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  1. 1
    Peer Reviewed

    Facilitating the WHO Expanded Program of Immunization: the clinical profile of a combined diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b vaccine.

    Arístegui J; Usonis V; Coovadia H; Riedemann S; Win KM

    International Journal of Infectious Diseases. 2003 Jun; 7(2):143-151.

    Background: Vaccines are important weapons in the fight against infectious diseases. The World Health Organization (WHO) Expanded Program on Immunization (EPI) has been extended to include recommendations for hepatitis B and Haemophilus influenzae type b (Hib) vaccinations. The WHO has recommended that combined vaccines be used where possible, to reduce the logistic costs of vaccine delivery. This paper reviews the efficacy, safety and cost-effectiveness of Tritanrix-HB/Hib, the only commercially available combined diphtheria, tetanus, whole cell pertussis, hepatitis B and conjugated Hib vaccine. Methods: The immunogenicity and reactogenicity results of five published clinical trials involving Tritanix-HB/Hib in a variety of immunization schedules and countries were reviewed. Based on these data and cost-effectiveness studies, an assessment of its suitability for use in national immunization programs was made. Results: Tritanix-HB/Hib has shown excellent immunogenicity in clinical trials using a variety of schedules, with no reduced immunogenicity observed for any of the components of the combined vaccine. It has similar reactogenicity to DTPw vaccines alone. Pharmacoeconomic analyses have shown combined DTP-HB/Hib vaccines to be cost-effective compared to separate vaccines. Conclusions: Replacement of DTPw vaccination by Tritanrix-HB/Hib can be done without modifying the existing national immunization programs. This should facilitate widespread coverage of hepatitis B and Hib vaccinations and their rapid incorporation into the EPI. (author's)
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  2. 2
    Peer Reviewed

    Importation and circulation of poliovirus in Bulgaria in 2001. [Importation et circulation du poliovirus en Bulgarie en 2001]

    Kojouharova M; Zuber PL; Gyurova S; Fiore L; Buttinelli G

    Bulletin of the World Health Organization. 2003 Jul; 81(7):476-481.

    Objective: To characterize the circumstances in which poliomyelitis occurred among three children in Bulgaria during 2001 and to describe the public health response. Methods: Bulgarian authorities investigated the three cases of polio and their contacts, conducted faecal and serological screening of children from high-risk groups, implemented enhanced surveillance for acute flaccid paralysis, and conducted supplemental immunization activities. Findings: The three cases of polio studied had not been vaccinated and lived in socioeconomically deprived areas of two cities. Four Roma children from the Bourgas district had antibody titres to serotype 1 poliovirus only, and wild type 1 virus was isolated from the faeces of two asymptomatic Roma children in the Bourgas and Sofia districts. Poliovirus isolates were related genetically and represented a single evolutionary lineage; genomic sequences were less than 90% identical to poliovirus strains isolated previously in Europe, but 98.3% similar to a strain isolated in India in 2000. No cases or wild virus isolates were found after supplemental immunization activities were launched in May 2001. Conclusions: In Bulgaria, an imported poliovirus was able to circulate for two to five months among minority populations. Surveillance data strongly suggest that wild poliovirus circulation ceased shortly after supplemental immunization activities with oral poliovirus vaccine were conducted. (author's)
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  3. 3

    Report of the European Region on Immunization Activities. (Global Advisory Group EPI, Alexandria, October 1984). WHO/Expanded Immunization Programme and the European Immunization Targets in the Framework of HFA 2000.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]. European Region on Immunization Activities

    [Unpublished] 1984. Presented at the EPI Global Advisory Group Meeting, Alexandria, Egypt, 21-25 October 1984. 3 p. (EPI/GAG/84/WP.4)

