transi’on to rou’ne vaccina’on: overview of plans in the meningi’s … · = children born...
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Transi'ontoRou'neVaccina'on:OverviewofPlansintheMeningi'sBelt
CarolTevi-Benissan(AFRO),NadiaTeleb(EMRO),IkeOgbuanu(HQ)
TheMeningi'sVaccineProjectClosureConference
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Overall Meningitis Control Strategy
l Enhancement of surveillance and outbreak response capacity – Rapid response to outbreaks (Nm W, C, X and A in the unprotected) – Outbreak containment: emergency stockpile
l Inducement of strong herd protection with Men A conjugate vaccine – Eliminate epidemics of Men A – Large-scale single dose preventive mass campaigns (1-29yrs)
l Protection of new birth cohorts – Introduction into routine EPI and catch-up campaigns
l Adequate treatment and care of meningitis cases
COMPARISON OF SCENARIOS A-D
http://www.who.int/immunization/sage/meetings/2014/october/presentations_background_docs/en/ Karachaliou A, Conlan AJK, Preziosi MP and TrotterC. Modelling long-term vaccination strategies with MenAfriVac® in the African meningitis belt. Clinical Infectious Diseases 2015; 61(Suppl.5): S594-600.
If routine EPI is NOT TIMELY… Epidemic likely in 2025 or before...
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Strategy to reduce the risk of MenA epidemics
1. One time catch-up new cohorts are also covered and herd protection is maintained
2. AND progressive routine introduction in all countries of the meningitis belt
This strategy will reduce the risk of MenA epidemics in the 26 meningitis belt countries
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WHO Updated Recommendations
l Complete the mass vaccination campaigns
l Introduce meningococcal A conjugate vaccine into the routine childhood immunization programme
– Within 1-5 years following the mass campaigns
l Conduct a one-time mini catch-up campaign for new birth cohorts
– Who were less than 1 year old during the initial mass campaigns – AND outside the age range targeted by the routine programme
WHO encourages streamlined applications to Gavi – Including all the above three components SOURCE: Weekly epidemiological record, No.8, 20 February 2015, vol. 90, (pp. 57–68), available at http://www.who.int/wer/en/
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Recommended Dosing Schedule
l A one-dose schedule At 9-18 months of age based on local programmatic and epidemiological considerations
l Any children who missed vaccination at the recommended age should be vaccinated as soon as possible thereafter
l For infants <9 months: If compelling reasons exist A 2-priming dose infant schedule should be used starting at 3 months of age, with doses at least 8 weeks apart
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Vaccine Presentations
l MenAfriVac vaccine (10 µg) – Should continue to be used for catch-up and periodic campaigns
from 12 months of age onwards*
l MenAfriVac 5 micrograms vaccine (5 µg) – Should be used for routine immunization of infants and young
children from 3 to 24 months of age*
*Note: bridging studies will be needed to demonstrate that MenAfriVac 5 µg can be used in older age groups
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Vaccine Presentations (2)
l Same diluent
l Different cap color (copper gold vs. silver)
l Different label color
MenAfriVac (10 µg)
MenAfriVac 5 (5 µg)
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Co-administration and safety issues l Co-administration evaluated and found to be safe
– diphtheria toxoid, tetanus toxoid, whole cell pertussis, hepatitis B, Haemophilus influenzae type b, oral poliovirus, yellow fever, measles and rubella vaccines
l No data yet for co-administration with – Rotavirus vaccine, pneumococcal conjugate vaccine or IPV – However, there is no reason to expect vaccine interference, and
absence of data should not discourage co-administration and evaluation
l Vaccination of pregnant women is safe – No reason to exclude pregnant women from mass vaccination
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Nationwide Routine Introduction in countries which conducted initial localized campaigns l Complexity of implementing different vaccination
programmes in the same country’
l Public perceptions of inequity could arise with regard to vaccination in different parts of the country
l Climate variability could result in evolution of at-high risk areas in the country
l Nationwide introduction might also benefit neighbouring countries
– e.g. by building geographic herd protection and maintaining the benefits of the initial mass campaigns
Plansforrou'neintroduc'on,inthe26countriesofthemeningi'sbeltin2016-2018
2016 BurkinaFaso-
Ghana
Mali-Niger
Sudan
2017 Benin–Cameroon–
CAR–Chad
Côted’Ivoire–Gambia-Guinea
Nigeria–Togo–Senegal
Kenya-Tanzania
2018
DRC–Ethiopia
GuineaBissau–Mauritania
SouthSudan–Uganda
Rwanda–Burundi-Eritrea
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Challenges of the routine transition
l Multiple injections at one visit – Already have MCV1 and Yellow Fever at 9 months – Some countries considered 15 or 18 months instead
l Health worker training – Different presentations for campaign versus routine – Different target ages for campaign versus routine
l Changing norms and behaviors on vaccination beyond 12 months of age:
– Mothers – Communities – Health workers
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Opportunities of MenA transition into routine
l High community demand for MenA in all countries
l An opportunity to catch up on previously missed vaccinations
– MCV1, MCV2, Penta, PCV, DTP4 booster, etc.
