Vaccines and Global Health: The Week in Review 28 May 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 david.r.curry@centerforvaccineethicsandpolicy.org.

pdf version A pdf of the current issue is available here:  Vaccines and Global Health_The Week in Review_28 May 2016

blog edition: comprised of the approx. 35+ entries posted below.

Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
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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.

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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
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU School of Medicine

World Health Assembly – WHA69 – Geneva 23-28 May 2016.

Editor’s Note:
The WHA was still in session today as this edition was in completion. We will provide a summary of key resolutions and other actions from WHA and the Executive Board in next week’s edition and going forward. Below are the current press release updates on WHA.

World Health Assembly – WHA69
Geneva 23-28 May 2016.
:: Main Documents

WHO Executive Board EB139
30–31 May 2016
Main Documents

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Sixty-ninth World Health Assembly update
News release
27 MAY 2016 | GENEVA – Delegates at the World Health Assembly have agreed resolutions and decisions on air pollution, chemicals, the health workforce, childhood obesity, violence, noncommunicable diseases, and the election of the next Director-General…

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World Health Assembly agrees new Health Emergencies Programme
News release
25 MAY 2016 | GENEVA – WHO Member States today agreed to one of the most profound transformations in the Organization’s history, establishing a new Health Emergencies Programme. The programme adds operational capabilities for outbreaks and humanitarian emergencies to complement its traditional technical and normative roles.

The new programme is designed to deliver rapid, predictable, and comprehensive support to countries and communities as they prepare for, face or recover from emergencies caused by any type of hazard to human health, whether disease outbreaks, natural or man-made disasters or conflicts.

WHO will provide leadership within the context of the International Health Regulations and health, in relation to the broader humanitarian and disaster-management system. As health cluster lead, it will draw on the respective strengths and expertise of a wide range of partners and Member States.

In order to fulfil these new responsibilities, delegates agreed a budget of US$ 494 million for the Programme for 2016−2017. This is an increase of US$160 million to the existing Programme Budget for WHO’s work in emergencies.

Delegates welcomed the progress WHO has made in developing the new Health Emergencies Programme, noting the new implementation plan and timeline, and the establishment of an Independent Oversight and Advisory Committee for the new programme.

They encouraged the ongoing collaboration with the United Nations Office for the Coordination of Humanitarian Affairs to align the management of disease outbreaks and other biological emergencies with the mechanisms and capacities of the Inter-Agency Standing Committee.

They requested the WHO Director-General to report to the Seventieth World Health Assembly on progress made in establishing and operationalizing the programme.

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World Health Assembly agrees resolutions on women, children and adolescents, and healthy ageing
26 May 2016

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World Health Assembly highlights importance of multisectoral action on health
24 May 2016

Zika virus [to 28 May 2016]

Zika virus [to 28 May 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

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WHO public health advice regarding the Olympics and Zika virus
28 May 2016 – Based on current assessment, cancelling or changing the location of the 2016 Olympics will not significantly alter the international spread of Zika virus. Brazil is one of almost 60 countries and territories which to-date report continuing transmission of Zika by mosquitoes. People continue to travel between these countries and territories for a variety of reasons. The best way to reduce risk of disease is to follow public health travel advice.

…Based on the current assessment of Zika virus circulating in almost 60 countries globally and 39 countries in the Americas, there is no public health justification for postponing or cancelling the games. WHO will continue to monitor the situation and update our advice as necessary….

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Zika situation report- 26 May 2016
Read the full situation report
Summary
:: As of 25 May 2016, 60 countries and territories report continuing mosquito-borne transmission of which:
…46 countries are experiencing a first outbreak of Zika virus since 2015, with no previous evidence of circulation, and with ongoing transmission by mosquitos.
…14 countries reported evidence of Zika virus transmission between 2007 and 2014, with ongoing transmission.

:: In addition, four countries or territories have reported evidence of Zika virus transmission between 2007 and 2014, without ongoing transmission: Cook Islands, French Polynesia, ISLA DE PASCUA – Chile and YAP (Federated States of Micronesia).

:: Ten countries have reported evidence of person-to-person transmission of Zika virus, probably via a sexual route.

:: In the week to 25 May 2016, no new country reported on mosquito-borne or person-to-person Zika virus transmission.

