News In this issue

News

First Polio National Immunization

Days organized in Guinea as the Ebola outbreak is under control

The Kingdom of Cambodia intro-duced IPV

WHO donates 162 refrigerators

to the NIP of Cambodia

Introduction of IPV in Vanuatu

A success story: Mustang, declared itself a fully immunized district

National review of the EPI and VPD surveillance in Sri Lanka

World’s first enterovirus 71 vac-

cine licensed in the PR China

Integrated Training for the Analysis of Vacc. and Deworming Coverage

Progress on MNTE as of Dec 2015

World Immunization Week 2016

Isolated gains in immunization need to become the norm

V3P update: reflecting on 2015

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Past meetings / workshops

EVM Assessment in Honduras

WS Effective Management of Im-ported MR cases in the Americas

31st Caribbean EPI Managers’ Mtg

Regional WS on poliovirus labora-tory containment

Stakeholders Consultation on

mHealth Initiative by VaxTrac in Nepal

Regional Polio Meeting: Next Steps for Certification and Containment

Benin LOGIVAC Center’s first short course on vaccine logistics

Briefing on WHO tools and guid-

ance related to immunization data quality and coverage surveys

International Expert Committee meets in Brazil to discuss Measles elimination in the Region of the

Americas

Workshop on training health workers for effective Hepatitis B

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Resources 18

Calendar 19

Links 20

Global Immunization News (GIN) December 2015

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You can click on the article you are

interested in and access it directly! Guinea introduces the Inactivated Polio Vaccine (IPV) Crépin Hilaire Dadjo, WHO, Inter-Country Support Team for West Africa

As the Ebola outbreak has so far been

contained in Guinea (the countdown to

zero cases started in mid-November

2015, and as of 11 December has been

successful), Inactivated Polio Vaccine

(IPV) was added to its routine immun-

ization schedule on 5 November 2015,

in a bid to accelerate polio eradication.

The launch ceremony for IPV was held

at Matoto, in the capital city of Cona-

kry, and chaired by the Minister of

Health in the presence, among other

dignitaries, of the Representative of

UNICEF and the Deputy Representative

of WHO to Guinea.

The vaccine is free of charge and is available in all facilities. The target population in 2015 is

452,076 children at three months and a half of age. Partners including WHO, UNICEF and

Gavi supported the introduction. IPV will be used together with OPV to boost the immunity

of children.

The last case of wild poliovirus was re-

ported in Guinea in 2011 and two circulat-

ing vaccine-derived polioviruses (cVDPVs)

were notified respectively in 2014 and in

2015. Because of the Ebola outbreak, no

response was conducted until September

and October 2015 where two rounds of

vaccination campaigns were organized in

four out of eight regions.

Many countries in West Africa have al-

ready introduced IPV. These include Be-

nin, Cote d’Ivoire, Gambia, Mauritania,

Niger, Nigeria and Senegal.

One of the first doses of IPV administered by a nurse.

Credit: I. Konaté_WHO_Guinea.

Mothers waiting for their children to be vaccinat-

ed. Credit: I. Konaté_WHO_Guinea

Page 2

Global Immunization News (GIN) December 2015

First Polio National Immunization Days organized in Guinea as the Ebola outbreak

is under control Crépin Hilaire Dadjo and Souleymane Kalilou, WHO Inter-Country Support Team for West Africa

On 8 December 2015 Guinea completed the first ever Polio Nation-

al Immunization Day (NID) held since the Ebola outbreak hit the

country in December 2013. The campaign was organized to respond

to the outbreak of two cases of circulating vaccine-derived po-

lioviruses (cVDPVs) detected in 2014 and 2015 in the Kankan region,

north-east of the country. Only two sub-National Immunization Days

were organized in four regions; the first in September and the sec-

ond in October 2015 in the regions of Faranah, Kankan, Labé and

Nzérékoré that surround Siguiri district where the cases were noti-

fied.

From 5-8 Decem-

ber 2015, the third

campaign reached

2,471,014 out of 2,523,431 targeted children aged zero to 59

months, according to administrative data available on 11 Decem-

ber 2015 (data still to be completed). Vitamin A and deworming

tablets were administered together with the polio vaccine.

Overall, some deficiencies in terms of quality were noted, however

with the support of partners including WHO, UNICEF, CDC,

BMGF, and HKI, corrective actions were conducted. An analysis of

lessons learned will inform the next polio NIDs , scheduled for

January 2016.

The Kingdom of Cambodia introduced IPV into its routine immunization

programme Sann Chan Soeung, National Immunization Programme, Samnang Chham and Md. Shafiqul Hossain, WHO Country

Office Cambodia, Dr Hasanuzzaman, WHO Consultant; and Aun Chum and Etienne Poirot, UNICEF

The Kingdom of Cambodia introduced the Inactivated Polio

Vaccine (IPV) into the national routine immunization pro-

gramme on 1 December 2015. To mark this day, the National

Immunization Programme organized a launch ceremony in

Kampong Speu province. Professor Eng Huot, Secretary of

State, Ministry of Health and Dr Dongil Ahn, WHO Repre-

sentative in Cambodia were present at the event as guests of

honour and delivered speeches. Also present at the ceremo-

ny were provincial heads of departments, Director of health

operational districts, and representatives from the communi-

ty .

IPV was rolled out across the country targeting eligible chil-

dren. “The introduction of IPV is a critical first step in the

eventual withdrawal of OPV. This introduction is for the

healthy future of our children and the global fight to eradicate

polio, where one day no child will ever be paralyzed by this

terrible disease again.” said Professor Eng Hout.

The first drop of vaccine given by the Minister of

Health of Guinea_Dr Rémy Lamah_ at Dubreka

in Kindia Region_Photo Credit CHDadjo_WHO

Vaccinators attending the official launch of the

NIDs at Dubreka_ Kindia Region_ Photo Credit

CHDadjo_WHO

Prof. Eng Hout, Secretary of State, Ministry of Health,

Cambodia delivering a speech at the launch ceremony.

Credit : WCO-Cambodia.

