Infant vaccine co-administration: review of 18 years of experience with GSK’s hexavalent vaccine co-administered with routine childhood vaccines | Expert Review of Vaccines.
[Open Access] [Received 06 Nov 2019, Accepted 17 Apr 2020, Published online: 18 May 2020]
Abstract.
Introduction: The benefits of vaccine co-administration include improved vaccine acceptance and uptake resulting in an increased coverage and protection against multiple childhood diseases, with minimal medical visits. The diphtheria-tetanus-acellular pertussis-hepatitis B-poliomyelitis-Haemophilus influenzae type b vaccine (DTaP-HBV-IPV/Hib) has been available for more than 19 years and is recommended for co-administration with several other infant vaccines.
Areas covered: This is a comprehensive review (34 studies, 21,000 participants) describing the immunogenicity and safety of DTaP-HBV-IPV/Hib when co-administered with 12 different vaccines in infants including pneumococcal, meningococcal, rotavirus or measles-mumps-rubella-varicella.
Expert opinion: Interactions among co-administered vaccines are complex. Therefore, co-administration data are critical before a vaccination regimen can be recommended. Co-administration of DTaP-HBV-IPV/Hib with other routinely administered vaccines was associated with high percentages of children achieving seroprotection/vaccine response against DTaP-HBV-IPV/Hib antigens. In addition, co-administration was not associated with clinically significant interference in immune responses to co-administered vaccines and was well tolerated. Increased systemic reactions observed with some combinations (DTaP-HBV-IPV/Hib + pneumococcal conjugate or meningococcal serogroup B vaccines) were mitigated by prophylactic paracetamol administration. The data reported here, which represent the most frequently used co-administrations of DTaP-HBV-IPV/Hib worldwide, support the concomitant administration of DTaP-HBV-IPV/Hib with other routinely recommended infant vaccines.
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India: ‘Expired’ polio vaccine given to 50 children of CRPF jawans at Delhi camp, probe ordered | ThePrint.
[19 May, 2020 2:35 pm IST]
Apart from the polio vaccine, 'expired' Easy 6 vaccine was also administered to the children. A CRPF officer, however, said not all vaccines were expired.
At the CRPF camp in south Delhi where at least 50 children of jawans were administered 'expired' polio vaccines on 16 May 2020 | By special arrangement
Ananya Bhardwaj writes:
New Delhi: Expired polio and Easy 6 vaccines were allegedly administered to at least 50 children, aged between one and four months, of jawans posted with the Special Duty Group (SDG) of CRPF, ThePrint has learnt.
The jawans were also charged Rs 300 for two drops of polio vaccine, which usually costs around Rs 20 in private hospitals, and Rs 3,000 for each shot of Easy 6 vaccine at a camp organised on 16 May by an SDG-commandant rank officer at Sector 4 Pushp Vihar in south Delhi. SDG, CRPF, takes care of PM’s security.
Easy 6 vaccine provides immunity against six diseases — diphtheria, whooping cough, tetanus, meningitis, hepatitis B and polio.
Commandant Harsh Vardhan allegedly roped in a private doctor, Dr R.K. Sinha, for the camp, which was organised without taking permission from the medical directorate of the CRPF (Central Reserve Police Force) or local authorities.
In order to set up any such camp to administer vaccines, due permission is required from local authorities, which then appoints a vaccine superintendent, who oversees that the medicine is being administered properly and also keeps a data of each child who is given the shot. A report of all these is then sent to the Health Ministry and then to the World Health Organisation. Administration of expired medicines is also punishable under law.
“No proper procedure was followed while setting up this camp and a private doctor was roped in for the same. They not only charged Rs 300 from each family but also administered expired medicines,” a source in the CRPF said.
“A jawan pointed it out when he saw the card given to him in which there was a bar code, which mentioned the expiry of the medicines as ‘April 2020’,” he said.
“Then most jawans checked their cards and found that their kids too were given expired medicines. When they asked the doctor, they were told to return their cards. Most of them were torn, but a few jawans managed to take pictures,” he added.
According to the source, the doctor then apologised and allegedly asked the jawans not to raise the issue with the higher authorities.
CRPF Director General (DG) A.P. Maheshwari was later apprised of the matter, following which he has ordered an inquiry.
Dr Sinha, however, told ThePrint the ‘expired’ vaccines would have “no reaction or side-effects”.
Speaking to ThePrint, a CRPF spokesperson confirmed the immunisation programme was not official. He, however, said the parents of the children knew it was a private camp and not organised by the forces.
‘Will not have any side-effects’.
Dr Sinha told ThePrint he had gone to administer the medicines on request and that only 3 to 4 medicines were found to be expired.
“We do not hold these private camps but went there only in good faith. The vaccines too were brought by distributors, who often supply the same to us. Some of those vaccines were later found to be expired. We assured the parents that it will not have any side-effects as in such a case only the potency of the medicine gets lower,” he said.
