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Dr. Marie-Claude Bottineau

PS12_Dr_Marie_BottineauDr. Marie-Claude Bottineau

Pediatrician, Neonatology, Pediatrics Intensive Care, MSF CH, Geneva, Switzerland

Dr. Bottineau is a French Pediatrician with a DESS in Neonatology, a competency in Pediatrics Intensive Care and a Master Degree in Public Health and Tropical Medicine. She did the first part of her carrier working in General and University Hospitals in France as Pediatrician in Pediatrics, Pediatrics and Neonatal Intensive Care in Nantes, Nancy, Le Havre and Paris and her Tropical Medicine Degree in Pitié Salpêtrière Hospital, Paris, with Pr Gentilini and Pr Duflo. She also studied Bio-Ethics in Paris as free auditor getting an equivalence of Master Degree.

In parallel, she was doing some regular missions around the world with several Humanitarian Organizations including MSF- France in Kosovo; Vietnam (Ho-Chi-Minh); Madagascar (Antananarivo); Nicaragua (Leon and Managua), during civil war; Nepal (Pokhara-Jomoson); India (Calcutta, slums of Howrah-Pilkhana) and Cameroon (Mpoundou, Abong-Mbang district).

From 1990 to 1996, she dedicated her carrier to the humanitarian action working exclusively in expatriation in different humanitarian contexts of which in Benin with Terre Des Hommes-Lausanne and in Angola with MSF-France (Uige and Benguela provinces during civil war).

After an urgent medical repatriation in December 1995, time for recovering, few months in HQ MSF-France in Paris and few years in Robert Debré Hospital (Pediatrics Emergencies and Neonatal SMUR), she was to the United States in order to complete her Master Degree in Public Health (2000). Then, she worked 2 years as Public Health Medical Specialist at CRED (Center for Research on the Epidemiology of Disasters), UCL, Brussels, Belgium. At the same time she made several missions to Cambodia for the Belgium Cooperation and some consultancies as Evaluator within the European Commission for INCO-DEV and INCO-MED programs.

From 2001 to 2003 she made regular consultancies for WHO Geneva in Switzerland (Geneva) on GAVI (Global Alliance for Vaccines & Immunizations); Chad (Tanjile), Mali (Bamako) and Indonesia (Djakarta, Bali and Iles de la Sonde) on Maternal and Neonatal Tetanus Elimination (MNTE) including Lot Quality Assurance Surveys (LQAS).

From January 2003 to July 2007 she worked as UNHCR Senior Regional Health/Nutrition/HIV – AIDS Co-ordinator for West Africa based in Sierra Leone (Freetown) and Ghana (Accra), then the Great Lakes Region based in Burundi (Bujumbura) and at least Chad – Darfour Emergency, based in Chad (Abéché).

Mid July 2007, she was appointed as Pediatrics Referent in MSF-CH to develop pediatrics vision, policy and strategic approach and to give adequate support to pediatrics fields. In April 2011, she took the coordination and leadership of the MSF International Pediatrics Working Group and early 2014 the coordination of the Mother, Neonatal and Child pool including nutrition.

She taught extensively (H.E.L.P Course, in MSF, UNHCR, Universities...) and participated actively in international congresses making some abstracts, publications, posters, and/or oral communications.

She contributed for many years to the work of Amnesty International against Torture, acting with the Medical Commission. After different professional affiliations, she is currently active member of the Target Advisory Group (TAG) of the International Pediatrics Association (IPA) on Children in Humanitarian Disasters, of the Partnership for Maternal, Newborn and Child Health (PMNCH) (WHO, UNICEF, Save The Children...) and of the Group of Tropical Pediatrics (Société Francaise de Pédiatrie).

She got certificates of recognition from CDC Atlanta, H.E.L.P Course and the UNAM of Nicaragua for her action in emergency settings and/or her contribution to the teaching.

GHF2014 – PS12 – Integrating Neonatal Care in Low Income Countries: the Big Place of the Very Small Babies

16:00
17:30
PS12 TUESDAY, 15 APRIL 2014 ROOM: LEMAN
ICON_Fishbowl
Integrating Neonatal Care in Low Income Countries:
the Big Place of the Very Small Babies

MODERATOR:
Dr. Marie-Claude Bottineau
MD, MPH & TM 
Pediatrician, Neonatology, Pediatrics Intensive Care, MSF CH, Geneva, Switzerland
SPEAKERS:
Dr. Anne Pittet, Pediatrician, Hôpital de l’Enfance à Lausanne and MSF CH, Geneva, Switzerland
Dr. Jean-Marie Choffat, Pediatrician, CHUV, Lausanne, Switzerland
OUTLINE:
 Worldwide experience on the way to promote neonatal care in remote settings, humanitarian emergencies, post emergency programs, LIC… including policy and strategic planning, implementation, integration into MoH structures, task shifting, training course and handover.
PROFILES:

