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Zuber PLF, Gruber M, Kaslow DC, Chen RT, Giersing BK, Friede MH. Evolving pharmacovigilance requirements with novel vaccines and vaccine components. BMJ Glob Health 2021; 6:bmjgh-2020-003403. [PMID: 34011500 PMCID: PMC8137242 DOI: 10.1136/bmjgh-2020-003403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/04/2020] [Accepted: 08/09/2020] [Indexed: 01/08/2023] Open
Abstract
This paper explores the pipeline of new and upcoming vaccines as it relates to monitoring their safety. Compared with most currently available vaccines, that are constituted of live attenuated organisms or inactive products, future vaccines will also be based on new technologies. Several products that include such technologies are either already licensed or at an advanced stage of clinical development. Those include viral vectors, genetically attenuated live organisms, nucleic acid vaccines, novel adjuvants, increased number of antigens present in a single vaccine, novel mode of vaccine administration and thermostabilisation. The Global Advisory Committee on Vaccine Safety (GACVS) monitors novel vaccines, from the time they become available for large scale use. GACVS maintains their safety profile as evidence emerges from post-licensure surveillance and observational studies. Vaccines and vaccine formulations produced with novel technologies will have different safety profiles that will require adapting pharmacovigilance approaches. For example, GACVS now considers viral vector templates developed on the model proposed by Brighton Collaboration. The characteristics of those novel products will also have implications for the risk management plans (RMPs). Questions related to the duration of active monitoring for genetic material, presence of adventitious agents more easily detected with enhanced biological screening, or physiological mechanisms of novel adjuvants are all considerations that will belong to the preparation of RMPs. In addition to assessing those novel products and advising experts, GACVS will also consider how to more broadly communicate about risk assessment, so vaccine users can also benefit from the committee’s advice.
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Affiliation(s)
- Patrick L F Zuber
- Access to Medicines and Health Products Division, World Health Organization, Geneva, Switzerland
| | - Marion Gruber
- Center for Biologics Evaluation and Research, Food and Drugs Administration, Silver Spring, Massachusetts, USA
| | | | - Robert T Chen
- Brighton Collaboration, Task Force for Global Health, Decatur, Georgia, USA
| | - Brigitte K Giersing
- Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | - Martin H Friede
- Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
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Gesualdo F, Marino F, Mantero J, Spadoni A, Sambucini L, Quaglia G, Rizzo C, Sahinovic I, Zuber PLF, Tozzi AE. The use of web analytics combined with other data streams for tailoring online vaccine safety information at global level: The Vaccine Safety Net's web analytics project. Vaccine 2020; 38:6418-6426. [PMID: 32788137 DOI: 10.1016/j.vaccine.2020.07.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 07/22/2020] [Accepted: 07/31/2020] [Indexed: 11/26/2022]
Abstract
The Vaccine Safety Net's Web Analytics Project (VSN-WAP) was launched in October 2017 to monitor the behavior of users visiting websites belonging to the VSN, a global network of websites providing science-based information on vaccine safety. Participating websites could provide web metrics in two ways: through a Google Analytics (GA) script, which automatically forwarded metrics to a central account and through manual input (MI) of a reduced subset of metrics (Sessions, Page Views, New Users, Bounce Rate, Views/Session and Average Session Duration), which were pooled with the metrics obtained through GA. Additional metrics were obtained from websites providing data through Google Analytics (Country, Age, Sex, Device). We report results from February 2018 to March 2019. In March 2019, 32 websites were participating in the project (21 through GA, 11 through MI). From February 2018 to March 2019 we recorded 22,471,535 sessions, with 38,307,349 page views. Sessions, New Users and Page views progressively increased, Views/Session, Bounce Rate and Average Session Duration remained stable. Most users were female (68%) and belonged to the 25-34 age range (37%), followed by 35-44 (22%) and 18-24 (19%). Fifty-four percent of users connected from a mobile device, 42% from a desktop and 4% from a tablet. Digital media monitoring techniques can provide insights on the characteristics of users with a specific interest in vaccines. These data can be exploited to improve the performance of websites providing information on vaccines to the general public.
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Affiliation(s)
| | | | - Jas Mantero
- Bambino Gesù Children's Hospital, Rome, Italy
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3
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Das MK, Arora NK, Gupta B, Sharan A, Kameswari K, Padmalatha P, Prasad GR, Shad J, Shyamala J, Harish Kumar S, Nagender Y, Sharmila K, Shad R, Garge S, Bharadia L, Gupta A, Goswami JK, Lahiri K, Sankhe L, Mane S, Patwari YP, Ajayakumar MK, Santhosh Kumar A, Sarangi R, Tripathy BB, Mohapatra SSG, Sahoo SK, Kumar V, Kumar R, Sarkar S, Sarkar R, Sarkar NR, Wakhlu A, Ratan SK, Dubey AP, Mohan N, Luthra M, Vyas BR, Trivedi H, Mathai J, Sam CJ, Jothilakshmi K, Arunachalam P, Bhat JI, Mufti G, Charoo BA, Jena PK, Debbarma SK, Ghosh SK, Aggarwal MK, Haldar P, Zuber PLF, Maure C, Bonhoeffer J, Ray A. Intussusception in children aged under two years in India: Retrospective surveillance at nineteen tertiary care hospitals. Vaccine 2020; 38:6849-6857. [PMID: 32553492 PMCID: PMC7528221 DOI: 10.1016/j.vaccine.2020.04.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 11/28/2022]
Abstract
Objective Intussusception has been linked with rotavirus vaccine (RVV) as a rare adverse reaction. In view of limited background data on intussusception in India and in preparation for RVV introduction, a surveillance network was established to document the epidemiology of intussusception cases in Indian children. Methods Intussusception in children 2–23 months were documented at 19 nationally representative sentinel hospitals through a retrospective surveillance for 69 months (July 2010 to March 2016). For each case clinical, hospital course, treatment and outcome data were collected. Results Among the 1588 intussusception cases, 54.5% were from South India and 66.3% were boys. The median age was 8 months (IQR 6, 12) with 34.6% aged 2–6 months. Seasonal variation with higher cases were documented during March-June period. The most common symptoms and signs were vomiting (63.4%), bloody stool (49.1%), abdominal pain (46.9%) and excessive crying (42.8%). The classical triad (vomiting, abdominal pain, and blood in stools) was observed in 25.6% cases. 96.4% cases were diagnosed by ultrasound with ileocolic location as the commonest (85.3%). Management was done by reduction (50.8%) and surgery (41.1%) and only 1% of the patients’ died. 91.1% cases met Brighton criteria level 1 and 3.3% Level 2. Between 2010 and 2015, the case load and case ratio increased across all regions. Conclusion Intussusception cases have occurred in children across all parts of the country, with low case fatality in the settings studied. The progressive rise cases could indicate an increasing awareness and availability of diagnostic facilities.
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Affiliation(s)
| | | | - Bini Gupta
- The INCLEN Trust International, New Delhi, India.
| | | | - K Kameswari
- Andhra Medical College, Vishakhapatnam, Andhra Pradesh, India.
| | - P Padmalatha
- Andhra Medical College, Vishakhapatnam, Andhra Pradesh, India.
| | | | - Jimmy Shad
- Apollo Hospitals, Chennai, Tamil Nadu, India.
| | - J Shyamala
- Apollo Hospitals, Chennai, Tamil Nadu, India.
| | | | | | - K Sharmila
- Apollo Hospital, Hyderabad, Telengana, India.
| | - Rashmi Shad
- Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India.
| | - Saurabh Garge
- Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India.
| | | | - Atul Gupta
- Fortis Escorts Hospital, Jaipur, Rajasthan, India.
| | | | | | - Lalit Sankhe
- Grant Medical College & JJ Hospital, Mumbai, Maharashtra, India.
| | - Sushant Mane
- Grant Medical College & JJ Hospital, Mumbai, Maharashtra, India.
| | | | - M K Ajayakumar
- Government Medical College & SAT Hospital, Thiruvananthapuram, Kerala, India.
