Progress Toward Hepatitis B Control and Elimination of Mother-to-Child Transmission of Hepatitis B Virus - World Health Organization African Region, 2016-2021.

Chronic hepatitis B virus (HBV) infection is one of the leading causes of cirrhosis and liver cancer. In 2019, approximately 1.5 million persons newly acquired chronic HBV infection; among these, 990,000 (66%) were in the World Health Organization (WHO) African Region (AFR). Most chronic HBV infections are acquired through mother-to-child transmission (MTCT) or during early childhood, and approximately two thirds of these infections occur in AFR. In 2016, the World Health Assembly endorsed the goal of elimination of mother-to-child transmission (EMTCT) of HBV, documented by ≥90% coverage with both a timely hepatitis B vaccine (HepB) birth dose (HepB-BD) and 3 infant doses of HepB (HepB3), and ≤0.1% hepatitis B surface antigen (HBsAg) seroprevalence among children aged ≤5 years. In 2016, the WHO African Regional Committee endorsed targets for a 30% reduction in incidence (≤2% HBsAg seroprevalence in children aged ≤5 years) and ≥90% HepB3 coverage by 2020. By 2021, all 47 countries in the region provided HepB3 to infants beginning at age 6 weeks, and 14 countries (30%) provided HepB-BD. By December 2021, 16 (34%) countries achieved ≥90% HepB3 coverage, and only two (4%) achieved ≥90% timely HepB-BD coverage. Eight countries (17%) conducted nationwide serosurveys among children born after the introduction of HepB to assess HBsAg seroprevalence: six countries had achieved ≤2% seroprevalence, but none had achieved ≤0.1% seroprevalence among children. The development of immunization recovery plans following the COVID-19 pandemic provides an opportunity to accelerate progress toward hepatitis B control and EMTCT, including introducing HepB-BD and increasing coverage with timely HepB-BD and HepB3 vaccination. Representative HBsAg serosurveys among children and a regional verification body for EMTCT of HBV will be needed to monitor progress.

Lessons Learned and Future Perspectives for Rotavirus Vaccines Switch in the World Health Organization, Regional Office for Africa.

BACKGROUND: Following the World Health Organization (WHO) recommendation, 38/47 countries have introduced rotavirus vaccines into the program of immunization in the WHO Regional Office for Africa (WHO/AFRO). Initially, two vaccines (Rotarix and Rotateq) were recommended and recently two additional vaccines (Rotavac and Rotasiil) have become available. However, the global supply challenges have increasingly forced some countries in Africa to switch vaccine products. Therefore, the recent WHO pre-qualified vaccines (Rotavac, Rotasiil) manufactured in India, offer alternatives and reduce global supply challenges related to rotavirus vaccines; Methods: Using a questionnaire, we administered to the Program Managers, Expanded Program for Immunization, we collected data on vaccine introduction and vaccine switch and the key drivers of the decisions for switching vaccines products, in the WHO/AFRO. Data was also collected fromliterature review and the global new vaccine introduction status data base maintained by WHO and other agencies. RESULTS: Of the 38 countries that introduced the vaccine, 35 (92%) initially adopted Rotateq or Rotarix; and 23% (8/35) switched between products after rotavirus vaccine introduction to either Rotavac (n = 3), Rotasiil (n = 2) or Rotarix (n = 3). Three countries (Benin, Democratic Republic of Congo and Nigeria) introduced the rotavirus vaccines manufactured in India. The decision to either introduce or switch to the Indian vaccines was predominately driven by global supply challenges or supply shortage. The withdrawal of Rotateq from the African market, or cost-saving for countries that graduated or in transition from Gavi support was another reason to switch the vaccine; Conclusions: The recently WHO pre-qualified vaccines have offered the countries, opportunities to adopt these cost-effective products, particularly for countries that have graduated or transitioning from full Gavi support, to sustain the demand of vaccines products.

Implementation of the World Health Organization recommendation on the use of rotavirus vaccine without age restriction by African countries.

