British Medical Journal
16 April 2016 (vol 352, issue 8053)
http://www.bmj.com/content/353/8053

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Research Update
Clinical features and neuroimaging (CT and MRI) findings in presumed Zika virus related congenital infection and microcephaly: retrospective case series study
BMJ 2016; 353 :i1901 (Published 13 April 2016)
Maria de Fatima Vasco Aragao, neuroradiologist and professor of radiology1, Vanessa van der Linden, paediatric neurologist2, Alessandra Mertens Brainer-Lima, neuroradiologist and professor of radiology3, Regina Ramos Coeli, paediatric infectologist and professor4, Maria Angela Rocha, infectologist4, Paula Sobral da Silva, paediatric neurologist4, Maria Durce Costa Gomes de Carvalho, paediatric neurologist4, Ana van der Linden, paediatric neurologist5, Arthur Cesario de Holanda, medical student6, Marcelo Moraes Valenca, neurosurgeon and full professor of neurology and neurosurgery7
Abstract
Objective
To report radiological findings observed in computed tomography (CT) and magnetic resonance imaging (MRI) scans of the first cases of congenital infection and microcephaly presumably associated with the Zika virus in the current Brazilian epidemic.
Design
Retrospective study with a case series.
Setting
Association for Assistance of Disabled Children (AACD), Pernambuco state, Brazil.
Participants
23 children with a diagnosis of congenital infection presumably associated with the Zika virus during the Brazilian microcephaly epidemic.
Main outcome measures
Types of abnormalities and the radiological pattern of lesions identified on CT and MRI brain scans.
Results
Six of the 23 children tested positive for IgM antibodies to Zika virus in cerebrospinal fluid. The other 17 children met the protocol criteria for congenital infection presumably associated with the Zika virus, even without being tested for IgM antibodies to the virus—the test was not yet available on a routine basis. Of the 23 children, 15 underwent CT, seven underwent both CT and MRI, and one underwent MRI. Of the 22 children who underwent CT, all had calcifications in the junction between cortical and subcortical white matter, 21 (95%) had malformations of cortical development, 20 (91%) had a decreased brain volume, 19 (86%) had ventriculomegaly, and 11 (50%) had hypoplasia of the cerebellum or brainstem. Of the eight children who underwent MRI, all had calcifications in the junction between cortical and subcortical white matter, malformations of cortical development occurring predominantly in the frontal lobes, and ventriculomegaly. Seven of the eight (88%) children had enlarged cisterna magna, seven (88%) delayed myelination, and six each (75%) a moderate to severe decrease in brain volume, simplified gyral pattern, and abnormalities of the corpus callosum (38% hypogenesis and 38% hypoplasia). Malformations were symmetrical in 75% of the cases.
Conclusion
Severe cerebral damage was found on imaging in most of the children in this case series with congenital infection presumably associated with the Zika virus. The features most commonly found were brain calcifications in the junction between cortical and subcortical white matter associated with malformations of cortical development, often with a simplified gyral pattern and predominance of pachygyria or polymicrogyria in the frontal lobes. Additional findings were enlarged cisterna magna, abnormalities of corpus callosum (hypoplasia or hypogenesis), ventriculomegaly, delayed myelination, and hypoplasia of the cerebellum and the brainstem.

International Health
Volume 8 Issue 2 March 2016
http://inthealth.oxfordjournals.org/content/current

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REVIEWS
Editor’s choice: Cardiac rehabilitation in low- and middle-income countries: a review on cost and cost-effectiveness
Int. Health (2016) 8 (2): 77-82 doi:10.1093/inthealth/ihv047
Neil B. Oldridge, Maureen T. Pakosh, and Randal J. Thomas
Abstract

