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Mirieri H, Nasimiyu C, Dawa J, Mburu C, Jalang'o R, Kamau P, Igboh L, Ebama M, Wainaina D, Gitonga J, Karanja J, Njenga E, Kariuki J, Machani J, Oginga P, Baraka I, Wamaru P, Muhula S, Ratemo P, Ayugi J, Kariuki Njenga M, Emukule GO, Osoro E, Otieno NA. Resilience of routine childhood immunization services in two counties in Kenya in the face of the COVID-19 pandemic. Vaccine 2023; 41:7695-7704. [PMID: 38008664 DOI: 10.1016/j.vaccine.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/03/2023] [Accepted: 09/13/2023] [Indexed: 11/28/2023]
Abstract
The recently emerged coronavirus disease 2019 (COVID-19) has caused considerable morbidity and mortality worldwide and disrupted health services. We describe the effect of the COVID-19 pandemic on utilization of childhood vaccination services during the pandemic. Using a mixed methods approach combining retrospective data review, a cross-sectional survey, focus group discussions among care givers and key informant interviews among nurses, we collected data between May and September 2021 in Mombasa and Nakuru counties. Overall, there was a <2 % decline in the number of vaccine doses administered during the pandemic period compared to the pre-pandemic period but this was statistically insignificant, both for the pentavalent-1 vaccine (ß = -0.013, p = 0.505) and the pentavalent-3 vaccine (ß = -0.012, p = 0.440). In government health facilities, there was 7.7 % reduction in the number of pentavalent-1 (ß = -0.08, p = 0.010) and 10.4 % reduction in the number of pentavalent-3 (ß = -0.11, p < 0.001) vaccine doses that were administered during the pandemic period. In non-government facilities, there was a 25.8 % increase in the number of pentavalent-1 (ß=0.23, p < 0.001) and 31.0 % increase in the number of pentavalent-3 (ß = -0.27, p < 0.001) vaccine doses that were administered facilities during the pandemic period. The strategies implemented to maintain immunization services during the pandemic period included providing messaging on the availability and importance of staying current with routine vaccination and conducting catch-up vaccinations and vaccination outreaches. Our findings suggest that the COVID-19 pandemic did not impact childhood vaccination services in Mombasa and Nakuru counties in Kenya. The private health facilities cushioned vaccination services against the effects of the pandemic and the strategies that were put in place by the ministry of health ensured continuation of vaccination services and encouraged uptake of the services during the pandemic period in the two counties in Kenya. These findings provide useful information to safeguard vaccination services during future pandemics.
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Affiliation(s)
- Harriet Mirieri
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya.
| | - Carolyne Nasimiyu
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Jeanette Dawa
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Caroline Mburu
- Department of Social Anthropology, University of St Andrews, Fife, Scotland, UK
| | - Rose Jalang'o
- National Vaccines and Immunization Program, Ministry of Health, Kenya
| | - Peter Kamau
- National Vaccines and Immunization Program, Ministry of Health, Kenya
| | - Ledor Igboh
- Global Immunization Division, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jorim Ayugi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - M Kariuki Njenga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Gideon O Emukule
- Influenza Division, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Eric Osoro
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Nancy A Otieno
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
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Umutesi G, Moon TD, Makam JK, Diomande F, Cherry CB, Tuopileyi II RNO, Zakari W, Craig AS. Evaluation of acute flaccid paralysis surveillance performance before and during the 2014-2015 Ebola virus disease outbreak in Guinea and Liberia. Pan Afr Med J 2023; 45:190. [PMID: 38020355 PMCID: PMC10656592 DOI: 10.11604/pamj.2023.45.190.21480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 12/31/2020] [Indexed: 12/01/2023] Open
Abstract
Introduction the number of wild poliomyelitis cases, worldwide, dropped from 350,000 cases in 1988 to 33 in 2018. Acute flaccid paralysis (AFP) surveillance is a key strategy toward achieving global polio eradication. The 2014 Ebola virus disease (EVD) epidemic in West Africa infected over 28,000 people and had devastating effects on health systems in Guinea, Liberia, and Sierra Leone. We sought to assess the effects of the 2014 Ebola outbreak on AFP surveillance in Guinea and Liberia. Methods a retrospective cross-sectional analysis was performed for Guinea and Liberia to evaluate EVD´s impact on World Health Organization (WHO) AFP surveillance performance indicators during 2012-2015. Results both Guinea and Liberia met the WHO target non-polio AFP incidence rate nationally, and generally sub-nationally, prior to the EVD outbreak; rates decreased substantially during the outbreak in seven of eight regions in Guinea and 11 of 15 counties in Liberia. Throughout the study period, both Guinea and Liberia attained appropriate overall targets nationally for "notification" and "stool adequacy" indicators, but each country experienced periods of poor regional/county-specific indicator performance. Conclusion these findings mirrored the negative effect of the Ebola outbreak on polio elimination activities in both countries and highlights the need to reinforce this surveillance system during times of crisis.
