Vaccination in Palestine
By: Mohammad Ba’ara
Ahmed Sawalha
Under the supervision of :
Dr.Sammar Musmar
History
• history
• The story of vaccines did not begin with the first vaccine–
Edward Jenner’s use of material from cowpox pustules to
provide protection against smallpox. Rather, it begins with
the long history of infectious disease in humans, and in
particular, with early uses of smallpox material to provide
immunity to that disease.
• Evidence exists that the Chinese employed smallpox
inoculation (or variolation, as such use of smallpox material
was called) as early as 1000 CE. It was practiced in Africa
and Turkey as well, before it spread to Europe and the
Americas.
• Edward Jenner’s innovations, begun with his successful
1796 use of cowpox material to create immunity to smallpox,
quickly made the practice widespread. His method
underwent medical and technological changes over the next
200 years, and eventually resulted in the eradication of
smallpox.
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First Generation of Vaccines (pre-1950s)
1798 Smallpox
1885 Rabies
1897 Plague
1917 Cholera
1917 Typhoid vaccine (parenteral)
1923 Diphtheria
1926 Pertussis
1927 Tuberculosis (BCG)
1927 Tetanus
1935 Yellow Fever
1940s DTP
1945 The first influenza vaccines (flu) began being used.
History of Anti-vaccination
Movements
• Yet, opposition to vaccination has existed as long as
vaccination itself. Critics of vaccination have taken a
variety of positions, including opposition to the
smallpox vaccine in England and the United States in
the mid to late 1800s, and the resulting antivaccination leagues; as well as more recent
vaccination controversies such as those surrounding
the safety and efficacy of the diphtheria, tetanus, and
pertussis (DTP) immunization, the measles, mumps,
and rubella (MMR) vaccine, and the use of a mercurycontaining preservative .
Smallpox and the Anti-vaccination Leagues in England
Edward Jenner’s showed that he could protect a
child from smallpox if he infected him or her with
lymph from a cowpox blister
•
Beginning with early vaccination in the
nineteenth century, these policies led to
resistance from a variety of groups,
collectively called anti-vaccinationists,
who objected on ethical, political,
medical safety, religious, and other
grounds. Common objections are that
compulsory vaccination represents
excessive government intervention in
personal matters, or that the proposed
vaccinations are not sufficiently safe
Brazil 1904
Vaccination policy
Vaccination policy refers to the policy a •
government adopts in relation to
vaccination. Vaccinations are voluntary in
some countries and mandatory in some
countries. Some governments pay all or
part of the costs of vaccinations for
vaccines in a national vaccination
schedule.
*Compulsory vaccination
• In an attempt to eliminate the risk of outbreaks of
some diseases, at various times several
governments and other institutions have instituted
policies requiring vaccination for all people. For
example:
• 1853 law required universal vaccination against
smallpox in England and Wales, with fines levied
on people who did not comply.
• In the United States, the Supreme Court ruled in
the 1905 that vaccination policies require that
children receive common vaccinations before
entering school.
• In Malaysia, mass vaccination is practised
in public schools. The vaccines may be
administered by a school nurse or a team of
other medical staff from outside the school.
All the children in a given school year are
vaccinated as a cohort. For example,
children may receive the oral polio vaccine
in Year One of primary school (about six or
seven years of age), the BCG in Year Six,
and the MMR in Form Three of secondary
school. Therefore, most people have
received their core vaccines by the time
they finish secondary school.
*Basic vaccination
Hep B •
IPV •
DTP •
PCV •
Hib •
MMR •
Varicella •
Vaccination schedule
A vaccination schedule is a series of •
vaccinations, including the timing of all doses,
which may be either recommended or
compulsory, depending on the country of
residence.
Many vaccines require multiple doses for •
maximum effectiveness, either to produce
sufficient initial immune response or to boost
response that fades over time. For example,
tetanus vaccine boosters are often
recommended every 10 years.
Vaccine schedules are developed by •
governmental agencies or physicians groups to
achieve maximum effectiveness using required
and recommended vaccines for a locality while
minimizing the number of health care system
interactions. Over the past two decades, the
recommended vaccination schedule has grown
rapidly and become more complicated as many
new vaccines have been developed.
Some vaccines are recommended only in •
certain areas (countries, subnational areas or atrisk populations) where a disease is common.
For instance, yellow fever vaccination is on the
routine vaccine schedule of French Guiana, is
recommended in certain regions of Brazil but in
the United States is only given to travelers
heading to countries with a history of the
disease.