l Future vaccines could take advantage of the high coverage – Malaria vaccine in the second and third years of life?
l An opportunity to build a stronger second year of life (2YL) platform
– Spread out the (crowded) immunization schedule beyond infancy? – Other healthy child visits in the 2YL (nutrition,Vit A, etc.)
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Next steps for all partners
l Complete the mass vaccination campaigns in the remaining 10 countries
l Support countries to introduce the conjugate vaccine into their routine program
– Ensure that countries conduct a one-time mini catch-up campaign for new birth cohorts
l Continue social mobilization and collaboration with communities and political leaders
l Support the development and deployment of a polyvalent meningitis vaccine as soon as possible
Thank you!
Back up slides
Tomaximizeitsefficiency,theideal4mingofthecatch-upcampaignwoulddependontheageatrou4nevaccina4on,i.e.ifacountrychoosestoadministertherou4nevaccinedose
Toensurealltherearenogapsinthecoverage:
o at9monthsofage:thecatch-upcampaignshouldbeconductedifpossible3monthsaAertherou4neintroduc4on
o at18monthsofage:thecatch-upcampaignshouldbeconductedifpossible7monthsbeforetherou4neintroduc4on
o inallinstances:thecatch-upcampaignshouldtargetallchildren≥12monthsofageANDbornlessthan1yearbeforeandany4meaAertheini4almasscampaign
Ques'on1Whatistherecommendedperiodbetweentheone-'mecatch-up
campaignandtheintroduc'oninrou'neimmuniza'on?
Example1.CountryA
v Conducteditsmassimmuniza7oncampaigntarge7ng1-29year-oldsinDec.2010
v Isplanningtostartrou7neimmuniza7ontarge7ng9month-oldsinSept.2016
o Ideallythecatch-upcampaignshould
q beconducted3monthsaaerSept.=inDec.2016
q targetchildren≥12month-olds,bornsincetheini4almassvaccina4onandoutsidetheagerangetargetedbytherou4neimmuniza4onprogramme,i.e.=childrenbornbetweenJan.2010andDec.2015
o Why?BecauseifthecampaignisconductedbeforeDec.2016,a2month-cohortofchildrenbornbetweenOct.–Nov.2015willbe10-11month-oldinSept.2016,i.e.willbe
q tooold(>9monthsofage)toreceiverou4neimmuniza4oninSept.2016
q tooyoung(<12monthsofage)toreceivecatch-upimmuniza4oninSept.2016
èinordertomaximizeefficiency:itisrecommendedtoconductthecatch-upcampaign3monthsaFertheintroduc7oninrou7ne,otherwisesomechildrenmightneverreceive
thevaccine
Examples
Example2.CountryB
v Conducteditsmassimmuniza7oncampaigntarge7ng1-29year-oldsinDec.2010
v Isplanningtostartrou7neimmuniza7ontarge7ng18month-oldsinSept.2016
o Ideallythecatch-upcampaignshould
q beconducted7monthsbeforeSept.=inFeb.2016
q targetchildren≥12month-olds,bornsincetheini4almassvaccina4onandoutsidetheagerangetargetedbytherou4neimmuniza4onprogramme,i.e.=childrenbornbetweenJan.2010andFeb.2015
o Why?Because,ifthecampaignisconductedinFeb.2016,childrenborninFeb.2015willbe
q oldenough(≥12monthsofage)toreceivecatch-upimmuniza4oninFeb.2016
q tooold(>18monthsofage)toreceiverou4neimmuniza4oninSept.2016
èinordertomaximizeefficiency:itisrecommendedtoconductthecatch-upcampaign7monthsbeforetheintroduc7oninrou7ne,otherwisesomechildrenmightreceive2dosesofvaccine
Examples
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