Agence de Medecine Preventive

Paris, France

Agence de Medecine Preventive

Paris, France
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Le Gargasson J.-B.,Agence de Medecine Preventive | Breugelmans J.G.,Agence de Medecine Preventive | Mibulumukini B.,Sante Rurale SANRU | Da Silva A.,Agence de Medecine Preventive | Colombini A.,Agence de Medecine Preventive
Vaccine | Year: 2013

Background: The Global Alliance for Vaccines and Immunization (GAVI) is a public-private global health partnership aiming to increase access to immunisation in poor countries. The Democratic Republic of the Congo (DRC) is the third largest recipient of GAVI funds in terms of cumulative disbursed support. We provided a comprehensive assessment of GAVI support and analysed trends in immunisation performance and financing in the DRC from 2002 to 2010. Methods: The scope of the analysis includes GAVI's total financial support and the value of vaccines and syringes purchased by GAVI for the DRC from 2002 to 2010. Data were collected through a review of published and grey literature and interviews with key stakeholders in the DRC. We assessed the allocation and use of GAVI funds for each of GAVI's support areas, as well as trends in immunisation performance and financing. Findings: DTP3 coverage increased from 2002 (38%) to 2007 (72%) but had decreased to a level below 70% in 2008 (68%) and 2010 (63%). The overall funding for vaccines increased from US$5.4 million in 2006 to US$30.5 million in 2010 (mostly from GAVI support for new vaccines). However, during the same period, the funding from national (government) and international (GAVI and other donors) sources for routine immunisation services (except vaccines) decreased from US$36.4 million to US$24.4 million. This drop in overall funding (33%) primarily affected surveillance, transport, and cold chain equipment. Interpretation: GAVI support to DRC has enhanced significant progress in routine immunisation performance and financing during 2002-2010. Although progress has been partly sustained, the initial observed increase in DTP3 coverage and available funding for routine immunisation halted towards the end of the analysis period, coinciding with tetravalent and pentavalent vaccine introduction. These findings highlight the need for additional efforts to ensure the sustainability of routine immunization program performance and financing. © 2013 Elsevier Ltd.


Griffiths U.K.,London School of Hygiene and Tropical Medicine | Clark A.,London School of Hygiene and Tropical Medicine | Gessner B.,Agence de Medecine Preventive | Miners A.,London School of Hygiene and Tropical Medicine | And 3 more authors.
Epidemiology and Infection | Year: 2012

Global coverage of infant Haemophilus influenzae type b (Hib) vaccination has increased considerably during the past decade, partly due to GAVI Alliance donations of the vaccine to low-income countries. In settings where large numbers of children receive only one or two vaccine doses rather than the recommended three doses, dose-specific efficacy estimates are needed to predict impact. The objective of this meta- Analysis is to determine Hib vaccine efficacy against different clinical outcomes after receiving one, two or three doses of vaccine. Studies were eligible for inclusion if a prospective, controlled design had been used to evaluate commercially available Hib conjugate vaccines. Eight studies were included. Pooled vaccine efficacies against invasive Hib disease after one, two or three doses of vaccine were 59%, 92% and 93%, respectively. The meta- Analysis provides robust estimates for use in decision- Analytical models designed to predict the impact of Hib vaccine. © 2011 Cambridge University Press.


Gessner B.D.,Agence de Medecine Preventive | Feikin D.R.,International Vaccine Access Center | Feikin D.R.,Centers for Disease Control and Prevention
Vaccine | Year: 2014

Traditionally, vaccines have been evaluated in clinical trials that establish vaccine efficacy (VE) against etiology-confirmed disease outcomes, a measure important for licensure. Yet, VE does not reflect a vaccine's public health impact because it does not account for relative disease incidence. An additional measure that more directly establishes a vaccine's public health value is the vaccine preventable disease incidence (VPDI), which is the incidence of disease preventable by vaccine in a given context. We describe how VE and VPDI can vary, sometimes in inverse directions, across disease outcomes and vaccinated populations. We provide examples of how VPDI can be used to reveal the relative public health impact of vaccines in developing countries, which can be masked by focus on VE alone. We recommend that VPDI be incorporated along with VE into the analytic plans of vaccine trials, as well as decisions by funders, ministries of health, and regulatory authorities. © 2014 Elsevier Ltd.


Gessner B.D.,Agence de Medecine Preventive | Shindo N.,Global Influenza Programme | Briand S.,Global Influenza Programme
The Lancet Infectious Diseases | Year: 2011

Acute respiratory infection (ARI) is a leading cause of mortality worldwide, of which influenza is an important cause that can be prevented with vaccination. We did a systematic review of research published from 1980 to 2009 on seasonal influenza epidemiology in sub-Saharan Africa to identify data strengths and weaknesses that might affect policy decisions, to assess the state of knowledge on influenza disease burden, and to ascertain unique features of influenza epidemiology in the region. We assessed 1203 papers, reviewed 104, and included 49 articles. 1-25% of outpatient ARI visits were caused by influenza (11 studies; mean 9·5%; median 10%), whereas 0·6-15·6% of children admitted to hospital for ARI had influenza identified (15 studies; mean 6·6%; median 6·3%). Influenza was highly seasonal in southern Africa. Other data were often absent, particularly direct measurement of influenza incidence rates for all ages, within different patient settings (outpatient, inpatient, community), and for all countries. Data from sub-Saharan Africa are insufficient to allow most countries to prioritise strategies for influenza prevention and control. Key data gaps include incidence and case-fatality ratios for all ages, the contribution of influenza towards admission of adults to hospital for ARI, representative seasonality data, economic burden, and the interaction of influenza with prevalent disorders in Africa, such as malaria, HIV, and malnutrition. © 2011 Elsevier Ltd.


