Vaccines as a powerful weapon against infectious diseases

This is a shared post from the National Institute Of Health:

Vaccines are one of biomedicine’s most powerful and successful tools for protecting against infectious diseases. While we currently have safe and effective vaccines to prevent measles, mumps, and a great many other common childhood diseases, we still lack a vaccine to guard against respiratory syncytial virus (RSV)—a leading cause of pneumonia among infants and young children. Keep reading: http://directorsblog.nih.gov/2015/11/17/protecting-kids-developing-a-vaccine-for-respiratory-syncytial-virus/

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Global vaccination targets ‘off track’ warns WHO

Culled this beautiful piece from the WHO site. Enjoy!

22 APRIL 2015 | GENEVA – Progress towards global vaccination targets for 2015 is far off-track with 1 in 5 children still missing out on routine life-saving immunizations that could avert 1.5 million deaths each year from preventable diseases. In the lead-up to World Immunization Week 2015 (24–30 April), WHO is calling for renewed efforts to get progress back on course. 

In 2013 nearly 22 million infants missed out on the required three doses of diphtheria-tetanus-pertussis-containing vaccines (DTP3), many of them living in the world’s poorest countries. WHO is calling for an end to the unnecessary disability and death caused by failure to vaccinate.

“World Immunization Week creates a focused global platform to reinvigorate our collective efforts to ensure vaccination for every child, whoever they are and wherever they live,” said Dr Flavia Bustreo, WHO Assistant Director-General, Family, Women’s and Children’s Health. “It is critical that the global community now makes a collective and cohesive effort to put progress towards our 6 targets back on track.”

In 2012, all 194 WHO Member States at the World Health Assembly endorsed the Global Vaccine Action Plan (GVAP), a commitment to ensure that no one misses out on vital immunization. However, a recent independent assessment report on GVAP progress rings an alarm bell, warning that vaccines are not being delivered equitably or reliably and that only 1 of the 6 key vaccination targets for 2015 is currently on track – the introduction of under-utilized vaccines.

Many countries worldwide have experienced large measles outbreaks in the past year, threatening efforts to achieve the GVAP target of eliminating measles in 3 WHO Regions by end-2015. 

Actions to get back on track

A global collaborative drive for immunization, begun in the mid-1970s — with the establishment of the Expanded Programme on Immunization in all countries — achieved dramatic results, raising vaccination levels from as low as 5% to more than 80% in many countries by 2013. WHO estimates that today immunizations prevent between 2 and 3 million deaths annually and protect many more people from illness and disability.

Although progress has stalled in recent years, this early success demonstrates the potential of vaccines, which are increasingly being extended from children to adolescents and adults, providing protection against diseases such as influenza, meningitis and cervical and liver cancers. 

The GVAP recommends three key steps for closing the immunization gap: 

  • integrating immunization with other health services, such as postnatal care for mothers and babies;
  • strengthening health systems so that vaccines continue to be given even in times of crisis; and
  • ensuring that everyone can access vaccines and afford to pay for them.

Dr Jean-Marie Okwo-Belé, Director of Immunization, Vaccines and Biologicals at WHO, says the Organization will work to increase its support to all countries that are lagging behind in meeting immunization targets. In May this year, WHO will bring together high-level representatives of 34 countries with routine vaccination (three doses of DTP3) coverage of less than 80% to discuss the challenges faced by countries and to explore solutions to overcome them.

Although many countries are already vaccinating four out of five children with DTP3, a full one-third of countries are still struggling to reach the ‘fifth child’, meaning millions of children remain at risk of illness, disability or death because they are not getting the immunizations they need.

“There is no one centralized approach that can ensure vaccines are delivered and administered to each child. Vaccination plans on the ground need to be adapted not just to countries, but to districts and communities,” said Dr Okwo-Belé.“What is required is a truly concerted effort and much stronger accountability so that each one of the key players involved fulfills its mandate and helps close the immunization gap.” 

Critical operational needs to ensure wider vaccination and delivery on the ground, include:

  • finding ways to simplify vaccination procedures in the field;
  • improving vaccination delivery to reach every last child, especially those living in remote and inaccessible areas;
  • ensuring vaccine affordability and strengthening vaccine supply chains;
  • training more health workers, skilled managers and providing supportive supervision;
  • improving the quality of data collected by countries and using this to improve immunization operations;
  • overcoming challenges posed by conflict, natural disasters and other crises;
  • increasing awareness and demand for immunization by communities; and
  • greater accountability linked to micro-planning of vaccination operations and clear lines of responsibility.

