The Sphere Project [to 21 March 2015]
http://www.sphereproject.org/news/

New resource: Sphere for Monitoring and Evaluation
19 March 2015 | Sphere Project
The Sphere Project office has published Sphere for Monitoring and Evaluation, a short guide to help humanitarian staff identify and implement the sections of the Sphere Handbook that are most relevant to these tasks…

Start Network [to 21 March 2015]
http://www.start-network.org/news-blog/#.U9U_O7FR98E
[Consortium of British Humanitarian Agencies]

Launch of the Shifting the Power project in Nairobi, 16 March 2015
March 17, 2015
Posted by Tegan Rogers
Where does power lie in the humanitarian system? What barriers need to be overcome for local organisations to play a leading role in decision-making and responding to crises?
The Shifting the Power project brings together 6 leading humanitarian agencies to work in 5 disaster-prone countries to strengthen the capacity of local organisations to determine and deliver humanitarian preparedness and response…

BMGF (Gates Foundation) [to 21 March 2015]
http://www.gatesfoundation.org/Media-Center/Press-Releases

MARCH 18, 2015
New Chief Digital Officer Joins Bill & Melinda Gates Foundation
SEATTLE, WA, USA (March 19, 2015) – The Bill & Melinda Gates Foundation today announced that Todd Pierce will join the organization in the newly created role of Chief Digital Officer. He comes to the foundation from salesforce.com where he served as Senior Vice President of the Healthcare and Life Sciences industry. Prior to salesforce.com, Pierce was Chief Information Officer at Genentech and for the County of Santa Clara, California, and held technology leadership roles at Roche and Veteran’s Affairs. Additionally, he has held key positions on multiple non-profit and foundation boards.

Kellogg Foundation [to 21 March 2015]
http://www.wkkf.org/news-and-media#pp=10&p=1&f1=news

Statement of Support: Maintenance of Native languages and cultures is essential for the well-being of children and communities
W.K. Kellogg Foundation President and CEO La June Montgomery Tabron issues statement on the Office of Head Start’s Information Memorandum
March 17, 2015
BATTLE CREEK, Mich. – Today, the federal Office of Head Start (OHS) reaffirmed its commitment to “the full integration of tribal language and culture into every aspect of the Head Start and Early Head Start program model.” At the W.K. Kellogg Foundation (WKKF), we fully support full implementation by all sectors toward the maintenance of Native languages and cultures, and consider it to be essential in sustaining the identity and values essential for the well-being of Native children and communities…

Open Society Foundation [to 21 March 2015]
http://www.opensocietyfoundations.org/termsearch/8175/listing?f[0]=type%3Anews

Guatemala Should Seek Renewal of UN-backed Anti-Impunity Commission
March 19, 2015News
The International Commission against Impunity in Guatemala is an “indispensable partner” in the battle against organized criminality and corruption, according to a new assessment from the Open Society Justice Initiative.

BMC Public Health
(Accessed 21 March 2015)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Impact of socioeconomic status and medical conditions on health and healthcare utilization among ageing Ghanaians
Bashiru II Saeed12*, Zhao Xicang1, Alfred Edwin Yawson3, Samuel Blay Nguah4 and Nicholas NN Nsowah-Nuamah5
Author Affiliations
BMC Public Health 2015, 15:276 doi:10.1186/s12889-015-1603-y
Published: 20 March 2015
Abstract (provisional)
Background
This study attempts to examine the impact of socioeconomic and medical conditions in health and healthcare utilization among older adults in Ghana. Five separate models with varying input variables were estimated for each response variable.
Methods
Data (Wave 1 data) were drawn from the World Health Organization Global Ageing and Adult Health (SAGE) conducted during 2007–2008 and included a total of 4770 respondents aged 50+ and 803 aged 18–49 in Ghana. Ordered logits was estimated for self-rated health, and binary logits for functional limitation and healthcare utilization.
Results
Our results show that the study provides enough grounds for further research on the interplay between socioeconomic and medical conditions on one hand and the health of the aged on the other. Controlling for socioeconomic status substantially contributes significantly to utilization. Also, aged women experience worse health than men, as shown by functioning assessment, self-rated health, chronic conditions and functional limitations. Women have higher rates of healthcare utilization, as shown by significantly higher rates of hospitalization and outpatient encounters.
Conclusion
Expansion of the national health insurance scheme to cover the entire older population- for those in both formal and informal employments- is likely to garner increased access and improved health states for the older population.