Global Immunization News (GIN) December 2015

Page 3

WHO donates 162 refrigerators to the National Immunization Programme of

Cambodia Sann Chan Soeung, National Immunization Programme, Md. Shafiqul

Hossain and Samnang Chham, WHO WPRO

World Health Organization has donated 162 refrigerators, 300 voltage

stabilizers, 2000 icepacks to the National Immunization Programme of

the Ministry of Health (MoH), Cambodia. In this regard, a handover

ceremony was held at the Central Medical Store in Phnom Penh on 23

November 2015 where Prof Eng Huot, Secretary of State, MoH re-

ceived the donated cold chain equipment from Dr Dongil Ahn, WHO

Representative in Cambodia. Dr Etienne, Chief of Health and Nutrition

was also present at this event.

Of the donated refrigerators, 102 units were distributed to provinces

and operational districts and 60 units were installed in the maternity

ward of referral hospitals for storing the Hep B birth dose and other

vaccines.

Introduction of Inactivated Polio Vaccine in Vanuatu Achyut Shrestha, Consultant, WHO Country Office, Vanuatu; Ridwan Gustiana, UNICEF

The Ministry of Health (MOH) Vanuatu committed to introducing the

Inactivated Polio Vaccine (IPV) in accordance with the Polio Endgame

Strategy 2013-2018.

Preparation and plans for the rollout have been ongoing since the end of

2014. With support and technical guidance from the primary implement-

ing partners UNICEF and WHO, Vanuatu proposed the introduction of

IPV to the Global Polio Eradication Initiative (GPEI). Access to sufficient

funds and vaccines through GPEI is crucial to supporting the successful

introduction of a new vaccine in the routine immunization programme

of a country like Vanuatu.

Vanuatu’s proposal to GPEI was accepted in early 2015, and soon after

implementation began. Plans, however, were interrupted in March when Vanuatu was struck by a Category 5 Tropical

Cyclone, Pam. The preparatory phase of IPV introduction was then postponed so that the MOH could focus attention

on the cyclone response.

Approximately 8,000 children are born every year in Vanuatu with the

total population spread out over 80 islands. The main urban locations of

Port Vila and Luganville have high numbers of children, however 75% of

Vanuatu’s population is based in rural areas. As a result, the organization

and effective planning required to contribute to a successful introduc-

tion of IPV was a major challenge for Vanuatu’s immunization team.

Introduction training for IPV was conducted in all of the provinces of

Vanuatu, involving nurses and midwives along with the EPI supervisors,

health managers and other representatives from the provincial health

offices. The training also included measles and rubella campaign micro

planning and a review of routine immunization.

With exemplary commitment from health staff throughout Vanuatu, strong leadership from the MOH, and technical

support from WHO and UNICEF, Vanuatu achieved the milestone of introducing IPV on 19 November 2015. IPV

supplies and communication materials such as information leaflets and posters on IPV have been distributed to all

provinces.

Prof Eng Hout, Secretary of State, Ministry of

Health, Cambodia receiving cold chain equip-

ment from the WHO Representative in Cam-

bodia. Photo: WCO-Cambodia.

Pamila Woetani- the first child to receive IPV

in Vanuatu

Pamila Woetani- the first child to receive IPV

in Vanuatu

Global Immunization News (GIN) December 2015

A success story of a District beyond the Himalayas: Mustang, declared itself a fully

immunized district Sudhan Gnawali, WHO Country Office Nepal

Resulting from strong local ownership, helping to ensure that 100% of chil-

dren under one year of age have received their complete immunization

schedule, the district of Mustang in the Himalayan region, has celebrated its

declaration as fully immunized. To boost the declaration and related sense of

accomplishment for all involved, the event is an important milestone that is

also a high prioritity for the government.

The event gathered a Member of

Parliament, the Regional Administra-

tor, the Regional Health Director,

the District Lawyer, the Repre-

sentative from the Ministry of Fed-

eral Affairs and Local Development, Representatives of WHO and UNICEF,

the Nepal Army and Police, Female Community Health Volunteers (FCHV)

and hundreds of local community members.

”It always seems impossible until it is done”, is a metaphor that has been set

in Mustang, the district that was declared Nepal’s twelveth to be fully im-

munized, despite the constraints of geography and access.

During the event to celebrate Mus-

tang’s achievement, the Member of Parliament marked the occason by lighting

16 lamps on 28 November, 2015 – each to represent one of the 16 Village

Development Committees (VDCs) in Nepal. At the end of the ceremony,

every stakeholder committed to the sustainability of full immunization ser-

vices. The event was witnessed by large crowds and was certainly a matter of

pride in the journey towards a healthy nation.

In Nepal, Mustang district is considered a Hard to Reach Area. In most of the

VDCs in upper Mustang, life becomes harder from December to February,

due to the extreme cold. The transportation of vaccines is not easy. To reach

children with immunization services and ensure that all children under one

year of age are immunized may seem an impossible task, but local level own-

ership and commitment has led to a favorable outcome.

The District Health Officer in Mustang cited that Mustang district is renowned for being ‘A district beyond the Hima-

layas’, where it is a two or three day walk from the district headquarters to deliver immunization services in the com-

munities. Despite this fact, the tireless health workers and their preservance have made the full immunization a suc-

cess story in Mustang.

Nepal is set to declare the entire country as fully immunized by 2017 and has moved ahead with clear vision of Clos-

ing the gap and Reaching every Child. The declaration in Mustang can be a model for other hard to reach areas.

Page 4

A member of parliament inaugurating the

event.

A member of parliament declaring Mus-

tang the nation’s 12th fully immunized

district.

A rally at the celebration in Mustang.

World’s first enterovirus 71 vaccine licensed in the People’s Republic of China Lance Rodewald and Zuo Shuyan, WHO China Country Office

The China Food and Drug Administration licensed the world’s first vaccine to pre-

vent enterovirus 71 (EV71) disease. EV71 vaccine was developed and is manufac-

tured by the Institute of Medical Biology, Chinese Academy of Medical Science, in

Kunming, Yunnan province.

EV71 virus, along with coxsackievirus A16 and other enteroviruses, causes Hand,

Foot, and Mouth disease (HFMD), a febrile rash illness of children that is often associ-

ated with painful mouth ulcers. HFMD caused by EV71 virus tends to be more se-

vere and is associated with neurological complications that have led to thousands of

death over the years. Most cases of HFMD occur among children under ten years old; severe complications and

death are most common among young children.

EV71 disease occurs worldwide, but most prominently in Asia, where it has emerged as a serious public health con-

cern in recent years due to escalating outbreaks.

