Hib Initiative Activities
Regions with Well Documented Burden of Hib Disease:
African continent, Middle East, the Americas and Pacific Island nations (including Papua New Guinea)
Meetings
Regional forums on bacterial meningitis and pneumonia sponsored by Hib Initiative:
- East and Southern Africa Regional Hib Forum: Kenya, June 2006
- West and Central Africa Regional Hib Forum: Democratic Republic of Congo, January 2007
- Eastern Mediterranean Regional Hib Forum: Egypt, November 2006
Country Consultations Conducted
- Burkina Faso
- Democratic Republic of Congo
- Tanzania
- Ethiopia
Research and Surveillance in the Region
Hib Initiative activities in the AFRO region are focused on supporting surveillance activities and evaluating the impact of Hib vaccine on disease. Support to the Pediatric Bacterial Meningitis Network will allow the network to expand within countries and to new countries providing local data on Hib disease.
Vaccine impact research studies are planned for Ethiopia, Mozambique and the Gambia. Specific research questions on Hib vaccine effectiveness in HIV positive children will be answered in the Mozambique study and specific research questions around waning immunity and the need for a booster dose will be answered in the Gambia. Ethiopia is the first country and the largest GAVI-eligible country to date to introduce the all-liquid pentavalent vaccine so demonstrating vaccine effectiveness here is important.
Surveillance in the Middle East region has been progressing steadily. Since 2004, WHO Eastern Mediterranean Regional Office (EMRO), which includes countries in the Eastern Mediterranean and Middle East regions, has supported Bacterial Meningitis Surveillance in 12 countries (Pakistan, Sudan, Syria, Yemen, Morocco, Iran, Libya, Lebanon, Oman, Egypt, Tunisia and Jordan). In 2007, in collaboration with PneumoADIP, the Hib Initiative expanded surveillance in 6 of these countries (Pakistan, Sudan, Syria, Yemen, Morocco and Iran) to form a comprehensive invasive disease surveillance network. In addition, Tunisia and Libya will be using their own financial resources to add enhanced surveillance. As more and more countries adopt Hib vaccine, the Hib Initiative will continue to support the establishment of surveillance systems to document impact and sustain use.
In both of the WHO African (AFRO) and European (EURO) regions, additional efforts such as post introduction evaluation activities will provide important lessons learned for neighboring countries.
Country Specific Activities
Burkina Faso
- Support hospital based Hib meningitis surveillance among children under 5 years of age and document vaccine impact.
- Determine the usefulness of clinical meningitis data in measuring the impact of Hib vaccine.
Ethiopia
- Case-control study to determine the effectiveness of fully liquid Hib conjugate vaccine; expansion of Pediatric Bacterial Meningitis (PBM) surveillance sites
Gambia
- Determine the long term effect of routine immunization with Hib conjugate vaccine through surveillance and a case-control study and including an assessment of Hib carriage and immunogenicity in Western Gambia.
Mozambique
- Support surveillance of invasive Hib disease and radiological pneumonia and measure the effectiveness of introducing Hib conjugate vaccine into the routine immunization schedule through a case-control study in Manhiça.
Tanzania
- Continuation of high quality pediatric blood culture surveillance at Teule hospital, Muheza.
Yemen, Sudan
- Support surveillance for H. influenzae type B and S. pneumococcus meningitis.
Central and Eastern Europe and Newly Independent States with Undetermined Burden of Hib Disease:
Armenia, Azerbaijan, Georgia, Krygyz Rep, Moldova, Tajikistan, Ukraine, Uzbekistan, Albania, Bosnia/Herzegovina
Meetings
Regional forums on bacterial meningitis and pneumonia sponsored by Hib Initiative:
- Workshop for Hib vaccine introduction: Ukraine, 2006
- EURO Regional Hib Forum: Russia, February 2006
Country Consultations Conducted
- Moldova
- Kyrgyzstan Republic
- Ukraine
- Uzbekistan
Research and Surveillance in the Region
Efforts in this region have focused on supporting studies to document vaccine impact on pneumonia and meningitis, and to provide technical assistance and coordination to neighboring countries through cost –effective analyses and surveillance support. Ukraine’s introduction of Hib vaccine in 2006 serves as a starting point for increasing momentum of vaccine introduction amongst GAVI-eligible countries.
In both of the WHO African (AFRO) and European (EURO) regions, additional efforts such as post introduction evaluation activities will provide important lessons learned for neighboring countries.
