posts: 27592

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    "id": "wp-27592",
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                                "text": "This week \u2013 24-30 April \u2013 is ",
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                            },
                            {
                                "children": [
                                    {
                                        "text": "World Immunization Week",
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                                    }
                                ],
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                            },
                            {
                                "text": ". The theme of this year's World Immunization Week is collective action to protect every person in the world from \"vaccine-preventable diseases\" (VPDs). VPDs are ",
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                        "url": "http://www.who.int/immunization/global_vaccine_action_plan/GVAP_doc_2011_2020/en/",
                        "children": [
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                                "children": [
                                    {
                                        "text": "25 viral and bacterial diseases",
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                                    }
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                        "children": [
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                                "text": " listed by the ",
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                            {
                                "children": [
                                    {
                                        "text": "World Health Organization",
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                            {
                                "text": " (WHO) that can be prevented by vaccination. ",
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                                "text": "Not only can individual deaths be avoided, but transmission of infectious diseases can also be interrupted if vaccination rates are high enough. This means that even those who are not vaccinated also gain protection.",
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                        "text": "{ref}If a high number of the population is vaccinated then it is harder for infectious diseases that are contagious to spread because the number of people that can be infected is lower. This is called ",
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                    },
                    {
                        "url": "http://vk.ovg.ox.ac.uk/herd-immunity",
                        "children": [
                            {
                                "text": "\u2018",
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                            },
                            {
                                "children": [
                                    {
                                        "text": "herd immunity",
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                                    }
                                ],
                                "spanType": "span-italic"
                            },
                            {
                                "text": "' or '",
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                            {
                                "children": [
                                    {
                                        "text": "herd protection",
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                            {
                                "text": "\u2019",
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                        "text": ", but this mechanism only works for contagious diseases and not diseases such as tetanus, which is caught from bacteria in the environment and not from other people.{/ref}",
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                        "text": " The ultimate goal in public health is often seen to be the eradication of disease through vaccination, as has been achieved for smallpox and it is in close sight for ",
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                    {
                        "children": [
                            {
                                "text": "polio. T",
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                        ],
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                    {
                        "text": "he world was able to reduce the number of paralytic polio cases from over 350,000 per year in the 1980s to just 42 cases in a year, as we show in ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://owid.cloud/polio/",
                        "children": [
                            {
                                "text": "our entry on polio",
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                            }
                        ],
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                        "children": [
                            {
                                "text": ".",
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                                "text": "The WHO estimates that ",
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                        "url": "http://www.who.int/mediacentre/news/releases/2017/infants-worldwide-vaccinations/en/",
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                                        "text": "2 to 3 million deaths",
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                        "children": [
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                                "text": " are prevented every year through immunization against diphtheria, tetanus, whooping cough, and measles.",
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                        "text": "{ref}In our graphics and visualizations we rely on the ",
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                    {
                        "children": [
                            {
                                "text": "Institute for Health Metrics",
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                            }
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                        "text": " (IHME) \u2018",
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                    {
                        "url": "http://ghdx.healthdata.org/gbd-results-tool",
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                                "text": "Global Burden of Disease Study 2016",
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                        "text": "\u2019 estimates of child death rates from individual VPDs (compared with other causes), TB death rates across countries, and death rates from individual VPDs; this dataset extends back to 1990 and therefore provides a longer-term perspective on these changes over time. However, lack of estimates from the IHME on the role of vaccination in the prevention of deaths means we rely on WHO data for the number of deaths prevented each year through vaccination and the total amount of deaths VPDs are responsible for.",
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                        "text": "The rates reported by the WHO and IHME are in a similar range but do differ slightly. WHO data on individual disease death rates can be found here: ",
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                    {
                        "url": "http://www.who.int/gho/mortality_burden_disease/en/",
                        "children": [
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                                "text": "http://www.who.int/gho/mortality_burden_disease/en/",
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                        "text": "{/ref}",