Earlier this year, donor countries and institutions pledged to meet the funding needs of Gavi, the Vaccine Alliance that brings together public and private sectors to create equal access to new and underused vaccines for children living in the world’s poorest countries.

Note to editors

The Global Vaccine Action Plan envisions a world where everyone lives life free from vaccine preventable diseases by 2020. It set 6 targets for 2015:

Immunization against diphtheria, tetanus and whooping cough (DTP3)
Target: 90% immunization coverage against diphtheria, tetanus and whooping cough by 2015.
Gap: 65 countries

Introduction of under-utilized vaccines
Target: At least 90 low or middle income countries to have introduced one or more under-utilized vaccines by 2015.
ON TRACK

Polio eradication 
Target: No new cases after 2014
Gap: 3 countries remain polio endemic

Maternal and neonatal tetanus: Global elimination by end-2015
Target: Eliminate maternal and neonatal tetanus
Gap: 24 countries

Measles elimination
Target: Eliminate from three WHO regions by end-2015
Gap: 16% of all children are not being immunized against measles

Rubella elimination 
Target: Eliminate rubella from two WHO regions by end-2015
Gap: Half of all children do not receive the rubella vaccine


Media contact: 

Christian Lindmeier
Communications Officer
Mobile: +41 79 500 65 52
Telephone: +41 22 791 19 48
E-mail: lindmeierch@who.int

Hayatee Hasan
Technical Officer
Mobile: +41 79 500 65 32
Telephone: +41 22 791 21 03
E-mail: hasanh@who.int

Final trial results of the world’s most advanced malaria vaccine | London School of Hygiene & Tropical Medicine | LSHTM

Final trial results of the world’s most advanced malaria vaccine | London School of Hygiene & Tropical Medicine | LSHTM.

Final trial results of the world’s most advanced malaria vaccine

Friday, 24 April 2015

Anopheles gambiae mosquitoThe first malaria vaccine candidate (RTS,S/AS01) to reach phase 3 clinical testing is partially effective against clinical disease in young African children up to 4 years after vaccination, according to final trial data, published in The Lancet. The results suggest that the vaccine could prevent a substantial number of cases of clinical malaria, especially in areas of high transmission.

The findings reveal that vaccine efficacy against clinical and severe malaria was better in children than in young infants, but waned over time in both groups. However, protection was prolonged by a booster dose, increasing the average number of cases prevented in both children and young infants.

Study author Brian Greenwood, Professor of Clinical Tropical Medicine at London School of Hygiene & Tropical Medicin, said: “Despite the falling efficacy over time, there is still a clear benefit from RTS,S/AS01. An average 1,363 cases of clinical malaria were prevented over 4 years of follow-up for every 1000 children vaccinated, and 1,774 cases in those who also received a booster shot. Over 3 years of follow-up, an average 558 cases were averted for every 1,000 infants vaccinated, and 983 cases in those also given a booster dose.”

“Given that there were an estimated 198 million malaria cases in 2013, this level of efficacy potentially translates into millions of cases of malaria in children being prevented.”

The RTS,S/AS01 vaccine was developed for use in sub-Saharan Africa where malaria still kills around 1,300 children every day. There is currently no licensed vaccine against malaria anywhere in the world.

The phase 3 randomised trial enrolled 15,459 young infants (aged 6 to 12 weeks at first vaccination) and children (5 to 17 months at first vaccination) from 11 sites across seven sub-Saharan African countries (Burkina Faso, Gabon, Ghana, Kenya, Malawi, Mozambique and United Republic of Tanzania) with varying levels of malaria transmission. In 2014, initial phase 3 results at 18 months showed vaccine efficacy of about 46% against clinical malaria in children and around 27% among young infants.*

In this study, members of the RTS,S Clinical Trials Partnership followed up the infants and children for a further 20 to 30 months, respectively, and assessed the impact of a fourth booster dose. Participants were each vaccinated three times with RTS,S/AS01 with or without a booster dose 18 months later, or given four doses of a comparator vaccine (control group).

