World Health Organization Position Research Articles

Human papillomavirus prophylactic vaccines: update on new vaccine development and implications for single-dose policy.

Human papillomavirus (HPV) prophylactic vaccines were first licensed in 2006 with the primary goal of preventing HPV-related cancers, with cervical cancer accounting for the highest morbidity and mortality globally. Six HPV vaccines have been licensed; 4 of these have been prequalified by the World Health Organization, and additional products are in the pipeline. This article provides an overview of HPV vaccine coverage and current and anticipated vaccine supply vs expected demand. Given that the 2022 World Health Organization position paper on HPV vaccines includes a 1-dose regimen as an alternate schedule, we will discuss the evidence for using licensed vaccines in single-dose regimens and the approach to generating similar supportive data for other current and future vaccines. The broad adoption of a single-dose HPV vaccine regimen would expand access to vaccines by improving the supply-demand balance, increasing affordability, and simplifying logistics, which will ultimately impact HPV-related morbidity and mortality.

Expert recommendations on hepatitis A vaccination for adults

Hepatitis A is a significant global public health concern, with severe clinical symptoms in adult cases that can progress to acute hepatic failure. With the implementation of comprehensive prevention and control measures based on vaccination, the reported incidence of hepatitis A in children has notably decreased in China, while the incidence of hepatitis A in adults has gradually increased. Vaccination against hepatitis A in adults remains a crucial preventive measure. This recommendation is formulated based on the World Health Organization's position paper on hepatitis A vaccines (2022), incorporating the latest domestic and international research advancements and opinions from domestic experts. Its aim is to provide recommendations for hepatitis A vaccination among Chinese adults, offering evidence for public health and vaccination professionals to scientifically use hepatitis A vaccines and maximize their preventive efficacy, thereby enhancing hepatitis A prevention and control efforts.

Interpretation of the National Regulation for the Rabies Exposure Prophylaxis (2023 Edition)

Rabies is one of the important zoonotic infectious diseases, with a mortality rate of almost 100%. Rabies is a vaccine preventable disease, and proper rabies exposure prophylaxis can effectively prevent the occurrence of human rabies. In recent years, there has been significant progress in clinical research on the rabies exposure prophylaxis both domestically and internationally. World Health Organization (WHO) released the Rabies Vaccine: WHO Position Paper-April 2018. In order to guide medical institutions of all levels in rabies exposure prophylaxis, the National Administration of Disease Prevention and Control, in conjunction with the National Health Commission of the People's Republic of China, organized the Rabies Vaccine Working Group of the National Immunization Program Technical Working Group and invited experts to revise and issue the National Regulation for the Rabies Exposure Prophylaxis (2023 Edition). This article compares the National Regulation for the Rabies Exposure Prophylaxis (2009 Edition) and interprets the updated key points and supporting basis of the new version of the guidelines to guide clinical application and implementation.

Progress and prospect of clinical application of anti-rabies virus monoclonal antibody preparation

Rabies is a severe infectious disease caused by the rabies virus, which seriously damages the central nervous system. Once it occurs, the fatality rate is close to 100%. The World Health Organization's position paper on rabies vaccines recognizes that rabies immunoglobulin (RIG) should be used for post-exposure prophylaxis (PEP) in all category Ⅲ exposure for the first time, as well as in category Ⅱ exposure that suffer from severe immune deficiency, long-term massive use of immunosuppressants, and head and face exposure. The anti-rabies virus monoclonal antibody has high purity and specific activity, can be produced on a sustainable scale, and has no risk of blood source virus contamination. Preclinical pharmacodynamic studies and clinical trial results of the anti-rabies virus monoclonal antibody preparation have confirmed that the preparation has a broad-spectrum neutralization effect on the rabies virus. Additionally, its combined application with the vaccine has little impact on the active immunity of the vaccine. Therefore, the anti-rabies virus monoclonal antibody preparation shows great potential for clinical application in PEP.

