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

Vaccine
Volume 34, Issue 21, Pages 2403-2466 (5 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/21
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Can the vaccine adverse event reporting system be used to increase vaccine acceptance and trust?
Original Research Article
Pages 2424-2429
Laura D. Scherer, Victoria A. Shaffer, Niraj Patel, Brian J. Zikmund-Fisher
Abstract
Vaccine refusal has an impact on public health, and the human pappillomavirus (HPV) vaccine is particularly underutilized. Research suggests that it may be difficult to change vaccine-related attitudes, and there is currently no good evidence to recommend any particular intervention strategy. One reason for vaccine hesitancy is lack of trust that vaccine harms are adequately documented and reported, yet few communication strategies have explicitly attempted to improve this trust. This study tested the possibility that data from the vaccine adverse event reporting system (VAERS) can be used to increase trust that vaccine harms are adequately researched and that potential harms are disclosed to the public, and thereby improve perceptions of vaccines. In the study, participants were randomly assigned to one of three communication interventions. All participants read the Centers for Disease Control (CDC) vaccine information statement (VIS) for the HPV vaccine. Two other groups were exposed to additional information about VAERS, either summary data or full detailed reports of serious adverse events from 2013. Results showed that the CDC’s VIS alone significantly increased perceptions of vaccine benefits and decreased perceived risks. Participants who were also educated about VAERS and given summary data about the serious adverse events displayed more trust in the CDC and greater HPV vaccine acceptance relative to the VIS alone. However, exposure to the detailed VAERS reports significantly reduced trust in the CDC and vaccine acceptance. Hence, general information about the VAERS data slightly increased trust in the CDC and improved vaccine acceptance, but the specific VAERS reports negatively influenced both trust and acceptance. Implications for communicating about vaccines are discussed.

Vaccine
Volume 34, Issue 21, Pages 2403-2466 (5 May 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/21
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SMS text message reminders to improve infant vaccination coverage in Guatemala: A pilot randomized controlled trial
Original Research Article
Pages 2437-2443
Gretchen J. Domek, Ingrid L. Contreras-Roldan, Sean T. O’Leary, Sheana Bull, Anna Furniss, Allison Kempe, Edwin J. Asturias
Abstract
Background
Patient reminder systems are an evidence-based way to improve childhood vaccination rates but are difficult to implement in low- and middle-income countries (LMICs). Short Message Service (SMS) texts may offer a potential low-cost solution, especially in LMICs where mobile phones are becoming more ubiquitous.
Objective
To determine if an SMS-based vaccination reminder system aimed at improving completion of the infant primary immunization series is feasible and acceptable in Guatemala.
Methods
A pilot randomized controlled trial was conducted at two public health clinics in Guatemala City. Infants aged 8–14 weeks presenting for the first dose of the primary immunization series were enrolled in March–April 2013. Participants randomized into the intervention received three SMS reminders one week before the second and third dose. A follow-up acceptability survey was administered to both groups.
Results
The participation rate was 86.8% (321/370); 8 did not own a cell phone and 12 could not use SMS. 96.9% of intervention parents were sent at least one SMS reminder prior to visit 2 and 96.3% prior to visit 3. Both intervention and usual care participants had high rates of vaccine and visit completion, with a non-statistically significant higher percentage of children in the intervention completing both visit 2 (95.0% vs. 90.1%, p = .12) and visit 3 (84.4% vs. 80.7%, p = .69). More intervention vs. usual care parents agreed that SMS reminders would be helpful for remembering appointments (p < .0001), agreed to being interested in receiving future SMS reminders (p < .0001), and said that they would be willing to pay for future SMS reminders (p = .01).
Conclusion
This proof of concept evaluation showed that a new application of SMS technology is feasible to implement in a LMIC with high user satisfaction. Larger studies with modifications in the SMS system are needed to determine effectiveness (Clinical Trial Registry NCT01663636).

American Journal of Men’s Health
2016 Apr 22. pii: 1557988316645155. [Epub ahead of print]
Factors Associated With HPV Vaccine Initiation, Vaccine Completion, and Accuracy of Self-Reported Vaccination Status Among 13-to 26-Year-Old Men.
Thomas R1, Higgins L2, Ding L3, Widdice LE3, Chandler E3, Kahn JA4.
Abstract
Human papillomavirus (HPV) vaccination coverage in young men is suboptimal. The aims of this study were (a) to examine HPV vaccination and factors associated with HPV vaccination in men 13 to 26 years of age and (b) to examine and determine factors associated with accurate self-report of vaccination. Young men (n = 400) recruited from a teen health center and a sexually transmitted disease (STD) clinic completed a survey. Accuracy was defined as correct report of at least one dose and number of doses. Mean age was 21.5 years, 104 (26.0%) received at least one vaccine dose and 49 (12.3%) received all three doses. Factors significantly associated with receipt of at least one dose in multivariable models included recruitment site (teen health center vs. STD clinic, adjusted odds ratio [AOR] = 2.75), public versus other insurance (AOR = 2.12), and age (AOR = 0.68). Most young men accurately reported their vaccination status but accuracy of report differed by age: 50.6% of 14- to 18-year-olds, 75.9% of 19- to 21-year-olds, and 93.2% of 22- to 26-year-olds. Most (293, 73.3%) accurately reported number of doses received. Age was associated with accuracy of self-report of at least one vaccine dose (AOR = 1.42), while recruitment site (STD vs. teen health center, AOR = 2.56) and age (AOR = 1.44) were associated with accuracy of self-report of number of vaccine doses. In conclusion, HPV initiation and completion in this study sample were low. Teen health center attendance, public insurance, and younger age were associated with vaccine initiation; older age and STD clinic setting were associated with accurate vaccination self-report.

Neurology
April 21, 2016
Association Between Influenza Vaccination and Development of Guillain-Barré Syndrome in Adults: A Vaccine Safety Datalink (VSD) and Vaccine Adverse Event Reporting System (VAERS) Study (S53.007)
Francisco Gomez2, Mohammad El-Ghanem4, Abu Nasar1 and Nizar Souayah3
Abstract
Objective: To investigate whether there is correlation between Guillain-Barré Syndrome (GBS) and influenza vaccination in adults, utilizing Vaccine Adverse Event Reporting System (VAERS), and vaccine safety datalink (VSD) databases Background: There are reports of GBS after influenza vaccination, efforts have been undertaken to find a link between the two Methods: Data from VAERS and VSD were used during 1991-2000 time period. Two approaches utilized: self-controlled case series and case-centered. Six weeks after vaccination was defined as the risk period of possible cause effect between vaccination and GBS. Results: There were 69 VSD and 62 VAERS GBS cases after vaccination. VSD mean age was 65.9±12.07 and VAERS 55.83±15.4 years. Male distribution in VSD and VAERS was 64[percnt] and 53[percnt] respectively (p0.221) The incidence of GBS after vaccination in the VSD population was 2/100,000 Using case centered analysis, there was no significant difference between the risk and control periods in the VSD database ( 10[percnt] vs 8.5[percnt] p0.771). Similar results were observed with self-controlled case design. However in VAERS most cases were reported within the risk period. (96.5[percnt] vs 3.5[percnt] p< 0.001). Conclusions: There was no significant increase in incidence of GBS after influenza vaccination in the risk period compared to the control period or the general population in the VSD database. There is a significant difference in the distribution of GBS cases between VSD and VAERS. Several factors may explain this discrepancy: VSD is an active surveillance system whereas VAERS is a passive surveillance system, case ascertainment was different between databases and no case in VAERS fulfilled Brighton criteria, all VSD, but not VAERS patients belong to one health care system, and acute event close to the vaccination date are more reported than events occurring late after vaccination.

Clinical Microbiology and Infection
Available online 26 April 2016
Potential safety issues and other factors that may affect the introduction and uptake of rotavirus vaccines
N Aliabadi, JE Tate, UD Parashar
Summary
Rotavirus vaccines have demonstrated significant impact in reducing the burden of morbidity and mortality from childhood diarrhea in countries that have implemented routine vaccination to date. Despite this success, in many countries, rotavirus vaccine coverage remains lower than that of other routine childhood vaccines. Several issues may potentially affect vaccine uptake, namely safety concerns related to intussusception with consequent age restrictions on rotavirus vaccination, contamination with porcine circovirus, vaccine-derived reassortant strains, and hospitalization in newborn nurseries at time of administration of live, oral rotavirus vaccine. In addition to these safety concerns, other factors may also affect uptake, including lower vaccine efficacy in the developing world, potential emergence of strains escaping from vaccine protection resulting in lower overall impact of a vaccination program, and sustainable vaccine financing. Although further work is needed to address some of these concerns, global policy bodies have reaffirmed that the benefits of rotavirus vaccination outweigh the risks and vaccine use is recommended globally.

Health Education
Vol. 116, Issue 4, 2016
Intention of college students to receive the human papillomavirus vaccine
K Richards, K Weare –
Abstract:
Purpose
The current study set out to better understand what influences the intentions of college students to receive the human papillomavirus (HPV) vaccine. HPV is the most common sexually transmitted infection in the U.S. and cancers related to HPV are on the rise.
Design/methodology/approach
A 2×2 experimental design was used to predict the intentions. Messages were created that manipulated the level of severity and vulnerability to determine which would increase intentions to receive the HPV vaccine. Each of the 278 participants viewed a message that contained one severity message (high or low) and one vulnerability message (high or low).
Findings
Regression was used to determine that elements of the protection motivation theory (PMT) such as vulnerability and fear, along with norms, and information seeking explained a significant portion of the variance in intent to be vaccinated (R2=.40, F(4,268)=44.47, p<.001). Norms had the most influence on intention (β = .42, p<.001), next was vulnerability (β = .21, p<.001) then fear (β = .16, p=.002), and finally information seeking (β = .10, p=.01).
Originality/value
The current college age population did not have the opportunity to be vaccinated early and the recent (2011) recommendation that males get vaccinated makes this research valuable to those designing vaccination messages. The current study shows that norms were the most influential variable in regards to increasing intent to get vaccinated.

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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Huffington Post
http://www.huffingtonpost.com/impact/
Accessed 30 April 2016
Vaccines: A Global Health Success Story That Keeps Us On Our Toes
| 26 April 2016
by Flavia Bustreo, WHO ADG and Vice Chair of Gavi, and Marie-Paule Kieny, WHO ADG , Health Systems and Innovation
Suspense and high stakes
It’s no secret that vaccines are considered one of the greatest global health achievements. Every year they avert an estimated 2 to 3 million deaths.

During the last two centuries, vaccines have eradicated smallpox, reduced global child mortality rates, and prevented countless birth defects and lifelong disabilities, such as paralysis from polio.
But, the success story of vaccination is not yet finished.

