Integrating New Vaccines into Measles Campaigns: Opportunities and Challenges

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Integrating New Vaccines into Measles Campaigns
Opportunities and Challenges

• Anne Schuchat, MD
• Director, National Center for Immunization and
  Respiratory Diseases, CDC
• Measles Partnership Meeting
• 24 September 2008

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New and Underutilized Vaccines

• Global and regional opportunities for impact
• Major preventable burden of endemic disease
  (pneumococcus, rotavirus, Hib, HPV-associated
  cervical cancer)
• Regionally important diseases with epidemic
  potential (JE, Yellow fever, Meningococcal
  meningitis epidemics)
• New vaccine initiatives advancing science,
  supply, and advocacy

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Hib, pneumo conj, rotavirus vaccines
Source WHO 2004 World Health Report
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Estimates of the Number of Cases and Incidence
of Cervical Cancer, 2002
Cases/100,000
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Worldwide distribution of Yellow Fever
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Geographic Range of Japanese Encephalitis
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(No Transcript)
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Immunization and Integration
SuccessfulStories
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Measles supplementary immunization activities,
January December 2007
SIAs in 35 countries delivered gt135 million
vaccinated against measles Vitamin A 39 mil
doses De-worming 19 mil doses MR vaccine 17
mil doses OPV 15 mil doses Bed nets 6.8
mil TT 1.9 mil doses
MMR vaccine
WHO/IVB SIA Database, as of 7 February 2008
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Rationale for integration

• Potential benefits
• Improve efficiency and reduce redundancy/cost
• Improve user satisfaction and convenience
• Benefit to other programs
• Reach and coverage of immunizations is often
  greater than other health programs
• Routine immunizations are among the most
  equitably delivered
• Reduce stigma
• Benefit to EPI
• Increase demand for immunization

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Challenges

• Management
• MoH support and buy-in from leadership of the
  services to be integrated
• Clearly-defined roles, responsibilities, and
  priorities
• Detailed planning and good communication
• Logistics
• Increased staff workload and potential reduction
  of quantity/quality of immunization services
• Multiple components can create additional delays
  and complexity
• Evaluation
• Defining what is a positive outcome for the
  combined intervention
• Defining measures to assess impact on both
  process outcome

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Some Nuts and Bolts Issues

• Target age groups may differ
• of doses needed may differ by antigen, age
• Complexity of follow-up efforts
• Potential for herd benefit
• can jumpstart impact of new program
• Immune response and safety of simultaneous
  administration
• Unintended consequences
• Complacency safety

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Experiences with Measles Vaccine
Co-Administration
Vaccine Setting Experience/available data
Japanese Encephalitis Philippines, 2008 Taiwan, 1999 Co-administration study Co-administration study
Pneumococcal Qatar, 2006, 2007 Campaign no study
Yellow Fever Angola, 2005 Burkina Faso, 2004 Brazil, 1999 Ivory Coast, 1989 Campaign no study Campaign no study Co-administration study Co-administration study
Rotavirus NA NA
Meningitis NA NA
Hib/Hep B USA, 2006 Lithuania, 2005 Co-administration studies
Polio (OPV) Multiple Studies Campaign Co-administration studies
Smallpox Multiple Studies, 1960s Co-administration studies
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Gatchalian S. et al, poster presented ASTMH, 2008
Group 1 JE alone M one month later Group 2
Simultaneous JE and M Group 3 M alone JE one
month later
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Challenges to Simultaneous Vaccine Administration

• Often limited supply of new vaccines
• Cost of additional vaccines, wastage, operations
• AEFI surveillance for new vaccine
• Different vaccine schedules, strategies, or
  target groups (age, sex, geographic targets)
• Simultaneous injections may not be desirable for
  parents children

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Measles co-administration plans on the Horizon
Vaccine On the Horizon Organizations Involved
Meningitis Desire to distribute new vaccine in Measles campaigns Meningitis Vaccine Project PATH, Gates, WHO, UNICEF
Yellow Fever GAVI-sponsored project to ensure sufficient supply and low cost for YF vaccine so simultaneous campaigns can be planned Yellow Fever Initiative GAVI, WHO, UNICEF
JE Active co-administration trials to show safety and effectiveness with Measles vaccine Japanese Encephalitis Project PATH, Gates, WHO, UNICEF
PCV Discussions on integrated campaign, possibly in Yemen
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New Vaccine Measles SIAPossible effects?
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Selected New Vaccine Initiatives and Resources

• Hib Initiative (Hibaction.org)
• Pneumo ADIP (Preventpneumo.org)
• Rotavirus Vaccine Project (Rotavirusvaccine.org)
• Meningitis vaccine project (meningvax.org)
• Alliance for cervical cancer prevention
  (alliance-cxca.org)
• PATH HPV, JE, YF vaccine programs (path.org)
• GAVI Alliance (gavialliance.org)
• World Health organization WHO.int/vaccines

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Acknowledgments

• Aaron Wallace
• Karen Hennessey
• Vance Dietz
• Karen Wilkins
• Brent Burkholder
• Marc Fischer
• Erin Staples
• Brendan Flannery
• Lauri Markowitz

• Meningitis Vaccine Project
• Pneumo-Accelerated Development and Introduction
  Plan
• Hib Initiative
• Rotavirus Vaccine Project