Vaccine Preventable Disease - Pneumonia and Measles From Epidemiological Perspective

1. PREVENTABLE
DEATH DISEASES
PNEUMONIA
MEASLES
PREVENTION
SYMPTOMS
TETANUS
IMMUNIZATION
VACCINE
ELDERS
RISK
COMMERCIAL
VACCINATIONS
UNDER5
LEAD
SOCIAL
SECRET
SPEED
PREVENTION
HEALTH
PLANNING
MEASLES
EDUCATION
PNEUMONIA
STUDY
INTERNET
COMMUNITY
VACCINE
DATA
IMPROVE
COMMERCIAL
RESOURCE
INDIA
MUMPS
POLITICAL
TRAINING
IMPROVE
VACCINE
GLOBAL
VILLAGES
HEALTH
CURE
RISK
DETERMINANTS
DATA
WHO
SLUM AREAS
CHILDREN
PNEUMONIA
RESOURCE
MEDIA
ECONOMIC
DIVERSE
YES
WHO
GAPPD CONTROL
TUBERCULOSIS
UNICEF
PLANNING
FACT
FICTION
UNITED
WEB
COVERAGE
MIRROR
BLOG
TEXT
INTERNET
MENINGITIS
TIME
WORLD
CAUSES
MEASLES
DOCTORS
SMART
UNICEF
INFECTIONS
ACCESS
YES CLOCK
NO
FACT TOWER
ECONOMIC
UNITED
COVERAGE
BLOG
FICTION
EXPAND
HEALTH
INTERNET
INFORMATION
ERADICATION
VIDEO
DOCTORS
DETERMINANTS
SOCIAL
NEWBORN
PERTUSSIS
RURAL
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2. 2
KABAK
TAMAR
SHIRISH
TIWARI
SONU
GUPTA
PURABI
RATH
HRITU
SHRIVASTAV
GROUP MEMBERS

3. VACCINE
PREVENTABLE
DISEASES
A vaccine-preventable
disease is an infectious
disease for which an
effective
preventive vaccine exists.(1)
25 Diseases – WHO. (2)
 Diphtheria
 Pneumonia
 Hepatitis B
 Measles
 Meningitis
 Mumps
 Pertussis
 Poliomyelitis
 Rubella
 Tetanus
 Tuberculosis
 Yellow Fever 3

4.  A CHILD DIES EVERY MINUTE FROM
PNEUMONIA IN INDIA.(3)
 1.4 MN – Children dies every year globally.
 1.4 MN > (AIDS + Malaria + TB).(3)
 436/1000 Live births – Under-5 children
mortality due to Pneumonia.(4)
PNEUMONIA
WHY IT IS AN
IMPORTANT
ISSUE??
4

5. CAUSES
- Infectious Agents
- Bacteria
- Virus
- Fungi
 COMMON SYMPTOMS
- Cough
- Chest Pain
- Fever
- Difficulty Breathing
- Diarrhea
MODE OF
TRANSMISSION
- Virus & Bacteria present
in nose & throat
- Cough/sneeze
- Blood
WHAT IS
PNEUMONIA?
Pneumonia is an
infection or
Inflammation in
one or both
lungs.(6)
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6. WHY
PNEUMONIA
IS
PREVALENT?
50% of World’s
Pneumonia deaths
occur in India
which means
approximately 3.7
lakh children die
of Pneumonia
annually in
India.(7)
 VULNERABILITY OF CHILDREN
- Undernourished Children/
Less Breastfed.(8)
- Other illness like AIDS or
measles.(8)
- NO/Low vaccine coverage.
- Environmental factors like
slum, crowding, parental
smoking.
 SOCIAL DETERMINANTS
- Region – Urban or Rural
- Gender – Male < Female(8)
- Mother’s Education(9)
- Income Level of Family(9)
- Political Stand
- Community Approach
6

7. Fig. Pneumonia
Proportional Mortality in
India.
Morris SK, Bassani DG, Awasthi S, Kumar R, et al. (2011) Diarrhea, Pneumonia,
and Infectious Disease Mortality in Children Aged 5 to 14 Years in India. PLoS
ONE 6(5): e20119. doi:10.1371/journal.pone.0020119
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0020119
CONTRASTING CONDITION
OF PNEUMONIA IN INDIA
 Gender Bias – Girls
mortality is more high than
the boys.(8)
 Geographical Inequities –
North, West and North-East,
Highly prevalent.(8)
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8. DESPITE
MANY
EFFORTS,
WHY IT STILL
PERSISTS?
WHO
UNICEF
GAPP
IMNCI
IAP
GoI-MOHFW
 KEY POINTS UNADDRESSED
- Lack of Social Awareness.
- Lack of Proper Primary
Prevention.
- No Vaccine Coverage(UIP).
- Improper Implementation of
Prevention and Treatment
Guidelines issued.
- Less attention from
Government
8
 INTEGRATED EFFORTS
• IMNCI - Integrated Management
of Neonatal and Childhood
Illnesses - UNICEF
• UIP – Universal Immunization
Programme - MOHFW
• GAPP – Global Action Plan For
Pneumonia - WHO

