ETHIOPIA LAUNCHES PNEUMOCOCCAL VACCINE 28/10/2011 from Fiona Braka, WHO Ethiopia Over 100,000 children die each year before their fifth birthday due to Pneumonia which accounts for 28% of under-five mortality in Ethiopia. The Government of Ethiopia has taken great strides to reduce under-five mortality: a decade ago, 200 children for every 1,000 died before their fifth birthday, this has been reduced by more than a half now, at 88 per 1,000 deaths (Preliminary Report, EDHS 2011). The introduction of pneumococcal vaccine in Ethiopia is seen as a major milestone in contributing to further reduction of child mortality and achieving the Millennium Development Goal (MDG) four. With support from GAVI, Ethiopia launched the pneumococcal vaccine on 16 October 2011. The launching ceremony was held at Adhare Hospital in Hawassa in the Southern Nations Nationalities Peoples Region (SNNPR) presided by His Excellency the President of SNNPR, Ato Shiferaw Shigute and the Honorable Minister for Health, Dr Tedros Adhanom. The Chief of Staff at the GAVI Secretariat, Daniel Thornton, Representatives from WHO, UNICEF, USAID, Clinton Health Access Initiative (CHAI), GSK, other Health Partners and all Regional Health Offices also participated. The launching ceremony coincided with the annual health sector review meeting involving all health partners and regions. The Honorable Minister for Health noted that Pneumonia is the leading cause of death among

children in Ethiopia, an economic burden for families and for the development of the country, and called on all stakeholders and communities to join the fight against Pneumonia in order to achieve the MDGs. The Minister further remarked that all necessary steps have been taken to ensure the vaccine is available and accessible to all children even in the most remote communities. The Government has allocated USD 2.2 Million as its co-financing obligation for the new vaccine for the first year. The WHO Representative pledged continued support to

strengthen supervision and monitoring to ensure that the vaccine is administered safely, as well as support to assess the impact of the vaccine on pneumococcal disease burden through the established sentinel surveillance network. Over the eight months preceding the launch of the new vaccine, the Federal Ministry of Health led intensive preparations to introduce the vaccine as well as to meet the WHO prequalification conditions for the special vaccine formulation (Synflorix). Several materials were developed for intensified training activities including Health Extension Worker reference hand books in four local languages and a training DVD. Preparations were made for a Phase four Safety Study and programmatic monitoring surveys post introduction.

Technical Information

World Health Organization

28 October 2011 Global Immunization News

Global Immunization News

Inside this issue: Promising results from clinical trial of ad-vanced malaria vaccine candidate

2

Partners and ideas sought to bring innova-tion to immunization systems

2

New WHO materials on Thiomersal 2

Immunizations for Hajj Travelers 3

NEW WHO PREQUALIFICATION NEWS 3

AFRICA

• Meningitis Vaccine Project research teams plan for persistence studies of MenAfriVac

• Workshop on Preparations for Introduc-tion of New Vaccines in Central and West Africa

• Maternal and Neonatal Tetanus Elimina-tion (MNTE) Pre-validation Assessment, Burkina Faso

• Workshop on Preparations for the Intro-duction of New Vaccines in East and Southern Africa

• Briefing of central Africa experts on immu-nization

4-6 5 6

AMERICAS

• Immunization Data Quality Self- Assess-ment in Belize

• Improving Immunization Services in Haiti: Partner Support Follow-up Meeting

• Guatemala’s Vaccination Information System: A tool to identify the unvacci-nated and improve logistics and supply management

• Status of the Vaccination Programme in Panama

7-9 8

9

EASTERN MEDITERRANEAN

• Resolution on the Pooled Vaccine Pro-curement Initiative

9

SOUTH EAST ASIA

• Indian Academy of Pediatrics Recom-mends Immediate Use of Typhoid Vac-cines

• Vaccine Management Assessment in India

10

WESTERN PACIFIC

• China Organizes National Japanese En-cephalitis Workshop

• WHO Assessment of subnational Mea-sles/rubella laboratory in Sabah Malaysia and Accreditation Visit to EPI Laboratories in Malaysia

11

Regional Meetings & Key Events 12

Related Links 13

Mothers waiting for their children to receive the new vaccine for the first time

First child being vaccinated

PROMISING RESULTS FROM CLINICAL TRIAL OF ADVANCED MALARIA VACCINE CANDIDATE 28/10/2011 from Alison Brunier, WHO HQ First results from a large-scale phase 3 clinical trial of the most advanced malaria vaccine candidate, RTS,S/AS01, announced at the Global Malaria Forum in Seattle, show a 55% reduction in the frequency of malaria episodes during the 12 months of follow-up in children 5-17 months of age at first immunization. "Malaria has never had a vaccine get this far. If licensed, it would be the very first human vaccine against a parasitic disease", said the WHO Director-General, Dr Margaret Chan, during her keynote address to participants at the three-day Forum, a major event for malaria experts across the world. More information.

