Category: Covid-19 Vaccine

June 9, 2022 - (Tarrant County) Tarrant County Public Health hosts numerous pop-up COVID-19 clinics across Tarrant County each week in partnership with public and private organizations listed below. Each site has the Moderna and Pfizer vaccines and at times the Johnson & Johnson. Children five and older are eligible for the vaccination. Parents need to bring proof of the childs age and their own ID for the vaccination. Booster vaccinations are available at all of the vaccination locations.

TCPH would like to bring a COVID-19 vaccination clinic to businesses, churches and organizations in the community who are interested in hosting a pop-up clinic. Its easy and free to host a clinic.In addition to the vaccination opportunities below, the cities of Arlington, Fort Worth, Mansfield, North Richland Hills, Hurst, and Tarrant County College have also added opportunities for vaccinations. To find a local vaccine site, the County created a vaccine finder page:VaxUpTC website.

Pop-Up COVID-19 locations:

Watermark at Broadway CityviewTuesday, June 14: 10 a.m. to 2 p.m.5301 Bryant Irvin Rd.Fort Worth, TX 76132

Advent Healthcare CenterWednesday, June 15: 1 p.m. to 5 p.m.301 Huguley BoulevardBurleson, TX 76028

Vaxmobile North Davis Church Thursday, June 16: 9 a.m. to 4 p.m.1601 N Davis Dr.Arlington, TX 76012

Cornerstone Assistance Network Thursday, June 16: 10 a.m. to 4 p.m.3500 Noble Ave.Fort Worth, TX 76111

Oakridge Alzheimer Special Care Friday, June 17: 11 a.m. to 3 p.m.4501 Silver Sage Dr.Haltom City, TX 76137

Tarrant County Public Health CIinics:

Northwest Public Health CenterMonday to Friday:8 a.m. to 12 p.m.and1 to 5 p.m.3800 Adam Grubb RoadLake Worth, TX 76135

Bagsby-Williams Health CenterMonday to Friday:8 a.m. to 12 p.m.and1 to 5 p.m.3212 Miller Ave.Fort Worth, TX 76119

Southeast Public Health CenterMonday to Friday:9 a.m. to 12 p.m.and1 to6p.m.536 W Randol MillArlington TX, 76011

Main Public Health CenterMonday to Friday:8 a.m. to 12 p.m.and1 to 6 p.m.1101 S. Main StreetFort Worth, TX 76104

Southwest Public Health CenterMonday to Friday:8 a.m. to 12 p.m.and1 to 5 p.m.6551 Granbury RoadFort Worth, TX 76133

Watauga Public Health CenterMonday to Friday:8 a.m. to 12 p.m.and1 to 5 p.m.6601 Watauga RoadWatauga, TX 76148

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COVID-19 Vaccine Clinics for the Week of June 11 - Tarrantcounty.com

Inactivated and mRNA COVID-19 vaccines appear to be safe for patients treated for hypothyroidism, according to a new study being presented at ENDO 2022, the Endocrine Societys annual meeting in Atlanta, Ga. The study found these vaccines do not cause significant fluctuations in thyroid function and are not associated with increased risks of emergency department visits or unscheduled hospitalizations.

No previous studies have looked at any possible relationship between COVID-19 vaccines and unstable thyroid function control among patients receiving thyroid hormone replacement for hypothyroidism, said lead researcher David T.W. Lui, M.B.B.S., of the University of Hong Kong in Hong Kong, China. Our reassuring findings should encourage patients treated for hypothyroidism to get vaccinated against COVID-19 for protection from potentially worse COVID-19-related outcomes.

The study evaluated an inactivated vaccine called CoronaVac and an mRNA vaccine, Pfizer BioNTech (BNT162b2) vaccine. CoronaVac uses a dead version of theSARS-CoV-2 virus. It is being used in vaccination campaigns in various countries in Asia, South America, Central America and Eastern Europe. Messenger RNA (mRNA) vaccines teach the bodys cells how to make a protein that will trigger an immune response. The Pfizer and Moderna vaccines are mRNA vaccines.

