Vaccines and Global Health: The Week in Review :: 25 August 2018

.– 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_25 Aug 2018

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

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

Support this knowledge-sharing service: Your financial support helps us cover our costs and to address a current shortfall in our annual operating budget. Click here to donate and thank you in advance for your contribution.

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

Ebola virus disease – Democratic Republic of the Congo :: Situation report on the Ebola outbreak in North Kivu :: WHO provides medicines and equipment for Ebola preparedness and control of Malaria & Neglected Tropical Diseases in Tanzania :: Uganda heightens Ebola preparedness response :: Congo: 2 Who Received Experimental Ebola Treatment Recover

Milestones :: Perspectives
 
Ebola – DRC

WHO
Ebola virus disease – Democratic Republic of the Congo
Disease outbreak news
24 August 2018
Since the last Disease Outbreak News on 17 August 2018, 25 additional cases have been laboratory confirmed for Ebola virus disease (EVD) in the Democratic Republic of the Congo. These new confirmed cases have been reported in Beni, Oicha and Mabalako health zones (North Kivu province) and Mandima health zone (Ituri Province). However, all exposures and transmission events, to date, have been linked back to the outbreak epi-centre, Mabalako. Beyond the EVD outbreak, the Democratic Republic of the Congo is in a complex humanitarian crisis and is experiencing several other concurrent epidemics.

As of 22 August 2018, a total of 103 EVD cases (76 confirmed and 27 probable) including 63 deaths (36 confirmed and 27 probable) have been reported1 in five health zones in North Kivu (Beni, Butembo, Oicha, Mabalako, Musienene) and one health zone in Ituri (Mandima) (Figure 1). The majority of cases (62 confirmed and 21 probable) have been reported from Mabalako in Mabalako Health Zone (Figure 2). As of 22 August, six new suspected cases from Mabalako (n=3) and Beni (n=3) are pending laboratory testing to confirm or exclude EVD. A total of 88 confirmed and probable cases have age and sex reported. As of 19 August, the median age was 32 years (age range: 0-74), with the age group 30-39 accounting for 28% (25/88) of cases. Fifty eight percent (51/88) of all cases were female (Figure 3).

Fourteen cases have been reported among health workers, of which 13 were laboratory confirmed; one has died. Many of these health care workers were likely infected in clinics before the declaration of the outbreak, not in Ebola treatment centres (ETCs). WHO and partners are working with health workers and communities to increase awareness on infection, prevention and control (IPC) measures, as well as vaccinate those at risk of infection.

The MoH, WHO and partners continue to systematically monitor and rapidly investigate all alerts in all provinces of the Democratic Republic of Congo, and in neighbouring countries2. Alerts in several provinces of the Democratic Republic of Congo as well as in Uganda, Rwanda, and the Central African Republic have been investigated; EVD has been ruled out in all alert events to date.
 
 
Situation report on the Ebola outbreak in North Kivu  22 August 2018
[Excerpt]
Case management
…The Ethics Committee in the Democratic Republic of the Congo has approved the use of four additional experimental therapeutics, namely: ZMapp, Remdesivir, Favipiravir, and Regn3450 – 3471 – 3479, to be used by the ETC medical and research teams. This is in addition to the mAb114, approved earlier….

WHO provides medicines and equipment for Ebola preparedness and control of Malaria & Neglected Tropical Diseases in Tanzania   24 August 2018

Uganda heightens Ebola preparedness response   23 August 2018

New York Times
http://www.nytimes.com/
Accessed 25 Aug 2018
Congo: 2 Who Received Experimental Ebola Treatment Recover
By The Associated Press
Aug. 25, 2018
KINSHASA, Congo — Congo’s health ministry says two of the first 10 people to receive an experimental treatment for the Ebola virus in the latest outbreak have recovered, and monitoring could show what role the treatment played.
The head of the World Health Organization on Saturday congratulated Congo’s government for making several experimental treatments available in this Ebola outbreak, calling it “a global first, and a ray of hope for people with the disease.”
The two people received the mAb114 treatment isolated from a survivor of an Ebola outbreak in 1995. It was the first of five experimental treatments Congo approved for use in the outbreak that was declared on Aug. 1. The others are ZMapp, Remdesivir, Favipiravir and Regn3450 – 3471 – 3479…

Measles cases hit record high in the European Region

Milestones :: Perspectives

Measles cases hit record high in the European Region
20 August 2018 | WHO News Release
Over 41 000 children and adults in the WHO European Region have been infected with measles in the first 6 months of 2018. The total number for this period far exceeds the 12-month totals reported for every other year this decade. So far, the highest annual total for measles cases between 2010 and 2017 was 23 927 for 2017, and the lowest was 5273 for 2016. Monthly country reports also indicate that at least 37 people have died due to measles so far this year.

