KARACHI, Feb 10: A vaccine protecting children against a pneumonia-causing bacterium has been added to the regular programme for immunisation in Sindh and other parts of the country in recent months without adequate publicity.

Experts in paediatric diseases and immunisation staff in the public sector said that in a situation when the uptake of the vaccine – haemophilus influenza type-B (HIB) – in the country had already been delayed considerably, the health authorities, both in the federal and provincial governments, were least bothered about publicising the inclusion of the vaccine coming in a new combination for the national immunisation programmes.

The provincial manager of the expanded programme on immunisation, Dr Mazhar A. Khamesani, said that after a phase-wise training of town health officers, paediatric health personnel, supervisors and vaccinators in all districts of the province and with the supply of the new five-in-one vaccines at all the EPI centres, the administration of five-in-one vaccines to newborn children had been made effective from January.

The federal health ministry had approved the introduction of the pentavalent vaccine giving children protection against diphtheria, tetanus, pertussis, hepatitis-B and HIB, with the technical and financial support of the Global Alliance for Vaccination and Immunisation (GAVI), in January 2008.

It is estimated that about 10 per cent of children in Pakistan do not reach their fifth birthday due to vaccine-preventable diseases. About 23,000 children die from HIB diseases in the country each year, while over a thousand others are left with life-long disabilities such as paralysis, deafness and brain damage.

In Sindh, 81 out of 1,000 children still do not survive their first year of birth, while the rate of mortality in children between birth and the fifth birthday is 101 per 1,000 births. Most child deaths are caused by an acute respiratory infection or pneumonia, diarrhoea, and other vaccine-preventable diseases.

The HIB vaccine has been around for about 20 years, but its cost was an obstacle in the case of Pakistan and many other developing countries.

Now with the help of GAVI, the new five vaccine shot has been introduced to replace a four-vaccine shot (the combo vaccine) which remained in use for many years.

Pakistan will have to pay only 10 per cent of the overall cost of the vaccines and the rest of the payment will be made by GAVI.

Experts said the introduction of the new combination was aimed at improving protection against diseases in children, but non-seriousness of the health managers of the country could be gauged from the fact that they did not come up with any publicity campaign or advertisements in the media. No social mobilisation schemes were launched either.

According to some reliable and recent assessment of the health sector, the rate of the overall routine immunisation coverage was from 45-48 per cent. Therefore, say the experts, there is a dire need that the government re-launch the immunisation campaigns to increase awareness of the new set of vaccines and their acceptability by parents for the newborns.

Beside the addition of GAVI’s pentavalent vaccine, the government has also decided to add an additional dose giving protection against measles in the routine immunisation programme and as such the programme will spread over a period of one and a half years, instead of nine months.

A GAVI consultant in Sindh, Dr Abdullah Katpar, told Dawn that now the measles doses, not included in the HIB combination, would be administered twice to children at the age of one year and one-and-a- half years.

The revised routine immunisation schedule for children is now as follows:

Childhood tuberculosis (BCG vaccine) – immediately after birth; poliomyelitis (OPV) – after birth, at six weeks, 10 weeks and 14 weeks; diphtheria, tetanus, whooping cough, hepatitis B and meningitis and pneumonia (pentavelent HIB vaccine) – at six, 10 and 14 weeks; measles at 12 months and 18 months.

In reply to a question, provincial manager Dr Khamesani said the administration of the old combo combination of vaccines had been stopped. Now in addition to the newborns, children who under the previous immunisation schedule had been receiving the combo vaccines should also be switched to the new pentavalent vaccines.

He said publicity of the routine immunisation schedule, introduction of new vaccines and relevant social mobilsation activities were normally done by the EPI Pakistan.

“However, now we too have moved the authorities for allocation of some extra funds for the purpose and it is hoped that awareness and motivation campaigns for an increase in routine immunisation coverage will be undertaken shortly,” he added.