1. VACCINE PREVENTABLE DISEASES – WAY FORWARD IN NIGERIA
Prof G. C. Onyemelukwe
FWACP, (MON)
19TH JULY 2013

2. VACCINATION POLICY IN NIGERIA SINCE EDWARD JENNER – COW POX
Mandatory for childhood, social mobilization and health education are very necessary. Child Rights Act vaccination is a right. Niger state Assembly passed a bill in 2010/2011 for compulsory polio vaccination of children. Federal government from 2012 purchases all vaccines with donor support of GAVI, WHO, UNICEF, DFID, BILL GATES FOUNDATION, CLINTON HEALTH ACCESS INITIATIVE and other partners. Private sector participation in vaccination. GERIATRIC ACT BY NIGERIA NATIONAL ASSEMBLY PASSED 2009.
Abuja Declaration of Africa Union on Tb, HIV and malaria in Africa.

3. TYPE S OF PREVENTIVE INTERVENTION
PRIMARY PREVENTION-
AVOIDANCE OF DISEASE OCCURRENCE
SECONDARY PREVENTION
PREVENTION (EARLY DETECTION AND REVERSAL) BEFORE COMPLICATIONS
TERTIARY PREVENTION
PREVENTION OR DELAY OF COMPLICATIONS IN ONGOING/ESTABLISHED CASES
Hotez P rescuing the bottom billion through control of neglected tropical diseases. THE LANCET (373:P – 1575)

4. UNIVERSAL HEALTH COVERAGE
Access for all to appropriate health services at an affordable cost, with highly cost effective prevention activities and therapies accessible to all citizens; Health care financing system mitigate risk of households falling into poverty or suffering large financial losses because of costly health system .
Vaccine security involving all stakeholders is a sine qua non

5. ACCESSIBLITY AND AFFORDABILITY
(a). A wide range of health services, including highly cost-
effective prevention activities and therapies, should be
accessible to all citizens of a give a Country and
(b). The system of financing healthcare should mitigate, as
much as possible, the risk that households would fall into
poverty or suffer large financial losses as a result of a
costly health problem.
The Joint Learning Network for Universal Health Coverage chronicles the challenges and successes of specific reforms within countries, providing a learning platform for senior policy-makers and practitioners in more than a dozen countries.

6. GOALS OF VACCINATION
Immunity and herd immunity: Herd Immunity is based on the idea that the pathogen will not spread when a significant part of the population has immunity against it. Primary prevention of cancer of cervix and liver possible. Mass immunization.
Eradication of disease: World Health Organization coordinated the global effort to eradicate smallpox globally. Endemic measles, mumps and rubella in Finland eradicated. Polio has been eradicated in most countries except Pakistan, Afghanistan, and Nigeria as at 2013.
Individual, group, selected vaccination of at risk groups: E.g rabies vaccination for veterinary workers.
Therapeutic vaccines or vaccination – anti-IgE vaccines in asthma, anti-cancer therapeutic vaccines e.g. for prostate cancer. Passive delivery of monoclonal antibodies (MoAb) against cancers.

7. FASTER PROGRESS WITH VACCINES TO MDGs (2000-2015)
MDG1: END POVERTY AND HUNGER – Vaccines protect from death, disability, free
family finances
MDG2: Achieve universal primary education – Healthy to immunized to attend
school
MDG3: Promote gender equality- Healthy children free women
MDG4: Reduce Child mortality- Vaccines prevent 2.5 million child deaths per year,
79% in developing countries, Pneumonia Diarrhea Rota virus) kill 3 million.
MDG5: Improve maternal health- Material neonatal tetanus vaccines
MDG 6: Combat HIV/AIDS, malaria other disease- Vaccinate HIV positives,
Pneumonia, Diarrhea reduce transmission.
MDG7: Ensure environmental sustainability – Rota virus vaccination reenergizes safe
drinking water.
MDG8: Develop global partnership for development
- WHO, UNICEF, GAVI, Bill and Melinda Gates, IVAC, CLINTON HEALTH ACCESS
INITIATIVE
- Parliamentary Advocacy and financing for immunization in Nigeria (PAFFIN)
HERFON
- Women Advocates for vaccine Access (WAVA)
- Nigeria National Vaccine Summit, PAN 2012
- World Pneumonia Day 2011, GAVI initiative from 2000 – Save children
lives, access to Immunization.

