Vaccines and Global Health: The Week in Review 22 Feb 2014

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

WHO: 140,000 people to get cholera vaccine in South Sudan

WHO: 140,000 people to get cholera vaccine in South Sudan
News release – Excerpt
22 February 2014 | GENEVA – WHO is working with the South Sudan Government and partners to provide vaccines to protect nearly 140,000 people living in temporary camps in South Sudan against cholera.

The vaccines come from an emergency stockpile managed by WHO, the International Federation of the Red Cross and Red Crescent Societies (IFRC), Médecins Sans Frontières (MSF) and UNICEF. It is the first time the stockpile, created in 2013 by WHO, is being activated.

Although currently there is not a cholera outbreak, people displaced by the recent conflict and living in the camps are at risk due to poor sanitary conditions and overcrowding.

Starting today, 94,000 people will be vaccinated in the Minkaman camp, Awerial County, targeting displaced people and host communities, followed by vaccination campaigns in camps based in Juba, covering an additional 43 000 people.

Two doses of vaccine are required for an individual to be protected. The campaign begins with an initial round of vaccinations followed by – after a required 14 day interval – a second round of doses, which will complete the vaccination. For such a campaign to be effective, it is vital that a second dose is administered and this factor has led to the decision to begin with Minkaman, Awerial County, and Juba camps.

“Minkaman camp in Awerial County and Juba camp have been selected because of the relative stability of the situation and easier access in those places,” says Dr Abdinasir Abubakar, from WHO’s Disease Surveillance and Response team, in South Sudan. “We are also looking at other camps, and once the accessibility and security improves, we will expand the cholera vaccination campaigns into these areas. We will be reviewing the situation day by day.” …

Update: Polio this week – As of 19 February 2014

Update: Polio this week – As of 19 February 2014
Global Polio Eradication Initiative
Full report:

[Editor’s extract and bolded text]
:: In Pakistan, six new wild poliovirus type 1 (WPV1) and two new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases are reported, all from the Federally Administered Tribal Areas (FATA) and Khyber Pakhtunkhwa (KP). Five of the cases are from North Waziristan and Peshawar, largely considered the ‘engine’ for polio transmission in the country.

:: One new WPV1 case was reported in the past week from 2014. The total number of WPV1 cases remains 14 for 2013 and is now three for 2014. The most recent WPV1 case had onset of paralysis on 31 January 2014 from Kunar province, Eastern Region

:: Six new WPV1 cases were reported in the past week, four from North Waziristan, FATA and one from Bannu and Peshawar, respectively, in KP. The total number of cases for 2013 remains 93. The total number of cases in 2014 is now 15. The most recent case had onset of paralysis on 31 January (WPV1 from FR Bannu, FATA).
:: Two new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 45, and three for 2014. The most recent cVDPV2 case had onset of paralysis on 24 January (from FR Bannu, FATA).
:: North Waziristan is the district with the largest number of children being paralyzed by poliovirus in the world (both wild and cVDPV2). Immunization activities have been suspended by local leaders since June 2012. It is critical that children in all areas are vaccinated and protected from poliovirus. Immunizations in neighbouring high-risk areas are being intensified, to further boost population immunity levels in those areas and prevent further spread of this outbreak.
:: The densely populated Peshawar valley is considered to be the main ‘engine’ of poliovirus transmission, alongside North Waziristan, due to large-scale population movements through Peshawar from across this region, and into other areas of Pakistan. The quality of operations must be urgently improved in Peshawar, and immunizations resumed in North Waziristan.
:: However, at the same time, concerning trends have been noted in greater Karachi, Sindh and in Quetta, Balochistan. Environmental positives isolates from every major city of Punjab confirm widespread virus circulation

Horn of Africa
:: Two new WPV1 cases from Somalia were reported in the past week. Onset of paralysis for both cases was in June 2013. The cases were reported late due to a laboratory processing backlog. The total number of WPV1 cases in the Horn of Africa is now 215 (192 from Somalia, 14 from Kenya and nine from Ethiopia). The most recent WPV1 case in the region had onset of paralysis on 20 December 2013 (from Bari, Somalia).
:: Outbreak response across the Horn of Africa is continuing. Recommendations from the recently held Horn of Africa Technical Advisory Group (TAG), which convened two weeks ago in Nairobi, are now actively being incorporated into outbreak response planning. The TAG had underscored that the initial response to the outbreak was appropriate, however expressed grave concern that gaps in SIA quality and surveillance remained in key infected areas of the region. Consequently, the group concluded there is a serious risk of the outbreak continuing and of further spread both within and beyond countries of the Horn of Africa. The group recommended that infected countries should focus efforts on high-risk and infected areas, by conducting high-quality SIAs no more than four weeks apart.

