Search

Measles and rubella micro-array patches (MR-MAPs) are a promising innovation to address limitations of the current needle and syringe (N&S) presentation due to their single-dose presentation, ease of use, and improved thermostability. To direct and accelerate further research and interventions, an initial full value vaccine assessment (iFVVA) was initiated prior to MR-MAPs entering phase I trials to quantify their value and identify key data gaps and challenges. The iFVVA utilized a mixed-methods approach with rapid assessment of literature, stakeholder interviews and surveys, and quantitative data analyses to (i) assess global need for improved MR vaccines and how MR-MAPs could address MR problem statements; (ii) estimate costs and benefits of MR-MAPs; (iii) identify the best pathway from development to delivery; and (iv) identify outstanding areas of need where stakeholder intervention can be helpful. These analyses found that if MR-MAPs are broadly deployed, they can potentially reach an additional 80 million children compared to the N&S presentation between 2030–2040. MR-MAPs can avert up to 37 million measles cases, 400,000 measles deaths, and 26 million disability-adjusted life years (DALYs). MR-MAPs with the most optimal product characteristics of low price, controlled temperature chain (CTC) properties, and small cold chain volumes were shown to be cost saving for routine immunization (RI) in low- and middle-income countries (LMICs) compared to N&S. Uncertainties about price and future vaccine coverage impact the potential cost-effectiveness of introducing MR-MAPs in LMICs, indicating that it could be cost-effective in 16–81% of LMICs. Furthermore, this iFVVA highlighted the importance of upfront donor investment in manufacturing set-up and clinical studies and the critical influence of an appropriate price to ensure country and manufacturer financial sustainability. To ensure that MR-MAPs achieve the greatest public health benefit, MAP developers, vaccine manufacturers, donors, financiers, and policy- and decision-makers will need close collaboration and open communications. [ABSTRACT FROM AUTHOR]

