David and Lucile Packard Foundation [to 2 April 2016]
http://www.packard.org/news/

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March 31, 2016
Carol Larson Receives Distinguished Service Award
Today the Council on Foundations announced the 2016 recipients of awards honoring exemplary leaders in the philanthropic field, including Packard Foundation President and CEO Carol Larson.

Carol, along with Ira Hirschfield, President and Trustee, Evelyn & Walter Haas, Jr. Fund, will receive the Distinguished Service Award, philanthropy’s highest honor, celebrates visionary leaders who embody those inspirational qualities that define excellence in philanthropy—commitment, courage, entrepreneurship, and impact…

Wellcome Trust [to 2 April 2016]
http://www.wellcome.ac.uk/News/2016/index.htm

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31 March 2016
Urgent action still needed in Ebola vaccine development
A panel of international experts today called for urgent steps to be taken to complete the development of safe, effective vaccines for Ebola, and ensure the world is prepared for future outbreaks.

A panel of international experts today called for urgent steps to be taken to complete the development of safe, effective vaccines for Ebola, and ensure the world is prepared for future outbreaks.

Although tremendous progress has been made in Ebola vaccine development in the last two years, the latest report by Wellcome and the University of Minnesota’s CIDRAP Ebola Vaccine Team B says without renewed commitment from the global public health community, progress towards approved vaccines for Ebola could grind to a halt as memories of the outbreak in West Africa begin to fade.

During the 2014-2015 epidemic, a total of 13 Ebola vaccine candidates (including different combinations of vaccines) were evaluated in phase 1 and/or phase 2 clinical trials and three phase 3 efficacy trials were initiated in Africa – one each in Guinea, Liberia, and Sierra Leone.

Vaccine manufacturers, such as Johnson & Johnson and GSK, have advanced their respective Ebola candidate vaccines well into the clinical trial process. Trials of one vaccine, Merck’s rVSV-ZEBOV, have progressed far enough to demonstrate that it is safe and effective, prompting GAVI, the vaccine alliance, to purchase 300,000 doses as a stockpile for use during future Ebola outbreaks.

However, to date, no vaccine has been submitted for regulatory review and many questions regarding Ebola vaccines remain unresolved. Today’s report from the Ebola Vaccine Team B identifies four main areas where work is still needed before the world is fully prepared for another Ebola outbreak:
.1. Filling in the gaps in data on the safety and efficacy of Ebola vaccines;
.2. Understanding the complex regulatory pathways for Ebola vaccines;
.3. Gaining direct input from African public health leaders to clarify how Ebola vaccines will be used or evaluated in respond to future Ebola outbreaks;
.4. Creating a business case for ongoing Ebola vaccine development and deployment.

The group outlines recommendations for how each of these can be achieved, including completing clinical trials of vaccine candidates to fill in the missing gaps in data, and being ready to run both phase 3 efficacy studies and phase 4 post-marketing studies from the start of the next Ebola outbreak.

Wellcome Trust Director Dr Jeremy Farrar, who co-chairs Ebola Vaccine Team B, said: “Although a global collaborative effort has moved us from having no drugs or vaccines in the early days of the Ebola epidemic to now having a safe, effective vaccine, and other promising candidates, it has taken too long, and the job is still not done.

“As Ebola infection rates come under control it’s a huge concern that complacency sets in, attention moves to more immediate threats, and Ebola vaccine development is left half-finished. Today we’re calling for a renewed commitment from the global health community. After the hard lessons we’ve learned, it would be a tragedy not to put a final stop to the current Ebola epidemic, and be prepared for the next outbreak.”

Co-chair, and Regents Professor and Director of CIDRAP, Dr Michael Osterholm added: “While many in the international public health community believe these efforts have solved ‘the problem of Ebola,’ the path forward is not quite so simple, and many unresolved challenges and questions remain. In our report, we identify the key areas in which critical additional work and effort are needed to enhance Ebola preparedness for future outbreaks, particularly in the megacities of equatorial Africa, and to address the ongoing concern that Ebola virus disease may become endemic in West Africa.”

This report from Team B follows a report published in February 2015, which set out a framework for developing vaccines for Ebola, and increasing preparedness for emerging infectious diseases. It can be downloaded from the CIDRAP website.

The group is called “Team B” in recognition of the principal role played by the World Health Organization and national governments in leading the international Ebola response.

