GLOBAL IMMUNIZATION NEW S

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TECHNICAL INFORM ATION life to school entry with a one month minimum interval between doses. M UM PS By December 2005, 110 (57%) of all the 192 WHO member states had included mumps in their 28/02/07 from Philippe Duclos, WHO/HQ: national immunization programmes, the vast An updated WHO position paper on mumps majority using the combined mumps, measles and vaccine published in the Weekly Epidemiological rubella (MMR) vaccine, and two-dose schedules Record (WER) in February 2007 reflects scientific were implemented in more than 80% of these developments and replaces the corresponding 110 countries. paper published in the WER No 76, 2001, pp 346- In November 2006, the Global Advisory 355. The updated document is written according to Committee on Vaccine Safety (GACVS) reviewed the new format for position papers and adverse events following mumps vaccination with accommodates conclusions and recommendations special reference to the risk of vaccine-associated from the April 2006 meeting of the WHO aseptic meningitis. Cases of aseptic meningitis immunization Strategic Advisory Group of Experts and estimates of incidence rates have been and the November 2006 meeting of WHO‘s Global reported following the use of the Urabe Am9, L- Advisory Committee on Vaccine Safety (GACVS). Zagreb, Hoshino, Torii, and Miyahara strains from As before, routine mumps vaccination is various surveillance systems and various recommended in countries with a well established epidemiological studies. However, in view of the effective childhood vaccination programme and the variability in the quality of these studies and in capacity to maintain high-level vaccination the methods used, no clear conclusion could be coverage with measles and rubella vaccination, made on possible differences in risk for this and where reduction of mumps is a public health complication between these strains. Clustering of priority. Due to the higher mortality and disease meningitis cases following large-scale use Urabe burden, WHO considers measles control and Am9 and L-Zagreb vaccines can occur as a result prevention of congenital rubella syndrome to be of increased awareness and reporting of adverse higher priorities than the control of mumps. As events during vaccination campaigns. So far, very with rubella, insufficient childhood vaccination low rates of aseptic meningitis and no virologically coverage against mumps can result in an proven case have been associated with the use of epidemiological shift in the disease incidence to the Jeryl-Lynn and RIT-4385 strains. older age groups, potentially leading to higher The position paper can be downloaded from the rates of serious disease and complications than following website: occurred before large scale immunization was http://www.who.int/immunization/documents/pos introduced. itionpapers/en/index.html Main updates /changes as compared with the previous position paper are as follows: Accumulated global experience now shows that POLIO two doses of the vaccine are required for long- 28/02/07 from Oliver Rosenbauer, term protection against mumps. The first dose of WHO/HQ: the mumps vaccine should be given at the age of Polio Consultation Reaches Broad 12-18 months. The age of administration of the Consensus to Complete Polio Eradication œ second dose may range from the second year of But without rapid injection of funds, global polio eradication effort is threatened:

