Immunization Newsletter Volume XXXIV Number 5 Immunize and Protect Your Family October 2012 XX TAG Meeting Paving the Way for Immunization Bolivian Uru Chipaya Community Receives PAHO The XX Meeting of the Technical Advisory Group (TAG) on Vaccine- Immunization Award preventable Diseases of the Pan American Health Organization The Uru Chipaya Ethnic Group of the Oruro (PAHO) was held from 17-19 October 2012 in Washington, D.C. Department of Bolivia received the 2011 Pan The twentieth TAG Meeting addressed several topics including polio vaccines; use of thiom- American Health Organization (PAHO) Im- ersal in vaccines; age restriction on rotavirus vaccine administration; Decade of Vaccines; evi- munization Award for their activities to keep dence on pertussis; proposal for standardizing PAHO’s TAG procedures; PAHO’s Revolving immunization coverage close to 100% in Fund in the current global vaccine market; improving regional vaccine production capacity their area. The group was presented with a to meet the needs of the Americas; measles, rubella and Congenital Rubella Syndrome (CRS) certificate of recognition, as well as a mon- elimination in the Region of the Americas; Haiti’s immunization program; and cholera vaccina- etary gift in the amount of three thousand US tion in the Americas. dollars at the twentieth Meeting of PAHO’s Technical Advisory Group (TAG) on Vac- The slogan for the meeting, “Paving the Way for Immunization,” reflected the Region’s leader- cine-preventable Diseases. PAHO created the ship in immunization in the global context. The purpose of the meeting was to draft TAG recom- Immunization Award to recognize outstand- mendations on how to address current and future challenges facing immunization programs in ing contributions to a national immunization the Americas. The following is a summary of TAG’s technical deliberation and recommenda- program and to the control and/or elimination tions as presented in the final report. of vaccine-preventable diseases. Despite extreme poverty conditions, mar- ginalization and inequity, the Uru Chipaya Ethnic Group of Bolivia made extraordinary contributions in the control and elimination of vaccine-preventable diseases. In the last 15 years, the municipality reached more than 95% vaccination coverage, even reaching 100% coverage in some years. Since 2000, the community no longer has confirmed cases of measles, rubella or neonatal tetanus, in ad- dition to other vaccine preventable diseases, such as polio and diphtheria, which have not occurred in 24 years. Their achievements were made possible by making immunization and health promo- tion a top priority. In 2001, the community put nearly 60% of its financial resources into health, education and basic hygiene. The group established and maintained a strong alliance with the community, indigenous au- thorities and health personnel. Other activi- Members of the Uru Chipaya Ethnic Group of the Oururu Department of Bolivia receiving the 2011 PAHO Immunization Award ties to increase success in health included the In This Issue development and use of creative tactics to 1 XX TAG Meeting -Paving the Way for Immunization 5 Cholera Vaccination in the Americas prevent morbidity and mortality in the com- 1 Bolivian Uru Chipaya Community Receives PAHO 6 Thimerosal-Containing Vaccines Continue to be Safe munity; ensuring vaccination completion for Immunization Award 7 The PAHO Revolving Fund and the Current Global Vaccine teenagers, senior citizens and migrant groups; 2 Polio Vaccines Market 3 Rotavirus Vaccination Schedule 8 Improving Regional Vaccine Production Capacity to Meet increasing vaccination hours; and promoting 3 Measles, Rubella and CRS Elimination the Needs of the Americas health in schools. 3 Evidence on Pertussis 8 WANTED: Trinidad and Tobago’s East Leo Club 1982 4 Decade of Vaccines: From Planning to Action 2 Immunization Newsletter Volume XXXIV Number 5 October 2012 Pan American Health Organization Polio Vaccines At its most recent meeting held in Geneva on the development, scientific vetting, and rapid age conditions recommended during TAG’s 10-12 April, the Strategic Advisory Group finalization of a comprehensive polio eradi- previous meeting (Argentina 2011). If a of Experts (SAGE) on Immunization recom- cation “endgame” strategy, and inform Mem- country does not meet these basic conditions, mended that, the World Health Organization ber States of the potential timing of a switch it should conduct at least two annual vacci- (WHO) should promote switching from the from trivalent to bivalent oral poliovirus vac- nation campaigns, administering the tOPV 2 to every child aged <5 years, without taking trivalent oral polio vaccine (tOPV) to the bi- cine for all routine immunization programs . into account their previous vaccination sta- valent oral polio vaccine (bOPV) for routine PAHO’s TAG discussed the implications of tus. Countries making plans to introduce the vaccination. This change should take place a potential change in vaccination recommen- IPV should be able to guarantee