Progress Toward Rubella and Congenital Rubella Syndrome Elimination - Worldwide, 2012-2022.

Rubella virus is a leading cause of vaccine-preventable birth defects. Infection during pregnancy can result in miscarriage, fetal death, stillbirth, or a constellation of birth defects, including cataracts, deafness, heart defects, and developmental delay, known as congenital rubella syndrome (CRS). A single dose of rubella-containing vaccine can provide lifelong protection against rubella. The Global Vaccine Action Plan 2011-2020 included a target to achieve elimination of rubella in at least five of the six World Health Organization (WHO) regions by 2020, and rubella elimination is a critical goal of the Immunization Agenda 2030. This report updates a previous report and describes progress toward rubella and CRS elimination during 2012-2022. During 2012-2022, among 194 WHO countries, the number that included rubella-containing vaccine (RCV) in their immunization schedules increased from 132 (68%) to 175 (90%) and the percentage of the world's infants vaccinated against rubella increased from 40% to 68%. Reported rubella cases declined 81%, from 93,816 in 2012 to 17,407 in 2022. Verification of rubella elimination was achieved in 98 (51%) of 194 countries by 2022, an increase from 84 (43%) countries in 2019. Despite significant progress in the introduction of RCV into routine immunization programs worldwide, approximately 25 million infants annually still do not have access to RCV. Nevertheless, even in complex settings, the increasing number of countries that have achieved and sustained rubella elimination demonstrates progress toward global rubella elimination.

The burden of congenital rubella syndrome in the Philippines: results from a retrospective assessment.

INTRODUCTION: In line with the regional aim of eliminating rubella and congenital rubella syndrome (CRS), phased introduction of rubella-containing vaccines (RCV) in the Philippines' routine immunization programme began in 2010. We estimated the burden of CRS in the country before widespread nationwide programmatic RCV use. METHODS: We performed a retrospective chart review in four tertiary hospitals. Children born between 1 January 2009 and 31 December 2014 and identified as possible CRS cases based on the presence of one or more potential manifestations of CRS documented in hospital or clinic charts were reviewed. Cases that met the clinical case definition of CRS were classified as either confirmed (with laboratory confirmation) or probable (without laboratory confirmation). Cases that did not fulfil the criteria for either confirmed or probable CRS were excluded from the analysis. RESULTS: We identified 18 confirmed and 201 probable cases in this review. Depending on the hospital, the estimated incidence of CRS ranged from 30 to 233 cases per 100 000 live births. The estimated national burden of CRS was 20 to 31 cases per 100 000 annually. DISCUSSION: This is the first attempt to assess the national CRS burden using in-country hospital data in the Philippines. Prospective surveillance for CRS and further strengthening of the ongoing measles-rubella surveillance are necessary to establish accurate estimates of the burden of CRS and the impact of programmatic RCV use in the future.

Progress toward measles elimination­Philippines, 1998-2014.

In 2005, the Regional Committee for the World Health Organization (WHO) Western Pacific Region (WPR) established a goal to eliminate measles by 2012.The recommended elimination strategies in WPR include 1) ≥95% 2-dose coverage with measles-containing vaccine (MCV) through routine immunization services and supplementary immunization activities (SIAs); 2) high-quality case-based measles surveillance; 3) laboratory surveillance with timely and accurate testing of specimens to confirm or discard suspected cases and detect measles virus genotypes; and 4) measles outbreak preparedness, rapid response, and appropriate case management. In the WPR, the Philippines set a national goal in 1998 to eliminate measles by 2008. This report describes progress toward measles elimination in the Philippines during 1998-2014 and challenges remaining to achieve the goal. WHO-United Nations Children's Fund (UNICEF)-estimated coverage with the routine first dose of MCV (MCV1) increased from 80% in 1998 to 90% in 2013, and coverage with the routine second dose of MCV (MCV2) increased from 10% after nationwide introduction in 2010 to 53% in 2013. After nationwide SIAs in 1998 and 2004, historic lows in the numbers and incidence of reported measles cases occurred in 2006. Despite nationwide SIAs in 2007 and 2011, the number of reported cases and incidence generally increased during 2007-2012, and large measles outbreaks occurred during 2013-2014 that affected infants, young children, older children, and young adults and that were prolonged by delayed and geographically limited outbreak response immunization activities during 2013-2014. For the goal of measles elimination in WPR to be achieved, sustained investments are required in the Philippines to strengthen health systems, implement the recommended elimination strategies, and develop additional strategies to identify and reduce measles susceptibility in specific geographic areas and older age groups.

