Vaccines and Global Health: The Week in Review 28 October 2017

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

Substantial decline in global measles deaths, but disease still kills 90,000 per year

Milestones – Perspectives


Substantial decline in global measles deaths, but disease still kills 90,000 per year
Joint Press Release: WHO, UNICEF, Gavi, CDC
GENEVA/NEW YORK /ATLANTA, 26 October 2017 – In 2016, an estimated 90, 000 people died from measles – an 84 per cent drop from more than 550, 000 deaths in 2000 – according to a new report published today by leading health organizations. This marks the first time global measles deaths have fallen below 100, 000 per year.

“Saving an average of 1.3 million lives per year through measles vaccine is an incredible achievement and makes a world free of measles seem possible, even probable, in our lifetime,” says Dr Robert Linkins, of the Measles and Rubella Initiative (MR&I) and Branch Chief of Accelerated Disease Control and Vaccine Preventable Diseases at the Centers for Disease Control and Prevention. M&RI is a partnership formed in 2001 of the American Red Cross, the US Centers for Disease Control and Prevention, the United Nations Foundation, UNICEF, and WHO.

Since 2000, an estimated 5.5 billion doses of measles-containing vaccines have been provided to children through routine immunization services and mass vaccination campaigns, saving an estimated 20.4 million lives.

“We have seen a substantial drop in measles deaths for more than two decades, but now we must strive to reach zero measles cases,” says Dr Jean-Marie Okwo-Bele, Director of WHO’s Department of Immunization, Vaccines and Biologicals. “Measles elimination will only be reached if measles vaccines reach every child, everywhere.”

The world is still far from reaching regional measles elimination goals. Coverage with the first of two required doses of measles vaccine has stalled at approximately 85 per cent since 2009, far short of the 95 per cent coverage needed to stop measles infections, and coverage with the second dose, despite recent increases, was only 64 per cent in 2016.

Far too many children – 20.8 million – are still missing their first measles vaccine dose. More than half of these unvaccinated children live in six countries: Nigeria (3.3 million), India (2.9 million), Pakistan (2.0 million), Indonesia (1.2 million), Ethiopia (0.9 million), and Democratic Republic of the Congo (0.7 million). Since measles is a highly contagious viral disease, large outbreaks continue to occur in these and other countries in Europe and North America, putting children at risk of severe health complications such as pneumonia, diarrhoea, encephalitis, blindness, and death.

Agencies noted that progress in reaching measles elimination could be reversed when polio-funded resources supporting routine immunization services, measles and rubella vaccination campaigns, and surveillance, diminish and disappear following polio eradication. Countries with the greatest number of measles deaths rely most heavily on polio-funded resources and are at highest risk of reversing progress after polio eradication is achieved.

“This remarkable drop in measles deaths is the culmination of years of hard work by health workers, governments and development agencies to vaccinate millions of children in the world’s poorest countries,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, one of the world’s largest supporters of measles immunization programmes. “However we cannot afford to be complacent. Too many children are still missing out on lifesaving vaccines. To reach these children and set ourselves on a realistic road to measles elimination we need to dramatically improve routine immunization backed by strong health systems.”


Weekly Epidemiological Record, 27 October 2017, vol. 92, 43 (pp. 649–660)
:: Progress towards regional measles elimination – worldwide, 2000–2016

The Human Vaccines Project Launches New Initiative To Accelerate Development Of Universally Effective Influenza Vaccines

Milestones :: Perspectives
The Human Vaccines Project Launches New Initiative To Accelerate Development Of Universally Effective Influenza Vaccines
NEW YORK, Oct. 26, 2017 /PRNewswire-USNewswire/ — The Human Vaccines Project, a public-private partnership with a mission to decode the immune system to advance human health, announced today the launch of the Universal Influenza Vaccine Initiative (UIVI), a first-of-its-kind program that will address the underlying scientific barrier impeding the development of broadly protective, universal influenza vaccines: the human immune response.

According to the World Health Organization (WHO), influenza is estimated to kill between 250,000 and 500,000 people around the world every year. As the world becomes more interconnected, the risks for a new pandemic continue to increase, carrying the potential for widespread social, economic and political upheaval. A universal vaccine, once developed, would protect everyone regardless of age, gender and geography against all strains of influenza, making significant strides toward preventing a global catastrophe.