8. GUAGING COUNTRY LEVEL MDGs ACHIEVEMENT(MIDTERM)

9. VACCINE LANDSCAPE 2000 TO 2020

10. IMMUNOLOGICAL SPECTRUM PRE NATAL TO OLD AGE
NEO-NATAL
CHILD
HOOD
IMMUNE COMPROMISED
GERIATRIC IMMUNO-SENESENCE
TRANS-
PLACEN-TAL IMMU-NITY
1.ROU
TINE
UNIVE
RSAL
IMMU
NIZA
TION
2.BREAST FEEDING
3. TB,POLIO,
DTP, Hib,
YF, measles
ROTAVIRUS
pneumococci
PREGNANCY
HIV-AIDS 3.5million
SICKLE CELL DISEASE
CHRONIC DISEASES
CANCERS
Anti-cancer vaccine
Monoclonal antibodies (MAb)
ASTHMA
Anti -
IgE vaccines
SPECIAL INFECTIONS
CHOLERA
YELLOW FEVER
LASSA FEVER
MALARIA
SCHISTOSOMIASIS
FILARIASIS
AVIAN INFLUENZA
RABIES/RELATED VIRUS
MENINGITIS
PNEUMONIA

11. MATERNAL ANTIBODIES IN BREAST MILK PROTECT THE CHILD FROM ENTEROVIRUS INFECTIONS.
Sadeharju K, Knip M, Virtanen SM, Savilahti E, Tauriainen S, Koskela P, Akerblom HK, Hyöty H; Finnish TRIGR Study Group. Pediatrics May;119(5):941-6.
Protective high maternal antibiotics in serum and breast milk better in breast fed > 2 weeks
. Secretory IgA for mucosal defence of baby
. Anti-tetanus transplacental antibodies after maternal immuinization.

12. BREAST MILK ADVANTAGES
SIMPLE OLIGOSACCHRIDES – Binding sites to intercept bacteria entry into intestinal cell.
2. MUCINS – Adhere to bacteria, viruses to eliminate them
3. LACTOFERRIN – Bind iron, unavailable to organisms
4. B12 BINDING PROTEIN – deprive organisms of Vit B12
5. BIFIDUS FACTOR – promotes beneficial Lactobaccilus bifidus growth
6. INTERFERON – In colostrum, antiviral activity
7. FIBRONECTIN – In Colostrum, repair of tissues, minimize
inflammation, make phagocytes more aggressive.
8. INDUCER FACTORS – Induce infants immune system
9. ENHANCER EFFECT – higher levels of antibodies, cortisol, epidermal
growth factor, nerve growth factor Insulin – like growth factor,
somatomedin C, to close leaky mucosal lining of newborn.
10. FREE FATTY ACIDS – damage membranes of enveloped viruses e.g.
chicken pox virus
11. SECRETORY IgA IN URINARY TRACT - Lactoferrin, lysozyme found
in large amounts in urinary tract of breast fed.
12. Induces increased local production of Lactoferrin

13. CELLULAR DEFENCES IN BREAST MILK
Immune cells abundant in breast milk – white blood cells, leukocytes 40% are macrophages, manufacture lysozyme that destroy bacteria.
Lymphocyte 10%.
B Lymphocytes produce antibodies. Milk lymphocytes proliferate in presence of Escherichia coli. Produce gamma – interferon, monocyte chemotactic factor.

14. INNATE SYSTEM WORKS WITH ADAPTIVE IMMUNE SYSTEM
Cell mediated

15. FOETAL IMMUNOLOGICAL PROGRAMMING
HELMINTH- AND BACILLUS CALMETTE-GUÉRIN-INDUCED IMMUNITY IN CHILDREN SENSITIZED IN UTERO TO FILARIASIS AND SCHISTOSOMIASIS
Indu Malhotra, Peter Mungai, Alex Wamachi, John Kioko, John H. Ouma, James W. Kazura and Christopher L. King
J. Immunol Jun 1; 162 (11): 6843 – 8.
FOETAL IMMUNOLOGICAL PROGRAMMING
Prenatal sensitization to filarial and schistosomiasis in
mother induces immunology memory that persists in
infancy in 50% of newborns, which leads to reduction
of induction of type I T cell immunity induced by BCG for
at least 2 – 10 years. Avoid parasite infection in pregnant
women.
2. Malnutrition in under 5 poor immunization antibody

17. Each case infects 10 A. Each case infects 10 other
MEMORY B CELLS AND MEMORY TH CELLS ARE GENERATED BY IMMUNIZATION AND HERD IMMUNITY INCREASED
Each case infects A. Each case infects 10 other
other individuals in individuals in a population
a susceptible population With 80% immunity.

18. ANTI - IgE VACCINES FOR ASTHMA AND ALLERGY

19. ASTHMA ALLERGENS IN NIGERIA
Dermatophagoides pteronnysinus
Dermatophagoides farinae Onyemelukwe et al
Egg yolk, egg white Rast specific IgE in Nigerian
Okro, frying oil, pepper asthmatic patients. Ann.Allergy
1986;56(2)
Pollens Onyemelukwe G. Rast specific IgE to egg
Airborne fungi etc. and milk in Nigerian asthmatic patients
African J Med. Med Sci 2011;40(7) 51-7
A. Severe Acute: Chimeric IgE Vaccines
DNA of Allergenic substances (Derf1)
Dermatophagoides farinae
ANTISERA to spider bites, jellyfish stings and other
allergies.
D. CYTO – 003 wing Q beta derived virus like
particles VLP

