Giuseppe
Emeritus
[Source: World Health Organization, Weekly Epidemiological Record, full PDF document: (LINK). Extract, edited.]
Weekly epidemiological record - Relev? ?pid?miologique hebdomadaire
20 may 2011, 86th year / 20 mai 2011, 86e ann?e
No. 21, 2011, 86, 205?220
http://www.who.int/wer
Meeting of the Strategic Advisory Group of Experts on immunization, April 2011 ? conclusions and recommendations
The Strategic Advisory Group of Experts (SAGE) on immunization(1) met on 5?7 April 2011 in Geneva, Switzerland.(2)
(?)
Report from the Global Advisory Committee on Vaccine Safety (GACVS)
The Chair of GACVS presented the conclusions from its December 2010 meeting and subsequent teleconferences during which GACVS reviewed: (i) new data related to intussusception risk following rotavirus vaccination, (ii) new data on the safety of pandemic influenza A (H1N1) 2009 vaccines, (iii) the experience of yellow fever vaccine use among HIV-infected individuals, and (iv) the experiences of 3 West African countries in monitoring the safety of meningitis A conjugate vaccine. Regarding the latter, GACVS addressed the theoretical concerns of using the vaccine during pregnancy even though no clinical data were available. GACVS considered that the benefits of immunizing pregnant women with the meningitis A conjugate vaccine in countries with increased risk of disease outweigh any theoretical risks of using the vaccine in pregnancy.
(?)
Seasonal and pandemic influenza
The Chair of the Review Committee on the Functioning of the International Health Regulations and Pandemic Influenza A(H1N1) 2009 provided a report on their conclusions and recommendations. Two key findings were that A(H1N1) 2009 influenza satisfied the current definition of a pandemic and that there was no evidence of commercial influence on WHO decision-making.
SAGE was appreciative of the report and its conclusions and recommendations; however, it did not support a recommendation for regular community-wide seasonal vaccination in low and middle income countries. SAGE will address this issue in November 2011 following a review by its working group on influenza vaccine and immunization.
SAGE received a report on H1N1 vaccine deployment and vaccination, and noted that rapid vaccine deployment and uptake is complicated by legal and regulatory frameworks in countries with limited influenza vaccine experience. Country-level survey data on vaccine usage showed variable utilization rates in targeted population groups.
An update on the current global epidemiology of seasonal influenza demonstrated a mixed pattern of virus transmission in the northern hemisphere during this past winter with more severe disease activity due to H1N1 in some areas, particularly the United Kingdom, and milder activity in the Asian region. Transmission of H1N1 demonstrated similar patterns as the previous season. SAGE encouraged WHO to work with low-and middle-income countries to improve the collection and use of epidemiological information on seasonal influenza.
The SAGE working group on influenza vaccine and immunization reported on the proposed conceptual matrix.(3)
Priorities identified included pregnant women and protection offered to their newborns (<6 months), infants <2 years old and health-care workers. The working group also summarized information on global disease burden.
SAGE noted the uncertainty of identifying priority groups due to limited information particularly from low- and middle-income countries, which lack epidemiological and disease burden data for seasonal influenza, although mortality rates in these countries may be higher. The difficulties in interpreting and extrapolating data collected for post-marketing effectiveness studies and the ethical issues related to randomized, placebo controlled trials were noted.
The working group was tasked to reconsider options for the nature, deployment and storage of the remaining 120 million doses of pledged pandemic A(H5N1) vaccine stockpile and report to SAGE in November 2011. Three main options are under consideration:
1. to generate a physical H5N1 vaccine stockpile, stored largely as bulk, possibly held by the manufacturer;
2. to keep all the vaccine as a virtual stockpile, only specifying the strain when a future pandemic emerges;
3. as 2, but to have a small quantity (possibly 1% of the total) as a filled physical stockpile for immediate deployment to respond to local H5N1 outbreaks.
The working group noted that option 3 would provide reassurance to countries without their own H5N1 vaccine stockpile to permit local outbreak response. SAGE noted the favourable arguments towards maintaining a small physical stockpile of H5N1 vaccine but raised the question of what other vaccines (e.g. cholera, typhoid) should be stockpiled for humanitarian response.
(?)
(1) Information on the Strategic Advisory Group of Experts (SAGE) is available at (LINK).
(2) The complete set of presentations and background materials used for the SAGE meeting of 5?7April 2011 is available at (LINK).
