dr. mohamed el bakry chairman of the pediatrics department banha university intercontinental city...
TRANSCRIPT
Dr. Mohamed El BakryChairman of the Pediatrics Department
Banha University
Intercontinental City StarsMay 19th, 2011
Vaccinations…
Where we R??
Where 2 go??
Bakry , 2011
Vaccination ScheduleVaccine Schedule
BCGDTwP
DTwP Hep
Hep B
Influenza 6-59 months; >50 years
MenAC
MenACWY
MMR 12-15 months; 4-6 years
OPVTd
TT
Vitamin A
Hep A 12-23 months
DTaP 2, 4, 6, 15-18 months; 4-6 years
Hib 2, 4, 6, 12-15 months
HPV 11-12 years
IPV 2, 4, 6-18 months; 4-6 years
MenC conj 11-12 years
Pneumo conj 2, 4, 6, 12-15 months
Pneumo ps >= 2 years
Rotavirus 2, 4, 6 months
Tdap 11-12 years
Varicella 12-18 months; 4-6 years Bakry , 2011
Licensed vaccines in routine use in the USA, 1980 and 2008
Bakry , 2011
Vaccination ScheduleVaccine Schedule
BCG Birth
DTwP
DTwP Hep
Hep B 2, 3, 16-18 months
Influenza
MenAC
MenACWY
MMR 12, 13-24 months
OPV
Td 16-18, 26-28, 38 48, 58, 68 years
TT
Vitamin A
DT 6, 11-15 years
DTaPHibIPV 2, 3, 4, 16-18 months
DTaPIPV 11-13 years
HPV 1st contact; +2, +6 months (girls at 14 years)
IPV 6, 11-13 years
Pa 26-28 years
Pneuma conj 2, 3, 12 months
YF 12 months, 11, 21, 31, 41, 51 years Bakry , 2011
Vaccination ScheduleVaccine Schedule
BCG birth
DTwP 4-6 years
DTwP HibHep 2, 4, 6 months
Hep B Birth
Influenza
MenAC
MenACWY
MMR 1, 4-6 years
OPV 4, 6, 12 18 months; 4-6 years
Td >= 7 years
TT (CBA, pregnant)
Vitamin A
DT < 7 years
DTwP Hib 18 months
Hep A 2, 4, 6 months
HIB 2, 4, 6 months
IPV 2 months
Measles 9 months
Pneuno conj 2, 4, 6, 12 months
Pneumo ps Risk groups
Varicella 1, 4-6 years
Bakry , 2011
Vaccination ScheduleVaccine Schedule
BCG birth
DTwP 18 months
DTwP HibHep 2, 4, 6 months
Hep B birth
Influenza (high risk groups)
MenAC
MenACWY (pilgrims)
MMR 12, 18 months
OPV 4, 6, 18 months; 6, 17 years
Td 12, 17 years
TT (pregnant/wound)
Vitamin A 9, 18 months
DT 6 years
IPV 9 weeks
Measles (part of country)
Pneumo conj 2, 4, 6, months
Rabies (high risk – animal bites)
Rubella 15-49 years (post partum)
Bakry , 2011
Vaccination ScheduleVaccine Schedule
BCG birth
DTwP 6, 10, 14 weeks
DTwP HibHep 6, 10, 14 weeks
Hep B
Influenza
MenAC
MenACWY
MMR
OPV Birth; 6, 10, 14 weeks
Td
TT 1st contact, +1, +6 months; +1, +1 year
Vitamin A 9-24 months
Measles 9, 18 monthsBakry , 2011
Vaccination ScheduleVaccine Schedule
BCG Birth
DTwP
DTwP HibHep 6, 10, 14 weeks
Hep B
Influenza
MenAC
MenACWY
