WHO, partners embark on largest ever emergency vaccination in Africa

One of the largest emergency vaccination campaigns ever attempted in Africa will start in Angola and the Democratic Republic of Congo in mid-August as WHO and partners work to curb a yellow fever outbreak that has killed more than 400 people and sickened thousands more.

Working with Ministries of Health in the 2 countries, WHO is coordinating 56 global partners to vaccinate more than 14 million people against yellow fever in more than 8000 locations. The yellow fever outbreak has found its way to dense, urban areas and hard-to-reach border regions, making planning for the vaccination campaign especially complex.

Emergency yellow fever vaccination campaigns have already reached more than 13 million people in Angola and more than 3 million in Democratic Republic of the Congo. These campaigns have been crucial to stopping the spread of the outbreak. Some areas are still considered at high risk and so preventive vaccination campaigns are planned for the capital city of Kinshasa in Democratic Republic of the Congo and along the country’s border with Angola, which spans 2,646 km. The preventive vaccination campaign aims to build protection in the population perceived to be at high risk of getting infected and prevent potential spread and expansion of the current outbreak.

Kinshasa has more than 10 million people, with only 2 million already vaccinated against yellow fever. With local transmission of the virus and low immunity in the population, there is a potential risk that the deadly outbreak could spread to other urban areas.

With limited supplies of the vaccine, and a 6-month minimum manufacturing process, WHO has been working with the Ministries of Health to plan the mass vaccination campaign that uses one-fifth of the standard vaccine dose as a short-term emergency measure to reach as many people as possible.

This method, known as fractional dosing, was recommended by WHO’s StrategicAdvisory Group of Experts on Immunization (SAGE), after it reviewed existing evidence that demonstrated lower doses would protect people safely and effectively against the disease for at least 12 months, and likely much longer. The fractional dose will not entitle people to travel internationally, but it will protect them from yellow fever during this outbreak and will help stop it from spreading further.

“Protecting as many people as possible is at the heart of this strategy. With a limited supply we need to use these vaccines very carefully,” says William Perea, Coordinator for the Control of Epidemic Diseases Unit at WHO.

WHO and partners including Médecins sans Frontières (MSF), International Federation of the Red Cross (IFRC) and UNICEF have been working closely together through the complex planning and logistics needed for the campaign.

Gavi, the Vaccine Alliance, has already enabled these countries to access almost 19 million doses of the vaccine since January and is providing strong support to the upcoming campaigns as well. Other partners providing expertise and support include Save the Children and the United States Centers for Disease Control (CDC).

Usually, planning a mass vaccination campaign can take anywhere between 3 to 6 months. This emergency campaign, however, must take place as soon as possible to end transmission before the rainy season starts in September.

“In order to vaccinate roughly 8 million people in Kinshasa within a short period, each team will need to vaccinate hundreds of people per day,” says Perea.

Approximately 17.3 million syringes and 41,000 health workers and volunteers are needed for the campaign. More than 500 vehicles will be used to transport the teams and supplies, which will be dispersed across more than 8000 vaccination sites in Kinshasa and along the Angola-Democratic Republic of the Congo border.

From the manufacturer to the person being immunized, the vaccine must be stored and transported at the right temperature –between 2 to 8 degrees Celsius – to maintain their potency. With lack of reliable electricity supply and fuel to run generators in large parts of the country, refrigeration is a big challenge. For this campaign alone, 115,000 ice packs are needed to keep vaccines cold and usable.


Genomic Data Commons expanded with data from 18,000 cancer patients

The recently launched Genomic Data Commons (GDC) will get a dramatic increase in the power and utility of its resources with the announcement of the signing of a data sharing agreement between the National Cancer Institute (NCI) and Foundation Medicine, Inc. (FMI), a molecular information company that has generated genomic profiles of people with cancer. NCI’s GDC is a unified data system that promotes the sharing of genomic and clinical data among researchers and is a core component of the Cancer Moonshot and the President’s Precision Medicine Initiative. NCI is part of the US National Institutes of Health.

The expanded number of cancer cases in the GDC will allow researchers to identify genomic changes that are responsible for the cancerous growth of tumours in individual patients, and identify which drugs may block the effects of these mutations. Such targeted drugs can produce remissions in certain patients.

