New England Journal of Medicine
May 5, 2016 Vol. 374 No. 18
http://www.nejm.org/toc/nejm/medical-journal

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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.)

Pediatrics
May 2016, VOLUME 137 / ISSUE 5
http://pediatrics.aappublications.org/content/137/5?current-issue=y

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Special Articles
Zika Virus Disease: A CDC Update for Pediatric Health Care Providers
Mateusz P. Karwowski, Jennifer M. Nelson, J. Erin Staples, Marc Fischer, Katherine E. Fleming-Dutra, Julie Villanueva, Ann M. Powers, Paul Mead, Margaret A. Honein, Cynthia A. Moore, Sonja A. Rasmussen
Pediatrics May 2016, 137 (5) e20160621; DOI: 10.1542/peds.2016-0621

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Special Articles
The Challenges in Measuring Local Immunization Coverage: A Statewide Case Study
Elizabeth Wolf, Ali Rowhani-Rahbar, Jeffrey Duchin, M. Patricia DeHart, Douglas Opel
Pediatrics May 2016, 137 (5) e20153755; DOI: 10.1542/peds.2015-3755
Abstract
There are many forms of existing immunization surveillance in the United States and Washington state, but all are limited in their ability to provide timely identification of clusters of unimmunized individuals and assess the risk of vaccine-preventable diseases. This article aims to: (1) describe challenges to measuring immunization coverage at a local level in the United States using Washington State as a case study; and (2) propose improvements to existing surveillance systems that address the challenges identified.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 7 May 2016)

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Essay
A Public Health Paradox: The Women Most Vulnerable to Malaria Are the Least Protected
Raquel González, Esperança Sevene, George Jagoe, Laurence Slutsker, Clara Menéndez
| published 03 May 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002014

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Effectiveness of and Financial Returns to Voluntary Medical Male Circumcision for HIV Prevention in South Africa: An Incremental Cost-Effectiveness Analysis
Markus Haacker, Nicole Fraser-Hurt, Marelize Gorgens
Research Article | published 03 May 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002012

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Interpreting the Global Enteric Multicenter Study (GEMS) Findings on Sanitation, Hygiene, and Diarrhea
Jonny Crocker, Jamie Bartram
Perspective | published 03 May 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002011

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Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study, 2007–2011: Case-Control Study
Kelly K. Baker, Ciara E. O’Reilly, Myron M. Levine, Karen L. Kotloff, James P. Nataro, Tracy L. Ayers, Tamer H. Farag, Dilruba Nasrin, William C. Blackwelder, Yukun Wu, Pedro L. Alonso, Robert F. Breiman, Richard Omore, Abu S. G. Faruque, Sumon Kumar Das, Shahnawaz Ahmed, Debasish Saha, Samba O. Sow, Dipika Sur, Anita K. M. Zaidi, Fahreen Quadri, Eric D. Mintz
Research Article | published 03 May 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002010

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 7 May 2016)

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Research Article
Potential Impact of Sexual Transmission on Ebola Virus Epidemiology: Sierra Leone as a Case Study
Jessica L. Abbate, Carmen Lia Murall, Heinz Richner, Christian L. Althaus
| published 02 May 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004676

PLoS One
http://www.plosone.org/
[Accessed 7 May 2016]

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Predictors of Uptake and Timeliness of Newly Introduced Pneumococcal and Rotavirus Vaccines, and of Measles Vaccine in Rural Malawi: A Population Cohort Study
Hazzie Mvula, Ellen Heinsbroek, Menard Chihana, Amelia C. Crampin, Storn Kabuluzi, Geoffrey Chirwa, Charles Mwansambo, Anthony Costello, Nigel A. Cunliffe, Robert S. Heyderman, Neil French, Naor Bar-Zeev, VacSurv Consortium
Research Article | published 06 May 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0154997
Abstract
Background
Malawi introduced pneumococcal conjugate vaccine (PCV13) and monovalent rotavirus vaccine (RV1) in 2011 and 2012 respectively, and is planning the introduction of a second-dose measles vaccine (MV). We assessed predictors of availability, uptake and timeliness of these vaccines in a rural Malawian setting.
Methods
Commencing on the first date of PCV13 eligibility we conducted a prospective population-based birth cohort study of 2,616 children under demographic surveillance in Karonga District, northern Malawi who were eligible for PCV13, or from the date of RV1 introduction both PCV13 and RV1. Potential predictors of vaccine uptake and timeliness for PCV13, RV1 and MV were analysed respectively using robust Poisson and Cox regression.
Results
Vaccine coverage was high for all vaccines, ranging from 86.9% for RV1 dose 2 to 95.4% for PCV13 dose 1. Median time delay for PCV13 dose 1 was 17 days (IQR 7–36), 19 days (IQR 8–36) for RV1 dose 1 and 20 days (IQR 3–46) for MV. Infants born to lower educated or farming mothers and those living further away from the road or clinic were at greater risk of being not fully vaccinated and being vaccinated late. Delays in vaccination were also associated with non-facility birth. Vaccine stock-outs resulted in both a delay in vaccine timeliness and in a decrease in completion of schedule.
Conclusion
Despite high vaccination coverage in this setting, delays in vaccination were common. We identified programmatic and socio-demographic risk factors for uptake and timeliness of vaccination. Understanding who remains most vulnerable to be unvaccinated allows for focussed delivery thereby increasing population coverage and maximising the equitable benefits of universal vaccination programmes.

Vaccine
Volume 34, Issue 23, Pages 2527-2634 (17 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/23

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A systematic review of human-to-human transmission of measles vaccine virus
Review Article
Pages 2531-2536
Kathryn P. Greenwood, Radwan Hafiz, Robert S. Ware, Stephen B. Lambert
Abstract
Measles is one of the most contagious human diseases. Administration of the live attenuated measles vaccine has substantially reduced childhood mortality and morbidity since its licensure in 1963. The live but attenuated form of the vaccine describes a virus poorly adapted to replicating in human tissue, but with a replication yield sufficient to elicit an immune response for long-term protection. Given the high transmissibility of the wild-type virus and that transmission of other live vaccine viruses has been documented, we conducted a systematic review to establish if there is any evidence of human-to-human transmission of the live attenuated measles vaccine virus. We reviewed 773 articles for genotypic confirmation of a vaccine virus transmitted from a recently vaccinated individual to a susceptible close contact. No evidence of human-to-human transmission of the measles vaccine virus has been reported amongst the thousands of clinical samples genotyped during outbreaks or endemic transmission and individual case studies worldwide.

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South Asia symposium on pneumococcal disease and the promise of vaccines – Meeting report
Original Research Article
Pages 2622-2626
Rakesh Kumar, Narendra Arora, Mathuram Santosham
Abstract
Despite the licensure of the pneumococcal conjugate vaccine (PCV) in the US and other Western countries for over 14 years, as of September 2014 only 4 South Asian countries were using PCV in their universal immunization program. To generate momentum toward addressing this issue a “South Asia symposium on pneumococcal disease and the promise of vaccines” was organized just prior to the 9th international symposium on pneumococci and pneumococcal diseases held in India recently. Leading scientists, program managers, and decision makers including ministry officials from the region participated in the meeting. The participants discussed available data on pneumococcal disease burden in South Asia, surveillance methods, efficacy and safety of pneumococcal conjugate vaccines (PCV), the status of PCV introduction, programmatic challenges in introducing PCV and available data on the impact of PCV in South Asia and globally. There was a strong consensus that available data on disease burden and the global experience with PCV justified the introduction PCV in all Asian countries in order to accelerate the gains in child survival in the region.

Vaccine: Development and Therapy
https://www.dovepress.com/vaccine-development-and-therapy-archive111
(Accessed 7 May 2016)

Review
Tularemia vaccine development: paralysis or progress?
Sunagar R, Kumar S, Franz BJ, Gosselin EJ
Vaccine: Development and Therapy 2016, 6:9-23
Published Date: 4 May 2016
Abstract:
Francisella tularensis (Ft) is a gram-negative intercellular pathogen and category A biothreat agent. However, despite 15 years of strong government investment and intense research focused on the development of a US Food and Drug Administration-approved vaccine against Ft, the primary goal remains elusive. This article reviews research efforts focused on developing an Ft vaccine, as well as a number of important factors, some only recently recognized as such, which can significantly impact the development and evaluation of Ft vaccine efficacy. Finally, an assessment is provided as to whether a US Food and Drug Administration-approved Ft vaccine is likely to be forthcoming and the potential means by which this might be achieved.

American Journal of Epidemiology
(2016) doi: 10.1093/aje/kwv273
First published online: April 28, 2016

Bayesian Correction of Misclassification of Pertussis in Vaccine Effectiveness Studies: How Much Does Underreporting Matter?
ND Goldstein, I Burstyn, EC Newbern, LP Tabb…
Abstract
Diagnosis of pertussis remains a challenge, and consequently research on the risk of disease might be biased because of misclassification. We quantified this misclassification and corrected for it in a case-control study of children in Philadelphia, Pennsylvania, who were 3 months to 6 years of age and diagnosed with pertussis between 2011 and 2013. Vaccine effectiveness (VE; calculated as (1 – odds ratio) × 100) was used to describe the average reduction in reported pertussis incidence resulting from persons being up to date on pertussis-antigen containing vaccines. Bayesian techniques were used to correct for purported nondifferential misclassification by reclassifying the cases per the 2014 Council of State and Territorial Epidemiologists pertussis case definition. Naïve VE was 50% (95% confidence interval: 16%, 69%). After correcting for misclassification, VE ranged from 57% (95% credible interval: 30, 73) to 82% (95% credible interval: 43, 95), depending on the amount of underreporting of pertussis that was assumed to have occurred in the study period. Meaningful misclassification was observed in terms of false negatives detected after the incorporation of infant apnea to the 2014 case definition. Although specificity was nearly perfect, sensitivity of the case definition varied from 90% to 20%, depending on the assumption about missed cases. Knowing the degree of the underreporting is essential to the accurate evaluation of VE.

Media/Policy Watch
This section is intended to alert readers to substantive news, analysis and opinion from the general media on vaccines, immunization, global; public health and related themes. Media Watch is not intended to be exhaustive, but indicative of themes and issues CVEP is actively tracking. This section will grow from an initial base of newspapers, magazines and blog sources, and is segregated from Journal Watch above which scans the peer-reviewed journal ecology.

We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.

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Forbes
http://www.forbes.com/
Accessed 7 May 2016
How Dangerous Are College Outbreaks Of Mumps To You?
The mumps vaccine is our best protection against outbreaks of disease, like those occurring on colleges across the country.
Judy Stone, Contributor May 02, 2016

A Flu Shot During Pregnancy Protects Babies From Flu Up To 6 Months Later
Babies were far less likely to get the flu if their mothers were vaccinated against it.
Tara Haelle, Contributor May 03, 2016

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Huffington Post
http://www.huffingtonpost.com/impact/
Accessed 7 May 2016
THE BLOG
When It Was Even Scarier
29 April 2016
…I came to the CDC in 1988. That year, the World Health Assembly announced a commitment to eradicate polio—which every day paralyzed 1,000 children. Today polio is on the brink of extinction, clinging to existence in only two nations.