PS12_Dr_Marie_BottineauDr. Marie-Claude BOTTINEAU is a French Pediatrician with a DESS in Neonatology, a competency in Pediatrics Intensive Care and a Master Degree in Public Health and Tropical Medicine. She did the first part of her carrier working in General and University Hospitals in France as Pediatrician in Pediatrics, Pediatrics and Neonatal Intensive Care in Nantes, Nancy, Le Havre and Paris and her Tropical Medicine Degree in Pitié Salpêtrière Hospital, Paris, with Pr Gentilini and Pr Duflo. She also studied Bio-Ethics in Paris as free auditor getting an equivalence of Master Degree.

In parallel, she was doing some regular missions around the world with several Humanitarian Organizations including MSF- France in Kosovo; Vietnam (Ho-Chi-Minh); Madagascar (Antananarivo); Nicaragua (Leon and Managua), during civil war; Nepal (Pokhara-Jomoson); India (Calcutta, slums of Howrah-Pilkhana) and Cameroon (Mpoundou, Abong-Mbang district).

From 1990 to 1996, she dedicated her carrier to the humanitarian action working exclusively in expatriation in different humanitarian contexts of which in Benin with Terre Des Hommes-Lausanne and in Angola with MSF-France (Uige and Benguela provinces during civil war).

After an urgent medical repatriation in December 1995, time for recovering, few months in HQ MSF-France in Paris and few years in Robert Debré Hospital (Pediatrics Emergencies and Neonatal SMUR), she was to the United States in order to complete her Master Degree in Public Health (2000). Then, she worked 2 years as Public Health Medical Specialist at CRED (Center for Research on the Epidemiology of Disasters), UCL, Brussels, Belgium. At the same time she made several missions to Cambodia for the Belgium Cooperation and some consultancies as Evaluator within the European Commission for INCO-DEV and INCO-MED programs.

From 2001 to 2003 she made regular consultancies for WHO Geneva in Switzerland (Geneva) on GAVI (Global Alliance for Vaccines & Immunizations); Chad (Tanjile), Mali (Bamako) and Indonesia (Djakarta, Bali and Iles de la Sonde) on Maternal and Neonatal Tetanus Elimination (MNTE) including Lot Quality Assurance Surveys (LQAS).

From January 2003 to July 2007 she worked as UNHCR Senior Regional Health/Nutrition/HIV – AIDS Co-ordinator for West Africa based in Sierra Leone (Freetown) and Ghana (Accra), then the Great Lakes Region based in Burundi (Bujumbura) and at least Chad – Darfour Emergency, based in Chad (Abéché).

Mid July 2007, she was appointed as Pediatrics Referent in MSF-CH to develop pediatrics vision, policy and strategic approach and to give adequate support to pediatrics fields. In April 2011, she took the coordination and leadership of the MSF International Pediatrics Working Group and early 2014 the coordination of the Mother, Neonatal and Child pool including nutrition.

She taught extensively (H.E.L.P Course, in MSF, UNHCR, Universities...) and participated actively in international congresses making some abstracts, publications, posters, and/or oral communications.

She contributed for many years to the work of Amnesty International against Torture, acting with the Medical Commission. After different professional affiliations, she is currently active member of the Target Advisory Group (TAG) of the International Pediatrics Association (IPA) on Children in Humanitarian Disasters, of the Partnership for Maternal, Newborn and Child Health (PMNCH) (WHO, UNICEF, Save The Children...) and of the Group of Tropical Pediatrics (Société Francaise de Pédiatrie).

She got certificates of recognition from CDC Atlanta, H.E.L.P Course and the UNAM of Nicaragua for her action in emergency settings and/or her contribution to the teaching.

 

OLYMPUS DIGITAL CAMERADr. Anne Pittet

After a pediatric specialization in Switzerland, I joined MSF OCG in 1999 for several field missions in Africa and Asia. I participated also to clinical studies in South Sudan and Myanmar. In 2005 I worked one year in Vietnam to help in the development of a neonatal project and I continue to follow up these activities.

Since 2006 I’m working 6 months a year with MSF and 6 months a year in the Pediatric Department of the University Hospital of Lausanne. Since 2011 I work with the Medical Department of MSF in Geneva and the Training Unit, performing formal training sessions, coaching, supervision and field visits in different countries of Africa, Asia and Haïti.

