4TH INTERNATIONAL CONFERENCE ON VACCINES & VACCINATIONVALENCIA, SPAIN, SEPTEMBER 24-26, 2014

 IMMUNIZATION AND HUMAN RIGHTS

 

Obradović Zarema1, Obradović Amina2

1. Institute for Public Health of Canton Sarajevo/Faculty of

Health Studies, University of Sarajevo

2. PhD student, Faculty of Public Health and Social Work,

Trnava University, Slovak Republic

INTRODUCTION

Among fundamental human rights are: - the right to life - the right to health

These two rights are very connected and they are also connected with the process of immunization

Immunization is one of the most important achievements in medicine because introduction of vaccine saved millions of lives on the global plan.

„Almost 11 milion children die every year of preventable causes. Milions of people die when lifesaving vaccines and medicines exist , but do not get to those who need them because they or the countries they live in are too poor to pay for or distribute, them“.

(UN Secretary- General, Kofi Annan Statement to the 59th Commission on Human Rights, 20 March 2003, Geneva, Switzerland)

During the war in Bosnia and Herzegovina (1992-1995) different human rights were violated and also the right to life and right to health.

From the aspect of immunization, there were few problems:

providing of necessary vaccines vaccines storage problems with the implementation of routine

vaccination program

Consequences are visible today in a form of occurence of different vaccine-preventable

diseases

AIM:

In this paper we will show the trend of vaccine-preventable diseases in people who were not vaccinated during the war

MATERIAL AND METHODS:

It is a retrospective epidemiological study

We used protocols and reports about vaccine-preventable diseases (measles, mumps,rubella)

Period January 1994 – July 2014 Place – Canton Sarajevo

Results:

9

BOSNIA AND HERZEGOVINA – facts:

51.129 km2

4.613.414 inhabitants

Two entities and one district

10

11

Health system organised on the entity and district level

Primary, secondary and tertiary health care (institutions)

Primary health care – municipality level Secondary health care – regional level Tertiary health care – entity level

Routine immunization program – primary health care

Sarajevo - capital city of Bosnia and Herzegovina

Cenzus 1991 - 416.497 citizens

Estimate 2008 - 304.614 citizens

Cenzus 2013 – 438 443 citizens

The siege of Sarajevo was one of the longest in the history of modern warfare and the longest siege of one capital ever

It lasted 44 months, from April 5, 1992 to 29 February 1996

During the siege, the city was almost completely cut off from the rest of the country and the resulting shortages of food, electricity, gas, medicine and water

Citizens were often exposed to sniper fire

An average of 329 missiles fired at the city daily

IMMUNIZATION PROGRAM DURING THE WAR

Completely disrupted shortages of vaccines problems with maintenance of cold chain difficulty in bringing children to vaccination risky to bring children to vaccination

a large number of children orphaned a large number of wounded children Immunization was neglected by parents, but

