06 Nov World Immunization Week

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Immunization Works

  1. Immunization has been widely acknowledged as the most successful means of preventing the suffering and death associated with life-threatening infectious diseases.[1] P1a
  2. Vaccines are rigorously tested and proven safe and effective prior to widespread use.2P3a
  3. Diseases that may be avoided through vaccination include polio, diphtheria, tetanus and measles, amongst others.
  4. Immunization prevents an estimated 2 to 3 million deaths per year.1 P1b
  5. An additional 1.5 million deaths per year could be avoided if global immunization coverage were more widespread.1 P1b
  6. It is estimated that 19.4 million infants, across the globe, do not receive immunization.1P1c
  7. About 60% of children who don’t receive immunization live in 10 countries.[2] P2a
  8. If we stop vaccination, diseases will return. When people are not vaccinated infectious diseases, such as diphtheria, measles, mumps and polio, can quickly reappear.2 P3b
  9. Global vaccination coverage has remained steady for the past few years.1 P1d
  10. The World Health Organization (WHO) initiated the Expanded Programme on Immunization (EPI) in May 1974 with the objective to vaccinate children throughout the world.[3] P1a
  11. In 1984 the WHO established a standardised immunization schedule.3 P1b
  12. Following the introduction of the EPI and standard immunization schedule, immunization rates went from less than 5% in 1974 to an estimated 86% in 2015 for 3 doses of the diphtheria-tetanus-pertussis vaccine.1 P1e
  13. The WHO recommends a routine paediatric vaccination schedule, which is administered between birth and 15 years of age.[4] P1
  14. Vaccinations are important throughout life, with different vaccines recommended through childhood, adolescence and adulthood.

Immunization in South Africa (SA)

  1. There are vaccines against 11 diseases covered by the SA national immunization schedule.5 P1a
  2. There has been a steady increase in the number of fully immunized children in SA, which stood at 91.7% in 2015.[5] P1b
  3. SA achieved neonatal tetanus elimination in 2002.5 P1c
  4. In 2006, SA was pre-certified polio-free by the Africa Regional Certification Committee.5 P1c
  5. In SA, newer vaccines have been introduced as they have been developed, allowing prevention of potentially debilitating disease.

The Human Papilloma Virus (HPV) and Herpes Zoster (Shingles) Vaccines

The Human Papilloma Virus (HPV) and a new Herpes Zoster (Shingles) vaccine were introduced into South Africa in 2008[6] P1a and 2014,[7] respectively.

HPV

  1. HPV is the most common infection of the reproductive tract. It can cause cervical cancer, other types of cancer, and genital warts in both males and felmales.3 P2a
  2. In South Africa, cervical cancer is the second most common cancer in women, and the most frequent cancer among women aged 15 to 44.6 P1b
  3. Two HPV vaccines are available in South Africa.6 P1a
  4. Both vaccines are highly efficacious at preventing infection with virus types 16 and 18, which are responsible for approximately 70% of cervical cancer cases globally. These are available for females aged 9 to 45.6 P1c
  5. Additionally, one of the vaccines protects against genital warts, and is also approved for administration in males aged 9 to 26. 6 P1d
  6. Dosing is either a 2 or 3 dose regimen depending on age. 6 P1e, P2a
  7. The HPV vaccine became part of the integrated school health programme in South Africa in 2014 for females aged 9 years and older in grade 4 in public schools. 6 P2b

Herpes Zoster (Shingles)

  1. Shingles is the re-activation of the chickenpox virus (varicella zoster).
  2. It usually occurs in adults aged >50 or in immunocompromised people.[8] P1a
  3. Shingles tends to cause a painful rash, which may result in longstanding severe neurological pain (post-herpetic neuralgia (PHN)) and permanent nerve damage.8 P1b,c
  4. A live varicella zoster vaccine has been shown to decrease the risk of shingles infection by 51% and PHN by 67%.7 P1a
  5. A single dose is recommended for adults over the age of 50 years, even if they have already had an attack of shingles.7 It is not recommended in people who are immunocompromised. P1b,c

