Challenges to the management of curable sexually transmitted infections

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

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Editorial
Challenges to the management of curable sexually transmitted infections
Marcus Y Chen, Sepehr N Tabrizi BMC Infectious Diseases 2015, 15:337 (1 December 2015)
Abstract
Each year, hundreds of millions of new cases of curable sexually transmitted infections (STIs) occur worldwide resulting in reproductive and other serious sequelae, as well as enhanced transmission of HIV. The clinical management and control of these STIs should include as a minimum access to services that provide timely and accurate diagnostic testing together with effective treatment. The provision of appropriate treatment is challenged by the development of increasing antimicrobial resistance, in particular with gonorrhoea and Mycoplasma genitalium infections, requiring new treatments and management algorithms. In addition, infections such as chlamydia, syphilis and trichomoniasis, which show few signs of resistance, are nevertheless highly prevalent and require better public health control measures. While these may be achievable in high income countries, they are still beyond the reach of many low and middle income countries, making substantial improvements in STI management and reductions in STI prevalence challenging.

 

Changes in equity of maternal, newborn, and child health care practices in 115 districts of rural Ethiopia: implications for the health extension program

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 10 October 2015)

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Research article
Changes in equity of maternal, newborn, and child health care practices in 115 districts of rural Ethiopia: implications for the health extension program
Ali Karim, Addis Tamire, Araya Medhanyie, Wuleta Betemariam BMC Pregnancy and Childbirth 2015, 15:238 (5 October 2015)
Abstract
Background
Reducing within-country inequities in the coverage of maternal, newborn, and child health (MNCH) interventions is essential to improving a country’s maternal and child health and survival rates. The community-based health extension program (HEP) of Ethiopia, launched in 2003, aims to provide equitable primary health care services. Since 2008 the Last Ten Kilometers Project (L10K) has been supporting the HEP in promoting equitable MNCH interventions in 115 districts covering about 14 million people. We report the inequities in MNCH programmatic indicators in 2008 and in 2010 in the L10K areas, along with changes in equity between the two survey periods, and the implications of these results for the national program.
Methods
The study used cross-sectional surveys of 3932 and 3867 women from 129 representative kebeles (communities) conducted in December 2008 and December 2010, respectively. Nineteen HEP outreach activity coverage and MNCH care practice indicators were calculated for each survey period, stratified by the inequity factors considered (i.e. age, education, wealth and distance from the nearest health facility). We calculated relative inequities using concentration indices for each of the indicators and inequity factors. Ninety-five percent confidence intervals and survey design adjusted Wald’s statistics were used to assess differentials in equity.
Results
Education and age related inequities in the MNCH indicators were the most prominent (observed for 13 of the 19 outcomes analyzed), followed in order by wealth inequity (observed for eight indicators), and inequity due to distance from the nearest health facility (observed for seven indicators). Age inequities in six of the indicators increased between 2008 and 2010; nevertheless, there was no consistent pattern of changes in inequities during that period. Some related issues such as inequities due to wealth in household visits by the health extension workers and prevalence of modern family household; and inequities due to education in household visits by community health promoters showed improvement.
Conclusions
Addressing these inequities in MNCH interventions by age, education and wealth will contribute significantly toward achieving Ethiopia’s maternal health targets for the Millennium Development Goals and beyond. HEP will require more innovative strategies to achieve equitable MNCH services and outcomes and to routinely monitor the effectiveness of those strategies.

The role of men in abandonment of female genital mutilation: a systematic review

BMC Public Health
http://www.biomedcentral.com/bmcpublichealth/content
(Accessed 10 October 2015)

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Research article
The role of men in abandonment of female genital mutilation: a systematic review
Nesrin Varol, Sabera Turkmani, Kirsten Black, John Hall, Angela Dawson BMC Public Health 2015, 15:1034 (8 October 2015)
Open Access
Abstract
Background
Men in their roles as fathers, husbands, community and religious leaders may play a pivotal part in the continuation of female genital mutilation (FGM). However, the research on their views of FGM and their potential role in its abandonment are not well described.
Methods
We undertook a systematic review of all publications between 2004 and 2014 that explored men’s attitudes, beliefs, and behaviours in regards to FGM, as well as their ideas about FGM prevention and abandonment.
Results
We included twenty peer-reviewed articles from 15 countries in the analysis. Analysis revealed ambiguity of men’s wishes in regards to the continuation of FGM. Many men wished to abandon this practice because of the physical and psychosexual complications to both women and men. Social obligation and the silent culture between the sexes were posited as major obstacles for change. Support for abandonment was influenced by notions of social obligation, religion, education, ethnicity, urban living, migration, and understanding of the negative sequelae of FGM. The strongest influence was education.
Conclusion
The level of education of men was one of the most important indicators for men’s support for abandonment of FGM. Social obligation and the lack of dialogue between men and women were two key issues that men acknowledged as barriers to abandonment. Advocacy by men and collaboration between men and women’s health and community programs may be important steps forward in the abandonment process.

Trends in utilization of FDA expedited drug development and approval programs, 1987-2014: cohort study

British Medical Journal
10 October 2015 (vol 351, issue 8026)
http://www.bmj.com/content/351/8026

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Trends in utilization of FDA expedited drug development and approval programs, 1987-2014: cohort study
BMJ 2015; 351 :h4633 (Published 23 September 2015)
Open Access
Abstract
Objective To evaluate the use of special expedited development and review pathways at the US Food and Drug Administration over the past two decades.
Design Cohort study.
Setting FDA approved novel therapeutics between 1987 and 2014.
Population Publicly available sources provided each drug’s year of approval, their innovativeness (first in class versus not first in class), World Health Organization Anatomic Therapeutic Classification, and which (if any) of the FDA’s four primary expedited development and review programs or designations were associated with each drug: orphan drug, fast track, accelerated approval, and priority review.
Main outcome measures Logistic regression models evaluated trends in the proportion of drugs associated with each of the four expedited development and review programs. To evaluate the number of programs associated with each approved drug over time, Poisson models were employed, with the number of programs as the dependent variable and a linear term for year of approval. The difference in trends was compared between drugs that were first in class and those that were not.
Results The FDA approved 774 drugs during the study period, with one third representing first in class agents. Priority review (43%) was the most prevalent of the four programs, with accelerated approval (9%) the least common. There was a significant increase of 2.6% per year in the number of expedited review and approval programs granted to each newly approved agent (incidence rate ratio 1.026, 95% confidence interval 1.017 to 1.035, P<0.001), and a 2.4% increase in the proportion of drugs associated with at least one such program (odds ratio 1.024, 95% confidence interval 1.006 to 1.043, P=0.009). Driving this trend was an increase in the proportion of approved, non-first in class drugs associated with at least one program for drugs (P=0.03 for interaction).
Conclusions In the past two decades, drugs newly approved by the FDA have been associated with an increasing number of expedited development or review programs. Though expedited programs should be strictly limited to drugs providing noticeable clinical advances, this trend is being driven by drugs that are not first in class and thus potentially less innovative.

Conflict and Health [Accessed 10 October 2015]

Conflict and Health
http://www.conflictandhealth.com/
[Accessed 10 October 2015]

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Research
The influence of maternal health education on the place of delivery in conflict settings of Darfur, Sudan
Adam IF Conflict and Health 2015, 9:31 (5 October 2015)

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Research
Health service resilience in Yobe state, Nigeria in the context of the Boko Haram insurgency: a systems dynamics analysis using group model building
Ager AK, Lembani M, Mohammed A, Mohammed Ashir G, Abdulwahab A, de Pinho H, Delobelle P and Zarowsky C Conflict and Health 2015, 9:30 (5 October 2015)

Assessing Latin America’s Progress Toward Achieving Universal Health Coverage

Health Affairs
October 2015; Volume 34, Issue 10
http://content.healthaffairs.org/content/current

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Global Health: Insurance
Assessing Latin America’s Progress Toward Achieving Universal Health Coverage
Adam Wagstaff, Tania Dmytraczenko, Gisele Almeida, Leander Buisman, Patrick Hoang-Vu Eozenou, Caryn Bredenkamp, James A. Cercone, Yadira Diaz, Daniel Maceira, Silvia Molina, Guillermo Paraje, Fernando Ruiz, Flavia Sarti, John Scott, Martin Valdivia, and Heitor Werneck
Health Aff October 2015 34:1704-1712; doi:10.1377/hlthaff.2014.1453
Abstract
Two commonly used metrics for assessing progress toward universal health coverage involve assessing citizens’ rights to health care and counting the number of people who are in a financial protection scheme that safeguards them from high health care payments. On these metrics most countries in Latin America have already “reached” universal health coverage. Neither metric indicates, however, whether a country has achieved universal health coverage in the now commonly accepted sense of the term: that everyone—irrespective of their ability to pay—gets the health services they need without suffering undue financial hardship. We operationalized a framework proposed by the World Bank and the World Health Organization to monitor progress under this definition and then constructed an overall index of universal health coverage achievement. We applied the approach using data from 112 household surveys from 1990 to 2013 for all twenty Latin American countries. No country has achieved a perfect universal health coverage score, but some countries (including those with more integrated health systems) fare better than others. All countries except one improved in overall universal health coverage over the time period analyzed.

The economic burden of influenza-associated outpatient visits and hospitalizations in China: a retrospective survey

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 10 October 2015]

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Research Article
The economic burden of influenza-associated outpatient visits and hospitalizations in China: a retrospective survey
Juan Yang, Mark Jit, Kathy Leung, Ya-ming Zheng, Lu-zhao Feng, Li-ping Wang, Eric Lau, Joseph Wu, Hong-jie Yu Infectious Diseases of Poverty 2015, 4:44 (6 October 2015)
Editor’s summary
This study estimated the direct and indirect costs of seasonal influenza-associated outpatient visits and hospitalizations in China from a societal perspective by conducting a retrospective telephone survey. The study is important to provide information on the burden of disease and the cost-effectiveness studies of seasonal influenza vaccination in China.

Cholera in pregnancy: Clinical and immunological aspects

International Journal of Infectious Diseases
October 2015 Volume 39, In Progress
http://www.ijidonline.com/issue/S1201-9712%2815%29X0010-5

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Cholera in pregnancy: Clinical and immunological aspects
Ashraful I. Khan, Fahima Chowdhury, Daniel T. Leung, Regina C. Larocque, Jason B. Harris, Edward T. Ryan, Stephen B. Calderwood, Firdausi Qadri
p20–24
Published online: August 14 2015
Preview
Cholera is a life threatening diarrheal disease caused predominantly by infection with Vibrio cholerae O1. Though cholera is rare in developed countries, it is prevalent in many areas of South and Southeast Asia and in Africa and may also cause major outbreaks worldwide.1 Bangladesh is a country in South Asia where cholera is endemic and is consistently present throughout the year in high risk areas.2 Cholera toxin (CT), the primary toxin produced by V. cholerae O1 and O139, causes the hypersecretion of electrolytes and water, sometimes with fatal results

JAMA Pediatrics – October 2015

JAMA Pediatrics
October 2015, Vol 169, No. 10
http://archpedi.jamanetwork.com/issue.aspx

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American Pediatric Society
Global Collaboration to Develop New and Existing Drugs for Neonates
Jonathan M. Davis, MD; Mark A. Turner, MB, PhD, MRCPCH
This Viewpoint discusses the specific areas that should be considered by global investigators when collaborating on the development of drugs for neonatal patients.
Neonates do not have access to medicines that have been adequately tested for dosing, safety, and efficacy.1 Physicians must use their best judgment to make up for these knowledge gaps, leading to incorrect, and possibly harmful, doses of unnecessary and expensive medications. Some experts even believe that it is difficult or unethical for research to be conducted in neonates.2 Neither of these beliefs are justified, and it is inappropriate to expose neonates to potential risk without conclusive evidence that the drugs they are receiving are safe and efficacious. Neonates must participate in all stages of drug development in trials that use contemporary methods, because the health care industry has an ethical duty to meet the needs of this population.3

Review
Influenza A Virus Infection, Innate Immunity, and Childhood
Bria M. Coates, MD; Kelly L. Staricha; Kristin M. Wiese, MD; Karen M. Ridge, PhD
Abstract
Infection with influenza A virus is responsible for considerable morbidity and mortality in children worldwide. While it is apparent that adequate activation of the innate immune system is essential for pathogen clearance and host survival, an excessive inflammatory response to infection is detrimental to the young host. A review of the literature indicates that innate immune responses change throughout childhood. Whether these changes are genetically programmed or triggered by environmental cues is unknown. The objectives of this review are to summarize the role of innate immunity in influenza A virus infection in the young child and to highlight possible differences between children and adults that may make children more susceptible to severe influenza A infection. A better understanding of age-related differences in innate immune signaling will be essential to improve care for this high-risk population.

