30th anniversary of starting EPI Introduction of Hib Vaccine Dr Mohammad Mehdi Gouya Center for Communicable Disease Control

Milestone/achievement of EPI in Iran Year Establishment of Expanded Program of Immunization 1984 Vaccination coverage (DTP3)>95% 1990 Hepatitis B vaccine introduction 1993 Validation of maternal and neonatal tetanus elimination 1995 Certification of ‘polio free’ status 2001 Mass campaign for measles and Rubella elimination 2003 MMR vaccine introduction 2004 Hib vaccine introduction (Pentavalent) 2014 Measles and Congenital Rubella Syndrome elimination 2015 ? IPV vaccine introduction 2015

EPI Schedule, Iran 2013 vaccine 6 Year 18 Month 12 Month 6 Month At Birth vaccine **** BCG OPV DTwP Hep B MMR This schedule covers just 9 antigens while in some other countries it is more than 20

Haemophilus influenzae Aerobic gram-negative bacteria Polysaccharide capsule Six different serotypes (a-f) of polysaccharide capsule 95% of invasive disease caused by type b

Haemophilus influenzae type b Pathogenesis Organism colonizes nasopharynx In some persons organism invades bloodstream and cause infection at distant site Antecedent upper respiratory tract infection may be a contributing factor

Haemophilus influenzae type b Clinical Features* *prevaccination era

Hib death* rate (per 100000 children under age 5, 2000) <10 10- <25 * HIV+ deaths excluded 25-<100 100-<200 * HIV+ deaths excluded >200 Date of slide: 03 August 2009

World Health Organization 23 April, 2017 Hib Pneumonia and Meningitis Global burden for children < 5 years old, based on 2000 data 8.13 (7.3 – 13.2) million cases of serious illness More than 370,000 (247.000 – 527.000) deaths/year The leading endemic cause of bacterial meningitis, where Hib vaccine not routinely used Important cause of bacterial pneumonia Up to 20% of life-threatening pneumonia Resistance to first line antibiotics increasing worldwide Acute respiratory infections (2 million deaths each year) are the leading infectious cause of death in children 1mo to 5 years of age. S. pneumo causes approximately 825,000 of those deaths, Hib accounts for almost 375K. Diarrheal diseases are the second leading cause of death with 1.7M deaths – 500K are estimated to be due to rotavirus. Other leading causes of death include Malaria (853), Measles (395) HIV aids (321) Meningitis case fatality rates in developing countries >20%. For pneumonia, Hib case fatality rates can be 5-15%. 15- 35% of survivors of meningitis suffer permanent neurologic damage World Health Organization estimates

New EPI Schedule, Iran 2015 vaccine Penta 6 Year 18 Month 12 Month At Birth vaccine **** BCG OPV Penta DTP Hep B MMR

Thank you

Decision-Making Summary