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Burkina Faso will conduct a nationwide campaign with the new vaccine targeting over 12 million people from 6 December 2010. Mali and Niger will roll out the vaccination in December and continue into 2011.
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NEW CONJUGATE VACCINE TO PROTECT AGAINST MENINGITIS A TO BE LAUNCHED 30/11/2010 from Maya van den Ent (UNICEF) & Carol Tevi Benissan (WHO) A new conjugate vaccine, to protect against meningococcal group A disease, was successfully used during pilot vaccination campaigns in Burkina Faso, Mali and Niger in September 2010. The campaigns vaccinated over 1 million people aged 1 – 29 years. Group A meningococcus is the main cause of meningitis epidemics and accounts for an estimated 80-85% of all cases in the 25 countries of the African meningitis belt. The new vaccine is expected to provide protection for at least 10 years, as compared to the polysaccharide vaccines currently in use, that protects for only three years. Burkina Faso will conduct a nationwide campaign with the new vaccine targeting over 12 million people from 6 December 2010. Mali and Niger will roll out the vaccination in December and continue into 2011. The vaccine, called MenAfriVac and manufactured by the Serum Institute of India Ltd, is available at less than US$ 0.50 per dose. Its development in less than a decade has been possible through a unique public-private partnership. The Meningitis Vaccine Project, which has coordinated development, is a collaboration between WHO and PATH, made possible through a grant from the Bill & Melinda Gates Foundation. The introduction in Burkina Faso, Mali and Niger is being funded by the governments of the introducing countries, the GAVI Alliance and other partners. UNICEF and WHO are playing a vital role in supporting countries to prepare for the mass campaigns. However, an additional US$ 475 million must be mobilized in order for the vaccine to be introduced in the remaining 22 countries of the meningitis belt.
Technical Information
World Health Organization
30 November 2010 Global Immunization News
Global Immunization News
Inside this issue:
Economic benefits of the Global Polio Eradication Initiative estimated at US$40-50 billion
2
Country immunization financing information online
2
Call for Documents on the Effects of New Vaccine Introduction
3
Regional information—Americas
8-10
Regional information—Eastern Mediterranean
10
Regional information— South East Asia
11
Regional information—Western Pacific
12
Vaccine Security and Supply at the Pacific immunization programme strengthening
4
Introducing a vaccine: policy and programmatic
4
Launch of the National Immunization Technical Advisory Groups (NITAG)
3
New TechNet21 website 5
SPECIAL FEATURE: Maternal & Neonatal Tetanus
6
GAVI Information 7
New Publications 7
Regional information— Africa
8
Regional Meetings & Key Events
13
Related Links 14
Photo: Jonathan Shadid, UNICEF, Kaya, Burkina
PHOTO
NEW NUVI WEBSITE The NUVI website has been reshaped to better correspond to the needs of its visitors. You can find it under the same address: http://www.who.int/NUVI
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ECONOMIC BENEFITS OF THE GLOBAL POLIO ERADICATION INITIATIVE ESTIMATED AT US$40-50 BILLION 29/10/2010 from Oliver Rosenbauer, WHO/HQ New study in Vaccine offers strong economic justification for finishing the job on polio as quickly as possible. A new study being released in November 2010 estimates that the global initiative to eradicate polio could provide net benefits of at least US$40-50 billion if transmission of wild polioviruses is interrupted within the next five years. The study provides the first rigorous evaluation of the benefits and costs of the Global Polio Eradication Initiative (GPEI)—the single largest project ever undertaken by the global health community. The study comes at a crucial time—following an outbreak in the Republic of the Congo and one in Tajikistan earlier this year—that highlight the risk of delays in finishing the job on polio. Published in the journal Vaccine, the study, “Economic Analysis of the Global Polio Eradication Initiative,” considers investments made since the GPEI was formed in 1988 and those anticipated through 2035. Over this time period, the GPEI’s efforts will prevent more than 8 million cases of paralytic polio in children. This translates into billions of dollars saved from reduced treatment costs and gains in productivity. The study also reported that “add-on” GPEI efforts improve health benefits and lead to even greater economic gains during the same time period. Notably, it estimates an additional $17-90 billion in benefits from life saving effects of delivering vitamin A supplements, which the GPEI has supplied alongside polio vaccines. The GPEI successfully reduced the global incidence of polio by 99 percent since 1988 and eradicated type 2 wild polioviruses in 1999. Intense efforts are under way to stop transmission of types 1 and 3 completely within the next several years, with indigenous transmission remaining only in relatively small areas in Afghanistan, India, Nigeria, and Pakistan and re-established transmission in a few countries, including Angola and the DRC. Until eradication occurs, all countries remain at risk for importation of the virus, as demonstrated by the 2010 polio outbreaks in Tajikistan and the Republic of the Congo. Congo’s recent outbreak has resulted in more than 200 cases of acute flaccid paralysis (AFP) since October, mostly affecting people older than 15. For more information, visit www.polioeradication.org.
