Cholera Vaccines: Need of the Hour in Haiti

By: Hilleman Laboratories on October 31, 2016

Haiti, the Caribbean nation has been frequently hit by natural disasters like hurricanes, floods and has also been struck by powerful earthquakes. In 1963, Hurricane Flora killed 6,000 people in Haiti and Cuba. During the hurricane season eight years ago, Haiti was hit by four storms- Fay, Gustav, Hannah and Ike, which killed more than 800 people and devastated nearly three fourth of its agricultural land. The country has also suffered dire flooding in 2002, 2003, 2006 and 2007. Devastating earthquake flattened parts of the capital, Port-au-Prince in 2010. It killed at least 90,000 people and displaced more than 1.5 million.

With so many natural calamities, Haiti had witnessed many Cholera outbreaks in the recent past. Cholera which causes severe diarrhea, is spread through contaminated water and has a short incubation period, which leads to rapid outbreaks. The major earthquake in 2010 claimed about 10,000 lives due to Cholera. 771 Cholera cases have been reported every week in 2016, with 28,559 cases in the last ten months.

Hurricane Matthew which hit the country on 4^th October has hit the country hard. More than 200,000 homes have been severely damaged and 175,000 people are still living in temporary shelters across the country. Since the storm, health workers have diagnosed more than 200 people with cholera, and 13 have died. As per WHO figures, 35 of 197 health facilities in Haiti, including hospitals, clinics and treatment centres have been affected by the floods and heavy winds following the hurricane.

International organizations like Gavi and WHO have announced that they will be sending doses of Cholera Vaccine in order to protect Haitians against the growing threat of cholera outbreak. According to Dominique Legros, cholera expert at the WHO, since Hurricane Matthew hit the island there has been a sharp increase in cholera cases, with more than 200 suspected cases reported since the storm hit. Public health officials have already indicated that there is a high risk of cholera transmission in the worst hit areas and the assessment will help in drawing an effective roadmap for the emergency vaccination programme in the country.

“Gavi will continue to work closely with the Government of Haiti and with our global health colleagues to stave off the potential threat of cholera outbreaks and enable the Haitian people to stay healthy and focused on repairing the damage caused by Hurricane Matthew.” said Dr. Seth Berkley, CEO of Gavi.

Though International organizations are working towards stopping another Cholera outbreak through vaccines, supplies are still low to reach the high number of people at risk. According to Justin Lessler, an associate professor of epidemiology at Johns Hopkins Bloomberg School of Public Health "the people who need cholera vaccine are generally the poorest people. People with money generally have the ability to get clean water, stay away from cholera"

Cholera is endemic in over 50 countries with estimated mortality of 100,000-120,000 deaths and a morbidity of 3.8-4.4 million annual cases attributed to this disease. There is an urgent need of highly effective and affordable Cholera vaccines both for outbreaks as well as mass vaccination campaigns.

The huge Cholera burden has led to a demand for an effective, low-cost Cholera vaccine for use in epidemic outbreaks as well as for mass vaccinations in endemic settings. A market also exists for travellers to endemic regions. Demand estimates for Cholera vaccines vary significantly across scenarios with an expected 30 million doses needed by 2016 rising to expected 200 million doses by 2025, assuming vaccination of all 1-14 year old patients in high risk populations. Global public health community has also expressed concern that current Cholera vaccine manufacturers may not be able to meet the projected increase in demand further strengthening the requirement for alternate, low-cost vaccine supply.

Hilleman Laboratories in collaboration with Gotovax AB (a University of Gothenburg spin-off biopharmaceutical company) aims to deliver a high impact Oral Cholera vaccine at a significantly more affordable price than the ones currently available in the market. Easy to administer, with cross protection against ETEC diarrhea and enhanced with a longer shelf life, this vaccine candidate will be most suited for geographies with the highest cholera burden like Africa and South Asia.

