International Journal of Infectious Diseases
February 2016 Volume 43, p1-110
Open Access
http://www.ijidonline.com/current

.
Editorial
Health literacy: a concept with potential to greatly impact the infectious diseases field
Richard H. Osborne, Alison Beauchamp, Roy Batterham
p101–102
Published online: December 24 2015
Preview
This edition of the International Journal of Infectious Diseases presents a comprehensive narrative review of health literacy research by Castro-Sánchez et al. that has been undertaken across conditions and countries. Health literacy is a relatively new concept in medicine and, for many, has some immediate appeal. The term was coined by Simonds in the 1970s, who argued the case for school health education, with the intention that pupils would not only be educated in the customary curriculum subjects, but might become as ‘literate’ in health as they were, for example, in history and science.

Reviews
Health literacy and infectious diseases: why does it matter?
Enrique Castro-Sánchez, Peter W.S. Chang, Rafael Vila-Candel, Angel A. Escobedo, Alison H. Holmes
p103–110
Published online: January 2 2016
Preview
The planetary scale of the threat presented by infectious diseases to human health and society has been well described.1 An intricate arrangement of clinical, societal, and ecological determinants powers the emergence of new infectious pathogens such as Ebola virus, and the resurgence of others previously considered to be under control. These same factors drive the unsustainable use and consumption of antimicrobials,2 sketching the looming prospect of a ‘world without antibiotics’ reflected upon by many,3 and without new therapeutic agents likely to be developed at a sufficient rate and periodicity to provide a significant counterbalance.
Highlights
:: Health literacy is an emerging public health and research field.
:: There are limited studies focused on health literacy and infectious diseases.
:: Infections such as malaria with a high burden of morbidity were underrepresented.
:: Most investigations considered functional but not critical health literacy.
Summary
Objectives
Multifactorial interventions are crucial to arrest the threat posed by infectious diseases. Public involvement requires adequate information, but determinants such as health literacy can impact on the effective use of such knowledge. The influence of health literacy on infectious diseases is examined in this paper.
Methods
Databases were searched from January 1999 through July 2015 seeking studies reporting on health literacy and infections such tuberculosis, malaria, and influenza, and infection-related behaviours such as vaccination and hand hygiene. HIV was excluded, as comprehensive reviews have already been published.
Results
Studies were found on antibiotic knowledge and use, the adoption of influenza and MMR immunizations, and screening for sexually transmitted and viral hepatitis infections. There was a lack of investigations on areas such as tuberculosis, malaria, hand hygiene, and diarrhoeal diseases.
Conclusions
Limited or insufficient health literacy was associated with reduced adoption of protective behaviours such as immunization, and an inadequate understanding of antibiotics, although the relationship was not consistent. Large gaps remain in relation to infectious diseases with a high clinical and societal impact, such as tuberculosis and malaria.

JAMA
February 23, 2016, Vol 315, No. 8
http://jama.jamanetwork.com/issue.aspx

.
Viewpoint | February 23, 2016
Critical Care in Resource-Restricted Settings
Arjen M. Dondorp, MD, PhD1,2; Shivakumar S. Iyer, MD3; Marcus J. Schultz, MD, PhD1,4
Author Affiliations
JAMA. 2016;315(8):753-754. doi:10.1001/jama.2016.0976.
Extract
This Viewpoint discusses the challenges of providing intensive care in settings and countries with limited resources.

In many low- and middle-income countries, with improved public health services like sanitation and immunization, the relative contribution of curative care for critically ill patients to overall health and life expectancy has increased considerably. The importance of intensive care facilities as a global good was emphasized by recent epidemics in which survival was highly dependent on adequate critical care. Examples include the SARS coronavirus (2002-2003), avian influenza H5N1 (2004 and onward), pandemic influenza A(H1N1) (2009), the MERS coronavirus (2012 and onward), and Ebola virus disease (2014-2015)…

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 5 Issue 1 March 2016
http://jpids.oxfordjournals.org/content/current

.
SLIPE HIGHLIGHTS: UPDATE FROM LATIN AMERICA
Influenza B Burden in Latin America and Potential Benefits of the New Quadrivalent Vaccines
Luiza Helena Falleiros Arlant, Lucia F. Bricks
Extract
Respiratory infections caused by the influenza virus have a huge impact on public health. Influenza vaccination offers many benefits to not only patients at high risk for complications of influenza but also to healthy individuals [1]. Because of pandemics, influenza A virus is perceived to carry greater risk than influenza B [2]. However, both types of influenza virus can affect people of any age group, and they cause clinically indistinguishable infections and pose equal risks [1, 2].
Globally, the influenza type B virus causes 20% to 25% of influenza infections. Influenza B viruses include 2 antigenically distinguished lineages, Victoria and Yamagata, which have been cocirculating globally since 2002 [3]. Circulation of the B lineages varies from year to year, so predicting which one to include in the next year’s trivalent influenza vaccine (IIV3) is difficult. In fact, data from the United States and Europe indicate that in half of the influenza seasons over the past decade, the B lineage included in …

Journal of Pediatrics
March 2016 Volume 170, p1-350
http://www.jpeds.com/current

.
Medical Progress
Moving Towards a More Aggressive and Comprehensive Model of Care for Children with Ebola
Indi Trehan, Tracy Kelly, Regan H. Marsh, Peter Matthew George, Charles W. Callahan
p28–33.e7
Published online: January 8 2016
Preview
Ebola is a devastating illness for children, particularly those under 5 years of age.1-3 Although children are proportionally less affected than adults during outbreaks of Ebola, including in the current West Africa outbreak,4 it remains a major threat to child health in the affected nations and a neglected area of investigation and discussion.5 The threat is not only for those infected with Ebola, but for all children in the affected region because of the tremendous impact of this outbreak on national health care systems.

PharmacoEconomics
Volume 34, Issue 2, February 2016
http://link.springer.com/journal/40273/34/2/page/1
Big Data Themed Issue

.
Editorial
Big Data and Its Role in Health Economics and Outcomes Research: A Collection of Perspectives on Data Sources, Measurement, and Analysis
Eberechukwu Onukwugha
Initial text
Health economists and outcomes researchers have watched the term ‘big data’ increase in prominence over the last several years. However, to date, the use of big data in medicine has not been concretely illustrated across a variety of health economics and outcomes research (HEOR). At the same time, many of the same observers agree that fundamental questions remain unanswered and include (1) “What does the term ‘big data’ mean?” and (2) “What does the availability of big data mean for individuals who produce and use findings from HEOR?” This editorial tackles the first question and leaves contributors to this issue of PharmacoEconomics to discuss the promises, possibilities and potential pitfalls of using big data in HEOR….

.

Current Opinion
Big Data and Health Economics: Strengths, Weaknesses, Opportunities and Threats
Brendan Collins
Abstract
‘Big data’ is the collective name for the increasing capacity of information systems to collect and store large volumes of data, which are often unstructured and time stamped, and to analyse these data by using regression and other statistical techniques. This is a review of the potential applications of big data and health economics, using a SWOT (strengths, weaknesses, opportunities, threats) approach. In health economics, large pseudonymized databases, such as the planned care.data programme in the UK, have the potential to increase understanding of how drugs work in the real world, taking into account adherence, co-morbidities, interactions and side effects. This ‘real-world evidence’ has applications in individualized medicine. More routine and larger-scale cost and outcomes data collection will make health economic analyses more disease specific and population specific but may require new skill sets. There is potential for biomonitoring and lifestyle data to inform health economic analyses and public health policy.

PLOS Currents: Disasters
http://currents.plos.org/disasters/
[Accessed 27 February 2016]

.

Characteristics of an Effective International Humanitarian Assistance: A Systematic Review
February 25, 2016 · Research Article
Introduction: The objective of this study is to identify the effectiveness characteristics, review the definition of them, and develop a conceptual mapping of existing domains in the field of International Humanitarian Assistance (IHA).
Methods: We conducted a systematic review and searched the major databases (Science Direct, Scopus, Springer and Pubmed) and grey literature, including references of potentially eligible articles and conference proceedings through March 2015. Articles were included if they focused on IHA effectiveness. Reviewers independently identified the eligible studies and extracted data.
Results: 10 studies were included and 48 characteristics were identified. There is a lack of scientific studies and agreement on the characteristics of IHA effectiveness.
Conclusion: This study could be the step toward an understanding of IHA effectiveness characteristics and its definitions with the findings making a base line for more research in this area.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 27 February 2016)

.
Reducing Cost of Rabies Post Exposure Prophylaxis: Experience of a Tertiary Care Hospital in Pakistan
Naseem Salahuddin, M. Aftab Gohar, Naila Baig-Ansari
Research Article | published 26 Feb 2016 | PLOS Neglected Tropical Diseases
10.1371/journal.pntd.0004448

.

Phase 1/2a Trial of Plasmodium vivax Malaria Vaccine Candidate VMP001/AS01B in Malaria-Naive Adults: Safety, Immunogenicity, and Efficacy
Jason W. Bennett, Anjali Yadava, Donna Tosh, Jetsumon Sattabongkot, Jack Komisar, Lisa A. Ware, William F. McCarthy, Jessica J. Cowden, Jason Regules, Michele D. Spring, Kristopher Paolino, Joshua D. Hartzell, James F. Cummings, Thomas L. Richie, Joanne Lumsden, Edwin Kamau, Jittawadee Murphy, Cynthia Lee, Falgunee Parekh, Ashley Birkett, Joe Cohen, W. Ripley Ballou, Mark E. Polhemus, Yannick F. Vanloubbeeck, Johan Vekemans, Christian F. Ockenhouse
Research Article | published 26 Feb 2016 | PLOS Neglected Tropical Diseases
10.1371/journal.pntd.0004423

PLoS One
http://www.plosone.org/
[Accessed 27 February 2016]

.
Do Maternal Knowledge and Attitudes towards Childhood Immunizations in Rural Uganda Correlate with Complete Childhood Vaccination?
Bryan J. Vonasek, Francis Bajunirwe, Laura E. Jacobson, Leonidas Twesigye, James Dahm, Monica J. Grant, Ajay K. Sethi, James H. Conway
Research Article | published 26 Feb 2016 | PLOS ONE
10.1371/journal.pone.0150131
Abstract
Improving childhood vaccination coverage and timeliness is a key health policy objective in many developing countries such as Uganda. Of the many factors known to influence uptake of childhood immunizations in under resourced settings, parents’ understanding and perception of childhood immunizations has largely been overlooked. The aims of this study were to survey mothers’ knowledge and attitudes towards childhood immunizations and then determine if these variables correlate with the timely vaccination coverage of their children. From September to December 2013, we conducted a cross-sectional survey of 1,000 parous women in rural Sheema district in southwest Uganda. The survey collected socio-demographic data and knowledge and attitudes towards childhood immunizations. For the women with at least one child between the age of one month and five years who also had a vaccination card available for the child (N = 302), the vaccination status of this child was assessed. 88% of these children received age-appropriate, on-time immunizations. 93.5% of the women were able to state that childhood immunizations protect children from diseases. The women not able to point this out were significantly more likely to have an under-vaccinated child (PR 1.354: 95% CI 1.018–1.802). When asked why vaccination rates may be low in their community, the two most common responses were “fearful of side effects” and “ignorance/disinterest/laziness” (44% each). The factors influencing caregivers’ demand for childhood immunizations vary widely between, and also within, developing countries. Research that elucidates local knowledge and attitudes, like this study, allows for decisions and policy pertaining to vaccination programs to be more effective at improving child vaccination rates.

.

