30th anniversary of starting EPIIntroduction of Hib Vaccine

Dr Mohammad Mehdi GouyaCenter 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 At Birth 2 Month

4 Month

6 Month

12 Month

18 Month

6 Year

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 bPathogenesis

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

Cellulitis6%

Arthritis8% Bacteremia

2%

Meningitis50%

Epiglottitis17%

Pneumonia15%

Osteomyelitis2%

Haemophilus influenzae type bClinical Features*

*prevaccination era

Hib death* rate (per 100000 children under age 5, 2000)

Date of slide: 03 August 2009

* HIV+ deaths excluded

<10

25-<100

10- <25

100-<200

>200* HIV+ deaths excluded

Hib Pneumonia and MeningitisGlobal 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

World Health Organization estimates

New EPI Schedule, Iran 2015

vaccine At Birth 2 Month

4 Month

6 Month

12 Month

18 Month

6 Year

BCG ****

OPV **** **** **** **** **** ****

Penta **** **** ****

DTP **** ****

Hep B ****

MMR **** ****

Thank you

Decision-Making Summary