Hilleman Laboratories has also recently announced the signing of an MoU with ICDDR,B and Incepta Vaccine Ltd, both based in Bangladesh for further development and manufacturing of our vaccine.

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Securing Our Children’s Future

By: Hilleman Laboratories on October 25, 2016

"Early childhood development will not only benefit the children of today, but will have a direct impact on the stability and prosperity of nations in the future".

-Dr. Margaret Chan, Director-General, WHO

Malnutrition and infection account for a large proportion of the mortality and morbidity that prevails in developing countries, especially among vulnerable groups of infants and young children. Millions of lives are being lost every year from disease for which there are vaccines. Hence, meeting the basic needs of nutritional wellbeing and addressing malnutrition in its various forms among children is therefore an urgent global priority.

Hilleman Laboratories also understands and recognizes the importance of interplaying role of nutrition and immunity, along with vaccination in reducing childhood mortality and improving child health and development. With an objective of ‘Improving Infant and Child Health’, Hilleman Laboratories recently organized ‘Securing Our Children’s Future’ a workshop on nutrition and immunity for infant and child health. The workshop brought together research scientists, academicians, nutritionists, medical community and policy makers and provided a platform to discuss the latest development, practices and challenges in the field of nutrition and immunity.

The workshop took place in New Delhi, on the 21^st and 22^nd of September, 2016. With speakers and participants from diverse backgrounds, the workshop started with opening remarks by Dr. Davinder Gill, Chief Executive Officer (CEO), Hilleman Laboratories. The first speaker of the workshop was Professor Gagandeep Kang, Christian Medical College (Vellore), who was able to set in the context with her keynote presentation on ‘Malnutrition and Vaccine Response’. She explained how malnutrition is the most common immunodeficiency globally through case studies and statistics. Professor Kang shared insights and cases on three key areas-1) Immunology of malnutrition 2) Vaccination in the context of malnutrition and 3) Malnutrition in the context of vaccination.

Followed by the insightful keynote presentation, Dr. Prema Ramachandran, Director, Nutrition Foundation of India (New Delhi) began Session 1 on ‘Nutritional Epidemiology for Infant and Child health’ by giving an overview of health and nutritional status of Indian children. She spoke about the challenges, interventions and achievements in the area of infant and child nutrition. Dr. Ramachandran also discussed the current status of World Health Assembly targets on low birth weight rates, breast feeding rates, and also stunting and wasting rates. Dr. Shweta Khandelwal from Public Health Foundation of India (New Delhi) continued the session and spoke on ‘Importance of nutrition in chronic diseases’. She threw light on the impact of changing diet patterns, nutrients and food items on chronic diseases. The session was wrapped up by Dr. Uma Chandra Mouli Natchu from Translational Health Science and Technology Institute (Faridabad) who spoke on ‘Early life nutritional influences on immunity’. Dr. Natchu shared some interesting facts on how Vitamin D deficiency leads to higher risk of respiratory syncytial virus (RSV) infections, ultimately leading to Asthma. He also revealed how daily zinc supplementation in childhood reduces incidence of pneumonia & all-cause mortality.

Second session on ‘Nutrition for Children’ was initiated by Dr. Sumathi Swaminathan from St. John’s National Academy of Health Sciences (Bengaluru). Dr. Swaminathan spoke about ‘Nutritional requirements in infants & children’. She talked about changes in nutrition requirements during infancy and young childhood and also covered key aspects of feeding. She also highlighted that how the existence of breast milk banks is fruitful and how they have been successful in many parts of the country. Dr. Swaroop Kumar Sahu from Jawaharlal Institute of Postgraduate Medical Education and Research (Puducherry) proceeded further with the session with the discussion on the topic ‘Effects of malnutrition in children’ which highlighted on the spectrum of malnutrition and the growth charts to monitor the malnutrition. Furthermore, both the direct and indirect effects of malnutrition on children were discussed along with the interventions to address the problem of malnutrition among children. Dr. Nisha Wadhwani continued the session and spoke on behalf of Dr. Sadhana Joshi from Bharati Vidyapeeth University (Pune) on the topic of ‘Prenatal maternal Nutrition’ which focussed on the direct effect of maternal nutrition on fetal programming and also threw light on the role of the epigenetic modification in altering placental function and fetal development. The last presentation of the second session was made by Dr. Anju Pradhan Sinha from Indian Council of Medical Research (New Delhi) on the ‘Intestinal Microbiota and the role of probiotics in child health’ and it gave a glimpse on the importance of the gut flora and its role in human immune functions and showcased case studies of using different probiotics for prevention of neonatal infection.

