Vaccines and Global Health: The Week in Review 15 Feb 2020

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

WHO – 146th session of the Executive Board

Milestones :: Perspectives :: Research

WHO – 146th session of the Executive Board
Geneva, 3–8 February 2020.

Resolutions
In an effort to respond to Member States’ needs, the present texts have been made available as quickly as possible. The definitive versions of the resolutions and decisions adopted, edited for the Official Records, will be made available in due course.
EB146.R1 Appointment of the Regional Director for Africa

EB146.R2 Appointment of the Regional Director for Europe

EB146.R3 Appreciation of the outgoing Regional Director for Europe

EB146.R4 Remuneration of staff in the professional and higher categories

EB146.R5 Salaries of staff in ungraded positions and of the Director-General

EB146.R6 Cervical cancer prevention and control: accelerating the elimination of cervical cancer as a public health problem

EB146.R7 Global strategy for tuberculosis research and innovation

EB146.R8 Integrated people-centred eye care, including preventable vision impairment and blindness

Decisions
In an effort to respond to Member States’ needs, the present texts have been made available as quickly as possible. The definitive versions of the resolutions and decisions adopted, edited for the Official Records, will be made available in due course.
EB146(1) Nelson Mandela Award for Health Promotion

EB146(2) Non-State actors in official relations with WHO

EB146(3) Geneva buildings renovation strategy

EB146(4) Membership of the Independent Expert Oversight Advisory Committee

EB146(5) Participation in the Programme, Budget and Administration Committee of the Executive Board

EB146(6) Meningitis prevention and control

EB146(7) Strengthening global immunization efforts to leave no-one behind
[See full text of Annex at end of this edition]

EB146(8) Epilepsy

EB146(9) Neglected tropical diseases

EB146(10) Global strategy and plan of action on public health, innovation and intellectual property

EB146(11) Polio eradication

EB146(13) Decade of Healthy Ageing

EB146(15) Data and innovation: global strategy on digital health

EB146(18) Primary health care

EMERGENCIES

EMERGENCIES

Editor’s Note:
While we have concentrated key reports below, COVID-19 announcements, analysis and commentary will be found throughout this issue, in all sections.

Coronavirus [COVID-19]
Public Health Emergency of International Concern (PHEIC)

Situation report – 25
Novel Coronavirus (COVID-19)
14 February 2020
[Excerpt]
SITUATION IN NUMBERS
Globally :: 49,053 laboratory-confirmed [2056 new]
China :: 48,548 laboratory-confirmed [1998 new]
:: 1,381 deaths [121 new]
Outside of China
:: 505 laboratory-confirmed [58 new]
:: 24 countries
:: 2 deaths [1 new]

WHO RISK ASSESSMENT
China – Very High
Regional Level – High
Global Level – High

HIGHLIGHTS
:: No new countries reported cases of 2019-nCoV in the past 24 hours.
:: The second death has been reported outside of China, in Japan. This individual did not have known travel history to China.
:: In China, health care workers account for 1716 confirmed cases of COVID-19 including six deaths.

STRATEGIC OBJECTIVES
WHO’s strategic objectives for this response are to:
:: Limit human-to-human transmission including reducing secondary infections among close contacts and health care workers, preventing transmission amplification events, and preventing further international spread from China*;
:: Identify, isolate and care for patients early, including providing optimized care for infected patients;
:: Identify and reduce transmission from the animal source;
:: Address crucial unknowns regarding clinical severity, extent of transmission and infection, treatment options, and accelerate the development of diagnostics, therapeutics and vaccines;
:: Communicate critical risk and event information to all communities and counter misinformation;
:: Minimize social and economic impact through multisectoral partnerships.

*This can be achieved through a combination of public health measures, such as rapid identification, diagnosis and management of the cases, identification and follow up of the contacts, infection prevention and control in health care settings, implementation of health measures for travelers, awareness-raising in the population and risk communication.