Cost-Effectiveness of Vaccinating Immunocompetent ≥65 Year Olds with the 13-Valent Pneumococcal Conjugate Vaccine in England
Albert Jan van Hoek, Elizabeth Miller
Research Article | published 25 Feb 2016 | PLOS ONE
10.1371/journal.pone.0149540

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH)
December 2015 Vol. 38, No. 6
http://www.paho.org/journal/

.
SECCIÓN ESPECIAL / SPECIAL SECTION
Declaración SPIRIT 2013: definición de los elementos estándares del protocolo de un ensayo clínico [SPIRIT 2013 Statement: defining standard protocol items for clinical trials]
An-Wen Chan, Jennifer M. Tetzlaff, Douglas G. Altman, Andreas Laupacis,
Peter C. Gøtzsche, Karmela Krleža-Jerić, Asbjørn Hrobjartsson, Howard Mann,
Kay Dickersin, Jesse A. Berlin, Caroline J. Dore, Wendy R. Parulekar,
William S. M. Summerskill, Trish Groves, Kenneth F. Schulz, Harold C. Sox,
Frank W. Rockhold, Drummond Rennie y David Moher
Abstract
The protocol of a clinical trial serves as the foundation for study planning, conduct, reporting, and appraisal. However, trial protocols and existing protocol guidelines vary greatly in content and quality. This article describes the systematic development and scope of SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013, a guideline for the minimum content of a clinical trial protocol. The 33-item SPIRIT checklist applies to protocols for all clinical trials and focuses on content rather than format. The checklist recommends a full description of what is planned; it does not prescribe how to design or conduct a trial. By providing guidance for key content, the SPIRIT recommendations aim to facilitate the drafting of high-quality protocols. Adherence to SPIRIT would also enhance the transparency and completeness of trial protocols for the benefit of investigators, trial participants, patients, sponsors, funders, research ethics committees or institutional review boards, peer reviewers, journals, trial registries, policymakers, regulators, and other key stakeholders.

Vaccine
Volume 34, Issue 11, Pages 1325-1422 (8 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/11

.

Meeting report
Implementing efficient and sustainable collaboration between National Immunization Technical Advisory Groups: Report on the 3rd International Technical Meeting, Paris, France, 8–9 December 2014
Pages 1325-1330
Christian Perronne, Alex Adjagba, Philippe Duclos, Daniel Floret, Hans Houweling, Corinne Le Goaster, Daniel Lévy-Brühl, François Meyer, Kamel Senouci, Ole Wichmann
Abstract
Many experts on vaccination are convinced that efforts should be made to encourage increased collaboration between National Immunization Technical Advisory Groups on immunization (NITAGs) worldwide. International meetings were held in Berlin, Germany, in 2010 and 2011, to discuss improvement of the methodologies for the development of evidence-based vaccination recommendations, recognizing the need for collaboration and/or sharing of resources in this effort. A third meeting was held in Paris, France, in December 2014, to consider the design of specific practical activities and an organizational structure to enable effective and sustained collaboration. The following conclusions were reached:
(i) The proposed collaboration needs a core functional structure and the establishment or strengthening of an international network of NITAGs.
(ii).Priority subjects for collaborative work are background information for recommendations, systematic reviews, mathematical models, health economic evaluations and establishment of common frameworks and methodologies for reviewing and grading the evidence.
(iii).The programme of collaborative work should begin with participation of a limited number of NITAGs which already have a high level of expertise. The amount of joint work could be increased progressively through practical activities and pragmatic examples. Due to similar priorities and already existing structures, this should be organized at regional or subregional level. For example, in the European Union a project is funded by the European Centre for Disease Prevention and Control (ECDC) with the aim to set up a network for improving data, methodology and resource sharing and thereby supporting NITAGs. Such regional networking activities should be carried out in collaboration with the World Health Organization (WHO).
(iv).A global steering committee should be set up to promote international exchange between regional networks and to increase the involvement of less experienced NITAGs. NITAGs already collaborate at the global level via the NITAG Resource Centre, a web-based platform developed by the Health Policy and Institutional Development Unit (WHO Collaborating Centre) of the Agence de Médecine Préventive (AMP-HPID). It would be appropriate to continue facilitating the coordination of this global network through the AMP-HPID NITAG Resource Centre.
(v).While sharing work products and experiences, each NITAG would retain responsibility for its own decision-making and country-specific recommendations.

Vaccine
Volume 34, Issue 11, Pages 1325-1422 (8 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/11

.

A qualitative study of healthcare provider awareness and informational needs regarding the nine-valent HPV vaccine
Pages 1331-1334
Monica L. Kasting, Shannon Wilson, Brian E. Dixon, Stephen M. Downs, Amit Kulkarni, Gregory D. Zimet
Abstract
The 9-valent Human Papillomavirus (HPV) vaccine, 9vHPV, was licensed in the U.S. in December, 2014. We assessed healthcare provider (HCP) awareness of the newly approved vaccine and identified questions HCPs have about the vaccine. As part of a larger study, we used semi-structured interviews to ask 22 pediatric HCPs about their awareness of 9vHPV, questions they have about the vaccine, and questions they anticipate from patients and parents. Interviews were audio-recorded and transcribed then analyzed using inductive content analysis. Over half were aware of the vaccine but few HCPs claimed to be familiar with it. HCPs indicated several questions with common themes pertaining to efficacy, side effects, and cost. Only half of HCPs believed patients or parents would have questions. The results suggest strategies and areas for health systems and public health organizations to target in order to resolve unmet educational needs among HCPs regarding 9vHPV.

Vaccine
Volume 34, Issue 11, Pages 1325-1422 (8 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/11

.

Antenatal immunisation intentions of expectant parents: Relationship to immunisation timeliness during infancy
Original Research Article
Pages 1379-1388
Cameron C. Grant, Mei-Hua Chen, Dinusha K. Bandara, Emma J. Marks, Catherine A. Gilchrist, Sonia Lewycka, Polly E. Atatoa Carr, Elizabeth M. Robinson, Jan E. Pryor, Carlos A. Camargo, Susan M.B. Morton
Abstract
Background
Most women decide about infant immunisation during pregnancy. However, we have limited knowledge of the immunisation intentions of their partners. We aimed to describe what pregnant women and their partners intended for their future child’s immunisations, and to identify associations between parental intentions and the subsequent timeliness of infant immunisation.
Methods
We recruited a cohort of pregnant New Zealand (NZ) women expecting to deliver between April 2009 and March 2010. The cohort included 11% of births in NZ during the recruitment period and was generalisable to the national birth cohort. We completed antenatal interviews independently with mothers and partners. We determined immunisation receipt from the National Immunisation Register and defined timely immunisation as receiving all vaccines (scheduled at 6-weeks, 3- and 5-months) within 30 days of their due date. We described independent associations of immunisation intentions with timeliness using adjusted odds ratios (OR) and 95% confidence intervals (CI).
Results
Of 6172 women, 5014 (81%) intended full immunisation, 245 (4%) partial immunisation, 140 (2%) no immunisation and 773 (13%) were undecided. Of 4152 partners, 2942 (71%) intended full immunisation, 208 (5%) partial immunisation, 83 (2%) no immunisation and 921 (22%) were undecided. Agreement between mothers and partners was moderate (Kappa = 0.42).
Timely immunisation occurred in 70% of infants. Independent of their partner’s intentions, infants of pregnant women who decided upon full immunisation were more likely to be immunised on time (OR = 7.65, 95% CI: 4.87 − 12.18). Independent of the future mother’s intentions, infants of partners who had decided upon full immunisations were more likely to be immunised on time (OR = 3.33, 95% CI: 2.29 − 4.84).
Conclusions
During pregnancy, most future parents intend to fully immunise their child; however, more partners than mothers remain undecided about immunisation. Both future mothers’ and future fathers’ intentions are independently associated with the timeliness of their infant’s immunisations.

Vaccine
Volume 34, Issue 11, Pages 1325-1422 (8 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/11

.

Changing the default to promote influenza vaccination among health care workers
Original Research Article
Pages 1389-1392
Birthe A Lehmann, Gretchen B Chapman, Frits ME Franssen, Gerjo Kok, Robert AC Ruiter
Abstract
Background
The prevention of health care acquired infections is an important objective for patient safety and infection control in all health care settings. Influenza vaccination uptake among health care workers (HCWs) is the most effective method to prevent transmission to patients, but vaccination coverage rates are low among HCWs. Several educational campaigns have been developed to increase the influenza vaccination coverage rates of HCWs, but showed only small
effects. The aim of this study was to test an opt-out strategy in promoting uptake among HCWs in a tertiary care center for patients with complex chronic organ failure.
Methods
HCWs were randomly assigned to one of two conditions. In the opt-out condition (N = 61), participants received an e-mail with a pre-scheduled appointment for influenza vaccination, which could be changed or canceled. In the opt-in condition (N = 61), participants received an e-mail explaining that they had to schedule an appointment if they wanted to get vaccinated.
Results
The findings show no statistically detectable effect of condition on being vaccinated against influenza. However, HCWs in the opt-out condition were more likely to have an appointment for influenza vaccination, which in turn increased the probability of getting vaccinated.
Conclusion
To change the default to promote influenza vaccination among HCWs might be an easy and cost-effective alternative to the complex vaccination campaigns that have been proposed in recent years.

Vaccine
Volume 34, Issue 10, Pages 1233-1324 (4 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/10

.

Place of influenza vaccination among children—United States, 2010–11 through 2013–14 influenza seasons
Original Research Article
Pages 1296-1303
Tammy A. Santibanez, Tara M. Vogt, Yusheng Zhai, Anne F. McIntyre
Abstract
Background
Studies are published on settings adults receive influenza vaccination but few have reported on settings children are vaccinated and how this might be changing over time or vary by socio-demographics.
Methods
Data from the National Immunization Survey-Flu were analyzed to assess place of influenza vaccination among vaccinated children 6 months–17 years during the 2010–11, 2011–12, 2012–13, and 2013–14 influenza seasons. The percentage of children vaccinated at each place was calculated overall and by age, race/ethnicity, income, and Metropolitan Statistical Area (MSA).
Results
The places children received influenza vaccination varied little over four recent influenza seasons. From the 2010–11 through 2013–14 influenza seasons the percentage of vaccinated children receiving influenza vaccination at a doctor’s office was 64.1%, 65.1%, 65.3%, and 65.3%, respectively with no differences from one season to the next. Likewise, for vaccination at clinics or health centers (17.8%, 17.5%, 17.0%. 18.0%), health departments (3.2%, 3.6%, 3.0%, 2.8%), and other non-medical places (1.6%, 1.4%, 1.2%, 1.1%), there were no differences from one season to the next. There were some differences for vaccinations at hospitals, pharmacies, and schools. There was considerable variability in the place of influenza vaccination by age, race/ethnicity, income, and MSA. Fewer Hispanic children were vaccinated at a doctor’s office than black, white, and other or multiple race children and fewer black children and children of other or multiple races were vaccinated at a doctor’s office than white children. More children at or below the poverty level were vaccinated at a clinic or health center than all of the other income groups.
Conclusion
Most vaccinated children receive their influenza vaccination at a doctor’s office. Place of vaccination changed little over four recent influenza seasons. Large variability in place of vaccination exists by age, race/ethnicity, income, and MSA. Monitoring place of vaccination can help shape future immunization programs.