Technical Information

Page 2

Global Immunization News

The information contained in this Newsletter de-pends upon your contributions

Please send inputs for inclusion to:

gaudink@who.int

“Immunizing in the context of global independence”

“Integrating Immunization, other linked health interventions and surveillance in the health systems context”

PARTNERS AND IDEAS SOUGHT TO BRING INNOVATION TO IMMUNIZATION SYSTEMS 28/10/2011 from Michel Zaffran, WHO HQ In one month, the Grand Challenges call for proposals on innovative approaches to optimize immunization systems will close. This is the first time the Gates Foundation is opening a funding window specifically focused on optimizing country immunization systems. Grants of $100,000 are available now, based on a two-page application, with up to $one million in further funding on completion. WHO and UNICEF country and regional offices, Ministries of Health, NGOs, scientists, inventors, and entrepreneurs around the world are encouraged to submit two-page proposals for novel approaches to address the following areas: Vaccine characteristic prioritization. Immunization supply system design. Environmental impact. Information systems. Human resources. Vaccination acceptance. The deadline for submissions is 17 November 2011. More information.

NEW WHO MATERIALS ON THIOMERSAL 28/10/2011 from Alison Brunier, WHO HQ In preparation for the third session of the Intergovernmental Negotiating Committee to prepare a global legally binding instrument on mercury (INC3), convened by the United Nations Environment Programme, due to take place in Nairobi, from 31 October-4 November 2011, WHO has prepared an information sheet and questions and answers on thiomersal. The materials cover the reasons for the use of thiomersal in vaccines, evidence regarding safety, and WHO's position. A more general document on mercury and health has also been prepared in the lead-up to the Nairobi meeting. WHO participates in the treaty process with observer status. As well as being present at the INC sessions, WHO is providing submissions, technical briefings, and contributions to Secretariat meeting documents.

Page 3

Technical Information

Global Immunization News

“Introducing new vaccines and technologies”

“Integrating Immunization, other linked health interventions and surveillance in the health systems context”

GAVI related Information Next GAVI Review Dates: GAVI Board Meeting, 16-17 November 2011, Dhaka, Bangladesh

IMMUNIZATIONS FOR HAJJ TRAVELERS 28/10/2011 from Chris Nelson and Leah Harvey, Sabin Vaccine Institute, Washington, DC, USA The Hajj, scheduled for 4-9 November 2011, is the world’s largest and most diverse religious pilgrimage. Two million Muslims from around the world congregate in Mecca, Saudi Arabia, in a singular display of religious devotion. In order to reduce the risk of vaccine preventable and other disease transmission during the Hajj, the Saudi Arabian health authorities and others have issued vaccination guidance since 1997. Currently, pilgrims are • required to certify that they have been

vaccinated against yellow fever, meningococcal meningitis, and polio, and are

• recommended to be vaccinated against seasonal influenza, hepatitis A, hepatitis B, and typhoid fever. The World Health Organization also recommends that travellers take necessary precautions to reduce their risk of contracting disease, including hand washing, proper hydration, and improving access to safe water and basic sanitation.

WHO PREQUALIFICATION NEWS NEW VACCINES PREQUALIFIED 29 September 2011 Killed bivalent (O1 and O139) whole cell oral cholera vaccine, Shanchol produced by Shantha Biotechnics Limited in India. More information.

AFRICAN REGION

Country Information by Region

Page 4

Global Immunization News

MENINGITIS VACCINE PROJECT RESEARCH TEAMS PLAN FOR PERSISTENCE STUDIES OF MENAFRIVAC 28/10/2011 from Alison Brunier, WHO HQ In late September, members of the Meningitis Vaccine Project (MVP) travelled to Senegal to work with clinical trial investigators and monitors, WHO staff in Senegal and Ministry of Health partners on planning for forthcoming antibody persistence studies of the new meningococcal A conjugate vaccine, MenAfriVac. They also took the opportunity to provide all clinical results relating to the vaccine's development and an update on the implementation of the 2010 MenAfriVac campaigns, and plans for campaigns in 2011 and beyond. The epidemiological studies in Senegal (named PERS-003), due to begin in the last quarter of 2011, will measure the persistence of meningitis A antibodies in the blood of those 2-29 year-olds vaccinated with one dose of MenAfriVac five years ago. Three hundred individuals were vaccinated in Senegal as part of the clinical study at that time. The results will provide important information regarding the duration of protection of MenAfriVac and will help inform future vaccination schedules. A highlight of the trip was a visit to the research centre conducting the trials in Senegal, the Institut de recherche pour le development (or IRD), located in Niakhar, a rural district 150 km from Dakar. During the half-day visit, the MVP team was delighted to participate in a community debriefing, attended by village leaders, local government authorities, and regional and district medical and health staff. The objective of the debriefing was to provide an update on the results to date of the Meningitis Vaccine Project and campaigns, and to seek the agreement of the local leaders for the participation of the local population in the forthcoming persistence studies. Despite much of the debriefing being conducted in the local languages, Wolof and Sereer, the trust of the local community in the research team and the overall goals of the project was evident to those of us with no knowledge of these languages. Members of the MVP team also travelled to Mali and The Gambia for similar purposes during September and October. Results of the three studies, which overall cover the 1-29 age group, are expected in September 2012. Given that infants are the ultimate target population for MenAfriVac, hopefully within the routine immunization schedule, clinical trials for vaccination of infants are ongoing. Phase 2 trials began in Ghana in 2008 and are expected to be completed in 2012. A further phase 3 study is shortly due to begin in Mali, and is due to be completed in 2013. For more information on meningitis. For more information on the Meningitis Vaccine Project.