There’s still a book waiting to be written that’s guaranteed to keep all of us, not just global health experts, up at night. Fortunately, many of the chapters full of suspense, high stakes and perseverance are being written right now…
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New York Times
http://www.nytimes.com/
Accessed 30 April 2016
6 Measles Cases Reported in Memphis Area, Exceeding Rest of U.S.
April 27, 2016 – By DANIEL VICTOR and CATHERINE SAINT LOUIS
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TIME
http://time.com/
Accessed 30 April 2016
Historic Global Vaccine Rollout Could End Polio Forever
27 April 2016
by Walter Orenstein, Associate Director of the Emory Vaccine Center
‘Never before in the history of vaccines have we collaborated on this scale, this quickly’
Let’s start simple: Imagine you need to vaccinate a child against a terrible disease. You acquire and administer the correct dosage to protect that child from a debilitating virus. Now, imagine doing that across a whole city. You train health workers, distribute the vaccine to every health facility, explain the process to parents and monitor closely to make sure all children in the city are being reached. Now, do it for a whole district. A whole country. 155 countries. Do all of that in just two weeks. It’s happening right now, all around the world. Between April 17 and May 1, health workers, governments and communities are working together to execute the largest, fastest effort in history to rollout a vaccine in routine immunization systems, as one of the final steps to end polio forever…
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Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 30 April 2016
Advocates hold NYC protest over price of pneumonia vaccine
April 27, 2016 1:26 pm ET
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Washington Post
http://www.washingtonpost.com/
Accessed 30 April 2016
Congress heads out with no resolution on Zika, Puerto Rico
Congress accomplished relatively little in a short work period, missing deadlines on the budget and on helping Puerto Rico with its financial crisis as lawmakers began a weeklong break.
Andrew Taylor | AP | Business | Apr 30, 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_23 April 2016

– blog edition: comprised of the approx. 35+ entries posted below on 24 April 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

World Immunization Week 2016: Close the immunization gap
21 April 2016 | Geneva – During World Immunization Week 2016, held 24-30 April, WHO highlights recent gains in immunization coverage, and outlines further steps countries can take to “Close the Immunization Gap” and meet global vaccination targets by 2020.

“Last year immunization led to some notable wins in the fight against polio, rubella and maternal and neonatal tetanus,” says Dr Margaret Chan, WHO Director-General. “But they were isolated wins. Polio was eliminated in 1 country, tetanus in 3, and rubella in 1 geographical region. The challenge now is to make gains like this the norm.”

Immunization averts 2 to 3 million deaths annually; however, an additional 1.5 million deaths could be avoided if global vaccination coverage improves. Today, an estimated 18.7 million infants – nearly 1 in 5 children – worldwide are still missing routine immunizations for preventable diseases, such as diphtheria, pertussis and tetanus…

Zika virus [to 23 April 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

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Zika situation report
14 April 2016
Zika virus, Microcephaly and Guillain-Barré syndrome
Read the full situation report
Summary
:: From 1 January 2007 to 20 April 2016, Zika virus transmission was documented in a total of 66 countries and territories.

:: 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.
>> 17 countries have reported evidence of Zika virus transmission prior to 2015, with or without ongoing transmission or have reported an outbreak since 2015 that is now over.

:: Person-to-person transmission:
>> Eight countries have now reported evidence of person-to-person transmission of Zika virus, other than mosquito-borne transmission (Argentina, Chile, France, Italy, New Zealand, Peru, Portugal and the United States of America).

:: In the week to 20 April, no additional countries have reported mosquito-borne Zika virus transmission. Peru and Portugal are the latest countries 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 (Brazil, Cabo Verde, Colombia, French Polynesia, Martinique and Panama). Two cases, each linked to a stay in Brazil, were detected in Slovenia and the United States of America. A further case, linked to a brief stay in Mexico, Guatemala and Belize, was detected in a pregnant woman in the United States of America.

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Disease Outbreak News (DONs)
:: 22 April 2016 Zika virus infection – Papua New Guinea
:: 21 April 2016 Zika virus infection – Peru
:: 20 April 2016 Zika virus infection – Saint Lucia

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Zika Open [to 23 April 2016]
[Bulletin of the World Health Organization]
:: All papers available here New papers below:
Analysis of the genetic divergence in Asian strains of ZIKA virus with reference to 2015-2016 outbreaks
– Jatin Shrinet, Aditi Agrawal, Raj K Bhatnagar & Sujatha Sunil
Posted: 22 April 2016
http://dx.doi.org/10.2471/BLT.16.176065
pdf, 2.38Mb

Clinical comparison, standardization and optimization of Zika virus molecular detection
– Victor M. Corman, Andrea Rasche, Cecile Baronti, Souhaib Aldabbagh, Daniel Cadar, Chantal B.E.M. Reusken, Suzan D. Pas, Abraham Goorhuis, Janke Schinkel, Richard Molenkamp, Beate M. Kuemmerer, Tobias Bleicker, Sebastian Brünink, Monika Eschbach-Bludau, Anna M. Eis-Hübinger, Marion P. Koopmans, Jonas Schmidt-Chanasit, Martin P. Grobusch, Xavier de Lamballerie, Christian Drosten, & Jan Felix Drexler
Posted: 19 April 2016
http://dx.doi.org/10.2471/BLT.16.175950

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CDC/ACIP [to 23 April 2016]
http://www.cdc.gov/media/index.html
FRIDAY, APRIL 22, 2016
CDC and OSHA Issue Interim Guidance for Protecting Workers from Occupational Exposure to Zika Virus
The Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) today issued new guidance and information for protecting workers from occupational exposure to Zika…

MONDAY, APRIL 18, 2016
CDC adds Belize 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 Belize. CDC has issued travel notices…

MMWR April 22, 2016 / Vol. 65 / No. 15
:: Patterns in Zika Virus Testing and Infection, by Report of Symptoms and Pregnancy Status — United States, January 3–March 5, 2016

EBOLA/EVD [to 23 April 2016]
“Threat to international peace and security” (UN Security Council)

Editor’s Note:
Following last week’s decision by WHO, we have removed the Public Health Emergency of International Concern (PHEIC) designation we have carried above. We have not identified any action by the UN Security Council to change the “Threat to international peace and security” designation. We will continue to present Ebola updates in this space for the near-term, and monitor whether the Security Council takes action on the threat designation.
The last “Ebola Situation Update” is dated 30 March 2016 and we observe that WHO has established an Ebola Situation Report archive, indicating that this may be the final situation report. There is no announcement on this evident on the website.

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The role of training in the West Africa Ebola response
April 2016
The magnitude of the 2014-2015 West Africa Ebola outbreak combined with a dearth of local and international expertise in tackling the disease necessitated training on a mass scale. Over the duration of the epidemic, WHO and partners trained more than 8,000 health professionals from over 80 nations, including the Ebola-affected countries.

The training courses focused on protecting first responders through disease-specific information and safety measures and preparing them for a range of specific Ebola response functions, including treatment of Ebola patients, case tracking, safe burials, epidemiology and infection prevention and control.
To better understand the impact of the trainings, WHO commissioned a review, which was conducted by an independent, external body.

:: Read the review, its conclusions and its recommendations

POLIO [to 23 April 2016]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 20 April 2016
:: The globally synchronized switch from the trivalent to bivalent oral polio vaccine, the first stage of objective 2 of the Polio Eradication and Endgame Strategic Plan 2013-2018, is underway between 17 April and 1 May. Follow a live update of which countries have undergone the switch here. Learn more about the rationale for the switch through this series of videos.

:: The Strategic Advisory Group of Experts on immunization (SAGE) met on the 12 to 14 April to discuss polio eradication. The official report from there meeting is available here.

:: The final communique of the Organisation of Islamic Cooperation (OIC) Istanbul Summit, adopted by OIC Heads of State and Government, reaffirmed the importance of preserving the health and wellbeing of children as a duty of parents and society as prescribed by Islam, and appealed to religious scholars and leaders to support polio eradication efforts.

:: The World Health Assembly (WHA) Report on Poliomyelitis has been published. The report summarises the status against the Polio Endgame Plan and Resolution WHA68.3, adopted by the WHA in May 2015.

:: 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.

Selected Country Levels Updates [excerpted]
Afghanistan
:: One new case of wild poliovirus type 1 (WPV1) was reported in the past week in Shigal Wa Shelten district of Kunar province with onset of paralysis on 27 March. The total number of WPV1 cases for 2016 is now three, compared to one reported by this date in 2015.
Pakistan
:: One new WPV1 environmental positive sample was reported in the past week from Sukkur district of Sindh province, with a collection date of 19 March.
:: Efforts continue to further strengthen surveillance activities in all provinces of the country to ensure that no child is missed with the vaccine
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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Pakistan polio: Seven killed in anti-vaccination attack
BBC News – 20 April 2016
Seven Pakistani policemen, three of whom were guarding polio workers, have been killed in Karachi, officials say.
Eight gunmen on motorcycles fired at a group of three police guards and later at a van containing four officers, officials told the Pakistan Tribune.

Islamist militants oppose vaccination, saying it is a Western conspiracy to sterilise Pakistani children.

In January, 15 people were killed in a bomb attack on a vaccination centre in the south-western city of Quetta.

Reward
Polio workers called off the vaccination drive in Karachi following the attack, despite the home minister’s order to continue, the Tribune reported.

According to Pakistan’s Dawn newspaper, police have offered a reward of 5 million rupees (£33,000) for information on the killers, and 2 million rupees (£13,000) compensation to the victims’ families.

Talking to reporters at the scene, Sindh police Inspector General AD Khawaja said polio drops would be “administered to our children at all costs” and said security for polio teams would be increased…

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Vaccination Boost for Pakistan’s Children: World Bank and Partners Provide New Funding for Immunization
Washington DC, April 21, 2016—The World Bank approved today an International Development Association (IDA) credit of $50 million to increase the availability of vaccines for infectious diseases, including polio, for children under two years of age in Pakistan.

The National Immunization Support Project (NISP) is supporting the country’s Expanded Program on Immunization (EPI) that aims to immunize all children against eight vaccine preventable diseases: tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus, hepatitis B, haemophilus influenza type b (Hib), and measles. Strengthening EPI will also support Pakistan’s access to newer vaccines which are either in the process of roll out (pneumococcal vaccine) or under planning (rotavirus vaccine).

The Project is also receiving additional support of $80 million grant from a World Bank administered multi-donor trust fund, Gavi – the Vaccine Alliance, and the United States Agency for International Development. The Bill and Melinda Gates Foundation is also supporting the project through an innovative partial conversion of the IDA credit into a grant upon successful achievement of project objectives.

“Pakistan is grappling with the public health emergency of polio virus transmission. Ensuring strong routine immunization services is the first essential pillar in polio eradication”, says Illango Patchamuthu, World Bank Country Director for Pakistan. “The World Bank and other development partners are working with the Government of Pakistan to strengthen routine immunization services at the critical endgame stage of polio eradication, particularly as Pakistan introducesinjectable polio vaccine into its routine schedule”.

The project will incentivize provincial government capacity for rigorous monitoring and effective implementation of its program, including strengthened vaccine logistics, and deploying and expanding qualified technical and managerial personnel.

“Pakistan’s performance in maternal and child health remains weak and inadequate immunization coverage is a major challenge. Childhood immunization against vaccine preventable diseases can help in significant reductions in disability and death”, says Robert Oelrichs, World Bank Task Team Leader of the Project. “The project will establish linkages of the federal and provincial EPI cells with private sector health providers and health-related civil society organizations (CSOs) working in low coverage catchment areas – especially urban slums.”

Children under two years of age in Pakistan are the main beneficiaries of NISP – particularly children belonging to the poorest households in which immunization coverage is lowest. In addition, all children will benefit from strengthened polio and measles interventions.

The credit is financed by IDA, the World Bank’s fund for the poor, with a maturity of 25 years, including a grace period of 5 years.

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WHO African Region AFRO
:: African countries withdraw type 2 component of polio vaccine
Brazzaville, 22 April 2016 – As the world gets closer to global polio eradication, all 47 countries in the African Region are joining the rest of the world to switch from trivalent Oral Polio Vaccine (tOPV) to bivalent Oral Polio Vaccine (bOPV) in routine immunization schedules.

