Discussions marquées : Disease surveillance

Updated Vaccine-Preventable Diseases (VPD) Surveillance Standards Released

Minal Patel Publié dans :
WHO has released the updated surveillance standards for more than 20 vaccine-preventable diseases. Each disease is its own self-contained chapter, available in color and in black and white (for ease of printing).  There is also an introductory chapter detailing some of the basics of surveillance.  French and Russian translations will be available in the coming months.  

HLN releases Version 1.13.1 of its Award Winning Open Source Immunization Forecaster

A new release (v 1.13.1) of the Immunization Calculation Engine (ICE) is now available (download ICE version 1.13.1). ICE is a state-of-the-art open-source software system that provides clinical decision support (CDS) for immunizations for use in Immunization Information Systems (IIS), Electronic Health Record (EHR) and Personal Health Record (PHR) Systems. The release includes support Earliest Date and Overdue Date for additional vaccines: Pneumococcal and Hib. If enabled, ICE will output two additional forecast dates along with the Recommendation Date: the Earliest Date and Overdue Date. The Earliest Date is the soonest date that the vaccine can be given and still be considered valid. The Overdue Date is the date after which an immunization administered would be considered late. With this release, ICE returns the earliest and overdue dates for nine vaccine groups, and the remaining three vaccine groups will be completely supported in a future release of ICE this summer. In addition, this release includes an adjustment to the Pneumococcal catch-up schedule (see Exception 1B in the Pneumococcal Vaccine Group documentation for details). All changes are documented in the release notes. There were no changes to the ICE Implementation Guide (v2r20) which describes how implementers should update their installation and software to properly read the Earliest, Recommended, and Overdue dates. Feel free to e-mail us at ice@hln.com if you have any questions.

HLN Adds Support for Earliest/Overdue Date in Latest Release of Open Source Immunization Forecaster

A new release (v 1.11.1) of the Immunization Calculation Engine (ICE) is now available (Download ICE version 1.11.1). ICE is a state-of-the-art open-source software system that provides clinical decision support for immunizations (CDSi) for use in Immunization Information Systems (IIS), Electronic Health Record (EHR) and Personal Health Record (PHR) Systems. The release includes support for Earliest Date and Overdue Date. If enabled, ICE will output two additional forecast dates along with the Recommendation Date: the Earliest Date and Overdue Date. The Earliest Date is the soonest date that the vaccine can be given and still be considered valid. The Overdue Date is the date after which an immunization administered would be considered late. In this release, ICE returns the earliest and overdue dates for 4 vaccine groups: Meningococcal ACWY, Polio, Rotavirus and Varicella. The ICE team expects the remaining vaccine groups will be completely supported in future releases of ICE in Spring 2018. In addition, this release includes a General Rule update which fixes an issue that resulted in the General Rule “Shots Administered Below Series Absolute Minimum Age for Dose 1” not being triggering when there are 2 or more invalid shots given below the absolute minimum age for Dose 1. The latest ICE Implementation Guide (v2r19) describes how implementers should update their installation and software to properly read the Earliest, Recommended, and Overdue dates. The relevant information starts on page 43. Note that a “track changes” version of this same guide is also available. The tracked changes are intended to make it easier for the reader to see what has changed in the Guide since the prior release of the ICE Implementation Guide (v2r18). You can determine which release of ICE you are using by viewing the README.HISTORY file that is included with each distribution. Please feel free to e-mail us at ice@hln.com if you have any questions.

Anyone from Brazil and Mali?

Is there anyone here who works in immunization program in Brazil and Mali? I need to ask some questions regarding immunization schedule and their respective immunization program. I tried reviewing available literature and publications online but there are some data that seem inconsistent.  Please send me a private message here, or email me through raguindin.md@gmail.com. Thank you!

Pulse polio Jan 2018 Sullia Block: 47th round

 Dear all, India is more committed, last case of WPV1 was in Jan 2011, along with other 10 countries got the certificate of eradication in March 2014. But as long as there is wild virus circulating in any part of the world, threat exists and may revert back to pre-eradication era as opined by the experts in polio. Hence India is conducting 2 rounds of Pulse Polio [NID] on 28 Jan 2018 and 11 March 2018. In Karnataka, the strategy is to administer 2 drops of Oral Polio Vaccine in the booths on day 1 followed by 2 to 3 days of house-to-house activity. In south states, from the beginning booth activity is very strong and ~90% coverage will happen on booth day itself. We expect the same this year also. The credit of eradicating polio is first given to the community, the responsible parents who brought their children to the booths and got vaccinated followed by innumerable PE’s from grass-root level workers, volunteers, NGO’s, Govt and all stakeholders. KVG Medical College, Sullia along with all other educational Institutions, NSS, NCC, Rotary, IMA along with the Govt, conducted 1 Km long rally to infuse jubilance and to create awareness to mobilize the children tomorrow. 10,845 under 5 children are expected to receive OPV tomorrow. The Block Medical Officer, MO’s of the planning units and all of us are confident to achieve ~97% coverage tomorrow itself and the remaining 3% will be covered on 29th and 30th. with regards  

Editorial from EPI Monthly Feedback Bulletin from AFRO East and South (August-October 2017): The use of innovations (ODK) supporting country level Integrated Supportive Supervision real time documentation.

