Date post: | 15-Dec-2015 |
Category: |
Documents |
Upload: | maxwell-gabriel |
View: | 223 times |
Download: | 1 times |
Children and Infectious Diseases:
Vaccine Preventable Diseases and Maternal Health
Yvonne Maldonado, MDDepartments of Pediatrics and Health Research and PolicyStanford University School of Medicine
Ten Great Public Health Achievements United States, 1900 - 1999
Vaccination Motor-vehicle safety Safer workplaces Control of infectious diseases Decline in deaths from coronary heart disease Safer and healthier foods Healthier mothers and babies Family planning Fluoridation of drinking water Recognition of tobacco use as a health hazard
– Source: Center for Disease Control and Prevention, 1999
Decreased Mortality in the US from Infectious Diseases in the 1900s
Sharp drop in infant and child mortalityIn 1900
30.4% of all deaths among children <5; by 1997 only 1.4%Leading causes of death pneumonia, tuberculosis, diarrhea, and diphtheria
29.2 year increase in life expectancy
DiseaseMaximum
Cases Year 1996*Percentage
Change
206,939894,134152,209265,269
21,26957,686
20,0001,560
20,000
0
(1921)(1941)(1968)(1934)(1952)(1969)(1964-5)(1948)(1984)
1488
6586,467
0210
227
276
11,690
-99.99-99.95-99.57-97.56
-100.00-99.64-99.99-98.27-98.62
+++
DiphtheriaMeaslesMumpsPertussisPolio (wild)RubellaCong. Rubella Synd.TetanusInvasive Hib Disease
Vaccine Adverse Events
* Provisional+ Estimated because no national reporting existed in the prevaccine era
++++
Comparison of Maximum and Current Reported MorbidityVaccine-Preventable Diseases and Vaccine Adverse Events
United States
Vaccine Successes and Failures
Pediatric vaccinations have had the most profound impact of any intervention on increasing global child survival, accounting for 3 million children’s lives saved annually.
Even in the 21st century, however, vaccine-preventable infectious diseases, including tetanus, measles and pertussis, cause disease and death in many parts of the world.
Global Burden of Disease – Where do vaccine preventable diseases fit in?
World Health Organization assessment of global scope and cause of deathMany sources of information to assess mortality throughout the worldCategories: infectious, non-infectious, trauma
Leading Global Causes of Death - 1990The Ten Leading Causes of Death, 1990
Developed Developing1 Ischemic heart disease Lower Respiratory Infections2 Cerebrovascular disease Ischemic heart disease3 Lung cancer Cerebrovascular disease4 Lower respiratory infections Diarrheal disease5 COPD Perinatal conditions6 Colon cancer Tuberculosis7 Stomach cancer COPD8 Road traffic accidents Measles9 Self-inflicted injuries Malaria
10 Diabetes mellitus Road traffic accidents
Global Burden of InfectionsOne death in three of the ~54 million deaths worldwide is from an infectious causeVirtually all of these deaths are in developing areas of the world – mainly India and sub-Saharan AfricaDisproportionately affect childrenMany of the developing world deaths are due to preventable causes
Pneumonia and Diarrhea – account for 40% of these deathsTuberculosisMeaslesMalaria
Limitations of GBD Index
In most developing areas, this is just an estimate of death
Does not account for incapacitating illness
Acute and chronic illness may have long term effects on family and social structure
Individuals in marginal circumstances, even in developed settings, are at higher risk
The Global Infectious Disease Threat
Infectious diseases are a leading cause of death worldwide
Spread due to two major causes•Changes in human behavior--including
lifestyles and land use patterns, increased trade and travel, inappropriate use of antibiotics
•Microbial factors – mutations, antibiotic resistance
The Global Infectious Disease Threat and Its Implications for the United States
Of the seven biggest killers worldwide, TB, malaria, hepatitis, and, in particular, HIV/AIDS continue to surge
HIV/AIDS and TB likely to account for the overwhelming majority of deaths from infectious diseases in developing countries by 2020
Acute lower respiratory infections, diarrheal diseases and measles appear to have peaked at high incidence levels
The Global Infectious Disease Threat and Its Implications for the United States
Global Burden of Vaccine Preventable Deaths
~2.5M deaths/year
What is the global status of immunization?
Each year 130 million children are born, 91 million of them (70%) in developing countries.
Almost 30 million children have no access to immunization.
Due to immunization, and in particular to the global Expanded Programme on Immunization (EPI), launched by the World Health Assembly in 1974, almost 3 million lives have been saved each year, and 750 000 children are saved from disability.
Global Impact of Immunization on Vaccine-Preventable Diseases
Disease # of Preventable Cases
Hepatitis B 900,000
Measles 888,000
Haemophilus influenzae type b (Hib)
400,000
Pertussis (Whooping cough) 346,000
Neonatal Tetanus 215,000
Tetanus 195,000
Yellow Fever 30,000
Diphtheria 5,000
Poliomyelitis 720
TOTAL 2,979,720
What is the global status of immunization?
In 1990, worldwide average vaccination coverage of children under five was 80% but by 1999 fell to 74%.
