Vaccines and Global Health: The Week in Review 26 March 2016

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

.Request an Email Summary: Vaccines and Global Health : The Week in Review is published as a single email summary, scheduled for release each Saturday evening before midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to

pdf version A pdf of the current issue is available here:  Vaccines and Global Health_The Week in Review_26 March 2016

blog edition: comprised of the approx. 35+ entries posted below on 27-28 March 2016.

Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.

David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

Zika virus [to 26 March 2016]

Zika virus [to 26 March 2016]
Public Health Emergency of International Concern (PHEIC)

WHO Situation Report
Zika virus, Microcephaly and Guillain-Barré syndrome 24 March 2016
Read the full situation report
:: From 1 January 2007 to 23 March 2016, Zika virus transmission was documented in a total of 61 countries and territories. Four of these countries and territories reported a Zika virus outbreak that is now over. Argentina and New Zealand are the latest countries to report sexual transmission of Zika virus. Thus, five countries have now reported locally acquired infection in the absence of any known mosquito vectors, probably through sexual transmission (Argentina, France, Italy, New Zealand and the United States of America).

:: The geographical distribution of Zika virus has steadily widened since the virus was first detected in the Americas in 2014. Autochthonous Zika virus transmission has been reported in 34 countries and territories of this region.

:: So far an increase in microcephaly and other fetal malformations has been reported in Brazil and French Polynesia. Two additional cases, linked to a stay in Brazil, were detected in the United States of America and Slovenia. Panama recently reported a newborn with microcephaly and occipital encephalocoele (neural tube defect) who died a few hours after birth and tested positive for Zika virus by RT-PCR.

:: In the context of Zika virus circulation, 12 countries or territories have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases.

:: The mounting evidence from observational, cohort and case-control studies indicates that Zika virus is highly likely to be a cause of microcephaly, GBS and other neurological disorders. Among the tasks ahead are to further quantify the risk of neurological disorders following Zika virus infection, and to investigate the biological mechanisms that lead to neurological disorders.

:: The global prevention and control strategy launched by the World Health Organization (WHO) as a Strategic Response Framework encompasses surveillance, response activities and research, and this situation report is organized under those headings.


Public consultation of Zika diagnostics
In order to address the limitations and gaps of current diagnostic tests for Zika, WHO and several key stakeholders have developed target product profiles (TPPs) to test for the disease. TPPs define the desired characteristics of Zika diagnostic tests, and are aspirational in nature.
WHO invites experts to comment and give input on these TPPS by 3 April 2016. The contact information is at the end of the TPPs.
The TPPs include a brief summary of additional important considerations that highlight technical challenges to test development and the limits to scientific understanding of the virus at this stage of the Zika response.
:: Target product profiles (TPPs)pdf, 263kb
:: WHO global consultation on research related to Zika virus infection 7-9 March 2016


Latest updates
:: WHO Director-General briefs the media on the Zika situation
22 March 2016

Guidance for health workers
:: Knowledge, Attitudes and Practice surveys
24 March 2016
:: Lab testing for Zika virus infection
23 March 2016

Zika Open
[Bulletin of the World Health Organization]
:: All papers available here
[No new papers posted]


CDC/ACIP [to 26 March 2016]
FRIDAY, MARCH 25, 2016
CDC Issues Updated Zika Recommendations: Timing of Pregnancy after Zika Exposure, Prevention of Sexual Transmission, Considerations for Reducing Unintended Pregnancy in Areas with Zika Transmission
CDC today issued new guidance and information to prevent Zika virus transmission and health effects.
:: Updated interim guidance for healthcare professionals for counseling patients about pregnancy planning and the timing of pregnancy after possible exposure to Zika virus;
:: Updated interim guidance for preventing sexual transmission with information about how long men and women should consider using condoms or not having sex; and
:: Considerations and challenges, based on Puerto Rico’s experience, for reducing unintended pregnancy in areas with active Zika transmission…