The year I came to CDC, the Haemophilus influenzae b (Hib) conjugate vaccine was just beginning to be used to prevent life-threatening meningitis and sepsis. Now Hib disease is nearly eliminated in the U.S., and the Vaccines for Children program makes sure vaccines are available to every child in America, and the GAVI Alliance has helped Hib vaccine be introduced in the poorest countries of the world.

Other things have changed since I came to CDC. Soon after I arrived, the U.S. experienced a major measles outbreak—55,000 cases and 123 deaths—and 1.9 million children worldwide were estimated to die from measles each year. By the year 2000, measles was eliminated from the U.S. And by 2014, worldwide measles deaths had declined to 115,000, with efforts in Africa and Asia accounting for most of the progress.

Twenty-five years ago, I made my first trip to West Africa to look for places to test a meningococcal A conjugate vaccine. In the past five years, 235 million people in the African meningitis belt have lined up to get the low-cost MenAfriVac developed by the Meningitis Vaccine Project. Today, epidemic group A meningococcal meningitis is gone.

Of course it’s not all smooth sailing now. We can’t take lifesaving vaccines for granted. In parts of Europe, we’ve seen many people forgo having their children immunized. The result: large outbreaks of measles that have been very difficult to control, including cases imported to the U.S. The progress in Africa is fragile — there’ve been very large measles outbreaks in the same countries that experienced Ebola, a result of interrupted health services and a tragic consequence of the Ebola epidemic.

Working with global partners and national governments, it is crucial we prevent, detect and respond to outbreaks before they spread; finish the job of polio eradication and secure its legacy through resilient immunization systems and sustained high coverage of measles vaccine.
Now I’ve reached the “mature” stage of my CDC career, and we are fighting a new threat called Zika. Our Ebola response showed we could move candidate vaccines from pre-clinical testing into large-scale field trials faster than ever. Zika, with its link to birth defects and miscarriage, provides an echo of the terrible rubella outbreak of the ‘60s. Improvements in science and global collaboration can help vaccine development against Zika advance even more rapidly…

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Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 7 May 2016
World
Study Sees Way to Limit Mosquitoes’ Ability to Spread Zika
By Betsy McKay, Reed Johnson, Rogerio Jelmayer
May 4, 2016
Introducing a common bacterium into a species of mosquitoes drastically limits the insects’ ability to transmit the dangerous Zika virus that has been spreading rapidly, according to researchers at Brazil’s leading medical-research institute…

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Washington Post
http://www.washingtonpost.com/
Accessed 7 May 2016
All those questions about Zika’s threat even touch baseball
Scientists know the Zika virus causes devastating birth defects but they can’t yet tell how big a threat it is or what to do about it. It’s not just pregnant women who are worried — now it’s touched baseball.
Lauran Neergaard | AP | Sports | May 6, 2016

Global Fund: $3.8 million fraud, stops aid to Nigeria agency
The Global Fund to Fight AIDS, Tuberculosis and Malaria has suspended payments to Nigeria’s AIDS agency over evidence that $3.8 million was stolen by its workers and consultants, the Geneva-based agency said Friday.
Michelle Faul | AP | Foreign | May 6, 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_30 April 2016

– blog edition: comprised of the approx. 35+ entries posted below on 1 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 Medical School

Editor’s Note:
Without any specific advisory or context information, WHO posted a report on a new ‘Yellow Fever” page titled: “Situation Report – Zika Virus Disease, Yellow Fever, Ebola Virus Disease.” The report appears to revive the previously discontinued Ebola Situation Report, partially duplicate the Zika Situation Report (which still appears as a free-standing report as below), and includes a “Risk Assessment” statement for each disease area:

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Situation Report – Zika Virus Disease, Yellow Fever, Ebola Virus Disease –
28 April 2016
[Excerpts]
Zika Virus Disease
Risk assessment
Overall, the global risk assessment has not changed since April 21. Zika virus continues to spread geographically to areas where competent vectors are present. Although a decline in cases of Zika infection has been reported in some countries, or in some parts of countries, vigilance needs to remain high. At this stage, based on the evidence available, WHO does not see an overall decline in the outbreak.

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Yellow Fever
Risk assessment
:: The outbreak in Angola remains of high concern due to:
:: Persistent local transmission in Luanda despite that fact that almost six million people have been vaccinated.
:: High risk of spread to neighbouring countries. Confirmed cases have already travelled from Angola to China, DRC and Kenya.
:: A field investigation concluded there is a high risk of local transmission of Yellow Fever in DRC.

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Ebola Virus Disease
Risk assessment:
Although all of the previous outbreaks have been stopped, the performance indicators suggest that the three countries still have variable capacity to prevent (care for survivors), detect (epidemiological and laboratory surveillance) and respond to new outbreaks (Table 7). The risk of additional outbreaks remains.

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Yellow fever vaccination essential for Angola, WHO reminds travellers
WHO News release
26 APRIL 2016 | GENEVA – As efforts to bring an outbreak of yellow fever in Angola under control continue, WHO is reminding all travellers to the country that they are required to receive the yellow fever vaccination and to have a valid certificate of vaccination to prove that they are protected from the disease and to prevent its further spread.

Since the outbreak in Angola began in December 2015, 1 975 suspected cases of yellow fever (618 laboratory confirmed) and 258 deaths have been reported, the majority of them in the capital, Luanda, and in 2 other provinces. Amid concerns that the virus will spread to other urban areas and to neighbouring countries, a large-scale vaccination campaign was launched in February 2016 and has so far reached almost 7 million people.

“Cases of yellow fever linked to this outbreak have been detected in other countries of Africa and Asia. We are particularly concerned that large urban areas are at risk and we strongly urge all travellers to Angola to ensure they are vaccinated against yellow fever and carry a valid certificate,” said Dr Margaret Chan, WHO Director-General…

Zika virus [to 30 April 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

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Zika situation report – 28 April 2016
Zika virus, Microcephaly and Guillain-Barré syndrome
Read the full situation report
Summary
As of 27 April, 55 countries and territories report continuing mosquito-borne transmission; for 42 countries this is their first documented Zika virus outbreak (Fig. 1).

:: Mosquito-borne transmission:
…42 countries are experiencing a first outbreak of Zika virus since 2015, with no previous evidence of circulation, and with ongoing transmission by mosquitos.
…13 countries reported evidence of Zika virus transmission between 2007 and 2014, with ongoing transmission.
…Four countries or territories have reported an outbreak since 2015 that is now over: 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 27 April, no additional countries reported mosquito-borne Zika virus transmission. Canada is the latest country to report person-to-person transmission.
…Microcephaly and other fetal malformations potentially associated with Zika virus infection or suggestive of congenital infection have been reported in six countries or territories (Table 3). 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.
…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 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.
…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 risk communication, and community engagement are available online.

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Latest updates
Dispelling rumours around Zika and complications
29 April 2016

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Zika Open [to 30 April 2016]
[Bulletin of the World Health Organization]
:: All papers available here
New papers below:
Spatial distribution of Zika virus infection in northeastern Colombia
Alfonso J Rodriguez-Morales, Ubydul Haque, Jacob D Ball, Carlos Julian García-Loaiza, Maria Leonor Galindo-Marquez, Juan Alejandro Sabogal-Roman, Santiago Marin-Loaiza, Andrés Felipe Ayala, Carlos O. Lozada-Riascos, Fredi A. Diaz-Quijano & Jorge L Alvarado-Socarras
Posted: 29 April 2016
http://dx.doi.org/10.2471/BLT.16.176529

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CDC/ACIP [to 30 April 2016]
http://www.cdc.gov/media/index.html
FRIDAY, APRIL 29, 2016
CDC adds Papua New Guinea to interim travel guidance related to Zika virus
CDC is working with other public health officials to monitor for ongoing Zika virus? transmission. Today, CDC posted a Zika virus travel notice for Papua New Guinea.

EBOLA/EVD [to 30 April 2016]
“Threat to international peace and security” (UN Security Council)

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Situation Report – Zika Virus Disease, Yellow Fever, Ebola Virus Disease – 28 April 2016
[Excerpt]
Ebola Virus Disease
Risk assessment:
Although all of the previous outbreaks have been stopped, the performance indicators suggest that the three countries still have variable capacity to prevent (care for survivors), detect (epidemiological and laboratory surveillance) and respond to new outbreaks (Table 7). The risk of additional outbreaks remains.

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African Union [to 30 April 2016]
http://www.au.int/en/
Terms of Reference for Multi-Disciplinary Clinical Teams (MDCT) – Government of the Republic of Sierra Leone, Ministry of Health and Sanitation
Following the end of the Ebola Virus Disease (EVD) Outbreak in Sierra Leone, the country is desirous of re-building its health system. To achieve this objective the country with support from Development Partners (DPs) developed a District Capacity Strengthening Project (DCSP). One of the components of the Projects is the Multi-Disciplinary Clinical Team (MDCT) Component. This component of the project aims to utilize the services of expatriate nationals as a short term measure to fill critical gaps in the health care delivery system as part of post-Ebola recovery activities, while the country works on a more sustainable human resource for health development program.

In support of the Government of Sierra Leone’s (GoSL) rebuilding efforts, the World Bank has made available funds to the GoSL under the Emergency Ebola Response Project (EERP). The GoSL wishes to apply part of these funds to secure the services of medical professionals to work in various district hospitals around the country.

File:
4 Medical Laboratory Technologists/Scientists
25 Medical Officers (with good General Medicine & Paediatrics skills)
18 Medical Officers (with good Surgical/Obstetrics & Gynaecology skills)
4 Radiographers /Imaging Technicians

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IPU Inter-Parliamentary Union [to 30 April 2016]
http://www.ipu.org/english/news.htm
27 APRIL 2016
Sierra Leone tackles Ebola prejudice and violence
MPs in Sierra Leone have received in-depth training at a workshop on ending the stigmatization of survivors of the deadly Ebola outbreak. A survey has found that 96 per cent of survivors had experienced some form of discrimination. The workshop, held in the capital, Freetown, also provided key information on tackling violence against women and girls (VAWG) and improving their health.
Forty MPs took part in the workshop, before taking the messages on Ebola and violence out into the community at two-day events in Freetown and the eastern town of Kenema. More than 80 people took part in each event, including local leaders, police and legal officials, health, education and social workers, civil society organizations, groups representing women and youth, and constituents. The events were organized by the Parliament of Sierra Leone with IPU assistance.

Community engagement is at the core of the new Global Strategy for Women’s, Children’s and Adolescents’ Health 2016-2030, which aims to end preventable deaths and enable people to thrive. IPU – in collaboration with the World Health Organization and the Partnership for Maternal, Newborn and Child Health – is at the forefront of work to ensure that national parliaments continue to play a critical role in improving women’s, children’s and adolescents’ health at the national, regional and global levels.

