Start Network [Consortium of British Humanitarian Agencies] [to 13 December 2014]
http://www.start-network.org/news-blog/#.U9U_O7FR98E

Humanitarian interoperability: is humanitarianism coming of age?
December 10, 2014
David Hockaday, Transition Manager
At the heart of the December 2014 UNOCHA global humanitarian policy conference was the concept of “humanitarian interoperability”. It is likely, as with all new buzzwords, that this concept will gather increasing momentum over the next 12 months, as practitioners, policy makers and decision-makers grapple to make sense of this new addition to the humanitarian lexicon…
Central to humanitarian interoperability will be common standards, values and principles, particularly as the currently insular aid system will need to collaborate with the new voices needed to be able to take gains to the necessary scale to meet the challenges of the 21st century.
These normative standards could be the uniting force, which help the aid agencies and private sector, business and commercial organisations find a common ground in the humanitarian endeavour..

Rockefeller Foundation
http://www.rockefellerfoundation.org/newsroom

500+ Organizations Launch Global Coalition to Accelerate Access to Universal Health Coverage
Dec 12, 2014
The coalition was launched today, on the first-ever Universal Health Coverage Day, to stress the importance of universal access to health services for saving lives, ending extreme poverty, building resilience against the health effects of climate change and ending deadly epidemics.

BMC Infectious Diseases
(Accessed 13 December 2014)
http://www.biomedcentral.com/bmcinfectdis/content

Study protocol
Multicenter case–control study protocol of pneumonia etiology in children: Global Approach to Biological Research, Infectious diseases and Epidemics in Low-income countries (GABRIEL network)
Valentina Sanchez Picot, Thomas Bénet, Melina Messaoudi, Jean-Noël Telles, Monidarin Chou, Tekchheng Eap, Jianwei Wang, Kunling Shen, Jean-William Pape, Vanessa Rouzier, Shally Awasthi, Nitin Pandey, Ashish Bavdekar, Sonali Sanghvi, Annick Robinson, Bénédicte Contamin, Jonathan Hoffmann, Maryam Sylla, Souleymane Diallo, Pagbajabyn Nymadawa, Budragchaagiin Dash-Yandag, Graciela Russomando, Wilma Basualdo, Marilda M Siqueira, Patricia Barreto, Florence Komurian-Pradel, Guy Vernet, Hubert Endtz, Philippe Vanhems, Gláucia Paranhos-Baccalà* and and on behalf of the pneumonia GABRIEL network
Author Affiliations
BMC Infectious Diseases 2014, 14:635 doi:10.1186/s12879-014-0635-8
Published: 10 December 2014
Abstract (provisional)
Background
Data on the etiologies of pneumonia among children are inadequate, especially in developing countries. The principal objective is to undertake a multicenter incident case-control study of <5-year-old children hospitalized with pneumonia in developing and emerging countries, aiming to identify the causative agents involved in pneumonia while assessing individual and microbial factors associated with the risk of severe pneumonia.
Methods/design
A multicenter case-control study, based on the GABRIEL network, is ongoing. Ten study sites are located in 9 countries over 3 continents: Brazil, Cambodia, China, Haiti, India, Madagascar, Mali, Mongolia, and Paraguay. At least 1,000 incident cases and 1,000 controls will be enrolled and matched for age and date. Cases are hospitalized children <5-years with radiologically confirmed pneumonia, and the controls are children without any features suggestive of pneumonia. Respiratory specimens are collected from all enrolled subjects to identify 19 viruses and 5 bacteria. Whole blood from pneumonia cases is being tested for 3 major bacteria. S. pneumoniae-positive specimens are serotyped. Urine samples from cases only are tested for detection of antimicrobial activity. The association between procalcitonin, C-reactive protein and pathogens is being evaluated. A discovery platform will enable pathogen identification in undiagnosed samples.
Discussion
This multicenter study will provide descriptive results for better understanding of pathogens responsible for pneumonia among children in developing countries. The identification of determinants related to microorganisms associated with pneumonia and its severity should facilitate treatment and prevention.

BMC Medical Ethics
(Accessed 13 December 2014)
http://www.biomedcentral.com/bmcmedethics/content