“While great progress has been made in understanding the influenza virus, seasonal vaccines are not consistently effective and people remain highly vulnerable,” said Wayne C. Koff, PhD, President and CEO of the Human Vaccines Project. “The public health disaster of the 1918 pandemic that infected a third of the world’s population and killed over 50 million looms heavy. We are long overdue to solve this very real global health threat.”

Koff adds, “There are many public and private sector resources dedicated to developing new and improved influenza vaccines, but they are all primarily focused on one part of the problem – making the vaccine. What makes the UIVI distinct is that we are focusing on understanding the second part of the puzzle – the human immune response. We have to find out what generates an effective immune response against influenza in all populations in order for a vaccine to be maximally effective.”

The Project’s influenza vaccine initiative, led by Dr. James Crowe Jr., Director of the Vanderbilt Vaccine Center, and Dr. Clarence B. Creech, Director of the Vanderbilt Vaccine Research Program at the Vanderbilt University Medical Center in Nashville, Tenn., will launch a series of influenza vaccine clinical trials in globally diverse populations beginning early in 2018.

Researchers based at the Project’s scientific hubs at the University of California San Diego, The Scripps Research Institute, the La Jolla Institute for Allergy and Immunology, and the J. Craig Venter Institute, and partners at the University of British Columbia and the Lawrence Livermore National Laboratory, will conduct a broad spectrum analysis of blood and tissue samples from vaccinated and infected individuals, coupled with artificial intelligence-driven computer simulation models, to decipher the elements of protection against influenza and determine why some people are protected while others are not…


Mortality and Morbidity Weekly Bulletin (MMWB) – Cox’s Bazar, Bangladesh   Volume No 2: 22 October 2017
5.1 Cholera vaccination campaign in Cox’s Bazar and Bandarban
Since August 2017, an influx of approximately 600,000 from Myanmar arrived in Bangladesh. Overcrowding, bad sanitation and malnutrition were prevalent and outbreaks of cholera resulting in thousands of cases anticipated. Considering lack of safe drinking water, proper sanitation facilities and poor personal hygiene practices, the UMN camps of two sub-districts, Teknaf and Ukhia, were at high risk of spreading cholera as experience from similar situations in other countries has shown. Moreover, it has been reported that a huge number of people are suffering from acute watery diarrhoea.

Based on field assessments conducted by WHO in the newly established settlements and makeshift camps, the water and sanitation conductions are dire. Sanitation facilities range between 1 latrine per 1,000 to 5,000 people, open defecation is a widespread practice. Coupled with rainfall these pose serious public health threats…

On 10 October 2017, the Government of Bangladesh launched an oral cholera vaccination (OCV) campaign with the support of WHO for 10 days, targeting over 650,000 people in 11 camps/settlements in Cox’s Bazar district, Chittagong division. It was the first OCV campaign to be conducted in the country, and comes at a critical time after UMNs influx to the country since August 2017.

Because of the large numbers of UMNs living in the camps and within the host community and the limited supply of OCV, the vaccination campaign in Cox’s Bazar Bangladesh was limited to UMN camps at full capacity or overcrowded and to all host community areas. The large influx of UMNs increased uncertainty about the size of the target population, data from the most recent measles vaccination campaign (2017) were used to estimate the population aged >1-year-old.

The vaccination campaign was preceded by extensive social mobilization efforts to inform the community of the benefits, availability and necessity of the vaccine. The main message included that vaccination is a preventive measure against cholera that supplements, but does not replace, other traditional cholera control measures such as improving access to safe water and sanitation and hygiene measures/interventions.

The vaccination strategy included a combination of fixed sites and mobile teams for door-to-door vaccine delivery. The vaccine cold chain was maintained, and vaccines were transported using a sufficient number of vaccine carriers and ice packs for a door-to-door strategy.     Experience from WHO’s technical staff supported the implementation of this campaign during the public health emergency.

As of October 18, 2017, a total of 700,487 persons were reported to have been vaccinated of them; 691,574 representing 105% % (691,574/658,372) of the target population (Table 2). An additional 8,913 (not included in the original micro-plan) were vaccination in 2 sites; Anjumanpara, and Sabrang Entry Point…


Public Health Emergency of International Concern (PHEIC)
Polio this week as of 25 October 2017 [GPEI]
:: On 24 October, millions of people around the globe engaged in actions for World Polio Day. Highlights included the 5th annual World Polio Day event, bringing together experts and celebrities to share progress on the road to polio eradication, hosted by Rotary and the Bill & Melinda Gates Foundation in Seattle, Washington, USA; and a show of support from individuals, national governments, and media outlets around the world.

