100 millionth person receives lifesaving meningitis vaccine Affordable, safe, effective vaccine protecting young people from devastating disease

 

100 millionth person receives lifesaving meningitis vaccine Affordable, safe, effective vaccine protecting young people from devastating disease

A boy grimaces as he receives a needle vaccination from a health worker during a two-day immunization session for all 5,000 people at the Wenela camp who have been displaced by the flooding, in the district of Chibuto, in the province of Gaza. Both children and adults are being vaccinated, as needed, against measles, tetanus and meningitis, and children are being given vitamin A capsules to boost their natural immune systems.  By mid-March 2000 in Mozambique, relief and rehabilitation efforts were well under way in response to the worst flooding in 50 years that followed torrential rains in late February, affecting at least seven provinces, causing some 500 deaths and leaving more than 300,000 people homeless or without a livelihood. UNICEF is working with the Government, NGOs, other UN agencies and foreign governments to respond to the emergency and has also supported a Ministry of Health mass vaccination campaign targeting tens of thousands of children and adults in three provinces in the Limpopo River valley, one of the most severely affected areas. Providing vaccinations against measles, meningitis and tetanus, as well as vitamin A capsules (to reinforce immune systems) for an estimated 45,000 children, the two-week campaign demonstrated the logistical challenges faced to vaccinate people in remote areas.GENEVA/ HONG KONG, 3 December, 2012 – A revolutionary meningitis vaccine will reach the 100 millionth person this week in a region of Africa that has been plagued by deadly epidemics for more than a century. The milestone will take place in northern Nigeria, part of Africa’s “meningitis belt,”where the country is conducting its second seasonal immunisation campaign against the disease.

The historic achievement comes two years after the MenAfriVac® vaccine was first launched in Burkina Faso. Since then, nine other countries have held vaccination campaigns to protect people from ages 1 to 29 against meningitis A.

Nigeria will vaccinate 16 million people over the next two weeks and Cameroon and Chad are also conducting immunisation campaigns this week targeting 5.5 million and 2.3 million people respectively. By the end of this year, the vaccine will have reached more than 112 million people, providing widespread and long-awaited protection.

A queue of people behind him waiting their turn, a boy is vaccinated against measles during a two-day immunization campaign to vaccinate all 5,000 residents of the Wenela camp for people who were displaced by the flooding, in the district of Chibuto in the province of Gaza. The two-day session is part of a week-long immunization campaign against measles, meningitis and tetanus, covering three of the provinces most affected by the flooding and carried out by the Ministry of Health with UNICEF supplies and logistics assistance. An estimated 45,000 children will also receive vitamin A capsules to reinforce their natural immune systems.  By mid-March 2000 in Mozambique, relief and rehabilitation efforts were well under way in response to the worst flooding in 50 years that hit the country in late February, affecting at least seven provinces, causing some 500 deaths and leaving more than 300,000 people homeless or without a livelihood. The extensive damage to agricultural land as well as to the transportation, water and sanitation and housing infrastructures also heightened the risk of malaria or cholera outbreak and required immediate food, health and water and sanitation assistance. Working with government ministries, other UN agencies and NGOs, UNICEF is coordinating the water and sanitation emergency response; supporting a vaccination campaign targeting tens of thousands of children and adults in the Limpopo River valley; providing essential drugs, oral rehydration salts (ORS) packets and educational materials; promoting community mobilization campaigns in health and hygiene to prevent the spread of disease; and supporting the rehabilitation of schools in affected areas.The achievement will be recognised at the GAVI Alliance Partners’ Forum, which is bringing together developing countries, donors, civil society, technical and research institutes, health agencies, and the vaccine industry this week in Dar es Salaam, the capital of the United Republic of Tanzania.

“When we began developing this vaccine, we knew how desperately it was needed, and we hoped it would quickly provide relief for the many people who dread sub-Saharan Africa’s meningitis season,” said Steve Davis, president and CEO of PATH, which partnered with the World Health Organization (WHO) to create MenAfriVac®. “We are so proud to see African countries quickly embrace this vaccine and to see that deadly and debilitating meningitis cases have virtually disappeared in the regions that have been vaccinated.”

“This milestone has been achieved thanks to the commitment of national governments and support from WHO and other partners,” said Dr.Flavia Bustreo, WHO assistant director-general for family, women, and children’s health. “We must continue our efforts to implement vaccination campaigns in the remaining meningitis belt countries and ensure widespread uptake of the MenAfriVac® vaccine.”

“Meningitis is a terrible disease which kills young people, creates severe neurological damage in many survivors, and devastates communities,” said Dr. Seth Berkley, CEO of the GAVI Alliance, which is providing funding for the vaccines being used in the campaigns. “It is nothing short of remarkable that exactly two years after the first GAVI-funded meningitis vaccination campaign in the meningitis belt, the 100 millionth will have their life protected.”