As part of the WHO African region efforts to improve immunization and surveillance performances in terms of quality, effectiveness, efficiency, coverage and equity and in order to strengthen the capacity of policy makers and health providers in countries, there is a need for accurate data in order to gauge the effectiveness of existing policies and programs in health care system to make it more accessible and reliable. Guided by the WHO regional office, the IVD cluster of the Inter-country Support Teams for the ESA sub-region (IST/ESA) is supporting the use of innovative technologies within the immunization systems through GIS and mHealth. The rapid proliferation of mHealth projects (mostly pilot efforts), has generated considerable enthusiasm among governments, donors, and implementers of health programs. GIS and mHealth are not a new concept to be adopted and recommended by the WHO or MoHs, and they are among the key technologies that have proven impact on the quality, timeliness, and cost effectiveness of the program activities at all levels reaching up to subnational, health facility, and case-based levels (i.e. for VPD surveillance, AFP environmental surveillance, routine immunization and micro-planning, LQAs, EPI reviews, containment, certification and Monitoring & Evaluation etc.). One of the innovations is the Integrated Supportive Supervision (ISS). The ISS is an Integrated Electronic Checklist used for supervision during Active Case Search and Routine Immunization which is mostly administered by both WHO staff and Government personnel via Smart mobile phones in the field at Health Facilities and Focal Sites. These supportive visits are automatically mapped on the country profile server managed by WHO. Supportive Supervision remains the bedrock for highlighting good surveillance and routine Immunization practices through systematic visits to priority sites for assessment, evaluation and on the job training for health workers and entire health system. As we move towards the last miles of polio eradication, advanced well to eliminate measles in our sub-region, thus to bridge immunity and surveillance gaps, WHO IST/ESA has gone a step further in institutionalizing supportive supervision by encapsulating the activity into mobile format that can be administered using smart phones in order to increases the accuracy and reliability of information collected. Accuracy of data can be enhanced by proper data collection and management, the development, execution and supervision of plans, policies, programs and practices that control, protect, deliver accurate, relevant and up-to-date data in the shortest time. In the use of m-health, data collection and management has become a critical component, which requires portable software, mobile devices and the software that houses the collected information. Open Data Kit (ODK) is a free and open-source set of tools that can help organizations author, field, and manage mobile data collection solutions. In the ESA sub-region, Ethiopia, Tanzania, Madagascar, Zambia, Kenya, Uganda and South Sudan had already adopted the use of this real time mobile assisted supportive supervision with over 1,603 visits to health facilities in three months (August – October, 2017) across different regions and districts. Other countries that adopted the tool and are ready to commence using it includes South Africa, Botswana, Namibia, Malawi, Seychelles, Lesotho, Eritrea, Zimbabwe, Swaziland. The Target is to have all countries under the ESA region to conduct all their supportive supervision using smart phones to foster accountability of WHO and Government staff. It also supports other health interventions outside the EPI programmes and countries are encouraged to take advantage of the opportunity to support other health interventions (e.g. Cholera outbreak). We therefore call to Government EPI managers and surveillance officers to position themselves to embrace and use the new innovations to enable them to attain and sustain immunization and surveillance targets. Contributors as well as members of the editorial board: Dr Ahmed Y, Mr Bello I, Dr Byabamazima C, Mr Chakauya J.M, Dr Daniel, F, Dr Eshetu, M.Shibeshi, ,Dr Lebo E, Mr Katsande R, Ms Machekanyanga ,Mr Masvikeni B, Dr Manyanga D, Dr Mumba,M. Dr Okiror S,Dr Petu A, Dr Umar S and Dr Weldegebrie G.

WHO guidelines on ethical issues in public health surveillance

WHO guidelines on ethical issues in public health surveillance World Health Organization, 2017 ISBN: 978-92-4-151265-7 The WHO Guidelines on Ethical Issues in Public Health Surveillance is the first international framework of its kind, it fills an important gap. The goal of the guideline development project was to help policymakers and practitioners navigate the ethical issues presented by public health surveillance. This document outlines 17 ethical guidelines that can assist everyone involved in public health surveillance, including officials in government agencies, health workers, NGOs and the private sector. I gratefully acknowledge the many experts and WHO colleagues who have made important contributions to this publication. WHO has rightly asserted that public health surveillance, conducted in a manner that anticipates ethical challenges and proactively seeks to reduce unnecessary risks, provides the architecture for social well-being. It is now up to the global community and countries to take up this challenge and implement the guidelines in their surveillance systems. Defining public health surveillance Some countries define surveillance narrowly, others quite broadly. These guidelines cover surveillance as broadly understood. In the simplest formulations, surveillance is defined as “continued watchfulness” or “the monitoring of events in humans, linked to action”. WHO generally defines surveillance as “the continuous, systematic collection, analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice”. Health data are those pertaining to communicable and NCDs, injuries and conditions and their related risks and determinants. For infectious disease outbreaks (and events that suggest a “potential for international disease spread”), the International Health Regulations (2005) (IHR) define surveillance as “the systematic on-going collection, collation and analysis of data for public health purposes and the timely dissemination of public health information for assessment and public health response as necessary”. Understanding of public health surveillance differs considerably from country to country. Although surveillance is usually described as systematic or continuous, not all countries, institutions or scholars single out the routine nature of public health surveillance but rather emphasize the purpose and function of data collection (see Table 1). Likewise, although disease and injury always figure centrally, some definitions include determinants of important public health events and environmental conditions that affect health. Vital registration of events like births and deaths, although often not specifically described as part of a “public health” surveillance system, is often considered to be surveillance… To access the publication - http://apps.who.int/iris/bitstream/10665/255721/1/9789241512657-eng.pdf?ua=1

For the first time, WHO is publishing immunization coverage data at the subnational level reported by 140 Member States worldwide.

