (91%) of the 11 RCTs. At least one positive outcome was detected in 5 (50%) of the 10 RCTs reporting increased participation; the ratio of positive results among all outcome variables measured in these studies was much smaller. Although proportions differed, similar patterns were found across the 105 nonrandomized studies. Conclusions: Very few RCTs in the field have measures of participation in decision making and at least one health outcome. Moreover, extant studies exhibit little consistency in measurement of these variables, and results are mixed. There is a great need for well-designed, reproducible research on clinically relevant outcomes of patient participation in medical decisions.

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Unknown Risks: Parental Hesitation about Vaccination
Med Decis Making May 2016 36: 479-489, first published on October 27, 2015 doi:10.1177/0272989X15607855
Laura L. Blaisdell, Caitlin Gutheil, Norbert A. M. Hootsmans, and Paul K. J. Han
Abstract
Objective. This qualitative study of a select sample of vaccine-hesitant parents (VHPs) explores perceived and constructed personal judgments about the risks and uncertainties associated with vaccines and vaccine-preventable diseases (VPDs) and how these subjective risk judgments influence parents’ decisions about childhood vaccination. Methods. The study employed semistructured focus group interviews with 42 VHPs to elicit parents’ perceptions and thought processes regarding the risks associated with vaccination and nonvaccination, the sources of these perceptions, and their approach to decision making about vaccination for their children. Results. VHPs engage in various reasoning processes and tend to perceive risks of vaccination as greater than the risks of VPDs. At the same time, VHPs engage in other reasoning processes that lead them to perceive ambiguity in information about the harms of vaccination—citing concerns about the missing, conflicting, changing, or otherwise unreliable nature of information. Conclusions. VHPs’ refusal of vaccination may reflect their aversion to both the risk and ambiguity they perceive to be associated with vaccination. Mitigating this vaccine hesitancy likely requires reconstructing the risks and ambiguities associated with vaccination—a challenging task that requires providing parents with meaningful evidence-based information on the known risks of vaccination versus VPDs and explicitly acknowledging the risks that remain truly unknown.

New England Journal of Medicine
May 19, 2016 Vol. 374 No. 20
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
Essential Medicines in the United States — Why Access Is Diminishing
Jonathan D. Alpern, M.D., John Song, M.D., M.P.H., and William M. Stauffer, M.D., M.S.P.H.
N Engl J Med 2016; 374:1904-1907 May 19, 2016 DOI: 10.1056/NEJMp1601559
Prices have been dramatically increasing for many older, off-patent drugs, some of which are considered “essential” by the World Health Organization. Some price hikes have made potentially life-saving therapies unavailable to disadvantaged patients in the United States

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Special Report
Zika Virus and Birth Defects — Reviewing the Evidence for Causality
S.A. Rasmussen, D.J. Jamieson, M.A. Honein, and L.R. Petersen
Free Full Text
Summary
The Zika virus has spread rapidly in the Americas since its first identification in Brazil in early 2015. Prenatal Zika virus infection has been linked to adverse pregnancy and birth outcomes, most notably microcephaly and other serious brain anomalies. To determine whether Zika virus infection during pregnancy causes these adverse outcomes, we evaluated available data using criteria that have been proposed for the assessment of potential teratogens. On the basis of this review, we conclude that a causal relationship exists between prenatal Zika virus infection and microcephaly and other serious brain anomalies. Evidence that was used to support this causal relationship included Zika virus infection at times during prenatal development that were consistent with the defects observed; a specific, rare phenotype involving microcephaly and associated brain anomalies in fetuses or infants with presumed or confirmed congenital Zika virus infection; and data that strongly support biologic plausibility, including the identification of Zika virus in the brain tissue of affected fetuses and infants. Given the recognition of this causal relationship, we need to intensify our efforts toward the prevention of adverse outcomes caused by congenital Zika virus infection. However, many questions that are critical to our prevention efforts remain, including the spectrum of defects caused by prenatal Zika virus infection, the degree of relative and absolute risks of adverse outcomes among fetuses whose mothers were infected at different times during pregnancy, and factors that might affect a woman’s risk of adverse pregnancy or birth outcomes. Addressing these questions will improve our ability to reduce the burden of the effects of Zika virus infection during pregnancy.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 21 May 2016)

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Research Article
Beyond Contact Tracing: Community-Based Early Detection for Ebola Response
May 19, 2016 ·
Introduction: The 2014 Ebola outbreak in West Africa raised many questions about the control of infectious disease in an increasingly connected global society. Limited availability of contact information made contact tracing diffcult or impractical in combating the outbreak.
Methods: We consider the development of multi-scale public health strategies that act on individual and community levels. We simulate policies for community-level response aimed at early screening all members of a community, as well as travel restrictions to prevent inter-community transmission.
Results: Our analysis shows the policies to be effective even at a relatively low level of compliance and for a variety of local and long range contact transmission networks. In our simulations, 40% of individuals conforming to these policies is enough to stop the outbreak. Simulations with a 50% compliance rate are consistent with the case counts in Liberia during the period of rapid decline after mid September, 2014. We also find the travel restriction to be effective at reducing the risks associated with compliance substantially below the 40% level, shortening the outbreak and enabling efforts to be focused on affected areas.
Discussion: Our results suggest that the multi-scale approach can be used to further evolve public health strategy for defeating emerging epidemics.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 21 May 2016)

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Policy Forum
Toward a Common Secure Future: Four Global Commissions in the Wake of Ebola
Lawrence O. Gostin, Oyewale Tomori, Suwit Wibulpolprasert, Ashish K. Jha, Julio Frenk, Suerie Moon, Joy Phumaphi, Peter Piot, Barbara Stocking, Victor J. Dzau, Gabriel M. Leung
| published 19 May 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002042
Summary Points
:: Four global commissions reviewing the recent Ebola virus disease epidemic response consistently recommended strengthening national health systems, consolidating and strengthening World Health Organization (WHO) emergency and outbreak response activities, and enhancing research and development.
:: System-wide accountability is vital to effectively prevent, detect, and respond to future global health emergencies.
:: Global leaders (e.g., United Nations, World Health Assembly, G7, and G20) should maintain continuous oversight of global health preparedness, and ensure effective implementation of the Ebola commissions’ key recommendations, including sustainable and scalable financing.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 21 May 2016)

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Research Article
A Cost-Effectiveness Tool for Informing Policies on Zika Virus Control
Jorge A. Alfaro-Murillo, Alyssa S. Parpia, Meagan C. Fitzpatrick, Jules A. Tamagnan, Jan Medlock, Martial L. Ndeffo-Mbah, Durland Fish, María L. Ávila-Agüero, Rodrigo Marín, Albert I. Ko, Alison P. Galvani
| published 20 May 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004743

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Research Article
Extent of Integration of Priority Interventions into General Health Systems: A Case Study of Neglected Tropical Diseases Programme in the Western Region of Ghana
Ernest O. Mensah, Moses K. Aikins, Margaret Gyapong, Francis Anto, Moses J. Bockarie, John O. Gyapong
| published 20 May 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004725

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Research Article
Cholera Incidence and Mortality in Sub-Saharan African Sites during Multi-country Surveillance
Delphine Sauvageot, Berthe-Marie Njanpop-Lafourcade, Laurent Akilimali, Jean-Claude Anne, Pawou Bidjada, Didier Bompangue, Godfrey Bwire, Daouda Coulibaly, Liliana Dengo-Baloi, Mireille Dosso, Christopher Garimoi Orach, Dorteia Inguane, Atek Kagirita, Adele Kacou-N’Douba, Sakoba Keita, Abiba Kere Banla, Yao Jean-Pierre Kouame, Dadja Essoya Landoh, Jose Paulo Langa, Issa Makumbi, Berthe Miwanda, Muggaga Malimbo, Guy Mutombo, Annie Mutombo, Emilienne Niamke NGuetta, Mamadou Saliou, Veronique Sarr, Raphael Kakongo Senga, Fode Sory, Cynthia Sema, Ouyi Valentin Tante, Bradford D. Gessner, Martin A. Mengel
| published 17 May 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004679

PLoS One
http://www.plosone.org/
[Accessed 21 May 2016]

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Research Article
Behavioral Perceptions of Oakland University Female College Students towards Human Papillomavirus Vaccination
Aishwarya Navalpakam, Mohammed Dany, Inaya Hajj Hussein
Research Article | published 20 May 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0155955
Abstract
Human Papillomavirus (HPV) vaccination decreases the risk for cervical cancer. However, the uptake of HPV vaccine remains low when compared with other recommended vaccines. This study evaluates the knowledge and attitudes towards HPV infection and vaccination, and the readiness for the uptake of HPV vaccine amongst female students attending Oakland University (OU) in Michigan, United States. This is a cross-sectional study targeting a randomized sample of a 1000 female OU students using an online questionnaire. The data were statistically analyzed using SPSS software. A total of 192 female students, with the mean age of 24 years completed the survey. The majority of participants had previous sexual experience with occasional use of contraceptives (78.1%), were non-smokers (92.7%), and non-alcohol drinkers (54.2%). The participants had a mean knowledge score of 53.0% with a standard error of 2.3% translating to a moderately informed population. The majority agreed that HPV is life threatening (79%), the vaccine prevents cervical cancer (62%), and that side effects would not deter them from vaccination (63%). Although two thirds (67%) believed that, based on sexual practices in the United States, female college students in Michigan have a higher chance of contracting HPV, about 50% did not believe they themselves were at risk. Higher knowledge correlated with increased recommendation for the vaccine (correlation-factor 0.20, p = 0.005). Results suggested that the best predictor for improvement of vaccination was the awareness level and health education. This indicates a need for an educational intervention to raise awareness, increase HPV vaccine uptake, and decrease the incidence of cervical cancer.

