Vaccines and Global Health: The Week in Review :: 08 December 2018

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

Industrial strategy delivers new vaccines manufacturing centre to lead the fight against deadly disease [U.K.] :: Johnson & Johnson Announces Participation in New Collaboration Funded by the UK to Support Vaccines for Pandemic Preparedness

Milestones :: Perspectives

Industrial strategy delivers new vaccines manufacturing centre to lead the fight against deadly disease [U.K.]
Ebola and Lassa fever are among the deadly diseases to be tackled in a pioneering new UK vaccine centre.
Press release   1 December 2018
:: The UK’s first-ever dedicated Vaccines Manufacturing Innovation Centre will ensure the UK life sciences industry remains at the forefront of worldwide efforts to tackle life-threatening diseases, including Ebola
:: The centre will be built in Oxford, creating more than 50 jobs in the local area
:: Through the modern Industrial Strategy, the government is investing £66 million through UK Research and Innovation in the centre to help make Britain the best place in the world for innovators, including new treatments to help people live longer, healthier and happier lives through the Life Sciences Sector Deal
:: Led by the Jenner Institute, a partnership between the University of Oxford and the Pirbright Institute, the new centre has been awarded funding by UK Research and Innovation of £66 million through the UK government’s Industrial Strategy Challenge Fund (ISCF) Medicines Manufacturing challenge.

… Additional funding of £10 million will come from commercial and other partners, including Janssen Vaccines & Prevention B.V. and Merck Sharp and Dohme. The centre will be further supported by expertise and training from GE Healthcare.

The core research teams will be drawn from academia and industry and will include significant new contributions from the London School of Hygiene & Tropical Medicine and Imperial College London as well as the University of Oxford. The programme will also benefit from access to technologies and intellectual property created by the partners.

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Johnson & Johnson Announces Participation in New Collaboration Funded by the UK to Support Vaccines for Pandemic Preparedness
Janssen joins forces with UK government and multiple academic and industrial partners to support creation of Vaccine Manufacturing and Innovation Centre
New Brunswick, N.J., Dec. 3, 2018 – Johnson & Johnson today announced that Janssen Vaccines & Prevention B.V., part of its Janssen Pharmaceutical Companies, will participate in a new collaboration with the UK government and multiple partners from academia and industry that will result in the UK’s first-ever dedicated Vaccine Manufacturing and Innovation Centre (VMIC).

UK Research and Innovation will invest £66 million in the centre as part of the Industrial Strategy Challenge Fund (ISCF) Medicines Manufacturing programme. VMIC will enable the development and manufacture of vaccines for clinical trials and for emergency outbreak response and preparedness.

“Infectious diseases with pandemic potential need to be proactively addressed, in advance of outbreaks occurring, and developing new vaccines is a central part of any preparedness strategy,” said Paul Stoffels, M.D., Vice Chairman of the Executive Committee and Chief Scientific Officer, Johnson & Johnson. “We applaud the UK’s leadership in mobilizing partners from the across the public, private and academic sectors to tackle this challenge.”

The VMIC is planned to be operational in Oxford by 2022, and will be a purpose-built facility capable of supporting multiple technologies, allowing for academic and industry collaboration on the development and manufacture of vaccines.

Three academic institutions will be engaged in VMIC: the Jenner Institute (a partnership between the University of Oxford and the Pirbright Institute), Imperial College, and the London School of Hygiene & Tropical Medicine. Additional funding of £10 million will come from commercial and other partners, including Janssen Vaccines & Prevention B.V. and Merck Sharp and Dohme (MSD), who will also share their extensive experience in the design and construction of such a facility, and in vaccine manufacturing and development. GE Healthcare will provide in-kind support on engineering and training.

“We are delighted to collaborate on this important initiative with the UK government and this impressive consortium of partners,” said Johan Van Hoof, M.D., Global Therapeutic Area Head IDV, Vaccines, Janssen Pharmaceuticals R&D and Managing Director, Janssen Vaccines & Prevention B.V., who will be joining the governing board of VMIC. “Only by working in common cause can we achieve the goal of pandemic preparedness. If we take action now, working together, we can prevent the pandemics of the future. We are delighted to support this vital mission.”

