We are NOT authorized by Govt of India for Yellow Fever Vaccination

Friday, May 12, 2017

CDC Now Recommends Cholera Vaccine Before Travel, may 2017

Adults between the ages of 18 and 64 years are recommended to receive one dose of the lyophilized CVD 103-HgR (Vaxchora, PaxVax) cholera vaccine before travel to areas with active cholera transmission, according to a recommendations published May 11 in the Morbidity and Mortality Weekly Report. The Advisory Committee on Immunization Practices initiallyrecommended use of the cholera vaccine in June 2016 to prevent cholera in adult travelers to areas with endemic or epidemic cholera.
The live attenuated oral lyophilized CVD 103-HgR, the first and only vaccine approved by the US Food and Drug Administration and licensed for use in the United States, prevents disease caused by Vibrio cholerae bacteria of serogroup O1, which is responsible for more than 99% of global cases. The vaccine does not protect against V cholerae O139, according to the World Health Organization. The vaccine should be administered at least 10 days before travel, according to the US Food and Drug Administration.
"The primary prevention strategy for cholera is consistent access to and exclusive use of safe water and food and frequent handwashing," write Karen K. Wong, MD, from the Centers for Disease Control and Prevention's National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia, and colleagues. "Nonetheless, travelers to areas of active cholera transmission, which include areas with current or recent endemic or epidemic cholera activity, might be exposed to toxigenic V. cholerae O1 through inadvertent or unexpected means, despite efforts to adhere to prevention measures."
Cholera is endemic in approximately 60 countries and is the source of epidemics, causing approximately 2.9 million cases and 95,000 deaths each year.
Those considered at higher risk for cholera exposure in endemic or epidemic areas include "travelers visiting friends and relatives, health care personnel, cholera outbreak response workers, and persons traveling to or living in a cholera-affected area for extended periods."
The Advisory Committee on Immunization Practices Cholera Vaccine Work Group assessed evidence for the vaccine's safety and efficacy and the epidemiology of cholera worldwide, using clinical trial data from both the current lyophilized CVD 103-HgR and a previous CVD 103-HgR formulation used abroad and discontinued for business reasons unrelated to safety or efficacy. According to findings presented at the August 2015 Advisory Committee on Immunization Practices meeting, the vaccine is 90% effective 10 days after vaccination and 80% effective 3 months after vaccination against severe diarrhea, with no serious adverse events reported in clinical studies. Both formulations induced a vibriocidal antibody response, "the best available correlate of protection against cholera infection," the authors state.
The only adverse event statistically different between groups was mild diarrhea, occurring in 3.8% of vaccine recipients compared with 1.6% of unvaccinated groups.
Overall safety data, however, were limited, given the relatively limited number of people who received the currently available formulation. In addition, there are no data regarding the coadministration of the cholera vaccine with other vaccines.
Furthermore, there are no data are available for safety or efficacy of booster doses of the vaccine or protection duration beyond 3 months.
Vaccine recipients should not have received oral or parenteral antibiotics in the 14 days before vaccine administration; effects of antibiotics taken after vaccination are unknown, according to the authors. Recipients should wait at least 10 days after vaccine administration to take chloroquine. Data are unavailable regarding potential interaction with the oral live-attenuated typhoid vaccine, but taking the typhoid vaccine at least 8 hours after the cholera vaccine may decrease potential interference.
Lyophilized CVD 103-HgR may shed in stool with the potential for transmission to close contacts. A week after administration, 11.1% of recipients had cultures of the vaccine strain in stool, but the strain was not found in any of 28 household contacts of recipients 7 days after vaccination. However, with the previous CVD 103-HgR vaccine, seroconversion was seen in 3.7% of family contacts of vaccine recipients at 9 or 28 days postvaccination.
Although no data exist on using CVD 103-HgR in pregnant or breast-feeding women, "maternal exposure to the vaccine is not expected to result in exposure of the fetus or breastfed infant to the vaccine" because of lack of systemic absorption of the vaccine. "However, the vaccine strain might be shed in stool for ≥7 days after vaccination, and theoretically, the vaccine strain could be transmitted to an infant during vaginal delivery," the authors write.
Those with history of a severe allergic reaction to components of this or previous cholera vaccines should not receive it. No data exist on the lyophilized CVD 103-HgR vaccine's use in immunocompromised populations; a previous CVD 103-HgR formulation showed lower vibriocidal seroconversion among HIV-positive (58%) individuals than among HIV-negative (71%) ones with no significant differences in adverse events.
The work group summarized the strength of current evidence from randomized controlled trials and observational studies at the February 2016 meeting for outcomes for "prevention of cholera death, life-threatening cholera diarrhea, severe cholera diarrhea, and cholera diarrhea of any severity" and for "induction of vibriocidal antibody response, occurrence of serious and systemic adverse events, and impact on effectiveness of co-administered vaccines and medications." Efficacy evidence was judged to be of type 1 (highly reliable), using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Safety outcome evidence was determined to be type 3.
The research was funded by the Centers for Disease Control and Prevention. The authors have disclosed no relevant financial relationships.
Morb Mortal Wkly Rep. 2017;66:482-485. Full text

