1. 30th anniversary of starting EPI
Introduction of Hib Vaccine
Dr Mohammad Mehdi Gouya
Center for Communicable Disease Control

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

3. 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

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

5. 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

6. Haemophilus influenzae type b
Clinical Features*
*prevaccination era

7. 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

8. 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 ( – ) 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

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

13. Thank you

14. Decision-Making Summary