PLoS Pathogens
http://journals.plos.org/plospathogens/
(Accessed 21 May 2016)

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Pearls
Immunizing against Anogenital Cancer: HPV Vaccines
Cloe S. Pogoda, Richard B. S. Roden, Robert L. Garcea
| published 19 May 2016 | PLOS Pathogens
http://dx.doi.org/10.1371/journal.ppat.1005587
… Future Outlook
Vaccines have remarkable potential to prevent cancers that are related to infectious agents (e.g., HPV and Hepatitis B). While the latest HPV vaccine offers protection against up to 90% of cervical cancer, next generation vaccines will potentially offer broader protection and be more practical for universal implementation. Hopefully, they will address the issues of cost by using alternative production systems, fewer but more cross-protective antigens (L1 or L2), and suitability for manufacture in the regions where the vaccines will be delivered. By utilizing techniques such as lyophilization, these new vaccines may be shipped and stored without refrigeration. New delivery methods, such as nanoparticle platforms, have the potential to eliminate the need for multiple doses through timed-release technology [20]. More stable formulations also create the potential for aerosol or patch deliverable vaccines to eliminate the need for needles. Second generation vaccines may even have therapeutic properties that treat existing HPV infections. These factors may alter the current guidelines regarding when and to which populations vaccines should be administered. As current vaccines are administered, it will be important to monitor if an increase of non-targeted hrHPV genotypes occur. This potential viral replacement may dictate that second generation vaccines must immunize against different strains or be more broadly effective. As the current and second generation vaccines continue to evolve and are used by a greater fraction of the global population, we look forward to seeing the decreasing rates of anogenital (and likely oropharyngeal) cancers and deaths due to HPV infection.

Preventive Medicine
Volume 86, Pages 1-166 (May 2016)
http://www.sciencedirect.com/science/journal/00917435/86

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Original Research Article
Trends and predictors of HPV vaccination among U.S. College women and men
Pages 92-98
Erika L. Thompson, Cheryl A. Vamos, Coralia Vázquez-Otero, Rachel Logan, Stacey Griner, Ellen M. Daley
Abstract
Background
HPV vaccination was recommended by the Advisory Committee on Immunization Practices for young adult females in 2006 and males in 2011 to prevent HPV-related cancers and genital warts. As this prevention mechanism continues to disseminate, it is necessary to monitor the uptake of this vaccine. College students represent an important population for HPV vaccination efforts and surveillance due to increased risk for HPV infection and representing a priority population for catch-up HPV vaccination. The purpose of this study was to assess the trends in HPV vaccination among U.S. college females and males from 2009 to 2013, and to examine whether predictors for HPV vaccination differ between males and females.
Methods
The National College Health Assessment-II (Fall 2009–2013) was used to assess trends in HPV vaccination using hierarchical logistic regression across genders and demographics. Data from 2013 were used to assess demographic variables associated with HPV vaccination for males and females, respectively. The analysis was conducted in 2015.
Results
Females had nearly double the rates of HPV vaccination compared to males over time. All demographic sub-groups had significant increases in vaccine rates over time, with select male sub-groups having more accelerated increases (e.g., gay). Young age (18–21 vs. 22–26 years) was a significant predictor for HPV vaccination among males and females, while race/ethnicity was a predictor of vaccination among females only.
Conclusions
These findings identified specific demographic sub-groups that need continued support for HPV vaccination. Campus health centers may be rational settings to facilitate clinical opportunities for HPV vaccination among unvaccinated college students.

Public Health Reports
Volume 131 , Issue Number 3 May/June 2016
http://www.publichealthreports.org/issuecontents.cfm?Volume=131&Issue=3

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Brief Report
Understanding Non-Completion of the Human Papillomavirus Vaccine Series: Parent-Reported Reasons for Why Adolescents Might Not Receive Additional Doses, United States, 2012
Sarah J. Clark, MPH / Anne E. Cowan, MPH / Stephanie L. Fillipp, MPH / Allison M. Fisher, MPH / Shannon Stokley, MPH

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Case Studies and Practice
Assessing Clinical Research Capacity in Vietnam: A Framework for Strengthening Capability for Clinical Trials in Developing Countries
Jonathan Kagan, PhD / Dao Duc Giang, MPH / Michael F. Iademarco, MD, MPH / Van TT Phung, MS / Chuen-Yen Lau, MD, MPH / Nguyen Ngo Quang, PhD

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Research
Human Papillomavirus Vaccination in Washington State: Estimated Coverage and Missed Opportunities, 2006–2013
Hanna N. Oltean, MPH / Kathryn H. Lofy, MD / Marcia Goldoft / Charla A. DeBolt, RN, MPH

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Law and the Public’s Health: Quarantine and Liability in the Context of Ebola
Polly J. Price, JD

Science
20 May 2016 Vol 352, Issue 6288
http://www.sciencemag.org/current.dtl

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Introduction to special issue
Cities are the Future
By Nicholas S. Wigginton, Julia Fahrenkamp-Uppenbrink, Brad Wible, David Malakoff
Science20 May 2016 : 904-905
Rapid urbanization is overtaxing the planet, but it may not have to

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Editorial
Leave no city behind
By Michele Acuto, Susan Parnell
Science20 May 2016 : 873
Summary
Close to 4 billion people live in cities. As the driver of environmental challenges, accounting for nearly 70% of the world’s carbon emissions, and as sites of critical social disparities, with 863 million dwellers now living in slums, urban settlements are at the heart of global change. This momentum is unlikely to disappear, as approximately 70 million more people will move to cities by the end of this year alone. The good news is that recent multilateral processes are now appreciating this key role of cities and are increasingly prioritizing urban concerns in policy-making. Yet, how can we ensure that these steps toward a global urban governance leave no city, town, or urban dweller behind?

Science Translational Medicine
11 May 2016 Vol 8, Issue 338
http://stm.sciencemag.org/

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Editorial
The need for global regulatory harmonization: A public health imperative
By Elias Zerhouni, Margaret Hamburg
Science Translational Medicine11 May 2016 : 338ed6
Because public health and innovation are no longer national issues, regulatory authorities must apply a global view to oversight.

Vaccine
Volume 34, Issue 25, Pages 2759-2862 (27 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/25
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Commentary
Introducing dengue vaccine: Implications for diagnosis in dengue vaccinated subjects
Pages 2759-2761
Kalichamy Alagarasu
Abstract
Diagnosis of dengue virus infections is complicated by preference for different diagnostic tests in different post onset days of illness and the presence of multiple serotypes leading to secondary and tertiary infections. The sensitivity of the most commonly employed diagnostic assays such as anti dengue IgM capture (MAC) ELISA and non structural protein (NS) 1 capture ELISA are lower in secondary and subsequent infections. Introduction of dengue vaccine in endemic regions will affect the way how dengue is diagnosed in vaccinated subjects. This viewpoint article discusses implications of introduction of dengue vaccine on the diagnosis of dengue infections in vaccinated subjects and the strategies that are needed to tackle the issue.

Vaccine
Volume 34, Issue 25, Pages 2759-2862 (27 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/25
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Review
Impact of the introduction of the pneumococcal conjugate vaccine in the Brazilian routine childhood national immunization program
Review Article
Pages 2766-2778
Marta Moreira, Otavio Cintra, Julie Harriague, William P. Hausdorff, Bernard Hoet
Abstract
Brazil introduced the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV, Synflorix™, GSK Vaccines) in the routine childhood immunization program in 2010 with a 3 + 1 schedule (with catch-up for children <2 years-old). This review represents the first analysis of the overall impact of a second-generation pneumococcal conjugate vaccine on nasopharyngeal carriage and all the major pneumococcal disease manifestations in a single, pneumococcal conjugate vaccine-naïve, developing country. A total of 15 published articles and 13 congress abstracts were included in the analysis. In children <5 years-old, studies showed a positive impact of PHiD-CV on the incidence of vaccine-type and any-type invasive pneumococcal disease (including decreases in pneumococcal meningitis morbidity and mortality), on pneumonia incidence and mortality, and on otitis media. Nasopharyngeal carriage of vaccine-type and any-type pneumococci decreased after the primary doses, with no early signs of replacement with other pathogens. Finally, herd protection against vaccine-type invasive pneumococcal disease and pneumonia in unvaccinated subjects was shown in some studies for some age groups. In conclusion, pneumococcal disease decreased after the introduction of PHiD-CV into the Brazilian national immunization program. Further follow-up is needed to evaluate the long-term overall impact of PHiD-CV in the Brazilian population.