POLIO [to 30 April 2016]
Public Health Emergency of International Concern (PHEIC)

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Polio this week as of 27 April 2016
:: This World Immunization Week, we are closer than ever to the target of a world free of polio, with just two remaining polio endemic countries- Afghanistan and Pakistan. Read more about what remains to be done to carry the world across the threshold here.

:: Around the world, countries that remain vulnerable to polio are continuing to vaccinate children and build immunity, as shown in Jordan through this series of photographs.

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.

:: Follow a live update of which countries have undergone the switch here. 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 25 April:
…75 of 155 (48%) countries and territories have stopped using the trivalent oral polio vaccine.
…Independent monitoring to ensure the switch goes smoothly has begun in 63 countries.
…The National Validation Committee has received switch monitoring data from four countries: Tuvalu, Rwanda, Sao Tome and Burundi.
…The WHO Regional Office has received the National Validation Report from one country: Tuvalu.
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Selected Country Levels Updates [excerpted]
Afghanistan
:: One new case of wild poliovirus type 1 (WPV1) was reported in the past week in Shigal Wa Sheltan district of Kunar province with onset of paralysis on 26 February. The most recent case had onset of paralysis on 27 March in Shigal Wa Sheltan district of Kunar. The total number of WPV1 cases for 2016 is now four, compared to one reported by this date in 2015.
:: National Immunization Days will be held on 17 to 20 May.
Madagascar
:: The third Outbreak Response Assessment in Madagascar found that the surveillance system is not yet strong enough to conclude that polio transmission has been interrupted. Thirty-nine high-risk districts have been identified to receive focused attention.

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World Bank [to 30 April 2016]
http://www.worldbank.org/en/news/all
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Kandahar Province on the Verge of Eradicating Polio
Date: April 26, 2016
Highlights
:: Kandahar Province is on the verge of eradicating polio as a result of improved access to health services and extensive health awareness programs.
:: It is one of many significant outcomes of the System Enhancement for Health Action in Transition project, implemented by the Ministry of Public Health.
:: The project aims to expand the scope, quality, and coverage of health services provided to the population. It is supported by the International Development Association (IDA), the World Bank Group’s fund for the poorest countries, and the Afghanistan Reconstruction Trust Fund (ARTF), in partnership with multiple donors.

MERS-CoV [to 30 April 2016]

Disease Outbreak News (DONs)
:: 26 April 2016 Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
:: 25 April 2016 Middle East respiratory syndrome coronavirus (MERS-CoV) – Bahrain

WHO & Regional Offices [to 30 April 2016]

World Immunization Week 2016: Close the immunization gap
:: Campaign toolkit
:: Poster, visual materials
:: Fact sheet on immunization coverage
:: Quiz: How much do you know about immunization?
Get Vaccinated: Go for the gold!
29 April 2016 – Immunization stops 2 to 3 million deaths each year, however an additional 1.5 million deaths could be avoided with better vaccination coverage. During World Immunization Week 2016, WHO offices around the world have highlighted recent gains in immunization coverage and emphasized the work still needed to meet vaccination targets. In the Americas, the week has been supported by the 6 time Olympic Games Gold Medallist, Usain Bolt, with the theme “Go for the gold! Get vaccinated!”
:: More about World Immunization Week

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Weekly Epidemiological Record (WER) 29 April 2016, vol. 91, 17 (pp. 217–236)
Contents:
217 Epidemic focus [yellow fever]
219 Dracunculiasis eradication: global surveillance summary, 2015

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IPAC – Call for nominations pdf, 126kb 25 April 2016
[Immunization Practices Advisory Committee]
Deadline for application: 31 May 2016

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Disease Outbreak News (DONs)
:: 28 April 2016 Salmonellosis – United States of America
:: 27 April 2016 Lassa Fever – Germany
:: 26 April 2016 Human infection with avian influenza A(H7N9) virus – China
:: 26 April 2016 Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
:: 25 April 2016 Middle East respiratory syndrome coronavirus (MERS-CoV) – Bahrain

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:: WHO Regional Offices
WHO African Region AFRO
:: New WHO Guidelines Make All Persons Living with HIV Eligible for Antiretroviral Treatment
Johannesburg, 29 April 2016 – According to the new World Health Organization (WHO) guidelines for the prevention, treatment and care of HIV and Hepatitis, all 26 million people currently living with HIV in the African Region are now eligible for antiretroviral treatment (ART). This is more than double the number of the current 11 million on treatment. “The recommendation that anyone infected with HIV should begin antiretroviral treatment as soon as possible after diagnosis will revolutionize treatment outcomes, where people living with HIV will be able to live long and healthy lives,” says Dr Matshidiso Moeti, WHO Regional Director …
:: A Call to Close the Immunization Gap – 26 April 2016
:: Yellow fever vaccination essential for Angola, WHO reminds travellers – 26 April 2016

WHO Region of the Americas PAHO
:: Communities urged to clean up mosquito breeding sites to prevent Zika, during Vaccination Week in the Americas (04/29/2016)
:: PAHO urges “Go for the gold! Get vaccinated!” during Vaccination Week in the Americas (04/25/2016)
:: “Malaria Champions of the Americas” seeks successful initiatives to eliminate malaria and prevent its reintroduction (04/25/2016)

WHO South-East Asia Region SEARO
:: WHO: One year on, health partners review Nepal quake response, call for scaling up emergency preparedness SEAR/PR/1624 Kathmandu, 21 April 2016
:: End malaria for good, scale-up and sustain Region-wide anti-malaria efforts 25 April 2016

WHO European Region EURO
:: Crown Princess of Denmark advocates immunization and addressing antimicrobial resistance 28-04-2016
:: Joint statement by Her Royal Highness Crown Princess Mary of Denmark and Dr Zsuzsanna Jakab, WHO Regional Director for Europe 27-04-2016
:: Governments call on WHO and partners to support achievement of global road safety targets 26-04-2016
:: European Immunization Week in the classroom 25-04-2016

WHO Eastern Mediterranean Region EMRO
:: The final frontier in polio eradication 28 April 2016
:: Chernobyl: 30 Years On 26 April 2016

WHO Western Pacific Region
:: WHO calls for action to protect young people from alcohol-related harm
HONG KONG SAR (CHINA), 30 APRIL 2016 – Every minute one person dies from alcohol-related harm in the Western Pacific Region. Alcohol is one of the biggest risk factors for deaths among young people in the Region. “One in three current drinkers in the Western Pacific aged 15 to 19 has engaged in excessive drinking,” notes Dr Shin Young-soo, WHO Regional Director for the Western Pacific. “Alcohol abuse is associated with depression and anxiety. Excessive drinking is closely linked to self-harm and suicide.”

CDC/ACIP [to 30 April 2016]
http://www.cdc.gov/media/index.html
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FRIDAY, APRIL 29, 2016
CDC adds Papua New Guinea to interim travel guidance related to Zika virus
CDC is working with other public health officials to monitor for ongoing Zika virus? transmission. Today, CDC posted a Zika virus travel notice for Papua New Guinea.

MONDAY, APRIL 25, 2016
World Immunization Week
CDC plays a critical role in promoting global immunization by providing scientific leadership and guidance to implement evidence-based vaccination strategies against disease. This year marks the 50th anniversary of the…

MMWR April 29, 2016 / Vol. 65 / No. 16
:: Food and Drug Administration Approval for Use of Hiberix as a 3-Dose Primary Haemophilus influenzae Type b (Hib) Vaccination Series

Sabin Vaccine Institute [to 30 April 2016]
http://www.sabin.org/updates/ressreleases

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April 28, 2016
Sabin PDP Begins Phase 1 Clinical Trial to Co-Administer Two Novel Hookworm Vaccine Candidates in Brazil
WASHINGTON, D.C. — April 29, 2016 — The Sabin Vaccine Institute (Sabin) today announced that its Product Development Partnership (Sabin PDP) began a Phase 1 clinical trial of Na-APR-1 (M74)/Alhydrogel® co-administered with Na-GST-1/Alhydrogel in Brazilian adults. The trial will evaluate the safety and immune response of co-administering these novel vaccine candidates in 60 healthy adults living in a hookworm-endemic area.

The George Washington University (GWU) in partnership with the Oswaldo Cruz Foundation (Fiocruz) of the Brazilian Ministry of Health is conducting the study in Americaninhas, Minas Gerais, Brazil. The study began in January and is expected to run through March 2017. Volunteers will be injected with one or both vaccine products, to determine if administering both at the same time produces an improved immune response over giving each of them separately.

“With this trial, we hope to build on the work of our previous studies in Brazil to develop a safe, effective and affordable vaccine to prevent human hookworm infection,” said David Diemert, MD, director of clinical trials of the Sabin PDP and associate professor at GWU in Washington, DC. “A vaccine, in combination with currently available drugs, could help turn the tide against this pervasive disease, which afflicts the world’s poorest communities.”…

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Uganda Enacts Law to Improve National Immunization Efforts, Increase Domestic Financing for the National Program
KAMPALA, UGANDA — April 28, 2016 — The Sabin Vaccine Institute (Sabin) applauds the enactment of Uganda’s Immunization Act, 2016, which was recently signed into law by President Yoweri Museveni. The law mandates compulsory immunization of children, women of reproductive age and other target groups and establishes a new national immunization fund.

Notably, this legislation includes a provision to establish an “Immunization Financing and Administration Fund” to purchase vaccines and related supplies, cold chains and funding of immunization outreach activities. The fund will be financed through parliamentary appropriations and donations. The bill was introduced as a private members bill in the Ugandan Parliament in 2012 by Hon. Huda Oleru, a Member of Parliament from the Yumbe district, and was passed as an Act of parliament in December 2015…

IVAC [International Vaccine Access Center] [to 30 April 2016]
http://www.jhsph.edu/research/centers-and-institutes/ivac/about-us/news.html

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[Undated]
IVAC Launches VIEW-hub Interactive Data Visualization Platform
IVAC’s new VIEW-hub (Vaccine Information and Epidemiology Window) platform is now live. VIEW-hub is a publicly accessible, interactive platform that enables users to instantly visualize data about vaccine introductions, product usage, dosing schedules, access, coverage, and more for a number of vaccines. Custom queries and maps, exportable data and graphics, and a map gallery are just some of the interactive features users can access.

VIEW-hub compiles data from a variety of official and unofficial vetted partner sources—WHO’s Immunization Data Repository and other official WHO sources, UNICEF, Gavi, government ministry of health websites, CDC, the Bill & Melinda Gates Foundation, recurring literature sources, and vetted media—in a central platform where data visualization and summaries can be easily generated and customized. Data are gathered systematically across official sources as needed to ensure validity. VIEW-hub extends the functionality and content of the former Vaccine Information Management System (VIMS), allowing users to track progress and strategize ways to accelerate and optimize vaccine implementation…

MSF/Médecins Sans Frontières [to 30 April 2016]
http://www.doctorswithoutborders.org/news-stories/press/press-releases

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Press release
More than 400,000 Demand Pfizer and GSK Cut Price of Lifesaving Pneumonia Vaccine
April 27, 2016
MSF hands over global petition as volunteers place 2,500 flowers in front of Pfizer’s headquarters in New York, representing the number of kids who die of pneumonia each day.

