Vaccine Preventable Diseases

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Tetanus

What is Tetanus?

Tetanus is caused by a bacterium called Clostridium tetani. Spores of the bacteria are present in soil and manure and can be picked up through a puncture wound, burn or more serious injury. The bacteria release toxins which act locally at the site of an injury and are then transported to the central nervous system (CNS) where they cause the disease symptoms. Cases occur within four to 21 days of exposure, and most commonly, at about ten days.

What are the symptoms of Tetanus?

Spasms and stiffness of jaw muscles, Stiffness of your neck muscles, Difficulty swallowing, Stiffness of your abdominal muscles, Painful body spasms lasting for several minutes, typically triggered by minor occurrences, such as a draft, loud noise, physical touch or light, Fever, Sweating, Elevated blood pressure, Rapid heart rate

What is the global scenario like?

The World Health Organization (WHO) reported 15,516 worldwide cases of tetanus in 2005, and an estimated 290,000 deaths between 2000 2003 most of these cases occurred in neonates. According to a study done in 2011, neonatal tetanus accounts for 18-38% and 17-22% of all neonatal and infant deaths respectively. Another study done by UNICEF reveals that 58,000 newborn children died because of neonatal tetanus in 2010 alone. These numbers are likely low as many cases are never brought to the attention of health officials because many infants die in rural areas without ever receiving medical help.

What is Tetanus‘s status in Pakistan?

Pakistan is one of the 34 countries that have not achieved the neonatal tetanus (NT) global elimination target set by the World Health Organization (WHO). It is one of the most underreported diseases and remains a major but preventable cause of neonatal and infant mortality in many developing countries.
Various literatures reveal that TT vaccination coverage in Pakistan ranged from 60% to 74% over the last decade. Low vaccination coverage, the main driver for NT in Pakistan, is due to many factors, including demand failure for TT vaccine resulting from inadequate knowledge of TT vaccine among reproductive age females and inadequate information about the benefits of TT provided by health care workers and the media. Other factors linked to low vaccination coverage include residing in rural areas, lack of formal education, poor knowledge about place and time to get vaccinated, and lack of awareness about the importance of vaccination. A disparity exists in TT vaccination coverage and antenatal care between urban and rural areas due to access and utilization of health care services. NT reporting is incomplete, as cases from the private sector and rural areas are underreported.

How do you prevent Tetanus?

Tetanus can be prevented by the administration of tetanus toxoid, which induces specific antitoxins. To prevent maternal and neonatal tetanus, appropriate doses of tetanus toxoid need to be given to the mother before or during pregnancy, and clean delivery and cord care practices need to be ensured.
The vaccine is given in a combined form along with vaccines for diphtheria and Pertussis. This vaccination is also known as DPT (Diphtheria-Tetanus-Pertussis). The vaccine is administered to infants in 5 doses at 2,4,6, and18 months of age and then again when the child is 4-6 years old, followed by a booster dose every 10 years. It is recommended that pregnant women receive the tetanus toxoid between 27 and 36 weeks of pregnancy.

GAVI

gavi

The GAVI Alliance (formerly the Global Alliance for Vaccines and Immunisation) is a public-private global health partnership committed to increasing access to immunisation in poor countries.

The GAVI Alliance was launched in 2000, at a time when the distribution of vaccines to children in the poorest parts of the world had begun to falter. By the end of the 1990s, immunisation rates were stagnating or even declining.

Since its launch in 2000, the GAVI Alliance has, contributed to the immunisation of an additional 370 million children, helping developing countries prevent more than 5.5 million future deaths from Hepatitis B, Haemophilus Influenza type B (Hib), Measles, Pertussis, Pneumococcal disease, Polio, Rotavirus Diarrhoea and yellow fever.

In July 2013, GAVI received a $700 million bond to purchase vaccines to fight pneumonia and diarrhea, which are two of the most frequent killers of children under the age of five. GAVI will also purchase vaccines for diphtheria, tetanus, pertussis, HIB and hepatitis B. The bond issue will fund immunization efforts supported by GAVI. The transaction was done by the International Finance Facility for Immunisation. Jim Yong Kim, president of the World Bank Group, which is IFFI’s treasury manager, said that having predictable, long-term funding in place will help them ensure that the world’s most vulnerable children have access to healthcare, and that is a critical step in achieving the goal of ending extreme poverty by 2030.

In Pakistan, GAVI Alliance is funding to fill the existing gaps in the health sector including immunisation, maternal and child health care and health system strengthening.

