Vaccines and immunization: The past, present and future in Nigeria

Vaccines are arguably the most important public health tools available today. Since the successful eradication of smallpox with the use of the vaccine, many vaccines have become available to man. Of great importance to public and child health are the vaccines against the so-called six killer diseases of childhood-measles, pertussis, diphtheria, tetanus, tuberculosis and poliomyelitis. In the last 2 decades, effective vaccines against the major causes of pneumonia, another childhood killer, have become available. Data from many parts of the world including African countries have shown the benefits of the pneumococcal and Haemophilus influenzae type b vaccines. The scientific world is still searching for appropriate candidate vaccines for malaria and HIV infection. Despite the availability and effectiveness of many vaccines, the benefits to a country is highly dependent on a viable and sustainable health system which include adequate financing, dynamic and motivated workforce, strong partnerships and effective community participation. If well deployed, available vaccines as elucidated in this discourse can accelerate the achievements of the Millennium Development Goals in Nigeria and many other developing countries.Key words: Vaccines, Immunizations, Nigeria

Predicting sequelae and death after bacterial meningitis in childhood: A systematic review of prognostic studies

Background: Bacterial meningitis (BM) is a severe infection responsible for high mortality and disabling sequelae. Early identification of patients at high risk of these outcomes is necessary to prevent their occurrence by adequate treatment as much as possible. For this reason, several prognostic models have been developed. The objective of this study is to summarize the evidence regarding prognostic factors predicting death or sequelae due to BM in children 0-18 years of age. Methods: A search in MEDLINE and EMBASE was conducted to identify prognostic studies on risk factors for mortality and sequelae after BM in children. Selection of abstracts, full-text articles and assessment of methodological quality using the QUIPS checklist was performed by two reviewers independently. Data on prognostic factors per outcome were summarized. Results: Of the 31 studies identified, 15 were of moderate to high quality. Due to substantial heterogeneity in study characteristics and evaluated prognostic factors, no quantitative analysis was performed. Prognostic factors found to be statistically significant in more than one study of moderate or high quality are: complaints > 48 hours before admission, coma/impaired consciousness, (prolonged duration of) seizures, (prolonged) fever, shock, peripheral circulatory failure, respiratory distress, absence of petechiae, causative pathogen Streptococcus pneumoniae, young age, male gender, several cerebrospinal fluid (CSF) parameters and white blood cell (WBC) count. Conclusions: Although several important prognostic factors for the prediction of mortality or sequelae after BM were identified, the inability to perform a pooled analysis makes the exact (independent) predictive value of these factors uncertain. This emphasizes the need for additional well-conducted prognostic studie