Vaccines and Global Health: The Week in Review :: 9 Feb 2019

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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy

Measles in Europe: record number of both sick and immunized

Milestones :: Perspectives


Measles in Europe: record number of both sick and immunized
7 February 2019 | WHO Europe News release
More children in the WHO European Region are being vaccinated against measles than ever before; but progress has been uneven between and within countries, leaving increasing clusters of susceptible individuals unprotected, and resulting in a record number of people affected by the virus in 2018. In light of measles data for the year 2018 released today, WHO urges European countries to target their interventions to those places and groups where immunization gaps persist.

Measles killed 72 children and adults in the European Region in 2018. According to monthly country reports for January to December 2018 (received as of 01 February 2019), 82 596 people in 47 of 53 countries contracted measles. In countries reporting hospitalization data, nearly 2/3 (61%) of measles cases were hospitalized. The total number of people infected with the virus in 2018 was the highest this decade: 3 times the total reported in 2017 and 15 times the record low number of people affected in 2016.

The surge in measles cases in 2018 followed a year in which the European Region achieved its highest ever estimated coverage for the second dose of measles vaccination (90% in 2017). More children in the Region received the full two-dose series on time, according to their countries’ immunization schedules, in 2017 than in any year since WHO started collecting data on the second dose in 2000. Coverage with the first dose of the vaccine also increased slightly to 95%, the highest level since 2013. However, progress in the Region, based on achievements at the national level, can mask gaps at subnational levels, which are often not recognized until outbreaks occur.

“The picture for 2018 makes it clear that the current pace of progress in raising immunization rates will be insufficient to stop measles circulation. While data indicate exceptionally high immunization coverage at regional level, they also reflect a record number affected and killed by the disease. This means that gaps at local level still offer an open door to the virus,” says Dr Zsuzsanna Jakab. “We cannot achieve healthier populations globally, as promised in WHO’s vision for the coming five years, if we do not work locally. We must do more and do it better to protect each and every person from diseases that can be easily avoided.”…


Resurgence of Vaccine-Preventable Diseases in Venezuela as a Regional Public Health Threat in the Americas

Featured Journal Content

Emerging Infectious Diseases
17 Apr 2019, 25(4)] Original Publication Date: 1/30/2019

Resurgence of Vaccine-Preventable Diseases in Venezuela as a Regional Public Health Threat in the Americas
Alberto E. Paniz-Mondolfi , Adriana Tami, Maria E. Grillet, Marilianna Márquez, Juan Hernández-Villena, María A. Escalona-Rodríguez, Gabriela M. Blohm, Isis Mejías, Huníades Urbina-Medina, Alejandro Rísquez, Julio Castro, Ana Carvajal, Carlos Walter, María G. López, Philipp Schwabl, Luis Hernández-Castro, Michael A. Miles, Peter J. Hotez, John Lednicky, J. Glenn Morris, James Crainey, Sergio Luz, Juan D. Ramírez, Emilia Sordillo, Martin Llewellyn, Merari Canache, María Araque, and José Oletta
Venezuela’s tumbling economy and authoritarian rule have precipitated an unprecedented humanitarian crisis. Hyperinflation rates now exceed 45,000%, and Venezuela’s health system is in free fall. The country is experiencing a massive exodus of biomedical scientists and qualified healthcare professionals. Reemergence of arthropod-borne and vaccine-preventable diseases has sparked serious epidemics that also affect neighboring countries. In this article, we discuss the ongoing epidemics of measles and diphtheria in Venezuela and their disproportionate impact on indigenous populations. We also discuss the potential for reemergence of poliomyelitis and conclude that action to halt the spread of vaccine-preventable diseases within Venezuela is a matter of urgency for the country and the region. We further provide specific recommendations for addressing this crisis.

According to the evaluation approach recommended by WHO, the risk level of the ongoing outbreaks in Venezuela is high. A correspondingly strong response is needed to curtail the expanse of these epidemics. We propose the following measures.
:: Global and hemispheric health authorities should urge the Venezuela government to allow the establishment of a humanitarian channel to provide immediate relief efforts addressing extreme food and medicine shortages.

:: Epidemiologic surveillance programs, early reporting, and rapid response systems should be restored immediately. Strengthening of infection control practices in healthcare facilities should be implemented with the aid of international agencies while ensuring public health neutrality.

:: Emergency relief operations should be put into effect across borders along with authorities in Colombia and Brazil to ameliorate the effects of massive migration by implementation of early nutritional and immunization interventions.

