Vaccines and Global Health: The Week in Review :: 25 January 2020

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– 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 mourns death of Dr. Peter Salama :: WHO mourns passing of Dr Peter Salama

Milestones :: Perspectives :: Research

 

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UNICEF mourns death of Dr. Peter Salama
Statement by Henrietta Fore, UNICEF Executive Director
NEW YORK, 24 January 2020 – “The entire UNICEF family is deeply saddened by the sudden death of Dr. Peter Salama from a heart attack in Geneva.

“Pete was a tireless advocate for children, a committed humanitarian and a highly respected professional.

“He was an inspiring and caring leader across a number of roles within UNICEF, as Chief of Health and Nutrition in Afghanistan, as Representative in Ethiopia and Zimbabwe, as Regional Director for the Middle East and North Africa in Jordan, as Global Chief of Health and HIV and as Global Ebola Coordinator in New York.

“Pete left UNICEF in 2016 to join the World Health Organization as Executive Director of its Health Emergencies Programme before becoming Executive Director of its Division of Universal Health Coverage – Life Course.

“All of us who had the privilege of working with Pete knew that he embodied the spirit of UNICEF like few others.

“Our most heartfelt condolences to his wife, his three children and all his friends and colleagues around the world. He will be sorely missed.”

WHO mourns passing of Dr Peter Salama

24 January 2020 – Statement

The World Health Organization announces with deep sadness the sudden death of Dr Peter Salama, Executive Director of WHO’s Division for Universal Health Coverage – Life Course.

The Organization extends its most profound sympathies and condolences to Dr Salama’s family, friends and colleagues. He was 51 and leaves behind his wife and three children.

“Pete embodied everything that is best about WHO and the United Nations – professionalism, commitment and compassion,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Our hearts are broken.”

Dr Salama, a medical epidemiologist from Australia, joined WHO in 2016 as Executive Director of WHO’s Health Emergencies programme, which he led until 2019.

Before joining WHO, Dr Salama was Regional Director for the Middle East and North Africa at UNICEF, an organization that he joined in 2002.

Dr Salama led UNICEF’s global response to Ebola, served as its Representative in Ethiopia and Zimbabwe (2009–2015), Chief of Global Health and Principal Advisor on HIV/AIDS in New York (2004–2009), and Chief of Health and Nutrition in Afghanistan (2002–2004).

He had also worked with Médecins Sans Frontières and Concern Worldwide in several countries in Asia and sub-Saharan Africa.

Wuhan+ – Novel Coronavirus [2019-nCoV]

Wuhan+ – Novel Coronavirus [2019-nCoV]

 
Situation report – 4 – WHO
Novel Coronavirus (2019-nCoV)
24 January 2020
[Excerpt]
PREPAREDNESS AND RESPONSE

WHO:
:: WHO has published an updated advice for international traffic in relation to the outbreak of the novel coronavirus 2019-nCoV;

:: WHO has been in regular and direct contact with Chinese as well as Japanese, Korean and Thai authorities since the reporting of these cases. The three countries have shared information with WHO under the International Health Regulations. WHO is also informing other countries about the situation and providing support as requested;

:: On 2 January, the incident management system was activated across the three levels of WHO (country office, regional office and headquarters);

:: Developed the surveillance case definitions for human infection with 2019-nCoV and is updating it as the new information becomes available;

:: Developed interim guidance for laboratory diagnosis, clinical management, infection prevention and control in health care settings, home care for mild patients, risk communication and community engagement;

:: Prepared disease commodity package for supplies necessary in identification and management of confirmed patients;

:: Provided recommendations to reduce risk of transmission from animals to humans;

:: Utilizing global expert networks and partnerships for laboratory, infection prevention and control, clinical management and mathematical modelling;

:: Activation of R&D blueprint to accelerate diagnostics, vaccines, and therapeutics;

:: WHO is working with our networks of researchers and other experts to coordinate global work on surveillance, epidemiology, modelling, diagnostics, clinical care and treatment, and other ways to identify, manage the disease and limit onward transmission. WHO has issued interim guidance for countries, updated to take into account the current situation.

