The vaccine and its controversy

The MMR vaccine is an immunization vaccine against measles, mumps, and rubella (German measles). It is a mixture of live attenuated viruses of the three diseases, administered via injection. The three vaccines (for mumps, measles, and rubella) were combined in 1971 to become the MMR vaccine.

​The MMR vaccine became the centre of a controversy following claims (which were subsequently established as fraudulent) that the vaccine was responsible for causing Autism-spectrum disorders in children. The controversy was kicked off in 1998 by the publication of a paper by British surgeon Andrew Wakefield in the medical journal The Lancet. Investigations later revealed that Wakefield had multiple undeclared conflicts of interest, had manipulated evidence, and had broken other ethical codes. The Lancet paper was partially retracted in 2004 and fully retracted in 2010, and Wakefield was found guilty by the General Medical Council of serious professional misconduct in May 2010 and was struck off the Medical Register.

ALARMIST NOTION

​Despite overwhelming scientific evidence for the fact that the vaccine's positive effects significantly outweigh any risks it may pose, some anti-vaccine groups in the US and UK have created an alarmist notion that the MMR vaccine is responsible for autism. Many parents have bought into this, so much so that several diseases, including measles, which had previously been controlled to a large degree, have seen serious outbreaks in the recent past. The New England Journal of Medicine has said that anti-vaccine propaganda has resulted in a high cost to society, "including damage to individual and community well-being from outbreaks of previously controlled diseases, withdrawal of vaccine manufacturers from the market, compromising of national security (in the case of anthrax and smallpox vaccines), and lost productivity.

Source: http://timesofindia.indiatimes.com/city/bangalore/The-vaccine-and-its-controversy/articleshow/34130024.cms

Yellow fever vaccination centre to come up in Aundh

PUNE: The Union government's yellow fever vaccination centre, which was supposed to come up in the city two years back, is yet to take off as authorities have now decided to shift the venue of the centre to Aundh Civil Hospital instead of B J Medical College.

The change of location is due to the technical issues related to the procurement of medical equipment. "Earlier, we had decided to set up the centre at B J Medical College attached to Sassoon Hospital, which is under the Maharashtra government's Directorate of Medical Education and Research (DMER). There were some technical issues in terms of procurement of medical paraphernalia. We have now decided to set up the centre at Aundh Civil Hospital which comes under the Maharashtra government's Directorate Public Health Department," said Vasant Gokak, senior regional director (regional office) of the Union ministry of health and family welfare.

"If everything goes as per our plans, the centre will become functional within a month," he said, adding that the Union government has also proposed to set up two more centres in Aurangabad and Nagpur.

Gokak said that the aim is to cater to the large number of people travelling to endemic countries in Africa and South America. Currently, they have to go to Mumbai to get the shot and obtain the mandatory yellow fever vaccination certificate, in the absence of which, they do not get the permission to travel.

Yellow fever is an acute viral haemorrhaegic disease transmitted by infected mosquitoes. 'Yellow' refers to jaundice that affects some patients. There is no cure for yellow fever. Treatment is symptomatic and is aimed at reducing the symptoms. "There will be a one-room facility at the government health centre. It will be manned by a medical officer and a nurse. It will offer vaccination only on fixed days and during fixed hours for those travelling to yellow-fever endemic countries," said a state health official.

Certain countries in South Africa and South America require travelers to get the yellow fever vaccination certificate. Also, people coming to India from these countries need a certificate stating that he or she is vaccinated otherwise they are quarantined at the airport hospitals and kept under observation for 10 days.

A yellow fever vaccination certificate is valid only if it conforms to the model certificate. The validity period of the international certificate is 10 years, beginning 10 days after vaccination.

Foreign nationals residing or who have passed through the yellow fever endemic countries during the preceding six days, are granted visas only after producing the vaccination certificate. After checking the vaccination certificate an entry read as 'Valid Yellow fever Vaccination Certificate Checked' is made in the passport of the passenger.

