What Matters in Global Health - 163

SAGE Marks 25th Anniversary with New Vaccine Policy Recommendations

On 1st October 2024, the Strategic Advisory Group of Experts (SAGE) held a virtual press conference to share the outcomes of their latest meetin g, coinciding with the group’s 25th anniversary. SAGE, which serves as the top advisory body on immunisation for the World Health Organization (WHO) , provided updates on several key vaccine-related topics, including policy recommendations for tackling respiratory syncytial virus (#RSV), #rubella, #polio, and other pressing global health concerns.

Dr Joachim Hombach , a senior health advisor and SAGE’s Executive Secretary, reflected on the anniversary's significance. He noted that over the past 25 years, SAGE has produced 78 position papers and guided the global immunisation response through multiple public health emergencies, including the COVID-19 pandemic. He emphasised the group's continued focus on evidence-based medicine and policy strategies to address new and ongoing challenges in immunisation.

One of the most pressing topics was RSV, a virus that causes severe lower respiratory infections, particularly in children from low- and middle-income countries, where 97% of RSV-related mortality occurs. After 60 years of searching for interventions, SAGE recommended that countries adopt two new options to prevent RSV in young children: maternal immunisation and monoclonal antibodies. While acknowledging a safety signal of preterm deliveries observed in trials, particularly in South Africa and Argentina, SAGE concluded that the benefits outweighed the risks and called for further research and risk minimisation strategies.

The conference also addressed rubella and polio. SAGE recommended that all countries introduce rubella-containing vaccines, especially those still reporting congenital rubella syndrome cases, which cause an estimated 32,000 infant cases annually. The group revised its earlier policy requiring 80% measles vaccine coverage before introducing rubella vaccines, suggesting countries move forward with wide-scale immunisation efforts to eliminate the disease. On polio, SAGE expressed concern over recent cases of wild poliovirus in Afghanistan and Pakistan, as well as vaccine-derived polio in Africa and Gaza. They endorsed a new strategy using novel oral and injectable polio vaccines to improve immunity and prevent outbreaks.

Other major updates included discussions on cholera, with signs of improvement in the vaccine supply anticipated for 2025, and the immunisation agenda for 2030. The group noted progress in introducing new vaccines, particularly in the uptake of HPV and malaria vaccines. Still, it raised concerns about the growing number of "zero-dose" children—those who have not received any vaccinations. In 2023, 14.5 million children remained unvaccinated, which SAGE hopes will decrease with a renewed focus on routine immunisation and government accountability.

Dr Kate OBrien , WHO’s Director of Immunisation, Vaccines, and Biologicals, highlighted the critical role of vaccines in preventing diseases and saving lives. She called on global leaders to prioritise immunisation programmes, particularly during COVID-19. She stressed the importance of replenishing funds for organisations like Gavi, which support vaccine access in low- and middle-income countries.

As the global community continues to face new and emerging health threats, SAGE remains committed to providing expert guidance on immunisation policy, ensuring that vaccines reach those who need them most and helping to prevent outbreaks before they occur.

Microbiome-Boosting Foods Offer New Hope for Treating Severe Malnutrition

A groundbreaking study published in Science Translational Medicine reveals that microbiome-boosting supplements may offer a more effective treatment for severe malnutrition. Conducted in Bangladesh, this research shows that children who received these supplements experienced faster recovery and improved growth compared to those treated with traditional ready-to-use therapeutic foods (#RUFs).

While standard treatments like RUFs help children gain weight, they often fail to address long-term health issues such as stunted growth and impaired immune function. This new study introduces microbiome-directed foods that target the gut’s microbial ecosystem, enhancing nutrient absorption and promoting sustainable recovery. The ingredients, such as chickpeas and bananas, were chosen to stimulate healthy bacteria growth in the intestines, leading to better overall health.