:: Read World Polio Day coverage about the unsung heroes of polio eradication and how we are ending polio. From the field, read Polio and Me: A Syrian Doctor’s Story, how one man became a doctor to end polio and protect children from the disease that crippled him as a young boy.
In a remarkable endorsement, German Chancellor Angela Merkel used her weekly podcast to draw attention to the World Polio Day (celebrated in Germany on 28 October) and the considerable progress in polio eradication.

:: Summary of newly-reported viruses this week:
Afghanistan: Two new wild poliovirus 1 (WPV1) positive environmental samples reported, one from Nangarhar and one from Kandahar provinces.
Pakistan: One new wild poliovirus 1 (WPV1) positive environmental sample reported, in Sindh province.
…Additionally, an advance notification was received this week of a new WPV1 case in Afghanistan from Shahwalikot district in Kandahar province.  The case will be officially reflected in next week’s global data reporting.


Situation reports on the polio outbreak in Syria
Situation update 24 October 2017
Key highlights
:: No new cases of cVDPV2 were reported this week. The total number of cVDPV2 cases remains 52. All confirmed cases to date have had onset of paralysis before 25 August 2017
:: Two immunization rounds have now been completed in both Deir Ez-Zor and Raqqa governorates bringing the first phase of the outbreak response to a close. Post Campaign Monitoring results for the second Raqqa round are still being compiled into a final report. However, initial data reports 84% of children were reported as vaccinated through market surveys
:: IPV campaign activities aiming to reach children aged between 2-23 months in 2 districts of Raqqa governorate (Raqqa and Thawra) have now concluded. Work is on ongoing to start this activity in Tell Abyad district as quickly as possible
:: A review of the ongoing risks of continued polio transmission in Syria has been conducted and critical contingency planning is in development for any potential breakthrough cases in known outbreak zones or spread of virus to new areas of the country
:: On World Polio Day (October 24) the polio programme thanks the dedicated vaccinators who work tirelessly to reach every child, the parents who demand the vaccine for their children and the donors who commit the funds necessary to finance eradication efforts


Bill Gates: Polio will be eradicated this year, the endgame is near
CNBC | 24 October 2017
:: In 1988 — when wild poliovirus was in more than 125 countries, paralyzing 350,000 people every year — the World Health Assembly launched the Global Polio Eradication Initiative to help eliminate the disease through a mass immunization campaign.
:: In 2007 the Bill and Melinda Gates Foundation joined other major health organizations already committed to the GPEI, contributing nearly $3 billion toward eradicating polio by 2020.
:: Today 12 cases of poliovirus exist in two countries, and the Gates Foundation is optimistic the last case of polio could be seen this year.
Tuesday marks Rotary International’s fifth annual World Polio Day, co-hosted by the Bill and Melinda Gates Foundation, and there is much cause for celebration: It is very possible that 2017 may see the end of the wild poliovirus — nearly two years earlier than Bill Gates predicted.    “What we’re looking at now is sort of the endgame of polio eradication,” says Dr. Jay Wenger, who leads the Gates Foundation’s polio eradication efforts. “We are closer than ever, and we’re optimistic that we can see the end of wild poliovirus disease by as early as this year,” he said…


World Polio Day: Gavi’s role in polio eradication
24 October marks World Polio Day, when the global community celebrates the immense progress and considers the work ahead to ensure no child suffers from polio again.
Gavi works with the Global Polio Eradication Initiative (GPEI) to support one of the fastest roll-outs of a new vaccine in the history of vaccination.
In partnership with GPEI, we support the introduction of at least one dose of inactivated polio vaccine (IPV) in all Gavi-supported countries…


WHO Grade 3 Emergencies  [to 28 October 2017]
The Syrian Arab Republic
:: WHO reinforces health care services for thousands of people in newly accessible areas of Ar-Raqqa governorate, Syria
24 October 2017, Damascus, Syria — As areas in Ar-Raqqa governorate become accessible, WHO continues to strengthen health care services for thousands of people in the area through the delivery of 5 tons of medicines and medical supplies with support from the United Kingdom Department for International Development, the European Union and Norway24 October 2017, Damascus, Syria — As areas in Ar-Raqqa governorate become accessible, the World Health Organization (WHO) continues to strengthen health care services for thousands of people in the area through the delivery of medicines and medical supplies to Al-Tabqa National Hospital, northwest of Ar-Raqqa city…
:: Situation reports on the polio outbreak in Syria
Situation update 24 October 2017
[See Polio above]