    Current reported levels of morbidity and mortality from measles, poliomyelitis, diphtheria, tetanus, and tuberculosis in most countries in the European Region are at or near record low levels. However, several factors threaten successful achievement of the Expanded Program on Immunization (EPI) goal of making immunization services available to all the world's children by the year 2000, including changes in public attitudes as diseases pose less of a visible threat, declining acceptance rates for certain immunizations, variations in vaccines included in the EPI, and incomplete information on the incidence of diseases preventable by immunization and on vaccination coverage rates. To launch a more coordinated approach to the EPI goals, a 2nd Conference on Immunization Policies in Europe is scheduled to be held in Czechoslovakia. Its objectives are: 1) to review and analyze the current situation, including achievements and gaps, in immunization programs in individual countries and the European Region as a whole; 2) to determine the necessary actions to eliminate indigenous measles, poliomyelitis, neonatal tetanus, congenital rubella, and diphtheria; 3) to consider appropriate policies regarding the control by immunization of other diseases of public health importance; 4) to strengthen existing or establish additional systems for effective monitoring and surveillance; 5) to formulate actions necessary to improve national vaccine programs in order to achieve national and regional targets; 6) to reinforce the commitment of Member Countries to the goals and activities of the EPI; and 7) to define appropriate activities for the Regional Office for Europe of the World Health Organization to achieve coordinated action.
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  4. 4

    Report of the Expanded Programme on Immunization Global Advisory Group Meeting, 21-25 October 1984, Alexandria.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]. Global Advisory Group

    [Unpublished] 1985. 51 p. (EPI/GEN/85/1)

    This report of the Expanded Program on Immunization Global Advisory Group Meeting, held during October 1984, contains the following: conclusions and recommendations; a summary of the global and regional programs; a review of the Expanded Program on Immunization (EPI) in the Eastern Mediterranean Region; a review of country programs in Denmark, Brazil, and India; a report on the epidemiology and control of pertussis; and discussion of sentinel surveillance, surveillance of neonatal tetanus, polio, and measles, and research and development; and proposals for the 1985 meeting of the Global Advisory Group. The Global Advisory Group concluded that national immunization programs have made much progress, realizing some 30% coverage in developing countries with a 3rd dose of DPT. Yet, the lack of immunization services continues to extract a toll of 4 million preventable child deaths annually in the developing world. The Global Advisory Group indicated that the acceleration of existing programs is essential if immunization services are to be provided for all children of the world by 1990. Such acceleration calls for continued vigorous action to mobilize political support and financial resources at national and international levels. Considerable experience has been gained in most countries regarding implementation of immunization programs. The knowledge now exists to bring about major improvements in program achievement, yet gaps in knowledge exist in both technical and administrative areas. Action is needed in the following areas if programs are to accelerate sufficiently to meet the target: management of existing resources; use of intensified strategies; program evaluation; coordination with other components of primary health care; collaboration among international agencies; and regional and country meetings. To take maximum advantage of the benefits offered by vaccine, each country should take the necessary steps to include all relevant antigens in its national program. In particular, the universal use of measles vaccine should be encouraged. It also is of concern that some countries are not yet using polio vaccine and that others omit pertussis vaccine from their programs. Countries are urged to review their current practices about the anatomical site of intramuscular immunization. Taking into account the criteria of safety and ease of administration, thigh injection for DPT and arm injection for TT are recommended strongly. The Global Advisory Group reaffirmed its 1983 recommendation to use every opportunity to immunize eligible children.
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  5. 5
    Peer Reviewed

    Strengthening immunization systems and introduction of hepatitis B vaccine in Central and Eastern Europe and the Newly Independent States.

    FitzSimons D; Van Damme P; Emiroglu N; Godal T; Kane M

    Vaccine. 2002; 20:1475-9.

    On June 24-27, 2001, the Viral Hepatitis Prevention Board conducted a meeting in St. Petersburg, Russia. The aim of this meeting was to review and strengthen a 1996 immunization initiative and to introduce the hepatitis B vaccine in central and eastern Europe and in the Newly Independent States. This meeting was organized in collaboration with Centers for Disease Control and Prevention, the Global Alliance for Vaccines and Immunization (GAVI), the Children's Vaccine Program, WHO and the UN International Children's Emergency Fund (UNICEF). This conference has several partner agencies that augment the process of enforcing affordable and sustainable programs. This partnership has helped encourage 11 countries to apply for support for immunization services and universal hepatitis B immunization from GAVI/The Vaccine Fund. Information on how to improve hepatitis B programs was also elicited.
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  6. 6

    Progress toward poliomyelitis eradication -- Europe and Central Asian Republics, 1997 - May 1998.

