PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 21 May 2016)

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Research Article
A Cost-Effectiveness Tool for Informing Policies on Zika Virus Control
Jorge A. Alfaro-Murillo, Alyssa S. Parpia, Meagan C. Fitzpatrick, Jules A. Tamagnan, Jan Medlock, Martial L. Ndeffo-Mbah, Durland Fish, María L. Ávila-Agüero, Rodrigo Marín, Albert I. Ko, Alison P. Galvani
| published 20 May 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004743

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Research Article
Extent of Integration of Priority Interventions into General Health Systems: A Case Study of Neglected Tropical Diseases Programme in the Western Region of Ghana
Ernest O. Mensah, Moses K. Aikins, Margaret Gyapong, Francis Anto, Moses J. Bockarie, John O. Gyapong
| published 20 May 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004725

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Research Article
Cholera Incidence and Mortality in Sub-Saharan African Sites during Multi-country Surveillance
Delphine Sauvageot, Berthe-Marie Njanpop-Lafourcade, Laurent Akilimali, Jean-Claude Anne, Pawou Bidjada, Didier Bompangue, Godfrey Bwire, Daouda Coulibaly, Liliana Dengo-Baloi, Mireille Dosso, Christopher Garimoi Orach, Dorteia Inguane, Atek Kagirita, Adele Kacou-N’Douba, Sakoba Keita, Abiba Kere Banla, Yao Jean-Pierre Kouame, Dadja Essoya Landoh, Jose Paulo Langa, Issa Makumbi, Berthe Miwanda, Muggaga Malimbo, Guy Mutombo, Annie Mutombo, Emilienne Niamke NGuetta, Mamadou Saliou, Veronique Sarr, Raphael Kakongo Senga, Fode Sory, Cynthia Sema, Ouyi Valentin Tante, Bradford D. Gessner, Martin A. Mengel
| published 17 May 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004679

PLoS One
http://www.plosone.org/
[Accessed 21 May 2016]

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Research Article
Consultations by Asylum Seekers: Recent Trends in the Emergency Department of a Swiss University Hospital
Martin Müller, Karsten Klingberg, David Srivastava, Aristomenis K. Exadaktylos
Research Article | published 18 May 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0155423
Abstract
Background
Large-scale war-related migration to Switzerland and other European countries is currently challenging European health systems. Little is known about recent patterns and trends in Emergency Department (ED) consultations by Asylum Seekers (AS).
Methods
A retrospective single-centre analysis was performed of the data from all adult patients with the official status of “Asylum Seeker” or “Refugee” who consulted the ED of Bern University Hospital, Switzerland, between June 2012 and June 2015. Patient characteristics and clinical information, such as triage category, type of referral and discharge, violence-related injury and diagnostic group on discharge, were extracted from the computerised database or determined from the medical reports. Changes in categorical variables between the three studied years were described.
Results
A total of 1,653 eligible adult patients were identified in the 3-year period. Between the first (06/12–06/13) and third periods (06/14–06/15), the number of presentations per year increased by about 45%. The AS came from 62 different nations, the most common countries being Eritrea (13%), Somalia (13%) and Syria (11%). The mean age was 33.3 years (SD 12.3) and two thirds (65.7%) were male. The proportion of women increased over time. Moreover the relative proportions shifted from patients between 20 and 50 years to patients of under 20 or over 60 years. Nearly two thirds of the patients were walk-in emergencies and this proportion increased over time. The mean triage score was 2.9 (SD 0.7), with more than 90% presenting as “urgent consultation”. About half of the patients were treated for trauma (17.2%), infections (16.8%) or psychiatric problems (14.2%). Trauma was seen in a higher proportion of male than female patients. About 25% of the patients were admitted for in-hospital treatment.
Conclusions
The recent rise in AS in the population has lead to an increase in AS presenting to EDs. This changes the composition of ED patients and should raise awareness that changes in procedures may be needed. Infectious diseases and psychiatric problems remain a heavy burden for AS presenting in the ED. A trend towards an increasing proportion of walk-in patients to the ED could not be explained by this study. Further studies and surveillance are needed to investigate this trend