Data for over 20 000 subnational entities were received, which represents about two-thirds of all the surviving infants worldwide. The information is essential for countries to target their efforts to address gaps and increase immunization coverage. By visiting our website ( http://www.who.int/immunization/monitoring_surveillance/data/subnational/en/) you will be able to access a summary presentation of the data received, information on the limitations of the data and some country specific visuals.

HLN Releases Version of its Award Winning Open Source Immunization Forecaster

A new release (v of the Immunization Calculation Engine (ICE) is now available (download ICE v ICE is a state-of-the-art open-source software system that provides clinical decision support for immunizations (CDSi) for use in Immunization Information Systems (IIS), Electronic Health Record (EHR) and Persona The release includes the following changes: l Health Record (PHR) Systems. Added support for Meningococcal B. Support for Meningococcal B has been added as a new vaccine group, separate from the existing Meningococcal ACWY vaccine group. Meningococcal ACWY will continue to be returned as its own vaccine group. Implementers may need to modify their software to start looking for the new Meningococcal B vaccine group code (835). Logic fixes for HPV and Hep B vaccine groups. Addition of non-U.S. vaccine DTaP-IPV-Hib (CVX 170) Release notes that describe the latest changes in more detail Please refer to the updated ICE Implementation Guide (v2r17) for information on how to make the appropriate adjustments to your software to be compatible with this release. The guide provides details about the new Meningococcal B vaccine group implementation as well as a few other vaccines and reason codes that have been added. In addition, a “tracked changes version” of this same guide is also available. The tracked changes are intended to make it easier to see what has changed since the prior release (v You can determine which release of ICE you are using by viewing the README.HISTORY file that is included with each distribution. Please feel free to e-mail us at ice@hln.com if you have any questions.

Engagement of private/nongovernmental health providers in immunization service delivery: Considerations for National Immunization Programmes

The WHO Guidance Note on "Engagement of private/nongovernmental health providers in immunization service delivery: Considerations for National Immunization Programmes" has recently been published on the WHO website: www.who.int/immunization/documents/policies/WHO_IVB_17.15/en/ This Guidance Note for national immunization programmes aims to: Present considerations regarding the involvement of nongovernmental (private) providers in vaccine delivery (including contribution to enhancing coverage and equity while maintaining delivery standards and quality), monitoring of coverage and safety, and disease surveillance; Provide recommendations to support optimal engagement of nongovernmental (private) providers in the effective delivery of national immunization programmes. This document does not attempt to quantify the impact of the private sector or propose a preferred hierarchy of delivery systems (i.e. private, mixed, or public model) nor does it prescribe the type of engagement or advocate for a greater or lesser role of the private sector in health care. The aim is to encourage closer collaboration between the public and private/nongovernmental sectors and hence a more effective engagement of the private sector in supporting national immunization programme priorities.

HLN Releases Roadmap for Open Source ICE Immunization Forecaster

HLN has released a product Roadmap for its award winning Immunization Calculation Engine (ICE).  ICE is an open source service-oriented, standards-based immunization forecasting software system that evaluates a patient’s immunization history and generates the appropriate immunization recommendations. The Roadmap describes modifications that have already been scheduled for inclusion in new releases of ICE in the near future, in addition to ongoing changes that may be required to maintain compliance with the US Advisory Committee on Immunization Practices (ACIP) recommendations. Addition of new vaccine schedules, changes to core business logic, and additional functionality are all included on the Roadmap. As additional modifications are scheduled they will be published on the Roadmap as well. HLN hopes this information will help clinical organizations seeking to use ICE in their practices and software vendors seeking to incorporate ICE into their products to plan for new feature availability. ICE provides state-of-the-art clinical decision support for immunizations (CDSi). ICE can be used in Immunization Information Systems (IIS), Electronic Health Records (EHR), Health Information Exchanges (HIEs), and Personal Health Record (PHR) Systems. See Press Release For more information contact ice@hln.com

Supplement recently published - The Expanded Program on Immunization in Ethiopia

Raoul Kamadjeu Publié dans :
A Supplement on EPI in Ethiopia recently published in the Pan African Medical Journal. http://www.panafrican-med-journal.com/content/series/27/2/

Measles elimination and rubella control - Case based surveillance

Dear viewers
“Measles & Rubella (MR) case based surveillance” is being launched to achieve the goals of measles elimination and rubella control. For any vaccine preventable disease, vaccinating routinely with potent vaccine, uniformly throughout the country following a standard schedule is mandatory. For eliminatiing Measles, >95% coverage of first dose on completion of 9 months before 12 months and second dose along with booster dose of DPT and OPV between 16 to 24 months has to be achieved. Private sector is contributing to the vaccination service; % varies between rural and urban, rich and the poor. Our pilot study depicted an alarming gap with regard to 8 selected operational components of routine immunization. We conducted this study for all the antigens of National Immunization Schedule of our country and Karnataka specific as 2 fractional doses of IPV of 0.1ml intradermally administered. But in this post, giving importance to Measles and Rubella, we are sharing our finding with Measles vaccine where in "when to give and how many times to give" itself is known to 17.14 %!!!. Multi-dose Vial Policy / Open vial policy, type of VVM were not responded. But the solutions suggested are practiced in our college; easily operable and can be implemented in a revolutionary way with marginalized financial burden.
Please do view and contribute for further simpler operable solutions to mitigate the gap to save the children especially of elite group.
Best wishes
Holla and Team