American Journal of Infection Control
April 2016 Volume 44, Issue 4, p373-494, e37-e58
http://www.ajicjournal.org/current

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Major Articles
Risk factors for measles in children younger than age 8 months: A case-control study during an outbreak in Guangxi, China, 2013
Zhen-Zhu Tang, Yi-Hong Xie, Chuleeporn Jiraphongsa, Xuan-Hua Liu, Zhong-You Li, Virasakdi Chongsuvivatwong
e51–e58
Published online: December 28 2015
Highlights
:: This measles outbreak occurred at a near-elimination point.
:: A quarter of cases were under the recommended vaccination age (8 months).
:: Coverage of two-dose measles-containing vaccine was low (34%).
::The disease possible transmission to children visiting the hospitals.
:: The need for SIAs and prevention of hospital transmission cannot be overemphasized.
Background
Following a period (2009-2012) during which zero measles cases were reported, a measles outbreak occurred in 2013 in Bama County, Guangxi, China, that involved more than 100 children younger than age 8 months. We aimed to identify the pitfalls and risk factors while implementing the control measures.
Methods
An outbreak investigation and a case-control study was conducted among children younger than age 8 months. The serum specimens of the study subjects and their mothers were tested for measles immunoglobulin M and immunoglobulin G.
Results
The attack rate was 2.3/1,000 population. The median (interquartile range) age was 18.6 months (7.9-52.8 months). The coverage of 2-dose measles-containing vaccine was only 34%. The case-control study revealed 2 independent risk factors: low education level of main caregiver (odds ratio [OR], 2.86; 95% confidence interval [CI], 1.31-6.22) and visiting a hospital 7-21 days before the date of symptoms onset (OR, 9.84; 95% CI, 4.27-22.67). The population attributable fraction of the latter was 52.8%. The mothers of the cases had nonsignificantly higher levels of immunoglobulin M and were significantly more likely to have protective levels of immunoglobulin G than those of the controls. This suggests a reactive rather than protective role of the antibody to the child’s infection.
Conclusions
In a near-elimination but low measles-containing vaccine coverage community, supplementary immunization activities should be emphasized for children and women who are potential future mothers. The minimum age of measles-containing vaccine should be further reduced. Hospital measles transmission must also be strictly prevented.

American Journal of Public Health
Volume 106, Issue 4 (April 2016)
http://ajph.aphapublications.org/toc/ajph/current

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AJPH EDITORIALS
ZIKA Preventing Zika Virus Infections in Pregnant Women: An Urgent Public Health Priority
American Journal of Public Health: April 2016, Vol. 106, No. 4: 589–590.
Beth P. Bell, Coleen A. Boyle, Lyle R. Petersen
[No abstract]

AJPH SPECIAL SECTION: ZIKA
Aedes Rides Again: Mosquitoes and Flaviviruses in the Americas
American Journal of Public Health: April 2016, Vol. 106, No. 4: 596–597.
John McNeill

Initial Description of the Presumed Congenital Zika Syndrome
American Journal of Public Health: April 2016, Vol. 106, No. 4: 598–600.
Demócrito de Barros Miranda-Filho, Celina Maria Turchi Martelli, Ricardo Arraes de Alencar Ximenes, Thalia Velho Barreto Araújo, Maria Angela Wanderley Rocha, Regina Coeli Ferreira Ramos, Rafael Dhalia, Rafael Freitas de Oliveira França, Ernesto Torres de Azevedo Marques Júnior, Laura Cunha Rodrigues

The Epidemic of Zika Virus–Related Microcephaly in Brazil: Detection, Control, Etiology, and Future Scenarios
American Journal of Public Health: April 2016, Vol. 106, No. 4: 601–605.
Maria G. Teixeira, Maria da Conceição N. Costa, Wanderson K. de Oliveira, Marilia Lavocat Nunes, Laura C. Rodrigues

History, Epidemiology, and Clinical Manifestations of Zika: A Systematic Review
American Journal of Public Health: April 2016, Vol. 106, No. 4: 606–612.
Enny S. Paixão, Florisneide Barreto, Maria da Glória Teixeira, Maria da Conceição N. Costa, Laura C. Rodrigues

Human Papillomavirus Vaccination in the United States: Uneven Uptake by Gender, Race/Ethnicity, and Sexual Orientation
American Journal of Public Health: April 2016, Vol. 106, No. 4: 746–747.
Jason Daniel-Ulloa, Paul A Gilbert, Edith A. Parker
Abstract
Objectives. To assess national differences in human papillomavirus (HPV) vaccine uptake among young adults in the United States by gender, race/ethnicity, and sexual orientation.
Methods. We tested group differences in initiation and completion of the HPV vaccine series (i.e., 3 doses) by Rao–Scott χ2 test among 6444 respondents aged 18 to 30 years from the 2013 National Health Interview Survey.
Results. Among men, 5% reported receiving the HPV vaccine, with no differences in uptake by race/ethnicity or sexual orientation. By contrast, 30% of the women reported receiving the HPV vaccine, with women of color having lower odds of initiating and completing the vaccine series compared with White women.
Conclusions. In the United States, HPV vaccine rates are lagging in men and show disparities among women. Increasing HPV vaccine uptake and series completion among women of color and all men may provide considerable long-term public health benefits.

