HPV vaccination series completion and co-vaccination: Pairing vaccines may matter for adolescents

Vaccine
Volume 33, Issue 43, Pages 5729-5888 (26 October 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/43

.

Short communication
HPV vaccination series completion and co-vaccination: Pairing vaccines may matter for adolescents
Pages 5729-5732
Jessica Keim-Malpass, Emma McKim Mitchell, Fabian Camacho
Abstract
Very little is known about the effect of concurrent co-vaccination on HPV series completion. This study utilized a retrospective review of a Clinical Data Repository to assess whether concurrent vaccination had an impact on HPV vaccination series completion, and whether there were differences based on age. 3371 patients who received the HPV vaccine at a single academic medical center between the years 2009–2013 were included in this analysis. The adjusted odds ratio (aOR) for effect of concurrent vaccination on series completion for the age group 9–18 was 1.32 (95% CI 1.09, 1.60). Although not statistically significant, the aOR for effect of concurrent vaccination on completion changed direction for the 19–25 age group and was 0.44 (95% CI 0.17, 1.12). This study provides preliminary evidence that pairing the HPV vaccine with one or more co-vaccines may yield a higher HPV vaccination completion rate among adolescents age 9–18.

Text message reminders for timely routine MMR vaccination: A randomized controlled trial

Vaccine
Volume 33, Issue 43, Pages 5729-5888 (26 October 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/43

.

Text message reminders for timely routine MMR vaccination: A randomized controlled trial
Original Research Article
Pages 5741-5746
Annika M. Hofstetter, Nathalie DuRivage, Celibell Y. Vargas, Stewin Camargo, David K. Vawdrey, Allison Fisher, Melissa S. Stockwell
Abstract
Objective
Measles–mumps–rubella (MMR) vaccination is important for preventing disease outbreaks, yet pockets of under-vaccination persist. Text message reminders have been employed successfully for other pediatric vaccines, but studies examining their use for MMR vaccination are limited. This study assessed the impact of text message reminders on timely MMR vaccination.
Study design
Parents (n = 2054) of 9.5–10.5-month-old children from four urban academically-affiliated pediatric clinics were randomized to scheduling plus appointment text message reminders, appointment text message reminder-only, or usual care. The former included up to three text reminders to schedule the one-year preventive care visit. Both text messaging arms included a text reminder sent 2 days before that visit. Outcomes included appointment scheduling, appointment attendance, and MMR vaccination by age 13 months, the standard of care at study sites.
Results
Children of parents in the scheduling plus appointment text message reminders arm were more likely to have a scheduled one-year visit than those in the other arms (71.9% vs. 67.4%, relative risk ratio (RRR) 1.07 [95% CI 1.005–1.13]), particularly if no appointment was scheduled before randomization (i.e., no baseline appointment) (62.1% vs. 54.7%, RRR 1.14 [95% CI 1.04–1.24]). One-year visit attendance and timely MMR vaccination were similar between arms. However, among children without a baseline appointment, those with parents in the scheduling plus appointment text message reminders arm were more likely to undergo timely MMR vaccination (61.1% vs. 55.1%, RRR 1.11 [95% CI 1.01–1.21]).
Conclusion
Text message reminders improved timely MMR vaccination of high-risk children without a baseline one-year visit.

Medicaid provider reimbursement policy for adult immunizations

Vaccine
Volume 33, Issue 43, Pages 5729-5888 (26 October 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/43

.

Medicaid provider reimbursement policy for adult immunizations
Original Research Article
Pages 5801-5808
Alexandra M. Stewart, Megan C. Lindley, Marisa A. Cox
Abstract
Background
State Medicaid programs establish provider reimbursement policy for adult immunizations based on: costs, private insurance payments, and percentage of Medicare payments for equivalent services. Each program determines provider eligibility, payment amount, and permissible settings for administration. Total reimbursement consists of different combinations of Current Procedural Terminology codes: vaccine, vaccine administration, and visit.
Objective
Determine how Medicaid programs in the 50 states and the District of Columbia approach provider reimbursement for adult immunizations.
Design
Observational analysis using document review and a survey.
Setting and participants
Medicaid administrators in 50 states and the District of Columbia.
Measurements
Whether fee-for-service programs reimburse providers for: vaccines; their administration; and/or office visits when provided to adult enrollees. We assessed whether adult vaccination services are reimbursed when administered by a wide range of providers in a wide range of settings.
Results
Medicaid programs use one of 4 payment methods for adults: (1) a vaccine and an administration code; (2) a vaccine and visit code; (3) a vaccine code; and (4) a vaccine, visit, and administration code.
Limitations
Study results do not reflect any changes related to implementation of national health reform. Nine of fifty one programs did not respond to the survey or declined to participate, limiting the information available to researchers.
Conclusions
Medicaid reimbursement policy for adult vaccines impacts provider participation and enrollee access and uptake. While programs have generally increased reimbursement levels since 2003, each program could assess whether current policies reflect the most effective approach to encourage providers to increase vaccination services.

What determines uptake of pertussis vaccine in pregnancy? A cross sectional survey in an ethnically diverse population of pregnant women in London

Vaccine
Volume 33, Issue 43, Pages 5729-5888 (26 October 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/43

.

What determines uptake of pertussis vaccine in pregnancy? A cross sectional survey in an ethnically diverse population of pregnant women in London
Original Research Article
Pages 5822-5828
Beverly Donaldson, Prerna Jain, Beth S. Holder, Benjamin Lindsay, Lesley Regan, Beate Kampmann
Abstract
Introduction
Following the major outbreak of pertussis and 14 infant deaths across England in 2012, the Department of Health (DH) introduced the UK’s first maternal pertussis vaccination programme. Data published by Public Health England (PHE) suggest uptake of the vaccine varies considerably across the country. The reasons for this heterogeneity need to be addressed to optimise the impact of the programme.
Objective
To assess uptake of antenatal pertussis and influenza vaccine in a leading NHS Trust in London and to explore awareness and attitudes of pregnant women towards the pertussis vaccination programme.
Design
A cross sectional survey was conducted in an ethnically diverse group of 200 pregnant women accessing antenatal care at Imperial Healthcare NHS Trust. Quantitative data was tabulated and content analysis was carried out on the free text. Qualitative data was divided into themes for accepting or declining the vaccine.
Results
Awareness of the programme was 63% (126/200) with actual uptake of the vaccine only 26.0% (52/200). Women had received information from multiple sources, primarily General Practitioners (GP) and midwives. 34.0% (68/200) of women were offered the vaccine at their GP practice, only 24% reported a meaningful discussion with their GP about it. Uptake differed by up to 15.0% between ethnicities. Qualitative data showed that uptake could be significantly enhanced if vaccination was recommended by a familiar healthcare professional. Feeling uninformed, lack of professional encouragement and uncertainties of risk and benefit of the vaccine were the greatest barriers to uptake.
Conclusion
Vaccine uptake in this cohort of pregnant women was poor. Understanding the target audience and engaging with key groups who influence women’s decision-making is essential. Knowledgeable health care professionals need to recommend the vaccine and provide accurate and timely information to increase success of this important programme.

The effect of various types of patients’ reminders on the uptake of pneumococcal vaccine in adults: A randomized controlled trial

Vaccine
Volume 33, Issue 43, Pages 5729-5888 (26 October 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/43

.

The effect of various types of patients’ reminders on the uptake of pneumococcal vaccine in adults: A randomized controlled trial
Original Research Article
Pages 5868-5872
Alexandra S. Ghadieh, Ghassan N. Hamadeh, Dina M. Mahmassani, Najla A. Lakkis
Abstract
Background
Invasive pneumococcal disease is one of the most important vaccine-preventable diseases threatening the adult community due to missed opportunities for vaccination. This study compares the effect of three different types of patient reminder system on adulthood Streptococcus pneumoniae immunization in a primary care setting.
Methods
The study targeted patients aged 40 and older eligible for pneumococcal vaccine, but did not receive it yet (89.5% of 3072 patients) based on their electronic medical records in a family medicine center in Beirut. The sample population was randomized using an automated computer randomization system into six equal groups, receiving short phone calls, short text messaging system (sms-text) or e-mails each with or without patient education. Each group received three identical reminders spaced by a period of four weeks. Documentation of vaccine administration was then added to the longitudinal electronic patient record. The primary outcome was the vaccine administration rate in the clinics.
Results
Of the eligible patients due for the pneumococcal 23-polyvalent vaccine, 1380 who had mobile phone numbers and e-mails were randomized into six equal intervention groups. The various reminders increased vaccination rate to 14.9%: 16.5% of the short phone calls group, 7.2% of the sms-text group and 5.7% of the e-mail group took the vaccine. The vaccination rate was independent of the age, associated education message and the predisposing condition.
Conclusion
Use of electronic text reminders via e-mails and mobile phones seems to be a feasible and sustainable model to increase pneumococcal vaccination rates in a primary care center.

Childhood vaccination requirements: Lessons from history, Mississippi, and a path forward

Vaccine
Volume 33, Issue 43, Pages 5729-5888 (26 October 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/43

.

Childhood vaccination requirements: Lessons from history, Mississippi, and a path forward
Original Research Article
Pages 5884-5887
Philip B. Cawkwell, David Oshinsky
Abstract
Mississippi consistently leads the United States in childhood vaccination with a greater than 99% measles–mumps–rubella vaccination rate for children entering kindergarten. The story of how this came to pass in a state that lags behind on nearly every other public health measure is pertinent given the recent outbreaks of measles in the United States, especially in pockets of the country where there is strong resistance to vaccination. The fight against compulsory vaccination law is centuries old and the enduring success of Mississippi at repelling challenges to their vaccination requirements is a testament to the public health infrastructure and legal framework established in the state. Herein we trace the anti-vaccination movement from its origins in England up until the present time in the United States and explore how Mississippi has established a model vaccination system. Seminal court cases and legislation are evaluated for their impact. Finally, contemporary battles over vaccination legislation are examined and the feasibility of national-level change is considered.

Value in Health – November 2015

Value in Health
November 2015 Volume 18, Issue 7
http://www.valueinhealthjournal.com/current

.
Public Health Impact and cost-Effectiveness of Malaria routine Vaccination in Infants
C Sauboin, E Sicuri, L Van Bellinghen, N Van de Velde, I Van Vlaenderen
A338–A339
Abstract
Final phase III trial results of the first malaria vaccine candidate RTS,S have been published. Based on these results, our study aims at estimating the public health impact and cost-effectiveness of RTS,S implementation in infants in 42 sub-Saharan countries

Cost-Effectiveness analysis of Quadrivalent Versus trivalent Influenza Vaccination In Germany — Linking a Dynamic Transmission Model with Health and Economic Outcomes
FC Dolk, M Eichner, R Welte, A Anastassopoulou, L Van Bellinghen, B Poulsen Nautrup, I Van Vlaenderen, R Schmidt-Ott, M Schwehm, M Postma
A339
Abstract
Trivalent influenza vaccine (TIV) contains two Influenza A strains, but only one of the two B-lineages, resulting in frequent mismatches between vaccines and circulating B-lineages during seasonal epidemics. Quadrivalent influenza vaccine (QIV) prevents such mismatches by including both B-lineages. The objective of our study was to estimate the cost-effectiveness (CE) of QIV versus TIV in Germany by coupling influenza incidence generated by a dynamic individual-based simulation to health and economic outcomes.

 

Vaccines and Global Health: The Week in Review 17 October 2015

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_17 October 2015

blog edition: comprised of the approx. 35+ entries posted below on 13 September 2015..

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

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

EBOLA/EVD [to 17 October 2015]

EBOLA/EVD [to 17 October 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

Ebola Situation Report – 14 October 2015
[Excerpts]
SUMMARY [excerpt]
No confirmed cases of Ebola virus disease (EVD) were reported in the week to 11 October. This is the second consecutive week with zero confirmed cases. However, 150 registered contacts remain under follow-up in Guinea, of which 118 are high risk, and an additional 259 contacts remain untraced. There remains a near-term risk of further cases among both registered and untraced contacts. In Sierra Leone, 2 high-risk contacts associated with the 2 most recently active chains of transmission in the country were lost to follow-up and have not yet been found. In addition, a patient who was reported as a case in the United Kingdom on 29 December 2014, and who later recovered, was hospitalised on 6 October in the United Kingdom after developing late EVD-related complications. As of 13 October, 62 close contacts have been identified in the UK for follow-up…
WHO: Preliminary study finds that Ebola virus fragments can persist in the semen of some survivors for at least nine months
Freetown, 14 October 2015 – Preliminary results of a study into persistence of Ebola virus in body fluids show that some men still produce semen samples that test positive for Ebola virus nine months after onset of symptoms.

The report, published today in the New England Journal of Medicine, provides the first results of a long-term study being jointly conducted by the Sierra Leone Ministry of Health and Sanitation, Sierra Leone Ministry of Defence, the World Health Organization and the U.S. Centers for Disease Control and Prevention.

“Sierra Leone is committed to getting to zero cases and to taking care of our survivors, and part of that effort includes understanding how survivors may be affected after their initial recovery,” said Amara Jambai, M.D., M.Sc., Deputy Chief Medical Officer for the Sierra Leone Ministry of Health and Sanitation. “Survivors are to be commended for contributing to the studies that help us understand how long the virus may persist in semen.”

The first phase of this study has focused on testing for Ebola virus in semen because of past research showing persistence in that body fluid. Better understanding of viral persistence in semen is important for supporting survivors to recover and to move forward with their lives.

“These results come at a critically important time, reminding us that while Ebola case numbers continue to plummet, Ebola survivors and their families continue to struggle with the effects of the disease. This study provides further evidence that survivors need continued, substantial support for the next 6 to 12 months to meet these challenges and to ensure their partners are not exposed to potential virus,” said Bruce Aylward, WHO Director-General’s Special Representative on the Ebola Response…

::::::

Two new Ebola cases in Guinea confound hopes of end to outbreak
Reuters – Friday 16 October 2015
Weeks away from west African country being declared free of disease, two men have contracted virus, one having had no contact with registered victims
Two people have fallen ill with Ebola in Guinea, the World Health Organisation has said, dashing hopes of an imminent end to the worst recorded outbreak of the disease after a two-week spell without any new cases across west Africa.

Guinea was weeks away from joining Liberia in being declared free of the virus that has killed more than 11,000 people in a near two-year rampage. Neighbouring Sierra Leone is also halfway through the 42-day countdown to being Ebola-free…

Authorities in Guinea said on Friday one of the cases in Forécariah, western Guinea, appeared to be linked to a previously known chain of infection, while the other in the capital, Conakry, seemed to be new.