A health worker displays a vaccine against five common childhood illnesses – Hib, diphtheria, tetanus, pertussis and hepatitis B – at a storage facility in the south-western city of Khulna. Hib is a common cause of pneumonia and bacterial meningitis.  In January 2009 in Bangladesh, a national campaign to vaccinate children against Haemophilus influenzae type b (Hib) was launched in Khulna District. Hib is a common cause of pneumonia and bacterial meningitis, causing an estimated three million serious illnesses and 400,000 deaths around the world annually. The country-wide campaign aims to immunize four million children under the age of five by year’s end, saving the lives of at least 20,000 children. The vaccine will also protect against diphtheria, tetanus, pertussis and hepatitis B, reducing the number and frequency of injections each child will need to build immunity against these diseases. The campaign is sponsored by the World Health Organization (WHO), UNICEF, the GAVI Alliance and the Hib Initiative. The GAVI Alliance is a public-private partnership among developing and donor governments, the vaccine industry and others, which funds immunization programmes around the world. The Hib Initiative is a body of experts on Hib vaccination from the Johns Hopkins School of Public Health, the London School of Hygiene and Tropical Medicine, WHO and the United States Centers for Disease Control and Prevention. WHO, UNICEF, GAVI and the Hib Initiative are working to extend Hib vaccine coverage to 72 developing countries by 2015. “The development of MenAfriVac® as a low-cost vaccine was critically important for the global health community,” said Chris Elias, president of Global Development at the Bill & Melinda Gates Foundation. “Vaccines work to save and improve lives and the speed with which the governments in meningitis-affected countries have introduced this new vaccine to protect young people is exemplary.”

“Meningitis A epidemics have affected the poorest families in countries of the Sahel, in the worst cases killing one third of the affected community,” said Geeta Rao Gupta, Deputy Executive Director of UNICEF. “But now campaigns are bringing hope to the poor families of previously unreached communities, which are mobilising their members around this safe, effective and affordable vaccine.”

A baby girl receives a pentavalent vaccine at the Kaniya Peripheral Health Unit in the village of Kaniya, in Bo District. The pentavalent vaccine protects against five common diseases: diphtheria, tetanus, pertussis (whooping cough), hepatitis B and Haemophilus influenza type b (also called Hib, a cause of pneumonia and meningitis). [#2 IN SEQUENCE OF TWO]  In April 2010 in Sierra Leone, child and maternal mortality rates remain among the highest in the world. Nearly one out of every five children dies before the age of five, and a woman’s lifetime risk of maternal death is one in eight. Many health clinics lack ambulances, electricity, skilled personnel, and essential supplies, and many people simply cannot afford basic health services. Maternity services are particularly poor, with only 43 per cent of women giving birth in the presence of a skilled birth attendant, such as a doctor, nurse or midwife. The high prevalence of malnutrition, malaria, acute respiratory infections, preventable diseases, poverty and gender inequality also contribute to the high rates of death and illness among children and mothers. On 27 April, the Government inaugurated a programme that abolishes fees for primary health services to pregnant and lactating mothers and children under the age of five. Support for this programme comes from UNICEF, the United Nations Population Fund (UNFPA), the World Health Organization (WHO), the World Bank, the African Development Bank, the European Union, Irish Aid and other partners. UNICEF is building clinics, supporting ambulance services, and providing essential drugs and supplies for obstetric care. UNICEF also supports preventative and curative health programmes, including vaccination campaigns, the distribution of insecticide-treated mosquito nets, the practice of exclusive breastfeeding and the promotion of hand-washing.Seasonal meningitis A epidemics threaten the lives of 450 million people living in the ‘meningitis belt’, which stretches through 26countries from Gambia in the west to Eritrea in the east. The disease causes a painful inflammation of the lining around the brain and the spine that can kill people within 24 to 48 hours. Those who survive often face severe learning difficulties, deafness, or amputated limbs. Children and young adults are most at risk.