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 2 April 2016)

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Research article
Analysis of vaccination campaign effectiveness and population immunity to support and sustain polio elimination in Nigeria
Alexander M. Upfill-Brown, Arend Voorman, Guillaume Chabot-Couture, Faisal Shuaib and Hil M. Lyons
Published on: 30 March 2016
Abstract
Background
The world is closer than ever to a polio-free Africa. In this end-stage, it is important to ensure high levels of population immunity to prevent polio outbreaks. Here, we introduce a new method of assessing vaccination campaign effectiveness and estimating immunity at the district-level. We demonstrate how this approach can be used to plan the vaccination campaigns prospectively to better manage population immunity in Northern Nigeria.
Methods
Using Nigerian acute flaccid paralysis surveillance data from 2004–2014, we developed a Bayesian hierarchical model of campaign effectiveness and compared it to lot-quality assurance sampling data. We then used reconstructed sero-specific population immunity based on campaign history and compared district estimates of immunity to the occurrence of confirmed poliovirus cases.
Results
Estimated campaign effectiveness has improved across northern Nigeria since 2004, with Kano state experiencing an increase of 40 % (95 % CI, 26–54 %) in effectiveness from 2013 to 2014. Immunity to type 1 poliovirus has increased steadily. On the other hand, type 2 immunity was low and variable until the recent use of trivalent oral polio vaccine. We find that immunity estimates are related to the occurrence of both wild and vaccine-derived poliovirus cases and that campaign effectiveness correlates with direct measurements using lot-quality assurance sampling. Future campaign schedules highlight the trade-offs involved with using different vaccine types.
Conclusions
The model in this study provides a novel method for assessing vaccination campaign performance and epidemiologically-relevant estimates of population immunity. Small-area estimates of campaign effectiveness can then be used to evaluate prospective campaign plans. This modeling approach could be applied to other countries as well as other vaccine preventable diseases

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 2 April 2016)

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Research article
Development of a tool to measure women’s perception of respectful maternity care in public health facilities
Maternal mortality continues to be the biggest challenge facing Ethiopia and other developing countries. Although progress has been made in making maternity services available closer to the community, the rate of deliveries attended by skilled birth attendants has remained very low. Absence of respectful maternity care (RMC) is believed to have contributed to low utilization of facility delivery services. This study outlines steps undertaken to construct and validate a scale that measures women’s perception of respectful maternity care provided in health facilities.
Ephrem D. Sheferaw, Teka Z. Mengesha and Solomon B. Wase
BMC Pregnancy and Childbirth 2016 16:67
Published on: 29 March 2016

BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content
(Accessed 2 April 2016)

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Research article
Prevalence and risk factors of three curable sexually transmitted infections among women in Nairobi, Kenya
Sexually transmitted infections (STIs) are a major public health problem, especially in developing countries. The complications of untreated STIs in the female genital tract and their role in adverse pregnancy and perinatal outcomes have been well documented. The prevalence of STIs in Kenya among women in the general population has not been extensively studied and there is a lack of guidelines for screening of non-pregnant women. Knowledge of the prevalence of curable STIs among this population can provide a basis for integrating STI screening in family planning clinics.
Anne Njeri Maina, Joshua Kimani and Omu Anzala
BMC Research Notes 2016 9:193
Published on: 29 March 2016

Bulletin of the World Health Organization
Volume 94, Number 4, April 2016, 233-308
http://www.who.int/bulletin/volumes/94/4/en/

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EDITORIALS
Best practices for sharing information through data platforms: establishing the principles
Vasee S Moorthy, Cathy Roth, Piero Olliaro, Christopher Dye & Marie Paule Kieny
http://dx.doi.org/10.2471/BLT.16.172882

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Addressing the health of vulnerable populations: a call for papers
Viroj Tangcharoensathien, Churnrurtai Kanchanachitra, Rebekah Thomas, James Headen Pfitzer & Paige Whitney
http://dx.doi.org/10.2471/BLT.16.172783

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Knowledge sharing during public health emergencies: from global call to effective implementation
Sophie Delaunay, Patricia Kahn, Mercedes Tatay & Joanne Liu
http://dx.doi.org/10.2471/BLT.16.172650
[Initial text]
In February 2016, the issue of data sharing during emergencies made headlines around the world after leading research funders, academic journals and nongovernmental organizations signed a joint declaration of commitment to rapidly share data relevant to the Zika virus outbreak.1 This action followed repeated calls from some of the same constituencies for sharing data from clinical trials2,3 conducted in the context of public health emergencies4,5 and public health in general.6,7
While the Zika open data initiative is a positive step, it also highlights the shortcomings of calling for knowledge sharing after an outbreak has already begun. To improve epidemic emergency response and to accelerate related research, health authorities in potentially exposed countries must put in place the necessary frameworks for collecting, managing and swiftly making available good-quality, standardized data and for safely securing and sharing biomaterial¬ – such as patient samples – collected during the outbreak…

