Tuesday, 23 August 2016

Workshop on Nutrition and Immunity for Infant and Child health

MSD-Wellcome Trust Hilleman Laboratories is a first of its kind joint venture between Merck & Co., USA and Wellcome Trust, UK Hilleman Laboratories is dedicated for improvement of child health by developing affordable vaccines for the developing world.

It is well known that appropriate functioning of the human immune system is dependent on nutritional status. There are a lot of insights gathered about interrelationship between nutrition and immunity and its role in reducing childhood morbidity and mortality.
Hilleman Laboratories understands and recognizes this interplaying role of nutrition and immunity in improving child health and its impact on the economic sustainability of our nation. To further our understanding of this key area, Hilleman Laboratories aims to convene a workshop on 21st and 22ndSeptember 2016 in NewDelhi, India. The workshop plans to provide a platform to spur a dialogue between esteemed academicians, researchers, public health experts and policy makers responsible for planning nutrition programs across the country. The workshop will have key-note presentation, theme presentations and discussions.

The workshop scopes to address the two-way association between nutrition with immune parameters in infants and young children. Infancy and early years of a child’s development represents the most nutritionally vulnerable stage of life cycle. Young children pay a lifelong price of undernutrition. Improvement in nutrition status is vital for saving young lives and thereby creating an impact on economic sustainability of a nation. The impact of nutrition is multi-faceted. Nutrition in early years of life is known to make a huge impact on immunity of an individual.

The workshop aims to cover key topics like integrating role of nutrition and immunity and provide insight for the nutrition focal persons/managers on key technical updates on child nutrition and immunity. Some of the key topics to be covered are: Nutrition requirements of children, Nutritional epidemiology for infant and child health,Nutritional deficiency associated Immune disorders in infants and children and Role of nutrition in prevention of disease, environmental eneteropathy, vaccines and nutritional health.

The first segment of this workshop session will throw light on importance of nutrition on immunity in infants and young children. It aims to landscape the trends and determinants in infant and child nutritionacross the country . The second segment aims to appraise and evaluate the nutritional requirements of infants and young children, and consider prenatal nutrition too. The third segment will shed light on ill effects of poor nutrition and its adverse impact on physical and cognitive growth of children.The fourth session will focus on how good nutrition in early years can strengthen immunity or vaccination against a disease can be chosen to prevent disease. It is well known that nutrition status alters response to vaccine and therefore, this session will explore the concept in conjunction with the role of environmental factors for infants and child health. The fifth and final session is planned to focus on the promotion of good health through nutrition and primary prevention of nutrition related illness in infants and young children. Apart from discussions on nutritional education and counseling programs for children, this session is also aimed to address integrated issues such as sanitation and hygiene which could indirectly affect infant and child health.

This workshop thus aims to highlight and resolve the gaps in current scenario while discussing malnutrition, immunity and vaccinesby providing a great opportunity to distinguished professionals to discuss the latest advancement, practices and challenges in the field to achieve the common goal of improving infant and child health. 

To register log on to http://www.hillemanlabs.org/registration.aspx
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Thursday, 11 August 2016

Undernutrition And Diminished Immunity: Breaking The Lethal Cycle

Healthy children are the bedrock of a healthy society. Good nutrition is the core pillar for healthy and productive communities and nations. The benefits of good nutrition are carried across generations, binding and supporting various facets of nation’s development. Hence it is in a nation’s best interest to safeguard its children’s health. As per UNICEF, around 3 million children die due to undernutrition every year. Asia alone is believed to be home to approximately 70% of the world's malnourished children, while India has the highest percentage of undernourished children in the world. Ironically when the economic development of India is growing at nearly 10% annually, the rate of undernourished children remain very high. As per the third National Family Health Survey (NFHS) India, 48% of children under the age of five are stunted due to chronic undernutrition. Undernutrition, often referred to as “hidden hunger”, is a form of malnutrition. It has long been a sore point for India, adversely impacting the overall social and economic development.

Without aggressive efforts, the undernutrition issue in India is escalating with devastating consequences on children’s development-physical growth retardation, increased susceptibility to diseases, hampered cognitive development.

