Vaccines and Global Health: The Week in Review is a weekly digest — summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated with the current issue date

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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
- Division of Medical Ethics, NYU Medical School
- The Wistar Institute Vaccine Center
- Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

Cholera, OCV: Haiti, South Sudan

PAHO/WHO: Haiti to launch cholera vaccination with PAHO/WHO support
Port-au-Prince, Haiti, 23 July 2014 (PAHO/WHO)
Excerpt
Haiti is set to vaccinate 200,000 people in three departments against cholera starting in August, with support from the Pan American Health Organization/World Health Organization (PAHO/WHO).
The campaign will be carried out in the Artibonite (Gonaives and Ennery), Central (Lascahobas, Saut d’Eau, Savanette and Mirebalais), and West (Arcahaie) departments, which were chosen by the Ministry of Public Health and Population (MSPP) because they are considered high-risk zones…

PAHO/WHO’s representative in Haiti, Jean-Luc Poncelet, noted that vaccination is one of a series of measures implemented by Haitian health authorities with support from PAHO/WHO and other international partners. Other key measures include timely treatment for people sickened by the disease, improved access to potable water and adequate sanitation, the promotion of community participation and strengthened epidemiological surveillance…

Last week, PAHO/WHO shipped 400,000 doses of oral cholera vaccine (OCV) to Haiti. UN Secretary-General Ban Ki-moon formally presented the vaccines to Minister of Health Florence Guillaume. They are being kept at Haiti’s PROMESS warehouse, which has been managed by PAHO/WHO since 1992.

Financed by the UN’s Central Emergency Response Fund (CERF), the vaccines are from a global stockpile created by the World Health Assembly in 2011 to provide an additional tool for controlling cholera epidemics around the world. Besides Haiti, the global stockpile—for which WHO serves as secretariat—has also provided vaccines to the Democratic Republic of Congo, South Sudan, Guinea and Ethiopia. The stockpile is also supported by the International Federation of Red Cross and Red Crescent Societies, Doctors without Borders and UNICEF.

PAHO/WHO is also assisting efforts to fight cholera in Haiti and the Dominican Republic along with other members of the Regional Coalition for Water and Sanitation to Eliminate Cholera in Hispaniola. The Coalition, for which PAHO/WHO serves as secretariat, provides technical expertise on cholera control and elimination and is seeking to mobilize resources to support the two countries’ national plans to eliminate cholera by 2022…

:: Oral cholera vaccine stockpile (WHO)
:: Regional Coalition for Water and Sanitation to Eliminate Cholera in Hispaniola

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WHO: Humanitarian Health Action [to 26 July 2014]
:: The cholera outbreak and health situation in South Sudan
25 July 2014 –“General security situation remained calm in most parts of the country, with isolated incidents and clashes in Upper Nile, Jonglei and Unity states. No new significant displacements have been reported. Efforts to contain the cholera outbreak continue. Health facilities had recorded 5,141 (CFR 2.2%) cases by 21 July 2014. Acute Watery Diarrhoea (AWD) is the leading cause of morbidity among Internally Displaced People (IDP)…
:: Read the latest health situation report
pdf, 894kb
:: Read the latest Health Cluster bulletin
pdf, 883kb

POLIO [to 26 July 2014]

POLIO [to 26 July 2014]

Report: Polio – Outbreak in the Middle East :: War in Syria Opens the Door to an Old Enemy
WHO, UNICEF
July 2014 12 pages
Excerpt from WHO announcement
Amman/ Cairo, 22 July 2014 – In a report released today, WHO and UNICEF announced completion of the first phase of the biggest polio vaccination campaign ever undertaken in the history of the Middle East; 25 million children under the age of five have been reached in seven countries in 37 rounds.

“Despite immense challenges and the desperate conditions around the region, children were vaccinated from three to six times. This gives a glimpse of hope and is largely thanks to thousands of unsung heroes: committed health workers and volunteers who undertook such a formidable task all over the region and inside Syria braving dangers to provide the polio vaccination to children,” said Maria Calivis, UNICEF’s Regional Director for the Middle East and North Africa.