Immunization status of young people attending a youth clinic in Geneva, Switzerland

Author(s) Anne Meynard1, Emilien Jeannot2, Lydia Markham3, Claire-Anne Lazarevic 4, Bernard Cerutti 5, Francoise Narring6
Affiliation(s) 1Department of Pediatrics, Geneca University Hospitals, Geneva, Switzerland, 2Institute of social and preventive medicine, Faculty of Medicine, University of Geneva, Institute of social and preventive medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland, 3Private general practice, Private general practice and school health service, Nyon, Switzerland, 4School Health Service , Department of Public instruction Geneva, Geneva, Switzerland, 5Faculty of medicine University of Geneva, Faculty of medicine University of Geneva, Geneva, Switzerland, 6Department of Pediatrics, University hospitals Geneva, Geneva, Switzerland.
Country - ies of focus Switzerland
Relevant to the conference tracks Advocacy and Communication
Summary This study aims to describe immunization status at first visit in a collective of young people coming to an academic youth clinic. Results confirm our hypothesis that many young immigrants have had adequate childhood vaccination especially for tetanus but  are missing Hepatitis B and HPV. Collaboration between nurses in the youth clinic and school health services allows, not only detection of under-vaccinated youth, but quick and effective vaccination .
Background Adolescents are under-vaccinated and have limited access to effective care or preventive services in many regions of the world. Data on immunization status of adolescents or young adults in Switzerland are scarce and little is known about barriers to adequate coverage. Swiss vaccination coverage data shows that children of foreign origin are usually better immunized, but that this difference is lost in adolescence, where the most important factor of adequate vaccination is the presence of a school health vaccination program.
Objectives The objective is to describe the immunization status at first visit and differences in immunization status according to duration of stay in Switzerland and nationality of young people coming to a mulitdisicplinary youth clinic in Geneva
Methodology Immunization status at first visit (medical file, immunization booklets or school health database) was collected retrospectively between January 2010 and June 2011 in all patients coming for a first visit at Geneva University hospital’s multidisicplinary youth clinic. The main outcomes were Tetanus antibody titers one month after a booster of tetanus containing regimen and immunization status at first visit and the comparing of rates between young people of Swiss or foreign origin and for foreigners according to duration of stay in Switzerland.
Results 89% of patients tested for tetanus antibodies had values above 1000 U/l indicating adequate childhood immunization with 29% above 10’000 U/l putting them at risk of hyperimmunization if given usual adult catch up regimens (3 dosis). On the contrary Hepatitis B serology was often negative among the same population in our sample. Finding written information about immunization is significantely higher in youth born in Switzerland regardless of sex and nationality for all vaccines studied (tetanus, measles, hepatitis B and HPV) but is inferior to Swiss vaccination coverage data. Collection of information was highly facilitated by collaboration between academic youth clinic and school health services.
Conclusion In the absence of data, many young people immunized against tetanus or measles might in fact already be well immunized for childhood vaccinations. Effective collaboration between school-health services, primary health care facilities and youth clinics is highly effective in improving adolescent vaccine coverage especially with the help of public heath policies. School health services are usually very well informed about vaccination strategies in countries of immigration and the WHO database can also help to adapt recommendations to migratory flows.  However, they might miss young people at higher risk of being under or over immunized for example those with no booklet, absent from school on the day of immunization campaign, or with no permanent address. In Switzerland, parental consent is required for Hepatitis B or HPV immunization for young people under 16 years of age.Individually adapted catch-up immunization plans for adolescents and young adults regardless of origin or gender can avoid unnecessary and unsafe vaccination, and bring attention to barriers to adolescent vaccination as well as other adolescent health issues. Individual counseling allows targeted screening for silent infectious diseases (STI’s, Hepatitis, Chagas disease or common parasitic infections) but should mainly focus on assessment of protective and risk factors for healthy development of young people.

Communications Platform for Tuberculosos to Supplement Mainstream Media: India

Author(s) Bharathi Ghanashyam1, 2, 3, 4, 5, 6, 7, 8
Affiliation(s) 1Journalists against TB, Journalists against TB, Bangalore, India, 2, , , , 3, , , , 4, , ,, 5, , , , 6, , , , 7, , , , 8, , ,
Country - ies of focus Global
Relevant to the conference tracks Advocacy and Communication
Summary Journalists against TB (JATB) is a communications platform created to supplement the information put out by the mainstream media on TB and to bring sharper focus to the issue by inviting participation from multi-stakeholders. Six journalists who have been active in the media have come together to create the space, which affords opportunities for dissemination of news on TB to focused audiences across the world. In the two years since inception, JATB has visibly demonstrated the need for such a platform and created good impact. This is evident from the response and participation, all of which is available to read on www.journalistsagainsttb.wordpress.com. JATB is completely unfunded.
What challenges does your project address and why is it of importance? JATB addresses knowledge gaps on TB, a disease shrouded in ignorance and misconceptions. It also complements mainstream media spaces by bringing various stakeholders together on one platform, exploiting the potential of new media. Consider these little known facts about TB.TB is completely preventable and curable. TB can be eradicated. And yet, in 2011, there were an estimated 8.7 million new cases of TB (13% co-infected with HIV) and 1.4 million people died from TB, including almost one million deaths among HIV-negative individuals and 430000 among people who were HIV-positive.Control of TB is governed by one V and two Ds – Vaccines, Diagnosis and Drugs. And as experts say, all three are outdated. The BCG Vaccine recently celebrated its 90th anniversary; the smear microscopy test, which is still the most widely used diagnostic tool is 125 years old and the most used TB drug is over 40 years old. And now we have MDR, XDR and XXDR TB which defy treatment and diagnosis.

