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1.
Arch Argent Pediatr ; 117(2): S37-S119, 2019 04.
Article in Spanish | MEDLINE | ID: mdl-31833342

ABSTRACT

Beginning in 1974, the date on which the Expanded Program on Immunization was established in the Americas, the number of deaths and disabilities due to certain infectious diseases decreased considerably thanks to universally applied vaccines. A program that initially included four vaccines that protected against six diseases (tuberculosis, diphtheria, pertussis, tetanus, polio and measles) was consolidated, over the years, by incorporating new vaccines and significantly raising coverage rates. The Sociedad Argentina de Pediatría (Argentine Society of Pediatrics), as a leader of opinion, played a leading role in the incorporation of new vaccines, currently reaching one of the most complete vaccination calendars in the world, which improves the levels of inequality and inequity in public health. Taking into account the significant role of the pediatrician in decision-making, the National Committee of Infectious Diseases, together with the Subsidiary Committees, prepared a document on updates and recommendations for 2018 on Polio, Rotavirus, Pneumococcus, Meningococcus, Human Papillomavirus, Chickenpox, Flu, Dengue vaccines and Whooping Cough.


Subject(s)
Immunization Programs/standards , Immunization Schedule , Pertussis Vaccine/administration & dosage , Streptococcal Vaccines/administration & dosage , Viral Vaccines/administration & dosage , Adolescent , Argentina/epidemiology , Chickenpox/epidemiology , Chickenpox/prevention & control , Child , Child, Preschool , Clinical Decision-Making , Contraindications , Dengue/epidemiology , Dengue/prevention & control , Diagnosis, Differential , Drug Storage/methods , Female , Global Health , Humans , Infant , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Latin America/epidemiology , Male , Meningococcal Infections/epidemiology , Meningococcal Infections/prevention & control , Meningococcal Infections/transmission , Papillomavirus Infections/epidemiology , Papillomavirus Infections/prevention & control , Pediatrics , Pertussis Vaccine/adverse effects , Pertussis Vaccine/immunology , Pneumococcal Infections/epidemiology , Pneumococcal Infections/prevention & control , Poliomyelitis/diagnosis , Poliomyelitis/epidemiology , Poliomyelitis/prevention & control , Poliomyelitis/transmission , Poliovirus Vaccines/administration & dosage , Poliovirus Vaccines/adverse effects , Poliovirus Vaccines/immunology , Rotavirus Infections/epidemiology , Rotavirus Infections/prevention & control , Societies, Medical , Streptococcal Vaccines/adverse effects , Streptococcal Vaccines/immunology , Vaccines, Conjugate/administration & dosage , Vaccines, Conjugate/adverse effects , Vaccines, Conjugate/immunology , Viral Vaccines/adverse effects , Viral Vaccines/immunology , Whooping Cough/epidemiology , Whooping Cough/prevention & control
2.
Sci Transl Med ; 11(522)2019 12 11.
Article in English | MEDLINE | ID: mdl-31826984

ABSTRACT

Flaviviruses such as dengue, yellow fever, Zika, West Nile, and Japanese encephalitis virus present substantial global health burdens. New vaccines are being sought to address safety and manufacturing issues associated with current live attenuated vaccines. Here, we describe a new insect-specific flavivirus, Binjari virus, which was found to be remarkably tolerant for exchange of its structural protein genes (prME) with those of the aforementioned pathogenic vertebrate-infecting flaviviruses (VIFs). Chimeric BinJ/VIF-prME viruses remained replication defective in vertebrate cells but replicated with high efficiency in mosquito cells. Cryo-electron microscopy and monoclonal antibody binding studies illustrated that the chimeric BinJ/VIF-prME virus particles were structurally and immunologically similar to their parental VIFs. Pilot manufacturing in C6/36 cells suggests that high yields can be reached up to 109.5 cell culture infectious dose/ml or ≈7 mg/liter. BinJ/VIF-prME viruses showed utility in diagnostic (microsphere immunoassays and ELISAs using panels of human and equine sera) and vaccine applications (illustrating protection against Zika virus challenge in murine IFNAR-/- mouse models). BinJ/VIF-prME viruses thus represent a versatile, noninfectious (for vertebrate cells), high-yield technology for generating chimeric flavivirus particles with low biocontainment requirements.