20. OTHER PARASITE VACCINE APPROACH
PARASITES
MALARIA VACCINE
Phase 3 trials of RTS, S/ASOI Malaria vaccine in Africa Infants (6573 infants). New Engl. J. Med 2012, 367, RTS, S CLINICAL TRIALS PARTNERSHIP
REDUCE EPISODES OF BOTH CLINICAL AND SEVERE MALARIA IN CHILDREN 5 – 17 months by about 50%. One month after 3doses all was positive for anticircumsporozoite antibodies.
OTHER PARASITE VACCINE APPROACH
1. PARASITE ANNEXINS (found in Nematodes, Trematodes,Protozoa) Annexins
bind phospholipids. used T. Solium vaccination of pigs, Giardia duodenalis
– trophozoite vaccine of cats, dogs.
2. PARAMYOSIN in muscles of invertebrates, found in Schistosomiasis (SM97)
filariasis, Taenia Solium, Echinococcus granulosa produce TH1 response
J.Vazquez – Talavera et al; America Society Microbiology Infection and
Immunology 2001.
3. Wuchereria Bancrofti GST vaccination for lymphatic filariasis. Veerapathran A et
al PLOS Neglected Tropical Diseases 2009.GST (Glutathione – S- Transferase).
rWbGST as a potential vaccine candidate against Lymphatic filariasis.
4. HOOKWORM VACCINES – (a) HHVI (Human Hookworm Vaccine Initiative) Na-
ASP2tried in Brazil. Peptide-Based Subunit Vaccine against Hookworm Infection
(PLOS ONE /article/info%3Adoi%2F %2Fjournal.pone
M. Skwarczynski et al.

21. ADVANCES IN TOXOPLASMOSIS VACCINES

22. CANCERS CANCER PREVENTIVE VACCINES 1. HPV ( 17 SEROTYPES) – 16 and 18
70%, other cervical cancer, vaginal, vulva, penile, oropharyngeal cancer
GARDASIL – 16, 18, 6, 11 (Quadruvalent) GARDASIL MERCK and COMPANY Age
6, 11 cause 90% genital wart.
Made of virus – like particles (VLPS) And correspond to HPV types 6, 11, 16, 18
2. CERVARIX (bivalent) GSK 16, 18. Age 9 – 25
3. HBV Vaccine – children vaccinated at birth
CANCER THERAPEUTIC VACCINES
SIPULEUCIL – T (PROVENGE BY DENDREON) Use of Dendritic cells.
Metastatic prostate cancer – Immune response to prostatic acid phosphate (PAP)
Customized to each patient.
Leukapharesis of antigen presenting cells (APCs) Dendritic cell cultured with protein PAP – GM – CSF. 3
treatments 2 weeks apart. Antologous vaccine
RUSSIA: VITESPAN (2008)
Heat shock protein HSPgp96 coupled to Dendritic cell – kidney cancer
HEAT SHOCK PROTEINS NEW TECHNOLOGY FOR CELLULAR IMMUNIT. Response to Leprosy, tuberculosis
and cancer.
Vaccine against MUC-1 Cancer protein ImMUCIN VAXIL BIOTHERAPEUTICS
ONGOING RESEARCH ON OTHER CANCER CAUSING ORGANISMS
1. Hepatitis C – PLCC
2. EBV – Burkitt’s lymphoma, NHL
3. KHSV – Kaposi sarcoma
4. HTLVI - Adult Tcell leukaemia
5. Helicobacter pylori – Gastric cancer
6. Schistoma – bladder cancer
haematodium.

24. VACCINE ACCEPTANCE(BUY IN) IN NIGERIA
CERVICAL CANCER RISK PERCEPTION AND PREDICTORS OF HUMAN PAPILLOMA VIRUS VACCINE ACCEPTANCE AMONG FEMALE UNIVERSITY STUDENTS IN NORTHERN NIGERIA.
Iliyasu Z, Abubakar IS, Aliyu MH, Galadanci HS .J Obstet Gynaecol. 2010;30(8):
doi: /
Of 375 females, 35.5% heard of HPV, 53.9% heard of cervical cancer, 74.0% willing to accept

25. HUMAN PAPILLOMA VIRUS VACCINE: KNOWLEDGE, ATTITUDE AND PERCEPTION OF PARENTS IN SOUTHWEST, NIGERIA
Kola M. Owonikoko, Adeola F. Afolabi, Lawrence A. Adebusoye, Oluseyi O. Atanda.
Ref. Medical Sciences and Public Health 1(1)2013; 13 – 19
Interviewed parent and guardians – 51.3% ignorant of vaccines, 89.4% agreed to vaccinate their children.

26. MONOCLONAL ANTIBODIES IN CANCER THERAPY: 25 YEARS OF PROGRESS
MONOCLONAL ANTIBODY PRODUCTS
NAME
TYPE
TARGET
CLINICAL
Rituximab
Chimeric
CD20
NHL
Trastuzumab
Humanized
Erb B2
Breast
Bevacizumab
VEGF
Colorectal
Alemtuzumab
CD52
CLL
Cetuximab
EGFR
Panitumumab
Human
Abbreviations: NHL, non-Hodgkin's lymphoma; VEGF, vascular endothelial growth factor; CLL, chronic lymphocytic leukemia; EGFR, epidermal growth factor receptor.

