Professionals in Humanitarian Assistance and Protection (PHAP) [to 31 October 2015]
https://phap.org/

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PHAP members provide input to Global Protection Cluster strategy review
26 October 2015
In 2015, the Global Protection Cluster (GPC) will update its Strategic Framework and revitalize its structures to react better to the needs of the field. As part of the consultations for this revision, PHAP fielded a survey to its members and wider contact network in September in order to gather…

HHMI – Howard Hughes Medical Institute [to 7 November 2015]
https://www.hhmi.org/news

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Research [ October 28, 2015 ]
Researchers Identify New Factors that Guide Organization of Plant Roots
HHMI scientists have identified a set of proteins that plays a surprisingly broad role in guiding tissue formation in plant roots.

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Research [ October 26, 2015 ]
Seeing the Big Picture
Within less than a second, the new IsoView microscope produces images of entire organisms, such as a zebrafish or fruit fly embryo, with enough resolution in all three dimensions that each cell appears as a distinct structure.

Rockefeller Foundation [to 7 November 2015]
http://www.rockefellerfoundation.org/newsroom

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Richard D. Parsons Elected Next Chair of The Rockefeller Foundation Board
October 28, 2015
David Rockefeller Jr. to Step Down at End of Five Year Term
NEW YORK—The Trustees of The Rockefeller Foundation announced today the unanimous election of business executive Richard D. Parsons as the next Chair of the Board of Trustees. Parsons will serve as Chair-Elect until June of 2016 when he will take over as Chair at the end of the term of the current Board Chair, David Rockefeller Jr. Parsons joined The Rockefeller Foundation Board of Trustees in 2008.
David Rockefeller Jr., joined The Rockefeller Foundation board of trustees in 2006 and he began serving as Board Chair in December 2010. His term of Chair included the Foundation’s Centennial in 2013, an historic opportunity to reflect on one hundred years of impact and to launch new work for a second century.
David Rockefeller Jr. said: “It has been an enormous honor to serve as Board Chair of the philanthropy established by my great-grandfather in 1913. It gives me great pleasure that my successor will be Dick Parsons, a good friend of mine. Dick has led an inspiring career in both business and public service and has been an invaluable member of the board since 2007. I am certain that under Dick and Judith’s leadership the Foundation will continue to go from strength to strength.”…

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HAMILTON: The Musical and The Rockefeller Foundation Announce Partnership to Provide 20,000 NYC Public School Students with Tickets to Hamilton on Broadway With $1.46 Million Grant
October 27, 2015
Innovative Educational Collaboration with the Gilder Lehrman Institute of American History and the NYC Department of Education Will Support Classroom Studies

Robert Wood Johnson Foundation [to 7 November 2015]
http://www.rwjf.org/en/about-rwjf/newsroom/news-releases.html

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RWJF Awards Eight Communities with RWJF Culture of Health Prize
October 28, 2015
The Robert Wood Johnson Foundation announced the eight winners of the 2015 RWJF Culture of Health Prize, which honors communities that are working to ensure that everyone has the opportunity to live a longer, healthier, and more productive life.

American Journal of Infection Control
November 2015 Volume 43, Issue 11, p1147-1268, e67-e81
http://www.ajicjournal.org/current

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Social and political determinants of vaccine hesitancy: Lessons learned from the H1N1 pandemic of 2009-2010
Gustavo S. Mesch, Kent P. Schwirian
p1161–1165
Preview
Public acceptance of vaccination programs is essential for vaccine preventable diseases. However, increasing sectors of the population have expressed hesitancy about participating in such programs, leading to the re-emergence of vaccine preventable diseases. In this study we rely on a recreancy hypothesis to test the association between confidence in the government and local hospitals and the willingness to take the vaccine.

American Journal of Public Health
Volume 105, Issue S5 (November 2015)
http://ajph.aphapublications.org/toc/ajph/current

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Universal Health Coverage: A Political Struggle and Governance Challenge
Scott L. Greer, Claudio A. Méndez
American Journal of Public Health: November 2015, Vol. 105, No. S5: S637–S639
Abstract
Universal health coverage has become a rallying cry in health policy, but it is often presented as a consensual, technical project. It is not.
A review of the broader international literature on the origins of universal coverage shows that it is intrinsically political and cannot be achieved without recognition of its dependence on, and consequences for, both governance and politics.

On one hand, a variety of comparative research has shown that health coverage is associated with democratic political accountability. Democratization, and in particular left-wing parties, gives governments particular cause to expand health coverage. On the other hand, governance, the ways states make and implement decisions, shapes any decision to strive for universal health coverage and the shape of its implementation.