HSS= Health Sys-tems Strengthening; IST = Inter Country Support Team; ISS = Immunization Services Support; INS = Injection Safety Support; NVS = New Vac-cine Support; DQA = Data Qual-ity Audit; DQS = Data Qual-ity Self Assessment; RED = Reach Every District; cMYP = Fully costed multi-year plan; NITAG = National Immunization Tech-nical Advisory Group; NRA = National Regulatory Author-ity

“Protecting more people in a changing world”

Local leaders are updated on the work of the Meningi-tis Vaccine Project during a community debriefing in Niakhar. Credit: WHO/A. Brunier

Page 5

AFRICAN REGION

Country Information by Region

Global Immunization News

WORKSHOP ON PREPARATIONS FOR INTRODUCTION OF NEW VACCINES IN CENTRAL AND WEST AFRICA 28/10/2011 from Auguste Ambendet, WHO AFRO IST Central Following the results from the GAVI Alliance Independent Review Committee (IRC) and the recommendations from the Sub-Regional Working Group on immunization (SRWG) which took place in Yamoussoukro, Cote d'Ivoire in August 2011, the Inter-country Support Teams (IST) for Central and West Africa, in collaboration with AFRO, HQ, UNICEF, the GAVI Secretariat, the "Agence de Médecine preventive" (AMP) and the Sabin Vaccine Institute organized from 28-30 September 2011 in Douala Cameroon, a workshop on new vaccines introduction plans related to GAVI applications. The following countries participated in this workshop (new vaccines to be introduced in brackets): Angola (PCV and Rota), Burundi (Measles second dose and Rota), Cameroon, the Central African Republic (Rota), the Congo, Sao Tome and Principe (Measles second dose and Rota) ,Guinea Bissau and Mauritania (PCV), Senegal (PCV) and Togo (PCV and Rota). The objectives of the meeting were: 1) For the approved countries with or without GAVI IRC clarifications (Angola, Burundi, Cameroon, the Congo, Sao Tome e Principe and Senegal), to transform the new vaccine introduction plan into an operational plan; 2) To assist the countries which were GAV IRC approved with conditions (the Central African Republic, Guinea Bissau, Mauritania and Togo) to respond to the conditionalities requested. 3) Update the follow-up scorecard (from the SRWG) of the activities related to the introduction of new vaccines from west and central African countries. In conclusion, the countries whose applications have been GAVI IRC approved with or without clarifications have developed an operational plan for the requested vaccine(s), including a timetable for the follow-up of the implementation of the plan; the countries that were approved with conditions drafted their responses to these conditions and included the timetable for the finalization of the application; the scorecard following up on the activities related to the introduction of vaccines was updated and shared with AFRO, HQ and the GAVI Secretariat. The IST teams will follow up with countries on the finalization of the operational plans and responses to the conditions for submission to GAVI. If you would like to receive the full report, please contact Auguste Ambendet.

HSS= Health Systems Strengthening; IST = Inter Country Sup-port Team; ISS = Immuni-zation Services Support; INS = Injec-tion Safety Support; NVS = New Vaccine Sup-port; DQA = Data Quality Audit; DQS = Data Quality Se lf Assessment; RED = Reach Every District; cMYP = Fully costed multi-year plan; NITAG = National Im-munization Technical Advisory Group; NRA = Na-tional Regula-tory Authority

“Protecting more people in a changing world”

MATERNAL AND NEONATAL TETANUS ELIMINATION (MNTE) PRE-VALIDATION ASSESSMENT, BURKINA FASO 28/10/2011 from Ahmadu Yakubu, WHO HQ. Having implemented all its planned MNTE activities that included routine immunization of pregnant women during prenatal visits and outreach, promotion of clean deliveries and supplementary immunization campaigns and active surveillance for neonatal tetanus (NT) in the 41 identified high risk districts, the Government of Burkina Faso felt that adequate progress had been made to reduce the incidence of NT to less than one per 1,000 live births and the country could, thus, claim elimination. A joint pre-validation assessment was undertaken by WHO and UNICEF in collaboration with the Ministry of Health from 19-29 September 2011 that included a desk review to select the poorest performing district looking at core (NT rates, TT2+ coverage and skilled delivery at birth) and surrogate (first antenatal care visit, DTP3, urban/rural) indicators that led to the selection of four districts where field visits were undertaken. The field visits were guided by questionnaires administered at the community level to mothers who have had at least one child and those with children under two years to assess protection-at-birth against NT, routine immunization performance for children and mothers and delivery and cord care practices; at health centres level to assess immunization and delivery practices; at the district and regional level to assess programme management. The consensus of the evaluation team was that Burkina Faso has likely eliminated MNT. A quantitative survey was recommended to validate the elimination status. Gorom-Gorom district was selected as the worst performing district for MNTE in the country where the validation survey will take place based on the assumption that if the worst performing district is found to have eliminated MNT, the better performing districts would have eliminated as well. The survey is scheduled for January 2012.