Vaccination schedules
‫• قبل السلطة‬
UAE
Israel •
BCG
polio
DPT
Measles
MMR
Hepatitis B •
DTP+eIPV •
TOPV •
eIPV •
MMR •
HbCV b •
B.C.G •
MOH
UNRWA •
VARIOLA
POLIOMYELITIS
DTP
B.C.G
OPV •
TT •
DT •
MMR •
B.C.G •
‫السلطة‬
‫بعد‬
UAE
BCG
Hep B
IPV
PCV
DPT + Hib + Hep B
DPT + Hib
MMR
MOH
MMR
DPT
DPT + Hib
OPV
IPV
HEP. B
BCG
Israel
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HEP B + HBV
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IPV
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Hib
•
DTaP
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OPV
•
MMR
•
VARICELLA ZOSTER
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HEP A + HAV
•
PNEUMOCOCCAL VACCINE
UNRWA
•
MMR
•
DTP
•
MEASLES
OPV
•
IPV
•
HEP B
•
BCG
•
Hib
•
Vit A
•
•
•
Global Immunization Data
October 2010
Summary: Global immunization coverage in 2008
Based on the latest World Health Organization •
(WHO)/UNICEF global estimates for 2009, trends
related to global vaccination coverage continue to be
positive.
Immunization currently averts an estimated 2.5 •
million deaths every year in all age groups from
diphtheria, tetanus, pertussis (whooping cough), and
measles.
The unprotected children
Deaths due to vaccine-preventable diseases
Total number of children who died from diseases preventable
by vaccines
currently recommended by WHO: 1.7 million.
• Hib: 260 000
• Pertussis: 195 000
• Measles: 118 000
• Neonatal tetanus: 59 000
• Tetanus (non-neonatal): 2 000
Estimated number of all deaths in children under five in
2008: 8.8 million.
Nearly 20% of all deaths in children under 5 is vaccine
preventable
Global coverage of infants
Global coverage of
infants
1990
2009
Notes
DTP3
75%
82%
# vaccinated2009/107 million
Polio-3 doses
75%
83%
1988/350 000
2009/1783 polio cases
polio-endemic countries :
1988-125 /// 2009-4
Measles- 2 birthday -one
dose
73%
82%
Measles deaths in 2008: 164 000
MNT: # cont. not
eliminate
2000/58
42
Hepatitis B
1%
70%
*Special vaccination
• Data for quantifying the risk of medical problems related to
religious pilgrimages are limited; the best documented, in
terms of health risk, is the Hajj
• In Hajj, more than 2 million Muslims from all over the world .
• The potential for spread of infectious diseases associated
with this pilgrimage has long been recognized
The Ministry of Health of Saudi
Arabia has issued the following
requirements and recommendations
for entry visas for the year 1431H
(2010) Hajj and
Umra seasons
… Yellow fever :
travellers from countries at risk of yellow fever
transmission . e.g :Somalia, Sudan
… Poliomyelitis :
Countries infected with poliomyelitis (e.g :
Niger, Sudan,) should be vaccinated against
poliomyelitis with the oral polio vaccine
• … Meningococcal meningitis
• For all arrivals: Visitors from all over the world
arriving for the purpose of ‘‘Umra’’ or pilgrimage or
for seasonal work are required to produce a
certificate of vaccination with the quadrivalent
(ACYW135) .
• Interior pilgrims and Hajj workers : vaccine is
required for:
• — all citizens and residents of Madina and Makkah
who have not been vaccinated during the past 3 years;
• — all citizens and residents undertaking the Hajj;
• —all Hajj workers & who work at entry points or in
direct contact with pilgrims in Saudi Arabia.
The view from the future//WHO
By the 2020s:
• child deaths from infectious diseases are expected to be
at an all-time low;
• polio should be eradicated, and measles eliminated in all
countries;
• hopes remain high that new vaccines will be available to
combat malaria, tuberculosis, AIDS, and other diseases.
Sources :
 Palestinian Ministry of health.
 Israel Ministry of health .
 UAE ministry of health .
 WHO. International Travel and Health — 2010
(www.who.int/ith).
 State of the world’s vaccines and immunization -3rd
edition/WHO
 Health conditions for travelers to Saudi Arabia for
(Hajj) for the year 1431H/2010 \\\ Journal of Infection and
Public Health (2010) 3, 92—94
 CDC website
 http://www.historyofvaccines.org/content/timelines/all
 http://www.historyofvaccines.org/content/articles/historyanti-vaccination-movements