Vaccine
Volume 34, Issue 10, Pages 1233-1324 (4 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/10

.
Conference report
Report on: “The 1st Workshop on National Immunization Programs and Vaccine Coverage in ASEAN Countries, April 30, 2015, Pattaya, Thailand”
Pages 1233-1240
Weerawan Hattasingh, Krisana Pengsaa, Usa Thisyakorn, 1st Workshop on National Immunization Programs and Vaccine Coverage in ASEAN Group
Abstract
The 1st Workshop on National Immunization Programs and Vaccine Coverage in Association of Southeast Asian Nations (ASEAN) Countries Group (WNIPVC-ASEAN) held a meeting on April 30, 2015, Pattaya, Thailand under the auspices of the Pediatric Infectious Diseases Society and the World Health Organization (WHO). Reports on the current status and initiatives of the national immunization program (NIP) in each ASEAN countries that attended were presented. These reports along with survey data collected from ministries of health in ASEAN countries NIPs demonstrate that good progress has been made toward the goal of the Global Vaccine Action Plan (GVAP). However, some ASEAN countries have fragile health care systems that still have insufficient vaccine coverage of some basic EPI antigens. Most ASEAN countries still do not have national coverage of some new and underused vaccines, and raising funds for the expansion of NIPs is challenging. Also, there is insufficient research into disease burden of vaccine preventable diseases and surveillance. Health care workers must advocate NIPs to government policy makers and other stakeholders as well as improve research and surveillance to achieve the goals of the GVAP.

European Geriatric Medicine
http://www.sciencedirect.com/science/journal/18787649
Available online 12 February 2016 – In Press, Corrected Proof

.
The role of vaccination in successful independent ageing
JE McElhaney, G Gavazzi, J Flamaing, J Petermans –
Abstract
Ageing increases the risk and severity of infectious diseases, especially when chronic diseases are present. Healthcare providers generally view vaccination as a childhood intervention and consider vaccination of the elderly not to be sufficiently effective due to immunosenescence. However, the burden of frequent vaccine-preventable diseases, such as influenza, pneumococcal disease and herpes zoster, increases with age, so that the perceived lower vaccine effectiveness should be considered in the context of this higher burden. Vaccination can prevent infection and mortality hospitalization and functional decline, and their consequences thereby having a positive impact. The use of medications will be reduced (e.g. antibiotics, analgesics) and therefore the iatrogenic risk would be lower. This contributes to an improved quality of life and to successful ageing. Many countries recommend influenza and pneumococcal vaccination in the elderly and, more recently, some recommend the live-attenuated herpes zoster vaccine. However, better guidelines and recommendations, especially for frail individuals are needed. Protection may be improved by offering vaccination to younger, fitter individuals, before they become frail. In addition, offering vaccination to caregivers and others who are in contact with the elderly could also improve protection. Many studies have demonstrated that influenza, pneumococcal and herpes zoster vaccinations in the elderly are cost-effective and can even be cost-saving. Healthcare providers and public health decision-makers need to understand more fully the value of vaccination and to consider it as an important preventive tool in the promotion of successful ageing.

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.

.

Forbes
http://www.forbes.com/
Accessed 27 February 2016
The HPV Vaccine Is Working, But Why Are So Many Teens Still Not Getting It?
Since the Food and Drug Administration approved the first human papillomavirus (HPV) vaccine in 2006, infections with the four types of HPV it targets have declined in adolescent girls and young women, scientists reported Monday. Certain types of HPV–the most common sexually transmitted infection in the United States–cause cervical, vulvar and […]
Rita Rubin, Contributor Feb 22, 2016

Bringing Compassion To The Sick Is Not Easy
By Arthur Caplan and Kenneth Moch
Three events are taking place this week that shed light on the challenges posed by trying to help those seeking access to unapproved drugs or vaccines for their terminal, chronic or dangerous conditions. Each event shows how careful we must be in designing well intended, […]
Feb 22, 2016

.

New Yorker
http://www.newyorker.com/
Accessed 27 February 2016
Daily Comment
February 25, 2016
The Dangerous Conspiracy Theories About the Zika Virus
By Michael Specter

.

New York Times
http://www.nytimes.com/
Accessed 27 February 2016
Obama on Vaccine for Zika
President Obama said there is a “promising pathway” for developing a vaccine against Zika, adding that the virus is not, apparently, a very complicated one.
February 25, 2016 – By REUTERS –

.

Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 27 February 2016
Sanofi’s Dengue Vaccine Made Widely Available for First Time
Philippines plans to immunize schoolchildren starting in April
By Cris Larano
Feb. 23, 2016 12:15 p.m. ET

.

Washington Post
http://www.washingtonpost.com/
Accessed 27 February 2016
CDC issues Olympics advisory: Pregnant women should ‘consider not going’ to Rio
U.S. officials issued their strongest travel warning yet, urging pregnant women to “consider not going” to the 2016 Summer Olympics in Rio de Janeiro.
Ariana Eunjung Cha | National/health-science | Feb 27, 2016

‘Seriously flawed’ study linking behavioral problems to Gardasil has been retracted
The authors of the study have come under fire for vaccine-critical studies before.
Rachel Feltman | National/health-science | Feb 25, 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_20 February 2016

– blog edition: comprised of the approx. 35+ entries posted below on 21- February 2016.

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

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

Zika virus [to 20 February 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

.
ZIKA – STRATEGIC RESPONSE FRAMEWORK & JOINT OPERATIONS PLAN – JANUARY-JUNE 2016
WHO – February 2016 :: 32 pages
Pdf: http://apps.who.int/iris/bitstream/10665/204420/1/ZikaResponseFramework_JanJun16_eng.pdf?ua=1
STRATEGIC OBJECTIVES
The over-arching goal of this strategy is to investigate and respond to the cluster of microcephaly and other neurological complications that could be linked to Zika virus infection, while increasing preventive measures, communicating risks and providing care to those affected.
.1. Surveillance
:: Provide up to date and accurate epidemiological information on Zika virus disease, neurological syndromes and congenital malformations.

.2. Response
:: Engage communities to communicate the risks associated with Zika virus disease and promote protective behaviors, reduce anxiety, address stigma, dispel rumors and cultural misperceptions.
:: Increase efforts to Control the spread of the Aedes and potentially other mosquito species as well as provide access to personal protection measures equipment and supplies.
:: Provide guidance and mitigate the potential impact on women of childbearing age and those who are pregnant, as well as families with children affected by Zika virus.

.3. Research
:: Investigate the reported increase in incidence of microcephaly and neurological syndromes including their possible association with Zika virus infection.
:: Fast-track the research and development (R&D) of new products (e.g. diagnostics, vaccines, therapeutics).

.

Zika Strategic Response Framework Announcement
Zika Outbreak: WHO’s Global Emergency Response Plan
Global prevention and control strategy
16 February 2016
WHO has launched a global Strategic Response Framework and Joint Operations Plan to guide the international response to the spread of Zika virus infection and the neonatal malformations and neurological conditions associated with it.

The strategy focuses on mobilizing and coordinating partners, experts and resources to help countries enhance surveillance of the Zika virus and disorders that could be linked to it, improve vector control, effectively communicate risks, guidance and protection measures, provide medical care to those affected and fast-track research and development of vaccines, diagnostics and therapeutics.

WHO says $56 million is required to implement the Strategic Response Framework and Joint Operations Plan, of which $25 million would fund the WHO/AMRO/PAHO response and $31 million would fund the work of key partners. In the interim, WHO has tapped a recently established emergency contingency fund to finance its initial operations.

As part of WHO’s new emergency programme, the agency’s headquarters activated an Incident Management System to oversee the global response and leverage expertise from across the organization to address the crisis.

WHO’s Regional Office for the Americas (AMRO/PAHO) has been working closely with affected countries since May 2015, when the first reports of Zika virus disease emerged from northeastern Brazil. AMRO/PAHO and partner specialists were deployed to help health ministries detect and track the virus, contain its spread, advise on clinical management of Zika and investigate the spikes in microcephaly and Guillain-Barré syndrome in areas where Zika outbreaks have occurred.

AMRO/PAHO will continue to work with partners to manage the response in the Americas.
WHO is issuing regular information and guidance on the congenital and neurological conditions associated with Zika virus disease, as well as related health, safety and travel issues.

Working with partners, WHO is also mapping efforts to develop vaccines, therapies, diagnostic tests and new vector control tactics and putting in place mechanisms to expedite data sharing, product development and clinical trials…

.
WHO – Press Conference: update on global response to Microcephaly (Geneva, 19 February 2016)
WHO update on global response to microcephaly, neurological disorders and Zika virus.
[Video: 1:09:31]
WHO has launched a global prevention and control strategy to guide its international response to the spread of Zika virus infection and the neonatal malformations and neurological conditions associated with it.

The strategy includes working with partners to investigate and respond to increases in microcephaly and other neurological disorders in areas where there are also Zika outbreaks, to contain the spread of Zika virus, and fast track R & D, and boost preparedness in at risk countries.

Zika has catalysed immediate action to put into place some of the practical processes that will underpin WHO’s new programme on outbreaks and emergencies.

WHO will also give an overview of the vector control measures that work to prevent Zika.
Speakers:
:: Dr Bruce Aylward, Executive Director, Outbreaks and Health Emergencies (ai), WHO
:: Dr Pedro Alonso, Director Global Malaria Programme, WHO

.
WHO activities on Zika R&D
Dr Marie-Paule Kieny, Assistant Director-General, Health Systems and Innovation
16 February 2016
Commentary [Excerpt; Editor’s text bolding]
The Ebola outbreak of 2014-15 highlighted the need for a master plan for research and development (R&D) to both prepare for health emergencies and to be able to mount a fast response in case of need. The World Health Organization’s “R&D Blueprint” aims to accelerate the availability of medical countermeasures during epidemics and limit damage as much as possible. We have now established critical paths for coordinated action and industry interest in providing platform technologies for the development of medical products.

Our relatively poor knowledge of the Zika virus presents a series of challenges for research and development. However, building on experience from the Ebola epidemic, WHO has been able to set in motion a rapid R&D response for Zika.

We have already identified a large number of manufacturers and research institutions either involved in the development of medical tools for Zika, or interested in embarking on such research.
Embarking on vaccine and diagnostic research

Numerous groups are looking at the feasibility of initiating animal or human testing, particularly for vaccines and diagnostics.

For vaccines, the landscape is evolving swiftly, and numbers change daily. About 15 companies and research groups have been identified so far, though most have only just started work.

Two vaccine candidates seem to be at a more advanced stage: a DNA vaccine from the US and an inactivated product from India.

Still, the current absence of standardized animal models and reagents is a hindrance. And although the landscape is encouraging, it will be at least 18 months before vaccines could be tested in large-scale trials.

For diagnostics, 10 biotech companies have been identified so far that can provide nucleic acid or serological tests. Nucleic acid tests are based on a molecular technique used to detect a virus in the blood; serological tests measure the levels of antibodies as a result of exposure to a particular virus…

.
WHO: Zika, Microcephaly, and Guillain–Barré syndrome situation report
19 February 2016
Read the full situation report
Summary
:: Between January 2007 and 17 February 2016, a total of 41 countries and territories reported local (autochthonous) transmission of Zika virus, including those where the outbreak is now over. One country (United States of America) reported a locally acquired case without vector-borne transmission, likely to have been contracted by sexual contact, and indirect evidence of local transmission has been documented in six additional countries. Two new countries/ territories have reported local transmission in the week running up to 17 February 2016 (Aruba and Bonaire).

:: Geographical distribution of Zika virus has steadily broadened since the virus was first detected in the Americas in 2015. Zika transmission has been reported in 28 countries /territories. The discovery of Zika virus in additional countries within the geographical range of competent mosquito vectors — especially Aedes aegypti— is considered likely.

:: Six countries/territories (Brazil, French Polynesia, El Salvador, Venezuela, Colombia and Suriname) have reported an increase in the incidence of cases of microcephaly and/or Guillain-Barré syndrome (GBS) following a Zika virus outbreak. Microcephaly has so far been reported only from Brazil and French Polynesia. Puerto Rico and Martinique have also reported cases of GBS associated with Zika virus infection, but without evidence of an overall increase in the incidence of GBS.

:: Evidence that neurological disorders, including microcephaly and GBS, are linked to Zika virus infection remains circumstantial, but a growing body of clinical and epidemiological data possibly leans towards a causal role for Zika virus.