MMR
OPV 6, 10, 14 weeks
Td
TT 1st contact; +1, +6 month; +1, +1 years
Vitamin A
Measles 9 months
Pneumo Conj From January 2011
Rotavirus From July 2010
Bakry , 2011
Vaccination Coverage 2009
Bakry , 2011
Vaccination ScheduleVaccine Schedule
BCG Birth
DT 6 years
DTwP 3, 4, 5, 18-24 months
Hep B Birth, 1, 6 months
Influenza
MenA 6-18 months (x2)
MenAC 3, 6 years
MMR 18-24 months
OPV 2, 3, 4 months, 4 years
Td
TT
Vitamin A
Hep A 18, 24-30 months
JapEnc 8 months, 2 years (or 8 months (x2); 2 , 6 years)
Measles 8 months
MM 18-24 months
MR 8 months
Bakry , 2011
Vaccination ScheduleVaccine Schedule
BCG 3 days, 7, 14 years
DTwP 3, 4, 5, 6, 18 months
DTwP Hep 3, 6 months
Hep B 1st day; 3,6 months
Influenza
MenAC Part of country
MenACWY Part of country
MMR 12 months; 6 years; part of country
OPV 18, 20 months; 14 years
Td 6-7, 14 years; +19 years
TT
Vitamin A
Dip +10 years
DT 3, 4, 5, 6 months
Measles 12 months; 6 years
MM 12 months; 6 years
Mumps 12 months; 6 years
Bakry , 2011
Vaccination ScheduleVaccine Schedule
BCG Birth
DTwP 6, 10, 14 weeks
DTwP Hep
Hep B
Influenza
MenAC
MenACWY
MMR
OPV Birth, 6, 10, 14 weeks
Td
TT 1st contact, +1, +6 months, +1, +1 year
Vitamin A 9 months
Measles 9 months
Bakry , 2011
الدنيا أم
Vaccination ScheduleVaccine Schedule
BCG Birth
DTwP 2, 4, 6, 18 months
DTwP Hep 2,4,6 months
Hep B 2, 4, 6 months
Influenza
MenAC 3, 6, 12, 15 years
MenACWY
MMR 12, 18 months
OPV Birth, 2, 4, 6, 9, 18 months
Td
TT
Vitamin A 9, 18 months Bakry , 2011
Egypt Vaccine Marketobligatory optional
BCGBCG
HBVHBV
DTPDTP
OPVOPV
MMRMMR
HibHib
VaricellaVaricella
PCVPCV
Rotavirus
Rotavirus
Influenza
Influenza
HAVHAV
MeningMening
Bakry , 2011
Vaccination Coverage 2009
Bakry , 2011
Bakry , 2011
Where do we want to go??
lobal lliance foraccines &mmunization
GA V I
GAVI Is a global alliance between PRIVATE and PUBLIC sectors committed to saving CHILDREN’S lives & protecting peoples health by increasing access to immunization in peer countries.
Bakry , 2011
“Supporting children’s immunization is undoubtedly the best investment we’ve ever made” – Bill Gates, Co-Chair Bill & Melinda Gates Foundation
GAVI
Bakry , 2011
Alliance board 2008
Bakry , 2011
GAVIs’ Goal!
Bakry , 2011
FACTS• 9 million children die before
their 5th birthday every year• 2.4 million children die from
diseases that are vaccine preventable (That is one child every 20 seconds!)
• 24 million children in the world remain unvaccinated!!