Efficacy, safety, and immunogenicity of an oral recombinant Helicobacter pylori vaccine in children in China: a randomised, double-blind, placebo-controlled, phase 3 trial

The Lancet
Oct 10, 2015 Volume 386 Number 10002 p1419-1508 e17
http://www.thelancet.com/journals/lancet/issue/current

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Comment
At last, vaccine-induced protection against Helicobacter pylori
Philip Sutton
Published Online: 30 June 2015
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60579-7
Summary
For a quarter of a century, countless attempts have been made to produce an effective vaccine against Helicobacter pylori, a major cause of peptic ulcer disease and gastric adenocarcinoma.1 An effective vaccine against H pylori is needed most for prevention of gastric adenocarcinoma, the third leading cause of cancer-related death worldwide.2 However, efforts to produce such a vaccine have so far failed, and H pylori vaccine research has slowed in the past few years. The main reason for this might have been disillusionment, arising from the inability to produce a vaccine that completely protects against the infection.

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Efficacy, safety, and immunogenicity of an oral recombinant Helicobacter pylori vaccine in children in China: a randomised, double-blind, placebo-controlled, phase 3 trial
Ming Zeng, Xu-Hu Mao, Jing-Xin Li, Wen-De Tong, Bin Wang, Yi-Ju Zhang, Gang Guo, Zhi-Jing Zhao, Liang Li, De-Lin Wu, Dong-Shui Lu, Zhong-Ming Tan, Hao-Yu Liang, Chao Wu, Da-Han Li, Ping Luo, Hao Zeng, Wei-Jun Zhang, Jin-Yu Zhang, Bo-Tao Guo, Feng-Cai Zhu, Quan-Ming Zou
1457
Summary
Background
Helicobacter pylori is one of the most common gastric pathogens, affecting at least half the world’s population, and is strongly associated with gastritis, peptic ulcer, gastric adenocarcinoma, and lymphoma. We aimed to assess the efficacy, safety, and immunogenicity of a three-dose oral recombinant H pylori vaccine in children in China.
Methods
We did this randomised, double-blind, placebo-controlled, phase 3 trial at one centre in Ganyu County, Jiangsu Province, China. Healthy children aged 6–15 years without past or present H pylori infection were randomly assigned (1:1), via computer-generated randomisation codes in blocks of ten, to receive the H pylori vaccine or placebo. Participants, their guardians, and study investigators were masked to treatment allocation. The primary efficacy endpoint was the occurrence of H pylori infection within 1 year after vaccination. We did analysis in the per-protocol population. This trial is registered with ClinicalTrials.gov, number NCT02302170.
Findings
Between Dec 2, 2004, and March 19, 2005, we randomly assigned 4464 participants to either the vaccine group (n=2232) or the placebo group (n=2232), of whom 4403 (99%) participants completed the three-dose vaccination schedule and were included in the per-protocol efficacy analysis. We extended follow-up to 3 years. We recorded 64 events of H pylori infection within the first year (14 events in 2074·3 person-years at risk in the vaccine group vs 50 events in 2089·6 person-years at risk in the placebo group), resulting in a vaccine efficacy of 71·8% (95% CI 48·2–85·6). 157 (7%) participants in the vaccine group and 161 (7%) participants in the placebo group reported at least one adverse reaction. Serious adverse events were reported in five (<1%) participants in the vaccine group and seven (<1%) participants in the placebo group, but none was considered to be vaccination related.
Interpretation
The oral recombinant H pylori vaccine was effective, safe, and immunogenic in H pylori-naive children. This vaccine could substantially reduce the incidence of H pylori infection; however, follow up over a longer period is needed to confirm the protection of the vaccine against H pylori-associated diseases.
Funding
Chongqing Kangwei Biological Technology.

The Lancet Global Health – Oct 2015

The Lancet Global Health
Oct 2015 Volume 3 Number 10 e576-e654
http://www.thelancet.com/journals/langlo/issue/current

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Comment
New WHO recommendations to improve the outcomes of preterm birth
Joshua P Vogel, Olufemi T Oladapo, Alexander Manu, A Metin Gülmezoglu, Rajiv BahlOpen Access
DOI: http://dx.doi.org/10.1016/S2214-109X(15)00183-7
Summary
An estimated 15 million babies are born preterm annually.1 Preterm birth complications account for more than 15% of deaths in children younger than 5 years2 and survivors often have long-term consequences with respect to their health, growth, and psychosocial functioning.3,4 The most beneficial interventions available are those that improve newborn outcomes when preterm birth is inevitable (tertiary interventions) and those that focus on special care for preterm newborns. Today WHO publishes new recommendations on interventions for pregnant women in whom preterm birth is imminent (including antenatal corticosteroids, tocolytics, magnesium sulfate, antibiotics, and mode of delivery) and for care of preterm neonates (including thermal care, continuous positive airway pressure [CPAP], surfactant administration, and oxygen therapy) to improve preterm birth outcomes.

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Mortality risks in children aged 5–14 years in low-income and middle-income countries: a systematic empirical analysis
Kenneth Hill, Linnea Zimmerman, Dean T Jamison
e609

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Prevalence of malaria infection in pregnant women compared with children for tracking malaria transmission in sub-Saharan Africa: a systematic review and meta-analysis
Anna M van Eijk, Jenny Hill, Abdisalan M Noor, Robert W Snow, Feiko O ter Kuile
e617

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Comparison of community-wide, integrated mass drug administration strategies for schistosomiasis and soil-transmitted helminthiasis: a cost-effectiveness modelling study
Nathan C Lo, Isaac I Bogoch, Brian G Blackburn, Giovanna Raso, Eliézer K N’Goran, Jean T Coulibaly, Sören L Becker, Howard B Abrams, Jürg Utzinger, Jason R Andrews
e629

Out-of-pocket health expenditures and antimicrobial resistance in low-income and middle-income countries: an economic analysis

The Lancet Infectious Diseases
Oct 2015 Volume 15 Number 10 p1115-1242
http://www.thelancet.com/journals/laninf/issue/current

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Out-of-pocket health expenditures and antimicrobial resistance in low-income and middle-income countries: an economic analysis
Marcella Alsan, Lena Schoemaker, Karen Eggleston, Nagamani Kammili, Prasanthi Kolli, Jay Bhattacharya
Summary
Introduction
The decreasing effectiveness of antimicrobial agents is a growing global public health concern. Low-income and middle-income countries are vulnerable to the loss of antimicrobial efficacy because of their high burden of infectious disease and the cost of treating resistant organisms. We aimed to assess if copayments in the public sector promoted the development of antibiotic resistance by inducing patients to purchase treatment from less well regulated private providers.
Methods
We analysed data from the WHO 2014 Antibacterial Resistance Global Surveillance report. We assessed the importance of out-of-pocket spending and copayment requirements for public sector drugs on the level of bacterial resistance in low-income and middle-income countries, using linear regression to adjust for environmental factors purported to be predictors of resistance, such as sanitation, animal husbandry, and poverty, and other structural components of the health sector. Our outcome variable of interest was the proportion of bacterial isolates tested that showed resistance to a class of antimicrobial agents. In particular, we computed the average proportion of isolates that showed antibiotic resistance for a given bacteria-antibacterial combination in a given country.
Findings
Our sample included 47 countries (23 in Africa, eight in the Americas, three in Europe, eight in the Middle East, three in southeast Asia, and two in the western Pacific). Out-of-pocket health expenditures were the only factor significantly associated with antimicrobial resistance. A ten point increase in the percentage of health expenditures that were out-of-pocket was associated with a 3·2 percentage point increase in resistant isolates (95% CI 1·17–5·15; p=0·002). This association was driven by countries requiring copayments for drugs in the public health sector. Of these countries, moving from the 20th to 80th percentile of out-of-pocket health expenditures was associated with an increase in resistant bacterial isolates from 17·76% (95% CI 12·54–22·97) to 36·27% (31·16–41·38).
Interpretation
Out-of-pocket health expenditures were strongly correlated with antimicrobial resistance in low-income and middle-income countries. This relation was driven by countries that require copayments on drugs in the public sector. Our data suggest cost-sharing of antimicrobials in the public sector might drive demand to the private sector in which supply-side incentives to overprescribe are probably heightened and quality assurance less standardised.
Funding
National Institutes of Health.

Threats to polio eradication in high-conflict areas in Pakistan and Nigeria: a polling study of caregivers of children younger than 5 years

The Lancet Infectious Diseases
Oct 2015 Volume 15 Number 10 p1115-1242
http://www.thelancet.com/journals/laninf/issue/current

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Comment
Overcoming barriers to polio eradication in conflict areas
Julie R Garon, Walter A Orenstein
Summary
Substantial progress has been made in the effort to eradicate polio. In 1988, the year the eradication effort began, an estimated 350 000 people were paralysed by poliovirus infection, which was regarded as endemic in 125 countries. By contrast, in 2014, 359 cases were detected worldwide, and only three countries are currently deemed endemic: Pakistan, Nigeria, and Afghanistan.1 Further progress has been made, particularly in Nigeria, which as of June 17, 2015, has not seen a case of polio caused by wild viruses since July 24, 2014, or a case of circulating vaccine-derived poliovirus type 2 since Nov 16, 2014.

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Threats to polio eradication in high-conflict areas in Pakistan and Nigeria: a polling study of caregivers of children younger than 5 years
Gillian K SteelFisher, Robert J Blendon, Sherine Guirguis, Amanda Brulé, Narayani Lasala-Blanco, Michael Coleman, Vincent Petit, Mashrur Ahmed, Noah Mataruse, Melissa Corkum, Mazhar Nisar, Eran N Ben-Porath, Susan Gigli, Christoph Sahm
Summary
Background
Elimination of poliovirus from endemic countries is a crucial step in eradication; however, vaccination programmes in these areas face challenges, especially in regions with conflict. We analysed interviews with caregivers of children living in two polio-endemic countries to assess whether these challenges are largely operational or also driven by resistance or misinformation in the community.
Methods
We designed and analysed polls based on face-to-face interviews of a random sample of parents and other caregivers of children younger than 5 years in regions of Pakistan and Nigeria at high risk for polio transmission. In both countries, the sample was drawn via a stratified multistage cluster design with random route household selection. The questionnaire covered awareness, knowledge, and attitudes about polio and oral polio vaccine (OPV), trust in vaccination efforts, and caregiver priorities for government action. We assessed experiences of caregivers in accessible higher-conflict areas and compared their knowledge and attitudes with those in lower-conflict areas. Differences were tested with two-sample t tests.
Findings
The poll consisted of 3396 caregivers from Pakistan and 2629 from Nigeria. About a third of caregivers who responded in higher-conflict areas of Pakistan (Federally Administered Tribal Areas [FATA], 30%) and Nigeria (Borno, 33%) were unable to confirm that their child was vaccinated in the previous campaign. In FATA, 12% of caregivers reported that they were unaware of polio, and in Borno 12% of caregivers reported that vaccinators visited but their child did not receive the vaccine or they did not know whether the child was vaccinated. Additionally, caregivers in higher-conflict areas are less likely to hold beliefs about OPV that could motivate acceptance and are more likely to hold concerns than are caregivers in lower-conflict areas.
Interpretation
Beyond the difficulties in reaching homes with OPV, challenges for vaccination programmes in higher-conflict areas extend to limited awareness, negative attitudes, and gaps in trust. Vaccination efforts might need to address underlying attitudes of caregivers through direct communications and the selection and training of local vaccinators.
Funding
Harvard T H Chan School of Public Health and UNICEF.

Preparation for global introduction of inactivated poliovirus vaccine: safety evidence from the US Vaccine Adverse Event Reporting System, 2000–12

The Lancet Infectious Diseases
Oct 2015 Volume 15 Number 10 p1115-1242
http://www.thelancet.com/journals/laninf/issue/current

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Comment
Good news for billions of children who will receive IPV
Kimberly M Thompson
Published Online: 16 August 2015
DOI: http://dx.doi.org/10.1016/S1473-3099(15)00099-7
Summary
In The Lancet Infectious Diseases, Shahed Iqbal and colleagues1 present their analysis of data from the US Vaccine Adverse Event Reporting System (VAERS), the largest database of reported events temporally associated with, but not necessarily causally related to, the delivery of inactivated poliovirus vaccine (IPV). Their results show low numbers of temporally associated events reported with the delivery of more than 250 million IPV doses in the USA and no substantial adverse events, which confirms the safety of IPV.