 
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National Health Commission of the People’s Republic of China
http://en.nhc.gov.cn/

Data key to staying ahead of pneumonia
China will continue to publicly post daily information on the new viral pneumonia outbreak and prevention and control measures taken by the government, the National Health Commission said on Jan 22.

 
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CEPI to fund three programmes to develop vaccines against the novel coronavirus, nCoV-2019
OSLO, NORWAY. Jan 23, 2020 – CEPI, the Coalition for Epidemic Preparedness Innovations, today announced the initiation of three programmes to develop vaccines against the novel coronavirus, nCoV-2019.

The programmes will leverage rapid response platforms already supported by CEPI as well as a new partnership. The aim is to advance nCoV-2019 vaccine candidates into clinical testing as quickly as possible.

The nCoV-2019 vaccine development efforts will build on existing partnerships with Inovio (Nasdaq: INO) and The University of Queensland (located in Brisbane, Australia). In addition, CEPI today announces a new partnership with Moderna, Inc., (Nasdaq: MRNA) and the U.S. National Institute of Allergy and Infectious Diseases.

All of these are pioneering technologies designed to speed up the development of vaccines against emerging threats such as nCoV-2019.

“Given the rapid global spread of the nCoV-2019 virus the world needs to act quickly and in unity to tackle this disease. Our intention with this work is to leverage our work on the MERS coronavirus and rapid response platforms to speed up vaccine development. There are no guarantees of success, but we hope this work could provide a significant and important step forward in developing a vaccine for this disease. Our aspiration with these technologies is to bring a new pathogen from gene sequence to clinical testing in 16 weeks – which is significantly shorter than where we are now,” said Richard Hatchett, CEO of CEPI.

The term “platform technology” broadly refers to systems that use the same basic components as a backbone but can be adapted for use against different pathogens as needed by inserting new genetic or protein sequences.

CEPI has moved with great urgency and in coordination with WHO, who is leading the development of a coordinated international response, to promote the development of new vaccines against the emerging threat of nCoV-2019. The novel coronavirus represents the first new epidemic disease of note to emerge since CEPI’s founding at Davos in 2017, with the express intent that it should be ready to respond to epidemics rapidly and effectively, wherever they emerge…

 
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CDC: Transcript of 2019 Novel Coronavirus (2019-nCoV) Response

Friday, January 24, 2020
[Excerpt]
Dr. Nancy Messonnier:

…To date, we have 63 of what we are calling patients under investigation or PUIs from 22 states.  So far, only two have been confirmed positive and 11 tested negative.  We anticipate by next week we’ll begin regular reporting of case information on our website.  There are likely to be many more PUIs identified in the coming days.

We have faced similar public health challenges before.  Those outbreaks were complex and required a comprehensive public health response.  This is what we are preparing for.  We have an aggressive response with the goal of identifying potential cases early. We want to make sure these patients get the best and most appropriate care.  This is a rapidly changing situation both abroad and domestically, and we are still learning.  Let’s remember this virus is identified within the past month and there is much we don’t know yet.  We are expecting more cases in the U.S., and we are likely going to see some cases among close contacts of travelers and human to human transmission.

Our goal is always to protect the health of Americans.  We at CDC have our best people working on this problem.  We have support across the entirety of the Federal Government.  We have one of the strongest public health systems in the world.  Again, while there are many unknowns, CDC believes that the immediate risk to the American public continues to be low at this time, but that the situation continues to evolve rapidly.

CDC recommends travelers avoid all non-essential travel to Wuhan.  We also recommend people traveling to other parts of China practice certain health precautions, like avoiding contact with people who are sick and practicing good hand hygiene.  Returning travelers with symptoms, or close contact with people confirmed with coronavirus, may be asked to take precautionary measures and there may be some disruptions.  I want to thank those people in advance for their cooperation.  Everyone can do their part here.

