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Hepatitis B vaccination in China
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Steven Bellemare, Child Protection Team, Dalhousie University, Halifax, Canada, adds, “In North America, people have become accustomed to quick fixes and medical intervention, such that parents may in fact expect intravenous rehydration, when in fact oral rehydration is just as good. The fact that treating physicians are very familiar with intravenous rehydration has promoted a preference for this procedure”. According to Bellemare, oral rehydration has many advantages: “It is atraumatic and can easily be
provided by parents at home. This is an appealing aspect, for those with a child with dehydration secondary to diarrhoea, especially if it means that the family can spend less time in hospital and prevent painful procedures, such as intravenous insertion”. Kristen Neville, Sydney Children’s Hospital, Australia, is not surprised by the results of the meta-analysis, saying: “Whenever oral therapy can be used, it should be strongly encouraged. I hope it will lead to oral rehydration being adopted more widely, but
unfortunately, there continues to be a lot of resistance to change”. Bellemare concludes, “In today’s climate of evidence-based medicine, a systematic review is about the best level of evidence one can get, because it pools so many studies together. Hopefully, this level of evidence will give physicians the data and confidence they need to adopt oral as an alternative to intravenous rehydration in children with diarrhoea”.
Cathel Kerr
Hepatitis B vaccination in China went unvaccinated each year because of access issues; health-care costs, lack of birth attendants, and the remoteness of their birthplaces—in herder’s huts, mountain villages, and remote farms. Until last year, when a law banning the practice was passed, parents were charged fees for the administration of the vaccine. Even though the GAVI alliance (whose partners include UNICEF and the WHO), and Chinese government were providing the vaccine and one-use needles free of charge, health-care workers charged fees that parents were unwilling or unable to pay. China is in urgent need of a comprehensive hepatitis B vaccination programme. Surveillance is still
UNICEF China/Liu Yu
China has successfully immunised 11·1 million children living in the country’s poorest provinces against hepatitis B according to the Chinese health ministry, and the Global Alliance for Vaccines and Immunization (GAVI). However, China still has a long way to go before immunisation levels reach a percentage able to limit the spread of hepatitis B. China’s health minister, Gao Qing told a Beijing press conference that the project, while effective, has covered only one third of all children born in China since the project began in 2002. This does not mean the rest of China’s children went unvaccinated. However, even within the project’s target area, over one million newborns
Vaccinating all of China’s children is a future challenge
548
poor—infection rates are estimates based on a 1992 epidemiological survey. Those estimates put the disease burden at 120 million people chronically infected with hepatitis B, one third of the burden (360 million) estimated by the WHO. China’s national target is to reach greater than 85% vaccination. The joint project with the GAVI alliance has shown that this is feasible with three quarters of the 1301 project counties reporting that 85% or more children received three doses of HepB vaccine. In hospitals designated ‘‘project hospitals’’, the percentage of newborns vaccinated within 24 h of birth in project hospitals is now over 90%. However, the overall newborn vaccination rate in the region covered by the GAVI alliance/government joint project was 70%, lower than the 75% they hoped to achieve. Achieving long-term success will require “assuring no new financial barriers arise”, said Julian Lob-Levyt, Executive Secretary of the GAVI Alliance. “This is one of the greatest challenges and the solution lies not just within China but with a global community mobilised to ensure access to vaccine financing for all developing nations.”
Margaret Harris Cheng http://infection.thelancet.com Vol 6 September 2006
Steven Bellemare, Child Protection Team, Dalhousie University, Halifax, Canada, adds, “In North America, people have become accustomed to quick fixes and medical intervention, such that parents may in fact expect intravenous rehydration, when in fact oral rehydration is just as good. The fact that treating physicians are very familiar with intravenous rehydration has promoted a preference for this procedure”. According to Bellemare, oral rehydration has many advantages: “It is atraumatic and can easily be
provided by parents at home. This is an appealing aspect, for those with a child with dehydration secondary to diarrhoea, especially if it means that the family can spend less time in hospital and prevent painful procedures, such as intravenous insertion”. Kristen Neville, Sydney Children’s Hospital, Australia, is not surprised by the results of the meta-analysis, saying: “Whenever oral therapy can be used, it should be strongly encouraged. I hope it will lead to oral rehydration being adopted more widely, but
unfortunately, there continues to be a lot of resistance to change”. Bellemare concludes, “In today’s climate of evidence-based medicine, a systematic review is about the best level of evidence one can get, because it pools so many studies together. Hopefully, this level of evidence will give physicians the data and confidence they need to adopt oral as an alternative to intravenous rehydration in children with diarrhoea”.
Cathel Kerr
Hepatitis B vaccination in China went unvaccinated each year because of access issues; health-care costs, lack of birth attendants, and the remoteness of their birthplaces—in herder’s huts, mountain villages, and remote farms. Until last year, when a law banning the practice was passed, parents were charged fees for the administration of the vaccine. Even though the GAVI alliance (whose partners include UNICEF and the WHO), and Chinese government were providing the vaccine and one-use needles free of charge, health-care workers charged fees that parents were unwilling or unable to pay. China is in urgent need of a comprehensive hepatitis B vaccination programme. Surveillance is still
UNICEF China/Liu Yu
China has successfully immunised 11·1 million children living in the country’s poorest provinces against hepatitis B according to the Chinese health ministry, and the Global Alliance for Vaccines and Immunization (GAVI). However, China still has a long way to go before immunisation levels reach a percentage able to limit the spread of hepatitis B. China’s health minister, Gao Qing told a Beijing press conference that the project, while effective, has covered only one third of all children born in China since the project began in 2002. This does not mean the rest of China’s children went unvaccinated. However, even within the project’s target area, over one million newborns
Vaccinating all of China’s children is a future challenge
548
poor—infection rates are estimates based on a 1992 epidemiological survey. Those estimates put the disease burden at 120 million people chronically infected with hepatitis B, one third of the burden (360 million) estimated by the WHO. China’s national target is to reach greater than 85% vaccination. The joint project with the GAVI alliance has shown that this is feasible with three quarters of the 1301 project counties reporting that 85% or more children received three doses of HepB vaccine. In hospitals designated ‘‘project hospitals’’, the percentage of newborns vaccinated within 24 h of birth in project hospitals is now over 90%. However, the overall newborn vaccination rate in the region covered by the GAVI alliance/government joint project was 70%, lower than the 75% they hoped to achieve. Achieving long-term success will require “assuring no new financial barriers arise”, said Julian Lob-Levyt, Executive Secretary of the GAVI Alliance. “This is one of the greatest challenges and the solution lies not just within China but with a global community mobilised to ensure access to vaccine financing for all developing nations.”
Margaret Harris Cheng http://infection.thelancet.com Vol 6 September 2006