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«Technical Advisory Group on Vaccine-preventable Diseases (TAG) XXIII Meeting Varadero, Cuba 1-3 July, 2015 XXIII TAG Meeting Varadero, Cuba Table of ...»

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Technical Advisory Group on Vaccine-preventable Diseases (TAG)

XXIII Meeting

Varadero, Cuba 1-3 July, 2015

XXIII TAG Meeting

Varadero, Cuba

Table of Contents

TABLE OF CONTENTS

TAG MEMBERS

ACRONYMS

INTRODUCTION

REGIONAL IMMUNIZATION ACTION PLAN

RECOMMENDATIONS

GLOBAL AND REGIONAL INITIATIVE FOR POLIO ERADICATION UPDATE

RECOMMENDATIONS

MONITORING IMMUNIZATION PROGRESS IN THE AMERICAS WITH THE PAHO/WHO-UNICEF JOINT REPORTING

FORM (JRF)

MONITORING SUSTAINABLE FINANCING FOR IMMUNIZATION IN THE AMERICAS

IMMUNIZATION COVERAGE TRENDS IN THE AMERICAS

RECOMMENDATIONS

UPDATE OF THE PAHO REVOLVING FUND IN THE GLOBAL CONTEXT

RECOMMENDATIONS

UPDATE ON MATERNAL IMMUNIZATION

RECOMMENDATIONS

UPDATE ON THE STATUS OF MEASLES, RUBELLA, AND CONGENITAL RUBELLA SYNDROME ELIMINATION.......... 27 RECOMMENDATIONS

UPDATE ON HPV VACCINATION IN THE AMERICAS

RECOMMENDATIONS

NEW VACCINES SURVEILLANCE UPDATE

RECOMMENDATIONS

MISSED VACCINATION OPPORTUNITIES

RECOMMENDATIONS

PROGRESS TOWARD REGIONAL NEONATAL TETANUS ELIMINATION

RECOMMENDATIONS

DENGUE VACCINE DEVELOPMENT UPDATE

RECOMMENDATIONS

UPDATE ON NATIONAL IMMUNIZATION TECHNICAL ADVISORY GROUPS (NITAGS)

–  –  –

RECOMMENDATIONS

UPDATE ON CHOLERA AND THE ORAL CHOLERA VACCINE STOCKPILE

RECOMMENDATIONS

IMPACT OF ROTAVIRUS VACCINATION IN THE AMERICAS

RECOMMENDATIONS

INFLUENZA VACCINATION IN TROPICAL AREAS

RECOMMENDATIONS

TRANSITIONING TO THE USE OF AUTO-DISABLE (AD) SYRINGES

RECOMMENDATIONS

CONTROL /ELIMINATION OF HEPATITIS B IN THE AMERICAS

RECOMMENDATIONS

–  –  –

TAG Members Dr. J Peter Figueroa TAG Chair Professor Public Health, Epidemiology & HIV/AIDS University of the West Indies Kingston, Jamaica Dr. Jon K. Andrus Executive Vice-President Vaccine Advocacy & Education Sabin Vaccine Institute Washington, DC, United States Roger Glass Director Fogarty International Center & Associate Director for International Research, NIH/JEFIC-National Institutes of Health Bethesda, MD, United States Dr. Akira Homma Chairman of Policy and Strategy Council Bio-Manguinhos Institute Rio de Janeiro, Brazil Dr. Arlene King Adjunct Professor Dalla Lana School of Public Health University of Toronto Toronto, Ontario, Canada Dr. José Ignacio Santos Professor Experimental Medicine Unit Faculty of Medicine of the National Autonomous University of Mexico Mexico City, Mexico Dr. Anne Schuchat* Director National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention Atlanta, GA, United States

–  –  –

Dr. Anushua Sinha Associate Professor Rutgers School of Public Health Newark, NJ, United States Dr. Jeanette Vega* Director Chile’s National Health Fund Santiago, Chile Dr. Cuauhtemoc Ruiz Matus Unit Chief, Comprehensive Family Immunization Ad hoc Secretary PAHO/WHO Washington, DC, United States * Not present at TAG 2015

