Global Immunization News (GIN) April 2014
In this issue News NEW! You can now click on the article you are interested in and World Immunization Week 2014: Know, check, protect access it directly! Hayatee Hasan, WHO HQ
News World Immunization Week, which Vaccination Week in the Americas 2 takes place in the last week of April
2014
every year, is an opportunity to re- Western Pacific Region Celebrates 2 mind families and communities how Regional Immunization Week 2014 effective vaccines can be, and to en- Measles and Rubella Preparedness for 3 courage people to take action to en- the World Cup Georgia achieves first-year target of 3 sure that more children, and increas- rotavirus vaccination ingly people in other age groups, are immunized against deadly and debilitating diseases. Paraguay and the Americas against 4 Measles and Rubella The World Immunization Week campaign website in the six official languages is now live. Oral Cholera Vaccine stockpile cam- 5 An online, multilingual toolbox which allows campaign supporters to build their own post-
paign amongst Internally Displaced
ers, choosing from different visuals is also available. Help us spread the word by choosing People (IDPs) in South Sudan 5 What works? What drives routine a poster from our online, multilingual toolbox. Print, post in your office, school, or health- immunization performance in Africa? care centre, and share on social media to make this year’s campaign truly global. Summary of the WHO Strategic Group 6 of Experts (SAGE) April 2014 meeting A 30-second public service announcement (PSA) is now online and we encourage cam- 6 WHO Strategic Advisory Group of paign supporters to share it on social media. A “What you need to know about measles” Experts approves 2 dose schedule for HPV vaccine fact file is also available. One way in which we are working with partners to help this hap-
Mid-Term Review for the GAVI- 7 pen is by encouraging use of new mobile and Internet technologies. A number of coun- Graduation Process in Honduras tries are now delivering information about vaccination directly to people’s mobile phones Meetings / workshops and social media accounts. Getting reliable information to those who need it is key to increasing access, and to helping countries implement the Global Vaccine Action Plan Training of trainers workshop for Rota- 8 virus vaccine introduction and EPI (GVAP) ― endorsed by the World Health Assembly in May 2012. The Action Plan aims programme performance evaluation, to prevent millions of deaths by 2020 through more equitable access to existing vaccines
Angola for people in all communities. WHO European Region Immunization 9 Programme Managers Meeting Let us and others know how you will be celebrating the Week by registering your event Peer-review of the WHO-UNICEF 10 Joint Reporting Forms (JRF) and of and activities. GAVI Annual Progress Reports (APR) from Central African Countries Join in the conversation about World Immunization Week on Twitter #RUuptodate and Seminar on Measles & Rubella for non- 11 Facebook. health professionals Second Meeting of the Network for 12
Evaluation of Influenza Vaccines in Latin America and the Caribbean (REVELAC- Global Immunization News (GIN) i ) Meeting of Measles and Rubella Labora- 13 tory Network for the Americas Region Survey Last month, with the Global Immunization Newsletter (GIN), we conducted a short sur- 14- Resources vey to gather your feedback and help us continue to improve the GIN to meet your needs 16 and interests. In order to allow more time to those who have not yet have the opportuni- 17- ty to contribute, we are extending the deadline for you to submit your response for an- Calendar 18 other month. Your responses to this short survey are anonymous and will be aggregated to those of Links 19 others to give us an insight into the preferences of our readers so we can tailor this news- letter to meet your needs. We value your input and thank you in advance for contrib- uting. Please find the survey here.
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Global Immunization News (GIN) April 2014
Vaccination Week in the Americas 2014 Hannah Kurtis, Alba Maria Ropero and Liz Thrush, PAHO
This week the countries and territories of the Americas are celebrating the 12th Vac- cination Week in the Americas (VWA) with the regional slogan: “Vaccination: Your best shot.” This slogan was chosen to encourage people to protect themselves and the Region against the importation of polio, measles, and other vaccine-preventable diseases, in the context of the mass sports gathering, where people from all over the world will come to the Region.
To kick-off VWA, the regional launch was held in Montevideo, Uruguay on 26 April 2014 with the participation of the PAHO Director, the Minister of Health of Uruguay, and key partners such as the Centers for Disease Control and Prevention of the United States, Food and Agriculture Organization, GAVI, Organization of American States, UNICEF, the United Nations, the United Nations Population Fund, and UN Women. Additional launching celebrations were also held throughout the Region at VWA Poster – Vaccination: local, national, and international levels. Your Best Shot!
During this year’s Vaccination Week in the Americas, thousands of health workers are vaccinating more than 63 million people of all ages, including those living in remote, border, and urban fringe areas, indigenous populations, and other at-risk groups against a wide range of diseases such as poliomyelitis, rubella, congenital rubella syn- drome, measles, diphtheria, mumps, whooping cough, neonatal tetanus, influenza, yellow fever, diarrhoea caused by rotavirus, bacterial pneumonia, and human papilloma virus, among others.
Additionally, at least 18 countries and territories are integrating other preventative health interventions into vac- cination campaigns. Some examples of these activities include deworming, vitamin A supplementation, chronic disease and obesity screening, and education on breastfeeding.
Visit the website to view more information and campaign materials.
Western Pacific Region Celebrates Regional Immunization Week 2014 Sergey Diorditsa, Shafiqul Hossain, and Eric Wiesen, WHO, Western Pacific Regional Office
The Region has been participating in and celebrating World Immun- ization Week since 2011. This year, the Western Pacific Region (WPR) adopted the theme of preventing liver cancer through hepati- tis B vaccination with the slogan: "Stop hepatitis B and liver cancer. Vaccinate at birth." The theme was chosen to capitalize on the mo- mentum of hepatitis B control including the achievement of the 2012 milestone of less than 2% hepatitis B prevalence among five-year-old children, and the verification of 11 countries as having reached the goal of less than 1% prevalence among children.