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Preparation for global introduction of inactivated poliovirus vaccine: safety evidence from the US Vaccine Adverse Event Reporting System, 2000–12
Shahed Iqbal, Jing Shi, Katherine Seib, Paige Lewis, Pedro L Moro, Emily J Woo, Tom Shimabukuro, Walter A Orenstein
Summary
Background
Safety data from countries with experience in the use of inactivated poliovirus vaccine (IPV) are important for the global polio eradication strategy to introduce IPV into the immunisation schedules of all countries. In the USA, IPV has been included in the routine immunisation schedule since 1997. We aimed to analyse adverse events after IPV administration reported to the US Vaccine Adverse Event Reporting System (VAERS).
Methods
We analysed all VAERS data associated with IPV submitted between Jan 1, 2000, and Dec 31, 2012, either as individual or as combination vaccines, for all age and sex groups. We analysed the number and event type (non-serious, non-fatal serious, and death reports) of individual reports, and explored the most commonly coded event terms to describe the adverse event. We classified death reports according to previously published body-system categories (respiratory, cardiovascular, neurological, gastrointestinal, other infectious, and other non-infectious) and reviewed death reports to identify the cause of death. We classified sudden infant death syndrome as a separate cause of death considering previous concerns about sudden infant syndrome after vaccines. We used empirical Bayesian data mining methods to identify disproportionate reporting of adverse events for IPV compared with other vaccines. Additional VAERS data from 1991 to 2000 were analysed to compare the safety profiles of IPV and oral poliovirus vaccine (OPV).
Findings
Of the 41 792 adverse event reports submitted, 39 568 (95%) were for children younger than 7 years. 38 381 of the reports for children in this age group (97%) were for simultaneous vaccination with IPV and other vaccines (most commonly pneumococcal and acellular pertussis vaccines), whereas standalone IPV vaccines accounted for 0·5% of all reports. 34 880 reports were for non-serious events (88%), 3905 reports were for non-fatal serious events (10%), and 783 reports were death reports (2%). Injection-site erythema was the most commonly coded term for non-serious events (29%), and pyrexia for non-fatal serious events (38%). Most deaths (96%) were in children aged 12 months or younger; most (52%) had sudden infant death syndrome as the reported cause of death. The safely profiles of combined IPV and whole-cell pertussis vaccines, OPV and whole-cell pertussis vaccines, and OPV and acellular pertussis vaccines were similar. We noted no indication of disproportionate reporting of adverse events after immunisation with IPV-containing vaccines compared with other vaccines between 1990 and 2013.
Interpretation
Fairly few adverse events were reported for the more than 250 million IPV doses distributed between 2000 and 2012. Sudden infant death syndrome reports after IPV were consistent with reporting patterns for other vaccines. No new or unexpected vaccine safety problems were identified for fatal, non-fatal serious, and non-serious reports in this assessment of adverse events after IPV.
Funding
None.

MERS—an uncertain future

The Lancet Infectious Diseases
Oct 2015 Volume 15 Number 10 p1115-1242
http://www.thelancet.com/journals/laninf/issue/current

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Editorial
MERS—an uncertain future
The Lancet Infectious Diseases
DOI: http://dx.doi.org/10.1016/S1473-3099(15)00324-2
Summary
Middle East respiratory syndrome (MERS), caused by the MERS coronavirus, has taken something of a back seat to Ebola among emerging diseases, but following the outbreak in South Korea earlier this year and a recent upsurge in cases in Saudi Arabia the disease is again in the limelight. 3 years after MERS was first reported, WHO has recorded 1517 confirmed cases worldwide with 539 deaths, a case fatality rate of 36%. Risk factors for infection include being aged at least 50 years and having an underlying medical condition such as diabetes.

Shifting to Sustainable Development Goals — Implications for Global Health

New England Journal of Medicine
October 8, 2015 Vol. 373 No. 15
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
Shifting to Sustainable Development Goals — Implications for Global Health
Christopher J.L. Murray, M.D., D.Phil.
N Engl J Med 2015; 373:1390-1393
October 8, 2015
DOI: 10.1056/NEJMp1510082
Preview
The Millennium Development Goals have brought remarkable success for global collective action. Unfortunately, the new Sustainable Development Goals are broad, with many aspirational or vague targets, and health does not occupy as central a role as it did in the MDG

Pediatrics – October 2015

Pediatrics
October 2015, VOLUME 136 / ISSUE 4
http://pediatrics.aappublications.org/current.shtml

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Monthly Feature
Treating Children With Cancer Worldwide—Challenges and Interventions
Trijn Israels, Julia Challinor, Scott Howard, and Ramandeep Harman Arora
Pediatrics 2015; 136:607-610
Summary
Although morbidity from childhood cancer is second only to unintentional injuries in high-income countries, in low-income countries, it hardly hits the radar screen compared with death from pneumonia, diarrhea, malaria, neonatal sepsis, preterm birth, and neonatal asphyxia. Nevertheless, the extraordinary progress made in treating childhood cancer in high-income countries brings into harsh focus the mammoth disparities that exist in impoverished areas of the world. As the capacity to diagnose and treat childhood cancer improves in low- and middle-income countries, the ability to improve outcomes for the more common diseases benefits as well. The authors have summarized the issues related to childhood cancer care with thoughtful attention to how children everywhere can gain from the advances in medical science in high-income nations.
Jay E. Berkelhamer
Column Editor

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Febrile Seizures After 2010–2011 Trivalent Inactivated Influenza Vaccine
Alison Tse Kawai, David Martin, Martin Kulldorff, Lingling Li, David V. Cole, Cheryl N. McMahill-Walraven, Nandini Selvam, Mano S. Selvan, and Grace M. Lee
Pediatrics 2015; 136:e848-e855
Abstract
OBJECTIVES: In the Post-Licensure Rapid Immunization Safety Monitoring Program, we examined risk of febrile seizures (FS) after trivalent inactivated influenza vaccine (TIV) and 13-valent pneumococcal conjugate vaccine (PCV13) during the 2010–2011 influenza season, adjusted for concomitant diphtheria tetanus acellular pertussis-containing vaccines (DTaP). Assuming children would receive both vaccines, we examined whether same-day TIV and PCV13 vaccination was associated with greater FS risk when compared with separate-day vaccination.
METHODS: We used a self-controlled risk interval design, comparing the FS rate in a risk interval (0–1 days) versus control interval (14–20 days). Vaccinations were identified in claims and immunization registry data. FS were confirmed with medical records.
RESULTS: No statistically significant TIV-FS associations were found in unadjusted or adjusted models (incidence rate ratio [IRR] adjusted for age, seasonality, and concomitant PCV13 and DTaP: 1.36, 95% confidence interval [CI] 0.78 to 2.39). Adjusted for age and seasonality, PCV13 was significantly associated with FS (IRR 1.74, 95% CI 1.06 to 2.86), but not when further adjusting for concomitant TIV and DTaP (IRR 1.61, 95% CI 0.91 to 2.82). Same-day TIV and PCV13 vaccination was not associated with excess risk of FS when compared with separate-day vaccination (1.08 fewer FS per 100 000 with same day administration, 95% CI −5.68 to 6.09).
CONCLUSIONS: No statistically significant increased risk of FS was found for 2010–2011 TIV or PCV13, when adjusting for concomitant vaccines. Same-day TIV and PCV13 vaccination was not associated with more FS compared with separate-day vaccination.

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Clinical Trial Decisions in Difficult Circumstances: Parental Consent Under Time Pressure
Marijke C. Jansen-van der Weide, Patrina H.Y. Caldwell, Bridget Young, Martine C. de Vries,
Dick L. Willems, William Van’t Hoff, Kerry Woolfall, Johanna H. van der Lee, and Martin Offringa
Pediatrics 2015; 136:e983-e992
Abstract
Treatments and interventions used to care for children in emergencies should be based on strong evidence. Well-designed clinical trials investigating these interventions for children are therefore indispensable. Parental informed consent is a key ethical requirement for the enrollment of children in such studies. However, if time is limited because of an urgent need for intervention, there are additional ethical challenges to adequately support the informed consent process. The acute situation and associated psychological impact may compromise the ability of parents to give informed consent. Little evidence exists to guide the process of consent seeking for a child’s research participation when time is limited. It is also unclear in what circumstances alternatives to prospective informed consent could be applied. This article describes possible options to manage the informed consent process in an appropriate, practical, and, we believe, ethical way when time is limited.

Improved Discrimination of Influenza Forecast Accuracy Using Consecutive Predictions

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 10 October 2015)

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Improved Discrimination of Influenza Forecast Accuracy Using Consecutive Predictions
October 5, 2015 · Research
Introduction: The ability to predict the growth and decline of infectious disease incidence has advanced considerably in recent years. In particular, accurate forecasts of influenza epidemiology have been developed using a number of approaches.
Methods: Within our own group we produce weekly operational real-time forecasts of influenza at the municipal and state level in the U.S. These forecasts are generated using ensemble simulations depicting local influenza transmission dynamics, which have been optimized prior to forecast with observations of influenza incidence and data assimilation methods. The expected accuracy of a given forecast can be inferred in real-time through quantification of the agreement (e.g. the variance) among the ensemble of simulations.
Results: Here we show that forecast expected accuracy can be further discriminated with the additional consideration of the streak or persistence of the forecast—the number of consecutive weeks the forecast has converged to the same outcome.
Discussion: The findings indicate that the use of both the streak and ensemble agreement provides a more detailed and informative assessment of forecast expected accuracy.

Achieving a “Grand Convergence” in Global Health: Modeling the Technical Inputs, Costs, and Impacts from 2016 to 2030

PLoS One
http://www.plosone.org/
[Accessed 10 October 2015]

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Achieving a “Grand Convergence” in Global Health: Modeling the Technical Inputs, Costs, and Impacts from 2016 to 2030
Colin F. Boyle, Carol Levin, Arian Hatefi, Solange Madriz, Nicole Santos
Research Article | published 09 Oct 2015 | PLOS ONE
10.1371/journal.pone.0140092
Abstract
Background
The Commission on Investing in Health published its report, GlobalHealth2035, in 2013, estimating an investment case for a grand convergence in health outcomes globally. In support of the drafting of the Sustainable Development Goals (SDGs), we estimate what the grand convergence investment case might achieve—and what investment would be required—by 2030.
Methods and Findings
Our projection focuses on a sub-set of low-income (LIC) or lower-middle-income countries (LMIC). We start with a country-based (bottom-up) analysis of the costs and impact of scaling up reproductive, maternal, and child health tools, and select HIV and malaria interventions. We then incorporate global (top-down) analyses of the costs and impacts of scaling up existing tools for tuberculosis, additional HIV interventions, the costs to strengthen health systems, and the costs and benefits from scaling up new health interventions over the time horizon of this forecast. These data are then allocated to individual countries to provide an aggregate projection of potential cost and impact at the country level. Finally, incremental costs of R&D for low-income economies and the costs of addressing NTDs are added to provide a global total cost estimate of the investment scenario.
Results
Compared with a constant coverage scenario, there would be more than 60 million deaths averted in LIC and 70 million deaths averted in LMIC between 2016 and 2030. For the years 2015, 2020, 2025, and 2030, the incremental costs of convergence in LIC would be (US billion) $24.3, $21.8, $24.7, and $27, respectively; in LMIC, the incremental costs would be (US billion) $34.75, $38.9, $48.7, and $56.3, respectively.
Conclusion
Key health outcomes in low- and low-middle income countries can significantly converge with those of wealthier countries by 2030, and the notion of a “grand convergence” may serve as a unifying theme for health indicators in the SDGs.

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Seasonal Influenza Vaccination amongst Medical Students: A Social Network Analysis Based on a Cross-Sectional Study
Rhiannon Edge, Joseph Heath, Barry Rowlingson, Thomas J. Keegan, Rachel Isba
Research Article | published 09 Oct 2015 | PLOS ONE
10.1371/journal.pone.0140085

Preventive Medicine (November 2015) :: Special Issue: Behavior change, health, and health disparities

Preventive Medicine
Volume 80, Pages 1-106 (November 2015)
http://www.sciencedirect.com/science/journal/00917435/80
Special Issue: Behavior change, health, and health disparities
Edited by Stephen T. Higgins

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Editorial: 2nd Special Issue on behavior change, health, and health disparities
Pages 1-4
Stephen T. Higgins
Abstract
This Special Issue of Preventive Medicine (PM) is the 2nd that we have organized on behavior change, health, and health disparities. This is a topic of fundamental importance to improving population health in the U.S. and other industrialized countries that are trying to more effectively manage chronic health conditions. There is broad scientific consensus that personal behavior patterns such as cigarette smoking, other substance abuse, and physical inactivity/obesity are among the most important modifiable causes of chronic disease and its adverse impacts on population health. As such behavior change needs to be a key component of improving population health. There is also broad agreement that while these problems extend across socioeconomic strata, they are overrepresented among more economically disadvantaged populations and contribute directly to the growing problem of health disparities. Hence, behavior change represents an essential step in curtailing that unsettling problem as well. In this 2nd Special Issue, we devote considerable space to the current U.S. prescription opioid addiction epidemic, a crisis that was not addressed in the prior Special Issue. We also continue to devote attention to the two largest contributors to preventable disease and premature death, cigarette smoking and physical inactivity/obesity as well as risks of co-occurrence of these unhealthy behavior patterns. Across each of these topics we included contributions from highly accomplished policy makers and scientists to acquaint readers with recent accomplishments as well as remaining knowledge gaps and challenges to effectively managing these important chronic health problems.