Global Fund [to 30 April 2016]
http://www.theglobalfund.org/

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27 April 2016
Global Fund Board Approves Strategy 2017-2022
ABIDJAN, Côte d’Ivoire – The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria today approved a Strategy 2017-2022 to maximize impact, strengthen systems for health, promote and protect human rights and gender equality, and mobilize additional resources…

The Strategy, named “Investing to End Epidemics,” sets the groundwork for more effective implementation of health programs, so that partners can reach more people and achieve greater impact. The Global Fund partnership fosters innovative approaches that meet diverse country needs, with the common goal of ending HIV, TB and malaria. For good…

The Strategy adopted by the Board emerged from extensive consultations and broad engagement over the past two years. Hundreds of partners participated in strategy discussions at Partnership Forums in 2015 that were convened in Addis Ababa, Bangkok and Buenos Aires, and contributed through an e-Forum that collected views from all over the world.

The new strategy is fully aligned with the Sustainable Development Goals embraced by member states of the United Nations in September 2015, with a holistic and multidisciplinary approach that seeks to reach those most in need, reduce inequalities, and support sustainable transition across the development continuum as countries move toward self-sustainability.

The new strategy underlines the Global Fund’s commitment to contribute to building resilient and sustainable systems for health to support national strategies for health and national disease-specific strategic plans in each country. Strengthening data systems, and using existing data more effectively, is a key factor…

USAID [to 30 April 2016]
http://www.usaid.gov/news-information/press-releases
April 25, 2016
Statement by USAID Administrator Gayle Smith on World Malaria Day
On World Malaria Day, USAID joins partners across the globe in commemorating incredible progress in the fight against malaria. But our fight is not over. A child still dies every two minutes from malaria. So we must also answer President Obama’s call and work to end malaria within a generation.

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EDCTP [to 30 April 2016]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials.
25 April 2016
World Malaria Day 2016: joining forces to end malaria
There has been remarkable progress made in malaria control based on current World health Organisation estimates. Nonetheless, there is still much to be done in the fight against malaria in malaria prevention, diagnostic testing and treatment. The European & Developing Countries Clinical Trials Partnership (EDCTP) supports malaria research in sub-Saharan African countries by funding clinical trials conducted by African-European research partnerships, as well as strengthening individual and institutional capacities to conduct trials. Since 2003, EDCTP has financed 42 malaria grants in malaria prevention, diagnostic testing and treatment. EDCTP, now in its second programme, is committed to continue working in partnership in a joint effort geared towards ending malaria.…

Reports/Research/Analysis/Commentary/Conferences/Meetings/Book Watch/Tenders
Vaccines and Global Health: The Week in Review has expanded its coverage of new reports, books, research and analysis published independent of the journal channel covered in Journal Watch below. Our interests span immunization and vaccines, as well as global public health, health governance, and associated themes. If you would like to suggest content to be included in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

Transitioning from Gavi Support in Lower-Middle-Income Countries
CSIS | 25 April 2016
By Katherine Bliss, Katherine Peck

Since 2000, the U.S. government has been a strong partner of Gavi, the Vaccine Alliance, providing more than US$730 million through the end of September 2015 to support the introduction of new and underutilized vaccines in the world’s poorest countries. Lower-income countries receiving Gavi assistance have long been required to cofinance a portion of each vaccine dose procured with Gavi funds, with the expectation that as the countries reach lower-middle-income country status (LMIC), they will eventually transition away from Gavi support. To date, at least 24 of the original 73 Gavi-eligible countries have started to transition, with 16 expected to complete the process by the end of 2018.

The long history of U.S. support for global maternal and child health programs, its emphasis on assisting countries in strengthening their immunization programs, and considerable U.S. investments in Gavi over the past 15 years all underscore why the United States has an interest in ensuring LMIC transitions from Gavi support proceed smoothly and sustainably. Yet in many LMICs, the United States is scaling back its bilateral engagement on health. Examining the factors shaping the way countries in Latin America and the Caribbean are experiencing the Gavi transition process provides a helpful lens through which to examine options for U.S. engagement to support the sustainability of immunization programs in LMICs.

Pdf of report: http://csis.org/files/publication/160425_Bliss_TransitioningGAVISupport_Web.pdf

Statement by Margaret Chan, WHO Director-General, and Anthony Lake, UNICEF Executive Director on attacks on medical facilities and personnel in Syria
GENEVA/NEW YORK, 29 April 2016 – We join the many voices expressing outrage at the attack on Al Quds Hospital in Aleppo. Among those killed were two doctors, including one of the only remaining pediatricians in the city, three paramedics, and numerous patients, among them children.

We are outraged at the alarming frequency of attacks on health personnel and facilities in Syria. These incidents come amid an escalation of violence in particular in the northern parts of the country.

A few days ago, a mortar killed a gynecologist on his way home after treating wounded civilians at a UNICEF-supported clinic in Aleppo.
These attacks remind us of the enormous difficulties and dangers that Syrian health workers face every day. Those workers deserve more than our admiration. They deserve greater protection.

Attacks on them and on health facilities and the denial of healthcare services as well as medical equipment and supplies anywhere in Syria, are not only a blatant violation of International Humanitarian Law, but deprive families and communities of essential health care when they need it most.

UNICEF and WHO urge all parties to the conflict to end all attacks on health facilities, personnel and ambulances and to allow the provision of health services to the many innocent civilians in desperate need. Thousands of lives are at stake.

IPU Inter-Parliamentary Union [to 30 April 2016]
http://www.ipu.org/english/news.htm

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27 APRIL 2016
MPs’ meeting breaks new ground at World Health Assembly
MPs will meet alongside the World Health Assembly next month in the first event of its kind. It follows WHO Director-General Margaret Chan’s historic first address to an IPU Assembly in Geneva last October, in which she exhorted MPs to fulfil their unique and powerful role in delivering better health care to citizens. The meeting will strengthen parliamentary involvement in the World Health Organization and help ensure its decisions are translated into practical action by parliaments. MPs will be able to share and hear ideas on delivering the ambitious targets set under Sustainable Development Goal 3 on health – including universal health coverage – and the new Global Strategy for Women’s, Children’s and Adolescents’ Health. The event, co-sponsored by Bangladesh, Italy and Lesotho, takes place on 26 May from 12:15 to 13:45 in Room 7 of the Palais des Nations in Geneva. The event is open to parliamentarians attending the 69th World Health Assembly as members of their national delegation.

African Union [to 30 April 2016]
http://www.au.int/en/

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April 27, 2016
Health experts define Africa’s health direction
Addis Ababa, Ethiopia, 27 April 2016- With the continental and global consensus on sustainable development in the Sustainable Development Goals and Agenda 2063 the African Union on Tuesday finalised the review of key health policy instruments that will guide the continent for the next 15 years. The review follows the Decision of the Ministers of Health last year mandating the AU Commission to finalise the revision of key AU health policy instruments.

“These health policy instruments will provide the strategic direction to secure health for all by 2030 in Africa” said Ambassador Olawale Maiyegun, the Director of Social Affairs.

The reviewed documents include the overarching Africa Health Strategy (2016-2030); the Maputo Plan of Action (2016-2030) for the implementation of the Continental Framework on Sexual and Reproductive Health and Rights and the Catalytic Framework to end AIDS, TB and Eliminate Malaria in Africa by 2030.

The Africa Health Strategy is the primary consolidative document for all African commitments in the health sector. It will inspire, guide and highlight Africa’s strategic priorities in the next one and a half decade. The strategy calls on Member States to prioritise and invest in health through strengthened health systems, community engagement, fostering public private partnerships.

During the meeting Member State Experts also deliberated on the establishment of the African Health Volunteers Corps. The African Union is establishing the Corps as part of the Africa Centres for Disease Control and Prevention. The Africa CDC will assemble, equip, and mobilise a deployable roaster of volunteer medical and public health professionals. This will ensure rapid and effective responses to public health emergencies to Member States and address matters of global concern including health impacts of natural disasters and humanitarian crises.

Journal Watch
Vaccines and Global Health: The Week in Review continues its weekly scanning of key peer-reviewed journals to identify and cite articles, commentary and editorials, books reviews and other content supporting our focus on vaccine ethics and policy.

Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher.

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

American Journal of Preventive Medicine
May 2016 Volume 50, Issue 5, p553-676, e123-e162
http://www.ajpmonline.org/current

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Research Articles
Childhood Adversity and Adult Reports of Food Insecurity Among Households With Children
Jing Sun, Molly Knowles, Falguni Patel, Deborah A. Frank, Timothy C. Heeren, Mariana Chilton
p561–572
Published online: November 16 2015
Open Access
Preview
Exposure to childhood adversity, including abuse, neglect, and household dysfunction, is associated with negative long-term health and economic outcomes. Little is known about how adversity exposure in parents’ early lives may be related to later food insecurity for parents and their children. This study investigated the association between female caregivers’ adverse childhood experiences (ACEs) and household and child food insecurity, taking into account depressive symptoms.
Abstract
Introduction
Exposure to childhood adversity, including abuse, neglect, and household dysfunction, is associated with negative long-term health and economic outcomes. Little is known about how adversity exposure in parents’ early lives may be related to later food insecurity for parents and their children. This study investigated the association between female caregivers’ adverse childhood experiences (ACEs) and household and child food insecurity, taking into account depressive symptoms.
Methods
This study used cross-sectional data from 1,255 female caregivers of children aged 7.1% higher than IIV, but never cost saving when absolute LAIV effectiveness was <3.5% higher than IIV.
Conclusions
Results support CDC’s decision to no longer prefer LAIV use and provide guidance on effectiveness differences between influenza vaccines that might lead to preferential LAIV recommendation for children aged 2–8 years.

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National and State-Specific Td and Tdap Vaccination of Adult Populations
Peng-jun Lu, Alissa O’Halloran, Helen Ding, Jennifer L. Liang, Walter W. Williams
p616–626
Published online: November 21 2015
Preview
The Advisory Committee on Immunization Practices recommends a single dose of tetanus, diphtheria, and acellular pertussis vaccine (Tdap) for adults followed by tetanus and diphtheria toxoids (Td) booster doses every 10 years thereafter. This study assessed recent Td and Tdap vaccination among adult populations.

