H5N1

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.

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. 

New arrangement for second dose of measles vaccination under DH's Hong Kong Childhood Immunisation Programme

Via the Centre for Health Protection: New arrangement for second dose of measles vaccination under DH's Hong Kong Childhood Immunisation Programme. Excerpt:

The Department of Health (DH) today (December 23) announced that a new arrangement for measles vaccination under the DH's Hong Kong Childhood Immunisation Programme (HKCIP) will be implemented from January 2, 2020.      

Children in Hong Kong are given the first dose of a combined measles, mumps and rubella (MMR) vaccine when they are 1 year old at the DH's Maternal and Child Health Centres (MCHCs). Under the new arrangement, this will be followed by a second dose of a measles-containing vaccine (i.e. combined measles, mumps, rubella and varicella (MMRV) vaccine) when they are 18 months old at MCHCs instead of receiving the vaccination at Primary One at school under the current practice.      

The new arrangement is applicable to children born on or after July 1, 2018. Those who were born before this date will continue to receive the vaccination concerned at Primary One via the School Immunisation Teams (SITs) of the DH through outreach visits to schools.      

After the implementation of the new measure, the DH will arrange for second doses of a measles-containing vaccine to children according to their date of birth. Detailed arrangements are as follows: 

Children born on or after July 1, 2018 

Those with scheduled appointments at 18 months old for receiving the diphtheria, tetanus, acellular pertussis and inactivated poliovirus vaccine (booster dose) at MCHCs on or after January 2, 2020, will receive the MMRV vaccine on the same day. 

Children born between January 1, 2013, and June 30, 2018 

As in previous years, these children will receive the MMRV vaccine at Primary One via the SITs through outreach visits to schools.

Global routine vaccination coverage, 2018

Via MMWR: Global Routine Vaccination Coverage, 2018. The summary:

What is already known about this topic?  

Since 1974, global coverage with vaccines to prevent tuberculosis, diphtheria, tetanus, pertussis, poliomyelitis, and measles has increased from <5% to 86%. 

What is added by this report?  

Global coverage with the third dose of diphtheria and tetanus toxoids and pertussis-containing vaccine has not increased above 86% since 2010. Coverage varies across regions and countries, with lower coverage in lower-income countries.  

What are the implications for public health practice? 

Equitable access to immunization to achieve and sustain high coverage can be enhanced through financial and technical support for program strengthening and vaccine introductions in lower-income settings, community engagement to increase vaccination acceptance and demand, collection and use of vaccination data, and commitment to improving immunization services.

Whooping cough epidemic declared in Denmark

Via The Local: Whooping cough epidemic declared in Denmark. Excerpt:

Over 1,300 cases of whooping cough were recorded in Denmark up to and including August this year. 

The figures, collected by Statens Serum Institut (SSI), have resulted in the medical and disease research institute declaring an epidemic of the illness. 

At 1,323 recorded cases, the incidence of the disease is over three times normal levels. 

SSI department doctor Peter Henrik Andersen said that the increase in cases is spread across all age demographics, but particular attention should be paid to small children.  

“Whooping cough can be serious for small children. Doctors are therefore advised to be particularly alert to potential cases of whooping cough in patients with attacks of dry coughing,” Andersen said in a press statement issued by SSI.

“That applies in particular to smaller children but also to older children and adults who can be a source of infection for smaller, unprotected children,” he added.  

“It’s important that parents are aware that small children, in particular, are vaccinated on time. Additionally, unvaccinated children under the age of 24 months who have been in contact with someone with whooping cough can be offered preventative antibiotics,” the SSI specialist continued.  

Whooping cough can be dangerous for small children due to their narrower airways, in which hardened mucus can collect and cause breathing difficulties.  

Long coughing fits can also result in the child not taking in sufficient oxygen. 

In a statement, health minister Magnus Heunicke advised parents to ensure their children follow the vaccination programme against the disease. Vaccines are given at the ages of 3, 5 and 12 months and at 5 years.  

“We have a vaccine that works. That’s why I feel it’s important to remind all parents of the responsibility they have – remember to get your small children vaccinated,” Heunicke said.