Fact sheet

Yellow fever is endemic in 33 countries in Africa and 11 countries in South America

The virus is transmitted in two ways - the sylvatic or forest cycle and the urban cycle

Transmission begins when vector mosquitoes feed on non-human primates infected with the virus. The infected mosquitoes then feed on humans

Once contracted, the virus incubates in the body for three to six days. The infection can occur in one or two phases. The first, 'acute', phase causes fever, muscle pain with backache, headache, shivers, loss of appetite, and nausea. In most patients symptoms disappear after three to four days

15% of the patients enter the second and more toxic phase within 24 hours of the initial remission. Along with high fever, the patient rapidly develops jaundice and complains of abdominal pain with vomiting. Bleeding can occur from the mouth, nose, eyes or stomach. Once this happens, blood appears in the vomit and faeces. Kidney function deteriorates

(Source: World Health Organization)
Article Source: TimesOfIndia

Pentavalent Vaccine – reshaping the conversation

As India celebrates being officially declared polio free, it is critical that the legacy of polio eradication transcends across child health in India. In one of its final acts before the UPA Government wrapped up its term in office, the health ministry announced that eleven additional states are set to include the pentavalent vaccine in their routine immunisation programmes.

Polio eradication in India has rightly been hailed as one of the greatest global public health achievements. However, the pentavalent scale up announcement went largely unnoticed despite being a tremendous step towards ensuring that all Indian children are protected against vaccine preventable diseases. The pentavalent vaccine, includes protection against Haemophilus influenza type b (Hib) to the existing diphtheria-pertussis-tetanus (DPT) and hepatitis B. Hib is a serious threat to India’s children, causing an estimated 2.3 million cases of pneumonia and more than 35,000 cases of meningitis in 2000.

India currently has the highest number of children under 5 dying every year. According to Unicef, 1.4 million children every year die from largely preventable diseases like pneumonia, diarrhoea, malnutrition and newborn complication like sepsis.  The pentavalent vaccine is a preventive tool in a comprehensive approach to child health. Early and exclusive breastfeeding, vaccines, hand-washing, zinc supplementation and oral rehydration salts could significantly reduce child deaths in India. Last month a special article published by India’s Ministry of Health in the Indian Journal of Pediatrics analysed all available evidence and found a significant burden of Hib disease in India to warrant the use of the Hib vaccine. The paper reasserted that the national introduction of a Hib-vaccine could prevent up to 72,000 child deaths every year.

In 2009, India’s National Technical Advisory Group on Immunisation advised the government to incorporate Hib via pentavalent into its national immunization program. Since then, around 8.2 million doses have been administered to children in nine Indian states and the government’s new scale up of the vaccine is a major step forward to ensuring that all children have an equal start in life. Over 100 countries use the pentavalent vaccine in their national immunisation systems. . Eighty-two of these countries use vaccines made by Indian manufactures. Despite providing pentavalent vaccines for the world, India is one of the last countries to protect its own children against Hib-disease. It’s time we ensure all of children have access to this protection, regardless of their families’ ability to pay. 

The pentavalent vaccine has long been available in the private market and is already in use in nine states. The Indian Academy of Paediatrics an umbrella body of 22,500 paediatricians, the World Health Organisation and many others have long supported the use of the pentavalent vaccine. A recent survey of over 1,000 paediatricians showed that over 80 percent have been using the pentavalent vaccine in their clinical practices for the last 5-15 years. Another crucial issue for vaccine introduction is the safety profile of a vaccine. All medical interventions carry some risk and public health programmes have to weigh the benefits and risks. The pentavalent vaccine has been tested in 23 clinical trials with more than 12,000 infants given the vaccine. After careful monitoring the results have shown the vaccine to be effective and have an excellent safety profile.  (Read: )