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Global Immunization News
The information contained in this Newsletter de-pends upon your contributions
Please send inputs for inclusion to:
“Immunizing in the context of global independence”
“Integrating Immunization, other linked health interventions and surveillance in the health systems context”
COUNTRY IMMUNIZATION FINANCING INFORMATION ONLINE 30/11/2010 from Claudio Politi, WHO/HQ The cMYP Immunization Financing Database has been updated with the most recent information from countries' comprehensive Multi-Year Plans. Fifty-six countries that used the WHO cMYP costing and financing tool are included in the database. The latest update now includes 20 countries with cMYPs covering the most recent period 2010-2015. Users can consult country and regional reports that present expenditure and financing information on routine immunization and immunization campaigns. These reports cover planning periods ranging from 2004 to 2015. Data are accompanied by graphs showing the composition of expenditure for immunization, sources of financing and estimated financial gaps. For further information and access to the database, click here.
Technical Information
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Global Immunization News
“Introducing new vaccines and technologies”
“Integrating Immunization, other linked health interventions and surveillance in the health systems context”
GAVI related Information Next GAVI Review Dates: GAVI Call for Proposals for New Vaccine Support: Closing date 15 May 2011
CALL FOR DOCUMENTS ON THE EFFECTS OF NEW VACCINE INTRODUCTION ON IMMUNIZATION SYSTEMS AND HEALTH SYSTEMS 30/11/2010 from Robert Steinglass, MCHIP As part of a WHO-led, multi-agency effort to document the effects of new vaccine introduction on immunization systems and health systems, MCHIP (Maternal and Child Health Integration Program, funded by USAID) seeks your assistance in identifying studies and reports from developing countries that contain information on effects - whether positive or negative - of new vaccine introduction on the immunization system and/or the health system. Documents on the effects of introducing pentavalent, pneumococcal, rotavirus, and HPV vaccines are of particular interest. MCHIP is interested in receiving unpublished documents that have not appeared in journals, the so-called "grey literature." The review of *grey literature* on the effects of new vaccine introduction is being undertaken in collaboration with the World Health Organization. Other partners (the London School of Hygiene & Tropical Medicine and U.S. Centers for Disease Control) are accessing other sources of information on the same question. (The US CDC is searching for published documents.) Please send a copy of any document of interest for this study to both Ryan Macabasco [[email protected]] and Robert Steinglass [[email protected]] by mid-December 2010. If electronic versions are not available, please send the scanned versions of either the executive summary or entire document Personal knowledge on the topic and willingness to be interviewed (by phone, Skype, or in person) should be expressed. Contributors and the wider Community will be informed on how to access the documents reviewed and the synopsis of findings. Thank you for sharing your valued experience.
LAUNCH OF THE NATIONAL IMMUNIZATION TECHNICAL ADVISORY GROUPS (NITAG) NITAG RESOURCE CENTRE 30/11/2010 from Marine Prado, AMP
The SIVAC Initiative (www.sivacinitiative.org) is pleased to announce the launch of the NITAG Resource Center. The NITAG Resource Center provides information, tools, and briefings to NITAGs and the global immunization community to improve evidence-based decision making on vaccines and immunization at national level. It can be accessed via the following link: www.nitag-resource.org
The NITAG Resource Center is a collaborative initiative between several countries and organizations (AMP, CDC, CPHA, Dalhousie University, IVI, LSHTM, PAHO/PROVAC, PATH Malaria Vaccine Initiative, Sabin Vaccine Institute, WAHO, and WHO).
The NITAG Resource Center is available in four languages, and it provides four dedicated services:
• An Observatory: to provide information on NITAG activities and recommendations; • A Digital Library: to share documentary resources and tools relevant to NITAGs; • A Center of Expertise: to provide briefing opportunities relevant to NITAGs; • An e-Community: to develop a network of NITAGs collaborating together.
The Center of Expertise includes the NITAG newcomers briefing. It is a distance learning tool that provides NITAG members and NITAG executive secretariats with a basic background on the rationale and role of a NITAG, as well as key elements for its efficient functioning. It can be accessed via the following link: www.nitag-resource.org/en/training/rapid-briefing.php
For more information on the NITAG Resource Center, please contact: Julia Blau (SIVAC, Agence de Médecine Préventive, AMP).
Technical Information
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Global Immunization News
“Introducing new vaccines and technologies”
“Integrating Immunization, other linked health interventions and surveillance in the health systems context”
GAVI related Information Next GAVI Review Dates: GAVI Call for Proposals for New Vaccine Support: Closing date 15 May 2011
INTRODUCING A VACCINE: POLICY AND PROGRAMMATIC CONSIDERATIONS 30/11/2010 from Susan Wang, WHO/HQ A new resource page on "Introducing a vaccine: policy and programmatic considerations" has been published on the new vaccines website (www.who.int/nuvi). This site brings together in one page, resources useful to address policy and programmatic aspects of introducing a new vaccine. It may be used as a reference for decision-making and implementation by country level policy-makers, national immunization programme managers, and others working on immunization. The page brings together links to the following resources: - Guidance on vaccine introduction (general and vaccine-specific) - WHO recommendations for routine immunization (immunization schedules and position papers) - WHO prequalified vaccines - UNICEF-procured vaccine products and presentations with weighted average prices - Tools to calculate vaccine wastage This page expands on and replaces the previous "Vaccine Production Selection Menu" which was produced in 2005 and available in CD format. To access this page directly, please click below: http://www.who.int/nuvi/Vaccine_Product_Menu/en/
VACCINE SECURITY AND SUPPLY AT THE PACIFIC IMMUNIZATION PROGRAMME STRENGTHENING PIPS PARTNERS MEETING SEPTEMBER 2010 30/11/2010 from Miloud Kaddar, WHO/HQ and Sarah Schmitt, consultant for WHO
The Annual PIPs partnership meeting was held in Nadi Fiji from 27 September to 1 October 2010. In response to a follow up recommendation from a combined UNICEF-WHO review done in March 2010, one full day was dedicated to Vaccine Security and Supply; more specifically the UNICEF Vaccines Independence Initiative Group Procurement being utilized by 13 of the Pacific Island Countries (PIC) for the supply of vaccines for their EPI programmes. The intention of the day was to educate and inform, to share ideas on challenges to achieving optimal performance and methods for improvement. Representatives from 18 countries were in attendance including all 13 of the current PIC Vaccine Independence Initiative (VII) group. Attendance also included the PIPs partners WHO, UNICEF, CDC Atlanta, AUSAid, JICA, and New Zealand Government officials.