TB is not a disease that is confined to the poor. TB spreads more rapidly among economically weaker people living in congested areas without access to good nutrition and healthcare, but it is airborne and spreads easily to attack anyone who is immune compromised. It can kill if left untreated.

How have you addressed these challenges? Do you see a solution? JATB has identified key challenges to the control of TB and created a platform that can discuss better ways to disseminate this information among stakeholders. Among the needs and solutions that JATB has identified for more effective TB control are greater awareness on its preventable and curable nature, far greater political will towards eradication and most importantly, larger investments for prevention, diagnosis and treatment. Framing these issues in a manner that get public attention becomes equally important. Failing this, discussion around TB can remain confined to academic and research groups, and the medical fraternity.In several countries such as India, TB control programmes are government led and run. While India has become known for a very effective programme, there is also a highly unregulated private sector at work which hampers TB control efforts through the use of inaccurate diagnostic tools such as serological tests and wrong treatment protocols. There is evidence that at least 1.5 million serological tests are performed in India every year. At $10-$30 per test, the cost of testing, plus the cost of TB drugs wasted on treating hundreds of thousands of patients with false-positive results, rival the entire Indian TB control program annual budget of $65 million. These tests are available in at least 17 of 22 highest TB burden countries, from China to South Africa to Afghanistan. This situation needs to be addressed and requires stronger advocacy. JATB has worked actively towards this as well.Recognizing social media as a powerful tool for advocacy, JATB has used it to complement the mainstream media to spread awareness around the curable and preventable nature of TB. This is based on an assumption that greater awareness by default will increase demand for treatment, thereby driving higher investments for the development of newer vaccines, better drugs and new diagnostic tools. JATB does this by publishing and disseminating expert opinion, real life incidents, discussion, debate and news on the latest advancements. JATB is a space dedicated solely to furthering debate on TB and does this by actively connecting decision makers and planners together. It has also been actively advocating for greater investments in media advocacy by the TB sector. JATB has worked actively to advance the debate around TB and make it relevant to the general public, policy makers and other stakeholders.
How do you know whether you have made a difference? JATB, within the first year of being founded found wide ranging acceptance among stakeholders, be it agencies working on the ground, governments or others. This acceptance and support has been on the rise since then. JATB, owing to the position it enjoys in the community as a voluntary space that affords opportunities for unbiased debate, has also pursued specific causes – such as advocating against the use of ineffective diagnostic tools for TB. This has included interfacing with the company that manufactures such tools and publishing their responses for the public to see, as also forwarding these replies to relevant government departments for action. Directly or indirectly it has achieved impact. That it makes a difference is evident from the fact that some of the most renowned experts on TB in the world have written for it.A story published on the blog won the WHO Stop TB Award for Excellence in writing on TB in 2011. In the same year, JATB was invited to present a session Lessons that can be learnt from a Health Journalist at the Childhood TB Conference held by European Centre for Disease Prevention and Control. This is clear evidence of the fact that such a platform is needed in the TB sector. Needless to say if this media platform can work for TB, it can work for most any other issue.As proof that JATB is making a difference, two documents are uploaded through the option later in this application. This further strengthens the value of the initiative. JATB has actively advocated for investment in the mainstream media for training and fellowships and this is also beginning to make a difference. Wider acceptance and knowledge among the mainstream media will increase visibility for TB.

The most important factor is probably that JATB is completely voluntary and unfunded. Despite the complete lack of any financial compensation, contributors have come forward to be part of JATB, enriching it with credible and useful content. This clearly points to the need for such initiatives as well as to the impact.

