New vaccines catalyst for child survival – Dr Muhammad

A handful of major vaccines are in Nigeria’s arsenal to combat preventable killer diseases. The latest, pneumonia conjugate vaccine, was introduced into routine immunisation last December. Dr Ado Muhammad, Executive Director of National Primary Health Care Development Agency (NPHCDA)—responsible for first-level health care in Nigeria—says introducing new vaccines are a catalyst for improving immunisation coverage and child survival.

There are already vaccines in routine immunisation for children across Nigeria. What’s the science behind new vaccines being introduced?
Infectious diseases are still responsible for nearly 30% of all deaths worldwide; more than 15 million people die every year, mostly in low-income and middle-income countries. The Global Immunization Vision and Strategy (GIVS) 2006-2015, for fighting VPDs has 3 priority objectives: (1) immunize more people against more diseases (2) introduce a range of newly available vaccines and technologies, and (3) provide a number of critical health interventions through immunization.

And combining five vaccines into a single shot is one such?
The Pentavalent vaccine is a combination vaccine that protects infants against the following 5 diseases: diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type b (Hib) pneumonia and meningitis. Prior to 2012, the RI schedule consisted of the traditional vaccines: BCG, OPV, DPT, Measles and Yellow Fever Vaccines. Commencing in May 2012, Nigeria introduced the Pentavalent Vaccine into its National Immunization Schedule in a phased manner over a 3-year period; in order to reduce substantially child mortality from pneumonia and meningitis and thus save up to 30,000 lives annually.  Currently, it is available in all PHC facilities nationwide.
Pneumonia is a disease caused by a number of infectious agents that include bacteria, viruses and fungi; the most common in children being Streptococcus pneumoniae (pneumococcus). The Haemophilus influenzae type b (Hib) is the second most common cause of bacterial pneumonia. Other causes are the Respiratory Syncytial Virus (RSV) and in infants infected with HIV, Pneumocystis jiroveci is one of the commonest causes of pneumonia.

And that warrants launching use of separate pneumonia vaccine?
Most recently, we have also introduced the PCV-10 to protect infants against diseases caused by the pneumococcal bacteria (Streptococcus pneumoniae) such as pneumonia, meningitis and bacteraemia.  Launched on the 22nd December 2014 at Lokoja, Kogi State. The 12 states of the federation that commenced this phased introduction were selected on zonal basis, immunization coverage and their capacities to receive and store the new vaccine: Adamawa, Yobe, Kaduna, Katsina, Kogi, Plateau, Ondo, Osun, Edo, Rivers, Anambra and Ebonyi. This introduction of the PCV-10 is continuing in a phased manner that by 2017, it will be available to infants in all the states and the FCT.

Beyond these major diseases covered by routine immunisation, what becomes of vaccination schedules?
Other supplemental vaccines such as Measles, Yellow Fever and the newer MenAfriVac vaccine that protects against the commonest cause of cerebro-spinal meningitis (CSM) serotype A are also given as needed. In the period 2011-2014, the MenAfriVac vaccine was administered through the 23 meningitis belt States in Nigeria to an extended age-group of 1 – 29 years old in our effort to eliminate CSM serotype A as a major public health issue.

Nigeria has reportedly made much progress on polio, but it isn’t yet out of the woods. Where does the country stand now?
The country has made an unprecedented progress in its polio eradication strategy (PEI) in the past 1 year. There have been only 6 confirmed cases of wild poliovirus type 1 (WPV1) in 2 states in 2014 compared to 50 cases in 9 states for the same period in 2013.  There have been no confirmed WPV3 since November 20124.
Nigeria has now achieved the interruption of the transmission of the wild poliovirus (WPV) ending 2014. Through the combined efforts of governments and other key stakeholders, we are going to put more efforts into the next 2 years to ensure certification of the country as polio-free.
Hitherto, only variants of the oral polio vaccine (OPV) have been used in our RI and the PEI efforts. However, as the country enters into the polio endgame, we have now introduced the injectable polio vaccine (IPV) to complement the supplemental effort. Initially, the IPV was introduced in the polio-endemic states of Adamawa, Borno, Yobe, Bauchi and Kano. IPV will also be available to be delivered in the RI schedule to all eligible children at age of 14 weeks, in addition to the OPV that is given in the traditional four-dose RI schedule.

Beyond the antigens that come in vaccines, what else do you think can strengthen efforts or response?
Other newly introduced vaccines are in form of injection. This necessitates for the health service provider to have good working knowledge of injection safety and apply the appropriate injection techniques during vaccine administration. The programme ensures the use of auto-destruct syringes, universal safety boxes and proper waste disposal, including incineration of the injection wastes.
The Midwives Service Scheme (MSS) & SURE-P Maternal & Child Health (MCH) are programmes federal government wants states to take charge of. In light of present realities of falling oil price, a probable phaseout and budgetary shortages, what’s the justification for them?
The MSS and SURE-P MCH both operate in 1,000 health facilities with a compliment of 4 midwives and 2 CHEWs per facility; this is a human resource pool of about 8,000 midwives and 2,000 CHEWs at the frontlines. We have put in place mechanisms for supply of drugs and commodities and in some places provided boreholes to complement the health services. These schemes serve a population of over 25 million Nigerians and have not only provided a platform for immunization services in the country but also a base for improving the health system of the country with special emphasis on PHC.
The introduction of new vaccines (Pentavalent, PCV, IPV, Rotavirus vaccines etc.) will help Nigeria to significantly reduce childhood mortality and accelerate the achievement of the MDGs. These new vaccines will help avert an additional 486,957 deaths over a 6-year period. To achieve the MDG 4 targets (70 under-5 deaths per 1,000 live births by 2015), Nigeria needs prompt action to drive down under-5 mortality by  approximately 30% (from the current 128/1000 live births). As Nigeria’s population is approximately 16% of Africa’s, our attainment of the health MDG targets will significantly improve the health outcomes in Africa as a whole.

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