Bakry , 2011
Causes of under five child deaths in low income countries
Bakry , 2011
GAVI supports 72 countries
Afghanistan Angola Armenia AzerbaijanBangladesh Benin Bhutan BoliviaBurkina Faso Burundi Cambodia CameroonCentral African Republic Chad ComorosCongo Dem Republic of Côte d'Ivoire CubaDjibouti Eritrea Ethiopia GambiaGeorgia Ghana Guinea Guinea BissauGuyana Haiti Honduras IndiaIndonesia Kenya Kiribati Korea DPRKyrgyz Republic Lao PDR Lesotho LiberiaMadagascar Malawi Mali MauritaniaMoldova Mongolia Mozambique
MyanmarNepal Nicaragua Niger NigeriaPakistan Papua New Guinea Rwanda São ToméSenegal Sierra Leone Solomon Islands SomaliaSri Lanka Sudan Tajikistan TanzaniaTimor Leste Togo Uganda UkraineUzbekistan Viet Nam Yemen ZambiaZimbabwe
½ the worlds
populationBakry , 2011
GAVI• Averted 5 million deaths 2000-
2010• Committed 4 billion US $ for 75
countries between 2000-2015• Start up grant US $ 750 million in
1999 by Bill & Melinda Gates Foundation
• Additional Hepatitis B vaccination 3 doses for 267 million children
Bakry , 2011
GAVI supporting newvaccines
Bakry , 2011
Vaccine preventable deaths and the global immunization vision
and strategy, 2006 - 2015
Bakry , 2011
Immunization coverage with DTP3, Hepatitis and Hib vaccines in GAVI supported countries 2000-2011
Bakry , 2011
Vaccination and decline of Hib disease in Finland
Bakry , 2011
GAVI’s Strategy
Bakry , 2011
The GAVI alliance strategy 2011-2015
Bakry , 2011
HSS: Health System
Strengtheningsix key components
Health service delivery: a network
of health facilities to provide access to
primary & secondary care.
Bakry , 2011
Health workers: in the right place at
the right time with training, experience
& incentives
Bakry , 2011
Health information systems: to generate quality data and to
measure what is being done & achieved
Bakry , 2011
Logistics & supply systems: so that drugs, equipment
and fuel are available
Bakry , 2011
Health financing: to raise sufficient
funds for health & improve financial
risk protection
Bakry , 2011
Leadership & governance: to ensure that strategic policy
frameworks exist and there is proper
accountability and oversight
Bakry , 2011
Egypt is strong in this area because of good infrastructure of existing high vaccination coverage
Bakry , 2011
Vaccine Research & the future
Vaccines by Period of Development
Bakry , 2011
Introduction of first generation of vaccines used on humans
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Vaccines used by the expanded Programme on Immunization (EPI)
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Stages of vaccine development Vaccine
development proceeds through discovery process engineering toxicology and animal studies to human phase I, II and III trials. The process can take more than 10 years, depending on the disease
Bakry , 2011
An ideal Vaccine should beGood immune response• Both cell mediated immunity and antibody responses• Immunity is long lived• Single doseSafety• Danger of reversion to virulence, or severe disease in
immunocomprisedStability• Organisms in the vaccine must remain viable in order to
infect and replicate in the host• Vaccine preparations are therefore very sensitive to
adverse storage conditions• Maintenance of the cold chain is very importantExpense• Cheap to prepare
Bakry , 2011
Calculated Cost effectiveness for any Calculated Cost effectiveness for any VaccineVaccine
No of doses of vaccine given Cost of Vaccination
(doses + admin.)
No of Episodes of disease prevented
e.g Otitis Media -Saving
Pneumonia -Saving
Invasive Diseases -Saving
No life Years Saved = Net Cost of Vaccine Program
Net Cost of Vaccine Program = Cost per Life –Year Saved
No life Years Saved
Pneumococcal Vaccine (1000 children)
1820
5
10
15
20
25
30
2009 2010
Children
Pneumococcal Vaccine (1000 children)
18
126
20
140
18
38
58
78
98
118
138
2009 2010
Private
GAVI
Conclusions
Bakry , 2011
Possible candidates• Varicella• Hepatitis A• Rota• Pneumococcal
Bakry , 2011
Funding• Approach MoH for co-ordination of
plans• Approach GAVI to renew status of
Egypt• Negotiate prices of vaccines with
