POLIO [to 5 December 2015]
Public Health Emergency of International Concern (PHEIC)

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GPEI Update: Polio this week as of 2 December 2015
http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: The Organisation of Islamic Cooperation (OIC) reaffirmed their commitment to poliovirus eradication, urged all countries affected by polio to implement their National Emergency Action Plans, and called for the necessary financial resources to finish the job, at the Fifth Session of the Islamic Conference of Health Ministers.

:: Commonwealth leaders united in Malta to recommit to ending polio. The theme of this year’s Commonwealth meeting was ‘Adding Global Value’. Eradicating polio will not only be a major public health success, it will also mean global savings of more than US$50 billion over the next 20 years.

:: Polio surveillance continues to improve in Afghanistan. Strengthening the surveillance networks to ensure that any poliovirus transmission is detected remains vital to the success of the polio endgame.

:: In Afghanistan in the year 2015, until 21 November, stool specimens from a total 2,399 children were tested. By then, 16 of these children had been found to be infected with wild poliovirus.

:: In 2015, wild poliovirus transmission is at the lowest levels ever, with fewer cases reported from fewer areas of fewer countries than ever before. In 2015 so far, 60 wild poliovirus cases have been reported from two countries (Pakistan and Afghanistan), compared to 316 cases from nine countries during the same period in 2014

[Selected elements from Country-level reports]
Afghanistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week, in Kunar province, with onset of paralysis on 3 November. This is the first case in Kunar province since January 2014. The total number of WPV1 cases for 2015 is 17.
:: One new WPV1 environmental positive sample was reported in the past week, collected on 25 October from Mandacool district of Asadabad province.

Pakistan
:: Two new wild poliovirus type 1 (WPV1) cases were reported in the past week, the first with onset of paralysis on 30 October in the Federally Administered Tribal Areas (FATA) and the second with onset on 2 November in Sindh province. The total number of WPV1 cases for 2015 is now 43.
:: Three new environmental samples positive for WPV1 were reported in the last week, one each from Jacobabad, Peshawar and Karachi, from samples collected on 4, 11 and 15 November respectively.

Lao People’s Democratic Republic
:: One new case of circulating vaccine-derived poliovirus type 1 (cVDPV1) was reported in the past week. The case was reported from Saysomboun district in Xaysomboune province, and had onset of paralysis on 28 October. This is the most recent date of onset. The total number of cVDPV1 cases in 2015 is now five. Outbreaks of cVDPVs can arise in areas with low population immunity, emphasizing the importance of maintaining strong vaccination coverage. Learn more about VDPVs.
:: An emergency outbreak response is continuing in the country, with particular focus on three high-risk provinces. The first Subnational Immunization Days (SNIDs) using trivalent oral polio vaccine (OPV) targeted an expanded age group of children under the age of fifteen in the three most high risk districts, and children under the age of ten elsewhere. According to independent monitoring conducted in the high-risk areas, coverage of 85-95% was achieved, with 5-15%…
:: In neighbouring countries, notably Thailand and Vietnam, both surveillance and immunization activities have been stepped up, particularly in border areas.

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UN: Polio Outbreak in Ukraine Is a State of Emergency
By The Associated Press
KIEV, Ukraine — Dec 1, 2015, 11:24 AM ET
The World Health Organization is urging Ukraine’s health ministry to declare a state of emergency due to a polio outbreak, a move meant to prompt more action from the government in Kiev.
In September, Ukraine announced two polio cases — the first in Europe since 2010.
The U.N. health agency recommended that Ukraine declare a state of emergency and “respond to the polio outbreak as quickly and effectively as possible,” Dorit Nitzan, head of the WHO’s office in Ukraine, told journalists.
Half of Ukraine’s children have not been vaccinated against polio…

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Building Bridges for Healthier Ummah
Draft Resolution No. 2/5-ICHM – On Healthy Life Style, Prevention and Control of Communicable and Non-Communicable Diseases, and Health Emergencies and Disasters
The Fifth Session of the Islamic Conference of Health Ministers held in Istanbul, Republic of Turkey, from 17 to19 November, 2015;

[Excerpt from Resolution]
Communicable Diseases
3. Reaffirms the support of all OIC Member States for the goal of global polio eradication and the full implementation of the Polio Eradication and Endgame Strategic Plan 2013-18 to protect all children from life-long polio paralysis;

4. Calls upon the polio affected countries to fully implement their National Emergency Action Plans for polio eradication and ensure that all children are consistently reached and vaccinated; effective implementation of vaccination campaigns will require regular oversight of polio eradication efforts by Government leaders, and a “whole of Government” approach to raise community awareness, address concerns, and successfully and safely access and vaccinate all children;

5. Reiterates its support for the religious injunctions (Fatwas) of the International Islamic Fiqh Academy regarding the safety and acceptability in Islam of polio vaccination and declaring it a duty of all parents and communities to protect children and to allow health workers to carry out their duty in safety;

6. Calls on the International Islamic Fiqh Academy and the Islamic Advisory Group (IAG) on polio eradication to continue to work closely with the Global Polio Eradication Initiative, polio-affected Members States and religious and community leaders to help address challenges regarding community perceptions on vaccinations, on the safety and acceptance of vaccines, and to help secure access to all children for immunization;

7. Calls upon all Member States and international development partners, including the Islamic Development Bank (IDB), the Saudi Fund for Development, and philanthropic organizations, in particular those in the Islamic world, to provide the necessary financial support to eradicate polio from the remaining OIC Member States and to help strengthen routine immunization efforts;

8. Further calls upon the Member States to work towards the SDG target of ending, by 2030, the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases…

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First doses of Injectable Polio Vaccine ShanIPV™ soon available for Indian infants
November 30, 2015
– This new polio vaccine is manufactured by Shantha in Hyderabad, India –
– Both Sanofi Pasteur and Shantha are to provide the majority of doses for the introduction of IPV in India, a key step towards polio eradication

Lyon, France – November 30, 2015 – Sanofi Pasteur, the vaccines division of Sanofi, announced today that the first shipment of ShanIPV™, a brand new injectable, inactivated polio vaccine (IPV) manufactured by its affiliate Shantha Biotechnics, in Hyderabad, India, will occur in a couple of days. These first vaccine doses will be available to implement one dose of IPV in India’s immunization schedule for all infants.

Today, India is officially introducing IPV in their national immunization schedule, to supplement the iconic “drops on sugar” of oral polio vaccine (OPV). Over 20 million newborns will eventually benefit from this new vaccine every year. This is a critical step towards a polio-free future, a prospect that is now very close. India’s 2014 certification as polio-free reassured experts that the decades-long global fight against polio was finally drawing to an end. Sanofi Pasteur and its affiliate Shantha Biotechnics will together produce most of India’s IPV supply.

“With the introduction of IPV in their immunization schedule, India moves the world much closer to being polio-free”, said Olivier Charmeil, President and CEO of Sanofi Pasteur. “As a company deeply rooted in India, we are very proud that vaccines produced by both Sanofi Pasteur and Shantha will be used in this vital step towards a polio-free world. We have worked as partners of the government of India for many years, with this day in mind.”

Only two countries in the world are still classified as polio endemic, meaning that wild polio virus passes routinely between members of the community. However, great progress has been made in both countries and the last case of polio in the world may possibly be only months away. “Ours will be the last generation to see the horror of children paralyzed or killed by polio. I am sure,” said Pr Jacob John (Former Christian Medical College, Vellore, Tamil Nadu, India). “Maybe we will remember 2015 as the year we took the final step to eradicate this disease forever.”…

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Introduction Of Inactivated Polio Vaccine (IPV) In Nepal
A PUBLIC HEALTH MILESTONE FOR POLIO FREE NEPAL
UNICEF, WHO
DECEMBER, 2015 :: 48 pages
Pdf: http://reliefweb.int/sites/reliefweb.int/files/resources/748913046413035946-documentation-on-ipv-introduction-in-nepal-final.pdf
Overview
This publication has been jointly authored by Child Health Division, Department of Health Services, UNICEF and WHO. It captures a comprehensive process of Inactivated Polio Vaccine (IPV) introduction in Nepal. In September 2014, Nepal introduced one dose of Inactivated Poliomyelitis Vaccine (IPV) at 14 weeks of age into its national routine immunization schedule. In doing so, Nepal became the first country in South Asia – and the first GAVI-supported country in the world to do so.
This document describes the process leading to the introduction of IPV in Nepal. Introduction of a new vaccine into a country consists of numerous steps and support/endorsement from multiple stakeholders at the policy level. In addition to lessons from previous introductions, Nepal utilized a policy framework developed by Orin, et al. (2010) which is based on the existing set of WHO guidelines for new vaccine introduction and the experience with acceleration the introduction of Hib, pneumococcal and rota virus vaccine. The proposed framework is based on observations of the process and drivers of new vaccine adoption in GAVI-eligible countries such as Nepal.

WHO & Regionals [to 5 December 2015]

Improving the quality of care at birth
4 December 2015 — Worldwide, the majority of maternal and newborn deaths occur around the time of birth, typically within the first 24 hours after childbirth. Most of these deaths are preventable. WHO’s new “Safe Childbirth Checklist and Implementation Guide” targets the major causes of maternal and newborn complications and deaths, including post-partum haemorrhage, infection, obstructed labour, preeclampsia and birth asphyxia.
Press release on the safe child birth checklist

First ever global estimates of foodborne diseases
3 December 2015 — Almost one third (30%) of all deaths from foodborne diseases are in children under the age of 5 years, despite the fact that they make up only 9% of the global population. This is among the findings of WHO’s “Estimates of the global burden of foodborne diseases” – the most comprehensive report to date on the impact of contaminated food on health and wellbeing. The report estimates the burden of foodborne diseases caused by 31 agents – bacteria, viruses, parasites, toxins and chemicals.
Read the press release
Global Alert and Response (GAR) – Disease Outbreak News (DONs)
:: 4 December 2015 Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
:: 3 December 2015 Zika virus infection – Venezuela
:: 3 December 2015 Zika virus infection – Mexico
:: 3 December 2015 Zika virus infection – Paraguay
Weekly Epidemiological Record (WER) 04 December 2015, vol. 90, 49 (pp. 661–680) includes;
661 African Programme for Onchocerciasis Control: progress report, 2014–2015
675 Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2015

IVB
:: Request for proposals Develop Design and Budget for Pilot Implementation of Malaria Vaccine
3 December 2015 Information and submission of proposals pdf, 101kb
Application deadline: 31 December 2015

:: Request for proposals: Group B streptococcus briefing document
2 December 2015 Information and submission of proposals pdf, 100kb
Deadline for application: 30 December 2015

:: GIN November 2015 pdf, 2.09Mb
30 November 2015
:: WHO Regional Offices
WHO African Region AFRO
No new digest content identified.

WHO Region of the Americas PAHO
:: The health challenges posed by urbanization must be addressed through cross-sector policies, experts say (12/03/2015)
:: PAHO/WHO and Foreign Medical Teams Examine How to Strengthen Emergency Response to Outbreaks and Disasters (12/01/2015)
:: Data from 17 countries and territories in the Americas point to elimination of mother-to-child transmission of HIV and syphilis (11/30/2015)

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

WHO European Region EURO
:: More than 23 million people in the WHO European Region fall ill from unsafe food every year 03-12-2015
:: Papers invited for Public Health Panorama 30-11-2015

WHO Eastern Mediterranean Region EMRO
No new digest content identified.

WHO Western Pacific Region
No new digest content identified.

CDC/ACIP [to 5 December 2015]
http://www.cdc.gov/media/index.html

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Transcript for CDC Telebriefing: Daily Pill Prevents HIV
WEDNESDAY, NOVEMBER 25, 2015
New CDC estimates underscore the need to increase awareness of a daily pill that can prevent HIV infection

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MMWR Weekly – December 4, 2015 / No. 47/ Volume (64) No. 47
http://www.cdc.gov/mmwr/index2015.html
:: Announcement: National Influenza Vaccination Week — December 6–12, 2015

UNICEF [to 5 December 2015]
http://www.unicef.org/media/media_78364.html

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Nepal: Serious shortage of essential supplies threatens millions of children this winter – UNICEF
KATHMANDU, Nepal, 30 November 2015 – More than 3 million children under the age of 5 in Nepal are at risk of death or disease during the harsh winter months due to a severe shortage of fuel, food, medicines and vaccines, UNICEF warns.

In the past 10 weeks, vital imports of essential commodities have been severely restricted at Nepal’s southern border due to unrest over the country’s new constitution.
The government’s regional medical stores have already run out of BCG vaccines against tuberculosis. Stocks of other vaccines and antibiotics are critically low…

…”The risks of hypothermia and malnutrition, and the shortfall in life-saving medicines and vaccines, could be a potentially deadly combination for children this winter,” said UNICEF

…Fears are also growing that the rising dependence on firewood because of the fuel crisis is increasing indoor pollution, which in turn could lead to a spike in cases of pneumonia. Last year more than 800,000 children under five suffered from the condition in Nepal and around 5,000 died.

Gavi [to 5 December 2015]
http://www.gavialliance.org/library/news/press-releases/

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New support for measles vaccine to help save more than one million lives
Gavi Board approves ambitious package to tackle highly-infectious disease
Geneva, 3 December 2015 – A new package of support for measles and rubella immunisation, approved today by the Board of Gavi, the Vaccine Alliance, will contribute towards saving more than a million lives. The decision marks a significant step forward in the approach to tackling measles and rubella in developing countries.

Despite progress over the past decade, global targets to eliminate measles are significantly off-track. The disease still claims the lives of more than 100,000 people worldwide every year, most of them children under 5 years of age. The disease is so infectious that an unvaccinated person could catch measles in a doctor’s waiting room hours after an infected person has left the building. Communities with measles vaccination coverage rates lower than 90-95% are at risk of fast-spreading outbreaks, leading to numerous fatalities.

Gavi’s revised strategy will help consolidate the currently fragmented approach to tackling measles in developing countries, underpinned by strong routine immunisation programmes with high coverage. This will put countries firmly on the road towards controlling the disease; they will also be able to take advantage of children’s visits to health facilities for measles vaccinations to increase coverage rates of other vaccines.

Gavi will support periodic, data-driven measles and rubella campaigns to ensure children who have not been reached through routine immunisation are protected, as well as supporting parts of the Measles & Rubella Initiative’s (M&RI) work to tackle any outbreaks. Under the new approach, these campaigns will be better planned and synchronised with other immunisation activities and be more targeted at the hardest to reach children. They will also be independently monitored.

Countries will be required to have a five-year rolling measles and rubella plan, as part of their long term routine immunisation plans, which will be updated annually…

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Gavi Board thanks Dagfinn Høybråten for inspirational leadership
03 December 2015
Gavi Board Chair steps down after five years of unparalleled achievement.

Nepal research has lessons for global vaccination efforts
3 Dec 2015
Oxford University researchers are making important progress evaluating the impact of an important new programme to save the lives of children in Nepal, which is being discussed in Geneva this week.

Gavi – the Global Alliance for Vaccines and Immunization – is meeting in Geneva to discuss progress on its plans to vaccinate an additional 300 million children by 2020. The Oxford team are working on assessment of the introduction of new vaccines in one of the world’s poorest countries.

The latest work is built on ten years’ partnership between Oxford University’s Oxford Vaccine Group, Kathmandu’s Patan Academy of Health Sciences and New Zealand’s Otago University. Together they have studied the spread and prevention of serious bacterial infections in Nepali children. Nepal is one of the world’s least economically developed countries in the world and infection-related illness imposes a high burden on its society and economy. Infections are particularly an issue for children less than five years of age, with pneumonia the leading cause of death for the age group.