:: The global prevention and control strategy launched by WHO as a Strategic Response Framework (SRF) encompasses surveillance, response activities, and research. Following consultation with partners and taking changes in caseload into account, the SRF will be updated at the end of March 2016 to reflect epidemiological evidence coming to light and the evolving division of roles and responsibilities for tackling this emergency.

:: From 2007 to 11 February 2016, Zika virus transmission was documented in a total of 48 countries/territories (Fig. 1 and Fig. 2). This includes 36 countries which reported local transmission between 2015 and 2016, six countries with indirect evidence of viral circulation, five countries with reported terminated outbreaks and one country with a locally acquired case but without vector-borne transmission (Table 1). Two new countries/territories – Aruba and Bonaire – reported autochthonous transmission in the week running up to 17 February 2016.

.
WHO: Maintaining a safe and adequate blood supply during Zika virus outbreaks, interim guidance
Publication date: February 2016 :: 4 pages
ISBN: WHO/ZIKV/HS/16.1
Pdf: Safe-blood_supply18Feb2016.pdf pdf, 290kb
Overview
These guidelines have been developed in recognition that infection with Zika virus may present a risk to blood safety, and in consideration of the declaration on 1 February 2016 by the WHO Director-General of a Public Health Emergency of International Concern with regard to clusters of microcephaly and other neurological disorders, potentially associated with Zika virus. Currently there is limited knowledge of Zika virus biology and lack of definitive evidence of a link between infection and potential complications. These guidelines will be regularly reviewed and updated as new information becomes available.

.
FDA [to 20 February 2016]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
February 16, 2016
FDA issues recommendations to reduce the risk for Zika virus blood transmission in the United States
As a safety measure against the emerging Zika virus outbreak, today the U.S. Food and Drug Administration issued a new guidance recommending the deferral of individuals from donating blood if they have been to areas with active Zika virus transmission, potentially have been exposed to the virus, or have had a confirmed Zika virus infection.

“The FDA has critical responsibilities in outbreak situations and has been working rapidly to take important steps to respond to the emerging Zika virus outbreak,” said Luciana Borio, M.D., the FDA’s acting chief scientist. “We are issuing this guidance for immediate implementation in order to better protect the U.S. blood supply.”

While there have been no reports to date of Zika virus entering the U.S. blood supply, the risk of blood transmission is considered likely based on the most current scientific evidence of how Zika virus and similar viruses (flaviviruses) are spread and recent reports of transfusion-associated infection outside of the U.S. Furthermore, about 4 out of 5 of those infected with Zika virus do not become symptomatic. For these reasons, the FDA is recommending that blood establishments defer blood donations from individuals in accordance with the new guidance.

In areas without active Zika virus transmission, the FDA recommends that donors at risk for Zika virus infection be deferred for four weeks. Individuals considered to be at risk include: those who have had symptoms suggestive of Zika virus infection during the past four weeks, those who have had sexual contact with a person who has traveled to, or resided in, an area with active Zika virus transmission during the prior three months, and those who have traveled to areas with active transmission of Zika virus during the past four weeks.

In areas with active Zika virus transmission, the FDA recommends that Whole Blood and blood components for transfusion be obtained from areas of the U.S. without active transmission. Blood establishments may continue collecting and preparing platelets and plasma if an FDA-approved, pathogen-reduction device is used. The guidance also recommends blood establishments update donor education materials with information about Zika virus signs and symptoms and ask potentially affected donors to refrain from giving blood…

PDF: Recommendations for Donor Screening, Deferral, and Product Management to Reduce the Risk of Transfusion-Transmission of Zika Virus; Guidance for Industry (PDF – 111KB)
Posted: 2/16/2016

.
Zika Open
[Bulletin of the World Health Organization]
:: New Papers available here

Update on Zika virus transmission in the Pacific islands, 2007 to February 2016 and failure of acute flaccid paralysis surveillance to signal Zika emergence in this setting
– Adam T Craig, Michelle T Butler, Roberta Pastmore, Beverley J Paterson, David N Durrheim
Posted: 19 February 2016

.
CDC [to 20 February 2016]
http://www.cdc.gov/media/index.html
FRIDAY, FEBRUARY 19, 2016
Updated Guidelines for Healthcare Providers Caring for Infants or Children with Possible Zika Virus Infection
CDC has updated its interim guidelines for healthcare providers who care for infants and children with possible Zika virus infection.

THURSDAY, FEBRUARY 18, 2016
CDC adds 2 destinations 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 added the following destinations to the Zika virus travel notices: Aruba and Bonaire…

MMWR February 19, 2016 / Vol. 65 / No. 6
:: Local Transmission of Zika Virus — Puerto Rico, November 23, 2015–January 28, 2016
:: Notes from the Field: Evidence of Zika Virus Infection in Brain and Placental Tissues from Two Congenitally Infected Newborns and Two Fetal Losses — Brazil, 2015

.
Global Virus Network
http://gvn.org/
February 11, 2016
GVN Launches Zika Task Force
Global Virus Network (GVN) Launches Zika Task Force Comprised of Leading Virus Researchers from Around the Globe
GVN catalyzes international collaborations in an effort to address the urgent need to share information and research to better combat the global Zika outbreak

Baltimore, MD: The Global Virus Network (GVN), representing 35 Centers of Excellence and 5 Affiliates in 26 countries, and comprising foremost experts in every class of virus causing disease in humans, today announced the formation of the GVN Zika Task Force chaired by Scott Weaver, PhD, who is also co-chairman for the GVN Chikungunya Task Force and is director of the University of Texas Medical Branch’s Institute for Human Infections and Immunity and scientific director of the Galveston National Laboratory, a GVN Center of Excellence. The GVN Zika Task force, which is expected to grow, fills a gap identified by leading scientists to catalyze urgent international collaborative research. The announcement was made today by Robert Gallo, MD, co-founder of the GVN and chair of GVN’s Scientific Leadership Board and José Esparza, MD, PhD, president of the GVN.

“I am pleased to chair GVN’s Zika Task Force which will serve as a catalyst for driving communication and information flow between fellow GVN colleagues researching and responding to the Zika epidemic gripping much of Central and South America and the Caribbean,” said Dr. Weaver. “Our research team has been studying Zika virus for several years now, including working with countries such as Senegal to study enzootic ecology as well as Brazil and Mexico in developing sensitive diagnostics to identify those infected and follow the epidemiology of these outbreaks.” Dr. Weaver continued, “We look forward to beginning nonhuman primate model development next month and continuing vaccine research, and to coordinating efforts with others in the GVN Zika Task Force in these efforts.”…

.
World Bank [to 20 February 2016]
http://www.worldbank.org/en/news/all
February 18, 2016
World Bank Provides $150 Million to Combat Zika Virus In Latin America and the Caribbean
Initial regional economic impact projected to be moderate but requires urgent action to halt virus spread
WASHINGTON,— In order to support countries in Latin America and the Caribbean affected by the Zika virus outbreak, the World Bank Group announced today that it has made US$150 million immediately available.

This amount is based on current country demands for financing and follows extensive engagement with governments across the region, including sending teams of technical experts to affected countries. If additional financing is needed, the World Bank Group stands ready to increase its support.

This announcement was accompanied by the release of initial projections that the short-term economic impact of the Zika virus on the region will be modest, totaling US$3.5 billion, or 0.06% of GDP in 2016. The World Bank Group noted, however, that these initial estimates are predicated on a swift, well-coordinated international response to the Zika virus. They also assume that the most significant health risks—and related behaviors to avoid transmission—are for pregnant women. This follows the World Health Organization’s February 1 declaration of the suspected link between Zika virus infection during pregnancy and microcephaly in newborns.

Even with these assumptions, however, a group of countries highly dependent on tourism—notably in the Caribbean—could suffer losses in excess of 1 percent of GDP and may require additional support from the international community to stem the economic impact of the virus. As new knowledge continues to emerge about Zika virus transmission and impact, or should public perceptions of risks from Zika rise sharply, the economic impacts will be reassessed…

EBOLA/EVD [to 20 February 2016]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

.

Ebola Situation Reports
[While no announcement of a change in reporting cycle is evident, we deduce that Ebola Situation Reports have been reduced to a bi-weekly cycle given the spacing of the last few reports (previous update at 3 February 2016)]
Ebola Situation Report – 17 February 2016
SUMMARY [Excerpts]
:: Human-to-human transmission directly linked to the 2014 Ebola virus disease (EVD) outbreak in West Africa was declared to have ended in Sierra Leone on 7 November 2015. The country then entered a 90-day period of enhanced surveillance… On 14 January, 68 days into the 90-day surveillance period, a new confirmed case of EVD was reported after a post-mortem swab collected from a deceased 22-year-old woman tested positive for Ebola virus. On 20 January, the aunt of the index case developed symptoms and tested positive for Ebola virus… All contacts linked to the two cases had completed follow-up by 11 February 2016. Efforts to locate several untraced contacts in the district of Kambia will continue until at least 24 February. If no further cases are detected, transmission linked to this cluster of cases will be declared to have ended on 17 March.

:: Human-to-human transmission linked to the most recent cluster of cases in Liberia was declared to have ended on 14 January 2016. Guinea was declared free of Ebola transmission on 29 December 2015, and is approximately halfway through a 90-day period of enhanced surveillance that is due to end on 27 March 2016.

:: With guidance from WHO and other partners, ministries of health in Guinea, Liberia, and Sierra Leone have plans to deliver a package of essential services to safeguard the health of the estimated more than 10 000 survivors of EVD, and enable those individuals to take any necessary precautions to prevent infection of their close contacts. Over 300 male survivors in Liberia have accessed semen screening and counselling services. In addition, over 2600 survivors in Sierra Leone have accessed a general health assessment and eye exam…

.
WHO Updates
Relief for families impacted by Ebola flare-up
February 2016
Sierra Leone is once again counting down the days until the latest flare-up of Ebola can be declared over. As part of the inter-agency response to the flare-up, dozens of people who were in contact with two individuals who had tested positive for Ebola were isolated and placed under medical observation. With the monitoring period now over, they are breathing a sigh of relief as their lives get back to normal.

.
CDC [to 20 February 2016]
http://www.cdc.gov/media/index.html
THURSDAY, FEBRUARY 18, 2016
Enhanced Entry Airport Screening and Routing for Ebola to End for Travelers from Guinea to the United States
On Feb. 19, 2016, the Centers for Disease Control and Prevention (CDC) and the Department of Homeland Security (DHS) will remove Guinea from the list of nations affected by Ebola…

WHO & Regionals [to 20 February 2016]

Weekly Epidemiological Record (WER) 19 February 2016, vol. 91, 7 (pp. 73–88) –
:: Zika virus infection: global update on epidemiology and potentially associated clinical manifestations
:: Risk communication – A moving target in the fight against infectious hazards and epidemics
:: Monthly report on dracunculiasis cases, January– December 2015

.
:: WHO Regional Offices
WHO African Region AFRO
:: Experts wrap up workshop on cancer registries
Brazzaville 12 February 2016 – Cancer control experts from nineteen French-speaking countries in Africa wrapped up a five-day workshop aimed at building their capacity to tackle the rising tide of cancer in the Region. The workshop which began on 8 February 2016, in Brazzaville, Congo brought together over forty high-level participants from ministries of health. It was organized by the World Health Organization Regional Office for Africa in collaboration with the International Atomic Energy Agency (IAEA), International Agency for Research on Cancer (IARC), African Cancer Registries Network (AFCRN) and the Registre des cancers de Brazzaville…

WHO Region of the Americas PAHO
:: PAHO defines excess levels of sugar, salt and fat in processed food and drink products (02/19/2016)
:: PAHO and EQUATOR Network provide tools in Portuguese to promote excellence in research reporting
(02/19/2016)
:: PAHO aims for faster diagnosis, more integration in combat against Zika, Dengue and Chikungunya viruses
(02/15/2016)

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

WHO European Region EURO
:: Newly updated training aims to improve quality of care for mothers and newborns 19-02-2016
:: Risk assessment of the 2015–2016 influenza season confirms that A(H1N1) is circulating as a seasonal virus but is included in the vaccine 18-02-2016

WHO Eastern Mediterranean Region EMRO
:: WHO reaches 5 besieged areas in Syria with life-saving medicines
19 February 2016
:: WHO condemns multiple attacks on health facilities in the Syrian Arab Republic
17 February 2016 – WHO is appalled at the recent attacks on health care facilities in the Syrian Arab Republic. These attacks have resulted in at least 14 people being killed, including 4 health care workers, and have left many others severely injured. Sadly, such attacks on health facilities and health workers are increasing in both frequency and scale. These attacks have severe immediate and long-term consequences, depriving Syria’s most vulnerable populations of life-saving health care.
:: Is Zika on our doorstep?
17 February 2016

WHO Western Pacific Region
No new digest content identified.

