The speakers mainly comprising senior paediatricians and pathologists were of the view that it was a collective responsibility of doctors and pharmacists to maintain safety and effectiveness of vaccines so that not only the desired results against preventable diseases were obtained but also misconception and controversies related to various vaccines were done away with.

The conference on “Updates in vaccination” was organised as part of the 6th Health Asia Exhibition and Conferences.

President of the Infection Control Society of Pakistan Prof M. Rafiq Khanani said that vaccination played an important role in the prevention of diseases, both among children and adults. But it was unfortunate that little attention was paid to vaccination of adults, he said. It was for this reason that thousands of deaths due to hepatitis, influenza, cervical cancers, shingles, pertussis and pneumococcal, which could be prevented in adults, were not averted in many developing countries, including Pakistan.

“We have been neglecting the vaccination of adults in the past, but now is the time to invest in adults’ vaccination and incorporate it in the national expanded immunisation programme.”

He said the culture of vaccination of adults should be promoted, as those going abroad, healthcare personnel, military troops, public safety personnel, sanitation workers, animal handlers, and camp dwellers were at the risk of developing preventable diseases in the later part of their lives.

He also called for investment in research and preparation of database on preventable diseases and efficacy of vaccines.

“Health practitioners should not just relax after vaccinating child and adult patients, but also should know whether the expected immunity after administration of the vaccines has developed in the recipients or not,” he said.

Dr Sobia Qamar of Liaquat National Hospital said that there was a lack of national surveillance data on typhoid. But international reports suggest that Pakistan is highly endemic country as far as typhoid is concerned, she added.

The doctor said that awareness about the typhoid must be inculcated in children at schools and the people at community level. Also, medical professional should undertake studies to have local approach to the solutions of vaccine preventable diseases, including typhoid, she added.

Prof Dr Sultan Mustafa, the head of paediatrics department of Karachi Medical and Dental College, gave a presentation on chicken pox to highlight the routes of the disease and its signs and symptoms. “Chicken pox is not a benign disease as it creates complications in healthy infants and adolescents as well,” he said.

During the question-answer session, Prof Dr Iqbal Memon of the Civil Hospital Karachi called for education of the masses on the value and cost-effective administration of vaccines. He said controversies related to vaccination could be removed through awareness campaigns.

About research studies on vaccines, he said that there was no use of carrying out studies on the efficacy of vaccines as the same had already been done in other parts of the world. He was of the view that instead of spending on studying the vaccines which had already been tested and verified internationally, efforts should be made to improve the preservation and effectiveness of vaccines through proper cold chains and by their timely delivery to the target population. He said a real success of our spending on vaccination could be measured only through the result of campaigns against polio, chicken pox, measles, typhoid, influenza, hepatitis and other preventable diseases.

Head of the National Institute of Child Health Prof Jamal Raza, who chaired the conference, summed up all by saying that there was a need to shift the paradigm from treatment to prevention of diseases.

“We should advocate across the board for the use of vaccines for preventable diseases in children as that is the way to have a cost-effective response to a wide range of ailments,” he said.

Source

The 2009 AIDS Epidemic Update by UNAIDS can be viewed by clicking here.

In a move to counter social exclusion and change discriminatory practices, a dialogue has begun in Pakistan between the government, parliamentarians and communities often overlooked by policymakers. An historic meeting was held late last month when a number of parliamentarians began a dialogue with community members on the challenges facing transgendered people, people who use drugs and people living with HIV. This meeting was a first, and aimed to create an enabling environment for policy changes related to HIV.

Peer outreach workers, Infection Control Society of Pakistan, Karachi. Credit: UNAIDS/P. Virot

Among the general population in Pakistan HIV prevalence is less than 0.1%, however results from the recent HIV Second Generation Surveillance in the country indicate that injecting drug users and the transgender community are the two populations with the highest rate of HIV infection in the country, with an estimated 20% and 7% prevalence respectively. HIV infection is not the sole concern of these populations who can also be caught up in a cycle of social and economic exclusion exposing them to marginalization and violence, limited access to health and others services, and, for drug users, a lack of drug substitution programmes.

The dialogue, held at a parliamentary sub-committee level, brought together parliamentarians from across party lines; associations and groups representing people living with HIV such as the Red Ribbon Initiative, Pak Plus and New Light AIDS Control Society; the Sathi Foundation for transgenders; as well as Nai Zindagi, an organization that provides services for drug users.

It was also an opportunity for parliamentarians to discuss with senior police, narcotics control and health officials who were present the need for changes in policy and practice towards key groups. Discussions ranged from an urgent call to push through pilot substitution therapy which is still awaiting final government clearance, to introducing a special focus on transgender within police training and investigations on sexual violence and abuse perpetuated against them.