| | - A Santhosh Kumar
- Government Medical College & SAT Hospital, Thiruvananthapuram, Kerala, India.
| | - Rachita Sarangi
- IMS & SUM Medical College & Hospital, Bhubaneswar, Odisha, India.
| | | | - S S G Mohapatra
- IMS & SUM Medical College & Hospital, Bhubaneswar, Odisha, India.
| | | | - Vijayendra Kumar
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
| | - Rakesh Kumar
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
| | - Suman Sarkar
- Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
| | - Ruchirendu Sarkar
- Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
| | - Nihar Ranjan Sarkar
- Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
| | - Ashish Wakhlu
- King George's Medical University, Lucknow, Uttar Pradesh, India.
| | | | | | | | | | - Bhadresh R Vyas
- MP Shah Government Medical College, Jamnagar, Gujarat, India.
| | - Harsh Trivedi
- MP Shah Government Medical College, Jamnagar, Gujarat, India.
| | - John Mathai
- PSG Institute of Medical Sciences, Coimbatore, Tamil Nadu, India.
| | - Cenita J Sam
- PSG Institute of Medical Sciences, Coimbatore, Tamil Nadu, India.
| | - K Jothilakshmi
- PSG Institute of Medical Sciences, Coimbatore, Tamil Nadu, India.
| | | | - Javeed Iqbal Bhat
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India.
| | - Gowhar Mufti
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India.
| | - Bashir Ahmad Charoo
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India.
| | - Pradeep K Jena
- SCB Medical College and SVP Postgraduate Institute of Paediatrics, Cuttack, Odisha, India.
| | | | - Sunil K Ghosh
- Agartala Government Medical College, Agartala, Tripura, India.
| | - Mahesh K Aggarwal
- Ministry of Health & Family Welfare, Government of India, New Delhi, India.
| | - Pradeep Haldar
- Ministry of Health & Family Welfare, Government of India, New Delhi, India.
| | | | | | - Jan Bonhoeffer
- University of Basel Children's Hospital, Basel, Switzerland.
| | - Arindam Ray
- Bill and Melinda Gates Foundation, India Country Office, New Delhi, India.
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Mungwira RG, Guillard C, Saldaña A, Okabe N, Petousis-Harris H, Agbenu E, Rodewald L, Zuber PLF. Global landscape analysis of no-fault compensation programmes for vaccine injuries: A review and survey of implementing countries. PLoS One 2020; 15:e0233334. [PMID: 32437376 PMCID: PMC7241762 DOI: 10.1371/journal.pone.0233334] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 04/06/2020] [Indexed: 11/21/2022] Open
Abstract
To update the landscape analysis of vaccine injuries no-fault compensation programmes, we conducted a scoping review and a survey of World Health Organization Member States. We describe the characteristics of existing no-fault compensation systems during 2018 based on six common programme elements. No-fault compensation systems for vaccine injuries have been developed in a few high-income countries for more than 50 years. Twenty-five jurisdictions were identified with no-fault compensation programmes, of which two were recently implemented in a low- and a lower-middle-income country. The no-fault compensation programmes in most jurisdictions are implemented at the central or federal government level and are government funded. Eligibility criteria for vaccine injury compensation vary considerably across the evaluated programmes. Notably, most programmes cover injuries arising from vaccines that are registered in the country and are recommended by authorities for routine use in children, pregnant women, adults (e.g. influenza vaccines) and for special indications. A claim process is initiated once the injured party or their legal representative files for compensation with a special administrative body in most programmes. All no-fault compensation programmes reviewed require standard of proof showing a causal association between vaccination and injury. Once a final decision has been reached, claimants are compensated with either: lump-sums; amounts calculated based on medical care costs and expenses, loss of earnings or earning capacity; or monetary compensation calculated based on pain and suffering, emotional distress, permanent impairment or loss of function; or combination of those. In most jurisdictions, vaccine injury claimants have the right to seek damages either through civil litigation or from a compensation scheme but not both simultaneously. Data from this report provide an empirical basis on which global guidance for implementing such schemes could be developed.
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Affiliation(s)
- Randy G. Mungwira
- Department of Molecular Medicine and Development, University of Siena, Siena, Italy
- * E-mail:
| | - Christine Guillard
- Access to Medicines and Health Products Division, World Health Organization, Geneva, Switzerland
| | | | - Nobuhiko Okabe
- Kawasaki City Institute for Public Health, Kawasaki-City, Japan
| | | | - Edinam Agbenu
- World Health Organization, Ouagadougou, Burkina Faso
| | - Lance Rodewald
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Patrick L. F. Zuber
- Access to Medicines and Health Products Division, World Health Organization, Geneva, Switzerland
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Gold MS, MacDonald NE, McMurtry CM, Balakrishnan MR, Heininger U, Menning L, Benes O, Pless R, Zuber PLF. Immunization stress-related response - Redefining immunization anxiety-related reaction as an adverse event following immunization. Vaccine 2020; 38:3015-3020. [PMID: 32131975 DOI: 10.1016/j.vaccine.2020.02.046] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 12/13/2022]
Abstract
The Council for the International Organizations of Medical Sciences (CIOMS) and WHO working group on pharmacovigilance defines five cause specific AEFI which includes an immunization anxiety-related reaction. Historically this term has been used to describe a range of symptoms and signs that may arise after immunization that are related to "anxiety" about the immunization. However, the term "anxiety" does not adequately capture all the elements of this cause specific AEFI. In 2015, the Global Advisory Committee for Vaccine Safety convened an expert working group with the purpose of redefining, preventing and managing this particular AEFI. The term "Immunization Stress-Related Response" is proposed to replace the former terminology. We present a manual that redefines this AEFI and present a framework for prevention, diagnosis and management in both an individual and also when such events occur as clusters and affect multiple individuals. Since such mass events can result in cessation of immunization programmes and/or a loss of public confidence, a communication response is essential.
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Affiliation(s)
- Michael S Gold
- Discipline of Paediatrics, School of Medicine, University of Adelaide, Australia.
| | - Noni E MacDonald
- Department of Paediatrics, Dalhousie University, IWK Health Centre, Halifax, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph and Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Madhava Ram Balakrishnan
- Department of Essential Medicines and Health Products (EMP), World Health Organization, Genève, Switzerland
| | - Ulrich Heininger
- Division of Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Lisa Menning
- Expanded Programme on Immunization, World Health Organisation, Geneva, Switzerland
| | - Oleg Benes
- Regional Office Europe, World Health Organisation, Denmark
| | - Robert Pless
- Clinical Evaluation Division, Vaccines/Blood Biologics and Genetic Therapies Directorate, Health Canada, Canada
| | - Patrick L F Zuber
- Department of Essential Medicines and Health Products (EMP), World Health Organization, Genève, Switzerland
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Mungwira RG, Maure CG, Zuber PLF. Economic and immunisation safety surveillance characteristics of countries implementing no-fault compensation programmes for vaccine injuries. Vaccine 2019; 37:4370-4375. [PMID: 31213377 DOI: 10.1016/j.vaccine.2019.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 11/24/2022]
Abstract
Improvements in vaccine safety surveillance and investigative capacity lead to identification of rare reactions attributable to vaccination. As a result, the issue of fair compensation for those who experience vaccine injuries is gaining growing attention. Although vaccine injury compensation programmes (VICP) have been developed in a few countries for more than 50 years, no global policy guidance to guide vaccine injury compensation in all countries wishing to adopt such compensation schemes is currently available. To update the landscape analysis of no-fault compensation programmes and characterize VICP implementing countries, we conducted a survey of all 194 Member States from the World Health Organization and received feedback from 151. This analysis describes the economic and vaccine safety surveillance characteristics of Member States implementing VICPs. This analysis describes the characteristics of 25 Member States implementing a compensation programmes. Characteristics examined include economic, vaccination and safety surveillance indicators. Twenty of the 25 Member States (80%) with compensation programmes are categorized as high-income countries, 20/25 (80%) met the Global Vaccine Action Plan (GVAP) safety indicator of reporting at least ten annual reports of adverse events following immunization per 100,000 population, 21/25 (84%) met the GVAP coverage indicator by achieving greater than 90% third dose of Diphtheria, Tetanus and Pertussis vaccine (DTP3) and 17/25 (68%) assessed vaccine hesitancy in 2017. All Member States with VICP have a national immunization technical advisory group. This study identified growing interest in the implementation of no-fault compensation programs beyond high-income countries. Global policies guiding compensation should be developed for countries regardless of the maturity of their immunization programmes. RESEARCH IN CONTEXT: As a result of improved vaccine safety surveillance, World Health Organization (WHO) Member States are facing situations where known untoward serious vaccine reactions are documented, including in low- and middle-income settings. This has led to increased interest for the development of national no-fault compensation policies for vaccine injuries. As of 2010, compensation schemes for vaccine related injuries had been identified and characterized in 19 out of 194 WHO member states. All these programmes were in the industrialized world with none in low- and middle-income countries. Previous reviews have described the characteristics of the existing programmes based on the six common elements identified by Evans in 1999 with less emphasis on characteristics from countries implementing these no-fault compensation programmes. This manuscript aimed to identify predictors of countries implementing no-fault compensation programmes for vaccine injuries and update the inventory of existing programmes as part of a more comprehensive global landscape evaluation of existing programmes. This information will be useful for country self-evaluation and future compensation policy formulation as discussion to develop policies guiding the implementation of vaccine injury compensation continues to gain growing attention.