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Affiliation(s)
- Grace Umutesi
- Vanderbilt Institute for Global Health, Nashville, Tennessee, United States of America
| | - Troy D Moon
- Vanderbilt Institute for Global Health, Nashville, Tennessee, United States of America
| | - Jeevan Kumar Makam
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Fabien Diomande
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | | | - Allen Scott Craig
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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de Araújo GR, de Castro PA, Ávila IR, Bezerra JMT, Barbosa DS. Effects of public health emergencies of international concern on disease control: a systematic review. Rev Panam Salud Publica 2023; 47:e74. [PMID: 37089787 PMCID: PMC10120386 DOI: 10.26633/rpsp.2023.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/17/2022] [Indexed: 04/25/2023] Open
Abstract
Objectives To assess the accumulated knowledge of the effects of public health emergencies of international concern on disease control and local health systems, and contribute to a better understanding of their effects on health programs and systems. Methods This was a systematic review of published and gray literature (in English, Portuguese, or Spanish). Electronic databases (BVS/LILACS, PubMed, and SciELO) and Google Scholar were searched. Search terms were: COVID-19 OR H1N1 OR Ebola OR Zika OR poliomyelitis AND (outbreaks OR epidemics) AND (public health systems OR public health surveillance). Results A total of 3 508 studies were retrieved, of which 31 met the inclusion criteria. The studies addressed the effects of the emergencies on: communicable diseases notification systems; malaria, HIV/AIDS, tuberculosis, poliomyelitis, and malaria surveillance, control, and treatment; microcephaly; dengue; and vaccinations. The populations affected by the emergencies experienced reduced health services, which included fewer health visits, failures in the diagnostic chain, decrease in vaccination, and increased incidence or underreporting of notifiable diseases. Conclusions Socioeconomic inequity is a determinant of the effects of public health emergencies of international concern within affected populations. The diversion of resources and attention from health authorities disproportionately affects vulnerable populations and can lead, over time, to a weakening of health systems. The analysis of the effects of public health emergencies is important for the development of new protocols that can better respond to future crises.
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Affiliation(s)
- Giovanna Rotondo de Araújo
- Universidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil.
| | - Pedro A.S.V. de Castro
- Universidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil.
| | - Isabela R. Ávila
- Universidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil.
| | - Juliana Maria T. Bezerra
- Universidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil.
| | - David S. Barbosa
- Universidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil.
- David S. Barbosa,
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Fischer LJ, Rains RC, Brett-Major SM, Senga M, Holden D, Brett-Major DM. Fielding vaccines-challenges and opportunities in outbreaks, complex emergencies, and mass gatherings. Hum Vaccin Immunother 2022; 18:2104500. [PMID: 35930505 DOI: 10.1080/21645515.2022.2104500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
With the recent COVID-19 pandemic, the importance of vaccine development, distribution, and uptake has come to the forefront of the public eye. Effectively fielding vaccines during an emergency-whether that emergency is a result of an infectious disease or not-requires an understanding of usual vaccine-related processes; the impact of outbreak, complex emergencies, mass gatherings, and other events on patients, communities, and health systems; and ways in which diverse resources can be applied to successfully achieve needed vaccine uptake. In this review, both the emergency setting and briefly vaccine product design are discussed in these contexts in order to provide a concise source of general knowledge from experts in fielding vaccines that can aid in future vaccine ventures and increase general awareness of the process and barriers in various settings.
