Technical Advisory Group (TAG) on Immunization and Vaccine Preventable Diseases in the Western Pacific Region (17th Meeting - 7-9 July 2008) - Meeting Report (Advisory Sessions)
The Seventeenth Meeting of the Technical Advisory Group (TAG) on Immunization and vaccine Preventable Diseases (VPDs) in the Western Pacific Region was held from 7 to 11 July 2008 in Manila, Philippines. The 17th meeting was divided into three sessions: the first two sessions, the Laboratory Network Meeting and the Vaccine Preventable Diseases (VPDs) Surveillance Workshop, were held concurrently from 7 to 9 July; the advisory session was held from 10 to 11 July and addressed technical issues related to various aspects of expanded programme on immunization (EPI) in the Western Pacific Region. The meeting of the Regional Interagency Coordinating Committee (ICC) was organized along with the TAG meeting as in previous years.
The key objectives of the meeting were to review surveillance needs for disease eradication, elimination and control; review performance of regional reference and network laboratories and discuss algorithms for poliomyelitis, measles and Japanese Encephalitis (JE); update recommendations on measles elimination, hepatitis B control, and maintaining poliomyelitis-free status; review technical and programmatic aspects of new and underutilized vaccine introduction; and to update recommendations on strengthening routine immunization services in the context of the Global Immunization Vision and Strategy (GIVS).
The TAG endorsed the recommendations and action points proceeding from the VPD surveillance and laboratory network workshops. Moreover, the TAG endorsed the Global Framework for Immunization Monitoring & Surveillance (GFIMS) and recommended that Member States strengthen both programme monitoring and surveillance according to this framework. Also, the TAG encouraged greater communication and collaboration between EPI, Surveillance and Laboratory staff to update epidemiologic and lab data and reconcile discrepancies and to use unique epidemiologic identification (EPID) numbers to reliably track case patients.
The TAG recommended that the Strategic Plan for Measles Elimination by 2012 be revised based on recommendations during the meeting and distributed to partners, that national governments in turn update national and sub-national plans, and that these plans be used to mobilize needed resources. The TAG emphasized the benefits of providing a second dose of measles containing vaccine (MCV) in the second year of life combined with a mandatory school entry check of immunization status.
The TAG recommended intensification of Hepatitis B control activities at the regional and country levels, particularly in the five countries with <80% Hepatitis B vaccine (HepB) birth dose (BD) coverage and/or <60% HepB3 coverage. Countries may use HepB vaccine out of the cold chain provided vaccine vial monitors are used, and collaboration with maternal and child health programme staff was encouraged. Programme performance should be monitored using standard indicators, and evaluations conducted within 12 months for the five low-performing countries. Universal policies of HepB vaccination of health care workers should be adopted. Validated laboratory assays were recommended for all countries conducting serosurveys, and sampling should include disadvantaged populations when serosurveys are done for certification purposes.
The TAG endorsed the Regional Strategic Plan for Maintaining Poliomyelitis-Free Status: 2008-2012, and suggested it be shared with national immunization programmes and partner representatives for comments before finalization. Countries and areas were reminded to maintain high polio immunization coverage, conduct high quality AFP surveillance, and maintain national inventories of materials potentially infected with wild poliovirus.
Countries that have not achieved elimination of maternal and neonatal tetanus should review risk indicators by district and implement a mix of strategies to achieve elimination. Child, adolescent and adult immunization with Td should be considered where applicable.
The TAG endorsed the seven key strategic areas outlined in the Regional Strategic Plan for New and Underutilized Vaccines: 2009-2015. The TAG further encouraged GAVI-eligible countries to avail themselves of opportunities for new vaccine introduction, and for non-GAVI eligible countries, to identify internal and external resources to support new vaccine introduction. Disease burden and cost effectiveness analyses may be useful to guide country decision making in this regard.
The TAG recommended development of a Regional Strategic Plan for Accelerated Control of Rubella and Congenital Rubella Syndrome (CRS), and that those countries with good immunization systems introduce rubella containing vaccine (RCV) in combination with MCV. Countries and areas were also encouraged to develop surveillance systems for CRS.
The TAG recommended ensuring vaccine quality and immunization safety by ensuring functionality of National Regulatory Authorities, especially licensing and adverse events following immunization (AEFI) surveillance for countries that procure vaccines through UNICEF. Cold chain storage capacity should be assessed carefully prior to new vaccine introduction, and single use syringes only should be used by national immunization programmes.
Recommendations for the Inter-Agency Coordinating Committee meeting included development of financing plans jointly with strategic and annual work plans by national governments, and to include EPI priorities as line items in national budgets. Partners were also encouraged to invest in VPD eradication, elimination and control as public goods benefiting the entire international community.