Milestones :: Perspectives
 
Region of the Americas eliminates maternal and neonatal tetanus
Joint press release
WASHINGTON/NEW YORK, 21 September 2017 – The Region of the Americas has eliminated maternal and neonatal tetanus (MNT), a disease that used to be responsible for the deaths of more than 10,000 newborns every year in the Americas.

The elimination of the disease was declared this year in Haiti, which made it possible to reach the regional goal. MNT is the sixth vaccine-preventable disease to be eliminated from the Americas, following the regional eradication of smallpox in 1971, poliomyelitis in 1994, rubella and congenital rubella syndrome in 2015, and measles in 2016.

“The elimination of maternal and neonatal tetanus is proof again that vaccines work to save the lives of countless mothers and babies,” said Carissa F. Etienne, director of the Pan American Health Organization/World Health Organization (PAHO/WHO). “Let us continue to protect the people of our Region by investing in strong national immunization programs that are capable of vaccinating all individuals and quickly identifying vaccine-preventable diseases.”

Unlike other vaccine-preventable diseases, MNT is considered eliminated when there is an annual rate of less than one case of neonatal tetanus per 1,000 live births at the district level. Tetanus cannot be fully eradicated because the bacterium that causes the disease, Clostridium tetani, exists throughout the environment in soil and the feces of many different animals.

Before widespread modern vaccination against MNT began in the 1970s, neonatal tetanus was responsible for the deaths of more than 10,000 newborns every year in the Americas – a number considered low by experts due to severe underreporting of cases. According to data from WHO, neonatal tetanus killed about 34,000 newborn children in 2015, a 96% reduction from 1988, when an estimated 787,000 newborn babies died of tetanus within their first month of life…

Recent progress in global elimination has led to 43 countries, including Haiti, eliminating MNT between 2000 and June 2017. There are 16 countries worldwide that have yet to eliminate the disease…

Most countries of the Region were able to eliminate MNT by the early 2000s. Starting in 2003, special efforts were made in Haiti to achieve MNT elimination. The country vaccinated all women of reproductive age against tetanus, regardless of whether they were previously vaccinated. Pregnant women were also vaccinated against the disease as part of the routine schedule. Furthermore, neonatal tetanus surveillance was incorporated with surveillance for other vaccine-preventable diseases like measles, rubella, polio, diphtheria, and pertussis. Additionally, the country focused on increasing the number of clean births and deliveries and practicing proper umbilical care.

Following field visits in Haiti in June 2016, experts determined that MNT elimination could be possible in the country. To confirm, a survey was carried out in the South Department, which was considered to have the highest risk of MNT, to determine how many neonatal deaths were due to tetanus in a one-year period. As no neonatal death due to tetanus was found during the survey, MNT was considered eliminated…

PAHO is encouraging all countries in the Region to strengthen their efforts to maintain coverage of maternal immunization against tetanus at the recommended 95%, as several have fallen short of this goal during recent years.

“Because tetanus can never be eradicated, a single case of newborn tetanus in the Americas could still happen,” said Cuauhtemoc Ruiz, head of PAHO’s Comprehensive Family Immunization Program. “In this case, countries should carry out a thorough evaluation to determine how the case could have been averted in order to prevent new cases.”

Key partners involved in in the effort to eliminate MNT at the Regional level include the ministries of health of PAHO/WHO’s Member States, the CDC, and the Brazilian government. In Haiti, UNICEF collaborated with the Government of Canada, UNFPA, WHO, UNICEF National Committees, and the private sector for MNT elimination efforts.
 
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The world is running out of antibiotics, WHO report confirms
WHO News release
Report: Antibacterial agents in clinical development – an analysis of the antibacterial clinical development pipeline, including tuberculosis
Report: Prioritization of pathogens to guide discovery, research and development of new antibiotics for drug-resistant bacterial infections, including tuberculosis
 
20 September 2017 | Geneva – A new report launched today by WHO shows a serious lack of new antibiotics under development to combat the growing threat of antimicrobial resistance.
Most of the drugs currently in the clinical pipeline are modifications of existing classes of antibiotics and are only short-term solutions. The report found very few potential treatment options for those antibiotic-resistant infections identified by WHO as posing the greatest threat to health, including drug-resistant tuberculosis which kills around 250 000 people each year.

