WHO Position Research Articles

Pertussis vaccines: WHO position paper, August 2015—Recommendations

This article presents the World Health Organization's (WHO) recommendations for the use of vaccines against Bordetella pertussis from the WHO position paper on Pertussis vaccines: WHO position paper—August 2015, recently published in the Weekly Epidemiological Record (Pertussis vaccines: WHO position paper. Wkly Epidemiol Rec 2015;90(August(35)):433–60). This position paper summarizes the most recent developments in the field of pertussis disease and its prevention by vaccination. It includes the WHO position on the choice of Pertussis vaccine as well as on the use of additional strategies, particularly vaccination during pregnancy, for prevention of early infant mortality. This document replaces the first WHO position paper on vaccines against disease caused by Pertussis published in 2010 (Pertussis vaccines: WHO position paper. Wkly Epidemiol Rec 2010;85(October(40)):385–400) and incorporates the revised guidance on the choice of pertussis vaccines published in July 2014 (Pertussis vaccines: WHO position paper. Wkly Epidemiol Rec 2014;89(July(30)):337–44).Footnotes to this paper provide a number of core references. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. This paper reflects the recommendations of WHO's Strategic Advisory Group of Experts (SAGE) on immunization. These recommendations were discussed by SAGE at its April 2014 and April 2015 meetings. The evidence presented at the meetings can be accessed at http://www.who.int/immunization/sage/previous/en/index.html.

Hepatitis E vaccine: WHO position paper, May 2015 – Recommendations

This article presents the World Health Organization's (WHO) recommendations on the use of hepatitis E vaccine excerpted from the WHO position paper on hepatitis E vaccines – May 2015 recently published in the Weekly Epidemiological Record [1]. The current document is the first WHO position paper on hepatitis E vaccination and focuses primarily on the available evidence concerning the only hepatitis E vaccine that is currently licensed. The position paper gives consideration to the epidemiological features of the disease and assesses the use of the vaccine for public health benefits.Footnotes to this paper provide a number of core references including references to grading tables that assess the quality of the scientific evidence. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. This paper reflects the recommendations of WHO's Strategic Advisory Group of Experts (SAGE) on immunization. These recommendations were discussed by SAGE at its October 2014 meeting. Evidence presented at the meeting can be accessed at http://www.who.int/immunization/sage/previous/en/index.html.

Japanese Encephalitis Vaccines: WHO position paper, February 2015 – Recommendations

This article presents the World Health Organization's (WHO) recommendations on the use of Japanese Encephalitis (JE) vaccines excerpted from the WHO position paper on Japanese Encephalitis vaccines recently published in the Weekly Epidemiological Record [1]. This updated position paper on JE vaccines replaces the 2006 position paper on this subject [2]; it focuses on new information concerning the availability, safety, immunogenicity and effectiveness of JE vaccines and the duration of protection they confer. Recent data on global prevalence and burden of disease caused by JE and cost-effectiveness considerations regarding JE vaccination are also summarized.Footnotes to this paper provide a number of core references including references to grading tables that assess the quality of the scientific evidence. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. This paper reflects the recommendations of WHO's Strategic Advisory Group of Experts (SAGE) on immunization. These recommendations were discussed by SAGE at its October 2014 meeting. Evidence presented at the meeting can be accessed at http://www.who.int/immunization/sage/previous/en/index.html.

Human papillomavirus vaccines: WHO position paper, October 2014—Recommendations

This article presents the World Health Organization's (WHO) recommendations for the use of vaccines against diseases caused by human papillomaviruses (HPV) from the WHO position paper on Human papillomavirus vaccines: WHO position paper – October 2014, recently published in the Weekly Epidemiological Record [1]. This position paper summarizes the most recent developments in the field of HPV vaccines and the WHO position on HPV vaccine schedules in females. This document replaces the first WHO position paper on vaccines against diseases caused by HPV published in 2009 [2].Footnotes to this paper provide a number of core references. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. This paper reflects the recommendations of WHO's Strategic Advisory Group of Experts (SAGE) on immunization. These recommendations were discussed by SAGE at its April 2014 meeting. Evidence presented at the meeting can be accessed at http://www.who.int/immunization/sage/previous/en/index.html.

Inactivated polio vaccine launch in Nepal: a public health milestone.

Inactivated polio vaccine launch in Nepal: a public health milestone.

Is preexposure prophylaxis ready for prime time use in HIV prevention research?

Is preexposure prophylaxis ready for prime time use in HIV prevention research?