Vaccine
Volume 34, Issue 25, Pages 2759-2862 (27 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/25
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Post-licensure safety surveillance of 23-valent pneumococcal polysaccharide vaccine in the Vaccine Adverse Event Reporting System (VAERS), 1990–2013
Original Research Article
Pages 2841-2846
Elaine R. Miller, Pedro L. Moro, Maria Cano, Paige Lewis, Marthe Bryant-Genevier, Tom T. Shimabukuro
Abstract
Background
23-Valent pneumococcal polysaccharide vaccine, trade name Pneumovax®23 (PPSV23), has been used for decades in the Unites States and has an extensive clinical record. However, limited post-licensure safety assessment has been conducted.
Objective
To analyze reports submitted to the Vaccine Adverse Event Reporting System (VAERS) following PPSV23 from 1990 to 2013 in order to characterize its safety profile.
Methods
We searched the VAERS database for US reports following PPSV23 for persons vaccinated from 1990 to 2013. We assessed safety through: automated analysis of VAERS data, crude adverse event (AE) reporting rates based on PPSV23 doses distributed in the US market, clinical review of death reports and reports involving vaccine administered to pregnant women, and empirical Bayesian data mining to assess for disproportional reporting.
Results
During the study period, VAERS received 25,168 PPSV23 reports; 92% were non-serious, 67% were in females and 86% were in adults aged ≥19 years. When PPSV23 was administered alone, fever (43%), injection site erythema (28%) and injection site pain (25%) were the most commonly reported non-serious AEs in children. Injection site erythema (32%), injection site pain (27%) and injection site swelling (23%) were the most commonly reported non-serious AEs in adults. Of serious reports (2129, 8% of total), fever was most commonly reported in both children (69%) and adults (39%). There were 66 reports of death, four in children and 62 in adults. Clinical review of death reports did not reveal any concerning patterns that would suggest a causal association with PPSV23. No disproportional reporting of unexpected AEs was observed in empirical Bayesian data mining.
Conclusions
We did not identify any new or unexpected safety concerns for PPSV23. The VAERS data are consistent with safety data from pre-licensure clinical trials and other post-licensure studies.

Vaccine
Volume 34, Issue 25, Pages 2759-2862 (27 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/25
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Progress towards hepatitis B prevention through vaccination in the Western Pacific, 1990–2014
Original Research Article
Pages 2855-2862
Eric Wiesen, Sergey Diorditsa, Xi Li
Abstract
Hepatitis B infections are responsible for more than 300 thousand deaths per year in the Western Pacific Region. Because of this high burden, the countries and areas of the Region established a goal of reducing hepatitis B chronic infection prevalence among children to less than 1% by 2017. This study was conducted to measure the progress in hepatitis B prevention and assess the status of achievement of the 2017 Regional hepatitis B control goal. A literature review was conducted to identify studies of hepatitis B prevalence in the countries and areas of the region, both before and after vaccine introduction. A mathematical model was applied to assess infections and deaths prevented by hepatitis B vaccination and hepatitis B prevalence in countries without recent empirical data. The majority of countries and areas (22 out of 36) were estimated to have over 8% prevalence of chronic hepatitis B infection among persons born before vaccine introduction. After introduction of hepatitis B vaccine, most countries and areas (24 out of 36) had chronic infection prevalence of less than 1% among children born after vaccine introduction. It was estimated that in the past 25 years immunization programmes in the Western Pacific Region have averted 7,167,128 deaths that would have occurred in the lifetime of children born between 1990 and 2014 if hepatitis B vaccination programmes had not been established. Regional prevalence among children born in 2012 was estimated to be 0.93%, meaning that the Regional hepatitis B control goal was achieved. While additional efforts are needed to further reduce hepatitis B transmission in the region, this study demonstrates the great success of the hepatitis B vaccination efforts in the Western Pacific Region

See content below…

Papillomavirus Research
Available online 17 May 2016
Monitoring the impact of HPV vaccine in males—considerations and challenges
JML Brotherton, AR Giuliano, LE Markowitz, EF Dunne… –
Abstract
In this article, we examine the issues involved if national or sub-national programs are considering extending post HPV vaccine introduction monitoring to include males. Vaccination programs are now being extended to include males in some countries, in order to improve population level HPV infection control and to directly prevent HPV-related disease in males such as anogenital warts and anal cancers. Coverage and adverse events surveillance are essential components of post-vaccination monitoring. Monitoring the impact of vaccination on HPV infection and disease in men raises some similar challenges to monitoring in females, such as the long time frame until cancer outcomes, and also different ones given that genital specimens suitable for monitoring HPV prevalence are not routinely collected for other diagnostic or screening purposes in males. Thus, dedicated surveillance strategies must be designed; the framework of these may be country-specific, dependent upon the male population that is offered vaccination, the health care infrastructure and existing models of disease surveillance such as STI networks. The primary objective of any male HPV surveillance program will be to document changes in the prevalence of HPV infection and disease due to vaccine targeted HPV types occurring post vaccination. The full spectrum of outcomes to be considered for inclusion in any surveillance plan includes HPV prevalence monitoring, anogenital warts, potentially pre-cancerous lesions such as anal squamous intraepithelial lesions (SIL), and cancers. Ideally, a combination of short term and long term outcome measures would be included. Surveillance over time in specific targeted populations of men who have sex with men and HIV-infected men (populations at high risk for HPV infection and associated disease) could be an efficient use of resources to demonstrate impact.

Obstetrics & Gynecology
May 2016
doi: 10.1097/01.AOG.0000483332.97659.57
Do Educational Seminars for the HPV Vaccine Improve Attitudes Toward and Likelihood of Vaccination?[12B].
Foster, Leah N. MD; Roussos-Ross, Kay MD; DeCesare, Julie Z. MD; McAlpin, Lindsey M. MD
Abstract
INTRODUCTION: In the United States, there are approximately 12,360 cases of invasive cervical cancer diagnosed annually resulting in 4,020 deaths each year. Human papillomavirus is the known cause for the majority of all cervical cancers. The FDA and CDC have approved vaccination for the prevention of HPV. Since the approval of HPV vaccines only 33 percent of eligible females and 10 percent of eligible males have been vaccinated. The goal of this study is to investigate the barriers to HPV vaccination for eligible recipients and to determine whether an educational intervention regarding HPV vaccination results in improved attitudes and likelihood of vaccination. The study is being performed in conjunction with the ACOG District XII Health Care for Underserved Women Committee.
METHODS: We conducted a community outreach educational seminar to evaluate participants’ baseline knowledge regarding HPV, the HPV vaccine, and opinions about vaccination. Each participant was asked to complete a survey on HPV upon arrival. We then executed a brief educational seminar about HPV. Following completion of the educational session, the study participants again completed the survey.
RESULTS: Data analyzed with Fisher Exact Test noted a statistically significant improvement in knowledge of HPV related facts and willingness to accept the HPV vaccine following the educational seminar, P<.01.
CONCLUSION: Educational seminars show a clear benefit increasing education and awareness regarding the purpose and benefits of the HPV vaccine. Providing addition educational opportunities of eligible recipients and their guardians may provide higher vaccination rates, and thereby lower cervical cancer rates in the future.

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HPV Vaccination Does Not Provide Herd Immunity for Unvaccinated Women or Cross-Protection for Nonvaccine HPV Types [12].
Tarney, Christopher MD; Pagan, Megan MD; Klaric, John PhD; Beltran, Thomas; Han, Jasmine MD
Abstract
INTRODUCTION: To determine if the human papillomavirus (HPV) vaccination offers cross-protection against nonvaccine HPV types and whether introduction of the vaccination has offered herd immunity to unvaccinated women.
METHODS: We collected and analyzed HPV prevalence data for females aged 18-29 from the prevaccine era (2007-2008) and postvaccine era (2009-2012) using the National Health and Nutrition Examination Surveys (NHANES); 1628 female respondents aged 18-29, representing 21,135,134 females in the United States non-institutionalized civilian population, provided vaginal swabs across three consecutive NHANES survey cycles.
RESULTS: Among females aged 18-29, the prevalence of high risk HPV among women who received at least one dose of the HPV vaccine decreased from 67% (95% confidence interval [CI] 50.7-81.4) in 2007-2008 to 41.5% (95% CI, 30.5-53.1) in 2011-2012; among the women vaccinated for HPV in the postvaccine era, the prevalence of HPV-16 and -18 was 6.4% versus 93.6% for all other high risk HPV types. There was no difference in prevalence in high risk HPV for women who did not receive the vaccine; 49.5% (95% CI, 42.5-56.6) in 2007-2008 versus 50.8% (95% CI, 43.0-58.7) in 2011-2012.
CONCLUSION/IMPLICATIONS: The prevalence of high risk HPV significantly decreased among females aged 18-29 years who received the HPV vaccine, but there appeared to be no cross-protection against nonvaccine HPV types. These findings may offer support for usage of the investigational 9-valent HPV vaccine. There also was no evidence to suggest protection against HPV infection for unvaccinated women.

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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The Atlantic
http://www.theatlantic.com/magazine/
Accessed 21 May 2016
The Plan to Avert Our Post-Antibiotic Apocalypse
19 May 2016
A new report estimates that by 2050, drug-resistant infections will kill one person every three seconds, unless the world’s governments take drastic steps now….Meanwhile, a “diagnostic market stimulus” would provide top-up payments to poorer countries that buy diagnostic tests, in the same way that organizations like Gavi fund vaccine use in the developing world.

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Forbes
http://www.forbes.com/
Accessed 21 May 2016
In Pursuit Of An HIV Vaccine And The AIDS-Free Generation
In the US, many people speak of “the AIDS crisis” as though it were something that happened and is now over. We do have effective treatments, and increasingly effective means of prevention. They include new, once-a-day pills that are very effective at preventing HIV infection as long as they are […]
Science Business, Contributor May 17, 2016

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New York Times
http://www.nytimes.com/
Accessed 21 May 2016
Stealing From Ebola to Fight Zika
19 May 2016
Nobody should be surprised when the present House of Representatives, dominated by penurious reactionaries, produces a stingy response to a danger that calls for compassionate largess. But for sheer fecklessness it’s hard to top the House’s response this week to the Zika virus. The salient feature is that in providing money to fight one health menace, it steals from other funds meant to fight an even more dangerous threat — the Ebola virus.

