. WHO 21.8 m infants yet to receive vaccination

. Search for HIV cure pushes ahead despite setbacks

 

THE World Health Organisation (WHO) and the United Nation International Children’s Fund (UNICEF) have reported significant progress in their quest for universal health coverage with more than 111 million infants receiving vaccines in 2013 to protect them from deadly diseases. According to new estimates released yesterday by the UN agencies, these infants account for about 84 per cent of the world’s children, but an estimated 21.8 million infants remained unvaccinated. The estimates tell a success story for the Expanded Programme on Immunisation, namely that global coverage with vaccines, measured by the proportion of kids who received three doses of vaccines containing diphtheria tetanus-pertussis (DTP3), rose from 73 per cent in 2000 to 84 per cent in 2013, a substantial increase.

 

According to the statement, the numbers still fall short of the goal set out in the Global Vaccine Action Plan, which was endorsed by the World Health Assembly in 2012. That plan, which aims to prevent millions of deaths through more equitable access to vaccines, has a target of 90 per cent coverage for all vaccines by the year 2020. The percentage of children who receive vaccines has been above 80 per cent since 2006.

 

Three of WHO’s regions reported very high immunisation coverage: the Western Pacific with 96 per cent; the European Region with 96 per cent; and the Region of the Americas with 90 per cent. Coverage was slightly lower: in the Eastern Mediterranean Region at 82 per cent; in the South-East Asia Region at 77 per cent; and in the African Region at 75 per cent. Also, Nigeria unlike penultimate week recorded no new cases of wild poliovirus type 1 (WPV1) in the past week. According to the Weekly Polio Update published by the Global Polio Eradication Initiative (GPEI), the most recent case had onset of paralysis on May 27, 2014, in Kano State and Nigeria’s total case count for 2014 is five.

 

The GPEI report reads: “Two new circulating Vaccine Derived Polio Vaccine type 2 (cVDPV2) cases were reported in the past week, from Borno and Kano states. The total number of cVDPV2 cases for 2014 is now 13, and for 2013 is four. The most recent cVDPV2 case was the one from Damboa in Borno, which had onset of paralysis on June 9.”

According to the Weekly Polio Update, the continuing circulation of cVDPV2, as evident both from Acute Flaccid Paralysis (AFP) and environmental surveillance, reflects very low levels of routine coverage with trivalent Oral Polio Vaccine (tOPV) and, therefore, very low immunity against type 2 poliovirus in the North of the country and the need for increased use of type-2 containing tOPV during Supplementary Immunisation Activities (SIAs). 

 

The GPEI also warned that it is also urgent that the quality and coverage of SIAs in northern Nigeria continue to improve this year. Mop-up vaccination activities took place in parts of four northern Nigerian states from July 12 to 15. Larger sub-national activities are planned for the country’s North during August 9 to 12 with tOPV and September 20 to 23 with bOPV. Also, a six-day world forum on Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) got under way on Sunday with tributes to six campaigners killed on Malaysia Airlines Flight MH17 and fresh vows to crush a disease that has claimed twice as many lives as World War I.

 

Thousands of delegates at the 20th International AIDS Conference in Melbourne stood for a minute’s silence in honour of six colleagues who had been aboard the plane. They included Joep Lange, a Dutch scientist, who had played a frontline role in the 33-year war on AIDS.

 

However, the scientists have vowed to press ahead with their quest for a cure for AIDS, despite losing a veteran colleague and suffering a setback in research. Addressing a symposium on the search for a cure, Nobel prize winner Francoise Barre-Sinoussi, said the death of Lange, a frontline scientist in the 33-year war on AIDS, was a major setback. “He was firmly believing that a cure for HIV was possible, as we all do, “she said of the Dutchman, who was on the Malaysia Airlines Flight MH17, which went down over Ukraine. “I am convinced that he, like the other members of the HIV community that were in that plane, would have encouraged us to go on.”