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National Health Commission of the People’s Republic of China
http://en.nhc.gov.cn/
News
:: Daily briefing on novel coronavirus cases in China
Updated: 2020-02-15
…As of 24:00 on Feb 14, the National Health Commission had received 66,492 reports of confirmed cases and 1,523 deaths in 31 provincial-level regions on the Chinese mainland and the Xinjiang Production and Construction Corps, and in all 8,096 patients had been cured and discharged from hospital. There still remained 56,873 confirmed cases (including 11,053 in serious condition) and 8,969 suspected cases. So far, 513,183 people have been identified as having had close contact with infected patients. 169,039 are now under medical observation…

China pushes for differentiated measures to battle coronavirus
Updated: 2020-02-14 Xinhua
Epidemic prevention and control in Hubei Province, particularly in the capital city of Wuhan, remain the top priority, said Premier Li Keqiang.
BEIJING, Feb. 13 (Xinhua) — Chinese authorities on Feb 13 stressed differentiated measures for different regions to fight the novel coronavirus outbreak at a high-level meeting chaired by Premier Li Keqiang.
The leading group of the Communist Party of China (CPC) Central Committee on the prevention and control of the novel coronavirus outbreak also demanded efforts to improve patient treatment and expedite research on drugs.
Epidemic prevention and control in Hubei Province, particularly in the capital city of Wuhan, remain the top priority, said the leading group headed by Li, who is also a member of the Standing Committee of the Political Bureau of the CPC Central Committee.
While ordering Wuhan to speed up hospital admission and suspected case quarantine, the leading group instructed hard-hit cities in Hubei such as Xiaogan and Huanggang to carry out equally strict measures as in Wuhan in surveillance, quarantine and treatment.
The demand for more medics in Hubei and Wuhan should be fulfilled, and the departure channels of the city and the province need further control, according to the meeting.
Multiple steps such as spacing out return trips have prevented large-scale flows of people after the Spring Festival, said the meeting.
Each province is responsible for formulating differentiated epidemic prevention and control strategies based on their own conditions, according to the meeting.
No one-size-fits-all approach should be taken and unfair and extreme practices must be corrected without delay, said the meeting…

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New York Times
http://www.nytimes.com/
Accessed 15 Feb 2020
China’s Leader, Under Fire, Says He Led Coronavirus Fight Early On
In pushing a new account of the country’s response, officials said President Xi Jinping was aware of the outbreak nearly two weeks before he first spoke publicly about it. It could draw him directly into questions about whether Chinese officials did too little, too late.
By Amy Qin
Feb. 15, 2020
Under fire for its response to the coronavirus epidemic, China’s authoritarian government appears to be pushing a new account of events that presents President Xi Jinping as taking early action to fight the outbreak that has convulsed the country.

But in doing so, the authorities have acknowledged for the first time that Mr. Xi was aware of the epidemic and involved in the response nearly two weeks before he first spoke publicly about it — and while officials at its epicenter in the city of Wuhan were still playing down its dangers.
That confirmation risks drawing the president, China’s most powerful leader in decades, directly into questions about whether top officials did too little, too late.

In an internal speech published on Saturday, Mr. Xi said he had “issued demands about the efforts to prevent and control” the coronavirus on Jan. 7, during a meeting of the Politburo Standing Committee, the highest council of the Communist Party, whose sessions are typically cloaked in secrecy.

In the speech, he also said he had authorized the unprecedented lockdown of Wuhan and other cities beginning on Jan. 23.

“I have at every moment monitored the spread of the epidemic and progress in efforts to curtail it, constantly issuing oral orders and also instructions,” Mr. Xi said of his more recent involvement…

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WHO News release 12 February 2020
World experts and funders set priorities for COVID-19 research
Leading health experts from around the world have been meeting at the World Health Organization’s Geneva headquarters to assess the current level of knowledge about the new COVID-19 disease, identify gaps and work together to accelerate and fund priority research needed to help stop this outbreak and prepare for any future outbreaks.

The 2-day forum was convened in line with the WHO R&D Blueprint – a strategy for developing drugs and vaccines before epidemics, and accelerating research and development while they are occurring.

“This outbreak is a test of solidarity — political, financial and scientific. We need to come together to fight a common enemy that does not respect borders, ensure that we have the resources necessary to bring this outbreak to an end and bring our best science to the forefront to find shared answers to shared problems. Research is an integral part of the outbreak response,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “I appreciate the positive response of the research community to join us at short notice and come up with concrete plans and commitment to work together.”

The meeting, hosted in collaboration with GloPID-R (the Global Research Collaboration for Infectious Disease Preparedness) brought together major research funders and over 300 scientists and researchers from a large variety of disciplines. They discussed all aspects of the outbreak and ways to control it including:
:: the natural history of the virus, its transmission and diagnosis;
:: animal and environmental research on the origin of the virus, including management measures at the human-animal interface;
:: epidemiological studies;
:: clinical characterization and management of disease caused by the virus;
:: infection prevention and control, including best ways to protect health care workers;
:: research and development for candidate therapeutics and vaccines;
:: ethical considerations for research;
:: and integration of social sciences into the outbreak response.