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Affiliation(s)
- Laura J Fischer
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Robert C Rains
- ARC Operational Development, Washington, District of Colombia, USA
| | | | - Mikiko Senga
- Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Debra Holden
- Veritas Management Group, Alpharetta, Georgia, USA
| | - David M Brett-Major
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Nigus M, Zelalem M, Abraham K, Shiferaw A, Admassu M, Masresha B. Implementing nationwide measles supplemental immunization activities in Ethiopia in the context of COVID-19: process and lessons learnt. Pan Afr Med J 2020; 37:36. [PMID: 33456660 PMCID: PMC7796832 DOI: 10.11604/pamj.supp.2020.37.36.26614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/13/2020] [Indexed: 11/11/2022] Open
Abstract
The COVID-19 pandemic has disrupted immunization activities in many countries, causing declines in the delivery of routine doses of antigens, and the postponement of scheduled supplemental immunization activities (SIAs). Following the declaration of the pandemic, Ethiopia postponed nationwide follow-up measles preventive vaccination campaign which was scheduled for April 2020. The disruptions to routine services and the postponement of the SIAs increased the risk for measles outbreaks. The national authorities, in consultation with the secretariat of the National COVID-19 Pandemic Prevention and Control Ministerial Coordination Committee, subnational level authorities, technical partner agencies and stakeholders, reviewed the risks for measles outbreaks and decided to implement the nationwide measles SIAs, with strict implementation of COVID prevention measures. The revised micro-plans accommodated the additional human resource and logistics needs for COVID prevention, for which partner resources were mobilized to fill the gaps. The key SIAs preparatory and implementation activities including training, logistics, social mobilization, service delivery and supervision were modified to take into consideration the COVID context. Infection prevention and control supplies were procured and distributed as a package with the bundled vaccines and other supplies. The SIAs were completed in July 2020 and reached 102.8% administrative coverage nationwide, with 78% of the 1123 woredas attaining the target of 95% coverage. The strong commitment of the leadership, the coordination role of the national and regional COVID prevention and control taskforces, the engagement of community leaders, the use of multi-channel communication, the timely availability of additional resources and modification of the service delivery approaches contributed to the success of the SIAs.
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Affiliation(s)
- Mulat Nigus
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | | | - Amsalu Shiferaw
- United Nations Children's Fund (UNICEF), Addis Ababa, Ethiopia
| | | | - Balcha Masresha
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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Nigus M, Zelalem M, Abraham K, Shiferaw A, Admassu M, Masresha B. Implementing nationwide measles supplemental immunization activities in Ethiopia in the context of COVID-19: process and lessons learnt. Pan Afr Med J 2020. [PMID: 33456660 PMCID: PMC7796832 DOI: 10.11604/pamj.supp.2020.37.1.26614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The COVID-19 pandemic has disrupted immunization activities in many countries, causing declines in the delivery of routine doses of antigens, and the postponement of scheduled supplemental immunization activities (SIAs). Following the declaration of the pandemic, Ethiopia postponed nationwide follow-up measles preventive vaccination campaign which was scheduled for April 2020. The disruptions to routine services and the postponement of the SIAs increased the risk for measles outbreaks. The national authorities, in consultation with the secretariat of the National COVID-19 Pandemic Prevention and Control Ministerial Coordination Committee, subnational level authorities, technical partner agencies and stakeholders, reviewed the risks for measles outbreaks and decided to implement the nationwide measles SIAs, with strict implementation of COVID prevention measures. The revised micro-plans accommodated the additional human resource and logistics needs for COVID prevention, for which partner resources were mobilized to fill the gaps. The key SIAs preparatory and implementation activities including training, logistics, social mobilization, service delivery and supervision were modified to take into consideration the COVID context. Infection prevention and control supplies were procured and distributed as a package with the bundled vaccines and other supplies. The SIAs were completed in July 2020 and reached 102.8% administrative coverage nationwide, with 78% of the 1123 woredas attaining the target of 95% coverage. The strong commitment of the leadership, the coordination role of the national and regional COVID prevention and control taskforces, the engagement of community leaders, the use of multi-channel communication, the timely availability of additional resources and modification of the service delivery approaches contributed to the success of the SIAs.