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                                "text": "Nonetheless, the WHO also estimates that VPDs are still responsible for ",
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                        "url": "http://www.who.int/mediacentre/commentaries/vaccine-preventable-diseases/en/",
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                                        "text": "1.5 million deaths",
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                        "children": [
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                                "text": " each year. ",
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                                "text": "In the chart we see the global number of deaths of children younger than 5 years per year from 1990 to 2017. The number of deaths which are wholly or partially preventable by vaccines are shown in color.{ref}Note that, as discussed later in this post, the role of vaccines in prevention varies between these causes of death. Measles, for example, has the capacity to be eliminated through vaccination. Diarrheal deaths, in contrast, cannot be eliminated through vaccination alone; hygiene, water services, and nutrition must also be prioritised.{/ref} The chart shows that the reductions in child deaths over this 25-year period were primarily achieved by a reduction of the number of deaths from vaccine-preventable diseases: The decline in causes which are not vaccine preventable has been modest, while the number of child deaths caused by diseases for which vaccines are available declined from 5.1 million deaths in 1990 to 1.8 million deaths 27 years later.",
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                                "text": "Two vaccines are responsible for saving millions each year: \u2018DTP\u2019 against diphtheria, tetanus, and pertussis (whooping cough) and \u2018MMR\u2019 against measles, mumps, and rubella.{ref}Some countries only give measles vaccines combined with rubella (MR) or with varicella in addition (MMRV).{/ref} Before the measles vaccine was introduced in 1963, measles caused a large number of deaths globally, estimated at ",
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                        "url": "http://www.who.int/mediacentre/factsheets/fs286/en/",
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                                        "text": "2.6 million each year",
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                        "children": [
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                                "text": ". \u00a0Because about 86% of the ",
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                        "url": "http://www.who.int/mediacentre/factsheets/fs378/en/",
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                                        "text": "world population is immunized today,",
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                                "text": " the number of people killed by measles have been cut dramatically to an estimated 95,000 deaths in 2017. Tetanus and pertussis were also previously much bigger killers, with pertussis affecting\u00a0especially children younger than 5 years and tetanus striking newborns (",
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                        "url": "http://www.who.int/immunization/diseases/tetanus/en/",
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                                        "text": "killing an estimated 787,000 newborns",
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                                "text": " in 1988, compared with 49,000 in 2013",
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                        "children": [
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                                "text": ").",
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                "text": [
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                        "text": "The way ahead",
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                                "text": "However, the gains in global vaccination coverage have slowed down slightly in the last few years. The WHO estimates that\u00a0",
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                        "url": "http://www.who.int/mediacentre/factsheets/fs378/en/",
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                                        "text": "19.5 million infants",
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                                "text": " worldwide are still at risk of VPDs because they miss out on basic vaccines.",
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                    {
                        "text": "{ref}Highlighted are 10 countries ",
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                        "url": "http://www.who.int/mediacentre/factsheets/fs378/en/",
                        "children": [
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                                "text": "where approximately 60%",
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                        "text": " of these infants live in: Angola, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Iraq, Nigeria, Pakistan, and South Africa.{/ref}",
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                                "text": "In addition, all the recommended doses of a vaccine need to be received for it to be most effective. In the case of measles three vaccine doses are recommended. Even though an estimated ",
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                                "text": "85% of children receive their first dose of the vaccine, ",
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                                "url": "http://www.who.int/mediacentre/factsheets/fs378/en/",
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                                        "text": "this drops to 64%",
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                                "text": " for the second dose.",
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                                "text": "Therefore, it is not only lack of vaccination that is a problem, but it is under-vaccination that leads to deaths from VPDs.",
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                                "text": "What then are the most deadly VPDs? Which diseases continue to kill the most people? ",
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                        "text": "The most deadly diseases",
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                                        "text": "Tuberculosis:",
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                                "text": " Determining which are the most deadly VPDs requires acknowledging that some vaccinations are more effective than others. While most vaccines included in national routine schedules are highly effective, a better vaccine for tuberculosis (TB) is desperately needed. It is Sub-Saharan Africa and parts of Asia in particular that are affected by TB, as the world map here shows.",
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                                "text": "The vaccine for TB \u2013 Bacillus Calmette\u2013Gu\u00e9rin (BCG) \u2013 has been in use for nearly 100 years. It protects against severe forms of TB but is ",
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                        "url": "https://wellcome.ac.uk/news/world-immunisation-week-seven-vaccine-challenges",
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                                        "text": "not effective against pulmonary TB",
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                                "text": " (in the lungs) and has variable effectiveness against TB in adults.",
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                        ],
