News In this issue
News
First Polio National Immunization
Days organized in Guinea as the Ebola outbreak is under control
The Kingdom of Cambodia intro-duced IPV
WHO donates 162 refrigerators
to the NIP of Cambodia
Introduction of IPV in Vanuatu
A success story: Mustang, declared itself a fully immunized district
National review of the EPI and VPD surveillance in Sri Lanka
World’s first enterovirus 71 vac-
cine licensed in the PR China
Integrated Training for the Analysis of Vacc. and Deworming Coverage
Progress on MNTE as of Dec 2015
World Immunization Week 2016
Isolated gains in immunization need to become the norm
V3P update: reflecting on 2015
2
2
3
3
4
5
5
6
6 7
7
8
Past meetings / workshops
EVM Assessment in Honduras
WS Effective Management of Im-ported MR cases in the Americas
31st Caribbean EPI Managers’ Mtg
Regional WS on poliovirus labora-tory containment
Stakeholders Consultation on
mHealth Initiative by VaxTrac in Nepal
Regional Polio Meeting: Next Steps for Certification and Containment
Benin LOGIVAC Center’s first short course on vaccine logistics
Briefing on WHO tools and guid-
ance related to immunization data quality and coverage surveys
International Expert Committee meets in Brazil to discuss Measles elimination in the Region of the
Americas
Workshop on training health workers for effective Hepatitis B
9
10
11
12
13
14
15
16
17
18
Resources 18
Calendar 19
Links 20
Global Immunization News (GIN) December 2015
SUBSCRIBE NOW
Send an email to [email protected]
with the following text in the body of the email:
subscribe GLOBALIMMUNIZATIONNEWS
VIEW PREVIOUS EDITIONS
For previous editions of the GIN,
visit the GIN archive on the WHO website:
www.who.int/immunization/gin
You can click on the article you are
interested in and access it directly! Guinea introduces the Inactivated Polio Vaccine (IPV) Crépin Hilaire Dadjo, WHO, Inter-Country Support Team for West Africa
As the Ebola outbreak has so far been
contained in Guinea (the countdown to
zero cases started in mid-November
2015, and as of 11 December has been
successful), Inactivated Polio Vaccine
(IPV) was added to its routine immun-
ization schedule on 5 November 2015,
in a bid to accelerate polio eradication.
The launch ceremony for IPV was held
at Matoto, in the capital city of Cona-
kry, and chaired by the Minister of
Health in the presence, among other
dignitaries, of the Representative of
UNICEF and the Deputy Representative
of WHO to Guinea.
The vaccine is free of charge and is available in all facilities. The target population in 2015 is
452,076 children at three months and a half of age. Partners including WHO, UNICEF and
Gavi supported the introduction. IPV will be used together with OPV to boost the immunity
of children.
The last case of wild poliovirus was re-
ported in Guinea in 2011 and two circulat-
ing vaccine-derived polioviruses (cVDPVs)
were notified respectively in 2014 and in
2015. Because of the Ebola outbreak, no
response was conducted until September
and October 2015 where two rounds of
vaccination campaigns were organized in
four out of eight regions.
Many countries in West Africa have al-
ready introduced IPV. These include Be-
nin, Cote d’Ivoire, Gambia, Mauritania,
Niger, Nigeria and Senegal.
One of the first doses of IPV administered by a nurse.
Credit: I. Konaté_WHO_Guinea.
Mothers waiting for their children to be vaccinat-
ed. Credit: I. Konaté_WHO_Guinea
Page 2
Global Immunization News (GIN) December 2015
First Polio National Immunization Days organized in Guinea as the Ebola outbreak
is under control Crépin Hilaire Dadjo and Souleymane Kalilou, WHO Inter-Country Support Team for West Africa
On 8 December 2015 Guinea completed the first ever Polio Nation-
al Immunization Day (NID) held since the Ebola outbreak hit the
country in December 2013. The campaign was organized to respond
to the outbreak of two cases of circulating vaccine-derived po-
lioviruses (cVDPVs) detected in 2014 and 2015 in the Kankan region,
north-east of the country. Only two sub-National Immunization Days
were organized in four regions; the first in September and the sec-
ond in October 2015 in the regions of Faranah, Kankan, Labé and
Nzérékoré that surround Siguiri district where the cases were noti-
fied.
From 5-8 Decem-
ber 2015, the third
campaign reached
2,471,014 out of 2,523,431 targeted children aged zero to 59
months, according to administrative data available on 11 Decem-
ber 2015 (data still to be completed). Vitamin A and deworming
tablets were administered together with the polio vaccine.
Overall, some deficiencies in terms of quality were noted, however
with the support of partners including WHO, UNICEF, CDC,
BMGF, and HKI, corrective actions were conducted. An analysis of
lessons learned will inform the next polio NIDs , scheduled for
January 2016.
The Kingdom of Cambodia introduced IPV into its routine immunization
programme Sann Chan Soeung, National Immunization Programme, Samnang Chham and Md. Shafiqul Hossain, WHO Country
Office Cambodia, Dr Hasanuzzaman, WHO Consultant; and Aun Chum and Etienne Poirot, UNICEF
The Kingdom of Cambodia introduced the Inactivated Polio
Vaccine (IPV) into the national routine immunization pro-
gramme on 1 December 2015. To mark this day, the National
Immunization Programme organized a launch ceremony in
Kampong Speu province. Professor Eng Huot, Secretary of
State, Ministry of Health and Dr Dongil Ahn, WHO Repre-
sentative in Cambodia were present at the event as guests of
honour and delivered speeches. Also present at the ceremo-
ny were provincial heads of departments, Director of health
operational districts, and representatives from the communi-
ty .
IPV was rolled out across the country targeting eligible chil-
dren. “The introduction of IPV is a critical first step in the
eventual withdrawal of OPV. This introduction is for the
healthy future of our children and the global fight to eradicate
polio, where one day no child will ever be paralyzed by this
terrible disease again.” said Professor Eng Hout.
The first drop of vaccine given by the Minister of
Health of Guinea_Dr Rémy Lamah_ at Dubreka
in Kindia Region_Photo Credit CHDadjo_WHO
Vaccinators attending the official launch of the
NIDs at Dubreka_ Kindia Region_ Photo Credit
CHDadjo_WHO
Prof. Eng Hout, Secretary of State, Ministry of Health,
Cambodia delivering a speech at the launch ceremony.
