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Immunization: The Bold and the New, The Tried and the True

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Measles, Hep B, Yellow Fever. 9 months. DTP3, OPV3, Hep B, Hib3. 14 weeks. DTP2, OPV2, Hep B, Hib2 ... Hib, Hep B, Yellow Fever. Injection safety 5 year limit ... – PowerPoint PPT presentation

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Title: Immunization: The Bold and the New, The Tried and the True


1
Immunization The Bold and the New,The Tried
and the True
  • Rebecca Fields, IMMUNIZATIONbasics
  • Youssef Tawfik, USAID/Global/HIDN
  • October 27, 2006, USAID Mini-University

2
Immunization 101 Vaccines usually included in
national immunization programs
  • BCG against Tb
  • DTP - diphtheria, tetanus,
  • pertussis (whooping cough)
  • Polio
  • Measles
  • Hepatitis B
  • Yellow fever
  • Haemophilus influenzae type b (Hib)

3
Routine Immunization Schedule
4
Global Immunization Goalsas per Global
Immunization Vision and Strategy (GIVS)
  • By 2010 or earlier
  • Increase coverage to gt 90 at national level and
    gt 80 in every district
  • Reduce measles mortality by 90 compared to 2000.
  • By 2015 or earlier
  • Sustain coverage. The vaccination coverage goal
    reached in 2010 will have been sustained.
  • Reduce morbidity and mortality. Global childhood
    cases and deaths due to vaccine-preventable
    diseases will be reduced by gt two thirds
    compared to 2000 levels.

5
Global and regional trends in immunization
coverage (DTP3)
6
UNICEF Expenditures on Immunization, 1990-1998
7
Reported DPT3 Coverage African Region, 2003 - 2005
2003
2004
Nov. 2005
EMRO
gt 80
Source 2003-2004 JRF 2005 EPI
Monthly report
50 - 79
lt50
8
Coverage varies within country Example
Madagascar, 2003
9
Comparing Vaccination Coverage Rates from Routine
Data and Surveys
10
Full Immunization Rates by Socio-economic Status
11
Immunization coverage is not enough !
Was potent vaccine administered safely and
efficiently in a timely manner before exposure to
disease?
12
Cost Profile of Immunization Programs
13
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14
Planning vaccination services
15
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16
Quality of ServicesSafety of injections
  • 12 billion injections annually in developing
    countries
  • Over 50 unsafe ? HIV, Hepatitis B, Hepatitis C
  • Immunization accounts for 10 of total but led
    push for safe injection

17
Disease Control Initiatives Supplemental
Immunization
  • Polio eradication
  • Measles mortality reduction/measles elimination
  • Maternal and neonatal tetanus elimination

18
Features common to all disease control initiatives
  • Campaigns to give EXTRA doses above beyond
    routine doses
  • Increased disease surveillance
  • A strong base of routine immunization

19
Polio Eradication
  • WHA resolution 1988 to eradicate polio
  • Huge decrease in cases, from 350,000 to 1500 so
    far in 2006
  • Great majority in a few endemic countries
    Afghanistan, India, Nigeria, Pakistan
  • Exportation to other countries a major issue

20
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21
Projected Impact of Different Measles
Vaccination Strategies on Measles Mortality in
Africa, 2001-2025
Constant routine
Catch-up Constant routine
Strengthen routine only
Strengthen routine catch-up follow-ups
Note routine strengthening assumes 5 annual
improvement in routine immunization coverage
until 95
22
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23
Global Estimated Deaths Occurring and Prevented,
2000Measles, Neonatal Tetanus and Pertussis
24
Immunization is a good investment
  • In high mortality environments, immunization of
    each 1000 infants prevents
  • 30 deaths from measles
  • 10 deaths from pertussis
  • 5 cases of lifelong disability from polio
  • Immunization of each 1000 women prevents
  • 5 deaths from neonatal tetanus

25
Vaccines could save as many as 17 million
lives/year
26
New Vaccines against Vaccine- Preventable
Diseases
27
Global Alliance for Vaccines and Immunization
(GAVI Alliance)
  • Improve access to sustainable immunization
    services
  • Expand use of all existing cost-effective
    vaccines
  • Accelerate RD and introduction of new vaccines
  • Assure injection safety for immunization

28
Categories of funding available to countries
through GAVI
  • Immunization Services Support cash support at
    20/child immunized with DTP3
  • New and under-utilized vaccines
  • Hib, Hep B, Yellow Fever
  • Injection safety 5 year limit
  • Health System Support new, to address broad
    obstacles in the health system

29
Results Reaching More Children
Cumulative Number of Children Reached in
GAVI-Supported Countries
Source WHO/UNICEF
projected
Source WHO/UNICEF
30
Prices of Newer Vaccines Increase Vaccine Costs
Exponentially for Under-ones
31
An ounce of prevention is worth a pound of
cureThe first cost-benefit ratio (116)
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