Vaccines and Global Health: The Week in Review 28 June 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

Ebola: WHO to convene regional experts for comprehensive operational response

Media Note – Ebola: WHO to convene regional experts for comprehensive operational response
26 June 2014 | GENEVA
The emergence of an Ebola virus disease outbreak in West Africa in 2014 has become a challenge to the 3 countries involved, as the Governments of Guinea, Liberia and Sierra Leone work intensively with WHO and other partners to ramp up a series of measures to control the outbreak.

Since March 2014, more than 600 cases of Ebola and over 390 deaths have been reported in Guinea, Liberia and Sierra Leone. While the number of suspected, probable and confirmed cases and deaths changes rapidly, the outbreak is causing concern among health authorities because the deadly disease is being transmitted in communities and in health-care settings, and it has appeared in cities as well as rural and border areas. The disease, which causes severe haemorrhaging and can kill up to 90% of those infected, is spread by direct contact with the blood and body fluids of infected animals or people….

…Recognizing that a coordinated regional response is essential, WHO is convening the leading health authorities from the affected and nearby countries in Accra, Ghana on July 2–3, to agree on a comprehensive operational response to control the Ebola outbreak. A wide range of partners have been invited, and Ministries of Health of Guinea, Liberia, and Sierra Leone will report on their preventive and control measures, contact identification and tracing; case management; infection and prevention control; social mobilization; and situation reports.

The countries are working to bring supportive care to the ill, inform affected communities of recommended practices, trace contacts of infected patients, control infections in health care settings, and taking other measures to control the outbreak. Despite their progress in implementing preventive and control measures, health authorities still face challenges in curbing the spread of the outbreak, and will discuss these at the Accra meeting….

…The latest numbers, which change as cases are discovered, investigated, or discarded, are:
:: Guinea has reported some 396 cases and 280 deaths
:: Sierra Leone has 176 cases and 46 deaths
:: Liberia reports 63 cases and 41 deaths.

WHO: Global Alert and Response (GAR) – Disease Outbreak News [to 28 June 2014]

WHO: Global Alert and Response (GAR) – Disease Outbreak News [to 28 June 2014]

:: Human infection with avian influenza A(H7N9) virus – update 27 June 2014

:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 26 June 2014
…Globally, 707 laboratory-confirmed cases of infection with MERS-CoV, including at least 252
related deaths have officially been reported to WHO.
WHO advice
Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-
CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.

Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease
from MERS‐CoV infection. Therefore, these people should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.

Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 26 June 2014
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 25 June 2014

:: Update on polio in central Africa 25 June 2014
[Full text; Editor’s text bolding]
On 17 March 2014, WHO elevated the risk assessment of international spread of polio from central Africa, particularly Cameroon, to very high. A new exportation event from Equatorial Guinea demonstrates that the risk of international spread from central Africa remains very high ( On 18 June 2014, Brazil reported that wild poliovirus type 1 (WPV1) had been detected in a sewage sample collected in March 2014 at Viracopos International Airport in Sao Paolo state. Genetic sequencing indicates that this virus is most closely related to the virus that is circulating in Equatorial Guinea.

Four wild poliovirus type 1 (WPV1) cases have been reported in Equatorial Guinea in 2014. The index case – Equatorial Guinea’s first case to be reported since 1999 – had onset of paralysis on 28 January 2014; the country’s most recent case occurred on 3 April 2014. Genetic sequencing indicates these cases are linked to an ongoing WPV1 outbreak in Cameroon (Cameroon’s most recent case was on 31 January 2014). Equatorial Guinea is implementing outbreak response activities, with three National Immunization Days (NIDs) with bivalent oral polio vaccine (OPV) in April and May, and plans for further NIDs in July and August. NIDs are deemed essential to stop the outbreak as an estimated 40% of children are fully immunized against polio through the routine immunization programme in the country.