27. FDA APPROVED MONOCLONAL THERAPEUTIC ANTIBODIES

28. FDA APPROVED MONOCLONAL THERAPEUTIC ANTIBODIES

29. NIGERIA HEALTH WATCH – YELLOW FEVER SOUTH AFRICA DIPLOMACY
On yellow fever, yellow cards, Nigeria and South Africa
Paper protection?? Faking?? Saudi Pilgrims – POLIO IMMUNIZATION, MENINGITIS, CHOLERA, REQUIREMENTS

30. "MEDICINE IS A SOCIAL SCIENCE, AND POLITICS IS NOTHING ELSE BUT MEDICINE ON A LARGE SCALE“ RUDOLF VIRCHOW
Nigeria: Vaccine suspicion aggravates measles outbreak in Kano and elsewhere and interrupts polio eradication

31. FACTORS CONTRIBUTING TO INFECTIOUS DISEASE REEMERGENCE AND ASSOCIATED DISEASES    
CONTRIBUTING FACTOR(S)
ASSOCIATED INFECTIOUS DISEASES
1. Human demographics and behavior
Dengue/dengue hemorrhagic fever, sexually transmitted diseases, giardiasis
2. Technology and industry
Toxic shock syndrome, nosocomial (hospital-acquired) infections, hemorrhagiccolitis/hemolytic uremic syndrome
3. Economic development and land use
Lyme disease, malaria, plague, rabies, yellow fever, Rift Valley fever, schistosomiasis

32. SOURCE: ADAPTED FROM US INSTITUTE OF MEDICINE, 1997.
4. International travel
and commerce
Malaria, cholera, pneumococcal pneumonia
5. Microbial adaptation
and change
Influenza, HIV/AIDS, malaria, Staphylococcus aureus infections
6. Breakdown of public
health measures
Rabies, tuberculosis, trench fever, diphtheria, whooping cough (pertussis), cholera
7. Climate change
Malaria, dengue, cholera, yellow fever
SOURCE: ADAPTED FROM US INSTITUTE OF MEDICINE, 1997

33. LASSA ENDEMIC STATES BAUCHI PLATEAU TARABA NASARAWA BENUE ENUGU EBONYI
ONDO
9. EDO

34. RABIES ENDEMIC IN NIGERIA
Detection of rabies virus antibodies in fruit bats (Eidolon helvum) from Nigeria.
Aghomo HO, Ako-Nai AK, Oduye OO, Tomori O, Rupprecht CE. J. Wild Dis
Five viruses related to rabies occurs in Africa related to rabies occurs in Africa
Obodhang – Sudan
Kotoukan – Nigeria
Mokola – Nigeria (Shrews)
Lagos Bat – Nigeria (fruit bats)
Duvenlage – South Africa (man bitten by bat)
Epizootic in Zimbabwe 1981 in dogs, cats. Africa is ancestral origin
Rabid dogs in Nigeria lack of immunization for dogs. Human diploid vaccine available but in short supply in Nigeria as well as anti – serum.
PS STAPH INFECTIONS
Engineered genetically StaphVAX (NIH)USA

35. OVER 100M NIGERIANS AT RISK OF YELLOW FEVER OUTBREAK
A. As many as 101 million Nigerians are at risk of a possible outbreak of yellow fever, if a mass vaccination campaign is not carried out, the National Primary Health Care Development Agency has warned. Some 377 local government areas in 25 states have been marked out as high risk areas, indicate an assessment survey of the country.
Oyewale Tomori
NOTE
EBOLA OUTBREAK IN UGANDA
Ebola Outbreak in Uganda Fruit bats reservoir. Effects to other African countries including Nigeria. Surveillance and preparedness?? Occurs in Remote villages in Central and West Africa from wild animals.

36. WHO ESTIMATES 20M NIGERIANS HAVE HEPATITIS B VIRUS –SOGHIN
(SOCIETY FOR GASTRO ENTEROLOGY AND HEPATOLOGY IN NIGERIA) Sept Port Harcourt

37. HIV, HEPATITIS B AND C VIRUSES’ COINFECTION AMONG PATIENTS IN A NIGERIAN TERTIARY HOSPITAL
Taiwo Modupe Balogun,, Samuel Emmanuel1, Emmanuel Folorunso Ojerinde
Pan African Medical Journal 2012:12:100
HbsAg + Anti-HIV (4%)
HbsAg + HIV (28%)
HCV + HIV (14.7%)
Industrialized countries: HCV 20% acute hepatitis 70% chronic hepatitis, 40% cirrhosis, 60% hepatocellular carcinoma, 30% liver transplants.
15 – 60% normal African positive for one more markers of HBV