Globalization and Health
[Accessed 21 March 2015]
http://www.globalizationandhealth.com/

Review
Health in the sustainable development goals: ready for a paradigm shift?
Kent Buse1 and Sarah Hawkes2*
Author Affiliations
Globalization and Health 2015, 11:13 doi:10.1186/s12992-015-0098-8
Published: 21 March 2015
Abstract (provisional)
The Millennium Development Goals (MDGs) galvanized attention, resources and accountability on a small number of health concerns of low- and middle-income countries with unprecedented results. The international community is presently developing a set of Sustainable Development Goals as the successor framework to the MDGs. This review examines the evidence base for the current health-related proposals in relation to disease burden and the technical and political feasibility of interventions to achieve the targets. In contrast to the MDGs, the proposed health agenda aspires to be universally applicable to all countries and is appropriately broad in encompassing both communicable and non-communicable diseases as well as emerging burdens from, among other things, road traffic accidents and pollution. We argue that success in realizing the agenda requires a paradigm shift in the way we address global health to surmount five challenges: 1) ensuring leadership for intersectoral coherence and coordination on the structural (including social, economic, political and legal) drivers of health; 2) shifting the focus from treatment to prevention through locally-led, politically-smart approaches to a far broader agenda; 3) identifying effective means to tackle the commercial determinants of ill-health; 4) further integrating rights-based approaches; and 5) enhancing civic engagement and ensuring accountability. We are concerned that neither the international community nor the global health community truly appreciates the extent of the shift required to implement this health agenda which is a critical determinant of sustainable development.

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Research
Tracking development assistance for health to fragile states: 2005–2011
Casey M Graves, Annie Haakenstad and Joseph L Dieleman*
Author Affiliations
Globalization and Health 2015, 11:12 doi:10.1186/s12992-015-0097-9
Published: 19 March 2015
Abstract (provisional)
Background
Development assistance for health (DAH) has grown substantially, totaling more than $31.3 billion in 2013. However, the degree that countries with high concentrations of armed conflict, ethnic violence, inequality, debt, and corruption have received this health aid and how that assistance might be different from the funding provided to other countries has not been assessed.
Methods
We combine DAH estimates and a multidimensional fragile states index for 2005 through 2011. We disaggregate and compare total DAH disbursed for fragile states versus stable states.
Results
Between 2005 and 2011, DAH per person in fragile countries increased at an annualized rate of 5.4%. In 2011 DAH to fragile countries totaled $6.2 billion, which is $5.05 per person. This is 43% of total DAH that is traced to a country. Comparing low-income countries, funding channeled to fragile countries was $7.22 per person while stable countries received $11.15 per person. Relative to stable countries, donors preferred to provide more funding to low-income fragile countries that have refugees or ongoing external intervention but tended to avoid providing funding to countries with political gridlock, flawed elections, or economic decline. In 2011, Ethiopia received the most health aid of all fragile countries, while the United States provided the most funds to fragile countries.
Conclusions
In 2011, 1.2 billion people lived in fragile countries. DAH can bolster health systems and might be especially valuable in providing long-term stability in fragile environments. While external health funding to these countries has increased since 2005, it is, in per person terms, almost half as much as the DAH provided to stable countries of comparable income levels.

JAMA
March 17, 2015, Vol 313, No. 11
http://jama.jamanetwork.com/issue.aspx

Viewpoint | March 17, 2015
Law, Ethics, and Public Health in the Vaccination Debates – Politics of the Measles Outbreak FREE
Lawrence O. Gostin, JD1
[+] Author Affiliations
JAMA. 2015;313(11):1099-1100. doi:10.1001/jama.2015.1518.

[Concluding text]
A TRAGEDY OF THE COMMONS
Parental decisions to opt out of immunizations can have a rational basis. Unvaccinated children avoid rare adverse effects, such as a serious allergic reaction. Moreover, if most children in the community in which they live are immunized, the unvaccinated child also benefits from herd immunity. The dilemma is that if a sufficient number parents act in their own interests by opting out of having their children immunized, then everyone is worse off.

Parents objecting to vaccines often claim the right to informed consent, which is an important medicolegal value. However, consent should not override the rights of others to live safely in their communities. Unvaccinated children put the wider public at risk, violating a basic ethical principle of not imposing harms on others. If an individual’s right ends at the point that its exercise jeopardizes the safety of others, then should states allow parents to opt out? Certainly, states should continue to grant medical exemptions for children particularly susceptible to vaccine adverse effects. However, states do not have to grant philosophical and religious exemptions. The main consideration is whether eliminating exemptions could inflame public opinion, thus undermining vaccine policy.