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Affiliation(s)
| | - Christine Guillard Maure
- Global Vaccine Safety Group, Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland.
| | - Patrick L F Zuber
- Global Vaccine Safety Group, Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland.
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7
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Zuber PLF, Moran AC, Chou D, Renaud F, Halleux C, Peña-Rosas JP, Viswanathan K, Lackritz E, Jakob R, Mason E, Lamprianou S, Guillard-Maure C. Mapping the landscape of global programmes to evaluate health interventions in pregnancy: the need for harmonised approaches, standards and tools. BMJ Glob Health 2018; 3:e001053. [PMID: 30364289 PMCID: PMC6195154 DOI: 10.1136/bmjgh-2018-001053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/11/2018] [Indexed: 01/31/2023] Open
Abstract
Pregnant women and their babies are among the populations most vulnerable to untoward health outcomes. Yet current standards for evaluating health interventions cannot be met during pregnancy because of lack of adequate evidence. The situation is even more concerning in low-income and middle-income countries, where the need for effective interventions is the greatest. Meeting the Sustainable Development Goals for health will require strengthened attention to maternal and child health. In this paper we examine ongoing initiatives aimed at improving the assessment of maternal interventions. We review current methodologies to monitor outcomes of maternal interventions and identify where harmonisation is needed. Based on this analysis we identify settings where different minimal data sets should be considered taking into consideration the clinical realities. Stronger coordination mechanisms and a roadmap to support harmonised monitoring of maternal interventions across programmes and partners, working on improving pregnancy and early childhood health events, will greatly enhance ability to generate evidence-based policies.
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Affiliation(s)
- Patrick L F Zuber
- Safety and Vigilance, Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Allisyn C Moran
- Department of Epidemiology, Monitoring and Evaluation, Department of Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland
| | - Doris Chou
- Adolescents and at-Risk Populations, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Françoise Renaud
- Strategic Information and Planning, Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Christine Halleux
- Intervention and Implementation Research, Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Juan Pablo Peña-Rosas
- Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Kavitha Viswanathan
- Global Platform for Measurement and Accountability, Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Eve Lackritz
- High Threat Pathogens, Department of Infectious Hazard Management, World Health Organization, Geneva, Switzerland
| | - Robert Jakob
- Data Standards and Informatics, Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | | | - Smaragda Lamprianou
- Safety and Vigilance, Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Christine Guillard-Maure
- Safety and Vigilance, Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
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8
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Das MK, Arora NK, Bonhoeffer J, Zuber PLF, Maure CG. Intussusception in Young Children: Protocol for Multisite Hospital Sentinel Surveillance in India. Methods Protoc 2018; 1:mps1020011. [PMID: 31164556 PMCID: PMC6526440 DOI: 10.3390/mps1020011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 11/23/2022] Open
Abstract
India has recently introduced a rotavirus vaccine under a universal immunization program. There is limited information on intussusception, an adverse event, following immunization in children from India. We are conducting sentinel surveillance for intussusception in children aged under two years at 19 hospitals. The sentinel sites’ selection followed a multistage process. The surveillance combines retrospective surveillance for 69 months and prospective surveillance for 18 months. The suspected intussusception cases shall be reviewed for capturing confirmed cases and detailed data collection and classification according to Brighton Collaboration criteria. Data shall be analysed to describe epidemiology, trends, regional and seasonal variations, clinical profiles, management modalities, and outcomes of intussusception. The combination of prospective and retrospective surveillance shall be informative about the trend of intussusception over the last seven years in India. At four sites where rotavirus vaccines have been introduced, the change in intussusception trends shall be documented. The potential association with rotavirus vaccines and other vaccines shall be assessed using case-control and self-controlled case series methodology. Results are forthcoming. The results shall support the national vaccine safety surveillance effort by providing baseline estimates of intussusception for continued monitoring. The surveillance protocol and site selection processes shall inform similar vaccine-safety surveillance in India and other developing countries.
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Affiliation(s)
| | | | - Jan Bonhoeffer
- University Children's Hospital (UKBB), University of Basel, 4056 Basel, Switzerland.
- Coordinator, Brighton Collaboration Foundation, 4056 Basel, Switzerland.
| | - Patrick L F Zuber
- Department of Essential Medicines and Health Products, World Health Organization, 1211 Geneva 27, Switzerland.
| | - Christine G Maure
- Department of Essential Medicines and Health Products, World Health Organization, 1211 Geneva 27, Switzerland.
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Lei J, Balakrishnan MR, Gidudu JF, Zuber PLF. Use of a new global indicator for vaccine safety surveillance and trends in adverse events following immunization reporting 2000-2015. Vaccine 2018; 36:1577-1582. [PMID: 29454518 PMCID: PMC5857292 DOI: 10.1016/j.vaccine.2018.02.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 01/26/2018] [Accepted: 02/03/2018] [Indexed: 11/30/2022]
Abstract
Reporting of adverse events following immunization (AEFI) is a key component for functional vaccine safety monitoring system. The aim of our study is to document trends in the AEFI reporting ratio globally and across the six World Health Organization (WHO) regions. We describe the number of AEFI reports communicated each year through the World Health Organization/United Nations Children's Fund Joint Reporting Form on Immunization from 2000 to 2015. The AEFI reporting ratios (annual AEFI reports per 100,000 surviving infants) were calculated to identify WHO countries (n = 191 in 2000 and n = 194 by 2015) that met a minimal reporting ratio of 10, a target set by the Global Vaccine Action Plan for vaccine safety monitoring as a proxy measure for a functional AEFI reporting system. The number of countries reporting any AEFI fluctuated over time but with progress from 32 (17%) in 2000 to 124 (64%) in 2015. In 2015, the global average AEFI reporting ratio was 549 AEFI reports per 100,000 surviving infants. The number of countries with AEFI reporting ratios greater than 10 increased from 8 (4%) in 2000 to 81 (42%) in 2015. In 2015, 60% of countries in the WHO Region of the Americas reported at least 10 AEFI per 100,000 surviving infants, followed by 55% in European Region, 43% in Eastern Mediterranean Region, 33% in Western Pacific Region, 27% in South-East Asia Region and 21% in African Region. Overall, AEFI reporting has increased over the past sixteen years worldwide, but requires strengthening in a majority of low- and middle- income countries. The AEFI reporting ratio is useful for benchmarking and following trends over time; but does not provide information on the quality of the reporting system and does not guarantee capacity to detect and manage a vaccine safety problem at a national level. Additional efforts are required to ensure and improve data quality, AEFI reporting and surveillance of immunization safety in every country.
