Childhood Diseases

CDC vaccination schedule for 2022

Over the last few decades, scientific advances have increased the availability of innovative vaccines for once-fatal illnesses. And public health investments in vaccines have resulted in high coverage for most routine childhood vaccines.

In the new issue of Pediatrics, published by the American Academy of Pediatrics on August 22, 2022, Talbird et al. reported significant estimates of reduced vaccine-preventable disease in the United States.

The authors analyzed various historical records and current public health data systems. They found greater than a 90% reduction in the incidence of ten illnesses after the introduction of vaccines: diphtheria, Haemophilus influenzae type b, measles, mumps, pertussis, polio, rotavirus, rubella, tetanus, and varicella.

An estimated 24 million cases of vaccine-preventable diseases were averted based on 2019 U.S. population estimates, with the most significant reductions seen in influenza, measles, mumps, rubella, pertussis, varicella, and acute otitis media caused by Streptococcus pneumonia.

Despite these profound benefits, the past successes of vaccination efforts in the U.S. are not guaranteed to persist into the future.

Talbird et al. noted, "With sustained vaccine coverage at levels >80% for most pediatric vaccines…many vaccine-preventable diseases are now controlled as a public health problem or eliminated in the United States."

The authors note the fragility of this accomplishment, citing that under-vaccination recently resulted in measles outbreaks in the U.S.

The National Immunization Survey–Child noted that, among school-aged children, the percentage of children who had received all required vaccines in the 2020–2021 school year fell by approximately one percentage point to 94% in one year.

And the percentage of kindergartners with an exemption for one or more school vaccines has increased from 1.6% (2011–2012) to 2.2% (2020–2021), with most of the increase because of nonmedical (versus medical) exemptions.

The World Health Organization has now listed vaccine hesitancy as #1 of the top ten threats to global health.

However, pediatricians have been aware of and fighting against misinformation for decades.

As noted in the 2021 Surgeon General's Advisory on Confronting Health Misinformation, pediatricians play an important role as trusted messengers for parents and can help dispel vaccine misinformation.

'A concerted effort across all parts of the health care and public health systems can assure that vaccines remain one of the greatest public health achievements of our time,' concluded this report.

Furthermore, as the U.S. confronts the 2022-2023 influenza season, trust in flu shots is essential to reducing respiratory disease.

The U.S. CDC published updated vaccination schedules in February 2022, which suggest most people over six months of age receive an annual flu shot.

As of mid-August, flu vaccinations became available at local clinics and pharmacies.

PrecisionVaccinations publishes fact-checked, research-based vaccine news curated for mobile readership.

Sub Title:

Vaccinations added 853,000 life-years while resulting in a net societal cost-savings of $55 billion

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AAP Pediatrics

Flu vaccines for 2022

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Worst Backslide in Children Vaccinations Confirmed

Karen McClorey Hackett — Sun, 17 Jul 2022 15:10:37 +0000

Reviewer:

WHO: Immunization coverage

The largest sustained decline in childhood vaccinations in approximately 30 years has been recorded in official data published today by WHO and UNICEF.

The percentage of children who received three doses of the vaccine against diphtheria, tetanus, and pertussis (DTP), a common marker for immunization coverage, declined by 5% between 2019 and 2021 to a low of 81%.

As a result, 25 million children missed out on one or more doses of DTP through routine immunization services in 2021 alone.

This is 2 million more than those who missed out in 2020 and 6 million more than in 2019, highlighting the growing number of children at risk from devastating but preventable diseases. The decline was due to many factors, including an increased number of children living in conflict and fragile settings where immunization access is often challenging, and COVID-19 related issues such as service and supply chain disruptions, resource diversion to response efforts, and containment measures that limited immunization service access and availability.

“This is a red alert for child health. We are witnessing the largest sustained drop in childhood immunization in a generation. The consequences will be measured in lives,” said Catherine Russell, UNICEF Executive Director, in a press release issued on July 15, 2022.

“While a pandemic hangover was expected last year due to COVID-19 disruptions and lockdowns, we are seeing a continued decline. COVID-19 is not an excuse.”

“We need immunization catch-ups for the missing millions, or we will inevitably witness more outbreaks, more sick children, and greater pressure on already strained health systems.”

It was hoped that 2021 would be a year of recovery during which strained immunization programs would rebuild, and the cohort of children missing vaccines in 2020 would be caught-up.

Instead, DTP coverage was set back to its lowest level since 2008, along with declines in coverage for other basic vaccines, pushed the world off-track to meeting global goals, including the immunization indicator for the Sustainable Development Goals.

Vaccine coverage dropped in every region, with the East Asia and Pacific regions recording the steepest reversal in DTP coverage, falling 9% in just two years.

Myanmar and Mozambique are among the countries with the largest relative increases in the number of children who did not receive a single vaccine between 2019 and 2021.

And unfortunately, over a quarter of the coverage of HPV vaccines that was achieved in 2019 has been lost.

This has grave consequences for the health of women, as global coverage of the first dose of the human papillomavirus (HPV) vaccine is only 15%, despite the first vaccines being licensed over 15 years ago.

And 3.5 million missed the first dose of the HPV vaccine, which protects women against cervical cancer later in life.

“Planning and tackling COVID-19 should also go hand-in-hand with vaccinating for killer diseases like measles, pneumonia, and diarrhea,” commented Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.

“It’s not a question of either/or, it’s possible to do both.”

Some countries notably held off declines. Uganda maintained high coverage in routine immunization programs while rolling out a targeted COVID-19 vaccination program to protect priority populations, including health workers.

Similarly, Pakistan returned to pre-pandemic levels of coverage thanks to high-level government commitment and significant catch-up immunization efforts. To achieve this in the midst of a pandemic, when healthcare systems and health workers were under significant strain, should be applauded.

Inadequate coverage levels have already resulted in avoidable outbreaks of measles and polio in the past 12 months, underscoring the vital role of immunization in keeping children, adolescents, adults, and societies healthy.

First dose measles coverage dropped to 81% in 2021, also the lowest level since 2008.

Similarly, compared to 2019, 6.7 million more children missed the third dose of the polio vaccine.