The following action points were agreed in the meeting:
• All countries participating in the Vaccine Independence Initiative (VII) are encouraged to improve accuracy of annual forecasting to minimize the need to place supplemental orders and reliance on the regional buffer stock.
• All countries participating in the VII should advocate with national decision-makers to ensure appropriate annual budget allocations for vaccine procurement, and timely budget release to ensure availability of funds, and ensure payment of each individual invoice within 60 days of receipt. Furthermore, VII participating countries should sign and return new/updated Memoranda of Understanding and new Letters of Guarantee to UNICEF within a month of receipt to ensure continued access to UNICEF vaccine procurement.
• UNICEF will improve the invoicing process to ensure timely issuance to countries, taking into consideration wherever possible the individual country financial year timing, and develop a monitoring tool to report to countries and partners on invoicing and payment response times.
Technical Information
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Global Immunization News
“Introducing new vaccines and technologies”
“Integrating Immunization, other linked health interventions and surveillance in the health systems context”
GAVI related Information Next GAVI Review Dates: GAVI Call for Proposals for New Vaccine Support: Closing date 15 May 2011
NEW TECHNET21 WEBSITE A new TechNet21 website (techNet21.org) will be launched after the TechNet Meeting planned for November 2010. The original TechNet started 20 years ago following a request from UNICEF to communicate quickly and easily with WHO and UNICEF on their needs and idea for new vaccine cold chain developments. Today the TechNet21 website has about 160,000 hits each month and 1,600 members registered for a discussion forum and a weekly digest and still aims to providing feedback from countries to immunization policy makers. The new site retains the same functions as the existing site and adds five new features: It is open so that registered members can post their own comments and thoughts directly on the site A new photo depot where pictures of immunization services and the vaccine supply chain can be added A new blog zone for views and comments on any aspect of the supply chain or immunization. A new zone for planning and management software applications A new network area where members can share information ‘offline’ from the open site.
Participants given response in a Vaccine Management Training session in Swakopmund Region, Namibia Photographer: WHO/AFRO, Serge Ganivet
The 2010 TechNet Consultation will be broadcast by webinar.
Register now by clicking a link below: Tue, Nov 30, 2010 8:30 AM - 6:30 PM SGT (Malaysia time)
<https://www1.gotomeeting.com/register/371203256> Wed, Dec 1, 2010 8:30 AM - 6:30 PM SGT (Malaysia time) <https://www1.gotomeeting.com/register/580939889> Thu, Dec 2, 2010 8:30 AM - 6:30 PM SGT (Malaysia time) <https://www1.gotomeeting.com/register/618961952> Once registered you will receive an email confirming your registration with information you need to join the Webinar. System Requirements for PC-based attendees: Required: Windows(r) 7, Vista, XP or 2003 Server System Requirements for Macintosh(r)-based attendees Required: Mac OS(r) X 10.4.11 (Tiger(r)) or newer
SPECIAL FEATURE
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Global Immunization News
“Introducing new vaccines and technologies”
“Integrating Immunization, other linked health interventions and surveillance in the health systems context”
GAVI related Information Next GAVI Review Dates: GAVI Call for Proposals for New Vaccine Support: Closing date 15 May 2011
MATERNAL & NEONATAL TETANUS ELIMINATION - 2010 30/11/2010 Martha Roper, WHO-HQ
Elimination of maternal and neonatal tetanus (MNT) is defined as less than one NT case per 1000 live births in every district. When a country believes it has met the criterion for elimination, a confirmatory community-based validation survey is performed. The survey has a lot of quality assurance – cluster sample design which evaluates if the NT rate is likely less than one per 1000 live births using standardized verbal autopsy questions to identify NT deaths. If NT is eliminated, maternal tetanus is assumed to be eliminated as well. As of November 2010, MNT elimination has been validated in 19 of the 58 high NT burden countries identified in 2000, and in 15 Indian States (approximately half of India’s population) and the two regions of Indonesia as described below. Thirty-nine countries have yet to achieve and/or validate MNT elimination. Because tetanus cannot be eradicated, all countries must ensure that appropriate strategies to achieve and maintain MNT elimination continue, even when the elimination target has been met. Mozambique: reported by Manuel Novela, WHO Mozambique: In October 2010, a validation survey was performed in Jangamo and Chinde Districts, Mozambique. These districts had been identified as being at highest risk for NT during a Joint MOH–WHO–UNICEF review in March 2010, and together provided a suitable population of about 10,000 annual live births for the survey. A total of 1384 live births were detected in the survey; none of the 36 identified neonatal deaths were due to tetanus, confirming MNT elimination in Jangamo and Chinde Districts. Because the survey districts had been purposively selected as those where the risk of NT was highest, the remaining districts at lower NT risk, and the country as a whole, can be considered to have eliminated MNT during the period covered by the survey. This conclusion is supported by the survey findings that 87% of mothers of eligible live births had received at least two doses of TT and 64% of deliveries were assisted by a medically-trained birth