H5N1

Progress toward regional measles elimination — worldwide, 2000–2021

Via MMWR: Progress Toward Regional Measles Elimination — Worldwide, 2000–2021. The summary:

What is already known about this topic?  

Progress toward measles elimination experienced setbacks in 2020 during the COVID-19 pandemic.  

What is added by this report?  

During 2000–2021, measles vaccination prevented an estimated 56 million deaths worldwide. In 2021, only 81% of children received their first dose of measles containing vaccine (MCV), the lowest coverage reported since 2008, leaving 25 million children vulnerable to measles. Measles surveillance continues to be suboptimal, and large and disruptive outbreaks were reported in 22 countries.  

What are the implications for public health practice?  

Reaching all children with 2 doses of MCV and strengthening measles surveillance is critical to close immunity gaps, prevent outbreaks, and recover progress lost during the pandemic.

Migration and outbreaks of vaccine-preventable disease in Europe: A systematic review

Via The Lancet Infectious Diseases: Migration and outbreaks of vaccine-preventable disease in Europe: a systematic review. The summary:

Migrant populations are one of several underimmunised groups in the EU or European Economic Area (EU/EEA), yet little is known about their involvement in outbreaks of vaccine-preventable diseases. This information is vital to develop targeted strategies to improve the health of diverse migrant communities. 

We did a systematic review (PROSPERO CRD42019157473; Jan 1, 2000, to May 22, 2020) adhering to PRISMA guidelines, to identify studies on vaccine-preventable disease outbreaks (measles, mumps, rubella, diphtheria, pertussis, polio, hepatitis A, varicella, Neisseria meningitidis, and Haemophilus influenzae) involving migrants residing in the EU/EEA and Switzerland. 

We identified 45 studies, reporting on 47 distinct vaccine-preventable disease outbreaks across 13 countries. Most reported outbreaks involving migrants were of measles (n=24; 6496 cases), followed by varicella (n=11; 505 cases), hepatitis A (n=7; 1356 cases), rubella (n=3; 487 cases), and mumps (n=2; 293 cases). 19 (40%) outbreaks, predominantly varicella and measles, were reported in temporary refugee camps or shelters. Of 11 varicella outbreaks, nine (82%) were associated with adult migrants. Half of measles outbreaks (n=11) were associated with migrants from eastern European countries. 

In conclusion, migrants are involved in vaccine-preventable disease outbreaks in Europe, with adult and child refugees residing in shelters or temporary camps at particular risk, alongside specific nationality groups. Vulnerability varies by disease, setting, and demographics, highlighting the importance of tailoring catch-up vaccination interventions to specific groups in order to meet regional and global vaccination targets as recommended by the new Immunisation Agenda 2030 framework for action. 

A better understanding of vaccine access and intent in migrant groups and a greater focus on co-designing interventions is urgently needed, with direct implications for COVID-19 vaccine delivery.

A look back to December 1, 2019

I just revisited my posts for December 1, 2019. It was a different world: Samoa and other Pacific nations were battling a serious measles outbreak, and Dr. Tedros was praising the courage of Ebola responders in the DR Congo who were coming under yet more attacks from violent groups.

But it was only a year ago, and disasters like measles, malaria, and countless other diseases are still with us—and aggravated by the COVID-19 pandemic.

I wonder what December 1, 2021 will be like.

New Ebola outbreak detected in northwest Democratic Republic of the Congo; WHO surge team supporting the response

WHO has published New Ebola outbreak detected in northwest Democratic Republic of the Congo; WHO surge team supporting the response.

The Government of the Democratic Republic of the Congo announced today that a new outbreak of Ebola virus disease is occurring in Wangata health zone, Mbandaka, in Équateur province. The announcement comes as a long, difficult and complex Ebola outbreak in eastern Democratic Republic of the Congo is in its final phase, while the country also battles COVID-19 and the world’s largest measles outbreak. 

Initial information from the Ministry of Health is that six Ebola cases have so far been detected in Wangata, of which four have died and two are alive and under care. Three of these six cases have been confirmed with laboratory testing. It is likely more people will be identified with the disease as surveillance activities increase.  

“This is a reminder that COVID-19 is not the only health threat people face,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Although much of our attention is on the pandemic, WHO is continuing to monitor and respond to many other health emergencies.”  

This is the Democratic Republic of the Congo’s 11th outbreak of Ebola since the virus was first discovered in the country in 1976. The city of Mbandaka and its surrounding area were the site of Democratic Republic of the Congo’s 9th Ebola outbreak, which took place from May to July 2018.  

