National HIB vaccination program urgent: Study

National HIB vaccination program urgent: Study

Sari P. Setiogi, The Jakarta Post, Jakarta

People's lack of access to Haemophilus influenzae type B (Hib)
vaccination is placing Indonesian children under five years of
age at higher risk of meningitis, a survey warned.

The research, conducted recently in Lombok, West Nusa
Tenggara, also indicated that one in every 33 children aged under
two years would develop meningitis or pneumonia as a result of
Hib infection.

American pediatrician Bradford D. Gessner, who carried out the
research, said the prevalence rate for Hib meningitis in Lombok
stood at 158 per 100,000 children under five years old, one of
the highest figures ever recorded.

The Philippines has reported 18 cases per 100,000 children,
while Vietnam 25.7 per 100,000 children.

"Other countries, such as India, Australia and Pacific Island
nations have rates similar to those documented in Indonesia. All
of this meningitis is preventable with the Hib vaccine," said
Gessner.

Meningitis is an inflammation of the 'lining' (meninges) of
the cerebral cortex and spinal cord caused by Hib bacteria. It
mainly affects the under fives, but particularly those aged three
months to three years.

The Center for Disease Control and Prevention said the global
incidence among children under two years stands at between 0.5
and five per 100,000 children per year.

"Lombok, which is a rural, relatively poor and agrarian area
and records a high infant mortality rate is thought to represent
conditions under which the majority of Asian children live,"
Gessner told The Jakarta Post.

Hib usually strikes children under five years old, manifesting
as pneumonia and nonbacterial meningitis. It can also cause
serious complications, including paralysis, mental retardation
and deafness, and in severe cases it can cause death.

The World Health Organization has estimated that Hib causes
serious disease in at least three million children, and the death
of about 400,000 to 700,000 others, each year worldwide.

In 2002, Malaysia became the first country in Asia -- and the
only Southeast Asian country -- to adopt Hib vaccination as part
of its routine immunization program.

After two years, Malaysia successfully halved the death rate
resulting from the disease.

Hib vaccine is apparently only accessible to middle- and
upper-class people in Indonesia, as it costs Rp 175,000 (US$19)
for each dose. The vaccination is commonly given three times at
two months of age, then again at four months, six months, and 15
months.

As Hib disease is rarely found among children older than five
years, Hib vaccine is not routinely recommended for children in
that age group.

Despite its relatively expensive price, the government has not
listed Hib in its Immunization Development Program (PPI), as has
been recommended by the Indonesian Pediatric Association (IDAI).

"The lack of access to vaccination programs has led to Hib
infection emerging as a leading cause of death and disability
among children," Asia Pacific Pediatric Association (APPA)
Secretary General Mohd. Sham Kasim said.

Director of the Health Systems Program at the Department of
International Health and Pediatrics, John Hopkins University,
Mathuram Santhosam, said there was proof that vaccination
dramatically reduced cases of Hib meningitis.

"We have evidence that the Hib vaccine is effective. Safe and
effective vaccines to prevent Hib infection are widely available
in developed countries," he said

However, he said only 25 percent of the world's children had
access to the vaccination.

"We urge health authorities and governments to consider
implementing Hib vaccinations because only when national
immunization schedules are enacted can there be an eradication of
this infectious disease," he said.

The first Hib vaccine was licensed in the United States in
1985. However, it was not very effective, and an improved vaccine
was licensed in December 1987.