The sharp two-year decline follows almost a decade of stalled progress, underscoring the need to address pandemic-related disruptions and systemic immunization challenges to ensure every child and adolescent is reached.

WHO and UNICEF are working with Gavi, the Vaccine Alliance, and other partners to deliver the global Immunization Agenda 2030 (IA2030), a strategy for all countries and relevant global partners to achieve set goals on preventing diseases through immunization and delivering vaccines to everyone, everywhere, at every age.

“It’s heartbreaking to see more children losing out on protection from preventable diseases for the second year in a row. The priority of the Alliance must be to help countries to maintain, restore and strengthen routine immunization alongside executing ambitious COVID-19 vaccination plans, not just through vaccines but also tailored structural support for the health systems that will administer them,” stated Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance.

Monumental efforts will be required to reach universal coverage levels and prevent outbreaks.

In the USA, the Centers for Disease Control and Prevention published an updated children's vaccination schedule in February 2022. And with the flu season fast approaching, the CDC is encouraging most children over six months of age to get their annual influenza vaccination.

Flu shots are often available at local pharmacies and health clinics in the USA beginning in August.

PrecisionVaccinations publishes fact-checked, research-based vaccine news curated for mobile readership.

Sub Title:

Millions of children missed routine immunization services in 2021

References:

COVID-19 pandemic fuels largest continued backslide in vaccinations in three decades

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Vaccine-Preventable Disease Outbreaks Increase in Africa

Karen McClorey Hackett — Thu, 28 Apr 2022 17:41:16 +0000

Reviewer:

WHO: Vaccine-preventable disease outbreaks on the rise in Africa

Africa has been witnessing a surge in outbreaks of vaccine-preventable diseases over the past year, announced the World Health Organization (WHO).

Disruptions by the COVID-19 pandemic impaired routine immunization services in many African countries and forced the suspension of vaccination drives.

In 2020, 23 million children missed out on childhood vaccines, the highest number since 2009 and 3.7 million more than in 2019.

One of the diseases is measles.

Twenty African countries reported measles outbreaks in the first quarter of 2022.

As of April 28, 2022, about 17,500 cases of measles were recorded in the African region between January and March 2022, marking a 400% increase compared with the same period in 2021.

Apart from its direct effect on the body, which can be lethal, the measles virus also weakens the immune system and makes a child more vulnerable to other infectious diseases like pneumonia, says the WHO.

“Measles is more than a dangerous and potentially deadly disease. But, unfortunately, it is also an early indication that there are gaps in our global immunization coverage, gaps vulnerable children cannot afford,” commented Catherine Russell, UNICEF Executive Director.

Fortunately, the U.S. has avoided the measles outbreak.

As of April 1, 2022, a total of 2 measles cases were reported by U.S. jurisdictions to the CDC.

Outbreaks of other vaccine-preventable diseases have also become more common.

Twenty-four countries confirmed outbreaks of a variant of polio in 2021, which is four more than in 2020.

And in 2021, 13 countries reported yellow fever outbreaks in the African region, compared to nine in 2020 and just three in 2019.

“The rise in outbreaks of other vaccine-preventable diseases is a warning sign. As Africa works hard to defeat COVID-19, we must not forget other health threats,” said Dr. Matshidiso Moeti, the WHO Regional Director for Africa, in a related press release.

“Health systems could be severely strained not only by COVID-19 but by other diseases.”

“Vaccines are at the heart of a successful public health response, and as countries restore services, routine immunization must be at the core of revived and resilient health systems.”

To urgently scale up coverage and protect children, the WHO and partners are supporting African countries to carry out catch-up routine vaccination campaigns, with more than 90% of the 38 African countries responding to a global survey reporting that they implemented at least one routine catch-up immunization campaign in the second half of 2021.

Some countries have successfully integrated other critical immunization campaigns with COVID-19 vaccination.

For example, Nigeria recently launched a vaccine scale-up strategy that guides the integration of routine immunization with COVID-19 vaccination for mothers and their babies.

Between January and April 2022, the percentage of Africans fully vaccinated against the coronavirus rose to 17.1% from 11.1%.

“In the wake of this pandemic, we are committed to support countries to devise smart approaches to scale up COVID-19 vaccination and restore and expand routine immunization services,” added Dr. Benido Impouma, Director, Communicable and Noncommunicable Diseases Cluster at WHO Regional Office for Africa.

For example, Ghana integrated COVID-19 vaccination with yellow fever campaigns in December 2021 to curb an outbreak that erupted a month earlier.

PrecisionVaccinations publishes fact-checked research-based vaccine news.

Note: The WHO announcement was edited for clarity and manually curated for mobile readership.

Sub Title:

Measles cases increase 400 percent in Africa in 2022

References:

UNICEF and WHO warn of ‘perfect storm’ of conditions for measles outbreaks, affecting children

Measles Vaccines

Yellow Fever Vaccines 2022

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Adolescents and Children Immunization Schedules Updated for 2022

Karen McClorey Hackett — Thu, 17 Feb 2022 22:48:52 +0000

Reviewer:

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children Aged 18 years or younger

The U.S. CDC issued a Morbidity and Mortality Weekly Report today highlighting the Advisory Committee on Immunization Practices (ACIP) recommended immunization schedule for children and adolescents for 2022.

Found on the CDC’s immunization schedule website, the ACIP recommendations issued on February 18, 2022, include several changes from the 2021 immunization schedule.

Vaccine-specific changes include new or updated ACIP recommendations for influenza, dengue, and COVID-19 vaccines.

Changes also include clarification of the recommendations for Haemophilus influenzae type b vaccine, hepatitis A vaccine, hepatitis B vaccine, human papillomavirus vaccine, measles, mumps, and rubella vaccine (MMR); meningococcal serogroups A, C, W, Y vaccine (MenACWY); tetanus, diphtheria, and pertussis vaccine (Tdap); and varicella vaccine (VAR).