38. EPIDEMIC HISTORY AND EVOLUTIONARY DYNAMICS OF HEPATITIS
B VIRUS INFECTION IN TWO REMOTE COMMUNITIES IN RURAL
NIGERIA
Joseph C. Forbi*, Gilberto Vaughan, Michael A. Purdy, David S. Campo, Guo-liang Xia, Lilia M.Ganova-Raeva, Sumathi Ramachandran, Hong Thai, Yury E. Khudyakov.
PLOS ONE July 2010 | Volume 5 | Issue 7 | e11615.
HBV hyperdemic (seropravalence 10 – 40%) in Nigeria. As part of West Africa/ Central Africa crescent from Senegal to Namibia. 11% HBV DNA positive.
37 distinct HBV variants belonging predominantly to genotype E(96.4%)
Note HBV genotypes are 8- A,B,C,D,E,F,G,H
HBV vaccine in program but became available in 2004
5.6% consists of genotype D and G in 5 individuals.
6. HbVA3 probably from Cameroon.

39. TECHNOLOGICAL CONJUGATION OF MULTIPLE ANTIGENS
IMMUNOGENICITY AND SAFETY OF A DTaP – IPV//PRP~T COMBINATION VACCINE GIVEN WITH HEPATITIS B VACCINE:
A randomized open-label trial Maria Rosario Capeding a, Josefina Cadorna-Carlos b, May Book- Montellano c, Esteban Ortiz Bulletin of the World Health Organization.
All antigens were adequately immunogenic without interfering with each other for the era of combined vaccines - pentavalent, hexavalent, heptavalent.
RCDCs for anti-hepatitis B surface antigen titres in sera obtained at 6 and 18 weeks of age from infants in Groups A and B

40. OTHER VIRUSES
ROTAVIRUS ENDEMIC IN NIGERIA causing diarrhoea especially in childhood.
2. ZIKA VIRUS INFECTIONS IN NIGERIA: VIROLOGICAL
AND SEROEPIDEMIOLOGICAL INVESTIGATIONS IN
OYO STATE. J Hyg (Lond) Oct; 83(2):213-
9.Fagbami AH.
3. RIFT VALLEY FEVER VIRUS (BUNYAVIRIDAE:
PHLEBOVIRUS): AN UPDATE ON PATHOGENESIS,
MOLECULAR EPIDEMIOLOGY, VECTORS, DIAGNOSTICS
AND PREVENTION
Michel Pepin, Michèle Bouloy, Brian H. Bird, Alan Kemp
and Janusz Paweska. INRAEDP Sciences 2010
Epidemic in Kenya 1930, Egypt 1977, West Africa including Nigeria 1988, Arabian Peninsula 2000

41. INFLUENZA SURVEILLANCE JAN – JUN 2013 BY NCDC
946 cases
788 Influenza like (ILI)
156 Severe acute respiratory infection (SARI)
617 processed sample
472 (76.5%) ILI
73 (11.8%) SARI
72 (11.7 negative)
617 IL1 cases, 42 positive for influenza
20 (47.6%) positive for influenza A
22 (52.4%) positive for influenza B
20 positive samples for influenza A (100%) were positive for A/H5N1 subtype
73 processed SARI, 3(4.0%) were positive for A/H1N1
2 (2.7%) positive for influenza b

42. RECOMBINANT VACCINE TO PREVENT H5N1 NOT YET AVAILABLE

43. BACTERIA - PNEUMOCOCCI
PRE-VACCINATION NASOPHARYNGEAL PNEUMOCOCCAL CARRIAGE IN A NIGERIAN POPULATION: EPIDEMIOLOGY AND POPULATION BIOLOGY
Ifedayo M. O. Adetifa mail, Martin Antonio, Christy A. N. Okoromah, Chinelo Ebruke, Victor Inem, David Nsekpong, Abdoulie Bojang, Richard A. Adegbola.
Plus one 2012, 7 (1) e30548
Pneumococcal carriage 52.5% higher in children (67.4%) than adults 26%, highest in infants < 9 months.
serotypes seen: 19F, 6A, 6B, 23F, 11, 15B, 3, 18C, 9V, 14, 15B,
20, 21,7F, 4, 11, 13, 17, 7C, 19A, 21, 4, 12, Nontypables.
3. PCV7 Serotypes – 4, 6B, 9V, 14, 18C, 19F, 23F. PCV10, Serotypes
PCV7 + 1,5,7F. PCV13, Serotypes PCV10 + 3,6A, 19A
4. H influenza H1b meningitis eliminated 90% by H1b vaccine.
5. Near elimination of meningococcal C in industrial countries by
vaccination

44. PNEUMOCOCCAL SEROTYPES IN ZARIA, NORTHERN NIGERIA
Onyemelukwe G.C and Greenwood B.M. Journal of Infection 1982 ST 1 2 3 4 5 9 10 11 12 15 17 18 19 21 23 25 41 45 46 48 T Mn 51 Pn 20 70 Bc 8 6 7 16
KEY:
ST= SEROTYPES
Mn= MENINGITIS
Pn=PNEUMONIA
Bc= BACTEREMIA/ANTIGENEMIA
T=TOTAL