Oxford’s Professor Andrew Pollard explained: ‘Vaccination is key to preventing fatal and serious infectious diseases in childhood – and throughout life. With limited resources, Nepal needs to make sure that any vaccines it introduces will be effective. We have worked with the Nepali doctors to assess a vaccine against Hib, an important cause of meningitis and pneumonia, and that vaccine is now part of Nepal’s expanded programme of immunisations.

‘We also looked at different ways to use a pneumonia vaccine that protects against ten types of pneumococcus, a common bacteria that can also cause pneumonia and meningitis. Our study with the team in Nepal showed that a programme of two doses of the vaccine in early life and one at nine months was a more effective way to prevent infections. The Nepalese Government adopted that programme last year.’

The team are now carrying out a four year evaluation to assess the impact of the pneumonia vaccine programme, funded by Gavi. This important follow-up impact study will look at the number of children hospitalised with meningitis and pneumonia as well as the number of children in Kathmandu carrying the pneumococcal bacteria.

The funding has also enabled the team to provide extra training to microbiology technicians at Patan hospital, enabling them to identify different strains of pneumococcus to improve monitoring of the bug and so strengthen efforts to limit its impact.

Professor Pollard said: ‘Gavi aims to reach 300 million more children with vaccines between 2016 and 2020, preventing a further five to six million more deaths. The information from Nepal regularly feeds into a global database, allowing researchers to spot emerging trends and perhaps identify weaknesses in the bacteria that we can target. The four-year study will also provide in-depth understanding of the effectiveness of vaccination in Nepal. That can provide lessons for vaccination efforts worldwide and ensure we meet the 300 million target.’

Global Fund [to 5 December 2015]
http://www.theglobalfund.org/en/news/

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New Toolkit for Differentiated Care in HIV and TB Programs
04 December 2015
HARARE, Zimbabwe – The Global Fund presented a toolkit to help partners implement differentiated care approaches in HIV and TB investments with the aim of maximizing cost efficiency and better serving the different needs of various communities most affected by diseases.

Unveiled at the International Conference on AIDS and sexually transmitted diseases in Africa (ICASA), the toolkit is intended to support country program managers and managers of health facilities by gathering examples of good practices at health facilities that seek to increase the quality and efficiency of service delivery.

The toolkit includes a section on how to best use data to emphasize the importance of supporting differentiated care with accurate data collection and analysis for planning and modifying approaches. It also provides information and practical steps on how health centres can develop differentiated approaches from testing and counselling to treatment and care to drug delivery.

The tool kit was based on innovative work from health facilities in Senegal, Uganda, Kenya and elsewhere, and also based on models of care pioneered by Médecins Sans Frontières and The AIDS Support Organisation in Uganda. It was developed in collaboration with a wide range of in-country and global partners, including Ministry of Health officials, the Bill & Melinda Gates Foundation, World Health Organization, the President’s Emergency Program for AIDS Relief, UNAIDS, the StopTB Partnership, and the International AIDS Society…

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Global Fund Embraces Fast-Track Approach on AIDS
30 November 2015
GENEVA – To mark World AIDS Day on 1 December, the Global Fund to Fight AIDS, Tuberculosis and Malaria declared its strong support for Fast-Track, the smart approach by UNAIDS to end the epidemic by 2030.

In a new report, “On the Fast-Track to end AIDS by 2030: Focus on location and population,” UNAIDS identifies all the most critical factors: the need to front-load investments; to focus on the locations, populations and programs that deliver the greatest impact; to catalyze innovation; engage local leadership; to creates new partnerships, to stand firm on human rights, and to deliver results that leave no one behind.

UNAIDS and the Global Fund work together closely, and are achieving impressive results in partnership. Antiretroviral therapy has grown from 4 percent coverage in 2005 in countries where the Global Fund invests to 21 percent in 2010 and 40 percent in 2014…

IAVI International AIDS Vaccine Initiative [to 5 December 2015]
http://www.iavi.org/press-releases/2015

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IAVI Marks World AIDS Day with Expert Panel Discussion in New York City
December 4, 2015
NEW YORK — Expert leaders from five diverse local, national and international organizations underscored the urgent need to work together to end AIDS, during a lively panel discussion Tuesday evening.

The panelists represented a broad cross-section from the frontlines of the battle against HIV/AIDS: Mary T. Bassett, Commissioner of the New York City Department of Health and Mental Hygiene; Mark Feinberg, President & CEO, the International AIDS Vaccine Initiative (IAVI); Charles King, President & CEO, Housing Works and Co-Chair of Governor Cuomo’s New York State End-AIDS Task Force; Kelsey Louie, CEO, GMHC and Member, Governor Cuomo’s New York State End-AIDS Task Force; and Chase Strangio, Staff Attorney, ACLU LGBT & AIDS Project.

They gathered at the Housing Works Bookstore Café in Manhattan for “It’s About Time: Together We Can End AIDS,” a World AIDS Day event that drew about 200 attendees. It was moderated by Mo Rocca, correspondent for CBS Sunday Morning…

Johnson & Johnson Marks World AIDS Day with Major New Global Commitments to End HIV Infection in Adolescent Girls and Women
NEW BRUNSWICK, N.J., Dec. 1, 2015 /PRNewswire/ — Building on its 25-year legacy in the fight against HIV/AIDS, Johnson & Johnson (NYSE: JNJ) today announced four new public-private partnerships through its Janssen Pharmaceutical Companies to significantly reduce the burden of HIV incidence, especially among adolescent girls, who make up 74 percent of new HIV infections among adolescents in sub-Saharan Africa1. Announced on World AIDS Day, these new initiatives include collaborations with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Clinton Health Access Initiative (CHAI) and the International Partnership for Microbicides (IPM), all focused on efforts to stem the tide of HIV infection and empower women and girls in HIV prevention…

Organization of Islamic Cooperation (OIC) [to 5 December 2015]
http://www.oic-oci.org/oicv2/news/
Selected Press Releases

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First Expert Meeting of the OIC Network on Population and Reproductive, Maternal, New-born and Child Health
The First Expert Meeting of the OIC Network on Population and Reproductive, Maternal, New-born and Child Health (OIC MHNet) was held in Ankara, Turkey, on 2-4 December 2015…
…The meeting is participated by a group of interdisciplinary experts in this area from OIC region who engage in collective efforts to share information and knowledge in an endeavor to improve OIC MHNet…
The meeting is the first step in the establishment of the OIC Network, which will serve as a deposit of innovative ideas, problem solving and best practices as well as a platform for disseminating knowledge to OIC countries. Members of the Network engaged in joint activities and discussions, and disseminate and exchange innovative ideas, best practices and viable means of addressing challenges to improve the health of mothers and children in OIC member countries.
04/12/2015

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International coalition on vaccines approved as member of OIC health committee
An international coalition of partners committed to saving children’s lives and protecting people’s health by increasing access to immunization [Gavi] has been officially approved as a member of the OIC’s Steering Committee on Health…
01/12/2015

Sabin Vaccine Institute [to 5 December 2015]
http://www.sabin.org/updates/pressreleases

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UK Government Allocates £1 billion to Combat Malaria, Other Infectious Diseases
Wednesday, November 25, 2015
The Sabin Vaccine Institute (Sabin) and its UK sister organization Sabin Foundation Europe, released the following statement on the UK government’s allocation of £1 billion for malaria and other infectious diseases. This funding will be distributed through the newly-developed Ross Fund, created by the Department for International Development (DFID) in collaboration with the Bill and Melinda Gates Foundation.
The £1 billion fund will include a £300 million package focused on malaria and other infectious diseases, including:
:: A £90 million eradication of malaria implementation fund;
: £100 million support for research and development into products for infectious diseases; and
:: £115 million to develop new drugs, diagnostics and insecticides for malaria, TB and other infectious disease resistance.
In addition, the Ross Fund will be used to target neglected tropical diseases (NTDs) and diseases with epidemic potential and emerging resistance.

Sabin and Sabin Foundation Europe are encouraged by the UK government’s investment in global health programs, despite austerity measures taking place across UK government departments and an increasing international focus on emerging humanitarian threats. The allocation of these funds demonstrates the government’s commitment to improving health worldwide and fighting diseases that primarily plague the world’s poorest populations.

The Ross Fund is an important development for global efforts to combat malaria, and will have positive implications for research and development for infectious and neglected diseases. DFID is doing remarkable work, supporting NTD programs to treat lymphatic filariasis (elephantiasis), onchocerciasis (river blindness), schistosomiasis and Guinea worm. The case for continuing to use and scale-up currently-available high-impact treatments remains clear; however, there is a need to consider future needs by investing in novel technologies, including the development of new affordable drugs, vaccines and point-of care technologies, if we are to achieve elimination of some of these diseases…

PATH [to 5 December 2015]
http://www.path.org/news/index.php

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Announcement | December 02, 2015
Ensuring access to oxygen therapy for children in low-resource settings
Consultation brings together manufacturers, distributors, and international partners focused on improving access to medical devices needed to prevent deaths among young children with pneumonia.

American Journal of Infection Control
December 2015 Volume 43, Issue 12, p1269-1382, e83-e106
http://www.ajicjournal.org/current

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Personal protective equipment for the Ebola virus disease: A comparison of 2 training programs
Enrique Casalino, Eugenio Astocondor, Juan Carlos Sanchez, David Enrique Díaz-Santana, Carlos del Aguila, Juan Pablo Carrillo
p1281–1287
Published online: August 12 2015

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Current vaccination status regarding measles among university students in Dresden, Germany
Henna Riemenschneider, Jeannine Schübel, Antje Bergmann, Joachim Kugler, Karen Voigt
p1363–1365
Published in issue: December 01 2015

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 5 December 2015)

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Research article
Knowledge and attitudes towards rotavirus diarrhea and the vaccine amongst healthcare providers in Yogyakarta Indonesia
Holly Seale, Mei Sitaresmi, Jarir Atthobari, Anita Heywood, Rajneesh Kaur, Raina MacIntyre, Yati Soenarto, Retna Padmawati
BMC Health Services Research 2015, 15:528 (30 November 2015)

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 5 December 2015)

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Research article
Volunteer experiences and perceptions of the informed consent process: Lessons from two HIV clinical trials in Uganda
Agnes Ssali, Fiona Poland, Janet Seeley
BMC Medical Ethics 2015, 1
Abstract
Background
Informed consent as stipulated in regulatory human research guidelines requires that a volunteer is well-informed about what will happen to them in a trial. However researchers are faced with a challenge of how to ensure that a volunteer agreeing to take part in a clinical trial is truly informed. We conducted a qualitative study among volunteers taking part in two HIV clinical trials in Uganda to find out how they defined informed consent and their perceptions of the trial procedures, study information and interactions with the research team.
Methods
Between January and December 2012, 23 volunteers who had been in the two trials for over 6 months, consented to be interviewed about their experience in the trial three times over a period of nine months. They also took part in focus group discussions. Themes informed by study research questions and emerging findings were used for content analysis.
Results
Volunteers defined the informed consent process in terms of their individual welfare. Only two of the volunteers reported having referred during the trial to the participant information sheets given at the start of the trial. Volunteers remembered the information they had been given at the start of the trial on procedures that involved drawing blood and urine samples but not information about study design and randomisation. Volunteers said that they had understood the purpose of the trial. They said that signing a consent form showed that they had consented to take part in the trial but they also described it as being done to protect the researcher in case a volunteer later experienced side effects.
Conclusion
Volunteers pay more attention during the consent process to procedures requiring biological tests than to study design issues. Trust built between volunteers and the research team could enhance the successful conduct of clinical trials by allowing for informal discussions to identify and review volunteers’ perceptions. These results point to the need for researchers to view informed consent as a process rather than an event.

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Debate
Is it ethical to prevent secondary use of stored biological samples and data derived from consenting research participants? The case of Malawi
Randy Mungwira, Wongani Nyangulu, James Misiri, Steven Iphani, Ruby Ng’ong’ola, Chawanangwa Chirambo, Francis Masiye, Joseph Mfutso-Bengo
BMC Medical Ethics 2015, 16:83 (2 December 2015)

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Research article
Readiness of ethics review systems for a changing public health landscape in the WHO African Region
Marion Motari, Martin Ota, Joses Kirigia BMC Medical Ethics 2015, 16:82 (2 December 2015)
Abstract
Background
The increasing emphasis on research, development and innovation for health in providing solutions to the high burden of diseases in the African Region has warranted a proliferation of studies including clinical trials. This changing public health landscape requires that countries develop adequate ethics review capacities to protect and minimize risks to study participants. Therefore, this study assessed the readiness of national ethics committees to respond to challenges posed by a globalized biomedical research system which is constantly challenged by new public health threats, rapid scientific and technological advancements affecting biomedical research and development, delivery and manufacture of vaccines and therapies, and health technology transfer.
Methods
This is a descriptive study, which used a questionnaire structured to elicit information on the existence of relevant national legal frameworks, mechanisms for ethical review; as well as capacity requirements for national ethics committees. The questionnaire was available in English and French and was sent to 41 of the then 46 Member States of the WHO African Region, excluding the five Lusophone Member States. Information was gathered from senior officials in ministries of health, who by virtue of their offices were considered to have expert knowledge of research ethics review systems in their respective countries.
Results
Thirty three of the 41 countries (80.5 %) responded. Thirty (90.9 %) of respondent countries had a national ethics review committee (NEC); 79 % of which were established by law. Twenty-five (83.3 %) NECs had secretarial and administrative support. Over 50 % of countries with NECs indicated a need for capacity strengthening through periodic training on international guidelines for health research (including clinical trials) ethics; and allocation of funds for administrative and secretariat support.
Conclusions
Despite the existing training initiatives, the Region still experiences a shortage of professionals trained in health research ethics/ethicists. Committees continue to face various capacity needs especially for evaluating clinical trials, for monitoring ongoing research, database management and for accrediting institutional ethics committees. Given the growing number of clinical trials involving human participants in the African Region, there is urgent need for supporting countries without NECs to establish them; capacity strengthening where they exist; and creation of a regional network and joint ethical review mechanisms, whose membership would be open to all NECs of the Region.