FRIDAY, MARCH 25, 2016
Transcript for CDC Telebriefing: Updates on CDC recommendations related to Zika virus

CDC adds Dominica to interim travel guidance related to Zika virus – Media Statement

MMWR – March 25, 2016 / Vol. 65 / No. 11
:: Travel-Associated Zika Virus Disease Cases Among U.S. Residents — United States, January 2015–February 2016
:: Preventing Transmission of Zika Virus in Labor and Delivery Settings Through Implementation of Standard Precautions — United States, 2016

EBOLA/EVD [to 26 March 2016]

EBOLA/EVD [to 26 March 2016]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

Ebola Situation Reports
[While no announcement of a change in reporting cycle is evident, we deduce that Ebola Situation Reports have been reduced to a bi-weekly cycle given the spacing of the last few reports – previous update: Ebola Situation Report – 16 March 2016]


WHO: Hundreds of contacts identified and monitored in new Ebola flare-up in Guinea
22 March 2016 Update from the field
Nzérékoré, Guinea — More than 800 contacts of recently confirmed Ebola cases in Guinea’s southern prefecture of Nzérékoré have been identified and placed under medical monitoring in a bid to contain a new flare-up of Ebola virus disease.

POLIO [to 26 March 2016]

POLIO [to 26 March 2016]
Public Health Emergency of International Concern (PHEIC)


Polio this week as of 16 March 2016
:: An innovative new product has been developed by a collaboration of Australian researchers. The Nanopatch may one day enable unprecedented levels of antigen sparing. Read more here.
:: There are three weeks to go until the globally synchronized switch from the trivalent to bivalent oral polio vaccine. Learn more about the switch through this series of videos.
Selected Country Levels Updates [excerpted]
[No new case activity reported globally]

WHO & Regional Offices [to 26 March 2016]

WHO & Regional Offices [to 26 March 2016]

WHO: Angola grapples with worst yellow fever outbreak in 30 years
March 2016
Angola is grappling with a yellow fever outbreak, which has infected more than 450 people and killed 178 – the first epidemic of the disease to hit the country in 30 years.
The outbreak, which was first reported in the capital city Luanda in December 2015, has since spread to 6 of the country’s 18 provinces…

Vaccination a powerful weapon but in short supply
WHO has taken urgent action to contain this outbreak, working with the Angolan Ministry of Health and partners to vaccinate people in the affected provinces. As of 24 March 2016, WHO and partners have vaccinated 5.7 million people in Luanda against yellow fever using vaccines from the International Coordination Group emergency stockpile.

WHO has established an incident management system and deployed around 65 experts in epidemiology, vector control, community engagement and other areas to support the vaccination campaign.

WHO’s recently established Contingency Fund for Emergencies released US$500,000 to enable a rapid response to this outbreak in Angola and WHO’s African Public Health Emergency Fund has provided US$289,383. WHO has also supported the development of an emergency response plan to provide an additional US$ 3 million funds from the UN Office for the Coordination of Humanitarian Affairs to cover 50% of the costs of the vaccines for the province of Luanda.

Vaccine storage
“The vaccination campaign has so far been effective. We are seeing case numbers dropping considerably, especially in Luanda. However, we have to keep going and vaccinate all the people in Luanda and the affected provinces to end this outbreak. This is an enormous job which is exhausting supplies of vaccines,” says Dr Yactayo.

Whilst concerted efforts are being made to stop the outbreak, there is a global vaccine shortage, with the emergency stockpile completely depleted. An additional 1.5 million doses are needed to vaccinate the population at risk in Luanda province alone.

With the spread of the outbreak to other provinces in Angola and increasing numbers of imported cases reported by countries in Africa, WHO requests prioritizing vaccination of people at highest risk. WHO is in discussion with manufacturers and partners to divert shipments of vaccines for national routine immunization programmes until the emergency stockpile is replenished.