Dr Shin Young-soo, WHO Regional Director A total of 35 out of 37 countries and areas planned to participate and for the Western Pacific and Dr Sergey celebrate the Immunization Week 2014 and shared the list of activi- Diorditsa, EPI Team Leader at the launching ceremony. Credit WHO/WPRO. ties. A variety of activities are planned during Immunization Week including national and local launching ceremonies; educational pro- grammes for health workers, parents and child care givers; awareness campaigns; advocacy; mass communication; vaccination session/campaign; training/workshop; and publicity in media.
Dr Shin Young-soo, Regional Director for WHO Western Pacific Region lead the launching ceremony of Regional Immunization Week on 21 April 2014 on the office premises with a follow up session related to the theme "Preventing hepatitis B infection and liver cancer: a journey of discovery" organized on 22 April 2014.
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Global Immunization News (GIN) April 2014
Measles and Rubella Preparedness for the World Cup Pamela Bravo and Liz Thrush, PAHO
The 2014 FIFA Football (Soccer) World Cup, which will be cel- ebrated in Brazil this year, is just around the corner (12-13 June 2014), and given that measles and rubella viruses are still circu- lating in other regions of the world, the Americas is at risk of virus importations, i.e. travelers potentially bringing the measles Measles and rubella health alert or rubella virus to the Region. poster (Health Alert Poster – Measles and Rubella). To this end, countries in the Americas - particularly those bor- dering with Brazil and whose national soccer teams will be participating in the World Cup – are taking measures to protect themselves from such importations. Nine countries will be holding Infographic – measles and rubella vaccination campaigns during Vaccination Week in the Americas and special The Americas efforts are being made to strengthen country surveillance systems so that no suspect measles and/ vs. Measles and or rubella cases will be missed. Rubella (Infographic – PAHO has created promotional materials which include digital messages, posters, flyers, in- The Americas fographics, and a video to increase awareness and preparedness among travelers. The messages vs. Measles and were designed to target travelers who will attend the World Cup and also health care workers Rubella). and physicians so that they too will be aware of the risks and advise patients on timely vaccination before travel. These materials are being promoted via social media and some countries are part- nering with airports, airlines, and the tourist sector to further disseminate these messages.
PAHO/WHO encourages travelers attending the World Cup to be vaccinated against measles and rubella at least two weeks prior to departure.
Georgia achieves first-year target of rotavirus vaccination Liudmila Mosina, WHO Regional Office for Europe
According to a recent post-introduction evaluation conducted by the health min- istry at the end of March 2014, the introduction of rotavirus vaccine in Georgia’s national immunization programme has gone smoothly. Georgia has vaccinated 60% of eligible infants with two doses of rotavirus vaccine, thus achieving the targeted coverage of the vaccine for the first year after introduction in March 2013. Caption: Baby receiving rotavirus The objectives of the evaluation were to identify strengths and areas for im- vaccination, Georgia. Credit: Dina provement associated with rotavirus vaccine introduction, and to improve plan- Oganova ning for introduction of pneumococcal vaccine later in 2014. Six evaluation teams composed of national specialists and advisors from the WHO Regional Office for Europe, WHO Headquarters and the United States Centers for Disease Control and Prevention visited 11 districts across the country and inter- viewed immunization personnel, vaccine providers and parents.
Basis for success The teams concluded that the programme’s success was due to: good advance planning; comprehensive training of medical workers; dissemination of education and information material; and broad advocacy and communication activi- ties implemented prior to the introduction.
Additional outcomes Although the targeted coverage was achieved at the national level, the evaluation also revealed significantly lower cov- erage in some districts and health facilities. Many infants were left unprotected against rotavirus because parents brought them for vaccination too late – beyond the age limitations for rotavirus vaccine. More effort is therefore needed to ensure that all eligible children equally benefit from the recently introduced vaccine.
The results of the post-introduction evaluation were presented and discussed at an Inter-agency Coordination Com- mittee (ICC) meeting led by Deputy Minister of Health Dr Mariam Jashi. The ICC members and the international ex- perts discussed the evaluation’s findings and agreed on additional activities needed to improve timelines of vaccination Page 3 and to further increase uptake of traditional and new vaccines.
Global Immunization News (GIN) April 2014
Paraguay and the Americas against Measles and Rubella Natalia González, PAHO
With a kickoff from the President of the Republic of Paraguay himself, Mr Ho- racio Cartes, who made a symbolic "goal" in front of the crowd, the National Vaccination Campaign against measles and rubella was launched in Asunción. This also marked the beginning of the meeting of the International Experts Committee (IEC) and National Commissions of the countries of the Americas, to document and verify the elimination of measles, rubella and congenital ru- bella syndrome (CRS) in the Americas. The event, held on Monday 21 April Dr Carlos Castillo Solórzano, 2014, was attended by representatives of 58 countries from around the globe; PAHO/WHO’s representative in PAHO/WHO’s representative in Paraguay, Dr Carlos Castillo Solórzano; IEC Paraguay, receives members of the President, Dr Merceline Dahl-Regis; and local authorities, as well as the Vice IEC and thanks those who con- tributed to elimination efforts. President of Paraguay, Mr Juan Afara; the Health Minister, Dr Antonio Barrios; members of the legislature, the mayor of the city of Luque, Mr Cesar Meza; among others.
According to Paraguayan health officials, the goal of the "Paraguay in action, mea- sles and rubella-free" (“Paraguay en acción, libre de rubéola y sarampión”) cam- paign is to vaccinate 738,000 children between one to five years old throughout the entire country. The vaccination, which has now started and will end on 5 June 2014, is supported by a media campaign. The material was presented at the launch. In a one minute clip, this material strongly encourages child vaccination with messages from the Minister of Health and Mr Horacio Cartes, President of the Republic of Paraguay, Deputy Minister, Dr María Teresa Barán. The makes a symbolic “goal” to message is then repeated with an animated initiate the campaign against football (soccer) game in which children are measles and rubella. playing against the viruses, which they manage to beat using vaccines as a shield.