Debate
Community engagement and the human infrastructure of global health research
Katherine F King, Pamela Kolopack, Maria W Merritt and James V Lavery
BMC Medical Ethics 2014, 15:84 doi:10.1186/1472-6939-15-84
Published: 13 December 2014
Abstract (provisional)
Background
Biomedical research is increasingly globalized with ever more research conducted in low and middle-income countries. This trend raises a host of ethical concerns and critiques. While community engagement (CE) has been proposed as an ethically important practice for global biomedical research, there is no agreement about what these practices contribute to the ethics of research, or when they are needed.
Discussion
In this paper, we propose an ethical framework for CE. The framework is grounded in the insight that relationships between the researcher and the community extend beyond the normal bounds of the researcher-research participant encounter and are the foundation of meaningful engagement. These relationships create an essential “human infrastructure” – a web of relationships between researchers and the stakeholder community–i.e., the diverse stakeholders who have interests in the conduct and/or outcomes of the research. Through these relationships, researchers are able to address three core ethical responsibilities: (1) identifying and managing non-obvious risks and benefits; (2) expanding respect beyond the individual to the stakeholder community; and (3) building legitimacy for the research project.
Summary
By recognizing the social and political context of biomedical research, CE offers a promising solution to many seemingly intractable challenges in global health research; however there are increasing concerns about what makes engagement meaningful. We have responded to those concerns by presenting an ethical framework for CE. This framework reflects our belief that the value of CE is realized through relationships between researchers and stakeholders, thereby advancing three distinct ethical goals. Clarity about the aims of researcher-stakeholder relationships helps to make engagement programs more meaningful, and contributes to greater clarity about when CE should be recommended or required.

Research article
Shortcomings of protocols of drug trials in relation to sponsorship as identified by Research Ethics Committees: analysis of comments raised during ethical review
Marlies van Lent, Gerard A Rongen and Henk J Out
BMC Medical Ethics 2014, 15:83 doi:10.1186/1472-6939-15-83
Published: 10 December 2014
Abstract (provisional)
Background
Submission of study protocols to research ethics committees (RECs) constitutes one of the earliest stages at which planned trials are documented in detail. Previous studies have investigated the amendments requested from researchers by RECs, but the type of issues raised during REC review have not been compared by sponsor type. The objective of this study was to identify recurring shortcomings in protocols of drug trials based on REC comments and to assess whether these were more common among industry-sponsored or non-industry trials.
Methods
Retrospective analysis of 226 protocols of drug trials approved in 2010-2011 by three RECs affiliated to academic medical centres in The Netherlands. For each protocol, information on sponsorship, number of participating centres, participating countries, study phase, registration status of the study drug, and type and number of subjects was retrieved. REC comments were extracted from decision letters sent to investigators after review and were classified using a predefined checklist that was based on legislation and guidelines on clinical drug research and previous literature.
Results
Most protocols received comments regarding participant information and consent forms (n = 182, 80.5%), methodology and statistical analyses (n = 160, 70.8%), and supporting documentation, including trial agreements and certificates of insurance (n = 154, 68.1%). Of the submitted protocols, 122 (54.0%) were non-industry and 104 (46.0%) were industry-sponsored trials. Non-industry trials more often received comments on subject selection (n = 44, 36.1%) than industry-sponsored trials (n = 18, 17.3%; RR, 1.58; 95% CI, 1.01 to 2.47), and on methodology and statistical analyses (n = 95, 77.9% versus n = 65, 62.5%, respectively; RR, 1.18; 95% CI, 1.01 to 1.37). Non-industry trials less often received comments on supporting documentation (n = 72, 59.0%) than industry-sponsored trials (n = 82, 78.8%; RR, 0.83; 95% CI, 0.72 to 0.95).
Conclusions
RECs identified important ethical and methodological shortcomings in protocols of both industry-sponsored and non-industry drug trials. Investigators, especially of non-industry trials, should better prepare their research protocols in order to facilitate the ethical review process.

British Medical Journal
13 December 2014 (vol 349, issue 7987)
http://www.bmj.com/content/349/7987

Research
Innovative research methods for studying treatments for rare diseases: methodological review
Joshua J Gagne, assistant professor, Lauren Thompson, research assistant, Kelly O’Keefe, research manager, Aaron S Kesselheim, assistant professor
BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g6802 (Published 24 November 2014) Cite this as: BMJ 2014;349:g6802
Abstract
Objective To examine methods for generating evidence on health outcomes in patients with rare diseases.
Design Methodological review of existing literature.
Setting PubMed, Embase, and Academic Search Premier searched for articles describing innovative approaches to randomized trial design and analysis methods and methods for conducting observational research in patients with rare diseases.
Main outcome measures We assessed information related to the proposed methods, the specific rare disease being studied, and outcomes from the application of the methods. We summarize methods with respect to their advantages in studying health outcomes in rare diseases and provide examples of their application.
Results We identified 46 articles that proposed or described methods for studying patient health outcomes in rare diseases. Articles covered a wide range of rare diseases and most (72%) were published in 2008 or later. We identified 16 research strategies for studying rare disease. Innovative clinical trial methods minimize sample size requirements (n=4) and maximize the proportion of patients who receive active treatment (n=2), strategies crucial to studying small populations of patients with limited treatment choices. No studies describing unique methods for conducting observational studies in patients with rare diseases were identified.
Conclusions Though numerous studies apply unique clinical trial designs and considerations to assess patient health outcomes in rare diseases, less attention has been paid to innovative methods for studying rare diseases using observational data.

