adolescent immunization as part of a life course approach · 2017-11-08 · adolescent immunization...
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Adolescent Immunization as part of a Life Course Approach:
Goals and experiences
Immunization in the Context of Adolescent Health
Dubai, 22-23 Oct 2017
Paul Bloem, Expanded Programme of Immunization/IVBWorld Health Organization
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Overview
• Adolescent immunization, integration and life course approach - WHO policies
• Global practise in vaccinating adolescents & integration
• A zoom on HPV vaccines
• Country Examples of Adolescent Immunisation Programmes
• Challenges and way forward
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Why is adolescent vaccination important?
1. Adolescence represents a critical phase of development between childhood and adulthood
2. Adolescents (10-19) in many LMIC represent up to 25% of the population
3. The health system has very limited interaction with this age group! Vaccination can be a key opportunity
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PIA meeting, Barcelona, Spain, June 22-26, 2015
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PIA meeting, Barcelona, Spain, June 22-26, 2015
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Member States recommending vaccinationsin 9-15 year olds by WHO region
WHORegion
Total # of MS
HPV DT-containing
TT/Td-containing
Polio-containing
MCV Other vaccines
Worldwide 194 70 14 95 26 16 31
AFRO 47 10 1 6 2 0 0
PAHO 35 15 1 26 5 2 7
EMRO 21 1 1 9 3 2 3
EURO 53 29 9 35 14 11 15
SEARO 11 1 0 5 0 1 0
WPRO 27 14 2 14 2 0 6
Source: JRF June 2015
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Countries recommending vaccines for the adolescent age group(9-15 years) ,by income group
Income Total # of MS
HPV DT-containing
TT/Td-containing
Polio-containing
MCV Other vaccines
Worldwide 194 70 36% 14 95 49% 26 16 31
Low 34 5 15% 0 3 22% 0 1 0
Middle 102 26 25% 2 50 49% 16 5 10
High 55 38 70% 12 22% 40 73% 10 18% 10 18% 21 38%
Not classified 3 1 0 2 0 0 0
Source: JRF June 2015
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PIA meeting, Barcelona, Spain, June 22-26, 2015
The opportunity schools provideCompulsory school age range in GAVI-eligible countries
0123456789
10111213141516171819
Mya
nmar
Paki
stan
Ban
glad
esh
Lao
PDR
Ben
inCam
eroo
nD
R C
ongo
Gui
nea-
Bis
sau
Hai
tiN
icar
agua
Sie
rra
Leon
eBur
undi
Gam
bia
Leso
tho
Moz
ambi
que
Nig
erU
gand
aZim
babw
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oros
Ken
yaM
alaw
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an (
pre-
)U
R T
anza
nia
Zam
bia
Cam
bodi
aEr
itrea
Ethi
opia
Indi
aM
adag
asca
rM
auri
tani
aN
iger
iaPa
pua
New
Gui
nea
Tim
or-L
este
Vie
t N
amYe
men
Afg
hani
stan
CAR
Cha
dCôt
e d'
Ivoi
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PR K
orea
Gha
naKyr
gyzs
tan
Mal
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anda
Sen
egal
Tajik
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goBur
kina
Fas
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jibou
tiG
uine
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Sao
Tom
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zbek
ista
n
Compulsory starting age Compulsory ending age
Source: UNESCO Institute for Statistics, 2012
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Global practice of school based vaccinationAre any routine doses of vaccine given to children at school?
2009: 166 out the 187 (89%) member countries who completed a JRF responded to this question
2016: 191 out of the 194 (97%) member countries who completed a JRF responded to this question
Source: JRF (2010, 2017)
95
96
97
98
99
100
101
2016 2009
20162009
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Routine, school based vaccination
Vertical program or Comprehenisive school program?
Comprehensive schoolhealth programVaccine delivery only
Source: JRF June 2015
any age/grade
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School based vaccination Country Study (2009):- More vaccination in earlier grades
HPV (2017)
HPV in demo programme.