Pentavalent vaccines are kept in a cold box at the health centre in Kaniaka Village, Katanga Province. The pentavalent vaccine protects against five common diseases: diphtheria, tetanus, pertussis (whooping cough), hepatitis B and Haemophilus influenza type b (also called Hib, a cause of pneumonia and meningitis). Cold boxes are a critical part of the ‘cold chain’, the series of temperature controls required to maintain vaccine potency from manufacture through inoculation.  In February 2011 in the Democratic Republic of the Congo, women and children remain vulnerable to maternal and neonatal tetanus (MNT), an infection that has no cure but is preventable with routine immunization. MNT threatens the lives of 130 million women and babies in 38 countries around the world, including D. R. Congo, where the disease sickened at least 1,038 babies and killed 483 last year. Globally, the disease kills 59,000 infants within their first month of life, the equivalent of one death every nine minutes, every year. Limited access to basic health services and poor hygiene conditions during birth are the major contributors to MNT mortality: Many infections take place when women give birth at home, alone or in the presence of an untrained birth attendant. Delivery on unclean surfaces and handling with unclean hands or instruments increase the chance of MNT infection in both mother and baby. Yet three doses of the tetanus toxoid vaccine – one of the world’s safest and least expensive vaccines – protects almost 100 per cent of recipients from the disease. Additionally, children born to immunized women are protected from the disease for the first two months of life. Since UNICEF re-launched its MNT Elimination Initiative in 1999, at least 20 countries have achieved the goal of eliminating MNT, and since 2006, private-sector partner Pampers has donated funds for 300 million vaccines. In D. R. Congo, this initiative is promoting vaccination among girls and women of child-bearing age, particularly in southern provinces where health infrastructure is weak and vaccine shortages are common. The goal of the initiative is to eliminate cases of MNT from the world by 2015.In the largest-ever seasonal epidemic in Africa’s history, in 1996-1997, meningitis A infected 250,000 people and killed 25,000. In 1997, African ministers of health appealed to WHO and other partners to find a lasting solution to the dreadful disease.

In 2001, PATH and WHO formed the Meningitis Vaccine Projectto develop a vaccine that would tackle the meningococcus strain that causes meningitis A at a price that African countries could afford. Historically, new vaccines have either not been designed to cover variants of diseases found in developing countries or have been too expensive for developing countries to include in their immunisation schedules. The partners worked with the Serum Institute of India Ltd. to develop and manufacture the vaccine at a cost of less than US$0.50 per dose.

The vaccine has already significantly reduced the burden of meningitis in the regions where it has been introduced. In Burkina Faso, which launched the inaugural MenAfriVac® campaign in December 2010, there were no cases of meningitis A among those who were vaccinated.

“This vaccine is having a tremendous impact on the lives of people in some of the world’s most vulnerable towns and villages,” Berkley said. “The partners involved in developing this vaccine deserve tremendous credit for ensuring the right vaccine is available at the right price.”

On October 31, 2012, MenAfriVac® received approval be kept outside the cold chain for up to four days at up to 40°C, in a controlled temperature chain (CTC). MenAfriVac® is the first vaccine intended for use in Africa approved for this type of use, potentially setting a regulatory path that other heat-stable vaccines can follow.

Immunization supervisor Nestor Sindimwo removes icepacks to reach measles vaccines in a ‘cold box’, in the dispensary of Hôpital Muyinga  (Muyinga Hospital), in Muyinga, capital of the north-eastern Muyinga Province. 'Cold boxes' play a critical role in preserving the ‘cold chain’, the series of temperature controls required to maintain vaccine potency from manufacture through inoculation. The dispensary is serving as a district vaccine depot during the campaign. Health districts, classified by the Ministry of Public Health, are distinctive from administrative divisions.  From 18 to 21 June 2012 in Burundi, an integrated measles vaccination campaign is being held as part of nationwide Maternal and Child Health Week activities. The campaign aims to vaccinate more than 1.4 million children aged 6 months to 5 years old against the easily preventable but highly contagious disease, which can cause severe complications and death. Worldwide, the disease remains a leading cause of death among young children: in 2010, an estimated 139,300 people – mainly children under the age of 5 – died globally from measles. But significant progress has been made: from 2001 to 2011, measles deaths worldwide decreased by 74 per cent, with the largest decline (about 85 per cent) in sub-Saharan Africa. Measles coverage in Burundi had surpassed 92 per cent by 2010. Nevertheless, outbreaks of the disease continue, with 8 districts affected in 2011. The nationwide campaign is being implemented by the Ministry of Health, with support from UNICEF and other partners. Children under age 5 are also receiving vitamin A, which has been shown to reduce the number of measles deaths by half. Children and women are also receiving deworming tablets. Burundi’s campaign is also part of the Measles & Rubella Initiative, a global partnership led by the American Red Cross, the United Nations Foundation, the United States Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) and UNICEF.

Cold chain limitations have posed logistical challenges for MenAfriVac® and other vaccine programmes, increasing programme costs, delaying roll-outs, limiting access to “last mile” communities and allowing outbreaks to continue. Benin launched the pilot project usingthe new CTC approach during its roll-out of the vaccine from 15-25 November 2012.
Burkina Faso, Mali, Niger, Nigeria, Chad, Cameroon, Sudan, Ghana, Benin and Senegal have all conducted campaigns with the MenAfriVac® vaccine since its introduction in 2010.