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WHO Eastern Mediterranean Region EMRO
:: National polio immunization campaign concludes in Yemen
Sana’a, 21 April 2016 – This week, a national house-to-house polio immunization campaign, organized by the Ministry of Public Health and Population and supported by WHO and UNICEF, concluded in Yemen. More than 4.5 million children under the age of 5 were successfully vaccinated by more than 40 000 health workers. Yemen has been polio free since 2006.
:: Libya completes first polio campaign since 2014 21 April 2016
:: Keeping up the fight against polio: maintaining population immunity in Jordan 19 April 2016

WHO & Regional Offices [to 23 April 2016]

Weekly Epidemiological Record (WER) 22 April 2016, vol. 91, 16 (pp. 209–216)
Contents:
209 Meningitis control in countries of the African meningitis belt, 2015

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Call for expressions of interest on tablet and smartphone app regarding in WHO Immunization Summary pdf, 50kb
18 April 2016
Deadline for application: 13 May 2016

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Disease Outbreak News (DONs)
:: 22 April 2016 Cholera – United Republic of Tanzania
:: 22 April 2016 Yellow Fever – China
:: 22 April 2016 Zika virus infection – Papua New Guinea
:: 22 April 2016 Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
:: 21 April 2016 Elizabethkingia – United States of America
:: 21 April 2016 Zika virus infection – Peru
:: 20 April 2016 Zika virus infection – Saint Lucia

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Highlights
Process to elect next Director-General of WHO begins
April 2016 — Member States can now nominate candidates to be the new head of WHO, the global public health body. This is the first step in a rigorous process which will culminate in a final vote at the World Health Assembly in May 2017.

Health and social effects of nonmedical cannabis use
April 2016 — Cannabis is the most commonly used psychoactive drug across the globe. A new WHO report examines nonmedical cannabis use, with a focus on the impact of cannabis on young people and the effects of long-term frequent use.

Global Leprosy Strategy 2016-2020
April 2016 — WHO’s new global leprosy strategy, “Accelerating towards a leprosy-free world”, focuses on strengthening government ownership and partnerships, stopping leprosy and its complication, and ending discrimination while promoting inclusion.

Yellow fever vaccination campaign extended in Angola
April 2016 — With 250 deaths and 1908 suspected cases of yellow fever reported since December 2015, Angola’s Ministry of Health, WHO, and partners have extended the vaccination campaign to 2 of the 5 provinces reporting local transmission in Angola.

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:: WHO Regional Offices
WHO African Region AFRO
:: African countries withdraw type 2 component of polio vaccine
Brazzaville, 22 April 2016 – As the world gets closer to global polio eradication, all 47 countries in the African Region are joining the rest of the world to switch from trivalent Oral Polio Vaccine (tOPV) to bivalent Oral Polio Vaccine (bOPV) in routine immunization schedules.
:: Angola extends yellow fever vaccination campaign to Huambo and Benguela provinces
19 April 2016 – As Angola grapples with its worst yellow fever outbreak in decades, the Ministry of Health, with the support of the World Health Organization (WHO) and partners have extended the vaccination campaign beyond the capital Luanda into Huambo and Benguela – 2 of the other 5 provinces reporting local transmission.

WHO Region of the Americas PAHO
:: Some 60 million people set to benefit from vaccines during Vaccination Week in the Americas (04/22/2016)

WHO South-East Asia Region SEARO
:: One year on, health partners review Nepal quake response, call for scaling up emergency preparedness 21 April 2016
:: WHO launches new global strategy seeking accelerated efforts to end leprosy 20 April 2016

WHO European Region EURO
:: From over 90 000 cases to zero in two decades: the European Region is malaria free 20-04-2016

WHO Eastern Mediterranean Region EMRO
:: National polio immunization campaign concludes in Yemen
Sana’a, 21 April 2016 – This week, a national house-to-house polio immunization campaign, organized by the Ministry of Public Health and Population and supported by WHO and UNICEF, concluded in Yemen. More than 4.5 million children under the age of 5 were successfully vaccinated by more than 40 000 health workers. Yemen has been polio free since 2006.
:: Libya completes first polio campaign since 2014 21 April 2016
:: Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks 21 April 2016
:: Keeping up the fight against polio: maintaining population immunity in Jordan
19 April 2016

WHO Western Pacific Region
:: Ending malaria: A priority in the Western Pacific Region
MANILA, 22 April 2016 – On World Malaria Day (25 April), the World Health Organization (WHO) in the Western Pacific Region calls on governments and partners to accelerate malaria control and elimination efforts in the Region and beyond by 2030.

CDC/ACIP [to 23 April 2016]
http://www.cdc.gov/media/index.html
[see Zika coverage above which includes CDC briefing content]

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MMWR April 22, 2016 / Vol. 65 / No. 15
:: Patterns in Zika Virus Testing and Infection, by Report of Symptoms and Pregnancy Status — United States, January 3–March 5, 2016
:: Notes from the Field: Development of a Contact Tracing System for Ebola Virus Disease — Kambia District, Sierra Leone, January–February 2015
:: Announcement: World Malaria Day — April 25, 2016

Two-thirds of unimmunized children live in conflict-affected countries – UNICEF
Press release
World Immunization Week –24-30th April
NEW YORK/GENEVA, 22 April 2016 – Almost two-thirds of children who have not been immunized with basic vaccines live in countries that are either partially or entirely affected by conflict, UNICEF said ahead of World Immunization Week.

Of countries in conflict, South Sudan has the highest percentage of unimmunized children, with 61 per cent not receiving the most basic childhood vaccines, followed by Somalia (58 per cent) and Syria (57 per cent).

“Conflict creates an ideal environment for disease outbreaks,” said UNICEF Chief of Immunization Robin Nandy. ”Children miss out out on basic immunizations because of the breakdown – and sometimes deliberate destruction – of vital health services. Even when medical services are available, insecurity in the area often prevents them from reaching children.”

Measles, diarrhoea, respiratory infections and malnutrition are major causes of childhood illness and death, and in conflict and emergencies, their effects can worsen. When children contract measles in non-conflict settings, fewer than 1 per cent of them die. In areas where crowding and malnutrition are rife, such as refugee camps, child deaths from measles can soar to up to 30 per cent of cases. Overcrowding and lack of basic necessities like food, water and shelter make children even more vulnerable to disease.

Areas in conflict also see the killing of health workers and the destruction of medical facilities, supplies and equipment, all of which have a disastrous effect on children’s health.
:: Conflict-affected areas in Pakistan and Afghanistan are the last remaining strongholds of the crippling poliovirus, now eliminated from the rest of the world. n Syria, immunization levels have plummeted from over 80 per cent in 2010, prior to the conflict, to 43 per cent in 2014. Polio resurfaced in the country in 2013, after 14 years with no cases.
:: In the Democratic Republic of Congo, over 2,000 suspected cases of measles have already been reported in 2016, with 17 deaths, most of them among children under 5 years old.

Vaccination – particularly against highly contagious measles – is a high priority in humanitarian emergencies and is a central part of UNICEF’s response to protect children’s health in such settings.
:: In Syria, a vaccination campaign planned to start on 24 April will target young children who have missed out on routine vaccination, especially those in besieged and hard-to-reach areas. Many of these children, born since the conflict began, have never been vaccinated.
:: In Yemen, despite fierce fighting across the country, UNICEF-supported vaccination campaigns immunized 2.4 million children against measles and rubella in January and 4.6 million children against polio in April 2016.
:: In Libya, the first nationwide polio immunization campaign in two years was completed in April. Earlier this month UNICEF shipped 1.5 million doses of vaccines to Tripoli.
:: Over 36 million children are being reached with polio vaccinations across Pakistan, where polio cases have dropped 65 per cent since 2015.
:: During 2014–2015, UNICEF supported emergency immunization campaigns against measles for more than 23 million children in Iraq, Syria and Yemen.

In emergencies and conflicts, UNICEF works with partners to restart the cold chain for vaccines and other essential medical supplies; put health teams back in place; and train health workers to provide immunization, nutrition screening, vitamin A supplements and medical treatment for women and children.

Immunization in conflict helps revive other badly needed health services. For example, in conflict-affected areas of Iraq, Syria and Yemen, health workers also offer health and nutrition services, as well as care for childhood illnesses, to populations who come forward in response to immunization campaigns.

“Children affected by conflict are pushed into a downward spiral of deprivation that robs them of their health and, by extension, their futures. Vaccination can help to break this vicious cycle,” said Nandy. “Immunization is a vital service that deserves and requires protection from all parties to a conflict.”

Gavi [to 23 April 2016]
http://www.gavialliance.org/library/news/press-releases/

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22 April 2016
Gavi tackling environmental challenges head on
Commitment to seek improvements in sustainability.
Geneva, 22 April 2016 – Gavi, the Vaccine Alliance has today published, for World Earth Day, an updated statement on Environmental Sustainability. The statement recognises the impact that issues such as resource scarcity, environmental degradation and climate change are having on global disease trends and how this can disproportionately affect children living in the countries Gavi supports. Immunisation can be a powerful tool to help countries protect the health of people.

Changes in temperature and rainfall can lead to increased prevalence and spread of vector- and water-borne diseases. Existing immunisation programmes can be severely disrupted by population displacement and resource scarcity, leading to further risks of disease outbreaks.

Gavi’s implementing partners have put in place a number of environmental sustainability policies and safeguards that guide Gavi programmes. The Alliance also encourages countries to have immunisation waste management plans compliant with WHO standards. Gavi promotes cold chain equipment improvements and for corporate procurement, Gavi requires its suppliers to comply with internationally recognised standards.

In 2016, Gavi is committed to exploring ways of making Vaccine Alliance programmes more environmentally friendly, while at the same time maintaining high standards of quality and safety. Gavi’s Secretariat will also conduct an audit of its corporate policies to reassess their environmental impact and take any relevant action to reduce the environmental impact of its activities.

Global Fund [to 23 April 2016]
http://www.theglobalfund.org/
21 April 2016
United Methodist Church Makes Major Contribution
GENEVA – The United Methodist Church’s contribution to the Global Fund has reached US$20 million, strongly supporting malaria programs in most-affected countries in Africa.

“We thank the United Methodist Church for their relentless efforts in the fight against malaria,” said Mark Dybul, Executive Director of the Global Fund. “This is the largest contribution ever received from a faith-based organization and it’s extremely encouraging to see partners of all sectors coming together to eliminate malaria.”
The people of The United Methodist Church and the Global Fund joined forces in the fight against malaria through the Imagine No Malaria campaign, which aims to raise US$75 million to address the impact of malaria in Africa through prevention, treatment, communication and education.

Bishop Thomas J. Bickerton, chair of the United Methodist Global Health Initiative, announced the latest contribution to the Global Fund ahead of World Malaria Day, April 25…

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21 April 2016
MCM Joins Partnership to Support Global Health
SEOUL, South Korea – MCM, the luxury travel goods brand from South Korea, announced that it will support global health by contributing US$10 million through (RED) over the next 10 years…

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20 April 2016
Portugal Makes New Pledge to the Global Fund
GENEVA – The Global Fund to Fight AIDS, TB and Malaria welcomed a pledge by Portugal for renewed financial support in 2016, just ahead of the Global Fund’s replenishment for the three-year period beginning in 2017.

Ambassador Pedro Nuno Bártolo announced Portugal’s contribution during a meeting at the Global Fund office in Geneva: “A partnership with the Global Fund is more than just providing a financial contribution, it’s about global solidarity. We are very honored to make this contribution.”

Mark Dybul, Executive Director of the Global Fund said: “It’s very important that Portugal is back at the table. We appreciate the efforts of Portugal to partner with the Global Fund in this important year.”

Portugal pledged €50,000 for 2016, doubling its contribution so far in the 2014-2016 funding period. The country also contributes technical assistance to Global Fund-supported programs in some Portuguese-speaking countries in order to improve the efficiency of grant implementation. In Guinea Bissau, for example, the Global Fund and the government of Portugal are currently working together to provide technical assistance to grants.