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Assessment of universal health coverage for adults aged 50 years or older with chronic illness in six middle-income countries
Christine Goeppel, Patricia Frenz, Linus Grabenhenrich, Thomas Keil & Peter Tinnemann
http://dx.doi.org/10.2471/BLT.15.163832

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An approach for setting evidence-based and stakeholder-informed research priorities in low- and middle-income countries
Eva A Rehfuess, Solange Durão, Patrick Kyamanywa, Joerg J Meerpohl, Taryn Young, Anke Rohwer, on behalf of the CEBHA+ & consortium
http://dx.doi.org/10.2471/BLT.15.162966

Child Care, Health and Development
March 2016 Volume 42, Issue 2 Pages 149–295
Original Articles
Deportation experiences and depression among U.S. citizen-children with undocumented Mexican parents (pages 220–230)
L. E. Gulbas, L. H. Zayas, H. Yoon, H. Szlyk, S. Aguilar-Gaxiola and G. Natera
Article first published online: 9 DEC 2015 | DOI: 10.1111/cch.12307
Abstract
Background
There is a critical need to document the mental health effects of immigration policies and practices on children vulnerable to parental deportation. Few studies capture the differential experiences produced by U.S. citizen-children’s encounters with immigration enforcement, much less in ways that analyse mental health outcomes alongside the psychosocial contexts within which those outcomes arise.
Methods
We explore the psychosocial dimensions of depression in U.S. citizen-children with undocumented Mexican parents to examine differences between citizen-children affected and not affected by parental deportation. An exploratory mixed-method design was used to integrate a quantitative measure of depression symptoms (CDI-2) within qualitative data collected with 48 citizen-children aged 8 to 15 with and without experiences of parental deportation.
Results
Stressors elicited by citizen-children in the qualitative interview included an inability to communicate with friends, negative perceptions of Mexico, financial struggles, loss of supportive school networks, stressed relation with parent(s) and violence. Fifty percent of citizen-children with probable depression – regardless of experiences with parental deportation – cited ‘stressed relation with parents,’ compared to 9% without depression. In contrast, themes of ‘loss of supportive school network’ and ‘violence’ were mentioned almost exclusively by citizen-children with probable depression and affected by parental deportation.
Conclusions
While citizen-children who suffer parental deportation experience the most severe consequences associated with immigration enforcement, our findings also suggest that the burden of mental health issues extends to those children concomitantly affected by immigration enforcement policies that target their undocumented parents.

Disaster Medicine and Public Health Preparedness
Volume 10 – Issue 02 – April 2016

http://journals.cambridge.org/action/displayIssue?jid=DMP&tab=currentissue

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Concepts in Disaster Medicine
The Waterless Portable Private Toilet: An Innovative Sanitation Solution in Disaster Zones
Yongkyun Kim, Shervin Hashemi, Mooyoung Han, Tschungil Kim and Hong-Gyoo Sohn
DOI: http://dx.doi.org/10.1017/dmp.2015.166 (About DOI), Published online: 19 January 2016
Abstract
Catastrophes can occur without warning and inevitably cause short-term and long-term problems. In disaster zones, having an action plan to alleviate difficulties can reduce or prevent many long-lasting complications. One of the most critical and urgent issues is sanitation. Water, energy, personnel, transportation, and the allocation of resources in disaster areas tend to become very limited during emergencies. Sanitation systems suffer in the process, potentially leading to crises due to unsafe and unhygienic surroundings. This article explores the problems of current sanitation practices in disaster areas and identifies the essential characteristics of sustainable sanitation systems. This study also presents a plan for an innovative and sustainable sanitation system using a waterless, portable, private toilet, in addition to a procedure for collecting and disposing waste. The system is agronomic, is socially acceptable, prevents contact with human waste, and can be used for individuals or families. Environmental pollution and social problems (such as sexual harassment) can be reduced both during and after restoration. (Disaster Med Public Health Preparedness. 2016;10:281–285)

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Editorial
Zika: Defining the Public Health and Exposing its Vulnerabilities
Frederick M. Burkle, Jr.
DOI: http://dx.doi.org/10.1017/dmp.2016.27 (About DOI), Published online: 08 March 2016
[No abstract]

