Impact of Haemophilus influenzae type b conjugate vaccine on bacterial meningitis in the Dominican Republic

OBJECTIVES: Widespread use of Haemophilus influenzae type b (Hib) vaccines has dramatically reduced the burden of Hib disease throughout the Americas. Few studies have evaluated the impact of Hib vaccination on non-culture-confirmed disease. This study analyzed trends in probable bacterial meningitis before and after the introduction of Hib vaccine in the Dominican Republic and estimated vaccine effectiveness against Hib meningitis. METHODS: Meningitis cases among children < 5 years of age were identified from admission records of the main pediatric hospital in Santo Domingo during 1998 - 2004. Laboratory criteria were used to classify meningitis cases with probable bacterial etiology; confirmed cases had positive bacterial culture or antigen detection in cerebrospinal fluid. Cumulative incidence rates of confirmed and probable bacterial meningitis were calculated for children living in the National District. Confirmed cases of Hib meningitis were enrolled in a case control study with age- and neighborhood-matched control children to calculate vaccine effectiveness. RESULTS: Before vaccine introduction, annual rates of meningitis with probable bacterial etiology were 49 cases per 100000 children < 5 years old; Hib accounted for 60 percent of confirmed bacterial cases. During 2002 - 2004, after vaccine introduction, annual rates of probable bacterial meningitis were 65 percent lower at 16 cases per 100000, and Hib accounted for 26 percent of confirmed cases. Rates of Hib meningitis and probable bacterial meningitis with no determined etiology declined by 13 and 17 cases per 100000, respectively. CONCLUSIONS: Introduction of Hib vaccine substantially reduced the incidence of confirmed and probable bacterial meningitis in the Dominican Republic. The estimated impact of Hib vaccination was twice as great when non-culture-confirmed disease was included

Immunization manual for health professionals

The surveillance of vaccine preventable diseases has been very successful and had been recognised at the highest levels. Trinidad and Tobago was awarded 1st place in 2001 for surveillance of EPI diseases by PAHO/WHO at the Caribbean EPI managers meeting. The ultimate hallmark of a successful immunization programme is demonstrating that vaccine reduces the incidence of diseases therefore routine surveillance must be an important activity in any immunization programme. Surveillance can be termed "watchdog of the EPI". The immunization coverage for all antigens have exceeded 89 percent for all antigens. There is no room for complacency. The levels of immunization coverage must be sustained at over 95 percent so that vaccine preventable diseases will not have any human loss. In addition, let us continue to maintain our efforts to eliminate other diseases such as neonatal tetanus, diptheria, rubella, measles, polio and pertussis. In light of these successes, let us continue to increase our coverage, and prevent missed opportunities at all health facilities, clinics and schools, or wherever vaccination is being administered. New initiatives are needed to reach families in difficult circumstances, areas of severe social privation, mobile families and those in remote areas. It is also important to identify pockets of unimmunized children in urban populations and have them vaccinated. Immunization is a safe and highly effective method of preventing morbidity and mortality due to vaccine preventable diseases and is well established as a most cost effective programme in Public Health

Health in Haiti

This meeting will review much of the work done in the Central American subregion, in Mexico, and in the Spanish-speaking Caribbean in the field of vaccines and the diseases they prevent. It will review progress achieved, the steps that have to be followed to consolidate the gains that have been made to date, and the strategies that have to be adopted to face the challenges ahead. It will comment on some new initiatives and, based on experiences shared, see how we may advance together (AU)

Informing maternal and child health (MCH) policy through research

Maternal and Child Health (MCH) policy over the past two decades has been strongly influenced by research. The paper presents examples of some of the research undertaken and its significant influence in shaping health service delivery. Research in child health has focussed on oral rehydration therapy, immunization and perinatal morbidity and mortality. On the maternal side, morbidity and mortality have been examined with particular focus on problems which contribute to maternal and perinatal morbidity and mortality. Policies arising out of the outcome of these studies have influenced organization of service delivery, information system development, manpower development and deployment, maternal education, surveillance/auditing, quality of care, design of physical facilites and selection of equipment. The results of these studies have also led to the identification of areas requiring further study and testing of intervention to correct the deficiencies identified. These studies demonstrate that research can and does influence health policy, and has impacted positively on the quality and cost of care provided through our health services.(AU)