Introduction and implications of WHO position paper: vaccines against influenza, May 2022

On May 13, 2022, World Health Organization(WHO) Position Paper on Influenza Vaccine (2022 edition) was published. This position paper updates information on influenza epidemiology, high risk population, the impact of immunization on disease, influenza vaccines and effectiveness and safety, and propose WHO's position and recommendation that all countries should consider implementing seasonal influenza vaccine immunization programmes to prepare for an influenza pandemic. In addition, it proposes that the influenza surveillance platform can be integrated with the surveillance of other respiratory viruses, such as SARS-CoV-2 and Respiratory Syncytial Virus. This position paper has some implications for the prevention and control of influenza and other respiratory infectious diseases in China: (1) Optimize influenza vaccine policies to facilitate the implementation of immunization services; (2) Influenza prevention and control should from the perspective of Population Medicine focus on the individual and community to integrate with "Promotion, Prevention, Diagnosis, Control, Treatment, Rehabilitation"; (3) Incorporate prevention and control of other respiratory infectious diseases such as influenza, COVID-19, respiratory syncytial virus and adenovirus, and intelligently monitor by integrating multi-channel data to achieve the goal of co-prevention and control of multiple diseases.

Expert consensus on preventive management of post-traumatic tetanus and establishment of vaccination clinic practice standards

Post-traumatic tetanus is the most important type of tetanus that occurs outside of the neonatal period. Wound management and rational use of tetanus immunological preparations are critically important for prevention of post-traumatic tetanus and reduction of tetanus-related morbidity and mortality. The Chinese Preventive Medicine Association (CPMA) convened a panel of experts to develop consensus on preventive management of post-traumatic tetanus and establishment of vaccination clinic practice standards. Based on relevant laws and regulations in China, the 2017 World Health Organization position paper on tetanus vaccines, and the most recent domestic and foreign research, the CPMA consensus document describes procedures for prevention and management of post-traumatic tetanus, appropriate use of active and passive tetanus immunological preparations, and requirements for vaccination clinics to manage post-traumatic tetanus prevention.

Скринінг на вірусні гепатити: актуальність проблеми та шляхи вдосконалення (огляд літератури)

В огляді актуальність скринінгу обговорюється в нерозривному зв’язку з позицією Всесвітньої організації охорони здоров’я про необхідність елімінації HCV-інфекції до 2030 року в Європі і США. Наведено визначення скринінгу і критерії, які роблять його проведення доцільним. Обговорюються показання до скринінгу, наведені в Національному керівництві, і необхідність їх уточнення відповідно до епідеміологічної ситуації в Україні. На підставі аналізу 55 літературних джерел автори роблять висновок про те, що скринінг є важливим інструментом, який відкриває для хворих на гепатит шлях до противірусної терапії. Скринінг повинен бути належним чином організований, тому що в іншому випадку він буде неефективним або надзвичайно витратним заходом. Загальноприйняті критерії для скринінгу повинні бути адаптовані до епідеміологічної ситуації в регіоні з урахуванням переважаючих шляхів інфікування. Рекрутувати пацієнтів для скринінгу можна через засоби масової інформації, але найбільш ефективним залишається відбір, що проводиться медичними працівниками. Необхідна постійна адаптація критеріїв відбору пацієнтів для скринінгу згідно з епідеміологічною ситуацією, що з часом змінюється.