“Leadership shown by a few, through a courageous dialogue with parliamentarians represent a voice of change for countless others.”

- Oussama Tawil, UNAIDS Country Coordinator for Pakistan

Outreach Work among drug users. Nai Zindagi, Lahore. Credit: UNAIDS/P. Virot

The government of Pakistan already endorses harm reduction within a wider approach to drug prevention and control, and non-governmental organizations collaborate closely with the Ministry of Health on needle exchange programmes.

Discussions also touched on issues affecting the general population. People living with HIV in Pakistan risk losing their employment or at times refusal by health workers to provide care to them; and people working overseas such as in the Gulf States have faced deportation back to Pakistan once detected HIV positive.

The Pakistan government’s response to HIV began in 1987 with the establishment of a Federal Committee on AIDS by the Ministry of Health, soon after the first case of AIDS was reported. Today the country’s National AIDS Control Programme is implemented through federal and provincial implementation units.

Funding gap

However Pakistan is currently facing a considerable gap in funding the scale-up of community-based efforts which represent the backbone of the national AIDS response. The country benefits from donor support, in particular from the World Bank, UK and other bi-laterals to scale up HIV prevention, treatment, care and support. Despite applications for resources from the Global Fund to Fight AIDS, TB and Malaria in recent years, grants on HIV have yet to be secured though needs are clear.

Needle disposal programme for people who inject drugs. Nai Zindagi, Lahore. Credit: UNAIDS/P. Virot

Speaking during the meeting, Member of the National Assembly and Chair of the Parliamentary Sub-Committee on AIDS, Dr Donya Aziz said, “Donor support is essential for us at this point, yet, in the long run, we cannot rely on external funds. Public and private sectors must mobilise resources, while policy decisions are needed to ensure services and to address social exclusion in our communities.”

In spite of the challenges ahead, participants at last month’s gathering felt that the breakthrough in challenging mistrust towards communities heralded by this meeting is an important milestone on which progress can be built.

The dialogue is just the beginning and will be followed up with a series of meetings to be held among a larger forum of parliamentarians across party lines and civil society groups. Hopes are high that policy change and attitude change will also follow.

UNAIDS Country Coordinator for Pakistan Oussama Tawil echoes this hope, “Leadership shown by a few, through a courageous dialogue with parliamentarians represent a voice of change for countless others.”

KARACHI, May 9: Experts speaking at a seminar on Saturday said that swine flu (A H1N1) virus, if at all entered the city, would have little chance to survive or surge owing to the hot and humid environment here. However, they warned, health providers were required to remain alert till the advent of winter.

Dr Iftikhar Ahmed and Dr Rafique Khanani, both associated with the Dow University of Health Sciences (DUHS), were expressing their views at the seminar on “Swine Influenza”, a virus that has been declared a pandemic by the World Health Organisation (WHO). The virus, after its outbreak in Mexico, has infected more than 2,500 people in about 25 countries and already caused dozens of deaths.

Organised by the DUHS, the seminar was presided over by its Pro-Vice-Chancellor, Prof Salahuddin Afsar.

Dr. Iftikhar Ahmed, the head of infectious diseases department at the DUHS, observed that swine flu was a highly contagious, acute respiratory disease of pigs, caused by one of several swine influenza-A viruses that regularly caused outbreaks of influenza in pigs and occasionally caused human-to-human transmission.

He said that though the exact time and location of the outbreak of the latest swine influenza was unknown, it was believed to have been first detected when influenza-like illness was reported by the health agencies and local news media in Mexico. The virus responsible was clinically defined as a new strain of influenza on April 24, 2009.

He said that pigs were now considered as a mixing vessel since they could catch human and avian or pig flu. “When flu viruses from different species infect pigs, they can mix inside the animal and create new mixed viruses,” he added.

“Our best countermeasure – vaccine – will probably be unavailable during the first wave of pandemic while antiviral treatment may improve outcomes, though will have only modest effect on transmission,” he remarked. He said that in the given situation, prevention was the best measure and individuals should cover their nose and mouth with a tissue when they cough or sneeze and trash the tissue after the use.

Dr Ahmed said that the symptoms of H1N1 virus were similar to those of seasonal flu and included fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people infected with this virus also reported diarrhoea and vomiting, he added, observing that the virus had the same properties in terms of spread as seasonal flu viruses.

Elaborating, he said that with seasonal flu, studies had shown that people might be contagious from the day before they developed symptoms till up to seven days after they fell sick. Children, might potentially be contagious for longer periods.

About preventive measures, he said that people should often wash their hands with soap and water, especially after they cough or sneeze. Alcohol-based hand cleaners were also effective. They should also avoid touching their eyes, nose or mouth as germs spread this way. The infected people should stay indoors for a week or so and other people should not come in direct physical contact with them.