CDC/ACIP [to 20 February 2016]
http://www.cdc.gov/media/index.html
http://www.cdc.gov/vaccines/acip/
[see Zika and Ebola coverage above which includes CDC briefing content]

.
ACIP Meeting – February 24, 2016 (Wednesday only)
Meeting Webcast Instructions
Registration is NOT required to watch the live meeting webcast or to listen via telephone.
DRAFT AGENDA[2 pages] (as of January 25)

.
MMWR February 19, 2016 / Vol. 65 / No. 6
http://www.cdc.gov/mmwr/mmwr_wk.html
:: Update: Influenza Activity — United States, October 4, 2015–February 6, 2016
:: Local Transmission of Zika Virus — Puerto Rico, November 23, 2015–January 28, 2016
:: Notes from the Field: Evidence of Zika Virus Infection in Brain and Placental Tissues from Two Congenitally Infected Newborns and Two Fetal Losses — Brazil, 2015
:: Notes from the Field: Administration Error Involving a Meningococcal Conjugate Vaccine — United States, March 1, 2010–September 22, 2015
:: Notes from the Field: Nosocomial Outbreak of Middle East Respiratory Syndrome in a Large Tertiary Care Hospital — Riyadh, Saudi Arabia, 2015

EU launches new European Medical Corps to respond faster to emergencies
Date: 15/02/2016
The European Union today launches the European Medical Corps to help mobilise medical and public health teams and equipment for emergencies inside and outside the EU

Through the European Medical Corps, EU Member States and other European countries participating in the system can make medical teams and assets available for rapid deployment before an emergency strikes – thus ensuring a faster and more predictable response. The medical corps could include emergency medical teams, public health and medical coordination experts, mobile biosafety laboratories, medical evacuation planes and logistical support teams.

“The aim of the European Medical Corps is to create a much faster and more efficient EU response to health crises when they occur. We need to learn the lessons from the Ebola response; a key difficulty was mobilising medical teams. I thank all the Member States that have already contributed so far, and encourage others to join so the EU’s response will be able to meet increasing needs and will allow for better planning and preparation before any disaster.” said Commissioner Christos Stylianides who is hosting today’s high-level inauguration event in Brussels.

The framework for the European Medical Corps is part of the EU Civil Protection Mechanism’s new European Emergency Response Capacity (otherwise known as the ‘voluntary pool’). So far Belgium, Czech Republic, Finland, France, Luxembourg, Germany, Spain, Sweden and the Netherlands have already committed teams and equipment to the voluntary pool.

Background
A key difficulty during the Ebola virus outbreak response was the quick deployment of medical staff, as well as the logistical and management challenges which increased as a result. This led Germany and France in late 2014 to propose the “White Helmets” initiative, which laid the foundations. The European Medical Corps is now part of the European Emergency Response Capacity.

The EU Civil Protection Mechanism facilitates cooperation in disaster response among 33 European states (28 EU Member States, the former Yugoslav Republic of Macedonia, Iceland, Montenegro, Norway and Serbia). Turkey is also in the process of joining the Mechanism. These participating states pool the resources that can be made available to disaster-stricken countries all over the world. When activated, the Mechanism coordinates the provision of assistance inside and outside the European Union. The European Commission manages the Mechanism through the Emergency Response Coordination Centre.

In an effort to step up the EU’s preparedness and response to disasters, the European Emergency Response Capacity (‘voluntary pool’) was created in 2014, bringing together a range of pre-committed relief teams and equipment, for deployment in emergency response operations all over the world.

The European Medical Corps will also be Europe’s contribution to the Global Health Emergency Workforce being set up under the helm of the World Health Organisation.

:: Fact Sheet – EU launches new European Medical Corps to respond faster to emergencies –
Date: 15/02/2016
:: WHO Director-General launches the European Medical Corps
Brussels, Belgium 15 February 2016

IAVI International AIDS Vaccine Initiative [to 20 February 2016]
http://www.iavi.org/press-releases/2016

.
February 17, 2016
IAVI Announces Continued Funding from Dutch Government
The International AIDS Vaccine Initiative (IAVI) is happy to announce continued funding from the Dutch Government, a longtime partner in the mission to ensure a safe, effective and accessible AIDS vaccine.

The Netherlands Ministry of Foreign Affairs will provide 16 million Euros (approximately US$18 million) to IAVI over five years to help accelerate the development of AIDS vaccine candidates effective for and accessible to the people most impacted by the epidemic, notably those in developing countries. This support under the Product Development Partnership III Fund extends through September 2020…

Sabin Vaccine Institute [to 20 February 2016]
http://www.sabin.org/updates/ressreleases

.
02.16.16
Workshop Pays Off Through Increased Immunization Budgets
In June 2015, immunization officials from Senegal, Mali and Cameroon came together in Dakar, Senegal, to discuss expenditure tracking mechanisms used by countries to improve budget accountability for immunization.

IVI [to 20 February 2016]
http://www.ivi.org/web/www/home

.
5 February, 2016
Dr. In-Kyu Yoon on Yonhap News about Zika
IVI’s Dr. In-Kyu Yoon, IVI Deputy Director General of Science and Director of the Dengue Vaccine Initiative, sat down with a reporter from Yonhap News to answer questions about Zika, which is causing concern in South Korea. Dr. Yoon, who has spent years studying flaviviruses like dengue and Zika, is among the few Zika experts in South Korea.

“The probability of Zika immediately spreading in Korea is very low. However, it remains uncertain what will happen over a period of time and if conditions are met.” Dr. Yoon In-Kyu, Director of the Dengue Vaccine Initiative (DVI) at the International Vaccine Institute (IVI), is a Zika virus expert in South Korea.

In an interview with Yonhap News at IVI on February 4, Dr. Yoon repeated “It is uncertain” several times. He said, “It is because adequate studies have not been conducted yet.” Zika virus generally causes mild febrile illness. Signs and symptoms also entail rash and conjunctivitis…

Global Fund [to 20 February 2016]
http://www.theglobalfund.org/en/news/

.
17 February 2016
Organization of Islamic Cooperation and the Global Fund Strengthen Partnership
JEDDAH, Saudi Arabia – The Secretary General of the Organization of the Islamic Conference (OIC), Iyad Ameen Madani, praised the support that the Global Fund extends to the member states of the OIC.

At a meeting with senior representatives of the Global Fund on 16 February, the Secretary General stressed that the OIC will continue to support the Global Fund’s efforts…

…The Global Fund is a major supporter of health efforts in OIC member states. Today, 50 of the 57 OIC member states are implementing programs supported by the Global Fund to fight diseases and build resilient and sustainable systems for health.

With US$11.3 billion signed in grants, 2.7 million people are currently receiving treatment for HIV, 5.3 million cases of TB have been detected and treated, 320 million mosquito nets have been distributed to prevent malaria and 1.6 million orphans and vulnerable children are receiving basic care and support services.

Center for Global Development [to 20 February 2016]
http://www.cgdev.org/page/press-center
Selected Press Releases, Blog Posts, Publications

.
Next Generation Financing for Global Health: What, Why, When, How?
2/16/16
Amanda Glassman and Rachel Silverman
Many researchers and policymakers have hypothesized that funding models tying grant payments to achieved and verified results — next generation financing models — offer an opportunity for global health funders to push forward their strategic interests and accelerate the impact of their investments. This brief, summarizing the conclusions of a CGD working group on the topic, outlines concrete steps global health funders can take to change the basis of payment of their grants from expenses (inputs) to outputs, outcomes, or impact.

PATH [to 20 February 2016]
http://www.path.org/news/index.php

.
Announcement | February 17, 2016
PATH to host inaugural conference focused on new vaccines against diarrheal disease
Submit an abstract, register for the conference, or apply for a travel grant on the conference website
PATH is convening a new biennial scientific conference series focused on making vaccines for Shigella and enterotoxigenic Escherichia coli (ETEC), two leading causes of diarrheal disease, a reality for children in the developing world. The inaugural Vaccines Against Shigella and ETEC (VASE) Conference will be held June 28 to 30, 2016, in Washington, DC. In order to make this conference as accessible as possible, there is no cost to register to attend and a limited number of travel grants are available.

The VASE Conference will bring together scientists, public health professionals, immunization leaders, vaccine industry representatives, international donors, and other experts from across the globe to work toward the goal of developing and introducing new enteric vaccines. Conference participants will share and discuss various research topics and ideas about vaccines that address human enteric diseases. PATH intends for this meeting to provide a highly collaborative, interactive environment that will spark innovation in the field and boost the momentum for Shigella and ETEC vaccine research and development.

PATH is currently accepting abstracts of original work for presentation at the conference. The deadline for abstract submissions is March 1, 2016. While the primary focus of the conference is on Shigella and ETEC, there are also many other enteric diseases emerging as important causes of illness and death among infants and children in the developing world. For this reason, PATH aims to include broader work on other pathogens in the conference program, so that the field can learn from work across the spectrum of neglected enteric diseases.

Each year, nearly 600,000 children younger than five years of age die from severe, dehydrating diarrhea and dysentery worldwide, and millions more are hospitalized, mostly in low-resource countries. In addition, many more children suffer from diarrheal disease-associated malnutrition and its adverse effects on physical and cognitive development that perpetuate the cycle of poverty. Insufficient data exist, but conservative estimates suggest that Shigella and ETEC are responsible for almost one-third of child deaths from diarrhea, as well as many deaths in older age groups. Prevention through vaccination is a critical part of the strategy to reduce the impact of diarrheal disease, and currently there are no licensed vaccines against either pathogen.
For more information, please visit the VASE Conference website

American Journal of Preventive Medicine
March 2016 Volume 50, Issue 3, p295-426, e65-e90
http://www.ajpmonline.org/current

.
Research Articles
Sex of Sexual Partners and Human Papillomavirus Vaccination Among U.S. Girls and Women
Madina Agénor, Heather L. McCauley, Sarah M. Peitzmeier, Sebastien Haneuse, Allegra R. Gordon, Jennifer Potter, S. Bryn Austin
p318–327
Published online: November 12 2015
Abstract
Introduction
Girls and women are at risk of human papillomavirus (HPV) infection and cervical cancer from male and female sexual partners throughout the life course. However, no study has assessed how sex of sexual partners, a dimension of sexual orientation, may relate to HPV vaccination among girls and women.
Methods
In 2014, data from the 2006–2010 National Survey of Family Growth were used to conduct logistic regression analyses estimating the relationship between sex of lifetime and past-year sexual partners and HPV vaccine awareness and initiation among U.S. girls and women aged 15–25 years (N=3,253).
Results
Among U.S. girls and women aged 15–25 years, the prevalence of HPV vaccine awareness and HPV vaccine initiation was 84.4% and 28.5%, respectively. Adjusting for sociodemographic factors, participants with only female past-year sexual partners had significantly lower odds of initiating HPV vaccination relative to those with only male past-year sexual partners (OR=0.16, 95% CI=0.05, 0.55). Similarly, respondents with no lifetime (OR=0.65, 95% CI=0.46, 0.92) or past-year (OR=0.69, 95% CI=0.50, 0.94) sexual partners had significantly lower adjusted odds of HPV vaccine initiation compared with those with only male sexual partners. No difference was apparent in the odds of initiating HPV vaccination between participants with male and female sexual partners and those with only male sexual partners.
Conclusions
Medical and public health professionals should ensure that girls and women with only female or no sexual partners are included in HPV vaccine education and promotion efforts.