“It’s happening at a challenging time, but WHO has worked over the last two years with health authorities, Africa CDC and other partners to strengthen national capacity to respond to outbreaks,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “To reinforce local leadership, WHO plans to send a team to support scaling up the response. Given the proximity of this new outbreak to busy transport routes and vulnerable neighbouring countries we must act quickly.” 

WHO is already on the ground in Mbandaka supporting the response to this outbreak, as part of capacity built during the 2018 outbreak. The team supported the collection and testing of samples, and reference to the national laboratory for confirmation. Contact tracing is underway. Work is ongoing to send additional supplies from North Kivu and from Kinshasa to support the government-led response. A further 25 people are expected to arrive in Mbandaka tomorrow. WHO is also working to ensure that essential health services are provided to communities despite these emergency events.  

The Democratic Republic of the Congo’s 10th outbreak of Ebola, in North Kivu, South Kivu and Ituri provinces, is in its final stages. On 14 May 2020, the Ministry of Health began the 42-day countdown to the declaration of the end of that outbreak.  

New outbreaks of Ebola are expected in the Democratic Republic of the Congo given the existence of the virus in an animal reservoir in many parts of the country.

What the growing rift between the US and WHO means for COVID-19 and global health

Via Nature.com: What the growing rift between the US and WHO means for COVID-19 and global health. Excerpt:

Experts in health policy are contending with the real possibility that the United States will pull away from the World Health Organization (WHO), fracturing a relationship that began in the wake of the Second World War. 

They say that the repercussions could range from a resurgence of polio and malaria, to barriers in the flow of information on COVID-19. Scientific partnerships around the world would also be damaged, and the United States could lose influence over global health initiatives, including those to distribute drugs and vaccines for the new coronavirus as they become available, say researchers.  

A fissure between the US and the international health agency opened further last week, when US President Donald Trump tweeted a letter to WHO director-general Tedros Adhanom Ghebreyesus, threatening to make permanent the US freeze on WHO funding that began in April, unless the organization “can actually demonstrate independence from China” within 30 days. He added that he will reconsider the United States’ membership of the organization. “I don’t think this is an idle threat,” says Kelley Lee, a global health-policy researcher at Simon Fraser University in Burnaby, Canada. 

Proposals for new US-led initiatives for pandemic preparedness abroad do little to quell researchers' concerns. Some say these efforts might even add incoherence to the world's response to COVID-19, and global health more generally, if they're not connected to a fully-funded WHO. “It’s surreal to even be having this conversation, since it’s so hard to get one’s head around the massive implications,” says Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University in Washington DC. 

The acrimony is poorly timed, given the need for international coordination and cooperation to contend with the coronavirus. “In this pandemic, people have said we’re building the plane while flying,” Katz says. “This proposal is like removing the windows while the plane is mid-air.”  

Balance due 

Trump’s letter, which he tweeted on 18 May, alleges that the WHO intentionally ignored reports that COVID-19 was spreading between people in Wuhan, China, in December. “I cannot allow American taxpayer dollars to continue to finance an organization that, in its present state, is so clearly not serving America’s interests,” he wrote. A few of Trump's points were immediately debunked. For example, he claimed that the medical journal The Lancet had published on the new coronavirus in December. The next day, the journal issued a statement calling the claim factually incorrect because their first reports on COVID-19 were published on 24 January. The journal also refuted other allegations in the letter, concluding that the claims are "damaging to efforts to strengthen international collaboration to control this pandemic." 

Tedros has reiterated his commitment to a comprehensive and independent evaluation of the WHO's response to COVID-19, and an assessment of the organization's operations in the first part of 2020 is already public. But when reporters asked Tedros about additional, immediate investigations in response to Trump's allegations at a WHO press briefing, he said, “Right now, the most important thing is fighting the fire, saving lives.”

Trump does not need Congressional approval to withhold funds from the WHO, and global health researchers say the gap left by the US is a big deal. Last year, the US government gave the WHO roughly US$450 million. Nearly 75% of that was voluntary, and the other quarter was mandatory — a sort of membership fee expected from the 194 member countries, adjusted by the size of their economies and populations. 

The United States is the biggest donor, representing about 15% of the WHO budget. So far this year, it has paid about one-quarter — $34 million — of its membership dues, according to a WHO spokesperson. Voluntary funds are more complicated because a large portion were paid last year, however the spokesperson says that the freeze has put a hold on new agreements, meaning that the full-blown effects of the decision will be felt in 2021. 