Motor palsies of cranial nerves (excluding VII) after vaccination: reports to the US Vaccine Adverse Event Reporting System.

We reviewed cranial nerve palsies, other than VII, that have been reported to the US Vaccine Adverse Event Reporting System (VAERS). We examined patterns for differences in vaccine types, seriousness, age, and clinical characteristics. We identified 68 reports of cranial nerve palsies, most commonly involving the oculomotor (III), trochlear (IV), and abducens (VI) nerves. Isolated cranial nerve palsies, as well as palsies occurring as part of a broader clinical entity, were reported. Forty reports (59%) were classified as serious, suggesting that a cranial nerve palsy may sometimes be the harbinger of a broader and more ominous clinical entity, such as a stroke or encephalomyelitis. There was no conspicuous clustering of live vs. inactivated vaccines. The patient age range spanned the spectrum from infants to the elderly. Independent data may help to clarify whether, when, and to what extent the rates of cranial nerve palsies following particular vaccines may exceed background levels.

The US Food and Drug Administration review of the safety and effectiveness of nonstandardized allergen extracts.

BACKGROUND: Nonstandardized allergen extracts have been used for a century. Until 1972, these products were regulated by the National Institutes of Health, and products were not required to have an individualized showing of effectiveness. Jurisdiction was then transferred to the US Food and Drug Administration (FDA), which established external review panels to make recommendations regarding safety and effectiveness. Two external panels deliberated, the first from 1974-1979 and the second from 1982-1983. OBJECTIVE: We sought to review external panels' recommendations and assess the safety and effectiveness of nonstandardized allergen extracts, FDA-reviewed available literature, and databases since 1972. METHODS: Currently licensed nonstandardized allergen extracts were reviewed according to extract type. Available data were collected from medical and nonscientific search engines. Nomenclature was ascertained by consulting www.itis.gov or www.atcc.org. The FDA's Adverse Event Reporting System was probed for events associated with extract use. Provisional threshold levels of safety and effectiveness were established, and extracts were sorted according to whether they met the thresholds. RESULTS: In the Adverse Event Reporting System, there were 178 adverse event reports, including 13 deaths, associated with allergen extract use over 23 years. No single group of extracts predominated. Among 1269 allergen extracts reviewed, there were 480 for which use in the diagnosis and treatment of allergic disease were addressed in the literature, 207 for which only diagnostic use was addressed, 565 for which minimal or no supportive literature was identified, and 17 for which potential safety concerns were found. CONCLUSIONS: When used according to professional guidelines, almost all nonstandardized allergen extracts for diagnosis and therapy appear to be safe. Provisional thresholds of effectiveness were met by 54% of extracts reviewed.

Preventing post-traumatic stress disorder after mass exposure to violence.

Bioterrorism preparedness plans must take into account the psychosocial consequences of exposure to mass violence. If possible, post-traumatic stress disorder (PTSD), which is associated with significant morbidity and cost, should be prevented. There are, however, no effective interventions that have been scaled up to prevent PTSD following mass exposure to violence. In fact, randomized controlled trials of the most commonly used preventive intervention, psychological debriefing, suggest no efficacy, or even potential harm. Fortunately, randomized controlled trials of cognitive behavioral therapy--that is, targeting individuals who are symptomatic in the weeks after trauma--reveal significant efficacy. Given the potential for repeated mass violence exposure, public health professionals need to refine methods for screening and tracking large numbers of casualties. At the same time, the use of telephone and internet-based cognitive behavioral therapy protocols should be further tested as strategies for bringing the only effective early intervention for PTSD to scale. Research on preventive pharmacotherapy for PTSD and on the effects of media exposure on PTSD severity is also a priority.

One-year sequelae in patients with West Nile Virus encephalitis and meningitis in Louisiana.

West Nile Virus (WNV) infection can be severe and complicated by neuroinvasive disease, such as meningitis and encephalitis. Not much is known about the one-year sequelae following a complicated WNV infection. From July to December 2002, the first large outbreak of WNV in the Southern United States occurred in Louisiana. This epidemic resulted in 329 cases of WNV infection including 125 cases of West Nile fever and 204 cases complicated by meningitis and encephalitis. One year later, during the fall of 2003, a telephone survey was conducted to understand the one-year effects of severe WNV infections. WNV case fatality rate was 19.6%. Death certificates of all the deceased were reviewed to verify the mortality rate from WNV infection. The telephone survey revealed that one-year sequelae from severe WNV infections are common and can affect the body and mind. In addition, it can change a person's perception of the state of their health.

Cancer in Micronesia.

