Archive for April, 2013

China’s bird flu outbreak: 3 good signs, 3 bad signs and 3 very bad signs

Tuesday, April 30th, 2013 (last updated)

Since the new avian flu strain H7N9 began appearing in China earlier this year, it’s infected over 100 people, killed 22, spread to five provinces plus Beijing and Shanghai and, as of Wednesday, is confirmed to have spread abroad to Taiwan.

How worried should you be about this? How serious is the H7N9 outbreak? The simplest and most honest answer is that we don’t know what’s going to happen next, either with the virus, which may or may not mutate and become more transmittable, or with Chinese and international health-care authorities responsible for tamping it down. But there are some good signs, some bad signs and some very bad signs. Here are a few.

Three good signs

1. China is being unusually transparent so far. Ten years ago, as the deadly viral respiratory illness known as SARS first spread across China, the government did not respond well. It suppressed information about the outbreak, making it that much harder to contain and study the disease, ultimately costing lives. This time, though, Chinese authorities have been sharing information about the disease’s spread, and state media appear to be freely reporting on new cases. Chinese officials seem to take the disease seriously and want to combat its rise, even if it means overcoming more secretive instincts. All health care for H7N9 is now free in China, for example, to help encourage people to report cases.

2. The number of cases has largely flatlined in the last week. After weeks of rising cases, the number seems to have stayed stable at around 110 over the last week. Big caveats here that there might be cases we don’t know about, and the count could change at any moment.

3. Shanghai has found some success limiting new cases. A lot of the cases started around Shanghai, but the city was able to reduce the number of new infections after it closed poultry markets, according to Laurie Garrett, a senior fellow at the Council on Foreign Relations covering health-care policy. The Wall Street Journal found the same thing.

Three bad signs

1. It’s spreading. With cases recently reported in Shandong province and now in Taiwan, the virus seems to be moving outward.

2. No verified human-to-human transmissions, but it’s possible. Neither China nor the World Health Organization has documented human-to-human transmission, which would allow the virus to spread far more quickly and widely, but nor have they ruled it out. The Taiwanese case had no known exposure to poultry.

3. Tough to identify birds with the virus. World Health Organization officials say the virus is more difficult to detect in sick poultry than were previous strains because the birds do not show symptoms that are as clearly identifiable. This makes it tougher to keep sick birds off the market.

Three very bad signs

1. It’s very deadly, with 18 percent mortality so far. For comparison, tuberculosis has a mortality rate of about 4 or 5 percent in China. Still, the avian flu virus that had its first outbreaks in China in 2006, known as H5N1, has a mortality rate of 60 percent and has killed hundreds of people on multiple continents. It’s way too early to tell H7N9′s mortality rate, given that many infected patients have not yet fully recovered, but it’s so far killed about 18 percent of patients.

2. “This is definitely one of the most lethal influenza viruses that we have seen so far. “That’s according to Keiji Fukuda, the World Health Organization’s assistant director general for health, security and the environment, who added, “This is an unusually dangerous virus for humans.” Fukuda said the WHO is still struggling to understand the disease, but he certainly seems to be sounding the alarm.

3. More easily transmitted than the 2006 avian flu outbreak. That’s also according to the WHO’s Fukuda, who says this new strain is more easily contracted than the H5N1 virus.

Bird flu

The Washington Post

Better vaccine supply systems could save 22 million children

Monday, April 29th, 2013 (last updated)

Better supply and logistics systems, international cooperation and funding are essential to reach the estimated 22 million children in developing countries who are still not protected from dangerous diseases with basic vaccines, according to a special supplement of Vaccine, published last week. Articles also underline the need to improve understanding about the health benefits of immunization.

With contributions from over 100 authors, the ‘Decade of Vaccines Supplement’ highlights strategies to further advance progress on the Global Vaccines Action Plan that was endorsed by the World Health Assembly in 2012. Supported by the World Health Organization (WHO), UNICEF, the GAVI Alliance and the Bill & Melinda Gates Foundation, the plan aims to deliver universal access to immunization by 2020.

According to one of the articles in the supplement, vaccination between 2011 and 2020 is expected to have a significant impact on public health, particularly in Africa and Southeast Asia.