States would be unwise to overreact to the current measles outbreak by fining or imprisoning parents, or subjecting them to tort litigation, if they fail to vaccinate their children. Harsh penalties could fuel public opposition to vaccine policy. It may not even be necessary to entirely eliminate nonmedical exemptions. The wiser course could be to require a rigorous process for claiming the exemption, relying on behavioral economics to encourage compliance. There are good models of tougher standards, including requiring counseling; explaining the benefits of vaccines; requiring parents to sign an affidavit stating the reasons for opting out; and requiring health department approval. Placing a higher burden on the exemption process would make it more difficult for parents to impose risks on their children’s friends and schoolmates without their agreement.

If exemptions were truly rare, as they should be, then herd immunity would operate. Everyone would be safer. The current system of generous opt outs virtually ensures that infectious disease outbreaks will continue, perhaps increasing in frequency and geographic scope. Childhood diseases that were once common but now rare could gain a foothold, becoming endemic once again.
Research Letter | March 17, 2015
Reporting of Noninferiority Trials in ClinicalTrials.gov and Corresponding Publications
Anand D. Gopal, BS, BA1; Nihar R. Desai, MD2; Tony Tse, PhD3; Joseph S. Ross, MD, MHS2
[+] Author Affiliations
JAMA. 2015;313(11):1163-1165. doi:10.1001/jama.2015.1697.
Noninferiority clinical trials are designed to determine whether an intervention is not inferior to a comparator by more than a prespecified difference, known as the noninferiority margin. Selection of an appropriate margin is fundamental to noninferiority trial validity, yet a point of frequent ambiguity.1,2 Given the increasing use of noninferiority trial designs, maintaining high standards for conduct and reporting is a priority.3,4 Publicly accessible trial registries and results databases promote transparency and accountability by requiring specification of research designs and end points and disclosure of summary results.1,5

JAMA Pediatrics
March 2015, Vol 169, No. 3
http://archpedi.jamanetwork.com/issue.aspx
[Reviewed earlier]

Online First
Research Letter| March 16, 2015
Substandard Vaccination Compliance and the 2015 Measles Outbreak ONLINE FIRST
Maimuna S. Majumder, MPH1,2; Emily L. Cohn, MPH2; Sumiko R. Mekaru, DVM, PhD2; Jane E. Huston, MPH2; John S. Brownstein, PhD2,3
Author Affiliations
JAMA Pediatr. Published online March 16, 2015. doi:10.1001/jamapediatrics.2015.0384

The ongoing measles outbreak linked to the Disneyland Resort in Anaheim, California, shines a glaring spotlight on our nation’s growing antivaccination movement and the prevalence of vaccination-hesitant parents. Although the index case has not yet been identified, the outbreak likely started sometime between December 17 and 20, 2014.1,2 Rapid growth of cases across the United States indicates that a substantial percentage of the exposed population may be susceptible to infection due to lack of, or incomplete, vaccination. Herein, we attempt to analyze existing, publicly available outbreak data to assess the potential role of suboptimal vaccination coverage in the population.

…Discussion
This preliminary analysis indicates that substandard vaccination compliance is likely to blame for the 2015 measles outbreak. Our study estimates that MMR vaccination rates among the exposed population in which secondary cases have occurred might be as lowas50% and likely no higher than 86%. Given the highly contagious nature of measles, vaccination rates of 96% to 99% are necessary to preserve herd immunity and prevent future outbreaks.3 Even the highest estimated vaccination rates from our model fall well below this threshold. While data on MMR vaccination rates are available, coverage is often calculated at the state or county level and may not be granular enough to assess risk in an outbreak situation; this is especially the case for outbreaks originating at a tourist destination, where vaccination coverage among visitors is highly heterogeneous. Clearly, MMR vaccination rates in many of the communities that have been affected by this outbreak fall below the necessary threshold to sustain herd immunity, thus placing the greater population at risk as well.

he Lancet Global Health
Apr 2015 Volume 3 Number 4 e178-e239
http://www.thelancet.com/journals/langlo/issue/current

Comment
Think big, World Bank: time for a public health safeguard
Richard Seifman, Sarah Kornblet, Claire Standley, Erin Sorrell, Julie Fischer, Rebecca Katz
Published Online: 09 February 2015
Summary
Sometimes great changes result from small actions. Technical advances might grab headlines, but changes to administrative processes can potentially have an equally important effect on how public health actions are carried out on the ground. In the past six decades, the World Bank’s increasingly diverse portfolio has grown to include more than US$1 billion in annual commitments for health, nutrition, and population activities—about a quarter of all its projects.1 That is why it is so essential that the global community pays attention to the discussion and any proposed decisions about safeguards against any unintended social and environmental effects of World Bank policies and investments.