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Experiences from the field: maternal, reproductive and child health data collection in humanitarian and emergency situations
Fiona M. Dickinson*, Thidar Pyone and Nynke van den Broek
Author Affiliations
Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
*Corresponding author: Tel: +44 0151 705 3314; Email: fiona.dickinson@lstmed.ac.uk
Received December 12, 2014.
Revision received May 21, 2015.
Accepted May 22, 2015.
Abstract
Background Humanitarian emergencies can disproportionately affect women of reproductive age, and children. Good data on reproductive maternal, newborn and child health (RMNCH) are vital to plan and deliver programmes to address RMNCH needs. There is currently a lack of information regarding the availability, use and applicability of data collection tools.
Methods Key informant interviews (KII) were conducted with participants with experience of data collection in humanitarian settings, identified from relevant publications. Data were analysed using the thematic framework approach.
Results All participants reported challenges, especially in the acute phase of an emergency and when there is insufficient security. Four common themes were identified: the importance of a mixed methods approach, language both with regard to development of data collection tools and data collection, the need to modify existing tools and build local capacity for data collection. Qualitative data collection was noted to be time consuming but considered to be important to understand the local context. Both those who have experienced trauma (including sexual violence) and data collectors require debriefing after documenting these experiences.
Conclusions There were numerous challenges associated with data collection assessing the health status of, and services available, to women and children in humanitarian settings, and researchers should be well prepared.

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Spillover effect of HIV-specific foreign aid on immunization services in Nigeria
Charles C. Chima* and Luisa Franzini
Author Affiliations
Division of Management, Policy and Community Health, The University of Texas School of Public Health, 1200 Pressler Street, Houston, Texas 77030, USA
*Corresponding author: Present address: Healthcare Transformation Initiatives, The University of Texas Health Science Center at Houston, 1200 Binz Street Houston TX 77004, USA; Tel: +1 832-231-4955; E-mail: chimacharles@gmail.com
Received December 13, 2014.
Revision received April 20, 2015.
Accepted April 20, 2015.
Abstract
Background
Health aid to Nigeria increased tremendously in the last decade and a significant portion of the funds were earmarked for HIV-associated programs. Studies on the impact of HIV-specific aid on the delivery of non-HIV health services in sub-Saharan Africa have yielded mixed results. This study assessed if there is a spillover effect of HIV-specific aid on childhood vaccinations in Nigeria.
Methods
Multivariate logistic regression models were used to estimate the effect of aid disbursements in a previous year on the receipt of vaccines at the individual level in a given year. Estimations were done for approximately 11 700 children using data from demographic and health surveys conducted in Nigeria in 2003 and 2008.
Results
US$1 increase in HIV aid per capita was associated with a decrease in the probability of receipt of vaccines by 8–31%: polio first dose decreased by 8%; polio final dose by 9%; diphtheria-pertussis-tetanus (DPT) first dose by 11%; DPT final dose by 19%; measles by 31%; final doses of polio and DPT plus measles vaccine by 8%.
Conclusions
HIV-specific aid had a negative spillover effect on immunization services in Nigeria over the study period. Donors may need to rethink their funding strategies in favour of more horizontal approaches.

JAMA
April 12, 2016, Vol 315, No. 14
http://jama.jamanetwork.com/issue.aspx

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Viewpoint
Neglected Dimensions of Global Security: The Global Health Risk Framework Commission
Lawrence O. Gostin, JD; Carmen C. Mundaca-Shah, MD, DrPH; Patrick W. Kelley, MD, DrPH

This Viewpoint discusses the Global Health Risk Framework Commission’s strategy to safeguard human and economic security from pandemic threats.

The world has experienced global health crises ranging from novel influenzas (H5N1 and H1N1) and coronaviruses (SARS and MERS) to the Ebola and Zika viruses. In each case, governments and international organizations seemed unable to react quickly and decisively. Health crises have unmasked critical vulnerabilities—weak health systems, failures of leadership, and political overreaction and underreaction. The Global Health Risk Framework Commission, for which the National Academy of Medicine served as the secretariat, recently set out a comprehensive strategy to safeguard human and economic security from pandemic threats (eTable in the Supplement).1

Journal of Global Ethics
Volume 12, Issue 1, 2016
http://www.tandfonline.com/toc/rjge20/.U2V-Elf4L0l#.VAJEj2N4WF8