Researchers used mathematical modelling to estimate the likely number of deaths averted in people vaccinated in 73 countries in the decade 2011–2020. They estimate that nine vaccinations given to people in 73 countries could avert an estimated 9.9 million deaths. These vaccines are for hepatitis B, yellow fever, Haemophilus influenzae type B (Hib), Streptococcus pneumoniae, rotavirus, Neisseria meningitidis serogroup A, Japanese encephalitis, human papillomavirus and rubella. In addition to these, measles vaccination and supplementary immunization activities are expected to avert an additional 13.4 million deaths.

However, the current surge in measles cases in the UK highlights the importance of communication to achieving vaccination goals.

“In some parts of the world, complacency about immunization has led to gaps in vaccination coverage,” said Geeta Rao Gupta, Deputy Executive Director of UNICEF. “When gaps occur, outbreaks follow.”

Better vaccine supply systems could save 22 million children


HPV vaccination to provide even more protection in future against infections

Saturday, April 27th, 2013 (last updated)

At present over one hundred strains of the human papillomavirus (HPV) are known, fourteen of which can trigger cancer. The HPV vaccinations currently in use provide protection from 70 percent of these cancers. “With the next generation of the HPV vaccine we will reach 90 percent,” says Elmar Joura of the University Department of Gynaecology at the MedUni Vienna. This next vaccine generation is currently undergoing clinical trials at the MedUni Vienna and should be available in approximately two years’ time.

In Austria, up to 400 women a year develop invasive cervical cancer. In more than 90 percent of the cases human papillomaviruses are responsible. Pre-cancerous stages of cervical carcinoma and genital warts, as well as types of cancer in the genital area and the throat, are being increasingly triggered by HPV viruses.

Goal: free HPV vaccination for everyone

The HPV mechanism of action is insidious: an HPV infection is slow-burning, goes undetected and without symptoms of illness until a cancer is caused. Vaccination provides protection and is not only advisable for young people. Says Joura: “There is data showing it is effective up to the 45th year of life.” According to Joura it would be desirable for the HPV vaccination not only to be recommended in the Austrian vaccination plan, but also for it to be included in the vaccination programme for children thus gaining public financing as childhood is the optimum time for prevention. There has been a recommendation to this effect by the Chief Medical Officer since 2007, and a consensus decision in the Health Ministry since last October.

At present, the quadruple vaccination, which has to be administered three times, costs a total of 570 Euros for example. At present it is recommended that girls and women between nine and 40 year old are vaccinated, boys and young men between nine and 26. Countries such as Australia, Germany and the USA have only just followed suit and adjusted their provisions accordingly.

The urgency of the public purse providing the finance is identifiable in the statistics according to the MedUni researcher: “In Austria there are, according to estimates, 700 avoidable cancer cases a year caused by HPV, in addition to this there are 3,000 preventable surgeries due to pre-cancerous developments to the cervix as well as 15,000 cases of genital warts. Vaccination would clearly cut this.”

MedUni leads the way in treatment and diagnosis of HPV worldwide

There has been a quadruple HPV vaccine since 2006, which has been trialled at the MedUni Vienna since 2002, and which protects against the most dangerous oncogenic HPV strains that cause cervical cancer and other types of cancer in the genital and throat area, but which also cause genital warts. The MedUni Vienna is taking on responsibility in this cause and has not only initiated an HPV action day but has also provided a reasonably priced vaccination campaign for employees and students. The clinics and institutes of the MedUni Vienna are regarded as world leaders in the treatment and diagnosis of HPV illnesses.

Medical University of Vienna

This is not a story about vaccines. This is the story of a mother.

Friday, April 26th, 2013 (last updated)

Bill & Melinda Gates Foundation

UNICEF reports one in five children still unimmunized and at risk

Thursday, April 25th, 2013 (last updated)

One and a half million children would not have died in 2011 had they been immunized, according to UNICEF at the start of World Immunization Week. But one in five children is not being reached with vital vaccines due to social or geographical exclusion, lack of resources, weak health systems or conflicts such as those raging today in Syria and parts of West Africa.

Every infant in the world needs to be immunized to better protect their health, and vaccines are estimated to save the lives of 2 to 3 million children each year – representing one of the ten greatest achievements in public health of the last century, according to the U.S. Centers for Disease Control and Prevention. Immunization is also highly cost effective.  For instance, it costs less than US$1 to protect a child against measles for life.

In 2011, however, 22.4 million children were not immunized – an increase of over one million from the preceding year.