attendant. Recommendations for sustaining MNT elimination in Mozambique include: maintaining high TT vaccination coverage in women of reproductive age; extending the existing school-based TT immunization program to all parts of the country, expanding clean delivery services and clean delivery kit availability, providing community education on clean cord care practices, and strengthening case-based NT surveillance. Indonesia: reported by Theresia Sandra Diah Ratih, MOH Indonesia and Madhav Ram, WHO/SEARO: Indonesia is the fourth largest country in the world with a 2010 population of 238 million people. Because of its large size and cultural diversity, validation of MNT elimination is being conducted region-wise in four phases. In August 2010, a validation survey was completed in the first region, Java and Bali. The survey was conducted using a double sampling design in Lebak District, Banten Province, Java, the district identified as at highest risk for NT in the region. Among the 3004 surveyed live births, there were 25 neonatal deaths, two caused by NT. This finding was within the pre-set acceptance level of <3 NT deaths, thereby confirming MNT elimination in Lebak, and thus in Java and Bali region as a whole. The elimination result was supported by the survey findings of high TT2+ and clean delivery coverage (78% and 52% respectively). In November 2010, a validation survey was performed in Sumatra, the second region defined for validation of MNT elimination. The survey was conducted using a single sampling design in the district of Tulang Bawang, Lampung Province, the district identified as being at highest NT risk in Sumatra. Nine (9) neonatal deaths were identified among the surveyed 1454 live births, none of which were caused by NT. Thus, MNT can be considered to have been eliminated in Tulang Bawang, and therefore in Sumatra as a whole. Supportive survey findings included 90% protection at birth (surveyed live births protected against tetanus based on maternal TT immunization history) and clean delivery coverage of 72%. The combined population of the first two MNTE validation regions of Java, Bali and Sumatra is 191 million or 80% of Indonesia’s entire population. Validation surveys for the remaining 2 regions are tentatively scheduled for 2011/ 2012. The report on the background of MNT elimination in Indonesia and the first validation survey can be found in the 26 November 2010 (Weekly Epidemiological Record (http://www.who.int/wer/2010/wer8548.pdf).
GAVI related Information
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Global Immunization News
“Introducing new vaccines and technologies”
“Integrating Immunization, other linked health interventions and surveillance in the health systems context”
GAVI related Information Next GAVI Review Dates: GAVI Call for Proposals for New Vaccine Support: Closing date 15 May 2011
Next GAVI Review Dates: GAVI Call for Proposals for New Vaccine Support: Closing date 15 May 2011 On 4 November 2010, the GAVI Alliance Executive Committee decided to announce a call for proposals from countries for New Vaccine Support (NVS). This decision follows a request by the GAVI Board to the Executive Committee to establish the timeline for a new round of proposals. The deadline for submissions is 15 May 2011. The application round will be for the introduction of new vaccines only. It will not cover funding for Health Systems Strengthening (HSS), for Civil Society Organizations (CSOs), Immunization Services Support (ISS) and Injection Safety Support (INS). Support for health systems is not subject to a “rounds” process and countries can apply under the new Health Systems Funding Platform (HSFP) as and when they are ready and in accordance with national planning cycles. Following the upcoming GAVI Board meeting in December 2010, GAVI will provide countries with a more comprehensive update on the call for proposals and other important developments resulting from Board decisions. This will include the revised NVS guidelines and application form for the 15 May 2011 proposals round. The update will also consist of information for graduating countries, revised co-financing policy, eligibility for new vaccines, the prioritization of applications, and the next phase of HSS and ISS. Countries are recommended to await receipt of this comprehensive update prior to initiating their application submission process. This is to ensure that each country is able to fully understand its eligibility status for new vaccine application. To help guide planning, the following timeline related to the new round is proposed: December 2010 – a comprehensive update and revised application guidelines will be provided to countries. 15 May 2011 – deadline for GAVI to receive completed applications. June 2011 – GAVI donor pledging meeting. Overall level of funding available for new proposals will be known after this meeting. June/July 2011 – Independent Review Committee meets to review and make recommendations on all completed NVS applications. August 2011 – based on fundraising efforts, funding envelope for 15 May 2011 NVS applications to be determined. September/October 2011 – GAVI Executive Committee approvals will be made and countries notified. The GAVI Alliance is committed to supporting the proposal submission process. Alliance partners including WHO, UNICEF and other country-level partners should be engaged to provide technical support for the application process.
New Publications THE IMMUNOLOGICAL BASIS FOR IMMUNIZATION SERIES - MODULE 16 : MUMPS (ISBN 978 92 4 150066 1) This IVB document is now online. The main purpose of the modules of the series - which are published as separate/vaccine specific modules - is to give immunization managers and vaccination professionals a brief and easily-understood overview of the scientific basis of vaccination. This module focuses on Mumps.