When the GDC was launched in June this year, it was able to immediately capitalize on the genomic data that existed in several large-scale NCI programs, such as The Cancer Genome Atlas (TCGA) and its paediatric equivalent, Therapeutically Applicable Research to Generate Effective Treatments (TARGET). Together, TCGA and TARGET represent some of the largest and most comprehensive cancer genomic datasets in the world, with information generated from about 14,500 patients.

The addition of data from 18,000 adult patients with a diverse array of cancers that underwent genomic profiling using FMI’s proprietary comprehensive genomic profiling assay, called FoundationOne, will provide a major boost to the GDC. FMIdeveloped FoundationOne as a commercially available test that uses advanced sequencing technology to routinely analyse cancer specimens.

“This major infusion of data in the GDC will greatly enhance our ability to use this tool to explore genetic abnormalities in cancer,” said Douglas Lowy, M.D., NCI Acting Director. “Through TCGA and TARGET, we had already established a strong cancer genomic foundation for the GDC at its launch, but with the addition of the genomic data from FMI, we believe that the GDC will be an even more useful resource for researchers worldwide to help us unravel the complexities of many forms of cancer.”

Importantly, in both the NCI and the Foundation Medicine databases, all patient information has been de-identified, meaning that personal information, such as addresses, Social Security numbers, and other possible identifiers, are not present – only crucial genetic data and key demographic information are available.


US NIH awards $55m to build millionperson Precision Medicine Initiative

The US National Institutes of Health announced US$55 million in awards in fiscal year 2016 to build the foundational partnerships and infrastructure needed to launch the Cohort Program of President Obama’s Precision Medicine Initiative (PMI). The PMI Cohort Program is a landmark longitudinal research effort that aims to engage 1 million or more US participants to improve the ability to prevent and treat disease based on individual differences in lifestyle, environment and genetics.

The awards will support a Data and Research Support Center, Participant Technologies Center and a network of Healthcare Provider Organizations (HPO). An award to Mayo Clinic, Rochester, Minnesota, to build the biobank, another essential component, was announced earlier this year. All awards are for five years, pending progress reviews and availability of funds. With these awards, NIH is on course to begin initial enrolment into the PMI Cohort Program in 2016, with the aim of meeting its enrolment goal by 2020.

The PMI Cohort Program is one of the most ambitious research projects in history and will set the foundation for new ways of engaging people in research. PMI volunteers will be asked to contribute a wide range of health, environment and lifestyle information. They will also be invited to answer questions about their health history and status, share their genomic and other biological information through simple blood and urine tests and grant access to their clinical data from electronic health records. In addition, mobile health devices and apps will provide lifestyle data and environmental exposures in real time. All of this will be accomplished with essential privacy and security safeguards. As partners in the research, participants will have ongoing input into study design and implementation, as well as access to a wide range of their individual and aggregated study results.

“This range of information at the scale of 1 million people from all walks of life will be an unprecedented resource for researchers working to understand all of the factors that influence health and disease,” said NIH Director Francis S. Collins, M.D., Ph.D. “Over time, data provided by participants will help us answer important health questions, such as why some people with elevated genetic and environmental risk factors for disease still manage to maintain good health, and how people suffering from a chronic illness can maintain the highest possible quality of life. The more we understand about individual differences, the better able we will be to effectively prevent and treat illness.”

The knowledge gained from the PMI Cohort Program will extend successes of precision medicine in some cancers to many other diseases. Importantly, the program will focus not just on disease, but also on ways to increase an individual’s chances of remaining healthy throughout life. “As someone who has personally benefited from precision medicine, I am excited for this study to intersect with other fundamental changes in medicine and research to empower people to live healthier lives,”added PMI Cohort Program Director Eric Dishman. “What potential participants need to know is that we are equally interested in learning how we can prevent illness in the first place, but when we do get ill, which treatment options are going to work best for each of us individually.”

These initial awards bring together the major elements through a variety of new partnerships that are needed to launch the PMI Cohort Program later this year.

“This is an incredibly complex study requiring new kinds of strategic and operational partnerships - this can’t be business as usual,” said Kathy L. Hudson, Ph.D., NIH Deputy Director for Science, Outreach, and Policy who helped orchestrate the PMI Cohort Program. “We are excited to break new ground in engaging people in research and building a study of this scale and scope.”