AFRICAN REGION

Country Information by Region

Page 6

Global Immunization News

WORKSHOP ON PREPARATIONS FOR THE INTRODUCTION OF NEW VACCINES IN EAST AND SOUTHERN AFRICA 28/10/2011 from Gillian Mayers, WHO HQ A three-day meeting was held in Harare, Zimbabwe, for MoH, WHO and UNICEF participants from the following 14 countries: Ethiopia, Gambia, Ghana, Kenya, Lesotho, Liberia, Mozambique, Nigeria, Rwanda, Sierra Leone, Tanzania, Uganda, Zambia and Zimbabwe. The meeting had two objectives: (1) support those countries preparing responses to the conditional approvals received from the June 2011 GAVI Independent Review Committee (IRC) for support to introduce pneumococcal, rotavirus, Meningitis A and Measles second dose vaccines; and (2) support those countries whose applications were approved by the GAVI IRC to translate their introduction plans into operational plans that take into consideration all activities to be conducted prior to introducing the new vaccines into the routine immunization system. The meeting was divided up into five components, as follows: (1) The initial sessions of the meeting consisted of technical presentations on: planning for new vaccines introduction at country; introduction of measles second dose; advocacy and communication for new vaccines; sustainable immunization financing; cold chain and vaccine management; injection safety and waste management; AEFI monitoring and surveillance; PBM-Hib and rotavirus sentinel surveillance; data management for new vaccines; training monitoring and supervision; looking beyond new vaccines introduction; GAVI updates on new vaccines support; and the GAVI IRC report for June 2011. (2) During the second session, countries worked on finalizing their responses to the GAVI IRC conditional approvals and on translating their national new vaccine introduction plans into operational plans. (3) The third session consisted of countries being divided into groups of two in which each country reviewed the other country's documentation through a peer review process and provided feedback to the country during a plenary session. (4) During the fourth and final session countries then worked on incorporating the comments received during the peer review process into their final documents. At all times, the Secretariat (WHO/HQ, WHO/AFRO/IST, GAVI, UNICEF, MCHIP) acted as resource persons providing guidance to the process and outcomes and answering specific questions raised by the countries.

HSS= Health Sys-tems Strengthening; IST = Inter Country Support Team; ISS = Immunization Services Support; INS = Injection Safety Support; NVS = New Vac-cine Support; DQA = Data Qual-ity Audit; DQS = Data Qual-ity Self Assessment; RED = Reach Every District; cMYP = Fully costed multi-year plan; NITAG = National Immunization Tech-nical Advisory Group; NRA = National Regulatory Author-ity

“Protecting more people in a changing world”

BRIEFING OF CENTRAL AFRICA EXPERTS ON IMMUNIZATION 28/10/2011 from Auguste Ambendet, WHO AFRO IST Central In order to reinforce the technical competencies at the country and sub-regional level, and also to enhance the performances of the national immunization programmes, the AFRO Central Inter-country Support Team (IST) in collaboration with AFRO and other partners, organized from 26-27 September 2011, a briefing of experts on immunization in Douala, Cameroon. These experts were identified in the countries from the sub-region and are already working within the national immunization programmes. The following subjects were discussed 1) the follow-up of new vaccines introduction, 2) the reinforcement of the immunization data quality through the use of the data quality self-assessment (DQS) tool, and 3) the Supplementary Immunization Activities (SIA) against Polio and measles. The goal of this briefing was to form a group of experts in the fields mentioned above at the country and sub-regional level, able to technically support the national immunization programmes. The briefed experts are now able to undertake missions to support countries in the sub-region in the following fields: 1) DQS: Assisting countries to reinforce the use of the DQS in view of improving the quality of immunization data. 2) New vac-cines: assisting countries in preparing the introduction of a new vaccine and following up on its impact. 3) SIA: assisting countries in organizing a quality SIA.

Page 7

AMERICAS

Country Information by Region

Global Immunization News

IMMUNIZATION DATA QUALITY SELF- ASSESSMENT IN BELIZE, SEPTEMBER 2011 28/10/2011 from Eufemia Waight, Carolina Danovaro, WHO PAHO An evaluation of the immunization monitoring system, using the WHO Data Quality Self-assessment Tool (DQS), was conducted in Belize from 12-19 September 2011. Belize is a small English-speaking Central American country of 312,000 inhabitants that over the last ten years has reported immunization coverage levels >95% for most vaccines. Three of the country’s six districts were evaluated. The evaluation team was composed of three nurses and three data clerks from the three districts not evaluated, plus five international participants: one from MOH Bahamas, one from MOH Jamaica, plus three PAHO staff members (the immunization focal point in the Dominican Republic, a regional systems analyst and a regional immunization advisor). A unique feature of this DQS was the inclusion of questions regarding the immunization module of the Belize Health Information System (BHIS), the country’s web-based nation-wide health information system launched in 2008. The nominal immunization registry module has been recently added to the BHIS (2010), but has not yet replaced the paper and Excel Maternal and Child Health (MCH) reports as the source of vaccination numerators (number of vaccines administered). The BHIS is not yet available in all health centres providing vaccination services and not all immunization reports have been developed. The DQS team found health staff and an EPI Manager committed with their work and transparent with the information and a clear and well-organized system (data collection and flow). The main recommendations were aimed at improving the monitoring of the data quality at the local level, particularly during the transition between the current MCH reports (paper to Excel) and the BHIS nominal immunization registry, as well as conducting periodic coverage verification in the community through rapid coverage monitoring. Also, recommendations to improve vaccine wastage documentation and monitoring, taking advantage of the BHIS supply inventory management module were put forward.

