Each year, 12 million people around the world are diagnosed with cancer. Amazingly, about 2 million of these patients have cancers caused by infections.
The four most common infections that lead to cancer are caused by:
Hepatitis B and HPV can be prevented by vaccination. Widespread immunizations would, therefore, decrease the incidence of two of the most common cancers caused by infections: liver and cervical cancers.
Each day throughout the world, approximately 1.3 billion people live below the poverty line, defined as living on less than $1.25 US dollars per day.
January 13, 2012 marked a huge milestone in the fight against polio. For the first time in history, India had no children paralyzed by polio over a one-year time period. Until now, transmission of polio had never been stopped in four countries — Nigeria, Pakistan, Afghanistan and India. With one less country on the list, we are even closer to realizing the goal of eradication.
Immunizations are important for keeping people around the world healthy and reducing the spread of infectious diseases. Estimates suggest that every year immunizations alone save between 2 and 3 million lives. Immunizations have had the greatest impact by reducing the number of deaths among children less than 5 years old and increasing the life expectancy of adults.
In April, the World Health Organization (WHO) published “10 Facts on Immunization.” Highlights included:
Ghana recently made history when its leaders announced the launch of a national program to distribute both pneumococcal and rotavirus vaccines to Ghanaian children. The announcement marked the first time any African nation has introduced more than one vaccine at a time. Pneumonia and severe infant diarrhea are responsible for 1 of every 5 deaths among Ghanaian children less than 5 years old. The new program will help Ghanaians reach their goal of decreasing childhood mortality by two-thirds before 2015.
The World Health Organization (WHO) published a report on the global status of measles control. Reported cases of measles worldwide decreased from 2000 to 2008, but increased during 2010 and continued in 2011 due to large outbreaks. In 2011, large outbreaks were reported in India, the Democratic Republic of Congo, Somalia, Nigeria, France, Indonesia, Zambia, Chad, Sudan, Italy, the Philippines, Pakistan, Romania, Ethiopia, Uganda, Spain and Afghanistan.
The report indicated gaps in vaccination, caused in part by lack of access to healthcare and parents’ reluctance to vaccinate because of unfounded concerns about vaccine safety. Reluctant parents have been of particular concern in the European region. The associated outbreaks serve as a stark reminder of how quickly years of progress can unravel with a slight drop in immunization coverage and the resulting herd immunity.
Maura Murphy, MPH, Global Health Program Manager at The Children’s Hospital of Philadelphia (CHOP)
Originally published in July 2011 Parents PACK newsletter
Every day at 4 p.m., after her work ends at the community health center, Ramona Cordero heads out on foot into the barrios of the town of Consuelo in the Dominican Republic. Ramona visits the homes of children in The Children’s Hospital of Philadelphia's vaccination program, reminding mothers to bring their children into the clinic to complete their vaccination schedule. Most of the families she visits have a very limited education and are living in extremely impoverished conditions. However, through the outreach work of Ramona and her staff of community health workers, nearly all of the children in the program are fully vaccinated according to the Dominican Republic immunization schedule, a feat that seemed almost impossible two years ago when the program began in the barrios.
By developing partnerships with local organizations, CHOP began a children’s health program called Niños Primeros en Salud, in a rural town in the Dominican Republic in 2009. Delivering timely immunizations to all children under the age of 5 is a priority of the center along with offering other preventive care, a nutrition initiative, de-parasite efforts, breastfeeding education and health education. Immunizing children in the program is such a priority because of the life-saving potential of vaccines, both in the Dominican Republic and throughout the world.
In 2000, world leaders set eight ambitious goals to reduce poverty around the globe by 2015. One of these goals, known as Millennium Development Goal (MDG) #4, is to reduce childhood deaths by two thirds, and is of particular importance to the health of children. The success of this goal is measured by three indicators:
The good news is that for the first time in history, the number of children dying every year has fallen below 10 million. The bad news is that nearly 8 million children will still die before their fifth birthday, largely because of preventable illnesses like pneumonia, diarrhea, malaria and measles. Two million of these deaths, primarily from pneumonia and diarrhea, could be prevented through the use of vaccines.
Immunizations are one of the most effective public health interventions available for decreasing the number of deaths each year in children less than 5. Vaccines are also very cost effective. For the price of a cup of coffee, a child in the developing world can be immunized against five killer diseases. As routine immunizations in many countries throughout the world are becoming more available, they are often delivered to children as a part of packages of interventions that include malaria nets and Vitamin A supplements, which also increase childhood survival rates.
Still, more than 23 million children are not up-to-date on their immunizations every year due to barriers such as inaccessibility of vaccines, low public awareness of the need for vaccines or unfounded fears about vaccine safety. These unique challenges make it difficult to achieve and maintain immunization rates in developing countries and are the reason global health programs, such as the vaccine program supported through CHOP Global Health, are so important. To learn more about vaccine delivery around the world, visit the GAVI alliance website.