Subject(s)
Chimera/immunology , Flavivirus Infections/diagnosis , Flavivirus Infections/immunology , Flavivirus/immunology , Insect Viruses/physiology , Recombination, Genetic/genetics , Viral Vaccines/immunology , Animals , Antigens, Viral/immunology , Flavivirus/ultrastructure , Horses , Humans , Immunoassay , Male , Mice, Inbred C57BL , Phylogeny , Receptor, Interferon alpha-beta/deficiency , Receptor, Interferon alpha-beta/metabolism , Vaccination , Virion/metabolism , Virus Replication
4.
MMWR Morb Mortal Wkly Rep ; 68(48): 1105-1111, 2019 Dec 06.
Article in English | MEDLINE | ID: mdl-31805033

ABSTRACT

In 2010, the World Health Assembly (WHA) set the following three milestones for measles control to be achieved by 2015: 1) increase routine coverage with the first dose of measles-containing vaccine (MCV1) among children aged 1 year to ≥90% at the national level and to ≥80% in every district, 2) reduce global annual measles incidence to less than five cases per 1 million population, and 3) reduce global measles mortality by 95% from the 2000 estimate* (1). In 2012, WHA endorsed the Global Vaccine Action Plan,† with the objective of eliminating measles§ in five of the six World Health Organization (WHO) regions by 2020. This report updates a previous report (2) and describes progress toward WHA milestones and regional measles elimination during 2000-2018. During 2000-2018, estimated MCV1 coverage increased globally from 72% to 86%; annual reported measles incidence decreased 66%, from 145 to 49 cases per 1 million population; and annual estimated measles deaths decreased 73%, from 535,600 to 142,300. During 2000-2018, measles vaccination averted an estimated 23.2 million deaths. However, the number of measles cases in 2018 increased 167% globally compared with 2016, and estimated global measles mortality has increased since 2017. To continue progress toward the regional measles elimination targets, resource commitments are needed to strengthen routine immunization systems, close historical immunity gaps, and improve surveillance. To achieve measles elimination, all communities and countries need coordinated efforts aiming to reach ≥95% coverage with 2 doses of measles vaccine (3).


Subject(s)
Disease Eradication , Global Health/statistics & numerical data , Measles/prevention & control , Adolescent , Adult , Child , Child, Preschool , Humans , Immunization Programs , Incidence , Infant , Measles/epidemiology , Measles/mortality , Measles Vaccine/administration & dosage , Young Adult
6.
Lancet Glob Health ; 7(12): e1655-e1663, 2019 12.
Article in English | MEDLINE | ID: mdl-31708146

ABSTRACT

BACKGROUND: BCG has been recommended at birth in countries with a high tuberculosis burden for decades, yet delayed vaccination is widespread. To support a WHO guidance review, we estimated the potential global tuberculosis mortality benefit of administering BCG on time and consequences of later administration. METHODS: We estimated age-specific BCG coverage in 152 high-burden countries using data from large, nationally representative household surveys, to parameterise a static mathematical model, calibrated to global childhood tuberculosis deaths in 2016. 12 hypothetical scenarios explored the effect of BCG delivery at birth, 6 weeks, 6 months, or 9-12 months, on tuberculosis deaths per global birth cohort by age 15 years, including delivery at the time of the first diphtheria-tetanus-pertussis vaccine (DTP1) or the first measles-containing vaccine (MCV1). We assumed constant vaccine efficacy by age, but varied coverage and degree of vaccination delay, including no delay. FINDINGS: In 152 high-burden countries, we estimated that BCG coverage in 2016 was 37% at 1 week of age, 67% at 6 weeks, and 92% at 3 years. Modelled scenarios in which 92% BCG coverage was achieved at birth reduced tuberculosis deaths in the global birth cohort by 5449 (95% uncertainty range 218-15 071) or 2·8% (0·1-7·0) by age 15 years. 100% coverage at birth reduced tuberculosis deaths by 16·5% (0·7-41·9). Later administration increased tuberculosis deaths-eg, BCG vaccination at 6 weeks, the recommended age of DTP1, increased tuberculosis deaths by 0·2% (0-0·4), even if BCG reached DTP1 coverage levels (94% at 3 years). INTERPRETATION: Reducing delays and increasing coverage at birth would substantially reduce global paediatric tuberculosis mortality. Modelled scenarios whereby BCG was administered later in the infant schedule were all estimated to increase tuberculosis deaths, even with increased coverage. The WHO recommendation for BCG at birth should be maintained and emphasised. FUNDING: WHO.