Pakistan is one of the ten pilot countries successfully implementing this support through a consortium of 15 CSOs working in selected districts of Punjab, Sindh, Khyber Pakhtunkhwa, Balochistan, AJK and Gilgit Baltistan. Since September 2009, CSOs are implementing their respective assignments and reporting to GAVI CSO Support Unit Pakistan.

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Disease, Cause of Infection, Vaccine and Routine immunization schedule

Disease Cause of infection Vaccine Doses Age of administration
Childhood TB Bacteria BCG 1 Soon after birth
Poliomyelitis Virus OPV+IPV 4+1 OPV0: soon after birth
OPV1: 6 wks
OPV2: 10 wks
OPV3 and IPV: 14 wks
Rota Diarrhea Virus Rota 2 Rota1: 6 wks
Rota2: 10 wks
Pneumonia and meningitis due to S. pneumoniae Bacteria Pnumococcal conjugate vaccine (PCV10) 3 Pneumo1: 6 wks
Pneumo2: 10 wks
Pneumo3: 14 wks
Diphtheria Bacteria Pentavalent vaccine
(DTP+Hep B + Hib)
3 Penta1: 6 wks
Penta2: 10 wks
Penta3: 14 wks
Tetanus Bacteria
Pertussis Bacteria
Hepatitis B Virus
Hib pneumonia and meningitis Bacteria
Measles Virus Measles 2 Measles1: 09 months
Measles2: 15 months

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Magnitude of the Program

Time line
  • Protect about 7 million children between 0 and 23 months against 10 diseases (Childhood TB, Polio, diarrhea, Diphtheria, Pneumonia, Pertussis, Tetanus, Hepatitis-B, H. Influenza-b and Measles)
  • Protect about 7 million pregnant and child bearing aged women and their neonates against Tetanus

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Our Background

The Programme was established in 1976 as a pilot project and has evolved as follows:

Time line

1976 Pilot project with 6 basic antigens (BCG, Measles, Diphtheria, Pertussis, Tetanus and Polio)
1978 Expanded nationwide
1981 Activities intensified
1994 National Polio Immunization Days
2002 Hepatitis B vaccine introduced
2009 Pentavalent vaccine introduced
2012 Pneumococcal vaccine (PCV10)
2015 Inactivated Polio Vaccine (IPV)
2017 Rotavirus Vaccine

Since the launch of the programme, the implementation of immunization activities has been carried out by the provinces themselves. However, Federal Government acted as a nucleus to coordinate, monitor and supervise provinces and areas in the implementation process of the provincial programmes The role of federal EPI cell was implementation, provision of policy and technical guidelines, coordination for international assistance, surveillance and monitoring. Additionally, the programme also facilitated provincial health departments by procurement and supply of requisite vaccines and other logistics.
In pursuance of 18th Constitutional Amendment, Ministry of Health was abolished and vertical Programmes including EPI were devolved to provinces. However, the Council of Common Interests (CCI) in its meeting held on 28th April 2011 inter-alia decided that the Federal Government will continue to finance these programmes till the next National Finance Commission (NFC) award. Accordingly, the federal EPI cell continues to be financially supported through the federal PSDP regularly at the 2010-11 levels. The resources provided therein are primarily used to procure and supply the vaccines, syringes, safety boxes and other logistics needed by the provincial and areas to vaccinate their target populations. Nevertheless, the provinces and areas through respective EPI programme units are themselves responsible to manage the operational cost of the immunization activities at the provincial and district levels.
EPI in Pakistan is coordinated at National level EPI Cell under the Ministry of National Health Services and Regulation Coordination (NHSR&C). The Federal EPI Cell is headed by a National Programme Manager supported by a team of technical and administrative staff from government and development partners. (WHO,UNICEF). The EPI at Provincial (Balochistan, Khyber Pakhtunkhwa, Punjab, Sindh) and areas (Azad Jammu & Kashmir, Gilgit Baltistan ,FATA, CDA and ICT) levels have Provincial /Area EPI cells under respective Departments of Health and managed by Provincial/Area EPI managers and other staff. The EPI at district level is managed and supported by staff at district level and the EPI services are provided at Union council level through Fixed Centers, Outreach Vaccination sites and mobile if applicable.

Diphtheria

What is Diphtheria?

Diphtheria is caused by infection with a bacterium called Corynebacteriumdiphtheriae (C. diphtheriae) or by orynebacterium ulcerans (C.ulcerans). These bacteria are usually spread in droplets of moisture coughed into the air. The bacteria then multiply in the mouth or throat of the individual who breathes them in.

What are the symptoms of Diphtheria?

A thick, gray membrane covering your throat and tonsils, A sore throat and hoarseness, Swollen glands (enlarged lymph nodes) in your neck, Difficulty breathing or rapid breathing, Nasal discharge, Fever and chills, Malaise.