The researchers evaluated data from more than 47,000 COVID-19 vaccine recipients taking levothyroxine for hypothyroidism. Patients were divided into three groups: unvaccinated, those who received the CoronaVac vaccine and those who received the mRNA vaccine. Patients who received either type of COVID-19 vaccine were not at increased risk of needing to have their levothyroxine dosage reduced or increased. COVID-19 vaccination was not associated with a higher risk of emergency department visits or unscheduled hospitalization.

Lui will present at the Societys ENDO 2022 thyroid health news conference at 11:30 AM on Monday, June 13. Register to attend at http://www.endowebcasting.com.

# # #

Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the worlds oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at http://www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.

Journal of the Endocrine Society

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

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COVID-19 vaccination appears to be safe for patients treated for hypothyroidism - EurekAlert

By Amanda Sealy and Nadia Kounang, CNN

Modernas Covid-19 vaccine is safe and generated an immune response in children ages 6 months through 17 years thats comparable to the response in adults, according to documents posted by the US Food and Drug Administration ahead of key meetings of its independent vaccine advisory group.

The FDAs vaccine advisers will evaluate next week Modernas Covid-19 vaccines for children 6 months through 5 years and 6 years through 17 years should be granted emergency use authorization.

Children under 5 years old about 18 million people are the only US age group that still isnt eligible to receive a Covid-19 vaccine. Modernas vaccine is currently available only to people 18 and older. Pfizers Covid-19 vaccine is already authorized for children age 5 and older; FDAs advisers will also evaluate its vaccine for younger children next week.

Briefing documents posted ahead of the FDA committee meetings describe how Modernas vaccine was assessed by immunobridging studies to see if the immune response among younger people was comparable to that of 18-to-25-year-olds, who are already eligible to receive the vaccine.

Immunobridging success criteria were met for all four pediatric age cohorts, the FDAs document stated.

In trials evaluating more than 6,000 children 6 months to under 6 years old, Moderna found two 25-microgram doses of vaccine taken 28 days apart yielded a similar immune response to a two-dose series of vaccine given to18-to-25-year-olds.

For children ages 6 to 17 years, Moderna found two doses of its vaccine also provided a similar immune response as two doses in adults. Children age 6 to 11 received 50-microgram vaccines and adolescents ages 12 to 17 received 100-microgram vaccines.

The vaccine trials took place at different times, when different coronavirus variants circulated. While the FDA did not require vaccine makers to submit vaccine efficacy data for authorization, Modernas vaccine was estimated to be 93.3% effective against symptomatic disease for 12-to-17-year-olds during a time when the original coronavirus and the Alpha variant were dominant. The vaccine was estimated to be 76.8% effective against symptomatic Covid-19 for children 6 to 11 during a time the Delta variant was predominant. However, the FDA also noted for 6-11-year-olds the vaccine efficacy could not be reliably determined due to the small number of COVID-19 cases accrued during the study.

The vaccine was tested in children 6 months through 5 years during a time when the Omicron variant was dominant. It was estimated to be 36.8% effective against symptomatic disease for 2-to-5-year-olds and 50.6% protective against symptomatic disease for those 6-to-23 months old.

Vaccine efficacy estimates for each age cohort were generally consistent with what has been seen in adults, the FDA said.

The vaccine was also found to be safe in all age groups. Adverse reactions were mostly mild to moderate in severity, generally of short duration, and occurred more frequently after Dose 2 than Dose 1.

Injection site pain was the most commonly reported adverse reaction and the document said serious adverse events were infrequent and didnt raise any concerns. No deaths were reported.

While there were no known cases of myocarditis or pedicarditis inflammation of the heart among any trial participants, its one of the known risks with the Moderna Covid-19 vaccine, especially among males 18-to-24 years old.

The FDAs Vaccine and Related Biological Products Advisory Committee Meeting will evaluate Modernas Covid-19 vaccines for children ages 6 through 17 on June 14 and will evaluate Modernas Covid-19 vaccines for children 6 months through 5 years of age on June 15.

Pfizers Covid-19 vaccine for children under 5 will also be discussed on June 15.

After the FDA vaccine advisers vote, the agency must decide whether to authorize the vaccines. Shots cannot be administered until US Centers for Disease Control and Preventions vaccine advisers have voted whether to recommend the vaccines and the CDC director has signed off on the recommendation. The White House has said vaccines for the youngest age group could be administered starting the week of June 20.