Dr Castillo-Solórzano highlighted the commitment already made by Paraguay towards the elimination of measles and rubella in the Americas. "Making this Patriotic colors and sounds dis- international meeting for documentation happen in Asunción is a tribute to played by a group of Paraguayan Paraguay, that in 2003 proposed the initiative to eliminate rubella and CRS in children receive President Cartes the Americas to PAHO’s Governing Bodies, so that no child is ever again born and his guests. deaf, blind, or with congenital heart malformations because of the rubella vi- rus," he stated.
The football (soccer) theme provided the framework for the campaign’s presentation. It was enacted by a group of children from a public school in Luque. Dressed in the colors of different countries and carrying their flags, they greeted officials and guests in attendance, giving a touch of color and warmth to the event.
Members of the IEC were declared distinguished visitors by the Municipality of Asunción and by the Municipality of Luque.
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Global Immunization News (GIN) April 2014
Oral Cholera Vaccine stockpile campaign amongst Internally Displaced People (IDPs) in South Sudan Stephen Martin, WHO Headquarters
The first use of the global oral cholera vaccine (OCV) stockpile, created in 2013, under the management of the Inter- national Coordinating Group (ICG) recently deployed 252 000 doses of vaccine to South Sudan.
The mandate for the OCV stockpile is primarily for cholera outbreaks but will also consider vaccine requests for hu- manitarian crisis response.
As a result of recent conflict in South Sudan (December 2013), population displacement occurred, internally as IDPs and externally as refugees. Many of the IDPs are living in Protection of Civilian (POCs) areas within the United Na- tions Mission to South Sudan (UNMISS) compounds. Living conditions for the IDPs have deteriorated below interna- tional standards, increasing the risk of waterborne diseases including cholera. These conditions are anticipated to de- teriorate further with the onset of seasonal rains.
A risk assessment completed by WHO CO concluded that the combination of historical outbreaks, the living condi- tions and the forthcoming rains placed the IDPs at an increased risk of cholera. At the request of the Ministry of Health, WHO facilitated the deployment of vaccine to the country.
The vaccine arrived in country on 22 February 2014. Over the following 38 days, two implementing partners MedAir and Medecins sans Frontiers have completed 3 campaigns in separate IDP locations, Mingkaman, Tomping and UN House delivering 132 925 doses. The vaccine regime requires two doses given as a single dose two weeks apart. Hy- giene messaging was given with the vaccine. In Mingkaman the second dose was co-administered with Meningococcal A conjugate vaccine. Further campaigns are anticipated.
As a new public health intervention to complement established cholera prevention and control measures, greater frequency of use of the vaccine stockpile will increase awareness and acceptability while at the same time providing evidence to demonstrate the full public health potential of this intervention.
For further details, follow this link. What works? What drives routine immunization performance in Africa? Robert Steinglass, John Snow, Inc.
Innovations in routine immunization (RI) occur throughout Africa, but rarely is a learning culture in place to system- atically identify what is working and to diffuse those good practices. To understand what drives improvements in RI coverage, the JSI-managed ARISE (Africa Routine Immunization System Essentials) project, funded by the BMGF, used an assets-based approach - - as opposed to the more familiar gap/barrier/bottleneck analysis -- to investigate the experience of 12 districts located in three countries: Ethiopia, Cameroon and Ghana.
Published last month in Health Policy and Planning, the article "Drivers of routine immunization coverage improve- ment in Africa: findings from district-level case studies" defines the pathways through which specific drivers im- proved RI system performance. It is freely available through open source access.
Six drivers of RI performance improvement emerged as common to the study districts where coverage improved. Although the way in which these drivers contributed to improved coverage varied by district, each was present in some way in the better-performing districts and was either absent or weaker in the study districts where coverage remained steady. They all worked in synergy with each other. None worked alone. The drivers include: Political and social commitment to RI (categorized as an enabling driver); Actions of development partners (also an enabling driver); Cadre of community-centered health workers (direct driver); Health system and community partnership (direct driver); Regular review of programme and health worker performance (direct driver); and Immunization services tailored to community needs (direct driver).
The ARISE approach was endorsed by the Task Force on Immunization (TFI) at the 2011 African Regional Confer- ence on Immunization: "Recommendation #11: Countries are encouraged to focus on an assets-based approach that focuses on positive drivers which contribute to improved immunization coverage and systems." Page 5 Additional ARISE resources are available at this link.
Global Immunization News (GIN) April 2014
Summary of the WHO Strategic Group of Experts (SAGE) April 2014 meeting Philippe Duclos, WHO HQ
SAGE reviewed the status of inactivated polio vaccine (IPV) introduction globally and the outcomes of the recent UNICEF tender process for IPV. SAGE noted that the vaccine will now be available to GAVI-supported countries for EURO 0.75 per dose (approximately US$1 per dose at current exchange rates) and EURO 1.50 to 2.40 per dose (approximately USD$2.1-3.3 per dose at current exchange rates) for middle-income countries; another man- ufacturer offered a price of US$1.90/dose in five dose vials, for any requesting country. SAGE reaffirmed the need for all countries to have completed planning for IPV introduction before the end of 2014.
