Elif N.Özmert, MD, PhD

Professor in Pediatrics

Hacettepe University Faculty of Medicine

Department of Pediatrics

Socail Pediatrics & Developmental Pediatrics

Vaccination: Current Application

What Is Vaccine ?

What Is Vaccine ?

Antigen Other• Live

• Bakteri• Virüs

• Inaktive• Bactria• Virüs• Rekombinant DNA• Toksoid• Antigen

• Kombined

• Adjuvant• Aluminum salts

• Konjugation substance

• Diluent

• Preservative, stabilisator• Antibiotic

• Timerasol

What Is Vaccine ?

1800, used by British physician Edward Jenner (1749-1823) for the technique he devised of preventing smallpox by injecting people with the cowpox virus (variolae vaccinae), from vaccine (adj.) "pertaining to cows, from cows" (1798), from Latin vaccinus"from cows," from vacca "cow"

At the first meeting of the Royal Jennerian Society , Edward Jenner insisted that the origin of the term vaccination, from the Latin for cow (“vacca”), be

credited to his friend and fellow physician, Richard Dunning.

History of Vaccines900

Measles &Smallpox described separatelyby Rhazes, Persian physician

1000

Early Chinese inoculation

1718

Variolationin Turkey

Lady Mary Montagu

1800-1810

Jenner's breakthrough

Origin of the term vaccination

Serial vaccinationof cows In Naples

1880-1900

Louis Pasteur first laboratoryvaccine (chickencholera)

Rabies Vaccine usedin human

Cholera VaccineSpanish Jaime Ferrán

1882Anti-Vaccination Arguments Spread

The Anti-Vaccination League of America held its first meeting

in New York

History of Vaccines1920-1930

-Ramon & Glenny Diphteria toxoidvaccine

Al salt adjuvant

-Albert Calmette& Camille Guérinfirst human testsof BCG

1935-1945

-Max Theiler develops yellowfever vaccine

-Pearl Kendrick & Grace Elderdingpertussis vaccine

-Influenza vaccineapproved

1947-1955

-Tuberculosis International Campaign

-The first combined DTP

-Salk givesvaccine to his family & vaccinelicenced

1958-1970

-Measles vaccine

-Mumps vaccine

-Rubella vaccine

-Sabin oral polio vaccine Licensed

-Smallpoxeradicationprogramme

1972-1980

-WHO advocates DTPfor new EPI-Michiaki Takahashichickenpox vaccine-Smallpox declarederadicated

History of Vaccines1981-1985

Hepatit B vaccine

P.Pneumococcal v.

1986-1990

Conjugate Hib vaccinelicensed

Oral Typhoid vaccinelicensed

Measles eliminationgoals

MNT elimination goals

Global Polio Eradication Initiative

1991-2000

Maurice Hilleman’s hepatitis A vaccinelicenced

2000-2015

Global Alliance forVaccines andImmunizationRotavirus vaccineC.Pneumococcal v.C.Meningococcal v.Group B meningoccocal v.HPVHepatitis E v.

MMR safetyquestioned

Vaccine Preventable Diseases

• Cholera

• Diphtheria

• Hepatitis A

• Hepatitis B

• Hepatitis E

• Haemophilus influenzae type b (Hib)

• Human papillomavirus (HPV)

• Influenza

• Japanese encephalitis

• Malaria

• Measles

• Meningococcal meningitis

• Mumps

• Pertussis

• Pneumococcal disease

• Poliomyelitis

• Rabies

• Rotavirus

• Rubella

• Tetanus

• Tick-borne encephalitis

• Tuberculosis

• Typhoid

• Varicella

• Yellow Fever

25 Diseases

Pipeline Vaccines

• Campylobacter

• Chagas disease

• Enterotoxigenic E.coli

• Streptococcus pyogenes

• HIV

• Herpes Simplex Virus

• Human Hookworm infection

• Leishmaniasis

• Malaria

• Nontyphoidal Salmonelloses

• Norovirus

• Paratyphoid fever

• Rotavirus vaccines (next-generation)

