Pneumonia is the leading killer of under-5 children worldwide In India it kills nearly 295000 children annually - highest in the world. Despite a consistent decline in Under-Five Mortality Rate in india, it remains the epicenter of childhood deaths. New Vaccines in routine immunisation: pentavalent and rotavirus.
Pneumonia is the leading killer of under-5 children worldwide In India it kills nearly 295000 children annually - highest in the world. Despite a consistent decline in Under-Five Mortality Rate in india, it remains the epicenter of childhood deaths. New Vaccines in routine immunisation: pentavalent and rotavirus.
Pneumonia is the leading killer of under-5 children worldwide In India it kills nearly 295000 children annually - highest in the world. Despite a consistent decline in Under-Five Mortality Rate in india, it remains the epicenter of childhood deaths. New Vaccines in routine immunisation: pentavalent and rotavirus.
Panna Choudhury Vice Chairman Child Health Foundation pannachoudhury@gmail.com Indias Under 5 mortality highest in the world There has been a consistent decline in Under-Five Mortality Rate (U5MR) in India. The rate of decline in current decade is higher than in the previous. However India remains the epicenter of childhood deaths and at the current rate of decline, India is unlikely to meet the target for Millennium Development Goal (MDG)-4, which aims to reduce childhood mortality by two thirds to 42/1000 live birth by 2015 The UN report 'Levels and Trends in Child Mortality 2014', found that India registered 1.34 million under-five deaths in 2013, which is still the highest in the world. Pneumonia 24% Diarrhea 13% Measles 3% Meningitis 2% Injury 3% Preterm birth complications 18% Intrapartum complications 10% Neonatal infection* 8% Congenital abnormalities 4% Other 15% Liu, et al. 2012 Lancet 379:2151-61 Causes of death in Indian Children Under 5 4 things to remember about Pneumonia
ONE. Pneumonia is the leading killer of under-5 children worldwide In India it kills nearly 295000 children annually highest in the world (Source: Committing to Child Survival, A Promise Renewed Progress Report, UNICEF 2013)
A Jumbo jet full of children crashing every 8 hours A school bus full of young children dying in a crash every hour 4 things to remember about Pneumonia TWO. Bacteria causes the most severe forms of pneumonia Pneumonia, a severe infection that affects the lungs, can be caused by bacteria, viruses or fungi. Bacteria cause the most severe forms of pneumonia. The bacteria Streptococcus pneumoniae, or pneumococcus, is the most common cause of severe pneumonia among children living in the developing world. Haemophilus influenzae type b (Hib) is another common bacterial cause of pneumonia. Together they cause 50% of the total pneumonia deaths
4 things to remember about Pneumonia THREE. Diagnosing and appropriately treating pneumonia is challenging Pneumonia in children is diagnosed most often by clinical symptoms. However, the clinical symptoms of bacterial and viral pneumonia are similar, making it difficult for providers to distinguish between these two causes. This can make appropriate treatment of pneumonia difficult. Chest x-rays and laboratory tests can be helpful in confirming pneumonia and determining its cause but use of these tools is limited by cost and technical challenges. Further, parents and caregivers may be unable to recognize the danger signs of pneumonia, or may face barriers in accessing medical care for their children, such as cost and distance. 4 things to remember about Pneumonia FOUR. Pneumonia prevention and treatment is possible, and can save millions of lives through comprehensive approach Protection: Ensuring adequate nutrition, including exclusive breastfeeding, reducing environmental risk factors, such as overcrowding in homes, exposure to tobacco smoke and indoor air pollution can help protect children from pneumonia. . Prevention: The use of vaccines against pneumococcus, Hib and other diseases can help prevent pneumonia before it occurs. Treatment: Early diagnosis of pneumonia to ensure that children receive early and appropriate medical care is critical. Hib Vaccine Hib Vaccine is available to protect children against Haemophilus influenzae type b (Hib), which is a major cause of severe pneumonia, as well as meningitis. In India the Hib vaccine is available as pentavalent vaccine in UIP. Pentavalent contains 5 vaccines in one shot - DPT + Hep B + Haemophilus influenzae b Government has introduced pentavalent vaccine in 9 states and will be introducing in another 11 states soon. Bihar is one of the states
3 things to remember about Hib vaccines Hib vaccine is safe and and has been in widespread use in developed countries for more than 20 years and in some developing countries for more than 10 years.