45. VACCINES STRATEGIES PCV13 - serotypes
1. Vaccination – pneumococcal conjugate vaccines. (PCV7,PCV10,
PCV13 - serotypes
4,6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F, 3, 6A, 19A) Pneumococcal polysaccharide protein D-conjugate vaccine (Synflorix; PHiDCV).
2. Vaccination-Pentavalent vaccine e.g.DTPw-HepB-Hib (Quinvaxem) Hexavalent vaccine e.g. DTPa-HBV-IPV-Hib (Infanrix hexa) These vaccines are compatible with measles vaccine and induce
adequate immunological memory and persistent antibody
production against Hib

46. ADEQUATE ANTIBODY RESPONSES OF COMPONENT ANTIGENS

47. PNEUMONIA BURDEN IN NIGERIA
Pneumonia reduction is part of MDG 4 targets 1. Childhood deaths 200,000 under 5 years per year 2. Vulnerable
–elderly -Sickle Cell disease -diabetes patients -chronic liver disease patients Nephrotic syndrome patients Measles patients - HIV patients 3. Multiple resistance to antibiotics. 4. Killer organisms.
-Streptococcus pneumonia -Haemophilus influenza
-Pneumocystis carinae

49. TUBERCULOSIS: NATIONAL TUBERCULOSIS CONTROL TREND 2002 - 2011

50. TREND OF TB/HIV KEY INDICATORS (2007 – 2011)

51. TREND OF ANNUAL NEW CASES OF LEPROSY DETECTED
(1999 – 2011)

52. NEW TB VACCINES TB KILLS 1.4MILLION PER YEAR
BCG Protection short lived not adequately protective in
children especially in developing countries.
BCG not protective of latent Tb which occurs in ½ of
persons.
3. Recent trial in South Africa of new Tb vaccine MVA85A
against protective antigens of TB bacteria Ag85A (Prof
Helen McShare, Oxford):Immune response provoked in
adults;
healthy infants aged 4 – 6 months vaccinated
with BCG and then a cohort with MVA85A. Only 17%
effects at preventing TB. LANCET Feb 2013
5. More candidate vaccines in progress.

53. BACTERIA – SALMONELLA ,VIBRIO CHOLERA
1. NIGERIA–ENDEMIC FOR SALMONELLOSIS in man, chickens, domestic
animals. Can Vivotif ( Typhoid live oral Ty21a) and others
control Salmonellosis in Nigeria vis vis the various serotypes in
Nigeria
2. SEROTYPE VARIATION IN VIBRIO CHOLERAE EL TOR
DIARRHOEA IN NORTHERN NIGERIA.
Onyemelukwe GC, Lawande RV. Central African Journal of
Medicine 1991: 37(6):
Serotyping of Vibrio cholerae organisms causing epidemics
in Zaria and environs since 1975 to 1986 shows that
Hikojima serotype was prevalent from , but Ogawa
became prevalent from 1984 till The internal and
external pressures responsible for these selections are
unclear.
3. CHOLERA – ORAL DUKORAL VACCINE (FORMALIN KILLED WHOLE CELL PLUS RECOMBINANT TOXIN B UNIT) OR SHANCOL VACCINE(NOT CONTAINING SUBUNIT TOXIN B) CONTROL CHOLERA?

54. AEFI( ADVERSE EVENTS FOLLOWING IMMUNIZATION) – YET TO BE FULLY ESTABLISHED IN NIGERIA AS AT 2013 (AEFI COMMITTEE IN PLACE 2011)
FIVE GROUPS OF AEFI (IMPORTANT ROLES OF NAFDAC AND NPHCDA)
1. VACCINE PRODUCT – RELATED REACTION – by inherent properties of product – limb swelling after DTP
2. VACCINE QUALITY – RELATED REACTION eg failure of manufacturer to inactivate a lot of inactivated polio vaccine
3. IMMUNIZATION ERROR – RELATED REACTION inappropriate vaccine handling, prescribing or administration which is preventable .e.g Transmission of infection by contaminated multidose vial.
4. IMMUNIZATION ANXIETY – RELATED REACTION. Anxiety .e.g vasovagal syncope
5. COINCIDENTAL EVENT e.g. fever occurs at time of vaccination due to another infection (TEMPORAL ASSOCIATION) effect national health problem.