Credit : WCO-Cambodia.
Global Immunization News (GIN) December 2015
Page 3
WHO donates 162 refrigerators to the National Immunization Programme of
Cambodia Sann Chan Soeung, National Immunization Programme, Md. Shafiqul
Hossain and Samnang Chham, WHO WPRO
World Health Organization has donated 162 refrigerators, 300 voltage
stabilizers, 2000 icepacks to the National Immunization Programme of
the Ministry of Health (MoH), Cambodia. In this regard, a handover
ceremony was held at the Central Medical Store in Phnom Penh on 23
November 2015 where Prof Eng Huot, Secretary of State, MoH re-
ceived the donated cold chain equipment from Dr Dongil Ahn, WHO
Representative in Cambodia. Dr Etienne, Chief of Health and Nutrition
was also present at this event.
Of the donated refrigerators, 102 units were distributed to provinces
and operational districts and 60 units were installed in the maternity
ward of referral hospitals for storing the Hep B birth dose and other
vaccines.
Introduction of Inactivated Polio Vaccine in Vanuatu Achyut Shrestha, Consultant, WHO Country Office, Vanuatu; Ridwan Gustiana, UNICEF
The Ministry of Health (MOH) Vanuatu committed to introducing the
Inactivated Polio Vaccine (IPV) in accordance with the Polio Endgame
Strategy 2013-2018.
Preparation and plans for the rollout have been ongoing since the end of
2014. With support and technical guidance from the primary implement-
ing partners UNICEF and WHO, Vanuatu proposed the introduction of
IPV to the Global Polio Eradication Initiative (GPEI). Access to sufficient
funds and vaccines through GPEI is crucial to supporting the successful
introduction of a new vaccine in the routine immunization programme
of a country like Vanuatu.
Vanuatu’s proposal to GPEI was accepted in early 2015, and soon after
implementation began. Plans, however, were interrupted in March when Vanuatu was struck by a Category 5 Tropical
Cyclone, Pam. The preparatory phase of IPV introduction was then postponed so that the MOH could focus attention
on the cyclone response.
Approximately 8,000 children are born every year in Vanuatu with the
total population spread out over 80 islands. The main urban locations of
Port Vila and Luganville have high numbers of children, however 75% of
Vanuatu’s population is based in rural areas. As a result, the organization
and effective planning required to contribute to a successful introduc-
tion of IPV was a major challenge for Vanuatu’s immunization team.
Introduction training for IPV was conducted in all of the provinces of
Vanuatu, involving nurses and midwives along with the EPI supervisors,
health managers and other representatives from the provincial health
offices. The training also included measles and rubella campaign micro
planning and a review of routine immunization.
With exemplary commitment from health staff throughout Vanuatu, strong leadership from the MOH, and technical
support from WHO and UNICEF, Vanuatu achieved the milestone of introducing IPV on 19 November 2015. IPV
supplies and communication materials such as information leaflets and posters on IPV have been distributed to all
provinces.
Prof Eng Hout, Secretary of State, Ministry of
Health, Cambodia receiving cold chain equip-
ment from the WHO Representative in Cam-
bodia. Photo: WCO-Cambodia.
Pamila Woetani- the first child to receive IPV
in Vanuatu
Pamila Woetani- the first child to receive IPV
in Vanuatu
Global Immunization News (GIN) December 2015
A success story of a District beyond the Himalayas: Mustang, declared itself a fully
immunized district Sudhan Gnawali, WHO Country Office Nepal
Resulting from strong local ownership, helping to ensure that 100% of chil-
dren under one year of age have received their complete immunization
schedule, the district of Mustang in the Himalayan region, has celebrated its
declaration as fully immunized. To boost the declaration and related sense of
accomplishment for all involved, the event is an important milestone that is
also a high prioritity for the government.
The event gathered a Member of
Parliament, the Regional Administra-
tor, the Regional Health Director,
the District Lawyer, the Repre-
sentative from the Ministry of Fed-
eral Affairs and Local Development, Representatives of WHO and UNICEF,
the Nepal Army and Police, Female Community Health Volunteers (FCHV)
and hundreds of local community members.
”It always seems impossible until it is done”, is a metaphor that has been set
in Mustang, the district that was declared Nepal’s twelveth to be fully im-
munized, despite the constraints of geography and access.
During the event to celebrate Mus-
tang’s achievement, the Member of Parliament marked the occason by lighting
16 lamps on 28 November, 2015 – each to represent one of the 16 Village
Development Committees (VDCs) in Nepal. At the end of the ceremony,
every stakeholder committed to the sustainability of full immunization ser-
vices. The event was witnessed by large crowds and was certainly a matter of
pride in the journey towards a healthy nation.
In Nepal, Mustang district is considered a Hard to Reach Area. In most of the
VDCs in upper Mustang, life becomes harder from December to February,
due to the extreme cold. The transportation of vaccines is not easy. To reach
children with immunization services and ensure that all children under one
year of age are immunized may seem an impossible task, but local level own-
ership and commitment has led to a favorable outcome.
The District Health Officer in Mustang cited that Mustang district is renowned for being ‘A district beyond the Hima-
layas’, where it is a two or three day walk from the district headquarters to deliver immunization services in the com-
munities. Despite this fact, the tireless health workers and their preservance have made the full immunization a suc-
cess story in Mustang.
Nepal is set to declare the entire country as fully immunized by 2017 and has moved ahead with clear vision of Clos-
ing the gap and Reaching every Child. The declaration in Mustang can be a model for other hard to reach areas.
Page 4
A member of parliament inaugurating the
event.
A member of parliament declaring Mus-
tang the nation’s 12th fully immunized
district.
A rally at the celebration in Mustang.
World’s first enterovirus 71 vaccine licensed in the People’s Republic of China Lance Rodewald and Zuo Shuyan, WHO China Country Office
The China Food and Drug Administration licensed the world’s first vaccine to pre-
vent enterovirus 71 (EV71) disease. EV71 vaccine was developed and is manufac-
tured by the Institute of Medical Biology, Chinese Academy of Medical Science, in
Kunming, Yunnan province.
EV71 virus, along with coxsackievirus A16 and other enteroviruses, causes Hand,
Foot, and Mouth disease (HFMD), a febrile rash illness of children that is often associ-
ated with painful mouth ulcers. HFMD caused by EV71 virus tends to be more se-
vere and is associated with neurological complications that have led to thousands of
death over the years. Most cases of HFMD occur among children under ten years old; severe complications and
death are most common among young children.