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 5 December 2015)

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Research article
Benchmarking health system performance across regions in Uganda: a systematic analysis of levels and trends in key maternal and child health interventions, 1990–2011
D. Roberts, Marie Ng, Gloria Ikilezi, Anne Gasasira, Laura Dwyer-Lindgren, Nancy Fullman, Talemwa Nalugwa, Moses Kamya, Emmanuela Gakidou
BMC Medicine 2015, 13:285 (3 December 2015)

BMC Public Health
http://www.biomedcentral.com/bmcpublichealth/content
(Accessed 5 December 2015)

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Research article
The burden of hypertension in sub-Saharan Africa: a four-country cross sectional study
David Guwatudde, Joan Nankya-Mutyoba, Robert Kalyesubula, Carien Laurence, Clement Adebamowo, IkeOluwapo Ajayi, Francis Bajunirwe, Marina Njelekela, Faraja Chiwanga, Todd Reid, Jimmy Volmink, Hans-Olov Adami, Michelle Holmes, Shona Dalal
BMC Public Health 2015, 15:1211 (5 December 2015)

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Research article
Charting the evolution of approaches employed by the Global Alliance for Vaccines and Immunizations (GAVI) to address inequities in access to immunization: a systematic qualitative review of GAVI policies, strategies and resource allocation mechanisms through an equity lens (1999–2014)
Gian Gandhi
BMC Public Health 2015, 15:1198 (30 November 2015)
Abstract
Background
GAVI’s focus on reducing inequities in access to vaccines, immunization, and GAVI funds, − both between and within countries – has changed over time. This paper charts that evolution.
Methods
A systematic qualitative review was conducted by searching PubMed, Google Scholar and direct review of available GAVI Board papers, policies, and program guidelines. Documents were included if they described or evaluated GAVI policies, strategies, or programs and discussed equity of access to vaccines, utilization of immunization services, or GAVI funds in countries currently or previously eligible for GAVI support. Findings were grouped thematically, categorized into time periods covering GAVI’s phases of operations, and assessed depending on whether the approaches mediated equity of opportunity or equity of outcomes between or within countries.
Results
Serches yielded 2816 documents for assessment. After pre-screening and removal of duplicates, 552 documents underwent detailed evaluation and pertinent information was extracted from 188 unique documents. As a global funding mechanism, GAVI responded rationally to a semi-fixed funding constraint by focusing on between-country equity in allocation of resources. GAVI’s predominant focus and documented successes have been in addressing between-country inequities in access to vaccines comparing lower income (GAVI-eligible) countries with higher income (ineligible) countries. GAVI has had mixed results at addressing between-country inequities in utilization of immunization services, and has only more recently put greater emphasis and resources towards addressing within-country inequities in utilization to immunization services. Over time, GAVI has progressively added vaccines to its portfolio. This expansion should have addressed inter-country, inter-regional, inter-generational and gender inequities in disease burden, however, evidence is scant with respect to final outcomes.
Conclusion
In its next phase of operations, the Alliance can continue to demonstrate its strength as a highly effective multi-partner enterprise, capable of learning and innovating in a world that has changed much since its inception. By building on its successes, developing more coherent and consistent approaches to address inequities between and within countries and by monitoring progress and outcomes, GAVI is well-positioned to bring the benefits of vaccination to previously unreached and underserved communities towards provision of universal health coverage.

BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content
(Accessed 5 December 2015)

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Research article
Characteristics of users of a tailored, interactive website for parents and its impact on adolescent vaccination attitudes and uptake
Amanda Dempsey, Julie Maertens, Brenda Beaty, Sean O’Leary BMC Research Notes 2015, 8:739 (1 December 2015)
Abstract
Background
We examined the characteristics of parents using an iPad-based intervention about vaccines, and its impact on vaccination attitudes and behavior.
Methods
Interventions were implemented in three primary care clinics from June 2012–September 2013. Baseline and follow up surveys assessed vaccination attitudes and intentions. Medical records were used to examine adolescent vaccine uptake.
Results
During the study, 42 parents viewed tailored educational content. Users were generally positive about vaccines, though one out of five worried that vaccines caused more harm than good. Among the 16 parents completing the post-intervention survey, there was a slightly higher, non-statistically significant, mean vaccination intention after viewing the website than prior to viewing it for three of the four adolescent vaccines (all except tetanus–diphtheria–acellular pertussis). Using the intervention did not increase the likelihood of adolescent vaccination.
Conclusions
Providing educational material via iPads in clinic waiting rooms does not appear to be an effective strategy for engaging parents about vaccines. Overall, parents’ interaction with TeenVaxScene was low, and had little impact on their vaccination attitudes and beliefs. However, use of TeenVaxScene did not appear to worsen parents’ attitudes about vaccines. New and creative ideas for engaging parents to use such educational materials are needed.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 5 December 2015]

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Research
Incorporating research evidence into decision-making processes: researcher and decision-maker perceptions from five low- and middle-income countries
Zubin Shroff, Bhupinder Aulakh, Lucy Gilson, Irene Agyepong, Fadi El-Jardali, Abdul Ghaffar Health Research Policy and Systems 2015, 13:70 (30 November 2015)
Abstract
Background
The ‘Sponsoring National Processes for Evidence-Informed Policy Making in the Health Sector of Developing Countries’ program was launched by the Alliance for Health Policy and Systems Research, WHO, in July 2008. The program aimed to catalyse the use of evidence generated through health policy and systems research in policymaking processes through (1) promoting researchers and policy advocates to present their evidence in a manner that is easy for policymakers to understand and use, (2) creating mechanisms to spur the demand for and application of research evidence in policymaking, and (3) increased interaction between researchers, policy advocates, and policymakers. Grants ran for three years and five projects were supported in Argentina, Bangladesh, Cameroon, Nigeria and Zambia. This paper seeks to understand why projects in some settings were perceived by the key stakeholders involved to have made progress towards their goals, whereas others were perceived to have not done so well. Additionally, by comparing experiences across five countries, we seek to illustrate general learnings to inform future evidence-to-policy efforts in low- and middle-income countries.
Methods
We adopted the theory of knowledge translation developed by Jacobson et al. (J Health Serv Res Policy 8(2):94–9, 2003) as a framing device to reflect on project experiences across the five cases. Using data from the projects’ external evaluation reports, which included information from semi-structured interviews and quantitative evaluation surveys of those involved in projects, and supplemented by information from the projects’ individual technical reports, we applied the theoretical framework with a partially grounded approach to analyse each of the cases and make comparisons.
Results and conclusion
There was wide variation across projects in the type of activities carried out as well as their intensity. Based on our findings, we can conclude that projects perceived as having made progress towards their goals were characterized by the coming together of a number of domains identified by the theory. The domains of Jacobson’s theoretical framework, initially developed for high-income settings, are of relevance to the low- and middle-income country context, but may need modification to be fully applicable to these settings. Specifically, the relative fragility of institutions and the concomitantly more significant role of individual leaders point to the need to look at leadership as an additional domain influencing the evidence-to-policy process.

Journal of Global Infectious Diseases (JGID)
October-December 2015 Volume 7 | Issue 4 Page Nos. 125-174
http://www.jgid.org/currentissue.asp?sabs=n

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The Ebola outbreak of 2014-2015: From coordinated multilateral action to effective disease containment, vaccine development, and beyond
Thomas R Wojda1, Pamela L Valenza2, Kristine Cornejo2, Thomas McGinley2, Sagar C Galwankar3, Dhanashree Kelkar3, Richard P Sharpe1, Thomas J Papadimos4, Stanislaw P Stawicki1
1 Department of Surgery, St. Luke’s University Health Network, Bethlehem, Pennsylvania and Phillipsburg, New Jersey, USA
2 Department of Family Medicine, St. Luke’s University Health Network, Bethlehem, Pennsylvania and Phillipsburg, New Jersey, USA
3 Department of Emergency Medicine, University of Florida, Jacksonville, Florida, USA
4 Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
Abstract
The Ebola outbreak of 2014-2015 exacted a terrible toll on major countries of West Africa. Latest estimates from the World Health Organization indicate that over 11,000 lives were lost to the deadly virus since the first documented case was officially recorded. However, significant progress in the fight against Ebola was made thanks to a combination of globally-supported containment efforts, dissemination of key information to the public, the use of modern information technology resources to better track the spread of the outbreak, as well as more effective use of active surveillance, targeted travel restrictions, and quarantine procedures. This article will outline the progress made by the global public health community toward containing and eventually extinguishing this latest outbreak of Ebola. Economic consequences of the outbreak will be discussed. The authors will emphasize policies and procedures thought to be effective in containing the outbreak. In addition, we will outline selected episodes that threatened inter-continental spread of the disease. The emerging topic of post-Ebola syndrome will also be presented. Finally, we will touch on some of the diagnostic (e.g., point-of-care [POC] testing) and therapeutic (e.g., new vaccines and pharmaceuticals) developments in the fight against Ebola, and how these developments may help the global public health community fight future epidemics.

Journal of Infectious Diseases
Volume 212 Issue 12 December 15, 2015
http://jid.oxfordjournals.org/content/current

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BCG Vaccination Enhances the Immunogenicity of Subsequent Influenza Vaccination in Healthy Volunteers: A Randomized, Placebo-Controlled Pilot Study
Jenneke Leentjens, Matthijs Kox, Robin Stokman, Jelle Gerretsen, Dimitri A. Diavatopoulos, Reinout van Crevel, Guus F. Rimmelzwaan, Peter Pickkers, and Mihai G. Netea
J Infect Dis. (2015) 212 (12): 1930-1938 doi:10.1093/infdis/jiv332
Abstract
Background.  Influenza-related morbidity and mortality remain high. Seasonal vaccination is the backbone of influenza management but does not always result in protective antibody titers. Nonspecific effects of BCG vaccination related to enhanced function of myeloid antigen-presenting cells have been reported. We hypothesized that BCG vaccination could also enhance immune responses to influenza vaccination.
Methods. Healthy volunteers received either live attenuated BCG vaccine (n = 20) or placebo (n = 20) in a randomized fashion, followed by intramuscular injection of trivalent influenza vaccine 14 days later. Hemagglutination-inhibiting (HI) antibodies and cellular immunity measured by ex vivo leukocyte responses were assessed.
Results. In BCG-vaccinated subjects, HI antibody responses against the 2009 pandemic influenza A(H1N1) vaccine strain were significantly enhanced, compared with the placebo group, and there was a trend toward more-rapid seroconversion. Additionally, apart from enhanced proinflammatory leukocyte responses following BCG vaccination, nonspecific effects of influenza vaccination were also observed, with modulation of cytokine responses against unrelated pathogens.
Conclusions. BCG vaccination prior to influenza vaccination results in a more pronounced increase and accelerated induction of functional antibody responses against the 2009 pandemic influenza A(H1N1) vaccine strain. These results may have implications for the design of vaccination strategies and could lead to improvement of vaccination efficacy.

The Lancet
Dec 05, 2015 Volume 386 Number 10010 p2227-2364 e46-e55
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
Adolescent health: boys matter too
The Lancet
Summary
It has been a good year for adolescents. Many global health reports and initiatives now mention adolescents. So also does the latest UN Population Fund’s State of the World Population 2015 report, released on Dec 3. Shelter from the Storm: a transformative agenda for women and girls in a crisis-prone world reminds us that there are 26 million women and adolescent girls in their childbearing years in need of humanitarian assistance worldwide. During the past 2 years or so, adolescents have been increasingly included in the women’s and child health agenda, culminating in UN Secretary-General Ban Ki-moon’s updated Global Strategy for Women’s and Children’s Health into the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030), presented on Sept 26 at the General Assembly.

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Articles
Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation
Dr Danzhen You, PhD, Lucia Hug, MA, Simon Ejdemyr, MA, Priscila Idele, PhD, Daniel Hogan, PhD, Colin Mathers, PhD, Patrick Gerland, PhD, Jin Rou New, MA, Leontine Alkema, PhD
for the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME)
Summary
Background
In 2000, world leaders agreed on the Millennium Development Goals (MDGs). MDG 4 called for a two-thirds reduction in the under-5 mortality rate between 1990 and 2015. We aimed to estimate levels and trends in under-5 mortality for 195 countries from 1990 to 2015 to assess MDG 4 achievement and then intended to project how various post-2015 targets and observed rates of change will affect the burden of under-5 deaths from 2016 to 2030.
Methods
We updated the UN Inter-agency Group for Child Mortality Estimation (UN IGME) database with 5700 country-year datapoints. As of July, 2015, the database contains about 17 000 country-year datapoints for mortality of children younger than 5 years for 195 countries, and includes all available nationally-representative data from vital registration systems, population censuses, household surveys, and sample registration systems. We used these data to generate estimates, with uncertainty intervals, of under-5 (age 0–4 years) mortality using a Bayesian B-spline bias-reduction model (B3 model). This model includes a data model to adjust for systematic biases associated with different types of data sources. To provide insights into the global and regional burden of under-5 deaths associated with post-2015 targets, we constructed five scenario-based projections for under-5 mortality from 2016 to 2030 and estimated national, regional, and global under-5 mortality rates up to 2030 for each scenario.
Results
The global under-5 mortality rate has fallen from 90·6 deaths per 1000 livebirths (90% uncertainty interval 89·3–92·2) in 1990 to 42·5 (40·9–45·6) in 2015. During the same period, the annual number of under-5 deaths worldwide dropped from 12·7 million (12·6 million–13·0 million) to 5·9 million (5·7 million–6·4 million). The global under-5 mortality rate reduced by 53% (50–55%) in the past 25 years and therefore missed the MDG 4 target. Based on point estimates, two regions—east Asia and the Pacific, and Latin America and the Caribbean—achieved the MDG 4 target. 62 countries achieved the MDG 4 target, of which 24 were low-income and lower-middle income countries. Between 2016 and 2030, 94·4 million children are projected to die before the age of 5 years if the 2015 mortality rate remains constant in each country, and 68·8 million would die if each country continues to reduce its mortality rate at the pace estimated from 2000 to 2015. If all countries achieve the Sustainable Development Goal of an under-5 mortality rate of 25 or fewer deaths per 1000 livebirths by 2030, we project 56·0 million deaths by 2030. About two-thirds of all sub-Saharan African countries need to accelerate progress to achieve this target.
Interpretation
Despite substantial progress in reducing child mortality, concerted efforts remain necessary to avoid preventable under-5 deaths in the coming years and to accelerate progress in improving child survival further. Urgent actions are needed most in the regions and countries with high under-5 mortality rates, particularly those in sub-Saharan Africa and south Asia.
Funding
None.

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Articles
Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
GBD 2013 Risk Factors Collaborators*
Summary
Background
The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.
Methods
Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.
Findings
All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5–89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.
Interpretation
Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.
Funding
Bill & Melinda Gates Foundation.

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Series
How to eliminate tuberculosis
Data for action: collection and use of local data to end tuberculosis
Grant Theron, Helen E Jenkins, Frank Cobelens, Ibrahim Abubakar, Aamir J Khan, Ted Cohen, David W Dowdy
2324

How to eliminate tuberculosis
Turning off the tap: stopping tuberculosis transmission through active case-finding and prompt effective treatment
Courtney M Yuen, Farhana Amanullah, Ashwin Dharmadhikari, Edward A Nardell, James A Seddon, Irina Vasilyeva, Yanlin Zhao, Salmaan Keshavjee, Mercedes C Becerra
2334

How to eliminate tuberculosis
Controlling the seedbeds of tuberculosis: diagnosis and treatment of tuberculosis infection
Molebogeng X Rangaka, Solange C Cavalcante, Ben J Marais, Sok Thim, Neil A Martinson, Soumya Swaminathan, Richard E Chaisson
2344

How to eliminate tuberculosis
Stopping tuberculosis: a biosocial model for sustainable development
Katrina F Ortblad, Joshua A Salomon, Till Bärnighausen, Rifat Atun
2354

The Lancet Infectious Diseases
Dec 2015 Volume 15 Number 12 p1361-1498
http://www.thelancet.com/journals/laninf/issue/current

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Editorial
Tuberculosis reaches new milestones, good and bad
The Lancet Infectious Diseases
DOI: http://dx.doi.org/10.1016/S1473-3099(15)00431-4
Summary
The 20th instalment of WHO’s Global tuberculosis report was published on Oct 28, 2015, heralded by the headline that tuberculosis mortality had nearly halved over the past 25 years. This positive news was closely followed by the sobering announcement that tuberculosis now ranks alongside HIV among the leading infectious causes of death, with the deaths of 1·5 million people being attributable to the disease. Most of these deaths could have been prevented; in fact, tuberculosis has been a curable disease since the 1950s.