SAGE reviewed the progress towards eventual confirmation of a specific date for global type 2 oral polio vaccine (OPV2) withdrawal, which requires the absence of ‘persistent’ type 2 circulating vaccine-derived poliovirus (cVDPV2) for at least six months globally. SAGE was alarmed by the persistent cVDPV2 circulation in northern Nigeria (since July 2005) and Pakistan (since August 2012), highlighting that these areas overlapped with some of the last wild poliovirus (WPV) reservoirs in the world. Stopping circulation of both WPVs and cVDPVs requires addressing gaps in supplementary immunization activity quality, increasing access, and using an appropriate mix of trivalent and bivalent oral poliovirus vaccine over the coming 10 months. SAGE emphasized that the elimination of persistent cVDPV2s by the end of 2014 or early-2015 must be a high priority to ensure that the global eradica- tion effort remains on-track for achieving the major milestones of the Polio Eradication & Endgame Strategic Plan 2013-18. SAGE urged countries to rectify the mix of OPV being used in large-scale immunization campaigns in cVDPV2-infected areas to ensure that OPV2 can be withdrawn during the ‘low season’ for poliovirus transmission in 2016, as originally scheduled.
Upon reviewing the relevant scientific evidence, SAGE endorsed the updates made to the existing WHO vaccina- tion recommendations for travelers from polio-infected countries in International Travel and Health (ITH).
Following the review of data on pertussis, SAGE concluded that the licensed acellular pertussis vaccines (aP) have lower initial efficacy, faster waning of immunity, and possibly a reduced impact on disease transmission relative to currently internationally available whole-cell vaccines (wP). The risk of resurgence of pertussis associated with the use of aP vaccines including increased infant disease, indicates that countries currently using wP should continue using wP vaccines for early infant vaccination.
The full meeting report will be published in the WHO Weekly Epidemiological Record on 23 May 2014. The meeting documents — including presentations and background readings — can be found at this link.
WHO Strategic Advisory Group of Experts approves two dose schedule for HPV vaccine Tracey Goodman, WHO HQ
At its most recent April 2014 meeting SAGE reiterated the importance of providing human papillomavirus immun- ization to girls as early as necessary, i.e. in girls aged 9 to 13 years prior to sexual debut, based on local data and patterns of sexual activity. Upon review of the evidence, SAGE recommended a 2-dose schedule for girls, if vac- cination is initiated prior to 15 years of age. A 3-dose schedule remains necessary if immunization is initiated after the girls’ 15th birthday. The recommended minimal interval between the 2 doses is 6 months. This interval may be extended to 12 months if this facilitates administration. A 3-dose schedule (i.e. at 0, 1-2, and 6 months) remains recommended for immunocompromised individuals, including those known to be HIV-infected.
Background documents Summary of recommendations
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Global Immunization News (GIN) April 2014
Mid-Term Review for the GAVI-Graduation Process in Honduras Claudia Castillo, Soledad Urrutia and Martha Velandia, PAHO
From 6-14 March 2014, a team from PAHO’s Immunization and Health Services Units, together with GAVI Secretari- at officers, met with Ministry of Health’s (MoH) authorities of Honduras to conduct a mid-term review of the coun- try’s GAVI graduation process. This assessment was conducted within the context of a new government administra- tion and broad reforms within the MoH.
PAHO conducted a desk review of key documentation: the EPI 2011-2015 strategic plan and 2014 plan of action, the Country Report submitted to PAHO’s Technical Advisory Group (TAG) in 2013, the latest GAVI Annual Progress Reports and JRFs, the 2007 EPI Review Report, and immunization-related results from the 2012 DHS. Interviews were conducted with key actors within the MoH, the Ministry of Finance (MoF), the National Statistics Institute (INE), the National Congress’ Commission for Health, and the National Immunization Advisory Group.
The mission concluded that there is sustained political and civil society commitment at all levels, to safeguard univer- sal access to the national immunization services. The 1998 EPI legal framework has been consolidated with a new Vaccine Law (2014) which puts in place measures to sustain the budget line for vaccines and guarantee operational costs for vaccination. Development of its norms and regulations is in progress, but the national financial crisis makes this a challenging undertaking.
Based on identified risks and opportunities, the MoH and the mission team agreed on strategic areas and activities to be supported technically and financially to better prepare the country for 2016 and beyond, i.e. establishing a health account and subaccount for immunization (seeking sustainable financing for local-level activities), strengthening MoH information systems (Vaccination Supplies Stock Management (VSSM), electronic registries, infrastructure), collabo- rating with the INE and the National Population Registry for more accurate denominators, maximizing the EPI model within the new Primary Health Care model, and implementing a cold chain replacement plan, supply chain optimiza- tion, social mobilization, etc. The country has consolidated a transition plan and will shortly present a GAVI proposal for Health System Strengthening.
Global Immunization News (GIN)
Survey
Last month, with the Global Immunization Newsletter (GIN), we conducted a short survey to gather your feedback and help us continue to improve the GIN to meet your needs and interests. In order to allow more time to those who have not yet have the opportunity to contribute, we are extending the deadline for you to submit your response for another month.
Your responses to this short survey are anonymous and will be aggregated to those of others to give us an insight into the preferences of our readers so we can tailor this newsletter to meet your needs. We value your input and thank you in advance for contributing. Please find the survey here.
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Global Immunization News (GIN) April 2014 Meetings / workshops
Training of trainers workshop for Rotavirus vaccine introduction and EPI programme performance evaluation, Angola Jean Marie Kipela and Fekadu Lemma, WHO Angola
Location: Luanda, Angola
Date: 19-21 March 2014
Participants: 85 participants: Provincial chiefs of depart- ment, EPI supervisors, National immuniza- tion and health promotion supervisors, Angolan pediatric society delegate and Partners including WHO, UNICEF, Core Group and Glaxo
Purpose: To train central and provincial trainers on A group photo of the participants of the workshop. Rotavirus vaccine introduction and to assess the routine immunization and sur- veillance performance status Details: Rotavirus is the major cause of severe forms of childhood diarrhoea in Angola. It is estimated that about 300,000 cases of diarrhoea in children less than five years of age and about 17,200 to 21,300 deaths are attributed to infections caused by Rotavirus. The government of Angola will be intro- ducing the rotavirus vaccine in the second quarter of 2014. The meeting was also used as an op- portunity to evaluate the routine immunization and surveillance performance of the country.
