Center for Communicable Diseases Control
New Vaccines Hossein Masoumi Asl Centerfor
CommunicableDiseasesControl Global Immunization Vision and Strategy
(GIVS):
Implications for Immunization Policy Development Realizing the
vision Four strategic areas Reaching more people
Introducing new vaccinesand technologies Synergies with other
interventions in health systems context Global interdependence
Context : - Remarkable progress but * Coverage
stagnation/disparities * Fragmentation of EPI - GIVS offers a
unifying vision of immunization main thrusts for Goals By 2010: 90%
routine vaccination coverage nationally and % in all districts 90%
reduction of global mortality due to measles(compared to 2000) By
2015: Maintain Coverage achievement (80%-90%) 2/3 reduction of
global childhood mortality andmorbidity due to VPDs (compared to
2000)[MDG4] Under-Five Child Mortality
Global Distribution of Cause-Specific Child Deaths Under-nutrition
(underlying cause) IMMUNIZATION POTENTIAL: ~25% CHILD MORTALITY
REDUCTION BY 2015 Source: World Health Report Leading causes of
vaccine-preventable deaths in children under 5 years old
Source/credits: The Global Burden of Disease: 2004 update, *
WHO/IVB estimates based on GBD estimates, deaths for2000 **WHO/IVB
estimates based on GBD estimates, 2004 update As at February 2009
Preventable with (current) expected improvements in coverage
Preventable if coverage is scaled up to 90% and widespread use of
new vaccines 60%-70% reduction in rate GIVS GOAL by 2015:
Two-thirds reduction of global childhood morbidity and mortality
due to VPDs compared to 2000 levels Not preventable by 2015
Source:Lara's calculations on 22 Oct 2004, based on files developed
for IFFI project. Mortality averted based on "existing vaccines"
includes tetanus (neonatal and other), pertussis, diphtheria,
measles, YF, and Hib. Polio is not shown (very little mortality),
and Hepatitis B is also not shown (primarily causes mortality in
adults; also, the impact of vaccination on HepB mortality will not
really be seen by 2015). Mortality based on "near term vaccines"
includes JE, Mening A/C, Pneumo, and Rotavirus, based on expected
date of introduction/availability, and assuming the vaccine is
relatively effective (ie 80% efficacy). Mortality curves are
calculated based on expected improvements in coverage: The top line
shows the expected mortality rate due to VPD if coverage stayed
constant at 2003 levels; the yellow difference is obtained by
projections of improvements in coverage, given current trends. The
blue difference is if coverage is scaled up to 90% by Includes the
impact of campaigns for measles, tetanus, and yellow fever. We have
not made big gains since 2000 in reducing the VPD mortality rate,
but even in the year 2000, there were averting 2-3 million deaths
per year from VPD. WHO estimates 2.7M childhood deaths from vaccine
preventable illnesses
Pneumococcal, Rota & Hib account for two thirds of the vaccine
preventable deaths among children GIVS Strategic Area 2:
Introducing new vaccines and new technologies
OBJECTIVES Empowerment forcountry decisionmaking Making
vaccinesavailable New vaccines also forthe disadvantaged Research
anddevelopment forneeded vaccines MAIN STRATEGIES Country capacity
forinformed decisionmaking Effective andsustainable supply ofnew
vaccines Research &Development What are the new vaccine in our
country? Hib Vaccine, 2008 No (21 countries or 11%) Yes (133
countries or 69%)
Highlight: India (IRC approved), Nigeria (IRC conditional approval)
Not introduced: AFRO: Botswana, Cape Verde. EMRO: Egypt, Iran, Iraq
and Tunisia. EURO: Bulgaria, Romania, Russian Federation,
Turkmenistan. SEARO: Maldives and Thailand. WPRO: China, Cook
