POST 01067E : MEASLES GOAL ACHIEVED
Follow-up on Post 01049E
(http://listes.ulaval.ca/cgi-bin/wa?A2=i ... .org&P=175)
20 March 2007
_____________________________________
NOTE : As you notice, we now insert the direct link to the previous posting
on the topic to facilitate access for consultation.
Robert Steinglass (mailto:[email protected]) from IMUNIZATIONbasics
in the United States sends the following comment about a commentary on the
article confirming that the measles goal had been achieved, published in
the same issue of The Lancet. In Post 01049E we had informed you about the
Lancet article to which he refers. The link to the commentary is the same
(http://www.thelancet.com/journals/lance ... X/fulltext).
Just search by author or title on the Lancet site. Be reminded that access
is through free registration that takes but a few minutes.
_____________________________________
Dear Claude,
Perhaps TECHNET members had a chance to read the excellent submission by
Wolfson LJ, Strebel PM, Gacic-Dobo M, et al. in The Lancet ("Has the 2005
measles mortality reduction goal been achieved? A natural history modeling
study." Lancet 2007; 369: 191-200.). The article deservedly was
disseminated widely and was the source of an effective media campaign. But
I wonder if TECHNET readers had access to the brief commentary on the
article in the same issue of The Lancet (Ellman D and Bedford H. "Achieving
the goal for global measles mortality." Lancet 2007; 369: 165-166).
I thought it was very odd indeed. First just a single comment on the full
measles article. Stating that 2.3 of 7.5 million deaths from 1999 to 2005
were prevented through intensified efforts to raise measles immunization
coverage from 71% to 77% and provision of a second immunization opportunity
primarily through measles campaigns, Wolfson et al. never explicitly
mention that the other 5.2 million deaths were prevented primarily through
routine (non-intensified) immunization services. Rather, the reader must
interpret this from a figure.
The accompanying comment by Ellman and Bedford could have highlighted the
need to keep routine immunization services strong, so as to sustain
mortality reduction from campaigns, reduce the required frequency of
campaigns, and most importantly to prevent all-cause mortality - - not just
from measles.
The commentary could have highlighted that increasing fractions of child
mortality due to diarrheal and respiratory diseases are
vaccine-preventable. Several million additional child deaths are
preventable through new pneumoccoccal and rotavirus vaccines, recently
approved for GAVI (Global Alliance for Vaccines and Immunization) funding,
and more complete use of recently-introduced Hib vaccine. Pertussis plus
tetanus have now overtaken measles as a cause of death. All these vaccines,
including against hepatitis B, require multiple timely doses be delivered
systematically through routine services to achieve and sustain mortality
reduction.
Instead, the commentary chose to stress that "immunization should be
delivered as part of a strategy of Integrated Management of Childhood
Illness" (IMCI) and then described the immunization-related strategy of
IMCI to be contact with health staff so as to "provide an opportunity to
inquire about and advise on issues such as nutrition and immunization."
While important to immunize ill children, a strategy whose principal
purpose is early detection and treatment of sick children to return them to
good health is no substitute for an active population-based preventive
strategy to immunize the entire birth cohort. Furthermore, convincing
health professionals to alter lifelong habits and immunize sick children
(the principal IMCI strategy related to immunization) is especially
challenging and an insufficiently robust platform to achieve high enough
immunization coverage.
IMCI does not deal with the operational and managerial challenges facing
routine delivery of immunization services for children and women. Potential
synergies between IMCI and routine immunization programs - - such as
greater systematic engagement of communities - - should be better explored.
Both c-IMCI (community-IMCI) and RED discuss the importance of linking
health workers with the communities they serve, but this potential linkage
between programs has not yet been adequately implemented or documented by
either IMCI nor EPI. Perhaps TECHNET can solicit the views of readers on
their experiences with community linkage (perhaps the least implemented of
the five RED strategies), whether in concert with c-IMCI or on its own.
Robert Steinglass
Technical Director
IMMUNIZATIONbasics
JSI Research & Training Institute, Inc.
______________________________________________________________________________
All members of the TechNet21 e-Forum are invited to send comments on any posting or to use the forum to raise a new discussion or request technical information in relation to immunization services.
The comments made in this forum are the sole responsibility of the writers and do not in any way mean that they are endorsed by any of the organizations and agencies to which the authors may belong.
______________________________________________________________________________
Visit the TECHNET21 Website at http://www.technet21.org
You will find instructions to subscribe, a direct access to archives, links to reference documents and other features.
______________________________________________________________________________
To UNSUBSCRIBE, send a message to : mailto:[email protected]
Leave the subject area BLANK
In the message body, write unsubscribe TECHNET21E
______________________________________________________________________________
The World Health Organization and UNICEF support TechNet21. The TechNet21 e-Forum is a communication/information tool for generation of ideas on how to improve immunization services. It is moderated by Claude Letarte and is hosted in cooperation with the Centre de coopération internationale en santé et développement, Québec, Canada (http://www.ccisd.org)
______________________________________________________________________________
Il n'y a pas encore de réponse à ce message.