Dengue: This new section was added to provide details for routine dengue vaccination in areas with endemic dengue. In addition, a hyperlink referring health care providers to the latest guidance on areas with endemic dengue and prevaccination laboratory testing is included.
Hib: The note was updated to include the recommendations for routine and catch-up vaccination when DTaP-IPV-Hib-HepB (Vaxelis) is used.
HepA: The note was revised to clarify that routine vaccination is at 12–23 months.
HepB: In the “Special situations” section, the text has been revised to clarify and emphasize post-vaccination serology and revaccination recommendations.
HPV: In the “Special situations” section, the text for immunocompromising conditions has been revised to clarify that three doses should be administered regardless of age at initial vaccination.
Influenza: The note has been updated to reflect the recommendations for the 2021–22 influenza season. The “Special situations” section was condensed by moving information on contraindications and precautions for influenza vaccines to the newly created appendix.
MMR: The note on routine vaccination was updated to include recommendations for the use of measles, mumps, rubella, and varicella vaccine (MMRV).
MenACWY: Language was added to the notes regarding the recommendation for simultaneous administration with the meningococcal serogroup B vaccine (MenB). The text reads, “MenACWY vaccines may be administered simultaneously with MenB vaccines if indicated, but at a different anatomic site, when feasible.
VAR: The note has been updated to include recommendations for using MMRV and to clarify that a second dose inadvertently administered after at least a 4-week interval may be counted as a valid dose.

Previously, the CDC published interim clinical considerations for the use of COVID-19 vaccines on February 11, 2022. These considerations include updated contraindication and precaution section for myocarditis or pericarditis cases following an mRNA COVID-19 vaccination.

And for people, ages 5 years and older who are moderately or severely immunocompromised, a 3-dose primary mRNA COVID-19 vaccine series is recommended, followed by a booster (4th) dose for those ages 12 years and older.

The Recommended Child and Adolescent Immunization Schedule, United States, 2022 is available here. In addition, the ACIP recommendations for each vaccine are also available.

Furthermore, a newly created appendix was added that lists the contraindications and precautions for each vaccine type included in the schedule.

Separately, the CDC published an update to the Adult Vaccination schedule for 2022.

PrecisionVaccinations publishes fact-checked, research-based antibody, antiviral, and vaccine news.

Sub Title:

Vaccine contraindications and precautions are included in the CDC schedule for 2022

References:

CDC: Interim Clinical Considerations

CDC: Adult Immunization Schedule

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Vaccinations Save Lives Everywhere

Don Hackett — Sun, 31 Jan 2021 15:37:45 +0000

Reviewer:

Estimating the health impact of vaccination against ten pathogens in 98 low-income and middle-income countries from 2000 to 2030

According to new modeling research, vaccinations against 10 major pathogens substantially impact public health in low-income and middle-income countries (LMICs).

Published in The Lancet on January 30, 2021, this study estimated that from 2000 to 2019, vaccinations prevented 37 million fatalities. Most of this impact is estimated to be among children younger than five years, most notably from measles vaccinations.

These results demonstrated that between 2000 and 2019, there was an increase in the average number of vaccines received per child, both for existing vaccines such as measles and for new vaccines such as rotavirus.

And this estimate by 16 independent research groups modeling the impact of childhood vaccination programs in 98 LMICs could increase to 69 million fatalities for the period 2000-2030.

The study assessed the impact of vaccination programs against ten pathogens: hepatitis B (HepB), Haemophilus influenzae type b (Hib), human papillomavirus (HPV), Japanese encephalitis (JE), measles, Neisseria meningitidis serogroup A (MenA), Streptococcus pneumoniae, rotavirus, rubella virus, and yellow fever virus (YF).

Dr. Caroline Trotter from the University of Cambridge UK, and a co-author on the study, said in a press statement, "There has been a much-needed investment in childhood vaccination programs in low-income and middle-income countries (LMICs), and this has led to an increase in the number of children vaccinated.”

“To inform future investment and ensure it continues, we need to evaluate the impact of these programs on public health. Our modeling has provided robust evidence on the effectiveness of vaccination programs in LMICs and indicated what might be lost if current vaccination programs are not sustained."

The study used two methods to assess impact to provide both a cross-sectional (yearly) and longer-term (lifetime) view of impact. The first method evaluated the difference in the number of deaths between the vaccination and no vaccination scenarios for each year and then totaled these annual results.

The second method assessed the long-term impact of vaccination by summarising the impact over the lifetime for groups of people born in the same year between 2000 and 2030 and then calculated the difference between vaccination and no vaccination scenarios.

This approach allowed for the inclusion of vaccination impact later in life, particularly relevant for diseases such as hepatitis B or HPV, where there is a long delay between infection and severe outcomes. Most of the impact of hepatitis B vaccination will be seen after 2030, whilst HPV impact will be seen after 2040.

Considering impact per year, the study estimates that from 2000 to 2030, vaccination will have prevented 69 million deaths from the ten diseases, 37 million of which were averted between 2000 and 2019. Vaccinations against measles had the most significant impact, preventing 56 million deaths between 2000 and 2030.

In terms of the impact of vaccination over the lifetime of people born between 2000 and 2030, the study estimated that vaccination would prevent 120 million deaths, of which 65 million are in children younger than five. Fifty-eight million deaths would be controlled by measles vaccines and 38 million by hepatitis B vaccines.

Considering those born in 2019, the study estimated that increases in vaccine coverage and introductions of additional vaccines resulted in a 72% reduction in lifetime mortality caused by the ten pathogens.

By taking this 2019 birth cohort and using UN World Population Prospects demographic estimates, the study estimated that mortality in children under five in the 98 countries would be 45% higher in the absence of vaccination against the ten pathogens.

The study also examined each vaccine's relative impact and demonstrated that measles, Hib, and pneumococcal conjugate vaccines (PCVs) have the largest impact on deaths of children under five.

Vaccines against HPV, hepatitis B, and yellow fever have the largest impact per person vaccinated over a lifetime.

Corresponding author, Professor Neil Ferguson from Imperial College London, UK, said: "Our study signifies the huge public health benefits that can be achieved from vaccination programs in low-income and middle-income countries.”

“By projecting up until 2030 in these 98 countries, we have provided insight on where investments in vaccine coverage should be directed to achieve further gains, for example, increasing HPV coverage in girls and pneumococcal conjugate vaccines coverage in children under five will have the most impact according to our modeling."