The Institute of Medical Biology’s EV71 vaccine is an inactivated vaccine that will be administered by intramuscular

injection in two doses, separated by one month. The first dose can be given at six months of age, providing protec-

tion during the ages of vulnerability.

Vaccine efficacy was shown to be over 97% in a clinical trial in which over 6,500 children received EV71 vaccine and

an equal number received placebo. Vaccine side effects were mild, primarily fever and local reactions.

“There is no specific treatment for Hand, Foot and Mouth Disease caused by enterovirus 71, which is what makes the

development and licensing of this vaccine so important: by preventing children from getting this dangerous disease in

the first place, this new vaccine has the potential to greatly reduce suffering and death from EV71 disease in China –

and hopefully one day, the rest of the world,” said Dr Bernhard Schwartländer, WHO Representative China.

Global Immunization News (GIN) December 2015

Page 5

National / international review of the Expanded Programme on Immunization (EPI)

and vaccine preventable disease (VPD) surveillance in Sri Lanka 16-26 October 2015 Sigrun Roesel, WHO SEARO

A national / international review of the Expanded Programme on

Immunization (EPI) and vaccine preventable disease (VPD) surveil-

lance in Sri Lanka was conducted on 16-26 October 2015 to pro-

vide insight into the status of the programme, to enable programme

managers and public health policy officials and to share best practic-

es. Overall the review focused on national level support for the

prevention and control of vaccine preventable diseases, EPI and

VPD surveillance implementation and management, and future stra-

tegic directions in achieving global and regional goals. Specific objectives included strengthening of life course vaccina-

tion (MMR2 at 3 years, school immunization, eligible couples and pregnant women), routine immunization at the core

of health system strengthening, and experiences with new vaccine introduction. Eleven teams composed of national

and international participants visited 20 districts throughout the country, and a review of central level functions also

took place.

The overall conclusion was outstanding service delivery throughout the island, with many best practices to share with

other countries. The review found strong central level support across areas such as high level advocacy, staff capacity,

planning and decision-making for new vaccine introduction, vaccine advisory bodies, and AEFI surveillance and inves-

tigation. Excellent EPI implementation and management is also based on the capacity and commitment of front line

health care workers and the subsequent trust of communities.

Recommendations from the review highlighted the benefits of representation of primary care and immunization

stakeholders in health care planning, including in ensuring adequate funding and human resourcing to sustain primary

care and public health sectors. The review outcomes also helped to identify a way forward for strengthening and reg-

ularizing the oversight of vaccination in the private sector, enhancing the role of surveillance in guiding the EPI, and

capitalizing on economic growth to increase funding for new vaccines.

Group photo from the EPI review.

EV71 vaccine licensed in China.

Global Immunization News (GIN) December 2015

Integrated Training for the Analysis of Vaccination and Deworming Coverage Martha Velandia, Marcela Contreras, Hannah Kurtis, Ana Luciañez and Laura Catalá (PAHO/WHO) and Ana Morice

(International Consultant)

PAHO’s Immunization Unit and Neglected Diseases Unit have together developed a Toolkit for Monitoring the Cov-

erage of Integrated Public Health Interventions, with modules on topics such as the analysis of administrative cover-

age, rapid coverage monitoring and the evaluation of data quality, among others. The Toolkit aims to facilitate the

analysis and monitoring of vaccination and deworming coverage at all levels of national health systems, ultimately im-

proving the health of the population under 15 years of age.

Throughout 2015, four training workshops on the Toolkit were carried out, including three national workshops in

Mexico (120 participants), Honduras (70 participants) and El Salvador (30 participants), and a regional workshop in

Roatán, Honduras. In this latter workshop, in addition to the host country, there were participants from Colombia

(two), the Dominican Republic (two), Mexico (two), Nicaragua (one) and Paraguay (two). In addition to presentations

and group work, the workshops in El Salvador and Roatán also included field work during which participants conduct-

ed rapid coverage monitoring in schools and communities and data quality analysis; these experiences were particular-

ly well-received.

One benefit of the Toolkit is that its modular design permits training workshops to be adapted to specific national

objectives. In Honduras and Mexico, the workshops focused on strengthening participants’ knowledge of vaccination

data analysis, whereas the El Salvador and Roatán workshops counted on participants from both the Expanded Pro-

gramme on Immunization (EPI) and neglected disease programmes and therefore covered methodologies applicable to

both immunization and deworming coverage monitoring. Following each workshop, the training materials were vali-

dated and adjusted, based on participants’ feedback.

The integrated workshops provided a unique opportunity to facilitate communication and cooperation between pro-

grammes. Participants shared their experiences and committed to future integrated efforts that take advantage of

each other’s strengths and learning. Participants agreed that similar trainings now need to be extended to the local

level.

Page 6

Progress on Maternal and Neonatal Tetanus Elimination as of December 2015 Azhar Abid Raza and Flint Zulu, UNICEF New York and Ahmadu Yakubu, WHO Headquarters

In 2015, another three countries, Cambodia, India, and Mauritania, and 16 out of 17 regions of the Philippines were

successfully validated for Maternal and Neonatal Tetanus elimination (MNTE). Consequently, 38 out of 59 countries

have eliminated MNT since 1999. In addition, 30 out of 34 provinces in Indonesia and all of Ethiopia with the excep-

tion of Somali Region have also been validated for MNTE.

Despite the MNTE initiative missing the 2015 elimination target, most of the remaining 21 countries are advancing;

Ethiopia will be completing the validation exercise by December 2015 and Equatorial Guinea in February 2016; Ango-

la, DRC and Haiti are scheduled to conduct pre-validation assessments; and six countries will complete the implemen-

tation of Tetanus Toxoid Supplementary Immunization Activities (TT SIAs) in 2016.

A much broader strategy to augment MNTE through strengthening the maternal health platform is receiving greater

attention. Integration of TT vaccination within Antenatal care (ANC) services will boost MNTE and ensure sustaina-

bility. The SAGE working group for MNTE has been established by the World Health Organization, and tasked to

reshape the MNTE Initiative in line with the Sustainable Development Goals (SDGs). Guidelines on Sustaining MNTE

are being finalized and will be disseminated soon after WHO endorsement. Donors and partners have shown com-

mitments to bridge the existing financial gap of US$ 130 million to protect an estimated 71 million women of repro-

ductive age, using a mix of routine methods and innovative approaches like TT Uniject for reaching the hardest to

reach.