Global development of human papillomavirus vaccination guidelines: a systematic review

Objective: To systematically summarize the development of global human papillomavirus (HPV) vaccination guidelines. Methods: The retrieval for all the Chinese and English literature published before August 2020 was conducted in PubMed, Embase and China Biomedical Literature Database, with "papillomavirus vaccines" "wart virus vaccine" "guideline" "practice guideline" "health planning guidelines" "guidelines as topic" "practice guidelines as topic" "immunization programs" in English as well as "papillomavirus vaccines" "HPV vaccine" "guideline" "recommendation" "consensus" in Chinese as search keywords. A total of 18 guidelines were included for data extraction and analysis. Results: The 18 pieces of guidelines included 1 pieces of World Health Organization (WHO) position paper, 6 pieces of guidelines at national or provincial level and other 11 pieces of by academic institutions. In national or provincial guidelines, the recommendation for routine vaccination mainly focused on 11-13 year-old adolescents and the recommendation for catch-up vaccination extends to 17-26 years old. Recommendation of guidelines by academic institutions were similar to the WHO position paper: girls aged 9-14 as the primary target for the routine vaccination; females aged 15-26 years old as the secondary target populations when it's feasible, affordable and cost-effective; women aged over 26 could be vaccinated at an individual level. There were only three guidelines simultaneously updated with the national immunization programme and covered four aspects: the vaccinated population (girls-only to gender-neutral vaccination), the periodic catch-up immunization, the dose schedule updates and the change of vaccine types. Conclusions: It's recommended that the development of Chinese HPV vaccination guidelines refer to global guidelines and updates and take full consideration of the epidemiological evidence, resources and current status of the immunization system in China.

Inclusive leisure for individuals with disabilities: Consideration of the case for social justice

Individuals with disabilities do not have the same avenues to experience social justice as the general public. Lack of opportunities and misinterpretation of living with disabilities are just a few of the obstacles this population experiences when attempting to engage in daily activities, including leisure. Contradictory to the World Health Organization position of all humans having the right to pursue the quality of life, individuals with disabilities often experience oppression rather than equal rights. This paper aims to make a case for framing inclusive leisure in tenets of social justice. Inclusive leisure, rooted in social justice, is on a footing to counter oppression and advance the quality of life for people with disabilities.

New research progress of the safety of human papillomavirus vaccine

Human papillomavirus infection is the main pathogenic factor leading to cervical cancer. About 630 000 new cancers are caused by HPV infection every year, among which cervical cancer accounts for the highest proportion (83%). The burden of cervical cancer is serious in China. Research data shows that there were nearly 110 000 new cases and nearly 50 000 deaths of cervical cancer in China in 2018, accounting for about 20 percent and 16 percent of the global total of cases and deaths, respectively. The World Health Organization's position paper clearly states that HPV vaccination can effectively prevent the occurrence of HPV-related diseases. Across clinical studies and real world data from around the world, HPV vaccines have shown good efficacy and safety. As of October 2019, 98 countries and regions around the world have included HPV vaccine in their national immunization program. However, with the increase of vaccination coverage and indications, the safety of HPV vaccine has become a global public health issue of high concern. Since the launch of HPV vaccine in 2006, many authorities around the world and countries have conducted long-term monitoring of the safety of HPV vaccine after its launch, and accumulated a large number of safety data, which showed that the HPV vaccine was safe and supported the use of HPV vaccine. In this paper, the safety data related to HPV vaccine in the world and mainland China will be combed to provide reference for the HPV vaccination in China.

Incidence of Tetanus and Diphtheria in Relation to Adult Vaccination Schedules.

The World Health Organization (WHO) does not recommend routine adult booster vaccination for tetanus and diphtheria after completion of the childhood vaccination series. However, many countries continue to implement adult booster vaccinations, leading to the question of whether this is necessary to reduce the incidence of these 2 rare diseases. We conducted an observational cohort study based on WHO case reports from 2001 through 2016. We compared the incidence of tetanus and diphtheria in 31 North American and European countries that either do or do not recommend adult booster vaccination. Countries that vaccinate adults every 5-20 years (group 1) were compared with countries that do not routinely vaccinate adults for tetanus or diphtheria (group 2). Comparison of group 1 vs group 2 revealed no significant decline in tetanus incidence rates among countries that vaccinate adults (P = .52; risk ratio [RR] = 0.78; 95% confidence interval [CI], .36 to 1.70). The risk of contracting diphtheria was increased among countries that vaccinate adults due to inclusion of Latvia, a country that had poor vaccination coverage (P < .001). However, if Latvia is excluded, there is no difference in diphtheria incidence between countries that do or do not routinely vaccinate adults (P = .26; RR = 2.46; 95% CI, .54 to 11.23). Review of >11 billion person-years of incidence data revealed no benefit associated with performing adult booster vaccinations against tetanus or diphtheria. Similar to other vaccines, this analysis supports the WHO position on adult booster vaccination and, if approved by governing health authorities, this may allow more countries to focus healthcare resources on vulnerable and undervaccinated populations.