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Governments, donors and international agencies donors, political organizations and independent leading the drive to eradicate polio fully supported technical experts. Of particular importance was the planned final attack on the poliovirus. the presence of special advisers to the heads of Indigenous wild poliovirus survives in only parts of state of three of the four endemic countries. four countries œ Nigeria, India, Pakistan and The eradication effort, predicated on reaching Afghanistan œ where transmission has never been every child multiple times with oral polio vaccine, stopped. The high-level consultation on polio has reduced the number of polio cases worldwide eradication held on 28 February 2007 agreed to by over 99%. Of the 193 Member States of WHO, raise within 12 months œ and then sustain for as 189 have stopped transmission of indigenous wild long as needed œ the levels of vaccination poliovirus. coverage and child immunity in the areas with endemic polio to levels that stopped the disease ROTAVIRUS altogether in the polio-free parts of these 28/02/07 from Robin Biellik, PATH: On 30 countries. Ten other countries are currently January 2007, WHO announced that the fighting the tail-end of outbreaks caused by prequalification process for GlaxoSmithKline‘s importations of poliovirus. Rotarix® vaccine had been successfully The Consultation outlined specific milestones in completed, marking the first time that a rotavirus two areas where improvements would raise the vaccine has been WHO prequalified. This coverage and immunity levels. The first is to designation of —acceptability in principle for use by ensure that vaccine reaches children by improving UN agencies“ will allow for purchase of the the quality of polio vaccination campaigns, vaccine by the UNICEF Supply Division and PAHO strengthening health infrastructure, addressing Revolving Fund. It represents a timely advance in security challenges, and by enhancing acceptance the accessibility of rotavirus vaccine for of vaccination through tailored social mobilization developing countries that procure their vaccines and community engagement strategies. through UN agencies or are eligible to receive Second, the Consultation agreed that there was a subsidized vaccine support from the GAVI collective responsibility to mobilize the resources Alliance. needed to complete polio eradication, in particular Rotarix® is pre-qualified initially for use in WHO‘s by filling the funding gap of US$575 million for American and European Regions. In issuing its 2007-2008. Of this amount, US$60 million is decision, WHO noted the need for data on the urgently needed by April 2007. Just today in its vaccine‘s safety and efficacy in Africa and Asia Parliament, India outlined its firm financing before the product will be prequalified for use in commitment, and other endemic countries have these settings. GSK is collaborating with PATH to outlined specific steps to provide domestic generate these data through clinical trials in resources. The international donor community will Bangladesh, Malawi, and South Africa. now need to rapidly fulfil its commitment to For further details, including WHO‘s provisions on securing the necessary resources. The first step is Rotarix® packaging and presentation, please see for donors to take the case for polio eradication the notes on Rotarix® within the organization‘s back to their capital cities and present it to major list of prequalified vaccines. international development fora between March and May 2007. Without a rapid injection of funding, VACCINE M ANAGEM ENT polio eradication activities will have to be curtailed, 28/02/07 from Diana Chang Blanc, threatening the global polio eradication effort. WHO/HQ: A consultation meeting on Vaccine The commitment of the four remaining polio- Stock Management was held in Lahore, Pakistan endemic countries remains strong and was re- from 9-10 January 2007 for the Eastern affirmed by the presence at this Consultation of Mediterranean Region. Based on assessments representatives from the offices of the Heads of made in 18 National Vaccine Stores in the region Government. Together, these countries vaccinate a since 2004, it was found that vaccine stock total of 250 million children many times each year. management is one of the common problems, The Consultation defined specific milestones to and some countries with reasonably effective monitor whether the collective capacity of all polio vaccine management system still lack a eradication stakeholders is being fully harnessed to systematic vaccine stock management in place. It make concrete and rapid progress. was understood that countries of other regions The Consultation, called for by Dr. Margaret Chan, are facing similar problems. WHO‘s Director-General, was hosted by WHO, with The meeting was held to: top representation from other spearheading ñ Review countries progress in developing partners of the Global Polio Eradication Initiative œ vaccine stock management; Rotary International, US CDC, and UNICEF œ ñ Learn from the global advances in developing together with representatives from the endemic software for vaccine stock management; countries‘ ministries of finance and health, major

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ñ To make demonstration and discuss in detail requested and general instructions on the content the first version of the software developed by and recommended format for the PSF: This EMRO; includes instructions for the preferred method for ñ Develop a plan for installation and training of incorporating information from the Common the staff in National Vaccine Stores in a few Technical Document (CTD) format into the PSF. selected countries of the region. The guideline lists the chapter titles and sub- In order to ensure the best result form the chapter headings as given in Annex 1 of the meeting, temporary advisers from Afghanistan, prequalification document with additional Oman, Pakistan, Sudan and Tunisia were invited to explanation or clarification of the expected the meeting, as well as staff from UNICEF Supply information and contents. Division, UNICEF country staff from Afghanistan http://www.who.int/vaccines- and Sudan, and WHO HQ and AFRO regional staff. documents/DocsPDF07/870.pdf Selection of countries were based on the degree of their development on the vaccine stock GAVI-RELATED INFORM ATION management system. EPI Sudan was the first country in the region that decided to develop REVIEW PROCESS software specifically for vaccine stock management in order to tackle the problem. Pakistan also developed software for the same purpose. Next Review Dates: For more information about the meeting and its outcomes, please contact Mr. Mojtaba Haghgou FIRST REVIEW 2007: HSS Applications: The ([email protected]) deadline to receive applications for HSS is 2 March 2007. The applications will be reviewed PUBLICATIONS from 13-23 April 2007.