:: International agencies should support regional efforts in neighboring countries to promote simultaneous massive vaccination campaigns and vaccination of all refugees from Venezuela arriving in host community populations.

:: Adequate supplies for mass vaccination and routine immunization should be ensured, and additional adjunct supplies (e.g., diphtheria antitoxin) should be stockpiled to assist in the establishment of standard treatment protocols and epidemic rapid response measures. These methods are crucial for healthcare delivery and mass vaccination catch-up campaigns to head off the resurgence of vaccine-preventable diseases in Venezuela.

:: In areas with low vaccination coverage, improving surveillance for early case detection and increasing vaccination coverage in high-risk age groups should be mandatory. Furthermore, Venezuela is in urgent need to reconstruct its devastated healthcare system, secure sustainable food and medication access, and reinstall proper sanitation policies to reduce the burden of diseases.

On September 27, 2018, the United Nations Human Rights Council adopted a resolution on Venezuela signaling the gravity of the human rights situation and the growing concern by governments worldwide about the country’s humanitarian crisis, including aspects such as malnutrition and the upsurge of preventable diseases (50). PAHO–WHO faces an enormous challenge in attending, without interference, to the complex emergency that affects Venezuela. Emergency funds must be released to acquire medicines, vaccines, laboratory reagents, and other supplies for health programs. As Venezuela rapidly becomes a regional nidus for the emergence of vaccine-preventable diseases, it must take decisive action now alongside regional and national partners to target this emerging regional crisis.


The role of National Immunisation Technical Advisory Groups in evidence-informed decision-making

Featured Journal Content

The role of National Immunisation Technical Advisory Groups in evidence-informed decision-makingEnablers, constraints and future support options
ODI  Research reports and studies | February 2019 :: 48 pages
Anne Buffardi and Susan Njambi-Szlapka
Executive Summary [Excerpt]
National Immunisation Technical Advisory Groups (NITAGs) are multidisciplinary groups of national experts who provide independent advice to policy-makers on issues related to immunisation and vaccines, based on evidence and the national context. The Global Vaccine Action Plan (GVAP) 2011–2020 and 2017 World Health Assembly resolution call on governments to establish and strengthen these advisory bodies, acknowledging their pivotal role in decision-making and in achieving national health goals. Although the number of NITAGs doubled between 2010 and 2016, accelerated progress is needed in order to meet the goal of a functional NITAG in all countries by 2020.
This report presents the findings of a scoping exercise initiated by the Wellcome Trust and the World Health Organization to determine how different types of NITAGs could be supported in the coming years. It is written for organisations who are familiar with and considering supporting the next phase of NITAGs’ development, NITAG members, and national and global stakeholders with whom NITAGs engage…
…Donors, the WHO and the Global NITAG Network (GNN) will continue to play important roles in supporting core NITAG functions and the expansion and embedding of NITAGs’ role in evidence-informed decision-making processes. To jointly move this work forward, three interdependent actions are most pressing:
:: Donors need to define their roles and more actively coordinate among themselves.
:: Donors also need to be more explicit in communicating what they can fund and how NITAGs can access these resources.
:: The WHO and the GNN need to clarify the ‘ask’ to donors and develop an investment case with defined national, regional and global support activities.





Public Health Emergency of International Concern (PHEIC)
Polio this week as of 6 February 2019
:: The 144th Session of the Executive Board concluded on 1 February with a renewed support from the public health leadership for a final push to end polio. Read more about polio eradication efforts and the report by the EB on polio eradication here.
:: The Global Surveillance Action Plan 2018-2020 is now online. The GPSAP aims to support endemic, outbreak, and high-risk countries in evaluating and increasing the sensitivity of their surveillance systems. 

Summary of new viruses this week:
:: Afghanistan – Afghanistan- one case of wild poliovirus type 1 (WPV1);
:: Pakistan – one case of WPV1 and six WPV1-positive environmental samples;
:: Niger – one case of circulating vaccine derived poliovirus (VDPV2). five WPV1 positive environmental samples.


Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.