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Commentary
US Public Health Preparedness for Zika and Other Threats Remains Vulnerable
Jeffrey S. Duchin
DOI: http://dx.doi.org/10.1017/dmp.2016.26 (About DOI), Published online: 08 March 2016
Abstract
The unanticipated global outbreak of Zika virus infection is the most current but certainly not the last emerging infectious disease challenge to confront the US public heath system. Despite a number of such threats in recent years, significant gaps remain in core areas of public health system readiness. Stable, sustained investments are required to establish a solid foundation for achieving necessary national public health emergency preparedness and response capacity. (Disaster Med Public Health Preparedness. 2016;10:298–299)

Ethics & International Affairs
Spring 2016 (Issue 30.1) | March 10, 2016
http://www.ethicsandinternationalaffairs.org/2016/spring-2016-issue-30-1/

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Essay
Defining Down Sovereignty: The Rights and Responsibilities of Nations
Amitai Etzioni | March 10, 2016
[Initial text]
“Defining down sovereignty” refers to the normative thesis that sovereignty should not grant a state absolute protection against armed intervention in its internal affairs by other states, and that instead the international community should condition such immunity on states living up to particular standards. This essay suggests two modifications to this thesis. First, the international community should spell out the kinds of failures to protect civilians that can justify armed interventions by other states, as well as which agency has the authority to determine when such failures have occurred. In other words, the international community should determine how low to set the bar for intervention, and who makes the rules. Second, the international community needs to establish an additional international responsibility, namely, a responsibility to prevent international terrorism. The essay treats both of these modifications as shared international normative understandings; it does not attempt to translate these changes into international law…

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FEATURES
Democracies and the Power to Revoke Citizenship
Patti Tamara Lenard
[Initial text]
Citizenship status is meant to be secure, that is, inviolable. Recently, however, several democratic states have adopted or are considering adopting laws that allow them the power to revoke citizenship. This claimed right forces us to consider whether citizenship can be treated as a “conditional” status, in particular whether it can be treated as conditional on the right sort of behavior. Those who defend such a view argue that citizenship is a privilege rather than a right, and thus in principle is revocable. Participating in a foreign state’s military, treason, spying, or committing acts that otherwise threaten the national security of one’s state may all warrant revocation. This article assesses the justifications given for the claimed power to revoke citizenship in democratic states and concludes that, ultimately, such a power is incompatible with democracy…

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 2 April 2016]

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Commentary
The ESTHER hospital partnership initiative: a powerful levy for building capacities to combat the HIV pandemic in low-resource countries
Gilles Raguin
Published on: 1 April 2016

Research
Protecting health workers from infectious disease transmission: an exploration of a Canadian-South African partnership of partnerships
Annalee Yassi, Muzimkhulu Zungu, Jerry M. Spiegel, Barry Kistnasamy, Karen Lockhart, David Jones, Lyndsay M. O’Hara, Letshego Nophale, Elizabeth A. Bryce and Lincoln Darwin
Published on: 31 March 2016

Journal of Medical Ethics
April 2016, Volume 42, Issue 4
http://jme.bmj.com/content/current

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Current controversy
The Ebola outbreak in Western Africa: ethical obligations for care
Aminu Yakubu, Morenike Oluwatoyin Folayan, Nasir Sani-Gwarzo, Patrick Nguku, Kristin Peterson, Brandon Brown
J Med Ethics 2016;42:209-210 Published Online First: 9 September 2014 doi:10.1136/medethics-2014-102434
Abstract
The recent wave of the Ebola Virus Disease (EVD) in Western Africa and efforts to control the disease where the health system requires strengthening raises a number of ethical challenges for healthcare workers practicing in these countries. We discuss the implications of weak health systems for controlling EVD and limitations of the ethical obligation to provide care for patients with EVD using Nigeria as a case study. We highlight the right of healthcare workers to protection that should be obligatorily provided by the government. Where the national government cannot meet this obligation, healthcare workers only have a moral and not a professional obligation to provide care to patients with EVD. The national government also has an obligation to adequately compensate healthcare workers that become infected in the course of duty. Institutionalisation of policies that protect healthcare workers are required for effective control of the spread of highly contagious diseases like EVD in a timely manner.

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Research led by participants: a new social contract for a new kind of research
Effy Vayena, Roger Brownsword, Sarah Jane Edwards, Bastian Greshake, Jeffrey P Kahn, Navjoyt Ladher, Jonathan Montgomery, Daniel O’Connor, Onora O’Neill, Martin P Richards, Annette Rid, Mark Sheehan, Paul Wicks, John Tasioulas
J Med Ethics 2016;42:216-219 Published Online First: 30 March 2015 doi:10.1136/medethics-2015-102663