In children who received 3 doses of RTS,S/AS01 plus a booster, the number of clinical episodes of malaria at 4 years was reduced by just over a third (36%). This is a drop in efficacy from the 50% protection against malaria seen in the first year.

Importantly, without a booster dose, significant efficacy against severe malaria was not shown in this age group. However, in children given a booster dose, overall protective efficacy against severe malaria was 32%, and 35% against malaria-associated hospitalisations.

In infants who received 3 doses of RTS,S/AS01 plus a booster, the vaccine reduced the risk of clinical episodes of malaria by 26% over 3 years follow-up. There was no significant protection against severe disease in infants.

Meningitis occurred more frequently in children given RTS,S/AS01 (11 children in the group who received the booster dose and 10 in those who did not) than in those given the control vaccine (1 child). RTS,S/AS02 produced more adverse reactions than the control vaccines. Convulsions following vaccination, although uncommon, occurred more frequently in children who received RTS,S/AS01 than in controls. The incidence of other serious adverse events was similar in all groups of participants.

Prof Greenwood added:  “The European Medicines Agency (EMA) will assess the quality, safety, and efficacy of the vaccine based on these final data. If the EMA gives a favorable opinion, WHO could recommend the use of RTS,S/AS01 as early as October this year.If licensed,RTS,S/AS01would be the first licensed human vaccine against a parasitic disease.”

The study was funded by GlaxoSmithKline Biologicals SA and the PATH Malaria Vaccine Initiative.

Podcast: Brian Greenwood talks about the findings from the RTS,S malaria vaccine trial and his lengthy career in global health.

– See more at: http://www.lshtm.ac.uk/newsevents/news/2015/malaria_vaccine.html#sthash.7OSNxZa9.dpuf

5 things to know about measles right now.

Culled from The Nation’s Health of the APHA. This excellent piece was reported by Lindsey Wahowiak.

Measles was declared eliminated in the U.S. in 2000. So why is the current outbreak happening?

The vaccine for measles, a highly contagious respiratory disease, was developed in the 1960s, and since then, the U.S. has seen a dramatic drop in the number of cases reported. The Centers for Disease Control and Prevention declared it eliminated: the absence of continuous disease transmission for 12 months or more in a specific geographic area. But measles is still a threat around the globe, and can be brought to the U.S. by travelers. And a new outbreak linked to visits to Disney theme parks in California is causing concern.

2014 saw a record number of measles cases, with 644 reported in 27 states. And in just the first 30 days of 2015, more than 100 new measles cases were reported. If measles was eliminated more than a decade ago, what’s the deal with the current outbreak?

1. Measles is wildly contagious.
It helps to know what measles is to understand why it is. Part of the issue is that it is caused by a virus that is spread through the air by sneezing and coughing. So unlike Ebola, in which you need to interact with the bodily fluids of an infected and symptomatic person to get the disease, measles can affect anyone near an infected person.

The Centers for Disease Control and Prevention describes measles symptoms this way: “Measles starts with a fever, runny nose, cough, red eyes and sore throat, and is followed by a rash that spreads all over the body. About three out of 10 people who get measles will develop one or more complications including pneumonia, ear infections or diarrhea.”

2. Measles can be deadly.
“In the decade before 1963 when a vaccine became available, nearly all children got measles by the time they were 15 years of age,” according to CDC. “It is estimated 3 to 4 million people in the United States were infected each year.” An estimated 400 to 500 people died each year pre-vaccine.

The World Health Organization reports that measles vaccination resulted in a 75 percent drop in measles deaths between 2000 and 2013 worldwide. And yet, about 145,700 people died from measles in 2013. Most were children 5 and younger. CDC reports that complications of the disease can include ear infection, pneumonia, seizures, brain damage and death.

3. The measles vaccine is widely available in the U.S.
In the U.S., the vaccine typically comes in a shot that also contains vaccinations for mumps and rubella, two other diseases that often strike in childhood. The measles-mumps-rubella shot, or MMR, is given to children once they are about a year old, and again between ages 4 and 6.

Even parents who cannot afford the MMR vaccine for their children can get their kids covered at no cost, thanks in part to the Affordable Care Act. And yet, WHO reports that only 91 percent of 1-year-olds in America are vaccinated. That’s lower than many other countries globally that have reached 99 percent, including Thailand, South Korea, Qatar, Morocco and the Czech Republic. It’s also lower than goals set by Healthy People 2020, which calls for 95 percent of U.S. kindergartners to be fully vaccinated.