The VMIC is being launched to enable the rapid manufacture of vaccines in the event of an epidemic affecting the UK. It will also enable a rapid global response to emerging highly infectious pathogens. Additionally, VMIC aims to develop new technologies such as personalized cancer vaccines and vectors for gene therapy.

“Improving the development, production and application of new vaccines against infectious diseases requires expertise and collaboration across academia and industry,” said UK Research and Innovation Chief Executive Professor Sir Mark Walport. “The Vaccine Manufacturing and Innovation Centre will play an important role in bringing expertise from industry and academia together to ensure we are prepared to respond to the threats of serious infections, including viruses with the potential to cause major national or global epidemics.”

PREVENT Guidance

Milestones :: Perspectives

PREVENT Guidance

Developed by the Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies (PREVENT) Working Group, Johns Hopkins Berman Institute of Bioethics
September 2018. :: 96 pages
PDF: http://vax.pregnancyethics.org/s/PREVENT-Web.pdf
Overview
This Guidance provides a roadmap for the ethically responsible, socially just, and respectful inclusion of the interests of pregnant women in the development and deployment of vaccines against emerging pathogens. The Guidance is a product of the Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies (PREVENT) Working Group—a multidisciplinary, international team of 17 experts specializing in bioethics, maternal immunization, maternal-fetal medicine, obstetrics, pediatrics, philosophy, public health, and vaccine research and policy— in consultation with a variety of external experts and stakeholders.

The Guidance begins by setting forth an aspirational vision and makes the case for its moral importance. We then specify 22 concrete recommendations, organized around three key areas: public health preparedness, R&D, and vaccine delivery.

The recommendations are directed at a range of actors, including global and national policymakers, regional and national regulatory authorities, funders and sponsors, vaccine manufacturers, research institutions, trial networks and research groups, individual researchers, oversight bodies, ethics review committees, community advisory boards, and civil society organizations.

 

Cholera in Yemen: A Case Study of Epidemic Preparedness and Response

Milestones :: Perspectives

Cholera in Yemen: A Case Study of Epidemic Preparedness and Response
Johns Hopkins Center for Humanitarian Health
2018 :: 108 pages
PDF: http://www.hopkinshumanitarianhealth.org/assets/documents/CHOLERA_YEMEN_REPORT_LONG_Low_Res_Dec_4_2018.pdf
Overview
In 2015, the United Nations declared Yemen a Level 3 emergency. On September 28, 2016, a large-scale cholera outbreak began. Between April 27, 2017 and July 1, 2018, more than one million suspected cases in two waves were reported. In the last decade, several large-scale and high-mortality cholera outbreaks have occurred during complex humanitarian emergencies including in Iraq, Somalia, and South Sudan. While the issues of “what to do” to control cholera are largely known, context-specific practices on “how to do it” in order to surmount challenges to coordination, logistics, insecurity, access, and politics, remain needed. During the Yemen cholera outbreak response, questions arose on how to effectively respond to a cholera outbreak at a national scale during an existing emergency. The main objective of this report was to identify lessons learned from the preparedness and detection phase to the end of second wave of the cholera epidemic in Yemen to better prepare for future outbreaks in Yemen and similar contexts.

Excerpts from Executive Summary
…The use of the oral cholera vaccine (OCV) was slowed by the lack of cholera response planning and technical knowledge among the Ministry of Public Health and Population (MoPHP) and partners. The lack of an updated cholera preparedness and response plan meant that OCV was not integrated into the response mindset and thus, there was a lack of technical knowledge and familiarly with OCV. OCV was not sufficiently discussed during the first wave, and was requested then rejected by the MoPHP during the second wave based on differing conceptions of the overall scale of distribution. The March 2018 plan is the first document that mentions

an OCV strategy, based on a January 2018 risk assessment. The MoPHP then made a successful

request to the Global Task Force for Cholera Control in April 2018 for 4.6 million doses for preventative use against future surges of cholera….

