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Influenza vaccination is recommended especially for persons at risk of complications. In 2003, the World Health Assembly urged Member States (MS) to increase vaccination coverage to 75% among older persons by 2010. To assess progress towards the 2010 vaccination goal and describe seasonal influenza vaccination recommendations in the World Health Organization (WHO) European Region. Data on seasonal influenza vaccine recommendations, dose distribution, and target group coverage were obtained from two sources: European Union and European Economic Area MS data were extracted from influenza vaccination surveys covering seven seasons (2008/2009–2014/2015) published by the Vaccine European New Integrated Collaboration Effort and European Centre for Disease Prevention and Control. For the remaining WHO European MS, a separate survey on policies and uptake for all seasons (2008/2009–2014/2015) was distributed to national immunization programmes in 2015. Data was available from 49 of 53 MS. All but two had a national influenza vaccination policy. High-income countries distributed considerably higher number of vaccines per capita (median; 139.2 per 1000 population) compared to lower-middle-income countries (median; 6.1 per 1000 population). Most countries recommended vaccination for older persons, individuals with chronic disease, healthcare workers, and pregnant women. Children were included in < 50% of national policies. Only one country reached 75% coverage in older persons (2014/2015), while a number of countries reported declining vaccination uptake. Coverage of target groups was overall low, but with large variations between countries. Vaccination coverage was not monitored for several groups. Despite policy recommendations, influenza vaccination uptake remains suboptimal. Low levels of vaccination is not only a missed opportunity for preventing influenza in vulnerable groups, but could negatively affect pandemic preparedness. Improved understanding of barriers to influenza vaccination is needed to increase uptake and reverse negative trends. Furthermore, implementation of vaccination coverage monitoring is critical for assessing performance and impact of the programmes.

First mooted in 2011, the concept of Trapped Populations referring to people unable to move from environmentally high-risk areas broadened the study of human responses to environmental change. While a seemingly straightforward concept, the underlying discourses around the reasons for being ‘trapped’, and the language describing the concept have profound influences on the way in which policy and practice approaches the needs of populations at risk from environmental stresses and shocks. In this article, we apply a Critical Discourse Analysis to the academic literature on the subject to reveal some of the assumptions implicit within discussing ‘trapped’ populations. The analysis reveals a dominant school of thought that assisted migration, relocation, and resettlement in the face of climate change are potentially effective adaptation strategies along a gradient of migrant agency and governance.

Objective To evaluate risk factors for severe outcomes in patients with seasonal and pandemic influenza. Design Systematic review. Study selection Observational studies reporting on risk factor-outcome combinations of interest in participants with influenza. Outcomes included death, ventilator support, admission to hospital, admission to an intensive care unit, pneumonia, and composite outcomes. Data sources Medline, Embase, CINAHL, Global Health, and the Cochrane Central Register of Controlled Trials to March 2011. Risk of bias assessment Newcastle-Ottawa scale to assess the risk of bias. GRADE framework to evaluate the quality of evidence. Results 63 537 articles were identified of which 234 with a total of 610 782 participants met the inclusion criteria. The evidence supporting risk factors for severe outcomes of influenza ranged from being limited to absent. This was particularly relevant for the relative lack of data for non-2009 H1N1 pandemics and for seasonal influenza studies. Limitations in the published literature included lack of power and lack of adjustment for confounders was widespread: adjusted risk estimates were provided for only 5% of risk factor-outcome comparisons in 39 of 260 (15%) studies. The level of evidence was low for “any risk factor” (odds ratio for mortality 2.77, 95% confidence interval 1.90 to 4.05 for pandemic influenza and 2.04, 1.74 to 2.39 for seasonal influenza), obesity (2.74, 1.56 to 4.80 and 30.1, 1.74 to 2.39), cardiovascular diseases (2.92, 1.76 to 4.86 and 1.97, 1.06 to 3.67), and neuromuscular disease (2.68, 1.91 to 3.75 and 3.21, 1.84 to 5.58). The level of evidence was very low for all other risk factors. Some well accepted risk factors such as pregnancy and belonging to an ethnic minority group could not be identified as risk factors. In contrast, women who were less than four weeks post partum had a significantly increased risk of death from pandemic influenza (4.43, 1.24 to 15.81). Conclusion The level of evidence to support risk factors for influenza related complications is low and some well accepted risk factors, including pregnancy and ethnicity, could not be confirmed as risks. Rigorous and adequately powered studies are needed.