Have you or the project mobilized others and if so, who, why and how? There is definite evidence that JATB has mobilized the TB sector at several levels. At one level it has brought academicians, researchers and experts together. At another, there is demand from activists and community members for information as is evident from the readership of various blog posts. JATB primarily set out to provide an alternative space to the mainstream media, which did not find TB a worthy enough topic to give space to.
JATB is now a part of several important discussions around TB in the country as well as internationally. JATB has been invited to either speak at, or contribute to the debate in each of the segments it addresses. Notable among these are JATB’s representation at media events, TB conferences or consultations. JATB is now considered a valuable partner in the fight against TB.By publishing his story on the blog, JATB has mobilized some funds for the treatment of an HIV+ boy who has suffered multiple attacks of TB. JATB also set aside a portion of the award it received for the treatment of the child.The very fact that JATB was considered worthy of the WHO Stop TB Award for Excellence in writing on TB, on par with publications such as the New Yorker, is irrefutable evidence of its acceptance of and value in the TB sector.
When your donor funding runs out how will your idea continue to live? This question is not relevant to JATB as it has not sought or accepted funding from any organisation or individual to keep it going. This adds strength and sustainability to the space. It is however important to say here that the one challenge JATB faces is its inability to exploit the full potential it affords for becoming an even more powerful vehicle for advocacy on TB. This is owing to the fact that it does not get full time attention from the members of the group who are all contributing on a voluntary basis. While its biggest strength comes from the fact that it can be completely unbiased, owing to its voluntary status, this also becomes its biggest challenge as it becomes difficult to give it the attention it deserves. JATB is giving serious thought to how this challenge can be overcome without having to ally with one group or the other, should it become necessary to seek or generate funds to make it more vibrant and useful.

Public-Private Partnerships: Beneficial or Undermining?

Author(s): Louis J. Currat1
Affiliation(s): 1Former Executive Secretary, Global Forum for Health Research, Geneva, Switzerland
Key issues: Many infectious diseases affecting the developing world are potentially treatable in the longer term. However, economic disincentives have resulted in underinvestment in medical research for new vaccines and medicines targeted at these diseases. Thus, of the more than 1200 drugs that reached the global market in the past three decades, only an estimated two to three per cent were for tropical infectious diseases that primarily affect the poor. Worse yet, three million children die each year from diseases that could have been prevented with existing vaccines (for example vaccines against hepatitis B and Haemophilus influenzae type b), underlining the huge economic, social and cultural obstacles existing between the availability of products and their accessibility by poor populations. The main reasons for this situation are that, on the one hand, high costs and inadequate commercial returns have resulted in the withdrawal of the private commercial sector from investments in tropical disease research and commercialization of health products for the poor populations of developing countries. On the other hand, the public sector has concentrated its financing on basic health research and generally lacks the expertise, mechanisms and resources to discover, develop, register and commercialize new products. In other words, there is a disconnection (or several) in the pipeline for producing, developing, and delivering health products to the poor between the public and private commercial sectors and these disconnections may be different for different diseases.
Meeting challenges: How to reconnect and/or reinforce this pipeline? The solution has to come from joint undertakings of the public and private sectors. In many cases, the initiative to launch a public/private partnership is likely to come from the public sector, as the sector is ultimately responsible for ensuring that the poor have access to health products. It may also come from civil society organizations, pursuing a global health objective with private resources. Examples also exist where the initiative was taken by the private commercial sector.
Conclusion (max 400 words): When are PPPs needed? In short, one could say that the larger the disconnection in the product discovery/delivery pipeline between the public sector and the private commercial sector, the higher the rationale for launching a PPP. Are PPPs the only strategy to reconnect and reinforce the discovery/delivery pipeline? No, the public sector may decide to use push and pull interventions to help correct the structural problem of under-investment in the diseases of developing countries. If the disconnection is particularly large, it may choose to use push and pull interventions together with support to specific PPPs in order to speed up the impact on the health of poor populations. Do PPPs always work and are they always cost effective? With good management, the benefit/cost ratio of PPPs may be very high, i.e. the benefits of joint action may be much larger than what each institution could obtain separately for the same amount of time and resources invested. In cases where the overall estimated benefits become limited, while the costs remain high, it is justified to stop the investment in the partnership. To illustrate these points, the presentation will draw upon a few examples of actual PPPs.

Working in Partnership to Improve Child Survival: Red Cross Support to the Ministry of Health During the Mali Integrated Campaign

Author(s): M. M. Erskine1, D. Adama*2, J. Peat1, O. I. Toure3
Affiliation(s): 1Health and Care Department, International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland, 2Governance Committee, Mali Red Cross Society, 3Ministry of Health, Bamako, Mali
Keywords:

Child survival, Mali, Ministry of Health, Red Cross, integration, vaccination, malaria, civil society, partnership

Background:

In 2007, the Malian Ministry of Health worked with its financial and technical partners to plan and implement one of the largest child survival campaigns to date. The Mali Child Survival campaign targeted over 2.8 million children under the age of five throughout the country. In one week, children received vaccination against measles and polio, supplementation with vitamin A, deworming treatment and long-lasting insecticide treated nets for malaria prevention. Together, the integrated package addresses a number of diseases that contribute to a high disease burden among African children.  A central part of the campaign planning was the communications and social mobilization strategy, to ensure that all segments of society were informed and motivated to promote and participate in the activities. One organization that played an important role was the Mali Red Cross Society, which trained 2,500 volunteers in six regions of the country. The partnership between the Malian Ministry of Health and the Malian Red Cross is an example of how civil society organizations can play a supportive role to improve healthcare delivery. The Malian Red Cross continues to play this auxiliary role for community- and household-based promotion of routine health services to work towards sustaining the high coverage rates attained during the integrated campaign.