Between November 1998 and December 1999, trained medical record abstractors visited the Micronesian jurisdictions of Chuuk, Kosrae, Pohnpei, and Yap (the four states of the Federated States of Micronesia), as well as the Republic of Palau (Belau), the Republic of Kiribati, the Republic of the Marshall Islands (RMI), and the Republic of Nauru to review all available medical records in order to describe the epidemiology of cancer in Micronesia. Annualized age-adjusted, site-specific cancer period prevalence rates for individual jurisdictions were calculated. Site-specific cancer occurrence in Micronesia follows a pattern characteristic of developing nations. At the same time, cancers associated with developed countries are also impacting these populations. Recommended are jurisdiction-specific plans that outline the steps and resources needed to establish or improve local cancer registries; expand cancer awareness and screening activities; and improve diagnostic and treatment capacity.

Epidemiology of cancer in the Republic of Kiribati.

Little is known about cancer epidemiology in Kiribati. Between November 1998 and December 1999, trained medical record abstractors visited 8 Micronesian jurisdictions including the Republic of Kiribati to review all available medical records in order to describe the epidemiology of cancer in Micronesia and to better understand the cancer data and control systems in each entity. The Republic of Kiribati has identified many prevalent preventable cancers. The lack of a robust cancer data tracking and surveillance system, as well as the lack of resources to institute a technologically and medically sustainable cancer control system was apparent. The implementation or existence of a national comprehensive cancer control strategic plan would facilitate greater identification, prevention, and treatment of cancer patients. The health sector and Government of Kiribati are working towards this end.

Cancer epidemiology in the freely associated U.S. Pacific Island jurisdictions: challenges and methodologic issues.

The health care systems of the U.S.-associated Pacific Island jurisdictions, especially the three freely associated states (Federated States of Micronesia, Republic of the Marshall Islands, and Republic of Belau), are faced with problems similar to developing countries such as malnutrition and infectious diseases, as well as diseases relating to westernization such as diabetes, heart disease, and cancer. Although cancer has emerged as an important cause of morbidity and mortality in the Pacific, little population-based data are currently available. This paper addresses some of the practical and methodological challenges to obtaining accurate and reliable cancer data in these jurisdictions. This paper discusses the use of annualized period prevalence to allow for some measurement of cancer burden when cancer incidence cannot be accurately calculated. This method, however, has its own limitations as cancer prevalence relates to both incidence and duration of illness, and numerous factors impact survival potential (i.e., preexisting diseases, lifestyle practices, and access to treatment). In addition, under-ascertainment and data quality issues will impact any cancer morbidity or mortality measurements. Thus, improvement in the health care systems, including the creation and ongoing support of active cancer registries would be the optimal approach to better delineating cancer occurrence and risk for the populations of these Pacific Island jurisdictions.

Epidemiology of cancer in the Republic of Nauru.

Between November 1998 and December 1999, the Republic of Nauru was one of 8 Micronesian jurisdictions visited by trained medical record abstractors to review all available medical records in order to describe the epidemiology of cancer in Micronesia and to better understand the cancer data and control systems in each entity. There is likely incomplete ascertainment of cancer cases in the Republic of Nauru because of historical events, and the lack of a robust cancer registry and a systematic cancer surveillance system. A national comprehensive cancer control strategic plan and the implementation of that plan would facilitate greater prevention, treatment and control of cancer. The government of Nauru is working towards this end.

Smoking rates and risk factors among youth in the Republic of the Marshall Islands: results of a school survey.

Rapidly increasing tobacco use in developing countries will result in a large and increasing burden of tobacco-related illnesses as their populations age. The Republic of the Marshall Islands (RMI) is an island nation in the Pacific with a 1999 census population of 50,840, of whom more than fifty percent were under twenty years of age. There are limited data on the prevalence of smoking among youth in the RMI. A school survey of 3,294 RMI students in grades 5 through 12 was conducted in 2000. Urban and outer atoll schools were included in the sample. Demographic data and information on tobacco use and risk factors were collected. The overall smoking rate in this school sample was 10.6%. There were significantly higher smoking rates in the high school age group; the rate of smoking among 18 year olds was 33.5%. Smoking rates were higher among males compared to females (18.7% vs. 3.4%) and higher among outer atoll students compared to urban students (14.5% vs. 9.4%). The most prominent risk factors for smoking were: age, male gender, receiving or wearing tobacco-labeled equipment or clothing and willingness to participate in other high-risk behaviors. The survey provides an estimate of smoking rates among Marshallese school students and identifies and quantifies significant risk factors for smoking. This information can assist in guiding a comprehensive tobacco control strategy in the Republic of the Marshall Islands.