Vaccines and Global Health: The Week in Review :: 14 July 2018

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

Explorations of inequality: Childhood immunization

Milestones :: Perspectives

Explorations of inequality: Childhood immunization
World Health Organization 2018 : 92 pages
ISBN 978-92-4-156561-5
This report takes a detailed look at the current status of childhood immunization in 10 priority countries: Afghanistan, Chad, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Kenya, Nigeria, Pakistan and Uganda.
In each country, childhood immunization coverage is broken down by multiple factors to show inequality according to child, mother, household and geographical characteristics. Then, the report employs multiple regression analysis to identify factors that are associated with immunization coverage. A multicountry assessment illustrates similarities and differences between countries.
The findings of the report show how a child’s likelihood of being vaccinated is affected by compounding advantage or vulnerability; they also provide insight into how policies, programmes and practices can be targeted to promote universal childhood immunization coverage. Interactive visuals and tables accompany the report, enabling further exploration of the data.
Key Messages
Across the 10 priority countries, the national DTP3 immunization coverages ranged from 34% in Chad to 90% in Kenya. Evaluating performance based on national averages alone, however, masks the situation in population subgroups. The countries faced distinct patterns of inequality, from Uganda, where inequality tended to be very small for most of the featured characteristics, to Nigeria, where inequality was pronounced for most characteristics.
Despite the uniqueness of each country situation, some commonalities emerged. Inequalities by child’s sex tended to be minimal or non-existent, and inequality by subnational region tended to be substantial. All countries reported variation by mother’s education and subnational region and all (except Uganda) demonstrated inequality on the basis of household economic status. All 10 priority countries showed a positive association between mother’s education level and childhood immunization coverage. Countries that reported low national coverage (e.g. Chad, Ethiopia and Nigeria) tended to demonstrate steep gradients and/or mass deprivation patterns across socioeconomic subgroups; the odds of immunization tended to be significantly higher in more advantaged subgroups in these countries. Countries with higher national coverage (e.g. India, Indonesia, Kenya and Uganda), more often demonstrated marginal exclusion or
universal patterns across socioeconomic subgroups, and tended to have lower urban–rural inequality.
When considered alongside knowledge of the country context, the results of this report can be used to inform equity-oriented policies, programmes and practices to promote universal childhood immunization coverage. This report serves as a basis for more detailed explorations at the national and subnational levels, and a baseline for future health inequality monitoring efforts. Monitoring and exploring inequalities in health is essential as countries strive to “leave no one behind” on the path towards sustainable development.

FDA approves the first drug with an indication for treatment of smallpox

Milestones :: Perspectives

FDA approves the first drug with an indication for treatment of smallpox
July 13, 2018
The U.S. Food and Drug Administration today approved TPOXX (tecovirimat), the first drug with an indication for treatment of smallpox. Though the World Health Organization declared smallpox, a contagious and sometimes fatal infectious disease, eradicated in 1980, there have been longstanding concerns that smallpox could be used as a bioweapon.

“To address the risk of bioterrorism, Congress has taken steps to enable the development and approval of countermeasures to thwart pathogens that could be employed as weapons. Today’s approval provides an important milestone in these efforts. This new treatment affords us an additional option should smallpox ever be used as a bioweapon,” said FDA Commissioner Scott Gottlieb, M.D. “This is the first product to be awarded a Material Threat Medical Countermeasure priority review voucher. Today’s action reflects the FDA’s commitment to ensuring that the U.S. is prepared for any public health emergency with timely, safe and effective medical products.”

Prior to its eradication in 1980, variola virus, the virus that causes smallpox, was mainly spread by direct contact between people. Symptoms typically began 10 to 14 days after infection and included fever, exhaustion, headache and backache. A rash initially consisting of small, pink bumps progressed to pus-filled sores before finally crusting over and scarring. Complications of smallpox could include encephalitis (inflammation of the brain), corneal ulcerations (an open sore on the clear, front surface of the eye) and blindness.