UNICEF is concerned that global efforts to vaccinate every child are plateauing as funding falls and political will stagnates. In 2011, only 152 out of 193 World Health Organization member states had dedicated budget lines for immunization.

UNICEF reports one in five children still unimmunized and at risk

Inequalities persist within and between countries. Children from wealthy families have the greatest access to the best health services in any given country, and they enjoy the highest rates of immunization coverage.

Unless disparities are addressed every last child cannot be immunized, says UNICEF. At the same time, investment in routine immunization as part of improved health care systems will benefit all children – thus further reducing inequities. To do so, governments have to provide sufficient funding and innovation should be encouraged – such as the recent introduction of vaccines against pneumonia and diarrhoea.

And, most importantly, unwavering political support is needed to extend the benefits of vaccines to children living in the poorest families and the most remote communities.

UNICEF’s unique position

UNICEF procures vaccines that reach 36 per cent of the world’s children. In 2012, UNICEF procured almost 1.9 billion doses of vaccine and over 500 million syringes. As the largest buyer of vaccines in the world, UNICEF works to keep vaccine prices at levels that low- and middle-income countries can afford. UNICEF and its partners supported immunization programmes in over 100 countries last year.

At country level, UNICEF and partners support governments in optimising immunization supply chains so that cold chain equipment and logistics effectively maintain vaccines at stable temperatures at every step of storage and transportation until the child is reached. And UNICEF also works to increase community awareness and acceptance of immunization.

When emergencies occur, children are more vulnerable, and immunization campaigns become critically important. One of the first highly contagious diseases to appear in humanitarian situations is measles, outbreaks of which have been reported recently in Syria, Pakistan, Nigeria and the Democratic Republic of Congo.

The enormous impact of immunization and the challenges to vaccination are starkly apparent in the crisis in Syria. Last year, UNICEF and its partners vaccinated 1.3 million children against measles and 1.5 million against polio, and a campaign is now under way to reach 2.5 million children with measles vaccinations. However, a combination of limited funds, enormous challenges to access and mass population movements are making it harder than ever to reach every child.

Concerted efforts to immunize children have reduced or eliminated the incidence of devastating illnesses:

  • Smallpox was eradicated in 1980. Polio was recently eliminated in India and is now endemic in only three countries: Pakistan, Nigeria and Afghanistan.
  • Between 2000 and 2011, measles deaths dropped 71 per cent worldwide.

29 countries eliminated neo-natal tetanus between 2000 and 2013.


To promote immunisation, involve community leaders

Wednesday, April 24th, 2013 (last updated)

As we mark the Immunisation Week, we need to critically think about how we can improve the uptake of immunisation services. It is important that we get communities involved if we are to prevent immunisable killer diseases such as Tuberculosis, Polio, Tetanus, Diphtheria, Measles, Whooping cough, Hepatitis B, Haemophilus influenzae and Pneumonia.

Immunisation programmes are very crucial because they reduce the burden of infectious diseases and serve as a key building block for health systems in developing countries, Uganda inclusive. In Uganda, immunisation services are provided by the government and development partners for free. One would, therefore, expect that all children get this important service. Unfortunately, the reality on the ground is different.

Whereas by 12 months all children are expected to be fully immunised, the 2011 survey conducted by the Ministry of Health revealed that only four in 10 children were fully immunised. The implication here is that majority of Ugandan children who receive the basic vaccinations are not immunised on schedule and remain at risk of suffering from preventable diseases. It is, however, worth noting that Uganda has registered some improvement in immunisation coverage over the years. For instance, the Health ministry survey 2011 revealed that the proportion of children fully immunised within the first year of life was 29 per cent in 2000/1; it increased to 36 per cent in 2006 and 40 per cent in 2011. However, this improvement is still below average and unlikely to guarantee the desired effect on child health.

Often, the socio-cultural context relevant for health seeking behaviour is not taken into consideration during programme design and implementation. One of the key interventions that could increase the uptake and coverage of immunisation services is involvement of community leaders. This is because community leaders serve as gate keepers for service providers to communities. In addition, these leaders know the number of children within their communities who are eligible for immunisation. More so, they are able to reach people at the grassroot and educate them on immunisation and where they can access the services from. Hence the community leaders involved should be given all necessary information about immunisation, including the available vaccinations and the service centres where these vaccines are administered in various communities.