Economic Rewards for Blood Donation: Validity of the Donor Questionnaire as Litmus Test

In a recent issue of Science , Lacetera, Macis, and Slonim summarize new information regarding the impact that economic rewards have on the blood supply and safety (1). For many years, the WHO has taken the stance that economic incentives decrease the safety of the blood supply. In support of the WHO position, the establishment of an all-volunteer blood supply led to a dramatic decrease in the incidence of posttransfusion hepatitis C. The authors submit, however, that the position of the WHO is based on studies that failed to control for several confounding variables (percentage of first-time donors, location of donation, and use of prisoners). Recent randomized field surveys reviewed by the authors found that economic incentives increase …

EFFECTIVENESS OF THE 13-VALENT PNEUMOCOCCAL CONJUGATE VACCINE: EMERGING DATA FROM INVASIVE PNEUMOCOCCAL DISEASE, PNEUMONIA, ACUTE OTITIS MEDIA AND NASOPHARYNGEAL CARRIAGE

научный биометрический журнал, который знакомит читателя с клиническими рекомендациями и особенностями применения лекарственных и вакцинных средств у детей, предоставляет исчерпывающую информацию о воздействии лекарственных средств на плод, о проводимых в

Specific immunotherapy, one century later

Specific immunotherapy, one century later

Vaccines against tick-borne encephalitis: WHO position paper – Recommendations

This article presents the WHO recommendations on the use of vaccines against tick-borne encephalitis excerpted from the recently published Vaccines against tick-borne encephalitis: WHO position paper. This is the first WHO position paper on the use of tick-borne encephalitis. It was published in the Weekly Epidemiological Record in June 2011. In this paper, footnotes provide a limited number of core references including references to grading tables that assess the quality of scientific evidence for a few key conclusions; a more comprehensive list of references is offered in the Background document on vaccines and vaccination against tick-borne encephalitis available at http://www.who.int/immunization/sage/6_TBE_backgr_18_Mar_net_apr_2011.pdf. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. This paper reflects the recommendations of WHO's Strategic Advisory Group of Experts (SAGE) on immunization. These recommendations were discussed by SAGE at its April 2011 meeting. Evidence presented at the meeting can be accessed at http://www.who.int/immunization/sage/previous/en/index.html.

Local allergic rhinitis: Allergen tolerance and immunologic changes after preseasonal immunotherapy with grass pollen

Local allergic rhinitis: Allergen tolerance and immunologic changes after preseasonal immunotherapy with grass pollen

Rubella vaccines: WHO position paper—Recommendations

This article presents the WHO recommendations on the use of rabies vaccines excerpted from the recently published Rabies vaccines: WHO position paper. This document replaces the WHO position paper entitled Rabies vaccines WHO position paper published in the Weekly Epidemiological Record in December 2007. Footnotes to this paper provide a limited number of core references; their abstracts as well as a more comprehensive list of references may be found at http://www.who.int/immunization/documents/positionpapers/en/index.html. Grading tables which assess the quality of scientific evidence for key conclusions are also available through this link and are referenced in the position paper. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. This updated paper reflects the recent recommendations of WHO's Strategic Advisory Group of Experts on immunization, or SAGE.

GA2LEN/EAACI pocket guide for allergen‐specific immunotherapy for allergic rhinitis and asthma

This pocket guide is the result of a consensus reached during several GA(2) LEN and EAACI meetings. The aim of the current pocket guide is to offer a comprehensive set of recommendations on the use of immunotherapy in allergic rhinoconjunctivitis and asthma in daily practice. This pocket guide is meant to give simple answers to the most frequent questions of practitioners in Europe, including 'practising allergists', general practitioners and any other physicians with special interest in allergen-specific immunotherapy (SIT). It is not a long or detailed scientific review of the topic. However, the recommendations in this pocket guide were compiled following an in-depth review of existing guidelines and publications, including the 1998 EAACI position paper, the 1998 WHO Position Paper on SIT and the 2001 Allergic Rhinitis and its Impact on Asthma (ARIA). It is also based on the ARIA update 2008 (prepared in collaboration with GA(2) LEN), the 'Sub-lingual Immunotherapy: WAO Position Paper 2009' (from the World Allergy Organisation) and the Methodology paper of ARIA. The recommendations cover patient selection, allergen extract to be used, route of administration of SIT (in particular, sublingual and subcutaneous immunotherapy), and necessary precautions to be followed in using SIT.