The meeting was opened by the national public health director and representatives from WHO and UNICEF. More than 85 participants from government institutions and partners attended the meeting. WHO Rotavirus vaccine power point training modules were used as the principal trai- ning materials. Lessons learnt from the evaluation of pneumo-13 vaccine introduction were also discussed during the meeting. Selected provinces were given the opportunity to discuss their rou- tine immunization and surveillance performances and experiences.
The following important conclusions and recommendations made during the meeting are worth mentioning: 1. Rotavirus vaccine is safe and if administered according to the schedule and indications it will provide high benefits in the prevention of severe diarrhea caused by rotavirus. 2. Strict compliance with the vaccination schedule by professionals and the country is of utmost importance to reduce the risk of adverse effects. 3. Improved surveillance of adverse events after immunization (AEFI) is a priority in the implemen- tation of the introduction of the Rotavirus vaccine.
By the end of the meeting all participating provinces developed and submitted their plan of action for the implementation of the introduction of the Rotavirus vaccine.
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Global Immunization News (GIN) April 2014
WHO European Region Immunization Programme Managers Meeting Catharina de Kat-Reynen, WHO Regional Office for Europe Location: Antalya, Turkey Date: 18-20 March 2014 Participants: 160 participants representing 46 countries, the World Health Organization (WHO), the European Centre for Disease Prevention and Control (ECDC), GAVI Alliance, United Nations Children´s Fund (UNICEF), associations of health care professionals and other partners.
Purpose: The objectives of the meeting were to exchange ide- Panel discussion on addressing vaccine hesitancy as and information on numerous topics of high im- during WHO European Region Immunization Pro- portance for immunization programmes in the Euro- gramme Managers Meeting. Credit: WHO. pean Region, including: elimination of measles and rubella; development of a Regional Vaccine Action Plan (RVAP); programme implications of the global Polio Endgame Strategy, including introduction of inactivated polio vaccine (IPV); ongoing threats to the Region’s polio-free status and preparation for potential reintroduction of the disease; tackling vac- cine hesitancy, and driving acceptance and demand for vaccines; introduction of new and under-utilized vaccines; tailoring immunization programmes to reach the underserved; impact and future plans for European Immunization Week. Details: After presentations on the status of vaccine-preventable diseases and surveillance in the Region, par- ticipants contributed to discussions, parallel working groups and a panel debate on responding to anti -vaccination sentiments. A summary of the presentations and discussions will be published shortly.
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Global Immunization News (GIN) April 2014
Peer-review of the WHO-UNICEF Joint Reporting Forms (JRF) and of GAVI Annual Progress Reports (APR) from Central African Countries Auguste Ambendet, WHO/IST central Location: Kinshasa, Democratic Republic of Congo Date: 07-12 April 2014 Participants: 31 participants: 10 national EPI staff; Heads from the Health system Strength- ening programme from Burundi, Came- roon, Central African Republic, Chad, the Democratic Republic of Congo (DRC) and Sao Tome è Principe; repre- sentatives from civil society from Burun- di and DRC; EPI focal points from WHO (countries mentioned above + Angola and Congo) and UNICEF (Burundi and DRC); Focal points from the WHO Health systems programme.
Purpose: To improve the quality of countries’ Joint Opening of the workshop with the Minister of Health, DRC Reporting Forms (JRF) and GAVI Annual Progress Reports (APR) through a peer review process Details: The Peer Review Process was established in 2007 to help GAVI eligible countries to improve the quality of their requests for funding for the introduction of new and under-utilized vaccines.
With the adoption of the Global Vaccine Action Plan, a framework for monitoring, evaluation and accountability was established. The JRFs are a way of measuring progress within this frameowrk. However, some weaknesses became apparent during the analyses of the JRFs transmitted by countries and needed to be improved through a workshop.
After the two three-day workshops, the peer reviewers did a critical and rational review of the draft JRFs and APRs for 2013 for each country; identified the strengths and weaknesses of each and suggested improvements; finalized the 2013 JRFs and forwarded them to the WHO Africa Regional Office; corrected the APRs based on feedback from peers; and each participating coun- try produced a timetable for completion of the APR which was discussed in plenary.
Participants adopted eight recommendations to keep the momentum for improving the quality of JRFs, with the introduction of functional groups involving all stakeholders in the health system.
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Global Immunization News (GIN) April 2014
Seminar on Measles & Rubella for non-health professionals Allyson Clouden, Ministry of Health, Grenada Location: Grenada, Carriacou & Petit Martinique
Date: 25-26 February 2014 Participants: Representatives from Grenada’s Ministry of Health and the Pan American Health Organization, as well as day care supervisors, pre-school teachers, police and correctional officers.
Purpose: To raise awareness about the Immunization Programme in Police officers gathered with the EPI Man- Grenada, focusing on maintaining measles & rubella elimination ager and community health nurse marking and congenital rubella syndrome (CRS). the completion of the Measles and Rubella Seminar held on 20 March 2014 in St. Georges, Grenada.
Prison officers attending the Measles and Rubella Seminar in St. Georges, Grenada on March 26th, 2014. Details: One hundred and seventy six persons from the targeted groups, both from the mainland Grenada and sister isles, Carriacou and Petite Martinique, participated in this series of eight seminars, which were facilitated by the EPI manager, assisted by five community health nurses who presented at alternate sessions. Among the topics presented were: overview of Grena- da’s immunization programme; the national immunization schedule; and measles, rubella, and CRS immunization records.