The-CNN-Wire & 2022 Cable News Network, Inc., a WarnerMedia Company. All rights reserved.

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FDA finds Moderna's Covid-19 vaccine is safe and effective in younger kids - KVIA

The Food and Drug Administration (FDA) could grant emergency use authorization of a COVID-19 vaccination for the youngest kids later this month. Pfizer asked the agency to review data and authorize its COVID-19 vaccine for children ages 6 months to 5 years.

If the FDA committee recommends authorization, the Centers for Disease Control and Prevention will still need to sign off on the vaccinations before they would go into the littlest of arms.

Once a COVID-19 vaccination is authorized for kids ages 6 months to 5 years, nearly everyone will be eligible for immunization.

Dr. Richard Kennedy, co-director of Mayo Clinic's Vaccine Research Group, says even though younger children have tended to fare better with COVID-19, the reality is that some are still getting sick and even dying of the disease.

More children were hospitalized during the omicron spike than during previous spikes not because the disease was worse but simply because omicron is so much more infectious and case numbers were so much higher.

"Having this vaccine will help prevent and reduce the level of severe disease and death in children. Even though the rate might be small now, let's get it reduced to zero if we can, or at least reduced as much as possible," says Dr. Kennedy.

Besides protecting children, he says it may also reduce the amount of transmission and exposure in places like day cares and schools.

"The best way to end the pandemic is to stop having the virus transmit," says Dr. Kennedy. "When it transmits, there's a chance for new variants to arise. That's what we're dealing with right now is multiple new variants. The only way to get ahead of that is to stop cases. And vaccines are one of our best preventive tools for doing that."

Parents can be assured that when a vaccination is approved for the most vulnerable of populations it will be safe.

"The FDA and other regulatory agencies do a very deep dive into the safety data. And that's why you typically see a rollout of a vaccine in several stages. Healthy adults can get it, and then they drop the age range a little bit, and they check it and make sure it's safe. And they drop it again," says Dr. Kennedy.

The stepwise approval follows sequential clinical trials. Once a vaccination is found to be safe in adults, the FDA allows trials in older children. Once safe in that population, clinical trials can begin in younger children.

____

Information in this post was accurate at the time of its posting. Due to the fluid nature of the COVID-19 pandemic, scientific understanding, along with guidelines and recommendations, may have changed since the original publication date.

___

2022 Mayo Clinic News Network. Visit newsnetwork.mayoclinic.org. Distributed by Tribune Content Agency, LLC.

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Mayo Clinic Minute: What to expect with COVID-19 vaccinations for youngest kids - Union Democrat

Safety and immunogenicity of the FINLAY-FR-1A vaccine in COVID-19 convalescent participants: an open-label phase 2a and double-blind, randomised, placebo-controlled, phase 2b, seamless, clinical trial  The Lancet

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Safety and immunogenicity of the FINLAY-FR-1A vaccine in COVID-19 convalescent participants: an open-label phase 2a and double-blind, randomised,...

COVID-19 vaccination efforts prove value of polio network for resilient health systems

As the first COVID-19 vaccines arrived into Somalia, polio programme staff were in position. Drawing on years of experience working to tackle polio and other health threats, staff had taken on key roles in logistics, cold-chain management and monitoring to ensure the success of the vaccine rollout.

Mohamud Shire, a WHO polio eradication officer working in the central zone of Somalia, explained, Regional and district polio officers acted as supervisors of the vaccine rollout. Some of the polio health workers worked as COVID-19 vaccinators, whereas others were social mobilizers.

A new WHO report entitled, Role of the polio network in COVID-19 vaccine delivery and essential immunization: lessons learned for successful transition, underscores the value of the polio network as an agile and experienced public health workforce, able to pivot to support national health programmes to deliver COVID-19 vaccines, and strengthen essential immunization. The introduction of COVID-19 vaccines in 2021 stretched country health systems, requiring all hands on deck to deliver vaccines to the most vulnerable. In this challenging context, hundreds of polio eradication staff led efforts in areas ranging from coordination and community mobilization, to training and surveillance. This work proves that sustaining these capacities is the way forward to build stronger, more equitable and resilient health systems.

