PRESENT DAY STATUS OF VACCINATION IN EGYPT AND CAUSES OF FAILURE

ESSAY Submitted for Partial Fulfillment of

The Master Degree In

PEDIATRICS

IP'n;:§ented !by

Sally Monir EI-Sayed Ahmed _ ,

1 M.B., B.Ch

/;:;;_,L.---- Ain Shams University <) /J .,

UttdeJt s~ Ol:

.,

Dr. Nancy Abdel-Aziz Soliman Ylssistant Professor of PeaiatrU.S

'[acu[ty of'/v{edicine 51. in .Sfiams 11 niversity

Prof. Dr. Mohsen Abdel-Hamid Gadallah ~'rofessor of Community 'A{etficine --': ;:'~

'[acu[ty of '/v{etfidne , ' ~- · · ,. 51.in.Siiams 'University (' • : ·. : • .-·-!::'!;'"

' -,~;,·r ., ~~

F&~IJLTV OF ltiEIU~INE &IN !UI&ltiS IJNIVEIISITV

nnu~

0:11 II II Ill II

TO ...

My husband ..

children ..

ACKNOWLEDGMENT

I wish to express my deep gratitude and heartful thanks

to Dr. Nancy Abdel-Aziz Soliman, Assistant Professor of

Pediatrics, A in Shams University, for her faithful guidance,

active supervision and continuous encouragement throughout

this study.

My heartful thanks are due to Professor Dr. Mohsen

Abdel-Hamid GaddAllah, Professor of Community Medicine,

A in Shams University, for his considerate help and valuable

remarks.

I greatly appreciate the help of Dr. Ahmed Darwish, EPI

Executive Director for his great help in collecting data.

To my mother Professor Dr. Nahed Hussein Ahmed

Riad , Faculty of Science, A in Shams University who kept no

effort, help or support from me.

CONTENTS

List of Abbreviations

List of Tables

List of Figures

Page

Introduction and Aim of the Work 1

Chapter I: IMMUNIZA1.10N AND VACCINES 4

• Definition 4

• Passive immunization 5

• Active immunization 6

• Herd immunity 7

• Types of vaccines 9

• Dose of vaccines 1 5

• Route of administration 16

• Timing of immunization 16

• Technique of immunization 17

• Special circumstances 18

• Vaccination in the premature infant & immunodeficient host. 20

• Simultaneous use of vaccines 21

• Clinical indications for immunization 22

• Contraindications for vaccine 22

• Hazards of immunization 24

The cold chain 28

Chapter II: VACCINES IN EGYPT 39

• BCG vaccination 39

• Polio virus vaccine 52

• Diphtheria immunization 65

• Pertussis immunization 72

• Tetanus vaccine 77

• Measles vaccine 81

• Hepatitis B vaccine 92

Chapter III: PRFSENT STATUS OF VACCINA110N IN 111

EGYPT

• Immunization schedule 112

• Poliomyelitis 119

• Neonatal tetanus (NNT). 126

• Tuberculosis and Tuberculous meningitis. 128

• Diphtheria. 130

• Pertussis (Whooping cough). 130

• Mensles. 133

• Hepatitis D. 135

Chapter IV: VACCINE FAILURE 137

• For Measles. 137

• For BCG. 142

• For Poliomyelitis. 147

• Causes of vaccination failure in Egypt. !52

Recommendations 155

Summary 161

References 166

Arabic summary

AFP

APT

BCG

Btm

CDC

CNS

CSP

DP

DPT

DPTP

DT

EIPV

ELISA

EPI

FT

HBIG

HBsAg

HI

HIV

lgG

IM

IPV

IVIG

INH

Kd

MMR

MOH

ABBREVIATIONS

Acute flaccid paralysis

Alum-precipitated toxoid

Bacille, Calmette and Guerrin

Bottom

Communicable Disease Control

Central Nervous System

Child Survival Project

Diphtheria-pertussis

Diphtheria-pertussis tetanus

OPT plus inactivated polio vaccine

Diphtheria Tetanus

Enhanced potency inactivated polio virus

vaccme

Enzyme linked immunosorbant assay

Expanded Program of Immunization

Forrnol toxoid

Hepatitis B immunoglobulin

Hepatitis B surface antigen

Haemagglutination inhibition test

Human Immuno-Defficiency Virus

Immunoglobulin G

Intramuscular

Inactivated poliovirus vaccine

Intravenous immunoglobulin

Isonihazid

Kilodalton

Measles-Mump.Rubella

Ministry of health

NID National Immunization Days

NNT Neonatal tetanus

OPV Oral polio virus vaccine

PASA Para amino salycilic acid

PHC Primary Health care

PPD Purified protein derivative

PTAP Purified toxoid, Aluminum-phosphate

precipitated

TCG Technical consultative group

TCID Tissue culture infective dose

TIG Tetanus immunoglobulin

TOPV Trivalent oral polio virus vaccine

TT Tetanus toxoid

WHO World Health Organization

LIST OF T4BLBS

No. Title Page

1 Results of some BCG trials 49

2 Recommended doses and schedules of HBV 96 vaccines

3 Recommendation for post-exposure HBV immuno- 106 prophylaxis

4 Vaccine coverage rate in children less than five 115 years of age, Egypt, 1984 and 1994.

5 Children vaccinations included in the national EPI 116 program of routine immunization, 1995

6 Reported cases of communicable diseases, 1988- 118 1995.

7 Reporting of AFP, 1992-1995. 123

8 Decline m reported measles cases for selected 133 epidemic years, 1985-1995.

LIST OF FIGURES No. Title Page

I Vaccine storage time and temperature (After 31 Lloyd,1984).

2 Cold chain Monitor 32

3 Interpretation of 10'C and 38'C monitor marks 36

4 Algorithm for the management of the pregnant 110 women in order to prevent perinatal transmission of HBV infection

5 National infant vaccination coverage rates, 1984-95. 117

6 Polio free districts, 1992-1995. 121

7 Polio incidence rate and national OPV3 122 immunization coverage, Egypt, 1984 to 1995

8 Reported cases of neonatal tetanus, 1986-95. 127

9 TB meningitis incidence rate in children younger 129 than 15 years and BCG coverage, 1985-1995.

10 Diphtheria incidence rate and DPT3 coverage, Egypt, 131 1984- 1995

II Pertussis cases and DPT3 coverage, Egypt, 1984 - 132 1995.

12 Measles incidence rate and vaccination coverage, 134 1982-1995.

!3 Inununization coverage of hepatitis B, 1995. 136