:: Daily epidemiology bulletin, 25 October 2017
872,415 – Suspected cases
2,180 – Associated deaths
0.25%  – Case Fatality Rate
96%  – Governorates affected   ( 22 / 23 governorates )
92%  – Districts affected   ( 305 / 333 districts )

WHO Grade 2 Emergencies  [to 28 October 2017]
::  Situation Report: 8 – Emergency type: Bangladesh/Myanmar: Rakhine Conflict 2017
Date: 20 October 2017
:: As of 17 October 2017, cumulative number of new arrivals in all sites of Ukiah, Teknaf, Cox’s Bazar and Ramu: 589,000, including 46,000 in host communities, 313,000 in Kutupalong Balukhali and 161 000 in new spontaneous sites.
:: By end of 8th day of the Oral Cholera Vaccine campaign, 700,487 people were vaccinated, reaching 106% of the total estimated target population. No immediate adverse events from immunization were reported.
:: First Morbidity Mortality Weekly Bulletin built on the Early Warning and Response System (daily data received from MoHFW and various service providers operating in settlements in Myanmar and CXB) provides data on the prevailing epidemiological situation for the period 25 August to 10 October.
:: MSF has issued an urgent appeal for humanitarian assistance, even as it scales up its response by hiring additional 800 staff, increasing five-fold their strength staff on the ground in Cox’s Bazar to 1,000.
:: WASH situation in temporary settlements in Shah Porir Dwip and Kerontuli/Chakmarkul show improvement though accessing safe water continues to be a challenge.
:: UN Humanitarian Advisor Mr Henry Glorieux and UN Humanitarian Specialist Mr Kazi from UNRC office visited the new and existing settlements in CXB for the OCV campaign and other public health efforts.

UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
:: Humanitarians are reaching thousands of recently displaced people [EN/AR/KU]  Report
(Baghdad, 21 October 2017) – Humanitarian partners are reaching thousands of people with emergency assistance on a daily basis.
During the past week, well over 100,000 civilians fled from Kirkuk, Makhmur and Tuz Khurmatu districts. Smaller numbers fled Zummar. The situation remains very fluid, with people sometimes fleeing for less than 24 hours before returning home.
Partners are rushing to provide assistance to highly vulnerable families. More than 15,000 emergency food rations were distributed and mobile medical teams are visiting camps and villages to provide health care. Emergency support including water, blankets, hygiene items and household kits is being distributed in areas hosting displaced people…

Syrian Arab Republic
:: 26 Oct 2017  First rehabilitated health centre in eastern Aleppo city, Syria, opens with WHO support
…The centre re-opened in September 2017 with 5 specialized clinics for internal medicine, reproductive health and child care, and orthopedic and dermatological care. Services are provided by 34 health workers, including 10 physicians and 12 nurses,” said Dr Hamdi Noufal, director of the Saad Ibn Abi Waqas health centre.
“Since its re-opening, the centre has treated more than 2400 patients,” Dr Noufal added…


UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.

DRC  No new announcements identified
EthiopiaNo new announcements identified
Nigeria  No new announcements identified
Somalia  – No new announcements identified

WHO & Regional Offices [to 28 October 2017]

WHO & Regional Offices [to 28 October 2017]

Latest news
Delivering kits for diabetes and hypertension during humanitarian crises
23 October 2017 – To treat people for noncommunicable diseases during humanitarian crises, WHO has developed and started delivering kits of medicines and equipment for people living with diabetes, hypertension, and related conditions.  [Video]

Director-General rescinds Goodwill Ambassador appointment
22 October 2017 – WHO Director-General Dr Tedros has rescinded the appointment of H.E. President Robert Mugabe as WHO Goodwill Ambassador for Noncommunicable Diseases in Africa.
:: Read WHO Statement

Vaccinating pregnant women against influenza
October 2017 – Immunizing future mothers against influenza is key for preventing complications during gestation, and for protecting future mothers and newborns. In the Region of the Americas, 32 countries and territories vaccinate pregnant women against influenza, a public health problem that for future mothers, newborns, and other high-risk populations can mean severe disease, complications, and hospitalization.