All participants contributed fully to discussions on the topics and applauded the effort of the Ministry of Health for this venture, which they deemed as very informative and enlightening. The stakeholders were very appreciative of the sessions, as they will enhance their advocacy role as key partners in the process of immunization. Requests were made for copies of the materials presented as well as additional information on other communicable diseases to share with others.
At the end of the seminars, the participants were provided with copies of the national sche- dule, the immunization law and a check list reminding them of their roles in maintaining the elimination status of measles, rubella and CRS in their specific area of work.
The sharing of information with key stakeholders in the immunization process is very impor- tant to maintain the gains achieved in the immunization programme, especially in countries which have already eradicated or eliminated vaccine-preventable diseases. Through part- nership with these stakeholders, advocacy and coverage will be improved as well as the timely surveillance for suspected cases. Page 11
Global Immunization News (GIN) April 2014
Second Meeting of the Network for Evaluation of Influenza Vaccines in Latin America and the Caribbean (REVELAC-i ) Carolina Danovaro, Nathalie El Olmeiri and Alba María Ropero, PAHO Location: Cartagena de Indias, Colombia
Date: 26-28 March 2014 Participants: Representatives from 13 Latin American countries
(LA), the US Centers for Disease Control and Prevention (influenza team and Central American Office), TEPHINET, I MOVE network, and PAHO (Communicable Diseases and Immunization Units)
Participants of the 2014 REVELAC-i Meeting in Cartagena de Indias, Colombia.
Purpose: 1) To review preliminary results from vaccine effectiveness studies in LA countries; 2) to discuss evidence needs for health authorities regarding maternal immunization and the correct use of the influenza vaccine; 3) to identify areas of cooperation and inter-agency collaboration principles in the REVELAC-i network; 4) to share the experiences Chile and Colombia had with the develop- ment and implementation of national electronic immunization registries; and 5) to train REVELAC-i team members on the analysis and interpretation of influenza vaccine effectiveness data, according to the current control-case protocol.
Details: Officially formed in March 2013, REVELAC-i currently includes 13 countries in the Americas Re- gion and collaborating institutions. During the second REVELAC-i meeting, the following topics were presented and discussed: Revisions to the REVELAC-i protocol for vaccine evaluation in 2014, keeping in mind the participation of new countries such as Ecuador; an update on influenza vaccination in Latin America and the Caribbean and on PAHO/WHO influenza surveillance proto- cols; country experiences with conducting assessments for influenza vaccine effectiveness using designs similar to the REVELAC-i project and translating the evidence generated for decision- making; the regional results following the multicentre evaluations of REVELAC-i during the 2013 season, including the experiences and lessons learned after implementing the project in Argentina, Brazil, Chile, Colombia and Paraguay, in addition to the countries that participated in the 2012 pilot phase (Costa Rica, El Salvador, Honduras and Panama); advancements and challenges of com- plementary projects related to influenza prevention and control; and REVELAC-i web platform, to share the progress, protocols, documents and updates related to the project.
In addition to the theoretical sessions, a group of representatives from immunization programmes went to the field to see Colombia’s national immunization registry in action in local health facilities. Immunization registries were highlighted as an important tool to provide accurate vaccination his- tories, which is crucial for the studies aiming at assessing influenza vaccine effectiveness.
Following the meeting, a teleconference with the participants will be scheduled to form working groups on the proposed research topics to move forward with the coordination and planning for each REVELAC-i project.
“Evaluating the Effectiveness of the Seasonal Influenza Vaccine in Latin America and the Caribbean: The Technical Declaration of the City of Antigua”. Immunization Newsletter. April 2013; Vol. XXXV No. 2 (p.1). Available at this link.
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Global Immunization News (GIN) April 2014
Meeting of Measles and Rubella Laboratory Network for the Americas Region Gloria Rey-Benito, PAHO Location: Atlanta, GA, USA Date: 2-4 April 2014 Participants: Representatives for 21 laboratories (18 national and three Regional Reference Laboratories (RRL’s), technical experts from the U.S. Centers of Disease Control (CDC), as well as the laboratory coordinators from WHO and PAHO.
Purpose: 1) review the status, achievements and challenges of the Mea- Participants of the 2014 Measles and Ru- sles and Rubella Regional Laboratory Network, 2) follow up bella Laboratory Network Meeting in At- on the performance of the laboratory network, 3) give rec- lanta, GA, United States. ommendations on testing and conducting interactive presen- tations of case studies. Details: Technical presentations and discussions took place on the following topics: global and regional situa- tion of the Measles and Rubella Laboratory Network, quality assurance and quality control, update on the achievements and challenges of measles/rubella laboratories, the enhancement of molecular test- ing in the Region, a plenary interactive presentation on how to do case analysis, recommendations for laboratory testing, molecular surveillance in tracking transmission patterns and routes, the role of the laboratory in elimination verification and how to maintain the capacity of the Regional Laboratory Network.
In the plenary session, an interactive presentation on how to analyze was given, and measles, rubella and congenital rubella syndrome (CRS) case analyses were led by participants from countries and through audience participation. Organized in a round table, participants discussed the role of the la- boratory in measles and rubella elimination.
The main conclusions and recommendations included referring specimens for quality control and la- boratory confirmation; collecting additional specimens and using additional laboratory tests; enhancing regional molecular surveillance; clearly defining the laboratory’s role in maintaining elimination, in quality assurance and quality control; and improving case classification.
Efforts should be made to strengthen the link between clinical, epidemiological and laboratory data for case classification. Laboratories should ensure the completeness and timeliness of reporting sur- veillance data to national authorities and PAHO/WHO, including data from non-network (private) laboratories, when possible.