Expert consensus on immunological prevention of human papillomavirus-related diseases (abridged)

Human papillomavirus (HPV)-related diseases such as cervical cancer are public health problems that threaten human health. In response to an action plan for the elimination of cervical cancer, we review the etiology, clinical features, and epidemiology of HPV-related diseases and HPV vaccinology. Our consensus statement is based on the World Health Organization position paper on HPV vaccines (2017) and on recent advances in Chinese and international HPV research. Its purpose is to strengthen HPV-related disease prevention and control by providing systematic, comprehensive evidence to enable health professionals use of HPV vaccine in a scientifically-appropriate manner that maximizes impact on disease.

Expert consensus on immunoprophylaxis of human papillomavirus-related diseases (abridged)

Human papillomavirus (HPV)-related diseases such as cervical cancer are public health problems that threaten human health. In response to an action plan for the elimination of cervical cancer, we review the etiology, clinical features, and epidemiology of HPV-related diseases and HPV vaccinology. Our consensus statement is based on the World Health Organization position paper on HPV vaccines (2017) and on recent advances in Chinese and international HPV research. Its purpose is to strengthen HPV-related disease prevention and control by providing systematic, comprehensive evidence to enable health professionals use of HPV vaccine in a scientifically-appropriate manner that maximizes impact on disease.

Expert consensus on immunological prevention of human papillomavirus-related diseases

Human papillomavirus (HPV)-related diseases such as cervical cancer have become a public health problem that seriously threatens human health. In response to the action plan for the elimination of cervical cancer, this consensus, on the basis of the World Health Organization position paper on HPV vaccine (2017) and the latest advances in research at home and abroad, provides an overview of HPV pathogens and the clinical, epidemiological and vaccine aspects of HPV related diseases. Through a comprehensive and systematic introduction of HPV disease-related knowledge, we aim to improve the level of prevention and control of HPV related diseases, especially to provide systematic and comprehensive evidence-based basis for professionals to use HPV vaccine scientificly.

Expert consensus on rabies exposure prophylaxis

Rabies is a zoonotic infectious disease caused by lyssavirus and characterized by central nervous system symptoms. The fatality rate of rabies is almost 100%. About 59 000 cases die of rabies worldwide every year, mainly in Asia and Africa. China is an epidemic country of rabies. Grade II and III exposures are the main types of rabies exposures in China. Standardized post-exposure prophylaxis (PEP) can prevent rabies almost 100%. Human Rabies Vaccine Technical Working Group, National Immunization Advisory Committee and invited experts reached an expert consensus on PEP by referring to the World Health Organization's position paper on rabies vaccine in 2018 and related research progress in recent.

Unscramble to World Health Organization position paper on vaccines against HPV published in 2017

Unscramble to World Health Organization position paper on vaccines against HPV published in 2017

Strategies and Challenges in Preventing Violence Against Canadian Indoor Sex Workers.