Subject(s)
BCG Vaccine/administration & dosage , Global Health/statistics & numerical data , Tuberculosis/mortality , Tuberculosis/prevention & control , Vaccination/statistics & numerical data , Adolescent , Age Factors , Child , Child, Preschool , Female , Humans , Immunization Schedule , Infant , Infant, Newborn , Male , Models, Theoretical
7.
Lancet Glob Health ; 7(12): e1664-e1674, 2019 12.
Article in English | MEDLINE | ID: mdl-31708147

ABSTRACT

BACKGROUND: Previous studies have found rotavirus vaccination to be highly cost-effective in low-income countries. However, updated evidence is now available for several inputs (ie, rotavirus disease mortality rates, rotavirus age distributions, vaccine timeliness, and vaccine efficacy by duration of follow-up), new rotavirus vaccines have entered the market, vaccine prices have decreased, and cost-effectiveness thresholds have been re-examined. We aimed to provide updated cost-effectiveness estimates to inform national decisions about the new introduction and current use of rotavirus vaccines in Gavi countries. METHODS: We calculated the potential costs and effects of rotavirus vaccination for ten successive birth cohorts in 73 countries previously and currently eligible for Gavi support, compared with no vaccination. We used a deterministic cohort model to calculate numbers of rotavirus gastroenteritis cases, outpatient visits, hospitalisations, and deaths between birth and 5 years, with and without rotavirus vaccination. We calculated treatment costs from the government and societal perspectives. The primary outcome measure was the incremental cost-effectiveness ratio (discounted US$ per disability-adjusted life-year averted). Country-specific model input parameters were based on the scientific literature, published meta-analyses, and international databases. We ran deterministic and probabilistic uncertainty analyses. FINDINGS: Over the period 2018-27, rotavirus vaccination has the potential to prevent nearly 600 000 deaths in Gavi countries. Averted outpatient visits and hospitalisations could lead to treatment savings of approximately $484·1 million from the government perspective and $878·0 million from the societal perspective. The discounted dollars per disability-adjusted life-year averted has a very high probability (>90%) of being less than 0·5 times the gross domestic product per capita in 54 countries, and less than 1·0 times gross domestic product per capita in 63 countries. INTERPRETATION: Rotavirus vaccination continues to represent good value for money across most Gavi countries despite lower rotavirus mortality estimates and more stringent willingness-to-pay thresholds. FUNDING: Bill & Melinda Gates Foundation.


Subject(s)
Global Health/statistics & numerical data , Immunization Programs/economics , Rotavirus Infections/economics , Rotavirus Infections/prevention & control , Rotavirus Vaccines/economics , Cohort Studies , Cost-Benefit Analysis , Disabled Persons/statistics & numerical data , Health Care Costs/statistics & numerical data , Humans , Models, Statistical , Program Evaluation , Quality-Adjusted Life Years , Rotavirus Infections/mortality , Rotavirus Vaccines/administration & dosage
12.
MMWR Morb Mortal Wkly Rep ; 68(39): 855-859, 2019 Oct 04.
Article in English | MEDLINE | ID: mdl-31581161

