Shyam Bawikar

Background: policies, EPI, schedule, GCC

Current policies on adult vaccination

Proposed vaccination policy and schedule: for HCWs, adults and adolescents

Adult vaccination delivery

Barriers and the way forward

Dr Bawikar, DCDSC, MoH

• National vaccination policies issued by MoH

• Consultation with NITAG

• Vaccination policies are implemented nationwide (Government and private sectors) - Obligatory

• EPI vaccines are provided free in all Governorate institutions and to all

• EPI extends to school immunization program

• Paediatric: Linked to birth certificate and school entry

• Adult: HCW is linked with recruitment policy

Dr Bawikar, DCDSC, MoH

1. Poliomyelitis 2. Tuberculosis 3. Diphtheria 4. Tetanus 5. Pertussis 6. Measles 7. Hepatitis ‘B’ (1990) 8. Rubella (1994) 9. Mumps (1997) 10. H influenzae, type b (2001) 11. PCV (2008) 12. Varicella (2010) • Rota virus • Hepatitis A • Seasonal Flu • HPV

Goals

• Eradication of Polio (2005) • Elimination neonatal Tetanus & adult

Tetanus • Elimination of Measles (2010) • Tuberculosis Elimination (2005) • Elimination of Rubella (and CRS - 2005)

• Control of Pertussis, Mumps, chickenpox & Hepatitis ‘B’

• Reduce childhood morbidity & mortality due to Hib & pneumococcal disease

Dynamic adjustment of targets

Dr Bawikar, DCDSC, MoH

# Age Vaccines

1 At birth • BCG

• HBV–0 2

3

2 months

(9 weeks)

• PENTA–1 (HBV-1, DTP-1, Hib-1), PCV-1

• IPV

4 4 months • PENTA–2 (HBV-2, DTP-2 , Hib-2), PCV-2

• OPV–1

5 6 months • PENTA–3 (HBV-3, DTP-3, Hib- 3),

• OPV–2

6 12 months • MMR–1, PCV-3

• OPV–3

7 18 months

• MMR–2

• DTP–4

• OPV–4 4-6 years

(school entry)

• OPV–5

• DTP–5

12 years (school) • dT

15 to >65 years • dT (single dose) every 10 years

AgeWHO-EMRO

2005GCC EPI Bahrain Kuwait Oman Qatar Saudi Arabia UAE

2 yearsACYW135 &

Hep-A x 2ACYW135

2-5 yrs OPV-5**

3-5 yrsOPV-6 &

DTwP-5

4-5 yrs OPV-7

4-6 yrs OPV-5 OPV-6 OPV-5 OPV-5 OPV-4

DTP-5 DTP-5 DTP-5 DT DTP (DT)

MMR-2 MMR-2 MMR -2

Varicella (4-12 yr) Varicella

MMR-2 MMR-2

OPV OPV-4

DTaP DT

10 yrs dT-1

12 yrs Td-1 dT-1 Hep-A Rubella (girls) dT-1

13 yrs T-dap & Hep-A Td-1

14 yrs HBV Rubella (girls)

15- 16 yrs  HPV dT-1

17-18 yrs dT-2  HPV

18 yrs dT-2

15 - >65 yrs dT / 10 yrs dT / 10 yrs

School Vaccination

5-6 yrs

Adolescents

Dr Bawikar, DCDSC, MoH

• Vaccination delivered through Government Institutions, non-MoH institutions and/or private sector

• Private sectors either buy from MoH or directly from suppliers and may charge for services

• All institutions (Hospital OR PHC) have an EPI unit with qualified staff to deliver the vaccine

• EPI coverage monitored on monthly basis

• Children: EPI targets well undefined

• Adults: Targets and assessment ill-defined Dr Bawikar, DCDSC, MoH

Target group EMRO 2005 Saudi Arabia Bahrain Kuwait Oman Qatar Saudi Arabia UAE

Postpartum Rubella

MMR Rubella

Pregnancy TT TT TT TT TT TT TT

Umra & Hajj Pilgrims ACYW135 ACYW135 ACYW135 ACYW135 ACYW135 ACYW135 ACYW135

Seasonal Flu Seasonal Flu Seasonal Flu Seasonal Flu Seasonal Flu Seasonal Flu Seasonal Flu