To examine indoor sex workers' strategies in preventing workplace violence and influential socio-structural conditions. Data included qualitative interviews with 85 sex workers in British Columbia, Canada, from 2014 through 2016. For analyses, we used interpretive thematic techniques informed by World Health Organization position statements on violence. Robbery, nonpayment, financial exploitation, and privacy violations were frequent types of violence perpetrated by clients, landlords, and neighbors. We identified 2 themes that depicted how sex workers prevented violence and mitigated its effects: (1) navigating physical spaces and (2) navigating client relationships. Sex workers' diverse strategies to prevent violence and mitigate its effects are creative and effective in many circumstances. These are limited, however, by the absence of legal and public health regulations governing occupational health and safety and stigma associated with sex work. Public Health Implications. Occupational health and safety regulatory policies that set conditions for clients' substance and condom use within commercial sex transactions are required. Revisions to the current legal regulations governing prostitution are critical to support optimal work environments that reduce the likelihood of violence. These revisions must recognize sex work as a form of labor versus victimization.

ALLERGEN IMMUNOTHERAPY: EFFICACY, PERSISTENCE, CONSISTENCY, AND COST EFFECTIVENESS

Although allergen immunotherapy (AIT) has been used for the treatment of allergic rhinitis (AR), allergic conjunctivitis, asthma, stinging insect hypersensitivity, and atopic dermatitis for over 100 years, it has been slow to gain universal acceptance. With the publication of the “World Health Organization Position Paper, Allergen Immunotherapy” in 1998 which summarized the scientific evidence for the efficacy and long-term benefit of this therapy, it has become an accepted and respected modality of treatment. In this review there are discussed following topics of allergen immunotherapy: the reasons for recommending AIT, mechanism of action, subcutaneous and sublingual methods of application, duration, adherence and cost effectiveness. It is necessary to support, not blame, the patient for nonadherence as it is the responsibility of the patient, the physician, and the health-care system to create an environment in which the patient can be adherent. Nonadherence is multifactorial in most every patient and the physician must address all of the factors if adherence is to be improved. The greatest challenge is taking the time to create an individualized patient-tailored strategy to improve adherence, as one size does not fit all. Adherence is dynamic and selecting the best time to start AIT and assuring that there is close follow-up through AIT years of treatment is essential. The patient who is persistent and consistent in year one of AIT may not continue to be so in year three without added encouragement and support. The health-care systems and professional organizations need to help train physicians and their staff both in efficient and accurate ways to assess nonadherence and in implementing interventions to optimize adherence. The multidisciplinary approach to treating this disease of nonadherence will require the involvement of all healthcare professionals, researchers, professional organizations, insurance companies, and policy-makers.

Announcing the publication of the WHO immunological basis for immunization series module on pertussis vaccines

In 2017, the World Health Organization (WHO) published an updated document aimed at facilitating the understanding of the immunological basis of pertussis vaccines and their use. The document “The Immunological Basis for Immunization Series: Pertussis Vaccines” is freely available on the WHO website. The main purpose of the module is to provide national immunization managers and vaccination professionals with an overview of the scientific basis of vaccination against pertussis and the immunological basis for the WHO position on pertussis vaccines.The Immunological Basis for Immunization Series was initially developed in 1993. Since then the series was regularly updated and extended. They reflect the biological differences in immune responses to the individual pathogens and the differing strategies employed to create the best possible level of protection that can be provided by vaccination.We invite the immunization community to use these references, and we hope the updated pertussis vaccine module will be a valuable resource.

Announcing the publication of the WHO immunological basis for immunization series module on influenza vaccines

In 2017, the World Health Organization (WHO) published a document aimed at facilitating influenza vaccine introduction and use in low- and middle-income countries. The document “The Immunological Basis for Immunization Series: Influenza Vaccines” is freely available on the WHO website. The main purpose of this document is to give immunization managers and vaccination professionals an authoritative but easily-understood overview of the scientific basis of influenza vaccination and the immunological basis for the WHO position on influenza vaccines. The influenza vaccine document comprises one module of the WHO Immunological Basis for Immunization series. We invite the immunization community to use these references, and we hope the influenza vaccine module will be a valuable resource for persons who manage and monitor influenza vaccine programs, particularly in low- and middle-income countries.