China Arrests 135 for Illegally Buying, Selling Vaccines
BEIJING — China has arrested 135 people in 22 provinces for illegally buying and selling vaccines, in the latest scandal shaking the Chinese public’s confidence in vaccine safety.
In an online statement Friday, the national prosecuting office said arrest warrants were issued for 125 people for running vaccine businesses without license.
It said 15 of them have been formally indicted, and two were found guilty. Ten health officials were arrested for on-duty negligence.
The accused health officials had worked at local public health centers and knowingly bought the illegal vaccines and used them on people, the prosecuting office said…
May 21, 2016 – By THE ASSOCIATED PRESS

C.D.C. Is Monitoring 279 Pregnant Women With Possible Zika Virus Infections
Doctors are monitoring 279 pregnant women with confirmed or suspected Zika virus infections in the United States and its territories, federal health officials said Friday.
Of those women, 157 are in the 50 states and the District of Columbia, and 122 are in territories, including Puerto Rico. Public health officials are gathering data on the health consequences of the infection, including the rate at which fetuses develop abnormally shrunken heads and brain damage, a birth defect called microcephaly.
May 21, 2016 – By DONALD G. McNEIL Jr –

The Opinion Pages | Op-Ed Contributor
Eliminate the TB Scourge
19 May 2016
By UVISTRA NAIDOOMAY 19, 2016

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Washington Post
http://www.washingtonpost.com/
Accessed 21 May 2016
Trying to get jump on Zika preparations with money in limbo
Beg, borrow and steal: Zika preparation involves a bit of all three as federal, state and local health officials try to get a jump on the mosquito-borne virus while Congress haggles over how much money they really need.
Lauran Neergaard | AP | Washington | May 21, 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_14 May 2016

– blog edition: comprised of the approx. 35+ entries posted below on 15 May 2016.

– 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.
Main Documents [Editor’s selection of documentation]
A69/15 – Health in the 2030 Agenda for Sustainable Development

A69/16 – Operational plan to take forward the Global Strategy for Women’s, Children’s and Adolescents’ Health

A69/21 – Implementation of the International Health Regulations (2005)
Report of the Review Committee on the Role of the International Health Regulations (2005) in the Ebola Outbreak and Response

A69/22 – Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits

A69/22 Add.1 – Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits
Report of the Special Session of the Pandemic Influenza Preparedness Framework Advisory Group

A69/23 – Smallpox eradication: destruction of variola virus stocks

A69/24 A69/24 Add.1 – Global action plan on antimicrobial resistance

A69/25 – Poliomyelitis

A69/26 – WHO response in severe, large-scale emergencies

A69/27 – Promoting the health of migrants

A69/29 – Options for strengthening information-sharing on diagnostic, preventive and therapeutic products and for enhancing WHO’s capacity to facilitate access to these products, including the establishment of a global database, starting with haemorrhagic fevers

A69/30 – Reform of WHO’s work in health emergency management
WHO Health Emergencies Programme

A69/31 – Draft global health sector strategies
HIV, 2016–2021

A69/32 – Draft global health sector strategies
Viral hepatitis, 2016–2021

A69/34 – Global vaccine action plan

A69/42 – Addressing the global shortages of medicines, and the safety and accessibility of children’s medication

Zika virus [to 14 May 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

Zika situation report – 12 May 2016
Zika virus, Microcephaly and Guillain-Barré syndrome
Read the full situation report
Summary
:: As of 11 May 2016, 58 countries and territories report continuing mosquito-borne transmission of which:
…45 countries are experiencing a first outbreak of Zika virus since 2015, with no previous evidence of circulation, and with ongoing transmission by mosquitoes.
…13 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).

Person-to-person transmission:
:: Nine countries have reported evidence of person-to-person transmission of Zika virus, probably via a sexual route.
:: In the week to 11 May 2016, Grenada is the latest country to report mosquito-borne Zika virus transmission.
:: Microcephaly, and other fetal malformations potentially associated with Zika virus infection or suggestive of congenital infection, have been reported in seven countries or territories. Two cases, each linked to a stay in Brazil, were detected in Slovenia and the United States of America. One additional case, linked to a brief stay in Mexico, Guatemala and Belize, was detected in a pregnant woman in the United States of America.
:: Three cases of microcephaly and other neurological abnormalities are under verification in Venezuela, Honduras and Spain (linked to a stay in Latin America).
:: 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.
:: Based on research to date, there is scientific consensus that Zika virus is a cause of microcephaly and GBS.
:: The global prevention and control strategy launched by the World Health Organization (WHO) as a Strategic Response Framework encompasses surveillance, response activities and research. Key interventions are being undertaken jointly by WHO and international, regional and national partners in response to this public health emergency.
:: Incident managers from the six WHO Regional Offices and headquarters, as well as relevant technical and support staff, met in Washington D.C., USA on 4 and 5 May 2016 to review past and ongoing activities, to discuss key lessons and to develop a strategy for future action to ensure that the response collaboration continues to work effectively. A draft of the Strategic Response Framework for the second half of 2016 will be shared with partners mid-May and finalized by 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 virus and the Olympic and Paralympic Games Rio 2016
WHO statement
12 May 2016
WHO and the Pan American Health Organization (PAHO) recognize that athletes and visitors are seeking more information on the risks of Zika and ways to prevent infection while attending the Olympic and Paralympic Games Rio 2016 (5 August to 18 September 2016).

Brazil is one of the 58 countries and territories which to-date report continuing transmission of Zika virus by mosquitoes. While mosquitoes are the primary vectors, a person infected with Zika virus can also transmit the virus to another person through unprotected sex. Zika virus disease usually causes mild symptoms(1), and most people will not develop any symptoms. However, there is scientific consensus that Zika virus is a cause of microcephaly (children being born with unusually small heads) and other brain malformations and disorders in babies born to women who were infected with Zika virus during pregnancy, and Guillain-Barré syndrome (a rare but serious neurological disorder that could lead to paralysis and death).

Athletes and visitors to Rio de Janeiro, and other areas where Zika virus is circulating, are being encouraged to:
:: follow the travel advice(2) provided by WHO and their countries’ health authorities, and consult a health worker before travelling;
:: whenever possible, during the day, protect themselves from mosquito bites by using insect repellents and by wearing clothing – preferably light-coloured – that covers as much of the body as possible;
:: practice safer sex (e.g. use condoms correctly and consistently) or abstain from sex during their stay and for at least 4 weeks after their return, particularly if they have had or are experiencing symptoms of Zika virus;
:: choose air-conditioned accommodation (windows and doors are usually kept closed to prevent the cool air from escaping, and mosquitoes cannot enter the rooms);
:: avoid visiting impoverished and over-crowded areas in cities and towns with no piped water and poor sanitation (ideal breeding grounds of mosquitoes) where the risk of being bitten is higher.

Pregnant women continue to be advised not to travel to areas with ongoing Zika virus transmission. This includes Rio de Janeiro. Pregnant women’s sex partners returning from areas with circulating virus continue to be counselled to practice safer sex or abstain throughout the pregnancy(3). The Games will take place during Brazil’s wintertime, when there are fewer active mosquitoes and the risk of being bitten is lower.

WHO/PAHO is providing public health advice to the Government of Brazil and, under a Memorandum of Understanding, the International Olympic Committee and, by extension, the Rio 2016 Local Organizing Committee, on ways to further mitigate the risk of athletes and visitors contracting Zika virus during the Games. An important focus of WHO advice revolves around measures to reduce populations of Aedes mosquitoes which transmit chikungunya, dengue and yellow fever in addition to Zika virus.

WHO/PAHO will continue to monitor the Zika virus transmission and risks in Brazil and in other affected areas to provide updates on how Zika virus outbreaks, risks and prevention interventions develop between now and August and beyond.
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WHO: Recovery toolkit: Supporting countries to achieve health service resilience
May 2016 :: 99 pages
WHO reference number: WHO/HIS/SDS/2016.2
Pdf: Recovery toolkit: Supporting countries to achieve health service resilience
pdf, 1.98 mb
Overview
The recovery toolkit is a library of guidance resources in a single place which can be quickly and easily accessed, to guide action. A key purpose of the Recovery Toolkit is to support countries in the reactivation of health services which may have suffered as a result of the emergency. These services include ongoing programmes such as immunization and vaccinations, maternal and child health services, and noncommunicable diseases. But in addition, and because the Toolkit contains core information needed to achieve functioning national health systems, it also supports countries to implement their national health plans during the recovery phase of a public health emergency.
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Zika Open [to 14 May 2016]
[Bulletin of the World Health Organization]
:: All papers available here
No new papers posted
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CDC/ACIP [to 14 May 2016]
http://www.cdc.gov/media/index.html
FRIDAY, MAY 13, 2016
CDC Announces Funds for States and Territories to Prepare for Zika
U.S. states and territories can now apply to CDC for funds to fight Zika locally. More than $85 million in redirected funds identified by the Department of Health and Human…

THURSDAY, MAY 12, 2016
CDC adds Grenada to interim travel guidance related to Zika virus
Today, CDC posted a Zika virus travel notice for Grenada. CDC has issued travel notices (level 2, “practice enhanced precautions”) for people traveling to destinations with Zika.

