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Dr. Mohamed El Bakry Chairman of the Pediatrics Department Banha University Intercontinental City Stars May 19 th, 2011.

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Presentation on theme: "Dr. Mohamed El Bakry Chairman of the Pediatrics Department Banha University Intercontinental City Stars May 19 th, 2011."— Presentation transcript:

1 Dr. Mohamed El Bakry Chairman of the Pediatrics Department Banha University Intercontinental City Stars May 19 th, 2011

2 Vaccinations … Where we R?? Where 2 go??


4 Bakry, 2011

5 Vaccination Schedule VaccineSchedule BCG DTwP DTwP Hep Hep B Influenza 6-59 months; >50 years MenAC MenACWY MMR 12-15 months; 4-6 years OPV Td TT Vitamin A Hep A 12-23 months DTaP 2, 4, 6, 15-18 months; 4-6 years Hib 2, 4, 6, 12-15 months HPV 11-12 years IPV 2, 4, 6-18 months; 4-6 years MenC conj 11-12 years Pneumo conj 2, 4, 6, 12-15 months Pneumo ps >= 2 years Rotavirus 2, 4, 6 months Tdap 11-12 years Varicella 12-18 months; 4-6 years Bakry, 2011

6 Licensed vaccines in routine use in the USA, 1980 and 2008 FDA licensed vaccines in routine use in 1980 Diphtheria Tetanus Pertussis Polio Measles Mumps Rubella Influenza Pneumococcal FDA licensed vaccines in routine use in 2008 Diphtheria Tetanus Pertussis Polio Measles Mumps Rubella Influenza Pneumococcal Hemophilus influenza type B Hepatitis A Hepatitis B Herpes Human papillomavirus Meningococcal Rotavirus Varicella Bakry, 2011


8 Vaccination Schedule VaccineSchedule BCGBirth DTwP DTwP Hep Hep B2, 3, 16-18 months Influenza MenAC MenACWY MMR12, 13-24 months OPV Td 16-18, 26-28, 38 48, 58, 68 years TT Vitamin A DT6, 11-15 years DTaPHibIPV2, 3, 4, 16-18 months DTaPIPV11-13 years HPV1 st contact; +2, +6 months (girls at 14 years) IPV6, 11-13 years Pa26-28 years Pneuma conj2, 3, 12 months YF12 months, 11, 21, 31, 41, 51 years Bakry, 2011


10 Vaccination Schedule VaccineSchedule BCGbirth DTwP4-6 years DTwP HibHep 2, 4, 6 months Hep BBirth Influenza MenAC MenACWY MMR1, 4-6 years OPV4, 6, 12 18 months; 4-6 years Td>= 7 years TT(CBA, pregnant) Vitamin A DT< 7 years DTwP Hib18 months Hep A2, 4, 6 months HIB2, 4, 6 months IPV2 months Measles9 months Pneuno conj 2, 4, 6, 12 months Pneumo psRisk groups Varicella 1, 4-6 years Bakry, 2011


12 Vaccination Schedule VaccineSchedule BCGbirth DTwP18 months DTwP HibHep2, 4, 6 months Hep Bbirth Influenza(high risk groups) MenAC MenACWY(pilgrims) MMR12, 18 months OPV 4, 6, 18 months; 6, 17 years Td12, 17 years TT(pregnant/wound) Vitamin A9, 18 months DT6 years IPV 9 weeks Measles(part of country) Pneumo conj2, 4, 6, months Rabies(high risk – animal bites) Rubella15-49 years (post partum) Bakry, 2011


14 Vaccination Schedule VaccineSchedule BCGbirth DTwP6, 10, 14 weeks DTwP HibHep 6, 10, 14 weeks Hep B Influenza MenAC MenACWY MMR OPVBirth; 6, 10, 14 weeks Td TT1 st contact, +1, +6 months; +1, +1 year Vitamin A9-24 months Measles9, 18 months Bakry, 2011


16 Vaccination Schedule VaccineSchedule BCGBirth DTwP DTwP HibHep 6, 10, 14 weeks Hep B Influenza MenAC MenACWY MMR OPV6, 10, 14 weeks Td TT1 st contact; +1, +6 month; +1, +1 years Vitamin A Measles9 months Pneumo Conj From January 2011 Rotavirus From July 2010 Bakry, 2011

17 Vaccination Coverage 2009 Bakry, 2011


19 Vaccination Schedule VaccineSchedule BCGBirth DT6 years DTwP3, 4, 5, 18-24 months Hep BBirth, 1, 6 months Influenza MenA6-18 months (x2) MenAC3, 6 years MMR 18-24 months OPV2, 3, 4 months, 4 years Td TT Vitamin A Hep A18, 24-30 months JapEnc8 months, 2 years (or 8 months (x2); 2, 6 years) Measles 8 months MM 18-24 months MR 8 months Bakry, 2011