Cell Membrane-Coated Nanoparticles As an Emerging Antibacterial Vaccine Platform

Vaccines — Open Access Journal
http://www.mdpi.com/journal/vaccines
(Accessed 10 October 2015)

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Review:
Cell Membrane-Coated Nanoparticles As an Emerging Antibacterial Vaccine Platform
by Pavimol Angsantikul, Soracha Thamphiwatana, Weiwei Gao and Liangfang Zhang
Vaccines 2015, 3(4), 814-828; doi:10.3390/vaccines3040814 – published 6 October 2015
Abstract:
Nanoparticles have demonstrated unique advantages in enhancing immunotherapy potency and have drawn increasing interest in developing safe and effective vaccine formulations. Recent technological advancement has led to the discovery and development of cell membrane-coated nanoparticles, which combine the rich functionalities of cellular membranes and the engineering flexibility of synthetic nanomaterials. This new class of biomimetic nanoparticles has inspired novel vaccine design strategies with strong potential for modulating antibacterial immunity. This article will review recent progress on using cell membrane-coated nanoparticles for antibacterial vaccination. Specifically, two major development strategies will be discussed, namely (i) vaccination against virulence factors through bacterial toxin sequestration; and (ii) vaccination against pathogens through mimicking bacterial antigen presentation.

Using Behavioral Insights to Increase Vaccination Policy Effectiveness

Policy Insights from the Behavioral and Brain Sciences
October 2015 vol. 2 no. 1 61-73

Using Behavioral Insights to Increase Vaccination Policy Effectiveness
Cornelia Betsch1, Robert Böhm2, Gretchen B. Chapman3
1University of Erfurt, Germany
2RWTH Aachen University, Germany
3Rutgers University, Piscataway, NJ, USA
Cornelia Betsch, Department of Psychology and Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Nordhäuser Str. 63, 99089 Erfurt, Germany. Email: cornelia.betsch@uni-erfurt.de
Abstract
Even though there are policies in place, and safe and effective vaccines available, almost every country struggles with vaccine hesitancy, that is, a delay in acceptance or refusal of vaccination. Consequently, it is important to understand the determinants of individual vaccination decisions to establish effective strategies to support the success of country-specific public health policies. Vaccine refusal can result from complacency, inconvenience, a lack of confidence, and a rational calculation of pros and cons. Interventions should, therefore, be carefully targeted to focus on the reason for non-vaccination. We suggest that there are several interventions that may be effective for complacent, convenient, and calculating individuals whereas interventions that might be effective for those who lack confidence are scarce. Thus, efforts should be concentrated on motivating the complacent, removing barriers for those for whom vaccination is inconvenient, and adding incentives and additional utility for the calculating. These strategies might be more promising, economic, and effective than convincing those who lack confidence in vaccination.

Clinical development of RTS, S/AS malaria vaccine: a systematic review of clinical Phase I-III trials

Future Microbiology
Posted online on October 6, 2015.
(doi:10.2217/fmb.15.90)
Clinical development of RTS, S/AS malaria vaccine: a systematic review of clinical Phase I-III trials
Selidji T Agnandji*,1,2, José F Fernandes1,2, Emmanuel B Bache1,2 & Michael Ramharter1,2,3
Summary
The first clinical Phase III trial evaluating a malaria vaccine was completed in December 2013 at 11 sites from seven sub-Saharan African countries. This systematic review assesses data of Phase I–III trials including malaria-naive adults and adults, children and infants from malaria endemic settings in sub-Saharan Africa. The main endpoint of this systematic review was an analysis of the consistency of efficacy and immunogenicity data from respective Phase I–III trials. In addition, safety data from a pooled analysis of RTS/AS Phase II trials and RTS,S/AS01 Phase III trial were reviewed. The RTS,S/AS01 malaria vaccine may become available on the market in the coming year. If so, further strategies should address challenges on how to optimize vaccine efficacy and implementation of RTS,S/AS01 vaccine within the framework of established malaria control measures.

Immunogenicity and Safety of Intradermal Influenza Vaccine in the Elderly: A Meta-Analysis of Randomized Controlled Trials

Drugs & Aging
First online: 06 October 2015
Immunogenicity and Safety of Intradermal Influenza Vaccine in the Elderly: A Meta-Analysis of Randomized Controlled Trials
Claudia Pileggi, Valentina Mascaro, Aida Bianco, Carmelo G. A. Nobile, Maria Pavia
Abstract
Introduction
Immunosenescence makes the elderly more susceptible to influenza complications and less responsive to vaccination. An intradermal formulation (IDflu) is one of several strategies being investigated to increase the immunogenicity of influenza vaccines.
Objective
The overall goal of the study was to assess the safety and immunogenicity of IDflu compared with the intramuscular route (IMflu) in the elderly.
Methods
A meta-analysis of randomized controlled trials (RCTs) was performed. Included articles met the following criteria: RCTs; primary studies, not re-analyses or reviews; enrolment of elderly people; comparing the immunogenicity and/or safety of IDflu with IMflu; measuring seroprotection and/or seroconversion rate to assess immunogenicity; measuring local reactions and/or general symptoms and/or other mild local reactions that could affect acceptability of vaccine as safety indicators, according to the European Medicines Agency (EMA) criteria; published through January 2015.
Results
The results of our meta-analysis on seroprotection showed that IDflu is comparable to IMflu for each strain (A/H1N1: risk ratio [RR] 1.02, 95 % confidence interval [CI] 0.98–1.07; A/H3N2: RR 1.01, 95 % CI 0.99–1.04; B 1.02, 95 % CI 0.98–1.08). The seroconversion rate achieved with IDflu was comparable to that of the control group (A/H1N1: RR 1.08, 95 % CI 0.97–1.2; A/H3N2: RR 1.08, 95 % CI 0.96–1.21; B: RR 1.21, 95 % CI 1–1.45). Systemic reactogenicity appeared similar in the two groups, while local reactions were significantly more frequent in the IDflu group.
Conclusions
The novel IDflu appears to have the adequate balance between immunogenicity and safety in the elderly compared with IMflu, and its utilization may be considered among the possible strategies to enhance the control of seasonal influenza outbreaks according to the existing policy recommendations in the elderly.

Viral and parasitic diseases are not only worth killing off, they are also increasingly vulnerable

The Economist
http://www.economist.com/
Accessed 10 October 2015

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Viruses and parasites
Eradicating disease
Viral and parasitic diseases are not only worth killing off, they are also increasingly vulnerable
Oct 10th 2015 | From the print edition
TO EXTERMINATE a living species by accident is normally frowned on. To do so deliberately might thus seem an extraordinary sin. But if that species is Plasmodium falciparum, the sin may be excused. This parasitic organism causes the most deadly form of malaria. Together with four cousins, it is responsible for about 450,000 deaths a year, and the ruination of the lives of millions more people who survive the initial crisis of disease. Besides the direct suffering this causes, the lost human potential is enormous. The Gates Foundation, an American charity, reckons that eradicating malaria would bring the world $2 trillion of benefits by 2040.

Malaria is one of the worst examples of the damage that transmissible diseases can wreak. But it is not alone. AIDS carries off fit, young adults by the millions and tuberculosis by the hundreds of thousands. Measles, whooping cough and diarrhoea together kill over 1m children a year. Parasitic worms and mosquito-borne viruses like dengue, though they take relatively few lives, debilitate many.

Campaigns have brought the toll down heroically. As recently as 2000, malaria killed around 850,000 people a year; likewise, since 2000 deaths from measles have fallen by 75%, to around 150,000. These successes are to be celebrated, but an even greater prize exists: to go beyond controlling infections and infestations and instead to eradicate some of them completely, by exterminating the pathogens and parasites that cause them. That has been accomplished a couple of times in the past, for smallpox (a human disease) and rinderpest (a cattle disease similar to measles). The end is reckoned to be close for polio (a virus that once killed and crippled millions) and dracunculiasis (a parasitic worm). But more must follow.

Swat teams
Some diseases are not suitable for eradication because the organisms that cause them hang around in the environment, or have other animal hosts. Others, such as tuberculosis, can infect people “silently”, without causing symptoms, so are invisible to doctors. But sometimes the culprit is a poverty of ambition. A list of five plausible targets—measles, mumps, rubella, filariasis and pork tapeworm—has hardly changed since the early 1990s, yet measles, mumps and rubella are all the subjects of intensive vaccination campaigns that could easily be converted into ones of eradication. And even though Swaziland is poised to become the first malaria-free country in sub-Saharan Africa (see article), only a few dare to make explicit the goal of ridding the planet of the disease. Hepatitis C should be made a target, too. It kills half a million a year, and affects rich and poor countries alike, yet new drugs against it are almost 100% effective and there are no silent carriers. Eradicating these seven diseases—the five, plus malaria and hepatitis C—would save a yearly total of 1.2m lives. It would transform countless more.

People argue that the cost of chasing down the last few cases of a disease is not worth it. If the mass-vaccination campaigns under way can lower the incidence of measles, mumps, rubella and so on in poor countries to something close to rich-world levels, the argument goes, that is surely good enough.
Well, it isn’t. A disease can bounce back. That is what malaria did in the 1960s, when political attention waned, and the parasites that cause it evolved resistance to drugs and the mosquitoes that spread it evolved resistance to insecticides.
Three big improvements underpin the argument for throwing eradication’s net more widely. The first is better communications. The technology for locating and monitoring cases of disease in poor countries, even when few and far between, has improved immeasurably in the past two decades with the spread of mobile phones and the internet, and the expansion of road networks.
The second is better medical technology. The reason filariasis is on the “possibles” list, for example, is the invention of ivermectin, a drug that kills the worm which causes it. The inventors of this drug won half of this year’s Nobel prize for medicine (see article). The other half was won by the woman who came up with an answer to drug resistance in malaria—a medicine called artemisinin, which has been crucial to the success of the recent push against the disease. (This time, alert to the risk of resistance, doctors have formulated it with other drugs to create combination therapies that natural selection finds hard to get around.)

Even better technology is in the pipeline. In the case of mosquito-borne illnesses such as malaria and dengue, genetic engineering promises ways of making the insects resistant to the pathogens that they pass on to people, of crashing the mosquito population, and even of attacking insects and pathogens with genetically modified fungi and bacteria. Genetic engineering also promises a wide range of new vaccines.

The third reason for seeking eradication is a change in political attitudes. The emergence of AIDS, in particular, made governments everywhere sit up and take notice. Last year’s west African outbreak of Ebola only reinforced the message. Political attention leads to better medical infrastructure. To deal with AIDS, new networks of clinics were created and staffed with trained personnel. These can serve as the backbone of the campaigns that would be the starting-point for many extermination programmes.

The Dalek doctrine
The list of candidates for such programmes should be extended as and when circumstances change. The biggest prize might be AIDS itself. Smallpox, the first target for eradication, was picked in part because the virus that caused it had only humans as hosts and could not survive independently for more than a few hours. It had, in other words, no hiding place. Both of these are true of HIV, the AIDS-causing virus. What is missing is the third ingredient for smallpox: a reliable vaccine.

Throughout history, humans and disease have waged a deadly and never-ending war. Today the casualties are chiefly the world’s poorest people. But victory against some of the worst killers is at last within grasp. Seize it.

Vaccines and Global Health: The Week in Review 3 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_3 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.
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Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.