WHO IMMUNIZATION WORK: HIGHLIGHTS 2008-09 (WHO/IVB/10.11) This IVB document is now online. This newsletter provides an overview of WHO's main achievements in immunization for 2008-09. It covers a broad scope of activities, from global immunization policy; to research and development of vaccines and technologies; quality, safety and standards; access to immunization services; and communication, advocacy and media. It also describes the framework and priorities for the Strategic Plan 2010-2015 of the Department of Immunization, Vaccines and Biologicals. The document will be of interest to all those who wish to learn more about the focus of WHO's vaccine and immunization work.
AFRICAN REGION
Country Information by Region
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Global Immunization News
HSS= Health Sys-tems Strengthening; IST = Inter Country Support Team; ISS = Immunization Services Support; INS = Injection Safety Support; NVS = New Vac-cine Support; DQA = Data Qual-ity Audit; DQS = Data Qual-ity Self Assessment; RED = Reach Every District; cMYP = Fully costed multi-year plan; NITAG = National Immunization Tech-nical Advisory Group; NRA = National Regulatory Author-ity
“Protecting more people in a changing world”
AMERICAS
DATA QUALITY SELF-ASSESSMENT IN JAMAICA, NOVEMBER 2010 30/11/2010 from Béatrice Carpano, WHO PAHO/AMRO An evaluation of the immunization monitoring system, using the WHO Data Quality Self-assessment Tool (DQS), was conducted in Jamaica from 1-8 November 2010. The evaluation team was composed of 15 persons from the MOH working at different levels of the EPI, and five international participants from the EPI in Belize, the U.S. Centers for Disease Control and Prevention, WHO, and PAHO. The objectives of the DQS were to evaluate the accuracy of the EPI, timeliness of reporting, quality of the immunization monitoring system, and also to identify strengths and weaknesses to propose recommendations for improvement. Overall, five Parish Health Departments were evaluated as well as 22 health centers and four private doctors. Among the strengths, a common theme was the commitment of the EPI personnel at all levels of the health system; a clear and well-defined data flow; the existence of a mechanism that allows individual follow-up of children’s vaccination schedules; and the good disposition and willingness to provide the data requested among the private physicians interviewed. The main weaknesses related to the outdated EPI database that does not allow electronic data transfer from Parishes to the national level; a lack of a mandate or mechanisms to get all the data from the private sector; insufficient human resources at all levels; the inability to accurately monitor vaccine wastage; and inconsistencies and problems related to recording, documenting, and aggregating vaccine doses given at the Health Centers. The main recommendations aim to update the database system (including the electronic submission of files) and optimize its use at Parish, regional and national levels; modify immunization regulations to strengthen reporting from the private sector and encourage it to keep immunization registries; develop mechanisms to better monitor vaccine wastage; and strengthen documentation practices at the local level through improved supervision and training. Finally, the team recommended evaluating the Parishes not visited during the DQS and developing a plan of action to implement the recommendations.
“AMP’S ADVIM PROGRAM LAUNCHES ACTIVITIES IN BURKINA FASO AND BENIN 30/11/2010 from Marine Prado, AMP
ADVIM (ADVocacy for IMmunization financing), a program of the Agence de Médecine Préventive (AMP), held two workshops to present the results of a study on the existing capacity of Burkina Faso and Benin for immunization financing advocacy. The first workshop took place in Ouagadougou, Burkina Faso on October 21-22, 2010, and the second one in Cotonou, Benin on November 5, 2010. The main objective of these workshops was to specify program activities in the countries, which will be carried out in cooperation with national authorities and other partners. Participants included members of the National Inter-agency Coordinating Committee (ICC) - Expanded Program on Immunization (EPI), district medical officers, and members of AMP’s EPIVAC International Network (EPINET). The workshops resulted in the development of a collaborative ADVIM action plan for Burkina Faso and Benin focused on the following: Strengthening capacity for immunization advocacy through training, supervision, and monitoring at all levels of the health system Having health districts create a secure budget line for immunization activities Establishing a special unit within the Ministry of Health for research on innovative funding mechanisms ADVIM focal points will be located at the National EPI Supporting the Ministry of Health in conducting advocacy aimed at securing funding from the Ministry of Economy and Finance as well as external stakeholders Providing technical support to develop and monitor comprehensive multi-year plan for immunization (cMYP) Setting up a framework for sharing information between countries on best practices for advocacy for immunization financing A similar workshop will subsequently be held in Côte d’Ivoire, the third GAVI-eligible country participating in ADVIM.”
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Global Immunization News
VACCINATION PROGRAMS AND NATIONAL COMMITTEES ON IMMUNIZATION PRACTICES OF 10 SOUTH AMERICAN COUNTRIES MEET IN PARAGUAY 30/11/2010 from Béatrice Carpano, WHO PAHO/AMRO The 4th South American Meeting on Vaccine-preventable diseases took place in Asunción, Paraguay, from 26-28 October 2010. Representatives from Argentina, Bolivia, Brazil, Colombia, Chile, Ecuador, Paraguay, Peru, Uruguay, and Venezuela discussed issues such as risk analysis regarding municipalities with low coverage, the measles and rubella documentation process, maintaining polio eradication in the Americas, lessons learned from the H1N1 pandemic vaccination activities, new vaccine introduction, and the strengthening of the Revolving Fund, the mechanism used by PAHO to assist Member States for the procurement of vaccines and vaccination-related products. During and official ceremony held in Paraguay’s presidential palace, PAHO expressed its recognition of the Paraguayan people after the vaccination of close to 1 million children during the 2009 campaign targeting children aged 1-8 years, which reached coverage >98%. Paraguay is a country free of measles and rubella because the government invested in the health of its people. The PAHO/WHO Representative in Paraguay presented Paraguay’s President with a plaque for his unrestricted commitment to the principle of vaccines as public goods. The Minister of Health was recognized as well for her long-standing involvement in immunization issues.