Islands, Japan, Nauru, Philippines, Rep of Korea, Singapore, Tuvalu
and Vanuatu. Yes Part of the country are: Belarus, Pakistan and
Sudan (only North Sudan introduced) 2009 and/or GAVI Approved:
AFRO: Cameroon, Comoros, Congo, Cte d'Ivoire, DRC, Equatorial
Guinea, Gabon, Mauritania, Mozambique, Namibia, Sao Tome Y
Principe, Seychelles, Swaziland and United Rep. Of Tanzania. EMRO:
Afghanistan. EURO: Albania, Armenia, Georgia, Kyrgyzstan, Rep. of
Moldova and Uzbekistan. SEARO: Bangladesh, Bhutan and Nepal. WPRO:
Lao and Vietnam. In addition, Cambodia was approved and said they
will introduce in January 2010. Applied not yet approved is:
Azerbaijan, India and Nigeria Never applied is DPRK, Haiti,
Indonesia, Myanmar, Somalia and Timor Leste No (21 countriesor 11%)
Yes (133 countriesor 69%) Yes-- part of country(3 countries--2%)
Intro 2009 or GAVI Approved (27 countries-4%) Applied for GAVI
Support(3 countries--2%) Never Applied (6 countries--3%) Source:
WHO/IVB database, 193 WHO Member States. Data as ofJune 2009 Date
of slide: 11 June 2009 The boundaries and names shown and the
designations used on this map do not imply the expression of any
opinion whatsoever on the part of the World Health Organization
concerning the legal status of any country, territory, city or area
or of its authorities, or concerning the delimitation of its
frontiers or boundaries.Dotted lines on maps represent approximate
border lines for which there may not yet be full agreement. WHO All
rights reserved Morbidity: Mortality: Disability
Global Burden of Hib diseases( WHO Estimates - Children < 5
years old) Morbidity: 3 million children with serious illness/ year
~20% of severe pneumonia Mortality: 450,000 deaths/year >1000
preventable deaths every day 1 in 25 child deaths Disability 15-35%
of survivors of Hib meningitissuffer lifelong consequences
(paralysis,hearing loss, mental retardation, speechproblems,
learning problems) Acute respiratory infections (2 million deaths
each year) are the leading infectious cause of death in children
1mo to 5 years of age.S. pneumo causes approximately 800,000 of
those deaths, Hib accounts for almost 400K.Diarrheal diseases are
the second leading cause of death with 1.7M deaths 500K are
estimated to be due to rotavirus.Other leading causes of death
include Malaria (853), Measles (395) HIV aids (321) Estimated total
Hib disease cases: Estimated total Hib deaths:
Burden of Hib disease in the EMR ( WHO Estimates - Children < 5
years old) Estimated total Hib disease cases: 1,140,271 Hib
cases/year Estimated total Hib deaths: 49,457 deaths Hib conjugate
vaccines
Available since early 1990s Excellent safety record Over 95%
efficacy against invasivedisease Compatible with EPI schedules
Vaccination Interrupts transmission andprotects community (Indirect
Effect orHerd Immunity) discontinued (1 country) Plans not clear (3
countries)
Hib Vaccine introduction in the EMR Palestine Bahrain introduced
(17 countries) discontinued (1 country) Plans not clear (3
countries) No plans (not eligible for GAVI support) Estimated
burden of Hib and pneumococcus for < 5 children Lumbar Puncture
for Detection of Meningitis in Age 2 m 5 y /100,000 (Population:
491,891) Sep ,Mar IRAN No. of highly suspicious No. of Other
bacteria N.meningitidis No. of S.pneumoniae No. of H.influenzae
Viral LP No. of proven & H.S. Bacterial Men. Abnormal LP N0. of
LP 63 45% 16 12% 6 4% 23 17% 30 22% 265 66% 138 34% 403 21% 1874
Incidence rate of H. influenzae Meningitis : 4/100,000/year in
2m-5y children Estimation of budget needed for Hib vaccine
integration
Total population:70,000,000 # of children < 5y:5,600,000 # of
children < 1y:1,200,000 # of H. influenza meningitis in
