BACKGROUND: Diphtheria (D), tetanus (T), pertussis (P), hepatitis B (HepB), invasive Haemophilus influenzae
type b (Hib) disease, and measles cause substantial global morbidity and mortality.
METHODS: This unique review highlights geographic differences in disease burden across certain
countries in the African, Americas, Mediterranean, South-East Asian, and Western Pacific World Health
Organization (WHO) regions, and relates this to vaccination coverage and local vaccine recommendations
using the authors’ countries as illustrations.
RESULTS: Substantial differences were observed in the incidence of these diseases and in vaccination
coverage between the countries studied. Disease incidence often reflected inadequate surveillance, but also
variable or poor vaccination coverage. Vaccination coverage against HepB was particularly low in the
African and South-East Asian WHO regions; vaccination coverage against invasive Hib disease was low in
these regions and in the Eastern Mediterranean and Western Pacific WHO regions. Vaccination schedules
within some countries in these regions do not include, or have only recently included, vaccinations against
HepB and Hib disease. The use of DTwP–HepB–Hib (diphtheria, tetanus, whole-cell pertussis, HepB, Hib)
combination vaccines has now been adopted by some countries to help increase vaccination coverage.
CONCLUSIONS: Vaccination coverage and vaccination schedules vary markedly between the countries
studied, often according to the resources available. DTwP–HepB–Hib combination vaccines represent a
cost-effective option, with the potential to substantially reduce the burden associated with these
diseases by increasing coverage and compliance.