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 21 May 2016)
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Biological Sciences – Ecology – Social Sciences – Sustainability Science:
The need to respect nature and its limits challenges society and conservation science
Jean-Louis Martin, Virginie Maris, and Daniel S. Simberloff
PNAS 2016 ; published ahead of print May 16, 2016, doi:10.1073/pnas.1525003113
Significance
The recent Paris accord on global climate change is a key step in acknowledging biophysical limits to human actions, but the challenge of respecting the biosphere’s ecological limits remains underrated. We analyze how respecting these limits squarely conflicts with an economy centered on growth and technology to mitigate environmental stress. The need to mitigate human impacts on species and natural systems has made conservation science a major multidisciplinary discipline. Society and conservation science have tried unsuccessfully to resolve this need within the growth paradigm. We show that its resolution increasingly demands profound shifts in societal values. Our aim is to identify the nature of these necessary shifts and to explore how they define future paths for conservation science.
Abstract
Increasing human population interacts with local and global environments to deplete biodiversity and resources humans depend on, thus challenging societal values centered on growth and relying on technology to mitigate environmental stress. Although the need to address the environmental crisis, central to conservation science, generated greener versions of the growth paradigm, we need fundamental shifts in values that ensure transition from a growth-centered society to one acknowledging biophysical limits and centered on human well-being and biodiversity conservation. We discuss the role conservation science can play in this transformation, which poses ethical challenges and obstacles. We analyze how conservation and economics can achieve better consonance, the extent to which technology should be part of the solution, and difficulties the “new conservation science” has generated. An expanded ambition for conservation science should reconcile day-to-day action within the current context with uncompromising, explicit advocacy for radical transitions in core attitudes and processes that govern our interactions with the biosphere. A widening of its focus to understand better the interconnectedness between human well-being and acknowledgment of the limits of an ecologically functional and diverse planet will need to integrate ecological and social sciences better. Although ecology can highlight limits to growth and consequences of ignoring them, social sciences are necessary to diagnose societal mechanisms at work, how to correct them, and potential drivers of social change.

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 21 May 2016)

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Empirical redefinition of comprehensive health and well-being in the older adults of the United States
Martha K. McClintocka,1, William Daleb, Edward O. Laumannc,d, and Linda Waitec,d
Author Affiliations
Edited by James S. House, University of Michigan, Ann Arbor, MI, and approved March 22, 2016 (received for review July 28, 2015)
Significance
Health has long been conceived as not just the absence of disease but also the presence of physical, psychological, and social well-being. Nonetheless, the traditional medical model focuses on specific organ system diseases. This representative study of US older adults living in their homes amassed not only comprehensive medical information but also psychological and social data and measured sensory function and mobility, all key factors for independent living and a gratifying life. This comprehensive model revealed six unique health classes, predicting mortality/incapacity. The healthiest people were obese and robust; two new classes, with twice the mortality/incapacity, were people with healed broken bones or poor mental health. This approach provides an empirical method for broadly reconceptualizing health, which may inform health policy.
Abstract
The World Health Organization (WHO) defines health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Despite general acceptance of this comprehensive definition, there has been little rigorous scientific attempt to use it to measure and assess population health. Instead, the dominant model of health is a disease-centered Medical Model (MM), which actively ignores many relevant domains. In contrast to the MM, we approach this issue through a Comprehensive Model (CM) of health consistent with the WHO definition, giving statistically equal consideration to multiple health domains, including medical, physical, psychological, functional, and sensory measures. We apply a data-driven latent class analysis (LCA) to model 54 specific health variables from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative sample of US community-dwelling older adults. We first apply the LCA to the MM, identifying five health classes differentiated primarily by having diabetes and hypertension. The CM identifies a broader range of six health classes, including two “emergent” classes completely obscured by the MM. We find that specific medical diagnoses (cancer and hypertension) and health behaviors (smoking) are far less important than mental health (loneliness), sensory function (hearing), mobility, and bone fractures in defining vulnerable health classes. Although the MM places two-thirds of the US population into “robust health” classes, the CM reveals that one-half belong to less healthy classes, independently associated with higher mortality. This reconceptualization has important implications for medical care delivery, preventive health practices, and resource allocation.

