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Introduction of Hib vaccine into national immunization programmes: A descriptive analysis of global trends.
Vaccine. 2007 Oct 10; 25(41):7075-7080.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. (author's)
Antimicrobial and support therapy for bacterial meningitis in children. Report of the meeting of 18- 20 June 1997, Geneva, Switzerland.
Geneva, Switzerland, WHO, Division of Emerging and Other Communicable Diseases Surveillance and Control, 1998.  p. (WHO/CHD/98.6; WHO/EMC/BAC/98.2)WHO and UNICEF have developed an integrated approach to address the major life-threatening illnesses of children known as Integrated Management of Childhood Illness (IMCI). Lessons learned from disease-specific programmes have been applied to promote co-ordination and integration of the activities to improve the prevention and management of childhood illness. Apart from five major killer diseases of children under five years (acute respiratory infections - mostly pneumonia, diarrhoea, measles, malaria and malnutrition) bacterial meningitis is an important cause of childhood morbidity and mortality. (excerpt)
International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control. Summary report of the Second Meeting, Geneva, Switzerland, 23-24 June 1997.
Geneva, Switzerland, WHO, Division of Emerging and Other Communicable Diseases Surveillance and Control, 1997.  p. (WHO/EMC/ DIS/ICG/97.10)The second meeting of the International Coordinating Group (ICG) was held at WHO Headquarters in Geneva on 23 and 24 June 1997. The meeting was chaired by Dr M. H. Wahdan, Assistant Regional Director, EMRO. Dr N. Begg, EMC, served as rapporteur. The agenda and participants are shown in the annexes. Dr Wahdan welcomed new participants, especially the representatives from countries of the meningitis belt and briefly described the background to the establishment of the ICG. Dr D. L. Heymann, Director EMC, emphasized that the ICG was set up to facilitate a working partnership between four lead agencies (International Federation of the Red Cross and Red Crescent Societies (IFRC), Médecins sans Frontières (MSF), United Nations Children’s Fund (UNICEF), World Health Organization (WHO), WHO Collaborating Centres and other technical partners, development agencies, representatives of industry and country representatives. Mr P. Evans representing Dr J.-W. Lee, Director GPV, also welcomed the participants. Details of the response of the ICG to epidemic meningitis in Africa in 1997 are contained in an interim report prepared by WHO. This report was subsequently updated and finalized as a joint report by IFRC, MSF, UNICEF and WHO. (excerpt)
International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control. Summary report of the Third Meeting, Geneva, Switzerland, 8-9 December 1997.
Geneva, Switzerland, World Health Organization [WHO], Division of Emerging and Other Communicable Diseases Surveillance and Control, 1998. 21 p. (WHO/EMC/ DIS/ICG/98.1)The Third meeting of the International Co-ordinating Group on Vaccine Provision for Epidemic Meningitis Control (ICG) was held at WHO Headquarters in Geneva on the 8th and 9th December 1997. The meeting was chaired by Dr D. Barakamfitiye, Director, Prevention and Control of Diseases (DDC) of the WHO Regional Office for Africa. Dr M. Hardiman, WHO/EMC, acted as rapporteur. The agenda and list of participants are to be found in the annexes. The Chairman welcomed the participants and outlined the objectives for the meeting. Dr D.L. Heymann, Director EMC, added his welcome and commented that, although meningococcal vaccine was not in such short supply this year, there are still a number of important issues to demand global attention. These include the need to improve the speed of response to epidemic situations, the continued political sensitivity to the issue of meningitis, the relative merits of preventive vaccination versus epidemic response and the impact that the development of a new conjugate vaccine might have on efforts to control meningitis. Dr J.-W.Lee, Director, GPV, in his opening remarks looked forward to the time when preventive actions for meningitis would render epidemic response through the ICG as no longer necessary. (excerpt)
International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control. Summary report. Geneva, Switzerland, 16-17 January 1997.