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 7 November 2015)

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Research article
Determinants of postnatal care use at health facilities in rural Tanzania: multilevel analysis of a household survey
Diwakar Mohan, Shivam Gupta, Amnesty LeFevre, Eva Bazant, Japhet Killewo, Abdullah H Baqui BMC Pregnancy and Childbirth 2015, 15:282 (30 October 2015)

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Research article
Adverse pregnancy outcomes in rural Uganda (1996–2013): trends and associated factors from serial cross sectional surveys
Gershim Asiki, Kathy Baisley, Rob Newton, Lena Marions, Janet Seeley, Anatoli Kamali, Lars Smedman
BMC Pregnancy and Childbirth 2015, 15:279 (29 October 2015)

BMC Public Health
http://www.biomedcentral.com/bmcpublichealth/content
(Accessed 7 November 2015)

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Research article
Prevalence and care-seeking for chronic diseases among Syrian refugees in Jordan
Shannon Doocy, Emily Lyles, Timothy Roberton, Laila Akhu-Zaheya, Arwa Oweis, Gilbert Burnham
BMC Public Health 2015, 15:1097 (7 November 2015)
Abstract
Background
There are currently more people displaced by conflict than at any time since World War II. The profile of displaced populations has evolved with displacement increasingly occurring in urban and middle-income settings. Consequently, an epidemiological shift away from communicable diseases that have historically characterized refugee populations has occurred. The high prevalence of non-communicable diseases (NCDs) poses a challenge to in terms of provision of appropriate secondary and tertiary services, continuity of care, access to medications, and costs. In light of the increasing burden of NCDs faced by refugees, we undertook this study to characterize the prevalence of NCDs and better understand issues related to care-seeking for NCDs among Syrian refugees in non-camp settings in Jordan.
Methods
A cross-sectional survey of 1550 refugees was conducted using a multi-stage cluster design with probability proportional to size sampling to obtain a nationally representative sample of Syrian refugees outside of camps. To obtain information on chronic conditions, respondents were asked a series of questions about hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and arthritis. Differences by care-seeking for these conditions were examined using chi-square and t-test methods and characteristics of interest were included in the adjusted logistic regression model.
Results
Among adults, hypertension prevalence was the highest (9.7 %, CI: 8.8–10.6), followed by arthritis (6.8 %, CI: 5.9–7.6), diabetes (5.3 %, CI: 4.6–6.0), chronic respiratory diseases (3.1 %, CI: 2.4–3.8), and cardiovascular disease (3.7 %, CI: 3.2, 4.3). Of the 1363 NCD cases, 84.7 % (CI: 81.6–87.3) received care in Jordan; of the five NCDs assessed, arthritis cases had the lowest rates of care seeking at 65 %, (CI:0–88, p=0.005). Individuals from households in which the head completed post-secondary and primary education, respectively, had 89 % (CI: 22–98) and 88 % (CI: 13–98) lower odds of seeking care than those with no education (p=0.028 and p=0.037, respectively). Refugees in North Jordan were most likely to seek care for their condition; refugees in Central Jordan had 68 % (CI: 1–90) lower odds of care-seeking than those in the North (p=0.047).
Conclusion
More than half of Syrian refugee households in Jordan reported a member with a NCD. A significant minority did not receive care, citing cost as the primary barrier. As funding limitations persist, identifying the means to maintain and improve access to NCD care for Syrian refugees in Jordan is essential.

Bulletin of the World Health Organization
Volume 93, Number 11, November 2015, 741-816
http://www.who.int/bulletin/volumes/93/11/en/

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EDITORIALS
Gender, health and the Sustainable Development Goals
Veronica Magar

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RESEARCH
An insecticide-treated bed-net campaign and childhood malaria in Burkina Faso
Valérie R Louis, Anja Schoeps, Justin Tiendrebéogo, Claudia Beiersmann, Maurice Yé, Marie R Damiba, Guang Y Lu, André H Mbayiha, Manuela De Allegri, Albrecht Jahn, Ali Sié, Heiko Becher & Olaf Müller
doi: 10.2471/BLT.14.147702

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POLICY & PRACTICE
Evidence on global medical travel
Kai Ruggeri, Ladislav Záliš, Christopher R Meurice, Ian Hilton, Terry-Lisa Ly, Zorana Zupan & Saba Hinrichs
doi: 10.2471/BLT.14.146027
Abstract
The potential benefits of travelling across national borders to obtain medical treatment include improved care, decreased costs and reduced waiting times. However, medical travel involves additional risks, compared to obtaining treatment domestically. We review the publicly-available evidence on medical travel. We suggest that medical travel needs to be understood in terms of its potential risks and benefits so that it can be evaluated against alternatives by patients who are seeking care. We propose three domains –quality standards, informed decision-making, economic and legal protection – in which better evidence could support the development of medical travel policies.

Conflict and Health
http://www.conflictandhealth.com/
[Accessed 7 November 2015]

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Debate
Coincident polio and Ebola crises expose similar fault lines in the current global health regime
Philippe Calain, Caroline Abu Sa’Da
Conflict and Health 2015, 9:29 (16 Sept 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.