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Affiliation(s)
- Mulat Nigus
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | | | - Amsalu Shiferaw
- United Nations Children's Fund (UNICEF), Addis Ababa, Ethiopia
| | | | - Balcha Masresha
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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Masresha BG, Luce R, Shibeshi ME, Ntsama B, N'Diaye A, Chakauya J, Poy A, Mihigo R. The performance of routine immunization in selected African countries during the first six months of the COVID-19 pandemic. Pan Afr Med J 2020; 37:12. [PMID: 33343791 DOI: 10.11604/pamj.supp.2020.37.12.26107] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction following the declaration of the COVID-19 pandemic on 11 March 2020, countries started implementing strict control measures, health workers were re-deployed and health facilities re-purposed to assist COVID-19 control efforts. These measures, along with the public concerns of getting COVID-19, led to a decline in the utilization of regular health services including immunization. Methods we reviewed the administrative routine immunization data from 15 African countries for the period from January 2018 to June 2020 to analyze the trends in the monthly number of children vaccinated with specific antigens, and compare the changes in the first three months of the COVID-19 pandemic. Results thirteen of the 15 countries showed a decline in the monthly average number of vaccine doses provided, with 6 countries having more than 10% decline. Nine countries had a lower monthly mean of recipients of first dose measles vaccination in the second quarter of 2020 as compared to the first quarter. Guinea, Nigeria, Ghana, Angola, Gabon, and South Sudan experienced a drop in the monthly number of children vaccinated for DPT3 and/or MCV1 of greater than 2 standard deviations at some point in the second quarter of 2020 as compared to the mean for the months January-June of 2018 and 2019. Conclusion countries with lower immunization coverage in the pre-COVID period experienced larger declines in the number of children vaccinated immediately after the COVID-19 pandemic was declared. Prolonged and significant reduction in the number of children vaccinated poses a serious risk for outbreaks such as measles. Countries should monitor coverage trends at national and subnational levels, and undertake catch-up vaccination activities to ensure that children who have missed scheduled vaccines receive them at the earliest possible time.
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Affiliation(s)
- Balcha Girma Masresha
- World Health Organization, Regional Office for Africa, Cite de Djoue, Brazzaville, Congo
| | - Richard Luce
- World Health Organization, Inter-Country Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Messeret Eshetu Shibeshi
- World Health Organization, Inter-Country Support Team for East and Southern Africa, Harare, Zimbabwe
| | - Bernard Ntsama
- World Health Organization, Inter-Country Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Abubacar N'Diaye
- World Health Organization, Inter-Country Support Team for Central Africa, Libreville, Gabon
| | - Jethro Chakauya
- World Health Organization, Inter-Country Support Team for East and Southern Africa, Harare, Zimbabwe
| | - Alain Poy
- World Health Organization, Regional Office for Africa, Cite de Djoue, Brazzaville, Congo
| | - Richard Mihigo
- World Health Organization, Regional Office for Africa, Cite de Djoue, Brazzaville, Congo
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Kolie D, Delamou A, van de Pas R, Dioubate N, Bouedouno P, Beavogui AH, Kaba A, Diallo AM, Put WVD, Van Damme W. 'Never let a crisis go to waste': post-Ebola agenda-setting for health system strengthening in Guinea. BMJ Glob Health 2019; 4:e001925. [PMID: 31908867 PMCID: PMC6936556 DOI: 10.1136/bmjgh-2019-001925] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/28/2019] [Accepted: 11/11/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction Guinea is a country with a critical deficit and maldistribution of healthcare workers along with a high risk of epidemics' occurrence. However, actors in the health sector have missed opportunities for more than a decade to attract political attention. This article aims to explain why this situation exists and what were the roles of actors in the agenda-setting process of the post-Ebola health system strengthening programme. It also assesses threats and opportunities for this programme's sustainability. Methods We used Kingdon’s agenda-setting methodological framework to explain why actors promptly focused on the health sector reform after the Ebola outbreak. We conducted a qualitative explanatory study using a literature review and key informant interviews. Results We found that, in the problem stream, the Ebola epidemic caused considerable fear among national as well as international actors, a social crisis and an economic system failure. This social crisis was entertained by communities’ suspicion of an 'Ebola-business'. In response to these problems, policy actors identified three sets of solutions: the temporary external funds generated by the Ebola response; the availability of experienced health workers in the Ebola control team; and the overproduction of health graduates in the labour market. We also found that the politics agenda was dominated by two major factors: the global health security agenda and the political and financial interests of national policy actors. Although the opening of the policy window has improved human resources, finance and logistics, and infrastructures pillars of the health system, it, however, disproportionally focuses on epidemic preparedness and response. and neglects patients’ financial affordability of essential health services. Conclusion Domestic policy entrepreneurs must realise that agenda-setting of health issues in the Guinean context strongly depends on the construction of the problem definition and how this is influenced by international actors.