“Antimicrobial resistance is a global health emergency that will seriously jeopardize progress in modern medicine,” says Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “There is an urgent need for more investment in research and development for antibiotic-resistant infections including TB, otherwise we will be forced back to a time when people feared common infections and risked their lives from minor surgery.”

In addition to multidrug-resistant tuberculosis, WHO has identified 12 classes of priority pathogens – some of them causing common infections such as pneumonia or urinary tract infections – that are increasingly resistant to existing antibiotics and urgently in need of new treatments.

The report identifies 51 new antibiotics and biologicals in clinical development to treat priority antibiotic-resistant pathogens, as well as tuberculosis and the sometimes deadly diarrhoeal infection Clostridium difficile.

Among all these candidate medicines, however, only 8 are classed by WHO as innovative treatments that will add value to the current antibiotic treatment arsenal.

There is a serious lack of treatment options for multidrug- and extensively drug-resistant M. tuberculosis and gram-negative pathogens, including Acinetobacter and Enterobacteriaceae (such as Klebsiella and E.coli) which can cause severe and often deadly infections that pose a particular threat in hospitals and nursing homes.

There are also very few oral antibiotics in the pipeline, yet these are essential formulations for treating infections outside hospitals or in resource-limited settings.

“Pharmaceutical companies and researchers must urgently focus on new antibiotics against certain types of extremely serious infections that can kill patients in a matter of days because we have no line of defence,” says Dr Suzanne Hill, Director of the Department of Essential Medicines at WHO.

To counter this threat, WHO and the Drugs for Neglected Diseases Initiative (DNDi) set up the Global Antibiotic Research and Development Partnership (known as GARDP). On 4 September 2017, Germany, Luxembourg, the Netherlands, South Africa, Switzerland and the United Kingdom of Great Britain and Northern Ireland and the Wellcome Trust pledged more than €56 million for this work.

“Research for tuberculosis is seriously underfunded, with only two new antibiotics for treatment of drug-resistant tuberculosis having reached the market in over 70 years,” says Dr Mario Raviglione, Director of the WHO Global Tuberculosis Programme. “If we are to end tuberculosis, more than US$ 800 million per year is urgently needed to fund research for new antituberculosis medicines”.

New treatments alone, however, will not be sufficient to combat the threat of antimicrobial resistance. WHO works with countries and partners to improve infection prevention and control and to foster appropriate use of existing and future antibiotics. WHO is also developing guidance for the responsible use of antibiotics in the human, animal and agricultural sectors.
 
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Cholera
 
Editor’s Note:
   We continue to monitor chorea outbreaks, with a special focus on the widely varying role OCV in playing in responses. Indeed, the Yemen outbreak response and the variable narratives on OCV from WHO have, in our view, become suspect [see second item below].
   Equally puzzling are parallel announcements by Gavi and MSF [further below] regarding the outbreak response in Nigeria: Gavi speaks of almost nothing but the OCV campaign launch, while MSF’s announcement does not mention OCV at all.
 
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Yemen Humanitarian Bulletin Issue 27 | 20 September 2017
HIGHLIGHTS
… Nearly 700,000 suspected cholera cases and over 2,000 associated deaths have been reported since 27 April…
 
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WHO urges Yemen to accept vaccines as cholera crisis deepens
18 September 2017 – 17H40
GENEVA (AFP) – The World Health Organization on Monday urged Yemen to approve cholera vaccinations it has offered to help contain an epidemic that could affect nearly a million people by year’s end.

Yemen, where a multinational conflict has caused a humanitarian crisis, had asked the UN health agency earlier this year for doses of the vaccine, said Dominique Legros, the agency’s cholera specialist.

The WHO sent a million doses in June only to see the Yemeni government change its mind, leading the United Nations to reassign the vaccines to Somalia and Sudan, Legros told reporters in Geneva.

Asked about Yemen’s reversal, Legros said only that discussions with countries about vaccinations could be “complicated”, noting the lack of familiarity with them in affected communities, especially in the case of newer vaccines like the one for cholera.

“We are still in negotiation with the government in Yemen to make sure we can also use (vaccines) to help control” the outbreak, he said.