Fondation Merieux [to 23 April 2016]
Mission: Contribute to global health by strengthening local capacities of developing countries to reduce the impact of infectious diseases on vulnerable populations.
http://www.fondation-merieux.org/news

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19 April 2016
Inauguration of Charles Mérieux Infectiology Center of Brazil in Rio Branco
Rio Branco (Brazil)
Fondation Mérieux provides the 1st high level (BSL3) lab in the Amazon, along with a training and research center.

…the Charles Mérieux Infectiology Center and its Rodolphe Mérieux Laboratory at the Fundhacre Hospital in Rio Branco. The 400 m2 center, which includes 245 m2 of laboratories, was built through a partnership between the State of Acre, Fundhacre Hospital, the NGO SOS Amazonia, the University of Salvador de Bahia and Fondation Mérieux.

The center will perform 3 vital missions:
:: Service: providing patients with quality diagnosis for improved care.
:: Training: contributing to training students in clinical biology and infectious diseases.
:: Research: conducting projects that address public health issues in Brazil, especially hepatitis.

The creation of the Charles Mérieux Infectiology Center and Rodolphe Mérieux Laboratory is an important milestone in the fight against viral hepatitis, a major public health problem in the Amazon, which affects thousands of patients. The center will provide training for laboratory personnel and enable the development of fundamental and clinical research in the region. The Rodolphe Mérieux Laboratory will also perform routine testing as well as infectious disease surveillance for research programs. It has the only high biosafety level laboratory (BSL3) in the region, three biosafety level 2 (BSL2) laboratories and rooms dedicated to techniques such as molecular biology…

NIH [to 23 April 2016]
http://www.nih.gov/news-events/news-releases

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April 19, 2016
NIH study finds factors that may influence influenza vaccine effectiveness
Long-held approach to predicting seasonal influenza vaccine effectiveness may need to be revisited.
The long-held approach to predicting seasonal influenza vaccine effectiveness may need to be revisited, new research suggests. Currently, seasonal flu vaccines are designed to induce high levels of protective antibodies against hemagglutinin (HA), a protein found on the surface of the influenza virus that enables the virus to enter a human cell and initiate infection. New research conducted by scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, found that higher levels of antibody against a different flu surface protein — neuraminidase (NA) — were the better predictor of protection against flu infection and its unpleasant side effects. Neuraminidase, which is not currently the main target antigen in traditional flu vaccines, enables newly formed flu viruses to exit the host cell and cause further viral replication in the body.

The findings, from a clinical trial in which healthy volunteers were willingly exposed to naturally occurring 2009 H1N1 influenza type A virus, appear online today in the open-access journal mBio (link is external):

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mBio
doi: 10.1128/mBio.00417-16
19 April 2016 mBio vol. 7 no. 2 e00417-16
Evaluation of Antihemagglutinin and Antineuraminidase Antibodies as Correlates of Protection in an Influenza A/H1N1 Virus Healthy Human Challenge Model
Matthew J. Memolia, Pamela A. Shawb, Alison Hana, Lindsay Czajkowskia, Susan Reeda, Rani Athotaa, Tyler Bristola, Sarah Fargisa, Kyle Risosa, John H. Powersc, Richard T. Davey Jr.d, Jeffery K. Taubenbergera
Author Affiliations
aViral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
bPerelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
cDivision of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
dClinical Research Section, Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
ABSTRACT
Despite long-term investment, influenza continues to be a significant worldwide problem. The cornerstone of protection remains vaccination, and approved vaccines seek to elicit a hemagglutination inhibition (HAI) titer of ≥1:40 as the primary correlate of protection. However, recent poor vaccine performance raises questions regarding the protection afforded and whether other correlates of protection should be targeted. A healthy volunteer challenge study was performed with a wild-type 2009 A(H1N1)pdm influenza A challenge virus at the NIH Clinical Center to evaluate two groups of participants with HAI titers of ≥1:40 and IMPORTANCE
This study represents the first time the current gold standard for evaluating influenza vaccines as set by the U.S. Food and Drug Administration and the European Medicines Agency Committee for Medicinal Products for Human Use, a “protective” hemagglutination inhibition (HAI) titer of ≥1:40, has been evaluated in a well-controlled healthy volunteer challenge study since the cutoff was established. We used our established wild-type influenza A healthy volunteer human challenge model to evaluate how well this antibody titer predicts a reduction in influenza virus-induced disease. We demonstrate that although higher HAI titer is predictive of some protection, there is stronger evidence to suggest that neuraminidase inhibition (NAI) titer is more predictive of protection and reduced disease. This is the first time NAI titer has been clearly identified in a controlled trial of this type to be an independent predictor of a reduction in all aspects of influenza.

IVAC [International Vaccine Access Center] [to 23 April 2016]
http://www.jhsph.edu/research/centers-and-institutes/ivac/about-us/news.html

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[Undated]
Dose Per Container Partnership (DPCP) Launched
IVAC is pleased to become a member of JSI Research and Training Institute’s Dose Per Container Partnership (DPCP) . Three members of the IVAC/Johns Hopkins Bloomberg School of Public Health, including Bruce Lee, Lois Privor-Dumm and Dan Salmon are now providing their expertise to an issue that has been an important concern for the team over the past several years. Projects leading up and contributing to this initiative included the Primary Container Roundtable, HERMES modeling efforts and work around vaccine safety and confidence. The aim of the partnership is to use Dose per Container (DPC) information to support vaccine product and program decision making in order to optimize high, equitable, timely, safe and cost-effective coverage. This work will involve documentation of current policies and processes in combination with studies that document the programmatic implications of vaccine presentation. Programmatic implications of DCP, which include cost, cost per dose delivered (including wastage), equitable and timely coverage, compliance with the multi-dose vial policy, healthcare worker perceptions, safety and missed opportunities, will be assessed in country so that the evidence case for sometimes complex decisions can be supported through a better understanding of the relationship between DPC and the various immunization and health system variables. Tools will be developed and data disseminated to help countries make better decisions about the key trade-offs between cost and health impact.

European Medicines Agency [to 23 April 2016]
http://www.ema.europa.eu/

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22/04/2016
First DNA vaccine in the EU recommended for use in salmon
Clynav to protect Atlantic salmon from serious infectious disease
The European Medicines Agency (EMA) has recommended granting a marketing authorisation in the European Union (EU) for Clynav, a DNA vaccine to protect Atlantic salmon against Salmon Pancreas Disease (SPD) caused by salmon alphavirus subtype 3.

SPD is a serious infectious disease which causes damage to the heart, pancreas and skeletal muscle and can lead to the death of salmon. The disease has become established in some Member States and outbreaks of SPD cause significant losses in salmon farms in the EU.

Clynav is the first DNA vaccine to be recommended for marketing authorisation in the EU. A DNA vaccine consists of a genetic sequence that triggers the production of proteins directly in the cells of the vaccinated animal. These proteins stimulate a protective immune response, in the case of Clynav against salmon alphavirus subtype 3, thereby preventing or reducing the impact of the disease should the fish subsequently be exposed to this virus…

EDCTP [to 23 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.

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20 April 2016
Abstract submission for the Eighth EDCTP Forum is now open
EDCTP is pleased to announce that as of today the service for submission of abstracts for the Eighth Forum is open. Till 24 June 2016, we welcome abstracts for presentation at the EDCTP Forum in Lusaka, Zambia, from 6-9 November 2016. The Forum is organised by EDCTP in partnership with the Ministry of Health of the Republic of Zambia. Since 2014, the Republic of Zambia is a member of the EDCTP-Association and a Participating State in the EDCTP2 programme.
Go to EDCTP 2016 Forum website.

European Vaccine Initiative [to 23 April 2016]
http://www.euvaccine.eu/news-events

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20 April 2016
Sanofi – Institut Pasteur Awards (SIPA) 2016
Call for Nominations
Sanofi and the Institut Pasteur are pleased to announce the Sanofi – Institut Pasteur 2016 Awards.

These Awards will honor and support four scientists, whose outstanding research shows real progress in the life sciences that contributes to global public health, specifically in the following fields:
– Tropical and neglected diseases
– Immunology
– Drug resistance
– Neuroscience

Investing in Nutrition: The Foundation for Development
World Bank, Results for Development Institute, and 1,000 Days – with support from the Bill & Melinda Gates Foundation and the Children’s Investment Fund Foundation
April 2016 :: 8 pages
Pdf: http://thousanddays.org/tdays-content/uploads/Investing-in-Nutrition-The-Foundation-for-Development.pdf

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Introduction
Every year, malnutrition claims the lives of 3 million children under age five and costs the global economy billions of dollars in lost productivity and health care costs. Yet those losses are almost entirely preventable. A large body of scientific evidence shows that improving nutrition
during the critical 1,000 day window from a woman’s pregnancy to her child’s second birthday has the potential to save lives, help millions of children develop fully and thrive, and deliver greater economic prosperity.1, 2, 3, 4, 5, 6

There is an urgent need for global action on nutrition. In 2012, the 194 member states of the World Health Assembly (WHA) endorsed the first-ever global targets to improve nutrition focusing on six areas: stunting, exclusive breastfeeding, wasting, anemia, low birth weight, and overweight. And while some
of the targets were enshrined within Sustainable Development Goal 2, which commits to end malnutrition in all its forms by the year 2030, the world is not on track to achieve any of the six nutrition targets.

Accelerating progress against malnutrition will require investment in both proven nutrition interventions and research to understand how to bring promising solutions to scale in a cost-effective manner.7…

…This brief summarizes the analysis of the costs, impacts, and investments needed to achieve the targets and how governments, donors, the private sector, foundations, and others can come together to finance these at scale.

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Key Messages
.1 Global action is urgently needed to tackle the pervasive problem of malnutrition.

.2 Reaching the targets to reduce stunting among children and anemia in women, increase exclusive breastfeeding rates, and mitigate the impact of wasting will require an average annual investment of $7 billion over the next 10 years. This is in addition to the $3.9 billion the world currently spends on nutrition annually.

.3 To catalyze progress toward the global nutrition targets, priority should be given to a set of the most cost-effective actions which can be scaled up immediately. Financing this more limited set of actions will require an additional annual investment of just over $2 billion for the next 10 years. The majority of this annual investment would come from country governments and donors, $1.4 billion and $650 million, respectively, while innovative financing mechanisms and
households fund the remaining gap.

.4 When combined with other health and poverty reduction efforts, this priority investment can yield significant returns: an estimated 2.2 million lives can be saved and there will be 50 million fewer cases of stunting in 2025 compared to in 2015.

.5 Achieving the targets is within reach if all partners work together to immediately step up in investments in nutrition

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PRESS RELEASE
Global Leaders Launch First-Ever Investment Framework for Nutrition and Call for Immediate Action
April 18, 2016
Additional nutrition investment of $2.2 billion/year over 10 years could save 2.2 million lives and reduce the number of stunted children by 50 million
… “An investment in nutrition can help make every other investment in health and development pay off,” said Bill Gates, co-chair of the Bill & Melinda Gates Foundation and keynote speaker at the event. “And while progress is possible, it is not inevitable. With the release of today’s analysis by the World Bank and Results for Development, we know there are proven, cost-effective tools to combat malnutrition – such as food fortification and breastfeeding. Investments in these interventions will help ensure millions more children globally have the opportunity to survive and thrive.”

Malnutrition is the underlying cause in nearly half of deaths of children under age five every year. In addition, millions more women and children bear the burden of poor health caused by malnutrition and the global economy loses billions of dollars due to lost productivity and health care costs. Yet these losses are almost entirely preventable. Investing in nutrition gives children the foundation for a healthy, productive life and establishes a foundation for sustainable global progress in health and development. The 2015 Global Nutrition Report indicates that every $1 of investment in nutrition yields $16 in benefits across health and productivity.