TPOXX’s effectiveness against smallpox was established by studies conducted in animals infected with viruses that are closely related to the virus that causes smallpox, and was based on measuring survival at the end of the studies. More animals treated with TPOXX lived compared to the animals treated with placebo. TPOXX was approved under the FDA’s Animal Rule, which allows efficacy findings from adequate and well-controlled animal studies to support an FDA approval when it is not feasible or ethical to conduct efficacy trials in humans.

The safety of TPOXX was evaluated in 359 healthy human volunteers without a smallpox infection. The most frequently reported side effects were headache, nausea and abdominal pain.

The FDA granted this application Fast Track and Priority Review designations. TPOXX also received Orphan Drug designation, which provides incentives to assist and encourage the development of drugs for rare diseases and a Material Threat Medical Countermeasure Priority Review Voucher, which provides additional incentives for certain medical products intended to treat or prevent harm from specific chemical, biological, radiological and nuclear threats.
The FDA granted approval of TPOXX to SIGA Technologies Inc.

TPOXX was developed in conjunction with the U.S. Department of Health and Human Services’ Biomedical Advanced Research and Development Authority (BARDA).


Public Health Emergency of International Concern (PHEIC)
Polio this week as of 10 July 2018 [GPEI]
:: A Disease Outbreak News (DON) notification was issued on 10 July on the Democratic Republic of the Congo’s three concurrent circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreaks.
:: Papua New Guinea prepares for the launch of large-scale immunization campaigns in Morobe, Madang and Eastern Highlands provinces, set to commence next week..

Summary of new cases this week:
:: Last week’s advance notification of one wild poliovirus type 1 (WPV1) case in Nad-e-Ali district, Helmand province, has been confirmed. The case had onset of paralysis on 1 June. This brings the total number of WPV1 cases in 2018 (in Afghanistan) to nine.
:: A sub-national immunization days campaign aiming to reach 6.4 million children under five years of age in 225 high risk districts of 27 provinces, primarily in the southern and eastern parts of the country including Kabul city, has concluded.
:: Two new WPV1 positive environmental samples have been reported: one in Kandahar City, Kandahar province, and one in Jalalabad, Nangarhar province.
:: Four new WPV1 positive environmental samples have been reported this week: one in Peshawar and one in Kohat, Khyber Pakhtunkhwa province (both 26 June), one in Karachi, Sindh province (23 June), and one in Islamabad, Punjab province (24 June).
:: An advance notification has been confirmed of one new cVDPV2 positive contact in Somalia.

Circulating vaccine-derived poliovirus type 2 – Democratic Republic of the Congo
10 July 2018
WHO risk assessment
WHO assessed the overall public health risk at the national level to be very high and the risk of international spread to be high. This risk is magnified by known population movements between the affected area of Democratic Republic of the Congo, Uganda, Central African Republic and South Sudan, and the upcoming rainy season which is associated with increased intensity of virus transmission.
The detection of cVDPV2s underscores the importance of maintaining high routine vaccination coverage everywhere to minimize the risk and consequences of any poliovirus circulation. These events also underscore the risk posed by any low-level transmission of the virus. A robust outbreak response is needed to rapidly stop circulation and ensure sufficient vaccination coverage in the affected areas to prevent similar outbreaks in the future. WHO will continue to evaluate the epidemiological situation and outbreak response measures being implemented…


WHO Grade 3 Emergencies  [to 14 Jul 2018]
The Syrian Arab Republic
:: Southern Syrian Arab Republic Health Cluster report pdf, 82kb  9 – 12 July 2018
:: WHO delivers over 17 tons of life-saving medicines and medical equipment to the newly accessible city of Douma  7 July 2018

Iraq  – No new announcements identified
Nigeria  – No new announcements identified
South Sudan  – No new announcements identified
Yemen  – No new announcements identified

WHO Grade 2 Emergencies  [to 14 Jul 2018]
[Several emergency pages were not available at inquiry]
Cameroon  – No new announcements identified
Central African Republic  No new announcements identified.
Democratic Republic of the Congo  No new announcements identified
Ethiopia  No new announcements identified.
LibyaNo new announcements identified.
Myanmar  – No new announcements identified
Niger  – No new announcements identified.
UkraineNo new announcements identified.