HSS= Health Sys-tems Strengthening; IST = Inter Country Support Team; ISS = Immunization Services Support; INS = Injection Safety Support; NVS = New Vac-cine Support; DQA = Data Qual-ity Audit; DQS = Data Qual-ity Self Assessment; RED = Reach Every District; cMYP = Fully costed multi-year plan; NITAG = National Immunization Tech-nical Advisory Group; NRA = National Regulatory Author-ity
“Protecting more people in a changing world”
AMERICAS
27TH CARIBBEAN EPI MANAGERS’ MEETING 30/11/2010 from Béatrice Carpano, WHO PAHO/AMRO The national EPI managers of the English- and Dutch-speaking Caribbean gathered in Georgetown, Grand Cayman, on 15-19 November 2010 for their yearly meeting. About seventy representatives of 23 island states and territories, in addition to Canada, French Guiana, Martinique, and the USA, were in attendance. International agencies such as the U.S. Centers for Disease Control and Prevention (CDC) and the Canadian Public Health Agency (CPHA) also participated. During the opening of the meeting, it was noted that the Caribbean celebrates 19 years without an indigenous measles case. Yet, the speed and frequency of global travel put all countries at risk of disease importations; therefore, vigilance and universal vaccination are necessary. Topics discussed included updates on the subregional process of documentation and verification of measles/rubella/CRS elimination, monitoring of events supposedly attributable to vaccination or immunization, and advances on new vaccine introduction and surveillance. As is customary, the participants also completed their countries’ 2011 national EPI Plan of Action. Attendees were also encouraged to ensure that vaccination is a priority in each country’s political, economic, and social agenda.
IMMUNIZATION COMPUTERIZED NOMINAL IMMUNIZATION REGISTRIES 30/11/2010 from Béatrice Carpano, WHO PAHO/AMRO Countries of the Americas Exchange Experiences: Following the recommendation of PAHO’s Technical Advisory Group on Immunization (TAG) in 2009 on sharing experiences and lessons learned from countries using national computerized nominal immunization registries, visits to exchange experiences between countries of the Americas have taken place in recent months. In September, representatives from Paraguay’s EPI and a systems analyst hired by Paraguay’s Ministry of Health to develop the EPI module of the national health information system visited Panama for a week. The objectives of the visit were to (1) familiarize the Paraguay professionals with Panama’s national nominal registry and learn how Panama designed, developed, and implemented the registry, (2) what training activities were conducted, and (3) discuss lessons learned. Similarly, in November, professionals from Peru’s EPI attended an immunization data quality workshop and training session on the implementation of Brazil’s new nominal immunization registry in Manaus, Brazil. Peru has since requested support from Brazil to develop its national immunization registry. The first PAHO-sponsored visit to exchange experiences on computerized nominal immunization registries took place in February 2008, when EPI and health information professionals from Honduras visited Uruguay to learn from Uruguay’s national computerized nominal immunization registry, the oldest (1987) such registry working in the Americas.
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AMERICAS
Country Information by Region
Global Immunization News
EPIDEMIOLOGICAL SENTINEL SURVEILLANCE OF BACTERIAL PNEUMONIA AND MENINGITIS IN CHILDREN AGED UNDER FIVE YEARS 30/11/2010 from Béatrice Carpano, WHO PAHO/AMRO From 16-17 November 2010, 57 professionals from 12 countries in the Region participated in a meeting in Panama City on the epidemiological sentinel surveillance of bacterial pneumonia and meningitis in children aged under five years. The objectives of the meeting were to discuss the progress of sentinel surveillance, analyze and compare epidemiological sentinel hospital information with laboratory information generated by the SIREVA II lab network, and develop an integrated laboratory and epidemiological plan of activities to strengthen surveillance in the Region during 2011. Participants concluded that the integration of epidemiology and laboratory is fundamental to improve bacterial pneumonia and meningitis surveillance data in the Region. All countries have agreed to submit a revised and updated integrated surveillance plan of action by 1 February 2011.