CONCLUSIONS:
The cholera response in Yemen was and remains extremely complicated and challenging for a variety of political, security, cultural, and environmental reasons. The study team recognizes these challenges and commends the government, international and national organizations, and the donors for working to find solutions in such a difficult context. There are no easy fixes to these challenges, and the conclusions and recommendations are meant to be constructive and

practical, taking into account the extreme limitations of working in Yemen during an active conflict.

The findings were consistent across respondents and methods. The study team found that several areas gained strength throughout the second wave, including: an extensive operational footprint which reached into insecure areas; the strengthening of the collaborations between WHO and UNICEF and the health and WASH clusters; the initiation of a funding mechanism through the World Bank which enabled a timely response at scale; the revitalization of the WASH strategy; and, eventual consensus and use of OCV.

Conversely, the major gaps of this response are rooted in weaknesses in preparedness and the early strategies developed in the first wave. An after-action review after the first wave could have institutionalized these areas in order to prevent a much larger second wave.

The World Bank’s commitment to the cholera response provides the rationale for major investment in bolstering the preparedness activities in Yemen and other conflict-affected

contexts which would go far for addressing the foundational gaps discussed in this case study.

 

TOP 20 RECOMMENDATIONS FOR FUTURE PREPAREDNESS AND RESPONSE

[Excerpt]

ORAL CHOLERA VACCINATION

  1. Global recommendation: Different scenarios for OCV according to varying contexts should be integrated ahead of time into national cholera preparedness plans in general. This is especially important for “fragile” countries where there is a possibility of humanitarian emergencies developing or continuing.
  2. Global and Yemen-specific recommendation: In complex and insecure environments like Yemen, smaller, geographically-targeted OCV campaigns should be anticipated and planned…

 

Ebola – Democratic Republic of the Congo

Milestones :: Perspectives

Ebola – Democratic Republic of the Congo

18: Situation report on the Ebola outbreak in North Kivu  5 December 2018
[Excerpts]
…Case Management
:: Since the beginning of the response, 5 649 samples have been tested (including repeat samples).
:: The ETCs continue to provide therapeutics under the MEURI protocol, in collaboration with the MoH and the Institut National de Recherche Biomédicale (INRB), together with supportive care measures. WHO is providing technical clinical expertise on-site and is assisting with the creation of a data safety management board.
:: New patients continue to be treated in ETCs. As of 3 December 2018, 144 confirmed cases have recovered and been discharged. Bed occupancy was 63% in Beni ETC, 75% in Beni transit centre and 56% in Butembo ETC. All confirmed cases are being treated with a therapeutic under the MEURI framework after evaluation by clinical expert committee. All hospitalized patients receive food and psychological support.
…Implementation of ring vaccination protocol
:: Vaccination continued on 3 December 2018 in Beni, Katwa, Butembo, Komanda, Vuhovi and Lubero, with 568 persons vaccinated, including 114 contacts, 175 contacts of contacts and 279 first line workers.
:: As of 3 December 2018, the cumulative number of people vaccinated,is 39 845.

DONs  Ebola virus disease – Democratic Republic of the Congo   6 December 2018
[Excerpt]
…Ebola virus disease in women and children
Concerns have been raised regarding the disproportionate number of women and children infected during this outbreak (Figure 3). To date, females accounted for 62% (280/450) of overall cases where sex was reported. Of all female cases, 83% (230/277) were aged ≥15 years. Of these women, at least 18 were pregnant, and an additional seven were breastfeeding or recently delivered at the time of infection. There have been 27 cases among infants less than one year of age, with 70% (19) of these being boys, and 21 fatalities (age-specific case fatality of 78%). There were also nine cases in infants aged less than one month. Children less than 15 years of age accounted for 24% (106/447) of cases.