See also this statement on the Danish Ministry of Health website.

Increasing childhood vaccination coverage of the refugee and migrant population in Greece through the European programme PHILOS, April 2017 to April 2018

Via Eurosurveillance: Increasing childhood vaccination coverage of the refugee and migrant population in Greece through the European programme PHILOS, April 2017 to April 2018. The abstract:

After the 2016 Balkan route border closures, vaccination of refugee children in Greece was mainly performed by non-governmental organisations. Activities varied between camps, resulting in heterogeneity of vaccination coverage (VC). 

In April 2017, the European programme ‘PHILOS - Emergency health response to refugee crisis’ took over vaccination coordination. Interventions were planned for the first time for refugee children in the community and unaccompanied minors at safe zones. From April 2017–April 2018, 57,615 vaccinations were performed against measles-mumps-rubella (MMR) (21,031), diphtheria-tetanus-pertussis (7,341), poliomyelitis (7,652), pneumococcal disease (5,938), Haemophilus influenzae type b (7,179) and hepatitis B (8,474). 

In April 2018, the vaccination status of children at camps (reception and identification centres and community facilities such as hostels/hotels were excluded) was recorded and VC for each disease, stratified by dose, nationality and camp size, was calculated. 

More than 80% of the children received the first MMR dose, with VC dropping to 45% for the second dose. For all other vaccines, VC was < 50% for the first dose in children aged 0–4 years and < 25% for the second dose. Despite challenges, PHILOS improved planning and monitoring of vaccination activities; however, further efforts towards improving VC in refugee children are needed.

Mandatory vaccination: Suited to enhance vaccination coverage in Europe?

An editorial in Eurosurveillance: Mandatory vaccination: suited to enhance vaccination coverage in Europe? Excerpt:

Vaccines are one of the most successful medical measures that save millions of human lives every year. With the implementation of routine immunisation programs, high and maintained vaccination coverages for many vaccine-preventable diseases—such as those against poliomyelitis or diphtheria—have been reached in most European countries and many others. Although vaccine acceptance is often high within the general population, even in countries with high vaccination coverage a significant number of children and adults are not sufficiently vaccinated because of missed opportunities or various concerns and misperceptions. 

The reasons for this ‘vaccine hesitancy’ are multifactorial, complex and vary across vaccines, time and countries/regions, and are influenced by factors such as complacency (not perceiving disease as high risk and vaccination as necessary), convenience and constraints (practical barriers), and confidence (lack of trust in safety and effectiveness). As a result, vaccination coverages against highly contagious pathogens such as measles virus are not sufficient to prevent outbreaks and infectious disease spread in many countries today.  

Despite the World Health Organization (WHO)’s goal to eliminate measles, a constant increase in measles cases has occurred in recent years. In 2018, more than 82,500 people in 47 of the 53 countries in the WHO European Region were infected with measles, leading to 72 deaths. These numbers were the highest in a decade. They were three times higher than in 2017 and 15 times higher than in 2016, when numbers were at a record low. 

In 2019, the situation seems to be even worse, indicating that current plans of action in the affected areas are insufficient to stop measles circulation. This is evidenced by the fact that the estimated coverage with the second dose of a measles-containing vaccine is far below the necessary 95% to achieve herd/population immunity in several European countries. 

In order to maintain or improve the population immunity acquired by vaccination, several countries are currently revisiting their strategies and discussing changes in vaccination policies, with a focus on either educating the population and giving individuals freedom of choice or implementing mandatory vaccination to ensure high coverage rates. 

With increasing calls to introduce mandatory vaccination programs, intense debates on their effectiveness have also started in several European countries. There are concerns that mandatory vaccination may lead to opposing attitudes and even less vaccine uptake, particularly in those with existing critical attitudes towards vaccines; nonetheless, other studies have disproved that implementation of compulsory vaccination led to opposing attitudes and/or had negative effects. 

However, it is indisputable that with any changes in vaccination policies, intensified information strategies are necessary to improve trust, rectify perceived risks and improve access and affordability of vaccines. Moreover, it is important to note that mandatory vaccination can follow different routes depending on a country’s specific social and cultural backgrounds, as well as epidemiological situations. 