>50 or 65 years Seasonal Flu Sesonal Flu Seasonal Flu Seasonal Flu Seasonal Flu Seasonal Flu

Health Care Workers IPV

IPV

Rubella Rubella

Rubella

MMR MMR

Hep-B Hep-B Hep-B Hep-B Hep-B Hep-B Hep-B

Lab Personnel IPV IPV

Food Handlers Typhoid Typhoid Typhoid Typhoid Typhoid Typhoid

Sickle cell disease

cases

Hib

ACYW135 ACYW135

PPV-13 PPV-13

International

Travellers

Yellow Fever Yellow Fever Yellow Fever Yellow Fever Yellow Fever Yellow Fever

Hep-A

Typhoid

Dr Bawikar, DCDSC, MoH

Vaccine Recommendations

Hepatitis B HCWs who have not received HBV before:

Offer 0.5 ml IM-3 dose series (at day 0, after 1 month and after 6 months)

Screen for anti-HBs 1-2 months after HBV-3

Influenza Should receive single dose (0.5 ml IM) of seasonal influenza vaccine

annually

Varicella HCW with no serologic proof of immunity, prior vaccination or history of

varicella

** Offer 2 doses (0.5 ml, SC) of varicella vaccine, 4 weeks apart

MMR HCWs have been divided in two subcategories:

o Omani : HCWs over 35 years of age

o Non Omani: For new recruits & existing non-Omani HCWs offer 2 doses

of MMR (0.5 ml, IM), 4 weeks apart

Dr Bawikar, DCDSC, MoH

Influenza

Varicella

HBV

MMR

6th month *1st month

Pre- screening

**Post- screening

Pre- screening

1 dose

1stdose

1stdose

1stdose

*2nd dose

2nd dose

2nd dose

3rd dose

* If HCW is due for 3 vaccines at 1st month, postpone 2nd dose of MMR by a week **Re-administer the HBV vaccine series (1,2, 3 months) to HCW in whom Anti-HBs level

is below the protective level of 10 ml µ/L. After 6 doses if these levels are not reached consider him/her as a non-responder.

Day ‘0’ 2nd month 5th month

A HCW, working in A&E received one dose of HBV, 2 years ago…

Should he repeat the series of 3 doses?

A 28 yr female HCW, working in ICU received 3 dose series of HBV. Post vaccination screening shows anti-HBs levels over 10 IU/µL…

Is screening and booster recommended after XX years?

Is post-vaccination screening for antibodies needed for varicella?

What are the contraindications for varicella vaccination?

Is HBV safe in pregnancy?

Can MMR be given without screening?

• HCW vaccination – Administered through Occupational Health or

Infection Control programs and EPI

– As pre-employment requirement viz. IPV, Varicella, Hep-B & MMR

• Adult Vaccination – Linked to adult health care program (above 40yrs)

viz. Seasonal Flu & Hep-B

– Linked to services provided for Umra and Hajj pilgrimage viz. Seasonal Flu & ACYW135

– PCV-10/13 (Saudi Arabia, Qatar, Kuwait)

– PPV-13 (Oman, Bahrain, UAE)

– Special campaign viz. Seasonal Flu & Hep-B

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Functional EPI in Government and Private sector and good infrastructure

NITAG to recommend strongly

GCC group procurement to reduce cost

Good Vaccine Management System

Free vaccination

Government’s commitment towards adult vaccination

Dr Bawikar, DCDSC, MoH

– Adult disease burden and immunity profile NOT fully studied in order to think about BOOSTER or for NEW vaccines. Estimates of burden of VPDs in adults UNKNOWN

– Poor awareness among HCWs and the adults on importance of vaccination (vaccines are for children)

– Prioritization of the preventable communicable diseases in adults (case management to prevention)

• HCWs: Varicella, MMR, Seasonal Flu

• Adults: Seasonal Flu, TT, dT OR T-dap

– Hence the adult vaccination program still NOT strongly accepted and advocated (political will)

Dr Bawikar, DCDSC, MoH

• Raise the priority of adult vaccination among health care professionals -> creating demand -> influencing policy makers

• Strengthen adult vaccination program – Collect evidence for policy

– Awareness and advocacy campaign among HCWs

– Link with other existing programs: Occupational Health

– Use available infrastructure

Dr Bawikar, DCDSC, MoH