Despite the challenges, progress is surely being made through the active engagement of countries, support from part-

ners and other stakeholders and the commitment from donors who are very focused on eliminating this disease that

depicts gross inequities.

Global Immunization News (GIN) December 2015

Page 7

Event announcement: World Immunization Week 2016 Hayatee Hasan, WHO Headquarters

World Immunization Week 2016 to take place from 24-30 April 2016 aims to promote the use of vaccines to protect

people of all ages against disease. Immunization saves millions of lives and is widely recognized as one of the world’s

most successful and cost-effective health interventions.

This will be the second year of the Close the Immunization Gap campaign, which celebrates the enormous successes to

date in reaching children all over the world with life-saving vaccines while also stressing the challenges we still face.

The 2016 campaign additionally stresses the need for immunization among adolescents and adults - throughout life;

and seeks to draw the world’s attention to the critical importance of reaching vulnerable people living in conflict situ-

ations or in the wake of emergencies.

In addition, countries across WHO’s six Regions will begin the phased withdrawal of oral polio vaccines in April 2016,

by switching from trivalent OPV to bivalent OPV – a historic change that will accelerate polio eradication and help to

secure a polio-free world.

Read the World Immunization Week 2016 announcement, or access more information about the OPV switch here.

Isolated gains in immunization need to become the norm Hayatee Hasan, WHO Headquarters

A WHO commentary highlights the need for the isolated gains in

immunization achieved in several countries to become the norm

in all countries. While substantial progress has been made in vac-

cinating 90% of children with the first dose of diphtheria-tetanus-

pertussis (DTP) containing vaccine globally, many children do not

come back for their second and third doses. Drop-out will need

to be reduced if we are to achieve 90% coverage in 194 countries

by 2015. In 2014, only 129 out of 194 countries had reached this

target.

One way of reducing drop-out is ensuring health workers always

check vaccination cards when children are seen for well-child care

or sick visits. Exit interviews conducted at health facilities in Chad

and Malawi this year found 75% of children did not receive the vaccines for which they were eligible. Checking vac-

cination cards at every visit is an easy way of improving global vaccination coverage. We already have the child and his

or her caregiver’s attention, so let’s make sure children have all of their vaccinations before they leave the clinic.

Most unvaccinated infants in the world remain located in a few large under-performing countries. With better data at

national and especially at the subnational levels countries could assess pockets of under-immunization, identify exactly

where missed opportunities exist and target these populations with localized solutions.

Read the commentary by Dr Okwo-Bele, Director of the WHO Department of Immunization, Vaccines and Biologi-

cals.

A smiling toddler. Credit: WHO/AMRO

Page 8

Global Immunization News (GIN) December 2015

V3P update: reflecting on 2015 Tania Cernuschi and Stephanie Mariat, WHO Headquarters

The Vaccine Product Price and Procurement (V3P) project was created a few years ago to address coun-

tries’ request for greater transparency on vaccine prices.

In October 2014, SAGE recommended that all countries share their vaccine price information with V3P (see GVAP

Assessment report 2014, p.23). This year, countries took a step further and a resolution (WHA 68.6) on the GVAP

was adopted at the World Health Assembly. It specifically addresses the issue of access to sustainable supply of

affordable vaccines for low and middle income countries (MICs), including the promotion of vaccine price trans-

parency.

Several WHO regional offices, countries and partners are already making progress and have integrat-

ed price transparency and access to affordable and timely supply into their work, supporting presentations, fo-

rums, workshops and meetings on the subject – recognizing the benefits that price transparency can bring to sus-

tainable immunization programs in all countries, and particularly for MICs transitioning out of Gavi support and

MICs that are not Gavi-eligible.

Thanks to this collective effort, for the first time, the V3P database can show the following results:

40 countries have shared data in 2015, from five WHO regions. More than half of the countries are

MICs. The Regional Office for Europe has been particularly supportive of the project: 28 countries of the region

have shared prices. Similarly, efforts done in the African and the Western Pacific Regions have resulted in four

countries from each region sharing price information with V3P for the first time this year.

PAHO and UNICEF are continuous strong supporters of the project, contributing several years of price in-

formation.

The database contains 1,600 vaccine price records.

Pricing information has been shared by countries on 47 different vaccine types.

It is the first year that the data is published on the website (graphs and download options are available).

More than 3,900 users have accessed the website, from all over the world.

A few countries are already using V3P data to inform their decision-making and secure better procurement con-

tracts. The data collected also enables to better understand vaccine pricing. According to this year’s data, the

strongest factors influencing prices seem to be linked to procurement mechanism and income level. These rela-

tionships seem stronger for the new vaccine markets. Also, no strong correlation could be highlighted between

price and volume, except when products are procured in very large quantities (e.g. through UNICEF SD or PA-

HO).

Efforts by regions need to be maintained and strengthened to increase participation: having additional coun-

tries share prices will improve the usefulness of the data, the variety and quality of analyses and will

allow for more decisive conclusions. More information and findings from the V3P data can be found in the

GVAP Vaccine Price Report 2015, an integrated part of the GVAP Secretariat Report 2015 (p. 154-163).

Given all these encouraging facts and recognizing the great efforts and achievements in this area, SAGE, in its GVAP

Assessment Report 2015 (p. 12), placed access to vaccine pricing data in the category “successes that can be the

norm”.

Within one year, efforts in vaccine price transparency and participation in V3P have grown from being a recom-

mendation to being recognized as a success. We therefore want to

thank all participating countries, as well as colleagues from WHO,

PAHO, UNICEF and other partners for the amazing progress done

this year.

Next year, we will continue to invite countries to participate in this

effort, in particular through the Joint WHO/UNICEF Reporting

Form (JRF) process.

Together, we can indeed turn this success into a norm. The V3P platform is accessible at: www.who.int/immunization/v3p.

For more information: v3p-project@who.int

Page 9

Global Immunization News (GIN) December 2015

Past Meetings/Workshops EVM Assessment in Honduras

Nora Lucia Rodriguez, PAHO, Washington DC

Location: Honduras

Date: 27 August – 11 September 2015

Participants: National health workers from the Ministry of

Health-Honduras and international evaluators

from Ministry of Health of Nicaragua, Paraguay

and from the Pan American Health Organization

(PAHO) participated in the Effective Vaccine Man-

agement (EVM) assessment.