The World Health Organization (WHO) recommended the worldwide use of rotavirus vaccines initially in 2007 and 2009 applying a strict age restriction criterion due to the potential for age-related association with increased risk of intussusception in infants. The restriction was relaxed in the 2013 after detailed review of robust safety data generated in post-marketing surveillance studies. We assessed the status of the implementation of the 2013 recommendation to remove age restriction in the WHO African region (AFR). Of the approximately 75% (35/47) of countries that had introduced the vaccine by 2018, only 43% (15/35) removed age restriction, exclusively from South and East sub-region (78%, 14/18). Avoiding confusion at the health facilities and financial constraints particularly resources required for re-training the health workers, use of vaccine off-label were cited as the main reasons for not implementing the 2013 WHO recommendation on age restriction removal. The 2013 WHO recommendation has not been fully implemented by African countries, suggesting the need for technical advisory bodies to further guide the countries, continue monitoring the implementation status and impact on the rotavirus vaccine coverage and intussusception in the Africa region.

Global progress on the elimination of viral hepatitis as a major public health threat: An analysis of WHO Member State responses 2017.

In 2016, the World Health Assembly passed a resolution to eliminate viral hepatitis as a public health threat by 2030. We aimed to examine the status of the global viral hepatitis response. METHODS: In 2017, the World Health Organization (WHO) asked the Ministries of Health in all 194 Member States to complete a Country Profile on Viral Hepatitis policy uptake indicators, covering national plans/funding, engagement of civil society, testing guidance, access to treatment, and strategic information. RESULTS: Of 194 Member States, 135 (70%) responded, accounting for 87% of the global population infected with hepatitis B virus (HBV) and/or C virus (HCV). Of those responding, 84 (62%) had developed a national plan, of which, 49 (58%) had dedicated funding, and 62 (46%) had engaged with civil society; those engaged with civil society were more likely to have a funded plan than others (52% vs. 23%, p = 0.001). Guidance on testing pregnant women (for HBV) and people who inject drugs (for HCV) was available in 70% and 46% of Member States, respectively; 59% and 38% of Member States reported universal access to optimal therapies for HBV and HCV, respectively. CONCLUSIONS: Most people living with hepatitis B and C reside in a country with a national hepatitis strategy. Governments who engaged with civil society were more advanced in their response. Member States need to finance these national strategies and ensure that those affected have access to hepatitis services as part of efforts to achieve universal health coverage. LAY SUMMARY: The World Health Organization's goal to eliminate viral hepatitis as a public health threat by 2030 requires global action. Our results indicate that progress is being made by countries to scale-up national planning efforts; however, our results also highlight important gaps in current policies.

Implementation of Rotavirus Surveillance and Vaccine Introduction - World Health Organization African Region, 2007-2016.

Rotavirus is a leading cause of severe pediatric diarrhea globally, estimated to have caused 120,000 deaths among children aged <5 years in sub-Saharan Africa in 2013 (1). In 2009, the World Health Organization (WHO) recommended rotavirus vaccination for all infants worldwide (2). Two rotavirus vaccines are currently licensed globally: the monovalent Rotarix vaccine (RV1, GlaxoSmithKline; 2-dose series) and the pentavalent RotaTeq vaccine (RV5, Merck; 3-dose series). This report describes progress of rotavirus vaccine introduction (3), coverage (using estimates from WHO and the United Nations Children's Fund [UNICEF]) (4), and impact on pediatric diarrhea hospitalizations in the WHO African Region. By December 2016, 31 (66%) of 47 countries in the WHO African Region had introduced rotavirus vaccine, including 26 that introduced RV1 and five that introduced RV5. Among these countries, rotavirus vaccination coverage (completed series) was 77%, according to WHO/UNICEF population-weighted estimates. In 12 countries with surveillance data available before and after vaccine introduction, the proportion of pediatric diarrhea hospitalizations that were rotavirus-positive declined 33%, from 39% preintroduction to 26% following rotavirus vaccine introduction. These results support introduction of rotavirus vaccine in the remaining countries in the region and continuation of rotavirus surveillance to monitor impact.