Although Chinese officials have closed transport within and out of Wuhan, China, CDC will continue to conduct enhanced screening at five designated airports: New York JFK, San Francisco, LAX, Chicago O’Hare and Atlanta Hartsfield-Jackson. We are currently evaluating the extent and duration of this enhanced screening.  Every day we learn more and every day we assess to see if our guidance or response can be improved.  As the response evolves, CDC will continue our aggressive public health response strategy.  Thank you…

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Statement on the meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV)

23 January 2020

Statement, Geneva, Switzerland

The meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) regarding the outbreak of novel coronavirus 2019 in the People’s Republic of China, with exportations currently reported in the Republic of Korea, Japan, Thailand and Singapore, took place on Wednesday, 22 January 2020, from 12:00 to 16:30 Geneva time (CEST) and on Thursday, 23 January 2020, from 12:00 to 15:10. The Committee’s role is to give advice to the Director-General, who makes the final decision on the determination of a Public Health Emergency of International Concern (PHEIC). The Committee also provides public health advice or suggests formal temporary recommendations as appropriate.

Proceedings of the meeting

Members and advisors of the Emergency Committee were convened by teleconference.

The Director-General welcomed the Committee and thanked them for their support. He turned the meeting over to the Chair, Professor Didier Houssin.

Professor Houssin also welcomed the Committee and gave the floor to the Secretariat.

On 22 January, representatives of WHO’s legal department and the department of compliance, risk management, and ethics briefed the Committee members on their roles and responsibilities.

Committee members were reminded of their duty of confidentiality and their responsibility to  disclose personal, financial, or professional connections that might be seen to constitute a conflict of interest. Each member who was present was surveyed and no conflicts of interest were judged to be relevant to the meeting.

The Chair then reviewed the agenda for the meeting and introduced the presenters.

On 23 January, representatives of the Ministry of Health of the People’s Republic of China, Japan, Thailand and the Republic of Korea updated the committee on the situation in their countries. There have been increased numbers of reported cases in China, with 557 confirmed as of today.

Conclusions and Advice

On 22 January, the members of the Emergency Committee expressed divergent views on whether this event constitutes a PHEIC or not. At that time, the advice was that the event did not constitute a PHEIC, but the Committee members agreed on the urgency of the situation and suggested that the Committee should be reconvened in a matter of days to examine the situation further.

After the announcement of new containment measures in Wuhan on 22 January, the Director-General asked the Emergency Committee to reconvene on 23 January to study the information provided by Chinese authorities about the most recent epidemiological evolution and the risk-management measures taken.

Chinese authorities presented new epidemiological information that revealed an increase in the number of cases, of suspected cases, of affected provinces, and the proportion of deaths in currently reported cases of 4% (17 of 557). They reported fourth-generation cases in Wuhan and second-generation cases outside Wuhan, as well as some clusters outside Hubei province. They explained that strong containment measures (closure of public-transportation systems in Wuhan City, as well as other nearby cities). After this presentation, the EC was informed about the evolution in Japan, Republic of Korea, and Thailand, and that one new possible case had been identified in Singapore.

The Committee welcomed the efforts made by China to investigate and contain the current outbreak.

   The following elements were considered as critical:

:: Human-to-human transmission is occurring and a preliminary R0 estimate of 1.4-2.5 was presented. Amplification has occurred in one health care facility. Of confirmed cases, 25% are reported to be severe. The source is still unknown (most likely an animal reservoir) and the extent of human-to-human transmission is still not clear. 

:: Several members considered that it is still too early to declare a PHEIC, given its restrictive and binary nature. 

Based on these divergent views, the EC formulates the following advice:

To WHO

The Committee stands ready to be reconvened in approximately ten days’ time, or earlier should the Director-General deem it necessary.