its long-term in a synchronized manner in order to mini- dations, noting that the Region of the Ameri- supply, in addition to considering the price of mize the risk of cVDPV2 circulation and out- cas managed to eliminate wild poliovirus in the vaccine. breaks, as well as to accelerate the elimina- 1991; and since then has remained free of • Countries should reinforce surveillance of tion of type 1 and type 3 wild viruses, since polio without outbreaks due to importation, AFP, attain adequate levels in all basic sur- the bivalent vaccine provides better protec- using the tOPV vaccine. veillance indicators, and continue working tion against those virus types than the triva- to achieve ≥95% polio coverage in every 1 Recommendations: lent vaccine . municipality. • TAG awaits the World Health Organiza- During its 65th meeting in May 2012, the • As IPV will be considered for use in the po- tion’s comprehensive polio eradication and World Health Assembly (WHA) adopted lio endgame requested by the WHA, it will endgame strategy, as well as results from Resolution WHA65.5, which states that be important for WHO to maintain a fluid ongoing and planned research to revisit dialogue with vaccine manufacturers to en- “substantial planning is required for a glob- its recommendations for the Region of the sure an adequate IPV supply at an afford- ally synchronized switch from trivalent to bi- Americas. At the present time, the trivalent able price for countries of all income levels, valent oral poliovirus vaccine for routine im- oral poliomyelitis vaccine (tOPV) remains as this will be a factor in the rapid adoption munization and, potentially, the introduction the vaccine of choice for the Americas. of the vaccine. beforehand of one or more doses of inacti- To this end, PAHO, in collaboration with • PAHO is in an advantageous position to vated poliovirus vaccine. In 2012, the SAGE WHO, should negotiate with providers to work with the GPEI, in the development will provide recommendations on the actual ensure sufficient supply of tOPV for coun- of the endgame strategy and for the syn- implementation of this strategy based on tries of the Americas. chronized cessation of vaccines containing broad-based consultations across a number of • Countries considering the introduction of the poliovirus type 2, and supporting cost-ef- work streams.” In the Resolution, the WHA inactivated polio vaccine (IPV) should first fectiveness studies for different scenarios. asks WHO’s Director-General to undertake fulfill the sanitation and vaccination cover- Additionally, the World Immunization Week 1 Available at: http://www.who.int/wer/2012/ 2 Available at: http://apps.who.int/gb/ebwha/pdf_files/ could be used as an effective platform for wer8721.pdf WHA65/A65_R5-en.pdf globally coordinated actions. Polio3 coverage in children under 1 year of age and Polio cases in the Americas, 1975- 2011 1979 to 2011: ~1550 million OPV doses acquired throughout the RF 7000 100 90 6000 80 s 5000 C e 70 o s v a e c r f 60 a o g 4000 r Cases Coverage e e ( b 50 % m ) u 3000 N 40 2000 30 20 1000 10 0 0 75 77 79 81 83 85 87 89 91 93 95 97 99 01 03 05 07 09 11 Sabin-derived outbreak in DOR and HAI Source: country reports Immunization Newsletter Volume XXXIV Number 5 October 2012 Pan American Health Organization 3 Rotavirus Vaccination Schedule Currently, the vaccination schedules used in from the benefits of rotavirus vaccines could immunization of children at greater risk of Latin America and the Caribbean follow the be immunized, and it is likely that these in- morbidity and mortality due to rotavirus di- most recent WHO position paper, which rec- clude some of the children most vulnerable arrhea. However, in areas of difficult access ommends administering the first dose of the to this serious disease. Thousands of deaths and /or high diarrheal mortality, vaccine can vaccine between 6 and 15 weeks of age and could be averted, with just a minimal increase be administered later, at any time of immu- the last dose no later than 32 weeks of age (2nd in cases of intestinal intussusception. SAGE nization contact and before 1 year of age. dose for the monovalent rotavirus vaccine and also stated that based on the age distribution • TAG encourages countries that have not 3rd dose of the pentavalent rotavirus vaccine)1. of rotavirus disease, vaccinating children over introduced rotavirus vaccine to reassess More importantly, risk/benefit analysis con- 24 months of age would have few beneficial the burden of disease in order to consider tinues to favor early immunization, but cur- effects. the introduction of rotavirus immuniza- rent age-related restrictions on administration tion. This in light of the current evidence Recommendations: demonstrating the huge impact of rotavirus of the first dose (<15 weeks) and the last dose • In the Region of the Americas, countries (<32 weeks) prevent vaccinating many vulner- vaccine administered in the current sched- should continue making efforts to admin- ule in reducing the morbidity and mortality able children.