KARACHI: The Expanded Programme of Immunisation (EPI) Sindh has decided to include Rotavirus in the routine immunisation by the end of this year. With the induction of Rotavirus in EPI routine immunization, the number of diseases in the list will rise to ten. “Sindh would be the second province to introduce rotavirus after Punjab,” said Dr Agha Muhammad Ashfaq, Project Director at EPI Cell Sindh. Dr Agha said that Global Alliance for Vaccines & Immunization (GAVI) will bear the major chunk of expanses of vaccination. “The expenditure will be bear on co-financing basis where GAVI to bear the expenditures up to 92 percent while rest will be bear by Pakistan. In this regard, trainings of health staff for vaccine administration will likely start in the coming months. The vaccine will be included in routine immunization in districts of Sindh phase-wise, he added. Rotavirus is the most common cause of diarrhoeal disease among infants and young children. Babies and toddlers between 6-24 months of age are at greatest risk for developing severe disease from rotavirus infection. Children who get infected may have severe watery diarrhea, often with vomiting, fever, and abdominal pain. Vomiting and watery diarrhea can last from 3 to 8 days. Adults sometimes become infected, but the resulting illness is usually mild. Rotavirus is spread through contact with the faeces (excrement) of an infected child or adult. It is easily spread if people don’t wash and dry their hands properly after going to the toilet or changing nappies. Rotavirus causes the death of about 500,000 children worldwide annually. According to an estimate, the lives of 29,000 children in Pakistan could be saved each year if the Rotavirus vaccine is included in the routine immunization programme. A recent unpublished study, done at Civil Hospital Karachi revealed that more than 20 per cent of all diarrhea cases were because of rotavirus. The study was done during six months span time and over 150 selective cases were diagnosed for the study. Since 2006, vaccination has been available for rotavirus infection worldwide. Prior to the availability of a vaccine, almost all children became infected with rotavirus by their third birthday. Unlike Sindh government’s statistics which claim to have EPI coverage near 85 per cent in the province, an independent survey namely Multiple Indicator Cluster Survey (MICS) 2014 reveals that Sindh coverage area is around 35 per cent. Sindh is far behind Punjab and Khyber Pakhtunkhwa which has coverage area around 85 per cent and above 50 per cent respectively. Leading pediatricians has stressed upon the increase of EPI coverage in Sindh. “Diarrhea and pneumonia are leading infant killers in allover Pakistan but EPI coverage is very low in Sindh,” said National Institute of Child Health (NICH) director Dr Jamal Raza. “In rural areas of Sindh, EPI coverage is as low as 15-20 per cent. If government’s figures are to be believed, then why do pneumonia and measles cases still exist,” he questioned. “There was strong need to strengthen the EPI coverage area throughout province in order to lessen health burden on individual and healthcare facilities,” he added. “Exclusive breastfeeding also protects against rotavirus diarrhea in infants”. “In Sindh, rotavirus is present in private sector. In EPI, it is likely to come by the end of this year that would be helpful for malnourished children,” said Dr Khalid Shafi, general secretary Pakistan Pediatric Association, Sindh. “With the induction of rotavirus, it is expected that Diarrhea related mortalities would go down,” he added. Prior to the introduction of the rotavirus vaccine, rotavirus infection was responsible for 200,000 emergency room visits, 55,000 hospitalizations, and 60 to 65 deaths each year in the U.S. Worldwide, it is the leading cause of severe diarrhea among young children, leading to 2 million hospitalizations and more than 500,000 deaths of children ages 5 and under annually. Older children and adults can also be infected with the virus, but the illness is generally milder. According to health experts, there are two brands of the rotavirus vaccine, RotaTeq (RV5) and Rotarix (RV1). Both vaccines are given orally, not as a shot. The only difference is the number of doses that need to be given. With RotaTeq, three doses are required. They should be given at ages 2 months, 4 months, and 6 months. Rotarix only requires two doses — at 2 months and 4 months. The vaccine may be given at the same time as other vaccines Experts say that both vaccines are given by mouth (orally), not by a shot. The first dose of either vaccine is most effective if it is given before a child is 15 weeks of age. Also, children should receive all doses of rotavirus vaccine before they turn 8 months old. Good hygiene and sanitation don’t effectively stop rotavirus disease, so immunization is best defense.