Summary/Objectives:

The objectives of the Integrated Child Survival campaign in Mali were to reach more than 95% of children with measles vaccination and more than 80% of children with all other interventions. Additional objectives included ensuring adequate social mobilization to persuade caretakers of the importance of the campaign, undertaking micro-planning for logistics and management of all campaign supplies and implementing an effective system for monitoring and supervision during the week of activities. The campaign will be evaluated in late January/early February using PDA technology.

Results:

Results for this presentation are divided into two components, one related to process and the other related to impact. In terms of process, a strong collaboration and cooperation existed amongst partners, with the Ministry of Health leading and coordinating all activities. Strong relationships with civil society organizations, including the Mali Red Cross, allowed for successful mobilization of parents and organization of sites for the child survival campaign. The role of the Red Cross as a civil society organization is highlighted here to emphasize the need for community-based volunteers to ensure that the most vulnerable, and the most resistant, households receive these necessary interventions. In terms of impact, data were collected daily during the seven days of campaign activities and information was relayed from the health centre level to the national level through telephones, computers and radios. The results of the campaign indicate that all objectives set at the outset of the campaign were not only reached but also exceeded. A cluster survey, using PDA technology, will be used to confirm the daily tally results from health facilities with household level data regarding under fives and their participation in the campaign.

Lessons learned:

The Mali Integrated Child Survival campaign was an enormous undertaking for the country. The importance of partnership, at both international and national levels, is highlighted as a major reason for the success of the initiative. Within the vast country, the contribution of community-based organizations is central, as demonstrated by the role of the Red Cross in mobilizing caretakers before, during and after the campaign. The importance of ongoing messaging to parents to ensure that health facilities are accessed for routine vaccination services, and to contribute to positive behaviour change at the household and community level, are retained as major lessons for sustaining achievements.

Rationalising Vaccine Delivery: A Contribution to the Health Workforce Crisis

Author(s): K. Wiedenmayer*1, F. Tediosi1, S. Weiss1, A. Mukherjee2, C. Chattopadhyay2, R. Kundu3, M. Tanner4
Affiliation(s):

1Swiss Centre for International Health, Swiss Tropical Institute, Basel, Switzerland, 2Research Department, S.B. Devi Charity Home, 3Medical Department, Institute of Child Health, Calcutta, India, 4Director, Swiss Tropical Institute, Basel, Switzerland

Keywords: Vaccine delivery, health workforce, combination vaccines, immunization programmes, time-motion study
Background:

The implementation of the WHO Expanded Programme on Immunization (EPI) is one of the most effective public health initiatives worldwide. Immunization is essential to achieve the Millennium Development Goal (MDG) of reducing child mortality. Immunization reduces the costs of treatment and of disability caused by infectious diseases. However, many obstacles remain in providing poor countries with appropriate vaccines to meet global objectives of eradicating vaccine-preventable diseases. Efforts to increase coverage are hampered by weak health and immunisation systems. Shortage of health staff is an important obstacle to scaling up immunization. Without efficient and effective delivery systems and a trained and motivated workforce, vaccines will not be delivered where they are needed. Rationalising vaccination delivery, for example by combining vaccines, can enable the introduction of new vaccines into immunization programmes without necessitating additional visits to the healthcare provider. Furthermore, simplification of vaccine delivery reduces the potential for handling errors, facilitates training and enables vaccination programmes to reach children in remote areas. Technological improvements such as fully liquid combination vaccines in a single injection have been developed to rationalize vaccine delivery and to simplify supply and administration of vaccines. The availability of new vaccines and easy-to use technologies will strengthen vaccination delivery systems, alleviate immunization workload and hence contribute to increasing health service performance.

Summary/Objectives:

A study was carried out to understand implications of a single vial fully liquid pentavalent DTP-HepB-Hib vaccine given as one injection in terms of resource requirements, efficiency and impact on vaccination programmes.
A time-motion study was conducted at the Institute of Child Health (ICH) in Calcutta, India. The observational study compared a fully liquid pentavalent DTP-HepB-Hib vaccine in a single vial with a combination vaccine in multiple vials requiring reconstitution. Vaccination staff preparing, administering and disposing the vaccines, and eligible children for the routine childhood vaccination schedule were observed during the immunization procedure. Every vaccination step was observed, timed and recorded. 312 children were vaccinated over 6 weeks in 2006. An analysis was done to estimate potential time savings for the immunization clinic and nationwide.