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

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Global governmentality: Biosecurity in the era of infectious diseases
Jlateh Vincent Jappah & Danielle Taana Smith
pages 1139-1156
DOI:10.1080/17441692.2015.1038843
Abstract
This paper uses Foucault’s concept of governmentality to examine relationships between globalisation, the threat of infectious diseases and biosecurity. It draws attention to forms of calculated practices which Foucault notes as technologies of power that aim to foster positive demographic and economic trends in societies through the apparatus of security. These practices are employed at the global level with similar ambitions; hence, we adopt the term global governmentality. We discuss the applications of global governmentality by actors in the global core through the apparatus of security and (neo)liberal economic practices. We then provide examples of resistance/contestation from actors mainly in the global periphery through discussions of viral sovereignty; access to essential medicines, including HIV drugs; and health for all as a human right. We conclude that despite the core-periphery power asymmetry and competing paradigms, these developments tend to complement and/or regulate the phenomenon termed global governmentality, which is made evident by the tremendous successes in global health.

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Making surgical missions a joint operation: NGO experiences of visiting surgical teams and the formal health care system in Guatemala
Stephanie Roche & Rachel Hall-Clifford
pages 1201-1214
DOI:10.1080/17441692.2015.1011189
Abstract
Each year, thousands of Guatemalans receive non-emergent surgical care from short-term medical missions (STMMs) hosted by local non-governmental organizations (NGOs) and staffed by foreign visiting medical teams (VMTs). The purpose of this study was to explore the perspectives of individuals based in NGOs involved in the coordination of surgical missions to better understand how these missions articulate with the larger Guatemalan health care system. During the summers of 2011 and 2013, in-depth interviews were conducted with 25 representatives from 11 different Guatemalan NGOs with experience with surgical missions. Transcripts were analysed for major themes using an inductive qualitative data analysis process. NGOs made use of the formal health care system but were limited by several factors, including cost, issues of trust and current ministry of health policy. Participants viewed the government health care system as a potential resource and expressed a desire for more collaboration. The current practices of STMMs are not conducive to health system strengthening. The role of STMMs must be defined and widely understood by all stakeholders in order to improve patient safety and effectively utilise health resources. Priority should be placed on aligning the work of VMTs with that of the larger health care system.

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 31 October2015]

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Research Article
Indirect costs associated with deaths from the Ebola virus disease in West Africa
Joses Kirigia, Felix Masiye, Doris Kirigia, Patricia Akweongo Infectious Diseases of Poverty 2015, 4:45 (29 October 2015)
Editor’s summary
Deaths associated with Ebola Virus Disease have been shown to impose a significant economic burden on the affected West African countries. The team did this study to complement the projection by the World Bank in 2014; and made a plea for increased domestic and external investments to enable Guinea, Liberia and Sierra Leone (and other vulnerable African countries) to develop resilient health systems. Image: Ebola v?rus disease treatment centre in Monrovia, Sierra Leone.

Abstract
Background
By 28 June 2015, there were a total of 11,234 deaths from the Ebola virus disease (EVD) in five West African countries (Guinea, Liberia, Mali, Nigeria and Sierra Leone). The objective of this study was to estimate the future productivity losses associated with EVD deaths in these West African countries, in order to encourage increased investments in national health systems.
Methods
A cost-of-illness method was employed to calculate future non-health (NH) gross domestic product (GDP) (NHGDP) losses associated with EVD deaths. The future non-health GDP loss (NHGDPLoss) was discounted at 3 %. Separate analyses were done for three different age groups (< =14 years, 15–44 years and = >45 years) for the five countries (Guinea, Liberia, Mali, Nigeria, and Sierra Leone) affected by EVD. We also conducted a one-way sensitivity analysis at 5 and 10 % discount rates to gauge their impacts on expected NHGDPLoss.
Results
The discounted value of future NHGDPLoss due to the 11,234 deaths associated with EVD was estimated to be Int$ (international dollars) 155,663,244. About 27.86 % of the loss would be borne by Guinea, 34.84 % by Liberia, 0.10 % by Mali, 0.24 % by Nigeria and 36.96 % by Sierra Leone. About 27.27 % of the loss is attributed to those aged under 14 years, 66.27 % to those aged 15–44 years and 6.46 % to those aged over 45 years. The average NHGDPLoss per EVD death was estimated to be Int$ 17,473 for Guinea, Int$ 11,283 for Liberia, Int$ 25,126 for Mali, Int$ 47,364 for Nigeria and Int$ 14,633 for Sierra Leone.
Conclusion
In spite of alluded limitations, the estimates of human and economic losses reported in this paper, in addition to those projected by the World Bank, show that EVD imposes a significant economic burden on the affected West African countries. That heavy burden, coupled with human rights and global security concerns, underscores the urgent need for increased domestic and external investments to enable Guinea, Liberia and Sierra Leone (and other vulnerable African countries) to develop resilient health systems, including core capacities to detect, assess, notify, verify and report events, and to respond to public health risks and emergencies.