:: As of 25 May 2016, microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection or suggestive of congenital infection, have been reported by ten countries or territories. Infection of the mothers took place in eight different countries, for one additional case the precise country in Latin America is not determined. Spain is the latest country to report a case of microcephaly associated with Zika virus in a returning pregnant traveller.

:: Two cases of microcephaly and other neurological abnormalities are currently under verification in the Bolivarian Republic of Venezuela and Costa Rica.

:: In the context of Zika virus circulation, 13 countries and territories worldwide have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases. One GBS case associated with Zika virus infection in a returning traveller to the Netherlands has been reported. A case of GBS from Guadeloupe is under verification.

:: Sequencing of the virus that causes the Zika outbreak in Cabo Verde showed that the virus is of the Asian lineage and the same as the one that circulates in Brazil. The precise implication of this finding is yet to be determined.

:: Based on research to date, there is scientific consensus that Zika virus is a cause of microcephaly and GBS.

:: The global Strategic Response Framework launched by WHO in February 2016 encompasses surveillance, response activities and research. An interim report has been published on some of the key activities being undertaken jointly by WHO and international, regional and national partners in response to this public health emergency. A revised strategy for the period July 2016 to December 2017 is currently being developed with partners and will be published in mid-June.

:: WHO has developed new advice and information on diverse topics in the context of Zika virus. WHO’s latest information materials, news and resources to support corporate and programmatic risk communication, and community engagement are available online.

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Zika Open [to 28 May 2016]
[Bulletin of the World Health Organization]
:: All papers available here
RESEARCH IN EMERGENCIES
Accuracy of ultrasound scanning relative to reference tests for prenatal diagnosis of microcephaly in the context of Zika virus infection: a systematic review of diagnostic test accuracy
– Ezinne C Chibueze, Alex JQ Parsons, Katharina da Silva Lopes, Takemoto Yo, Toshiyuki Swa, Chie Nagata, Nobuyuki Horita, Naho Morisaki, Olukunmi O Balogun, Amarjargal Dagvadorj, Erika Ota, Rintaro Mori, Olufemi T Oladapo
Posted: 25 May 2016
http://dx.doi.org/10.2471/BLT.16.178301

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CDC/ACIP [to 28 May 2016]
http://www.cdc.gov/media/index.html
THURSDAY, MAY 26, 2016
CDC adds Argentina to interim travel guidance related to Zika virus
Today, CDC posted a Zika virus travel notice for Argentina. Local transmission of Zika virus infection (Zika) has been reported in Tucumán Province, Argentina.

THURSDAY, MAY 26, 2016
CDC Director Addresses National Press Club
CDC Director Tom Frieden, M.D., M.P.H., discussed the latest news and developments in the Zika virus outbreak today at the National Press Club.

MMWR May 27, 2016 / Vol. 65 / No. 20
:: Possible Zika Virus Infection Among Pregnant Women — United States and Territories, May 2016
:: Notice to Readers: Changes in the Presentation of Zika Virus Disease, Non-Congenital Infection, and Addition of Zika Virus Congenital Infection to Notifiable Diseases and Mortality Table I

EBOLA/EVD [to 28 May 2016]

EBOLA/EVD [to 28 May 2016]
“Threat to international peace and security” (UN Security Council)

Editor’s Note:
It appears that weekly Ebola Situation Reports have resumed. We will present the first page summary and risk assessment here.

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EBOLA VIRUS DISEASE – SITUATION REPORT 26 MAY 2016
Summary
:: The Public Health Emergency of International Concern (PHEIC) related to Ebola in West Africa was lifted on 29 March 2016. A total of 28 616 confirmed, probable and suspected cases have been reported in Guinea, Liberia and Sierra Leone, with 11 310 deaths.

:: In the latest cluster, seven confirmed and three probable cases of Ebola virus disease (EVD) were reported between 17 March and 6 April from the prefectures of N’Zerekore (nine cases) and Macenta (one case) in south-eastern Guinea. In addition, three confirmed cases were reported between 1 and 5 April from Monrovia in Liberia; these cases, the wife and two children of the Macenta case, travelled from Macenta to Monrovia.