These researchers reported the level of uncertainty from data on disease burden and the structural assumptions of the different models. Still, they could not evaluate uncertainty in demographic estimates and estimates of past and future vaccine coverage.

In a related commentary published by The Lancet, this study underestimates vaccination impact because it includes only ten of the vaccines commonly used in routine childhood immunization programs.

Pertussis vaccination was not included and could impact pediatric mortality more than some of the other vaccines included in this analysis. Although variably used in children around the globe, the seasonal influenza vaccine was not included and would reduce severe disease and potentially mortality if used more broadly.

The study also excluded most vaccines against epidemic-prone and pandemic-prone diseases, such as cholera, Ebola virus, and typhoid, potentially saving many lives.

This study was funded by the Vaccine Alliance and The Bill and Melinda Gates Foundation. Researchers from Imperial College London conducted it, London School of Hygiene & Tropical Medicine, National University of Singapore, Public Health England, Laval University, Johns Hopkins University, Colorado State University, The Pennsylvania State University, Lafayette College, Kaiser Permanente, University of Cambridge, University of Notre Dame, Dublin City University, Harvard University, Oxford University, University of Southampton, Conservatoire national des arts et metiers, University of Hong Kong and the Center for Disease Analysis Foundation.

No researcher disclosed industry conflicts of interest.

PrecisionVaccinations publishes research-based vaccine news.

Sub Title:

Vaccines against 10 diseases could prevent 69 million vaccine-preventable deaths this decade

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Vaccines work: a reason for celebration and renewed commitment

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Measles Outbreaks Returned in Every Region

Don Hackett — Thu, 12 Nov 2020 23:22:37 +0000

Reviewer:

The Measles & Rubella Initiative supports implementation of the Measles & Rubella Strategic Framework 2021-2030

Around the world, measles cases surged in 2019 reaching the highest level in 23 years, reported the World Health Organization (WHO), and the US Centers for Disease Control and Prevention (CDC).

Global measles fatalities climbed nearly 50 percent since 2016, claiming an estimated 207,500 lives in 2019 alone, reported the WHO on November 12, 2020.

Measles outbreaks occur when people who are not protected from the virus are infected and spread the disease to unvaccinated or under-vaccinated populations. Around 90 percent of people who are not protected will become infected following exposure to the measles virus.

The reason behind this alarming increase is ‘a failure to vaccinate children on time with 2-doses of measles-containing vaccines (MCV1 and MCV2), stated this new WHO report.

“We know how to prevent measles outbreaks and deaths,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, in a related press statement. “These data send a clear message that we are failing to protect children from measles in every region of the world.”

“We must collectively work to support countries and engage communities to reach everyone, everywhere with measles vaccine, and stop this deadly virus.”

To prevent measles outbreaks, measles vaccination coverage rates must reach 95 percent and be maintained at national and sub-national levels.

MCV1 coverage has been stagnant globally for more than a decade at between 84 and 85 percent. And MCV2 coverage has been steadily increasing but is now only at 71 percent.

However, the COVID-19 pandemic has resulted in disruptions in vaccination and crippled efforts to prevent and minimize measles outbreaks.

As of November 2020, more than 94 million people were at risk of missing vaccines due to paused measles campaigns in 26 countries. Many of these countries are experiencing ongoing measles outbreaks.

Of countries with postponed vaccination campaigns, only eight (Brazil, Central African Republic, Democratic Republic of Congo, Ethiopia, Nepal, Nigeria, Philippines, and Somalia) resumed their campaigns after initial delays report the WHO.

As of October 13, 2020, the CDC’s latest data indicates Brazil (4,256) and Nigeria (3,149) have reported the most measles cases during 2020.

And during 2019, most measles outbreaks in the USA were all linked to travel-related cases that reached at-risk populations.

To address these outbreaks, on November 6, 2020, the WHO and UNICEF issued an emergency call to action for measles prevention and response.

Henrietta Fore, UNICEF Executive Director, added: “While health systems are strained by the COVID-19 pandemic, we must not allow our fight against one deadly disease to come at the expense of our fight against another. This means ensuring we have the resources to continue immunization campaigns for all vaccine-preventable diseases, even as we address the growing COVID-19 pandemic.”

In response, global immunization partners are engaging leaders and public health professionals in affected and at-risk countries to ensure that measles vaccines are available and safely delivered and that caregivers understand the life-saving benefit of the vaccine.

“Measles virus easily finds unprotected children, adolescents, and adults because it is so contagious,” said Dr. Robert Linkins, Measles & Rubella Initiative (M&RI) Management Team Chair and Accelerated Disease Control Branch Chief at U.S. CDC.

Since 2000, M&RI has helped deliver over 5.5 billion doses of measles vaccine to children worldwide and saved over 25.5 million lives by increasing vaccination coverage, responding to outbreaks, monitoring, and evaluation, and supporting demand for the vaccine.

A bold strategy released by M&RI, Measles & Rubella Strategic Framework 2021 – 2030, will help to address reversals in global progress toward measles elimination by bolstering strong, national immunization systems that can reach and protect children. This strategic shift by the partnership will focus on strengthening the routine delivery of all vaccines, and quickly and effectively detecting and responding to measles outbreaks.

“Our collective efforts to reach children with vaccines now, ahead of the possible easing of COVID-19 travel restrictions and increased population movement, will save lives.”

The M&RI includes American Red Cross, the United Nations Foundation, the U.S. CDC, UNICEF, and global immunization partners like Gavi, the Vaccine Alliance, the Bill and Melinda Gates Foundation, and others.

In the USA, the M-M-R-II vaccine is commonly available. It is indicated for simultaneous vaccination against measles (rubeola), mumps, and rubella (German measles). This vaccine is usually given to people 1-year-old or older.

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Almost 41 countries have delayed measles campaigns due to the COVID-19 pandemic

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What is Measles?

WHO: Worldwide Measles Deaths Climb 50% from 2016 to 2019 Claiming Over 207,500 Lives in 2019

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Measles and Polio Vaccination Programs Need Support

Don Hackett — Fri, 06 Nov 2020 15:21:34 +0000

Reviewer:

UNICEF and WHO call for emergency action to avert major measles and polio epidemics

The World Health Organization (WHO) issued an urgent call to action to avert major measles and polio epidemics around the globe.

