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IVAC Blog

 
Date: Nov 2015

By Dr. Mathuram Santosham, Chair for the Rotavirus Organization of Technical Allies (ROTA) Council, Director of the Johns Hopkins Center for American Indian Health, and Senior Advisor for the International Vaccine Access Center (IVAC) at the Johns Hopkins University, where he is also a Professor of International Health and Pediatrics.

This article was originally published on Impatient Optimists and is cross-posted here with permission. 

In 1980, the first summer I worked on the White Mountain Apache reservation, a community of fewer than 10,000 people in Arizona, so many babies were dying of diarrhea that we buried one every week.

To combat this major problem, we trained community outreach workers to give oral rehydration solution (ORS)—a mixture of sugar, salt and safe water—to babies and young children sick with severe, dehydrating diarrhea. Over time the practice spread and diarrhea deaths in the community dropped to nearly zero.

Proven solutions like ORS, vaccines and better sanitation and hygiene have dramatically reduced childhood diarrhea deaths around the world—from 5 million deaths in 1980 to 600,000 today.

But it’s not just deaths we have to worry about. Illnesses are a major issue too. As the rate of diarrhea deaths have dramatically come down, incidence has barely decreased at all. Children continue to experience an average of three episodes of diarrhea each year. A case of severe diarrhea, especially during important development stages in a child’s life, can have a lasting impact on physical and cognitive growth. Diarrhea can also make children more susceptible to death from other causes like pneumonia.

Recently, at TropMed in Philadelphia, recent progress in global efforts to protect children from diarrhea was hailed and the unfinished agenda highlighted.

Here are four critical things we need to do to protect children from diarrhea:

1. Expand access to ORS.

Children sick with severe diarrhea can be fully rehydrated within a few hours when provided with ORS. However, only one-third of children in low- and middle-income countries who need ORS get it. 

2. Improve nutrition and be sure to feed children suffering from diarrhea to stop the vicious cycle of malnutrition and diarrhea.

Malnutrition weakens immune systems, making children more vulnerable to infections like diarrhea. Diarrhea, in turn, prevents children from absorbing nutrients, contributing to malnutrition. This creates a vicious cycle. Because of malnutrition, one in five children worldwide is moderately to severely stunted. Children with two to three diarrheal disease infections a year suffer an average of 8 cm growth loss and a 10 IQ point loss.

Making the situation worse, many caregivers withhold food from children and babies when they are suffering from diarrhea. It is very important to continue feeding children appropriate food during an episode of diarrhea.  

3. Vaccinate all children against rotavirus, the leading cause of severe and deadly diarrhea.

Rotavirus causes 40% of diarrhea hospitalizations—and 200,000 deaths in children under 5 each year. Unlike other forms of diarrhea, rotavirus infections cannot be controlled by hygiene and sanitation alone. Vaccines are essential to prevention.

Two rotavirus vaccines are available and have been internationally licensed since 2006. These vaccines are currently used in the national immunization programs of nearly 80 countries. Despite this, only 15 % of the children in Gavi countries—the world’s poorest—have access to this life saving vaccine. Even in countries where rotavirus vaccines are used, the poorest children often do not get vaccinated.         

In the US, use of rotavirus vaccines led to a striking decline in rotavirus-related hospitalizations. In some years, there are almost no cases observed. Yet because coverage is still not routinely high (it’s varies geographically from 59-88% now), the accumulation of unvaccinated infants periodically leads to outbreaks. In the US, rotavirus vaccine coverage must be improved.

Worldwide, more than 90 million children still don’t have access to rotavirus vaccines. In countries where the most diarrhea deaths occur, almost none have introduced the rotavirus vaccine, despite considerable evidence of its public health impact, cost saving potential and the prospect of introduction support from Gavi, the Vaccine Alliance

Public health impact has been dramatic in low- and middle-income countries where rotavirus vaccines have been introduced. In Mexico, the vaccine led to a decrease by 50% in diarrheal deaths in children under 5.

Countries that do not already include the rotavirus vaccine in their national immunization program should consider the striking public health and economic benefits and take steps to introduce it as soon as possible. Countries that do, should work to ensure good coverage.  