Clinical Review
Ebola virus disease
BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g7348 (Published 10 December 2014) Cite this as: BMJ 2014;349:g7348

Disasters
January 2015 Volume 39, Issue 1 Pages 1–184
http://onlinelibrary.wiley.com/doi/10.1111/disa.2015.39.issue-1/issuetoc

Social media and disasters: a functional framework for social media use in disaster planning, response, and research
J. Brian Houston1,*, Joshua Hawthorne2, Mildred F. Perreault3, Eun Hae Park4, Marlo Goldstein Hode5, Michael R. Halliwell6, Sarah E. Turner McGowen7, Rachel Davis8, Shivani Vaid9, Jonathan A. McElderry10 and Stanford A. Griffith11
Article first published online: 22 SEP 2014
DOI: 10.1111/disa.12092
Abstract
A comprehensive review of online, official, and scientific literature was carried out in 2012–13 to develop a framework of disaster social media. This framework can be used to facilitate the creation of disaster social media tools, the formulation of disaster social media implementation processes, and the scientific study of disaster social media effects. Disaster social media users in the framework include communities, government, individuals, organisations, and media outlets. Fifteen distinct disaster social media uses were identified, ranging from preparing and receiving disaster preparedness information and warnings and signalling and detecting disasters prior to an event to (re)connecting community members following a disaster. The framework illustrates that a variety of entities may utilise and produce disaster social media content. Consequently, disaster social media use can be conceptualised as occurring at a number of levels, even within the same disaster. Suggestions are provided on how the proposed framework can inform future disaster social media development and research.

Predicting support for non-pharmaceutical interventions during infectious outbreaks: a four region analysis
Francesca Matthews Pillemer1,*, Robert J. Blendon2, Alan M. Zaslavsky3 andBruce Y. Lee4
Article first published online: 22 SEP 2014
DOI: 10.1111/disa.12089
Abstract
Non-pharmaceutical interventions (NPIs) are an important public health tool for responding to infectious disease outbreaks, including pandemics. However, little is known about the individual characteristics associated with support for NPIs, or whether they are consistent across regions. This study draws on survey data from four regions—Hong Kong, Singapore, Taiwan, and the United States—collected following the Severe Acute Respiratory Syndrome (SARS) outbreak of 2002–03, and employs regression techniques to estimate predictors of NPI support. It finds that characteristics associated with NPI support vary widely by region, possibly because of cultural variation and prior experience, and that minority groups tend to be less supportive of NPIs when arrest is the consequence of noncompliance. Prior experience of face-mask usage also results in increased support for future usage, as well as other NPIs. Policymakers should be attentive to local preferences and to the application of compulsory interventions. It is speculated here that some public health interventions may serve as ‘gateway’ exposures to future public health interventions.

Global Health: Science and Practice (GHSP)
December 2014 | Volume 2 | Issue 4
http://www.ghspjournal.org/content/current

It’s not Ebola … it’s the systems
Victor K Barbiero
Glob Health Sci Pract 2014;2(4):374-375. First published online October 31, 2014. http://dx.doi.org/10.9745/GHSP-D-14-00186
The 2014 Ebola outbreak in West Africa demonstrates key deficiencies in investment in health systems. Despite some modest investment in health systems, our field has instead largely chosen to pursue shorter-term, vertical efforts to more rapidly address key global health issues such as smallpox, polio, malaria, and HIV/AIDS. While those efforts have yielded substantial benefits, we have paid a price for the lack of investments in general systems strengthening. The Ebola deaths we have seen represent a small portion of deaths from many other causes resulting from weak systems. Major systems strengthening including crucial nonclinical elements will not happen overnight but should proceed in a prioritized, systematic way.

COMMENTARIES
The future of routine immunization in the developing world: challenges and opportunities
Angela K Shen, Rebecca Fields, Mike McQuestion
Glob Health Sci Pract 2014;2(4):381-394. http://dx.doi.org/10.9745/GHSP-D-14-00137
Vaccine costs in the developing world have grown from < US$1/child in 2001 to about $21 for boys and $35 for girls in 2014, as more and costlier vaccines are being introduced into national immunization programs. To address these and other challenges, additional efforts are needed to strengthen 8 critical components of routine immunization: (1) policy, standards, and guidelines; (2) governance, organization, and management; (3) human resources; (4) vaccine, cold chain, and logistics management; (5) service delivery; (6) communication and community partnerships; (7) data generation and use; and (8) sustainable financing.

Strategies to reduce risks in ARV supply chains in the developing world
Chris Larson, Robert Burn, Anja Minnick-Sakal, Meaghan O’Keefe Douglas, Joel Kuritsky
Glob Health Sci Pract 2014;2(4):395-402. http://dx.doi.org/10.9745/GHSP-D-14-00105
Key strategies of the main ARV procurement program for PEPFAR to reduce supply chain risks include: (1) employing pooled procurement to reduce procurement and shipping costs and to accommodate changing country needs by making stock adjustments at the regional level, and (2) establishing regional distribution centers to facilitate faster turnaround of orders within defined catchment areas.

