Hepatitis B virus infection on Kwajalein Atoll, Marshall Islands: a seroprevalence, knowledge and attitudes study

@#Objective: A study was conducted to determine the seroprevalence of chronic hepatitis B virus (HBV) infection among children and their mothers on Kwajalein Atoll in the Marshall Islands two decades after routine vaccination was introduced in the 1990s. Mothers’ knowledge and attitudes towards HBV disease and vaccination were also assessed. Methods: Results of a national seroprevalence survey conducted in 2016–2017 and antenatal records were used to determine the prevalence of HBV seropositivity in children aged 6–8 years and their biological mothers. The associations between demographic, social and vaccination-related factors and seropositivity were explored using Fisher’s exact tests. Results: HBV seroprevalence was 0.3% in children and 6.8% in their mothers (during pregnancy). Coverage of timely HBV vaccination was 90.3% for the birth dose and was significantly associated with factors related to place of residence (P < 0.001), place of birth (P < 0.001) and number of antenatal visits (P < 0.001). Maternal attitudes towards infant vaccination and antenatal screening were largely positive (95.8% and 96.7%, respectively) despite low vaccination rates (20.9%) among mothers. Knowledge levels were low for disease complications, treatment and transmission. Discussion: Prevalence of HBV in children and mothers residing on Kwajalein Atoll in 2016–2017 was lower than the national average for the Marshall Islands. Timely birth dose administration appears to have been effective in preventing mother-to-child transmission of HBV in this setting and should be promoted in remote settings where antiviral therapy is not available. Provision of out-of-cold-chain HBV vaccines should be considered to improve access in remote settings.

COVID-19 preparedness and response in the Pitcairn Islands: keeping one of the world’s smallest and most isolated populations safe in a pandemic

@#Problem: While the COVID-19 pandemic threatened the entire world, the extremely remote Pitcairn Islands faced unique vulnerabilities. With only a physician and a nurse to care for an ageing population of fewer than 40 residents, and with very limited referral pathways, Pitcairn encountered distinct challenges in preparing for and responding to the COVID-19 pandemic. Context: The Pitcairn Islands is an overseas territory of the United Kingdom of Great Britain and Northern Ireland consisting of four islands in the South Pacific: Pitcairn, Henderson, Ducie and Oeno. Pitcairn is the only inhabited island with a local resident population of approximately 31 people, around half of whom were over 60 years old in 2023. The islands are only accessible by sea and are located more than 2000 km from the nearest referral hospital in French Polynesia. Actions: Pitcairn’s Island Council took aggressive action to delay the importation of SARS-CoV-2, vaccinate its small population and prepare for the potential arrival of the virus. Outcomes: As of May 2024, Pitcairn was one of the only jurisdictions in the world not to have had a single COVID-19 hospitalization or death. Nevertheless, the pandemic presented the islands’ population with many economic, social and health challenges. Discussion: Pitcairn’s population avoided COVID-19-related hospitalizations and deaths despite its elderly population’s vulnerability to COVID-19, a significant level of comorbidities, and limited clinical management capabilities and options for emergency referrals. The pandemic highlighted some of the population’s health vulnerabilities while also underscoring some of their innate strengths.

Ensuring access to COVID-19 therapeutics in Pacific island countries and areas

@#Problem: As of November 2022, over 417 397 confirmed cases and 2631 deaths related to coronavirus disease (COVID-19) were reported in Pacific island countries and areas (PICs). Most PICs have faced challenges accessing therapeutics recommended for the treatment of COVID-19 due to their high demand worldwide and supply chain constraints. Context: The World Health Organization (WHO) coordinates and provides tailored technical and operational support to 21 PICs. Since the start of the pandemic, WHO has worked with partners to establish a mechanism to ensure equitable access to three novel COVID-19 therapeutics (tocilizumab, molnupiravir and nirmatrelvir/ritonavir) for lower-income countries, including 11 eligible PICs. Action: WHO coordinated the requests, procurement and distribution of the three novel therapeutics. In addition, WHO supported PICs by providing trainings in clinical management of COVID-19, developing critical supply needs estimates, and facilitating regulatory approval of clinical therapeutics, including emergency use authorization. Lessons learned: The main barriers to procurement of novel COVID-19 therapeutics were identified as prolonged negotiations with licence holders, sourcing funding, the high cost of therapeutics and limited capacity to provide safety monitoring. Discussion: Uninterrupted supply and availability of essential medicines in the Pacific region is dependent on external and local sourcing. To overcome procurement barriers and ensure access to novel COVID-19 therapeutics in PICs, WHO‘s pandemic support to Member States focused on strengthening regulatory requirements, safety monitoring and supply chain activities.