Partners working with WHO and the Ministry of Health include UNICEF, CDC/Atlanta, CORE Group, Médicins Sans Frontières, Medicos del Mundo, the National Red Cross of Angola and local community based organizations…


Iraq’s 2015 response to cholera outbreak minimizes future risk
23 March 2016, Baghdad, Iraq – After the declaration of a cholera epidemic in Iraq in September 2015, and in anticipation of a potential new outbreak, WHO, UNICEF and the Ministry of Health of Iraq, jointly with water and sanitation and health cluster partners held a consultation today to review lessons learnt and best practices from the successful 2015 response to the outbreak. Consultations such as these will help guide cholera contingency plans for 2016 and beyond….

…The meeting focused on a number of key issues, including the need to:
:: build local capacities to scale up surveillance, case investigation and management, as well as cholera prevention and control measures
:: strengthen laboratory capacities at central, governorate, and peripheral levels to ensure early detection and confirmation of a cholera outbreak
:: enhance collaborative activities between relevant ministries and agencies, with clear roles and accountability
:: maintain strong and regular communication with the health sector and apply an intersectoral approach for the management of cholera/acute watery diarrhoea.
…Cholera is endemic in Iraq, and the outbreak, officially declared in September 2015, resulted in 4945 cases confirmed in 17 of the 18 governorates across Iraq. WHO and UNICEF supported the Ministry of Health and other partners to put in place immediate preventive and control measures that included targeting approximately 249 319 people with oral cholera vaccine in a 2-round immunization campaign for vulnerable populations in 62 refugee and internally displaced persons camps and collective centres throughout the country.


WHO Launches a New Vaccine Pipeline Tracker
21 March 2016
A new resource for vaccine research – the global vaccine development tracker – has been launched by WHO. This brings together the global clinical development pipeline for the following seven diseases in one single location: HIV, tuberculosis, malaria, RSV (Respiratory Syncytial Virus), ETEC (Enterotoxigenic E.Coli), Shigella, and Norovirus. [These diseases were chosen somewhat empirically and it is anticipated that the list will be expanded in future. An update will occur every 6 months or more often.]
The tracker will be updated every six months, and may be expanded to other disease areas. This initiative was recommended as a priority by the WHO Product Development for Vaccines Advisory Committee (PDVAC).
WHO Vaccine Pipeline Tracker
WHO gratefully acknowledges the following groups as sources for the data provided:
:: HIV Vaccine Trials Network
:: The US Military’s HIV Research Program (MHRP)
:: The International AIDS Vaccine Initiative (IAVI)
:: European & Developing Countries Clinical Trials Partnership
:: European Vaccine Initiative
:: PATH Malaria Vaccine Initiative
:: Aeras
:: RSV Vaccine Program
ETEC, Shigella & Norovirus
:: PATH Enteric Vaccine Initiative


WHO SAGE Meeting
Geneva: 12 – 14 April 2016.
:: Draft agenda pdf, 145kb As of 11 March 2016


Pandemic Influenza Preparedness Framework Review
30 March 2016 – Geneva, Switzerland
As recommended by the Advisory Group in the Special Session of 13-14 October 2015, a review group on the implementation of the (Pandemic Influenza Preparedness) PIP Framework has been established. The first 2 meetings were held via teleconference on 7 January and 19 February 2016, where the group agreed on the terms of reference, method of work and next steps forward.
The purpose of the meeting is for the Review Group to receive views from stakeholders on the implementation of the PIP Framework…


Weekly Epidemiological Record (WER) 25 March 2016, vol. 91, 11 (pp. 145–168)
145 Polio vaccines: WHO position paper – March, 2016


Disease Outbreak News (DONs)
:: 23 March 2016 Human infection with avian influenza A(H7N9) virus – China
:: 23 March 2016 Human infection with avian influenza A(H5N6) virus – China
:: 23 March 2016 Lassa Fever – Germany
:: 23 March 2016 Lassa Fever – Togo
:: 23 March 2016 Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
:: 22 March 2016 Yellow Fever – Angola
:: 21 March 2016 Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia


WHO Fact sheets
:: Measles 24 March 2016
:: Rubella 24 March 2016
:: Immunization coverage 24 March 2016
:: Dengue and severe dengue 22 March 2016
:: Tuberculosis 21 March 2016
:: Leishmaniasis 21 March 2016


:: WHO Regional Offices
WHO African Region AFRO
No new digest content identified.