“On the bumpy road we keep talking about – the high risk of recurrence – once again we are navigating a few bumps,” Margaret Harris, a WHO spokeswoman, told a briefing in Geneva. “Of course we didn’t want it, but we did expect it. Guinea hadn’t got to the stage where we were looking at 42 days.”…

POLIO [to 17 October 2015]

POLIO [to 17 October 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week as of 14 October 2015
Global Polio Eradication Initiative
Full report link: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: In Lao People’s Democratic Republic a circulating vaccine-derived poliovirus type 1 (cVDPV1) outbreak has been confirmed, with one case, an eight year old boy who had onset of paralysis on 7 September. Outbreaks of cVDPVs can arise in areas of low population immunity, emphasizing the importance of strong vaccination coverage. Learn more about VDPVs.
:: Thirty five million children were reached with polio vaccines during the September campaigns in Pakistan. Nearly 3 million children who were previously missed were vaccinated during the catch up days following this campaign. ‘Continuous community-protected vaccination’ (community based vaccinators who carry out immunization activities on an ongoing basis) and health camps are helping to reach children in the most difficult to reach areas.
:: Last week, the Independent Monitoring Board met in London to assess progress towards polio eradication and to make recommendations for the coming months. The report is expected to be published in the next few weeks.
[Selected Country Update Information]
Afghanistan
:: One new wild poliovirus type 1 (WPV1) cases was reported in the past week in Batikot district of Nangarhar with onset of paralysis on 4 September. This is the first case in this district in 2015. The most recent case had onset of paralysis on 6 September in Sherzad district of Nangarhar province. The total number of WPV1 cases for 2015 is now 13.
:: No new positive environmental samples were reported in the past week.
:: Mop-up campaigns are planned in Nangarhar on 18 – 20 October using bivalent oral polio vaccine (OPV), and Gulestan district of Farah using the inactivated polio vaccine (IPV) and bivalent OPV with dates to be confirmed. National Immunization Days (NIDs) will take place on 1 – 3 November using trivalent OPV and Subnational Immunisation Days (SNIDs) are planned from 29 November to 1 December in the south and east of the country using bivalent OPV. Further mop up campaigns will take place in Balabuluk and Khak-E-Safed districts of Farah in November.
Pakistan
:: Two new wild poliovirus type 1 (WPV1) cases were confirmed in the past week, one in Chakwal district of Punjab and one in Karachi-Gulberg, Sindh. The most recent case had onset of paralysis on 16 September in Peshawar. The total number of WPV1 cases for 2015 is now 38, compared to 205 at this time last year.
Lao People’s Democratic Republic
:: One new case of circulating vaccine-derived poliovirus type 1 (cVDPV1) was reported in Lao in the past week, in Bolikhanh district of Borikhamxay province, with onset of paralysis on 7 September. Based on epidemiological considerations and indications that the virus has been circulating for a prolonged period of time, this has been classified as circulating despite it being a single case. This case, an eight year old boy who had received zero doses of polio vaccine, is the only one reported in 2015.
:: Outbreaks of cVDPVs can arise in areas of low population immunity, emphasizing the importance of strong vaccination coverage. Learn more about VDPVs.
:: Planning is underway for an emergency outbreak response
Ukraine
:: No new circulating vaccine-derived poliovirus type 1 (cVDPV1) cases have been reported in the past week. The most recent case had onset of paralysis on 7 July in the Zakarpatskaya oblast, in south-western Ukraine, bordering Romania, Hungary, Slovakia and Poland. The number of cVDPV1 cases reported in 2015 remains 2.
:: Ukraine had been at particular risk of emergence of a cVDPV, due to inadequate vaccination coverage. In 2014, only 50% of children were fully immunized against polio and other vaccine-preventable diseases.
:: Discussions are currently ongoing with national health authorities to plan and implement an urgent outbreak response. More.

.
UNICEF and WHO ready to support immediate polio vaccination campaign in Ukraine
UN agencies concerned further delay puts 1.8 million children’s lives at risk
Joint press release
KYIV, Ukraine/COPENHAGEN/GENEVA, 9 October 2015 – Six weeks after the polio outbreak in Ukraine, UNICEF and WHO have stepped up calls for an immediate first round of nationwide polio vaccination…UNICEF and WHO are on standby to support the campaign.

.
Vaccination teams work to keep Iraq polio free and combat the spread of cholera
Baghdad, 13 October 2015 – A nationwide campaign to vaccinate 5.8 million children in Iraq against polio was concluded on 11 October after a 2-day extension recommended by the Ministry of Health to achieve maximum vaccination coverage. This effort to ensure that Iraq remains polio free also included the dissemination of life-saving information to 1.5 million households across the country on how to detect, prevent and treat cholera.

Led by the Federal Ministry of Health, in coordination with WHO and UNICEF, the 7-day polio vaccination campaign begun on 4 October included nearly 13 000 vaccination teams deployed throughout Iraq. Each team travelled door to door, visiting individual households to vaccinate children against polio. The current campaign is the eleventh such national effort in Iraq since October 2013, when polio was first detected in neighbouring Syria, and the fourth this year alone.

“WHO is supporting the campaign through a provision of technical expertise at national, regional, and subnational levels in high-risk areas,” said Altaf Musani, acting WHO Representative in Iraq. “Our support also includes financial assistance for polio campaign workers and finger-marking, as well as conducting surveillance activities, which is the only scientific tool to prove that polio has been contained in Iraq,” he added.

Based on preliminary field reports from the campaign, immunization activities are being implemented smoothly. However, security constraints in parts of Ninewa, Al Shergat district in Sala El Din, and parts of Kirkuk are compromising access to all children in these areas.

“UNICEF and partners have taken an innovative approach to the double threat of disease facing children and families in Iraq,” said Peter Hawkins, UNICEF’s Representative in Iraq. “In the context of mass displacement and continuing violence, the humanitarian community has succeeded in administering 36 million doses of oral polio vaccine, doubling the country’s cold chain capacity. Converging existing activities can help the very limited resources make a greater impact, and ultimately save more lives.”

WHO & Regionals [to 17 October 2015]

WHO & Regionals [to 17 October 2015]

.
Cholera – Iraq
Disease Outbreak News
12 October 2015
WHO has received notification from the National IHR Focal Point of Iraq of additional laboratory-confirmed cases of cholera. As of 8 October, a total of 1,263 laboratory-confirmed cases of Vibrio cholerae 01 Inaba were reported….

Public health response
The Cholera task force led by the Ministry of Health (MoH) has established a Cholera Command and Control Centre to enhance multisectoral coordination for effective response to the outbreak. In the affected governorates, active surveillance has been stepped up for case findings in the community and case management has been standardized across all health facilities currently admitting the cholera cases.

In cholera affected areas, and particularly in the camps hosting the internally displaced people and refugees, preparedness activities have been geared up as well…

Furthermore, discussions are ongoing with the International Coordinating Group to release oral cholera vaccine from the global stock. A risk assessment to identify priority groups for vaccination and a vaccination plan is being developed.

WHO has deployed a team of international experts under the Global Outbreak Alert and Response Network (GOARN) to support MoH respond to this outbreak. Additional requests have also been sent out to the technical partners in GOARN in case of request for additional international support for cholera response.

.

Vaccinations made friendly
4 October 2015
Globally, 1 in 5 children still do not receive routine life-saving immunizations, and an estimated 1.5 million children die each year of diseases that could be prevented by vaccines that already exist. WHO recommends how to reduce the pain at the time of vaccination across all age groups.

.

The Weekly Epidemiological Record (WER) 16 October 2015, vol. 90, 42 (pp. 561–576)
Includes:
561 Antigenic and genetic characteristics of zoonotic influenza viruses and development of candidate vaccine viruses for pandemic preparedness
571 Chikungunya disease: gaps and opportunities in public health and research in the Americas

.

:: WHO Regional Offices
WHO African Region AFRO
:: North central states of Nigeria boost population immunity along nomadic routes
Abuja, 16 October 2015 – The World Health Organization (WHO) in collaboration with the government, has recently intensified its efforts to reach the most marginalised, hard-to-reach and nomadic communities of the North Central region of the country.
Following the adoption of a blueprint, states of Nasarawa, Niger and Plateau are working assiduously to provide the required health interventions to pastoral nomadic populations in their respective states with a view to boost population immunity and improve disease surveillance…
:: Liberia Plans to Strengthen Mental Health
Monrovia 15 October – In view of the traumatic effects of the decade long civil war and the recent Ebola outbreak, mental health promotion is now more relevant to Liberia than ever before.
As part of its concerted efforts to build a Resilient Health System in Liberia, the Ministry of Health (MOH) in collaboration with WHO and other major international and national partners is focusing on advocacy and provision of adequate mental and psychosocial support services for persons affected by the epidemic and people with mental disorders in general…
:: Mass Measles campaign launched in Uganda
Kyegegwa 12th October 2015: The Mass Measles Campaign was launched in Kyegegwa district at the Humura Primary School grounds under the theme ‘Uganda united against measles’. The key message to parents was to have their children immunized against the Vaccine Preventable Diseases (‘VPDs’).
Launching the campaign, Honorable Sarah Opendi, the Minister of State for Health in charge of primary health care called on parents to adhere to the immunization schedule provided to them at health centers. She further denounced the myth about vaccine safety, “vaccine development is a long and laborious process, which lasts for several years, it’s tested and once recommended and certified by the World Health Organization (WHO), then you know that it is safe for our population.” Hon Opendi also said that this is the fourth measles follow up campaign which aims at reducing measles morbidity and mortality by 95 percent in 2015. At the same occasion, Hon. Opendi launched the supplementary Oral Polio Vaccine vaccination that targets at least 2.3 million children between 0-59 months in the 23 high risk districts…

WHO Region of the Americas PAHO
:: PAHO urges accelerated shift to community-based mental health services to widen access, protect human rights (10/10/2015)

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

WHO European Region EURO
No new digest content identified.

WHO Eastern Mediterranean Region EMRO
:: Vaccination teams work to keep Iraq polio free and combat the spread of cholera
Baghdad, 13 October 2015 – A nationwide campaign to vaccinate 5.8 million children in Iraq against polio ended on 11 October after a 2-day extension recommended by the Ministry of Health of Iraq to achieve maximum vaccination coverage. The campaign aimed to keep Iraq polio free and also included the dissemination of information to 1.5 million households across the country on how to detect, prevent and treat cholera.

WHO Western Pacific Region
:: Sixty-sixth session of the WHO Regional Committee celebrates progress on ageing and health, NCD prevention and control, and regulatory systems strengthening
GUAM, 15 OCTOBER 2015 – The WHO Regional Committee for the Western Pacific—the Organization’s governing body in the Region—noted significant progress on ageing and health, noncommunicable disease (NCD) prevention and control, and regulatory systems strengthening at its sixty-sixth annual meeting Thursday on Guam.
Read the news release
:: WHO tackles violence, injury prevention; and urban health
GUAM, 14 OCTOBER 2015 – The WHO Regional Committee for the Western Pacific—the Organization’s governing body in the Region—today endorsed an action plan that will help Member States reduce violence and injuries, and a framework plan that will assist the Region’s cities in their efforts to effectively meet the health challenges caused by rapid and unplanned urbanization.
:: WHO takes action to stop viral hepatitis and tuberculosis; promotes universal health coverage
GUAM, 13 October 2015 – On Day 2 of its annual meeting, the World Health Organization (WHO) Regional Committee for the Western Pacific—the Organization’s regional governing body—approved action plans and frameworks to strengthen efforts to reduce viral hepatitis and tuberculosis, and attain universal health coverage in the Region.
Read the news release

CDC/MMWR/ACIP Watch [to 17 October 2015]

CDC/MMWR/ACIP Watch [to 17 October 2015]
http://www.cdc.gov/media/index.html

.
WEDNESDAY, OCTOBER 14, 2015
Preliminary study finds that Ebola virus fragments can persist in the semen of some survivors for at least nine months
Preliminary results of a study into persistence of Ebola virus in body fluids show that some men still produce semen samples that test positive for Ebola virus nine months after onset of symptoms….

MMWR October 16, 2015 / No. 40/ Vol. 64
:: State and Territorial Ebola Screening, Monitoring, and Movement Policy Statements — United States, August 31, 2015
::Human Papillomavirus Vaccination Coverage Among School Girls in a Demonstration Project — Botswana, 2013

ACIP Meeting – October 21, 2015 [one-day meeting]
October 21, 2015[2 pages] Final, October 8, 2015

New Partnership with India Aims to Build Vaccine Manufacturing Network for Hookworm, Other Diseases – Sabin

Sabin Vaccine Institute [to 17 October 2015]
http://www.sabin.org/updates/pressreleases

.
New Partnership with India Aims to Build Vaccine Manufacturing Network for Hookworm, Other Diseases
WASHINGTON, D.C., BANGALORE, AMSTERDAM — October 14, 2015 — The Amsterdam Institute for Global Health and Development (AIGHD) and Sabin Vaccine Institute Product Development Partnership (Sabin PDP) today announced a new research and innovation partnership with the Association of Biotechnology Led Enterprises (ABLE) of India on vaccine development for hookworm and other neglected tropical diseases (NTDs). The European Union, through its EuropeAid program, recently awarded a five-year grant of €333,000 to AIGHD to establish this EU-India partnership.

Sanofi Pasteur and the Infectious Disease Research Institute Partner on a Global-Health, Open-Innovation, Vaccine Research & Development Center

Industry Watch [to 17 October 2015]
:: Sanofi Pasteur and the Infectious Disease Research Institute Partner on a Global-Health, Open-Innovation, Vaccine Research & Development Center
SWIFTWATER, Pennsylvania, October 15, 2015 /PRNewswire/ —

Sanofi Pasteur, the vaccines division of Sanofi, announced today the creation of a Global Health Vaccine Center of Innovation (GHVCI) with the Infectious Disease Research Institute (IDRI), a Seattle, USA-based global-health, non-profit institute with a focus on developing new products to combat the world’s most devastating infectious diseases. This project is also funded in part by a grant from the Bill & Melinda Gates Foundation, as the proposed R&D alliance is related to the Gates Foundation and Sanofi Pasteur’s strategic agreement on a Vaccine Discovery Partnership signed in 2013.

The addition of IDRI will enable vaccine adjuvant/formulation platforms and a pipeline of vaccine candidates to be discovered, evaluated and developed to address a range of infectious diseases under the center of innovation based at IDRI. The GHVCI will be co-funded by the Gates Foundation and Sanofi Pasteur under a tripartite agreement.