EV71 disease occurs worldwide, but most prominently in Asia, where it has emerged as a serious public health con-
cern in recent years due to escalating outbreaks.
The Institute of Medical Biology’s EV71 vaccine is an inactivated vaccine that will be administered by intramuscular
injection in two doses, separated by one month. The first dose can be given at six months of age, providing protec-
tion during the ages of vulnerability.
Vaccine efficacy was shown to be over 97% in a clinical trial in which over 6,500 children received EV71 vaccine and
an equal number received placebo. Vaccine side effects were mild, primarily fever and local reactions.
“There is no specific treatment for Hand, Foot and Mouth Disease caused by enterovirus 71, which is what makes the
development and licensing of this vaccine so important: by preventing children from getting this dangerous disease in
the first place, this new vaccine has the potential to greatly reduce suffering and death from EV71 disease in China –
and hopefully one day, the rest of the world,” said Dr Bernhard Schwartländer, WHO Representative China.
Global Immunization News (GIN) December 2015
Page 5
National / international review of the Expanded Programme on Immunization (EPI)
and vaccine preventable disease (VPD) surveillance in Sri Lanka 16-26 October 2015 Sigrun Roesel, WHO SEARO
A national / international review of the Expanded Programme on
Immunization (EPI) and vaccine preventable disease (VPD) surveil-
lance in Sri Lanka was conducted on 16-26 October 2015 to pro-
vide insight into the status of the programme, to enable programme
managers and public health policy officials and to share best practic-
es. Overall the review focused on national level support for the
prevention and control of vaccine preventable diseases, EPI and
VPD surveillance implementation and management, and future stra-
tegic directions in achieving global and regional goals. Specific objectives included strengthening of life course vaccina-
tion (MMR2 at 3 years, school immunization, eligible couples and pregnant women), routine immunization at the core
of health system strengthening, and experiences with new vaccine introduction. Eleven teams composed of national
and international participants visited 20 districts throughout the country, and a review of central level functions also
took place.
The overall conclusion was outstanding service delivery throughout the island, with many best practices to share with
other countries. The review found strong central level support across areas such as high level advocacy, staff capacity,
planning and decision-making for new vaccine introduction, vaccine advisory bodies, and AEFI surveillance and inves-
tigation. Excellent EPI implementation and management is also based on the capacity and commitment of front line
health care workers and the subsequent trust of communities.
Recommendations from the review highlighted the benefits of representation of primary care and immunization
stakeholders in health care planning, including in ensuring adequate funding and human resourcing to sustain primary
care and public health sectors. The review outcomes also helped to identify a way forward for strengthening and reg-
ularizing the oversight of vaccination in the private sector, enhancing the role of surveillance in guiding the EPI, and
capitalizing on economic growth to increase funding for new vaccines.
Group photo from the EPI review.
EV71 vaccine licensed in China.
Global Immunization News (GIN) December 2015
Integrated Training for the Analysis of Vaccination and Deworming Coverage Martha Velandia, Marcela Contreras, Hannah Kurtis, Ana Luciañez and Laura Catalá (PAHO/WHO) and Ana Morice
(International Consultant)
PAHO’s Immunization Unit and Neglected Diseases Unit have together developed a Toolkit for Monitoring the Cov-
erage of Integrated Public Health Interventions, with modules on topics such as the analysis of administrative cover-
age, rapid coverage monitoring and the evaluation of data quality, among others. The Toolkit aims to facilitate the
analysis and monitoring of vaccination and deworming coverage at all levels of national health systems, ultimately im-
proving the health of the population under 15 years of age.
Throughout 2015, four training workshops on the Toolkit were carried out, including three national workshops in
Mexico (120 participants), Honduras (70 participants) and El Salvador (30 participants), and a regional workshop in
Roatán, Honduras. In this latter workshop, in addition to the host country, there were participants from Colombia
(two), the Dominican Republic (two), Mexico (two), Nicaragua (one) and Paraguay (two). In addition to presentations
and group work, the workshops in El Salvador and Roatán also included field work during which participants conduct-
ed rapid coverage monitoring in schools and communities and data quality analysis; these experiences were particular-
ly well-received.
One benefit of the Toolkit is that its modular design permits training workshops to be adapted to specific national
objectives. In Honduras and Mexico, the workshops focused on strengthening participants’ knowledge of vaccination
data analysis, whereas the El Salvador and Roatán workshops counted on participants from both the Expanded Pro-
gramme on Immunization (EPI) and neglected disease programmes and therefore covered methodologies applicable to
both immunization and deworming coverage monitoring. Following each workshop, the training materials were vali-
dated and adjusted, based on participants’ feedback.
The integrated workshops provided a unique opportunity to facilitate communication and cooperation between pro-
grammes. Participants shared their experiences and committed to future integrated efforts that take advantage of
each other’s strengths and learning. Participants agreed that similar trainings now need to be extended to the local
level.
Page 6
Progress on Maternal and Neonatal Tetanus Elimination as of December 2015 Azhar Abid Raza and Flint Zulu, UNICEF New York and Ahmadu Yakubu, WHO Headquarters
In 2015, another three countries, Cambodia, India, and Mauritania, and 16 out of 17 regions of the Philippines were
successfully validated for Maternal and Neonatal Tetanus elimination (MNTE). Consequently, 38 out of 59 countries
have eliminated MNT since 1999. In addition, 30 out of 34 provinces in Indonesia and all of Ethiopia with the excep-
tion of Somali Region have also been validated for MNTE.
Despite the MNTE initiative missing the 2015 elimination target, most of the remaining 21 countries are advancing;
Ethiopia will be completing the validation exercise by December 2015 and Equatorial Guinea in February 2016; Ango-
la, DRC and Haiti are scheduled to conduct pre-validation assessments; and six countries will complete the implemen-
tation of Tetanus Toxoid Supplementary Immunization Activities (TT SIAs) in 2016.
A much broader strategy to augment MNTE through strengthening the maternal health platform is receiving greater
attention. Integration of TT vaccination within Antenatal care (ANC) services will boost MNTE and ensure sustaina-
bility. The SAGE working group for MNTE has been established by the World Health Organization, and tasked to
reshape the MNTE Initiative in line with the Sustainable Development Goals (SDGs). Guidelines on Sustaining MNTE
are being finalized and will be disseminated soon after WHO endorsement. Donors and partners have shown com-
mitments to bridge the existing financial gap of US$ 130 million to protect an estimated 71 million women of repro-
ductive age, using a mix of routine methods and innovative approaches like TT Uniject for reaching the hardest to
reach.