“It was not intentional. We have also given an undertaking to the parents that nothing will happen to the children. There will no reaction or side-effects. We have also told them these shots will be repeated after a month,” he added.
‘Not all vaccines were expired’.
A senior officer of the CRPF said out of 116 doses administered, only four were expired.
“We were also told by doctors that the expired dosages also have an extended time limit until which they can be used and they also do not have any side-effects,” he added.
The officer said around 50 children of jawans posted with the SDG of CRPF were due for vaccination. As they could not be given shots due to the lockdown, the parents of these children tied up with a private clinic and were facilitated into the camp for vaccination after observing Covid protocols, he added.
“These families wanted to get their children the vaccines and the officer concerned had contacted CGHS (central government health scheme), but because of the lockdown, nothing could be arranged. This is when the officer approached the local clinic,” he added.
“The doctor involved is a prestigious pediatrician and was a registrar at the Ram Manohar Lohia hospital and Safdarjung hospital,” he added.
The officer also said the SDG commandant tied up with the private doctor only to ensure the children are vaccinated.
“An inquiry has been ordered by CRPF Medical Directorate and a report is likely to be received soon and findings of the report will be taken to its logical end as per the facts,” the CRPF spokesperson told ThePrint.
Wife of a jawan writes to Modi, Amit Shah.
Concerned about the health of their children who were administered the ‘expired’ medicines, the wife of a jawan has written a letter on 17 May to the DG, CRPG, marking the same to Prime Minister Narendra Modi and Union Home Minister Amit Shah, urging them to take appropriate action.
The woman wrote she has been duped by authorities by putting her child’s life in danger.
She also alleged after the jawans at the camp pointed out the expired medicines, the staff there tore the slips pasted on the cards, which were proof of the expired vaccines.
She also claimed the medicine bottles were thrown out of the room and some even burnt to junk evidence.
“Sir, it is my request to kindly look into this matter and get it thoroughly investigated,” she wrote.
The woman also asked in the letter as to why a doctor from the CRPF was not at the camp and why they were asked to hush up the matter when the jawans pointed out the expiry of the vaccines to the doctor.
She also alleged that when the jawans threatened to complain to the higher authorities, they were told they will be transferred to Chhattisgarh.
The woman in her letter also said that while the jawans risk their lives for the security of the PM, their kids are being subjected to this treatment.
When ThePrint asked a second senior CRPF officer to comment on the allegations, he said the inquiry is on and he will comment on the matter once the report comes out.
This report has been updated to reflect that ‘expired’ Easy 6 vaccine was also administered to the children, and to include the version of the doctor who administered the medicines.
Original Source Article »
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Factbox: Who finances the World Health Organization? | Reuters.
[MAY 19, 2020 / 5:17 PM]
(Reuters) - After accusing the World Health Organization of pro-China bias last month and suspending contributions, U.S. President Donald Trump went further this week, threatening to halt funding altogether if the body does not commit to reforms within 30 days.
So who are the main sources of finance here for the U.N. agency based in Geneva?
Washington is the WHO’s largest funder and has been particularly supportive of programs such as polio eradication, HIV/AIDS and childhood immunization.
For the current two-year period, ending in December 2021, the United States was due to contribute $553 million in combined membership fees and voluntary contributions, or 9% of the agency’s approved budget of $5.8 billion, according to the WHO.
That’s nearly three times China’s $187.5 million share, WHO figures show.
Other major contributors include Britain on $519 million, the Bill and Melinda Gates Foundation with $340.9 million, the European Commission with $269.8 million, Germany with $228.7 million, and Japan with $217.2 million, according to WHO figures.
Compiled by Giles Elgood; Editing by Alison Williams
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With ultimatum, Trump deepens crisis with the World Health Organization | The Washington Post.
[May 19, 2020 at 8:16 p.m. GMT+1] Emily Rauhala, Staff writer covering Canada and foreign affairs, Teo Armus and Gerry Shih, write:
A World Health Organization meeting to rally an international response to the coronavirus pandemic has instead amplified the discord between the United States and China, leaving the U.N. agency caught in the middle and struggling to lead amid the crisis.
The World Health Assembly — an annual WHO meeting that this year transformed into a virtual strategy session for the covid-19 fight — was quickly overshadowed by President Trump’s latest ultimatum in his widening battles with Beijing and the U.N. health organization.
Trump threatened to permanently halt U.S. funding to the WHO and “reconsider” the country’s membership in the U.N. body if it does not “commit to major substantive improvements” within the next 30 days.
In a letter to the WHO posted in a late-night tweet Monday, Trump elaborated on assertions he has been making since April when he suspended U.S. payments to the WHO for 60 days over what he called its “China centric” coronavirus response.