HSS= Health Systems Strengthening; IST = Inter Country Sup-port Team; ISS = Immuni-zation Services Support; INS = Injec-tion Safety Support; NVS = New Vaccine Sup-port; DQA = Data Quality Audit; DQS = Data Quality Se lf Assessment; RED = Reach Every District; cMYP = Fully costed multi-year plan; NITAG = National Im-munization Technical Advisory Group; NRA = Na-tional Regula-tory Authority

“Protecting more people in a changing world”

IMPROVING IMMUNIZATION SERVICES IN HAITI: PARTNER SUPPORT FOLLOW-UP MEETING 28/10/2011 from Cuauhtémoc Ruiz Matus, WHO PAHO The Pan American Health Organization (PAHO) held a meeting in support of Haiti’s national immunization programme in Washington DC, USA on 20-21 October 2011. The objective of the meeting was to provide an update on the implementation of Haiti’s National Multi-year Immunization Plan 2011-2015 and discuss remaining funding gaps with partners. Participants included officials from Haiti’s Ministry of Health and representatives from key health organizations working in Haiti. Among the partners present at the meeting were: UNICEF, the GAVI Alliance, the U.S.’s Centers for Disease Control and Prevention (CDC), the Canadian International Development Agency (CIDA), the Ministry of Health of Brazil, the Cuban Medical Brigade, the Paediatric Society of Haiti, the American Red Cross, the Lions Club International Foundation and the American Academy of Paediatrics. After two days of sessions that highlighted the progress and challenges in implementing the multi-year plan, partners pledged their continued technical and financial support to strengthen Haiti’s routine immunization programme and for the introduction of new vaccines against Haemophilus influenzae type b (Hib) in 2011, and pneumococcal disease and rotavirus in 2013. Haiti’s current immunization programme includes vaccines against tuberculosis (BCG); diphtheria, pertussis and tetanus (DPT); polio (OPV); measles and rubella. For 2010, the country reported average national vaccine coverage rates of less than 70 percent. The overall objectives of the plan presented in this meeting are to maintain Haiti free of polio, measles and rubella, and to save lives and prevent illness through expanded coverage and the introduction of new vaccines. A key focus of the plan is strengthening the routine immunization programme. It includes measures to modernize the cold chain by increasing the number of refrigeration units and converting from propane to solar power; to improve delivery and follow-up services; to increase public awareness and improve communication; to install environmentally friendly incinerators for immunization-related waste disposal; to improve quality, logistics, surveillance and programme management in immunization; to provide technical and managerial training and to build institutional capacity within the Ministry of Health.

Country Information by Region

Page 8

Global Immunization News

GUATEMALA’S VACCINATION INFORMATION SYSTEM: A TOOL TO IDENTIFY THE UNVACCINATED AND IMPROVE LOGISTICS AND SUPPLY MANAGEMENT 28/10/2011 from Anabella Batres, Lisette Barrera and Ana Elena Chévez, WHO PAHO As part of the efforts to maintain the gains in immunization and increase vaccination coverage, the Ministry of Public Health and Social Welfare (MSPAS) of Guatemala is implementing a vaccination information system. This development has been possible thanks to technical and financial support of the Optimize Project (See description below), in collaboration with PAHO. This system is part of Guatemala’s Management Information System in Health (SIGSA) MSPAS’s and will be comprised of three key components: 1) a nominal immunization registry component; 2) a vaccine, syringe, and supplies logistics component, and 3) a mobile technology application component. The nominal registry component will allow for information on all children below five years of age in the country to be captured. The information contained in the register includes the child’s entire personal data (name, date of birth, age, gender, address), including the names and contact details of the parents (address, telephone number). The logistics component is to provide support for the work performed by nurses at the operational levels, facilitating the process of monthly planning for vaccines, syringes, and other supplies. For this, the system will consider the balances of vaccines, the number of children to vaccinate that month, the wastage factor, and the cold chain capacity. The mobile technology component will contribute to the information/education/communication activities, by sending SMS to the children’s parents/guardians regularly. These will serve to remind parents of the next vaccination date, as well as other primary health care aspects such as: Vitamin A, micronutrients, nutrition, among others, for their child(ren). Furthermore, an SMS will be sent to the health workers reminding them about logistical aspects of the vaccination. Some examples of the messages that will hopefully be sent include: “Ms Laura Figueroa: according to SIGSA you have reached recommended minimum stock of MMR vaccines. We recommend that you consider submitting an additional order” or “Mrs Albina Guerra: according to SIGSA you still have ten vials of a rotavirus vaccine lot that expire next month. We recommend that you adopt the necessary administrative actions.” Over the following six months, the implementation process for this new tool will be completed helping to identify in detail the number and identity of unvaccinated children. This will provide the opportunity to learn the epidemiology of unvaccinated children in Guatemala. Furthermore, it will facilitate guaranteeing that the number of vaccines, syringes, and supplies required at each local establishment be available when the establishments require them. Project Optimize is a collaboration between the World Health Organization and PATH that has the mandate to think far into the future: to put technological and scientific advances to work, helping define the ideal characteristics and specifications for health products; and to create a vaccine supply chain that is flexible and robust enough to handle an increasingly large and costly portfolio of vaccines.