The WHO stated on November 5, 2020, ‘COVID-19 continues to disrupt immunization services, leaving millions of vulnerable children at heightened risk of preventable childhood diseases.’

The WHO and UNICEF estimate that $655 million ($400 million for polio and $255 million for measles) in funding is needed to address dangerous immunity gaps in non-Gavi eligible countries and target age groups.

“COVID-19 has had a devastating effect on health services and in particular immunization services, worldwide,” commented Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, in a press statement.

“But unlike with COVID, we have the tools and knowledge to stop diseases such as polio and measles. What we need are the resources and commitments to put these tools and knowledge into action. If we do that, children’s lives will be saved.”

In recent years, there has been a global resurgence of measles with ongoing outbreaks in all parts of the world. During 2019, measles climbed to the highest number of new infections in more than two decades.

In the USA, a nationwide measles outbreak started in New York City from international travelers who were under-immunized for the measles virus.

The M-M-R-II vaccine remains a highly recommended vaccine in the USA.

Separately, poliovirus transmission is accelerating in various African and Middleast countries during 2020. In response, the WHO extended its Polio Alert.

‘Failure to eradicate polio now would lead to the global resurgence of the disease, resulting in as many as 200,000 new cases annually, within 10 years,’ added the WHO press statement.

The U.S. CDC recommends that before traveling to these countries, adults who completed their routine polio vaccine series as children should receive a single, lifetime adult booster dose of an inactivated poliovirus vaccine (IPV) booster dose, which has been the only polio vaccine offered in the USA since 2000.

Because of the generous financial support from Gavi, the Vaccine Alliance, and previous access to funding for outbreak response, preventive catch-up vaccinations for children who were missed due to COVID-19 disruptions in Gavi-eligible countries are underway.

‘However, significant financing gaps remain in middle-income countries that are not Gavi-eligible. This new call for emergency action will go to support those middle-income countries that are not eligible for support from Gavi,’ concluded the WHO’s comments.

To know more about UNICEF’s work on immunization, visit UNICEF.

PrecisionVaccinations publishes research-based vaccine news.

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WHO’s urgent call to action to increase vaccinations for measles and poliovirus

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Africa’s Island States Collaborate to Purchase Vaccines and Medicines

Don Hackett — Wed, 30 Sep 2020 16:53:48 +0000

Reviewer:

WHO: African island states launch joint medicines procurement initiative

The ministers of health from (7) African island states have signed an agreement to jointly procure drugs and vaccines in a bid to improve quality and access to medicines and other health products, announced the World Health Organization’s Africa Region.

The cost of drugs and medical supplies is one of the major challenges Africa’s Small Island States face due to the modest size of the populations.

Joint procurement is the ultimate model of intercountry collaboration aimed at improving procurement efficiency, says the WHO.

The ministers from Cabo Verde, Comoros, Guinea-Bissau, Madagascar, Mauritius, Sao Tome & Principe and Seychelles that form the Small Island Developing States signed the Pooled Procurement agreement on September 29, 2020, to take advantage of economies of scale and collective bargaining.

These nations comprise an archipelago containing 115 islands.

The WHO’s Director-General, Dr. Tedros Adhanom Gebreyesus, and the Regional Director for Africa, Dr. Matshidiso Moeti, joined the ministers in the virtual signing ceremony.

Dr. Moeti noted that ‘the efforts made so far in establishing the joint procurement program had already increased the attractiveness of the pharmaceutical market of the Small Island Developing States.’

“By creating a larger stream of demand, we can look forward to better access to quality and competitively-priced medicines. The high cost of medicines is one of the major barriers many countries in our region face in providing affordable health care of good standard. Pooling our resources is one way of overcoming this challenge,” added Dr. Moeti.

As the African region faces the double burden of communicable and noncommunicable diseases, it is essential that countries have systems in place for the timely procurement of supplies at a reasonable cost and in sufficient quantities to address treatment needs and efficiently complement important investments in health promotion, says the WHO.

Plans to set up the joint procurement initiative began in 2017 in Seychelles during a meeting of health ministers from Small Island Developing States who expressed commitment to implement the program, particularly for medicines for non-communicable diseases.

The countries of Guinea-Bissau and Madagascar joined later.

“We must admit that it has been a long and tedious effort, and I commend the contributions of past and present Ministers and their teams for the dedication in creating an enabling environment for this mechanism to be launched,” concluded Dr. Moeti.

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African Small Island Developing States agree to collectively purchase vaccines and medicines

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WHO: Tackling the common health challenges of African Small Island Developing States

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Measles Outbreaks Could Occur in These States

Don Hackett — Thu, 20 Aug 2020 16:57:55 +0000

Reviewer:

Persistence of US measles risk due to vaccine hesitancy and outbreaks abroad

In recent years, a growing vaccine hesitancy movement has contributed to decreasing measles vaccination rates in Europe and the USA.

Even if a US state has an average vaccination rate approaching herd-immunity, about 95 percent, measles outbreaks can still occur if there exist localized communities with a high proportion of unvaccinated individuals, and, if the community is highly connected by travel to international regions experiencing large outbreaks, reported a study published in The Lancet on July 30, 2020.

In response to these persistent risk factors, these researchers expanded upon previous work to identify the set of US counties at the highest risk of measles outbreaks.

Multiple regions in California, Florida, New York, Washington, and Texas are identified as being of the highest risk of measles outbreaks, which is concordant with the 2019 outbreaks.

The risk to each county was computed with a multiplicative function of four factors: incidence rate of measles at travel origin, international air travel volume from each such origin to a US destination county, measles, mumps, and rubella (MMR) vaccination rates in the county, and county population.

Results from the model are illustrated in the figure in Appendix 1, which shows the percentage of the population unvaccinated for measles in each US county, the location and relative size of the reported measles outbreaks in 2019, the location of the 20 most visited airports in the USA, and the 30 counties at highest risk of measles outbreaks.