:: The index case of this cluster (a 37-year-old female from Koropara sub-prefecture in N’Zerekore) had symptom onset on or around 15 February and died on 27 February without a confirmed diagnosis. The source of her infection is likely to have been due to exposure to infected body fluid from an Ebola survivor.

:: In Guinea, the last case tested negative for Ebola virus for the second time on 19 April. In Liberia, the last case tested negative for the second time on 28 April.

:: The 42-day (two incubation periods) countdown must elapse before the outbreak can be declared over in Guinea and Liberia. This is due to end on 31 May in Guinea and on 9 June in Liberia.

:: Having contained the last Ebola virus outbreak in March 2016, Sierra Leone has maintained heightened surveillance with testing of all reported deaths and prompt investigation and testing of all suspected cases. The testing policy will be reviewed on the 30 June.

Risk assessment:
For the outbreak to be declared over, a 42-day countdown must pass after the last case tested negative for Ebola virus for the second time. This countdown is due to elapse on 31 May in Guinea and on 9 June in Liberia. Until then, active surveillance in Guinea and Liberia will continue. The performance indicators suggest that Guinea, Liberia and Sierra Leone still have variable capacity to prevent, detect (epidemiological and laboratory surveillance) and respond to new outbreaks (Table 1). The risk of additional outbreaks originating from exposure to infected survivor body fluids remains and requires sustained.

POLIO [to 28 May 2016]

POLIO [to 28 May 2016]
Public Health Emergency of International Concern (PHEIC)

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Statement on the 9th IHR Emergency Committee meeting regarding the international spread of poliovirus
WHO statement
20 May 2016
[Excerpts; Editor’s text bolding]
The 9th meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened via teleconference by the Director¬ General on 12th May 2016. As with the seventh and eighth meetings, the Emergency Committee reviewed the data on wild poliovirus as well as circulating vaccine-¬derived polioviruses (cVDPV). The latter is important as cVDPVs reflect serious gaps in immunity to poliovirus due to weaknesses in routine immunization coverage in otherwise polio-¬free countries. In addition, any further spread of type 2 cVDPVs is a public health emergency following the globally synchronized withdrawal of type 2 OPV completed 1st May 2016…

…Conclusion
The Committee unanimously agreed that the international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC), and recommended the extension of the Temporary Recommendations for a further three months. The Committee considered the following factors in reaching this conclusion:
:: The continued international spread of wild poliovirus during 2015 and 2016 involving Pakistan and Afghanistan.
:: The current special and extraordinary context of being closer to polio eradication than ever before in history.
:: The risk and consequent costs of failure to eradicate globally one of the world’s most serious vaccine preventable diseases. Even though globally transmission has fallen and therefore the likelihood of international spread has also fallen, the consequences and impact of international spread should it occur become more serious, and this possibility is greater if global complacency sets in.
:: The continued necessity of a coordinated international response to improve immunization and surveillance for wild poliovirus, stop its international spread and reduce the risk of new spread.
:: The serious consequences of further international spread for the increasing number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies. Populations in these fragile states are vulnerable to outbreaks of polio. Outbreaks in fragile states are exceedingly difficult to control and threaten the completion of global polio eradication during its end stage.
:: The importance of a regional approach and strong cross¬border cooperation, as much international spread of polio occurs over land borders, while recognizing that the risk of distant international spread remains from zones with active poliovirus transmission.
:: Additionally with respect to cVDPV:
…cVDPVs also pose a risk for international spread, and if there is no urgent response with appropriate measures, particularly threaten vulnerable populations as noted above;
…the emergence and circulation of VDPVs in four WHO regions demonstrates significant gaps in population immunity at a critical time in the polio endgame;
…there is a particular urgency of preventing type 2 cVDPVs following the globally synchronized withdrawal of type 2 component of the oral poliovirus vaccine in April 2016;
…the ongoing challenges of improving routine immunization in areas affected by insecurity and other emergencies, including Ebola; and
…the global shortage of IPV poses fresh challenges…

…The Committee recognised that the communication message explaining why a PHEIC is being maintained should be carefully prepared. On the one hand the world is applauding the successful switch from tOPV to bOPV and the reduction of new cases of wild poliovirus, while on the other hand a PHEIC is being maintained to ensure that all possible measures are brought to bear to support these final phases of polio eradication. This apparent paradox needs careful explanation.