Geneva, Switzerland, World Health Organization [WHO], Division of Emerging and Other Communicable Diseases Surveillance and Control, 1997. 19 p. (WHO/EMC/ DIS/ICG/97.9)This was the first meeting of the International Coordinating Group (ICG) proposed at the 2-3 December, 1996 meeting of the Ad Hoc Working Group on WHO Strategy for Provision of Meningitis Vaccine for Epidemic Prevention and Control. The meeting was chaired by Dr d'Almeida, DPM, AFRO, and the agenda and list of participants are provided as annexes. The objectives of the meeting were to define terms of reference, agree on the membership of the International Coordinating Group (ICG) and its Executive Sub-Group, to establish the criteria for determining priority distribution of vaccine for epidemic control in the 1997 season, for which only 14 million doses of vaccine would be available, and to consider a strategy for ensuring adequate vaccine supplies in future years. The expected outcome of the meeting was to obtain agreement on the responsibilities of the ICG and its Executive Sub-Group, on the criteria for vaccine distribution in 1997, on a funding mechanism for an emergency stock of vaccines and auto-destruct syringes, and on a strategy to address adequate vaccine and syringe supplies for future years. The meeting met these goals. (excerpt)
International Coordinating Group (ICG) on Vaccine Provision for Epidemic Control. Report of the Fifth Meeting, Geneva, Switzerland, 8-9 December 1999.
Geneva, Switzerland, World Health Organization [WHO], Department of Communicable Disease Surveillance and Response, 2000.  p. (WHO/CDS/CSR/EDC/2000.6)The fifth meeting of the International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control (ICG) was held on 8 and 9 of December 1999 at WHO Headquarters in Geneva. Dr L. Martinez, Director of the Department of Surveillance and Response (CSR), welcomed the participants and opened the meeting. Summarizing the history of the ICG, Dr L. Martinez stressed the fact that the success of the group relies on the cooperation and goodwill of a wide range of partners, in addition to the four agencies making up the Executive Sub-group of the ICG. The manufacturers of the products in the emergency stockpile, including Pasteur Mérieux Connaught, SmithKline Beecham Biologicals and Univec, have been essential partners. Donor governments came forward with the resources needed to set up the mechanism and continue to support its functioning. As part of a wider initiative, the ICG involves WHO Collaborating Centres and other partners, providing technical expertise in strengthening surveillance systems and the laboratory capacity to detect epidemics rapidly. The objectives of the meeting were to prepare for the epidemic meningitis season 1999/2000 by reviewing the events of the last epidemic season. The lessons learned from that season will be applied in future work of the ICG. The meeting also considered the future role of the ICG, and how it has developed from crisis intervention, to a forum for the wider issues of epidemic meningitis preparedness. The meeting will make recommendations to shape the ICG's response both to epidemics in the coming season and, equally important, to prevent the crises that occurred in 1996. (excerpt)
International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control. Report of the ninth meeting, Ouagadougou, Burkina Faso, 15–16 December 2003. [Groupe de Coordination Internationale (GCI) sur l'Approvisionnement en Vaccins en vue de la Lutte contre la Méningite. Rapport de la neuvième réunion, Ouagadougou, Burkina Faso, 15-16 décembre 2003]
Geneva, Switzerland, World Health Organization [WHO], Department of Communicable Disease Surveillance and Response, 2004.  p. (Global Health Security. Epidemic Alert and Response; WHO/CDS/CSR/GAR/2004.17)At present, Aventis Pasteur has 50 million doses of bivalent vaccine in its stores. For 2004, the doses requested by the ICG will be available at US$ 0.27 per dose. GSK has produced 7,172,000 doses of trivalent vaccine, which will be available to the ICG at €1.00 per dose for 2004. For oily chloramphenicol, the International Dispensary Association’s (IDA) new facility in Malta has a production capacity of 660 000 vials per year, which will be available in 2004 at a similar price to 2003. Two important research studies were conducted during 2002–2003. A clinical equivalence trial undertaken by Epicentre concluded that ceftriaxone is a very good alternative treatment for epidemic meningitis – cheaper than oily chloramphenicol and also more effective against Streptococcus pneumoniae (Sp) and Haemophilus influenzae. However, before its widespread use as an alternative to oily chloramphenicol can be recommended, the