SECOND REVIEW 2007: ISS, INS, New NEW LY PUBLISHED W HO Vaccines & Measles 2nd Dose: The deadline for DOCUM ENTS receiving applications is 20 April 2007. The 28/02/07 from Mario Conde, WHO/HQ: The applications will be reviewed from 21-30 May following new publications are available online on 2007. the WHO website: Immunization Costing & Financing: A Tool SECOND REVIEW 2007: HSS Applications: and User Guide for comprehensive Multi-Year The deadline to receive applications for HSS is 11 Planning (cMYP) (WHO/IVB/06.15) œ May 2007. The applications will be reviewed from Estimating the costs and financing of immunization 1-11 June 2007. programmes is a key step in the development of a comprehensive multi-year plan (cMYP). To help MONITORING REVIEW: The deadline for undertake the costing and financing of a cMYP, a receiving annual progress reports is 15 May tool has been developed œ the cMYP Costing and 2007. The APRs will be reviewed from 18-27 Financing Tool. This tool is accompanied by a User June 2007. Guide which provides an overview of important how to use the costing and financing tool, including how THIRD REVIEW 2007: ISS, INS, New to analyse the data and findings: Vaccines & Measles 2nd Dose, HSS: The http://www.who.int/vaccines- deadline for receiving applications is 5 October documents/DocsPDF07/848.pdf 2007. The applications will be reviewed from 24 Guideline for Preparation of the product October to 2 November 2007. summary file for vaccine prequalification (WHO/IVB/06.16) œ The WHO document —Procedure for assessing the acceptability, in principle, of vaccines for purchase by United Nations Agencies“ (WHO/IVB/05.19) explains the procedure followed by WHO under their mandate to purchase these vaccines. The Pre-Qualification procedure document includes an Annex # 1 which provides a brief outline of the topics expected to be in the PSF. Upon request from manufacturers and in the context of a grant given by USAID to the Developing Countries Vaccine Manufacturers Network, this new guideline was developed to provide further clarification on the information

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COUNTRY INFORM ATION1 BY Uruguay has set a goal to vaccinate 200,000 REGION girls and boys aged 1-4 years, as well as susceptible populations, during October 2007. Vaccination Week in the Americas 2007 œ AM ERICAS Fifth Anniversary: Under the principles of equity, access, and Pan Americanism, Vaccination REGIONAL INFORM ATION Week in the Americas (VWA) targets children, women, men, older adults, and vulnerable 28/02/07 from PAHO: populations such as indigenous and minority Rubella Elimination Campaigns in the Region communities, individuals living in peri-urban of the Americas, 2006-2007: During 2006, areas, and municipalities with low coverage. VWA Argentina, Bolivia, the Dominican Republic, and 2007 will take place from 21-28 April 2007. This Peru, conducted national mass vaccination year marks the fifth anniversary of this regional campaigns to reduce populations susceptible to initiative. Planning started in November 2006, measles and rubella and prevent future CRS cases. during the Meeting of Caribbean Managers of the Bolivia conducted the first stage of its campaign Expanded Program on Immunization (EPI), where in May 2006 and vaccinated men and women aged countries discussed their goals and strategies. 15-39 years. Coverage in the country‘s ñ All countries and territories of the Caribbean departments reached levels >95%. In September, signed the Paramaribo Declaration, which Argentina launched a campaign targeting women promotes collaboration to strengthen aged 15-39 years, men considered at high-risk for surveillance efforts and intensify vaccination contracting and spreading the virus, and men in activities in preparation for the Cricket captive populations. Overall, 6,674,419 individuals World Cup (CWC) 2007. PAHO advises were vaccinated, and national coverage reached visitors to get vaccinated before travelling 98.8%. Peru conducted an elimination campaign to the Caribbean to reduce the risk of in October, vaccinating both men and women aged importation of diseases. PAHO also invites 2-39 years (over 70% of the population) and visitors to celebrate VWA on 28 April, during achieving coverage levels of 99%. The last 2006 the Cup‘s last match. campaign was launched in November in the ñ Close to 40 countries and territories will Dominican Republic. National coverage of 95% participate in activities ranging from was reached after vaccinating men and women national vaccination campaigns to social aged 7-39 years. The Guatemalan Ministry of communication and public awareness Public Health and Social Welfare signed a campaigns. ministerial agreement on 15 January 2007 ñ As part of the Regional goal to eliminate supporting the implementation of a mass rubella and congenital rubella campaign to vaccinate 7.4 million men and women syndrome by 2010, Guatemala will aged 9-39 years against rubella and CRS in April vaccinate almost 8 million men and women 2007. This campaign will spearhead the 2007 against measles and rubella. rubella vaccination campaigns which will also ñ Bolivia will launch a national yellow fever include Bolivia (2nd stage), Cuba, Haiti, campaign, with a target population of over Mexico (2nd stage), and Venezuela (2nd 4 million men, women, and children aged 2- stage). Several supplementary immunization 44 years. Ecuador will immunize over 3 activities (SIAs) have also been planned for 2007 million people with yellow fever vaccine. which will strengthen measles elimination efforts in Peru also plans to vaccinate against yellow the region and complement countries‘ efforts to fever and to raise routine immunization attain rubella and CRS elimination by 2010. El coverage in disadvantaged areas. Salvador has planned a follow-up campaign to ñ Paraguay will focus on neonatal tetanus vaccinate 800,000 boys and girls aged 1-4 years and diphtheria control by vaccinating 1 during the month of June. Guyana will coordinate million men and women aged 20-29 years. activities during Vaccination Week in the Americas The country will also seek to vaccinate to reach children < 1 year of age considered at indigenous populations with all antigens to high risk for contracting the disease. Finally, increase coverage in children aged <5 years in border districts where coverage is <80%.