MONDAY, MAY 9, 2016
CDC adds Saint Barthelemy to interim travel guidance related to Zika virus
Today, CDC posted a Zika virus travel notice for Saint Barthelemy. CDC has issued travel notices (level 2, “practice enhanced precautions”) for people traveling to destinations with Zika.

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MMWR May 13, 2016 / Vol. 65 / No. 18
:: Interim Guidance for Zika Virus Testing of Urine — United States, 2016
:: Comparison of Test Results for Zika Virus RNA in Urine, Serum, and Saliva Specimens from Persons with Travel-Associated Zika Virus Disease — Florida, 2016
:: Reduced Incidence of Chikungunya Virus Infection in Communities with Ongoing Aedes Aegypti Mosquito Trap Intervention Studies — Salinas and Guayama, Puerto Rico, November 2015–February 2016

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United Nations Zika Response Multi-Partner Trust Fund Launched
6 May 2016
SG/2228
United Nations Secretary-General Ban Ki-moon has established the United Nations Zika Response Multi-Partner Trust Fund to finance critical unfunded priorities in the response to the Zika outbreak. The Trust Fund provides a rapid, flexible and accountable platform to support a coordinated response from the United Nations system and partners.

Urgent funds are required to support the implementation of national response plans and address the broader social and economic challenges that lie ahead. The United Nations Zika Response Multi-Partner Trust Fund will directly support the Zika Strategic Response Framework, developed by the World Health Organization (WHO) in consultation with United Nations agencies, partners, and international epidemiological experts.

Donors contribute to a central point and an Advisory Committee directs funds to the highest-priority activities in the affected countries…

EBOLA/EVD [to 14 May 2016]
“Threat to international peace and security” (UN Security Council)

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EBOLA VIRUS DISEASE – SITUATION REPORT 12 MAY 2016
:: 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, having travelled to Monrovia, Liberia, the wife and two children of the Macenta case were confirmed as Ebola cases between 1 and 5 April.

:: 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. In Guinea, this is due to end on 31 May and in Liberia, this is due to end on 9 June.

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

Risk assessment:
Active surveillance is ongoing in Guinea and Liberia and will continue 42 days after the last case tested negative for Ebola virus. The performance indicators suggest that Guinea, Liberia and Sierra Leone still have variable capacity to prevent (EVD survivor programme), 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 mitigation through counselling on safe sex practices and testing of body fluids.

POLIO [to 14 May 2016]
Public Health Emergency of International Concern (PHEIC)

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Polio this week as of 11 May 2016
:: From the 17 April to the 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.

:: Liechtenstein has contributed 15 000 Swiss francs to the Global Polio Eradication Initiative through Rotary International. With the Bill and Melinda Gates Foundation’s pledge to triple commitments made to polio eradication, this brings Liechtenstein’s contribution for 2016 to a per-capita contribution of more than 2 Swiss francs for every inhabitant of the country.

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 a globally 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.

:: Thanks to the efforts of a wide range of stakeholders from Ministries of Health, health workers, volunteers, switch monitors, WHO, UNCEF and partners of the World Health Organization, confirmation has been received that 152 countries have completed the switch.

:: 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 10 May:
…154 of 155 (99%) countries and territories have stopped using the trivalent oral polio vaccine.
…Independent monitoring to ensure the switch goes smoothly has begun in 149 of 153 countries (98%).
…The National Validation Committee has received switch monitoring data from 45 of 153 countries.
…The WHO Regional Office has received the National Validation Report from 43 countries.

Selected Country Levels Updates [excerpted]
Afghanistan
:: One new case of wild poliovirus type 1 (WPV1) was reported in the past week in Shahwalikot district of Kandahar, with onset of paralysis on 4 April. The total number of WPV1 cases for 2016 is now five, compared to one reported by this date in 2015.

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Weekly Epidemiological Record (WER) 13 May 2016, vol. 91, 19 (pp. 249–256)
Contents:
250 Progress towards polio eradication worldwide, 2015–2016

Yellow Fever [to 14 May 2016]
http://www.who.int/emergencies/yellow-fever/en/

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Yellow Fever – Situation Report – 12 May 2016
Full Report:
http://apps.who.int/iris/bitstream/10665/206312/1/yellowsitrep_12May2016_eng.pdf?ua=1
Summary:
Angola: 2267 suspected cases
As of 11 May 2016, Angola has reported 2267 suspected cases of yellow fever with 293 deaths. Among those cases, 696 have been laboratory confirmed. Despite vaccination campaigns in Luanda, Huambo and Benguela provinces circulation of the virus in some districts persists.
Three countries have reported confirmed yellow fever cases imported from Angola: Democratic Republic of The Congo (DRC) (39 cases), Kenya (two cases) and People’s Republic of China (11 cases). This highlights the risk of international spread through non-immunised travellers.

Democratic Republic of The Congo: 41 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 11 May, DRC has reported three probable cases and 41 laboratory confirmed cases: 39 imported from Angola, reported in Kongo central province and Kinshasa and two autochthonous cases in Ndjili, Kinshasa and in Matadi, Kongo Central province. The possibility of locally acquired infections is under investigation for at least 10 non-classified cases in both Kinshasa and Kongo central provinces.

Uganda: 51 suspect cases
In Uganda, the Ministry of Health notified yellow fever cases in Masaka district on 9 April 2016. As of 11 May, 51 suspected cases and seven laboratory confirmed cases 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 the three countries remains a serious concern. The risk is high also for potential spread to bordering countries especially those classified as low risks for yellow fever disease (i.e. Namibia, Zambia) where the population, travellers and foreign workers are not vaccinated against yellow fever.

:: 10 May 2016: Press briefing on yellow fever outbreak in Africa

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Yellow fever outbreak in Angola: EU deploys medical experts
11/05/2016
Amid the ongoing outbreak of yellow fever in the Republic of Angola, the European Union has deployed a team of medical experts under the European Medical Corps established earlier this year.

Experts from three EU Member States (Germany, Portugal and Belgium), the European Commission and the European Centre for Disease Prevention and Control will travel to the African country for what will be the first deployment of a public health team under the European Medical Corps…

WHO & Regional Offices [to 14 May 2016]

Weekly Epidemiological Record (WER) 13 May 2016, vol. 91, 19 (pp. 249–256)
Contents:
249 Epidemic focus
250 Progress towards polio eradication worldwide, 2015–2016

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Disease Outbreak News (DONs)
:: Human infection with avian influenza A(H5N6) virus – China 10 May 2016

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Rapid diagnostic test and shorter, cheaper treatment signal new hope for multidrug-resistant tuberculosis patients
News release
12 MAY 2016 | GENEVA – New WHO recommendations aim to speed up detection and improve treatment outcomes for multidrug resistant tuberculosis (MDR-TB) through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen.

“This is a critical step forward in tackling the MDR-TB public health crisis,” said Dr Mario Raviglione, Director of WHO’s Global TB Programme. “The new WHO recommendations offer hope to hundreds of thousands of MDR-TB patients who can now benefit from a test that quickly identifies eligibility for the shorter regimen, and then complete treatment in half the time and at nearly half the cost.”

Shorter treatment with better outcomes
At less than US$ 1000 per patient, the new treatment regimen can be completed in 9–12 months. Not only is it less expensive than current regimens, but it is also expected to improve outcomes and potentially decrease deaths due to better adherence to treatment and reduced loss to follow-up.

The conventional treatment regimens, which take 18–24 months to complete, yield low cure rates: just 50% on average globally. This is largely because patients find it very hard to keep taking second-line drugs, which can be quite toxic, for prolonged periods of time. They therefore often interrupt treatment or are lost to follow-up in health services.

The shorter regimen is recommended for patients diagnosed with uncomplicated MDR-TB, for example those individuals whose MDR-TB is not resistant to the most important drugs used to treat MDR-TB (fluoroquinolones and injectables), known as “second-line drugs”. It is also recommended for individuals who have not yet been treated with second line drugs.
WHO’s recommendations on the shorter regimens are based on initial programmatic studies involving 1200 patients with uncomplicated MDR-TB in 10 countries . WHO is urging researchers to complete ongoing randomised controlled clinical trials in order to strengthen the evidence base for use of this regimen…

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:: WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
No new content identified.

WHO Region of the Americas PAHO
No new content identified.

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

WHO European Region EURO
:: Health system reform and obesity discussed during visit from Minister of Health of Croatia 13-05-2016
:: International Code protects breastfeeding from inappropriate marketing of breast-milk substitutes 13-05-2016
:: WHO Regional Director visits Armenia 12-05-2016
:: Nurses and midwives: A force for enhancing health and strengthening health systems 12-05-2016
:: Transforming integrated health service delivery in the WHO European Region 11-05-2016

WHO Eastern Mediterranean Region EMRO
:: Air pollution levels rising in many of the world’s poorest cities 12 May 2016
:: Laws to protect breastfeeding inadequate in most countries 9 May 2016

WHO Western Pacific Region
No new content identified.

