Saving the Kids

from All Africa

By Catherine Riungu
Nairobi

FIVE YEARS AFTER UGANDA introduced a vaccine to fight Haemophilus influenza Type B (Hib) meningitis, the disease has been virtually eliminated, says a study.

Hib is a leading cause of pneumonia and meningitis - an inflammation of the lining covering the brain and spinal cord.

Each year, Hib kills about 400,000 children under five years of age, most of them in the developing world. It is also responsible for about three million cases of serious illness resulting in long-term consequences such as deafness, paralysis, mental retardation and learning disabilities.

The positive results are outlined in a study to be published in the April issue of The Bulletin of the World Health Organisation, a peer-review international public health journal.

Upon monitoring the incidence of bacterial meningitis due to Hib between 2001 and 2006, the researchers saw a marked decline in the disease resulting from implementation of a new vaccination programme.

The incidence dropped by 85 per cent within four years of the introduction of the vaccine and to zero in the fifth year.

The authors estimate that the Hib vaccine prevents almost 30,000 cases of severe Hib and 5,000 child deaths (under five years) annually, equivalent to the successful control of measles in the country.

Funding for the Hib vaccine is a major part of the programme support to Uganda by the Gavi Alliance (formerly the Global Alliance for Vaccines and Immunisation). With Gavi support, Uganda was able to dispense 16.5 million doses of the vaccine nationwide between 2002 and 2006.

The government chose to use what is known as a pentavalent vaccine - a five-in-one injection that includes vaccines for Hib as well as diphtheria, pertussis, tetanus and hepatitis B.

"Gavi welcomes these positive results," said Dr Julian Lob-Levyt, executive secretary of the Gavi Alliance, attributing them to the collaborative efforts of Uganda's Ministry of Health, the WHO, Unicef and other partners. "We can applaud a true success in controlling this deadly disease that has claimed so many lives."

Uganda was one of the first countries eligible for Gavi support to adopt the Hib vaccine, preceding what is now a global trend.

ACCORDING TO A RECENT REport released by WHO, the Centres for Disease Control and Prevention and the Hib Initiative, between 2004 and 2007, the proportion of the 72 poorest countries eligible for Gavi support using or approved to use the vaccine increased from 18 per cent to 65 per cent.

In November, the Gavi board approved additional funding for the vaccine, bringing the total number of countries with approved proposals to 44.

Rana Hajjeh, director of the Hib Initiative, said, "This is excellent news for the future generations of Ugandan children. Uganda has been a frontrunner in Africa in adopting this life-saving vaccine. The leadership of early introducers such as Uganda, Kenya and the Gambia has strongly influenced the decisions of many other countries in the region to adopt the vaccine.

"Today, 83 per cent of the African countries eligible for Gavi aid include or will soon include the Hib vaccine in their national immunisation programmes," he added.

"These interventions in Uganda and elsewhere are making a significant contribution towards achieving the Millennium Development Goals of reducing mortality in children less than five years of age," says Dr Sam Zaramba, director general of Uganda's Ministry of Health.

"The introduction of the Hib vaccine has completely changed the epidemiology of bacterial meningitis in Uganda, with elimination of meningitis as a public health problem," said Dr Addy Kekitiinwa a paediatrician at Mulago Hospital in Kampala and co-author of the study.

"High quality surveillance has allowed us to understand and monitor those trends to ensure the quality of the immunisation programme, improve collaboration between clinicians and laboratories and inform on drug susceptibility for the common organisms."

Although Hib vaccines for infants were first licensed in 1991 and have since been widely adopted in industrialised countries, they have not been used extensively in the developing world due to multiple barriers such as limited Hib disease awareness, uncertainty about the burden of disease and concerns about the financial and logistical implications of vaccine introduction.

It took almost 15 years for the Hib vaccine to be introduced in developing countries after it was first licensed.

Efforts are underway to reduce the number of years developing countries have to wait to benefit from new vaccines. In 2007, a pilot advance market commitment was announced, aimed at accelerating the introduction of new vaccines in poor countries.

The Ugandan results follow similar ones in Bangladesh, Kenya, Chile the Gambia, the UK and the US, which have all concluded that the Hib vaccine cuts the incidence of disease by 88 per cent or more within three to five years.

IN JULY 2007, A STUDY IN BANGladesh showed that routine immunisation of infants with a Hib conjugate vaccine prevented over one third of life-threatening pneumonia cases and about 90 per cent of Hib meningitis cases.

A Kenyan study in 2006 showed that the Hib vaccine cut the incidence of disease by 88 per cent within three years. The authors say that vaccinating against the bacterium Haemophilus influenzae Type B prevented approximately 3,370 Kenyan children from being hospitalised in 2005.

The authors say that prior studies have shown that for every child with Hib meningitis in developing countries, there may be five to 10 others with Hib-related pneumonia, which is also preventable by vaccination.

To achieve quicker results, the WHO recommends that children at highest risk - those under two years - be immunised at the time of vaccine introduction.

The Gavi Alliance is a public-private partnership of major stakeholders in vaccines and immunisation.

It includes developing countries and donor governments, the WHO, Unicef, the World Bank, the vaccine industry in both industrialised and developing countries, research and technical agencies, NGOs, the Bill & Melinda Gates Foundation and other private philanthropists.

The WHO projections show that Gavi support had prevented more than 2.9 million deaths by the end of 2007.