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

Vaccines and Global Health: The Week in Review 26 September 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_26 September 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

Vaccines and Global Health: The Week in Review 19 September 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_19 September 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 19 September 2015]

EBOLA/EVD [to 19 September 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

Ebola Situation Report – 16 September 2015
[Excerpts]
SUMMARY
:: There were 5 confirmed cases of Ebola virus disease (EVD) reported in the week to 13 September, all of which were in Sierra Leone. Guinea recorded its first EVD-free week in over 12 months. All but one of the cases in Sierra Leone were registered contacts associated with the Kambia chain of transmission. A new confirmed case was also reported from the central Sierra Leonean district of Bombali, which has not reported a case for over 5 months. The case, a 16-year-old girl, had severe symptoms in the community for several days before being admitted to an Ebola treatment centre (ETC). There is considered to be a high-risk of further transmission associated with this case, and over 600 contacts have been identified so far. A rapid-response team has been deployed in order to minimise the risk of further transmission and establish the origin of infection. The total number of contacts under observation in Guinea and Sierra Leone has increased from approximately 1300 on 6 September to 1800 on 13 September. The vast majority of these contacts are located in the Sierra Leonean districts of Bombali and Kambia. Approximately 60 contacts are considered to be high-risk.

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Ebola response phase 3: Framework for achieving and sustaining a resilient zero
WHO
September 2015 :: 17 pages
Downloads: Ebola response phase 3: Framework for achieving and sustaining a resilient zero pdf, 1.46
Overview
The purpose of the Ebola response Phase 3 framework is to incorporate new knowledge and tools into the ongoing Ebola response and recovery work to achieve and sustain a “resilient zero”. Phase 3 of the response builds upon the rapid scale-up of treatment beds, safe and dignified burial teams, and behaviour change capacities during Phase 1 (August-December 2014); and the enhanced capacities for case finding, contract tracing, and community engagement during Phase 2 (January-July 2015). This framework incorporates new developments and breakthroughs in Ebola control, from vaccines, diagnostics and response operations to survivor counselling and care.
Phase 3 objectives: Objective 1 – To accurately define and rapidly interrupt all remaining chains of Ebola transmission. Objective 2 – To identify, manage and respond to the consequences of residual Ebola risks.
The chapters include:
:: Context for the outbreak and descriptions of Objectives 1 and 2
:: Risks to the implementation of Phase 3
:: Priorities to operationalize Phase 3
:: Phase 3 and early recovery
:: Key timelines & milestones for Phase 3.

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Rapid response to new Ebola infection in Bombali, Sierra Leone
16 September 2015

Johnson & Johnson Announces BARDA Funding Award to Accelerate Ebola Vaccine Program

Johnson & Johnson Announces BARDA Funding Award to Accelerate Ebola Vaccine Program
Prime-boost vaccine regimen in development at the Janssen Pharmaceutical Companies currently in Phase I and II clinical studies in Europe, U.S. and Africa

NEW BRUNSWICK, N.J., – September 14, 2015 – Johnson & Johnson (NYSE: JNJ) announced today that Crucell Holland B.V., one of its Janssen Pharmaceutical Companies, has been awarded $28.5 million from The Biomedical Advanced Research and Development Authority (BARDA), part of the U.S. Department of Health and Human Services, to help accelerate the development of its investigational Ebola prime-boost vaccine regimen. The regimen, which is currently being tested in clinical studies, uses a combination of two components based on AdVac technology from Crucell Holland B.V. and MVA-BN® technology from Bavarian Nordic.

The agreement involves a 5-year commitment, with options for an additional $40.5 million funding, to optimize manufacturing systems and capacity for the vaccine regimen, including technology transfers to large-scale production facilities, heat-stability studies to verify that the regimen is optimized for use in African countries, and final product manufacturing and quality control activities.

“We are committed to finding a way to support the fight to get to and stay at zero Ebola cases worldwide,” said Paul Stoffels, M.D., Chief Scientific Officer and Worldwide Chairman, Pharmaceuticals, Johnson & Johnson. “Future outbreaks are a real danger, and we need to be prepared for them. This BARDA investment in our prime-boost vaccine approach will help us to further develop and potentially deliver a vaccine with both short and long-term protection.”

Phase I clinical studies of the prime-boost vaccine regimen began in the United Kingdom and United States in December 2014, followed by several sites in Africa. A Phase II study, to be carried out in the U.K. and France, started in July 2015, and plans are well advanced for the commencement of a safety and immunogenicity study in Sierra Leone and additional phase II studies outside the outbreak area in Africa. While clinical studies continue, BARDA will focus on supporting manufacturing development of the regimen’s prime and boost components.

Prime-boost vaccine regimens involve an initial dose that primes the immune system to develop disease-specific antibodies, followed by a booster dose at a later date that can strengthen and optimize the duration of the immune response. A number of widely used vaccines use a multi-dose approach to create stronger and longer-lasting immunity, including some for polio, rotavirus and HPV.

Janssen, in partnership with Bavarian Nordic, has produced drug supply for more than 800,000 regimens and is set-up to be able to produce a total of 2 million regimens of the Ebola vaccine regimen during the course of 2015.

To date, there is no licensed vaccine, treatment or cure for the Ebola virus. The Ebola outbreak in West Africa has put the health care systems of Liberia, Sierra Leone and Guinea under tremendous pressure. As of September 2015, after more than one year of this sustained Ebola outbreak, over 28,100 people have been infected with the virus across the three countries, and over 11,300 have died – including more than 500 healthcare workers. Although the outbreak has been brought under control in recent months, it could easily resurge and preparedness for future outbreaks is essential.

POLIO [to 19 September 2015]

POLIO [to 19 September 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 16 September 2015
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: Pakistan launched a nationwide polio campaign this week to vaccinate more than 35 million children in 163 districts of the country. Approximately 200,000 polio workers are participating in the polio campaign, during which Vitamin A will also be distributed. More
:: As progress continues to be made towards polio eradication, surveillance is increasingly one of the most important things the programme can do to protect children against every last poliovirus. Read more about how surveillance works here.
:: The Global Polio Eradication Initiative is proud to partner with the Global Citizen Festival on 26 September, featuring Beyonce, Ed Sheeran, Pearl Jam and other headliners to help fight extreme poverty and inequality around the world, and support approaches that will make life more sustainable for people and the planet.

Selected Country Report Content
Pakistan
:: Two new wild poliovirus type 1 (WPV1) cases were confirmed in the past week in Khyber Agency in the Federally Administered Tribal Areas. The most recent case had onset of paralysis on 22 August. The total number of WPV1 cases for 2015 is now 32, compared to 145 at this time last year.

WHO & Regionals [to 19 September 2015]

WHO & Regionals [to 19 September 2015]
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Addressing noncommunicable diseases in emergencies
16 September 2015 — Due to ongoing humanitarian crisis in Ukraine people struggle to receive treatment for noncommunicable diseases (NCDs) such as cancer, lung and heart disease and diabetes. Working closely with the Ukrainian Ministry of Health and partners, WHO provides emergency kits with training materials to treat these diseases in the field.

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The Weekly Epidemiological Record (WER) 18 September 2015, vol. 90, 38 (pp. 489–504) includes:
:: Global programme to eliminate lymphatic filariasis: progress report, 2014

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Global Alert and Response (GAR) – Disease Outbreak News (DONs)
:: 18 September 2015 – Middle East Respiratory Syndrome coronavirus (MERS-CoV) – Jordan
:: 17 September 2015 – Chikungunya – Spain (update)
:: 17 September 2015 – West Nile virus – Portugal
:: 17 September 2015 – Middle East Respiratory Syndrome coronavirus (MERS-CoV) – Saudi Arabia
:: 14 September 2015 – Chikungunya – Senegal

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:: WHO Regional Offices
WHO African Region AFRO
No new digest content identified.

WHO Region of the Americas PAHO
:: PAHO/WHO and U.S. National Park Service partner to connect people to parks for better health (09/18/2015)
Countries of the Americas agree to step up action toward rabies elimination (09/17/2015)
Wellness Week in the Americas, Sept. 12-19, will focus on “Healthy Parks, Healthy People” (09/14/2015)

WHO South-East Asia Region SEARO
:: Regional Committee adopts resolution on cancer prevention, control
WHO Regional Committee meeting, which ended on 11 September, adopted six resolutions on priority areas. The countries resolved to strengthen cancer prevention and control programme, tobacco control, preparedness to respond to emergencies and outbreaks, anti-microbial resistance, community based health services and patient safety for sustainable Universal Health Coverage. Press Release

WHO European Region EURO
:: Day 4 highlights: RC65 adopts new tuberculosis action plan and closes 17-09-2015
:: Refugee crisis in Europe: update on the situation and WHO response 17-09-2015
Vilnius and Copenhagen, 14 September 2015
In response to the growing numbers of refugees and migrants arriving in the European Region, WHO supports countries by offering medical supplies, assessing national preparedness to assist people in need, training personnel at points of entry in public health and migration matters, and providing information materials.
Senior government officials of the 53 Member States in the WHO European Region discussed the public health impact of large-scale migration during the 65th session of the Regional Committee for Europe in Vilnius, Lithuania. They called for continued involvement and support from WHO to respond adequately to the public health implications of large influxes of people by conducting additional assessments in countries and by providing policy advice on contingency planning, training of health personnel and delivery of supplies. It was decided that a high-level WHO conference would be organized as soon as possible to agree on a common public health approach to large-scale migration in the Region.
“As refugee and migration movements escalate and the migratory routes change, more European countries face this challenge,” said Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “Today more than ever, this situation calls for a regional, comprehensive and systematic public health response. As refugees and migrants move, intercountry coordination must be strengthened across the European Region, as well as with the countries of origin and transit.”…
:: Day 3 highlights: adoption of strategy on physical activity and roadmap for tobacco control 16-09-2015
:: WHO European Region Member States commit to denormalizing tobacco 16-09-2015
:: European ministers of health adopt strategy to tackle physical inactivity in 53 WHO Member States 16-09-2015
:: European countries review progress and synergize efforts for control of vaccine-preventable diseases
14-09-2015
Three days of discussion and sharing of experience among national immunization programme managers, WHO, partners and international experts on 1–3 September 2015 brought into full focus the challenges facing the European Region in the area of immunization and progress towards implementation of the European Vaccine Action Plan at national level. Over 130 delegates from 47 Member States of the European Region gathered in Antwerp, Belgium, to discuss remaining barriers to full immunization in Europe and the actions needed to achieve regional goals, such as elimination of measles and rubella and maintenance of the Region’s polio-free status.
“The European Vaccine Action Plan (EVAP) embodies regional commitment to immunization, and this meeting offers immunization programme managers the chance to voice their opinions and experience, interact with each other and WHO staff and work together to translate EVAP strategies into national priorities and actions,” said Dr Pierre van Damme, Professor of Vaccinology at the University of Antwerp and chair of the European Technical Advisory Group of Experts on Immunizaton (ETAGE), with reference to the interactive approach taken at the meeting. The format included included panels, small group discussion and question-and-answer sessions….

WHO Eastern Mediterranean Region EMRO
:: Malaria MDG target achieved amid sharp drop in cases and mortality, but 3 billion people remain at risk 17 September 2015
:: Improving the health of women, children and adolescents 14 September

WHO Western Pacific Region
:: UN: Progress made but more to be done to ensure all children are born free of HIV & syphilis in Asia-Pacific
BANGKOK, 14 September 2015 – The Asia–Pacific region has made significant progress in efforts to eliminate the transmission of HIV and syphilis, but thousands of mothers and children have yet to feel the benefits. Addressing this gap will be a key area for discussion at the 10th Asia-Pacific United Nations Parent-to-Child Transmission of HIV and Syphilis Task Force meeting in Beijing, China, this week. Read the joint news release

CDC/MMWR/ACIP Watch [to 19 September 2015]

CDC/MMWR/ACIP Watch [to 19 September 2015]
http://www.cdc.gov/media/index.html

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Enhanced Airport Entry Screening To End for Travelers from Liberia to the United States
FRIDAY, SEPTEMBER 18, 2015
On September 21, 2015, the Centers for Disease Control and Prevention (CDC) and the Department of Homeland Security (DHS) will remove Liberia from the list of nations affected by Ebola…

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MMWR September 18, 2015 / Vol. 64 / No. 36
:: Influenza Vaccination Coverage Among Health Care Personnel — United States, 2014–15 Influenza Season
The Advisory Committee on Immunization Practices recommends annual influenza vaccination for all health care personnel (HCP) to reduce influenza-related morbidity and mortality among both HCP and their patients and to decrease absenteeism among HCP (1–5). To estimate influenza vaccination coverage among U.S. HCP for the 2014–15 influenza season, CDC conducted an opt-in Internet panel survey of 1,914 HCP during March 31–April 15, 2015. Overall, 77.3% of HCP survey participants reported receiving an influenza vaccination during the 2014–15 season, similar to the 75.2% coverage among HCP reported for the 2013–14 season (6). Vaccination coverage was highest among HCP working in hospitals (90.4%) and lowest among HCP working in long-term care (LTC) settings (63.9%). By occupation, coverage was highest among pharmacists (95.3%) and lowest among assistants and aides (64.4%). Influenza vaccination coverage was highest among HCP who were required by their employer to be vaccinated (96.0%). Among HCP without an employer requirement for vaccination, coverage was higher for HCP working in settings where vaccination was offered on-site at no cost for 1 day (73.6%) or multiple days (83.9%) and lowest among HCP working in settings where vaccine was neither required, promoted, nor offered on-site (44.0%). Comprehensive vaccination strategies that include making vaccine available at no cost at the workplace along with active promotion of vaccination might help increase vaccination coverage among HCP and reduce the risk for influenza to HCP and their patients (1,6,7).