Purpose: To analyze Honduras’s cold chain, vaccine supply

chain and vaccine management operations.

National and international assessment team, Honduras, Aug-2015. Photo: Nora Rodriguez.

Details: During the evaluation, 42 randomly-selected storage and health facilities were visited and their rec-

ords were assessed from 1 January 31 December 2014. The 42 sites included 7 of the 20 Health Sani-

tary Regions at the sub-national level, 16 vaccine stores from the lower distribution level and 18 ser-

vice delivery points; furthermore, the evaluation included the National Vaccine Store (ANB). A total of seven teams were responsible for data collection. Each team included one international

assessor and two to three national health workers. Before initiating the evaluation, a review of the

EVM tools and methodology was carried out in order to standardize the knowledge and the manage-

ment of 1) the EVM tool and 2) the structured questionnaires. In its first EVM assessment, Honduras obtained an overall average score of 97%, a very significant

achievement considering that 80% is the minimum score established by EVM. This included the score

reached for the 4 levels of the supply chain that is in place in the country and the 9 evaluated EVM

criteria. With 97% as the average score achieved at the time of the assessment, Honduras is ranked

first among the top 104 EVM assessments performed worldwide since 2009. The primary level scored

98%, the sub-national level scored 96%, the lowest distribution level scored 97% and the service de-

livery level scored 98%.

Page 10

Global Immunization News (GIN) December 2015

Workshop for the Effective Management of Imported Measles and Rubella Cases

in the Americas

Desiree Pastor, Gloria Rey Benito, PAHO, Washington DC

Location: Bogota, Colombia

Date: 29-30 October 2015

Participants: 122 Ministry of Health officials from the national

and subnational levels. Officials from the im-

munization and epidemiological surveillance

programmes of the 32 departments and four

districts of the country. PAHO, the Colombian

Ministry of Health and Colombia’s National

Institute of Health conducted the workshop.

Purpose: To strengthen the national capacity for measles,

rubella and Congenital Rubella Syndrome (CRS)

surveillance in Colombia, to effectively respond to

imported measles or rubella cases. This was a joint

effort by the immunization and epidemiological

surveillance programmes and Colombia’s Public

Health Laboratory Network.

Participants at the Workshop for the Effective

Management of Imported Measles and Rubella Cases in Bogota, Colombia, held on 29-30 Octo-ber 2015. Photo credit: Desiree Pastor, PAHO-

Washington, DC.

Details: The workshop also included the participation of health officials from the National Police and

from other public entities that enforce the monitoring of diseases that must be declared, such

as measles, rubella and CRS. Between 2011 and 2015, measles cases imported from other regions of the world have drasti-

cally increased, directly causing 4,357 imported cases during this period. In the Americas, the

most affected countries during that period were Brazil, Canada, Ecuador and the United

States. During the two-day workshop, knowledge of the global and regional measles, rubella, and CRS

situation was shared to highlight the importance of good vaccination coverage and the strict

surveillance of suspected cases to prevent spreading of the virus by those imported cases origi-

nating from other regions of the world. Finally, 122 officials were trained to effectively manage imported measles cases through lec-

tures, group work with case studies from the Region and simulation exercises for the manage-

ment of these outbreaks.

Global Immunization News (GIN) December 2015

Page 11

31st Caribbean EPI Managers’ Meeting

Karen Lewis-Bell, PAHO-Jamaica; Hannah Kurtis, Cara Janusz-PAHO-Washington, DC

Location: Guyana Marriott Georgetown Hotel,

Georgetown, Guyana

Date: 17-19 November 2015

Participants: 73 participants including National EPI Man-

agers from 24 countries of the English,

Dutch and French Speaking Caribbean and

partners/ advisors from CARICOM, the

Caribbean Public Health Agency and PAHO.

Purpose: To analyze achievements in immunization in

the Caribbean for 2015 and plan activities for

2016 while sharing country experiences on

their immunization programme. Specific focus

was placed on the Regional Immunization Ac-

tion Plan (RIAP) to guide achievements of the

Global Vaccine Action Plan, maintaining Mea-

sles, Rubella, and Congenital rubella syndrome

(CRS) elimination in the Region as well as the

requirements for the Polio Eradication and

Endgame Strategic Plan including introduction

of Inactivated Polio Vaccine (IPV) in the rou-

tine immunization schedule of each country,

polio containment and the switch from triva-

lent OPV (tOPV) to bivalent OPV (bOPV).

Participants of the 31st Caribbean EPI Managers’ Meeting 17-19 November 2015, Georgetown, Guyana.

Details: The meeting was officially opened by the Honorable Dr George Norton, Minister of Public

Health, Guyana who welcomed all participants to Guyana and lauded the dedication of health

care workers in the field of immunization. Their work, under sometimes challenging condi-

tions, has helped to ensure that the Caribbean and indeed the Americas sustain the elimination

and control of vaccine preventable diseases through consistent high vaccination coverage and

quality surveillance. The format of the meeting involved technical updates on various disease topics and program-

matic areas in immunization by PAHO/WHO advisors and other technical experts, as well as

the sharing of country experiences in disease surveillance, surveys/campaigns conducted during

the year, vaccine introduction, investigations related to adverse events, cold chain manage-

ment, etc. The EPI managers were divided into groups to facilitate discussions on their overall

achievements with their Plans of Action for 2015 and to finalize their plans for 2016 with input

from their peers. Countries were urged to align their EPI strategies and targets to the RIAP, ensure high, sus-

tained and homogenous coverage above 95% for all antigens to protect against the risk of im-

portations, and to be alert for the Zika virus through strengthened fever and rash surveillance.

Page 12

Global Immunization News (GIN) December 2015

Regional workshop on poliovirus laboratory containment

Sigrun Roesel, WHO SEARO

Location: Bangkok, Thailand

Date: 23-24 November 2015

Participants: National poliovirus laboratory containment

coordinators from 9 countries and other na-

tional key stake holders in poliovirus laboratory

containment, WHO HQ, EMRO, SEARO and

WPRO.

Purpose: The workshop objectives were: to update na-

tional poliovirus laboratory containment coor-

dinators and key stake holders on GAPIII, phase

1 and 2 requirements and expected timelines;

to provide clarifications on roles and responsi-

bilities of individual stakeholders (national con-

tainment coordinators, laboratory and vaccine

production facilities, national regulatory author-

ities, WHO); and to prepare for the updates of

national action plans.