4. Herd immunity matters.
Some people are unable to get the MMR vaccine because of health issues. Others choose not to vaccinate their children because of fears, some of which are based on a debunked and later retracted study that erroneously linked the vaccine to autism.

Vaccinating as many people as possible is what keeps the disease from coming back, particularly against those who are too young or sick to be vaccinated themselves, including babies. A recent measles outbreak affecting five babies in a Chicago day care is evidence of how important herd immunity is.

On occasion, some people who get vaccinated still get measles. Most likely, that is because they only got one dose of the two-dose vaccine. It is important to get both. And if you do not know if you got the second dose as an adult, there’s no harm in getting another dose, just in case, according to CDC.

5. Vaccines eradicate diseases.
In the U.S., polio is a disease of the past. Smallpox was declared eradicated globally, too. But polio is still a threat in some parts of the world, so vaccination campaigns continue. We live in a global community, and we know diseases can spread all too quickly.+
The steps you can take to keep yourself and your community healthy are simple, and so important in promoting public health. Vaccinations are the safest way to stop deadly diseases before they spread.

Experts: Employers Can’t Force Workers To Get Vaccinated

Another interesting piece to share. Culled from VoiceGlance:

“One of the biggest stories of the past week has been the Disneyland measles outbreak, where at least 50 people in the United States and Mexico acquired measles, with the outbreak originating out of the California theme park.

The story is controversial because measles is a preventable disease: in 2000, the disease was declared eliminated from the United States, thanks largely to the measles vaccine. However, there has since been a push by select parents to refuse to vaccinate their children, which has allowed the measles to start spreading again.

In response to the outbreak, Disney offered up free vaccinations to any of its employees who weren’t already vaccinated. What’s interesting, though, is that they didn’t force their employees to get vaccinated, but instead just strongly encouraged it.

Why wouldn’t Disney require their employees – particularly their employees who interact with children – to be vaccinated? Well, because they can’t.

Yes, employers can make rules that all of their employees have to be vaccinated. But there are many exceptions to those rules and, by installing such a policy, the company is opening itself up to lawsuits.

The Law

A few states, including New York and Maryland, have laws that require healthcare workers to be vaccinated. But the vast majority of states do not, and even laws like the ones in Maryland and New York are subject to exceptions.

Those laws just regard healthcare professionals, though. If a company like Disney demanded all of its park workers be vaccinated, for example, they would open themselves up to lawsuits alleging discrimination or an invasion of privacy, Veena Iyer, a Minnesota-based employment attorney, told The Wall Street Journal.

“Employers should weigh the risks of mandating vaccinations or even asking about them before proceeding,” Audrey Mross, an employment-law attorney with Munck Wilson Mandala in Dallas, told The Columbus Dispatch.

Mross went on to say that employees are protected under the Americans With Disabilities Act, which prohibits discrimination on medical grounds in the workplace, and could sue an employer for requiring vaccinations under the Civil Rights Act of 1964, alleging that their religious rights are being infringed upon.

Meanwhile, the arguments against vaccinations – they cause autism, they aren’t necessary anymore, etc. – have been proven false time and time again.”

Measles outbreak in Berlin dashed the government’s hope of eradicating the disease in 2015

The emergence of measles in developed economies of the world is now becoming a global issue that require urgent attention.

In addition to the measles outbreak in California, Berlin has also recorded an outbreak.
The news piece you are about to read was authored by Zulfikar Abbany.

“There’s new pressure on parents to vaccinate their kids against measles as outbreaks spread in California and Berlin. Germany had wanted to eradicate measles by 2015. Some are blaming migrants and tourists.

Germany’s Robert Koch Institute (RKI) said the country faces its largest outbreak of measles since the introduction of an Infection Protection Act in 2001.

The RKI said there have been 375 cases of measles in Germany in the past four months. More than half of infected people are adults. But in January, the RKI said the number of new cases rose rapidly by 254, with 82 of those cases reported in the fourth week of the month.

Health authorities said the outbreak was first detected in October among asylum seekers from Bosnia and Herzegovina, and Serbia. They suggest this could be because vaccination programs failed during the Yugoslav civil war of the 1990s.