:: Influenza Vaccination Coverage Among Pregnant Women — United States, 2014–15 Influenza Season
:: Clinical Inquiries Received by CDC Regarding Suspected Ebola Virus Disease in Children — United States, July 9, 2014–January 4, 2015
:: Update: Influenza Activity — United States and Worldwide, May 24–September 5, 2015
:: Announcement: Available Online: Final 2014–15 Influenza Vaccination Coverage Estimates for Selected Local Areas, States, and the United States

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ACIP Meeting – October 21, 2015 [one-day meeting]
October 21, 2015[2 pages] Draft Agenda – September 9, 2015

NFID Announces Recipients of Prestigious 2016 Awards

NFID Announces Recipients of Prestigious 2016 Awards
Bethesda, MD (September 8, 2015) – The National Foundation for Infectious Diseases (NFID) has selected Robert E. Black, MD, MPH as recipient of the 2016 Jimmy and Rosalynn Carter Humanitarian Award, Diane E. Griffin, MD, PhD as recipient of the 2016 Maxwell Finland Award for Scientific Achievement and Larry K. Pickering, MD as recipient of the 2016 John P. Utz Leadership Award.

In recognition of his contributions as a world leading public health scientist and his lifetime contribution to improving the health of children in the developing world. NFID has selected Robert E. Black, MD, MPH to receive the 2016 Jimmy and Rosalynn Carter Humanitarian Award…

…Larry K. Pickering, MD has been selected to receive the 2016 John P. Utz Leadership Award in recognition of his outstanding leadership skills demonstrated at the Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases and the Advisory Committee on Immunization Practices (ACIP), as well as key leadership roles at NFID.

The award was established in honor of the late John P. Utz, MD, one of NFID’s original founders.

UN-Habitat and UNAIDS call for renewed efforts to address HIV in urban areas

UNAIDS [to 19 September 2015]
http://www.unaids.org/en/resources/presscentre/

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UN-Habitat and UNAIDS call for renewed efforts to address HIV in urban areas
NAIROBI/GENEVA, 18 September 2015—A new report by UN-Habitat and UNAIDS urges cities to do more to respond to HIV epidemics in urban areas. The report outlines that cities and urban areas are particularly affected by HIV, with the 200 cities most affected by the epidemic estimated to account for more than a quarter of all people living with HIV around the world.

The report, Ending the urban AIDS epidemic, was launched in Nairobi, Kenya, by the Executive Director of UN-Habitat, Joan Clos, and the Executive Director of UNAIDS, Michel Sidibé. It reveals that in many countries, rapidly growing cities are home to more than half of all people living with HIV and that many are facing challenges in ensuring access to HIV services.

“Although cities often have resources, viable health systems and the capacity for innovation and service delivery, they sometimes struggle to design and implement focused, effective and rights-based AIDS responses, often leaving behind the most vulnerable and marginalized populations,” said Mr Clos. “Cities are central to bringing a paradigm shift to the AIDS response—a concerted move towards shared responsibility between national and city authorities and community-based organizations in support of local leadership and local evidence to transform the social, political and economic determinants of HIV risk and vulnerability.”

The report highlights that city leaders have a unique opportunity to seize the dynamism, innovation and transformative force of the AIDS response to not only expand HIV services in cities but also address other urban challenges, including social exclusion, inequality and extreme poverty.

“Cities can lead change,” said Mr Sidibé. “As centres for innovation, cities can broker broad partnerships and use their vast resources to provide an inclusive, effective response to HIV based on evidence and grounded in human rights—to leave no one behind.”

In almost half (94) of the 200 cities most affected, HIV is transmitted mainly through unprotected heterosexual sex. In the remaining 106 cities, sex work, unprotected sex between men and injecting drug use are the main drivers of the epidemics. In the Asia–Pacific region, about 25% of all people living with HIV are estimated to reside in 31 major cities, while in western and central Europe, an estimated 60% of all people living with HIV reside in just 20 cities.

According to the new report, data from 30 countries that have conducted nationally representative household-based population surveys show that HIV prevalence among people 15–49 years old living in urban areas is higher than among those living in rural areas in most countries.

Even in countries that are still predominantly rural, cities are often home to disproportionate numbers of people living with HIV. For example, urban areas account for only 18% of Ethiopia’s population but for almost 60% of people living with HIV nationally.

The report outlines the need for cities to establish renewed efforts for an urban health approach that serves the evolving needs of cities and the people who live and work within them. It adds that these measures would help reach the UNAIDS Fast-Track Targets to end the AIDS epidemic as a global health threat by 2030.
The UNAIDS Fast-Track approach requires rapidly scaling up and focusing the implementation and delivery of proven, high-impact HIV prevention and treatment services: an approach that increasingly relies on urban leadership.

A number of countries have introduced specific legislation, national policies or strategies to respond to the needs of people living with and affected by HIV. However many countries continue to lag behind in allocating adequate resources and implementing inclusive and urban-friendly HIV programmes.

Progress made but more to be done to ensure all children are born free of HIV & syphilis in Asia-Pacific: UN

UNICEF [to 19 September 2015]
http://www.unicef.org/media/media_78364.html

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Progress made but more to be done to ensure all children are born free of HIV & syphilis in Asia-Pacific: UN
BANGKOK, Thailand, 14 September 2015 – The Asia–Pacific region has made significant progress in efforts to eliminate HIV and syphilis, but thousands of mothers and children have yet to feel the benefits.

NIH framework points the way forward for building national, large-scale research cohort, a key component of the President’s Precision Medicine Initiative

NIH [to 19 September 2015]
http://www.nih.gov/news/releases.htm

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NIH framework points the way forward for building national, large-scale research cohort, a key component of the President’s Precision Medicine Initiative
September 17, 2015 — Effort is a key component of the President’s Precision Medicine Initiative.

MDG Gap Task Force Report 2015: Taking Stock of the Global Partnership for Development

MDG Gap Task Force Report 2015: Taking Stock of the Global Partnership for Development
18 September 2015 :: 92 pages
ISBN: 978-92-1-101317-7
Pdf – Full report/English: http://www.un.org/en/development/desa/policy/mdg_gap/mdg_gap2015/2015GAP_FULLREPORT_EN.pdf
Overview
The 2015 Report continues to monitor the five core domains of the Global Partnership for Development, namely, official development assistance (ODA), market access (trade), debt sustainability, access to affordable essential medicines and access to new technologies, as prescribed by MDG 8. This year marks the last of the series of this monitoring process with a closing report tracking 15 years of the global partnership for development. As has been reported throughout the monitoring process, there have been significant positive developments pointing to an effective international partnership in the five domains, but several deficits in development cooperation have continuously highlighted the need for a rejuvenation of the global partnership for development.

The report finds that ODA increased substantially over the MDG period, although ODA to LDCs has declined in recent years. Additionally, global trade of goods and services expanded significantly over the last fifteen years to more than USD20 trillion, with improved levels of participation by developing countries. However, a key challenge of MDG 8 has been the failure of the international community to conclude the Doha Development Round after 13 years of negotiation. This failure has had ramifications for the potential of trade as an enabler of economic growth and development.

Debt relief initiatives have alleviated debt burdens of many developing countries, but the need for enhanced policies towards debt crisis prevention and resolution remains to address the concerns of other vulnerable countries whose debt problems remain unresolved.

Monitoring studies on access to affordable essential medicines have repeatedly shown that, in general, access remains insufficient and, in particular, that generic medicines are significantly less available in public health facilities than in private health facilities.

Finally, the report notes that access to new technologies, in particular information and communication technologies has grown tremendously since 2000 but these impressive gains observed during the MDG era continue to be marred by a digital divide between developed and developing countries.

WHO/UNICEF report: Malaria MDG target achieved amid sharp drop in cases and mortality, but 3 billion people remain at risk

WHO/UNICEF report: Malaria MDG target achieved amid sharp drop in cases and mortality, but 3 billion people remain at risk
Joint WHO/UNICEF news release
17 September 2015 ¦ London – Malaria death rates have plunged by 60% since 2000, translating into 6.2 million lives saved, the vast majority of them children, according to a joint WHO-UNICEF report released today.

The report – “Achieving the malaria MDG target” – shows that the malaria MDG target to “have halted and begun to reverse the incidence” of malaria by 2015, has been met “convincingly”, with new malaria cases dropping by 37% in 15 years.

“Global malaria control is one of the great public health success stories of the past 15 years,” said Dr. Margaret Chan, Director-General of WHO. “It’s a sign that our strategies are on target, and that we can beat this ancient killer, which still claims hundreds of thousands of lives, mostly children, each year.”

An increasing number of countries are on the verge of eliminating malaria. In 2014, 13 countries reported zero cases of the disease and 6 countries reported fewer than 10 cases. The fastest decreases were seen in the Caucasus and Central Asia, which reported zero cases in 2014, and in Eastern Asia.

Journey not over
Despite tremendous progress, malaria remains an acute public health problem in many regions. In 2015 alone, there were an estimated 214 million new cases of malaria, and approximately 438 000 people died of this preventable and treatable disease. About 3.2 billion people – almost half of the world’s population – are at risk of malaria.
Some countries continue to carry a disproportionately high share of the global malaria burden. Fifteen countries, mainly in sub-Saharan Africa, accounted for 80% of malaria cases and 78% of deaths globally in 2015.

Children under 5 account for more than two-thirds of all deaths associated with malaria. Between 2000 and 2015, the under 5 malaria death rate fell by 65% or an estimated 5.9 million child lives saved.

“Malaria kills mostly young children, especially those living in the poorest and most remote places. So the best way to celebrate global progress in the fight against it is to recommit ourselves to reaching and treating them,” said UNICEF Executive Director Anthony Lake. “We know how to prevent and treat malaria. Since we can do it, we must.”

A surge in funding – but not enough
Global bi-lateral and multi-lateral funding for malaria has increased 20-fold since 2000. Domestic investments within malaria-affected countries have also increased year by year.
A number of donor governments have made the fight against malaria a high global health priority. In the United States of America, the President’s Malaria Initiative has mobilized hundreds of millions of dollars for treatment and prevention, while the government of the United Kingdom tripled its funding for malaria control between 2008 and 2015.

Many governments have also channeled their investments through the Global Fund to Fight AIDS, Tuberculosis and Malaria, or directly to countries.

“A healthy, prosperous world is in all our interests and the prevention of deadly diseases is one of the smartest investments we can make.” said the Rt. Hon. Justine Greening, Secretary of State for International Development of the United Kingdom. “That is why, working with malaria-affected countries and partners like the Global Fund, Britain will continue to provide bednets to millions, tackle resistance to life saving medicines and insecticides, and boost health systems across Africa to help bring an end to this terrible disease.”

The surge in funding has led to an unprecedented expansion in the delivery of core interventions across sub-Saharan Africa. Since 2000, approximately 1 billion insecticide-treated bednets (ITNs) have been distributed in Africa. The increased use of rapid diagnostic tests (RDTs) has made it easier to distinguish between malarial and non-malarial fevers, enabling timely and appropriate treatment. Artemisinin-based combination therapies (ACTs) are highly effective against Plasmodium falciparum, the most prevalent and lethal malaria parasite affecting humans, but drug resistance is a looming threat which must be prevented.
New research demonstrates the impact of core interventions

New research from the Malaria Atlas Project – a WHO Collaborating Centre based at the University of Oxford – shows that ITNs have been by “far the most important intervention” across Africa, accounting for an estimated 68% of malaria cases prevented since 2000. ACTs and indoor residual spraying contributed to 22% and 10% of cases prevented, respectively. The research, published yesterday in the journal Nature, provides strong support for increasing access to these core interventions in post-2015 malaria control strategies.

The way forward
In May 2015, the World Health Assembly adopted the WHO Global Technical Strategy for Malaria – a new 15-year road map for malaria control. The strategy aims at a further 90% reduction in global malaria incidence and mortality by 2030.