55. NIGERIAN CENTER FOR DISEASES CONTROL (NCDC) CUMMULATIVE DATA
COMPARATIVE JUNE JUNE 2013
2012
2013
GEOGRAPHICAL
POLIO
1,3 1 3
cVDPV 57 44 13 8 26 9
15 northern states and FCT
LASSA FEVER
Cases
Death
1058 98
892
Edo state and 10 states
CHOLERA
Deaths
306 4 33
Kwara, Kaduna , Zamfara
CSM
916 58
750 30
26 Endemic states
MEASLES
7225
102
45,927
272
26 states – 36 states and FCT
URTI
N/A
269
ACUTE WATERY
DIARRHOEA
Diarrhoea with blood
495
323
*ROTAVIRUS
Not available
*YELLOW FEVER not available

56. NIGERIAN NATIONAL YEARLY DATA – 2010 - 2012 (SOURCE WHO)
INFECTIONS FACT SHEET
NIGERIAN NATIONAL YEARLY DATA – (SOURCE WHO)
DISEASES
2012
2011
2010
CSM
1,206
1,167
4,983
MEASLES
11,061
10,715
2,563
YELLOW FEVER
250
387
570
LASSA FEVER
1,723
1,246 -
PERTUSSIS
11,628
10,023
TETANUS
112
113
199
POLIO - WPV
122 62 21
cVDPV 8 35 27

57. Immunization schedule for children U 1year and WCBA
Women of child bearing age(WCBA Imm. schedule
11/01/2019

58. USA 2012 IMMUNIZATION SCHEDULE 0 – 6 YEARS

59. Cumulative RI coverage for all antigens 2005-2012 IN NIGERIA
SOURCE ;NATIONAL PRIMARY HEALTH CARE DEVELOPMENT 2013

60. TIMELINESS OF RECEIPT OF IMMUNIZATION
TIMELINESS AND COMPLETION RATE OF IMMUNIZATION AMONG NIGERIAN CHILDREN ATTENDING A CLINIC-BASED IMMUNIZATION SERVICE.
Ayebo E. Sadoh and Charles O. Eregie. J. Health Popul Nutr. 2009;27(3):
Vaccine
TIMELINESS OF RECEIPT OF IMMUNIZATION
Too early
On time
Acceptably early
Delayed
No. %
OPV1 30
6.7
232
51.7 49
10.9
138
30.7
DPT1 37
8.1
283
61.5 53
11.6 87
18.9
HepB2 12
2.8 94
21.8 45
10.4
281
65.0
OPV2 16
3.8
175
43.8 69
16.0
146
36.4
DPT2 24
5.8
215
51.8
16.6
107
25.8
OPV3
3.9
118
38.7 68
19.0
117
38.4
DPT3
4.5
166
46.7 71
19.9
103
28.9
HepB3 18
5.5 61
18.7 39
12.0
208
63.8
Timeliness of receipt of vaccines among 512 children attending a clinic-based immunization service. Commencement at age above 28days associated with non-completion. VACCINATION CARDS OFTEN LOST OR NOT AVAILABLE/RETRIEVABLE.

61. NIGERIA IMMUNIZATION COVERAGE IS LOW NEEDS TO BE UP TO 90% AND ABOVE

62. UNDER FIVE CHILD DEATH,
1 IN USA = 1744 IN NIGERIA

63. USA HAS ADDITIONAL VACCINES
ROTAVIRUS
PNEUMOCOCCI
INFLUENZA
HEPATITIS A
MUMPS
RUBELLA(MMR)
MENINGOCOCCAL IN ROUTINE IMMUNIZATION SCHEDULE WHICH NIGERIA DOES NOT HAVE
BUT NO BCG IN USA

64. NATIONAL STRATEGIC RESPONSE BY NPHCDA WITH STATES AND LGAs
ROUTINE
SUPPLEMENTAL MASS IMMUNIZATION
BCG and other routine vaccines
Polio supplemental
Sub-national, MOPV, TOPV, BOPV
2. Cerebrospinal immunization
Oct 2011 – 5 states
Jan 2012 – 5 states
Nov 2013 – 8 states
22.29 million
(1 – 29 years)
With MENAFRIVAC – TYPE A
3. Measles – All states in 2 phases
Phase 1 – 19 northern states.
15.9 million – Oct 2013
Phase 2 – southern states
13.69 million – Oct – 1 week after

65. 4. Yellow fever
Nov – Dec 2013
Akwa Ibom, Cross river, Nassarawa
5. Neonatal Tetanus Elimination Initiative
39 high risk LGAS Risk analysis
i. 130 LGA’s (SE Zone)
(SW zone)
ii. 95 LGAs (S-S zone)
(NC zone)
iii LGAs North East zone

66. IMPEDIMENTS TO USE OF VACCINES IN NIGERIA
1. SUPPLY DEMAND BARRIERS
Supply inadequate for the large population vis – vis other
GAVI supplied African countries.
Funding constraints
Logistical challenges
Lack of leadership to prioritize
Inadequate finance to expand to other antigen, other
ages(young women) and geriatric
population.
2. ACCEPTABILITY
Mother education, Cultural barrier by Fathers, Social
religious barrier, use of social networks by gatekeepers.
Religious resistance = Missed children

67. 3. IMMUNOGENICITY ISSUES
Vaccine potency and cold chain ineffectiveness
Immunodeficiency of vaccine failed vaccines
Non – vaccine type shifts appearance – pneumococci,
CVDPV, Non Typable
Haemophilus influenza.
4. WEAK HEALTH SYSTEM AND SERVICE DELIVERIES
Human resources, Accurate information.
5. SURVEILLANCE, MONITORING AND EVALUATION INADEQUATE – ( LONG TERM FOCUS
ON SAFE WATER AND SANITATION)