The GHVCI has been established to accelerate the development of vaccines and supporting technologies to address infectious diseases and ensuring that new critical vaccines are available to populations in developing countries. Sanofi Pasteur will leverage the resources and expertise of this external R&D innovation center and obtain access to IDRI’s adjuvants and vaccine antigens.

“IDRI is a partner of choice as they are a world-leader in the development and evaluation of adjuvant formulations, using a broad portfolio of adjuvants with different immune-stimulating properties,” commented Jim Tartaglia, PhD, R&D VP for new vaccine projects at Sanofi Pasteur. “The Institute has a world-class staff and capabilities in immunology and GMP production”.

“There are a number of diseases that are of great global-health significance, where Sanofi Pasteur could significantly contribute,” according to John Shiver, PhD, Sr. VP for R&D at Sanofi Pasteur; “however, commercial realities provide a challenge to investment. The establishment of this Global Health Vaccines Center of Innovation represents a new opportunity–operating within the open innovation R&D model–to provide antigens, adjuvanted formulations, funding, and expertise to allow development of needed vaccines.”

This distinctive collaboration brings together the complementary expertise of Sanofi Pasteur’s position as a leading, multi-national vaccine developer, manufacturer, and seller; IDRI’s antigens, vaccine design, formulation and production expertise; and the Gates Foundation’s knowledge, global influence and financial support. A Joint Steering Committee, comprised of representatives from each of the three partners, will be formed to manage the mission of the GHVCI.

Human Vaccines Project Partners with MedImmune to Help Accelerate Research and Development in Infectious Disease and Oncology

IAVI International AIDS Vaccine Initiative [to 17 October 2015]
http://www.iavi.org/press-releases/2015

.
Human Vaccines Project Partners with MedImmune to Help Accelerate Research and Development in Infectious Disease and Oncology
October 13, 2015
MedImmune is the newest member of the Human Vaccines Project, which will help to accelerate the research and development of vaccines and immunotherapies for infectious disease and cancer.

Incubated at the International AIDS Vaccine Initiative (IAVI), the Human Vaccines Project is an ambitious new public-private partnership seeking to transform the future of global disease prevention and treatment by solving the primary scientific obstacles impeding the research and development of new vaccines and immunotherapies. Endorsed by 35 leading vaccine scientists, the Project brings together top academic research centers, and government, non-profit and industry research and development efforts into a global consortium.

MedImmune will help establish the Project’s global consortium, launch its research program and guide its scientific plan and future direction as a participant of the consortium and member of the Industrial Advisory Committee, a panel of leading industry partners that will advise the Project on its scientific plan and future direction…

Global Fund Hails Swaziland Partnership at Grant Signing

Global Fund [to 17 October 2015]
http://www.theglobalfund.org/en/news/

.
News
Global Fund Hails Swaziland Partnership at Grant Signing
14 October 2015
MBABANE, Swaziland – Swaziland and the Global Fund deepened their partnership with the signing of three grants totaling more than US$66 million, to expand prevention and treatment for HIV and tuberculosis.

The financial resources provided through the Global Fund come from many sources and partners, represented at the signing ceremony today by the United States and the European Union, as well as technical partners from UNAIDS and WHO.

The new grants will go to government and civil society implementers selected through a vibrant country dialogue. The HIV grants will support treatment for people living with HIV as well prevention of new infections among key populations and vulnerable groups, including young women and girls.

The TB grant will accelerate the response toward TB/HIV co-infection and concentrate on treatment and prevention of key populations affected by tuberculosis. Swaziland is a high disease-burden country, with 26 percent HIV prevalence – one of the highest in the world, as well as a high TB burden…

A new approach to research for health to combat infectious diseases in Africa – UNESCO

UNESCO [to 17 October 2015]
http://en.unesco.org/news

.
15.10.2015 – Natural Sciences Sector
A new approach to research for health to combat infectious diseases in Africa
The burden of infectious diseases continues to be disproportionately high in some African countries, particularly in sub-Saharan Africa, with significant impacts on health and socio-economic development. However, the difficulties in applying scientific research to improve health are particularly acute in the region. Creating an enabling political environment and building capacity for life sciences and health research are fundamental to improving people’s wellbeing across the continent. This will be the focus of the Africa Research Summit organized by UNESCO and Merck that will be live-streamed on 19-20 October 2015 from Geneva.

There is currently a lack of international resources dedicated to regional health needs and a shortage of expenditure on health research. The need to support research in order to address the challenges of infectious disease is recognized in the recently adopted 2030 Agenda for Sustainable Development, as Target 3.b: “Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries”. This year’s Nobel prize in Physiology or Medicine, awarded to research on infectious diseases, is another strong message, shining a light on health-related issues that can only be addressed adequately when countries have built a strong scientific research environment to support discoveries, inventions, and innovations.

The Africa Research Summit is part of an effort to build the capacities of African researchers in the life and medical sciences and thus, support the improvement of health systems in Africa. There are two key areas which must be addressed. Firstly, the lack of local capacity in the life sciences to perform high-quality research on neglected health needs. Secondly, the ineffectiveness of current mechanisms for translating research into health solutions, which can be disseminated to those most in need. The 2015 Summit will focus on the role of building capacities in the life sciences to address challenges of infectious diseases, most notably the Ebola crises…

Lack of access to hygiene could endanger new Development Agenda – UNICEF

UNICEF [to 17 October 2015]
http://www.unicef.org/media/media_78364.html

.
Selected press releases
Lack of access to hygiene could endanger new Development Agenda – UNICEF
NEW YORK, 15 October 2015 – Handwashing with soap is dangerously low in many countries, UNICEF reports, despite its proven benefits to child health.
The eighth Global Handwashing Day comes less than a month after the United Nations adopted the Sustainable Development Goals, including hygiene for the first time in the global agenda. One of the SDG targets is to achieve ‘access to adequate and equitable sanitation and hygiene’ by 2030.

UNICEF says improvements in hygiene must supplement access to water and sanitation, or children will continue to fall victim to easily preventable diseases like diarrhoea.
“Along with drinking water and access to toilets, hygiene – particularly handwashing with soap – is the essential third leg of the stool holding up the Goal on water and sanitation,” said Sanjay Wijesekera, global head of UNICEF’s water, sanitation and hygiene programmes. “From birth – when unwashed hands of birth attendants can transmit dangerous pathogens – right through babyhood, school and beyond, handwashing is crucial for a child’s health. It is one of the cheapest, simplest, most effective health interventions we have.”…

Declaration of the G7 Health Ministers:: 8 – 9 October 2015 in Berlin [Antimicrobial Resistance; Ebola]

Declaration of the G7 Health Ministers:: 8 – 9 October 2015 in Berlin
G7 Germany
October 2015
1. In continuation of the G7 Summit in Elmau on 7 and 8 June 2015, we, the G7 Health Ministers, discussed the health topics Antimicrobial Resistance (AMR) and Ebola during our G7-Meeting in Berlin on 8 and 9 October 2015.

2. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being. We are therefore strongly committed to continuing our engagement in this field with a specific focus on strengthening health systems through bilateral programmes and multilateral structures.

3. The G7 Health Ministers agreed on the following actions for the implementation of the G7 Leaders’ Declaration as outlined in the “Berlin Declaration on AMR” and “G7 Health Ministers’ Commitment – Lessons learned from Ebola”…

Berlin Declaration on Antimicrobial Resistance –
Global Union for Antibiotics Research and Development (GUARD)
Agreed by G7 Health Ministers in Berlin 2015
[Excerpt from 22 paragraphs]
…17. We will work, in collaboration with WHO, building on existing networks, to promote a global network of researchers; experts from academia, industry, healthcare, veterinary care, regulatory agencies, food safety and agriculture; philanthropic organizations; and international organizations to provide opportunities to exchange information on ongoing research activities, access to expertise for funded projects, and retention of accumulated knowledge. We welcome the initiative by Germany to organise the first expert meeting in 2016/2017.

18. Given the global nature of drug research, development and commercialisation and the global challenge antimicrobial resistance poses, we call for greater interaction and synergies between research initiatives. We see the need for global access to – and availability, affordability and rational use of – safe, effective and quality-assured antimicrobials. We will therefore explore the feasibility and need of setting up a global antibiotic product development partnership for new and urgently needed antibiotics, vaccine development, alternative therapies and rapid point of care diagnostics and seek collaboration with others such as WHO and Drugs for Neglected Disease Initiative (DNDi).

19. We encourage international cooperation on antimicrobial stewardship and regulatory dialogue on the approval and regulation for antibiotics. Convergence and harmonisation on technical requirements including for clinical trials and for the approvals for new antibiotics can help to bring new antibiotics faster to the market. In this perspective, we support the ongoing efforts in the wider context of the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH), and its veterinary equivalent VICH and emphasise to take the special needs for antibiotics into account. We will take into account the recommendations and action areas of antibiotics of the Transatlantic Taskforce on Antimicrobial Resistance (TATFAR) as it enters the next five year implementation period.

20. We are committed to explore innovative economic incentives to enhance the research and development of new antibiotics, other therapeutic options, and diagnostics. We will investigate various instruments, such as a global antibiotic research fund and a market entry reward mechanism for truly new antibiotics targeting the most important pathogens and most needed for global public health. We recognise and commend the work of various reviews on AMR, such as the OECD, and other independent Reviews on AMR, tackling the lack of new antibiotics internationally and the initial proposals on how governments around the world could act collectively to stimulate innovation from a range of organisations, private or public, big or small.

21. We will continue close collaboration with our science ministers to advance these goals related to research and development, and invite other countries, international and philanthropic organizations to join this initiative.

22. We call for a High Level Meeting on AMR in 2016 at the United Nations General Assembly to promote increased political awareness, engagement and leadership on antimicrobial resistance among Heads of States, Ministers and global leaders.

.

G7 Health Ministers’ Commitment – Lessons Learned from Ebola
Agreed by G7 Health Ministers in Berlin 2015
[Excerpt from 20 paragraphs]
…10. We support the ongoing work of the IHR Review Committee and look forward to the Committee’s findings on effectiveness and functioning of the International Health Regulations, as well as its recommendations for improvement, for instance, related to training, for innovative ways forward for standardized, transparent, and reliable instruments for effective monitoring and reporting under IHR. In this regard, we support a clear role for the WHO to assist countries in IHR implementation.

11. In order to prevent future outbreaks from becoming large-scale public health emergencies, the G7 Leaders have agreed to offer to assist at least 60 countries, including the countries of West Africa, over the next five years to implement the IHR, including through the Global Health Security Agenda (GHSA) and its common targets and other multilateral initiatives. By the end of 2015 we will, in collaboration with WHO, announce the countries that the G7 are collectively supporting or have consulted with or agreed plans to support to fulfill the Leaders’ commitment. This work is responding to country needs and entails building on existing in-country expertise and partnerships, programmes and projects. It is an integral part of an overall health systems strengthening agenda, which includes the development of basic health care systems as well as water, sanitation and hygiene programs. The initiative will be conducted in close cooperation and coordination with the WHO. We will continue also to work closely with other relevant institutions including the World Bank, the Global Fund to fight AIDS, Tuberculosis and Malaria, and Gavi, the Vaccine Alliance.

12. The serious domestic and international consequences of the Ebola virus disease outbreak have highlighted the need for a more effective global system of disease surveillance, allowing early event detection, in part through the development of rapid diagnostic tests and the
development of better risk modelling, prevention, and surveillance to trigger timely national and global responses. In the future, countries should be encouraged to immediately notify health risks to the WHO in accordance with the IHR, in addition to removing bureaucratic barriers to escalating early notifications at the local, country and global levels. We commend ongoing efforts of the African Union and its regional organizations to build up a surveillance system that will, in cooperation with WHO, be instrumental in the struggle against future disease.

13. In the research and development (R&D) response to the Ebola crisis, we identified a number of gaps and inefficiencies where actions are needed to prevent and manage future outbreaks. We stress that progress should be made as a matter of preparedness on lead candidate products (vaccines, treatments, diagnostics, and personal protective equipment) pre-established protocols, and capacity to ensure the ability to quickly move to advanced phase clinical trials, product development, and scaled-up product manufacturing, which may only be performed when the outbreak occurs. We highlight the need for a more comprehensive applied and translational research in partnership with at-risk countries. We underline the importance of direct collaboration between countries and health research funders, and we call for continued financing, collaboration and coordination on their collective response to emerging epidemics of global concern, including through initiatives such as the proposed WHO blueprint for research and development preparedness and rapid research response during future public health emergencies and the Global Research Collaboration for Infectious Disease Preparedness (GloPID-R).

14. We are convinced that it is essential to ensure that country-owned research is enhanced, including non-medical research such as social, behavioural, medical anthropology, and communication research. We consider that a broad range of capacity-building is needed in developing countries afflicted by or at risk of serious infectious disease outbreaks. It also requires training of research workers and of health staff extending down to the local level. It is important to ensure that epidemiological and, wherever possible, relevant trial information data is shared openly and transparently and shared early in the event of a public health emergency. It is also important to ensure good coordination and prioritisation of timely access to biological materials and clinical samples for research in accordance with national and international legal frameworks.

15. We recognise global gaps in medical facility infection control and related occupational health and safety frameworks designed to protect and train healthcare workers. Healthcare workers are critical national assets at the front line of initial epidemic detection and containment. Enhanced, national occupational health and safety administrations play a key role in the development of resilient, sustainable, and ready health systems.

16. The Ebola crisis has demonstrated a critical lack of safe and effective systems for deployment of medical experts to public health emergencies of this nature, in particular around insurance, medical evacuation and safe return to work post-deployment. It has also highlighted a lack of standard procedures and protocols across deployable teams which limits their inter-operability. Therefore, we will support national and international efforts, including the WHO’s global health emergency workforce, to provide a sustainable multi-disciplinary pool of experts. WHO should play a central role in coordination and facilitating the deployment of these experts. We welcome the process of developing one such initiative within the European Union (EU) (European Medical Corps), which will provide certain capacities to the global health emergency workforce.

17. We recognize the valuable recommendations of the WHO Ebola Interim Assessment Panel and the reform measures adopted by the 68th World Health Assembly in May 2015 – including the establishment of a contingency fund and the decision to establish a global health emergency workforce, making use of existing and strengthened partner mechanisms. We share the assessment that the WHO needs to be strengthened, and we support the reform process to make WHO fit for purpose to effectively fulfil its core functions in health emergencies.

18. We commit ourselves to strengthening WHO in order to better perform its leadership coordination roles on global health issues, and particularly in the face of epidemic threats, global health security, and the necessary support to countries in their efforts to be better prepared for global health crises. We share the view that the WHO must re-establish itself as the authoritative body, providing leadership, and coordinating the international preparedness for and response to health emergencies. This includes informing governments and the public around the world about the extent and severity of an outbreak as rapidly and as comprehensively as possible.

