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Dr Collins TabuNational Vaccines and Immunization Program,
Ministry of Health, Kenya
New Vaccine Introduction‘Polio Vaccine switch (tOPV to bOPV), IPV and
MR vaccine introduction in Kenya’
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Evolution of the Immunizationprogram
Established in 1980 with the main aim of providing immunizationagainst six killer diseases of childhood, before then, provided on an ad-hoc basis through schools and the larger health facilities
Therefore concentrated initially on establishing and strengthening thehealth service delivery
Later, targeted Universal Child Immunization goals of immunizing atleast 80% of the target population
Program focus has since shifted to Disease Elimination andEradication, with the Goals of: Polio Eradication and Measles, Rubellaand Maternal Neonatal Tetanus Elimination
Shift with to universal access to immunization with SDGs andUniversal Health Coverage as guiding principles
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Vaccination strategies Routine
immunization serves80% of population
Venues: Clinics,schools, out reachfacilities
• Offer rapid scaleup ofimmunizationservices.
• Time limitedinterventions
• Very expensivestrategy
• Important fordisease control
• Service is takento clients
• Done incollaborationwith otheractivities
• Time limitedapproach
• Expensiveservice strategy
• Useful to reachboth hard toreachpopulations
RoutineImmunization
Supplementaryimmunizationcampaigns
NationalImmunizationdays
• Not a time limitedstrategy
• Clients present toreceiveimmunizationservices
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…….So,…WhyImmunize?
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Immunization & Disease Once your immune system is trained to resist a disease, you are said to
be immune to it
Before vaccines, the only way to become immune to a disease was toactually get it and…….with luck, survive it
You may be contagious and pass the disease to family members,friends, or others who come into contact with you
Diseases have been able to circumvent drugs through development ofresistance but this is yet to be reported for vaccination
Vaccine Efficacy in individuals and population effectiveness differ- basisfor prevention programs
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Polio: A Paralyzing Disease for Life
Delhi, 2002
Freetown, Sierra Leone, 2001
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……IPV Introduction&
tOPV to bOPV Switch
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• Immunization efforts have reduced the number of poliocases globally by more than 99% over the last twodecades
• The transition from trivalent OPV (tOPV) tobivalent OPV (bOPV) is part of the polioendgame strategy
• There are three types of polio viruses:1, 2, and 3. The last type 2 wild polioviruswas detected in 1999
Together, we can finish the job of eradicating polio
We are close to the eradication of polioWe are close to the eradication of polio
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0
100
200
300
400
1988
1989
1990
1991
1992
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1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Pol
io c
ases
(th
ousa
nds)
2014
Polio Eradication: Significant decline in number ofpersons paralyzed by wild polioviruses, 1988-2014*
Last case oftype 2 polio
1352
650
223
416 359
0
200
400
600
800
1000
1200
1400
1600
2010 2011 2012 2013 2014
Poli
o C
ases
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As wild polioviruses are eradicated, number of circulatingvaccine-derived (cVDPV) cases exceeds wild poliovirus cases
Estimated VDPV cases compared to reported cases of wild poliovirus (asof 31 December, 2014)
11
1604
1352
650
223416
0 0 00
200
400
600
800
1000
1200
1400
1600
1800
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Polio
case
s
Wild poliovirus cases
Vaccine-derived poliovirus cases(VDPVs)/VAPP
Post interruption of WPVtransmission
?
359
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Polio Eradication and EndgameStrategic Plan
Polio Eradication and EndgameStrategic Plan
In 2013, the Polio Eradication and Endgame Strategic Plan2013-2018 was endorsed by the World Health Assembly.
This global plan recommends the:
• Withdrawal of all OPV worldwide, beginning with the type 2component in April 2016 (“the switch” from tOPV to bOPV)
• Introduction of IPV into routine immunization before theswitch from tOPV to bOPV to maintain protection against all3 types of poliovirus
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Introduce• at least one dose of IPV into
routine immunization
Switch• tOPV to bOPV
Withdraw• bOPV & routine OPV
use
Ongoing STRENGTHENING of routine immunization services
The Plan addresses the Endgamethrough three distinct stages
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• tOPV and IPV protect againstpoliovirus types 1, 2 and 3.
• The type 2 component of tOPVcauses the majority of cVDPV cases.
• bOPV and IPV protect againstpoliovirus types 1, 2 and 3.
• bOPV has a lower risk of cVDPVs.