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State Law and Standing Orders for Immunization Services
Alexandra M. Stewart, Megan C. Lindley, Marisa A. Cox
e133–e142
Published online: December 1 2015
Abstract
Introduction
This study determined whether state laws permit the implementation of standing orders programs (SOPs) for immunization practice. SOPs are an effective strategy to increase uptake of vaccines. Successful SOPs require a legal foundation authorizing delegation of immunization services performed by a wide range of providers, administered to broad patient populations, in several settings. Without legal permission to administer vaccines, non-physician health professionals (NPHPs) are unable to provide preventive services.
Methods
From 2012 through 2013, researchers analyzed the legal environment in 50 states and the District of Columbia to determine whether NPHPs are authorized to (1) assess patient immunization status; (2) prescribe vaccines; and (3) administer vaccines under their own practice license or delegated authority. Laws governing the following NPHPs were included: (1) medical assistants; (2) midwives; (3) nurses in advanced practice; (4) registered, practical, and vocational nurses; (5) physician assistants; and (6) pharmacists. Additionally, the review determined which vaccines may be administered, permissible patient populations, and allowable practice settings for each category of NPHP.
Results
The laws are highly variable, and no state authorizes all NPHPs to conduct all elements of immunization practice for all patients. The laws frequently indicate where NPHPs may or may not administer vaccines and outline permissible vaccines, eligible patients, and required level of supervision.
Conclusions
The variation in the laws could potentially present a challenge to successful implementation of public health goals to improve immunization rates. Expanded authorization of SOPs in all states could increase health practitioners’ ability to deliver recommended vaccines.

American Journal of Public Health
Volume 106, Issue 5 (May 2016)
http://ajph.aphapublications.org/toc/ajph/current

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AJPH GLOBAL HEALTH FORUM
UNIVERSAL COVERAGE
Being Fair in Universal Health Coverage: Prioritize Public Health Services for Low- and Middle-Income Countries
Mathew George
American Journal of Public Health: May 2016, Vol. 106, No. 5: 830–831

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 30 April 2016)

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Research article
Assessment of medicines use pattern using World Health Organization’s Prescribing, Patient Care and Health facility indicators in selected health facilities in eastern Ethiopia
About one-third of the world’s population lack access to essential medicines and this is further compounded by inappropriate prescription, dispensing, sale and use of the available medicines.
Arebu I. Bilal, Ebrahim D. Osman and Anwar Mulugeta
BMC Health Services Research 2016 16:144
Published on: 23 April 2016

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 30 April 2016)

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Research article
The ethics of community-based research with people who use drugs: results of a scoping review
Rusty Souleymanov, Dario Kuzmanović, Zack Marshall, Ayden I. Scheim, Mikiki Mikiki, Catherine Worthington and Margaret (Peggy) Millson
Published on: 29 April 2016
Abstract
Background
Drug user networks and community-based organizations advocate for greater, meaningful involvement of people with lived experience of drug use in research, programs and services, and policy initiatives. Community-based approaches to research provide an opportunity to engage people who use drugs in all stages of the research process. Conducting community-based participatory research (CBPR) with people who use drugs has its own ethical challenges that are not necessarily acknowledged or supported by institutional ethics review boards. We conducted a scoping review to identify ethical issues in CBPR with people who use drugs that were documented in peer-reviewed and grey literature.
Methods
The search strategy focused on three areas; community-based research, ethical issues, and drug use. Searches of five academic databases were conducted in addition to a grey literature search, hand-searching, and consultation with organizational partners and key stakeholders. Peer reviewed literature and community reports published in English between 1985 and 2013 were included, with initial screening conducted by two reviewers.
Results
The search strategy produced a total of 874 references. Twenty-five references met the inclusion criteria and were included in our thematic analysis. Five areas were identified as important to the ethics of CBPR with people who use drugs: 1) participant compensation, 2) drug user perspectives on CBPR, 3) peer recruitment and representation in CBPR, 4) capacity building, and 5) participation and inclusion in CBPR.
Conclusions
We critically discuss implications of the emerging research in this field and provide suggestions for future research and practice.

Child Care, Health and Development
May 2016 Volume 42, Issue 3 Pages 297–454
http://onlinelibrary.wiley.com/doi/10.1111/cch.v42.3/issuetoc

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Reviews
Long-term cognitive and school outcomes of late-preterm and early-term births: a systematic review (pages 297–312)
E. Chan, P. Leong, R. Malouf and M. A. Quigley
Article first published online: 10 FEB 2016 | DOI: 10.1111/cch.12320

Reviews
The role of collaboration in the cognitive development of young children: a systematic review (pages 313–324)
J. Sills, G. Rowse and L.-M. Emerson
Article first published online: 16 MAR 2016 | DOI: 10.1111/cch.12330

Reviews
Interagency collaboration in children and young people’s mental health: a systematic review of outcomes, facilitating factors and inhibiting factors (pages 325–342)
M. Cooper, Y. Evans and J. Pybis
Article first published online: 10 FEB 2016 | DOI: 10.1111/cch.12322

Eurosurveillance
Volume 21, Issue 17, 28 April 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Review articles
Best practices in ranking communicable disease threats: a literature review, 2015
by EC O’Brien, R Taft, K Geary, M Ciotti, JE Suk
The threat of serious, cross-border communicable disease outbreaks in Europe poses a significant challenge to public health and emergency preparedness because the relative likelihood of these threats and the pathogens involved are constantly shifting in response to a range of changing disease drivers. To inform strategic planning by enabling effective resource allocation to manage the consequences of communicable disease outbreaks, it is useful to be able to rank and prioritise pathogens. This paper reports on a literature review which identifies and evaluates the range of methods used for risk ranking. Searches were performed across biomedical and grey literature databases, supplemented by reference harvesting and citation tracking. Studies were selected using transparent inclusion criteria and underwent quality appraisal using a bespoke checklist based on the AGREE II criteria. Seventeen studies were included in the review, covering five methodologies. A narrative analysis of the selected studies suggests that no single methodology was superior. However, many of the methods shared common components, around which a ‘best-practice’ framework was formulated. This approach is intended to help inform decision makers’ choice of an appropriate risk-ranking study design.

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News
World Health Organization announces European Region malaria free
On 20 April 2016, the World Health Organization (WHO) announced that the WHO European Region, which comprises 53 countries, is the first of the WHO regions to have interrupted the indigenous transmission of malaria [1].

In 2005, the WHO European Regional Office for Europe adopted the Tashkent Declaration, ‘The Move from Malaria Control to Elimination’ [2] which paved the way for a new malaria elimination strategy, the ‘Regional Strategy: From Malaria Control to Elimination in the WHO European Region 2006-2015’ [3]. The Regional Strategy set out milestones for the countries of the WHO European Region to eliminate malaria. Between 1995 and 2015, the number of indigenous malaria cases went from around 90,000 to zero in the European Region.

In July 2016, the WHO will hold its first meeting on the prevention of the re-introduction of malaria into the WHO European Region. According to the WHO, the meeting will focus on prevention through (i) sustained political commitment, (ii) strong vigilance to test and treat all malaria cases promptly, (iii) understanding how malaria transmission could be reintroduced and the risk it poses; and (iv) immediate action if local malaria transmission resumes.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 30 April 2016]

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Research
Partnerships in global health and collaborative governance: lessons learnt from the Division of Tropical and Humanitarian Medicine at the Geneva University Hospitals
David Beran, Sigiriya Aebischer Perone, Gabriel Alcoba, Alexandre Bischoff, Claire-Lise Bussien, Gilles Eperon, Olivier Hagon, Olivia Heller, Frédérique Jacquerioz Bausch, Nicolas Perone, Thomas Vogel and François Chappuis
Published on: 29 April 2016
Abstract
Background
In 2007 the “Crisp Report” on international partnerships increased interest in Northern countries on the way their links with Southern partners operated. Since its establishment in 2007 the Division of Tropical and Humanitarian Medicine at the Geneva University Hospitals has developed a variety of partnerships. Frameworks to assess these partnerships are needed and recent attention in the field of public management on collaborative governance may provide a useful approach for analyzing international collaborations.
Methods
Projects of the Division of Tropical and Humanitarian Medicine were analyzed by collaborators within the Division using the model proposed by Emerson and colleagues for collaborative governance, which comprises different components that assess the collaborative process.
Results
International projects within the Division of Tropical and Humanitarian Medicine can be divided into four categories: Human resource development; Humanitarian response; Neglected Tropical Diseases and Noncommunicable diseases. For each of these projects there was a clear leader from the Division of Tropical and Humanitarian Medicine as well as a local counterpart. These individuals were seen as leaders both due to their role in establishing the collaboration as well as their technical expertise. Across these projects the actual partners vary greatly. This diversity means a wide range of contributions to the collaboration, but also complexity in managing different interests. A common definition of the collaborative aims in each of the projects is both a formal and informal process. Legal, financial and administrative aspects of the collaboration are the formal elements. These can be a challenge based on different administrative requirements. Friendship is part of the informal aspects and helps contribute to a relationship that is not exclusively professional.
Conclusion
Using collaborative governance allows the complexity of managing partnerships to be presented. The framework used highlights the process of establishing collaborations, which is an element often negated by other more traditional models used in international partnerships. Applying the framework to the projects of the Division of Tropical and Humanitarian Medicine highlights the importance of shared values and interests, credibility of partners, formal and informal methods of management as well as friendship.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 30 April 2016]

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Commentary
The Life Science Exchange: a case study of a sectoral and sub-sectoral knowledge exchange programme
Brian Lee Perkins, Rob Garlick, Jodie Wren, Jon Smart, Julie Kennedy, Phil Stephens, Gwyn Tudor, Jonathan Bisson and David V. Ford
Published on: 27 April 2016
Abstract
Background
Local and national governments have implemented sector-specific policies to support economic development through innovation, entrepreneurship and knowledge exchange. Supported by the Welsh Government through the European Regional Development Fund, The Life Science Exchange® project was created with the aim to increase interaction between stakeholders, to develop more effective knowledge exchange mechanisms, and to stimulate the formation and maintenance of long-term collaborative relationships within the Welsh life sciences ecosystem. The Life Science Exchange allowed participants to interact with other stakeholder communities (clinical, academic, business, governmental), exchange perspectives and discover new opportunities.
Methods
Six sub-sector focus groups comprising over 200 senior stakeholders from academia, industry, the Welsh Government and National Health Service were established. Over 18 months, each focus group provided input to inform healthcare innovation policy and knowledge mapping exercises of their respective sub-sectors. Collaborative projects identified during the focus groups and stakeholder engagement were further developed through sandpit events and bespoke support.
Results
Each sub-sector focus group produced a report outlining the significant strengths and opportunities in their respective areas of focus, made recommendations to overcome any ‘system failures’, and identified the stakeholder groups which needed to take action. A second outcome was a stakeholder-driven knowledge mapping exercise for each area of focus. Finally, the sandpit events and bespoke support resulted in participants generating more than £1.66 million in grant funding and inward investment. This article outlines four separate outcomes from the Life Science Exchange programme.
Conclusions
The Life Science Exchange process has resulted in a multitude of collaborations, projects, inward investment opportunities and special interest group formations, in addition to securing over ten times its own costs in funding for Wales. The Life Science Exchange model is a simple and straightforward mechanism for a regional or national government to adapt and implement in order to improve innovation, skills, networks and knowledge exchange.