Routine immunization services in Pakistan: seeing beyond the numbers

Interesting paper from EMHJ describing systemic bottlenecks and proposes potentialsolutions for routine EPI in Pakistan


Dear viewers Govt of India declared 2012-2013 as year of "Intensified Routine Immunization" and 200 districts who were below national coverage of 71% for DPT 3rd dose as per DLHS3 were selected. This gave us an opportunity to conduct this study. 4 Immunization Weeks (IWs), one week per month in 4 successive months were supposed to start from April 2012 in Jharkhand, due to some reasons, the launch got postponed by 4 months. We took advantage of this "window period" and piloted simulation study in 5 selected Health Sub Centres of combined districts - Deoghar and Jamtara of Jharkhand, without incurring extra expenditure and in the regular outreach sessions itself in intensified mode. The lessons learnt and the micro-plan model developed in this study, with a few modifications were replicated and applied to the entire state by the Govt of Jharkhand for which we are indebted. We are thankful to the ANMs who actively participated in this study and the superiors for their support. Next we wish to share the Immunogram Study article with the viewers.


Evolution, growth and development, extension-expansion, operational research are all natural processes. Launch of a new programme with a properly fitting outfit, infuses rejuvenation, jubilance, reminds the commitment and sustains interest among the service providers in implementing the old programme. Mission Indradhanush completed one year and we thought of sharing the “Power of Peer Education” for sustenance of the success during the inter MI periods through regular outreach sessions as recommended in the MI guidelines also. The attached is partially shared with RI/MI stakeholders and now sharing with techNet community for valuable inputs.

Immunization Summary smart-phone and tablet apps is updated with 2014 data

The fabulous app "Immunization Summary" was updated with 2014 data and in the 6 WHO officials languages. The Immunization Summary is an app for visualizing (tables, graphs, maps) data on policies, activities and impact of national immunization systems. There's a just discovered bug, which is the country name selection needs the English country name to select the country in the appropriate chosen language! Ah well... If you do not know the English name of the country sought, just scroll down the list in the chosen language; there the country names appear in the proper language. When we finalize the JRF 2014 data exercice, sometimes next month, another update will be done on the app. If you already have the app on your device, redownload it from the App store: http://appstore.com/immunizationsummary or Google Play: https://play.google.com/store/apps/details?id=com.who.immunizationsummary cheers






This posting continues from the discussion of logistics and polio
surveillance activities begun in TECHNET Forum posts 0196 on 27 October
1999, LOGISTICS + POLIO ERADICATION, and Post0197, 28/10/99, Post0198,
and Post0198 on 29/10/99. At the end of the discussion Maureen Birmingham,
WHO/V&B, pointed out that a Logistics for Surveillance module was under

Maureen kindly made copies of the draft module available at Technet'99
Harare, 6-10 December 1999. TECHNET Members who have received copies are
requested to provide comments at an early stage.

The DRAFT module is now available for download!

On the web - go to the website:
Click on the directory: Surveillance
Click on the file: SurveillanceLogisticsModuleDraftJan2000.pdf 371 kb

Get the file by email- send an email to: [email=listserv@acithn.uq.edu.au]listserv@acithn.uq.edu.au[/email]
with the message: get technet SurveillanceLogisticsModuleDraftJan2000.pdf

* Your comments and suggestions would be appreciated.

Action, comments and additions please: [email=technet@acithn.uq.edu.au]technet@acithn.uq.edu.au[/email]
or use your reply button

From: [email=birminghamm@who.ch]birminghamm@who.ch[/email]
Date: Fri, 07 Jan 2000 10:18:41 +0100
Subject: Reminder On Logistics Module For Surveillance

Hi, Allan!

I would like to send a reminder to all Technet-ites that we would very
much like to receive comments on the logistics for surveillance module
that was introduced (as a draft) at the Dec 1999 Technet meeting. We
intend to finalize this module during the first quarter of 2000.

Marcus Hodge (lead developer), Mojtaba Haghgou and myself are currently
involved in it, but we welcome others who want to get involved.

Please send your comments to Marcus Hodge, .

Maureen Birmingham



Marcus kindly posted the file to Technet. It has been converted to the
Adobe Acrobat? pdf file format.

To obtain the free viewer go to: www.adobe.com

The file SurveillanceLogisticsModuleDraftJan2000.pdf is 371 kb.

Action, comments and additions please: [email=technet@acithn.uq.edu.au]technet@acithn.uq.edu.au[/email]
or use your reply button

From: "Marcus Hodge"
To: [email=technet@acithn.uq.edu.au]technet@acithn.uq.edu.au[/email]
Subject: Draft surveillance logistics manual
Date: Fri, 21 Jan 2000 17:23:07 +0700

Dear Allan,

Here is a copy of our draft Surveillance Logistics Manual for the Technet
FTP site. I'll email updates as they become available. Any feedback from
Technet members would be gratefully received!

Marcus Hodge
Get the file by email by sending an email to: [email=listserv@acithn.uq.edu.au]listserv@acithn.uq.edu.au[/email]
with the message: get technet SurveillanceLogisticsModuleDraftJan2000.pdf

[Clipped and cross posted from a variety of selected sources]

"Eradication of Poliomyelitis"
Lancet (11/27/99) Vol. 354, No. 9193, P. 1910; Hull, Harry F.;
Tangermann, Rudolf H.; Aylward, R. Bruce; et al.