1 ICP = Inter Country Programme ñ Countries will also vaccinate against ISS = Immunization Services Support influenza. Colombia will focus on INS = Injection Safety Support vaccinating older adults and children aged NVS = New Vaccine Support DQA = Data Quality Audit 6-18 months, while Paraguay will vaccinate DQS = Data Quality Self Assessment children aged 6-23 months, adults aged FSP = Financial Sustainability Plan >60 years, bird farmers, and other high-risk RED = Reach Every District cMYP = Fully costed multi-year plan groups.

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ñ El Salvador will focus its efforts on ñ In the border area between Mexico and the vaccinating border districts, poor urban United States, VWA efforts will focus on areas, and districts with low coverage. social communication and Ecuador will vaccinate half a million students mobilization. Representatives from both against hepatitis B. governments, local authorities, and ñ Caribbean countries will launch social international organizations will take part in communication campaigns to raise kick-off events, press conferences, health awareness about vaccination in the general fairs, and visits to clinics. population.

Produced by WHO, in collaboration with UNICEF and the GAVI Alliance:

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LIST OF M EETINGS & KEY EVENTS RELATED TO IM M UNIZATION

Regional Meetings & Key Events Related to Immunization: 2007 to 2009

Responsible Title of Meeting Start Finish Location Region Partner Mar-07 W PRO Hepatitis B Expert Group 05-Mar 06-Mar Tokyo, Japan W PRO W PR Meeting AFRO EPI Managers Meeting for 05-Mar 09-Mar Libreville AFRO (Central) AFRO Central Block AFRO EPI Managers Meeting for 12-Mar 16-Mar Harare AFRO (E&S) AFRO East and Southern Blocks Second Integrated Polio and Measles/Rubella Laboratory Ashgabat, 13-Mar 16-Mar W HO/EURO EUR Network Meeting for NIS Turkmenistan Countries HSS W orkshop/Orientation 19-Mar 21-Mar Harare AFRO AFR AFRO EPI Managers Meeting for 19-Mar 23-Mar Ouagadougou AFRO (W est) AFR W estern Block GAVI W est & Central African Sub- 24-Mar 24-Mar Ouagadougou AFRO (W &C) AFR Regional W orking Group EPI Managers Meeting for the Copenhagen, 27-Mar 29-Mar EURO EUR European Region Denmark PAHO Sub-Regional W orkshop 26-Mar 28-Mar Lima, Peru PAHO PAHO on Influenza Apr-07 HSS W orkshop/Orientation 02-Apr 04-Apr Libreville AFRO AFR GAVI Review for HSS GAVI Applications (Deadline: 2 March 13-Apr 23-Apr Geneva Specific Secretariat 2007) Strategic Advisory Group of 17-Apr 18-Apr Geneva W HO/HQ Global Experts (SAGE) meeting SEARO Regional W orkshop on Vaccine Procurement and Introduction of Guidelines for 16-Apr 20-Apr Bangkok SEARO SEAR "Expedited Approval of Vaccines used in National Immunization Programme" European Immunization W eek 16-Apr 22-Apr tbd EURO EUR Vaccination W eek in the Americas 21-Apr 28-Apr PAHO PAHO PAHO European Programme Managers 23-Apr 25-Apr tbd EURO EUR Meeting European Regional ICC Meeting 26-Apr 26-Apr tbd EURO EUR Bi-Regional (SEARO&W PRO) Ho Chi Minh meeting on Japanese 26-Apr 27-Apr SEARO/W PRO SEAR/W PR City, Vietnam Encephalitis GAVI East & South African Sub- April April tbd AFRO (E&S) AFR Regional W orking Group Meeting May-07 GAVI Quarterly Fund Executive GAVI 11-May 11-May Geneva Specific Committee Meeting Secretariat GAVI Joint Alliance & Fund Board GAVI 12-May 12-May Geneva Specific Meetings Secretariat EMRO RTAG Meeting 13-May 16-May Abu Dhabi EMRO EMR