The WHO-UNICEF report notes that these targets can only be achieved with political will, country leadership and significantly increased investment. Annual funding for malaria will need to triple – from US$ 2.7 billion today to US$ 8.7 billion in 2030.

Other key findings from the report
:: In 2015, 89% of all malaria cases and 91% of deaths were in sub-Saharan Africa.
Of the 106 countries and territories with malaria transmission in 2000, 102 are projected to reverse the incidence of malaria by the end of 2015.
:: Between 2000 and 2015, the proportion of children under 5 sleeping under an ITN in sub-Saharan Africa increased from less than 2% to an estimated 68%.
:: 1 in 4 children in sub-Saharan Africa still lives in a household with no ITN and no protection provided by indoor residual spraying.
:: In 2015, only an estimated 13% of children with a fever in sub-Saharan Africa received an ACT.

USAID: Annual Progress Report To Congress: Global Health Programs FY 2014

USAID: Annual Progress Report To Congress: Global Health Programs FY 2014
September 2015 :: 46 pages
[Excerpt p. 11]
PROTECTING THROUGH IMMUNIZATION
IMMUNIZATION IS AMONG THE MOST COST-EFFECTIVE INTERVENTIONS FOR CHILDREN TO SURVIVE THE MOS T PERILOUS PERIOD OF LIFE, BEFORE TURNING ONE, WHEN IMMUNE SYSTEMS ARE NOT FULLY DEVELOPED . VACCINES AVERT AN ESTIMATED 2 TO 3 MILLION DEATHS EACH YEAR .

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Smallpox killed some 300 million people in the 20th century alone before it was eradicated i n 1979. Before widespread immunization, measles caused 2.6 million deaths each year.

Sixty years ago, polio was one of the most feared diseases in the U.S. Today, polio is close r to being eradicated than ever before—only 35 9 cases were reported in 2014, and more than 1 0 million cases of childhood paralysis have bee n prevented. The U.S. has been working wit h the Global Polio Eradication Initiative since the beginning of this effort.

Today, we vaccinate children to prevent diphtheria, hepatitis B, measles, mumps , pertussis, pneumonia, polio, rotavirus, rubella and tetanus.

Despite global coverage at 83%, nearly 22 million infants worldwide are still not receiving basic vaccines. This estimate masks inequalities between and among countries. To help ensure that children do not die of vaccine-preventable diseases, USAID is working to strengthen routine immunization systems in the 24 priority countries.

Immunization is central to the strategy to end preventable child and maternal deaths. USAID works with partners around the world including national governments, UNICEF, WHO, Gavi , and others to extend access to life-saving vaccines. Strong direct support for Gavi and complementary technical assistance at the country level, predominantly through investing in immunization systems, strengthens local capacity to vaccinate effectively at scale. USAID’s work on immunizations focuses on three priority actions: Work through and with Gavi; Strengthen Country-Level Immunization Systems; Eradicate Polio Globally….

Good Publication Practice for Communicating Company-Sponsored Medical Research: GPP3

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

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Research and Reporting Methods | 15 September 2015 ]
Good Publication Practice for Communicating Company-Sponsored Medical Research: GPP3
FREE
Wendy P. Battisti, PhD; Elizabeth Wager, PhD; Lise Baltzer; Dan Bridges, PhD; Angela Cairns; Christopher I. Carswell, MSc; Leslie Citrome, MD, MPH; James A. Gurr, PhD; LaVerne A. Mooney, DrPH; B. Jane Moore, MS; Teresa Peña, PhD; Carol H. Sanes-Miller, MS; Keith Veitch, PhD; Karen L. Woolley, PhD; and Yvonne E. Yarker, PhD
Article, Author, and Disclosure Information
Ann Intern Med. 2015;163(6):461-464. doi:10.7326/M15-0288
Abstract
This updated Good Publication Practice (GPP) guideline, known as GPP3, builds on earlier versions and provides recommendations for individuals and organizations that contribute to the publication of research results sponsored or supported by pharmaceutical, medical device, diagnostics, and biotechnology companies. The recommendations are designed to help individuals and organizations maintain ethical and transparent publication practices and comply with legal and regulatory requirements. These recommendations cover publications in peer-reviewed journals and presentations (oral or poster) at scientific congresses. The International Society for Medical Publication Professionals invited more than 3000 professionals worldwide to apply for a position on the steering committee, or as a reviewer, for this guideline. The GPP2 authors reviewed all applications (n = 241) and assembled an 18-member steering committee that represented 7 countries and a diversity of publication professions and institutions. From the 174 selected reviewers, 94 sent comments on the second draft, which steering committee members incorporated after discussion and consensus.
The resulting guideline includes new sections (Principles of Good Publication Practice for Company-Sponsored Medical Research, Data Sharing, Studies That Should Be Published, and Plagiarism), expands guidance on the International Committee of Medical Journal Editors’ authorship criteria and common authorship issues, improves clarity on appropriate author payment and reimbursement, and expands information on the role of medical writers. By following good publication practices (including GPP3), individuals and organizations will show integrity; accountability; and responsibility for accurate, complete, and transparent reporting in their publications and presentations…

BMC Health Services Research (Accessed 19 September 2015)

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 19 September 2015)

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Research article
Challenges in the provision of healthcare services for migrants: a systematic review through providers’ lens
Rapeepong Suphanchaimat, Kanang Kantamaturapoj, Weerasak Putthasri, Phusit Prakongsai BMC Health Services Research 2015, 15:390 (17 September 2015)
Abstract
Background
In recent years, cross-border migration has gained significant attention in high-level policy dialogues in numerous countries. While there exists some literature describing the health status of migrants, and exploring migrants’ perceptions of service utilisation in receiving countries, there is still little evidence that examines the issue of health services for migrants through the lens of providers. This study therefore aims to systematically review the latest literature, which investigated perceptions and attitudes of healthcare providers in managing care for migrants, as well as examining the challenges and barriers faced in their practices.
Methods
A systematic review was performed by gathering evidence from three main online databases: Medline, Embase and Scopus, plus a purposive search from the World Health Organization’s website and grey literature sources. The articles, published in English since 2000, were reviewed according to the following topics: (1) how healthcare providers interacted with individual migrant patients, (2) how workplace factors shaped services for migrants, and (3) how the external environment, specifically laws and professional norms influenced their practices. Key message of the articles were analysed by thematic analysis.
Results
Thirty seven articles were recruited for the final review. Key findings of the selected articles were synthesised and presented in the data extraction form. Quality of retrieved articles varied substantially. Almost all the selected articles had congruent findings regarding language andcultural challenges, and a lack of knowledge of a host country’s health system amongst migrant patients. Most respondents expressed concerns over in-house constraints resulting from heavy workloads and the inadequacy of human resources. Professional norms strongly influenced the behaviours and attitudes of healthcare providers despite conflicting with laws that limited right to health services access for illegal migrants.
Discussion
The perceptions, attitudes and practices of practitioners in the provision of healthcare services for migrants were mainly influenced by: (1) diverse cultural beliefs and language differences, (2) limited institutional capacity, in terms of time and/or resource constraints, (3) the contradiction between professional ethics and laws that limited migrants’ right to health care. Nevertheless, healthcare providers addressedsuch problems by partially ignoring the immigrants’precarious legal status, and using numerous tactics, including seeking help from civil society groups, to support their clinical practice.
Conclusion
It was evident that healthcare providers faced several challenges in managing care for migrants, which included not only language and cultural barriers, but also resource constraints within their workplaces, and disharmony between the law and their professional norms. Further studies, which explore health care management for migrants in countries with different health insurance models, are recommended.

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Research article
A systematic review of social, economic and diplomatic aspects of short-term medical missions
Paul Caldron, Ann Impens, Milena Pavlova, Wim Groot BMC Health Services Research 2015, 15:380 (15 September 2015)
Abstract
Background
Short-term medical missions (STMMs) represent a grass-roots form of aid, transferring medical services rather than funds or equipment. The objective of this paper is to review empirical studies on social, economic and diplomatic aspects of STMMs.
Methods
A systematic literature review was conducted by searching PubMed and EBSCOhost for articles published from 1947–2014 about medical missions to lower and middle income countries (LMICs). Publications focused on military, disaster and dental service trips were excluded. A data extraction process was used to identify publications relevant to our objective stated above.
Results
PubMed and EBSCOhost searches provided 4138 and 3262 articles respectively for review. Most articles that provide useful information have appeared in the current millennium and are found in focused surgical journals. Little attention is paid to aspects of volunteerism, altruism and philanthropy related to STMM activity in the literature reviewed (1 article). Evidence of professionalization remains scarce, although elements including guidelines and tactical instructions have been emerging (27 articles). Information on costs (10 articles) and commentary on the relevance of market forces (1 article) are limited. Analyses of spill-over effects, i.e., changing attitudes of physicians or their communities towards aid, and characterizations of STMMs as meaningful foreign aid or strategic diplomacy are few (4 articles).
Conclusions
The literature on key social, economic and diplomatic aspects of STMMs and their consequences is sparse. Guidelines, tactical instructions and attempts at outcome measures are emerging that may better professionalize the otherwise unregulated activity. A broader discussion of these key aspects may lead to improved accountability and intercultural professionalism to accompany medical professionalism in STMM activity.

BMC Infectious Diseases (Accessed 19 September 2015)

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 19 September 2015)

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Research article
Modeling the prevalence of immunodeficiency-associated long-term vaccine-derived poliovirus excretors and the potential benefits of antiviral drugs
Radboud Duintjer Tebbens, Mark Pallansch, Kimberly Thompson BMC Infectious Diseases 2015, 15:379 (17 September 2015)
Abstract
Background
A small number of individuals with B-cell-related primary immunodeficiency diseases (PIDs) may exhibit long-term (prolonged or chronic) excretion of immunodeficiency-associated vaccine-derived polioviruses (iVDPVs) following infection with oral poliovirus vaccine (OPV). These individuals pose a risk of live poliovirus reintroduction into the population after global wild poliovirus eradication and subsequent OPV cessation. Treatment with polio antiviral drugs may potentially stop excretion in some of these individuals and thus may reduce the future population risk.
Methods
We developed a discrete event simulation model to characterize the global prevalence of long-term iVDPV excretors based on the best available evidence. We explored the impact of different assumptions about the effectiveness of polio antiviral drugs and the fraction of long-term excretors identified and treated.
Results
Due to the rarity of long-term iVDPV excretion and limited data on the survival of PID patients in developing countries, uncertainty remains about the current and future prevalence of long-term iVDPV excretors. While the model suggests only approximately 30 current excretors globally and a rapid decrease after OPV cessation, most of these excrete asymptomatically and remain undetected. The possibility that one or more PID patients may continue to excrete iVDPVs for several years after OPV cessation represents a risk for reintroduction of live polioviruses after OPV cessation, particularly for middle-income countries. With the effectiveness of a single polio antiviral drug possibly as low as 40 % and no system in place to identify and treat asymptomatic excretors, the impact of passive use of a single polio antiviral drug to treat identified excretors appears limited. Higher drug effectiveness and active efforts to identify long-term excretors will dramatically increase the benefits of polio antiviral drugs.
Conclusions
Efforts to develop a second polio antiviral compound to increase polio antiviral effectiveness and/or to maximize the identification and treatment of affected individuals represent important risk management opportunities for the polio endgame. Better data on the survival of PID patients in developing countries and more longitudinal data on their exposure to and recovery from OPV infections would improve our understanding of the risks associated with iVDPV excretors and the benefits of further investments in polio antiviral drugs.

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Research article
The differential impact of oral poliovirus vaccine formulation choices on serotype-specific population immunity to poliovirus transmission
Kimberly Thompson, Radboud Duintjer Tebbens BMC Infectious Diseases 2015, 15:376 (17 September 2015)
Abstract
Background
Prior analyses demonstrated the need for some countries and the Global Polio Eradication Initiative (GPEI) to conduct additional supplemental immunization activities (SIAs) with trivalent oral poliovirus vaccine (tOPV) prior to globally-coordinated cessation of all serotype 2-containing OPV (OPV2 cessation) to prevent the creation of serotype 2 circulating vaccine-derived poliovirus (cVDPV2) outbreaks after OPV2 cessation. The GPEI continues to focus on achieving and ensuring interruption of wild poliovirus serotype 1 (WPV1) and making vaccine choices that prioritize bivalent OPV (bOPV) for SIAs, nominally to increase population immunity to serotype 1, despite an aggressive timeline for OPV2 cessation.
Methods
We use an existing dynamic poliovirus transmission model of northwest Nigeria and an integrated global model for long-term poliovirus risk management to explore the impact of tOPV vs. bOPV vaccine choices on population immunity and cVDPV2 risks.
Results
Using tOPV instead of bOPV for SIAs leads to a minimal decrease in population immunity to transmission of serotypes 1 and 3 polioviruses, but a significantly higher population immunity to transmission of serotype 2 polioviruses. Failure to use tOPV in enough SIAs results in cVDPV2 emergence after OPV2 cessation in both the northwest Nigeria model and the global model. Despite perceptions to the contrary, prioritizing the use of bOPV over tOPV prior to OPV2 cessation does not significantly improve serotype 1 population immunity to transmission.
Conclusions
Immunization leaders need to focus on all three poliovirus serotypes to appropriately manage the risks of OPV cessation in the polio endgame. Focusing on population immunity to transmission to interrupt WPV1 transmission and manage pre-OPV cessation risks of cVDPVs, all countries performing poliovirus SIAs should use tOPV up until the time of OPV2 cessation, after which time they should continue to use the OPV vaccine formulation with all remaining serotypes until coordinated global cessation of those serotypes.