When new vaccines are introduced, it is critical that they are monitored closely in case of reports of adverse events from immunisation (AEFIs). For example, in Bhutan, Vietnam and Sri Lanka there were several cases of suspected adverse events reported. Each country suspended use of the vaccine and subsequently reinstated it following investigations by local governments and the World Health Organisation, which found no causal link between pentavalent vaccinations and reported infant deaths. India’s health ministry also set-up a mechanism to thoroughly investigate and evaluate all infant deaths and other adverse events reported around vaccinations by an expert committee. This was the case in Kerala and Tamil Nadu, the first two states to receive the vaccine. All AEFI’s have been investigated and none have been reported as being connected with the vaccine.That doesn’t mean there are no risks or side effect to vaccines but the pentavalent benefits far outweigh the risks.

It’s not just the pentavalent vaccine, which is helping to save lives. Training health workers to wipe the umbilical cord with a disinfectant has been shown to reduce neonatal deaths by half. And the development of a new low cost indigenous rotavirus vaccine could save tens of thousands from diarrhoeal death or hospitalisation. Learning the lessons of polio eradication, the government has not been swayed by unfounded criticisms and is moving forward to ensure all children are protected against deadly disease. No child should suffer from Hib-pneumonia, meningitis or any other preventable disease when the power of prevention is already in our hands. 

Source: health.india.com

By: Dr CP Bansal April 1, 2014

New rotavirus vaccine showed promising results in India

The monovalent human-bovine rotavirus vaccine was effective and well tolerated among infants in India, according to recent study findings published in The Lancet

Nita Bhandari, PhD, of the Centre for Health Research and Development of the Society for Applied Studies in India, and colleagues conducted a randomized, double blind, placebo-controlled trial to determine the efficacy and tolerability of a monovalent human-bovine rotavirus vaccine (116E; Rotavac, Bharat Biotech International) for severe gastroenteritis in low-resource urban and rural settings in India. Children enrolled in the study were assigned to three doses of 116E (n=4,532) or placebo (n=2,267) at age 6 to 7 weeks, 10 weeks, and 14 weeks.

The overall efficacy of 116E against severe rotavirus gastroenteritis was 53.6%. During the first year of life, the vaccine efficacy was 56.4% against severe rotavirus gastroenteritis.

According to Bhandari and colleagues, to prevent one episode of severe rotavirus gastroenteritis, 55 infants must be immunized, and 31 must be immunized to prevent rotavirus gastroenteritis of any severity. In the vaccine group, the incidence of severe rotavirus gastroenteritis per 100 person-years was 1.5 compared with 3.2 in the placebo group.

Immediate adverse events were reported in less than 1% of participants in each group.

“Finally, this successful product development validates the concept that new vaccines and other health commodities can be developed through socially committed collaborative efforts with effective government participation, and engagement of small- to medium-size enterprises resulting in substantially lower investment,” the researchers wrote. “In this regard, the vaccine is a product of a path-setting model for development of health technologies at prices that ensure increased access in places where these are needed most.”

In an accompanying comment, Shabir A. Madhi, MD, PhD, of the National Institute for Communicable Diseases at the National Health Laboratory Service, and Umesh D. Parashar, MBBS, of the CDC, said the efficacy is modest, but it would still have a substantial public health effect.

“Reassuringly, 116E vaccine was not linked with intussusception — an adverse event that has been associated with other rotavirus vaccines in some settings,” they wrote.

In another accompanying comment, Maharaj K. Bhan, MD, of the Ministry of Science and Technology for India, and colleagues wrote that the final success of the program would be complete licensure and introduction of the vaccine into the childhood immunization program in India.

“Much still needs to be done to achieve this goal, including research to test alternative formulations, further analysis to identify ways to increase vaccine effectiveness, and post-marketing surveillance to assess the risk of rare adverse events, such as intussusception,” the researchers wrote. “Nonetheless, proof of the efficacy of the 116E vaccine against a disease that effects almost every child in India, leads to millions of clinic visits, and hundreds of thousands of hospital admissions, and kills roughly one child in every 175-250 born in India before their fifth birthday, is cause for celebration.”