In a letter to the editor of The Lancet, researchers from the
World Health Organization discuss the eradication of polio. The
authors note that the global eradication effort has highlighted
problems within various health systems, such as in India, where
the immunization campaign brought to light deficiencies in the
standard immunization system. The government, therefore, has
increased support for routine immunization, including the repair
and replacement of damaged cold chain equipment. The authors
also note that as polio immunization activities took place in
Cambodia, coverage for measles and diphtheria, tetanus, pertussis
vaccines increased from 35 percent to 70 percent and from 37
percent to 68 percent, respectively, between 1993 and 1997. The
researchers report that the WHO is investigating the effects of
polio eradication on health systems and plans to issue a full
report on the subject in early 2000.

Date: Fri, 7 Jan 2000 06:34:16 -0500 (EST)
From: ProMED-mail

Subject: PRO/EDR> Polio - China (Qinghai): alert

A ProMED-mail post

Date: Fri, 7 Jan 2000 12:13:35 +0800
Translated by: "K.Yip Associates"
Source: Chinese News Net 5 Jan 2000 [in Chinese]

China's Health Ministry issues emergency announcement on poliomyelitis
virus discovered in Qinghai

According to a Health Journal report, China's Health Ministry issued an
emergency announcement nationwide, on a case triggered by poliomyelitis
virus in Qinghai Province. The Ministry has instructed local authorities
to pull together comprehensive anti-epidemic action plans.

Not long ago in Qinghai, a 16-month old infant boy, who had not received
any vaccine, was reported of having acute poliomyelitis in one of his
limbs. The doctor diagnosed this as a poliomyelitis-suspected case. The
Immunology Department of the Health Ministry of Qinghai Province isolated
poliomyelitis virus from the fecal sample of the infant. Based on the
result of the test, the department confirmed that poliomyelitis virus type
1 was the cause of the case. Initially, it was believed that the virus
came from external sources [was imported].

The Health Ministry has dispatched millions of doses of vaccine to the area

According to to expert analysis, the imported virus which has caused the
case in Qinghai Province may have spread considerably far. The low
temperature right now does not favour the spread of the intestine-based
poliomyelitis virus, hence, it is the best time to step up immunization.

- --

[Poliomyelitis was thought to have been eradicated from China. Qinghai
(Tsinghai) Province is in west central China, well off the tourist track,
so at the moment there is no threat to international travel - Mod.JW]
Visit ProMED-mail's web site at .


WP/PR/01 18 January 2000

A vigilant surveillance system detects an imported case of polio in rural

Despite the fact that the last indigenous case of polio in the Western
Pacific Region was detected in March 1997, importation of polio from
outside the Region still poses a risk. On 15 December 1999, WHO was
officially informed by the Ministry of Health (MOH), China that a case of
polio had been detected in Qinghai province.

The case, a sixteen-month old boy belonging to the Sala minority group, was
first reported at the clinic in Geizi township (Xunhua County, Haidong
Prefecture) on 13 October 1999 with onset of paralysis the day before.
Timely laboratory tests confirmed the case to be due to wild poliovirus.

Members of the Sala minority group travel widely as traders and workers in
neighbouring countries.

A combined mission of experts from the MOH, WHO, UNICEF and Japanese
International Cooperation Agency (JICA) visited Qinghai province from 20-25
December to review the case.

Preliminary genomic sequencing indicated that the virus is significantly
different from those that circulated in China up to the last case which was
detected in 1994. The studies indicated that the poliovirus was similar to
viruses recently circulating in polio endemic areas outside the Region.

Despite intensive investigation in the area where the case appeared,
including searches of health facilities, to date no evidence of wide-scale
circulation of wild poliovirus has been found.

Surveillance quality, including laboratory proficiency in Qinghai province,
is in general good. The case is thus believed to have been due to imported

Extensive additional activities are currently being carried out, including
large-scale immunization across several provinces, intensified
surveillance, a retrospective review of hospital records at all levels in
several provinces, and an active search for cases of acute flaccid

The situation has highlighted the need for countries of the Western Pacific
Region to remain extremely vigilant for importation while the virus still
circulates anywhere in the world. The prompt detection of this case in a
sparsely populated rural area in China is an encouraging example of such a
vigilant surveillance system.

Reprinted under the fair use doctrine of international copyright law:


05:53 PM ET 12/09/99

WHO: Europe Sees No Polio

COPENHAGEN, Denmark (AP) _ The World Health Organization said Thursday that
no polio cases have been reported in the past year in its European region.

``We are truly on the brink of eradicating a fearsome disease which has
crippled and killed so many,'' said Joe E. Asvall, the head of U.N. group's
regional European headquarters in Copenhagen.

Eastern and southeastern Turkey were the last areas within the agency's
European sphere to have polio. The last case was reported in November 1998
in a Turkish province along the Iranian border.

Turkish authorities and the WHO have performed mass vaccinations this year
in ``high-risk provinces'' and made ``house-to-house searches for
children,'' Asvall said in a statement.

More than 200 cases of polio were observed in the region every year before
the launch of a mass vaccination campaign in 1995, said George Oblapenko,
the agency's coordinator for the eradication program.

The vaccination enterprise stretched from the Mediterranean Sea to central
Asian republics. The disease continued, however, to threaten the European
region with several cases reported in Afghanistan and Iran.

Last year, the U.N. agency launched a global initiative to eradicate polio
by the end of 2000. To be certified as being free of polio, a WHO region
must prove that three years of extensive surveillance have found no wild
polio, the agency said.

Both the Americas were certified polio-free in 1994 and WHO's Western
Pacific region was declared free of the disease three years later.