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Paper: Incorporating ethical principles into clinical research protocols: a tool for protocol writers and ethics committees
Rebecca H Li, Mary C Wacholtz, Mark Barnes, Liam Boggs, Susan Callery-D’Amico, Amy Davis,
Alla Digilova, David Forster, Kate Heffernan, Maeve Luthin, Holly Fernandez Lynch, Lindsay McNair, Jennifer E Miller, Jacquelyn Murphy, Luann Van Campen, Mark Wilenzick, Delia Wolf,
Cris Woolston, Carmen Aldinger, Barbara E Bierer
J Med Ethics 2016;42:229-234 Published Online First: 25 January 2016 doi:10.1136/medethics-2014-102540
Abstract
A novel Protocol Ethics Tool Kit (‘Ethics Tool Kit’) has been developed by a multi-stakeholder group of the Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard. The purpose of the Ethics Tool Kit is to facilitate effective recognition, consideration and deliberation of critical ethical issues in clinical trial protocols. The Ethics Tool Kit may be used by investigators and sponsors to develop a dedicated Ethics Section within a protocol to improve the consistency and transparency between clinical trial protocols and research ethics committee reviews. It may also streamline ethics review and may facilitate and expedite the review process by anticipating the concerns of ethics committee reviewers. Specific attention was given to issues arising in multinational settings. With the use of this Tool Kit, researchers have the opportunity to address critical research ethics issues proactively, potentially speeding the time and easing the process to final protocol approval

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Ethics briefing
The Mediterranean refugee crisis: ethics, international law and migrant health
Sophie Brannan, Ruth Campbell, Martin Davies, Veronica English, Rebecca Mussell, Julian C Sheather
J Med Ethics 2016;42:269-270 doi:10.1136/medethics-2016-103444
Extract
Europe is experiencing levels of forced migration not seen since the Second World War. Its sources lie in the fragile, strife-torn states of the Middle East and Africa: four million people have fled Syria since the conflict began; 12 million of those remaining require humanitarian assistance. Large numbers of people are fleeing violence in Iraq, Afghanistan and Eritrea. Although millions have been displaced by violence, others are seeking relief from endemic poverty and brutally restricted life-choices. Overwhelmingly their chosen routes into Europe are perilous—according to the UN High Commissioner for Refugees (UNHCR) over 590 000 people have arrived in Europe by sea this year.1 Nor do their difficulties end once they reach Europe. The asylum systems of the frontline countries, overwhelmingly Greece and Italy, never designed for such high levels of migration, are inadequate. In this thematic ethics brief we provide some background information to the crisis and raise a number of ethical issues it gives rise to…

Journal of the Royal Society – Interface
01 March 2016; volume 13, issue 116
http://rsif.royalsocietypublishing.org/content/current

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Life Sciences–Mathematics interface
Research article:
Model-based reconstruction of an epidemic using multiple datasets: understanding influenza A/H1N1 pandemic dynamics in Israel
R. Yaari, G. Katriel, L. Stone, E. Mendelson, M. Mandelboim, A. Huppert
J. R. Soc. Interface 2016 13 20160099; DOI: 10.1098/rsif.2016.0099. Published 30 March 2016

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Research articles:
Potential impact of spatially targeted adult tuberculosis vaccine in Gujarat, India
Sourya Shrestha, Susmita Chatterjee, Krishna D. Rao, David W. Dowdy
J. R. Soc. Interface 2016 13 20151016; DOI: 10.1098/rsif.2015.1016. Published 23 March 2016
Abstract
Some of the most promising vaccines in the pipeline for tuberculosis (TB) target adolescents and adults. Unlike for childhood vaccines, high-coverage population-wide vaccination is significantly more challenging for adult vaccines. Here, we aimed to estimate the impact of vaccine delivery strategies that were targeted to high-incidence geographical ‘hotspots’ compared with randomly allocated vaccination. We developed a spatially explicit mathematical model of TB transmission that distinguished these hotspots from the general population. We evaluated the impact of targeted and untargeted vaccine delivery strategies in India—a country that bears more than 25% of global TB burden, and may be a potential early adopter of the vaccine. We collected TB notification data and conducted a demonstration study in the state of Gujarat to validate our estimates of heterogeneity in TB incidence. We then projected the impact of randomly vaccinating 8% of adults in a single mass campaign to a spatially targeted vaccination preferentially delivered to 80% of adults in the hotspots, with both strategies augmented by continuous adolescent vaccination. In consultation with vaccine developers, we considered a vaccine efficacy of 60%, and evaluated the population-level impact after 10 years of vaccination. Spatial heterogeneity in TB notification (per 100 000/year) was modest in Gujarat: 190 in the hotspots versus 125 in the remaining population. At this level of heterogeneity, the spatially targeted vaccination was projected to reduce TB incidence by 28% after 10 years, compared with a 24% reduction projected to achieve via untargeted vaccination—a 1.17-fold augmentation in the impact of vaccination by spatially targeting. The degree of the augmentation was robust to reasonable variation in natural history assumptions, but depended strongly on the extent of spatial heterogeneity and mixing between the hotspot and general population. Identifying high-incidence hotspots and quantifying spatial mixing patterns are critical to accurate estimation of the value of targeted intervention strategies.