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Articles
Exploitative, irresistible, and coercive offers: why research participants should be paid well or not at all
Sara Belfrage
pages 69-86
DOI:10.1080/17449626.2016.1150318
ABSTRACT
This paper begins with the assumption that it is morally problematic when people in need are offered money in exchange for research participation if the amount offered is unfair. Such offers are called ‘coercive’, and the degree of coerciveness is determined by the offer’s potential to cause exploitation and its irresistibility. Depending on what view we take on the possibility to compensate for the sacrifices made by research participants, a wish to avoid ‘coercive offers’ leads to policy recommendations concerning payment for participation. For sacrifices considered compensable, we ought to offer either no payment or payment at a level deemed fair, while for sacrifices deemed incompensable, we always ought to offer no payment because as compensation appears and increases, so too does coercion. This article provides a model for thinking of the way in which degrees of exploitativeness, irresistibility, and coerciveness interact with the size of the reward for compensable and incompensable cases. The conclusions are of particular relevance in contexts where potential research participants are poor or in other ways lack reasonably good options, as is often the case when international pharmaceutical companies or researchers based in the Global North place clinical trials in the Global South.

The Lancet
Apr 16, 2016 Volume 387 Number 10028 p1591-1692
http://www.thelancet.com/journals/lancet/issue/current

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Comment
Yellow fever vaccine supply: a possible solution
Thomas P Monath, Jack P Woodall, Duane J Gubler, Thomas M Yuill, John S Mackenzie, Reinaldo M Martins, Paul Reiter, David L Heymann
Summary
The global threat of the emerging epidemic of yellow fever in Angola1 is underscored by the recent spread of similar Aedes aegypti mosquito-borne viruses including dengue, chikungunya, and now Zika. Since their emergence in the 1950s, dengue virus infection has been reported from more than 128 countries, the chikungunya virus has been reported from over 60 countries,2,3 while yellow fever, first identified as a viral infection in 1900, has been reported from more than 57 countries and is on the move once again.

The Milbank Quarterly
A Multidisciplinary Journal of Population Health and Health Policy
March 2016 Volume 94, Issue 1 Pages 1–223
http://onlinelibrary.wiley.com/doi/10.1111/1468-0009.2016.94.issue-1/issuetoc

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Op-Ed
Global Health Security After Ebola: Four Global Commissions (pages 34–38)
LAWRENCE O. GOSTIN
Article first published online: 14 MAR 2016 | DOI: 10.1111/1468-0009.12176

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 16 April 2016)

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Research Article
Clinical and Epidemiological Characterization of Laboratory-Confirmed Autochthonous Cases of Zika Virus Disease in Mexico
April 15, 2016 ·
Introduction: Since 2014, authoctonous circulation of Zika virus (ZIKV) in the Americas was detected (Easter Island, Chile). In May 2015, Brazil confirmed authoctonous ¬¬transmission and in October of that year Colombia reported their first cases. Now more than 52 countries have reported cases, including Mexico. To deal with this contingency in Mexico, several surveillance systems, in addition to systems for vector-borne diseases were strengthened with the participation of all health institutions. Also, the Ministry of Health defined an Action Plan against ZIKV for the whole country.
Methods: We analyzed 93 authoctonous cases of ZIKV disease identified by Epidemiological Surveillance System for Zika Virus in Mexico. All authoctonous cases confirmed by laboratory since November 25, 2015 to February 19, 2016 were included. A description of clinical and epidemiological characteristics of 93 cases of ZIKV disease are presenting and, we describe the Action Plan against this public health emergency.
Results: The distribution of cases by sex was 61 men and 32 women; mean age was 35 years old (S.D. 15, range 6-90). The main clinical features in the 93 cases were fever (96.6%), rash (93.3%), non-purulent conjunctivitis (88.8%), headache (85.4%), and myalgia (84.3%). No deaths were reported.
Conclusion: The ZIKV epidemic poses new challenges to public health systems. The information provided for basic, clinical, and epidemiological research, in addition to the data derived from epidemiological surveillance is essential. However, there are still many unanswered questions regarding mechanisms of transmission, complications, and impact of this virus.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 16 April 2016)