The four-page letter came the same day as Chinese President Xi Jinping addressed the assembly by video link. Xi skimmed over China’s handling of the initial outbreak late last year and emphasized its commitment to the global pandemic fight, pledging $2 billion.
The standoff between Trump and Xi took attention away from much of the other news from the assembly, including the WHO agreeing to hold an inquiry into the global response to the coronavirus pandemic.
“The assembly has turned into a political circus,” said Lawrence Gostin, a professor of global health law at Georgetown University who also provides technical assistance to the Geneva-based WHO.
“To see this unfolding in the middle of the coronavirus pandemic is deeply problematic,” he added.
Trump’s letter is clear: either the WHO make changes or the United States walks.
But the president did not specify what reforms were needed for him to restore U.S. funding, the WHO’s largest single source of funding. Trump also said discussions between the United States and the agency’s leaders were already underway, but gave no details.
The WHO said only it was “considering the contents of the letter,” it said in a statement.
World Health Organization’s Director-General Tedros Adhanom Ghebreyesus delivers a speech in front of a blue backdrop at the opening of the World Health Assembly virtual meeting from the WHO headquarters in Geneva. (Christopher Black/World Health Organization/AFP/Getty Images)
Trump’s central argument is that the WHO’s handling of the crisis cost lives by accepting China’s assessments of the spread and threat in the early weeks.
“It is clear the repeated missteps by you and your organization in responding to the pandemic have been extremely costly for the world,” Trump wrote.
The timeline he lays out, however, mixes legitimate concerns and inaccuracies. It also excludes information about what Trump himself knew and said at the time.
For instance, many governments, researchers and public health experts were baffled that the WHO did not express more skepticism about China’s claims, in mid-January, that there was no evidence of human-to-human transmission.
The letter restated some of these concerns and added new ones — including some that do not hold up to scrutiny.
Trump’s first claim, for instance, is that the WHO “ignored credible reports of the virus spreading in Wuhan in early December 2019 or even earlier.” He cites as evidence information published by the Lancet.
But Richard Horton, chief editor of the well-known publication, said Tuesday that the journal did not publish its first reports on the coronavirus until late January.
The letter also takes aim the WHO for repeatedly praising China’s “transparency” despite evidence that Chinese officials silenced whistleblowers and undercounted cases.
But the letter does not mention that Trump himself made similar claims. Trump said Jan. 24 that “The United States greatly appreciates [China’s] efforts and transparency,” for instance.
On Feb. 7, Trump said he was not concerned about China covering things up. On Feb. 26 he said China was working “very hard” and on March 4 that it had the situation under control.
If Trump makes good on his threat, the WHO programs could take a hit.
The United States makes mandatory payments to maintain its membership in the WHO in addition to larger voluntary donations, which in total amount to about 15 percent of the agency’s budget.
The mandatory payment, known as the “assessed contribution,” may prove difficult for Trump to cut without congressional approval.
At greater risk is the “voluntary contribution,” money provided to U.S. agencies for health efforts and then given to WHO programs. The largest share of this money goes to polio eradication, with large chunks to fight vaccine preventable disease, malaria, tuberculosis, HIV/AIDS and the provision of basic health care.
There are signs the United States is already moving away from the organization. Administration officials have looked to redirect the WHO payments to other nongovernmental public health organizations, The Washington Post reported.
In recent weeks, U.S. officials have appeared to loosen ties with the agency in other ways. The State Department removed mentions of the WHO from virus fact sheets, and staffers were ordered to “cut out the middle man” for public health initiatives previously managed through the WHO.
That move has sparked concerns that the United States could lose influence on the international stage to China.
The Chinese government immediately hit back and said the United States was using China as an excuse to shirk financial obligations that had been jointly determined by the WHO member states.
“The unilateral U.S. move to stop funding is a violation of its own international obligations,” Foreign Ministry spokesman Zhao Lijian told reporters Tuesday in Beijing. “We are still in a critical juncture and supporting the WHO is upholding multilateralism and supporting international anti-pandemic cooperation to save lives.”
The Trump administration, Zhao added, was “trying to mislead the public, smear China and shift blame for its own incompetent response.”
The United States is already less visible in global health diplomacy. Both Trump and Xi were invited to address the World Health Assembly — but only Xi chose to speak.
On Tuesday, Chinese state media revved into gear on official channels and on social media to portray the Chinese president as a world leader who cared for the global “community” and the WHO as an indispensable agency that coordinated the international response and offered technical guidance.
His message to the world, according to state broadcaster anchor Guo Zhijian: “China is sincere, China is responsible, China is contributing.”
The WHO said it welcomed an investigation. “We want accountability more than anyone,” said director general, Tedros Adhanom Ghebreyesus, on Tuesday.
He urged countries to act cooperatively. “Now is the time to act. We need to fight and defeat coronavirus in all continents,” he said.