–  –  –

Acronyms AD Auto-Disable Syringes AFP Acute Flaccid Paralysis AMR Region of the Americas (under World Health Organization) BCG Bacillus Calmette-Guérin (vaccine against severe forms of tuberculosis) BP-BM Bacterial Pneumonia-Bacterial Meningitis BP Bacterial Pneumonia BM Bacterial Meningitis bOPV Bivalent Oral Polio Vaccine CAP Community-Acquired Pneumonias CDC Centers for Disease Control and Prevention of the United States CLAP Latin American Center of Perinatology CRS Congenital Rubella Syndrome cVDPV Circulating Vaccine-derived Poliovirus DPT Diphtheria-Pertussis-Tetanus vaccine DPT3 Third dose of the Diphtheria-Pertussis-Tetanus vaccine EMTCT Elimination of Mother to Child Transmission EPI Expanded Program on Immunization ESAVI Event Supposedly Attributable to Vaccination or Immunization FLASOG Latin American Federation of Obstetricians and Gynecologists Federation of Obstetricians and Gy GHSS Global Health Sector Strategy Federation of Obstetricians and Gynecologists GPEI Global Polio Eradication Initiative GVAP Global Vaccine Action Plan HBIG Hepatitis B immune globulin HBV Hepatitis B Virus HCC Hepatocellular carcinoma Hi Haemophilus influenzae Hib Haemophilus influenzae type b HIV Human Immunodeficiency Virus HPV Human Papilloma Virus ICG International Coordination Group International Expert Committee (for the documentation and verification of IEC measles, rubella, and Congenital Rubella Syndrome elimination in the Americas) IPV Inactivated Polio Vaccine ISO International Organization for Standardization JRF PAHO-WHO/UNICEF Joint Reporting Form on Immunization LAC Latin America and the Caribbean MCV1 First dose of the measles-containing vaccine MIC Middle Income Countries

XXIII TAG Meeting Varadero, Cuba

MIG Maternal Immunization Group MNTE Maternal and Neonatal Tetanus Elimination MMR Measles-Mumps-Rubella Vaccine MOV Missed Opportunities for Vaccination M&E Monitoring and Evaluation NIP National Immunization Program NITAG National Immunization Technical Advisory Group NNT Neonatal tetanus NPCC National Polio Containment Coordinator OCV Oral Cholera Vaccine OPV Oral Polio Vaccine Oral Polio Vaccine, 2nd dose OPV2 PAHO Pan American Health Organization PEESP Polio Eradication and Endgame Strategic Plan PCR Polymerase Chain Reaction PCV Pneumococcal Conjugate Vaccine RCC Regional Certification Committee RF PAHO’s Revolving Fund for the Purchase of Vaccines and Immunization Supplies RIAP Regional Immunization Action Plan RIVS Regional Immunization Vision and Strategy RSV Respiratory Syncytial Virus RVA Rotavirus group A RV1 Rotavirus type 1 Strategic Advisory Group of Experts on Immunization (for the World Health SAGE Organization) SH Southern Hemisphere SIA Supplemental Immunization Activity Spn Streptococcus pneumoniae SUDS Single Use Disposable Syringes TAG Technical Advisory Group on Vaccine-preventable Diseases Td Tetanus-diphtheria vaccine Tdap Tetanus Toxoid Acellular Pertussis Vaccine (for adolescents and adults) tOPV Trivalent Oral Polio Vaccine UNFPA United Nations Population Fund UNICEF United Nations Children's Fund V3P Vaccine Product, Price and Procurement Platform VAPP Vaccine-Associated Paralytic Poliomyelitis A nonprofit, nonpartisan initiative dedicated to helping solve the global safe WASH drinking Water, Sanitation, and Hygiene challenge WHA World Health Assembly WHO World Health Organization WPV Wild Poliovirus

–  –  –





Introduction The XXIII Meeting of the Technical Advisory Group (TAG) on Vaccine‐preventable Diseases of the Pan American Health Organization (PAHO) was held in Varadero, Cuba on 1-3 July 2015.The slogan for the meeting was “Bye-bye rubella! Let’s go for more!” selected in recognition of the recent certification of the regional elimination of rubella and Congenital Rubella Syndrome (CRS). The objectives of this meeting were to present the Regional adaptation of the Global Vaccine Action Plan (GVAP), to review progress on several disease elimination and control initiatives and issue recommendations to address the many challenges faced by national immunization programs in the Americas.

PAHO’s Assistant Director, Dr. Francisco Becerra, welcomed everyone and gave introductory remarks.

Following Dr. Becerra, Dr. Peter Figueroa, was introduced as the newly appointed TAG Chair, a role he served in interim during the XXII TAG meeting after the passing of the former chair Dr. Ciro de Quadros.

Dr. Figueroa is a former member of the World Health Organization’s (WHO) Strategic Advisory Group of Experts on Immunization (SAGE) as well as a TAG member since 1991, and he will now preside as PAHO TAG Chair for the next four year term.

This XXIII Meeting of the TAG was different from past meetings in many ways. The first was that this year’s TAG was the first Regional immunization meeting of its size and magnitude to be hosted in Cuba.

The second was that it was the first TAG to be presided by the newly elected TAG President, Dr.

Figueroa. Last but not least, this XXIII TAG Meeting was the first time the Regional Immunization Action Plan (RIAP) was officially presented to the TAG and all PAHO Member States.