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Health in Action
Mobile Phones As Surveillance Tools: Implementing and Evaluating a Large-Scale Intersectoral Surveillance System for Rabies in Tanzania
Zacharia Mtema, Joel Changalucha, Sarah Cleaveland, Martin Elias, Heather M. Ferguson, Jo E. B. Halliday, Daniel T. Haydon, Gurdeep Jaswant, Rudovick Kazwala, Gerry F. Killeen, Tiziana Lembo, Kennedy Lushasi, Alpha D. Malishee, Rebecca Mancy, Matthew Maziku, Eberhard M. Mbunda, Geofrey J. M. Mchau, Roderick Murray-Smith, Kristyna Rysava, Khadija Said, Maganga Sambo, Elizabeth Shayo, Lwitiko Sikana, Sunny E Townsend, Honorathy Urassa, Katie Hampson
| published 12 Apr 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002002
Summary Points
:: Surveillance is critical to manage preventative health services and control infectious diseases. Integrated surveillance involving public health, veterinary, and environmental sectors is urgently needed to effectively manage zoonoses and vector-borne diseases. However, most surveillance in low-income countries is paper-based, provides negligible timely feedback, is poorly incentivised, and results in delays, limited reporting, inaccurate data, and costly processing.
:: The potential of mobile technologies for improving health system surveillance has been demonstrated through small-scale pilots, but large-scale evaluations under programmatic implementation remain rare.
:: An intersectoral mobile-phone–based system was developed and implemented for rabies surveillance across southern Tanzania. Since 2011, the system has facilitated near real-time reporting of animal bites and human and animal vaccine use (almost 30,000 reports) by over 300 frontline health and veterinary workers across a catchment area of 150,000 km2 with >10 million inhabitants, improving data quality, timeliness, and completeness while reducing costs.
:: The surveillance system infrastructure is a platform that can be further developed to improve services and deliver health interventions; for example, generating automated personalized text messages (SMS) to alert patients to their vaccination schedules improved their compliance with regimens. Other interventions targeting patients and health workers can now be implemented easily.
:: The system has become an integrated, popular, and valuable tool across sectors, used routinely throughout southern Tanzania to evaluate the impacts of rabies control and prevention activities and to improve their management, directly informed by the experiences of frontline users.
We discuss challenges encountered during development and deployment, how we overcame these, and our recommendations for scaling up mobile-phone–based health (mHealth) interventions in low-income countries.

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Policy Forum
Building Learning Health Systems to Accelerate Research and Improve Outcomes of Clinical Care in Low- and Middle-Income Countries
Mike English, Grace Irimu, Ambrose Agweyu, David Gathara, Jacquie Oliwa, Philip Ayieko, Fred Were, Chris Paton, Sean Tunis, Christopher B. Forrest
| published 12 Apr 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1001991
Summary Points
:: Achieving universal coverage that supports high-quality care will require that health systems are designed to integrate the delivery of health services with the generation of new knowledge about the effectiveness of these services.
:: System strengthening and research will need to be better integrated to achieve this in low- and middle-income countries (LMIC) so that changes in coverage, quality, and impact are measured, costs are contained, and health systems are responsive to users’ needs and concerns.
:: In high-income countries, learning health systems (LHS) are emerging to meet similar needs. The LHS vision aspires to engage policy makers, researchers, service providers, and patients in learning that uses and strengthens routinely collected data to conduct pragmatic, contextually appropriate research, promote rapid adoption of findings to improve quality and outcomes, and promote continuous learning.
:: Although there are significant challenges, we should begin to develop LHS in LMIC for their immediate and longer term benefits and to avoid having to retrofit health systems with the capability to promote learning at a later date and even greater cost.
:: A global coalition on how to build LHS effectively that shares accumulating learning could enable such a strategy.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 16 April 2016)