Undernutrition issues among the age of under-five children is an important concern for the health authorities in India. It is acknowledged widely that infections are as much a cause of malnutrition as they are a consequence. Malnourished children have increased risk of mortality from infectious diseases. Investing in elevating maternal and child nutritional status is a long-term investment that will benefit the present generation and their children as well.
The nutrition of mothers and children is closely linked. When malnutrition starts at conception, most of the damage is already done as the child enters the second year of life. The first 1000 days of a child’s life is a critical window and represents the most vulnerable period to the impact of poor nutrition. Deficits during this period can have irreversible consequences for the child. Other than adversely impacting the cognitive ability, a child’s nutritional status also influences the immune responses in varied and complex ways. A common thread links nutrition, immunity and infections. Nutritional deficiencies are known to affect various components of the immune system putting a child at a greater risk of developing a disease. The severity of malnutrition and the age of onset of nutritional deprivation often decide the extent of immunological impairment. A stunted, undernourished child is at a greater risk of various diseases. Infection and malnutrition overlap and interact; infact they form a vicious cycle. Undernutrition weakens the immune system, putting children at higher risk of more severe, frequent and prolonged bouts of illness. Looking at this from other end of the spectrum, undernutrition appears to be a consequence of repeated infections, which can further worsen the child’s nutritional status. Thus recurrent infections contribute to pathogenesis of malnutrition. This interaction between under nutrition and infection creates a potentially lethal cycle of worsening illness and deteriorating nutritional status. Critical nutrition interventions have the potential to break this cycle and are important for accelerating progress. Scrimshaw et al (1968) first described this vicious cycle of infection and under nutrition. His research stated that infections predispose to malnutrition, through reduced intake and absorption and diversion of nutrients away from growth, while malnutrition reduces immune function and increases the risk and/or severity of infections.

Immunization and improved nutrition are among the key factors in a multi-sectoral package of interventions for reducing childhood mortality and feature prominently in the Gates Grand Challenges in Global Health. Vaccination programs also stand to hugely benefit the malnourished population as well. Vaccination programs are particularly valuable health resource for settings that are in high-disease environment. Reforming children’s health status translates into higher worker productivity promoting economic success and poverty reduction for a nation. Improving nutritional status will further add to the overall success of the multi sectoral interventions that include immunization and vaccination programs undertaken by the government.

It is reassuring that the enormity of the adverse impacts of poor nutrition on a child’s growth and development are being recognized and acted upon aggressively. Entities such as Hilleman Laboratories understand and recognize the interplaying role of nutrition and immunity in improving child health and development and its impact on the economic sustainability of our nation and are looking ahead and promoting actions for transforming lives.
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Friday, 29 July 2016

India: Current Vaccination Scenario

India’s immunization program is one of the largest Universal Immunization Programs (UIP) in the world. In India, the Universal Immunization Program targets 27 million infants and 30 million pregnant women every year. Effective vaccine utilization is an integral component of vaccine security and vaccine wastage is one of the key factors to be considered with regards to vaccine forecasting and need estimation. Heat sensitivity of most vaccines calls for the need of adequate cold-chain system and ensure its maintenance to preserve the potency of the vaccine before it is administered. The World Health Organization (WHO) recommends that all childhood vaccines except the oral polio vaccine be kept at 2–8 °C during their in-country distribution.

In a bid to ensure success of the immunization program, India has a five-level supply chain. It commences at the government medical supply depots (n=4) which supply state vaccine stores (n = 35), which, in turn, supply regional vaccine stores (n = 116). Vaccine is sent from the regional stores to district vaccine stores (n = 626), and thereon the last links in the chain: the primary or community health centers function as the peripheral vaccine stores (n = 26 439).

In spite of all the positive efforts there are ongoing challenges and shortcoming in the program that hamper the coverage rates.Within the entire chain, storage of vaccines at optimum temperature is critical. Most vaccines(except the oral polio vaccine) need to be stored at temperature between 2–8 °C.This is either achieved by building walk-in coolers or ice-lined refrigerators or transported in cold boxes with ice packs that have been allowed to reach 0 °C.Immunization services in the public sector are mostly provided at district hospitals, urban health centers and primary or community health centers. However, outreach vaccination sessions at health subcenters or in remote villages are also conducted, using vaccine transported from the nearest primary or community health center.

A study by Galhotraet al in the year 2007 highlighted incidence of avoidable errors like uninterrupted power supply, in adequate number of exhaust fan, voltage stabilizers, etc. were the identified reasons for the errors and cited a room for improvement.

Use of thermo stable vaccines is on the anvil and is likely to change the dynamics in future.
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Tuesday, 19 July 2016

Need Of The Hour: Heat Stable Vaccines

It is estimated that vaccination programs save about 3 million lives worldwide from the adverse impact of infectious diseases. However it is also reported that about 3 million individuals succumb to vaccine –preventable diseases and the fact that many vaccines not being thermo stable plays a part in this tragedy.