The Lancet
Apr 02, 2016 Volume 387 Number 10026 p1347-1482 e24
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
Yellow fever: a global reckoning
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(16)30116-7
Summary
Angola is currently facing its worst outbreak of yellow fever in 30 years. Since December, 2015, when the outbreak was first declared in the capital of Luanda, there have been 178 deaths, more than 1000 suspected cases, and spread to several provinces. Imported cases have now been reported in China, Kenya, and the Democratic Republic of the Congo, posing a global health security risk. A mass vaccination campaign in Luanda began in February, but the emergency stockpile of the vaccine has already been exhausted.

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Comment
Lean economies and innovation in mental health systems
Sara Evans-Lacko, Wagner Ribeiro, Elisa Brietzke, Martin Knapp, Jair Mari, David McDaid, Cristiane S Paula, Renee Romeo, Graham Thornicroft, Lawrence Wissow
1356

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The Lancet Commissions
Public health and international drug policy
Joanne Csete, Adeeba Kamarulzaman, Michel Kazatchkine, Frederick Altice, Marek Balicki, Julia Buxton, Javier Cepeda, Megan Comfort, Eric Goosby, João Goulão, Carl Hart, Thomas Kerr, Alejandro Madrazo Lajous, Stephen Lewis, Natasha Martin, Daniel Mejía, Adriana Camacho, David Mathieson, Isidore Obot, Adeolu Ogunrombi, Susan Sherman, Jack Stone, Nandini Vallath, Peter Vickerman, Tomáš Zábranský, Chris Beyrer
1427
Summary
In September, 2015, the member states of the UN endorsed Sustainable Development Goals (SDGs) for 2030, which aspire to human-rights-centred approaches to ensuring the health and wellbeing of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientific evidence as they seek to better humankind. In April, 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy and thought of as inconsistent with human rights norms, and in which scientific evidence and public health approaches have arguably had too limited a role.

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Case Report
Guillain-Barré syndrome associated with Zika virus infection
Patrícia Brasil, Patricia Carvalho Sequeira, Andrea D’Avila Freitas, Heruza Einsfeld Zogbi, Guilherme Amaral Calvet, Rogerio Valls de Souza, André Machado Siqueira, Marcos Cesar Lima de Mendonca, Rita Maria Ribeiro Nogueira, Ana Maria Bispo de Filippis, Tom Solomon
1482

The Lancet Infectious Diseases
Apr 2016 Volume 16 Number 4 p385-506 e34-e63
http://www.thelancet.com/journals/laninf/issue/current

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Editorial
Costs, compassion, and the case for vaccination
The Lancet Infectious Diseases
DOI: http://dx.doi.org/10.1016/S1473-3099(16)00139-0
Summary
If you want an overview of the major political issues in the UK, the government’s petitioning website is a good place to start. Calls for action on Islamic State, immigration, and the National Health Service (NHS) have all garnered hundreds of thousands of signatures. But the most popular current petition—indeed, the issue that has received the most signatures ever on the site—concerns meningitis B vaccination.

Public funding for research on antibacterial resistance in the JPIAMR countries, the European Commission, and related European Union agencies: a systematic observational analysis
Ruth Kelly, Ghada Zoubiane, Desmond Walsh, Rebecca Ward, Herman Goossens
431
Open Access

Preventive malaria treatment for contacts of patients with Ebola virus disease in the context of the west Africa 2014–15 Ebola virus disease response: an economic analysis
Cristina Carias, Bradford Greening Jr, Caresse G Campbell, Martin I Meltzer, Mary J Hamel
449

Potential for reduction of burden and local elimination of malaria by reducing Plasmodium falciparum malaria transmission: a mathematical modelling study
Jamie T Griffin, Samir Bhatt, Marianne E Sinka, Peter W Gething, Michael Lynch, Edith Patouillard, Erin Shutes, Robert D Newman, Pedro Alonso, Richard E Cibulskis, Azra C Ghani
Open Access

Association between spending on social protection and tuberculosis burden: a global analysis
Andrew Siroka, Ninez A Ponce, Knut Lönnroth

Lancet Global Health
Apr 2016 Volume 4 Number 4 e215-e286
http://www.thelancet.com/journals/langlo/issue/current

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Comment
A second affordable oral cholera vaccine: implications for the global vaccine stockpile
Sachin N Desai, Lorenzo Pezzoli, Stephen Martin, Alejandro Costa, Carmen Rodriguez, Dominique Legros, William Perea
Summary
On Dec 23, 2015, WHO prequalified a second affordable oral cholera vaccine (OCV), Euvichol (Eubiologics, South Korea), which is expected to double current global OCV production and has the potential to further increase production capacity.1 The increased production will have implications for vaccine availability and reduced costs per dose, and will ultimately represent an added value for global cholera prevention and control.