This plan has been approved by PAHO’s Executive Committee and will be presented to the Directing Council in September 2015. The RIAP provides an outline for the next five years, serving not only as the Regional adaptation of the GVAP but also as the official Regional Strategy and Plan of Action (2016 – 2020). The introduction of the RIAP arrives to reinforce the Expanded Program on Immunization’s (EPI) foundations and provide additional guidance for meeting the ever increasing challenges faced by programs in the Region. The RIAP has four strategic lines of action: a) sustain the achievements; b) complete the unfinished agenda in order to prevent and control vaccine-preventable diseases; c) tackle new challenges in the introduction of vaccines and assess their impact; and d) strengthen health services for the effective vaccine administration. Finally, the RIAP intends to successfully guide PAHO Member States through second half of the Decade of Vaccines.

–  –  –

Regional Immunization Action Plan Since the inception of the Expanded Program on Immunization (EPI) 38 years ago, countries and territories in the Americas have made significant strides in protecting their populations against vaccinepreventable diseases. Many Member States consider immunization a public good and a political priority;

national immunization programs have also contributed significantly to the progress towards reaching the Millennium Development Goals.

From 2005-2013, coverage with the third dose of DPT reached a sustained 90% or higher on average in the Region; however, coverage has stagnated in recent years. Provisional data for 2014, however, shows that regional DPT3 coverage dropped to 88%1. As of 2013, the Americas ranked third in DPT3 coverage, when compared to other regions of the World Health Organization. The Region has remained on the forefront in the sustainable introduction of new vaccines; to date, 24 countries and territories have introduced the pneumococcal conjugate vaccine, 18 countries and territories have introduced the rotavirus vaccine and 22 countries and territories have introduced the vaccine against human papilloma virus. In 2015, the elimination of rubella and Congenital Rubella Syndrome (CRS) was officially declared and – with the exception of Haiti – neonatal tetanus is no longer a public health problem in the Region.

The work of national immunization programs protects individuals across the life cycle from deadly diseases and related suffering and the success of a program is based on strong performance across a multitude of areas, activities and strategies, including country ownership and financial sustainability by securing the political priority of the program and a legal framework for immunization, careful planning and coordination, procurement of a safe and uninterrupted supply of vaccines and injection supplies, maintenance of the cold chain, training, supervision and monitoring, epidemiological surveillance and laboratory capacities, and communication and social mobilization. The efforts of national immunization programs also do not happen in isolation; they are instead an integral part of national health systems and contribute to the achievement of universal health coverage.

Upcoming immunization challenges facing the Region are numerous and include: certifying the elimination of the endemic transmission of measles; adding a dose of the injectable polio vaccine and switching from the use of tOPV to bOPV, in accordance with the Polio Eradication and Endgame Strategic Plan, 2013-2018; overcoming a limited global supply of certain biologicals, identifying better strategies to reach vulnerable populations at the local level and improve coverage and improving the quality of immunization data and its use for decision-making and strategic intervention.

In order to provide strategic guidance to confront these challenges and achieve technical excellence, an overarching regional framework for immunization is critical. Over the last eight years (2007-2015), PAHO’s Regional Immunization Vision and Strategy (RIVS) – approved by the 50th annual Directing Council through Resolution CD50.R5 – has served this purpose, as the strategic roadmap for national immunization programs across the Region.

In 2010, the global health community began work on the Decade of Vaccines Collaboration, with the goal of establishing the global vision for national immunization programs through the year 2020. This participatory, multifaceted effort culminated in the development of the Global Vaccine Action Plan Provisional data as of 26 June 2015.

XXIII TAG Meeting Varadero, Cuba

(GVAP), which was subsequently endorsed by the World Health Assembly in May 2012 through resolution WHA65.17. As part of this process, it was established that all regions of the World Health Organization would be responsible for adapting the GVAP to fit their own specific and unique contexts.

In October 2012, the contents of the GVAP were presented to the TAG and it was reaffirmed that the Region would move forward in tailoring the global goals and strategies to the fit the needs of Member States in the Americas; this new Regional Immunization Action Plan (RIAP) will extend the RIVS framework when it expires in 2015 as the strategic document for immunization in the Americas. During the TAG meeting in July 2013, an additional presentation was given on the GVAP framework for monitoring, evaluation and accountability; this framework set forth a global structure for regular monitoring of the GVAP at all levels of implementation, including global, regional and national levels.

In anticipation of the transition from the RIVS to the GVAP adaptation for the Americas, the PAHO Secretariat has developed a proposal for the Regional Immunization Action Plan (RIAP) that was presented during the 156th session of the PAHO Executive Committee in June 2015. The RIAP will now be presented at the 54th Directing Council in September 2015 for the consideration of all Member States.



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