Of the 20 highest ranked counties, together they reported over 700 of the 1,276 confirmed cases in the USA. The model indicates the cities of Los Angeles (CA), Seattle (WA), Honolulu (HI), Miami (FL), and Santa Ana (CA) to be the 5 counties at highest risk.

As an example, the Los Angeles County Department of Public Health confirmed a measles outbreak among 5 persons on February 5, 2020. This measles outbreak began when a measles infectious international visitor was visiting the greater Los Angeles area.

Furthermore, the Philippines, Samoa, Ukraine, New Zealand, and Israel are the countries of highest risk for measles importation to the USA.

The 4 air travel routes posing the highest risk of measles importation ended in Los Angeles and originated in the Philippines, Samoa, New Zealand, and Ukraine.

The top 100 US counties and travel routes are listed in Appendix 2.

Measles is considered among the most contagious viruses in the world. About 90 percent of people who have never been immunized against measles become ill 7-21 days after exposure.

Infected people can infect those around them before they have symptoms and know they are infected, says the U.S. CDC.

The CDC stresses MMR vaccinations prior to international travel.

Unfortunately, a Massachusetts General Hospital study published on December 9, 2019, found a large number of children traveling abroad are not protected from the measles virus. This study was published in JAMA Pediatrics and reported about 44 percent of MMR vaccination–eligible infants were not protected.

Besides the measles vaccines, the CDC encourages travelers to speak with a healthcare provider regarding other travel vaccines options.

Vax-Before-Travel publishes research-based international travel vaccination news.

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Measles outbreak risk increased in California, Florida, New York, Washington, and Texas

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Ensilicated Technology Empowers Safer Vaccines

Don Hackett — Mon, 08 Jun 2020 12:30:39 +0000

Reviewer:

Ground-breaking research makes childhood vaccines safe in all temperatures

Most scientists say vaccines are notoriously difficult to transport to remote locations, as they spoil when not refrigerated.

‘Cold Chain’ distribution requires a vaccine to be refrigerated from the moment of manufacturing to the endpoint destination.

Specific formulations are safe between 2°C and 8°C, but at other temperatures the proteins start to unravel, making the vaccines ineffective.

Currently, up to 50 percent of vaccine doses are discarded before use due to exposure to suboptimal temperatures.

As a result, millions of children around the world often miss out on life-saving inoculations says a team of University of researchers with the University of Newcastle.

However, scientists have now found a way to prevent warmed-up vaccines from degrading. By encasing protein molecules in a silica shell, the structure remains intact even when heated to 100°C or stored at room temperature for up to three years.

The technique for tailor-fitting a vaccine with a silica coat - known as ensilication- was developed by a Bath research team.

This pioneering technology was seen to work in the lab 2-years ago, and now it has demonstrated its effectiveness in the real world too.

In their latest study, published in the journal Scientific Reports, the researchers sent both ensilicated and regular samples of the tetanus vaccine from Bath to Newcastle by ordinary post (a journey time of over 300 miles, which by post takes a day or two).

When doses of the ensilicated vaccine were subsequently injected into mice, an immune response was triggered, showing the vaccine to be active.

No immune response was detected in mice injected with unprotected doses of the vaccine, indicating the medicine had been damaged in transit.

Dr. Asel Sartbaeva, who led the project from the University of Bath's Department of Chemistry, said in a press statement: "This is really exciting data because it shows us that ensilication preserves not just the structure of the vaccine proteins but also the function - the immunogenicity."

"This project has focused on tetanus, which is part of the DTP (diphtheria, tetanus and, pertussis) vaccine given to young children in three doses.”

“Next, we will be working on developing a thermally-stable vaccine for diphtheria, and then pertussis.”

“Eventually we want to create a silica cage for the whole DTP trivalent vaccine so that every child in the world can be given DTP without having to rely on cold chain distribution."

Silica is an inorganic, non-toxic material, and Dr. Sartbaeva estimates that ensilicated vaccines could be used for humans within 15 years.

She hopes the technology to silica-wrap proteins will eventually be adopted to store and transport all childhood vaccines, as well as other protein-based products, such as antibodies and enzymes.

"Ultimately, we want to make important medicines stable so they can be more widely available," she said.

"The aim is to eradicate vaccine-preventable diseases in low-income countries by using thermally stable vaccines and cutting out dependence on cold chain."

According to the World Health Organisation, 19.4 million infants did not receive routine life-saving vaccinations in 2018.

The Bath research was funded by the Royal Society, Alumni Fund in the University of Bath, specifically the Annett Trust, BBSRC, MRC, and ERC.

Vaccine development news is published by Precision Vaccinations.

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Ensilicated vaccine triggered immune responses showing cold chain risks can be mitigated

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80 Million Under-Immunized Children

Don Hackett — Mon, 25 May 2020 12:35:29 +0000

Reviewer:

WHO: At least 80 million children under one at risk of diseases such as diphtheria, measles and polio as COVID-19 disrupts

The COVID 19 disease pandemic is disrupting life-saving immunization services around the world, putting millions of children – in rich and poor countries alike – at risk of diseases.

According to new information, about half (53%) of the 129 countries where data were available reported moderate-to-severe disruptions or a total suspension of vaccination services during March-April 2020.

These disruptions are likely to affect approximately 80 million children living in these countries.

This stark warning comes from the World Health Organization (WHO), UNICEF, and Gavi in a statement published on May 22, 2020.

This bleak insight comes ahead of the Global Vaccine Summit on June 4, 2020, at which world leaders will come together to help maintain immunization programs and mitigate the impact of the pandemic in lower-income countries.

Since March 2020, routine childhood immunization services have been disrupted on a global scale that may be unprecedented since the inception of expanded programs on immunization (EPI) in the 1970s.

“Immunization is one of the most powerful and fundamental disease prevention tools in the history of public health,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.

“Disruption to immunization programs from the COVID-19 pandemic threatens to unwind decades of progress against vaccine-preventable diseases like measles.”

The reasons for disrupted services vary.

Some parents are reluctant to leave home because of restrictions on movement, lack of information, or because they fear infection with the COVID-19 virus.

And many health workers are unavailable because of restrictions on travel, or redeployment to COVID response duties, as well as a lack of protective equipment.