JAMA
April 26, 2016, Vol 315, No. 16
http://jama.jamanetwork.com/issue.aspx

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Special Communication | April 26, 2016
The Association Between Income and Life Expectancy in the United States, 2001-2014
Raj Chetty, PhD1; Michael Stepner, BA2; Sarah Abraham, BA2; Shelby Lin, MPhil3; Benjamin Scuderi, BA4; Nicholas Turner, PhD5; Augustin Bergeron, MA4; David Cutler, PhD4
Author Affiliations
JAMA. 2016;315(16):1750-1766. doi:10.1001/jama.2016.4226.
Abstract
Importance
The relationship between income and life expectancy is well established but remains poorly understood.
Objectives
To measure the level, time trend, and geographic variability in the association between income and life expectancy and to identify factors related to small area variation.
Design and Setting
Income data for the US population were obtained from 1.4 billion deidentified tax records between 1999 and 2014. Mortality data were obtained from Social Security Administration death records. These data were used to estimate race- and ethnicity-adjusted life expectancy at 40 years of age by household income percentile, sex, and geographic area, and to evaluate factors associated with differences in life expectancy.
Exposure
Pretax household earnings as a measure of income.
Main Outcomes and Measures
Relationship between income and life expectancy; trends in life expectancy by income group; geographic variation in life expectancy levels and trends by income group; and factors associated with differences in life expectancy across areas.
Results
The sample consisted of 1,408,287,218 person-year observations for individuals aged 40 to 76 years (mean age, 53.0 years; median household earnings among working individuals, $61 175 per year). There were 4 114 380 deaths among men (mortality rate, 596.3 per 100,000) and 2,694,808 deaths among women (mortality rate, 375.1 per 100,000). The analysis yielded 4 results. First, higher income was associated with greater longevity throughout the income distribution. The gap in life expectancy between the richest 1% and poorest 1% of individuals was 14.6 years (95% CI, 14.4 to 14.8 years) for men and 10.1 years (95% CI, 9.9 to 10.3 years) for women. Second, inequality in life expectancy increased over time. Between 2001 and 2014, life expectancy increased by 2.34 years for men and 2.91 years for women in the top 5% of the income distribution, but by only 0.32 years for men and 0.04 years for women in the bottom 5% (P < .001 for the differences for both sexes). Third, life expectancy for low-income individuals varied substantially across local areas. In the bottom income quartile, life expectancy differed by approximately 4.5 years between areas with the highest and lowest longevity. Changes in life expectancy between 2001 and 2014 ranged from gains of more than 4 years to losses of more than 2 years across areas. Fourth, geographic differences in life expectancy for individuals in the lowest income quartile were significantly correlated with health behaviors such as smoking (r=-0.69, P  < .001), but were not significantly correlated with access to medical care, physical environmental factors, income inequality, or labor market conditions. Life expectancy for low-income individuals was positively correlated with the local area fraction of immigrants (r = 0.72, P < .001), fraction of college graduates (r= 0.42, P < .001), and government expenditures (r=0.57, P < .001).
Conclusions and Relevance
In the United States between 2001 and 2014, higher income was associated with greater longevity, and differences in life expectancy across income groups increased over time. However, the association between life expectancy and income varied substantially across areas; differences in longevity across income groups decreased in some areas and increased in others. The differences in life expectancy were correlated with health behaviors and local area characteristics

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Editorials:
Associations Between Money and Death; Angus Deaton, PhD
Improving Opportunity, Population Health, and Well-being Collectively; Steven H. Woolf, MD, MPH; Jason Q. Purnell, PhD, MPH
Income, Longevity, and Community Health; J. Michael McGinnis, MD, MPP

Journal of Health Care for the Poor and Underserved (JHCPU)
Volume 27, Number 2, May 2016 Supplement
https://muse.jhu.edu/issue/33442

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Introduction to Public Health and Incarceration: Social Justice Matters
Overview Providing health care in jails, prisons, half-way houses, and community-supervised correctional programs, correctional facilities, and community systems has a direct effect on health outcomes of incarcerated populations. Moreover, effective linkages to a myriad of services upon release and assistance with community reintegration are key components for reducing recidivism. In an effort to highlight some of the disparity issues and challenges in corrections, we offer this issue, titled, Public Health and Incarceration: Social Justice Matters. In 2012, U.S. state prison systems, comprising 50 independent entities, incarcerated over 1.3 million people, of whom a disproportionate share were minorities, primarily African Americans and Hispanics. Despite recent reports that 2012 marked a decrease in the number of imprisonments of males and females, the U.S. continues to lead the world in incarceration of its residents. The reported decrease in incarceration may be attributed to alternative sentences, such as probation, which maintains individuals under correctional supervision.

Mass incarceration disrupts families and affects health status and the quality of life within families. Prisoners are more likely than the general population to have chronic health conditions and infectious diseases. In 2012, 43.9% of offenders reported a chronic condition, relative to 31.0% of the general population; 21.0% of offenders had had an infectious disease, relative to 4.8% of the general population. The disparities in mental health and substance abuse are equally troubling. These health risks are not proportionately distributed across populations. African American males have an imprisonment rate of 2,841 per 100,000; Hispanic males have a rate of 1,158 per 100,000; and White males have a rate of 463 per 100,000. There are similar disparities for African American and Hispanic females relative to Whites.

Although some of the health problems experienced by offenders are addressed during their incarceration, many are not addressed upon their release, which poses serious health risks for the former offenders and for the local communities to which they return. Health problems of former offenders become those of the local community, where there may be little knowledge and discussion related to the intersections of corrections, public health, and reentry for this subset of a vulnerable population.

This special issue of the JHCPU-with a focus on disparities related to racial and ethnic minorities, reentry, and public health-explores innovative research, services, and programs that deal with the health of the offender population. The social justice system is burdened with imperfections deleterious to health equity. The system disproportionately lessens the life opportunities of African Americans, Latinos, and other disadvantaged ethnic minority groups. Eliminating such imperfections is a formidable task, but nevertheless one that must be accomplished if the nation is to achieve true health equity.

The articles in this issue of the JHCPU report on strategies for change. In the commentary by Ferguson, et al., a strong case is made that systems change is the “order of the day”; this case is eloquently presented as a “Call for Action.” While there have been many other such appeals, this call offers recommendations for clinical practice, criminal justice studies, health science institutions, and communities. Much like the compelling call for action in Michelle Alexander’s book, The New Jim Crow: Mass Incarceration in the Age of Colorblindness, a stage is set for sector stakeholders to move in a new direction, one involving sector accountability without compromise. We must change the mass incarceration practices and eliminate their catastrophic effects on racial and ethnic minorities, in the U.S. In the manuscript by Coughlin, Lewis, and Smith, developments in ethics in the context of the racial/ethnic disparities that exist in corrections, are discussed. Ethical considerations in clinical and public health research on HIV in prison and jail settings are considered. Factors in mental health research are summarized, along with issues pertaining to research involving female inmates. The ethics of research involving incarcerated people extends beyond traditional ethical concerns related to human subjects to include issues in the domains of bioethics and public health ethics. Tamburello and Ferguson present a commentary on marginalized individuals diagnosed with mental health conditions and the medication-prescribing practices in correctional facilities. Several articles in this issue concern incarcerated women specifically…

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Commentaries
Ethical and Social Issues in Health Research Involving Incarcerated People
pp. 18-28
Steven S. Coughlin, Sharon R. Lewis, Selina A. Smith
Abstract:
The use of inmates in research in the U.S. was restricted by the recommendations of the National Commission and by federal regulations and guidelines that followed. By the 1980s, many health care officials became concerned about the exclusion of inmates from experimental treatments for human immunodeficiency virus infection (HIV). These developments in ethics occurred in the context of racial/ethnic disparities in health. In this article, ethical considerations in clinical and public health research on HIV in prison and jail settings are considered. Ethical considerations in mental health research are summarized as well as issues pertaining to research involving female inmates. Issues related to oversight of research involving incarcerated people are considered along with the ethics of public health research. The ethics of research involving incarcerated people extends beyond traditional issues in human subjects ethics to include issues within the domains of bioethics and public health ethics.

Journal of Patient-Centered Research and Reviews
Volume 3, Issue 2 (2016)
http://digitalrepository.aurorahealthcare.org/jpcrr/

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Topic Synopsis
Is 13-Valent Pneumococcal Conjugate Vaccine (PCV13) Combined With 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23) Superior to PPSV23 Alone for Reducing Incidence or Severity of Pneumonia in Older Adults? A Clin-IQ
Starla Hayward, Lou Ann Thompson, and Andrea McEachern

Journal of Public Health Policy
Volume 37, Issue 2 (May 2016)
http://www.palgrave-journals.com/jphp/journal/v37/n2/index.html

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Editorial
How to understand the results of the climate change summit: Conference of Parties21 (COP21) Paris 2015 FREE
Our Co-Editor reports on developments from Paris, where he joined 40,000 people in November at the Summit at Le Bourget
Anthony Robbins
J Public Health Pol 37: 129-132; advance online publication, January 7, 2016; doi:10.1057/jphp.2015.47

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Viewpoints
Zika virus: An international emergency? FREE
A distinguished Mexican researcher anguishes about next steps to control this epidemic and its frightening consequences
Adolfo Martinez Palomo
J Public Health Pol 37: 133-135; advance online publication, February 25, 2016; doi:10.1057/jphp.2016.11
Abstract
This Viewpoint discusses the World Health Organization’s Declaration on 1 February 2016 that the epidemic infection caused by the Zika virus is a public health emergency of international concern – the basis of the decision and controversy surrounding it.

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Viewpoints
Unhealthy marketing of pharmaceutical products: An international public health concern
Shai Mulinari
J Public Health Pol 37: 149-159; advance online publication, February 25, 2016; doi:10.1057/jphp.2016.6
Abstract
I consider the current state of pharmaceutical marketing vis-à-vis ethical and legal standards and advocate measures to improve it. There is abundant evidence of unethical or illicit marketing. It fuels growing concerns about undue corporate influence over pharmaceutical research, education, and consumption. The most extensive evidence of industry transgressions comes from the United States (US), where whistle-blowers are encouraged by financial rewards to help uncover illicit marketing and fraud. Outside the US increasing evidence of transgressions exists. Recently I have observed a range of new measures to align pharmaceutical marketing practices with ethical and legal standards. In the interest of public health, I highlight the need for additional and more profound reforms to ensure that information about medicines supports quality and resource-efficient care

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Original Articles
Misconceptions about Ebola virus disease among lay people in Guinea: Lessons for community education
Lonzozou Kpanake, Komlantsè Gossou, Paul Clay Sorum, and Etienne Mullet
J Public Health Pol 37: 160-172; advance online publication, February 11, 2016; doi:10.1057/jphp.2016.1
Abstract
To characterize the perception of Ebola virus disease (EVD) in Guinea, we administered, from November 2014 to February 2015, a questionnaire to a convenience sample of 200 lay people in Conakry and a group of 8 physicians. We found widespread misconceptions among lay people, including that praying to God can protect against EVD, that traditional healers are more competent than physicians in treating EVD, that people get infected through physical proximity without contact, that the Ebola epidemic is the result of Western bioterrorism experiments, that Western medical staff disseminated the virus, and that the purpose of quarantine measures is to hasten the death of Ebola patients. Major educational interventions, sensitive to local cultural beliefs, are needed to overcome the misconceptions about Ebola in Guinea.

