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  2. Migration and vaccination: Protecting Syrian refugee children in Turkey “I learned in Syria that vaccinations are important,” says a Syrian refugee mother waiting in the lobby of a clinic in southeastern Turkey. Holding her baby boy, she explains that she is here to have him immunized. “I got the first two rounds of the vaccination at a Turkish hospital and health centre,” says another Syrian mother in her native Arabic. Turkish and Arabic are very different languages and use different alphabets, so Syrian patients and parents can encounter problems understanding when they go to Turkish medical facilities. “It was a little difficult with the language,” she continues. “It’s good that there are Syrian doctors here.” The mothers are at one of Turkey’s clinics for Syrian refugees, staffed by both Turkish doctors and WHO-trained Syrian doctors and nurses who are themselves refugees. Since the brutal conflict in Syria began, 3 million Syrians have poured into neighbouring Turkey. Although the Turkish Ministry of Health has worked hard to provide for their needs, the strain on Turkey’s health system has been immense. In addition, experienced Syrian doctors and nurses had earlier been unable to practice medicine in Turkey due to accreditation issues. With help from WHO, these Syrian health professionals are being screened and then trained to adapt to Turkey’s health care system. When they successfully complete classroom work and six weeks of on-the-job training, they can be employed legally in Turkey’s public clinics and provide care to their fellow refugees. Vaccination is an important part of this care, especially because the conflict caused many Syrian children to miss out on vaccines in their home country. “I remember one child about 3 years old,” says Selam, a Syrian nurse trained as part of the WHO programme. “The parents didn’t want to get the vaccination because of the language barrier.” Refugee children visit a vaccination centre in southeastern Turkey. Photo: WHO/Sheahen “The Turkish government has been encouraging and providing vaccination, but some people didn’t want to,” continues Selam. Immunizing all children in Turkey is urgently important. As the Syrian conflict has decimated vaccination efforts, there have been outbreaks of polio and measles across the border in Syria, just a few hours’ drive away from cities in southeastern Turkey. Now that refugee parents in Turkey can talk to Syrian doctors in their own language at the clinics, there is less confusion and concern. Dr Dalal Kouryani, who escaped Syria with her husband, took the training, which included information on Turkish acronyms for vaccines and the Turkish vaccination schedule. “We like this training because we’re helping Syrians,” she says. The WHO programme also trains bilingual Turkish-Arabic speakers in understanding medical terminology, including words related to immunization. Earlier, “There were lots of translators, but sometimes they can’t bridge the gap, they don’t know the terms,” says Selam. Now, hundreds of WHO-trained Syrian staff have been hired by Turkey’s clinics for refugees. WHO is also helping to build, equip, and cover operating costs of several refugee health centres where basic primary care, including vaccinations, is free. WHO also helps Turkey’s Ministry of Health spread the word about vaccination campaigns that specially target refugee children. In 2017, these campaigns reached more than 360 000 refugee children in Turkey to prevent diseases including measles and polio, using the same vaccination schedule used for Turkish children. “With outbreaks of polio and measles in nearby Syria, it’s more important than ever to protect children living in Turkey,” says Dr Pavel Ursu, WHO Representative for WHO Turkey. “The strategy of reaching every child through proper and timely immunisation is part of the universal health coverage which the Turkish government offers to all Syrian refugees."