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Comment
Neonatal rotavirus vaccination making headway
Timo Vesikari
Published Online: 26 August 2015
Summary
The randomised trial reported by Julie Bines and colleagues1 in The Lancet Infectious Diseases is a clear step forward in the long history of the Australian neonatal rotavirus vaccine. In 1983, Bishop and colleagues2,3 noted that children who had acquired a rotavirus infection in the neonatal period were protected against severe (but not mild) rotavirus diarrhoea later in life. The study had been made possible because a so-called nursery strain of rotavirus was circulating in a hospital in Melbourne, which was later identified as G3P2A[6] rotavirus and is the origin of the present vaccine designated as RV3-BB.

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Articles
Safety and immunogenicity of RV3-BB human neonatal rotavirus vaccine administered at birth or in infancy: a randomised, double-blind, placebo-controlled trial
Julie E Bines, Margaret Danchin, Pamela Jackson, Amanda Handley, Emma Watts, Katherine J Lee, Amanda West, Daniel Cowley, Mee-Yew Chen, Graeme L Barnes, Frances Justice, Jim P Buttery, John B Carlin, Ruth F Bishop, Barry Taylor, Carl D Kirkwood, RV3 Rotavirus Vaccine Program
Summary
Background
Despite the success of rotavirus vaccines, suboptimal vaccine efficacy in regions with a high burden of disease continues to present a challenge to worldwide implementation. A birth dose strategy with a vaccine developed from an asymptomatic neonatal rotavirus strain has the potential to address this challenge and provide protection from severe rotavirus disease from birth.
Methods
This phase 2a randomised, double-blind, three-arm, placebo-controlled safety and immunogenicity trial was undertaken at a single centre in New Zealand between Jan 13, 2012, and April 17, 2014. Healthy, full-term (≥36 weeks gestation) babies, who weighed at least 2500 g, and were 0–5 days old at the time of randomisation were randomly assigned (1:1:1; computer-generated; telephone central allocation) according to a concealed block randomisation schedule to oral RV3-BB vaccine with the first dose given at 0–5 days after birth (neonatal schedule), to vaccine with the first dose given at about 8 weeks after birth (infant schedule), or to placebo. The primary endpoint was cumulative vaccine take (serum immune response or stool shedding of vaccine virus after any dose) after three doses. The immunogenicity analysis included all randomised participants with available outcome data. This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611001212943.
Findings
95 eligible participants were randomised, of whom 89 were included in the primary analysis. A cumulative vaccine take was detected in 27 (90%) of 30 participants in the neonatal schedule group after three doses of RV3-BB vaccine compared with four (13%) of 32 participants in the placebo group (difference in proportions 0·78, 95% CI 0·55–0·88; p<0·0001). 25 (93%) of 27 participants in the infant schedule group had a cumulative vaccine take after three doses compared with eight (25%) of 32 participants in the placebo group (difference in proportions 0·68, 0·44–0·81; p<0·0001). A serum IgA response was detected in 19 (63%) of 30 participants and 20 (74%) of 27 participants, and stool shedding of RV3-BB was detected in 21 (70%) of 30 participants and 21 (78%) of 27 participants in the neonatal and infant schedule groups, respectively. The frequency of solicited and unsolicited adverse events was similar across the treatment groups. RV3-BB vaccine was not associated with an increased frequency of fever or gastrointestinal symptoms compared with placebo.
Interpretation
RV3-BB vaccine was immunogenic and well tolerated when given as a three-dose neonatal or infant schedule. A birth dose strategy of RV3-BB vaccine has the potential to improve the effectiveness and implementation of rotavirus vaccines.
Funding
Australian National Health and Medical Research Council, the New Zealand Health Research Council, and the Murdoch Childrens Research Institute.

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Immunogenicity of the RTS,S/AS01 malaria vaccine and implications for duration of vaccine efficacy: secondary analysis of data from a phase 3 randomised controlled trial
Michael T White, Robert Verity, Jamie T Griffin, Kwaku Poku Asante, Seth Owusu-Agyei, Brian Greenwood, Chris Drakeley, Samwel Gesase, John Lusingu, Daniel Ansong, Samuel Adjei, Tsiri Agbenyega, Bernhards Ogutu, Lucas Otieno, Walter Otieno, Selidji T Agnandji, Bertrand Lell, Peter Kremsner, Irving Hoffman, Francis Martinson, Portia Kamthunzu, Halidou Tinto, Innocent Valea, Hermann Sorgho, Martina Oneko, Kephas Otieno, Mary J Hamel, Nahya Salim, Ali Mtoro, Salim Abdulla, Pedro Aide, Jahit Sacarlal, John J Aponte, Patricia Njuguna, Kevin Marsh, Philip Bejon, Eleanor M Riley, Azra C Ghani
1450
Open Access
Summary
Background
The RTS,S/AS01 malaria vaccine targets the circumsporozoite protein, inducing antibodies associated with the prevention of Plasmodium falciparum infection. We assessed the association between anti-circumsporozoite antibody titres and the magnitude and duration of vaccine efficacy using data from a phase 3 trial done between 2009 and 2014.
Methods
Using data from 8922 African children aged 5–17 months and 6537 African infants aged 6–12 weeks at first vaccination, we analysed the determinants of immunogenicity after RTS,S/AS01 vaccination with or without a booster dose. We assessed the association between the incidence of clinical malaria and anti-circumsporozoite antibody titres using a model of anti-circumsporozoite antibody dynamics and the natural acquisition of protective immunity over time.
Findings
RTS,S/AS01-induced anti-circumsporozoite antibody titres were greater in children aged 5–17 months than in those aged 6–12 weeks. Pre-vaccination anti-circumsporozoite titres were associated with lower immunogenicity in children aged 6–12 weeks and higher immunogenicity in those aged 5–17 months. The immunogenicity of the booster dose was strongly associated with immunogenicity after primary vaccination. Anti-circumsporozoite titres wane according to a biphasic exponential distribution. In participants aged 5–17 months, the half-life of the short-lived component of the antibody response was 45 days (95% credible interval 42–48) and that of the long-lived component was 591 days (557–632). After primary vaccination 12% (11–13) of the response was estimated to be long-lived, rising to 30% (28–32%) after a booster dose. An anti-circumsporozoite antibody titre of 121 EU/mL (98–153) was estimated to prevent 50% of infections. Waning anti-circumsporozoite antibody titres predict the duration of efficacy against clinical malaria across different age categories and transmission intensities, and efficacy wanes more rapidly at higher transmission intensity.
Interpretation
Anti-circumsporozoite antibody titres are a surrogate of protection for the magnitude and duration of RTS,S/AS01 efficacy, with or without a booster dose, providing a valuable surrogate of effectiveness for new RTS,S formulations in the age groups considered.
Funding
UK Medical Research Council.

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Cost-effectiveness of high-dose versus standard-dose inactivated influenza vaccine in adults aged 65 years and older: an economic evaluation of data from a randomised controlled trial
Ayman Chit, Debbie L Becker, Carlos A DiazGranados, Michael Maschio, Eddy Yau, Michael Drummond
Summary
Background
Adults aged 65 years and older account for most seasonal influenza-related hospital admissions and deaths. Findings from the randomised controlled FIM12 study showed that high-dose inactivated influenza vaccine is more effective than standard-dose vaccine for prevention of laboratory-confirmed influenza in this age group. We aimed to assess the economic impact of high-dose versus standard-dose influenza vaccine in participants in the FIM12 study population.
Methods
The FIM12 study was a head-to-head randomised controlled trial in which 31 989 participants aged 65 years and older were randomly assigned (1:1) to receive either high-dose or standard-dose trivalent inactivated influenza vaccine over two influenza seasons (2011–12 and 2012–13). Data for health-care resource consumption obtained in the FIM12 study were summarised across vaccine groups. Unit costs obtained from standard US cost sources were applied to each resource item, including to the vaccines (high dose US$31·82, standard dose $12·04). Clinical illness data were mapped to existing quality-of-life data. The time horizon was one influenza season; however, quality-adjusted life-years (QALYs) lost due to death during the study were calculated over a lifetime. We calculated incremental cost-effectiveness ratios (ICERs) for high-dose versus standard-dose vaccine and used QALYs as an outcome in the cost-utility analysis. We undertook a probabilistic sensitivity analysis using bootstrapping to explore the effect of statistical uncertainty on the study results.
Findings
Mean per-participant medical costs were lower in the high-dose vaccine group ($1376·72 [SD 6857·59]) than in the standard-dose group ($1492·64 [7447·14]; difference –$115·92 [95% CI −264·18 to 35·48]). Mean societal costs were likewise lower in the high-dose versus the standard-dose group ($1506·48 [SD 7305·19] vs $1634·50 [7952·99]; difference −$128·02 [95% CI −286·89 to 33·30]). Hospital admissions contributed 95% of the total health-care-payer cost and 87% of the total societal costs. The mean per-participant number of hospital admissions was 0·0937 (SD 0·3644) in the high-dose group and 0·1017 (0·3708) in the standard-dose group (difference −0·0080, 95% CI −0·0160 to −0·0003). The high-dose vaccine provided a gain in QALYs (mean 8·1502 QALYs gained per participant [SD 0·5693]) compared with the standard-dose vaccine (8·1499 QALYs [0·5697]) and, due to cost savings, dominated standard-dose vaccine in the cost-utility analysis. The probabilistic sensitivity analysis showed that the high-dose vaccine is 93% likely to be cost saving.
Interpretation
High-dose trivalent inactivated influenza vaccine is a less costly and more effective alternative to the standard-dose vaccine, driven by a reduction in the number of hospital admissions. These findings are relevant to US health-care beneficiaries, providers, payers, and recommending bodies, especially those seeking to improve outcomes while containing costs.
Funding
Sanofi Pasteur.

Maternal and Child Health Journal
Volume 19, Issue 12, December 2015
http://link.springer.com/journal/10995/19/12/page/1

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Original Paper
An Intervention to Enhance Obstetric and Newborn Care in India: A Cluster Randomized-Trial
Shivaprasad S. Goudar, Richard J. Derman
Abstract
Objectives
This study assessed whether community mobilization and interventions to improve emergency obstetric and newborn care reduced perinatal mortality (PMR) and neonatal mortality rates (NMR) in Belgaum, India.
Methods
The cluster-randomised controlled trial was conducted in Belgaum District, Karnataka State, India. Twenty geographic clusters were randomized to control or the intervention. The intervention engaged and mobilized community and health authorities to leverage support; strengthened community-based stabilization, referral, and transportation; and aimed to improve quality of care at facilities.
Results
17,754 Intervention births and 15,954 control births weighing ≥1000 g, respectively, were enrolled and analysed. Comparing the baseline period to the last 6 months period, the NMR was lower in the intervention versus control clusters (OR 0.60, 95 % CI 0.34–1.06, p = 0.076) as was the PMR (OR 0.74, 95 % CI 0.46–1.19, p = 0.20) although neither reached statistical significance. Rates of facility birth and caesarean section increased among both groups. There was limited influence on quality of care measures.
Conclusions for Practice
The intervention had large but not statistically significant effects on neonatal and perinatal mortality. Community mobilization and increased facility care may ultimately improve neonatal and perinatal survival, and are important in the context of the global transition towards institutional delivery.

Nature
Volume 528 Number 7580 pp7-158 3 December 2015
http://www.nature.com/nature/current_issue.html

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World View
The world must accept that the HPV vaccine is safe
But the science alone will not be enough to build public and political confidence, says Heidi Larson.
01 December 2015

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Supplement: Infectious disease control and elimination: Modelling the impact of improved diagnostics
Diagnostic technologies play a pivotal part in understanding and addressing the burden of infectious diseases. The Diagnostics Modelling Consortium was established in 2013 to facilitate the integration of diagnostic data into models of disease transmission dynamics. In this supplement, the Consortium and its partners report on the latest research outcomes across several major diseases. The outputs demonstrate that improved, well-considered diagnostics could support the elimination of multiple diseases in the field.
Free full access

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Introduction
Expanding the role of diagnostic and prognostic tools for infectious diseases in resource-poor settings
Open Access
Azra C. Ghani, Deborah Hay Burgess, Alison Reynolds & Christine Rousseau
Nature 528, S50-S52 (03 December 2015)

Pediatrics
December 2015, VOLUME 136 / ISSUE 6
http://pediatrics.aappublications.org/content/136/6?current-issue=y

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Characteristics of Physicians Who Dismiss Families for Refusing Vaccines
Sean T. O’Leary, Mandy A. Allison, Allison Fisher, Lori Crane, Brenda Beaty, Laura Hurley, Michaela Brtnikova, Andrea Jimenez-Zambrano, Shannon Stokley, Allison Kempe
Abstract
BACKGROUND AND OBJECTIVES: Physicians dismissing families who refuse vaccines from their practices is controversial. We assessed the following among pediatricians (Peds) and family physicians (FPs): (1) reported prevalence of parental refusal of 1 or more vaccines in the infant series; (2) physician response to refusal; and (3) the association between often/always dismissing families and provider/practice characteristics and state exemption laws.
METHODS: Nationally representative survey conducted June to October 2012. A multivariable analysis assessed association of often/always dismissing families with physician/practice characteristics, state philosophical exemption policy, and degree of difficulty obtaining nonmedical exemptions.
RESULTS: The response rate was 66% (534/815). Overall, 83% of physicians reported that in a typical month, ≥1% of parents refused 1 or more infant vaccines, and 20% reported that >5% of parents refused. Fifty-one percent reported always/often requiring parents to sign a form if they refused (Peds 64%, FP 29%, P < .0001); 21% of Peds and 4% of FPs reported always/often dismissing families if they refused ≥1 vaccine. Peds only were further analyzed because few FPs dismissed families. Peds who dismissed families were more likely to be in private practice (adjusted odds ratio [aOR] 4.90, 95% confidence interval [CI] 1.40–17.19), from the South (aOR 4.07, 95% CI 1.08–15.31), and reside in a state without a philosophical exemption law (aOR 3.70, 95% CI 1.74–7.85).
CONCLUSIONS: Almost all physicians encounter parents who refuse infant vaccines. One-fifth of Peds report dismissing families who refuse, but there is substantial variation in this practice. Given the frequency of dismissal, the impact of this practice on vaccine refusers and on pediatric practices should be studied.

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FDA Safety Reviews on Drugs, Biologics, and Vaccines: 2007–2013
Judith U. Cope, Geoffrey L. Rosenthal, Pamela Weinel, Amy Odegaard, Dianne M. Murphy
Abstract
BACKGROUND AND OBJECTIVES: In 2002, Congress mandated that the US Food and Drug Administration (FDA) monitor postmarketing pediatric adverse events and present safety reports to the FDA’s Pediatric Advisory Committee (PAC). These safety reviews play a critical role in the postmarketing surveillance and identification of pediatric safety issues. This article follows a previous review ending in 2007 and summarizes 6 years of recent pediatric safety reporting, recommendations by the PAC, and actions by the FDA, including labeling changes.
METHODS: An analysis of the FDA’s PAC safety reviews performed from November 2007 through September 2013 was conducted. PAC recommendations for subsequent labeling changes, future studies, or other safety issues were reviewed.
RESULTS: There were 6930 serious adverse event reports in 181 reviews. These findings resulted in 33 (18%) recommended labeling changes, and 21 (64%) of these changes were adopted. For 10 products, information was added to the Warning and Precautions section of the label. The PAC also discussed or recommended additional studies for certain products.
CONCLUSIONS: This article highlights the importance of the FDA’s ongoing pediatric postmarketing safety reviews of regulated products, advice from the PAC, and FDA actions in the best interest of pediatric patients. This mandated process facilitates detection of safety concerns that may not be identified in prelicensure clinical trials. It continues to identify critical safety concerns, including unlabeled adverse events, frequent off-label use, product misuse, and secondary exposures in children.