“We need tests, medicines, and a vaccine, and we need them to be affordable for all.”
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Africa on verge of being certified polio-free – WHO | Premium Times.
[May 19, 2020] [Agency Report]
The African Region is on the verge of being certified free of wild poliovirus, Matshidiso Moeti, the World Health Organisation (WHO) Regional Director for Africa, has said.
Ms Moeti disclosed this on Tuesday at the ongoing virtual World Health Assembly 2020 in Geneva.
This is the first time the assembly, which is WHO’s main governing body, will convene virtually since the pandemic began.
According to her, the development is a major public health milestone in Africa.
The regional director, however, called for continued support to make healthcare a reality for every African.
On COVID-19, Moeti said the pandemic had reached every member state, and that over half of the countries had community transmission of the virus.
“Much has been said about the weaknesses of African health systems, and many African communities are very vulnerable because of socio-economic determinants
“Governments are working day and night; WHO and partners like Africa Centre for Disease Control are supporting them to saves lives.
“Global solidarity is urgently needed to address shortages of test kits across the region and ensure equitable access,” she said.
Ms Moeti said the office had repurposed more than 900 regional and country office staff and deployed 100 international experts to curb the spread of the virus.
Besides, Ms Moeti said the office was working with governments and partners to establish humanitarian corridors to provide additional support and supplies, adding that the assistance had helped to mobilise over 300 million dollars for public health actions.
“We are coordinating the plan with other UN agencies and partners to mitigate the socio-economic impacts of COVID-19
“As we fight this pandemic, we cannot lose sight of other priorities,’’ she said.
The two-day World Health Assembly is to stop the spread of the COVID-19; map out easing of the stay-at-home and [sic]
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Psychometric properties of the Walking Impact Scale (Walk‐12) in persons with late effects of polio | PM&R.
[Pay to View Full Text] [Manuscript received: 06 February 2020; Manuscript revised: 01 May 2020; Manuscript accepted: 06 May 2020; Accepted manuscript online: 15 May 2020]
Abstract.
Background: Many persons with late effects of polio (LEoP) perceive walking limitations in everyday life. A common rating scale to assess walking limitations is the Walking Impact Scale (Walk-12). However, there is limited knowledge about its psychometric properties.
Objective: To investigate the psychometric properties of Walk-12 in persons with LEoP.
Design: Rasch model analysis of cross-sectional data.
Setting: University Hospital.
Participants: A total of 325 persons with LEoP (175 women; mean age 70 ± 10 yr).
Main outcome measurement: The Walk-12, comprising 12 items with five response categories ranging from 1 (not at all) to 5 (extremely).
Methods: Data of Walk-12 were collected by a postal survey. The Rasch model analysis was used to analyze unidimensionality of the scale, local dependency, targeting, hierarchical order of items, Differential Item Functioning (DIF), response category functioning and reliability (Person Separation Index, PSI). Raw score transformation to interval measurements was also performed.
Results: The analysis revealed that Walk-12 was multidimensional and suffered from some local dependency. Targeting was compromised among persons with less and worse walking limitations. Hierarchically, the most difficult item to perform was "running" and the easiest was "walking indoors with support". There was a minor DIF for gender in one item ("support when walking outdoors"). Reliability was high (PSI = 0.94). Disordered response category thresholds were found for three items; when merging the middle response categories for these items model fit slightly improved and unidimensionality was achieved.
Conclusion: The Walk-12, in its current version, does not fully meet the rigorous psychometric Rasch measurement standards in persons with LEoP. Further development of the scale is warranted, including merging response categories and complementing Walk-12 with objective measures of gait in order to improve targeting. As these limitations can be considered minor, the current version of Walk-12 can still be useful for research and clinical practice. This article is protected by copyright. All rights reserved.
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Severe Acute Flaccid Myelitis Associated With Enterovirus in Children: Two Phenotypes for Two Evolution Profiles? | Frontiers in Neurology.
[Open Access] [Received: 20 January 2020; Accepted: 07 April 2020; Published: 28 April 2020]
Abstract.
Acute flaccid myelitis (AFM) is an acute paralysis syndrome defined by a specific inflammation of the anterior horn cells of the spinal cord. From 2014, worrying waves of life-threatening AFM consecutive to enterovirus infection (EV-D68 and EV-A71) have been reported. We describe 10 children displaying an AFM with an EV infection, the treatments performed and the 1 to 3-years follow-up. Two groups of patients were distinguished: 6 children (“polio-like group”) had severe motor disability whereas 4 other children (“brainstem group”) displayed severe brainstem weakness requiring ventilation support. Electrodiagnostic studies (n = 8) support the presence of a motor neuronopathy associated to myelitis. The best prognosis factor seems to be the motor recovery after the first 4 weeks of the disease.
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At the 