VIEWPOINTS
A stewardship approach to shaping the future of public health supply chain systems
Alan Bornbusch, Todd Dickens, Carolyn Hart, Chris Wright
Glob Health Sci Pract 2014;2(4):403-409. First published online October 29, 2014. http://dx.doi.org/10.9745/GHSP-D-14-00123
Guiding Principles: (1) Governments should see themselves as stewards of supply chains, providing vision, guidance, and oversight, not necessarily as operators of supply chains. (2) Governments should not be afraid to leverage the multiple supply chain actors and diverse options available; these can be woven into a coherent, integrated system, providing flexibility and reducing risk. (3) Governments will need new skills in leadership, regulation, market research, contract design, oversight of outsourced providers, financial analysis, and alliance-building.

Global Public Health
Volume 10, Issue 1, 2015
http://www.tandfonline.com/toc/rgph20/10/1#.VI0Y33tW_4U

The integration of water, sanitation and hygiene services into the US President’s Emergency Plan for AIDS Relief: A qualitative study
Lyana B. Mahmoudia, Jennifer L. Plattb & Jay P. Grahamac*
DOI:10.1080/17441692.2014.966736
pages 1-14
Abstract
Water, sanitation and hygiene (WASH) interventions have been associated with improving the health of people living with HIV/AIDS (PLHIV). WASH is increasingly integrated into the HIV sector and is now considered a key component of the transition from an emergency response to a better incorporated and coordinated AIDS response. However, limited research exists on integration efforts. This qualitative research study aims to address the limited body of research on WASH integration into HIV programmes through examining the US President’s Emergency Plan for AIDS Relief (PEPFAR). PEPFAR is the US government’s initiative to combat AIDS in the most afflicted countries. This study analyses the perceptions of people who have worked or are working on WASH integration into PEPFAR, highlighting their views on accomplishments, challenges and areas for improvement. It concludes with recommendations for moving forward.

An economic framework for transitioning to capacity building
Eric Baranicka, Aaron Bairdb* & Ajay Vinzec
DOI:10.1080/17441692.2014.964745
pages 15-27
Abstract
Global Health Organizations (GHOs) often focus on resource provisioning strategies to assist communities in need, especially when disaster strikes. While such strategies are commendable, how should GHOs approach the challenge of developing sustainable strategic objectives after critical needs have been addressed? Leveraging the context of GHOs partnering with communities in need of support after disaster strikes, we propose an economic framework for use in strategic assessment and transition planning. We focus on a strategic process by which GHOs can systematically assess and manage the temporal shift from resource provisioning to capacity building strategies. The proposed framework is applied to pragmatic field experiences undertaken by the American Red Cross in the aftermath of the 2007 Peru earthquake. We specifically develop and propose: (1) An economic strategy assessment framework for GHOs seeking to provide support to communities characterised by high risk variances, incentive complexities and contingencies, and, (2) A practical strategic transition model for GHOs that emphasises proactively moving towards capacity building programme objectives through an emphasis on co-creation of value with community partners.

Globalization and Health
[Accessed 13 December 2014]
http://www.globalizationandhealth.com/

Research
Integration of community home based care programmes within national primary health care revitalisation strategies in Ethiopia, Malawi, South-Africa and Zambia: a comparative assessment
Aantjes C, Quinlan T and Bunders J Globalization and Health 2014, 10:85 (11 December 2014)

Commentary
Non‐Communicable Diseases (NCDs) in developing countries: a symposium report
Islam SMS, Purnat TD, Phuong NTA, Mwingira U, Schacht K and Fröschl G Globalization and Health 2014, 10:81 (11 December 2014)

Health Affairs
December 2014; Volume 33, Issue 12
http://content.healthaffairs.org/content/current
Issue Theme: Children’s Health

How A New Funding Model Will Shift Allocations From The Global Fund To Fight AIDS, Tuberculosis, And Malaria
Victoria Y. Fan1,*, Amanda Glassman2 and Rachel L. Silverman3
Author Affiliations
1Victoria Y. Fan (vfan@post.harvard.edu) is an assistant professor in the Department of Public Health Sciences and Epidemiology at the University of Hawaii at Manoa, in Honolulu, and a research fellow at the Center for Global Development, in Washington, D.C.
2Amanda Glassman is director of global health policy and senior fellow at the Center for Global Development.
3Rachel L. Silverman is a policy analyst at the Center for Global Development.
Corresponding author
Abstract
Policy makers deciding how to fund global health programs in low- and middle-income countries face important but difficult questions about how to allocate resources across countries. In this article we present a typology of three allocation methodologies to align allocations with priorities. We then apply our typology to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. We examined the Global Fund’s historical HIV allocations and its predicted allocations under a new funding model that creates an explicit allocation methodology. We found that under the new funding model, substantial shifts in the Global Fund’s portfolio are likely to result from concentrating resources in countries with more HIV cases and lower per capita incomes. For example, South Africa, which had 15.8 percent of global HIV cases in 2009, could see its Global Fund HIV funding more than triple, from historic levels that averaged 3.0 percent to 9.7 percent of total Global Fund allocations. The new funding model methodology is expected, but not guaranteed, to improve the efficiency of Global Fund allocations in comparison to historical practice. We conclude with recommendations for the Global Fund and other global health donors to further develop their allocation methodologies and processes to improve efficiency and transparency.

