Slide 1 Welcome to Week 14 Part II on Vaccine Preventable Disease Week 14 Part II Surveillance. In this part, we will discuss immunization Vaccine Preventable coverage as an indicator for vaccine preventable disease Disease Surveillance surveillance, on a global scale. To accomplish this, we will use the most updated information from the World Health Organization (W.H.O.). ©DJH2013 Slide 2 The following slides were excerpted from a presentation entitled “Progress Towards Global Immunization Goals-2012”. This is a summary presentation of key indicators from the World Health Organization which was last updated in July 2013. This is the most current available information at the time of this lecture. Source: http://www.who.int/immunization_monitoring/data/SlidesGlobalI mmunization.pdf http://www.who.int/immunization_monitorin ©DJH2013 g/data/SlidesGlobalImmunization.pdf Slide 3 This graph shows the % coverage with diphtheria, tetanus, & pertussis (DTP3) vaccine (from 0-100%) on the “y” axis and the year (from 1980-2012) on the “x” axis. The yellow bars represent the global percentages. The different colored lines represent the 6 regions designated by the W.H.O.: African, American, Eastern Mediterranean, European, Southeast Asian, and Western Pacific. In 2012, coverage for this vaccine series on a global scale was 83%. In that same year, the Western ©DJH2013 Pacific and European Regions, followed by the American ©DJH2013 Region, had the highest % coverage for this vaccine. Slide 4 This pie chart divides the 6 regions by the numbers of infants not immunized for diphtheria toxoid, tetanus toxoid and pertussis vaccine (DTP3). In 2012, the total number of infants not immunized for DTP3 was 22.6 million. The Southeast Asian and African regions had the highest number of infants not immunized for DTP3 vaccine in 2012. ©DJH2013 Slide 5 On a global scale, the annual surviving infants cohort = 133.2 million. For the 83% global coverage with DTP3 vaccine reported on the first graph, 110.6 million children were vaccinated, leaving 22.6 million unvaccinated. To achieve 90% coverage would involve vaccinating 9.3 million additional children and leaving 13.3 million unvaccinated. To achieve 100% coverage with this vaccine, would involve vaccinating an additional 22.6 million children, leaving none unvaccinated. ©DJH2013 Slide 6 This color-coded map represents immunization coverage with DTP3 vaccines in infants from <50% for the year 2012. Red indicates <50% coverage, which occurred in 6 (or 3%) of countries, pink indicates 50-79% coverage (23 or 12% of countries), light blue 80-89% coverage (in 34 or 18% of countries) and dark blue in ≥ 90% (in 131 or 68% of countries). ©DJH2013 ©DJH2013 Slide 7 This color-coded map represents countries with ALL districts achieving at least 80% coverage with DTP3 vaccines in infants for the year 2012. You can see, when comparing with the previous map, not all countries that have achieved 80% coverage have equal success through the entire country; there are still disparities by district. Dark blue indicates that ALL districts within that country have achieved 80% coverage of DTP3 vaccine (63 or 32% of countries), light blue indicates countries that have not reached 80% coverage in ALL of their ©DJH2013 ©DJH2013 districts (87 countries or 45%). These specific data were not available for 44 countries (23%). Slide 8 Between 1988-2012, much progress has been made towards polio eradication. One hundred and fourteen countries are certified to be polio-free, 73 countries are not certified but have non-endemic polio cases and 3 countries still have endemic wild polio virus. The 3 countries are: Afghanistan, Nigeria, and Pakistan. In February of 2012, India was taken out of the endemic with wild polio virus category. ©DJH2013 Slide 9 This chart shows the progress in polio eradication, for estimated and reported cases of polio, between 1985-2012. On the “y” axis are the number of cases, in thousands. On the “x” axis are years from 1985-2012. The light blue color depicts reported and darker blue, estimated numbers of cases. In 1988, there was a resolution to eradicate polio. In 1999, the resolution was to accelerate polio eradication activities. The year 2000 was the original target date for interruption of transmission, with 2971 reported and 3500 estimated cases. In ©DJH2013 2012 there were 293 reported polio cases, a marked reduction when compared to 1985. Slide 10 Worldwide, reported measles cases have decreased from 853,480 in 2000 to 227,245 in 2012. (http://www.who.int/immunization_monitoring/diseases/measles /en/index.html ). In 2011, there were 157,700 deaths due to measles, an increase from 2010 where there were 139,300. Most of these deaths occur in children under the age of 5 years. This color-coded map represents immunization with measles-containing vaccines in infants for the year 2012. Red indicates <50% coverage, which occurred in 3 (or 2%) of ©DJH2013 countries, pink indicates 50-79% coverage (32 or 16% of countries), light blue 80-89% coverage (in 31 or 16% of countries) and dark blue in ≥ 90% (in 128 or 66% of