    World Health Organization [WHO]. Regional Office for Europe. Communicable Diseases and Immunization Unit; World Health Organization [WHO]. Expanded Programme on Immunization [EPI]; United States. Centers for Disease Control and Prevention [CDC]. National Center for Infectious Diseases. Division of Viral and Rickettsial Diseases. Respiratory and Enteric Viruses Branch; United States. Centers for Disease Control and Prevention [CDC]. National Immunization Program. Vaccine-Preventable Disease Eradication Division

    MMWR. Morbidity and Mortality Weekly Report. 1998 Jun 26; 47(24):504-8.

    The World Health Assembly, held in 1988, set to eradicate poliomyelitis globally by the year 2000. In 1995, the WHO European Union, comprising 51 member states (including Israel and the Central Asian Republics) accelerated efforts toward polio eradication. This report summarizes the progress toward polio eradication during 1997-98 in Europe and the Central Asian Republics. The paper further demonstrates that polio incidence decreased to 7 cases in 1997 and 2 cases in 1998, and surveillance has improved substantially. The major contributing factor to this decline was the National Immunization Days, which were conducted in 18 contiguous countries of the WHO Eastern Mediterranean and European regions. Furthermore, reported coverage levels were >95% in 1997 with 2 doses of oral poliovirus vaccine, similar to levels achieved during previous years. The WHO recommended surveillance and virologic testing of stool specimens as the key strategies to polio eradication.
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  7. 7

    Installation of a computerized EPI information system, Turkey, May 8-19, 1989.

    Wilson E

    [Unpublished] 1989. [2], 10, [30] p. (USAID Contract No. DPE-5927-C-00-5068-00)

    The Turkish Ministry of Health, Primary Health Care Directorate, Expanded Program on Immunization Division (MOH/EPI), requested technical assistance in the installation of a Computerized EPI Information System (CEIS), which the Resources for Child Health (REACH) Project provided to the MOH/EPI from May 8-May 19, 1989, in Ankara, Turkey. A CEIS was installed to enable the MOH/EPI to process routine vaccination and disease surveillance data and to feed back data to the provinces on EPI vaccine coverage, tetanus toxoid vaccine coverage, and communicable disease incidence. The CEIS provides a standardized format for data entry, report generation, and graph production. It uses FoxBASE+ for the data entry and report production and LOTUS 1-2-3 to produce the graphs. All of the reports, graphs, data entry screens, menus, and prompts were translated into Turkish. Coverage data and disease incidence data for 1988 were entered while the consultant was in Turkey. It was recommended that the MOH/EPI validate the coverage data entered by comparing it with the data contained in its LOTUS 1-2-3 files. The MOH/EPI should enter at least two more years of historical data for both cases and deaths and coverage. This will permit the evaluation of trends in coverage and disease incidence and allow the comparison of intra-year coverage rates and disease incidence. The MOH/EPI should enter current data on a monthly basis and test all of the reporting and graphing capabilities of the system. All of the MDs in the MOH/EPI unit should be trained in the operation of the CEIS. Another technical, assistance visit to Turkey should be made in August 1989 to determine how the CEIS is being used, to correct any flaws in existing programs, and to provide some enhancements identified by the MOH/EPI.
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  8. 8

    Communicable diseases in the CCEE / NIS.