19. It is important that financial resources and mechanisms be strengthened, both within the WHO and elsewhere, to ensure timely, effective and coordinated response to disease outbreaks. Therefore, along with WHO’s Contingency Fund, we support the initiative by the World Bank to develop a Pandemic Emergency Facility…

A survey of Ethiopian physicians’ experiences of bedside rationing: extensive resource scarcity, tough decisions and adverse consequences

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 17 October 2015)

.
Research article
A survey of Ethiopian physicians’ experiences of bedside rationing: extensive resource scarcity, tough decisions and adverse consequences
Frehiwot Defaye, Dawit Desalegn, Marion Danis, Samia Hurst, Yemane Berhane, Ole Norheim, Ingrid Miljeteig BMC Health Services Research 2015, 15:467 (14 October 2015)
Abstract
Background
Resource scarcity in health care is a universal challenge. In high-income settings, bedside rationing is commonly discussed and debated as a means to addressing scarcity. However, little is known about physicians’ experiences in resource-limited contexts in low- income countries. Here we describe physicians’ experiences regarding scarcity of resources, bedside rationing, use of various strategies to save resources, and perceptions of the consequences of rationing in Ethiopia.
Methods
A national survey was conducted amongst physicians from 49 public hospitals using stratified, multi-stage sampling in six regions. All physicians in the selected hospitals were invited to respond to a self-administered questionnaire. Data were weighted and analyzed using descriptive statistics.
Results
In total, 587 physicians responded (91 % response rate). The majority had experienced system-wide shortages of various types of medical services. The services most frequently reported to be in short supply, either daily or weekly, were access to surgery, specialist and intensive care units, drug prescriptions and admission to hospital (52, 49, 46, 47 and 46 % respectively). The most common rationing strategies used daily or weekly were limiting laboratory tests, hospital drugs, radiological investigations and providing second best treatment (47, 47, 47 and 39 % respectively). Availability of institutional or national guidelines for whom to see and treat first was lacking. Almost all respondents had witnessed different adverse consequences of resource scarcity; 54 % reported seeing patients who, in their estimation, had died due to resource scarcity. Almost 9 out of 10 physicians were so troubled by limited resources that they often regretted their choice of profession.
Conclusion
This study provides the first glimpses of the untold story of resource shortage and bedside rationing in Ethiopia. Physicians encounter numerous dilemmas due to resource scarcity, and they report they lack adequate guidance for how to handle them. The consequences for patients and the professionals are substantial.

BMC Infectious Diseases (Accessed 17 October 2015)

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 17 October 2015)

.
Research article
Frequency and impact of confounding by indication and healthy vaccinee bias in observational studies assessing influenza vaccine effectiveness: a systematic review
Cornelius Remschmidt, Ole Wichmann, Thomas Harder BMC Infectious Diseases 2015, 15:429 (17 October 2015)
Abstract
Background
Evidence on influenza vaccine effectiveness (VE) is commonly derived from observational studies. However, these studies are prone to confounding by indication and healthy vaccinee bias. We aimed to systematically investigate these two forms of confounding/bias.
Methods
Systematic review of observational studies reporting influenza VE and indicators for bias and confounding. We assessed risk of confounding by indication and healthy vaccinee bias for each study and calculated ratios of odds ratios (crude/adjusted) to quantify the effect of confounder adjustment. VE-estimates during and outside influenza seasons were compared to assess residual confounding by healthy vaccinee effects.
Results
We identified 23 studies reporting on 11 outcomes. Of these, 19 (83 %) showed high risk of bias: Fourteen due to confounding by indication, two for healthy vaccinee bias, and three studies showed both forms of confounding/bias. Adjustment for confounders increased VE on average by 12 % (95 % CI: 7–17 %; all-cause mortality), 9 % (95 % CI: 4–14 %; all-cause hospitalization) and 7 % (95 % CI: 4–10 %; influenza-like illness). Despite adjustment, nine studies showed residual confounding as indicated by significant off-season VE-estimates. These were observed for five outcomes, but more frequently for all-cause mortality as compared to other outcomes (p = 0.03) and in studies which indicated healthy vaccinee bias at baseline (p = 0.01).
Conclusions
Both confounding by indication and healthy vaccinee bias are likely to operate simultaneously in observational studies on influenza VE. Although adjustment can correct for confounding by indication to some extent, the resulting estimates are still prone to healthy vaccinee bias, at least as long as unspecific outcomes like all-cause mortality are used. Therefore, cohort studies using administrative data bases with unspecific outcomes should no longer be used to measure the effects of influenza vaccination.

Research article
Immunogenicity and safety of intradermal influenza vaccine in immunocompromized patients: a meta-analysis of randomized controlled trials
Claudia Pileggi, Francesca Lotito, Aida Bianco, Carmelo Nobile, Maria Pavia BMC Infectious Diseases 2015, 15:427 (14 October 2015)

Research article
The epidemiology of all-cause and rotavirus acute gastroenteritis and the characteristics of rotavirus circulating strains before and after rotavirus vaccine introduction in Yemen: analysis of hospital-based surveillance data
Salem Banajeh, Basheer Abu-Asba BMC Infectious Diseases 2015, 15:418 (13 October 2015)

Research article
Epidemiology of Ebola virus disease transmission among health care workers in Sierra Leone, May to December 2014: a retrospective descriptive study
Olushayo Olu, Brima Kargbo, Sarian Kamara, Alie Wurie, Jackson Amone, Louisa Ganda, Bernard Ntsama, Alain Poy, Fredson Kuti-George, Etsub Engedashet, Negusu Worku, Martin Cormican, Charles Okot, Zabulon Yoti, Kande-Bure Kamara, Kennedy Chitala, Alex Chimbaru, Francis Kasolo BMC Infectious Diseases 2015, 15:416 (13 October 2015)

The importance of values in evidence-based medicine

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 17 October 2015)

.
Debate
The importance of values in evidence-based medicine
Michael Kelly, Iona Heath, Jeremy Howick, Trisha Greenhalgh BMC Medical Ethics 2015, 16:69 (12 October 2015)
Abstract
Background
Evidence-based medicine (EBM) has always required integration of patient values with ‘best’ clinical evidence. It is widely recognized that scientific practices and discoveries, including those of EBM, are value-laden. But to date, the science of EBM has focused primarily on methods for reducing bias in the evidence, while the role of values in the different aspects of the EBM process has been almost completely ignored.
Discussion
In this paper, we address this gap by demonstrating how a consideration of values can enhance every aspect of EBM, including: prioritizing which tests and treatments to investigate, selecting research designs and methods, assessing effectiveness and efficiency, supporting patient choice and taking account of the limited time and resources available to busy clinicians. Since values are integral to the practice of EBM, it follows that the highest standards of EBM require values to be made explicit, systematically explored, and integrated into decision making.
Summary
Through ‘values based’ approaches, EBM’s connection to the humanitarian principles upon which it was founded will be strengthened.

BMC Pregnancy and Childbirth (Accessed 17 October 2015)

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 17 October 2015)

.
Research article
Longitudinal adherence to antiretroviral drugs for preventing mother-to-child transmission of HIV in Zambia
Sumiyo Okawa, Mable Chirwa, Naoko Ishikawa, Henry Kapyata, Charles Msiska, Gardner Syakantu, Shinsuke Miyano, Kenichi Komada, Masamine Jimba, Junko Yasuoka BMC Pregnancy and Childbirth 2015, 15:258 (12 October 2015)

Research article
A case series study on the effect of Ebola on facility-based deliveries in rural Liberia
Jody Lori, Sarah Rominski, Joseph Perosky, Michelle Munro, Garfee Williams, Sue Bell, Aloysius Nyanplu, Patricia Amarah, Carol Boyd BMC Pregnancy and Childbirth 2015, 15:254 (12 October 2015)

A cross-sectional serosurvey on hepatitis B vaccination uptake among adult patients from GP practices in a region of South-West Poland

BMC Public Health
http://www.biomedcentral.com/bmcpublichealth/content
(Accessed 17 October 2015)

.
Research article
A cross-sectional serosurvey on hepatitis B vaccination uptake among adult patients from GP practices in a region of South-West Poland
Maria Ganczak, Gabriela Dmytrzyk-Daniłów, Marcin Korzeń, Zbigniew Szych BMC Public Health 2015, 15:1060 (16 October 2015)

Practical tools for improving global primary care

British Medical Journal
17 October 2015 (vol 351, issue 8029)
http://www.bmj.com/content/351/8029

.
Editorials
Practical tools for improving global primary care
BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h5361 (Published 13 October 2015)
[Initial text]
Universal health coverage can be achieved only by strengthening primary care, and new tools are needed
The sustainable development goals launched last month commit the world to achieving universal health coverage by 2030.1 Achievement will depend on providing high quality primary healthcare. Last month also saw the launch of a new partnership, the Primary Health Care Performance Initiative (www.phcperformanceinitiative.org), which aims to strengthen primary care in low and middle income countries through enhanced monitoring and sharing of best practices and tools. But the few practical tools that currently exist are often inadequate. We need better integrated, concise, and user friendly materials that can help health workers manage the wide range of problems seen in primary care.
For the past three decades, the World Health Organization has led the development of practical tools for primary care with the publication of charts, handbooks, and intervention guides for use by health workers with limited resources and training. The guidelines of the 1990s advised empirical treatments with essential medicines for clusters of symptoms and covered sexually transmitted infections2 and life threatening illnesses in young children.3 In the 2000s this approach was replicated for pregnancy and childbirth4 and respiratory conditions. …

Association Between Hospitalization With Community-Acquired Laboratory-Confirmed Influenza Pneumonia and Prior Receipt of Influenza Vaccination

JAMA
October 13, 2015, Vol 314, No. 14
http://jama.jamanetwork.com/issue.aspx

.
Association Between Hospitalization With Community-Acquired Laboratory-Confirmed Influenza Pneumonia and Prior Receipt of Influenza Vaccination
Carlos G. Grijalva, MD, MPH; Yuwei Zhu, MD, MS; Derek J. Williams, MD, MPH; Wesley H. Self, MD, MPH; Krow Ampofo, MD; Andrew T. Pavia, MD; Chris R. Stockmann, MSc; Jonathan McCullers, MD; Sandra R. Arnold, MD; Richard G. Wunderink, MD; Evan J. Anderson, MD; Stephen Lindstrom, PhD; Alicia M. Fry, MD, MPH; Ivo M. Foppa, ScD, MD; Lyn Finelli, DrPH, MS; Anna M. Bramley, MPH; Seema Jain, MD; Marie R. Griffin, MD, MPH; Kathryn M. Edwards, MD
Abstract
Importance
Few studies have evaluated the relationship between influenza vaccination and pneumonia, a serious complication of influenza infection.
Objective
To assess the association between influenza vaccination status and hospitalization for community-acquired laboratory-confirmed influenza pneumonia.
Design, Setting, and Participants
The Etiology of Pneumonia in the Community (EPIC) study was a prospective observational multicenter study of hospitalizations for community-acquired pneumonia conducted from January 2010 through June 2012 at 4 US sites. In this case-control study, we used EPIC data from patients 6 months or older with laboratory-confirmed influenza infection and verified vaccination status during the influenza seasons and excluded patients with recent hospitalization, from chronic care residential facilities, and with severe immunosuppression. Logistic regression was used to calculate odds ratios, comparing the odds of vaccination between influenza-positive (case) and influenza-negative (control) patients with pneumonia, controlling for demographics, comorbidities, season, study site, and timing of disease onset. Vaccine effectiveness was estimated as (1 − adjusted odds ratio) × 100%.
Exposure
Influenza vaccination, verified through record review.
Main Outcomes and Measures
Influenza pneumonia, confirmed by real-time reverse-transcription polymerase chain reaction performed on nasal/oropharyngeal swabs.
Results
Overall, 2767 patients hospitalized for pneumonia were eligible for the study; 162 (5.9%) had laboratory-confirmed influenza. Twenty-eight of 162 cases (17%) with influenza-associated pneumonia and 766 of 2605 controls (29%) with influenza-negative pneumonia had been vaccinated. The adjusted odds ratio of prior influenza vaccination between cases and controls was 0.43 (95% CI, 0.28-0.68; estimated vaccine effectiveness, 56.7%; 95% CI, 31.9%-72.5%).
Conclusions and Relevance
Among children and adults hospitalized with community-acquired pneumonia, those with laboratory-confirmed influenza-associated pneumonia, compared with those with pneumonia not associated with influenza, had lower odds of having received influenza vaccination.

The Lancet – Oct 17, 2015

The Lancet
Oct 17, 2015 Volume 386 Number 10003 p1509-1598 e18-e20
http://www.thelancet.com/journals/lancet/issue/current

.
Editorial
Ageing and health—an agenda half completed
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(15)00521-8
The unprecedented increase in longevity across the world is a dividend from investment in health and progressive socioeconomic policies. It should be the source of celebration and pride; yet, the very systems that fostered longevity now risk squandering that success—and shaming themselves—because they are not aligned to the challenges and opportunities of older populations. To make healthy ageing a reality, radical changes are required in the education, organisation, and delivery of health care. The Lancet Series on ageing, published in 2014, outlined the challenges; now WHO’s World report on ageing and health, published Sept 30, guides the public health response.

The report avoids rigid age-definitions that perpetuate discrimination. Instead, it emphasises the heterogeneity of individuals and the importance of functional ability, rather than chronological age. Key domains that optimise functional ability are basic needs, autonomy, mobility, relationships, and contribution to society. Much of the diversity observed in older age is a consequence of social determinants and the advantages and disadvantages that accumulate across an individual’s life course. The authors consider how these factors can be influenced through environmental strategies, the delivery of health and long-term care, and policy.

Environment is formed not only by physical location, but also by government policies and societal attitudes. Environments are dynamic and can modify the trajectory of functional ability in older age by influencing an individual’s physical and mental capacity as either a facilitator or barrier to healthy ageing. They go beyond housing (which should be affordable, safe, and accessible), to include transport, cultural and community factors, opportunities for physical activity, and exposure to tobacco and other harmful materials.

Historically, health-care systems were designed to address isolated acute episodes of illness, rather than to manage the chronic multimorbidity that becomes increasingly common with age. So disappointed with their experience of care was one WHO sample of older patients from high-income countries, that it dissuaded almost a quarter of them from seeking care at a subsequent episode. A total change is called for, from improving the skills and understanding of health-care providers to a more age-friendly, holistic, integrated, sustainable, and dignified approach that focuses care across a range of services on common priorities identified by the individual. While such a role might seem tailored for primary care, it requires underpinning from adequately supported centres of expertise in geriatric care and a cadre of trained care-providers. A further weakness of current approaches is that non-clinical carers are often inadequately prepared, resourced, and respected for their role.