WHO Grade 3 Emergencies  [to 9 Feb 2019]
Democratic Republic of the Congo
:: Ebola virus disease – Democratic Republic of the Congo   7 February 2019
…During the last 21 days (16 January – 5 February 2019), 119 new cases have been reported from 13 health zones (Figure 2), including: Katwa (75), Butembo (9), Beni (8), Kyondo (5), Kayna (5), Oicha (4), Manguredjipa (4), Biena (2), Kalunguta (2), Mabalako (2), Masereka (1), Mutwanga (1), and Vuhovi (1)2. Current epidemiological analyses points to nosocomial transmission due to poor infection prevention and control (IPC) practices, persistent delays in detection and isolation of new cases, frequent community deaths (and subsequent contact with deceased), and transmission within family and community networks, as the main drivers of ongoing disease transmission. Insecurity and pockets of community resistance have continuously stifled efforts to combat these risks; nevertheless, response teams remain committed to actively strengthening community trust and participation in all affected areas, and are beginning to observe tangible improvements in Katwa and elsewhere….

:: 27: Situation report on the Ebola outbreak in North Kivu  5 February 2019

Case management
On 24 November 2018, the MoH announced the launch of a randomized control trial for Ebola therapeutics. This is ongoing, with all confirmed cases in ETCs receiving therapy under the compassionate use protocol, together with supportive care.
As of 3 February 2018, 194 patients were admitted to Ebola transit and treatment centres. Among nine treatment ETCs and transit centres (TC), two have bed occupancy of more than 100% (Katwa ETC and Beni TC).
Patient sorting in Beni hospital and Beni ETC is being supervised; community re-integration of two cured cases is ongoing in Kirumba and Kanyabayonga.
…Implementation of ring vaccination protocol
As of 3 February 2019, a cumulative total of 73,309 people have been vaccinated since the start of the outbreak.
The Immunization Commission is being supported in their efforts to persuade contacts to be vaccinated in Kivika, Kambuli and Mukuna in Katwa health zone.

Bangladesh – Rohingya crisis – No new digest announcements identified  
Myanmar – No new digest announcements identified  
NigeriaNo new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified  
Syrian Arab Republic – No new digest announcements identified  
Yemen – No new digest announcements identified

WHO Grade 2 Emergencies  [to 9 Feb 2019]
Brazil (in Portugese)
:: Sarampo na Europa: número recorde de pessoas doentes e imunizadas  7 de fevereiro de 2019

:: WHO warns of increasing attacks on health facilities in Libya
5 February 2019 – The World Health Organization (WHO) warns of increasing attacks on health facilities and workers in both frequency and scale. WHO has documented more than 41 attacks targeting health workers and facilities throughout 2018–2019 across the country. These attacks resulted in 6 health workers and patients killed and 25 health workers injured. An additional seven health workers were also assaulted during this period…

Cameroon  – No new digest announcements identified
Central African Republic  – No new digest announcements identified
Ethiopia – No new digest announcements identified
Hurricane Irma and Maria in the Caribbean – No new digest announcements identified
Iraq – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory  – No new digest announcements identified
Sao Tome and Principe Necrotizing Cellulitis (2017) – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

WHO Grade 1 Emergencies  [to 9 Feb 2019]
Indonesia – Sulawesi earthquake 2018
Lao People’s Democratic Republic
Namibia – viral hepatitis
Philippines – Tyhpoon Mangkhut
WHO AFRO Outbreaks – Week 05: 26 January – 01 February 2019
The WHO Health Emergencies Programme is currently monitoring 60 events in the region. This week’s edition covers key new and ongoing events, including:
:: Ebola virus disease in the Democratic Republic of the Congo
:: Lassa fever in Nigeria
:: Cholera in Burundi
:: Humanitarian crisis in Democratic Republic of the Congo
:: Humanitarian crisis in Ethiopia.

UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
:: Yemen: Hajjah Governorate – Flash Update 2 | 28 January-3 Feb …
Syrian Arab Republic   – No new digest announcements identified


UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
:: Ethiopia Humanitarian Bulletin Issue #2 | 21 January-03 Febr …

:: Humanitarian Bulletin Somalia, 1 January – 5 February 2019 …
Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.
EBOLA/EVD  [to 9 Feb 2019]
:: 27: Situation report on the Ebola outbreak in North Kivu  5 February 2019
:: Ebola virus disease – Democratic Republic of the Congo   7 February 2019
MERS-CoV [to 9 Feb 2019]
– No new digest announcements identified.
Yellow Fever  [to 9 Feb 2019]
– No new digest announcements identified.
Zika virus  [to 9 Feb 2019]
– No new digest announcements identified.