Studies have shown that involving community leaders is a successful strategy in improving the uptake and coverage of immunisation services, particularly in developing countries. For instance, a study carried out in Burkina Faso in 1994 established that mothers who had various sources of information, including their cultural leaders, were likely to know the importance of completing the vaccination schedule and the dates for specific vaccines. This was attributed to the perception of the communities towards their cultural leaders as high opinion members of society.

To promote immunisation, involve community leaders

It is, therefore, important to have community leaders at the forefront of immunisation campaigns in Uganda for the programmes to succeed. These leaders can easily integrate messages promoting immunisation in community meetings, functions and also use their platforms to mobilise communities for immunisation.

Furthermore, community leaders are in a better position to inform the service providers on the actual number of children eligible for immunisation for better planning purposes. Since these leaders are respected and trusted members of society, their community members are likely to take their children for immunisation when they receive such messages from them.

This is likely to foster positive attitude and behaviour towards immunisation, thus creating demand for such services, particularly in rural areas.

Daily Monitor

World Immunization Week

Tuesday, April 23rd, 2013 (last updated)

Immunization averts an estimated 2-3 million deaths every year, providing protection from diphtheria, measles, pertussis (whooping cough), pneumonia, polio, rotavirus diarrhoea, rubella and tetanus. Yet, an estimated 22 million infants are not fully immunized with routine vaccines. There is an urgent need to better communicate the health benefits of vaccination and the dangers of not immunizing children.

The value of vaccines


2 million children in UK at risk of measles as disease spreads

Saturday, April 20th, 2013 (last updated)

Two million children could be in danger of catching ­measles because they were not fully vaccinated during the MMR scare, health experts have warned.

They are thought to be ­vulnerable to falling victim to the current epidemics which are wreaking havoc in two outbreak clusters – one in Swansea, South Wales, and one in Teesside, County Durham.

Many of the cases are being seen in children, with the 10 to 18 age group hit hardest, with health experts blaming the now-discredited study by Dr Andrew Wakefield in 1998 which linked the triple measles, mumps and rubella (MMR) jab to autism.

2 million children in UK at risk of measles as disease spreads

This led to a massive drop in take-up of the vaccine with parents worried about its side effects. But yesterday a panel of Britain’s top immunisation and children’s health experts admitted that 15 years on, the nation is now seeing the effects of that widespread fear with huge outbreaks which are spreading uncontrollably.

Dr Helen Bedford, of University College London’s Institute of Child Health, said: “There have been outbreaks all around the country. So yes, there is the chance of further outbreaks but children are going to get measles. Approaching two million children are susceptible to this infection because they have not been immunised.

“Parents need to be encouraged to find out if their children have been vaccinated and if not, go out and do it.”

Her comments come as official figures confirmed the number of cases in the Swansea measles epidemic have risen to 808 (April 19th, 2013).


WHO, governments and scientists seek to end polio by 2018

Thursday, April 18th, 2013 (last updated)

WHO, governments and scientists seek to end polio by 2018

A new contract to eradicate polio worldwide by 2018 has been established with the support of the WHO, an international community of scientists and government bodies.

The Eradication and Endgame Strategic Plan (EESP), formed by the Global Polio Eradication Initiative (GPEI), hopes to cure the world of polio, a disease which attacks the children across the globe. The initiative acknowledges significant advancements in technology to fight against polio and strategizes how to rid the world of the disease within the next five years.

Since the development of polio vaccinations in the late 1950s-early 1960s, new cases of wild poliovirus have fallen from 350,000 in 125 countries to only 250 in 5 countries in 2012, according to the GPEI. Nigeria, Pakistan and Afghanistan, three of the five affected countries, initiated emergency plans in 2012 to eradicate the disease permanently.

The EESP outlines how to eliminate polio over the next 5 years by means of administering vaccines to those who have not yet received them and by administering a stronger vaccine to protect against a stronger strand of poliovirus.

Aside from the eradication of polio, this initiative seeks to make life-saving immunizations readily available to every child in the world. An increase in infrastructure will be needed to ensure routine immunizations to meet this goal, benefiting children in every corner of the world.

The GPEI warns against scaling back on efforts, since this disease can be transmitted from human-to-human and spreads quickly. Without routine immunizations, it projects to see a jump from 250 to 200,000 infected persons in one year.

The initiative has received support from 439 signatories representing 80 countries.

Vaccine News Daily

Reality Check: Concerned about aluminum in vaccines?

Wednesday, April 17th, 2013 (last updated)