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Research Article
Zika Virus Outbreak in Rio de Janeiro, Brazil: Clinical Characterization, Epidemiological and Virological Aspects
Patrícia Brasil, Guilherme Amaral Calvet, André Machado Siqueira, Mayumi Wakimoto, Patrícia Carvalho de Sequeira, Aline Nobre, Marcel de Souza Borges Quintana, Marco Cesar Lima de Mendonça, Otilia Lupi, Rogerio Valls de Souza, Carolina Romero, Heruza Zogbi, Clarisse da Silveira Bressan, Simone Sampaio Alves, Ricardo Lourenço-de-Oliveira, Rita Maria Ribeiro Nogueira, Marilia Sá Carvalho, Ana Maria Bispo de Filippis, Thomas Jaenisch
| published 12 Apr 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004636

PLoS One
http://www.plosone.org/
[Accessed 16 April 2016]

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Research Article
Health Service Utilization among Syrian Refugees with Chronic Health Conditions in Jordan
Shannon Doocy, Emily Lyles, Laila Akhu-Zaheya, Arwa Oweis, Nada Al Ward, Ann Burton
Research Article | published 13 Apr 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0150088
Abstract
Introduction
The influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system, particularly in treating chronic health conditions. This study was undertaken to assess utilization of health services for chronic health conditions among Syrian refugees in non-camp settings.
Methods
A survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care for hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, and arthritis. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households.
Results
Of 1363 cases with a chronic health condition diagnosis, 84.7% had received care in Jordan. Public facilities faced a heavy burden serving over half (53.9%) of care-seekers; the remainder received care in the private (29.6%) and NGO/charity (16.6%) sectors. Individuals with non-communicable diseases (NCDs) in the central region of Jordan and with arthritis had the lowest rates of care-seeking when compared to other regions and conditions. Overall, 31.6% of care-seekers had an out-of-pocket payment for the most recent care-seeking event which averaged 18.8 USD (median = 0 USD), excluding cost of medications.
Discussion
Forced displacement presents major challenges to those with NCDs, which have the potential to seriously impact both the quality of life and life expectancy amongst refugees. NCD patterns among Syrian refugees indicate the importance of continuing support to public sector services in Jordan to adequately meet expanding needs and ensure appropriate prevention and control of priority NCDs.