The report attributes the return of polio to Syria after 14 years to the following factors: disruption of routine immunization; severe damage to Syria’s health infrastructure; continuous population displacement within Syria and across its borders; and missed children…

“Polio has forced its way back to Syria, adding to what was already a humanitarian disaster. We got to a point where we had to work with very limited resources to defeat what had been a long forgotten enemy in this region: one that does not know borders or checkpoints and can travel fast, infecting children not just in war torn Syria but across the region” said Chris Maher, WHO Manager for Polio Eradication and Emergency Support…

The report says that a number of critical actions must be undertaken to end the polio spread in the region:
:: Grant immediate and unhindered access to hard-to-reach children under the age of five inside Syria.
:: Guarantee the safe passage of health workers and protect medical vehicles and other cold chain equipment inside Syria.
:: Raise awareness on polio and the need to vaccinate all children under the age of five around the region multiple times.
:: Secure funding to undertake repeated vaccination rounds by the end of 2014…

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GPEI Update: Polio this week – As of 23 July 2014
Global Polio Eradication Initiative
Editor’s Excerpt and text bolding
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: Polio vaccination campaigns reaching more than 25 million children multiple times in the Middle East since October have helped slow the outbreak: new report from UNICEF and WHO emphasises that the second phase of outbreak response focuses on reaching those children who continue to be missed.
:: In the Horn of Africa, further efforts are on to intensify the outbreak response, following confirmation of new cases from Somalia last week. These cases underscore the risk that ongoing low-level poliovirus transmission continues to pose to children across the region, and of the urgent need to fully stop the outbreak rapidly completely.
Afghanistan
:: Khost province borders Pakistan, where communities displaced by military action have been leaving North Waziristan, Pakistan. Health authorities in surrounding districts of Pakistan and across the border in Afghanistan have been vaccinating displaced children: more than 35,000 displaced children under the age of 10 are reported to have received a dose of bivalent oral polio vaccine (bivalent OPV) as they entered the Afghan provinces of Paktyka and Khost.
Nigeria
:: One new circulating vaccine-derived poliovirus type 2 (cVDPV2) case was reported in the past week, with onset of paralysis on 13 June from Borno. The total number of cVDPV2 cases for 2014 is now 14. It is the most recent cVDPV2 case in the country.
Pakistan
:: Five new WPV1 cases were reported in the past week, three from Federally Administered Tribal Areas (FATA – two from North Waziristan and one from South Waziristan), one from Khyber Pakhtunkhwa (KP) and one from Gadap, greater Karachi, Sindh. This brings the total number of WPV1 cases in the country to 99 for 2014. The case from South Waziristan is the most recent in the country, with onset of paralysis on 28 June.
:: In order to protect those displaced by the military action in North Waziristan, people of all ages continue to be vaccinated against polio at transit points within the country (over 394,000 vaccinated to date) and during several rounds of house-to-house immunization campaigns in the host communities (over 500,000 vaccinated in the first two rounds, with a third round just concluded)
Central Africa
:: The entire population of Equatorial Guinea, regardless of age, will be vaccinated in a campaign starting on 26 July. A house-to-house search for acute flaccid paralysis (AFP) cases will be conducted during the campaign; a similar search is currently taking place in Gabon. Cameroon, the Central African Republic (CAR), the Democratic Republic of the Congo (DR Congo), Gabon and the Republic of Congo also have mass vaccination campaigns planned for July.

PATH: New tools for polio surveillance could aid eradication efforts

PATH: New tools for polio surveillance could aid eradication efforts
July 22, 2014
Excerpt
With grant funding made possible by the Paul G. Allen Family Foundation, two new tools to help detect the poliovirus may soon strengthen global efforts to eradicate the disease. The foundation will invest up to US$5.3 million dollars in support of this goal.

The tools, a system to improve environmental surveillance and a simplified diagnostic test, were developed by PATH, a leading international health organization, and researchers at the University of Washington (UW). They have the potential to help workers identify and stop polio by making it easier to find the virus in sewage and among people. Although polio spreads very quickly and can be devastating, many people will never show symptoms—making early detection and response crucial for controlling the spread of disease.