Oral polio vaccine must for travellers

PUNE: India has made oral polio vaccine (OPV) mandatory for all travellers across all age groups visiting polio-endemic countries such as Ethiopia, Afghanistan, Syria, Kenya, Somalia, Nigeria and Pakistan. The new regulation, which came into effect from March 1, is aimed at preventing re-entry of polio virus from these countries.

To enforce the new vaccination regime, the state health department has set up designated vaccination centres for travellers at its 33 civil hospitals and 16 state-run medical colleges attached hospitals. Besides, 26 municipal corporations in Maharashtra have also been instructed to set up such vaccination centres for travellers.

To ensure easy facilitation of OPV in Pune city, the Pune Municipal Corporation (PMC) has started a designated OPV centre at its Narayan Peth vaccination centre. "Polio vaccine will be administered to all travellers from Maharashtra travelling to these polio-affected countries at these designated OPV centres. The new polio vaccination regime has come into effect from March 1," said state immunisation officer R M Kumbhar.

S T Pardeshi, medical officer of health (MoH), PMC said, "We have already made a vaccination centre operational at our Narayan Peth centre."

Milind Khedkar, PMC's designated medical officer of overseeing the work at Narayan Peth vaccination centre said that more than 50 travellers approached the centre for vaccination ever since it became operational from March 1. "Every day around 7 to 8 people travelling to the polio endemic countries approach the centre for OPV," Khedkar said.

The Union government has declared that any case of poliovirus would be treated as an emergency and high-quality surveillance has been in place to detect any untoward importation of the poliovirus into India.

The emergency preparedness and response capacity is being reviewed on a continuous basis and nearly 200 rapid response team members have been trained to roll out emergency response to polio. "The new polio vaccination regime has come since India is awaiting polio-free certification from the World Health Organization (WHO)," said another state health official.

For queries on OPV vaccination, PMC's designated medical officer Milind Khedkar can be contacted on 9689931102. People can also write in to pmc.immunisation@gmail.com

Why the new vaccination regime?

* India has not reported any case of polio for over 3 years

* However, the risk of polio persists as Afghanistan, Pakistan and Nigeria continue to be polio-endemic, re-infecting six countries in 2013 and causing major polio outbreaks in the Horn of Africa region and the Middle East

* In view of the persisting threat of polio virus importation, the independent monitoring board of the global polio eradication initiative, recommended in its October 2013 report that the International Health Regulations (IHR) should be used to ensure all people travelling from polio-endemic country have vaccination prior to travel, and this should be extended to any persistently affected country

* As per the WHO guidelines, until polio is eradicated globally, the risk of introduction of poliovirus in polio-free areas through travellers remains. Hence, all travellers, to and from poliovirus-infected areas, are advised to be adequately vaccinated.

* Earlier, in May 2013, the India Expert Advisory Group (IEAG) on polio eradication recommended that the Union government should strongly promote the current WHO polio immunisation recommendations for travellers to and from endemic or infected areas

* India is taking several other measures to mitigate the risk of poliovirus importation. Continuous polio immunisation posts have been set up along the international borders with Pakistan, Nepal, Bangladesh, Myanmar and Bhutan.

* Initiated in 2011, the number of posts has gone up to 102 this year with nearly 4.2 million children immunized at these posts in the last two years

* All efforts are being made to maintain population immunity against polio through high quality polio immunization campaigns and increased routine immunization coverage

* Two national and six sub-national polio campaigns were held in 2013

* On January 13, India completed three years without a single case of polio. It was in 2011 that the last case of polio was reported in India, when a two year-old girl from Howrah district of West Bengal was paralysed because of the infection.

* However, the risk posed by travellers from polio infected areas continued to be a source of concern among the health officials.