International Survey Of Older Adults Finds Shortcomings In Access, Coordination, And Patient-Centered Care
Robin Osborn1,*, Donald Moulds2, David Squires3, Michelle M. Doty4 and Chloe Anderson5
Author Affiliations
1Robin Osborn (ro@cmwf.org) is vice president and director of the International Health Policy and Practice Innovations program at the Commonwealth Fund, in New York City.
2Donald Moulds is executive vice president for programs at the Commonwealth Fund.
3David Squires is senior researcher to the president at the Commonwealth Fund.
4Michelle M. Doty is vice president of survey research and evaluation at the Commonwealth Fund.
5Chloe Anderson is a research associate in the International Health Policy and Practice Innovations program at the Commonwealth Fund.
Corresponding author
Abstract
Industrialized nations face the common challenge of caring for aging populations, with rising rates of chronic disease and disability. Our 2014 computer-assisted telephone survey of the health and care experiences among 15,617 adults age sixty-five or older in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States has found that US older adults were sicker than their counterparts abroad. Out-of-pocket expenses posed greater problems in the United States than elsewhere. Accessing primary care and avoiding the emergency department tended to be more difficult in the United States, Canada, and Sweden than in other surveyed countries. One-fifth or more of older adults reported receiving uncoordinated care in all countries except France. US respondents were among the most likely to have discussed health-promoting behaviors with a clinician, to have a chronic care plan tailored to their daily life, and to have engaged in end-of-life care planning. Finally, in half of the countries, one-fifth or more of chronically ill adults were caregivers themselves.

The Lancet
Dec 13, 2014 Volume 384 Number 9960 p2083-2172 e63-e66
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Universal health coverage post-2015: putting people first
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(14)62355-2
Summary
Dec 12, 2014 marks the world’s first Universal Health Coverage (UHC) Day. Defined in the World Health Report 2010, UHC means that all people who need quality, essential health services (prevention, promotion, treatment, rehabilitation, and palliation) receive them without enduring financial hardship. UHC also means different things to different people. Vivian Lin, health systems director (WHO regional office for the Western Pacific), told The Lancet, “some define UHC as a journey or an aspiration but it is actually a strategy to get to equitable and sustainable outcomes”.

Comment
Meningococcal carriage: the dilemma of 4CMenB vaccine
Muhamed-Kheir Taha, Ala-Eddine Deghmane
Published Online: 18 August 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)60935-1
Summary
The prevalence of acute bacterial meningitis and septicaemia due to Haemophilus influenzae b (Hib), Streptococcus pneumoniae, and Neisseria meningitidis has greatly decreased in Europe and North America since the successful introduction of capsular polysaccharide conjugate vaccines targeting Hib, serogroup C (and ACWY in the USA) meningococci, and S pneumoniae. Incidence of meningitis due to N meningitidis serogroup A has also decreased in sub-Saharan Africa since the introduction of the meningococcal serogroup A conjugate vaccine (MenAfriVac).

Comment
Ebola and human rights in west Africa
Patrick M Eba
Published Online: 19 September 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61412-4
Summary
The fear caused by the Ebola outbreak in west Africa, which is projected to infect some 20 000 people, is understandable.1 However, the disproportionate measures recently adopted in some of the affected countries are a cause for concern. Some 25 years ago, Jonathan Mann, then Director of WHO’s Global Programme on AIDS, warned world leaders alarmed at the relentless spread of HIV.

Comment
Offline: Making it happen for women and girls
Richard Horton
DOI: http://dx.doi.org/10.1016/S0140-6736(14)62046-8
Summary
It was not a matter of forgetting. “There were forces within the UN that didn’t want to include contraception.” Dr Babatunde Osotimehin is the Executive Director of the United Nations Population Fund (UNFPA) and doesn’t mince his words. He was speaking last week at the launch of the Guttmacher Institute’s signature report, Adding It Up. Sexual and reproductive health and rights were “deliberately” dropped by the UN back in 2000, he argued. Those forces are still active today. And they are “more nimble in pushing back”.