  3. Last week
  4. The magnitude of refugee and migration movements in recent years in the Region and complexities associated with the migration phenomenon pose significant public health challenges that necessitate a coordinated response. Taking note of this situation, a technical briefing session on “Immunization and Migration” was organized on 11 September 2017 during the Regional Committee Meeting of the WHO European Region in Budapest, Hungary. The European Vaccine action plan 2015-2020 outlines the need for an equitable access to vaccination of all vulnerable populations including refugees and migrants. The session brought together the Member States, development partners, and other relevant stakeholders to better understand the provision and implementation of immunization services for the refugees and migrants. I joined Mr Robb Butler, Programme Manager Vaccine-Preventable diseases and Immunization (VPI), WHO European Region who co-hosted the session with Dr Santino Severoni from Migration and Health unit of WHO European Region. Listening to the experiences from Germany, Greece, Italy, Sweden and Turkey including the other Member States and partners in the audience on their experiences in providing immunization services to the migrants and refugees was an immense learning for me. Local innovations, coordination between national policy planners and subnational implementers, necessary changes in legislation and regulations, and using local data by the technical advisory groups for decision-making were the key highlights of the discussion. A brief synopsis of the session is available here; http://www.euro.who.int/en/about-us/governance/regional-committee-for-europe/67th-session/news/news/2017/09/day-1-highlights-rc67-opens WHO Europe is developing a Health Evidence Network (HEN) synthesis report which will assimilate the available evidence on equitable delivery, access, and utilization of immunization services for migrants and refugees in the WHO European Region. I will be glad to share the HEN report once it is finalized and available for sharing. What has been your experience regarding the provision of immunization services to the migrants and refugees in your setting? I am keen to expand my knowledge base on this as I hear the first-hand experiences from everyone.
  5. I'm giving you a gift! Immunizing for hepatitis.

    Thank you, Miriam, you're doing a great job!
  6. Earlier
  7. ECDC has published an Expert Opinion on rotavirus vaccination in infancy. The paper provides EU/EEA Member States with relevant scientific information on burden of rotavirus disease, vaccine effectiveness and safety, and cost-effectiveness studies to support the decision-making process on the possible introduction of routine vaccination of children against rotavirus gastroenteritis. Authorised vaccines provide a high level of protection against severe disease in need of medical attention. Evidence suggests that rotavirus vaccination should be initiated before 12 weeks of age and can be administered together with other infant vaccines. The Expert Opinion provides options for monitoring and evaluating the impact of rotavirus vaccination. Read more rotavirus-vaccination-expert opinion-september-2017.pdf
  8. I work in Roskilde in a substance abuse clinic. We see all kinds of patients, aged 18 and over, who have problems with drugs or alcohol. My job is to give them medicine and to arrange for blood tests and to vaccinate them for hepatitis. Immunizing for hepatitis is a big part of my job. This client group uses needles, which they share, meaning they end up infecting each other with all kinds of diseases. Even though we give them free needles, they still share because when people are taking drugs they don’t think about risk in the same way. This is an extremely vulnerable group of people. A lot of them are homeless, they’re the people you see on the streets, many of them are prostitutes and criminals. We use different pedagogical approaches depending on the person. For hepatitis I try to ‘sell’ the good idea of being vaccinated - everyone understands that theory. Young people feel they will be freer in their ‘party life’ if they can’t get hepatitis, so then I have another job to tell them about other diseases. I have to talk to the person in front of me in such a way that they will understand it. Sometimes I draw a picture to show them how the infection spreads. I tell the patient: “I am giving you a gift so you don’t get sick from the life you are living.” Some of my patients don’t get the idea of being immunized but it’s not a trust problem. It can be really hard work making them understand the importance of it and even harder work to get them to turn up for the appointment. When we send patients for blood tests we can order the tests electronically rather than giving people pieces of paper. Where possible we actually walk with them to the place where they get the blood test. The most frustrating thing is when patients don’t show up. It’s unfortunately rare to get to finish all three doses of the vaccine. In an ideal world we would vaccinate at the same time as giving methadone so the patients are at the clinic anyway, using every contact with a patient to vaccinate is a very good strategy and I hope we may soon be able to do that here. A trickier aspect of my ideal world would be a wonder vaccine for hepatitis that would only require one dose. Could you do that for me? I am very patient…..