(Source: timesofindia.indiatimes.com)

Polio is gone from India

'Polio Is Gone From India'
Vaccination Certificate Is Too Kinds Of The Pass Port
National Immunization Days, 2014 : (19th Jan 2014/23rd Feb 2014)

REDUCING RISK OF IMPORTATION FROM NEIGHBORING COUNTRIES

Continuous immunization at border crossing points and greater focus on border populations

SOME QUOTES FROM THE INDEPENDENT MONITORING BOARD

"India should demonstrate to every country where polio still exists, and to the world, that there is no such thing as impossible."

"India has demonstrated the value of a logical and systematic approach. It led to the quality of data being challenged and improved. It led to the programme wanting to learn from its trials and its errors, and improving as a result."

"For years, many believed that the challenge of stopping polio transmission in India would be the downfall of the Programme; that, quite simply, it could not be done. They have been proven wrong. What many thought unachievable has been achieved. Confidence in the Programme should receive a major boost as a result of this."

"Polio is gone from India – a magnificent achievement and proof of the capability of a country to succeed when it truly takes to heart the mission of protecting its people from this vicious disease."

It is
o Historic achievement
o Monumental milestone
o Unprecedented success

But.....

Threat of polio resurgence persists…

o A total of 389 polio cases reported globally in 2013
o Pakistan alone reported 91 cases in 2013 and first four cases in 2014
o 7 previously polio-free countries re-infected in 2013

MITIGATING RISK OF IMPORTATIONS – VACCINATION OF TRAVELERS

o Polio vaccination for travellers to and from Afghanistan, Ethiopia, Kenya, Nigeria, Pakistan, Somalia and Syria from 1 March 2014

INBOUND TRAVELLERS TO INDIA: 

o Resident nationals required to receive a dose of OPV, regardless of age and vaccination status, at least four weeks prior to departure to India
o A certificate of vaccination with OPV required while applying for entry visa to India

OUTBOUND TRAVELLERS FROM INDIA: 

o Indian residents required to receive a dose of OPV regardless of age and vaccination status at least four weeks prior to departure.
o Each district in India has designated at least one center for providing OPV & vaccination certificate.
o RCHO is the designated official for issuance of certificate
o Vaccination certificate will be valid for one year
o Unvaccinated travelers shall be vaccinated at international airports
o State governments responsible for making arrangements to administer OPV at international airports
o Link to the GoI guidelines on "Requirements of polio vaccination for international travelers between India and polio infected countries".

PROGRAM PRIORITIES FOR MAINTAINING POLIO-FREE STATUS

o Maintain high population immunity against polio
o Ensure certification standard surveillance
o Be in a state of emergency preparedness to rapidly respond to any WPV importation
o Plan for Polio Endgame strategy

TRACKING AND VACCINATION OF NEWBORNS

o 2 million children vaccinated in congregations each year
o 8 million children in transit immunized in India each round
o 100,000 of these in running trains
o 250,000 settlements with migrants identified and covered

India continues to be polio free, however risk of importations remains as long as WPV circulates globally. Maintaining high population immunity essential for mitigating risks of WPV importations and emergence of VDPVs. Need to focus on high risk areas for maintaining high population immunity,

During polio campaigns
Intensification of routine immunization
Lessons learnt from polio eradication initiative are being used for strengthening routine immunization 

Source: e-pao.net

Halfway there - Delivering on the promise of immunisation for all

At the midpoint of the 2011–2015 strategy of the Global Alliance for Vaccines and Immunisation (GAVI), Halfway There serves as a progress and accountability check on GAVI and its partners. the report evaluates performance and identifies weaknesses where efforts must be improved.

It focuses on the following areas:

• financing for immunisation
  
• progress in reducing the price of vaccines
  
• vaccine rollouts
  
• support for countries to strengthen their health systems
  and promote broader and more equitable coverage
  of immunisation
  
• GAVI’s governance

In conclusion, this report makes recommendations to GAVI, donors, countries receiving GAVI support, the private sector and civil society organisations. the aim is to help accelerate progress towards our shared goal – that all children enjoy the full benefits of immunisation

Read full story: Halfway there- Delivering on the promise of immunisation for all