HSS= Health Systems Strengthening; IST = Inter Country Sup-port Team; ISS = Immuni-zation Services Support; INS = Injec-tion Safety Support; NVS = New Vaccine Sup-port; DQA = Data Quality Audit; DQS = Data Quality Se lf Assessment; RED = Reach Every District; cMYP = Fully costed multi-year plan; NITAG = National Im-munization Technical Advisory Group; NRA = Na-tional Regula-tory Authority
“Protecting more people in a changing world”
PROVAC WORKSHOP TO FINALIZE COUNTRY-LED COST-EFFECTIVENESS ANALYSES ON ROTAVIRUS AND PNEUMOCOCCAL CONJUGATE VACCINES IN 7 COUNTRIES 30/11/2010 from Béatrice Carpano, WHO PAHO/AMRO From 18-19 November 2010, PAHO’s ProVac Initiative convened a workshop in Panama City, Panama, to provide support to seven countries in the Region that are performing cost-effectiveness analyses on one of two new vaccines: rotavirus or pneumococcal conjugate. The seven countries present were Argentina, Bolivia, Ecuador, El Salvador, Guatemala, Nicaragua, and Paraguay. Multidisciplinary country teams included EPI managers, PAHO/Immunization country focal points, and ProVac national consultants. Professionals from the Ministry of Health and PAHO country office in Panama were also in attendance. The workshop provided a unique opportunity for ProVac multidisciplinary national teams to exchange experiences, challenges, and lessons learned during the process of evaluating the cost-effectiveness of new vaccines. They will use the study results to inform national level decision-making on new vaccine introduction. Other objectives of the workshop included discussions regarding the inputs and data sources for TriVac, ProVac’s new Excel-based, integrated vaccine cost-effectiveness model to evaluate pneumococcal, rotavirus and Hib vaccines; technical clarifications on the use of TriVac; completion and revision of the TriVac model; and interpretation, contextualization, and presentation of TriVac results to inform national decision-making processes regarding new vaccine introduction. Over the next few months, the 7 multidisciplinary national teams will be finalizing their studies and preparing to present the vaccine cost-effectiveness results to national authorities.
EASTERN MEDITERRANEAN REGION
SECOND VACCINATION WEEK IN THE EASTERN MEDITERRANEAN, 24–30 APRIL 2011 30/11/2010 from Nahad Sadr-Azodi, WHO EMRO Working together to reach the most vulnerable, finish the unfinished agenda, and sustain the success stories in a diverse and complex region are essential if Millennium Development Goal 4 —to reduce under-five mortality by two thirds between 1990 and 2015—is to be equitably met. In response to the remarkable opportunities and daunting challenges, the WHO Regional Office for the Eastern Mediterranean and partners are launching the second Vaccination Week in the Eastern Mediterranean during the week of 24–30 April 2011, which will coincide with the inaugural African Vaccination Week, European Immunization Week and the Vaccination Week in the Americas. Vaccination Week is an annual Region-wide initiative celebrating and promoting immunization through advocacy, education and communication activities. Vaccination Week activities require collaboration among multiple private, non-government and government sectors such as education, youth, sports, police and culture. The success of 2010 Vaccination Week was largely due to its flexibility, as countries designated their own national objectives based on priorities and evidence, and decided on which key activities to implement. Each year, the Regional Office in consultation with countries will suggest overarching themes demonstrating the same level of flexibility which assured both regional relevance and national focus. For 2011 Vaccination Week, a briefing is scheduled on 3 December in Sharm el Sheikh, Egypt to discuss and build consensus on a regional theme and approach. The 2011 event can be leveraged to further expand and formalize partnerships with communities, media, and private sector, explore possibilities for innovative financing, strengthen public support for vaccine use, work across national borders, expand services to high risk populations, and maintain immunization high on the agenda of politicians and decision-makers.
Country Information by Region
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Global Immunization News
134 MILLION INDIAN CHILDREN TARGETED FOR SECOND DOSE OF MEASLES VACCINATION DRIVE 30/11/2010 from Satish Kumar Gupta, UNICEF India The Government of India launched the second dose of measles vaccination program in country. The measles campaign started in the states of Assam (Morigaon district) and Arunachal Pradesh (East Siang district) on 8 November 2010. The drive is the first in a year long public health initiative, targeting 134 million children in 14 high risk states to prevent an estimated 60,000 to 100,000 child deaths annually. Globally, an estimated 400 children die from measles every day. Three out of the four children, who died from measles in 2008, were from India. As part of the Indian national immunization strategy, fourteen states were identified by the National Technical Advisory Group on Immunization (NTAGI) as having less than eighty per cent coverage and were thus advised to introduce a measles catch-up drive for children between the ages of nine months to ten years. In the rest of the country, the second dose of measles vaccination will be given as part of the Routine Immunization (RI) programme. See Figure below
SOUTH EAST ASIA REGION
The measles catch up campaigns will be carried out in phase over one year targeting 134 million children between ages of 9 months to 10 years. Detailed operational guidelines, training manuals, communication strategy and AEFI management protocols have been developed and are being implemented in campaign districts. In remaining 17 states, measles 2nd dose is being introduced into routine immunization program to immunize children between ages of 16-24 months.
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“Protecting more people in a changing world”
Figure: Measles 2nd dose introduction in India
Country Information by Region
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Global Immunization News
THE 2ND INTERCOUNTRY HANDS-ON TRAINING ON THE LABORATORY DIAGNOSIS OF JAPANESE ENCEPHALITIS (JE) IN THE WESTERN PACIFIC REGION (WPR), HONG KONG, CHINA, 15-19 NOVEMBER 2010 30/11/2010 from Youngmee Jee, WHO WPRO Five days of the follow-up hands-on training workshop on laboratory diagnosis of Japanese encephalitis was held in the Public Health Laboratory Centre, Hong Kong China. Fourteen participants from ten network laboratories from eight member countries of WPR were trained for JE ELISA techniques and quality assurance. Experts from US CDC and the National Institute for Infectious Diseases, Japan as well as from the Centre for Health Protection and WHO participated in this training as facilitators. The 2nd WHO JE proficiency panel samples were distributed to network laboratories for the external quality assurance and the results should be reported within two weeks.