The polio transition process aims to sustain the workforce and infrastructure set up to eradicate polio to strengthen immunization programmes, protect against outbreaks, and deliver essential health services to communities. A 2020 report documented the outstanding contributions of the polio network to the emergency stage of the COVID-19 pandemic, with over 5900 staff in the 20 priority countries for polio transition stepping up. The new report provides evidence of the role of polio staff to support essential immunization, and makes the case to transition their valuable skills and expertise to strengthen immunization programmes, building on the COVID-19 experience.

In Sudan, 13 polio staff coordinated with partner agencies, trained vaccinators and provided comprehensive technical support for the COVID-19 rollout. In Nepal, 15 polio and immunization officers monitored the quality of COVID-19 vaccine sessions, whilst in India, polio and immunization Open Data Kit software was used to record data from more than 450,000 COVID-19 vaccination sessions. In Nigeria, at least 121 polio staff worked to sensitize communities to COVID-19, support trainings for the e-registration of vaccine recipients, and manage Adverse Events Following Immunization (AEFI). In these countries, this work builds upon historical contributions of polio staff to essential immunization, including working with national essential immunization programmes for the co-delivery of polio with other vaccines, and using electronic surveillance tools developed for polio eradication to detect other vaccine-preventable diseases.

The report also details lessons learned from the COVID-19 vaccine rollout. One is the value of integrating polio functions into other health programmes. The pandemic response showed that with an integrated approach it is possible to achieve more with limited resources. For instance, in the Eastern Mediterranean Region, the pandemic experience has led to the introduction of Integrated Public Health Teams, which bring together public health staff to provide broader services to communities.

Another lesson is the value of transferable skills that can contribute to vaccination across the life-course. Polio personnel have specific strengths in childhood vaccination, but the pandemic has shown that their cross-cutting skills including coordination, disease surveillance, monitoring, data management and microplanning can be used to make progress towards global immunization goals. The pandemic has impacted rates of routine immunization, leading to an increase in numbers of un- or under-vaccinated children. Harnessing the skills of polio personnel, and integrating them into other programmes, is key to achieving the goals of the Immunization Agenda 2030.

The report further serves to emphasise that polio transition and polio eradication are interdependent, and must go hand-in-hand. In the context of ongoing polio outbreaks, the sustainable transition of functions in polio-free counties is a necessary step to ensure that health systems are resilient to future health threats, including poliovirus importations.

To support these aspects, sustainable financing for the integration and transition of polio essential public health functions is vital. As of 2022, over 50 countries have transitioned out of GPEI support, but still require funding and technical support from WHO and other partners. Long-term domestic and international support is needed to ensure that the knowledge, expertise and lessons learned from polio eradication continue to serve populations. This is especially important as governments face long-term financial constraints on their health spending due to the pandemic.

As we move towards health systems recovery, we must ensure that the polio infrastructure is transitioned in a sustainable manner, to support more resilient health systems.

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Role of the polio network in COVID-19 vaccine delivery and essential immunization - Lessons learned for successful transition - World - ReliefWeb

WATCH TIME: 6 minutes

Matt Hoffman: I'm here with Dr. Daniel Kantor, sitting down at CMSC.

Daniel Kantor, MD: Thank you for having me.

Matt Hoffman: I want to talk a little bit about a poster you're presenting on COVID-19 vaccine response on patients treated with ozanimod (Zeposia; Bristol Myers Squibb) and other S1P receptor modulators. To start from a point if you weren't familiar with the workabroad overview, how did we get to this point? What prompted this study?

Daniel Kantor, MD: What prompted the study is this virus called coronavirus. The novel coronavirus-19 and the COVID-19 pandemic made a lot of questions for the MS community. The first question was, is the MS community more at risk? And the next question is, once there was a vaccine, what does that mean in terms of vaccine response?

For the first question, it looks like overall, people with multiple sclerosis are not more at risk than other people with other autoimmune diseases or frankly, with other conditions in general. People on certain medications may be at a higher risk, and one of the things we noticed is that when you deplete or push down the B cellswell, B cells are important in in response to viruses in response to vaccines. There are very popular medications we use now in multiple sclerosis or ocrelizumab (Ocrevus; Genentech), we use ofatumumab (Kesimpta; Novartis), and some people are still using off label rituximab (Rituxan; Genentech/Biogen). It looked like those people had more severe COVID-19, perhaps more intensive care unit visits, and so then, the question was overall, if you give a vaccine, would they have the same responses as it would in somebody without multiple sclerosis not on any of those medicines.