WHO Region of the Americas PAHO
:: PAHO/WHO calls on countries to work together to end tuberculosis in the next 20 years (03/24/2016)
:: Sesame Street Muppets Join PAHO to Educate Families About Preventing Zika Mosquito Bites (03/23/2016)

WHO South-East Asia Region SEARO
:: Media statement – Invest in safe water to enhance public health
22 March 2016

WHO European Region EURO
:: Public Health Panorama: TB in central Asia
:: Regional workshop on the global oral polio vaccine “switch” 30–31 March 2016, Vienna, Austria

WHO Eastern Mediterranean Region EMRO
:: Iraq’s 2015 response to cholera outbreak minimizes future risk
23 March 2016

WHO Western Pacific Region
:: Stronger action and commitment needed to end tuberculosis
MANILA, 23 March 2016 – As the world observes World TB Day (24 March), the World Health Organization (WHO) in the Western Pacific Region urges governments and partners to strongly support calls to action to end the burden of tuberculosis (TB) in the Region. “Sadly, tuberculosis continues to be an agonizing chapter in the public health history of the Region,” said Dr Shin Young-soo, WHO Regional Director for the Western Pacific. “We must strengthen efforts to close the book on TB for the Region’s 1.8 billion people.”

CDC/ACIP [to 26 March 2016]

CDC/ACIP [to 26 March 2016]
[see Zika coverage above which includes CDC briefing content]


MMWR – March 25, 2016 / Vol. 65 / No. 11
:: World TB Day — March 24, 2016
:: Leveling of Tuberculosis Incidence — United States, 2013–2015
:: Tuberculosis Among Temporary Visa Holders Working in the Tourism Industry — United States, 2012–2014
:: Travel-Associated Zika Virus Disease Cases Among U.S. Residents — United States, January 2015–February 2016
:: Preventing Transmission of Zika Virus in Labor and Delivery Settings Through Implementation of Standard Precautions — United States, 2016

New EU-Turkey agreement on refugee and migrants could leave children at risk: UNICEF

New EU-Turkey agreement on refugee and migrants could leave children at risk: UNICEF
GENEVA, 22 March 2016 – UNICEF today expressed concern that the new agreement between the EU and Turkey, which comes into effect this week, does not address the pressing humanitarian needs of 19,000 refugee and migrant children stranded in Greece. Children make up 40 percent of the refugee and migrant population in Greece. It is estimated that unaccompanied children make up 10 percent of the child population.

UNICEF warned the new agreement could push children and families to take other more dangerous routes including the central Mediterranean Sea. UNICEF welcomes EU leaders’ commitment to determining the individual status of refugees and migrants rather than collective expulsions, push-back practices or other measures that may be harmful to children.

The children’s agency, however, urges that a number of priorities are addressed:
:: Unaccompanied and separated children are properly identified and taken into protective care rather than detention. They are entitled to a full hearing and assessment of their best interests prior to any decision related to them, including on return. The capacity of state institutions in Greece needs to be scaled up significantly to deal with this new caseload.

:: Child and family support services such as child friendly spaces, and safe mother and baby areas are rapidly expanded in ‘Blue Dots’ services.

:: Children stranded for longer periods in Greece will require an expanded set of basic services such as emergency education. Many children have been out of school for several months and would benefit even from short term learning.

:: To prevent disease outbreaks among children, urgent consideration has to be given to vaccinating refugee and migrant children, especially as many have been living in unsanitary conditions for weeks. An initial response would include vaccinating against measles, polio and pneumococcal infections.