also by health professionals

Vaccination against measles, mumps and rubella introduced in 1980

Schedule:- First dose with 13 months of life- Second dose with 6 years

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014(jul)0

500

1000

1500

2000

2500

7 6 18

2015

925

24 10 6 2 3 1 2 15

116

0 3 4 1 1 1

677

7 10

7037 27

901

747

587

9763

32 23 0 14 16 12 21

1313

554

49187 22

46

777

58 36 14 9 8 3 2 0 1 2 0 0

951

2 0 0 0

measlesmumpsrubeolla

Graph 1. Measles, mumps, rubella January 1994- July 2014

MEASLES- OUTBREAK 2014

First case: 26.3.2014 – still going on

GRAPH 2. MEASLES CASES PER WEEK

24.0

3.-3

0.03

.201

4

31.0

3.-0

6.04

.201

4

07.0

4.-1

3.04

.201

4

14.0

4.-2

0.04

.201

4

21.0

4.-2

7.04

.201

4

28.0

4.-0

4.05

.201

4

05.0

5.-1

1.05

.201

4

12.0

5.-1

8.05

.201

4

19.0

5.-2

5.05

.201

4

26.0

5.-0

1.06

.201

4

02.0

6.-0

8.06

.201

4

09.0

6.-1

5.06

.201

4

16.0

6.-2

2.06

.201

4

23.0

6.-2

9.06

.201

4

30.0

6.-0

6.07

.201

4

07.0

7.-1

3.07

.201

4

14.0

7.-2

0.07

.201

4

21.0

7.-2

7.07

.201

4

28.0

7.-0

3.08

.201

40

20

40

60

80

100

120

50

1217

1014

28 28 29

41

50

71

102

84

91

40

30

21

4

GRAPH 3. AGE DISTRIBUTION

0-6 mo 6 mo-12 mo

13 mo-24 mo

25 mo-5y

6y-7y 8 y-14 y 15 y-18 y

19 y-25y

26y-30y 31y-35y 36y-40y 41y-45y 46y-50y 50 +0

20

40

60

80

100

120

8

36

56

114

26

84

114

92

50 48

25

13 11

0

TABLE 1. VACCINAL STATUS

Category

Not vaccinated< 12 months and >36 years

Vaccinated – 1 dose13 months-5 years

Vaccinated – 2 doses (could be completely vaccinated)6 years -35years

Total

Number 76

41 170 414 701

% 17% 25% 58% 100 %

GRAPH 4. VACCINAL STATUS

Vaccinated1%

Unvaccinated94%

Incopl.vac3%

Unknown2%

THE POSSIBLE WAR IMPACT ON IMMUNIZATION

Categories I II III Total

Number 360 300 41 701

% 51% 43% 6% 100 %

I category – young people where war did not have any impact on immunization: 0-15 years

II category – people where war could have impact on immunization: 16-35 years

III category – older people where war did not have any impact on immunization: > 36 years

Table 2. Measles cases per categories

DISCUSSION

During the war health services are disrupted Garfield RM.War-related changes in health and health services in Nicaragua.Soc Sci Med.1989;

28(7):669-76

CDC: Vaccination sercices in postwar Iraq, May 2003. MMWR 2003, Aug 8; 52(31):734-5

Health effects of the war are different Neisen et all: Health consequences of armed conflict in Guinea-Bissau, Ugesk. Laeg 2010 Jan 11;

172(2):132-6

Miller et all:Afgan refugee children and mothers. Arch Pediatr. Adoles.Med. 1994 Jul; 148 (7):704-8

Big impact on child health Cliff J, Noormahomed AR.The impact of war on children‘s. Soc.Sci.Med 1993.Apr; 36(7): 843-8

Barath A. Children‘s well-being after the war in Kosovo: survey in 2000, Croat Med J 2002 Apr; 43(2):199-208

Michael Rieder,Imti Choonara,.Armed conflict and child health, publiched online Mar 9, 2011

Agadjanian V, Prata N. Civil war and child health: regional and ethnic dimensions of child immunization and malnutrition in Angola. Soc Sci Med 2003 Jun; 56(12):2515-27

The impact of the war on immmunisation coverage is known Cetorelli V. The impact of the Iraq War on neonatal polio immunisation coverage: a quasi –

experimental study.J.Epid.Comm.Health 2013, Nov 23

Vargha D.Between East and West:polio vaccination across the Iron Curtain in Cold War Hingary, Bull.Hist.Med 2014, Summer; 88(2):319-43

Mashal T et all. Impact of conflict on infant immunisation coverage in Afganistan: a countrywide study 2000-2003.Int J Health Geogr.2007 Jun 7; 6:23

Measles are a frequent consequence Tuchinsky TH at all. Measles during the Gulf War:public health threat in Israel, the West

Bank and Gaza. Pub.Healt. Rev.1992-1993; 20(3-4);285-96

Aaby P et all. Survival of previously measles- vaccinated and measles unvaccinated children in an emergency situation: an unplanned study. Pedij Infet. Dis J.2003. Sept; 22(9): 798-805.

Hukic M et all. An outbreak of rubella in the Federation of Bosnia and Herzegovina between December 2009 and May 2010 indicates failure to vaccinte during wartime (1992-1995). Epidem. Infe 2012 Mar; 140(3):447-53

CONCLUSION

43% of measles cases can be associated with war

Nearly 20 years after the war we feel the consequences of it

In all emergencies and crises, it is necessary to pay attention to immunization as a preventive measure important for the future of each country

Security within a country is an important factor for affecting the delivery of immunization services

Immunization is a human right

In order to respect this human right every country must make efforts

Thank you!