ABSTRACT

Rubella is a leading cause of vaccine-preventable birth defects. Although rubella virus infection usually causes a mild febrile rash illness in children and adults, infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or a constellation of birth defects known as congenital rubella syndrome (CRS). A single dose of rubella-containing vaccine (RCV) can provide lifelong protection (1). In 2011, the World Health Organization (WHO) updated guidance on the use of RCV and recommended capitalizing on the accelerated measles elimination activities as an opportunity to introduce RCV (1). The Global Vaccine Action Plan 2011-2020 (GVAP) includes a target to achieve elimination of rubella in at least five of the six WHO regions by 2020 (2). This report on the progress toward rubella and CRS control and elimination updates the 2017 report (3), summarizing global progress toward the control and elimination of rubella and CRS from 2000 (the initiation of accelerated measles control activities) and 2012 (the initiation of accelerated rubella control activities) to 2018 (the most recent data) using WHO immunization and surveillance data. Among WHO Member States,* the number with RCV in their immunization schedules has increased from 99 (52% of 191) in 2000 to 168 (87% of 194) in 2018†; 69% of the world's infants were vaccinated against rubella in 2018. Rubella elimination has been verified in 81 (42%) countries. To make further progress to control and eliminate rubella, and to reduce the equity gap, introduction of RCV in all countries is important. Likewise, countries that have introduced RCV can achieve and maintain elimination with high vaccination coverage and surveillance for rubella and CRS. The two WHO regions that have not established an elimination goal (African [AFR] and Eastern Mediterranean [EMR]) should consider establishing a goal.§.


Subject(s)
Disease Eradication , Global Health/statistics & numerical data , Population Surveillance , Rubella Syndrome, Congenital/prevention & control , Rubella/prevention & control , Female , Humans , Infant , Infant, Newborn , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/prevention & control , Rubella/epidemiology , Rubella Syndrome, Congenital/epidemiology , Rubella Vaccine/administration & dosage
13.
Am J Public Health ; 109(12): 1714-1716, 2019 12.
Article in English | MEDLINE | ID: mdl-31622151

ABSTRACT

Measles epidemics are still a public health challenge worldwide, necessitating a rapid response. The Jerusalem District Health Office applied a community-oriented intervention during the 2018-2019 epidemic (2150 notified cases). Program development targeted the socioeconomic and cultural characteristics of high-incidence Jewish ultraorthodox communities. Health care and community collaboration led to coverage rates of measles vaccination increasing from 80% to 95% within three months and a significant decline in incidence. Epidemic preparedness calls for maintaining the infrastructure of countermeasures combined with sustaining immunization coverage.


Subject(s)
Communicable Disease Control/organization & administration , Epidemics/prevention & control , Measles Vaccine/administration & dosage , Measles/epidemiology , Measles/prevention & control , Adolescent , Child , Child, Preschool , Community Participation/methods , Cultural Characteristics , Global Health , Humans , Immunization Programs/organization & administration , Infant , Measles/ethnology , Public Health , Socioeconomic Factors , Vaccination Coverage/statistics & numerical data
14.
BMJ Glob Health ; 4(5): e001713, 2019.
Article in English | MEDLINE | ID: mdl-31565416

ABSTRACT

Background: Several West African countries are unlikely to achieve the recommended Global Vaccine Action Plan (GVAP) immunisation coverage and dropout targets in a landscape beset with entrenched intra-country equity gaps in immunisation. Our aim was to assess and compare the immunisation coverage, dropout and equity gaps across 15 West African countries between 2000 and 2017. Methods: We compared Bacille Calmette Guerin (BCG) and the third dose of diphtheria-tetanus-pertussis (DTP3) containing vaccine coverage between 2000 and 2017 using the WHO and Unicef Estimates of National Immunisation Coverage for 15 West African countries. Estimated subregional median and weighted average coverages, and dropout (DTP1-DTP3) were tracked against the GVAP targets of ≥90% coverage (BCG and DTP3), and ≤10% dropouts. Equity gaps in immunisation were assessed using the latest disaggregated national health survey immunisation data. Results: The weighted average subregional BCG coverage was 60.7% in 2000, peaked at 83.2% in 2009 and was 65.7% in 2017. The weighted average DTP3 coverage was 42.3% in 2000, peaked at 70.3% in 2009 and was 61.5% in 2017. As of 2017, 46.7% of countries (7/15) had met the GVAP targets on DTP3 coverage. Average weighted subregional immunisation dropouts consistently reduced from 16.4% in 2000 to 7.4% in 2017, meeting the GVAP target in 2008. In most countries, inequalities in BCG, and DTP3 coverage and dropouts were mainly related to equity gaps of more than 20% points between the wealthiest and the poorest, high coverage regions and low coverage regions, and between children of mothers with at least secondary education and those with no formal education. A child's sex and place of residence (urban or rural) minimally determined equity gaps. Conclusions: The West African subregion made progress between 2000 and 2017 in ensuring that its children utilised immunisation services, however, wide equity gaps persist.