The NIH’s PMI Cohort Program
www.nih.gov/precision-medicine-initiative-cohort-program

 


Polio returns to Nigeria after two-years free of the disease

After more than two years without wild poliovirus in Nigeria, the Government reported on 11 August that two children have been paralyzed by the disease in the northern Borno state.

As an immediate priority, the Government of Nigeria is collaborating with the WHO and other partners of the Global Polio Eradication Initiative to respond urgently and prevent more children from being paralyzed. These steps include conducting large-scale immunization campaigns and strengthening surveillance systems that help catch the virus early. These activities are also being strengthened in neighbouring countries.

“We are deeply saddened by the news that two Nigerian children have been paralyzed by polio. The Government has made significant strides to stop this paralyzing disease in recent years. The overriding priority now is to rapidly immunize all children around the affected area and ensure that no other children succumb tothis terrible disease”, said Dr Matshidiso Moeti, WHO Regional Director for Africa.

Genetic sequencing of the viruses suggests that the new cases are most closely linked to a wild poliovirus strain last detected in Borno in 2011. Low-level transmission of the poliovirus is not unexpected, particularly in areas where it is diffi cult to reach children with the vaccine. Subnational surveillance gaps persist in some areas of Borno, as well as in areas of neighbouring countries.

“We are confi dent that with a swift response and strong collaboration with the Nigerian Government, we can soon rid the country of polio once and for all. This is an important reminder that the world cannot afford to be complacent as we are on the brink of polio eradication – we will only be done when the entire world has been certifi ed polio-free,” said Dr Michel Zaffran, Director of polio eradication at WHO Headquarters.

As recently as 2012, Nigeria accounted for more than half of all polio cases worldwide, but the country has made signifi cant strides, recently marking two years without a case on 24 July 2016. This progress has been the result of a concerted effort by all levels of government, civil society, religious leaders and tens of thousands of dedicated health workers.

The two cases in Nigeria particularly highlight the need to prioritize immunization of children in hard-to-reach areas such as the Lake Chad region, which spans several countries and is often affected by confl ict and large population movements. Reaching these children requires vaccinating populations as they move in and out of inaccessible areas and using local-level groups and organizations, such as religious institutions and community based organizations, to negotiate access for vaccination teams.

Globally, the world is very close to reaching the goal of polio eradication. Only 21 wild polio cases have been reported so far in 2016, compared to 34 cases at the same point last year. Only two other countries are reporting polio: Pakistan and Afghanistan. Four out of the six WHO Regions of the world have been certifi ed poliofree, and only one of the three types of wild poliovirus is still circulating in the world (type 1)


WHO encourages countries to reduce deaths from viral hepatitis

To mark World Hepatitis Day on 28 July 2016, WHO urged countries to take rapid action to improve knowledge about the disease, and to increase access to testing and treatment services. Only 1 in 20 people with viral hepatitis know they have it. And just 1 in 100 with the disease is being treated.

“The world has ignored hepatitis at its peril,” said Dr Margaret Chan, WHO Director-General. “It is time to mobilize a global response to hepatitis on the scale similar to that generated to fi ght other communicable diseases like HIV/AIDS and tuberculosis.”

Around the world 400 million people are infected with hepatitis B and C, more than 10 times the number of people living with HIV. An estimated 1.45 million people died of the disease in 2013 – up from less than a million in 1990.

In May 2016, at the World Health Assembly, 194 governments adopted the fi rst-ever Global Health Sector Strategy on viral hepatitis and agreed to the fi rst-ever global targets. The strategy includes a target to treat 8 million people for hepatitis B or C by 2020. The longer term aim is to reduce new viral hepatitis infections by 90% and to reduce the number of deaths due to viral hepatitis by 65% by 2030 from 2016 fi gures.

The strategy is ambitious, but the tools to achieve the targets are already in hand. An effective vaccine and treatment for hepatitis B exists. There is no vaccine for hepatitis C but there has been dramatic progress on treatment for the disease in the past few years. The introduction of oral medicines, called direct-acting antivirals, has made it possible to potentially cure more than 90% of patients within 2–3 months. But in many countries, current policies, regulations and medicine prices put the cure out of most people’s reach.

“We need to act now to stop people from dying needlessly from hepatitis,” said Dr Gottfried Hirnschall, WHO’s Director of the HIV/AIDS Department and Global Hepatitis Programme. “This requires a rapid acceleration of access to services and medicines for all people in need.”

 

Date of upload: 13th Sep 2016

                                  
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