    Roure C; Oblapenko G


    Two main types of operational indicator were used to evaluate the regional Expanded Programme on Immunization (EPI): immunization coverage by different vaccines in children under 1 or 2 years old and morbidity trends. The European Region is passing through a period of rapid transition, with the most dramatic changes in the countries of central and eastern Europe (CCEE) and newly independent states (NIS). The provision of adequate vaccine supplies has become a priority for many member states in their efforts to sustain immunization activities. The World Health Organization's Regional Office has therefore launched a special program on vaccines for CCEE/NIS. New operational targets for EPI in Europe in the 1990s were established by the European Advisory Group on EPI in 1993. These operational targets emphasize the steps countries need to follow to achieve the European target 5, which calls for no indigenous cases of poliomyelitis, diphtheria, neonatal tetanus, measles, mumps, and congenital rubella by the year 2000. Immunization coverage generally remains high and stable in the region. During 1990-1992, pockets of nonimmunized individuals in different countries led to outbreaks of disease. Currently, the low coverage with diphtheria-pertussis-tetanus (DPT/DT) vaccines in many provinces of the Russian Federation is one of the reasons for the epidemic of diphtheria that has affected the country since 1990. Despite the difficulties experienced by many CCEE and NIS, progress has occurred. Morbidity from poliomyelitis declined during 1990-1993. There remain only a few areas with endemic transmission of wild poliovirus: the Balkans, trans-Caucasus, and central Asia. The diphtheria situation deteriorated in 1990, becoming increasingly dramatic in 1992 and 1993. Almost all cases have been reported from the Russian Federation and the Ukraine. Increasing diphtheria morbidity has been observed in Belarus, Kazakhstan and Uzbekistan.
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  9. 9

    Preparatory Meeting on Diphtheria Control Strategy, Berlin, December 15, 1994.

    Steinglass R

    Arlington, Virginia, Partnership for Child Health Care, 1994. [3], 7, [75] p. (BASICS Trip Report; BASICS Technical Directive: 000 NS 01 001; USAID Contract No. HRN-6006-C-00-3031-00)

    In December 1994 in Berlin, Germany, WHO and UNICEF sponsored a meeting on diphtheria control strategy for the Newly Independent States (NIS). The participants prepared a proposed strategy to be elaborated on and endorsed by ministries of health (MOHs) of the NIS and donor agencies at 2 follow-up meetings scheduled for January 1995. The NIS is experiencing a diphtheria epidemic. The epidemic is starting to stabilize only in the Ukraine. Children comprise 40% of cases. Diphtheria has become firmly established in all age groups and throughout entire countries, so past immunization strategies (i.e., 3 doses of diphtheria toxoid-containing vaccine [Td] for just high risk groups) cannot curb the epidemic. Now as many people as possible must receive 1 dose of such a vaccine. Some high risk age groups should receive additional doses. A group at very high risk of diphtheria is school-aged children. Last year it was estimated that the Ukraine needed 22 million doses of Td for mass immunization, but it now needs 81 million doses of Td. UNICEF will provide 4 doses of DPT (diphtheria, pertussis, tetanus toxoid) vaccine as part of the standard primary series and 1 booster dose of diphtheria-tetanus vaccine (pediatric formulation) at school entry. Manufacturers are not responding to requests for production of additional quantities of antitoxin by the spring, thereby prolonging the chronic global shortage of antitoxin. The meeting was productive in developing a technically sound strategy, but more attention is needed to produce political interest/will and to mobilize resources. In addition to WHO talking to MOHs, more media coverage and social mobilization are needed within each NIS. During the next few months, WHO and UNICEF will determine whether a pledging session of potential donors is needed. The International Federation of Red Cross is donating $2 million for diphtheria control in the Ukraine.
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  10. 10

    Mission impossible.

    Carlisle D

    NURSING TIMES. 1994 Jan 19-25; 90(3):14-5.

    In response to a UNICEF request, the Overseas Development Administration of the United Kingdom recruited, briefed, and sent nine nurses to Angola with the goal of immunizing 70,000 children and 95,000 women. The nurses, however, stayed in a capital city hotel for their first week in Angola due to security problems instead of going directly to their front line destinations. It also became clear that competent Angolan staff were available to handle the task. Help was instead needed in establishing the cold chain and retraining. These needs certainly did not necessitate exposing nine expatriate nurses to unsafe conditions. After four weeks on site, the nurses noted in debriefing the inadequacy of their first aid kits for the conditions. Both nurses and the administration acknowledge that the initiative was unsuccessful. Practical support in the form of radio equipment, useful first-aid kits, and security were absent. The administration also realizes that future initiatives must be based upon more up-to-date information and be better planned. The presence of the nurses may, however, have encouraged indigenous nurses with whom they came in contact.
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  11. 11

    Diphtheria, pertussis, and tetanus vaccination [letter]

    Cutts FT; Begg N

    Lancet. 1992 May 30; 339(8805):1355-6.