AMERICAS

The information contained in this Newsletter de-pends upon your contributions

Please send in-puts for inclusion to:

gaudink@who.int

“Protecting more people in a changing world”

Country Information by Region

Page 9

Global Immunization News

STATUS OF THE VACCINATION PROGRAMME IN PANAMA 28/10/2011 from Itzel de Hewitt and Dilsa Lara, WHO PAHO Panama has been one of the first countries in the Region of the Americas to reach important targets set by PAHO/WHO regarding vaccine-preventable disease eradication and elimination. From its inception, the EPI has effectively maintained its commitment to achieve the essential objectives of the programme, i.e. the vaccination of the susceptible populations with the available vaccines and to do so reaching the highest possible coverage (see Figure). The achievement of the objectives has been possible through the implementation of various strategies, such as routine facility-based vaccination; house-to-house immunization; different vaccination campaigns modalities (Vaccination Week in the Americas, catch-up and follow-up campaigns). This is in addition to actively searching for unvaccinated persons in at-risk municipalities; responding to risk situations (suspected cases and outbreaks); and supplying vaccines to the private sector. In recent years, seven new vaccines have been included in the national immunization schedule: 1) the rotavirus vaccine for infants aged below eight months; 2) hepatitis A vaccine for children aged one year; 3) the Tdap vaccine for specific age groups, such as adolescents aged 11 years, women post-partum, partners of pregnant women, and health care workers; 4) the HPV vaccine, prioritized exclusively for girls aged ten years; 5) the pneumococcal conjugate vaccine (PCV) for infants aged under one year; 6) the pneumococcal polysaccharide vaccine for adults aged above 60 years; and 7) the pandemic influenza vaccine (H1N1). This new vaccination schedule provides the population protection against 17 diseases. This new vaccine introduction has been paired with the reinforcement and modernization of the cold chain equipment. National authorities and authorities of the Ministry of Health have historically supported, and continue to do so, the availability of the supplies and the use of national financial resources that support the immunization programne. In 2007, the country passed a vaccine law ensuring the continuous supply of vaccines and biologicals and the financial sustainability of vaccine procurement.

AMERICAS

HSS= Health Systems Strengthening; IST = Inter Country Support Team; ISS = Immunization Services Support; INS = Injection Safety Support; NVS = New Vaccine Support; DQA = Data Quality Audit; DQS = Data Quality Self Assessment; RED = Reach Every District; cMYP = Fully costed multi-year plan; NITAG = National Immunization Techni-cal Advisory Group; NRA = National Regulatory Authority

EASTERN MEDITERRANEAN REGION

RESOLUTION ON THE POOLED VACCINE PROCUREMENT INITIATIVE 28/10/2011 from Murat Hakan Öztürk, WHO EMRO The 58th Session of the Regional Committee of the Eastern Mediterranean Region (EMR) took place in Cairo from 2-5 October 2011. During the Regional Committee meeting, the Resolution EM/RC58/R4 on scaling up the Expanded Programme on Immunization (EPI) for meeting global and regional targets was approved. As part of the strategies to scale up EPI, EMR Member States are urged to participate in the establishment of a regional Pooled Vaccine Procurement (PVP) system and WHO/EMRO is requested to promote the establishment of this regional PVP system. A side meeting for discussing the technical details and addressing the request and queries of countries was held on 3 October at WHO EMRO. It is to be noted that upon regional countries’ request, WHO EMRO has started the PVP Initiative with the key partners, i.e. the WHO Headquarters (HQ), the Pan American Health Organization (PAHO), UNICEF Supply Division (SD) and UNICEF Middle-East and North Africa Regional Office (MENARO) and the US Centers for Disease Control and Prevention (CDC) Atlanta. One of the main goals of the PVP Initiative is to improve access to highest quality vaccines, particularly to new and underutilized vaccines, at competitive prices in predictable and appropriate timing to maximize the efficiency and minimize the risk of disruption to the immunization programmes due to access and supply issues. While promoting equity in access to vaccines, the PVP initiative will be strengthening immunization programmes by creating a com-munication, coordination and cooperation platform throughout the region. In the initial stage of the initia-tive, WHO/EMRO will be working with UNICEF SD which will act as a procurement agent for the partici-pating countries (mostly the Middle Income Countries for this stage). WHO/EMRO is planning to organize a technical meeting for the consensus and action plans development for the implementation of PVP Initiative, in Sharm El Sheikh, Egypt, 29-30 November 2011.

Page 10

SOUTH EAST ASIA REGION

Country Information by Region

Global Immunization News

INDIAN ACADEMY OF PEDIATRICS RECOMMENDS IMMEDIATE USE OF TYPHOID VACCINES 28/10/2011 from Chris Nelson and Ciro de Quadros, Sabin Vaccine Institute, Washington DC, USA

In recognition of the huge typhoid fever burden in India, the Indian Academy of Pediatrics Committee on Immunization (IAPCOI) has recommended the immediate use of the Vi polysaccharide vaccine to prevent typhoid. In their recommendation, the IAPCOI notes that “Improvements in hygiene and sanitation are still a distant dream. The Vi polysaccharide vaccine has been demonstrated to have reasonable efficacy in the Indian setting and is available. The IAPCOI therefore recommends the immediate inclusion of the Vi polysaccharide vaccines in the national immunization schedule.”

