Pediatric disease burden and vaccination recommendations: understanding local differences.
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.
Gentile
Angela
A
Ricardo Guiterrez Children's Hospital, Gallo Buenos Aires, Argentina. angelagentile@fibertel.com.ar
Bhutta
Zulfiqar
Z
Bravo
Lulu
L
Samy
Aly Gamal
AG
Garcia
R Dennis J
RD
Hoosen
Anwar
A
Islam
Tazul
T
Karimi
Abdollah
A
Salem
Mona
M
Simasathien
Sriluck
S
Sohail
Amir
A
Watanaveeradej
Veerachai
V
Wiedenmayer
Karin
K
Schmitt
Heinz-J
HJ
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
D001428:Bacterial Vaccines; D017778:Vaccines, Combined; D014765:Viral Vaccines