1. Introduction of Hib in UIP Dr. Prashant P. Ghodam Moderator : Dr. Ranjan Solanki

2. Framework Introduction What is Haemophilus influenzae ? Hib disease Hib in India Hib Vaccines Hib conjugate vaccines Post Introduction Evaluation of Hib in Tamil Nadu and Kerala Hib Initiative: a GAVI success story References

3. Introduction Haemophilus influenzae type b (Hib) causes approx.8.1 million cases of serious Hib diseases, and an estimated 371,000 deaths globally Manifestations-pneumonia, meningitis and other invasive diseases occur primarily in children aged < 2 years, particularly in infants Vaccines are the only tool of preventing serious Hib disease, MDG-4

4. Introduction WHO recommendation in 2006, included in RI in nearly 180 countries India introduced Pentavalent Vaccine containing DPT, Hepatitis-B and Hib vaccines in two states viz. Kerala and Tamil Nadu under routine immunisation programme from December 2011. Government of India declared 2012 as Year of Intensification of Routine Immunization ‖ (IRI). The Pentavalent vaccine is being expanded to 6 more states i.e. Haryana, Jammu & Kashmir, Gujarat, Karnataka, Goa and Pondicherry in 2012-13.

5. What is Haemophilus influenzae Haemophilus influenzae Mode of transmission Age distribution

6. Hib DISEASE Diseases caused by Hib infection  Bacterial meningitis:  Inflammation of the lungs:  Other Hib infections:-Septicaemia, Septic arthritis, Osteomyelitis, Epiglottitis. Diagnosis Antibiotic resistance

7. Hib in India In India, one of the leading causes of meningitis and pneumonia 2.4 to 3.0 million Hib cases occur annually in the country with total deaths estimated to be at 72,000. Hib contributes 40-50% of all meningitis & 25-30% of all pneumonia cases. Hib is the most common cause of meningitis and the second largest cause of pneumonia (after Strept. pneumoniae) in India

8. Hib in India... Case fatality ratio for the Hib meningitis and pneumonia is in the range of 10-30%. Hib causes a substantial morbidity burden with 25-30% of Hib meningitis survivors suffering from long term neurological sequelae. The Hib as pentavalent vaccine has been introduced in Tamil Nadu and Kerala states of in December 2011

9. Hib Vaccines Formulation Storage volume Storage temperature Age group for vaccination Vaccination schedule

10. Hib Vaccines.... Dosage and route Immunogenicity Adverse events Contraindications

11. Hib conjugate vaccines very affordable price. fewer numbers of injections lesser pain to the child and protection against multiple diseases H. influenza type b, Hepatitis-B, Diphtheria, Pertussis and Tetanus in one injection.

12. Post Introduction Evaluation of Hib in Tamil Nadu and Kerala GOI introduced Hib as pentavalent vaccine in Tamil Nadu and Kerala states, starting December 2011 WHO planned, led, coordinated and conducted a PIE of pentavalent vaccine in seven selected districts in July/August 2012  Major findings: good leadership Proactive engagement with relevant stakeholders The widely publicised launch events well trained health staff at all levels Open Vial policy, effectively implemented high a acceptance amongst community and health staff

13. Post Introduction Evaluation of Hib in Tamil Nadu and Kerala  Major recommendations: Update recording and reporting formats strengthen AEFI monitoring and reporting system Use local data for action Streamline HepB Birth dose and OPV zero dose Strengthen immunization waste disposal system

14. Hib Initiative: a GAVI success story Global Alliance for Vaccines and Immunisation was set-up in 2000, support for Hib vaccine In 2008 - 10 years after high-income countries crossed the 50 percent line - the vaccine had been introduced in half of all low-income countries. By 2009, 62 countries, nearly all low-income countries, had introduced Hib vaccines with GAVI support, preventing an estimated 430,000 future deaths. GAVI's subsidisation of the combination pentavalent vaccine has also encouraged uptake by allowing low-income countries to introduce the Hib vaccine  Hib meningitis eradicated in many Sub-Saharan countries It is estimated that, with GAVI support helping Uganda to introduce Hib vaccine into the national vaccination programme (June 2002), the incidence of Hib meningitis declined by 85 percent, and by the following year, the number of cases fell to nearly zero

15. References 1.Subcommittee of NTAGI. NTAGI subcommittee recommendations on Haemophilus influenzae type b (Hib) vaccine introduction in India. Indian Pediatr. 2009 2.Government of India. Operational guidelines: Introduction of Hib as Pentavalent Vaccine in Universal Immunization program in India. Ministry of Health and Family Welfare, Govt. of India, New Delhi, 2011. 3.World Health Organization. Introduction of Haemophilus influenzae type b vaccine into immunization programmes. WHO, Geneva, 2000.