No one in Brazil has been paralyzed by the virus nor is there evidence of transmission within the population of that country. This importation event in Brazil demonstrates that all regions of the world continue to be at risk of exposure to wild poliovirus until polio eradication is completed globally. It is important that all countries, in particular those with frequent travel and contacts with polio-affected countries and areas, strengthen surveillance for polioviruses (especially through the detection and investigation of Acute Flaccid Paralysis or AFP cases) in order to rapidly detect any new virus importations and to facilitate a rapid response. Uniformly high routine immunization coverage should be maintained at the district level to minimize the consequences of any new virus introduction.
An analysis of immunity levels across central Africa found important immunity gaps in most countries in 2014, prompting the large-scale polio immunization campaigns that are ongoing in the area. In Gabon, a nationwide immunization campaign was held in June (with a further round planned for July), and in the Republic of Congo, a nationwide activity was conducted in May (another round is planned for June). Polio vaccination campaigns have been conducted where possible in the Central African Republic (May to June), with another round planned for accessible areas in July.

WHO note
There is no evidence to date that Brazil was re-infected by the poliovirus of Equatorial Guinea origin that was detected in a sewage sample collected in Sao Paolo State in March 2014; to date there has been no evidence of transmission of the virus in Brazil following this exposure.

Given Brazil’s high levels of population immunity, reflected in the high routine immunization coverage (>95%) and periodic vaccination campaigns, the lack of evidence so far of WPV1 transmission and the response being implemented, WHO assesses the risk of spread of this virus within or from Brazil as low.

WHO travel recommendations
WHO’s International Travel and Health recommends that all travellers to and from polio-affected areas be fully vaccinated against polio.

POLIO [to 28 June 2014]

POLIO [to 28 June 2014]

GPEI Update: Polio this week – As of 25 June 2014
Global Polio Eradication Initiative
Editor’s Excerpt and text bolding
Full report:
:: On 18 June, Brazil reported that wild poliovirus type 1 (WPV1) had been detected in a sewage sample collected in March 2014 at Viracopos International Airport in Sao Paolo state. Genetic sequencing indicates that this virus is most closely related to the virus that is circulating in Equatorial Guinea. No one in Brazil has been paralyzed by the virus nor is there evidence of transmission within the population of that country. This importation is a reminder of the importance of responding to the central Africa outbreak efficiently, of the critical need to vaccinate residents of Equatorial Guinea before international travel, and of the need for all countries to maintain high immunity against polio.
:: In the Bara sub-division of the Federally Administered Tribal Areas (FATA), Pakistan, a successful door-to-door polio vaccination campaign took place for the first time in five years reaching more than 42,000 children. The campaign – led by the FATA Secretariat and conducted by volunteers – was made possible by new financial support from the United Arab Emirates.
:: On 20 June, the Polio Oversight Board (POB) – made up of the heads of GPEI partners WHO, UNICEF, Rotary International and the US Centers for Disease Control and Prevention, and senior leadership from the Bill & Melinda Gates Foundation – met for the third time this year to examine progress against the Strategic Plan and review updates on GPEI management, financials and communications. Among other decisions, the POB endorsed additional activities to protect at-risk polio-free areas.
;: One new WPV1 case was reported in the past week from the previously uninfected Sumaila LGA, Kano state, with onset of paralysis on 17 May. The total number of WPV1 cases for 2014 is four.
:: Two new cVDPV2 cases were reported in the past week including one from Damboa LGA, Borno state with onset of paralysis on 2 May, and one from the previously uninfected Gwale LGA, Kano state with onset of paralysis on 10 May. The total number of cVDPV2 cases for 2014 is nine…
:: One new WPV1 case was reported in the past week from North Waziristan, Federally Administered Tribal Areas (FATA) with onset of paralysis on 28 May. The total number of WPV1 cases reported from Pakistan for 2014 is 83.
:: Six new cVDPV2 cases were reported in the past week including three cases from North Waziristan, FATA, and three cases from FR Bannu, FATA. The most recent cVDPV2 case had onset of paralysis on 27 May (from FR Bannu). The total number of cVDPV2 cases for 2014 is 16.
:: North Waziristan is the district with the largest number of children being paralyzed by poliovirus (both wild and cVDPV2) in the world. Immunization activities have been suspended by local leaders since June 2012. Immunizations in neighboring high-risk areas are being intensified, to further boost population immunity levels in those areas and prevent further spread of this outbreak. With thousands of people moving out of North Waziristan following the recent military operation against insurgents, the polio programme has been working with local government to identify displaced populations and reach them with the polio vaccine at either permanent transit points, or camps, or once they reach host communities.
:: According to the Technical Advisory Group (TAG) on Polio Eradication in Pakistan, convened in Islamabad from 2-3 June, the country is not in a position to interrupt transmission without radical change in reservoir areas including FATA, Peshawar, and Karachi. To put the program back on the path to polio eradication, the TAG recommended full political commitment and ownership, mobilization of national assets to facilitate access of vaccination teams, restoration of vaccination in FATA and addressing insecurity and chronic gaps in reservoirs and high risk areas. The TAG also recommended that all provinces integrate communications and social mobilization activities in their planning and operations.
Central Africa
:: One new WPV1 case was reported in the past week from Equatorial Guinea. The case is from the previously uninfected Mbini district in Litoral province and had onset of paralysis on 3 May.