Changes are also necessary in the organisation of health care. Just as it seems unimaginable to deliver equitable care of high quality to older people in the absence of universal health coverage, some form of integrated and affordable social support in old age will also be required. To demonstrate the simultaneous acuteness and distance of that goal, the UK released figures on Oct 6 showing that only a minority of the 1·85 million requests for social services in the previous financial year, 72% of which came from people aged older than 65 years, could be supported by local councils.

The report is a welcome catalyst for much-needed research in the care of older people. The messages are relevant to all practitioners and health systems, particularly in middle-income and low-income countries where, by 2050, 80% of people aged older than 60 years will live. To translate the report into action, WHO is working with Member States to develop a global strategy and action plan, which is open for a web consultation until Oct 30. Engagement at high levels is important, including linkage with the Sustainable Development Goals for inclusiveness and wellbeing. However, just as older people will each have unique needs and preferences, so, too, countries will need to adapt their own health systems to local needs and circumstances.

At present only one country, Japan, has more than 30% of its population aged older than 60 years. By 2050, there will be many, including Chile, China, Iran, and Thailand. Opportunities for shared learning abound, such as the ongoing Joint Research Network on Ageing and Health in Asia, a multidisciplinary, multicountry collaboration, organised jointly by Mahidol University and the University of Tokyo that meets in Bangkok on Oct 22. Sharing perspectives and ideas in similar gatherings will create the environment from which local innovative solutions arise.

.
Comment
Maternal, newborn, and child health and the Sustainable Development Goals—a call for sustained and improved measurement
John Grove, Mariam Claeson, Jennifer Bryce, Agbessi Amouzou, Ties Boerma, Peter Waiswa, Cesar Victora, Kirkland Group
DOI: http://dx.doi.org/10.1016/S0140-6736(15)00517-6
Immunisation is one of the great global health successes of the past century, with millions of lives saved.1 Ensuring vaccination of millions of children is complex, but is made possible by one fundamental task: systematic counting at multiple levels and at frequent intervals. From charts in thousands of rural health posts, to databases in ministries of health, to standardised surveys and global reports from WHO, UNICEF, and GAVI, the Vaccine Alliance, a robust interconnected system of data collection and use enables health workers, programme managers, and global actors to track who is vaccinated and make course corrections as needed to improve performance, policies, and programmes…

.
Articles
Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013
Aparna Schweitzer, Johannes Horn, Rafael T Mikolajczyk, Gérard Krause, Jördis J Ott

Complete Protection against Pneumonic and Bubonic Plague after a Single Oral Vaccination

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 17 October 2015)

.
Complete Protection against Pneumonic and Bubonic Plague after a Single Oral Vaccination
Anne Derbise, Yuri Hanada, Manal Khalifé, Elisabeth Carniel, Christian E. Demeure
Research Article | published 16 Oct 2015 | PLOS Neglected Tropical Diseases
10.1371/journal.pntd.0004162
Abstract
Background
No efficient vaccine against plague is currently available. We previously showed that a genetically attenuated Yersinia pseudotuberculosis producing the Yersinia pestis F1 antigen was an efficient live oral vaccine against pneumonic plague. This candidate vaccine however failed to confer full protection against bubonic plague and did not produce F1 stably.
Methodology/Principal Findings
The caf operon encoding F1 was inserted into the chromosome of a genetically attenuated Y. pseudotuberculosis, yielding the VTnF1 strain, which stably produced the F1 capsule. Given orally to mice, VTnF1 persisted two weeks in the mouse gut and induced a high humoral response targeting both F1 and other Y. pestis antigens. The strong cellular response elicited was directed mostly against targets other than F1, but also against F1. It involved cells with a Th1—Th17 effector profile, producing IFNγ, IL-17, and IL-10. A single oral dose (108 CFU) of VTnF1 conferred 100% protection against pneumonic plague using a high-dose challenge (3,300 LD50) caused by the fully virulent Y. pestis CO92. Moreover, vaccination protected 100% of mice from bubonic plague caused by a challenge with 100 LD50 Y. pestis and 93% against a high-dose infection (10,000 LD50). Protection involved fast-acting mechanisms controlling Y. pestis spread out of the injection site, and the protection provided was long-lasting, with 93% and 50% of mice surviving bubonic and pneumonic plague respectively, six months after vaccination. Vaccinated mice also survived bubonic and pneumonic plague caused by a high-dose of non-encapsulated (F1-) Y. pestis.
Significance
VTnF1 is an easy-to-produce, genetically stable plague vaccine candidate, providing a highly efficient and long-lasting protection against both bubonic and pneumonic plague caused by wild type or un-encapsulated (F1-negative) Y. pestis. To our knowledge, VTnF1 is the only plague vaccine ever reported that could provide high and durable protection against the two forms of plague after a single oral administration.
Author Summary
Yersinia pestis, the agent of plague, is among the deadliest infectious agents affecting humans. Injected in the skin by infected fleas, Y. pestis causes bubonic plague, which occasionally evolves into the very lethal and contagious pneumonic plague. Y. pestis is also a dangerous potential bioweapon but no plague vaccine is available. The current study describes the development of a vaccine highly efficient against plague in both its bubonic and pneumonic forms. The strategy consists of a live, avirulent, genetically modified Yersinia pseudotuberculosis that produces the capsule antigen of Y. pestis, named F1. The goal was to propose a vaccine that would be both easy to produce rapidly in large amounts with high quality, and easy to administer to individuals via a single oral dose. The VTnF1 strain described fulfills these demands. The immune response generated is long-lasting, involving both antibodies and memory cells directed against F1 and other antigens. We conclude that VTnF1 is a very promising candidate vaccine against plague.

Measuring the impact of Ebola control measures in Sierra Leone

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 17 October 2015)

.
Biological Sciences – Population Biology:
Measuring the impact of Ebola control measures in Sierra Leone
Adam J. Kucharski, Anton Camacho, Stefan Flasche, Rebecca E. Glover, W. John Edmunds, and Sebastian Funk
PNAS 2015 ; published ahead of print October 12, 2015, doi:10.1073/pnas.1508814112
Significance
Between June 2014 and February 2015, thousands of Ebola treatment beds were introduced in Sierra Leone, alongside other infection control measures. However, there has been criticism of the timing and focus of this response, and it remains unclear how much it contributed to curbing the 2014–2015 Ebola epidemic. Using a mathematical model, we estimated how many Ebola virus disease cases the response averted in each district of Sierra Leone. We estimated that 56,600 (95% credible interval: 48,300–84,500) Ebola cases were averted in Sierra Leone as a direct result of additional treatment beds. Moreover, the number of cases averted would have been even greater had beds been available 1 month earlier.
Abstract
Between September 2014 and February 2015, the number of Ebola virus disease (EVD) cases reported in Sierra Leone declined in many districts. During this period, a major international response was put in place, with thousands of treatment beds introduced alongside other infection control measures. However, assessing the impact of the response is challenging, as several factors could have influenced the decline in infections, including behavior changes and other community interventions. We developed a mathematical model of EVD transmission, and measured how transmission changed over time in the 12 districts of Sierra Leone with sustained transmission between June 2014 and February 2015. We used the model to estimate how many cases were averted as a result of the introduction of additional treatment beds in each area. Examining epidemic dynamics at the district level, we estimated that 56,600 (95% credible interval: 48,300–84,500) Ebola cases (both reported and unreported) were averted in Sierra Leone up to February 2, 2015 as a direct result of additional treatment beds being introduced. We also found that if beds had been introduced 1 month earlier, a further 12,500 cases could have been averted. Our results suggest the unprecedented local and international response led to a substantial decline in EVD transmission during 2014–2015. In particular, the introduction of beds had a direct impact on reducing EVD cases in Sierra Leone, although the effect varied considerably between districts.

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH) – August 2015 Vol. 38, No. 2

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH)
August 2015 Vol. 38, No. 2
http://www.paho.org/journal/

.
SERIES ON EQUITY IN HEALTH AND SUSTAINABLE DEVELOPMENT
Desigualdades educacionales en mortalidad y supervivencia de mujeres y hombres de las Américas, 1990–2010 [Educational inequalities in mortality and survival of women and men in the Americas, 1990–2010]
Mariana Haeberer, Isabel Noguer y Oscar J. Mújica

Assessing equitable care for Indigenous and Afrodescendant women in Latin America
[Evaluación de la equitatividad de la atención a las mujeres indígenas y afrodescendientes de América Latina]
Arachu Castro, Virginia Savage, and Hannah Kaufman

ORIGINAL RESEARCH ARTICLES
Formative evaluation of a proposed mHealth program for childhood illness management in a resource-limited setting in Peru [Evaluación formativa de un programa de salud móvil propuesto para el manejo de las enfermedades de la infancia en un entorno del Perú con recursos limitados]
T. A. Calderón, H. Martin, K. Volpicelli, C. Diaz, E. Gozzer, and A. M. Buttenheim

CURRENT TOPICS
Paving pathways: Brazil’s implementation of a national human papillomavirus immunization campaign [Allanando el camino: implementación de una campaña nacional de vacunación contra el virus del papiloma humano en Brasil]
Misha L. Baker, Daniella Figueroa-Downing, Ellen Dias De Oliveira Chiang,
Luisa Villa, Maria Luiza Baggio, José Eluf-Neto, Robert A. Bednarczyk, and Dabney P. Evans
Abstract
In 2014, Brazil introduced an HPV immunization program for girls 9–13 years of age as part of the Unified Health System’s (SUS) National Immunization Program. The first doses were administered in March 2014; the second ones, in September 2014. In less than 3 months more than 3 million girls received the first dose of quadrivalent HPV vaccine, surpassing the target rate of 80%. This paper examines three elements that may influence the program’s long-term success in Brazil: sustaining effective outreach, managing a large technology-transfer collaboration, and developing an electronic immunization registry, with a focus on the State of São Paulo. If these three factors are managed, the Government of Brazil is primed to serve as a model of success for other countries interested in implementing a national HPV vaccination program to decrease HPV-related morbidity and mortality.

An Update on the Role of Immunotherapy and Vaccine Strategies for Primary Brain Tumors.

Current Treatment Options in Oncology
2015, 16(11):54
An Update on the Role of Immunotherapy and Vaccine Strategies for Primary Brain Tumors.
Neagu MR, Reardon DA
Pappas Center for Neuro-Oncology, Massachusetts General Hospital, WACC 8-835m 55 Fruit St, Boston, MA, 02114, USA.
Type: Journal Article
DOI: 10.1007/s11864-015-0371-3
OPINION STATEMENT:
Existing therapies for glioblastoma (GBM), the most common malignant primary brain tumor in adults, have fallen short of improving the dismal patient outcomes, with an average 14-16-month median overall survival. The biological complexity and adaptability of GBM, redundancy of dysregulated signaling pathways, and poor penetration of therapies through the blood-brain barrier contribute to poor therapeutic progress. The current standard of care for newly diagnosed GBM consists of maximal safe resection, followed by fractionated radiotherapy combined with concurrent temozolomide (TMZ) and 6-12 cycles of adjuvant TMZ. At progression, bevacizumab with or without additional chemotherapy is an option for salvage therapy. The recent FDA approval of sipuleucel-T for prostate cancer and ipilumimab, nivolumab, and pembrolizumab for select solid tumors and the ongoing trials showing clinical efficacy and response durability herald a new era of cancer treatment with the potential to change standard-of-care treatment across multiple cancers. The evaluation of various immunotherapeutics is advancing for GBM, putting into question the dogma of the CNS as an immuno-privileged site. While the field is yet young, both active immunotherapy involving vaccine strategies and cellular therapy as well as reversal of GBM-induced global immune-suppression through immune checkpoint blockade are showing promising results and revealing essential immunological insights regarding kinetics of the immune response, immune evasion, and correlative biomarkers. The future holds exciting promise in establishing new treatment options for GBM that harness the patients’ own immune system by activating it with immune checkpoint inhibitors, providing specificity using vaccine therapy, and allowing for modulation and enhancement by combinatorial approaches.

Pneumococcal Carriage and Vaccine Coverage in Retirement Community Residents

Journal of the American Geriatrics Society
Early View
Pneumococcal Carriage and Vaccine Coverage in Retirement Community Residents
Sylvia Becker-Dreps MD, MPH1,*, Christine E. Kistler MD, MASc1,2, Kimberly Ward BA2, Ley A. Killeya-Jones PhD1, Olga Maria Better BS3, David J. Weber MD, MPH4, Sheryl Zimmerman PhD2,5, Bradly P. Nicholson PhD6, Chris W. Woods MD, MPH7 andPhilip Sloane MD, MPH1,2
Article first published online: 12 OCT 2015
DOI: 10.1111/jgs.13651
Abstract
Objectives
To evaluate pneumococcal immunization in older adults living in retirement communities and to measure nasopharyngeal carriage of Streptococcus pneumoniae to better assess the potential for herd protection from the 13-valent pneumococcal conjugate vaccine (PCV-13) in these settings.
Design
Cross-sectional observational study of adults aged 65 and older living in retirement communities to determine coverage with 23-valent pneumococcal vaccine (PPSV-23), coverage with PCV-13 in immuncompromised individuals according to 2012 Advisory Committee on Immunization Practices (ACIP) guidelines, and nasopharyngeal carriage of S. pneumoniae.
Setting
Two retirement communities in North Carolina.
Participants
Older adults recruited between December 2013 and April 2014 (N = 21, 64.8% female, mean age 81.4).
Measurements
A survey was used to assess chronic illnesses, immunization history, and potential risk factors for pneumococcal carriage; a chart review was used to confirm immunization history and abstract chronic conditions; and a nasopharyngeal swab was collected and cultured for S. pneumoniae.
Results
Eighty-seven percent of participants reported receiving PPSV-23 since age 65. Of the 16.2% of participants with an immunocompromising condition, only one had received PCV-13. Nasopharyngeal carriage with S. pneumoniae was detected in 1.9% (95% confidence interval = 0.0–3.8%) of participants.
Conclusion
In this select sample, PPSV-23 coverage was high, but adherence to the ACIP recommendation for PCV-13 in immunocompromised groups was low. Nasopharyngeal carriage of S. pneumoniae was present, although infrequent, suggesting that immunization with PCV-13 could provide an individual benefit and a small degree of herd protection.