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Comment
A call for international accountability—preserving hope amid false protection
Agnes Binagwaho, Corine Karema
Published Online: 23 February 2015
Summary
Today’s struggle to control the Ebola outbreak in west Africa is a reminder that trust within health systems is absolutely crucial to fight disease—not only locally, but also globally. We describe Rwanda’s experience with a breakdown of communication, accountability, and trust that threatened the great strides in malaria control made over the past decade.

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Articles
Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil
Cesar G Victora, Bernardo Lessa Horta, Christian Loret de Mola, Luciana Quevedo, Ricardo Tavares Pinheiro, Denise P Gigante, Helen Gonçalves, Fernando C Barros

.
The consequences of tobacco tax on household health and finances in rich and poor smokers in China: an extended cost-effectiveness analysis
Stéphane Verguet, Cindy L Gauvreau, Sujata Mishra, Mary MacLennan, Shane M Murphy, Elizabeth D Brouwer, Rachel A Nugent, Kun Zhao, Prabhat Jha, Dean T Jamison

.
Effect of a comprehensive programme to provide universal access to care for sputum-smear-positive multidrug-resistant tuberculosis in China: a before-and-after study
Renzhong Li, Yunzhou Ruan, Qiang Sun, Xiexiu Wang, Mingting Chen, Hui Zhang, Yanlin Zhao, Jin Zhao, Cheng Chen, Caihong Xu, Wei Su, Yu Pang, Jun Cheng, Junying Chi, Qian Wang, Yunting Fu, Shitong Huan, Lixia Wang, Yu Wang, Daniel P Chin

.
Geographical and socioeconomic inequalities in women and children’s nutritional status in Pakistan in 2011: an analysis of data from a nationally representative survey
Mariachiara Di Cesare, Zaid Bhatti, Sajid B Soofi, Lea Fortunato, Majid Ezzati, Zulfiqar A Bhutta

Maternal and Child Health Journal
Volume 19, Issue 4, April 2015
http://link.springer.com/journal/10995/19/4/page/1

Reducing Child Mortality: The Contribution of Ceará State, Northeast of Brazil, on Achieving the Millennium Development Goal 4 in Brazil
Anamaria Cavalcante e Silva, Luciano Lima Correia…

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Explaining Inequity in the Use of Institutional Delivery Services in Selected Countries
Mai Do, Rieza Soelaeman, David R. Hotchkiss

.
Influenza Vaccination of Pregnant Women: Attitudes and Behaviors of Oregon Physician Prenatal Care Providers
Robert F. Arao, Kenneth D. Rosenberg, Shannon McWeeney, Katrina Hedberg
Abstract
In spite of increased risk of influenza complications during pregnancy, only half of US pregnant women get influenza vaccination. We surveyed physician prenatal care providers in Oregon to assess their knowledge and behaviors regarding vaccination of pregnant women. From September through November 2011, a state-wide survey was mailed to a simple random sample (n = 1,114) of Oregon obstetricians and family physicians. The response rate was 44.5 %. Of 496 survey respondents, 187 (37.7 %) had provided prenatal care within the last 12 months. Of these, 88.5 % reported that they routinely recommended influenza vaccine to healthy pregnant patients. No significant differences in vaccine recommendation were found by specialty, practice location, number of providers in their practice, physician gender or years in practice. In multivariable regression analysis, routinely recommending influenza vaccine was significantly associated with younger physician age [adjusted odds ratio (AOR) 2.01, 95 % confidence interval (CI) 1.29–3.13] and greater number of pregnant patients seen per week (AOR 1.95, 95 % CI 1.25–3.06). Among rural physicians, fewer obstetricians (90.3 %) than family physicians (98.5 %) had vaccine-appropriate storage units (p = 0.001). Most physician prenatal care providers understand the importance of influenza vaccination during pregnancy. To increase influenza vaccine coverage among pregnant women, it will be necessary to identify and address patient barriers to receiving influenza vaccination during pregnancy.