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Global Immunization News (GIN) April 2014
Resources
Principles and considerations for adding a vaccine to a national immunization programme - From decision to implementation and monitoring (ISBN 978 92 4 15068 92)
This document reviews the principles and issues to be considered when making decisions about and planning the introduction of a vaccine into a national immunization program. Importantly, the document also highlights ways to use the opportunity provided by the vaccine introduction to strengthen immunization and health systems. This comprehensive resource document describes the latest references and tools related to vaccine decision-making, eco- nomic analyses, cold chain, integrated disease control and health promotion, vaccine safety, communications, monitoring, and more, and provides URL links to many of these resources. For more detailed information about a specific vaccine or aspect of immunization, decision-makers and planners should consult vaccine-specific position papers, vaccine- specific introduction guidance and other tools developed by WHO, UNICEF and other partners’
Use of MenAfriVac™ (meningitis A vaccine) in a controlled temperature chain (CTC) during campaigns Utilisation du MenAfriVac™ (vaccine contre la méningite A) en chaîne à température contrôlée (CTC) pendant les campagnes (WHO/IVB/13.04F) (File size : 1.97 MB)
Module de formation pour l’organisation de séances de vaccination (WHO/IVB/13.05F) (File size: 2.54 MB)
Guide d’adaptation et guide du formateur (WHO/IVB/13.06F) (File size: 1.75 MB)
Eliminating measles and rubella: Framework for the verification process in the WHO European Region
The WHO European Region is committed to eliminating measles and rubella by 2015. This revised framework for documenting and verifying interruption of endemic transmission was developed through consultations with Mem- ber States and the Regional Verification Commission for Measles and Rubella Elimination.
Key components in assessing whether endemic transmission of these diseases has been interrupted in a particular Member State include: detailed information about measles and rubella epidemiology; virologic surveillance supported by molecular epidemiology; analyses of vaccinated population cohorts; quality surveillance; and sustainability of the national immunization programme.
National verification committees to be created in all Member States are responsible for compiling and annually submitting the data.
Review and evaluation of annual national reports will continue in each Member State for at least three years after the Regional Verification Commission for Measles and Rubella Elimination confirms that endemic measles and ru- bella transmission has been interrupted in all 53 Member States of the Region.
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Global Immunization News (GIN) April 2014
Les pratiques qui améliorent la couverture par la vaccination anti-hépatite B à la naissance (WHO/IVB/12.11F) (Practices to improve coverage of the hepatitis B birth dose vaccine (WHO/ IVB/12.11) )
This review summarizes and appraises the evidence from published and grey literature on improving coverage of the hepatitis B birth dose. Specifically, the review looks at implementation evidence in relation to two main questions: What practices improve coverage of the hepatitis B birth dose? What are important facilitators and barriers to improving coverage of the birth dose?
Report of the Immunization and Vaccines related Implementation Research (IVIR), Advisory Committee Meeting, Geneva, 26-28 June 2013 (WHO/IVB/14.02)
The Immunization and Vaccines related Implementation Research (IVIR) Advisory Committee (AC) meeting report summarizes the deliberations of the Committee on matters related to implementation research and their relevance to immunization policies and practices during the face-to-face meeting June 26-27 June 2014.
The document highlight issues on hepatitis impact evaluation, malaria vaccine impact and cost- effectiveness, a measles investment case, burden of yellow fever estimation across Africa, vari- cella and zoster vaccination modelling and cost-effectiveness in low and middle income coun- tries and the WHO implementation research priority setting framework.
Case studies on dual vaccine introductions bring valuable lessons for inactivated poliovirus vaccine (IPV) Dalia Lourenco Levin, WHO HQ
Case studies highlighting lessons and efficiencies gained through the introduction of multiple vaccines are now availa- ble on the World Health Organization (WHO) website for IPV introduction, OPV withdrawal and routine immuniza- tion strengthening. The case studies provide valuable lessons to countries planning on introducing inactivated po- liovirus vaccine (IPV) vaccine at the same time as other vaccines.
Experiences from Ghana and Tanzania show that dual vaccine introduction provides advantages including im- proved efficiency in planning and training as well as cost savings when compared to the costs of introducing each separately. Both countries introduced rotavirus vaccine and pneumococcal conjugate vaccine (PCV) concurrently.
In Indonesia, where IPV was introduced into Yogyakar- ta’s routine immunization schedule, appropriate educa- tion and training ensured multiple injections were well accepted by providers and parents.
The WHO has recommended that all countries introduce at least one dose of IPV into their routine immunization schedule by the end of 2015. The IPV dose should be should be given in addition to other scheduled vaccine doses. To access the case studies and other resources related to IPV introduction, view the National Immunization Tech- nical Advisory Groups (NITAGs) toolkit on the IPV toolbox page.
Please email any questions in relation to these materials.
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Global Immunization News (GIN) April 2014
Records for Life: innovative child health record designs now publicly available! Skye Gilbert, The Bill & Melinda Gates Foundation
Earlier this year, the winners of the Records for Life contest were honored at the annual Interaction Design Asso- ciation’s Awards Dinner. The contest received >300 submissions from 41 countries. To evaluate the submissions, the Gates Foundation and Center for Knowledge Societies developed a multi-stage evaluation process including three stages of technical review and focus groups of health provid- ers and caregivers in India, Indonesia and Kenya. Winners were determined based on input from Melinda Gates, Co- Chair, Bill and Melinda Gates Foundation; Margaret Chan, Director-General, World Health Organization; Anthony Lake, Executive Director, United Nations Children’s Fund; Walt Orenstein, Associate Director, Emory University Vac- cine Center and former Director of the United States Im- munization Program; Robert Fabricant, Vice President of Creative, Frog Design; and Jocelyn Wyatt Co-Lead and Exec- utive Director, IDEO.org.