“The unconscionably high rates of childhood stunting in middle- and low-income countries—30 and 45 percent – are a damning indictment on us all,” said Jim Yong Kim, President, the World Bank Group. “Stunted growth has life-long consequences not only for the individual, but for countries as well, in an increasingly digitalized and service-oriented economy. Equal opportunity for all is an empty slogan if we don’t address this issue.”…

Annals of Internal Medicine
19 April 2016, Vol. 164. No. 8
http://annals.org/issue.aspx

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History of Medicine
Judging the Past: How History Should Inform Bioethics
Barron H. Lerner, MD, PhD; and Arthur L. Caplan, PhD
Bioethics has become a common course of study in medical schools, other health professional schools, and graduate and undergraduate programs. An analysis of past ethical scandals, as well as the bioethics apparatus that emerged in response to them, is often central to the discussion of bioethical questions. This historical perspective on bioethics is invaluable and demonstrates how, for example, the infamous Tuskegee syphilis study was inherently racist and how other experiments exploited mentally disabled and other disadvantaged persons. However, such instruction can resemble so-called Whig history, in which a supposedly more enlightened mindset is seen as having replaced the “bad old days” of physicians behaving immorally.

Bioethical discourse—both in the classroom and in practice—should be accompanied by efforts to historicize but not minimize past ethical transgressions. That is, bioethics needs to emphasize why and how such events occurred rather than merely condemning them with an air of moral superiority. Such instruction can reveal the complicated historical circumstances that led physician-researchers (some of whom were actually quite progressive in their thinking) to embark on projects that seem so unethical in hindsight. Such an approach is not meant to exonerate past transgressions but rather to explain them. In this manner, students and practitioners of bioethics can better appreciate how modern health professionals may be susceptible to the same types of pressures, misguided thinking, and conflicts of interest that sometimes led their predecessors astray.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 23 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
Arebu I. Bilal, Ebrahim D. Osman and Anwar Mulugeta
BMC Health Services Research 2016 16:144
Published on: 23 April 2016 Abstract
Abstract
Background
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. The objective of the study was to assess the patterns of medicine use among health facilities in eastern Ethiopia using World Health Organization’s Prescribing, Patient Care and Health facility indicators.
Methods
A cross sectional study was carried out in eight randomly selected health centers and data were collected retrospectively as well as prospectively. Prescribing indicators were assessed retrospectively using 636 prescriptions selected by systematic random sampling technique among prescriptions filled between September 2013 and September 2014. Patient care indicators were assessed prospectively by interviewing 708 patients from the health facilities. Health facilities were assessed through observation. Data were entered and analyzed using Statistical Packages for Social Sciences version 20. P-value less than 0.05 at 95 % confidence interval considered for significance of relationships for associations in statistical tests.
Results
The average number of medicines per prescription was 2.2 with standard deviation of 0.8. The proportion of medicines prescribed by generic name was 97 and 92 % of the prescribed medicines were included in List of Essential Medicines for Ethiopia, Prescriptions containing antibiotics and injections constituted (82.5 and 11.2 %) respectively. Of the total of 1426 medicines prescribed, 49.6 % were antibiotics, with amoxicillin (33.3 %) and co-trimoxazole (16.0 %) being the most commonly prescribed agents. The average consultation and dispensing times were 5.6 and 2.7 min, respectively. Among the medicines dispensed, 64.0 % were adequately labeled and the proportion of patients with adequate knowledge about medicines was 69 %.
Conclusion
The prescribing and dispensing practices in the health facilities are fairly good and are not that far from the standard WHO requirements. However, there is a need to do more on some issues, including prescribing practice of antibiotics, average number of medicines per prescription, and patients’ dosage form knowledge

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 23 April 2016)

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Research article
Treatment outcomes for patients with Middle Eastern Respiratory Syndrome Coronavirus (MERS CoV) infection at a coronavirus referral center in the Kingdom of Saudi Arabia
Mohammed Al Ghamdi, Khalid M. Alghamdi, Yasmeen Ghandoora, Ameera Alzahrani, Fatmah Salah, Abdulmoatani Alsulami, Mayada F. Bawayan, Dhananjay Vaidya, Trish M. Perl and Geeta Sood
BMC Infectious Diseases 2016 16:174
Published on: 21 April 2016
Abstract
Background
Middle Eastern Respiratory Syndrome coronavirus (MERS-CoV) is a poorly understood disease with no known treatments. We describe the clinical features and treatment outcomes of patients with laboratory confirmed MERS-CoV at a regional referral center in the Kingdom of Saudi Arabia.
Methods
In 2014, a retrospective chart review was performed on patients with a laboratory confirmed diagnosis of MERS-CoV to determine clinical and treatment characteristics associated with death. Confounding was evaluated and a multivariate logistic regression was performed to assess the independent effect of treatments administered.
Results
Fifty-one patients had an overall mortality of 37 %. Most patients were male (78 %) with a mean age of 54 years. Almost a quarter of the patients were healthcare workers (23.5 %) and 41 % had a known exposure to another person with MERS-CoV. Survival was associated with male gender, working as a healthcare worker, history of hypertension, vomiting on admission, elevated respiratory rate, abnormal lung exam, elevated alanine transaminase (ALT), clearance of MERS-CoV on repeat PCR polymerase chain reaction (PCR) testing, and mycophenolate mofetil treatment. Survival was reduced in the presence of coronary artery disease, hypotension, hypoxemia, CXR (chest X-ray) abnormalities, leukocytosis, creatinine >1 · 5 mg/dL, thrombocytopenia, anemia, and renal failure. In a multivariate analysis of treatments administered, severity of illness was the greatest predictor of reduced survival.
Conclusions
Care for patients with MERS-CoV remains a challenge. In this retrospective cohort, interferon beta and mycophenolate mofetil treatment were predictors of increased survival in the univariate analysis. Severity of illness was the greatest predictor of reduced survival in the multivariate analysis. Larger randomized trials are needed to better evaluate the efficacy of these treatment regimens for MERS-CoV.

Contemporary Clinical Trials
Volume 48, In Progress (May 2016)
http://www.sciencedirect.com/science/journal/15517144/48

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Clinical Trial Management and Optimization
Systematic collection of patient reported outcome research data: A checklist for clinical research professionals
Original Research Article
Pages 21-29
Leslie Wehrlen, Mike Krumlauf, Elizabeth Ness, Damiana Maloof, Margaret Bevans
Abstract
Understanding the human experience is no longer an outcome explored strictly by social and behavioral researchers. Increasingly, biomedical researchers are also including patient reported outcomes (PROs) in their clinical research studies not only due to calls for increased patient engagement in research but also healthcare. Collecting PROs in clinical research studies offers a lens into the patient’s unique perspective providing important information to industry sponsors and the FDA. Approximately 30% of trials include PROs as primary or secondary endpoints and a quarter of FDA new drug, device and biologic applications include PRO data to support labeling claims. In this paper PRO, represents any information obtained directly from the patient or their proxy, without interpretation by another individual to ascertain their health, evaluate symptoms or conditions and extends the reference of PRO, as defined by the FDA, to include other sources such as patient diaries.
Consumers and clinicians consistently report that PRO data are valued, and can aide when deciding between treatment options; therefore an integral part of clinical research. However, little guidance exists for clinical research professionals (CRPs) responsible for collecting PRO data on the best practices to ensure quality data collection so that an accurate assessment of the patient’s view is collected. Therefore the purpose of this work was to develop and validate a checklist to guide quality collection of PRO data. The checklist synthesizes best practices from published literature and expert opinions addressing practical and methodological challenges CRPs often encounter when collecting PRO data in research settings.

Eurosurveillance
Volume 21, Issue 16, 21 April 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Editorials
Importance of timely monitoring of seasonal influenza vaccine effectiveness
by RG Pebody, K Mølbak

Surveillance report
Pandemic vaccination strategies and influenza severe outcomes during the influenza A(H1N1)pdm09 pandemic and the post-pandemic influenza season: the Nordic experience
by J Gil Cuesta, P Aavitsland, H Englund, Ó Gudlaugsson, SH Hauge, O Lyytikäinen, G Sigmundsdóttir, A Tegnell, M Virtanen, the Nordic influenza comparison group, T Grove Krause

Systematic review
Concordance of interim and final estimates of influenza vaccine effectiveness: a systematic review
by VK Leung, BJ Cowling, S Feng, SG Sullivan

Review articles
Lessons learnt to keep Europe polio-free: a review of outbreaks in the European Union, European Economic Area, and candidate countries, 1973 to 2013
by T Derrough, A Salekeen

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 23 April 2016]

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Review
The Pan-University Network for Global Health: framework for collaboration and review of global health needs
M. S. Winchester, R. BeLue, T. Oni, U. Wittwer-Backofen, D. Deobagkar, H. Onya, T. A. Samuels, S. A. Matthews, C. Stone and C. Airhihenbuwa
Published on: 21 April 2016
Abstract
In the current United Nations efforts to plan for post 2015-Millennium Development Goals, global partnership to address non-communicable diseases (NCDs) has become a critical goal to effectively respond to the complex global challenges of which inequity in health remains a persistent challenge. Building capacity in terms of well-equipped local researchers and service providers is a key to bridging the inequity in global health. Launched by Penn State University in 2014, the Pan University Network for Global Health responds to this need by bridging researchers at more than 10 universities across the globe. In this paper we outline our framework for international and interdisciplinary collaboration, as well the rationale for our research areas, including a review of these two themes. After its initial meeting, the network has established two central thematic priorities: 1) urbanization and health and 2) the intersection of infectious diseases and NCDs. The urban population in the global south will nearly double in 25 years (approx. 2 billion today to over 3.5 billion by 2040). Urban population growth will have a direct impact on global health, and this growth will be burdened with uneven development and the persistence of urban spatial inequality, including health disparities. The NCD burden, which includes conditions such as hypertension, stroke, and diabetes, is outstripping infectious disease in countries in the global south that are considered to be disproportionately burdened by infectious diseases. Addressing these two priorities demands an interdisciplinary and multi-institutional model to stimulate innovation and synergy that will influence the overall framing of research questions as well as the integration and coordination of research.

