Vaccines and Global Health: The Week in Review 24 Feb 2018

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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 pdf version A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_24 Feb 2018

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

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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy

UNICEF: The urgent need to end newborn deaths :: World is failing newborn babies

Milestones :: Perspectives

Every Child Alive: The urgent need to end newborn deaths
February 2018 :: 44 pages
Every year, 2.6 million babies die before turning one month old. One million of them take their first and last breaths on the day they are born. However, millions of these young lives could be saved every year if every mother and every baby had access to affordable, quality health care, good nutrition and clean water. This report addresses the challenges of keeping every child alive, and calls for strong cooperation among governments, businesses, health-care providers, communities and families to give every newborn a fair chance to survive, and to collectively work towards the achievement of universal health coverage, and a world where no newborn dies of a preventable cause.

Excerpts [Editor’s text bolding]
After birth, breastmilk is a baby’s first vaccine – the first and best protection against illness and disease. It is critical that health workers provide adequate nutritional counselling to mothers during pregnancy…
The 10 most critical products for newborn survival
:: Ambu-bags, used to manually resuscitate newborns who fail to breathe after birth
:: Antibiotics to treat mothers and newborns who have infections
:: Blankets and cloth to keep the baby warm and support skin-to-skin contact, including during breastfeeding
:: Chlorhexidine, a broad-spectrum antiseptic used to prevent infection of the umbilical cord, which can lead to sepsis
:: Continuous positive airway pressure (CPAP) machines for premature babies whose underdeveloped lungs make it difficult for them to breathe
:: Oxygen concentrator equipment, used to help very low-birthweight babies breathe
:: Phototherapy machines to reduce jaundice in newborns
:: Micronutrient supplements, especially iron and folic acid to prevent iron deficiency anaemia in pregnant women and reduce the risk of low-birthweight babies and complications at birth
:: Tetanus toxoid vaccine to prevent tetanus infection, which can result from unhygienic birth conditions
:: Thermometers, used to closely monitor the temperature of sick newborns

Press Release
World is failing newborn babies, says UNICEF
NEW YORK, 20 February 2018 – Global deaths of newborn babies remain alarmingly high, particularly among the world’s poorest countries, UNICEF said today in a new report on newborn mortality. Babies born in Japan, Iceland and Singapore have the best chance at survival, while newborns in Pakistan, the Central African Republic and Afghanistan face the worst odds.

“While we have more than halved the number of deaths among children under the age of five in the last quarter century, we have not made similar progress in ending deaths among children less than one month old,” said Henrietta H. Fore, UNICEF’s Executive Director. “Given that the majority of these deaths are preventable, clearly, we are failing the world’s poorest babies.”
Globally, in low-income countries, the average newborn mortality rate is 27 deaths per 1,000 births, the report says. In high-income countries, that rate is 3 deaths per 1,000. Newborns from the riskiest places to give birth are up to 50 times more likely to die than those from the safest places.

The report also notes that 8 of the 10 most dangerous places to be born are in sub-Saharan Africa, where pregnant women are much less likely to receive assistance during delivery due to poverty, conflict and weak institutions. If every country brought its newborn mortality rate down to the high-income average by 2030, 16 million lives could be saved.

Unequal shots at life
Highest newborn mortality rates
1. Pakistan: 1 in 22
2. Central African Republic: 1 in 24
3. Afghanistan: 1 in 25
4. Somalia: 1 in 26
5. Lesotho: 1 in 26
6. Guinea-Bissau: 1 in 26
7. South Sudan: 1 in 26
8. Côte d’Ivoire: 1 in 27
9. Mali: 1 in 28
10. Chad: 1 in 28

Lowest newborn mortality rates
1. Japan: 1 in 1,111
2. Iceland: 1 in 1,000
3. Singapore: 1 in 909
4. Finland: 1 in 833
5. Estonia: 1 in 769
5. Slovenia: 1 in 769
7. Cyprus: 1 in 714
8. Belarus: 1 in 667
8. Luxembourg: 1 in 667
8. Norway: 1 in 667
8. Republic of Korea: 1 in 667

More than 80 per cent of newborn deaths are due to prematurity, complications during birth or infections such as pneumonia and sepsis, the report says. These deaths can be prevented with access to well-trained midwives, along with proven solutions like clean water, disinfectants, breastfeeding within the first hour, skin-to-skin contact and good nutrition. However, a shortage of well-trained health workers and midwives means that thousands don’t receive the life-saving support they need to survive. For example, while in Norway there are 218 doctors, nurses and midwives to serve 10,000 people, that ratio is 1 per 10,000 in Somalia.