The Committee urged to support ongoing efforts through a WHO international multidisciplinary mission, including national experts. The mission would review and support efforts to investigate the animal source of the outbreak, the extent of human-to-human transmission, the screening efforts in other provinces of China, the enhancement of surveillance for severe acute respiratory infections in these regions, and to reinforce containment and mitigation measures. A mission would provide information to the international community to aid in understanding of the situation and its potential public health impact.

WHO should continue to provide all necessary technical and operational support to respond to this outbreak, including with its extensive networks of partners and collaborating institutions, to implement a comprehensive risk communication strategy, and to allow for the advancement of research and scientific developments in relation to this novel coronavirus.

In the face of an evolving epidemiological situation and the restrictive binary nature of declaring a PHEIC or not, WHO should consider a more nuanced system, which would allow an intermediate level of alert. Such a system would better reflect the severity of an outbreak, its impact, and the required measures, and would facilitate improved international coordination, including research efforts for developing medical counter measures.

To the People’s Republic of China

:: Provide more information on cross-government risk management measures, including crisis management systems at national, provincial, and city levels, and other domestic measures.

:: Enhance rational public health measures for containment and mitigation of the current outbreak.

:: Enhance surveillance and active case finding across China, particularly during the Chinese New Year celebration.

:: Collaborate with WHO and partners to conduct investigations to understand the epidemiology and the evolution of this outbreak, including specific investigations to understand the source of the novel coronavirus, notably the animal reservoir, and animals involved in the zoonotic transmission, as well as the understanding of its full potential for human-to-human transmission, and where transmission is taking place, the clinical features associated with infection, and the required treatment to reduce morbidity and mortality.

:: Continue to share full data on all cases with WHO, including genome sequences, and details of any health care worker infections or clusters.

:: Conduct exit screening at international airports and ports in the affected provinces, with the aims early detection of symptomatic travelers for further evaluation and treatment, while minimizing interference with international traffic.

:: Encourage screening at domestic airports, railway stations, and long-distance bus stations as necessary.

To other countries

It is expected that further international exportation of cases may appear in any country. Thus, all countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoV infection, and to share full data with WHO.

Countries are required to share information with WHO according to the IHR.

Technical advice is available here.  Countries should place particular emphasis on reducing human infection, prevention of secondary transmission and international spread and contributing to the international response though multi-sectoral communication and collaboration and active participation in increasing knowledge on the virus and the disease, as well as advancing research. Countries should also follow travel advice from WHO.

To the global community

As this is a new coronavirus, and it has been previously shown that similar coronaviruses required substantial efforts for regular information sharing and research, the global community should continue to demonstrate solidarity and cooperation, in compliance with Article 44 of the IHR (2005), in supporting each other on the identification of the source of this new virus, its full potential for human-to-human transmission, preparedness for potential importation of cases, and research for developing necessary treatment.

The Director-General thanked the Committee for its advice.

WHO – 146th session of the Executive Board

WHO – 146th session of the Executive Board
Geneva, 3–8 February 2020.
Main Documents [selected documents/Editor’s text bolding]]

EB146/1 Rev.1
Provisional agenda

EB146/1(annotated)
Provisional agenda (annotated)

EB146/6
Follow-up to the high-level meetings of the United Nations General Assembly on health-related issues
Universal health coverage: moving together to build a healthier world

EB146/7
Follow-up to the high-level meetings of the United Nations General Assembly on health-related issues
Political declaration of the third high-level meeting of the General Assembly on the prevention and control of non-communicable diseases

EB146/8
Global vaccine action plan

EB146/9
Accelerating the elimination of cervical cancer as a global public health problem

EB146/10
Ending tuberculosis
Progress in implementing the global strategy and targets for tuberculosis prevention, care and control after 2015 (the End TB Strategy)

EB146/11
Ending tuberculosis
Draft global strategy for tuberculosis research and innovation

EB146/14
Neglected tropical diseases

EB146/15
Global strategy and plan of action on public health, innovation and intellectual property

EB146/16
Public health emergencies: preparedness and response
Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme

EB146/17
Public health preparedness and response
WHO’s work in health emergencies