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Articles
Accuracy of the WHO Haemoglobin Colour Scale for the diagnosis of anaemia in primary health care settings in low-income countries: a systematic review and meta-analysis
Heiko Marn, Julia Alison Critchley

Timing of initiation, patterns of breastfeeding, and infant survival: prospective analysis of pooled data from three randomised trials
NEOVITA Study Group

The UN Commission on Life Saving Commodities 3 years on: global progress update and results of a multicountry assessment
Paul M Pronyk, Bennett Nemser, Blerta Maliqi, Nora Springstubb, Diana Sera, Rouslan Karimov, Elizabeth Katwan, Benedicte Walter, Pascal Bijleveld, UNCoLSC Technical Resource Teams, UN Agency Leads, UNCoLSC Monitoring and Evaluation Advisory Group

New England Journal of Medicine
March 31, 2016 Vol. 374 No. 13
http://www.nejm.org/toc/nejm/medical-journal
Special Report
The Neglected Dimension of Global Security — A Framework for Countering Infectious-Disease Crises
Peter Sands, M.P.A., Carmen Mundaca-Shah, M.D., Dr.P.H., and Victor J. Dzau, M.D.
N Engl J Med 2016; 374:1281-1287 March 31, 2016 DOI: 10.1056/NEJMsr1600236
[Initial text]
Pandemics and epidemics have ravaged human societies throughout history. The plague, cholera, and smallpox killed tens of millions of people and destroyed civilizations. In the past 100 years, the “Spanish Flu” of 1918–1919 and HIV–AIDS caused the deaths of nearly 100 million people.

Advances in medicine have transformed our defenses against the threat of infectious disease. Better hygiene, antibiotics, diagnostics, and vaccines have given us far more effective tools for preventing and responding to outbreaks. Yet the severe acute respiratory syndrome (SARS), the Middle East respiratory syndrome (MERS), and the recent West African Ebola outbreak show that we cannot be complacent (Figure 1). Infectious-disease outbreaks that turn into epidemics and potential pandemics can cause massive loss of life and huge economic disruption.

Indeed, Ebola demonstrated how ill-prepared we are for such infectious-disease crises. There were failures at almost every level. Identifying the outbreak in the community and raising alerts took too long. Local health systems were quickly overwhelmed. Response teams did not adequately engage communities and deepened distrust in health authorities. The international response was slow, cumbersome, and poorly coordinated. Rapid diagnostics, protective equipment, effective therapeutics, and a vaccine were lacking. Ultimately, the crisis was contained, thanks to the courage and commitment of medical staff and communities on the ground and a massive deployment of international resources. Yet the cost in human lives and economic and social disruption was far greater than it should have been.

In this context, the Commission on a Global Health Risk Framework for the Future was initiated in the spring of 2015. Eight sponsors came together to support the initiative. The U.S. National Academy of Medicine provided leadership and guidance. An International Oversight Group comprising 12 leaders in science, business, and government was established to set up and guide the Commission…

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 2 April 2016)

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Editorial
Pragmatic Trials for Noncommunicable Diseases: Relieving Constraints
Anushka Patel, Ruth Webster
| published 29 Mar 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1001986
[No abstract]

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 2 April 2016)

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Research Article
Cost-Effectiveness of Antivenoms for Snakebite Envenoming in 16 Countries in West Africa
Muhammad Hamza, Maryam A. Idris, Musa B. Maiyaki, Mohammed Lamorde, Jean-Philippe Chippaux, David A. Warrell, Andreas Kuznik, Abdulrazaq G. Habib
Research Article | published 30 Mar 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004568
Author Summary
Antivenom is the main intervention against snakebite poisoning but is relatively scarce, unaffordable and the situation has been compounded further by the recent cessation of production of effective antivenoms and marketing of inappropriate products. Given this crisis, we assessed the cost effectiveness of providing antivenoms in West Africa by comparing costs associated with antivenom treatment against their health benefits in decreasing mortality. In the most comprehensive analyses ever conducted, it was observed the incremental cost effectiveness ratio of providing antivenom ranged from $1,997 in Guinea Bissau to $6,205 for Liberia and Sierra-Leone per death averted while cost per Disability Adjusted Life Year (DALY) averted ranged from $83 for Benin Republic to $281 for Sierra-Leone. There is probability of 97.3–100% that antivenoms are very cost-effective in the analyses. These demonstrate antivenom is highly cost-effective and compares favorably to other commonly funded healthcare interventions. Providing and broadening antivenom access throughout areas at risk in rural West Africa should be prioritized given the considerable reduction in deaths and DALYs that could be derived at a relatively small cost.