impact of its introduction should be evaluated by the 13th Expert Committee on the Selection and Use of Essential Medicines. A study of the effectiveness of trivalent vaccine undertaken by WHO with the Centers for Disease Control and Prevention (CDC) estimated that the vaccine was 96% against Nm A+ W135 and 98% effective against Nm A alone. There were no evidence of adverse side-effects causally linked to the vaccine . Results from an immunogenicity study in Ghana are expected in 2004. Since inception of the ICG in 1997, its terms of reference have been revised at each annual meeting. Moreover, the ICG has been growing in scope and responsibility. Meeting participants concluded that a new structure was needed in order to adjust the role of the ICG according to its origin, as well as to respond to the increasing need for a forum to address various technical subjects on epidemic meningitis. (excerpt)
Epidemic meningitis: surveillance and response activities during the 2002–2003 season in the countries of the African meningitis belt. Report on an informal WHO consultation, Geneva, 24–25 July 2003.
Geneva, Switzerland, WHO, Department of Communicable Disease Surveillance and Response, 2004.  p. (Global Health Security. Epidemic Alert and Response; WHO/CDS/CSR/GAR/2003.13)During the 2002–2003 epidemic season, epidemics of meningitis were detected in Burkina Faso, in Niger and in northern Nigeria, together with an epidemic focus in northern Ghana. From bacteriological analyses, serogroup A was by far the predominant pathogen (40–70% isolates) followed by pneumococcus and serotype W135 (10–20% isolates). Molecular biology analyses have demonstrated the predominance of ST-7 and ST-11 clones in serotypes A and W135 respectively. In most countries in the region, the proportion of serogroup W135 among the germs isolated increased. Serogroup W135 has epidemic potential in future years in countries such as Mali, Niger and Nigeria. Reinforced surveillance of meningitis has been extended to nine countries in the African belt, and a regional technical team has been established in Ouagadougou. Epidemiological surveillance has proved effective in three countries –: Burkina Faso, Mali and Niger – despite the absence of standardized notification and occasionally inappropriate use of thresholds at the district level. Surveillance remained inadequate in the six other countries. (excerpt)
Epidemic preparedness and response in Africa: an epidemiological block approach. Summary report. AFRO / EMC epidemiological blocks.
Washington, D.C., AED, SARA, 2001 Mar.  p. (USAID Contract No. AOT-00-99-00237-00)Following a series of epidemics that occurred in 1995 and 1996 in several countries in West and Central Africa, the World Health Organization (WHO) Regional Office for Africa (AFRO) and the USAID Africa Bureau, Office of Sustainable Development (AFR/SD), decided to strengthen their cooperation on epidemic preparedness and response (EPR) throughout the continent. Many African countries lack drugs and other supplies for prompt and effective interventions to address epidemic outbreaks. Many country officials lack both awareness of the risk of epidemics and the capacity to effectively detect and manage them. In order to improve the situation, WHO/AFRO defined five groups of countries with similar epidemiological profiles, and created a political framework to facilitate inter-country collaboration within each of these epidemiological blocks. The Swiss Disaster Relief (SDR), the European Union (EU), and the U.S. Centers for Disease Control and Prevention (CDC) also joined the effort to strengthen capacity for EPR in West Africa. Almost four years later, AFRO and AFR/SD decided to organize a review and documentation of the epidemic preparedness and response program. The present summary report contains the findings and recommendations of this review. The report presents the epidemiological block approach used by WHO/AFRO to implement its Emerging and other Communicable Diseases Surveillance and Control (EMC) programs, and discusses the performance of the epidemiological teams in the West Africa Block (WAB) and Great Lakes Block (GLB). It discusses the availability and use of data for assessing trends in the incidence, mortality, and occurrence of outbreaks of epidemic-prone diseases — cholera and meningitis in particular. It concludes with a short discussion and recommendations for further efforts to strengthen capacities for epidemic preparedness and response in the Africa region. (excerpt)
The use of polysaccharide trivalent ACW vaccine for the control of epidemic meningococcal disease outbreaks in countries of the African meningitis belt. Recommendations from an international informal consultation.