Weekly Epidemiological Record, 27 October 2017, vol. 92, 43 (pp. 649–660)
:: Progress towards regional measles elimination – worldwide, 2000–2016
:: Monthly report on dracunculiasis cases, January-September 2017
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Nationwide house-house polio supplementary immunization campaign starts in Sierra Leone
27 October 2017
:: WHO and ITU to use digital technology to strengthen public health services in Africa  27 October 2017
:: Rumours, Misinformation and Negative Beliefs underpin the Current Marburg Outbreak in Uganda  27 October 2017
:: South Sudan boosts Polio immunization coverage on the World Polio Day to keep the disease at bay  26 October 2017
:: Rwanda conducted a national vaccination campaign on Measles and Rubella integrated in Mother and Child Health Week  25 October 2017
:: Gambia observes World Mental Health day: WHO and partners engage stakeholders to create healthy work places  25 October 2017
Rwanda celebrated the World Mental Health Day 2017  25 October 2017
On 10th October, Rwanda joined other countries all over the World to…
:: United Nations Day: WHO South Sudan offers essential promotive health services in commemoration of UN’s 72nd Anniversary  25 October 2017
:: Kuwait Fund and WHO in $4million multi-year agreement to tackle Neglected Tropical Diseases in Africa  24 October 2017
:: WHO, UNICEF and Rotary International urge to sustain the polio-free status of Ethiopia
24 October 2017
:: Ministry of Health, WHO experts highlight results of life-saving programme for children under five.  23 October 2017
:: Training clinicians to provide lifesaving emergency care for women and newborns
23 October 2017
:: WHO promptly responds to Marburg Outbreak in Eastern Uganda  23 October 2017
:: WHO calls for strengthening of laboratory systems in efforts to fulfill their important role in the fight against infectious and chronic diseases.23 October 2017

WHO Region of the Americas PAHO
:: The Region of the Americas leads in the vaccination of pregnant women against influenza (10/24/2017)

WHO South-East Asia Region SEARO
::  Mortality and Morbidity Weekly Bulletin (MMWB) – Cox’s Bazar, Bangladesh   Volume No 2: 22 October 2017
5.1 Cholera vaccination campaign in Cox’s Bazar and Bandarban
[See Cholera above for detail]

WHO European Region EURO
:: 15th anniversary of polio-free certification in the European Region – but the hard work to prevent future cases is not over 24-10-2017
:: WHO supports polio vaccination campaign for nearly 200 000 Syrian children from Turkey 24-10-2017

WHO Eastern Mediterranean Region EMRO
:: WHO Regional Adviser for Nutrition recognized as food fortification champion  25 October 2017
:: Danger in the rubble: fighting leishmaniasis in Syria  23 October 2017

CDC/ACIP [to 28 October 2017]

CDC/ACIP [to 28 October 2017]
Press Release
Thursday, October 26, 2017
Getting Ahead of the Next Pandemic: Is the World Ready?
…A new article released today in CDC’s Emerging Infectious Diseases (EID) journal details early results of CDC’s global health security work through collaboration with 17 partner countries. Implementing the Global Health Security Agenda in 17 Countries: Contributions by the Centers for Disease Control and Prevention shows how CDC is accelerating progress toward a world more prepared for public health threats. Part of EID’s new Global Health Security Supplement, the article outlines CDC-supported progress during the first two years of GHSA implementation…

MMWR News Synopsis for October 26, 2017
:: Timeliness of Receipt of Early Childhood Vaccinations Among Children of Immigrants — Minnesota, 2016
This study demonstrates vaccination disparities between children with U.S.-born parents and children with immigrant parents, as well as disparities by mother’s country of birth. Additional studies are needed to identify barriers to vaccination faced by groups with lower vaccination coverage and to inform the development of effective strategies to address these barriers. This study used data from the Minnesota Immunization Information Connection (MIIC) and the Office of Vital Records to measure childhood vaccination coverage and examine coverage differences across selected demographic characteristics at ages 2, 6, 18, and 36 months for children born in Minnesota in 2011 and 2012. Coverage levels were higher for children with two U.S.-born parents compared with children having at least one foreign-born parent at all four ages. When children were divided into groups by mother’s country of birth, some groups were vaccinated at higher rates than were children of U.S.-born mothers (Mexico, Central and South America), and others at much lower rates (Somalia, Eastern Europe). Outreach to groups with lower vaccination rates may be needed to improve vaccination coverage in young children.