“More children in more countries are now protected against more vaccine-preventable diseases than at any point in history,” said Dr. Seth Berkley, Gavi CEO.

“Due to COVID-19 this immense progress is now under threat, risking the resurgence of diseases like measles and polio.”

“Not only will maintaining immunization programs prevent more outbreaks, but it will also ensure we have the infrastructure we need to roll out an eventual COVID-19 vaccine on a global scale.”

Transport delays of vaccines are exacerbating the situation.

UNICEF has reported a substantial delay in planned vaccine deliveries due to the lockdown measures and the ensuing decline in commercial flights and limited availability of charters.

To help mitigate this, UNICEF is appealing to governments, the private sector, the airline industry, and others, to free up freight space at an affordable cost for these life-saving vaccines.

Gavi recently signed an agreement with UNICEF to provide advance funding to cover increased freight costs for delivery of vaccines, in light of the reduced number of commercial flights available for transport.

“We cannot let our fight against one disease come at the expense of long-term progress in our fight against other diseases,” said Henrietta Fore, UNICEF Executive Director.

“We have effective vaccines against measles, polio, and cholera.”

“While circumstances may require us to temporarily pause some immunization efforts, these immunizations must restart as soon as possible, or we risk exchanging one deadly outbreak for another.”

Many countries have temporarily and justifiably suspended preventive mass vaccination campaigns against diseases like cholera, measles, meningitis, polio, tetanus, typhoid, and yellow fever, due to the risk of transmission and the need to maintain physical distancing during the early stages of the COVID-19 pandemic, says the WHO.

Measles and polio vaccination campaigns, in particular, have been badly hit, with measles campaigns suspended in 27 countries and polio campaigns put on hold in 38 countries.

At least 24 million people in 21 Gavi-supported lower-income countries are at risk of missing out on vaccines against polio, measles, typhoid, yellow fever, cholera, rotavirus, HPV, meningitis A and rubella due to postponed campaigns and introductions of new vaccines.

In late March 2020, concerned that mass gatherings for vaccination campaigns would enflame transmission of COVID-19 WHO recommended countries to temporarily suspend preventive campaigns while assessments of risk and effective measures for reducing COVID virus transmission were established.

WHO has since monitored the situation and has now issued advice to help countries determine how and when to resume mass vaccination campaigns.

The guidance notes that countries will need to make specific risk assessments based on the local dynamics of COVID-19 transmission, the health system capacities, and the public health benefit of conducting preventive and outbreak response vaccination campaigns.

Based on this guidance, and following growing concerns about increasing transmission of polio, the Global Polio Eradication Initiative (GPEI), is advising countries to start planning for the safe resumption of polio vaccination campaigns, especially in polio high-risk countries.

Despite the challenges, several countries are making special efforts to continue immunization. Uganda is ensuring that immunization services continue along with other essential health services, even funding transportation to ensure outreach activities.

Next week, WHO will issue new advice to countries on maintaining essential services during the pandemic, including recommendations on how to provide immunizations safely.

Vax-Before-Travel publishes international vaccine news.

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Childhood immunization services have been disrupted on a global scale

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Coronavirus Pandemic Disrupted Children’s Vaccinations

Don Hackett — Fri, 08 May 2020 18:14:08 +0000

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CDC: Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration

Kelley Lu, PharmD

With reports of laboratory-confirmed COVID-19 disease cases in all 50 states, disruptions were anticipated in the U.S. health care system’s ability to continue providing routine preventive vaccinations.

To the extent that this is the case, reminding parents of the vital need to protect their children against serious vaccine-preventable diseases is critical.

And, as social distancing requirements are relaxed, children who are not protected by vaccines will be more vulnerable to diseases such as measles.

In response to this concern, the US Centers for Disease Control and Prevention (CDC) posted new guidance on March 24, 2020, emphasizing the importance of well-child immunizations.

To better understand the coronavirus pandemic’s impact, a new CDC report published on May 8, 2020, examined two data sources to assess the impact of the pandemic on pediatric vaccination in the USA: Vaccines for Children Program (VFC) provider order data from CDC’s Vaccine Tracking System and Vaccine Safety Datalink (VSD) vaccine administration data.

The VFC is a national program that provides federally purchased vaccines to approximately 50% of U.S. children aged 0–18 years.

Cumulative doses of VFC-funded vaccines ordered by healthcare providers at weekly intervals during two periods January 7 –April 21, 2019, and January 6 –April 19, 2020, were tallied, and differences in cumulative weekly vaccine doses ordered between period 2 and period 1 were calculated for all non-influenza vaccines§ that the Advisory Committee on Immunization Practices (ACIP) recommends for children and, as an example, for measles-containing-vaccines.

VSD is a collaborative project between CDC’s Immunization Safety Office and eight U.S. health care organizations serving publicly and privately insured patients.

Aggregate counts of measles-containing vaccine doses administered each week at VSD sites during period 2 were compared between two pediatric age groups: children aged ≤24 months and those aged >24 months through 18 years.

The Vaccine Tracking System data indicates a notable decrease in orders for VFC-funded, ACIP-recommended non-influenza childhood vaccines, and for measles-containing vaccines during period 2 compared with period 1.

The decline began the week after the national emergency declaration; similar declines in orders for other vaccines were also observed.

VSD data show a corresponding decline in measles-containing vaccine administrations beginning the week of March 16, 2020.

The decrease was less prominent among children aged ≤24 months than among older children.

The subsequent increase in vaccine administrations observed in late March was more prominent in younger than older children.

The substantial reduction in VFC-funded pediatric vaccine ordering after the COVID-19 emergency declaration is consistent with changes in vaccine administration among children in the VSD population receiving care through eight large U.S. health care organizations.

The smaller decline in measles-containing vaccine administration among children aged ≤24 months suggests that system-level strategies to prioritize well child care and immunization for this age group are being implemented.

Increases in vaccine administration to children aged ≤24 months beginning in late March might reflect the early success of strategies implemented by VSD health care organizations to promote childhood vaccinations in the context of the pandemic, including outreach to patients overdue for vaccinations and changing office workflows to minimize contact between patients.