Mengel M.A.,Agence de Medecine Preventive
Transactions of the Royal Society of Tropical Medicine and Hygiene | Year: 2014

Cholera remains a grave public health problem in Africa. It is endemic with seasonal variations around the central African Great Lakes. Along the coasts, it occurs mostly in rapidly expanding epidemics, with intercalated 3-5 year lull-periods. Case-fatality ratios remain high at 2-5% against the global declining trend. Insufficient safe water and sanitation coverage are the main causes of persistent cholera in Africa and this is unlikely to improve soon. However, an efficacious oral cholera vaccine is now available and new groups and initiatives like the African Cholera Surveillance Network (Africhol) allow countries to enhance their capacities for an integrated cross-border approach using all means necessary to tackle cholera in Africa. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved.


Mengel M.A.,Agence de Medecine Preventive | Delrieu I.,Agence de Medecine Preventive | Heyerdahl L.,Agence de Medecine Preventive | Gessner B.D.,Agence de Medecine Preventive
Current Topics in Microbiology and Immunology | Year: 2014

During the current seventh cholera pandemic, Africa bore the major brunt of global disease burden. More than 40 years after its resurgence in Africa in 1970, cholera remains a grave public health problem, characterized by large disease burden, frequent outbreaks, persistent endemicity, and high CFRs, particularly in the region of the central African Great Lakes which might act as reservoirs for cholera. There, cases occur year round with a rise in incidence during the rainy season. Elsewhere in sub-Saharan Africa, cholera occurs mostly in outbreaks of varying size with a constant threat of widespread epidemics. Between 1970 and 2011, African countries reported 3,221,050 suspected cholera cases to the World Health Organization, representing 46 % of all cases reported globally. Excluding the Haitian epidemic, sub-Saharan Africa accounted for 86 % of reported cases and 99 % of deaths worldwide in 2011. The number of cholera cases is possibly much higher than what is reported to the WHO due to the variation in modalities, completeness, and case definition of national cholera data. One source on country specific incidence rates for Africa, adjusting for underreporting, estimates 1,341,080 cases and 160,930 deaths (52.6 % of 2,548,227 estimated cases and 79.6 % of 209,216 estimated deaths worldwide). Another estimates 1,411,453 cases and 53,632 deaths per year, respectively (50 % of 2,836,669 estimated cases and 58.6 % of 91,490 estimated deaths worldwide). Within Africa, half of all cases between 1970 and 2011 were notified from only seven countries: Angola, Democratic Republic of the Congo, Mozambique, Nigeria, Somalia, Tanzania, and South Africa. In contrast to a global trend of decreasing case fatality ratios (CFRs), CFRs have remained stable in Africa at approximately 2 %. Early propagation of cholera outbreaks depends largely on the extent of individual bacterial shedding, host and organism characteristics, the likelihood of people coming into contact with an infectious dose of Vibrio cholerae and on the virulence of the implicated strain. Cholera transmission can then be amplified by several factors including contamination of human water- or food sources; climate and extreme weather events; political and economic crises; high population density combined with poor quality informal housing and poor hygiene practices; spread beyond a local community through human travel and animals, e.g., water birds. At an individual level, cholera risk may increase with decreasing immunity and hypochlorhydria, such as that induced by Helicobacter pylori infection, which is endemic in much of Africa, and may increase individual susceptibility and cholera incidence. Since contaminated water is the main vehicle for the spread of cholera, the obvious long-term solution to eradicate the disease is the provision of safe water to all African populations. This requires considerable human and financial resources and time. In the short and medium term, vaccination may help to prevent and control the spread of cholera outbreaks. Regardless of the intervention, further understanding of cholera biology and epidemiology is essential to identify populations and areas at increased risk and thus ensure the most efficient use of scarce resources for the prevention and control of cholera. © 2014 Springer-Verlag Berlin Heidelberg.


Gessner B.D.,Agence de Medecine Preventive | Duclos P.,World Health Organization | Nelson E.A.S.,Chinese University of Hong Kong
Vaccine | Year: 2010

This supplement of Vaccine contains detailed descriptions of the experiences and processes of 15 well-established National Immunization Technical Advisory Committees from all regions of the world. All of these committees provide information to national governments that is used to make evidence-based decisions regarding vaccine and immunization policy. Nevertheless, many differences between committees exist including their legal basis, size and scope of committee membership, scope of work, role of the Ministry of Health on the committee, existence of conflict of interest policies, and ultimate role in the decision-making process. Individual country authors identified numerous areas for improvement and these are summarized here. © 2010 Elsevier Ltd. All rights reserved.