Participants from the Regional Workshop on poliovirus labora-

tory containment

Details: Following the May 2015 WHA resolution on full implementation of the Polio Eradication and End-

game Strategic Plan 2013-2018, and with it, the third Global Action Plan to minimize poliovirus facili-

ty-associated risk (GAPIII), countries in the WHO South East Asia Region prepared to survey bio-

medical facilities to identify infectious or potentially infectious poliovirus 2 materials and update na-

tional inventories of facilities that handle and/or store such poliovirus materials. To support the implementation of appropriate containment of type 2 wild polioviruses in essential

facilities by the end of 2015 and of type 2 Sabin poliovirus within three months of global withdrawal

of the type 2 component in oral poliovirus vaccine in April 2016, this Regional workshop was con-

ducted to provide a forum for discussion, situation review and technical support. National poliovirus laboratory containment coordinators and key stakeholders from nine countries

came together to be updated on GAPIII and expected timelines. Clarifications were provided on

roles and responsibilities to ensure appropriate poliovirus containment, and next steps were agreed

upon for updating and implementing national action plans. Requirements for poliovirus essential facil-

ities and establishing national authorities for containment were reviewed, with a realization that

timely implementation of laboratory containment activities pose a major challenge.

Global Immunization News (GIN) December 2015

Page 13

Stakeholders Consultation on mHealth Initiative by VaxTrac in Nepal

Subecha Dahal, VaxTrac

Location: Kathmandu, Nepal

Date: 24-28 November 2015

Participants: 66 participants representing various stake-

holders in Nepal including WHO, UNICEF,

Ministry of Health and Population, Depart-

ment of Health Services, Child Health Divi-

sion, Health Management Information Sys-

tem.

Purpose: Five different focus group discussions were

conducted with national stakeholders to objec-

tively assess and consolidate feedback on a

mHealth intervention for vaccination manage-

ment by VaxTrac in Nepal. VaxTrac is an elec-

tronic mobile vaccine registry system that can

be used by frontline health workers in health

clinics while administering vaccinations to chil-

dren. The Vial-to-Child project, in partnership

with UNICEF, WHO and VaxTrac, chose two

districts, Dadeldhura and Nawalparasi for pilot

programme implementation in Nepal. VaxTrac

has been working in Benin, West Africa since

2012.

Glimpse from one of the focus group discussions for consultation with ICT experts in Nepal.

Details: Extensive consultations with stakeholders gave valuable insight into the VaxTrac system and

eHealth initiatives in general for vaccination management in Nepal. The stakeholders concurred

that the mHealth initiative by VaxTrac has the potential to improve the overall vaccination pro-

cess in Nepal. These meetings were also an opportunity for all parties to better understand na-

tional priorities for designing a system that is most relevant to the needs of Nepal. For example,

the stakeholders identified vaccine wastage as a priority issue. The system can be designed to

generate data that can help ministry officials understand the primary causes of vaccine wastage

and use that information to prevent future wastage from occurring. The key lesson learned from these meetings was the importance of collaboration and buy-in

from stakeholders involved in the value chain of the national vaccine delivery system. Another

success was starting the national conversation about eHealth and mHealth projects, leading to

the drafting of a comprehensive policy on eHealth in Nepal. The inputs from the stakeholders’ consultation will be used to inform the next phase of the

project’s implementation in Nawalparasi district in Nepal.

Page 14

Global Immunization News (GIN) December 2015

Regional Polio Meeting: Next Steps for Certification and Containment

Cristina Pedreira, Gloria Rey Benito and Elizabeth Thrush, PAHO-Washington, DC

Location: Brasilia, Brazil

Date: 30 November – 1 December 2015

Participants: A total of 72 people from 24 countries in

the Region including 20 National Certifica-

tion Committees (NCCs), 24 National Po-

liovirus Containment Coordinators

(NPCCs), four members of the Regional

Certification Commission (RCC) on the

Polio Endgame; Representatives from PA-

HO, WHO, CDC, and the Ministry of

Health, Brazil.

Purpose: To update NCCs on their roles and responsi-

bilities for the polio eradication endgame and

to update NPCCs on their roles and responsi-

bilities with the Regional Plan for Containment

of Poliovirus in the Americas, and present the

model for the Phase 1 Containment Report.

Participants at the Regional Polio Meeting held on 30 November- 1 December in Brasilia, Brazil. Credit: Liz Thrush

Details: Joaquin Molina, PAHO Representative in Brazil, and José Agenor Alvares da Silva, Vice Minister

of Health of Brazil, welcomed the participants to the meeting, and Arlene King, RCC Chair and

Cristina Pedreira, Immunization Advisor, PAHO, reviewed the objectives of the meeting and

expected outcomes. The two main topics for this meeting were (1) the role and expectations of the RCC and NCCs

and (2) the Regional Poliovirus Containment Plan, including the software application for the

GAP III laboratory survey and the model for the Phase 1 Containment Report. Additional topics were covered at this meeting to give the NCCs and the NPCCs a broad over-

view of the current progress and the next steps for the polio eradication endgame plan. These topics included the Global polio eradication progress; the Regional update on the imple-

mentation of the polio eradication endgame plan; the Guidelines for monitoring the switch from

tOPV to bOPV; the protocol for notification, risk assessment, and response following detection

of type 2 poliovirus after the switch; the Regional dashboards to follow national and regional

progress on the switch and the polio endgame.

Available documents and resources on the PAHO polio webpage.

Some of the main recommendations of the meeting were: Strengthening AFP surveillance is essential in preparing for the switch due to the risk of the

emergence of cVDPV2 in the post-switch period. Countries should update their protocols to detect and respond to polio outbreaks during

the final phase of the polio eradication endgame. In preparation for the switch, countries should analyze vaccination coverage and intensify

immunization activities within areas with low tOPV coverage. Countries should intensify preparation efforts for the switch from tOPV to bOPV to ensure

a safe switch and comply with the established timelines. NCCs should submit the revision and validation of the wild poliovirus containment report to

the Ministry of Health in January 2016 (report should be prepared by the national poliovirus

containment coordinator).