Despite the challenges, progress is surely being made through the active engagement of countries, support from part-
ners and other stakeholders and the commitment from donors who are very focused on eliminating this disease that
depicts gross inequities.
Global Immunization News (GIN) December 2015
Page 7
Event announcement: World Immunization Week 2016 Hayatee Hasan, WHO Headquarters
World Immunization Week 2016 to take place from 24-30 April 2016 aims to promote the use of vaccines to protect
people of all ages against disease. Immunization saves millions of lives and is widely recognized as one of the world’s
most successful and cost-effective health interventions.
This will be the second year of the Close the Immunization Gap campaign, which celebrates the enormous successes to
date in reaching children all over the world with life-saving vaccines while also stressing the challenges we still face.
The 2016 campaign additionally stresses the need for immunization among adolescents and adults - throughout life;
and seeks to draw the world’s attention to the critical importance of reaching vulnerable people living in conflict situ-
ations or in the wake of emergencies.
In addition, countries across WHO’s six Regions will begin the phased withdrawal of oral polio vaccines in April 2016,
by switching from trivalent OPV to bivalent OPV – a historic change that will accelerate polio eradication and help to
secure a polio-free world.
Read the World Immunization Week 2016 announcement, or access more information about the OPV switch here.
Isolated gains in immunization need to become the norm Hayatee Hasan, WHO Headquarters
A WHO commentary highlights the need for the isolated gains in
immunization achieved in several countries to become the norm
in all countries. While substantial progress has been made in vac-
cinating 90% of children with the first dose of diphtheria-tetanus-
pertussis (DTP) containing vaccine globally, many children do not
come back for their second and third doses. Drop-out will need
to be reduced if we are to achieve 90% coverage in 194 countries
by 2015. In 2014, only 129 out of 194 countries had reached this
target.
One way of reducing drop-out is ensuring health workers always
check vaccination cards when children are seen for well-child care
or sick visits. Exit interviews conducted at health facilities in Chad
and Malawi this year found 75% of children did not receive the vaccines for which they were eligible. Checking vac-
cination cards at every visit is an easy way of improving global vaccination coverage. We already have the child and his
or her caregiver’s attention, so let’s make sure children have all of their vaccinations before they leave the clinic.
Most unvaccinated infants in the world remain located in a few large under-performing countries. With better data at
national and especially at the subnational levels countries could assess pockets of under-immunization, identify exactly
where missed opportunities exist and target these populations with localized solutions.
Read the commentary by Dr Okwo-Bele, Director of the WHO Department of Immunization, Vaccines and Biologi-
cals.
A smiling toddler. Credit: WHO/AMRO
Page 8
Global Immunization News (GIN) December 2015
V3P update: reflecting on 2015 Tania Cernuschi and Stephanie Mariat, WHO Headquarters
The Vaccine Product Price and Procurement (V3P) project was created a few years ago to address coun-
tries’ request for greater transparency on vaccine prices.
In October 2014, SAGE recommended that all countries share their vaccine price information with V3P (see GVAP
Assessment report 2014, p.23). This year, countries took a step further and a resolution (WHA 68.6) on the GVAP
was adopted at the World Health Assembly. It specifically addresses the issue of access to sustainable supply of
affordable vaccines for low and middle income countries (MICs), including the promotion of vaccine price trans-
parency.
Several WHO regional offices, countries and partners are already making progress and have integrat-
ed price transparency and access to affordable and timely supply into their work, supporting presentations, fo-
rums, workshops and meetings on the subject – recognizing the benefits that price transparency can bring to sus-
tainable immunization programs in all countries, and particularly for MICs transitioning out of Gavi support and
MICs that are not Gavi-eligible.
Thanks to this collective effort, for the first time, the V3P database can show the following results:
40 countries have shared data in 2015, from five WHO regions. More than half of the countries are
MICs. The Regional Office for Europe has been particularly supportive of the project: 28 countries of the region
have shared prices. Similarly, efforts done in the African and the Western Pacific Regions have resulted in four
countries from each region sharing price information with V3P for the first time this year.
PAHO and UNICEF are continuous strong supporters of the project, contributing several years of price in-
formation.
The database contains 1,600 vaccine price records.
Pricing information has been shared by countries on 47 different vaccine types.
It is the first year that the data is published on the website (graphs and download options are available).
More than 3,900 users have accessed the website, from all over the world.
A few countries are already using V3P data to inform their decision-making and secure better procurement con-
tracts. The data collected also enables to better understand vaccine pricing. According to this year’s data, the
strongest factors influencing prices seem to be linked to procurement mechanism and income level. These rela-
tionships seem stronger for the new vaccine markets. Also, no strong correlation could be highlighted between
price and volume, except when products are procured in very large quantities (e.g. through UNICEF SD or PA-
HO).
Efforts by regions need to be maintained and strengthened to increase participation: having additional coun-
tries share prices will improve the usefulness of the data, the variety and quality of analyses and will
allow for more decisive conclusions. More information and findings from the V3P data can be found in the
GVAP Vaccine Price Report 2015, an integrated part of the GVAP Secretariat Report 2015 (p. 154-163).
Given all these encouraging facts and recognizing the great efforts and achievements in this area, SAGE, in its GVAP
Assessment Report 2015 (p. 12), placed access to vaccine pricing data in the category “successes that can be the
norm”.
Within one year, efforts in vaccine price transparency and participation in V3P have grown from being a recom-
mendation to being recognized as a success. We therefore want to
thank all participating countries, as well as colleagues from WHO,
PAHO, UNICEF and other partners for the amazing progress done
this year.
Next year, we will continue to invite countries to participate in this
effort, in particular through the Joint WHO/UNICEF Reporting
Form (JRF) process.
Together, we can indeed turn this success into a norm. The V3P platform is accessible at: www.who.int/immunization/v3p.
For more information: [email protected]
Page 9
Global Immunization News (GIN) December 2015
Past Meetings/Workshops EVM Assessment in Honduras
Nora Lucia Rodriguez, PAHO, Washington DC
Location: Honduras
Date: 27 August – 11 September 2015
Participants: National health workers from the Ministry of
Health-Honduras and international evaluators
from Ministry of Health of Nicaragua, Paraguay
and from the Pan American Health Organization
(PAHO) participated in the Effective Vaccine Man-
agement (EVM) assessment.