COVID-19 vaccine-related adverse events following immunization in the WHO Western Pacific Region, 2021–2022

@#The speed at which new vaccines against coronavirus disease (COVID-19) were developed and rolled out as part of the global response to the pandemic was unprecedented. This report summarizes COVID-19 vaccine-related safety data in the World Health Organization Western Pacific Region. Data for 1 March 2021 to 31 March 2022 from 36 out of 37 countries and areas in the Western Pacific Region are presented. More than 732 million doses of eight COVID-19 vaccines were administered; reporting rates of adverse events following immunization (AEFIs) and serious AEFIs were 130.1 and 5.6 per 100 000 doses administered, respectively. Anaphylaxis, thrombosis with thrombocytopenia syndrome, and myocarditis/pericarditis were the most frequent COVID-19 adverse events of special interest (AESIs) reported. The reported rates of AESIs in the Western Pacific Region were within the range of expected or background rates. Vaccine benefits far outweigh the risk of reported serious adverse reactions and serious outcomes of COVID-19. Continued AEFI surveillance is recommended to better understand and ensure the safety profiles of novel COVID-19 vaccines.

COVID-19 vaccine in the Pacific Islands related to COVAX Facility and bilateral assistance / 国際保健医療

  Vaccines were developed at an unprecedented speed in response to the COVID-19 pandemic. High-income countries, including Japan, recorded high vaccination rates in 2021. However, many low-income countries still recorded low vaccination rates, highlighting a global vaccine disparity.  The COVID-19 Vaccines Global Access Facility (COVAX Facility) is a global risk-sharing framework established to ensure the equitable distribution of COVID-19 vaccines. This paper explains the mechanism of the COVAX Facility and discusses the following aspects: (1) issues related to vaccine supply through the COVAX Facility, and vaccine donation or provision as a means of bilateral assistance; (2) case studies of vaccine supply and the number of vaccines administered in the Pacific Islands; and (3) the state of vaccine support in terms of the island nations’ vulnerability to COVID-19.  COVAX Facility was established in May 2020 and started to supply vaccines to low-income countries in February 2021. The framework also played a significant role as a means of vaccine donation from developed countries having had surplus COVID-19 vaccines to low-income countries when COVAX Facility experienced a shortage of vaccines. However, despite these efforts, COVAX Facility was unable to achieve “equal access” to COVID-19 vaccines.  For instance, vaccine disparities persist among the 14 Pacific Island countries, which continue to face challenges pertaining to land dispersal, narrowness, and remoteness from global markets. On some of these islands, received bilateral assistance and vaccine donations through COVAX Facility have provided the necessary and sufficient vaccines and achieved high vaccination rates. However, in some island countries such as Kiribati, Solomon Islands, and Vanuatu, the vaccine supply is sufficient, but it does not translate into vaccinations being administered actively. Such places are particularly susceptible to vaccine wastage. Furthermore, in Papua New Guinea, a country with low basic health care standards, improving vaccination coverage may be a challenge even if large-scale support of the health care system for COVID-19 would be provided in the short term.  It has been over two years since the detected outbreak of COVID-19. To improve vaccination rates globally, it is necessary to not only provide support in terms of vaccine supply but also to offer mid- to long-term assistance, including support for the establishment of vaccination systems and basic health care services.

Progress on diagnosis and treatment of drug-resistant tuberculosis in line with World Health Organization recommendations in six priority countries in the Western Pacific Region

@#Background: Diagnosis and treatment of drug-resistant tuberculosis (DR-TB) have radically changed in accordance with recommendations from the World Health Organization (WHO) in the past decade, allowing rapid and simple diagnosis and shorter treatment duration with new and repurposed drugs. Methods: A descriptive analysis of the status and progress of DR-TB diagnosis and treatment in six priority countries in the Western Pacific Region was conducted using information from interviews with countries and the WHO TB database. Results: Over the past decade, the use of Xpert MTB/RIF has increased in the six priority countries, in parallel with implementation of national policies and algorithms to use Xpert MTB/RIF as an initial diagnostic test for TB and detection of rifampicin resistance. This has resulted in increases in the number of people diagnosed with multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB). Shorter treatment regimens with new and repurposed drugs have also been adopted for MDR/RR-TB cases, alongside a decentralized model of care, leading to improved treatment outcomes. Discussion: The Western Pacific Region has achieved considerable progress in the diagnosis and treatment of DR-TB, in line with the evolving WHO recommendations in the past decade. The continued commitment of Member States is needed to address remaining challenges, such as the impact of the coronavirus disease pandemic, suboptimal management and health system issues.