Global Immunization News (GIN) December 2015

Page 15

Benin LOGIVAC Center organizes first short course on vaccine logistics

Eustache Agboton and Alice Henry-Tessier, Agence de Médecine Préventive (AMP)

Location: Ouidah Regional Institute of Public Health

(IRSP), Benin

Date: 30 November – 18 December 2015

Participants: 73 participants including National EPI Man-

agers from 24 countries of the English,

Dutch and French Speaking Caribbean and

partners/ advisors from CARICOM, the

Caribbean Public Health Agency and PAHO.

Purpose: To ensure optimal management of the vaccine

supply chain, using the practices currently rec-

ommended by the health authorities and tech-

nical and financial partners.

Students of the first Vaccines Logistics training.

Details: This inaugural course, delivered by a pool of trainers from the Benin LOGIVAC Center, was

directed at health personnel responsible for managing the logistics of the immunization pro-

gramme at various levels of the health pyramid: operational logistics officers from health zones;

logistics officers at central level; chief medical officers from health zones; and officials in charge

of supervising logistics personnel. The training session equipped learners with the skills needed to design and implement a logistics

system; to ensure vaccine availability; and to safeguard the continuity of the cold chain. The

course, which consisted of lectures, group work and practical field work, also aimed to show

participants how to administer the IT system for vaccine logistics and ensure vaccine safety, as

well as carry out waste management and provide staff supervision. This first session of the short training course will finish on December 18 with the presentation

of certificates to students who successfully complete the programme.

Page 16

Global Immunization News (GIN) December 2015

Briefing on WHO tools and guidance related to immunization data quality and

coverage surveys

Carolina Danovaro, Marta Gacic-Dobo and Jan Grevendonk, WHO HQ

Location: Istanbul, Turkey

Date: 1-4 December, 2015

Participants: Sixty-eight participants from Ministries of Health,

Statistics Offices and national institutes from five re-

gions of the World Health Organization (WHO);

Agence de Medicine Préventive (AMP); the Bill &

Melinda Gates Foundation (BMGF); the US Centers

for Diseases Control and Prevention (CDC); the

Demographic and Health Survey (DHS) Programme;

Epicentre; John Snow Inc. (JSI); PATH; UNICEF, and

WHO. A representative from Gavi, the Vaccine Alli-

ance joined by phone.

Purpose: To present the new tools developed by WHO on

immunization data quality and the new vaccina-

tion coverage survey manual. To train participants, including potential consultants

or academic or similar organizations to provide

technical assistance, on one of the following

tracks: 1) immunization data quality, and; 2)

vaccination coverage survey planning and imple-

mentation.

Participants at the briefing on WHO tools and guidance related to immunization data quality and coverage sur-veys

Details: The importance of using high quality data both to improve immunization programme performance

and to monitor the results has been highlighted in recent years, for example following the roll-out

and annual assessment of the Global Vaccine Action Plan (GVAP). Also, Gavi, the Vaccine Alliance,

now requires countries applying for all types of Gavi support to conduct: 1) an annual desk review;

2) periodic in-depth assessments of routine administrative vaccination coverage data; and, 3) peri-

odic nationally representative vaccination coverage surveys. Given this background, over the next few years, it is expected that there will be an increased need

for guidance and technical assistance to assess the quality of country immunization data and pro-

duce actionable data improvement plans, as well as to implement vaccination coverage surveys using

the revised WHO vaccination coverage survey methodology. This briefing was the first of such

activities aimed at sharing the new materials and tools, seeking expert advice to complete those

materials related to data quality, sharing best practices among participants and thinking critically

about the design of a vaccination coverage survey in a given country, from survey protocol design,

to implementation and interpretation of results.

The current working draft of the survey methodology can be found here. The methodology for

annual desk reviews and periodic in-depth assessment of the data quality will be finalized based on

the feedback received from this briefing and published early 2016.

Global Immunization News (GIN) December 2015

Page 17

International Expert Committee meets in Brazil to discuss Measles elimination in

the Region of the Americas

Pamela Bravo, Desiree Pasto and Gloria Rey, PAHO, Washington DC

Location: Brasilia, Brazil

Date: 2 December 2015

Participants: Members of the International Expert Committee for

Measles and Rubella Elimination in the Americas

(IEC), authorities from Brazil’s Ministry of Health,

health authorities from the states of Ceara and Per-

nambuco, as well as immunization advisors from the

Pan American Health Organization (PAHO).

Purpose: 1. To review the evidence that verifies the interrup-

tion of endemic measles virus circulation in Brazil. 2. To discuss the evidence outlined in the country

elimination report (period of 2012-2015), which pro-

vides an update of the main documentation and veri-

fication components. 3. To discuss the challenges and commitments neces-

sary to sustain measles and rubella elimination in Bra-

zil.

IEC Members and participants at the IEC Meeting in Bra-

silia, Brazil. Photo credit: Samia Abdul Samad.

Details: During the meeting, health authorities from the state of Ceará presented on the epidemiological situa-

tion of the measles outbreak that lasted for 20 months during the time period of 2013-2015. They also

presented compelling evidence indicating that the outbreak had finally been interrupted, meeting PA-

HO’s verification criteria (laboratory, surveillance and vaccination components). The International Expert Committee (IEC) was satisfied with the evidence provided and agreed with the

federal and state health authorities that the measles outbreak had finally being interrupted. Nevertheless, it is important that Brazil sustain these efforts and that there are no new cases of endem-

ic measles for a period of one year following the last endemic measles case, confirmed on 6 July 2015. To this end, the IEC remains confident that Brazil will succeed and that after the one-year period, PA-

HO will be able to declare the Americas as free of measles during next year’s Directing Council

(September 2016).

Resources

Page 18

Global Immunization News (GIN) December 2015

Workshop on training health workers for effective Hepatitis B birth dose

introduction, Dakar, Senegal, 7-11 December 2015

Ousseynou Badiane, Ministry of Health Senegal, Aliou Dialo, WHO Country Ofice Senegal, Dorothy Leab, Training

Expert, Vietnam

Location: Dakar, Senegal

Date: 7-11 December 2015

Participants: Ministry of Health Senegal, WHO, USAID representatives.

Purpose: To prepare for introducing hepatitis B birth dose (HepB-BD) into the national immunization schedule

by developing communication materials, revising monitoring and reporting tools, and designing a train-

ing programme for the introduction.