Purpose: To analyze Honduras’s cold chain, vaccine supply
chain and vaccine management operations.
National and international assessment team, Honduras, Aug-2015. Photo: Nora Rodriguez.
Details: During the evaluation, 42 randomly-selected storage and health facilities were visited and their rec-
ords were assessed from 1 January 31 December 2014. The 42 sites included 7 of the 20 Health Sani-
tary Regions at the sub-national level, 16 vaccine stores from the lower distribution level and 18 ser-
vice delivery points; furthermore, the evaluation included the National Vaccine Store (ANB). A total of seven teams were responsible for data collection. Each team included one international
assessor and two to three national health workers. Before initiating the evaluation, a review of the
EVM tools and methodology was carried out in order to standardize the knowledge and the manage-
ment of 1) the EVM tool and 2) the structured questionnaires. In its first EVM assessment, Honduras obtained an overall average score of 97%, a very significant
achievement considering that 80% is the minimum score established by EVM. This included the score
reached for the 4 levels of the supply chain that is in place in the country and the 9 evaluated EVM
criteria. With 97% as the average score achieved at the time of the assessment, Honduras is ranked
first among the top 104 EVM assessments performed worldwide since 2009. The primary level scored
98%, the sub-national level scored 96%, the lowest distribution level scored 97% and the service de-
livery level scored 98%.
Page 10
Global Immunization News (GIN) December 2015
Workshop for the Effective Management of Imported Measles and Rubella Cases
in the Americas
Desiree Pastor, Gloria Rey Benito, PAHO, Washington DC
Location: Bogota, Colombia
Date: 29-30 October 2015
Participants: 122 Ministry of Health officials from the national
and subnational levels. Officials from the im-
munization and epidemiological surveillance
programmes of the 32 departments and four
districts of the country. PAHO, the Colombian
Ministry of Health and Colombia’s National
Institute of Health conducted the workshop.
Purpose: To strengthen the national capacity for measles,
rubella and Congenital Rubella Syndrome (CRS)
surveillance in Colombia, to effectively respond to
imported measles or rubella cases. This was a joint
effort by the immunization and epidemiological
surveillance programmes and Colombia’s Public
Health Laboratory Network.
Participants at the Workshop for the Effective
Management of Imported Measles and Rubella Cases in Bogota, Colombia, held on 29-30 Octo-ber 2015. Photo credit: Desiree Pastor, PAHO-
Washington, DC.
Details: The workshop also included the participation of health officials from the National Police and
from other public entities that enforce the monitoring of diseases that must be declared, such
as measles, rubella and CRS. Between 2011 and 2015, measles cases imported from other regions of the world have drasti-
cally increased, directly causing 4,357 imported cases during this period. In the Americas, the
most affected countries during that period were Brazil, Canada, Ecuador and the United
States. During the two-day workshop, knowledge of the global and regional measles, rubella, and CRS
situation was shared to highlight the importance of good vaccination coverage and the strict
surveillance of suspected cases to prevent spreading of the virus by those imported cases origi-
nating from other regions of the world. Finally, 122 officials were trained to effectively manage imported measles cases through lec-
tures, group work with case studies from the Region and simulation exercises for the manage-
ment of these outbreaks.
Global Immunization News (GIN) December 2015
Page 11
31st Caribbean EPI Managers’ Meeting
Karen Lewis-Bell, PAHO-Jamaica; Hannah Kurtis, Cara Janusz-PAHO-Washington, DC
Location: Guyana Marriott Georgetown Hotel,
Georgetown, Guyana
Date: 17-19 November 2015
Participants: 73 participants including National EPI Man-
agers from 24 countries of the English,
Dutch and French Speaking Caribbean and
partners/ advisors from CARICOM, the
Caribbean Public Health Agency and PAHO.
Purpose: To analyze achievements in immunization in
the Caribbean for 2015 and plan activities for
2016 while sharing country experiences on
their immunization programme. Specific focus
was placed on the Regional Immunization Ac-
tion Plan (RIAP) to guide achievements of the
Global Vaccine Action Plan, maintaining Mea-
sles, Rubella, and Congenital rubella syndrome
(CRS) elimination in the Region as well as the
requirements for the Polio Eradication and
Endgame Strategic Plan including introduction
of Inactivated Polio Vaccine (IPV) in the rou-
tine immunization schedule of each country,
polio containment and the switch from triva-
lent OPV (tOPV) to bivalent OPV (bOPV).
Participants of the 31st Caribbean EPI Managers’ Meeting 17-19 November 2015, Georgetown, Guyana.
Details: The meeting was officially opened by the Honorable Dr George Norton, Minister of Public
Health, Guyana who welcomed all participants to Guyana and lauded the dedication of health
care workers in the field of immunization. Their work, under sometimes challenging condi-
tions, has helped to ensure that the Caribbean and indeed the Americas sustain the elimination
and control of vaccine preventable diseases through consistent high vaccination coverage and
quality surveillance. The format of the meeting involved technical updates on various disease topics and program-
matic areas in immunization by PAHO/WHO advisors and other technical experts, as well as
the sharing of country experiences in disease surveillance, surveys/campaigns conducted during
the year, vaccine introduction, investigations related to adverse events, cold chain manage-
ment, etc. The EPI managers were divided into groups to facilitate discussions on their overall
achievements with their Plans of Action for 2015 and to finalize their plans for 2016 with input
from their peers. Countries were urged to align their EPI strategies and targets to the RIAP, ensure high, sus-
tained and homogenous coverage above 95% for all antigens to protect against the risk of im-
portations, and to be alert for the Zika virus through strengthened fever and rash surveillance.
Page 12
Global Immunization News (GIN) December 2015
Regional workshop on poliovirus laboratory containment
Sigrun Roesel, WHO SEARO
Location: Bangkok, Thailand
Date: 23-24 November 2015
Participants: National poliovirus laboratory containment
coordinators from 9 countries and other na-
tional key stake holders in poliovirus laboratory
containment, WHO HQ, EMRO, SEARO and
WPRO.