• Schistosomiasis

• Shigella

• Streptococcus pneumoniae (pediatric vaccines)

• Tuberculosis (new vaccines)

• Universal Influenza vaccine

• RSV (Respiratory Syncytial Virus)

Why Do We Vaccinate

Personalrisks

Cocoon strategy

Diseases

Long-term complications-malignancy

Morbidity

Mortality

Why Do We Vaccinate

Personalrisks

Cocoon strategy

Diseases

Long-term complications-malignancy

Disability

Mortality

Why Do We Vaccinate

Personalrisks

Cocoon strategy

Diseases

Long-term complications-malignancy

Disability

Mortality

Why Do We Vaccinate

Personalrisks

Cocoon strategy

İllness

Long-term complications-malignancy

Disability

Mortality

Why Do We Vaccinate

Personalrisks

Cocoon strategy

İllness

Long-term complications-malignancy

Disability

Mortality

Why Do We Vaccinate

Personalrisks

Cocoon strategy

İllness

Long-term complications-malignancy

Disability

Mortality

Who Do We Vaccinate

Life-long immunization

Current Situation

•Immunization currently averts an estimated 2 to 3 million deaths every year.•But an estimated 18.7 million infants worldwide are still missing out on basic vaccines.

•Global vaccination coverage is generally holding steady.•Uptake of new and underused vaccines is increasing.

Global Causes of Child Deaths in2013

Liu L. Et al. Lancet 2015; 385: 430–40

Global Immunization 1980-2014, DTP3 Coverage

Source: WHO/UNICEF coverage estimates 2014 revision. July 2015

Immunization Vaccines and Biologicals, (IVB), World Health Organization.

194 WHO Member States. Date of slide: 21 July 2015. Global coverage 86% in 2014

18.7 million infants not immunized (DTP3), 2014

African

American

Eastern Mediterranean

European

South East Asian

Western Pacific

Source: WHO/UNICEF coverage estimates 2014 revision. July 2015 / United Nations, Population Division. The World Population Prospects - the 2012 revision". New York, 2013.

Immunization Vaccines and Biologicals, (IVB), World Health Organization.

194 WHO Member States. Date of slide: 23 July 2015.

21

Polio Eradication Progress, 1988 – 2014

Source: WHO/POLIO database, as of Jul 2015

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. ©WHO 2015. All rights reserved

Certified polio-free regions (126 countries)

Endemic with wild poliovirus ( 3 countries)

Not certified but non-endemic (65 countries)

2000: ≈3000 wild polio cases reported2014: 359 wild polio cases reported

0 2,100 4,2001,050 Kilometers

Immunization Coverage With 1st Dose of Measles ContainingVaccines in Infants, 2014

Source: WHO/UNICEF coverage estimates 2014 revision. July 2015. Map

production: Immunization Vaccines and Biologicals, (IVB). World Health

Organization

Date of slide: 16 July 2015

The boundaries and names shown and the designations used on this map do not imply the

expression of any opinion whatsoever on the part of the World Health Organization

concerning the legal status of any country, territory, city or area or of its authorities, or

concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent

approximate border lines for which there may not yet be full agreement. © WHO 2015. All

rights reserved

<50% (4 countries or 2%)

50-79% (33 countries or 17%)

80-89% (35 countries or 18%)

>=90% (122 countries or 63%)

Not available

Not applicable

0 1,500 3,000 4,500 6,000750

Kilometers

35 Countries Eliminated MNT Between 2000 & 2014 (Plus 30 States out of 36 in India, Ethiopia all except Somali region and 30/34 provinces in Indonesia) leaving 24 countries yet to eliminate MNT

Source: WHO/UNICEF Database

Date of slide :26 May 2015

Map production: Immunization Vaccines and

Biologicals, (IVB), World Health Organization

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. ©WHO 2015. All rights reserved

MNT eliminated from 2000-2014

MNT not eliminated

MNT eliminated before 2000

Number of Countries Introduced HepB Vaccine &Global Infant HepB3 Coverage, 1989-2014

*excluding 3 countries where HepB administered for adolescence

Source: WHO/UNICEF coverage estimates 2014 revision. July 2015 and WHO database as

at 07 July 2015

Immunization Vaccines and Biologicals, (IVB), World Health Organization.