Country Specific Activities
Ukraine
- Sentinel surveillance for bacterial meningitis and x-ray confirmed pneumonia.
- Evaluation of vaccine effectiveness against radiologically confirmed pneumonia through a case-control study.
South and East Asian Regions with Emerging Data:
Afghanistan, Pakistan, India, Nepal, Bhutan, Bangladesh, Sri Lanka, Mongolia, Indonesia, Vietnam, Myanmar, Laos, Cambodia, Korea DPR, and Timor Leste
Meetings
Regional forums on bacterial meningitis and pneumonia sponsored by Hib Initiative:
- Asia (South East Asia and Western Pacific) Regional Hib Forum: Malaysia, March 2006
Country Consultations Conducted
- India
- Bangladesh
- Pakistan
- Sri Lanka
- Bhutan
- Mongolia
- Vietnam
- Cambodia
Research and Surveillance in the Region
Data from the South and East Asian regions continues to emerge. As some of the world’s largest birth cohorts are based in this region of the world, it represents a strategic and important focus for the Hib Initiative. India, which alone represents roughly 1/3 of the birth cohort of all GAVI eligible countries, will be a primary focus, with research efforts targeted to help guide state level introduction and sustained use of the vaccine. Other key activities in the region will be to support surveillance in Bangladesh, Sri Lanka and Nepal and to fund studies to assess the impact of Hib vaccine introduction, as well as examining the long term sequelae of Hib disease. For countries in the East Asia region, where data continues to emerge, key activities will be to support surveillance in Vietnam. Cost effectiveness analyses will provide further data to sustain the use of Hib vaccine to countries that plan to, or have already introduced Hib vaccine.
Since 2004, WHO Eastern Mediterranean Regional Office (EMRO), which includes countries in the Eastern Mediterranean and Middle East regions, has supported Bacterial Meningitis Surveillance in 12 countries (Pakistan, Sudan, Syria, Yemen, Morocco, Iran, Libya, Lebanon, Oman, Egypt, Tunisia and Jordan). In 2007, in collaboration with PneumoADIP, the Hib Initiative expanded surveillance in 6 of these countries (Pakistan, Sudan, Syria, Yemen, Morocco and Iran) to form a comprehensive invasive disease surveillance network. As more and more countries adopt Hib vaccine, the Hib Initiative will continue to support the establishment of surveillance systems to document impact and sustain use. Additional efforts such as post introduction evaluation activities will provide important lessons learned for neighboring countries.
Country Specific Activities
Bangladesh
- ٭ Competitive RFP Recipient: Assessment of the impact of routine introduction of Hib vaccine on childhood diseases in urban and rural Bangladesh through enhanced surveillance and a nested case control study.
- Surveillance activities to document the burden of Hib and pneumococcal disease in children.
India
- ٭ Competitive RFP Recipient: A case control study to assess the effectiveness of Hib vaccine in children in Vellore, India
- Study the long term sequelae of Hib meningitis in children in Vellore
- A study to assess cost effectiveness analyses of Hib vaccine in North India
- Comprehensive India Strategy
- Develop burden of disease estimates for each of the states in India using the global burden of disease model, to guide state level introduction of Hib vaccine
- Support studies aimed at assessing the impact of Hib vaccine on meningitis, by establishment of sentinel surveillance for meningitis in select referral hospitals.
India, Sri Lanka and Nepal
- Support for invasive Bacterial Infections Surveillance to Nepal and Sri Lanka which make up the South Asian Pneumococcal Alliance (SAPNA) - a consortium of Nepalese and Sri Lankan hospitals and an existing Indian surveillance network formed to better define the regional burden of pneumococcal and Hib disease.
Indonesia
- ٭ Competitive RFP Recipient: Further analysis of the results of the Indonesia Hib vaccine trial completed in 2002
Pakistan
- ٭ Competitive RFP Recipient: Support a case control study and surveillance activities to document the impact of introduction of Hib vaccine in selected Pakistan districts.
- Support surveillance for H. influenzae type B and S. pneumococcus meningitis.
Mongolia
- H. influenzae type B and S. pneumococcus meningitis and pneumonia surveillance
Vietnam
- ٭ Competitive RFP Recipient: Evaluation of Hib vaccine introduction in selected districts in Vietnam to evaluate vaccine impact
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