Articles
Effect of a quadrivalent meningococcal ACWY glycoconjugate or a serogroup B meningococcal vaccine on meningococcal carriage: an observer-blind, phase 3 randomised clinical trial
Prof Robert C Read, MD, David Baxter, PhD, David R Chadwick, PhD, Prof Saul N Faust, FRCPH, Prof Adam Finn, PhD, Prof Stephen B Gordon, MD, Prof Paul T Heath, FRCPCH, Prof David J M Lewis, MD, Prof Andrew J Pollard, PhD, David P J Turner, PhD, Rohit Bazaz, MD Amitava Ganguli, MRCP, Tom Havelock, MRCP, Prof Keith R Neal, MD, Ifeanyichukwu O Okike, MD, Begonia Morales-Aza, BSc, Kamlesh Patel, BSc, Matthew D Snape, MD, John Williams, MRCP, Stefanie Gilchrist, MSc, Steve J Gray, PhD, Prof Martin C J Maiden, PhD, Daniela Toneatto, MD, Huajun Wang, MSc, Maggie McCarthy, MPH, Peter M Dull, MD, Prof Ray Borrow, PhD
Published Online: 18 August 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)60842-4
Summary
Background
Meningococcal conjugate vaccines protect individuals directly, but can also confer herd protection by interrupting carriage transmission. We assessed the effects of meningococcal quadrivalent glycoconjugate (MenACWY-CRM) or serogroup B (4CMenB) vaccination on meningococcal carriage rates in 18–24-year-olds.
Methods
In this phase 3, observer-blind, randomised controlled trial, university students aged 18–24 years from ten sites in England were randomly assigned (1:1:1, block size of three) to receive two doses 1 month apart of Japanese Encephalitis vaccine (controls), 4CMenB, or one dose of MenACWY-CRM then placebo. Participants were randomised with a validated computer-generated random allocation list. Participants and outcome-assessors were masked to the treatment group. Meningococci were isolated from oropharyngeal swabs collected before vaccination and at five scheduled intervals over 1 year. Primary outcomes were cross-sectional carriage 1 month after each vaccine course. Secondary outcomes included comparisons of carriage at any timepoint after primary analysis until study termination. Reactogenicity and adverse events were monitored throughout the study. Analysis was done on the modified intention-to-treat population, which included all enrolled participants who received a study vaccination and provided at least one assessable swab after baseline. This trial is registered with ClinicalTrials.gov, registration number NCT01214850.
Findings
Between Sept 21 and Dec 21, 2010, 2954 participants were randomly assigned (987 assigned to control [984 analysed], 979 assigned to 4CMenB [974 analysed], 988 assigned to MenACWY-CRM [983 analysed]); 33% of the 4CMenB group, 34% of the MenACWY-CRM group, and 31% of the control group were positive for meningococcal carriage at study entry. By 1 month, there was no significant difference in carriage between controls and 4CMenB (odds ratio 1•2, 95% CI 0•8–1•7) or MenACWY-CRM (0•9, [0•6–1•3]) groups. From 3 months after dose two, 4CMenB vaccination resulted in significantly lower carriage of any meningococcal strain (18•2% [95% CI 3•4–30•8] carriage reduction), capsular groups BCWY (26•6% [10•5–39•9] carriage reduction), capsular groups CWY (29•6% [8•1–46•0] carriage reduction), and serogroups CWY (28•5% [2•8–47•5] carriage reduction) compared with control vaccination. Significantly lower carriage rates were also noted in the MenACWY-CRM group compared with controls: 39•0% (95% CI 17•3–55•0) carriage reduction for serogroup Y and 36•2% (15•6–51•7) carriage reduction for serogroup CWY. Study vaccines were generally well tolerated, with increased rates of transient local injection pain and myalgia in the 4CMenB group. No safety concerns were identified.
Interpretation
Although we detected no significant difference between groups at 1 month after vaccine course, MenACWY-CRM and 4CMenB vaccines reduced meningococcal carriage rates during 12 months after vaccination and therefore might affect transmission when widely implemented.
Funding
Novartis Vaccines.

New England Journal of Medicine
December 11, 2014 Vol. 371 No. 24
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Ebola Vaccine — An Urgent International Priority
Rupa Kanapathipillai, M.D., Ana Maria Henao Restrepo, M.D., Patricia Fast, M.D., Ph.D., David Wood, Ph.D., Christopher Dye, D.Phil., Marie-Paule Kieny, Ph.D., and Vasee Moorthy, B.M., B.Ch., Ph.D.
N Engl J Med 2014; 371:2249-2251 December 11, 2014
DOI: 10.1056/NEJMp1412166
This article was published on October 7, 2014, at NEJM.org.

PLOS Currents: Disasters
[Accessed 13 December 2014]
http://currents.plos.org/disasters/

Communicable Diseases Surveillance System in East Azerbaijan Earthquake: Strengths and Weaknesses
December 8, 2014 • Research article
Background:
A Surveillance System was established for 19 diseases/syndromes in order to prevent and control communicable diseases after 2012 East Azerbaijan earthquakes. This study was conducted to investigate the strengths and weaknesses of the established SS.
Methods:
This study was carried out on an interview-based qualitative study using content analysis in 2012. Data was collected by semi-structured deep interviews and surveillance data. Fifteen interviews were conducted with experts and health system managers who were engaged in implementing the communicable disease surveillance system in the affected areas. The selection of participants was purposeful. Data saturation supported the sample size. The collected data was analyzed using the principles suggested by Strauss and Corbin.
Results:
Establishment of the disease surveillance system was rapid and inexpensive. It collected the required data fast. It also increased confidence in health authorities that the diseases would be under control in earthquake-stricken regions. Non estimated denominator for calculating the rates (incidence & prevalence), non-participation of the private sector and hospitals, rapid turnover of health staff and unfamiliarity with the definitions of the diseases were the weak points of the established disease SS.
Conclusion:
During the time when surveillance system was active, no significant outbreak of communicable diseases was reported. However, the surveillance system had some weaknesses. Thus, considering Iran’s susceptibility to various natural hazards, repeated exercises should be conducted in the preparedness phase to decrease the weaknesses. In addition, other types of surveillance system such as web-based or mobile-based systems should be piloted in disaster situations for future.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 13 December 2014)