The grant announcement, made today by PATH and UW, comes at a time of heightened attention to the spread of polio worldwide. In early May, the World Health Organization (WHO) declared it a Public Health Emergency of International Concern, warning that the recent spread of the virus from Pakistan, Syria, and Cameroon to neighboring countries could spark widespread epidemics if leaders do not take action.

The initial $2.4 million of the grant, administered in partnership with the Bill & Melinda Gates Foundation, will allow the PATH/UW team to accelerate development, evaluation, and introduction of the tools in coordination with global polio eradication partners. Additional technical and administrative support will be provided by the Gates Foundation as part of its longstanding support for eradication. PATH and UW will seek additional technical advice from the US Centers for Disease Control and Prevention (CDC) and WHO….

WHO Watch [to 26 July 2014]

WHO Watch [to 26 July 2014]
:: WHO Director-General addresses conference on cervical cancer in Africa
Dr Margaret Chan, Director-General of the World Health Organization
Goodwill message to participants of the 8th Stop cervical, breast and prostate cancer in Africa conference: Moving forward to end cervical cancer by 2030: Universal access to cervical cancer prevention
Windhoek, Namibia , 20 July 2014

:: World Hepatitis Day 2014: Think again
25 July 2014 — On World Hepatitis Day, 28 July, WHO welcomes new progress in tackling one of the world’s most serious diseases. Viral hepatitis – a group of infectious diseases known as hepatitis A, B, C, D, and E – affects millions of people worldwide, causing acute and chronic liver disease and killing close to 1.4 million people every year. WHO and partners urge policy-makers, health workers and the public to “think again” about this silent killer.
Find out more about World Hepatitis Day 2014

GAVI Watch [to 26 July 2014]

GAVI Watch [to 26 July 2014]
http://www.gavialliance.org/library/news/press-releases

24 July 2014
German Government to host crucial GAVI Alliance pledging event under the patronage of Chancellor Angela Merkel
Excerpt
Berlin, 24 July 2014 – The German Government today announced that it will convene the GAVI Alliance replenishment pledging meeting under the patronage of Federal Chancellor Angela Merkel in Berlin on 27th January 2015.
The event will mark the final stage of the Alliance’s replenishment process, in which donors have been asked to commit an additional US$ 7.5 billion to support immunisation programmes in developing countries between 2016 and 2020…

CDC/MMWR Watch [to 26 July 2014]

CDC/MMWR Watch [to 26 July 2014]
http://www.cdc.gov/mmwr/mmwr_wk.html

Safe and effective vaccine that prevents cancer continues to be underutilized
Latest vaccination coverage estimates for adolescents show only small increase for HPV vaccine
July 24, 2014
Excerpt
CDC officials announced today that the number of girls and boys aged 13-17 years receiving human papillomavirus (HPV) vaccine remains unacceptably low despite a slight increase in vaccination coverage since 2012, according to data from CDC′s 2013 National Immunization Survey-Teen (NIS-Teen) published in this week′s Morbidity and Mortality Weekly Report (MMWR).
HPV vaccine prevents various forms of cancer, but HPV vaccine remains underutilized. There is a substantial gap between the number of adolescents receiving tetanus, diphtheria, and pertussis (Tdap) vaccine and the number receiving HPV vaccine. It is estimated that only 57 percent of adolescent girls and 35 percent of adolescent boys received one or more doses of HPV vaccine. However, nearly 86 percent of adolescents had received one dose of Tdap vaccine…

MMWR Weekly – July 25, 2014 / Vol. 63 / No. 29
:: World Hepatitis Day — July 28, 2014
:: Progress Toward Prevention of Transfusion-Transmitted Hepatitis B and Hepatitis C Infection — Sub-Saharan Africa, 2000–2011
:: Human Papillomavirus Vaccination Coverage Among Adolescents, 2007–2013, and Postlicensure Vaccine Safety Monitoring, 2006–2014 — United States
:: National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2013
:: WHO Global Rotavirus Surveillance Network: A Strategic Review of the First 5 Years, 2008–2012