Health Affairs
April 2016; Volume 35, Issue 4
http://content.healthaffairs.org/content/current

Issue Focus: Patients’ & Consumers’ Use Of Evidence
ANALYSIS & COMMENTARY: The Ethical Imperative And Moral Challenges Of Engaging Patients And The Public With Evidence
Mildred Z. Solomon, Michael K. Gusmano, and Karen J. Maschke
Health Aff April 2016 35:583-589; doi:10.1377/hlthaff.2015.1392
Abstract
Engaging patients and the public with evidence is an ethical imperative because engagement is central to respect for persons and will likely improve health outcomes, facilitate the stewardship of resources, enhance prospects for justice, and build public trust. However, patient and public engagement is also morally complex, because evidence alone is never definitive. As patients and the public engage with evidence, value conflicts will arise and must be managed to achieve trustworthy decision making. We outline value conflicts likely to emerge in the following five settings: clinical care, health care organizations, public health, the regulatory context, and among payers. Using a variety of examples, we offer suggestions about how such conflicts may be managed, including providing more opportunities for democratic deliberation and having more explicit community discussion of how to balance personal choice and community well-being, transparent discussions of cost and quality outcomes, and greater patient engagement in community-based participatory research and the governance of learning health systems.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 23 April 2016]

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Research
The West African Health Organization’s experience in improving the health research environment in the ECOWAS region
Jude Aidam and Issiaka Sombié
Published on: 20 April 2016
Abstract
Background
The West African Health Organization (WAHO) implemented a research development program in West Africa during 2009–2013 using the Knowledge for Better Health Research Capacity Development Framework, developed by Pang et al. (Bull World Health Organ 81(11):815–820, 2003), on strategies used to improve the research environment. The framework has the following components: stewardship, financing, sustainable resourcing and research utilization. This paper describes how WAHO implemented this research development program in the West African region to help improve the research environment and lessons learnt.
Methods
This is a retrospective review of the regional research development program using a triangulation of activity reports, an independent evaluation and the authors’ experiences with stakeholders. This program was designed to address gaps along the components of the framework and to improve partnership. The activities, results and challenges are summarised for each component of the framework. The independent evaluation was conducted using over 180 semi-structured interviews of key stakeholders in the West African region and activity reports. WAHO and major stakeholders validated these findings during a regional meeting.
Results
All 15 ECOWAS countries benefited from this regional research development program. WAHO provided technical and financial support to eight countries to develop their policies, priorities and plans for research development to improve their research governance. WAHO, along with other technical and financial partners, organised many capacity-strengthening trainings in health systems research methodology, resource mobilization, ethical oversight and on HRWeb, a research information management platform. WAHO helped launch a regional network of health research institutions to improve collaboration between regional participating institutions. Further, WAHO developed strategic research partnerships and mobilised additional funding to support the program. The program supported 24 health research projects. High staff turnover, weak institutional capacities and ineffective collaboration were some of the challenges encountered during program activity implementation.
Conclusion
The regional collaborative approach to health research development using this framework was effective given the challenges in the West African region. The achievements particularly with improved research partnerships and funding helped strengthen local health research environments. This highlights WAHO’s role and the common experiences in the West African region in improving health research.

Humanitarian Exchange Magazine
Number 66 A pril 2016
http://odihpn.org/magazine/humanitarian-innovation/

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Special Focus: Humanitarian Innovation
by Humanitarian Practice Network and Kim Scriven April 2016
This edition of Humanitarian Exchange, co-edited with ELRHA Humanitarian Innovation Fund (HIF) manager Kim Scriven, focuses on innovation in the humanitarian sector.
:: Kim Scriven provides an overview of the rising interest in and funding for innovation, while highlighting what more needs to be done to improve the evidence base, relocate capacity and develop guidance.
:: In her article, Alice Obrecht proposes three success criteria for innovation based on case studies of HIF-funded innovation projects.
:: Nathaniel A. Raymond and Casey S. Harrity argue for clear ethnical and technical doctrine to guide the use of technology innovation.
:: Rahel Dette and Julia Steets explore the role of technology in monitoring aid in insecure environments.
:: Monica Zikusooka and colleagues report on using technology to conduct simulated field visits in Somalia.
:: Karen Kisakeni Sørensen highlights the challenges of innovating in the midst of armed conflict in her article on the use of technology in mine action in Ukraine.
:: Andrew Schroeder and Patrick Meier explore the opportunities and challenges posed by robotics.
:: Josiah Kaplan and Evan Easton-Calabria look at the opportunities and hazards of military innovation for the humanitarian sector.
:: Ben Ramalingam shares lessons on innovation in the Nepal earthquake response.
:: Elizabeth Gilmour discusses crowd-sourced mapping during the Nepal earthquake response.
:: Ronak Patel and Mihir Bhatt discuss a small-business micro-insurance programme in India.
:: Robert Hakiza and Evan Easton-Calabria elaborate on their research into urban micro-finance programmes run by refugees in Uganda.
:: Caetano Dorea describes the development of a new water filtration product.
:: Eric James and Laura James explore the potential of 3D printing of humanitarian supplies in the field.
:: Paul Currion offers personal reflection on the rise and decline of Humanitarian Information Centres (HICs).

Infectious Diseases of Poverty

[Accessed 23 April 2016]

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Opinion
The global spread of Zika virus: is public and media concern justified in regions currently unaffected?
Narayan Gyawali, Richard S. Bradbury and Andrew W. Taylor-Robinson
Published on: 19 April 2016

JAMA
April 19, 2016, Vol 315, No. 15
http://jama.jamanetwork.com/issue.aspx

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Preliminary Communication
Safety and Immunogenicity of Novel Adenovirus Type 26– and Modified Vaccinia Ankara–Vectored Ebola Vaccines: A Randomized Clinical Trial
Iain D. Milligan, MRCP; Malick M. Gibani, MRCP; Richard Sewell, BA; Elizabeth A. Clutterbuck, PhD; Danielle Campbell, BScN; Emma Plested; Elizabeth Nuthall, BSc; Merryn Voysey, MBiostat; Laura Silva-Reyes, MSc; M. Juliana McElrath, MD, PhD; Stephen C. De Rosa, MD; Nicole Frahm, PhD; Kristen W. Cohen, PhD; Georgi Shukarev, MD; Nicola Orzabal, BSc; Wilbert van Duijnhoven, MSc; Carla Truyers, PhD; Nora Bachmayer, PhD; Daniel Splinter, PhD; Nathaly Samy, MD; Maria Grazia Pau, PhD; Hanneke Schuitemaker, PhD; Kerstin Luhn, PhD; Benoit Callendret, PhD; Johan Van Hoof, MD; Macaya Douoguih, MD, MPH; Katie Ewer, PhD; Brian Angus, MD; Andrew J. Pollard, FRCPCH, PhD; Matthew D. Snape, FRCPCH, MD
Author Affiliations
1Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
2Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
3Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
4Janssen, Pharmaceutical Companies of Johnson & Johnson, Leiden, the Netherlands
5Bavarian Nordic, Martinsried, Germany
6Jenner Institute, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, United Kingdom
7National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, United Kingdom
8Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
Includes: Supplemental Content
JAMA. 2016;315(15):1610-1623. doi:10.1001/jama.2016.4218.

Abstract
Importance
Developing effective vaccines against Ebola virus is a global priority.
Objective
To evaluate an adenovirus type 26 vector vaccine encoding Ebola glycoprotein (Ad26.ZEBOV) and a modified vaccinia Ankara vector vaccine, encoding glycoproteins from Ebola virus, Sudan virus, Marburg virus, and Tai Forest virus nucleoprotein (MVA-BN-Filo).
Design, Setting, and Participants
Single-center, randomized, placebo-controlled, observer-blind, phase 1 trial performed in Oxford, United Kingdom, enrolling healthy 18- to 50-year-olds from December 2014; 8-month follow-up was completed October 2015.
Interventions
Participants were randomized into 4 groups, within which they were simultaneously randomized 5:1 to receive study vaccines or placebo. Those receiving active vaccines were primed with Ad26.ZEBOV (5 × 1010 viral particles) or MVA-BN-Filo (1 × 108 median tissue culture infective dose) and boosted with the alternative vaccine 28 or 56 days later. A fifth, open-label group received Ad26.ZEBOV boosted by MVA-BN-Filo 14 days later.
Main Outcomes and Measures
The primary outcomes were safety and tolerability. All adverse events were recorded until 21 days after each immunization; serious adverse events were recorded throughout the trial. Secondary outcomes were humoral and cellular immune responses to immunization, as assessed by enzyme-linked immunosorbent assay and enzyme-linked immunospot performed at baseline and from 7 days after each immunization until 8 months after priming immunizations.
Results
Among 87 study participants (median age, 38.5 years; 66.7% female), 72 were randomized into 4 groups of 18, and 15 were included in the open-label group. Four participants did not receive a booster dose; 67 of 75 study vaccine recipients were followed up at 8 months. No vaccine-related serious adverse events occurred. No participant became febrile after MVA-BN-Filo, compared with 3 of 60 participants (5%; 95% CI, 1%-14%) receiving Ad26.ZEBOV in the randomized groups. In the open-label group, 4 of 15 Ad26.ZEBOV recipients (27%; 95% CI, 8%-55%) experienced fever. In the randomized groups, 28 of 29 Ad26.ZEBOV recipients (97%; 95% CI, 82%- 99.9%) and 7 of 30 MVA-BN-Filo recipients (23%; 95% CI, 10%-42%) had detectable Ebola glycoprotein-specific IgG 28 days after primary immunization. All vaccine recipients had specific IgG detectable 21 days postboost and at 8-month follow-up. Within randomized groups, at 7 days postboost, at least 86% of vaccine recipients showed Ebola-specific T-cell responses.
Conclusions and Relevance
In this phase 1 study of healthy volunteers, immunization with Ad26.ZEBOV or MVA-BN-Filo did not result in any vaccine-related serious adverse events. An immune response was observed after primary immunization with Ad26.ZEBOV; boosting by MVA-BN-Filo resulted in sustained elevation of specific immunity. These vaccines are being further assessed in phase 2 and 3 studies.
Trial Registration
clinicaltrials.gov Identifier: NCT02313077

The Lancet
Apr 23, 2016 Volume 387 Number 10029 p1693-1788
http://www.thelancet.com/journals/lancet/issue/current

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Review
The path to eradication: a progress report on the malaria-eliminating countries
Gretchen Newby, Adam Bennett, Erika Larson, Chris Cotter, Rima Shretta, Allison A Phillips, Richard G A Feachem
Summary
In the past several years, as worldwide morbidity and mortality due to malaria have continued to decrease, the global malaria community has grown increasingly supportive of the idea of malaria eradication. In 2015, three noteworthy global documents were released—the WHO’s Global Technical Strategy for Malaria 2016–2030, the Roll Back Malaria Partnership’s Action and Investment to defeat Malaria 2016–2030, and From Aspiration to Action: What Will It Take to End Malaria?—that collectively advocate for malaria elimination and eradication and outline key operational, technical, and financial strategies to achieve progress toward malaria eradication. In light of this remarkable change in global attitudes toward malaria elimination and eradication, and as the malaria community debates how and when to embark on this ambitious goal, it is important to assess current progress along the path to eradication. Although low-income, high-burden countries are often the focus when discussing the substantial challenges of eradication, the progress toward elimination in middle-income, low-burden countries is a major driver of global progress and deserves better recognition. Additionally, although global support and guidance is essential for success, malaria elimination and eradication efforts will ultimately be driven at the country level and achieved in a collaborative manner, region by region. In this Review, we examine the present status of the 35 malaria-eliminating countries, summarise existing national and regional elimination goals and the regional frameworks that support them, and identify the most crucial enabling factors and potential barriers to achieving eradication by a theoretical end date of 2040.

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Public Health
Averting a malaria disaster: will insecticide resistance derail malaria control?
Janet Hemingway, Hilary Ranson, Alan Magill, Jan Kolaczinski, Christen Fornadel, John Gimnig, Maureen Coetzee, Frederic Simard, Dabiré K Roch, Clément Kerah Hinzoumbe, John Pickett, David Schellenberg, Peter Gething, Mark Hoppé, Nicholas Hamon
Summary
World Malaria Day 2015 highlighted the progress made in the development of new methods of prevention (vaccines and insecticides) and treatment (single dose drugs) of the disease. However, increasing drug and insecticide resistance threatens the successes made with existing methods. Insecticide resistance has decreased the efficacy of the most commonly used insecticide class of pyrethroids. This decreased efficacy has increased mosquito survival, which is a prelude to rising incidence of malaria and fatalities. Despite intensive research efforts, new insecticides will not reach the market for at least 5 years. Elimination of malaria is not possible without effective mosquito control. Therefore, to combat the threat of resistance, key stakeholders need to rapidly embrace a multifaceted approach including a reduction in the cost of bringing new resistance management methods to market and the streamlining of associated development, policy, and implementation pathways to counter this looming public health catastrophe.