21 Vaccination Schedule VaccineSchedule BCG3 days, 7, 14 years DTwP3, 4, 5, 6, 18 months DTwP Hep3, 6 months Hep B1 st day; 3,6 months Influenza MenACPart of country MenACWYPart of country MMR12 months; 6 years; part of country OPV18, 20 months; 14 years Td6-7, 14 years; +19 years TT Vitamin A Dip+10 years DT3, 4, 5, 6 months Measles12 months; 6 years MM12 months; 6 years Mumps12 months; 6 years Bakry, 2011


23 Vaccination Schedule VaccineSchedule BCGBirth DTwP6, 10, 14 weeks DTwP Hep Hep B Influenza MenAC MenACWY MMR OPVBirth, 6, 10, 14 weeks Td TT1 st contact, +1, +6 months, +1, +1 year Vitamin A9 months Measles9 months Bakry, 2011

24 أم الدنيا

25 Vaccination Schedule VaccineSchedule BCGBirth DTwP2, 4, 6, 18 months DTwP Hep2,4,6 months Hep B2, 4, 6 months Influenza MenAC3, 6, 12, 15 years MenACWY MMR12, 18 months OPVBirth, 2, 4, 6, 9, 18 months Td TT Vitamin A9, 18 months Bakry, 2011

26 Egypt Vaccine Market obligatory optional BCG HBV DTP OPV MMR Hib Varicella PCV Rotavirus Influenza HAV Mening Bakry, 2011

27 Vaccination Coverage 2009 Bakry, 2011


29 Where do we want to go??

30 lobal lliance for accines & mmunization G A V I

31 Is a global alliance between PRIVATE and PUBLIC sectors committed to saving CHILDREN’S lives & protecting peoples health by increasing access to immunization in peer countries. Bakry, 2011

32 “Supporting children’s immunization is undoubtedly the best investment we’ve ever made” – Bill Gates, Co- Chair Bill & Melinda Gates Foundation GAVI Bakry, 2011

33 Alliance board 2008 GAVI WHOWorld Bank Bill & Melinda Gates Foundation Governments of donor countries Governments of developing countries Research of Health institutions Civil Society Organizations Independent individuals Vaccine industry of developing & industrialized countries Bakry, 2011

34 GAVIs’ Goal! Reducing childhood mortality by 2/3 by 2015 Bakry, 2011

35 FACTSFACTS 9 million children die before their 5 th birthday every year 2.4 million children die from diseases that are vaccine preventable (That is one child every 20 seconds!) 24 million children in the world remain unvaccinated!! Bakry, 2011

36 Causes of under five child deaths in low income countries Bakry, 2011

37 GAVI supports 72 countries AfghanistanAngolaArmeniaAzerbaijan BangladeshBeninBhutanBolivia Burkina FasoBurundiCambodiaCameroon Central African RepublicChadComoros CongoDem Republic of Côte d'IvoireCuba DjiboutiEritreaEthiopiaGambia GeorgiaGhanaGuineaGuinea Bissau GuyanaHaitiHondurasIndia IndonesiaKenyaKiribatiKorea DPR Kyrgyz RepublicLao PDRLesothoLiberia MadagascarMalawiMaliMauritania MoldovaMongoliaMozambiqueMyanmar NepalNicaraguaNigerNigeria PakistanPapua New Guinea RwandaSão Tomé SenegalSierra LeoneSolomon IslandsSomalia Sri LankaSudanTajikistanTanzania Timor LesteTogoUgandaUkraine UzbekistanViet NamYemenZambia Zimbabwe ½ the worlds population Bakry, 2011

38 GAVI Averted 5 million deaths 2000-2010 Committed 4 billion US $ for 75 countries between 2000-2015 Start up grant US $ 750 million in 1999 by Bill & Melinda Gates Foundation Additional Hepatitis B vaccination 3 doses for 267 million children Bakry, 2011

39 Pentavalent (DPT, HBV, Hib) Rotavirus vaccine Pneumococc al ?? GAVI supporting new vaccines Bakry, 2011

40 Vaccine preventable deaths and the global immunization vision and strategy, 2006 - 2015 Priorities in Public Health interventionsVPD deaths can be averted if existing vaccines used at full potentialIn 2002 deaths from diseases for which vaccines are WHO recommended<1,000 children < 5 died from polio4,000 children died from diphtheria15,000 children died from yellow fever198,000 children died from tetanus294,000 children died from pertussis386,000 children died from (Hib) Hemophilus influenza type B540,000 children died from measles Bakry, 2011

