Strategic Advisory Group of Experts on Immunization (SAGE) - April 2012

10 – 12 April 2012

The SAGE meeting of 10-12 April 2012 took place in Salle A of the CCV in Geneva. Available on this site you will find meeting information material, background reading materials and presentations made during the meeting. The conclusions and recommendations of SAGE meeting are published in the WHO Weekly Epidemiological Record in English and French within two months of each SAGE meeting.

Meeting materials

Agenda
List of participants
Declaration of interest
SAGE report - conclusions and recommendations

 

Related

Background Documents and Presentations 

Session: Report from Director, IVB

Session: Reports from other advisory committees on immunization 

Session: Polio eradication

Background documents

Wild poliovirus map - last six months (21 September 2011 - 20 March 2012)

Report Of The Independent Monitoring Board Of The Global Polio Eradication Initiative - February 2012

Background paper on switch from 'tOPV to bOPV' for routine immunization - SAGE Working Group

First Meeting of the Pakistan Technical Advisory Group on Polio Eradication Islamabad, 21 & 22 March 2012: Brief Summary & Recommendations

23rd Meeting of the Expert Review Committee (ERC) on Polio Eradication Initiative & Routine Immunization: Major Findings & Recommendations

Global Polio Emergency Action Plan 2012-13

Presentations

Introduction - B. Aylward

Pakistan - S. Wazir Ali, Special Assistant to the Prime Minister/ Co-Chair Pakistan Education Task Force, Government of Pakistan

Nigeria - M. Ado on behalf of M. Pate, Honourable Minister of State for Health, Federal Ministry of Health, Abuja, Nigeria

Afghanistan - M.T. Mashal, Director General Preventive Medicine, Ministry of Public Health, Kabul, Afghanistan

Prioritizing emergency polio eradication activities in view of the chronic financing gap - H. Jafari, WHO

The tOPV - bOPV switch and suggested IPV policy to complete type 2 eradication - P. Figueroa, member of the SAGE Working Group on polio

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Session: Seasonal influenza vaccine 

Background documents

Background paper on Influenza Vaccines and Immunization SAGE Working Group

4th Meeting Of The Sage Working Group On Influenza Vaccines And Immunization, 14 – 15 February 2012

Minutes of the 2nd meeting of the SAGE Working Group on influenza vaccine and immunization, WHO HQ, 14-15 February 2011

WHO position paper on influenza vaccines

Nair H, et al. Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis. Lancet. 2011 Dec 3;378(9807):1917-30. Epub 2011 Nov 10.

Minutes of the Aug 2011 meeting of the SAGE Working Group on influenza vaccines and immunization

Zaman K, et al. Effectiveness of maternal influenza immunization in mothers and infants. N Engl J Med. 2008 Oct 9;359(15):1555-64. Epub 2008 Sep 17

Jefferson T, Di Pietrantonj C, Al-Ansary LA, Ferroni E, Thorning S, Thomas RE. Vaccines for preventing influenza in the elderly (Cochrane Review)

Jefferson T, Rivetti A, Harnden A, Di Pietrantonj C, Demicheli V. Vaccines for preventing influenza in healthy children (Cochrane Review)

Presentations

Global influenza burden of disease - J. Bresee, member of the SAGE Working Group on influenza vaccines and immunization

Influenza vaccine effectiveness - J. Englund, member of the SAGE Working Group on influenza vaccines and immunization

Safety of influenza vaccines - P. Lambach, WHO

Presentation of recommendations - A. Reingold, member of SAGE Working Group on influenza vaccines and immunization

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Session: Impact of introduction of new vaccines on the strengthening of immunization and health systems

Background documents

Summary of main themes and findings from review of 5 data sources by WHO health system building blocks

Executive summary of data sources: Published literature review

Executive summary of data sources: Grey literature review

Executive summary of data sources: In-depth study of 3 countries

Executive summary of data sources: Interviews with key informants from countries and regions

Executive summary of data sources: Analysis of DTP3 coverage

Principles for adding a vaccine to a national immunization programme while strengthening the immunization and health systems

Selected parts of the updated WHO tool for countries: Principles and considerations for adding a vaccine to a National Immunization Programme

Presentations

Brief introduction to the session - D. Durrheim, member of SAGE

Summary of findings from literature reviews and assessments and interviews in the context of the WHO Health System Building Blocks Framework - T. Hyde, US Centers for Disease control and Prevention

Review of findings and gaps in information on impact of new vaccines on immunization and health systems - N. Arora, member of SAGE

Principles for new vaccine introduction - D. Durrheim, member of SAGE

A practical tool for countries, updated WHO document entitled: "Principles and Considerations for Adding a Vaccine to a National Immunization Programme” - S. Wang, WHO

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Session: Vaccination in humanitarian emergencies 

Background documents

Vaccination in Humanitarian Emergencies: Literature review and case studies

Ethical Considerations for Vaccination Programmes in Acute Humanitarian Emergencies

A Framework for Deciding on Vaccinations in Acute Emergencies

Presentations

Brief introduction of the process that is being followed for the development of the framework - H. Rees, Chair of SAGE Working Group on vaccination in humanitarian emergencies

Literature review of vaccination experience in previous humanitarian emergencies /Existing recommendations and guidance - Z. Bhutta, member of the SAGE Working Group on vaccination in humanitarian emergencies

Ethical issues surrounding use of vaccines in emergency settings - K. Moodley, member of the SAGE Working Group on vaccination in humanitarian emergencies

Vaccination in acute humanitarian emergencies: a framework for decision-making - R. Waldman, member of the SAGE working group on use of vaccination in humanitarian emergencies

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Session: Rotavirus vaccine schedules 