Dr Rafique Khanani was also of the view that there was little chance for H1N1 to survive in the weather conditions that prevailed currently in the southern parts of the country. Hot and humid conditions were less favourable for the virus to spread but at the same time it was necessary to continue with the vigilance exercises and remain prepared as the virus could hit with more intensity the countries already affected by it. The virus, he said, was very much fragile outside the animal or human bodies but could have an intensified transmission in winters.

He warned that the comforts like air-conditioning of houses, offices and vehicles could help the virus to spread although the outdoor climate was not favourable for its spread. A degree of caution should be observed in this regard.

Dr Khanani, who is also the president of Infection Control Society, Pakistan, said that the swine virus contained gene segments from different influenza types —North American swine, North American avian, North American human and Eurasian swine — and it had acquired two new tools/capabilities: 1) Human-to-human transmissibility and 2) Enhanced virulence.

He said that WHO had raised the alert level to Phase 5. Its alert system was revised after avian influenza began to spread in 2004, and April 27 this year was the day when it was raised above Phase 3. On April 29, it was raised to Phase 5, which was characterised by human-to-human spread of the virus into at least two countries in one WHO region.

While most countries are not likely to be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalise the organisation, communication and implementation of the planned mitigation measures is short.

Highlighting the transmission of influenza A (H1N1) to human, Dr Khanani said that it happened through contact with infected pigs and humans or the environments contaminated with swine flu viruses.

“A confirmed case of swine influenza-A (H1N1) virus infection is defined as a person with an acute febrile respiratory illness with laboratory-confirmed swine influenza-A (H1N1) virus infection by real-time RT-PCR or viral culture,” he concluded.

Source: Dawn.com

• The Lancet H1N1 Flu Resource Center
• CDC H1N1 Flu Website
• Questions and Answers about H1N1 – World Bank
• Swine influenza A (H1N1) Outbreak in US & Mexico: Potential for a Pandemic – Lecture by Rashid A. Chotani, MD, MPH, DTM, Adjunct Assistant Professor, Uniformed Services University of the Health Sciences (HSUHS)
• The Flu and How to Avoid it – UPMC

The first program was a free Hepatitis B and C screening camp held at KPC.

Dr.Majeed Chotto, program manager Hepatitis Control Program Sindh, addressing the inauguration of the camp said that it is very encouraging to see institutions like Karachi Press Club and organizations like Infection control Society Pakistan working hand in hand for the important cause of disease prevention.

He informed the audience that this program was Chief Ministers’ initiative for Hepatitis Free Sindh. He said that MOUs have been signed with the Dow University of Health Sciences, Karachi and Liaqat University of Health and Medical Sciences, Jamshoro for providing PCR test for Hepatitis B and C patients. He said that Jail inmates are also being screened for Hepatitis B and C under this program. Facilities for diagnosis and treatment of hepatitis B and C, including Interferon, are being provided free of cost. He informed that up to now 2000 jail inmates and 2000 persons from the general population have been provided PCR test. Hepatitis Control Program Sindh is paying Rs.1800/- for each test to the collaborating universities.

Dr.Syed Ali Anjum, deputy program manager, Hepatitis Control Program Sindh, said that journalists are a very important and responsible community of the society and it is commendable that KPC and ICSP have joined hands in this noble cause of public health importance.

The first program was a free Hepatitis B and C screening camp held at KPC.

Mr. A.H.Khanzada said that it is heartening to see that this activity is being held at KPC. He said that journalists are a very important and responsible community of the society and it is commendable that KPC has collaborated in this noble cause of Public Health importance.

Mr.Wajid Ali of ICSP said Hepatitis B and C is increasing day by day. These diseases are usually diagnosed very late when a lot of damage to liver has already occurred. That is why ICSP advocates for prevention and early diagnosis of Hepatitis and other infectious diseases. Since Hepatitis B is incurable and the treatment of Hepatitis C is very long, expensive and not very successful, it is very important that these diseases are diagnosed early and that is the main purpose of holding this free screening camp.

Professor Masood Hameed Khan, Vice Chancellor Dow University of Health Sciences in his address said that Pakistan is among those countries where Hepatitis B and C are prevalent at a high rate. This is so because we have not been able to control the various factors responsible for spread of these infectious diseases. He said that for the diagnosis and treatment of one hepatitis C patient more than one lac rupees are needed. Considering the seriousness and economic loss due to this disease we must eliminate the factor responsible i.e. unsafe blood transfusion, IV drug abuse, lack of infection control in health care. He lauded the efforts of ICSP and KPC for fulfilling their responsibility in the prevention of such diseases.