189 countries have introduced a Hib-containing vaccine into their National Immunization Program; four of these have introduced subnationally. (source: IVAC-VIMS-Report-2014-Mar.pdf)
Many countries have shown significant decline in Hib meningitis after the introduction of the vaccine
The Million Death Study Collaborators. Causes of neonatal and child mortality in India: a nationally representative mortality survey. Lancet 2010 Proportion of deaths due to diarrhea for children 1-59 months Diarrheal diseases in states 4 things to remember about Rotavirus Diarrhea ONE. Diarrhea is one of the leading killer of under-5 children worldwide and rotavirus is the most common cause of severe diarrhea Globally, rotavirus takes the lives of more than 450,000 children each year and hospitalizes millions more. In India, diarrhea causes approx. 141,400 deaths. Rotavirus causes over 50,000 deaths. Beyond these deaths, the burden of rotavirus is substantial; one study estimated 457,000-884,000 hospitalized cases and over 2 million outpatient visits in 2007; another suggested the burden is even higher, approximately 600,000 to 1 million hospitalizations and 5-8 million outpatient visits
India: multiple studies show rotavirus largest cause of moderate-to-severe diarrhea in children <5 Rotavirus Detection Rates in Children <5 from Surveillance at 6 Hospitals in India 2005-2007 Kang, JID, 2009 Incidence of Moderate-to-Severe Diarrhea in Children <5 in Kolkata, India, by Cause 2007-2011 GEMS India Factsheet (supplemental materials for Kotloff, Lancet, 2013) TWO. Rotavirus is highly contagious and cannot be treated with antibiotics or other drugs.
While mild rotavirus infections can be treated effectively in the same manner as other forms of diarrhea, by providing fluids and salts (oral rehydration therapy), children with severe rotavirus diarrhea can become dehydrated and often need intravenous fluids or they risk dying. Where this type of urgent care is inaccessible or unavailable, rotavirus prevention through vaccination is critical to saving childrens lives.
4 things to remember about Rotavirus Diarrhea THREE. Rotavirus is ubiquitous and resilient, and poses a serious threat in India
Almost every child worldwide is infected by age 5. Especially <1 yr, most at-risk for dehydration. Through contaminated hands and objects ; can survive on hands and surfaces in the environment for long periods of time.
It rapidly induces severe diarrhea, vomiting, and fever, and quickly leads to dehydration.
4 things to remember about Rotavirus Diarrhea FOUR. Vaccination is the best way to protect children from rotavirus
Improvements in water quality, hygiene, and sanitation stop bacteria and parasites that cause other forms of diarrhea but do not prevent the spread of rotavirus.
A coordinated approach that combines rotavirus vaccines with other prevention and treatment methods, including oral rehydration therapy, exclusive breastfeeding, zinc treatment, improvements in water, sanitation, and hygiene, as well as proper nutrition, will achieve the greatest impact on diarrheal disease illness and death.
4 things to remember about Rotavirus Diarrhea Rotavirus Vaccine India has a new, more affordable indigenous rotavirus vaccine licensed (116E or Rotavac) The National Technical Advisory Group on Immunization (NTAGI) has recommended the introduction of the vaccine Prime Ministers Office announced that rotavirus vaccine will be added to the Universal Immunization Programme (UIP). Worldwide Fifty-six countries have introduced rotavirus vaccine into their National Immunization Program; six of these countries have introduced subnationally. Forty-eight countries have announced plans to introduce rotavirus vaccine into their NIP. (source: IVAC-VIMS-Report-2014- Mar.pdf)
4.1 episodes prevented 2 episodes prevented 6.7 episodes prevented 4.2 episodes prevented Reduction in Incidence of Rotavirus Diarrhea, Low vs. Middle Income Countries In the first year of life, incidence per 100 child-years 50% vaccine efficacy 77% vaccine efficacy 46% vaccine efficacy 72% vaccine efficacy Madhi, NEJ M 2010 Zaman, Lancet 2010 Rotavirus vaccines: prevent disease, despite lower vaccine efficacy levels* in low-income countries
*Reasons for lower efficacy are not well understood, but possible explanations include: higher levels of malnutrition; interference by other microbes (high levels of infections with other viruses/bacteria); and high levels of maternal antibodies (Patel, JID, 2009) Vaccines in India have helped to dramatically reduce the burden of several common childhood diseases. Cases of tetanus, diphtheria, pertussis, and measles have decreased by at least 84% since the introduction of vaccines. India has remained polio- free since 2011. India's success offers many lessons to be learned for the global community.
A comprehensive approach towards managing these diseases is needed
Bihar Snapshot Total Population 104,099,452 Total Literacy Rate 61.8% Under-5 Mortality Rate 77 Under5 pneumonia deaths Approx. 58,000 (MDS 2005) Under5 diarrhea deaths Approx. 51,003 (MDS 2005) Immunization Schedule DPT3, OPV, BCG, Measles, JE and Hep-B Full immunization coverage 64.5%
Sources: Census of India 2011, < http://www.census2011.co.in/states.php> Annual Health Survey 2010-11, Census of India Million Death Study (2005) Discussions