The complete focus group and technical review findings are now available upon request. A few early takeaways are: Health records that included photographs of the child were well-received by caregivers Providers and caregivers preferred data to be laid out in one direction rather than in a matrix Providers and caregivers wanted a prominent “Date of next visit” data field To prepare for the transition to a digital system, block letters and scanning technologies were favored by the technical panel For health information, minimal text and detailed, realistic images were generally preferred.
The innovative design ideas have been presented at a few regional EPI manager meetings and the Gates Founda- tion is interested in partnering with countries to design, print and distribute child health records with improved designs. If you are interested in partnering and/or learning more about how these designs could help improve data quality, access or use in your local area, send an email for more information.
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Global Immunization News (GIN) April 2014 Calendar 2014
May
01-02 Global Measles and Rubella Management workshops Geneva, Switzerland
05-11 Regional measles and rubella lab network training Muscat, Oman
19-24 67th World Health Assembly Geneva, Switzerland
20-22 Expert consultation on accelerated control of Japanese encephalitis in the Western Pacif- Manila, Philippines ic Region 27-29 Bi-regional meeting on prevention and control of Japanese Encephalitis New Delhi, India
June
3-5 Third Workshop for NRAs for Vaccines in Western Pacific Manila, Philippines
9-13 WHO Regional Focal Points and Consultants meeting on Immunization Financing Geneva, Switzerland
9-20 Consultant training workshop on measles & rubella surveillance review and measles elim- Cairo, Egypt ination validation 11-12 Immunization Practices Advisory Committee (IPAC) Geneva, Switzerland
12-13 8th African Rotavirus Symposium Livingstone, Zambia
16-18 Combined SubRegional Committees for the Certification of Polio Eradication and Verifi- TBD cation of Measles Elimination in the Pacific 18-19 GAVI Board Meeting Geneva, Switzerland
23-25 Global Polio Management Team meeting Geneva, Switzerland
July
14-18 SEARO Expanded Programme of Immunization Managers’ meeting and Immunization Colombo, Sri Lanka Technical Advisory Group Meeting 28-31 Regional Measles Rubella Laboratory Network meeting New Delhi, India
August
25-29 SEARO Immunization Technical Advisory Group Meeting New Delhi, India
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Global Immunization News (GIN) April 2014 Calendar
September 3-5 11th International Rotavirus Symposium New Delhi, India
8-12 SEARO Regional Committee meeting New Delhi, India
22-24 Global Measles Rubella Laboratory Meeting Istanbul, Turkey
29-2 PAHO’s Directing Council Washington DC, USA
October
13-17 Regional workshop on surveillance for new vaccine-preventable diseases Manila, Philippines
21-23 Strategic Advisory Group of Experts Geneva, Switzerland
27-29 DCVMN Annual General meeting New Delhi, India
November
17-20 EMRO Expanded Programme on Immunization Managers meeting Amman, Jordan
22-25 Intercountry Meeting on Measles and Rubella Amman, Jordan
December
8-12 Vaccine-Preventable Diseases Laboratory Network Meeting Manila, Philippines
9-10 SEAR Regional Working Group on New Vaccine Introduction and HSS Myanmar
2015
April
14-16 Strategic Advisory Group of Experts Geneva, Switzerland
October
20-22 Strategic Advisory Group of Experts Geneva, Switzerland
2016
April
12-14 Strategic Advisory Group of Experts Geneva, Switzerland
October
18-20 Strategic Advisory Group of Experts Geneva, Switzerland
2017
April
25-27 Strategic Advisory Group of Experts Geneva, Switzerland
October
17-19 Strategic Advisory Group of Experts Geneva, Switzerland
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Global Immunization News (GIN) April 2014 Links
Organizations and Initiatives
American Red Cross Sabin Vaccine Institute Child Survival Sustainable Immunization Financing
Agence de Médecine Préventive UNICEF Africhol Immunization EpiVacPlus Supplies and Logistics LOGIVAC Project SIVAC USAID Maternal and Child Health Integrated Program Centers for Disease Control and Prevention Polio WHO Global Vaccines and Immunization Department of Immunization, Vaccines & Biologicals New and Under-utilized Vaccines Implementation Johns Hopkins ICO Information Centre on HPV and Cancer International Vaccine Access Center Immunization financing Vaccine Information Management System Immunization service delivery Immunization surveillance, assessment and monitoring JSI SIGN Alliance Africa Routine Immunization Systems Essentials Project IMMUNIZATIONbasics Maternal and Child Health Integrated Program (MCHIP) Other Coalition Against Typhoid PAHO Dengue Vaccine Initiative ProVac Initiative European Vaccine Initiative Gardasil Access Program PATH GAVI Alliance Vaccine Resource Library International Association of Public Health Logisticians Rotavirus Vaccine Access and Delivery International Vaccine Institute Malaria Vaccine Initiative Measles & Rubella Initiative Meningitis Vaccine Project Multinational Influenza Seasonal Mortality Study RHO Cervical Cancer TechNet-21 Vaccines Today
WHO Regional Websites UNICEF Regional Websites Routine Immunization and New Vaccines (AFRO) Immunization (Central and Eastern Europe) Immunization (PAHO) Immunization (Eastern and Southern Africa) Vaccine-preventable diseases and immunization (EMRO) Immunization (South Asia) Vaccines and immunization (EURO) Immunization (West and Central Africa) Immunization (SEARO) Child survival (Middle East and Northern Africa) Immunization (WPRO) Health and nutrition (East Asia and Pacific) Health and nutrition (Americas)
Newsletters
Immunization Newsletter (PAHO)
The Civil Society Dose (GAVI CSO Constituency)
TechNet Digest
RotaFlash (PATH)
GAVI Programme Bulletin (GAVI)
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