With the introduction of pneumococcal conjugate vaccines (PCV) into the routine immunisation yesterday, the vaccine would now be given to infants at six weeks, 10 weeks and nine months of age in all health facilities.

The vaccine prevents transmission of pneumococcal bacterial diseases such as pneumonia, otitis media, bacteraemia, and meningitis in children under 5 years.

The health ministry, with support from Global Alliance for Vaccines and Immunisation (GAVI) and UNICEF introduced PCV 13 into the routine immunisation.

Director of public health department, Dr Karma Lhazeen, said that pneumococcal infection affects children and adults causing morbidity and mortality, especially in low and middle-income countries.

Dr Karma Lhazeen said pneumococcal disease burden in Bhutan is high. In the last six years, 71,595 pneumonia cases were reported in the country. A total of 83,425 otitis media and 1,744 meningitis were reported during the same duration.

“Incidence of Pneumonia is comparatively high and increasing among children under the age of five. The data shows the mortality trend among the population is increasing,” she said.

From 2008 to 2016, about 631 deaths due to pneumonia and 237 deaths due to meningitis were recorded in the country. This translates to 70 deaths due to pneumonia and 26 deaths due to meningitis, annually.

She said that respiratory infections remain a major cause of morbidity and mortality among children in Bhutan. “The government spends huge resources on the treatment of pneumococcal diseases.”

These diseases, she said, also contribute to high societal costs, as parents have to take time off their work to tack care of their sick children.

Due to the high disease burden, the National Technical Advisory Body for immunisation services recommended the health ministry to introduce the vaccine for children.

A feasibility study was undertaken and completed in June 2017. The study result indicated that introduction of PCV would be cost-effective and provide good value for money and would prevent mortality and morbidity due to pneumococcal diseases.

The study findings showed that the introduction of PCV 13 would avert 3,177 cases and prevent 42 deaths per study cohort. It also showed that the introduction of the vaccine would reduce the workload of various categories of health workers.

The vaccine would cost the Bhutan Health Trust Fund Nu 9.2M annually.

The GAVI provided support for one time operational or introduction cost, which includes training and other logistics through a grant amounting to Nu 7.5M. WHO and UNICEF provided technical support for the introduction of this vaccine

“We trained all Maternal and Child Health expanded programme on immunisation focal persons and BHU staff before we introduced the vaccine,” Dr Karma Lhazeen said.

The head of the national referral hospital’s community health department, Dr Sonam Ugen, said that immunisation was one of the greatest public health success stories in Bhutan, preventing sufferings and saving more lives.

“The introduction of the PCV 13 is another significant milestone for the vaccine preventable disease programme in Bhutan,” she said. “We firmly believe that the introduction of the pneumococcal vaccine is most timely and a crucial step to reduce pneumonia associated illness.”

The PCV 13 and two other vaccines were launched in the country on June 4, last year coinciding with the birthday of His Majesty the Gyaltsuen.

Senior programme officer with the vaccine preventable disease programme, Tshewang Dorji Tamang, said the ministry was carrying out cost-effectiveness study on the introduction of rotavirus and flu vaccines.

He said that the National Committee for Immunisation Practice in Bhutan noted that there was currently insufficient data to support Pneumococcal vaccination for the elderly population and that there were documented positive effects of herd protection in adult age group following routine infant immunisation with PCV 13.

With the addition of PCV, a total of 12 vaccinations will be provided through routine immunisation programme in the country.

Dechen Tshomo