Global Immunization News 28 May 2010

World Health Organization Global Immunization News

Inside this issue: Technical Information 66th World Health 2 Assembly endorsed LIVE-WEBCAST resolutions on a vari- ety of immunization GLOBAL NEW AND UNDER-UTILIZED VACCINES IMPLEMENTATION MEETING Family and Community 2 23-25 JUNE 2010 Health: contributing to the MDGs For the upcoming Global NUVI meeting on 23-25 June in Montreux, Switzerland, a live webcast will be running during the plenary sessions 30 years of smallpox 3 eradication com- and selected workshops of the meeting, enabling visitors to the site to memorated watch presentations as they are being given.

WHO Leads Revision 3 of International Tech- To view the agenda and register for the webcast please visit the nical Specifications of following website: http://www.who.int/nuvi/global_meetings/en/ Yellow Fever Vaccines index.html

New Publications 4 Once registered you will receive an email confirming your registration with information you need to join the Webinar. AfriFlu - international 4 conference on influ- enza in Africa OVER 100 COUNTRIES PARTICIPATED IN Selected officials 5 IMMUNIZATION WEEK contemplate a na- 28/05/2010 from Hayatee Hasan WHO/HQ: tional immunization Best opportunity yet 5 In 2010, for the first time, 112 countries in the WHO for a polio-free world: regions of the Americas, Eastern Mediterranean and WHA Europe hosted simultaneous immunization weeks which Update: WHO recom- 6 began on 24 April. This unprecedented collaborative mendation for recall effort between the three regions provided further and destruction of all momentum towards a worldwide immunization week. lots of Shan5 vaccine Various regional launches were held to kick off the week and a range of activities were carried out including workshops, training sessions, social mobilization, Recommendations on 6 use of rotavirus vac- round-table discussions, exhibitions and media events addressing a wide range of vaccine-related issues. cines In addition, large scale vaccination campaigns, tracking of unvaccinated people and the delivery of an integrated package of life-saving health interventions during "Child Health Days" also took place. The Revised RFP for Tech- 6 Net electronic forum target audiences for activities included parents, caregivers, health workers, mass media, and decision- and website makers. In addition, presidents and prime ministers, first ladies, health ministers, ambassadors and leading personalities such as international soccer star Ronaldhino Gaucho provided valuable support to GAVI Information 7 this important initiative. Beyond increasing immunization rates, the initiative is an effective tool for communicating the value of immunization. For more information, visit http://www.who.int/immunization/ Regional Meetings & 8- newsroom/advocacy_events_immunization_weeks_2010/en/index.html Key Events 10

Regional Meetings & 11 Key Events Announcement of 2011 GIM dates: Related Links 12 The 6th Global Immunization Meeting (GIM) will be held Feb 15-17, 2011 in New York. Further information will be made available in September.

Global Immunization News

Technical Information SIXTY-THIRD WORLD HEALTH ASSEMBLY ENDORSED RESOLUTIONS ON A VARIETY OF IMMUNIZATION ISSUES 28/05/2010 from Hayatee Hasan WHO/HQ: “Introducing new The World Health Assembly, which brought together Health Ministers and senior health officials from the WHO Member vaccines and States, concluded business and closed on 21 May. The delegates technologies” adopted resolutions on a variety of global health issues including: Global eradication of measles: Nineteen countries took the floor during the discussion and endorsed the following targets Flags flying during the WHA to be achieved by 2015: measles vaccination coverage of >90% Credit: Melinda Henry, WHO at national level and >80% in every district; a reported annual incidence of measles of <5 cases per million population; and =>95% reduction in global measles mortality compared with 2000 estimates. These targets should be viewed as milestones towards the eventual global eradication of measles. Member States were encouraged by the efforts and progress made in controlling measles but also highlighted the formidable challenges that need to be addressed to achieve the 2015 targets. These include: competing public health priorities, weak immunization systems, sustaining high routine vaccination coverage, addressing the US$ 298 million funding gap, vaccinating the hard-to-reach population and addressing an increasing number of measles outbreaks particularly in cross border areas. Success in achieving the measles 2015 targets is essential if the Millennium The information Development Goal 4 to reduce child mortality is to be reached. More Information. contained in this Newsletter depends Viral hepatitis: Member States accepted the report to the World Health Assembly and adopted a upon your resolution including a World Hepatitis Day on 28 July. Viral hepatitis (i.e. hepatitis A, B, C, D and E) —a contributions combination of diseases that are estimated to kill over 1 million people each year. An estimated 1 in 12 persons are currently infected and have to face a life with liver disease if unrecognized. This Please send inputs endorsement by Member States calls for WHO to develop a comprehensive approach to the for inclusion to: prevention and control of these diseases. More Information. [email protected] Treatment and prevention of pneumonia: Member States adopted a resolution on the treatment and prevention of pneumonia -- the number one killer of children under five years globally. The resolution makes it clear that intensified efforts to address pneumonia are imperative if the achievement of Millennium Development Goal 4 is to be achieved. More Information.