194 WHO Member States. Date of slide: 29 July 2014.

0 2,100 4,2001,050 Kilometers

Immunization Coverage With 3rd Dose of HepB VaccinesIn Infants, 2014

Source: WHO/UNICEF coverage estimates 2015 revision. July 2015. Map

production: Immunization Vaccines and Biologicals, (IVB). World Health

Organization

Date of slide: 16 July 2015

The boundaries and names shown and the designations used on this map do not imply the expression of any

opinion whatsoever on the part of the World Health Organization concerning the legal status of any country,

territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted

lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO

2015. All rights reserved

<50% (7 countries or 4%)

50-79% (30 countries or 16%)

80-89% (32 countries or 17%)

>=90% (115 countries or 62%)

Not available / HepB not introduced or no coverage data available (10 countries or 5%)

Not applicable

Countries Introduced Hib Vaccine1997 and 2014

29 countries introduced

1997

190 countries introduced

2014

2 countries partially introduced

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health

Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the del imitation of its frontiers or boundaries.

Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

© WHO 2015. All rights reserved

2 countries partially introduced

Source: WHO/IVB Database as at 24 July 2015.

Map production: Immunization Vaccines and Biologicals, (IVB),

World Health Organization.

194 WHO Member States. Date of slide: 28 July 2014

0 2,100 4,2001,050 Kilometers

0 2,100 4,2001,050 Kilometers

Immunization Coverage With PCV3 Containing VaccinesIn Infants, 2014

Source: WHO/UNICEF coverage estimates 2015 revision. Map production:

Immunization Vaccines and Biologicals, (IVB). World Health Organization

Date of slide: 16 July 2015

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion

whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area

or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent

approximate border lines for which there may not yet be full agreement. © WHO 2015. All rights reserved

<50% (11 countries or 6%)

50-79% (22 countries or 11%)

80-89% (20 countries or 10%)

>=90% (49 countries or 25%)

Not available / not in national immunization schedule (77 countries or 40%)

Not applicable

PCV in schedule but no coverage data available (15 countries or 8%)

0 2,100 4,2001,050 Kilometers

Immunization Coverage With Rotavirus Vaccine In Infants, 2014

Source: WHO/UNICEF coverage estimates 2015 revision. Map production:

Immunization Vaccines and Biologicals, (IVB). World Health Organization

Date of slide: 16 July 2015

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part

of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the

delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full

agreement. © WHO 2015. All rights reserved

<50% (15 countries or 8%)

50-79% (15 countries or 8%)

80-89% (15 countries or 8%)

>=90% (20 countries or 10%)

Not applicable

Rotavirus vaccine in schedule but no coverage data available (9 countries or 5%)

Not available / not in national immunization schedule (120 countries or 62%)

0

20

40

60

80

100

120

140

160

180

200

DBT MEASLES POLİO HİB BCG RUBELLA MUMPS PCV ROTA HPV

194 194 194 192

158

140

121 117

7463

Number of Countries With Vaccines In The National Programme, 2014

No of countries

0

10

20

30

40

50

60

70

80

90

BCG DBT POLİO MEASLES HEP B HİB PCV ROTA

8986 86 85

82

56

31

19

Global Coverage % of Vaccines, 2014

Global Coverage %

Goals of the Decade of Vaccines (2011–2020)

Six Strategic Objectives

1. All countries commit to immunization as a priority.

2. Individuals and communities understand the value of vaccines and demand immunization as both their right and responsibility.

3. The benefits of immunization are equitably extended to all people.

4. Strong immunization systems are an integral part of a well functioning health system

5. Immunization programmes have sustainable access to predictable funding, quality supply and innovative technologies.

6. Country, regional and global research and development innovations maximize the benefits of immunization.

Lo

For our children

Love Peace

For our future

Thank you...