Background documents

Expanding the potential of rotavirus vaccines (RV) to reduce mortality by optimizing the immunization schedules

Soares K et al (2012). Vaccines for preventing rotavirus diarrhoea: vaccines in use

Soares K et al (2012). Rotavirus vaccine schedules: a systematic review of safety and efficacy from RCTs and observational studies of childhood schedules using RV1 and RV5 vaccines- Report to WHO/IVR

Sanderson C et al (2011) Global review of rotavirus morbidity and mortality data by age and WHO region. Report to WHO/IVR

De Oliveria L et al (2011). Progress in the Introduction of the Rotavirus Vaccine in Latin America and the Caribbean: Four Years of Accumulated Experience. The Pediatric Infectious Disease Journal . Volume 30, Number 1, January 2011

Patel M et al (2012). Age restrictions for rotavirus vaccination: evidence-based analysis of rotavirus mortality reduction versus risk of fatal intussusception by mortality stratum. Report to WHO/IVR

Patel M (2011). Intussusception risk and health benefits of rotavirus vaccination in Mexico and Brazil. New England Journal of Medicine,364:24 (2283-2292)

Patel M et al (2009). Broadening the age restrictions for initiating rotavirus vaccination in regions with high rotavirus mortality: benefits of mortality reduction versus risk of fatal intussusception. Vaccine 27 (2916-2922)

Table: Rotavirus vaccines efficacy and effectiveness by WHO mortality strata - List of included studies 

Table: Rotavirus disease epidemiology and potential to provide one or more doses of vaccine to children by week of age: Country level estimates –examples from countries with data available

Data on intussusception after vaccination with RV: RCTs and observational studies

Presentations

Optimizing rotavirus schedules: what are the key questions for today's session? - P. Fine, London School of Hygiene and Tropical Medicine

Rotavirus vaccine effectiveness after 2 or 3 doses and risk of Intussusception after rotavirus vaccination - U. Parashar, US Centres for Disease Control and Prevention

Rotavirus vaccination: tailoring the immunization schedule to the local epidemiology and operational realities - C. Sanderson, London School of Hygiene and Tropical Medicine

Benefits of mortality reduction versus risk of fatal intussusception - M. Patel, US Centres for Disease Control and Prevention

Overview of major conclusions from the ad hoc group of experts - J. Abramson, member of SAGE

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Session: Use of Hepatitis A vaccine

Background documents

Evidence for the use of single dose inactivated hepatitis A vaccine schedules: Background paper for SAGE decision Addendum to SAGE Hepatitis A Working Group report to SAGE November 2011

Background paper prepared for the November 2011 SAGE meeting

GRADE table: Efficacy and safety of hepatitis A vaccines

GRADE table: Hepatitis A vaccine and post-exposure prophylaxis

GRADE table: Population impact of Hepatitis A immunization programs

GRADE table: Hepatitis A vaccines and long-term protection

The Immunological Basis for Immunization Series: Hepatitis A

Presentations

Impact and monitoring the impact of single dose hepatitis A vaccine use in Argentina - C. Vizzotti, Ministry of Health, Argentina

Process of evidence and data collection and overview of evidence obtained including GRADE tables - D. Shouval, Hadassah Hebrew University Hospital, Israel

Draft recommendations for flexible use of inactivated hepatitis A vaccine booster dose - A. Reingold, Chair of SAGE working group on hepatitis A

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Session: Report from GAVI Alliance Secretariat 

Session: Information on vaccines for an Intergovernmental Negotiating Committee on Mercury

Background documents

The following materials are from presentations and statements made at the WHO informal Consultation to develop further guidance on vaccines for the UNEP-convened Intergovernmental Negotiating Committee Meeting 4, WHO-HQ, 3-4 April 2012

Statement by SafeMinds

Statement by CoMeds

Setting the scene - D. Wood

Updates on (a) the safety profile of thiomersal; (b) the biological plausibility of thiomersal contributing to cumulative mercury toxicity - R. Mitkus 

Safety profile of thiomersal and the safety of alternative preservatives - M. Pichichero

Experience with alternatives to thiomersal from other fields (eg biotherapeutics; veterinary vaccines) - J. Löwer

Alternatives to thiomersal as preservatives for vaccines - G. Cirefice on behalf of EDQM and D. Meek

The R&D pipeline for alternative preservatives - G V. Bossche

Assessing the impact of preservative-free vaccine on the immunization supply chain - A. Battersby

Trends in use of multi-dose vaccine vials - J. Liu

Regulators perspectives on alternatives to thiomersal - USFDA

Regulators perspectives on alternatives to thiomersal - EMA

NIFDC's comments on the use of thiomersal in vaccines - J. Wang

Procurement agencies perspectives on alternatives to thiomersal - UNICEF

Procurement agencies perspectives on alternatives to thiomersal - PAHO Revolving Fund

Manufacturing perspectives on alternatives to thiomersal - Novartis, Sanofi Pasteur, Crucell

Manufacturing perspectives on alternatives to thiomersal - DCVMN

Manufacturing perspectives on alternatives to thiomersal - IFAH

Timerosol: Problems, costs and solutions - G. de Chile

Meeting summary: Sessions 1 and 2

Meeting summary: Sessions 3 and 4

Presentations

Outcomes from a WHO Informal Consultation (3-4 April) on further guidance on vaccines in preparation for the fourth Intergovernmental Negotiating Committee (INC4) - E. Griffiths

Perspectives from stakeholders countries - C. Ruiz-Matus, WHO

Manufacturers perspective - S. Jadhav, Developing Countries Vaccine Manufacturers Network

Potential guidance to countries on vaccines for the mercury: treaty negotiations - D. Wood, WHO

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