                        "spanType": "span-fallback"
                    },
                    {
                        "text": "{ref}Zwerling A, Behr MA, Verma A, Brewer TF, Menzies D, Pai M. The BCG World Atlas: A Database of Global BCG Vaccination Policies and Practices. ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "children": [
                            {
                                "text": "PLoS Medicine",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": ". 2011;8(3):e1001012. doi:10.1371/journal.pmed.1001012. Available ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001012",
                        "children": [
                            {
                                "text": "here",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
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                        "text": ".{/ref} {ref}For a detailed commentary on why we do not yet have an effective TB vaccine see: Davenne T, McShane H. Why don\u2019t we have an effective tuberculosis vaccine yet?",
                        "spanType": "span-simple-text"
                    },
                    {
                        "children": [
                            {
                                "text": " Expert Review of Vaccines",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": ". 2016;15(8):1009-1013. doi:10.1586/14760584.2016.1170599. Available ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950406/",
                        "children": [
                            {
                                "text": "here.",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": "{/ref} Furthermore, resistance of antibiotics used to treat TB is increasing, meaning some people can no longer be cured by drugs. The estimated number of people in 2016 with ",
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                    },
                    {
                        "url": "http://www.who.int/features/qa/79/en/",
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                                "children": [
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                                        "text": "multi-drug resistant TB was 490,000",
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                                ],
                                "spanType": "span-fallback"
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                        "children": [
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                                "text": ". ",
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                                "text": "The fact that there is not a fully effective vaccine and that antibiotic treatment is facing serious difficulties makes TB the most deadly VPD, as we see in the chart. This chart shows the latest data on the number of deaths from VPDs. In 2017 more than 1 million people died as a result of TB.",
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                                "text": "Meningococcal meningitis and hepatitis B are also deadly VPDs.",
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                            }
                        ],
                        "spanType": "span-fallback"
                    },
                    {
                        "text": "{ref}Susan T Goldstein, Fangjun Zhou, Stephen C Hadler, Beth P Bell, Eric E Mast, Harold S Margolis; A mathematical model to estimate global hepatitis B disease burden and vaccination impact, ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "children": [
                            {
                                "text": "International Journal of Epidemiology",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": ", Volume 34, Issue 6, 1 December 2005, Pages 1329\u20131339, ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://doi.org/10.1093/ije/dyi206",
                        "children": [
                            {
                                "text": "https://doi.org/10.1093/ije/dyi206",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". Available ",
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                    },
                    {
                        "url": "https://www.ncbi.nlm.nih.gov/pubmed/16249217",
                        "children": [
                            {
                                "text": "here",
                                "spanType": "span-simple-text"
                            }
                        ],
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                    },
                    {
                        "text": ".{/ref}",
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                        "text": "There are even more",
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                    {
                        "children": [
                            {
                                "text": " deadly diseases for which there are vaccines that can prevent some (but not all) deaths \u2013 we focus on these in the 'additional discussion' below. ",
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                                "text": "In World Immunization Week it is a good moment to look at what we have achieved and what we have to work on next. That 2 to 3 million deaths each year are prevented through immunization shows the capability and imperative of vaccination. The prospect that vaccines could prevent an additional 1.5 million deaths each year makes clear what is within reach if the efforts to fight VBDs are continued.",
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                                "text": "Additional information",
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                                        "text": "Which other deadly diseases can be prevented by vaccines?",
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                                        "text": "Deadly diseases that can be prevented by vaccines include diarrheal diseases and lower respiratory diseases: Rotavirus vaccines can protect against rotavirus infections that are the\u00a0",
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                                    },
                                    {
                                        "url": "https://www.cdc.gov/vaccines/hcp/vis/vis-statements/rotavirus.html",
                                        "children": [
                                            {
                                                "text": "leading causes of severe diarrhea",
                                                "spanType": "span-simple-text"
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                                        ],
                                        "spanType": "span-link"
                                    },
                                    {
                                        "text": "\u00a0in young children. However, the vaccine does not work as well in low-income countries in Africa and Asia (for reasons that remain unclear but hypotheses include a difference in behavior of oral vaccines in the gut){ref}Patel M, Shane AL, Parashar UD, Jiang B, Gentsch JR, Glass RI. Oral Rotavirus Vaccines: How Well Will They Work Where They Are Needed Most? T",
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                                    },
                                    {
                                        "children": [
                                            {
                                                "text": "he Journal of infectious diseases.",
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                                        ],
                                        "spanType": "span-italic"
                                    },
                                    {
                                        "text": " 2009;200(0 1):S39-S48. doi:10.1086/605035. Available ",
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                                    },
                                    {