    Researchers compared the immune responses of infants vaccinated at 2, 3, and 4 months of age with the diphtheria-pertussis-tetanus (DPT) conjugate vaccine with those of infants vaccinated at 3, 5, and 9 month intervals. The antibody titer for pertussis was the same for both the old and new schedules. Further, no reliable immunological correlates of protection existed for pertussis. Different batches of DPT vaccine and maternal antibodies may have accounted for the variation in immune responses. No one measured maternal antibodies in the infants in the 3, 5, and 9 month group, though. The protective level of antitoxin for tetanus and diphtheria (0.01 neutralizing units/ml) cannot be applied to ELISA assays, since the relationship between the 2 assays is inadequate at levels less than 0.1 IU/ml. 1964 research of 9 injection schedules showed that when infants received the first dose at 3 months rather than later, or when the intervals were 1 month long instead of 2 months, diphtheria and tetanus antitoxin titers were lower 2 weeks after series completion. Therefore, clinical researchers should do lengthy longitudinal studies of infants vaccinated at 2, 3, and 4 months before the clinicians can actually determine the persistence of immunity to school entry. The UK Public Health Laboratory Service is doing a longitudinal study of early and long term antibody responses to the new schedules. In fact, the accelerated vaccination schedule has improved coverage during the first year of life. 20-30% of pertussis cases are less than 6 months old in developing countries. WHO's Expanded Programme on Immunization encourages health workers to begin vaccine series as early in life as possible and to keep the intervals as short as possible. Even though no primary series of 3 doses of DPT protects an infant for a lifetime, health workers should achieve high coverage with early doses and shorter intervals. WHO already advocates giving women of reproductive age in developing countries 5 doses of tetanus toxoid to reduce neonatal deaths.
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  12. 12
    Peer Reviewed

    WHO: World Health Assembly.

    McGregor A

    Lancet. 1992 May 23; 339(8804):1287.

    1200 delegates from 175 member countries attended the 45th World Health Assembly in Geneva. Everyone at the Assembly ratified measures to prevent and control AIDS. 12 countries intended to do long term planning for community based care for AIDS patients. Further the Assembly denounced instances where countries and individuals denied the gravity of the AIDS pandemic. In fact, it expressed the importance for urgent and intensive action against HIV/AIDS. The assembly backed proposals to prevent and control sexually transmitted diseases that affect AIDS patients, especially hepatitis B. For example, in countries with hepatitis B prevalence >8% (many countries in Sub-Sahara Africa, Asia, the Pacific region, and South America), health officials should introduce hepatitis B vaccine into their existing immunization programs by 1995. By 1997, this vaccine should be part of all immunization programs. The Assembly was aware of the obstacles of establishing reliable cold chains for nationwide distribution, however. Delegates in Committee A objected to the fact that >50% of the populations of developing countries continued to have limited access to essential drugs. They also expressed disapproval in implementation of WHO's 1988 ethical criteria for promotion of drugs which WHO entrusted to the Council for International Organisations of Medical Sciences (CIOMS). CIOMS lacked WHO's status and thus could not effectively monitor drug advertising. In fact, the pharmaceutical industry as well as WHO provided the funds for a meeting of 25 experts to discuss principles included in the ethical criteria. At least 4 countries insisted that WHO have the ultimate authority in monitoring drug advertising. Delegates did adopt a compromise resolution on this topic which required that industry promotion methods be reported to the 1994 Assembly via the Executive Board. The Assembly requested WHO to establish an international advisory committee on nursing and midwifery and to improve the network of WHO collaborating centers which help national nursing groups.
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  13. 13

    Expanded Programme on Immunization: global overview.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    [Unpublished] 1985. [19] p. (EPI/GAG/85/WP.1)