Journal of the Royal Society – Interface
01 April 2016; volume 13, issue 117
http://rsif.royalsocietypublishing.org/content/current

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Life Sciences–Mathematics interface
Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination
Amy Wesolowski, Keitly Mensah, Cara E. Brook, Miora Andrianjafimasy, Amy Winter, Caroline O. Buckee, Richter Razafindratsimandresy, Andrew J. Tatem, Jean-Michel Heraud, C. Jessica E. Metcalf
J. R. Soc. Interface 2016 13 20151101; DOI: 10.1098/rsif.2015.1101. Published 27 April 2016
Abstract
Few countries in Africa currently include rubella-containing vaccination (RCV) in their immunization schedule. The Global Alliance for Vaccines Initiative (GAVI) recently opened a funding window that has motivated more widespread roll-out of RCV. As countries plan RCV introductions, an understanding of the existing burden, spatial patterns of vaccine coverage, and the impact of patterns of local extinction and reintroduction for rubella will be critical to developing effective programmes. As one of the first countries proposing RCV introduction in part with GAVI funding, Madagascar provides a powerful and timely case study. We analyse serological data from measles surveillance systems to characterize the epidemiology of rubella in Madagascar. Combining these results with data on measles vaccination delivery, we develop an age-structured model to simulate rubella vaccination scenarios and evaluate the dynamics of rubella and the burden of congenital rubella syndrome (CRS) across Madagascar. We additionally evaluate the drivers of spatial heterogeneity in age of infection to identify focal locations where vaccine surveillance should be strengthened and where challenges to successful vaccination introduction are expected. Our analyses indicate that characteristics of rubella in Madagascar are in line with global observations, with an average age of infection near 7 years, and an impact of frequent local extinction with reintroductions causing localized epidemics. Modelling results indicate that introduction of RCV into the routine programme alone may initially decrease rubella incidence but then result in cumulative increases in the burden of CRS in some regions (and transient increases in this burden in many regions). Deployment of RCV with regular supplementary campaigns will mitigate these outcomes. Results suggest that introduction of RCV offers a potential for elimination of rubella in Madagascar, but also emphasize both that targeted vaccination is likely to be a lynchpin of this success, and the public health vigilance that this introduction will require.

The Lancet
Apr 30, 2016 Volume 387 Number 10030 p1789-1878 e25
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
The next Director-General of WHO
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(16)30358-0
Summary
WHO last week fired a starting pistol to launch the election for its next Director-General. The final vote does not take place until May, 2017. Procedures have been substantially revised since 2012, when Margaret Chan was elected to serve a second term. It is likely that this lengthy process will therefore be more transparent, accountable, and disputatious (and considerably less corrupt) than past elections.

[Excerpt]
…The deadline for member states to nominate candidates is Sept 22. Several prominent individuals have already disclosed their intentions to stand. Philippe Douste-Blazy served two terms as France’s Minister of Health and subsequently became Foreign Minister. He has been a leader on innovative financing for health and has chaired UNITAID since 2006. Tedros Adhanom Ghebreyesus is currently Ethiopia’s Minister of Foreign Affairs. He was Minister of Health from 2005–12. The African Union has endorsed him as the sole African candidate for Director-General. Sania Nishtar, Pakistan’s former Minister of Health (among several other government portfolios), has had a distinguished career as a civil society leader. She founded the influential non-governmental organisation Heartfile in 1999. All three candidates are highly accomplished global health leaders, which bodes well for the future of WHO…

New England Journal of Medicine
April 28, 2016 Vol. 374 No. 17
http://www.nejm.org/toc/nejm/medical-journal

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Original Article
Phase 1 Trials of rVSV Ebola Vaccine in Africa and Europe
Selidji T. Agnandji, M.D., Angela Huttner, M.D., Madeleine E. Zinser, M.D., Patricia Njuguna, M.Med., Christine Dahlke, Ph.D., José F. Fernandes, M.D., Sabine Yerly, M.Sc., Julie-Anne Dayer, M.D., Verena Kraehling, Ph.D., Rahel Kasonta, Ph.D., Akim A. Adegnika, M.D., Ph.D., Marcus Altfeld, M.D., Ph.D., Floriane Auderset, Ph.D., Emmanuel B. Bache, M.Sc., Nadine Biedenkopf, Ph.D., Saskia Borregaard, Ph.D., Jessica S. Brosnahan, M.H.Sc., Rebekah Burrow, B.Sc., Christophe Combescure, Ph.D., Jules Desmeules, M.D., Markus Eickmann, Ph.D., Sarah K. Fehling, Ph.D., Axel Finckh, M.D., Ana Rita Goncalves, Ph.D., Martin P. Grobusch, M.D., Ph.D., Jay Hooper, Ph.D., Alen Jambrecina, M.D., Anita L. Kabwende, M.D., Gürkan Kaya, M.D., Ph.D., Domtila Kimani, B.Sc., Bertrand Lell, M.D., Barbara Lemaître, M.Sc., Ansgar W. Lohse, M.D., Marguerite Massinga-Loembe, Ph.D., Alain Matthey, M.D., Benjamin Mordmüller, M.D., Anne Nolting, M.D., Caroline Ogwang, M.B., Ch.B., Michael Ramharter, M.D., Jonas Schmidt-Chanasit, M.D., Stefan Schmiedel, M.D., Peter Silvera, Ph.D., Felix R. Stahl, M.D., Ph.D., Henry M. Staines, D.Phil., Thomas Strecker, Ph.D., Hans C. Stubbe, M.D., Benjamin Tsofa, Ph.D., Sherif Zaki, M.D., Ph.D., Patricia Fast, M.D., Ph.D., Vasee Moorthy, Ph.D., Laurent Kaiser, M.D., Sanjeev Krishna, Sc.D., Stephan Becker, Ph.D., Marie-Paule Kieny, Ph.D., Philip Bejon, Ph.D., Peter G. Kremsner, M.D., Marylyn M. Addo, M.D., Ph.D., and Claire-Anne Siegrist, M.D.*
N Engl J Med 2016; 374:1647-1660 April 28, 2016 DOI: 10.1056/NEJMoa1502924

Abstract
Background
The replication-competent recombinant vesicular stomatitis virus (rVSV)–based vaccine expressing a Zaire ebolavirus (ZEBOV) glycoprotein was selected for rapid safety and immunogenicity testing before its use in West Africa.
Methods
We performed three open-label, dose-escalation phase 1 trials and one randomized, double-blind, controlled phase 1 trial to assess the safety, side-effect profile, and immunogenicity of rVSV-ZEBOV at various doses in 158 healthy adults in Europe and Africa. All participants were injected with doses of vaccine ranging from 300,000 to 50 million plaque-forming units (PFU) or placebo.
Results
No serious vaccine-related adverse events were reported. Mild-to-moderate early-onset reactogenicity was frequent but transient (median, 1 day). Fever was observed in up to 30% of vaccinees. Vaccine viremia was detected within 3 days in 123 of the 130 participants (95%) receiving 3 million PFU or more; rVSV was not detected in saliva or urine. In the second week after injection, arthritis affecting one to four joints developed in 11 of 51 participants (22%) in Geneva, with pain lasting a median of 8 days (interquartile range, 4 to 87); 2 self-limited cases occurred in 60 participants (3%) in Hamburg, Germany, and Kilifi, Kenya. The virus was identified in one synovial-fluid aspirate and in skin vesicles of 2 other vaccinees, showing peripheral viral replication in the second week after immunization. ZEBOV-glycoprotein–specific antibody responses were detected in all the participants, with similar glycoprotein-binding antibody titers but significantly higher neutralizing antibody titers at higher doses. Glycoprotein-binding antibody titers were sustained through 180 days in all participants.
Conclusions
In these studies, rVSV-ZEBOV was reactogenic but immunogenic after a single dose and warrants further evaluation for safety and efficacy. (Funded by the Wellcome Trust and others; ClinicalTrials.gov numbers, NCT02283099, NCT02287480, and NCT02296983; Pan African Clinical Trials Registry number, PACTR201411000919191.)

New England Journal of Medicine
April 28, 2016 Vol. 374 No. 17
http://www.nejm.org/toc/nejm/medical-journal
Original Article
A Monovalent Chimpanzee Adenovirus Ebola Vaccine Boosted with MVA
Katie Ewer, Ph.D., Tommy Rampling, M.R.C.P., Navin Venkatraman, M.R.C.P., Georgina Bowyer, B.A., Danny Wright, M.Sc., Teresa Lambe, Ph.D., Egeruan B. Imoukhuede, M.D., Ruth Payne, M.R.C.P., Sarah Katharina Fehling, Ph.D., Thomas Strecker, Ph.D., Nadine Biedenkopf, Ph.D., Verena Krähling, Ph.D., Claire M. Tully, B.A., Nick J. Edwards, B.Sc., Emma M. Bentley, B.Sc., Dhanraj Samuel, Ph.D., Geneviève Labbé, Ph.D., Jing Jin, Ph.D., Malick Gibani, M.R.C.P., Alice Minhinnick, M.B., Ch.B., Morven Wilkie, M.R.C.P., Ian Poulton, Dip.H.E., Natalie Lella, B.A., Rachel Roberts, M.Sc., Felicity Hartnell, M.B., B.S., Carly Bliss, B.A., Kailan Sierra-Davidson, B.A., Jonathan Powlson, B.Sc., Eleanor Berrie, Ph.D., Richard Tedder, M.B., B.Chir., Francois Roman, M.D., Iris De Ryck, Ph.D., Alfredo Nicosia, Ph.D., Nancy J. Sullivan, Ph.D., Daphne A. Stanley, M.S., Olivier T. Mbaya, M.D., Julie E. Ledgerwood, D.O., Richard M. Schwartz, Ph.D., Loredana Siani, Ph.D., Stefano Colloca, Ph.D., Antonella Folgori, Ph.D., Stefania Di Marco, Ph.D., Riccardo Cortese, M.D., Edward Wright, Ph.D., Stephan Becker, Ph.D., Barney S. Graham, M.D., Richard A. Koup, M.D., Myron M. Levine, M.D., Ariane Volkmann, Ph.D., Paul Chaplin, Ph.D., Andrew J. Pollard, Ph.D., Simon J. Draper, D.Phil., W. Ripley Ballou, M.D., Alison Lawrie, Ph.D., Sarah C. Gilbert, Ph.D., and Adrian V.S. Hill, D.M.
N Engl J Med 2016; 374:1635-1646 April 28, 2016 DOI: 10.1056/NEJMoa1411627