Colombini A.,Agence de Medecine Preventive | Badolo O.,Direction de la Lutte contre les Maladies | Gessner B.D.,Agence de Medecine Preventive | Jaillard P.,Agence de Medecine Preventive | And 2 more authors.
Vaccine | Year: 2011

Epidemic meningococcal meningitis remains a serious health threat in the African meningitis belt. New meningococcal conjugate vaccines are relatively costly and their efficiency will depend on cost savings realized from no longer having to respond to epidemics. Methods: We evaluated the cost and impacts to the public health system of the 2007 epidemic bacterial meningitis season in Burkina Faso through a survey at the different level of the health system. A micro-economic approach was used to evaluate direct medical and non medical costs for both the public health system and households, as well as indirect costs for households. Results: The total national cost was 9.4. million US$ (0.69. US$ per capita). Health system costs were 7.1. million US$ (1.97% of annual national health spending), with 85.6% for reactive vaccination campaigns. The remaining 2.3. million US$ was borne by households of meningitis cases. The mean cost per person vaccinated was 1.45. US$; the mean cost of case management per meningitis case was 116.3. US$ when including household costs and 26.4. US$ when including only health sector costs. Meningitis epidemics disrupted all health services from national to operational levels with the main contributor being a large increase in medical consultations. Conclusions: Preventive meningococcal conjugate vaccines should contribute to more efficient use of funds dedicated to meningitis epidemics and limit the disruption of routine health services. © 2011 Elsevier Ltd.


Le Gargasson J.-B.,Agence de Medecine Preventive | Nyonator F.K.,Ghana Health Service | Adibo M.,Independent Consultant | Gessner B.D.,Agence de Medecine Preventive | Colombini A.,Agence de Medecine Preventive
Vaccine | Year: 2015

Background: Limited knowledge exists on the full cost of routine immunization in Africa. Ghana was the first African country to simultaneously introduce rotavirus, pneumococcal and measles second-dose vaccines. Given their high price, it would be beneficial to Ghanaian health authorities to know the true cost of their introduction. Methods: The economic costs of routine immunization for 2011 and the incremental costs of new vaccines were assessed as part of a multi-country study on costing and financing of routine immunization known as the Expanded Program on Immunization Costing (EPIC). Immunization delivery costs were evaluated at the local facility, district, regional, and central levels. Stratified random sampling was used for district and facility selection. We calculated the allocation of nationwide costs to the four health-system levels. Results: The total aggregated national costs for routine immunization - including vaccine costs - equaled US$ 53.5 million during 2011 (including central, regional, and district costs); this equated to US$ 60.3 per fully immunized child (FIC) when counting vaccine costs, or US$ 48.1 without. National immunization program delivery costs were allocated as follows: local facility level, 85% of total national cost; district, 11%; central, 2% and regional, 2%. Salaried labor represented 61% of total costs, and vaccines represented 17%. For new vaccine introduction, programmatic start-up costs amounted to US$ 3.9 million, primarily due to salaried labor (66%). The mean facility-level cost per vaccine dose administered in a routine immunization program was US$ 5.1 (with a range of US$ 2.4-7.8 depending on facility characteristics) and US$ 3.7 for delivery costs. Discussion: We identified a high cost per fully immunized child, mostly due to non-vaccine costs at the facility level, which indicates that immunization program financing - whether national or donor-driven - must take a broad viewpoint. This substantial variation in overall costs emphasizes the additional effort associated with reaching children in various settings. © 2015 Elsevier Ltd.


Steffen C.,Agence de Medecine Preventive | Debellut F.,Agence de Medecine Preventive | Gessner B.D.,Agence de Medecine Preventive | Kasolo F.C.,World Health Organization | And 3 more authors.
Bulletin of the World Health Organization | Year: 2012

Problem Little is known about the burden of influenza in sub-Saharan Africa. Routine influenza surveillance is key to getting a better understanding of the impact of acute respiratory infections on sub-Saharan African populations. Approach A project known as Strengthening Influenza Sentinel Surveillance in Africa (SISA) was launched in Angola, Cameroon, Ghana, Nigeria, Rwanda, Senegal, Sierra Leone and Zambia to help improve influenza sentinel surveillance, including both epidemiological and virological data collection, and to develop routine national, regional and international reporting mechanisms. These countries received technical support through remote supervision and onsite visits. Consultants worked closely with health ministries, the World Health Organization, national influenza laboratories and other stakeholders involved in influenza surveillance Local setting Influenza surveillance systems in the target countries were in different stages of development when SISA was launched. Senegal, for instance, had conducted virological surveillance for years, whereas Sierra Leone had no surveillance activity at all. Relevant changes Working documents such as national surveillance protocols and procedures were developed or updated and training for sentinel site staff and data managers was organized. Lessons learnt Targeted support to countries can help them strengthen national influenza surveillance, but long-term sustainability can only be achieved with external funding and strong national government leadership.

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