Science
15 April 2016 Vol 352, Issue 6283
http://www.sciencemag.org/current.dtl
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Policy Forum
Opportunities for advances in climate change economics
By M. Burke, M. Craxton, C. D. Kolstad, C. Onda, H. Allcott, E. Baker, L. Barrage, R. Carson, K. Gillingham, J. Graff-Zivin, M. Greenstone, S. Hallegatte, W. M. Hanemann, G. Heal, S. Hsiang, B. Jones, D. L. Kelly, R. Kopp, M. Kotchen, R. Mendelsohn, K. Meng, G. Metcalf, J. Moreno-Cruz, R. Pindyck, S. Rose, I. Rudik, J. Stock, R. S. J. Tol
Science15 Apr 2016 : 292-293
Target carbon’s costs, policy designs, and developing countries
Summary
There have been dramatic advances in understanding the physical science of climate change, facilitated by substantial and reliable research support. The social value of these advances depends on understanding their implications for society, an arena where research support has been more modest and research progress slower. Some advances have been made in understanding and formalizing climate-economy linkages, but knowledge gaps remain [e.g., as discussed in (1, 2)]. We outline three areas where we believe research progress on climate economics is both sorely needed, in light of policy relevance, and possible within the next few years given appropriate funding: (i) refining the social cost of carbon (SCC), (ii) improving understanding of the consequences of particular policies, and (iii) better understanding of the economic impacts and policy choices in developing economies.
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Reports
Zika virus in the Americas: Early epidemiological and genetic findings
By Nuno Rodrigues Faria, Raimunda do Socorro da Silva Azevedo, Moritz U. G. Kraemer, Renato Souza, Mariana Sequetin Cunha, Sarah C. Hill, Julien Thézé, Michael B. Bonsall, Thomas A. Bowden, Ilona Rissanen, Iray Maria Rocco, Juliana Silva Nogueira, Adriana Yurika Maeda, Fernanda Giseli da Silva Vasami, Fernando Luiz de Lima Macedo, Akemi Suzuki, Sueli Guerreiro Rodrigues, Ana Cecilia Ribeiro Cruz, Bruno Tardeli Nunes, Daniele Barbosa de Almeida Medeiros, Daniela Sueli Guerreiro Rodrigues, Alice Louize Nunes Queiroz, Eliana Vieira Pinto da Silva, Daniele Freitas Henriques, Elisabeth Salbe Travassos da Rosa, Consuelo Silva de Oliveira, Livia Caricio Martins, Helena Baldez Vasconcelos, Livia Medeiros Neves Casseb, Darlene de Brito Simith, Jane P. Messina, Leandro Abade, José Lourenço, Luiz Carlos Junior Alcantara, Maricélia Maia de Lima, Marta Giovanetti, Simon I. Hay, Rodrigo Santos de Oliveira, Poliana da Silva Lemos, Layanna Freitas de Oliveira, Clayton Pereira Silva de Lima, Sandro Patroca da Silva, Janaina Mota de Vasconcelos, Luciano Franco, Jedson Ferreira Cardoso, João Lídio da Silva Gonçalves Vianez-Júnior, Daiana Mir, Gonzalo Bello, Edson Delatorre, Kamran Khan, Marisa Creatore, Giovanini Evelim Coelho, Wanderson Kleber de Oliveira, Robert Tesh, Oliver G. Pybus, Marcio R. T. Nunes, Pedro F. C. Vasconcelos
Science15 Apr 2016 : 345-349
Zika virus genomes from Brazil
The Zika virus outbreak is a major cause for concern in Brazil, where it has been linked with increased reports of otherwise rare birth defects and neuropathology. In a phylogenetic analysis, Faria et al. infer a single introduction of Zika to the Americas and estimated the introduction date to be about May to December 2013—some 12 months earlier than the virus was reported. This timing correlates with major events in the Brazilian cultural calendar associated with increased traveler numbers from areas where Zika virus has been circulating. A correlation was also observed between incidences of microcephaly and week 17 of pregnancy.
Abstract
Brazil has experienced an unprecedented epidemic of Zika virus (ZIKV), with ~30,000 cases reported to date. ZIKV was first detected in Brazil in May 2015, and cases of microcephaly potentially associated with ZIKV infection were identified in November 2015. We performed next-generation sequencing to generate seven Brazilian ZIKV genomes sampled from four self-limited cases, one blood donor, one fatal adult case, and one newborn with microcephaly and congenital malformations. Results of phylogenetic and molecular clock analyses show a single introduction of ZIKV into the Americas, which we estimated to have occurred between May and December 2013, more than 12 months before the detection of ZIKV in Brazil. The estimated date of origin coincides with an increase in air passengers to Brazil from ZIKV-endemic areas, as well as with reported outbreaks in the Pacific Islands. ZIKV genomes from Brazil are phylogenetically interspersed with those from other South American and Caribbean countries. Mapping mutations onto existing structural models revealed the context of viral amino acid changes present in the outbreak lineage; however, no shared amino acid changes were found among the three currently available virus genomes from microcephaly cases. Municipality-level incidence data indicate that reports of suspected microcephaly in Brazil best correlate with ZIKV incidence around week 17 of pregnancy, although this correlation does not demonstrate causation. Our genetic description and analysis of ZIKV isolates in Brazil provide a baseline for future studies of the evolution and molecular epidemiology of this emerging virus in the Americas.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 9 April 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 9 April 2016

blog edition: comprised of the 35+ entries  posted below.

American Journal of Tropical Medicine and Hygiene
April 2016; 94 (4)
http://www.ajtmh.org/content/current

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Perspective Piece
An Improved Ward Architecture for Treatment of Patients with Ebola Virus Disease in Liberia
Jianping You and Qing Mao
Am J Trop Med Hyg 2016 94:701-703; Published online January 11, 2016, doi:10.4269/ajtmh.15-0209
Abstract
During the recent outbreak of Ebola virus disease (EVD) in west Africa, we established an Ebola treatment center (ETC) with improved ward architecture. The ETC was built with movable prefabricated boards according to infectious disease unit standard requirements. The clinical staff ensured their own security while providing patients with effective treatment. Of the 180 admissions to the ETC, 10 cases were confirmed with EVD of which six patients survived. None of the clinical staff was infected. We hope that our experience will enable others to avoid unnecessary risks while delivering EVD care.