In recent years, it has increasingly been recognized that due to the uncertain geographic context problem caused by daily human mobility, the residential population is too static to serve as a valid measure of the population at risk for criminal victimization. Various alternative measures have been suggested instead. Guided by the routine activity approach, this study furthers the concept of crime risk population and its measurement across space and time. Using exceptionally comprehensive data sets on population mobility and on theft from the person in a large city in China, we select the best indicator of the risk population from the following four candidates: residential population, subway ridership, taxi ridership, and mobile phone users. Controlling for the potentially confounding effects of offender and guardian presence, we show that on both weekdays and weekends, the best indicators of risk population vary over the course of the day. In the morning, residential population outperforms other measures. In the afternoon and evening, taxi ridership and phone users are better indicators. Although the mobile phone user base forms an arguably more representative measure of ambient population, during some periods taxi ridership is superior because it provides a better indicator of outdoor (as opposed to indoor) activities. In terms of practical applications to security policy and law enforcement, these findings can help identify crime hot spots by calculating accurate crime risks.

Malaria is an important disease that has a global distribution and significant health burden. The spatial limits of its distribution and seasonal activity are sensitive to climate factors, as well as the local capacity to control the disease. Malaria is also one of the few health outcomes that has been modeled by more than one research group and can therefore facilitate the first model intercomparison for health impacts under a future with climate change. We used bias-corrected temperature and rainfall simulations from the Coupled Model Intercomparison Project Phase 5 climate models to compare the metrics of five statistical and dynamical malaria impact models for three future time periods (2030s, 2050s, and 2080s). We evaluated three malaria outcome metrics at global and regional levels: climate suitability, additional population at risk and additional person-months at risk across the model outputs. The malaria projections were based on five different global climate models, each run under four emission scenarios (Representative Concentration Pathways, RCPs) and a single population projection. We also investigated the modeling uncertainty associated with future projections of populations at risk for malaria owing to climate change. Our findings show an overall global net increase in climate suitability and a net increase in the population at risk, but with large uncertainties. The model outputs indicate a net increase in the annual person-months at risk when comparing from RCP2.6 to RCP8.5 from the 2050s to the 2080s. The malaria outcome metrics were highly sensitive to the choice of malaria impact model, especially over the epidemic fringes of the malaria distribution.

Flooding is the most common and damaging of all natural disasters in USA, and climate change is exacerbating the problem. Accurate flood maps are critical to communicating flood risk to vulnerable populations, to mitigating and adapting to floods, and to the functioning of the federal flood insurance program. Yet, we know little about how the mapping process works in practice. This article argues that politics can shape the remapping process in ways that leave communities vulnerable. Because mapping takes place within the context of the National Flood Insurance Program, the conversation at the local level often centers on the costs of revising the flood hazard zones rather than the risks associated with flooding. This can lead to less than optimal responses by individuals and communities, and suggests that the USA is not adequately preparing for future climate change impacts.

•Most comprehensive review of Group B Streptococcal serotypes through 2018.•First systematic review of Group B Streptococcal strain type and protein data.•Theoretically candidate vaccines may protect against 93-99% disease-causing strains.•More studies on GBS strains in low- and middle-income countries are needed. 21 million pregnant women worldwide (18%) are estimated to carry Group B Streptococcus (GBS), which is a risk for invasive disease in newborns, pregnant women, and stillbirths. Adults ≥ 60 years or with underlying health conditions are also vulnerable to invasive GBS disease. We undertook systematic reviews on GBS organism characteristics including: capsular polysaccharide (serotype), sequence type (multi-locus sequence types (MLST)), and virulence proteins. We synthesised data by at-risk populations, to inform vaccine development. We conducted systematic reviews and meta-analyses to estimate proportions of GBS serotypes for at risk populations: maternal colonisation, invasive disease in pregnant women, stillbirths, infants 0–90 days age, and older adults (≥60 years). We considered regional variation and time trends (2001–2018). For these at-risk population groups, we summarised reported MLST and surface proteins. Based on 198 studies (29247isolates), 93–99% of GBS isolates were serotypes Ia, Ib, II, III, IV and V. Regional variation is likely, but data gaps are apparent, even for maternal colonisation which has most data. Serotype III dominates for infant invasive disease (60%) and GBS-associated stillbirths (41%). ST17 accounted for a high proportion of infant invasive disease (41%; 95%CI: 35–47) and was found almost exclusively in serotype III strains, less present in maternal colonisation (9%; 95%CI:6–13),(4%; 95%CI:0–11) infant colonisation, and adult invasive disease (4%, 95%CI:2–6). Percentages of strains with at least one of alp 1, alp2/3, alpha C or Rib surface protein targets were 87% of maternal colonisation, 97% infant colonisation, 93% infant disease and 99% adult invasive disease. At least one of three pilus islands proteins were reported in all strains. A hexavalent vaccine (serotypes Ia, Ib, II, III, IV and V) might provide comprehensive cover for all at-risk populations. Surveillance of circulating, disease-causing target proteins is useful to inform vaccines not targeting capsular polysaccharide. Addressing data gaps especially by world region and some at-risk populations (notably stillbirths) is fundamental to evidence-based decision-making during vaccine design.