HPV (2010) HPV (2017)
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Types of Health Services Provided to School Children with Vaccination
Services:
• Deworming
• General check up (vision, hearing, growth)
• Dental
• Screening (NCDs, nutritional status)
• Education, awareness, mental health
• Curative, referral
• Nutrition (supplements, food)
• Water & sanitation and hygiene
Other services delivered through SBI
0
5
10
15
20
25
30
35
Genera
l che
ck-up
Educat
ion/C
ounse
lling
Dental
Deworm
ing
Screen
ing
Nutritio
n
Curativ
e
Health services
Num
ber o
f cou
ntrie
s re
port
ing
Source: JRF June 2015
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Zoom in on HPV vaccines
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WHO Position paper on HPV vaccine(WER May, 2017)
(www.who.int/immunization/documents/positionpapers/en/)
•Target: girls 9-13 years of age•)
•If the interval < 5 months, give an extra dose 6 months after the first one
WHO recommandations (May,2017):Target: Girls, 9 to 14 years of ageDoses: 2 doses Interval : 6 months minimum
No maximum interval (suggesteduntil 12-15 months after first dose)
@ introduction: vaccinate multi- agecohort 9-14 years old (or up to 18yrs) Immuno depressed or ≥15 years of age:
=> 3 doses
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* Includes partial introduction
Data source: WHO/IVB Database, as of 09 August 2017Map production Immunization Vaccines and Biologicals (IVB),World Health Organization
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. ©WHO 2017. All rights reserved.
Introduced* to date (74 countries or 38.1%)
Not Available, Not Introduced/No Plans
(120 countries or 61.9%)
Not applicable
Global Progress in HPV introduction
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1. Comprehensive Cervical Cancer Prevention & Control
2.ADO LESCENT
HEALTH
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Integrating HPV vaccination with adolescent health interventions and programs
• An opportunity for reaching girls and boys with additional health interventions..
Broutet et al. JAH, 2013; Hindin et al. JAH, 2015
ADOLESCENT
HEALTH
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PIA meeting, Barcelona, Spain, June 22-26, 2015
Country examples of adolescent immunization
Mexico: Home-based records across the life course
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Case study HPV vaccination in New ZealandIntegrating school based programmes with general practice
• All New Zealand districts offer HPV as a school based programme, as well as in general practice
• Improved connection between school based programmes and GPs – GPs now recall incompletely immunised individuals at age 14
• Reminder Poster developed for GP practices
• Change HPV from grade 7 to Grade 6 to coincide with Tdap vaccination (co-delivery)
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(HPV @ 13 years)
Malaysia: HPV vaccine as part of a school health package
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South Africa: Integrated school health programmes includes HPV
• New integrated school health policy launched in 2012
• Package of services is provided according to age (grouped into educational phases)
– HIV Counseling and Testing and access to contraception required enabling legislation
• School activity booklet with health messages for girls and boys is delivered with HPV
• De-worming medication to be introduced in 2016 and administered by teachers whilst nurses are vaccinating at the school
Source: Presentation by South Africa at the Global Learning Meeting on HPV vaccine introduction, November 2015
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Common practice in Western Pacific Region countries(2013)
13
14
Check of vaccination status at school entry?
Yes
No
Vaccination check up @ school entry
Source: JRF 2014
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Consent• For infants, presence of mother at
the clinic is implied consent
• Redefine the consent process for
vaccinating adolescents not in parents' presence
Social mobilization even more important • Inform both caregivers and adolescents (and teachers and
stakeholders…)
• Non traditional stakeholders (eg .OBGYN)
• Vaccines targeting only girls predisposes to rumours (TT, HPV)
Challenges with vaccination of adolescents
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Choice of strategy (Effort and cost considerations)• Health facilities or school-based?
• Community outreaches, Campaigns (eg. Child Health days)
• Balance of cost and coverage
• Coordination with the education and other sectors
How to reach vulnerable populations?• Out-of-school (non-enrolled/absent), Institutionalized, migrant,
farming communities
Reporting and monitoring of vaccination coverage• Challenge of denominators for this new age group
• Grade based/wide age range
Challenges with vaccination of adolescents
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The way forward
Ever more vaccines target adolescents and school aged children. This holds potential to develop an adolescent vaccination "platform"
Adolescent vaccination can be integrated in and reinforce school health or adolescent health
Raise awareness and improve vaccination status through School-entry screening or medical check–up's (eg 12 yr old check up)
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THANK YOU