PharmacoEconomics
Volume 33, Issue 12, December 2015
http://link.springer.com/journal/40273/33/12/page/1

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Dealing with Time in Health Economic Evaluation: Methodological Issues and Recommendations for Practice
James F. O’Mahony, Anthony T. Newall, Joost van Rosmalen
Abstract
Time is an important aspect of health economic evaluation, as the timing and duration of clinical events, healthcare interventions and their consequences all affect estimated costs and effects. These issues should be reflected in the design of health economic models. This article considers three important aspects of time in modelling: (1) which cohorts to simulate and how far into the future to extend the analysis; (2) the simulation of time, including the difference between discrete-time and continuous-time models, cycle lengths, and converting rates and probabilities; and (3) discounting future costs and effects to their present values. We provide a methodological overview of these issues and make recommendations to help inform both the conduct of cost-effectiveness analyses and the interpretation of their results. For choosing which cohorts to simulate and how many, we suggest analysts carefully assess potential reasons for variation in cost effectiveness between cohorts and the feasibility of subgroup-specific recommendations. For the simulation of time, we recommend using short cycles or continuous-time models to avoid biases and the need for half-cycle corrections, and provide advice on the correct conversion of transition probabilities in state transition models. Finally, for discounting, analysts should not only follow current guidance and report how discounting was conducted, especially in the case of differential discounting, but also seek to develop an understanding of its rationale. Our overall recommendations are that analysts explicitly state and justify their modelling choices regarding time and consider how alternative choices may impact on results.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 5 December 2015)

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The Ebola Vaccine, Iatrogenic Injuries, and Legal Liability
Amir Attaran, Kumanan Wilson
Policy Forum | published 01 Dec 2015 | PLOS Medicine
10.1371/journal.pmed.1001911
Summary Points
:: The development and eventual deployment of an Ebola vaccine was delayed for various technical and financial reasons, but with the apparent success of a vaccine candidate in a recently reported clinical trial, an urgent problem is the lack of any system to protect vaccine firms from the risks of legal liability caused by vaccine-related injuries.
:: Without indemnity or security against the legal risks, vaccine firms are less likely to engage in research and development of vaccines, particularly for rare diseases of poor countries such as Ebola.
:: WHO’s traditional method of mitigating the legal risks through indemnification agreements with countries appears too slow to implement in urgent pandemic situations. Also, the enforceability of any WHO-backed legal agreement is placed in doubt because the United Nations has the option to claim immunity from lawsuits.
:: Creating a compensation system for vaccine injuries, based on no-fault principles and, most likely, overseen by the World Bank, could address the liability concerns and facilitate getting novel vaccines into clinical trials and to the market. This system would also ensure that recipients of these vaccines are fairly compensated in the rare instances that they are harmed.

Prehospital & Disaster Medicine
Volume 30 – Issue 06 – December 2015
https://journals.cambridge.org/action/displayIssue?jid=PDM&tab=currentissue
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Frameworks for Disaster Research and Evaluation
Samuel J. Stratton
DOI: http://dx.doi.org/10.1017/S1049023X15005397 (About DOI), Published online: 11 November 2015

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Special Reports
Research and Evaluations of the Health Aspects of Disasters, Part III: Framework for the Temporal Phases of Disasters
Marvin L. Birnbaum, Elaine K. Daily and Ann P. O’Rourke

Research and Evaluations of the Health Aspects of Disasters, Part IV: Framework for Societal Structures: the Societal Systems
Marvin L. Birnbaum, Elaine K. Daily and Ann P. O’Rourke

Research and Evaluations of the Health Aspects of Disasters, Part V: Epidemiological Disaster Research
Marvin L. Birnbaum, Elaine K. Daily and Ann P. O’Rourke

Science
4 December 2015 vol 350, issue 6265, pages 1125-1288
http://www.sciencemag.org/current.dtl

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Introduction to Special Issue – Toward Healthy Aging
Putting Off the Inevitable
Stella Hurtley, Leslie Roberts, L. Bryan Ray, Beverly A. Purnell, Caroline Ash
The dream of cheating death has evolved into a scientific quest to extend healthy life span. Scientists and doctors are looking for ways to maximize the number of years that we live free of chronic diseases, cancer, and cognitive decline. But before we can intervene, we have to understand the cellular and molecular mechanisms that drive aging and senescence. Some clues reside in our telomeres, the tips of our chromosomes that shrink with age. Others lie in our stem cells, which can only go on for so long repairing our tissues. Our mitochondria, too, the so-called powerhouses of the cell, may hold some answers to prolonging youthfulness. Other research points to changes in the gut microbiota associated with frailty in the aged. At a mechanistic level, the modulation of coenzyme NAD+ usage or production can prolong both health span and life span. Current geroscience initiatives aim to harness basic insights in aging research to promote general advances in healthy aging.

Questions remain throughout the aging field. By tweaking everything from genes to diets to environmental temperature and mating, scientists have created Methuselah flies and other remarkably long-lived animals while garnering fundamental insights into the biology of aging. Still, researchers puzzle over the most basic questions, such as what determines the life spans of animals. Meanwhile, a handful of molecular biologists are searching for ways to measure a person’s biological, as opposed to chronological, age, but that quest, too, has proved elusive.

An ever-growing literature addresses both theoretical and pragmatic approaches to the challenge of aging. In this special issue, we have focused mainly on the cellular aspects of mammalian aging, with the goal of spurring future developments in promoting health span, if not life span.

Social Science & Medicine
Volume 145, Pages 1-248 (November 2015)
http://www.sciencedirect.com/science/journal/02779536/145

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Special issue section Health Systems in Asia 2013; Edited by Kai Hong Phua, Shenglan Tang and Kabir Sheikh
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Editorial – Health Systems of Asia: Equity, Governance and Social Impact
Pages 141-144
Kai Hong Phua, Kabir Sheikh, Sheng-Lan Tang, Vivian Lin
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District-level variations in childhood immunizations in India: The role of socio-economic factors and health infrastructure
Original Research Article
Pages 163-172
Anu Rammohan, Niyi Awofeso
Abstract
Routine childhood immunizations against measles and DPT are part of the World Health Organization’s (WHO) Expanded Program on Immunization (EPI) set up in 1974, with the aim of reducing childhood morbidity and mortality. Despite this, immunization rates are sub-optimal in developing countries such as India, with wide heterogeneity observed across districts and socio-economic characteristics. The aim of this paper is to examine district-level variations in the propensity to vaccinate a child in India for measles and DPT3, and analyse the extent to which these immunizations are given age-inappropriately, either prematurely or delayed. The present study uses data from the Indian District Level Household Survey (DLHS-3) collected in 2008, and the final sample contains detailed information on 42157 children aged between 12 and 60 months, across 549 Indian districts for whom we have complete information on immunization history. Our empirical study analyses: (i) the district-level average immunization rates for measles and DPT3, and (ii) the extent to which these immunizations have been given age-appropriately. A key contribution of this paper is that we link the household-level data at the district level to data on availability and proximity to health infrastructure and district-level socio-economic factors. Our results show that after controlling for an array of socio-economic characteristics, across all our models, the district’s income per capita is a strong predictor of better immunization outcomes for children. Mother’s education level at the district-level has a statistically significant and positive influence on immunization outcomes across all our models.
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Emerging challenges in implementing universal health coverage in Asia
Original Research Article
Pages 243-248
Caryn Bredenkamp, Timothy Evans, Leizel Lagrada, John Langenbrunner, Stefan Nachuk, Toomas Palu
Abstract
As countries in Asia converge on the goal of universal health coverage (UHC), some common challenges are emerging. One is how to ensure coverage of the informal sector so as to make UHC truly universal; a second is how to design a benefit package that is responsive and appropriate to current health challenges, yet fiscally sustainable; and a third is how to ensure “supply-side readiness”, i.e. the availability and quality of services, which is a necessary condition for translating coverage into improvements in health outcomes. Using examples from the Asia region, this paper discusses these three challenges and how they are being addressed.
On the first challenge, two promising approaches emerge: using general revenues to fully cover the informal sector, or employing a combination of tax subsidies, non-financial incentives and contributory requirements. The former can produce fast results, but places pressure on government budgets and may induce informality, while the latter will require a strong administrative mandate and systems to track the ability-to-pay. With respect to benefit packages, we find considerable variation in the nature and rigor of processes underlying the selection and updating of the services included. Also, in general, packages do not yet focus sufficiently on non-communicable diseases (NCDs) and related preventive outpatient care. Finally, there are large variations and inequities in the supply-side readiness, in terms of availability of infrastructure, equipment, essential drugs and staffing, to deliver on the promises of UHC. Health worker competencies are also a constraint.
While the UHC challenges are common, experience in overcoming these challenges is varied and many of the successes appear to be highly context-specific. This implies that researchers and policymakers need to rigorously, and regularly, assess different approaches, and share these findings across countries in Asia – and across the world.

Tropical Medicine & International Health
December 2015 Volume 20, Issue 12 Pages 1591–1854
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2015.20.issue-12/issuetoc

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Systematic Reviews
Acute respiratory infection case definitions for young children: a systematic review of community-based epidemiologic studies in South Asia (pages 1607–1620)
Daniel E. Roth, Michelle F. Gaffey, Evelyn Smith-Romero, Tiffany Fitzpatrick and Shaun K. Morris
Article first published online: 20 SEP 2015 | DOI: 10.1111/tmi.12592

Systematic Reviews
Who, What, Where: an analysis of private sector family planning provision in 57 low- and middle-income countries (pages 1639–1656)
Oona M. R. Campbell, Lenka Benova, David Macleod, Catherine Goodman, Katharine Footman, Audrey L. Pereira and Caroline A. Lynch
Article first published online: 28 SEP 2015 | DOI: 10.1111/tmi.12597

Role of the private sector in childbirth care: cross-sectional survey evidence from 57 low- and middle-income countries using Demographic and Health Surveys (pages 1657–1673)
Lenka Benova, David Macleod, Katharine Footman, Francesca Cavallaro, Caroline A. Lynch and Oona M. R. Campbell
Article first published online: 28 SEP 2015 | DOI: 10.1111/tmi.12598

Vaccine
Volume 33, Issue 48, Pages 6503-6946 (27 November 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/48
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Report on the second WHO integrated meeting on development and clinical trials of influenza vaccines that induce broadly protective and long-lasting immune responses: Geneva, Switzerland, 5–7 May 2014
Pages 6503-6510
Nancy J. Cox, Julian Hickling, Rebecca Jones, Guus F. Rimmelzwaan, Linda C. Lambert, John Boslego, Larisa Rudenko, Leena Yeolekar, James S. Robertson, Joachim Hombach, Justin R. Ortiz
Abstract
On 5–7 May 2014, the World Health Organization (WHO) convened the second integrated meeting on “influenza vaccines that induce broadly protective and long-lasting immune responses”. Around 100 invited experts from academia, the vaccine industry, research and development funders, and regulatory and public health agencies attended the meeting. Areas covered included mechanisms of protection in natural influenza-virus infection and vaccine-induced immunity, new approaches to influenza-vaccine design and production, and novel routes of vaccine administration. A timely focus was on how this knowledge could be applied to both seasonal influenza and emerging viruses with pandemic potential such as influenza A (H7N9), currently circulating in China. Special attention was given to the development of possible universal influenza vaccines, given that the Global Vaccine Action Plan calls for at least one licensed universal influenza vaccine by 2020. This report highlights some of the topics discussed and provides an update on studies published since the report of the previous meeting.

Vaccine
Volume 33, Issue 48, Pages 6503-6946 (27 November 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/48
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The current situation of meningococcal disease in Latin America and updated Global Meningococcal Initiative (GMI) recommendations
Review Article
Pages 6529-6536
Marco Aurélio P. Sáfadi, Miguel O’Ryan, Maria Teresa Valenzuela Bravo, Maria Cristina C. Brandileone, Maria Cecília O. Gorla, Ana Paula S. de Lemos, Gabriela Moreno, Julio A. Vazquez, Eduardo L. López, Muhamed-Kheir Taha, Ray Borrow, Global Meningococcal Initiative
Abstract
The Global Meningococcal Initiative (GMI) was established in 2009 and comprises an international team of scientists, clinicians, and public health officials with expertise in meningococcal disease (MD). Its primary goal is to promote global prevention of MD through education, research, international cooperation, and developing recommendations that include decreasing the burden of severe disease. The group held its first roundtable meeting with experts from Latin American countries in 2011, and subsequently proposed several recommendations to reduce the regional burden of MD. A second roundtable meeting was convened with Latin American representatives in June 2013 to reassess MD epidemiology, vaccination strategies, and unmet needs in the region, as well as to update the earlier recommendations. Special emphasis was placed on the emergence and spread of serogroup W disease in Argentina and Chile, and the control measures put in place in Chile were a particular focus of discussions. The impact of routine meningococcal vaccination programs, notably in Brazil, was also evaluated. There have been considerable improvements in MD surveillance systems and diagnostic techniques in some countries (e.g., Brazil and Chile), but the lack of adequate infrastructure, trained personnel, and equipment/reagents remains a major barrier to progress in resource-poor countries. The Pan American Health Organization’s Revolving Fund is likely to play an important role in improving access to meningococcal vaccines in Latin America. Additional innovative approaches are needed to redress the imbalance in expertise and resources between countries, and thereby improve the control of MD. In Latin America, the GMI recommends establishment of a detailed and comprehensive national/regional surveillance system, standardization of laboratory procedures, adoption of a uniform MD case definition, maintaining laboratory-based surveillance, replacement of polysaccharide vaccines with conjugate formulations (wherever possible), monitoring and evaluating implemented vaccination strategies, conducting cost-effectiveness studies, and developing specific recommendations for vaccination of high-risk groups.

