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Address correspondence to: Sotirios Tsiodras, MD, MSc, PhD, e-mail: tsiodras@med.uoa.gr
A hidden risk of the current Ebola outbreak is the significant effect on the implementation of routine childhood immunization against other communicable diseases like measles and polio. Discontinuation of regular immunization campaigns has been advocated due to: a) the almost universal occupancy of healthcare personnel with the response efforts; b) the overburden health structures that cannot host immunizations on top of other essential services; c) a hypothesized increased risk for acquiring Ebola during immunization services in an environment where hundreds of healthcare workers became sick [1].
In this context, the World Health Organization (WHO) published guidance that vaccination campaigns are to be postponed in countries with widespread and intense transmission [1]. This should be done until countries with current outbreaks would be declared Ebola free [1]. Since the best case scenario for ending the outbreak with all response measures has been predicted to be late January 2015 [2] and a country has to have 42 days without detection of any new cases, it is anticipated that the earliest possible reintroduction of a vaccination campaign in Sierra Leone, Guinea and Liberia would be at least March 2015 and probably long after that.
As evident from WHO/UNICEF estimate data assessing immunization coverage in the three affected countries main childhood immunizations rates are already low in the affected countries over the last decade compared to developed ountries (Figures 1-4) [3]. Measles, DTP3, and Pol3 vaccine coverage was as low as 62%, 63% and 64% in Guinea during 2013 according to WHO/UNICEF estimates [3].
Further immunization reductions represent a significant, not well emphasized, hidden danger associated with this epidemic. Reinstating immunization services should be done at the earliest possible time in order to prevent childhood outbreaks of diseases like measles; childhood deaths associated with such diseases have been reported and there is an increased risk to see more such outbreaks as immunization rates further drop [1]. This should be performed in accordance with appropriate infection control measures such as the use of one person, autodisable syringes that should be appropriately discarded [1]. International assistance activities should include educational and awareness campaigns for the issue of childhood immunizations but more importantly assist in the re-institution of vaccination in the field, in affected countries. It would be even more tragic to mourn for additional human loss, especially when we can actually prevent it.
REFERENCES
1. WHO Information Note (Version Oct. 24/2014 rev). Guidance for Immunization Programmes in the African Region in the Context of Ebola. Available at: http://apps.who.int/iris/bitstream/10665/137330/1/WHO_IVB_14.08_eng.pdf?... Accessed on December 27th 2014
2. Meltzer MI, Atkins CY, Santibanez S, et al. Estimating the future number of cases in the Ebola epidemic-Liberia and Sierra Leone 2014. MMWR Surveill Summ 2014;63 Suppl 3:1-14
3. WHO/UNICEF estimates of national immunization coverage. Estimated coverage by country, year and vaccine. Available at: http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tsw... Accessed on December 27th 2014
Ebola virus and Childhood Immunization lapse. Another hidden Public Health risk
Sotirios Tsiodras1,2, MD, PhD, Athanassios Tsakris3, MD, PhD, FRCPath
Address correspondence to: Sotirios Tsiodras, MD, MSc, PhD, e-mail: tsiodras@med.uoa.gr
A hidden risk of the current Ebola outbreak is the significant effect on the implementation of routine childhood immunization against other communicable diseases like measles and polio. Discontinuation of regular immunization campaigns has been advocated due to: a) the almost universal occupancy of healthcare personnel with the response efforts; b) the overburden health structures that cannot host immunizations on top of other essential services; c) a hypothesized increased risk for acquiring Ebola during immunization services in an environment where hundreds of healthcare workers became sick [1].
In this context, the World Health Organization (WHO) published guidance that vaccination campaigns are to be postponed in countries with widespread and intense transmission [1]. This should be done until countries with current outbreaks would be declared Ebola free [1]. Since the best case scenario for ending the outbreak with all response measures has been predicted to be late January 2015 [2] and a country has to have 42 days without detection of any new cases, it is anticipated that the earliest possible reintroduction of a vaccination campaign in Sierra Leone, Guinea and Liberia would be at least March 2015 and probably long after that.
As evident from WHO/UNICEF estimate data assessing immunization coverage in the three affected countries main childhood immunizations rates are already low in the affected countries over the last decade compared to developed ountries (Figures 1-4) [3]. Measles, DTP3, and Pol3 vaccine coverage was as low as 62%, 63% and 64% in Guinea during 2013 according to WHO/UNICEF estimates [3].
Further immunization reductions represent a significant, not well emphasized, hidden danger associated with this epidemic. Reinstating immunization services should be done at the earliest possible time in order to prevent childhood outbreaks of diseases like measles; childhood deaths associated with such diseases have been reported and there is an increased risk to see more such outbreaks as immunization rates further drop [1]. This should be performed in accordance with appropriate infection control measures such as the use of one person, autodisable syringes that should be appropriately discarded [1]. International assistance activities should include educational and awareness campaigns for the issue of childhood immunizations but more importantly assist in the re-institution of vaccination in the field, in affected countries. It would be even more tragic to mourn for additional human loss, especially when we can actually prevent it.
REFERENCES
1. WHO Information Note (Version Oct. 24/2014 rev). Guidance for Immunization Programmes in the African Region in the Context of Ebola. Available at: http://apps.who.int/iris/bitstream/10665/137330/1/WHO_IVB_14.08_eng.pdf?... Accessed on December 27th 2014
2. Meltzer MI, Atkins CY, Santibanez S, et al. Estimating the future number of cases in the Ebola epidemic-Liberia and Sierra Leone 2014. MMWR Surveill Summ 2014;63 Suppl 3:1-14
3. WHO/UNICEF estimates of national immunization coverage. Estimated coverage by country, year and vaccine. Available at: http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tsw... Accessed on December 27th 2014
Competing interests: No competing interests