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Healthy Start: Description of a Safety Net for Perinatal Support During Disaster Recovery
Gloria Giarratano, Emily W. Harville, Veronica Barcelona de Mendoza, Jane Savage, Charlotte M. Parent
Abstract
Publicly funded programs and safety net organizations have key roles during post disaster recovery to care for vulnerable populations, including pregnant women with low resources. The objective of this study was to compare the health of prenatal women who accessed the New Orleans Healthy Start program to those women who only used traditional prenatal care (PNC) during long-term recovery from the Hurricane Katrina disaster. During 2010–2012, this descriptive, cross-sectional study recruited 402 prenatal women (24–40 weeks) from prenatal clinics and classes. All women were enrolled in PNC, with 282 experiencing only traditional PNC, while 120 women added Healthy Start participation to their usual PNC. Measures were obtained to determine, past hurricane experience, hurricane recovery, perceptions of prenatal care, mental health, and birth outcomes. Women accessing Healthy Start-New Orleans were more socially “at risk” (younger, lower income, not living with a partner, African American), lived through more hurricane trauma, and had a higher incidence of depression (40 %) and post-traumatic stress disorder (PTSD) (15 %) than women in traditional PNC (29 % depression; 6.1 % PTSD). Women using Healthy Start reported more mental health counseling and prenatal education than did women in only traditional PNC. Birth outcomes were similar in the two groups. The Healthy Start participants with less resources and more mental health difficulties after disaster, represented a more vulnerable population in need of additional support. This study underscores the necessity for community and governmental programs to develop disaster response plans that address needs of vulnerable populations during prolonged recovery.

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Factors Associated with Safe Delivery Service Utilization Among Women in Sheka Zone, Southwest Ethiopia
Abyot Asres, Gail Davey

Medical Decision Making (MDM)
April 2015; 35 (3)
http://mdm.sagepub.com/content/current

An Emerging Field of Research – Challenges in Pediatric Decision Making
Ellen A. Lipstein, MD, MPH, William B. Brinkman, MD, MEd, MSc, Alexander G. Fiks, MD, MSCE
Kristin S. Hendrix, PhD, Jennifer Kryworuchko, PhD, RN, Victoria A. Miller, PhD, Lisa A. Prosser, PhD, Wendy J. Ungar, MSc, PhD, David Fox, MD
Abstract
There is growing interest in pediatric decision science, spurred by policies advocating for children’s involvement in medical decision making. Challenges specific to pediatric decision research include the dynamic nature of child participation in decisions due to the growth and development of children, the family context of all pediatric decisions, and the measurement of preferences and outcomes that may inform decision making in the pediatric setting. The objectives of this article are to describe each of these challenges, to provide decision researchers with insight into pediatric decision making, and to establish a blueprint for future research that will contribute to high-quality pediatric medical decision making. Much work has been done to address gaps in pediatric decision science, but substantial work remains. Understanding and addressing the challenges that exist in pediatric decision making may foster medical decision-making science across the age spectrum.

Nature
Volume 519 Number 7543 pp261-382 19 March 2015
http://www.nature.com/nature/current_issue.html

World View
Share the risks of Ebola vaccine development
Ebola vaccines have little in the way of commercial markets, so the risks should be shared between governments and industry, says Seth Berkley.
18 March 2015
There are hundreds of infectious diseases out there that people could catch. More than 300 such conditions were discovered in the second half of the twentieth century alone. And how many of these diseases can scientists and clinicians protect against with a licensed vaccine? Fewer than 30.

Those are not always the biggest killers, or the most terrifying. Vaccine development is driven not by the risk that a pathogen poses to people, but by the economic pay-off. Given the difficulty of the science involved, how much money will it take to develop the vaccine? And given the size of the market, how much money can we make by selling it?

That helps to explain why, more than a year on from the first confirmed cases of the ongoing Ebola outbreak in West Africa, no vaccine is available, even though work started towards one more than a decade ago. Phase III trials for two vaccines have now been launched in Liberia and Guinea, and we have great hope for them, assuming that there are still enough cases developing to test the vaccines for efficacy. But for the more than 10,000 people who have lost their lives, and countless others who have suffered and will continue to suffer, these trials have come too late.

Our inability to protect people against Ebola is part of what makes the disease so frightening. In most cases, it is not what a disease is capable of that scares us, but that we can do so little about it.

But why is this the case for Ebola? We have known about the disease since 1976, and the first vaccine candidate was developed more than a decade ago. Ebola is not hypervariable like influenza or HIV, constantly changing and finding new ways to evade our immune systems, so we have had ample time to develop a vaccine or effective treatment during any one of the previous 23 outbreaks. Why were we caught by surprise this time?

The short answer is that we were not, but that the development of a vaccine was considered too financially risky. With a disease such as Ebola, which kills ferociously but occurs sporadically and usually in remote areas, there is simply no commercial market. Who would buy it? Outbreaks usually involve only a couple of hundred cases and occur every few years in poor rural communities in Africa. This leaves little in the way of incentives for manufacturers to invest the hundreds of millions of dollars it takes to develop a vaccine and get it clinically approved.