Congenital rubella syndrome: a matter of concern / Síndrome de rubéola congénita: un motivo de preocupación

Congenital rubella syndrome (CRS), an important cause of severe birth defects, remains a public health problem in a significant number of countries. Therefore, global health experts encourage use of rubella vaccination, with the primary aim of preventing CRS. While large-scale rubella vaccination during the last decade has drastically reduced or eliminated both the virus and CRS in Europe and the Americas, many countries in Africa, South-East Asia, the Eastern Mediterranean, and the Western Pacific have not yet incorporated any type of rubella-containing vaccine into their immunization schedule. As a result, through travel and migration, rubella has been imported into countries that had successfully eliminated the virus, leading to outbreaks and the reestablishment of endemic transmission. The objective of this study was to identify the key factors required for CRS elimination (prevalence reduction, vaccination strategies, and surveillance methods) by reviewing publications in PubMed on rubella and CRS (systematic reviews, country experiences, and position papers from the World Health Organization (WHO) and other intergovernmental organizations). Based on the results of the review, to eliminate rubella and CRS in endemic areas and reduce re-emergence in previously disease-free areas, all countries should carry out two types of mass rubella vaccination campaigns: 1) one single mass national immunization campaign targeting all men and women 5-39+ years old (with the upper age limit depending on the year in which the rubella-containing vaccine was introduced and the epidemiology of rubella in the country) and 2) incorporation of an rubella-containing vaccine in routine childhood immunization programs, including regular vaccination campaigns for 12-month-olds and measles follow-up campaigns. In addition to mass rubella immunization campaigns and routine childhood vaccination programs, the following measures should be taken to help fight rubella and CRS: 1) surveillance of the number of susceptible women of childbearing age, and the emergence of imported cases; 2) coverage of susceptible populations with "second-chance" ("catch-up") campaigns (vaccination of older children and adults who may have missed earlier immunization programs); 3) rapid response to outbreaks; 4) strengthening of CRS surveillance; 5) involvement of the private sector in awareness and vaccination campaigns; and 6) reduction of the number of false-positive laboratory test results.

El síndrome de rubéola congénita (SRC), una causa importante de defectos congénitos graves, sigue siendo un problema de salud pública en un número significativo de países. Por consiguiente, los expertos mundiales en salud promueven el uso de la vacunación antirrubeólica con el objetivo primario de prevenir el SRC. Aunque, durante el último decenio, la vacunación antirrubeólica administrada a gran escala ha reducido drásticamente o eliminado tanto el virus como el SRC en Europa y la Región de las Américas, muchos países de África, Asia Sudoriental, el Mediterráneo Oriental y el Pacífico Occidental aún no han incorporado ningún tipo de vacuna con componente antirrubeólico en su calendario de vacunaciones. Como resultado, y a consecuencia de los viajes y las migraciones, la rubéola se ha importado a países que habían eliminado eficazmente el virus, provocando brotes y el restablecimiento de la transmisión endémica. El objetivo de este estudio fue determinar los factores clave requeridos para la eliminación del SRC (reducción de la prevalencia, estrategias de vacunación y métodos de vigilancia) mediante la revisión de publicaciones aparecidas en PubMed sobre la rubéola y el SRC (revisiones sistemáticas, experiencias de países y documentos de posición de la Organización Mundial de la Salud y otras organizaciones intergubernamentales). Con base en los resultados de la revisión, y con objeto de eliminar la rubéola y el SRC en las zonas endémicas y reducir su reaparición en las zonas previamente libres de la enfermedad, todos los países deben llevar a cabo dos tipos de campañas de vacunación antirrubeólica masivas: 1) una única campaña de vacunación masiva a escala nacional dirigida a todos los hombres y mujeres de 5 a 39 años de edad (el límite superior de edad depende del año de introducción de la vacuna con componente antirrubeólico y de la epidemiología de la rubéola en el país), y 2) la incorporación de una vacuna con componente antirrubeólico en los programas sistemáticos de vacunación infantil, incluidas las campañas regulares de vacunación dirigidas a lactantes de 12 meses de edad y las campañas de seguimiento de las enfermedades exantemáticas. Además de las campañas de vacunación masiva contra la rubéola y los programas sistemáticos de vacunación infantil, se deben aplicar las siguientes medidas para ayudar a combatir la rubéola y el SRC: 1) la vigilancia de las mujeres en edad fecunda susceptibles, y de la aparición de casos importados; 2) la cobertura de las poblaciones vulnerables mediante campañas de "segunda oportunidad" ("puesta al día") (vacunación de niños mayores y adultos a los que no hubieran alcanzado los programas de vacunación anteriores); 3) la respuesta rápida ante los brotes; 4) el fortalecimiento de la vigilancia del SRC; 5) la participación del sector privado en las campañas de concientización y vacunación; y 6) la reducción del número de resultados de pruebas de laboratorio falsamente positivos.