This month, UNICEF is launching Every Child ALIVE, a global campaign to demand and deliver solutions on behalf of the world’s newborns. Through the campaign, UNICEF is issuing an urgent appeal to governments, health care providers, donors, the private sector, families and businesses to keep every child alive by:
:: Recruiting, training, retaining and managing sufficient numbers of doctors, nurses and midwives with expertise in maternal and newborn care;
:: Guaranteeing clean, functional health facilities equipped with water, soap and electricity, within the reach of every mother and baby;
:: Making it a priority to provide every mother and baby with the life-saving drugs and equipment needed for a healthy start in life; and
:: Empowering adolescent girls, mothers and families to demand and receive quality care.

“Every year, 2.6 million newborns around the world do not survive their first month of life. One million of them die the day they are born,” said Ms. Fore. “We know we can save the vast majority of these babies with affordable, quality health care solutions for every mother and every newborn. Just a few small steps from all of us can help ensure the first small steps of each of these young lives.”

Urgent need to scale up health services in Cox’s Bazar: WHO

Milestones :: Perspectives

Urgent need to scale up health services in Cox’s Bazar: WHO
Cox’s Bazar, Bangladesh, 20 February 2018: Calling for continued efforts to further scale up health services for nearly 1.3 million people in Cox’s Bazar, Rohingyas and their surrounding host communities, the World Health Organization today said six months after the start of the refugee crisis, the vulnerable populations remain at risk of several diseases and in need of critical services for survival.

“Commendable efforts have been made by the Government of Bangladesh and partner agencies to provide health services; prevent diseases such as cholera; and rapidly control outbreaks of measles and diphtheria. However, the challenges are huge, multiple and evolving. The magnitude of the crisis requires continued efforts and generous contributions by all partners to scale up health services for the vulnerable population,” said Dr Poonam Khetrapal Singh, Regional Director for WHO South-East Asia.

An estimated 688,000 Rohingyas crossed over to Cox’s Bazar from Myanmar beginning 25 August 2017, joining nearly 212,500 others who had arrived in earlier waves, in one of the largest population movement in the shortest span.

While majority of the refugees are living in Kutapalong and Balukhali mega camps and 11 other clusters of small and big settlements, about 79 000 are living with the host population.
The mega camps are currently one of the world’s biggest refugee settlement areas and also one of the world’s most densely populated areas.

The health needs of this population continue to be immense. Women and young mothers need reproductive health services. An estimated 60 000 children are expected to be born in the camps in the next one year. Besides newborns, pregnant and young mothers; children, adults and the elderly need basic health services and that for injuries, trauma and various non-communicable diseases such as heart disease, diabetes, and importantly, psychosocial support.

“Water and sanitation, and shelter continues to be far from optimum, increasing the risk of rapid spread of several communicable and water borne diseases,” the Regional Director said, stressing the need to accelerate efforts to address the key determinants of health on a priority.
The upcoming rainy season and the risk of cyclone and floods, increase the vulnerability of these people to waterborne diseases such as diarrhea and hepatitis, and vector borne diseases such as malaria, dengue and chikungunya.

For keeping a close watch on the situation, WHO established the Early Warning and Response System (EWARS), early as the crisis started, to rapidly detect and respond to disease outbreak to minimize death and disease. Additionally, WHO has been periodically carrying out risk assessments to enable Ministry of Health and partners take measures to detect potential health risks and take timely and appropriate measures.

The EWARS and risk assessments helped Bangladesh’s decision to carry out large scale vaccination campaigns with cholera, measles and rubella, polio and diphtheria vaccines. WHO has been working with the Ministry of Health and partners to plan, roll out and monitor vaccination campaigns to ensure all children are protected.

WHO continues to lead and coordinate efforts of over 100 partners managing more than 270 health facilities – health posts, hospitals, treatment centers and mobile clinics – while also providing medicines and medical equipment, diagnostics, guidelines and trainings and building laboratory capacity.

Despite efforts by government and partners, challenges are many. The affected population has distinct and unique culture and language, a major barrier in impacting health seeking and hygiene behavior.

But the most impending challenge is finding a safe space to relocate the refugees in case of floods and cyclone during the upcoming rainy season, which may further impact their health.
“The Government of Bangladesh has been extremely generous and forthcoming in hosting and providing for the Rohingyas. However, the health sector is grossly under-funded and grappling to meet the needs of the affected population,” Dr Khetrapal Singh said, appealing to international community to contribute generously and commit to support what clearly is set to be a protracted emergency.