Middle East
:: In Syria, one new WPV1 case was reported in the past week from Hasakeh governorate. The total number of laboratory-confirmed WPV1 cases is now 24. The most recent case had onset of paralysis on 17 December and was reported from Mara, Edleb governorate.
:: Additionally, there are 13 cases confirmed from contested areas but not yet reflected in official figures.

Editor’s Note: Please see post below for:
The polio eradication end game: what it means for Europe
D Heymann 1,2, Q Ahmed3
Volume 19, Issue 7, 20 February 2014

Gunmen kidnap six-member polio team in Pakistan
The Global Post/AFP via Agence France-Presse
February 17, 2014 14:12
The kidnapping is the latest setback to efforts to eradicate the disease in Pakistan. It followed a bombing on Sunday targeting a polio team in Peshawar which killed a policeman.
A Pakistani health worker administers a polio vaccination to a child during a polio immunization campaign in Peshawar on Feb. 2, 2014

Masked gunmen kidnapped a six-member polio vaccination team — a doctor, two local employees of the World Health Organization (WHO) and three guards — in northwest Pakistan on Monday, an official said.

Local administration official Niamat Ullah Khan said the team was seized some 190 miles southwest of Peshawar, in Ping village at the border of South Waziristan.

A local official of the WHO in Peshawar confirmed the incident…


  Rotary announced US$36 million in new grants supporting polio eradication. The grants include $6.8 million for Afghanistan, $7.7 million for Nigeria and $926,000 for Pakistan. Grant amounts “are based on requests from eradication initiative partners UNICEF and the World Health Organization, which work with the governments of polio-affected countries to plan and carry out immunization activities.” UNICEF will use a grant of $2.73 million to bolster vaccination activities throughout the Horn of Africa as part of an on-going response to an outbreak that began in 2013 and has now infected more than 200 children. The other countries where Rotary funds will be used to fight polio are Burkina Faso, $2.1 million; Cameroon, $3.4 million; Democratic Republic of Congo, $3.9 million; Niger, $2.3 million; Somalia, $1.3 million; South Sudan, $2.6 million; and Sudan, $1.2 million. WHO also received $934,000 to study the impact of introducing injectable, inactivated polio vaccine into the immunization program as part of the initiative’s endgame plan, as the goal of global eradication nears. Unrelated to this round of grants, Rotary released $500,000 in December 2013 as an emergency response to the polio outbreak in strife-torn Syria, which had not reported polio since 1999. Through Jan. 31, there were 23 confirmed cases in Syria since October 2013, all traceable to the polio strain circulating in Pakistan.

Weekly Epidemiological Report (WER) for 21 February 2014

The Weekly Epidemiological Report (WER) for 21 February 2014, vol. 89, 8 (pp. 61–72) includes:
:: Preventive chemotherapy: planning, requesting medicines, and reporting
:: WHO Strategic Advisory Group of Experts (SAGE) on immunization: request for nominations
:: Monthly report on dracunculiasis cases, January– December 2013

GAVI opens 2014 round of applications for new vaccines and health system strengthening support

GAVI Watch [to 22 February 2014]

GAVI has now opened its 2014 round of applications for new vaccines and health system strengthening support
New in 2014
Applications for both New Vaccine Support (NVS) and Health System Strengthening (HSS) will now be accepted through the same application and review timelines. The General Guidelines document offers an introduction to the principles, policies and processes that are applicable to all types of GAVI support.

Visit the updated section of the French website for all materials in French.

Countries are requested to submit an ‘Expression of Interest’ (EOI) as the first step in the application process. Submission of the EOI will be made mandatory starting with the September cut-off date for applications.

Country applications will be accepted on a rolling basis, so if a country misses a cut-off date, the application will be reviewed by the subsequent Independent Review Committee (IRC)

MMWR: Interim Estimates of 2013–14 Seasonal Influenza Vaccine Effectiveness — United States, February 2014

CDC/MMWR Watch [to 22 February 2014]

CDC Telebriefing: Update on Flu Activity and Vaccine Effectiveness Estimates – Transcript
Thursday, February 20, 2014, 12:00 PM
Telebriefing on articles that appear in today’s Morbidity and Mortality Weekly Report on Flu activity and 2013–14 Seasonal Influenza Vaccine Effectiveness.