Macroinvertebrados dulceacuícolas de la Isla del Coco, Costa Rica: especies y comparación con otras islas del Pacífico Tropical Oriental / Freshwater macroinvertebrates from Cocos Island, Costa Rica: species and comparison with other islands of the Eastern Tropical Pacific

Cocos Island is an oceanic island in the Eastern Pacific, at 496km from Cabo Blanco, Costa Rica. This 24km² island is surrounded by a protected marine area of 9 640km². It was declared National Park in 1978 and a World Heritage by UNESCO in 1997. Freshwater macroinvertebrate fauna was collected in 20 sites covering three rivers (Genio, Chatam and Sucio) and two creeks (Minuto and an unnamed creek behind the park rangers’ house). Tank bromeliads or phytotelmata were also examined for aquatic macroinvertebrates. Physicochemical parameters were determined in 13 study sites. Additionally, a comparison with other islands in the Eastern Tropical Pacific was conducted to determine the most important factors controlling the diversity in Tropical Pacific islands. A total of 455 individuals were collected belonging to 20 taxa (mostly identified to genus level) from 15 families of aquatic insects. Other macroinvertebrates such as Palaemonid shrimps, Hidrachnida and Oligochaeta were also collected. The family Staphylinidae (Coleoptera) was the most abundant, followed by Chironomidae (Diptera). Diptera was the order of insects with the highest taxonomic richness. A relationship between distance and the number of families was observed supporting the premises of the Theory of island Biogeography. This relationship was improved by correcting area by island elevation, indicating that mountainous islands had the richest faunas, potentially due to high cloud interception that feeds freshwater environments favoring the establishment of aquatic fauna. Physicochemical variables were similar in all sites, possibly due to the geology and the absence of significant sources of pollution on the island.

La Isla del Coco es una isla oceánica localizada en el Pacífico Tropical Oriental a unos 492km de Cabo Blanco. La isla cuenta con un área terrestre de 24km² y un área marina protegida de 9 640km². Fue declarada Parque Nacional en 1978 y Patrimonio de la Humanidad por la UNESCO en 1997. Se realizó una gira de recolecta del 22 de mayo al 12 junio 2008. Se recolectaron macroinvertebrados acuáticos en 20 tramos de tres ríos (Genio, Chatham y Sucio) y dos quebradas (Minuto y quebrada sin nombre atrás de estación de guarda parques). En 13 sitios se toma- ron parámetros fisicoquímicos. En total se recolectaron 455 individuos de 20 táxones de 15 familias de insectos acuáticos y otros macroinvertebrados. La familia Staphylinidae presentó la mayor abundancia seguida por Chironomidae, los dípteros fueron el orden con mayor riqueza taxonómica. Una relación entre distancia y número de familias se observó apoyando en parte la Teoría de Biogeografía de Islas. La relación mejoró al corregir área con elevación, indicando que islas montañosas tenían alta riqueza, posiblemente debido a la mayor intercepción de nubes que alimentan los ambientes dulceacuícolas que favorecen el establecimiento de la fauna acuática. Las variables ambientales fueron similares en todos los sitios.