Early estimation of pandemic influenza Antiviral and Vaccine Effectiveness (EAVE): use of a unique community and laboratory national data-linked cohort study.

Health Technology Assessment (Winchester, England)
2015, 19(79):1-32
Early estimation of pandemic influenza Antiviral and Vaccine Effectiveness (EAVE): use of a unique community and laboratory national data-linked cohort study.
Centre for Medical Informatics, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
Simpson CR, Lone N, McMenamin J, Gunson R, Robertson C, Ritchie LD, Sheikh A
DOI: 10.3310/hta19790
Abstract
BACKGROUND: After the introduction of any new pandemic influenza, population-level surveillance and rapid assessment of the effectiveness of a new vaccination will be required to ensure that it is targeted to those at increased risk of serious illness or death from influenza.
OBJECTIVE: We aimed to build a pandemic influenza reporting platform that will determine, once a new pandemic is under way: the uptake and effectiveness of any new pandemic vaccine or any protective effect conferred by antiviral drugs once available; the clinical attack rate of pandemic influenza; and the existence of protection provided by previous exposure to, and vaccination from, A/H1N1 pandemic or seasonal influenza/identification of susceptible groups.
DESIGN: An observational cohort and test-negative study design will be used (post pandemic).
SETTING: A national linkage of patient-level general practice data from 41 Practice Team Information general practices, hospitalisation and death certification, virological swab and serology-linked data.
PARTICIPANTS: We will study a nationally representative sample of the Scottish population comprising 300,000 patients. Confirmation of influenza using reverse transcription polymerase chain reaction and, in a subset of the population, serology.
INTERVENTIONS: Future available pandemic influenza vaccination and antivirals will be evaluated.
MAIN OUTCOME MEASURES: To build a reporting platform tailored towards the evaluation of pandemic influenza vaccination. This system will rapidly measure vaccine effectiveness (VE), adjusting for confounders, estimated by determining laboratory-confirmed influenza; influenza-related morbidity and mortality, including general practice influenza-like illnesses (ILIs); and hospitalisation and death from influenza and pneumonia. Once a validated haemagglutination inhibition assay has been developed (and prior to the introduction of any vaccination), cross-reactivity with previous exposure to A/H1N1 or A/H1N1 vaccination, other pandemic influenza or other seasonal influenza vaccination or exposure will be measured.
CONCLUSIONS: A new sentinel system, capable of rapidly determining the estimated incidence of pandemic influenza, and pandemic influenza vaccine and antiviral uptake and effectiveness in preventing influenza and influenza-related clinical outcomes, has been created. We have all of the required regulatory approvals to allow rapid activation of the sentinel systems in the event of a pandemic. Of the 41 practices expressing an interest in participating, 40 have completed all of the necessary paperwork to take part in the reporting platform. The data extraction tool has been installed in these practices. Data extraction and deterministic linkage systems have been tested. Four biochemistry laboratories have been recruited, and systems for serology collection and linkage of samples to general practice data have been put in place.
FUTURE WORK: The reporting platform has been set up and is ready to be activated in the event of any pandemic of influenza. Building on this infrastructure, there is now the opportunity to extend the network of general practices to allow important subgroup analyses of VE (e.g. for patients with comorbidities, at risk of serious ILI) and to link to other data sources, in particular to test for maternal outcomes in pregnant patients.
STUDY REGISTRATION: This study is registered as ISRCTN55398410.
FUNDING: The National Institute for Health Research Health Technology Assessment programme.

Media/Policy Watch [to 17 October 2015]

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.

.

The Guardian
http://www.guardiannews.com/
Accessed 17 October 2015
Two new Ebola cases in Guinea confound hopes of end to outbreak
Reuters – Friday 16 October 2015
Weeks away from west African country being declared free of disease, two men have contracted virus, one having had no contact with registered victims

.

New York Times
http://www.nytimes.com/
Accessed 17 October 2015
More Than 400 Dead in Southeast Congo Measles Outbreak-U.N.
World Health Organization warned last November that progress towards wiping out measles has stalled worldwide due to poor vaccine coverage. (Reporting By Aaron Ross; Editing by Andrew Heavens)
October 16, 2015 – By REUTERS
California’s Sweeping New Social Policies Could Set Trend
the brass ring for setting policies — and then testing whether those policies can withstand rigorous challenges. “Both the vaccine bill and the right-to-die legislation will be seriously looked at by other states,” said Sherry
October 13, 2015 – By THE ASSOCIATED PRESS –

.

Washington Post
http://www.washingtonpost.com/
Accessed 17 October 2015
Larry Summers: How finance can fight disease epidemics
October 14, 2015
Lawrence H. Summers, the Charles W. Eliot university professor at Harvard, is a former treasury secretary and director of the National Economic Council in the White House. He is writing occasional posts, to be featured on Wonkblog, about issues of national and international economics and policymaking.

During the annual IMF-World Bank meetings last week in Lima, Peru, I was part of a discussion on a proposed pandemic emergency financing facility. The subject brought together two things I am very interested in. First, the Lancet Commission on Global Health 2035, which I recently chaired, argues that underinvestment in health-related global public goods is a major problem — and that in particular the world is badly underinvesting in epidemic and pandemic protection relative to the risks involved. Second, after all that has gone wrong in recent years, it seems incumbent on all of us involved in finance to think about how financial innovations can address the real problems of real people.

The idea under discussion is a potentially powerful one: some public entity would issue bonds to investors which would be deemed to default in the event of an epidemic, assuring the availability of resources to respond before the epidemic takes on pandemic proportions. The facility would complement the new World Health Organization contingency fund as well as its existing financing mechanisms. Such bonds are routinely issued to mobilize resources that will trigger in the event of hurricanes or earthquakes. So called catastrophe bonds or cat-bonds offer higher yields to investors in return for taking risks that are not correlated with the normal risks of business cycle downturns.

This has the potential to be a win-win-win. The World Bank is using financial innovation to mitigate a major threat to the world, and especially the world’s poor. The vast resources of the global capital market are being tapped to provide vitally important insurance – and bring much-needed financial discipline to pandemic preparedness and response. And investors who, at this time of zero rates, are desperate for return are getting a new vehicle in which to invest. Little wonder that the session brought together health advocates, national aid agencies and leading financial firms, all of whom were very positive.

I hope 2016 will see the advent of epidemic or pandemic bonds. But there are two hurdles that will have to be overcome if this initiative is to succeed. These hurdles, amidst the happy talk of cooperation, were I thought somewhat elided in the conversation.

First, a suitable price has to be found for these bonds: a price that works for both investors and for those who will issue them. Experience with hurricane and earthquake bonds suggests that in order to accept a 1 percent chance of default, investors require about a 3 percent yield premium. The same is likely true of epidemic or pandemic bonds. In an expected value sense the bonds are expensive for issuers and attractive to investors. So the question posed is this: As an aid agency concerned with, say, health in sub-Saharan Africa, is it better to pay $3 million to support the issuance of a bond that will with 1 percent probability pay off $100 million or is it better to give the $3 million to support improvements in local health care systems?

Second, a suitable contract has to be drafted specifying when exactly the bonds will default. Investors will expect something observable that does not involve any discretion so that actuaries can make rigorous models. The health community seems to see these bonds as vehicles for driving all sorts of good things like reform of local systems and very rapid response at the first instant in an epidemic situation. A way of satisfying both constituencies needs to be found.

I think these problems are solvable. But it will take more than rhetoric of cooperation and good will. It will take good ideas and hard negotiation. We can all hope that they will be forthcoming.

Vaccines and Global Health: The Week in Review 10 October 2015

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_10 October 2015

blog edition: comprised of the approx. 35+ entries posted below on 13 September 2015..

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

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

EBOLA/EVD [to 10 October 2015]

EBOLA/EVD [to 10 October 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

Ebola Situation Report – 30 September 2015
[Excerpts]
SUMMARY [excerpt]
No confirmed cases of Ebola virus disease (EVD) were reported in the week to 4 October. This is the first time that a complete epidemiological week has elapsed with zero confirmed cases since March 2014. All contacts have now completed follow-up in Sierra Leone. However, over 500 contacts remain under follow-up in Guinea, and several high-risk contacts associated with active and recently active chains of transmission in Guinea and Sierra Leone have been lost to follow-up. There remains a near-term risk of further cases…

::::::

Statement on the 7th meeting of the IHR Emergency Committee regarding the Ebola outbreak in West Africa
WHO statement
5 October 2015
The 7th meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) regarding the Ebola virus disease (EVD) outbreak in West Africa took place by teleconference on Thursday, 1 October 2015, and by electronic correspondence from 1-3 October 2015.

As in previous meetings, the Committee’s role was to advise the WHO Director-General as to:
:: whether the event continues to constitute a Public Health Emergency of International Concern (PHEIC) and, if so,
:: whether the current temporary recommendations should be extended or revised, and whether new temporary recommendations should be issued.

Presentations were made by representatives of Guinea, Liberia and Sierra Leone on the current epidemiological situation in those countries, response operations and exit screening.
Since the 6th meeting of the Committee, Liberia has been declared free of EVD transmission for a second time (3 September 2015), the overall case incidence in Guinea and Sierra Leone has been below 10 cases per week, and the Sierra Leonean capital city of Freetown has remained free of EVD transmission for over 42 days. The Committee noted the enhanced Ebola control measures being implemented in each country and reaffirmed the importance of the community outreach, social mobilization, and other best practices.

However, 2 active chains of EVD transmission continue, one in Guinea and one in Sierra Leone. The Committee highlighted that the continued identification (including post-mortem) of cases not previously registered as contacts, resistance to response operations in some areas, and the ongoing movement of cases and contacts to Ebola-free areas, all constitute risks to stopping all EVD transmission in the subregion. The Committee noted the small number of Ebola cases in which virus from a convalescent individual could not be ruled out as the origin of infection; while viral persistence is understood to be time-limited, further investigation is needed on the nature, duration and implications of such persistence.

The Committee was concerned that although some improvements have been observed in the rescinding of excessive or inappropriate travel and transport measures, 34 countries continue to enact measures that are disproportionate to the risks posed, and which negatively impact response and recovery efforts. Furthermore, a number of international airlines have yet to resume flights to the affected countries.

The Committee advised that the EVD outbreak continues to constitute a Public Health Emergency of International Concern. In addition, the Committee advised the Director-General to consider the following temporary recommendations, which supersede and replace those issued previously…

…Based on this advice and information, the Director-General declared that the 2014-2015 Ebola outbreak in these West African countries continues to constitute a Public Health Emergency of International Concern. The Director-General endorsed the Committee’s advice and issued that advice as Temporary Recommendations under the IHR. These Temporary Recommendations supersede and replace all previous recommendations issued under the IHR in the context of the Ebola Outbreak in West Africa.

The Director-General thanked the Committee members and advisors for their advice and requested their reassessment of this situation within 3 months should circumstances require.

::::::

Johnson & Johnson Announces Start of Clinical Trial of Ebola Vaccine Regimen in Sierra Leone
:: First study of Janssen’s prime-boost vaccine regimen in an Ebola outbreak country
:: Study being initiated on parallel track with multiple ongoing Phase I and II studies across U.S., Europe and Africa as part of accelerated development plan for vaccine regimen
:: Milestone reached just one year after Johnson & Johnson announced expanded commitment to combating Ebola

NEW BRUNSWICK, N.J., Oct. 9, 2015 /PRNewswire/ — Johnson & Johnson (NYSE: JNJ) today announced the start of a safety and immunogenicity clinical trial in Sierra Leone of a preventive Ebola vaccine regimen in development at its Janssen Pharmaceutical Companies. Trial recruitment is underway, and the first volunteers have received their initial vaccine dose. This is the first study conducted of Janssen’s Ebola prime-boost vaccine regimen in a West African country affected by the recent Ebola epidemic.

The new study, EBOVAC-Salone, will take place in Sierra Leone’s Kambia district, where some of the country’s most recent Ebola cases have been reported. The regimen being tested uses a combination of two vaccine components based on AdVac® technology from Crucell Holland B.V., one of the Janssen Pharmaceutical Companies, and MVA-BN® technology from Bavarian Nordic. Volunteers in the study will first be given the AdVac dose to prime their immune system, and then the MVA-BN dose two months later to boost their immune response, with the goal of potentially strengthening and optimizing the duration of the immunity…

…Since announcing its commitment to combat Ebola in October 2014, Johnson & Johnson has mobilized significant resources to advance the research and development of an Ebola vaccine regimen with the goal of addressing the urgent public health need of affected countries such as Sierra Leone. With this goal in mind, in 2015 Janssen developed partnerships and consortia with other companies and research institutions, secured funding from European and U.S. public authorities, and launched multiple Phase I and II studies in rapid succession across the U.S., Europe and Africa. Additionally, Janssen in partnership with Bavarian Nordic, rapidly scaled up production of the vaccine regimen to more than 800,000 regimens, with the capacity to produce a total of 2 million regimens as needed.

Professor Peter Piot, M.D., Director of the London School of Hygiene & Tropical Medicine, which is one of the partners conducting the study, said: “We cannot afford to be complacent about Ebola. We urgently need a vaccine that offers long-term protection of the population, including health workers and other care givers, in order to prevent a resurgence of the virus. To achieve this goal, it is vital to test a range of vaccine candidates, particularly in the areas affected by the epidemic where we are still seeing new cases emerging, and there is evidence that the infection may have longer-term effects among survivors. Prime-boost vaccination is an effective strategy for long-term prevention of several infectious diseases, and we believe it may have a key role to play in the fight against Ebola.”

The EBOVAC-Salone study is notable in that it will evaluate the vaccine regimen’s safety and immune response within the general population of Sierra Leone, including vulnerable groups such as adolescents, children, and people with HIV. In addition to the London School of Hygiene & Tropical Medicine which is coordinating the EBOVAC-Salone trial, Janssen is partnering with Sierra Leone’s Ministry of Health and Sanitation, the College of Medicine and Allied Health Sciences, and two consortia of which Janssen is a member that are funded by Europe’s Innovative Medicines Initiative (IMI): EBOVAC1 (Ebola Vaccine Development), which is conducting the study, and EBODAC (Ebola Vaccine Deployment, Acceptance & Compliance), which is developing a communication strategy and tools to promote the acceptance and uptake of the Ebola vaccine regimen.