The IAPCOI recommendation is consistent with a WHO SEARO prioritization workshop that also classified typhoid vaccination as an ‘immediate’ priority. IAPCOI explicitly recommended “administration of a single dose of the polysaccharide vaccine in the age group of 2-15 years,” and noted this was a highly cost-effective strategy (US$160 per DALY averted). In response to the emergence of multidrug resistant typhoid in city hospitals, the Delhi municipal government has been vaccinating children between 2-5 years of age since 2004. An estimated 300,000 children are vaccinated annually with Vi polysaccharide vaccine, primarily from low-income households. Typhoid is included in the national communicable disease surveillance system, which includes testing for multidrug resistance. According to WHO, the Indian National Technical Advisory Group on Immunization (NTAGI) has discussed the implementation of typhoid vaccination and intends to deliberate further at their next meeting. The Indian NTAGI will also consider recommending sentinel typhoid surveillance in collaboration with the Indian Council of Medical Research (ICMR). Read the complete Indian Academy of Pediatrics 2011 recommendation Read the recently updated Government of India National Vaccine Policy (April 2011)

HSS= Health Systems Strengthening; IST = Inter Country Sup-port Team; ISS = Immunization Ser-vices Support; INS = Injection Safety Support; NVS = New Vaccine Support; DQA = Data Quality Audit; DQS = Data Quality Se lf Assessment; RED = Reach Every Dis-trict; cMYP = Fully costed multi-year plan; NITAG = National Im-munization Technical Advisory Group; NRA = National Regula-tory Authority

Credit: DFID/Russell Watkins

VACCINE MANAGEMENT ASSESSMENT IN INDIA 28/10/2011 from Srihari Dutta, UNICEF India For strengthening the immunization pro-gramme, the Government of India along with several State governments and part-ners has initiated steps for a systematic as-sessment of the existing cold chain and vac-cine management system. Cold chain and vaccine management assessment training has been undertaken in ten States of India using global tools like vaccine management assess-ment tool (VMAT), Effective Vaccine Man-agement Initiative (EVSM) and Effective Vac-cine Management (EVM) covering a popula-tion of 640.7million. Ten State vaccine stores, 38 Regional vaccine stores, 137 District vaccine stores and 269 Primary Health Center vaccine stores have been assessed between December 2007 and Octo-ber 2011. Currently, field work in Maharashtra is expected to be completed by 24 October 2011. Data con-solidation and analysis will follow and the finalization of the report is expected in early November 2011. An adult learning methodology, i.e. learning by doing, is used in the training. The five-day training on the vac-cine management and assessment tool is carried out with hands-on practice on doing assessment; this is fol-lowed by the actual assessment for five to six days. Subsequently, each team leader participates in the analysis and recommendation formulation. This helps in developing capacity within the state to conduct self-assessments on a regular basis as a sustainable strategy. The process has been effective to win ownership by the stakeholders and further stimulate a sustainable improvement due to the active participatory approach, especially in the analysis and development of recommendations.

States PopulationMP 72,597,565 Rajasthan 68,621,012 Gujarat 60,383,628 Orissa 41,947,358 Jharkhand 32,966,238 Chhattisgarh 25,540,196 West Bengal 91,347,736 Bihar 103,804,637 Assam 31,169,272 Maharashtra 112,372,972 TOTAL 640,750,614

State PopulationUttar Pradesh 199,581,477

VMA/EVM

Proposd EVM

EVM conducted ‐ 2010‐11 VMA conducted ‐ 2007‐10 Proposed EVM ‐ 2011

Country Information by Region

Page 11

Global Immunization News

CHINA ORGANIZES NATIONAL JAPANESE ENCEPHALITIS WORKSHOP, CHENGDU CHINA 30/09/2011 from Kimberley Fox and Youngmee Jee, WHO WPRO

The China Centers for Disease Control (China CDC) organized a "National Workshop on Japanese Encephalitis Surveillance and Laboratory Testing" from 28-29 September 2011 in Chengdu, China. Over 65 participants from China CDC, selected provincial CDCs, vaccine manufacturers and WHO attended. Officials from China CDC presented summaries of national JE surveillance data and recent JE-related research activities followed by presentations by nine provincial CDCs on JE incidence, disease burden and vaccination data. Most provincial laboratories conduct human (healthy children) serosurveys, vector (mosquito) surveillance and pig (animal host) serosurveillance as well as Japanese Encephalitis/ acute encephalitis syndrome (JE/AES) surveillance. The first JE vaccine came into use in China in the 1970s and the number of reported JE cases has gradually declined since then, but China still accounts for an estimated half of all global JE cases. JE vaccine was added to the national EPI schedule in 2008 to accelerate JE control. Experience presented from the provinces in this meeting suggests that routine JE vaccine use along with catch-up campaigns has had a positive impact. The China CDC JE laboratory is a WHO Regional Reference Laboratory and provides training and quality assurance for a network of provincial and lower-level laboratories which conduct primary testing for JE cases. In 2011, China MOH will designate ten sub-national JE laboratories in China which will also collaborate with WPRO.