                                        "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673012/#R1",
                                        "children": [
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                                                "text": "here.",
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                                    {
                                        "text": "{/ref}",
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                                "type": "text",
                                "value": [
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                                        "text": " and getting these vaccines to those who need them the most is challenging. A ",
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                                    },
                                    {
                                        "children": [
                                            {
                                                "text": "\"cold chain\"",
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                                        ],
                                        "spanType": "span-italic"
                                    },
                                    {
                                        "text": " is often required to keep vaccines at the right temperature to be safe and effective \u2013 this is particularly ",
                                        "spanType": "span-simple-text"
                                    },
                                    {
                                        "url": "https://wellcome.ac.uk/news/world-immunisation-week-seven-vaccine-challenges",
                                        "children": [
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                                                "text": "difficult in",
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                                        ],
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                                        "children": [
                                            {
                                                "text": "rural areas or if there is not a constant electricity supply",
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                                        "children": [
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                                                "text": ". ",
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                                        "children": [
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                                                "text": "There are also vaccines that protect against pneumococcus diseases (including pneumonia, meningitis and febrile bacteraemia) and ",
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                                            }
                                        ],
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                                        "children": [
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                                                "children": [
                                                    {
                                                        "text": "Haemophilus influenzae",
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                                        ],
                                        "spanType": "span-italic"
                                    },
                                    {
                                        "children": [
                                            {
                                                "text": " type b (Hib), which cause pneumonia and lower respiratory infections. These vaccines are available but not yet in widespread use in several countries including China, India, Nigeria, Bangladesh, Afghanistan, and Indonesia.",
                                                "spanType": "span-simple-text"
                                            }
                                        ],
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                                    },
                                    {
                                        "text": "{ref}Laxminarayan, Ramanan et al. (2016) \u2013 Access to effective antimicrobials: a worldwide challenge.",
                                        "spanType": "span-simple-text"
                                    },
                                    {
                                        "children": [
                                            {
                                                "text": " The Lancet",
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                                            }
                                        ],
                                        "spanType": "span-italic"
                                    },
                                    {
                                        "text": " Volume 387, Issue 10014, 168 \u2013 175. Available ",
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                                    },
                                    {
                                        "url": "http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)00474-2.pdf",
                                        "children": [
                                            {
                                                "text": "here",
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                                            }
                                        ],
                                        "spanType": "span-link"
                                    },
                                    {
                                        "text": ".{/ref} Global coverage ",
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                                    },
                                    {
                                        "url": "http://www.who.int/mediacentre/factsheets/fs378/en/",
                                        "children": [
                                            {
                                                "text": "is estimated at",
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                                            }
                                        ],
                                        "spanType": "span-link"
                                    },
                                    {
                                        "children": [
                                            {
                                                "text": "25% for rotavirus vaccines and 42% for pneumococcal vaccines.",
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                                            }
                                        ],
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                                                "text": "Vaccine shortages and other crises within countries present further immediate challenges in the context of outbreaks. In 2018 Brazil is facing a shortage of the yellow fever vaccine. Conflict and political instability remain barriers, as can be seen for the last two remaining countries to wipe out polio, Afghanistan and Pakistan. To protect people from VPDs not only are new, improved vaccines needed but also support for the more widespread use of existing vaccines in spite of crisis. This is especially true in low-income countries.",
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        "type": "article",
        "title": "How is the world doing in its fight against vaccine preventable diseases?",
        "authors": [
            null
        ],
        "dateline": "November 13, 2019",
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    "createdAt": "2019-11-13T14:07:18.000Z",
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    "updatedAt": "2022-02-11T12:35:58.000Z",
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    "publishedAt": "2019-11-13T14:07:15.000Z",
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