The first part of that question is that a lot of us around the world scrambled to try to answer that. Some people, what they did is they looked back at their patients, and they looked at case series, and they said, Well, these people were on these medicines, and they got the vaccine, how many of them got COVID, et cetera, et cetera. There are obviously problems with that kind of design. What we designed was a prospective study. The prospective study was looking at people who were in anyway choosing to get the vaccine because not everyone chose to get the vaccine. But in anyway choosing to get the vaccine, and then the question is, well, if we look at your immune markers beforehand, your lab markers beforehand, your questionnaires beforehand, and then after you get the vaccine and after you get the second shots, what happens when we follow those people out for the rest of the year?

The way it was designed was actually to look specifically at one of the novel S1P receptor modulators. Many people remember the legacy S1P receptor modulator, and it was unselective, this medicine Gilenya, or fingolimod. There have been questions and other peoples studies that suggested that well, it doesn't just look like B cells are a problem, it looks like if you sequester the immune cells inside the lymphoid organs, then maybe that's not good for that vaccine response. But maybe it's different when you don't have an effect on S1P4. When you think about ozanimod, it's selected for S1P1 and S1P5these two receptors, but not S1P4. Because of that, it might be that we see some sort of different response. So, we wanted to test that.

The primary end point of the trial is to look at the vaccine response. So, have they had a change in their immunoglobulin response to the spike protein, and has it happened 4 weeks after the second vaccine. We have the data, it's fresh, that's why it's late breaking here. The data shows us that yes, actually, when you gave it to people with ozanimod, 100% of the people actually went ahead and had the response.

Then we look in the poster at other questions, we looked at other disease modifying agents also. I would have loved to do the study where we actually have 30 subjects for patients in each arm for each disease-modifying agentbut were blessed in MS. Now there's more than 20depends on how you count themdisease-modifying agents. So, we looked at 30 on ozanimod, and we looked at 30 at all other comers. When looked at the other 30, what we saw is if you ignore the 1 patient who was on fingolimod and then the 3 patients on ocrelizumab, then yes, those people also had a really good response. When you looked at the peopleand I don't want to make conclusions about 1 and 3 patients, it's very hard to make anybut overall, the primary end point was really about ozanimod, and that actually did show an immune response.

Now, we didn't just look at the immune response, we looked at the quantitative the number of immune responses. What's interesting is the numbers are still protective. They're a little lower than other medications. So, a little lower than people who are taking glatiramer acetate (Copaxone; Teva), or the beta interferons, for example, but they're still protected. Then we also looked at T cell markers. Now the problem is, to do a really good T cell study, you need fresh samples. This study was distributed across the United States, the idea was to get virtual enrollment, and we send phlebotomists to people's homes. We couldn't necessarily send it to one of the very scientific labs that do amazing jobs at T cell response. But there is a company called Adaptive Biotechnologies that got an EUAemergency use authorizationto look at T cell response in a binary fashion: yes and no. It was made not for vaccine response, actually for whether you were infected with SARS-CoV-2 (COVID-19) or not, but many of us use it to also look at vaccine response. Remember, we're not getting a gradient of response, we're really just getting a yes versus no. Even though the patients on ozanimod had a lower, still protected, but a lower antibody response, they still have protective T cell responses. That was what was significant about this study.

Transcript edited for clarity.

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What Is Known About COVID-19 Vaccine Response in MS - Neurology Live

DePauw students are required to be up to date with COVID-19 vaccines. The CDC defines someone as up to date with COVID-19 vaccines when they have received all doses in the primary series and all recommended boosters, when eligible. Medical and religious exemptions for all immunizations are permitted. See depauwhealth.org for more information.

DePauw also requires employees to provide proof of up to date COVID-19 vaccination. As with the required flu vaccine, employees who have a medical or religious reason, or philosophical belief, will be exempt from this requirement but will be required to follow the protocols outlined below.