Reiterating WHO’s committed to work with the Ministry of Health and Family Welfare and partners to address health issues of the vulnerable population, the Regional Director said concerted efforts by both national and international community is the need of the hour to strengthen and reinforce health services for both the Rohingyas and the their host population in Cox’s Bazar.



Public Health Emergency of International Concern (PHEIC)
Polio this week as of 21 February 2018 [GPEI]
:: New on Ending polio and yellow fever in Nigeria, and why the polio vaccine must be delivered multiple times.
::  Our brand new animation on the two polio vaccines has been released, available in English, French, and Arabic.
:: In response to recent cases, the government of the Democratic Republic of the Congo (DRC) has announced the circulating vaccine-derived poliovirus 2 (cVDPV2) outbreak ongoing in the country as a Public Health Emergency of National Concern. Since the outbreak began, the Ministry of Health, supported by WHO and partners of the Global Polio Eradication Initiative, has implemented four monovalent oral polio vaccine 2 (mOPV2) supplementary immunization campaigns and one mop-up campaign to prevent virus spread. They have worked hard to strengthen surveillance and routine immunization in the outbreak zones and across the country, and are fully committed to ending the outbreak. The total number of officially reported cVDPV2 cases in the DRC in 2017 is 21. No cases of cVDPV2 with onset in 2018 have so far been reported.
:: Summary of newly-reported viruses this week: No new viruses reported.

Syria cVDPV2 outbreak situation report 35, 20 February 2018
Situation update 20 February 2018
[Editor’ text bolding]
:: No new cases of cVDPV2 were reported this week. The total number of cVDPV2 cases remains 74. The most recent case (by date of onset of paralysis) is 21 September 2017 from Boukamal district, Deir Ez-Zor governorate.
:: An inactivated polio vaccine (IPV) immunization round has successfully concluded in Damascus, Hasakah, parts of Aleppo governorates, and Jurmana district of rural Damascus as part of the second phase of the outbreak response. IPV vaccination is continuing in accessible parts of Aleppo governorate.
:: Reportedly, a total of 233 518 children aged 2–23 months received IPV, representing 71% of the estimated target.
:: Post campaign monitoring of the IPV campaign has concluded in Damascus, Hasakah and parts of Aleppo governorate that completed the implementation. Overall, post campaign monitoring indicates 81% vaccination rates by parental/caregiver recall and 77% by finger marking.
:: Post campaign monitoring particularly focused on the internally displaced persons (IDP) camps; the data indicates 91% vaccination rates by parental/caregiver recall and 89% by finger marking.
:: A nationwide immunization round utilizing bivalent OPV (bOPV) is planned for March. The campaign will target all children aged less than 5 years.


WHO Grade 3 Emergencies  [to 24 February 2018]
The Syrian Arab Republic
:: Syria cVDPV2 outbreak situation report 35, 20 February 2018
[See Polio above for detail]

Weekly cholera bulletins
:: Weekly epidemiology bulletin, 5–11 February 2018
Cumulative figures
-The cumulative total from 27 April 2017 to 11 Feb 2018 is 1,059,970 suspected cholera cases and 2,258 associated deaths, (CFR 0.21%), 1104 have been confirmed by culture.
– 59.3 % of death were severe cases at admission
– The total proportion of severe cases among the suspected cases is 16%
– The national attack rate is 382.7 per 10,000. The five governorates with the highest cumulative attack rates per 10,000 remain Amran (894), Al Mahwit (857), Al Dhale’e (644), Hajjah (520) and Sana’a (515).
– Children under 5 years old represent 28.8% of total suspected cases.
– In total, 29,629 rapid diagnostic tests (RDT) have been performed which represents 28 % coverage.
– 2,732 cultures have been performed which represents 22.3% coverage.
– The last positive culture was on 4 Feb 2018 in Al Harith district in Amant Al Asimah
– 182 districts are still reporting suspected cholera cases since last 3 weeks
– 123 districts (out of 305 affected districts) did not report any suspected cases for the last three consecutive weeks
Governorate and District level
– At governorate level, the trend from W4 –W6 decrease or was stable in all governorates except (Aden governorate)
– The weekly number of cases is decreasing for the 22 consecutive weeks.
– The weekly proportion of severe cases has significantly decreased representing now 9% of the admitted cases.
Week 6 2018
– 3,886 suspected cases and 3 associated deaths were reported
– 9 % are severe cases
– 589 RDTs were performed, 131 were positive
– No culture test was performed this week

WHO Grade 2 Emergencies  [to 24 February 2018]
Bangladesh/Myanmar: Rakhine Conflict 2017
[See WHO announcement in Milestones/Perspectives above]