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Infectious Diseases in Sub-Saharan Immigrants to Spain
Núria Serre Delcor, Begoña Treviño Maruri, Antoni Soriano Arandes, Isabel Claveria Guiu, Hakima Ouaarab Essadik, Mateu Espasa Soley, Israel Molina Romero, and Carlos Ascaso
Am J Trop Med Hyg 2016 94:750-756; Published online February 15, 2016, doi:10.4269/ajtmh.15-0583
Abstract
Immigrants may be carriers of infectious diseases because of the prevalence of these diseases in their country of origin, exposure during migration, or conditions during resettlement, with this prevalence being particularly high in sub-Saharan Africans. We performed a retrospective review of 180 sub-Saharan immigrants screened for infectious diseases at an International Health Center from January 2009 to December 2012. At least one pathogenic infectious disease was diagnosed in 72.8% patients: 60.6% latent tuberculosis infection, 36.8% intestinal parasites (intestinal protozoa or helminths), 28.1% helminths, 14.8% hepatitis B surface antigen positive, 1.2% anti-hepatitis C virus positive, 1.2% human immunodeficiency virus–positive, and 1.2% malaria. Coinfections were present in 28.4%. There was significant association between eosinophilia (absolute count or percentage) or hyper-IgE and the presence of helminths (P < 0.001). Relative eosinophilia and hyper-IgE were better indicators of helminth infection than absolute eosinophilia, particularly for schistosomiasis and strongyloidiasis. We found a high prevalence of infectious diseases in sub-Saharan immigrants, which could lead to severe health problems (in the absence of prompt treatment), representing a high cost to the public health system and possible transmission in the host country. Accurate screening and tailored protocols for infectious diseases are recommended in sub-Saharan immigrants.

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Retrospective Analysis of the 2014–2015 Ebola Epidemic in Liberia
Katherine E. Atkins, Abhishek Pandey, Natasha S. Wenzel, Laura Skrip, Dan Yamin, Tolbert G. Nyenswah, Mosoka Fallah, Luke Bawo, Jan Medlock, Frederick L. Altice, Jeffrey Townsend,
Martial L. Ndeffo-Mbah, and Alison P. Galvani
Am J Trop Med Hyg 2016 94:833-839; Published online February 29, 2016, doi:10.4269/ajtmh.15-0328
Abstract
The 2014–2015 Ebola epidemic has been the most protracted and devastating in the history of the disease. To prevent future outbreaks on this scale, it is imperative to understand the reasons that led to eventual disease control. Here, we evaluated the shifts of Ebola dynamics at national and local scales during the epidemic in Liberia. We used a transmission model calibrated to epidemiological data between June 9 and December 31, 2014, to estimate the extent of community and hospital transmission. We found that despite varied local epidemic patterns, community transmission was reduced by 40–80% in all the counties analyzed. Our model suggests that the tapering of the epidemic was achieved through reductions in community transmission, rather than accumulation of immune individuals through asymptomatic infection and unreported cases. Although the times at which this transmission reduction occurred in the majority of the Liberian counties started before any large expansion in hospital capacity and the distribution of home protection kits, it remains difficult to associate the presence of interventions with reductions in Ebola incidence.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 9 April 2016)

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Research article
Drivers of improved health sector performance in Rwanda: a qualitative view from within
Rwanda has achieved great improvements in several key health indicators, including maternal mortality and other health outcomes. This raises the question: what has made this possible, and what makes Rwanda so …
Felix Sayinzoga and Leon Bijlmakers
BMC Health Services Research 2016 16:123
Published on: 8 April 2016

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Research article
Effectiveness, cost effectiveness, acceptability and implementation barriers/enablers of chronic kidney disease management programs for Indigenous people in Australia, New Zealand and Canada: a systematic review of mixed evidence
Indigenous peoples in Australia, New Zealand and Canada carry a greater burden of chronic kidney disease (CKD) than the general populations in each country, and this burden is predicted to increase.
Rachel Reilly, Katharine Evans, Judith Gomersall, Gillian Gorham, Micah D. J. Peters, Steven Warren, Rebekah O’Shea, Alan Cass and Alex Brown
BMC Health Services Research 2016 16:119
Published on: 6 April 2016