Submission of Vaccination and Booster Shot Information.

Incoming students should report their vaccine and booster information on their immunization record through Med+Proctor (www.medproctor.com) due Aug. 1, 2022.

Returning students who have received their vaccine booster should provide a copy of their vaccination booster document here.

Employees should use this form to submit vaccination and booster information.

How to find COVID-19 vaccination locations.Pharmacies like Walgreens, CVS, Kroger and Target, among others, are now able to administer COVID-19 vaccinations, including booster shots. Visit their respective websites for information on how to schedule an appointment.

State of Indiana sponsored vaccination locations can be found by visiting ourshot.in.gov or by calling 2-1-1. For step by step instructions on how to schedule an appointment on ourshot.in.gov, click here.

Who to call if you have questions about getting vaccinated.DePauw students and employees who utilize the DePauw Health Wellness Clinic are welcome to call DePauw Health at 765-658-4555 to speak with a member of the Hendricks Regional Health staff with general questions about the COVID-19 vaccines or about COVID-19 vaccines and their specific health.

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COVID-19 Vaccines - DePauw University

Pop-up COVID-19 vaccine clinics

ACT Health is running free Pfizer COVID-19 vaccine clinics at the following locations:

The Australian Technical Advisory Group on Immunisation (ATAGI) has expanded recommendations on winter COVID-19 booster doses for people at increased risk of severe COVID-19.

People should wait for 3 months after a confirmed COVID-19 infection before they get their next COVID-19 vaccine dose.

See ourlatest COVID-19 vaccine news.

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Vaccination - COVID-19

Football players engaged in COVID-19 communication efforts

A recently launched awareness-raising campaign promotes the benefits of vaccination against COVID-19 and contributes to achieving the national vaccination targets. The campaign, launched in December last year in partnership with one of the countrys most popular football clubs, Dacia Buiucani, has so far reached over 100 000 people on social media channels alone.

Football is arguably the most popular sport in the country, with over 85% of the male population and over 51% of the female population watching the sport regularly.

Through this special partnership we want to reach all football fans, including young people and their parents, with the message that vaccines bring us closer to doing what we love with those we love. Vaccines bring us one step closer to achieving a world where no one suffers or dies from a vaccine-preventable disease, said Miljana Grbic, WHO Representative in the Republic of Moldova.

Echoing this sentiment, the captain of the Dacia Buiucani football team said, We football players have always been role models for the younger generations thats why we are very happy that in addition to the love for football, we can now also promote messages that help to keep our fans informed and healthy.

The campaign includes the distribution of posters, footballs and backpacks with vaccine-related messages during the home matches of the Chiinu-based football club, as well as awareness-raising activities during events held in schools and kindergartens, organized by the Dacia Buiucani club.

In close collaboration with the Republic of Moldovas Ministry of Health and Ministry of Education, together with the Moldovan Association of Students and Residents in Medicine, a large-scale awareness campaign is being implemented to inform students and young people about COVID-19.

The campaign, called Roll up your sleeve, get vaccinated, highlights the importance of immunization efforts against COVID-19 and seeks to involve young people by engaging with them in universities and other student spaces to pass on key information to their families and peers.

Informational materials are being widely distributed and a series of public lectures is being held to reach students at all stages of their studies.

By rolling up their sleeves to get vaccinated and by passing on key information to those at home and those around them, young people can help us to protect everyones health, said Ala Nemerenco, Minister of Health, during the campaign launch event.

Authorities observed a 22% increase in the number of vaccinations administered to young people aged 1824 years in October 2021, compared to the number in the previous month, prior to the start of the campaign.

The campaign is part of the European Union (EU) and WHO/Europe partnership to support the deployment of COVID-19 vaccines and routine vaccination in the 6 EU Eastern Partnership countries of Armenia, Azerbaijan, Belarus, Georgia, the Republic of Moldova, and Ukraine.

The project, funded by the EU and implemented by WHO/Europe, covers all phases of COVID-19 vaccine deployment and vaccination, constituting end-to-end support. It also serves as a major investment to strengthen routine immunization systems in the 6 countries.

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Mobilizing young people to promote vaccination against COVID-19 in the Republic of Moldova - World Health Organization