With efforts focused on the elimination of maternal and neonatal tetanus, less attention has been given to tetanus incidence and mortality among men. Since 2007 voluntary medical male circumcision has been scaled-up in 14 sub-Saharan African countries as an effective intervention to reduce the risk of human immunodeficiency virus (HIV) acquisition among men. As part of a review of adverse events from these programmes, we identified 13 cases of tetanus from five countries reported to the World Health Organization (WHO) up to March 2016. Eight patients died and only one patient had a known history of tetanus vaccination. Tetanus after voluntary medical male circumcision was rare among more than 11 million procedures conducted. Nevertheless, the cases prompted a review of the evidence on tetanus vaccination coverage and case notifications in sub-Saharan Africa, supplemented by a literature review of non-neonatal tetanus in Africa over the years 2003-2014. The WHO African Region reported the highest number of non-neonatal tetanus cases per million population and lowest historic coverage of tetanus-toxoid-containing vaccine. Coverage of the third dose of diphtheria-tetanus-polio vaccine ranged from 65% to 98% across the 14 countries in 2013. In hospital-based studies, non-neonatal tetanus comprised 0.3-10.7% of admissions, and a median of 71 % of patients were men. The identification of tetanus cases following voluntary medical male circumcision highlights a gender gap in tetanus morbidity disproportionately affecting men. Incorporating tetanus vaccination for boys and men into national programmes should be a priority to align with the goal of universal health coverage. Avec l'orientation des efforts sur l'elimination du tetanos maternel et neonatal, une moindre attention a ete portee sur l'incidence et la mortalite du tetanos dans la population masculine. Depuis 2007, la circoncision medicale masculine volontaire s'est intensifiee dans 14 pays d'Afrique subsaharienne, en tant qu'intervention efficace pour reduire le risque d'acquisition du virus de l'immunodeficience humaine (VIH) chez les hommes. Dans le cadre d'une analyse des effets indesirables de ces programmes, nous avons identifie 13 cas de tetanos, dans cinq pays, qui ont ete notifies a l'Organisation mondiale de la Sante (OMS) jusqu'a mars 2016. Huit patients sont decedes et un seul patient avait un antecedent connu de vaccination antitetanique. Sur plus de 11 millions de procedures realisees, les infections tetaniques suite a une circoncision medicale masculine volontaire ont ete rares. Neanmoins, ces cas d'infection nous ont pousses a mener une etude des donnees disponibles sur la couverture antitetanique et sur la notification des cas en Afrique subsaharienne, completee par une revue de la litterature sur le tetanos non-neonatal en Afrique sur la periode de 2003 a 2014. Sur la periode etudiee, les pays repertories dans la Region africaine de l'OMS correspondent au plus grand nombre de cas de tetanos non-neonatal pour un million d'habitants et a la plus faible couverture vaccinale par anatoxine tetanique. En 2013, dans les 14 pays consideres, letaux d'administration de la troisieme dose du vaccin diphterie-tetanospoliomyelite se situait entre 65% et 98%. Selon les etudes realisees dans des hopitaux, le tetanos non neonatal est responsable de 0,3 a 10,7% des admissions, pour lesquelles 71% des patients, en moyenne, sont des hommes. L'identification des cas de tetanos declares apres une circoncision medicale masculine volontaire a permis de reveler une disparite homme-femme en termes de mortalite, en defaveur des hommes. L'integration de la vaccination antitetanique des garcons et des hommes dans les programmes nationaux devrait etre une priorite pour poursuivre l'objectif de couverture sanitaire universelle. Dado que se han concentrado los esfuerzos en la eliminacion del tetanos materno y neonatal, se ha prestado menos atencion a la incidencia y mortalidad del tetanos en los hombres. Desde 2007, ha aumentado la circuncision medica masculina voluntaria en 14 paises subsaharianos, puesto que se trata de una intervencion efectiva para reducir el riesgo de contagio del virus de la inmunodeficiencia humana (VIH) en los hombres. Como parte de una revision de los fenomenos adversos derivados de estos programas, se identificaron 13 casos de tetanos de cinco paises notificados a la Organizacion Mundial de la Salud (OMS) hasta marzo de 2016. Ocho pacientes murieron y solo uno estaba vacunado contra el tetanos.Tras practicar la circuncision medica masculina voluntaria, el tetanos era poco frecuente entre mas de 11 millones de intervenciones realizadas. No obstante, los casos dieron lugar a una revision de la prueba de la cobertura de vacunas contra el tetanos y las notificaciones de los casos en el Africa subsahariana, junto con una revision documental del tetanos no neonatal en Africa durante los anos 2003 a 2014. La OMS de la region africana informo del mayor numero de casos de tetanos no neonatal por cada millon de habitantes y de la menor cobertura de la vacuna con toxoide tetanico de la historia. En 2013, la cobertura de la tercera dosis de la vacuna de la difteria, tetanos, polio abarco de un 65% a un 98% en los 14 paises. En estudios centrados en los hospitales, el tetanos no neonatal abarco entre un 0,3% y un 10,7% de admisiones, y una media de 71% de los pacientes eran hombres. La identificacion de los casos de tetanos tras la circuncision medica masculina voluntaria destaca una diferencia desproporcionada entre hombres y mujeres en cuanto a la morbilidad por tetanos, en detrimento de los hombres. La incorporacion de vacunas contra el tetanos para ninos y hombres en programas nacionales deberia ser prioritaria para ajustarse al objetivo de cobertura sanitaria universal., Introduction Tetanus is a rapidly progressing, painful disease with a high mortality rate, yet is inexpensive to prevent. Although tetanus toxoid was first licensed as a vaccine in 1937, tetanus [...]

A total of 35 of the 59 countries that had not eliminated maternal and neonatal tetanus (MNT) as a public health problem in 1999 have since achieved the MNT-elimination goal. Neonatal tetanus deaths have decreased globally from 200,000 in 2000 to 49,000 in 2013. This is the result of increased immunization coverage with tetanus toxoid-containing vaccines among pregnant women, improved access to skilled birth attendance during delivery, and targeted campaigns with these vaccines for women of reproductive age in high-risk areas. In the process, inequities have been reduced, private-public partnerships fostered, and innovations triggered. However, lack of funding, poor accessibility to some areas, suboptimal surveillance, and a perceived low priority for the disease are among the main obstacles. To ensure MNT elimination is sustained, countries must build and maintain strong routine programs that reach people with vaccination and with clean deliveries. This should also be an opportunity to shift programs into preventing tetanus among all people. Regular assessments, and where needed appropriate action, are key to prevent increases in MNT incidence over time, especially in areas that are at higher risk. The main objective of the paper is to provide a detailed update on the progress toward MNT elimination between 1999 and 2014. It elaborates on the challenges and opportunities, and discusses how MNT elimination can be sustained and to shift the program to protect wider populations against tetanus. [ABSTRACT FROM AUTHOR]