Geneva, Switzerland, WHO, Department of Communicable Disease Surveillance and Response, 2003. 8 p. (WHO/CDS/CSR/GAR/2003.14)Epidemic meningococcal disease (EMD) outbreaks are usually due to Neisseria meningitidis (Nm) serogroups A or C. However Nm serogroup W135 has recently emerged as a cause of epidemic disease. In 2002, the first major W135 meningococcal disease outbreak occurred in Burkina Faso, with 13 125 suspected meningitis cases and 1510 deaths. The response to the 2002 epidemic in Burkina Faso was hindered by the lack of a serogroup W135- containing meningococcal vaccine due to both limited worldwide production and high cost. In response to the unexpected W135 outbreak in 2002, the World Health Organization (WHO) sounded the alarm to the pharmaceutical industry, asking their assistance to make a W135-containing polysaccharide (PS) vaccine available at an affordable price for African countries. GlaxoSmithKline (GSK) responded favourably and developed 3 million doses of a new ACW meningococcal PS vaccine for evaluation and limited use in Africa in 2003. This vaccine was licensed by the Belgian National Regulatory Authority by the end of January 2003 and can be exported to countries that authorize its use. During the 2002-2003 season, Burkina Faso was affected by a mixed Nm A-W135 epidemic (7900 cases). In response to the outbreak, two million people were vaccinated with the new trivalent vaccine. At the same time, an increased proportion of Nm W135 isolates was reported by several African meningitis belt countries, suggesting that W135 could be the cause of further outbreaks in the region (alone or together with serogroup A). WHO recently reached an agreement with GSK for the production of 6 million doses of PS trivalent ACW vaccine at 1 Euro per dose. However to ensure production, WHO would have to raise the required funds before the beginning of the epidemic season. The funds obtained will be used for establishing a revolving emergency stock. No additional supply of this vaccine is expected to be available for the 2003–2004 epidemic season. The recommended strategy for EMD outbreak control in the African meningitis belt is based on reactive mass vaccination with the meningococcal PS vaccine and effective case management. While the case management strategy does not differ according to the strain, the vaccination strategy to be adopted is less clear. Indeed, in the current context of a limited supply of PS trivalent ACW vaccine, the use of the vaccine must be carefully evaluated. In making informed and optimal decisions regarding outbreak response, two issues must therefore be urgently addressed: (i) determining the most appropriate meningococcal PS vaccine to be used in the affected areas; and (ii) developing an optimal vaccination strategy for the use of the PS trivalent ACW vaccine in the field. The recommendations presented in this document are the result of an informal consultation organized by WHO in March 2003 to obtain technical advice from various experts on the two issues mentioned above. (excerpt)
International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control. Report of the Sixth Meeting, Cairo, Egypt, 20-21 September 2000.