Vaccine
Volume 33, Issue 48, Pages 6503-6946 (27 November 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/48
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A systematic review of the social and economic burden of influenza in low- and middle-income countries
Review Article
Pages 6537-6544
Natasha de Francisco (Shapovalova), Morgane Donadel, Mark Jit, Raymond Hutubessy
Abstract
Objectives
The economic burden of seasonal influenza outbreaks as well as influenza pandemics in lower- and middle-income countries (LMIC) has yet to be specifically systematically reviewed. The aim of this systematic review is to assess the evidence of influenza economic burden assessment methods in LMIC and to quantify the economic consequences of influenza disease in these countries, including broader opportunity costs in terms of impaired social progress and economic development.
Methods
We conducted an all language literature search across 5 key databases using an extensive list of key words for the time period 1950–2013. We included studies which explored direct costs (medical and non-medical), indirect costs (productivity losses), and broader economic impact in LMIC associated with different influenza outcomes such as confirmed seasonal influenza infection, influenza-like illnesses, and pandemic influenza.
Results
We included 62 full-text studies in English, Spanish, Russian, Chinese languages, mostly from the countries of Latin American and the Caribbean and East Asia and Pacific with pertinent cost data found in 39 papers. Estimates for direct and indirect costs were the highest in Latin American and the Caribbean. Compared to high-income economies, direct costs in LMIC were lower and productivity losses higher. Evidence on broader impact of influenza included impact on the wider national economy, security dimension, medical insurance policy, legal frameworks, distributional impact, and investment flows.
Conclusion
The economic burden of influenza in LMIC encompasses multiple dimensions such as direct costs to the health service and households, indirect costs due to productivity losses as well as broader detriments to the wider economy. Evidence from sub-Saharan Africa and in pregnant women remains very limited. Heterogeneity of methods used to estimate cost components makes data synthesis challenging. There is a strong need for standardizing research, data collection and evaluation methods for both direct and indirect cost components

Vaccine
Volume 33, Issue 48, Pages 6503-6946 (27 November 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/48
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Is immunotherapy an opportunity for effective treatment of drug addiction?
Review Article
Pages 6545-6551
Jadwiga Zalewska-Kaszubska
Abstract
Immunotherapy has a great potential of becoming a new therapeutic strategy in the treatment of addiction to psychoactive drugs. It may be used to treat addiction but also to prevent neurotoxic complications of drug overdose. In preclinical studies two immunological methods have been tested; active immunization, which relies on the administration of vaccines and passive immunization, which relies on the administration of monoclonal antibodies. Until now researchers have succeeded in developing vaccines and/or antibodies against addiction to heroin, cocaine, methamphetamine, nicotine and phencyclidine. Their effectiveness has been confirmed in preclinical studies. At present, clinical studies are being conducted for vaccines against nicotine and cocaine and also anti-methamphetamine monoclonal antibody. These preclinical and clinical studies suggest that immunotherapy may be useful in the treatment of addiction and drug overdose. However, there are a few problems to be solved. One of them is controlling the level of antibodies due to variability between subjects. But even obtaining a suitable antibody titer does not guarantee the effectiveness of the vaccine. Additionally, there is a risk of intentional or unintentional overdose. As vaccines prevent passing of drugs through the blood/brain barrier and thereby prevent their positive reinforcement, some addicted patients may erroneously seek higher doses of psychoactive substances to get “high”. Consequently, vaccination should be targeted at persons who have a strong motivation to free themselves from drug dependency. It seems that immunotherapy may be an opportunity for effective treatment of drug addiction if directed to adequate candidates for treatment. For other addicts, immunotherapy may be a very important element supporting psycho- and pharmacotherapy.

Vaccine
Volume 33, Issue 48, Pages 6503-6946 (27 November 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/48
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Burden of vaccine preventable diseases at large events
Review Article
Pages 6552-6563
Amani S. Alqahtani, Mohammad Alfelali, Paul Arbon, Robert Booy, Harunor Rashid
Abstract
Background
Large events or mass gatherings (MGs) are known to amplify the risk of infectious diseases, many of which can be prevented by vaccination. In this review we have evaluated the burden of vaccine preventable diseases (VPDs) in MGs.
Methods
Major databases like PubMed and Embase, Google Scholar and pertinent websites were searched by using MeSH terms and text words; this was supplemented by hand searching. Following data abstraction, the pooled estimate of the burden of VPDs was calculated when possible; otherwise a narrative synthesis was conducted.
Results
In the past, at religious MGs like Hajj and Kumbh Mela, cholera caused explosive outbreaks; but currently respiratory infections, notably influenza, are the commonest diseases not only at Hajj but also at World Youth Day and Winter Olympiad. The recent cumulative attack rate of influenza at Hajj is 8.7% (range 0.7–15.8%), and the cumulative prevalence is 3.6% (range: 0.3–38%). Small outbreaks of measles (13–42 cases per event) have been reported at sport, entertainment and religious events. A sizeable outbreak (>200 cases) was reported following a special Easter Festival in Austria. An outbreak of hepatitis A occurred following the ‘Jam bands’ music festival. Other VPDs including pneumococcal disease, pertussis and tuberculosis have been reported in relation to MG attendance.
Conclusion
VPDs not only affect the participants of MGs but also their contacts; vaccine uptake is variable and vaccine implementation is likely to have beneficial effects. Research to address the knowledge gaps surrounding VPDs at MGs is needed.

Vaccine
Volume 33, Issue 48, Pages 6503-6946 (27 November 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/48
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Pediatric provider vaccine hesitancy: An under-recognized obstacle to immunizing children
Original Research Article
Pages 6629-6634
Manika Suryadevara, Andrew Handel, Cynthia A. Bonville, Donald A. Cibula, Joseph B. Domachowske
Abstract
Objective
To describe vaccine attitudes among pediatric healthcare providers attending immunization conferences.
Study design
Attendees of 5 American Academy of Pediatrics (AAP)-sponsored vaccine conferences held between June and November 2013 anonymously completed a questionnaire assessing vaccine attitudes and practices prior to the opening of educational sessions. Pearson’s chi-square tests and Fisher’s exact tests were used to analyze associations between vaccine attitudes, vaccine practices and provider characteristics.
Results
680 providers attending AAP-sponsored vaccine conferences were included. 661/666 (99%) enrolled providers state they routinely recommend standard pediatric vaccines, yet, 30 (5%) state that they do not routinely recommend influenza and/or human papillomavirus (HPV) vaccines. These providers expressed vaccine safety (87/680 (13%)) and efficacy (21/680 (31%)) concerns and stated belief in vaccine misperceptions: vaccine causes autism (34/668, 5%), multiple vaccines at a single visit reduces vaccine efficacy (43/680, 6%) or overwhelms the immune system (63/680, 9%), and administering HPV vaccine will increase the likelihood of unprotected adolescent sexual activity (29/680, 4%). Six percent of providers who do not routinely recommend all pediatric vaccines correctly identified themselves as vaccine hesitant.
Conclusion
Vaccine hesitancy is under-recognized among pediatric providers attending AAP-sponsored immunization conferences. Educational interventions tailored to address provider vaccine concerns are needed to improve provider vaccine confidence.

Vaccine
Volume 33, Issue 48, Pages 6503-6946 (27 November 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/48
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“Everybody just wants to do what’s best for their child”: Understanding how pro-vaccine parents can support a culture of vaccine hesitancy
Original Research Article
Pages 6703-6709
Eileen Wang, Yelena Baras, Alison M. Buttenheim
Abstract
Background
Although a large majority of parents vaccinate their children, vaccine hesitancy has become more widespread. It is not well understood how this culture of vaccine hesitancy has emerged and how it influences parents’ decisions about vaccine schedules.
Objective
We sought to examine how attitudes and beliefs of parents who self-report as pro-vaccine are developed and contribute to immunization decisions, including delaying or spacing vaccines.
Methods
Open-ended, in-depth interviews (N = 23) were conducted with upper-middle class parents with young children living in Philadelphia. Interview data were coded and key themes identified related to vaccine decision-making.
Results
Parents who sought out vaccine information were often overwhelmed by the quantity and ambiguity when interpreting that information, and, consequently, had to rely on their own instinct or judgment to make vaccine decisions. In particular, while parents in this sample did not refuse vaccines, and described themselves as pro-vaccine, they did frequently delay or space vaccines. This experience also generated sympathy for and tolerance of vaccine hesitancy in other parents. Parents also perceived minimal severe consequences for deviating from the recommended immunization schedule.
Conclusion
These findings suggest that the rise in and persistence of vaccine hesitancy and refusal are, in part, influenced by the conflicts in the information parents gather, making it difficult to interpret. Considerable deviations from the recommended vaccination schedule may manifest even within a pro-vaccine population due to this perceived ambiguity of available information and resulting tolerance for vaccine hesitancy.

Vaccine
Volume 33, Issue 48, Pages 6503-6946 (27 November 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/48
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Costing RTS,S introduction in Burkina Faso, Ghana, Kenya, Senegal, Tanzania, and Uganda: A generalizable approach drawing on publicly available data
Original Research Article
Pages 6710-6718
Katya Galactionova, Melanie Bertram, Jeremy Lauer, Fabrizio Tediosi
Abstract
Recent results from the phase 3 trial of RTS,S/AS01 malaria vaccine show that the vaccine induced partial protection against clinical malaria in infants and children; given the high burden of the disease it is currently considered for use in malaria endemic countries. To inform adoption decisions the paper proposes a generalizable methodology to estimate the cost of vaccine introduction using routinely collected and publicly available data from the cMYP, UNICEF, and WHO-CHOICE. Costing is carried out around a set of generic activities, assumptions, and inputs for delivery of immunization services adapted to a given country and deployment modality to capture among other factors the structure of the EPI program, distribution model, geography, and demographics particular to the setting. The methodology is applied to estimate the cost of RTS,S introduction in Burkina Faso, Ghana, Kenya, Senegal, Tanzania, and Uganda. At an assumed vaccine price of $5 per dose and given our assumptions on coverage and deployment strategy, we estimate total economic program costs for a 6–9 months cohort within $23.11–$28.28 per fully vaccinated child across the 6 countries. Net of procurement, costs at country level are substantial; for instance in Tanzania these could add as much as $4.2 million per year or an additional $2.4 per infant depending on the level of spare capacity in the system. Differences in cost of vaccine introduction across countries are primarily driven by differences in cost of labour. Overall estimates generated with the methodology result in costs within the ranges reported for other new vaccines introduced in SSA and capture multiple sources of heterogeneity in costs across countries. Further validation with data from field trials will support use of the methodology while also serving as a validation for cMYP and WHO-CHOICE as resources for costing health interventions in the region.

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

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

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The Atlantic
http://www.theatlantic.com/magazine/
Accessed 5 December 2015
Measles Outbreaks Are a Sign of Bigger Problems
For health agencies tracking global vaccine coverage, the disease is the canary in the coal mine.
Seth Berkley
1 December 2015
This year was supposed to mark the point when measles—one of the most infectious diseases on the planet—was finally under control. As a step in its plan to eliminate measles worldwide by 2020, the World Health Organization set a target to reduce the number of cases by 95 percent between 2000 and 2015. The effect has been significant: Measles deaths have fallen from more than 700,000 in 2000 to around 115,000 last year. But for a disease that’s easily preventable, 115,000 deaths—the majority of them children under 5 years old—is still too high. And as the WHO reported in November, progress has flat-lined over the past five years, and outbreaks are still common.

What, exactly, went wrong?

At first glance, it seems impossible to pinpoint just one reason for all the various outbreaks around the world. In the Nuba mountains of Sudan, a key factor is the lack of access to humanitarian aid for people trapped in conflict zones; in West Africa, a measles resurgence can be attributed largely to the Ebola epidemic’s crippling effect on local health systems. And in California, the blame rests squarely on the shoulders of anti-vaccine groups for whipping up unfounded fears about the safety of measles-mumps-rubella (MMR) vaccines.

However, all of these seemingly disparate cases—and all other measles outbreaks, for that matter—still have a common underlying cause. Whenever measles strikes, it’s more than just an outbreak of a single disease, or an indication that children aren’t receiving their measles shots; it’s also a warning that immunization coverage in general, for all vaccine-preventable diseases, is lower than it should be. To put it another way: When rates of routine vaccination—children receiving all their shots on schedule, as a preventive measure rather than a reaction to an outbreak—start to fall, the first sign is usually a measles outbreak. In global-health security terms, these outbreaks are the proverbial canaries in the coal mine…

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The Huffington Post
http://www.huffingtonpost.com/
Accessed 5 December 2015
COP21: A Defining Moment for Human Health
Margaret Chan
3 December 2015
This week’s United Nations Climate Change Conference (COP21) in Paris offers a chance to save the planet from severe, pervasive and irreversible damage. Though often lost in the debate, saving the planet also means saving the conditions that sustain human life in good health. If sufficiently ambitious and effective, the climate agreement will be a major turning point in environmental policy, but also a far-reaching treaty for protecting public health.

The stakes are high. Unless a deal is clinched to keep the temperature rise within two degrees Celsius, the consequences will be catastrophic. Many of the same inefficient and polluting energy choices that are driving climate change are also devastating human health. Climate change degrades air quality, reduces food security and compromises water supplies and sanitation.

WHO estimates that, each year, more than 7 million deaths worldwide can be attributed to air pollution. Climate change is also causing tens of thousands of yearly deaths from other causes. Records for extreme weather events — like droughts and floods, storm surges, heatwaves and wildfires — are being broken a record number of times, claiming human lives and livelihoods. The World Meteorological Organization says 2015 is already the hottest year since records began in 1880. Next year is predicted to be even hotter…

…The health sector has critical evidence, and positive arguments, to bring to the climate talks. Existing strategies that work well to combat climate change also bring important health gains. Investments in low-carbon development, clean renewable energy, and greater climate resilience are investments in better health….

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New York Times
http://www.nytimes.com/
Accessed 5 December 2015
Health
Ebola Crisis Passes, but Questions on Quarantines Persist
By SHERI FINKDEC. 2, 2015
The Ebola epidemic has subsided, but in the United States the fallout over how health care workers and their families were treated during the crisis continues.

Throughout the months of fear and uncertainty, the federal Centers for Disease Control and Prevention recommended monitoring people entering the United States from Ebola-affected countries, not confining them, because research showed that people with Ebola are not contagious before they show symptoms. But states, which have the legal authority to impose quarantines, often exceeded those guidelines, restricting the movements of returning health workers and others.

Interviews with more than a dozen people who either were quarantined or were involved in imposing quarantines revealed troubling details about the steps that were taken. Some said they were left without basic necessities like garbage removal and without psychological support. In one case in New York, a stove was left inoperable after an apartment was cleaned and no one was allowed to come fix it. Others were not given the legally required notice of the restrictions to be imposed.

Similar findings are documented in a report released on Thursday by the Yale Global Health Justice Partnership and the American Civil Liberties Union, which for the first time tried to quantify how widespread quarantines were in response to the Ebola epidemic…

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Washington Post
http://www.washingtonpost.com/
Accessed 5 December 2015
Everything went wrong in the Ebola outbreak. We’re still not ready if it happens again.
By Editorial Board 28 November 2015
ALMOST EVERYTHING that could go wrong did go wrong in the world’s early response to the outbreak of the Ebola virus in West Africa in 2014. Before it was over, the virus infected some 28,634 people and claimed more than 11,000 lives. It could happen again — and the world is still not ready.

Guinea had a weak health-care system when the virus took root in its remote regions, making it easier for the virus to spread to neighboring Liberia and Sierra Leone. Guinean authorities played down the seriousness for fear of creating panic and disrupting business. The World Health Organization declared the outbreak “relatively small still” in April 2014, and expert teams that had been sent in to the region were pulled out prematurely in May. WHO outbreak response teams had been “disproportionally” cut in a wave of headquarters layoffs. Margaret Chan, director general of the WHO, did not use her authority to declare a public-health emergency of international concern until five months after Guinea and Sierra Leone had notified the organization. Even after the emergency was declared, and a substantial global response was mobilized, “this response arrived late, was slow to deliver funds and health workers, was inflexible in adapting to rapidly changing conditions on the ground, was inadequately informed about cultural factors relevant to outbreak control, and was poorly coordinated,” according to a new study. “The result was, in essence, a $5 billion scramble.”

This is a sample of the findings contained in a report made public Nov. 22 by an independent panel of 19 experts who examined responses to the outbreak, particularly by the WHO, an agency of the United Nations. The report describes a cascade of failures and serves as a reminder that the existing methods of coping with infectious disease outbreaks are fragmented and fragile. The panel, launched by the Harvard Global Health Institute and the London School of Hygiene and Tropical Medicine, found that during the Ebola outbreak, the WHO fell down in all of its core functions: helping nations build up health-care capacity, providing early warning, establishing technical norms and mobilizing resources. The agency now faces an “existential crisis of confidence,” is “starved” of resources and “seems to have lost its way,” the experts write. “Confidence in the organization’s capacity to lead is at an all-time low.”

