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COVID-19 response in northwest Syria: innovation and community engagement in a complex conflict | Journal of Public Health (Oxf).

[Open Access] [Received: 03 May 2020; Revision received: 03 May 2020; Accepted: 04 May 2020; Published: 21 May 2020]

Abstract.

Despite lacking capacity and resources, the health system in the northwest Syria is using innovative approaches for the containment of COVID-19. Lessons drawn from previous outbreaks in the region, such as the polio outbreak in 2013 and the annual seasonal influenza, have enabled the Early Warning and Response Network, a surveillance system to develop mechanisms of predicting risk and strengthening surveillance for the new pandemic. Social media tools such as WhatsApp are effectively collecting health information and communicating health messaging about COVID-19. Community engagement has also been scaled up, mobilizing local resources and encouraging thousands of volunteers to join the ‘Volunteers against Corona’ campaign. Bottom-up local governance technical entities, such as Idleb Health Directorate and the White Helmets, have played key leadership role in the response. These efforts need to be scaled up to prevent the transmission of COVID-19 in a region chronically affected by a complex armed conflict.


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Surveillance to Track Progress Toward Polio Eradication — Worldwide, 2018–2019 | CDC Morbidity and Mortality Weekly Report (MMWR).

[Open Access] [Weekly / May 22, 2020 / 69(20);623–629]

Summary.

What is already known about this topic?

High-quality surveillance is essential to achieving polio eradication. Acute flaccid paralysis (AFP) surveillance is the primary means of detecting poliovirus, supplemented by environmental surveillance in selected locations.

What is added by this report?

In 2019, 25 (63%) of 40 priority countries met AFP surveillance indicators nationally. The proportion of priority countries that achieved targeted AFP detection and stool collection adequacy indicators declined from 2018 to 2019. Surveillance gaps remained at the subnational level.

What are the implications for public health practice?

All countries must resolve national and subnational surveillance gaps to ensure that poliovirus circulation is quickly detected. Important activities to enhance and maintain sensitive surveillance include effective case detection, investigation, reporting, monitoring, and supervision.


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Polio eradication in the context of the Covid-19 pandemic - Updated urgent country and regional recommendations (21 May 2020) | ReliefWeb.

[Source: GPEI] [Posted: 23 May 2020] [Originally Published: 21 May 2020] [Origin: View original]

COVID-19 continues to have an unprecedented impact on daily life, including access to and demand for essential health services. On March 24, the Polio Oversight Board (POB) of GPEI made recommendations related to polio eradication efforts for countries and regions in the context of the COVID-19 pandemic.

Since the recommendations were issued, thousands of polio workers have assisted in the COVID-19 response, and polio as well as other vaccine-preventable disease campaigns have been halted. COVID-19 related disruptions to polio programs have resulted in expanding transmission of poliovirus, further compounded by disruption to essential immunization and other essential health services. This is particularly of concern in polio-endemic countries affected by outbreaks of both wild and vaccine-derived polioviruses, where the circulation of polioviruses is expected to increase exponentially during the upcoming high transmission season. Other countries affected by outbreaks of vaccine-derived polioviruses are also expected to see increase in transmission. GPEI recommended that surveillance for polioviruses should continue, however, maintaining quality surveillance has proven difficult, leading to possible knowledge gaps on the extent of polio virus transmission.

GPEI reaffirmed unwavering commitment to polio eradication, and a regular review of the situation. Looking forward, the pandemic will evolve and affect regions, countries and subnational areas in different ways and in different stages. Similarly, countries and subnational regions will be in different stages of restriction on movement and population contact rates.

In the context of the ongoing pandemic and the resumption of vaccination campaigns,
GPEI will support countries to make decisions on when and where to implement polio vaccination campaigns, based on national risk assessments in close collaboration with national immunization and other health programmes. This will require innovative and adaptive strategies to engage communities.

GPEI has made available detailed guidance on Polio Eradication programme continuity and has updated the Polio Oversight Board recommendations as follows:

1. Critical functions related to Acute Flaccid Paralysis and Environmental Surveillance should remain a priority to be strengthened. Governments and GPEI partners should strive for the maintenance of adequate polio surveillance, with gradual scale up, in line with GPEI guidance . As much as possible, and where required in the local context, these surveillance activities should be conducted with COVID-19 surveillance, and country polio data systems should be upgraded to support this expanded portfolio of work.
The provision of appropriate personal protective equipment (PPE) and training on infection prevention and control (IPC) for surveillance personnel must be ensured.