Democratic Republic of the Congo 
:: Read the health situation report in French pdf, 4.28Mb, February 2018

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. 
Syrian Arab Republic
:: 23 Feb 2018   UN chiefs call for stepped-up support for vulnerable Syrians, refugees and host communities, amid escalating violence inside Syria

:: 20 Feb 2018  Yemen Humanitarian Update Covering 12 – 18 February 2018


WHO & Regional Offices [to 24 February 2018]

WHO & Regional Offices [to 24 February 2018]

Latest news
Europe observes a 4-fold increase in measles cases in 2017 compared to previous year
Copenhagen, 19 February 2018
Measles has rebounded in the WHO European Region. The disease affected 21 315 people and caused 35 deaths in 2017, following a record low of 5273 cases in 2016. The WHO Regional Office for Europe has released new data for 2017 one day ahead of a health ministerial meeting on immunization in Montenegro on 20 February 2018.
“Every new person affected by measles in Europe reminds us that unvaccinated children and adults, regardless of where they live, remain at risk of catching the disease and spreading it to others who may not be able to get vaccinated. Over 20 000 cases of measles, and 35 lives lost in 2017 alone, are a tragedy we simply cannot accept,” says Dr Zsuzsanna Jakab, WHO Regional Director for Europe.
“Elimination of both measles and rubella is a priority goal that all European countries have firmly committed to, and a cornerstone for achieving the health-related Sustainable Development Goals,” Dr Jakab continues. “This short-term setback cannot deter us from our commitment to be the generation that frees our children from these diseases once and for all.”..


Recommended composition of influenza virus vaccines for use in the 2018-2019
February 2018- A periodic replacement of viruses contained in influenza vaccines is necessary in order for the vaccines to be effective due to the constant evolving nature of influenza viruses. Twice a year, WHO organizes consultations, and issues recommendations on the composition of the influenza vaccines for the following influenza season.

Weekly Epidemiological Record, 23 February 2018, vol. 93, 08 (pp. 73–96)
:: BCG vaccines: WHO position paper – February 2018
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: WHO strategizes to address the worsening challenge of the malaria burden in South Sudan
24 February 2018
:: Sierra Leone maximizes protection against polio with Inactivated Polio Vaccine launch
23 February 2018
Today Sierra Leone officially introduced injectable polio vaccine (or…
:: WHO and GAVI Alliance Partners along with the Ministry of Health strategizes to vaccinate over 485 000 children under one year of age in 2018  22 February 2018
Despite widespread conflict and insecurity, South Sudan has witnessed…
:: Experts agree on guidelines to boost vaccine uptake through improved communication
20 February 2018  Health experts from over 15 countries have begun a two-day meeting in…

WHO Region of the Americas PAHO
:: PAHO reminds international travelers to get vaccinated before traveling to areas with yellow fever (02/23/2018)
WHO European Region EURO
::  12 European countries commit to greater efforts to protect people from vaccine-preventable diseases 23-02-2018
:: European Region countries convene to boost emergency preparedness and response 20-02-2018
:: Portraits from Ukraine’s conflict line, where humanitarian assistance is most needed 20-02-2018
:: South-eastern European countries meet to develop regional action plan 19-02-2018

WHO Western Pacific Region
:: Questions and answers on avian influenza
21 February 2018 — Avian influenza viruses normally spread between birds. However, some viruses have been found to infect humans. The primary risk factor for humans is exposure to infected live or dead poultry or contaminated environments, such as live bird markets. Read our Q&A to learn more.

CDC/ACIP [to 24 February 2018]

CDC/ACIP [to 24 February 2018]

MMWR News Synopsis for February 22, 2018 / No. 5
:: HIV Diagnoses Among Persons Aged 13–29 Years — United States, 2010‒2014
A new analysis provides a clearer picture of the remarkable escalations in HIV diagnosis rates among adolescents as age increases between 13-21 years. Between 2010 and 2014, there were large differences in diagnosis rates among adolescents and young adults as age increased (between 13 and 21 years). An analysis of data from the National HIV Surveillance System revealed large differences in HIV diagnosis rates per 100,000 between adolescents ages 13-15 years (0.7); 16-17 years (4.5); and 18-19 years (16.5). The analysis also found that while diagnosis rates were higher among young adults than adolescents, they were less variable among age groups: 20-21 years (28.6 per 100,000); 22-23 years (34.0); 24-25 years (33.8); 26-27 years (31.3); and 28-29 years (28.7). The findings demonstrate the importance of targeting primary prevention efforts to people younger than 18 years and continuing through the period of elevated risk in the mid-20s.