Please see Polio eradication in Syria, The Lancet Infectious Diseases, in Journal Watch below.

Polio vaccine effort in Syria reaches 1.4 million children as volunteers brave violence
Washington Post | 22 June 2014
By Tik Root Ju
GAZIANTEP, Turkey — Despite grave danger, a campaign to combat the spread of polio in rebel-held Syria has been surprisingly successful, with volunteers inoculating about 1.4 million children since the beginning of the year.
The reemergence of polio in Syria in October alarmed health organizations, which feared that factors such as tainted water, dysfunctional sanitation systems and a mobile population could contribute to a broader, region-wide epidemic.
In response, a coalition of nonprofit organizations quickly recruited and deployed thousands of volunteers in the country’s embattled north, where they won the cooperation of rebel fighters and braved shelling and airstrikes to administer the vaccine to children under age 5. Four volunteers have been killed in the process, but there has not been a confirmed case of polio in Syria in nearly five months….

The Weekly Epidemiological Record (WER) for 27 June 2014, vol. 89, 26 (pp. 289–296) includes:
:: Index of countries/areas; Index, Volume 89, 2014, Nos. 1–26
:: Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis,

Global Fund Watch [to 28 June 2014]

Global Fund Watch [to 28 June 2014]

:: New Framework on Malaria Drugs to Save $100 Million
24 June 2014
GENEVA – In a major initiative that fundamentally changes how anti-malaria drugs are procured, the Global Fund is entering into new framework agreements with suppliers of artemisinin-based combination therapy (ACT) that are aimed at improving delivery and having a bigger impact, both in value for money and in lives saved.
Working closely with the UK’s Department for International Development, partners achieved a way to maximize transition funding for a private sector co-payment mechanism for ACTs, the driving factor in projected savings of over US$100 million through price reductions over two years. World Health Organization, the President’s Malaria Initiative, UNICEF, UNITAID and the Clinton Health Access Initiative all aligned their efforts in the process.
The agreement establishes framework contracts of two years with allocated and committed volumes of ACTs with a group of nine selected suppliers. In addition to the financial benefits, the framework will bring improvements in pipeline visibility, delivery performance and market sustainability, and also encourage local production…

WHO: Antimicrobial resistance: global report on surveillance 2014

Antimicrobial resistance: global report on surveillance 2014
April 2014 – 257 pages
ISBN: 978 92 4 156474 8
Antimicrobial resistance (AMR) threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi. An increasing number of governments around the world are devoting efforts to a problem so serious that it threatens the achievements of modern medicine. A post-antibiotic era – in which common infections and minor injuries can kill – far from being an apocalyptic fantasy, is instead a very real possibility for the 21st Century.