Assessment of state and local vaccination coverage is needed to quantify the impact among U.S. children of all ages and prioritize areas for intervention.

The ongoing COVID-19 pandemic is a reminder of the importance of vaccination.

The identified declines in routine pediatric vaccine ordering and doses administered might indicate that U.S. children and their communities face increased risks for outbreaks of vaccine-preventable diseases.

Parental concerns about potentially exposing their children to COVID-19 during well-child visits might contribute to the decline observed.

In response, continued coordinated efforts between health care providers and public health officials at the local, state, and federal levels will be necessary to achieve rapid catch-up vaccination.

Precision Vaccinations publishes children’s vaccine news.

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Children not protected by vaccines are vulnerable to diseases such as measles

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Only 63% Of Children Meet Recommended Vaccination Schedule

Don Hackett — Sat, 22 Feb 2020 14:37:35 +0000

Reviewer:

Adherence to Timely Vaccinations in the United States

A new study found a large number of children were not ‘on-schedule’ to complete their initial vaccination schedule.

Being from a low-income family, moving out of state and receiving vaccines from a public facility were linked to not following the recommended schedule.

Published on February 21, 2020, this study reported most children’s (63%) vaccination patterns were consistent with the recommended schedule, but 23 percent followed an alternate pattern, and about 15 percent were in the unknown category.

And, about 42 percent of young children were not up-to-date on vaccinations by 19-35 months, these researchers reported.

These researchers analyzed vaccination data on more than 15,000 children ages 19-35 months from the 2014 National Immunization Survey. They included coverage at birth, 2 months, 4 months, 6 months and 12-19 months, allowing some flexibility when determining whether children were being vaccinated on schedule.

They also included rotavirus and hepatitis A vaccinations, which typically aren’t included in determining whether children are up to date.

Children were found to be more likely to follow an alternate schedule if they were not the firstborn or if they had moved out of state.

And, low-income children who were black or multiracial were more likely to follow an alternate schedule, according to the study.

"This combination of factors suggests that many parents in this category may be attempting to adhere to a recommended schedule but, because of external circumstances, fall behind on the appointments required to maintain a recommended schedule," authors wrote.

Children were 4 times more likely to be behind if they were following an alternate schedule and twice as likely to be behind if they had an unknown schedule, when compared to children following the recommended schedule, according to the study.

“Vaccine schedule adherence patterns are strongly associated with up-to-date status, and future research should be focused on identifying the parent actions and circumstances that increase the likelihood of deviating from the recommended schedule,” the authors said.

The US Centers for Disease Control and Prevention recommended vaccination schedules for children can be found on this webpage.

Ms. Hargreaves and Dr. Frew conducted this work while at Emory University. The authors have indicated they have no financial relationships relevant to this article to disclose.

Address correspondence to Robert A. Bednarczyk, Ph.D., Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322. E-mail: rbednar@emory.edu.

This research was supported in part by a grant from the National Vaccine Program Office (1VSRNV00000). Dr. Bednarczyk is supported by a grant (K01AI106961) from the National Institute for Allergy and Infectious Diseases, National Institutes of Health. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the US Department of Health and Human Services.

Vaccination news published by Precision Vaccinations.

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Many parents follow an alternative child vaccination schedule

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Vaccine Misinformation Can Be Cured

Don Hackett — Tue, 18 Feb 2020 13:31:47 +0000

Reviewer:

Vaccine Misinformation and Social Media

People who rely on social media for information were more likely to be misinformed about vaccines than those who rely on traditional media, according to a study published by researchers at the Annenberg Public Policy Center of the University of Pennsylvania.

This study’s conclusions say ‘high level of misinformation is “worrying” because misinformation undermines vaccination rates, and high vaccination rates are required to maintain community immunity.

These Annenberg researchers also found that an individual’s level of trust in medical experts affects the likelihood that a person’s beliefs about vaccination will change.

This means low levels of trust in medical experts coincide with believing vaccine misinformation.

Published in the Harvard Kennedy School Misinformation Review on February 17, 2020, this study found the type of ‘media’ consumption patterns helped to explain vaccine misinformation levels.

As an example, study respondents who reported increased exposure to information about measles and the measles, mumps, and rubella (MMR) vaccine on social media were more likely to grow more misinformed about vaccines.

By contrast, those people who reported increased exposure to news accounts about those topics in traditional media were more likely to grow less misinformed about vaccines.

This finding is consistent with research suggesting that social media contain a fair amount of misinformation about vaccination while traditional media are more likely to reflect the scientific consensus on its benefits and safety, according to the Annenberg researchers.

The researchers found that:

18% of respondents mistakenly say that it is very or somewhat accurate to state that vaccines cause autism;
15% mistakenly agree that it is very or somewhat accurate to state that vaccines are full of toxins;
20% wrongly report that it is very or somewhat accurate to state that it makes no difference whether parents choose to delay or spread out vaccines instead of relying on the official vaccine schedule from the Centers for Disease Control and Prevention (CDC); and
19% incorrectly say it is very or somewhat accurate to state that it is better to develop immunity by getting the disease than by vaccination.

In addition, the research found that vaccine misinformation proved resilient over time.

Most of those in the sample (81%) were just as informed or misinformed in the spring (February/March) as they were five months later (September/October), despite the extensive news coverage of the measles outbreak and attempts by the CDC to educate the public.

Among the 19% whose level of knowledge changed substantially, 64% were more misinformed and 36% were better informed.

The researchers point out that although the findings only show correlations between media coverage and individual attitudes – not causation – these findings still hold implications for the effectiveness of national pro-vaccination campaigns, the role of health professionals in addressing misinformation, and the impact of social media misinformation.

The researchers said this study suggests that “increasing the sheer amount of pro-vaccination content in media of all types may be of value over the longer term.”

“How Trust in Experts and Media Use Affect Acceptance of Common Anti-Vaccination Claims,” was published in the inaugural issue of the Harvard Kennedy School Misinformation Review in January 2020.

Research-based vaccine news published by Precision Vaccinations.

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Low trust in medical experts coincide with people believing vaccine misinformation

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How trust in experts and media use affect acceptance of common anti-vaccination claims

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