Based on the advice concerning wild poliovirus and cVDPV, and the reports made by Afghanistan, Pakistan, Nigeria, Lao People’s Democratic Republic and Guinea, the Director¬ General accepted the Committee’s assessment and on 20 May 2016 determined that the events relating to poliovirus continue to constitute a PHEIC, with respect to wild poliovirus and cVDPV. The Director ¬General endorsed the Committee’s recommendations for ‘States currently exporting wild polioviruses or cVDPV’, for ‘States infected with wild poliovirus or cVDPV but not currently exporting’ and for ‘States no longer infected by wild poliovirus, but which remain vulnerable to international spread, and states that are vulnerable to the emergence and circulation of VDPV’ and extended the Temporary Recommendations as revised by the Committee under the IHR to reduce the international spread of poliovirus, effective 20 May 2016.

The Director¬ General thanked the Committee Members and Advisors for their advice and requested their reassessment of this situation within the next three months

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Polio this week as of 25 May 2016
:: This week, health ministers from around the world are convening in Geneva for the annual World Health Assembly (WHA). Among other public health topics, delegates will review and discuss the latest global polio epidemiology. The GPEI has set up a WHA-specific polio website, with the key documents that are guiding discussions.

:: At the Women Deliver conference in Copenhagen focusing on solutions to the health, economic and social challenges facing girls and women, the Government of Canada announced a Can$19.9 million contribution to Nigeria’s polio eradication efforts.

:: From 17 April to 1 May, 155 countries and territories participated in the historic trivalent to bivalent oral polio vaccine switch, withdrawing the type two component of the vaccine to protect future generations against circulating vaccine-derived polioviruses. Track the switch live.

The Trivalent to Bivalent Oral Polio Vaccine Switch
:: Between 17 April and 1 May, the type 2 component of the oral polio vaccine (OPV) is being removed from use through aglobally synchronized switch from the trivalent to bivalent oral polio vaccine. This is the first stage of objective 2 of the Polio Eradication and Endgame Strategic Plan 2013-2018 to withdraw OPV in a phased manner starting with the type 2 component following the eradication of wild poliovirus type 2 in September 2015.

:: Follow a live update of which countries have undergone the switch. Learn more about why the switch is such an important part of ensuring a polio-free world through this series of videos.

:: The following indicators are being carefully tracked to ensure the switch goes smoothly. As of 24 May:
…155 of 155 (100%) countries and territories have stopped using the trivalent oral polio vaccine.
…Independent monitoring to ensure the switch goes smoothly has begun in 152 countries (100%).
…The National Validation Committee has received switch monitoring data in 145 countries (95%).
…The WHO Regional Offices has received the National Validation Report from 147 countries (95%).

Selected Country Levels Updates [excerpted]
Pakistan
:: One new case of wild poliovirus type 1 (WPV1) was reported in the past week, from Bannu district in Khyber Pakhtunkhwa (KP) province with onset of paralysis on 26 April. It is the most recent case in the country, and brings the total number of WPV1 cases for 2016 to 11, compared to 23 at this date in 2015.
:: Four new WPV1 environmental positive samples were reported in the past week: two collected from Sindh province in the districts of Khi Gulshan-Iqbal and Jacobabad on 15 and 10 March respectively, one in the Rawalpindi district of Punjab on 14 April, and the most recent in Peshawar district of Khyber Pakhtunkhwa on 22 April. Although four positives were reported this week, two duplicates were removed, thus the total went from 17 to 19 environmental positives.
:: Efforts continue to further strengthen surveillance activities in all provinces of the country

Yellow Fever [to 28 May 2016]

Yellow Fever [to 28 May 2016]
http://www.who.int/emergencies/yellow-fever/en/

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Yellow Fever – Situation Report – 26 May 2016
Full Report:
http://www.who.int/emergencies/yellow-fever/situation-reports/26-may-2016/en/
Summary:
Angola: 2536 suspected cases
As of 25 May 2016, Angola has reported 2536 suspected cases of yellow fever with 301 deaths. Among those cases, 747 have been laboratory confirmed. Despite vaccination campaigns in Luanda, Huambo and Benguela provinces, circulation of the virus persists in some districts. Vaccination campaigns started on 16 May in Cuanza Sul, Huila and Uige provinces. Lunda Norte has reported, for the first time since the beginning of the outbreak, 5 autochthonous laboratory confirmed cases in 2 districts.
Three countries have reported confirmed yellow fever cases imported from Angola: Democratic Republic of The Congo (DRC) (41 cases), Kenya (2 cases) and People’s Republic of China (11 cases). This highlights the risk of international spread through nonimmunised travellers.

