Maternal Influenza: Infection, Vaccination, and Compelling Questions

Influenza presents a significant risk for increased morbidity and mortality to pregnant women and infants based on evidence from previous influenza pandemics, seasonal epidemics, and the recent H1N1 pandemic. Since 2004, influenza vaccine has been recommended for pregnant women during any trimester of pregnancy to reduce this risk. This chapter presents an overview of influenza risks associated with pregnancy as well as a review of our current understanding of vaccine effectiveness in pregnant women, neonates, and young infants. In addition, some of the current compelling questions related to influenza risk and prevention across all trimesters of pregnancy are explored

Curricular Models and Learning Objectives for Undergraduate Minors in Global Health

Background: A growing number of institutions of higher education offer undergraduate educational programs in global health. Objective: To identify all undergraduate minors in global health being offered in the United States during the 2019–20 academic year, categorize the curricula being used by secondary programs of study, evaluate the content of required foundational courses, and examine the types of experiential learning opportunities that are offered. Methods: A working group of the Consortium of Universities for Global Health (CUGH) conducted a systematic review of the websites of all accredited 4-year colleges and universities, identifying 84 institutions offering general global health minors. Findings: A typical global health minor consists of one introduction to global health course, one epidemiology or health research methods course, several additional required or selective courses, and one applied learning experience. Within this general structure, five curricular models are currently being used for global health minors: (1) intensive minors composed of specialty global health courses, (2) global public health minors built on a core set of public health courses, (3) multidisciplinary minors requiring courses in the sciences and social sciences, (4) anthropology centric minors, and (5) flexible minors. Conclusions: CUGH recommends ten undergraduate student learning objectives in global health that encompass the history and functions of global health; globalization and health; social determinants of health; environmental health; health and human rights; comparative health systems; global health agencies and organizations; the global burden of disease; global health interventions; and interdisciplinary and interprofessional perspectives

Naturally Acquired Antibodies Specific for Plasmodium falciparum Reticulocyte-Binding Protein Homologue 5 Inhibit Parasite Growth and Predict Protection From Malaria

Background. Plasmodium falciparum reticulocyte-binding protein homologue 5 (PfRH5) is a blood-stage parasite protein essential for host erythrocyte invasion. PfRH5-specific antibodies raised in animals inhibit parasite growth in vitro, but the relevance of naturally acquired PfRH5-specific antibodies in humans is unclear. Methods. We assessed pre–malaria season PfRH5-specific immunoglobulin G (IgG) levels in 357 Malian children and adults who were uninfected with Plasmodium. Subsequent P. falciparum infections were detected by polymerase chain reaction every 2 weeks and malaria episodes by weekly physical examination and self-referral for 7 months. The primary outcome was time between the first P. falciparum infection and the first febrile malaria episode. PfRH5-specific IgG was assayed for parasite growth-inhibitory activity. Results. The presence of PfRH5-specific IgG at enrollment was associated with a longer time between the first blood-stage infection and the first malaria episode (PfRH5-seropositive median: 71 days, PfRH5-seronegative median: 18 days; P = .001). This association remained significant after adjustment for age and other factors associated with malaria risk/exposure (hazard ratio, .62; P = .02). Concentrated PfRH5-specific IgG purified from Malians inhibited P. falciparum growth in vitro. Conclusions. Naturally acquired PfRH5-specific IgG inhibits parasite growth in vitro and predicts protection from malaria. These findings strongly support efforts to develop PfRH5 as an urgently needed blood-stage malaria vaccine. Clinical Trials Registration NCT01322581