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 
:: Syrian Arab Republic: Dar’a, Quneitra, As-Sweida Situation Report No. 2 as of 11 July 2018
Published on 11 Jul 2018
:: Yemen Humanitarian Update Covering 12 June – 9 July 2018 | Issue 20
Published on 10 Jul 2018


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.
Ethiopia  – No new announcements identified.
Somalia   – No new announcements identified.

Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.

EBOLA/EVD  [to 14 Jul 2018]
Ebola virus disease – Democratic Republic of the Congo   6 July 2018
The Ministry of Health and WHO continue to closely monitor the outbreak of Ebola virus disease in the Democratic Republic of the Congo.
Contact tracing activities concluded on 27 June after the last people with potential exposure to the virus completed their 21-day follow-up without developing symptoms. Over 20 000 visits to contacts have been conducted by the field team throughout the outbreak.
On 12 June, the last confirmed Ebola virus disease patient in Équateur Province was discharged from an Ebola treatment centre, following two negative tests on serial laboratory specimens. Before the outbreak can be declared over, a period of 42 days (two incubation periods) following the last possible exposure to a confirmed case must elapse without any new confirmed cases being detected. Until this milestone is reached, it is critical to maintain all key response pillars, including intensive surveillance to rapidly detect and respond to any resurgence.
In light of progress in the response, WHO has revised the risk assessment for this outbreak…
there remains a risk of resurgence from potentially undetected transmission chains and possible sexual transmission of the virus by male survivors. It is therefore, critical to maintain all key response pillars until the end of the outbreak is declared. Strengthened surveillance mechanisms and a survivor monitoring program are in place to mitigate, rapidly detect and respond to respond to such events. Based on these factors, WHO considers the public health risk to be moderate at the national level.
In the absence of ongoing transmission, the probability of exported cases is low and diminishing, and has been further mitigated by the undertaking of preparedness activities and establishment of contingency plans in neighbouring countries. WHO has assessed the public health risk to be low at the regional and global levels…

MERS-CoV [to 14 Jul 2018]
No new announcements identified.

Yellow Fever  [to 14 Jul 2018]
No new announcements identified.


Zika virus  [to 14 Jul 2018]
No new announcements identified.

WHO & Regional Offices [to 14 Jul 2018]

WHO & Regional Offices [to 14 Jul 2018]
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: Borno targets more than 1 million children with anti-malaria therapy.   13 July 2018
:: Rising cases of sickle cell disease prompts calls for urgent action  13 July 2018
:: Adamawa conducts first vaccination campaign in response to cholera outbreak  10 July 2018
:: Ethiopia launched the 1st round synchronized mOPV2 campaign  10 July 2018
:: Targeted vaccine campaign underway to interrupt measles outbreak in remote northern Sierra Leone  07 July 2018

WHO Region of the Americas PAHO
No new announcements identified.
WHO South-East Asia Region SEARO
No new announcements identified.
WHO European Region EURO
:: Health ministers of south-eastern Europe meet to share good practices, discuss health challenges 12-07-2018
:: Twenty years of explaining the evidence – the European Observatory on Health Systems and Policies 12-07-2018
:: Portugal on fast track to achieve HIV targets ahead of 2020 deadline 11-07-2018
:: Making the link between transport, health, environment and achieving the SDGs 11-07-2018

WHO Eastern Mediterranean Region EMRO
:: WHO concerned about access to health services for displaced people in southern Syria
12 July, 2018 – WHO today called for the protection of health facilities and increased access to southern Syria, where recent hostilities have left over 210 000 people displaced and in need of urgent health services. Up to 160 000 displaced Syrians currently seeking safety in Quneitra are inaccessible to health partners, raising concerns for their health. Since the escalation of violence, WHO has provided medicines and supplies to health partners, hospitals, and primary health care centres for almost 200 000 medical treatments…

WHO Western Pacific Region
No new announcements identified.