Nature
Volume 532 Number 7599 pp282-408 21 April 2016
http://www.nature.com/nature/current_issue.html

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Editorials
Monkeying around
China, with its freedom from the ethical pressures experienced by researchers elsewhere, is poised to become the go-to country for work on non-human primates.

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World View
The Paris Agreement has solved a troubling problem
By endorsing a limit of 1.5 °C, the climate negotiations have effectively defined what society considers dangerous, says Simon L. Lewis.

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Comment
Track climate pledges of cities and companies
Data transparency is key to accounting for how local governments and the private sector are contributing to global emissions reduction, say Angel Hsu and colleagues.

New England Journal of Medicine
April 21, 2016 Vol. 374 No. 16
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
Partnerships, Not Parachutists, for Zika Research
David L. Heymann, M.D., Joanne Liu, M.D., and Louis Lillywhite, M.B., B.Ch.
[Free full-text]
N Engl J Med 2016; 374:1504-1505 April 21, 2016 DOI: 10.1056/NEJMp1602278
Initial text
When the director-general of the World Health Organization (WHO) declared that the recently reported clusters of microcephaly and other neurologic disorders represent a Public Health Emergency of International Concern (PHEIC), she called for increased research into their cause, including the question of whether the Zika virus is the source of the problem.1 The declaration provides an opportunity to step up the pace of research in order to find the answer to some important questions more quickly. It could not only facilitate the accumulation of knowledge about the relationship between the Zika virus and microcephaly, but also accelerate the study of newer technologies for mosquito control, which could have far-reaching effects on global health security beyond controlling Zika infections.
But to answer these research questions effectively and maximize their contribution to enhancing health security, we believe it is critical that research be conducted collaboratively. Building and strengthening public health capacities (in part through collaborative research) are central to the International Health Regulations, an international agreement of all WHO member countries designed to strengthen health security…

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Perspective
Zika Virus as a Cause of Neurologic Disorders
Nathalie Broutet, M.D., Ph.D., Fabienne Krauer, M.Sc., Maurane Riesen, M.Sc., Asheena Khalakdina, Ph.D., Maria Almiron, M.Sc., Sylvain Aldighieri, M.D., Marcos Espinal, M.D., Nicola Low, M.D., and Christopher Dye, D.Phil.
N Engl J Med 2016; 374:1506-1509 April 21, 2016 DOI: 10.1056/NEJMp1602708
Final text
… Even with limited evidence linking Zika virus to neurologic disorders, the severe potential risks demand decisive, immediate action to protect public health. The WHO recommends applying key interventions such as intensive mosquito control; personal protection against mosquito bites; provision of appropriate clinical care for all patients with Guillain–Barré syndrome and for women before, during, and after pregnancy; and prevention of Zika virus transmission through sexual contact or blood transfusion.4 Most of these are not new interventions, but they do need strengthening. Populations must be informed of the potential current and future risks of neurologic disorders, wherever the virus is being or could be locally transmitted and in other regions inhabited by the mosquito vectors. As the putative link between Zika virus and neurologic disorders is reinforced, refined, or even refuted, public health measures will be adjusted accordingly.

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Review Article
Zika Virus
Lindsey R. Baden, M.D., editor; Lyle R. Petersen, M.D., M.P.H., Denise J. Jamieson, M.D., M.P.H., Ann M. Powers, Ph.D., and Margaret A. Honein, Ph.D., M.P.H.
N Engl J Med 2016; 374:1552-1563 April 21, 2016 DOI: 10.1056/NEJMra1602113

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 23 April 2016)

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Research Article
Vaccine Effectiveness of Polysaccharide Vaccines Against Clinical Meningitis – Niamey, Niger, June 2015
April 18, 2016 ·
Introduction: In 2015, a large outbreak of serogroup C meningococcal meningitis hit Niamey, Niger, in response to which a vaccination campaign was conducted late April. Using a case-control study we measured the vaccine effectiveness (VE) of tri – (ACW) and quadrivalent (ACYW) polysaccharide meningococcal vaccines against clinical meningitis among 2-15 year olds in Niamey II district between April 28th and June 30th 2015.
Methods: We selected all clinical cases registered in health centers and conducted a household- vaccination coverage cluster survey (control group). We ascertained vaccination from children/parent reports. Using odds of vaccination among controls and cases, we computed VE as 1-(Odds Ratio). To compute VE by day since vaccination, we simulated a density case control design randomly attributing recruitment dates to controls based on case dates of onset (3 controls per case). We calculated the number of days between vaccination and the date of onset/recruitment and computed VE by number of days since vaccination using a cubic-spline model. We repeated this simulated analysis 500 times and calculated the mean VE and the mean lower and upper bound of the 95% confidence interval (CI).
Results: Among 523 cases and 1800 controls, 57% and 92% were vaccinated respectively. Overall, VE at more than 10 days following vaccination was 84% (95%CI: 75-89) and 97% (94-99) for the tri- and quadrivalent vaccines respectively. VE at days 5 and 10 after trivalent vaccination was 84% (95% CI: 74-91) and 89% (95% CI: 83-93) respectively. It was 88% (95% CI: 75-94) and 95.8% (95% CI: 92 -98) respectively for the quadrivalent vaccine.
Conclusion: Results suggest a high VE of the polysaccharide vaccines against clinical meningitis, an outcome of low specificity, and a rapid protection after vaccination. We identified no potential biases leading to VE overestimation. Measuring VE and rapidity of protection against laboratory confirmed meningococcal meningitis is needed.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 23 April 2016)

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Research Article
Experimental Treatment of Ebola Virus Disease with TKM-130803: A Single-Arm Phase 2 Clinical Trial
Jake Dunning, Foday Sahr, Amanda Rojek, Fiona Gannon, Gail Carson, Baimba Idriss, Thomas Massaquoi, Regina Gandi, Sebatu Joseph, Hassan K. Osman, Timothy J. G. Brooks, Andrew J. H. Simpson, Ian Goodfellow, Lucy Thorne, Armando Arias, Laura Merson, Lyndsey Castle, Rebecca Howell-Jones, Raul Pardinaz-Solis, Benjamin Hope-Gill, Mauricio Ferri, Jennifer Grove, Mark Kowalski, Kasia Stepniewska, Trudie Lang, John Whitehead, Piero Olliaro, Mohammed Samai, Peter W. Horby, for the RAPIDE-TKM trial team
| published 19 Apr 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1001997
Abstract
Background
TKM-130803, a small interfering RNA lipid nanoparticle product, has been developed for the treatment of Ebola virus disease (EVD), but its efficacy and safety in humans has not been evaluated.
Methods and Findings
In this single-arm phase 2 trial, adults with laboratory-confirmed EVD received 0.3 mg/kg of TKM-130803 by intravenous infusion once daily for up to 7 d. On days when trial enrolment capacity was reached, patients were enrolled into a concurrent observational cohort. The primary outcome was survival to day 14 after admission, excluding patients who died within 48 h of admission.
After 14 adults with EVD had received TKM-130803, the pre-specified futility boundary was reached, indicating a probability of survival to day 14 of ≤0.55, and enrolment was stopped. Pre-treatment geometric mean Ebola virus load in the 14 TKM-130803 recipients was 2.24 × 109 RNA copies/ml plasma (95% CI 7.52 × 108, 6.66 × 109). Two of the TKM-130803 recipients died within 48 h of admission and were therefore excluded from the primary outcome analysis. Of the remaining 12 TKM-130803 recipients, nine died and three survived. The probability that a TKM-130803 recipient who survived for 48 h will subsequently survive to day 14 was estimated to be 0.27 (95% CI 0.06, 0.58). TKM-130803 infusions were well tolerated, with 56 doses administered and only one possible infusion-related reaction observed. Three patients were enrolled in the observational cohort, of whom two died.
Conclusions
Administration of TKM-130803 at a dose of 0.3 mg/kg/d by intravenous infusion to adult patients with severe EVD was not shown to improve survival when compared to historic controls.

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 23 April 2016)

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Biological Sciences – Population Biology:
National- and state-level impact and cost-effectiveness of nonavalent HPV vaccination in the United States
David P. Durham, Martial L. Ndeffo-Mbah, Laura A. Skrip, Forrest K. Jones, Chris T. Bauch, and Alison P. Galvani
PNAS 2016 ; published ahead of print April 18, 2016, doi:10.1073/pnas.1515528113
Significance
Vaccination protects against human papilloma virus (HPV)-induced cervical cancer, but coverage varies markedly across the United States. The nonavalent vaccine produces greater health benefits than the bivalent and quadrivalent vaccines at a lower societal cost. Because of the impact of herd immunity, any expansion in coverage will be much more effective in reducing cancer incidence and healthcare costs if targeted in those states with the lowest coverage. Because of interstate migration and the long duration between HPV infection and resultant cervical cancer, much of the benefit of vaccination will be realized beyond a state’s borders. Therefore, both cervical cancer incidence and expenditure can be substantially reduced if the states coordinate policies to promote expansion of coverage, particularly for the new nonavalent vaccine.
Abstract
Every year in the United States more than 12,000 women are diagnosed with cervical cancer, a disease principally caused by human papillomavirus (HPV). Bivalent and quadrivalent HPV vaccines protect against 66% of HPV-associated cervical cancers, and a new nonavalent vaccine protects against an additional 15% of cervical cancers. However, vaccination policy varies across states, and migration between states interdependently dilutes state-specific vaccination policies. To quantify the economic and epidemiological impacts of switching to the nonavalent vaccine both for individual states and for the nation as a whole, we developed a model of HPV transmission and cervical cancer incidence that incorporates state-specific demographic dynamics, sexual behavior, and migratory patterns. At the national level, the nonavalent vaccine was shown to be cost-effective compared with the bivalent and quadrivalent vaccines at any coverage despite the greater per-dose cost of the new vaccine. Furthermore, the nonavalent vaccine remains cost-effective with up to an additional 40% coverage of the adolescent population, representing 80% of girls and 62% of boys. We find that expansion of coverage would have the greatest health impact in states with the lowest coverage because of the decreasing marginal returns of herd immunity. Our results show that if policies promoting nonavalent vaccine implementation and expansion of coverage are coordinated across multiple states, all states benefit both in health and in economic terms.

Science
22 April 2016 Vol 352, Issue 6284
http://www.sciencemag.org/current.dtl

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In Depth
Refugee crisis brings new health challenges
By Kai Kupferschmidt
Science22 Apr 2016 : 391-392
Imported pathogens are a much bigger threat to migrants than they are to Europeans.
Summary
More than a million refugees and migrants entered Europe last year, mostly from Syria, Afghanistan, and Iraq. This exodus is creating new challenges for European public health officials. Many of the migrants come from countries where public health systems are in disarray, and some are infected with pathogens that are rare, or even unheard of, in Europe. Germany saw a 30% increase in the number of tuberculosis cases in 2015; doctors also need to be prepared for diseases they have never seen before. Still, scientists say that the influx of unusual infections is far less a threat to native-born Europeans than to the health of the refugees themselves.