There are likely a multitude of factors contributing towards this disproportionate disease burden observed in women and children. These include: exposure within formal and informal health facilities, involvement in traditional burial practices, transmission within family groups (including transmission between mothers caring for children), differences in health seeking behaviour, as well as the impact of ongoing conflict on the underlying population structure in affected areas. Among those with available information, commonly identified risk factors reported by cases include: having contact to a known case (224/320, 70%), having attended funerals (121/299, 40%) and having visited/admitted to a health facility before onset of EVD (46/139, 33%). Of note, 46% of female cases (84/181) reported having attended funerals, in contrast to 31% of male cases (37/118).

A concurrent increase in cases of malaria and the inadequate accompanying IPC in health settings are also likely to be contributory to the high rates of EVD among children. The recent conclusion of a four-day malaria control campaign in Beni on 2 December aimed at preventing further malaria deaths, as well as lessen the burden on health centres in order to address this potential source of transmission.

The MoH, WHO, are actively working with UNICEF and other partners to address the increased risks observed in women (including pregnant or breastfeeding women) and young children, and further strengthen measures to prevent and manage infections in these groups…

 

Emergencies

Emergencies
 
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 04 December 2018 [GPEI]
:: The circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak in Syria, which was first detected in 2017, has been successfully stopped. The announcement came at the heels of an official outbreak response assessment, comprising of experts in public health, epidemiology and virology, who reviewed evidence and concluded the outbreak was closed. Read the full statement here.
 
 
:: On 27 November 2018, the 19th IHR Emergency Committee including members, advisers, and invited Member States convened to discuss the status of international spread of poliovirus. The Committee unanimously agreed that the risk of polio spread continues to be a Public Health Emergency of International Concern (PHEIC) and proposed an extension of Temporary Recommendations for an additional three months. The Committee expressed concern that complacency to achieving a polio-free world could now become the biggest risk to the effort and urged that all countries and partners regard polio eradication as an emergency.  “We have the tools, we need to focus on what works, we need to get to every child,” commented Prof. Helen Rees, Chairperson of the Committee.  “The reality is that there is no reason why we should not be able to finish this job, but we have to keep at it.”  Prof. Rees and the Committee urged countries, donors and partners to continue their support, until a polio-free world is achieved, cautioning that failure to eradicate polio would lead to global resurgence of the disease, with potentially as many as 200,000 new cases occurring annually within ten years.  “We have achieved eradication of a disease once before, with smallpox,” Rees concluded.  “The world is a much better place without smallpox.  It’s now more urgent than ever that we redouble our efforts and finish this job once and for all as well.”  The recommendations come amid the notification of the fourth cVDPV circulation in DRC, which underscores the need for sustained partnership, funding, and socio-political resolve. Read the full WHO statement including the Temporary Recommendations.

:: The Africa Regional Commission for the Certification of poliomyelitis eradication (ARCC) was held in Nairobi, Kenya, from 12-16 November 2018. Made up of 16 health experts, recommendations were made to ten countries to address issues of disease surveillance gaps, inaccessibility and insecurity. Read the recommendations here.

The Technical Advisory Groups (TAG) on Polio Eradication in Horn of Africa and Lake Chad Basin convened recently, to review the current status of polio outbreaks in both the regions and provide guidance on the next phase of the outbreak response.

::Featured on http://www.polioeradication.org: Coffee with Polio Experts – Dr Mohammad Al Safadi, Technical Officer for Polio Outbreak Preparedness and Response, talks about the tactics and strategies used to stop the Syria outbreaks of 2013, 2014, and the most recent outbreak of 2017, which was compounded by accessibility, security, and conflict issues.

:: Call for nomination of experts to serve on the Polio Research Committee to provide guidance to the Director of the Polio Department at WHO HQ on the research and development aspects in poliovirus eradication. Read the details here.

The GPEI report to the upcoming WHO Executive Board (in January) has been published.  The report provides a status update on polio eradication, summarizing programmatic, epidemiological and financial challenges to securing a lasting polio-free world, and introduces the concept of a new extended strategic plan to achieve global certification by 2023, taking into account the fact that circulation of wild poliovirus has not yet been interrupted.  Read the report here.