Effect of Maternal HIV Infection on Measles Susceptibility During Early Infancy: Implications for Optimizing Protection of the Infant

The measles virus was first isolated as the causative pathogen of measles approximately 50 years ago by John Enders and Thomas Peebles. Despite a safe and effective vaccine extant for nearly the same amount of time, control of measles nevertheless remains a challenge in developing countries. This article investigates the possible contribution of maternal HIV infection on measles susceptibility in infants. The current WHO position on measles vaccination in HIV-infected children recommends vaccinating asymptomatic HIV-infected infants as early as 6 months of age, followed with two additional doses at 9 and 18 months. This is rarely implemented due to logistical constraints related to early HIV diagnosis in infants and access to vaccines in low-resource settings. In addition, measles vaccine safety and immunogenicity in HIV-infected children are based on very low levels of scientific evidence. There are no specific recommendations for measles immunization of HIV-uninfected children born to HIV-infected mothers. We reviewed the available data on transplacental transfer of measles antibody and the influence of HIV, the findings of which suggest that consideration should be given to extending early measles immunization to all infants born to HIV-infected women.

Production-scale purification of the recombinant major house dust mite allergen Der f 2 mutant C8/119S

A WHO position paper states that allergen immunotherapy is an effective treatment for allergic diseases, and well characterized allergens should be used in immunotherapy. The house dust mite is a major cause of allergic disease. However, the biological activity of the mite extracts currently used cannot be clearly determined, since these extracts contain various impurities. The use of recombinant allergens can avoid this problem. However, there remains a risk of contamination by other impurities, such as host cell-derived proteins (HCPs). Advanced purification techniques are thus required to remove these contaminants. C8/119S is a mutant of the major house dust mite allergen Der f 2, and is expressed and accumulated as an inclusion body in Escherichia coli. The C8/119S was refolded and purified through three column chromatography steps. Using this method, we could obtain about 2g of the purified C8/119S in one purification batch. This amount is equivalent to 100,000 of the maintenance doses required for immunotherapy based on the WHO position paper. The purity of the C8/119S was 99% or more. The antigenicity of HCPs in the C8/119S was examined by passive cutaneous anaphylaxis assays. When the C8/119S was administered at 40 μg/kg, no local anaphylaxis was observed. C8/119S was thus highly purified with an extremely low level of impurities, and our procedure was shown to be an effective advanced production-scale purification process for this Der f 2 mutant. In this study, we established an advanced purification processes for C8/119S, then characterized the purified C8/119S and evaluated its purity.

Allergen immunotherapy

Specific immunotherapy (SIT) involves the administration of allergen extracts to achieve clinical tolerance of those allergens that cause symptoms in patients with allergic conditions. Immunotherapy is effective in patients with mild forms of allergic disease and also in those who do not respond well to standard drug therapy. Most SIT is given by means of injection, but there is increasing interest in performing SIT through the sublingual route. SIT remains the treatment of choice for patients with systemic allergic reactions to wasp and bee stings and should be considered as an option in patients with allergic rhinitis, asthma, or both. SIT can modify the course of allergic disease by reducing the risk of new allergic sensitizations and inhibiting the development of clinical asthma in children treated for allergic rhinitis. The precise mechanisms responsible for the beneficial effects of SIT remain a matter of research and debate. An effect on regulatory T cells seems most probable and is associated with switching of allergen-specific B cells toward IgG4 production. Few direct comparisons of SIT and drug therapy have been made. Existing data suggest that the effects of SIT take longer to develop, but once established, SIT achieves long-lasting relief of allergic symptoms, whereas the benefits of drugs only last as long as they are continued.

Programme diversity is key to the success of insecticide-treated bednets

In todays Lancet Greg Fegan and colleagues from the Kenyan Medical Research Institute provide important mortality data from a large national programme on insecticide-treated bednets in Kenya. They report an impressive 44% reduction in the risk of dying in children who used the bednets. Their work confirms earlier findings from The Gambia and Tanzania which evaluated smaller shorter and less diversified programmes. The public release of these data coincides with the new WHO Position Statement on insecticide-treated bednets. With this work the use of insecticide-treated bednets is confirmed as a major child-survival intervention in malaria-endemic settings in sub-Saharan Africa. The ongoing switch to long-lasting insecticidal bednets will further reinforce this intervention. (excerpt)

Clinical trials initiative: patients or patents?