“We need to stop waiting until we see evidence of a disease becoming a global threat before we treat it like one.”

It is childish to blame the drug industry for failing to develop an Ebola vaccine — a product with no market. Instead, governments, public funders and private donors should be stepping up and investing.

We must work on a strategy that allows meaningful quantities of proven vaccines to be quickly produced and distributed when an outbreak occurs — of Ebola or other infectious diseases.

A first step is to identify the biggest threats, and that demands better disease surveillance. More and better-equipped laboratories, as well as trained epidemiologists, in developing countries would improve our ability to quickly detect and investigate outbreaks of commonly occurring diseases, as well new threats.

The vast amount of data produced by this kind of surveillance network would have an added bonus. With the right smart data-mining algorithms, the information could be used to radically increase our understanding of how pathogens travel and mutate, and then how our immune systems respond to these changes.

When an outbreak occurs and vaccines are needed, it would help significantly to have vectors ready to deliver them. With the right investment, these vectors, typically a harmless virus or bacterium, could be prepared and tested in advance. Crucially, they could be pressed into service to tackle a range of diseases. Four of the five Ebola vaccines currently going through clinical trials use vectors developed and tested for HIV.

Such generic vectors would, in effect, modularize the vaccine development process — conducting much of the safety testing and ironing out manufacturing processes for different vectors ready for the addition of a ‘payload’ antigen. By developing such mechanisms in advance, and pre-testing them for safety and dose, we can save significant amounts of money and time by having stockpiles frozen and ready for use or efficacy testing as soon as an outbreak occurs.

This is similar to the way in which technology developed using public funds through NASA has reduced the cost of placing scientific probes, telescopes and satellites into space. Same rocket, different payload.

It demands a different attitude to disease control. We need to stop waiting until we see evidence of a disease becoming a global threat before we treat it like one. Vaccine development is expensive, but the United States currently spends at least US$11 billion a year to keep fleets of nuclear-armed submarines patrolling the oceans to protect people from a threat that will almost certainly never happen. That is 60 times more than the World Health Organization puts into global disease preparedness.

Governments and donors need to invest in public-health capability, and they need to take on more of the risk of investing in vaccine development. We must view vaccines as the ultimate deterrent: make sure they are there, and pray that we never have to use them.

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Comment
Agriculture: Increase water harvesting in Africa
Meeting global food needs requires strategies for storing rainwater and retaining soil moisture to bridge dry spells, urge Johan Rockström and Malin Falkenmark.

New England Journal of Medicine
March 19, 2015 Vol. 372 No. 12
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Having and Fighting Ebola — Public Health Lessons from a Clinician Turned Patient
Craig Spencer, M.D., M.P.H.
N Engl J Med 2015; 372:1089-1091 March 19, 2015 DOI: 10.1056/NEJMp1501355

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 21 March 2015)

Viewpoints
Neglected Tropical Disease Control and Elimination: Is Human Displacement an Achilles Heel?
Kaylee Myhre Errecaborde, William Stauffer, Martin Cetron
Published: March 19, 2015
DOI: 10.1371/journal.pntd.0003535

[Initial text]
The United Nations High Commission for Refugees (UNHCR) has estimated that over 40 million people [1] are currently displaced and have variable access to health care in the country in which they reside. Populations displaced by conflict are largely disenfranchised, and high prevalence of neglected tropical diseases (NTDs) has been documented [2]. NTDs generally affect the least advantaged people in poor societies—populations with little voice or representation. These already susceptible people become even more vulnerable when forced from their communities as internally displaced persons (IDPs), refugees, or forced migrants. To further complicate matters, many of these people of concern are under 18 years old. Children experience the greatest risk and suffer the most consequences of NTDs. As marginalized populations flee from conflict or environmental catastrophe, they are often burdened with insidious NTDs ranging from asymptomatic to overt and debilitating disease. Many suffer from chronic consequences such as malnutrition, growth stunting and developmental delays, inhibiting chances for sustainable livelihoods and making it less likely that they will successfully overcome the adversity of displacement.

