I.

Expanded Program on Immunization: Updates and Trends

Dramatic fall in cases of meningitis A after new vaccine introduction
Six months after the successful introduction of a new vaccine aimed at eliminating the primary cause of meningitis epidemics in sub-Saharan Africa, Burkina Faso, Mali, and Niger report the lowest number of confirmed meningitis A cases ever recorded during an epidemic season. With the 2010-2011 epidemic season largely over, WHO surveillance data show just four confirmed cases of meningitis A in Burkina Faso, the first country to introduce the vaccine nationwide. Three of the four cases occurred in individuals from neighboring Togo who crossed the border for medical care, and the fourth case was a citizen of Burkina Faso who had not received the new vaccine. No confirmed cases were reported in Mali, while four cases were reported in Niger, all in unvaccinated individuals. While these initial data are extremely encouraging, continuing surveillance for cases of meningitis and robust systems for monitoring vaccination coverage reported to be around 100 per cent during the December campaigns will be crucial to confirm the impact of the vaccine as it is introduced across the African meningitis belt. Planning is now under way for a new round of immunization campaigns in 2011-2012. Campaigns will be finalized in Mali and Niger, countries which opted to introduce the vaccine in a phased approach, and new campaigns will begin in Cameroon, Chad, and Nigeria. Nearly 65 million people overall are expected to have received the MenAfriVac vaccine by the end of the year. "The commitment of ministries of health in the African meningitis belt, partners, and affected communities to introduce this vaccine quickly, is remarkable," said Dr. Luis Sambo, WHO Regional Director for Africa, adding that "WHO and partners will continue to support countries in strengthening disease surveillance and vaccine safety monitoring systems as the vaccine is introduced across Africa." Introducing countries and project partners are aiming for introduction in the other 19 countries of the meningitis belt by 2016. They are keenly aware, however, that achievement of this goal is dependent on mobilization of a further US$ 375 million. It is hoped that the international community will use the opportunity of the GAVI Alliance's Pledging Conference for Immunisation, to be held on 13 June in London, to commit sufficient funds to supplement the budgets of introducing countries to meet this gap.

Introduction of new-generation pneumococcal vaccine will help save lives

In an effort to protect more children against pneumococcal disease which causes life-threatening illnesses such as pneumonia, meningitis and sepsis the Government of Kenya, with support from WHO and partners, is introducing the pneumococcal conjugate vaccine. Kenya is the fourth country to include the vaccine into its national immunization programme in the past three months, after Nicaragua, Sierra Leone and Yemen. The introduction comes less than two years after the same vaccine was introduced in industrialized countries. The rapid roll-out of new-generation pneumococcal vaccine shows how innovation and technology can be harnessed, at affordable prices, to save lives in the developing world. The payback, as measured by reduced childhood mortality, will be enormous, said Dr Margaret Chan, WHO Director-General. Every year, an estimated 1.6 million deaths worldwide occur due to childhood pneumonia. The consequences of these illnesses are staggering more than half a million child deaths, thousands of disabled children, high treatment costs, productivity losses as well as pain and suffering for millions of children and families. Accelerating routine use of pneumococcal conjugate vaccines in developing countries can make a real difference in reducing child deaths and put priority countries closer to reaching Millennium Development Goal four, to reduce the under-five mortality rate by two-thirds between 1990 and 2015.

No

change to pandemic recommendations

H1N1

influenza

vaccination

WHO's Strategic Advisory Group of Experts on Immunization reviewed the latest data on pandemic influenza A (H1N1) vaccines, concluding that its previous recommendations on priority target groups and number of doses still stand. The Committee endorsed plans to revise recommendations on H5N1 vaccines in view of evidence gathered during the H1N1 pandemic and approved the updating of a WHO position paper on seasonal influenza vaccination. Other recommendations made included the need for robust and independent oversight of the new strategic plan on polio eradication and continued vigilance in ensuring high coverage with pertussis-containing vaccines.

Countries encouraged to use the opportunity of accelerated measles vaccination activities to introduce rubellacontaining vaccines
In an updated position paper, published in the Weekly Epidemiological Record today, WHO recommends that countries use the opportunity of accelerated measles control and elimination activities to introduce rubellacontaining vaccine. All countries that have not yet introduced rubella vaccine, and are providing two doses of measles vaccine using routine immunization and/or supplementary immunization activities should consider the inclusion of rubella-containing vaccine in their immunization programme. Countries planning to introduce rubella-containing vaccine should review the epidemiology of rubella including: the susceptibility profile of the population; assess the burden of congenital rubella syndrome (CRS); and establish the public health priority of rubella and CRS prevention. Costbenefit studies are not needed in every country before implementing rubella vaccination as results from studies in countries with similar sociodemographic circumstances can be informative. Countries should determine a goal and the time frame for achieving it before introduction. Strong political commitment to the elimination of rubella and CRS as well as sustainable financing for vaccination and surveillance activities should be in place before initiating rubella vaccination in childhood immunization programmes. Transmitted through airborne droplets, rubella is an acute, usually mild viral disease traditionally affecting susceptible children and young adults worldwide. Rubella infection just before conception and in early pregnancy may result in CRS. The highest risk of CRS is found in countries with high rates of susceptibility to rubella among women of childbearing age. While large-scale rubella vaccination during the last decade has enabled the elimination of rubella and CRS in the Western Hemisphere and several European countries, the current burden of CRS in Africa, South-East Asia and the Western Pacific regions is still thought to be high