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Summary Shortages of vaccines for epidemic diseases, such as cholera, meningitis, and yellow fever, have become common over the past decade, hampering efforts to control outbreaks through mass reactive vaccination campaigns. Additionally, various epidemiological, political, and logistical challenges, which are poorly documented in the literature, often lead to delays in reactive campaigns, ultimately reducing the effect of vaccination. In June 2015, a cholera outbreak occurred in Juba, South Sudan, and because of the global shortage of oral cholera vaccine, authorities were unable to secure sufficient doses to vaccinate the entire at-risk population—approximately 1 million people. In this Personal View, we document the first public health use of a reduced, single-dose regimen of oral cholera vaccine, and show the details of the decision-making process and timeline. We also make recommendations to help improve reactive vaccination campaigns against cholera, and discuss the importance of new and flexible context-specific dose regimens and vaccination strategies.

Summary Objectives To explore clinical and socioeconomic factors related to congenital syphilis in Posadas, Argentina. Methods Data were collected from 102 mothers who had given birth to an infant with congenital syphilis at Dr. Ramon Madariaga Central Hospital (2005–2007) and 306 control mothers. Clinical and demographic information were collected from clinical records, and socioeconomic details were obtained by interview. Multivariable logistic regression was used to explore the relationships between congenital syphilis and clinical and socioeconomic factors. Results Receiving the recommended number of prenatal health checks had a clear protective effect on congenital syphilis in the univariate analysis (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.31–0.86), as did being in a stable relationship (OR 0.23, 95% CI 0.14–0.38). Furthermore, women with secondary education or above were over four-times less likely to have a child with congenital syphilis compared to women who had not completed primary school education, even after controlling for the number of prenatal health checks and other factors (adjusted OR 0.24, 95% CI 0.08–0.72). In addition, women with previous stillborn births were over three-times more likely to have a baby with congenital syphilis after controlling for education and prenatal care (adjusted OR 3.37, 95% CI 1.24–9.16). Conclusions There is a clear opportunity for reducing the burden of congenital syphilis by promoting syphilis screening and treatment in women with previous stillborn births. In addition, the potential impact of more general policies addressing social determinants of health, such as those improving education, must not be overlooked.

Objectives To adapt the Quality Assessment of Diagnostic Accuracy Assessment (QUADAS) to the particular methodological challenges posed by research on ‘-omics’-based diagnostic tests. Design and methods We generated new guidelines by appraising the suitability of each criterion from QUADAS to ‘-omics’-based diagnostic research, and by adding new items that addressed specific sources of error. In addition, we defined four phases in the evaluation of a diagnostic test. Results Twelve of the 14 criteria from QUADAS were retained in the new tool. The items relating to selection criteria and the description of the test were reformulated, and the criteria about external validation and the availability of clinical data were applied only in studies in the last research phase. Four new items were incorporated to QUADOMICS related to pre-analytical conditions and methods to avoid overfitting. Conclusions QUADOMICS is an adaptation of QUADAS to the special nature of ‘-omics’-based diagnostic research. The tool adds new items that assess quality issues specific to this research, and may enhance the application of ‘-omics’-based discoveries to clinical \and public health practice.