Immunization summit rota 2010

359 views
213 views

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
359
On SlideShare
0
From Embeds
0
Number of Embeds
5
Actions
Shares
0
Downloads
11
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Immunization summit rota 2010

  1. 1. Immunization Summit -2010 Rotavirus vaccines Is a road map needed for introduction to the EPI in Sri Lanka ? Dr. Pushpa Ranjan Wijesinghe, MD Consultant Epidemiologist
  2. 2. Consensus statement Immunization summit-2007 • Current rotavirus vaccine is less effective against the serotype G9 which is the second commonest reported serotype after G3 which is the commonest • Hence, introduction of rotavirus vaccine to Sri Lanka should be considered at a later date. • Rotavirus surveillance activities should be extended and strengthened further.
  3. 3. What is known about rotavirus in SL ? Authors No of Rotavirus + patients No of Diarrhea patients % Rotavirus + patients Mendis L et al (1980) 98 326 30.1% Chandrasena et al (2006) - NCTH 126 606 20.8% EPID Unit / IVI study phase I (2005-2007) 428 1806 23.9% EPID Unit / IVI study phase II ( July 2008- June 2009) 182 624 29.1% 88 343 25.7% 103 360 28.6% EPID Unit / WHO ( July 2008- Dec 2009) EPID Unit / WHO (Jan – March 2010)
  4. 4. What are the circulating strains ? • What was detected in the phase I • Detection of antigens by enzyme-immunoassay (EIA) • WHO Reference lab was set up in Chennai – 2010 • Strain identification – from this month
  5. 5. What are the circulating strains ? Type G1 G2 G3 G4 G9 mixed NT Total P4 0 4 0 0 0 0 1 5 P6 0 0 0 0 0 0 1 1 P8 6 0 17 0 14 4 13 54 P9 0 0 0 0 0 0 0 0 mixed 0 0 0 0 0 0 0 0 NT 3 3 13 0 14 0 0 33 Total 9 7 30 0 28 4 15 93 SOURCE : Epidemiology Unit
  6. 6. Epidemiology of rotavirus diarrhea Source Rate of gastroenteritis 1119.4/100000 population (under estimate ?) AHB 2007 Expected number of diarrhoeal diseases among under five 19477 Based on AHB 2007 Mean incidence rate of Rotavirus diarrhoea 26.4% (95% CI = 22.8%-30.0%) Based on all studies Expected number of rotavirus cases per year 5142 (4440- 5843) Based on all studies Estimate of Rota specific deaths for Sri Lanka 1500 per year Case Fatality Ratio = 29%/? (Over estimate ?) CDC
  7. 7. Efficacy/Effectiveness of monovalent RV(Rotarix) Efficacy of preventing severe diarrhoea South Africa & Malavi combined 61.2% ( 95% CI-44-73%) Efficacy of preventing severe diarrhoea South Africa 76.9% (95% CI-56-88%) Efficacy of preventing severe diarrhoea Malawi 49.5 % (95% CI-19-68%) Efficacy of preventing severe diarrhoea China, Hong Kong, Taiwan & Singapore 96.1% Effectiveness of preventing severe diarrhea El Salvador 74% ( 95%CI- 51%-89%) Effectiveness of preventing very severe diarrhoea El Salvador 88% (95% CI- 47%-97%)
  8. 8. Efficacy/Effectiveness of Pentavalent RV(Rotateq) Efficacy of preventing severe diarrhoea Africa 64.2% (95% CI -40%-79%) Efficacy of preventing severe diarrhoea Asia 51 (95% CI -13%-73%) Effectiveness of preventing severe diarrhoea US 85%-95% Effectiveness of preventing Hospitalization needing IV fluids Nicaragua 46%(95%CI-18%-64% ( children under 2 years) Effectiveness of preventing severe diarrhea Nicaragua 58% ( 95 % CI = 30%-74%) Effectiveness of preventing very severe diarrhoea Nicaragua 77% ( 95% CI- 39%-92%) Source – WHO
  9. 9. Source : WHO
  10. 10. Are these vaccines safe ? • Recommendations of GACVS – Vaccines are safe – Risk of intussusception ruled out with confidence – No data to support increased risk of intussusception when administered outside the age range • 6–15 weeks for the first dose • 32 weeks for the second dose – No interference with OPV and other EPI vaccines – OPV inhibit the response of the first dose of Rota vaccines – No change in clinical status of • HIV infected children • Children born to HIV infected mothers.