Ramona’s dedication in the Dominican Republic is an example of how innovative programs can overcome the barriers that often prevent successful immunization efforts in the developing world. By improving immunization rates in children throughout the world through programs like Niños Primeros en Salud, more children can be saved and the Millennium Development Goal of reducing childhood deaths will become a reality.
Maura Murphy, MPH, Global Health Program Manager at The Children’s Hospital of Philadelphia
Botswana is a country of remarkable natural beauty, political stability and economic prosperity. Located in southern Africa and about the size of Texas, Botswana has a population of about 2 million people. Since its independence in 1966, Botswana has made investing in health, including childhood immunizations, a priority. Although it has one of the region’s highest rates of HIV/AIDS, it boasts one of the most comprehensive national responses to the disease, and the rates of new infections have decreased dramatically over the past few years. In Botswana, routine pediatric vaccination rates are very high; in fact, national immunization rates surpass many of the World Health Organization’s goals.
In health posts and clinics all across the delta and rolling plains of Botswana, mothers can be found holding their child’s personal health record in their hand. Called the karata, which means “Under-5 card” in Setswana, the local language of Botswana, these cards are given to children at birth and contain valuable health information, including their growth charts and vaccine history. Many mothers store the cards in plastic or decorate them with stickers, highlighting the importance of these “traveling medical records.”
These are especially important because, although health centers have records of all of their patients, sometimes they are not readily available when a child visits a clinic, and oftentimes children visit different clinics. The karata travels with children as they grow; and, in fact, many adults also carry their own karata tucked into their current health record, so their medical history is always at hand.
Pediatric immunizations are an important part of the health strategy for the Botswana Ministry of Health, the governing body of public healthcare in the country. In fact, vaccines are provided free of charge to all children through the public sector at health posts throughout the country. Typically, children get their vaccinations at a local clinic, such as a rural outpost or larger community clinics.
Ensuring that all children are vaccinated becomes more important with the prevalence of HIV/AIDS in the general and pediatric populations. According to Elizabeth Lowenthal, MD, a CHOP pediatrician and HIV specialist who spent years living and working in Botswana: “The high prevalence of HIV in countries such as Botswana makes herd immunity for vaccine-preventable diseases of particular importance since sometimes children with HIV won’t mount sufficient immunity from vaccinations, particularly if they are given before the child’s HIV is well-controlled.” Herd immunity refers to the concept that a disease cannot spread as easily throughout a community in which most people have been immunized against it, therefore, protecting individuals who have not developed immunity, especially children and those with weakened immunity, such as people suffering from HIV and AIDS.
Because diarrhea and pneumonia are very common in the pediatric population, the Ministry of Health in Botswana hopes to introduce the rotavirus and pneumococcal vaccines into their immunization program. Clinicians in Botswana are excited about these additional ways to keep their patients healthy. According to Matt Kelly, MD, the CHOP David N. Pincus Global Health Fellow who currently lives and works in Botswana, "Pneumonia and diarrheal illnesses are the most common reasons for children in Botswana to be admitted to the hospital. The addition of pneumococcal and rotavirus vaccines to the national immunization schedule will undoubtedly save lives and improve the health of children throughout the country."
As health officials in Botswana continue to focus on improving the health of their citizens, progress against HIV/AIDS and vaccine-preventable diseases is likely to remain among their top priorities.
To learn more about pediatric vaccines in the developing world, visit the UNICEF immunization website.
Neglected tropical diseases (NTDs) are a group of infectious diseases that affect the world’s poorest people in developing countries. NTDs are called “neglected” because they have traditionally received relatively little attention from global governments and health organizations.
More than 1 billion people suffer from one or more NTDs. This group includes more than 500 million children in the developing world who are infected with one or more of the seven most common NTDs:
NTDs thrive in places with:
Although these diseases are transmitted in different ways and cause different symptoms, people are often infected with more than one at a time. Communities with many members affected by one or more of these diseases have problems associated with:
As a result, NTDs contribute to a cycle of poverty that traps the world’s poorest individuals and stifles economic growth in developing countries.
An improved understanding of the relationship between NTDs and extreme poverty has led to increased attention from global and national organizations in recent years. Inexpensive, safe and effective drugs are now available to treat each of the seven most common NTDs. Current efforts to control or eliminate these diseases include:
Vaccines are not currently available to prevent any of the NTDs, but efforts are being made to develop safe and inexpensive vaccines for some of these diseases.
Polio is a vaccine-preventable disease caused by a virus that spreads when food or water is contaminated with feces. Polio causes a wide range of symptoms, but 90 of 100 people typically experience no symptoms. Because this group is still contagious, they unknowingly spread the virus. Mild symptoms typically occur in 6 of 100 people infected with polio virus and are similar to those of other viral infections (e.g., sore throat, fever and nausea). Severe symptoms are less common, affecting about 1 of 100 people, and can include muscle aches, spasms and paralysis.
Before the first polio vaccine was made in 1955, polio paralyzed about 15,000 children and caused the deaths of about 1,000 children every year in the United States.