EB146/18
Influenza preparedness

EB146/19
The public health implications of implementation of the Nagoya Protocol

EB146/20
Public health emergencies: preparedness and response
Cholera prevention and control

EB146/21
Poliomyelitis
Polio eradication

EB146/22
Poliomyelitis
Polio transition planning and polio post-certification

Emergencies

Emergencies

Ebola – DRC+
Public Health Emergency of International Concern (PHEIC)

Ebola Outbreak in DRC 76: 21 January 2020
Situation Update
From 13 to 19 January 2020, 15 new confirmed cases of Ebola virus disease (EVD) were reported from North Kivu Province in the Democratic Republic of the Congo. The cases were reported from Beni (9 cases) and Mabalako (6 cases) Health Zones and all were linked to a confirmed case in a known chain of transmission…

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POLIO
Public Health Emergency of International Concern (PHEIC)
http://polioeradication.org/polio-today/polio-now/this-week/

Polio this week as of 22 January 2020
:: The GPEI Polio Partners Group convened the eighth annual technical workshop on 6 December 2019 where a global overview of the status of poliovirus detection was presented among other polio updates. The meeting presentations are now available here.

Summary of new viruses this week (AFP cases and ES positives):
:: Afghanistan: one WPV1 case and three WPV1-positive environmental samples
:: Pakistan: two WPV1 cases, four WPV1-positive environmental samples and six cVDPV2 cases
:: Democratic Republic of the Congo (DR Congo):  ten cVDPV2 cases
:: Côte d’Ivoire: two cVDPV2 positive environmental samples
:: Ghana: two cVDPV2 positive environmental samples
:: Malaysia: two cVDPV1 cases
:: Philippines: two cVDPV2 cases and two cVDPV2 positive environmental samples
:: Togo: one cVDPV2 case

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Rotary and the Bill & Melinda Gates Foundation extending fundraising partnership to eradicate polio
Partnership will infuse an additional US$450 million into global polio eradication effort
EVANSTON, Ill., Jan. 22, 2020 /PRNewswire/ — Rotary and the Bill & Melinda Gates Foundation are renewing their longstanding partnership to end polio, announcing a joint commitment of up to $450 million to support the global polio eradication effort…
…In addition to the extended funding partnership with the Gates Foundation, Rotary is also announcing US$45 million in funding for polio eradication efforts in countries throughout Africa (Angola, Ethiopia, Mali, Nigeria, Somalia and South Sudan), and Asia (Afghanistan, Pakistan, Papua New Guinea, Pakistan and the Philippines). The funding will help support crucial polio eradication activities such as immunization and disease detection, research, and community mobilization…

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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 25 Jan 2020]

Democratic Republic of the Congo
:: Ebola Outbreak in DRC 76: 21 January 2020
[See Ebola above for detail]

Mozambique floods – No new digest announcements identified
Nigeria – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified

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WHO Grade 2 Emergencies [to 25 Jan 2020]
Angola
:: Angola honours WHO Representative at end of mission 22 January 2020

Measles in Europe
:: Strengthening response to measles outbreak in Ukraine 22-01-2020

Afghanistan – No new digest announcements identified
Burkina Faso [in French] – No new digest announcements identified
Burundi – No new digest announcements identified
Cameroon – No new digest announcements identified
Central African Republic – No new digest announcements identified
Ethiopia – No new digest announcements identified
HIV in Pakistan – No new digest announcements identified
Iran floods 2019 – No new digest announcements identified
Iraq – No new digest announcements identified
Libya – No new digest announcements identified
Malawi floods – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Myanmar – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

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WHO Grade 1 Emergencies [to 25 Jan 2020]

Chad – No new digest announcements identified
Djibouti – No new digest announcements identified
Kenya – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Tanzania – No new digest announcements identified

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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. 
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest 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.
CYCLONE IDAI and Kenneth – No new digest announcements identified
EBOLA OUTBREAK IN THE DRC – No new digest announcements identified

