The government has applied for funding for a Hib vaccine that could help prevent childhood pneumonia and save more than a thousand lives a year when it is introduced
Video by: Rick Valenzuela
NINE-month-old Mom Losh pants for breath as a simple device - a nasal tube connected to an oxygen tank and a bottle of water - puts just enough pressure on his lungs to keep them from collapsing when he exhales, while the antibiotics fight the infection in his lungs.
The child's mother watches over him, helpless to calm her ailing son.
"I knew he was sick because he had a high temperature, diarrhoea, was very tired and coughed many times," said Mom Den, 22, from Srah Khvav commune in Siem Reap province.
She travelled a day and a half to get her son to hospital after he fell ill three days earlier. She said her son had been sick before, but this time looked more serious.
Mom Losh - too exhausted to stay awake - drifts into a troubled sleep that offers no relief from the pneumonia attacking his lungs.
At the intensive care unit at the Angkor Hospital for Children (AHC) in Siem Reap, this scenario is far from uncommon. The hospital sees 350 young patients each day, many of them suffering from pneumonia.
This vaccine... is expected to prevent 1,200 deaths in Cambodia every year
"[It] is one of the top two diseases we see in kids admitted into the hospital," said Dr Varun Kumar,Â medical adviser and the only foreign doctor on staff at AHC. He said in the intensive care unit, where the sickest kids go, it is the leading diagnosis.
Some 30,000 children die before their fifth birthday each year in Cambodia. Many of them die from preventable or treatable diseases such as pneumonia, which causes one in five of these deaths annually.
However, these numbers could soon change.
Cambodia has applied to the GAVI Alliance, a public-private organisation, for funding to expand its National Immunisation Program to include a new vaccine against haemophilus influenzae type-b (Hib), a bacteria that causes pneumonia, as well as several other infections.
Physicians believe that more than half of all cases of pneumonia in Cambodia are caused by only two bacteria: Hib and the pneumococcus bacteria.
"Highly effective vaccines are available against both agents, but they have until recently been too expensive for developing countries," said Dr Niklas Danielsson, the World Health Organisation's medical officer for child and adolescent health in Cambodia. He believes the Hib vaccine could make an important contribution to reducing the number of child deaths in Cambodia.
"Hib is a [principal] cause of pneumonia, and therefore deaths, in young children," he said. "This vaccine that the government has now decided to introduce is expected to prevent 1,200 deaths in Cambodia every year."
But Hib doesn't just cause child pneumonia. It can causeÂ infections like meningitis, which attacks the brain and spinal cord.
Hib can also cause infections of the throat and bloodstream, according to the AHC's Kumar.Â "It is a bacteria that causes a wide variety of disease, and the vaccine will target all of those," he said.
The GAVI Alliance was created in 2000 to improve access to immunisation in poor countries. Its partners include national governments, Unicef, WHO, the World Bank, the Bill & Melinda Gates Foundation, the vaccine industry, and research and technical health institutions.
The alliance currently provides infants free tetravalent DTP-HepB vaccines at six, 10 and 14 weeks to protect against diphtheria, tetanus, pertussis (whooping cough) and hepatitis B.
But the vaccine is funded by GAVI only through 2010, making this an ideal time to introduce the new Hib vaccine, the WHO's Danielsson said.
"We have sent our application to GAVI and now we are waiting for approval. We plan to introduce [the Hib vaccine] in early 2010," said Dr Sann Chan Soeung, director of the National Immunisation Programme, or NIP.
Danielsson said he is confident that the application will be approved.
Beginning in 2010, the nearly 400,000 babies born in Cambodia each year will get three shots of a five-to-one pentavalent vaccine, adding Hib protection to the current vaccine.
The Cambodian government will co-fund the program, an initiative the GAVI alliance introduced in 2007 to make immunisation support more sustainable, Danielsson said.
Danielsson added that the vaccine with Hib protection normally costs US$3.50 per dose, but that Cambodia can purchase it through the alliance for $0.20 per dose. In 2011, the cost will rise to $0.30 per dose.
"According to government policy, vaccines are free of charge for patients, and we want all parents to take their children to health centres to get the vaccine," said Veng Thai, director of Phnom Penh's Department of Health.
The free vaccinations, available through the NIP, cover immunisation against tuberculosis, measles and polio, as well as the DTP-HepB vaccine.
The NIP has seen great progress in recent years and aÂ WHO/Unicef Review of National Immunisation Coverage, released in August, found that 82 percent of newborns in Cambodia received all three doses of the DTP-HepB in 2007, compared with only 60 percent in 2001.
The WHO's Danielsson said health care service in Cambodia is more equitable than in other poor countries.
"Vaccines are an important part of the interventions we use to reduce child deaths because [they] can prevent the disease instead of having to treat it," Danielsson said.
"Pneumonia is becoming more and more difficult to treat, as more ... cases do not respond to antibiotics because the bacteria has become resistant," he added.
But childhood deaths have dropped substantially in Cambodia in part because of an increase in the availability of vaccines, Danielsson said.
"[Child deaths] dropped dramatically in the last five years, and we hope Cambodia will be able to achieve its Millennium Development Goals for 2015 by reducing the number ... by two-thirds. The new Hib vaccine, and hopefully in the future the pneumococcal vaccine, will be an important contribution to that," Danielsson said.
The Angkor Hospital for Children
Although the publicâ€™s attention is often focused on the Kingdomâ€™s Kantha Bopha network of childrenâ€™s hospitals, the Angkor Hospital for Children, after 10 years, has quietly become one of the leading paediatric centres and training hospitals in Cambodia. It started in 1998, with just a handful of Cambodian nurses and doctors, a host of foreign medical volunteers and an influx of 10,000 patients. Today it is a paediatric teaching hospital where volunteers have been replaced by well-trained Cambodian paediatricians, doctors who write international medical articles, and the patient load has reached some 100,000 children a year â€“ many from homes that rank among the poorest and most vulnerable in Cambodia. The AHC has trained hundreds of Ministry of Health doctors and thousands of nursing students. The hospital has 20 medical doctors and three surgeons on staff. It offers care for an optional 500 riel donation, and on average it treats 350 children per day. CAT BARTON