producers• Approach civil society associations
for funding start ups and maintenance
• Cost sharing with the public
Bakry , 2011
:المطلوب
توفير اكبر قدر من التطعيمات لالطفال
شارع شارع
حارة حارة
زنجا زنجا )زنقة زنقة(
الطفـــل
يريد
حقــه
فــى
التطعــ ــيم
Thank You
Timeline of vaccines (20th century)
1932 1945 1952 1954 1957 1962 1964
Yellow fever
Influenza
polio
Japanese encephalitis
Adenovirus – 4 & 7
measles
Oral polio vaccine
1962
Mumps
Bakry , 2011
Timeline of vaccines
1970
1974
1977
1978
1981
1992
1998
rubella
Chicken pox
pneumonia
meningitis
Hepatitis B
rotavirus
Hepatitis A
Bakry , 2011
New vaccines and combinations• Hepatitis B (and A) catch up• Haemophilus influenza b (Hib)- universal• MMR, Measles, mumps, rubella x 2 – universal• DPT x 4 – update policies, catch up, also for elderly
(H zoster)• Influenza – all ages• Pneumococcal pneumonia – all ages• Rotavirus• Human papilloma virus (HPV) and cancer cervix• Future vaccines – streptococcus, cytomegalovirus
(CMV), helicobacter, HIV, malaria, avian flu• Cocktails- maximum combination of routine
vaccines• New methods of production of vaccines
Bakry , 2011
WHO/UNICEF’s current vaccines
Bakry , 2011
• Cold chain monitor card: upon arrival to a health clinic, vaccines are stored in refrigerators and temperatures recorded on a chart. The temperatures are monitored and recorded twice a day to ensure that a safe temperature is maintained
• Vaccine vial monitor (VVM): the vaccine vial monitor consists of a temperature sensitive label placed on each vial that registers cumulative heat exposure for that vial. GAVI resolved that all vaccines be purchased by the Vaccine Fund after 2003 will include VVM (immunization focus, July 2003, GAVI newsletter)
• Freeze watch: in the freeze watch, a vial with a red liquid that bursts and stains a white placard if exposed to temp. below zero for > 1 hour is packed with DTP, TT (freezing pt. -6.5 C) (WHO, vaccines-cold chain, 2005)
GIVS Global Immunization vision and strategy 2006-2015
Bakry , 2011
Canadian Institutes of Health Research CIHR in the 1st 10 years of 21st century research in development of new vaccines has accelerated to meet antibiotic resistance infections as well as combat cancers and diseases that were once thought invincible.
Bakry , 2011
Canadian successes in vaccines research include• an acellular pertussis vaccine;
• a candidate vaccine for Severe Acute Respiratory Syndrome (SARS);
• a cattle vaccine against E. coli 0157:H7;the development of vaccine technology to prevent meningitis;
• candidate vaccines against hemorrhagic fevers;• the preparation for and assessment of the impact of
human papilloma virus (HPV) immunization in Canada;• the development of therapeutic cancer vaccines;• the safe administration of vaccines produced in eggs to
egg-allergic individuals;• the evaluation of influenza vaccination strategies and
transmission dynamics within a community; and, • the development of new vaccination strategies for
Human Immunodeficiency Virus (HIV-1) Bakry , 2011
WHO state of the art of new vaccines:
Research and development 2006
Sexually transmitted diseases
• Chlamydia trachomatis• Gonorrhea• Herpes simplex type 2• HIV/AIDS
Bakry , 2011
Vector borne viral infant• Dengue fever• Japanese encephalitis• Tick-borne encephalitis• West Nile virus
Bakry , 2011
Zoonotic infections• Anthrax• Hepatitis E• Leptospirosis• Plague• Rabies
Bakry , 2011
Viral cancer• Epstein-Barr virus• Hepatitis C• Human papillomavirus
Bakry , 2011
Diarrhea disease• Caliciviruses• Campylobacter• Cholera• Enterotoxigenic Escheria coli
(ECTC)• Rotavirus• Shigellosis• Typhoid fever
Bakry , 2011
Respiratory infections• Influenza• Parainfluenza viruses• Respiratory syncytial virus
(RSV)• Severe acute respiratory
syndrome (SARS)• Streptococcus pneumoniae• tuberculosis
Bakry , 2011
Bacterial infections• Helicobacter pylori• Neisseria meningitidis• Mycobacterium ulcerans
(Buruli ulcer)• Staphylococcus aueus• Group A Streptococcus• Group B Streptococcus
Bakry , 2011
Parasitic diseases• Amoebiasis• Hookworm disease• Leishmaniasis• Malaria• schistosomiasis
Bakry , 2011