Despite a fair amount of progress on understanding human immunodeficiency virus (HIV) epidemiology globally, the Middle East and North Africa (MENA) region is the only region where knowledge of the epidemic continues to be very limited, and subject to much controversy. It has been more than 25 years since the discovery of HIV, but no scientific study has provided a comprehensive data-driven synthesis of HIV/AIDS (acquired immunodeficiency syndrome) infectious spread in this region. The current report provides the first comprehensive scientific assessment and data-driven epidemiological synthesis of HIV spread in MENA since the beginning of the epidemic. It is based on a literature review and analysis of thousands of widely unrecognized publications, reports, and data sources extracted from scientific literature or collected from sources at the local, national, and regional levels. The recommendations provided here focus on key strategies related to the scope of this report and its emphasis on understanding HIV epidemiology in MENA as a whole. The recommendations are based on identifying the status of the HIV epidemic in MENA, through this synthesis, as a low HIV prevalence setting with rising concentrated epidemics among priority populations. General directions for prevention interventions as warranted by the outcome of this synthesis are also discussed briefly, but are not delineated because they are beyond the scope of this report. This report was not intended to provide intervention recommendations for each MENA country.

Co-occurrence with humans presents substantial risks for large carnivores, yet human-dominated landscapes are increasingly crucial to carnivore conservation as human land use continues to encroach on wildlife habitat. Flexibility in large carnivore behavior may be a primary factor mediating coexistence with people, allowing carnivores to calibrate their activity and habitat use to the perceived level of human risk. However, our understanding of how large carnivores adjust the timing and location of behaviors in response to variations in human activity across the landscape remains limited, impacting our ability to identify important habitat for populations outside of protected areas. Here we examine whether African lions (Panthera leo) modify their behavior and habitat use in response to risk of a human encounter, and whether behavior-specific habitat selection allows lions to access feeding opportunities in a human-dominated landscape in Kenya. We determined fine-scale behavioral states for lions using high-resolution GPS and accelerometer data, and then investigated behavior-specific habitat selection at multiple temporal and spatial scales (ranging from 15 minutes to 12 hours and from approximately 200 meters to several kilometers). We found that lions exhibit substantial differences in habitat selection with respect to humans based on behavioral state and time of day. During the day, when risk of human encounter is highest, lions avoided areas of high human use when resting, meandering, and feeding. However, lions specifically selected for habitat near people when feeding at night. Flexible habitat use by lions thus permits access to prey, which appear to concentrate in areas near humans. The importance of habitat near people for feeding was only apparent when analyses explicitly accounted for lion behavioral state and spatiotemporal scale, highlighting the necessity of incorporating such information when investigating human impacts on large carnivore habitat use. Our results support the contention that behavior-specific habitat selection promotes carnivore persistence in human-dominated landscapes, demonstrating the importance of considering not just whether but how large carnivores use habitat near humans when managing vulnerable populations.

Heatwaves have become more frequent and intense due to anthropogenic global warming and have serious and potentially life-threatening impacts on human health, particularly for people over 65 years old. While a range of studies examine heatwave exposures, few cover the whole globe and very few cover key areas in Africa, South America, and East Asia. By using global gridded climate reanalysis, population, and demographic data, this work analyses trends in change in exposure of vulnerable populations to heatwaves, providing global and per-country aggregate statistics. The difference between the global mean of heatwave indexes and the mean weighted by vulnerable population found that these populations are experiencing up to five times the number of heatwave days relative to the global average. The total exposures, measured in person-days of heatwave, highlight the combined effect of increased heatwaves and aging populations. In China and India, heatwave exposure increased by an average of 508 million person-days per year in the last decade. Mapping of changes per country highlighted significant exposure increases, particularly in the Middle East and in South East Asia. Major disparities were found between the heatwave exposures, country income group, and country health system capacity, thus highlighting the significant inequalities in global warming impacts and response capacities with respect to health across countries. It is therefore of prime importance that health development and response are coordinated with climate change mitigation and adaptation work.