Bulletin of the World Health Organization
Volume 92, Number 5, May 2014, 309-384
http://www.who.int/bulletin/volumes/92/5/en/

Editorial
International Health Regulations (2005): taking stock
Isabelle Nuttall a
a. Department of Global Capacities, Alert and Response, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland.
Bulletin of the World Health Organization 2014;92:310. doi: http://dx.doi.org/10.2471/BLT.14.138990
Excerpt
In 2007, the coming into force of the revised International Health Regulations (2005)1 [IHR (2005)] – the most powerful, far-reaching instrument of international law ever conceived to protect people’s health – was met with excitement. The purpose behind the IHR (2005) was to prevent and detect international health threats with minimal disruption to travel, trade and the economy. A simple logic lay at the heart of the IHR (2005): in an interconnected, interdependent world, a threat in one country puts all countries at risk.
Today, international public health threats, be they infectious or not, are harder to prevent and detect because of the mass movement of people, goods and animals facilitated by faster, cheaper modes of travel and complex trade systems. In the last couple of years alone, emerging pathogens such as avian influenza viruses A(H7N9) and A(H10N8) and the Middle East respiratory syndrome coronavirus have for the first time been reported to cause human disease. Three out of four new diseases affecting humans emerge at the human–animal interface.
To ensure compliance with IHR (2005), countries were given until June 2012 to develop systems with capacity in several core areas: legislation and policy; coordination and IHR national focal points; preparedness, surveillance and response; risk communication; human resources; laboratory practice; and points of entry. However, the magnitude of the work led more than 100 countries to request a two-year extension for building up capacity in these domains. In June 2014 this extension period will be over and further requests for extension are expected. What does this mean?
…In terms of the IHR, it is time to take stock of the capacities amassed so far and those that still need to be developed. Countries have yet to implement their concrete plans to meet the capacity requirements of the IHR (2005). Some target capacities call for substantial investment, either from national budgets or international cooperation, and hence renewed financial commitments; others could probably be achieved through improved cost–effectiveness and collaboration between different sectors, including the animal and human health sectors. WHO is also striving, through its programme of reform, to serve its Member States better and in a more coordinated manner so that we can all live in a more secure and prosperous world.

Editorials
Influenza seasonality: timing and formulation of vaccines
Nancy Cox a
a. Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States of America.
Bulletin of the World Health Organization 2014;92:311. doi: http://dx.doi.org/10.2471/BLT.14.139428
Excerpt
…While strategies for influenza vaccination are well advanced in many temperate areas, data to support the timing of vaccination efforts in tropical areas of Asia have been quite limited. For this and other reasons, many countries in tropical Asia use little or no influenza vaccine – despite their considerable burdens of influenza disease. The information collected by Saha et al.4 clearly demonstrates that country-specific recommendations on influenza vaccination should focus not only on whether the country lies to the north or south of the Equator but also on the number and types of seasonal patterns in influenza activity that exist within the country’s borders. Countries with long latitudinal spans may need two distinct vaccine policies – one for the temperate areas and another for the more tropical areas – and to use both the “northern hemisphere” and “southern hemisphere” formulations.4,6,7 If appropriate vaccination policies – that couple the best timing of influenza vaccine administration with the most recent vaccine composition – are to be developed, the seasonality of influenza in many countries needs to be better understood.

RESEARCH
Influenza seasonality and vaccination timing in tropical and subtropical areas of southern and south-eastern Asia
Siddhartha Saha, Mandeep Chadha, Abdullah Al Mamun, Mahmudur Rahman, Katharine Sturm-Ramirez, Malinee Chittaganpitch, Sirima Pattamadilok, Sonja J Olsen, Ondri Dwi Sampurno, Vivi Setiawaty, Krisna Nur Andriana Pangesti, Gina Samaan, Sibounhom Archkhawongs, Phengta Vongphrachanh, Darouny Phonekeo, Andrew Corwin, Sok Touch, Philippe Buchy, Nora Chea, Paul Kitsutani, Le Quynh Mai, Vu Dinh Thiem, Raymond Lin, Constance Low, Chong Chee Kheong, Norizah Ismail, Mohd Apandi Yusof, Amado Tandoc, Vito Roque, Akhilesh Mishra, Ann C Moen, Marc-Alain Widdowson, Jeffrey Partridge & Renu B Lal
doi: 10.2471/BLT.13.124412

Research
Monitoring progress towards the elimination of measles in China: an analysis of measles surveillance data
Chao Ma, Lixin Hao, Yan Zhang, Qiru Su, Lance Rodewald, Zhijie An, Wenzhou Yu, Jing Ma, Ning Wen, Huiling Wang, Xiaofeng Liang, Huaqing Wang, Weizhong Yang, Li Li & Huiming Luo
Objective
To analyse the epidemiology of measles in China and determine the progress made towards the national elimination of the disease.
Methods
We analysed measles surveillance data – on the age, sex, residence and vaccination status of each case and the corresponding outcome, dates of onset and report and laboratory results – collected between January 2005 and October 2013.
Findings
Between 2005 and October 2013, 596 391 measles cases and 368 measles-related deaths were reported in China. Annual incidence, in cases per 100 000 population, decreased from 9.95 in 2008 to 0.46 in 2012 but then rose to more than 1.96 in 2013. The number of provinces that reported an annual incidence of less than one case per million population increased from one in 2009 to 15 in 2012 but fell back to one in 2013. Median case age decreased from 83 months in 2005 to 14 months in 2012 and 11 months in January to October 2013. Between 2008 and 2012, the incidence of measles in all age groups, including those not targeted for vaccination, decreased by at least 93.6%. However, resurgence started in late 2012 and continued into 2013. Of the cases reported in January to October 2013, 40% were aged 8 months to 6 years.
Conclusion
Although there is evidence of progress towards the elimination of measles from China, resurgence in 2013 indicated that many children were still not being vaccinated on time. Routine immunization must be strengthened and the remaining immunity gaps need to be identified and filled.

Perspectives
Health system cost of delivering routine vaccination in low- and lower-middle income countries: what is needed over the next decade?
Patrick Lydon a, Gian Gandhi b, Jos Vandelaer b & Jean-Marie Okwo-Bele a
a. Immunization, Vaccines and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
b. United Nations Children’s Fund, New York, United States of America.
(Submitted: 12 September 2013 – Revised version received: 23 January 2014 – Accepted: 31 January 2014 – Published online: 07 February 2014.)
Bulletin of the World Health Organization 2014;92:382-384. doi: http://dx.doi.org/10.2471/BLT.13.130146
Excerpt
On the eve of the 40th anniversary of launching of the Expanded Programme on Immunization (EPI) in 1974, during the twenty-seventh World Health Assembly (WHA), fundamental questions about the level of financing needed to sustain achievements and scale up the EPI in low- and lower-middle income countries continue to permeate the discourse on the economics of immunization. The answer to this question is all the more important in light of the fact that at the sixty-fifth WHA in 2012, ministers of health embraced the Global Vaccine Action Plan (GVAP) – a 10-year global strategic plan for immunization.1 But how much – and in what areas – are the investments needed for this decade?
Today, improved transparency in pricing information allows for relatively accurate vaccine cost estimates.2 Unfortunately, trends in the health system costs of delivering vaccination beyond the cost of the vaccines themselves continue to be poorly understood…