title: Pediatric disease burden and vaccination recommendations: understanding local differences.
abstract: BACKGROUND
  Diphtheria (D), tetanus (T), pertussis (P), hepatitis B (HepB), invasive Haemophilus influenzae type b (Hib) disease, and measles cause substantial global morbidity and mortality.
  
  
  METHODS
  This unique review highlights geographic differences in disease burden across certain countries in the African, Americas, Mediterranean, South-East Asian, and Western Pacific World Health Organization (WHO) regions, and relates this to vaccination coverage and local vaccine recommendations using the authors' countries as illustrations.
  
  
  RESULTS
  Substantial differences were observed in the incidence of these diseases and in vaccination coverage between the countries studied. Disease incidence often reflected inadequate surveillance, but also variable or poor vaccination coverage. Vaccination coverage against HepB was particularly low in the African and South-East Asian WHO regions; vaccination coverage against invasive Hib disease was low in these regions and in the Eastern Mediterranean and Western Pacific WHO regions. Vaccination schedules within some countries in these regions do not include, or have only recently included, vaccinations against HepB and Hib disease. The use of DTwP-HepB-Hib (diphtheria, tetanus, whole-cell pertussis, HepB, Hib) combination vaccines has now been adopted by some countries to help increase vaccination coverage.
  
  
  CONCLUSIONS
  Vaccination coverage and vaccination schedules vary markedly between the countries studied, often according to the resources available. DTwP-HepB-Hib combination vaccines represent a cost-effective option, with the potential to substantially reduce the burden associated with these diseases by increasing coverage and compliance.
authors.affiliation: Ricardo Guiterrez Children's Hospital, Gallo Buenos Aires, Argentina. angelagentile@fibertel.com.ar
authors.forename: Angela
authors.initials: A
authors.lastname: Gentile
authors.forename: Zulfiqar
authors.initials: Z
authors.lastname: Bhutta
authors.forename: Lulu
authors.initials: L
authors.lastname: Bravo
authors.forename: Aly Gamal
authors.initials: AG
authors.lastname: Samy
authors.forename: R Dennis J
authors.initials: RD
authors.lastname: Garcia
authors.forename: Anwar
authors.initials: A
authors.lastname: Hoosen
authors.forename: Tazul
authors.initials: T
authors.lastname: Islam
authors.forename: Abdollah
authors.initials: A
authors.lastname: Karimi
authors.forename: Mona
authors.initials: M
authors.lastname: Salem
authors.forename: Sriluck
authors.initials: S
authors.lastname: Simasathien
authors.forename: Amir
authors.initials: A
authors.lastname: Sohail
authors.forename: Veerachai
authors.initials: V
authors.lastname: Watanaveeradej
authors.forename: Karin
authors.initials: K
authors.lastname: Wiedenmayer
authors.forename: Heinz-J
authors.initials: HJ
authors.lastname: Schmitt
mesh_terms: D001428:Bacterial Vaccines / Q000008:administration & dosage*; D002648:Child; D004165:Diphtheria / Q000453:epidemiology* / Q000517:prevention & control; D014943:Global Health; D006192:Haemophilus Infections / Q000453:epidemiology* / Q000517:prevention & control; D019741:Haemophilus influenzae type b / Q000276:immunology; D006287:Health Planning Guidelines; D006509:Hepatitis B / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D007115:Immunization Schedule; D015994:Incidence; D008457:Measles / Q000453:epidemiology* / Q000517:prevention & control; D013742:Tetanus / Q000453:epidemiology* / Q000517:prevention & control; D014611:Vaccination / Q000379:methods / Q000706:statistics & numerical data; D017778:Vaccines, Combined / Q000008:administration & dosage; D014765:Viral Vaccines / Q000008:administration & dosage*; D014917:Whooping Cough / Q000453:epidemiology* / Q000517:prevention & control; D014944:World Health Organization
chemical_list: D001428:Bacterial Vaccines; D017778:Vaccines, Combined; D014765:Viral Vaccines