Consideration of these factors can lead to implementing temporary or permanent vaccine mandates for certain vaccines (such as measles/measles-mumps-rubella (MMR) partial compulsory vaccination), for all vaccines included in a national vaccination program or for selected target groups, such as infants and children before entrance in educational settings or certain occupational groups, such as healthcare workers (HCW).  

For example, in France three mandatory vaccines (against diphtheria, tetanus and poliomyelitis (DTP)) co-existed with eight recommended vaccines (against MMR, pertussis, Streptococcus pneumoniae, hepatitis B (HepB), Neisseria meningiditis serogroup C (MenC) and Haemophilus influenza (Hib)) for routine childhood immunisation up until 2017. However, misperceptions in the population, i.e. that non-mandatory vaccines are less valuable, optional or not as safe and effective as the mandatory ones, resulted in insufficient and stagnating vaccine coverages of the recommended vaccines. This growing vaccine hesitancy, as well as large outbreaks and deaths from measles, led to a change in French policy to extend the mandates to all 11 childhood vaccines.  

Italy has had a similar situation, where four mandatory vaccines were in place already before 2017 (against poliomyelitis, tetanus, diphtheria and HepB). The coverage for vaccination against measles, mumps and rubella dropped country-wide from 90% to 87% between 2000–16. This, together with large measles outbreaks, led the government to extend the existing vaccine mandates to 10 mandatory vaccines (hexavalent vaccine against DTPert (pertussis)-poliomyelitis-Hib-HepB, as well as MMR and Varicella (V) vaccine) in 2017, whereas vaccination against Men C, S. pneumoniae and rotavirus remained recommended vaccines.  

The current issue of Eurosurveillance presents articles from France and Italy on approaches and experiences after the extension of mandatory vaccination. While an article in last week’s issue of Eurosurveillance by Mathieu et al describes the population’s general attitude towards mandatory vaccination shortly before implementation of extended vaccination mandates in France, the rapid communication by Lévy-Bruhl et al. in this issue evaluates the effects of mandatory vaccination on vaccine coverage 2 years after its implementation. D’Ancona et al., also in this issue, depict challenges in Italy in the year following the introduction of the new mandate and how these are being addressed.

Canada: New Brunswick moves toward mandatory immunization for students

Via CBC News: New Brunswick moves toward mandatory immunization for students. Excerpt:

The New Brunswick government introduced legislative amendments Friday that would make medical exemptions the only acceptable reason for children in public schools and licensed early learning and child care centres not to be immunized.  

Under the proposed changes, starting Sept. 21, 2021, all existing and new students would have to either provide proof they're immunized against various diseases, such as measles and whooping cough, or provide a medical exemption form signed by a health-care professional. 

If they don't, they won't be allowed in and will have to go to private school or be home-schooled instead, said Dominic Cardy, minister of education and early childhood development. 

"It's about protecting our kids, accepting science and evidence, and that's the reason why we're making these changes," he said. 

The amendments to the Education Act and the Public Health Act come amid a measles outbreak in the Saint John health region, where 12 cases of the highly contagious respiratory disease have been confirmed, and a whooping cough outbreak in the Fredericton health region, with 28 cases now confirmed.

"Right now, there's a very broad exemption that allows for basically anyone who just says they don't wish to have their children vaccinated," said Cardy. 

But there are some children who can't be vaccinated for health reasons, such as being immunocompromised, he said.  

The amendments would remove all non-medical exemptions and help protect those vulnerable children through so-called herd immunity, or community immunity, by ensuring at least 95 per cent of students are vaccinated.  

The government also plans to look into making immunization mandatory for teachers, bus drivers and other staff, said Cardy, but that will require discussions with unions.

Papua New Guinea is rich in resources but poor in health

Via The New York Times: Papua New Guinea Is Rich in Resources but Poor in Health. Excerpt:

PORT MORESBY, Papua New Guinea — Polio was vanquished by the Pacific nation of Papua New Guinea 18 years ago. Now, as world leaders gather there for the Asia-Pacific Economic Cooperation summit meeting this week, polio has returned — on top of raging drug-resistant epidemics of tuberculosis, malaria and H.I.V., and deadly flash points of preventable diseases like whooping cough and measles.  