(?)
-
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Weekly epidemiological record - Relev? ?pid?miologique hebdomadaire
20 may 2011, 86th year / 20 mai 2011, 86e ann?e
No. 21, 2011, 86, 205?220
http://www.who.int/wer
Meeting of the Strategic Advisory Group of Experts on immunization, April 2011 ? conclusions and recommendations
The Strategic Advisory Group of Experts (SAGE) on immunization(1) met on 5?7 April 2011 in Geneva, Switzerland.(2)
(?)
Report from the Global Advisory Committee on Vaccine Safety (GACVS)
The Chair of GACVS presented the conclusions from its December 2010 meeting and subsequent teleconferences during which GACVS reviewed: (i) new data related to intussusception risk following rotavirus vaccination, (ii) new data on the safety of pandemic influenza A (H1N1) 2009 vaccines, (iii) the experience of yellow fever vaccine use among HIV-infected individuals, and (iv) the experiences of 3 West African countries in monitoring the safety of meningitis A conjugate vaccine. Regarding the latter, GACVS addressed the theoretical concerns of using the vaccine during pregnancy even though no clinical data were available. GACVS considered that the benefits of immunizing pregnant women with the meningitis A conjugate vaccine in countries with increased risk of disease outweigh any theoretical risks of using the vaccine in pregnancy.
(?)
Seasonal and pandemic influenza
The Chair of the Review Committee on the Functioning of the International Health Regulations and Pandemic Influenza A(H1N1) 2009 provided a report on their conclusions and recommendations. Two key findings were that A(H1N1) 2009 influenza satisfied the current definition of a pandemic and that there was no evidence of commercial influence on WHO decision-making.
SAGE was appreciative of the report and its conclusions and recommendations; however, it did not support a recommendation for regular community-wide seasonal vaccination in low and middle income countries. SAGE will address this issue in November 2011 following a review by its working group on influenza vaccine and immunization.
SAGE received a report on H1N1 vaccine deployment and vaccination, and noted that rapid vaccine deployment and uptake is complicated by legal and regulatory frameworks in countries with limited influenza vaccine experience. Country-level survey data on vaccine usage showed variable utilization rates in targeted population groups.
An update on the current global epidemiology of seasonal influenza demonstrated a mixed pattern of virus transmission in the northern hemisphere during this past winter with more severe disease activity due to H1N1 in some areas, particularly the United Kingdom, and milder activity in the Asian region. Transmission of H1N1 demonstrated similar patterns as the previous season. SAGE encouraged WHO to work with low-and middle-income countries to improve the collection and use of epidemiological information on seasonal influenza.
The SAGE working group on influenza vaccine and immunization reported on the proposed conceptual matrix.(3)
Priorities identified included pregnant women and protection offered to their newborns (<6 months), infants <2 years old and health-care workers. The working group also summarized information on global disease burden.
SAGE noted the uncertainty of identifying priority groups due to limited information particularly from low- and middle-income countries, which lack epidemiological and disease burden data for seasonal influenza, although mortality rates in these countries may be higher. The difficulties in interpreting and extrapolating data collected for post-marketing effectiveness studies and the ethical issues related to randomized, placebo controlled trials were noted.
The working group was tasked to reconsider options for the nature, deployment and storage of the remaining 120 million doses of pledged pandemic A(H5N1) vaccine stockpile and report to SAGE in November 2011. Three main options are under consideration:
1. to generate a physical H5N1 vaccine stockpile, stored largely as bulk, possibly held by the manufacturer;
2. to keep all the vaccine as a virtual stockpile, only specifying the strain when a future pandemic emerges;
3. as 2, but to have a small quantity (possibly 1% of the total) as a filled physical stockpile for immediate deployment to respond to local H5N1 outbreaks.
The working group noted that option 3 would provide reassurance to countries without their own H5N1 vaccine stockpile to permit local outbreak response. SAGE noted the favourable arguments towards maintaining a small physical stockpile of H5N1 vaccine but raised the question of what other vaccines (e.g. cholera, typhoid) should be stockpiled for humanitarian response.
(?)
(1) Information on the Strategic Advisory Group of Experts (SAGE) is available at (LINK).
(2) The complete set of presentations and background materials used for the SAGE meeting of 5?7April 2011 is available at (LINK).
(?)
-
-------