Public Health Reports
Volume 131 , Issue Number 3 May/June 2016
http://www.publichealthreports.org/issuecontents.cfm?Volume=131&Issue=3

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Brief Report
Understanding Non-Completion of the Human Papillomavirus Vaccine Series: Parent-Reported Reasons for Why Adolescents Might Not Receive Additional Doses, United States, 2012
Sarah J. Clark, MPH / Anne E. Cowan, MPH / Stephanie L. Fillipp, MPH / Allison M. Fisher, MPH / Shannon Stokley, MPH

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Case Studies and Practice
Assessing Clinical Research Capacity in Vietnam: A Framework for Strengthening Capability for Clinical Trials in Developing Countries
Jonathan Kagan, PhD / Dao Duc Giang, MPH / Michael F. Iademarco, MD, MPH / Van TT Phung, MS / Chuen-Yen Lau, MD, MPH / Nguyen Ngo Quang, PhD

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Law and the Public’s Health: Quarantine and Liability in the Context of Ebola
Polly J. Price, JD

Risk Analysis
May 2016 Volume 36, Issue 5 Pages 863–1068
http://onlinelibrary.wiley.com/doi/10.1111/risa.2016.36.issue-5/issuetoc

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Current Topics
Risk Management Should Play a Stronger Role in Developing and Implementing Social Responsibility Policies for Organizations (pages 870–873)
Shital A. Thekdi
Version of Record online: 19 MAY 2016 | DOI: 10.1111/risa.12643

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Exploring the Predictors of Organizational Preparedness for Natural Disasters (pages 1040–1053)
Abdul-Akeem Sadiq and John D. Graham
Version of Record online: 1 SEP 2015 | DOI: 10.1111/risa.12478
Abstract
There is an extensive body of research on the determinants of disaster preparedness at the individual and household levels. The same cannot be said for the organizational level. Hence, the purpose of this study is to shed light on the predictors of organizational preparedness for natural disasters. Since leaders of organizations have an incentive to overstate their level of preparedness and because surveys of organizational leaders suffer from selection bias and low response rates, we take the novel approach of interviewing employees about the organizations that employ them. Using an online survey, we collected information from a national sample of 2,008 U.S. employees and estimated the predictors of preparedness at the organizational level. We find, among other results, that organization size (facility level) is a consistent predictor of preparedness at the organizational level. We conclude with policy recommendations and outline an agenda for future research on organizational preparedness for natural disasters.

Science
20 May 2016 Vol 352, Issue 6288
http://www.sciencemag.org/current.dtl

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Introduction to special issue
Cities are the Future
By Nicholas S. Wigginton, Julia Fahrenkamp-Uppenbrink, Brad Wible, David Malakoff
Science20 May 2016 : 904-905
Rapid urbanization is overtaxing the planet, but it may not have to

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Editorial
Leave no city behind
By Michele Acuto, Susan Parnell
Science20 May 2016 : 873
Summary
Close to 4 billion people live in cities. As the driver of environmental challenges, accounting for nearly 70% of the world’s carbon emissions, and as sites of critical social disparities, with 863 million dwellers now living in slums, urban settlements are at the heart of global change. This momentum is unlikely to disappear, as approximately 70 million more people will move to cities by the end of this year alone. The good news is that recent multilateral processes are now appreciating this key role of cities and are increasingly prioritizing urban concerns in policy-making. Yet, how can we ensure that these steps toward a global urban governance leave no city, town, or urban dweller behind?