Intervention – Journal of Mental Health and Psychological Support in Conflict Affected Areas
November 2015 – Volume 13 – Issue 3 pp: 200-296
http://journals.lww.com/interventionjnl/pages/currenttoc.aspx

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Mental health and psychosocial support in humanitarian settings: reflections on a review of UNHCR’s approach and activities
Meyer, Sarah; Morand, Mary-Beth
Abstract
Mental health and psychosocial support activities are increasingly becoming a core component of humanitarian response and support for displaced persons in emergencies. However, recognition of the mental health and psychosocial impacts of conflict, disaster and displacement is relatively new within the sphere of humanitarian assistance. This paper, therefore, describes and expands on findings from a review of the UN Refugee Agency’s engagement with mental health and psychosocial support for refugees. While this review specifically focused on one agency within the humanitarian field, it should be useful to many humanitarian agencies working in the field as the number of displacement scenarios grow and mental health and psychosocial aspects of displacement are increasingly evident. This review identified three key themes; 1) engaging with mental health and psychosocial support in humanitarian settings as an approach and as a set of interventions was found to be a useful framework; 2) challenges in measuring and evaluating mental health and psychosocial support activities, and the ways in which these challenges influence mental health and psychosocial support in humanitarian settings is discussed; and 3) limitations in provision of clinical mental health services were evident.

Journal of International Development
October 2015 Volume 27, Issue 7 Pages 881–1350
http://onlinelibrary.wiley.com/doi/10.1002/jid.v27.6/issuetoc

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Rescuing Girls, Investing in Girls: A Critique of Development Fantasies (pages 881–897)
Cynthia M. Caron and Shelby A. Margolin
Article first published online: 24 SEP 2015 | DOI: 10.1002/jid.3146
Abstract
The girl child increasingly is at the centre of development programming. We draw on Slavoj Zizek’s notion of fantasy to show how and, more importantly, why girl-centred initiatives reproduce the shortcomings of women and gender-focused programmes before them. Through an analysis of three girl-centred campaigns, we illustrate how experts identify and diagnose girls’ problems and prescribe solutions that not only circumscribe girls’ futures, but are also counterproductive. We argue that even as campaigns try to integrate lessons learned from earlier gender and development initiatives, the critical reflection that a Zizekian approach promotes would better enable development actors to reformulate campaigns and fundamental campaign assumptions.

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Knowing and Doing Between the Academic and Policy Worlds in Development Assistance (pages 1294–1311)
Morgan Brigg, Jodie Curth-Bibb, Elizabeth Strakosch and Martin Weber
Article first published online: 22 JAN 2015 | DOI: 10.1002/jid.3068
Abstract
Policy professionals overseeing the provision of development assistance and their critical academic counterparts are often at odds with each other. Although many agree that it is useful to deal with this tension, current efforts to do so tend to exhort each to be more like the other under the rhetoric of ‘evidence-based policy’. Meanwhile, the differences between these players are kept alive by mutual misunderstandings that can border upon stereotyping. This paper reflects on this situation from the perspective of the critical academic and offers an enhanced understanding of key positions and misapprehensions to contribute to a foundation for improved relationships.

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From Unconventional to Ordinary? The Bill and Melinda Gates Foundation and the Homogenizing Effects of International Development Cooperation (pages 1098–1112)
Adam Moe Fejerskov
Article first published online: 9 SEP 2015 | DOI: 10.1002/jid.3149
Abstract
The majority of the literature on new actors in development cooperation explores how these alter the field. This article presents a reverse case of how the strong homogenizing norms and principles of international development may turn an unconventional development actor into something quite conventional and more alike to well-established actors. Drawing on insights from institutional theory, it examines organizational changes in the Bill and Melinda Gates Foundation from formation until today and argues that the foundation has progressed from a state of intentional isolation to one of actively engaging in and adhering to the field’s norm and principle-setting. Copyright © 2015 John Wiley & Sons, Ltd.

The Lancet
Oct 31, 2015 Volume 386 Number 10005 p1707-1794 e22-e26
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
What next for the malaria RTS,S vaccine candidate?
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(15)00733-3
Summary
On Oct 23, the Strategic Advisory Group of Experts on Immunization (SAGE) and the Malaria Policy Advisory Committee (MPAC) announced their much-anticipated recommendations for the world’s first malaria vaccine candidate known as RTS,S/AS01. Their decision is not to recommend widespread deployment of the vaccine based on existing evidence, but instead to assess the feasibility of delivering the vaccine and its impact in real-world settings. This decision was perhaps unexpected given the fact that earlier this year the European Medicines Agency reviewed the same safety and efficacy data, and approved the vaccine’s use in young children.