Friday, May 5, 2017

U.S. Supply Of Yellow Fever Vaccine Will Run Out By Midsummer 2017

U.S. authorities are working on an emergency deal to import the yellow fever vaccine Stamaril, which is not currently licensed in the U.S.
BSIP/UIG via Getty Images
Come July, the yellow fever vaccine could be tough to find.
So, if you're traveling this summer to a place with the disease, you probably want to schedule a trip to a clinic sooner rather than later, the Centers for Diseases for Control and Prevention tells NPR.
"Take heed of our warning: Plan ahead," says CDC spokesperson Tom Skinner. "It may be difficult to get this vaccine. And if you can't get it, then you should postpone your trip."
The U.S. supply of the yellow fever vaccine will run out by about midsummer, the CDCreported Friday in the Morbidity and Mortality Weekly Report.
Officials are working on an emergency importation of an alternative vaccine, which is already licensed Europe, but is not currently licensed in the U.S. Even then, there will be a limited number of doses, available at only a small number of clinics, Skinner says.
"We're going from the yellow fever vaccine being available in 4,000 clinics across the country to only 250 clinics," he says.
Yellow fever is surging around the world. Last year, a large outbreak in Angola and Democratic Republic of the Congo triggered a massive immunization campaign, in which 30 million people received the vaccine.

That outbreak depleted the global supply of the yellow fever vaccine several times and forced the World Health Organization to give fractional doses of the shot.
Now, a growing outbreak in Brazil has health officials stretching the global supply once again. Health officials are concerned that outbreak could spread across South America and even into the U.S.
"Right now, we don't have enough vaccine for everyone in Brazil," says Dr. Anthony Fauci of the National Institutes of Health. "We're going to have to make more vaccine. And that will take time."
There is currently only one yellow fever vaccine licensed in the U.S. The pharmaceutical company Sanofi Pasteur manufactures it. It's called YF-VAX.
Back in 2015, Sanofi Pasteur began updating its manufacturing facility for YF-VAX. And it stopped production of the vaccine. The company planned to have enough doses to cover U.S. demand until the new facility opens in 2018, but "manufacturing complications resulted in the loss of a large number of doses," the company writes in the MMWR.
The supply will run out in a few months, so the FDA has given Sanofi Pasteur emergency approval to import a second vaccine, called Stamaril. It has a similar safety profile and effectiveness as YF-VAX. It's already approved in 70 countries.
It's rare for the FDA to grant emergency approval to import an unlicensed vaccine. The last time that occurred was in 2013 when a meningitis B outbreak hit Princeton University.
"The yellow fever vaccine is really important," Skinner says. "We're doing everything we can to make sure people who need it can still get it."
If you're taking an international trip soon, check to see if the CDC recommends a yellow fever vaccine for your destination. And, if it does, go get it now, Skinner says.

Friday, April 7, 2017

CDC’s MMWR Examines Yellow Fever Outbreak In DRC, April 2017

CDC’s “Morbidity and Mortality Weekly Report”: Yellow Fever Outbreak — Kongo Central Province, Democratic Republic of the Congo, August 2016
John O. Otshudiema of the Epidemic Intelligence Service Program and the Meningitis and Vaccine Preventable Diseases Branch in the Division of Bacterial Diseases at the CDC’s National Center for Immunization and Respiratory Diseases and colleagues examine the yellow fever outbreak in the Democratic Republic of the Congo’s Kongo Central Province, including the steps taken to control the outbreak, as well as challenges faced (3/31).

Friday, March 31, 2017

Yellow fever – Suriname, 28th March 2017. WHO

On 9 March 2017, the National Institute for Public Health and the Environment (RIVM) in the Netherlands reported a case of yellow fever to WHO. The patient is a Dutch adult female traveller who visited Suriname from the middle of February until early March 2017. She was not vaccinated against yellow fever.
The case was confirmed for yellow fever in the Netherlands by RT-PCR in two serum samples taken with an interval of three days at the Erasmus University Medical Center (Erasmus MC), Rotterdam. The presence of yellow fever virus was confirmed on 9 March 2017 by PCR and sequencing at Erasmus MC, and by PCR on a different target at the Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
While in Suriname, the patient spent nights in Paramaribo and visited places around Paramaribo, including the districts of Commewijne (Frederiksdorp and Peperpot) and Brokopondo (Brownsberg), the latter is considered to be the most probable place of infection. She experienced onset of symptoms (headache and high fever) on 28 February 2017 and was admitted to an intensive care unit (University Medical Center) in the Netherlands on 3 March 2017 with liver failure. The patient is currently in critical condition.
Suriname is considered an area at risk for yellow fever and requires a yellow fever vaccination certificate at entry for travellers over one year of age arriving from countries with risk of yellow fever, according to the WHO list of countries with risk of yellow fever transmission; WHO also recommends yellow fever vaccination to all travellers aged nine months and older. This is the first reported case of yellow fever in Suriname since 1972.

