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.

Message from MoNHSR&C Health Dignitaries

Message from Dr. Nadeem Jan (Honourable Federal Health Minister)

It gives me immense pleasure to reiterate Ministry’s Mission Statement on FDI Official Website. Ministry of National Health Services Regulations and Coordination is committed to helping the people of Pakistan to maintain and improve their health. Our vision is provision of a health system for our motherland Pakistan.

Immunization is one of the most cost-effective public health interventions, saving millions of lives every year. The Federal Directorate of Immunization (FDI), Ministry of National Health Services Regulations and Coordination (MoNHSR&C) is working against 12 vaccine preventable disease inclusive of Childhood Tuberculosis, Diarrhea, Diphtheria, Hepatitis B, Measles, Meningitis, Pertussis (Whooping Cough), Pneumonia, Polio, Tetanus, Typhoid and Rubella.
 
On behalf of Government of Pakistan, I would like to acknowledge and highlight the unwavering support of our national and provincial leaderships, communities, caregivers, parents, partner organizations and the EPI team/staff (especially the Front-Line Health Care Workers) all across Pakistan. With their support, we are working tirelessly to protect the children of Pakistan.

Ministry of National Health Services Regulations and Coordination stands affirm to fight against the 12 vaccine preventable diseases. I assure you of all possible support from Government of Pakistan to make each and every child a Fully Immunized Child (FIC). We are Pakistan, there’s nothing — not a single thing — we’re unable to do if we do it together.  So let us stay together and achieve our Immunization targets.

Message from Mr. Iftikhar Ali Shallwani (Worthy Federal Health Secretary)

Vaccines are the world’s safest method to protect children from life-threatening diseases. Immunization is a key component of primary health care and an indisputable human right. It’s also one of the best health investments money can buy. That is why the Ministry of National Health Services Regulations & Coordination takes great pride in Pakistan’s efficacious Immunization Programme being implemented by Federal Directorate of Immunization and provincial/area Expanded Programme on Immunization (EPIs). The programme is working day and night to convert vaccines into vaccinations.

The online world has become such a powerful tool for organizations to communicate and interact. An organization’s official website is a gateway that establishes a constant liaison with all direct and indirect stakeholders to provide timely information to save lives. FDI envision its official website to serve as a powerful tool and a ‘Go To’ place for information exchange and updating the national and international stakeholders on immunization against 12 vaccine preventable diseases. 

I would take this opportunity and on behalf of the Ministry of National Health Services Regulations & Coordination, I highly commend the role played by all stakeholders (namely Religious Leaders, Academia, Doctors, Medical Forums, Media Personal, NGOs/CBOs, Parliamentarians, FBOs, Partner & Donor Organizations (Gavi, WHO and UNICEF), Government Departments, Volunteers and specially the Parents and Health Care Workers for making Expanded Programme on Immunization a Success).

Message from Dr. Muhammad Ahmad Kazi (Director General Health, Ministry of National Health Services Regulations & Coordination / Director General FDI)

Immunization is the most cost-effective public health intervention. Due to routine immunization, millions of children are saved in Pakistan from illness and death by vaccine-preventable diseases.

Federal Directorate of Immunization under the guidance and direct supervision of Ministry of National Health Services Regulations and Coordination is working to reach out every child especially zero dose children in hard to reach areas of Pakistan. GoP firmly believe, wherever children are not immunized, their lives and communities are at risk. That’s why, FDI tailor new approaches to vaccinate every child against the targeted 12 vaccine preventable diseases in every community, no matter how remote or challenging by mobilizing the community at levels.   

Bringing innovation and building capacities lies at the core of the programme hence capacity building is an ongoing process in the thematic areas of Cold Chain Management, Vaccine Logistics, Vaccine Safety, Campaign Planning, Surveillance, Monitoring and Evaluation, Waste Management, and Advocacy Communications and Social Mobilization.

Capitalizing on the nationwide reach of FDI Website, on Behalf of the FDI, MoNHSR&C, I highly commend  the role played by all stakeholders; Religious Leaders, Academia, Doctors, Medical Forums, Media Personal, NGOs/CBOs, Parliamentarians, FBOs, Partner & Donor Organizations, Government Departments, Volunteers and specially the Parents and Health Care Workers for making Expanded Programme on Immunization a Success.    I would also like to take this opportunity to extend a gesture of gratitude to all donor and partner organizations inclusive of World Health Organization, UNICEF, Bill and Melinda Gates Foundation, World Bank, JICA, USAID, Aga Khan Foundation, ACASUS, IRD, Red Cross Movement and many other national and international stakeholders.

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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Magnitude of the Program

  • Protect children aged 0-15 months against 12 diseases (Childhood TB, Diarrhoea, Diphtheria, Hepatitis-B, Measles, Meningitis, Pertussis, Pneumonia, Polio, Tetanus, Typhoid, Rubella)
  • Protect pregnant and childbearing aged women and their neonates against Tetanus.

Our Background

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

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 (PCV)
2015 Inactivated Polio Vaccine (IPV)
2017 Rotavirus Vaccine
2021 MR Vaccine

Pakistan’s Immunization program is in place since 1978. During this time, it has gone through a lot of improvement in vaccine management, vaccine delivery, introducing new vaccines in the program and vaccine coverage.

EPI in Pakistan is coordinated at National level via Federal Directorate of Immunization, Ministry of National Health Services, Regulation and Coordination (NHSR&C). The EPI primarily covers the mothers, infants and children for immunization. The EPI program shall be including vaccines for prevention of vaccine preventable diseases among the adolescents and older age groups as the evidence of vaccines’ effectiveness is acquired and advised by the NITAG. The immunization schedule shall thus be periodically updated as and when required depending upon the local disease burden and requirements.

FDI Stakeholders:

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 diarrhoea 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

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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