  11. 11. Update on rotavirus vaccines • FDA recommendations – USA • Addition of Severe Combined Immunodeficiency as a Contraindication • DNA from porcine circovirus type 1(PCV1) in the vaccine (Monovalent RV) • Fragments of DNA from PCV1 and from a related porcine circovirus type 2 (PCV2) (pentavalent RV) • Resumption of using both vaccines • strong safety records-trials/post marketing surveillance • Benefits > theoretical risks • Follow-ups by the FDA
  12. 12. Can Rotarix be incorporated into the EPI schedule ? • 2 & 4 months schedule – effectiveness demonstrated • 6 weeks , 10 weeks schedule - effectiveness not demonstrated
  13. 13. Can Rotateq be incorporated into the EPI schedule ? • Rotateq vaccine – 3 dose schedule only used in clinical trials – 6, 10, 14 weeks • General guidelines • first dose of either RotaTeq or Rotarix – at age 6–15 weeks. • The maximum age for administering the last dose of either vaccine – 32 weeks.
  14. 14. Preventable number of Rotavirus cases by live attenuated monovalent vaccine in Sri Lanka Non vaccinated scenario Rotavirus infection Vaccinated – vaccine recipients (90%) Vaccinated – vaccine non recipients (10%) Total cases prevented by vaccine 5142 532 514 4096 Target population – under five children Efficacy – 86 % with 2 doses of monovalent RV vaccine Vaccine coverage – 90%
  15. 15. What are the costs involved ? Approximate cost for vaccines 7$ per a dose (376843 X 7 $ X 2) 52 75 802 $ per year 12.4 $ a dose (376843 X 12.4 $ X 2) 9345706 US $ Treatment cost in a non vaccinated scenario 33 $ per a case ( 33$X5142) 169686 $ per year Treatment cost in a vaccinated scenario 33 $ per a case ( 33$X1046) 34518$ per year Treatment cost saved from vaccination Cost per case averted 135168 $ (0.14 million) per year Scenario I Scenario II 1288 US $ 2281 US $
  16. 16. What are the costs involved ? Approximate annual cost for vaccines 7$ per a dose 2 dose schedule 5 million US $ Average cost of an episode of rotavirus diarrhoea hospitalization Rs. 3626 (US$ 33) Cost saved through averting rotavirus hospitalizations per year US$ 0.26 million. Deaths averted per a year 8 Hospital-based study of the severity and economic burden associated with rotavirus diarrhea in Sri Lanka Nilmini Chandrasena ,*, Shaman Rajindrajith b, Ahmed Kamruddin c, Arunachalam Pathmeswaran d and Osamu Nakagomi e Journal of Pediatric Infectious Diseases 2009; 4(4)
  17. 17. Future • Rotavirus disease burden study • General population • Among high risk groups • Morbidity cost study • Economic analysis • Expansion of surveillance to other areas • semi urban, rural ,slum, estate settings • PCR training for the virological focal point @ MRI ( WHO support) • Strain identification @ the MRI • A large base of rotavirus strains
  18. 18. Discussion points • Is there a need for introduction of rotavirus vaccine ? – present & future • If so, what will be the time line ? • If so what approach do we need ? – Population or high risk • What should be the risk groups – Role of epidemiology and disease surveillance information • What will be the communication strategy for the community – Perception – all cause remedy for all diarrhoea – One strategy in the intervention package • What and how can NPI learn from the private sector ?
  19. 19. Acknowledgement • • • • • • • • • • • • • • • • Dr.Nihal Abeysinghe Dr.Paba Palihawadana Dr. Sudath Pieris Dr. Ranjith Batuwanthudawe Dr.Geethani Galagoda Dr.Sarath Silva Dr. Kalyani Guruge Dr. Padmakanthi Wijesuriya Dr.Paul Kilgore Dr. Niyambat Batmunkh –IVI Dr.Aparna Singh Shah Royal Murdoch children’s hospital – Melborne International Vaccine Institute GAVI’s ROTAADIP WHO- SEAR & HQ-Geneva Asian Rotavirus Surveilance Network

×