VoICE Immunization Evidence: Health inequity

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Health Inequity

Health inequities are reflected in differences in the distribution of disease and illness within a given population. Health inequity limits people’s ability to gain access to resources and experiences required for health and well-being. Immunization is important in as vaccine preventable diseases disproportionately affect those in poorer overall health. Through immunization, Herd Effect can protect those unable to be vaccinated and in general improves the equity of health outcomes.
9 Key Ideas, 18 Sources
Key Idea

In urban residents in the Democratic Republic of Congo, chronically malnourished children were less likely to have received two doses of measles-containing vaccine, compared to healthy children (OR=0.4).

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Key Idea

Kenyan parents who were HIV positive were 16% more likely to be carriers of pneumococcal bacteria than HIV negative parents living in the same compounds. HIV positive parents in poorer health (those with a CD4 count below 250) were at a significantly greater risk of being pneumococcal carriers.

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In a study of national surveillance records in South Africa, HIV positive people over 5 years of age were found to have a 43-fold risk of invasive pneumococcal disease compared to HIV negative person. This risk was highest among children age 5-19 who were found have a more than 120-fold risk of invasive pneumococcal disease compared to HIV negative uninfected children of the same age. 90% of South Africa’s invasive pneumococcal disease cases during the 5 year period occurred in the 18% of the population who are HIV positive.

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“HIV-infected individuals are living longer, and non-AIDS-defining conditions are affecting this population in increasing numbers. HPV infections are more prevalent and persistent in HIV-infected women and men. Earlier studies reported anal HPV prevalence rates of 76% in HIV-infected women and 46% in HIV-uninfected women and cervical prevalence rates of 48% to 73% compared to 28% in HIV-uninfected women.” In addition, the burden of HPV infections and HPV-associated diseases is higher in HIV-infected women compared with HIV-uninfected women.

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Key Idea

In the mid-1980s, the Indian government embarked on one of the largest childhood immunization programs-called Universal Immunization Program (UIP)-in order to reduce the high mortality and morbidity among children. Results indicate that exposure to the program reduced infant mortality by 0.4 percentage points and under five child mortality by 0.5 percentage points. These effects on mortality are sizable{they account for approximately one-fifth of the decline in infant and under five child mortality rates between 1985- 1990. The effects are more pronounced in rural areas, for poor people, and for members of historically disadvantaged groups. The 0.5 percentage point reduction each year over 5 years (from 15% under 5 mortality in 1985 to 12.3% in 1990), represents an 18% reduction overall in under 5 mortality.

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Models based on demographic data from Ghana suggest that immunization would eliminate the childhood mortality risk associated with living in poverty and greatly diminish the increased risk of mortality borne by children whose parents have low levels of education.

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Key Idea

In survivors of pediatric and young adult cancers in the US, the risk of mortality from infectious complications is 4 times higher than in their cancer-naïve siblings. Within the first five years after cancer diagnosis, the risk of some vaccine-preventable infections such as pneumonia and hepatitis is more than 9-fold and 6-fold higher, respectively. More than 5 years after cancer diagnosis, the risk of these two infections remains high at 3.7 and 2.5 times higher than siblings.

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Among children and young adults being treated for certain cancers, immunosuppressive therapies can erase immunity previously acquired through vaccination, dramatically increasing the risk of vaccine-preventable infections. The authors assert that vaccination during and after immunosuppressive treatment is necessary to rebuild immunity and protect the most at-risk children.

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Key Idea

A review of evidence for the use of pneumococcal conjugate vaccine in South Africa showed that children who are HIV positive are at significantly increased risk of pneumococcal disease, and so will benefit the most from vaccination, despite decreased vaccine efficacy in this group compared to healthy children.

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A large randomized controlled trial of a pneumococcal conjugate vaccine in South Africa found that use of the vaccine prevented 10 times as many cases of pneumococcal pneumonia in HIV positive children than in HIV negative children.

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Key Idea

Nearly a quarter of a million children are born with sickle cell disease in Africa each year. SCD was found to increase the risk of Hib infections by 13-fold and pneumococcal infections by 36 fold. This means that children with SCD stand to benefit enormously from PCV and Hib immunization.

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In a long-term study of Canadian surveillance data researchers found that immunocompromised people were at a 12-fold risk of invasive pneumococcal disease (IPD) compared to healthy people. In addition the risk of death from IPD in immunocompromised people was found to be 30-80% higher than healthy individuals who had contracted IPD. 10 years after introduction of PCV7 in Canada, the incidence of IPD due to serotypes included in the vaccine had decreased by 90%.

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A study of children under 5 years of age in Dhaka Bangladesh found that severely malnourished children were at a significantly increased risk (nearly 8x) of death from diarrhea than those who were not severely malnourished.

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A study of Kenyan children under 5 years of age found that immunization with polio, BCG, DPT and measles to be protective against stunting in young children (27% less likely to be stunted than unimmunized children under age 2 years). In addition, children with diarrhea and cough in the 2 weeks prior to the survey were 80-90% more likely to be underweight or to suffer from wasting.

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An analysis of undernutrition and mortality in young children found that among the principal causes of death, 60.7% of deaths as a result of diarrhea, 52.3% of deaths as a result of pneumonia, 44.8% of deaths as a result of measles, and 57.3% of deaths as a result of malaria are attributable to undernutrition.

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Key Idea

In a US-based study of more than 65,000 longterm survivors of pediatric and young adult cancers spanning nearly three decades, researchers found an increased risk of later HPV infections and malignancies among these survivors. Female survivors of childhood and young adult cancers were found to have a 40% greater chance of developing HPV-associated malignancies, compared to cancer-naïve females. This risk was even greater in male cancer survivors, who had a 150% relative excess of HPV malignancies compared to cancer-naive males.

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A study in the US found that the incidence of invasive pneumococcal disease was 22 to 38 times higher in adults with cancer than in healthy adults.

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Key Idea

In a long-term study of Canadian surveillance data researchers found that immunocompromised people were at a 12-fold risk of invasive pneumococcal disease (IPD) compared to healthy people. In addition the risk of death from IPD in immunocompromised people was found to be 30-80% higher than healthy individuals who had contracted IPD.

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A study of the impact of measles vaccine in Bangladesh found that unvaccinated children in the poorest quintile were more than twice as likely to die as those from the least poor quintile. In addition, vaccination reduced socioeconomic status-related mortality differentials

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Key Idea

Among the principal causes of death in young children, 60.7% of deaths as a result of diarrhea, 52.3% of deaths as a result of pneumonia, 44.8% of deaths as a result of measles, and 57.3% of deaths as a result of malaria are attributable to under nutrition.

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A woman carrying vaccines

Search for immunization evidence

The VoICE tool allows you to search for research studies and published evidence based on a topic, location, and disease or vaccine.

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