9. WHAT
NEEDS
TO BE
DONE?
MEASURES
PREVENTION
TREATMENT
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PRIMARY
PREVENTION
CARE
SUPPORT
TREATMENT
STRATEGIC
INFORMATION
INSTITUTIONAL
STRENGTHENING
SYSTEM
 LOW COST & EASY PREVENTION
- Washing hands with soap
- Controlling Indoor Air Pollution
- Exclusive Breastfeeding
- Oral Rehydration
- Zinc Supplementation
- Availability of Vaccines
RECOMMENDATION

10. 10
MEASLES

11. MEASLES:
CONTAINING
THE
CONTAGIOUS
WHYMEASLES
NEEDS
ATTENTION?
 A CHILD DIES IN EVERY
FOUR HOURS IN INDIA
 92,000 – Dies every year
in India.
 122 000 - Deaths
globally.
 330 deaths every day or
14 deaths every hour.
 Less than 80% - First
Dose Vaccine coverage.
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12. WHAT IS
MEASLES?
“Any person
with fever
,maculo-papular
rashes and
coryza/cough/
conjunctivitis.”
- WHO
 CAUSE
- Myxovirus
- Vitamin A deficiency
- Malnourishment
 SYMPTOMS
- Fever
- Rashes
- Cough
- Conjunctivitis
- Diarrhea
 MODE OF TRANSMISSION
- Droplet, direct contact
with nasal and throat
secretions.
12

13. WHY
MEASLES IS
NOT
LEAVING
US?
Each year
60000-100000
children die of
measles in
India.
EPIDEMIOLOGICAL
DETERMINANTS
- Poor living condition.
- Poverty.
- Co-morbid disease
- Suppressed immunity
- Unvaccinated community
leading to OUTBREAK
- Inaccessibility to healthcare
coverage
- Onset of Winter season.
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14. WHAT
IS ITS
MAGNITUDE
AND
TRENDS?
VACCINES
IMMUNIZATION
 PRE-VACCINATION ERA
- Prior to 1960: 8 MN
children death/year
- 135 MN/year globally.
- 100-400 times - likely to
cause death in
developing countries
than developed.
MEASLES VACCINATION
PERIOD:
- Measles mortality
reduces more than three-quarter
in all WHO
regions except SEAR.
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16. WHO STRATEGY: “CATCH-UP, KEEP-UP, FOLLOW-UP”
HOW
TO STOP
MEASLES?
MEASURES
PREVENTION
CONTROL
STRATEGIES
 Planning and Coordination :
central, state and DTF
 Routine Immunizations :
9mnths of age(6mnths-outbreak)
 SIA : catch-up + follow-up
campaign
 ACSM: multi-sectoral , NGOs ,
CBOs , professional bodies ,
religious institutions, media
etc.
 Human resource management
: training, remuneration and
capacity buildings 16

17. WHERE
ARE
THE
CHALLENGES
LIES?
 Lack of trained professional
 Lack of trust in MCV
 Poor health care delivery system
 Issues of Social Determinants
 Measles outbreak
 HARD TO REACH Population
 Unpredictable Funding
HOW
CAN
WE
MOVE
 Improve Vaccine coverage (quality and quantity)
 Effective treatment measures to prevent
AHEAD?
complications
 Outbreak preparedness
 Targeted interventions –hard to reach
populations
 Ensure social equities
 Building trust to the communities through
multi-sectoral approaches 17

18. MILLENIUM
DEVELOPMENT
GOALS
MDG4 GOALS: FOR PNEUMONIA AND MEASLES
 Reduce child mortality by two-thirds by 2015 (Vs. 1998).
 More than 90% Immunization coverage.
 Vaccination Coverage: 90% national and 80% district level.
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REFERENCES
1. http://www.cdc.gov/vaccines/vpd-vac/vpd-list.htm
2. http://www.who.int/immunization/diseases/en/
3. Times of India - http://tinyurl.com/pazhgme
4. The Hindu - http://tinyurl.com/pnrl9zv
5. http://www.nlm.nih.gov/medlineplus/pneumonia.html
6. IAP Recommendations – Page 1. / www.iapindia.org
7. WHO - http://www.who.int/mediacentre/factsheets/fs331/en/
8. http://www.plosone.org/article/info:doi/10.1371/journal.pone.0020119
9. Pneumonia: The Forgotten Killer of Children by UNICEF (pdf)
10. Indian pediatrics, vol.49-may16,2012
11. Global eradication of measles,WHO executive board ,126th session ,26th nov 2009
12. Millenium development goal India , country report 2011, www.mospi.nic.in
13. Operational guidelines for measles catch – up campaign-MoHFW-GoI june 2009
14. Control of communicable diseases, David l heyman 18th edition p 379-385

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