What is the global scenario like?

In the l920′s, when data were first gathered, there were approximately 150,000 cases and 13,000 deaths reported annually. After diphtheria immunization was introduced, the number of cases gradually fell to about 19,000 in 1945.
Before the implementation of routine immunization against diphtheria in the 1940s and 1950s, diphtheria occurred throughout the world in large cyclical epidemics.  In 2012, the WHO estimated that about 2,500 deaths occur annually worldwide.

What is Diphtheria‘s status in Pakistan?

The reported cases for Diphtheria in Pakistan” were 37 on in 2010. The all-time low was a number of 34 cases reported in 2009 and in 2011 a total of 22 cases were reported.

How do you prevent Diphtheria?

Vaccination consists of DPT 3 doses of 0.5 ml each/IM administered to the children less than one year of age according to the following schedule: 1st dose at age six weeks; 2nd dose at age ten weeks; 3rd dose at age fourteen weeks. DPT (also DTP and DTwP) refers to a class of combination vaccines against three infectious diseases in humans Diphtheria, Pertussis (whooping cough), and tetanus. The vaccine components include diphtheria and tetanus toxoidsand killed whole cells of the organism that causes Pertussis.

Vaccine Preventable Diseases

Childhood Tuberculosis (TB)

TB is usually spread through breathing and that is how it enters the lungs. If left untreated, it can harm the lungs and brain.

Polio

Polio is a highly infectious viral disease that mainly affects young children. The virus is transmitted through contaminated water and food, and from person to person by infected saliva or faeces. The virus attacks the nervous system which can cause paralysis, mostly in the lower limbs and it is often permanent.

Diarrhoea

Rotavirus infection is common in young children and adults. Rotavirus is the number one cause of diarrhea and kills around 53,300 children in Pakistan each year.

Its symptoms appear after two days and last for a week. If left untreated, it can also result in death, especially in young infants.

Pneumonia

Pneumonia is a lungs infection that spreads through breathing. It causes inflammation which  results in stiffness of lungs and makes it difficult to breathe. If left untreated, it can also result in death, especially in young infants.

Pertussis (Whooping Cough)

Pertussis is an infectious disease that causes violent coughing spells with a whooping noise which makes it difficult to breathe. Pertussis is spread from one child to another through the nose or mouth by coughing, sneezing or touching infected surfaces. If left untreated it can harm the child’s internal organs.

Tetanus

Tetanus is caused by bacteria found in the soil and it enters the body through open wounds like cuts, burns and non-sterile surgery. If left untreated, it can result in death through paralysis of the throat and respiratory muscles.

Hepatitis-B

Hepatitis B is a contagious liver disease that results from the Hepatitis B virus. It is spread through exchange of blood or other body fluids of an infected person and also transmitted from an infected mother to a child at birth. If left untreated, it can result in liver failure.

Meningitis

Meningitis is an inflammation of the inside layers of the brain. It can be bacterial, viral or fungal. Meningitis can be triggered by an autoimmune disease when the body attacks itself e.g. lupus. An adverse reaction to medicines may cause meningitis. The virus can be transmitted through the nose, skull fractures or spinal fluid. If left untreated, it can result in death.

Diphtheria

Diphtheria is a contagious bacterial infection that spreads from one person to another and attacks the respiratory system (nose, throat and tonsils). If left untreated, it can damage internal organs that may result in death.

Measles

Measles is a highly infectious disease that can easily be spread from person to person by sneezing, coughing or physical contact. Measles is a highly infectious disease that can easily be spread from person to person by sneezing, coughing or physical contact.

Typhoid

Typhoid fever is a life-threatening disease caused by a bacteria Salmonella Typhi . Salmonella Typhi only lives in humans. People with typhoid fever carry the bacteria in their bloodstream and intestinal tract. Severe cases may lead to serious complications or even death. Fatality rates in typhoid fever range from 1-4% in treated cases and 10-20% in untreated cases. The highest fatality rates are reported in children <4 years of age.

Rubella

Typhoid fever is a life-threatening disease caused by a bacteria Salmonella Typhi . Salmonella Typhi only lives in Rubella is an infection caused by a virus and is usually mild in children and adults. Congenital rubella syndrome (CRS) is a group of birth defects that occur when the rubella virus infects a fetus. A woman infected with the rubella virus early in pregnancy has a 90% chance of passing the virus on to her fetus and this can lead to death of the fetus or to CRS. The most common birth defect is deafness, but CRS can also cause defects in the eyes, heart and brain.

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  • +92 51 9255101

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Prime Minister’s National Health Complex,
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Islamabad.

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