“This meeting allowed us to identify the urgent priorities for research. As a group of funders we will continue to mobilize, coordinate and align our funding to enable the research needed to tackle this crisis and stop the outbreak, in partnership with WHO,” said Professor Yazdan Yazdanpanah, chair of GloPID-R. “Equitable access – making sure we share data and reach those most in need, in particular those in lower and middle-income countries, is fundamental to this work which must be guided by ethical considerations at all times.”

During the meeting, the more than 300 scientists and researchers participating both in person and virtually agreed on a set of global research priorities. They also outlined mechanisms for continuing scientific interactions and collaborations beyond the meeting which will be coordinated and facilitated by WHO. They worked with research funders to determine how necessary resources can be mobilized so that critical research can start immediately.

The deliberations will form the basis of a research and innovation roadmap charting all the research needed and this will be used by researchers and funders to accelerate the research response.

WHO News release 13 February 2020
Remarks by Dr Michael Ryan, Executive Director, WHO Health Emergencies Programme at media briefing on COVID-19 on 13 February 2020

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Transcript for CDC Media Telebriefing: Update on COVID-19
Friday, February 14, 2020

FDA’s Actions in Response to 2019 Novel Coronavirus at Home and Abroad
Feb 14, 2020

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Ebola Outbreak in DRC 79: 11 February 2020

Emergencies

 

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

Ebola Outbreak in DRC 79: 11 February 2020
[Excerpts]
Situation Update
From 3 to 9 February 2020, three new confirmed cases of Ebola virus disease (EVD) were reported in Beni Health Zone, North Kivu Province in the Democratic Republic of the Congo (Figure 1). All of the cases were registered as contacts and two were under surveillance at the time of detection.

In the past 21 days (20 January to 9 February 2020), 13 new confirmed cases were reported from four of the 30 health areas in two active health zones in North Kivu Province (Figure 2, Table 1): Beni (92%; n=12) and Mabalako (8%; n=1) Health Zones. Although recent trends of this outbreak, including the small number of weekly cases and limited geographic area affected by EVD are encouraging, continued vigilance is crucial, particularly for contact identification and follow up, in order to interrupt possible nosocomial transmission linked to traditional practitioner facilities. In the last 21 days, there were three cases of the 13 new confirmed cases who passed away in the community, outside of Ebola treatment centres.

The security situation in several EVD-affected health areas remain unstable and unpredictable. On 8 February, a health centre was attacked in Butembo, destroying equipment and infrastructure. On 8 February 2020, an attack on civilians in Mabalako Health Zone led to a suspension of response activities for 48 hours. This attack resulted in displacement of people fearing armed attacks.

As of 9 February 2020, a total of 3431 EVD cases, including 3308 confirmed and 123 probable cases have been reported, of which 2253 cases died (overall case fatality ratio 66%). Of the total confirmed and probable cases, 56% (1920) were female, 28% (968) were children aged less than 18 years, and 5% (172) were healthcare workers…

 

…Conclusion
Beni Health Zone remains the hotspot of this outbreak. Ongoing insecurity in other areas is of concern. Continued access and heightened vigilance is required to maintain case investigation and contact tracing activities in all health zones.

 

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12 February 2020 Statement
Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 12 February 2020
…Conclusions and Advice
It was the unanimous view of the Committee that this event still constitutes a public health emergency of international concern (PHEIC) under the IHR (2005).

The Committee acknowledged the revised risk assessment, which puts the risk now as high at national and regional levels, and low at the global level.

The Committee was concerned that withdrawing the PHEIC now might have adverse consequences for the response efforts through diminishing focus. Additionally, although the primary concern of the Committee is EVD, there are serious ongoing outbreaks of other diseases, including measles and cholera, in DRC. The country continues to need support to combat infectious diseases as well as to strengthen its health system. Further, there remains an urgent need to maintain international solidarity for the response.

The Committee noted the ongoing discussions about the interpretation in the text of the IHR (2005) of the terms international and regional spread, and about creating an intermediate level of response between the binary possibilities of PHEIC or no PHEIC, in a way that does not require reopening negotiations on the Regulations. The Committee supports these discussions, as an intermediate level would be as useful for gradually ending a PHEIC and for signaling the potential for one to be declared…

…Based on this advice, the reports made by the affected State Party, and the currently available information, the Director-General accepted the Committee’s assessment and on 12 February 2020 maintained the Ebola outbreak in the Democratic Republic of the Congo as a Public Health Emergency of International Concern (PHEIC).