One in four children in the world remains without immunization against the six diseases initially covered by EPI (measles, polio, pertussis, diphtheria, tetanus and tuberculosis).
Access to immunization varies greatly across the world
A child in a developing country is ten times more likely to die of a vaccine-preventable disease than a child from an industrialized one.
In some countries, up to 70% of children do not receive the full set of vaccines; the lowest coverage is found in sub-Saharan Africa.
In Africa as a whole, over 40% of children are not immunized against measles, a major cause of infant mortality that kills one child every minute.
Access to immunization varies greatly across the world
WHO has been recommending vaccination against Hepatitis B since 1993, yet it kills approximately one million people each year.
Recommendations have also been made for yellow fever, yet 30 000 deaths occur each year.
What is the global status of immunization?
There is no equality of access to vaccines for children in industrialized and developing countries, and there is a lack of equality between rural and urban areas within countries. It is estimated that a child in an industrialized country receives eleven vaccines on average, while a child from a developing country is lucky to receive half that number.
What is the global status of immunization?
There is a lack of investment in research and development for new vaccines or to disseminate existing vaccines to combat the diseases that are prevalent in developing countries:
Diarrhoeal diseases (Rotavirus, E. coli, Salmonella, Shigella, Cholera)MalariaTuberculosisPneumonia (Pneumococcus, H. influenzae type B, RSV)HIV/AIDS.
Progress in Eradication of Global Infections
Eradication of Smallpox in 1977Elimination of Poliomyelitis from the Western Hemisphere in 1994Potential elimination of global poliomyelitis in the next 5 to 10 yearsPotential elimination of measles in the next 10 to 20 yearsVaccines in development for prevention of diarrheal diseases, cervical cancer (HPV)
New Modes of Vaccination
Administration of vaccines is a major area of research
Many antigens given in the first year of life so combination vaccines available and in development
“Needle-less” injections a global priority for compliance and safety reasons (decrease spread of HIV and HBV through reuse of needles)
• Development of edible vaccines (bananas, potatoes)• Nasal or other mucosal routes
Impact of Infectious Diseases in the Next 20 years
Three variables will affect the immediate futureRelationship between increasing microbial resistance and scientific efforts to develop new antibiotics and vaccinesTrajectory of developing and transitional economies, especially concerning the basic quality of life of the poorest groups in these countriesDegree of success of global and national efforts to create effective systems of surveillance and response
The interplay of these drivers will determine the overall outlook
Why Global Eradication of Infectious Diseases?
Immunization is one of the most cost effective health interventions in existence.
If polio is eradicated by 2005, $ 1.5 billion per annum will be saved on immunization costs alone.
Similarly, eradication of smallpox in 1979 led to direct savings of $ 275 million per annum.
Immunization reduces the social and financial costs of treating diseases, offering opportunities for poverty reduction and greater social and economic development.
Why Global Eradication of Infectious Diseases?
Improved survival generally result in improved standard of living for allBenefits to society when most members are healthy and productiveOverall global stability
Maternal and Neonatal Health
Maternal-Perinatal Morbidity & Mortality
InfectionsInadequate Perinatal Care
Premature BirthsObstructed Labor
FistulasGenital Mutilation
Cancer
Maternal and Neonatal Health
Women and their babies suffer at the hands of
• Poverty• Poor nutrition• Infection• Lack of effectively trained health
workers and medical staff• Natural disasters
Maternal and Neonatal Health
529,000 pregnant women die per annum, 1 per minute, and 5.7 million newborns die, almost all in the developing countries of the world
In addition, for every woman who dies in childbirth, 20 more suffer injury, infection and disease– 10 million women a year.
A woman living in sub-Saharan Africa has a 1 in 16 chance of dying on pregnancy or childbirth, compared with a 1 in 2,800 risk for a woman in a developed country.
Maternal and Neonatal Health
70% of maternal deaths are due to hemorrhage, obstructed labor, eclampsia, sepsis, and unsafe abortion.
Of the 529,000 maternal deaths, 527,000 are from the developing world.
2.7 million newborns are born dead each year and 3 million will not survive the first week of life– the astonishing total of 5.7 million!
Maternal and Neonatal HealthThe WHO Department of
Making Pregnancy Safer (MPS) “every birth should be attended by a skilled
health worker if the terrible toll of maternal deaths is to be reduced… many of the deaths could be avoided if all women had the assistance of a skilled health care worker before, during and after pregnancy, including access to emergency medical care if complications should arise.”
Maternal and Neonatal Health
Goals
• UN Goal is to reduce by three-quarters the rate that women die by childbirth by 2015
• WHO Goal is to dramatically increase the number, training and availability of trained health care workers in areas where there is unmet need.
Pediatric Preventable Infections – Immigrant Populations
Immunizations are keyLack of a sustained medical homePoor tracking by immunizations registries
Tuberculosis rates are high among immigrant populations in the US
Exposure to infected adults Disease most severe in infants and young children
Maternal prenatal care important for good perianatal outcomes
Lack of consistent prenatal care in immigrant women