The US government provides 27% of the WHO’s budget for polio eradication; 19% of its budget for tackling tuberculosis, HIV, malaria and vaccine-preventable diseases such as measles; and 23% of its budget for emergency health operations. If these initiatives shrink, researchers say, death and suffering will surge. David Heymann, an epidemiologist at the London School of Hygiene and Tropical Medicine, says this will also amount to squandered investment for the United States, particularly for polio. Gains won through vaccination campaigns that cost hundreds of millions of dollars would be lost, he says.

ECDC: Measles continues to spread across the EU/EEA – No time for complacency

ECDC has published Measles continues to spread across the EU/EEA – No time for complacency. Excerpt:

The most recent ECDC Measles Annual Epidemiological Report published today shows that in 2019, a total of 13 200 cases were reported by the EU/EEA countries and UK. 

In 2019 all EU/EEA countries and the UK reported measles cases. The data shows a decline in measles cases compared to 2017 and 2018 data, when approximately 18 000 cases were reported for each year but this is much higher than the number of cases observed in 2015–2016 (around 4 000 for 2015 and 4 600 cases for 2016) before the start of the current epidemic in Europe. More recent data from the first two months of 2020 also shows fewer cases (1 032) as compared to the first months of the previous three years (average of 3 072 cases). 

Despite this decline, the fact that measles cases continue to occur across the EU/EEA shows that vaccination coverage in many countries remains suboptimal.      

Hard fought gains in immunization coverage at risk without critical health services, warns WHO

A news release: Hard fought gains in immunization coverage at risk without critical health services, warns WHO. Excerpt:

Shutting down immunization services in the COVID-19 pandemic risks triggering a resurgence of diseases that can be prevented with safe and effective vaccines, warns WHO in the lead-up to World Immunization Week (24-30 April).   

When immunization services are disrupted, even for brief periods during emergencies, the risk of vaccine-preventable disease outbreaks, such as measles and polio, increase. Last year’s deadly measles outbreak in the Democratic Republic of the Congo, which took more than 6000 lives in a country already facing its largest Ebola outbreak, highlights the importance of maintaining essential health services, such as immunization in times of emergency. Further disease outbreaks will also overwhelm health systems already battling the impacts of COVID-19. 

“Disease outbreaks must not remain a threat when we have safe and effective vaccines to protect us,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “While the world strives to develop a new vaccine for COVID-19 at record speed, we must not risk losing the fight to protect everyone, everywhere against vaccine-preventable diseases. These diseases will come roaring back if we do not vaccinate.” 

WHO is working with partners all over the world to accelerate research and development of a safe and effective vaccine and ensure equitable access for the billions of people who will need it.  

But even with an expedited process, development of a vaccine for COVID-19 will take time. Precautionary measures are essential now to help keep us safe from disease, including diseases for which vaccines already protect children and adults. 

Too many people are still excluded from the benefits of vaccines 

Prior to the COVID-19 pandemic, the world had made immense progress in ensuring that children are vaccinated. In 2018, 86 percent of children under the age of five globally were vaccinated with three doses of diphtheria, tetanus and pertussis (DTP3) and one dose of the measles vaccine, up from 72 percent in 2000 and 20 percent in 1980. The number of children paralyzed by polio has been reduced by 99.9 percent worldwide.  

Yet, global vaccination coverage is still far from the 95 per cent coverage needed to fully protect communities against outbreaks of this vaccine-preventable disease.  

In 2018 nearly 20 million children worldwide – more than 1 in 10 – missed out on lifesaving vaccines, such as measles, diphtheria and tetanus. Roughly, 13 million of the children have never received any vaccines, putting them and their communities at risk of disease and death. The majority of these children live in countries with already fragile health systems, further limiting their access to essential health services when they fall sick. 

Measles continues to remain an ever-present threat, especially if vaccination rates drops. Current projections indicate that the number of reported measles cases for 2019 will be at least 800 000. In 2020 there are increasing concerns about another resurgence, especially if vaccination rates fall due to delay or suspension of scheduled immunization activities as a result of COVID-19. 

Canada: BC judge orders vaccinations for 2 boys over their mother's objections

Via CBC News Vancouver, some good news: B.C. judge orders vaccinations for 2 boys over their mother's objections. Excerpt:

A B.C. judge has ordered the vaccination of two children over the objections of their mother, who questioned the safety of immunization.  

The case went to provincial court in Salmon Arm, in B.C.'s southern interior, because of the father's concerns about recent measles outbreaks and a warning that education officials might not allow his two sons to attend school during an outbreak unless they were immunized. 

The mother attempted to introduce a report into evidence written by a U.S. doctor who testified in the high-profile case of a Michigan mother who fought for years to keep from vaccinating her young daughter.  