 

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ERVEBO® (Ebola Zaire Vaccine, Live) Now Registered in Four African Countries, Within 90 Days of Reference Country Approval and WHO Prequalification
Democratic Republic of the Congo One of the First African Countries to Register ERVEBO
February 14, 2020 11:20 AM Eastern Standard Time
KENILWORTH, N.J.–(BUSINESS WIRE)–Merck (NYSE: MRK), known as MSD outside the United States and Canada, today confirmed that four African countries, including the Democratic Republic of the Congo (DRC), have approved ERVEBO (pronounced er-VEE-boh). ERVEBO was granted a conditional marketing authorization by the European Commission on November 11, 2019 and approved by the U.S. Food and Drug Administration (FDA) on Dec. 20, 2019. In the United States, ERVEBO is indicated for the prevention of disease caused by Zaire ebolavirus in individuals 18 years of age and older. The duration of protection conferred by ERVEBO is unknown. ERVEBO does not protect against other species of Ebolavirus or Marburgvirus. Effectiveness of the vaccine when administered concurrently with antiviral medication, immune globulin (IG), and/or blood or plasma transfusions is unknown…

 

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Polio this week as of 12 February 2020

Emergencies

 

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

Polio this week as of 12 February 2020
:: A time-limited working group has been put together to manage and coordinate GPEI’s activities to enable a rapid and effective roll out of nOPV2. Take a look at the terms of reference for the working group.
:: With the evolving public health emergency associated with the increase in new emergences of circulating vaccine-derived poliovirus type 2, a draft decision was adapted by the WHO Executive Board during last week’s meeting. [see text below]

 

Summary of new viruses this week (AFP cases and ES positives):
:: Pakistan: five WPV1 cases, twelve WPV1 positive environmental samples and three cVDPV2 positive environmental samples
:: Nigeria: one cVDPV2 case and one cVDPV2 positive environmental sample
:: Democratic Republic of the Congo (DR Congo):  two cVDPV2 cases
:: Somalia: two cVDPV2 positive environmental samples
:: Angola: three cVDPV2 cases
:: Cote d’Ivoire: three cVDPV2 positive environmental samples
:: Ethiopia: seven cVDPV2 cases
:: Philippines: one cVDPV2 case and three cVDPV2 positive environmental samples

 

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WHO EXECUTIVE BOARD
146th session Provisional agenda item 16.1
24 January 2020 EB 146/21 Add.1
Poliomyelitis
Polio eradication :: Draft decision
The Executive Board is invited to consider the following draft decision:
The Executive Board, having considered the report on poliomyelitis: polio eradication;1 noting with great concern the evolving public health emergency associated with the increase in new emergences due to circulating vaccine-derived poliovirus type 2, particularly in parts of Africa; and noting the development of the draft Strategy for Control of cVDPV2 2019–2021, an addendum to the Polio Endgame Strategy 2019–2023,2 to more effectively address the evolving circulating vaccine-derived poliovirus type 2 epidemiology, decided:

(1) to request the Director-General to: (a) continue to ensure adequate and uninterrupted supply of oral polio vaccine type 2 to respond to such outbreaks, in line with existing mandates; (b) accelerate the assessment and roll-out of a novel oral polio vaccine type 2 including through the WHO Emergency Use Listing procedure; (c) initiate a transparent and evidence-based process for prioritizing the equitable allocation of limited supplies of novel oral polio vaccine type 2; and,

(2) to urge Member States to: (a) expedite the processes for authorizing the importation and use of vaccines to respond to polio outbreaks, including novel oral polio vaccine type 2 on the basis of its emergency use listing; and (b) mobilize domestic financial resources to complement international financial and political commitments.

 

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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 15 Feb 2020]

Democratic Republic of the Congo
:: Ebola Outbreak in DRC 79: 11 February 2020
[See Emergencies above ford detail]

Yemen
:: Journey to recovery: Yemeni patients get new lease on life in Jordan 9 February 2020

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

 

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WHO Grade 2 Emergencies [to 15 Feb 2020]
Burkina Faso [in French]
:: Cas suspect d’infection par le nouveau coronavirus au Burkina Faso : les résultats …
14 février 2020
Ouagadougou, le 11 février 2020, le Ministère de la santé a fait un exposé sur les mesures sanitaires préventives prises par le Burkina Faso  pour faire face à un risque de survenue d’une éventuelle épidémie due au nouveau coronavirus dans le pays.
:: Burkina Faso : Riposte vaccinale contre la poliomyélite dans le District sanitaire d…
11 février 2020
Ouargaye( Centre Est au Burkina Faso), 7 févier 2020, lancement du  round 0 de la campagne de vaccination de riposte contre la poliomyélite sous la coordination du Gouverneur de la Région.