Science Translational Medicine
11 May 2016 Vol 8, Issue 338
http://stm.sciencemag.org/

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Editorial
The need for global regulatory harmonization: A public health imperative
By Elias Zerhouni, Margaret Hamburg
Science Translational Medicine11 May 2016 : 338ed6
Because public health and innovation are no longer national issues, regulatory authorities must apply a global view to oversight.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 14 May 2016

This weekly digest is intended to aggregate and distill key content from a broad spectrum of practice domains and organization types including key agencies/IGOs, NGOs, governments, academic and research institutions, consortia and collaborations, foundations, and commercial organizations. We also monitor a spectrum of peer-reviewed journals and general media channels. The Sentinel’s geographic scope is global/regional but selected country-level content is included. We recognize that this spectrum/scope yields an indicative and not an exhaustive product. Comments and suggestions should be directed to:

David R. Curry
Editor &
Founding Managing Director
GE2P2 – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf version: The Sentinel_ week ending 14 May 2016

Aga Khan Foundation [to 21 May 2016]
http://www.akdn.org/pr.asp

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12 May 2016
Increasing access to quality health care in Naryn [Kyrgyz Republic]

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12 May 2016
Portuguese Republic and Ismaili Imamat sign Research Cooperation Agreement
Lisbon, Portugal, 12 May 2016 – The Ministry of Science, Technology and Higher Education of the Portuguese Republic and the Ismaili Imamat today signed an Agreement of Cooperation to strengthen research capacity and to improve the quality of life in Portugal and in Portuguese-speaking countries, particularly in Africa. This endeavour will be supported by the Ismaili Imamat with a 10 million euro grant over 10 years.

The agreement emphasises research in the areas of poverty alleviation, food security and biodiversity, early childhood development, sustainable energy systems and urban development, resettlement of migrants, civil society and pluralism. It will also build research capacity to support the forthcoming establishment in Lisbon of the International Centre for Advanced Training of Researchers from Portuguese speaking Countries…

Conrad N. Hilton Foundation [to 21 May 2016]
http://www.hiltonfoundation.org/news

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Our News
An anniversary unmarked, but not forgotten
By Robert Miyashiro, May 10, 2016
…For our part, following Steven Hilton’s call to action, we made another firm commitment to the children of Syrian refugees living in Turkey. The Conrad N. Hilton Foundation has partnered with Theirworld offsite link, to support the rapid scale-up of access to formal primary education for refugee children. The catalytic funding provided in this grant is aimed at replicating a similar program Theirworld implemented in Lebanon, which expanded access to education through research, advocacy, and campaigning. The program in Lebanon is on track to provide classes to 200,000 refugee schoolchildren during this school year alone. Ultimately, this project aims to generate additional transnational support from donor countries, foundations, and other stakeholders capable of financing the delivery of education for 450,000 Syrian refugee children in Turkey for the 2016-17 school year.

While we are fortunate to be part of some of this forward momentum to bring both attention and resources to the countries adjacent to the conflict in Syria, we also understand that the situation in the region itself remains dire. As the number of refugees hosted by Jordan, Lebanon, and Turkey tops five million, the challenges will loom larger and the need for support from the international community will become greater. Moreover, the increased instability caused by the stresses of the refugee influx could further destabilize what is already a tense region. The international community must redouble its efforts to support the refugees in a manner that addresses their livelihoods more directly within the countries that are bearing the brunt of the massive humanitarian needs resulting from this civil war, as it enters its sixth year.

MacArthur Foundation [to 21 May 2016]
http://www.macfound.org/

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Publication
Report Examines States’ Retiree Health Plan Spending
Published May 13, 2016
State strategies for addressing post-employment benefit liabilities vary greatly, and the methods states choose to contribute to their retirees’ health insurance premiums substantially affect those liabilities, according to a report issued as part of the State Health Care Spending Project, an initiative of The Pew Charitable Trusts and MacArthur. The report is the first of its kind to provide data about the cost in today’s dollars of benefits to be paid to current workers and retirees over future years. It is intended to help states better understand how their spending, long-term liabilities, and criteria for premium contributions and coverage eligibility compare with those of other states.

Gordon and Betty Moore Foundation [to 21 May 2016]
https://www.moore.org/news

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May 13, 2016
Moore Foundation commits $31M to deepen understanding of ocean microbial ecosystems as a pillar of microbiome science
The Gordon and Betty Moore Foundation will provide $31 million in research grants during the next four years to uncover a deeper understanding of microbial ecosystems in the sea and their role in supporting the ocean’s food webs and global elemental cycles.