American Journal of Public Health
Volume 106, Issue 3 (March 2016)
http://ajph.aphapublications.org/toc/ajph/current

.
AJPH LAW & ETHICS
EBOLA VACCINE
Ethical Rationale for the Ebola “Ring Vaccination” Trial Design
Annette Rid, Franklin G. Miller
American Journal of Public Health: March 2016, Vol. 106, No. 3: 432–435.
Abstract |
The 2014 Ebola virus epidemic is the largest and most severe ever recorded. With no approved vaccines or specific treatments for Ebola, clinical trials were launched within months of the epidemic in an unprecedented show of global partnership. One of these trials used a highly innovative “ring vaccination” design. The design was chosen for operational, scientific, and ethical reasons—in particular, it was regarded as ethically superior to individually randomized placebo-controlled trials.

We scrutinize the ethical rationale for the ring vaccination design. We argue that the ring vaccination design is ethical but fundamentally equivalent to placebo-controlled designs with respect to withholding a potentially effective intervention from the control group.
We discuss the implications for the ongoing ring vaccination trial and future research.

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 20 February 2016)

.
Research article
Factors influencing completion of multi-dose vaccine schedules in adolescents: a systematic review
K. E. Gallagher, E. Kadokura, L. O. Eckert, S. Miyake, S. Mounier-Jack, M. Aldea, D. A. Ross and D. Watson-Jones
BMC Public Health 2016 16:172
Published on: 19 February 2016
Abstract
Background
Completion of multiple dose vaccine schedules is crucial to ensure a protective immune response, and maximise vaccine cost-effectiveness. While barriers and facilitators to vaccine uptake have recently been reviewed, there is no comprehensive review of factors influencing subsequent adherence or completion, which is key to achieving vaccine effectiveness. This study identifies and summarises the literature on factors affecting completion of multi-dose vaccine schedules by adolescents.
Methods
Ten online databases and four websites were searched (February 2014). Studies with analysis of factors predicting completion of multi-dose vaccines were included. Study participants within 9–19 years of age were included in the review. The defined outcome was completion of the vaccine series within 1 year among those who received the first dose.
Results
Overall, 6159 abstracts were screened, and 502 full texts were reviewed. Sixty one studies were eligible for this review. All except two were set in high-income countries. Included studies evaluated human papillomavirus vaccine, hepatitis A, hepatitis B, and varicella vaccines. Reported vaccine completion rates, among those who initiated vaccination, ranged from 27 % to over 90 %. Minority racial or ethnic groups and inadequate health insurance coverage were risk factors for low completion, irrespective of initiation rates. Parental healthcare seeking behaviour was positively associated with completion. Vaccine delivery in schools was associated with higher completion than delivery in the community or health facilities. Gender, prior healthcare use and socio-economic status rarely remained significant risks or protective factors in multivariate analysis.
Conclusions
Almost all studies investigating factors affecting completion have been carried out in developed countries and investigate a limited range of variables. Increased understanding of barriers to completion in adolescents will be invaluable to future new vaccine introductions and the further development of an adolescent health platform.
PROSPERO reg# CRD42014006765.

.

Research article
Reducing routine vaccination dropout rates: evaluating two interventions in three Kenyan districts, 2014
Adam Haji, S. Lowther, Z. Ngan’ga, Z. Gura, C. Tabu, H. Sandhu and Wences Arvelo
BMC Public Health 2016 16:152
Published on: 16 February 2016
Abstract
Background
Globally, vaccine preventable diseases are responsible for nearly 20 % of deaths annually among children <5 years old. Worldwide, many children dropout from the vaccination program, are vaccinated late, or incompletely vaccinated. We evaluated the impact of text messaging and sticker reminders to reduce dropouts from the vaccination program.
Methods
The evaluation was conducted in three selected districts in Kenya: Machakos, Langata and Njoro. Three health facilities were selected in each district, and randomly allocated to send text messages or provide stickers reminding parents to bring their children for second and third dose of pentavalent vaccine, or to the control group (routine reminder) with next appointment date indicated on the well-child booklet. Children aged <12 months presenting for their first dose of pentavalent vaccine were enrolled. A dropout was defined as not returning for vaccination ≥2 weeks after scheduled date for third dose of pentavalent vaccine. We calculated dropout rate as a percentage of the difference between first and third pentavalent dose.
Results
We enrolled 1,116 children; 372 in each intervention and 372 controls between February and October 2014. Median age was 45 days old (range: 31–99 days), and 574 (51 %) were male. There were 136 (12 %) dropouts. Thirteen (4 %) children dropped out among those who received text messages, 60 (16 %) among who received sticker reminders, and 63 (17 %) among the controls. Having a caregiver with below secondary education [Odds Ratio (OR) 1.8, 95 % Confidence Interval (CI) 1.1–3.2], and residing >5 km from health facility (OR 1.6, CI 1.0–2.7) were associated with higher odds of dropping out. Those who received text messages were less likely to drop out compared to controls (OR 0.2, CI 0.04–0.8). There was no statistical difference between those who received stickers and controls (OR 0.9, CI 0.5–1.6).
Conclusion
Text message reminders can reduce vaccination dropout rates in Kenya. We recommend the extended implementation of text message reminders in routine vaccination services.

.

Research article
The first mile: community experience of outbreak control during an Ebola outbreak in Luwero District, Uganda
A major challenge to outbreak control lies in early detection of viral haemorrhagic fevers (VHFs) in local community contexts during the critical initial stages of an epidemic, when risk of spreading is its highest…
Daniel H. de Vries, Jude T. Rwemisisi, Laban K. Musinguzi, Turinawe E. Benoni, Denis Muhangi, Marije de Groot, David Kaawa-Mafigiri and Robert Pool
BMC Public Health 2016 16:161
Published on: 16 February 2016

BMC Cost Effectiveness and Resource Allocation
http://resource-allocation.biomedcentral.com/
(Accessed 20 February 2016)

.
Research
The economic burden of childhood pneumococcal diseases in The Gambia
Effua Usuf, Grant Mackenzie, Sana Sambou, Deborah Atherly and Chutima Suraratdecha
Published on: 17 February 2016
Abstract
Background
Streptococcus pneumoniae is a common cause of child death. However, the economic burden of pneumococcal disease in low-income countries is poorly described. We aimed to estimate from a societal perspective, the costs incurred by health providers and families of children with pneumococcal diseases.
Methods
We recruited children less than 5 years of age with outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and bacterial meningitis at facilities in rural and urban Gambia. We collected provider costs, out of pocket costs and productivity loss for the families of children. For each disease diagnostic category, costs were collected before, during, and for 1 week after discharge from hospital or outpatient visit.
Results
A total of 340 children were enrolled; 100 outpatient pneumonia, 175 inpatient pneumonia 36 pneumococcal sepsis, and 29 bacterial meningitis cases. The mean provider costs per patient for treating outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and meningitis were US$8, US$64, US$87 and US$124 respectively and the mean out of pocket costs per patient were US$6, US$31, US$44 and US$34 respectively. The economic burden of outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and meningitis increased to US$15, US$109, US$144 and US$170 respectively when family members’ time loss from work was taken into account.
Conclusion
The economic burden of pneumococcal disease in The Gambia is substantial, costs to families was approximately one-third to a half of the provider costs, and accounted for up to 30 % of total societal costs. The introduction of pneumococcal conjugate vaccine has the potential to significantly reduce this economic burden in this society.

British Medical Journal
20 February 2016 (vol 352, issue 8045)
http://www.bmj.com/content/352/8045

.
Research Update
Publication and reporting of clinical trial results: cross sectional analysis across academic medical centers
BMJ 2016; 352 :i637 (Published 17 February 2016)
Abstract
Objective
To determine rates of publication and reporting of results within two years for all completed clinical trials registered in ClinicalTrials.gov across leading academic medical centers in the United States.
Design
Cross sectional analysis.
Setting
Academic medical centers in the United States.
Participants
Academic medical centers with 40 or more completed interventional trials registered on ClinicalTrials.gov.
Methods
Using the Aggregate Analysis of ClinicalTrials.gov database and manual review, we identified all interventional clinical trials registered on ClinicalTrials.gov with a primary completion date between October 2007 and September 2010 and with a lead investigator affiliated with an academic medical center.
Main outcome measures
The proportion of trials that disseminated results, defined as publication or reporting of results on ClinicalTrials.gov, overall and within 24 months of study completion.
Results
We identified 4347 interventional clinical trials across 51 academic medical centers. Among the trials, 1005 (23%) enrolled more than 100 patients, 1216 (28%) were double blind, and 2169 (50%) were phase II through IV. Overall, academic medical centers disseminated results for 2892 (66%) trials, with 1560 (35.9%) achieving this within 24 months of study completion. The proportion of clinical trials with results disseminated within 24 months of study completion ranged from 16.2% (6/37) to 55.3% (57/103) across academic medical centers. The proportion of clinical trials published within 24 months of study completion ranged from 10.8% (4/37) to 40.3% (31/77) across academic medical centers, whereas results reporting on ClinicalTrials.gov ranged from 1.6% (2/122) to 40.7% (72/177).
Conclusions
Despite the ethical mandate and expressed values and mission of academic institutions, there is poor performance and noticeable variation in the dissemination of clinical trial results across leading academic medical centers.

Eurosurveillance
Volume 21, Issue 7, 18 February 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

.
Surveillance report
Hepatitis B vaccination coverage and risk factors associated with incomplete vaccination of children born to hepatitis B surface antigen-positive mothers, Denmark, 2006 to 2010
by A Kunoee, J Nielsen, S Cowan

.
Research Articles
Vaccine effectiveness in preventing laboratory-confirmed influenza in primary care patients in a season of co-circulation of influenza A(H1N1)pdm09, B and drifted A(H3N2), I-MOVE Multicentre Case–Control Study, Europe 2014/15
by M Valenciano, E Kissling, A Reuss, C Rizzo, A Gherasim, J Horváth, L Domegan, D Pitigoi, A Machado, I Paradowska-Stankiewicz, A Bella, A Larrauri, A Ferenczi, Joan O´Donell, M Lazar, P Pechirra, M Korczyńska, F Pozo, A Moren, on behalf of the I-MOVE multicentre case–control team

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 20 February 2016]

.
Research
The 10 largest public and philanthropic funders of health research in the world: what they fund and how they distribute their funds
Roderik F. Viergever and Thom C. C. Hendriks
Published on: 18 February 2016
Abstract
Background
Little is known about who the main public and philanthropic funders of health research are globally, what they fund and how they decide what gets funded. This study aims to identify the 10 largest public and philanthropic health research funding organizations in the world, to report on what they fund, and on how they distribute their funds.
Methods
The world’s key health research funding organizations were identified through a search strategy aimed at identifying different types of funding organizations. Organizations were ranked by their reported total annual health research expenditures. For the 10 largest funding organizations, data were collected on (1) funding amounts allocated towards 20 health areas, and (2) schemes employed for distributing funding (intramural/extramural, project/‘people’/organizational and targeted/untargeted funding). Data collection consisted of a review of reports and websites and interviews with representatives of funding organizations. Data collection was challenging; data were often not reported or reported using different classification systems.
Results
Overall, 55 key health research funding organizations were identified. The 10 largest funding organizations together funded research for $37.1 billion, constituting 40% of all public and philanthropic health research spending globally. The largest funder was the United States National Institutes of Health ($26.1 billion), followed by the European Commission ($3.7 billion), and the United Kingdom Medical Research Council ($1.3 billion). The largest philanthropic funder was the Wellcome Trust ($909.1 million), the largest funder of health research through official development assistance was USAID ($186.4 million), and the largest multilateral funder was the World Health Organization ($135.0 million). Funding distribution mechanisms and funding patterns varied substantially between the 10 largest funders.
Conclusions
There is a need for increased transparency about who the main funders of health research are globally, what they fund and how they decide on what gets funded, and for improving the evidence base for various funding models. Data on organizations’ funding patterns and funding distribution mechanisms are often not available, and when they are, they are reported using different classification systems. To start increasing transparency in health research funding, we have established http://www.healthresearchfunders.org that lists health research funding organizations worldwide and their health research expenditures.

