WHO: meningococcal disease situation in the African Meningitis Belt

WHO reported on the meningococcal disease situation in the African Meningitis Belt. During the first 11 weeks of 2009 (January 1- March 15), a total of 24,868 suspected cases, including 1,513 deaths, have been reported to WHO by countries of the meningitis belt. More than 85% of the cases have occurred in one epidemic foci, encompassing Northern Nigeria and Niger and are characterized by the predominance of Neisseria meningitidis (Nm) serogroup A. WHO said it is supporting the Nigerian Federal and National Ministry of Health to strengthen disease surveillance, laboratory diagnosis, case management and in defining adapted vaccination strategies. Technical experts from WHO have been supporting the Federal Ministry of Health in Nigeria since mid February 2009.

The International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control (ICG) have released 2.3 million doses of polysaccharide vaccines to Nigeria and 1.9 million doses of vaccine to Niger. ICG partners include WHO, International Federation of Red Cross and Red Crescent Societies, United Nations Children Fund, Médecins sans Frontières). The stockpile of the ICG for this epidemic season was set at 12.97 million doses. The emergency stockpile has been established with the support of Global Alliance for Vaccines and Immunization (GAVI) and EU Humanitarian Aid Office (ECHO).

http://www.who.int/csr/don/2009_03_25/en/index.html 25 March 2009

New WHO report: HIV-related TB deaths higher at 456,000 /1.37 million new TB cases among HIV-infected

WHO released a new report noting that HIV-related TB deaths are higher than in past estimates with 1.37 million new TB cases in 2007 among HIV-infected people and 456,000 deaths. The total number of new tuberculosis (TB) cases remained stable in 2007, and the percentage of the world’s population becoming ill with TB has continued the slow decline that was first observed in 2004, according to the report. However, the new 2009 global TB control report “also reveals that one out of four TB deaths is HIV-related, twice as many as previously recognized.” The new figures “reflect an improvement in the quality of the country data, which are now more representative and available from more countries than in previous years.”

Dr Margaret Chan, Director-General of WHO, said, “These findings point to an urgent need to find, prevent and treat tuberculosis in people living with HIV and to test for HIV in all patients with TB in order to provide prevention, treatment and care. Countries can only do that through stronger collaborative programmes and stronger health systems that address both diseases.” The report also notes a sharp increase in HIV testing among people being treated for TB, especially in Africa. In 2004, just 4% of TB patients in the region were tested for HIV; in 2007 that number rose to 37%, with several countries testing more than 75% of TB patients for their HIV status.

Because of increased testing for HIV among TB patients, more people are getting appropriate treatment though the numbers still remain a small fraction of those in need.

TB/HIV co-infection and drug-resistant forms of tuberculosis present the greatest challenges, the report says. In 2007 an estimated 500,000 people had multidrug-resistant TB (MDR-TB), but less than 1% of them were receiving treatments that was known to be based on WHO’s recommended standards.

Dr Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, commented, “We have made remarkable progress against both TB and HIV in the last few years. But, TB still kills more people with HIV than any other disease. The financial crisis must not derail the implementation of the Global Plan to Stop TB. Now is the time to scale-up financing for effective interventions for the prevention, treatment and care of TB worldwide.” To meet the 2009 milestones in the Stop TB Partnership’s Global Plan to Stop TB, the funding shortfall for the core 94 countries has risen to about US$1.5 billion. Full funding of the Global Plan will achieve its aim of halving TB prevalence and deaths compared with 1990 levels by 2015, the report said.


Global tuberculosis control – epidemiology, strategy, financing

WHO Report 2009

WHO’s report on Global TB Control compiles data from over 200 countries and territories each year, monitoring the scale and direction of TB epidemics, implementation and impact of the Stop TB Strategy, and progress towards the Millennium Development Goals.


GAVI thanks U.S. for US$75 million contribution, largest to date

GAVI Alliance CEO Dr Julian Lob-Levyt thanked the United States government for a US$75 million contribution – its highest ever – “to support the Alliance’s work to immunise children and strengthen health systems in the world’s poorest countries.” The contribution was part of an omnibus appropriations bill passed by the US Congress that includes the contribution to support the work of the GAVI Alliance for fiscal year 2009. The new contribution will be administered through the US Agency for International Development, a GAVI partner and Board member. U.S. support to GAVI in FY 2008 amounted to $71.9 million. Dr Lob-Levyt commented, “As the deepening financial crisis forces donors to make tough choices, the priority must be to improve the health of the world’s poor, particularly children. We greatly appreciate the commitment of the US Congress and President Obama to increase support to GAVI.”


GAVI releases update on Immunisation Services Support (ISS)

GAVI released an update on Immunisation Services Support (ISS) after a review by an independent task team around “the quality of data and the resulting estimates of coverage that this performance-based programme relies upon.”