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Abstracts
Researching Complex Interventions in Health: The State of the Art
KEYNOTE PRESENTATIONS
Peter Craig, Ingalill Rahm-Hallberg, Nicky Britten, Gunilla Borglin, Gabriele Meyer, Sascha Köpke, Jane Noyes, Jackie Chandler, Sara Levati, Anne Sales, Lehana Thabane, Lora Giangregorio, Nancy Feeley, Sylvie Cossette, Rod Taylor, Jacqueline Hill…
BMC Health Services Research 2016 16(Suppl 1):101
Published on: 4 April 2016

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 9 April 2016)

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Research article
Are all immigrant mothers really at risk of low birth weight and perinatal mortality? The crucial role of socio-economic status
Judith Racape, Claudia Schoenborn, Mouctar Sow, Sophie Alexander and Myriam De Spiegelaere
Published on: 8 April 2016

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Research article
Birth preparedness, complication readiness and other determinants of place of delivery among mothers in Goba District, Bale Zone, South East Ethiopia
Semere Sileshi Belda and Mulugeta Betre Gebremariam
Published on: 6 April 2016

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 9 April 2016)

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Research article
Adherence to and acceptability of home fortification with vitamins and minerals in children aged 6 to 23 months: a systematic review
Vitamin and mineral deficiencies affect more than two million people worldwide. In 2011, based on recent scientific evidence and the low effectiveness of current strategies, the World Health Organization recommends…
Samara Fernandes de Barros and Marly Augusto Cardoso
BMC Public Health 2016 16:299
Published on: 7 April 2016

Conflict and Health
http://www.conflictandhealth.com/
[Accessed 9 April 2016]

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Research
A quantitative assessment of termination of sexual violence-related pregnancies in eastern Democratic Republic of Congo
Shada A. Rouhani, Jennifer Scott, Gillian Burkhardt, Monica A. Onyango, Sadia Haider, Ashley Greiner, Katherine Albutt, Michael VanRooyen and Susan A. Bartels
Published on: 6 April 2016

Eurosurveillance
Volume 21, Issue 14, 07 April 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Perspectives
Risk communication as a core public health competence in infectious disease management: Development of the ECDC training curriculum and programme
by P Dickmann, T Abraham, S Sarkar, P Wysocki, S Cecconi, F Apfel, Ü Nurm

International Journal of Infectious Diseases
April 2016 Volume 45, In Progress
http://www.ijidonline.com/current

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Editorial
Zika virus outbreak and the case for building effective and sustainable rapid diagnostics laboratory capacity globally
Alimuddin Zumla, Ian Goodfellow, Francis Kasolo, Francine Ntoumi, Philippe Buchy, Matthew Bates, Esam I Azhar, Matthew Cotten, Eskild Petersen
p92–94
Published online: March 4 2016
Preview
New and re-emerging pathogens with epidemic potential have threatened global health security for the past century.1 As with the recent Ebola Virus Disease (EVD) epidemic, the Zika Virus (ZIKV) outbreak has yet again surprised and overwhelmed the international health community with an unexpected event for which it might have been better prepared.

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Editorial
Engaging high and low burden countries in the “TB end game”
B.J. Marais, A.C. Outhred, A. Zumla
p100–102
Published online: March 19 2016
Preview
Tuberculosis (TB) is now the single biggest infectious disease killer in the world, surpassing malaria and HIV/AIDS. In 2014, there were an estimated 9.6 million incident TB cases and 1.5 million deaths.1 It is not widely appreciated that TB is also a major cause of disease and death in young children.2,3 New estimates from the World Health Organization (WHO) are that 1 million children developed TB during 2014.1 This is disconcerting because children have poor access to TB services in most resource-limited settings and paediatric cases provide an accurate reflection of uncontrolled TB transmission within communities.