In April 2016,withdraw type 2
The switch from tOPV to bOPVThe switch from tOPV to bOPV
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Both OPV and IPV are neededat this stage of polio eradication
Both OPV and IPV are neededat this stage of polio eradication
• IPV will provide protection againstpolio type 2 after the type 2component of OPV is removed.
• IPV also provides additionalprotection against types 1 and 3.
• IPV is not a 'live' vaccine, thereforecarries no risk of VAPP or cVDPV
Used together, OPV and IPV provide the best form ofprotection in the final stages of polio eradication.
After April2016
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• All 156 OPV countries must switch from tOPV to bOPV inroutine immunization and SIAs• Manufacturers will not supply tOPV for use after the switch
• WHY April 2016?• To coincide with the “low” season for poliovirus transmission in
countries with endemic polio or recent polio cases• WHY globally synchronize during 2 weeks?
• To ensure that no country is put at risk of importing a cVDPV2 fromanother country
• Regions with continued tOPV use after the switch may generatetype 2 cVDPVs, which could spread elsewhere
The switch is occuring simultaneously in allcountries during 2 weeks in April 2016
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……..Measles RubellaVaccine Introduction
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Measles & Rubella Highly infectious, humans are the only reservoir
In 2000, measles was leading cause of vaccine preventablepediatric deaths, now 3rd after Pneumococcal and Rotavirus
Rubella is a leading cause of congenital defects, 100,000cases in developing countries annually (Year 2000)
Primary objective of rubella vaccination is to prevent this
Deaths and Disabilities from Measles and Rubella arecompletely preventable
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95% population immunity not achievable with only 1 dose (routine)even at very high vaccination coverage
Only 85% of children vaccinated against measles develop immunityfrom the first dose
Accumulation of susceptible children occurs over time (i.e. childrenwith no immunity)
High risk of outbreak when number of susceptible ≥ annual birthcohort
Second opportunity for vaccination against measles needed to achieve& sustain high population immunity
Need to conduct wide age range SIAs prior to Introduction of Rubellavaccine to reduce Risk of paradoxical increase in CRS Cases
Measles- Rubella Introduction &SIAs, Rationale
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Measles Coverage by year, Kenya,2013-2015
0
20
40
60
80
100
2013 2014 2015Measles Cov. 1,082,420 (75%) 1,129,057 (78%) 1,178,281 (81%)
Un-vaccinated 360,832 (25%) 322,587 (22%) 276,386 (19%)
Non Immune 162,363 169,358 176,742
523,1951,015,140 1,468,268
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Vaccination status of confirmed cases ofmeasles by year
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Distribution of measles and RubellaCases in Kenya, 2011- 2015
2011 2013 201520142012
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Strengthening routine immunization (RI)- at 9 & 18 months Providing a second opportunity for vaccination with measles
vaccine: Supplemental immunization (catch up and follow up) Introduction of second dose of measles vaccine in RI
Strengthening of case-based measles surveillance Strengthening of measles Case Management (including Vita A
supplementation)
Measles & Rubella control strategies
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Next for Measles Rubella?, Kenya MR SIAs planned for 16th to 24th May 2016, target 18.9 million
children 9months – 14 years
Plans to introduce Measles Rubella vaccine into Routineimmunization after SIAs
Plans to integrate with Tetanus Toxoid sNIDs (in some high risk sub-counties)
Logistics Required:
21.8 million doses of MR vaccine, 23.5 million syringes
42,000 health workers and 24,000 Volunteers
20,000 vaccination centers, 2,100 vehicles
Total expenditure: KShs. 2.3 Billion
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Immunization Key Issues,……. Understandably,…..vaccine safety gets more public attention
than vaccination effectiveness,…..but vaccines are far saferthan therapeutic medicines
Did Jenner have it easy compelling people to comply?
Most of the time the games played are according to rules thatare not generally those of science
The number of deaths & disabilities caused by traditionalvaccine-preventable has Reduced dramatically over the years
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Key issues…Considerations in introducingImmunization Interventions
Is the magnitude of public health problem conclusivelydetermined?
Are the risk groups clearly identified?
Ensured availability of an effective vaccine?
Ability of vaccination services to cover > 80% of at-risk-population in order to break transmission
Political Goodwill
Cost Implications/ Cost effectiveness
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A world free of Vaccine preventable diseases means NOchild gets paralysed, BETTER quality of life, COSTSAVINGS on resources spent on rehabilitation,treatment & time from work, and MORE resourcesavailable for other priority health needs
Immunization is all our responsibility
EVERY CHILD COUNTS!
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Thank you