Before another bacterium or virus goes on a rampage, the panel recommends bolstering the WHO’s ability to respond quickly, including with a worldwide research and development fund for diagnostics, drugs and vaccines for diseases that have been neglected by the pharmaceutical industry. In many poor countries, basic health-care systems are still lacking, hampering their ability to fight outbreaks. It is also essential that governments give early warning of disease, regardless of the consequences. Response teams must take into account not only health and science concerns but also the beliefs, traditions, cultures and fears of local populations. The world fails to learn these lessons of Ebola at its peril.

Center for Global Development
http://www.cgdev.org/

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Briefs
Commitment to Development Index 2015
12/4/15
Petra Krylováa and Owen Barder
The Commitment to Development Index ranks 27 of the world’s richest countries on policies that affect the more than five billion people living in poorer nations. Those policies extend well beyond giving foreign aid, which is just one of seven components on the CDI:
Aid; Finance; Technology; Environment; Trade; Security; Migration

The Index gives credit for generous and high-quality aid, financial transparency and incentives for foreign direct investment, robust support for technological research and development, policies that protect the environment, open and fair trade policies, contributions to global security, and open immigration policies. Scores are reduced for barriers to imports from developing countries, selling arms to poor and undemocratic nations, barriers to sharing technology, and policies that harm shared environmental resources.

Visit cgdev.org/cdi to explore the Commitment to Development Index, view additional publications and background papers, and dive deeper into the CDI methodology, data, and code.

Vaccines and Global Health: The Week in Review is a weekly digest  summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated with the current issue date

.– Request an Email Summary: Vaccines and Global Health : The Week in Review is published as a single email summary, scheduled for release each Saturday evening before midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.

– pdf version:  A pdf of the current issue is available here:  Vaccines and Global Health_The Week in Review_28 November 2015

– blog edition: comprised of the approx. 35+ entries posted below on 29 November 2015.

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

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

Advisory Group on Reform of WHO’s Work in Outbreaks and Emergencies with Health and Humanitarian Consequences
http://www.who.int/about/who_reform/emergency-capacities/advisory-group/en/

WHO Emergency Reform newsletter No 5, 27 November 2015
3 pages
:: Advisory Group report recommends actions to be taken on WHO outbreak and emergency Reform
:: WHO heads of country offices provide feedback into the process of reform of Organizations work in outbreaks and emergencies with health consequences
:: WHO briefs Member States on the Contingency Fund for Emergencies, receives contributions from Germany and China
:: Governments sign up to new WHO emergency medical team coordination methodology, strengthening surge medical support in sudden onset disasters.

EBOLA/EVD [to 28 November 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

The Lancet
22 November 2015
Health Policy
Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola
Suerie Moon, Devi Sridhar, Muhammad A Pate, Ashish K Jha, Chelsea Clinton, Sophie Delaunay, Valnora Edwin, Mosoka Fallah, David P Fidler, Laurie Garrett, Eric Goosby, Lawrence O Gostin, David L Heymann, Kelley Lee, Gabriel M Leung, J Stephen Morrison, Jorge Saavedra, Marcel Tanner, Jennifer A Leigh, Benjamin Hawkins, Liana R Woskie, Peter Piot
Full text (may require registration): http://lancet.com/journals/lancet/article/PIIS0140-6736%2815%2900946-0/fulltext

Summary
The west African Ebola epidemic that began in 2013 exposed deep inadequacies in the national and international institutions responsible for protecting the public from the far-reaching human, social, economic, and political consequences of infectious disease outbreaks. The Ebola epidemic raised a crucial question: what reforms are needed to mend the fragile global system for outbreak prevention and response, rebuild confidence, and prevent future disasters? To address this question, the Harvard Global Health Institute and the London School of Hygiene & Tropical Medicine jointly launched the Independent Panel on the Global Response to Ebola.

Recommendations Summary [full text includes discussion on each recommendation]
Recommendation 1: Develop a global strategy to invest in, monitor, and sustain national core capacities

Recommendation 2: Strengthen incentives for early reporting of outbreaks and science-based justifications for trade and travel restrictions

Recommendation 3: Create a unified WHO Centre for Emergency Preparedness and Response with clear responsibility, adequate capacity, and strong lines of accountability

Recommendation 4: Broaden responsibility for emergency declarations to a transparent, politically protected Standing Emergency Committee

Recommendation 5: Institutionalise accountability by creating an independent Accountability Commission for Disease Outbreak Prevention and Response (Accountability Commission)

Recommendation 6: Develop a framework of rules to enable, govern and ensure access to the benefits of research

Recommendation 7: Establish a global facility to finance, accelerate, and prioritise research and development

Recommendation 8: Sustain high-level political attention through a Global Health Committee of the Security Council

Recommendation 9: A new deal for a more focused, appropriately financed WHO

Recommendation 10: Good governance of WHO through decisive, timebound reform, and assertive leadership

Conclusion
Taken together, the Panel’s ten recommendations provide a vision for a more robust, resilient global system able to manage infectious disease outbreaks. Preventing small outbreaks from becoming large-scale emergencies demands investment in minimum capacities in all countries and encouragement of early international reporting of outbreaks by adhering to agreed international rules. Responding effectively to outbreaks demands much stronger operational capacity within WHO and within the broader aid system if outbreaks escalate into humanitarian emergencies, a politically protected process for WHO’s emergency declarations, and strong mechanisms for the accountability of all involved actors, from national governments to non-governmental organisations and from UN agencies to the private sector. Mobilisation of the knowledge needed to combat outbreaks will require an international framework of rules to enable, govern, and ensure access to the benefits of research, and financing to develop technology when commercial incentives are inappropriate. Finally, effective governance of this complex global system demands high-level political leadership and a WHO that is more focused and appropriately financed and whose credibility is restored through the implementation of good governance reforms and assertive leadership.

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Ebola Situation Report – 25 November 2015
A cluster of three confirmed cases of Ebola virus disease (EVD) were reported from Liberia in the week to 22 November. The first-reported case was a 15-year-old boy who tested positive for EVD after admission to a health facility in the Greater Monrovia area on 19 November. He was then transferred to an Ebola treatment centre along with the 5 other members of his family. Two other members of the family – the boy’s 8-year old brother and his 40-year-old father – subsequently tested positive whilst in isolation. In addition to the family, 149 contacts have been identified so far, including 10 health workers who had close contact with the 15-year-old prior to isolation. Investigations to establish the origin of infection are at an early stage. Liberia was previously declared free of Ebola transmission on 3 September 2015.

On 7 November WHO declared that Sierra Leone had achieved objective 1 of the phase 3 framework, and the country has now entered a 90-day period of enhanced surveillance scheduled to conclude on 5 February 2016. As of 22 November it had been 6 days since the last EVD patient in Guinea received a second consecutive EVD-negative blood test. The last case in Guinea was reported on 29 October 2015.

The recent cases in Liberia underscore the importance of robust surveillance measures to ensure the rapid detection of any reintroduction or re-emergence of EVD in currently unaffected areas. In order to achieve objective 2 of the phase 3 response framework – to manage and respond to the consequences of residual Ebola risks – Guinea, Liberia, and Sierra Leone have each put surveillance systems in place to enable health workers and members of the public to report any case of illness or death that they suspect may be related to EVD to the relevant authorities. In the week to 22 November, 29 176 such alerts were reported in Guinea, with alerts reported from all of the country’s 34 prefectures. Equivalent data are not currently available for Liberia. In Sierra Leone, 1420 alerts were reported from 14 of 14 districts in the week ending 15 November (the most recent week for which data are available)…

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WHO – Press Conference: Update on Ebola situation (Geneva, 20 November 2015)
20 Nov 2015 – Subject: Update on Ebola situation in West Africa
Speaker: Dr Bruce Aylward, Executive Director a.i., Outbreaks and Health Emergencies
Video: 46:58
At approx 15:50 Dr. Aylward notes:
“…Still the vaccine is not licensed and able to be used only under a trial, but we are working very hard with the producers and regulators to put in for an expanded access protocol to allow people to use the vaccine as part of a response in the interim as we work towards licensure of the vaccine…”

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Global Humanitarian Assistance (GHA) [to 28 November 2015]
http://www.globalhumanitarianassistance.org/
Ebola virus disease in Liberia
Report Synopsis
Date: 2015/11/23
On 20 November 2015 we responded to a funding alert for a new case of the Ebola virus disease in Liberia. The day before, less than three months after Liberia was last declared free of Ebola, it was confirmed that a 10-year-old boy had tested positive for the virus.

According to the UN Office for the Coordination of Humanitarian Affairs (OCHA)’s Financial Tracking Service (FTS), donors have committed/contributed US$236.9 million of humanitarian assistance to Liberia since the start of 2015. At least US$227.7 million of this is for the Ebola response. However, there are currently no financial contributions or pledges in response to this new outbreak of the disease.
Read our full analysis of the current funding situation.

POLIO [to 28 November 2015]
Public Health Emergency of International Concern (PHEIC)

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Statement on the Seventh IHR Emergency Committee meeting regarding the international spread of poliovirus
WHO statement
26 November 2015 [Editor’s text bolding]
The seventh meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened via teleconference by the Director-General on 10 November 2015. The Director General of WHO had noted the concerns expressed by the Emergency Committee in its August 2015 report with respect to circulating vaccine-derived polioviruses (cVDPV). In response, she convened this meeting of the Emergency Committee with broader terms than was previously the case to also look at outbreaks of cVDPV. During the current polio endgame cVDPVs reflect serious gaps in immunity to poliovirus due to weaknesses in routine immunization coverage in otherwise polio-free countries. Moreover, there is a particular urgency to stopping type 2 cVDPV in advance of the globally synchronized withdrawal of type 2 OPV in April 2016.

The following IHR States Parties submitted an update on the implementation of the Temporary Recommendations since the Committee last met on 4 August 2015: Afghanistan and Pakistan. The following IHR State Parties were invited to present their views to the committee and all except South Sudan submitted reports on measures and plans to stop circulating vaccine derived poliovirus: Nigeria, Guinea, Madagascar, Ukraine and Lao People’s Democratic Republic.

Wild polio
The Committee noted that since the declaration that the international spread of polio constituted a Public Health Emergency of International Concern (PHEIC), strong progress has been made by countries toward interruption of wild poliovirus transmission, implementation of Temporary Recommendations issued by the Director-General, and overall decline in occurrence of international spread of wild poliovirus. The Committee appreciated these commendable achievements. The Committee acknowledged the strong efforts of countries in Africa to eradicate polio noting that no cases of wild poliovirus have been reported in Africa for more than twelve months, and that Nigeria has interrupted endemic transmission of wild poliovirus. The Committee was particularly encouraged by the intensified efforts and the strong progress toward interruption of poliovirus in Pakistan and Afghanistan.

The Committee noted however that the international spread of wild poliovirus has continued, with two new documented exportations from Pakistan into Afghanistan which occurred in July and August 2015. The poliovirus isolates found in the two cases in Afghanistan were more closely related to strains recently circulating in Pakistan than to those currently found in Afghanistan. Both of these cases occurred in Achin district of Nangarhar Province, adjacent to the border with Pakistan. While there has been no new exportation from Afghanistan to Pakistan, ongoing transmission particularly in inaccessible parts of the Eastern Region of Afghanistan close to the international border presents an ongoing risk.

The Committee noted that while Pakistan and Afghanistan have historically shared a vast common zone of poliovirus transmission, the recent spread between the two countries is occurring from discrete zones of persistent transmission in each country. Strong programmatic action in such zones should interrupt such cross-border transmission, as illustrated by the experience in regions that were previously endemic for polio. The committee re-emphasized that under the IHR, spread of poliovirus between two Member States can constitute international spread. While the Committee appreciated that efforts are being made for cross border collaboration, the committee noted and concurred with the recent recommendation of the Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI). The IMB has recommended that the GPEI partners should help the governments of Pakistan and Afghanistan to establish a joint executive and planning body to instigate cross-border polio prevention and control. The committee was pleased that the Temporary Recommendations for international travellers of all ages are now being implemented in Afghanistan at the international airport in Kabul.

The committee noted that globally there are still significant vulnerable areas and populations that are inadequately immunized due to conflict, insecurity and poor coverage associated with weak immunization programmes. Such vulnerable areas include countries in the Middle East, the Horn of Africa, central Africa and parts of Europe. The hard-earned gains can be quickly lost if there is re-introduction of poliovirus in settings of disrupted health systems and complex humanitarian emergencies. The large population movements across the Middle East and from Afghanistan and Pakistan create a heightened risk of international spread of polio. There is a risk of missing polio vaccination among refugee and mobile populations, adding to missed and under vaccinated populations in Europe, the Middle East and Africa. An estimated three to four million people have been displaced to Turkey, Lebanon, and Jordan and are at the centre of a mass migration across Europe.

Vaccine derived poliovirus
The current cVDPV outbreaks across three WHO regions illustrate serious gaps in routine immunization programs of affected countries leading to large pockets of vulnerability to polio outbreaks. In 2015, five outbreaks of circulating vaccine derived poliovirus have occurred, three cVDPV1 outbreaks (Ukraine, Madagascar and Lao People’s Democratic Republic) and two cVDPV2 outbreaks (Nigeria and Guinea); furthermore an additional case of VDPV2 in a conflict-affected state of South Sudan is of concern.

There has been no international exportation of cVDPV during 2014 and 2015. Nonetheless, at least five past episodes of international spread of cVDPV have been recorded, all due to cVDPV type 2. While historically the overall risk of international spread of cVDPV appears to be lower than WPV, lack of adequate measures to control cVDPV can increase that risk.

The committee was concerned by the slow initial response in Ukraine and Madagascar, but encouraged that the response is improving in both countries. Additional efforts are needed to improve SIA quality in both countries. The committee also noted that targeted communication and strong engagement of communities were needed in Ukraine and Lao People’s Democratic Republic to overcome vaccine hesitancy, and that GPEI should assist with development of appropriate communications strategies and materials. The significant decline in immunization rates and AFP surveillance in Guinea and neighbouring Liberia and Sierra Leone due to the health system disruption caused by Ebola outbreak poses a risk for further spread of cVDPV, and the committee urged international partners to increase support to Guinea in its cVDPV outbreak response. Moreover, the testing of samples from AFP cases should be restored immediately and the overall systems for surveillance and immunization should be strengthened as soon as possible in the three Ebola-affected countries. The committee emphasized the importance of maintaining the quality of the programme along with strong political and civic engagement until global certification of polio eradication.

Conclusion – PHEIC
The Committee unanimously agreed that the international spread of polio remains a PHEIC and recommended the extension of the Temporary Recommendations, as revised, for a further three months. The Committee considered the following factors in reaching this conclusion:

:: The continued international spread of wild poliovirus during 2015 involving Pakistan and Afghanistan.

:: The risk and consequent costs of failure to eradicate globally one of the world’s most serious vaccine preventable diseases.

:: The continued necessity of a coordinated international response to improve immunization and surveillance for wild poliovirus, stop its international spread and reduce the risk of new spread.

:: The serious consequences of further international spread for the increasing number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies. Populations in these fragile states are vulnerable to outbreaks of polio. Outbreaks in fragile states are exceedingly difficult to control and threaten the completion of global polio eradication during its end stage.

:: The importance of a regional approach and strong cross-border cooperation, as much international spread of polio occurs over land borders, while recognizing that the risk of distant international spread remains from zones with active poliovirus transmission.