FAMILY AND COMMUNITY HEALTH: CONTRIBUTING TO THE MILLENNIUM DEVELOPMENT GOALS (MDGS) 28/05/2010 from Hayatee Hasan WHO/HQ: “Integrating The contribution of WHO's work in family and community Immunization, other health to MDGs 3 (to promote gender equality and empower linked health women), 4 (to reduce child mortality), 5 (to improve maternal interventions and health), and 6 (to combat HIV/AIDS, malaria and other surveillance in the diseases) was featured at the exhibit of the Family and health systems Community Health Cluster at the 2010 World Health context” Assembly. The role of vaccines and immunization in achieving these goals was highlighted in documentation available to visitors to the stand. Activities include: immunization against measles and other vaccine-preventable diseases; the introduction of new vaccines such as those against pneumonia Exhibit of the Family and Community and rotavirus diarrhoea; the provision of insecticide-treated Health Cluster at the 2010 World Health nets during immunization campaigns, and collaboration in the Assembly development of vaccines against diseases such as HIV, malaria, tuberculosis and epidemic meningitis. For more information, see http://www.who.int/immunization/ newsroom/fch_mdgs_flyer_wha_2010.pdf and http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_7- en.pdf

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Technical Information

The information THIRTY YEARS OF SMALLPOX ERADICATION COMMEMORATED contained in this 28/05/2010 from Hayatee Hasan WHO/HQ: Newsletter depends upon your On the sidelines of the 63rd World Health Assembly, public health leaders unveiled a statue at WHO contributions headquarters to commemorate 30 years of smallpox eradication. At a moving ceremony overlooking the bronze statue designed and crafted by Welsh artist Martin Williams, WHO Director-General Dr Please send inputs Margaret Chan was joined by many people who played a key role in this epic story. The statue depicts for inclusion to: "a global family" being vaccinated against smallpox and shows the bifurcated needle which together with the vaccine and tens of thousands of health workers, was instrumental in eradicating this disease. Dr [email protected] Halfdan Mahler, WHO Director-General during the period when the disease was eradicated; Dr Donald Henderson, former Director of the WHO Smallpox Eradication Programme and Dr Jean Roy, Director of Smallpox Eradication Commemoration Committee 2010, all spoke of the tremendous innovation, creativity, and dedication which helped end a 3,000 year-old disease which left death, blindness and disfigurement behind and marginalized those who survived. Dr Chan pointed out that the statue commemorates a time of great idealism that attracted talent and inspired commitment and personal sacrifice. "Above all, it stands as a reminder of the power of international health cooperation to do great and lasting good," she said. A new generation of public health workers, including those working on eradicating diseases such as polio and measles, looked on at the ceremony as veteran public health experts were reunited after three decades since smallpox eradication. More information Statue at WHO headquarters to commemorate 30 years of smallpox eradication

WHO LEADS REVISION OF INTERNATIONAL TECHNICAL SPECIFICATIONS OF YELLOW FEVER VACCINES 28/05/2010 from Tiequn Zhou, WHO/HQ:

Yellow Fever (YF) virus is endemic in tropical areas of Africa and Latin America. In Africa, an estimated 508 million people are at risk. WHO estimates that a total of 200 000 cases of YF occur each year, with about 30 000 deaths. YF is also a significant risk to more than 3 million travelers to areas affected with YF each year and it is the only viral disease specifically cited in the International Health Regulation as requiring vaccination and an international vaccination certificate for entry into some countries due “Protecting more to its potential global impact. The vaccines used must be of assured quality and approved by WHO people in a changing through the prequalification process. world” The 17D YF vaccine has been used for decades, has a long record of safety and has shown to be very effective for the control of YF. In light of scientific advances over the years, the WHO technical specifications for YF vaccines (WHO Technical Report Series 872, 1998) are being revised. An Informal Consultation on Revision of WHO Recommendations to Assure the Quality, Safety and Efficacy of Yellow Fever Vaccine was convened in 27 to 28 April 2010, at WHO Headquarters, to review a proposed update, in a global forum of experts from academia, industry and vaccine regulators. Consensus was reached on the updated international specifications of assessment of YF vaccine quality, non-clinical and clinical aspects in light of the technical advances, including use of specific pathogen free eggs for vaccine production; update on vaccine safety; implementation of international standards; introduction of new techniques for quality control and evaluation, etc. A new draft document will be prepared based on the outcome of the consultation and submitted to the Expert Committee for Biological Standardization (ECBS) in October this year.

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Technical Information IMMUNOLOGICAL BASIS FOR IMMUNIZATION: MODULE 4: PERTUSSIS - UPDATE 2009 28/05/2010 from Mario Conde, WHO/HQ:

This IVB document is now available online: Immunological basis for immunization: Module 4: Pertussis - Update 2009 This module focuses on Pertussis and replaces the publication WHO/EPI/93.14. 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.