  9. Vaccine Volume 35, Issue 37, 5 September 2017, Pages 4840-4850 Abstract Objectives The success of vaccination strategies depends in part on population perceptions of benefits and risks of vaccines and related confidence in vaccination. Better knowledge of public concerns about vaccines and what is driving them is needed to inform vaccination strategies and communications. This literature reviewer examined studies on vaccine and vaccination risk perceptions and concerns across European populations. Read more
  10. VoICE is a browsable, queryable online database intended to capture the many ways in which immunization can be valued, and the evidence supporting this more comprehensive view of the value of vaccination. The information contained in the compendium has been drawn from peer-reviewed literature, expert commentaries and other high quality sources and synthesized with policy-focused global health advocacy organizations in mind. http://view-hub.org/voice/
  11. This position paper replaces the 2006 WHO position paper on diphtheria vaccine. It incorporates recent evidence on diphtheria and provides revised recommendations on the optimal number of doses and timing of diphtheria vaccination. In view of the widespread use of combination vaccines, it provides guidance on the alignment of vaccination schedules for different antigens included in routine childhood immunization programmes. http://www.who.int/immunization/policy/position_papers/wer_31_diphtheria_updated_position_paper.pdf?ua=1
  12. GACVS held its 36th meeting in Geneva, Switzerland, on 7–8 June 2017. The Committee reviewed updates on the safety profiles of Bacillus Calmette-Guérin (BCG) vaccine and human papilloma virus (HPV) vaccine and pharmacovigilance planning for the pilot implementation programme for the antimalaria vaccine. Among other findings, the Committee concluded that "Ten years after introduction, global HPV vaccine uptake remains slow, and the countries that are most at risk for cervical cancer are those least likely to have introduced the vaccine. Since licensure of HPV vaccines, GACVS has found no new adverse events of concern based on many very large, high quality studies. The new data presented at this meeting have strengthened this position." Regarding BCG: "The vaccine has been shown to be consistently protective against infant tuberculous meningitis and miliary tuberculosis, and remains an important tool for the prevention of tuberculosis" See the full GACVS meeting report: http://apps.who.int/iris/bitstream/10665/255870/1/WER9228.pdf
  13. The 7th World Hepatitis Day on 28 July 2017 provides a historic opportunity to campaign to "Eliminate hepatitis", the 2030 goal to which all 53 WHO European Member States committed in 2016. Eliminating the threat of infection with the hepatitis B virus (HBV) requires a comprehensive approach that includes prevention of infections acquired immediately before and after birth and during childhood, as well as during adolescence and adulthood. Following a thorough review of available evidence, WHO concluded in its updated vaccine position paper on hepatitis B released in early July 2017 that vaccination programmes against hepatitis B are very safe and effective. Studies have shown a dramatic decrease in deaths due to acute and chronic liver diseases among vaccinated people and in the number of cases of hepatitis-related liver cancer. Hepatitis B vaccine is known as the first vaccine that prevents cancer (the second being the vaccine against human papillomavirus to prevent cervical cancer). 48 of the 53 countries in the WHO European Region conduct universal hepatitis B vaccination, offering population-wide protection against hepatitis B and its complications. In addition, United Kingdom will start administering a hexavalent vaccine to children born after 1 August 2017. For more information about hepatitis B in Europe, see: · WHO fact sheet on Hepatitis B: http://www.euro.who.int/en/health-topics/communicable-diseases/hepatitis/news/news/2015/07/viral-hepatitis-400-deaths-a-day-in-the-who-european-region-could-be-prevented/factsheet-hepatitis-b · Action plan for the health sector response to viral hepatitis in the WHO European Region. DRAFT (2016): http://www.euro.who.int/en/health-topics/communicable-diseases/hepatitis/publications/2016/action-plan-for-the-health-sector-response-to-viral-hepatitis-in-the-who-european-region.-draft-2016 · World Hepatitis Day: Making hepatitis elimination a reality: http://www.euro.who.int/en/health-topics/communicable-diseases/hepatitis/news/news/2017/07/world-hepatitis-day-making-hepatitis-elimination-a-reality · WHO European Region moving closer to control of hepatitis B: http://www.euro.who.int/en/health-topics/communicable-diseases/hepatitis/news/news/2017/07/who-european-region-moving-closer-to-control-of-hepatitis-b
  14. The authors conducted a systematic review of qualitative studies investigating parental perceptions and expectations regarding health communication efforts (context: vaccination). The authors concluded that “parents want clear, timely and balanced information, but that they often find this information to be lacking” (Ames & Glenton, 2017, p. 3). More details about the key findings etc. can be found in the insightful abstract. OPEN ACCESS