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Affiliation(s)
- Delphin Kolie
- Research, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Alexandre Delamou
- Research, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.,Department of Public Health, University of Conakry, Conakry, Guinea
| | - Remco van de Pas
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Nafissatou Dioubate
- Research, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Patrice Bouedouno
- Research, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Abdoul Habib Beavogui
- Research, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Abdoulaye Kaba
- Bureau de Stratégie et de Développement, Ministère de la Santé, Conakry, Guinea
| | | | - Willem Van De Put
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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O’Connor DJ, Buckland J, Almond N, Boyle J, Coxon C, Gaki E, Martin J, Mattiuzzo G, Metcalfe C, Page M, Rose N, Valdazo-Gonzalez B, Zhao Y, Schneider CK. Commonly setting biological standards in rare diseases. Expert Opin Orphan Drugs 2019. [DOI: 10.1080/21678707.2019.1652598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
| | - Jenny Buckland
- National Institute for Biological Standards and Control (NIBSC), Blanche Ln, South Mimms, Potters Bar, UK
| | - Neil Almond
- National Institute for Biological Standards and Control (NIBSC), Blanche Ln, South Mimms, Potters Bar, UK
| | - Jennifer Boyle
- National Institute for Biological Standards and Control (NIBSC), Blanche Ln, South Mimms, Potters Bar, UK
| | - Carmen Coxon
- National Institute for Biological Standards and Control (NIBSC), Blanche Ln, South Mimms, Potters Bar, UK
| | - Eleni Gaki
- Medicines & Healthcare products Regulatory Agency (MHRA), London, UK
| | - Javier Martin
- National Institute for Biological Standards and Control (NIBSC), Blanche Ln, South Mimms, Potters Bar, UK
| | - Giada Mattiuzzo
- National Institute for Biological Standards and Control (NIBSC), Blanche Ln, South Mimms, Potters Bar, UK
| | - Clive Metcalfe
- National Institute for Biological Standards and Control (NIBSC), Blanche Ln, South Mimms, Potters Bar, UK
| | - Mark Page
- National Institute for Biological Standards and Control (NIBSC), Blanche Ln, South Mimms, Potters Bar, UK
| | - Nicola Rose
- National Institute for Biological Standards and Control (NIBSC), Blanche Ln, South Mimms, Potters Bar, UK
| | - Begona Valdazo-Gonzalez
- National Institute for Biological Standards and Control (NIBSC), Blanche Ln, South Mimms, Potters Bar, UK
| | - Yuan Zhao
- National Institute for Biological Standards and Control (NIBSC), Blanche Ln, South Mimms, Potters Bar, UK
| | - Christian K. Schneider
- National Institute for Biological Standards and Control (NIBSC), Blanche Ln, South Mimms, Potters Bar, UK
- Twincore Centre for Experimental and Clinical Infection Research GmbH, Hannover, Germany
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