Geneva, Switzerland, World Health Organization [WHO], Department of Communicable Disease Surveillance and Response, 2001. 25 p. (WHO/CDS/CSR/EDC/2001.11)The sixth meeting of the International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control (ICG) was held on 20 and 21 September 2000 at the Hotel Meridien, Heliopolis, Cairo at the invitation of the WHO Regional Office for the Eastern Mediterranean. Dr Hussein Al-Gezairy, the WHO Regional Director welcomed the participants. In his opening address Dr Al-Gezairy described the achievements of the ICG since its inception in 1997 and emphasized the effective collaboration of many partners including commercial industry. Dr Al-Gezairy recognised the role of the ICG in responding to outbreaks in Sudan and finally, reminding the meeting of the power of immunisation as a tool in disease prevention, looked forward to the development of an effective conjugate meningococcal vaccine for use in routine programmes. Dr B. Sabri, Director of Health Care Delivery, WHO/EMRO chaired the opening session and began by outlining the objectives of the meeting: to review the last year's experience of epidemic meningitis: epidemiology, response actions and any lessons learned; to report on the relevant activities of the ICG partners and update on any new developments in related areas of operational research; to review the state of preparedness for the 2000/2001 epidemic meningitis season; to make recommendations on the continuing operation of the ICG and its partners responding to epidemic meningococcal meningitis. The preliminary agenda was adopted by the meeting. During periods of the meeting when Dr Sabri would be unable to be present it was agreed that Dr E. Tikhomirov, WHO/HQ would chair the meeting. (excerpt)
Response to epidemic meningitis in Africa, 1997. Report by IFRC-MSF-UNICEF-WHO to the International Coordinating Group (ICG).
Geneva, Switzerland, WHO, Division of Emerging and Other Communicable Diseases Surveillance and Control, 1997. 7 p. (WHO/EMC/ DIS/ICG/97.8)Large-scale epidemics of meningococcal meningitis occur in cycles with irregular intervals in the African meningitis belt. The epidemic season is usually between November and April with peak activity in February-March. The widespread outbreaks which occurred in Niger in 1994 and 1995 indicated that a new epidemic cycle was about to start. In 1996, the worst epidemic ever was reported in Nigeria and vast outbreaks also occurred in Burkina Faso, Chad, Mali, and continued in Niger. The outbreaks in 1996 exhausted the global supply of meningococcal vaccine and evidenced the need for a coordinated response to meet the epidemics anticipated for 1997 with a limited supply of vaccine. WHO therefore launched an initiative to enhance the ability of countries to respond to epidemic meningitis with targeted immunization programmes based on stronger epidemiological surveillance and laboratory services, improved public health communication and social mobilization and enhanced training in prevention, control and case management. Governments of 16 African countries committed themselves to this initiative in a meeting held in Ouagadougou in October 1996 and developed national plans of action. These plans included a national estimate of needs of vaccine and drugs based on criteria of population at risk, the epidemiological pattern of the disease, and available stocks of vaccine and other supplies at the country level. Similar steps were taken in countries at risk in the WHO region for the Eastern Mediterranean. The plan represented a shift from the epidemic response of the past to epidemic preparedness. (excerpt)
Lancet Infectious Diseases. 2004 Aug; 4:478.In order to meet the global need for immunisation against meningitis, India has decided to develop a meningitis vaccine. The Serum Institute of India (SII), a premier Indian organisation that claims to supply 75% of the measles vaccine needed worldwide by the United Nations Children's Fund, has signed an agreement with international Meningitis Vaccine Project (MVP), run globally by WHO and an international charity called Path. According to the agreement, the SII would produce a new conjugate vaccine for meningitis A, by combining the meningitis A polysaccharide with tetanus toxoid, through a new conjugation technology transferred from the Center for Biologics Evaluation and Research (CBER), part of the US Food and Drug Administration (FDA). Carl Frasch, an expert at the FDA, told TLID that, “SII would prepare the vaccine with raw materials coming from two sources: the group A polysaccharide would be produced under contract with SynCo BioPartners, a Dutch enterprise, and the SII itself would produce the tetanus toxoid carrier protein. (excerpt)
International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control. Report of the seventh meeting, Geneva, Switzerland, 18-19 September 2001.