WHO launches final push for polio eradication

INCORPORATES UN-Polio. Embargoed by source until 0730 GMT Thursday, Jan. 6
By HEMA SHUKLA, Associated Press Writer

NEW DELHI, India (AP) _ The World Health Organization Thursday urged the
governments of 30 African and Asian nations whose people are still
afflicted by polio to help in the final push to wipe out the crippling
disease by the end of the year 2000.

``We are on the verge of a historic public health victory _ the eradication
of poliomyelitis, a disease which has caused untold suffering to millions
of children in all parts of the world,'' said WHO chief Gro Harlem

After more than a decade of concerted action by the WHO countries
participating in the anti-polio program, the number of reported polio cases
worldwide has declined from 35,000 in 1988 to 5,200 in 1999.

``Five thousand cases a year globally shows a dramatic decline in cases,''
Brundtland said.

The WHO has urged heads of affected nations in sub-Saharan Africa and South
Asia to provide the necessary leadership for extra immunization activities
and facilitate ``tranquility days'' in areas of conflict to allow mass
vaccination campaigns.

At a conference in New Delhi, Brundtland described the year 2000 as a
``window of opportunity'' to defeat the disease. The U.N. health agency has
set the end of a year as a target for the campaign which will cost
approximately dlrs 1 billion.

``We are on a wave. We can reach the target in one year,'' she said, adding
the world needed to be ambitious in its target to eradicate the disease
from the world.

An estimated 70 percent of the world's remaining polio cases are in India,
where the size and density of the population living in tropical conditions
and low immunization coverage has made it a ``reservoir'' with a high rate
of transmission of the polio virus. The country is in the midst of a vast
immunization drive to try to combat the disease.

``A major effort in the Indian subcontinent is important if we are to
succeed by the year 2000,'' Brundtland said.

Many of the other cases are in conflict-stricken sub-Saharan African
nations like Angola, Congo and Sierra Leone where the WHO has sent health
workers to administer the polio vaccine.

``We have reached to the bushes, areas where they haven't seen health
people before,'' Brundtland said.

Synchronization of the immunization drive among nations was essential to
the security of success, Brundtland said, because a gap between campaigns
could allow the virus to sneak in.

Polio is highly infectious. It affects the spinal cord and brain, causing
paralysis and sometimes death. It usually affects children under 5 years of


02:10 PM ET 01/05/00

New Appeal on Polio Launched

GENEVA (AP) _ The World Health Organization and the U.N. children's fund on
Thursday urged heads of state of 30 African and Asian countries to make a
final push to wipe out polio.

WHO and UNICEF sent the appeal to countries still afflicted by the
crippling disease. Polio has been wiped out in the Americas, Europe and the
Western Pacific region.

``We are on the verge of an historic public health victory _ the
eradication of poliomyelitis, a disease which has caused untold suffering
to millions of children in all parts of the world,'' WHO chief Gro Harlem
Brundtland and UNICEF head Carol Bellamy wrote in a letter.

They urged heads of affected nations in sub-Saharan Africa and South Asia
to provide leadership for extra immunization efforts. They also asked the
leaders to push truces that would allow mass vaccination campaigns in areas
of conflict.

At a conference in New Delhi, Brundtland described the year 2000 as a
``window of opportunity'' to defeat the disease. The U.N. health agency has
set the end of the year as a target for its elimination.

Polio is highly infectious. It affects the spinal cord and brain, causing
paralysis and sometimes death. It usually affects children under 5 years
old. The number of reported polio cases worldwide has declined from 35,000
in 1988 to 5,200 in 1999, but many cases aren't reported.

An estimated 70 percent of the world's remaining cases are in India. The
country is in the midst of a vast immunization drive to combat the disease.
Many of the other cases are in conflict-stricken sub-Saharan African
nations like Angola, Congo and Sierra Leone.


"Today's Goal: Rid World of Polio"
USA Today (01/06/00) P. 10D; Manning, Anita

The World Health Organization, Rotary International, and UNICEF are coming
together today to announce their attempt to eradicate polio from the world,
with the goal of stopping polio transmission by year-end 2000. There are
an estimated 5,000 cases of polio worldwide, confirmed in 22 countries and
suspected in eight others, all in Africa, the Middle East and Southeast
Asia, with 70 percent existing in India. That is down from roughly 350,000
cases in 1988, and is a good sign toward the potential disappearance of the
disease. If all countries are certified polio-free in 2005, about $1.5
billion in treatment will be saved, covering the $1 billion necessary for
the final sweep attempted this year.

[Clipped and cross posted from a variety of selected sources]

A ProMED-mail post

Date: Mon, 17 Jan 2000 09:23:10 -0600
From: Clyde Markon
Source: The Lancet [edited abstract]

The Lancet reported during 3 weeks in September, 1999, four children from
different families in urban slums in north India (3-8 years of age; three
girls, one boy) presented with diphtheria. All these children had fever,
sore throat, dysphagia, and swelling in the neck of 2-10 days' duration.
Two children had not been immunized, whereas the other two had received
only two doses of the diphtheria-pertussis-tetanus vaccine in their first
year of life. The children all had extensive membranes in the throat; one
child also had laryngeal involvement. Electrocardiography showed features
suggestive of myocarditis in three children, two of whom died within a few
hours of admission as a result of arrhythmias.