Afghanistan – No new digest announcements identified
Angola – 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
Measles in Europe – 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 15 Feb 2020]

Chad – No new digest announcements identified
Djibouti – No new digest announcements identified
Kenya – 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
:: Recent Developments in Northwest Syria – Situation Report No. 8 – As of 13 February 2020
HIGHLIGHTS
:: People in northwest Syria are living through some of the worst crisis since the war in Syria began. More than 800,000 people have been displaced since 1 December, due to intense conflict in freezing weather. The humanitarian community is doing everything it can but is overwhelmed by the scale of needs. An immediate cessation of the violence is critical. More resources, including funding, is immediately needed to save people’s lives and alleviate their suffering…

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 15 Feb 2020]

WHO & Regional Offices [to 15 Feb 2020]
News release 14 February 2020
Four countries in the African region license vaccine in milestone for Ebola prevention

News release 13 February 2020
Remarks by Dr Michael Ryan, Executive Director, WHO Health Emergencies Programme at media briefing on COVID-19 on 13 February 2020

News release 12 February 2020
World experts and funders set priorities for COVID-19 research

News release 10 February 2020
WHO and FIND formalize strategic collaboration to drive universal access to essential diagnostics

 

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Weekly Epidemiological Record, 14 February 2020, vol. 95, 07 (pp. 61–68)
:: Report of the thirtieth meeting of the International Task Force for Disease Eradication, 22 October 2019

 

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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Four countries in the African region license vaccine in milestone for Ebola preventi…
14 February 2020
:: Supporting media to bust harmful myths on coronavirus disease 13 February 2020

WHO Region of the Americas PAHO
:: PAHO prepares a further 9 countries in the Americas for laboratory diagnosis of new coronavirus (02/14/2020)
:: PAHO prepares 8 Caribbean countries for laboratory diagnosis of new coronavirus (02/12/2020)
:: Cases of dengue in the Americas exceeded 3 million in 2019 (02/12/2020)
:: New coronavirus: Fiocruz, Ministry of Health of Brazil and PAHO provide training in laboratory diagnosis in nine countries (02/11/2020)

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

WHO European Region EURO
:: Coronavirus disease (COVID-19): European Region focusing on readiness 14-02-2020
:: Poland can strengthen financial protection by exempting poor people from copayments for medicines 12-02-2020
:: Harms and benefits of evidence-based screening outlined in new WHO report 11-02-2020
:: Well-prepared laboratories are first line of defence against novel coronavirus in Europe 10-02-2020

WHO Eastern Mediterranean Region EMRO
:: Yemeni patients get new lease on life in Jordan 9 February 2020

WHO Western Pacific Region
:: 14 February 2020 | Commentary
It is time for all of us to play our part in the fight against the novel coronavirus in the Pacific
Our Region is at a critical juncture in the novel coronavirus (now known as COVID-19) outbreak. While the vast majority of cases are still in China, as of 14 February the virus has also been confirmed in 24 other countries on several continents. And there are now cases of local transmission in several countries, increasing the risk of onward spread.

CDC/ACIP [to 15 Feb 2020]

CDC/ACIP [to 15 Feb 2020]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html
ACIP Meetings
Next ACIP Meeting: February 26-27, 2020
Agenda (Draft) pdf icon[2 pages]

Latest News Releases
:: Transcript for CDC Media Telebriefing: Update on COVID-19 Friday, February 14, 2020
:: CDC Media Telebriefing: Update on COVID-19 Friday, February 14, 2020
:: CDC Confirms 15th Case of Coronavirus Disease (COVID-19) Thursday, February 13, 2020
:: CDC Confirms 14th Case of 2019 Novel Coronavirus Wednesday, February 12, 2020
:: Transcript for CDC Telebriefing: CDC Update on Novel Coronavirus Wednesday, February 12, 2020

MMWR News Synopsis Friday, February 14, 2020
Travel-Associated and Locally Acquired Dengue Cases — United States, 2010–2017
Persons Evaluated for 2019 Novel Coronavirus — United States, January 2020