2. Strategic considerations for resumption of Supplementary Immunization Activities (SIAs):

i. All countries with active polio transmission should plan to implement response campaigns after assessing risk of expansion of polio transmission and risk of COVID-19 transmission among frontline workers and communities and ensure that the benefits of carrying out the activity outweigh the risks. Programmes should refer to the “WHO Framework to support decision making on how to safely resume vaccination activities, and at what scale” and the “Guiding principles for immunization activities during the COVID-19 pandemic”.

ii. The safety of health workers and communities is paramount. Primary consideration should be given to adapt campaign implementation and tactics to ensure physical distancing and protect front line workers and communities with reference to the relevant guidance.

iii. Resumption of SIAs in endemic and outbreak countries: Polio transmission in endemic and outbreak countries poses a high- risk for international spread and risk of progression to uncontrolled multi-country outbreaks.
The national governments of endemic and outbreak countries should, after a careful risk-benefit analysis, resume polio immunization activities, as soon as conditions are in place to do so safely and adequately.

iv. Resumption of SIAs in polio-free countries. GPEI continues to recommend that all non-endemic and non-outbreak countries continue the suspension of preventive polio campaigns until the local situation permits safe and effective resumption. Countries should start now to plan safe resumption of campaigns, and should continue risk assessments, particularly in the context of disruption to polio vaccination, potential gaps in surveillance, and the current COVID-19 epidemiology.

v. All efforts should be made to closely coordinate with all potential stakeholders due to the pandemic’s multiple health impacts on communities. This joint planning will explore the delivery of other health and relief services to the most vulnerable and underserved communities, through an integrated approach taking advantage of the opportunity of polio campaigns. The approach may differ from place to place depending on community needs and availability of resources. Options could include, but are not limited to, distribution of COVID-19 educational or protective material or vaccination campaigns which include other antigens.

vi. Communication: In view of public concerns and circulation of misinformation and rumours in many communities, robust and effective communications and community engagement will be a critical element of campaigns. Plans should be developed early to engage with communities. Communications should be synchronised with the essential immunization programme, particularly in the context of increased vaccination misinformation during the COVID-19 pandemic.

vii.Vaccine supply: While global OPV supplies remain sufficient, there has been disruption to vaccine freight.
Therefore, countries should make vaccine requests well in advance of planned campaigns, and carefully monitor cold chain capacity. In addition, those countries that have had to fill gaps in vaccine supply by using OPV destined for campaigns should work to ensure that these are replaced as soon as possible7 .

3. All polio eradication country programmes should continue to support the response to COVID-19 until COVID-19 is no longer considered a national public health emergency. At the same time, and to the extent possible, care should be taken to ensure that essential polio programme activities, are maintained at adequate levels and that sufficient personnel are available for safe and quality resumed campaigns.

4. Efforts to obtain an Emergency Use Listing recommendation for novel Oral Polio Vaccine type 2 (nOPV2), must continue at full speed. The preparation for nOPV2 roll-out, across the range of technical, communications, policy and manufacturing activities should also continue. Engagement with countries around initial use of nOPV2 will continue, as appropriate to their specific COVID-19 situation, with the goal of deploying nOPV2 for outbreak response during the second half of 2020.

These recommendations will be reviewed and updated by the GPEI Strategy Committee as needed, including when additional evidence becomes available.

Revised and additional technical and operational guidance will be made available on www.polioeradication.org.


Download report (PDF | 610.55 KB)


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Pakistan: Punjab reports polio case, tally reaches 49 | Pakistan Today.

[23rd May 2020]

LAHORE: One more polio case was reported from Punjab on Saturday, taking the countrywide figure for this year to 49.

According to reports, the latest victim of the virus is a three-year-old boy hailing from Taunsa, Dera Ghazi Khan. The samples of the patient were taken and referred to the National Institute of Health (NIH) on May 10.

His polio test returned positive on Saturday, the sources said.

On May 20, a polio case was detected in Bannu, Khyber Pakhtunkhwa. According to the Health Department sources, a one-year-old child had been diagnosed with poliovirus in Union Council Mamakhel of Bannu.

The fresh polio cases have surfaced at a time when all the vaccination campaigns are suspended due to the coronavirus threat. The government is now easing the lockdown gradually and markets and other businesses and transport are being opened. It is expected that the government may also resume vaccination campaigns keeping in view the needs of children who are at risk of contracting the virus, particularly in vulnerable areas.


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Polio and Measles Could Surge After Disruption of Vaccine Programs | The New York Times.

[May 22, 2020]

A new study of 129 countries found that the interruption of inoculation efforts could put 80 million babies at risk of getting deadly, preventable diseases.

A health worker administered polio vaccines to children on a three-day vaccination campaign in Peshawar, Pakistan, in February.

A health worker administered polio vaccines to children on a three-day vaccination campaign in Peshawar, Pakistan, in February. Arshad Arbab/EPA, via Shutterstock

Jan Hoffman writes:

The widespread interruption of routine immunization programs around the world during the coronavirus pandemic is putting 80 million children under 1 year old at risk of contracting deadly, vaccine-preventable diseases, according to a report Friday by the World Health Organization, UNICEF and Gavi, the Vaccine Alliance.