 

Barre-Sinoussi, who co-discovered HIV, which causes AIDS, launched the cure campaign several years ago amid skepticism by some that the goal could ever be attainable.

Despite this, optimism has grown and cure scientists are confident that they know a lot more about HIV. After being beaten back by antiretroviral drugs, HIV retreats to a tiny number of cells in the body, holing up there as a safe haven, and becomes undetectable in the blood.

 

But if the drugs are stopped, the virus rebounds within a few weeks, infecting CD4 cells in the immune system and exposing the body once more to dangerous, opportunistic microbes. The six-day International AIDS Conference in Melbourne, which started on Sunday, will hear more on today (Monday) about the so-called “kick-and-kill” strand in cure research. The objective is to pinpoint these reservoirs, flush out the virus with powerful drugs and then destroy it.

 

But a strategy that sparked hopes of a cure -delivering a powerful dose of drugs at the earliest stage of infection - has been dealt a blow.

 

The hopes centered on an American infant, known anonymously as “the Mississippi Baby”, who was born with HIV. She was given drugs immediately at birth and the treatment continued for 18 months, when physicians lost track of her. When doctors next checked her five months later, they found no sign of the virus. In the run-up to the AIDS conference, though, it was discovered that after the child had lived 27 months without HIV and drugs, the virus had bounced back.

 

Director, Office for AIDS Research at the U.S. National Institutes of Health, Jack Whitescarver, said: “This really demonstrates that we are still in the early days” of research. “We will continue to make cure research a high priority and use this information to move the scientific agenda forward,” he added.

 

Another area of cure research is bone marrow transplants to generate new, uninfected immune cells. Researchers at Australia’s University of New South Wales said two men with HIV now had undetectable levels of the virus after receiving bone marrow transplants for cancer. In one case, the patient had a successful transplant for non-Hodgkin’s lymphoma. His donor had one of two possible copies of a gene that gives protection against HIV. But in the second case, the man had a bone marrow transplant for acute myeloid leukemia with a donation that did not have the gene protecting against HIV.

 

Until now, the only person considered to have been cleared of HIV was American Timothy Ray Brown, who had bone marrow transplants in 2007 and 2008. His donor had both copies of the gene that protects against HIV. Brown was able to stop antiretroviral therapy and remains clear of the virus. However, when two patients in Boston had transplants without the gene mutation, the virus returned after antiretrovirals were stopped.

 

A leading cure investigator at Melbourne’s Monash University, Sharon Lewin, said it was “very premature” to consider the latest research a cure. “The patients are still on antiviral therapy, so you cannot say that a patient is cured of HIV until you’ve stopped the treatment,” she said. Millions of lives have been saved by the advent of antiretroviral drugs. Even so, around 35 million people around the world have HIV, a toll that mounts each year.

 

Wayne Koff, from the International AIDS Vaccine Initiative, said HIV was the most complex virus ever encountered by vaccine developers. Coordinator of WHO’s Expanded Programme on Immunisation, Michel Zaffran, said: “We face a challenge in closing the gap between 84 per cent and 90 per cent. The countries have succeeded in maintaining a high level of vaccination coverage while, at the same time, introducing new vaccines and immunising an increasing number of children born each year. However, it is hard for them to reach all children, including those in remote areas or in urban slums.”

 

“Small anti-vaccination groups in some countries also sometimes cause difficulties with misinformation about vaccines, presenting added challenges to national immunisation programmes in some cases.”

 

The data used in these estimates comes from official reports by national authorities, as well as survey data from the published and grey literature. On a country by country basis, about two thirds of WHO’s 194 member-states achieved immunisation coverage of 90 per cent or higher for the commonly used Didhtheria (DPT) 3 vaccine measurement, the figures show.

 

Global coverage with at least one dose of measles containing vaccine was 84 per cent and 128 WHO member-states reached at least 90 per cent national coverage. An estimated 52 per cent of children were vaccinated with two doses of measles containing vaccine during 2013 through routine immunisation services.

 

By Chukwuma Munya

Guardianng