 
 
Summary of new viruses this week:
Afghanistan – one wild poliovirus type 1 (WPV1) case and two positive WPV 1 environmental samples.
Pakistan – nine WPV1 positive environmental samples.
DRC – two cases of circulating vaccine-derived poliovirus type 2 (cVDPV2).
Nigeria – four cases of cVDPV2.
Somalia – one positive cVDPV2 environmental sample. See country sections below for more details.

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Djibouti carries out mass immunization to protect children against polio, amid outbreaks in the Horn of Africa

5 December 2018 – Early analysis of campaign data points to a successful vaccination round in a polio-free country at risk of possible importation.
In the last week of October, Djibouti’s Ministry of Health, working with WHO, UNICEF and other partners, successfully carried out the country’s first polio National Immunization Days (NIDs) since 2015.
While Djibouti has not had a case of polio since 1999, the recent outbreak of polio in neighbouring countries in the Horn of Africa, and the low levels of routine immunization coverage in some areas in the country, are indications that Djibouti is still at risk if poliovirus spreads through population movements. Other countries in the Horn of Africa are already cooperating to control the existing outbreak and to reduce the risk of spread, and given that Djibouti is on a major migration route in the Horn of Africa, it makes a lot of sense for Djibouti to join this coordinated response…

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Countries of the Americas seek to strengthen measures to keep the Region free of polio and move towards global eradication (12/05/2018)
PAHO convenes strategic partners and 140 public health professionals from 22 countries in the Region, in Guatemala this week. If polio is not eradicated there could be up 200,000 new cases worldwide each year within ten years.

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Global Polio Eradication Initiative – Certification of poliovirus eradication
November 2018 :: Statement
Global Commission for the Certification of Poliomyelitis Eradication (GCC) reviews criteria for certification
Attaining and sustaining a world free from all polioviruses
On 29-31 October 2018, the Global Commission for Certification of Poliomyelitis Eradication (GCC) met to review the criteria that will need to be met to achieve global certification of wild poliovirus (WPV) eradication.

As the world approaches successful eradication of WPV transmission, the GCC’s work takes on urgency, including consideration of circulating vaccine-derived polioviruses (cVDPVs). While these are not a new phenomenon, they become more significant, as does the need for effective containment of all polioviruses in laboratories and vaccine manufacturing facilities. The GCC has recommended a process of sequential certification of WPV eradication and confirmation of the absence of VDPVs, when the data become available. The Director General has accepted the GCC recommendation for sequential certification.

While the operational and programmatic aspects of achieving and sustaining a world free of all polioviruses – be they wild or vaccine-derived – have been well-established, the GCC is focusing its discussions on the necessary verification processes associated with this eventual achievement. Following the certification that WPV transmission has been stopped – and after OPV has been withdrawn – the absence of VDPVs will also need to be validated.

The assessment that all WPV transmission has been interrupted globally is the critical step which will mark the launch of preparations for cessation of all oral polio vaccine (OPV) use. Inadequate routine immunization levels coupled with subnational gaps in surveillance in high-risk countries continue to be the main risk factors for the emergence or continuation of cVDPVs. Both risk factors must be addressed. However, the only and surest way to prevent cVDPVs in the future is to rapidly stop OPV use, which can only occur after the successful eradication of WPVs. As such, the polio eradication program now has two urgent tasks – to eradicate WPVs as quickly as possible and to stop the use of OPV globally.

With no wild poliovirus type 3 (WPV3) reported globally since November 2012 (from Nigeria), the GCC concluded that the world could be ready to certify the eradication of WPV3, and urged the GPEI and Member States to ensure that full documentation is available to achieve this goal. This type-specific global certification would ideally follow a similar process as that used for the certification of WPV2 eradication in 2015. The GCC recommended that the GPEI conduct a comprehensive review of the implications of such sequential certification, and report back to it in 2019.

The GCC also continues to evaluate evidence that polioviruses will be rigorously contained where they are being held (in a limited number of research or diagnostics laboratories, and in vaccine manufacturing facilities). The Containment Advisory Group and the Containment Working Group guide the operationalization of this work, through implementation of the WHO Global Action Plan to minimize poliovirus facility-associated risk after type-specific eradication of wild polioviruses and sequential cessation of oral polio vaccine use (GAPIII).