Last week, the International Committee of the Red Cross (ICRC) said the rampant cholera crisis in Yemen had reached “colossal proportions”, warning that it could affect 850,000 people by the end of the year.

More than 2,000 people have perished from the disease, according to the WHO.

The epidemic has put further strain on a ravaged health system in Yemen, where less than half of healthcare facilities are functioning as the conflict drags on.

Since March 2015, a Saudi-led coalition has been waging a war on behalf of the internationally recognised government against Iran-backed Huthi rebels.

More than 8,000 people have been killed, including at least 1,500 children, and millions displaced in the conflict which has pushed the impoverished country to the brink of famine.

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MSF/Médecins Sans Frontières  [to 23 September 2017]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
Nigeria: MSF Scales Up Activities as Cholera Outbreak Continues to Spread Across Borno State
September 18, 2017
As new cases of cholera emerge in Monguno, Dikwa, and Maiduguri, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) continues to scale up its response in Borno state, including recently opening an additional cholera treatment unit (CTU) near Muna Garage camp.
…MSF is closely coordinating its efforts with the Borno Ministry of Health, the World Health Organisation (WHO) and other humanitarian organizations in the prevention and treatment of cholera, including providing training for their health workers….
 
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Gavi [to 23 September 2017]
http://www.gavi.org/library/news/press-releases/
18 September 2017
Cholera vaccination campaign begins in north-eastern Nigeria
Mass vaccination effort will target over 915,000 people to contain cholera outbreak in Borno state.
Maiduguri, 18 September 2017 – A major vaccination campaign to halt the spread of cholera starts in Nigeria’s Borno state today.

Gavi, the Vaccine Alliance, WHO and partners delivered 915,005 doses of Oral Cholera Vaccine to the country last week.

The Government of Nigeria, supported by WHO and partners, plan to vaccinate everyone over the age of one – more than 915 000 people – over the next few days. The campaign will take place in Muna internally displaced persons (IDPs) camp in Maiduguri as well as Jere, Monguno and Dikwa local government areas (LGAs).

“The Federal Government of Nigeria through the Nigeria Centre for Disease Control (NCDC) and the National Primary Health Care Development Agency (NPHCDA) in collaboration with the WHO, UNICEF and other partners are all supporting the Borno State Ministry of Health in leaving no stone unturned to ensure that the current cholera outbreak in some parts of Borno state is contained shortly,” said NCDC Chief Executive Officer Dr. Chikwe Ihekweazu. “The Government at all levels is working closely with partners to improve the sanitation situation, conducting hygiene promotion and disinfection of the affected areas including Muna, Custom house, Monguno and Farm centre IDPs camp, Dikwa, Konduga, Jere LGAs and Maiduguri Municipal Council.”

Following heavy rainfall and lack of access to safe water, more than 2600 suspected cholera cases have been reported, as of 16 September, in Borno state with more than 40 deaths since the first case was confirmed in mid-August. The majority of cases have been detected in the Muna IDP camp on the outskirts of Borno state’s capital Maiduguri, which houses 20,000 people who have fled the Boko Haram conflict. The number of suspected cholera cases has also increased dramatically in Dikwa and Monguno areas in the past few weeks.

The decision to send cholera vaccines from the global stockpile was taken on 7 September by the International Coordinating Group (ICG) for Vaccine Provision.

“Thousands of people in these camps have already left their homes to flee violence and terror. They now find themselves at risk of cholera,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. ”These lifesaving vaccines will play a vital role in slowing the spread of the disease, buying valuable time to put the right water, sanitation and hygiene infrastructure in place to stop the root causes of this outbreak,” he added.

“WHO and partners are already making a difference by alerting people of the risks of cholera, supporting the early detection of cases, treating cases and taking other steps to end the outbreak,” said Dr Wondi Alemu, WHO Representative in Nigeria. “We are focusing on delivering a single dose to vaccinate as many people as quickly as possible. As we proceed with this vaccination campaign, we hope to contain this outbreak, and support the collective commitment by partners from the health sector and other sectors to help people in Borno state. Then we can move forward with addressing the myriad of other pressing health needs in Borno.”

Gavi, WHO and partners are working with the NCDC and Borno State Ministry of Health to make the vaccine available free-of-cost to affected populations, while supporting ongoing cholera prevention and preparedness.