The Hib Initiative

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UPDATE
Ros OLoughlin, CDC Hib Initiative Karen
Edmond, LSHTM Hib Initiative Fourth Annual
Network meeting November 9th 2006
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Outline

• Background on Hib Initiative
• Status of Hib vaccine introduction in the Africa
  region
• Current and future activities in Africa

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MISSIONTo expedite sustainable
evidence-informed decisions at the global,
regional, and country levels regardingthe use of
Hib vaccination to prevent childhood meningitis
and pneumonia

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Vision

• To reduce risk of childhood death and disability
  through sustained use of Hib vaccine

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Global Alliance for Vaccines and Immunization
(GAVI) Initiative

• Supported by a 37M grant
• 4 year project (2005-2009)
• Success to be measured by support and
  implementation of evidence-informed decision
  making in an expedited manner
• Vaccine decisions need to be made based on the
  evidence presented and priorities of each country

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Hib Initiative ApproachCountry driven with
consideration of health system implications
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Global Groupings

• Regions with well documented disease burden
• African continent, Middle East, the Americas and
  Pacific Island nations
• Regions with emerging data
• South and East Asian Regions
• Regions with undefined disease burden
• Central and Eastern Europe and Newly Independent
  States (NIS)

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Hib Disease The Global Burden

• 3 million children with
• serious illness/ year
• gt 400,000 deaths/year
• A leading cause of infectious death in children
  under 5 years of age
• A leading cause of neurological damage in children

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Strategies for the control of childhood pneumonia

• Improved nutrition
• Improved indoor air quality
• Case management Integrated Management of
  Childhood Illness (IMCI)
• Vaccines
• Hib conjugate vaccines
• Pneumococcal conjugate vaccine

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Status of Hib Vaccine Introduction in the AFRO
Region
Introduced
Introduced with own resources
Approved/Plan to Introduce
Not Introduced
EMRO
Not GAVI-eligible/Not Introduced
Non GAVI eligible
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Africa Region

• 46 countries
• 13/46 (28) using Hib vaccine
• 36 GAVI eligible countries
• 11/36 (31) using Hib vaccine
• Approximately 20 of children in region are
  receiving Hib vaccine.

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Hib programs AFRO
05
95
98
03
98
05
Results pending
01
05
02
06
02
06
02
03
GAVI 2002 self-financed To be
introduced
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Importance of surveillance for impact studies

• National surveillance data
• South Africa
• Population based surveillance
• Kenya
• The Gambia
• Malawi
• Case control study using sentinel surveillance
  data
• Malawi
• Uganda

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Current and future Hib Initiative Activities in
Africa

• Regional forums
• Africa Anglophone, June 06, Nairobi
• Africa Francophone, Jan 07, Brazzaville
• Country consultations / visits
• Regional office, Burkina Faso, DR Congo,
  Ethiopia, Tanzania
• Request for proposals
• 6 letters of interest received from Africa
• Full proposal requested from Mozambique and
  Burkina Faso

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• Surveillance support to PBM / NetSPEAR
• New countries and new sites
• Impact assessments
• Ethiopia
• Burkina Faso
• Mozambique
• Technical support
• To research projects
• For Hib rapid assessments
• GAVI applications

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New vaccine forum in June

• Early adopters
• GAVI bridge financing
• Sustainability of vaccine
• Demonstrating vaccine impact
• Countries approved to introduce
• Supply of vaccine
• Issues for a successful introduction
• Countries who have not yet decided
• More advocacy at country level
• Better define Hib burden

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Priority countries for 2007

• Ethiopia
• Large birth cohort and about to introduce
• DR Congo
• Large birth cohort
• Angola
• About to introduce
• Tanzania
• No decision to introduce, large birth cohort
• Kenya
• Sustainability issues

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10 Largest Birth CohortsTotal GAVI Phase 2
countries 83.4 million
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Summary

• Hib introduction in Africa slowly increasing
• Several studies have demonstrated impact of Hib
  vaccine on Hib disease
• Priorities of Hib Initiative include
• Ensuring all countries make an evidence-informed
  decision
• Giving technical assistance to countries with
  communications, advocacy, impact assessment, GAVI
  applications etc.

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