Journal of Epidemiology & Community Health
March 2016, Volume 70, Issue 3
http://jech.bmj.com/content/current

.

Editorial
Methods to estimate maternal mortality: a global perspective
Serena Donati, Alice Maraschini, Marta Buoncristiano, the Regional Maternal Mortality Working Group
Author Affiliations
National Centre for Epidemiology, Surveillance, and Health Promotion—Istituto Superiore di Sanità, Italian National Institute of Health, Rome Italy
Extract
The maternal mortality ratio (MMR) is globally a reproductive health core indicator, and the death of a woman, while pregnant or within 42 days of termination of pregnancy, is always, anywhere and anyway, a tragedy for the entire community. Reducing the MMR is one of the Millennium Development Goals and the UN Global strategy for women’s and children’s health mobilised multiple resources and commitments to accelerate this objective.1 However MMR estimates and accurate identification of the causes of maternal death are still a complex and difficult challenge. In most developing country settings, owing to the lack of complete and accurate civil registration systems, MMR estimates are based on data from a variety of alternative sources including censuses, household surveys, reproductive age mortality studies and verbal autopsies.2 The WHO classified 183 countries/territories according to the availability and quality of maternal mortality data: 67 countries (covering 17% of births) having complete civil registration data with good attribution of causes of death, 96 countries (covering 81% of births) having incomplete civil registration and/or other types of maternal mortality data and 20 countries (covering 2% of births) lacking national data on maternal mortality. For the last two categories, a regression model has been developed to estimate maternal mortality figures.3 The Demographic and Health Surveys Program4 uses the sisterhood method for Maternal Mortality estimations. This method remains the major source of empirical data on maternal mortality in developing countries, although it presents notable limitations.

Journal of Epidemiology & Community Health
March 2016, Volume 70, Issue 3
http://jech.bmj.com/content/current

.

Ebola, jobs and economic activity in Liberia
Jeremy Bowles, Jonas Hjort, Timothy Melvin, Eric Werker
J Epidemiol Community Health 2016;70:271-277 Published Online First: 5 October 2015 doi:10.1136/jech-2015-205959
Abstract
Background
The 2014 Ebola virus disease (EVD) outbreak in the neighbouring West African countries of Guinea, Liberia and Sierra Leone represents the most significant setback to the region’s development in over a decade. This study provides evidence on the extent to which economic activity declined and jobs disappeared in Liberia during the outbreak.
Methods
To estimate how the level of activity and number of jobs in a given set of firms changed during the outbreak, we use a unique panel data set of registered firms surveyed by the business-development non-profit organisation, Building Markets. We also compare the change in economic activity during the outbreak, across regions of the country that had more versus fewer Ebola cases in a difference-in-differences approach.
Findings
We find a large decrease in economic activity and jobs in all of Liberia during the Ebola outbreak, and an especially large decline in Monrovia. Outside of Monrovia, the restaurants, and food and beverages sectors have suffered the most among the surveyed sectors, and in Monrovia, the construction and restaurant sectors have shed the most employees, while the food and beverages sectors experienced the largest drop in new contracts. We find little association between the incidence of Ebola cases and declines in economic activity outside of Monrovia.
Conclusions
If the large decline in economic activity that occurred during the Ebola outbreak persists, a focus on economic recovery may need to be added to the efforts to rebuild and support the healthcare system in order for Liberia to regain its footing.

Journal of Epidemiology & Community Health
March 2016, Volume 70, Issue 3
http://jech.bmj.com/content/current

.

Immunisation coverage in rural–urban migrant children in low and middle-income countries (LMICs): a systematic review and meta-analysis
Abiyemi Benita Awoh, Emma Plugge
J Epidemiol Community Health 2016;70:305-311 Published Online First: 7 September 2015 doi:10.1136/jech-2015-205652
Abstract
Background
The majority of children who die from vaccine-preventable diseases (VPDs) live in low-income and-middle-income countries (LMICs). With the rapid urbanisation and rural–urban migration ongoing in LMICs, available research suggests that migration status might be a determinant of immunisation coverage in LMICs, with rural–urban migrant (RUM) children being less likely to be immunised.
Objectives
To examine and synthesise the data on immunisation coverage in RUM children in LMICs and to compare coverage in these children with non-migrant children.
Methods A multiple database search of published and unpublished literature on immunisation coverage for the routine Expanded Programme on Immunisation (EPI) vaccines in RUM children aged 5 years and below was conducted. Following a staged exclusion process, studies that met the inclusion criteria were assessed for quality and data extracted for meta-analysis.
Results
Eleven studies from three countries (China, India and Nigeria) were included in the review. There was substantial statistical heterogeneity between the studies, thus no summary estimate was reported for the meta-analysis. Data synthesis from the studies showed that the proportion of fully immunised RUM children was lower than the WHO bench-mark of 90% at the national level. RUMs were also less likely to be fully immunised than the urban-non-migrants and general population. For the individual EPI vaccines, all but two studies showed lower immunisation coverage in RUMs compared with the general population using national coverage estimates.
Conclusions
This review indicates that there is an association between rural–urban migration and immunisation coverage in LMICs with RUMs being less likely to be fully immunised than the urban non-migrants and the general population. Specific efforts to improve immunisation coverage in this subpopulation of urban residents will not only reduce morbidity and mortality from VPDs in migrants but will also reduce health inequity and the risk of infectious disease outbreaks in wider society.

The Lancet
Feb 20, 2016 Volume 387 Number 10020 p717-816
http://www.thelancet.com/journals/lancet/issue/current

.
Editorial
An ambitious agenda for humanity
The Lancet
As highlighted in today’s Lancet, protracted conflicts continue to harm human health and wellbeing. In Yemen, 21 million of 24 million people are now in need of humanitarian assistance and 15 million lack access to health care (see World Report). In Syria, despite a recent ceasefire agreement, fighting looks set to continue into its sixth year. A letter in this issue draws attention to the plight of the 1 million Syrian children who have been orphaned by the war.

.

Comment
Zika virus and microcephaly: why is this situation a PHEIC?
David L Heymann, Abraham Hodgson, Amadou Alpha Sall, David O Freedman, J Erin Staples, Fernando Althabe, Kalpana Baruah, Ghazala Mahmud, Nyoman Kandun, Pedro F C Vasconcelos, Silvia Bino, K U MenonPublished Online: 10 February 2016
Summary
When the Director-General of WHO declared, on Feb 1, 2016, that recently reported clusters of microcephaly and other neurological disorders are a Public Health Emergency of International Concern (PHEIC),1 it was on the advice of an Emergency Committee of the International Health Regulations and of other experts whom she had previously consulted. We are the members of the Emergency Committee, and we were identified by the Director-General from rosters of experts that had been submitted by WHO Member States.

.

Health Policy
Moving towards universal health coverage: lessons from 11 country studies
Michael R Reich, Joseph Harris, Naoki Ikegami, Akiko Maeda, Cheryl Cashin, Edson C Araujo, Keizo Takemi, Timothy G Evans
Summary
In recent years, many countries have adopted universal health coverage (UHC) as a national aspiration. In response to increasing demand for a systematic assessment of global experiences with UHC, the Government of Japan and the World Bank collaborated on a 2-year multicountry research programme to analyse the processes of moving towards UHC. The programme included 11 countries (Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam), representing diverse geographical, economic, and historical contexts. The study identified common challenges and opportunities and useful insights for how to move towards UHC. The study showed that UHC is a complex process, fraught with challenges, many possible pathways, and various pitfalls—but is also feasible and achievable. Movement towards UHC is a long-term policy engagement that needs both technical knowledge and political know-how. Technical solutions need to be accompanied by pragmatic and innovative strategies that address the national political economy context.

New England Journal of Medicine
February 18, 2016 Vol. 374 No. 7
http://www.nejm.org/toc/nejm/medical-journal

.
Perspective
Zika Virus in the Americas — Yet Another Arbovirus Threat
A.S. Fauci and D.M. Morens
[Extract; Free full text]
The explosive pandemic of Zika virus infection occurring throughout South America, Central America, and the Caribbean and potentially threatening the United States is the most recent of four unexpected arrivals of important arthropod-borne viral diseases in the Western Hemisphere over the past 20 years. It follows dengue, which entered this hemisphere stealthily over decades and then more aggressively in the 1990s; West Nile virus, which emerged in 1999; and chikungunya, which emerged in 2013. Are the successive migrations of these viruses unrelated, or do they reflect important new patterns of disease emergence? Furthermore, are there secondary health consequences of this arbovirus pandemic that set it apart from others?..

Original Articles
Clinical Management of Ebola Virus Disease in the United States and Europe
T.M. Uyeki and Others

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 20 February 2016)

.
Essay
The Health Care Consequences Of Australian Immigration Policies
John-Paul Sanggaran, Bridget Haire, Deborah Zion
Essay | published 16 Feb 2016 | PLOS Medicine
10.1371/journal.pmed.1001960
Summary Points
:: In Australia, immigration policy is to incarcerate those seeking asylum in order to deter others from coming.
:: Within this environment, health care providers frequently experience “dual loyalty” conflict, whereby they cannot serve the interests of both their patients and their employers.
:: The ratification of the Optional Protocol to the Convention Against Torture (OPCAT) would allow for domestic and international monitoring of places of detention, which would serve to ameliorate some of the most problematic aspects of the detention system, including the undemocratic lack of transparency.
:: This would assist in resolving the “dual loyalty” conflict that health care workers must contend with in the current situation.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 20 February 2016)