WESTERN PACIFIC REGION

HSS= Health Systems Strengthening; IST = Inter Country Support Team; ISS = Immunization Services Support; INS = Injection Safety Support; NVS = New Vaccine Support; DQA = Data Quality Audit; DQS = Data Quality Self Assessment; RED = Reach Every District; cMYP = Fully costed multi-year plan; NITAG = National Immunization Techni-cal Advisory Group; NRA = National Regulatory Authority

WHO ASSESSMENT OF SUBNATIONAL MEASLES/RUBELLA LABORATORY IN SA-BAH MALAYSIA AND ACCREDITATION VISIT TO EPI LABORATORIES IN MALAYSIA, 3-7 OCTOBER 2011 30/09/2011 from Youngmee Jee, WHO WPRO

The public health laboratory in Sabah was assessed for possi-ble designation as a sub-national measles and rubella labora-tory in Malaysia to test the increasing number of measles outbreak samples from Sabah states in collaboration with WHO National measles/rubella laboratory in Selangor, Ma-laysia. Based on the assessment, the public health laboratory will function as a sub-national measles/rubella laboratory to conduct serological testing of samples from Sabah and Sara-wak states in Malaysia. The WHO national polio, measles/rubella and Japanese encephalitis laboratories in Malaysia were fully accredited for 2012 based on on-site review.

Global Immunization News

Regional Meetings & Key Events Related to Immunization Title of Meeting Start Finish Location Region

2011 Meetings Vaccine safety workshop 01-Nov 04-Nov Costa Rica PAHO

PAHO ProVac Regional Workshop on cost-effectiveness of HPV vaccination and screening strategies for cervical cancer control

02-Nov 04-Nov Bogota, Colombia PAHO

Training Workshop on Strengthening Events Allegedly Attributable to Vaccination or Immunization (ESAVI) Monitoring and Causality Assessment

07-Nov 11-Nov Brazil PAHO

WHO HQ Strategic Advisory Group of Experts (SAGE) Meeting 08-Nov 10-Nov Geneva, Switzerland Global

WPRO Regional Commission for the Certification of Poliomyelitis Eradication in the Western Pacific Region 14-Nov 18-Nov Viet Nam WPRO

PAHO Caribbean EPI managers meeting Postponed Freetown, Guyana PAHO

PAHO Study Tour to Brazil and Chile: Visit of Technical Staff of the Ministry of Health of China to observe sur-veillance strategies for Congenital Rubella Syndrome

14-Nov 22-Nov Brazil and Chile PAHO

PAHO ProVac Regional Workshop on the Use of Cost-effectiveness Analysis to Inform Regional Meeting on the Epidemiological Surveillance and the Introduction of New Vaccines: to discuss epidemiological surveillance progress and the introduction of rotavirus and pneumo-coccal vaccines in the Region of the Americas

14-Nov 18-Nov Montevideo, Uruguay PAHO

PAHO Regional New Vaccines Meeting 16-Nov 18-Nov Uruguay PAHO

GAVI Board Meeting 16-Nov 17-Nov Dhaka, Bangladesh Global

WPRO Regional Workshop on Cervical Cancer Control and HPV Vaccination 28-Nov 30-Nov Manila, Philippines WPRO

WPRO Regional Workshop on Surveillance for New Vaccine-Preventable Diseases and Multi-Year Planning for National Immunization Programmes

30-Nov 02-Dec Manila, Philippines WPRO

EURO Regional workshop for MICs on economical evaluations of new vaccines Nov Nov TBD EURO

AFRO Annual Regional Conference on Immunization (ARCI) and Annual Regional Inter-Agency Coordination Committee (ARICC)

05-Dec 08-Dec Windhoek, Namibia AFRO

Global Advisory Committee on Vaccine Safety (GACVS) Meeting 07-Dec 08-Dec Geneva, Switzerland Global

AFRO West and Central Africa Sub Regional Working Group Workshop 09-Dec 09-Dec Windhoek, Namibia AFRO

PAHO ProVac Centers of Excellence Meeting 13-Dec 15-Dec Cartagena, Colombia PAHO

GAVI WCA sub-regional working group meeting Dec Dec Tanzania AFRO

Progress Toward Rubella Elimination and CRS Preven-tion in Europe 09-Feb 10-Feb Rome, Italy Global

WPRO Regional Verification Committee for Measles Elimination 2012 2012 Philippines WPRO

Page 12

Links Relevant to Immunization

Page 13

Global Immunization News

Regional Websites New Vaccines in AFRO PAHO’s website for Immunization Vaccine Preventable Diseases in EURO New Vaccines in SEARO Immunization in WPRO

Newsletters PAHO/Comprehensive Family Immunization Program-FCH: Immunization Newsletter

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

Global Websites Department of Immunization, Vaccines & Biologicals, World Health Organization WHO New Vaccines Immunization Financing Immunization Monitoring Agence de Médecine Préventive EPIVAC GAVI Alliance Website IMMUNIZATION basics (JSI) International Vaccine Institute PATH Vaccine Resource Library Pediatric Dengue Vaccine Initiative SABIN Sustainable Immunization Financing SIVAC Program Website UNICEF Supply Division Website Hib Initiative Website Japanese Encephalitis Resources Malaria Vaccine Initiative Measles Initiative Meningitis Vaccine Project Multinational Influenza Seasonal Mortality Study (MISMS) RotaADIP RHO Cervical Cancer (HPV Vaccine) WHO/ICO Information Center on HPV and Cervical Cancer SIGN Updates Technet Vaccine Information Management System PneumoAction

Global Websites International Vaccine Access Center American Red Cross Child Survival PAHO ProVac Initiative NUVI Website Gardasil Access Program