A survey of hepatitis B among health workers in Jamaica

One thousand, five hundred and thirty-seven health staff, presenting for hepatitis B vaccination in Jamaica, were surveyed in 1990/91 for hepatitis B markers and/or expose to blood or hepatitis. Antibodies to either hepatitis B surface antigen (HBsAg) or hepatitis B core (HBc) were found in 19.8 percent of 817 persons tested. Males were more likely to have antibodies to Hepatitis B Virus (HBV) than females (29 percent compared with 18 percent, Odds Ratio 1.6;95 percent CI 0.98-2.9). HBsAg was found in 5.3 percent of 562 persons tested compared with 1 percent of blood donors. One or more needlestick accidents were reported by 60 percent of the sample, and blood or liquid splashing on the face was reported by 48 percent. Jaundice and hepatitis were reported by 1.2 percent and 3.5 percent of health staff, respectively. HBaAg carrier status was associated with years of service (p=0.039). Prevalence of antibodies to HBV increased with age (p=0.004) and years of service (p=0.028). The effect of age and years of service appears to be largely independent (r=0.44). This survey reaffirms the importance of health workers being immunized with hepatitis B vaccine, and adhering rigorously to universal precautions in patient care and laboratory practice (AU)

A comparison of immunization knowledge, attitude and practice among parents and guardians in two health districts in the parish of Clarendon

One hundred and fifty nine parents and guardians from the May Pen West and Chapelton were interviewed between March and April 1994 to compare their knowledge, attitude and practice on immunization. The data were collected through the administration of questionnaires. Both parents and guardians had similar knowledge on immunization in both health districts. However, in the Chapelton District there were more highly educated respondents. Their attitude toward immunization as being very important to them. The practice of taking their immunization card to the clinic on each visit was given high priority because of the Governments legislation that children would not be admitted to school without being fully immunized. This study reaffirms the importance of health education on immunization to the public, not only in the health centres but to make the information available on the media and in literature (AU)

Tuberculosis occurence in the CAREC member-countries 1983-1992

A review of reported Tuberculosis in CAREC member-countries 1983-1992 shows an overall, downward trend in annual numbers of reported cases for the first half of the period followed by an increase in the latter half of the period. The vast majority of cases were reported from eight countries viz. Bahamas, Belize, Dominica, Guyana, Jamaica, Saint Lucia, Suriname and Trinidad and Tobago which together make up 90 percent of the population (AU)

Coverage survey, an evaluation of the immunization programme for infants - abstract

The objective of this study was to obtain information on the coverage rate for DPT, poliomyelitis and MMR/measles and rubella among children in Curacao. A cluster sampling technique was used to select 211 children, aged 15 to 26 months, whose immunization status was evaluated. Data were obtained from the immunization card and by interviewing the parent. The coverage rate ranged from 99.1 percent (first DPT) to 70.6 percent(MMR); 67.8 percent of children were fully immunized. Two children (0.9 percent were not immunized at all. Less than 10 percent of all immunization doses was administered outside the Well Baby Clinics. Some of the recorded doses were given too early (invalid)according to the WHO criteria. Accurate registration was recommended as a possible way to decrease the number of invalid doses. It was found that many of the 3 doses of poliomyelitis vaccine were administered too late and it is recommended that the 3rd oral polio dose should be given earlier. Reasons why children were not fully immunized could be divided into: obstacles to participation in the programme (55.9 percent), lack of motivation (10.3 percent) and lack of information (33.8 percent). Illness of the child was the main obstacle (AU)

Eight meeting of Caribbean EPI managers expanded program on immunization

The three main objectives of the meeting were to review the progress of EPI in the countries of the English-speaking Caribbean, to National Work Plans for 1992, and to explore all venues for further collaboration between the Ministries of Health and the NGOs to strengthen EPI and ensure achievement of the goals of measles elimination and polio eradication. All countries have produced a National Work Plan for 1992. These plans were discussed during the Working Group Sessions, in which there was the participation from all the collaborating agencies and NGOs. The plans cover several program components such as: biologicals and logistics, cold chain, training, supervision, surveillance, research, social communication, evaluation and operational costs (AU)