This WHO report, produced in collaboration with Member States and other partners, provides for the first time, as accurate a picture as is presently possible of the magnitude of AMR and the current state of surveillance globally.

The report makes a clear case that resistance to common bacteria has reached alarming levels in many parts of the world and that in some settings, few, if any, of the available treatments options remain effective for common infections. Another important finding of the report is that surveillance of antibacterial resistance is neither coordinated nor harmonized and there are many gaps in information on bacteria of major public health importance.

Strengthening global AMR surveillance is critical as it is the basis for informing global strategies, monitoring the effectiveness of public health interventions and detecting new trends and threats. As WHO, along with partners across many sectors moves ahead in developing a global action plan to mitigate AMR, this report will serve as a baseline to measure future progress.

American Journal of Infection Control – July 2014

American Journal of Infection Control
Vol 42 | No. 7 | July 2014 | Pages 697-818

Trends in racial/ethnic disparities in influenza vaccination coverage among adults during the 2007-08 through 2011-12 seasons
Peng-Jun Lu, MD, PhD, Alissa O’Halloran, MSPH, Leah Bryan, MPH, Erin D. Kennedy, DVM, MPH,
Helen Ding, MD, MSPH, Samuel B. Graitcer, MD, Tammy A. Santibanez, PhD, Ankita Meghani, MSPH, James A. Singleton, PhD
Annual influenza vaccination is recommended for all persons aged ≥6 months. The objective of this study was to assess trends in racial/ethnic disparities in influenza vaccination coverage among adults in the United States.
We analyzed data from the 2007-2012 National Health Interview Survey (NHIS) and Behavioral Risk Factor Surveillance System (BRFSS) using Kaplan-Meier survival analysis to assess influenza vaccination coverage by age, presence of medical conditions, and racial/ethnic groups during the 2007-08 through 2011-12 seasons.
During the 2011-12 season, influenza vaccination coverage was significantly lower among non-Hispanic blacks and Hispanics compared with non-Hispanic whites among most of the adult subgroups, with smaller disparities observed for adults age 18-49 years compared with other age groups. Vaccination coverage for non-Hispanic white, non-Hispanic black, and Hispanic adults increased significantly from the 2007-08 through the 2011-12 season for most of the adult subgroups based on the NHIS (test for trend, P < .05). Coverage gaps between racial/ethnic minorities and non-Hispanic whites persisted at similar levels from the 2007-08 through the 2011-12 seasons, with similar results from the NHIS and BRFSS.
Influenza vaccination coverage among most racial/ethnic groups increased from the 2007-08 through the 2011-12 seasons, but substantial racial and ethnic disparities remained in most age groups. Targeted efforts are needed to improve coverage and reduce these disparities.

Baseline immunity to diphtheria and immunologic response after booster vaccination with reduced diphtheria and tetanus toxoid vaccine in Thai health care workers
Surasak Wiboonchutikul, MD, Weerawat Manosuthi, MD, Chariya Sangsajja, MD, Varaporn Thientong, RN, Sirirat Likanonsakul, MSc, Somkid Srisopha, BSc, Patamavadee Termvises, RN, Jitlada Rujitip, RN, Suda Loiusirirotchanakul, PhD, Pilaipan Puthavathana, PhD
A prospective study to evaluate immune status against diphtheria and immunologic response after tetanus-diphtheria (Td) booster vaccination was conducted in 250 Thai health care workers (HCWs). A protective antibody was found in 89.2% of the HCWs (95% confidence interval [CI], 83.3%-91.5%) before receipt of the Td booster vaccination, compared with 97.2% (95% CI, 95.1%-99.3%) after receipt of the first dose of booster (P < .001). The mean antibody level against diphtheria increased from 0.39 IU/mL (95% CI, 0.35-0.44 IU/mL) before the Td booster vaccination to 1.20 IU/mL (95% CI, 1.12-1.29 IU/mL) after the vaccination (P < .001). Td booster vaccination should be considered for Thai HCWs to maintain immunity against diphtheria, which still circulates in Thailand.