Dear all, Can anyone have an idea on the scientific basis for the use of the fractional dose (0.1 ml) of Yellow Fever vaccine during a pre-emptive mass vaccination campaign? As a reminder, in August 2016, the congolese health authorities in collaboration with WHO and CDC launched a preventive mass vaccination campaign against Yellow Fever in Kinshasa and other potentially YF affected provinces. In Kinshasa alone, 7.8 million people were reached in a period of 10 days. As a Vaccinologist I was unable to provide appropriate answer to those asking (and I was asking myself) why a fractional dose was used. From the literature, I know that there is a set lower limit (as per WHO standards) of the amount of viral materials in the 0.5 ml dose, the upper limit is not set. How come that with WHO support, a dose below that set lower limit was given? Was that part of a large scale clinical study at the level of a population in the context of YF vaccine stockout risk? If that's the case, no informed consent was administered and no explanation as such was provided to the vaccinees,is that ethical? Additionally, is it ethical to test a regimen whose efficacy and/or immunogenicity is unproven in a setting of an ongoing outbreak of a dreadful disease? Was the vaccination campaign even needed in the first place to afford that? Those are questions that trouble me. Your comments and inputs will be very welcome. Regards Trésor, Trésor Bodjick Muena Mujobu, MD, MSc Vaccinology and Clinical Development Specialist E-mail:tresor.bodjick@gmail.com Tel. (00243)819792529

Hello All,
In the website for WHO PQ vaccines BCG and Yellow Fever are the two vaccines which have multi dose preparations packaged in ampoules. As soon as we open a mulit-dose ampoule and administer the first dose, we are leaving the remining doses in the ampoule exposed to environment (very often the not so clean undersurface of the vaccine carrier as the opened ampoule is kept in a slit in the top sponge and the VC closed).
Grateful if someone can enlighten me about the safety of this practice and whether there is any evidence comparing relative incidence of AEFI from multi dose vaccines in an ampoule vs. a vial.
Thanks and regards,
Anindya Bose

The Strategic Advisory Group of Experts (SAGE) on Immunization was established by the Director-General of the World Health Organization in 1999. It is the principal advisory group to WHO for vaccines and immunization and is concerned not just with childhood vaccines and immunization, but all vaccine-preventable diseases.

The Group met in Geneva from 9 April to 11 April 2013. The topics listed below were discussed. Please read the WHO Weekly Epidemiological Report for a detailed description of the discussion and recommendations.


Report from the WHO Department of Immunization, Vaccines and Biologicals
The report focused on: (i) the Global Vaccine Action Plan (GVAP) roll-out; (ii) the strengthening of routine immunization and efforts to integrate immunization and other child health interventions; and (iii) the changing epidemiology of measles.

Report from the GAVI Alliance
The report provided an update on: (i) the processes and timelines for developing the next Vaccine Investment Strategy (for the period 2015–2020) beyond existing commitments, (ii) the preliminary Board discussions regarding GAVI’s potential role in supporting the GPEI, including supporting inactivated polio vaccine (IPV)introduction and potential innovative financing instruments for mobilizing resources, and (iii) the preparations for the next GAVI replenishment round in 2014.

Report from the Global Advisory Committee on Vaccine Safety (GACVS)
A report of the December 2012 GACVS meeting was presented. SAGE acknowledged the detailed review and the recommendations of GACVS on the safety profile of varicella vaccines, risk of narcolepsy and Guillain-Barré syndrome with influenza vaccines, and the safety of dengue vaccines.

Report from the Immunization Practice Advisory Committee (IPAC)
A report of the April 2013 IPAC meeting was presented. SAGE endorsed IPAC’s ongoing contributions to the development of the “Reaching Every Community” toolkit and to the immunization session checklist. SAGE supported these additional tools and validated IPAC’s proposal to pilot test the tools before wide-spread implementation.