  15. In a two-stage approach, the authors developed a ‘Communicate to vaccinate’ taxonomy. This taxonomy may help health authorities to map their potential communication strategies to increase vaccination uptake within the population. The final tool summarizes promising communicational interventions to increase the overall vaccination coverage in a very practical way. OPEN ACCESS
  16. WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) for 2016 are now available on the WHO website: http://www.who.int/immunization/monitoring_surveillance/data/en/
  17. Special issue of Journal of Infectious Diseases on “Polio Endgame & Legacy-Implementation, Best Practices, and Lessons Learned” See also article: Acceptance of the Administration of Multiple Injectable Vaccines in a Single Immunization Visit in Albania
  18. https://www.cdc.gov/vaccines/ed/courses.html
  19. until
    The Global Advisory Committee on Vaccine Safety (GACVS) was established in 1999 to respond promptly, efficiently, and with scientific rigour to vaccine safety issues of potential global importance. Report from the previous meetings can be found here: http://www.who.int/vaccine_safety/committee/reports/en/
  20. The Confederation of Meningitis Organisations (CoMO) are pleased to share the new: Vaccines Question & Answer Resource! This resource answers many of the more challenging questions surrounding vaccines including the topics of: Vaccine Manufacture and Availability Vaccine Protection Vaccine Safety View online>> Download PDF>> Please share this resource as far and wide as you consider appropriate within your professional and personal networks alike. Use the link: http://bit.ly/VaxQandA and the hashtag: #VaccinesWork CoMO's Vaccines Q&A Resource.pdf
  21. Courses on immunization

    Although not a course, for answers to some of the more difficult questions regarding vaccines, see CoMO's new Vaccines Q & A Resource. It's available to view online or PDF download. We've also created some graphics to help you share the resource on social media! CoMO's Vaccines Q&A Resource.pdf
  22. The Guardian, 9 July 2017 Babies born from the 1 August will be offered new ‘hexavalent’ jab in effort to clamp down on infections that cause cirrhosis and liver cancer. Read the full article: https://www.theguardian.com/society/2017/jul/09/hepatitis-b-jab-to-be-added-to-5-in-1-jab-for-babies-born-in-uk
  23. WHO Hepatitis B position paper (July 2017): http://apps.who.int/iris/bitstream/10665/255841/1/WER9227.pdf?ua=1 (PDF) See all Hepatitis B position papers: http://www.who.int/immunization/policy/position_papers/hepatitis_b/en/
  24. WHO page with information and resources on the World Hepatitis Day, 28 July 2017. http://www.who.int/campaigns/hepatitis-day/2017/en/
  25. WHO/Europe is looking for qualified experts interested in playing a key role in measles and rubella elimination as (volunteer) members of the RVC. The application deadline is 30 September 2017. http://www.euro.who.int/en/about-us/jobs-and-internships/short-term-opportunities/call-for-expressions-of-interest-in-serving-as-member-of-the-european-regional-verification-commission-for-measles-and-rubella-elimination-rvc
  26. Hi all, Vaccines Today has run a competition for each of the past six years to encourage the public to think of new ways to highlight the importance of vaccination. In the past, we've had video and photo competitions aimed at students, young doctors, travelers, photographers and the general public. This year, the 2017 Communication Challenge invites the public to tell a story - in images and words - about 'Nina' and the lifetime of memories she can create if she's in good health. The message is that vaccines can help to keep people healthy, enabling them to live a full and active life. Participants can draw Nina, or print out a ready-made image from our competition site. They then place her in a scenario, take a photo, and describe it in 100-200 words. Sounds complicated - but the website (hopefully) explains it a little more clearly than I can! Feel free to share with anyone who might be interested. Prizes are available for European entrants (as they are our target audience) so please consider this if you choose to promote it. I also attach some pre-written tweets and Facebook posts that a digital communications agency has helped us to developed. Thanks! Gary Vaccines Today-Communication Challenge 2017_ Social media posts_07.0.2017.docx
  27. Hi all, In light of proposals from France and Italy to make several childhood vaccines mandatory, I was thinking of writing an article on this topic for Vaccines Today. I found an article based on 2010 data from the VENICE project. Is there any way to find out the current state-of-play? We have had questions from readers and people on social media asking which vaccines are mandatory in which countries - but it's not easy to answer. Thanks and regards, Gary Finnegan Editor Vaccines Today
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