Results:

Study results indicated statistically significant time savings for vaccine preparation and total vaccine consultation for the single vial combination vaccine of about 50% and 20% as compared to multiple vial combination vaccines. At current vaccine load, working time savings at ICH are estimated to be about 20 working days per year. Extrapolated to India, delivery time savings could be over 100,000 working days per year.

Lessons learned:

A single vial fully liquid pentavalent combination vaccine offers important time gains for vaccine delivery as compared to a multiple vial vaccine requiring reconstitution. Single injection combination vaccines simplify logistics, training and delivery management and offer significant time savings, critical for scaling up immunization coverage in view of the health workforce crisis. Single vial combination vaccines might contribute to better resource management and ultimately improve efficiency of immunization programmes.

A Pooled Economic Evaluation of Intermittent Preventive Treatment of Malaria in Infants (IPTi)

Author(s):

E. Sicuri*1, F. Manzi, C. Davy, B. Obonyo, P. Biao, P. Masika, F. Matovu, F. Tediosi, G. Hutton, L. Conteh2

Affiliation(s): 1CRESIB- Centre de Recerca en Salut Internacional de Barcelona, Barcelona, Spain, 2Swiss Tropical Institute, Basel, Switzerland
Keywords: Malaria, intermittent preventive treatment on infants, economic evaluation
Background:

This paper focuses on the economic evaluation of IPTi (Intermittent Preventive Treatment of Malaria in Infants). IPTi is the delivery of a treatment dose of an antimalarial drug during the first year of life when receiving EPI (Expanded Programme on Immunization) vaccines. This trial and the economic analysis are part of the IPTi Consortium www.ipti-malaria.org IPTi trials were undertaken in several sub-Saharan African countries (Mozambique, Kenya, Tanzania and Gabon) and in a South-Pacific country (Papua New Guinea).

Summary/Objectives:

This paper aims to undertake a pooled economic evaluation of IPTi. A range of cost effectiveness and implementation issues were investigated using efficacy results from the various sites. Information on provider and household costs averted (both inpatients and outpatients), together with data on the potential absorption capacity of IPTi into the existing health system were analysed. The economic analysis also aimed to compare the different characteristics of the trial settings and how these influenced costs. Such issues included the different antimalarial drugs used; different malaria incidence levels; and the different levels of capacity of EPI to accommodate IPTi.

Results:

Previous results of two trials delivering Sulfadoxine-Pyrimethamine in Manhiça, Mozambique and Ifakara, Tanzania have shown efficacy and safety of IPTi and the economic evaluation of the two sites also appeared highly cost-effectiveness. Further analysis suggests that this cost effectiveness extends to a wide range of other scenarios and settings.

Lessons learned:

Early results show the potential of IPTi as a health intervention. As a preventive intervention, its implementation is cheap because of its delivery alongside EPI; this allows minimisation of household opportunity costs, and the increase in health system costs is, in many cases, marginal. IPTi is currently under consideration by the WHO for policy recommendation. It is hoped that our results on its pooled cost-effectiveness will add to this debate.

Active Monitoring of the Adverse Events Following Immunization (AEFI) with the Yellow Fever Vaccine during the Vaccination Campaign in Cameroon

Author(s): Z. Sando*1, F. N. G. A. Enoah2, J. Ateudjieu3, M. Demanou4, B. Anya5, M. Kobela6
Affiliation(s): 1Ministry of public health Yaounde-Cameroon, Gyneco-obstetric and paediatric hospital, Yaounde, 2Ministry of Public health, Gynaeco-obstetric and Paediatric Hospital, 3Ministry of Public health, Division of operational research, 4Ministry of public health Yaounde-Cameroon, Centre Pasteur, 5WHO-Cameroon, WHO, 6Ministry of Public health, Expanded program of immunization, Yaounde, Cameroon
Keywords: Yellow fever vaccine, Adverse events following immunization
Background:

In the perspective of putting in place of mass yellow fever vaccination campaigns, 12 African countries including Cameroon were targeted by the Global Alliance Vaccines and Immunization (GAVI) amongst the 34 countries of high risk of epidemic. The yellow fever vaccine is considered as one of the most efficient and sure vaccines and Adverse Events Following Immunization (AEFI) are rarely reported, the estimated risk being 1 to 3 cases per one million doses of vaccine administered. The vaccines used during the May 2009 mass vaccination campaign in the 62 health districts at high risk of yellow fever in Cameroon were supplied by Sanofi Pasteur Paris and Biomanguinhos in Brazil. This campaign involved a population of 7471062 persons, which constitutes 92% of the total population.

