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INTERNATIONAL

PERSPECTIVE
ON INFECTIOUS
DISEASES

Rahul Gupta, MD, MPH, MBA, FACP


Chief Medical & Health Officer
Senior Vice President
March of Dimes

July 31, 2019

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OBJECTIVES

• Global state of Vaccine


Preventable Diseases
• A typical day for a
practicing physician
• Case Studies
• Ensuring state level
immunization coverage
in U.S.
DISCLOSURES:

NONE

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OUR MISSION

MARCH OF
DIMES LEADS
THE FIGHT FOR
THE HEALTH
OF ALL MOMS
AND BABIES.
GLOBAL IMMUNIZATION
COVERAGE

• Global vaccination coverage remains at 86%, with


no significant changes during the past few years
• Immunization currently prevents 2-3 million deaths
every year
• An additional 1.5 million deaths could be avoided, if
global immunization coverage improves
• An estimated 19.4 million children under the age of
one year did not receive basic vaccines
DTP1 COVERAGE & NUMBERS OF
DTP-UNVACCINATED CHILDREN

Source: WHO, accessed at https://www.who.int/immunization/monitoring_surveillance/data/en/


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GLOBAL BURDEN OF DISEASE
Source: WHO/UNICEF
And
reasons can
vary

And reasons can vary


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SO, WHAT’S
IT LIKE TO BE
A PHYSICIAN
IN SUCH
A COUNTRY?
UNIVERSITY COLLEGE OF
MEDICAL SCIENCES, DELHI

Largest Tertiary Care Hospital in East Delhi


OUTPATIENT:
AVERAGE
CENSUS 100+ IN
ONE MORNING SHIFT
INPATIENT
AFTERNOON
ROUNDS
CASE STUDY
Polio eradication in India
Last case in United States
in 1979
POLIO Western Hemisphere certified
ERADICATION polio free in 1994
Last isolate of type 2 poliovirus
in India in October 1999

Global eradication goal


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PULSE POLIO
PROGRAM,
DELHI - 1994
Until every child is protected,
every child is at risk...
• National immunization days
(NIDs) has been a cornerstone
in polio eradication strategy in
many countries
• Pulse polio Immunization (PPI)
in India was initiated in Delhi
(10/2/94 & 12/4/94)
• 1.4 million children <3yrs
were targeted
• In 1995, Government of India
implemented this strategy
throughout the country
Prior to introduction of Pulse Polio Program in 1995 there
were estimated 50,000 polio cases in India annually

A PATH TO In 1995, Govt. of India launches its first nationwide polio

POLIO
campaign - NID (National Immunization Day), immunizing 88
million children in the age group of 0–3 years

ERADICATION
IN INDIA Last case of wild virus type 2 in country was reported in 1999
from Aligarh, Northern India

On 27th March 2014, the Regional Certification Commission


of World Health Organization certified South-East Asia
Region of WHO, which includes India, as polio free

There are 2.4 million vaccinators and 150K supervisors


involved in the successful implementation of the polio
campaigns
GLOBAL ERADICATION OF POLIO

What makes it possible What makes it difficult


• No animal reservoir • Asymptomatic infection
• Effective intervention in majority
available (vaccine) to • Early diagnosis: other
disrupt transmission
diseases may have
• Survives poorly in similar symptoms
environment
• Lack of will/money
• Highly visible and/or
good diagnostics • Low sanitation/poor
• Political/community will - quality health systems
perceived burden is
high
CASE STUDY
Tetanus and Measles

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ELIMINATING TETANUS
• Tetanus is a non-communicable disease contracted through
exposure to the spores of the bacterium, Clostridium tetani, that
exists worldwide in soil and in animal intestinal tracts, and can
contaminate many surfaces and substances
• Tetanus occurring during pregnancy or within 6 weeks of the end
of pregnancy is called “maternal tetanus”, while tetanus
occurring within the first 28 days of life is called “neonatal
tetanus”
• WHO estimated that neonatal tetanus killed about 30,848
newborn children in 2017, a 96% reduction from the situation in
1988 when an estimated 787,000 newborn babies died of
tetanus within their first month of life
• People who recover from tetanus do not have natural immunity
and can be infected again. To be protected throughout life, WHO
recommends that an individual receives 6 doses (3 primary plus
3 booster doses) of TTCV through routine immunization.
• As of March 2019, 13 countries have not eliminated MNT
IN 1980'S AND 90'S,
INDIA REPORTED
150,000 TO 200,000
NEONATAL TETANUS
CASES ANNUALLY

• In 2015, India achieved


a public health feat – the
elimination of maternal and
neonatal tetanus. Maternal
and neonatal tetanus
is reduced to less than one
case per 1,000 live births in
the entire country.
• However, unlike
smallpox and polio, tetanus
cannot be eradicated as
tetanus spores remain
stubbornly present in the
environment.
MEASLES CHALLENGES

• The global estimates for the year 2013


suggest that close to 140,000 deaths
were attributed to measles, accounting
for nearly 16 deaths each hour
• A third to half of all measles deaths
worldwide are among children in India
• Because measles is so infectious, a
country needs to ensure that at least
95% of all children receive two doses
of the vaccine.

Source: WHO, accessed at https://www.who.int/news-room/fact-sheets/detail/measles


CASE STUDY
Tuberculosis
CHALLENGES
REMAIN IN
ELIMINATION
• BCG, or Bacille Calmette-Guerin, is
a vaccine for tuberculosis (TB) disease
• BCG is used in many countries with
a high prevalence of TB to
prevent childhood tuberculous
meningitis and miliary disease
• The World Health Organization
(WHO) TB statistics for India for 2016
give an estimated incidence figure of
2.79 million cases of TB for India –
the highest burden in the world
ENSURING
IMMUNIZATION
COVERAGE IN U.S.
Source: NCSL, accessed at http://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx
CASE STUDY
West Virginia Immunization Laws
A SUSTAINED CAMPAIGN
TO WEAKEN LAWS
ANTI-VAX CAMPAIGN
SUMMARY
The successful implementation of large-scale comprehensive national immunization
programs and the consequent eradication or reduction of smallpox, polio, measles,
pertussis, meningococcal meningitis, diphtheria, hepatitis B, congenital rubella syndrome,
and tetanus are among the most notable public health achievements of the 20th century

Even in countries where resources for national health programs are severely limited, it has
been possible to achieve significant progress

There is good reason to expect that these advances will be sustained in the 21st century

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SUMMARY
There are 4 elements of successful public health efforts

Law and regulations, usually


Highly credible scientific at the national level (with
Passionate advocates Media campaigns
evidence adequate resources and
political will)

Paradox: As vaccines have become increasingly more


effective, safe, and of good quality, public concerns about
their safety have increased

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TWITTER:​
@DRGUPTAMD​
@MARCHOFDIMES

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