The World Health Organization (WHO) estimates that annually 10-50 percent of vaccines may be wasted globally because of temperature control, logistics and shipment-related issues.
The vaccines currently available need to be kept constantly cold at temperatures between 2°C to 8°C from the point of manufacture until reaching the recipient. Considering the variable stability of vaccines, for a country like India, which experiences a tropical climate, the cold chain remains a highly vulnerable point. Low resource setting areas, which are not only isolated but lack reliable electricity for refrigeration, pose a major obstacle. This impacts the overall immunization rates negatively.

Storage of vaccines at optimum temperature is critical. Inadequate refrigeration systems lead to unintended interruption of the cold chain. Further lack of quality monitoring apparatus, exposure to high heat and damaging exposure to temperatures below 0°C harm the vaccine efficacy. Currently, the requirement for a vaccine to be transported and stored in a constant cold chain, from the time it leaves the manufacturer until it is used at a vaccination point, places huge logistical challenges on vaccination providers who must ensure that the cold chain is maintained each step of the way.
Development of thermo stable vaccines, vaccines that can withstand elevated or fluctuating temperatures is an emerging thought. Use of thermo stable vaccines has the potential to ease such logistical hurdles imposed by the ‘cold chain’. Thermo stable vaccine formulations that would be resistant to damage caused by freezing or excessive heat can reduce the dependence on the cold chain.

Benefits of thermo stable vaccines are huge, including cost savings, preventing vaccine damage, and, most importantly, making it easier to reach children living in remote places who would otherwise remain unvaccinated.

A clinical study published in “Vaccine” in the year 2012; by Lee BY et al has another interesting perspective, “Eliminating the need for refrigerators and freezers should not necessarily be the only benefit and goal of vaccine thermo stability. Rather, making even a single vaccine (or some subset of the vaccines) thermo stable could free up significant cold storage space for other vaccines, and thereby help alleviate supply chain bottlenecks that occur throughout the world.
Nevertheless, making individual vaccines thermo stable could still have benefits if their removal from the cold chain could relieve bottlenecks in the vaccine supply chain.”

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Monday, 27 June 2016

Mission Indradhanush: Spectrum of seven will now be eleven

Mission Indradhanush was launched by Ministry of Health and Family Welfare (MOHFW) on 25th December, 2014. The health ministry’s flagship programme, which provided immunisation against seven life threatening diseases, is all set to be renamed as four new vaccines have been introduced to fight against various life threatening diseases.

Mission Indradhanush, signifies the spectrum of seven colours of the rainbow, which provides vaccination against seven vaccine-preventable diseases including diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and Hepatitis B.

"We have added four new vaccinations - rotavirus, measles rubella, inactivated polio vaccine biavalent and Japanese Encephalitis for adults. In that, very important is rotavirus. 10 lakh children get hospitalised every year suffering from diarrhoea and 80,000 lose their lives every year," said Health Minister JP Nadda.  The four added vaccines had been made a part of the ‘India Newborn’ action plan in January this year.

With an aim to fight against various vaccine preventable diseases and to reach out to the unvaccinated and partially vaccinated children by 2020, the project has additionally brought 1.62 crore children under the ambit of immunization within a year of its launch. India had been facing the problem of low immunization coverage since many years as period between 2009-2013 saw just 1 per cent increase in coverage year-on-year.

"Mission Indradhanush has brought change in the lives of people. We have to keep some other name in place of Indradhanush as the vaccinations have gone up from seven to eleven," added the Union Health Minister.

However regardless of the name, the project has shown improvements in immunization coverage and with the added new four vaccines, a new set of unvaccinated  and partially vaccinated children will be brought under the scope of Immunization.
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Sunday, 5 June 2016

Implementation Of Routine Immunization

Routine immunization is the foundation through which countries provide access to lifesaving vaccines and control and eradicate vaccine-preventable diseases. It is the process of timely vaccination on a regular basis with vaccines considered important for a given country to reduce morbidity and mortality. This process is enabled by a country's health system and maintained through a set of management subsystems needed to continuously supply the full complement of scheduled vaccines, monitor their safety, control population coverage, and measure their epidemiological impact 
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Sunday, 29 May 2016

National Immunization Schedule (NIS)

India's Universal Immunisation Programme (UIP) is one of the largest in the world in terms of quantities of vaccine used, the number of beneficiaries, the number of Immunisation session organised, the geographical spread and diversity of areas covered. Under UIP, Government of India provides vaccination to prevent many vaccine preventable diseases.

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About Me

Hilleman Laboratories is a global vaccine research & development organization focused on making affordable vaccines using innovation to address gaps that exist in low resource settings. Hilleman Labs acts as a catalyst in bridging the gap between academic research and product development by targeting novel vaccines and increasing the efficiency of existing vaccines. Know More

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