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Series
Faith-based health care
Understanding the roles of faith-based health-care providers in Africa: review of the evidence with a focus on magnitude, reach, cost, and satisfaction
Jill Olivier, Clarence Tsimpo, Regina Gemignani, Mari Shojo, Harold Coulombe, Frank Dimmock, Minh Cong Nguyen, Harrison Hines, Edward J Mills, Joseph L Dieleman, Annie Haakenstad, Quentin Wodon

Faith-based health care
Controversies in faith and health care
Andrew Tomkins, Jean Duff, Atallah Fitzgibbon, Azza Karam, Edward J Mills, Keith Munnings, Sally Smith, Shreelata Rao Seshadri, Avraham Steinberg, Robert Vitillo, Philemon Yugi

Faith-based health care
Strengthening of partnerships between the public sector and faith-based groups
Jean F Duff, Warren W Buckingham
1786

The Lancet Global Health
Nov 2015 Volume 3 Number 11 e654-e724
http://www.thelancet.com/journals/langlo/issue/current

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Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali: a cluster-randomised controlled trial
Amy J Pickering, Habiba Djebbari, Carolina Lopez, Massa Coulibaly, Maria Laura Alzua
Summary
Background
Community-led total sanitation (CLTS) uses participatory approaches to mobilise communities to build their own toilets and stop open defecation. Our aim was to undertake the first randomised trial of CLTS to assess its effect on child health in Koulikoro, Mali.
Methods
We did a cluster-randomised trial to assess a CLTS programme implemented by the Government of Mali. The study population included households in rural villages (clusters) from the Koulikoro district of Mali; every household had to have at least one child aged younger than 10 years. Villages were randomly assigned (1:1) with a computer-generated sequence by a study investigator to receive CLTS or no programme. Health outcomes included diarrhoea (primary outcome), height for age, weight for age, stunting, and underweight. Outcomes were measured 1·5 years after intervention delivery (2 years after enrolment) among children younger than 5 years. Participants were not masked to intervention assignment. The trial is registered with ClinicalTrials.gov, number NCT01900912.
Findings
We recruited participants between April 12, and June 23, 2011. We assigned 60 villages (2365 households) to receive the CLTS intervention and 61 villages (2167 households) to the control group. No differences were observed in terms of diarrhoeal prevalence among children in CLTS and control villages (706 [22%] of 3140 CLTS children vs 693 [24%] of 2872 control children; prevalence ratio [PR] 0·93, 95% CI 0·76–1·14). Access to private latrines was almost twice as high in intervention villages (1373 [65%] of 2120 vs 661 [35%] of 1911 households) and reported open defecation was reduced in female (198 [9%] of 2086 vs 608 [33%] of 1869 households) and in male (195 [10%] of 2004 vs 602 [33%] of 1813 households) adults. Children in CLTS villages were taller (0·18 increase in height-for-age Z score, 95% CI 0·03–0·32; 2415 children) and less likely to be stunted (35% vs 41%, PR 0·86, 95% CI 0·74–1·0) than children in control villages. 22% of children were underweight in CLTS compared with 26% in control villages (PR 0·88, 95% CI 0·71–1·08), and the difference in mean weight-for-age Z score was 0·09 (95% CI –0·04 to 0·22) between groups. In CLTS villages, younger children at enrolment (<2 years) showed greater improvements in height and weight than older children.
Interpretation
In villages that received a behavioural sanitation intervention with no monetary subsidies, diarrhoeal prevalence remained similar to control villages. However, access to toilets substantially increased and child growth improved, particularly in children <2 years. CLTS might have prevented growth faltering through pathways other than reducing diarrhoea.
Funding
Bill & Melinda Gates Foundation.

The Lancet Infectious Diseases
Nov 2015 Volume 15 Number 11 p1243-1360
http://www.thelancet.com/journals/laninf/issue/current

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Comment
Polio eradication: inching forward, with safety nets
Beth D Kirkpatrick, Josyf C Mychaleckyj
Summary
By mid-2015, WHO-reported cases of paralytic disease caused by polioviruses had reached a new low: only 34 cases were caused by wild polioviruses and nine cases were due to circulating vaccine-derived poliovirus (cVDPV).1 In light of this progress, WHO’s Polio Endgame Strategy is moving into a pivotal new stage, focusing on global withdrawal of a vaccine component from primary immunisation schedules. This plan will minimise the time to reach eradication, while maintaining the protection of children in case of disease re-emergence.

Comment
Near full control of human papillomavirus vaccine types
Joakim Dillner
Published Online: 19 July 2015
The Lancet Infectious Diseases, Eric Chow and colleagues1 report on the near elimination of the major human papillomavirus (HPV) types 6, 11, 16, and 18 after introduction of vaccination against these types in Australia when analysed in high-risk women. The authors use the innovative strategy of establishing HPV prevalence in women who are chlamydia positive. Traditional monitoring strategies would typically enrol from the general population, which is both cumbersome and expensive, and potentially biased because volunteering women would tend to be low risk, therefore possibly missing HPV circulation in high-risk core groups.

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Ebola: missed opportunities for Europe–Africa research
Giuseppe Ippolito, Simone Lanini, Philippe Brouqui, Antonino Di Caro, Francesco Vairo, Salim Abdulla, Francesco Maria Fusco, Sanjeev Krishna, Maria Rosaria Capobianchi, Henry Kyobe-Bosa, David J M Lewis, Vincenzo Puro, Roman Wolfel, Tatjana Avsic-Zupanc, Osman Dar, Peter Mwaba, Matthew Bates, David Heymann, Alimuddin Zumla
Summary
The current unprecedented Ebola virus disease outbreak in parts of west Africa, which has caused more than 11 200 deaths, has emphasised how the medical and scientific communities lack specific pathways for tackling relevant logistical, design, and ethical issues for assessment of novel diagnostics, treatments, and vaccines through implementation of appropriate clinical trials.1,2 The phenomenal outbreak arose because of several weaknesses in local, regional, and international public health responses, which delayed provision and implementation of effective intervention.