The World Health Organization (WHO) has defined 17 key neglected diseases, but several others exist [3]. These diseases are highlighted in Millennium Development Goal (MDG) 6, which aims to combat HIV/AIDS and “other diseases,” of which the NTDs are discussed at length [4,5]. It is the intent of these authors to raise the awareness of readers, and argue that inclusion of these displaced populations in preventive chemotherapy (PCT) programs and multi-model community-based interventions is not only necessary for sustained success of NTD control but is also a moral imperative…

PLoS One
[Accessed 21 March 2015]
http://www.plosone.org/

Research Article
Mechanisms of Immunity in Post-Exposure Vaccination against Ebola Virus Infection
Steven B. Bradfute, Scott M. Anthony, Kelly S. Stuthman, Natarajan Ayithan, Prafullakumar Tailor, Carl I. Shaia, Mike Bray, Keiko Ozato, Sina Bavari
Published: March 18, 2015
DOI: 10.1371/journal.pone.0118434
Abstract
Ebolaviruses can cause severe hemorrhagic fever that is characterized by rapid viral replication, coagulopathy, inflammation, and high lethality rates. Although there is no clinically proven vaccine or treatment for Ebola virus infection, a virus-like particle (VLP) vaccine is effective in mice, guinea pigs, and non-human primates when given pre-infection. In this work, we report that VLPs protect Ebola virus-infected mice when given 24 hours post-infection. Analysis of cytokine expression in serum revealed a decrease in pro-inflammatory cytokine and chemokine levels in mice given VLPs post-exposure compared to infected, untreated mice. Using knockout mice, we show that VLP-mediated post-exposure protection requires perforin, B cells, macrophages, conventional dendritic cells (cDCs), and either CD4+ or CD8+ T cells. Protection was Ebola virus-specific, as marburgvirus VLPs did not protect Ebola virus-infected mice. Increased antibody production in VLP-treated mice correlated with protection, and macrophages were required for this increased production. However, NK cells, IFN-gamma, and TNF-alpha were not required for post-exposure-mediated protection. These data suggest that a non-replicating Ebola virus vaccine can provide post-exposure protection and that the mechanisms of immune protection in this setting require both increased antibody production and generation of cytotoxic T cells

PNAS – Proceedings of the National Academy of Sciences of the United States of America
(Accessed 21 March 2015)
http://www.pnas.org/content/early/

Global trends in antimicrobial use in food animals
Thomas P. Van Boeckela,1, Charles Browerb, Marius Gilbertc,d, Bryan T. Grenfella,e,f, Simon A. Levina,g,h,1, Timothy P. Robinsoni, Aude Teillanta,e, and Ramanan Laxminarayanb,e,j,1
Author Affiliations
Contributed by Simon A. Levin, February 18, 2015 (sent for review November 21, 2014; reviewed by Delia Grace and Lance B. Price)

Significance
Antimicrobials are used in livestock production to maintain health and productivity. These practices contribute to the spread of drug-resistant pathogens in both livestock and humans, posing a significant public health threat. We present the first global map (228 countries) of antibiotic consumption in livestock and conservatively estimate the total consumption in 2010 at 63,151 tons. We project that antimicrobial consumption will rise by 67% by 2030, and nearly double in Brazil, Russia, India, China, and South Africa. This rise is likely to be driven by the growth in consumer demand for livestock products in middle-income countries and a shift to large-scale farms where antimicrobials are used routinely. Our findings call for initiatives to preserve antibiotic effectiveness while simultaneously ensuring food security in low- and lower-middle-income countries.

Abstract
Demand for animal protein for human consumption is rising globally at an unprecedented rate. Modern animal production practices are associated with regular use of antimicrobials, potentially increasing selection pressure on bacteria to become resistant. Despite the significant potential consequences for antimicrobial resistance, there has been no quantitative measurement of global antimicrobial consumption by livestock. We address this gap by using Bayesian statistical models combining maps of livestock densities, economic projections of demand for meat products, and current estimates of antimicrobial consumption in high-income countries to map antimicrobial use in food animals for 2010 and 2030. We estimate that the global average annual consumption of antimicrobials per kilogram of animal produced was 45 mg⋅kg−1, 148 mg⋅kg−1, and 172 mg⋅kg−1 for cattle, chicken, and pigs, respectively. Starting from this baseline, we estimate that between 2010 and 2030, the global consumption of antimicrobials will increase by 67%, from 63,151 ± 1,560 tons to 105,596 ± 3,605 tons. Up to a third of the increase in consumption in livestock between 2010 and 2030 is imputable to shifting production practices in middle-income countries where extensive farming systems will be replaced by large-scale intensive farming operations that routinely use antimicrobials in subtherapeutic doses. For Brazil, Russia, India, China, and South Africa, the increase in antimicrobial consumption will be 99%, up to seven times the projected population growth in this group of countries. Better understanding of the consequences of the uninhibited growth in veterinary antimicrobial consumption is needed to assess its potential effects on animal and human health.