THE INITIATIVE FOR VACCINE RESEARCH STRATEGIC PLAN 2010-2020 28/05/2010 from Mario Conde, WHO/HQ:

This IVB document is now available in hard copy and online: The Initiative for Vaccine Research - Strategic Plan 2010-2020 The WHO initiative for vaccine research (IVR) has prepared a long-term Strategic Plan to address critical challenges in vaccine development and vaccination research over the period 2010–2020. The Plan will be aligned with WHO's strategy and policies to stimulate innovation in health research, as well as with the immunization agenda of the Organization - the Global Immunization Vision and Strategy (GIVS). “Immunizing in the context of AFRIFLU - INTERNATIONAL CONFERENCE ON INFLUENZA IN AFRICA global 28/05/2010 from Marine Prado, AMP: independence” The Agence de Médecine Préventive (AMP: www.aamp.org) is organizing AfriFlu, an international conference focusing on influenza in Africa. The meeting will be held from 1 to 2 June, 2010 in Marrakech, Morocco. The conference will bring together key surveillance and influenza specialists from over 20 African countries and international partners active in the area of influenza, to share information on issues related to influenza disease burden and surveillance, to strengthen existing networks, and to identify possible solutions and recommendations to improve the understanding of influenza disease burden in Africa. AfriFlu is made possible by an unrestricted grant from Sanofi Pasteur.

VACCINE JOURNAL PUBLISHES A SUPPLEMENT ON NITAGS 28/05/2010 from Marine Prado, AMP:

In April 2010, Vaccine journal published a supplement entitled “The Role of National Advisory Committees in Supporting Evidence-Based Decision Making for National Immunisation Programs” (Volume 28, Supplement 1, pages A1-A110). The supplement, developed by SIVAC (www.sivacinitiative.org) in collaboration with partner countries and the WHO, is part of the Initiative's overall objective of supporting countries to enhance the use of The information evidence-based decision making in the establishment of immunization policies. contained in this For free access to the supplement, click here. Download Vaccine supplement, click here. Newsletter de- STATE OF THE WORLD'S VACCINES AND IMMUNIZATION. THIRD EDITION - pends upon your NOW AVAILABLE IN FRENCH AND SPANISH contributions 28/05/2010 from Alison Brunier, WHO/HQ: Please send in- puts for inclusion The report is a call to action to governments and donors to sustain and increase funding for immunization in to: order to build upon the progress made so far in meeting the global goals. It focuses on the major developments in vaccines and immunization since 2000. Part I examines the impact of immunization on efforts to meet the Mil- [email protected] lennium Development Goals, especially the goal to reduce deaths among children under five. It looks at the de- velopment and use of vaccines and at the safeguards that have been put in place to ensure their safety, efficacy, and quality. It sets out the progress and challenges in meeting the immunization-related global goals. It discusses both the cost of scaling up immunization coverage to meet these goals, and efforts to ensure that the achieve- ments are sustainable in the long term. Finally, it looks beyond 2015 to likely changes in the immunization land- scape. Part 2 describes over 20 vaccine-preventable diseases and reviews progress since 2000 in efforts to pro- tect populations against these diseases through the use of vaccines. French - Download document Spanish - Download document Hard copies of the English, French and Spanish versions can be ordered from [email protected]

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Technical Information SELECTED OFFICIALS CONTEMPLATE A NATIONAL IMMUNIZATION FUND FOR CAMEROON 28/05/2010 from Mike McQuestion, Sabin SIF:

“Immunizing in the On 29 to 30 April 2010, a group of parliamentarians and elected mayors met to discuss immunization financing in Cameroon. Ministry of Health, Finance and Decentralization officials and a visiting delega- context of global tion from Mali also attended the Sabin-sponsored workshop, which took place in Yaoundé. Motivating independence” the meeting was a recent executive order from His Excellency President Paul Biya to implement the country’s decentralization programme. The order took effect on 1 January 2010. Each of the country’s ten districts must henceforth form its own budget. The mayors have agreed to use immunization as a vehicle for developing this new capacity for the health sector. Cameroon is well on its way to sustainably financing its EPI Programme. GAVI is its only remaining external EPI partner. Following briefings from national EPI Manager Dr. KOBELA Marie and WHO Immunization Focal Point Dr. ANYA Blanche, the MPs and mayors decided to include immunization line items in their regional budgets. Concerned with donor dependency, they further recommended forming a national immunization fund, to be financed jointly by the federal government and the ten re- gional governments. The Ministry of Health will relay this recommendation to the Prime Minister. A task force will prepare a draft law instituting the fund. If the Council of Ministers agrees, the proposed law will be submitted later this year to parliament for its approval. To download a copy of SIF Sabin’s Summary Digest please visit: In English (Volume 2, Issue 1); In French (Volume 2, Issue 1)

BEST OPPORTUNITY YET FOR A POLIO-FREE WORLD: WHA 28/05/2010 from Rod Curtis, WHO/HQ:

Two years ago, recognizing the stalled progress in the remaining four countries which had never interrupted wild poliovirus transmission, the World Health Assembly (WHA) called for a new strategy to complete the job. Over the past 24 months, the Global Polio Eradication Initiative (GPEI) coordinated a major programme of work to develop new approaches. Targeted, new area- and Children being immu- population-specific approaches to reach chronically missed children were proposed and evaluated, and nized in Kano, Nigeria, new vaccines and vaccine solutions developed, including a powerful, new bivalent oral polio vaccine Nov 2009 supplementary (OPV). All of these activities helped inform the finalization of the new GPEI Strategic Plan 2010- immunization plus days 2012, which was developed in broad consultation with partners, stakeholders, ministries of health of the remaining infected countries and technical advisory bodies. The WHA welcomed this Strategic Plan during its meeting in Geneva from 17-21 May, 2010-2012 and noted the significant progress which had already been achieved as a result of these new approaches, particularly in the traditional reservoirs of northern Nigeria and northern India. By the first quarter of 2010, the number of polio cases in Nigeria had been slashed by 99% over the previous year. In northern India, record-low levels of type 1 polio transmission are being reported in the final two endemic states of Bihar and Uttar Pradesh, as both states have now gone for a record six months without any type 1 polio. And 10 of the 15 previously polio-free countries that were re-infected in The information 2009 have successfully stopped their outbreaks. The WHA concluded that there is clear evidence that contained in this the new approaches outlined in the Strategic Plan work, and endorsed the measures being put in place Newsletter depends to cement and monitor progress to rapidly identify any eventual problem areas. upon your At the same time, the WHA expressed concern that insufficient financing for the new Plan is contributions compromising its full implementation, as US$1.3 billion is still needed for the period 2010-2012. Please send inputs Countries have scaled back eradication activities, and for inclusion to: more such cuts are likely, all of which threatens [email protected] the progress achieved. The WHA concluded that the world now has perhaps the best opportunity ever to achieve a polio- free world. Every Member State - from donor government to endemic-country government - has a role to play to ensure the new GPEI Strategic Plan 2010-2012 is fully financed and fully implemented. If it is, it will lead to a polio-free world by 2013.

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UPDATE: WHO RECOMMENDATION FOR RECALL AND DESTRUCTION OF ALL LOTS OF SHAN5 VACCINE AS A PRECAUTIONARY MEASURE 28/05/2010 from Alison Brunier, WHO/HQ:

As of 26 April 2010, the World Health Organization (WHO) recommended as a precautionary measure the recall and destruction of all lots of the Shantha Biotechnics (India)-produced pentavalent Shan5 (DTwP-hepatitis B-Hib) vaccine remaining in stock in countries. The statement issued indicated that vials of the Shan5 vaccine being held in stock in countries should not be used. Countries having already identified the concerned stock were requested to organize transport of all unused vaccine to central level, in coordination with WHO and UNICEF country offices (or the in-country entity facilitating the procurement of the vaccines if vaccines were not supplied through UNICEF or the Pan American Health Organization). Once collected, the vaccine was to be handed over to the named Shantha representative in the country for appropriate handling of return and/or destruction. This recommendation was based on the advice of an ad hoc committee of experts convened on 8 April, following incidents of white sediment sticking to Shan 5 vaccine vials that was difficult or impossible to resuspend. No reports of any side effects from the use of Shan5 had been received. WHO recommended in the statement that countries continue vaccination using pentavalent vaccine from an alternative manufacturer or an alternative DTP-containing vaccine. Countries were advised to contact WHO or UNICEF country offices (or the in-country entity facilitating the shipments or procurement of these vaccines) for assistance with ensuring sufficient supply of vaccine for continuation of immunization programmes. Shan5 remains on the list of WHO prequalified vaccines for the time being. If, however, the manufacturer is not able to identify the root cause of the quality issue and prepare a robust plan for corrective action within two months of the recommendation for recall and destruction, the product will be removed from the list of WHO prequalified products. For more information please see the Joint WHO-UNICEF statement

RECOMMENDATIONS ON USE OF ROTAVIRUS VACCINES 28/05/2010 from Alison Brunier, WHO/HQ:

On 14 May 2010, the U.S. Food and Drug Administration issued a statement advising clinical and health-care professionals in the United States of America to resume the use of the rotavirus vaccine Rotarix and to continue using the vaccine RotaTeq. The statement followed a meeting of the FDA's Vaccines and Related Biological Products Advisory Committee on 7 May at which the latest data relating to the finding of DNA fragments of the porcine circovirus (PCV1) in the Rotarix vaccine, and the subsequent finding of DNA fragments of PCV1 and PCV2 in the RotaTeq vaccine. At this meeting, the FDA was informed by the Advisory Committee of its view, based on available evidence, that the benefit of using both Rotarix and RotaTeq outweighed any theoretical risk. Since notification of the issues relating to both Rotarix and RotaTeq, WHO has been in extensive communication with: the reference national regulatory authority for prequalification purposes (the EMA for Rotarix, and the U.S. FDA for Rotateq); experts in testing for unexpected agents; and the manufacturers; in order to gather further information. Statements have been issued on Rotarix by WHO, and the WHO committees, the Global Advisory Committee on Vaccine Safety (GACVS) and the Strategic Advisory Group of Experts (SAGE) on immunization. Questions and answers have also been issued. At its 13-15 April meeting, SAGE strongly recommended, in the absence of any known risk, the continued use of Rotarix for immunization programmes, in particular in those parts of the world with elevated under-5 mortality associated with rotaviruses. 22 March - WHO statement on Rotarix 26 March - GACVS statement on Rotarix 21 April - SAGE statement on Rotarix 21 April: Questions and answers on Rotarix Updated questions and answers, following review of the latest data on Rotarix and RotaTeq, are expected to be issued by WHO shortly. WHO will continue to communicate closely with all relevant authorities on new data relating to this issue and will issue further statements as appropriate. REVISED RFP FOR TECHNET ELECTRONIC FORUM AND WEBSITE 28/05/2010 from Jhilmil Bahl,WHO/HQ:

