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 |  | | Introduction of new vaccines in Russia | | Haemophilus type b (Hib) Research and Pilot Vaccination Programs | | • | A recent study by RVF showed a heavy burden of Hib meningitis in children at study sites in Western Russia and the Russian Far East. Meningitis and other serious diseases caused by Haemophilus influenzae type b (Hib) can lead to brain damage or death. | | • | At the request of Chief Sanitary Physician of RF, Dr. Gennady Onischenko, RVF is supporting pilot (Hib) vaccination programs in the cities of Yaroslavl and Vladivostok, as well as throughout the Murmansk region. The programs are financed by grants from the French energy company Total and USAID. | | • | The overarching goal is to support the Russian Ministry of Health and Social Development in evaluating the inclusion of the Hib conjugate vaccine in the National Immunization Calendar, which would protect all children in Russia from the ravages of Hib infection |
| The Rostropovich-Vishnevskaya Foundation (RVF) is an organization with deep interest and experience in modernizing childhood vaccination in the Russian Federation (RF).
Following the handing off of its highly successful hepatitis B vaccination initiative for adolescents to the Russian federal |
|  | | RVF-Russia representative conducts training of health care workers on the vaccine for Haemophilus influenzae type b (Hib) |
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| government, the RVF agreed to a request from Dr. G. G. Onishenko, Chief Sanitary Physician of the RF, to conduct a two-year pilot vaccination program for the prevention of Haemophilus influenzae type b (Hib) infection in infants at three major sites: the Murmansk region and the cities of Yaroslavl and Vladivostok. Dr. Onischenko’s request was prompted by the findings of RVF’s recent study of the epidemiology of Hib infection at sites throughout the country. The data showed high rates of attack of meningitis caused by Hib in such diverse locations as Murmansk, Tula, Ulan-Ude, Vladivostok, and Yaroslavl. In the Murmansk region the attack rate of Hib meningitis reached 21.4 per 100,000 in children under 5 years of age. Since meningitis generally accounts for about half of the burden of Hib disease, the true prevalence in young children in the Murmansk region and several other study sites exceeds 40 per 100,000 children aged under 5 years – a rate comparable to that of Finland in the pre-vaccine era. By criteria established by the World Health Organization (WHO), rates in excess of 10 cases per 100,000 population under 5 years of age indicate the need for a strategy of prevention based on the routine immunization of children in the first two years of life.
The epidemiological study, a collaboration with the Central Institute of Epidemiology in Moscow, follows the guidelines of WHO’s “Generic Protocol for Population-Based Surveillance of Haemophilus influenzae type b.”
Over the course of the study, the performance of microbiology laboratories has been dramatically improved; to wit, the proportion of meningitis of known etiology has risen from 3%-20% to as high as 84%. The significant advance in diagnostic capability is improving treatment outcomes and reducing the associated morbidity and mortality.
The Hib pilot vaccination programs in the Murmansk Region and the city of Yaroslavl were launched in 2007 with a grant from the French energy company Total. The programs target all children under the age of 2 years, in accordance with WHO guidelines. As of January 2009, 63,000 doses had been delivered to Murmansk and 43,700 doses to Yaroslavl. The average coverage rates range from 84% - 99%. RVF has also supplied 256 refrigerators and 716 thermal containers to ensure the proper storage and distribution of the vaccine. In addition RVF has provided 40 computers and 50 software sets to modernize the record-keeping of vaccinations.
In August 2008, thanks to support from USAID, the city of Vladivostok was added as a third site for a pilot vaccination program. The success of this vaccination program is already apparent: 4,810 children of the 12,000 children targeted for vaccination have been fully vaccinated, 230 refrigerators and 300 thermal containers have been delivered to strengthen the cold chain, and 45 computers and software sets have been provided to support the electronic collection and analysis of vaccination data. | | » Vaccination chart | Hib infection was common among infants and children under 5 years of age in Western Europe and the United States until the introduction of Hib conjugated vaccines in the early 1990s. However, the failure of many countries to institute a preventive approach to such a common and severe public health problem is the reason why the world still sees about 380,000 children die unnecessarily each year due to Hib disease, chiefly through meningitis and pneumonia. Thus the Hib vaccination programs in Russia should be viewed in the context of the national priority on public health and infectious diseases control through immunization, which is part of the national program known as “Health” announced by President Putin in September 2005.
The RVF does not create parallel structures to implement its programs. Thus, all vaccinations are performed by local health care workers, and all vaccines are administered at the child’s standard location of health care delivery (polyclinics and primary care stations). The implementation of the Hib pilot vaccination programs through the existing local health care infrastructure is making a significant contribution to modernizing childhood immunization and sets the stage for program sustainability. As in the case of our successful hepatitis B vaccination initiative for adolescents and healthcare workers, which is now financed by the Russian government, the Hib vaccination program is expected to be expanded throughout Russia and fully financed by the federal government within 3 – 5 years of its inception.
The RVF is working collaboratively with officials from the federal Ministry of Health and Social Development in Moscow as well as regional health and government representatives to educate health care workers about the urgent medical need for and safety of the vaccine. To this end the RVF provides educational materials and training to health care workers involved in the program. This includes a series of seminars dealing with indications and contraindications to the Hib vaccine, adverse events following immunization, and ongoing surveillance of the Hib disease burden. For example, in October 2008, RVF conducted a two-day workshop for health care workers on Hib diagnosis and prevention in the city of Vladivostok. The workshop included information and training regarding laboratory diagnosis of Hib, common questions and answers about the Hib vaccine, and modernizing immunization record-keeping through computerization. 75 professionals from the Primorsky Krai, the Irkutsk region, and the republics of Buryatia and Yakutia took part in the workshop, which included presentations by Hib experts from Moscow, St. Petersburg, Murmansk, and Yaroslavl. In order to strengthen the efficacy of their interactions with parents, health care workers at all vaccination sites have been provided with professional teaching materials as well as informational brochures for distribution to parents.
It is expected that the successful accomplishment of defining the epidemiology of Hib infection and the introduction of the Hib vaccine in pilot vaccination programs will provide the necessary impetus for including the Hib vaccine in the national immunization calendar of the Russian Federation in the near future.
More Information on Hib from the WHO | | |
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The Rostropovich-Vishnevskaya Foundation (RVF) is a non-political, non-partisan organization whose mission is to make a difference in the health and wellbeing of vulnerable children...
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