Activities for Rotavirus Vaccine Introduction in the Region of the - - PowerPoint PPT Presentation

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Activities for Rotavirus Vaccine Introduction in the Region of the Americas

Lucia De Oliveira, MSc Inmunization Unit/FCH

Topics

• Implementation and results of

rotavirus surveillance

• Distribution of Rotavirus serotypes in

the Region

• Rotavirus vaccine introduction
• Adverse Event Sentinel Surveillance

Network

• Activities: conducted and planed

• Standardized case definitions &

investigation forms

• Sentinel hospital sites – strategic

selection and follow-up support

• Standardized laboratory techniques

Essential Components of RV Surveillance in the Americas

• Timely flow of information
• Monitoring using standardized

indicators & feedback strategies

• Economic analysis studies: ProVac

Essential Components of RV Surveillance in the Americas

Surveillance in the Americas

• Standardized Surveillance of diarrheas in sentinel

hospitals :

• BOL, ELS, GUAT, HON, PAR,VEN, and

English-speaking Caribbean countries (4 countries)

• Protocols developed and being implemented in ARG,

and PER

• Nicaragua is developing a demonstration project for

the introduction of the vaccine

Data from Sentinel Rotavirus Surveillance, selected countries, Region of Americas, 2005.

Source: Country reports to PAHO

Surveillance Indicators, 2005

Source: country reports to PAHO

Venezuela: total hospitalized diarrhea cases not reported Caribbean: included diarrhea cases in outpatients

10 20 30 40 50 60 70 80 90 100 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Guatemala Honduras El Salvador Caribeean Bolivia Paraguay Bolivia

Percentage positive rotavirus results, selected countries, American Region, Jan-Dec, 2005.

Source: country reports to PAHO

260

• 5

2 60 23 67 103 Mix infections 559 23 21 16 49 29 62 37 119 203 Not typed 71

• 3

2 14 1 35 16 P[4]G1 27

• 5
• 4
• 18

P[4]G3 1

• 1
• P[4]G9

19

• 4
• 2
• 2

11 P[6]G9 1

• 01
• P[6]G8

17

• 4
• 1

12 P[6]G4 5

• 1
• 4

P[6]G2 26

• 8

18 P[6]G1 34

• 34
• P[8]G8

126 3 16 15

• 12
• 80

P[8]G9 35

• 9

2 24 P[8]G5 35

• 1

9

• 2

23 P[8]G2 419

• 1

20 66 1 246 85 P[4]G2 133 19

• 4
• 30

59 21 P[8]G4 95 1 6

• 55
• 1

32 P[8]G3 691

• 31

1 3 65 184 10 136 261 P[8]G1 Total Nicaragua CAREC Guatemala Colombia Chile México Paraguai Argentina Brasil Type P-G

DI STRI BUTI ON OF ROTAVI RUS TYPES I N LATI N AMERI CA FROM 1982 TO 2004

Laird et al. 2003; Castello et al., 2004; Urbina et al., 2004; Parra et al., 2005; Mascarenhas et al., 2006; Volotão et al. 2006; countries data, 2005-2006.

P[8]G4 6% P[8]G9 4% P[4]G2 22% Unusual 6% NT 23% P[8]G3 5% P[8]G1 34%

P[8] G2, 5 P[6] G1,4,9 P[4] G3,1 P[8] G8 P[6] G2, 4,12

Genotypes of Rotavirus Circulating in Latin America 1996-2005

Laird et al. 2003; Castello et al., 2004; Urbina et al., 2004; Parra et al., 2005; Mascarenhas et al., 2006; Volotão et al. 2006; countries data, 2005-2006.

Pro-Vac: Economic Analysis of New Vaccine Introduction

Costs Benefits Vaccine Introduction Costs Tool Burden of Disease Tools

Tools for Economic Analysis

Answering questions with economic analyses Economics for Decision Making Gathering data & performing analyses Working with Partners

Regional Workshop Ongoing Support to Countries Distance Learning

Countries considering introduction Countries using Rotavirus Vaccine

Countries Introducing Rotavirus Vaccine into their routine schedule

Brazil: March Pop <1 yr: 3,711,000 Venezuela: April

Pop < 1yr :590,000

Panama: March Pop < 1 yr:70,000

Sustainability of national EPI Programmatic feasibility:

√ vaccination schedules in routine programs; √ cold chain capability; √ human resources available; √ training and supervision at all levels; √ information system; √ strengthening adverse event reporting system

Lessons learned for introduction of new vaccines: evaluation points

Sentinel Adverse Event Surveillance Network (SANEVA)

Meeting in Brazil, March 2006 Participants included epidemiological surveillance and NRA from

Argentina, Brazil, Mexico, Panamá , Venezuela, WHO and PAHO

Objectives:

• To start post-marketing surveillance for ESAVIs (adverse events

following immunization) of new vaccines with rotavirus

• To build an alert system for unexpected adverse events
• To strengthen the existing systems
• To facilitate the opportunity exchange information about adverse

events

• To monitor effectiveness of new vaccines in a medium term
• To strengthen the coordination between EPI and NRA

ESAVIs related rotavirus vaccine reported by SANEVA

Diarrhea Vomiting Fever Abdominal Distension Intestinal obstruction Intramuscular administration (programmatic error) Intussusception: Brazil: 0.3 / 10,000 doses administered Venezuela: 2 / 10,000 doses administered

Activities conducted (1/2)

• International Workshop for Rotavirus Diarrhea

Surveillance, Brazil (Dec 2005): surveillance and laboratory personal from all Latin American countries

• Enhanced on-site technical cooperation (since Nov-

Dec 2005): Consultants working in Bolivia, El Salvador, Honduras, Nicaragua, and Guatemala.

Activities conducted (2/2)

• Training for laboratory personnel (Nov-Dec 2005): for

Guatemala and Venezuela in Evandro Chagas/Brazil, and for Bolivia and Peru in FIOCRUZ/Brazil

• Training on rotavirus vaccine adverse events for staff

in sentinel sites ( Brazil, Mar 2006)

• Field guide “Rotavirus Diarrhea Surveillance in

Sentinel Hospitals” (Publication expected in Jul 2006)

Planned Activities

• Accelerate development of rotavirus surveillance projects in all PAHO

countries ( 2004-2006)

• International workshop on economic studies-ProVac followed by country-

led cost-effectiveness studies (September 2006)

• Workshop on virus concentration in rotavirus vaccines- PAHO/WHO

ARG, BRA, CHI, COL, CUB, ECU, MEX, PER, and VEN ( Jun 2006)

• To publish Vaccine Introduction Guidelines based on WHO Guidelines

(Sep 2006)

• Laboratory network coordination meeting and training (Feb 2007)
• Regional surveillance meeting (2007)

Thank you! Muito obrigada!