From the outset, the EBOVAC-Salone team’s goal has been to conduct a study that meets Sierra Leone’s Ebola prevention needs, has the support of the Sierra Leonean people, and can play a sustaining role in helping to restore the country’s health infrastructure following the Ebola outbreak. Significant investment has been made to build new facilities in Kambia to conduct the study, which will contribute substantially to the strengthening of the local health system. These include establishing the first Emergency Room at the Kambia District Hospital, and building a new vaccine storage facility on the hospital site. These efforts are complemented by the employment and training of doctors, nurses and other frontline health care workers who will gain valuable experience while contributing to the clinical study…

…The EBOVAC-Salone study is being initiated on a parallel track with multiple ongoing Phase I and II studies that are being conducted across the U.S., Europe and Africa as part of the accelerated development plan for the Ebola vaccine regimen. First-in-human Phase I clinical studies of the prime-boost vaccine regimen began in the United Kingdom and United States in January 2015, followed by several sites in Africa. In May 2015, Johnson & Johnson presented promising preliminary data from the UK Phase I study to the U.S. Food and Drug Administration (FDA). A Phase II study, being carried out in the UK and France, started in July 2015, and a second multi-site Phase II study will shortly commence in several West and East African countries in outside epidemic areas. These Phase II studies are being coordinated by Institut National de la Sante et de la Recherche Medicale (Inserm), another consortium partner with Janssen.

To date, there is no licensed vaccine, treatment or cure for the Ebola virus….

::::::

Ebola nurse Pauline Cafferkey ‘in serious condition’
9 October 2015
BBC
A Scottish nurse who contracted Ebola in Sierra Leone last year is in a “serious condition” after being readmitted to an isolation unit in London.

NHS Greater Glasgow and Clyde confirmed that the virus is still present in Pauline Cafferkey’s body after being left over from the original infection.
She is not thought to be contagious.

The 39-year-old has been flown back to the isolation unit at the Royal Free Hospital in London.
Bodily tissues can harbour the Ebola infection months after the person appears to have fully recovered.

Ms Cafferkey, from Cambuslang in South Lanarkshire, spent almost a month in the unit at the beginning of the year after contracting the virus in December 2014…

POLIO [to 10 October 2015]

POLIO [to 10 October 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week
Global Polio Eradication Initiative
[No update for 7 October identified on GPEI website]

::::::

UNICEF and WHO ready to support immediate polio vaccination campaign in Ukraine
UN agencies concerned further delay puts 1.8 million children’s lives at risk
Joint press release
KYIV, Ukraine/COPENHAGEN/GENEVA, 9 October 2015 – Six weeks after the polio outbreak in Ukraine, UNICEF and WHO have stepped up calls for an immediate first round of nationwide polio vaccination.

Ukraine’s Ministry of Health confirmed two cases of polio on 1 September. They were found in children living in Zakarpatska region, in southwest Ukraine. Both children, aged 10 months and 4 years, were not vaccinated against the disease.

If not stopped immediately, the virus can spread across Ukraine, putting 1.8 million children’s lives at risk. Risk of further polio outbreak remains unless a full-scale immunization campaign begins immediately to stop the transmission of the polio virus.

International guidelines state that just one polio case constitutes an outbreak, requiring an urgent response because of how quickly polio can spread if all children are not fully immunized. The outbreak and low level of vaccination rates in Ukraine risks children’s health and well-being as well as threatens Europe’s polio-free status.

The outbreak can be rapidly stopped through nationwide immunization of children with three rounds of oral polio vaccines, according to guidelines from the Global Polio Eradication Initiative*, which brings together WHO, UNICEF and other health partners. UNICEF has procured 3.7 million oral polio vaccines for Ukraine, with funding from the Government of Canada. WHO has confirmed that the vaccines are entirely safe and ready to use.

“The longer the polio virus is allowed to circulate in Ukraine, the higher the risk that this outbreak will spread and paralyse more children. We call on decision-makers and health care providers in Ukraine to take immediate action and vaccinate all children to urgently stop the transmission of the virus,” said Zsuzsanna Jakab, WHO Regional Director for Europe.

This is the first polio outbreak to hit Ukraine in 19 years, revealing the vulnerability of children in the country. These two cases highlight once again the importance of full vaccination coverage for all children.

“Government authorities have the responsibility to protect children against this debilitating disease. I am pleased that today 70 per cent of Ukrainian mothers are aware of the benefits of vaccination to protect their children. Vaccination rounds should start now,” said Marie-Pierre Poirier, UNICEF Regional Director.

Ukraine’s political leaders must take the decision to support the outbreak response measures and launch the nationwide immunization campaign to protect children from avoidable paralysis and possible death.

UNICEF and WHO are on standby to support the campaign.

WHO & Regionals [to 10 October 2015]

WHO & Regionals [to 10 October 2015]

WHO Welcomes Nobel Prize for Medicine Awards for Discoveries of Tropical Disease Drugs
October 2015 — WHO welcomes the decision to award the Nobel Prize for Medicine for the discovery of drugs that have radically improved treatment for tropical diseases such as Malaria, onchocerciasis (River Blindness), and lymphatic filariasis.

.
The Weekly Epidemiological Record (WER) 9 October 2015, vol. 90, 41 (pp. 545–560) includes:
545 Recommended composition of influenza virus vaccines for use in the 2016 southern hemisphere influenza season
559 Monthly report on dracunculiasis cases, January-July 2015

.
World Mental Health Day 2015
Dignity in mental health

.
:: WHO Regional Offices
WHO African Region AFRO
:: Dr Moeti – Health is a reliable measure of progress towards the Sustainable Development Goals
Cape Town, 6 October 2015 – The WHO Regional Director for Africa, Dr Matshidiso Moeti has underscored the critical role of health in achieving the Sustainable Development Goals (SDGs). Addressing delegates at the Second Ministerial Forum on China-Africa Health Development, in Cape Town, South Africa, Dr Moeti observed that although health is a desirable outcome of the SDGs in its own right and an input into other goals, it is a reliable measure of sustainable development. She noted that health can no longer be considered as a consuming sector…

WHO Region of the Americas PAHO
:: Breast cancer awareness, screening and treatment save lives, PAHO experts say (10/06/2015)

WHO South-East Asia Region SEARO
:: Dignity in mental health – 10 October 2015
:: Ensure eye care for all – 08 October 2015

WHO European Region EURO
:: UNICEF and WHO ready to support immediate polio vaccination campaign in Ukraine 09-10-2015
:: Food, water and health care: WHO reviews basic services for refugees crossing Serbia 09-10-2015
:: New WHO guidelines on antiretroviral therapy and pre-exposure prophylaxis for HIV infection 07-10-2015
:: Medical professionals trained in refugee and migrant health in the former Yugoslav Republic of Macedonia 05-10-2015

WHO Eastern Mediterranean Region EMRO
:: 62nd session of the WHO Regional Committee concludes in Kuwait
9 October 2015 – The WHO Regional Committee for the Eastern Mediterranean concluded its 62nd session on 8 October with the adoption of important resolutions and decisions to advance the health agenda in the Region. Resolutions outline the joint work expected from Member States and WHO in the areas of health security, prevention and control of emerging infections, prevention of cardiovascular diseases, diabetes, and cancer, medical education, mental health, and assessment and monitoring of the implementation of the IHR 2005, among others.
:: Scaling up response to the cholera outbreak in Iraq – 8 October 2015
:: WHO delivers additional medical supplies to Yemen – 8 October 2015

WHO Western Pacific Region
No new digest content identified.

2015 Nobel Prize in Physiology or Medicine

2015 Nobel Prize in Physiology or Medicine
The Nobel Prize in Physiology or Medicine 2015 was awarded with one half jointly to William C. Campbell and Satoshi Ōmura for their discoveries concerning a novel therapy against infections caused by roundworm parasites and the other half to Youyou Tu for her discoveries concerning a novel therapy against Malaria.

Diseases caused by parasites have plagued humankind for millennia and constitute a major global health problem. In particular, parasitic diseases affect the world’s poorest populations and represent a huge barrier to improving human health and wellbeing. This year’s Nobel Laureates have developed therapies that have revolutionized the treatment of some of the most devastating parasitic diseases.

William C. Campbell and Satoshi Ōmura discovered a new drug, Avermectin, the derivatives of which have radically lowered the incidence of River Blindness and Lymphatic Filariasis, as well as showing efficacy against an expanding number of other parasitic diseases. Youyou Tu discovered Artemisinin, a drug that has significantly reduced the mortality rates for patients suffering from Malaria.

These two discoveries have provided humankind with powerful new means to combat these debilitating diseases that affect hundreds of millions of people annually. The consequences in terms of improved human health and reduced suffering are immeasurable.

Parasites cause devastating diseases
We live in a biologically complex world, which is populated not only by humans and other large animals, but also by a plethora of other organisms, some of which are harmful or deadly to us.

A variety of parasites cause disease. A medically important group are the parasitic worms (helminths), which are estimated to afflict one third of the world’s population and are particularly prevalent in sub-Saharan Africa, South Asia and Central and South America. River Blindness and Lymphatic Filariasis are two diseases caused by parasitic worms. As the name implies, River Blindness (Onchocerciasis) ultimately leads to blindness, because of chronic inflammation in the cornea. Lymphatic Filariasis, afflicting more than 100 million people, causes chronic swelling and leads to life-long stigmatizing and disabling clinical symptoms, including Elephantiasis (Lymphedema) and Scrotal Hydrocele.

Malaria has been with humankind for as long as we know. It is a mosquito-borne disease caused by single-cell parasites, which invade red blood cells, causing fever, and in severe cases brain damage and death. More than 3.4 billion of the world’s most vulnerable citizens are at risk of contracting Malaria, and each year it claims more than 450 000 lives, predominantly among children.

After decades of limited progress in developing durable therapies for parasitic diseases, the discoveries by this year’s Laureates radically changed the situation…
Read more

.
Wellcome Trust reaction to Nobel Prize in Physiology or Medicine 2015
5 October 2015
Wellcome Trust Director Jeremy Farrar has issued the below statement in reaction today’s announcement that the Nobel Prize in Physiology or Medicine has been awarded for groundbreaking work on parasitic diseases:

The 2015 prize is shared between William C Campbell and Satoshi Omura for their work on a new way of tackling infections caused by roundworm parasites; and Tu Youyou for her role in the discovery of a therapy against malaria.

Dr Jeremy Farrar, Director of the Wellcome Trust, said: “I am delighted that the development of drugs to tackle parasitic infectious diseases has been recognised. Today’s Nobel Prize rightly highlights the impact of studying the neglected tropical diseases that kill millions worldwide – the discovery of artemisinin and avermectins has transformed the treatment of malaria, river blindness and lymphatic filariasis.

“The restrictions of the Prize, however, mean that other Chinese scientists who played a critical role in the discovery of artemisinin are unfortunately not acknowledged alongside Dr Tu Youyou. The pivotal role they played in China’s first Nobel Prize for medicine should be honoured and celebrated. We should also remember those whose work ensured it was developed as a medicine and then used worldwide. Scientific endeavour is increasingly a collaborative and global effort that involves great contributions from many individuals.”

New commitment from the Republic of Korea to Gavi will support childhood immunisation in the world’s poorest countries

Gavi [to 10 October 2015]
http://www.gavialliance.org/library/news/press-releases/

.
New commitment from the Republic of Korea to Gavi will support childhood immunisation in the world’s poorest countries
Korean support for immunisation in developing countries now stands at US$ 15 million.

Geneva, 6 October 2015 – The Republic of Korea today signed a new agreement with Gavi, the Vaccine Alliance to increase its contribution towards childhood immunisation in developing countries between 2015 and 2017. Under the terms of the agreement, Korea will provide an additional US$ 3 million per year.

The agreement – signed this afternoon by Mr Lee Yongsoo, Director-General for Development Cooperation, Ministry of Foreign Affairs of Korea and Gavi CEO Dr Seth Berkley – marks the third time Korea has committed support for Gavi.

Make vaccine coverage a key UN health indicator – Seth Berkley

Make vaccine coverage a key UN health indicator
Track progress towards universal care using a wide-reaching intervention that all countries can readily measure, says Seth Berkley.
06 October 2015
Nature 526, 165 (08 October 2015) doi:10.1038/526165a

At the United Nations meeting in New York late last month, attendees started to refer to the new Sustainable Development Goals by a different name. The aims morphed into the Global Goals for sustainable development, or just Global Goals.

Whatever we call them, if the goals are to achieve what they set out to, the next few weeks will be crucial. At the end of this month, a UN expert group will meet to try to agree on how to measure progress — and success or failure.

Each of the 17 goals is made up of several targets — 169 in all. Global Goal 3, for example — to “ensure healthy lives and promote well-being for all at all ages” — includes a target to achieve universal health coverage (UHC). UHC is something that the World Health Organization has been pushing for since 2005, asking all countries to provide comprehensive health care for all citizens at an affordable cost.

The UN is exploring having each of these 169 targets judged against two ‘indicators’. But what can best indicate UHC? Unlike the Millennium Development Goals (MDGs) that preceded them, the Global Goals focus on both rich and poor countries. ‘Universal’ really must mean everyone.

One way to indicate progress towards UHC is to measure access to health interventions. But which treatments should we choose? Shine the spotlight on one and another is cast into the shadows. And how important is it for everyone to have access to the same treatments anyway? A child with type 1 diabetes growing up in Kansas clearly does not need the same access to mosquito nets as a child living in Somalia. And should we judge the health of the Somalian child on the basis of their access to blood-glucose monitoring?

Given the challenge of trying to capture this complexity in a single measure, the UN is exploring having an indicator for UHC that is broken down into sub-indicators, which it calls tracers. Possible tracers include access to treatments for tuberculosis, hypertension and diabetes, as well as access to antiretroviral therapy and preventative measures for neglected tropical diseases. Others include improved sanitation, having a skilled attendant present during births, provision of insecticide-treated bed nets and access to full childhood immunization. In some countries, the list could extend to mental-health provision, treatment for cataracts, palliative care and other interventions.

At first glance, the list looks balanced. It reflects a good cross-section of disease burden, and each tracer can be monitored with relative ease using existing data sources such as health records or ones that can be readily set up, including household surveys. But does the list ensure the true health of a population?

Even if all countries made all these interventions available, it would not necessarily mean that people were healthier. The fact that someone is in need of care suggests that they are not healthy, possibly because the system has in some way failed to prevent an illness.

With so many Global Goal targets — the eight MDGs had just 21 — there has been pressure on the UN to reduce the number of indicators. For UHC, one indicator is likely to be concerned with ‘affordability’, meaning that it is possible that all the chosen interventions, including those mentioned above, will be bundled into a single indicator.

This is a difficult problem. Even the common definition of ‘health’ as a state free from injury or disease is disputed by some. So it is no surprise that measuring health is fraught with problems. In trying to encompass this complexity, the UN risks creating an indicator that merely measures service coverage of a few selected therapeutic interventions.