WHO & Regional Offices [to 9 Feb 2019]

WHO & Regional Offices [to 9 Feb 2019]

8 February 2019 | News release
WHO supports five countries to fight lassa fever outbreaks

6 February 2019 | Story
House by house, telling girls and families the dangers of female circumcision in Kenya

4 February 2019 | News release
Gaza patients’ painful journey to cancer treatment


Weekly Epidemiological Record, 8 February 2019, vol. 94, 06 (pp. 65–80)
:: Circulating vaccine-derived poliovirus type 1 and outbreak response in Papua New Guinea, 2018
:: Proceedings of the 2018 annual meeting of partners to Eliminate Yellow Fever Epidemics (EYE), Dakar, Senegal
:: Monthly report on dracunculiasis cases, January- December 2018


WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: WHO supports five countries to fight lassa fever outbreaks  08 February 2019
Ebola – Rwanda completes the revision of its National Contingency Plan  06 February 2019
South Sudan strengthens the country’s capacity to detect, investigate and respond seasonal and pandemic Influenza  04 February 2019

WHO Region of the Americas PAHO
:: Costa Rican Minister of Heath outlines priority areas for collaboration in visit to PAHO headquarters (02/05/2019)

WHO South-East Asia Region SEARO
– No new digest announcements identified.

WHO European Region EURO
:: Measles in Europe: record number of both sick and immunized 07-02-2019
:: Social science training enhances community engagement in health emergencies in 11 countries of the European Region 06-02-2019
:: Keep antibiotics working – limit their use this flu season 05-02-2019
:: What you need to know about digital health systems 05-02-2019

WHO Eastern Mediterranean Region EMRO
:: Gaza patients’ painful journey to cancer treatment  4 February 2019
:: Cancer patients face ‘death sentence’ in Yemen  4 February 2019

WHO Western Pacific Region
– No new digest announcements identified.

CDC/ACIP [to 9 Feb 2019]

CDC/ACIP [to 9 Feb 2019]

Latest News
CDC Media Statement from Dr. Redfield on Ending the HIV Epidemic: A Plan for America
Wednesday, February 6, 2019
“I’m excited that CDC is part of this unprecedented opportunity to end the HIV epidemic in America. The Administration’s plan will deploy the people and key prevention and treatment strategies needed to reduce new HIV infections by 75 percent over the next 5 years, with the hope of a 90 percent reduction within 10 years.

We have the tools to end new HIV infections in this Nation, but they must be applied now. The most recent data suggest that progress in reducing new infections has plateaued, and many communities remain vulnerable to HIV infection. Under this proposed initiative, we will focus on four key strategies to meet the needs of communities with the highest HIV burden: diagnose new HIV infections; treat those with infection rapidly and effectively; protect people from being infected through access to comprehensive prevention and treatment, including medications that can prevent infection; and respond quickly to and stop new outbreaks. To accomplish this, we will accelerate our work with state and local health departments. We will establish HIV elimination teams—for ‘boots-on-the-ground’ support—to ensure communities with the greatest burden make progress. We will listen to people living with HIV, and to public health partners in the most-affected communities, so we reach those in greatest need.

CDC is proud to have been part of the fight to prevent HIV from the very beginning, and we are honored to continue to work with our HHS colleagues on this important initiative. I thank the President and Secretary Azar for their visionary leadership in seizing this opportunity. The time to end the HIV epidemic is now. I have always believed in seeing the possible. Embracing the possible, we will do it together.”
–Robert R. Redfield, MD, Director, Centers for Disease Control and Prevention

MMWR News Synopsis for February 08, 2019
Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger — United States, 2019
The child/adolescent and adult immunization schedules help health care professionals identify which vaccines their patients need, when they need them, and how many doses of each vaccine they need based on age, health conditions, and other factors. The design of the 2019 Child and Adolescent Immunization Schedule has been updated. Content updates include new or revised ACIP recommendations for hepatitis A vaccine (HepA); hepatitis B vaccine (Hep B); influenza vaccine; tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap); and clarification of recommendations for inactivated poliovirus vaccines (IPV).

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2019
The child and adolescent and adult immunization schedules help health care professionals identify which vaccines their patients need; when they need them; and how many doses of each vaccine they need based on age, health conditions, and other factors. Each year, CDC and partner organizations publish an updated schedule of immunizations recommended for every child, adolescent, and adult in the U.S. The design of the 2019 schedule has been updated. Updates to the 2019 Adult Immunization Schedule include new or revised Advisory Committee on Immunization Practices (ACIP) recommendations for influenza, hepatitis B, and hepatitis A vaccinations.