“Following the decade’s lowest number of cases in 2016, we are seeing a dramatic increase in infections and extended outbreaks,” says Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “We call on all countries to immediately implement broad, context-appropriate measures to stop further spread of this disease. Good health for all starts with immunization, and as long as this disease is not eliminated we are failing to live up to our Sustainable Development Goal commitments.”

Seven countries in the Region have seen over 1000 infections in children and adults this year (France, Georgia, Greece, Italy, the Russian Federation, Serbia and Ukraine). Ukraine has been the hardest hit, with over 23 000 people affected; this accounts for over half of the regional total. Measles-related deaths have been reported in all of these countries, with Serbia reporting the highest number of 14.

Uneven progress towards measles and rubella elimination
According to the latest assessment by the European Regional Verification Commission for Measles and Rubella Elimination (RVC), released today, 43 of the Region’s 53 Member States have interrupted the endemic spread of measles and 42 have interrupted rubella (based on 2017 reporting).

At the same time, the RVC expressed concerns about inadequate disease surveillance and low immunization coverage in some countries. It also concluded that chains of measles transmission continued for more than 12 months in some countries that had interrupted the endemic spread of the disease, reverting their status back to endemic.

“This partial setback demonstrates that every person who is not immune remains vulnerable no matter where they live, and every country must keep pushing to increase coverage and close immunity gaps, even after achieving interrupted or eliminated status,” says Dr Nedret Emiroglu, Director of the Division of Health Emergencies and Communicable Diseases at the WHO Regional Office for Europe…

AT&T, Softbox and Merck Test Connected Payloads and Drone Flights to Deliver Medical Supplies in Puerto Rico

Milestones :: Perspectives

AT&T, Softbox and Merck Test Connected Payloads and Drone Flights to Deliver Medical Supplies in Puerto Rico
GUAYNABO, Puerto Rico, Aug. 24, 2018 /PRNewswire/ — AT&T* is taking part in a proof of concept with Softbox to test connected medical payloads carried by drones. The goal? Successfully and safely deliver temperature-sensitive medicines using drones.

An LTE-connected drone carrying Softbox’s thermal-insulated packaging system “Skypod,” which includes a smartbox powered by AT&T’s Internet of Things (IoT) technology, successfully completed demonstration flights. The field trial with Merck, the pharmaceutical company, took place in locations across Puerto Rico. Softbox, based in the UK, provides specialist temperature control packaging to the pharmaceutical industry.

“Merck is pleased to collaborate on this innovative new model for delivering medicines to patients in areas affected by natural disasters,” said Brenda Colatrella, executive director, Corporate Responsibility at Merck. “We’re proud of our long history of expanding access to our medicines and vaccines and collaborating to provide humanitarian assistance. The drone test flights give us hope that we will be able to provide a reliable supply of our medicines for disaster.”

AT&T’s IoT technology tracks the Skypod with data viewed on a web and mobile app dashboard. The data includes near-real time external and internal temperatures of the box and its location. Light exposure data helps signal if there is box tampering during daylight, by determining if the box is open or closed.

The dashboard app will flash alerts to help drive appropriate action. For example, it will send an alert if there is a change to the temperature range of 2°C to 8°C. It will also send an alert if the drone goes outside of defined geofencing parameters.

AT&T and Softbox have adapted the Skypod from a connected flask prototype developed in the AT&T Foundry, which they showcased earlier this year. The AT&T Foundry is a network of innovation centers that collaborates with startups, technology providers and enterprises to move ideas to market faster through rapid prototyping. It moved the IoT sensors that track temperature and location from the lid of the original prototype and fit them into the smartbox.
“We’re proud to be working with AT&T in this dynamic, industry-first trial. The connected Skypod could be rapidly deployed globally in times of humanitarian disaster relief,” said Softbox Technical Director Richard Wood…

Emergencies

Emergencies

 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 23 August 2018 [GPEI]
Summary of new viruses this week:
Afghanistan – two new wild poliovirus type 1 (WPV1) positive environmental samples. Democratic Republic of the Congo – circulating vaccine-derived poliovirus type 2 detected in the stool samples of two healthy contacts of two different negative AFP cases.
Nigeria – one new case of cVDPV2, and two new cVDPV2 positive environmental samples. Somalia – one new case of cVDPV2. See country sections below for more details.

::::::
::::::

WHO Grade 3 Emergencies  [to 25 Aug 2018]
The Syrian Arab Republic
:: Critical funding shortage threatens WHO’s response in northwest Syria
20 August 2018 – As the conflict in northwest Syria escalates, WHO is appealing for US$ 11 million to provide life-saving health care to people in parts of Aleppo, Hama, Idleb and Lattakia governorates.
Hundreds of thousands of people, many of whom have been previously displaced, may be displaced yet again as they flee growing insecurity and violence. The situation in Idleb is particularly dire; more than half a million people have been displaced to and within the governorate since January 2017…

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 25 Aug 2018]
Myanmar 
:: Major outbreaks averted, thousands of lives saved; but Rohingyas continue to be vulnerable: WHO  24 August 2018
Ukraine
:: Measles cases hit record high in the European Region  20 August 2018

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.
Niger  – No 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. 
Yemen
:: Yemen Humanitarian Update Covering 9 – 15 August 2018 |

Syrian Arab Republic   No new announcements identified.