WHO's newly proposed rules on the disclosure of data when researchers register clinical trials they are planning has drawn a mixed reaction from corporations, academic and other institutions funding pharmaceutical R&D. pharmaceutical industry fears that companies may refrain from doing R&D in certain fields, firstly, because they would not want to make sensitive information public too early--as required under the initiative--as would become available to their competitors, and secondly, if they are unable to protect their innovations with patents. International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) stated clearly does not agree with the final vision WHO presented on 19 May of how the International Clinical Trials Registry Platform (ICTRP) initiative will work (see Bulletin Vol. 84, No. 6, June 2006) but that was prepared to work with WHO to develop a new concept that addresses these industry concerns. Whilst the industry shares other stakeholders' concerns about ensuring adequate transparency, IFPMA Director Harvey Bale tells the Bulletin, it believes that the WHO position is a reflection of the views of some stakeholders, but is not a consensus. The IFPMA, in conjunction with its member associations and companies, will work with the WHO, national drug regulatory authorities and other stakeholders to reach a final consensus position on the ICTRP, Bale says, noting that the Geneva-based industry association had launched its own transparency platform, the IFPMA Clinical Trials Portal, in 2005, which would continue to develop in the meantime. For Dr David Korn, Senior Vice President in the Biomedical and Health Science Research division of the Association of American Medical Colleges, the reaction to what he called a bold and frankly unexpected move to include early phase trials, comes as no surprise. In all of my interactions with industry leaders, they have always argued that disclosure of early phase research, often dubbed 'hypothesis-generating', as contrasted with 'hypothesis-testing', would be unacceptable to them, he says. Guy Willis, IFPMA Director of Communications, cites as daily preoccupations of industry players: fierce competition, shareholder expectations, and, above all, the crucial issue of patent ability--a weakening of which could dent profits. Patents are the life blood of the R&D-driven segment of the industry and a company's ability to stake a claim with a new product, a key competitive factor. timing of that claim--broadly speaking: the later, the better--is critical, though more so in Europe than in the United States where patent law enshrines the principle of 'first to invent' as opposed to 'first to file'. Late application for a patent gives a trial sponsor time to realize the full potential of what he has developed, and, as Willis puts it: The later you patent, the later your patent expires. Late application for a patent implies, in turn, the late release of results because, Willis argues, once the results have become public, acquiring the patent becomes problematic. Andrew Freeman, Director of R&D Policy at GlaxoSmithKline shares Willis's concerns: Early disclosure of drug names and trial outcome could, in rare circumstances, prevent patentability or give away novel ways of assessing the effects of investigational medicines, he says. Outside of the pharmaceutical industry, such arguments find few supporters. The trial sponsors have no reason to refuse to register their protocols, which is the only way to make sure that the interest of patients is protected, says Professor Silvio Garattini, Director of the Mario Negri Institute in Milan, while Davina Ghersi, a senior research fellow at the University of Sydney, points at out that after extensive consultation with the pharmaceutical industry regarding the minimum data set, none of the parties who objected to the public release of data were able to provide concrete examples demonstrating how full disclosure at the time of registration had given rise to negative outcomes for the trial or its sponsor. …

A novel adjuvant complex, tyrosine-MPL, for prophylactic and therapeutic vaccines

Therapeutic vaccination for the treatment of allergy has been used for nearly a century but it is only recently that the mechanisms whereby benefits can be achieved have begun to be identified [Bousquet J, Lockey FR, Malling HJ. Allergy immunotherapy: therapeutic vaccines for allergic diseases. WHO Position Paper. Allergy 1998;53:1–42.]. The induction of blocking antibodies was originally thought to lead to amelioration of allergic symptoms. There is now evidence that a switch from a Th2 (IgE/inflammatory) response to a Th1 biased allergen specific response is part of the answer [Durham SR, Till SJ, Immunologic changes associated with allergen immunotherapy. J Allergy Clin Immunol, 1998;102:157–64.]. Specific anergy induced by raised IL10 and TGFβ and the induction of regulatory T cells may also be important [Akdis CA, Blaser K, Allergen-specific immunotherapy. Allergy 2000;55:522–30.]. A new adjuvant complex, l-tyrosine-MPL can accelerate these processes.

P8-12 Mise en place d’un système de gestion des déchets d’activité de soins au niveau du secteur sanitaire de Ben-Badis

This article presented the World Health Organization’s (WHO) recommendations on the use of Rabies vaccines excerpted from the Rabies vaccines: WHO position paper – April 2018 published in the Weekly Epidemiological Record [1] This position paper replaces the 2010 WHO position paper on rabies vaccines [2]. It presents new evidence in the field of rabies and the use of rabies vaccines, focussing on programmatic feasibility, simplification of vaccination schedules and improved cost-effectiveness. The recommendations concern the 2 main immunization strategies, namely vaccination for post-exposure prophylaxis and vaccination for pre-exposure prophylaxis. In the context of post-exposure prophylaxis, recommendations are also provided on the use of rabies immunoglobulins.Footnotes to this paper provide a number of core references including references to grading tables that assess the quality of the scientific evidence, and to the evidence-to-recommendation tables. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO’s current position on the use of vaccines in the global context. Recommendations on the use of cholera vaccines were discussed by the Strategic Advisory Group of Experts (SAGE) in October 2017; evidence presented at these meetings can be accessed at:http://www.who.int/immunization/sage/meetings/2017/october/presentations_background_docs/en/.