Diseases Covered by Immunization on the SA National EPI

Disease Potential Complications SA Vaccination Schedule[9] P8 Global Trends
Diphtheria Cough fever, rash, difficulty breathing and death.[10] P1a 6 weeks, 10 weeks, 14 weeks and 18 months as part of a combined vaccine with tetanus and pertussis (DTP) Global coverage for DTP was at 86% in 2015.[11] P1a
Haemophilus Influenza Type B (Hib) Typically affects children under 5 years. Pneumonia, meningitis and death.[12] P1a 6 weeks, 10 weeks, 14 weeks and 18 months Global coverage with 3 doses is estimated at 64%, with great variation between regions.1P1f
Hepatitis B Liver damage, liver cancer and death. 6 weeks, 10 weeks, 14 weeks and 18 months Global coverage with three doses of Hepatitis B is estimated at 83%.1P1g
Human Papilloma Virus (HPV)* Cervical cancer, other types of cancer and genital warts.1 P2a Girls aged 9 to 14 The HPV vaccine was introduced to 66 countries by the end of 2015.1 P2a
Measles High fever and rash. Diarrhoea, dehydration, deafness, eye complications, pneumonia, brain damage and death.1P2b 6 months and 12 months In 2015, about 85% of the world’s children had received at least one dose of measles vaccine by their second birthday.1P2b
Pertussis (whooping cough) Headache, fever and paroxysmal bouts of coughing. 6 weeks, 10 weeks, 14 weeks and 18 months There are about 195,000 pertussis-related deaths in children per year. Most deaths occur in babies who are unvaccinated or incompletely vaccinated.[13] P1a
Pneumococcal Severe infections of the blood, ears or brain.14 P1a 6 weeks, 14 weeks and 9 months The routine use of the pneumococcal vaccine has dramatically reduced the incidence of severe disease related to the Streptococcus pneumoniaebacterium.[14] P1b
Polio Affects nerves of the body causing weakness, paralysis or death. Birth, 6 weeks, 10 weeks 14 weeks and 18 months 125 countries were polio-endemic in 1988, with only 3 countries remaining so today.1 P2c
Rotavirus A major cause of diarrhoea worldwide and can lead to severe dehydration. 6 weeks and 14 weeks A decline of up to 50% in diarrhoeal related deaths in children aged <5 has been observed in some countries and is attributable directly to vaccine use.[15] P1a
Tetanus (lock jaw) Muscle spasms, breathing and heart problems and carries a very high risk of death. 6 weeks, 10 weeks, 14 weeks and 18 months Maternal and neonatal tetanus persists as a public health problem in 19 countries, mainly in Africa and Asia.1P2d
Tuberculosis (TB) Coughing, chest pain, sweating, weight loss, meningitis and death if untreated. BCG vaccine at birth Global rates of TB have slowly declined although SA struggles with the TB epidemic, with high rates driven by HIV.[16]P1a

* The HPV vaccine is offered as part of the integrated school health programme rather than the National EPI.

References

[1] World Health Organization, Media Centre, Immunization coverage. Facts sheet. WHO (Internet). March 2017, cited April 4th 2017. Available from: http://www.who.int/mediacentre/factsheets/fs378/en/.

[2] World Health Organization, WHO global health days. Infographics: #VaccinesWork. WHO (Internet). March 2017, cited 4th April 2017. Available from: http://www.who.int/campaigns/immunization-week/2017/infographic/en/.

[3] Wikipedia, Expanded Program on Immunization. Wikipedia (Internet). 31stJanuary 2017, cited 4th April 2017. Available at: https://en.wikipedia.org/wiki/Expanded_Program_on_Immunization.

[4] World Health Organization. Table 1 – Summary of WHO Position Papers – Recommendations for Routine Immunization. WHO. March 2017. Available at: http://www.who.int/immunization/policy/Immunization_routine_table1.pdf?ua=1.

[5] World Health Organization, Regional Office for Africa. South Africa, Expanded Programme on Immunization (EPI). WHO (Internet). 2015, cited 4th April 2017. Available at: http://www.afro.who.int/en/south-africa/country-programmes/4245-expanded-program-on-immunization-epi.html.

[6] Richter K. Public Health Association of South Africa: Implementation of HPV vaccination in South Africa. Feb 26, 2015. Available at: https://www.phasa.org.za/implementation-hpv-vaccination-south-africa/.

[7] Drug Info. New Product Focus. Zostavax®: varicella-zoster virus (live vaccine). South African Pharmacy Journal. 2014, Vol 81(3). P34-35.

[8] Centres for Disease Control and Prevention. Vaccine Information Statements (VIS). Shingles VIS. CDC (Internet). 10th June 2009, cited 7th April 2017. Available at: https://www.cdc.gov/vaccines/hcp/vis/vis-statements/shingles.pdf.

[9] National Institute for Communicable Diseases and Centre for Vaccines and Immunology. Vaccine Information for Parents and Caregivers, First Edition, November 2016. Available at: http://www.nicd.ac.za/assets/files/NICD%20Vaccine%20Booklet%20D132%20FINAL.pdf

[10] World Health Organization: Immunization, Vaccines and Biologicals. Diptheria. WHO (Internet). 14th August 2015, cited 4th April 2017. Available at: http://www.who.int/immunization/diseases/diptheria/en/.

[11] World Health Organization. Global Health Observatory Data. Diptheria-tetenus-pertussis (DTP3) immunization coverage. WHO (Internet). 2017, cited 4thApril 2017. Available at: http://www.who.int/gho/immunization/dtp3/en/.

[12] World Health Organization: Immunization, Vaccines and Biologicals. Haemophilus influenzae type b (Hib). WHO (Internet). 23rd January 2014, cited 4thApril 2017. Available at: http://www.who.int/immunization/diseases/hib/en/.

[13] Centres for Disease Control and Prevention. Pertussis (whooping cough): Pertussis in other countries. CDC (Internet).27th June 2016, cited 4th April 2017. Available at: https://www.cdc.gov/pertussis/countries/.

[14] World Health Organization: Immunization, Vaccines and Biologicals. Pneumococcal. WHO (Internet). 29th September 2014, cited 4th April 2017. Available at: http://www.who.int/immunization/diseases/pneumococcal/en/

[15] World Health Organization: Immunization, Vaccines and Biologicals. Rotavirus. WHO (Internet). 3rd June 2016, cited 4th April 2017. Available at: http://www.who.int/immunization/diseases/rotavirus/en/.

[16] Churchyard GJ et al. Tuberculosis control in South Africa: Successes, challenges and recommendations. South African Medical Journal. March 2014, Vol. 104 (3), Suppl. 1, 244-248. Available at: http://www.samj.org.za/index.php/samj/article/viewFile/7689/5854.

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