POST 01067E : MEASLES GOAL ACHIEVED

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. 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