Abstract
Background
The West African outbreak of Ebola virus disease that peaked in 2014 has caused more than 11,000 deaths. The development of an effective Ebola vaccine is a priority for control of a future outbreak.
Methods
In this phase 1 study, we administered a single dose of the chimpanzee adenovirus 3 (ChAd3) vaccine encoding the surface glycoprotein of Zaire ebolavirus (ZEBOV) to 60 healthy adult volunteers in Oxford, United Kingdom. The vaccine was administered in three dose levels — 1×1010 viral particles, 2.5×1010 viral particles, and 5×1010 viral particles — with 20 participants in each group. We then assessed the effect of adding a booster dose of a modified vaccinia Ankara (MVA) strain, encoding the same Ebola virus glycoprotein, in 30 of the 60 participants and evaluated a reduced prime–boost interval in another 16 participants. We also compared antibody responses to inactivated whole Ebola virus virions and neutralizing antibody activity with those observed in phase 1 studies of a recombinant vesicular stomatitis virus–based vaccine expressing a ZEBOV glycoprotein (rVSV-ZEBOV) to determine relative potency and assess durability.
Results
No safety concerns were identified at any of the dose levels studied. Four weeks after immunization with the ChAd3 vaccine, ZEBOV-specific antibody responses were similar to those induced by rVSV-ZEBOV vaccination, with a geometric mean titer of 752 and 921, respectively. ZEBOV neutralization activity was also similar with the two vaccines (geometric mean titer, 14.9 and 22.2, respectively). Boosting with the MVA vector increased virus-specific antibodies by a factor of 12 (geometric mean titer, 9007) and increased glycoprotein-specific CD8+ T cells by a factor of 5. Significant increases in neutralizing antibodies were seen after boosting in all 30 participants (geometric mean titer, 139; P<0.001). Virus-specific antibody responses in participants primed with ChAd3 remained positive 6 months after vaccination (geometric mean titer, 758) but were significantly higher in those who had received the MVA booster (geometric mean titer, 1750; P<0.001).
Conclusions
The ChAd3 vaccine boosted with MVA elicited B-cell and T-cell immune responses to ZEBOV that were superior to those induced by the ChAd3 vaccine alone. (Funded by the Wellcome Trust and others; ClinicalTrials.gov number, NCT02240875.)

Science Translational Medicine
27 April 2016 Vol 8, Issue 336
http://stm.sciencemag.org/

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Editorial
An incentive-based approach for improving data reproducibility
By Michael Rosenblatt
Science Translational Medicine27 Apr 2016 : 336ed5
A scientist who has worked in both academia and industry offers an incentive-based and nonprescriptive proposal to reduce data irreproducibility.

Vaccine
Volume 34, Issue 22, Pages 2467-2526 (11 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/22
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Regular papers
Cost-effectiveness of an influenza vaccination program offering intramuscular and intradermal vaccines versus intramuscular vaccine alone for elderly
Original Research Article
Pages 2469-2476
Man-Kit Leung, Joyce H.S. You
Abstract
Background
Intradermal (ID) injection is an alternative route for influenza vaccine administration in elderly with potential improvement of vaccine coverage. This study aimed to investigate the cost-effectiveness of an influenza vaccination program offering ID vaccine to elderly who had declined intramuscular (IM) vaccine from the perspective of Hong Kong public healthcare provider.
Methods
A decision analytic model was used to simulate outcomes of two programs: IM vaccine alone (IM program), and IM or ID vaccine (IM/ID program) in a hypothetic cohort of elderly aged 65 years. Outcome measures included influenza-related direct medical cost, infection rate, mortality rate, quality-adjusted life years (QALYs) loss, and incremental cost per QALY saved (ICER). Model inputs were derived from literature. Sensitivity analyses evaluated the impact of uncertainty of model variables.
Results
In base-case analysis, the IM/ID program was more costly (USD52.82 versus USD47.59 per individual to whom vaccine was offered) with lower influenza infection rate (8.71% versus 9.65%), mortality rate (0.021% versus 0.024%) and QALYs loss (0.00336 versus 0.00372) than the IM program. ICER of IM/ID program was USD14,528 per QALY saved. One-way sensitivity analysis found ICER of IM/ID program to exceed willingness-to-pay threshold (USD39,933) when probability of influenza infection in unvaccinated elderly decreased from 10.6% to 5.4%. In 10,000 Monte Carlo simulations of elderly populations of Hong Kong, the IM/ID program was the preferred option in 94.7% of time.
Conclusions
An influenza vaccination program offering ID vaccine to elderly who had declined IM vaccine appears to be a highly cost-effective option.

Vaccine
Volume 34, Issue 22, Pages 2467-2526 (11 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/22
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Stability of live attenuated rotavirus vaccine with selected preservatives and primary containers
Original Research Article
Pages 2483-2489
Manjari Lal, Courtney Jarrahian, Changcheng Zhu, Nancy A. Hosken, Chris L. McClurkan, David M. Koelle, Eugene Saxon, Andrew Roehrig, Darin Zehrung, Dexiang Chen
Abstract
Rotavirus infection, which can be prevented by vaccination, is responsible for a high burden of acute gastroenteritis disease in children, especially in low-income countries. An appropriate formulation, packaging, and delivery device for oral rotavirus vaccine has the potential to reduce the manufacturing cost of the vaccine and the logistical impact associated with introduction of a new vaccine, simplify the vaccination procedure, and ensure that the vaccine is safely and accurately delivered to children. Single-dose prefilled presentations can be easy to use; however, they are typically more expensive, can be a bottleneck during production, and occupy a greater volume per dose vis-à-vis supply chain storage and medical waste disposal, which is a challenge in low-resource settings. Multi-dose presentations used thus far have other issues, including increased wastage of vaccine and the need for separate delivery devices. In this study, the goals were to evaluate both the technical feasibility of using preservatives to develop a liquid multi-dose formulation and the primary packaging alternatives for orally delivered, liquid rotavirus vaccines. The feasibility evaluation included evaluation of commonly used preservatives for compatibility with rotavirus vaccines and stability testing of rotavirus vaccine in various primary containers, including Lameplast’s plastic tubes, BD’s oral dispenser version of Uniject™ (Uniject DP), rommelag’s blow-fill-seal containers, and MEDInstill’s multi-dose vial and pouch. These presentations were compared to a standard glass vial. The results showed that none of the preservatives tested were compatible with a live attenuated rotavirus vaccine because they had a detrimental effect on the viability of the virus. In the presence of preservatives, vaccine virus titers declined to undetectable levels within 1 month. The vaccine formulation without preservatives maintained a stability profile over 12 months in all primary containers that was similar to its profile in standard glass vials. This study demonstrates that there are multiple options for the primary container for rotavirus vaccines intended for oral delivery. Selection of an optimal primary container should take into consideration additional factors, including stability as well as cold chain volume, usability, cost, and manufacturing feasibility.

Vaccine
Volume 34, Issue 22, Pages 2467-2526 (11 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/22
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HPV vaccine uptake among overweight and obese US adolescents: An analysis of the National Health and Nutrition Examination Survey (NHANES) 2009–2014
Original Research Article
Pages 2501-2506
Maria E. Sundaram, Susan M. Mason, Nicole E. Basta
Abstract
Background
Human papillomavirus (HPV) vaccine uptake in the US is suboptimal; identifying risk factors associated with low vaccine uptake is critical to increase vaccination coverage. Some evidence suggests body mass index (BMI) is associated with low HPV vaccine uptake and increased risk of HPV infection in adults. BMI may therefore be an important factor in targeting HPV vaccine to US adolescents.
Methods
We investigated the relationship between BMI categories (underweight, normal weight, overweight and obese) and HPV vaccine uptake in 4109 adolescents (9–18 years old) using data from the 2009 to 2014 National Health and Nutrition Examination Survey (NHANES). We used modified Poisson regression to assess the relationship between BMI and receipt of at least one HPV vaccine, and BMI and completion of the vaccine three-dose series. We assessed the relationship between BMI and age at first HPV vaccination using linear regression.
Results
Receipt of at least one dose of HPV vaccine was low in both females (35%) and males (10%). High BMI was not associated with initiation of the HPV vaccine series, age at first HPV vaccination, or completion of the HPV vaccine three-dose course.
Conclusions
We found no evidence that high BMI is associated with reduced initiation or completion of the HPV vaccination series, or age at initiation of the three-dose course among a general population sample of US adolescents. Our results suggest that efforts to increase HPV vaccine uptake need not consider targeting by weight status at this time.

Vaccine
Volume 34, Issue 22, Pages 2467-2526 (11 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/22
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The effect of diarrheal disease on bivalent oral polio vaccine (bOPV) immune response in infants in Nepal
Original Research Article
Pages 2519-2526
Cristina V. Cardemil, Concepcion Estivariz, Laxman Shrestha, Jeevan B. Sherchand, Arun Sharma, Howard E. Gary Jr., M. Steven Oberste, William C. Weldon III, Michael D. Bowen, Jan Vinjé, W. William Schluter, Abhijeet Anand, Ondrej Mach, Susan Y. Chu
Abstract
Background
A globally-coordinated phase out of all type 2 containing oral polio vaccine (OPV) is planned for April 2016 during which bivalent 1 + 3 OPV (bOPV) will replace trivalent OPV (tOPV) in routine immunization schedules and campaigns. Diarrhea impairs the immune response to tOPV, but the effect of diarrhea on bOPV is unknown.
Methods
Infants aged 6 weeks to 11 months, who had received 5 loose stools per day (OR = 0.36, 95% CI 0.21–0.62).
Conclusions
Diarrhea reduced the immune response to bOPV. Provision of additional doses of polio vaccine is necessary to maintain high population immunity in areas with high prevalence of diarrheal disease.
Clinical trial registry
This study is registered at clinicaltrials.gov as NCT01559636.

Vaccine
Volume 34, Issue 21, Pages 2403-2466 (5 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/21

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Review
Hepatitis B control among children in the Eastern Mediterranean Region of the World Health Organization
Review Article
Pages 2403-2409
Robert D. Allison, Nadia Teleb, Salah Al Awaidy, Hossam Ashmony, James P. Alexander, Minal K. Patel
Abstract
In the pre-vaccination era, the prevalence of chronic hepatitis B virus (HBV) infection in the World Health Organization (WHO) Eastern Mediterranean Region (EMR) ranged from two to seven percent in a total population of over 580 million people. Mortality estimates place cirrhosis among the top ten causes of years of life lost in the EMR. The region has made notable achievements, improving coverage from only 6% in 1992, when WHO recommended hepatitis B vaccination of all infants, to 83% in 2014. Member states adopted a hepatitis B control target in 2009 to reduce chronic hepatitis B virus infection prevalence to less than one percent among children aged