The WHO Director-General has accepted the outcomes and recommendations of the GCC and these will be incorporated into a global strategy for eradication covering the period 2019-2023 (currently being developed in a broad consultative process, and to be presented to the World Health Assembly in May 2019). The full report from the GCC’s meeting will subsequently be made available upon publication at www.polioeradication.org.

The GCC’s work and efforts will assure the independent verification that transmission of all polioviruses has been interrupted globally, and that all necessary safeguards to sustain a polio-free world have been put in place.

Additional background:
The GCC is independent of WHO and of involvement in national polio vaccination implementation or polio surveillance programmes. WHO Regions are eligible for certification following the absence of WPV from any country in that region from any population source in the presence of certification-standard surveillance. Regional certification is conducted by Regional Certification Commissions (RCCs). Global certification will follow the successful certification of all six WHO regions, and will be conducted by the GCC.
As at 2018, four regions have been certified as free of WPVs: Region of the Americas (1994), the Western Pacific Region (2000), the European Region (2002),  and the South-East Asia Region (2014).
  For more information, please see:
http://polioeradication.org/polio-today/preparing-for-a-polio-free-world/certification/
http://polioeradication.org/polio-today/preparing-for-a-polio-free-world/containment/

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Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.
 
 
WHO Grade 3 Emergencies  [to 8 Dec 2018]
Democratic Republic of the Congo
:: 18: Situation report on the Ebola outbreak in North Kivu  5 December 2018
:: DONs Ebola virus disease – Democratic Republic of the Congo   6 December 2018
[See Milestones above for more detail]
 
 
Bangladesh – Rohingya crisis
:: Weekly Situation Report 53 -30 November 2018
[Excerpt]
HEALTH OPERATIONS
OCV Campaign:
After completion of 2nd week of OCV campaign, 163,441 ( 101.5%.) received the vaccination. Among them 119,649 (107.3%) were FDMN beneficiaries and 43,792 (88.5%) from host community. Out of total target of 328, 556, 49.7% vaccination completed. Among them 53.2% were FDMN beneficiaries and 42.3% from host community. Besides the major portion of the FDMN and HC: Registered camps, No-man’s land and people engaged in different activities adjacent to camps are being covered.
Rapid Convenience monitoring through house to house:
In total 2116 beneficiaries were interviewed till 28 November 2018. Evaluated coverage was 92.5%. The main reasons not being vaccinated were beneficiaries not at home (32%), not aware of campaign (23%) and beneficiaries too busy (14%). The main means of mobilization were majhee and FDMN mobilizers (46.2), megaphone (30.1) and moni flag (17.5)…
 
 
Syrian Arab Republic
:: WHO update on reported chemical event in Aleppo, Syria   29 November 2018
 
 
Myanmar – No new announcements identified
Nigeria – No new announcements identified
Somalia – No new announcements identified
South Sudan – No new announcements identified
Yemen – No new announcements identified
 
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WHO Grade 2 Emergencies  [to 8 Dec 2018]
Sudan
:: WHO Member States sign Khartoum Declaration on Sudan and Bordering Countries: Cross-Border Health Security
4 December 2018 – Six countries in WHO’s Eastern Mediterranean and African Regions have signed a declaration committing themselves to strengthening preparedness and response to public health threats and events across borders in an effort to further the implementation of the International Health Regulations (IHR 2005) and enhance global health security. The Khartoum Declaration on Sudan and Bordering Countries: Cross-Border Health Security was signed by Chad, Egypt, Ethiopia, Libya, South Sudan and Sudan on 22 November 2018 in Khartoum, Sudan…
 
 
Brazil (in Portugese) – No new announcements identified
Cameroon  – No new announcements identified
Central African Republic  – No new announcements identified
Ethiopia – No new announcements identified
Hurricane Irma and Maria in the Caribbean – No new announcements identified
Iraq – No new announcements identified
occupied Palestinian territory – No new announcements identified
Libya – No new announcements identified
MERS-CoV – No new announcements identified
Niger – No new announcements identified
Sao Tome and Principe Necrotizing Cellulitis (2017) – No new announcements identified
Ukraine – No new announcements identified
Zimbabwe – No new announcements identified
 