    This year's progress and evaluation report of the Expanded Program on Immunization (EPI) includes background information, a summary of the progress, actions needed to realize the EPI goal, and a draft resolution for consideration by the executive board. The EPI has its basis in resolution WHA27.57, adopted by the World Health Assembly in May 1974. General program policies, including the EPI goal of providing immunizations for all children of the world by 1990, were approved in resolution WHA30.53, adopted in May 1977. In 1982, the Assembly warned that progress would have to be accelerated to meet the 1990 goal and urged Member States to act on a 5-point program (resolution WHA35.31). Immunization, one of the most cost-effective of all health services, remains tragically underutilized. In the developing world, excluding China, less than 40% of infants receive a 3rd dose of DPT or polio vaccine, in part because it is only now being introduced in some programs, and over 3 million children still die annually from measles, neonatal tetanus, and pertussis, while over 250,000 children are crippled by poliomyelitis. The 1st point of the World Health Assembly 5-point action program calls for the promotion of EPI in the context of primary health care, with special emphasis on involving communities as active partners in the program and on delivering immunization with other health services so that they are mutually supportive. The use of "channelling" strategies and immunizations days currently are providing powerful stimuli to community participation in a number of programs. Points 2 and 3 of the action program stress the need to invest adequate human and financial resources in EPI. Support for immunization programs, both from within national programs and from external resources, has increased markedly. More support is coming from many organizations long associated with EPI, and the number of collaborators is growing. Point 4 of the action program calls for ensuring that programs are continuously evaluated and adapted so as to achieve high immunization coverage and maximum reduction in target-disease deaths and cases. Evaluation continues to be a priority for EPI. Point 5 calls for the pursuit of research as a part of program operations. Investments in research on the cold chain have resulted in a marked increase in the range and quality of products now available on the market. In the European Region the coverage goal of EPI has been largely achieved. Dramatic progress has been made in the Region of the Americas since the beginning of EPI. The Southeast Asia Region has made steady progress since the start of EPI. In the Western Pacific Region the main program constraints relate to strengthening the cold chain and to improving the quality of vaccines. Progress in increasing immunization coverage has been very good in most of the Eastern Mediterranean Region, and there has been extensive use of national program reviews and meetings of national managers in supporting country programs. Progress in the African Region has been satisfactory in many countries and exemplary in a few. Management capacity within national programs remains the most severe global constraint for EPI.
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  14. 14

    Expanded Programme on Immunization: progress and evaluation report by the Director-General.

    World Health Organization [WHO]

    [Unpublished] 1985 Nov 19. Presented to the Executive Board, Seventy-seventh Session, Provisional Agenda Item 18. 20 p. (EB77/27)

    The Expanded Program on Immunization (EPI) has made major public health gains in the past decade. The central EPI strategy has been to deliver immunization in consonance with other health services, particularly those directed toward mothers and children. However, in the least developed countries and many other developing countries, it does not appear likely that national budgets will be sufficient by 1990 to support full immunization coverage on a sustained basis or that an adequate number of national managers can be assembled to staff effective programs. At the November 1985 meeting of the EPI Global Advisory Group, recommendations were made to accelerate global progress. These recommendations reflect optimism that the 1990 goal of reducing morbidity and mortality by immunizing all children of the world can be achieved, but also acknowledge that many fundamental problems of national program management remain to be resolved. 3 general actions needed are: 1) promote the achievement of the 1990 immunization goal at national and international levels through collaboration among ministries, organizations, and individuals in both the public and private sectors; 2) adopt a mix of complementary strategies for program acceleration; and 3) ensure that rapid increases in coverage can be sustained through mechanisms which strengthen the delivery of other primary health care interventions. The 4 specific actions needed are: 1) provide immunization at every contact point, 2) reduce drop-out rates between first and last immunizations, 3) improve immunization services to the disadvantaged in urban areas, and 4) increase priority for the control of measles, poliomyelitis, and neonatal tetanus. Continued efforts are also required to strengthen disease surveillance and outbreak control, reinforce training and supervision, ensure quality of vaccine production and administration, and pursue research and development.
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  15. 15

    The Expanded Programme on Immunization: global overview.

