Medical Product Alert N° 8/2019 (English version)

This Medical Product Alert relates to 3 different falsified rabies vaccines (Verorab, Speeda, and Rabipur) and 1 falsified anti-rabies serum (Equirab) circulating in the Philippines. It is linked to the WHO Medical Product Alert N°1/2019 issued on 30 January 2019 regarding falsified Verorab rabies vaccines circulating in the Philippines. Rabies is a vaccine-preventable viral disease that is almost always fatal following the onset of clinical symptoms. Rabies is present worldwide, with over 95% of human deaths occurring in the Asia and Africa regions. Genuine Verorab, Speeda and Rabipur vaccines are used for pre-exposure vaccination or post-exposure prophylaxis. Genuine Equirab anti-rabies serum provides passive immunization against rabies.

WHO recently received confirmation that falsified batches of Verorab, Speeda, Rabipur and Equirab were available at patient level in the Philippines. Investigations are ongoing, and laboratory analyses are being facilitated for available samples to determine their contents and better assess the risk to public health. At this stage, no adverse reactions attributed to the below mentioned falsified products have been reported to WHO. A rabies vaccine shortage is ongoing in the Philippines.

HIV cases–Pakistan

On 25 April 2019, the local administration in Larkana district was alerted by media reports of a surge in human immunodeficiency virus (HIV) cases among children in Ratodero Taluka, Larkana district, Sindh province, Pakistan. A screening camp was initially established at Taluka’s main hospital. Later, screening was expanded to other health facilities including selected Rural Health Centers (RHCs) and Basic Health Units (BHUs). HIV rapid test kits that were initially used were replaced with pre-qualified WHO test kits.

From 25 April through 28 June 2019, a total of 30,192 people have been screened for HIV, of which 876 were found positive. Eighty-two per cent (719/876) of these were below the age of 15 years. During the screening, several risk factors were identified, including: unsafe intravenous injections during medical procedures; unsafe child delivery practices; unsafe practices at blood banks; poorly implemented infection control programs; and improper collection, storage, segregation and disposal of hospital waste.

Ebola virus disease – Republic of Uganda

On 11 June 2019, the Ugandan Ministry of Health (MoH) has confirmed a case of Ebola Virus Disease (EVD) in Kasese district, Uganda. The patient is a 5-year-old child from the Democratic Republic of Congo (DRC) who travelled with his family from Mabalako Health Zone in DRC after attending, on 1 June 2019, the funeral of his grandfather (confirmed EVD case on 2 June 2019). On 10 June 2019, the child and the family entered the country through Bwera border post and sought medical care at Kagando hospital where health workers identified Ebola as a possible cause of illness. The child was transferred to Bwera Ebola Treatment Unit (ETU) for management. The confirmation of Ebola Virus was made on 11 June 2019 at the Uganda Virus Research Institute (UVRI), and the child has deceased in the early hours of 12 June 2019. Two other suspected cases, a 50-year-old female (grandmother of the first case) and 3-year-old male (younger brother of the first case) part of the family members who travelled together with the first confirmed child were also admitted in the same ETU and were confirmed for EVD by UVRI on 12 June 2019. The 50 year-old-male has deceased during the night between 12 and 13 June. 27 other contacts have been identified and are being monitored. Healthcare workers from both health care facilities where the child was treated have been previously vaccinated.

All three confirmed cases are imported from DRC and belong to the same family who travelled together from Mabalako Health Zone, an area currently affected by Ebola outbreak in North Kivu, DRC. To date, they remain as a single episode of EVD in Uganda, and the geographical spread in Uganda appears to be limited to one district near DRC border. Further investigations are ongoing both in Uganda and DRC to assess the full extent of the outbreak.

Circulating vaccine-derived poliovirus type 2 – Cameroon

On 23 May 2019, WHO received notification through the Global Polio Laboratory Network (GPLN) of the detection of circulating vaccine-derived poliovirus type 2 (cVDPV2) from an environmental sample collected on 20 April 2019 in a hospital in Northern Cameroon which borders Borno state in Nigeria and Chad.

Wild poliovirus type 1 – Islamic Republic of Iran

On 9 May 2019, the Global Polio Laboratory Network (GPLN) notified WHO of the detection of wild poliovirus type 1 (WPV1) from an environmental sewage sample collected on 20 April 2019 in Konarak district, Sistan-Baluchistan province, Islamic Republic of Iran. The virus was detected in an environmental sample only, and to date, no associated cases of paralysis have been detected.

The subsequent scheduled sewage sample collected from the same site on 4 May 2019 (2 weeks after the positive sample) tested negative for poliovirus.