Day 1 of the workshop ended with Dr. Anjali Ahuja from Nestle Nutrition (Gurgaon) speaking about ‘Complementary Feeding - Role of Critical micronutrients in Paediatric nutrition’. Dr. Ahuja showcased how micronutrient deficiencies are linked to poor growth, intellectual impairment & increased risk of morbidity & mortality. She spoke about fortified complementary feed and its impact on infant and child health. Dr. Ahuja also covered key initiatives by Nestle Nutrition and how the organization is committed to the well-being and overall health of children.

The second day of the workshop started with Ms. Ruchika Chugh Sachdeva from PATH speaking on ‘Role of nutrition in prevention of disease’. She started the fourth session by drawing audience attention to the relationship of nutrition with health and disease. She focused on the link between nutrition and immunity with respect to macronutrient & micronutrient deficiency, and over-nutrition. Ms. Sachdeva also spoke about food fortification and stated various facts related to the same. She ended her presentation with interesting quote by Thomas Edison-

“The doctor of the future will no longer treat the human frame with drugs, but rather will cure and prevent disease with nutrition”

The session proceeded with Dr. B S Ramakrishna from SRM Institute of Medical Science (Chennai), who spoke on ‘Environmental Enteropathy’. The key areas covered in his presentation were tropical enteropathy, and consequences of enteropathy and how it is measured. Dr. Ramakrishna also gave examples of cases highlighting relationship of stunting with diarrhoea. The fourth session was concluded by Dr. Ira Praharaj from Christian Medical College (Vellore) who addressed the audience on ‘Probiotics and the response to vaccines’ highlighting the immunomodulation by the gut microbiota and probiotics. Through her talk she emphasized on one of the key questions on the role of probiotics to improve/affect immune responses to vaccines by discussing various case studies.

Dr. Francis Odhiambo from UNICEF India (New Delhi) took the last session of the workshop, and delivered a presentation on the pertinent topic of ‘Integrated approaches to address underlying risks’. He spoke on Water, Sanitation and Hygiene Programme (WASH) and various interventions executed by UNICEF, related to water quality, sanitation, safe handling and storage, hand washing with soap. The final presentation was given by Dr. Vanisha S Nambiar from Maharaja Sayajirao University of Baroda (Vadodara). Dr. Nambiar spoke on Nutritional programming (nutritional education and counselling programs). She took the audience through the various stages of change, in case of nutritional programming. She explained how nutrition education as well as counselling has a high potential in bringing about a behavioural change.

Dr. Davinder Gill concluded the workshop by calling it “A truly successful endeavour, which saw participation from cross disciplinary set of speakers, attendees, stakeholders and other members of the community who came together and shared insightful details on key topics like advocacy, clinical trials and some recent scientific innovations that are happening around the country, which in totality is helping to build a strong case for the interplaying role of nutrition and immunity as the key factors along with vaccination in reducing childhood mortality and improving child health and development”. He also underlined the significance of such workshops in building new friendships and collaborations.

Through this workshop, Hilleman Laboratories was successfully able to provide a platform for meaningful discussions which could help resolve gaps related to public health issues on infant and child health and at the same time provided a great opportunity for the nutrition focal managers to be oriented on key technical updates on child nutrition and immunity. 

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