16.
Clin Infect Dis ; 69(Suppl 5): S408-S411, 2019 10 15.
Article in English | MEDLINE | ID: mdl-31612940

ABSTRACT

With a newly World Health Organization (WHO)-prequalified typhoid conjugate vaccine (TCV), Gavi funding for eligible countries, and a WHO policy recommendation for TCV use, now is the time for countries to introduce TCVs as part of an integrated typhoid control program, particularly in light of the increasing burden of antimicrobial resistance. Continued vaccine development efforts will lead to secure supply of low-cost vaccines, and ongoing vaccine studies will provide critical vaccine performance data and inform optimal deployment strategies, in both routine use and in outbreak settings. TCV programs should include thoughtful communication planning and community engagement to counter vaccine hesitancy.


Subject(s)
Global Health , Typhoid Fever/prevention & control , Typhoid-Paratyphoid Vaccines/administration & dosage , Vaccination/standards , World Health Organization , Communicable Disease Control/legislation & jurisprudence , Communicable Disease Control/organization & administration , Communicable Disease Control/standards , Disease Outbreaks/prevention & control , Humans , Salmonella typhi/immunology , Sanitation , Typhoid-Paratyphoid Vaccines/economics , Typhoid-Paratyphoid Vaccines/standards , Vaccination/legislation & jurisprudence , Vaccination/statistics & numerical data , Vaccines, Conjugate/administration & dosage , Water
17.
JMIR Public Health Surveill ; 5(4): e14664, 2019 Oct 29.
Article in English | MEDLINE | ID: mdl-31663863

ABSTRACT

The many challenges in the Eastern Mediterranean region put the involved countries at risk of polio transmission and affect their ability to meet progress targets in eliminating vaccine-preventable diseases. The Global Health Development (GHD) and Eastern Mediterranean Public Health Network (EMPHNET) are working together on the project "Strengthening sustainable public health capacity in the Eastern Mediterranean region for polio eradication and routine immunization activities" with an overall goal of improving routine immunization, eradicating poliovirus, and controlling/eliminating or eradicating other vaccine-preventable diseases in the Eastern Mediterranean region. The aim of this manuscript is to describe the project and the achievements of GHD/EMPHNET over the last 3 years (2016-2018) to build effective surveillance and immunization systems in the Eastern Mediterranean region through the development of a sustainable and competent public health system to eradicate polio and control/eliminate vaccine-preventable diseases. This project assists the targeted Eastern Mediterranean region countries to build effective surveillance and immunization systems in an effort to expand their capacities to eradicate polio and control/eliminate other vaccine-preventable diseases. The project is streamlined with the Global Polio Eradication Initiative, the Centers for Disease Control and Prevention's Strategic Framework for Global Immunization 2016-2020, and the Polio Eradication and Endgame Strategic Plan 2013-2018. The project also supports the Global Health Security Agenda by focusing on efforts to accelerate progress toward a world safe and secure from infectious disease threats. Project activities were designed to respond to countries' needs and assist them in building their institutional and workforce capacity to effectively plan, implement, and evaluate activities to eradicate polio and strengthen routine immunization activities. The project activities covered a set of areas including surveillance of acute flaccid paralysis and other vaccine-preventable diseases, family and community engagement, workforce capacity building, improvement of data quality, management and use of information systems, use of polio assets to control/eliminate other vaccine-preventable diseases, support of countries to develop national strategies, piloting of innovative initiatives, program evaluation and accountability, and immunization strengthening. The project adopts the Global Polio Eradication Initiative strategies for assisting countries to strengthen routine immunization services, maintain highly sensitive acute flaccid paralysis surveillance, and sustain polio eradication functions.