 
WHO-AFRO: Outbreaks and Emergencies Bulletin, Week 48: 24-30 November 2018
The WHO Health Emergencies Programme is currently monitoring 57 events in the region. This week’s edition covers key ongoing events, including:
:: Yellow fever in South Sudan
:: Ebola virus disease in the Democratic Republic of the Congo
:: Cholera in Zimbabwe
:: Hepatitis E in Central African Republic
:: Humanitarian crisis in Ethiopia.
 
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WHO Grade 1 Emergencies  [to 8 Dec 2018]
Afghanistan
Chad
Indonesia – Sulawesi earthquake 2018
Kenya
Lao People’s Democratic Republic
Mali
Namibia – viral hepatitis
Peru
Philippines – Tyhpoon Mangkhut
Tanzania
 
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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: Al Hudaydah Update Situation Report No. 15, Reporting period: 14 November – 2 December 2018

Syrian Arab Republic   No new announcements identified.

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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.

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 “Other Emergencies”
Indonesia: Central Sulawesi EarthquakeNo new announcements identified.
 
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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 8 Dec 2018]
http://www.who.int/ebola/en/
:: 18: Situation report on the Ebola outbreak in North Kivu  5 December 2018
:: DONs Ebola virus disease – Democratic Republic of the Congo   6 December 2018
[See Milestones above for more detail]
 
 
MERS-CoV [to 8 Dec 2018]
http://who.int/emergencies/mers-cov/en/
No new announcements identified.
 
 
Yellow Fever  [to 8 Dec 2018]
http://www.who.int/csr/disease/yellowfev/en/
No new announcements identified.
Zika virus  [to 8 Dec 2018]
http://www.who.int/csr/disease/zika/en/
No new announcements identified.
 
 

WHO & Regional Offices [to 8 Dec 2018]

WHO & Regional Offices [to 8 Dec 2018]
7 December 2018
News Release
New WHO report highlights insufficient progress to tackle lack of safety on the world’s roads

5 December 2018
News Release
Health benefits far outweigh the costs of meeting climate change goals

3 December 2018
Statement
WHO statement for COP24

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Weekly Epidemiological Record, 7 December 2018, vol. 93, 49 (pp. 661–680)
:: Meeting of the Strategic Advisory Group of Experts on Immunization, October 2018 – Conclusions and recommendations

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GIN November 2018  pdf, 1.22Mb 3 December 2018

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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: Ethiopia launches Human Papillomavirus Vaccine for 14 year old girls  06 December 2018
:: Niger vaccinates 152,000 people against cholera in high-risk areas  06 December 2018
:: African countries test their capacity to respond to a deadly global flu pandemic  04 December 2018
:: Uganda and DRC bordering districts agree to intensify cross-border surveillance to tackle Ebola  03 December 2018
:: Tackling cholera outbreaks in North-east humanitarian emergencies   03 December 2018

WHO Region of the Americas PAHO
:: Countries of the Americas seek to strengthen measures to keep the Region free of polio and move towards global eradication (12/05/2018)
PAHO convenes strategic partners and 140 public health professionals from 22 countries in the Region, in Guatemala this week. If polio is not eradicated there could be up 200,000 new cases worldwide each year within ten years. 

WHO South-East Asia Region SEARO
– No new announcement identified

WHO European Region EURO
:: Health is a human right 07-12-2018
:: Preventing hospital-acquired infections in eastern Ukraine saves lives 06-12-2018
:: Interparliamentary Assembly of Member Nations of the Commonwealth of Independent States supports international measures to stop illicit tobacco trade 04-12-2018

WHO Eastern Mediterranean Region EMRO
:: Initiating hepatitis C treatment in Afghanistan  5 December 2018
:: Djibouti carries out mass immunization to protect children against polio 5 December 2018

WHO Western Pacific Region
– No new announcement identified