“The Moore Foundation has been a steady supporter of fundamental research in microbial science,” said Robert Kirshner, Ph.D., chief program officer for science at the Moore Foundation. “We want to help deepen understanding of these fascinating natural systems: we have confidence that advances in biology will benefit society.”

The White House Office of Science and Technology Policy will announce the funding this afternoon at its event on microbiomes—communities of microorganisms that live on and in people, animals, plants, soil and the ocean.

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May 12, 2016
Brazilian soy agreement renewed indefinitely: provides long-term conservation of the Amazon
The landmark Soy Moratorium, a primary outcome of the foundation’s support of the Amazon Environmental Research Institute (IPAM) and the subject of extensive research by the University of Wisconsin’s Holly Gibbs, has been renewed indefinitely–a boon for long-term conservation of the Amazon. Originally renewed on an annual basis, the moratorium aims to prevent soy trade linked to deforestation, and ensure producers and trading companies can continue to rely on forest-friendly Amazon soy.

Soy tops the list of exports of agricultural commodities in Brazil, having generated $31.27 billion in revenue in 2015. This agreement guarantees market access only to soy that is free from deforestation, slave labor or threats to indigenous lands.

For more information about this announcement, see the press release from Greenpeace USA: Brazilian Soy Moratorium Renewed Indefinitely…

Pew Charitable Trusts [to 21 May 2016]
http://www.pewtrusts.org/en/about/news-room/press-releases

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May 11, 2016
Pew Releases Scientific Roadmap to Spur Antibiotic Discovery and Innovation
Press Release – Antibiotic Resistance Project
WASHINGTON—The Pew Charitable Trusts today released a strategy to end the 30-year drought in the discovery of new types of antibiotics, key to fighting some of the most serious microbial threats. The Scientific Roadmap for Antibiotic Discovery identifies priority research goals and specific steps to break through the most significant scientific barriers impeding antibiotic discovery and to pave the way for urgently needed new drugs.

“Drug-resistant bacteria are an ever-increasing threat, but the discovery of new antibiotics has slowed to a crawl,” said Allan Coukell, senior director for health programs at The Pew Charitable Trusts. “Every antibiotic in use today is based on a discovery made more than 30 years ago.”…

Rockefeller Foundation [to 21 May 2016]
http://www.rockefellerfoundation.org/newsroom

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May 12, 2016
The Rockefeller Foundation launches “100×25” campaign to reach 100 women CEOs of the Fortune 500 companies by 2025
New research report commissioned by The Rockefeller Foundation shows American men and women believe business leaders and companies have the greatest responsibility when it comes to creating gender equality in the workplace
NEW YORK—Today at the Forbes Women’s Summit, The Rockefeller Foundation announced a commitment to accelerate the number of women leaders in corporate America through the launch of “100×25,” an ongoing and multi-faceted campaign that will influence decision makers to achieve the goal of 100 women leading Fortune 500 companies by 2025. 100×25 is the first in a series of campaigns that will ask “what if” questions that will define the future of work and the global economy.

The Foundation also released a new research report conducted by grantee Global Strategy Group on the topic of gender parity in leadership positions in business. The underlying research found that men and women believe corporate America is falling short in terms of advancing gender equality in leadership positions and that business leaders are best positioned to create solutions to the problem.

Currently, only 21 women are at the helm of Fortune 500 companies and only one woman was hired as a CEO in 2015. This reality is at odds with Americans’ perceptions of progress toward gender parity in leadership positions in 2016. According to The Rockefeller Foundation’s new research report, 9 in 10 Americans think there are more women leading Fortune 500 companies than there actually are. And 40 percent of Americans think women should make up at least half of the top executives at Fortune 500 companies…

:: Journal Watch
The Sentinel will track key peer-reviewed journals which address a broad range of interests in human rights, humanitarian response, health and development. It is not intended to be exhaustive. We will add to those monitored below as we encounter relevant content and upon recommendation from readers. We selectively provide full text of abstracts and other content but note that successful access to some of the articles and other content may require subscription or other access arrangement unique to the publisher. Please suggest additional journals you feel warrant coverage.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 14 May 2016)