The groups surveyed 129 poor and middle-income countries and found that 68 had some degree of disruption of vaccine services through clinics and through large inoculation campaigns.

Measles initiatives, for example, have been suspended in 27 countries, including Chad and Ethiopia, and polio programs are on hold in 38, including Pakistan and the Democratic Republic of Congo.

Many public health experts say they are worried that deaths from diseases including cholera, rotavirus and diphtheria could far outstrip those from Covid-19 itself.

The report highlighted warnings about polio, which had recently been all but eradicated, a hard-won victory that resulted from mass immunization programs that reached millions of children.

Dr. Seth Berkley, chief executive of Gavi, said that developing countries had made big gains in immunizations against numerous diseases in recent years. Before the pandemic hit, he said, more children in more countries had been protected against more vaccine-preventable diseases than ever before.

“Due to Covid-19, this immense progress is now under threat, risking the resurgence of diseases like measles and polio,” he said.

Restarting immunization programs is crucial not just for preventing more outbreaks of life-threatening diseases, he said: “It will also ensure we have the infrastructure we need to roll out an eventual Covid-19 vaccine on a global scale.”

The problem of slipping vaccine rates is not limited to developing countries. This week, the Centers for Disease Control and Prevention reported that coverage rates among Michigan infants had dropped below 50 percent for all childhood immunizations. New York City announced that during a six-week period of pandemic lockdown, the number of vaccine doses administered to children dropped 63 percent, compared with the same period last year.

According to health ministers and medical providers in the countries surveyed, there are a number of reasons for the disruptions.

In late March, up to 80 percent of flights to Africa that deliver vaccines and syringes were canceled. The health care workers who administer vaccines have been afraid to proceed with the supplies they have on hand, because they lack sufficient protective gear. Parents have been afraid to take children to health clinics. Many areas are in lockdown altogether. And thousands of health care workers who might otherwise be engaged in vaccination are being diverted to respond to Covid-19.

International public health experts, including the W.H.O., had initially recommended that mass vaccine programs in particular be halted while the pandemic raged to protect against further spread occasioned by long lines of children waiting for shots.

But officials are now moving toward a cautious risk-benefit analysis. Noting that Covid-19 has flared inconsistently worldwide, varying not only from country to country but also within national borders, the Global Polio Eradication Initiative, a consortium of international organizations, is urging countries to evaluate their own situations closely and devise alternative, pandemic-safe vaccination strategies as soon as possible.

Because of the pandemic, Nigeria, which had been well on track to be certified as free of wild polio virus, had to cancel two polio vaccine campaigns in targeted areas that would have otherwise immunized a total of 37.6 million children.

The Nigerian campaigns required that health care workers go door-to-door. “We couldn’t expose vaccinators,” explained Dr. Anis Siddique, the head of immunization for UNICEF in Nigeria, about why the programs were suspended.

A similar report last month that focused just on the suspension of measles and rubella immunization campaigns already sounded an alarm.

Before the coronavirus pandemic, measles cases were already rising. In 2017, there were 7,585,900 estimated measles cases and 124,000 estimated deaths, according to the World Health Organization. In 2018, the last year for which international figures have been compiled, there were 9,769,400 estimated measles cases and 142,300 related deaths.

In 2019, the United States reported 1,282 measles cases, its highest in more than 25 years.

“Prior to Covid, measles was moving across the world as people flew,” said Dr. Frank Mahoney, an immunization expert and medical epidemiologist with the International Federation of Red Cross and Red Crescent Societies. “With more and more children becoming susceptible to it, it could be amplified and become a major international problem.”

Henrietta Fore, the executive director of UNICEF, addressed the terrible calculus countries must make in determining how to proceed. “While circumstances may require us to temporarily pause some immunization efforts,” she said, “these immunizations must restart as soon as possible, or we risk exchanging one deadly outbreak for another.”

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Jan Hoffman writes about behavioral health and health law. Her wide-ranging subjects include opioids, vaping, tribes and adolescents. @JanHoffmanNYT


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Trained Immunity: a Tool for Reducing Susceptibility to and the Severity of SARS-CoV-2 Infection | Cell.

[Open Access] [Published online: April 29, 2020] [In Press Corrected Proof]

Abstract.

SARS-CoV-2 infection is mild in the majority of individuals but progresses into severe pneumonia in a small proportion of patients. The increased susceptibility to severe disease in the elderly and individuals with co-morbidities argues for an initial defect in anti-viral host defense mechanisms. Long-term boosting of innate immune responses, also termed “trained immunity,” by certain live vaccines (BCG, oral polio vaccine, measles) induces heterologous protection against infections through epigenetic, transcriptional, and functional reprogramming of innate immune cells. We propose that induction of trained immunity by whole-microorganism vaccines may represent an important tool for reducing susceptibility to and severity of SARS-CoV-2.


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