MMWR Weekly
February 21, 2014 / Vol. 63 / No. 7
:: Interim Estimates of 2013–14 Seasonal Influenza Vaccine Effectiveness — United States, February 2014
February 21, 2014 / 63(07);137-142
Brendan Flannery, PhD1, Swathi N. Thaker, PhD1, Jessie Clippard, MPH1, Arnold S. Monto, MD2, Suzanne E. Ohmit, DrPH2, Richard K. Zimmerman, MD3, Mary Patricia Nowalk, PhD3, Manjusha Gaglani, MBBS4, Michael L. Jackson, PhD5, Lisa A. Jackson, MD5, Edward A. Belongia, MD6, Huong Q. McLean, PhD6, LaShondra Berman, MS1, Angie Foust, MA1, Wendy Sessions, MPH1, Sarah Spencer, PhD1, Alicia M. Fry, MD1

In the United States, annual vaccination against seasonal influenza is recommended for all persons aged ≥6 months (1). Each season since 2004–05, CDC has estimated the effectiveness of seasonal influenza vaccine to prevent influenza-associated, medically attended acute respiratory illness (ARI). This report uses data from 2,319 children and adults enrolled in the U.S. Influenza Vaccine Effectiveness (Flu VE) Network during December 2, 2013–January 23, 2014, to estimate an interim adjusted effectiveness of seasonal influenza vaccine for preventing laboratory-confirmed influenza virus infection associated with medically attended ARI. During this period, overall vaccine effectiveness (VE) (adjusted for study site, age, sex, race/ethnicity, self-rated health, and days from illness onset to enrollment) against influenza A and B virus infection associated with medically attended ARI was 61%. The influenza A (H1N1)pdm09 (pH1N1) virus that emerged to cause a pandemic in 2009 accounted for 98% of influenza viruses detected. VE was estimated to be 62% against pH1N1 virus infections and was similar across age groups. As of February 8, 2014, influenza activity remained elevated in the United States, the proportion of persons seeing their health-care provider for influenza-like illness was lower than in early January but remained above the national baseline, and activity still might be increasing in some parts of the country (2). CDC and the Advisory Committee on Immunization Practices routinely recommend that annual influenza vaccination efforts continue as long as influenza viruses are circulating (1). Persons aged ≥6 months who have not yet been vaccinated this season should be vaccinated. Antiviral medications are an important second line of defense to treat influenza illness and should be used as recommended (3) among suspected or confirmed influenza patients, regardless of patient vaccination status. Early antiviral treatment is recommended for persons with suspected influenza with severe or progressive illness (e.g., hospitalized persons) and those at high risk for complications from influenza, no matter how severe the illness.

:: Influenza-Associated Intensive-Care Unit Admissions and Deaths — California, September 29, 2013–January 18, 2014
:: Update: Influenza Activity — United States, September 29, 2013–February 8, 2014
:: Notes from the Field: Varicella-Associated Death of a Vaccinated Child with Leukemia — California, 2012

WHO Fact sheets: Immunization coverage :: Measles [Feb 2014]

WHO Fact sheet N°378: Immunization coverage:
Updated February 2014
Key facts
:: Immunization prevents illness, disability and death from vaccine-preventable diseases including diphtheria, measles, pertussis, pneumonia, polio, rotavirus diarrhoea, rubella and tetanus.
:: Global vaccination coverage is holding steady.
:: Immunization currently averts an estimated 2 to 3 million deaths every year.
:: But an estimated 22.6 million infants worldwide are still missing out on basic vaccines.

Immunization averts an estimated 2 to 3 million deaths every year from diphtheria, tetanus, pertussis (whooping cough), and measles. Global vaccination coverage—the proportion of the world’s children who receive recommended vaccines—has remained steady for the past few years. For example, the percentage of infants fully vaccinated against diphtheria-tetanus-pertussis (DTP3) has held steady at 83% for the last three years.

During 2012, about 110.6 million infants worldwide got three doses of DTP3 vaccine, protecting them against infectious diseases that can cause serious illness and disability or be fatal. By 2012, 131 countries had reached at least 90% coverage of DTP3…

WHO Fact sheet N°286: Measles
Updated February 2014
Key facts
:: Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.
:: In 2012, there were 122 000 measles deaths globally – about 330 deaths every day or 14 deaths every hour.
:: Measles vaccination resulted in a 78% drop in measles deaths between 2000 and 2012 worldwide.
:: In 2012, about 84% of the world’s children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000.
:: Since 2000, more than 1 billion children in high risk countries were vaccinated against the disease through mass vaccination campaigns ― about 145 million of them in 2012…