Immunization, Vaccines and Biologicals

Summary of the SAGE April 2014 meeting

Photo of participants during the meeting
C. Scudamore

SAGE reviewed the status of inactivated polio vaccine (IPV) introduction globally and the outcomes of the recent UNICEF tender process for IPV. SAGE noted that the vaccine will now be available to GAVI-supported countries for EURO 0.75 per dose (approximately US$1 per dose at current exchange rates) and EURO 1.50 to 2.40 per dose (approximately USD$2.1-3.3 per dose at current exchange rates) for middle-income countries. SAGE concurred that these represent the best possible IPV prices in the near term and constitute a firm basis for proceeding with the goal of global IPV introduction by the end of 2015 as an integral part of the polio endgame strategy. SAGE reaffirmed the need for all countries to have completed planning for IPV introduction before the end of 2014.

SAGE reviewed the progress towards eventual confirmation of a specific date for global type 2 oral polio vaccine (OPV2) withdrawal, which requires the absence of ‘persistent’ type 2 circulating vaccine-derived poliovirus (cVDPV2) for at least 6 months globally. SAGE was alarmed by the persistent cVDPV2 circulation in northern Nigeria (since July 2005) and Pakistan (since August 2012), highlighting that these areas overlapped with some of the last wild poliovirus (WPV) reservoirs in the world. Stopping circulation of both WPVs and cVDPVs requires addressing gaps in supplementary immunization activity quality, increasing access, and using an appropriate mix of trivalent and bivalent oral poliovirus vaccine over the coming 10 months. SAGE emphasized that the elimination of persistent cVDPV2s by the end of 2014 or early-2015 must be a high priority to ensure that the global eradication effort remain on-track for achieving the major milestones of the Polio Eradication & Endgame Strategic Plan 2013-18. SAGE urged countries to rectify the mix of OPV being used in large-scale immunization campaigns in cVDPV2-infected areas to ensure that OPV2 can be withdrawn during the ‘low season’ for poliovirus transmission in 2016, as originally scheduled.

Upon reviewing the relevant scientific evidence, SAGE endorsed the updates made to the existing WHO vaccination recommendations for travellers from polio-infected countries in International Travel and Health (ITH).

SAGE reiterated the importance of providing human papillomavirus immunization to girls as early as necessary, i.e. in girls aged 9 to 13 years prior to sexual debut, based on local data and patterns of sexual activity. Upon review of the evidence, SAGE recommended a 2-dose schedule for girls, if vaccination is initiated prior to 15 years of age. A 3-dose schedule remains necessary if immunization is initiated after the girls’ 15th birthday. The recommended minimal interval between the 2 doses is 6 months. This interval may be extended to 12 months if this facilitates administration. A 3-dose schedule (i.e. at 0, 1-2, and 6 months) remains recommended for immunocompromised individuals, including those known to be HIV-infected.

Following the review of data on pertussis, SAGE concluded that the licensed acellular pertussis vaccines (aP) have lower initial efficacy, faster waning of immunity, and possibly a reduced impact on disease transmission relative to currently internationally available whole-cell vaccines (wP). The risk of resurgence of pertussis associated with the use of aP vaccines including increased infant disease, indicates that countries currently using wP should continue using wP vaccines for early infant vaccination.

SAGE reviewed current initiatives to improve coordination and integration of vaccination with other critical maternal and child health services, and assessed what additional measures in this context may be needed to strengthen synergies at the global, regional, national, district and service delivery levels. SAGE was pleased to hear of Ethiopia’s experience in improving child survival and achieving the fourth Millennium development goal to cut child deaths by two-thirds between 1990 and 2015 through integrated delivery of life-saving interventions.

The full meeting report will be published in the WHO Weekly Epidemiological Record on 23 May 2014.