CDC/ACIP [to 14 May 2016]
http://www.cdc.gov/media/index.html
[see Zika coverage above which includes CDC briefing content]
FRIDAY, MAY 13, 2016
CDC Announces Funds for States and Territories to Prepare for Zika
U.S. states and territories can now apply to CDC for funds to fight Zika locally. More than $85 million in redirected funds identified by the Department of Health and Human…

THURSDAY, MAY 12, 2016
CDC adds Grenada to interim travel guidance related to Zika virus
Today, CDC posted a Zika virus travel notice for Grenada. CDC has issued travel notices (level 2, “practice enhanced precautions”) for people traveling to destinations with Zika.

MONDAY, MAY 9, 2016
CDC adds Saint Barthelemy to interim travel guidance related to Zika virus
Today, CDC posted a Zika virus travel notice for Saint Barthelemy. CDC has issued travel notices (level 2, “practice enhanced precautions”) for people traveling to destinations with Zika.

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MMWR May 13, 2016 / Vol. 65 / No. 18
:: Hepatitis Awareness Month and Testing Day — May 2016
:: Identification and Clinical Management of Persons with Chronic Hepatitis C Virus Infection — Cherokee Nation, 2012–2015
:: Birth Cohort Testing for Hepatitis C Virus — Indian Health Service 2012–2015
:: Progress Toward Polio Eradication — Worldwide, 2015–2016
:: Interim Guidance for Zika Virus Testing of Urine — United States, 2016
:: Comparison of Test Results for Zika Virus RNA in Urine, Serum, and Saliva Specimens from Persons with Travel-Associated Zika Virus Disease — Florida, 2016
:: Reduced Incidence of Chikungunya Virus Infection in Communities with Ongoing Aedes Aegypti Mosquito Trap Intervention Studies — Salinas and Guayama, Puerto Rico, November 2015–February 2016

NIH [to 14 May 2016]
http://www.nih.gov/news-events/news-releases

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May 9, 2016
Investigational malaria vaccine protects healthy U.S. adults for more than one year
PfSPZ Vaccine is first to show durable, sterile protection in people with no prior infection.

An experimental malaria vaccine protected a small number of healthy, malaria-naïve adults in the United States from infection for more than one year after immunization, according to results from a Phase 1 trial described in the May 9th issue of Nature Medicine. The vaccine, known as the PfSPZ Vaccine, was developed and produced by Sanaria Inc., of Rockville, Maryland, with support from several Small Business Innovation Research (SBIR) awards from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. NIAID researchers and collaborators at the University of Maryland School of Medicine in Baltimore, conducted the clinical evaluation of the vaccine, which involved immunization and exposing willing healthy adults to the malaria-causing parasite Plasmodium falciparum (P. falciparum) in a controlled setting…

IVI – International Vaccine Institute [to 14 May 2016]
http://www.ivi.org/web/www/home

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May 11, 2016 Press Release
Single dose of oral cholera vaccine proves protective in an endemic setting
SEOUL, – A new study by the International Vaccine Institute (IVI) and icddr,b and published in The New England Journal of Medicine has shown for the first time that a single dose of the oral cholera vaccine Shanchol is effective in older children and adults in an area where cholera is endemic.

These findings will be eagerly received globally by health agencies interested in using the vaccine in a single dose in endemic areas where cholera is common, as well as in epidemic situations where disruption of healthcare infrastructure makes it difficult to complete the currently recommended two-dose regimen….

…The findings further support use of the vaccine against epidemic and endemic cholera. The oral cholera vaccine was developed through international product development partnerships led by IVI with partners from Vietnam, India, Sweden, South Korea and the United States. More recently, Euvichol was prequalified by WHO and is the first oral cholera vaccine made in South Korea for global public health.

“The potential public health impact is significant,” said Dr. Jerome Kim, Director General of IVI, “A single dose OCV will help increase access of the vaccine in humanitarian crises and other settings with very challenging conditions that makes vaccine delivery difficult.”
[Abstract from last week’s edition below]

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New England Journal of Medicine
May 5, 2016 Vol. 374 No. 18
http://www.nejm.org/toc/nejm/medical-journal
Original Article
Efficacy of a Single-Dose, Inactivated Oral Cholera Vaccine in Bangladesh
Firdausi Qadri, Ph.D., Thomas F. Wierzba, Ph.D., Mohammad Ali, Ph.D., Fahima Chowdhury, M.P.H., Ashraful I. Khan, Ph.D., Amit Saha, M.Med., Iqbal A. Khan, M.Sc., Muhammad Asaduzzaman, M.Phil., Afroza Akter, M.B., B.S., Arifuzzaman Khan, M.B., B.S., Yasmin A. Begum, Ph.D., Taufiqur R. Bhuiyan, Ph.D., Farhana Khanam, M.Sc., Mohiul I. Chowdhury, M.P.H., Taufiqul Islam, M.B., B.S., Atique I. Chowdhury, M.Sc., Anisur Rahman, M.Sc., Shah A. Siddique, M.P.H., Young A. You, M.Sc., Deok R. Kim, M.Sc., Ashraf U. Siddik, M.S.S., Nirod C. Saha, M.Sc., Alamgir Kabir, M.Sc., Alejandro Cravioto, Ph.D., Sachin N. Desai, M.D., Ajit P. Singh, M.D., and John D. Clemens, M.D.
N Engl J Med 2016; 374:1723-1732 May 5, 2016 DOI: 10.1056/NEJMoa1510330
Abstract
Background
A single-dose regimen of the current killed oral cholera vaccines that have been prequalified by the World Health Organization would make them more attractive for use against endemic and epidemic cholera. We conducted an efficacy trial of a single dose of the killed oral cholera vaccine Shanchol, which is currently given in a two-dose schedule, in an urban area in which cholera is highly endemic.
Methods
Nonpregnant residents of Dhaka, Bangladesh, who were 1 year of age or older were randomly assigned to receive a single dose of oral cholera vaccine or oral placebo. The primary outcome was vaccine protective efficacy against culture-confirmed cholera occurring 7 to 180 days after dosing. Prespecified secondary outcomes included protective efficacy against severely dehydrating culture-confirmed cholera during the same interval, against cholera and severe cholera occurring 7 to 90 versus 91 to 180 days after dosing, and against cholera and severe cholera according to age at baseline.
Results
A total of 101 episodes of cholera, 37 associated with severe dehydration, were detected among the 204,700 persons who received one dose of vaccine or placebo. The vaccine protective efficacy was 40% (95% confidence interval [CI], 11 to 60%; 0.37 cases per 1000 vaccine recipients vs. 0.62 cases per 1000 placebo recipients) against all cholera episodes, 63% (95% CI, 24 to 82%; 0.10 vs. 0.26 cases per 1000 recipients) against severely dehydrating cholera episodes, and 63% (95% CI, −39 to 90%), 56% (95% CI, 16 to 77%), and 16% (95% CI, −49% to 53%) against all cholera episodes among persons vaccinated at the age of 5 to 14 years, 15 or more years, and 1 to 4 years, respectively, although the differences according to age were not significant (P=0.25). Adverse events occurred at similar frequencies in the two groups.
Conclusions
A single dose of the oral cholera vaccine was efficacious in older children (≥5 years of age) and in adults in a setting with a high level of cholera endemicity. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov number, NCT02027207.)

UNAIDS [to 14 May 2016]
http://www.unaids.org/en/resources/presscentre/

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13 May 2016
South Africa takes bold step to provide HIV treatment for all
Antiretroviral therapy to be offered to all people living with HIV as soon as possible after HIV-positive diagnosis
GENEVA, 13 May 2016—The Government of South Africa has announced a major policy shift that will move the world faster towards the global 90–90–90 treatment target. On 10 May 2016, the South African Minister of Health, Aaron Motsoaledi, announced in his Health Budget Vote Speech to the Parliament of South Africa that the country will implement a new evidence-based policy of offering HIV treatment to all people living with HIV by September 2016. This ground-breaking announcement brings South Africa, which already has the world’s largest HIV treatment programme, in line with the latest World Health Organization guidelines on HIV treatment. South Africa is among the first countries in Africa to formally adopt this policy.

South Africa already encourages everyone who is HIV-negative or who does not know their HIV status to be tested for HIV at least once a year. However, instead of having to undergo an additional test of the immune system (the CD4 cell count) to determine eligibility for treatment, people who are diagnosed HIV-positive will be offered HIV treatment as soon as possible after diagnosis.

“South Africa takes another bold step towards ending its AIDS epidemic by 2030, once again demonstrating that scientific evidence, paired with political will, saves lives,” said UNAIDS Executive Director Michel Sidibé…

1st Governing Board Meeting of the Africa Center for Disease Control and Prevention Endorses Five Regional Collaborating Centers
Addis Ababa, Ethiopia 9 May 2016- The inaugural meeting of the governing board of the Africa Centers for Disease Control and Prevention (Africa CDC) was hosted by the African Union Commission at the African Union headquarters in Addis Ababa. The board comprises ten (10) ministers of health, two (2) representatives of the Commission, two (2) nominees of the private sector and civil society and one (1) representative of regional health organizations.

…The 15 member board endorsed Kenya, Nigeria, Gabon, Egypt and Zambia as the Regional Collaborating Centers (RCCs) for the Africa CDC, after reading and reviewing the onsite assessment mission report for the selection of the centers. The RCC’s will support the day-to-day execution of the Africa CDC strategic work plan to effectively monitor public health, respond to emergencies, and address complex health challenges and build needed capacity. They will support the continent at the point of need, rather than from a centralized, distant location.

The board also vetted the 5 candidates for the Africa CDC director position, the outcome of which is yet to be announced.