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Affiliation(s)
- Jiayao Lei
- Karolinska Institutet, Stockholm, Sweden
| | | | - Jane F Gidudu
- Centers for Disease Control and Prevention, Atlanta, GA, United States
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Bravo-Alcántara P, Pérez-Vilar S, Molina-León HF, Sturkenboom M, Black S, Zuber PLF, Maure C, Castro JL. Building capacity for active surveillance of vaccine adverse events in the Americas: A hospital-based multi-country network. Vaccine 2017; 36:363-370. [PMID: 28803714 DOI: 10.1016/j.vaccine.2017.04.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/11/2017] [Accepted: 04/17/2017] [Indexed: 12/01/2022]
Abstract
New vaccines designed to prevent diseases endemic in low and middle-income countries are being introduced without prior utilization in countries with robust vaccine pharmacovigilance systems. Our aim was to build capacity for active surveillance of vaccine adverse events in the Americas. We describe the implementation of a proof-of-concept study for the feasibility of an international collaborative hospital-based active surveillance system for vaccine safety. The study was developed and implemented in 15 sentinel sites located in seven countries of the region of the Americas, under the umbrella of the World Health Organization (WHO) Global Vaccine Safety Initiative. The study evaluated the associations between measles-mumps-rubella vaccines and two well-recognized adverse events: Immune thrombocytopenic purpura (ITP) and aseptic meningitis. The regional network contributed 63 confirmed ITP and 16 confirmed aseptic meningitis eligible cases to the global study, representing, respectively, 33% and 19% of the total cases. To ensure long-term sustainability and usefulness to investigate adverse events following new vaccine introductions in low and middle-income countries, the network needs to be strengthened with additional sites and integrated into national health systems.
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Affiliation(s)
- Pamela Bravo-Alcántara
- Unit of Comprehensive Family Immunization, Department of Family, Gender and Life Course, Pan American Health Organization (PAHO/WHO), Washington DC, DC, United States
| | - Silvia Pérez-Vilar
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands; International Professional Consultant, Pan American Health Organization (PAHO/WHO), Washington DC, DC, United States.
| | - Helvert Felipe Molina-León
- International Professional Consultant, Pan American Health Organization (PAHO/WHO), Washington DC, DC, United States
| | - Miriam Sturkenboom
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands; Vaccine.GRID Foundation, Basel, Switzerland
| | - Steven Black
- Vaccine.GRID Foundation, Basel, Switzerland; Department of Global Child Health, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Patrick L F Zuber
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Christine Maure
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Jose Luis Castro
- Unit of Medicines and Health Technologies, Department of Health Systems and Services, Pan American Health Organization (PAHO/WHO), Washington DC, DC, United States
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11
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Guillard-Maure C, Elango V, Black S, Perez-Vilar S, Castro JL, Bravo-Alcántara P, Molina-León HF, Weibel D, Sturkenboom M, Zuber PLF. Operational lessons learned in conducting a multi-country collaboration for vaccine safety signal verification and hypothesis testing: The global vaccine safety multi country collaboration initiative. Vaccine 2017; 36:355-362. [PMID: 28780118 DOI: 10.1016/j.vaccine.2017.07.085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 11/18/2022]
Abstract
Timely and effective evaluation of vaccine safety signals for newly developed vaccines introduced in low and middle- income countries (LMICs) is essential. The study tested the development of a global network of hospital-based sentinel sites for vaccine safety signal verification and hypothesis testing. Twenty-six sentinel sites in sixteen countries across all WHO regions participated, and 65% of the sites were from LMIC. We describe the process for the establishment and operationalization of such a network and the lessons learned in conducting a multi-country collaborative initiative. 24 out of the 26 sites successfully contributed data for the global analysis using standardised tools and procedures. Our study successfully confirmed the well-known risk estimates for the outcomes of interest. The main challenges faced by investigators were lack of adequate information in the medical records for case ascertainment and classification, and access to immunization data. The results suggest that sentinel hospitals intending to participate in vaccine safety studies strengthen their systems for discharge diagnosis coding, medical records and linkage to vaccination data. Our study confirms that a multi-country hospital-based network initiative for vaccine safety monitoring is feasible and demonstrates the validity and utility of large collaborative international studies to monitor the safety of new vaccines introduced in LMICs.
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Affiliation(s)
- Christine Guillard-Maure
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland.
| | - Varalakshmi Elango
- International Professional Consultant, World Health Organization, Geneva, Switzerland
| | - Steven Black
- Center for Global Child Health, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; VACCINE.GRID Foundation, Basel, Switzerland
| | - Silvia Perez-Vilar
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands; Vaccine Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO, Valencia, Spain
| | - Jose Luis Castro
- Unit of Medicines and Health Technologies, Department of Health Systems and Services, Pan American Health Organization (PAHO/WHO), Washington DC, DC, United States
| | - Pamela Bravo-Alcántara
- Unit of Comprehensive Family Immunization, Department of Family, Gender and Life Course, Pan American Health Organization (PAHO/WHO), Washington DC, DC, United States
| | - Helvert Felipe Molina-León
- International Professional Consultant, Pan American Health Organization (PAHO/WHO), Washington DC, DC, United States
| | - Daniel Weibel
- VACCINE.GRID Foundation, Basel, Switzerland; Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Miriam Sturkenboom
- VACCINE.GRID Foundation, Basel, Switzerland; Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands; Utrecht University Medical Center, Julius Global Health, The Netherlands
| | - Patrick L F Zuber
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
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12
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Perez-Vilar S, Weibel D, Sturkenboom M, Black S, Maure C, Castro JL, Bravo-Alcántara P, Dodd CN, Romio SA, de Ridder M, Nakato S, Molina-León HF, Elango V, Zuber PLF. Enhancing global vaccine pharmacovigilance: Proof-of-concept study on aseptic meningitis and immune thrombocytopenic purpura following measles-mumps containing vaccination. Vaccine 2017; 36:347-354. [PMID: 28558983 DOI: 10.1016/j.vaccine.2017.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 05/02/2017] [Accepted: 05/04/2017] [Indexed: 11/16/2022]
Abstract
New vaccines designed to prevent diseases endemic in low and middle-income countries (LMICs) are now being introduced without prior record of utilization in countries with robust pharmacovigilance systems. To address this deficit, our objective was to demonstrate feasibility of an international hospital-based network for the assessment of potential epidemiological associations between serious and rare adverse events and vaccines in any setting. This was done through a proof-of-concept evaluation of the risk of immune thrombocytopenic purpura (ITP) and aseptic meningitis (AM) following administration of the first dose of measles-mumps-containing vaccines using the self-controlled risk interval method in the primary analysis. The World Health Organization (WHO) selected 26 sentinel sites (49 hospitals) distributed in 16 countries of the six WHO regions. Incidence rate ratios (IRR) of 5.0 (95% CI: 2.5-9.7) for ITP following first dose of measles-containing vaccinations, and of 10.9 (95% CI: 4.2-27.8) for AM following mumps-containing vaccinations were found. The strain-specific analyses showed significantly elevated ITP risk for measles vaccines containing Schwarz (IRR: 20.7; 95% CI: 2.7-157.6), Edmonston-Zagreb (IRR: 11.1; 95% CI: 1.4-90.3), and Enders'Edmonston (IRR: 8.5; 95% CI: 1.9-38.1) strains. A significantly elevated AM risk for vaccines containing the Leningrad-Zagreb mumps strain (IRR: 10.8; 95% CI: 1.3-87.4) was also found. This proof-of-concept study has shown, for the first time, that an international hospital-based network for the investigation of rare vaccine adverse events, using common standardized procedures and with high participation of LMICs, is feasible, can produce reliable results, and has the potential to characterize differences in risk between vaccine strains. The completion of this network by adding large reference hospitals, particularly from tropical countries, and the systematic WHO-led implementation of this approach, should permit the rapid post-marketing evaluation of safety signals for serious and rare adverse events for new and existing vaccines in all settings, including LMICs.