Assessment of the Risk of Ebola Importation to Australia
December 10, 2014 • Research
Objectives:
To assess the risk of Ebola importation to Australia during the first six months of 2015, based upon the current outbreak in West Africa.
Methodology:
We assessed the risk under two distinct scenarios: (i) assuming that significant numbers of cases of Ebola remain confined to Guinea, Liberia and Sierra Leone, and using historic passenger arrival data into Australia; and, (ii) assuming potential secondary spread based upon international flight data. A model appropriate to each scenario is developed, and parameterised using passenger arrival card or international flight data, and World Health Organisation case data from West Africa. These models were constructed based on WHO Ebola outbreak data as at 17 October 2014 and 3 December 2014. An assessment of the risk under each scenario is reported. On 27 October 2014 the Australian Government announced a policy change, that visas from affected countries would be refused/cancelled, and the predicted effect of this policy change is reported.
Results:
The current probability of at least one case entering Australia by 1 July 2015, having travelled directly from West Africa with historic passenger arrival rates into Australia, is 0.34. Under the new Australian Government policy of restricting visas from affected countries (as of 27 October 2014), the probability of at least one case entering Australia by 1 July 2015 is reduced to 0.16. The probability of at least one case entering Australia by 1 July 2015 via an outbreak from a secondary source country is approximately 0.12.
Conclusions:
Our models suggest that if the transmission of Ebola remains unchanged, it is possible that a case will enter Australia within the first six months of 2015, either directly from West Africa (even when current visa restrictions are considered), or via secondary outbreaks elsewhere. Government and medical authorities should be prepared to respond to this eventuality. Control measures within West Africa over recent months have contributed to a reduction in projected risk of a case entering Australia. A significant further reduction of the rate at which Ebola is proliferating in West Africa, and control of the disease if and when it proliferates elsewhere, will continue to result in substantially lower risk of the disease entering Australia.

PLoS Medicine
(Accessed 13 December 2014)
http://www.plosmedicine.org/

Open Access
Policy Forum
From Joint Thinking to Joint Action: A Call to Action on Improving Water, Sanitation, and Hygiene for Maternal and Newborn Health
Yael Velleman mail, Elizabeth Mason, Wendy Graham, Lenka Benova, Mickey Chopra, Oona M. R. Campbell, Bruce Gordon, Sanjay Wijesekera, Sennen Hounton, Joanna Esteves Mills, Val Curtis, Kaosar Afsana, Sophie Boisson, [ … ], Oliver Cumming , [ view all ]
Published: December 12, 2014
DOI: 10.1371/journal.pmed.1001771
Summary Points
:: There is sufficient evidence that water, sanitation, and hygiene (WASH) may impact maternal and newborn health (MNH) to warrant greater attention from all stakeholders involved in improving MNH and achieving universal WASH access.
:: Enabling stronger integration between the WASH and health sectors has the potential to accelerate progress on MNH; this should be accompanied by improving monitoring of WASH in health care facilities providing MNH services as part of routine national-level monitoring, and at the global level through international instruments.
:: Global and national efforts to reduce maternal and newborn mortality and morbidity should adequately reflect WASH as a pre-requisite for ensuring the quality, effectiveness, and use of health care services.
:: The Post-2015 development framework is an opportunity for a stronger, more inter-sectoral response to the MNH challenge, and the goals and targets aimed at maximizing healthy lives and increasing access to quality health care should adequately embed WASH targets and success indicators.
:: Further implementation research is needed to identify effective interventions to improve WASH at home and in health care facilities, and to impact on MNH in different health system contexts.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 13 December 2014)

Global Programme to Eliminate Lymphatic Filariasis: The Processes Underlying Programme Success
Kazuyo Ichimori, Jonathan D. King, Dirk Engels, Aya Yajima, Alexei Mikhailov, Patrick Lammie, Eric A. Ottesen
Policy Platform | published 11 Dec 2014 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003328

Global Programme to Eliminate Lymphatic Filariasis: The Processes Underlying Programme Success
Kazuyo Ichimori, Jonathan D. King, Dirk Engels, Aya Yajima, Alexei Mikhailov, Patrick Lammie, Eric A. Ottesen
Policy Platform | published 11 Dec 2014 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003328