The Africa CDC will put in place a structure to support African countries in their efforts to effectively monitor public health, respond to emergencies, address complex health challenges and build needed capacity. The Africa CDC, as an African-owned institution, will provide a strong platform for technical coordination, ultimately strengthening public health systems, preparedness, surveillance and interventions across the continent. Furthermore, the Africa CDC will build capacity on the continent to respond to public health emergencies including outbreaks, man-made and natural disasters as well as public health events of regional and international concern

Partnership launched to tackle cervical cancer in Africa – AFRO Comprehensive Cervical Cancer Prevention and Control Initiative
11 May 2016
Brazzaville/Kigali, 11 May 2016 – Ongoing efforts to prevent and control cervical cancer in the African Region have received a significant boost following the announcement of a pioneering partnership between the World Health Organization African Region (WHO AFRO) and the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA).

The new partnership, “AFRO Comprehensive Cervical Cancer Prevention and Control Initiative”, will work across the African Region to improve awareness; help empower women and healthcare professionals to improve prevention, screening and treatment rates of breast and cervical cancers.

“There are many obstacles to cervical cancer screening in resource-constrained countries, generally attributed to the lack of infrastructure as well as technical, medical and financial resources, and a lack of awareness and education on cervical cancer among women and healthcare providers,” explains Dr Abdikamal Alisalad, Acting Director, Non-Communicable Diseases, at WHO Regional Office for Africa. Many lives can be saved if public awareness is strengthened on the importance of testing and early treatment,” he added.

Cancer is an emerging public health problem throughout the African Region; and breast and cervical cancers are among the most common cancers affecting women. In sub-Saharan Africa, the incidence of cervical cancer and breast cancer is no higher than in other parts of the world, but the risk of death among women with either disease is much higher than in high-income countries – eight times higher in the case of cervical cancer. This is because too many African women are diagnosed too late which hampers effective treatment and care. In sub-Saharan Africa, 22.5 per 100,000 women die from cervical cancer, compared to 2.5 per 100,000 women in North America.

Supported by some funding and in-kind contributions from IFPMA, the partnership will implement cancer prevention and control activities in four countries with a high burden of cervical cancer: Cameroon, Uganda, Swaziland and Zambia, in collaboration with the respective ministries of health. In addition, the partnership will work with healthcare providers to improve their knowledge about screening strategies…

Global Fund [to 14 May 2016]
http://www.theglobalfund.org/

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12 May 2016
Global Fund Welcomes WHO Recommendations on Shorter Treatment for MDR-TB
GENEVA – The Global Fund to Fight AIDS, Tuberculosis and Malaria welcomes the new recommendations issued by WHO to encourage the use of a shorter treatment regimen for multidrug-resistant tuberculosis (MDR-TB) and a rapid diagnostic test, which could save lives by speeding detection and improving outcomes.

WHO is recommending a standardized shorter MDR-TB regimen of 9-12 months that can reduce the length of treatment by one half for many adults and children. The conventional treatment regimens, which take 18-24 months to complete, have low cure rates at just 50 percent on average globally.

The shorter treatment regimen, which costs less than US$1,000 per patient or at least half the cost of the current conventional treatment, is expected to benefit the majority of MDR-TB patients in many countries, enabling improved outcomes and potentially lower deaths due to better adherence to treatment and reduced loss to follow-up, according to WHO…

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09 May 2016
Canada to Host Global Fund Replenishment
OTTAWA – The Prime Minister of Canada, Justin Trudeau, announced today that Canada will host the Fifth Replenishment Conference of the Global Fund to Fight AIDS, Tuberculosis and Malaria in Montréal, Québec, on 16 September 2016…

Industry Watch [to 14 May 2016]

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:: Pfizer Presents Results from Two Phase 3 TRUMENBA® (Meningococcal Group B Vaccine) Studies at the European Society for Paediatric Infectious Diseases Meeting
NEW YORK–(BUSINESS WIRE)–Pfizer Inc. (NYSE:PFE) today announced results of two Phase 3 studies demonstrating the immunogenicity of TRUMENBA® (Meningococcal Group B Vaccine) against invasive meningococcal B (MnB) strains representative of prevalent strains in the U.S. and Europe. The two studies, one in adolescents and one in young adults, met all primary immunogenicity endpoints. Also, secondary data presented show that TRUMENBA demonstrated similar immune responses against ten additional MnB strains, in both adolescents and young adults. The data, which continue to support the vaccine’s current safety and tolerability profile, were presented at the 34th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID 2016).

“TRUMENBA is designed to provide protection against serogroup B meningococcal disease,” said Kathrin Jansen, Ph.D., senior vice president and head of Vaccine Research and Development for Pfizer Inc. “The Phase 3 data show that TRUMENBA elicits an immune response that is effective against prevalent meningococcal serogroup B strains in the U.S. and Europe, as well as 10 additional strains of this unpredictable disease. These data support the expectation that vaccination with TRUMENBA will help prevent this uncommon, but devastating disease in adolescents and young adults.”

These Phase 3 data support additional upcoming global regulatory submissions and the planned U.S. supplement to request the conversion of Accelerated Approval to Traditional Approval for TRUMENBA…

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:: PhRMA Member Companies Invested $58.8 Billion in R&D in 2015
WASHINGTON (May 12, 2016) — Pharmaceutical Research and Manufacturers of America’s (PhRMA) member companies invested an estimated $58.8 billion in research and development (R&D) in 2015, up 10.3 percent from 2014. New R&D data based on findings from the 2016 PhRMA annual member survey released today in the 2016 Biopharmaceutical Research Industry Profile and corresponding industry chart pack, Biopharmaceuticals In Perspective, highlight the wide-reaching impact of PhRMA member companies on the economy and biopharmaceutical innovation.

PATH [to 14 May 2016]
http://www.path.org/news/index.php

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Announcement | May 06, 2016
PATH announces leader for China country program
Mr. YanXiang Wang to lead PATH’s innovative product development partnerships in China
…A history of collaboration and impact
Since 1979, PATH has collaborated with Chinese government agencies, research institutes, nongovernmental organizations, and manufacturers to address the country’s health needs and build its capacity to contribute to global health. PATH’s public-private partnership model for developing health products has been key to reaching several milestones.

As leader of PATH China country program, Mr. Wang will oversee partnerships with Chinese manufacturers to develop and produce low-cost, high-quality health products across vaccines, medical devices, and drugs. PATH has collaborated with both state-owned and private companies to develop multivalent rotavirus vaccine and live attenuated influenza vaccine, and conduct overseas phase III clinical trials for bivalent oral poliomyelitis vaccine. PATH’s work with the Chinese manufacturer Chengdu Institute of Biological Products Co., Ltd., beginning in 2006, resulted in an effective and affordable vaccine against Japanese encephalitis being the first vaccine made in China to obtain World Health Organization (WHO) prequalification, and has allowed the vaccine to reach millions of children throughout Southeast Asia.

PATH also has collaborated with a Chinese private company to develop, manufacture, and introduce an innovative contraceptive—the Woman’s Condom—a next-generation female condom that studies have found to be more acceptable to users than earlier products. In March 2016, the Woman’s Condom received the prequalification from both WHO and United Nations Population Fund, an important step toward reaching more women with this inventive product.

PATH is partnering with a Chinese pharmaceutical company to seek US Food and Drug Administration approval and WHO prequalification of a locally invented drug to treat a neglected disease. In addition, the PATH China country program has efforts under way with the Chinese CDC to implement a comprehensive tuberculosis control project…

European Vaccine Initiative [to 14 May 2016]
http://www.euvaccine.eu/news-events

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News
A new publication emerges from the MVVC project
12 May 2016
The following new publication relating to the EVI coordinated and EDCTP funded MVVC project: Safety and Immunogenicity of ChAd63 and MVA ME-TRAP in West African children and infants, has just been published in Mol Ther. The abstract is also available on this web site under publications

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News
First publication from the BELLEROPHON project
12 May 2016
The first publication relating to the EC funded BELLEROPHON project, in which EVI is a partner, has been published in Vaccine. The abstract is also available on this web site under publications.

CHOP’s Vaccine Education Center Creates Educational Game for Kids
PHILADELPHIA, May 11, 2016 /PRNewswire-USNewswire/ — What do Franklin D. Roosevelt, Jonas Salk and 18th century milkmaid Sarah Nelmes all have in common? It turns out they’re Vax Pack Heroes—people who had roles to play in the history of vaccines. Along with some 50 others, these heroes are central figures in Vax Pack Hero, a program created by the Vaccine Education Center (VEC) at The Children’s Hospital of Philadelphia (CHOP). The program consists of a web-based video game, trading cards and an educational website designed to teach kids about how vaccines fight germs…

Scientific Roadmap for Antibiotic Discovery
A sustained and robust pipeline of new antibacterial drugs and therapies is critical to preserve
public health
Pew Charitable Trusts
May 2016 :: 47 pages
pdf: http://www.pewtrusts.org/~/media/Assets/2016/05/AScientificRoadmapforAntibioticDiscovery.pdf

Overview
In recent decades, the discovery and development of new antibiotics have slowed dramatically as scientific barriers to drug discovery, regulatory challenges, and diminishing returns on investment have led major drug companies to scale back or abandon their antibiotic research. Consequently, antibiotic discovery—which peaked in the 1950s—has dropped precipitously. Of greater concern is the fact that nearly all antibiotics brought to market over the past 30 years have been variations on existing drugs.1 Every currently available antibiotic is a derivative of a class discovered between the early 1900s and 1984.2

At the same time, the emergence of antibiotic-resistant pathogens has accelerated, giving rise to life-threatening infections that will not respond to available antibiotic treatment. Inevitably, the more that antibiotics are used, the more that bacteria develop resistance—rendering the drugs less effective and leading public health authorities worldwide to flag antibiotic resistance as an urgent and growing public health threat.

