Immunization Update & focus on meningococcal vaccine PART 1

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1 Immunization Update & focus on meningococcal vaccine PART 1 Gregory Hussey Vaccines for Africa Initiative Institute of Infectious Diseases University of Cape Town

2 Disclosures Received funding for research and training from big pharma and other funding agencies. Served as SA NAGI chairperson. Served on a number of international vaccine committees including WHO GACVS.

3 Outline Immunization update Importance of vaccines Impact of vaccines Global strategies Adolescent and adult immunization Meningococcal vaccine update Epidemiology Available vaccines SA recommendations

4 Immunization is one of the most cost effective public health interventions. Globally, an estimated 3m child deaths and adult deaths are prevented annually

5 Parchment signed at Geneva on 9 December 1979, by the members of the Global Commission for Certification of Smallpox Eradication

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7 Coverage with three doses of diphtheria, tetanus, and pertussis (DTP3) containing vaccines, by country income levels, High-income countries 96% 86% 78% Global Low-income countries Year Global High-Income countries Low Income countries Source: WHO/UNICEF coverage estimates 2016 revision, July 2017, and Country Income Categories (World Bank), as of July 2017 (2016 GNI per capita). Income classification not available for: Cook Islands and Niue. Immunization Vaccines and Biologicals, (IVB), World Health Organization. 194 WHO Member States. Date of slide: 17 July 2017.

8 Top 10 countries with most under-and un-vaccinated children (DTP3), in 2016 Globally DTP3 coverage reached 86% in 2016 leaving 19.4 million children vulnerable to vaccine preventable diseases undervaccinated unvaccinated Nigeria India Pakistan Indonesia Ethiopia Democratic Republic of the Congo Iraq Angola Brazil South Africa Source: WHO/UNICEF coverage estimates 2016 revision, July Immunization Vaccines and Biologicals, (IVB), World Health Organization. 194 WHO Member States. Date of slide: 15 July 2017.

9 WHO recommendations for immunization Universal recommendations BCG Polio DTP H influenzae type b Hepatitis B Pneumococcal conjugate Rotavirus Measles Rubella Human papilloma virus Regional/ at risk recommendations 12 Meningococcal conjugate - MenA, MenC, MenACYW Yellow fever Japanese encephalitis Tick borne encephalitis Hepatitis A Rabies Dengue Typhoid Cholera Mumps Influenza Varicella 12

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11 Polio Eradication Progress, Certified polio-free regions (126 countries) X Not certified but non-endemic (65 countries) Endemic with wild poliovirus ( 2 countries) Source: WHO/POLIO database, as of Aug member states. The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved 2017: 22 polio cases - 14 AFG & 8 PAK 1 June 2018: 7 AFG & 1 PAK

12 Reduction in measles deaths Source: WER 2013; 88(3): measles deaths : % drop from

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16 Milestones and achievements in the history of immunization in SA 1995 EPI SA launched 1995 HBV introduced 1999 Hib introduced 2000 Converted from PC to ID BCG NNT Elimination Declared polio free 2008 PCV and RVV introduced 2009 Phase 1 HIV vaccine trial 2009 Phase 2b MV85A (TB) vaccine trial 2014 HPV vaccine introduced

17 Coverage with three doses of diphtheria, tetanus, and pertussis (DTP3) containing vaccines, by country income levels, High-income countries 96% 86% 78% Global Low-income countries Year Global High-Income countries Low Income countries South Africa WHO Afro region Source: WHO/UNICEF coverage estimates 2016 revision, July 2017, and Country Income Categories (World Bank), as of July 2017 (2016 GNI per capita). Income classification not available for: Cook Islands and Niue. Immunization Vaccines and Biologicals, (IVB), World Health Organization. 194 WHO Member States. Date of slide: 17 July 2017.

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20 BCG OPV Measles DTP/Hib/HBV/IPV RVV PCV HPV HPV Tdap

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22 Vaccine costs WHO estimates - $30 per child for basic EPI vaccines (excl HPV) - Excludes delivery costs. Viewed in context of current health expenditure - many African countries: <$50 per person pa - SA : $1148 per person pa (2016)

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24 GAVI Eligibility 47 countries will be eligibleto apply for Gavi support in 2018 based on a Gross National Income(GNI) per capita below or equal to US$ 1,580 on average over the past three years

25 Vaccine costs for SA BCG OPV Measles Hib/DTP/IPV/HB Rota Pneumo HPV TOTAL R4 R2 R8 R416 R160 R510 R700 R1800

26 Cost of vaccines in SA; SEP per dose ex VAT, PBB, June R500

27 Why immunize adolescents? Optimal time before development of disease in adulthood egtb, HPV & HIV. Adolescents are a reservoir for infection for infants, the elderly and at risk populations. Waning infant vaccine induced immunity results in cases occurring in adolescents Catch up vaccinations

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29 Why immunize adults? Vaccine preventable diseases cause significant morbidity and mortality. Waning vaccine induced immunity. Immunosenecence. Concomitant health problems. Costs of disease in adults. High risk situations including: Pregnancy. Health care workers. People in institutions.

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32 Vaccines recommended during pregnancy Tetanus Influenza Acellularpertussis (Tdap)

33 Vaccine effectiveness was 90% (95% CI 82 to 95) when the analysis was restricted to cases in children younger than 2 months.

34 Immunization of healthcare workers Protect the worker and their family from an occupationally-acquired infection Protect vulnerable patients Protect other healthcare and laboratory staff Prevents disruption of services.

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