68. FINANCE AND VACCINE SECURITY
LOGISTICS, TRANSPORT, COLD CHAIN
GOVERNANCE
Professionals keeping distance from immunisation

69. 8. Vaccination of preterm babies with BCG.
WAY FORWARD
1. OSHOGBO DECLARATION: WEST AFRICAN COLLEGE OF PHYSICIANS INVOLVEMENT
IN VACCINE SUCCESS, ADVOCACY WITH COPERATION WITH VETERINARY
PRACTITIONERS TO CURB ZOONOSES.
2. CREATE A NIGERIAN NUCLEUS TEAM OF VACCINE TECHNOLOGISTS – Vaccinologists
in training linked with established World centers.
3. INNOVATIVE PRIVATE PUBLIC PARTERSHIP – FEDERAL GOVERNMENT, STATE, LOCAL
GOVERNMENT,NPHCDA, WEST AFRICAN COLLEGE OF PHYSICIANS/
PAEDIATRIC ASSOCIATION OF NIGERIA.
4. GATE KEEPERS NETWORKERS – Gastroenterologists get, update and keep
Nigerian surveillance data on infections through gut. Same with respiratory,
neurology etc specialists.
5. PRESCHOOL ADMISSION WITH COMPLETE CERTIFICATE OF IMMUNIZATION -
KINDERGATEN, PRIMARY, SECONDARY,TERTIARY.
5. MAINTAIN VACCINE SECURITY – Industries, Manufacturers, UNICEF, Accurate and
long term forecasts, affordable vaccines, logistics, cold chain maintenance
6. Breast feeding exclusive policy
7. In view of emergence of polio vaccine associated paralysis ( VAPP) as well as
circulating derived poliovirus (cVDPV), nation to decide when and where to
introduce IPV (Inactivated polio vaccine) alone or as part of hexavalent/
pentavalent or intercalation of OPV at birth with subsequent IPV.
8. Vaccination of preterm babies with BCG.
9. Surveillance epidemiology for disease patterns
Serotypes – Meningococci A,C, W135; Vibrio el tor, Pneumococci, Salmonella
serotypes vaccination

70. 10. VACCINE ACCEPTABILITY AND ACCOUNTABILITY
Serology surveys and data on vaccines for seroconversions national data.
Serotype replacement after vaccination by non – vaccine serotypes: Pneumococci H.Influenzae
Neglected diseases INTO view in urban and rural areas.
10. VACCINE ACCEPTABILITY AND ACCOUNTABILITY
Social marketing expansion
Education of mothers and recipients
11. ELIMINATION OF MALNUTRITION (under 5) affects vaccine performance.
12. MICRONUTRIENT DEFICIENCY ELIMINATION
Vitamin D induces Tumor suppressor gene (Goubart et al)
Vitamin D induces Innate cells and immune cells to secrete Cathelicidin peptides
and improves anti TB response
Vitamin D and Vitamin A induce expression of p21 (cyclicin dependent Kinase inhibitor p21.)
Organoselenium in garlic and brocolli Aqueate.
13. MEASLES
study mechanism of measles RNA editing by which it increases number of aggressive proteins, its RNA genome occurs for more virulence. Studies on strategies of evasion by HIV and other organisms.
14. NEW VACCINE DEVELOPMENT – Vaccine TB Vaccine grand challenge.
TB vaccine acceleration program .
Study of Latent TB granuloma
HSP vaccine development, more coverage, low cost.
Malaria, HIV, Parasites etc.

71. 15. BEFORE TRAVEL – PILGRIMAGE.
Yellow fever vaccination
Meningococcal vaccination A,C, W135
Cholera vaccination
IPV vaccination for Muslim and Christian pilgrimages
16. GERIATRIC POPULATION, SICKLE CELL AND OTHER VULNERABLE POPULATION
VACCINATION PROGRAM
17. MATERNAL TETANUS VACCINATION AND EXPANSION OF MMR in women
18. PREVENT PRENATAL MATERNAL INFECTION WITH PARASITES - TO AVOID FOETAL
IMMUNE PROGRAMMING AND POOR BCG RESPONSE.
19.IN COUNTRY MANUFACTURE OF VACCINES MONOCLONAL ANTIBODIES.
20. ENVIRONMENT
Improved housing
Nutrition
Water
Sanitation
Environmental Tobacco smoke prevention
21. AEFI – Adverse events following immunization monitoring and evaluation in
Nigeria
22. ADJUVANT Research : eg Adjuvant to promote TH1/ TH7 for BCG better response
and other infections requiring cell mediated immunity response.
23. EXPANSION OF CANCER TREATMENTS AND NONCOMMUNICABLE DISEASES

72. MAGIC BULLET VACCINE – OMNIVALENT, OMNIPOTENT WITH ALL ANTIGENS –
1 OR 2 SHOTS!!!!
I HAVE IT