    Keja J; Henderson R

    [Unpublished] 1984. Presented at the Second Conference on Immunization Policies in Europe, Karlovy Vary, 10-12 December 1984. Issued by the World Health Organization [WHO]. Expanded Programme on Immunization [EPI]. 8 p. (EPI/GEN/84/9)

    This discussion of the Expanded Program on Immunization (EPI) presents some background history and discusses current program status, some linkages between the global EPI and immunization programs in Europe, and the use of vaccines. In the early 1970s, as confidence grew that the global smallpox eradication program would achieve its goals, policy advisers within and outside of the World Health Organization (WHO) looked for an initiative which could become its successor. Representatives from industrialized nations and particularly from European countries were influential in selecting childhood immunization, as such programs had been such an early and successful element of their own health systems. Thus, the EPI was born. The resolution creating the EPI was passed by the World Health Assembly in 1974. Program policies were formalized by the World Health Assembly in 1977. It was at that time that the goal of providing immunization services for all children of the world by 1990 was set and that WHO's priority attention to developing countries was specified. The European Region takes pride of place in establishing the EPI and in supporting its work in developing countries and is itself a full-fledged member of the program with respect to immunization challenges which remain within its own countries. When the EPI began, no global immunization information system existed, and it is likely that coverage in developing countries was less than 5%. It now is on the order of 30% for a 3rd dose of DPT. Given the high dropout rates persisting in many developing countries, coverage for a 1st dose of DPT may be on the order of 50%, reflecting the delivery capacity of present immunization programs. Coverage for measles and poliomyelitis in infants and for tetanus toxoid among women of childbearing age is considerably less than 30%, reflecting the perception until the last 3-4 years that measles was a problem only in Africa, that poliomyelitis was not a problem in countries with poor levels of sanitation, and that neonatal tetanus was simply not a problem. While the EPI is working at the global level to help strengthen routine disease reporting systems, particularly in developing countries, it also has had to take refuge in estimates to obtain a picture of actual morbidity and mortality. A table presents a summary of such estimates. Not all countries of the Region are yet making optimal use of existing vaccines. Countries of the Region might want to recommit themselves to the EPI goal of reducing morbidity and mortality by providing immunization services for all children by 1990.
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  16. 16

    [Effectiveness of the expanded programme on immunization] Efficacite du programme elargi de vaccination

    Keja K; Chan C; Brenner E; Henderson R

    World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1986; 39(2):161-70.

    The Expanded Program on Immunization (EPI) aims at the reduction of morbidity and mortality from vaccine-preventable diseases through the provision of immunization to women and children. Program effectiveness is measured by immunization coverage and by incidence of the target diseases. Information on these 2 indicators is provided by national programs to WHO Regional Offices and forwarded to EPI, Geneva. Although considerable progress has been made in delivering vaccines to the children of the world, the potential impact of immunization remains unfulfilled. In the developing world (excluding China) less than 40% of infants receive a 3rd dose of DPT or polio vaccines, and coverage with measles vaccine remains at only 1/2 of that level. Over 3 million children still die each year from measles, neonatal tetanus and pertussis, while over a 1/4 of a million children are crippled by poliomyelitis. In the European Region the coverage goal of the EPI has been largely achieved. In the American Region dramatic progress has been made since the beginning of EPI. The South-East Asia Region has made steady progress since the start of the EPI. The Western Pacific Region is the most heterogenous within WHO, with countries ranging in size from the smallest to the largest in the world. Levels of socioeconomic development and immunization coverage also differ widely. Nevertheless, satisfactory progress is observed in the majority of countries. In the African Region, the problems of drought, famine and civil unrest are extensive. Despite these problems, progress has been satisfactory and exemplary in a few countries. In the Eastern Mediterranean Region, progress in increasing immunization coverage has been remarkably good. It will be difficult, however, to improve immunization services for the remainder of the decade in a number of countries currently ravaged by drought, famine and civil unrest.
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  17. 17

    The World Health Organization's Expanded Programme on Immunization: a global overview. Le Programme Elargi de Vaccination de L'Organization Mondiale de la Sante: apercu mondial.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1985; 38(2):232-52.