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Inactivated poliovirus vaccine given alone or in a sequential schedule with bivalent oral poliovirus vaccine in Chilean infants: a randomised, controlled, open-label, phase 4, non-inferiority study
Miguel O’Ryan, Ananda S Bandyopadhyay, Rodolfo Villena, Mónica Espinoza, José Novoa, William C Weldon, M Steven Oberste, Steve Self, Bhavesh R Borate, Edwin J Asturias, Ralf Clemens, Walter Orenstein, José Jimeno, Ricardo Rüttimann, Sue Ann Costa Clemens, Chilean IPV/bOPV study group
Summary
Background
Bivalent oral poliovirus vaccine (bOPV; types 1 and 3) is expected to replace trivalent OPV (tOPV) globally by April, 2016, preceded by the introduction of at least one dose of inactivated poliovirus vaccine (IPV) in routine immunisation programmes to eliminate vaccine-associated or vaccine-derived poliomyelitis from serotype 2 poliovirus. Because data are needed on sequential IPV–bOPV schedules, we assessed the immunogenicity of two different IPV–bOPV schedules compared with an all-IPV schedule in infants.
Methods
We did a randomised, controlled, open-label, non-inferiority trial with healthy, full-term (>2·5 kg birthweight) infants aged 8 weeks (± 7 days) at six well-child clinics in Santiago, Chile. We used supplied lists to randomly assign infants (1:1:1) to receive three polio vaccinations (IPV by injection or bOPV as oral drops) at age 8, 16, and 24 weeks in one of three sequential schedules: IPV–bOPV–bOPV, IPV–IPV–bOPV, or IPV–IPV–IPV. We did the randomisation with blocks of 12 stratified by study site. All analyses were done in a masked manner. Co-primary outcomes were non-inferiority of the bOPV-containing schedules compared with the all-IPV schedule for seroconversion (within a 10% margin) and antibody titres (within two-thirds log2 titres) to poliovirus serotypes 1 and 3 at age 28 weeks, analysed in the per-protocol population. Secondary outcomes were seroconversion and titres to serotype 2 and faecal shedding for 4 weeks after a monovalent OPV type 2 challenge at age 28 weeks. Safety analyses were done in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01841671, and is closed to new participants.
Findings
Between April 25 and August 1, 2013, we assigned 570 infants to treatment: 190 to IPV–bOPV–bOPV, 192 to IPV–IPV–bOPV, and 188 to IPV–IPV–IPV. 564 (99%) were vaccinated and included in the intention-to-treat cohort, and 537 (94%) in the per-protocol analyses. In the IPV–bOPV–bOPV, IPV–IPV–bOPV, and IPV–IPV–IPV groups, respectively, the proportions of children with seroconversion to type 1 poliovirus were 166 (98·8%) of 168, 95% CI 95·8–99·7; 178 (100%), 97·9–100·0; and 175 (100%), 97·9–100·0. Proportions with seroconvsion to type 3 poliovirus were 163 (98·2%) of 166, 94·8–99·4; 177 (100%), 97·9–100·0, and 172 (98·9%) of 174, 95·9–99·7. Non-inferiority was thus shown for the bOPV-containing schedules compared with the all-IPV schedule, with no significant differences between groups. In the IPV–bOPV–bOPV, IPV–IPV–bOPV, and IPV–IPV–IPV groups, respectively, the proportions of children with seroprotective antibody titres to type 1 poliovirus were 168 (98·8%) of 170, 95% CI 95·8–99·7; 181 (100%), 97·9–100·0; and 177 (100%), 97·9–100·0. Proportions to type 3 poliovirus were 166 (98·2%) of 169, 94·9–99·4; 180 (100%), 97·9–100·0; and 174 (98·9%) of 176, 96·0–99·7. Non-inferiority comparisons could not be done for this outcome because median titres for the groups receiving OPV were greater than the assay’s upper limit of detection (log2 titres >10·5). The proportions of children seroconverting to type 2 poliovirus in the IPV–bOPV–bOPV, IPV–IPV–bOPV, and IPV–IPV–IPV groups, respectively, were 130 (77·4%) of 168, 95% CI 70·5–83·0; 169 (96·0%) of 176, 92·0–98·0; and 175 (100%), 97·8–100. IPV–bOPV schedules resulted in almost a 0·3 log reduction of type 2 faecal shedding compared with the IPV-only schedule. No participants died during the trial; 81 serious adverse events were reported, of which one was thought to be possibly vaccine-related (intestinal intussusception).
Interpretation
Seroconversion rates against polioviruses types 1 and 3 were non-inferior in sequential schedules containing IPV and bOPV, compared with an all-IPV schedule, and proportions of infants with protective antibodies were high after all three schedules. One or two doses of bOPV after IPV boosted intestinal immunity for poliovirus type 2, suggesting possible cross protection. Additionally, there was evidence of humoral priming for type 2 from one dose of IPV. Our findings could give policy makers flexibility when choosing a vaccination schedule, especially when trying to eliminate vaccine-associated and vaccine-derived poliomyelitis.
Funding
Bill & Melinda Gates Foundation.

