KARACHI, Nov 23: The Sindh health department may take three more weeks to include the much-awaited pneumococcal conjugate vaccine (PCV) in its routine free immunisation service for children across the province, it emerged on Friday.

Sources in the health department said that a delay in training of the vaccination staffs and health technicians at Karachi, Larkana and a couple of other districts caused rescheduling of the new pneumonia vaccine launch.

The pneumococcal vaccine campaign was launched in the federal capital and Punjab on Oct 10, while Sindh was supposed to start PCV administration to the children under the age of one year from Nov 10, said a source.

The national manager of the federal government’s expanded programme for immunisation (EPI), Dr Zahid Larik, had said that the administration of the vaccine to around 5.5 million children born every year in the country was already launched last month (October), while after imparting some necessary training to field workers in Larkana, Sukkur and Dadu, the vaccine would be introduced simultaneously in all districts across Sindh in the mid of November.

Sindh EPI has set up eight new cold-rooms across the province, in addition to 11 standard cold rooms already working at Karachi, Hyderbad, Sukkur and Larkana, with the support of the Global Alliance for Vaccines and Immunisation (Gavi), to store the vaccines properly.

Recalling the PCV initiatives in the country, a source said that the launch of the pneumococcal vaccine was first planned for Jan 2011 with major financial support of the Gavi. However, the devolution of health-related activities and offices and some technical requirements delayed the introduction of the vaccine in the public sector health-care delivery system.

Pneumococcal disease is the leading cause of pneumonia, the biggest infectious killer of children under five in Pakistan and around the world. Globally, pneumonia is responsible for 4,300 child deaths daily, or one in every 20 seconds, while in 2007, the World Health Organisation had recommended the introduction of pneumococcal vaccine into all national immunisation programmes, particularly in countries with high child-mortality rates.

Experts believed that with a PCV coverage rate of over 85 per cent, about 27,000 to 30,000 children could be saved from dying of pneumonia in Sindh alone.

The pneumococcus germ may cause meningitis, pneumonia, blood stream infections in children and as such there was a dire need to protect children from the most serious pneumococcal infections, which happened during the first two years of life.

At present, the national EPI targeted prevention of eight EPI diseases — childhood tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus, hepatitis, haemophilus influenza type b and measles — by vaccination.

An official of the provincial EPI said that the administration of the new pneumonia vaccine in question would begin by Dec 15 and about 57,000 newborn children could be covered this year. There were about 2,450 vaccinators associated with about 1,300 EPI centres across the province, he added.

Provincial EPI director Dr Mazhar Khamesani said that the new service (PCV) would be provided to about 1.37 million children aged up to one year on a yearly basis.

Almost all the prerequisites of the PCV launch, including specific cold-rooms for the storage of the new vaccines, had been met and a relevant verification and clearance by authorities concerned, including the foreign agencies, was anticipated by the end of this month, he said, adding that the process of training of the field staffers through the master trainers had almost been completed, while the vaccine in question had also been received from Islamabad.

He informed that Sindh had 11 standard cold rooms at Karachi, Hyderabad, Sukkur and Larkana, while Kashmore, Badin, Dadu, Sanghar, Khairpur, Benazirabad, Naushehro Feroze and Tharparkar got one room each lately.

He said that three doses of the new vaccine would be given to children in the first year — at six weeks, 10 weeks and 14 weeks of age — at the government vaccination centres, where children were already being brought at six, 10 and 14 weeks of age to get one dose each of OPV and Pentavalent vaccine during each of these visits.

He said that Pakistan was the first country in South Asia to introduce pneumococcal vaccine and also happened to be the largest country in terms of birth cohorts, where a WHO approved pneumococcal vaccine would be available free of cost from the EPI programme to help fight pneumococcal disease (including pneumonia, meningitis and bacteria).A town health officer said that since the PCV, an intramuscular injection, was some thing new in the country, specific training was needed in the case of vaccinators and other technical staffers. The training of focal persons from the towns of Karachi had begun a couple of days back and it was expected that the process of training of vaccinators through them would consume the first week of December, the officer added.

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