The occurrence of four cases in a short period suggests a resurgence of
diphtheria. Records between 1990 and 1998 did not reveal any cases of
microbiologically confirmed diphtheria. Although clinically diagnosed
diphtheria has been reported in India up to the early 1990s, the cases were
not microbiologically confirmed. The epidemic in the former USSR in the
early 1990s was attributed to a large population of susceptible children
and adults, a decline in childhood immunization, poor socioeconomic
conditions, and large-scale population movements. In India, there is 44%
drop-out rate between the third dose of primary immunization and the first
booster. Large-scale migration and overcrowding in the urban slums are also
problems in India.

- --
e-mail: [email=promed@promedmail.org]promed@promedmail.org[/email]
Visit ProMED-mail's web site at .


"Progress Toward Measles Elimination--Eastern Mediterranean
Region, 1980-1998"
Morbidity and Mortality Weekly Report (12/03/99) Vol. 48, No. 47,
P. 1081

The World Health Organization's goal to eliminate measles from
the Eastern Mediterranean Region by 2010 was set in 1997.
Preliminary data from the 14 countries in group two, which are
polio-free, shows that significant progress has been made towards
measles elimination, especially in countries following the
recommended strategies. All the group two countries except
Morocco used a two-dose schedule for measles vaccination, with 96
percent coverage for one dose among children aged one year. To
uphold routine measles coverage, some group two countries began
to identify and track children with home visits, educate more of
the community, and supervise vaccine providers. The reported
incidence of measles has decreased from 184,000 cases in 1980 to
61,000 in 1985, and continues to fall. In the 14 countries that
began measles elimination activities, there has been high
vaccination coverage since 1994. Bahrain, Jordan, Saudi Arabia,
Syria, Tunisia, and UAE have reported high coverage in catch-up
efforts launched in 1998 and 1999; Oman has performed a
successful catch-up campaign as well. Currently, the programs
seek to achieve higher coverage in catch-up campaigns in Lebanon,
Morocco, and Palestine, and hope to strengthen measles
surveillance with better monitoring and reporting of coverage.
Political commitment and sufficient resources are essential in
reaching the campaign's goal by 2010.


Date: Mon, 17 Jan 2000 12:58:10 -0500 (EST)
From: ProMED-mail

Subject: PRO/EDR> Meningococcal disease, group C increasing - UK

A ProMED-mail post

Date: Thu, 13 Jan 2000 21:18:50 -0500
From: George A. Robertson
Source: UK Independent, 14 Jan 2000 [edited]

A lethal form of meningitis is growing rapidly in Britain and is poised to
strike scores more victims as the flu outbreak peaks, doctors warned

Meningococcal septicaemia, a form of blood poisoning caused by the same
bacterium as meningitis, is up 21 per cent on a year ago according to
figures obtained by The Independent, and is claiming over 150 new victims
each month.

Septicaemia is the most lethal complication of meningitis and spreads
through the bloodstream. Cases have risen threefold in five years and in
the worst cases the infection causes rapid organ failure and death,
sometimes in hours.

Experts say some of the increase is due to improved testing but consultant
paediatricians are reporting a sharp rise in cases of children with

Meningitis tends to surge in the weeks after a flu outbreak because more
people have inflamed throats as a result of their illness, providing a
ready route for entry of the bacterium.

Latest flu figures published yesterday show the rate has risen to 203 cases
per 100 000 population, above the normal winter level of 50 to 200 cases
per 100 000.

Cases of [meningococcal] meningitis and septicaemia, collectively known as
meningococcal disease, reached their highest levels since the Second World
War in 1998 but are continuing to soar. Provisional figures for 1999 from
the Government's Public Health Laboratory Service show there were 2973
notifications of the disease, up 12 per cent on 1998. Cases of septicaemia
rose to 1828, up by 319 cases (21 per cent) on 1998. In 1994 there were 430
cases of septicaemia.

Specialists in infectious disease say meningitis, which strikes the young
and fit with unnerving speed and ferocity, has changed and become more
virulent. The group C strain of the disease which is more common in older
children and teenagers has been growing since the mid 1990s and has a
higher death rate. Figures for deaths in 1999 are not available but in 1998
the group C strain claimed 210 lives.

A new vaccine against [group C meningococcal disease] was introduced on 1
Nov 1999 and it is planned to cover all 14 million of the population aged
up to 18 by the end of 2000. Cases for this winter are already lower than
last although experts are uncertain whether that is the effect of the
vaccine or the natural cycle of the disease.

The Meningitis Research Foundation said the rise in cases of septicaemia
was the most worrying development. A spokeswoman said: "If you ask any
consultant who treats children in hospital the number of cases referred to
them is hugely increased with a much greater frequency of septicaemia.
There is better reporting but there is also a change in the disease."

Dr Mary Ramsay, consultant at the Public Health laboratory Service said:
"There has been a nastier bug around for the last few years and there is no
doubt there is more meningococcal disease. We keep waiting for it to peak
and go away but it hasn't yet."

Professor Robert Booy, professor of child health at the Royal London
Hospital, said: "We have had more patients with meningitis and septicaemia
referred in the last two weeks than in the previous two months. It is part
of the seasonal surge but flu will have contributed to that."

The UK has the second highest rate of meningococcal disease in the western
world after the Republic of Ireland, but the reasons are not understood.
The total cases in the UK are approximately equal to those in the US, a
country with ten times the population.