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Safety and immunogenicity of double-dose versus standard-dose hepatitis B revaccination in non-responding adults with HIV-1 (ANRS HB04 B-BOOST): a multicentre, open-label, randomised controlled trial
David Rey, Lionel Piroth, Marie-Josée Wendling, Patrick Miailhes, Marie-Louise Michel, Cécilie Dufour, Georges Haour, Philippe Sogni, Alexandra Rohel, Faiza Ajana, Eric Billaud, Jean-Michel Molina, Odile Launay, Fabrice Carrat, ANRS HB04 B-BOOST study group

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Post-exposure prophylaxis against Ebola virus disease with experimental antiviral agents: a case-series of health-care workers
Michael Jacobs, Emma Aarons, Sanjay Bhagani, Ruaridh Buchanan, Ian Cropley, Susan Hopkins, Rebecca Lester, Daniel Martin, Neal Marshall, Stephen Mepham, Simon Warren, Alison Rodger
Summary
Background
Although a few international health-care workers who have assisted in the current Ebola outbreak in west Africa have been medically evacuated for treatment of Ebola virus disease, more commonly they were evacuated after potential accidental exposure to Ebola virus. An urgent need exists for a consensus about the risk assessment of Ebola virus transmission after accidental exposure, and to investigate the use of post-exposure prophylaxis (PEP). Experimental vaccines have occasionally been used for Ebola PEP, but newly developed experimental antiviral agents have potential advantages. Here, we describe a new method for risk assessment and management of health-care workers potentially exposed to Ebola virus and report the use of experimental antiviral therapies for Ebola PEP in people.
Methods
We devised a risk assessment and management algorithm for health-care workers potentially exposed to Ebola virus and applied this to eight consecutive individuals who were medically evacuated to the UK from west Africa between January, and March, 2015. PEP with antiviral agents was given to health-care workers assessed to have had substantial risk exposures to Ebola virus. Participants were followed up for 42 days after potential exposure.
Findings
Four of eight health-care workers were classified as having had low risk exposures and managed by watchful waiting in the community. None of these health-care workers developed Ebola virus disease. The other four health-care workers had intermediate or maximum risk exposures and were given PEP with antiviral agents. PEP was well tolerated with no serious adverse effects. None of these four health-care workers, including two with maximum risk exposures from penetrating injuries with freshly used hollow-bore needles, developed Ebola virus disease.
Interpretation
Standardised risk assessment should be adopted and consensus guidelines developed to systematically study the efficacy and safety of PEP with experimental agents. New experimental antiviral treatments are a viable option for PEP against Ebola.
Funding
Royal Free London NHS Foundation Trust.

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Human papillomavirus in young women with Chlamydia trachomatis infection 7 years after the Australian human papillomavirus vaccination programme: a cross-sectional study
Eric P F Chow, Jennifer A Danielewski, Glenda Fehler, Sepehr N Tabrizi, Matthew G Law, Catriona S Bradshaw, Suzanne M Garland

PLOS Currents: Disasters
http://currents.plos.org/disasters/
[Accessed 31 October2015]

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An Analysis of the Relationship Between the Heat Index and Arrivals in the Emergency Department
October 29, 2015 · Research article
Background: Heatwaves are one of the most deadly weather-related events in the United States and account for more deaths annually than hurricanes, tornadoes, floods, and earthquakes combined. However, there are few statistically rigorous studies of the effect of heatwaves on emergency department (ED) arrivals. A better understanding of this relationship can help hospitals plan better and provide better care for patients during these types of events.
Methods: A retrospective review of all ED patient arrivals that occurred from April 15 through August 15 for the years 2008 through 2013 was performed. Daily patient arrival data were combined with weather data (temperature and humidity) to examine the potential relationships between the heat index and ED arrivals as well as the length of time patients spend in the ED using generalized additive models. In particular the effect the 2012 heat wave that swept across the United States, and which was hypothesized to increase arrivals was examined.
Results: While there was no relationship found between the heat index and arrivals on a single day, a non-linear relationship was found between the mean three-day heat index and the number of daily arrivals. As the mean three-day heat index initially increased, the number of arrivals significantly declined. However, as the heat index continued to increase, the number of arrivals increased. It was estimated that there was approximately a 2% increase in arrivals when the mean heat index for three days approached 100°F. This relationship was strongest for adults aged 18-64, as well as for patients arriving with lower acuity. Additionally, a positive relationship was noted between the mean three-day heat index and the length of stay (LOS) for patients in the ED, but no relationship was found for the time from which a patient was first seen to when a disposition decision was made. No significant relationship was found for the effect of the 2012 heat wave on ED arrivals, though it did have an effect on patient LOS.
Conclusion: A single hot day has only a limited effect on ED arrivals, but continued hot weather has a cumulative effect. When the heat index is high (~90°F) for a number of days in a row, this curtails peoples activities, but if the heat index is very hot (~100°F) this likely results in an exacerbation of underlying conditions as well as heat-related events that drives an increase in ED arrivals. Periods of high heat also affects the length of stay of patients either by complicating care or by making it more difficult to discharge patients.