The World Health Organization (WHO) is soliciting requests for proposals for the ongoing management and updating of the Technical Network for Strengthening Immunization Services (TechNet21) electronic forum and website. All organi- zations or individuals should submit proposals by June 8th 2010. This is a revised RFP and applicants are encouraged to provide complete proposals addressing both areas of work, namely website development and website moderation. However applications covering only one of the two areas will also be accepted. Further details

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GAVI related Information The information 28/05/2010 from Kerstin Reisdorf, GAVI contained in this Newsletter de- FIRST AMC ANNUAL REPORT PUBLISHED pends upon your contributions For the first time, the GAVI Secretariat has published an Annual Report on the Advance Market Commitment (AMC). The report gives a comprehensive overview of this new approach to development Please send in- financing, illustrating the work of the pilot AMC for pneumococcal conjugate vaccines and summarizing the puts for inclusion first months of implementation. to: Milestones of the development of the AMC were the signature of the legal agreements by the donors in June 2009 and the first supply agreement with two pharmaceutical companies in March 2010. Supply of a [email protected] pneumococcal vaccine that addresses the needs of developing countries is to start this year and at a fraction of the price charged in industrialized countries. In an AMC, donors commit funds to guarantee the price of vaccines once they have been developed. Donors to the AMC are the governments of Canada, Italy, Norway, Russia and the United Kingdom as well as the Bill & Melinda Gates Foundation - who together have committed US$ 1.5 billion. The report has been developed by the AMC Secretariat at GAVI, in collaboration with the World Bank and UNICEF Supply Division and was approved by the AMC Independent Assessment Committee on 13 April 2010. Next GAVI IFFIM VACCINE BONDS RAISE US$ 1.2 BILLION IN JAPAN Review Dates: In only three years, Vaccine Bonds that raise money for GAVI Alliance programmes have yielded US$ 1.2 billion through sales in Japan. The International Finance Facility for Immunisation (IFFIm) launched the bonds Information in cooperation with Japanese banks that sold them to retail investors. Women make up the majority of the on 2010 Japanese investors in IFFIm bonds. This support has boosted GAVI’s grant giving capacity by 100%. That GAVI sub- means that half of GAVI’s commitments to developing countries come from funds raised by IFFIm. A mission and considerable share of the number of premature deaths that GAVI funding has prevented so far can be review dates attributed to IFFIm bonds. The IFFIm is funded by France, Italy, the Netherlands, Norway, South Africa, Spain, yet to be Sweden and the United Kingdom. confirmed.

GAVI JOINS PMNCH

The GAVI Alliance has joined the Partnership for Maternal Newborn Child Health (PMNCH) whose secretariat is hosted by WHO. GAVI aims to strengthen its engagement with women and children’s health partners. The high vaccination coverage rates of diphtheria, tetanus and pertussis show that immunization services reach deep into countries. A newly created internal working group on women's health and MNCH will align organizational efforts so that GAVI can strengthen its contribution to women's and children's health. An integrated approach to maternal, newborn and child health as well as to HIV/AIDS, malaria and tuberculosis has been widely accepted as the right way to accelerate progress towards the health-related Millennium Development Goals (MDGs). Recognising this, GAVI is a partner with the World Bank and the Global Fund to Fight AIDS, TB and Malaria – with coordination from WHO – in the newly created Health System Funding Platform. The Platform will provide funding for integrated delivery of maternal, newborn and child health, HIV, TB and malaria services.

GAVI SECRETARIAT MEETS WHA DELEGATES

The GAVI Secretariat took advantage of this year’s World Health Assembly in Geneva to invite delegates from developing and donor countries to an informal briefing during an evening reception on 20 May – to celebrate GAVI’s 10th anniversary. WHO has been instrumental in creating the GAVI Alliance in 2000. Rwanda’s health minister Richard Sezibera and GAVI’s CEO Julian Lob-Levyt took stock of the achievements in immunization over the past 10 years and highlighted future challenges. GAVI aims to roll out the vaccines against the biggest child killers pneumonia and diarrhoea – on top of its current programmes and therefore needs to raise an additional US$ 2.6 billion between now and 2015. Rwanda was the first developing country which introduced pneumococcal vaccines into its routine immunization programme with GAVI support. Some 50 guests also used the opportunity to discuss the 2011 – 2015 GAVI Alliance strategy and the eligibility and co-financing policies.