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Affiliation(s)
- Silvia Perez-Vilar
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands; Vaccine Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO, Valencia, Spain.
| | - Daniel Weibel
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands; VACCINE.GRID Foundation, Basel, Switzerland
| | - Miriam Sturkenboom
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands; VACCINE.GRID Foundation, Basel, Switzerland
| | - Steven Black
- VACCINE.GRID Foundation, Basel, Switzerland; Center for Global Child Health, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Christine Maure
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Jose Luis Castro
- Unit of Medicines and Health Technologies, Department of Health Systems and Services, Pan American Health Organization (PAHO/WHO), Washington DC, DC, United States
| | - Pamela Bravo-Alcántara
- Unit of Comprehensive Family Immunization, Department of Family, Gender and Life Course, Pan American Health Organization (PAHO/WHO), Washington DC, DC, United States
| | - Caitlin N Dodd
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Silvana A Romio
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Maria de Ridder
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Swabra Nakato
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Helvert Felipe Molina-León
- International Professional Consultant, Pan American Health Organization (PAHO/WHO), Washington DC, DC, United States
| | - Varalakshmi Elango
- International Professional Consultant, World Health Organization, Geneva, Switzerland
| | - Patrick L F Zuber
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
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13
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Diomandé FVK, Yaméogo TM, Vannice KS, Preziosi MP, Viviani S, Ouandaogo CR, Keita M, Djingarey MH, Mbakuliyemo N, Akanmori BD, Sow SO, Zuber PLF. Lessons Learned From Enhancing Vaccine Pharmacovigilance Activities During PsA-TT Introduction in African Countries, 2010-2013. Clin Infect Dis 2016; 61 Suppl 5:S459-66. [PMID: 26553675 PMCID: PMC4639501 DOI: 10.1093/cid/civ599] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background. The rollout of the group A meningococcal vaccine, PsA-TT, in Africa's meningitis belt countries represented the first introduction of a vaccine specifically designed for this part of the world. During the first year alone, the number of people who received the vaccine through mass vaccination campaigns was several hundredfold higher than that of subjects who participated in the closely monitored clinical trials. Implementation of a system to identify rare but potentially serious vaccine reactions was therefore a high priority in the design and implementation of those campaigns. Methods. National authorities and their technical partners set up effective vaccine pharmacovigilance systems, including conducting active surveillance projects. Results. Implementation of national expert advisory groups to review serious adverse events following immunization in all countries and active monitoring of conditions of interest in 3 early-adopter countries did not identify particular concerns with the safety profile of PsA-TT, which had already provided tremendous public health benefits. Conclusions. Lessons learned from this experience will help to improve preparations for future vaccine introductions in resource-poor settings and capitalize on such efforts to advance vaccine safety systems in the future.
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Affiliation(s)
| | - Téné M Yaméogo
- Institut Supérieur des Sciences de la Santé, Université Polytechnique de Bobo-Dioulasso, Burkina Faso
| | - Kirsten S Vannice
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Marie-Pierre Preziosi
- Meningitis Vaccine Project, PATH, Ferney-Voltaire, France Meningitis Vaccine Project, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | | | - Claude-Roger Ouandaogo
- Direction Générale de la Pharmacie du Médicament et des Laboratoire, Ministère de la santé, Ouagadougou, Burkina Faso
| | - Modibo Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Mamoudou H Djingarey
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Nehemie Mbakuliyemo
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Bartholomew Dicky Akanmori
- Department of Immunization Vaccines and Emergency, World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Patrick L F Zuber
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
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14
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Vannice KS, Keita M, Sow SO, Durbin AP, Omer SB, Moulton LH, Yaméogo TM, Zuber PLF, Onwuchekwa U, Sacko M, Diomandé FVK, Halsey NA. Active Surveillance for Adverse Events After a Mass Vaccination Campaign With a Group A Meningococcal Conjugate Vaccine (PsA-TT) in Mali. Clin Infect Dis 2016; 61 Suppl 5:S493-500. [PMID: 26553680 PMCID: PMC4639483 DOI: 10.1093/cid/civ497] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The monovalent meningococcal A conjugate vaccine (PsA-TT, MenAfriVac) was developed for use in the "meningitis belt" of sub-Saharan Africa. Mali was 1 of 3 countries selected for early introduction. As this is a new vaccine, postlicensure surveillance is particularly important to identify and characterize possible safety issues. METHODS The national vaccination campaign was phased from September 2010 to November 2011. We conducted postlicensure safety surveillance for PsA-TT in 40 government clinics from southern Mali serving approximately 400 000 people 1-29 years of age. We conducted analyses with individual-level data and population-level data, and we calculated rates of adverse events using the conditional exact test, a modified vaccine cohort risk interval method, and a modified self-controlled case series method for each outcome of interest, including 18 prespecified adverse events and 18 syndromic categories. RESULTS An increased rate of clinic visits for fever within 3 days after vaccination was found using multiple methods for all age groups. Although other signals were found with some methods, complete assessment of all other prespecified outcomes and syndromic categories did not reveal that PsA-TT was consistently associated with any other health problem. CONCLUSIONS No new safety concerns were identified in this study. These results are consistent with prelicensure data and other studies indicating that PsA-TT is safe. The approach presented could serve as a model for future active postlicensure vaccine safety monitoring associated with large-scale immunization campaigns in low-income countries.
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Affiliation(s)
- Kirsten S Vannice
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Modibo Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Anna P Durbin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Saad B Omer
- Emory Vaccine Center and Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lawrence H Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Téné M Yaméogo
- Institut supérieur des sciences de la Santé, Université Polytechnique de Bobo-Dioulasso, Burkina Faso
| | - Patrick L F Zuber
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Uma Onwuchekwa
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Massambou Sacko
- World Health Organization, Mali Country Office, Bamako, Mali
| | | | - Neal A Halsey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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15
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Jones CE, Munoz FM, Spiegel HML, Heininger U, Zuber PLF, Edwards KM, Lambach P, Neels P, Kohl KS, Gidudu J, Hirschfeld S, Oleske JM, Khuri-Bulos N, Bauwens J, Eckert LO, Kochhar S, Bonhoeffer J, Heath PT. Guideline for collection, analysis and presentation of safety data in clinical trials of vaccines in pregnant women. Vaccine 2016; 34:5998-6006. [PMID: 27481360 DOI: 10.1016/j.vaccine.2016.07.032] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/15/2016] [Accepted: 07/18/2016] [Indexed: 11/25/2022]
Abstract
Vaccination during pregnancy is increasingly being used as an effective approach for protecting both young infants and their mothers from serious infections. Drawing conclusions from published studies in this area can be difficult because of the inability to compare vaccine trial results across different studies and settings due to the heterogeneity in the definitions of terms used to assess the safety of vaccines in pregnancy and the data collected in such studies. The guidelines proposed in this document have been developed to harmonize safety data collection in all phases of clinical trials of vaccines in pregnant women and apply to data from the mother, fetus and infant. Guidelines on the prioritization of the data to be collected is also provided to allow applicability in various geographic, cultural and resource settings, including high, middle and low-income countries.
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Affiliation(s)
- Christine E Jones
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, UK
| | - Flor M Munoz
- Baylor College of Medicine, Houston, TX, United States
| | | | | | - Patrick L F Zuber
- Safety and Vigilance (SAV), Regulation of Medicines and other Health Technologies (RHT), Department of Essential Medicines and Health Products (EMP), Health Systems and Innovation (HIS), World Health Organization, Geneva, Switzerland
| | - Kathryn M Edwards
- Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University, Nashville, TN, United States
| | - Philipp Lambach
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Pieter Neels
- International Alliance of Biological Standardization, IABS-EU, Lyon, France
| | - Katrin S Kohl
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jane Gidudu
- Global Immunization Division, Center for Global Health, CDC, Atlanta, GA, United States
| | - Steven Hirschfeld
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - James M Oleske
- Division of Pediatrics Allergy, Immunology & Infectious Diseases, Rutgers, New Jersey Medical School, Newark, NJ, United States
| | - Najwa Khuri-Bulos
- Infectious Disease and Vaccine Center, University of Jordan, Amman, Jordan
| | | | | | | | - Jan Bonhoeffer
- University of Basel Children's Hospital, Basel, Switzerland
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, UK.