Purpose: The workshop objectives were: to update na-
tional poliovirus laboratory containment coor-
dinators and key stake holders on GAPIII, phase
1 and 2 requirements and expected timelines;
to provide clarifications on roles and responsi-
bilities of individual stakeholders (national con-
tainment coordinators, laboratory and vaccine
production facilities, national regulatory author-
ities, WHO); and to prepare for the updates of
national action plans.
Participants from the Regional Workshop on poliovirus labora-
tory containment
Details: Following the May 2015 WHA resolution on full implementation of the Polio Eradication and End-
game Strategic Plan 2013-2018, and with it, the third Global Action Plan to minimize poliovirus facili-
ty-associated risk (GAPIII), countries in the WHO South East Asia Region prepared to survey bio-
medical facilities to identify infectious or potentially infectious poliovirus 2 materials and update na-
tional inventories of facilities that handle and/or store such poliovirus materials. To support the implementation of appropriate containment of type 2 wild polioviruses in essential
facilities by the end of 2015 and of type 2 Sabin poliovirus within three months of global withdrawal
of the type 2 component in oral poliovirus vaccine in April 2016, this Regional workshop was con-
ducted to provide a forum for discussion, situation review and technical support. National poliovirus laboratory containment coordinators and key stakeholders from nine countries
came together to be updated on GAPIII and expected timelines. Clarifications were provided on
roles and responsibilities to ensure appropriate poliovirus containment, and next steps were agreed
upon for updating and implementing national action plans. Requirements for poliovirus essential facil-
ities and establishing national authorities for containment were reviewed, with a realization that
timely implementation of laboratory containment activities pose a major challenge.
Global Immunization News (GIN) December 2015
Page 13
Stakeholders Consultation on mHealth Initiative by VaxTrac in Nepal
Subecha Dahal, VaxTrac
Location: Kathmandu, Nepal
Date: 24-28 November 2015
Participants: 66 participants representing various stake-
holders in Nepal including WHO, UNICEF,
Ministry of Health and Population, Depart-
ment of Health Services, Child Health Divi-
sion, Health Management Information Sys-
tem.
Purpose: Five different focus group discussions were
conducted with national stakeholders to objec-
tively assess and consolidate feedback on a
mHealth intervention for vaccination manage-
ment by VaxTrac in Nepal. VaxTrac is an elec-
tronic mobile vaccine registry system that can
be used by frontline health workers in health
clinics while administering vaccinations to chil-
dren. The Vial-to-Child project, in partnership
with UNICEF, WHO and VaxTrac, chose two
districts, Dadeldhura and Nawalparasi for pilot
programme implementation in Nepal. VaxTrac
has been working in Benin, West Africa since
2012.
Glimpse from one of the focus group discussions for consultation with ICT experts in Nepal.
Details: Extensive consultations with stakeholders gave valuable insight into the VaxTrac system and
eHealth initiatives in general for vaccination management in Nepal. The stakeholders concurred
that the mHealth initiative by VaxTrac has the potential to improve the overall vaccination pro-
cess in Nepal. These meetings were also an opportunity for all parties to better understand na-
tional priorities for designing a system that is most relevant to the needs of Nepal. For example,
the stakeholders identified vaccine wastage as a priority issue. The system can be designed to
generate data that can help ministry officials understand the primary causes of vaccine wastage
and use that information to prevent future wastage from occurring. The key lesson learned from these meetings was the importance of collaboration and buy-in
from stakeholders involved in the value chain of the national vaccine delivery system. Another
success was starting the national conversation about eHealth and mHealth projects, leading to
the drafting of a comprehensive policy on eHealth in Nepal. The inputs from the stakeholders’ consultation will be used to inform the next phase of the
project’s implementation in Nawalparasi district in Nepal.
Page 14
Global Immunization News (GIN) December 2015
Regional Polio Meeting: Next Steps for Certification and Containment
Cristina Pedreira, Gloria Rey Benito and Elizabeth Thrush, PAHO-Washington, DC
Location: Brasilia, Brazil
Date: 30 November – 1 December 2015
Participants: A total of 72 people from 24 countries in
the Region including 20 National Certifica-
tion Committees (NCCs), 24 National Po-
liovirus Containment Coordinators
(NPCCs), four members of the Regional
Certification Commission (RCC) on the
Polio Endgame; Representatives from PA-
HO, WHO, CDC, and the Ministry of
Health, Brazil.
Purpose: To update NCCs on their roles and responsi-
bilities for the polio eradication endgame and
to update NPCCs on their roles and responsi-
bilities with the Regional Plan for Containment
of Poliovirus in the Americas, and present the
model for the Phase 1 Containment Report.
Participants at the Regional Polio Meeting held on 30 November- 1 December in Brasilia, Brazil. Credit: Liz Thrush
Details: Joaquin Molina, PAHO Representative in Brazil, and José Agenor Alvares da Silva, Vice Minister
of Health of Brazil, welcomed the participants to the meeting, and Arlene King, RCC Chair and
Cristina Pedreira, Immunization Advisor, PAHO, reviewed the objectives of the meeting and
expected outcomes. The two main topics for this meeting were (1) the role and expectations of the RCC and NCCs
and (2) the Regional Poliovirus Containment Plan, including the software application for the
GAP III laboratory survey and the model for the Phase 1 Containment Report. Additional topics were covered at this meeting to give the NCCs and the NPCCs a broad over-
view of the current progress and the next steps for the polio eradication endgame plan. These topics included the Global polio eradication progress; the Regional update on the imple-
mentation of the polio eradication endgame plan; the Guidelines for monitoring the switch from
tOPV to bOPV; the protocol for notification, risk assessment, and response following detection
of type 2 poliovirus after the switch; the Regional dashboards to follow national and regional
progress on the switch and the polio endgame.
Available documents and resources on the PAHO polio webpage.
Some of the main recommendations of the meeting were: Strengthening AFP surveillance is essential in preparing for the switch due to the risk of the
emergence of cVDPV2 in the post-switch period. Countries should update their protocols to detect and respond to polio outbreaks during
the final phase of the polio eradication endgame. In preparation for the switch, countries should analyze vaccination coverage and intensify
immunization activities within areas with low tOPV coverage. Countries should intensify preparation efforts for the switch from tOPV to bOPV to ensure
a safe switch and comply with the established timelines. NCCs should submit the revision and validation of the wild poliovirus containment report to
the Ministry of Health in January 2016 (report should be prepared by the national poliovirus
containment coordinator).