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Country Information by Region

AFRICAN REGION:

PILOT TESTING OF REVISED NEW VACCINES SURVEILLANCE (NVSM) AND ROUTINE IMMUNIZATION (RIM3) MODULES 28/05/2010 from Jason Mwenda, WHO/AFRO:

CDC are currently updating new vaccines surveillance (NVSM) and Routine Immunization (RIM3) modules to analyze surveillance data, targeted at sentinel and county level staff to assist in data entry and management. Pilot testing of these revised tools were conducted jointly by AFRO and CDC in Ghana from 26 to 27 April and in Kenya from 29 to 30 April. In addition, Training of Trainers to train WHO country office and inter country support team (IST) data managers was conducted from 4 to 7 May 2010.

The information contained in this Newsletter depends UNITED NATIONS DEVELOPMENT GROUP (UNDG) FOR upon your EAST AND SOUTHERN AFRICA (ESA) - contributions HEALTH WORKING GROUP PLANNING MEETING 28/05/2010 from Ahmadu Yakubu, UNICEF ESARO: Please send inputs for inclusion to: The UNDG for ESA Health Working Group had its planning meeting for 2010 in Johannesburg, South Africa, on 30 April 2010 under the leadership of the WHO [email protected] Inter-Country Support Team (IST) East and Southern Africa (ESA) and chaired by Dr. Oladapo Walker, the IST Coordinator. Also in attendance were UNICEF, UNFPA and the Regional Directors’ Team. The meeting resolved to address the agreed UNDG-ESA priorities for 2010 which include: 1. Provision of integrated support to the six 2010 UN Development Assis- tance Framework (UNDAF) roll out countries (Eritrea, Ethiopia, Malawi, Mozambique, South Africa, Zimbabwe); 2. Enhancement of regional inter-agency support to UN Country Teams (UNCTs): Follow up with the UNCTs to provide technical assistance in the implementation of their 2010 work plans; 3. Operationalization of the strategy for increased interaction with the Resi- dent Coordinators and UN Country Teams during the current reporting year; 4. Development of a strategy for integrated support to UNCTs in Eastern Afri- can and the Horn of Africa; 5. Provision of support to UNCTs in updating their contingency plans and Dis- aster Risk Reduction programming. The working group would also implement the unfinished business from the 2009 work plan that includes supporting countries to reach unvaccinated children, supporting the comprehensive multiyear immunization plan review and updating, and supporting new vaccines (specifically pneumococcal and rotavirus vaccines) introduction including community case management for pneumonia and diar- rhoea as part of broader pneumonia and diarrhoea control measures.. UNICEF ESARO’s Regional Adviser for Child Survival, Dr. Tesfaye Shiferaw, was selected to be the Co-Chair of the UNDG-ESA for 2010.

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 Technical Advisory Group; NRA = National Regulatory Authority

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Country Information by Region

EASTERN MEDITERRANEAN REGION: 28/05/2010 from Nahad Sadrazodi, WHO/EMRO:

FIRST VACCINATION WEEK IN THE EASTERN MEDITERRANEAN The first Vaccination Week in the Eastern Mediterranean was launched on 24 April 2010 with participation from 100% of countries in the Region. This historic event coincided with similar endeavors in the WHO Regions of the Americas and Europe, bringing the total to 112 participating countries and territories. Vaccination Week provides a unique opportunity to revive commitment to national immunization programmes and increase public awareness on the importance of immunization through advocacy, education and communication. The target audiences for these activities include parents, caregivers, health workers, mass media, decision-makers and stakeholders. A variety of activities were carried out during the week, addressing a wide range of vaccine-related issues, for example outreach activities in Djibouti, Iraq, Kuwait, Oman, Pakistan and Saudi Arabia, training sessions in Bahrain, Iran and Jordan, social mobilization in Morocco and Syria, round table discussions in Somalia, Sudan and Tunisia, and media events in Egypt, Lebanon and Yemen. In addition most countries organized launching ceremonies to kick off Vaccination Week with presence of high level dignitaries, partners and media. A regional launching ceremony held in Beirut on 24 April under the patronage of Her Excellency the First Lady of Lebanon, Mrs Wafaa Michel Sleiman, was jointly organized with the Government of Lebanon. Renowned artist Duraid Lahham, as well as leading television personalities from Lebanon and the region extended their support to this important initiative through several public service announcements and other advocacy materials. For more information and access to the advocacy materials, country action plans and media coverage, please refer to the website.

EUROPEAN REGION 28/05/2010 from Leo Weakland, WHO/EURO: POLIO OUTBREAK IN TAJIKISTAN