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Research article
Correlates of unequal access to preventive care in China: a multilevel analysis of national data from the 2011 China Health and Nutrition Survey
Chi Huang, Chao-Jie Liu, Xiong-Fei Pan, Xiang Liu and Ning-Xiu Li
BMC Health Services Research 2016 16:177
Published on: 12 May 2016

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Research article
Economic burden of multimorbidity among older adults: impact on healthcare and societal costs
Multimorbidity is not uncommon and the associated impact it places on healthcare utilisation and societal costs is of increased concern.
Louisa Picco, Evanthia Achilla, Edimansyah Abdin, Siow Ann Chong, Janhavi Ajit Vaingankar, Paul McCrone, Hong Choon Chua, Derrick Heng, Harish Magadi, Li Ling Ng, Martin Prince and Mythily Subramaniam
BMC Health Services Research 2016 16:173
Published on: 10 May 2016

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 14 May 2016)

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Commentary
Ethical priority setting for universal health coverage: challenges in deciding upon fair distribution of health services
Ole F. Norheim
Published on: 11 May 2016
Abstract
Priority setting is inevitable on the path towards universal health coverage. All countries experience a gap between their population’s health needs and what is economically feasible for governments to provide. Can priority setting ever be fair and ethically acceptable? Fairness requires that unmet health needs be addressed, but in a fair order. Three criteria for priority setting are widely accepted among ethicists: cost-effectiveness, priority to the worse-off, and financial risk protection. Thus, a fair health system will expand coverage for cost-effective services and give extra priority to those benefiting the worse-off, whilst at the same time providing high financial risk protection. It is considered unacceptable to treat people differently according to their gender, race, ethnicity, religion, sexual orientation, social status, or place of residence. Inequalities in health outcomes associated with such personal characteristics are therefore unfair and should be minimized. This commentary also discusses a third group of contested criteria, including rare diseases, small health benefits, age, and personal responsibility for health, subsequently rejecting them. In conclusion, countries need to agree on criteria and establish transparent and fair priority setting processes.

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 14 May 2016)

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Research article
Signal functions for measuring the ability of health facilities to provide abortion services: an illustrative analysis using a health facility census in Zambia
Annually, around 44 million abortions are induced worldwide. Safe termination of pregnancy (TOP) services can reduce maternal mortality, but induced abortion is illegal or severely restricted in many countries…
Oona M. R. Campbell, Estela M. L. Aquino, Bellington Vwalika and Sabine Gabrysch
BMC Pregnancy and Childbirth 2016 16:105
Published on: 14 May 2016

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Research article
Previous induced abortion among young women seeking abortion-related care in Kenya: a cross-sectional analysis
Unsafe abortion is a leading cause of death among young women aged 10–24 years in sub-Saharan Africa. Although having multiple induced abortions may exacerbate the risk for poor health outcomes, there has been…
Caroline W. Kabiru, Boniface A. Ushie, Michael M. Mutua and Chimaraoke O. Izugbara
BMC Pregnancy and Childbirth 2016 16:104
Published on: 14 May 2016

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Research article
Antenatal consultation for parents whose child may require admission to neonatal intensive care: a focus group study for media design
For parents whose child may require admission to a neonatal intensive care unit (NICU), the antenatal consultation is often their first point of contact with the child’s medical team.
Patrick von Hauff, Karen Long, Barbara Taylor and Michael A. van Manen
BMC Pregnancy and Childbirth 2016 16:103
Published on: 14 May 2016

Current Opinion in Infectious Diseases
June 2016 – Volume 29 – Issue 3 pp: v-v,229-318
http://journals.lww.com/co-infectiousdiseases/pages/currenttoc.aspx
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PAEDIATRIC AND NEONATAL INFECTIONS
Edited by Paul T. Heath