Universal coverage is a means towards better health, but is not an end in itself. We should not be measuring health by access to treatments such as nicotine replacement therapy and lung surgery. Instead, we should be looking at tobacco control and other measures aimed at reducing smoking uptake in the first place.

A true indicator of UHC should be an intervention that every country can readily measure, that speaks to equitable access and quality, and that will reliably ensure the health of a population. Immunization is such an indicator. (Some data are missing, but all countries have agreed to work towards measuring vaccination rates.)

That is why some voices, including that of my organization, Gavi, the Vaccine Alliance, are calling for the Global Goals framework to make full childhood immunization a separate ambitious indicator of UHC in its own right.

More than 30 vaccine doses are administered globally every second. No other health intervention reaches so many people, or is capable of preventing such a diverse range of public-health concerns — from virulent infectious diseases such as measles, to cervical and liver cancer. And at the same time, it helps to identify worrying trends in rich countries — such as the drop in immunizations in parts of California to levels on a par with South Sudan, which has led to outbreaks in recent years.

If immunization is not made a separate indicator, then the UN should make clear that some of the tracers on its long list — including immunization — carry more weight than others. After all, as the old adage goes, when it comes to health, an ounce of prevention is worth a pound of cure.

CBD Convention on Biological Diversity [to 10 October 2015]

CBD Convention on Biological Diversity [to 10 October 2015]
http://www.cbd.int/press-releases/

.
The first internationally recognized certificate of compliance is issued under the Nagoya Protocol on Access and Benefit-sharing
Montreal, 7 October 2015 – The first internationally recognized certificate of compliance was issued on 1 October 2015, following a permit made available to the Access and Benefit-sharing (ABS) Clearing-House by India.

Under the Nagoya Protocol on Access to Genetic Resources and the Fair and Equitable Sharing of Benefits Arising from their Utilization, Parties are to issue a permit or its equivalent at the time of access as evidence that access to genetic resources was based on prior informed consent and that mutually agreed terms were established. Parties are required by the Nagoya Protocol to make information on the permit or its equivalent, available to the ABS Clearing-House for the constitution of the internationally recognized certificate of compliance.

The permit was issued by India’s National Biodiversity Authority, the competent national authority under the Nagoya Protocol. The certificate then constituted through the ABS Clearing-House serves as evidence of the decision by India to grant access to ethno-medicinal knowledge of the Siddi community from Gujarat to a researcher affiliated with the University of Kent in the United Kingdom. The researcher can now demonstrate that s/he has respected the ABS requirements of India when using this knowledge.

“Last week was an important week for the Nagoya Protocol,” said Braulio Ferreira de Souza Dias, Executive Secretary of the Convention on Biological Diversity. “In addition to having the first internationally recognized certificate of compliance published in the ABS Clearing-House, two additional countries joined the Protocol: the Philippines and Djibouti, which brings the total number of ratifications to 68.”…

Industry Watch [to 10 October 2015]

Industry Watch [to 10 October 2015]

.
:: Johnson & Johnson Announces Start of Clinical Trial of Ebola Vaccine Regimen in Sierra Leone
Oct 09, 2015 [see Ebola coverage above]

:: Pfizer’s Phase 2 Study Demonstrates Safety, Tolerability and Immunogenicity of TRUMENBA® When Coadministered with Meningococcal A, C, Y and W-135 Polysaccharide Conjugate (MCV4) and Tetanus, Diphtheria and Pertussis (Tdap) Vaccines in Adolescents
October 09, 2015
Pfizer Inc. (NYSE:PFE) announced today that researchers presented for the first time data from a randomized, controlled Phase 2 study…

:: Focus on International Cooperation for Global Access to Vaccines at the DCVMN 16th Annual AGM
October 06, 2015
Under the auspices of the Queen Saovabha Memorial Institute (QSMI) of the Thai Red Cross Society and BioNet-Asia, the 16th Annual General Meeting of the Developing Countries Vaccine Manufacturers Network…

:: Global Pharmaceutical Associations Welcome MEDICRIME Convention, Landmark Tool to Curb Global Medicines Counterfeiting IFPMA –
01 October 2015

:: PhRMA Statement On the TransPacific Partnership Negotiations
Washington, D.C. (October 5, 2015) — Pharmaceutical Research and Manufacturers of America (PhRMA) President and CEO, John Castellani, issued the following statement:
“PhRMA believes that strong intellectual property protection is necessary for the discovery and development of new treatments and therapies for the world’s patients.
“We are disappointed that the Ministers failed to secure 12 years of data protection for biologic medicines, which represent the next wave of innovation in our industry. This term was not a random number, but the result of a long debate in Congress, which determined that this period of time captured the appropriate balance that stimulated research but gave access to biosimilars in a timely manner.

WHO/UNAIDS :: Global Standards for quality health-care services for adolescents

Global Standards for quality health-care services for adolescents
WHO
2015 :: Number of pages: 40, 28, 100, 132
WHO reference number: 978 92 4 154933 2
Volume 1: Standards and criteria pdf, 918kb
Volume 2: Implementation guide pdf, 867kb
Volume 3: Tools to conduct quality and coverage measurement surveys to collect data about compliance with the global standards pdf, 887kb
Volume 4: Scoring sheets for data analysis pdf, 927kb
Policy brief pdf, 770kb
.
Overview
Global initiatives are urging countries to prioritize quality as a way of reinforcing human rights-based approaches to health. Yet evidence from both high- and low-income countries shows that services for adolescents are highly fragmented, poorly coordinated and uneven in quality. Pockets of excellent practice exist, but, overall, services need significant improvement and should be brought into conformity with existing guidelines.
WHO/UNAIDS Global Standards for quality health care services for adolescents aim to assist policy-makers and health service planners in improving the quality of health-care services so that adolescents find it easier to obtain the health services that they need to promote, protect and improve their health and well-being.

.
Press Release
WHO and UNAIDS launch new standards to improve adolescent care
GENEVA, 6 October 2015—New Global Standards for quality health-care services for adolescents developed by the World Health Organization (WHO) and UNAIDS aim to help countries improve the quality of adolescent health care.

Existing health services often fail the world’s adolescents (10-19-year-olds). Many adolescents who suffer from mental health disorders, substance use, poor nutrition, intentional injuries and chronic illness do not have access to critical prevention and care services. Meanwhile, many behaviours that have a lifelong impact on health begin in adolescence.

“These standards provide simple yet powerful steps that countries – both rich and poor – can immediately take to improve the health and wellbeing of their adolescents, reflecting the stronger focus on adolescents in the new Global Strategy for Women’s, Children’s and Adolescents’ Health that was launched in New York in September,” says Dr Anthony Costello, Director of Maternal, Children’s and Adolescents’ Health at WHO.

Adolescents form a unique group, rapidly developing both physically and emotionally but are often dependent on their parents or guardians. WHO and UNAIDS Global Standards for quality health-care services for adolescents recommend making services more “adolescent friendly”, providing free or low-cost consultations, and making medically accurate age-appropriate health information available. They also highlight the need for adolescents to be able to access services without necessarily having to make an appointment or requiring parental consent, safe in the knowledge that any consultation remains confidential, and certain that they will not experience discrimination…

…“AIDS is the leading cause of death among adolescents in Africa and the second primary cause of death among adolescents globally,” says Dr Mariângela Simão, Director of Rights, Gender, Prevention and Community Mobilization at UNAIDS. “All adolescents, including key populations, have a right to the information and services that will empower them to protect themselves from HIV.” …

…The Global Standards for quality health-care services for adolescents call for an inclusive package of information, counselling, diagnostic, treatment and care services that go beyond the traditional focus on sexual and reproductive health.

Adolescents should be meaningfully involved in planning, monitoring and providing feedback on health services and in decisions regarding their own care.

More than 25 low- and middle-income countries have already adopted national standards for improving adolescent health services.

The global standards from WHO and UNAIDS are built on research from these countries, as well as feedback from health providers and more than 1000 adolescents worldwide. They are accompanied by an implementation and evaluation guide that outlines concrete steps that countries can take to improve health care for adolescents.

American Journal of Tropical Medicine and Hygiene – October 2015

American Journal of Tropical Medicine and Hygiene
October 2015; 93 (4)
http://www.ajtmh.org/content/current

.
Economic Burden of Dengue Virus Infection at the Household Level Among Residents of Puerto Maldonado, Peru
Gabriela Salmon-Mulanovich, David L. Blazes, Andres G. Lescano, Daniel G. Bausch, Joel M. Montgomery, and William K. Pan
Am J Trop Med Hyg 2015 93:684-690; Published online July 27, 2015, doi:10.4269/ajtmh.14-0755

.
Detection of Chikungunya Virus in Nepal
Basu Dev Pandey, Biswas Neupane, Kishor Pandey, Mya Myat Ngwe Tun, and Kouichi Morita
Am J Trop Med Hyg 2015 93:697-700; Published online July 20, 2015, doi:10.4269/ajtmh.15-0092

.
Investigating Barriers to Tuberculosis Evaluation in Uganda Using Geographic Information Systems
Jennifer M. Ross, Adithya Cattamanchi, Cecily R. Miller, Andrew J. Tatem, Achilles Katamba, Priscilla Haguma, Margaret A. Handley, and J. Lucian Davis
Am J Trop Med Hyg 2015 93:733-738; Published online July 27, 2015, doi:10.4269/ajtmh.14-0754

Cost-Effectiveness of Herpes Zoster Vaccine for Persons Aged 50 Years

Annals of Internal Medicine
6 October 2015, Vol. 163. No. 7
http://annals.org/issue.aspx

.
Original Research
Cost-Effectiveness of Herpes Zoster Vaccine for Persons Aged 50 Years
Phuc Le, PhD, MPH; and Michael B. Rothberg, MD, MPH
Abstract
Background: Each year, herpes zoster (HZ) affects 1 million U.S. adults, many of whom develop postherpetic neuralgia (PHN). Zoster vaccine is licensed for persons aged 50 years or older, but its cost-effectiveness for those aged 50 to 59 years is unknown.
Objective: To estimate the cost-effectiveness of HZ vaccine versus no vaccination.
Design: Markov model.
Data Sources: Medical literature.
Target Population: Adults aged 50 years.
Time Horizon: Lifetime.
Perspective: Societal.
Intervention: HZ vaccine.
Outcome Measures: Number of HZ and PHN cases prevented and incremental cost per quality-adjusted life-year (QALY) saved.
Results of Base-Case Analysis: For every 1000 persons receiving the vaccine at age 50 years, 25 HZ cases and 1 PHN case could be prevented. The incremental cost-effectiveness ratio (ICER) for HZ vaccine versus no vaccine was $323 456 per QALY.
Results of Sensitivity Analysis: In deterministic and scenario sensitivity analyses, the only variables that produced an ICER less than $100 000 per QALY were vaccine cost (at a value of $80) and the rate at which efficacy wanes. In probabilistic sensitivity analysis, the mean ICER was $500 754 per QALY (95% CI, $93 510 to $1 691 211 per QALY). At a willingness-to-pay threshold of $100 000 per QALY, the probability that vaccination would be cost-effective was 3%.
Limitation: Long-term effectiveness data for HZ vaccine are lacking for 50-year-old adults.
Conclusion: Herpes zoster vaccine for persons aged 50 years does not seem to represent good value according to generally accepted standards. Our findings support the decision of the Advisory Committee on Immunization Practices not to recommend the vaccine for adults in this age group

Propensity to seek healthcare in different healthcare systems: analysis of patient data in 34 countries

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 10 October 2015)

.
Research article
Propensity to seek healthcare in different healthcare systems: analysis of patient data in 34 countries
Tessa van Loenen, Michael van den Berg, Marjan Faber, Gert Westert BMC Health Services Research 2015, 15:465 (9 October 2015)

Long-term immunogenicity and safety after a single dose of the quadrivalent meningococcal serogroups A, C, W, and Y tetanus toxoid conjugate vaccine in adolescents and adults: 5-year follow-up of an open, randomized trial

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 10 October 2015)

.
Research article
Long-term immunogenicity and safety after a single dose of the quadrivalent meningococcal serogroups A, C, W, and Y tetanus toxoid conjugate vaccine in adolescents and adults: 5-year follow-up of an open, randomized trial
Charissa Fay Corazon Borja-Tabora, Cecilia Montalban, Ziad Memish, Dominique Boutriau, Devayani Kolhe, Jacqueline Miller, Marie Van der Wielen BMC Infectious Diseases 2015, 15:409 (6 October 2015)
Abstract
Background
Long-term protection against meningococcal disease is associated with persistence of post-vaccination antibodies at protective levels. We evaluated the bactericidal antibody persistence and safety of the quadrivalent meningococcal serogroups A, C, W and Y tetanus-toxoid conjugate vaccine (MenACWY-TT) and the meningococcal polysaccharide serogroups A, C, W, and Y vaccine (MenACWY-PS) up to 5 years post-vaccination.
Methods
This phase IIb, open, randomized, controlled study conducted in the Philippines and Saudi Arabia consisted of a vaccination phase and a long-term persistence phase. Healthy adolescents and adults aged 11–55 years were randomized (3:1) to receive a single dose of MenACWY-TT (ACWY-TT group) or MenACWY-PS (Men-PS group). Primary and persistence results up to 3 years post-vaccination have been previously reported. Antibody responses against meningococcal serogroups A, C, W, and Y were assessed by a serum bactericidal antibody assay using rabbit complement (rSBA, cut-off titers 1:8 and 1:128) at Year 4 and Year 5 post-vaccination. Vaccine-related serious adverse events (SAEs) and cases of meningococcal disease were assessed up to Year 5.
Results
Of the 500 vaccinated participants, 404 returned for the Year 5 study visit (Total Cohort Year 5). For the Total Cohort Year 5, 71.6–90.0 and 64.9–86.3 % of MenACWY-TT recipients had rSBA titers ≥1:8 and ≥1:128, respectively, compared to 24.8–74.3 and 21.0–68.6 % of MenACWY-PS recipients. The rSBA geometric mean titers (GMTs) remained above the pre-vaccination levels in both treatment groups. Exploratory analyses suggested that both rSBA GMTs as well as the percentages of participants with rSBA titers above the cut-offs were higher in the ACWY-TT than in the Men-PS group for serogroups A, W and Y, with no apparent difference for MenC. No SAEs related to vaccination or cases of meningococcal disease were reported up to Year 5.
Conclusion
These results suggest that a single dose of MenACWY-TT could protect at least 72 % of vaccinated adolescents and adults against meningococcal disease at least 5 years post-vaccination.