41 Immunization coverage with DTP3, Hepatitis and Hib vaccines in GAVI supported countries 2000-2011 Bakry, 2011

42 Vaccination and decline of Hib disease in Finland Bakry, 2011

43 GAVI’s Strategy GAVI’s ability to secure predictable long-term funding and prompt demand for vaccines Manufacturers (including in developing countries) have increased commitment to providing suitable vaccines for developing countries Increased competition for vaccine productionDecreased prices of GAVI supported vaccines Bakry, 2011

44 The GAVI alliance strategy 2011-2015 Bakry, 2011

45 HSS: Health System Strengthening six key components

46 Health service delivery: a network of health facilities to provide access to primary & secondary care. Bakry, 2011

47 Health workers: in the right place at the right time with training, experience & incentives Bakry, 2011

48 Health information systems: to generate quality data and to measure what is being done & achieved Bakry, 2011

49 Logistics & supply systems: so that drugs, equipment and fuel are available Bakry, 2011

50 Health financing: to raise sufficient funds for health & improve financial risk protection Bakry, 2011

51 Leadership & governance: to ensure that strategic policy frameworks exist and there is proper accountability and oversight Bakry, 2011

52 Egypt is strong in this area because of good infrastructure of existing high vaccination coverage Bakry, 2011

53 Vaccine Research & the future

54 Vaccines by Period of Development 18th Century Smallp ox (1798) 19th Century RabiesHog choleraDiphtheria Antitoxin Cholera Plague Typhoid (1896) Early 20th Century BCG tuberculosis Pertussis (1926) Diphtheria (1923) Influenza (1936) Tetanus toxoid (1927) Yellow fever (1935) Rickettsia (1936) Influenza A (1936) Post WW II Yellow Fever (1935) Influenza (1945) Diphtheria Typhoid (1952) Polio salk (1955) Meningococcus (1962) PolioSabin (1963)Measles (1963)Mumps (1967) Tick-borne encephalitis rubella (1970) Anthrax (1970)MMR (1971) 1980- 1999 Adenovirus Rabies (1980, human) Hemophilus influenza Hepatitis B (1987)Typhoid (1992)Salmonella Japanese encephalitis Hepatitis B (1981)Varicella (1995) Pertussis acellular (1993) Lyme disease (1998) Hepatitis A (1995)Rotavirus (1998) 2000- 2010 Pneumococca l Meningococc al disease InfluenzaParainfluenza Human papillpmavirus (HPV) Future H. Pylori Streptococ uss HIVHepatitis C adenoviruse s Bakry, 2011

55 Introduction of first generation of vaccines used on humans Originals 1798 Smallpox 1885 Rabies 1897 Plague 1923 Diphtheria 1926 Pertussis 1927 Tuberculosis (BCG) 1927 Tetanus 1935 Yellow Fever After WW II 1955 Injectable Polio Vaccine (IPV) 1962 Oral Polio Vaccine (OPV) 1964 Measles 1967 Mumps 1970 Rubella 1981 Hepatitis B Bakry, 2011

56 Vaccines used by the expanded Programme on Immunization (EPI) From 1974 onwards BCG Polio DTP Measles* Added Later Yellow fever (in endemic countries Hepatitis B MMR used in industrialized countries and now in many developing countries Bakry, 2011

57 Stages of vaccine development Vaccine development proceeds through discovery process engineering toxicology and animal studies to human phase I, II and III trials. The process can take more than 10 years, depending on the disease Bakry, 2011

58 An ideal Vaccine should be Good immune response Both cell mediated immunity and antibody responses Immunity is long lived Single dose Safety Danger of reversion to virulence, or severe disease in immunocomprised Stability Organisms in the vaccine must remain viable in order to infect and replicate in the host Vaccine preparations are therefore very sensitive to adverse storage conditions Maintenance of the cold chain is very important Expense Cheap to prepare Bakry, 2011

59 Calculated Cost effectiveness for any Vaccine No of doses of vaccine given Cost of Vaccination (doses + admin.) No of Episodes of disease prevented e.g Otitis Media -Saving Pneumonia -Saving Invasive Diseases -Saving No life Years Saved = Net Cost of Vaccine Program Net Cost of Vaccine Program = Cost per Life –Year Saved No life Years Saved

60 Pneumococcal Vaccine (1000 children)


62 Conclusions Lobbying for improving states of vaccinations in Egypt. Start by introduction of Hib as part of the national program Then gradually introduce other vaccines according to priorities Bakry, 2011