4. Develop new, low-cost rotavirus vaccines to help reach all children. 

New rotavirus vaccines are in the pipeline and could help to accelerate coverage. Companies in China, India, Indonesia and Vietnam are developing new vaccines with prices as low as US$1.00 per dose for governments (such as Bharat Biotech’s ROTAVAC, which India is rolling out soon in four states). There are not yet enough doses of these new vaccines to cover all children in the countries where they are being produced, much less the millions of children around the world who are in need of this vaccine. Yet with new product licensures expected as soon as 2017, the product landscape could be quite different very soon. 

One thousand children per day still die from diarrhea—a preventable tragedy. We’ve made progress, but we can do much better.

As Nobel Laurate Gabriela Mistral said:

"We are guilty of many errors and many faults, but our worst crime is abandoning the children, neglecting the fountain of life. Many of the things we need can wait. The child cannot. Right now is the time his bones are being formed, his blood is being made, and his senses are being developed. To him we cannot answer ‘Tomorrow,’ his name is today.”

The Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea goal is to reduce mortality from diarrhea in children under 5 to fewer than 1 per 1,000 live births. This is a very ambitious goal but we know it is possible as long as the public health community can work together and garner political support. We need to make it happen.

To learn more about how you can get involved, visit this page.

By Huma Khawar, freelance journalist and consultant for Vaccine Implementation Technical Advisory Consortium (VITAC).

This article was originally published on the VaccinesWork blog and is cross-posted here with permission.

Girl with vaccine card

A little girl with her vaccination card. Photo: Gavi/Doune Porter

Doctors from across Pakistan gathered in Islamabad last Thursday to fight a disease that’s threatening children across the country. This time it wasn’t polio they were working against, but pneumonia, which kills as many as 71,000 children every year in Pakistan.

The event, held to mark World Pneumonia Day, aimed to empower key influencers to better advocate to stop pneumonia and discuss challenges to its prevention. It took place at the Children’s Hospital, Pakistan Institute of Medical Sciences (PIMS), which itself sees many cases of the disease with a daily turnover of over 500 children in its outpatient department from in and around Islamabad.

WPD Seminar Event

The entrance to the seminar. Photo: Huma Khawar.

The pneumococcal vaccine was rolled out in Pakistan in 2012 as part of the routine immunization schedule, when it had already helped children in many other countries avoid pneumonia. It is also proving effective in Pakistan, as Dr. Asad Ali, from Aga Khan University Karachi, demonstrated by sharing preliminary findings from the vaccine impact assessment in Sindh. He explained that even one dose of pneumococcal vaccine is highly effective against the main germs that cause pneumonia (pneumococcus and Hib).

However, pneumonia is still one of the major killers of children under five years old in Pakistan.  A major reason is limited routine immunization coverage – a little more than 50% of children are covered by a basic set of vaccines nationally, and the numbers of children immunized has even been declining in Balochistan. As a result, pneumococcal vaccine faces challenges reaching children across the whole country through this system, and so its population-level effects cannot yet be expected to be significant.

Doctors estimated that this underperformance is fuelled by caregivers’ lack of awareness. Too few parents know that the vaccine is necessary for child health, free-of-cost and available at immunization centers nationally. Yet improving vaccine coverage is crucial, as once infected, access to treatment options for infants remain limited especially in Pakistan’s rural, impoverished regions. Dr. Syed Saqlain Ahmad Gillani, National Immunization Program Manager, concluded the session by voicing support for a public-private health sector partnership to increase routine immunization coverage in the country.

Presentation at Pakistan Event

One presentation from the day. Photo: Huma Khawar.

Facing such a challenge, medical professionals are not the only ones who need to advocate for vaccination against pneumonia. Following the conclusion of the main session, an advocacy session tailored for teachers and headmistresses of public schools was initiated during which they were informed of the need to prevent pneumonia through other proven, low-cost techniques such as immunization, sound hygienic practices and balanced diets for infants and exclusive breast feeding for six months, ensuring good nutrition.

The teachers also shared various risk factors which make children more prone to pneumonia. Poor parental healthcare seeking was one: when children with severe pneumonia often undergo of trial and error at the field levels, before they actually reach the health facility for the right treatment in time.