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Research article
Health and economic consequences of different options for timing the coordinated global cessation of the three oral poliovirus vaccine serotypes
Kimberly Thompson, Radboud Duintjer Tebbens BMC Infectious Diseases 2015, 15:374 (17 September 2015)
Abstract
Background
World leaders remain committed to globally-coordinated oral poliovirus vaccine (OPV) cessation following successful eradication of wild polioviruses, but the best timing and strategy for implementation depend on existing and emerging conditions.
Methods
Using an existing integrated global poliovirus risk management model, we explore alternatives to the current timing plan of coordinated cessation of each OPV serotype (i.e., OPV1, OPV2, and OPV3 cessation for serotypes 1, 2, and 3, respectively). We assume the current timing plan involves OPV2 cessation in 2016 followed by OPV1 and OPV3 cessation in 2019 and we compare this to alternative timing options, including cessation of all three serotypes in 2018 or 2019, and cessation of both OPV2 and OPV3 in 2017 followed by OPV1 in 2019.
Results
If Supplemtal Immunization Activity frequency remains sufficiently high through cessation of the last OPV serotype, then all OPV cessation timing options prevent circulating vaccine-derived poliovirus (cVDPV) outbreaks after OPV cessation of any serotype. The various OPV cessation timing options result in relatively modest differences in expected vaccine-associated paralytic poliomyelitis cases and expected total of approximately 10–13 billion polio vaccine doses used. However, the expected amounts of vaccine of different OPV formulations needed changes dramatically with each OPV cessation timing option. Overall health economic impacts remain limited for timing options that only change the OPV formulation but preserve the currently planned year for cessation of the last OPV serotype and the global introduction of inactivated poliovirus vaccine (IPV) introduction. Earlier cessation of the last OPV serotype or later global IPV introduction yield approximately $1 billion in incremental net benefits due to saved vaccination costs, although the logistics of implementation of OPV cessation remain uncertain and challenging.
Conclusions
All countries should maintain the highest possible levels of population immunity to transmission for each poliovirus serotype prior to the coordinated cessation of the OPV serotype to manage cVDPV risks. If OPV2 cessation gets delayed, then global health leaders should consider other OPV cessation timing options.

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Research article
Vaccination of boys or catch-up of girls above 11 years of age with the HPV-16/18 AS04-adjuvanted vaccine: where is the greatest benefit for cervical cancer prevention in Italy?
Paolo Bonanni, Giovanni Gabutti, Nadia Demarteau, Sara Boccalini, Giuseppe La Torre BMC Infectious Diseases 2015, 15:377 (17 September 2015)

Ethical oversight in quality improvement and quality improvement research: new approaches to promote a learning health care system

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 19 September 2015)

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Debate
Ethical oversight in quality improvement and quality improvement research: new approaches to promote a learning health care system
Kevin Fiscella, Jonathan Tobin, Jennifer Carroll, Hua He, Gbenga Ogedegbe BMC Medical Ethics 2015, 16:63 (17 September 2015)

BMC Public Health (Accessed 19 September 2015)

BMC Public Health
http://www.biomedcentral.com/bmcpublichealth/content
(Accessed 19 September 2015)

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Research article
Subjective health of undocumented migrants in Germany – a mixed methods approach
Anna Kuehne, Susann Huschke, Monika Bullinger BMC Public Health 2015, 15:926 (19 September 2015)

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Research article
Experiencing ‘pathologized presence and normalized absence’; understanding health related experiences and access to health care among Iraqi and Somali asylum seekers, refugees and persons without legal status
Mei Fang, Judith Sixsmith, Rebecca Lawthom, Ilana Mountian, Afifa Shahrin BMC Public Health 2015, 15:923 (19 September 2015)

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Research article
Socioeconomic inequalities in non-communicable diseases and their risk factors: an overview of systematic reviews
Isolde Sommer, Ursula Griebler, Peter Mahlknecht, Kylie Thaler, Kathryn Bouskill, Gerald Gartlehner, Shanti Mendis BMC Public Health 2015, 15:914 (18 September 2015)

Coincident polio and Ebola crises expose similar fault lines in the current global health regime

Conflict and Health
http://www.conflictandhealth.com/
[Accessed 19 September 2015]

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Debate
Coincident polio and Ebola crises expose similar fault lines in the current global health regime
Calain P and Abu Sa’Da C Conflict and Health 2015, 9:29 (16 September 2015)

Abstract

Background

In 2014, the World Health Organization (WHO) declared two “public health emergencies of international concern”, in response to the worldwide polio situation and the Ebola epidemic in West Africa respectively. Both emergencies can be seen as testing moments, challenging the current model of epidemic governance, where two worldviews co-exist: global health security and humanitarian biomedicine.

Discussion

The resurgence of polio and the spread of Ebola in 2014 have not only exposed the weaknesses of national health systems, but also the shortcomings of the current global health regime in dealing with transnational epidemic threats. These shortcomings are of three sorts. Firstly, the global health regime is fragmented and dominated by the domestic security priorities of industrialised nations. Secondly, the WHO has been constrained by constitutional country allegiances, crippling reforms and the limited impact of the (2005) International Health Regulations (IHR) framework. Thirdly, the securitization of infectious diseases and the militarization of humanitarian aid undermine the establishment of credible public health surveillance networks and the capacity to control epidemic threats.

Summary

The securitization of communicable diseases has so far led foreign aid policies to sideline health systems. It has also been the source of ongoing misperceptions over the aims of global health initiatives. With its strict allegiance to Member States, the WHO mandate is problematic, particularly when it comes to controlling epidemic diseases. In this context, humanitarian medical organizations are expected to palliate the absence of public health services in the most destitute areas, particularly in conflict zones. The militarization of humanitarian aid itself threatens this fragile and imperfect equilibrium. None of the reforms announced by the WHO in the wake of the 68 th World Health Assembly address these fundamental issues.

Development in Practice – Volume 25, Issue 7, 2015

Development in Practice
Volume 25, Issue 7, 2015
http://www.tandfonline.com/toc/cdip20/current

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Articles
Strengthening public health supply chains in Ethiopia: PEPFAR-supported expansion of access and availability
DOI:10.1080/09614524.2015.1069794
Daniel Taddesse*, David Jamieson & Logan Cochrane
pages 1043-1056
Accepted: 22 Jun 2015
Published online: 02 Sep 2015
Abstract
When the US President’s Emergency Plan for AIDS Relief (PEPFAR)-supported Supply Chain Management System (SCMS) programme began working in Ethiopia in 2006, the estimated population of people living with HIV exceeded one million, while only 24,000 were on treatment and only 50 treatment sites were in operation. SCMS and other key partners entered into this context to support the Ethiopian government in significantly strengthening the public health supply chain system, with the aim of increasing the availability and accessibility of pharmaceutical products. The country now has 1,047 treatment sites and is nearing complete treatment coverage. This article discusses how priorities were set among many competing challenges from 2006 until 2014, and how the four-step strategy of build, operate, transfer, and optimise has resulted in a successful partnership.

From SARS to Ebola – 10 years of disease prevention and control at ECDC

Eurosurveillance
Volume 20, Issue 37, 17 September 2015
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Editorials
From SARS to Ebola – 10 years of disease prevention and control at ECDC
A decade ago, the European Centre for Disease Prevention and Control (ECDC) appeared as a new player among international health organisations, with the mandate ‘to identify, assess and communicate current and emerging threats to human health from communicable diseases’ in the European Union (EU) [1]. As part of the ECDC 10-year anniversary celebrations, Eurosurveillance compiled a print issue with a selection of articles published over this period in the journal. The 10 articles, representing a year each, mark the organisation’s evolution and show its leadership and influence in the areas of its mandate…

Global Health: Science and Practice (GHSP) – September 2015 | Volume 3 | Issue 3

Global Health: Science and Practice (GHSP)
September 2015 | Volume 3 | Issue 3
http://www.ghspjournal.org/content/current

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EDITORIALS
Women’s Groups to Improve Maternal and Child Health Outcomes: Different Evidence Paradigms Toward Impact at Scale
The Care Group model, with relatively intensive international NGO implementation at moderate scale, appears successful in a wide variety of settings, as assessed by high-quality evaluation with rich program learning. Another women’s group approach—Participatory Women’s Groups—has also been implemented across various settings but at smaller scale and assessed using rigorous RCT methodology under controlled—but less naturalistic—conditions with generally, although not uniformly, positive results. Neither approach, as implemented to date, is directly applicable to large-scale integration into current public programs. Our challenge is to distill the elements of success across these approaches that empower women with knowledge, motivation, and increased self-efficacy—and to apply them in real-world programs at scale.
Glob Health Sci Pract 2015;3(3):323-326. http://dx.doi.org/10.9745/GHSP-D-15-00251

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ORIGINAL ARTICLES
Care Groups I: An Innovative Community-Based Strategy for Improving Maternal, Neonatal, and Child Health in Resource-Constrained Settings
Care Groups use volunteers to motivate mothers to adopt key MCH behaviors. The volunteers meet as a group every 2–4 weeks with a paid facilitator to learn new health promotion messages. Key ingredients of the approach include: peer-to-peer health promotion, selection of volunteers by the mothers, a manageable workload for the volunteers (no more than 15 households per volunteer), frequent (at least monthly) contact between volunteers and mothers, and regular supervision of the volunteers.
Henry Perry, Melanie Morrow, Sarah Borger, Jennifer Weiss, Mary DeCoster, Thomas Davis, Pieter Ernst
Glob Health Sci Pract 2015;3(3):358-369. http://dx.doi.org/10.9745/GHSP-D-15-00051

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Care Groups II: A Summary of the Child Survival Outcomes Achieved Using Volunteer Community Health Workers in Resource-Constrained Settings
Care Group projects resulted in high levels of healthy behavior, including use of oral rehydration therapy, bed nets, and health care services. Accordingly, under-5 mortality in Care Group areas declined by an estimated 32% compared with 11% in areas with child survival projects not using Care Groups.
Henry Perry, Melanie Morrow, Thomas Davis, Sarah Borger, Jennifer Weiss, Mary DeCoster, Jim Ricca, Pieter Ernst
Glob Health Sci Pract 2015;3(3):370-381. http://dx.doi.org/10.9745/GHSP-D-15-00052

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Improved Reproductive Health Equity Between the Poor and the Rich: An Analysis of Trends in 46 Low- and Middle-Income Countries
In light of advocacy efforts to reach the poorest with better health services, an examination of recent history reveals that overall the poor-rich gap in contraceptive use is already narrowing substantially, and more so where family planning programs are stronger. For most of 18 other reproductive health indicators, the gap is also narrowing. However, contraceptive use gaps in many sub-Saharan African countries have not diminished, calling for strong family planning program efforts to improve equity.
John Ross
Glob Health Sci Pract 2015;3(3):419-445. First published online September 7, 2015. http://dx.doi.org/10.9745/GHSP-D-15-00124

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INNOVATIONS
Remote Sensing of Vital Signs: A Wearable, Wireless “Band-Aid” Sensor With Personalized Analytics for Improved Ebola Patient Care and Worker Safety
This wireless sensor technology, currently being field-tested in an Ebola Treatment Unit in Sierra Leone, monitors multiple vital signs continuously and remotely. When connected with enhanced analytics software, it can discern changes in patients’ status much more quickly and intelligently than conventional periodic monitoring, thus saving critical health care worker time and reducing exposure to pathogens.
Steven R Steinhubl, Mark P Marriott, Stephan W Wegerich
Glob Health Sci Pract 2015;3(3):516-519. http://dx.doi.org/10.9745/GHSP-D-15-00189