Methods:

A multidisciplinary expert committee, made up of 13 persons was formed. This committee was assigned the task of elaborating the documents and monitoring materials and to investigate AEFI with the yellow fever vaccine, to investigate and classify all cases of severe AEFI. The members of the committee were briefed by national and international experts with good experience on the monitoring of AEFI with the yellow fever vaccine. Likewise central and regional supervisors were briefed as well as the principal field actors.

Results/Conclusions:

Amongst the 356 cases of the AEFI with the yellow fever vaccine notified during the period of monitoring, we registered 312 minor cases, representing a proportion of 87.64% and 53 severe cases, representing a proportion of 14.88%. Amongst the severe AEFI, 09 cases were excluded (03 cases reclassified as minor and 06 cases lacked information). We therefore had a total of 50 cases of severe AEFI, which corresponds to the expected number. Amongst these severe cases were 05 deaths. 44 cases of severe AEFI were investigated excluding the 05 deaths. Amongst these, 03 were viscerotropic, 2 were cases of hypersensitivity, 1 neurotropic, and 38 programmatic errors or coincidence.In conclusion, the monitoring of AEFI during the yellow fever mass vaccination campaign of May 2009 in Cameroon led to the confirmation of the rarity of AEFI with the yellow fever vaccine in general, but showed that there is a probability of the occurrence of severe AEFI. Severe AEFI in Cameroon were mostly due to programmatic errors and coincidences.

Q Fever Outbreak in the Province of Noord-Brabant: Overview and Measures

Author(s): R. Dumont*1, C. Wijkmans2, P. Schneeberger3, S. Lutgens4
Affiliation(s): 1Healthcare department, Province of Noord-Brabant, 2Infectious diseases department, Public health service GGD Hart voor Brabant, 3Microbiology department, Jeroen Bosch hospital, ‘s-Hertogenbosch, 4Microbiology department, Maastricht University Medical Centre, Maastricht, Netherlands
Keywords: Coxiella burnetii, Q fever, zoonosis, outbreak, one medicine concept, the Netherlands
Background:

Since the year 2007, three consecutive outbreaks of Q fever have been reported in the Netherlands. The ongoing 2009 outbreak in the north-eastern part of the province of Noord-Brabant is the largest community outbreak ever, with 2,204 cases reported until October 8, 2009. The hospitalisation rate of cases was 20,4%. Six patients died as a result of this infection. The changing epidemiology of Q fever has not yet been clarified, but it is highly suspected that many of the cases are associated with infected goats and sheep living in intensive farms. Agricultural and public health ministries, branches, health services, and the province work together intensively in order to stem the tide of the disease, and ultimately prevent human cases in the future. This is an example of the “one medicine concept”, which focuses on the commonality of human and veterinary medicine.

Results/Conclusions: This is by far the largest community outbreak of Q fever ever reported in scientific literature. The severe increase in cases and the widespread pattern of this outbreak with more than 2,200 cases reported from January until October 2009 is alarming. This high number of notified cases is partly due to an increased awareness of Q fever among general practitioners (GP), specialists, public health services and medical microbiological laboratories, especially in the region where the outbreaks have occurred. Presumably, this has also led to a different diagnostic approach and earlier diagnosis of suspected cases. Signals from rural GP practices indicate, however, that there is an unprecedented, striking increase in pneumonia and signs and symptoms associated with Q fever amongst their patients. Conclusive evidence as for the sources of the epidemic has yet to be discovered. Although a single animal source can cause many human Q fever cases, the larger geographic area in which cases occur in 2009, compared to 2007 and 2008 points at multiple sources. Several studies to assess the risk factors for Q fever in the general population, high-risk groups, and in ruminants are in progress or starting in the near future. Currently more than 3 million Euros is available for the research agenda, nationwide. The measures are expected to control the disease but must not deserve too much optimism in the short term. A reduction of Q fever patients is not expected in 2010, at most stabilized. This is due to the scarcity of vaccines in 2009 and the large scale of the outbreak. Another reason is that C. burnetii survives in the environment between particles. This year, over 2,204 people with Q fever are reported. Six people in the Netherlands deceased due to Q fever. All had a different underlying condition. Despite the expected positive effects of the measures, people will still fall ill in 2010. However, national, regional and local administrators, human and veterinary experts increasingly work together to solve the questions regarding the Q fever outbreak. The battle continues. All organizations invest heavily in cooperation although they have conflicting interests. The public health is important in the choice of measures. But the expected effectiveness, feasibility and proportionality of the proposed measures have to be balanced before a decision is taken. New knowledge is continuously becoming available, thus the measures are continuously being adjusted. It is important to take verifiable measures which have the support of parties and can be enforced. This requires agreement on the measures to be taken. Some organizations characterize the discussions and compromises as swimming against the tide.