PLoS One
[Accessed 13 December 2014]
http://www.plosone.org/

Research Article
The Link between Inequality and Population Health in Low and Middle Income Countries: Policy Myth or Social Reality?
Ioana van Deurzen mail, Wim van Oorschot, Erik van Ingen
Published: December 11, 2014
DOI: 10.1371/journal.pone.0115109
Abstract
An influential policy idea states that reducing inequality is beneficial for improving health in the low and middle income countries (LMICs). Our study provides an empirical test of this idea: we utilized data collected by the Demographic and Health Surveys between 2000 and 2011 in as much as 52 LMICs, and we examined the relationship between household wealth inequality and two health outcomes: anemia status (of the children and their mothers) and the women’ experience of child mortality. Based on multi-level analyses, we found that higher levels of household wealth inequality related to worse health, but this effect was strongly reduced when we took into account the level of individuals’ wealth. However, even after accounting for the differences between individuals in terms of household wealth and other characteristics, in those LMICs with higher household wealth inequality more women experienced child mortality and more children were tested with anemia. This effect was partially mediated by the country’s level and coverage of the health services and infrastructure. Furthermore, we found higher inequality to be related to a larger health gap between the poor and the rich in only one of the three examined samples. We conclude that an effective way to improve the health in the LMICs is to increase the wealth among the poor, which in turn also would lead to lower overall inequality and potential investments in public health infrastructure and services.

Social Science & Medicine
Volume 126, In Progress (February 2015)
http://www.sciencedirect.com/science/journal/02779536/126

Latent and manifest empiricism in Q’eqchi’ Maya healing: A case study of HIV/AIDS
Original Research Article
Pages 9-16
James B. Waldram, Andrew R. Hatala
Abstract
Highlights
:: Develops a framework for understanding the empirical nature of Indigenous healing.
:: Argues for compatibility of traditional medicine and biomedicine.
:: Presents ethnographic case study of treatment of HIV/AIDS by Q’eqchi’ Maya healers.
:: Argues the need for communication between traditional medicine and biomedicine.

Inequalities in social capital and health between people with and without disabilities
Original Research Article
Pages 26-35
Johanna Mithen, Zoe Aitken, Anne Ziersch, Anne M. Kavanagh
Abstract
Highlights
:: Australian adults with disabilities have less access to social capital.
:: Australian adults with disabilities have poorer self-rated health.
:: Lower levels of social capital explain little of the health inequalities.
:: People with psychological and intellectual impairments fare worst.

Stability: International Journal of Security & Development
[accessed 13 December 2014]
http://www.stabilityjournal.org/articles

Losses of Humanity in Times of War: The Actions of Alternative Subjects of Justice
Julia Monárrez
10 Dec 2014
Abstract
This article discusses loss of humanity due to violence in Ciudad Juarez (2008–2014) and the actions of alternative subjects of justice – the organized civil society – seeking to address it. This paper resonates with theoretical currents of feminism and humanism, both of which have created a critical apparatus for thinking about social inequality in the context of life, death, and injustice. The discussion draws on the theoretical concepts of discourse societies, necropolitics, private government and actions. With this theoretical structure, the paper seeks to understand the political actions of eight civil society organizations aiming to recover the right to the body, to space and to be a political subject for a community shattered by violence. The paper argues that, through these actions, they helped to prevent crime, enhance public safety and stabilise a society suffering from continued violence due in large part to the war on drugs.

Tropical Medicine & International Health
January 2015 Volume 20, Issue 1 Pages 1–119
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2014.20.issue-1/issuetoc

Original Article
Participation in medical research as a resource-seeking strategy in socio-economically vulnerable communities: call for research and action
Raffaella M. Ravinetto1,2,*, Muhammed O. Afolabi3,4, Joseph Okebe3,4, Jennifer Ilo Van uil5,6,
Pascal Lutumba7,8, Hypolite Muhindo Mavoko8, Alain Nahum9, Halidou Tinto10, Adamu Addissie11, Umberto D’Alessandro3,4,12 and Koen Peeters Grietens12,13,14
Article first published online: 10 OCT 2014
DOI: 10.1111/tmi.12396
Abstract
The freedom to consent to participate in medical research is a complex subject, particularly in socio-economically vulnerable communities, where numerous factors may limit the efficacy of the informed consent process. Informal consultation among members of the Switching the Poles Clinical Research Network coming from various sub-Saharan African countries, that is Burkina Faso, The Gambia, Rwanda, Ethiopia, the Democratic Republic of Congo (DRC) and Benin, seems to support the hypothesis that in socio-economical vulnerable communities with inadequate access to health care, the decision to participate in research is often taken irrespectively of the contents of the informed consent interview, and it is largely driven by the opportunity to access free or better quality care and other indirect benefits. Populations’ vulnerability due to poverty and/or social exclusion should obviously not lead to exclusion from medical research, which is most often crucially needed to address their health problems. Nonetheless, to reduce the possibility of exploitation, there is the need to further investigate the complex links between socio-economical vulnerability, access to health care and individual freedom to decide on participation in medical research. This needs bringing together clinical researchers, social scientists and bioethicists in transdisciplinary collaborative research efforts that require the collective input from researchers, research sponsors and funders.