CDC and Partners Protect Haitian Children against Vaccine Preventable Diseases
Immunization is considered the first line of public health defense and one of the most efficient and cost-effective public health interventions in the world. A high level of vaccination coverage in a population group can stop the spread of vaccine preventable diseases (VPDs) by reducing the number of people who are at risk of infection. The protection from an effective national immunization program also decreases the likelihood for VPDs to spread to other countries.
Before the 2010 earthquake, routine immunization coverage in Haiti had stagnated, and there were longstanding challenges with vaccine management and safe vaccine storage and shipping. CDC is working in Haiti to increase national vaccination coverage for all routine vaccines to above 90% and introduce new vaccines.
Measles is one of the most contagious infectious diseases. In developing countries, up to 1 in 10 children who become sick with measles can die from the disease. Rubella infection during pregnancy can severely affect the unborn baby, resulting in miscarriage, fetal death, or a combination of devastating birth defects known as congenital rubella syndrome (CRS), which includes heart disease, blindness, mental retardation, and deafness.
In Haiti, in 2011, only 59% of children younger than 1 year of age received measles-rubella (MR) vaccine. A vaccination rate above 90% is necessary to ensure that a country’s population is protected from the spread of measles or rubella viruses.
Between April and June 2012, CDC provided technical assistance and funding to the Haitian Ministry of Public Health and Population (MSPP), the Pan American Health Organization (PAHO), and the United Nations’ Children’s Fund (UNICEF) to implement a national MR vaccination campaign targeting children younger than 10 years of age.
MSPP worked hand-in-hand with PAHO staff to train vaccinators, develop micro-plans to reach all children younger than 10 with vaccines, and deliver vaccinations at schools, fixed health posts, and from house-to-house. UNICEF worked with MSPP to prepare the cold chain, the system of refrigerators and cold boxes which is essential to keep vaccines at the proper temperature to maintain potency. CDC joined all these partners to facilitate trainings, develop protocols and tools for data collection, and monitor immunization activities.
At the request of MSPP and PAHO, CDC designed and funded a nationwide survey to evaluate the success of the measles-rubella vaccination activities. A team of 25 CDC-trained Haitian interviewers went door-to-door to administer the questionnaire to 7,000 households representing 10,000 children.
A CDC analysis of the survey data showed that 91% of children 1-9 years of age received at least one dose of MR vaccine. Almost 30% of the children received their first dose of MR vaccine during the campaign. The campaign also provided a second dose of MR vaccine to over half of children 1-9 years of age, ensuring that these children have complete protection against measles and rubella. These results indicate a real improvement in vaccination in Haiti compared to 2010 when only 65% of children in the same age group had received at least one dose of MR vaccine.
The survey also identified a need for improved vaccination coverage among children younger than 4 years of age. To meet this challenge, CDC is focusing efforts on strengthening routine immunization. During 2012, pentavalent vaccine was introduced in Haiti, protecting children against 5 serious diseases with one shot: diphtheria, tetanus, pertussis (whooping cough), hepatitis B, and Hib disease (which can cause pneumonia, meningitis, and other deadly illnesses).
Rotavirus vaccine, which protects against the leading cause of severe and fatal diarrhea worldwide, is scheduled for introduction in 2013. Pneumococcal conjugate vaccine will be introduced in Haiti in 2014 to protect against pneumonia, which is the #1 killer of children younger than 5 years of age worldwide. These efforts will protect more children from sickness and death from VPDs, and will reduce the risk of VPD outbreaks in Haiti and the Americas.