GAVI said team members included academics and technical experts from a range of institutions, including the University of Aberdeen and the Harvard School of Public Health, the World Bank, and UNAIDS, among others. From December to March, the team “assessed the metrics that are currently used to measure ISS delivery and performance, reviewed relevant data collection sources and systems and compared these with alternative processes. Upon completion of its final meeting in February, the team produced a series of recommendations for GAVI.

The experts “agreed that there exists no single ‘gold standard’ for measuring the effectiveness of aid programme results and performance. The team recommended that GAVI continue to use the annual estimates compiled by WHO and UNICEF that relies on multiple data sources to monitor progress of immunisation programmes and calculate reward payments.” The experts also advised GAVI “to support the strengthening of the WHO/UNICEF estimation process to ensure systematic and transparent use of all data sources and made a number of specific recommendations to strengthen that process.

In order to provide an incentive to countries to increase immunisation coverage, as opposed to just the number of children immunised, the experts also recommended that future reward calculations be based in part on the number of children immunised and in part on the proportion of children immunised.”

The task team also recommended that GAVI “consider the reinstatement of ISS payments as soon as possible, whilst continuing to work with countries GAVI has identified as having data discrepancies.” At a meeting in early March, GAVI agreed to lift the suspension of ISS payments to all countries except for seven, which require further analysis. (GAVI originally identified 12 countries with discrepancies but removed five from the list after assessing their data collection processes and recognising that significant upgrades and improvements have been made which should prevent major discrepancies in the future.) The GAVI Alliance, in particular through the Health Metrics Network, WHO and UNICEF, is working with these remaining countries to address the data issues identified.

Further details on the review and recommendations at: http://www.gavialliance.org/media_centre/statements/25_03_09_UpdateonImmunisationServicesSupport_March.php

Pneumonia Hospitalizations Among Young Children Before/After Intro of Pneumococcal Conjugate Vaccine – U.S. 1997-2006

Vol. 301 No. 12, pp. 1201-1304, March 25, 2009

News and Analysis
Pneumonia Hospitalizations Among Young Children Before and After Introduction of Pneumococcal Conjugate Vaccine -United States, 1997-2006
JAMA. 2009;301(12):1220-1222.
[Extract: first 75 words]
Streptococcus pneumoniae is the leading bacterial cause of community-acquired pneumonia hospitalizations and an important cause of bacteremia and meningitis, especially among young children and older adults.1-2 A 7-valent pneumococcal conjugate vaccine (PCV7) was licensed and the Advisory Committee on Immunization Practices formulated recommendations for its use in infants and children in February 2000.2 Vaccination coverage rapidly increased during the second half of 2000, in part through funding by CDC’s Vaccines for Children program. Subsequently, active population- and laboratory-based surveillance demonstrated substantial reductions in invasive pneumococcal disease (IPD) among children and adults.3 In addition, decreases in hospitalizations and ambulatory-care visits for all-cause pneumonia also were reported.4-5 To gauge whether the effects of PCV7 on reducing pneumonia continue, CDC is monitoring pneumonia hospitalizations by using data from the Nationwide Inpatient Sample. This report provides an update for 2005 and 2006, the most recent years for . . .

Hypoxaemia among ill children in developing countries: a systematic review

The Lancet Infectious Disease
Apr 2009   Volume 9  Number 4   Pages 203 – 264

The prevalence of hypoxaemia among ill children in developing countries: a systematic review
Rami Subhi, Matthew Adamson, Harry Campbell, Martin Weber, Katherine Smith, Trevor Duke, for the Hypoxaemia in Developing Countries Study Group
Hypoxaemia is a common complication of childhood infections, particularly acute lower respiratory tract infections. In pneumonia-a disease that disproportionately impacts developing countries, and accounts for more than two million deaths of children worldwide-hypoxaemia is a recognised risk factor for death, and correlates with disease severity. Hypoxaemia also occurs in severe sepsis, meningitis, common neonatal problems, and other conditions that impair ventilation and gas exchange or increase oxygen demands.

IFFIm vaccine “bonds” expected to raise at least UK£50 million

The Lancet Infectious Disease
Apr 2009   Volume 9  Number 4   Pages 203 – 264

Vaccine investments raise millions to save children’s lives
Kathryn Senior
In March, HSBC, a leading UK bank, offered innovative vaccine-themed investments to individuals and institutional investors in the UK, to provide additional funding to the Global Alliance for Vaccines and Immunization (GAVI) for its childhood immunisation programme. Heike Reichelt from the treasury of the World Bank (Washington DC, USA) confirms that “the investments, issued by the International Finance Facility for Immunisation (IFFIm) and rated triple-A, are expected to raise at least UK£50 million.