Global Immunization News (GIN) December 2015
Page 15
Benin LOGIVAC Center organizes first short course on vaccine logistics
Eustache Agboton and Alice Henry-Tessier, Agence de Médecine Préventive (AMP)
Location: Ouidah Regional Institute of Public Health
(IRSP), Benin
Date: 30 November – 18 December 2015
Participants: 73 participants including National EPI Man-
agers from 24 countries of the English,
Dutch and French Speaking Caribbean and
partners/ advisors from CARICOM, the
Caribbean Public Health Agency and PAHO.
Purpose: To ensure optimal management of the vaccine
supply chain, using the practices currently rec-
ommended by the health authorities and tech-
nical and financial partners.
Students of the first Vaccines Logistics training.
Details: This inaugural course, delivered by a pool of trainers from the Benin LOGIVAC Center, was
directed at health personnel responsible for managing the logistics of the immunization pro-
gramme at various levels of the health pyramid: operational logistics officers from health zones;
logistics officers at central level; chief medical officers from health zones; and officials in charge
of supervising logistics personnel. The training session equipped learners with the skills needed to design and implement a logistics
system; to ensure vaccine availability; and to safeguard the continuity of the cold chain. The
course, which consisted of lectures, group work and practical field work, also aimed to show
participants how to administer the IT system for vaccine logistics and ensure vaccine safety, as
well as carry out waste management and provide staff supervision. This first session of the short training course will finish on December 18 with the presentation
of certificates to students who successfully complete the programme.
Page 16
Global Immunization News (GIN) December 2015
Briefing on WHO tools and guidance related to immunization data quality and
coverage surveys
Carolina Danovaro, Marta Gacic-Dobo and Jan Grevendonk, WHO HQ
Location: Istanbul, Turkey
Date: 1-4 December, 2015
Participants: Sixty-eight participants from Ministries of Health,
Statistics Offices and national institutes from five re-
gions of the World Health Organization (WHO);
Agence de Medicine Préventive (AMP); the Bill &
Melinda Gates Foundation (BMGF); the US Centers
for Diseases Control and Prevention (CDC); the
Demographic and Health Survey (DHS) Programme;
Epicentre; John Snow Inc. (JSI); PATH; UNICEF, and
WHO. A representative from Gavi, the Vaccine Alli-
ance joined by phone.
Purpose: To present the new tools developed by WHO on
immunization data quality and the new vaccina-
tion coverage survey manual. To train participants, including potential consultants
or academic or similar organizations to provide
technical assistance, on one of the following
tracks: 1) immunization data quality, and; 2)
vaccination coverage survey planning and imple-
mentation.
Participants at the briefing on WHO tools and guidance related to immunization data quality and coverage sur-veys
Details: The importance of using high quality data both to improve immunization programme performance
and to monitor the results has been highlighted in recent years, for example following the roll-out
and annual assessment of the Global Vaccine Action Plan (GVAP). Also, Gavi, the Vaccine Alliance,
now requires countries applying for all types of Gavi support to conduct: 1) an annual desk review;
2) periodic in-depth assessments of routine administrative vaccination coverage data; and, 3) peri-
odic nationally representative vaccination coverage surveys. Given this background, over the next few years, it is expected that there will be an increased need
for guidance and technical assistance to assess the quality of country immunization data and pro-
duce actionable data improvement plans, as well as to implement vaccination coverage surveys using
the revised WHO vaccination coverage survey methodology. This briefing was the first of such
activities aimed at sharing the new materials and tools, seeking expert advice to complete those
materials related to data quality, sharing best practices among participants and thinking critically
about the design of a vaccination coverage survey in a given country, from survey protocol design,
to implementation and interpretation of results.
The current working draft of the survey methodology can be found here. The methodology for
annual desk reviews and periodic in-depth assessment of the data quality will be finalized based on
the feedback received from this briefing and published early 2016.
Global Immunization News (GIN) December 2015
Page 17
International Expert Committee meets in Brazil to discuss Measles elimination in
the Region of the Americas
Pamela Bravo, Desiree Pasto and Gloria Rey, PAHO, Washington DC
Location: Brasilia, Brazil
Date: 2 December 2015
Participants: Members of the International Expert Committee for
Measles and Rubella Elimination in the Americas
(IEC), authorities from Brazil’s Ministry of Health,
health authorities from the states of Ceara and Per-
nambuco, as well as immunization advisors from the
Pan American Health Organization (PAHO).
Purpose: 1. To review the evidence that verifies the interrup-
tion of endemic measles virus circulation in Brazil. 2. To discuss the evidence outlined in the country
elimination report (period of 2012-2015), which pro-
vides an update of the main documentation and veri-
fication components. 3. To discuss the challenges and commitments neces-
sary to sustain measles and rubella elimination in Bra-
zil.
IEC Members and participants at the IEC Meeting in Bra-
silia, Brazil. Photo credit: Samia Abdul Samad.
Details: During the meeting, health authorities from the state of Ceará presented on the epidemiological situa-
tion of the measles outbreak that lasted for 20 months during the time period of 2013-2015. They also
presented compelling evidence indicating that the outbreak had finally been interrupted, meeting PA-
HO’s verification criteria (laboratory, surveillance and vaccination components). The International Expert Committee (IEC) was satisfied with the evidence provided and agreed with the
federal and state health authorities that the measles outbreak had finally being interrupted. Nevertheless, it is important that Brazil sustain these efforts and that there are no new cases of endem-
ic measles for a period of one year following the last endemic measles case, confirmed on 6 July 2015. To this end, the IEC remains confident that Brazil will succeed and that after the one-year period, PA-
HO will be able to declare the Americas as free of measles during next year’s Directing Council
(September 2016).
Resources
Page 18
Global Immunization News (GIN) December 2015
Workshop on training health workers for effective Hepatitis B birth dose
introduction, Dakar, Senegal, 7-11 December 2015
Ousseynou Badiane, Ministry of Health Senegal, Aliou Dialo, WHO Country Ofice Senegal, Dorothy Leab, Training
Expert, Vietnam
Location: Dakar, Senegal
Date: 7-11 December 2015
Participants: Ministry of Health Senegal, WHO, USAID representatives.
Purpose: To prepare for introducing hepatitis B birth dose (HepB-BD) into the national immunization schedule
by developing communication materials, revising monitoring and reporting tools, and designing a train-
ing programme for the introduction.