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2011 Joplin, Missouri Tornado Experience, Mental Health Reactions, and Service Utilization: Cross-Sectional Assessments at Approximately 6 Months and 2.5 Years Post-Event
October 26, 2015 · Research article
Introduction. On May 22, 2011 the deadliest tornado in the United States since 1947 struck Joplin, Missouri killing 161 people, injuring approximately 1,150 individuals, and causing approximately $2.8 billion in economic losses.
Methods. This study examined the mental health effects of this event through a random digit dialing sample (N = 380) of Joplin adults at approximately 6 months post-disaster (Survey 1) and a purposive convenience sample (N = 438) of Joplin adults at approximately 2.5 years post-disaster (Survey 2). For both surveys we assessed tornado experience, posttraumatic stress, depression, mental health service utilization, and sociodemographics. For Survey 2 we also assessed social support and parent report of child strengths and difficulties.
Results. Probable PTSD relevance was 12.63% at Survey 1 and 26.74% at Survey 2, while current depression prevalence was 20.82% at Survey 1 and 13.33% at Survey 2. Less education and more tornado experience was generally related to greater likelihood of experiencing probable PTSD and current depression for both surveys. Men and younger participants were more likely to report current depression at Survey 1. Low levels of social support (assessed only at Survey 2) were related to more probable PTSD and current depression. For both surveys, we observed low rates of mental health service utilization, and these rates were also low for participants reporting probable PTSD and current depression. At Survey 2 we assessed parent report of child (ages 4 to 17) strengths and difficulties and found that child difficulties were more frequent for younger children (ages 4 to 10) than older children (ages 11 to 17), and that parents reporting probable PTSD reported a greater frequency of children with borderline or abnormal difficulties.
Discussion. Overall our results indicate that long-term (multi-year) community disaster mental health monitoring, assessment, referral, outreach, and services are needed following a major disaster like the 2011 Joplin tornado

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 31 October2015)

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Using Qualitative Evidence in Decision Making for Health and Social Interventions: An Approach to Assess Confidence in Findings from Qualitative Evidence Syntheses (GRADE-CERQual)
Simon Lewin, Claire Glenton, Heather Munthe-Kaas, Benedicte Carlsen, Christopher J. Colvin, Metin Gülmezoglu, Jane Noyes, Andrew Booth, Ruth Garside, Arash Rashidian
Guidelines and Guidance | published 27 Oct 2015 | PLOS Medicine
10.1371/journal.pmed.1001895
Summary Points
:: Qualitative evidence syntheses are increasingly used, but methods to assess how much confidence to place in synthesis findings are poorly developed.
:: The Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach helps assess how much confidence to place in findings from a qualitative evidence synthesis.
:: CERQual’s assessment of confidence for individual review findings from qualitative evidence syntheses is based on four components: the methodological limitations of the qualitative studies contributing to a review finding, the relevance to the review question of the studies contributing to a review finding, the coherence of the review finding, and the adequacy of data supporting a review finding.
:: CERQual provides a transparent method for assessing confidence in qualitative evidence syntheses findings. Like the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for evidence of effectiveness, CERQual may facilitate the use of qualitative evidence to inform decisions and shape policies.
:: The CERQual approach is being developed by a subgroup of the GRADE Working Group.

PLoS One
http://www.plosone.org/
[Accessed 31 October2015]

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The Impact of Hepatitis B Vaccination Status on the Risk of Diabetes, Implicating Diabetes Risk Reduction by Successful Vaccination
Jean Huang, Horng-Yih Ou, James Lin, Rudruidee Karnchanasorn, Wei Feng, Raynald Samoa, Lee-Ming Chuang, Ken C. Chiu
Research Article | published 28 Oct 2015 | PLOS ONE
10.1371/journal.pone.0139730

Missed Opportunities for Measles, Mumps, and Rubella (MMR) Immunization in Mesoamerica: Potential Impact on Coverage and Days at Risk
Ali H. Mokdad, Marielle C. Gagnier, K. Ellicott Colson, Emily Dansereau, Paola Zúñiga-Brenes, Diego Ríos-Zertuche, Annie Haakenstad, Casey K. Johanns, Erin B. Palmisano, Bernardo Hernandez, Emma Iriarte
Research Article | published 27 Oct 2015 | PLOS ONE
10.1371/journal.pone.0139680