Vaccine
Volume 34, Issue 20, Pages 2291-2402 (29 April 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/20

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Editorial
Another emerging arbovirus, another emerging vaccine: Targeting Zika virus
Pages 2291-2293
Ricardo Palacios, Gregory A. Poland, Jorge Kalil
Excerpt
…There are three main current strategies to control further outbreaks of ZIKV: vector control, supportive treatment of affected patients, and protection through immunization. None of them is a fully effective stand-alone strategy; rather, they are combined options to address a broad public health issue with the current tools available. While vector control is the ideal option as it simultaneously impacts other mosquito-borne transmission of several diseases, sustainable and durable measures to do so are not widely available. In that regard, one of the next challenges is to measure the efficacy of mosquito control measures using the reduction of human cases, rather than only entomological parameters, as the appropriate metric. Of immediate need is the development of a vaccine, as well as other therapeutic and prophylactic products, to address this public health emergency.
What is clear is that significantly enhanced research efforts are urgently needed. We suggest a research agenda that includes the following:
.1 Better understand ZIKV as a zoonotic disease in humans, the molecular evolution of ZIKV, and its adaptation to humans and specific geographic regions.
.2 Better understand the immunology and pathophysiology of human ZIKV infection.
.3 Determine whether ZIKV infection is causative of CMRM and of GBS in humans.
.4 Better understand the pathophysiology of ZIKV infection in pregnant women and the effect of the developing fetus.
.5 Better understand the pathophysiology of ZIKV infection in relation to GBS.
.6 Develop an animal model of human ZIKV infection that recapitulates the important elements of immunology and pathophysiology in humans. Such a model is useful in better understanding the disease and its consequences, and in the development of diagnostic kits, mmunotherapeutics and vaccines.
.7 Fund research to develop novel ZIKV vaccine candidates and bring promising candidates through the development process to licensure.
.8 Fund research to develop antivirals and immunotherapeutics for treatment of ZIKV infections.
Much of the above could be accelerated by the establishment of a global research fund to address emerging and rapidly pandemic viruses such as ZIKV and others, particularly in regard to the above items and the development of antivirals and vaccines…

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Commentary
Every rabies death is a veterinary and health system failure until proven otherwise
Pages 2294-2295
David N. Durrheim
No abstract

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Estimating the public health importance of the CYD-tetravalent dengue vaccine: Vaccine preventable disease incidence and numbers needed to vaccinate
Original Research Article
Pages 2397-2401
Bradford D. Gessner, Annelies Wilder-Smith
Abstract
Background
To evaluate the potential public health impact of the live attenuated tetravalent Sanofi Pasteur dengue vaccine (CYD-TDV) we analyzed data from the reported clinical trials to calculate vaccine preventable disease incidence (VPDI) and number needed to vaccinate (NNV) based on the licensure indication for persons age 9 years and above.
Methods
VPDI is defined as incidence in an unvaccinated population X vaccine efficacy (VE), and thus incorporates both VE and the underlying burden of disease. NNV was calculated as 100,000 divided by VPDI divided by 2-year length of study. We compared these values to data for three newer vaccines that are currently integrated into some national immunization programs in Asia and Latin America, namely pneumococcal conjugate, Haemophilus influenzae type b, and rotavirus vaccines.
Results
In the Asian-Pacific trial, in the first 25 months after the first dose of the dengue vaccine, CYD-TDV prevented annually 2639 cases of virologically confirmed dengue for every 100,000 persons vaccinated, for an NNV of 18. In the Latin American trial, given the overall lower annual dengue incidence compared to Asia, VPDI was 1707, and NNV 28. For the Asian-Pacific and Latin American studies, the VPDIs for hospitalized virologically confirmed disease at the trials’ end were 638 and 239 per 100,000 population per year, respectively, with NNVs of 75 and 201. VPDI for confirmed dengue hospitalization was higher than that for Hib vaccine against Hib meningitis or all cause severe pneumonia while lower than that for rotavirus vaccine against severe rotavirus gastroenteritis.
Conclusions
Our analysis found that the CYD-TDV dengue vaccine had favorable VPDI and NNV, also when compared to existing vaccines used in Latin America and Asia. VPDI and NNV varied by serotype distribution, extent of prior dengue exposure (baseline seroprevalence) and country. These findings will help policy-makers decide where and how to introduce this vaccine post-licensure.

From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary

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Cancer Epidemiology Biomarkers & Prevention
doi: 10.1158/1538-7755.DISP15-B90
March 2016 25; B90
Abstract B90: Predictors of HPV vaccine initiation and completion among Hispanic mothers of 11-17 year old daughters living along the Texas-Mexico border
DY Morales-Campos, DA Parra-Medina –
Abstract
Background: Cervical cancer incidence and mortality are higher for Hispanic women along the Texas-Mexico border than for other female population groups. Incidence could be reduced if teenaged Hispanic girls received the HPV vaccine before they became sexually active. However, few Hispanic girls compared to U.S. girls receive all three HPV vaccine doses (31% vs 36%), which prevent cervical cancer. Mothers are crucial to the success of HPV vaccine uptake efforts, but few studies have examined predictors of vaccine initiation and completion. The purpose of this study is to assess predictors (socio-demographics, HPV and vaccine knowledge, and vaccine self-efficacy) of vaccine initiation and completion.
Methods: We utilized baseline data from an outreach and education program utilizing promotoras and peer educators to deliver health education to mothers and daughters to increase HPV knowledge and promote HPV immunization. Our analyses utilized data from mothers of never vaccinated girls (n=371) to examine the association between the predictors and vaccine initiation and completion. To control for potential confounders, we conducted multivariable logistic regression analyses.
Results: Findings showed both health insurance (Initiators AOR: 0.27; 95% CI= .09, .79; Completers AOR: 0.29; 95% CI= .10, .83) and program status (Initiators AOR: 3.04; 95% CI= 1.76, 5.26; Completers AOR: 2.21; 95% CI= 1.27, 3.58) were associated with HPV vaccine initiation and completion among mothers. Results also showed preferred language (AOR: 0.15; 95% CI= .04, .53) and health status (AOR: 0.52; 95% CI= .29, .92) were associated with series initiation.
Conclusions: Findings suggest mothers who spoke English, had health insurance, and reported having good health were at lower odds of vaccine initiation. Also, mothers with health insurance also had lower odds of series completion. Mothers who participated in the program compared to the brochure only group were more likely to initiate and complete the vaccine series. These findings assist in identifying appropriate intervention strategies to enhance vaccine initiation in border communities at risk for cervical cancer.

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Cancer Epidemiology Biomarkers & Prevention
doi: 10.1158/1538-7755.DISP15-A51
March 2016 25; A51
Abstract A51: Racial and gender disparities in knowledge and awareness of HPV and HPV vaccine in a national sample of US adults
EA Boakye, BB Tobo, N Osazuwa-Peters
Abstract
Background: Nearly 80 million people in the U.S. are currently infected with at least one of two strains of human papillomavirus (HPV), which is associated with 70% of cervical, and more than 90% of oropharyngeal, cancers. Racial/ethnic disparities in cervical cancer are pervasive, with non-Hispanic Black and Hispanic women experiencing disproportionately higher incidence and mortality rates than other racial or ethnic groups. Further, although it has been almost 10 years since the approval of the first of three HPV vaccines for boys and girls, disparities in knowledge and awareness about HPV and the HPV vaccine persist, and vaccination rates are suboptimal. The goal of this study was to assess racial/ethnic and gender disparities in the knowledge and awareness of HPV and the HPV vaccine among US adults.
Methods: Cross-sectional data were obtained from the Health Information National Trends Survey Cycles 3 and 4 (HINTS; N=6,862). Descriptive statistics and multivariable logistic regression were used to assess racial/ethnic and gender disparities in HPV knowledge and HPV vaccination awareness.
Results: Sixty-six percent of Americans had heard of HPV and the HPV vaccine; and seventy percent knew that HPV causes cervical cancer. However, we found racial/ethnic and gender disparities in knowledge and awareness of HPV and the HPV vaccine. In multivariate analyses, females were 3.28 times (95% CI: 2.62 – 4.09) more likely to have heard of HPV, and 3.86 times (95% CI: 3.11 – 4.79) more likely to have heard of the HPV vaccine compared to males. Non-Hispanic Blacks were 33% (95% CI: 0.47 – 0.96) and 44% (95% CI: 0.39 – 0.81) less likely than non -Hispanic Whites to have heard of HPV and the HPV vaccine, respectively. There was no significant difference between Hispanics and non-Hispanic Whites regarding HPV knowledge; however, Hispanics were 53% (95% CI: 0.34 – 0.64) less likely than non-Hispanic Whites to have heard of the HPV vaccine. Females were more likely than males to know that HPV causes cervical cancer (OR = 1.49, 95% CI: 1.13 – 1.96). Non-Hispanic Blacks were 48% (95% CI: 0.35 – 0.76) less likely to know that HPV causes cervical cancer compared to non-Hispanic Whites. However, there was no statistically significant difference between Hispanics and non-Hispanic Whites regarding awareness that HPV causes cervical cancer. Forty-six percent of Americans were aware that HPV often clears on its own without treatment.
Conclusions: Non-Hispanic Blacks and males suffer the greatest disparities associated with knowledge and awareness of HPV and the HPV vaccine. Increasing awareness about the HPV vaccine may help improve vaccination uptake, especially among males and minority populations. Thus, future interventions targeting males and minority populations, for whom knowledge gaps currently exist, are needed. There is also a need to improve physician-patient communications to maximize physician discussion of the HPV vaccine with patients and parents of children eligible for the HPV vaccine.

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Cancer Epidemiology Biomarkers & Prevention
doi: 10.1158/1538-7755.DISP15-B58
March 2016 25; B58
Abstract B58: Assessing university students’ sexual risk behavior, knowledge of the human papillomavirus,(HPV), HPV vaccine, and association between HPV and …
N Osazuwa-Peters, KM Christopher, C Geneus
Abstract
Background/Objectives: There has been a 225% increase in the incidence of oropharyngeal cancer, a sub-site of head and neck cancer, in the United States in the last three decades. This massive increase is largely associated with HPV, a sexually transmitted infection that peaks in prevalence among adolescents and young adults of college age. This study aimed at assessing sexual risk-taking behavior among university students, analyzing predictors of HPV vaccine initiation, as well as assessing levels of knowledge of the association between HPV and head and neck cancer.
Methods: An anonymous online cross-sectional survey was distributed to 921 university students between the ages of 19-26 years. The survey elicited sociodemographic characteristics, HPV and HPV vaccine knowledge, and barriers and facilitators for vaccine initiation and completion.
Results: Seven-hundred and forty-six students completed the survey; primarily female (68%), White (78%), and non-smokers (96%). Among participants, 61.7% have had vaginal sex and 70.7% oral sex. A greater number of participants have had multiple (4 or more) oral sexual partners than vaginal sexual partners (25.5% vs. 20.3%). Average age at first vaginal and oral sex onset were similar (18.41 vs. 17.80 years). Almost half of participants (49%) had completed all 3-doses of the HPV vaccine, and 60% had received at least one dose. Only 38% had a high knowledge of association between HPV and head and neck cancer.
After adjusting for covariables, it was found that HPV knowledge was the main predictor of HPV vaccine initiation. Those with a higher level of knowledge of HPV were more likely to have initiated the vaccine (aOR = 1.04, 95% CI 1.00-1.08). Additionally, there were decreased odds of initiating HPV vaccine as age increased (aOR = 0.83, 95% CI 0.75-0.90); and participant single or dating (aOR 1.72, 95% CI 1.12-2.65) and not currently dating (aOR 1.91, 95% CI 1.22-2.99) had higher odds of initiating the vaccine than those in committed relationships, including marriage.
Race was a significant predictor of knowledge of association between HPV and head and neck cancer. Non-White students were 2.25 times (95% CI: 1.14 – 4.45) more likely to have low knowledge compared to White students.
Conclusions: Sexual risk-taking behavior associated with HPV infection is high among university students, while knowledge of the association between HPV and head and neck cancer is low. These findings provide impetus for developing specifically targeted interventions that serve to increase head and neck cancer knowledge, improve HPV vaccine education and uptake, and mitigate sexual risk-taking behaviors among college-aged students.