Details: In January 2016, Senegal plans to add HepB-BD vaccine to the national schedule. The country plans to

train over 2000 health workers from both EPI and MNCH (medical doctors, midwifes, and nurs-

es). This workshop convened 20 national EPI and MNCH staff, and immunization and training experts (WHO

and USAID). The workshop proposed the following training programme.

Learning content: The training programme includes eight modules: 1. HBV infection and importance of HepB-BD

2. HepB vaccine attributes and storage conditions

3. HepB-BD eligibility

4. HepB-BD immunization strategy

5. Administering HepB-BD within 24h

6. Immunization data management

7. AEFI notification and case management

8. Communicating about HepB-BD to community and health workers

Training materials: A training package composed of a training guide, a slideshow, a case study, a pre

and post-test, a simplified job-aid, and an aide-memoire.

Cascade training: A training-of-trainers approach was used to enable knowledge to be passed to all

levels of the health system. This will also establish a pool of trainers at regional (14 regions) and dis-

trict levels (76 districts) before the introduction. District trainers will then train health workers in

the 1300 health stations. In addition to cascade training, supportive supervision will be provided to

support health staff.

Publication of the SAGE October 2015 meeting report

The report from the October 2015 meeting of the Strategic Advisory Group of

Experts (SAGE) on immunization has been published in today’s edition of the

WHO Weekly Epidemiological Record outlining the conclusions and recommen-

dations, including the use of Ebola vaccines and vaccination, measles and rubella

vaccine, RTS,S/AS01 malaria vaccine, polio eradication and the assessment of

Global Vaccine Action Plan progress and recommendations.

Read the SAGE October 2015 meeting report.

Report of the Immunization and Vaccines related Implementation Research (IVIR),

Advisory Committee Meeting, Geneva, 9-11 June 2015 (WHO/IVB/15.09)

The Immunization and Vaccines related Implementation Research (IVIR) Advisory Committee (AC) meeting report

summarizes the deliberations of the Committee on matters related to implementation research and their relevance

to immunization policies and practices during the face-to-face meeting June 9 - 11 June 2015.

The document highlight issues on hepatitis impact evaluation, malaria vaccine impact and cost-effectiveness, a mea-

sles investment case, burden of yellow fever estimation across Africa, varicella and zoster vaccination modelling and

cost-effectiveness in low and middle income countries and the WHO implementation research priority setting

framework.

Participants at the October 2015

SAGE meeting held in Geneva.

Credit: WHO/H. Hasan.

Calendar

Global Immunization News (GIN) December 2015

Page 19

2016

January

19-20 WPRO Gavi Regional Working Group meeting Manila, Philippines

25-30 Executive Board Geneva, Switzerland

29-2Mar Institut Pasteur Vaccinology course Paris, France

February

24-25 AFRO ministerial conference on immunization Addis Ababa, Ethiopia

29-25Mar Institut Pasteur Vaccinology Course Paris, France

March

14-16 PAHO Regional Workshop on Evidence-Based Decision-Making (ProVac)

and Data Quality

TBD

15-17 Global Vaccine and Immunization Research Forum (GVIRF) Johannesburg, South Africa

April

12-14 Meeting of the Strategic Advisory Group of Experts (SAGE) on Immuniza-

tion

Geneva, Switzerland

May

23-28 Sixty-ninth World Health Assembly Geneva, Switzerland

June

6-10 SEARO Immunization Technical Advisory Group (ITAG) New Delhi, India

13-17 WPRO Technical Advisory Group TBD

22-23 Gavi Board Meeting TBD

July

4-8 AMRO Technical Advisory Group TBD

September

5-9 Regional Committee for SEARO Colombo, Sri Lanka

12-15 Regional Committee for EURO Copenhagen, Denmark

26-30 Regional Committee for AMRO Washington DC, USA

October

3-6 Regional Committee for EMRO Cairo, Egypt

10-14 Regional Committee for WPRO Manila, Philippines

18-20 Meeting of the Strategic Advisory Group of Experts (SAGE) on Immuniza-

tion

Geneva, Switzerland

December

7-8 Gavi Board Meeting TBD

Page 20

WHO Regional Websites Routine Immunization and New Vaccines (AFRO)

Immunization (PAHO)

Vaccine-preventable diseases and immunization (EMRO)

Vaccines and immunization (EURO)

Immunization (SEARO)

Immunization (WPRO)

Newsletters Immunization Monthly update in the African Region (AFRO) Immunization Newsletter (PAHO) The Civil Society Dose (GAVI CSO Constituency) TechNet Digest RotaFlash (PATH) Gavi Programme Bulletin (Gavi)

Organizations and Initiatives American Red Cross Child Survival Agence de Médecine Préventive Africhol EpiVacPlus LOGIVAC Project National Immunization Technical Advisory Groups Resource Center SIVAC Centers for Disease Control and Prevention Polio Global Vaccines and Immunization Johns Hopkins International Vaccine Access Center Vaccine Information Management System JSI Africa Routine Immunization Systems Essentials Project IMMUNIZATIONbasics Immunization Center Maternal and Child Health Integrated Program (MCHIP) PAHO ProVac Initiative PATH Vaccine Resource Library Rotavirus Vaccine Access and Delivery Malaria Vaccine Initiative Meningitis Vaccine Project RHO Cervical Cancer

Sabin Vaccine Institute Sustainable Immunization Financing UNICEF Immunization Supplies and Logistics USAID Maternal and Child Health Integrated Program WHO Department of Immunization, Vaccines & Biologicals New and Under-utilized Vaccines Implementation ICO Information Centre on HPV and Cancer Immunization financing Immunization service delivery Immunization surveillance, assessment and monitoring SIGN Alliance Other Coalition Against Typhoid Dengue Vaccine Initiative European Vaccine Initiative Gardasil Access Program Gavi the Vaccine Alliance International Association of Public Health Logisticians International Vaccine Institute Measles & Rubella Initiative Multinational Influenza Seasonal Mortality Study Network for Education and Support in Immunisation (NESI) TechNet-21 Vaccines Today

UNICEF Regional Websites Immunization (Central and Eastern Europe)

Immunization (Eastern and Southern Africa)

Immunization (South Asia)

Immunization (West and Central Africa)

Child survival (Middle East and Northern Africa)

Health and nutrition (East Asia and Pacific)

Health and nutrition (Americas)

Links

Global Immunization News (GIN) December 2015