The European Region of WHO (WHO EURO) has experienced the first importation of wild poliovirus since it was certified polio free in 2002. A sharp increase in April of acute flaccid paralysis (AFP) cases prompted Tajikistan’s government to request WHO support for an outbreak investigation. The WHO Regional Reference Laboratory in Moscow confirmed wild poliovirus type 1 as the outbreak cause on 23/04/2010 and found that the poliovirus is closely related to a virus from Uttar Pradesh, India. WHO EURO deployed an expert team to investigate the outbreak in the south- west of Tajikistan, in the area bordering Afghanistan and Uzbekistan. This expert team is implementing a re- sponse plan per international guidelines established by the World Health Assembly. The WHO EURO alerted all countries to the public health risk in Central Asia as required under the International Health Regulations, and asked all Member States to: i) strengthen their surveillance for polio to be able to detect any importation in a timely manner; ii) be prepared for an immediate response in the event of an importation, and; iii) review immuni- zation status at sub-national levels. Importation of one wild poliovirus case has been detected in the Russian Federation. Synchronized SIA’s are ongoing in Tajikistan (3 rounds) and Uzbekistan (2 rounds) and planned for Kyrgyzstan with support from WHO, UNICEF, the US CDC and other partners. Kazakhstan and Turkmenistan have formed polio task forces and are enhancing surveillance and considering immunization plans. Emergency resource mobilization is under way by the Global Polio Eradiation Initiative and WHO EURO to meet vaccine and operational cost requirements for vacci- nation activities in the sub-region. The WHO EURO Regional Director visited Tajikistan and plans to visit Uz- bekistan from 5-7 June (during the second round) to assist the concerned Ministers of Health to raise awareness of the need to curtail the outbreak.

HSS= Health Systems Strengthening; IST = Inter Country Support Team; ISS = Immunization Services Support; INS = Injec- tion 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 Technical Advisory Group; NRA = National Regulatory Authority Page 9 Global Immunization News

Country Information by Region

WESTERN PACIFIC REGION 28/05/2010 from Manju Rani, WHO/WPRO:

TYPHOID VACCINATION IN FIJI

Fiji and other pacific island countries (e.g. Samoa) have one of the highest rates of typhoid fever in the world. Longer term measures to improve sanitation and hygiene are frequently hampered by natural disasters and an unstable political environment. Fiji has currently no typhoid vaccination policy. Following cyclone Tomas in March 2010, WHO, with the Ministry of Health, have secured funding from the Australian aid program (AusAID) for a mass Vi polysaccharide typhoid vaccination campaign for people at high risk of typhoid fever where capacity for improvement of hygiene and sanitation is severely limited. Mass vaccination will commence shortly in areas known to have a high incidence of typhoid fever that were severely affected by the recent cyclone. Sanofi Pasteur donated 10,000 doses of vaccine to be used in the emergency response . A national workshop involving all stakeholders is planned in August 2010 to develop a routine typhoid vaccination policy in Fiji.

INTRODUCTION OF HPV VACCINE IN MALAYSIA

Following Australia and New Zealand (both high-income countries), Malaysia becomes the first middle-income country in the Western Pacific Region to introduce HPV vaccine. Cervical cancer is the 2nd most common cancer among women in Malaysia after breast cancer with an estimated incidence of 16.1 cases per 100,000 population, translating into 2,000 new cases each year. The Ministry of Health in Malaysia will start the HPV immunization programme in June 2010 targeting an estimated 300,000 13-year-old girls through its School Health Programme, as well as through government health clinics. The vaccine will be provided free of charge to all the eligible girls. The government currently spends US$ 123 million on cervical cancer treatment compared to an estimated annual cost of US$ 48 Million for the vaccination.

INTRODUCTION OF HIB VACCINE IN VIETNAM IN JUNE 2010

Vietnam received the first shipment of pentavalent vaccine on 2 and 3 May. Training for vaccine introduction has already been conducted down to the lowest administrative level (province, district and commune). Leaflets and information sheets have been distributed and a TV spot is being aired. The Ministry of Health is planning to conduct the launching ceremony on 1 June 2010, which happens to be Vietnamese Children's day.

NATIONAL WORKSHOP ON ROTAVIRUS SURVEILLANCE IN CHINA, JUNE 2010

The sentinel surveillance for rotavirus diarrhea conducted in China since 1998 by CDC China has suggested rotavirus to be the most common cause of severe diarrhoea in the country. The current surveillance system includes 17 sentinel hospitals across the country and is integrated into a surveillance network for viral diarrhoea. In order to further improve the quality of the surveillance network, CDC China has hosted a rotavirus surveillance workshop on 24 to 27 May 2010. Technical staff from provincial CDCs and sentinel hospitals has participated in the workshop, along with staff from the national diarrhoea surveillance division, the national rotavirus laboratory and national immunization programme. Experts from WHO WPRO, WHO country office, and the rotavirus Global Specialized Laboratory at CDC USA have supported the workshop.

CHINA POLIO LABORATORY NETWORK WORKSHOP

China organized a workshop of its polio laboratory in Beijing from 19 to 21 May. The WHO polio Regional Reference Laboratory (RRL) at CDC China coordinated the workshop. Laboratory focal persons from WHO Regional Office, WHO China, RRL and all 31 sub-national (provincial) laboratories attended the workshop. The topics discussed included: update on progress of global polio eradication, the situation following importation of wild poliovirus in Tajikistan, national plans for responding to importation of wild poliovirus and emergence of cVDPV (circulating vaccine derived polio virus). Additionally, environmental surveillance and implementation of real-time PCR (polymerase chain reaction) techniques, laboratory diagnosis of HFMD (hand, foot and mouth disease) as well as of AFP laboratory performance quality in selected provinces were introduced at the workshop.