In the US state of California, public health officials are also battling a measles outbreak, with latest reports suggesting more than 100 people have been infected in the country.

The measles virus up close
Californian officials have said 92 of the cases diagnoses in the state are believed to be linked to an outbreak that may have started when an infected non-US resident visited Disneyland in late December.
At least 12 additional cases have been reported in other US states and Mexico.

The rapid spread of measles has reignited debate in the US and Europe over vaccination programs.

Some say efforts to get parents to have their children vaccinated were derailed by incorrect science that had suggested the combined measles, mumps and rubella (MMR) vaccine could cause autism.

The allegation was made in 1998 by Andrew Wakefield, a British medical practitioner whose his study has since been withdrawn.

But fears remain among the anti-vaccination movement, with some parents still refusing the MMR jab.

Many parents refuse to have their children vaccinated against measles
US Senator Ben Allen has proposed new legislation to end a parent’s right to exempt their child from vaccination. “The high number of unvaccinated students is jeopardizing public health not only in schools but in the broader community,” he said.

In Germany, health officials are equally keen to encourage more parents to allow their children to be vaccinated against measles.

While the immunization rate lies at around 90 percent, it is below the 95 percent goal set by Germany and other European countries to eradicate the disease by 2015.

In 2013, the then German Health Minister Daniel Bahr considered mandatory vaccination.”

California lawmakers aim to limit vaccine exemptions

An interesting development on Measles in the US, culled from Yahoo news, as reported by FENIT NIRAPPIL Feb 4, 2015 9:45 PM

SACRAMENTO, Calif. (AP) — California lawmakers proposed legislation Wednesday that would require parents to vaccinate all school children unless a child’s health is in danger, joining only two other states with such stringent restrictions.

Parents could no longer cite personal beliefs or religious reasons to send unvaccinated children to private and public schools under a proposal introduced after dozens of people have fallen ill from a measles outbreak that started at Disneyland. Mississippi and West Virginia are the only other states with such strict vaccine rules, though the California bill’s chief author said he would consider including a religious exemption.

“People are starting to realize, ‘I’m vulnerable, my children are vulnerable,'” said Sen. Richard Pan, a Democratic pediatrician from Sacramento. “We should not wait for more children to sicken or die before we act.”

Childhood vaccine has become an emotionally charged topic amid a measles outbreak that has sickened more than 100 people across the U.S. and in Mexico. No deaths have been reported.

According to the National Conference of State Legislatures, California is among 20 states that allow for personal belief exemptions and 48 that allow for religious exemptions.

A Washington state lawmaker introduced a bill Wednesday that would remove the personal belief allowance for an exemption in that state.

Public health officials believe an immunization rate of at least 90 percent is critical to minimizing the potential for a disease outbreak. California’s kindergarteners met that threshold at the start of this school year, according to state statistics: 2 percent were exempted because of their parents’ personal beliefs and another half a percent were exempted because of their parent’s religion.

Less than one-fifth of a percent of all students – about 1,000 – had a medical vaccine exemption that would be preserved under the bill.

Pan, who previously served in the Assembly, was the author of another vaccination bill that took effect last year. It requires parents who don’t have their children vaccinated for non-religious reasons to get a note from the doctor’s office before enrolling their children in school.

A spokesman for Gov. Jerry Brown, who signed that bill, did not say if the governor would oppose efforts to end exemptions.

“The Governor believes that vaccinations are profoundly important and a major public health benefit and any bill that reaches his desk will be closely considered,” spokesman Evan Westrup wrote in an email.

Parents cite a variety of reasons for not immunizing their children: religious values, concerns the shots could cause illness and a belief that allowing children to get sick helps them to build a stronger immune system.

The American Academy of Pediatrics says doctors should bring up the importance of vaccinations during visits but should respect a parent’s wishes unless there’s a significant risk to the child.

The California bill is also backed by Democratic Assemblywoman Lorena Gonzalez and Democratic Sen. Ben Allen, a former Santa Monica school board member.

Separately on Wednesday, U.S. Sens. Barbara Boxer and Dianne Feinstein called on California’s top health official to reconsider the state’s policy on vaccine exemptions in light of the measles outbreak.

“We believe there should be no such thing as a philosophical or personal belief exemption, since everyone uses public spaces,” the Democratic senators wrote in an open letter.