American Journal of Tropical Medicine and Hygiene
November 2016; 95 (5)
http://www.ajtmh.org/content/current

.
Perspective Pieces
Partnerships that Facilitate a Refugee’s Journey to Wellbeing
Nina Marano, Abbey E. Wojno, William M. Stauffer, Michelle Weinberg, Alexander Klosovsky, J. Daniel Ballew, Sharmila Shetty, Susan Cookson, Patricia Walker, and Martin S. Cetron
Am J Trop Med Hyg 2016 95:985-987; Published online October 10, 2016, doi:10.4269/ajtmh.16-0657
Abstract
The current global refugee crisis involves 65.3 million persons who have been displaced from their homes or countries of origin. While escaping immediate harm may be their first priority, displaced people go on to face numerous health risks, including trauma and injuries, malnutrition, infectious diseases, exacerbation of existing chronic diseases, and mental health conditions. This crisis highlights the importance of building capacity among health-care providers, scientists, and laboratorians to understand and respond to the health needs of refugees. The November 2016 American Society of Tropical Medicine and Hygiene (ASTMH) conference in Atlanta will feature an interactive exhibit entitled “The Refugee Journey to Wellbeing” and three symposia about refugee health. The symposia will focus on tropical disease challenges in refugee populations, careers in refugee health, and recent experiences of governmental agencies and nongovernmental organizations in responding to the global refugee crisis. We invite ASTMH attendees to attend the exhibit and symposia and consider contributions they could make to improve refugee health through tropical disease research or clinical endeavors

.

An Outbreak of Fearsome Photos and Headlines: Ebola and Local Newspapers in West Africa
Eric S. Halsey Am J Trop Med Hyg 2016 95:988-992; Published online July 25, 2016, doi:10.4269/ajtmh.16-0245
OPEN ACCESS ARTICLE

.

Dengue Dynamics and Vaccine Cost-Effectiveness Analysis in the Philippines
Eunha Shim
Am J Trop Med Hyg 2016 95:1137-1147; Published online September 6, 2016, doi:10.4269/ajtmh.16-0194
Abstract
Dengue is one of the most problematic vector-borne diseases in the Philippines, with an estimated 842,867 cases resulting in medical costs of $345 million U.S. dollars annually. In December 2015, the first dengue vaccine, known as chimeric yellow fever virus–dengue virus tetravalent dengue vaccine, was approved for use in the Philippines and is given to children 9 years of age. To estimate the cost-effectiveness of dengue vaccination in the Philippines, we developed an age-structured model of dengue transmission and vaccination. Using our model, we compared two vaccination scenarios entailing routine vaccination programs both with and without catch-up vaccination. Our results indicate that the higher the cost of vaccination, the less cost-effective the dengue vaccination program. With the current dengue vaccination program that vaccinates children 9 years of age, dengue vaccination is cost-effective for vaccination costs up to $70 from a health-care perspective and up to $75 from a societal perspective. Under a favorable scenario consisting of 1 year of catch-up vaccinations that target children 9–15 years of age, followed by regular vaccination of 9-year-old children, vaccination is cost-effective at costs up to $72 from a health-care perspective and up to $78 from a societal perspective. In general, dengue vaccination is expected to reduce the incidence of both dengue fever and dengue hemorrhagic fever /dengue shock syndrome. Our results demonstrate that even at relatively low vaccine efficacies, age-targeted vaccination may still be cost-effective provided the vaccination cost is sufficiently low.

.

Herd Protection from Drinking Water, Sanitation, and Hygiene Interventions
James A. Fuller and
Joseph N. S. Eisenberg
Am J Trop Med Hyg 2016 95:1201-1210; Published online September 6, 2016, doi:10.4269/ajtmh.15-0677
Abstract
Herd immunity arises when a communicable disease is less able to propagate because a substantial portion of the population is immune. Nonimmunizing interventions, such as insecticide-treated bednets and deworming drugs, have shown similar herd-protective effects. Less is known about the herd protection from drinking water, sanitation, and hand hygiene (WASH) interventions. We first constructed a transmission model to illustrate mechanisms through which different WASH interventions may provide herd protection. We then conducted an extensive review of the literature to assess the validity of the model results and identify current gaps in research. The model suggests that herd protection accounts for a substantial portion of the total protection provided by WASH interventions. However, both the literature and the model suggest that sanitation interventions in particular are the most likely to provide herd protection, since they reduce environmental contamination. Many studies fail to account for these indirect effects and thus underestimate the total impact an intervention may have. Although cluster-randomized trials of WASH interventions have reported the total or overall efficacy of WASH interventions, they have not quantified the role of herd protection. Just as it does in immunization policy, understanding the role of herd protection from WASH interventions can help inform coverage targets and strategies that indirectly protect those that are unable to be reached by WASH campaigns. Toward this end, studies are needed to confirm the differential role that herd protection plays across the WASH interventions suggested by our transmission model.