The microbiome plays a crucial role in digestion, immunity, and nutrient absorption. Children with severe malnutrition often have underdeveloped microbiomes, which can hinder recovery even after their immediate caloric needs are met. These targeted foods aim to restore weight and prevent long-term developmental deficits by repairing the gut microbiome.

The study showed that children receiving the microbiome-boosting supplement gained weight faster and exhibited higher levels of proteins vital for skeletal, muscular, and brain development than those on RUFs. This suggests that a microbiome-directed approach could offer a more comprehensive solution to severe malnutrition by addressing immediate and long-term health needs.

Researchers identified a microbial species, Prevotella copri, as a key player in this recovery. This bacterium helps break down carbohydrates in the supplement, supporting the growth of other beneficial bacteria. In animal studies, mice with P. copri in their microbiomes gained more weight and showed improved gut function compared to those without.

A large-scale trial is currently underway, involving over 6,000 children across several countries, to determine whether this approach is effective in diverse settings. If successful, microbiome-boosting foods could become a new standard of care, replacing or complementing RUFs.

Challenges such as cost, production, and acceptance remain, but the potential to revolutionise malnutrition treatment is clear. By focusing on the gut microbiome, this approach offers hope for millions of children suffering from malnutrition, providing long-term health benefits and a more sustainable recovery.

Marburg Virus Outbreak in Rwanda: Urgent Measures and Global Watch

A recent outbreak of the deadly #Marburg virus in Rwanda has prompted immediate action by the Rwandan Ministry of Health. As of early October 2024, 29 cases have been confirmed, with 10 fatalities. This marks an alarming escalation since the outbreak was first announced, with cases rising quickly and the virus spreading primarily among health workers in Kigali, the capital city.

The Marburg virus, a highly contagious haemorrhagic fever from the same family as Ebola, presents a severe global health threat due to its high mortality rate, ranging between 20% and 90%, depending on the outbreak. With no current vaccine or widely effective treatment available, the virus spreads primarily through contact with bodily fluids from infected individuals. Symptoms include high fever, severe headaches, malaise, and bleeding from multiple sites, usually within five to seven days of infection.

The Rwandan government has introduced stringent public health measures to curb the spread in response to the outbreak. Hospital visits have been restricted, funerals of suspected Marburg victims have been limited to 50 attendees, and home vigils and open caskets are banned. The Ministry of Education has also suspended visits to students in boarding schools, a precaution designed to prevent transmission in these vulnerable populations.

Of the current cases, health workers account for 70%, raising concerns about the safety of frontline responders. In addition to Kigali, cases have been reported in three districts bordering the Democratic Republic of Congo, Uganda, and Tanzania, raising fears that the virus may spread across borders into countries with weaker health systems. Currently, 19 patients remain isolated in the hospital.

On a global scale, the World Health Organization (WHO) and the Africa Centres for Disease Control and Prevention (Africa CDC) are closely monitoring the situation. A suspected case in Belgium was investigated after a contact travelled from Rwanda. However, WHO confirmed that the individual completed the 21-day monitoring period without symptoms, alleviating fears of further spread to Europe.

As the international community responds, the WHO, with support from USAID, has delivered over 500 kits of clinical care and infection prevention supplies to Rwanda. Despite the severity of the situation, Rwanda’s Health Minister, Dr Sabin Nsanzimana, urged the public to remain calm, assuring them that the government is working diligently to contain the outbreak and identify high-risk areas. He called on the public to maintain hygiene, wash hands frequently, and seek medical attention if they exhibit symptoms.

Although no cure exists for Marburg, several vaccine candidates are in various stages of development, offering hope for future prevention. Experts advise strict infection control measures to prevent further outbreaks, drawing on lessons learned from past Ebola crises.

This Marburg virus outbreak underscores the importance of global preparedness, surveillance, and response mechanisms for controlling the spread of infectious diseases. As the situation in Rwanda evolves, the international community remains vigilant and prepared to support Rwanda in managing the crisis.