Public health response

This report of a yellow fever case in the Netherlands with travel history to Suriname has triggered further investigations. Following this event, health authorities in Suriname have implemented several measures to investigate and respond to a potential outbreak in their country, including:
  • Enhancing vaccination activity to increase vaccination coverage among residents. Suriname will continue with its national vaccination programme and will focus on the district of Brokopondo. A catch-up vaccination campaign is also being conducted to increase coverage in Brownsweg.
  • Enhancing epidemiologic and entomologic surveillance including strengthening laboratory capacity.
  • Implementing vector control activities in the district Brokopondo.
  • Carrying out a survey of dead monkeys in the suspected areas.
  • Conducting social mobilization to eliminate Aedes aegypti breeding sites (e.g. by covering water containers/ barrels).
  • Issuing a press release to alert the public.
  • Mapping of the suspect area of Brownsweg, as well as the Peperpot Resort.

WHO risk assessment

Yellow fever is an acute viral haemorrhagic disease that has the potential to spread rapidly and cause serious public health impact in unimmunized populations. Vaccination is the most important means of preventing the infection.
Suriname is a country with a risk of yellow fever transmission in endemic areas. Vaccination is recommended before travelling to Suriname for all travellers aged nine months and older. Suriname requires proof of vaccination against yellow fever for all travellers over one year of age.
Suriname introduced the yellow fever vaccination into the routine program for all children aged one years old in 2014.The estimate of national immunization coverage is 86% and only includes children aged one years old. The unvaccinated populations living in the endemic areas are at high risk of yellow fever infection.
The current report of a travel-associated case provides evidence to consider local transmission of yellow fever in the country. More investigations are also needed for animal health sectors.
In addition, Suriname shares borders with Brazil, which has been experiencing yellow fever outbreaks since January 2017 (the largest outbreak of yellow fever in the Americas in the past three decades).
Sequencing and comparison to cases from various other countries is still ongoing, but it is likely that the case is not related to the yellow fever outbreak in Brazil.
As South America is currently experiencing a cyclical increase in the number of cases in non-human primates and human cases, an increase in the number of cases in unvaccinated travellers returning from affected areas in South America is not unexpected. The risk of spread of the disease by non-immunized travellers from Suriname to the countries that have the vector for the transmission of the yellow fever virus is considered to be low but cannot be ruled out.
Currently, five countries in South America report yellow fever virus activity: Brazil, Bolivia, Peru, Colombia and Ecuador. This multi-country yellow fever virus activity might reflect current, wide-spread ecological conditions that favour elevated yellow fever virus transmissibility among wildlife and spill-over to humans. The sequencing analysis of currently circulating strains in Brazil, Bolivia, Colombia, Peru, Ecuador and Suriname should provide insight whether the human cases in these countries are epidemiologically linked or represent multiple, independent spill-over events without extensive ongoing community transmission.

WHO advice

Advice to travellers planning to visit areas at risk for yellow fever transmission in South America includes:
  • Vaccination against yellow fever at least 10 days prior to the travel. A single dose of yellow fever vaccine is sufficient to confer sustained immunity and life-long protection against yellow fever disease and a booster dose of the vaccine is not needed;
  • Travellers with contraindications for yellow fever vaccine (children below nine months, pregnant or breastfeeding women, people with severe hypersensitivity to egg antigens, and severe immunodeficiency) or over 60 years of age should consult their health professional for advice based on risk benefit analysis;
  • Observation of measures to avoid mosquito bites;
  • Awareness of symptoms and signs of yellow fever;
  • Promotion of health care seeking behaviour while travelling and upon return from an area at risk for yellow fever transmission, especially to a country where the establishment of a local cycle of transmission is possible (i.e. where the competent vector is present).
  • Seeking care in case of symptoms and signs of yellow fever, while travelling and upon return from areas at risk for yellow fever transmission.
This case report illustrates the importance of yellow fever vaccination for travellers to countries with risk of yellow fever virus transmission, even for countries that have not reported cases for decades.
WHO, therefore, urges Members States to comply with the requirement for yellow fever vaccination for travellers to certain countries and the recommendation for all travellers to countries or areas with risk of yellow fever transmission (see ‘Yellow fever vaccination requirements and recommendations; malaria situation; and other vaccination requirements – List of countries, territories and areas’ in related links). Viraemic returning travellers may pose a risk for the establishment of local cycles of yellow fever transmission predominantly in areas where the competent vector is present. If there are medical grounds for not getting vaccinated, this must be certified by the appropriate authorities.
WHO does not recommend that any general travel or trade restriction be applied on Suriname based on the information available for this event.