Jonas Salk created the first polio vaccine, commonly known as the inactivated polio vaccine (IPV). Another polio vaccine was made in 1961 by Albert Sabin. Both polio vaccines contained three types of polio virus; however Salk’s vaccine used inactivated or killed polio virus whereas Sabin’s was a live viral vaccine made by weakening polio virus in laboratory cells.
The polio vaccine program has been very successful and has led to the eradication of polio in the United States and other countries. However, Nigeria, Pakistan and Afghanistan have never stopped transmission of the virus.
Eradication efforts began in 1994, causing a decrease in the number of people getting polio in Pakistan. However, that number began to climb in 2008, and by 2011, Pakistan was considered the “global epicenter” of polio, with more cases of polio than any other country in the world. The increase in the number of people with polio in Pakistan also led to a large polio outbreak in China. Experts attribute the rise in polio cases in Pakistan to many factors, including:
Recently, reinvigorated polio eradication efforts have focused on the mobile subgroups of the Pakistani population. Transit posts offering polio vaccinations have been set up at popular entrances and exits to problem areas. During a 16-day period between April and May of 2012, about 14,000 children were given the polio vaccine.
Unfortunately, nine polio workers, most of whom were women, were targeted and killed during a mass three-day vaccination campaign in December 2012. As a result, vaccination programs in Pakistan were stopped for the remainder of December but resumed in January 2013 during polio’s “low transmission” season. These attacks led public health officials around the world to be more concerned about the situation in Pakistan because without success there, the opportunity to eradicate polio from the world may be lost.
Pandora Chua, Medical student at the Perelman School of Medicine at the University of Pennsylvania
The summer between the first and second years of medical school is the last unscheduled summer that medical students have. As my classmates and I formulated plans for this “last summer,” our advisors repeatedly counseled us to do something we would enjoy, regardless of its relevance to medicine. I decided to spend the summer doing research in Gaborone, the capital city of Botswana, in Southern Africa. At the time, I didn’t realize how much I was going to enjoy and appreciate my summer experience.
While in Gaborone, I worked on a clinical research study investigating the causes and treatment outcomes of severe pneumonia among infants. It was a perfect fit for my interests in vaccines, pediatrics, infectious diseases and global health.
One of my first observations was how different the hospital facilities were compared to those of urban America. And I had never before seen infants that were so sick. In the emergency room, I quickly learned that the children who were strong enough to cry and struggle should worry us less than those who were so weak they could barely move or breathe. Children sick enough to stay in the one-story hospital were assigned to one of many cots in large shared rooms in the pediatric medical ward, where our study team monitored their progress. For the entire ward, which had 30 to 50 beds, there was one computer and X-rays were analyzed by holding them up to the sunlight or room light.
The significance of the study to the community and the concern of the families shone through in my interactions with them. One worried father asked me what causes pneumonia. I answered that we hoped the study would help us learn more about the causes of pneumonia in Botswana. Another mother explained to us how one of her children had been very sick with severe pneumonia, and it was this experience that motivated her to allow another one of her children to participate in the study. She told us she wanted to prevent other families from experiencing what she had experienced when her child had pneumonia.
Pneumonia, an infection of the lungs, is the leading killer of children worldwide. It can be caused by infection with viruses or bacteria, but in places like Botswana, illness and death from pneumonia are made worse by the large number of people infected with HIV/AIDS. Botswana’s current HIV/AIDS epidemic is one of the most severe in the world. Whether or not they become infected with HIV, infants born to HIV-positive mothers are at a higher risk of getting sick or dying from many infections, including pneumonia. I doubt that I will see as many patients with HIV during the rest of my time in medical school as I did during one summer in Botswana.
Despite challenges, such as limited medical facilities and supplies and the ongoing HIV epidemic, Botswana has leveraged its economic growth and political stability to respond aggressively, creating ambitious programs to prevent mother-to-child transmission of HIV and providing free treatment medications to infected individuals. The University of Botswana recently established the country’s first medical school, and a new hospital is due for completion in 2013. Interacting with students from the pioneering generation of Botswana-trained physicians was a privilege I will not forget. The work they will face as doctors in Botswana is very different from that which I will as a physician in the United States.
I was fortunate to be present for a remarkable milestone in the country’s fight against pneumonia. In July, two new vaccines were introduced to the national immunization schedule. The pneumococcal vaccine will help reduce the number of cases of pneumonia, meningitis or deaths caused by infection with pneumococcal bacteria, and the rotavirus vaccine will combat diarrheal disease, another major cause of childhood illness and death. It was amazing to see the excitement surrounding these vaccines, especially in contrast to the sometimes complacent attitude toward vaccines in the United States.
When first year students ask me about their “last summer” plans, I now give the same advice I received: Do something that you’ll find personally fulfilling. For me, learning about the health needs and priorities of a community outside of the U.S. made for an unforgettable summer. Here in the U.S. it can be easy to forget that a place facing strikingly different circumstances – where HIV is widespread, where families travel for hours to reach the nearest clinic, and where vaccines are treasured and not taken for granted – is only a plane ride away. As I proceed with my career, I am certain that this newfound perspective will make me be a better scientist, clinician and advocate for my future patients.
Updated: January 2013
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