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WHO & Regional Offices [to 25 Jan 2020]

WHO & Regional Offices [to 25 Jan 2020]
Message for World Leprosy Day 2020
24 January 2020 Statement

Effective outbreak response reduces the risk of measles spread in the Pacific
Joint WHO-UNICEF statement on Pacific measles situation
In 2019, the Pacific saw the re-emergence of measles, with outbreaks declared in Samoa, Tonga, Fiji and American Samoa, and cases reported in Kiribati. For Samoa, the country experienced a widescale measles outbreak which had significant impact upon the country’s population and health system. The disease has cost lives, with infants and young children being most affected.
In response to the identification of measles in the region, many Pacific countries and areas have made serious efforts to close immunity gaps in their population and strengthen infectious disease prevention, surveillance and response systems. These efforts align to the core public health capacities required by all countries under the International Health Regulations (IHR) 2005, and critical to preventing and controlling the spread of infectious diseases, such as measles.
The governments of Samoa, Tonga and Fiji, have conducted vaccination campaigns aimed at closing immunity gaps in their populations to stop the transmission of the virus. These immunization activities are bringing the outbreaks under control. In Samoa, the mass immunization campaign which targeted individuals aged six months to 60 years achieved 95 per cent vaccination coverage, the rate needed to prevent measles transmission in a population.  Fiji and Tonga continue immunizing those most at risk of measles to meet the target of 95 per cent and ensure that populations are protected. Other Pacific countries and areas have also conducted supplementary immunization activities to reduce the risk of potential measles outbreaks.
Due to the public health efforts of Pacific countries and areas, the risk of measles spreading in Samoa and in other Pacific Island countries and areas has notably reduced…

 

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Weekly Epidemiological Record, 24 January 2020, vol. 95, 04 (pp. 25–36)
Global Advisory Committee on Vaccine Safety, 4–5 December 2019

 

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Calls for consultants / proposals
Health impact and cost-effectiveness of introduction of diphtheria, tetanus and pertussis booster doses in low- and middle-income countries pdf, 1.05Mb
Deadline for applications: 14 February 2020

 

WHO African Regions Immunization Technical Advisory Group (RITAG)
:: Call for nominations pdf, 147kb Deadline for applications: 28 February 2020
:: RITAG Terms of Reference pdf, 211kb
:: RITAG application annexes pdf, 91kb

 

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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
No new digest content identified.

WHO Region of the Americas PAHO
:: PAHO Director urges readiness to detect cases of new coronavirus in the Americas (01/24/2020)
:: Haiti reaches one-year free of Cholera (01/23/2020)
:: PAHO issues epidemiological alert on Novel Coronavirus for the Americas (01/20/2020)

WHO South-East Asia Region SEARO
No new digest content identified.

WHO European Region EURO
:: 2019-nCoV outbreak: first cases confirmed in Europe 25-01-2020
:: Novel coronavirus outbreak in China – What does it mean for Europe? 24-01-2020
:: New report reveals the role of physical activity in preventing and treating cardiovascular diseases 22-01-2020
:: Romania: tuberculosis patients to avoid unnecessary hospitalization 21-01-2020

WHO Eastern Mediterranean Region EMRO
No new digest content identified.

WHO Western Pacific Region
No new digest content identified.

CDC/ACIP [to 25 Jan 2020]

CDC/ACIP [to 25 Jan 2020]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html
Latest News Releases
Transcript of 2019 Novel Coronavirus (2019-nCoV) Response
Friday, January 24, 2020
[See Milestones above for detail]

Marburg Virus Found Circulating in Bats in West Africa
Friday, January 24, 2020

Second Travel-related Case of 2019 Novel Coronavirus Detected in United States
Friday, January 24, 2020

Transcript of Update on 2019 Novel Coronavirus (2019-nCoV)
Tuesday, January 21, 2020

First Travel-related Case of 2019 Novel Coronavirus Detected in United States
Tuesday, January 21, 2020