Reducing the inappropriate and unnecessary use of antibiotics will help slow this process, but it cannot halt it. Existing antibiotics will continue to lose their effectiveness over time, and patients will continue to need new drugs and therapies. Regulatory policies and economic incentives that encourage antibiotic development are vital; however, it is also critical to address fundamental gaps in basic scientific research that hinder new drug discovery.

The Pew Charitable Trusts convened a multidisciplinary group of leading industry and academic experts to identify the key scientific roadblocks to antibiotic discovery and consulted with numerous other public and private sector stakeholders to develop a Scientific Roadmap for Antibiotic Discovery. The roadmap outlines a concrete approach—both a scientific plan and organizational structure to support this research—that would lay a foundation for the sustained and diversified discovery and development of new antibiotics and therapies over the coming decades.

The report’s key findings show a need for:
:: A targeted approach to tackle the basic scientific barriers impeding antibiotic discovery and development.
:: A better understanding of how to overcome the cellular defenses of drug-resistant Gram-negative bacteria, which cause some of the most difficult-to-treat infections.
:: Generation of new chemical matter designed for antibiotic discovery.
:: Tools and methodologies to evaluate promising alternatives to traditional antibiotic use.
:: A framework for sharing information, expertise, and materials across the research community to foster innovative science and spur the discovery of novel antibacterial therapies.

Success will require dedicated teams of multidisciplinary scientists to tackle key questions and share knowledge and skills across sectors.
:: A core scientific leadership group would set priorities and direct and manage milestone-driven research.
:: New methodologies and guidelines for antibiotic discovery generated by this initiative would provide scientists in industry and academia with a foundation to support the discovery of new drugs over a sustained period of time.

If successfully implemented, this initiative has the potential to revitalize innovation in antibiotic research and accelerate the discovery of new types of antibacterial drugs and therapies…

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Press Release – Antibiotic Resistance Project
Pew Releases Scientific Roadmap to Spur Antibiotic Discovery and Innovation
May 11, 2016
WASHINGTON—The Pew Charitable Trusts today released a strategy to end the 30-year drought in the discovery of new types of antibiotics, key to fighting some of the most serious microbial threats. The Scientific Roadmap for Antibiotic Discovery identifies priority research goals and specific steps to break through the most significant scientific barriers impeding antibiotic discovery and to pave the way for urgently needed new drugs.

“Drug-resistant bacteria are an ever-increasing threat, but the discovery of new antibiotics has slowed to a crawl,” said Allan Coukell, senior director for health programs at The Pew Charitable Trusts. “Every antibiotic in use today is based on a discovery made more than 30 years ago.”

At the same time, the emergence of antibiotic-resistant pathogens has accelerated, giving rise to life-threatening infections that will not respond to any available antibiotic treatment. Inevitably, the more that antibiotics are used, the more bacteria develop resistance—rendering the drugs less effective and leading public health authorities worldwide to flag antibiotic resistance as an urgent and growing public health threat.

“There’s an urgent need for a new kind of research and development effort—different from what currently exists in both the pharmaceutical industry and academia—to tackle the foundational scientific questions outlined in this roadmap,” Coukell added…

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

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 14 May 2016)

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Research article
Correlates of unequal access to preventive care in China: a multilevel analysis of national data from the 2011 China Health and Nutrition Survey
Chi Huang, Chao-Jie Liu, Xiong-Fei Pan, Xiang Liu and Ning-Xiu Li
BMC Health Services Research 2016 16:177
Published on: 12 May 2016

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 14 May 2016)

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Commentary
Ethical priority setting for universal health coverage: challenges in deciding upon fair distribution of health services
Ole F. Norheim
Published on: 11 May 2016
Abstract
Priority setting is inevitable on the path towards universal health coverage. All countries experience a gap between their population’s health needs and what is economically feasible for governments to provide. Can priority setting ever be fair and ethically acceptable? Fairness requires that unmet health needs be addressed, but in a fair order. Three criteria for priority setting are widely accepted among ethicists: cost-effectiveness, priority to the worse-off, and financial risk protection. Thus, a fair health system will expand coverage for cost-effective services and give extra priority to those benefiting the worse-off, whilst at the same time providing high financial risk protection. It is considered unacceptable to treat people differently according to their gender, race, ethnicity, religion, sexual orientation, social status, or place of residence. Inequalities in health outcomes associated with such personal characteristics are therefore unfair and should be minimized. This commentary also discusses a third group of contested criteria, including rare diseases, small health benefits, age, and personal responsibility for health, subsequently rejecting them. In conclusion, countries need to agree on criteria and establish transparent and fair priority setting processes.

Current Opinion in Infectious Diseases
June 2016 – Volume 29 – Issue 3 pp: v-v,229-318
http://journals.lww.com/co-infectiousdiseases/pages/currenttoc.aspx
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PAEDIATRIC AND NEONATAL INFECTIONS
Edited by Paul T. Heath

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Interactions between intestinal pathogens, enteropathy and malnutrition in developing countries
Prendergast, Andrew J.; Kelly, Paul
Abstract
Purpose of review: This review focuses on recent data highlighting the interactions between intestinal pathogens, enteropathy and malnutrition in developing countries, which drive morbidity and mortality and hinder the long-term developmental potential of children.
Recent findings: Diarrhoea remains the second commonest cause of death in children below 5 years, and malnutrition underlies 45% of all child deaths. Even in the absence of diarrhoea, subclinical pathogen carriage and enteropathy are almost universal in developing countries. Here, we review recent studies addressing the causes and consequences of diarrhoea; emerging data on environmental influences that govern postnatal development of the gut and microbiota; current concepts of environmental enteric dysfunction; and recent intervention trials in the field. We highlight the interactions between these processes, whereby intestinal pathogens drive a cycle of gut damage, malabsorption, chronic inflammation and failed mucosal regeneration, leading to malnutrition and susceptibility to further enteric infections.
Summary: Efforts to improve child survival and long-term developmental potential need to address the overlapping and interacting effects of diarrhoea, enteropathy and malnutrition. Recent insights from human and animal studies suggest potential targets for intervention.
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HIV-1 at the placenta: immune correlates of protection and infection
Johnson, Erica L.; Chakraborty, Rana
Abstract
Purpose of review: Mother-to-child transmission (MTCT) of HIV-1 remains a significant global health concern despite implementation of maternal combination antiretroviral therapy for treatment as prevention to offset transmission. The risk of in-utero HIV-1 transmission in the absence of interventions is ∼7%. This low rate of transmission points to innate and adaptive mechanisms to restrict lentiviral infection within the placenta.
Recent findings: Placental macrophages (Hofbauer cells) are key mediators in in-utero transmission of HIV-1. Hofbauer cells constitutively express elevated concentrations of regulatory cytokines, which inhibit HIV-1 replication in vitro, and possess intrinsic antiviral properties. Hofbauer cells sequester HIV-1 in intracellular compartments that can be accessed by HIV-1-specific antibodies and may occur in vivo to offset MTCT. Intriguingly, studies have reported strong associations between maternal human cytomegalovirus (HCMV) viremia and MTCT of HIV-1. HCMV infection at the placenta promotes inflammation, chronic villitis, and trophoblast damage, providing potential HIV-1 access into CD4+CCR5+ target cells. The placenta exhibits a variety of mechanisms to limit HIV-1 replication, yet viral-induced activation with maternal HCMV may override this protection to facilitate in-utero transmission of HIV-1.
Summary: Understanding immune correlates of protection or transmission at the placenta during on-going HIV-1 exposure may contribute to understanding HIV pathogenesis and the development of effective immunotherapies.
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Group B Streptococcus: developing a correlate of protection for a vaccine against neonatal infections
Dangor, Ziyaad; Lala, Sanjay G.; Kwatra, Gaurav; More
Abstract
Purpose of review: Maternal vaccination to prevent invasive Group B Streptococcus (GBS) disease in infants is an important alternative strategy to intrapartum antibiotic prophylaxis. Licensure of GBS vaccines could be expedited using immunological correlates of protection.
Recent findings: Between 2014 and 2015, we identified two studies that demonstrated an inverse association between invasive GBS disease and maternal serotype III capsular antibody levels greater than 1 μg/ml and greater than 3 μg/ml, and higher maternal antibody levels were associated with protection against serotype Ia disease. Furthermore, serotype Ia and III antibody levels greater than 3 μg/ml were associated with a reduced risk of GBS colonization in pregnant women.
Experimental studies have investigated the use of GBS surface proteins as vaccine candidates. Although the immunogenic potential of pilus island and other surface proteins has been shown in animal-model studies, no association between maternal pilus island antibody levels and invasive GBS disease was demonstrated in infants. Additionally, several novel innate immune mediators that prevent GBS infection have been described in human and experimental studies.
Summary: Recent studies suggest that maternal capsular antibody thresholds may be used as immunological correlates of protection for vaccine licensure. Surface proteins, as candidate vaccines or conjugates to the polysaccharide-protein vaccine, may broaden protection against invasive GBS disease.