Risk Analysis
February 2015 Volume 35, Issue 2 Pages 179–344
http://onlinelibrary.wiley.com/doi/10.1111/risa.2015.35.issue-2/issuetoc

Current Topics
The Role of Risk Analysis in Understanding Ebola
Charles N. Haas*
Article first published online: 19 MAR 2015
DOI: 10.1111/risa.12361
[No abstract]

Original Research Article
Risk Management for Development—Assessing Obstacles and Prioritizing Action
Stéphane Hallegatte1,* and Jun Rentschler1,2
Article first published online: 25 AUG 2014
DOI: 10.1111/risa.12269
Abstract
Throughout the process of economic and social development, decisionmakers from the household to the state level are confronted with a multitude of risks: from health and employment risks, to financial and political crises, as well as environmental damages and from the local to global level. The World Bank’s 2014 World Development Report (WDR) provides an in-depth analysis of how the management of such risks can be improved. In particular, it argues that a proactive and integrated approach to risk management can create opportunities for fighting poverty and achieving prosperity—but also acknowledges substantial obstacles to its implementation in practice. This article presents and discusses these obstacles with respect to their causes, consequences, interlinkages, and solutions. In particular, these include obstacles to individual risk management, the obstacles that are beyond the control of individuals and thus require collective action, and, finally, the obstacles that affect the ability of governments and public authorities to manage risks. From these obstacles, this article derives a policy roadmap for the development of risk management strategies that are designed not only around the risk they have to cope with, but also around the practical obstacles to policy implementation.

Quantifying Flood Risks in the Netherlands (pages 252–264)
R. B. Jongejan and B. Maaskant
Article first published online: 6 JAN 2015 | DOI: 10.1111/risa.12285

Risk Perceptions and Trust Following the 2010 and 2011 Icelandic Volcanic Ash Crises (pages 332–343)
J. Richard Eiser, Amy Donovan and R. Stephen J. Sparks
Article first published online: 26 SEP 2014 | DOI: 10.1111/risa.12275

Science
20 March 2015 vol 347, issue 6228, pages 1285-1388
http://www.sciencemag.org/current.dtl

In Depth
Infectious Diseases
MERS surges again, but pandemic jitters ease
Kai Kupferschmidt
The number of infections of the deadly Middle East respiratory syndrome virus surges again in Saudi Arabia, but scientists are less worried that the virus will cause a pandemic than they were 3 years ago. Still, many details about the virus discovered in 2012 and harbored by camels are unclear. New research suggests that many more people than previously thought may have been infected with no or little symptoms. The best way to protect people may be a camel vaccine, and experiments to test two candidate vaccines in camels have just been finished in the United States and Europe.

Addiction
Early View
Article first published online: 10 MAR 2015

Editorial
Why are we not doing more for alcohol use disorder among conflict-affected populations?
Bayard Roberts1,* and Nadine Ezard2,3
DOI: 10.1111/add.12869
Excerpt [Open Access]
Despite considerable risk of alcohol use disorder (AUD) among civilians affected by armed conflict, the humanitarian response and research on this issue are inadequate. There needs to be greater engagement with AUD among humanitarian, developmental, United Nations, governmental, donor and research agencies. There also needs to be more comprehensive guidance and tools on ways to address AUD.

There are currently more than 50 million people forcibly displaced from their homes as refugees and internally displaced persons (IDPs) due to armed conflict—the highest number since the Second World War. There are also many millions more who remain in areas affected by conflict or have recently returned to them after displacement. The vast majority are in low- and middle-income countries.

There are a number of reasons why we should be concerned about alcohol use disorder (AUD) among conflict-affected civilian populations in low- and middle-income countries. They are often exposed to high levels of violent and traumatic events which are strongly associated with mental disorders such as post-traumatic stress disorder (PTSD), depression and anxiety [1]. Both exposure to traumatic events and these mental disorders are, in turn, associated with AUD [2-6]. Conflict and forced displacement of refugees and IDPs also lead commonly to worse living conditions and impoverishment; the loss of family, friends and livelihoods; and erosion of social support, self-esteem and resilience. Alcohol may be used as a form of self-medication or a coping strategy. Poor living conditions and limited access to health care further increase the disease burden per unit of alcohol consumed [7]. The post-conflict environment may also witness a scaling-up of alcohol promotion as new markets open up and national and transnational alcohol companies expand their activities [8, 9]…