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16
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Brotherton JML, Zuber PLF, Bloem PJN. Primary Prevention of HPV through Vaccination: Update on the Current Global Status. Curr Obstet Gynecol Rep 2016. [DOI: 10.1007/s13669-016-0165-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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17
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Asturias EJ, Wharton M, Pless R, MacDonald NE, Chen RT, Andrews N, Salisbury D, Dodoo AN, Hartigan-Go K, Zuber PLF. Contributions and challenges for worldwide vaccine safety: The Global Advisory Committee on Vaccine Safety at 15 years. Vaccine 2016; 34:3342-9. [PMID: 27195758 PMCID: PMC5085263 DOI: 10.1016/j.vaccine.2016.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/04/2016] [Accepted: 05/08/2016] [Indexed: 11/23/2022]
Abstract
In 1999, the Global Advisory Committee on Vaccine Safety (GACVS) was established by the World Health Organization (WHO) to provide independent scientific advice on issues relating to the safety of vaccines and immunization. Fifteen years onward, we conducted a multi-faceted review to evaluate the impact, reach and challenges facing GACVS, including the role GACVS plays in informing global, regional and WHO member state vaccine policy. The methods included measures of organizational structure, citation impact, themes approached, and a discussion by previous and current members to evaluate past, present and future challenges. Given the increasing range of data sources and the deployment of many new vaccines, the Committee is facing the complex task of identifying the best available evidence for recommendations on vaccine safety. To help meet the increased demand for public transparency in decision making, GACVS-structured methodology for evidence-based decisions is evolving. GACVS also promotes best practices and capacity building for timely and accurate risk assessment; risk communications; outreach to help countries maintain and, if needed, rebuild public trust in vaccines; and advocacy for bridging the major gaps in vaccine safety capacity globally.
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Affiliation(s)
- Edwin J Asturias
- Center for Global Health, Colorado School of Public Health, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Melinda Wharton
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert Pless
- Communicable Disease Surveillance, Public Health Agency of Canada, Canada
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Robert T Chen
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicholas Andrews
- Statistics, Modelling and Economics Department, Public Health England, London, UK
| | - David Salisbury
- Centre for Global Health Security, Chatham House, London, UK
| | - Alexander N Dodoo
- WHO Collaborating Centre for Advocacy and Training in Pharmacovigilance, School of Medicine and Dentistry, University of Ghana Medical School, Ghana
| | - Kenneth Hartigan-Go
- Center for Development Management, Asian Institute of Management, Philippines
| | - Patrick L F Zuber
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
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18
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Cassidy C, MacDonald NE, Steenbeek A, Ortiz JR, Zuber PLF, Top KA. A global survey of adverse event following immunization surveillance systems for pregnant women and their infants. Hum Vaccin Immunother 2016; 12:2010-2016. [PMID: 27159639 PMCID: PMC4994761 DOI: 10.1080/21645515.2016.1175697] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Strengthening antenatal care as a platform for maternal immunization is a priority of the World Health Organization (WHO). Systematic surveillance for adverse events following immunization (AEFI) in pregnancy is needed to identify vaccine safety events. We sought to identify active and passive AEFI surveillance systems for pregnant women and infants. Representatives from all National Pharmacovigilance Centers and a convenience sample of vaccine safety experts were invited to complete a 14-item online survey in English, French or Spanish. The survey captured maternal immunization policies, and active and passive AEFI surveillance systems for pregnant women and infants in respondents' countries. The analysis was descriptive. We received responses from 51/185 (28%) invited persons from 47/148 (32%) countries representing all WHO regions, and low, middle and high-income countries. Thirty countries had national immunization policies targeting pregnant women. Eleven countries had active surveillance systems to detect serious AEFI in pregnant women and/or their infants, including six low and middle-income countries (LMIC). Thirty-nine countries had passive surveillance systems, including 23 LMIC. These active and passive surveillance programs cover approximately 8% and 56% of the worldwide annual birth cohort, respectively. Data from one active and four passive systems have been published. We identified 50 active and passive AEFI surveillance systems for pregnant women and infants, but few have published their findings. AEFI surveillance appears to be feasible in low and high resource settings. Further expansion of AEFI surveillance for pregnant women and sharing of vaccine safety information will provide additional evidence in support of maternal immunization policies.
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Affiliation(s)
- Christine Cassidy
- a School of Nursing, Faculty of Health Professions, Dalhousie University , Halifax , Nova Scotia , Canada
| | - Noni E MacDonald
- b Department of Pediatrics , Dalhousie University , Halifax , Nova Scotia , Canada.,c Canadian Center for Vaccinology, IWK Health Center , Halifax , Nova Scotia , Canada
| | - Audrey Steenbeek
- a School of Nursing, Faculty of Health Professions, Dalhousie University , Halifax , Nova Scotia , Canada.,c Canadian Center for Vaccinology, IWK Health Center , Halifax , Nova Scotia , Canada
| | - Justin R Ortiz
- d Initiative for Vaccine Research, World Health Organization , Geneva , Switzerland
| | - Patrick L F Zuber
- d Initiative for Vaccine Research, World Health Organization , Geneva , Switzerland
| | - Karina A Top
- b Department of Pediatrics , Dalhousie University , Halifax , Nova Scotia , Canada.,c Canadian Center for Vaccinology, IWK Health Center , Halifax , Nova Scotia , Canada
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Abstract
Major vaccine safety controversies have arisen in several countries beginning in the last decades of 20th century. Such periodic vaccine safety controversies are unlikely to go away in the near future as more national immunization programs mature with near elimination of target vaccine-preventable diseases that result in relative greater prominence of adverse events following immunizations, both true reactions and temporally coincidental events. There are several ways in which vaccine safety capacity can be improved to potentially mitigate the impact of future vaccine safety controversies. This paper aims to take a "lifecycle" approach, examining some potential pre- and post-licensure opportunities to improve vaccine safety, in both developed (specifically U.S. and Europe) and low- and middle-income countries.
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Affiliation(s)
- Robert T Chen
- Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Tom T Shimabukuro
- Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - David B Martin
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, United States
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20
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Chen RT, Shimabukuro TT, Martin DB, Zuber PLF, Weibel DM, Sturkenboom M. Enhancing vaccine safety capacity globally: A lifecycle perspective. Vaccine 2015; 33 Suppl 4:D46-54. [PMID: 26433922 PMCID: PMC4663114 DOI: 10.1016/j.vaccine.2015.06.073] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 12/22/2022]
Abstract
Major vaccine safety controversies have arisen in several countries beginning in the last decades of 20th century. Such periodic vaccine safety controversies are unlikely to go away in the near future as more national immunization programs mature with near elimination of target vaccine-preventable diseases that result in relative greater prominence of adverse events following immunizations, both true reactions and temporally coincidental events. There are several ways in which vaccine safety capacity can be improved to potentially mitigate the impact of future vaccine safety controversies. This paper aims to take a "lifecycle" approach, examining some potential pre- and post-licensure opportunities to improve vaccine safety, in both developed (specifically U.S. and Europe) and low- and middle-income countries.
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Affiliation(s)
- Robert T Chen
- Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Tom T Shimabukuro
- Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - David B Martin
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, United States
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21
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Wak G, Williams J, Oduro A, Maure C, Zuber PLF, Black S. The Safety of PsA-TT in Pregnancy: An Assessment Performed Within the Navrongo Health and Demographic Surveillance Site in Ghana. Clin Infect Dis 2015; 61 Suppl 5:S489-92. [PMID: 26553679 PMCID: PMC4639506 DOI: 10.1093/cid/civ625] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Group A meningococcal disease occurs in large epidemics within the meningitis belt of Africa that includes northern Ghana. Major epidemics in the meningitis belt have infection rates ranging from 100 to 800 per 100 000 population. In 2012, a group A meningococcal conjugate vaccine, PsA-TT (MenAfriVac), was introduced into the region in large campaigns. METHODS We report here on the safety of this vaccine when used in pregnant women in the Navrongo region of Ghana. RESULTS Rates of events in 1730 immunized pregnant women and their infants were compared to the rates of the same events in pregnant women who did not receive the vaccine during the campaign and also to women who were pregnant in the prior year. CONCLUSIONS We found no evidence of any safety concerns when this vaccine was administered during pregnancy.