But Judge Stella Frame questioned Dr. Toni Lynn Bark's qualifications to speak about immunology, virology or epidemiology as well as her claims to be an expert in "vaccine adversomics."  

"It is difficult to know whether or not this is junk science or a recognized emerging field," Frame wrote in her eight-page decision. 

"Presented as it is in her report, her theory or opinion sounds like a conspiracy theory."  

'Vaccination is preferable to non-vaccination' 

The ruling highlights the role of the courts in adjudicating splits between parents divided over vaccination.  

Frame's decision refers to an earlier B.C. Supreme Court decision in which a judge rejected attempts to link vaccines to autism. Frame said she had reached the same conclusion.  

"The current best evidence is that vaccination is preferable to non-vaccination, that it is required in order to protect those who cannot be vaccinated as well as to protect ourselves, and that any adverse reaction the person may have from the vaccine is largely outweighed by the risk of contracting the targeted disease," Frame wrote.

WHO: Deaths from DR Congo measles outbreak top 6000

WHO AFRO has published Deaths from Democratic Republic of the Congo measles outbreak top 6000.

Kinshasa, 7 January 2020 – With the death toll from the world’s worst measles epidemic in the Democratic Republic of the Congo (DRC) surpassing 6000, the World Health Organization (WHO) is calling for more funding to stop the outbreak.  

Under the leadership of the DRC Ministry of Health, WHO, Gavi, the Vaccine Alliance, and other partner aid agencies vaccinated more than 18 million children under five across the country in 2019. However, in some areas, routine vaccination coverage remains low and 25% of the reported measles cases are in children over the age of five, who are the most vulnerable. 

“We are doing our utmost to bring this epidemic under control. Yet to be truly successful we must ensure that no child faces the unnecessary risk of death from a disease that is easily preventable by a vaccine. We urge our donor partners to urgently step up their assistance,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. 

Since the start of 2019, around 310 000 suspected measles cases have been reported. The epidemic has been aggravated by low vaccination coverage among vulnerable communities, malnutrition, weak public health systems, outbreaks of other epidemic-prone diseases, difficult access by vulnerable populations to health care and insecurity that has hampered response in some areas.  

Lack of funding remains a huge impediment to successfully curbing the outbreak. So far, US$ 27.6 million have been mobilized. However, a further US$ 40 million are required for a six-month plan to extend the vaccination to children between six and 14 years and to reinforce elements of the outbreak response beyond vaccination, including improving treatment, health education, community engagement, health system strengthening, epidemiological surveillance and response coordination.  

“We recognize the Government’s engagement in the efforts to end the outbreak and we are grateful for the generosity of our donors. But we still need to do more,” said Dr Amédée Prosper Djiguimdé, Officer in charge of WHO office in the DRC. “Thousands of Congolese families need our help to lift the burden of this prolonged epidemic from their backs. We cannot achieve this without adequate finances.” 

The European Civil Protection and Humanitarian Aid Operations, Gavi, the Vaccine Alliance, Médecins du Monde, Médecins Sans Frontières, United Nations Children’s Fund, WHO and other partners have been supporting the Government to bring the long-running epidemic under control. In December 2019, WHO trained 60 health professionals from the Ministry of Health to conduct a range of services, including community engagement, health education and surveillance. These health professionals are being deployed this week as part of the response.

Samoa measles: Update, January 6

Thanks to @drfixus for tweeting the link to this ReliefWeb report from the government of Samoa: National Emergency Operation Centre: Update on the measles outbreak, January 6, 2020 - Samoa.

January 6th, 2020; The Ministry of Health confirms a cumulative total of 5,697 measles cases have been reported to the Disease Surveillance Team, since the outbreak started. 

Currently the outbreak is declining with 30 new cases reported between December 29, 2019 and January 5, 2020. 

As of 8.30am January 5th 2020, there were 16 measles currently admitted at the Tupua Tamasese Meaole Hospital (TTMH) including 4 critically ill children in ICU/HDU. 

The total number of measles cases admitted to all hospitals recorded for the outbreak to date is 1,860. Of that, 1,761 (95%) patients have recovered and been discharged. 

To date, 83 measles related deaths have been recorded. There were 2 fatalities (one infant and one adult) between December 29, 2019 and January 5, 2020.  

There are currently no travel restrictions or vaccination requirement for those travelling to Samoa. Additionally, proof of MMR vaccination is not currently required for Samoans travelling to Australia, New Zealand, or the United States. 

Only travelers to American Samoa are required to provide proof of vaccination for MMR.