WESTERN PACIFIC REGION
HSS= Health Systems Strengthening; IST = Inter Country Support Team; ISS = Immunization Services Support; INS = Injection Safety Support; NVS = New Vaccine Support; DQA = Data Quality Audit; DQS = Data Quality Self Assessment; RED = Reach Every District; cMYP = Fully costed multi-year plan; NITAG = National Immunization Techni-cal Advisory Group; NRA = National Regulatory Authority
THE HANDS-ON TRAINING WORKSHOP ON THE LABORATORY DIAGNOSIS OF MEASLES AND RUBELLA FOCUSING ON MOLECULAR DIAGNOSIS IN THE WESTERN PACIFIC REGION, HONG KONG CHINA 22-27 NOVEMBER 2010 30/11/2010 from Youngmee Jee, WHO WPRO The 4th regional hands-on training workshop on the Laboratory Diagnosis of Measles and Rubella was held from 22-27 November 2010 in the Public Health Laboratory Centre, Hong Kong China. Fourteen laboratory colleagues representing twelve laboratories from nine countries were trained on the molecular detection of measles and rubella viruses using reverse transcription-polymerase chain reaction (RT-PCR), sequencing and sequence analysis to further strengthen the capacity for molecular surveillance. Experts from US CDC, China CDC and the National Institute for Infectious Diseases, Japan as well as from the Centre for Health Protection and WHO participated in this training as facilitators. This hand-on training will contribute to strengthening of molecular surveillance for measles and rubella virus strains circulating in the region.
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Global Immunization News
Regional Meetings & Key Events Related to Immunization
Title of Meeting Start Finish Location Region
2010 Meetings
Immunization Data Quality Assessment 01-Nov 12-Nov Jamaica PAHO
Strategic Advisory Group of Experts (SAGE) Meeting 09-Nov 11-Nov Geneva, Switzerland Global
Caribbean EPI Managers’ Meeting 15-Nov 19-Nov TBC PAHO
Malaria Vaccine Advisory Committee meeting 2010 22-Nov 24-Nov TBC Global
Intercountry Meeting on Measles/Rubella Control/Elimination 28-Nov 01-Dec Sharm El Sheikh EMRO
Planned Joint SIVAC/WPRO Intercountry Workshop on NITAGs and new vaccines 29-Nov 30-Nov Seoul, Republic of Korea WPRO
Technet Meeting 30-Nov 02-Dec Kuala Lumpur, Malaysia Global
First Meeting of the Presidents of the National Commissions to Document and Verify Measles, Rubella, and CRS Elimination Nov Nov Washington, D.C., USA PAHO
Preparatory meeting for regional vaccination week 2011 03-Dec 03-Dec Sharm El Sheikh EMRO
Intercountry Training Workshop on Surveillance of Vaccine Preventable Diseases and Monitoring & Evaluation of National Immunization Pro-grammes
04-Dec 06-Dec Sharm El Sheikh EMRO
Annual Regional Conference on Immunization (ARCI) and the Annual Afri-can Regional Inter-Agency Coordination Committee 06-Dec 09-Dec Ouagadougou, Burkina Faso AFRO
Global Advisory Committee on Vaccine Safety (GACVS) 08-Dec 09-Dec Geneva, Switzerland Global
First Meeting of the International Expert Committee (International Commis-sion for the Documentation and Verification of Measles, Rubella, and CRS Elimination in the Region of the Americas)
09-Dec 10-Dec Washington, D.C., USA PAHO
Subregional Working Group for West and Central Africa 10-Dec 10-Dec Ouagadougou, Burkina Faso AFRO
2011 Meetings
Workshop to Revise the International EPI Evaluation Methodology 24-Jan 28-Jan Washington, D.C., USA PAHO
Workshop on Computerized Nominal Registries 01-Feb 03-Feb Bogotá, Colombia PAHO
Subregional Working Group for West and Central Africa Feb Feb Sao Tome and Principe AFRO
WHO Global Meeting on Implementing New and Under-utilized Vaccines 22-Jun 24-Jun TBC Global
Global Vaccine Research Forum 2011 25-Jun 29-Jun Geneva, Switzerland Global
Links Relevant to Immunization
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Global Immunization News
Regional Websites New Vaccines in AFRO PAHO’s website for Immunization Vaccine Preventable Diseases in EURO New Vaccines in SEARO Immunization in WPRO
Newsletters PAHO/Comprehensive Family Immunization Program-FCH: Immunization Newsletter
Produced by WHO, in collaboration with UNICEF and the GAVI Alliance:
Global Websites Department of Immunization, Vaccines & Biologicals, World Health Organization WHO New Vaccines Immunization Financing Immunization Monitoring Agence de Médecine Préventive EPIVAC GAVI Alliance Website IMMUNIZATION basics (JSI) International Vaccine Institute PATH Vaccine Resource Library Pediatric Dengue Vaccine Initiative SABIN Sustainable Immunization Financing SIVAC Program Website UNICEF Supply Division Website Hib Initiative Website Japanese Encephalitis Resources Malaria Vaccine Initiative Measles Initiative Meningitis Vaccine Project Multinational Influenza Seasonal Mortality Study (MISMS) RotaADIP RHO Cervical Cancer (HPV Vaccine) WHO/ICO Information Center on HPV and Cervical Cancer SIGN Updates Technet Vaccine Information Management System PneumoAction International Vaccine Access Center