Increased Risk for Mother-to-Infant Transmission of Hepatitis C Virus Among Medicaid Recipients ― Wisconsin, 2011–2015
Health care providers can protect babies from hepatitis C virus (HCV) infections by testing for, treating, and curing HCV infection among women of childbearing age. Practices for HCV screening of pregnant women and babies born to HCV-infected mothers should be improved to prevent serious but preventable complications among mothers and babies. Increasing injection drug use, suspected to be linked with America’s growing opioid epidemic, has led to rapid increases of new HCV infections among young adults. The rise in new HCV infections among young adults could affect the next generation when the virus is passed from mothers to babies. About 6 percent of babies born to HCV-infected mothers will get the virus. Trends in HCV infection during pregnancy and infant testing were estimated using Wisconsin Medicaid and Public Health Surveillance data. Between 2011 and 2015, among the Wisconsin Medicaid population, the proportion of women who had HCV infection during pregnancy increased 93 percent, from 2.7 to 5.2 per 1,000 births. Of the babies born to women with HCV infection, only 34 percent were tested for HCV per CDC recommendations.

Rapid Field Response to a Cluster of Illnesses and Deaths — Sinoe County, Liberia, April–May, 2017
The rapid detection and control of the meningococcal disease outbreak in Liberia demonstrates how post-Ebola improvements in public health capacities are contributing to global health security. In April 2017, Liberia’s Ministry of Health reported a cluster of illnesses and deaths from an unknown cause. Within 24 hours, a response was initiated to identify cases, monitor at-risk persons, and prevent additional illnesses. During the 2014 Ebola epidemic, it took the country more than 90 days to coordinate a response. This significant decrease in response time reflects capabilities established during and after Ebola with CDC and partner support. Enhanced in-country laboratory capacity contributed to rapid diagnosis, ruling out Ebola in less than 24 hours, while effective case management and supportive treatment increased survival among patients even before the confirmation of meningococcal disease as the cause. CDC-supported efforts toward strengthening global health security led to effective management and control of this outbreak.

Rapid Laboratory Identification of Neisseria meningitidis Serogroup C as the Cause of an Outbreak — Liberia, 2017
Rapid laboratory detection and response allowed a cluster of unexplained illness, initially suspected to be Ebola virus disease, to be identified as serogroup C meningococcal disease. This was an unusual outbreak of serogroup C meningococcal disease in a country that typically does not report meningitis outbreaks and that is not in the African meningitis belt. Prompt and accurate detection of outbreaks allows public health officials to respond quickly and implement appropriate control measures. In April 2017, an unexplained cluster of 31 cases and 13 deaths surrounding a funeral was reported in Liberia. Initially suspected as Ebola virus disease in this previously affected country, rapid laboratory detection and response from CDC identified Neisseria meningitidis serogroup C as the cause of the outbreak. This bacterium causes meningococcal disease, which includes meningitis and bloodstream infections. Laboratory confirmation helped Liberian health authorities administer antibiotic prophylaxis to more than 200 people in order to prevent secondary cases of this deadly disease. This was an unusual presentation of serogroup C meningococcal disease with a high case-fatality rate, high prevalence of gastrointestinal symptoms, and low prevalence of fever. This extremely unusual meningococcal disease outbreak in Liberia, a country not in the African meningitis belt, highlights the importance of rapid laboratory confirmation in an outbreak investigation.

Progress Toward Regional Measles Elimination — Worldwide, 2000–2016
For the first time, there were fewer than 100,000 annual estimated measles deaths in 2016 due to stable measles-containing vaccine (MCV1) coverage, increasing second-dose (MCV2) coverage, and measles vaccination campaigns. Vaccination efforts need to be strengthened in order to reduce these preventable deaths to zero. During 2000–2016, measles vaccination prevented an estimated 20.4 million deaths worldwide. The number of countries providing the second dose of measles-containing vaccine through routine immunization services increased to 85 percent; in 2016, global MCV2 coverage was 64 percent. Also during 2000-2016, annual reported measles cases decreased 87 percent and annual measles deaths decreased 84 percent. Despite advances, the WHO 2015 milestones haven’t been met. Only one WHO region, the Americas, has been declared free of measles. To eliminate measles, countries and their partners need to focus on increasing vaccination coverage through sustained investments in health systems, strengthening surveillance systems, using surveillance data to drive programmatic actions, securing political commitment, raising the visibility of measles elimination goals, and mitigating the threat of decreasing resources once polio eradication is achieved.