Pandemic (H1N1) 2009 – update 79 Weekly update
18 December 2009
As of 13 December 2009, worldwide more than 208 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 10582 deaths. More at:
WHO reported on its deployment actions of pandemic influenza vaccine
In a single-page pdf WHO summaries its actions to date, noting “to help countries protect people from developing severe disease from pandemic influenza H1N1 infection, the World Health Organization (WHO) is coordinating the distribution of donated pandemic influenza vaccine to 95 countries. These countries were identified based on their vulnerability to pandemic influenza and their readiness and ability to use the vaccine for priority populations. WHO is working with UN and country partners to facilitate the distribution of the vaccine.
WHO and partners are assisting the 95 countries prepare to receive and use vaccines, with an immediate focus on a first group of 35 countries. Before countries receive donated vaccines, they complete three steps: 1) make a request to receive donated vaccines, 2) sign an agreement accepting the terms and conditions of support and 3) develop a national pandemic vaccine deployment plan.
1. 34 of the first 35 countries have requested vaccine donations.
2. 20 countries have signed agreements with WHO.
3. 4 countries have finalized national deployment plans.
WHO also presented a summary of resource mobillzation in terms of need, pledge resources and the current gap. The current gap in financial resources for global and in-country operations involved stands at US$165.6 million, with the gap in needed syringes at 125.5 million units.
More at: http://www.who.int/csr/disease/swineflu/vaccines/h1n1_vaccination_deployment_update_20091217.pdf
WHO reported that Afghanistan became the first country in the world to use the new bivalent oral polio vaccine (bOPV) recommended by the Advisory Committee on Poliomyelitis Eradication. The committee, the global technical advisory body of the Global Polio Eradication Initiative, describes the new vaccine “as a critical tool to eradicate polio, (which) can provide the optimal concurrent protection needed by young children against both surviving serotypes (types 1 and 3) of the paralysing virus. This will vastly simplify the logistics of vaccination in the conflict-affected parts of this country. This sub-national immunization campaign, from 15-17 December, will deliver bOPV to 2.8 million children under five in the Southern, South-Eastern and Eastern Regions of Afghanistan.”
WHO said that bOPV “allows countries to simplify vaccine logistics and to optimize protection using a mix of the available polio vaccines according to local needs,” noting that in southern Afghanistan, where access to children can be limited depending on the security situation, using bOPV helps maximise the impact of each contact with a child.
WHO noted that most of Afghanistan is polio-free, with 28 out of the 31 children paralysed by polio this year coming from 13 highly insecure districts (of 329 districts in the country). In 2009, polio eradication efforts in Afghanistan have focused on improving operations and creating a safe environment for vaccination teams.
The Weekly Epidemiological Record (WER) for 18 December 2009, vol. 84, 50 (pp 533–540) includes:
Rotavirus vaccines: an update.
The summary paragraphs from the WER report:
WHO recommends that rotavirus vaccine for infants should be included in all national immunization programmes. In countries where diarrhoeal deaths account for ≥10% of mortality among children aged <5 years, the introduction of the vaccine is strongly recommended.
WHO recommends that the first dose of either RotaTeq or Rotarix be administered at age 6–15 weeks. The maximum age for administering the last dose of either
vaccine should be 32 weeks. It is recommended that 2 doses of Rotarix be administered with the first and second doses of DTP rather than with the second and third doses. This ensures maximum immunization coverage and reduces the potential for late administration beyond the approved age window. This schedule will be reviewed as new data become available.
WHO reiterates that rotavirus vaccines are an important measure that can be used to reduce severe rotavirus-associated diarrhoea and child mortality. The use of rotavirus vaccines should be part of a comprehensive strategy to control diarrhoeal diseases; this strategy should include, among other interventions, improvements in hygiene and sanitation, zinc supplementation, community-based administration of oral rehydration solution and overall improvements in case management. http://www.who.int/wer/2009/wer8451_52.pdf
The MMWR for December 18, 2009 / Vol. 58 / No. 49 includes”
Assessment of Epidemiology Capacity in State Health Departments
United States, 2009
During April-June 2009, the Council of State and Territorial Epidemiologists sent a web-based questionnaire to the state epidemiologist in each of the 50 states and the District of Columbia. The assessment inquired into workforce capacity and technological advancements to support surveillance. Measures of capacity included total number of epidemiologists and self-assessment of the state’s ability to carry out four essential services of public health. This report summarizes the results of that assessment.
Dec 19, 2009 Volume 374 Number 9707 Pages 2027 – 2128
a title=”http://www.thelancet.com/journals/lancet/issue/current” href=”http://www.thelancet.com/journals/lancet/issue/current”>http://www.thelancet.com/journals/lancet/issue/current
The health illiteracy problem in the USA
Referred to as the silent epidemic, health illiteracy is the inability to comprehend and use medical information that can affect access to and use of the health-care system. It exacerbates health inequity since those whose health and life expectancy is already low—eg, elderly people, poor people, and minorities—are the ones without the ability to make health-related choices, seek health-related information, or engage in health-related communications.
The US Agency for Healthcare Research and Quality reported that low health literacy is associated with worse health care and poorer health outcomes. The problem inflates the cost of health care, since individuals who have low health literacy are more prone to visit the emergency room, enroll as inpatients, stay longer in hospitals, and use fewer preventive services.
Although it is estimated that up to half of US adults have trouble interpreting medical information, the exact number is unknown because a reliable national health literacy measurement method is not available. This gap was addressed at a recent workshop of the US Institute of Medicine, entitled Measures of Health Literacy. The only existing source for national health literacy is the Department of Education’s National Assessment of Adult Literacy (NAAL) database from 2003. And the two frequently mentioned health literacy measurement tools, the Test of Functional Health Literacy in Adults (TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine (REALM), are not yet widely implemented in the clinic and preferentially measure an individual’s reading ability rather than health literacy. A proper health literacy measurement tool should take into account the multitude of social, personal, and cognitive skills that are imperative for proper function within a health-care system.
The much-anticipated universal US health-care system will, ironically, be accessible to all but not understood by all. The US Department of Health and Human Services must engage in the development and assessment of a national health literacy measurement tool that will be trustworthy and transparent. Perhaps the USA can also learn from the European Health Literacy Survey, which in 2011 should provide first-time data for health literacy in European countries.
Dec 19, 2009 Volume 374 Number 9707 Pages 2027 – 2128
Importance of background rates of disease in assessment of vaccine safety during mass immunisation with pandemic H1N1 influenza vaccines
Steven Black, Juhani Eskola, Claire-Anne Siegrist, Neal Halsey, Noni MacDonald, Barbara Law, Elizabeth Miller, Nick Andrews, Julia Stowe, Daniel Salmon, Kirsten Vannice, Hector S Izurieta, Aysha Akhtar, Mike Gold, Gabriel Oselka, Patrick Zuber, Dina Pfeifer, Claudia Vellozzi
Because of the advent of a new influenza A H1N1 strain, many countries have begun mass immunisation programmes. Awareness of the background rates of possible adverse events will be a crucial part of assessment of possible vaccine safety concerns and will help to separate legitimate safety concerns from events that are temporally associated with but not caused by vaccination. We identified background rates of selected medical events for several countries. Rates of disease events varied by age, sex, method of ascertainment, and geography.