Rotavirus Disease Burden in Africa and the Need to Accelerate Introduction of Vaccines

It is important to establish the burden of rotavirus disease before and after the introduction of a rotavirus vaccine. Regional effortshave focused on building an unequivocal evidence base for rotavirus diarrhoea to support decisionmaking and sustained investment in new vaccine introduction. WHO recommends routine use ofrotavirus vaccines in all countries; particularlyin those with high mortality attributable todiarrhoeal disease. In countries where diarrhoeal deaths account for more than 10 of mortality inchildren aged under five years; the introduction of the vaccine is strongly recommended. This article reviews the available literature and summarizesthe estimated number of deaths in children underfive years attributable to rotavirus diarrhoea in the WHO African Region. Based on the available data; it can be concluded that the rotavirus disease burden is very high and that the introduction of rotavirus vaccines should be accelerated in the Region

Surveillance for Diseases Targeted by new Vaccines: Progress; Challenges and Way Forward

Thirteen years ago; WHO-AFRO proposed the establishment of a sentinel disease surveillance network as part of efforts to improve surveillance for invasive bacterial diseases (IBD) including paediatric pneumonia and meningitis and rotavirus diarrhoea in all Member States as part of surveillance for vaccine-preventable diseases and in line with the regional strategy integrated disease surveillance and response (IDSR). This was prompted by the eminent availability of new and prospective vaccines against Haemophilus influenzae type b (Hib); Streptococcus pneumoniae (S. pneum); Neisseria meningitides (Nm) and rotavirus vaccines. The Regional Office for Africa developed guidelines and tools and standardized methodology; including cases definitions to be used to recruit eligible cases. This article outlines the challenges and results of this initiative to date and aims for the future

New vaccine introduction in the East and Southern African sub-region of the WHO African region in the context of GIVS and MDGs.

Immunization programmes have over the years proven to be effective and useful in infectious disease control. However, based on current trends that show that many developing countries will not reach the Millennium Development Goals (MDG) targets, there is an urgent need to accelerate efforts to control the most common conditions still responsible for the largest morbidity and mortality in children under 5 years of age, like diarrhoea and pneumonia, for which safe and effective vaccines are now available. Through World Health Organization (WHO) and United Nations Children's Fund (UNICEF) strategies and initiatives like the Global Immunization Vision and Strategy (GIVS), Accelerated Disease Control and Reach Every District (RED), major positive achievements like the increasing number of children reached with Diphtheria-Tetanus-Pertussis (DTP) vaccines, significant measles mortality reduction, and the almost complete eradication of polio, have been realised. Many children in developing countries have access to life saving vaccines through the Global Alliance for Vaccines and Immunization (GAVI) support. Supplementary immunization activities against measles and polio continue to offer opportunities to deliver measles and polio vaccines, and other life-saving interventions. The Global Immunization Vision and Strategy 2006-2015 (GIVS framework) can effectively be used to guide countries in addressing some of the remaining challenges to reach the unreached and increase coverage of traditional vaccines, immunize more people against more diseases, support decision making to introduce new vaccines, as well as recognize the opportunity to invest in community health through cost-effective immunization programmes. Introduction of new vaccines should be strengthened and used as vehicles for health systems strengthening as well as for delivery of comprehensive primary health interventions to impact positively on the spiralling disease burden and reduce overall child mortality. A number of countries have adopted and operationalized GIVS through comprehensive multi-year plans for immunization (cMYP). This paper reviews progress with respect to introduction of some of the new vaccines in the East and Southern sub-region of WHO African region in the context of GIVS and MDGs as well as the challenges thereof.

A Piot model to analyse case management in malaria control programmes.

At the beginning of the 21st century, malaria remains one of the most important public health problems in the world. An important control strategy to address this burden is adequate case management of malaria patients. The success of this strategy, however, does not solely depend on diagnosis and treatment, but also on a sequence of steps that patients have to take when they are ill. Only when patients go through all these steps successfully will they be cured. In this paper, a model is presented in which these steps are described. The model provides a framework for analysing this type of malaria control strategy and for identifying the most critical challenges faced. Furthermore, the model is used to analyse recent literature on case management as part of malaria control programmes in order to highlight current knowledge, core issues and constraints, and to make recommendations for programme development and research.