63 Possible candidates Varicella Hepatitis A Rota Pneumococcal Bakry, 2011

64 Funding Approach MoH for co-ordination of plans Approach GAVI to renew status of Egypt Negotiate prices of vaccines with producers Approach civil society associations for funding start ups and maintenance Cost sharing with the public Bakry, 2011

65 المطلوب : توفير اكبر قدر من التطعيمات للاطفال شارع شارع حارة زنجا زنجا ( زنقة زنقة )

66 الطفـــل يريد حقــه فــى التطعــــيم

67 Thank You

68 Timeline of vaccines (20 th century) 1932194519521954195719621964 Yellow fever Influenza polio Japanese encephalitis Adenovirus – 4 & 7 measles Oral polio vaccine 1962 Mumps Bakry, 2011

69 Timeline of vaccines 1970197419771978198119921998 rubella Chicken pox pneumonia meningitis Hepatitis B rotavirus Hepatitis A Bakry, 2011

70 New vaccines and combinations Hepatitis B (and A) catch up Haemophilus influenza b (Hib)- universal MMR, Measles, mumps, rubella x 2 – universal DPT x 4 – update policies, catch up, also for elderly (H zoster) Influenza – all ages Pneumococcal pneumonia – all ages Rotavirus Human papilloma virus (HPV) and cancer cervix Future vaccines – streptococcus, cytomegalovirus (CMV), helicobacter, HIV, malaria, avian flu Cocktails- maximum combination of routine vaccines New methods of production of vaccines Bakry, 2011

71 WHO/UNICEF’s current vaccines Bakry, 2011

72 Cold chain monitor card: upon arrival to a health clinic, vaccines are stored in refrigerators and temperatures recorded on a chart. The temperatures are monitored and recorded twice a day to ensure that a safe temperature is maintained Vaccine vial monitor (VVM): the vaccine vial monitor consists of a temperature sensitive label placed on each vial that registers cumulative heat exposure for that vial. GAVI resolved that all vaccines be purchased by the Vaccine Fund after 2003 will include VVM (immunization focus, July 2003, GAVI newsletter) Freeze watch: in the freeze watch, a vial with a red liquid that bursts and stains a white placard if exposed to temp. below zero for > 1 hour is packed with DTP, TT (freezing pt. -6.5 C) (WHO, vaccines-cold chain, 2005)

73 GIVS Global Immunization vision and strategy 2006-2015 Bakry, 2011

74 Canadian Institutes of Health Research CIHR in the 1 st 10 years of 21 st century research in development of new vaccines has accelerated to meet antibiotic resistance infections as well as combat cancers and diseases that were once thought invincible. Bakry, 2011

75 Canadian successes in vaccines research include an acellular pertussis vaccine; a candidate vaccine for Severe Acute Respiratory Syndrome (SARS); a cattle vaccine against E. coli 0157:H7;the development of vaccine technology to prevent meningitis; candidate vaccines against hemorrhagic fevers; the preparation for and assessment of the impact of human papilloma virus (HPV) immunization in Canada; the development of therapeutic cancer vaccines; the safe administration of vaccines produced in eggs to egg-allergic individuals; the evaluation of influenza vaccination strategies and transmission dynamics within a community; and, the development of new vaccination strategies for Human Immunodeficiency Virus (HIV-1) Bakry, 2011

76 WHO state of the art of new vaccines: Research and development 2006

77 Sexually transmitted diseases Chlamydia trachomatis Gonorrhea Herpes simplex type 2 HIV/AIDS Bakry, 2011

78 Vector borne viral infant Dengue fever Japanese encephalitis Tick-borne encephalitis West Nile virus Bakry, 2011

79 Zoonotic infections Anthrax Hepatitis E Leptospirosis Plague Rabies Bakry, 2011

80 Viral cancer Epstein-Barr virus Hepatitis C Human papillomavirus Bakry, 2011

81 Diarrhea disease Caliciviruses Campylobacter Cholera Enterotoxigenic Escheria coli (ECTC) Rotavirus Shigellosis Typhoid fever Bakry, 2011

82 Respiratory infections Influenza Parainfluenza viruses Respiratory syncytial virus (RSV) Severe acute respiratory syndrome (SARS) Streptococcus pneumoniae tuberculosis Bakry, 2011

83 Bacterial infections Helicobacter pylori Neisseria meningitidis Mycobacterium ulcerans (Buruli ulcer) Staphylococcus aueus Group A Streptococcus Group B Streptococcus Bakry, 2011

84 Parasitic diseases Amoebiasis Hookworm disease Leishmaniasis Malaria schistosomiasis Bakry, 2011

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