:: Additionally with respect to cVDPV:
…cVDPVs also pose a risk for international spread, and if there is no urgent response with appropriate measures, particularly threaten vulnerable populations as noted above;
…The emergence and circulation of VDPV in three WHO regions, underline significant gaps in population immunity at a critical time in the polio endgame, potentially threatening successful completion of global polio eradication;
…There is a particular urgency of stopping type 2 cVDPV in advance of the globally synchronized withdrawal of type 2 component of the oral poliovirus vaccine in April 2016….

…Additional considerations for all infected countries
The Committee strongly urged global partners in polio eradication to provide optimal support to all infected countries at this critical time in the program for implementation of the Temporary Recommendations under the IHR. The Committee advised that in view of the evolving situation, periodic review and assessment of the risk of international spread and measures to mitigate these risks are warranted.

The Committee recommended that international partners assist countries affected by cVDPV with development of appropriate communications strategies and materials to ensure clear public understanding of cVDPV, their distinction from wild poliovirus and maintenance of confidence in the effectiveness, safety and necessity of polio vaccines during the polio endgame. Recognizing that cVDPV illustrate serious gaps in routine immunization programs in otherwise polio free countries, the Committee recommended that the international partners in routine immunization, for example the Gavi Alliance, should urgently assist affected countries to improve the national immunization program.
The Committee requested the Secretariat to conduct an analysis of the public health benefits and costs of implementing the temporary recommendation requiring exporting countries to vaccinate all international travellers before departure.

Based on the advice concerning wild poliovirus and circulating VDPV, the reports made by Afghanistan, Pakistan, Nigeria, Madagascar, Guinea, Ukraine and Lao People’s Democratic Republic and the currently available information, the Director-General accepted the Committee’s assessment and on 25 November 2015 determined that the events relating to poliovirus continue to constitute a PHEIC, including with respect to cVDPV. The Director-General endorsed the Committee’s recommendations for ‘States currently exporting wild polioviruses or cVDPV’, for ‘States infected with wild poliovirus or cVDPV but not currently exporting’ and for ‘States no longer infected by wild poliovirus, but which remain vulnerable to international spread, and states that are vulnerable to the emergence and circulation of VDPV’ and extended the Temporary Recommendations as revised by the Committee under the IHR to reduce the international spread of poliovirus, effective 25 November 2015.

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

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GPEI Update: Polio this week as of 25 November 2015
http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: The emergency committee of the International Health Regulations (IHR) has met for the seventh time and assessed that the international spread of polio continues to constitute a Public Health Emergency of International Concern (PHEIC). They also expanded the temporary recommendations to outbreaks of circulating vaccine derived poliovirus, due to the importance of stopping all types of poliovirus as we near the finish line of polio eradication. Learn more about cVDPVs. The statement from the emergency committee can be found here.

:: In 2015, wild poliovirus transmission is at the lowest levels ever, with fewer cases reported from fewer areas of fewer countries than ever before. In 2015, 57 wild poliovirus cases have been reported from two countries (Pakistan and Afghanistan), compared to 305 cases from nine countries during the same period in 2014.

:: On November 27 – 29, heads of governments, staff and experts from 53 commonwealth nations will gather in Malta to discuss shared global priorities at the biennial Commonwealth Heads of Government Meeting (CHOGM). Commonwealth leadership on polio has brought the disease within touching distance of eradication. Now is the time to reaffirm support and wipe the disease off the face of the earth. Sustained political and financial commitment from all countries remain critical to finishing the job to eradicate polio for good.

[Selected elements from Country-level reports]
Afghanistan
:: Three new wild poliovirus type 1 (WPV1) cases were reported in the past week, from Faryab and Nangahar provinces. The most recent case had onset of paralysis on 27 October, from Nangahar. The total number of WPV1 cases for 2015 is 16.
:: One new WPV1 environmental positive sample was reported in the past week, collected on 25 October from Lashkargah district of Hilmand province.
:: Urgent efforts are underway to strengthen the implementation of the national emergency action plan in the country. Focus is on:
– Improving governance and coordination of partners through the National and Provincial Emergency Operations Centres
– Improving SIA quality by focusing resources on low-performing districts, and clearly identifying and targeting persistently missed children
– Maximising the impact of front-line health workers through more systematic vaccinator selection, training and supervision
– Ensuring closer cross-border coordination in border areas with Pakistan
– Further strengthening surveillance, including by expanding environmental surveillance activities
:: Mop up campaigns have taken place in areas of Farah using trivalent and bivalent OPV from 15 to 24 November, and Subnational Immunisation Days (SNIDs) are planned from 29 November to 1 December in the south and east of the country using bivalent OPV

Pakistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week, with onset of paralysis on 1 November. It is the most recent WPV1 case in the country, from Kamari town, Karachi, Sindh. The total number of WPV1 cases for 2015 is now 41.

Lao People’s Democratic Republic
:: One new case of circulating vaccine-derived poliovirus type 1 (cVDPV1) was reported in the past week, from a new province. The case was reported from Hom district bordering Xaysomboune province, and had onset of paralysis on 3 October. The most recent date of onset is 7 October. The total number of cVDPV1 cases in 2015 is now four.
:: An emergency outbreak response is continuing in the country, with particular focus on three high-risk provinces. The first Subnational Immunization Days (SNIDs) using trivalent oral polio vaccine (OPV) targeted an expanded age group of children under the age of fifteen in the three most high risk districts, and childen under the age of ten elsewhere. According to independent monitoring conducted in the high-risk areas, coverage of 85-95% was achieved, with 5-15% of children missed (primarily due to children not being present at the time of the vaccination teams’ visit).
:: A second round of SNIDs is taking place from 16 – 30 November, and National Immunization Days (NIDs) will take place fom 21 to 31 December. Most of the campaigns are targeting an expanded age group range of children up to the age of 15 years.
:: All three cases are from the same village in the same province. Efforts are underway to further strengthen surveillance activities in other parts of the country, to determine if other sources of transmission are occurring elsewhere in the country.
:: Depending on the evolving epidemiology, the age group of the outbreak response may be expanded.
:: In neighbouring countries, notably Thailand and Vietnam, both surveillance and immunization activities have been stepped up, particularly in border areas.

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Circulating vaccine-derived poliovirus – Lao People’s Democratic Republic
Global Alert and Response (GAR) – Disease Outbreak News (DONs)
26 November 2015
Two additional cases of type 1 vaccine-derived poliovirus (VDPV1) have been reported from Lao People’s Democratic Republic (PDR), bringing the total number of cases in this outbreak to three.

Between 6 and 8 November 2015, the National IHR Focal Point of the Lao People’s Democratic Republic (PDR) notified WHO of 2 confirmed VDPV1 cases. Furthermore, circulating VDPV1 (cVDPV1) has also been isolated from the stools of 12 healthy contacts. All these contacts live in the same village, Bolikhan district (Bolikhamxay Province)…

…Public health response
Since the detection of the first confirmed cVDPV1 in Lao PDR, outbreak response activities have been conducted in three provinces, including the affected province (Bolikhamxay) and neighbouring provinces (Xaisounboun and Xiengkhuang). The national emergency operations centre has been activated to coordinate response efforts and a polio outbreak response plan was drafted. Enhanced surveillance is occurring throughout the country including daily zero-reporting of AFP cases. Active case finding is ongoing in the three provinces, including retrospective review of hospital and health centre records.

Six rounds with trivalent OPV vaccine have been planned from October 2015 to March 2016 (4 sub-national and 2 national) with ~ 8.6 million doses to be administered to children younger than 15 years. This age range was determined by the age distribution of the cases and their contacts. The first round of supplementary immunization activity (SIA) with OPV vaccine was completed in October in Bolikhamxay, Xaisounboun and Xiengkhuang provinces. Monitoring of October OPV SIA has occurred to identify areas with missed children and plan for mop-up activities. It is planned that this will continue during the next rounds to identify villages that require mop-up. Independent monitors were recruited to assess the quality of the campaigns.

To ensure the success of SIAs, emergency risk communications and social mobilization activities, including training of mobilizers and information sessions to build trust and address barriers to immunization, are being conducted. Key messages have been developed for radio and loudspeaker and are being translated to target identified communities…

WHO & Regionals [to 28 November 2015]

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Iraq cholera vaccination campaign
24 November 2015 — An oral cholera vaccine campaign in Iraq helps to control and contain the outbreak. This photo story follows the vaccination teams that are disseminating the vaccine and educational material on how to prevent the disease. The campaign has reached over 232 000 people during the first round. In the last 3 weeks the number of cases has continued to decline with only a few cases being reported from the affected areas.

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New recommendations show how to treat all people living with HIV and decrease new infections
Harare, 27 November 2015 –The world is poised to end the AIDS epidemic by 2030 – provided it can accelerate the pace of progress achieved globally over the past 15 years, according to a new World Health Organization (WHO) report…

Treatment for all people living with HIV
Recent findings from clinical trials have confirmed that the early and expanded use of antiretroviral treatment saves lives by keeping people living with HIV healthier and by reducing the risk that they will transmit the virus to partners.

In September, that confirmation led WHO to recommend that all people living with HIV start ART as soon as possible after diagnosis.

At ICASA, WHO is presenting a set of recommendations to enable countries to expand treatment to all — rapidly and efficiently. These recommendations include using innovative testing strategies to help more people learn they are HIV positive; moving testing and treatment services closer to where people live; starting treatment faster among people who are at advanced stages of HIV infection when they are diagnosed; and reducing the frequency of clinic visits recommended for people who are stable on ART…

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Eliminate violence against women
25 November 2015 — WHO releases a new tool for medical and legal professionals to ensure that proper evidence is collected in cases of sexual violence to help bring justice for victims. The goal is to end impunity for perpetrators of sexual violence and help eliminate violence against women. Globally 1 in 3 women has been a victim of physical/sexual partner violence in her lifetime.
New toolkit to strengthen the medico-legal response to sexual violence

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Global Alert and Response (GAR) – Disease Outbreak News (DONs)
:: 27 November 2015 Zika virus infection – Guatemala
:: 27 November 2015 Zika virus infection – El Salvador
:: 27 November 2015 Microcephaly – Brazil
:: 26 November 2015 Cholera – Iraq
:: 26 November 2015 Cholera – United Republic of Tanzania
:: 26 November 2015 Circulating vaccine-derived poliovirus – Lao People’s Democratic Republic

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Weekly Epidemiological Record (WER) 27 November 2015, vol. 90, 48 (pp. 645–660)
Contents:
645 Review of the 2015 influenza season in the southern hemisphere

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:: WHO Regional Offices
WHO African Region AFRO
:: New recommendations show how to treat all people living with HIV and decrease new infections
:: Youngest victims of the health crisis in Central African Republic – 26 November 2015
:: Health Ministers Endorse a Research Strategy for the African Region – 25 November 2015

WHO Region of the Americas PAHO
:: Lila Downs and PAHO launch campaign to prevent postpartum hemorrhage deaths in the Americas (11/24/2015)
:: First meeting of the Program to Strengthen Cooperation for Health Development in the Americas, in Brazil (11/24/2015)

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

WHO European Region EURO
:: New HIV guidelines will help Europe meet the ambitious global goal 27-11-2015
:: Highest number of new HIV cases in Europe ever 26-11-2015
:: “Europe is Europe because of migration”: highlights from day 2 of the high-level conference on refugee and migrant health 24-11-2015
:: “We cannot turn away our eyes”: highlights from day 1 of the high-level conference on refugee and migrant health 24-11-2015
:: European health decision-makers meet for high-level discussion on refugee and migrant health 23-11-2015

WHO Eastern Mediterranean Region EMRO
No new digest content identified.

WHO Western Pacific Region
:: The Royal Government of Cambodia launches the first dedicated, nationally representative study on the prevalence of intimate partner violence
PHNOM PENH, 24 November 2015 – One in five women in Cambodia has experienced sexual and/or physical intimate partner violence, according to the National Survey on Women’s Health and Life Experiences launched by the Ministry of Women’s Affairs and the National Institute of Statistics. The study documents significant physical, mental, sexual and reproductive health consequences, including injuries and pain, suicide and miscarriage. The study shows that 90% of women who reported being injured by their intimate partner had been hurt severely enough to need health care. However, 47% never sought health care.

CDC/ACIP [to 28 November 2015]
http://www.cdc.gov/media/index.html

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New CDC estimates underscore the need to increase awareness of a daily pill that can prevent HIV infection
TUESDAY, NOVEMBER 24, 2015
A new Vital Signs report published today estimates that 25 percent of sexually active gay and bisexual adult men, nearly 20 percent of adults who inject drugs, and less than…

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MMWR Weekly – November 27, 2015 / Volume (64) No. 46
http://www.cdc.gov/mmwr/index2015.html
:: World AIDS Day — December 1, 2015
:: Lower Levels of Antiretroviral Therapy Enrollment Among Men with HIV Compared with Women — 12 Countries, 2002–2013
:: Scale-up of HIV Viral Load Monitoring — Seven Sub-Saharan African Countries
:: Vital Signs: Estimated Percentages and Numbers of Adults with Indications for Preexposure Prophylaxis to Prevent HIV Acquisition — United States, 2015
:: Vital Signs: Increased Medicaid Prescriptions for Preexposure Prophylaxis Against HIV infection — New York, 2012–2015

Gavi [to 28 November 2015]
http://www.gavialliance.org/library/news/press-releases/

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Organisation of Islamic Cooperation approves Gavi membership to key health committee
Vaccine Alliance support already helping to immunise millions of children in OIC member states.
Geneva, 26 November 2015 – Gavi, the Vaccine Alliance has been officially invited to become a member of the Organisation for Islamic Cooperation’s (OIC) Steering Committee on Health.

The invitation, which recognises Gavi’s support for childhood immunisation in OIC member states, meant the Vaccine Alliance was able to participate in the 10th Steering Committee on Health (SCH) in Istanbul last week. The SCH, set up at the first Islamic Conference of Health Ministers (ICHM) in 2007, tracks implementation of a framework for action through progress and evaluation reports.

From 2000 to 30 September 2015, Gavi provided more than US$ 4 billion to support immunisation in 33 OIC member states – equivalent to 49% of Gavi disbursements. This has helped developing countries immunise more than 210 million children, saving over four million lives.

Ambassador Mohammed Naeem Khan, Assistant Secretary-General of Science and Technology at the Organisation of Islamic Cooperation (OIC), said: “We welcome Gavi as a member of SCH and highly appreciate its active support to OIC member states and look forward to further strengthening of the partnership between OIC and Gavi.”…

IAVI International AIDS Vaccine Initiative [to 28 November 2015]
http://www.iavi.org/press-releases/2015

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Updated Guidelines Released to Respect, Protect and Fulfill the Needs of Men Who Have Sex with Men (MSM) in HIV Research
November 25, 2015
Experience consistently shows that better collaboration is needed between researchers and community-based organizations (CBOs) around studies of HIV treatment and prevention interventions involving gay men and other men who have sex with men (MSM). This is, especially true in resource-constrained settings. In addition, working with MSM in these contexts presents unique challenges from the often prevalent stigma, discrimination, and security concerns.

To meet this ongoing need, a group led by amfAR, The Foundation for AIDS Research; the International AIDS Vaccine Initiative (IAVI); the John Hopkins University – Center for Public Health and Human Rights (JHU-CPHHR); and the United Nations Development Program (UNDP) has updated important guidance to help researchers and CBOs maximize the benefits and minimize any potential risks of working together on this critically needed research.

The revised “Respect, Protect, Fulfill” will be released on 28 November, at the Key Populations Pre-conference of the 18th International Conference on HIV/AIDS and other STIs in Africa (ICASA), which takes place in Harare, Zimbabwe, from 29 November through 4 December 2015…