countries). Slide 11 This chart shows the number of countries on the “y” axis and the years 1989 through 2012 on the “x” axis. The light blue bars represent the number of countries that have introduced the hepatitis B vaccine and the blue dotted line indicates the percentage of global infant coverage with 3 doses of the hepatitis B vaccine. In 2012, 181 countries had introduced hepatitis B vaccine and approximately 80% of the countries had global infant hepatitis B coverage. ©DJH2013 Slide 12 This map depicts the number and percentage of countries that achieved coverage of infants with the 3rd dose of hepatitis B vaccine. Hepatitis B vaccine is not in the schedule of 14 (7%) of countries, ≥90% coverage was achieved in 119 (61%) of countries, 80-89% in 29 (15%), 50-79% in 24 (12%) and <50% coverage in 7 countries (or 4%). ©DJH2013 ©DJH2013 Slide 13 This set of maps compares the number of countries who introduced the Haemophilus influenzae B (Hib) vaccine in 1997 vs. 2012. In 1997, 29 countries had introduced this vaccine; in 2012, 180 countries had introduced it and an additional 4 countries partially introduced it. ©DJH2013 Slide 14 In 2012, 153 or 79% of countries had a national 3-5 year strategic plan for an immunization program, 27 countries or 14% did not, and no data were available for 14 (7%) of countries. ©DJH2013 Slide 15 In 2012, 166 countries or 86% of countries had a national annual work plan for immunization services. 12 countries (or 6%) did not have such a plan and no data were available for 16 (or 8%) of countries. ©DJH2013 ©DJH2013 Slide 16 A consultant group to the World Health Organization is called Per S.A.G.E. the Strategic Advisory Group of Experts (SAGE) on Immunization. It is charged with advising W.H.O. on overall global policies and strategies, ranging from vaccines and technology, research and development, to delivery of immunization and its linkages with other health interventions. SAGE is concerned not just with childhood vaccines and immunization, but all vaccine-preventable diseases. In their assessment of World Health Organization’s global ©DJH2013 immunization coverage for vaccine preventable diseases, SAGE has specified the types of surveillance that match up with specific surveillance objectives. In order to document the eradication or elimination, find all chains of transmission, and certify areas are free of certain diseases such as polio and measles, country-wide, active surveillance with lab confirmation of all cases should be used. For routine monitoring or outbreak detection investigation, country-wide passive, aggregate reporting, with selective investigation should be used. Sentinel site surveillance, when used as a network of sentinel sites, can provide representative data for the population. Various other epidemiological studies should be used to obtain epidemiologic information. Source: http://www.who.int/immunization/sage/SAGE_November_2011 _Cherian.pdf Slide 17 There are many positive changes that have occurred with Global Successes global immunization coverage. Here are a few examples: • More children are being reached with 1) More children are being reached with immunization. In immunization (DTP3 example) 2012, about 111 million infants worldwide were vaccinated with • More countries achieve high levels of vaccination coverage (DTP3 in 2012 vs. three doses of diphtheria-tetanus-pertussis (DTP3) vaccine. 2011) These children are protected against a number of infectious • Access to new & underused vaccines diseases that can have serious consequences in terms of increased by end of 2012 (HPV, rubella, other examples) illness and disability or can be fatal. Source: http://www.who.int/hpvcentre/Global_Immunization_Data.pdf 2) More countries achieve high levels of vaccination ©DJH2013 coverage. The number of countries reaching 90% or more DTP3 coverage in 2012 was 131, compared with 128 in 2011. 3) Access to new and underused vaccines is increasing. The number of countries using specific vaccines by the end of 2012 was: •Human papillomavirus (HPV) vaccines: 45 •Pneumococcal vaccines: 88 •Rotavirus vaccines: 41 •Rubella vaccines: 134 •Yellow fever vaccines: 36 countries and territories (out of the 48 at risk for yellow fever in Africa and the Americas) Source: http://www.who.int/hpvcentre/Global_Immunization_Data.pdf Slide 18 Despite the successes, there are still challenges to be met. In Global Challenges 2011, an estimated 22 million infants worldwide are still not being reached by routine immunization services.1 Nearly • ~ 22 million infants worldwide still not 2 reached by routine immunizations seventy percent of these children live in ten countries : • ~ 70% live in 10 countries (see •Philippines transcript) •Democratic Republic of the Congo • Priority to strengthening global routine vaccination, especially in •Ethiopia countries ↑ # of unvaccinated children •India ©DJH2013 •Indonesia •Iraq •Nigeria •Pakistan •South Africa and •Uganda Priority needs to be given to strengthening routine vaccination globally, especially in the countries that are home to the highest number of unvaccinated children.