18.
MMWR Morb Mortal Wkly Rep ; 68(42): 937-942, 2019 10 25.
Article in English | MEDLINE | ID: mdl-31647786

ABSTRACT

Endorsed by the World Health Assembly in 2012, the Global Vaccine Action Plan 2011-2020 (GVAP) (1) calls on all countries to reach ≥90% national coverage with all vaccines in the country's national immunization schedule by 2020. Building on previous analyses (2) and using the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) global vaccination coverage estimates as of 2018, this report presents global, regional, and national vaccination coverage estimates and trends, including vaccination dropout rates. According to these estimates, global coverage with the first dose of diphtheria and tetanus toxoids and pertussis-containing vaccine (DTP1) remained relatively unchanged from 2010 (89%) to 2018 (90%). Global coverage with the third DTP dose (DTP3) followed a similar global trend to that of DTP1, remaining relatively consistent from 2010 (84%) to 2018 (86%) (3). Globally, 19.4 million children (14%) were not fully vaccinated in 2018, and among them, 13.5 million (70%) did not receive any DTP doses. Overall, dropout rates from DTP1 to DTP3 decreased globally from 6% in 2010 to 4% in 2018. Global coverage with the first dose of measles-containing vaccine (MCV1) remained between 84% and 86% during 2010-2018. Among countries that offer a second MCV dose (MCV2) during the second year of life, coverage increased from 19% in 2007 to 54% in 2018; among countries offering MCV2 to older age groups (children aged 3-14 years), coverage also increased, from 36% in 2007 to 69% in 2018 (3). Globally, the estimated difference in coverage with MCV1 and MCV2 in 2018 was 17%. However, among new and underused vaccines, global coverage increased from 2007 to 2018 for completed series of rotavirus vaccine, pneumococcal conjugate vaccine (PCV), rubella vaccine, Haemophilus influenzae type b vaccine (Hib), and hepatitis B vaccine (HepB). To reach global vaccination coverage goals for vaccines recommended during childhood, adolescence, and adulthood, tailored strategies that address local determinants for incomplete vaccination are needed, including targeting hard-to-reach and hard-to-vaccinate populations.


Subject(s)
Global Health , Vaccination Coverage/statistics & numerical data , Vaccines/administration & dosage , Adolescent , Child , Child, Preschool , Diphtheria-Tetanus-Pertussis Vaccine/administration & dosage , Humans , Immunization Programs , Immunization Schedule , Infant , Infant, Newborn , World Health Organization
19.
Cell ; 179(1): 13-17, 2019 Sep 19.
Article in English | MEDLINE | ID: mdl-31519310

ABSTRACT

This year's Lasker-Bloomberg Public Service Award goes to GAVI, the Vaccine Alliance, for providing sustained access to childhood vaccines around the globe, saving millions of lives, and highlighting the power of immunization to prevent disease.


Subject(s)
International Cooperation , Vaccination/economics , Vaccination/history , Vaccines/history , Vaccines/supply & distribution , Child , Global Health , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, 21st Century , Humans , Immunization Programs , Investments , Poverty , Preventive Medicine/methods , Vaccines/economics
20.
Future Microbiol ; 14: 1321-1330, 2019 10.
Article in English | MEDLINE | ID: mdl-31482728

ABSTRACT

Although global polio eradication is within reach, sustained eradication of all polioviruses requires cessation of oral poliovirus vaccine use to mitigate against vaccine-derived poliovirus circulation and vaccine-associated paralytic poliomyelitis. The first step in this direction was the WHO-recommended global withdrawal of live attenuated type 2 Sabin poliovirus from routine immunisation in May 2016, with future use restricted to outbreak response, and handling controlled by strict containment provisions (GAPIII). This creates unique challenges for development and testing of novel type 2 poliovirus vaccines. We describe the creation of a novel purpose-built containment facility, Poliopolis, to study new monovalent OPV2 vaccine candidates in healthy adult volunteers, which may be a model for future endeavors in vaccine development for emergency use.


Subject(s)
Containment of Biohazards/methods , Disease Eradication/methods , Global Health , Housing , Poliomyelitis/prevention & control , Poliovirus Vaccine, Oral/administration & dosage , Adult , Disease Outbreaks/prevention & control , Feces/virology , Healthy Volunteers , Humans , Poliovirus , Poliovirus Vaccine, Oral/immunology , Quarantine , Vaccination , Vaccines, Attenuated/administration & dosage , Vaccines, Attenuated/immunology , Virus Shedding , World Health Organization
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