::::::

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 25 Aug 2018]
http://www.who.int/ebola/en/
Disease outbreak news
24 August 2018
Ebola virus disease – Democratic Republic of the Congo
[See Milestones above for more detail]

MERS-CoV [to 25 Aug 2018]
http://who.int/emergencies/mers-cov/en/
No new announcements identified.
 
Yellow Fever  [to 25 Aug 2018]
http://www.who.int/csr/disease/yellowfev/en/
No new announcements identified.

Zika virus  [to 25 Aug 2018]
http://www.who.int/csr/disease/zika/en/
No new announcements identified.

WHO & Regional Offices [to 25 Aug 2018]

WHO & Regional Offices [to 25 Aug 2018]

24 August 2018 | News Release
Samoa rolls out triple drug therapy to accelerate elimination of lymphatic filariasis

20 August 2018 | News Release
Measles cases hit record high in the European Region
[See Milestones above for more detail]

::::::
 
Weekly Epidemiological Record, 24 August 2018, vol. 93, 34 (pp. 429–444)
:: Review of the 2017–2018 influenza season in the northern hemisphere
 
::::::
 
WHO Regional Offices
 
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: WHO provides medicines and equipment for Ebola preparedness and control of Malaria & Neglected Tropical Diseases in Tanzania   24 August 2018
:: Uganda heightens Ebola preparedness response   23 August 2018

WHO Region of the Americas PAHO
:: PAHO urges rapid increase in vaccination coverage to stop spread of measles in the Americas (08/24/2018)
 
WHO South-East Asia Region SEARO
:: Major outbreaks averted, thousands of lives saved; but Rohingyas continue to be vulnerable: WHO   Cox’s Bazar, Bangladesh, 24 August 2018
 
WHO European Region EURO
:: Strengthening human resources for rehabilitation in Tajikistan 23-08-2018
:: Q&A: Transforming the health system for better antenatal care in Georgia 22-08-2018
:: West Nile virus infections spike in southern and central Europe 21-08-2018
:: Measles cases hit record high in the European Region 20-08-2018

WHO Eastern Mediterranean Region EMRO
No new digest content identified.

WHO Western Pacific Region
:: Federated States of Micronesia forges a way forward to health security in the Pacific
20 August 2018 – The Federated States of Micronesia has become the first Pacific island country to complete a Joint External Evaluation (JEE). JEEs are voluntary, and involve a team of local and international experts working together to evaluate the country’s preparedness for outbreaks and health emergencies…

More US adolescents up to date on HPV vaccination

CDC/ACIP [to 25 Aug 2018]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html

Latest News
More US adolescents up to date on HPV vaccination
Thursday, August 23, 2018
The number of adolescents who are up to date on HPV vaccination – meaning they started and completed the HPV vaccine series – increased five percentage points from 2016 to 2017, according to results from a national survey published today in CDC’s Morbidity and Mortality Weekly Report (MMWR).
In 2017, nearly 66 percent of adolescents aged 13-17 years received the first dose to start the vaccine series, and nearly 49 percent of adolescents received all the recommended doses to complete the series.
“This vaccine is the best way to protect our youth from developing cancers caused by HPV infection,” said CDC Director Robert R. Redfield, M.D. “Vaccination is the key to cervical cancer elimination. I’m pleased to see parents are taking advantage of this crucial public health tool and thank the clinicians who are working to ensure all children are protected from these cancers in the future.”
While HPV vaccination rates are increasing, there is room for improvement as many adolescents have not received all the recommended doses of the HPV and meningococcal conjugate vaccines. One of the new reports show that 51 percent of adolescents have not completed the HPV vaccine series, and 56 percent of adolescents have not received both doses of meningococcal conjugate vaccine.
Also, fewer adolescents in rural areas, compared with youth in urban areas, are getting the HPV and meningococcal conjugate vaccines. The number of adolescents who received the first dose of the HPV vaccine was 11 percentage points lower in rural areas compared to urban areas. The number of adolescents receiving the first dose of the meningococcal conjugate vaccine was 7 percentage points lower in rural areas compared to urban areas.
“While we understand it can be a challenge for some clinicians in rural areas to stock all recommended vaccines, these clinicians can still play a critical role in their patients’ health and protect them from serious diseases by referring them to other vaccine providers,” said Nancy Messonnier, M.D., director of CDC’s National Center for Immunization and Respiratory Diseases…