.
Research Article
Concerted Efforts to Control or Eliminate Neglected Tropical Diseases: How Much Health Will Be Gained?
Sake J. de Vlas, Wilma A. Stolk, Epke A. le Rutte, Jan A. C. Hontelez, Roel Bakker, David J. Blok, Rui Cai, Tanja A. J. Houweling, Margarete C. Kulik, Edeltraud J. Lenk, Marianne Luyendijk, Suzette M. Matthijsse, William K. Redekop, Inge Wagenaar, Julie Jacobson, Nico J. D. Nagelkerke, Jan H. Richardus
Research Article | published 18 Feb 2016 | PLOS Neglected Tropical Diseases
10.1371/journal.pntd.0004386
Abstract
Background
The London Declaration (2012) was formulated to support and focus the control and elimination of ten neglected tropical diseases (NTDs), with targets for 2020 as formulated by the WHO Roadmap. Five NTDs (lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths and trachoma) are to be controlled by preventive chemotherapy (PCT), and four (Chagas’ disease, human African trypanosomiasis, leprosy and visceral leishmaniasis) by innovative and intensified disease management (IDM). Guinea worm, virtually eradicated, is not considered here. We aim to estimate the global health impact of meeting these targets in terms of averted morbidity, mortality, and disability adjusted life years (DALYs).
Methods
The Global Burden of Disease (GBD) 2010 study provides prevalence and burden estimates for all nine NTDs in 1990 and 2010, by country, age and sex, which were taken as the basis for our calculations. Estimates for other years were obtained by interpolating between 1990 (or the start-year of large-scale control efforts) and 2010, and further extrapolating until 2030, such that the 2020 targets were met. The NTD disease manifestations considered in the GBD study were analyzed as either reversible or irreversible. Health impacts were assessed by comparing the results of achieving the targets with the counterfactual, construed as the health burden had the 1990 (or 2010 if higher) situation continued unabated.
Principle Findings/Conclusions
Our calculations show that meeting the targets will lead to about 600 million averted DALYs in the period 2011–2030, nearly equally distributed between PCT and IDM-NTDs, with the health gain amongst PCT-NTDs mostly (96%) due to averted disability and amongst IDM-NTDs largely (95%) from averted mortality. These health gains include about 150 million averted irreversible disease manifestations (e.g. blindness) and 5 million averted deaths. Control of soil-transmitted helminths accounts for one third of all averted DALYs. We conclude that the projected health impact of the London Declaration justifies the required efforts.
Author Summary
Neglected tropical diseases (NTDs) are a group of infectious diseases that occur mostly in poor, warm countries. NTDs are caused by various bacteria and parasites, such as worms. They can either be cured or prevented through drugs and other interventions, such as control of insects that spread the infection. The London Declaration is a statement by various organizations, including the World Health Organization (WHO) and pharmaceutical companies that donate the necessary drugs. The declaration endorses targets for disease reductions by 2020, as recently formulated in the WHO Roadmap, to be achieved by rigorous application of available interventions. We explore how much health can be gained if these targets are indeed achieved. We estimate that in such case 5 million deaths can be averted before 2030 and also that huge reductions in ill-health and disability can be realized. Over the period 2011–2030, a total health gain would be accomplished of about 600 million disability adjusted life years (DALYs) averted. DALYs are a measure of disease burden, consisting of life years lost and years lived with disability. This enormous health gain seems to justify similar investments as for e.g. HIV or malaria control.

Science
19 February 2016 Vol 351, Issue 6275
http://www.sciencemag.org/current.dtl

.
Perspectives
Beyond Ebola
By Janet Currie, Bryan Grenfell, Jeremy Farrar
Science19 Feb 2016 : 815-816
[Free full text]
Summary
On 14 January 2016, Liberia was declared Ebola-free. A new case was identified shortly after the announcement, but it is nevertheless clear that the West African epidemic has moved on to a more hopeful phase. What lessons can be drawn from the Ebola crisis to help the international community to prepare for and respond to the next global epidemic? This question is particularly pertinent given the recent declaration of the Zika virus as a public health emergency.

Vaccine
Volume 34, Issue 9, Pages 1139-1232 (24 February 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/9
.

Conference report
Beyond efficacy: The full public health impact of vaccines
Pages 1139-1147
Mitra Saadatian-Elahi, Olaf Horstick, Robert F. Breiman, Bradford D. Gessner, Duane J. Gubler, Jacques Louis, Umesh D. Parashar, Roberto Tapia, Valentina Picot, Jean-Antoine Zinsou, Christopher B. Nelson
Abstract
There is an active discussion in the public health community on how to assess and incorporate, in addition to safety and measures of protective efficacy, the full public health value of preventive vaccines into the evidence-based decision-making process of vaccine licensure and recommendations for public health use. The conference “Beyond efficacy: the full public health impact of vaccines in addition to efficacy measures in trials” held in Annecy, France (June 22–24, 2015) has addressed this issue and provided recommendations on how to better capture the whole public health impact of vaccines.
Using key examples, the expert group stressed that we are in the midst of a new paradigm in vaccine evaluation, where all aspects of public health value of vaccines beyond efficacy should be evaluated. To yield a wider scope of vaccine benefits, additional measures such as vaccine preventable disease incidence, overall efficacy and other outcomes such as under-five mortality or non-etiologically confirmed clinical syndromes should be assessed in addition to traditional efficacy or effectiveness measurements. Dynamic modelling and the use of probe studies should also be considered to provide additional insight to the full public health value of a vaccine. The use of burden reduction and conditional licensure of vaccines based on collection of outcome results should be considered by regulatory agencies.

Vaccine
Volume 34, Issue 9, Pages 1139-1232 (24 February 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/9
.

Brief report
Trends in differences between births and surviving infants reported for immunization program planning and external data sources in Eastern and Southern Africa 2000–2013
Pages 1148-1151
Reinhard Kaiser, Jethro M. Chakauya, Messeret E. Shibeshi, Immunization, Vaccines, Emergencies Unit of the Inter-country Support Team for East, Southern Africa, World Health Organization Regional Office for Africa, Harare, Zimbabwe
Abstract
To inform our WHO team’s support for immunization programs in Member States in Eastern and Southern Africa, we compared annual trends from 2000 to 2013 in target populations reported by Member States through the WHO-UNICEF joint reporting form with United Nations (UN) population projections and modeled infant mortality estimates from the UN Inter-agency Group for Child Mortality Estimation. Our findings indicated a tendency of underestimating births and surviving infants used by Member States as denominators for administrative immunization coverage rates, resulting in or contributing to overestimation of coverage. The difference with UN estimates appeared to be more pronounced for surviving infants than births. Measures of central tendency for individual country differences indicated that those differences decreased over time. Comparing trends of births and surviving infants with external sources can help monitoring progress in efforts to provide accurate and reliable target population estimates and sampling frames.

Vaccine
Volume 34, Issue 9, Pages 1139-1232 (24 February 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/9
.

Provider communication and HPV vaccination: The impact of recommendation quality
Original Research Article
Pages 1187-1192
Melissa B. Gilkey, William A. Calo, Jennifer L. Moss, Parth D. Shah, Macary W. Marciniak, Noel T. Brewer
Abstract
Background
Receiving a healthcare provider’s recommendation is a strong predictor of HPV vaccination, but little is known empirically about which types of recommendation are most influential. Thus, we sought to investigate the relationship between recommendation quality and HPV vaccination among U.S. adolescents.
Methods
In 2014, we conducted a national, online survey of 1495 parents of 11–17-year-old adolescents. Parents reported whether providers endorsed HPV vaccination strongly, encouraged same-day vaccination, and discussed cancer prevention. Using an index of these quality indicators, we categorized parents as having received no, low-quality, or high-quality recommendations for HPV vaccination. Separate multivariable logistic regression models assessed associations between recommendation quality and HPV vaccine initiation (≥1 dose), follow through (3 doses, among initiators), refusal, and delay.
Results
Almost half (48%) of parents reported no provider recommendation for HPV vaccination, while 16% received low-quality recommendations and 36% received high-quality recommendations. Compared to no recommendation, high-quality recommendations were associated with over nine times the odds of HPV vaccine initiation (23% vs. 74%, OR = 9.31, 95% CI, 7.10–12.22) and over three times the odds of follow through (17% vs. 44%, OR = 3.82, 95% CI, 2.39–6.11). Low-quality recommendations were more modestly associated with initiation (OR = 4.13, 95% CI, 2.99–5.70), but not follow through. Parents who received high- versus low-quality recommendations less often reported HPV vaccine refusal or delay.
Conclusions
High-quality recommendations were strongly associated with HPV vaccination behavior, but only about one-third of parents received them. Interventions are needed to improve not only whether, but how providers recommend HPV vaccination for adolescents.

Vaccine
Volume 34, Issue 9, Pages 1139-1232 (24 February 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/9
.

Evaluation of measles–rubella vaccination for mothers in early puerperal phase
Original Research Article
Pages 1208-1214
Michi Hisano, Tatsuo Kato, Eisuke Inoue, Haruhiko Sago, Koushi Yamaguchi
Abstract
Background
The postpartum period is an ideal opportunity to vaccinate mothers with inadequate immunity to vaccine-preventable diseases including measles and rubella.
Methods
A prospective study of measles–rubella (MR) vaccination in the early puerperal phase was conducted in 171 mothers, who had insufficient antibody titers when screened for immunity to measles (≤1:4 on the neutralization test [NT]) or rubella (≤1:16 on the hemagglutination inhibition [HI] test) during pregnancy. To evaluate the efficacy of MR vaccination in the postpartum period, we determined their post-vaccination antibody titers and immune responses to vaccination, and investigated the association between these and their prolactin (PRL) levels and Th1/Th2 ratios at the time of vaccination. We also examined the passage of viral RNA and antigen into breast milk.
Results
Of the 169 participants who completed the study schedule, 117 and 101 had low antibody titers against measles and rubella, respectively. In the measles-seronegative group, the antibody-positive rate was 87% on the NT assay, and the NT geometric mean antibody titer was 11.4 (95% confidence interval [CI], 10.0–13.0). In the rubella-seronegative group, the antibody-positive rate was 88% on the HI test assay, and the HI geometric mean antibody titer was 64.0 (95% CI, 53.9–76.0). There was no association between the post-vaccination antibody titers and the PRL levels or Th1/Th2 ratios at the time of vaccination. In the rubella-seronegative group, subjects with higher Th1/Th2 ratios showed higher rates of responsiveness than those with lower ratios (P = 0.045). Although measles virus RNA was isolated from the breast milk of two vaccinated mothers, breastfeeding was not associated with clinical disease in any infants.
Conclusion
MR vaccination in the early puerperal phase is considered an effective way to prevent the diseases, regardless of the mother’s immunological status and hormonal milieu.

International Journal of Cancer
15 April 2016 Volume 138, Issue 8
http://onlinelibrary.wiley.com/doi/10.1002/ijc.v138.8/issuetoc
Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)

.
Research Article
Quadrivalent HPV vaccine effectiveness against high-grade cervical lesions by age at vaccination: A population-based study
Eva Herweijer1,*, Karin Sundström2, Alexander Ploner1, Ingrid Uhnoo3, Pär Sparén1 and
Lisen Arnheim-Dahlström1
DOI: 10.1002/ijc.30035
Abstract
Human papillomavirus (HPV) types 16/18, included in HPV vaccines, contribute to the majority of cervical cancer, and a substantial proportion of cervical intraepithelial neoplasia (CIN) grades 2/3 or worse (CIN2+/CIN3+) including adenocarcinoma in situ or worse. The aim of this study was to quantify the effect of quadrivalent HPV (qHPV) vaccination on incidence of CIN2+ and CIN3+. A nationwide cohort of girls and young women resident in Sweden 2006-2013 and aged 13-29 (n=1,333,691) was followed for vaccination and histologically confirmed high-grade cervical lesions. Data were collected using the Swedish nationwide healthcare registers. Poisson regression was used to calculate incidence rate ratios (IRRs) and vaccine effectiveness [(1-IRR)x100%] comparing fully vaccinated with unvaccinated individuals. IRRs were adjusted for attained age and parental education, and stratified on vaccination initiation age. Effectiveness against CIN2+ was 75% (IRR=0.25, 95%CI=0.18-0.35) for those initiating vaccination before age 17, and 46% (IRR=0.54, 95%CI=0.46-0.64) and 22% (IRR=0.78, 95%CI=0.65-0.93) for those initiating vaccination at ages 17-19, and at ages 20-29, respectively. Vaccine effectiveness against CIN3+ was similar to vaccine effectiveness against CIN2+. Results were robust for both women participating to the organized screening program and for women at pre-screening ages. We show high effectiveness of qHPV vaccination on CIN2+ and CIN3+ lesions, with greater effectiveness observed in girls younger at vaccination initiation. Continued monitoring of impact of HPV vaccination in the population is needed in order to evaluate both long-term vaccine effectiveness and to evaluate whether the vaccination program achieves anticipated effects in prevention of invasive cervical cancer.

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_13 February 2016

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

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

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