Exposure to indoor smoke, which in rural Pakistan is an issue for more than 60% of families, is also damaging beyond imagination. There, an average household size is seven, which makes overcrowding (i.e the number of people sharing same room where children sleep) is another important factor contributing to pneumonia.

The teachers agreed that, more than ever before, we know how to protect and prevent children from catching pneumonia, and how to treat those suffering with this illness. They returned home to spread the message. 

By Rachel Bierbrier, a Policy, Advocay and Communications intern working with IVAC. 

International Vaccine Access Center (IVAC) is proud to celebrate the seventh annual World Pneumonia Day on November 12th, 2015.

Despite being preventable and treatable, pneumonia remains the leading killer of children under five years old; responsible for 16% of global under five mortality in 2015. More than half of these deaths occur in only six countries where gaps in access to life saving interventions exist.

Although World Pneumonia Day began seven years ago, IVAC’s commitment to reducing the burden of pneumonia originated much earlier with PneumoADIP; an innovative project that aimed to improve child survival and health by accelerating the evaluation of and access to new, life-saving pneumococcal vaccines for the world's children. Although this project is now complete, it was critical in sparking both the birth of IVAC as an organization and its ongoing commitment to increasing access to pneumonia prevention interventions, with a specific focus on vaccination.

IVAC is thrilled to announce the release of its annual Pneumonia and Diarrhea Progress Report. This year’s theme is Sustainable Progress in the Post-2015 Era. Using the most recent available data, the report documents the progress of the 15 countries with the greatest burden of pneumonia and diarrhea, in implementing high-impact interventions outlined in the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD) relative to GAPPD coverage targets. For the first time, the report includes in depth analysis of the challenges associated with the sustainability of pneumonia and diarrhea interventions in Gavi graduating countries as well as country specific analysis of the challenges and successes in three focus countries - India, Indonesia and Nigeria. The report and other great resources can be found at www.worldpneumoniaday.org.

Other events hosted by IVAC for World Pneumonia Day 2015 are taking place at the Johns Hopkins Bloomberg School of Public Health. An information table with World Pneumonia Day facts and goodies is set up from 12:00pm-1:00pm in front of the school’s Wall of Wonder – to share information with the future leaders of global health. In the evening, the Child Health Society is hosting a talk by IVAC’s own Dr. Laura Hammit. Dr. Hammit’s talk takes place from 5pm - 7pm in the Hampton House Auditorium.

Pneumonia Fighters

In Abuja Nigeria, IVAC has joined forces with the government of Nigeria and the Pediatric Association of Nigeria to host a high-level symposium on pneumonia. During the symposium senate leaders, Senator Olanrewaju Tejuosho and Senator Mao Ohuabunwa, will unveil two creative projects on pneumonia – a World Pneumonia Day Calendar, created from paintings done by teenagers in Abuja, and a Pneumonia Social Media Video Challenge. Using the precision of science and the drama of arts, IVAC is helping to propel the message to #BeatPneumonia.

Student artists whose works were used in the calendar. (Nigeria)

Student artists whose work were featured in the calendar. (Nigeria)

Today, IVAC continues to be active in many pneumonia-related initiatives. In addition to the PERCH project, the PCV Technical Coordination Project and many other innovative projects ongoing at our center, IVAC recently received generous support from the Bill and Melinda Gates Foundation to assume the role as a coordinator for the Global Coalition Against Childhood Pneumonia and Diarrhea. Under this grant, IVAC will work to increase collaboration and communication between members of the Coalition. These activities won’t stop on World Pneumonia Day, they are year round and include the creation and implementation of innovative advocacy tools and efforts.

Pneumonia remains the leading killer of children under the age of five despite being both preventable and treatable. Decreasing the global burden of pneumonia cannot and will not occur without continued advocacy, innovation and collaboration. As a global community, we must continue to work together beyond World Pneumonia Day to ensure that all children have access to sustainable, life saving pneumonia interventions. We have the tools to fight pneumonia; we now need to ensure that these tools are being distributed equitably around the globe.