The Meningitis Research Foundation, in Thornbury, Bristol, has received a
donation of BPS250 000 from Dyson makers of the vacuum cleaner, to fund
research but is lacking worthwhile proposals from scientists to spend it
on. A spokeswoman said: "We have never received a donation as large as
this. There must be scientists desperate for funding whom we could help."
Meningitis Research Foundation 0808 800 3344 (24 hour helpline)
[Byline: Jeremy Laurance]

ProMED-mail e-mail: [email=promed@promedmail.org]promed@promedmail.org[/email]

[Vaccines covering Group C meningococcal disease have been available for
some time. I am unfamiliar with the new vaccine reported in this article
to be available since November, 1999. This problem is not restricted to
the UK, although the incidence may be higher there. The Advisory Committee
on Immunization Practices of the US Centers for Disease Control has
reportedly recommended that college students housed in dormitories should
be immunized (1). Adolescent smoking has been cited as a risk factor (2).
- - Mod.ES

1. US Centers for Disease Control press release, October, 1999.

2. Gold, R. Epidemiology of bacterial meningitis. Infect Dis Clin North Am
1999 Sep;13(3):515-25.]
Visit ProMED-mail's web site at .


Date: Mon, 17 Jan 2000 18:37:13 -0500 (EST)
From: ProMED-mail

Subject: PRO/AH/EDR> Yellow fever - Brazil (Rio de Janeiro ex interior)

A ProMED-mail post http://www.promedmail.org

Date: Mon 17 Jan 2000
From: Promed-mail

Source: newspaper O Dia Online, Brazil 17 Jan 2000
[Translated & edited by Mod.JW]

Rio has 3 more cases of suspected yellow fever (YF), according to the
Municipal Health Secretariat. They are: a 43-year-old resident of
Ipanema, who caught it in Amazonia; a 30-year-old resident of Campo
Grande, who spent New Year's Eve in Goiania [Goias state]; & a 47-
year-old male resident of Para State, who came to visit his family in the
district of Meier, in the north of the city of Rio de Janeiro, & who has
been in the University Hospital of Rio since last Saturday.

Blood specimens from the patients have been sent to the Institute
Oswaldo Cruz & the results will be available on Wed 19 Jan. "If the
results are positive, we will see, along with the Ministry of Health, what
needs to be done," said Meri Baran, epidemiology coordinator of the
Secretariat, which continues to not recommend mass vaccination. "We
will immunize only those travelling to endemic areas," he explains.

The only case of YF so far confirmed in Rio was a student who became
infected during a visit to Chapada dos Veadeiros, in Goias state. The 24-
year-old girl has completely recovered. Residents of Itanhanga, where
she lives, have already been vaccinated. "Our greatest concern is to
control the _Aedes aegypti_ mosquito, the vector of dengue & yellow
fever. To do this, the Secretariat has contracted 350 professionals, who
will sweep through the whole city," says Meri.

Already in the year 2000, Brazil has had 4 deaths from yellow fever, 7
confirmed & 5 suspect cases.
- --

[If one case has already been confirmed, there could well be more
infected residents of Rio now returning home from vacation in the interior
of Brazil. Brazil has enough vaccine available for mass vaccination of Rio
de Janeiro. It might be prudent to do it now before more cases are
hospitalized in the city. The University Hospital of Rio does not have
mosquito screens on the windows. - Mod.JW]
Visit ProMED-mail's web site at .

"Emergency Vaccination Against Epidemic Meningitis in Ghana:
Implications for the Control of Meningococcal Disease in West
Lancet (www.thelancet.com) (01/01/00) Vol. 355, No. 9197, P. 30;
Woods, Christopher W.; Armstrong, Gregory; Sackey, Samuel; et al.

Epidemics of meningococcal disease in Africa have led to the use of
meningococcal polysaccharide vaccines that prevent disease. However, in the
case of an epidemic in Ghana that began in 1996 in Togo, a study of the
cases and number of deaths shows that vaccination may not be the most
effective and simplest strategy. Using a simple mathematical model,
researchers evaluated reports of 18,703 cases and 1,356 deaths from
November 1996 to May 1997 caused by meningitis. An estimated 61 percent of
cases would have been prevented by routine childhood and adult
immunization, similar to the number prevented under World Health
Organization (WHO) guidelines if vaccination had been started at the onset
of the epidemic. However, the scientists conclude that, based on analysis
of the epidemic and its case numbers, the use of polysaccharide vaccines
is limited in its protection. Because the vaccine is only 85 percent
effective, routine immunization would not prevent many of the cases and
does not replace the need for constant surveillance of disease and the
ability for quick response. Therefore it remains crucial that surveillance
continues as advocated by WHO, although conjugate vaccines may help when
given as part of routine infant vaccination.


"Emergency or Routine Vaccination Against Meningococcal Disease
in Africa?"
Lancet (www.thelancet.com) (01/01/00) Vol. 355, No. 9197, P. 3;
Peltola, Heikki

A commentary about a study in Ghana investigating the need for
meningococcal vaccinations in Africa discusses meningococcal epidemics
caused by serogroup A or group C in sub-Saharan Africa. These epidemics
cause up to 1 percent of the population to become ill, but Heikki Peltola,
of Helsinki University Central Hospital and a member of the working group
that produced the World Health Organization practical guidelines for the
control of meningococcal infection, notes that this can be prevented if the
meningococci vaccines were added to routine immunizations given in Africa.
Mass vaccinations based on WHO guidelines could have saved about 60 percent
of the lives lost in a 1997 outbreak in Ghana. Even though the WHO system
of emergency vaccination appears to have been successful in this instance,
identifying an epidemic remains of chief importance for less developed
countriesthat seek to save lives, Peltola concludes.

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