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Affiliation(s)
- George Wak
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - John Williams
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Abraham Oduro
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Christine Maure
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Patrick L. F. Zuber
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Steven Black
- Center for Global Health, Cincinnati Children's Hospital, Ohio
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22
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Maure CG, Dodoo AN, Bonhoeffer J, Zuber PLF. The Global Vaccine Safety Initiative: enhancing vaccine pharmacovigilance capacity at country level. Bull World Health Organ 2014; 92:695-6. [PMID: 25378762 PMCID: PMC4208577 DOI: 10.2471/blt.14.138875] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 03/21/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Christine G Maure
- Department of Essential Medicines and Health Products, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Alexander N Dodoo
- Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana, Accra, Ghana
| | | | - Patrick L F Zuber
- Department of Essential Medicines and Health Products, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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23
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Tozzi AE, Asturias EJ, Balakrishnan MR, Halsey NA, Law B, Zuber PLF. Assessment of causality of individual adverse events following immunization (AEFI): a WHO tool for global use. Vaccine 2013; 31:5041-6. [PMID: 24021304 DOI: 10.1016/j.vaccine.2013.08.087] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/23/2013] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
Abstract
Serious illnesses or even deaths may rarely occur after childhood vaccinations. Public health programs are faced with great challenges to establish if the events presenting after the administration of a vaccine are due to other conditions, and hence a coincidental presentation, rather than caused by the administered vaccines. Given its priority, the Global Advisory Committee for Vaccine Safety (GACVS) commissioned a group of experts to review the previously published World Health Organization (WHO) Adverse Event Following Immunization (AEFI) causality assessment methodology and aide-memoire, and to develop a standardized and user friendly tool to assist health care personnel in the processing and interpretation of data on individual events, and to assess the causality after AEFIs. We describe a tool developed for causality assessment of individual AEFIs that includes: (a) an eligibility component for the assessment that reviews the diagnosis associated with the event and identifies the administered vaccines; (b) a checklist that systematically guides users to gather available information to feed a decision algorithm; and (c) a decision support algorithm that assists the assessors to come to a classification of the individual AEFI. Final classification generated by the process includes four categories in which the event is either: (1) consistent; (2) inconsistent; or (3) indeterminate with respect of causal association; or (4) unclassifiable. Subcategories are identified to assist assessors in resulting public health decisions that can be used for action. This proposed tool should support the classification of AEFI cases in a standardized, transparent manner and to collect essential information during AEFI investigation. The algorithm should provide countries and health officials at the global level with an instrument to respond to vaccine safety alerts, and support the education, research and policy decisions on immunization safety.
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Affiliation(s)
- Alberto E Tozzi
- Multifactorial Diseases and Complex Phenotypes, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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24
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Tate JE, Steele AD, Bines JE, Zuber PLF, Parashar UD. Research priorities regarding rotavirus vaccine and intussusception: a meeting summary. Vaccine 2012; 30 Suppl 1:A179-84. [PMID: 22520129 DOI: 10.1016/j.vaccine.2011.08.110] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 08/11/2011] [Accepted: 08/24/2011] [Indexed: 11/24/2022]
Abstract
Currently available rotavirus vaccines have been associated with a small increased risk of intussusception (~1-2 cases per 100,000 vaccinated infants) in some populations. In response to this newly emerging data on intussusception related to current rotavirus vaccines, a group of technical experts convened by the Program for Applied Technology in Health met to review the data, establish what gaps in knowledge exist, and identify what future research is needed. This manuscript outlines the evidence that is currently available and the research agenda that was generated during this meeting. It also highlights the need for countries that are using or considering introducing the rotavirus vaccine to evaluate both the benefits and risks of vaccination.
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Affiliation(s)
- Jacqueline E Tate
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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25
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Rossi IA, Zuber PLF, Dumolard L, Walker DG, Watt J. Introduction of Hib vaccine into national immunization programmes: A descriptive analysis of global trends. Vaccine 2007; 25:7075-80. [PMID: 17825458 DOI: 10.1016/j.vaccine.2007.07.058] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 07/27/2007] [Accepted: 07/28/2007] [Indexed: 11/18/2022]
Abstract
Despite the demonstration of effectiveness and public health impact of Hib conjugate vaccines, the majority of infants from poorest countries do not yet have access to this safe and effective preventive intervention. This paper provides a descriptive analysis of the main characteristics of countries that have included Hib vaccine in their national immunization programmes before 2006. It highlights the importance of regularly analyzing the process of decision-making involved in implementation of public health interventions, in order to learn from cumulative experience and expedite the introduction of future interventions.
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Affiliation(s)
- Isabelle A Rossi
- Institute of Social and Preventive Medicine, University of Lausanne, rue du Bugnon 17, 1005 Lausanne, Switzerland.
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26
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Hennessey KA, Lago H, Diomande F, Akoua-Koffi C, Caceres VM, Pallansch MA, Kew OM, Nolan M, Zuber PLF. Poliovirus Vaccine Shedding among Persons with HIV in Abidjan, Cote d’Ivoire. J Infect Dis 2005; 192:2124-8. [PMID: 16288377 DOI: 10.1086/498166] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Accepted: 06/07/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND As polio eradication nears, the development of immunization policies for an era without the disease has become increasingly important. Outbreaks due to circulating vaccine-derived poliovirus (VDPV) and rare cases of immunodeficient persons with prolonged VDPV shedding lend to the growing consensus that oral poliovirus vaccine (OPV) use should be discontinued as soon after polio eradication as possible. The present study was conducted to assess whether persons infected with human immunodeficiency virus (HIV) experience prolonged VDPV shedding and serve as a source of reintroduction of virus into the population. METHODS Adults infected with HIV had specimens tested (1) 8 months after a mass OPV campaign, to determine whether poliovirus related to OPV administered during the campaign was present (i.e., prolonged excretion), and (2) starting 7 weeks after a subsequent campaign, to determine whether poliovirus could be detected after the height of OPV exposure. RESULTS A total of 419 participants were enrolled--315 during the 8-12 months after an OPV campaign held in 2001 and 104 during the 7-13 weeks after a 2002 campaign. No poliovirus was isolated from any participants. CONCLUSIONS It appears unlikely that adults infected with HIV experience prolonged vaccine virus shedding, and, therefore, they probably represent a minimal risk of reintroducing vaccine virus into the population after poliovirus has been eradicated.
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Affiliation(s)
- Karen A Hennessey
- Global Immunization Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30309, USA.
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27
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Kohler KA, Deshpande JM, Gary HE, Banerjee K, Zuber PLF, Hlady WG. Contribution of second stool specimen to increased sensitivity of poliovirus detection in India, 1998-2000. Epidemiol Infect 2003; 131:711-8. [PMID: 12948371 PMCID: PMC2870012 DOI: 10.1017/s0950268803008562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Acute flaccid paralysis (AFP) surveillance data from India were analysed to examine sensitivity of poliovirus isolation from stool specimens and the added sensitivity obtained from collection of a second stool specimen. Analysis was restricted to Indian AFP cases, 1998-2000, with two adequate stool specimens. The proportion of cases confirmed with wild poliovirus isolation by the second specimen only was calculated, regardless of specimen quality. Overall specimen sensitivity (1998-2000) was 81% using the first specimen, 78% using the second, and 96% using both. Sensitivity increased from 1998 to 2000, with slightly higher sensitivity each year for the first specimen. The second specimen increased sensitivity by 15% overall and contributed more when the first specimen was collected late or was in poor condition. As wild poliovirus disappears, increased sensitivity provided by a second stool specimen may reduce the risk of missing circulating virus.
