Editorial: Public health problems: vaccine-preventable diseases and travel-associated infections
Published: 23.09.10 Updated: 26.10.2010 14:36:38
I.Velicko, Managing Editor, EpiNorth Journal
K. Kutsar, Editor-in-Chief, EpiNorth Journal
Citation: Velicko I, Kutsar K. Public health problems: vaccine-preventable diseases and travel-associated infections. EpiNorth 2010; 11:33-5.
Immunization is the most cost-effective public health preventive measure. The importance of immunization in the control of vaccine-preventable diseases was previously raised in the EpiNorth Journal (1). Immunization primarily prevents diseases by improving population health and avoiding possible death due to infectious diseases. Secondarily, it also saves money for the health care sector. Some of the “old” vaccines including measles, polio, diphtheria, tetanus and pertussis are well established in childhood vaccination schedules in many countries. Some other vaccines may be included in childhood vaccination programmes such as hepatitis B (available since 1982), rotavirus (available since 1998) and human papilloma virus (available since 2006) vaccines. By 2009, 46 of 53 countries in the WHO European Region implemented universal hepatitis B immunization (3). Among those were all EpiNorth project countries except Finland and Iceland (7). In this issue V. Shaginyan et al. from Ukraine present their experience in controlling of hepatitis B infection through the mass vaccination. The report provides important evidence because 2 billion people worldwide have been infected with the hepatitis B virus and about 350 million live with chronic hepatitis B infection according to the World Health Organization (WHO) (2). It is estimated that 600,000 persons die every year due to acute or chronic consequences of hepatitis B, all of which could be prevented (2). Hepatitis B vaccination is one of the top priorities of WHO in line with other important activities to reduce disease burden including reducing risk of infection through safer sexual behaviour and reducing harm related to injecting drug use (3).
Another “new” vaccine, the rotavirus vaccine, is being used in the national immunization programs of several Latin American countries (4) but is not widely used in Europe. Among EpiNorth project countries, Finland announced after economic evaluation that rotavirus vaccination would be included in the national immunization schedule (5). Rotavirus vaccine will be also introduced in the Latvian childhood vaccination schedule in 2011 (6). The remaining countries are still awaiting results from disease burden studies in order to decide whether to introduce rotavirus vaccine into the childhood vaccination schedule. According to WHO estimates, more than 10,000 children under 5 years of age die each year in the WHO European Region due to rotavirus infection (8). As countries in the European region are diverse in terms of economic development, rotavirus plays an important role in less economically developed countries in terms of high disease burden (including high burden to the health care facilities) and mortality. Low-income countries account for 44% of the estimated annual rotavirus deaths in the European Region (8). Again, these are cases and death that could be prevented. In this issue of the EpiNorth Journal Z. Milisiunaite et al. present data on rotavirus and norovirus infections in Lithuania where the burden of rotavirus infection is due to the high number of infections among children under 5 years of age. This report provides evidence that supports further considerations addressing the introduction of rotavirus vaccine in the childhood vaccination schedule in Lithuania.
Another important health issue we are covering in this issue of EpiNorth is travel-related infections. There is evidence that people acquire some infections such as diarrheal diseases more often when travelling (9).In some cases diseases can be prevented by vaccination (e.g. yellow fever, hepatitis A), taking prophylactics (e.g. malaria) and practicing good hand hygiene and carefully choosing food and drinks (e.g. bottled water). Hand washing is recognized as one of the eff ective ways to prevent diarrheal diseases not only when travelling abroad (10). R. Rimhanen-Finne et al. present results from the analysis of giardiasis cases in Finland where two thirds of the reported cases were travelrelated. However, one should also pay attention to the domestic cases as these may indicate some unrecognized epidemiological features and risk factors.
- Kutsar K. Vaccine-Preventable Diseases-The Effort Must Be Maintained. EpiNorth.2009:10(1):3-5. Available from: http://www.epinorth.org/dav/e79bc218e8.pdf
- World Health Organization. Hepatitis B. Key facts. Available from: http://www.who.int/mediacentre/factsheets/fs204/en/
- World Health Organization Regional Office for Europe. Hepatitis B. Available from: http://www.euro.who.int/en/what-we-do/health-topics/diseases-and-conditions/hepatitis/facts-and-figures/hepatitis-b
- Parashar UD, Glass RI. Rotavirus vaccination in Europe: the time has finally arrived. J Pediatr Gastroenterol Nutr. 2008 May;46 Suppl 2:S21-3.
- Nohynek H, Salo H, Renko M, Leino T. Finland introduces rotavirus vaccine into the national vaccination programme in September 2009. Euro Surveill. 2009;14(35):pii=19322. Available from: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19322
- EUVAC.NET data. Available from: http://www.euvac.net/graphics/euvac/index.html
- EpiVax. EpiNorth project. Available from: www.epinorth.org
- World Health Organization Regional Office for Europe. Rotavirus. (http://www.euro.who.int/en/what-we-do/health-topics/diseases-and-conditions/rotavirus)
- Ekdahl K, Giesecke J. Travellers returning to Sweden as sentinels for comparative disease incidence in other European countries, campylobacter and giardia infection as examples. Euro Surveill. 2004;9:6 Available from: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=476
- Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA. Hand washing for preventing diarrhoea. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD004265.