Democratic Republic of The Congo: 48 laboratory confirmed cases
On 22 March 2016, the Ministry of Health of DRC confirmed cases of yellow fever in connection with Angola. The government officially declared the yellow fever outbreak on 23 April. As of 25 May, DRC has reported three probable cases and 48 laboratory confirmed cases: 41 of those are imported from Angola, reported in Kongo Central, Kinshasa and Kwango (formerly Bandundu) provinces, two are autochthonous cases in Ndjili, Kinshasa and in Matadi, Kongo Central provinces. The possibility of locally acquired infection is under investigation for at least three non-classified cases in both Kongo Central (Muanda district) and Kwango provinces.

Uganda: 60 suspect cases
In Uganda, the Ministry of Health notified yellow fever cases in Masaka district on 9 April 2016. As of 25 May, 60 suspected cases, of which seven are laboratory confirmed, have been reported from three districts: Masaka, Rukungiri and Kalangala. According to sequencing results, those clusters are not epidemiologically linked to Angola.

The risk of spread
The virus in Angola and DRC is largely concentrated in main cities. The risk of spread and local transmission to other provinces in Angola, DRC and Uganda remains a serious concern. There is also a high risk of potential spread to bordering countries especially those previously classified as low-risk for yellow fever disease (i.e. Namibia, Zambia) and where the population, travellers and foreign workers are not vaccinated against yellow fever.
Confirmed yellow fever cases exported from Angola has been documented in Kenya (two cases) and People’s Republic of China (11 cases). This highlights the risk of international spread through non-immunised travellers.

Risk assessment
The outbreak in Angola remains of high concern due to:
:: Persistent local transmission in Luanda despite the fact that more than seven million people have been vaccinated.
:: Local transmission has been reported in seven highly populated provinces including Luanda. Luanda Norte is the province that most recently reported yellow fever transmission.
:: The continued extension of the outbreak to new provinces and new districts.
:: High risk of spread to neighbouring countries. As the borders are porous with substantial crossborder social and economic activities, further transmission cannot be excluded. Viraemic travelling patients pose a risk for the establishment of local transmission especially in countries where adequate vectors and susceptible human populations are present.
:: Inadequate surveillance system capable of identifying new foci or areas of cases emerging.
:: High index of suspicion of ongoing transmission in areas hard to reach like Cabinda.

WHO & Regional Offices [to 28 May 2016]

WHO & Regional Offices [to 28 May 2016]

Weekly Epidemiological Record (WER) 27 May 2016, vol. 91, 21 (pp. 265–284)
Contents
265 Epidemic focus: Lassa Fever
266 Meeting of the Strategic Advisory Group of Experts on immunization, April 2016 – conclusions and recommendation

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Disease Outbreak News (DONs)
:: Lassa Fever – Nigeria 27 May 2016

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:: WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: WHO AFRO launches new project to help African countries control and eliminate neglected tropical diseases – 23 May 2016

WHO Region of the Americas PAHO
:: PAHO honors Canadian and U.S. academics, Brazilian NGO with regional 2016 World No Tobacco Day awards (05/26/2016)
:: PAHO and Lila Downs launch PSAs to promote prenatal care and save lives (05/25/2016)

WHO South-East Asia Region SEARO
:: Floods in Sri Lanka WHO Sit Rep 4 26 May 2016 pdf, 852kb

WHO European Region EURO
:: Day 2 of the World Health Assembly: Highlights for the European Region 26-05-2016
:: New tool: AirQ+ quantifies health impacts of air pollution 25-05-2016
:: Opening day of World Health Assembly: 2030 Agenda for Sustainable Development in focus 24-05-2016
:: Results of joint FAO/WHO Meeting on Pesticide Residues (JMPR) 24-05-2016

WHO Eastern Mediterranean Region EMRO
:: Kuwait supports kidney patients in Syria 24 May 2016

WHO Western Pacific Region
No new content identified.