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European Human Papilloma Virus Copenhagen, 14-May 15-May EURO EUR Meeting Denmark GAVI Review for ISS, INS, NVS & GAVI Measles 2nd Dose Applications 21-May 30-May Geneva Specific Secretariat (Deadline: 20 April 2007) GAVI Eastern Mediterranean 27-May 27-May Muscat, Oman EMRO EMR Regional W orking Group Meeting EMRO EPI Managers Meeting 28-May 31-May Muscat, Oman EMRO EMR Jun-07 16th Meeting of Virologists from June June New Delhi SEARO SEAR SEARO Polio Laboratory Network GAVI Review for HSS Proposals GAVI 01-Jun 11-Jun Geneva Specific (Deadline: 11 May 2007) Secretariat Central America and USMB 05-Jun 08-Jun tbd PAHO PAHO Regional EPI Managers Meeting Global Advisory Committee of 12-Jun 13-Jun Geneva W HO/HQ Global Vaccine Safety (GACVS) Meeting European Regional Certification Commission for Poliomyelitis 13-Jun 15-Jun tbd EURO EUR Eradication New and Under-Utilized Vaccines 18-Jun 20-Jun Geneva W HO/HQ Global Introduction Retreat GAVI Review of Annual Progress GAVI 18-Jun 27-Jun Geneva Specific Reports (Deadline: 15 May 2007) Secretariat W PRO EPI Managers W orkshop 19-Jun 22-Jun tbd W PRO W PR Jul-07 SEAR EPI Managers Meeting and 12th Meeting of Technical 09-Jul 13-Jul New Delhi SEARO SEAR Consultative Group (TCG) GAVI South East Asian Regional 14-Jul 14-Jul New Delhi SEARO SEAR W orking Group Meeting Aug-07 First Meeting of the Virologists of the regional JE Laboratory Network and Training in Laboratory procedures for August August Bangalore, India SEARO SEAR diagnosis of Bacterial Pathogens causing Acute Encephalitis Syndrome (AES) South America Regional EPI 07-Aug 10-Aug tbd PAHO PAHO Managers Meeting Sep-07 EMRO Regional W orking Group 10-Sep 12-Sep Cairo, Egypt EMRO EMR on Rotavirus Surveillance GAVI Quarterly Fund Executive GAVI 12-Sep 12-Sep W ashington DC Specific Committee Meeting Secretariat GAVI Review of Annual Progress GAVI 24-Sep 28-Sep Geneva Specific Reports Secretariat Ninth Meeting of International Certification Commission for Polio 27-Sep 29-Sep New Delhi SEARO SEAR Eradication Oct-07 GAVI Review for ISS, INS, NVS & GAVI Measles 2nd Dose Applications 24-Oct 02-Nov Geneva Specific Secretariat (Deadline: 05 October 2007) GAVI Eastern Mediterranean 28-Oct 29-Oct Tripoli, Libya EMRO EMR Regional W orking Group Meeting

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EMRO ICM on Measles and 30-Oct 01-Nov Tripoli, Libya EMRO EMR Rubella HPV Planning Policy Meeting for Late Early tbd PAHO PAHO Latin America and the Caribbean Oct Nov Nov-07 EMRO RTAG Meeting 02-Nov 02-Nov Tripoli, Libya EMRO EMR Strategic Advisory Group of 06-Nov 08-Nov Geneva W HO/HQ Global Experts (SAGE) meeting GAVI Quarterly Fund Executive GAVI 12-Nov 12-Nov Johannesburg Specific Committee Meeting Secretariat EMRO RTAG Meeting 12-Nov 12-Nov Libya EMRO EMR GAVI Joint Alliance & Fund Board GAVI 13-Nov 15-Nov Cape Town Specific Meetings Secretariat Caribbean EPI Managers Meeting 13-Nov 16-Nov tbd PAHO PAHO GAVI South East Asian Regional 27-Nov 28-Nov Thimphu SEARO SEAR W orking Group Meeting EURO TAG Meeting 28-Nov 29-Nov tbd EURO EUR Dec-07 Global Advisory Committee of 12-Dec 13-Dec CICG W HO/HQ Global Vaccine Safety (GACVS) Meeting 2008 Meetings Strategic Advisory Group of 08-Apr 10-Apr Geneva W HO/HQ Global Experts (SAGE) meeting Strategic Advisory Group of 03-Nov 05-Nov Geneva W HO/HQ Global Experts (SAGE) meeting 2009 Meetings Strategic Advisory Group of 07-Apr 09-Apr Geneva W HO/HQ Global Experts (SAGE) meeting Strategic Advisory Group of 27-Oct 29-Oct Geneva W HO/HQ Global Experts (SAGE) meeting

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