Researchers call for independent body to monitor deaths in wars and other crises

The accurate documentation of deaths during wars and other humanitarian emergencies is critical to grading the severity of the crisis and adjusting relief operations accordingly, and yet collection of data on death rates is often incomplete, say two researchers in this week's PLoS Medicine.

Accurate data on death rates, they say, can provide a basis for both "humanitarian" advocacy (i.e. calling for appropriate assistance) as well as "political" advocacy (for example, calling for compliance with international humanitarian law, a set of rules that seek to limit the effects of armed conflict for humanitarian reasons).

Francesco Checchi (London School of Hygiene and Tropical Medicine), who has worked on mortality surveys in Darfur and Northern Uganda, and Les Roberts (Columbia University, New York), who has worked on mortality surveys in Iraq and the Democratic Republic of the Congo (DRC), say that the best tools for prospectively monitoring deaths were missing or deficient "in all recent high-mortality crises" with the exception of Bosnia. The authors call for the establishment of a new independent body to ensure that the best measurement tools are used to oversee the documentation of deaths during crises.

"How many of the more than 3 million estimated to have died in the DRC because of war might still be alive," ask the authors, "if credible, crisis-wide mortality estimates had become available sooner, and been used to inform policy?"

The establishment of a technical, apolitical body dedicated to timely, systematic collection of valid mortality data, say Checchi and Roberts, especially in the least funded and publicized crises, could help to ensure that the DRC experience is not repeated.

"Such a body could also independently evaluate mortality study protocols and reports, promote best practice methods, and train a cadre of researchers to be deployed to emergent crises. Such a body could constitute a resource for relief agencies and improve the quality of press coverage and discussion around ongoing crises."

Citation: Checchi F, Roberts L (2008) Documenting mortality in crises: What keeps us from doing better? PLoS Med 5(7): e146. doi:10.1371/journal.pmed.0050146.

IN YOUR ARTICLE, PLEASE LINK TO THIS URL, WHICH WILL PROVIDE ACCESS TO THE PUBLISHED PAPER: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050146

PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-05-07-checchi.pdf

CONTACTS: Francesco Checchi Department of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine 49-51 Bedford Square London, WC1B3DP United Kingdom +44 20 7927 2336 francesco.Checchi@lshtm.ac.uk

Les Roberts Center for International Emergency Disaster and Refugee Studies Johns Hopkins Bloomberg School of Public Health Baltimore, MD United States of America +1 410 955 3928 les@a-znet.com

Lindsay Wright Media Manager London School of Hygiene and Tropical Medicine 49-51 Bedford Square London, WC1B3DP United Kingdom +44 20 7927 2073 Lindsay.Wright@lshtm.ac.uk

WHO panel recommends single, simple test for new TB vaccine trials

The World Health Organization Initiative for Vaccine Research recently convened a panel of TB vaccine trial experts to examine the best way of testing immunity in blood taken from people vaccinated with a new TB vaccine. The panel reports its recommendations in this week's PLoS Medicine.

"The panel recognised that many new and diverse tuberculosis vaccines are currently under development," says the lead author Professor Hanekom, of the South African TB Vaccine Initiative. "The ability to compare results of how the immune systems of people who received these vaccines have responded would be an important asset for TB vaccine research globally." Previously, it has been difficult to compare results because of differences in laboratory approaches, logistics and diverse populations being tested.

The panel evaluated advantages and disadvantages of many types of immune tests, and made specific recommendations for human trials of new vaccines, which included introducing a single and simple test that is used in all vaccine trials.

"The panel recommended the use of a test that had performed excellently, that could yield informative results, and that could be implemented in even the most remote of field sites," says Professor Hanekom. "It is anticipated that this single and simple test will speed up decision-making on which of the new TB vaccines currently being tested globally will proceed to phase three trials." Phase three trials focus on testing whether the vaccines will work to protect people against TB. The single and simple test recommended by the panel would allow comparison of results on the human immune response to all new TB vaccines currently being tested by the many research initiatives globally. If implemented, this could shorten the process to find an effective vaccine against TB.

Citation: Hanekom WA, Dockrell HM, Ottenhoff THM, Doherty TM, Fletcher H, et al. (2008) Immunological outcomes of new tuberculosis vaccine trials: WHO panel recommendations. PLoS Med 5(7): e145. doi:10.1371/journal.pmed.0050145.

IN YOUR ARTICLE, PLEASE LINK TO THIS URL, WHICH WILL PROVIDE ACCESS TO THE PUBLISHED PAPER: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050145

PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-05-07-hanekom.pdf

CONTACTS: Willem Hanekom South African Tuberculosis Vaccine Initiative Institute of Infectious Disease and Molecular Medicine University of Cape Town Anzio Road Observatory, Western Cape 7925 South Africa +27 27214066080 +27 27214066081 (fax) willem.hanekom@uct.ac.za

Linda Rhoda Communications Manager South African Tuberculosis Vaccine Initiative University of Cape Town Anzio Road Observatory, Western Cape 7925 South Africa +27 21 406 6697 Linda.Rhoda@uct.ac.za

Learning Forum: A 58-year-old woman with abdominal symptoms and elevated C-reactive protein

Babak Javid (University of Cambridge) and colleagues discuss the differential diagnosis, investigation, and management of a woman with abdominal symptoms and a raised C-reactive protein.

Citation: Daly M-L, Cartwright DJ, Lehner PJ, Javid B (2008) A 58-year-old woman with abdominal symptoms and elevated C-reactive protein. PLoS Med 5(7): e149. doi:10.1371/journal.pmed.0050149.

IN YOUR ARTICLE, PLEASE LINK TO THIS URL, WHICH WILL PROVIDE ACCESS TO THE PUBLISHED PAPER: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050149

PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-05-07-javid.pdf

CONTACT: Babak Javid Department of Medicine University of Cambridge Box 25, Ward D10 Hills Road Cambridge, Cambridgeshire CB2 2QQ United Kingdom +1-857-234-2816 bj10001@cam.ac.uk