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Interactions between intestinal pathogens, enteropathy and malnutrition in developing countries
Prendergast, Andrew J.; Kelly, Paul
Abstract
Purpose of review: This review focuses on recent data highlighting the interactions between intestinal pathogens, enteropathy and malnutrition in developing countries, which drive morbidity and mortality and hinder the long-term developmental potential of children.
Recent findings: Diarrhoea remains the second commonest cause of death in children below 5 years, and malnutrition underlies 45% of all child deaths. Even in the absence of diarrhoea, subclinical pathogen carriage and enteropathy are almost universal in developing countries. Here, we review recent studies addressing the causes and consequences of diarrhoea; emerging data on environmental influences that govern postnatal development of the gut and microbiota; current concepts of environmental enteric dysfunction; and recent intervention trials in the field. We highlight the interactions between these processes, whereby intestinal pathogens drive a cycle of gut damage, malabsorption, chronic inflammation and failed mucosal regeneration, leading to malnutrition and susceptibility to further enteric infections.
Summary: Efforts to improve child survival and long-term developmental potential need to address the overlapping and interacting effects of diarrhoea, enteropathy and malnutrition. Recent insights from human and animal studies suggest potential targets for intervention.
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HIV-1 at the placenta: immune correlates of protection and infection
Johnson, Erica L.; Chakraborty, Rana
Abstract
Purpose of review: Mother-to-child transmission (MTCT) of HIV-1 remains a significant global health concern despite implementation of maternal combination antiretroviral therapy for treatment as prevention to offset transmission. The risk of in-utero HIV-1 transmission in the absence of interventions is ∼7%. This low rate of transmission points to innate and adaptive mechanisms to restrict lentiviral infection within the placenta.
Recent findings: Placental macrophages (Hofbauer cells) are key mediators in in-utero transmission of HIV-1. Hofbauer cells constitutively express elevated concentrations of regulatory cytokines, which inhibit HIV-1 replication in vitro, and possess intrinsic antiviral properties. Hofbauer cells sequester HIV-1 in intracellular compartments that can be accessed by HIV-1-specific antibodies and may occur in vivo to offset MTCT. Intriguingly, studies have reported strong associations between maternal human cytomegalovirus (HCMV) viremia and MTCT of HIV-1. HCMV infection at the placenta promotes inflammation, chronic villitis, and trophoblast damage, providing potential HIV-1 access into CD4+CCR5+ target cells. The placenta exhibits a variety of mechanisms to limit HIV-1 replication, yet viral-induced activation with maternal HCMV may override this protection to facilitate in-utero transmission of HIV-1.
Summary: Understanding immune correlates of protection or transmission at the placenta during on-going HIV-1 exposure may contribute to understanding HIV pathogenesis and the development of effective immunotherapies.
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Group B Streptococcus: developing a correlate of protection for a vaccine against neonatal infections
Dangor, Ziyaad; Lala, Sanjay G.; Kwatra, Gaurav; More
Abstract
Purpose of review: Maternal vaccination to prevent invasive Group B Streptococcus (GBS) disease in infants is an important alternative strategy to intrapartum antibiotic prophylaxis. Licensure of GBS vaccines could be expedited using immunological correlates of protection.
Recent findings: Between 2014 and 2015, we identified two studies that demonstrated an inverse association between invasive GBS disease and maternal serotype III capsular antibody levels greater than 1 μg/ml and greater than 3 μg/ml, and higher maternal antibody levels were associated with protection against serotype Ia disease. Furthermore, serotype Ia and III antibody levels greater than 3 μg/ml were associated with a reduced risk of GBS colonization in pregnant women.
Experimental studies have investigated the use of GBS surface proteins as vaccine candidates. Although the immunogenic potential of pilus island and other surface proteins has been shown in animal-model studies, no association between maternal pilus island antibody levels and invasive GBS disease was demonstrated in infants. Additionally, several novel innate immune mediators that prevent GBS infection have been described in human and experimental studies.
Summary: Recent studies suggest that maternal capsular antibody thresholds may be used as immunological correlates of protection for vaccine licensure. Surface proteins, as candidate vaccines or conjugates to the polysaccharide-protein vaccine, may broaden protection against invasive GBS disease.