Details: In January 2016, Senegal plans to add HepB-BD vaccine to the national schedule. The country plans to
train over 2000 health workers from both EPI and MNCH (medical doctors, midwifes, and nurs-
es). This workshop convened 20 national EPI and MNCH staff, and immunization and training experts (WHO
and USAID). The workshop proposed the following training programme.
Learning content: The training programme includes eight modules: 1. HBV infection and importance of HepB-BD
2. HepB vaccine attributes and storage conditions
3. HepB-BD eligibility
4. HepB-BD immunization strategy
5. Administering HepB-BD within 24h
6. Immunization data management
7. AEFI notification and case management
8. Communicating about HepB-BD to community and health workers
Training materials: A training package composed of a training guide, a slideshow, a case study, a pre
and post-test, a simplified job-aid, and an aide-memoire.
Cascade training: A training-of-trainers approach was used to enable knowledge to be passed to all
levels of the health system. This will also establish a pool of trainers at regional (14 regions) and dis-
trict levels (76 districts) before the introduction. District trainers will then train health workers in
the 1300 health stations. In addition to cascade training, supportive supervision will be provided to
support health staff.
Publication of the SAGE October 2015 meeting report
The report from the October 2015 meeting of the Strategic Advisory Group of
Experts (SAGE) on immunization has been published in today’s edition of the
WHO Weekly Epidemiological Record outlining the conclusions and recommen-
dations, including the use of Ebola vaccines and vaccination, measles and rubella
vaccine, RTS,S/AS01 malaria vaccine, polio eradication and the assessment of
Global Vaccine Action Plan progress and recommendations.
Read the SAGE October 2015 meeting report.
Report of the Immunization and Vaccines related Implementation Research (IVIR),
Advisory Committee Meeting, Geneva, 9-11 June 2015 (WHO/IVB/15.09)
The Immunization and Vaccines related Implementation Research (IVIR) Advisory Committee (AC) meeting report
summarizes the deliberations of the Committee on matters related to implementation research and their relevance
to immunization policies and practices during the face-to-face meeting June 9 - 11 June 2015.
The document highlight issues on hepatitis impact evaluation, malaria vaccine impact and cost-effectiveness, a mea-
sles investment case, burden of yellow fever estimation across Africa, varicella and zoster vaccination modelling and
cost-effectiveness in low and middle income countries and the WHO implementation research priority setting
framework.
Participants at the October 2015
SAGE meeting held in Geneva.
Credit: WHO/H. Hasan.
Calendar
Global Immunization News (GIN) December 2015
Page 19
2016
January
19-20 WPRO Gavi Regional Working Group meeting Manila, Philippines
25-30 Executive Board Geneva, Switzerland
29-2Mar Institut Pasteur Vaccinology course Paris, France
February
24-25 AFRO ministerial conference on immunization Addis Ababa, Ethiopia
29-25Mar Institut Pasteur Vaccinology Course Paris, France
March
14-16 PAHO Regional Workshop on Evidence-Based Decision-Making (ProVac)
and Data Quality
TBD
15-17 Global Vaccine and Immunization Research Forum (GVIRF) Johannesburg, South Africa
April
12-14 Meeting of the Strategic Advisory Group of Experts (SAGE) on Immuniza-
tion
Geneva, Switzerland
May
23-28 Sixty-ninth World Health Assembly Geneva, Switzerland
June
6-10 SEARO Immunization Technical Advisory Group (ITAG) New Delhi, India
13-17 WPRO Technical Advisory Group TBD
22-23 Gavi Board Meeting TBD
July
4-8 AMRO Technical Advisory Group TBD
September
5-9 Regional Committee for SEARO Colombo, Sri Lanka
12-15 Regional Committee for EURO Copenhagen, Denmark
26-30 Regional Committee for AMRO Washington DC, USA
October
3-6 Regional Committee for EMRO Cairo, Egypt
10-14 Regional Committee for WPRO Manila, Philippines
18-20 Meeting of the Strategic Advisory Group of Experts (SAGE) on Immuniza-
tion
Geneva, Switzerland
December
7-8 Gavi Board Meeting TBD
Page 20
WHO Regional Websites Routine Immunization and New Vaccines (AFRO)
Immunization (PAHO)
Vaccine-preventable diseases and immunization (EMRO)
Vaccines and immunization (EURO)
Immunization (SEARO)
Immunization (WPRO)
Newsletters Immunization Monthly update in the African Region (AFRO) Immunization Newsletter (PAHO) The Civil Society Dose (GAVI CSO Constituency) TechNet Digest RotaFlash (PATH) Gavi Programme Bulletin (Gavi)
Organizations and Initiatives American Red Cross Child Survival Agence de Médecine Préventive Africhol EpiVacPlus LOGIVAC Project National Immunization Technical Advisory Groups Resource Center SIVAC Centers for Disease Control and Prevention Polio Global Vaccines and Immunization Johns Hopkins International Vaccine Access Center Vaccine Information Management System JSI Africa Routine Immunization Systems Essentials Project IMMUNIZATIONbasics Immunization Center Maternal and Child Health Integrated Program (MCHIP) PAHO ProVac Initiative PATH Vaccine Resource Library Rotavirus Vaccine Access and Delivery Malaria Vaccine Initiative Meningitis Vaccine Project RHO Cervical Cancer
Sabin Vaccine Institute Sustainable Immunization Financing UNICEF Immunization Supplies and Logistics USAID Maternal and Child Health Integrated Program WHO Department of Immunization, Vaccines & Biologicals New and Under-utilized Vaccines Implementation ICO Information Centre on HPV and Cancer Immunization financing Immunization service delivery Immunization surveillance, assessment and monitoring SIGN Alliance Other Coalition Against Typhoid Dengue Vaccine Initiative European Vaccine Initiative Gardasil Access Program Gavi the Vaccine Alliance International Association of Public Health Logisticians International Vaccine Institute Measles & Rubella Initiative Multinational Influenza Seasonal Mortality Study Network for Education and Support in Immunisation (NESI) TechNet-21 Vaccines Today
UNICEF Regional Websites Immunization (Central and Eastern Europe)
Immunization (Eastern and Southern Africa)
Immunization (South Asia)
Immunization (West and Central Africa)
Child survival (Middle East and Northern Africa)
Health and nutrition (East Asia and Pacific)
Health and nutrition (Americas)
Links
Global Immunization News (GIN) December 2015