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Photo: Kamila Hyat/IRIN

New vaccine against Hib is to help bring down the rate of infection and death, say doctors

LAHORE, 15 January 2009 (IRIN) - Health officials are hoping the introduction of a new vaccine against Hib, a major and largely under-reported cause of pneumonia and bacterial meningitis, can help bring down the rate of infection and death.

The vaccine has been introduced in some districts as part of the Expanded Programme on Immunisation (EPI) and it is hoped the results will be seen over the coming years.

"The Pentavalent vaccine has been introduced, and combines a vaccine against five diseases - diptheria, tetanus, pertussis, hepatitis B and haemophilus influenza type-B (Hib)," H.B. Memon, the national EPI manager, told IRIN.

Respiratory sickness is a major killer of young children in the developing world. According to the UN Children’s Fund (UNICEF), Hib pneumonia kills 500,000 children each year globally.

An estimated 23,000 children die of Hib meningitis in Pakistan, according to the Science Daily website. Others suffer brain damage or other kinds of neurological damage, including deafness. The difference between Hib pneumonia and Hib meningitis is that in the former the lungs are affected, whilst in the latter there is an inflammation of the lining of the brain and spinal cord.

The Hib pneumonia and meningitis bacteria spreads when an infected person coughs or sneezes, sending infected droplets into the air where they are inhaled by others. Crowded housing conditions, with many children together, add to the risk of infection.

"Some districts in the Punjab have started using the vaccine, and its use will be extended to other areas soon," Memon said.

A training programme to educate government vaccinators about the vaccine was started last year. The Global Alliance for Vaccination and Immunisation (GAVI) is helping to pay for the use of the vaccine in Pakistan.

Available at private health centres

The Hib vaccine is widely available at private health care centres across Pakistan, where parents pay the cost. "Both my children have received it, and I am happy they are safe," said Azeem Anjumn, 30, an office stenographer.

Anjumn, who earns Rs 15,000 (about US$200) per month, has been able to pay for the vaccine. Others cannot do so and the new government-led initiative hopes to protect the most vulnerable children by offering the vaccine free of charge at all public health facilities.

According to official data for 2008, there is one doctor for every 1,225 people and one nurse for every 2,501 individuals. The ratio is lower still in rural areas, where most people live.

"This situation means people only seek medical care when they are desperately ill. This is also true for children. I have seen many brought in with acute respiratory infections, only after they have become critically sick," Azmat Ali, a Lahore-based paediatrician, told IRIN.

Cold weather brings respiratory infections

The bitter cold in northern parts of the country has pushed temperatures down to three degrees Centigrade in Lahore, and brought all kinds of respiratory infections with it.

Pneumonia, according to the UN Children’s Fund (UNICEF), accounts for 13 percent of under-five child deaths in Pakistan. The under-five mortality rate was 97 per 1000 live births in 2006, according to UNICEF.

Wrapped in the warmest blanket in the house, Muhammad Asim coughs as his mother looks on. His face is flushed and his breathing seems laboured. Zahida Bibi, 25, fears her two-year-old son may have contracted something worse than a typical cold, but she says she must wait for her husband to return home.

"He has high fever and is trembling, so I think we need medicine to make him better. But I don't have any means to reach a hospital till my husband comes home, and take us on his bicycle," says Zahida who has two other children to care for.

She is especially cautious as she is familiar with pneumonia, an infection that killed her six-month-old niece two years ago.

"I held the child in my arms as she died because my sister was very sick herself. It was a terrible experience," Zahida told IRIN in Lahore, capital of Punjab Province. "We had thought it was just a bad cold and she would recover." Her sister's impoverished family lacked access to medical care.

"If there is a vaccine that could prevent him suffering like this or becoming even sicker, I would definitely ensure he receives it," said Zahida Bibi, stroking her son's hot forehead with a damp cloth.

kh/at/cb