Dengue vaccines
... There are unique challenges for dengue vaccine development, including a lack of animal disease models, absence of immunological correlates of protection, and a potential immunopathological component in severe disease, as previous infection with dengue is a risk factor for severe disease upon secondary infection by a heterologous dengue virus. There are currently 5 vaccine candidates in human trials, all of which are tetravalent vaccines designed to protect against all 4 dengue serotypes; 3 are chimeric live attenuated vaccines and 2 are inactivated or subunit vaccines. Several other vaccine candidates are in the preclinical stage of development. SAGE reviewed the results of the Phase IIb trial of the lead vaccine candidate, a tetravalent live attenuated vaccine.

Polio eradication
SAGE commended the GPEI on remarkable continued progress made towards decreasing wild poliovirus transmission in the remaining endemic areas, especially in view of significant difficulties. The programme has also intensified systematic preparations for the withdrawal of oral polio vaccine type 2 (OPV2) along several key workstreams. SAGE recognised that the need to introduce IPV in up to 130 countries that use OPV over a relatively short period of time represented a major and unprecedented challenge.

Yellow fever vaccination
Based on currently available surveillance data, SAGE concluded that vaccine failures are extremely rare and do not cluster as time increases after immunization. A single dose of YF vaccine is sufficient to confer sustained immunity and life-long protection against yellow fever disease and a booster dose of YF vaccine is not needed. Surveillance in endemic countries and clinical studies may possibly identify specific risk groups (such as infants or HIV-infected patients) that could benefit from a second primary or booster dose. SAGE requested WHO to revisit the IHR provisions relating to the period of validity for international certificates for vaccination against YF.

Non-specific effects of vaccines on mortality
SAGE previously requested that WHO review the evidence concerning the possible non-specific mortality effects of vaccines included in the routine infant immunization schedule. SAGE has now established a working group to review data on non-specific effects and consider whether current evidence is sufficient to merit adjustments in policy recommendations, or may warrant further scientific investigation and if so, to outline a path towards obtaining unequivocal evidence that would inform future robust, evidence-based adjustments in immunization policies, if warranted. SAGE recognized that there have been previous reviews on this topic by WHO committees, including reviews by the GACVS between 2000 and 2008.

SAGE was asked to review the protocols for 2 systematic reviews to assess the possible non-specific effects of vaccines: one regarding the epidemiological mortality studies and the other on human immunological studies of non-specific effects of vaccine on mortality in children

Post0221 LOGISTICS, SURVEILLANCE & DISEASE CONTROL 25 January 2000

CONTENTS

1. LOGISTICS MODULE FOR SURVEILLANCE
2. DRAFT MANUAL ON SURVEILLANCE LOGISTICS AVAILABLE FOR DOWNLOAD
3. POLIO ERADICATION NEWS
4. VACCINE PREVENTABLE DISEASE NEWS

1. LOGISTICS MODULE FOR SURVEILLANCE

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
development.

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:
ftp://ftp.acithn.uq.edu.au/technet/1-clickherefortechnetfiles/
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
To:
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

____________________________________*________________________

2. DRAFT MANUAL ON SURVEILLANCE LOGISTICS AVAILABLE FOR DOWNLOAD

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!

Regards,
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
____________________________________*________________________

3. POLIO ERADICATION NEWS
[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

POLIO - CHINA (QUINGHAI): 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]
http://www.duoweinews.com/entdigest/life/wed_jan__5_10_11_58_2000.html)

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
concerned.

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.

- --
ProMED-mail



[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]
..............................................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
China

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
poliovirus.

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
paralysis.

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:
http://www4.law.cornell.edu/uscode/17/107.html

---

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
Brundtland.

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
age.

---

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.
____________________________________*________________________

4. OTHER VACCINE PREVENTABLE DISEASES NEWS
[Clipped and cross posted from a variety of selected sources]
_____________________________________________________________

DIPHTHERIA - INDIA (NORTH)
**************************
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.

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

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
yesterday.

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
septicaemia.

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


References:
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.]
......................................jw/es
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)

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
http://www.uol.com.br/cidadesonline/rj/riodejaneiro/url1.shl
[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.
**************
- --
Promed-mail



[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]
...................................................jw
Visit ProMED-mail's web site at .

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"Emergency Vaccination Against Epidemic Meningitis in Ghana:
Implications for the Control of Meningococcal Disease in West
Africa"
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.

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"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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