    In recognition that immunization is an essential element of primary health care, the World Health Organization (WHO), with other agencies, is sponsoring the Global Program on Immunization whose goal is to reduce morbidity and mortality from vaccine-preventable diseases by providing immunization for all children of the world by 1990. A global advisory group of experts meets yearly to review the program. This paper summarizes the most salient features of the 1984 meeting. The major event for the Expanded Program on Immunization (EPI) in 1984 was the Bellagio Conference on protecting the world's children. Activities undertaken as a result of this conference are discussed. 1 outcome was the formation of the Task Force for Child Survival whose main objective is to promote the reduction of childhood morbidity and mortality through acceleration of key primary health care activities. Focus is on supporting Colombia, India and Senegal in accelerating the expansion of their immunization programs and strengthening other elements of primary health care, such as diarrheal diseases control, family planning and improved nutrition. The 5-point action program consists of the following components: promoting EPI within the context of primary health care; investing adequate human resources in EPI; ensuring that programs are continuously evaluated and adapted so as to achieve high immunization coverage and maximum reduction in target-disease deaths and cases; and pursuing research efforts as part of program operations. EPI has continued to collaborate with other programs to help assure that immunization services are provided to support delivery of other services. Integration of EPI in Africa, the Americas, the Eastern Mediterranean Region, Europe, the South-East Asia Region, and the Western Pacific Region is examined.
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  18. 18

    Sixth report on the world health situation. Pt. 2. Review by country and area.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 1980. 412 p.

    This report on the world health situation comes in 2 volumes, and this, the 2nd volume, reviews the health situation by country and area, with the additions and amendments submitted by the governments, and an addendum for later submissions. Information is presented for countries in the African Region, the Region of the Americas; the Southeast Asia Region, the European Region, the Eastern Mediterranean Region, and the Western Pacific Region. The information provided includes the following areas: the primary health problems, health policy; health legislation; health planning and programming; the organization of health services; biomedical and health services research; education and training of health manpower; health establishments; estimates of the main categories of health manpower; the production and sale of pharmaceuticals; health expenditures; appraisal of health services; demographic and health data; major public health problems; training establishments; actions taken; preventive medicine; and public health.
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  19. 19

    Measles: summary of worldwide impact.

    Assaad F

    REVIEWS OF INFECTIOUS DISEASES. 1983 May-Jun; 5(3):452-9.

    This summary of the worldwide impact of measles discusses epidemiology, reported incidence, clinical severity, community attitudes toward measles, and the impact of immunization programs on measles. Measles, 1 of the most ubiquitous and persistent of human viruses, occurs regularly everywhere in the world except in very remote and isolated areas. Strains of measles virus from different counties are indistinguishable, and serum antibodies from diverse population have identical specificity. Yet, the epidemic pattern, average age at infection, and mortality vary considerably from 1 area to another and provide a contrasting picture between the developing and the developed countries. In the populous areas of the world, measles causes epidemics every 2-5 years, but in the rapidly expanding urban conglomerations in the developing world, the continuous immigration from the rural population provides a constant influx of susceptible individuals and, in turn, a sustained occurrence of measles and unclear epidemic curves. In the economically advanced nations, measles epidemics are closely tied to the school year, building up to a peak in the late spring and ceasing abruptly after the summer recess begins. Maternal antibody usually confers protection against measles to infants during the 1st few months of life. The total number of cases of measles reported to WHO for 1980 is 2.9 million. Considering that in the developing world alone almost 100 million infants are born yearly, that less than 20% of them are immunized against measles, and that various studies indicate that almost all nonimmunized children get measles, less than 3 million cases of measles in 1980 is a gross underestimate. There was adecrease in the global number of reported cases of measles during the 1979-80 period due primarily to the reduction in the number of cases in the African continent and, to a lesser extent, in Europe. It is premature to conclude that such a reported decline is real and that it reflects the beginning of a longterm trend. The contrast between the developed and the developing worlds is most marked in relation to the severity and outcome of measles. Case fatality rates of more than 20% have been reported from West Africa. It has been estimated that 900,000 deaths occur yearly in the developing world because of measles, but data available to WHO indicate that the global case fatality rate in the developing world approaches 2% (in contrast to 2/10,000 cases in the US), and the actal mortality may be greater than 1.5 million deaths per year. The advent of WHO's Expanded Program on Immunization has brought about an awareness of the measles problem. Whenever and wherever measles vaccine has been used effectively on a large scale, a marked reduction in the number of cases has been recorded.
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