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Affiliation(s)
- K A Kohler
- Global Immunization Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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28
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Zuber PLF, Yaméogo KR, Yaméogo A, Otten MW. Use of administrative data to estimate mass vaccination campaign coverage, Burkina Faso, 1999. J Infect Dis 2003; 187 Suppl 1:S86-90. [PMID: 12721897 DOI: 10.1086/368052] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Administrative coverage data are commonly used to assess coverage of mass vaccination campaigns. These estimates are obtained by dividing the number of doses administered by the number of children of eligible age, usually at the health district level. This study used data from a cluster survey conducted in each of the 53 Burkina Faso health districts immediately after 1999 the National Immunization Days to assess whether administrative estimates correlated with those obtained through survey and whether the former identified districts that achieved suboptimal coverage as measured by cluster survey. During the first round of the campaign there was no significant correlation between data obtained by either method. The correlation was only marginally better during the second round. Although useful to help plan the logistics of a campaign, administrative coverage data should be used with other evaluation techniques in order to determine the number of eligible children vaccinated during a mass campaign.
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Affiliation(s)
- Patrick L F Zuber
- Global Immunization Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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29
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Kambiré C, Konde MK, Yaméogo A, Tiendrébéogo SRM, Ouédraogo RT, Otten MW, Cairns KL, Zuber PLF. Measles incidence before and after mass vaccination campaigns in Burkina Faso. J Infect Dis 2003; 187 Suppl 1:S80-5. [PMID: 12721896 DOI: 10.1086/368043] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Burkina Faso conducted mass measles vaccination campaigns among children aged 9 months to 4 years during December 1998 and December 1999. The 1998 campaign was limited to six cities and towns, while the 1999 campaign was nationwide. The last year of explosive measles activity in Burkina Faso was 1996. Measles surveillance data suggest that the 1998 urban campaigns did not significantly impact measles incidence. After the 1999 national campaign, the total case count decreased during 2000 and 2001. However, 68% of measles cases occurred among children aged 5 years or older who were not included in the mass vaccination strategy. During 2000 and 2001, areas with high measles incidence were characterized by low population density and presence of mobile and poor populations. Measles control strategies in Sahelian Africa must balance incomplete impact on virus circulation with cost of more aggressive strategies that include older age groups.
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Affiliation(s)
- Chantal Kambiré
- Office of the World Health Organization Representative, Ouagadougou, Burkina Faso
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30
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Yaméogo KR, Yaméogo A, Nacoulma SD, Zuber PLF. Measles vaccination coverage during poliomyelitis national immunization days in Burkina Faso, 1999. J Infect Dis 2003; 187 Suppl 1:S74-9. [PMID: 12721895 DOI: 10.1086/368027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In 1999, Burkina Faso added measles vaccine during the second round of its poliomyelitis national immunization days (NIDs). A cluster survey was conducted in each of the country's 53 health districts to assess vaccination coverage achieved by the campaign. Forty-four percent of children aged 9-59 months had a documented prior measles vaccination, and 88% were vaccinated during NIDs. Eighty-five percent of children not previously vaccinated received measles vaccine during the campaign. Although routine vaccination coverage varied substantially among children from various socioeconomic groups, the campaign appeared to almost equally reach all groups of children surveyed. Poliovirus vaccine coverage was 90% when measles vaccine was added to the campaign, compared with 88% during the first round. In Burkina Faso, the addition of measles vaccine to poliomyelitis NIDs achieved greater equity in measles vaccination coverage according to a number of socioeconomic factors without compromising the coverage of poliovirus vaccination.
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Affiliation(s)
- K Robert Yaméogo
- Health Information System, Directorate of Studies and Planning, Ministry of Health, Ouagadougou, Burkina Faso
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31
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Kohler KA, Hlady WG, Banerjee K, Gupta D, Francis P, Durrani S, Zuber PLF, Sutter RW. Compatible poliomyelitis cases in India during 2000. Bull World Health Organ 2003; 81:2-9. [PMID: 12640469 PMCID: PMC2572314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE To describe the characteristics of compatible poliomyelitis cases and to assess the programmatic implications of clusters of such cases in India. METHODS We described the characteristics of compatible poliomyelitis cases, identified clusters of compatible cases (two or more in the same district or neighbouring districts within two months), and examined their relationship to wild poliovirus cases. FINDINGS There were 362 compatible cases in 2000. The incidence of compatible cases was higher in districts with laboratory-confirmed poliomyelitis cases than in districts without laboratory-confirmed cases. Of 580 districts, 96 reported one compatible case and 72 reported two or more compatible cases. Among these 168 districts with at least one compatible case, 123 had internal or cross- border clusters of compatible cases. In 27 districts with clusters of compatible cases, no wild poliovirus was isolated either in the same district or in neighbouring districts. Three of these 27 districts presented laboratory-confirmed poliomyelitis cases during 2001. CONCLUSION Most clusters of compatible cases occurred in districts identified as areas with continuing wild poliovirus transmission and where mopping-up vaccination campaigns were carried out. As certification nears, areas with compatible poliomyelitis cases should be investigated and deficiencies in surveillance should be corrected in order to ensure that certification is justified.
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Affiliation(s)
- Kathryn A Kohler
- Global Immunization Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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32
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Kojouharova M, Zuber PLF, Gyurova S, Fiore L, Buttinelli G, Kunchev A, Vladimirova N, Korsun N, Filipova R, Boneva R, Gavrilin E, Deshpande JM, Oblapenko G, Wassilak SG. Importation and circulation of poliovirus in Bulgaria in 2001. Bull World Health Organ 2003; 81:476-81. [PMID: 12973639 PMCID: PMC2572497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVE To characterize the circumstances in which poliomyelitis occurred among three children in Bulgaria during 2001 and to describe the public health response. METHODS Bulgarian authorities investigated the three cases of polio and their contacts, conducted faecal and serological screening of children from high-risk groups, implemented enhanced surveillance for acute flaccid paralysis, and conducted supplemental immunization activities. FINDINGS The three cases of polio studied had not been vaccinated and lived in socioeconomically deprived areas of two cities. Four Roma children from the Bourgas district had antibody titres to serotype 1 poliovirus only, and wild type 1 virus was isolated from the faeces of two asymptomatic Roma children in the Bourgas and Sofia districts. Poliovirus isolates were related genetically and represented a single evolutionary lineage; genomic sequences were less than 90% identical to poliovirus strains isolated previously in Europe, but 98.3% similar to a strain isolated in India in 2000. No cases or wild virus isolates were found after supplemental immunization activities were launched in May 2001. CONCLUSIONS In Bulgaria, an imported poliovirus was able to circulate for two to five months among minority populations. Surveillance data strongly suggest that wild poliovirus circulation ceased shortly after supplemental immunization activities with oral poliovirus vaccine were conducted.
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Affiliation(s)
- Mira Kojouharova
- Department of Epidemiology, National Center for Infectious and Parasitic Diseases, Sofia, Bulgaria
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33
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Kohler KA, Hlady WG, Banerjee K, Francis P, Durrani S, Zuber PLF. Predictors of virologically confirmed poliomyelitis in India, 1998-2000. Clin Infect Dis 2002; 35:1321-7. [PMID: 12439794 DOI: 10.1086/344190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2002] [Revised: 07/16/2002] [Indexed: 11/03/2022] Open
Abstract
As we progress toward eradication of polio, a growing proportion of cases of acute flaccid paralysis (AFP) reported are due to causes other than polio. AFP surveillance data from India for 1998-2000 were analyzed to determine the sensitivity and specificity of signs and symptoms present at initial case investigation and of residual weakness (which is used to classify AFP cases) for virologically confirmed poliomyelitis. Sensitivity was highest for age of <5 years (93%-97%) and residual weakness (74%-96%). Residual weakness was more sensitive among children aged <5 years. Cases of AFP in patients aged <5 years who have fever and asymmetrical paralysis are most likely to be confirmed as poliomyelitis. In countries with suboptimal surveillance for AFP, these results may help to prioritize investigation of AFP cases. The high sensitivity of residual weakness demonstrates the importance of 60-day follow-up examination for all patients with AFP, particularly those for whom the initial case investigation was inadequate or delayed.
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Affiliation(s)
- Kathryn A Kohler
- Global Immunization Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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