All over the country, there are symptoms of a profound public health emergency; young and old are getting sick and dying unnecessarily, while facilities lack basic medicines and equipment. 

Doctors and experts say the unfolding crisis is the realization of their worst fears after years of deterioration and neglect.  

“We were expecting something like this,” Dr. Anup Gurung, a public health specialist with the World Health Organization, said of the polio outbreak at a news conference in the capital, Port Moresby, in September. 

He pointed to the erosion of vaccination rates, which are down to 30 percent in some parts of the country. “It’s like someone lit a paper castle where everything is on fire,” he said. 

Officials in Papua New Guinea hope that hosting the Asia-Pacific Economic Cooperation, or APEC, meeting in Port Moresby will elevate the country’s international profile, but the health crisis has become an embarrassment for a nation with an abundance of gold, copper, silver, oil and gas. 

Public frustration with the summit spending has already led to two national strikes. The collapse of health services has been a focus of the protests. 

The return of polio is a clear indicator of the failures, with Papua New Guinea accounting for 21 of 109 cases found globally this year. 

The Papua New Guinea outbreak is vaccine-derived, which means that weakened live virus excreted by vaccinated children has mutated and escaped into the rapidly increasing unprotected population. Dr. Gurung blamed “the steady breakdown of the health system” for the country’s polio emergency.  

Local and international experts point to three interlinked causes of the country’s health crisis: the collapse of the medical supply chain; changing relations with the country’s biggest aid donor, Australia; and rampant corruption. 

Getting medicines, equipment and other supplies around Papua New Guinea has always been challenging. The country has few roads, formidable geography and a widely dispersed population, with about 80 percent living in rural and remote locations.  

That improved with assistance from Australia, but the Australian government withdrew from the arrangement in protest in 2013 after Papua New Guinea awarded the national medicine supply contract to a local company that Julie Bishop, then the Australian foreign minister, said had no accreditation and “a history of supplying substandard drugs.” 

The company, Borneo Pacific, won the contract — worth 32 million Australian dollars, or $23 million — despite its bid being millions of dollars higher than those of reputable international organizations. At the time, the Medical Society of Papua New Guinea said the deal would “lead to the deaths of many Papua New Guineans.”  

Reports from health facilities across the country indicate those fears have been borne out. (Borneo Pacific did not respond to requests for comment.)

'Ebola allowed us to discover things that are not going well in our hospitals'

Via Radio Moto Butembo-Beni: Ebola allowed us to discover things that are not going well in our hospitals ... (Dr. MUNDAMA). The Google translation:

Heads of educational institutions must already consider affiliating their schools with health facilities for monitoring the health of learners. This is an interpellation of Dr. MUNDAMA WITENDE Jean Paul expressed last Friday during the sensitization session of education executives on the Ebola virus disease.  

This provincial health officer in Butembo regrets that school officials do not seem to care about the health of their learners. For him, health professionals will have to regularly examine learners. 

 "When a school has less than 600 students, it is necessary to have a contract with a hospital that must visit each child at least once a year. But I know that children will come out without having visited. However, during schooling, one must know the growth of the child, see if the child listens well, examine if the child sees well because a child can fail because he does not see, but neither the child's teacher, nor the parent know it. A medical visit must do it. But, we do not do it. And when a school has 600 students, it has permission to operate an infirmary," said Dr. Mundama. 

In addition, this health specialist lamented the absence of isolation rooms in most health facilities in the square. For Dr. MUNDAMA WITENDE Jean-Paul, the promoters of these structures must already think about the construction of such a framework.

"Something wrong is good. On the occasion of this disease, I discovered that our hospitals lack hygiene, cases are piled up like sardines on top of each other, first unfortunate finding. The second observation is that several pestilential diseases such as measles and pertussis have disappeared. So there is no isolation structure in our hospitals. So from this illness, we have to recreate isolation services because we can have a case, but we do not know how to isolate it," said this health worker. 

Dr. MUNDAMA WITENDE Jean-Paul also called on people to take health as their first concern.