Geneva, Switzerland, WHO, 2002. 52 p. (WHO/CDS/CSR/GAR/2002.2)The seventh meeting of the International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control (ICG) was held on 18 and 19 September 2001 at the Palais des Nations, Geneva at the invitation of the WHO. This ICG meeting follows a scientific consultation meeting on the emergence of Neisseria meningitidis serogroup W135 as a public health problem. Dr Guenael Rodier, Director of the WHO Department of Communicable Disease Surveillance and Response, welcomed the participants. In his opening address Dr Rodier outlined the structure and the successes of the ICG partnership. He underlined some of the challenges that had arisen in recent times: the global vaccine shortage and the misunderstanding of countries about the goal of the ICG, which is to facilitate the timely supplies from a global buffer stock upon urgent request from countries affected by epidemic meningococcal disease. Although epidemic meningococcal disease is not one of the three priority communicable diseases for WHO, namely tuberculosis, HIV/AIDS and malaria, it remains a major public health problem in the African meningitis belt area. Disappointment was expressed that major vaccine manufacturers were absent from the meeting, however the report of the meeting will be shared with them and communications with these manufacturers will continue. The preliminary agenda was adopted by the meeting. Dr. Max Hardiman was elected chairman, with Steve Edgerton as rapporteur. (excerpt)
Routine vaccination with polysaccharide meningococcal vaccines is an ineffective and possibly harmful strategy.
Bulletin of the World Health Organization. 2003 Oct; 81(10):751-755.Robbins et al. suggest that mass campaigns followed by routine vaccination in the meningitis belt would be more effective against epidemic and endemic meningococcal meningitis than the current outbreak response strategy. They propose two doses of group A meningococcal polysaccharide vaccine for routine infant immunization and two booster doses of tetravalent (A, C, W135, and Y) polysaccharide vaccine at two and five years of age. In our view, this strategy is ill conceived for numerous programmatic and epidemiological reasons and would not prevent meningitis epidemics. (excerpt)
Meningococcal meningitis in sub-Saharan Africa: the case for mass and routine vaccination with available polysaccharide vaccines. [Méningite méningococcite en Afrique sub-saharienne : l'affaire en faveur de la vaccination de masse et de la vaccination systématique avec les vaccins polysaccharides disponibles]
Bulletin of the World Health Organization. 2003 Oct; 81(10):745-750.Endemic and epidemic group A meningococcal meningitis remains a major cause of morbidity and mortality in sub- Saharan Africa, despite the availability of the safe and inexpensive group A meningococcal polysaccharide vaccine, which is protective at all ages when administered as directed. Despite optimal therapy, meningococcal meningitis has a 10% fatality rate and at least 15% central nervous system damage. WHO’s policy of epidemic containment prevents, at best, about 50% of cases and ignores endemic meningitis, which is estimated at 50 000 cases per year. The effectiveness of group A, C, W135, and Y capsular polysaccharides is the basis for recommending universal vaccination with group A meningococcal polysaccharide twice in infancy, followed by the four-valent vaccine in children aged two and six years. This could eliminate epidemic and endemic disease, prepare for the use of conjugates when they become available, and probably could have prevented the recent epidemics of groups A and W135 meningitis in Burkina Faso. (author's)
RNIS. Report on the Nutrition Situation of Refugees and Displaced Populations. 2003 Jan; (40):31-32.The Current food security situation in Burundi seems to be very precarious. Close monitoring and food aid should be provided in order to prevent any significant deterioration of the nutrition status. (excerpt)
Africa Health. 2002 Jan; 24(2):26.WHO guidelines for detection of meningococcal meningitis epidemics in the meningitis belt of sub-Saharan Africa were changed in 2000. Previously a weekly incidence of 15 cases/100,000 population, averaged over 2 weeks, was taken as the threshold for the onset of an epidemic in populations of 30,000-100,000. Now the guidelines recommend an alert threshold of 5 cases/100,000 inhabitants per week and an epidemic threshold of 10/100,000 per week at times of high epidemic risk and 15/100,000 per week at other times. These changes were, in large part, in response to data from Mali. (excerpt)