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 Dis- trict; cMYP = Fully costed multi-year plan; NITAG = National Immunization Technical Advisory Group; NRA = National Regulatory Authority Page 10 Global Immunization News

Regional Meetings & Key Events Related to Immunization Title of Meeting Start Finish Location Region 2010 Meetings Surveillance Meeting 07-Jun 09-Jun Minsk, Belarus EURO EMRO EPI Managers Meeting & NTAG/RTAG 07-Jun 12-Jun Hamamat, Tunisia EMRO First Meeting of the International Expert Committee to Verify Measles, Ru- 09-Jun 10-Jun Washington D.C., USA PAHO bella, and CRS Elimination in the Americas Countdown to 2015 and Sustainable Immunization Financing: Role of Ro- 15-Jun 15-Jun Kathmandu, Nepal SEARO tarians (Sabin) Global Advisory Committee on Vaccine Safety (GACVS) 16-Jun 17-Jun Geneva, Switzerland Global 26th Intercountry Meeting of National Managers of the Expanded Pro- gramme on Immunization & 2nd National Immunization Technical Advisory 04-Jul 07-Jul Cairo, Egypt EMRO Group Meeting Inter-country workshop on monitoring EPI performance and vaccination 05-Jul 07-Jul TBC WPRO coverage at district level 25th Regional Technical Advisory Group Meeting 08-Jul 08-Jul Cairo, Egypt EMRO 3rd Joint Rotavirus and Hib-pediatric surveillance meeting and data man- 13-Jul 16-Jul Harare, Zimbabwe AFRO agement training Regional Review Meeting on Immunization 19-Jul 23-Jul New Delhi, India SEARO Presentation of Progress Report on Rubella and CRS Elimination to Execu- 21-Jun 25-Jun Washington D.C., USA PAHO tive Committee Global Meeting on Implementing New and Under-utilized Vaccines 23-Jun 25-Jun Montreux, Switzerland Global Immunization Practices Advisory Committee (IPAC) Meeting 29-Jun 30-Jun Geneva, Switzerland Global Global Technical Consultation on the Feasibility of Measles Eradication 28-Jul 30-Jul Washington D.C., USA PAHO The 9th International Rotavirus Symposium 02-Aug 03-Aug Johannesburg, South Africa AFRO

23-Aug 23-Aug TBC WPRO Regional working group meeting [tentative] Technical Advisory Committee Meeting 24-Aug 27-Aug TBC WPRO Regional Meeting on Mumps 23-Aug 27-Aug Washington D.C., USA PAHO Global Consultation Meeting on Feasibility of measles eradication 06-Sep 09-Sep TBC Global Global Measles/Rubella LabNet Meeting 20-Sep 23-Sep Geneva, Switzerland Global Global Surveillance Meeting (TBC) Sep Sep Geneva, Switzerland Global Regional workshop on Surveillance, Monitoring & Evaluation (8 Countries) 27-Sep 30-Sep Damascus, Syria EMRO Regional Committee EMRO 03-Oct 06-Oct Cairo, Egypt EMRO Regional Working Group meeting in East and South Africa 06-Oct 07-Oct Kigali, Rwanda AFRO QUIVER Meeting 12-Oct 14-Oct Geneva, Switzerland Global Global Alliance for Vaccine & Immunization (GAVI) / Regional Working 18-Oct 20-Oct Sanaa, Yemen EMRO Group (RWG) New vaccines and surveillance meeting TBC TBC TBC WPRO Pacific Immunization Program Strengthening (PIPS) Meeting TBC TBC TBC WPRO Regional Vaccine Security meeting for Pacific Island countries TBC TBC TBC WPRO Regional TOT training on AEFI monitoring and management TBC TBC TBC WPRO Intercountry Meeting on Measles/Rubella Control/Elimination 01-Nov 04-Nov Amman, Jordan EMRO Strategic Advisory Grop of Experts (SAGE) Meeting 09-Nov 11-Nov Geneva, Switzerland Global First Meeting of the Presidents of the National Commissions to Document 10-Nov 11-Nov TBC PAHO and Verify Measles, Rubella, and CRS Elimination Malaria Vaccine Advisory Committee meeting 2010 22-Nov 24-Nov TBC Global Measles, Rubella Meeting - Laboratory Meeting - Regional Technical Advi- 28-Nov 02-Dec Amman, Jordan EMRO sory Group Meeting (RTAG) Intercountry Training Workshop on Surveillance of Vaccine Preventable Damascus, Syrian Arab Re- Diseases and Monitoring & Evaluation of National Immunization Pro- 04-Dec 09-Dec EMRO public grammes Global Advisory Committee on Vaccine Safety (GACVS) 08-Dec 09-Dec Geneva, Switzerland Global Global Immunization News

Links Relevant to Immunization 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

Regional Websites Newsletters

New Vaccines in AFRO PAHO/Comprehensive Family Immunization Program- FCH: Immunization Newsletter PAHO’s website for Immunization

Vaccine Preventable Diseases in EURO

New Vaccines in SEARO

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

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